Archive for the ‘Hormone Clinic’ Category

Coronaviruses (CoV) are a group of viruses whose antigens are expressed on their membranes in a characteristic crown like appearance, hence giving them their name (from Latin corona [crown]). Since their initial discovery in 1965,1 about 46 species have been identified in animals and humans with 2 species, namely, severe acute respiratory syndrome (SARS)-CoV-1 and Middle Eastern Respiratory Syndrome (MERS)-CoV receiving a great deal of attention due to their high rate of transmission and mortality.2 In December 2019, a novel strain of CoV emerged in the city of Wuhan, China and was termed SARS-CoV-2 as it had an 80% genetic similarity with the SARS-CoV-1 virus.3 This new infection which was also named COVID-19, based on the year of its appearance, rapidly spread throughout the world and was announced as a global pandemic on 11 March 2020. The SARS-CoV-2 virus is an RNS virus that belongs to the -CoV subgroup and is characterized by having spike (S) proteins which facilitate viral cell entry, membrane (M) proteins and envelope (E) proteins which assist in viral assembly, and nucleocapsid (N) proteins which mediate viral transcription.4 The SARS-CoV-2 S protein undergo proteolytic priming by transmembrane protease, serine 2 (TMPRSS2) and gain access into host cells through the angiotensin-converting enzyme 2 (ACE2) receptor (Figure 1).5

Figure 1. Cellular entry mechanism

The ACE2 receptors are widely expressed in various tissues including the lungs, cardiovascular system, gastrointestinal system, nervous system, and the testes. The identification of ACE2 receptors in human testes forms the basis of a potential impact for the virus on the male reproductive system. After all, a number of viruses including the Ebola, Zika, herpes simplex, Epstein-Barr, human papilloma, and Mumps have been known to illicit orchitis or to undergo shedding within the seminal fluid. Other CoV, such as the SARS-CoV-1 have been also associated with orchitis.6 While there is a significant increase in the number of publications on COVID-19 infection since the emergence of the disease, the impact of SARS-CoV-2 infection on the male reproductive system and conception has been generally under-investigated. This was the main reason for our systematic review of published literature to understand the potential impact of SARS-CoV-2 infection on male reproduction.

We conducted a literature search using PubMed and Google Scholar as search engines and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The keyword strings included (severe acute respiratory syndromecoronavirus 2 OR severe acute respiratory syndrome coronavirus 2 OR COVID-19 OR SARS-CoV-2 OR 2019-nCoV OR SARS CoV2 OR SARS CoV 2) AND (semen OR sperm* OR seminal OR testes OR testicular OR male fertil* OR male infertil* OR epididymis OR prostate OR testosterone OR LH OR FSH OR pregnancy OR ART OR assisted reproduc* OR IVF OR in vitro fertilization OR ICSI OR intracytoplasmic sperm injection OR cryopreservation). A total number of 1,171 articles were retrieved and after screening the titles, abstracts, and full texts, 24 articles were considered eligible for inclusion in this study. Six articles investigated the impact of SARS-CoV-2 infections on semen parameters.7-12 while 3 articles addressed male reproductive hormones13-15 and the remaining 15 articles assessed pregnancy outcomes.16-31

Semen samples from 120 patients with active or resolving infections were tested for the presence of SARS-CoV-2 viral RNA. Positive results were identified from 6 patients representing 5% of the tested samples. A single small-sampled study investigated the impact of SARS-CoV-2 infection on semen parameters and reported a significant reduction in sperm concentration, total number of sperm per ejaculate, total number of motile sperm, and total number of progressively motile sperm in patients with moderate infection in comparison to those with mild infection or normal controls.9

With regards to reproductive hormones, there is evidence stating that the androgenic state could be inversely correlated with the severity of COVID-19 infection. Ma et al. observed significantly higher luteinizing hormone (LH) levels and significantly lower testosterone: LH and follicle-stimulating hormone: LH ratios in recovered patients in comparison to healthy counterparts.13 Rastrelli et al. reported a negative association between total testosterone and CRP levels in COVID-19 recovered patients.14 Schroeder et al. observed that the majority of men with active infection had low testosterone and dihydrotestosterone levels.15

As for the effect of COVID-19 infection on pregnancy outcomes, 15 studies including 598 confirmed cases of SARS-CoV-2 assessed the effect of infection on women during their third trimester. While the virus had a minimal influence on maternal mortality (0.8%), intensive care unit admission was observed in 8.5% of women, and preterm delivery was seen in 33.2% of them. 30% of neonates required neonatal intensive care unit (NICU) admission and perinatal mortality was 1.5%. Vertical transmission was reported in 2.3% of cases. Four case-control studies were analyzed. Only Li et al. observed a slightly higher rate of maternal complications and preterm delivery in COVID-19 confirmed cases compared with normal controls.31 The remaining three studies did not report any significant differences.23, 27, 28

We then applied a strengths-weaknesses-opportunities-threats (SWOT) analysis of the available evidence on the topic. While SARS-CoV-2 may be associated with alterations in male and female reproduction, low quality of evidence is noted. Reasons for this finding include a less diligent peer-review process that is practiced on COVID-19 related research, the under-sized and observational designs of the available studies, and the lack of information on the consequences of infection during earlier stages of pregnancy. Taking this into consideration together with the fact that this pandemic will most likely persist for several years, efforts made to propose new standards to reproductive practices may be threatened by the low quality of evidence available so far.

We further elaborated on the current recommendations with regards to the practice of assisted reproduction during the COVID-19 pandemic (AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE (ASRM) PATIENT MANAGEMENT AND CLINICAL RECOMMENDATIONS DURING THE CORONAVIRUS (COVID-19) PANDEMIC)

In conclusion, the evidence regarding a putative impact of SARS-CoV-2 infection on male reproduction, as well as the potential of SARS-CoV-2 viral transmission through seminal fluids, remains inconclusive. Currently, extra precautions are strongly recommended for natural or ART-related conception, as clear evidence regarding the impact of the SARS-CoV-2 and the possible complications of COVID-19 on reproductive outcomes require additional investigation.

Written by:Ahmad Majzoub, MD1, 2, 3 and Ashok Agarwal, PhD3

Excerpt from:
Male Fertility and the COVID-19 Pandemic: Systematic Review of the Literature - Beyond the Abstract - UroToday

For a world crippled by the coronavirus, salvation hinges on a vaccine.

But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded COVID-19: obesity.

Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different.

Will we have a COVID vaccine next year tailored to the obese? No way, said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill.

Will it still work in the obese? Our prediction is no.

More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them.

In March, still early in the global pandemic, a little-noticed study from China found that heavier Chinese patients afflicted with COVID-19 were more likely to die than leaner ones, suggesting a perilous future awaited the U.S., whose population is among the heaviest in the world.

And then that future arrived.

As intensive care units in New York, New Jersey and elsewhere filled with patients, the federal Centers for Disease Control and Prevention warned that obese people with a body mass index of 40 or more known as morbid obesity or about 100 pounds overweight were among the groups at highest risk of becoming severely ill with COVID-19. About 9% of American adults are in that category.

As weeks passed and a clearer picture of who was being hospitalized came into focus, federal health officials expanded their warning to include people with a body mass index of 30 or more. That vastly expanded the ranks of those considered vulnerable to the most severe cases of infection, to 42.4% of American adults.

Obesity has long been known to be a significant risk factor for death from cardiovascular disease and cancer. But scientists in the emerging field of immunometabolism are finding obesity also interferes with the bodys immune response, putting obese people at greater risk of infection from pathogens such as influenza and the novel coronavirus. In the case of influenza, obesity has emerged as a factor making it more difficult to vaccinate adults against infection. The question is whether that will hold true for COVID-19.

A healthy immune system turns inflammation on and off as needed, calling on white blood cells and sending out proteins to fight infection. Vaccines harness that inflammatory response. But blood tests show that obese people and people with related metabolic risk factors such as high blood pressure and elevated blood sugar levels experience a state of chronic mild inflammation; the inflammation turns on and stays on.

Adipose tissue or fat in the belly, the liver and other organs is not inert; it contains specialized cells that send out molecules, like the hormone leptin, that scientists suspect induces this chronic state of inflammation. While the exact biological mechanisms are still being investigated, chronic inflammation seems to interfere with the immune response to vaccines, possibly subjecting obese people to preventable illnesses even after vaccination.

An effective vaccine fuels a controlled burn inside the body, searing into cellular memory a mock invasion that never truly happened.

Evidence that obese people have a blunted response to common vaccines was first observed in 1985 when obese hospital employees who received the hepatitis B vaccine showed a significant decline in protection 11 months later that was not observed in non-obese employees. The finding was replicated in a follow-up study that used longer needles to ensure the vaccine was injected into muscle and not fat.

Researchers found similar problems with the hepatitis A vaccine, and other studies have found significant declines in the antibody protection induced by tetanus and rabies vaccines in obese people.

Obesity is a serious global problem, and the suboptimal vaccine-induced immune responses observed in the obese population cannot be ignored, pleaded researchers from the Mayo Clinics Vaccine Research Group in a 2015 study published in the journal Vaccine.

Vaccines also are known to be less effective in older adults, which is why those 65 and older receive a supercharged annual influenza vaccine that contains far more flu virus antigens to help juice up their immune response.

By contrast, the diminished protection of the obese population both adults and children has been largely ignored.

Im not entirely sure why vaccine efficacy in this population hasnt been more well reported, said Catherine Andersen, an assistant professor of biology at Fairfield University who studies obesity and metabolic diseases. Its a missed opportunity for greater public health intervention.

In 2017, scientists at UNC-Chapel Hill provided a critical clue about the limitations of the influenza vaccine. In a paper published in the International Journal of Obesity, they showed for the first time that vaccinated obese adults were twice as likely as adults of a healthy weight to develop influenza or flu-like illness.

Curiously, they found that adults with obesity did produce a protective level of antibodies to the influenza vaccine, but they still responded poorly.

That was the mystery, said Chad Petit, an influenza virologist at the University of Alabama.

One hypothesis, Petit said, is that obesity may trigger a metabolic dysregulation of T cells, white blood cells critical to the immune response. Its not insurmountable, said Petit, who is researching COVID-19 in obese patients. We can design better vaccines that might overcome this discrepancy.

Historically, people with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results. The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Larry Corey, MD, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase 3 trials sponsored by the National Institutes of Health.

Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants BMI will be documented and results evaluated.

Timothy Garvey, MD, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it is still safer for obese people to get vaccinated than not.

The influenza vaccine still works in patients with obesity, but just not as well, Garvey said. We still want them to get vaccinated.

This article was originally published on August 6, 2020, by Kaiser Health News. It is republished with permission.

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America's Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine - POZ

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Osteoporosis Treatment Market Estimated to Discern 2X Expansion by 2019-2025 - StartupNG

While the act of continuously scrolling through social media or surfing the web and taking in a constant torrent of bad news isnt really new, its gotten new attention during the pandemic and even a new name: doomscrolling.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

Chances are, at some point, youve found yourself doing this, an unending scroll in the harsh light of your smartphone or computer screen. Whether its Facebook or Google or any number of other places, youre subjecting yourself to a constant stream of terrible news.

But, surprise, doomscrolling isnt good for your mental health for a variety of reasons. We talked to psychologist Susan Albers, PsyD, about doomscrolling, including why we do it and how we can stop this bad habit.

We may be telling ourselves that were staying informed, but theres something deeper at work when we find ourselves constantly scrolling through social media and bad news headlines.

If youre depressed, you often look for information that can confirm how you feel, says Dr. Albers. If youre feeling negative, then reading negative news reconfirms how you feel. Its the same mindset.

If you do that a few times, it can easily become a habit. If youre continuously scrolling, it becomes a mindless habit, she says. A lot of times, you might not even be aware youre doing it. But it becomes such a habit that if you have a down moment, you might pick up your phone and start scrolling without even really being aware of it.

Dr. Albers notes that doomscrolling can also be a function of obsessive-compulsive disorder (OCD). In this scenario, your brain continues to loop around on a particular topic similar to endless scrolling, she says. The behavior is not really about finding news, its about reducing anxiety.

When OCD is at the root of the problem, its likely that more structured cognitive behavioral therapy is needed or therapy.

Doomscrolling can reinforce negative thoughts and a negative mindset, something that can greatly impact your mental health. Consuming negative news has been linked in research with greater fear, stress, anxiety and sadness.

If youre are prone to anxiety, depression or sadness, doomscrolling can be like stepping into quicksand, says Dr. Albers. The negativity can pull you under quickly and can lead to panic attacks.

She also says it can impact your sleep: When youre anxious, its hard to turn your mind off to go to sleep.

But another risk of doomscrolling is that it has the potential to create what is called crazy-making. In other words, you might see one set of information from one media outlet but the very next source you scroll by might give completely conflicting information. Your mind doesnt know how to reconcile the information.

Theres also a big downside to simply being online so much. Too much time on any media or social media sites, whether the news is bad or not, has been linked with feelings of depression, Dr. Albers says. Burying your nose in a phone can exacerbate disconnection and loneliness. Being locked on a screen can zap your energy and leave you feeling drained.

Whats happening on a biological level, she says, is that you are feeding your brain a continual stream of cortisol, or the stress hormone. Over time, the brain and body become exhausted by the high levels of this stress hormone. It breaks down and leads to health problems or mental health issues.

Its not all doom and gloom, though. There are ways you can give yourself distance and reduce the urge to dive into the social media abyss, says Dr. Albers. And she has ways you can gently alter your behavior so that you can make sure you set up healthier patterns of mindfulness and news consumption.

Localizing means limiting a behavior to a specific time or place, says Dr. Albers. Its okay that you need to read some news to stay informed, but by setting these boundaries and sticking to them,youre channeling behavior into more appropriate or specific time periods that are more ideal.

If youre scrolling first thing in the morning, Dr. Albers says, plug your phone in on the other side of the room so you dont pick up your phone before you even get out of bed. Instead of opening your phone before anything else, get up, have some coffee get your day underway before you dive into the news.

Be mindful of how a particular article makes you feel as you are scrolling by it, Dr. Albers suggests. Notice or observe the sensations in your body or your minds response to the news.

When you pay attention consciously to the bad feelings such as anxiety, agitation or stress, she says, its more likely to motivate you to put on the brakes. This, she adds, is your bodys way of saying stop.

Catastrophizing is when your mind jumps straight to the worst-case scenario. Often, these thoughts are possible but not really probable, Dr. Albers says. Youre mind is jumping right from A to Z.

Instead, she says, reel your thoughts back in by asking yourself what is a more realistic or likely outcome of the situation youre reading about.

Thought stopping is a cognitive-behavioral technique typically used for ending obsessive or anxious thoughts. When you have difficulty turning off a thought, imagine a red stop sign, suggest Dr. Albers. The power of imagination is helpful in curbing your thinking.

Check your phone consciously, not compulsively, she adds. Compulsive checking is something you do automatically without even much thought. So when you pick up your phone, pause for a second and be mindful of what you are doing. If the stop sign doesnt work and you find yourself still engaging in too much scrolling, try wearing a rubber band around your wrist as a physical reminder.

If you cant stop the scrolling, consider slowing down the pace. The human attention span is very short, Dr. Albers points out. When we scroll quickly, we continue to shorten the length of time. You need a solid attention span to help you concentrate and focus. Consciously tell yourself, to pace, dont race through the articles.

