Archive for the ‘Hormone Physician’ Category

From Harper's BAZAAR

Like most of us, Im doing my best to stay healthy right now. Im social distancing and washing my hands almost obsessively. Im trying to eat as many vegetables as possible to ensure I'm getting health-supporting nutrients that I'm not exactly taking in via all the stress baking.

Its also not surprising that Ive been bombarded with news over the past few months about how to bolster my immune system. I cant scroll through my Instagram feed without seeing some influencer bragging about an immune-boosting smoothie or a supplement company promoting pills with elderberry and citrus.

Let's take a step back though. Immunity has a PR problem right now. The whole idea that you can power up your immunity in some quick-fix way overnight (and, you know, avoid a cold or flu...or Covid-19) isn't actually how it works.

Think of immunity like in American football terms: if youre the star quarterback of your life, your immune system is like that super-jacked lineman whose number-one job is to protect you from all directions. And, separately (but still in that sports realm!), just like how strategic leadership can whip a team into shape, you can train your system to more efficiently pick off any opponentbug, virus, germthat comes your way. But that conditioning takes time and dedication.

So, taking a last-minute, reactionary approach to immunity is the opposite of how you should think about it, says Nicole Avena, PhD, visiting professor of health psychology at Princeton University. Immunity is a marathon, not a sprint. Because of that, there isnt any fast and easy way to immediately amplify yours. Youve got to take an all-in, holistic approach if youre going keep your immune system in fighting form, says Avena.

Recalibrating your immunity for the long game comes down to the classic health habits you hear time and time again: sleep, stress reduction, and sweating it out. The key is doing all of these to at least some degree and not expecting one to be the ultimate cure-all. You wont make your immune system healthier in a week by pumping yourself with vitamins because someone close to you is sick, says E. John Wherry, PhD, director of the Institute for Immunology at the University of Pennsylvania. But you absolutely can help your immunity by making certain lifestyle changes.

Photo credit: Akira Kawahata

Nail Your Sleep Routine

Sleepspecifically getting at least seven hours most nightsmight be the Most Important Thing. The best data we have about how to improve immunity is on getting the right amount of good sleep, says Wherry. People who got six hours of shut-eye a night or less for one week were about four times more likely to catch a cold when exposed to a virus compared to those who got more than seven hours, according to a study published in the journal Sleep. (The risk of getting sick was even higher for those who snoozed less than five hours a night.)

Everything you do when youre awakeeating, digesting, working, walking, exercisingprompts your body to release inflammatory cells, says Rita Kachru, MD, section chief of the clinical immunology and allergy division and assistant professor at the David Geffen School of Medicine at UCLA. Sleep gives your body a break from all of that. Dont get hung up on one crappy night of Zs (or give yourself too much praise for one amazing one, for that matter); focusing on long-term, consistent good sleep habits is the way to go. Your building blocks, right here.

Story continues

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Mara de la Paz Fernndez, PhD, a sleep researcher and assistant professor of neuroscience and behavior at Barnard College of Columbia University

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Mariana Figueiro, PhD, director of the Lighting Research Center and a professor of architecture at Rensselaer Polytechnic Institute

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Mikka Knapp, a registered dietitian-nutritionist

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Rebecca Robbins, PhD, a sleep researcher and co-author of Sleep for Success!

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Megan Roche, MD, epidemiology researcher and Strava running coach

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Its well established that stress prompts the release of cortisol, that fight-or-flight hormone that enables you to run for your life. When cortisol is high, your immune system isnt as active, says Daniel M. Davis, PhD, professor of immunology at the University of Manchester in England; your body sends all of its resources to the thing it thinks is most likely to kill you, and away from other stuff, like your protective network.

Dont stress? Ill just give up now, youre thinking. Stay calm and try this: instead of attempting to eliminate negativity, refine the way you cope (with the genius advice ahead!)which will make the blues more manageable and mitigate that cortisol response, Davis says.

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Joy Lere, a psychologist

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Kevin Gilliland, PsyD, a clinical psychologist and executive director of Innovation360

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Patricia Celan, MD, a psychiatry resident at Dalhousie University in Canada

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Beatrice Tauber Prior, PsyD, a clinical psychologist

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Working out creates inflammation in the body, but its the good kind, says Wherry. Its a little counterintuitive, because exercise actually disrupts your bodys homeostasis, he says. But when your sweat session is finished, your bod goes back to its status quokeeping your immunity on its toes in that brilliant way, he says. Research backs this up: people who exercise regularly develop more T cells (those destroyer white blood cells) than their sedentary peers, a recent study found. It also helps modulate the stress hormone cortisol, which, when raised, leads to inflammatory activity.

Some experts agree that overtraining (you know, that feeling when youve been pushing yourself too hard and youre feeling it) can hinder immunity. So if youre an everyday athlete, moderate exercise on a consistent basis is the end zone to aim for.

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Jennifer Haythe, MD, a critical care cardiologist at Columbia University Medical Center

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Lisa Ballehr, DO, an osteopathic physician and Institute for Functional Medicine certified practitioner

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Ian Braithwaite, MD, an emergency physician at The Royal London Hospital

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Kym Niles, certified personal trainer

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Kristen Gasnick, board-certified physical therapist

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Jenn Randazzo, registered dietitian

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Excerpt from:
15 health habits experts use to boost their own immunity - Yahoo Lifestyle UK

Image Source: Courtesy of Molly Burke

Molly Burke's YouTube channel is full of fun videos about fashion, beauty, and everyday life. Burke, who has amassed over two million subscribers on the platform and hundreds of thousands of followers on Instagram and TikTok, respectively, also posts informational footage about her blindness some address misconceptions and others discuss steps to making the world more accessible for those who are disabled.

Burke was legally blind from birth but lost the majority of her sight at age 14 due to retinitis pigmentosa, the breakdown of cells in the retina. She was diagnosed with situational depression, short-term depression resulting from a traumatic life event, which differs from clinical depression, after losing her vision. "My situational depression was triggered by my vision loss and the bullying that I was experiencing because of that," Burke told POPSUGAR. "And it led to me dealing with suicidal ideation." Burke attended five different schools growing up in Canada in the hopes of getting the best education for herself as a blind student and to escape that bullying.

"The bullying was a constant throughout my life, but once bullying was coupled with my vision loss, it just all became too much," Burke recalled. Being 14 is an overwhelming time for most newly minted teenagers as it is. "You're getting ready to transition to high school, and you're going through a lot of self-discovery, figuring out your own sense of style, starting to date, having puberty and hormone changes," she said. "So to then also be going blind was very difficult for me."

The journey to recover from her situational depression was exactly that: a journey "with ups and downs," as Burke described it. Working on all facets of health "mind, body, soul" was key. She found spirituality and started seeing a nutritionist "to fuel my body with foods that really built me up and made me strong." She also turned to fitness and yoga, specifically, and she went to therapy, her "safe space," to seek guidance from a psychologist, which lasted until she was 21.

Burke's outlet for her depression a healthy, positive way to express her emotions was writing music, singing, and being in a band, leading her to connect with fellow musicians. "We were a good ol' angsty punk rock band," she added (we both laughed at that). She worked through her depression, too, by learning to embrace herself, "so really exploring my own self, my interests, my likes and dislikes and owning them instead of doing what you're supposed to do to fit in."

Burke was diagnosed with post-traumatic stress disorder (PTSD) after an accident a few weeks following her 20th birthday where she almost broke her neck (she fell off a stage during a soundcheck for one of her speeches). "I was a full-time motivational speaker at the time, so the thing that I did every single day, all day, for a living suddenly became a source of trauma and fear for me," she said. To help heal from her PTSD, she specifically turned to talk therapy and cognitive behavioral therapy.

Also at 20 years old, Burke was diagnosed with generalized anxiety with OCD tendencies. For her anxiety in particular, she copes through breathing techniques and making sure she gets proper nutrition (when her anxiety is triggered, she often has trouble eating, she explained). She went on and off anxiety medication up until recently as well.

Through it all, finding purpose has been a big component for Burke in tending to her mental health. This purpose, to her, is to "educate, motivate, or inspire one person every day with my story." She wants to break barriers for people living with disabilities because, she said, "I realized that I cannot be angry at society's ignorance towards me if I'm not willing to do anything to actively educate society to stop it."

Burke began public speaking when she was little, and she currently speaks on topics such as accessibility, bullying, and the social model of disability. This model of disability, which she learned at age 16 from a special-education teacher, differs from the medical model of disability that essentially tells those who are disabled that they are the problem. "The medical model of disability really puts a lot of the blame or the burden of guilt on the disabled person themselves, when really there's nothing we can do," she explained. "For many of us, it is incurable, and so to add a burden on top of an incurable condition, to feel like it is your fault, is very damaging." The social model says, instead, that it's society that is the problem.

Burke continued, "I think it's very hard to cultivate young, strong, disabled leaders if that's the mindset we build into them versus the social model that completely takes the burden, the guilt, the blame off of us as disabled people and says, 'You know what? It is us as a whole, as a society, that needs to improve and simply become accessible to all needs.'"

When it comes down to it, "the reality is waiting for a cure isn't living. Accepting who you are is living," Burke said. "You can accept who you are by walking away from the medical model and accepting the social model. It's just a far more empowering way to live."

If you are feeling anxious or depressed and need help finding help or resources, the Anxiety and Depression Association of America and the National Alliance on Mental Illness (1-800-950-6264) have resources available. Also, the National Suicide Prevention Lifeline has several resources and a 24/7 lifeline at 1-800-273-8255 (slated to change to 988 in the future).

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YouTuber Molly Burke Became Depressed After Losing Her Eyesight Here's How She Coped - POPSUGAR

Building up a tolerance to caffeine may cause you to reach for more over time.

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These days, caffeine-infused products are everywhere. You can score a buzz from caffeinated chewing gum, water, popcorn, hot sauce, lip balm you name it.

Although the U.S. Food & Drug Administration (FDA) recommends limiting caffeine to 400 milligrams per day (that's four to five cups of coffee, FYI), consumption is on the rise. An April 2019 study in the American Journal of Preventive Medicine confirmed a significant uptick in energy drink intake, and the National Coffee Association reports that 62 percent of Americans have coffee every day, an increase of 5 percent since 2015.

Whether coffee is your lifeblood, you sip mugs of green tea all day long or you're prone to tossing back energy shots when you're working late-night, here's the scoop on whether it's a big deal to surpass the recommended max.

First, How Does Caffeine Affect the Body?

Caffeine is a stimulant that can either be naturally occurring (like in coffee beans or tea leaves) or synthetic (produced artificially and then added to foods and beverages, like energy drinks).

How Caffeine Perks You Up

"Caffeine affects adenosine, a neurochemical that mellows us out," says Jabraan Pasha, MD, physician of internal medicine at the University of Oklahoma College of Medicine. "It blocks the receptors that adenosine attaches to, so your body can't detect adenosine." By suppressing these sleep-inducing chemicals, we feel more awake.

"Keep in mind that people metabolize caffeine differently. One person can feel fine after drinking several cups of coffee, whereas someone else might feel jittery after just one cup."

"Caffeine also triggers your brain to release dopamine, a neurotransmitter that regulates pleasure and reward, and also has a role in alertness," says Nicole Avena, PhD, assistant professor of neuroscience at Mt. Sinai University and author of Why Diets Fail. "In addition to mental stimulation, caffeine slightly increases your heart rate and blood pressure, which is why you get a physical buzz from it."

According to the American Academy of Sleep Medicine, the effects of caffeine peak 30 to 60 minutes after consumption. And a December 2018 study in Risk Management and Healthcare Policy found that caffeine has a half-life of two to 10 hours, which means it takes your body up to 10 hours to digest half of the caffeine you've consumed.

"Keep in mind that people metabolize caffeine differently," Dr. Pasha says. "One person can feel fine after drinking several cups of coffee, whereas someone else might feel jittery after just one cup."

Healthy Benefits of Coffee and Tea

Most people get their daily caffeine from coffee and tea, and in moderation, these drinks are good for you. A November 2017 study in the BMJ confirmed that drinking coffee is linked to lower rates of heart disease, diabetes, stroke, kidney disease, liver disease, Parkinson's, dementia and cancer.

A December 2013 study in Current Pharmaceutical Design found that certain types of caffeinated tea are connected to lower rates of cancer, cardiovascular disease, diabetes and arthritis. It may also benefit your brain. In a May 2019 study in Molecules, older adults who drank tea were determined to have better cognitive function than their peers.

Researchers surmise these health boosts are thanks to high levels of protective antioxidants in coffee and tea. "The caffeine itself doesn't cause these benefits," Avena says. "You get the same positive outcome whether you drink regular coffee or decaf."

What Happens If You Have Too Much Caffeine?

The short answer is that it depends on the amount, how quickly it is consumed and how sensitive you are to caffeine.

"It might make you feel agitated, jittery or light-headed, or make your heart pound," Dr. Pasha says. "Still, for the most part, caffeine from coffee and tea is relatively safe, even in doses slightly above the recommendation."

A severe caffeine overdose, which the FDA estimates might result from rapid ingestion of about 1,200 milligrams of caffeine (that's about five energy shots or 12 cups of coffee), can cause vomiting, diarrhea, disorientation, seizures or a coma.

Tally Up Your Caffeine Load

According to a January 2014 study in Food and Chemical Toxicology, 85 percent of the U.S. population has at least one caffeinated beverage a day, with a mean of 165 milligrams a day. Use this chart to figure out your total. (Keep in mind that most coffee cups and drink bottles contain more than 8 ounces of liquid for example, a Starbucks Venti is 20 ounces.)

1 oz energy shot

215 mg

8 oz brewed coffee

96 mg

1 oz espresso

64 mg

8 oz black tea

47 mg

8 oz energy drink

29 mg

1 oz dark chocolate

23 mg

8 oz green tea

28 mg

8 oz cola

22 mg

8 oz bottled iced tea

19 mg

Source: Mayo Clinic. "Caffeine Content for Coffee, Tea, Soda and More"

4 Times When You Need to Watch Your Caffeine Intake

If you have a bun in the oven, you've probably heard that you should take it easy with the caffeine. According to the American Pregnancy Association, caffeine can raise your blood pressure and heart rate, lead to dehydration and disrupt sleep patterns for you and baby all of which are not recommended during pregnancy.

The American College of Obstetricians and Gynecologists deems less than 200 milligrams per day (two cups of coffee) to be safe during pregnancy, but some studies, including an August 2020 review in the BMJ, have linked caffeine during pregnancy to miscarriage, stillbirth, low birth weight, leukemia and childhood obesity.

2. You Have a Heart Condition

"If you have a condition that results in heart palpitations, such as cardiac arrhythmia, you may want to cut back on caffeine," Dr. Pasha says.

3. You Have Insomnia or Other Sleep Problems

"Some people are really sensitive to caffeine, and it can stick around in your body for eight hours or more," Dr. Pasha says, which can disrupt sleep.

Plus, if you're sleeping poorly at night, you might need more coffee or tea to feel awake in the morning and before you know it, your caffeine intake can snowball.

Finally, if you're taking an iron supplement, steer clear of caffeine an hour before and after popping your pill. "Caffeine blocks iron absorption," Dr. Pasha says.

Caffeine Dependence Is Real

If you've noticed your coffee or tea intake creeping up, then you may have built up a tolerance.

"When caffeine blocks your adenosine receptors, your body responds by creating more receptors to compensate," Dr. Pasha says. "As a result, you require more caffeine in order to feel alert." Now, you're sipping three or four cups when you used to have just two.

Not only do you start drinking more, but you feel crappy if you don't get your caffeine fix. "You might get a headache and feel sluggish or irritable," Avena says.

Luckily, it's reversible. "If you slowly cut back your caffeine intake over the course of a week or so, your body will reduce the number of adenosine receptors," Dr. Pasha says. It's like starting with a clean slate again.

"If you have a super busy period and drink more than the recommended amount of coffee for a couple of days, it is not the end of the world."

Want to Cut Back? Heres How

Try these five ideas to reduce your caffeine intake without feeling blah.

Vitamin B12 deficiency is common, affecting up to 15 percent of the population, according to the National Institutes of Health, and it can lead to fatigue. "If you are relying on caffeine to get yourself going, you might be deficient in B12," Avena says.

Because B12 is present in animal products (like fish, meat, poultry, eggs and dairy), vegans and vegetarians are at risk for deficiency. Same goes for older adults, who may not absorb B12 as easily.

"Eating foods rich in vitamin B12 or taking a supplement can make you feel like you have your energy back," Avena says. (She recommends Frunutta Dynamo B12 Blaze, a sublingual supplement that contains a small amount of caffeine along with B12.) With more pep in your step, you might not reach for the coffee pot as frequently.

B12 is a water-soluble vitamin, which means it's unlikely you'll overdose on it. Still, talk to your doctor before adding a supplement to your diet, to make sure it's right for you.

"Coffee drinking is very ritualistic we become psychologically hooked on having it at a certain time and place," Avena says. "Look at how you can you alter your routine to disrupt the connection to your caffeine habit."

For example, if you always have a mug of coffee first thing every morning, instead drink a big glass of water right when you wake up and delay that initial cup of joe until after breakfast. If you like the feeling of having a warm beverage in hand when you sit at your computer, try switching to decaf or herbal tea.

Make sure you're getting the recommended seven to nine hours of sleep. "When you feel rested, you may find that you need less caffeine," Dr. Pasha says.

"Exercising gives you a surge of endorphins and dopamine that will help you feel energized and can take the place of a caffeine rush," Dr. Pasha says.

Sunlight suppresses melatonin, a natural hormone that makes you feel sleepy. If you open all the shades when you wake up in the morning or take a walk around the block, your coffee cravings might not be as strong.

Even with moderate caffeine consumption, it's smart to follow these guidelines.

1. Skip Energy Drinks and Shots

Super high levels of caffeine in some energy-boosting beverages can cause your mood to yo-yo. You may have supercharged focus and pep at first, and then crash later.

"When you are hit with a bolus of caffeine, it raises your heart rate and increases your blood pressure, making your body work overtime," Avena says. "Instead, nurse a cup coffee; you will have a steady, lower dose of caffeine and won't experience those up and downs."

