Healthcare And Healthy Aging In The 21st Centurywelldoc
Dr. Phillips will present philosophical, practical and evaluative information that strongly supports the need for a different way of thinking about wellness and aging. Supported by a body of research and experiential evidence already in the literature he will provide practical examples and approaches to demonstrate that a positive, asset based focus on wellness is much more likely to produce “Successful” (vs. “Usual”) Aging.
10 Steps to Ensuring Premature Aged Skin...and what to do when the damage is done.
Covers the effects of sun worshipping, smoking, stress, lack of sleep and exercise, free radical damage, poor nutrition and diet, overconsumption of alcohol, facial expressions and lack of moisture on the skin.
For boomers, seniors, and the professionals that care and provide service for them. Identify benefits, protocol, specificity of programming for optimal active aging.
Physical, emotional, cognitive benefits are described. Exercise prescription guidelines from American College of Sports Medicine and American Heart Association are delivered and then pulled into practical interpretations.
Healthcare And Healthy Aging In The 21st Centurywelldoc
Dr. Phillips will present philosophical, practical and evaluative information that strongly supports the need for a different way of thinking about wellness and aging. Supported by a body of research and experiential evidence already in the literature he will provide practical examples and approaches to demonstrate that a positive, asset based focus on wellness is much more likely to produce “Successful” (vs. “Usual”) Aging.
10 Steps to Ensuring Premature Aged Skin...and what to do when the damage is done.
Covers the effects of sun worshipping, smoking, stress, lack of sleep and exercise, free radical damage, poor nutrition and diet, overconsumption of alcohol, facial expressions and lack of moisture on the skin.
For boomers, seniors, and the professionals that care and provide service for them. Identify benefits, protocol, specificity of programming for optimal active aging.
Physical, emotional, cognitive benefits are described. Exercise prescription guidelines from American College of Sports Medicine and American Heart Association are delivered and then pulled into practical interpretations.
Nelson Vergel, author of Testosterone: A Man's Guide (amazon.com) provides an overview of the latest developments on men's health including testosterone replacement, exercise, nutrition and other health issues
Co-Chairs, Jaime Almandoz, MD, MBA, FTOS, and Angela Fitch, MD, FACP, FOMA, prepared useful Practice Aids pertaining to obesity for this CME activity titled “Leading the Charge to Change the Obesity Narrative: Supporting Primary Care to Improve Weight Management Discussions, Diagnosis, and Decisions.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/42vnSPs. CME credit will be available until September 17, 2024.
Abdominal obesity : the risks factors .Redustim, a medical device solutionCOSMOSOFT SAS
Redustim is a class 2a medical device based on an innovative procedure that uses BioMagnetic action to gradually reduce harmful abdominal fat. The 100% hands-free treatment delivers visible results after 12 x 30 minute sessions. ReduStim is suitable for all patients who want to reduce their waist size. Clinical tests show an average reduction of more than 6 cm.
Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag. Der Vortrag ist auf einem hohen Niveau und richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.
Clinical Uses of FDA-Approved Anabolic-Androgenic Steroids (AAS)NELSON VERGEL
Nelson Vergel, author of Built to Survive, Testosterone: A Man's Guide and Beyond Testosterone, and founder of www.ExcelMale.com, www.DiscountedLabs.com, and Clinical Optimizers, speaks about the clinical uses of nandrolone, oxandrolone, and other FDA-approved anabolic androgenic steroids.
Characterized by low serum testosterone levels and diverse symptoms, male hypogonadism is a common condition. Current medical treatment focuses on testosterone supplementation using multiple modalities such as injections, gels and pellets. Interestingly, while testosterone is considered an anabolic androgenic steroid, it has not been saddled with the social stigma that other, similar medications have. The goal of this review is to highlight an anabolic steroid, 19-nortestosterone (i.e., nandrolone, deca-durabolin) and illustrate prospective therapeutic applications for male health.
Nandrolone, like other anabolic steroids, is not however, suitable as a substitute for testosterone for the treatment of testosterone deficiency, as it does not produce the effects on libido, quality-of- life and physical hardiness that testosterone itself does. In truth only testosterone itself is appropriate for testosterone replacement therapy.
