Bridging a "weird" loss of memory of the cause, cognitive impairment

Coronary artery bypass graft (CABG) offers a new chance of life for thousands of people each year whose hearts do not get the blood they need to function properly. But he was also accused of "brain fog", memory loss and thinking skills following the procedure of some people. These cerebral disorders are often called cognitive impairment.

The operation itself can not be to blame, according to a review of the Annals of Internal Medicine today. To review, a team of researchers, mainly the Department of Veterans Affairs American Affairs synthesized data from 17 clinical trials and observational studies well designed four adults 65 years. Most study participants had undergone bypass surgery, but some had other procedures-usually related to the heart to replace a valve or treat atrial fibrillation.

The researchers concluded that the medium and long-term cognitive impairment after cardiovascular procedures "can be rare." However, they recommend that anyone considering open heart surgery or other major cardiovascular procedure should discuss the possibility of cognitive impairment with your surgeon.

Researchers applaud his attempt to answer this important question. But there were several important limitations to their results, even if they chose only the best studies:

* The studies used different methods to compare the procedures and cognitive changes after surgery. 
*  "Cognitive impairment" is sometimes loosely defined. 
*  Those potentially increased risk of cognitive impairment after a procedure were excluded, either from the study or not identified as a subgroup.
*  The studies did not look at other factors affecting the rapid cognitive decline, such as depression, hypertension, diabetes and levels of education and social support.

These limits mean the results are not the final word on the connection between bypass surgery and cognitive impairment. But they must reassure people who need this.

Bypass and brain
 If you have heart disease significantly improved by surgery or another invasive procedure that will get the benefit is likely to outweigh the risk of cognitive impairment. In addition, the risk of cognitive impairment may be greater than the drug therapy of surgery.  

For example, people with severe narrowing of their carotid arteries are less likely to have a stroke (one of the main causes of cognitive impairment) if they have a procedure to resolve the problem rather than controlled with medication.

Note that the most important causes of memory loss and a decline in thinking skills are lifestyle choices that harm the brain, not heart surgery.

Whatever your age and your current health condition, you can reduce your risk of cognitive impairment

    *  A Mediterranean-style diet
    *  Staying physically active, with time spent each day for exercise
    *  No Smoking
    *  Maintain a healthy weight
    *  Keep blood pressure under control
    *  Maintain moderate drinking (if you drink) - which means no more than two drinks per day for men and no more than one per day for women.

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The studies support the wider use of statins for lowering cholesterol

The latest guidelines used to determine who should take statins to lower cholesterol to prevent heart disease appear to be more accurate and cost-effective than previous guidelines. This is according to two studies by Harvard researchers, both published this week in the Journal of the American Medical Association.

For many years, the main determining factor in who needed to take a statin cholesterol was a harmful low-density lipoprotein person (LDL). Updated guidelines issued in 2013 by the American College of Cardiology and the American Heart Association LDL removed and recommend instead a statin for men and women between the ages of 40 and 75 who have a 7- 5% or more at risk having a heart attack or stroke over the next 10 years. (You can use this online calculator to calculate your risk, you will need your total cholesterol and HDL cholesterol and the values ​​of blood pressure.) Statins are commonly prescribed atorvastatin (Lipitor) and simvastatin (Zocor).  

Shortly after the new guidelines were released, two Harvard experts argued that went too far, citing concerns that the calculator often overestimated the risk of having a heart attack or stroke. Paul Ridker cardiologist and epidemiologist Nancy Cook, makes the case that, following the new guidelines, many healthy people end up taking a statin but get few benefits of the drug while the risk of side effects such as pain muscle and tracks diabetes.

The two JAMA studies have attempted to address these concerns by comparing the new guidelines with the elderly. Although older guidelines focused primarily on reducing the harmful LDL cholesterol in a person, the new guidelines have a broader vision, which is to the age, sex of a person, weight, blood pressure and snuff consumption, in addition to cholesterol.

One of the JAMA study looked at 2,435 people in the long-term Framingham Heart Study who were not taking a statin. Lead author Dr. Udo Hoffmann, professor of radiology at Harvard-affiliated Massachusetts General Hospital and colleagues found that 39% of study participants would have been eligible to take statins under the new guidelines compared to 14% according to most guidelines. 
 
Then they looked at the number of heart attacks, strokes and cardiovascular deaths in both groups over a period of nearly 10 years. The rates in the two groups were almost the same (a little over 6%), suggesting that the new guidelines would not put too many people on drugs unnecessarily. And when they looked for people who were not entitled to a statin under the new guidelines, only 1% had a heart attack or stroke. In the old, 2.4% did. This suggests that the new guidelines provide a more accurate assessment would benefit from a statin and who would not.