What's more: "Energy drinks tend to have a lot of added sugar to mask the chemical taste of synthetic caffeine," Avena says. According to the Harvard School of Public Health, a typical energy drink contains around 40 grams of sugar, as much as a can of soda. That blast of sweetness is not great for your body.

2. Avoid Caffeine After Lunch

A November 2013 study in the Journal of Clinical Sleep Medicine found that consuming 400 milligrams of caffeine six hours before bed reduced total sleep by more than one hour. Have your most highly caffeinated beverage early in the day, and then taper off.

3. Don't Forget Sneaky Sources of Caffeine

An ounce of dark chocolate (70 to 85 percent cocoa) has about 23 milligrams of caffeine, while coffee ice cream can have anywhere from 5 to 45 milligrams per serving. Some medications also contain caffeine (for example, the headache medicine Excedrin has 65 milligrams of caffeine per tablet). Remember to count these sources toward your daily intake, and hold off on them in the late afternoon and evening to avoid interfering with sleep.

So, How Bad Is It Really to Have More Than the Daily Recommended Amount of Caffeine?

As long as you stick to coffee or tea (rather than sugary, additive-laden energy drinks), aren't experiencing any negative side effects and aren't pregnant, it's not that bad.

"As a physician, I wouldn't recommend it," Dr. Pasha says, "But at the end of the day, is it dangerous? No."

Also consider whether you are regularly going overboard or if it's an occasional thing.

"If you have a super busy period and drink more than the recommended amount of coffee for a couple of days, it is not the end of the world," Avena says. "On the other hand, if you are drinking too much every day, you might want to cut back. Honestly, though, there are worse things you could be overdoing it on!"

Continued here:
The Effects of Too Much Caffeine on the Body - LIVESTRONG.COM

A recently published report describes the case of an 88-year-old female patient who experienced drug-induced syndrome of inappropriate antidiuretic hormone (SIADH) due to the combination of naproxen and citalopram and highlights the importance of performing medication reconciliation to prevent adverse drug events.

The patient, who had a history of asymptomatic chronic hyponatremia, presented to the emergency department (ED) complaining of generalized body ache. She additionally stated that she had been experiencing nausea, decreased appetite, and malaise the 4 days prior to her presentation.

Her medical history included hypertension, depression, and osteoarthritis for which she was prescribed amlodipine 10mg daily, losartan 50mg daily, citalopram 20mg daily, and naproxen 250mg every 8 hours as needed. The patient noted that she was initiated on naproxen by her primary care physician 2 weeks prior to her presentation as acetaminophen, which she had been taking for more than 5 years, was not providing pain relief any longer.

Upon admission, the patient had a serum sodium of 113 mmol/L, a urine sodium of 120 mmol/L, and urine osmolality of 487 mOsm/kg. It was noted that her sodium level 10 months prior was 129 mmol/L. Based on her physical exam and other laboratory testing (ie, cortisol level, thyroid-stimulating hormone, pro-BNP, creatinine, liver enzymes, serum albumin, cholesterol; all within range), she was diagnosed with SIADH.

The offending agents, citalopram and naproxen, were discontinued and fluid was restricted to 1 L per day. Instead of using hypertonic saline in our case, we decided to start fluid restriction alone at the beginning because of advanced age (which entails higher risk for osmotic demyelination syndrome), chronic hyponatremia, and relatively stable clinical condition, the authors explained.

On day 3 of her stay, the patients serum sodium level remained unchanged since admission and she experienced worsening mental status. She was then initiated on 2g sodium chloride tablets twice daily and her fluid was further restricted. On day 10 of admission, the patients serum sodium was reported to be 131 mmol/L and the sodium chloride tablets were discontinued. She was discharged on day 14 to a subacute rehabilitation center.

After an inpatient psychiatric evaluation determined that an antidepressant was not necessary at the time, the patient was discharged on amlodipine 10mg daily, losartan 100mg daily, and meloxicam 15mg daily. She was advised to continue to limit fluid to 1 L per day.

In our case, laboratory evaluation led to the diagnosis of SIADH, and the history of presenting illness pointed towards a medication adverse effect as the culprit, the study authors stated. They concluded, When faced with hyponatremia in an elderly patient, medication reconciliation should be one of the initials steps in the assessment.

Chiu C, Sarwal A, Munir RA, Widjaja M, Khalid A, Khanna R. Syndrome of inappropriate antidiuretic hormone (SIADH) induced by long-term use of citalopram and short-term use of naproxen. Am J Case Rep. 2020; 21: e926561. doi: 10.12659/AJCR.926561.

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Antidepressant, NSAID Identified as Culprits in SIADH Case - Monthly Prescribing Reference

Insulin controls the amount of sugar in your blood by regulating the conversion of glucose into energy, or storage in the liver for further use.

When we eat food, our body takes glucose from food, which leads to a rise in blood sugar levels. This leads to the release of insulin in healthy individuals, which signals your cells to absorb glucose and use it as energy, which in turn reduces your blood sugar level.

People suffering from type 1 or type 2 diabetes need to take insulin injection to facilitate this process. Nearly 24 per cent people suffering from diabetes take insulin.

There are several types of insulin that a person can take but it depends on how well everyone's body utilizes it and what is the type of diet they follow.

People who are resistant to insulin or consume too many carbohydrates, need to take higher doses of insulin.

See the article here:
Different types of insulin and how to use them for diabetes treatment - Times of India

Insulin is a naturally-occurring hormone that helps the body regulate blood sugar, or blood glucose.

Healthy individuals produce all the insulin they need. But people with type 1 diabetes do not produce any insulin, so they need to take insulin injections.

People with type 2 diabetes produce some insulin, but their body is not always able to use it effectively. Because of that, some people with type 2 diabetes also need to take insulin injections.

Here's what you need to know about the different types of insulin and which might be best for you.

Insulin controls the amount of sugar in your blood by regulating the conversion of glucose into energy, or storage in the liver for future use.

When you eat, your body takes in glucose from food, and your blood sugar levels rise. This triggers the release of insulin in healthy individuals. The insulin signals your cells to absorb glucose and use it as energy, which reduces your blood sugar.

An insulin injection helps facilitate this process for people with diabetes. Overall, roughly 24% of people with diabetes are treated using insulin.

However, there are several different types of insulin that you can take. This depends on how well each person's body utilizes insulin, as well as their diets.

"Patients who are more resistant to the effects of insulin or consume excessive amounts of carbohydrate, particularly simple sugars, require higher doses of insulin," says Joseph Barrera, MD, an endocrinologist with Mission Hospital in Mission Viejo, California.

The types of insulin vary in the following ways:

A standard strength insulin in the United States is U-100, which has 100 units of insulin per milliliter of fluid. Here are the most common types of insulin:

Most insulin-dependent diabetics need to use both a short-acting and long-acting insulin to control their diabetes.

"The long-acting insulin is injected once a day to provide a 'ceiling' of insulin coverage to prevent blood sugars from escalating and the short-acting insulin is injected prior to meals to cover the carbohydrate consumed at each meal," Barrera says.

Intermediate insulin and inhaled insulin are not as commonly used, because they don't provide flexibility in dosing, Barrera says, and they can be more difficult to precisely control.

People with diabetes who are dependent on insulin will need to inject it, usually multiple times a day. However, if you dislike injecting insulin, you can talk to your doctor about getting an insulin pump, which delivers insulin continuously through a catheter. These can be paired with a continuous glucose monitor to deliver the correct dose of insulin.

"Ultimately, a physician, physicians' assistant, or nurse practitioner often in combination with a dietitian are most qualified to determine which type of insulin and insulin delivery device is best for each patient," Barrera says.

Insulin is highly effective at treating diabetes, especially if you have type 1. But for most people with type 2 diabetes, it's best to regulate your blood sugar levels through healthy lifestyle changes, so that you do not need insulin, Barrera says.

"Type 1 diabetics must be treated with insulin, as their pancreas do not produce insulin," Barrera says. "However, type 2 diabetics, which comprise 90% of the diabetic population, can either avoid insulin or discontinue insulin altogether if they are able to achieve an ideal body weight through diet and exercise under the care of an experienced health care team."

Read more:
The different types of insulin and how to use them for diabetes treatment - Insider - INSIDER

Trodelvy (sacituzumab govitecan), a recently approved antibody-drug conjugate, delayed disease progression and improved overall survival for women with hard-to-treat triple-negative breast cancer (TNBC) and shrank tumors in about a quarter of people with metastatic bladder cancer, researchers reported this week at the European Society for Medical Oncologys ESMO Virtual Congress 2020.

Trodelvy, from Immunomedics (soon to be acquired by Gilead Sciences), uses a monoclonal antibody to deliver a potent chemotherapy drug. The antibody targets Trop-2, a cell surface protein found in more than 90% of triple-negative breast tumors and at lower rates in many other types of cancer.

Triple-Negative Breast Cancer

Aditya Bardia, MD, MPH, of Massachusetts General Cancer Center and Harvard Medical School, presented the latest findings from the ASCENT study, a randomized Phase III trial comparing Trodelvy versus chemotherapy for TNBC. Based on an earlier Phase II study, the Food and Drug Administration (FDA) granted accelerated approval of Trodelvy for this indication in April.

Breast cancer is classifiedaccording to the types of receptors it expresses. A majority of breast tumors carry estrogen or progesterone hormone receptors (HR-positive) and can be treated with hormone therapy. Others express a receptor called HER2 and can be treated with HER2 inhibitors such as Herceptin (trastuzumab). Triple-negative breast cancer doesnt express any of these receptors and is more difficult to treat.

ASCENT (ClinicalTrials.gov NCT02574455) enrolled 529 people with metastatic TNBC in seven countries. Almost all were women, most were white and the median age was 54 years. They had received at least two and a median of four prior therapies. All had used various chemotherapy drugs, and about a quarter had tried checkpoint inhibitor immunotherapy. The most common metastasis sites were the lungs (44%), liver (43%) and bones (22%); a small proportion of participants with brain metastasis were not included in the main analysis.

The participants were randomly assigned to receive either Trodelvy by IV infusion on days 1 and 8 in each 21-day cycle or a physicians choice of a single chemotherapy drug (eribulin, vinorelbine, gemcitabine or capecitabine). Treatment continued until they experienced disease progression or unacceptable toxicity.

More than a third of Trodelvy recipients (35%) experienced tumor remission compared with just 5% of chemotherapy recipients; 4% and 1%, respectively, had complete responses.

Trodelvy reduced the risk of disease progression or death by 59% compared with chemotherapy in the subgroup without brain metastasis; the median progression-free survival time was 5.6 versus 1.7 months, respectively. The benefit was somewhat less when those with brain metastasis were included. The benefit was consistent across racial/ethnic groups and regardless of prior treatment regimens.

Overall survival time was 12.1 months in the Trodelvy group versus 6.7 months in the chemotherapy group, a clinically meaningful 52% improvement. At the time of the analysis, 15 Trodelvy recipients, but none of the chemotherapy recipients, were still taking their assigned treatment.

Trodelvy was generally safe, and side effects were usually manageable. The most common side effects were neutropenia, anemia, diarrhea, nausea, hair loss and fatigue. About 5% of people in both treatment groups stopped treatment due to adverse events.

The randomized Phase III study results confirm that sacituzumab govitecan should be considered as a new standard of care in patients with third-line metastatic TNBC, Bardia said in an Immunomedics press release.

The ASCENT study was halted in April after a data safety monitoring committee found that Trodelvy demonstrated compelling evidence of efficacy. Based on these findings, the company intends to seek full FDA approval for this indication later this year.

Bladder Cancer

Trodelvy for bladder cancer is further back in the pipeline. Yohann Loriot, MD, PhD, of Institut de Cancrologie Gustave Roussy near Paris, presented findings from the global Phase II TROPHY-U-01 trial (ClinicalTrials.gov NCT03547973), which enrolled people with inoperable locally advanced or metastatic urothelial carcinoma, which arises from cells lining the urinary tract and is the most common type of bladder cancer.

Participants were grouped based on prior therapy. Loriot presented findings from cohort 1, which included 113 people whose cancer progressed despite platinum-based chemotherapy and checkpoint inhibitors. More than three quarters were men, most were white and the median age was 75 years. The most common metastasis sites were the internal abdomen (62%), lungs (40%) and liver (28%).

All participants received Trodelvy on days 1 and 8 of each 21-day cycle until it no longer worked or they experienced intolerable side effects. There was no comparison regimen or placebo group.

The overall response rate was 27%, including 5% with complete remission. Loriot noted that the response rate for chemotherapy is generally around 10%. The median duration of response was 5.9 months, the media progression-free survival time was 5.4 months and the median overall survival time was 10.5 months.

Again, treatment was generally well tolerated, with side effects similar to those seen in the breast cancer study; 6% stopped treatment for this reason. One patient died of sepsis related to neutropenia, or depletion of infection-fighting white blood cells.

These findings, the researchers concluded, support a randomized Phase III trial of Trodelvy for metastatic urothelial carcinoma. Accordingly, the TROPICS-04 study is now underway (ClinicalTrials.gov NCT04527991). Immunomedics plans to seek FDA accelerated approval this year based on the Phase II results.

Another antibody-drug conjugate, Padcev (enfortumab vedotin), from Astellas and Seattle Genetics, was granted accelerated approval for the same indication last December based on promising Phase II findings; a Phase III trial was recently stopped early based on good interim results.

In addition to TNBC and bladder cancer, Trodelvy is also being studied alone or in combination regimens for other malignancies, including HR-positive/HER2-negative metastatic breast cancer (TROPICS-02; ClinicalTrials.gov NCT03901339), metastatic non-small-cell lung cancer and glioblastoma brain cancer.

Click here for full prescribing information for Trodelvy.

Click here to learn more about breast cancer.

Click here to learn more about bladder cancer.

Original post:
Trodelvy Improves Outcomes for Breast and Bladder Cancer - Cancer Health Treatment News

Youll find no shortage of medical advice out there during the coronavirus. Separating myth from fact, the current from the outdated can be tricky. And what advice is truly essential, the most important to prioritize?

Cutting through the noisethats why we asked doctors for the most important advice they wish you knew. Heres what they told us. Read on, and to ensure your health and the health of others, dont miss these Sure Signs Youve Already Had Coronavirus

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The coronavirus threat is not ending anytime soon, no matter where you live. People of all ages can become seriously ill with COVID-19, and you can spread it even without developing symptoms. Follow all official recommendations about wearing face masks, social distancing and good hygiene practices to reduce the spread.

Wash your hands throughout the day, especially if you have been out and have just arrived home, before you touch anything in the house. And take social distancing seriously. It will be a while before you can see family and friends, but you put your like at riskand theirsby not following the rules, says Dr. Deborah Lee.

RELATED: COVID Mistakes You Should Never Make

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Many people associate switching to diet soda, or other diet drinks, as a healthy alternative to some beverages, says Drew Miller, MD, a family physician in Lakin, Kansas. However, there have been numerous studies reporting the link between diet soda and weight gain, as well as increased risk of developing diabetes, heart problems, or other chronic health issues.

The Rx: Switch out that soda for water, seltzer without artificial sweeteners, or homemade spa water add slices of lemons, limes, oranges or grapefruit to a pitcher of H20.

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For the most part, people are trying to be helpful, live up to expectations and keep their patients healthy, says says Ariel B. Grobman, MD, a board-certified otolaryngologist with Greater Miami ENT. Mistakes do happen, and problems can be missed, but we should have compassion for healthcare practitioners.

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Many people think that bubbling of hydrogen peroxide on a wound is proof that there were bacteria in the wound and that the bacteria are being killed, says Dr. Robert Beam of Novant Health-GoHealth Urgent Care in Kernersville, North Carolina. The bubbling justifies its repetitive use.

The Rx: Clean wounds with soap and water, apply antibacterial ointment, and cover with a Band-Aid. But skip the bubbly stuff. Hydrogen peroxide is a potent oxidizing agent, says Beam. It damages all organic material, bacterial and human.

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Breathing through the nose is a simple yet effective method to achieve better sleep, says Anil Rama, MD, adjunct clinical faculty at the Stanford Center for Sleep Sciences and Medicine. Our nervous system consists of two parts: the sympathetic system and the parasympathetic system. The sympathetic or fight and flight system is active during the day; the parasympathetic or rest and digest system is more active at night. Any process that increases the activity of the sympathetic nervous system makes sleep difficult. Mouth breathing increases the activity of the sympathetic nervous system.

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If I could give one health tip, it would be to preserve your mental health and inner peace at all costs, says Sophia O. Tolliver, MD, MPH, a family medicine physician with the Ohio State University Wexner Medical Center.

The Rx: Meditating in the morning and setting an inner agenda and positive intention can be a great way to set the tone for the day, she says. At the end of a long day, meditating to clear your mind of all negativity, forgiving the upsets of the day, and reconciling your authentic self can set the stage for restful and relaxing sleep and really is a form of self-care at its highest level.

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Get your annual screening mammograms, know your family cancer history, and educate your children about cancer risk identification, management and reduction, says Anjali Malik, MD, a breast imaging radiologist in Washington, D.C. Annual screening mammograms decrease deaths from breast cancer by 40 percent.

The Rx: With the top two risk factors for breast cancer being non-modifiable (female gender and aging), it is important for every woman, regardless of family history, to have an annual mammogram starting at the age of 40, he says.

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Knowing your family history of all cancers (breast, colon, ovarian, pancreatic, thyroid, lung, melanoma) may impact your overall risk for cancer, and may raise the need for genetic testing, says Malik. Identifying our risks, and knowing how to reduce those that are modifiable, are a key part of prevention and precision medicine in the 21st century.

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Aging is a process none of us are immune to, and so preparing for it is crucial, says Dr. Thanu Jey, DC, clinic director at Yorkville Sports Medicine Clinic. Many old-age accidents occur from falls, and its important to start fall-prevention training before its too late.

The Rx: As your parents age, its a good idea to begin stability and balance training early, so it becomes part of their daily routine, says Jey.

