Turbo Metabolism
Weight loss has got to be the most frustrating experience for many people, young and old alike. Eating foods that are just horrible, denying yourself foods you truly love and enjoy. Exercising, even though you absolutely hate exercising, and end up stiff as a board with no results. Finally Learn amazing secrets that will increase your metabolism, allowing your body to turn into a fat burning furnace day after day!
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To determine whether modestly severe obesity modifies
Glucose homeostasis, Levels of cardiometabolic markers, and HDL function in African Americans (AAs) and White Americans (WAs) with pre-diabetes.
Targeting abdominal obesity in diabetology: What can we do about it?My Healthy Waist
By Luc Van Gaal, MD, PhD, Professor of Medicine, Antwerp University Hospital, Faculty of Medicine, Department of Diabetology, Metabolism & Clinical Nutrition, Antwerp, Belgium
DOI:10.21276/ijlssr.2016.2.4.22
ABSTRACT- Diabetes mellitus, an impaired blood glucose status is a major cause for loss of valuable human life. The
important risk factors include: High familial aggregation, insulin resistance, lifestyle changes due to rapid urbanization
and obesity specially central one. This study was carried out in diabetics (study group) & non-diabetic (control group)
women of 30-50 years age. They were subjected to anthropometric measurement and body composition assessment by
bioelectrical impedance analysis. This include waist circumference (WC), hip circumference (HC), waist hip ratio (WHR),
body mass index (BMI), body fat % (BF %) and lean body mass % (LBM %). It was found that the BMI of study group
was significantly higher as compared to that of controls. Values of WC and WHR were significantly higher in Type 2 DM
women than control. This shows that there is association of abdominal obesity (WC and WHR) with Type 2 DM. BF %
gives the relative percentage of fat in human body. BF% was significantly high in diabetic women than in control. Mean
value of body fat % in study group was 35.67±3.03% while that of controls was 28.29±2.66%. This shows that Asians
having higher BF % at low BMI values and also individuals with a similar BMI can vary considerably in their abdominal
fat mass. In such a situation, body fat would constitute the only true measure of obesity. Key-words- Body Composition, Bioelectrical impedance, Type 2 Diabetes Mellitus
To determine whether modestly severe obesity modifies
Glucose homeostasis, Levels of cardiometabolic markers, and HDL function in African Americans (AAs) and White Americans (WAs) with pre-diabetes.
Targeting abdominal obesity in diabetology: What can we do about it?My Healthy Waist
By Luc Van Gaal, MD, PhD, Professor of Medicine, Antwerp University Hospital, Faculty of Medicine, Department of Diabetology, Metabolism & Clinical Nutrition, Antwerp, Belgium
DOI:10.21276/ijlssr.2016.2.4.22
ABSTRACT- Diabetes mellitus, an impaired blood glucose status is a major cause for loss of valuable human life. The
important risk factors include: High familial aggregation, insulin resistance, lifestyle changes due to rapid urbanization
and obesity specially central one. This study was carried out in diabetics (study group) & non-diabetic (control group)
women of 30-50 years age. They were subjected to anthropometric measurement and body composition assessment by
bioelectrical impedance analysis. This include waist circumference (WC), hip circumference (HC), waist hip ratio (WHR),
body mass index (BMI), body fat % (BF %) and lean body mass % (LBM %). It was found that the BMI of study group
was significantly higher as compared to that of controls. Values of WC and WHR were significantly higher in Type 2 DM
women than control. This shows that there is association of abdominal obesity (WC and WHR) with Type 2 DM. BF %
gives the relative percentage of fat in human body. BF% was significantly high in diabetic women than in control. Mean
value of body fat % in study group was 35.67±3.03% while that of controls was 28.29±2.66%. This shows that Asians
having higher BF % at low BMI values and also individuals with a similar BMI can vary considerably in their abdominal
fat mass. In such a situation, body fat would constitute the only true measure of obesity. Key-words- Body Composition, Bioelectrical impedance, Type 2 Diabetes Mellitus
Intake of Black Vinegar on Anthropometric Measures, Cardiometabolic Profiles,...mahendrareddychirra
Obesity and type 2 diabetes mellitus are the most important chronic diseases around the world. They are associated with huge medical expenditure and with increasing morbidity and mortality among related cardio-metabolic diseases in developing and developed countries [1,2].
