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Archive for the ‘Hormone Clinic’ Category

Shower vs grower: What is the difference and does it really matter? – Medical News Today

How much a penis extends in length while erect varies from person to person. It may also change over time and with age. However, there is no evidence to suggest this affects an individuals health or sex life.

A shower or grower refers to how much a penis expands in length when erect compared with its flaccid state.

This article explores the science behind the terms, how common they are, and whether being a shower or a grower has any significant impact on health and sex life.

According to the popular colloquialism, a shower is a person with a penis that does not expand relatively significantly in length when it becomes erect.

In contrast, a grower is a person with a penis that grows relatively significantly longer when erect.

The erectile tissue of the penis comprises:

All of these allow the penis to become erect.

However, with age, the penis can lose tissue elasticity, which may affect how it stretches.

People may also experience inflammation and less blood flow to the penis as they age, which can affect erection.

A 2018 study involving 274 males found that age played a role in whether participants were a grower or a shower.

The researchers defined a grower as having a flaccid to erect penile length increase of 4 centimeters (cm) or more, while an increase of less than 4 cm indicated that a person was a shower.

All of the participants had previously undergone penile duplex ultrasound (PDDU) for erectile dysfunction.

Researchers measured flaccid penile length and gave participants a vasodilation drug before measuring erect penile length.

Growers had an average length change of 5.3 cm, while showers had an average length change of 3.1 cm. The mean age of the growers was 47.5 years, compared with an average of 55.9 years in the showers.

The research also reported that 37% of males who fell into the grower category were single, compared with 23% in the showers category, although this may also relate to age.

Growers also had a lower dose of the vasodilation drug.

There were no differences in the showers or growers regarding:

The study notes that confirming these findings requires more research, including larger scale, multicultural, and multinational studies.

The research did find an age difference between growers and showers. According to the International Society for Sexual Medicine, the way the penis changes as people age may account for this age differentiation.

The 2018 study found that out of 274 participants, 73 males (26%) were growers, while 205 males (74%) were showers, according to the researchers criteria on flaccid to erect penis length.

This suggests that showers may be more common, but there is not enough evidence to reflect the whole population.

Further studies are needed to confirm the findings.

People may be able to tell if they are a shower or grower without any tests.

If people have a penis that does not significantly change size between a flaccid and erect state, they may be a shower.

In contrast, if an individuals penis size changes drastically between a flaccid and erect state, they may be a grower.

People can measure their penis when flaccid, from the base to the tip. They can then take the same measurement when their penis is erect.

If the difference between the two measurements is greater than 4 cm, people meet the definition of a grower.

However, if the difference is less than 4 cm, people meet the definition of a shower.

The 2018 study found that age was the main factor in whether people were a grower or a shower, which suggests that people may change between a grower and a shower as they age.

When people age, collagen and elastic fibers in the penis decrease, which may affect whether they are a shower or grower.

Other penis changes can also happen as people age. Testosterone levels start to decline after a person reaches 40 years of age, which can cause the penis to shrink slowly.

Health conditions that impair blood flow can also affect penis color and erection.

According to the Kinsey Institute, flaccid penis size is not a reliable indicator for its erect size.

Generally, shorter flaccid penile lengths enlarge by a greater percentage than longer flaccid penile lengths.

The 2018 study found that growers had a larger erect penis size, measuring 15.5 cm compared with 13.1 cm in the showers group.

There is no research to suggest whether being a shower or a grower impacts a persons sex life.

However, concerns about penis appearance may affect sexual activity.

A 2016 survey looked at genital dissatisfaction in 4,198 males aged 1865 years and living in the United States.

Participants reported the lowest satisfaction with flaccid penile length, with 27% reporting dissatisfaction. Different demographics had no bearing on survey answers.

Those who reported dissatisfaction with their genitals reported less sexual activity, including less vaginal sex and less receptive oral sex.

If a person has concerns that their penis appearance is affecting their self-esteem, confidence, or sex life, people may find it helpful to talk with their partner or healthcare professional.

Being a shower or a grower refers to the change in penis length from a flaccid to erect state.

If people have a penis that increases significantly in length from a flaccid to erect state, they may be a grower. If there is no significant change, they may be a shower.

Some research suggests being a shower or a grower relates to age. Therefore a persons category may change over time.

However, there is no evidence to suggest that being a shower or grower affects their health or sex life.

Shower vs grower: What is the difference and does it really matter? - Medical News Today

Positive decision from SMC on Takeda’s breast cancer treatment – Pharmafield

The Scottish Medicines Consortium (SMC) has accepted Takedas PROSTAP SR DCS & PROSTAP 3 DCS (leuprorelin acetate) for use in patients with early breast cancer and advanced breast cancer.1,2,*,

Leuprorelin acetate belongs to a family of drugs called gonadotrophin-releasing hormone (GnRH) agonists which is used as adjuvant treatment in combination with tamoxifen or an aromatase inhibitor for endocrine responsive early-stage breast cancer and in advanced breast cancer suitable for hormone manipulation. In patients with breast cancer cells that have oestrogen receptors (ER) about 70% of cases of breast cancer3 it is important to lower the levels of oestrogen in the body to stop the cancer cells from growing.

Leuprorelin acetate works by suppressing the release of luteinising hormone (LH) and follicle stimulating hormone (FSH) and offers an additional treatment choice as its dosing regimen means that suitable patients with early-stage breast cancer require four clinic visits a year, up to 13 visits a year as with other GnRH agonists licenced for breast cancer.

GnRH agonists are an important part of treatment for women with oestrogen receptor positive breast cancer. In patients with early breast cancer, the combination of (GnRH) agonists with the peripheral oestrogen antagonist, tamoxifen results in a significant benefit in recurrence-free survival and overall survival, while the regime in those with advanced breast cancer has been shown to prolong progression-free survival.4

Dr Roger Henderson, GP in Dumfries and Galloway, said: As a GP I find that being able to use PROSTAP 3 DCS in women with early breast cancer helps to reduce both the number of times a woman with early breast cancer needs to visit the hospital and the stress associated with these, while maintaining efficacy of treatment.




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Positive decision from SMC on Takeda's breast cancer treatment - Pharmafield

Could metabo-oncology be the treatment modality of the future? – Drug Target Review

Jim Shanahan from SynDevRx explains why metabo-oncology treatment modalities could be the answer to a rise in metabolic disorders and cancers.

The global pandemic of metabolic disorders such as obesity and diabetes combined with an ageing population is leading to an upcoming tsunami of cancers, according to Jim Shanahan, Co-Founder, Vice President of Business Development and Director of SynDevRx.

Some cancers, such as breast, colon, liver, prostate and certain parts of lung, are sensitive to dysregulated metabolic hormones. In an interview with Drug Target Reviews Victoria Rees, Shanahan highlighted that metabolic hormone signalling pathways could be exploited to treat these cancers, including with SynDevRxs lead molecule, SDX-7320.

Shanahan began by explaining that the metabolic hormones insulin, leptin and adiponectin are the three primary signalling molecules that work through well understood cancer signalling pathways. Insulin primarily signals through the PI3K/AKT/mTOR pathway, leptin through the MAPK and JAK2-STAT3 pathways, while adiponectin is an agonist of the cyclic adenosine monophosphate pathway (cAMP) and protects against the phosphorylation and activation of notch signalling.

While these pathways have been thoroughly researched and described in many peer-reviewed research papers, Shanahan emphasised that how these externalities affect cancer growth and outcomes have been underappreciated.

Cancer looks for external signals that indicate there is sufficient energy for the cell to replicate. That is where the PI3K/AKT/mTOR pathway, the JAK-STAT pathway and other pathways come in, he said, as aberrant signalling by dysregulated hormones stimulates these pathways.

Having developed a lead molecule to fulfil this unmet need for oncology and metabolic disorders, Shanahan explained that SDX-7320 is in the fumagillin class of methionine aminopeptidase 2 (MetAP2) inhibitors. He explained that fumagillin is a naturally occurring biomass from the fungus named Aspergillus fumigatus Fresenius.

This was discovered by accident in the lab of Dr Judah Folkman in the mid-1980s a researcher named Dr Don Ingber had a contamination in one of his angiogenesis experiments that lead to the discovery. When he returned to the lab after the weekend, he found that there was a part of the dish that was clear of blood vessels. He was then able to isolate fumagillin and realised this could be a potential drug.

Working with Takeda in the 1990s, they developed a drug called TNP-470 that went into the clinic as an anticancer agent and demonstrated promising antitumour efficacy. However, while this drug was successful against late-stage tumours across a variety of different solid tumour types, it crossed the blood-brain barrier and induced central neural toxicity.

After several years, Takeda returned the technology to Dr Folkmans lab and the researchers investigated how to change its physical characteristics while maintaining its activity. One strategy they explored was conjugating the drug to a high molecular weight polymer backbone. By attaching TNP-470 to a polymer, the researchers developed a molecule called caplostatin.

Shanahan said that around this time, SynDevRx were exploring ways to improve the risk associated with drug development. Their aim was to identify drug classes that had been explored clinically and had proven human activity but had side effects that could be addressed.

Meeting with Dr Folkman, they began to work on the molecule. Shanahan said that SynDevRx brought in a polymer chemist and spent several years developing a new compound that is their current lead molecule.

the focus on metabo-oncology as a new and complimentary treatment modality could be critical to the improvements in patient outcomes

While the discovery of fumagillin and its potent antiangiogenic effects were reported in the early 1990s, Shanahan said that its mechanism of action was not elucidated until the late 1990s by researchers at MIT. He explained that this fumagillin drug class inhibits the metalloprotease class enzyme MetAP2, also known as protein 67 (p67), referring to its molecular weight.

Shanahan explained that there are two known methionine aminopeptidase isoforms, identified as MetAP1 and MetAP2. Both carry out code translational functions, meaning the enzymes sit on the ribosome and cleave the initiator methionine concurrent with protein synthesis and in preparation for post-translation modifications.

He said that MetAP2 has six identified exclusive AP2 substrates. These are: thioredoxin-1 (TRX-1); cyclophilin A (CypA); GAPDH; eukaryotic elongation factor-2 (eEF2); Rab37; and SH3BGRL.

The fumagillin drug class inhibits methionine aminopeptidase activity. When it is administered, it binds irreversibly to the histidine 231 pocket of MetAP2 and prevents the removal of methionine. Where MetAP1 will remove methionine for most other molecules, the exclusive MetAP2 substrates do not undergo the removal of their methionine; this has some interesting downstream effects, said Shanahan.

By inhibiting MetAP2, the methionine on these proteins is retained and therefore post-translational modifications that would add different fatty acids do not occur. The proteins do not fold properly, causing some to be ubiquitinated, while others are relocated to a different part of the cytosol because of changes to their solubility. Shanahan explained that these cause a cascade effect and have a downstream impact, including on the metabolic hormone signalling pathways.

By inhibiting MetAP2, you affect these six proteins then by impacting these six proteins, you get this pleiotropic set of effects, from very potent antiangiogenic effects, to changes to the cell signalling, to really potent effects on metabolic and lipid processing, said Shanahan.

We see this as a prime modality for treatment in combination with other modalities, highlighted Shanahan. He said that the researchers have so far completed Phase I clinical trials in solid tumours, which included a dose escalation to determine the maximum tolerated dose and schedule for Phase II and subsequent clinical phases.

We have demonstrated pre-clinically that by coming at the tumours with a multimodal attack, we can have a profound effect. Over the last five to 10 years, it has now been demonstrated through the immune system that external factors have a large impact on the fate of the cancer and the patient. With the increase in obesity and diabetes and rise of tumours sensitive to systemic metabolic dysfunction, Shanahan said that the focus on metabo-oncology as a new and complimentary treatment modality could be critical to the improvements in patient outcomes.

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Could metabo-oncology be the treatment modality of the future? - Drug Target Review

Men’s health: What is the best anti-ageing treatment? Q&A – Eastern Daily Press

A new clinic has launched in Norwich to focus on mens health, including male hormone replacement therapy, anti-aging treatments and erectile dysfunction.

Dr Gary Horn, consultant plastic surgeon and mens health expert, answers some of the questions he is most frequently asked:

Q: What are the benefits of attending a specialist mens clinic?

We are able to focus on mens health as a whole as we have a more comprehensive understanding of how the whole body is working and how we can make it better. If someone comes to me for liposuction, for example, I can ask them about why they think they have so much fat and find out more about their diet and look into their hormone levels. Some products work better for men or for women they are two different types of patient and need specific advice and treatment.

A patient of Dr Gary Horn, pre-reshaping operation and post-operation.- Credit: Dr Gary F. Horn

Q: What is the main cause of erectile dysfunction?

There are different causes. I look into lifestyle, weight and whether someone smokes, for example. As well as conducting a physical examination, I might end up ordering blood tests and checking testosterone levels. The problem might be neurological or vascular, where vessels in the penis have become smaller. This is often is the first sign of having a more general cardiovascular problem, which could go on to affect the heart or other vessels in the body. I may therefore need to refer this person to a cardiologist. Erectile dysfunction can also follow prostate surgery, or it can be a psychological issue.

Q: How can I improve my erectile dysfunction?

There was a time when Viagra was one of our only options, but now we can also treat erectile dysfunction with low-intensity shock waves and that can be used alone or combined with injections of stem cells which is becoming quite popular.

Q: Is male hormone therapy safe?

Yes, absolutely. But you dont give it without carrying out certain checks. It starts with a questionnaire; then a physical examination and then, of course, there is a blood test to assess different things, including testosterone levels, which can then be managed with oral or injectable applications.

Dr Gary Horn, consultant plastic surgeon and mens health expert. - Credit: Dr Gary F. Horn

Q: What are the signs that I might need hormone replacement therapy?

Feeling tired all the time; not being able to complete different activities or do sport; having problems concentrating and not being able to finish tasks can all be signs that you may need hormone replacement therapy. There can be sleeping issues, a reduction in libido or problems maintaining a proper erection. The majority of men requiring hormone replacement therapy will be over 50 but anyone from 20 to 80 can have an assessment.

Q: What is the best anti-aging treatment for men?

Apart from hormone replacement therapy and the other supplements that go along with it, peptides etc, as a plastic surgeon I can offer non-surgical treatments such as facial injections, including fillers and botox, and maybe different types of cream to maintain and restore texture of the skin. On the surgical side, I can offer eyelid surgery, facelifts, rhinoplasty and hair transplants.

Q: What other treatments do you offer?

I have a reshaping clinic for men. Apart from looking at exercise and diet, I also offer surgery such as scar revision or laser liposuction and high definition liposuction for people who want to look more athletic. I can carry out tummy tucks and body lifts, when patients have had massive weight loss and can offer implants, ranging from pectoral implants to calf, buttock and bicep implants.

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Men's health: What is the best anti-ageing treatment? Q&A - Eastern Daily Press

How multi-disciplinary treatment of cancer is giving hope to patients – The Standard

Dr Miriam Mutebi, Consultant Breast Cancer Surgeon.

What started as a lump in her left breast early last year would mark the beginning of Sylvia Sandagis fight for survival against cancer.

The 40-year-old was having a bath when she noticed the swelling. And there was some pain.

I thought Id probably been hit by something. I went to hospital and an ultrasound was done. The doctor said blood was not flowing in the lump and recommended a biopsy, Sandagi says.

Five days later, the biopsy results were out and the swelling was found to be cancerous. I remember that day, on August 31. I didnt want to believe what Id just heard. But I didnt cry. All I could think of was when I would start treatment and who would take care of my daughter should I get weak, especially because her father does not live in Kenya."

The mother of one is among patients under the care of various clinicians at Aga Khan University Hospitals Multidisciplinary Breast Cancer Clinic, which is touted as the hope for those in need of cancer treatment.

Sandagi says an oncologist referred her to Aga Khan where she was admitted to the centre and started her treatment. What I love about multidisciplinary clinic is a patient is not attended to by one doctor, or one medical professional," she says.

I found several experts when I came. That is when I learnt my cancer was in Stage Four. They told me the rate of survival for breast cancer is high. The doctors said the drugs they would give me were effective and that I would survive.

Horror stories

Sandagi is currently taking the drugs which will also ensure her oestrogen levels are reduced as breast cancer feeds on it. After six months, the doctors will decide whether she will need chemotherapy or radiotherapy.

Many patients have interpreted Stage Four cancer to mean death. However, Sandagi says the treatment she has been receiving has reduced the pain and shes living a near-normal life.

What people share about cancer are more of horror stories. It is true I have cancer and it is in Stage Four. But there is no pain. Im not bedridden. The only time I remember I have cancer is when someone mentions it or when Im taking my medicine, Sandagi says.

She has never told her eight-year-old daughter she is suffering from cancer because of the stigma attached to the disease by some communities.

All that I told her was Im unwell and that Ill be going to the hospital more often. I fear talking to her about cancer because when she tells people about it, the horror stories they will tell her will scare her. Shell think Im dying. I dont want that to happen, she says. I will fight. I dont want to die. I want to see my daughter grow up.

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Aga Khan launched the Multidisciplinary Breast Cancer Clinic to improve treatment. At any given time, a patient is able to be attended to by a breast surgeon, a medical and a radiation oncologist in one sitting.

It takes a village to care for a cancer patient. But here, we have decided to bring the village to the patient with our multi-disciplinary treatment, says Dr Mansoor Saleh, the founding chair of the Department of Hematology-Oncology at Aga Khan University.

He adds: Here, we have a breast cancer surgeon, a pathologist who helps with diagnosis, a radiologist who helps with imaging, a medical oncologist who does chemotherapy, and a radiation oncologist who gives radiation therapy, all in one place, at the same time. This enables the patient to get a unanimous report. When each doctor attends to a patient by themselves, they work in silence and the patient may not get the full picture.

Dr Miriam Mutebi, a breast surgical oncologist at Aga Khan, notes there are many types of breast cancers with the distinguishing factor being either hormone-positive breast cancers or hormone-negative breast cancers.

Think of a breast cancer cell as having three little spikes or receptors on its surface. These receptors act like doors to the cell and can influence how the cancer cell behaves. Different hormones act like keys that sit in the doors to the cell causing activity to increase or reduce, Dr Mutebi says.

The receptors we see on the surface of a breast cancer cell are ER-estrogen receptor, PR-progesterone receptor and HER-2 receptor (a special molecule on the cell). Its the presence or absence of these three doors or receptors that determines the type of breast cancer one has.

Mutebi says this is important information that must be established before treatment starts as it has implications on how the cancers behave and determines the treatment options.

The most common are the hormone-positive breast cancers (ER positive, PR positive) that account for between 60-70 per cent of cancers. When we say a breast cancer is hormone-positive, we mean female hormones in the body will act as keys to these cancer doors and encourage the cancer to grow.

"Therefore, as part of treatment after surgery, chemotherapy or radiotherapy, a patient may need medicine for five to ten years to minimise chances of the cancer recurring.

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How multi-disciplinary treatment of cancer is giving hope to patients - The Standard

Perceptions and experiences of women with premature ovarian insufficiency about sexual health and reproductive health – BMC Blogs Network

In this study, 16 women with POI, aged from 27 to 46years old, and a POI duration of 125years were interviewed. The age range of women at the time of POI and definitive diagnosis was 13 to 40years. Among the participants, three women had remarried, two of whom had divorced after diagnosis POI due to infertility. The level of education of women was from primary to doctorate. The cause of the POI was mainly unknown, but in 2 participants, POI occurred after cancer treatment and a participant afflicted to POI following an autoimmune disease. The Other demographic characteristics of the participants are presented in Table 1.

After content analysis of the interviews with a focus on the perception and experience of women with POI of reproductive-sexual health, four categories emerged (endangerment of women's health, psychological agitation, disruption of social life disturbance in sexual life), explained as follows.