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Its important to maintain a healthy weight and lifestyle, because overall health and wellness decreases chances of many problems, including heart disease, diabetes, sleep apnea and more, says Nodar Janas, MD, medical director of Upper East Side Rehabilitation and Nursing Center in New York City. Eating mindfully can be a powerful tool for maintaining a healthy weight.

The Rx: At mealtime, Decrease your portion size by at least half, make sure you are actually chewing your food, make one meal daily only fruits and vegetables, and stop eating at least two hours before sleep, advises Janas. It takes 15 minutes for stomach receptors to send information to the brain telling it youre full, so if you eat slowly in the beginning of your meal, you may eat a third of the portion you might otherwise eat.

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If youre having pain with sitting for long periods of time near where the front pocket of your jeans are, this is probably coming from your hip joint, says Derek Ochiai, MD, an orthopaedic surgeon and sports medicine doctor in Arlington, Virginia. You should probably not ignore it, and at least get it checked out by an orthopaedic surgeon, before it becomes arthritis.

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Even as cities reopen after the lockdown, it is still important to maintain a six-feet distance from other people to prevent the spread of coronavirus. Until a vaccine is developed, or an antibody test, we cannot be sure who is at riskso must assume everyone is at risk.

RELATED: Everything Dr. Fauci Has Said About Coronavirus

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When prescribed medication, ask your doctor to explain why you need it, and if you agree, be compliant, says Janas. In the U.S., we are being overmedicated.

The Rx: When you are prescribed a medication by your doctor, make sure to take the time to understand why its been prescribed, says Janas.

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Feed a cold, starve a fever is not true! says Betsy Koickel, MD, associate medical director of Northwell Health-GoHealth Urgent Care in New York. Taking in an adequate amount of calories and fluids are important to your body fighting off most illnesses. Increasing your fluid intake during any illness is helpful to your immune system. Fasting during illness may make you more at risk for weakness, dehydration, and fainting.

The Rx: Eat as normal when youre ill, and make sure youre hydrating. Aim for four glasses of water a day when youre healthy; during illness, you might need more.

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If you think you should go to therapy, but dont really want to invest emotionally in it, arent really willing to be vulnerable and work hard and sometimes even suffer in it, it probably wont work so dont waste your time and money, says Gail Saltz, MD, associate professor of psychiatry at the New York Presbyterian Hospital Weill-Cornell School of Medicine. Therapy isnt a magic wand, you actually have to fully participate in it.

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However difficult things are in life, take a few minutes every day to think about what you do appreciate, says Saltz. If you dont make a point of it, you probably wont do it and honestly you can completely lose perspective on your life.

The Rx: Take five minutes every day and think about what you do feel grateful for, says Saltz. Youll find that even over a couple of weeks youll feel more positively.

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The winter blues arent a myth or something to be ignored. Many people really do have a mood change for the worse when the days become shorter. If you feel seasonally down or irritable or tired and slowed down, try light! says Saltz. Its odd to people to think light could do something to your brain, but it does. You need the right type of light, and then daily use, but it can change your entire state of wellbeing during the fall/winter months.

The Rx: Many models of light boxes are available, from the inexpensive to the deluxe. Talk to your doctor about any season-related emotional changes youre feeling, and if light box therapy might be right for you.

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Make sure youre getting at least seven hours of sleep, says Janas. Lower room temperature if you cant fall asleep, or listen to relaxing music instead of relying on medications. Ironically, this is one I dont follow myself. I get about four hours of sleep a night because I am constantly getting calls from patients or colleagues. However, I have trained myself to work and function this way and I try, throughout the day, to take naps when possible.

The Rx: Experts like the National Sleep Foundation recommend getting seven to nine hours of sleep a night. If youre having chronic trouble getting that amount, talk to your doctor. He or she might advise cutting back on caffeine, limiting naps, getting more exercise or addressing anxiety or depression.

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You might not have had an injury, but you could still get a stress fracture, which is microscopic damage to the bone, says Velimir Petkov, MD, a board-certified podiatrist with Premier Podiatry in Clifton, New Jersey. You can get them by wearing flip flops, sandals or shoes that fail to provide sufficient cushioning and shock absorption. Walking, jumping, running or even standing for extended periods of time can cause stress fractures.

The Rx: Wearing comfortable shoes with good padding, as well as getting plenty of Vitamin D and calcium is important in preventing stress fractures, says Petkov. Your primary care doctor can order a bone density test to verify your bone mass.

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As nail salons reopen: Getting a pedicure might seem like a great idea, but many salons dont disinfect the whirlpools or footbaths properly, says Petkov. Drains and filters often dont get cleaned in between appointments. You can get a plantar wart, or a bacterial or fungal infection which would require medication, lots of patience and time to get rid of. Athletes foot (tinea pedis) is a very common fungal infection that spreads particularly well in moist areas.

RELATED: Im an Infectious Disease Doctor and Would Never Touch This

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Those are eating the best foods, getting adequate exercise throughout the day, managing chronic stress, enhancing sleep, avoid all tobacco products, challenge your mind daily and spend time with friends and family, says Stephen C. Schimpff, MD, MACP, a board-certified oncologist and infectious disease specialist and author of Longevity Decoded The 7 Keys to Healthy Aging.

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We ate quality foods in my mothers day, but the emphasis was on meat as the centerpiece with vegetables as an add-on, says Schimpff. If she were alive today, I would encourage her to add many more vegetables to her diet organic if possible reduce the potatoes, and only buy grass-fed beef and free-range chicken.

The Rx: Make the vegetables one-half or more of your plate and the meat no more than one quarter, advises Schimpff. Increase fish for the omega-3s, use olive oil and eat nuts and seeds and avocados, all for their healthy oils.

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This is a very quick and inexpensive CT scan that can tell you if you have hard plaque in your coronary vessels, says Anthony Youn, MD, author of Playing God: The Evolution of a Modern Surgeon. I recommend it for anyone over the age of 40 whos concerned about developing heart disease. Its super-easy and inexpensive and just might save your life.

The Rx: Ask your doctor if the test is right for you.

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The most important advice I could give is to keep your mouth clean, says Carl Medgaus, DMD, a dentist in Pittsburgh, Pennsylvania. People often dont realize the systemic effect that oral health has on the body. Plaque buildup on teeth, for example, can lead to atherosclerotic heart disease.

The Rx: Use an electric toothbrush with a two-minute timer, separated in 30-second intervals, so you know how long to spend on each section of the mouth, says Medgaus. Then equip yourself with a water flosser. No one likes to floss. Even I hate it. But it has to be done. Water flossing makes it easier. I had my doubts about water flossers at first, but clinical research shows that they are equivalent to traditional floss when it comes to removing plaque.

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Every day, drink a tea or coffee, and also a cup of pomegranate juice, says William W. Li, MD, author of Eat To Beat Disease: The New Science of How Your Body Can Heal Itself. Coffee and tea can slow cellular aging, starve cancer, reduce the risk of stroke, and improve longevity. Natural chemicals in pomegranate improves your gut microbiome to help boost the immune system.

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Dont stay long-term on estrogen replacement therapy, says Li. Many older women have been taking hormone replacements for years, but long-term use can increase the risk of breast cancer.

RELATED: Worst Things For Your HealthAccording to Doctors

27

Eat more soy, says Li. Contrary to popular belief, soy doesnt cause breast cancer. In fact, research shows eating more soy actually lowers the risk of breast cancer.

The Rx: Experts recommend eating a moderate amount of soy one to two servings a day. Foods that are rich in soy include edamame, alternative meats such as the Impossible Burger, soy milk, tempeh and soy protein.

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As a healthcare professional, I cant stress this one enough, says Dena Nader, MD, regional medical director of MedExpress based in Washington, Pennsylvania. Washing your hands frequently, and well, is one of the best ways to avoid sickness and spreading germs to others. But what we often forget about are those other surfaces that we touch all the time our phones, steering wheels, doorknobs, faucets, toys, remotes that also harbor bacteria that can make us sick.

The Rx: I typically recommend to my patients that at least once a week, and more during cold and flu season, they remember to wipe down these frequently touched, but easily overlooked surfaces with antibacterial wipes to help slow the spread of germs, says Nader. Also, avoid putting pens or pencils in your mouth but if its a habit you just cant seem to break, make sure you disinfect these items every day.

RELATED: Everything Dr. Fauci Has Said About Coronavirus

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Many of the patients I talk to feel overwhelmed at the idea of regular exercise because they think its time consuming and hard work but it doesnt have to be, says Nader.

The Rx: Making little adjustments to your normal routine, like taking the steps instead of the elevator at work or in your apartment complex, can make a big difference, she says. When youre running errands, try parking as far away from stores as possible so you have to walk a little bit extra. Take time during your lunch break and get some steps in by walking around your building. If and when youre ready to take it to the next level, remember that its always a good idea to talk to your doctor before starting a new exercise routine.

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Dehydration is very common in fact, many of my patients dont even realize theyre chronically dehydrated, says Nader. Im always reminding my patients to drink more water even before theyre thirsty. If it becomes an ongoing issue, lack of water and dehydration can lead to serious complications, like urinary and kidney problems, heat-related illness, and seizures.

The Rx: While water is a great way to get and stay hydrated, there are alternatives for people who struggle to drink enough water or get bored with the taste, says Nader. Many vegetables, like celery, tomatoes, cucumbers, and broccoli, offer a unique alternative to water. And all fruits, especially grapefruit, watermelon, strawberries, and oranges, have a high water content and are an excellent source of vitamins and fiber, too. Homemade fruit smoothies, coconut water, and water infused with fruits like lemon and strawberries are also great ways to spice up your liquid intake for the day.

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Breakfast really is one of the most important meals of the day, says Nader. Not only can it help control weight, but it also helps you get the important vitamins and minerals that you need in a day.

The Rx: I try to plan ahead as much as I can the night before, she says. There are so many different recipes for overnight oats, for example, which you can prep beforehand, so all you have to do is pull it out of the fridge the next morning. Pairing that with some fruit is a great first step to a healthy breakfast routine. If you are a morning person, try waking up a little bit earlier and starting simple. Opt for protein-rich eggs and pair it with a piece of whole-grain toast and some fruit.

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Loneliness is the leading epidemic plaguing individuals over the age of 50 in America today, says Prakash S. Masand, MD, CEO of the Centers of Psychiatric Excellence (COPE). It is often missed by healthcare providers and family members, yet its consequences can be far-reaching and even tragic.

The Rx: Feeling lonely and being lonely take a real toll on the brain and on your overall health, concurs Saltz. You truly need to connect with others and have a few relationships that matter and nourish you, this is not something to just let go on. Do what you have to do to keep a few people in your life to care about, to connect with, to invest in.

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Make the most of your relationship with your physicians, says Angela U. Tucker, MD, a family medicine physician with the Ohio State University Wexner Medical Center. Be organized when you go to your appointments with exactly what your concerns are and what symptoms have occurred since the problem started. If you feel that your health providers are not listening to you and have your best interest in mind, find someone who will. Your life may depend on it.

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Medicine has changed a lot in the previous 20 years, in terms of shifting focus toward improving quality of life, says Ariel B. Grobman, MD, a board-certified otolaryngologist with South Florida ENT Associates. In the past, people were encouraged to seek treatment and intervention when things were really bad. In my line of work, having one deaf ear was previously seen as not that big of a deal, after all, you have a second good ear. Nowadays, we strive to improve patients lives by restoring function to as normal a level as possible.

The Rx: Everyone has a right to live their best life, says Grobman. Prioritize your mental and physical health, talk openly with your physician about symptoms, and dont suffer in silence.

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Follow this link:
These Health Tips Could Save Your Life, According to Doctors - KYR News

The following article was written by Christine Bishara, MD who is the A4M member of the month, she practices preventive and personalized patient care, and believes in a proactive approach to healthcare.

Intermittent fasting has become the #1 dieting method and theres a valid reason. As someone who has done intermittent fasting for over 30 years, I have found it to be the most effective method of weight management.

As an obese teen, my impetus for change came the summer of my sophomore year of high school. My mom, sister and I had gone on a cruise to Bermuda. As is the protocol on these ships, the Captains Dance Night was one of the highlighted events. Just as the dance was starting, a stranger approached both my mom and older sister to dance, but they politely declined. He took a look at me and walked away. A few weeks later, I had my annual pediatrician appointment, which involved the dreaded getting on a scale. My pediatrician did not mince words. I still remember the exact words she said, as she told me I was sixty pounds overweight. I distinctly also remember her saying you will never be able to lose all this weight. Those were harsh words to hear as a 15-year-old. I am not sure why she said that to me, but in hindsight, maybe she knew me better than I knew myself. That summer, I set out to prove her wrong.

Initially, my plan involved consuming 1,000-1,200 calories daily. I often found myself hungry, so I started experimenting with eating more. I increased my caloric intake to approximately 1400-1600 per day, but started ending my meals earlier than usual and waiting as long as I could the next day before eating breakfast. Intermittent fasting was not even a thing back then, and in all reality, I was just trying to find a way to eat a little more and still lose weight. I soon discovered that my plan was working. That summer I lost 30 pounds.

It wasn't until I studied Biochemistry in medical school that I discovered why intermittent fasting is such an effective mechanism for weight loss and maintenance. Eventually, I managed to lose 70 pounds by the time I graduated and have kept my weight stable since then. We now know that there are many benefits to fasting and I believe its what has helped me stay relatively healthy with no medical problems.

Id love to share the reasons why its a great option for maintaining overall health. To do that, we will first need to understand the science behind it.

Autophagy: The word autophagy in Greek literally means eating oneself and this is exactly what happens when we fast. Think of autophagy as the low battery mode setting on your phone. Our bodies are constantly in survival mode, always trying to ensure that we have enough fuel for our cells to function. Autophagy works to protect us for as long as possible in case we encounter times when we don't have access to food. When in a fasting state, your body must reserve energy for its most vital functions, so it kicks into cleaning house mode. This means that any unnecessary components of our cells are lysed, or removed. Apoptosis-programmed cell death, also helps to save energy for the bodys most vital functions. Apoptosis and Autophagy are accelerated when we sleep and autophagy is initiated by fasting. Autophagy usually kicks in after 16-20 hours of fasting. The longer your body is in autophagy, the better. Since autophagy stimulates the death of certain cells or parts of cells, it can also program the death of dysregulated and dysfunctional cells that have gone haywire or have become prone to developing cancer.

Now let's discuss the types of fasting that allow us to benefit most from autophagy. There are two types of fasting - intermittent and prolonged.

Intermittent Fasting:

This is a loose term as there are several different methods. Ill focus on the three most effective ones:

Time-restricted:

This is my personal favorite. Time-restricted fasting and I have a long history together, so maybe Im a little biased in my love for it. This is also probably the most common method of intermittent fasting. It involves restricting the time of eating to a 6-8 hour window. I recommend that if you have not done this before, to start with twelve hours first. Although intermittent fasting is generally considered safe, there are some medical conditions where fasting is not recommended, and its always best to get the all-clear from your doctor before starting.

During the time-restricted fast, I recommend eating two meals and a snack, or- just two meals. Everyone is different, but I believe unless one is underweight, most people do not need to eat three square meals a day. You also want your meals to be at least 60-70% plant-based. Once you've mastered twelve hours, move on to fourteen, then sixteen hours and finally eighteen hours of caloric restriction. Ideally, you do not want to eat four hours before you sleep since the best time for autophagy to kick in is during that time.

5:2 day fast:

This fast consists of two days of fasting where you don't eat from 24 hours the day prior, For example, If your last meal was 7 pm the night before, you can fast till 7pm the next day and then eat a 500 calorie meal. The two days do not have to be consecutive, although its more effective when they are. During the 5 days of normal eating, the average person should not consume more than 2,100 calories, but this varies based on sex, weight and muscle mass.

Alternate day fast:

This is similar to the 5:2 day fast but, you're alternating normal calorie days with 3-4 fasting days of 500 calories. This is good in that it gives the sense of not being deprived of food on a regular basis.

Although the alternate day and 5:2 day fasts are a little more rigid, they are also beneficial since the longer a fast, the better the health results, especially when it comes to autophagy which is potentiated with longer fasts.

Prolonged fasting:

This is defined as fasting of longer than 2 consecutive days. The most common of these is a 3-5 day water fast, however, I do not recommend prolonged water fasts except under extreme circumstances and closely monitored by a physician. Risks are involved with long term water fasts, not to mention that they're also almost impossible to stick to. Last year, I was introduced to a safer and more effective method. I am not big on promoting anything, but I do believe in the science behind this particular diet called the Fasting Mimicking Diet (FMD) by Prolon. The goal of the FMD is to mimic a 5-day water fast, but while eating food. The benefits of prolonged fasts are sustained autophagy, weight loss and cell rejuvenation. The diet has been studied extensively and has been patented and proven to initiate cell renewal.

Now that weve explored how to fast and why its beneficial, let's discuss what happens to initiate this cascade of potentially life long health benefits.

Glycogenolysis and Gluconeogenesis

We have all experienced hunger sensations. Again, this is our bodys survival mode kicking in to make sure it receives adequate glucose for all its cells, at ALL times. Hunger is a good sensation. It is what prevents us from starving to death when we dont have food in front of us to remind us to eat. What makes it problematic is when that sensation occurs more frequently than wed like. We have all experienced that hunger feeling that hits late in the evening after we have eaten dinner and eventually entices us towards the pantry or fridge for a late-night snack.

Understanding the reason behind the cravings makes us better equipped to resist them.

So why does that hunger feeling kick in? Blame it on Insulin, the hormone responsible for facilitating glucose transport into our cells. Insulin needs to do its job, so when your body runs out of carbohydrates consumed from food, it knows it has to alert you to bring in more fuel. Here's the trick though-Insulin didnt get the memo that our bodies have a backup plan. Enter Insulins arch-enemy, the hormone, Glucagon. When insulin is up, Glucagon is down and vice versa. Although they are opposites, they're both essentially fighting for the bodys survival, but through different means. The role of Insulin and Glucagon is to ensure that cells receive fuel at all times. So, when insulin drops, it stimulates the hunger pathway urging you to eat. What happens when you ignore that urge? The levels drop and in comes Glucagon. Glucagons job is to get fuel to the cells when we dont eat. It does this in two ways:

Glycogenolysis:

Your liver has a stored supply of glycogen (roughly 1200 calories worth) which can be converted to glucose for cells. The body starts to utilize glycogen stores after about 8-10 hours of fasting. When Insulin levels decrease and hunger signals are ignored, Glucagon alerts your liver to start using stored glycogen for fuel, hence the word LYSIS, meaning to "break down." This is why when you go to bed hungry, you don't usually wake up hungry since your body has utilized other means to feed its cells.