Vinegar was first reported to have anti-glycemic effects since 1988 in animal and human studies [3]. Vinegar may be associated with improved insulin sensitivity and delayed gastric emptying that accompanied improved glycemic control and reduced body weight [4,5].
Animal Model Selection, Study Design and Current Trends in Preclinical Obesit...InsideScientific
During this presentation, Dr. Fred Beasley gives a broad-level overview of the factors to consider when deciding on an appropriate preclinical rodent model for studying obesity and its treatments. It features an overview of trends in obesity and associated illnesses, and the role of pharmacological intervention. Dr. Beasley discusses criteria for establishing a study’s aims and review commonly used rodent models obesity, addressing both genetically inherited and diet-induced obesity. The webinar concludes with additional considerations for improving your study design.
Key topics include…
- An introduction to the role of pharmacological intervention in treating obesity
- A guide to establishing study aims for obesity research
- An overview of commonly used rodent obesity models (diet and genetic)
- Additional considerations for obesity research study design
Key methods reviewed include…
Pharmacotherapy, diet induced obesity, Western-style diet, monogenic obese rodents, polygenic obese rodents, NAFLD activity score
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Women who test positive for one of the two breast cancer susceptibility genes, BRCA1 and BRCA2, increase their risk by 45-55 percent. Currently, there are no specific physical activity recommendations for these women. However, research supports the positive effect of exercise on reducing breast cancer risk by reducing BMI, adipose tissue, and damage caused by lipid peroxidation.
Clinical Usefulness of a New Equation for Estimating Body Fat
(Utilidad clínica de una nueva ecuación para estimar la grasa corporal)
Javier Gómez-Ambrosi, PHD1,2⇓, Camilo Silva, MD2,3, Victoria Catalán, PHD1,2, Amaia Rodríguez, PHD1,2, Juan Carlos Galofré, MD, PHD3, Javier Escalada, MD, PHD2,3, Victor Valentí, MD, PHD2, Fernando Rotellar, MD, PHD2, Sonia Romero, MSC2,3, Beatriz Ramírez, MSC1,2, Javier Salvador, MD, PHD2,3 and Gema Frühbeck, MD, PHD1,2,3
Corresponding author: Javier Gómez-Ambrosi, jagomez@unav.es.
Diabetes Care 2012 Feb; 35(2): 383-388. https://doi.org/10.2337/dc11-1334
Grape Seed Extract : A potential Cancer suppressing agent sudharani028
Natural Polyphenol "Resveratrol" present predominantly in the grape seed plays an very important role in the treatment of devastating disorder Cancer (diseases involving abnormal and uncontrolled growth of cell with the potential to spread to other parts of the body)
Abstract
Background and purpose: Diet and muscle fiber type are all major factors in predicting intramuscular carnosine concentration [1]. Constituent substrate availability, including the amino acids L-histidine and more specifically beta alanine, play the greatest role in determining the concentration of intramuscular carnosine, a potent intracellular Hydrogen ion buffer. The purpose of this review is to analyze the efficacy of beta alanine supplementation on exercise performance, specifically activities relying on anaerobic glycolysis.
Method: The review included articles from peer-reviewed journals with sufficient data related to the purpose and focus of the study. Inclusion criteria included randomized control trials, systematic reviews and meta-analysis published since 2007.
Results: Twenty relevant studies were identified; various experimental protocols were employed, including both acute and chronic effects of beta alanine supplementation on physical performance. All studies were published 2007 through 2017, providing a robust overview of experimentation over the last 10 years.
Discussion and conclusion: Among studies analyzed in this mini-review, the consensus reached regarding the efficacy of beta alanine supplementation for performance enhancement was relatively positive. Most studies followed similar supplementary strategies, consuming anywhere from 1.6 to 6.4g/day for 2 to 10 weeks. The majority of these studies demonstrated statistically significant increases in intramuscular carnosine content, a physiological parameter that is positively correlated with sprinting and power performance. Many studies presented results in support of enhanced muscular endurance performance subsequent to supplementation relative to the placebo group. Researchers also noted a decline in peak aerobic capacity concurrent to a delay in the onset of blood lactate accumulation, supporting the notion of enhanced glycolytic capacity. More research is necessary to identify optimal dosing strategies for performance optimization across the spectrum of physical activities.