The results showed that all participants were concerned about the effects of decreased ovarian function and changes in hormone levels on their future health.

This main category consists of four subcategories (irregular menstruation, emergence of menopausal symptoms, infertility, signs of early aging) as follows:

Menstrual cycle changes (irregular menstrual cycle, primary amenorrhea or sudden cessation of menstrual bleeding) are one of the first suspicious signs of POI in women that resulted mostly to consult a physician.

One of the participants, who had POI for 8years, said:

The first time my period became irregular, I went to the doctor and she told me that I should take hormone therapy. Before that, I had regular periods, but after 2-3years, I did not have regular periods, and the doctor said there was a possibility of premature ovarian insufficiency (p. 9, 43 y).

Another participant who had regular periods for 27years, stated:

Suddenly, I did not have another period. I went to the doctor. I had an ultrasound and found that I no longer had an ovum (p. 3, 46 y).

A number of participants did not experience menstruation at puberty and had primary amenorrhea, or spotted only once.

One participant that had a spontaneous POI, said:

I did not menstruate at all from the beginning, like my sister (p. 1, 30 y).

Following changes in hormone levels, participants experienced some degree of menopausal complications.

One of the participants who had POI following treatment of cancer, said:

Dry uterus bothers me a lot, especially during sex (p. 10, 46 y).

Another participant who had POI for 10years, stated:

It was very hard at first. In particular, flushing much annoyed me (p. 11, 44 y).

The other participant had POI with an autoimmune disease origin and had one live child with successful spontaneous pregnancy, said:

Premature ovarian insufficiency reduced libido (p. 8, 35 y).

This issue was the main concern of most participants and one of the main complaints of participants with POI was infertility.

A participant who had underwent chemotherapy for cancer treatment in 2008 and had lost her fertility for 11years, said:

I did not know before, but when I inclined to have a baby, I later realized that POI result to infertility (p.2, 4 y).

Another woman who had divorced due to have a 17-year-old history of infertility and remarried, stated:

When I did ultrasound check for infertility, the report showed that my ovaries are very small like as ovaries in menopause women (p.12, 43 y).

Due to decreased levels of estrogen in afflicted women, some of them reported conditions like loss of beauty, wrinkling of the skin and decreased feeling of youth.

One participant, who had been suffering from premature ovarian failure since the age of 22 and for 10years, said:

My first concern was this: I was no longer beautiful (p.16, 34 y).

The other participant that is pregnant currently with donated egg, said:

Eventually you f1eel the changes in your body. For example, you notice wrinkles on your skin (p.9, 43 y).

One participant that had POI for 13years, stated:

Although I am 37years old, I do not feel young I feel aging and I am old (p.13, 38 y).

POI occur in women is less than 40years old, while the normal age of menopause in women is 4555years. Hence the acceptance of POI for participants was accompanied with psychological reactions.

This main category consists of three subcategories [anxiety reaction, mood reaction, agitation in the selection of childbearing] as following:

Participants experienced an onslaught of negative emotions after being diagnosed with POI by a physician, including feelings of despair, depression, a sense of aging, and shock from menopause.

A participant who had POI since the beginning of her marriage and for 5years said:

When it told me to get menopause, I tried for traditional medicine but, due to that was not successful, I was disappointed (p.7, 37 y).

Another participant expressed:

At that time, when I realized my problem, I became depressed and thought that I was the only one. It had a great effect on my mood (p.1, 30 y).

A participant told in despair:

Because I dont have children, I be early menopause, that is, I got oldThese are other signs of aging (p.4, 46 y).

Another participant, who had POI since the age of 22 and had been struggling with it for 12years, said:

I really didnt expect such a thing at all. I was planning to have a planned pregnancy. But the exact opposite happened. The shock was so great it was the biggest shock of my life I have ever experienced (p.16, 34 y).

Popular reactions in afflicted women with POI were included: feeling of uncertainty of future conditions, fear of disease outcome, feeling eternal problems [eternal infertility] negative effect on mood and weakness of the nerves.

One of the participants expressed with surprise and confusion:

I have no idea about the future. I'm very confused. I dont know what will happen to me (p.4, 42 y).

Also part of the conversation with a participant was as follows:

I think more about the fact that this [pregnancy] may never have happened to me (p.14, 27 y).

Another participant said:

Premature ovarian insufficiency makes me angry quickly. I'll get mad soon (p.10, 46 y).

A participant told:

I am worried that I will not have any problems after the age of 40. I am afraid of the consequences of this disease (p.2, 34 y).

Considering that the options available to solve the problem of infertility in women with POI are currently limited and unfortunately there is no definitive treatment for female infertility in these women and the issue of cell therapy is being researched on animal models and do not use so far on humans, the only options offered to couples are the use of donated egg and adoption. Nevertheless, some participants opposed to accept them. If a participant commented on the issue of donated egg as follow:

I think to myself about the baby Because the egg is not mine, I am afraid I will not feel like a mother when she was born. Also she continue:

I must convince myself about this pregnancy and deal with it (p.15, 43 y).

Spiritual aspects of donated egg were important for some participants.

A participant was concerned about this, saying,

I do not care if I conceive with the donated egg, but its religious issue is important to me. It bothers me a little (p.1, 30y).

Moreover, it was important for a number of participants to know that the donor be a familiar person.

A participant stated:

I'm happy to have an ovum from my sister rather than a stranger (p.2, 34 y).

Most participants expressed POI has disrupted the social aspects of their lives. Social isolation, having privacy, unconscious jealousy and seeking support are four subcategories that related to this main category and be explain as follows:

Patients stated that they were reluctant to be in public because of impatience, a tendency to be alone, and to become nervous about social relationships.

A participant said:

I'm not bored totally. I like to be at home, to be alone (p.13, 38y).

Most afflicted women tended to maintain their privacy for fear of being judged by others, the importance of hiding the problem of infertility and believing in the privacy of the subject.

Some of the statements of the participants are as follows:

It is important for us that the donated egg is kept secret. Because if I get a donated egg, I will not be my own child and I will not judge (p.6, 34 y).

This is a personal matter and has nothing to do with anyone (p.13, 38 y).

Some participants expressed a reluctance to associate with families that have children and they are jealous of pregnancies in others or seeing children.

If a participant that had POI for 26years, said:

I was upset when I saw that others had children and became pregnant. Because I have a problem getting pregnant myself (p.12, 43 y).

This issue was the most important item that as a motivation factor helped afflicted women not only to accept complicated condition but also to pursue infertility treatment seriously. According to participants, the support of husbands, family and friends helped to increase hope and reduce psychological threat to women. In the meantime, the supportive role of the husbands was very prominent for women, as one of the participants that had POI for 18years, said:

I am most supported by my husband. If he did not help me, I wouldn't be able to control the situation and control myself. He encourages me to continue my treatment and does not let me Disappointed. (p.5, 30 y).

Another participant stated:

My sister, like me, had an early menopause. He tells me you are young now. Get treated sooner. You get the result. She is very hopeful and encourages me (p.7, 37 y).

In most patients, POI had a negative effect on the couple's sexual relationship.

Due to changes in hormone levels, women experienced sexual function disorders such as dyspareunia, reduced libido, and anorgasmia. These factors caused women to worry about the stability of their married life and the instability in marriage that they formed two subcategories from three.

In contrast, a number of other patients reported that POI had no effect on their sexuality.

The third subcategory was the ambivalence sensations that all of them explained as follows:

The disease had a negative effect on sexual intercourse and sexual pleasure of affected women and on the other hand, sexual intercourse was important for the husband. As a result, a number of participants were concerned about the stability of married life.

A participant stated:

Before my problem, I had sexual desire, but now I do not have it at all, and this causes us to have sex more often with fights, and it has disrupted our relationship (p.10, 46 y).

Beside to decreased sexual satisfaction in couple, infertility also, leaded to some women felt insecure and worried about divorce. A few others threated to divorce from the spouse's family, and some be feared from their husband remarriage.

A participant said:

From the beginning of my marriage, I was stressed until now because I did not have children. My concern is to have children and that our marriage will fall apart (p.1, 30 y).

Another participant stated:

Now my mother-in-law can easily divorce me. She says either bring a child or we will divorce you (p.4, 42 y).

The cessation of menstrual bleeding on the one hand created negative feelings for the participants and caused a kind of psychological pressure on them, but on the other hand had different effects on the participants spouses such as sexual satisfaction and helping to improve sexuality. Moreover, in the context of Iran religiously, having sex during a woman's period is against the Sharia, some patients even said that their partners were delighted with stopping in their menstruation to have sex freely. Therefore, these conditions caused women had been had a dual feeling about the negative impact of POI on their sexuality.

One of the participants said:

My husband says how good I am. I am comfortable without a condom. No man is happier than me (p.5, 31y).

Another participant, who has been suffering from POI since the age of 22 and for 12years, said:

We are trying to cope with and we are trying to control and improve the condition ourselves. For example, we use lubricant for dyspareunia (p.16, 34 y).

Or another participant said:

My husband thought POI meant we could no longer have sex. But when he saw that we had no problem with sex, he said it didn't matter. The important thing is that we can have sex without any limitation (p.11, 44 y).

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Perceptions and experiences of women with premature ovarian insufficiency about sexual health and reproductive health - BMC Blogs Network

Global Endometriosis Treatment Market Share Global Growth, Trends, Industry Analysis, Key Players and Forecast 2020 2028 KSU | The Sentinel…

The Endometriosis Treatment market report provides a detailed analysis of global market size, regional and country-level market size, segmentation market growth, market share, development, competitive Landscape, sales analysis, impact of domestic and global market players, value chain optimization, trade regulations, recent developments, opportunities analysis, strategic market growth analysis, product launches, area marketplace expanding, and technological innovations.

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Our industry professionals are working relentlessly to understand, assemble and timely deliver assessment on impact of COVID-19 disaster on many corporations and their clients to help them in taking excellent business decisions.

The key points of the report:

For competitor segment, the report includes global key players of Endometriosis Treatment as well as some small players.

The information for each competitor includes:

For product type segment, this report listed main product type of Endometriosis Treatment market in global and china.

For end use/application segment, this report focuses on the status and outlook for key applications. End users are also listed.

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The report comprises a broad overview of the major retailers operating in the target market. The research forecasts the market development in the established year and prediction time frame from 2020 to 2026. The report encompasses key factors related to market share detained by each region along with development chances expected major geographies. The global Endometriosis Treatment market division by product, type, application, and areas has been explained. Comprehensive particulars on market opportunities, restrictions, and probabilities are provided further in this report. The report also helps companies in marketing for tasks like identifying their prospective customers, building relationships with them.

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Table of Contents

1 Study Coverage

2 Executive Summary

3 Breakdown Data by Manufacturers

4 Breakdown Data by Type

4.1 Global Endometriosis Treatment Sales by Type

4.2 Global Micro Server IC

System Revenue by Type

4.3 Endometriosis Treatment Price by Type

5 Breakdown Data by Application

5.1 Overview

5.2 Global Endometriosis Treatment Breakdown Data by Application

6 North America

7 Europe

8 Asia Pacific

9 Central & South America

10 Middle East and Africa

11 Company Profiles

12 Future Forecast

13 Market Opportunities, Challenges, Risks and Influences Factors Analysis

14 Value Chain and Sales Channels Analysis

15 Research Findings and Conclusion

16 Appendix

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Global Endometriosis Treatment Market Share Global Growth, Trends, Industry Analysis, Key Players and Forecast 2020 2028 KSU | The Sentinel...

Sore Penis After Sex: Why It Happens and How to Treat It – Greatist

In a split second, your body might go from oooh to ow! Sex shouldnt be painful. So what gives? Why is your penis sore afterward?

First things first: If you have a sore penis after sex, youre not alone. This malady can be traced to anything from friction (ooh, sound familiar?) to an STI.

Should I be worried about a sore penis after sex?

That depends. A sore penis after sex doesnt always indicate a bigger problem. Maybe you a little too jiggy with it.

However, if you have accompanying symptoms that indicate infection or allergic reaction, call your doctor to rule out serious illness.

So, put on your cotton boxers, take a seat, and scroll down to figure out whats going on with your nether regions and how to fix it.

If your junks a little tender, dont sweat it. Heres a list of possible culprits and what to do about them.

Your penis is a pretty sensitive organ. Thats a *good* thing. But it also means you can injure it by going too hard or for too long.


Solution: Give it time.

Rough sex? Check in

Rough sex can potentially cause injuries to all parties. If its yours and your partner or partners thing, thats fine. But make sure youre on the same page before getting into rough sex.

If youre in pain after getting it on vigorously with someone else, check on them too. And dont forget to have a safe word in place or communicate when enoughs enough.

Communicating in the bedroom is central to safe, consensual, and enjoyable sex.

Hello, friction, my old friend

Chafing happens. On your thighs, glutes, armpits, and yep your peen.

Lack of lubrication during sex can rub or wear away at the top layer of skin. That leads to sensitivity and soreness.

If lack of lube is your issue, you might also notice:

Solution: Time. Avoid sex or masturbation until your penis is back to normal. (Also, use lube, condoms with lube, or even coconut oil next time.)

A range of lubes is available for purchase online.

In general, taking longer than 30 minutes to ejaculate is considered delayed ejaculation (DE).

DE is one of several types of ejaculatory dysfunction erectile dysfunction being the most common.

What causes delayed ejaculation?

Any combo of these factors can lead to DE:

DE can make your penis feel swollen (and not in a good way), but the tenderness should go away within a few hours of ejaculation.

Solution: Wait it out. But also, if this was your first time experiencing DE, call your doctor. DE can be a sign of other health problems.

Are you allergic to latex? The chemicals in certain lubes? Or the material of your newest sex toy?

If you have sensitive skin, an allergic reaction mightve happened, aka contact dermatitis. Allergic reactions usually cause some of these other symptoms too:

Contact dermatitis can last a few days to a few weeks. Avoid sex (and irritating products) until your skin has cleared up.

Solution: Your course of action will depend on the severity of your allergy. If its extreme, call a doc. Otherwise, try an over-the-counter (OTC) allergy med or topical treatment.

Allergic medications and OTC topical creams are available to buy online.

Yep, sometimes a sore penis is a sign of an STI. And if you think you have an STI, youre not in uncharted waters.

According to the Centers for Disease Control and Prevention (CDC), people reported a record-breaking 2,457,118 STI cases in the U.S. during 2018.

TBH, some folks with STIs never experience symptoms. But if an STI is causing pain, its probably one of these:

Other signs of an STI include:

Solution: Visit a healthcare clinic or call your doctor. Your sore penis requires medical treatment. Its always best to be open with sexual partners about current STIs and you should expect the same in return.

Whether you have acute or chronic prostatitis, the swelling can cause pain and soreness in your junk. That includes your penis.

What exactly is prostatitis?

A little Latin lesson: The suffix -itis means inflammation.

Prostatitis = an inflamed prostate.


Prostatitis can occur due to an underlying infection, so sit up and listen if you notice these other symptoms:

Solution: If you feel fever, chills, and UTI symptoms alongside a painful peen, seek medical treatment immediately.

Phimosis = when you cant pull your foreskin back from around the tip of your penis. (Its like that time you found it really hard to get your swimming hat on, but for your wang.)

An infection or skin condition causes the head of your penis to swell, restricting blood flow and mobility.

If you have phimosis, youll notice soreness when you pee, get a boner, and have sex. Other signs include:

Solution: Talk to your doctor. This requires medical treatment and analysis of the underlying cause.

Yep, folks with penises get yeast infections too.

A yeast infection is an overgrowth of a fungus called Candida albicans (wow, catchy).

Youre more likely to experience a yeast infection if you have a weak immune system, dont wash your junk often enough, or your partner has a yeast infection. Certain meds can also make you more prone to yeast infections.

Other signs of a penile yeasty:

The good news? Yeast infections are totally treatable. Youll want to start an antifungal cream or ointment pronto to get it under control.

Solution: Treat your yeast infection to soothe your sore penis. If youve never had a yeast infection, its best to confirm your diagnosis and any recommended treatments with a doctor.

Topical antifungal creams are available for purchase online.

Urinary tract infections (UTIs) are no joke. Youll probably have a painful, burning sensation when you pee and you might even feel the sting in your anus or rectum.

Other symptoms of UTIs include:

If your sore penis is the first sign of a UTI, youre in luck! You can nip that infection in the bud. As a UTI progresses, it can cause kidney, bladder, and urethra problems.

Solution: Call your doctor. UTIs dont always go away and might even cause complications without treatment.

According to the U.S. Department of Health and Human Services, up to 10 percent of folks with penises could have Peyronies disease a buildup of scar tissue that causes your penis to curve.

For obvious reasons, Peyronies disease can lead to a sore penis. Depending on the severity of the curve, penetrative sex might be painful. Or you might just feel tender and sore after the act.

Folks with autoimmune disorders seem more likely to develop Peyronies. Diabetes, prostate cancer, and age might also raise your risk.

Peyronies takes time to develop. You might notice these other symptoms first:

Solution: Talk to your doctor if you think you might have Peyronies disease. If they agree, theyll refer you to a urologist. Peyronies is treatable, but the type of treatment depends on the severity of your symptoms.

First things first: POIS is a *rare* and serious cause of penis soreness.

Researchers are still trying to figure out what causes POIS. Most agree that it has something to with an allergic reaction to your own semen or hormones.

If you have POIS, youre likely to feel pain and fatigue almost immediately after ejaculating. The reaction can last anywhere from a few minutes to several hours.

Other signs of POIS:

How serious is POIS?

POIS isnt life-threatening, but it could impact your quality of life. No one wants to feel crappy after what should be a fun and intimate experience.

Its important to get a diagnosis so that you can work with a specialist on pinpointing the best treatment for you.

Solution: If you notice any of the above symptoms right after sex, make an appointment with your doctor. Tell them youre concerned about POIS.

If you winced reading that, youre absolutely correct (our eyes are also watering a little). No, your boner doesnt actually contain bones. But a penile fracture can occur all the same.

An erection involves the penis engorging with blood. This blood rushes into a body called the tunica albuginea. Penile trauma (yikes) or a sudden bending of the penis can tear this lining. This is absolutely a medical emergency.

Symptoms include:

A severe penile fracture might also cause a tear in your urethra (aka your pee-hole).

Penile fracture? Yep, its an emergency

Seek immediate treatment at your nearest ER if you notice signs of a penile fracture.

Surgery is the only way to fix it.

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Sore Penis After Sex: Why It Happens and How to Treat It - Greatist

From eczema to spots to wrinkles, why the pandemic is wreaking havoc on our skin –

Until last year, Anna Robertson never had problems with her skin. But in October, with the strain of lockdown culminating in the end of her marriage, the mother-of-three from Wiltshire, 47, noticed patches of rough, scaly, itchy skin. They started on my nose and spread to my eyelids, she says. Managing the sale of our house, working and looking after the children, aged seven, 12 and 15, during the pandemic has been incredibly stressful. I saw a private dermatologist who diagnosed stress-related eczema.

In the year since the coronavirus pandemic began, experts have reported a huge rise in skin complaints, from sudden outbreaks of eczema to acne to increased signs of ageing none of which is being helped by the current cold weather.

Increased screen use, changes to our diet, increased alcohol intakeand masks are all thought to raise the risk of breakouts and skin problemsthough, in many cases, stress is thought to be the key driver as it was for Anna, who'd never had eczema before in her life.

Dr Alia Ahmed, consultant dermatologist at the Frimley Health Foundation Trust, says she has seen an uptick in patients presenting with stress-related skin problemssuch as eczema, psoriasis, acne, alopecia (hair loss) and urticaria (hives).

I have also had to increase the potency of treatment for some patients to control their skin condition, says Dr Ahmed, who also runs a private practice. My patients both men and women are experiencing high levels of stress. The pandemic adds to existing problems like financial worries, poor sleep and diet and lack of motivation to exercise.