Gluconeogenesis.

Additionally, our bodies are able to make glucose for cells by activating a mechanism called Gluconeogenesis. The word genesis here means "to create" and in this case, the body creates glucose. In order to do this, the body resorts to fat burning for fuel and we enter into a state of ketosis.

These mechanisms have many health benefits including stabilization of blood glucose levels and prevention of insulin resistance, a condition caused by consistent stimulation of Insulin release throughout the day.

Here are my tips on how to start your fasting journey:

1- Find a doctor who can effectively rule out any contraindications to fasting. Its good to have bloodwork taken to monitor progress.

2- Pick a type of intermittent fasting and resolve to do it 80% of the time. You can experiment with the different types to see what works best for you.

3- At least two to three times a year, consider doing a prolonged fasting-mimicking diet to get all the benefits of cell renewal through autophagy.

I hope this helps. Cheers till next time.

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The Benefits of Intermittent And Prolonged Fasting - Anti Aging News

In SOLAR-1 final analysis, Piqray (alpelisib) plus fulvestrant demonstrated 8 months clinically relevant improvement in overall survival (OS) in HR+/HER2- advanced breast cancer (aBC) patients with a PIK3CA mutation compared to fulvestrant alone1

14+ months OS improvement was achieved in patients with lung or liver metastases, which are observed in 41% of postmenopausal women with HR+ aBC, and considered more aggressive and challenging to treat1-3

Data add to growing body of evidence for Piqray, the first and only treatment specifically approved for aBC with a PIK3CA mutation

Basel, September 19, 2020 Novartis today announced results of the final overall survival (OS) analysis from the SOLAR-1 trial, which evaluated Piqray (alpelisib) in combination with fulvestrant, compared to fulvestrant alone, in hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2-) advanced breast cancer patients with tumors harboring a PIK3CA mutation. Piqray is the only treatment approved in Europe, the United States and 15 other countries specifically for people with HR+/HER2- advanced breast cancer with a PIK3CA mutation. These data will be presented as a late-breaking oral presentation during the ESMO Virtual Congress 2020.

In the study, there was a clinically relevant improvement in OS of eight months for patients with a PIK3CA mutation taking Piqray plus fulvestrant compared to fulvestrant alone (median OS 39.3 months vs. 31.4 months; one-sided p0.0161; HR=0.86; 95% CI: 0.64-1.15; p=0.15)1. This difference did not reach the prespecified threshold of statistical significance set for the secondary objective of OS in patients with PIK3CA-mutated breast cancer. A more than 14 month OS improvement was observed in patients with lung or liver metastases, which signify more aggressive disease (median OS 37.2 months vs. 22.8 months; HR=0.68; 95% CI: 0.46-1.00)1-3.

These results build on previous data showing that alpelisib nearly doubled median progression-free survival in this patient population, said Fabrice Andr, MD, PhD, research director and head of INSERM Unit U981, professor in the Department of Medical Oncology at Institut Gustave Roussy in Villejuif, France, and global SOLAR-1 principal investigator. Patients whose tumors have a PIK3CA mutation, particularly those with lung or liver metastases, have a more aggressive, harder to treat cancer, so these results showing alpelisib offers longer life, are promising.In addition, data showed the need for chemotherapy was delayed in patients taking Piqray plus fulvestrant by nine months compared to those taking fulvestrant alone (23.3 months vs. 14.8 months; HR=0.72; 95% CI: 0.54-0.95)1. Quality of life (QOL) was maintained for people taking Piqray plus fulvestrant.

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These data demonstrating survival benefit give the 40% of HR+/HER2- advanced breast cancer patients with PIK3CA mutations in their tumors more time to spend with loved ones and do what they value most, said Susanne Schaffert, PhD, President, Novartis Oncology. We are committed to reimagining a world where advanced breast cancer becomes a curable disease, and these data reinforce our confidence as we continue to explore the potential use of Piqray in other types of breast cancer with PIK3CA mutations.

No new safety signals were observed; adverse events were consistent with previously reported SOLAR-1 results.

Visit https://www.virtualcongress.novartis.com/ESMO20 for the latest information from Novartis including our bold approach to reimagining cancer care, and access to our ESMO Virtual Congress 2020 symposia and data presentations (for registered participants).

In July 2020, the European Commission (EC) approved Piqray in combination with fulvestrant for the treatment of postmenopausal women, and men, with HR+/HER2- locally advanced or metastatic breast cancer with a PIK3CA mutation after disease progression following endocrine therapy as monotherapy.

About Piqray (alpelisib)Piqray is a kinase inhibitor developed for use in combination with fulvestrant for the treatment of postmenopausal women, and men, with HR+/HER2-, PIK3CA-mutated, advanced or metastatic breast cancer following progression on or after endocrine-based regimen. Piqray is approved in 48 countries, including the US and European member states.

About SOLAR-1SOLAR-1 is a global, Phase III, randomized, double-blind, placebo-controlled trial studying Piqray in combination with fulvestrant for postmenopausal women, and men, with PIK3CA-mutated HR+/HER2- advanced or metastatic breast cancer that progressed on or following aromatase inhibitor treatment with or without a CDK4/6 inhibitor7-9.

The trial randomized 572 patients. Patients were allocated based on central tumor tissue assessment to either a PIK3CA-mutated cohort (n=341) or a PIK3CA non-mutated cohort (n=231). Within each cohort, patients were randomized in a 1:1 ratio to receive continuous oral treatment with Piqray (300 mg once daily) plus fulvestrant (500 mg every 28 days + Cycle 1 Day 15) or placebo plus fulvestrant. Stratification was based on visceral metastases and prior CDK4/6 inhibitor treatment7-9. Patients and investigators are blinded to PIK3CA mutation status and treatment.

The primary endpoint is local investigator assessed PFS using RECIST 1.1 for patients with a PIK3CA mutation. The key secondary endpoint is overall survival, and additional secondary endpoints include, but are not limited to, overall response rate, clinical benefit rate, health-related quality of life, efficacy in PIK3CA non-mutated cohort, safety and tolerability7-9.

About Novartis in Advanced Breast CancerNovartis tackles breast cancer with superior science, collaboration and a passion for transforming patient care. We've taken a bold approach to our research by including patient populations often neglected in clinical trials, identifying new pathways or mutations that may play a role in disease progression and developing therapies that not only maintain, but also improve, quality of life for patients. Our priority over the past 30 years and today is to deliver treatments proven to improve and extend lives for those diagnosed with advanced breast cancer.

Important Safety Information from the PIQRAY EU SmPC The most common ADRs and the most common grade 3 / 4 ADRs (reported at a frequency >20% and 2%, respectively) were plasma glucose increased, creatinine increased, gamma-glutamyltransferase increased, rash, lymphocyte count decreased, nausea, alanine aminotransferase increased, anaemia, fatigue, lipase increased, decreased appetite*, stomatitis, vomiting*, weight decreased, hypocalcaemia, plasma glucose decreased*, activated partial thromboplastin time prolonged*, alopecia**, diarrhoea, hypokalaemia, hypertension, nausea, creatinine increased, and mucosal inflammation (*<2% grade 3/4 ADRs reported, ** no grade 3/4 ADRs reported).

Piqray can cause serious side effects such as severe hypersensitivity, severe cutaneous reactions, hyperglycaemia, pneumonitis, diarrhoea and osteonecrosis of the jaw.

The following should be taken into consideration prior to or during treatment with Piqray:

Piqray should be permanently discontinued in patients with serious hypersensitivity reactions.

Piqray should not be initiated in patients with a history of severe cutaneous reactions, should be interrupted if signs or symptoms of severe cutaneous reactions are present, and permanently discontinued if a severe cutaneous reaction is confirmed.

Fasting glucose and HbA1c levels should be monitored frequently in the first 4 weeks of treatment, and patients should be advised of the signs and symptoms of hyperglycaemia.

In case of new or worsening respiratory symptoms, the patient should be evaluated for pneumonitis.

Patients should be advised to notify their physician if diarrhoea occurs.

Caution should be exercised when Piqray and bisphosphonates or denosumab are used together or sequentially. Piqray should not be initiated in patients with ongoing osteonecrosis of the jaw.

The efficacy and safety of Piqray has not been studied in patients with symptomatic visceral disease.

Animal studies suggest that Piqray may cause fetal harm in pregnant women. Therefore, as a precaution, women of childbearing potential should use effective contraception while receiving Piqray during treatment and at least 1 week after stopping treatment. Women should not breast feed for at least 1 week after the last dose of Piqray. Piqray may affect fertility in males and females.

Please see full Prescribing Information for Piqray, available at http://www.Piqray.com.

DisclaimerThis press release contains forward-looking statements within the meaning of the United States Private Securities Litigation Reform Act of 1995. Forward-looking statements can generally be identified by words such as potential, can, will, plan, may, could, would, expect, anticipate, seek, look forward, believe, committed, investigational, pipeline, launch, or similar terms, or by express or implied discussions regarding potential marketing approvals, new indications or labeling for the investigational or approved products described in this press release, or regarding potential future revenues from such products. You should not place undue reliance on these statements. Such forward-looking statements are based on our current beliefs and expectations regarding future events, and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those set forth in the forward-looking statements. There can be no guarantee that the investigational or approved products described in this press release will be submitted or approved for sale or for any additional indications or labeling in any market, or at any particular time. Nor can there be any guarantee that such products will be commercially successful in the future. In particular, our expectations regarding such products could be affected by, among other things, the uncertainties inherent in research and development, including clinical trial results and additional analysis of existing clinical data; regulatory actions or delays or government regulation generally; global trends toward health care cost containment, including government, payor and general public pricing and reimbursement pressures and requirements for increased pricing transparency; our ability to obtain or maintain proprietary intellectual property protection; the particular prescribing preferences of physicians and patients; general political, economic and business conditions, including the effects of and efforts to mitigate pandemic diseases such as COVID-19; safety, quality, data integrity or manufacturing issues; potential or actual data security and data privacy breaches, or disruptions of our information technology systems, and other risks and factors referred to in Novartis AGs current Form 20-F on file with the US Securities and Exchange Commission. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.

About NovartisNovartis is reimagining medicine to improve and extend peoples lives. As a leading global medicines company, we use innovative science and digital technologies to create transformative treatments in areas of great medical need. In our quest to find new medicines, we consistently rank among the worlds top companies investing in research and development. Novartis products reach nearly 800 million people globally and we are finding innovative ways to expand access to our latest treatments. About 109,000 people of more than 140 nationalities work at Novartis around the world. Find out more athttps://www.novartis.com.

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References1. Andr F, Ciruelos EM, Juric D, et al. Overall Survival (OS) Results From SOLAR-1, a Phase 3 Study of Alpelisib (ALP) + Fulvestrant (FUL) for Hormone Receptor-Positive (HR+), Human Epidermal Growth Factor Receptor 2-Negative (HER2) Advanced Breast Cancer (ABC). Presented at the European Society for Medical Oncology (ESMO) Congress, September 19, 2020 (LBA18).2. Harb, WA. Management of patients with hormone receptor-positive breast cancer with visceral disease: challenges and treatment options. Cancer Manag Res. 2015;7:37-46.3. Wang R, Zhu Y, Liu X, et al. The Clinicopathological features and survival outcomes of patients with different metastatic sites in stage IV breast cancer. BMC Cancer. 2019;19(1):1091.4. The Cancer Genome Atlas Network. Comprehensive molecular portraits of human breast tumours. Nature. 2012;490(7418):61-70.5. Miller TW, Rexer BN, Garrett JT, Arteaga CL. Mutations in the phosphatidylinositol 3-kinase pathway: role in tumor progression and therapeutic implications in breast cancer. Breast Cancer Res. 2011.6. Saal LH, Johansson P, Holm K, et al. Poor prognosis in carcinoma is associated with a gene expression signature of aberrant PTEN tumor suppressor pathway activity. Proc Natl Acad Sci U S A. 2007;104(18):7564-7569.7. Piqray (alpelisib) Prescribing Information. East Hanover, New Jersey, USA: Novartis Pharmaceuticals Corporation; May 2019.8. Andr F, Ciruelos E, Rubovszky G. Alpelisib for PIK3CA-Mutated, Hormone-Receptor-Positive Advanced Breast Cancer. N Eng J Med. 2019.9. Andr F, Ciruelos EM, Rubovszky G et al. Alpelisib (ALP) + fulvestrant (FUL) for advanced breast cancer (ABC): Results of the phase III SOLAR-1 trial. Annals of Oncology, Vol 29, Suppl 8, October 2018, Abstract LBA3_PR.

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Novartis Piqray data show survival benefit for patients with HR+/HER2- advanced breast cancer with a PIK3CA mutation - Yahoo Finance

A treat here or there is no big deal, but eating dessert every day could hinder your health and weight-loss goals.

Image Credit: LIVESTRONG.com Creative

Maybe you always find yourself reaching for a peanut butter cup when the late afternoon slump hits and you're dragging. Maybe you tend to top off dinner with a cookie (or two, or three). Or perhaps you're hooked on your mid-morning mocha latte, which, let's face it, has a lot more in common with dessert than a cup of coffee.

Yeah, you know sugar's not the best thing in the world for you but if you've got a sweet tooth, it's pretty darn hard to resist.

So just how harmful (or not) is eating dessert on a daily basis? The short answer is that it depends. Read on for the breakdown.

Not All Sugar Is Created Equal

First, it's important to keep in mind that your body processes a bowl of berries very differently than a bowl of ice cream.

"The natural sugar in fruit comes bound in fiber as well as a host of phenols, polyphenols, antioxidants and phytochemicals that have a compensatory benefit," says family physician Joel Fuhrman, MD, author of Eat for Life. "These substances support the growth of healthy bacteria in the gut, which eats up some of that sugar and slows its entry into the bloodstream."

It's a different story for added sugars. "As opposed to the slow and steady caloric release associated with low-glycemic foods, sugar calories rush rapidly into your bloodstream because they are not accompanied by fiber," Dr. Fuhrman says.

For example, when you eat an apple, one or two calories a minute will enter your bloodstream over the next three hours, according to Dr. Fuhrman. Eating a chocolate bar, on the other hand, could shunt 40 sugar calories per minute into your bloodstream, causing a spike in glucose much higher than your body is able to burn for energy.

OK, so a slice of cake isn't the best thing for your body. Still, you might think, what's the big deal about having just one treat a day? Everything in moderation, right? But added sugar is already hiding in so many of the foods we eat.

According to the University of California San Francisco (UCSF), 74 percent of packaged food contains added sugar, so it's easy to go overboard without realizing it. Although the American Heart Association recommends limiting added sugar to 6 to 9 teaspoons daily, the average American consumes a whopping 17 teaspoons a day. (That's 57 pounds a year!)

One of the issues with this excess sugar is that it leads to overeating. Per UCSF, high levels of sugar in the blood create a resistance to leptin, a naturally occurring hormone that tells your brain when you're full. As a result, your brain doesn't get the message that it's time to stop eating.

What's more, sweets are hard to put down. "They stimulate the same dopamine receptors in the central nervous system that are activated by narcotic use," Dr. Fuhrman says. "As you keep eating sweets, you require a higher and higher sugar hit to get the same dopamine stimulation, and the cravings can be hard to control."

You also become habituated to sweet flavors. "Eating highly sweetened substances deadens your taste buds," Dr. Fuhrman says. "Because your threshold for sweetness has been lowered, you need a higher degree of sugar to get the same taste sensations."

You may find, for example, that naturally sweet fruits and veggies taste flat; you can no longer appreciate a deliciously ripe strawberry or peach.

An occasional indulgence is one thing, but too much added sugar on the regular can lead to a host of health problems.

Image Credit: itakdalee/iStock/GettyImages

The Problem With Too Much Sugar

Before you bite into that chocolate chip cookie, let's talk about how your body responds to a high-sugar diet.

It Can Lead to Weight Gain

Even if you opt for a fat-free treat like sorbet or Swedish Fish, sugar is one of the fastest ways to pile on pounds. How come? Eating sugar spikes glucose in the bloodstream.

"Your body responds to this influx of glucose by secreting more of the hormone insulin, which drives sugar calories into fat cells," says Dr. Fuhrman.

With a surplus of fat cells in your body, you'll likely notice the number on the scale start creeping up. Indeed, a December 2017 analysis in Obesity Facts confirmed a link between obesity and sugar-sweetened beverages.

Youre More Prone to Chronic Health Conditions

According to the UCSF, long-term consumption of large quantities of sugar can damage your organs, including your pancreas and liver, and lead to high blood pressure and high cholesterol.

But that's not all. An April 2014 article in Diabetes Care suggests that sugar intake is linked to type 2 diabetes, heart disease, metabolic syndrome and fatty liver disease. Plus, a 2014 study in JAMA Internal Medicine found a connection between sugar and death from cardiovascular disease, regardless of body weight.

Another thing that's not so sweet about dessert? A July 2016 study in the Journal of the American Academy of Dermatology (AAD) revealed a link between a high-sugar diet and acne. According to the AAD, spikes in blood sugar increase inflammation and the production of sebum (an oily substance found on the skin), two contributing factors that lead to zits.

Your shut-eye could be compromised if you go heavy on the sweet stuff. Eating sugar was linked to lighter, less restorative sleep with more nighttime awakenings in a small study published January 2016 in the Journal of Clinical Sleep Medicine.

People with a high-glycemic diet spend a shorter time in slow-wave sleep, which is key for memory consolidation, cognitive function and growth hormone secretion, according to the American Sleep Association. And remember that some types of dessert, like chocolate, also contain caffeine, which further disturbs your zzzs.