How To Increase Your Metabolism And Lose Weight Easier & Faster!Amelia Payne
======================
THE FAT LOSS CHALLENGE
======================
A CLEARLY-DEFINED STRATEGY to get you thinking about your weight problem and how to tackle it successfully. FLC is for Fat people who know they’re fat and are seriously committed to turning their life around. If that’s You then this is gonna be a revelation.
READ THE FULL PRESENTATION FOR FREE AT:
==> http://www.ThinVibe.com
Intake of Black Vinegar on Anthropometric Measures, Cardiometabolic Profiles,...mahendrareddychirra
Obesity and type 2 diabetes mellitus are the most important chronic diseases around the world. They are associated with huge medical expenditure and with increasing morbidity and mortality among related cardio-metabolic diseases in developing and developed countries [1,2].
Vinegar was first reported to have anti-glycemic effects since 1988 in animal and human studies [3]. Vinegar may be associated with improved insulin sensitivity and delayed gastric emptying that accompanied improved glycemic control and reduced body weight [4,5].
Animal Model Selection, Study Design and Current Trends in Preclinical Obesit...InsideScientific
During this presentation, Dr. Fred Beasley gives a broad-level overview of the factors to consider when deciding on an appropriate preclinical rodent model for studying obesity and its treatments. It features an overview of trends in obesity and associated illnesses, and the role of pharmacological intervention. Dr. Beasley discusses criteria for establishing a study’s aims and review commonly used rodent models obesity, addressing both genetically inherited and diet-induced obesity. The webinar concludes with additional considerations for improving your study design.
Key topics include…
- An introduction to the role of pharmacological intervention in treating obesity
- A guide to establishing study aims for obesity research
- An overview of commonly used rodent obesity models (diet and genetic)
- Additional considerations for obesity research study design
Key methods reviewed include…
Pharmacotherapy, diet induced obesity, Western-style diet, monogenic obese rodents, polygenic obese rodents, NAFLD activity score
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Women who test positive for one of the two breast cancer susceptibility genes, BRCA1 and BRCA2, increase their risk by 45-55 percent. Currently, there are no specific physical activity recommendations for these women. However, research supports the positive effect of exercise on reducing breast cancer risk by reducing BMI, adipose tissue, and damage caused by lipid peroxidation.
Clinical Usefulness of a New Equation for Estimating Body Fat
(Utilidad clínica de una nueva ecuación para estimar la grasa corporal)
Javier Gómez-Ambrosi, PHD1,2⇓, Camilo Silva, MD2,3, Victoria Catalán, PHD1,2, Amaia Rodríguez, PHD1,2, Juan Carlos Galofré, MD, PHD3, Javier Escalada, MD, PHD2,3, Victor Valentí, MD, PHD2, Fernando Rotellar, MD, PHD2, Sonia Romero, MSC2,3, Beatriz Ramírez, MSC1,2, Javier Salvador, MD, PHD2,3 and Gema Frühbeck, MD, PHD1,2,3
Corresponding author: Javier Gómez-Ambrosi, jagomez@unav.es.
Diabetes Care 2012 Feb; 35(2): 383-388. https://doi.org/10.2337/dc11-1334
Grape Seed Extract : A potential Cancer suppressing agent sudharani028
Natural Polyphenol "Resveratrol" present predominantly in the grape seed plays an very important role in the treatment of devastating disorder Cancer (diseases involving abnormal and uncontrolled growth of cell with the potential to spread to other parts of the body)
Abstract
Background and purpose: Diet and muscle fiber type are all major factors in predicting intramuscular carnosine concentration [1]. Constituent substrate availability, including the amino acids L-histidine and more specifically beta alanine, play the greatest role in determining the concentration of intramuscular carnosine, a potent intracellular Hydrogen ion buffer. The purpose of this review is to analyze the efficacy of beta alanine supplementation on exercise performance, specifically activities relying on anaerobic glycolysis.
Method: The review included articles from peer-reviewed journals with sufficient data related to the purpose and focus of the study. Inclusion criteria included randomized control trials, systematic reviews and meta-analysis published since 2007.
Results: Twenty relevant studies were identified; various experimental protocols were employed, including both acute and chronic effects of beta alanine supplementation on physical performance. All studies were published 2007 through 2017, providing a robust overview of experimentation over the last 10 years.