"We will dial for a more accurate prediction of the risk of heart disease and its relevance to statin therapy," says co-author Dr. Christopher O'Donnell, chief of cardiology at the VA health system Boston and associate professor at the Medical School of Harvard University. 

Another JAMA study was based on a computer model to calculate the cost-effectiveness of the new guidelines. Model projects costs for a hypothetical group of Americans between the ages of 40 and 75 who take a statin based on the new guidelines. These costs include the costs of visits cholesterol tests, medications, laboratory and medical as well as the cost of treating heart attacks and strokes, said lead author Dr. Thomas A. Gaziano, associate professor Health policy and management and a cardiologist at Brigham and Women's Hospital. The disadvantages of taking a statin, including the disadvantage of taking a pill every day and a slightly higher risk of diabetes associated with statin use were also part of the equation. Another key factor in the model was a measure called adjusted life year on quality, which measures the burden of disease in terms of quality and quantity of life lived.

The model showed that the new guidelines - which would be almost half of adults 40 to 75 years on a statin - be profitable. In fact, the model predicts that lowering the threshold for prescribing statins risk down 7.5% at 10 years to a 3% risk to ten years would save even more money. In this scenario, about two-thirds of adults between the ages of 40 and 75 would take a statin.

An explanation of the results: Most statins are now available in generic form, so that the annual cost of the catch was reduced from several thousand dollars per year to about $ 100 per year.

If all this have to wonder if you should take a statin - especially if your risk is about 7.5% or less - this is another way to think about the decision. Statins reduce the risk of heart attack by 20%. "If you are in a low-risk group, say 5%, taking a statin reduces the risk to 4%," says Dr. Gaziano. Some people in the group may decide it's not worth taking any medications day for a small profit. But others might want to do everything possible to reduce the risk, he said. Therefore, it is very important to have a discussion with your doctor about your own situation and preferences.

Finally, do not overlook other important aspects to reduce the risk of heart disease. "The World Health Organization says that almost 80% of all heart disease could be prevented through lifestyle changes," says Dr. John Abramson, a professor of health policy at Harvard Medical School. This means eating a healthier diet, regular exercise and not smoking. "Statins are the most widely used class of prescription medicines in the world's history, but has never been a study comparing lifestyle changes," says Dr. Abramson.

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FDA strengthens warning that NSAIDs increase heart attack and stroke risk

In 2005, the FDA warned that taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen risk of having a heart attack or stroke increased. Last week, the unusual warning to further strengthen this initiative was made.  

This was done with the guidance of an expert group that reviewed the new information on NSAIDs and its risks. Because NSAIDs are widely used, it is important to be aware of the drawbacks of an NSAID and take measures to limit the risk. 

Many people take NSAIDs to relieve mild to moderate pain. These drugs may be particularly effective in conditions where pain is mainly due to inflammation, such as arthritis and sports injuries. Examples of commonly used over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve); Celecoxib (Celebrex), diclofenac (Cataflam, Voltaren) are prescription NSAIDs. Aspirin is also an NSAID, but not the risk of heart attack or stroke and are not covered by the new warning.

For over 15 years, experts have known that NSAIDs increase the risk of heart attack and stroke. They can also raise blood pressure and cause heart failure. The risk of heart attack and stroke gained particular notoriety with rofecoxib (Vioxx), a type of NSAID called COX-2. It caused up to 140,000 heart attacks in the United States during the five years it was on the market (Vioxx was withdrawn in 2004). The unfortunate experience with Vioxx raised awareness of cardiovascular risk of NSAIDs, and led to several studies showing that the risk is not limited to Vioxx, but is associated with all NSAIDs. 

The new FDA warnings state:

    *   Heart attack and stroke risk rose even with short-term use, and the risk may start in a few weeks to start taking an NSAID.

    *   The risk increases with high doses of NSAIDs taken for longer periods of time.
 
    *   The risk is higher for people who already have heart disease, but even those without heart disease may be at risk.

    *   Previous studies have suggested that naproxen may be safer than other types of NSDAIDs but the new review by the panel of expert evidence is not solid enough to be certain. 

NSAID use it safely
 Take NSAIDs for headache, or a few days to relieve shoulder pain is not likely to cause a heart attack or stroke. There is more that can get risky use.

Given the new warnings, the better for people with heart disease is to avoid NSAIDs if possible, and to all those who are considering taking an NSAID proceed with caution. Here are some strategies:

 *   It is important to take the lowest effective dose and to limit the length of time you take the medicine.

 *   Never take more than one type of NSAID at a time. It seems that there are risks associated with all types of NSAIDs.