Nandrolone's decreased androgenic potential means that there is less chance that it will promote hair loss or enlargement of the prostate than testosterone. This is partly because testosterone's 5-alpha reduced metabolite, called dihydrotestosterone, is more androgenic than nandrolone's 5-alpha reduced metabolite, called dihydronandrolone. Because of its lower androgenic potential, nandrolone may also be used at low doses by women who are experiencing severe weight loss.
Nandrolone is a nor-testosterone, which means that there is no carbon at the 19 position of the molecule. This prevents the binding of the enzyme called aromatase, which converts testosterone into estrogen. While some textbooks say that this means that nandrolone should not convert to estrogen at all, nandrolone has been shown to convert to estrogen at a rate of approximately 20 percent as much as testosterone does at therapeutic doses. Therefore, nandrolone has significantly less potential to cause estrogen-related side effects such as gynecomastia (breast growth) than testosterone in men. Reduced potential for androgenic and estrogenic effects, along with its high anabolic potential makes nandrolone a very good steroid to combine with testosterone for higher-dose anabolic therapy.
This lecture includes definitions and roles of every lab test included in a complete blood count (CBC) panel along with how to interpret high or low values of each. Provided by www.DiscountedLabs.com , a site that provides affordable blood tests to consumers in the United States without the need of a doctor's visit. https://www.discountedlabs.com/popular-tests
Nelson Vergel, author of Testosterone: A Man's Guide (amazon.com) provides an overview of the latest developments on men's health including testosterone replacement, exercise, nutrition and other health issues
Co-Chairs, Jaime Almandoz, MD, MBA, FTOS, and Angela Fitch, MD, FACP, FOMA, prepared useful Practice Aids pertaining to obesity for this CME activity titled “Leading the Charge to Change the Obesity Narrative: Supporting Primary Care to Improve Weight Management Discussions, Diagnosis, and Decisions.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/42vnSPs. CME credit will be available until September 17, 2024.
Abdominal obesity : the risks factors .Redustim, a medical device solutionCOSMOSOFT SAS
Redustim is a class 2a medical device based on an innovative procedure that uses BioMagnetic action to gradually reduce harmful abdominal fat. The 100% hands-free treatment delivers visible results after 12 x 30 minute sessions. ReduStim is suitable for all patients who want to reduce their waist size. Clinical tests show an average reduction of more than 6 cm.
Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag. Der Vortrag ist auf einem hohen Niveau und richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.
Clinical Uses of FDA-Approved Anabolic-Androgenic Steroids (AAS)NELSON VERGEL
Nelson Vergel, author of Built to Survive, Testosterone: A Man's Guide and Beyond Testosterone, and founder of www.ExcelMale.com, www.DiscountedLabs.com, and Clinical Optimizers, speaks about the clinical uses of nandrolone, oxandrolone, and other FDA-approved anabolic androgenic steroids.
Characterized by low serum testosterone levels and diverse symptoms, male hypogonadism is a common condition. Current medical treatment focuses on testosterone supplementation using multiple modalities such as injections, gels and pellets. Interestingly, while testosterone is considered an anabolic androgenic steroid, it has not been saddled with the social stigma that other, similar medications have. The goal of this review is to highlight an anabolic steroid, 19-nortestosterone (i.e., nandrolone, deca-durabolin) and illustrate prospective therapeutic applications for male health.
Nandrolone, like other anabolic steroids, is not however, suitable as a substitute for testosterone for the treatment of testosterone deficiency, as it does not produce the effects on libido, quality-of- life and physical hardiness that testosterone itself does. In truth only testosterone itself is appropriate for testosterone replacement therapy.
Nandrolone's decreased androgenic potential means that there is less chance that it will promote hair loss or enlargement of the prostate than testosterone. This is partly because testosterone's 5-alpha reduced metabolite, called dihydrotestosterone, is more androgenic than nandrolone's 5-alpha reduced metabolite, called dihydronandrolone. Because of its lower androgenic potential, nandrolone may also be used at low doses by women who are experiencing severe weight loss.
Nandrolone is a nor-testosterone, which means that there is no carbon at the 19 position of the molecule. This prevents the binding of the enzyme called aromatase, which converts testosterone into estrogen. While some textbooks say that this means that nandrolone should not convert to estrogen at all, nandrolone has been shown to convert to estrogen at a rate of approximately 20 percent as much as testosterone does at therapeutic doses. Therefore, nandrolone has significantly less potential to cause estrogen-related side effects such as gynecomastia (breast growth) than testosterone in men. Reduced potential for androgenic and estrogenic effects, along with its high anabolic potential makes nandrolone a very good steroid to combine with testosterone for higher-dose anabolic therapy.