Dr Mayoni Gooneratne, a former NHS surgeon and founder of The Clinic private health and skincare clinics in London, adds: I have seen more acute conditions like eczema and other types of dermatitis than before. Ageing has become accelerated too.

Dermatologist Dr Hiba Injibar, founder of the Dermasurge Clinic on Harley Street, says the number of people enquiring about adult acne at her practice has gone up by 30 per cent. She says that, despitecoming into contact with fewer pore-blocking pollutants because we're at home, more people have fallen victim to adult acne this year due to falling out of their skincare routines and because stress is a major cause of cystic acne. There is also the added issue of maskne [acne caused by mask-wearing] and acne on the brow caused by visors, she says.

Its well known that stress has a major effect on skin, with psychodermatology where psychological techniques are used to treat skin complaints increasingly popular.Studies have shown that emotional stress slows wound healing and can increase acne severity and some research suggests antidepressants have the side-effect of improved skin.

The brains stress response causes the release of various chemicals and hormones, including the stress hormonecortisol, that drive inflammation both in the body and the skin, Dr Ahmed explains.

Our skin becomes less able to defend itself, delaying the healing process and driving allergic responses.

Stress hormones can also alter the production and breakdown of collagen and elastin, causing premature ageing, lines, wrinkles, increased pigmentation and dull skin, and reduce production of hyaluronic acid which results in dehydrated skin.

The longer the pandemic lasts, the more likely that our skin will suffer, says Dr Ahmed. Long-term or chronic stress results in the body entering a permanent stress-response state, which can aggravate existing skin problems through a poor natural immune response, ongoing inflammation and loss of an effective skin barrier.

Stress can also encourage unhealthy lifestyle habits and poor sleep one in four of us are struggling to sleep well during the pandemic, according to researchers at Southampton University. Its a vicious circle: stress hormones correlate with lack of sleepand sleep deprivation activates their release. This is one of the reasons why poor sleep is associated with signs of premature aging, lack of hydration, larger pores, textural changes, and changes in blood flow to the skin. In addition, lack of sleep can disrupt the process of skin repair overnight, says Dr Ahmed.

For Nicola McCamley, 30, lockdown brought back the acne she thought she had beaten years ago. I stopped running and going to the gym, which was how I managed stress, and was glued to the news on TV. Everything felt so uncertain and frightening. I wasnt sure how the pandemic would affect my financial stability, and I was worried about my family.

Soon, she saw changes in her skin. It started with red and bumpy spots on the side of my face which then spread down my neck and even onto my chest. I was so upset.

She saw a dermatologist, at the Woodford Medical chain of cosmetic clinics, who ruled out allergies as she was not using any new productsand advised it was caused by stress.

How can you tell if your skin is stressed? In terms of acne, a telltale sign that emotions are the cause is when it shows up around the lower face and jaw, says Dr Gooneratne.

Dr Ahmed advises keeping a symptom diary to see if flare ups have correlated with a stressful time in your life.

Treatment requires a holistic approach, she adds. I treat the mind and skin together, as stress can trigger skin disorders which in turn cause stress, creating a vicious circle.

For eczema, Dr Ahmed recommends using gentle soap substitutes, emollients and treatment creams that may contain steroids.Acne treatment can include topical or oral antibiotics, topical retinoids, or oral isotretinoin and rosacea treatment that can include topical antibiotics, antiparasitic medications or azelaic acid, oral antibiotics or low dose oral isotretinoin.

These chronic conditions benefit from treatment that manages the signs and symptoms as well as addressing the psychological impact with interventions such as stress management techniques, relaxation therapies and mindfulness, she says.

For premature aging, useful skincare ingredients include retinoids, vitamin C and hydroxy acids, says Dr Mayoni. Plus, when clinics are open, an injectable skin hydrating and plumping cosmetic treatment will help to give your skin a real zing.

Dr Ahmed says simple lifestyle changes can help too, including drinking 2.5 litres of fluid a day to keep skin hydratedand reduce anxiety taking regular exercise, and getting plenty of sleep.

Try meditation or mindfulness to help combat stress, she adds. I often recommend the Headspace App to my patients.

Create positivity around you. Surround yourself with your favourite scents, music or colours at home to improve your mental health.

Find an achievable act that makes you happy, incorporate it into your morning routine, and another into the evening. This way you start off the day with mood enhancement and you have the same to look forward to in the evening.

Anna was prescribed a mild steroid cream, but says things really improved when she completed her house sale. I started doing yoga with an online teacher and used a meditation app which have both helped me feel less anxious. My skin is much better, she says.

Nicolas acne improved after treatment, too, but she also addressed her lifestyle. My skin problems made me realise I had to tackle my stress, so I started running again, I exercise at home and limit the amount of news I watch - and my skin looks great.

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From eczema to spots to wrinkles, why the pandemic is wreaking havoc on our skin -

Why Avocado Toast Is the Best Breakfast for Healthy Skin – LIVESTRONG.COM

Avocado is a great place to start for healthy skin, but the other toppings you sprinkle on your toast can also add glow and luster.

Image Credit: 1989_s/iStock/GettyImages

If you want to start each day by adding healthy luster to your skin, there's one breakfast dermatologists recommend you eat: avocado toast topped with lime juice, berries and seeds.

You may associate this staple with trendy cafes, but it's easy to make at home. Simply mash avocado with lime juice, spread it on whole-wheat toast and top with sliced strawberries and chia seeds.

This breakfast will benefit your skin in a number of ways, and as a bonus, the foods that benefit your skin also tend to boost your overall health.

While research on foods for healthy skin is still limited, antioxidant-rich foods seem to protect your skin, per the Mayo Clinic. On the other hand, a diet high in refined sugars, carbs and unhealthy fats is associated with skin aging one good reason to swap sugary cereal and bacon for this breakfast.

Here's why avocado toast, in particular, will give your skin a healthy boost.

Why Avocado Toast With Berries and Seeds Is the Best Breakfast for Healthy Skin

1. It Gives Your Skin More Luster

Let's start with the star ingredient: delicious avocado. You may already use it topically as part of a DIY mask, but eating this stone fruit will also support your skin.

"Avocados are famous for being chock-full of healthy fats, namely monounsaturated fats," says Elizabeth Geddes-Bruce, MD, a board-certified dermatologist. "A high intake of monounsaturated fats is associated with a lower risk of severe photoaging [premature aging of the skin due to ultraviolet radiation exposure], which is good news for our skin."

Monounsaturated fat is found in plant foods like avocados, nuts and vegetable oils, and eating moderate amounts of it in place of saturated and trans fat can benefit your overall health, per the U.S. National Library of Medicine (NLM).

Researchers surveyed 1,264 women and 1,655 men ages 45 to 60 and estimated their dietary monounsaturated fatty acid intakes in a September 2012 study in PLOS One. A lower risk of severe photoaging was associated with a higher intake of monounsaturated fatty acids from olive oil, but not animal sources, in both men and women.

One avocado contains 19.7 grams of monounsaturated fats, per the USDA. In addition to benefiting your skin, monounsaturated fats can help lower your LDL (bad) cholesterol level and develop and maintain your cells, per the NLM.

That said, avocado isn't the only powerhouse ingredient in this breakfast that will make your skin look dewy and tout.

"Chia seeds are loaded with antioxidants and have omega-3 fatty acids that contribute to the skin's luster and elasticity," says Michelle Henry, MD, a board-certified dermatologist. "They also contain small amounts of our skin's favorite trace minerals selenium and zinc which may be important in maintaining our skin's elasticity."

2. It Supports Collagen Production

Lime juice is a secret ingredient in your avocado toast that will help maintain your body's collagen levels, a structural protein that gives skin elasticity.

"It's high in vitamin C, a great antioxidant our skin relies upon to fight free radicals that cause damage and aging," Dr. Geddes-Bruce says. "In addition to that, vitamin C is needed for wound healing and is necessary to maintain the structure of collagen."

As you age, the vitamin C content in your skin and your body's production of collagen naturally decrease, per the Oregon State University Linus Pauling Institute.

That decline in collagen is what contributes to wrinkles and crepey skin, and it can also cause other health issues like weakening muscles, joint pain, osteoarthritis or even gastrointestinal problems due to the thinning of your digestive tract lining, according to the Cleveland Clinic. Apart from aging, a poor diet is the most common cause of too little collagen in the body.

"To increase intake of vitamin C, I like to eat avocado toast in the morning with some lime juice sprinkled on the top," says Anna Chacon, MD, a board-certified dermatologist.

Vitamin C is tied to improving skin appearance, wrinkling, elasticity and roughness, per a March 2015 review in the journal Nutrition Research. That said, the authors note that more research is needed to pinpoint the exact effect of dietary intake on appearance.

The juice of one lime contains 15 percent of your daily value (DV) of vitamin C. Add a quarter cup of sliced strawberries to your breakfast, and you'll get 27 percent more of your DV of C.

"Strawberries also have [the polyphenol] ellagic acid, which prevents collagen destruction," Dr. Henry says.

3. It Could Help You Avoid Acne

Swap white bread for a whole-grain slice, and you might be able to avoid a few unwanted pimples.

"Whole-grain alternatives have lower glycemic indexes than their refined counterparts, which means they do not cause as great of a spike in the blood hormone insulin," Dr. Geddes-Bruce says. "Insulin and insulin-like growth factor (IGF-1) increase inflammation and may increase acne. Skipping those highly processed and refined carbohydrates might help you skip a pimple or two."

That also goes for sugary pastries you eye up for breakfast: If it spikes your blood sugar, it may just spike your acne. "Some studies have shown a correlation of the high glycemic index in Western diets with acne," Dr. Chacon says.

Eating high-glycemic foods often can raise hormones that elevate the activity of your skin's oil glands, ultimately causing acne, per UW Health.

4. It May Protect Your Skin From Damage

"In addition to vitamin C, berries like strawberries contain anthocyanins," Dr. Geddes-Bruce says. "Anthocyanins are what give strawberries their rich red pigment, and they also function as powerful antioxidants and have anti-inflammatory properties."

Research has shown that anthocyanins are linked to protecting the skin from UV radiation damage, photoaging and skin cancer and they possess anti-carcinogenic potential on different types of cancer cell lines, per a September 2020 study in the journal Biomedicines, however, more research needs to be done to confirm these findings.

Meanwhile, the omega-3 fatty acids in chia seeds may help create a strong barrier to your skin. "Omega-3 fats are photoprotective, and they strengthen the lipid barrier of the outermost layer of our skin, the epidermis," Dr. Geddes-Bruce says.

3 More Tips for a Healthy-Skin Breakfast

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Why Avocado Toast Is the Best Breakfast for Healthy Skin - LIVESTRONG.COM

Hormones are key in brain health differences between men and women – The Philadelphia Tribune

Medical science has come a long way since the days of "bikini medicine," when the only time doctors managed a woman's health differently than a man's was when treating the parts of her body found under a bikini.

Over the past few decades, researchers have uncovered countless ways in which women's and men's bodies react differently to the same diseases. And just as it's now widely recognized women experience heart disease differently than men, scientists are beginning to understand why the sexes experience illness differently in another vital organ the brain.

It's not that male and female brains are built differently, said Lisa Mosconi, director of the Women's Brain Initiative at Weill Cornell Medicine in New York. It's that they age differently.

Women bear the brunt of Alzheimer's disease, the most common form of dementia, accounting for 2 of every 3 people diagnosed. Women are twice as likely as men to experience major depression. They are three times more likely to be diagnosed with autoimmune disorders that attack the brain, such as multiple sclerosis. They are four times more likely to have migraines and also are more likely to die from strokes.

What's driving these disparities? While multiple factors are at play, Mosconi said, it's hormones testosterone in men and estrogen in women that are the orchestral conductors of the brain. They are responsible for whether it performs well, or not.

"We are used to thinking of sex hormones as important for fertility and reproduction," Mosconi said. "But hormones also play crucial roles in brain health."

Estradiol, the type of estrogen produced by the ovaries during a woman's reproductive years, is the most important driver of brain health, said Dr. Kejal Kantarci, director of the Women's Health Research Center and a radiology professor at Mayo Clinic in Rochester, Minnesota. Her research suggests longer exposure to estradiol may offer some protection to the brain.

In a 2020 study published in Brain Communications, she showed women with longer reproductive periods measured from the time they start menstruation to the time they enter menopause were better protected against progressive forms of multiple sclerosis. The study also showed the more pregnancies a woman had, the less her disease progressed, suggesting that the flood of estrogen during pregnancy increased protection.

Losing estradiol, on the other hand, can harm the brain. The end of a woman's reproductive years and the accompanying drop in estradiol triggers numerous brain changes, some of which, researchers are learning, may not become evident until decades later.

For example, studies show Alzheimer's disease, typically diagnosed in a woman's 70s, likely begins to develop while she is still in her 50s. Mosconi's research found evidence that amyloid plaques, the proteins associated with the development of Alzheimer's disease, were already accumulating in the brains of women as they transitioned to menopause, though the women showed no evidence of cognitive decline at that age. She also found shrinkage in the memory centers of the women's brains.

"We never talk about Alzheimer's disease as something that happens in midlife," Mosconi said. "But for women, that's the timeline we need to think about."

There are other signs the brain is changing at midlife, when the loss of estradiol makes women more vulnerable to disease, Mosconi said. Studies have shown an increase in anxiety, depression, multiple sclerosis and other immune disorders during menopause. "For women with a predisposition to these conditions, this is when the condition seems to get activated."

Mosconi has used imaging to track brain energy levels, showing that, on average, it "declines by 20% or more during menopause." Men at the same age showed no changes, she said, which could be because they don't typically experience a hormone decline as rapidly or as early as women do.

But more estrogen isn't always better, Kantarci said. "You can't just say estrogens are good for you. It's not that simple."

A growing body of research suggests that it's not just about how much estrogen a woman's brain gets exposed to but when.

For example, a 2005 review published in The Lancet Neurology about clinical trials in postmenopausal women 65 or older showed women who received hormone therapy, including estrogen, had an increased risk for dementia and other types of cognitive decline. But a more recent study in 2019 in the journal Menopause found taking estrogen therapy earlier within the first five years of menopause might protect against cognitive decline. It also showed women exposed longer to natural estrogen because of more reproductive years had better cognitive function later in life.

Kantarci's work supports the idea that the transition to menopause offers a critical window for intervention. Her research found women given estradiol in a patch during their 50s showed less brain shrinkage in later years. "The front of the brain, which is used for decision-making and attention, was relatively preserved," she said. "It did not decline as much as it did in the placebo group."

In an ongoing study, she and her team will continue to explore whether hormone therapy given during the transition to menopause is associated with any long-term cognitive impacts.

But Kantarci cautioned against placing all the blame on hormones.

"Women are also the caregivers to dementia patients, and they are at higher risk for mental health issues that may also increase their risk of cognitive impairment," she said. "They live longer, and they are caregivers. And because they are caregivers, they are at higher risk. It's a circular problem."

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Hormones are key in brain health differences between men and women - The Philadelphia Tribune

Folx Makes Health Care More Accessible for the Trans Community – The Mighty

Finding good health care can be challenging, but for certain communities, including queer and trans people, it can be nearly impossible. Stigma, lack of training and insensitivity are rampant for these groups of people, and with something as important as health care, the effects can be mentally and physically devastating.

A new startup, Folx Health, is working to change all that through a personalized approach that matches trans and queer people seeking care with providers and services who understand their unique needs. Folx just raised $25 million in series A venture funding and is accepting patients now.

When a patient contacts Folx, they begin by filling out a complete online medical history. If their need requires a consultation with a health provider, theyll be matched with someone for a virtual appointment by phone or video. Medication, labs and supplies are delivered to the patients door, according to the Folx Health website. One of the companys foundational principles is care on our terms, which means no judgement, gatekeeping or having to explain yourself.

One 2015 study conducted with more than 27,000 transgender people found that 19% reported being refused medical care, 28% harassed by providers and 50% had to educate health care providers on transgender care. Twenty-eight percent of respondents also told researchers that they avoid going to the doctor altogether because of such treatment.

Folx founder and CEO A.G. Breitenstein told Fast Company that theyre on the verge of becoming a one-stop resource for members of the queer and trans community from information you might find in subreddit threads to clinical information from sources like the Mayo Clinic.

Were about to launch what we call The Library, which is a set of resources, Breitenstein said. Well have a balance between really well clinically vetted information, but presented in a way thats accessible and usable for folks.

Current topics in The Library include sexual health, hormone treatment and company news. There are tips like how to overcome needle fears for self-injection, and explainers on hormone lab results.

In the future Folx is also preparing to expand services to include treatments for sexually transmitted infections, erectile dysfunction and lab samples taken at home.

Right now, users must pay a $59 monthly fee for access to the service, in addition to any treatment costs. Breitenstein said that theyre working to integrate with insurance companies so patients can take advantage of their health care plans. Folx is also working on creating a grant program for people who cant afford the monthly subscription cost, according to Axios.

Folx service is currently available in 12 states, including New York, California and Florida. The company plans to expand nationwide by the end of 2021.

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Folx Makes Health Care More Accessible for the Trans Community - The Mighty

Transforming Outcomes in Advanced CSCC with Immunotherapy – LWW Journals

Are there updated data for LIBTAYO in advanced CSCC? What do they show?

Longer-term data from EMPOWER-CSCC-1 were presented at the 2020 American Society of Clinical Oncology (ASCO) virtual meeting. These results showed an ORR of 46% (95% CI: 39%-53%) following treatment with LIBTAYO, with a median time to response of 2 months (interquartile range: 2-4 months) across the three treatment groups, which were metastatic CSCC and locally advanced CSCC dosed at 3mg/kg every 2 weeks and metastatic CSCC dosed at 350mg every 3 weeks. The median time to CR was 11 months (interquartile range: 7.4-14.8months) among those who achieved a CR in any group. The median DoR hadyet to be reached for any treatment group (range for groups combined: 1.9-34.3 months).4,10

Updated response rates arein the table below.4,10

Safety was generally consistent with previous data. The most common adverse reactions reported were fatigue (35%), diarrhea (28%) and nausea (24%). The most common Grade 3 or higher adverse reactions were pneumonitis (3%), autoimmune hepatitis (2%), anemia, colitis and diarrhea (each 1%).

Warnings and Precautions

Severe and Fatal Immune-Mediated Adverse Reactions

Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue at any time after starting treatment. While immune-mediated adverse reactions usually occur during treatment, they can also occur after discontinuation. Immune-mediated adverse reactions affecting more than one body system can occur simultaneously. Early identification and management are essential to ensuring safe use of PD-1/PD-L1 blocking antibodies. The definition of immune-mediated adverse reactions included the required use of systemic corticosteroids or other immunosuppressants and the absence of a clear alternate etiology. Monitor closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate.

No dose reduction for LIBTAYO is recommended. In general, withhold LIBTAYO for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue LIBTAYO for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated adverse reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone equivalent per day within 12 weeks of initiating steroids.

Withhold or permanently discontinue LIBTAYO depending on severity. In general, if LIBTAYO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroids.

Immune-mediated pneumonitis:LIBTAYO can cause immune-mediated pneumonitis. In patients treated with other PD-1/PD-L1 blocking antibodies, the incidence of pneumonitis is higher in patients who have received prior thoracic radiation. Immune-mediated pneumonitis occurred in 3.7% (22/591) of patients receiving LIBTAYO, including fatal (0.3%), Grade 4 (0.3%), Grade 3 (1.0%), and Grade 2 (1.9%). Pneumonitis led to permanent discontinuation in 1.9% of patients and withholding of LIBTAYO in 1.9% of patients. Systemic corticosteroids were required in all patients with pneumonitis. Pneumonitis resolved in 59% of the 22 patients. Of the 11 patients in whom LIBTAYO was withheld, 7 reinitiated after symptom improvement; of these 1/7 (14%) had recurrence of pneumonitis. Withhold LIBTAYO for Grade 2, and permanently discontinue for Grade 3 or 4. Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to less than 10 mg per day (or equivalent) within 12 weeks of initiating steroids.