When the news is dismal, it can lead you to feel hopeless and down. Hang positive mantras, sayings and slogans in your workspace or around your home. These words help to keep your mind pointed in a positive direction.

We cant control what is going to happen in the future, Dr. Albers says. But you can control what is happening right now. Ask yourself what is going to help you to feel better in this moment.

Be honest with yourself about whats at the root of your scrolling. Are you looking for reassurance? Guidance? Confirming your fears? If you are feeling lonely, a more lasting and healing intervention would be to connect with someone.

While technology is part of the problem with doomscrolling, it can still be part of the solution thanks to a variety of wellness apps that are currently available. Set time limits on apps or set alarms on your phone to set boundaries on the time you spend on social media sites, Dr. Albers suggests.

Unfollow negative new sources or those that tend to make you anxious, she says, and limit the number of sources you consult. Put a cap on the number of sites you consult in one sitting or per day.

Sometimes looking at the news can be a positive and give you perspective. Your own problems seem more manageable or not as difficult compared to some of the things you are reading about in the news, Dr. Albers says. If you find yourself sinking into doomscrolling, ask yourself for the nugget of gold from this behavior. What does it tell you to be grateful for or appreciate in your life?

Unhook yourself from your screen by mindful movement. Exercise and deep breaths help to reconnect you with your body and gives your mind a rest while exercising your muscles. Exercise has also been shown to help pump up your serotonin level, that feel-good neurotransmitter in your brain.

See original here:
Everything You Need to Know About Doomscrolling and How to Avoid It - Health Essentials from Cleveland Clinic

GRABILL, Ind. (WANE) Infertility is an issue millions of couples face across the United States. It can be caused by a man or a woman.

A Grabill couple shared their journey to being parents, as the husband suffers from infertility.

Although not talked about often, according to the Cleveland Clinic, 10% of all men in the United States attempting to conceive suffer from infertility.

You never, ever dream of the guy, or in my mind, I never thought Id have an issue being able to have kids. You know, I was crushed at first. Because I could see my wife, and not being able to give her the thing she really wanted, said Craig Nickols.

Craig said he had moments where he felt embarrassed about being infertile. However, those feelings have subsided.

The Nickols didnt know if being surrounded by their children on the couch of their home would ever be a possibility. Craig and Kristin married in 2010, and shortly after wanted to start a family.

The couple says they always had desires to adopt. Craigs infertility led them down the path to adopting Xavier in 2015. The couple fed him in the hospital, and took him home from there.

A few years later, the five year old is in kindergarten learning how to spell. But before then, Kristin and Craig wanted him to become a big brother.

We wanted him to have a sibling. And what does that look like? And how are we going to do that? And so we started kind of going down the road of embryo adoption, said Kristin.

The Nickols enlisted help from the National Embryo Donation Center in Knoxville, Tennessee.The center stores remaining embryos from couples that went through in vitro fertilization.Couples can then adopt the remaining embryos.

My wife wanted to be able to experience pregnancy. We thought this would be an incredible option for us, said Craig.

Yeah, its basically carrying your adopted baby. So, that was kind of interesting to us. We didnt know what that looked like, or how it worked, or anything like that at first, explained Kristin.

The Nickols selected embryos and received the transfer. The first transfer ended in a miscarriage. The couple tried again, becoming pregnant with twins. However, by the 9-week ultrasound both of their hearts stopped beating.

With support from their friends and family and receiving a grant to continue their journey, the Nickols became pregnant with Stella in the fall of 2019.

Stellas embryo was frozen for 6 years prior to the transfer.

Along the way there was just the lord showing us, Keep going. And you know, Im so glad we didnt give up, because she wouldnt be here now. Is that right, said Kristin.

Kristin and Craig took photos of the newborn surrounded by hormone treatments and medication to make it possible. Stella arrived early, but shes now a chatty 4 month old.

To learn more about infertility in the United States, click here.

To learn more about the National Embryo Donation Center, click here.

Continue reading here:
Grabill couple struggles with infertility, adopts infant and embryo - WANE

Coleen Kivlahan, a physician and head of primary care at the University of California-San Francisco (UCSF), has had symptoms of Covid-19 since she tested positive for the novel coronavirus in Marcha difficult experience with one upside: Kivlahan says being a Covid-19 "long-hauler," and a patient at UCSF, helps her provide better care to patients with the virus, Sumathi Reddy reports for the Wall Street Journal.

Covid-19 guidance from clinicians at the forefront

According to Reddy, Kivlahan is one of the roughly 15% of "long-haul" Covid-19 patients, or patients who still experience symptoms of Covid-19 months after they initially were diagnosed with the new coronavirus, which causes the disease. These symptoms often include lingering chest pain, fatigue, and neurological issues.

Kivlahan fell ill, and was diagnosed with, Covid-19 in March. Her first coronavirus test came back negative, but when she later went to the ED with a cough, fever, shortness of breath, and night sweats, she received another test that came back positive. Tests also revealed that Kivlahan had developed "diffuse bronchitis," as well as another uncommon respiratory virus.

Kivlahan said that, after her visit to the ED, her cough got worse and she experienced chest and stomach pains from the persistent coughing. Kivlahan said, at times, she was so weak that she had to sit down in the shower.

"I was short of breath just sitting there," Kivlahan told Reddy. "I had to lay down with my head down off the bed just to breathe."

Kivlahan went to the ED again, and her chest pain was so bad that "she got an EKG to rule out a heart attack," Reddy reports. But by March 21, Kivlahan began feeling better.

The improvement was short-lived, however. A few days later, Kivlahan's cough returned and she again began experiencing chills, shortness of breath, and chest pain. She went to the respiratory screening clinic at UCSF the next day, and she tested positive for the coronavirus yet again. A couple of days later, Kivlahan said she couldn't smell mint or taste hot chocolate, Reddy reports.

Kivlahan was concerned her symptoms might send her to the hospitalor even lead to her death. She made an advance directive for end-of-life care and "packed a bag several times to go to the hospital," Kivlahan told Reddy, though she ultimately would "decid[e]" that she could "make it one more night at home," Kivlahan said.

Kivlahan still experienced symptoms of Covid-19 through April, and there were some evenings when she "could not take a full breath," she told Reddy. "[T]he pressure in my chest was so intense I had to lie very still in bed to avoid breathing deeply."

Kivlahan tested positive for the coronavirus again in April. "It was a big emotional backslide," she said. "It was really the first time I felt like 'This is a virus we don't understand.'"

Kivlahan said she ultimately tested positive for the coronavirus a total of nine times from March until June 11, when she received her first negative coronavirus test since she had initially sought ED care. At that point, her symptoms were also subsiding. "I celebrated by taking a walk outside with a mask on," she said.

Now, Kivlahan's heart and lung function are almost normal and her energy level is about "90%" of what it normally is, she told Reddy. However, Kivlahan said she still experiences some lingering symptoms of Covid-19. According to Reddy, Kivlahan said her senses of smell and taste haven't yet returned, and she still has a mild cough. Kivlahan also said that, every now and then, she can smell and taste fire that isn't therea disorder known as phantosmia, which can be triggered by upper respiratory infections. "I have to look outside to see if Northern California is on fire," she said. "It is very real."

Despite her symptoms, Kivlahan has been seeing patients virtually since March, and she now plans to resume seeing patients in-person at UCSF this month.

Kivlahan said she treats up to 20 Covid-19 patients per day, and her own experience with the illness has helped her understand her patients' experiences on a more personal level. "Because this virus has so many unique ways of impacting the human body, my personal illness has allowed me to reassure and direct care in a special way," Kivlahan told Reddy.

For instance, Kivlahan better understands the psychological toll Covid-19 can have on patientsespecially on long-haul patients who can experience symptoms of the illness for months. Kivlahan told Reddy that the three-months period during which she tested positive for the coronavirus were psychologically taxing. "I spent months not being able to hug my kids," she said. "All that emotion and anxiety absolutely affects our organ systems and increases the stress hormone cortisol. Those things are hard to tease out from the virus effect itself."

Kivlahan said her patients often express concern that she won't understand the physical and psychological hardship of Covid-19 and that doctors might not know how to empathize with patients who have been sick for months. But to reassure them, "[w]hen it's appropriate clinically, I tell them my story," Kivlahan said. "It causes tremendous relief. People begin to believe there's hope."

Kivlahan also is a patient, herself, at the post-Covid-19 multidisciplinary clinic at UCSF, and she's currently participating in a Covid-19 study being conducted at the hospital. Kivlahan said she hopes to help other clinicians better understand the impact of Covid-19 on long-haul patients.

"These are patients who weren't in the ICU, weren't on a vent, didn't die. But they have ongoing symptoms that are just scary and unknown," Kivlahan said. "We can learn a great deal about the virus by understanding those lasting symptoms" (Reddy, Wall Street Journal, 8/10).

Read the rest here:
What it's like to be a Covid-19 'long-hauler'and a doctor - The Daily Briefing

Women with Alzheimers disease tend to live longer than men with the disease and a new study suggests that a gene on the X chromosome may help explain why.

Each person typically has one pair of sex chromosomes in each cell of their body. People assigned female at birth typically have two X chromosomes, while people assigned male at birth typically have one X chromosome and one Y chromosome.

Researchers say a gene called KDM6A may explain why women with Alzheimers disease tend to live longer than men with the same condition.

The gene is only found on X chromosomes. It tells the body how to produce the KDM6A protein, which is known to play a role in cognition.

In a study published last week in the journal Science Translational Medicine, researchers investigated the effects of the KDM6A gene in humans and mice.

They found evidence that KDM6A protein helps slow cognitive decline and improve survival in those with Alzheimers disease.

The gene KDM6A was found to have protective effects on the brain. Thus, the more doses of the gene i.e., XX vs. XY the better resilience, Michelle M. Mielke, PhD, director of the Specialized Center of Research Excellence on Sex Differences at Mayo Clinic College of Medicine in Rochester, Minnesota, told Healthline. She wasnt involved in the study.

A next step in this research will be to identify other genes on the X or Y chromosomes that are beneficial or detrimental to the brain, Mielke added. This will help experts develop a better understanding of some of the pathways that can protect the brain and therefore be potential drug targets.

Compared with men, women are more likely to develop Alzheimers disease. Women account for nearly two-thirds of Americans affected by it.

On the other hand, Alzheimers disease tends to progress more quickly in men. They tend to experience more rapid cognitive decline and die sooner.

Past studies have found that sex-related differences in hormones, immune function, and energy metabolism may help account for these gaps.

The new study on KDM6A adds another piece to the puzzle, highlighting the role that non-hormone-related genes on sex chromosomes may play.

The Alzheimers Association held a think tank in 2015 to explore the biology that may contribute to sex differences in Alzheimers disease, Heather M. Snyder, PhD, the Alzheimers Associations vice president of medical and scientific engagement, told Healthline.

One of the outstanding questions from that think tank was that we did not yet have the tools to fully evaluate the impact of the X or Y chromosome.

She added that the new study is helping to start to address some important scientific questions by using emerging technologies to look at the complexity of the X chromosome.

To assess the potential role of X chromosomes in Alzheimers disease, the authors of the new study conducted a series of experiments in a mouse model of the disease.

They found that male mice with Alzheimers disease demonstrated greater cognitive impairments and died more quickly than female mice.

When they genetically engineered male mice with Alzheimers disease to have two X chromosomes, those mice performed better on cognitive tests and lived longer than male mice with one X chromosome.

Conversely, female mice that were engineered to have only one X chromosome showed more cognitive impairment and died more quickly than those with two X chromosomes.

The authors show that the addition of an X leads to brain resilience, Mielke explained. Notably, it is not that the Y gene is necessarily detrimental, just that having two X chromosomes, indicative of females, offers more brain protection.

The authors of the new study suspected the KDM6A gene may help account for the differences observed in mice with one versus two X chromosomes.

When mice have two X chromosomes, most of the genes on the second X chromosome are inactivated. But KDM6A is one of a small group of genes that remains active on both chromosomes.

After reviewing a public dataset of gene expression studies, the researchers found that about 14 percent of people carry a particularly active variant of the KDM6A gene.

This variant of the gene wasnt associated with lower risk of developing Alzheimers disease, but it was linked to slower cognitive decline in people who have the disease.

When the researchers engineered male mice with Alzheimers disease to produce more KDM6A protein than usual, they found the mice performed much better than average on cognitive tests.

The findings of this study may help experts understand why symptoms of Alzheimers disease develop more quickly in some people than in others.

As we understand more about Alzheimers pathology, we know that some patients with significant pathology may not develop any clinical symptoms and protection from genes such as KDM6A may offer clues as to why, said Dr. Gayatri Devi, a neurologist at Lenox Hill Hospital in New York City and author of The Spectrum of Hope: An Optimistic and New Approach to Alzheimers Disease and Other Dementias.

In turn, identifying protective genes and other biological factors that shape the progression of the disease may help researchers develop more effective prevention, diagnosis, and treatment strategies.

Understanding the biological differences of Alzheimers between the sexes would potentially be a huge benefit to the field in researching and developing more specific diagnostic tools, therapies, and preventions, said Snyder.

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This Gene May Be Why Women with Alzheimer's Disease Live Longer Than Men - Healthline

August 31, 2020 2:45 PM

Posted: August 31, 2020 2:45 PM

Updated: September 3, 2020 5:52 PM

DEAR MAYO CLINIC: Diabetes runs in my family. My mother was diagnosed in her 20s and requires daily insulin. Last month, my 45-year-old sister was diagnosed and is now on medication. My doctor told me I was a pre-diabetic. I am curious how I might be able to reduce my risk for diabetes, especially since Ive heard that diabetics are at greater risk of COVID-19. Are there extra steps my sister and I should take to stay safe?

ANSWER: Diabetes is a chronic health condition that occurs when the level of sugar in the blood is too high. That happens because of a problem with the hormone insulin, which is made in the pancreas. When you eat, the pancreas releases insulin into the bloodstream. This allows sugar to enter your cells, lowering the amount of sugar in your blood.

There are several forms of diabetes, including Type 1, which is an autoimmune disorder, and Type 2, which results from both loss of insulin production and development of insulin resistance in body tissues. Gestational diabetes is another form that may occur during pregnancy.

Patients with Type 1 diabetes are completely insulin-deficient and require daily insulin injections. Given her age of onset and insulin requirement, your mother likely has Type 1 diabetes. Despite ongoing research, Type 1 diabetes currently has no cure. Treatment focuses on managing blood sugar levels with insulin as well as diet and lifestyle to prevent complications.

Type 2 diabetes develops when the pancreas does not make enough insulin, and the body cant use insulin as well as it should. That means sugar cannot move into the cells, and it builds up in the blood. Exactly what causes Type 2 diabetes is unknown, although genetics and environmental factors, such as being overweight and inactivity, seem to be contributing factors. Your sister most likely has Type 2 diabetes.

Although theres no cure for Type 2 diabetes, studies show it is possible for some people to reverse the condition. For many patients, losing weight, eating well and exercising can help manage the disease. If lifestyle changes are not enough, some people, like your sister, may be prescribed any number of oral medications or even insulin to help them manage their disease.