This lecture includes definitions and roles of every lab test included in a complete blood count (CBC) panel along with how to interpret high or low values of each. Provided by www.DiscountedLabs.com , a site that provides affordable blood tests to consumers in the United States without the need of a doctor's visit. https://www.discountedlabs.com/popular-tests
Testosterone Replacement Benefits and Side EffectsNELSON VERGEL
Main information and facts about testosterone treatment and how to maximize benefits and minimize side effects of TRT. Included treatments are: hCG to reverse and prevent loss of fertility and testicular size, FSH to improve fertility, Androgel, Testim, Axiron, Fortesta, Natesto, Aveed (Nebido), testosterone creams and pellets, testosterone cypionate , testosterone enanthate. Blood test parameters to monitor while a patient is on TRT are also listed along with the management of such variables. Information about thyroid hormone balance is also included since it affects TRT efficacy. This information was extracted from www.ExcelMale.com by Nelson Vergel, author of Testosterone: A Man's Guide and Built to Survive.
Author and lecturer Nelson Vergel speaks about erectile dysfunction, testosterone replacement, nutrition, supplementation and exercise techniques for best health and performance. You can find this information in www.ExcelMale.com and www.TestosteroneWisdom.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. This information (and any accompanying printed
material) is not intended to replace the attention or
advice of a physician or other health care professional.
Anyone who wishes to embark on any dietary, drug,
exercise, or other lifestyle change intended to prevent
or treat a specific disease or condition should first
consult with and seek clearance from a qualified health
care professional.
4. AGENDA
• Update on lipodystrophy
• How to prevent bone loss
• Protecting yourself from anal cancer
• Exercise: The best therapy
• What you did not know about testosterone
• Questions?
5. Glucose metabolism Dyslipidaemia Abnormalities of body composition
impairment
The changing pattern of clinical spectrum of
HIV: LIPODYSTROPHY and Non-infectious
Co-MORBIDITIES depict the HIV specific
Ageing phenotypes
Body image
HAND CVD Hepatic steatosis Bone & Kidney disease
alterations
Sexual
Depression HT Vit D T2D Cancer
7. Poly-pathology prevalence in cases and controls,
stratified by age categories
Pp 3.9% 9.0% 20.0% 46.9% Pp 0.5% 1.9% 6.6% 18.7%
Pp prevalence was higher in cases than controls in all age strata (all p-values <0.001)
Pp prevalence seen cases aged 41-50 was similar to that observed among controls
aged 51-60 controls (p=0.282)
9. Abdominal Obesity and the
Cardiometabolic Risk
OUTSIDE INSIDE
Intra-abdominal or
Visceral Fat
Waist Circumference Intra-abdominal Fat
Intra-abdominal fat is a
strong correlate of
Cardiometabolic Risk
9
10. High visceral fat (VAT) increases
cardiovascular risk
Triglycerides HDL-cholesterol
310 60
248
(mg/dl)
(mg/dl)
186
45
124
62
30
0
Nonobese Obese Nonobese Obese
Low High Low High
VAT VAT VAT VAT
10
Pouliot et al. Diabetes. 1992;41:826-834.
15. Researched Options to Decrease Visceral Fat
Changing
Testosterone
HIV Meds?
Anabolic
Metformin?
Steroids?
Supplements
Egrifta ?
Low Carb,
High Fiber Weight Loss
Diet?
Exercise
Visceral Liposuction?
Fat
16. Reduction in Abdominal Subcutaneous and Visceral
Fat In Response to a 7% Exercise-Induced Weight
loss, 6 cm reduction in Waist Circumference
Visceral Fat
Subcutaneous Fat *p< 0.05 vs control
MEN WOMEN
* *
Reduction (%)
30 30
Reduction (%)
20 * 20 *
10 10
0 0
Control Exercise Control Exercise
16
Adapted from Ross et al. Ann Intern Med. 2001; Obesity Research. 2004.
17. DIET Study (Dietary Intervention:Effects
on Tryglicerides in HIV Lipodystrophy)
Using food records that began from 6 to 24 months before
development of fat deposition the following factors were
identified.