Immune-mediated colitis: LIBTAYO can cause immune-mediated colitis. The primary component of immune-mediated colitis was diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis treated with PD-1/PD-L1 blocking antibodies. In cases of corticosteroid-refractory immune-mediated colitis, consider repeating infectious workup to exclude alternative etiologies. Immune-mediated colitis occurred in 1.2% (7/591) of patients receiving LIBTAYO, including Grade 3 (0.3%) and Grade 2 (0.7%). Colitis led to permanent discontinuation in 0.2% of patients and withholding of LIBTAYO in 0.7% of patients. Systemic corticosteroids were required in all patients with colitis. Colitis resolved in 71% of the 7 patients. Of the 4 patients in whom LIBTAYO was withheld, none reinitiated LIBTAYO. Withhold LIBTAYO for Grade 2 or 3, and permanently discontinue for Grade 4. Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to less than 10 mg per day (or equivalent) within 12 weeks of initiating steroids.

Immune-mediated hepatitis:LIBTAYO can cause immune-mediated hepatitis. Immune-mediated hepatitis occurred in 1.9% (11/591) of patients receiving LIBTAYO, including fatal (0.2%), Grade 4 (0.2%), and Grade 3 (1.5%). Hepatitis led to permanent discontinuation of LIBTAYO in 0.8% of patients and withholding of LIBTAYO in 0.8% of patients. Systemic corticosteroids were required in all patients with hepatitis. Additional immunosuppression with mycophenolate was required in 9% (1/11) of these patients. Hepatitis resolved in 64% of the 11 patients. Of the 5 patients in whom LIBTAYO was withheld, none reinitiated LIBTAYO.

For hepatitis with no tumor involvement of the liver: Withhold LIBTAYO if AST or ALT increases to more than 3 and up to 8 times the upper limit of normal (ULN) or if total bilirubin increases to more than 1.5 and up to 3 times the ULN. Permanently discontinue LIBTAYO if AST or ALT increases to more than 8 times the ULN or total bilirubin increases to more than 3 times the ULN.

For hepatitis with tumor involvement of the liver: Withhold LIBTAYO if baseline AST or ALT is more than 1 and up to 3 times ULN and increases to more than 5 and up to 10 times ULN. Also, withhold LIBTAYO if baseline AST or ALT is more than 3 and up to 5 times ULN and increases to more than 8 and up to 10 times ULN. Permanently discontinue LIBTAYO if AST or ALT increases to more than 10 times ULN or if total bilirubin increases to more than 3 times ULN. If AST and ALT are less than or equal to ULN at baseline, withhold or permanently discontinue LIBTAYO based on recommendations for hepatitis with no liver involvement.

Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to less than 10 mg per day (or equivalent) within 12 weeks of initiating steroids.

Immune-mediated endocrinopathies: For Grade 3 or 4 endocrinopathies, withhold until clinically stable or permanently discontinue depending on severity.

Immune-mediated nephritis with renal dysfunction: LIBTAYO can cause immune-mediated nephritis. Immune-mediated nephritis occurred in 0.5% (3/591) of patients receiving LIBTAYO, including Grade 3 (0.3%) and Grade 2 (0.2%). Nephritis led to permanent discontinuation in 0.2% of patients and withholding of LIBTAYO in 0.3% of patients. Systemic corticosteroids were required in all patients with nephritis. Nephritis resolved in all 3 patients. Of the 2 patients in whom LIBTAYO was withheld, none reinitiated LIBTAYO. Withhold LIBTAYO for Grade 2 or 3 increased blood creatinine, and permanently discontinue for Grade 4 increased blood creatinine. Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to less than 10 mg per day (or equivalent) within 12 weeks of initiating steroids.

Immune-mediated dermatologic adverse reactions: LIBTAYO can cause immune-mediated rash or dermatitis. Exfoliative dermatitis, including Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has occurred with PD-1/PD-L1 blocking antibodies. Immune-mediated dermatologic adverse reactions occurred in 2.0% (12/591) of patients receiving LIBTAYO, including Grade 3 (1.0%) and Grade 2 (0.8%). Immune-mediated dermatologic adverse reactions led to permanent discontinuation in 0.3% of patients and withholding of LIBTAYO in 1.4% of patients. Systemic corticosteroids were required in all patients with immune-mediated dermatologic adverse reactions. Immune-mediated dermatologic adverse reactions resolved in 42% of the 12 patients. Of the 8 patients in whom LIBTAYO was withheld for dermatologic adverse reaction, 5 reinitiated LIBTAYO after symptom improvement; of these 60% (3/5) had recurrence of the dermatologic adverse reaction. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-exfoliative rashes. Withhold LIBTAYO for suspected SJS, TEN, or DRESS. Permanently discontinue LIBTAYO for confirmed SJS, TEN, or DRESS. Resume in patients with complete or partial resolution (Grade 0 to 1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to less than 10 mg per day (or equivalent) within 12 weeks of initiating steroids.

Other immune-mediated adverse reactions: The following clinically significant immune-mediated adverse reactions occurred at an incidence of <1% in 591 patients who received LIBTAYO or were reported with the use of other PD-1/PD-L1 blocking antibodies. Severe or fatal cases have been reported for some of these adverse reactions.

Infusion-related reactions

Severe infusion-related reactions (Grade 3) occurred in 0.2% of patients receiving LIBTAYO. Monitor patients for signs and symptoms of infusion-related reactions. Interrupt or slow the rate of infusion for Grade 1 or 2, and permanently discontinue for Grade 3 or 4.

Complications of Allogeneic HSCT

Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/PD-L1 blocking antibody. Transplant-related complications include hyperacute graft-versus-host-disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/PD-L1 blockade and allogeneic HSCT. Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with a PD-1/PD-L1 blocking antibody prior to or after an allogeneic HSCT.

Embryo-fetal toxicity

LIBTAYO can cause fetal harm when administered to a pregnant woman due to an increased risk of immune-mediated rejection of the developing fetus resulting in fetal death. Advise women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with LIBTAYO and for at least 4 months after the last dose.

Adverse reactions

Use in specific populations

Please click here for full Prescribing Information.


LIBTAYO is indicated for the treatment of patients with metastatic cutaneous squamous cell carcinoma (mCSCC) or locally advanced CSCC (laCSCC) who are not candidates for curative surgery or curative radiation.



1. LIBTAYO (cemiplimab-rwlc) injection full U.S. prescribing information. Regeneron Pharmaceuticals, Inc., and sanofi-aventis U.S. LLC. Available at:

2. Mansouri B, Housewright C. The treatment of actinic keratosesthe rule rather than the exception. J Am Acad Dermatol 2017; 153(11):1200. doi:10.1001/jamadermatol.2017.3395.

3.Schmults CD, et al. High-Risk Cutaneous Squamous Cell Carcinoma A Practical Guide for Patient Management. Springer. ISBN 978-3-662-47081-7 (eBook).DOI 10.1007/978-3-662-47081-7.

4. Data on File. Regeneron Pharmaceuticals Inc. 2020.

5. Data on File. Regeneron Pharmaceuticals Inc. 2018.

6. Migden M, Rischin D, Schmults C, Guminski A, Hauschild A, Lewis K et al. PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2018;379(4):341-351.

7. NCCNClinical Practice Guidelines in Oncology (NCCN Guidelines) forSquamous Cell Skin Cancer V.2.2020. National Comprehensive CancerNetwork, Inc. 2020.

8. Califano JA, Lydiatt WM, Nehal KS, et al. Cutaneous squamous cell carcinoma of the head and neck. In: Amin MB, Edge SB, Greene FL, et al, eds. AJCC Cancer Staging Manual. 8th ed. Springer; 2017:171-181.

9. Jennings L, Schmults CD. Management of high-risk cutaneous squamous cell carcinoma. J Clin Aesthet Dermatol. 2010;3(4):39-48.

10. RischinD, Khushalani NI, Schmults CD, et al. Phase 2 study of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (CSCC): longer follow-up. Poster presented at: American Society of Clinical Oncology (ASCO) 2020 Virtual Scientific Program; May 29-31, 2020.

LIB.20.04.0063 1/21

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New Jersey Health And Wellness Clinic The Youth Fountain Is Offering Holistic Weight Loss Treatments – Press Release – Digital Journal

The Youth Fountain, a health and wellness clinic in New Jersey, is offering holistic weight loss treatments for patients. The clinic is spearheaded by Dr. Rada and Dr. Emil Shakov.

According to the CDC, the prevalence of obesity was 42.4% in 2017-2018, up from 30% in 1999-2000. Obesity brings along with it health conditions that can lead to premature death. These health conditions are diabetes, heart disease, stroke, and some types of cancer. In the United States alone, obesity is a contributor to anywhere from 100,000 to 400,000 deaths every year. The medical cost for people with obesity was on an average $1429 higher than one without. Apart from dangers to physical health, the stigma and ridicule associated with obesity are also known to cause psychological distress leading to poor quality of life.

Though obesity has a negative impact on ones health it is also completely preventable through lifestyle changes that include changes in diet. The Youth Fountain believes in holistic treatment that looks at not just short term weight loss goals but prepares the patient for lifelong wellness as well. The doctors first take the time to understand a patients health goals. They then quiz them about their lifestyle, trying to arrive at a treatment that will suit them the best. This attention to detail is provided to every patient. Dr. Emil and Rada understand that every patient is unique and no size fits all. The doctors then craft a treatment regiment that incorporates all the tools at their disposal. The doctors can also set up follow up appointments to monitor a patients progress throughout the treatment.

When asked about the clinics philosophy, Dr. Emil says, When clients come to us, they are doing so because they are looking for a change in their lives. We do our best to live up to the trust that they put in us. We listen and understand the clients problems. We come up with solutions that best suit them on a case by case basis. The goal is to not just hit your target weight but to give you the tools to stay there for the rest of your life. Follow us on our Facebook page to stay up to date with our services.

The Youth Fountain offers skincare treatments such as tattoo removal, IPL, laser genesis, Picogenesis, chemical peel, Dermapen, vein treatments, hair removal, and SecretRF. The clinic also offers injectable treatments such as fillers, BOTOX, Dysport, PRP, and Jeuveau. The clinics wellness treatments include IV Infusions, weight loss, anti-aging, hormone replacement, and peptides. They provide hair restoration treatments such as medical treatment, laser cap, mesotherapy, PRP, and surgery. They also provide body sculpting treatments such as EmSculpt, Coolsculpting, truSculpt iD, mesotherapy, and Laser Liposculpting.

Dr. Emil Shakov is a board-certified surgeon at The Youth Fountain with extensive experience and training in advanced surgical techniques, advanced aesthetics, anti-aging, weight-loss, and hair transplantation. Fellowship trained in Advanced GI, Bariatrics, and Minimally Invasive Surgery (MIS), he continued to further his training and education at The American Academy of Procedural Medicine and The American Academy of Aesthetic Medicine where he mastered aesthetic procedures, anti-aging, and medical weight-loss. Dr. Shakov brings his unique skill set to The Youth Fountain to provide a pleasant experience with the confidence you can trust.

Dr. Rada Shakov is a board-certified gastroenterologist at The Youth Fountain who specializes in all aspects of aesthetic medicine. She has extensive training in a variety of procedures and is always continuing her education to stay on the cutting edge of the newest and best practices. In practice since 2010, Dr. Shakov believes in seeing the patient as more than just their problem areas; taking an emphatic and whole-body approach.

A review of the clinics service by Rachel K. says, Dr. Rada Shakov and Dr. Emil Shakov are the finest doctors around. They are not only knowledgeable in their field but are also incredibly kind, helpful, and care tremendously about their patients. So happy with my outcome and I would highly recommend them and their wonderful office staff to anyone. I'm so glad I found them! More reviews can be viewed on the clinics GMB listing.


For more information about The Youth Fountain, contact the company here:

The Youth FountainDr. Shakov+1 732-333-5992info@theyouthfountain.com501 Iron Bridge Rd Suite 9, Freehold,NJ 07728, United States

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Lost in Translation – Splice Today

President Joe Biden is already proving to be a better friend to the LGBTQ community than his predecessor. During his first week in office, Biden issuedan executive orderextending federal LGBTQ protections, reversedTrumps trans military ban, and includedgender-neutral pronouns and honorificson the White Houses contact page.

With these victories came the inevitable backlash. Abigail Shrier, author of the controversial bookIrreversible Damage: The Transgender Craze Seducing Our Daughters,denounced Bidens executive order on Twitter, claiming that it unilaterally eviscerates womens sports. Other self-described gender critical (i.e., anti-trans) feminists agreed, creating the hashtag#BidenErasesWomento voice their opposition. Meanwhile, at least 14 states have introduced aslew ofanti-trans bills. Contrary to what lawmakers and gender critical feminists say, its not about protecting women and children. Its an organized effort to legislate trans bodies based on misinformation, ignorance, and bigotry.

Earlier this year, Montana lawmakers introducedHB 113, which wouldvebarred health care professionals from providing gender-affirming services to trans adolescents such as puberty blockers and hormones. The bill died on its third reading in anarrow 51-49 voteon January 26 after five Republicans who initially supported HB 113 changed theirminds. Similar bills inUtah,Alabama,Missouri,Texas,Mississippi,Indiana, andNew Hampshireare still on the table.

The argument supporting these bills is the same that Shrier makes in her book, which is that providing puberty blockers and hormones to minors can cause a lifetime of damage. The facts are more nuanced. According to the MayoClinic, puberty blockers dontchange an adolescents body permanently. Instead, theMayo Clinics websiteexplains, it pauses puberty, providing time to determine if a child's gender identity is long lasting. If a child decides not to continue medical transitioning, normal development will resume once the child stops taking puberty blockers.

Atalking point among anti-trans activists is that 70 to 80 percent of adolescents diagnosed with gender dysphoria eventually grow out of it, or desist. The exact numbers are hard to pin down. A2008 studyfound that 61 percent of children with gender dysphoria desisted by the age of 29, while a2019 studyfound that about 10percent desisted within 18months of seeking treatment. The 80 percent number comes from a2013 study whichinitially reported that out of 127 Dutch children who sought gender-affirming health care at a clinic, 47 of them still went to the clinic as adolescents, while 80 of them stopped. It was initially reported that the 80 desisted, but asJame M. CantorandJesse Singalrespectively point out, only 56 of the 80 said they desisted, while the rest didntrespond to the researchers questionnaires. The actual study says 54 percent desisted, not 80.

Cantor and Singalwhovebeenheavily criticizedfor theirviews on trans issuesconclude that most children who initially report having gender dysphoria eventually grow out of it. Even if this is true, making gender-affirmingcare for children illegal isntthe solution. A study published inPediatricslast year shows that having access to puberty blockers in adolescence reduces the risk of suicidal thoughts in transgender adults. Is it worth risking the lives of trans kids who legitimately need puberty blockers and hormones because a few might later change their minds?

While Montanas HB 113 has been defeated,HB112remains. Known as the Save Womens Sports Act, the bill seeks to ban young trans girls from competing in girls sports. This is the latest example of an ongoing debate; the main argument against including trans women in sports is that since trans women naturally produced testosterone for a significant period before undergoing hormone replacement therapy (HRT), they have an unfair physical advantage over cis women. Once again, the truth is more complex.

Medicalphysicist Joanna Harper, whosalso an athlete and a trans woman, publisheda study in 2015that looked at run times for eight trans distance runners over a seven-year period, and found littledifference from cis runners times. Likewise, a2017 literature reviewfound no direct or consistent research that proves trans women have an unfair physical advantage. However,a 2019 studyshows only modest changes in muscle mass in trans women after a year on estrogen, as did amore recent studythat looked at the athletic abilities of trans women serving in the Air Force.

It's still no excuse to outright ban trans women from sports because rules can be adjusted. Dr. Timothy Roberts, who led the most recent study, toldNBC Newshe suggests making it so trans women athletes have to be on HRT for at least two years instead of the International Olympic Committees current one-year rule.Even then, Robertspointedout that many cis female athletes have physical advantages over others. We have a lot of elite female athletes who tend to be tall and thin with slender hips, he said, and we're not outlawing them.

HB 112 and HB 113 are just the latest attempts to banish trans women from public life. Like bathroom bills, these new bills perpetuate the ideathat the trans rights movement seeks to harm women andchildren. No evidence supports this; trans people, for the most part, just want to live their lives in peace with full bodily autonomy like everyone else.

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The GOP’s future is in flux as the party divides over support for Representatives Marjorie Taylor Greene and Liz Cheney – Yahoo News

National Review

President Joe Bidens recent executive order to expand food assistance to U.S. households, while well-intentioned, represents a substantial overreach of the executive branch and a blatant attempt to override the intent of Congress. If successful, this dangerous precedent would open the door to major expansions of the social safety net without congressional approval. Congress must resist the presidents attempts to subvert the intent of existing law. Less than one week into the Biden presidency, the new administration issued a series of executive orders focused on COVID-19 economic relief. One such order seeks to expand food assistance through the Supplemental Nutrition Assistance Program (SNAP), or food stamps. In it, President Biden instructed the Department of Agriculture (USDA) to take immediate steps to make it easier for the hardest-hit families to enroll and claim more generous benefits in the critical food and nutrition assistance area. In reality, the executive order asks a federal agency the USDA to intentionally misinterpret the Families First Act and subvert the constitutional authority of Congress over the legislative process. The Families First Act, which passed in March 2020, clearly outlined that states could request waivers from the Agriculture Department to provide emergency allotments to SNAP households not greater than the applicable maximum monthly allotment for the household size. In normal times, 60 percent of households enrolled in SNAP do not receive the maximum benefit because they have income from other sources such as earnings that they can use for purchasing food. The emergency allotments recognized that millions of people lost jobs or faced other employment disruptions when the pandemic hit, and that those enrolled in SNAP were at particular risk for job loss in the early aftermath of the pandemic. Rather than requiring SNAP households to report a job or income change to their state agency and wait for bureaucrats to recalculate their benefits, the emergency allotments gave every SNAP recipient the maximum allowed. This was, admittedly, not a very targeted effort. Some families received a boost in SNAP dollars without a change in household income or financial circumstances. But the immediacy of the economic shock brought on by the pandemic, and the employment instability that persists today, necessitated an equally expedient policy response. The Agriculture Department, under President Trump, had approved emergency allotment plans for all 50 states, the District of Columbia, Guam, and the U.S. Virgin Islands but only in accordance with the law. The department extended these emergency-allotment waivers numerous times, most recently extending them through January 2021. The USDA and Congress itself also offered states flexibility in the aftermath of the pandemic. According to federal government spending data, all of the efforts outlined above have caused SNAP benefits to rise more than 40 percent in the last fiscal year, with more than $31 billion in added spending compared to FY 2019. Class-action suits have been filed in Pennsylvania and California by people who disagree with the USDAs interpretation of the law: that regular SNAP plus emergency allotments cannot extend benefits beyond the maximum benefit level. Lawyers for the lawsuits argue that the law allows the USDA to approve emergency allotments in the amount of the maximum benefit, which if true, would mean that households could receive the maximum SNAP benefit plus the maximum emergency allotment essentially doubling benefit amounts. A federal judge in California agreed with the USDA, while the Pennsylvania case is ongoing. The Biden administrations executive order is encouraging its USDA to misinterpret the 2020 law in a similar way. The legislative text is not ambiguous. It is hard to imagine Congress being any clearer than, to address temporary food needs not greater than the applicable maximum monthly allotment for the household size. If Congress had wanted to give people more than the SNAP maximum, it would have done so. In fact, Congress eventually did just that expanding benefits by 15 percent in the COVID-19 relief package passed last month. If the Biden administration is successful in this attempt, it will open the door to a number of executive actions aimed at expanding the safety net without congressional action. If political appointees in the Biden administration feel unconstrained by the law, we will see larger benefits directed to an increasing number of people. Such action not only undermines the integrity of the social safety net by going around Congress, it disregards the separation of powers ensconced in the founding documents of our republic. The American public has been largely supportive of efforts by Congress to provide economic relief to struggling households. Lets keep that authority in its proper place.