Discussion and conclusion: Among studies analyzed in this mini-review, the consensus reached regarding the efficacy of beta alanine supplementation for performance enhancement was relatively positive. Most studies followed similar supplementary strategies, consuming anywhere from 1.6 to 6.4g/day for 2 to 10 weeks. The majority of these studies demonstrated statistically significant increases in intramuscular carnosine content, a physiological parameter that is positively correlated with sprinting and power performance. Many studies presented results in support of enhanced muscular endurance performance subsequent to supplementation relative to the placebo group. Researchers also noted a decline in peak aerobic capacity concurrent to a delay in the onset of blood lactate accumulation, supporting the notion of enhanced glycolytic capacity. More research is necessary to identify optimal dosing strategies for performance optimization across the spectrum of physical activities.
How To Increase Your Metabolism And Lose Weight Easier & Faster!Amelia Payne
======================
THE FAT LOSS CHALLENGE
======================
A CLEARLY-DEFINED STRATEGY to get you thinking about your weight problem and how to tackle it successfully. FLC is for Fat people who know they’re fat and are seriously committed to turning their life around. If that’s You then this is gonna be a revelation.
READ THE FULL PRESENTATION FOR FREE AT:
==> http://www.ThinVibe.com
This cross sectional study was conducted at Department of Biochemistry, Govt. Medical College Srinagar Kashmir. A total of 120 Kashmiri Type 2 diabetic patients and 30 normal controls were randomly selected. Diabetic dyslipidaemia is characterized by raised triglycerides, low high density lipoprotein and raised low density lipoprotein. Determination of serum lipid levels in people with diabetes is considered a standard of care because detection and treatment of dyslipidaemia is one means of reducing cardiovascular disease risk. The lipid profiles and lipoprotein levels of 120 known diabetic patients were studied. Total cholesterol (TC), Triacylglycerol’s (TG) Low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) levels were assayed for each group using standard biochemical methods. Dyslipidaemia was defined using the national cholesterol education programme – adult treatment panel III (NCEP-AT III) criteria. BMI and waist and hip circumferences were measured.
П. Сутерс "Проявления инсулинорезистентности и гликемический контроль в интен...rnw-aspen
Доклад с 15 Межрегиональной научно-практической конференции "Искусственное питание и инфузионная терапия больных в медицине критических состояний" 21-22 мая 2015 г
Association of cardio metabolic risk factors, serum nitric oxide metabolite a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Effects of milk supplementation with conjugated linoleic acid (isomers cis-9, trans-11 and trans-10, cis-12) on body composition and metabolic syndrome components
Alterations of Mitochondrial Functions and DNA in Diabetic Cardiomyopathy of ...CrimsonPublishersIOD
Alterations of Mitochondrial Functions and DNA in Diabetic Cardiomyopathy of CCK1 Receptors-Deficient Rats by Abdelbary Prince, Magdy A Ghoneim, Abdallah M El-Ebidi, Hala A Mousa and Jin Han in Interventions in Obesity & Diabetes
Many successful ultra-endurance athletes have switched from a high-carbohydrate to a low-carbohydrate diet, but they have not previously been studied to determine the extent of metabolic adaptations. The concept that a diet high in carbohydrate is necessary for optimizing exercise performance gained credence in the late 1960s when it was discovered that muscle glycogen depletion was associated with fatigue, and that a high-carbohydrate diet-maintained muscle glycogen and performance.
HXR 2016: Which Comes First: Overeating or Obesity? -Dr. David Ludwig, Boston...HxRefactored
The conventional approach to weight loss, based on the calorie balance model, offers the simple advice, “eat less and move more.” Unfortunately, few people can maintain weight loss over the long term through calorie restriction because the body fights back, with rising hunger and slowing metabolism. An alternative approach to treatment aims to target the underlying driver of weight gain – fat cells overstimulated to hoard too many calories – leading to weight loss with less struggle.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
2. Conduit vessel endothelial function was the pri-
mary end point and was determined by brachial arte-
rial flow-mediated dilation (FMD) measured with
high-resolution vascular ultrasonography. Nitroglyc-
erin-mediated dilation (endothelial-independent vaso-
motion) also was determined as previously de-
scribed.11 Subjects rested in a supine position in a
temperature-controlled room for Ն15 minutes before
each vascular study. Validation studies in 25 healthy
subjects performed in the same laboratory demon-
strated a high degree of FMD reproducibility consis-
tent with published literature.2
Waist (thinnest abdominal circumference below
the xiphoid process), hip (circumference at the level of
the femoral heads), and waist cir-
cumference (circumference at the
level of the iliac crest) measurements
were obtained from each subject.