Prediabetes is a condition in which blood sugar is higher than normal, but its not high enough to be considered Type 2 diabetes. If left uncontrolled, prediabetic patients are at high risk to develop Type 2 diabetes.

The good news is that often lifestyle changes alone, such as diet and exercise, can lower your blood sugar level and decrease your risk of developing diabetes.

In general, no matter what type of diabetes a person has, monitoring and managing blood sugar are the most important things to minimize risk for complications. It can be harder to control blood glucose levels during an illness or infection.

COVID-19 is no exception.

It is important to remember that diabetic patients are not at higher risk of COVID-19 infection. Rather, people with diabetes are experiencing more severe symptoms, particularly those people whose glucose control is not optimal. Among patients who are hospitalized due to COVID-19, a higher proportion has diabetes.

Although it is not yet understood why, COVID-19 seems to affect patients with Type 1 diabetes differently than those with Type 2 diabetes. Although more research is needed, it is believed that Type 2 diabetics are having more complications due to coexisting conditions they often have, including obesity, heart disease and kidney disease.

As the COVID-19 pandemic continues, you should encourage your family to be vigilant about managing their diabetes and maintaining good blood glucose control. Also, encourage your mother and sister not to postpone visits with their endocrinologist or health care provider due to COVID-19. It is important to have regular check-ins so issues can be addressed promptly.

For yourself, commit to move more, improve your diet and monitor your blood sugar.

Your family also should continue to practice good infection control, including proper hand hygiene, wearing a mask when out in public and social distancing. Lastly, stay up-to-date on any recommended vaccines to minimize your risk for illness. Bithika Thompson, M.D., Endocrinology, Mayo Clinic, Phoenix, Arizona

(Mayo Clinic Q & A is an educational resource and doesnt replace regular medical care. E-mail a question to MayoClinicQ&A@mayo.edu. For more information, visit http://www.mayoclinic.org.)

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How to deal with diabetes and COVID-19 risk - KXLY Spokane

We continue to zero in on fixing the broken menopause healthcare system that leaves women in the dark on how best to manage their symptoms, said Jill Angelo, co-founder and CEO at Gennev.

SEATTLE (PRWEB) September 03, 2020

To support 38 million women juggling menopause symptoms, Gennev (http://www.gennev.com) today announced three new menopause systems to support the daily lives of women over the age of 40. The new menopause systems include the CBD Sleep System, AM/PM Daily Menopause Pack, and Menopause Dryness Care, which can be purchased in 30-day supplies individually or as a monthly subscription. Each menopause system is designed to help women personalize their care based on their unique symptoms.

We continue to zero in on fixing the broken menopause healthcare system that leaves women in the dark on how best to manage their symptoms, said Jill Angelo, co-founder and CEO at Gennev. By covering her needs from the moment she needs a doctor, to a health coach, to supporting her daily routine with specific formulations created by and for women, we give women a trusted and reliable approach based on science to live their best life.

According to Gennevs 2019 Menopause Zeitgeist with results from more than 6,000 women, fatigue, mood changes, and sleep disturbances lead the list of challenges with alarming impact on quality of life for menopausal women. By introducing flexible, symptom-specific menopause systems that are easily integrated into the daily lives of women over the age of 40, Gennev takes the guess-work out of sourcing home-health products that arent backed by evidence-based, practitioner-proven practices.

Gennevs New Menopause Daily Living Systems (Read the blog post here)*Gennev Sleep System: Designed to offer an easy-to-follow regimen for women struggling to fall asleep and stay asleep. In the Sleep System, you get Gennevs Sleep CBD Tincture + Mint which offers premium, broad-spectrum cannabidiol (CBD), 30+ terpenes, flavonoids, antioxidants and omega acids precisely formulated for a peaceful sleep. You also get pharma-grade Gennev Magnesium Glycinate to support a sound sleep with the added bonus of relieving joint pain and irritating PMS cramps. Gennev also includes access to its 30-Day Sleep Challenge for free. Pricing is $56.95 for a 30-day supply; those who subscribe monthly get a 20 percent savings.

*Gennev AM/PM Daily Menopause Pack: Offers a no-fuss AM/PM menopause regimen that's formulated to naturally tame and prevent symptoms. In the AM/PM Daily Menopause Pack, you get Vitality, the definitive premium multivitamin for women 40+, in the morning, and Gennevs Sleep CBD + Melatonin Softgels paired with Magnesium at night. During the day, pharmaceutical-grade nutrients in Gennevs Vitality will help women feel more energetic and in a better mood, while their bones, hair and nails benefit from the inside out. And at night, Gennevs Sleep CBD + Melatonin Softgels helps women fall asleep faster and stay asleep until they wake in the morning. Gennev also includes access to its 30-Day Vitality Challenge for free. Pricing is $89.95 for a 30-day supply; those who subscribe monthly get a 20 percent savings.

*Gennev Menopause Dryness Care: Offers long-lasting moisture to help soothe vaginal dryness with Gennevs personal care menopause moisture care system formulated by OB/GYNs and naturopathic doctors. This pack includes Gennevs Ultra-Gentle Body Wash to gently cleanse and balance the pH of a womans intimate area. In addition, the pack includes Gennevs Intimate Moisture which feels and functions like a woman's own moisture to relieve feminine dryness instantly, enhance intimacy, and help with painful sex. The aloe-infused Cleansing Cloths are a fabulous way to freshen up on-the-go. Perfect for intimacy or daily use. Pricing is $34.95 for a 30-day supply; those who subscribe monthly will save 20 percent.

Gennev takes a unique approach to managing menopause with solutions created by experts, therapeutic dosages, and a supportive community, said Dr. Wendy Ellis, a Naturopathic Physician who serves as functional medicine specialist and hormone disorder expert for Gennev. These systems re-imagine the way women manage menopause in a highly personalized way with easy-to-follow regimens that bring relief and improve quality of life.

Over the past 12 months, over 1 million women have benefited from Gennevs line of supplements, lubricants, telehealth services, and community for menopause. The company aims to serve 2 million women in 2020 with a modern approach to menopause that includes telehealth services specializing in gynecology, primary care and lifestyle behaviors as well as natural, quality sourced wellness products and supplements that support sleep, mood, energy, stress response, immune health, joint pain, inflammation, sexual wellness and vaginal health.

About GennevGennev is the first-of-its-kind online clinic for women in menopause. The company's mission is to empower every woman to take control of her health in the second half of life. Founded by former Microsoft executive Jill Angelo and former Neutrogena executive Jacqui Brandwynne, Gennev provides telemedicine with menopause-certified OB/GYNs, on-demand telehealth coaching with registered dietitians, plus health and wellness products, community, and free education. Thousands of women globally have completed the Gennev Menopause Assessment to understand where they are in the journey and receive recommended health and wellness solutions. For more information, visit https://gennev.com.

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Gennev Creates New Menopause Systems to Help Women 40+ with Sleep, Energy, Mood, and Sexual Wellness - PR Web

Katie, who has PCOS, now has two kids (Picture: PA Real Life)

Office manager Katie Newman was 21 when she was diagnosed with the hormonal condition polycystic ovary syndrome (PCOS), which can cause problems with fertility.

Katie was told that at a size 22 and weighing 18 stone 7lb, she would need to lose weight to become pregnant.

After three years of yo-yo dieting Katie, now 31, booked 5,000 gastric band surgery, which saw her shed eight stone.

Since then, Katie has had two daughters, Hollie, two, and Lucy, two months, with her electrician husband, Anthony, 32.

Katie, from Southampton, said: Without a doubt the gastric band enabled me to have children. If I hadnt had it done I might not have my girls.

With the PCOS and my weight combined it would have been next to impossible to conceive.

It was the best 5,000 Ive ever spent.

Katie experienced irregular periods, which led her to see a doctor in 2010.

With a body mass index (BMI) higher than the NHS recommended range of 18.5 to 24.9, Katie was classed as extremely obese.

Blood tests revealed she had PCOS, which stops the ovaries from regularly releasing eggs.

Doctors warned Katie that her weight would make it very difficult for her to conceive naturally and she was also told she would be unlikely to qualify for NHS fertility treatment unless she lost weight.

After being diagnosed with PCOS, Katie who was already seeing Anthony was told that losing just 5% of her body weight could improve her symptoms.

Katie said: Doctors said PCOS couldnt be cured, but that if I lost weight it could really improve my chances of falling pregnant.

I tried all the usual diets but nothing worked.

Booking a consultation at a private clinic in 2014, Katie decided to put 5,000 from her savings to have a gastric band operation.

Discharged the next day, Katie noticed a difference immediately.

Katie, who now eats three well-balanced meals a day containing around 1,000 calories, saw her weight slowly and steadily reduce.

By the time she walked down the aisle, Katie was down to her desired size.

She said: I cut out anything remotely bad for me and was also seeing a personal trainer four times a week, I was so determined to look amazing.

I never dreamed Id be able to wear a strapless dress but I felt like a real princess.

My hubby was certainly shocked by my transformation, but I think it was my commitment that really blew him away.

He always says hell love me no matter what size I am.

Ive also noticed a huge difference in my confidence. Ive always been the life and soul of the party, but it was a bit of an act before and now I dont have to pretend.

In mid-2017, a check-up at the doctors revealed that Katies hormone levels had regulated and less than a year after tying the knot, she discovered she was pregnant.

I was on my lunch break, suffering with really bad period cramps and thought Id give a test a go, said Katie.

I was so shocked when it came back positive that I told my best friend at work before Ant!

It was a few weeks before Christmas, so I unwrapped one of his pressies and put the positive test in there.

We were laughing with shock all day he didnt even notice any of his other presents.

The couple celebrated Hollies arrival in August 2018 and a year later, Katie fell pregnant again.

She added: That was definitely a surprise, albeit a welcome one.

Id been on a massive bender and was convinced I had a four-day hangover, but then the penny dropped and on June 22 this year, I gave birth to Lucy.

Katie says she still has some baby weight left but isnt obsessing over it and is just enjoying motherhood.

Do you have a story you want to share?

Email metrolifestyleteam@metro.co.uk to tell us more.

MORE: Most of us struggled with weight gain in lockdown, says study

MORE: When doctors told me to lose weight I almost died

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Size 22 woman told she was too fat to conceive now has two kids - Metro.co.uk

The global report of Osteoporosis Treatment Industry explores the company profiles, product applications, types and segments, capacity, production value, and market shares for each and every company. The Report Monitors 2020 to 2026 Market Development Trends Of All Osteoporosis Treatment Market Report And Analysis Of Demand, Consumption-Production And Market Trends.

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Top Companies in the Global Osteoporosis Treatment Market areAllergan Plc, Amgen, Inc., Actavis Plc., Eli Lilly and Company, F. Hoffmann La Roche Ltd., GlaxoSmithKline Pharmaceutical Ltd., Merck & Co AG, Novartis AG, Novo Nordisk A/S, Pfizer, Inc., Teva Pharmaceuticals Industries Ltd. and Others.

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Osteoporosis Treatment Market Competitive Research And Precise Outlook 2020 To 2026 - Bulletin Line

During a virtual Case Base Peer Perspectives event, Eleni Efstathiou, MD, PhD, associate professor, Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX discussed treatment options for a 57-year-old African American man with nonmetastaic castration resistant prostate cancer (CRPC)

CASE:

October 2016

November 2016

February 2017

October 2019 - Restaging

Targeted OncologyTM: What are your impressions of this case?

Efstathiou: It looks [as though] after he nadired, he quickly recurred with a detectable PSA and a doubling time of 8.6 months. This is a case thats pointing toward the nonmetastatic castration-resistant prostate cancer [CRPC] status. And in the case, we dont have it, but testosterone would be checked, and it is within the castrate levels.

According to the case, this was followed with conventional imaging. This gentleman is now 60 years old in October 2019.

According to the case, the patient refused [radiotherapy]. Having said that, if you look at the data from the phase 3 trials that were done, you would see that 24% of patients who were included, at least in 1, had not been offered any treatment at the beginning, at their diagnosis, even of their primary [tumor]. So its quite impressive that still, to this day, a lot of patients do not get radiation even on the primary [tumor] when it is needed, and it calls for more education. We dont know if these cases were from the European side, the Asia side, or the United States side. Its not exactly granular, but it was disappointing for me to see.

Would you get advanced testing done for this patient?

Ive been sending patients who can [go for PSMA PET] to University of California, Los Angeles, recently, because I believe that Axumin and PSMA, looking at the data, are equally sensitive. However, it appears that PSMA is more specific. Ive had a lot of false positives on PETs. Im not pointing fingers, but its from different places that I got them, so Im not relying on the results. But, for this case, if the Axumin is still lining up in the prostate, then you have a clear move forward. But, to this day, for nonmetastatic CRPC or for PSA-recurring CRPC only, we do not have an indication to do the PET scan. That is in line with these studies being done with conventional imaging, and that can be a concern with approvals.

Now, this man was given conventional imaging, and this is more the standard across the board.

Do you actively pursue germline testing in high-risk disease or metastatic disease?

I was recently on an ad board, and I was speaking to people from Duke University, Mayo Clinic, and the like. Nobody has any systemic approach yet, and its not even routine in most cases. Its up to the physicians, and it can be more taxing that way, I find, because its 1 more thing added and sometimes can be missed. So I hope that in the future it will become as straightforward as doing the PSA, doing the testosterone, and [other processes such as that].

What are your thoughts on the results of this poll? What would you have voted for?

Most seem to have gone for any of the novel hormonal agents. Somebody put down chemotherapy. Somebody else also voted for nilutamide, flutamide, or bicalutamide.

I would go for other.

Seventy-seven percent voted for enzalutamide [Xtandi], apalutamide [Erleada], darolutamide [Nubeqa], or abiraterone [Zytiga].

How would you compare these agents?

Ive been starting to use [darolutamide] recently. Its approval was more recent.

I dont see a big difference between enzalutamide and apalutamide, not only in the fatigue, per se, but also the central nervous system [CNS] effect, which has to do with some extra depression, some extra insomnia, some extra effects that are not trivial. The difference is small [between these 2]. But the claim from the preclinical data was that apalutamide would have less of a CNS impact. Of course, when you test it in humans is when you see the real deal, and more so in the real-world experience.

With enzalutamide, my experience had always been that at least I can draw a line that I can say if a patient is over 70 years old, he may not perform that well. But, more recently, Ive even seen young men not being able to tolerate it.

And, in the case of this patient, I would say that we should all agree that both enzalutamide and apalutamide would be totally contraindicated because of the seizure disorder. So darolutamide is the only path forward.

What about abiraterone?

These [other] 3 drugs have an indication for nonmetastatic CRPC. Would you expect the insurance to go for abiraterone? I would find it hard [to believe the insurance would accept it,] because its not within the indication.

What are the takeaways from this poll?

Essentially, the bottom line is, you dont see any difference in the efficacy between the 3 agents, but you see an advantage in the safety profile.

Im starting to use darolutamide more, and I was reluctant at first. But now that most data are out, I would say I would agree; theres nothing holding me back in that aspect.

CASE (continued)

After shared decision-making, darolutamide was initiated.

What are your thoughts on the choice of darolutamide?

[The PSA doubling time] was a major concern in the beginning and now, as of this ASCO [American Society of Clinical Oncology Annual Meeting], we have overall survival [OS] data that exceed a year in the CRPC space, which has not been shown before.