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The GOP's future is in flux as the party divides over support for Representatives Marjorie Taylor Greene and Liz Cheney - Yahoo News

[Full text] Dissolution Rates of Calcium Boluses and Their Effects on Serum Calciu | VMRR – Dove Medical Press


The onset of lactation results in a sudden and considerable demand for calcium, imposing arduous physiologic challenges to calcium homeostasis in dairy cows.1 Cows that are unable to adapt to this change in calcium demand develop hypocalcemia. Cows with hypocalcemia (colloquially referred to as milk fever) present with weakness, depression, inappetence, and an inability to rise.1 Cows with clinical hypocalcemia are more likely to develop secondary mastitis, as well as muscle and nerve damage from prolonged periods of recumbency.2 As the condition name would suggest, subclinical hypocalcemia shows no overt clinical signs in affected animals, despite low blood calcium; however, there are other negative health consequences. Hypocalcemia reduces the ability of immune cells to respond to stimuli, thus contributing to infections, such as mastitis or metritis.3,4 Hypocalcemia also reduces smooth muscle contraction,5 which can result in reduced rumen and abomasal motility, leading to reduced feed intake and subsequent transition disorders (displaced abomasum, mastitis, metritis, retained fetal membranes, ketosis, etc).6 Subclinical hypocalcemia has also been shown to negatively affect early lactation milk production and reproduction.7 An increased culling rate was also observed for animals with subclinical hypocalcemia.8 Clinical hypocalcemia may occur in up to 510% of dairy cows, whereas its subclinical form is more prevalent, with estimates ranging up to 50% of mature fresh cows.9 Some authors have estimated the overall economic cost of subclinical hypocalcemia to be 4 times that of clinical cases, resulting in a substantial impact on the profitability of dairy operations.10

Several strategies have been studied to enhance the ability of periparturient dairy cows to maintain calcium homeostasis. These practices include limiting total calcium intake prepartum (which may be difficult to achieve), adding a calcium chelator to the prepartum transition ration, and modifying the dietary cation-anion difference (DCAD) by feeding anionic salts prepartum, which has become the mainstay in many herds. Oral supplementation of calcium at calving has proven effective in reducing clinical milk fever.11 Research has shown that, even in very well-managed herds with a low incidence of clinical hypocalcemia, oral calcium supplementation may have health, reproductive, and increased production benefitsmost notably in lame and high producing cows.1214

There are several commercial boluses with substantial differences in composition, primarily with calcium chloride, calcium sulfate, and calcium carbonate. The dissolution properties of the commercial boluses will affect the delivery of product to the animal. Moreover, not all calcium salts are absorbed by the animal in the same manner. Calcium chloride and calcium sulfate are absorbed through the rumen wall by passive transport, whereas calcium carbonate is absorbed in the small intestine by vitamin D-dependant active transport.15 In addition, the acidogenic properties of calcium chloride and calcium sulfate stimulate parathyroid hormone (PTH) function, thereby increasing calcium resorption from bone, kidney tubular reabsorption of calcium, as well as absorption of calcium in the intestine.16

In order to evaluate differences in bolus composition with respect to calcium delivery, this study measured the dissolution times of three different boluses in fistulated animals and the in vivo uptake of two calcium sources utilizing two administration protocols.

The dissolution rate was evaluated for three commercially available boluses, each with different calcium chloride and calcium carbonate compositions: Bolus 1 (high calcium chloride, no calcium carbonate bolus): 209-g Bolus supplying 43 g of calcium from 112 g of calcium chloride dihydrate and 53.6 g of calcium sulfate (Cal-Boost Bolus, Solvet Animal Health, Calgary, Alberta, Canada); Bolus 2 (intermediate calcium chloride, intermediate calcium carbonate bolus): 176-g Bolus supplying 39.0 g of calcium from 106.9 g of calcium chloride, 4.5 g of calcium propionate, and 22.3 g of calcium carbonate (Transition Bolus, Vetoquinol N.-A Inc, Lavaltrie, Quebec, Canada); and Bolus 3 (low calcium chloride, high calcium carbonate bolus): 206-g Bolus supplying 54 g of calcium from 92.2 g of calcium chloride and 72.8 g of calcium carbonate (RumiLife CAL24 Bolus, Genex Cooperative Inc, Shawano, Wisconsin, USA). Table 1 shows the composition of these boluses. The research facility provided two fistulated steers, approximately 28 months of age and weighing 450 kg, 1-year post-cannulation. The steers were housed in an open-air feedlot pen approximately 18 meters deep and 36 meters wide and fed a total mixed ration (TMR) including barley silage, minerals, and vitamins from a feed mixer truck once daily (late afternoon) in a cement feed bunk upon the completion of the bolus study each day. Well water was supplied ad libitum from an automatic cattle waterer. A bolus was placed in a pre-weighed coarse mesh net with a recovery cord. The net and bolus were then placed in the rumen through a fistula. A pretreatment pH was determined using pH strips (pH Test Strips, EMD Millipore) and a pH meter (LRCpH logger, DASCOR Inc., Oceanside, California, USA). After 30, 60, 90, 120, 180, and 240 minutes, the bolus was recovered, weighed, described, and photographed. The recovered bolus was then returned to the rumen. The rumen pH was determined at each sampling time using pH strips, in order to ensure that the boluses were not causing acidosis. If the entire bolus was dissolved at the time of sample collection, sampling was terminated. Each animal only received one bolus at a time, with a minimum of one full day between tests. Each bolus type was tested a total of three times, meaning that it was tested twice in one animal and once in the other; the decision of which animal received which bolus type twice was made at random.

Table 1 Composition of the Commercially Available Boluses Used in This Study

A 380-cow Holstein dairy herd in the province of Quebec, Canada was selected. The study was conducted from November 2019 to March 2020. Cattle were housed in two tie-stall barns for the duration of their lactation, with a third tie stall barn dedicated to the dry and transition cows. Dry cows were moved to this third barn and were fed a dry cow ration. One month prior to their expected calving date, cows were transitioned to a prepartum ration consisting of 20 kg of grass silage, 5 kg of dry hay, 0.85 kg of soybean meal 48% and a 200-g mineral pack. The mineral concentration of this total ration was as follows: calcium 0.52% dry mass (DM.), phosphorus 0.33% DM, magnesium 0.38% DM, and potassium 2.4% DM. In mid-December, the potassium in the close-up ration was lowered. The new ration consisted of 7.85 kg of grass silage, 8 kg of corn silage, 3 kg of dry hay, and 4 kg of a supplement created for this farm. The modified mineral concentrations were calcium 0.56% DM, phosphorus 0.31% DM, magnesium 0.50% DM, and potassium 1.41% DM. The pre-partum ration was not prepared as a Total Mixed Ration (TMR) and therefore implementing a Dietary Cation-Anion Difference (DCAD) strategy was not deemed a practical option. Each cow was transferred to one of the milking barns the morning following calving.

Only cows in their second and third lactations were enrolled in this study. Because of the high level of potassium in both rations, all older cows (>third lactation) received intravenous calcium at calving to prevent clinical milk fever, sometimes followed by oral calcium supplementation, and were therefore not included in this study. Twenty-seven healthy second- and third-lactation cows with body condition score (BCS) of 2.753.5 and an estimated average weight of 767 kg (second lactation) or 787 kg (third lactation) were randomly allocated to one of three oral calcium treatment protocols (9 cows per group irrespective of parity). Treatment 1 received two high calcium chloride boluses (Cal-Boost Bolus, Solvet Animal Health, Calgary Alberta, Canada) at time 0; Treatment 2 received one high calcium chloride Cal-Boost Bolus (Solvet Animal Health, Calgary Alberta, Canada) at time 0 with a second bolus 12 hours later; and Treatment 3 received two high calcium carbonate boluses (RumiLife CAL24 Bolus, Genex Cooperative Inc, Shawano, Wisconsin, USA) at time 0. Treatments were initiated within 12 hours following calving and this was considered Time 0 (t=0). The intermediate calcium chloride/calcium carbonate bolus was excluded from this study as we were most interested in the two extremes (high calcium chloride vs high calcium carbonate). Cows calving between 5:00 p.m. and 5:00 a.m. commenced the protocol at 5:00 am. Cows calving between 5:00 a.m. and 5:00 p.m. started their protocol at 5:00 p.m. Blood was taken in a 10-mL red-topped vacutainer vial from the coccygeal vein pretreatment at time 0, and at 1, 6, 12, 13, and 24 hours post-treatment. The blood was immediately centrifuged on the farm (3000 rpm, 10 minutes) and the serum was transferred into a 3-mL red-topped vacutainer tube for storage at 18C. Total calcium was analyzed by an in-clinic Idexx Catalyst One Chemistry Analyzer. One cow in the Treatment 2 group developed clinical milk fever within 12 hours after receiving the initial bolus and was removed from the study because it did not receive the second bolus. Another cow in Treatment 3 also developed clinical milk fever; however, this was the day after the 24-hour study period and she was therefore included in the trial.

Even though allocation to treatment groups was randomized, there was an age discrepancy between groups. There were more older cows in Treatment 1, which explains the lower Time 0 serum calcium levels (Table 2). Upon analyzing the raw data from the first 27 animals, cows with more severe hypocalcemia had a greater response to oral calcium supplementation than cows with moderate hypocalcemia. With this new information, it was decided to end the original trial and to evaluate serum response to calcium supplementation depending on whether the cow had moderate (1.8 mmol/L) or severe (<1.8 mmol/L) hypocalcemia. The new trial consisted of second and third lactation cows assigned to Treatment 1. The additional enrollment resulted in 11 animals in the moderate and 10 in the severe hypocalcemia groups as depicted in Table 3.

Table 2 Initial Serum Calcium Concentration by Treatment Group

Table 3 Initial Serum Calcium Concentration in Animals with Severe vs Moderate Hypocalcemia

Statistical significance was determined based on a mixed model with repeated measures. Multiple comparisons (treatment effects at each time point) were analyzed using Tukeys multiple comparisons test or Sidaks multiple comparisons test. Data were assessed for normality using a ShapiroWilk test. The cut-off for significance was P < 0.05. The experimental unit was defined as each individual animal. Statistical analyses were carried out in Prism v 8.4.3 (GraphPad Software, San Diego, California, USA).

The dissolution rate of Bolus 1 (high calcium chloride, no calcium carbonate bolus) was the most rapid of the three calcium boluses tested, with the entire bolus being dissolved before 90 minutes in all three trials (Figure 1 and Table 4). Bolus 2 (intermediate calcium chloride, intermediate calcium carbonate bolus) was slower to dissolve, with complete dissolution by 240 minutes in two trials and 180 minutes in the third (Figure 1 and Table 4). Bolus 3 (low calcium chloride, high calcium carbonate bolus) was very slow to dissolve where, after 240 minutes, 75% of the original bolus weight was still present (Figure 1 and Table 4). No major fluctuations in rumen pH were observed over the time course for any of the tested boluses (Table 4).

Table 4 Wet Weights and Rumen pH of Various Calcium Boluses After Incubation in the Rumen of Fistulated Cattle

Figure 1 Dissolution of various calcium boluses in the rumen of fistulated cattle. Representative images of each bolus type are shown for each time point. Note that Bolus 1 had to be photographed in the recovery net at 30, 60, and 90 minutes due to its compromised structural integrity.

Treatment 2 (the single-dose regimen of high calcium chloride) yielded significantly higher serum calcium levels than Treatment 3 (the double dose of calcium carbonate bolus) at 1 hour, with similar calcium levels over the remainder of the time course (Figure 2). Treatment 1 (the double dose of the High Calcium Chloride bolus) yielded significantly higher serum calcium levels at 1 and 6 hours relative to Treatment 3, with similar levels over the remainder of the time course. Importantly, Treatment 1 yielded significantly higher serum calcium levels over the first 13 hours than Treatment 2 (Figure 2), indicating that two calcium chloride boluses at time 0 lead to a greater increase in serum calcium than the traditional regimen of giving one bolus each at t=0 and t=12 hours.

Figure 2 Changes in serum calcium upon treatment with commercial boluses. Treatments were initiated within 12 hours following calving (not before) and this time is considered Time 0 (t=0). Treatment 1 = two high calcium chloride boluses at Time 0; Treatment 2 = one high calcium chloride bolus at t=0 and another at t=12 hours; Treatment 3 = two high calcium carbonate boluses at t=0. Data represent the mean SEM (standard error of the mean) for 9 independent animals per treatment group. *P<0.05; **P<0.01; ***P<0.001, ****P<0.0001. Blue, orange, and red asterisks denote statistically significant differences between Treatment 1 vs 3, 2 vs 3, and 1 vs 2, respectively.

The severe hypocalcemia cattle had a greater and more persistent response to calcium supplementation than cows suffering from moderate hypocalcemia, with statistically significantly higher serum calcium levels at 6, 12, and 13 hours (Figure 3). The moderately hypocalcemic cows receiving Treatment 1 returned to their baseline value after 24 hours, while severely hypocalcemic cows receiving treatment 1 remained well above their baseline value even after 24 hours (Figure 3). These data suggest that two high calcium chloride boluses administered rapidly after calving are more effective at raising serum calcium compared to the traditional treatment of one bolus followed by a second bolus twelve hours later.

Figure 3 Changes in serum calcium upon treatment with two high calcium chloride boluses (Treatment 1) in animals with moderate hypocalcemia (>1.8 mmol/L) versus severe hypocalcemia (<1.8 mmol/L). Treatments were initiated within 12 hours following calving (not before) and this time is considered Time 0 (t=0). Data represent the mean SEM for 10 (severe hypocalcemic cows, treated with 2 high calcium chloride at t=0) or 11 (moderate hypocalcemic cows, treated with 2 high calcium chloride at t=0) animals. *P<0.05.

The objectives of this study were to evaluate dissolution times of boluses containing different calcium salts, and their effect on serum calcium in postpartum dairy cows. Calcium chloride and calcium sulfate are absorbed passively through the rumen wall by a process called paracellular absorption. Resistance to movement across the tight junction between epithelial cells can be overcome if the concentration of a mineral, in a freely ionized state, on the luminal side of the tight junction greatly exceeds the ionized concentration of that mineral in the extracellular fluids within the interstitial space on the other side of the tight junction.17 When ionized calcium in the rumen is greater than 6 millimoles (a fivefold increase from the extracellular fluid concentration), the diffusional force created by this difference will be great enough to push the calcium through the tight junction into the interstitial space, and from there it passes through the openings in the capillary endothelium and into the blood.17 This process is very rapid and serum calcium will peak in about an hour. Calcium carbonate is absorbed in the duodenum through the cell wall by vitamin D-dependent active transport. Parathyroid hormone (PTH) stimulates the kidneys to produce vitamin D which, in turn, activates the calcium-binding protein and the ATPase pump to transfer calcium ions through the cell wall into the blood. This process has little effect on raising serum calcium levels for at least 6 hours15 and this was confirmed in our study. In addition, calcium chloride and calcium sulfate are acidifying agents that increase the sensitivity of receptor cells to PTH. The in vivo dissolution study demonstrates that calcium boluses that contain calcium carbonate dissolve at a slower rate in the rumen. When comparing Bolus 2 and Bolus 3, the concentration of calcium carbonate is a good indicator of the boluss dissolution rate. The calcium uptake study confirmed that the bolus containing a high concentration of calcium carbonate did not raise serum calcium levels before at least 6 hours, even though two boluses were administered at once. Although this high calcium carbonate bolus contains approximately 44% calcium chloride, this calcium does not appear to be available to the cow before 6 hours. This is an important observation as cows need a rapid supplementation of calcium in the early postpartum period.15 The traditional protocol of administering one high calcium chloride bolus shortly after calving followed by a second bolus 12 hours later resulted in a similar two peak graph as reported in a Sampson et al (2009) study.16 Notably, the present study compared the traditional protocol (suggested by all brands) of giving one bolus at t=0 and another bolus 12 hours later to the more convenient protocol of giving two boluses at t=0, as the latter approach would be very appealing to a producer. Although it was not surprising that blood calcium peaked at a higher level following an initial dose of two high calcium chloride boluses because of the greater rumen calcium osmolarity, the persistence of this increase was higher than expected. Serum calcium levels were significantly superior to the two-bolus at a 12-hour interval regimen over the first 13 hours and remained numerically higher after 24 hours. When the trial involving Treatment 1 was prolonged to compare the response of cows with severe subclinical hypocalcemia to cows with normal/moderate hypocalcemia, both the serum calcium peak and serum calcium persistence was greater in the severe group. Both calcium chloride and calcium sulfate dissolve rapidly in the rumen. Passive transport of calcium ions between rumen epithelial cells into the extracellular fluid is dependent on diffusion down a concentration gradient.15 It stands to reason that the greater the difference between rumen calcium concentration and blood calcium concentration, the more efficient this passive transport will be, thus positively affecting the increase in serum calcium.

Before the arrival on the market of the calcium bolus, cows were commonly drenched with calcium salts. In one trial, various amounts of calcium chloride were administered to hypocalcemic cows as an oral drench. Three different amounts of calcium, provided by calcium chloride, were evaluated. Cows were orally administered either 50, 75 or 100 grams of calcium chloride twice within 24 hours. As expected, blood calcium concentrations increased as the doses of calcium chloride increased. However, three hours after the second treatment of 100 grams of calcium, the cow presented signs of severe metabolic acidosis with heavy and deep breathing. A treatment protocol of 75 grams of calcium from calcium chloride twice over 24 hours had no ill effects.15 In this study, calcium was provided as a pure calcium chloride solution.

In a more recent trial, cows received 86 grams of calcium for the first 2 days post calving followed by 3 consecutive days of 43 grams. Calcium was provided by triglyceride-coated oral boluses containing a combination of calcium chloride and calcium sulfate.18 They determined that the Blood pH did not differ with administration of oral calcium and averaged 7.488, 7.483, and 7.483 0.012 for 0, 43, and 86 g of calcium, respectively. Therefore, any negative health effects were not due to metabolic acidosis.

The present study suggests that administering two high calcium chloride/calcium sulfate boluses shortly after calving will be more effective in preventing clinical milk fever than the traditional protocol of one bolus after calving followed by a second bolus twelve hours later. Convenience is a huge factor when it comes to making decisions on the dairy farm and the recommendation to give two boluses 12 hours apart is neither convenient nor management or cow friendly.