Percent body fat was calculated as
the average of the values obtained by
bioelectrical impedance and skinfold
thicknesses at 3 sites12 (triceps,
thigh, and suprailiac in women;
chest, abdomen, and thigh in men).
Blood was drawn for fasting lev-
els of glucose, insulin, lipoprotein
subfractions, CRP, and leptin, and
then subjects performed a 6-hour
oral fat tolerance test. Baseline tri-
glyceride and insulin levels were
measured before each subject con-
sumed a milkshake containing 50 g
of fat/m2
of body surface area. Sub-
jects drank the shake over 5 to 10
minutes, and triglycerides were mea-
sured at hours 2, 4, and 6 while sub-
jects refrained from physical activity
and food consumption.
CRP, lipoproteins, and leptin
measurements: CRP and lipoprotein
subclass levels (very-low-density li-
poprotein [LDL] cholesterol, high-
density lipoprotein cholesterol, LDL
cholesterol, their patient particle di-
ameters, and LDL particle concentra-
tion) were measured by LipoScience
Incorporated (Raleigh, North Caro-
lina). Lipoproteins were analyzed by
nuclear magnetic resonance spectros-
copy, and high-sensitivity CRP was
analyzed by the Immuline 2000 ana-
lyzer (Diagnostic Product Corporation,
Los Angeles, California), as described
elsewhere.13
Plasma leptin concentration was
measured with a commercially avail-
able enzyme-linked immunosorbent
assay kit (Linco Research, St. Louis,
Missouri) according to the manufac-
turer’s instructions. The intra-assay
coefficient of variation was 4.1%.
Dietary intervention: All dietary
counseling and analyses were performed and stan-
dardized by the same registered dietician. A detailed
3-day food diary was collected and analyzed for intake
of kilocalories, carbohydrates, proteins, fats, saturated
fats, polyunsaturated fats, monounsaturated fats, vita-
mins, minerals, caffeine, and alcohol at baseline and
completion of the study (Elizabeth Stuart Hands and
Associates Food Processor 7.6 for Windows, ESHA
Research, Salem, Oregon). Subjects were instructed to
consume a moderately calorie-restricted diet during
the study. Each subject was prescribed a diet that was
500 calories less than weight-maintenance needs, with
30% of calories coming from fat. If maintenance en-
ergy requirements were Ͻ1,500 calories/day, caloric
FIGURE 1. The effects of 3 months of weight-loss therapy on body mass index, waist
circumference, percent fat, and body weight. Boxes, the first and third quartiles; bars,
the median values; and whiskers, the minimum and maximum values. Mean ؎ SD is
presented above each plot. Paired t tests showed significant differences in body mass
index (p <0.001), waist circumference (p ؍ 0.001), percent fat (p ؍ 0.007), and
body weight (p <0.001).
TABLE 1 Metabolic and Blood Pressure Responses to Weight Reduction
Baseline
Post-Treatment
(12 wks) p Value
Serum total cholesterol (mg/dl) 177 Ϯ 32 164 Ϯ 31 0.002*
Serum triglycerides (mg/dl) 114 Ϯ 64 106 Ϯ 64 0.208
Serum high-density lipoprotein (mg/dl) 46 Ϯ 10 44 Ϯ 10 0.029*
Serum LDL (mg/dl) 114 Ϯ 27 104 Ϯ 25 0.005*
Total cholesterol/high-density lipoprotein 3.96 Ϯ 0.96 3.84 Ϯ 0.94 0.185
LDL particle size (nm) 20.56 Ϯ 0.67 20.57 Ϯ 0.60 0.900
LDL particle concentration (mmol/L) 1,339 Ϯ 359 1,222 Ϯ 325 0.009*
High-density lipoprotein particle size (nm) 8.74 Ϯ 0.32 8.80 Ϯ 0.36 0.107
Blood glucose (mg/dl) 88.3 Ϯ 6.8 85.5 Ϯ 9.2 0.069
Insulin (UU/ml) 8.8 Ϯ 4.1 7.4 Ϯ 2.7 0.002*
CRP (mg/dl) 0.47 Ϯ 0.41 0.40 Ϯ 0.45 0.226
Systolic blood pressure (mm Hg) 121 Ϯ 13 120 Ϯ 16 0.538
Diastolic blood pressure (mm Hg) 69 Ϯ 10 68 Ϯ 9 0.452
Baseline values versus values after treatment by paired-samples t test.