I dont know how patients tolerate it yet. I gradually started to give it to the first patient, the second, but Ive got about 10 patients who are on it now, so Im getting there. Its a big deal, because I always say that if we havent had the hands-on experience in research or a clinical trial, it hits the market and then youre [deciding], I dont know this drug, Im going to stay with my comfort level. I can use enzalutamide and abiraterone blindfolded, but it looks [as though] darolutamide is going to be pretty easy. I want to see their data.

My only thing is I want to see more data coming from them with regards to bone density, and I think theyre getting ready to give those datathe effects of that antiandrogen. Were also looking forward to getting their hormone-nave data, which is also going to come forth. Theres a trial where investigators are combining it with chemotherapy. So its pretty new; its the new agent, but Im feeling more and more comfortable with it.

What are the data supporting the use of the 3 newest agentsapalutamide, enzalutamide, and darolutamidein this setting?

My impression of the NCCN [National Comprehensive Cancer Network] guidelines is that theyre there to help us get through the insurance, because most of us are familiar with the datasets. And here [with] a PSA doubling time of less than 2 months in a man who has, by conventional imaging criteria, negative disease, you can use either apalutamide, darolutamide, [or] enzalutamideall category 1 [recommendations].1 But theyre also leaving open the option for other secondary hormonal therapy, allowing for older agents, which I think is not fair in view of all primary and secondary end points being met.

All 3 trialsSPARTAN [NCT01946204], PROSPER [NCT02003924], and ARAMIS [NCT02200614]were identical, with a primary end point looking at metastasis-free survival [MFS] of the agent plus ADT versus placebo, and secondary end points including progression-free survival [PFS], local progression, quality of life, and OS. That was [not a] secondary end point for a lot of the physicians. They still held [off] on it until they heard the final OS data. My prior chair would say, If Im going to treat a patient with an agent for 3 extra years, I need to make sure Im not compromising his quality of life or making his other morbidities worse. But there was a point in the SPARTAN trial [of apalutamide and ADT versus ADT and placebo in patients with nonmetastatic CRPC] that was important for me. It was the only [trial] that looked at the PFS2, which essentially compared starting earlier versus starting later and showed that starting earlier is better.

I think, in the interest of science, we should not stick with, This is what the SPARTAN trial says, this is what the PROSPER trial says, this is what ARAMIS trial says. We have 11 phase 3 trials across the board, across the cancer with novel androgen signaling inhibitors that are all positive. There has been no negative trial, which is phenomenal. The data is superimposable. You cant see a big difference in the efficacy. For efficacy assessment, I dont see a difference between the agents, and I use the datasets across the board. I think they are supportive of each other rather than antagonizing each other.

The [SPARTAN] results are old news now. There was a phenomenal difference in MFS that exceeds the 2-year mark [median MFS, 40.5 months with apalutamide versus 16.2 months without; HR, 0.28; 95% CI, 0.23-0.35; P<.001].2

The new finding that was reported at the [2020] ASCO meeting [was OS], and it was a poster discussion for all 3 [trials]. I like that they made them poster discussions rather than making them big oral discussions. They left oral discussions for more innovative things, [such as] the trials that we do with finding prescriptive markers. A lot of people complained that this was a big deal and should have been more showcased, but I think the fact that they were lumped together and discussed as a success for novel androgen signaling inhibitors is enough, and now we all would agree that their use in this space is valid. The main concern is finding these patients. The OS [had] about a median difference of a little over a year, which is not trivial, for the apalutamide [73.9 versus 59.9 months with ADT/placebo; HR, 0.78; 95% CI, 0.64-0.96; P=.0161].3

I was not involved in the SPARTAN or the ARAMIS trials, but I am an investigator on the PROSPER trial [of enzalutamide and ADT versus ADT and placebo in patients with nonmetastatic CRPC], and I was [included] in this New England Journal of Medicine paper that came out where we showed an OS benefit.4 [The design of the PROSPER trial was] exactly like SPARTAN.

Similar data [were] originally presented. OS difference looking at a year again [67.0 months with enzalutamide vs 56.3 months without; HR, 0.73; 95% CI, 0.61-0.89; P<.001]. The analysis that we saw on SPARTAN is the final analysis with the longest follow-up, but this is not far behind, [with] 48 months of median follow-up.

The ARAMIS trial [of darolutamide and ADT versus ADT and placebo in patients with high-risk nonmetastatic CRPC,] was the one that took us by surprise, because a lot of us were not familiar with this agent. I was seeing it in the background when it was developed, and I could hear Karim Fizazi, MD, PhD, whos a good friend, speaking about it. And I [said], We already have 3, what is this extra fourth going to come through with? And it turns out that they were right in pursuing it. Because they did exactly the same trial as the previous [trials of the other androgen signaling inhibitors], but with an agent that had all the prerequisites to be potentially safer, and they delivered.

The MFS with a short median follow-up [of 17.9 months], looking at about 2 years of difference of MFS [40.4 months with darolutamide versus 18.4 months with placebo], a hazard ratio of 0.41 [95% CI, 0.34-0.50; P<.0001]. Just as a reminder, for the other 2, it was about 0.3. Some people have commented on this, but I would not be able to compare.5

Now, their secondary end points were [more] defiant. At the first presentation, the OS was already starting to look good [with a hazard ratio of 0.71 (95% CI, 0.50-0.99; P<.045)]. It had not [yet] met their threshold, but it was close, and there was a short follow-up compared [with] the other trials.

The time to progression data [show a median time to pain progression of 40.3 months with darolutamide vs 25.4 months without (HR, 0.65; 95% CI, 0.53-0.79; P<.0001)]the other 2 trials also had similar data, which, as I see it, are supportive of each other rather than the inverse. This, for our patients, is a big deal.

Their PFS data [showing a median PFS of 36.8 versus 14.8 months (HR, 0.38; 95% CI, 0.32-0.45; P<.0001)] confirm what I said: superimposable MFS to PFSreinforcing the fact that the addition of a drug [such as] darolutamide, that seems to be safer, adds to these patients more time without need for further interventions and amounts to about 2 years.

The OS at a median follow-up of 29.1 months [was not reached in either arm]; its rather early compared [with] the rest but an obvious improvement here. The hazard ratio was around 0.69 and a P value of 0.003.6 So positive OS data for all 3 trials.

How do the safety profiles of these 3 agents compare?

[In terms of] adverse event reporting [from the PROSPER trial], the main concern, according to them, seems to be grade 3 and above hypertension and some fatigue. I would not pay a lot of attention to what is over grade 3 because when I use a drug for 2 to 3 years, for me even grade 1 and 2 matters. It makes absolute sense to use the least-compromising agent.4

Now, the [ARAMIS safety profile] the winner. They had little adverse events that are treatment related [with darolutamide] [TABLE].5 Its impressive if you look at it versus placebo. And if you want to look at a difference thats at least 2%, I see almost nothing. Its impressive.

When we were working on apalutamide, I got excited because I saw for the first time that 15% of patients were getting a weight decrease. If you look at the data from SPARTAN, it shows up. If you see [the data with] darolutamide, its 3.6%. We started doing some measurements, and its [because of] loss of muscle, and it adds on to the CNS effects. So the falls are not just a result of the CNS effect; its also a lot of muscle weakness, as well.

Overall, how do these 3 trials and drugs compare?

Of course, we shouldnt be [comparing these 3 trials] officially. But there is really no difference between the 3 trials when it comes to the primary and secondary end points. The only difference between the 3 trials with regard to their contact was that, in the apalutamide trial, patients came every month; in the other 2, it was every 4 months. But for MFS and OS, theres no difference between them. They had close hazard ratios.

So we have all [these] agents approved at this pointabiraterone acetate, enzalutamide, apalutamide, and darolutamide. Abiraterone is approved for the hormone-nave metastatic setting, and its also approved for metastatic CRPC; enzalutamide for hormone-nave and nonmetastatic and metastatic CRPC; apalutamide for nonmetastatic CRPC and hormone-nave; and darolutamide for nonmetastatic CRPC. I would argue that for me, these 4 agents have equivalence in their efficacy, and its more a matter of safety.

How does the use of novel imaging affect the duration of treatment and quality of life of these patients?

With the advent of enhanced androgen signaling in the hormone-nave space, I feel that were adding these drugs for an indefinite amount of time. Were going to try to do that with finite-duration hormones, so that we may get the opportunity to prolong the quality of life of the patients. But, as its standing right now, if you do a PET early on in the disease, you may end up treating those men indefinitely.

We know well that if you dont take care to look out for cardiovascular morbidity, bone health, and the like, especially in the older men, you can get a tradeoff thats not to the benefit of the patient. Its a big discussion. But I sometimes say that 1 option is to be more diligent about making sure that the patients are followed at least by their primary care physicians and their cardiologist more carefully.

What are some of the drugs that should be avoided during use with these agents?

Thankfully most of us use electronic prescribing, so we see the drug-drug interactions show up. I dont think we can ever remember all of that by heart.

References:

1. NCCN Clinical Practice Guidelines in Oncology: Prostate cancer. Version 2.2020. May 21, 2020. Accessed August 17, 2020. https://bit.ly/32pmz7H

2. Smith MR, Saad F, Chowdhury S, et al. Apalutamide (APA) and overall survival (OS) in patients (pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC): updated results from the phase III SPARTAN study. Ann Oncol. 2019;30(suppl 5):v325. doi:10.1093/annonc/mdz248

3. Small EJ, Saad F, Chowdhury S, et al. Final survival results from SPARTAN, a phase III study of apalutamide (APA) versus placebo (PBO) in patients (pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC). J Clin Oncol. 2020;30(suppl 15):5516. doi:10.1200/JCO.2020.38.15_suppl.5516

4. Sternberg CN, Fizazi K, Saad F, et al; PROSPER Investigators. Enzalutamide and survival in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2020;382:2197-2206. doi:10.1056/NEJMoa2003892

5. Fizazi K, Shore ND, Tammela TL, et al; ARAMIS Investigators. Darolutamide in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2019;380:1235-1246. doi:10.1056/NEJMoa1815671

6. Fizazi K, Shore ND, Tammela T, et al. Overall survival (OS) results of phase III ARAMIS study of darolutamide (DARO) added to androgen deprivation therapy (ADT) for nonmetastatic castration-resistant prostate cancer (nmCRPC). J Clin Oncol. 2020;38(suppl 15):5514. doi:10.1200/JCO.2020.38.15_suppl.5514

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Efstathiou Compares the Efficacy and Safety of AR Inhibitors in Nonmetastatic CRPC - Targeted Oncology

Global In Vitro Fertilization (IVF) Market report an in depth study of various aspects of the worldwide Market. It shows the steady growth in market in spite of the fluctuations and dynamic market trends. The rising technology in Market is additionally delineated during this analysis report. Factors that are boosting the expansion of the market and giving a positive push to thrive within the international market is explained well. It includes a meticulous analysis of market trends, market shares and revenue growth patterns and also the volume and price of the market. Its conjointly supported a meticulously structured methodology. These strategies facilitate to analyze markets on the premise of thorough research and analysis.

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In this analysis report, the world In Vitro Fertilization (IVF) Market focuses on the key players that are in operation within the global market and their competitive landscape present within the worldwide. The In Vitro Fertilization (IVF) report includes an inventory of initiatives taken by the businesses within the past years in conjunction with those, that are doubtless to happen within the coming back years. Analysts have conjointly created a note of their enlargement plans for the close to future, monetary analysis of those firms and their analysis and development activities. This analysis report includes a whole dashboard read of the worldwide In Vitro Fertilization (IVF) market, that helps the readers to look at an in-depth data regarding the report.

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The analysis report summarizes companies from many different regions. This In Vitro Fertilization (IVF) Market report has been combined with a spread of market segments like applications, finish users and sales. Specialise in existing market research and future innovation to produce higher insight into your business. This study includes subtle technology for the market and numerous views of assorted industry professionals. In Vitro Fertilization (IVF) Market is that the arena of accounting distressed with the outline, analysis and news of monetary dealings touching on a business. This includes the coaching of monetary statements offered for public ingesting. The service involves temporary, studying, checking and news of the monetary contacts to collecting activities and objects. It conjointly involves checking and creating monetary declarations, scheming accounting systems, rising finances and accounting consultive.

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Global Major Market Players indulged in this report are:

AVA-PETER CLINICMD MEDICAL GROUP INVESTMENTS PLC (MD MEDICAL GROUP)IVF RUSSIA (THE INTERNATIONAL CENTRE OF THE REPRODUCTIVE MEDICINES)

The In Vitro Fertilization (IVF)The In Vitro Fertilization (IVF) Market market report is segmented into following categories:

End User segmentFertility ClinicsHospitalsSurgical CentersClinical Research InstitutesCycle Type segmentFresh IVF cycles (Non-donor)Thawed IVF cycles (Non-donor)Donor Egg IVF CyclesType segmentNon-ICSI IVF CyclesICSI-assisted IVF CyclesDrug segmentClomiphene CitrateAromatase InhibitorsGonadotropins & Gonadotropin-releasing HormoneFollicle-stimulating HormoneProgesteroneOthersMode of Administration segmentOralInjectableVaginal

The report offers in-depth assessment of the expansion and different aspects of the In Vitro Fertilization (IVF) market in necessary regions, together with the U.S., Canada, Germany, France, U.K., Italy, Russia, China, Japan, Asian nation, Taiwan, geographic area, United Mexican States and Brazil, etc. Key regions lined within the report are North America, Europe, Asia-Pacific and geographical region.

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For a more robust understanding of the worldwide market, analysts have metameric the worldwide In Vitro Fertilization (IVF) market supported application, sort and regions. Every phase provides a transparent image of the aspects that are doubtless to drive it and also the ones expected to restrain it. The segment-wise rationalization permits the reader to induce access to explicit updates regarding the worldwide In Vitro Fertilization (IVF) market. Evolving environmental issues, dynamic political situations and differing approaches by the govt. towards regulative reforms have conjointly been mentioned within the In Vitro Fertilization (IVF) analysis report 2020-2026.

Major factors lined within the international In Vitro Fertilization (IVF) marketing research Report 2020-2026

Global In Vitro Fertilization (IVF) Market Outlook and Summary.Economic Impact on the Industry.Global In Vitro Fertilization (IVF) Market Competition in terms of players.Global In Vitro Fertilization (IVF) Market Production, Revenue (Value) by geographical segmentation.Global In Vitro Fertilization (IVF) Market Production, Revenue (Value), worth Trend by sort.Global In Vitro Fertilization (IVF) market research by Application.Global In Vitro Fertilization (IVF) Market price Investigation.Global In Vitro Fertilization (IVF) Market Industrial Chain, material sourcing strategy and Downstream patrons.Marketing Strategy comprehension, Distributors and Industryrs.Global In Vitro Fertilization (IVF) Market Study on marketing research Factors.Global In Vitro Fertilization (IVF) Market Forecast 2020-2026.

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In Vitro Fertilization (IVF) Market 2020-2026: AVA-PETER CLINIC, MD MEDICAL GROUP INVESTMENTS PLC (MD MEDICAL GROUP), IVF RUSSIA (THE INTERNATIONAL...

Incorporating healthy fats is beneficial for weight loss, as well as for your overall health.