Dairy cows experience many metabolic challenges around the time of calving. Some of these cows will experience clinical milk fever (510%), while up to 50% of mature cows in some herds will show no symptoms but have subclinical hypocalcemia (SCH).9,19 Recent studies have shown that chronic SCH is more damaging to health than transitory SCH.19,20 Our study focused on the serum calcium effects of supplementing calcium. Research conducted in the last decade has shown that SCH is associated with metabolic diseases,6 an increased susceptibility to metritis in the early postpartum period,3,4,6 a compromised reproductive performance,7 and increased culling rates in the early lactation.8 The awareness of the effects of subclinical hypocalcemia in postpartum dairy cows on the farm level has increased thanks to communication efforts by veterinarians and publications. The case for calcium supplementation has been made but many questions are left to answer on timing, composition, benefits, and dosing regimen of these boluses. Oetzel and Miller (2012) found that cows with higher previous lactation mature-equivalent milk production at 105% of their herd mates, that were supplemented with oral calcium boluses, produced 2.9 kg more milk at first DHIA (Dairy Herd Information Association) test than similar high producing cows not administered postpartum calcium supplementation.13 They also found that lame cows benefited from calcium supplementation. Martinez et al (2016) provided calcium boluses on multiple days with more than one bolus given at a time.21 High producing cows supplemented with calcium produced 0.8 to 2.7 kg more milk per day than their high producing peers not supplemented with calcium. They also concluded that supplementing cows with oral calcium reduced the incidence and prevalence of SCH, but that oral calcium increased the incidence of metritis. This negative effect was primarily observed in primiparous cows considered to be at low risk of metritis. However, reproductive performance improved in multiparous cows with this same regimen. Martinez et al (2016) suggested that this multiple-dose treatment regimen for oral calcium should be avoided in primiparous cows and target only populations at high risk of developing hypocalcemia.21 Domino et al (2017) found that cows with a high relative herd milk rank, that received calcium either subcutaneously or as a bolus, were almost half as likely as non-supplemented cows to be diagnosed with mastitis in the first 60 Days in Milk (DIM).22 They did not report any other health or production benefits between the control group and the two supplemented groups. Leno et al (2018) researched the effects of a single dose of oral calcium on postpartum plasma calcium concentration in Holstein cows and found that a single dose of an oral calcium bolus did not increase the blood calcium concentration between 1 and 24 hours following administration.12 However, responses observed for health and performance outcomes suggest that, in primiparous cows with higher age at first calving or higher body condition score (BCS) at parturition, calcium supplementation positively affected health status and early lactation performance, respectively.12 In multiparous cows, supplementation of cows with higher parity, higher BCS, and lameness also resulted in improved health status. Leno suggested that supplementing Ca could alleviate some of the underlying causes of increased risk for metabolic disease in these animals by supporting gut motility, which can be compromised when blood Ca declines.12 Improved gut motility could support a more rapid increase in postpartum intake and lead to a reduction in the rate or severity of metabolic disease, and higher DMI would support greater milk yield in these cows.12 For multiparous cows, those with low plasma calcium responded with decreased health disorders but cows with higher plasma calcium had varied responses. The authors concluded that low blood calcium concentration was less reliable than other periparturient risk factors to identify cows with a potential to favorably respond to calcium supplementation.

Target group calcium supplementation strategies have been found to be cost-effective.23 A two-bolus regimen, one administered after calving and the second about 24 hours later, was applied to herds following four treatment strategies: lame cows only, high producers only, lame cows and high producers, and all multiparous cows. Although there was a minor herd net impact with the blanket multiparous cow treatment strategy, the greatest return on investment was with the lame cows.

The question remains to be asked whether two boluses at once would be able to amplify these positive responses and whether giving two boluses simultaneously would reduce the number of animals in a herd with a persistent or delayed subclinical hypocalcemia. Giving two boluses at once would negate the need for additional handling (and the accompanying risk of injury to the animal) and likely reduce the behavioral impact of giving boluses the traditional way 12 hours apart. Our study demonstrates that a treatment of two initial high calcium chloride boluses significantly increases blood calcium over the first 13 hours after administration compared to the traditional administration of two boluses at a 12-hour interval. Furthermore, the persistence of these calcium levels remains numerically greater over the 24-hour period. Therefore, the recommendation to provide two boluses at once after calving is practical, convenient, safe, and will more than likely improve the compliance rate of providing the suggested application of two boluses.

A limitation of this study is the lack of blinding of farm personnel to treatments for the first part of the on-farm trial (27 cows) involving two different calcium boluses. However, treatments were administered to cows according to a randomized list prepared before commencement of the study. Farm personnel abided strictly by this list as well as the pre-established blood collection protocol. For the second part of the on-farm trial, all second- and third-lactation cows were administered the same type of bolus (Bolus 1; high calcium chloride) according to the same treatment regimen (two boluses simultaneously, within 12 hours of calving).

The dissolution study and the serum calcium response study in Quebec clearly demonstrate the complexity of a proper calcium supplementation. Boluses containing calcium carbonate may cause a delayed delivery of calcium when it is needed most, and this may ultimately have an impact on the health and wellbeing of the animal. Further research on the impact of calcium carbonate as it relates to the ability and to the timing of a serum calcium increase seems warranted. There are many different calcium boluses on the Canadian market and the dairy producer would likely benefit from the involvement of the herd veterinarian to help design a calcium bolus strategy. This study demonstrated that the increase in total calcium concentrations lasted for 24 hours when two high calcium chloride boluses were administered shortly after calving. Based on our study findings and on a literature review, the recommendation to provide two boluses at once after calving is practical, convenient, safe, and will likely improve the compliance rate of providing the suggested application of two boluses.

BCS, body condition score; DCAD, dietary cation-anion difference; DHIA, dairy herd information association; PTH, parathyroid hormone; SCH, subclinical hypocalcemia; TMR, total mixed ration.

The present field-based study was conducted in compliance with the best practice of veterinary care in accordance with the research guidelines set forth by the Canadian Council on Animal Care and was approved by the Institutional Animal Care and Use Committee (Airdrie, Alberta, Canada) and the Lacombe Research and Development Centre Animal Care Committee.

The owners provided informed consent for their animals to be used in the present study.

The authors wish to acknowledge the producer and the farm staff responsible for treatment administration, blood sample collection, centrifugation, and storage, as well as the technicians, the researchers, and the dairy animals that contributed to this study.

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

The funding of both studies was entirely provided by Solvet Animal Health.

Dr Walter Verhoef reports personal fees from Solvet Canada, during the conduct of the study; personal fees from Bureau Vtrinaire de Richmond and Solvet Canada, outside the submitted work; is a partner in Bureau Vtrinaire de Richmond, and was consulting for Solvet. Dr Brenda Ralston reports Dr Merle Olson was her Masters supervisor in 2001; they have published numerous other papers and have collaborated on various grants. Dr Joseph A Ross reports compensation paid to his employer (Chinook Contract Research) for time spent writing, preparing figures, and statistical analyses for Alberta Veterinary Laboratories, during the conduct of the study. Dr Merle Olson reports personal fees from Alberta Veterinary Laboratories, during the conduct of the study; receives salary from Solvet, and Sjoert Zuidhof is providing consulting services to Solvet, which markets the Cal-Boost bolus. The authors report no other potential conflicts of interest for this work.

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[Full text] Dissolution Rates of Calcium Boluses and Their Effects on Serum Calciu | VMRR - Dove Medical Press

Serum antioxidant vitamin concentrations and oxidative stress markers associated with symptoms and severity of premenstrual syndrome: a prospective…

Participants and study design

The BioCycle Study (20052007) was a prospective cohort study designed to evaluate the relationship between reproductive hormones and oxidative stress levels throughout the menstrual cycle [26, 27]. The participant cohort consisted of 259 regularly menstruating, healthy women between the ages of 1844years, recruited from western New York. Participants were recruited in a variety of ways, including: advertising in clinical practices and the University at Buffalo student health center, paid advertising in print media, radio and television interviews, notices sent via list serves, and flyers at the university and throughout the region. For those interested, an initial screening phone call was conducted, followed by a mailing and an in-person visit. Exclusion criteria included factors that may interfere with a normal menstrual cycle or vitamin levels, such as: use of oral contraceptives during the study period or in the previous three months; use of Depo provera, implant or IUD in previous twelve months; current use of vitamin, mineral, or herbal supplements; use of prescription medications; pregnancy or breast feeding in the previous six months; reported attempts to conceive in the previous six months; diagnosis of uterine abnormalities or chronic conditions, such as ovulatory disorders and premenstrual dysphoric disorder (PMDD); and a self-reported body mass index (BMI) of <18 or >35kg/m2 at screening [27]. Those eligible and interested after the screening visit were scheduled for a baseline enrollment visit 12weeks prior to the start of their next menses. Women were followed for one (n=9) or two (n=250) menstrual cycles (Additional file 1: Figure S1).

Women completed up to 8 clinic visits per cycle for up to 2 cycles. Study visits were scheduled using fertility monitors (Clearblue Easy Fertility Monitor; Inverness Medical, Waltham, Massachusetts) to coincide with critical phases of the menstrual cycle, including menstruation; mid- and late follicular phases; luteinizing hormone (LH) surge (predicted ovulation); and early, mid-, and late luteal phases [28]. At each of these visits, fasting blood samples were collected from participants from which the antioxidant vitamins and oxidative stress concentrations were measured. Participants were highly compliant with the study protocol; 94% of the women completed 7 or 8 clinic visits, and 100% completed at least 5 clinic visits per cycle.

The University at Buffalo Health Sciences Institutional Review Board (IRB) approved this study and served as the IRB designated by the National Institutes of Health under a reliance agreement. All participants provided written informed consent. Further details of the study design are described elsewhere [27].

Ascorbic acid (vitamin C), retinol (vitamin A), and - and - tocopherol (vitamin E) were measured in all blood samples taken from participants across a menstrual cycle and subsequently averaged to reflect the mean levels across a cycle. Total ascorbic acid was determined by the dinitrophenylhydrazine (DNPH) method. Samples for ascorbate analysis were stabilized immediately following phlebotomy and centrifugation by adding 0.5mL of heparin plasma to 2.0mL of 6% meta-phosphoric acid and centrifuging at 3000g for 10min. Clear supernatant was decanted and frozen at 80C for analysis. The absorbance of each DNPH derivatized sample was determined at 520nm on a Shimadzu 160U spectrophotometer (Shimadzu Scientific Instruments, Inc.). Across the study period, the coefficient of variation (CV) for this test reported by the laboratory was 10%.

Fat-soluble vitamins (including retinol, and vitamin E components: - and -tocopherol) were measured at the Kaleida Health Center (Buffalo, New York) simultaneously in serum using high performance liquid chromatography with photodiode array detection [29]. -tocopherol was also detected but was below the lower limit of quantification for our assay (0.28). The limits of detection were 0.0054 for retinol, 0.0768 for -tocopherol, and 0.1052 for -tocopherol. The CV for these tests across the study period were <6% for retinol and <2% for - and -tocopherol. Continuous monitoring of standard reference material 968c from the National Institute of Standards and Technology (NIST) and participation in the NIST Micronutrients Measurement Quality Assurance Program provided external checks on analytical accuracy.

Mean concentrations of antioxidants, including vitamin A, vitamin C, -tocopherol, and -tocopherol, were calculated per cycle and were used in all analyses. Overall median concentrations were also compared with levels reported previously by reproductive aged women (i.e., 2039years) in the 2012 National Health and Nutrition Examination Survey (NHANES) to assess the comparability of our results with those of a nationally representative population [30].

Plasma free F2-isoprostane, a breakdown product of ROS and a marker of oxidative stress, was measured with a gas chromatography-mass spectrometrybased method by the Molecular Epidemiology and Biomarker Research Laboratory (University of Minnesota, Minneapolis, Minnesota) (CV=9.4%).

Frequency and severity of 20 premenstrual symptoms was assessed through questionnaires completed at four time points of each menstrual cycle: menses, follicular phase, peri-ovulation, and luteal phase (Additional file 2: Figure S2). Participants recalled the occurrence and severity of symptoms in the prior week. The symptoms included in this assessment were: sadness, crying spells, anger, nervousness, insomnia, tension, abdominal bloating, cravings of chocolates, cravings of sweets, cravings of salty foods, cravings of other foods, breast tenderness, lower abdominal cramping, general aches, backache, headache, acne outbreaks, change in appetite, fatigue, and swelling of the hands/feet. The severity of each symptom was ranked by the participant on a scale of 0 to 3 (0=none, 1=mild, 2=moderate, 3=severe). The symptoms included in this questionnaire were adapted from validated surveysincluding the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST)but slightly modified, given that DRSP and the PSST were designed to identify patients with PMDD specifically (a population excluded in our study) [31,32,33,34].

We categorized severity as none/mild (reference group) or moderate/severe to estimate odds of having a moderate or severe symptom during the premenstrual week. We then calculated severity scores for groups of related symptoms by summing the severity score of symptoms (as reported in the premenstrual week) within each grouping to generate an overall score. The groupings were established based on clinical expertise and included: depression (sadness, crying spells, anger) and anxiety (nervousness, insomnia, tension); hydration (abdominal bloating) and cravings (chocolate cravings, sweets cravings, salty food cravings, other food cravings); pain (breast tenderness, lower abdominal cramping, general aches, backache, headache); and other (acne outbreak, change in appetite, fatigue, swelling of hands or feet).

Overall PMS severity was evaluated using four different approaches, which utilize information on all symptoms from the luteal and follicular phase questionnaires from each cycle: (1) 5 or more moderate or severe symptoms during the luteal phase; (2) 8 or more moderate or severe symptoms during the luteal phase; (3) 3 or more moderate or severe symptoms where the luteal phase score was 30% greater than the follicular phase and at least one symptom was psychological (referred to as PMS-1 in the tables and results); and (4) 5 or more moderate or severe symptoms where the luteal phase score was 30% greater than the follicular phase and at least one symptom was psychological (referred to as PMS-2 in the tables and results) [8, 35, 36]. When summing the number of moderate or severe symptoms for each cycle, each of the individual cravings symptoms were combined into a single variable. These criteria were based upon various defintions of PMSincluding those of the National Institute of Mental Health, [37] the American College of Obstetrics and Gynecology, [38] the American Psychiatric Association, [39] and the International Society for Premenstrual disorders (ISPMD) [40]which were further expanded and implemented in studies such as Gollenberg et al. [35] and Borenstein et al. [8] Of note, these approaches attempt to establish the necessary temporality between pre- and post-menstrual symptoms in line with traditional PMS definitions and diagnoses that assume resolution of symptoms within 12days of the onset of menses.

At study enrollment, a trained research assistant measured height and weight for the calculation of BMI using standardized protocols. Demographics such as age, race, education, smoking habits, reproductive history, and physical activity were also collected at baseline through self-reported questionnaires. Physical activity was assessed at baseline using the International Physical Activity Questionnaire, and estimated for high, moderate, and low levels of activity based upon accepted cutoffs [41]. Dietary information was obtained using 24-h recalls (up to 4 times per cycle) and analyzed using the Nutrition Data System for Research software (version 2005) developed by the Nutrition Coordinating Center of the University of Minnesota (Minneapolis, Minnesota). Cycle-averaged measures of total energy (kcal/day) and fiber (g/day) were used in these analyses, as we previously found these intakes do not vary significantly across the cycle [42]. All covariates assessed had at least a 95% response rate.

Demographic characteristics were compared between those with <5 versus 5 moderate or severe symptoms during the luteal phase of either study menstrual cycle, and between those with <8 versus 8 moderate or severe luteal phase symptoms in either cycle. Repeated measures ANOVA and McNemars tests were used for comparisons.

We estimated associations between mean antioxidant concentrations and F2-isoprostane concentrations from each menstrual cycle and odds of reporting a moderate/severe symptom during the premenstrual week for each cycle using generalized linear models. Next, we evaluated associations between antioxidant concentrations, F2-isoprostane concentrations, and scores for symptom severity within groups during the premenstrual week (e.g., depression, cravings, pain) using linear mixed models. We used generalized linear models to assess the association between mean antioxidant concentrations, F2-isoprostane concentrations, and overall PMS severity in each cycle using the four different classifications of PMS severity (5 or more moderate or severe symptoms, 8 or more moderate or severe symptoms, PMS-1 criterion, PMS-2 criterion). All models were adjusted for age, race, BMI, physical activity, smoking status, alcohol use, pain reliever use, and average total energy intake per cycle and accounted for repeated measures (i.e., multiple cycles per woman). Results were adjusted for multiple comparisons using the false discovery rate (FDR). An alpha of 0.05 was considered statistically significant. As antioxidants and oxidative stress measures have been shown to vary somewhat over the menstrual cycle [26, 43], we also evaluated associations between time-varying measures of antioxidants and oxidative stress, with time-varying symptoms as a sensitivity analysis. Splines were used to evaluate the assumption of linearity. We did not find evidence to suggest that linear modeling was inappropriate (e.g., quadratic or restricted cubic spline modeling did not help explain the associations in our population). All statistical analyses were calculated using SAS 9.4 (SAS Institute, Cary, North Carolina).

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Serum antioxidant vitamin concentrations and oxidative stress markers associated with symptoms and severity of premenstrual syndrome: a prospective...

COVID antibody treatment – Yahoo News

National Review

President Joe Bidens recent executive order to expand food assistance to U.S. households, while well-intentioned, represents a substantial overreach of the executive branch and a blatant attempt to override the intent of Congress. If successful, this dangerous precedent would open the door to major expansions of the social safety net without congressional approval. Congress must resist the presidents attempts to subvert the intent of existing law. Less than one week into the Biden presidency, the new administration issued a series of executive orders focused on COVID-19 economic relief. One such order seeks to expand food assistance through the Supplemental Nutrition Assistance Program (SNAP), or food stamps. In it, President Biden instructed the Department of Agriculture (USDA) to take immediate steps to make it easier for the hardest-hit families to enroll and claim more generous benefits in the critical food and nutrition assistance area. In reality, the executive order asks a federal agency the USDA to intentionally misinterpret the Families First Act and subvert the constitutional authority of Congress over the legislative process. The Families First Act, which passed in March 2020, clearly outlined that states could request waivers from the Agriculture Department to provide emergency allotments to SNAP households not greater than the applicable maximum monthly allotment for the household size. In normal times, 60 percent of households enrolled in SNAP do not receive the maximum benefit because they have income from other sources such as earnings that they can use for purchasing food. The emergency allotments recognized that millions of people lost jobs or faced other employment disruptions when the pandemic hit, and that those enrolled in SNAP were at particular risk for job loss in the early aftermath of the pandemic. Rather than requiring SNAP households to report a job or income change to their state agency and wait for bureaucrats to recalculate their benefits, the emergency allotments gave every SNAP recipient the maximum allowed. This was, admittedly, not a very targeted effort. Some families received a boost in SNAP dollars without a change in household income or financial circumstances. But the immediacy of the economic shock brought on by the pandemic, and the employment instability that persists today, necessitated an equally expedient policy response. The Agriculture Department, under President Trump, had approved emergency allotment plans for all 50 states, the District of Columbia, Guam, and the U.S. Virgin Islands but only in accordance with the law. The department extended these emergency-allotment waivers numerous times, most recently extending them through January 2021. The USDA and Congress itself also offered states flexibility in the aftermath of the pandemic. According to federal government spending data, all of the efforts outlined above have caused SNAP benefits to rise more than 40 percent in the last fiscal year, with more than $31 billion in added spending compared to FY 2019. Class-action suits have been filed in Pennsylvania and California by people who disagree with the USDAs interpretation of the law: that regular SNAP plus emergency allotments cannot extend benefits beyond the maximum benefit level. Lawyers for the lawsuits argue that the law allows the USDA to approve emergency allotments in the amount of the maximum benefit, which if true, would mean that households could receive the maximum SNAP benefit plus the maximum emergency allotment essentially doubling benefit amounts. A federal judge in California agreed with the USDA, while the Pennsylvania case is ongoing. The Biden administrations executive order is encouraging its USDA to misinterpret the 2020 law in a similar way. The legislative text is not ambiguous. It is hard to imagine Congress being any clearer than, to address temporary food needs not greater than the applicable maximum monthly allotment for the household size. If Congress had wanted to give people more than the SNAP maximum, it would have done so. In fact, Congress eventually did just that expanding benefits by 15 percent in the COVID-19 relief package passed last month. If the Biden administration is successful in this attempt, it will open the door to a number of executive actions aimed at expanding the safety net without congressional action. If political appointees in the Biden administration feel unconstrained by the law, we will see larger benefits directed to an increasing number of people. Such action not only undermines the integrity of the social safety net by going around Congress, it disregards the separation of powers ensconced in the founding documents of our republic. The American public has been largely supportive of efforts by Congress to provide economic relief to struggling households. Lets keep that authority in its proper place.