When compared to people with HIV who developed fat
deposition, patients without fat deposition had:
- greater overall energy intakes from their diet (p = 0.03)
- greater intakes of total protein (p = 0.01)
- more total dietary fiber (p = 0.01)
- more soluble dietary fiber (p = 0.01)
- insoluble dietary fiber (p = 0.03)
- pectin (P = 0.02)
Those without fat deposition also were currently doing more
resistance training exercise and were less likely to be smoking -
(only borderline statistical significance (p = 0.05))
Hendricks at al, Am J Clin Nutr, 2003 Oct;78(4):790-5
18. Newly FDA Approved Product
to Decrease Visceral Fat in HIV+ Patients
•2 mg injections under the skin every day. Effect
disappears when stopped
•A patient assistance program for those without
insurance and incomes under $60K
•More information on Egrifta.com
19. Effect of HIV Drugs on Lipids
Higher Risk Lower Risk
Stavudine- D4T Nevirapine- Viramune
AZT Tenofovir- Viread
Didanosine-DDI Abacavir- Ziagen
Lopinavir/r-Kaletra Cholesterol/ Lamivudine- 3TC
Amprenavir-Lexiva Emtricitabine- Emtriva
Triglycerides Enfurvitide-Fuzeon
Duranavir-Prezista
Sustiva (Atripla) Saquinavir- Invirase
Atazanavir- Reyataz
Raltegravir- Isentress
Maraviroc- Selzentry
Etravirine-Intelence
DHS/P
P
23. FDA Approved Facial Lipoatrophy Products
Off Label Use: Silicone Microdroplet, Artefill
24. Commonly Used Options for HIV-related Facial Lipoatrophy
(From FacialWasting.org)
Product Type/Sessions Approved? Cost
Sculptra Non- permanent Patient Assistance for Product only
http://www.needymeds.org/drug_list.taf
(New Fill- 3-7 sessions FDA approved ?_function=name&name=Sculptra
Labor cost avg. $500 per session.
PolyLactic Acid) needed, the 1 Full price: $1,100 per session for
touch up a year product.
Radiesse Non- permanent Limited Patient Assistance
(Calcium Available
hydroxylapitite 2-3+ sessions FDA approved http://www.radiesse-fl.com/Physician-
(CaHA) section/Patient-access-program/
needed, then 1 Full Price: $1,200 per session.
microspheres) touch up a year
Off label use-
Permanent FDA approved for
Silikon 1000 intraocular No Patient Assistance-
Microdroplets 4-8+ sessions injections to treat $700-900 per session
needed CMV- related
retinal detachment
Available in
PMMA Permanent Mexico, Brazil and $3,000+ avg. total cost for total
other countries.
(Polymethyl- 1-2 sessions FDA approved:
reconstruction in Mexico:
methacrylate ) Artefill but too http://www.avantiderma.com/
needed expensive
Number of sessions depends on severity of facial lipoatrophy
25. Proposed Decision Memo for Dermal injections
for the treatment of facial lipodystrophy
syndrome (FLS) (Jan 2010)
“Dermal injections for facial lipodystrophy
syndrome are only reasonable and necessary
using dermal fillers approved by FDA for this
purpose, and then only in HIV infected
beneficiaries who manifest depression
secondary to the physical stigmata of HIV
treatment. All other indications are
noncovered.”
32. Bone Disorders in HIV
Treatments for bone loss
– Resistance exercise, preventing wasting
syndrome, and avoiding tobacco
– Calcium (1000- 1500 mg/day) and Vitamin D
(400-1000 IU/day ). Get 20 minutes of sun
daily
– Biophosphonates (Alendronate- Fosamax)
– Calcitonin (Intranasal and oral)
– Teriparatide (Forteo)
– Testosterone and/or thyroid replacement
therapy
33. Bone Drugs Once monthy
IV
Once a year
Subcutaneous, once daily
36. Vitamin D Terminology
Serum 25-hydroxy vitamin D = 25-OHD
Indicator of vitamin D nutritional “status”
Vitamin D Status 25-OHD serum concentration
ng/mL nmol/L
Deficient <12 <30
Insufficient 12 to <20 30 to 50
Sufficient >20 to 50 >50 to 125
Excess >50 >125
http://books.nap.edu/openbook.php?record_id=13050&page=11
37.