Image Credit: autumnhoverter/iStock/GettyImages

If you're old enough to recall the '80s and '90s, you probably remember it as a time of low-fat everything. Dietary fats, regardless of type unsaturated, saturated, omega-3s or trans fats were, for the most part, lumped together and seen as problematic when it came to weight loss and heart health.

It took us some time (read: a few decades) to understand that this line of thinking wasn't entirely accurate and that avoiding all fats was hurting our hearts and waistlines.

Fast forward to today where the keto diet is king, and it appears we're now living on the opposite end of the spectrum. We've gone from limiting fats as much as possible, to a trendy diet that is about 75 percent fat, 20 percent protein, and 5 percent carbohydrates.

So, where do fats belong when it comes to managing our weight and overall health?

The truth is, somewhere in the middle, and the science on this will continue to evolve annoying, I know. The current Institute of Medicine guidelines, based on available science, recommend a diet that is 20 to 35 percent fat, 45 to 65 percent carbs and 10 to 35 percent protein.

Did you know that keeping a food diary is one of the most effective ways to manage your weight? Download the MyPlate app to easily track calories, stay focused and achieve your goals!

Dietary Fat and Weight Loss

Fats are a crucial part of our diet. They are a source of energy and they help our bodies produce hormones and better absorb fat-soluble nutrients like vitamins A, D, E and K, as outlined by the American Heart Association.

A gram of fat (regardless of type) has 9 calories. They're more calorically dense than protein (4 calories per gram) and carbs (also 4 calories per gram). This is one of the reasons why we pursued low-fat diets long ago.

But it's important to keep in mind that eating an excess of calories, regardless of the macronutrient source, will lead to weight gain, and be aware that fats are actually beneficial for weight loss. Here's why:

Dietary Fats Slow Down Digestion

Dietary fats naturally slow "gastric emptying," i.e., the time it takes for food to leave your stomach and continue its course through your GI tract, according to the July 2014 issue of Today's Dietitian.

We know that foods that take a while to digest leave us feeling fuller longer. So, adding a little bit of fat to your meal, like olive oil on a salad, or avocado in your smoothie, will help to slow down how quickly you digest your meal.

Furthermore, research shows adding fiber slows down the digestion of fat even further.

Dietary Fats Favorably Affect Hunger Hormones

There's a growing body of research looking at the effect different types of fat have on various hunger hormones and satiety levels.

A March 2019 study published in Appetite found that eating meals higher in polyunsaturated fats (PUFAs) led to a greater decrease in ghrelin (a hormone that triggers hunger) and higher CCK levels (a hormone that suppresses hunger) compared to monounsaturated fat. The diet high in PUFAs also resulted in lower hunger ratings, although there was no difference between the amount of calories consumed and the reported feelings of fullness.

4 Fats to Add When Youre Trying to Lose Weight

Adding some avocados to your tacos will help you digest the meal slower.

Image Credit: sveta_zarzamora/iStock/GettyImages

What makes avocados so special when it comes to weight loss? It's the healthy fat and fiber combo. A serving of avocado (one-third of the fruit) has 4.5 grams of fiber and 9 grams of fat, according to the USDA.

If you pair the avocado with a salad, chips or tacos, the added fat will help to slow down the digestion of the meal and the grams of fiber slow it down even further. The only caveat is portion control. Avocado is good, yes, but polishing off a bowl of guac isn't going to help your cause.

Yes, eating fish is great for your health and waistline but salmon (and a few other fish like tuna and sardines) may have the upper hand. These specific types of fish are rich in omega-3 fatty acids and it turns out, these fats may help improve leptin resistance, according to a July 2015 article published in Today's Dietitian.

If you are carrying some extra weight, chances are you also have chronic inflammation and it's the inflammatory chemicals that cause our body to be less sensitive to leptin, a hormone that decreases our food intake and regulates our metabolism. Omega-3s however, can help make your body less resistant to leptin, allowing it to do its job.

Nuts are a good source of healthy fats they can be up to 80 percent fat, per the Mayo Clinic. And, all tree nuts are good for us. Eating nuts is great for our heart because they help to lower LDL cholesterol levels and reduce inflammation linked to cardiovascular disease.

But walnuts are a standout because they're unique in that they contain a solid dose of omega-3s, according to California Walnuts. This also means they're rich in PUFAs, which we know has been shown to favorably alter our hunger hormone levels as well.

A drizzle of olive oil on your salad may help with your weight-loss efforts.

Image Credit: Nicholas77/iStock/GettyImages

It may seem counterintuitive to add oil to your salad if you're trying to lose weight, but olive oil may actually help you better manage your body weight. It is a staple of the Mediterranean diet after all, which has been touted as one of the healthiest and most researched diets that we can follow.

Researchers looked at 11 different randomized clinical trials addressing olive oil and weight management and concluded that a diet enriched with olive oil led to a greater reduction in weight than a control diet without, according to a November 2018 meta-analysis published in Revista Espaola de Salud Pblica.

2 Fats to Limit if Youre Trying to Lose Weight

The biggest thing that will lead to weight gain is overeating no matter the source of calories.

That said, we know some foods are beneficial for our health while others are not. Trans fats and saturated fats provide no benefit to our diet and can do more harm than good, although more research is coming out on the effects of different saturated fats stay tuned!

Here's the deal: Trans fats have no redeeming qualities, so much so that the U.S. Food and Drug Administration has required that the artificial fat be removed from all processed foods. While the amount in our food supply has been cut back drastically, some still exists, according to the Mayo Clinic.

Margarine, refrigerated dough, baked goods and fried foods like French fries and doughnuts may all contain trans fats.

You won't find trans fats in healthy fat sources of food like chia seeds and almonds, but you may find them in ultra-processed junk food that is typically high in refined grains, too. These are the types of foods you'll want to limit if you're trying to lose weight.

If you're trying to lose weight, chances are you're watching what you eat and trying to eat less. When we do that, it's especially critical that we focus on nutrient-dense foods so that we get all of the nutrients that we need.

By limiting the saturated fat in our diet which we know provides no benefit we leave room for more beneficial sources of fat like mono- and poly-unsaturated fats.

You'll find saturated fat in fatty meats, fried food and butter.

Additionally, saturated fats may increase inflammation by kicking on a pathway that triggers what's called obesity-induced inflammatory response, according to an April 2018 study published in Nutrients. So, if you're overweight, eating foods high in saturated fat may trigger a greater inflammatory response in your body.

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Trying to Lose Weight? Here Are 4 Fats to Enjoy and 2 to Avoid - LIVESTRONG.COM

Blood Testing Market Scope of the Report:

Factors and Blood Testing Market execution are analyzed using quantitative and qualitative approaches to give a consistent picture of current and future trends in the boom. The study also allows for a detailed market analysis focused primarily on geographic locations. The Global Blood Testing Market Report offers statistical graphs, estimates, and collateral that explain the state of specific trade within the local and global scenarios.

The worldwide market for Blood Testing is expected to grow at a CAGR of roughly xx% over the next five years, will reach xx million US$ in 2025, from xx million US$ in 2018, according to a new study.

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segment by Type, the product can be split intoGlucoseLipidBUNA1CCRPVitamin DALTASTThyroid Stimulating HormoneMarket segment by Application, split intoHospitalsClinic and Diagnostic CentersOthers

Market segment by Regions/Countries, this report coversNorth AmericaEuropeChinaJapanSoutheast AsiaIndiaCentral & South America

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The Blood Testing Market report has 150 tables and figures browse the report description and TOC:

Table of Contents

1 Study Coverage

1.1 Blood Testing Product

1.2 Key Market Segments in This Study

1.3 Key Manufacturers Covered

1.4 Market by Type

1.4.1 Global Blood Testing Market Size Growth Rate by Type

1.5 Market by Application

1.5.1 Global Blood Testing Market Size Growth Rate by Application

2 Executive Summary

2.1 Global Blood Testing Market Size

2.1.1 Global Blood Testing Revenue 2014-2025

2.1.2 Global Blood Testing Production 2014-2025

2.2 Blood Testing Growth Rate (CAGR) 2019-2025

2.3 Analysis of Competitive Landscape

2.3.1 Manufacturers Market Concentration Ratio (CR5 and HHI)

2.3.2 Key Blood Testing Manufacturers

2.3.2.1 Blood Testing Manufacturing Base Distribution, Headquarters

2.3.2.2 Manufacturers Blood Testing Product Offered

2.3.2.3 Date of Manufacturers Enter into Blood Testing Market

2.4 Key Trends for Blood Testing Markets & Products

3 Market Size by Manufacturers

3.1 Blood Testing Production by Manufacturers

3.1.1 Blood Testing Production by Manufacturers

3.1.2 Blood Testing Production Market Share by Manufacturers

3.2 Blood Testing Revenue by Manufacturers

3.2.1 Blood Testing Revenue by Manufacturers (2019-2025)

3.2.2 Blood Testing Revenue Share by Manufacturers (2019-2025)

3.3 Blood Testing Price by Manufacturers

3.4 Mergers & Acquisitions, Expansion Plans

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Rising number of corona virus cases has impacted numerous lives and led to numerous fatalities, and has affected the overall economic structure globally. The Adenomyosis Treatment has analyzed and published the latest report on the global Adenomyosis Treatment market. Change in the market has affected the global platform. Along with the Adenomyosis Treatment market, numerous other markets are also facing similar situations. This has led to the downfall of numerous businesses, because of the widespread increase of the number of cases across the globe.href=mailto:[emailprotected]>[emailprotected] or call us on +1-312-376-8303.

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In Depth Analysis and Survey of COVID-19 Pandemic Impact on Global Adenomyosis Treatment Market 2020 Key Players Bayer AG, Ferring BV, Johnson &...

My working title for this story was Fat at 50, Forever, and you can hardly blame me. While it was definitely tongue-in-cheek, for those of us whove gained a few pounds in midlife, maintaining a healthy size becomes and theres no way to sugar-coat it increasingly difficult. As you age, you put on weight, says the founder of the diagnostic clinic Viavi:be Dr Sabine Donnai, who specialises in health and exercise programmes for the over fifties. And thats if youre just standing still, not eating, not doing anything, just purely because your metabolism goes down each year.

Tempting as it is to accept this as an unavoidable part of getting older, there is (vanity aside) good reason for resisting this seemingly inexorable increase. As well as the surface weight were amassing, were also accumulating visceral fat, which surrounds our organs and stops them functioning as well as they should, which leads to a shorter lifespan.

Women have it twice as bad: along with the ageing process, during which the body swaps muscle for fat, we have the menopause to deal with. The loss of oestrogen has a particular effect on the way your fat is distributed, says Dr Donnai. Firstly, when oestrogen drops, you get mood swings, and frequently you overeat to compensate. You sleep badly as your progesterone drops, and your stress levels rise, often because its easy at this age to lose a sense of purpose especially if youve had children and theyre growing up and relying on you less.

Additionally, your body stores fat differently, as its lipoprotein lipase (which sits on the surface of the fat cells, pulling in fat from the blood) goes into overproduction, no longer kept in check by the now declining oestrogen. If the fat gets pulled into a muscle cell, it gets burnt off as fuel; but if it gets pulled into a fat cell, it just makes the fat cell bigger. You get the idea.

At this point, youre probably expecting a paragraph starting with the word fortunately, followed by a quick-fix diet with, quite possibly, some new gadget or machine promising that the whole sorry situation will be resolved in no time. Im sorry to disappoint. You need to get into the gym and lift weights, says Dr Donnai matter-of-factly. I know this is often alien to mature women, who are more used to yoga and some Pilates, both of which play a part, but its weights that will slow down the ageing process.

The physiological explanation behind this is that when you start training and lifting weights that feel like theyre too much for you, your body responds by making more muscle, in order to prevent what it perceives as damage. It stimulates a growth hormone, which in turn stimulates testosterone, and lifting that weight each time causes your metabolism to speed up. The lipoprotein lipase now pulls the fat into muscle cells, and because you have more muscle now anyway, thanks to lifting weights, your basic metabolic rate goes up, so you can eat without gaining weight, or lose weight if you eat slightly less.

Are weights the only option? Women really need to create high muscular overload on two fronts: to burn more calories, and raise the metabolism; but also to maintain bone density, says Matt Roberts, founder of the Matt Roberts Evolution personal training gym. When you stress the muscles, the tendons which are attached to the bone pull on it; the bone thinks it needs assistance and stores more calcium, and your bone density increases. High-impact exercise, going for a run, jumping, landing and moving, all also increase bone density. The impact of boxing is really good for bone density in the upper body, whereas running is good for the lower body. But you need a strategy in place for injury prevention this is where the yoga and Pilates come in as they create elasticity in the muscle tissue around the joints.

Sooner rather than later, we also have to address diet. To kick-start weight loss before a surf trip on which I didnt want to be carrying excess pounds, I embarked on a metabolic balancing diet under the guidance of Amanda Griggs at the Khera-Griggs clinic. I lost 8lbs in two weeks, and Id do it again, but perhaps only once a year it was tough.

You have to look at taking out starches and carbohydrates, rethink your portions, says Griggs. You have to realise, This is my meal. If that sounds a little grim, it has the advantage of reintroducing discipline. With a ban on snacking between meals, the diet which is restrictive for a fortnight but moves on to a maintenance plan thats all about mindful eating is healthy and delivers results. My BMI dropped to bang-on healthy. Of course, how you keep up those results is another matter. Youre quite disobedient, says Griggs, who guided me through the two weeks with plenty of stern, kind and highly motivating WhatsApp messages. Sometimes you only ate two meals a day, and Im not sure you always stuck to the quantities of protein you needed.

Roberts also homes in on protein. If you focus on eating enough protein, you just wont have the appetite for carbs. A womans protein intake is woefully low, he says. Government guidelines suggest 45g of protein for a 60kg woman, but Roberts explains, One egg is about 5g. So shifting away from carbs and loading up on beans and quinoa or eating sardines, as theyre high in calcium, will help control your blood sugar, raise your metabolism, and activate fat burn.

As well as advising abstaining from alcohol It gives you nothing other than a hangover and strips away Vitamin B13, which is vital for brain function hes also a fan of intermittent fasting. As women get older, they tend to think they need to eat less, and go on extreme low-calorie diets, but they dont work. You just add on more weight than you did before. Women have greater levels of visceral fat if you fast for 16 hours (from around 8pm until midday) for two to four days a week, for up to four weeks, and for the rest of the week take out the obvious foods that build up blood sugar, and increase protein, your body gets into a state of ketosis (where your metabolism is more energised due to lower blood sugar levels) and youll be burning away your visceral fat.

It all sounds easy enough, but as an inveterate carb-loading snacker who has eaten two and a half croissants while writing this I apparently still have a way to go.

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Whats Really The Best Way To Maintain A Healthy Weight Over 50? - British Vogue

Most discussion in hormone receptor (HR)positive metastatic breast cancer are now focused on CDK4/6 inhibition, according to Denise A. Yardley, MD, who added that, after demonstrating significant survival benefits, these agents have transformed the standard of care.

There are 3 key agents: palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio). Several phase 3 trials incorporating these agents showed a resounding, reinforcing message of improvement in median progression-free survival (PFS). In earlier lines of therapy, this translated to a doubling in PFS, said Yardley. Ultimately, these data put these agents on our radar, which later resulted in approvals. We now have 1 of the gold standards in terms of selecting agents and making treatment algorithm recommendations for our patients because there are finally data to support an overall survival (OS) advantage.