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COVID antibody treatment - Yahoo News

Mayo Clinic Q And A: Genetic abnormalities and cancer risk – Greater Milwaukee Today

DEAR MAYO CLINIC: My mom was diagnosed with breast cancer. During her care, she was found to have a BRCA2 mutation. Her doctor suggested that my brothers and I get tested for this mutation, too. I am a 26-year-old woman, and I am not sure what this means for me and my risk of cancer.

ANSWER: Having a loved one with a breast cancer diagnosis can be scary. It also can become confusing when you start to hear about genetic mutations. The good news is that the information can help guide your family regarding screening and future cancer risk.

BRCA2 is a genetic abnormality that can be passed down from a parent to children. It is autosomal dominant, which means there is a 50% chance that each of your mom's biological children could have the mutation. Being positive for the mutation would mean that you or your brothers may be at increased risk of developing certain cancers, compared to the general population.

In addition to breast cancer, these cancers are also known to be associated with BRCA2: ovarian cancer, melanoma, prostate cancer and pancreatic cancer.

To understand your risk, you would want to meet with a genetic counselor who can help you understand the implications of undergoing genetic testing and whether this is something you want to do. Typically, genetic testing is performed using a blood or saliva sample. The counselor would review the results with you and, if you are positive, recommend next steps to learn more about personalized screening and specific risk reduction options.

Generally speaking, it is recommended that women who have a BRCA2 mutation begin monthly breast self-examinations, beginning at 18. Clinical breast examinations are recommended every six months, beginning at 25, or before if there is an earlier breast cancer in the family. Annual breast MRIs should begin at 25. Tomosynthesis mammograms are recommended annually, beginning at 30. They are usually alternated with breast MRIs every six months. Based on risk and family history, some woman may choose to undergo a preventive mastectomy to remove their breast tissue and hopefully decrease their risk of developing breast cancer.

There is no screening test for ovarian cancer. However, women can have transvaginal ultrasounds and a blood test called CA 125 every six to 12 months, beginning at ages 30-35, while their ovaries are still in place.

If desired, women can undergo surgery to remove their ovaries and fallopian tubes once they are done having children. Ideally, this would occur between the ages of 40-45. As this surgery results in women going through menopause, some women may be started on hormone therapy until ages 50-51 to alleviate menopausal symptoms and offset some long-term risks associated with early menopause.

Research has shown that many ovarian cancers begin in the fallopian tubes. With this knowledge, women have recently been having surgery to remove their fallopian tubes and delay surgery to remove their ovaries for a few years though the recommended age for a woman to have her ovaries removed is still 40-45 in a BRCA2 mutation carrier. The benefit of removing just the fallopian tubes is that this allows women to preserve their natural hormonal function longer. The safety of this strategy is being studied, and this type of surgery is being performed as part of clinical trials.

Women who undergo surgery to remove their ovaries before menopause have a 50% reduction in their risk of developing breast cancer. In addition to surgeries, there are medications that can be given to help decrease the risk of developing breast and ovarian cancers. Selective Estrogen Receptor Modulators (SERMS) and Aromatase Inhibitors (AIs) are types of medications that can reduce the risk of developing breast cancer. Oral contraceptives can decrease the risk of developing ovarian cancer by 50%.

Since the BRCA2 mutation can be passed down to offspring, understanding your status and that of a future partner is important, as there is a genetic condition called Fanconi anemia that can occur if both the male and female partners have a BRCA2 mutation.

Thus, for men and women who test positive for BRCA2 and have not yet had biological children, it may be worthwhile to meet with a specialist in reproductive endocrinology and infertility to discuss options.

There are no standard screening guidelines for pancreatic cancer or melanoma. Based on your situation, a consultation with a pancreatic specialist may be worthwhile to discuss whether to pursue MRI or endoscopic ultrasound. Likewise, a referral to a dermatologist can be made to initiate skin cancer screenings.

Understandably, you may be nervous about your risk for cancer, given your mother's diagnosis. However, you are young, and you should not feel rushed to make any decisions regarding genetic testing. If you choose to undergo testing and are found to have a BRCA2 mutation, your health care providers will give you the information that you need so that you can begin to think about what makes sense for your life and your priorities.

Casey Swanson, physician assistant, Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota

Mayo Clinic Q And A: Genetic abnormalities and cancer risk - Greater Milwaukee Today

First period: Early signs, how long it lasts, and self-care tips – Medical News Today

For most females, the first period usually begins around 2 years after the first signs of puberty start. Signs of puberty can include the development of breasts, the growth of body hair, and changes in body shape.

This information comes from the Office on Womens Health.

Knowing the signs of a first period can help young females and their parents or caregivers feel prepared.

Around 98% of females begin their first period by the time they are 15 years of age, but the average age has decreased over time.

This article will look at some of the signs a female can expect before they begin their period, as well as what it might be like and what to do when it begins.

The best way to tell if a female is about to have their first period is to assess whether or not they have begun puberty.

Some signs of puberty include:

The first period will typically begin a couple of years after the first signs of puberty appear. However, there is no precise way of knowing when it will begin.

Several days before the first period, some females may notice spotting in their underwear or abdominal cramps. Some may also notice more acne appearing. Not everyone will experience this, however.

The first period typically occurs after a female first ovulates. This happens when the ovaries release an egg into the fallopian tube.

When this happens, the womb lining thickens in preparation for the egg to be fertilized. If fertilization does not occur, the lining sheds, as the body no longer needs it. This is where period blood comes from.

In most females, this cycle continues regularly from the age of the first period until menopause, which is when periods end.

According to the Centers for Disease Control and Prevention (CDC), the average age at which females began menstruating in the United States in 20132017 was 1112 years old. However, periods can start earlier or later than this.

Every females period is different. Periods can vary in duration, frequency, and heaviness. Some females have very light periods, while others have heavy periods.

For some, the first period is light, with a small amount of blood. It may begin gradually, starting with some spotting or brown discharge before becoming red.

For others, periods begin suddenly, with bright red blood appearing straight away. In either case, this is normal. Period blood can range in color from brown to dark red. Some people may also pass small blood clots.

Having a period can feel similar to having vaginal discharge, but some females do not feel much at all.

When a period begins, try to find a way to absorb the blood. A female can do this by asking a friend or family member for a pad or tampon.

If it is not possible to use a pad or tampon, try to wrap something absorbent, such as toilet paper or a clean washcloth, around the crotch area of some underwear. This can absorb the blood and prevent leaks.

It can be helpful to prepare a period kit before the first period arrives. This can help with feeling ready. This period kit could consist of:

Most periods last for 37 days. However, first periods can be less predictable, so they may be slightly shorter or longer.

During the first few years after a females first period, periods may be irregular, coming at unpredictable intervals. Over time, however, they typically become more regular.

Most females get a period about every 28 days, though the actual length varies from person to person as well as period to period. The cycle length may vary by as much as a week in any given year.

The following sections will look at some absorption methods in more detail.

Sanitary pads are a popular form of period protection. They line the underwear with absorbent material, which soaks up the blood.

Some benefits of pads include the fact that they:

Some drawbacks of pads include the fact that they:

It is also possible to purchase reusable fabric pads or period panties, which absorb blood in a similar way to a pad. These products are washable, meaning that a female can reuse them. This can be more cost effective than using disposable pads.

Change pads every 48 hours or whenever the current one starts to feel uncomfortable.

Some benefits of tampons include the fact that they:

Some drawbacks of tampons include the fact that they:

It is crucial to change tampons every 48 hours and to use the lowest absorbency possible. Parents and caregivers should ensure that young females who want to use tampons understand how to use them safely to prevent TSS.

Menstrual cups are small silicone cups that females can wear internally. They work by catching blood inside the vagina. When the cup is full, it is important to remove it and rinse it with clean water before reusing it.

Some benefits of menstrual cups include the fact that they:

Some drawbacks include the fact that they:

Although many manufacturers say that there is no risk of TSS with menstrual cups, there has been at least one confirmed case of TSS in a cup user.

It takes time to adjust to having a period, and they can sometimes cause discomfort. However, periods are a normal part of life, and they do not have to limit or change anyones daily activities.

The following tips may help females take care of themselves during their first period.

For pain and cramping, try:

After the first period, it can be difficult to predict when the next period will happen. It also takes some time to adjust to using period products. Occasionally, this may result in leaks.


It is generally safe to assume that most females who get periods can get pregnant.

The first period usually means that ovulation has occurred. Ovulation means that pregnancy is possible. However, both periods and ovulation can be irregular during the first few years after the first period, making it difficult to predict fertility.

Although it is normal for periods to be somewhat irregular to begin with, it is a good idea to talk with a doctor if they do not settle into a regular rhythm or if they cause symptoms that disrupt daily life.

The frequency and heaviness of periods, and any symptoms that accompany them, can be an important indicator of a females health.

It is a good idea for a person to talk with a doctor if they or a young female in their care experiences:

Emergency medical help is necessary if someone develops any symptoms of TSS, which can include:

A females first period is an important milestone. Waiting for it can be scary, exciting, or both. There is no reliable way to predict when it will arrive, and periods affect females in different ways.

Once a period begins, it can take time to learn how to manage them. Talk with a trusted adult, doctor, or nurse to ask questions and get advice.

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First period: Early signs, how long it lasts, and self-care tips - Medical News Today

Aeterna Zentaris Expands Orphan Drug Development Pipeline with Targeted Immunosuppressive Therapeutics – GlobeNewswire

- Company licenses exclusive worldwide rights to develop, manufacture and commercialize targeted, highly specific immunosuppressive therapeutic proteins for the potential treatment of neuromyelitis optica spectrum disorder (NMOSD) from Julius-Maximilians-University of Wuerzburg, Germany- Initial step in growth strategy to build-out pipeline of assets - Aeterna Zentaris to develop potential therapeutic treatment option for neuromyelitis optica spectrum disorder (NMOSD), an orphan indication with strong unmet medical need and significant market opportunity

CHARLESTON, S.C., Jan. 28, 2021 (GLOBE NEWSWIRE) -- Aeterna Zentaris Inc. (NASDAQ: AEZS) (TSX: AEZS), through its wholly-owned subsidiary Aeterna Zentaris GmbH, (Aeterna or the Company), a specialty biopharmaceutical company commercializing and developing therapeutics and diagnostic tests, today announced that it has licensed the exclusive worldwide rights to develop, manufacture and commercialize targeted, highly specific, autoimmunity modifying proteins (AIM Biologicals) for the potential treatment of neuromyelitis optica spectrum disorder (NMOSD) from the Julius-Maximilians-University Wuerzburg (the University).

This demonstrates Aeternas commitment to execute on our stated plans of expanding our pipeline to have multiple assets in research and development. The work that Dr. Valentin Bruttel and Prof. Joerg Wischhusen have conducted at the University represents what we believe to be a compelling opportunity for innovative development in the high-value indication NMOSD, an orphan indication with significant unmet need, commented Dr. Klaus Paulini, Chief Executive Officer of Aeterna.

Prof. Joerg Wischhusen of the University added, Based on pre-clinical data obtained by the University to date, the AIM Biologicals technology has the potential to be a breakthrough in the treatment of autoimmune-related diseases. It is based on a mechanism developed by nature to protect the fetus from the mothers immune system without compromising immune protection against foreign antigens. This has the potential to offer a new treatment for NMOSD patients. We believe that the collaboration with Aeterna will accelerate the further development towards the clinic.

Autoimmunity Modifying (AIM) Biologicals - Targeted Immunosuppressive Therapeutics

During pregnancy, the maternal immune system tolerates paternal antigens from the embryo but is still effective to protect mother and embryo from foreign antigens. Parts of the natural mechanisms responsible for this feto-maternal immune tolerance form the scientific basis for the concept of AIM Biologicals.

AIM Biologicals utilize a novel mechanism which is believed to demonstrate that peptide antigens presented on immunosuppressive MHC class I molecules can selectively and efficiently induce antigen-specific tolerance. Based on this mechanism, the targeted immunosuppressive therapeutics are being designed as optimized soluble molecules with the goal that they may be adapted to selectively induce tolerance to various autoantigens. Pre-clinical studies conducted by the University thus far indicate that tolerance induction appears to be achieved via selective elimination of antigen-specific immune effector cells and via induction of antigen-specific regulatory T cells from nave T cells. AIM Biologicals thus have the potential to become highly specific and effective yet not personalized treatments of NMOSD.

For the treatment of NMOSD, it is believed that the AIM Biologicals will present a specific antigen derived from the water channel protein aquaporin-4 (AQP4) loaded to soluble immunoregulatory HLA-G protein to selectively induce immunological tolerance in the central nervous system.

In collaboration with the University and the University clinic, Aeterna plans to conduct further pre-clinical research to identify and characterize an AIM Biologicals based development candidate for the treatment of NMOSD, including meeting with the regulatory authorities to confirm the further pre-clinical data required as we work towards advancing such candidate into human clinical trials.

About Neuromyelitis Optica Spectrum Disorder (NMOSD)

NMOSD is an antibody mediated inflammatory central nervous system (CNS) disorder that affects about one per million population per year. NMOSD, also known as Devic disease, is a chronic disorder of the brain and spinal cord dominated by inflammation of the optic nerve (optic neuritis) and of the spinal cord (myelitis). Typical symptoms include visual loss, muscle spasms, paraparesis, and incontinence. If left untreated, 50% of individuals with NMOSD will be wheelchair bound and blind, and 30% will have died within five years after the first attack. The water channel protein AQP4 is widely expressed in the brain, spinal cord, and optic nerves. Auto-antibodies directed against the AQP4 channel play an important role in the pathogenesis of NMOSD.

Currently there are only three approved medications available for the treatment of NMOSD with very high annual treatment costs, and the risk of the patient contracting serious infections. Therefore, there is a strong medical need to offer new therapeutic options to the patients.

In the U.S. and Europe there are currently approximately 10,000 to 15,000 patients living with NMOSD. Of these the AQP4 antibody seropositive patients who represent about 80% of the NMOSD population are the targeted patients for a potential therapy based on the AIM Biologicals technology.

Transaction Terms and Conditions

Under the terms of the exclusive patent license agreement entered into with the University, Aeterna obtained worldwide rights to develop, manufacture and commercialize products for the treatment of NMOSD using the AIM Biologicals technology for an up-front cash payment of 100,000 and milestone payments to be paid upon the achievement of certain development and regulatory milestones as well as royalty payments on net sales. Aeterna will be responsible for the formal preclinical and clinical development, regulatory activities, and manufacturing of the licensed products. Aeterna has also engaged the University and University clinic to conduct certain pre-development activities with respect to the AIM Biologicals program to be funded by Aeterna.

The Company intends to continue balancing risks and secure growth opportunities by re-establishing a diversified, yet focused, development pipeline to which Aeterna can best leverage its expertise and experience. Aeterna is focused on opportunistically utilizing its network with universities in Europe and the U.S. The license of the AIM Biologicals program for NMOSD demonstrates Aeternas progress towards achieving its goal to obtain access to innovative development candidates in different indications, with a focus on rare or orphan indications with potential significant commercial opportunity.

About Aeterna Zentaris Inc.

Aeterna Zentaris Inc. is a specialty biopharmaceutical company commercializing and developing therapeutics and diagnostic tests. The Companys lead product, macimorelin, is the first and only U.S. FDA and European Commission approved oral test indicated for the diagnosis of adult growth hormone deficiency (AGHD). Macimorelin is currently marketed in the United States under the tradename Macrilen through a license agreement with Novo Nordisk where Aeterna receives royalties on net sales. According to a commercialization and supply agreement, MegaPharm Ltd. will seek regulatory approval and then commercialize macimorelin in Israel and the Palestinian Authority. Additionally, upon receipt of pricing and reimbursement approvals, Aeterna expects that macimorelin will be marketed in Europe and the United Kingdom through a recently established license agreement with Consilient Health Ltd. and Aeterna will receive royalties on net sales and other potential payments.

Aeterna is also leveraging the clinical success and compelling safety profile of macimorelin to develop it for the diagnosis of childhood-onset growth hormone deficiency (CGHD), an area of significant unmet need.

Aeterna is actively pursuing business development opportunities for the commercialization of macimorelin in Asia and the rest of the world, in addition to other non-strategic assets to monetize their value. For more information, please visit and connect with the Company on Twitter, LinkedIn and Facebook.

Forward-Looking Statements

This press release contains forward-looking statements (as defined by applicable securities legislation) made pursuant to the safe-harbor provision of the U.S. Securities Litigation Reform Act of 1995, which reflect our current expectations regarding future events. Forward-looking statements include those relating to the potential to obtain the necessary pre-clinical data and regulatory approvals necessary to advance any product using the AIM Biologicals technology into human clinical trials or to develop the AIM Biologicals to treat NMOSD or any other indication into an approved product, the ability of any product using the AIM Biologicals technology to compete with existing approved products (or any other products in development) for NMOSD, the ability of the Company to obtain approval of macimorelin for CGHD, the Companys ability to secure marketing partners for macimorelin in other key markets, the timing of the commencement of the CGHD Study P02, and may include, but are not limited to statements preceded by, followed by, or that include the words "will," "expects," "believes," "intends," "would," "could," "may," "anticipates", potential and similar terms that relate to future events, performance, or our results. Forward-looking statements involve known and unknown risks and uncertainties, including those discussed in this press release and in our Annual Report on Form 20-F, under the caption "Key Information - Risk Factors" filed with the relevant Canadian securities regulatory authorities in lieu of an annual information form and with the U.S. Securities and Exchange Commission. Known and unknown risks and uncertainties could cause our actual results to differ materially from those in forward-looking statements. Such risks and uncertainties include, among others, our ability to raise capital and obtain financing to continue our currently planned operations, our ability to continue to list our Common Shares on the NASDAQ, our now heavy dependence on the success of Macrilen (macimorelin) and related out-licensing arrangements and the continued availability of funds and resources to successfully commercialize the product, including our heavy reliance on the success of the License Agreement with Novo Nordisk, the global instability due to the global pandemic of COVID-19, and its unknown potential effect on our planned operations, including studies, our ability to enter into out-licensing, development, manufacturing, marketing and distribution agreements with other pharmaceutical companies and keep such agreements in effect, our reliance on third parties for the manufacturing and commercialization of Macrilen (macimorelin), potential disputes with third parties, leading to delays in or termination of the manufacturing, development, out-licensing or commercialization of our product candidates, or resulting in significant litigation or arbitration, uncertainties related to the regulatory process, unforeseen global instability, including the instability due to the global pandemic of the novel coronavirus, our ability to efficiently commercialize or out-license Macrilen (macimorelin), our reliance on the success of the pediatric clinical trial in the European Union (E.U.) and U.S. for Macrilen (macimorelin), the degree of market acceptance of Macrilen (macimorelin), our ability to obtain necessary approvals from the relevant regulatory authorities to enable us to use the desired brand names for our product, our ability to successfully negotiate pricing and reimbursement in key markets in the E.U. for Macrilen (macimorelin), the outcome of our pre-clinical and clinical development efforts of in-licensed products (including the AIM Biologicals), any evaluation of potential strategic alternatives to maximize potential future growth and shareholder value may not result in any such alternative being pursued, and even if pursued, may not result in the anticipated benefits, our ability to take advantage of business opportunities in the pharmaceutical industry, our ability to protect our intellectual property, and the potential of liability arising from shareholder lawsuits and general changes in economic conditions. Investors should consult our quarterly and annual filings with the Canadian and U.S. securities commissions for additional information on risks and uncertainties. Given these uncertainties and risk factors, readers are cautioned not to place undue reliance on these forward-looking statements. We disclaim any obligation to update any such factors or to publicly announce any revisions to any of the forward-looking statements contained herein to reflect future results, events or developments, unless required to do so by a governmental authority or applicable law.