 *   Try alternatives to NSAIDs such as acetaminophen. It relieves pain but does not appear to increase the risk of heart attack or stroke. However, acetaminophen can cause liver damage if the daily limit of 4,000 milligrams is exceeded, or if you drink more than three alcoholic drinks a day.

 *   If nothing works and you have to take an NSAID for arthritis or other chronic pain, try taking a "holiday" in a week from them and take acetaminophen instead.

 *   If you experience chest pain, shortness of breath or sudden difficulty speaking or weakness while taking an NSAID, see a doctor immediately.
 

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University of maryland medical center

Founded in 1807, the School of Medicine is the first public school and the oldest American Medical fifth, and the first to institute a residency training program. The School of Medicine was the founding of the University of Maryland School and is now an integral part of the University System of Maryland campus 11.  

On the Maryland University campus in Baltimore, School medicine serves as an anchor for a large academic health center that seeks to provide the best medical education, biomedical research conduct the most innovative and provide better patient care and community service to Maryland and beyond. While its tradition of excellence is kept constant, the School of Medicine and his academic performance reputation continue to grow.

World class education, research and patient care
The School of Medicine has more than 2,800 faculty members (full time, part time and auxiliary); 3300 administrative, research and clinical staff; and maintains a current workforce of over 1,200 medical students, graduates and allied health professionals. School of Medicine and its clinical partner, the University of Maryland Medical Center, educate and train a large number of Maryland healthcare professionals; continuing education programs serving more than 5,000 doctors and other health professionals each year.

A first level Research Institute
The research productivity of the faculty is among the highest in the country, and the School of Medicine is still one of the fastest growing research companies in the country. Total grants and contracts to medical school were $ 429.9 million in FY12. Of all the schools of medicine, School of Medicine is ranked eighth in direct spending by the principal investigator, according to the Association of American Medical Colleges (AAMC). The School of Medicine is ranked 16th in direct grants and contracts costs between 138 medical schools. The School of Medicine is ranked sixth among 76 public medical schools.

Economic impact
Direct expenditure and associated handsets for the school and its practical level, a faculty was 1.5 billion in FY09, or about five percent of the state's total economy. This amounts to $ 24 in revenue from $ 1 using the condition. 
Source: here.

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Fasting for weight loss

Fasting for weight loss seems to be one of the hottest trends in diet right now. But despite its current popularity, fasting has been used for thousands of years for various purposes. (Even intermittent fasting can increase his report?. Not only for weight loss) Due to its popularity among celebrities, people came to believe that intermittent fasting for weight loss has an advantage over traditional dieting approaches and exercise. 

It does not. Although it may be a strategy for losing weight safely (if done correctly!) That actually does not give better results than other methods of fat loss.

Today there are a variety of ways that people use intermittent fasting for weight loss. These are two of the most popular methods.

24 hours fasting: 
This protocol popularized by Brad Pilon in his book Eat, Stop, eat. (I really presented at the science behind intermittent fasting for weight loss). Brad's approach is simple just do not eat for two consecutive periods of 24 hours per week.

16/8: This protocol requires fasting shorten the "window to eat" each day so that your fasting for 16 hours and eat for eight hours for many people, this means that breakfast starts at noon or 13:00 and then exit . eat 8 or 21 hours a day.

Whichever protocol you choose, there are three universal components for weight loss that people often forget when they turn to fasting as a weight loss strategy. Here's how they might affect your success with intermittent fasting for fat loss:

You must maintain a calorie deficit: 
At the most basic level, intermittent fasting requires long periods of not eating so that when you eat, you can eat normally and not worry about eating less create a calorie deficit. Here is a concrete example:

Focus traditional diet: 1750 calories per day are burned, if you eat 1,250 calories a day to create a deficit of 500 calories / day. During the week, you will have a total calorie deficit of 3500 calories, which produces about one pound of weight loss per week.

Intermittent fasting approach: 1750 calories per day and burn rather than eat less each day, choosing to fast for two non-consecutive 24 hours during the week. The rest of the week, eat as much as your body needs (1,750 calories / day). This creates a weekly calorie deficit of 3500 calories, which produces about one pound of weight loss per week.

You must display self-control:  
Self-control is a necessity during times of fasting and not fasting. Calorically reward for quick success not undermine what you're trying to achieve. Pilon advises: ".. When the fast is finished, you have to pretend never happened fast No compensation, no reward, no special way to eat, no shakes, drinks or special pills" It's harder than n 'but it seems crucial for the success of fasting for weight loss. Fasting for several hours does not give you permission to eat what you want in the amount you want. 