Sugar Can Affect Your Mood

It turns out having dessert won't put a smile on your face: A July 2017 study in Scientific Reports suggests that habitual intake of treats is related to depression and other mood disorders.

Even if you don't have full-blown depression, December 2016 research in the journal Appetite found that people who eat a lot of sweets and carbs tend to be less energetic and alert than folks who stick to low-sugar foods.

Its Bad for Your Brain

"The spike of sugar in your bloodstream accelerates brain damage," Dr. Fuhrman says. "It has been linked to loss of brain cells, poor neurologic function and diminished neuroplasticity."

Indeed, an August 2013 study in The New England Journal of Medicine found that people with higher glucose levels were at greater risk of dementia.

4 Ways to Satisfy Your Sweet Tooth in a Healthy Way

You don't have to cut out sugar entirely, but you can be more strategic about how and when you eat it. These tips can all help lessen sugar's negative effects.

1. Indulge at the End of the Meal

"When you eat a piece of fruit or a small dessert right after dinner, you are also eating other nutritious food along with the meal," Dr. Fuhrman says. "As a result, the glycemic effect is somewhat lessened as opposed to if you just sat down and had a big dessert on its own."

2. Divide Your Dessert into Serving Sizes

"You'll be less likely to succumb to cravings and overeat," Dr. Fuhrman says.

3. Use Fruit as Sweetener

"You'll get just as much flavor with no added sugar and high levels of fiber," Dr. Fuhrman says.

He suggests mashing up one to two dates or dried apricots per dessert serving. Mashed bananas or frozen cherries also work well. One yummy idea to try? Dr. Fuhrman's "vanilla ice cream:" blend a frozen banana with vanilla bean powder and soaked walnuts.

4. Savor a Piece of Chocolate

"Two-thirds of our tongue is covered with sweet receptors, so we are designed to seek out the flavor of sweetness," says heart surgeon and pioneer in nutrition Steve Gundry, MD, author of the upcoming book The Energy Paradox. "I advise people to slowly eat a single square of dark chocolate 72 percent cacao or above by literally letting it melt on your tongue."

That way, you'll get maximum flavor and minimal sugar. Win-win!

So, How Bad Is It Really to Eat Dessert Every Day?

We hate to leave a bad taste in your mouth, but if your daily treat is pushing your sugar intake past the healthy range, then it could be taking a serious toll on your health.

But here's a silver lining: If you follow the guidelines above, you can satisfy your sugar cravings while still being sweet to your body.

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Is It Bad to Eat Dessert Every Day? - LIVESTRONG.COM

Diabetes is one of the leading causes of death across the globe. Its treatment and management of optimal blood sugar levels are tiresome for the patient and their family. Especially for the patients that are suffering from type-1 diabetes.

Furthermore, AI technology provides an easy means of treating a diabetic patient according to the latest studies, particularly during pandemics.

Diabetes is a disease in which your body is unable either to produce insulin or to respond to existing insulin. Insulin is a hormone that works to regulate blood sugar levels along with glucagon.

Insulin enables the bodys tissues and muscles to uptake glucose from the blood and maintains blood glucose levels within the normal range, a process lacking in diabetes patients.

Either glucose forms energy in the form of ATP by tissues, or the storage of glucose may occur. Moreover, deficiency of insulin results in hyperglycemia. Unlike diabetes, hyperglycemia is a condition in which blood glucose levels rise above the normal range.

Persistent hyperglycemia in diabetic patients leads to complications. Added to that, it can cause blindness, kidney failure, heart attacks, stroke, limb amputation, and death.

ALSO READ:A Straw To The Drowning Liquified Diet Forces Diabetes Into Remission

There are three major types of diabetes. Type-1 diabetes, or juvenile diabetes, also known as insulin-dependent diabetes, occurs at an early age. It involves the administration of insulin injection in patients.

Type-2 diabetes, also known as insulin-independent diabetes, occurs at an older age.

Gestational diabetes occurs in women during pregnancy. Women may or may not be able to overcome it after childbirth. Proper physical activity, a healthy diet, regular exercise, and anti-diabetic drugs enable the diabetic patient to control elevations of blood glucose effectively.

Artificial intelligence technology is the intelligence of machines. It has many applications in daily life, business, medicine, agriculture, space exploration, autonomous vehicles, and artificial creativity. Moreover, it is helpful in medical diagnosis, electronic trading platforms, robot control, and remote sensing.

All the relevant information regarding a particular application is installed into the machines associated with AI technology. Added to that, AI in healthcare is capable of evaluating CT scans or EKGs, as well as plays a vital role in monitoring diabetes patients.

AI technology is able to calculate the precise dosage according to an individual patient, particularly helpful in treating diabetes patients. Moreover, research is being carried out to develop AI technology that can assist doctors in the treatment of cancer patients.

Surgeons at the Childrens National Medical Center, in Washington, in a recent study demonstrated successful surgery with an autonomous robot. IBM has created IBM Watson, its own artificial intelligence computer. Furthermore, it has successfully proven itself in the field of healthcare.

AI in healthcare has certain other applications. This includes AI for heart sound analysis, tumor detection, design treatment plans, provide consultations, and drug creation. Added to that, AI enables us to predict HIV progression and predict the likelihood of death from surgical procedures.

The life of a diabetic patient is somewhat tiresome as being a diabetic patient you need to monitor your glucose levels on regular bases. Moreover, physical activity and diet need to be planned according to the current condition of a diabetic patient.

Furthermore, to make a diabetic patients life easier the NextDREAM Consortium group designed an automated AI-based decision-support-system, the DreaMed Advisor.

ALSO READ:Modern Science: Artificial Intelligence can Help Diagnose Your Health Conditions via Selfies

Moreover, the group conducted a six-month study to assess the efficacy and safety of DreaMed Advisor. In this study, they made a comparison between consultations given by AI-based decision-support systems and physician-guided recommendations.

The study was published in Nature Medicine. The result of the study was that the DreaMed Advisor was able to control glucose levels of the diabetic patient. Somewhat a physician with diabetes expertise would control.

DreaMed Advisor an AI-based decision-support technology, provides a standard way to manage insulin therapy for diabetic patients. Moreover, it acts as a full-time personalized medical advisor, especially ideal for type-1 diabetic patients. DreaMed Advisor dose adjustment is as effective as an expert physician dose adjustment.

Original post:
AI Technology Can Cause Remission of Diabetes - Health Writeups

DAYTON, Ohio (WDTN) At the start of the pandemic, with gyms closed and staying home becoming more of a norm, personal health and fitness goals may have fallen by the wayside.Sports medicine physician with Premier Health, Dr. Aloiya Earl, said some people are still battling the unpleasant side effects of those unhealthy habits, and she said its not too late to get back on track.

Were sitting with our pantry and our refrigerator very accessible, right there, everyday. So it was a very common thing that many people gained weight during the early part of the pandemic and are still struggling with that.

Earl said those whove fallen victim to losing sight of their health goals and stress eating are not alone, explaining that people often find comfort in indulging in tasty, and often unhealthy foods.

When our bodies are stressed, it increases a hormone in our bodies called cortisol, Earl said. Its called the stress hormone, and it makes us crave calories for one, but specifically, it makes us crave like processed, carbohydrate, refined, sugary-type calories. Those things that are sitting our cupboard that are really easy to just grab like chips and sweets, candies.

While theyre satisfying in the moment, they dont offer many positives down the line.

They kind of quell your stress very short-term, but long-term, it can kind of lead to more of that weight gain and even more stress as a snowball effect, Earl said.

She said thats because after enjoying those sweets and unhealthy options, physical changes could give way to emotional ones.

The psychological toll is a really important thing to consider because not only are we dealing with this pandemic, something that none of us has ever with before, which is stressful in and of itself, were dealing now with the anxiety over our own behaviors during the pandemic.

She added, with some people losing or having to switch jobs, as well as the sudden change in exercise and eating habits, a whole new layer of psychological stress begins to develop. But there are feasible options for getting back on track, starting with adopting healthy eating habits.

Manager of The Culinary Center at Dorothy Lane Market, Peggy Neary, said making healthy choices isnt difficult, but requires dedication to small, consistent changes.

Whole wheat pasta rather than just regular pasta is a great idea. Theres more fiber in it, or better for you. Stick to whole grains, Neary said. Make your own salad dressing. Put vegetables on your sandwiches. Use whole grain bread. Things like that.

She added, substitution for your favorite foods is key to remaining motivated, trading sugary foods like ice cream for plain yogurt with berries, or another healthy alternative youre sure to enjoy.

Snack-wise, you can make your own granola. Popcorn is probably a great snack especially if you make it yourself and of course limit the butter, Neary said.

When in doubt she added, starting in the produce section and shopping the perimeter of most grocery stores will offer exposure to options that more closely align with health goals in comparison to other items in the store.

Filling your pantry with healthy food items and purging sugary, salty and processed foods can help cement these changes.

Dr. Earl said if youve fallen off the bandwagon, walking is an easy and effective way to burn fat while doing other activities, like listening to music or podcasts, or talking to a friend. This can serve as a launch pad to new, healthier activities in the future.

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Premier Health physician says stress eating is common during pandemic, offers tips for healthier habits - WDTN.com

Administration of the CDK4/6 inhibitor, abemaciclib, in combination with standard endocrine therapy to patients with high-risk, hormone receptor-positive, HER2-negative, early-stage breast cancer following completion of primary treatment was associated with an approximately 25% reduction in the risk of developing a recurrence of invasive disease, according to results of a preplanned interim analysis of a phase 3 study. These findings were presented at the European Society of Medical Oncology (ESMO) Virtual Congress 2020 and simultaneously published in the Journal of Clinical Oncology.1,2

Despite high rates of cure in patients with early-stage invasive breast cancer treated with standard therapies, such as chemotherapy, radiation therapy, and endocrine therapy, a substantial minority of patients with disease characterized by high-risk features, such as 4 or more positive lymph nodes, histologic grade 3 disease, and large tumor size, will experience disease recurrence. Hence, there is a need for new therapeutic approaches in this setting.

Abemaciclib plus endocrine therapy in the adjuvant setting is was explored based on its efficacy and safety in the metastatic setting in this breast cancer subtype.

This study was an open-label phase 3 trial (monarchE; ClinicalTrials.gov Identifier: NCT03155997) in which adult patients with high-risk, early-stage, hormone receptor-positive, HER2-negative invasive breast cancer were randomly assigned in a 1:1 ratio to receive adjuvant endocrine therapy either alone or in combination with the CDK4/6 inhibitor, abemaciclib, with the latter agent administered for 2 years following completion of primary therapy (that must have included surgery).

High-risk disease was characterized by 4 or more positive lymph nodes, or 1 to 3 positive lymph nodes in the setting of a tumor of at least 5 cm, grade 3 or centrally confirmed Ki-67 expression of at least 20% in untreated breast tissue.

The primary study endpoint was invasive disease-free survival (IDFS), with secondary study endpoints including distant relapse-free survival (DRFS), overall survival (OS), and safety.

The 5637 patients in the intention-to-treat (ITT) population were stratified according to prior chemotherapy, menopausal status, and region of treatment. Choice of standard endocrine therapy was based on physician choice.

The median patient age was 51 years, more than 99% of patients were female, and nearly 95% had received either neoadjuvant (37%) or adjuvant chemotherapy (approximately 58%) at baseline.

At a median follow-up of 15.5 months, there was a significantly higher rate of 2-year IDFS in patients receiving abemaciclib plus endocrine therapy (92.2%) compared with endocrine therapy alone (88.7%), with a hazard ratio (HR) for IDFS of 0.747 (95% CI, 0.598-0.932; P =.0096).

Furthermore, this benefit was observed across all prespecified subgroups, including whether patients had received prior chemotherapy or not, and whether they were classified as pre- or postmenopausal.

Similarly, 2-year DRFS was 93.6% for patients treated with the combination vs 90.3% for those receiving endocrine therapy alone, with a HR for DRFS of 0.717 (95% CI, 0.559-0.920). Thus, the risk of recurrence was reduced by 28.3%. This represents a 3.3% absolute difference. According to the presentation slides, the greatest reduction in distant metastases was to the liver and bone.

Regarding safety, no new safety signals were associated with administration of abemaciclib in the adjuvant setting compared with its US Food and Drug Administration (FDA)-approved use in combination with endocrine therapy in patients with advanced hormone receptor-positive, HER2-negative disease.3

Specifically, grade 3 or higher diarrhea, neutropenia, and leukopenia were more common in patients treated with combination therapy. In addition, the incidences of venous thrombotic events, interstitial lung disease and febrile neutropenia, AEs of interest, were more frequent in patients treated with abemaciclib, but low in both study arms. Interestingly, the frequency of all-grade arthralgia and hot flushes were lower in the combination arm compared with endocrine therapy alone. The treatment discontinuation rates due to adverse events in the abemaciclib and control arms were 16.6% and 0.8%, respectively.

In his concluding remarks, presenter Stephen R. Johnston, MD, professor of breast cancer medicine at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom, stated that abemaciclib is the first CDK4/6 inhibitor to show a significant improvement in IDFS when combined with endocrine therapy in patients with hormone-positive early-breast cancer.1

According to an ESMO press release on the findings from this study, Giuseppe Curigliano, MD, PhD, associate professor of medical oncology at the University of Milan, Italy, and chair of the ESMO Guidelines Committee, noted that for the future it will be important to understand if we can potentially spare chemotherapy in this group of patients treated with a CDK4/6 inhibitor. This would need to be investigated in a [randomized] clinical trial.4

Disclosures: Research funding for this study was provided by Eli Lilly and Co. Some of the presenters reported financial relationships with the pharmaceutical industry. For a full list of disclosures, please refer to the original abstract.

Read more of Cancer Therapy Advisors coverage of the ESMO Virtual Congress 2020 by visiting the conference page.

References

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Addition of a CDK4/6 Inhibitor to Adjuvant Endocrine Therapy Improves Outcomes in HR+, HER2-, High-Risk Early Breast Cancer - Cancer Therapy Advisor

Sweating a ton can truly be the pits. Just ask country pop-singer and reality star Jessie James Decker, who recently posted a photo to her Instagram airing out her own troubles with excess sweat.

The 32-year-old candidly showed her fans what happens after spending a day talking to the press on Zoom from the comfort of her own home: a whole lot of armpit sweat. In fact, Decker (who recently released a cookbook) posed for the image complete with what appears to be toilet paper (or maybe napkins?) wadded up against her underarms. While it makes for a pretty funny post, the fact is that excessive perspiration is a problem encountered by many people, and maybe its time someone drew attention to it.

Excessive sweating is also known as hyperhidrosis and affects about 4.8 percent of the U.S. population. The condition can be spread throughout your body, or it may be localized in certain areas. Some common areas in which to experience excess sweat include the palms of your hands, the soles of your feet, your face, and as in Deckers case, your armpits.

While everyone sweats to a certain extent (especially after exercise, when its particularly hot out, or even when youre nervous), if it goes beyond that, then youre dealing with at least primary hyperhidrosis. That means that you can be sitting on the couch watching television and feel sweat collecting on your forehead or suddenly see your palms dripping when youre simply driving home from work with the air conditioning on.

Secondary hyperhidrosis, however, means theres actually an underlying condition thats causing your body to produce more sweat than is needed to simply cool down the body. While Decker didnt share more details about why she may be sweating so much (from the post, it sounds like shes still unsure), these are some of the conditions that can be associated with an overproduction of sweat: glucose control disorders, lung disease, stroke, menopause, tuberculosis, Parkinson's disease and hormone-related conditions like an overactive thyroid, pheochromocytoma (a tumor on the adrenal gland tumor) and acromegaly. It can also point to cancer, as well as carcinoid syndrome (when a tumor releases chemicals into the bloodstream). But sometimes its simply due to an anxiety disorder or due to the use of certain medications, as well as to substance abuse.

If, like Decker, youre bothered by your bodys excess sweat, its likely time to go and see a doctor. A physician may request a number of tests, including a starch iodine test (which turns sweat brown in order to more easily track just how much youre sweating and whether any of it is beyond the usual), as well as use of a vapometer, which measures how much water is lost via your feet, scalp, hands, and armpits. Blood work and imaging tests might also be ordered if hormone issues or tumors are suspected.

The good news for folks like Decker is that once the root cause is determined, there are a number of ways to try and alleviate symptoms. For excess underarm sweat (as in Deckers case), a stronger prescription antiperspirant may just do the trick. There are also prescription creams to try, as well as nerve-blocking medications that may reduce sweat, and botulinum toxin injections (such as Botox) which can serve as temporary nerve blocks. In more severe cases, individuals may consider surgical remedies such as sweat gland removal (for underarms), and nerve surgery (for extremely sweaty hands and a few other areas).

If youre not ready to make such a drastic commitment, lifestyle changes like wearing shoes, socks, and clothing made of natural materials like cotton, leather, silk, and wool; as well as daily bathing, using astringents on sweaty areas, and relaxation techniques (if your sweating is anxiety-related) may all be helpful. But if youre in a pinch, Deckers napkins under the pits technique might at least help get you by.

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Adding the CDK4/6 inhibitor abemaciclib (Verzenio) to endocrine therapy significantly reduces the risk of early recurrence in high-risk hormone receptor positive (HR+), human epidermal growth factor receptor 2 (HER2)-negative breast cancer, suggests a preplanned interim analysis of a phase 3 trial.

The research was presented September 19 at the ESMO Virtual Congress 2020 and simultaneously published in the Journal of Clinical Oncology.

The monarchE trial compared 2 years of abemaciclib plus endocrine therapy vs endocrine therapy alone among 5600 patients and found that the combination was associated with a 25% relative risk reduction in the primary endpoint invasive disease-free survival (P =.0096; HR, 0.75; 95% CI, 0.60 - 0.93)

At 2 years, the rate of invasive disease-free survival was 92.2% in the abemaciclib arm vs 88.7% in the group that took endocrine therapy alone.

"This is the first time in more than 20 years that we have seen an advance in the adjuvant treatment of this form of breast cancer," said lead investigator Stephen Johnston, MD, PhD, from the Royal Marsden Hospital NHS Foundation Trust in London, UK, in a meeting press release.