Investor Contact:

Jenene ThomasJTC TeamT (US): +1 (833) 475-8247E:

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Aeterna Zentaris Expands Orphan Drug Development Pipeline with Targeted Immunosuppressive Therapeutics - GlobeNewswire

UK variant will cause rise in cases in the U.S., says doctor – Yahoo News

The Daily Beast

Erin Scott/GettyWhether its harassing the survivor of a school shooting for the benefit of a cameraman or accusing the Rothschild family of building a satellite-mounted laser that nearly burned down California, Rep. Marjorie Taylor Greene (R-GA) has made it clear that she will do almost anything for attention.But unlike nearly everyone else in the country, the White House isnt interested in giving it to her. Period.The Biden administrations policy regarding the first-term congresswoman from Georgia was made clear on Wednesday when a reporter asked White House press secretary Jen Psaki whether the president had any reaction to recent reports of online behavior that many found appalling, even for an avowed supporter of the QAnon conspiracy cult.Was there any response to the first-term congresswomans online and in-person behavior, which included the harassment of David Hogg, a survivor of the Stoneman Douglas High School shooting she once called #littleHitler? As well as her apparent belief that the shooting itself was a false flag? And a Facebook comment in which she suggested removing House Speaker Nancy Pelosi with a bullet to the head?We dont, Psaki said curtly. And Im not going to speak further about her, I think, in this briefing room.For an administration that has made fighting disinformation and right-wing extremism a top priority following the attack on the U.S. Capitol earlier this month, and a communications team with a demonstrated unwillingness to cede ground to unhelpful narratives, Psakis blunt refusal even to say Greenes name was surprising. But according to those familiar with the administrations thinking, it was also strategicand proof, they said, that the Biden administration has learned the lesson of the early months of Donald Trumps campaign for the White House, when unfettered attention helped raise his profile and stoke the followers who would eventually carry him to the Oval Office.Like Trump, one person familiar with the communications teams thinking said, Greene thrives off both positive and negative attention, and is validated when those in power stoop to fight her. In a media landscape that plays up conflict, such an engagement would actually raise her profileand while a West Wing-style takedown from the briefing room podium would make great television, it would also give Greenes stans one more battle arena in which to root for her.Refusing even to say her name in the White House briefing room makes their disapproval clear, one administration ally said, without dignifying her behavior with the attention of the leader of the free world.It was the perfect balance, the ally told The Daily Beast, who said that Psakis refusal to feed the trolleven one elected to Congresswas clearly rooted in a rare understanding of the modern environment.She simultaneously displayed sincere condemnation while denying that anthropomorphic hemorrhoid the attention she craves, the ally said, perhaps a bit graphically.Psakis refusal to engage may have been frustrating for those expecting a full-throated condemnation of Greenes conspiracism and calls for violence, but experts in the far right told The Daily Beast that the approach is the least-bad option when dealing with extremists desperate for the spotlight.By talking about her, they make her a hero to the folks on the fringeshed become sort of the right-wing AOC, and then gets more attention than she probably should have, said Randy Blazak, an Oregon-based sociology professor and hate crime researcher who specializes in movements that want to overthrow the U.S. government.The Biden administration is treading carefully on this matter, because its easy to blame them, Blazak said, summing up how far-right extremists would view any on-camera condemnation from the White House. One basket of deplorables comment and theyve got a whole new bunch of recruits to bring in. They have to be very careful in how they navigate this because this is no longer a small fringe groupits now a largely mainstream movement that includes people in our own families.House Democrats, meanwhile, are forced by proximity to deal directly with Greene. And few within their ranks feel like ignoring her: In her short time in office, the freshman congresswoman has explained away the Jan. 6 attack with a conspiracy theory, conspicuously shunned a mask in a crowded safe room where several of her colleagues later came down with COVID, immediately moved to impeach President Joe Biden, and was discovered to have endorsed the execution of the Democratic partys leader and to have flirted with the theory that a Jewish-controlled space laser started California wildfires.Greene has responded by calling the reporting on her publicly available social media activity by CNNs KFILEmuch of which has been scrubbed sincea project of the Democrats and the so-called fake news. They are coming after me because Im a threat to their goal of Socialism, said Greene, in a statement given on Thursday. They are coming after me because like President Trump, I will always defend conservative values. They want to take me out because I represent the people. And they absolutely hate it.On Twitter on Thursday morning, Greene posted a 2016 Facebook comment in which she said I have friends of different races, religions, and political preferences and asked why that sentiment was being ignored alongside her endorsement of killing Pelosi.Many Democratic lawmakers feel that Greenes conduct deserves the most forceful reprimand they can mustera vote to expel her from Congress. On Wednesday night, Rep. Jimmy Gomez (D-CA) introduced a resolution calling for just that, and it could come to the floor as soon as Tuesday. Two-thirds of the House would have to vote in favor to secure her removal, however, and few Republicans expect that dozens of their lawmakers will vote to oust Greene, even if many believe shes the second coming of Steve King, the former congressman and notorious racist.GOP Thought Steve King Was as Bad as It Got, Then Came Marjorie Taylor GreeneHouse Democratic leaders arent disavowing the push to remove Greene, but their careful remarks so far suggest they are just as interested, if not more so, in holding House GOP leadership accountable for Greene than Greene herself.Party brass have zeroed in on the House GOP leader, Rep. Kevin McCarthy (R-CA), who has so far done little to signal any repercussions for Greenes conduct. After the CNN story dropped, McCarthy promised to have a conversation with her about the Facebook posts.At a press conference on Thursday, the first question asked of Pelosi was about concern around Greene, but the first words out of her mouth were about McCarthy. What Im concerned about is Republican leadership in the House of Representatives, said the speaker. Mentioning GOP leaderships appointment of Greenewho has posited that the countrys most horrific school shootings, from Sandy Hook to Parkland, Florida, were false flagsto the House Education and Labor Committee, Pelosi asked, What could they be thinking? before quickly adding thinking might be too generous a word.Asked about Pelosis comments Thursday, a McCarthy spokesperson forwarded the comment they provided to Axios two days ago: These comments are deeply disturbing and Leader McCarthy plans to have a conversation with the Congresswoman about them.Later Thursday, Rep. Pramila Jayapal (D-WA), chair of the Congressional Progressive Caucus, said at a press briefing that the group had not talked about taking a position on Greenes ouster. I know there is a lot of rage and even fear from many of our members, frankly across the Democratic caucus, about serving with people like Marjorie Taylor Greene who condoned putting a bullet in the head of Speaker Pelosi, said Jayapal, when asked by The Daily Beast. Were looking at all of the options, working with leadership on how we bring accountability.But Jayapal hastened to add a question: What is Kevin McCarthy doing about this? What are our Republican colleagues doing about this?To one House Democratic aide, those moves solidified what the partys approach should be. As a matter of strategy, when you start talking about expelling, it puts the onus on Dems, the aide told The Daily Beast. And I think the argument that the onus should be on Republicans is persuasive.Democrats are betting that McCarthy wont reprimand Greene in any serious wayand are laying the groundwork to make Republicans pay for it at the ballot box. Already, those who are working to elect more Democrats in 2021 and 2022 as reinforcements for Biden have seized on the lightning-rod lawmaker the president conspicuously ignores as an effective bogeyman for the post-Trump era.In the last week, the Democratic Congressional Campaign Committee, the partys official House campaign arm, has sent out a press release on a near-daily basis in an attempt to make Greene an albatross for McCarthy and every GOP lawmaker running for re-election. Several Democrats are fundraising off Greeneincluding Terry McAuliffe, the former DNC chair running for another term as governor of Virginia, who put Greenes name as the subject line of a recent fundraising email.Democratic strategists see the attempt to make Greene the face of todays GOP as a potent strategy to put vulnerable Republicans in a tight spot. Tying the opposing party to its most extreme members is the playbook Republicans ran last year against House and Senate candidates. But Democrats are confident that independent-minded suburban voters will find Greenes endorsement of political assassinations and a conspiracy theory about cannibalistic pedophile elites more extreme and off-putting than Rep. Alexandria Ocasio-Cortezs (D-NY) endorsement of, for example, the Green New Deal.While the White House isnt going to engage, Democratic strategists around the House map plan to put her front and center, said one Democratic operative of Greene. Every day that Marjorie Taylor Greene dominates, and is the face of Republicans in the House, is another bad day for them.But as long as Greene remains in a position of authority, she will likely remain a hero to those who see her as an ally in the dream of overthrowing liberal democracy.In Georgia, few believe that Greenes constituents will boot hershe convincingly won a June primary after many of her Q-sympathetic and Islamophobic comments were already public knowledgeand there is not, as of yet, any kind of real effort brewing to defeat her. The district is so heavily Republican that a Democratic win is virtually impossible.Blazak pointed to The Turner Diariesan ur-text of white supremacist fantasies about violently toppling the U.S. government, which he called sort of a flowchart model of how to start a civil war in Americaas a guideline for what those who stormed the U.S. Capitol hope to see out of Greene.Part of the plan is to have people who are sympathetic on the inside who can figuratively, or literally, open the door and let the barbarians into the gates, that can provide access to nuclear code so they can bomb Israel, Blazak said. This is how far it goes.The current unwillingness of Republican congressional leadership to take action against Greene has only emboldened the extremists who back herwith potentially catastrophic consequences.I have this naive hope that Biden, being an old-school politician, can talk to the Democratic leadership and talk to the Republican leadership in a way that says, weve got a real crisis here and we have to determine what the country is going to look like, what these political parties are going to look like, and encourage them, maybe behind the scenes, to push this person off, Blazak said. But the fact that she was given a pretty decent committee position on education, of all things, means that work really needs to be done inside the community.Were gonna see the Tea Party on meth, Blazak said.Read more at The Daily Beast.Get our top stories in your inbox every day. Sign up now!Daily Beast Membership: Beast Inside goes deeper on the stories that matter to you. Learn more.

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5 Reasons Why You Sweat in Your Sleep – LIVESTRONG.COM

You might sweat in your sleep because you're too hot, but it could also be a symptom of something more serious.

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There are certain times you expect to sweat in the middle of a heat wave, during your spin class and maybe even before a gigantic work presentation. But if you've ever woken up in the middle of the night drenched, you may wonder what's happening.

"Sweating itself is completely normal it's a way for your body to regulate its temperature," says Donald Ford, MD, a family medicine specialist at the Cleveland Clinic.

If you wake up sweaty in the middle of the night underneath a heavy blanket or in a too-hot bedroom, it's one thing. That's due to overheating, and when you remove the culprit, your body temp and your nocturnal awakenings should return to normal.

But if you wake up in soaking sheets and your thermostat is set to a cool 65 degrees, there may be other, underlying health issues causing your night sweats, Dr. Ford says.

They're actually surprisingly common up to 41 percent of people in a primary care setting reported having them in the last month, per a November-December 2012 review in the Journal of the American Board of Family Medicine. They were most common in people ages 41 to 55.

Here, five common reasons you might get night sweats, and what to do about them.

1. You're Going Through Menopause

The years leading up to menopause known as perimenopause are prime time for hot flashes: Almost 80 percent of women report experiencing them as they go through this stage of life.

This is due to significant fluctuations in your body's production of the sex hormones estrogen and progesterone, says Stephanie Faubion, MD, medical director of the North American Menopause Society and director of the Mayo Clinic's Center for Women's Health. These fluctuations occur multiple times a day, including at night, when they cause night sweats.

Fix it: If your hot flashes are mild, you can try lifestyle changes such as keeping your thermostat at a low temperature, using lighter bedding and sleeping in lightweight, loose-fitting clothing, Dr. Faubion says.

You should also avoid caffeine and alcohol, especially in the evening, as they can cause spikes in body temperature and trigger sweating.

Regular exercise may also help: A February 2017 study in Menopause found sedentary people who completed a 20-week exercise program reported reductions in hot flashes, including night sweats.

But if these changes don't help, or your symptoms are more severe, talk to your doctor about your options.

If you're within the first 10 years of menopause and you don't have risk factors such as heart disease, diabetes, high cholesterol, high blood pressure or a history of breast cancer, then you can try a course of hormone therapy, Dr. Faubion notes. You can also ask about Brisdelle, an anti-depressant that's also FDA approved to treat hot flashes.

2. It's a Side Effect of Your Meds

Certain medications are known to be associated with night sweats: "They alter neurotransmitters in your brain, causing it to overproduce the hormone serotonin, which in turn throws your body temperature out of whack," Dr. Ford explains.

The biggest offenders are a class of anti-depressants known as selective serotonin reuptake inhibitors (SSRIs), certain blood pressure and diabetes medications and over-the-counter drugs like the heartburn drug omeprazole (Prilosec) or the pain-reliever naproxen (Aleve).

Fix it: Talk to your doctor. You may be able to switch to another type of medication that won't cause the same reaction, Dr. Ford says. You should also avoid caffeine and alcohol, since they can exacerbate the problem.

3. You've Got a Hormone Issue

Hyperthyroidism (where your body produces too much thyroid hormone) can overstimulate your nervous system, which means you not only have trouble falling and staying asleep, but you can wake up in the middle of the night sweating up a storm, says Peter Bidey, DO, an osteopathic family physician and assistant professor in the Department of Family Medicine at the Philadelphia College of Osteopathic Medicine.

If you have undiagnosed diabetes, that can also wreak havoc with your blood sugar levels and cause you to sweat more easily, including at night.

While there are other conditions caused by adrenal tumors such as pheochromocytoma and carcinoid syndrome that can cause night sweats, these diseases are relatively rare, Dr. Bidey says.

Fix it: See your doctor, especially if you have other symptoms of hyperthyroidism such as heart palpitations, mood swings, hyperactivity and weight loss, or of type 2 diabetes, such as increased thirst, hunger and urination. Your physician can run blood tests to diagnose either condition, Dr. Bidey says.

4. It's a Side Effect of Sleep Apnea

Night sweats occur about three times as often in people with untreated sleep apnea a condition where your throat tissue blocks your airway, causing you to stop breathing multiple times throughout the night according to an April 2013 study in BMJ Open.

This is because each episode of apnea causes your body to release the stress hormone cortisol, which activates your nervous system, Dr. Bidey says.

Fix it: Watch for other symptoms of sleep apnea, including snoring, morning headache and feeling super fatigued during the day (to the point where if you sit down, you sometimes nod off). If you have them, see your doctor, who can refer you to a sleep specialist.

Sleep apnea is diagnosed via an overnight sleep study, where you're hooked up to equipment that monitors your breathing patterns and blood oxygen levels while you sleep.

If you do have sleep apnea, you'll need a CPAP, a machine that delivers air pressure through a mask while you sleep.

Life-threatening infections such as tuberculosis, human immunodeficiency virus (HIV), endocarditis (a heart valve infection) and osteomyelitis (a bone infection) are associated with night sweats, most likely because they can trigger a fever, Dr. Ford says.

Fix it: These diseases usually present with other symptoms, such as chills, fever, body aches, fatigue and loss of appetite, Dr. Ford says. If you notice any of these, see your doctor right away.

When to See a Doctor for Night Sweats

If you get night sweats once or twice, there's no need to be concerned, Dr. Bidey reassures, especially if they're relieved by opening a window or applying ice packs or cold compresses to your body.

But if they occur more often than that, or you've got other symptoms like fatigue, high fever, weight loss or body aches, see your doctor. He or she can rule out underlying medical conditions such as an infection, a hormonal condition, or, more rarely, a blood cancer such as leukemia or lymphoma.

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5 Reasons Why You Sweat in Your Sleep - LIVESTRONG.COM

6 Causes of Morning Diarrhea and How to Treat It – LIVESTRONG.COM

Morning diarrhea is often due to something you ate or drank the day before.

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Wow. This morning has been something else. You woke up with diarrhea. Aside from being sick, it might also have to do with what you ate, an as-yet undetected GI condition or even the monster to-do list you have brewing today.

Here's what's up and what you can do about it.

1. Youre Worried About All the Things Today

Not everyone feels well-rested when they get up and you might be swimming in worries about what's on your plate (e.g. a ton of to-dos, a not-so-pleasant meeting with your boss, a worrisome visit to the doctor, news from a friend).

When you're stressed, your body releases cortisol the fight-or-flight hormone and two things can happen in terms of your gut function: you can get diarrhea or constipation, plus bloating and flatulence, Monica S. Borkar, MD, a gastroenterologist with NorthShore University HealthSystem in Glenview, Ilinois, tells

Fix it: Taking care of yourself will help out your gut.

"Getting enough sleep, eating a healthy diet, drinking at least 64 ounces of water daily, avoiding caffeine, alcohol and tobacco and exercising can help your gut-brain axis get back on track," she says.

2. You Overserved Yourself Last Night

Alcohol tends to cause diarrhea, Dr. Borkar says. Imbibing too many IPAs or glasses of vino can cause the runs the next morning because you're drinking more fluid and alcohol might change your gut microbiome in ways that alter your BM habits.

Another possible related factor: Midnight snacking, she says. If you drank alcohol and then followed it up by diving into the chips or slices of pizza to quell the booze-induced munchies, then you can see why your BMs are making themselves known this morning.

Research in the Asian Pacific Journal of Cancer Prevention in 2019 suggests that diarrhea following drinking is associated with an increased risk of developing colorectal tumors, so this isn't a sign you should just brush off if it happens to you regularly.

Fix it: To reduce the risks associated with drinking, the Centers for Disease Control and Prevention recommends those assigned male at birth limit themselves to two drinks per day while those assigned female consume no more than one per day.

3. You Took a Laxative a Couple Days Ago

If you're constipated, OTC laxatives can be tricky they don't produce pooping immediately.

"Most over-the-counter laxatives can take anywhere from 8 to 72 hours to work," Dr. Borkar says.

If you popped one a couple of days ago, now just might be your time to have a BM.

Talk to your doctor before starting any of these medications, Dr. Borkar advises: They can interact with other medications you are taking and have the potential to cause incontinence.

4. Youre Sensitive to Your Nighttime Treat

Did you hit the pint of low-cal ice cream hard last night? Some artificial sweeteners and sugar alcohols in these types of desserts and other foods are associated with GI complaints, like bloating or diarrhea in some people, Dr. Borkar says. Dairy can loosen your stools, too, if you're sensitive to lactose, the sugar found in milk.

Fix it: If you notice that this happens frequently after you eat certain foods, you can try avoiding them to see if that quells your symptoms.

For a more thorough investigation to pinpoint your GI triggers, talk to a registered dietitian or your doctor.

5. Youve Got the 'Stomach Flu'

The "stomach flu" (read: viral gastroenteritis) can seemingly strike out of nowhere. You go to bed fine and you wake up with watery diarrhea (that has no blood), stomach pain, nausea, vomiting, a headache and a fever.

Fix it: Unfortunately, there's no treatment for this bug, notes the Mayo Clinic. And sometimes it's tough to know what got you sick in the first place, because the symptoms can appear several days after you came in contact with the contaminated food (or water).

You can make yourself more comfortable by avoiding mediations like NSAIDs that can cause stomach upset, avoiding food until your stomach starts to feel better and taking small sips of water to avoid dehydration. And let your doctor know if symptoms don't subside in a couple days.

Pregnancy is another contributor to morning diarrhea, Dr. Borkar says.

The American Pregnancy Association notes that this not-so-great symptom can be chalked up to newfound sensitivities to foods that didn't bother you before or hormonal changes that slow digestion.

If you have diarrhea, make sure youre drinking adequate fluids to avoid dehydration, which can be dangerous during pregnancy. And if it's persistent, definitely mention it to your ob-gyn.

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