38. Vitamin D Therapy Decreases
Parathyroid Hormone (PTH) in Patients
Taking Viread (tenofovir)
• Randomized trial of Vit D 50,000 IU/wk x 12 weeks vs. placebo in patients on (n=118) or not on
(n=85) TDF
• Higher baseline PTH levels at baseline in TDF group
• Vitamin D had no impact on PTH levels in patients not on TDF
Mean Baseline PTH by Vitamin D status and Tenofovir Use
PTH Differs by Tenofovir use, not Vitamin D status
Changes in PTH on study
52 TDF No TDF
43
35 Day Day
Change Change
0 0
27
Vit D 47 -6 26 -2
P=0.001 P<0.001
PBO 37 +2 25 0
Havens P, et al. 18th CROI; Boston, MA; February 27-March 2, 2011. Abst. 80.
39. Human Papiloma Virus (HPV) Related
Cancers
HPV Infection
Incidence of HPV infection
increases with sexual exposure
Re-infection
Associated with
persistent risk factors
Clearance
Common; increases after the age of 40
(as the immune system clears the virus)
Reactivation
Mainly associated
with
immunosuppression
Persistent Infection
Associated with the development of cancer
Cancers caused by HPV: Cervical, Vagino/vulvar, Penile, Anal, Oropharyngeal, Squamous cell
Higher risk with sero-types: 16, 18, 45 and 56
Levine A, et al. 49th ICAAC; San Francisco, CA; Sept. 12-15, 2009; Abst. 400.
41. Anal Cancer in HIV+ Men and Women
Diagnosis and Treatment
Pap-smears and simple anoscopy done in the office.
Cytology obtained from pap smears.
Outpatient under anesthesia: after high resolution
anoscopy (HRA) with vinegar, any lesions are treated with
infrared coagulation (IRC), which involves inserting a light
probe into the anal canal under direct visualization,
touching the tip of this light probe to the lesion, and
delivering a pre-specified amount of energy.
Trained Physicians by UCSF’s anal neoplasia and research
group web site :
http://www.analcancerinfo.ucsf.edu/
42.
43. Signs and Symptoms of Low
Testosterone
Loss of muscle mass and strength
Loss of libido and erectile dysfunction
Depression
Lethargy (fatigue, lack of focus)
Bone loss
Some regression of secondary sexual
characteristics (body hair loss, etc)
Low or no sperm count
Tenover JL. Endocrinol Metab Clin North Am. 1998;27:969-987
Petak SM, et al. AACE Clinical Practice Guidelines. Available at: http://www.aace.com/clin/guides/hypogonadism.html
46. Testosterone Fractions in the Blood
Free T
2%
Albumin-bound T
38%
T = testosterone
Only 2% is free
Sex Hormone Binding Globulin
testosterone SHBG-bound T
and 98% is bound 60%
48. Testosterone Deficiency
(Hypogonadism)
• Normal levels in blood:
Men... Total test. 300-1100 ng/dL,
Free test. 5 - 21 ng/dL
Women... Total test. 10-50 ng/dL
Free test. 0.10-0.85 ng/dL
• Symptoms of testosterone deficiency:
Fatigue, low or lack of sex drive, poor appetite,
loss of muscle mass & strength, depression
58. Side Effect: Gynecomastia (breast enlargement in men)
Treatment: Estrogen Blocker Medications or surgery (in worst cases)
59. Side Effect: Increased number of red blood cells (polycythemia)
Watch out for
hematocrit over 52 !