Dr Stephen Johnston

He told Medscape Medical News that the high-risk patients in their study "are predicted to relapse quite quickly," as a result of having a degree of endocrine resistance, "and by intervening early we are stopping these recurrences within the first 2 years."

He continued: "The key issueis whether you need 2 years of treatment or perhaps even longer. One other trial is looking at 3 years with another drug and we'll just have to await further follow-up of the data to see if the [monarchE] curves continue to separate while on treatment."

According to Giuseppe Curigliano, MD, PhD, head of the Division of Early Drug Development at the European Institute of Oncology, Milan, Italy, "This is a very important trial and the findings will change practice. Once approved for high risk HR+ HER2-negative early breast cancer, the new standard of care for these patients will be to add two years of abemaciclib to endocrine therapy."

Curigliano, who was not involved with the study, further commented during a meeting press conference that a randomized trial will be needed to answer a new important question: Can these high-risk patients treated with a CDK4/6 inhibitor be spared chemotherapy?

Investigator Johnston pointed out that many patients diagnosed with HR+, HER-2 breast cancer will not experience recurrence with standard-of-care therapies.

But he also explained "that up to 20% may develop recurrence or distant relapse in the first 10 years," and that the risk of recurrence is "much greater" for patients who have high-risk clinical or pathological features, "especially during the first few years on their adjuvant endocrine therapy."

Abemaciclib was approved by the US Food and Drug Administration in 2017 and is approved in combination with the endocrine therapy fulvestrant for the treatment of HR+, HER2-negative advanced or metastatic breast cancer that has progressed after endocrine therapy.

The approval was in-part based on data from the MONARCH-2 trial, which showed consistent overall survival benefits with the combination.

MonarchE, on the other hand, examined the impact of abemaciclib in the first-line adjuvant setting, enrolling patients with HR+, HER2-negative, node-positive early breast cancer who had a tumor size of 5 cm, histologic grade 3 disease, and/or Ki67 index of 20%.

They were randomly assigned in a 1:1 fashion to abemaciclib 150 mg twice daily for up to two years plus standard of care endocrine therapy or standard of care endocrine therapy alone.

The choice of endocrine therapy was left to the physician and was continued for 5-10 years, as clinically indicated.

The trial included 5637 patients. An efficacy interim analysis was planned for when 75% of the estimated invasive disease-free survival events had occurred, which equated to 323 events in the intention-to-treat population.

This occurred after approximately 15.5 months of follow-up in each arm, when 12.5% of patients had completed the two-year treatment period, leaving 70% still in treatment.

The intention-to-treat population included 2808 patients from the abemaciclib plus endocrine therapy group and 2829 in the group taking endocrine therapy alone.

The two groups were well balanced in terms of their baseline characteristics. The vast majority (approximately 85%) of patients were younger than age 65 years, and 56.5% were postmenopausal.

Also, 37% had previously received neoadjuvant chemotherapy and approximately 58% adjuvant chemotherapy.

Distant relapse-free survival was also significantly reduced with abemaciclib plus endocrine therapy vs endocrine therapy alone, at a hazard ratio of 0.72 (P = .0085), and a two-year rate of 93.6% and 90.3%, respectively.

Johnston highlighted that not only was the number of patients with distant recurrences reduced with the combination therapy, at 92 vs 142 with endocrine therapy alone, but also the reductions were in key locations.

The number of patients with recurrences in the bone were 32 with abemaciclib and 81 with endocrine therapy alone; 29 patients with abemaciclib and 42 with endocrine therapy alone had recurrences in the liver.

The results show that the most frequent adverse events in the abemaciclib arm were diarrhea (82%), neutropenia (45%), and fatigue (38%), whereas arthralgia (31%), hot flush (21%), and fatigue (15%) were seen most often in the control group.

A venous thromboembolic event was recorded in 2.3% of patients in the abemaciclib group versus 0.5% of those on endocrine therapy alone; interstitial lung disease was seen in 2.7% and 1.2%, respectively.

Despite the protocol allowing dose reductions from 150 mg to 100 mg twice daily if required, 463 (16.6%) patients discontinued abemaciclib as a result of adverse events. Of those, 306 continued on endocrine therapy.

"Adherence to treatment will be an important issue to be considered in the real-life population of patients when this treatment is approved and used in clinical practice," Johnston said.

Nevertheless, diarrhea frequency and severity decreased significantly over time and only 4.8% of the abemaciclib group discontinued use as a result of this adverse event.

George W. Sledge Jr, MD, professor of medicine (oncology) at Stanford University Medical Center, Palo Alto, California, was the invited discussant after the presentation.

He said that "positive trails raise as many questions as they answer, and monarchE is no exception."

For example, there is the conundrum posed by the negative results of the very similar PALLAS trial, which looked at the addition of palbociclib to adjuvant endocrine therapy for HR+, HER2-negative early breast cancer, and was also presented at the ESMO meeting.

Returning to monarchE, Sledge asked what the ultimate increase in invasive disease- and distant relapse-free survival will be with the drug combination, noting that the trial has "very, very short follow-up."

"Second, will the improvements seen in disease-free survival lead to what we really care about: improved overall survival? Again, time will tell, but healthcare systems and patients care deeply about the answer to this question."

Sledge continued: "How about late recurrence? Do CDK4/6 inhibitors kill off dormant or slow-growing micro-mets that lead to recurrences 5 or more years out?"

He also asked what the optimum duration therapy would be: "Is it more than we need, or not enough?"

Sledge wondered whether it is possible to determine who benefits "and why the drug fails some patients."

Finally, Sledge said, "These drugs are expensive2 years of adjuvant therapy is simply out of reach for the majority of patients around the globe who might be candidates for adjuvant CDK4/6 inhibitor therapy."

And he observed an important truism: "A patient cannot benefit from a drug she cannot take."

The study was funded by Eli Lilly and Company. Johnston, Sledge, and Curigliano have financial ties to Eli Lilly and multiple other drug companies.

ESMO Virtual Congress 2020: Abstract LBA5_PR. Presented September 19, 2020.

J Clin Oncol. Published online September 19, 2020. Full text

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About 24% of people with diabetes are treated with insulin. However, insulin cannot be taken as a pill because it would be broken down during the digestive process. Instead, it must be delivered into the tissues under the skin. This is most commonly done using insulin injections.

Here's what you need to know about using insulin and how to inject it properly.

Insulin is a hormone produced in the pancreas that signals your cells to absorb glucose, reducing your blood sugar.

People with type 1 diabetes do not produce insulin, so they must take insulin daily. People with type 2 diabetes are able to produce insulin, but their body can not utilize it efficiently, so they sometimes need to take injectable insulin. In both cases, insulin injections are a highly effective treatment for diabetes.

Insulin should be injected into the abdomen, says Emory Hsu, MD, an endocrinologist at Santa Clara Valley Medical Center. That's because the insulin is absorbed most quickly into your bloodstream when it's injected into the skin your abdomen. The abdomen also gives you the largest area to work with, compared with injection sites in the arms and legs.

"Insulin is absorbed into the blood fastest from the abdomen, a little slower from the arms, even more slowly from the legs, and slowest from the buttocks," Hsu says. "When insulin is injected into sites like arms and legs, more blood sugar variation occurs, especially when these muscles are involved in exercise."

In addition, it's important to change your injection site each day to avoid lipohypertrophy, a condition where the tissue beneath your skin can harden because insulin is injected there too often.

Hsu recommends using the following guidance when selecting a spot to inject insulin:

Your clinician will give you detailed guidance on how to inject insulin. It should be noted that there are a few different types of devices for taking insulin, so your exact procedure may vary. For many people, the process looks like this:

After injecting your insulin, you should put the used syringe in a sharps disposal container. These hard boxes will keep anyone else from being pricked by the used needles.

While a sharps container is always best, you could also use a hard container with a permanent top, like a laundry detergent container. Don't throw the sharps box into the trash. Rather, when it's almost full, make a plan for proper disposal. Some pharmacies and doctors offices have drop boxes for used sharps containers.

For most people, injecting insulin is easy after their doctor or nurse walks them through the process, Hsu says.

"If a patient is having difficulty injecting insulin on their own, they should let their diabetes educator or primary care provider know and have an open discussion on what can be done to assist them," he says.

To avoid common mistakes, make sure that you always do the following, says Hsu:

While insulin is generally a safe medication, people using it can experience low blood sugar, or hypoglycemia, if they don't have a good match between their insulin dose and their food intake.

Just in case, Hsu recommends always carrying a source of fast-acting sugar, like glucose tablets or a high-carbohydrate snack, when you're out of the house.

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SAN DIEGO, Sept. 21, 2020 (GLOBE NEWSWIRE) -- Dar Bioscience, Inc. (NASDAQ:DARE), a leader in womens health innovation, today announced that it received the final approximately $0.9 million in funding under the current grant from the Bill & Melinda Gates Foundation. The grant payment will support ongoing development activities for Dars investigational user-controlled, long-acting reversible contraceptive (UC-LARC), DARE-LARC1. Development of DARE-LARC1 has been supported by approximately $19.5 million in grant funding from the foundation prior to this most recent disbursement.

The technology underpinning DARE-LARC1 is designed to store and precisely deliver therapeutic doses over months or years in a single implant and was originally developed at the Massachusetts Institute of Technology (MIT) by renowned researchers Robert Langer, Ph.D. and Michael J. Cima, Ph.D.

We believe the non-dilutive funding support from the foundation for the development of DARE-LARC1 is a clear validation of the unmet need in the long-acting, reversible contraceptive, or LARC, category, said Sabrina Martucci Johnson, President & CEO of Dar Bioscience. LARCs are one of the most successful innovations in contraception, due to their exceedingly high effectiveness rates and duration of protection ranging from 3 to 10 years. The current FDA-approved LARCs require physician insertion and subsequent removal procedures for return to fertility, which can be a deterrent for women who know they will likely want to pause their contraception at some point during a typical 3 to 10 year implant duration. Our DARE-LARC1 program seeks to improve upon this product profile by providing a user-controlled LARC with a comparably high level of contraceptive effectiveness that will not require a woman to undergo procedures to remove and re-insert the device when she wants to return to fertility and, subsequently, when she wants resume contraception.

DARE-LARC1 is a preclinical stage implantable contraceptive product that is designed to deliver the benefits of traditional long-acting, reversible contraceptive products with the added flexibility of wirelessly controlling the duration of drug release based on individual user needs. The implant is intended to be operated by the user to deliver medication on a pre-determined schedule that can be activated or deactivated wirelessly, as required to provide contraceptive protection or enable her to return to fertility. This grant payment will support critical ongoing preclinical activities necessary to advance the program to the next stage of development.

About Dar Bioscience

Dar Bioscience is a clinical-stage biopharmaceutical company committed to the advancement of innovative products for womens health. The companys mission is to identify, develop and bring to market a diverse portfolio of differentiated therapies that expand treatment options, improve outcomes and facilitate convenience for women, primarily in the areas of contraception, vaginal health, sexual health, and fertility.

Dars clinical-stage product portfolio includes potential first-in-category candidates in clinical development: Ovaprene, a hormone-free, monthly contraceptive intravaginal ring whoseU.S.commercial rights are under a license agreement with Bayer; Sildenafil Cream, 3.6%, a novel cream formulation of sildenafil to treat female sexual arousal disorder utilizing the active ingredient in Viagra; DARE-BV1, a unique hydrogel formulation of clindamycin phosphate 2% to treat bacterial vaginosis via a single application; and DARE-HRT1, a combination bio-identical estradiol and progesterone intravaginal ring for hormone replacement therapy following menopause. To learn more about Dars full portfolio of womens health product candidates, and mission to deliver differentiated therapies for women, please visitwww.darebioscience.com.

Dar may announce material information about its finances, product candidates, clinical trials and other matters using its investor relations website (http://ir.darebioscience.com), SEC filings, press releases, public conference calls and webcasts. Dar will use these channels to distribute material information about the company, and may also use social media to communicate important information about the company, its finances, product candidates, clinical trials and other matters. The information Dar posts on its investor relations website or through social media channels may be deemed to be material information. Dar encourages investors, the media, and others interested in the company to review the information Dar posts on its investor relations website (https://darebioscience.gcs-web.com/) and to follow these Twitter accounts: @SabrinaDareCEO and @DareBioscience. Any updates to the list of social media channels the company may use to communicate information will be posted on the investor relations page of Dars website mentioned above.

Forward-Looking Statements

Dar cautions you that all statements, other than statements of historical facts, contained in this press release, are forward-looking statements. Forward-looking statements, in some cases, can be identified by terms such as believe, may, will, estimate, continue, anticipate, design, intend, expect, could, plan, potential, predict, seek, should, would, contemplate, project, target, tend to, or the negative version of these words and similar expressions. Such statements include, but are not limited to, statements relating to DARE-LARC1s potential to satisfy an unmet need in the contraceptive market, DARE-LARC1s ability to operate as designed and to demonstrate a rate of contraceptive effectiveness comparable to currently marketed LARCs and the potential for DARE-LARC1 to advance into clinical development. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause Dars actual results, performance or achievements to be materially different from future results, performance or achievements expressed or implied by the forward-looking statements in this press release, including, without limitation, risk and uncertainties related to: Dars ability to raise additional capital when and as needed, to advance its product candidates and continue as a going concern; the effects of the COVID-19 pandemic on Dars operations, financial results and condition, and ability to achieve current plans and objectives, including the potential impact of the pandemic on Dars ability to timely enroll, conduct and report results of its clinical trials and on the ability of third parties on which Dar relies to assist in the conduct of its business, including its clinical trials, to fulfill their contractual obligations to Dar; Dars ability to develop, obtain regulatory approval for, and commercialize its product candidates; the failure or delay in starting, conducting and completing clinical trials or obtaining FDA or foreign regulatory approval for Dars product candidates in a timely manner; Dars ability to conduct and design successful clinical trials, to enroll a sufficient number of study volunteers, to meet established clinical endpoints, to avoid undesirable side effects and other safety concerns, and to demonstrate sufficient safety and efficacy of its product candidates; the risk that positive findings in early clinical and/or nonclinical studies of a product candidate may not be predictive of success in subsequent clinical and/or nonclinical studies of that candidate; Dars ability to retain its licensed rights to develop and commercialize a product candidate; Dars ability to satisfy the monetary obligations and other requirements in connection with its exclusive, in-license agreements covering the critical patents and related intellectual property related to its product candidates; the risks that the license agreement with Bayer may not become effective and, if it becomes effective, that future payments to Dar under the agreement may be significantly less than the anticipated or potential amounts; developments by Dars competitors that make its product candidates less competitive or obsolete; Dars dependence on third parties to conduct clinical trials and manufacture clinical trial material; Dars ability to adequately protect or enforce its, or its licensors, intellectual property rights; the lack of patent protection for the active ingredients in certain of Dars product candidates which could expose its products to competition from other formulations using the same active ingredients; the risk of failure associated with product candidates in preclinical stages of development that may lead investors to assign them little to no value and make these assets difficult to fund; and disputes or other developments concerning Dars intellectual property rights. Dars forward-looking statements are based upon its current expectations and involve assumptions that may never materialize or may prove to be incorrect. All forward-looking statements are expressly qualified in their entirety by these cautionary statements. For a detailed description of Dars risks and uncertainties, you are encouraged to review its documents filed with the SEC including Dars recent filings on Form 8-K, Form 10-K and Form 10-Q. You are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date on which they were made. Dar undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law.

Contacts:

Investors on behalf of Dar Bioscience, Inc.:Lee RothBurns McClellanEmail: lroth@burnsmc.com+1 212-213-0006

Source: Dar Bioscience, Inc.

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Dar Bioscience Receives $0.9 million Under the Current Grant - BioSpace

More than 60% of Americans report feeling significant stress on a daily basis, according to a Gallup poll conducted in March 2020. Stress is the emotional or physical tensions caused by any event or thought that triggers frustration, anger, or nervousness.

Stress isn't necessarily bad, says Ben Hagopian, MD, a primary care physician at Maine Integrative Family Care. As part of your fight or flight response, stress causes your body to release cortisol and adrenaline, two hormones that make you more alert, tensing your muscles and increasing your blood pressure and heart rate.

This is beneficial when you are in danger, but overtime, chronic stress can have negative effects on your health, causing symptoms like:

Hagopian says his first advice for anyone who feels stressed is to identify the cause and see if you can eliminate it. If your stress is caused by something you can't eliminate, or is due to uncertainty, there are ways you can cope and manage it.

Here are some of the best ways to relieve stress:

Hagopian recommends aerobic exercise, such as jogging, cycling or dancing, but says the specific type doesn't matter as much as just getting some physical activity. "You need to get your heart rate up, you need to be sweating a little bit and be breathing hard," he says.

The main way exercise helps relieve stress is by increasing endorphins, leading to the so-called "runner's high," Hagopian says. Endorphins are the hormones produced naturally by your brain to alleviate pain and reduce stress. Exercise also ultimately decreases the levels of hormones associated with stress, including cortisol and adrenaline.

Working out even when you aren't feeling stressed can also help you manage stress later on. A 2007 study published in the journal Psychoneuroendocrinology compared the stress response of elite athletes to healthy non-athletes. Researchers put participants through the Trier Social Stress Test, or TSST, a standard procedure for inducing stress in studies.

While both groups saw increased cortisol levels and heart rate, the increase was significantly less for the elite athletes compared to the healthy non-athletes. The athlete group also reported being calmer and in a better mood.

Hagopian recommends finding a type of exercise you actually enjoy, so that it's not a chore. General recommendations are to get 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week. If you are just starting out, Hagopian suggests taking 10 to 20 minute walks three times a week and building from there.

Practicing relaxation techniques like deep breathing, meditation, or yoga can also help manage stress.

Usually, when you are stressed, you breathe faster and take shallow breaths, because your heart is racing. Other people actually hold their breath, Hagopian says. Slowing down your heart rate by focusing on your breath can help. Hagopian recommends a technique called 4-7-8 breathing, where you inhale for 4 seconds, hold it for 7 seconds and then exhale for 8 seconds.