You must be consistent:  
Consistency is the asset for the long term success of weight loss. You can not fast for a couple of days, then switch to a low carbohydrate diet for a week, then go back fasting or a high-carbohydrate approach. I know people who are more successful with losing weight fasting take a long-term approach to lose and maintain your weight, not a quick fix to lose weight quickly. The most consistent fast (not the length of the fast current, but days, weeks, months in which you use intermittent fasting), so that you will reap more benefits. As time passes, your body will have time to rise and appropriate enzymes to maximize fat burning during the fast roads. 
 
So if you fast?
Fasting for weight loss works, but so do many other approaches. No dietary approach is magical. Some research suggests that a very low carbohydrate produces exactly the same benefits of fasting-no need to stop eating. If you find yourself overeating after fasting or get brittle and light head during fasting (signs of low blood sugar), fasting is probably not a good method for you. Know your body and select the appropriate diet accordingly.
Source: here 

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Christian fasting

Christian fasting - what is it?

What is the Christian fasting? Biblically, fasting is abstaining from food, drink, sleep and sex to focus on spiritual growth period. Specifically, we humbly deny something of the flesh to glorify God, enhance our spirit, and deepen our prayer life.

Focus deeper stock of God - the Christian fasting

Christian fasting is not some kind of "work" is commanded by Christ or required by Scripture. However, this does not mean that fasting is not recommended as part of our spiritual growth. The book of Acts records believers fasting before making important decisions (Acts 13: 4; 2:23 p.m.). Fasting and prayer are often linked together (Luke 2:37; 5:33). Too often, the focus of fasting is the lack of food. However, the purpose of fasting is to take our eyes the things of this world and instead focus on God. Fasting is a way of showing God and ourselves that we are serious about our relationship with Him.  

Although fasting in Scripture is almost always a fasting from food, there are other ways to fast. All you can give a temporary basis to focus more on God can be considered a fast (1 Corinthians 7: 1-5). Fasting should be limited to a set time, especially when food is fast. Prolonged periods of time without eating are harmful to the body. Fasting is not intended to punish our flesh, but to focus on God.

Fasting should not be considered a "dieting method" either. We should not fast to lose weight, but to gain deeper fellowship with God. Yes, anyone can fast. Some may not be able to fast food (diabetics, for example), but everyone can temporarily give up something in order to focus on God. Even unplugging the television for a period of time can be an effective fast.

Yes, it is a good idea for believers fast from time to time. Fasting is not required in Scripture, but is highly recommended. The primary Biblical reason to fast is to develop a closer walk with God. By taking our eyes the things of this world, we can focus better on Christ. "When you fast, do not take gloomy like the hypocrites. For they disfigure their faces to show men they are fasting, I tell you the truth, they have received their reward But when you fast, anoint your head and wash. Your face to not be obvious to men to fast, but to thy Father which is in secret; and your Father who sees in secret will reward you "(Matthew 6:16 -18).

Christian fasting - A lifestyle life Servant

Christian fasting is more than denying us food or whatever meat - is a lifestyle sacrifice to God. In Isaiah 58; We learn what a "true fast" is. It is not just a one-time act of humility and denial before God, it is a lifestyle of ministry in the service of others. As Isaiah says, fasting encourages humility, loosens the chains of injustice and untie the cords of the yoke, frees the oppressed, feeds the hungry, gives to the poor and clothing the naked. The concept of fasting is not something overnight - it is a servant lifestyle living for God and others.

"Then shall thy light break forth as the morning, your healing shall spring forth speedily: and thy righteousness shall go before thee, and the glory of the Lord will be your rear guard Then shalt thou call, and the Lord will answer; This should cry and they will say: . "Here I am" (Isaiah 58: 8-9).
source: here

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Soluble tablets do not work for people with severe allergies to grass pollen

It is summer and you are in Eugene, Oregon, is the livin Sneezy. Eugene is the first in the nation for allergies this week according to IMS Health, a company in the health information that provides allergy alerts for cities across the country. Eugene residents can blame their runny nose and itchy eyes with abundant grasses of the city, currently obtain high concentrations of pollen in the air.

Eugene is just the tip of the iceberg of allergy. If you live near a green, regularly inhaled pollen. You're in good company if your body reacts. Over 50 million Americans have allergies to pollen or hayfever.

If you have an allergy to pollen from grasses boring but resisted receive injections against allergies, which would have encouraged last year when the FDA approved a non-needle alternative tablet a day you let dissolve under the tongue. 

Unfortunately, an analysis of 13 controlled clinical trials published online this week in Archives of Internal Medicine suggests that soluble tablets are only slightly more effective than placebo in reducing the classic symptoms of pollen allergy nasal grass nose, itchy eyes and tickle in the throat. To make matters worse, over 60% of people who use tablets experienced irritating side effects.