*p Ͻ0.05.
MISCELLANEOUS/WEIGHT LOSS AND VASCULAR FUNCTION 1013
3. deficit was adjusted to provide no fewer than 1,000
calories/day.
Subjects faxed or e-mailed detailed food records
daily and received instruction, feedback, and support
by the dietitian by telephone or e-mail. Subjects also
had formal one-on-one nutrition counseling for at least
1 hour with the dietician every 4 weeks.
Statistical analyses: Paired-samples t tests were
used to compare the effect of the weight-loss inter-
vention on different variables. Univariate Pearson’s
correlation coefficients were obtained between study
variables and changes in FMD, nitroglycerin-medi-
ated dilation, and arterial compliance. Given the ex-
pected 3.5% SD in FMD from our laboratory, we had
80% power to determine a 1.5% change in FMD after
weight loss in 43 subjects. Statistical significance was
defined as p Ͻ0.05.
RESULTS
Seventy-one subjects completed the initial assess-
ment and were enrolled into the trial. Ten men and 33
women (43 subjects) completed the study and the 2
assessments of vascular function. Only 1 subject left
the trial because of an adverse event, abdominal
cramping associated with the medication. Seven other
subjects dropped out of the study because of their
inability to adhere to the restricted fat content of the
diet, which resulted in fecal urgency and oily stools.
The remaining subjects were unavailable or unwilling
to complete the final assessment. The mean age for the
43 subjects who completed the study was 38 Ϯ 8
years.
The average daily meal compositions at baseline
versus those at study completion were 2,216 Ϯ 722
versus 1,622 Ϯ 409 total calories, 35 Ϯ 6% versus 29
Ϯ 7% calories from fat, 11.2 Ϯ 2.9% versus 1.1 Ϯ
0.0% calories from saturated fat, 1.0 Ϯ 0% versus 0.5
Ϯ 1.0% calories from monounsaturated fat, and 0.5 Ϯ
0.3% versus 0.6 Ϯ 0.1% calories from polyunsatu-
rated fat.
After 12 weeks, subjects lost an average of 6.6 Ϯ
3.4% of their initial body weight, and 9 of 43 subjects
lost Ն10%. All anthropometric measurements were
significantly decreased (Figure 1). Overall, weight
loss lessened the metabolic syndrome. Insulin, LDL
particle concentration, LDL cholesterol, and high-den-
sity lipoprotein cholesterol decreased significantly,
whereas fasting glucose, CRP, and high-density li-
poprotein size trended toward improvement (Table 1).
Despite these changes, brachial artery FMD, brachial
nitroglycerin-mediated dilation (Figure 2), and blood
pressure (Table 1) remained the same.
Oral fat tolerance improved modestly after inter-
vention (Figure 3). The 2-hour postprandial increase
in triglycerides was significantly decreased at study
completion compared with the 2-hour postprandial
increase at baseline. All other postprandial triglycer-
ide levels and the area under the triglyceride curve did
not change significantly as a result of the intervention.
Plasma leptin concentration decreased significantly
after weight loss (Figure 4). This decrease in plasma
leptin positively correlated with the change in FMD
after weight loss (Figure 5). There were no other
significant correlations between the changes in FMD
FIGURE 2. The effects of 3 months of weight-loss therapy on FMD
and nitroglycerin-mediated dilation (NMD). Boxes, the first and
third quartiles; bars, the median values; and whiskers, the mini-
mum and maximum values. Mean ؎ SD is presented above each
plot. Paired t tests showed no significant differences in FMD (p ؍
0.857) or NMD (p ؍ 0.129).
FIGURE 3. Triglyceride concentrations throughout the oral fat tol-
erance test before and 12 weeks after weight loss.
1014 THE AMERICAN JOURNAL OF CARDIOLOGYா VOL. 93 APRIL 15, 2004
4. or nitroglycerin-mediated dilation and any other study
measurement.