Meditation also has a number of benefits, including stress relief. In a small 2013 study, medical students who participated in a four-day mindfulness meditation program had significantly lower cortisol levels compared to before the program. A review of more than 200 studies published in the journal Clinical Psychology Review also found that mindfulness meditation was effective at reducing stress.

Hatha yoga has also been shown to reduce cortisol levels during a stressful event. A 2017 study published in Complementary Therapies in Medicine found that a single Hatha yoga session before a stressful task lowered cortisol levels and blood pressure levels in participants, when compared to a control group.

Anyone who has ever had to function on just a few hours of shut eye knows that lack of sleep makes it harder to deal with anything, including stress. In fact, 21% of adults report feeling more stressed when they don't get enough sleep.

Adults typically need seven to nine hours of sleep a night, and those who sleep less than that report being more stressed. But for many people, being stressed makes it harder to fall asleep. Cortisol, the stress hormone, makes you stimulated and alert, which can make it difficult to doze off.

There are some basic ways to improve sleep, including:

Another key to managing stress is your diet. "Healthy nutrition is super important," Hagopian says. "Eating lots of fast food, or food with a lot of processed flour or sugar, is going to make you feel worse."

Here are some stress-reducing nutrients to look for in foods:

You should also try to avoid consuming too much alcohol, caffeine, or sugar, as these can all exacerbate stress, Hagopian says. Plus, if you are turning to food to cope with stress, you may be engaging in emotional eating, or stress eating. Learn more about how to stop emotional eating.

When you are feeling stressed, reaching out to your friends and family can help. Studies have found that people with less social support are more reactive to stress, exhibiting increased heart rates, blood pressure, and hormone levels, according to a 2007 review published in the journal Psychiatry.

Having a best friend by your side might make it even easier to cope with stress. A 2011 study published in Developmental Psychology of kids ages 10 to 12 found that having a best friend nearby led to lower cortisol levels after an unpleasant situation. The researchers had kids write in a journal multiple times a day to record their experiences, and tested cortisol levels in their saliva.

Moreover, a study done at the University of North Carolina found that women who spent time with their partner, including receiving a hug from them, had higher oxytocin levels (the "feel good" hormone) and lower blood pressure when asked to then prepare and record a speech about a recent event that made them angry or stressed.

Having sex, either solo or with a partner, can also help relieve stress. Like exercise, sex triggers the release of endorphins, which boost your mood. Your body also releases oxytocin during sex, especially during a woman's orgasm.

When it comes to stress, laughter truly is one of the best medicines. Laughing actually triggers immediate changes in your body that can help counteract the stress response.

When you laugh, you take in more oxygen-rich air, which stimulates your heart, lungs, and muscles. It also increases your release of endorphins, improves circulation, and helps you relax your muscles, which are often tense when you are stressed.

Hagopian says it doesn't really matter what makes you laugh, as long as you try finding ways to lift your mood when you're feeling stressed. Here are some easy ways to induce laughter:

For most of us, stress is a part of our lives, but there are ways to manage and relieve it. Maintaining healthy habits will make you better able to respond to stressful situations.

If you are struggling to adopt some of these healthy habits, Hagopian suggests what he calls "habit stacking" or trying to incorporate many of these strategies at once. For example, after your 20 minutes of exercise, do breathing exercises as you cool down. Or try exercises like yoga, that combines physical activity with mindfulness.

It's important to remember that everyone responds differently to stress, and everyone has a different threshold for managing stress. Finding what helps you relieve stress may take some trial and error, so don't get discouraged.

Finally, Hagopian says if stress is affecting your ability to function daily, you should reach out to your doctor or a mental health professional for further treatment.

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6 ways to relieve stress naturally - Insider - INSIDER

Newswise A new study published in Circulation by University of Alabama at Birmingham researchers showed that Black heart failure patients have worse prognoses even after achieving biomarker-based treatment goals.

Vibhu Parcha, M.D., a clinical research fellow in the Division of Cardiovascular Disease, says prior studies have shown that those heart failure patients who take medications regularly and have their NT-proBNP levels a heart failure biomarker less than 1,000 pg/mL do better in terms of being admitted to hospital for worsening of heart failure or dying due to cardiac causes.

Heart failure affects nearly 5 million patients in the United States, and there are key racial differences in the disease pathophysiology and care of heart failure patients, according to Parcha. Therefore, it is important to understand the racial differences in the prognosis of heart failure patients who achieve the treatment goal of NT-proBNP levels of less than 1,000.

In this investigation, Parcha and his team analyzed the data from the heart failure patients enrolled in the NHLBI-sponsored Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure trial.

The assessment of heart failure patients in the setting of a randomized clinical trial allowed us to look closely at the racial differences in the clinical characteristics and outcomes of heart failure patients, Parcha said.

Researchers found that, regardless of race, heart failure patients who achieve the treatment goal of NT-proBNP levels 1,000 pg/mL were less likely to be admitted with worsening heart failure or die due to cardiovascular reasons. Notably, they found that Black heart failure patients had worse prognoses compared to their white counterparts at any level of the NT-proBNP levels reached.

Heart failure is a serious medical condition, and all heart failure patients require close medical attention and care, said senior author Pankaj Arora, M.D., a physician-scientist in the UAB Division of Cardiovascular Disease. We have previously shown that even healthy Black individuals have lower levels of beneficial hormones produced by the heart called natriuretic peptides. The diseased heart in conditions like heart failure produces higher levels of these hormones. As heart failure worsens, the secretion of the hormone increases as a reflection of the activation of the neurohormonal system. Therefore these hormones act as a gold-standard biomarker for the status of heart failure. With appropriate treatment, we can improve the functioning of the heart, which in turn causes a reduction in this biomarker hormone.

Arora adds that it is important for patients to take their heart failure medications regularly and seek medical care to ensure that their medications are being changed adequately based on their clinical condition.

Both Black individuals and white individuals with heart failure have a good prognosis when they are receiving adequate medical care for their heart failure and also have their biomarker (NT-proBNP) levels less than 1,000, he said. However, Black heart failure patients had worse prognosis irrespective of attainment of the biomarker targets, which indicates that aggressive up-titration of goal-directed therapy must be done for these heart failure patients despite the attainment of biomarker goals. These racial differences in the care are important as Black individuals are at a greater risk of developing cardiovascular diseases such as heart failure and need to be treated adequately once the disease develops.

This work was supported by the National Institutes of Health grant, and the UAB Minority Health and Health Disparities Research Center research grant to Arora.

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Black heart failure patients have worse prognosis even after reaching treatment targets - Newswise

With upwards of 1 million licensed doctors in the United States, there have never been more caretakers to help you maintain perfect health. But nearly all patients would agree that finding the right Doc can be tricky. Yes, most doctors wear a white coat or a pair of scrubs, and can be found in hospitals or steely offices but the truth is that doctors are vastly different from one another, and most have an expertise in one particular area of medicine. There are hundreds of documented medical specialities and related certifications that physicians can pursue in their career, and there is often a special doctor for each affliction or illness, no matter how complex or rare that condition may be.

Where does one start when faced with a specific health issue? First step: It's a good idea to establish care with a primary care doctor, so that you have someone to oversee your healthcare treatment. They'll work with other doctors when the time comes, too: "Your primary care provider is an important first stop when receiving care, and they can help you to determine when you may need to see a specialist," says Craig Hersh, M.D., a board certified family medicine physician and the Chief Medical Officer for Empire BlueCross BlueShield.

"Think of your primary care provider as the front door to the healthcare system, who can also help you navigate and work with the specialist who best matches your needs," Dr. Hersh tells Good Housekeeping.

Sometimes, though, you might need direct access to a specialist say, if you've moved recently and don't have a primary care provider just yet. With the help of Dr. Hersh, we'll explore the most common types of doctors you'll likely turn to for help in your lifetime each of these 26 specialists can help address unique health concerns, and may finally get you the treatment you've been searching for.

This article generalizes the roles and descriptions of common doctors and specialists: It isn't intended to be a complete list, nor is it reflective of laws, statutes, regulations, license issues, or Medical Practice Acts by state. It is meant to be educational in nature and isn't a substitute for actual medical or treatment advice from a licensed professional. Remember: Always call 911 if you are experiencing a life-threatening emergency.

Primary care providers | Internist | Pediatrician | Geriatric specialists | Gynecologist, OB/GYN | Dermatologist | Allergist | Cardiologist | Ophthalmologist |Endocrinologist | Gastroenterologist | Geneticist| Hematologist | Neurologist | Otolaryngologist |Podiatrist |Pulmonologist| Nephrologist | Infectious disease specialists | Oncologist |Osteopath | Radiologists | Urologist | Plastic surgeons|Mental health care providers

Also known as a family physician, a primary care provider is in charge of handling your routine healthcare appointments, including annual physicals and vaccinations over time. Primary care doctors should always be your first call if you have a health concern that isn't an emergency, as they can help treat everything from the common cold to a physical injury. More often than not, they'll attempt to alleviate any symptoms you are experiencing; they may also refer you to another doctor or specialist.

A primary care provider can treat symptoms associated with conditions like:

These doctors work similarly to a primary care provider, in that they can see a patient routinely over their lifetime; unlike their counterparts, however, they usually have a background in internal medicine and spend their time in hospitals. Internists don't usually treat children or preteens, but care for anyone else from young adults to elderly patients, especially those who need help in diagnosing or managing chronic conditions or diseases. They may specialize in certain areas as well, like gastroenterology.

Pediatricians handle scheduled care and check-ins for infants, toddlers, younger children, adolescents, preteens, and most teenagers. They function like a primary care provider, designed for children specifically, but also keep kids' vaccinations up to date and do important screenings as they get older. Pediatricians are also a good point of contact to discuss any particular health concerns or questions about your child's physical or mental development.

Some elderly individuals may transition from a primary care doctor to what's know in the healthcare space as a geriatric specialist. Geriatricians take over primary care of people who are aging, and can help manage conditions that particularly impact the elderly, everything from severe arthritic pain to diabetes and dementia. These docs are on the other end of the family medicine spectrum from pediatricians!

Gynecologists, of course, handle preventative care for women in reproductive health, menopause, and hormone issues and you know that an obstetrician specifically looks after pregnant women and delivers their babies. An ob/gyn office (combining the two specialties) is also be a place where cervical cancer is tested and diagnosed, and where breast exams are performed.

Nearly everyone knows that dermatologists have the best information about routine skincare but they're also the specialist in charge of treating more serious skin issues, hair loss, or nail irregularities. Rashes or severe acne, rosacea or psoriasis, and skin cancer are treated; these specialists examine symptoms, help you manage them as best as possible, and provide a longterm treatment plan if possible.

These physicians are specially trained to determine if someone has an allergy, and they may also be referred to as an immunologist. If you're wondering if you have an allergy, an allergist is the doctor to see. In addition to diagnosing and managing allergies, these specialists may also help manage asthma, certain lung conditions, and immunodeficiency disorders. An allergist can give patients with allergies injections to help manage their allergies in the long run.

These physicians are in charge of taking care of your heart, but they'll most likely step in for direct care if you have high blood pressure, or experience heart failure or irregular heartbeats. Cardiologists often use physical stress tests and electrocardiography to diagnose, treat, and prevent other issues. You'll also have to be under their care after a heart attack, as your primary doctor may need screening done for future heart conditions.

These physicians look after your eyes, both medically and surgically, which is different from a optometrist, who is responsible for eye tests and corrective lenses as well as prescribing medication for some diseases. Opticians solely help you with the fit of your glasses and contacts overall.Ophthalmologists will also be needed if you develop a serious eye impairment, like glaucoma and cataracts as you age.

For those dealing with diabetes or a thyroid issue, an endocrinologist will help you pinpoint the source of trouble or help you troubleshoot longterm solutions. These specialists assess and treat internal glands that produce hormones and other bodily functions.

Digestive issues? If they're not clearing up whether it's diarrhea, bloating, acid reflux, or excessive flatulence it's time to ask for a gastroenterologist's help. Gastroenterologists who are licensed physicians, unlike gastrologists treat anything related to your digestive system (including bad breath!), and for longterm treatment, they help you control issues like irritable bowel syndrome or Crohn's disease. They may also screen you for issues later in life, like a colon cancer screening such as a colonoscopy.

Out of all doctors on this list, this may be one of the few that often require a referral; these doctors specifically look at whether a health issue has been inherited at birth, or if your genes are causing (or will cause) an issue in the future. They'll often help patients understand how genetic conditions could be passed along to a child preemptively, or they'll help to treat hereditary conditions that turn up.

If you're suffering an iron deficiency, or more serious conditions like anemia or hemophilia (inability to clot), a hematologist will step in to assess issues in your blood. They can be instrumental in preventing and treating cancers of the blood, such as leukemia.

Ah, the good brain doctor. But did you know that neurologists are also in charge of managing symptoms related to the nervous system, or anything that relates to your spine? Most often, neurologists tend to patients who have survived a stroke, or battle serious conditions like Parkinson's disease, multiple sclerosis (MS), and numbness or nerve pain caused by neuropathy. You may also seek them out for migraines and severe headaches that aren't going away.

These specialized surgeons also take care of your head and neck, but they focus on sinus, hearing, and throat disorders, among other issues. They are more commonly referred to as ENTs because they take care of your "ear, nose, and throat" primarily. You may visit an ENT for sinus issues, allergies and their side effects, as well as swallowing and hearing issues.

Ouch! You'll be heading to a podiatrist if you have foot, ankle, or lower leg pain or issues that can't be addressed by your primary care provider. While a visit to the podiatrist is often because someone has physically injured muscles, joints, or bones in their feet, these foot docs can also manage side effects from chronic conditions like diabetes.

Often mentioned in the same breath as a immunologist, these specialists are in charge of mitigating any pain or health concerns in your lungs and the entire respiratory system. You'll be referred to them for asthma often, but pulmonologists also diagnose and treat conditions like chronic obstructive pulmonary disease (COPD), emphysema, and lung cancer.

Believe it or not, this doctor is just focused on a singular organ in your body: The kidney. They are often called in for longterm treatment for serious chronic kidney diseases, of which there are many: They may also set up dialysis for those experiencing kidney failure.

These doctors may be known as virologists, or epidemiologists, but more routinely they're called infectious disease physicians. These targeted specialists treat ailments that are caused by viral bacteria or viruses themselves, including conditions like HIV/AIDS, tuberculosis, and malaria.

A referral to an oncologist might be terrifying for some, especially if they have yet to yield a positive result for any kind of cancer, but oncologists are often first examining your body, blood, or tissue samples beforehand. They may treat a benign tumor, which isn't cancerous by nature, but these specialist are still required. Oncologists are the point people for anyone who is living with cancer, and they'll draft treatment options, plus additional care when you reach remission.

These doctors are different from what's known as a naturopath, or a natural doctor. Osteopaths, titled as D.O.s in the field, receive similar training to a traditional M.D. but a greater emphasis is placed on treating a person for holistic health using elements of alternative medicine. Particularly, they often focus on relieving physical pain and tension in your body, especially in muscles and in joints.

These specialized care providers only see you for a short amount of time, and mainly for one thing only: Tests. Radiologists use imaging of all kinds to make an official diagnosis after another doctor or your primary care provider orders a test. The radiologist will make a detailed report to send back to your primary doctor or the specialist who ordered the test. Their testing services most commonly include:

Another highly targeted care provider, a urologist will treat pain and conditions related to the urinary tract (including bladders and urethra) for both men and women. They may troubleshoot issues like incontinence or help you pass a kidney stone; for men, they also deal with reproductive concerns.

A visit to a plastic surgeon's office isn't always for "craniofacial" adjustments. A bulk of a plastic surgeon's doesn't have to do with cosmetic procedures: They take care of the physical reconstruction of the body, and can help to repair your skin after a serious injury or burn, for example.

A special note on the following healthcare providers: They all address aspects of mental health in one way or another, with differences based on patients' needs. Each of them have different academic qualifications of various degrees, and they work in vastly different settings as well. "Only one type can prescribe medication and treat other medical conditions," Dr. Hersh explains.

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25 Different Types of Doctors - The Most Common Types of Doctors and Specialists - GoodHousekeeping.com

My paralegal, Anne, buzzed me. You have a couple on the phone who have Covid-19. They are very upset with their family doctor and want to talk with you about a possible lawsuit for malpractice.

Now, this sounded interesting.

Just diagnosed with COVID-19 doctor yelled at them

Mr. Beaver, our family was just diagnosed with COVID-19, and fortunately no one is sick enough to go to the hospital, but we feel very disrespected by how our family doctor reacted.

I wondered how long have they gone to this doctor, and why they feel so disrespected.

We have been his patients for several years and never had a problem until now. But when he called us and confirmed that we all had COVID-19, it is what he said that hurt our feelings terribly. He was so angry! We recorded it. (They played the recording.)

Whats wrong with you all? I told you months ago that you were dangerously obese and that you were not taking your blood pressure medication as prescribed. Dont you watch TV? Almost all of the faces of the people who died from COVID-19 who you see on the evening news are horribly obese and you are too, all of you, mom, dad and your four young kids! Dont you get it! You are sentencing yourselves to death because of being morbidly obese!

Mr. Beaver, we arent that much overweight and our kids are otherwise healthy, if a bit big.

Was the doctor correct? Were they all obese? Dr. Skype would answer that question, and so I askedand the family agreedto do a Skype video chat. As soon as their webcam was active, it was clear to me that I was looking at an entire family of morbidly obese people in complete denial of their own health status.

See original here:
You and the Law: Obese COVID patients and their angry doctor - Hanford Sentinel

Read the Full Video Transcript

Alicia Morgans: Hi. I'm so excited to talk today with Dr. Michael Morris, who is a Professor of Medicine at Memorial Sloan Kettering Cancer Center and a GU Medical Oncologist, and Dr. Chris Sweeney, who is a Professor of Medicine at Harvard Medical School and a GU Medical Oncologist at Dana-Farber Cancer Institute. Thank you both so much for talking with me today.

Michael Morris: Thank you, Alicia.

Chris Sweeney: You bet. Yeah.