"I'm disappointed when I saw the data indicating how they are ineffective," says Dr. Nicolas Busaba, associate professor of otology and laryngology at Harvard Medical School professor. However, Dr. Busaba is not too surprised, because tablets needed to be only 25% to 30% more effective than placebo in relieving allergy symptoms in order to obtain FDA approval. "If your symptoms are severe, for example 9 on a 10 point scale, and reduced to 7 tablet will even notice the difference?"

How the tablets work
 An allergy to grass pollen, like all allergies, it is a case of mistaken identity. Your immune system sees grass pollen as potentially dangerous invaders, and made war against them. (Polen, and other things that trigger allergies, called allergens.) In people with allergies to pollen, the immune system reacts to pollen by sending antibodies to catch it. Once an antibody antigen intercepted alert cells in the lining of the nose, throat and the roof of the mouth to release chemicals called histamines. Histamines are responsible for the itching, sneezing, swelling and experience.

The tablets work by 'teaching' the immune system that grass pollen is not a threat. They do this by providing safe dose of pollen to the tissues lining the mouth. Allergens from there into the bloodstream. The first tablet is taken at the doctor's office on the case of the tablet triggered a severe allergic reaction. If no alarming side effects, you can take the medicine at home.

The FDA has approved two tablets allergy to grass pollen. Grastek contains timothy pollen extract. It is meant to be taken every day, all year round. Oralair contains a mixture of pollens bluegrass of Kentucky, orchardgrass, perennial ryegrass, mild spring, and Timothy grass. Should be taken daily for about six months, starting four months before the start of allergy season. People taking all the tablets are also given epinephrine autoinjector (EpiPen) to use if they have a life-threatening allergic reaction. 

Disappointing data

Analysis Archives of Internal Medicine was conducted by a team of researchers from the University of Palermo, Italy. They found that people who use scored tablets unless a higher point on a scale of 18 points symptoms than those who took a placebo. Seven people using tablets have had severe reactions to therapy requiring adrenaline injections. None of those who took a placebo had this type of reaction related to treatment.

Less serious side effects are also more common among trial participants using the tablets. Over 60% reported problems such as swelling of the lips, tongue, tingling and itching in the mouth. In comparison, 20% of those taking a placebo reported one or other side effects.

A problem with the tablets containing only grass allergens says Dr. Busaba. They offer no protection against tree pollen or weeds, which may be in the air simultaneously. They provide protection against other allergens like mold or dust mites. 

Other hay fever treatment
 There is other evidence of allergy to grass pollen remedies. They target the immune system response to allergens in different ways.

Over-the-counter antihistamines such as cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Alavert, Claritin) relieve symptoms by blocking histamine. Nasal sprays containing cromolyn sodium can prevent mast cell histamine release. But the pharmacy remedies often do not work for people with severe allergies.

Sprays and prescription nasal corticosteroid mometasone furoate (Nasonex) and fluticasone propionate (Flonase) can be a little more effective. They control the symptoms by reducing inflammation.

Desensitization immunotherapy of origin, were used to treat allergies for over a century. The injections not only relieve symptoms but may also prevent the development of new allergies. As an added bonus, children who received the full course of allergy shots are less likely to develop asthma. 

If you decide to take allergy shots, you need a pencil on a number of visits to the doctor on your calendar. Such as tablets, allergy shots require skin or blood test to determine what substances you are allergic. Then create an injectable laboratory solutions containing low doses of allergens. Initially, you will one or two injections a week, each time with a slightly higher concentration of allergens. Once the effective dose is reached usually after three to six months, you need monthly injections for three to five years.

This program is a deterrent for many people. According to the American Academy of Allergy and Immunology, only a third of people who could benefit from allergy shots, and three quarters of people who start to drop shots before treatment is finished. A new procedure that involves injection of allergen directly into the lymph nodes tested in clinical trials. If successful, the treatment would require three or four shots a year. 

What can you do else

The grass pollen levels vary widely depending on weather conditions. They can increase in dry day, hot or windy and fall after a storm. If you have hay fever, you can check your local paper pollen level. The American Academy of Allergy and Immunology recommends these strategies for people with allergies to pollen:

     *  Keep windows closed and turn on the air conditioning at home and in the car.
     *  Protect your eyes from pollen wear glasses or sunglasses outdoors.
     *  Wash your hands often.
     *  Do what you can to reduce other common allergens. Vacuum often to reduce dust mites; Use a dehumidifier to reduce moisture; ask someone else groom your pets.  

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