In an interview with OncLive during the 2020 International Perspectives in Cancer webinar on Breast Cancer, Yardley, a senior investigator in the Breast Cancer Program at Sarah Cannon Research Institute, highlighted the evolving role of adjuvant CDK4/6 inhibition in HR-positive metastatic breast cancer.

OncLive: Could you expand on the HR-positive metastatic breast cancer treatment landscape?

Yardley: All discussions of HR-positive metastatic breast cancer now involve CDK4/6 inhibitors, as these agents have really evolved and changed our standard of care. Three trials have shown an OS advantage [with this approach], which is a resonating message of a good surrogate for having benefit. We are seeing the median PFS benefit translate into an OS advantage.

On the heels of that, an important question with patients who have HR-positive disease is determining how to incorporate [what we have learned] into our day-to-day practice. One of the groups that we've always had some hesitation in approaching with endocrine-based therapy is the group with visceral metastasis.

During the 2020 ASCO Virtual Scientific Program, data presented from the MONALEESA-3 and the MONALEESA-7 trials, which examined ribociclib. Results showed that about 60% of the population had visceral metastasis on both of trials. I would say benefits mirrored what we saw with the overall MONALEESA-3 and the MONALEESA-7 study populations. We saw a 20% reduction in the risk of death in patients with visceral metastasis in MONALEESA-3 who received treatment with ribociclib and approximately 30% for those [with metastasis] in MONALEESA-7. We carved out just those with liver metastasis, which is a life-threatening organ to be involved with metastatic disease, and we saw similar benefit in both PFS and OS.

That may have been a group of patients that practitioners have concern about in terms of using endocrine therapy or endocrine therapy with CDK4/6 inhibition, which is cytostatic. Now, we have great data showing that these patients do just as well [with this treatment] as the study

population as a whole. The benefit of that doublet therapy didnt translate into more adverse effects for that population; it reinforces the efficacy of taking the approach in a more challenging group of patients with visceral metastasis, whether it's liver or lung.

I believe that provides comfort and shows the importance of not pulling the trigger for chemotherapy or even the consideration of oral chemotherapy. We can now feel comfortable moving forward with making that recommendation of endocrine therapy in combination with CDK4/6 inhibition based on these studies.

What challenges have been faced in terms of research?

I believe we can widen the audience of patients with HR-positive metastatic breast cancer who are going to benefit from the CDK4/6 inhibitors; however, a challenge is that resistance does develop. Now we must determine if we can categorize and predict that resistance.

Many studies have examined potential biomarkers of sensitivity or resistance. Right now, we still say ER positivity is the only biomarker for benefit. Many markers have been examined, but none have been consistently validated. That research avenue continues to be explored.

We are now wondering whether we could identify a patient who might derive less benefit from this approach due to intrinsic resistance or patients who stop deriving benefit beyond 6 months due to acquired resistance. Although a lot of emphasis has been placed on that, I believe we are challenged by many different signals, in addition to learning how to incorporate them. Mutations in the RBG, PI3K, and cyclin E, all seem to resonate but are not ready to be used for real-time assessment and decision making.

How do ESR1 mutations play a role in decision making? What are some of the data that we have seen with regard to treating this patient subset?

The ESR1 mutations are also emerging as having a role in making treatment decisions in patients with HR-positive metastatic breast cancer. For patients who develop the ESR1 mutation either at baseline, which is 1% to 5%, or after exposure to an aromatase inhibitor (AI), which increases to 30% to 40%, what do we do? Many of these patients have gone onto fulvestrant (Faslodex), which clearly has a role in those who demonstrate ESR1 mutations.

Interesting data from the PADA-1 trial, which were presented during the ASCO 2020 Virtual Scientific Program, examined patients at baseline and measured the ESR1 mutation. We know if patient was treated with an AI and palbociclib and they had [the ESR1] mutation [at baseline], the [prevalence] rate [of the mutation] was approximately 3%; if they had received a prior AI in the adjuvant setting, that rate goes up to about 7%. Those patients did poor versus the group who had no mutation, with a median PFS of about [7] months versus about 26 months, respectively.

Interestingly, when the group that had the ESR1 mutations who were treated with an AI and palbociclib were remeasured 1 month later, those who cleared their ESR1 mutation with treatment with a CDK4/6 inhibitor and an AI did just as well as those who didn't have [the mutation] at baseline. How do we adopt this to our practice? Before I saw these data, I would be hesitant to give AI after measuring an ESR1 mutation. However, now I have some comfort level, particularly in those patients who have already received fulvestrant or may not be a candidate, to challenge with an AI and a CDK4/6 inhibitor. Maybe I would remeasure it in a month to determine if I have cleared it and feel confident that the patient has every reason to hopefully benefit and continue monitoring them.

Were still trying to figure out all the different permutations of how to get around ESR1 mutations. I think the oral selective estrogen receptor downregulators are certainly very prevalent in the clinical trials and may be vastly easier than fulvestrant in a group of patients. We will hopefully see an approval of 1 of these therapies in the near future so that we can get them into the clinics and in commercial use.

Shifting to those with PI3K mutations, could you shed light on the BELIEVE trial?

Another challenge is understanding what to do after CDK4/6 inhibition. This has [shifted] our standard of care as a first-line therapy and second-line therapy for patients who didn't receive it in the first line. Were working on becoming savvy with continuing to screen those patients now for other actionable mutations. PI3K mutations really come up in that particular setting.

In the BYLieve trial, investigators assessed patients with a PI3K3CA mutation who had received a prior CDK4/6 inhibitor plus an endocrine agent, endocrine therapy, or systemic chemotherapy. In the trial, they either received [a CDK4/6 inhibitor plus an AI,] alpelisib (Piqray) with fulvestrant, [or chemotherapy or endocrine therapy following progression on an AI].

Those patients did remarkably better than the group who were just treated with standard-of-care agents from a FLATIRON database. Looking at post CDK4/6 failures just treated with either fulvestrant, CDK4/6 inhibitor, or chemotherapy, compared with those tested in the BYLieve trial who were offered an alpha-specific PI3K alpelisib with fulvestrant, results showed that this [approach] doubled the [benefit] for these patients in a matched analysis. As such, if you find that population, its certainly worth testing because they fare better [with this approach] as compared with standard therapy.

The ways in which we think about treating our patients with HR-positive metastatic breast cancer is constantly broadening. Were also embracing doublet therapy over monotherapy endocrine therapy. There is a clear rationale and basis for scrutinizing these tumors, in addition to continuing to look for these alterations that we can target very effectively; by doing this, we continue to improve outcomes.

Several other PI3K [inhibitors are being examined] in clinical trials. We're now examining triplets comprised of PI3K inhibitor, a CDK4/6 inhibitor, and endocrine therapy in the first-line setting for patients with PI3K-mutated disease. We're going to see if we can build on the data, we already have with the doublet CDK4/6/endocrine therapy. That may be quite a challenge, but it will be interesting to see how that triplet therapy may fare in comparison with doublet therapy.

What is some of the research that is being done with AKT inhibitors?

Some trials are examining AKT inhibitors and their role in combination with endocrine therapy. We have capivasertib (AZD5363), which is being evaluated in a post-CDK4/6 pathway and investigators assessed whether the patient had PI3K mutation or not. [The presence of the mutation] did not appear to affect the benefit and the outcome of the doublet comprised of the AKT inhibitor and endocrine therapy. That's likely going to be another targetable agent that's not going to be mutation dependent as a PI3K to achieve that efficacy.

I believe we're starting to see this algorithm of an endocrine backbone partnered with a targeted agent. What we see is really manipulation of what we know in the HR-positive metastatic breast cancer space in terms of that estrogen signaling pathway and where we see alterations that result in shortened duration of benefit or resistance that we're able to target and provide more longevity to an endocrine therapy-based approach for these patients.

We need to keep chemotherapy on the back burner as we learn how to sequence these agents. I believe the trials are going to continue and we're going to have a continued altering standard of care and algorithm of standard-of-care options for these patients. Its very exciting to be a part of some of these trials and see these drugs make it to the clinic where they can benefit so many more patients.

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CDK4/6 Inhibitors Shift Standards in HR+ Metastatic Breast Cancer - OncLive

Home abortions for women up to 10 weeks pregnant are set to become permanent following their success during lockdown.

Under Covid emergency measures introduced in March, up to 90,000 women have been able to take the two pills needed after a phone consultation rather than go to a clinic.

It was the first Boris Johnson U-turn of the pandemic the PM initially barred home terminations.

Now ministers are expected to change the law to keep the new system in place before the corona provision ends in 18 months.

Covid minister James Bethell said there will be a public consultation on permanent home use of both pills for early medical abortion.

Dr Jonathan Lord, of abortion provider Marie Stopes UK, said: Thanks to telemedicine, women have been able to access the timely, high-quality care they deserve.

Had this not been available the consequences could have been catastrophic.

Lisa Hallgarten, of Brook sexual health charity, added: Many will benefit from this permanent option, including those with childcare responsibilities, disabilities, who cannot travel, or are in domestic violence situations.

And Clare Murphy, of the British Pregnancy Advisory Service, said: All evidence supports the continuation of this service as in the best interests of women.

"Early abortion care at home has been one of the few healthcare success stories of the pandemic.

Waiting times have been cut thanks to the service.

The first pill, mifepristone, stops the hormone that allows the pregnancy to continue.

The second, misoprostol, is taken 24-48 hours later to end the pregnancy by breaking down the wombs lining.

Previously, women went to a clinic for the first pill and took the second at home.

The BPAS insists the first visit is not necessary.

It is a result of outdated laws from the days of backstreet abortionists which ruled terminations be carried out in a clinic.

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Home abortions to become permanent as 90,000 women used service during lockdown - Mirror Online

Detailed Analysis & SWOT analysis, Infantile Spasms Therapeutics Market Trends 2020, Infantile Spasms Therapeutics Market Growth 2020, Infantile Spasms Therapeutics Industry Share 2020, Infantile Spasms Therapeutics Industry Size, Infantile Spasms Therapeutics Market Research, Infantile Spasms Therapeutics Market Analysis, Infantile Spasms Therapeutics market Report speaks about the manufacturing process. The process is analyzed thoroughly with respect three points, viz. raw material and equipment suppliers, various manufacturing associated costs (material cost, labor cost, etc.) and the actual process of whole Enterprise Infantile Spasms Therapeutics Market.

Infantile Spasms Therapeutics market 2020 is a professional and in-intensity look at on the modern state of the key-word industry. The document provides a simple review of the key-word marketplace together with definitions, classifications, programs and chain shape. The key-word enterprise evaluation is supplied for the worldwide marketplace which include improvement records, competitive landscape evaluation, and principal local development popularity.

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The Infantile Spasms Therapeutics marketplace file elaborates Infantile Spasms Therapeutics industry evaluation with various definitions and category, Product kinds & its packages and chain shape. Infantile Spasms Therapeutics market document presentations the manufacturing, sales, charge, and market proportion and boom rate of every type as following.

2020 Short Detail of this Infantile Spasms Therapeutics market report:

An infantile spasm (IS), also known as West Syndrome, is a specific type of seizure seen in an epilepsy syndrome of infancy and childhood. West Syndrome is characterized by infantile spasms, developmental regression, and a specific pattern on electroencephalography (EEG) testing called hypsarrhythmia (chaotic brain waves). The onset of infantile spasms is usually in the first year of life, typically between 4-8 months. The seizures primarily consist of a sudden bending forward of the body with stiffening of the arms and legs; some children arch their backs as they extend their arms and legs. The condition is usually observed in 2% of childhood epilepsies and 25% of epilepsies that start in the first year of life.

The global infantile spasms therapeutics market is growing at a slow pace. This is due to the increased availability of generic drugs and less approved therapies in the market and the less awareness of the disease and the available treatment options, especially in the low- and middle-income countries.

The classification of Infantile Spasms Therapeutics includes Oral, Injection. The proportion of Injection in 2016 is about 45%, and the proportion of Oral in 2016 is about 55%.

Based on application, the nitinol medical devices market is segmented into Hospital, Clinic and others. Clinic segment accounted for larger market share in terms of sales in 2016, Clinic segmented accounted for more than 45% of the market share in 2016.

United States is the largest consumption place, with a consumption market share nearly 83% in 2016. Following United States, Europe is the second largest consumption place with the consumption market share of 12.6% in 2016.

The US market is dominated by two approved products H.P. Acthar Gel (adrenocorticotropin hormone) and Sabril (vigabatrin). Sabril was the first drug to be approved by the Food and Drug Administration (FDA) in 2009 and H.P. Acthar Gel (adrenocorticotropin hormone) was approved for infantile spasms in 2010. Both have Orphan Drug Exclusivity (ODE) in the US.

In the future, the Infantile Spasms Therapeutics will have a good future; the price fluctuation has relationship with the raw material. The technology will more mature and the industry is more dispersion.

Market Analysis and Insights: Global Infantile Spasms Therapeutics Market

In 2019, the global Infantile Spasms Therapeutics market size was USD 138.9 million and it is expected to reach USD 178.4 million by the end of 2026, with a CAGR of 3.6% during 2021-2026.

Global Infantile Spasms Therapeutics Scope and Market Size

Infantile Spasms Therapeutics market is segmented by Type, and by Application. Players, stakeholders, and other participants in the global Infantile Spasms Therapeutics market will be able to gain the upper hand as they use the report as a powerful resource. The segmental analysis focuses on revenue and forecast by Type and by Application in terms of revenue and forecast for the period 2015-2026.

Segment by Type, the Infantile Spasms Therapeutics market is segmented into Oral, Injection, etc.

Segment by Application, the Infantile Spasms Therapeutics market is segmented into Hospital, Clinic, etc.

Regional and Country-level Analysis

The Infantile Spasms Therapeutics market is analysed and market size information is provided by regions (countries).

The key regions covered in the Infantile Spasms Therapeutics market report are North America, Europe, China, Japan, Southeast Asia, India and Central & South America, etc.

The report includes country-wise and region-wise market size for the period 2015-2026. It also includes market size and forecast by Type, and by Application segment in terms of revenue for the period 2015-2026.

Competitive Landscape and Infantile Spasms Therapeutics Market Share Analysis

Infantile Spasms Therapeutics market competitive landscape provides details and data information by vendors. The report offers comprehensive analysis and accurate statistics on revenue by the player for the period 2015-2020. It also offers detailed analysis supported by reliable statistics on revenue (global and regional level) by player for the period 2015-2020. Details included are company description, major business, company total revenue and the revenue generated in Infantile Spasms Therapeutics business, the date to enter into the Infantile Spasms Therapeutics market, Infantile Spasms Therapeutics product introduction, recent developments, etc.

The major vendors include Mallinckrodt, H. Lundbeck, Insys Therapeutics, Orphelia Pharma, Valerion Therapeutics, Catalyst Pharmaceuticals, Anavex Life Sciences, Retrophin, GW Pharmaceuticals, etc.

This report focuses on the global Infantile Spasms Therapeutics status, future forecast, growth opportunity, key market and key players. The study objectives are to present the Infantile Spasms Therapeutics development in North America, Europe, China, Japan, Southeast Asia, India and Central & South America.