Alicia Morgans: Wonderful. So I wanted to really pick your brains about the treatment of metastatic hormone-sensitive prostate cancer or some people say mCSPC, castration -sensitive prostate cancer, because I think that there has been a lot of data in this space. There's a lot of confusion. The first thing being that it's not always clear to everyone that the backbone of all treatment is really testosterone suppression with GnRH agonist or antagonist, or if you want to do bilateral orchiectomy, but these treatments to lower testosterone are actually critical.

But then we're really, I think, in the United States moving to a place where we need to combine, for all appropriate patients, which is most patients, use combination therapy. Whether that is ADT plus docetaxel or ADT plus an AR targeted agent, is actually something that we all need to work out. And I just want to talk to you both, about how you make those decisions and what your thoughts are. So maybe we can start with Chris. What are your thoughts when you see a new patient with metastatic hormone-sensitive prostate cancer, of course in addition to traditional ADT, what are you doing to help make that decision about that other treatment that you're adding on?

Chris Sweeney: I ask myself three questions. I think it's three, let's see how we go. One, what is their prognosis? And that's driven by, did they present with metastatic disease as their first presentation and the amount of cancer on a CAT scan or a bone scan. So when we're talking about metastatic disease, we're talking about the amount of cancer that we can see on conventional scans.

Alicia Morgans: Okay.

Chris Sweeney: So that's the first thing and second thing. And chemo fit, volume of disease, and the... How they relapsed or did they present de novo?

Alicia Morgans: Okay.

Chris Sweeney: Because they have very different prognosis and outcome and I think that's what's causing some variations in the trials that we're going to talk about in the outcomes and why one trial may be giving one signal and another trial may be giving another because of patient mix. We looked at the Dana-Farber data set of about 450 patients and it's published, about a third of patients are this high volume de novo metastatic and with just the ADT testosterone suppression, half of those patients would die by about the three-year mark.vWe've made major progress in that group of patients, with the drugs you've mentioned.

And the other spectrum, the other third, is the late relapsing person who years later, has a two bony metastases. You put them on testosterone suppression and their median survival is actually eight years, from the start of the hormones and then this is middle ground. De novo low volume, which is... has a median survival of about five years and some of them have a rapid progression and some of them would be slow. And then there's this very rare bird if somebody has surgery and then a year later they have a high burden of disease because they rapidly progressed after the radiation or their surgery. So I think the more we can annotate the patient in front of us, we can personalize the options for them and then look at all the treatment data sets that have come out. And I suspect Mike and I probably would actually offer the same treatments for the different groups of patients based on their chemo fitness, volume and the timing of the presentation with metastatic disease.

Alicia Morgans: Yeah. And how do you think about things Micheal because... And maybe comment too on the STAMPEDE trial, the CHAARTED trial, which we just got an update from for the STAMPEDE trial, in terms of thinking about volume of disease and sensitivity to docetaxel in addition to ADT, which was a little bit disruptive in a really interesting way to the paradigm that had been laid out by the prior STAMPEDE data and the CHAARTED data. So what, what are your thoughts there?

Michael Morris: Yeah, I'm not sure I see the update of the STAMPEDE data, which had suggested that perhaps the low volume patients actually did have a benefit. I'm not sure that that changes all that much in our landscape. In this case, we know a lot of what we don't know and we know we have one outright negative study. We know that we have CHAARTED, which was a positive study, but there was a readout that led us to believe that perhaps some patients benefit more from others and now we have a look back at a study that didn't initially separate patients by volume, which suggests that there's still more questions to be asked on this front. So it's an ambiguous situation. I think it's an ambiguity that has new information to inform what we're ambiguous about. I also think though, that there are unknown unknowns here that we have to consider.

So, for example, you know, for patients who are really high-risk patients, I do try to profile those patients, at least with germline sequencing, if not somatic as well. And germline for those patients who have high-grade disease at presentation for an initial diagnosis with a localized disease with a family history or anyone with metastatic disease is standard of care.

Alicia Morgans: Yes.

Michael Morris: So I know that volume isn't the great teller of who may respond and who may not. P53 and RB status, would probably make me think about even a low volume patient who I know is probably not going to respond particularly long to any of the AR directed therapies that may trump the volume of disease. So there are other factors here that we know that we don't have enough information about beyond disease distribution, which may be very informative, which are coming into their own as the... As we appreciate as well, that the DNA repair population has yet another set of options to be explored.

Alicia Morgans: Yes.

Michael Morris: That... I think that that's going to factor into our consideration as well. I think that there's some really basic fundamentals... Factors to consider. Even beyond data sets. Not everybody has access to the same drugs. Insurers won't necessarily reimburse for the same drugs. Chemotherapy has great advantages in terms of brevity, a limited course, and financial economy.

Alicia Morgans: Yes.

Michael Morris: So those factors are really important to patients because that really impacts their lives. Beyond distribution, beyond genomics, there's some real practical considerations even in choosing the AR inhibitor that you might be selecting. Different side effect profiles. Some of those drugs get along better with other drugs.

Alicia Morgans: Yes.

Michael Morris: So there are many factors to consider beyond an update on STAMPEDE or beyond a new analysis of the data of head to head, for example.

Alicia Morgans: Absolutely. Go ahead.

Chris Sweeney: So let me pick up on a couple of things there and I agree 100% it is not an easy conversation. This is one where you've got to sit the whole time and sit down and have the patient tell you what their interests are. Sometimes it may be, get the chemotherapy out of the way. Others may be saying, "I've got a lot going on. I just need the simple hormones approach." But two things I want to just pick up on. One is there's a fantastic collaboration that's developing between the ENZAMET team, the CHAARTED team and the STAMPEDE team where we're gene expression profiling, exome sequencing, all the patients, and we'll actually have some data at GU ASCO where we are starting to see some prognostic and predictive markers.

Alicia Morgans: Wonderful.

Chris Sweeney: So hopefully that'll get... We'll have everything ready and have some air time on that to make some progress on that. We've got the gene expression profiling, but we're now doing the whole exome sequencing. We're just pulling the DNA now to send that off from CHAARTED and we're going to train in CHAARTED and validate with the STAMPEDE and the ENZAMET, so we're on the case.

The second thing is just breaking down, thinking through this new information where, well, the high volume de novo we... You're absolutely right, your options are chemotherapy, or the new hormones. It's very unlikely that you wouldn't do something adding that. That's, there's no controversy there. This low-volume de novo metastatic, is one entity, and I just want to say the... If you look at the pattern of the studies, so if you pull out the low volume de novo metastatic from GETUG-12 they actually have a survival curve and European urology paper and they're overlapping, in their study for that patient population. When we look at it and CHAARTED, it's a hazard ratio of about 0.86 for docetaxel and it was 0.72 or something for the low volume. So the STAMPEDE data is a little bit of an outlier when you look at all the other data sets, granted this power issue and they're missing 25% of the scans because they've did it retrospectively.

But let's just take a step back and just look at the pattern across the data because this trials... We can see there's probably a subgroup in there and it's going to be our job to find what that biology is, who's got the rapid proliferating that may benefit from chemotherapy and who can we take a slower approach?

Alicia Morgans: Absolutely.

Chris Sweeney: But let's also recognize that low-volume de novo metastatic group has another really good option in addition to the hormones and that's radiation to the prostate that can be considered, which looks like it has as much as a treatment effect as the docetaxel. So if a patients and physicians sit down and think through those different options and what can you access and what's right for them. Let's also take another extreme. Is there a patient that you'd never had on these other agents?

Michael Morris: Yeah, I would say that that's the one, you know, in a problem created by an embarrassment of riches in this space, the main mistake that can be made, is not to do any of these options and just do some testosterone lowering agent alone. There aren't that many patients that I can think about except for those with significant comorbid disease.

Chris Sweeney: Exactly.

Michael Morris: So at the end of life.

Alicia Morgans: Or advanced dementia.

Michael Morris: Advanced dementia or for whom you'd think that just the prostate cancer is not their primary medical issue, but pretty much everybody else should be on ADT plus something.

Chris Sweeney:We'll annotate that patient, that rare patient. It's the 85... Depends on which practice you are. It's the 85-year-old patient with severe congestive heart failure. Maybe some memory disturbance, frail who's relapsed 20 years after their bony... With two bony metastases. And you could just maybe get away with some radiation and some hormones because you know they're going to live a long time and you can maybe just radiate the two spots as per the STOMP. Maybe give some hormones and just de-escalate in that rare scenario.

Alicia Morgans: Maybe, but I do think it's still going to be, you know, if there are things like repeated admissions for CHS and dementia, I think though what you've both said is it's a conversation and that each of these decisions is probably going to be a real negotiation and education process for both the patient and for the physician on what's going to be the right thing. And, and my 85-year-old be may be different than your 85-year-old. And I think that it's important for us as we see new patients to at least consider that the standard of care is combination therapy and potentially radiation to the prostate if it's low-volume disease, and we need to at least think what is the reason why I would not use this combination.

Chris Sweeney: Exactly.

Alicia Morgans: Before we just default to using single agent.

Michael Morris: Yes. And I just to pick up something that Chris said that we're going to explore much more deeply in a session that we're planning for a GU ASCO is this issue that for the patient for whom this standard of care is not appropriate, that creating a new standard of care that has no evidence of clinical benefit is appropriate. That is the SBRT. Is...

Chris Sweeney: Work in progress.

Michael Morris: Is cause presuming that the patient has no symptoms, there is no organ threatening, that there's not an impending fracture. There actually is no need to make that lesion disappear without some evidence that you're doing some benefit. And we don't really have that evidence. So I just put a little caveat into what Chris just said.

Chris Sweeney: Absolutely.

Michael Morris: That we don't know that ADT free survival is a beneficial thing, but we do know that ADT plus is a beneficial thing. So...

Chris Sweeney: I've got... I have to admit, I'm not a fan of the radiation alone, approach to the MDT. I always have some testosterone suppression with everything I do, including the radiation. Now the bigger question is what about the patient who is three, two years in, their PSA is less than 0.2, if you image them and there's nothing growing at all, and they've got significant quality of life impairment from this profound androgen deprivation and four pills a day.

Michael Morris: Yeah.

Chris Sweeney: We need to think about, can we actually revisit intermittent dosing or dose de-escalation?

Alicia Morgans: Yes. Well, lots of questions to be answered and just so that everyone understands these are questions that we should answer in a clinical trial. And so referral to clinical trials or consideration of clinical trials in your own center is always the way that we should go about trying these approaches and so many patients can benefit. So much work for us to do. But I so appreciate both of your perspectives and I hope that our conversation brings... Sheds some light on what has become a very murky, set of questions that it's really those physician, patient, caregiver, family conversations about practical and even molecular, potentially at some point and disease volume. All of these considerations are going to be important.

Chris Sweeney: And patient preference.

Alicia Morgans: Patient preference, of course.

Chris Sweeney:What... I don't think we've talked about it enough, but we need to start saying that every conclusion of every hormone-sensitive conversation.

Michael Morris: Especially when this murkiness or ambiguity is because you have so many good choices.

Alicia Morgans: Yes.

Michael Morris: That the patient's voice needs to be heard so that you can make the right choice for that patient.

Alicia Morgans: Absolutely. Well, we will definitely end on that high note, and I appreciate the time that you've both given to this. Thank you.

Michael Morris: Thank you, Alicia.

Chris Sweeney: Thank you.

Read the original post:
Standard of Care in the Treatment of Metastatic Hormone-Sensitive Prostate Cancer - Michael Morris & Christopher Sweeney - UroToday

Hyperglycemia is when you have elevated blood sugar. Before a meal, or when you have not eaten in several hours, high blood sugar is defined as 130 mg/dL. Two hours after eating, hyperglycemia is when blood sugar levels are above 180 mg/dL.

By comparison, normal blood sugar levels are generally between 80 mg/dL and 130 mg/dL. Hyperglycemia is most common for people with diabetes, and essentially, it describes the high blood sugars that define the chronic condition.

In some cases, hyperglycemia can also occur as a result of stress or as a side effect of steroid medication. Here's how you can recognize the signs of high blood sugar and lower it quickly.

The most common symptoms of hyperglycemia include:

However, the only way to know for sure if you have hyperglycemia is with a blood draw, says Jordan Messler, MD, a hospitalist at Morton Plant Hospitalist group in Clearwater, Florida. This can confirm that your blood sugar levels are elevated, and by how much. In fact, symptoms often won't become severe until blood sugars rise above 200 mg/dL.

If left untreated, hyperglycemia can lead to diabetic ketoacidosis (DKA) within 24 hours in some cases. This condition, most common in people with type 1 diabetes, occurs when the body is not able to break down sugar properly for fuel, so it breaks down fats instead, Messler says. This naturally releases acids into the blood, and because the body cannot flush the acid quickly enough, it becomes toxic in the blood.

DKA is a medical emergency, and people with the following symptoms should visit the emergency room, especially if they have diabetes, Messler says:

Both type 1 and type 2 diabetes can cause hyperglycemia. But there are also other potential causes, like stress or steroid medications.

People with diabetes are not able to process blood sugar effectively, either because they do not produce insulin, the hormone that breaks down blood sugar (type 1), or because their body does not utilize insulin effectively (type 2).

Since the body cannot break down blood sugar, it builds in the bloodstream and is more likely to cause high blood glucose levels, or hyperglycemia.

Hyperglycemia can also occur occasionally in people who are being treated for diabetes. These spikes in blood sugar levels can be caused by:

Even people without diabetes can get hyperglycemia. For example, stress can cause insulin resistance a condition where your body doesn't utilize insulin effectively.

At the same time, the stress hormone cortisol encourages the release of hepatic glucose, or glucose stored in the liver, which further raises blood sugar. This so-called "stress hyperglycemia" can occur during acute medical situations, such as an infection or heart attack, Messler says.

Steroids, like Prednisone and methylprednisolone, can also cause hyperglycemia in up to 46% of patients without diabetes, but this usually resolves when the medication is stopped.

Like the effect of stress, these medications also increase hepatic glucose release and increase insulin resistance, and can cause hyperglycemia even if you don't have diabetes.

The goal of treatment for hyperglycemia is to lower blood sugar. For people with diabetes, this could mean adjusting your insulin dose, or following a plan that you and your doctor have created ahead of time for when you experience hyperglycemia.

People who have chronic hyperglycemia caused by diabetes should also work to lower their blood sugar over time, in addition to treating individual episodes of hyperglycemia.

"The best ways to begin lowering blood glucose, for someone who has diabetes, is through lifestyle changes, such as diet and exercise," Messler says.

People with type 1 diabetes will need insulin to lower blood sugar levels, while type 2 diabetics are often treated with oral medication like metformin, and possibly insulin as well, Messler says.

However, for people with stress or steroid-induced hyperglycemia, the condition usually resolves on its own, as soon as the stress dissipates, or about four to six hours after the medication is discontinued.

If hyperglycemia persists after the underlying health condition is addressed, the patient may be diagnosed with diabetes, Messler says.

Hyperglycemia is a serious condition, especially if left untreated. Since it can only be diagnosed by measuring blood sugar, it's important to talk to your doctor if you're concerned about hyperglycemia.

"If you are suffering from symptoms of increased thirst and frequent urination with weight loss, then you should discuss with your doctor and check your blood sugar," Messler says.

He also recommends that people who have risk factors for diabetes including being overweight, having a family history of diabetes, or being older than 45 have their blood sugar levels checked regularly.

Originally posted here:
The most common signs and symptoms of hyperglycemia, or high blood sugar - Insider - INSIDER

A small study in the U.K. says cases of Type 1 diabetes nearly doubled in children during the peak of the pandemic.

WASHINGTON We are learning more about how COVID-19 could affect kids. A recent study out of the U.K. said the virus could be linked to Type 1 diabetes in children after cases of the chronic condition nearly doubled. An expert at Childrens National Hospital weighed in on the research.

It is another mystery in the battle against the coronavirus as researchers discovered a possible link between the virus and Type 1 diabetes in children and adolescents.

The autoimmune disease destroys cells in the pancreas that make insulin. Insulin is a hormone that turns blood sugar into energy. Without it, complications occur since high blood sugar is damaging to the body.

A small study in the U.K. is raising questions about possible ties between COVID-19 and Type 1 diabetes after cases nearly doubled, compared to previous years, in children and teens during the height of the pandemic.

The study was done between March and June on patients as old as 16. When hospitals tested kids with Type 1 diabetes, some were COVID-19 positive while others had antibodies.

Pediatric Endocrinologist Dr. Brynn Marks tells WUSA9 that it is still not clear whether the virus can cause the autoimmune disease to develop or if children who have it are at greater risk of contracting COVID-19.

We still dont know what exactly causes Type 1, Dr. Marks said. Theres some evidence that a related virus, the SARS virus which is similar to COVID, can attack the cells and pancreas that makes insulin so there is still that possibility that COVID-19 may be linked to Type 1, but without larger-scale studies, we just dont know the answer right now."

Dr. Marks said it is important for parents to watch for symptoms that include: extreme thirst, frequent urination, weight loss, fatigue and bed-wetting in children that dont normally wet the bed.

Its better to ask that question and find out sooner by going to your pediatrician than waiting until things get more serious, Dr. Marks said. One of my big worries as a physician is that the kids who do come in with diabetes are more sick when they come in.

Dr. Marks also said kids with Type 1 diabetes are oftentimes asymptomatic. It is only detected due to screening.

Seventy percent of children in the study also exhibited a more serious complication to Type 1, Diabetic Ketoacidosis (DKA). It happens when blood insulin levels are too low and the body tries to make up for it by creating something called ketones, excess blood acids.

Between March 1 and Aug. 31, 109 cases of Type 1 diabetes have been diagnosed at Childrens National, according to Dr. Marks. On average, there are about 20 new cases each month or between 230-240 annually.

Dr. Marks said there have not been many variations as the number of cases ranged between 17 and 22. However, when compared to last year's total number, nearly 300 cases will be diagnosed.

Newer technology like "continuous glucose monitors," which are little devices about the size of your pinky finger that sends data to your smartphone, are available to help monitor blood sugar, according to Dr. Marks.

Originally posted here:
Study finds possible link between COVID-19 and Type 1 diabetes in children - 11Alive.com WXIA