Solution: Donate blood
or therapeutic phlebotomy
(4-5 units every 3-4 months)
64. Low Arm Muscle is associated with
highest population-level mortality risk
in multivariable analysis
20%
Population Attributable Risk
15.1%
15%
10%
7.2%
6.5%
5%
0%
Arm SM Leg SM VAT Tertile 3
Tertile 1 Tertile 1
Tertile of Skeletal Muscle or Adipose Tissue
65. Exercise: The Best Medicine
Benefits:
total and abdominal fat
improves insulin sensitivity
improves glucose tolerance
increases HDL cholesterol
triglycerides and LDL
increases muscle mass
improves endurance
improves strength
improves bone density
improves mood
decreases frailty
67. Aerobic (Cardiovascular)
Exercise
Start with a brisk walk every day if tired
Concentrate in low impact or no impact
exercises (e.g. Elliptical Trainers)
Do what you enjoy (bicycling, roller
skating, etc)
Good for burning fat, triglycerides, blood
sugar, but it may decrease muscle mass
20 - 30 minutes 3-4 times a week is
enough for many people
Cardiovascular exercise may increase fat
loss under the skin
68. Progressive Resistance
Exercise (PRE)
Warm up and stretch before a session
Start with compounded exercises
Lift maximum weight for muscular failure
(exhaustion) at 8-12 repetitions
One body part per week
One hour sessions 3-4 times a week
One light set and two heavier sets per body part
If no access to a gym, start with crunches, push
ups, and squats at home. Use stairs!
For more details, visit www.medibolics.com
69. Best Exercise Sites with
videos, etc
www.exrx.net
www.MyFit.ca
Ipod exercise routine downloads:
http://www.menshealth.com/download/
70. For More Information
More details in “Built To Survive” and ”Testosterone- A
Man’s Guide” (amazon.com or testosteronewisdom.com)
Email:
Nelson Vergel – Nelsonvergel@yahoo.com
Websites:
www.powerusa.com
www.facialwasting.org
www.tpan.com
www.TheBody.com
Join my Internet discussion group by sending a blank email
to Pozhealth-subscribe@yahoogroups.com
Background: Tenofovir (TDF) is associated with renal phosphate wasting, elevation in markers of bone turnover, and decrease in bone density. Vitamin D3 (VITD) treatment increases renal tubular phosphate absorption in VITD deficiency. VITD deficiency/insufficiency (serum 25-OH VITD <30 ng/mL) occurs in >80% of HIV+ youth in the U.S. We hypothesized that VITD administration would increase tubular reabsorption of phosphate (TRP) and decrease serum parathyroid hormone (PTH), bone alkaline phosphatase (BAP), and C telopeptide (CTX) in HIV+ youth treated with TDF.Methods: Randomized controlled trial (RCT) of VITD 50,000 IU vs placebo (PL) every 4 weeks for 12 weeks (3 directly observed oral doses) in HIV+ youth ages 18 to 24, viral load <5,000 copies/mL, and unchanged cART for ≥90 days. Participants were enrolled based on treatment with cART containing TDF (N = 118) or noTDF (N = 85) and randomized within those groups to VITD (N = 102) or PL (N = 101). Results: At baseline, VITD and PL groups were similar in age, race/ethnicity, body mass index, VITD, and calcium (Ca) intake (self-report). Prevalence of VITD insufficiency/deficiency was 84% overall. Participants on no TDF had longer duration of HIV infection and cART, higher viral load, and more advanced Centers for Disease Control and Prevention stage of HIV disease. Those on TDF had lower TRP, higher PTH and CTX; but similar BAP. At week 12, 52% in the VITD group had sufficient VITD, an increase from 17% at baseline, compared to16% at baseline and at week 12 in the PL group (p <0.001 vs VITD). TRP did not change in either group. PTH decreased in the TDF group receiving VITD, but not in the no TDF group receiving VITD or the PL groups. Ca intake affected the strength of the VITD-TDF interaction. CTX and BAP did not change significantly with VITD. There were no clinical bone or renal toxicities or elevations of serum Ca above normal in either group.Conclusions: Supplementation with VITD3 50,000 IU monthly for 12 weeks in HIV+ youth was safe and reduced VITD insufficiency by 46%. VITD was associated with a significant decrease in PTH in those on TDF-containing cART. There was no change in TRP, CTX, or BAP. The effect of VITD on PTH was seen only in those on TDF, suggesting a possible interaction between TDF, PTH, and VITD.
We also calculated the population attributable risk, which accounts for not only the strength of the association of a risk factor with mortality, but also for the prevalence of the condition in the population.We found that having arm muscle in the lowest tertile was associated with a population level risk of 15%. This represents the proportion of deaths over five years in an HIV-infected population that are expected due to having low arm muscle. As an absolute risk, this translates to two deaths per 100 HIV+ ppl expected over five years.For low leg muscle or high VAT, the population level risk was around 7%. This translates to an absolute risk of about 1 death per 100 HIV+ ppts over 5 years.