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Infantile Spasms Therapeutics Market by Product Type:

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Next part of the Infantile Spasms Therapeutics Market analysis report speaks about the manufacturing process. The process is analysed thoroughly with respect three points, viz. raw material and equipment suppliers, various manufacturing associated costs (material cost, labour cost, etc.) and the actual process. Infantile Spasms Therapeutics market competition by top manufacturers, with production, price, and revenue (value) and market share for each manufacturer as per following;

Top Manufacturer Included in Infantile Spasms Therapeutics Market:

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After the basic information, the Infantile Spasms Therapeutics report sheds light on the production, production plants, their capacities, global production and revenue are studied. Also, the Infantile Spasms Therapeutics Market growth in various regions and R&D status are also covered.

Infantile Spasms Therapeutics Market Report by Key Region:

The global Infantile Spasms Therapeutics market is anticipated to rise at a considerable rate during the forecast period, between 2020 and 2026. In 2020, the market was growing at a mild rate and with the rising adoption of strategies by key players, the market is predicted to rise over the projected horizon. The report also tracks the most recent market dynamics, like driving factors, restraining factors, and industry news like mergers, acquisitions, and investments.

The report can help to know the market and strategize for business expansion accordingly. Within the strategy analysis, it gives insights from market positioning and marketing channel to potential growth strategies, providing in-depth analysis for brand fresh entrants or exists competitors within the Infantile Spasms Therapeutics industry. Global Infantile Spasms Therapeutics Market Report 2020 provides exclusive statistics, data, information, trends and competitive landscape details during this niche sector.

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Further in the report, Infantile Spasms Therapeutics Market is examined for price, cost and gross revenue. These three points are analysed for types, companies and regions. In prolongation with this data sale price for various types, applications and region is also included. The Infantile Spasms Therapeutics Industry consumption for major regions is given. Additionally, type wise and application wise consumption figures are also given.

To provide information on competitive landscape, this report includes detailed profiles of Infantile Spasms Therapeutics Market key players. For each player, product details, capacity, price, cost, gross and revenue numbers are given. Their contact information is provided for better understanding.

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It's not a coincidence that at medical school, when student doctors are first taught how to examine patients, they are always told to start by looking at the hands. They can reveal a lot about your health. Read on to discover the warning signs for disease, just a fingertip away. And to get through this pandemic at your healthiest, don't miss these COVID Mistakes You Should Never Make.

You may have heard about "COVID toes" as one of the most common symptoms of coronavirus, but not many people know that the virus can also manifest as swollen hands. According to the Mayo Clinic, this swelling is called edema and it could be linked to kidney or heart problems, both of which may be caused by coronavirus. Weakness or numbness of your hands, as well as a pain in hand or wrist, are also a reported symptom for many sufferers. To ensure your health and the health of others check these Sure Signs You've Already Had Coronavirus to see if you've experienced any.

Each hand consists of bone, nerves, blood vessels, connective tissue, and skin. Under each fingernail, the nail bed contains a capillary network. Healthy nails look pink as they are near the skin surface and you can see the red oxygenated blood within these capillaries. If your oxygen stores are depleted, for example, in chronic lung or heart disease, your fingers become blueand this is called cyanosis.

Examples of medical conditions which cause peripheral cyanosis include: Chronic Obstructive Pulmonary Disease (COPD), asthma, congenital heart disease, pulmonary embolism and heart failure. Abnormal haemoglobin, such as carbon monoxide poisoning, is also a cause of cyanosis.

You'll notice if you're ever a patient at the hospital, you have to take your nail polish off. This is why.

A tremor in both hands can be a sign of anxiety, alcohol withdrawal or too much caffeine. Other examples include Parkinson's Diseasetypically a "pill-rolling tremor"or an overactive thyroid gland. Sometimes a tremor can be caused by antipsychotic medication used to treat schizophrenia or bipolar disorder. A "liver flap" is a sign of serious liver failure.

A tremor in one hand could be due to a neuromuscular weakness such as a stroke, or rarely, a brain tumor.

4

woman looking at fingers nails obsessing about cleanliness

You may notice looking at the color of the skin on the hands, that it is yellowed. In fact, the skin all over the body may be yellow, even the whites of the eyes. This is jaundice and is a sign of liver, gall bladder or pancreatic disease.

Cold, pale, puffy hands may be a sign of an underactive thyroid gland.

Anemia may also cause the palmar skin creases to look pale, instead of pink.

Liver disease causes bright red palms"liver palms."

5

Itching of skin diseases in women using the hand-scratching

If the skin is reddened, and has characteristic features such as thickening and fissures, this may be eczema or contact dermatitissometimes due to occupational exposure to allergens.

6

woman suffering from pain in bone

Arthritis affects the joints of each finger, the thumbs and the wrists. These may appear red, swollen and may be tender to touch. Rheumatoid and osteoarthritis have different characteristic features.

Rheumatoid arthritis causes the fingers of each hand to splay out in an ulnar distribution. The tendons become inflamed, and there are painful synovial cysts which can rupture. The fingers become overextended at the joints and become misaligned. Typically the distal finger joints are spared. Rheumatoid arthritis is also associated with Sjogren's syndrome, a condition in which sufferers have dry eyes and a dry mouth.

Osteoarthritis causes hard bony lumps at the distal and middle finger joints. Those of the distal joints are called Heberden's nodes. In fact, osteoarthritis can affect any joints of the body.

7

Young female suffering from hand and finger joint pain with redness.

Gout can result in acute, painful swelling of one or more joints of the fingers. Gout is a condition in which your body either produces too much or can't break down uric acid. As a result, uric acid crystals are deposited in the joints. Sometimes these look like hard, white lumps called tophi.

Cholesterol deposits may occur around the knucklescalled tendon xanthoma. These are a sign of familial hypercholesterolemia, a condition affecting 1 in 500 of the population.

8

Hand of an man with Dupuytren contracture disease

Dupuytren's contracture is a condition in which connective tissue in the palm of the hand becomes thickened. The tendons become shortened, pulling the 4th and 5th fingers of the hand inwards so they are fixed in a resting position, partially flexed. It means you are unable to fully straighten your fingers and can become very disabling.

Trigger finger occurs when a tendon in the finger or thumb, becomes inflamed (tenosynovitis) and cannot function properly. You can bend the finger, but you cannot straighten it again without manually putting the finger back in place. Sometimes it may "pop" when you try to bend or straighten it.

Carpal tunnel syndrome is a common condition in which the median nerve becomes compressed as it passes from the forearm through the carpal tunnel and into the hand. You may get numbness and tingling in the thumb and index fingers, and over time muscle wasting and weakness. Carpal tunnel syndrome is associated with diabetes, rheumatoid arthritis and thyroid disease. It may be a problem in pregnancy.

9

Plastic surgeon examining a hand

Anaemia may cause nails to be brittle or even spoon-shapedkoilonychia. This can be a sign of celiac disease, diabetes, vitamin B12 deficiency or haemochromatosis (a condition in which your body iron stores are too high).

Diabetics may have a condition known as cheiroarthropathy. In this condition hands and fingers are stiff. If you put your two palms together and straighten your fingers as much as possible, you will not be able to touch the full length of each finger together.

"Half and half" nails are a rare but pathognomonic sign of kidney failure. When they occur the proximal part of the nail near the nail bed is pale or white, and the distal part of the nail is brown.

10

Raynaud's Disease occurs when the blood vessels in your fingers or toes suddenly become constricted. As a result, there is a reduced blood supply to the fingers or toes. They may turn white, then blue, and it can be painful. The fingers or toes feel very cold. If the area is warmed, the fingers and toes will then flush red as the blood supply returns.

An overactive thyroid may cause hot sweaty palms.

Acromegaly is a condition in which your body produces too much growth hormone. People with acromegaly may have extra-large hands and feet.

11

woman with afro hair over isolated background looking stressed and nervous with hands on mouth biting nails

Bitten nailsthe medical term is onychophagiamay be a sign of anxiety. They may have deep-seated roots including separation anxiety, stress, or Attention Deficit Disorder (ADHD).

Deliberate self-harmthis may be apparent if you look at the wrists and see scars from attempts to cut the wrists. This may represent depression and/or true suicidal intentions.

12

Woman looking at fingernails

Around 80% of people with psoriasis, find the disease affects their fingernails. (Sometimes, it is only the nails which are affected.) The nails appear crumbly, thickened, discolored and have small dents or "pits" within them. Sometimes they lift off the nail bedonycholysis.

Fungal nail infections can occur on the hands, although they are more common on the feet. They are commonly caused by a dermatophyte infection with the organism tinea unguium, but also sometimes by other yeasts or fungi. The nails look discolored and there is thickening and lifting of the distal portion of the nail. This can also occur if someone is immune-suppressedfor example, if they are on chemotherapy, or have diabetes.

Small hemorrhages may occur in the nails called splinter hemorrhages. These may be a sign of psoriasis, lichen planus or are sometimes drug-induced. They can also reflect subacute bacterial endocarditis a bacterial infection of the heart muscle.

The skin cancer melanoma can develop under a fingernail. It is a black or brownish streak developing in the nail bed. It is usually just one nail affected. The overlying mail may appear brittle, with lifting of the nail off the nail bed. This is an emergency and must be referred immediately to a dermatologist.

Clubbing is a condition in which the nails grow right around the fingertip to give it a bulbous appearance. This is seen most commonly in people with chronic lung disease, and congenital heart disease, TB or lung cancer.

13

Geriatric doctor (geriatrician) consulting and diagnostic examining elderly senior adult patient (older person) on aging and mental health care in medical clinic office or hospital examination room

One of the first things to notice when examining hands is that they give us an indication of your age. As you age, the skin on the back of your hands gets thinner and the veins become more prominent. Sometimes people get brownish patches of discoloration called age spots. As for yourself: To get through this pandemic at your healthiest, don't miss these 37 Places You're Most Likely to Catch Coronavirus.

Dr. Lee is a physician at Dr Fox Online.

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What Your Hands Say About Your Health - Yahoo Canada Shine On

Bland left behind other instructions, too. She said to everyone: Make sure Lauren gets a fella, she has been single long enough and she deserves to be loved, says Mahon.

Dating is less than straightforward for Mahon, who is looking for a partner who is willing to go through IVF treatment with her, using the eggs she froze before chemotherapy.

Its going to be a little bit more complex [for me to have a baby], so its just finding someone whos willing to go through that, she says. If my cancer diagnosis is too much to handle, you can f--- off.

She found menopause a gruelling experience. There were hot flashes that made her tomato-red, depression, mood swings, exhaustion, and brain fog. But worst of all, her libido disappeared. I was a 33-year-old woman who did not want to have sex, she says. I was so mortified and depressed about it all.

Menopause made her quality of life so poor that her doctors recommended she come off some of the hormone-suppressing drugs she was taking. It was a difficult decision to make and I was terrified my cancer would return and I still am, she says.

Just seeing a woman like Mahon - who has tattooed arms, short dark hair and a mouth like a sailor who has stubbed his toe - talk about menopause feels slightly radical. And thats sort of the problem, she says. She wants us to realise how common early menopause is: No one talks about it.

She hates the stigma surrounding womens bodies. Every person on the planet has come out of a vagina pretty much, so we need to get used to saying the word, she says. In this vein, she has joined with period product company Bodyform, for an ad campaign that tries to destigmatise the changes that happen to womens bodies during sex, pregnancy, menopause and periods.

Continued here:
Lauren Mahon: 'Getting breast cancer in my 30s was bad enough then they said I'd be infertile too' - Telegraph.co.uk

Authors note: This is not MY personal story, per se, (despite the my pandemic pregnancy headline), but a story told by our readers, week by week. Todays is shared by Hillary, from The Woodlands, Texas.

You might have heard that being pregnant, trying to get pregnant, or delivering right about now is strange, in this age of coronavirus. But how? In what ways? Were going to tell you. To contribute your own experience, scroll all the way down to the bottom of this article and tap the link.

When Hillary Calhouns fertility doctor brought her in for a procedure and then a nurse called her just a few short days later, asking her to come into the office immediately, the now-36-year-old had a hunch something wasnt right.

Hillarys husband, Bobby Calhoun, was out of town for work, so he couldnt accompany her to the appointment, but Hillary headed to the Houston-area clinic anyway, holding her breath a little, so to speak. The couple had been trying to get pregnant for years. Bobby had even gone under the knife as doctors reversed his vasectomy, which happened about 3 to four years ago, Hillary said in a phone call last week.

But back to Hillarys appointment. It was April 2019, and Hillary was in the office to learn about the results from her procedure. The previous Friday, doctors had performed a hysteroscopy, which is when they take a look at the uterus. A camera, of sorts, goes up the cervix, and specialists can then examine the fallopian tubes, ovaries and womb. Hillary waited and waited for the bottom line.

(The doctor) kept using the word abnormalities -- and he went on and on without really saying it, Hillary said.

After battling infertility for years, Hillary was aching to know what it was.

Then the doctor showed her the test results on a computer, and Hillary spotted the word carcinoma. Shes had family members whove experienced cancer, so she was familiar with some of the terminology. She knew that word.

Finally, Hillary said something to the effect of, OK, so I have cancer?

The doctor confirmed: That appeared to be the case. He told Hillary he thought the cancer looked to be in its early stages, but she would have to go through some more tests. The cancer, Hillary learned, was endometrial.

It was like, within one moment, someone took my dream away to have a baby, Hillary recalls thinking.

As soon as she could, she called Bobby, who was still in North Carolina on business, and she broke the news to him over the phone. Bobby was up on a roof at the time, and he got down and sped to the airport to be by Hillarys side.

The couple has been married about seven years. Bobby is a wonderful husband, Hillary said. He was incredibly supportive through this stressful time.

Hillary then made an appointment with a gynecological oncologist, who confirmed the cancer, ordered more tests and recommended a hysterectomy. The doctor said she believed this was a serious and life-threatening situation. A hysterectomy is an operation to remove a womans uterus entirely. But Hillary wanted to pause before making any major decisions.

Now, Im not trying to be reckless with my own life, but I thought it was early, said Hillary, adding that the doctor did confirm that the cancer appeared to be stage one.

I wanted to preserve my fertility, Hillary said.

While Bobby has four children (who are now a little older) from a previous marriage, Hillary still dreamed of becoming a mother. So she examined her options and asked about the possibility of hormone therapy. Her doctor agreed -- she could give it a shot.

Six months after starting, Hillary was cancer-free. It worked.

And then in October 2019, she went straight from cancer treatment to in vitro fertilization. It was a whirlwind.

Before they knew it, January arrived, and the couple learned they were pregnant. It worked.

It was unbelievable news, Hillary said.

To rewind a bit, the Calhouns werent always sure a baby would be possible.

Between Bobbys vasectomy and Hillarys history of endometriosis, polycystic ovary syndrome and uterine fibroids, she said, she had been told by doctors over the years that pregnancy might not be in the cards for her.

Shed tried the infertility drug Clomid to no avail.

And at some point, she started to fear that the doctors might be right.

I thought Id have to kiss that (pregnancy) dream goodbye, Hillary said.

But the couple thought it was worth it to fully explore the possibility. It was Bobby, after all, who was inspired and motivated to go for it.

I just kept thinking, if Gods going to put it on my husbands heart, there has to be a reason, Hillary said.