DISCUSSION
Orlistat-assisted weight reduction improved the
metabolic syndrome profile of overweight adults after
3 months. LDL particle concentration also decreased
significantly (Table 1). Despite the substantial meta-
bolic benefits, a 6.6% body weight reduction over 3
months did not lessen conduit (brachial) arterial en-
dothelial dysfunction (Figure 2).
A novel observation in this study was that the
change in endothelial function after weight loss was
predicted only by the change in plasma leptin concen-
tration (Figure 5). From this finding and the ability of
leptin to mediate endothelium-dependent vasodilation
by the release of nitric oxide,4–7 it is plausible to
speculate that the reduction in leptin may have blunted
the expected improvement in FMD. This is the first
observation to suggest that leptin positively modulates
vascular endothelial function in humans. Further stud-
ies are required to directly test this hypothesis.
In at least 3 previous articles, endothelial function
improved after comparable amounts of weight loss.7–9
The reasons for the discrepancy between our results
and those of previous reports are not entirely clear, but
small differences in the dietary prescriptions may have
played a role. However, the dietary changes in our
study (e.g., reductions in total and saturated fats)
would be expected to improve vessel function. There
were no other significant dietary nutrient or antioxi-
dant changes observed in our study that could account
for our results. Although we cannot exclude the pos-
sibility, it is unlikely that the use of orlistat was
responsible. No significant effects on fat-soluble vita-
mins, plasma antioxidants, or other nutrients have
been reported from larger weight-loss studies using
orlistat10 that would be expected to impair FMD. The
very small reduction in mean high-density lipoprotein
cholesterol among our subjects could have played a
role. However, this also seems unlikely given the
substantial improvements in most other components
of the metabolic syndrome (Table 1) and all other
lipoprotein factors (e.g., total cholesterol/high-density
lipoprotein ratio) and the reduction in postprandial
lipemia.
The most probable explanation is that this is the
first study to report the effect of weight loss on conduit
(brachial) arterial endothelial function. In previous
experiments, endothelial function was measured at the
resistance arteriole level8,9 or by the plasma concen-
trations of soluble adhesion molecules.14 Vascular
function may vary within the same patient when de-
termined by different methodologies using different
stimuli and at different vascular territories.15 There-
fore, the lack of improvement in conduit vessel endo-
thelial function instigated by shear stress (brachial
FMD) does not contradict prior investigations that
demonstrated enhanced endothelial-dependent flow at
the resistance arteriole level after receptor agonist-
mediated stimulation.8,9
The implication from our findings is that, although
resistance vessel endothelial function may improve,
comparable time periods, dietary changes, and
amounts of weight loss may not be capable of restor-
ing conduit artery function. Although adequately pow-
ered (80%) with our sample size (n ϭ 43) to determine
a 1.0% change in FMD, improvements in conduit
FIGURE 4. The effects of 3 months of weight-loss therapy on lep-
tin levels. Boxes, the first and third quartiles; bars, the median
values; and whiskers, the minimum and maximum values. Mean
؎ SD is presented above each plot. Paired t test of the differ-
ences in leptin before and after weight loss was significant.
FIGURE 5. Correlations between the change in leptin after weight
loss with the changes in FMD (*p ؍ 0.05) and nitroglycerin-me-
diated dilation (NMD) of the brachial artery (p ؍ NS).
MISCELLANEOUS/WEIGHT LOSS AND VASCULAR FUNCTION 1015
5. endothelial function may be seen with more subjects
for a longer time and/or after a greater weight loss.
An additional study on weight loss and endothelial
function has also been published. Raitakari et al16
demonstrated an improvement in brachial artery FMD
(from 5.5 Ϯ 3.7% to 8.8 Ϯ 3.7%, p Ͻ0.0001) in 67
nondiabetic, obese adults after following a very low
calorie diet (daily energy intake of 580 kcal/2.3 MJ)
for 6 weeks. The increase in FMD was only related to
a decrease in blood glucose and occurred indepen-
dently of all other metabolic improvements. As in our
study, there was no relation between the change in
FMD and the overall similar amount of weight loss
observed (11 kg). The only substantial difference
among studies that can potentially explain their dif-
ferent findings is the extremely low-calorie diet.
Taken together with our results, it appears that the
lifestyle changes and diet used to achieve weight loss
appear to be more important determinants of the
change in vascular function than the actual decrease in
adiposity.
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