Cancer, Hillary said, turned out to be a blessing in disguise.

She had been experiencing some unexplained health issues, and her yearly or bi-yearly exams werent showing anything out of the ordinary.

But a Pap smear only tests for cervical cancer, not uterine cancer, Hillary said.

If I hadnt had infertility, I wouldnt have known, she told us. It was better than being diagnosed later, like when I had an infant. It happened exactly how it was supposed to, and this is how it was supposed to be.

Hillary has clarity and confidence about this. You can hear it in her voice. Shes also incredibly warm, chatty, open and ready for this miracle baby.

By waking up every morning and being grateful for the small things, it keeps you from getting frustrated from not being able to do all the things were used to doing, she said.

And thats not to say the ongoing pandemic has been easy on the couple.

Hillary was a few months into her pregnancy when COVID-19 hit. She and Bobby agreed: With so many unknowns, shed essentially go on lockdown mode. It seemed to be the safest option. Luckily, Hillary was able to work from home, for the most part.

Its just one of those things where you adapt because you have to, Hillary said. You survive because you have to. You cant let the fear consume you.

Still, she didnt shy away from addressing the sad parts. It feels strange that Bobby hasnt even met her doctor. Their doula, as it stands now, wont be able to attend the birth.

The couple even went through a bit of a scare at 20 weeks -- a bad bleed, as Hillary describes it -- and she had to take an ambulance to the emergency room.

Policies at their medical facility were strict. At first, hospital officials wouldnt even let Bobby in the door. Although he was eventually permitted into labor and delivery, where doctors were treating Hillary, he was told he couldnt leave the couples room -- not even to get a Coke, Hillary said.

The baby, by the way, is a girl. She and Hillary are doing just fine these days, despite a hot Texas summer. Olivia Grace is due Oct. 2. Her name has been picked out for a while now. Its almost like shes here already, the way Hillary talks about her and refers to her so effortlessly as Olivia. This is the little girl she was destined to have.

As far as labor and delivery are concerned, the plan for now is to labor at home with the doula for as long as possible. When Hillary arrives at the hospital, shes told shell have to wear a mask throughout labor. It sounds hard, but shes been rolling with the punches.

Ive had to learn to be a lot more open, Hillary said. With coronavirus, its easy to let fear consume you. And that could affect the delivery. So I want to avoid that as much as possible. I (have to) just go with the flow.

For a couple who doubted at some point that theyd ever get to this stage of life, it sounds like theyre doing a lot of stopping, taking in their surroundings and appreciating the beauty all around them.

(This surreal time) is a lot more intentional than normal life, which can be like, go go go go! Hillary said. To slow down has been really healthy for my pregnancy. Olivia was meant to be born in this time. There was a reason for it. Ill find out someday.

Go here to see the original:
My pandemic pregnancy: From infertility to cancer to IVF to a 20-week scare: It happened exactly how it was supposed to' - KPRC Click2Houston

GIRLS Aloud singer Sarah Harding revealed this week that she has advanced breast cancer at the age of just 38.

Her shocking diagnosis led to an outpouring of support from fans and stars, including former bandmates Cheryl, 37, Nadine Coyle, 35, Kimberley Walsh, 38, and Nicola Roberts, 34.

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Sarah shared her diagnosis on social media, saying she is doing her best to keep positive.

And she has good reason. Three women who were once given the exact same news as Sarah have told us how they have carried on living.

They have also backed our Get Checked breast cancer campaign and urged women - of any age - who are worried they may have the disease to see their doctors.

Here, they reveal the battles they faced and overcame.

FORMER city worker Louisa Rasmussen was diagnosed with incurable breast cancer at 34 - but says she is "living with" the disease and believes Sarah can do the same.

A year after Louisa gave up a high-flying, stressful career to become a yoga teacher she discovered she had incurable breast cancer and eight secondary tumours in her liver.

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Today Louisa, now 38, who lives with boyfriend James Ralph, 37, in London runs Breathe, Balance, Be - which helps other cancer victims to meditate.

In 2013 Louisa found a lump on her left breast and after a biopsy it was found to be benign.

But then in 2017 a second lump appeared this time on her right side - but she didnt get it checked for nine months.

She said: I put it down to monthly changes in my cycle initially. I have no idea why I waited that long. A part of me was scared.

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A biopsy confirmed it was oestrogen positive breast cancer. Then a full body scan to start planning treatments confirmed I had multiple metastases in my liver.

There were eight tumours in all incurable secondary breast cancer.

Being told was like an out of body experience. I had a sense of disbelief, shock. I needed six cycles of combination chemotherapy.

I was hoping I might be able to have my eggs frozen but because it has already spread they wanted to get me on treatment asap.

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Its a hell of a lot to take in. You are still processing and grieving for that years on.

During treatment I wore the cold cap which I hated. I lost 70 percent of my hair but it was awful when it came out in the shower in clumps.

Your life stops and there were days I was too ill to get up. Its tough.

The weekend after my chemotherapy finished I trained as a Yoga Nidra teacher and started breath work so I could guide others into relaxation and better breathing which I think helps when you have cancer.

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I have never asked for my prognosis and I dont want to know.

I feel very good and very bloody lucky. Im living with secondary, incurable breast cancer. And living is key.

So is early detection. I did have some 'what ifs?' after what happened to me. I used to ask myself what if it was caught earlier, why did I wait so long?

But my message is simple: dont be scared, take control, it could be nothing, but you must get checked.

BTW

CATHERINE Priestley, Clinical Nurse Specialist at Breast Cancer Now said: Secondary breast cancer - also referred to as advanced, metastatic or stage four - is when breast cancer cells spread from the breast to other parts of the body, most commonly the liver, lungs, bones, or brain. At this point, while it can be treated and managed, it is no longer curable.

The aim of treatment is to control the cancer, relieve any symptoms, and maintain health, wellbeing, and a good quality of life for as long as possible. Treatment can include chemotherapy, hormone therapies and targeted therapies.

Everyones diagnosis is different, but what we do know is that as treatments have improved, more and more people are living longer after a secondary breast cancer diagnosis.

"Accessing the right support and treatment can help the thousands of people living with the disease in the UK continue normal life as much as possible so we must ensure that everyone gets the care they need."

EMMA Gittens is 40, separated, and lives in Hereford with her sons Noah, nine, and Freddie, seven. She was diagnosed with triple-negative breast cancer in October 2017, at the age of 37.

In September last year, doctors discovered it had spread to her pancreas and she was told it was incurable.

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She says she sees her condition as a "chronic illness rather than a death sentence".

Emma, an HR administrator, said: It was such a shock when I was diagnosed.

I never expected to have cancer at such a young age. After I found the tumour in my right breast I had chemotherapy and surgery and doctors said that it hadnt spread.

But then in September last year they found that it had, to my pancreas and ovaries and at that stage it was diagnosed as incurable.

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Id had a thickening of the breast tissue which was quite painful for about 12 months before I was diagnosed. I went to see the GP but they said it was hormonal and not to worry.

"Then when a lump eventually appeared a year later, I went back to the GP and was referred to the breast clinic straight away.

"I wish Id pushed for more investigations at the time that I had the pain - I dont know if it was linked, but if it had been looked into it could have been caught earlier and made a difference to me.

I fully back the Sun on Sunday's campaign - I think getting to the doctors and getting checked out straight away is so important.

I never expected to have cancer at such a young age.

"I have two sons and I just make the most of every minute with them. During lockdown they have been at home with me for six months, and weve done loads of things together which has been lovely.

"I have weekly chemotherapy now at the hospital and its keeping me stable. I feel really healthy - I go to spinning classes at the gym once a week. I see it as a chronic illness rather than a death sentence.

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"When I was first diagnosed I found that talking to other women my age who had breast cancer too really helped me get through it.

"It saved me from plunging into deep despair at having such a life threatening illness, and thats what Sarah should do too.

"If Sarah has lots of support like I did, from other women who understand what she is going through, then she will get through it too.

"She needs not to treat it like a death sentence - like I dont - and just take each day at a time.

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Book a GP check

WOMEN who fear they may have breast cancer must book a GP appointment, a health minister has said.

Jo Churchill, who beat the disease twice, said seeing your doctor as soon as possible will mean a better chance of survival.

Ms Churchill said: I heard Sarah Harding bravely sharing the difficult news about the progress of her cancer this week and I wish her the very best with her treatment.

As someone who has had breast cancer twice, I cannot stress enough the importance of going to see your GP.

Catching any cancer early means a higher chance of successful treatment.

Ms Churchill is supporting our campaign Get Checked for women to get their breasts looked at early.

It is backed by Breast Cancer Now and CoppaFeel! as we ask women to see their GPs if they notice anything suspect.

ZEENAT Khanam is married to husband Ash, 40, and lives in Oldham, Greater Manchester. The couple run their own website clothing company.

Zeenat, 38, was diagnosed with breast cancer when she was just 32, that had already spread into her lungs and neck too.

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She said: Id felt something wasnt right in my breast for a few months. It felt very tight.

"But I was focused on my career, working hard and there wasnt any time to think about anything else.

I should have got checked out and gone to the doctors earlier. I should have taken more notice because I found a lump in my neck about six months later - it had already spread.

A doctor took a biopsy and two days later I got a letter from the hospital telling me I had breast cancer.

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It was such a shock. Id never checked my breasts either as I was so young, I never even gave breast cancer a second thought. I didnt think I needed to.

More than anything I wish that Id listened to my body earlier - and Id tell any other young woman to check themselves regularly and not ignore any changes.

Breast cancer can happen at a young age - as Sarah Harding knows. But early detection is vital.

"Because of the treatment I had, I havent been able to have children either, which has been heartbreaking for me.

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Doctors discovered another lump in my right breast in 2017, and Ive had chemotherapy treatment for it. I have treatment every three weeks, and its keeping the cancer from spreading, which is good.

"Sarah will need a lot of support - the cancer support group Macmillan helped me so much.

"Sarah needs to know that although her cancer has spread, she will get through it. I am still here to prove that.

What is breast cancer and how does it spread?

Breast cancer is the most common type of cancer in the UK - with one woman diagnosed every ten minutes.

While most women can get breast cancer, it is most common in women who are over the age of 50.

According to Cancer Research UK, breast cancer starts in the breast tissue.

Breast cancer develops when abnormal cells in the breast begin to grow and divide in an uncontrolled way and eventually form a growth.

Most invasive breast cancers are found in the upper-outer quadrant of the breast.

If its not diagnosed and treated it can move through the lymph or blood vessels to other areas of the body.

Each year in the UK there are around 55,200 new breast cancer cases.

This equates to around 150 new cases a day.

It also accounts for 15 per cent of all new cancer cases each year.

If the cancer is diagnosed at its earliest stage then 98 per cent of people will survive the disease for five years or more.

If it is diagnosed at the latest stage, then just 26 per cent of people survive for five years or more.

What are the four stages of breast cancer?

Stage one:The cancer is small and only in the breast tissue - but can also be found in lymph nodes close to the breast.

Stage two:The cancer is either in the breast or in the nearby lymph nodes or both.

See the original post:
We were diagnosed with advanced breast cancer like Sarah Harding but we carried on living - The Sun

Feeling stressed out and exhausted? You might be tempted to blame the infamous stress hormone known as cortisol.

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Theres a lot of information and theories about cortisol floating around. For instance: You can lower cortisol levels with a nice cup of tea or even better chocolate.

Alas, its not quite that simple. (Is it ever?) Nutrition is absolutely important for coping with stress and supporting your mood, but theres no single food thats going to do it all, says integrative medicine doctor Yufang Lin, MD. You have to look at the whole lifestyle picture.

Taking everything like that into account is more important than ever right now as we deal not just with the stress from the ongoing coronavirus pandemic, but the emotional ups and downs that come with it.

Heres her big-picture advice for keeping cortisol and the rest of your body and mind in balance.

Cortisol is one of several hormones the body produces naturally. Cortisol levels do go up when youre stressed. But it doesnt deserve its bad rap.

Cortisol supports overall health, Dr. Lin says. It helps us wake up, gives us energy during the day and lowers at night to help us sleep and rest.

The problem arises when chronic stress keeps cortisol levels high for the long haul. High cortisol levels over weeks or months can lead to inflammation and a host of mental and physical health problems, from anxiety to weight gain to heart disease.

Yes, no and maybe. Some research suggests that foods like tea, chocolate and fish oils might lower cortisol. But such studies tend to be small and not very conclusive, Dr. Lin says.

Youre unlikely to balance cortisol levels by adding anchovies to your pizza or scarfing a block of chocolate, she says. But good nutrition can make a difference.

Cortisol interacts with neurotransmitters, the chemical messengers that send signals in the brain. Neurotransmitters play an important role in mood. And cortisol isnt the only compound that influences them. To make those neurotransmitters, you need all the raw ingredients: vitamins, minerals and other nutrients, Dr. Lin says.

The best way to get them is with a balanced, plant-heavy diet, such as the Mediterranean diet, she adds. A healthy diet is the underpinning of stress management.

A balanced meal plan can ensure youre getting the nutrients your body needs. And talk to your doctor about taking a basic multivitamin. Its a good insurance policy to make sure youre not deficient in any vitamins, Dr. Lin says.

The supplement aisle at the natural foods store is hardly a one-way ticket to a stress-free life. But some items may help keep cortisol levels in a healthy range, Dr. Lin says. Research suggests these herbs and natural supplements might lower stress, anxiety and/or cortisol levels:

While some herbs might help lower cortisol levels naturally, you dont want to swallow everything in sight, Dr. Lin says. Teas like lemon balm and chamomile are quite safe. But if youre thinking about trying herbs in supplement form, talk to a trained provider first.

Dr. Lin stresses that a big-picture approach is key to maintaining healthy cortisol levels and feeling less stressed. These go-to strategies are good for the body and the mind.

Exercise benefits health from head to toe. So its no surprise that it helps with stress relief, too, possibly by reducing cortisol levels. Studies show, for instance, that exercise can bring down cortisol levels in the elderly and in people with major depressive disorder.

Almost nothing beats a good nights sleep. When youre not sleeping well, you tend to be more anxious, irritable and stressed, Dr. Lin says. Like exercise, sleep is important for health in all sorts of ways including managing stress and keeping cortisol in check.

Sleep deprivation may increase cortisol levels. The increased cortisol can impair memory, contribute to weight gain and even accelerate the aging process. In other words: Dont skimp on shut-eye.

Spending time in the great outdoors is a great way to lower cortisol and calm your brain. The practice of forest bathing essentially, hanging out in the woods and breathing the forest air can reduce cortisol levels and lower stress. (Just pack your bug spray, so the mosquitoes dont stress you out.)

While they might not be something youve ever considered, practices like yoga, tai chi, qi gong, mindfulness meditation and breathing exercises can be great stress busters and a lot of skeptics have turned to converts. Research has found, for example, that mindfulness-based stress reduction therapy can lower cortisol and feelings of stress. And yoga can bring down high cortisol levels, heart rate and blood pressure.

When it comes to de-stressing, cortisol is just one piece of the puzzle, Dr. Lin adds. No one food or pill can deliver you to blissful calm. But healthy choices can set your body up for low-stress success.

Link:
How to Reduce Cortisol and Turn Down the Dial on Stress - Health Essentials from Cleveland Clinic