Sunday, September 27, 2009
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Monday, September 21, 2009
METABOLIC SYNDROME
Review Article
(Syndrome X/ Insulin Resistance Syndrome)
Dr.ISHRAT ALI SIDDIQUI . PROF.J FEELY.
TRINITY COLLEGE RESEARCH CENTRE
PHARMACOLOGY AND THEAPEUTIC
ST ;JAMES HOSPITAL ,
DUBLIN 8 , IRELAND
Definition: Metabolic Syndrome is a cluster of disorders of the body metabolism. Its characteristic including, glucose intolerance hyperinsulinemia hypertriglycermia hypertensin reduced concentration of HDL-cholesterol, and central Obesity are the predominant components.1
This is a review study on metabolic syndrome (MS), with the following objectives:
Study objectives:
1- To assess the utility of clinical definitions of metabolic syndrome (MS)
2 - To identify individuals with increased cardiovascular risk.
3 - To assess the association between MS and arterial stiffness
1. Utility of clinical definitions of MS
For MS definition, the two most commonly used criteria: Are the ATP III (ADULT TREATMENT PANEL III), and the WHO (WORLD HEALTH ORGANIZATION) criteria. 1 At the outset, a brief background into MS (both epidemiological and clinico-pathological profile) is given.
ATP III (Adult Treatment Panel III):
The ATP IIII criterion describes MS, if any three of the following five criteria is present: 3
1 - Hypertension
2 - Excessive Waist Circumference.
3 - High fasting glucose
4 - Hypertriglyceridemia
5 - Low HDL
WHO clinical criteria:
Insulin resistance is identified by 1 of the following criteria:,4
1- Type II D.M
2 - Impaired fasting glucose
3 - Impaired Glucose tolerance.
4 - For those with normal fasting glucose levels (< 110 mg/dl). For back ground population under investigation under hyperinsulinemic, euglycemic conditions.
Plus any 2 of the following criteria:
1 - Antihypertensive medication and / or high blood pressure
(=>140 mmHg systolic or =>90mmHg diastolic)
2 - Plasma triglycerides (=>150mg/dl/=>1.7mmol/l)
3 - HDL Cholesterol (< 35 mg/dl / < 0.9 mmol/l in Men
Or < 39 mg / dl /1.0 mmol/l in Women)
4 - BMI (> 30 Kg /msquare and / or Waist hip ratio > 0.9 in Men or > 0.85 in Women)
5 - Urinary albumin excretion rate (=> 20 μg / min) or albumin: creatinine ratio (=> 30 mg /g/)
0r
WHO.
1 - Diabetes.IFG, or HOMA – IR
2 - Blood pressure (=> 160 systolic or=> 90 diastolic mmHg).
3 - Hypertriglyceridemia (=> 150 mg/dl )
4 - Low HDL ( Men < 35: Women < 39 mg/dl )
5 - Obesity (waist to hip ratio: Men >0.9, Women >0.85 )5
NCEP ATP III clinical criteria for MS:
Risk factors, such as:
1 - Abdominal obesity (waist circumference:
Men > 102 cm (> 40 inches Women > 88 cm (> 35 inches)
2 - Triglycerides (=> 150 mg /dl/=>1.7 mmol/l)
3 - HDL Cholesterol;
Men < 40 mg /dl (< 1.0 mmol/l) Women < 50 mg/dl (< 1.3mmol/l)
4 - Blood pressure (=> 130 mmHg systolic or => 85 mmHg diastolic)
5 - Fasting Glucose (=> 110 mg/dl /=>6.1 mmol/l )
Incidence of MS:
In America, the incidence of MS is increasing over the past ten years, and has reached 61%. One in four adults below the age of forty years has MS.6
Definition of MS: 7
1 - This is the association of insulin resistance in tissues, with hyperinsulinaemia (fasting insulin > 89.4 pmol/L)
2 - Abdominal obesity or central obesity; Waist measure,
Men = 40inches or more (102cm) Women=35inches or more (88 cm).
3 - Hypertension;
Systolic BP = 135 mm Hg
Diastolic BP = 85 mm Hg.
4 - Hyperglycaemia or Fasting Glucose Level = 110 mg/dl or more.
5 - Increase Plasma Triglyceride Level = 150 mg/dl or more
6 - Decrease HDL OR Low HDL [ good ] Cholesterol below;
Men = 40 mg/ dl. Women = 50 mg/ dl.
It has also been argued that MS is not a disease, but a cluster of disorders of our body metabolism. 8 There are five clusters, and the presence of any three will qualify a patient to have MS. These include:
1- High Blood Pressure
2- High Insulin Level
3 -Excessive Body Weight
4-Abnormal Cholesterol Level
5-Low HDL Level and High HDL
Causes of MS:
The exact cause of MS is not known,8 but few factors are associated with MS. They are:9
1 - Obesity
2 - Hypertension.
3 - Pregnancy.
4 - Asian Origin
5 - Acute and Chronic Renal Failure.
6 - Acromegaly
7 - NIDDM
8 - Sympathetic tone Increase
9 - Cystic fibrosis
10-Poly Cystic Ovaries.
11-Ataxia telangiectasia.
Risk factors for MS:
A few risk factors associated with MS have been identified. They are:
Age:
Less than 10% of the patients in their 20s are diagnosed with MS, while 40% are in their 60s.10
Race:
MS is more common in blacks and in Mexican – Americans than among Caucasians.
Also, black women are affected more relative to black men, while white men are relatively more affected.11
Obesity:
1 - Genetically.
2 - Excessive taking fatty meal.
3 - Less Physical work.
4 - Because of Disease.
5 - Excessive Calorie in take 12
History of Diabetes Mellitus (DM):
MS is more common in the following categories of patients:
1 - Family history of type II DM
2 - History of DM during pregnancy (gestational DM)
Others:
1 - Hypertension
2 - Cardiovascular Disease.
3 - PCO.(Polycystic ovary syndrome)
PATHOGENESIS OF MS:
The most of the body glucose is derived from liver and then kidney produce less glucose.13
And this glucose production is used in the brain and all body tissues in the shape of insulin.
Glucocorticoids are also involved in metabolic inflammatory, cardiovascular and in behavioural process. The cause of action in MS has not been appreciated, but clinical findings suggest that glucocorticoids may play an important role.14
Following glucose ingestion, plasma glucose concentration increases, which stimulate Insulin release and may give rise to Hyper-insulinemia and Hyperglycemia.15
Genes may also play role in MS, because MS is reported to be clustered in a family. 16
When insulin hormone is excreted from pancreas, the pancreas loses its ability to absorb glucose from blood. This blood glucose uses body for energy, and because of excessive dietary intake pancreas releases a high level of insulin in the blood stream. However, loss of insulin production may be genetic or secondary to high fat level with fatty deposits in the pancreas.17
2. Studies on the cardiovascular risk pattern for MS
The STRONG HEART STUDY 18
The strong heart study done by Chinali and colleagues in North Dakota in American Indians (USA) between July 1989 and January 1992 used the ATP III criteria .Their main conclusions were .In Women MS is ( p< 0.001 ) more found with similar aged compare with those with out the MS.
After controlling for confounders, the participants with MS had great dimessio, mass and relative wall thickness, and left atrial diameter ( all p < 0.05 ),mid wall shortening ( p < 0.001 ) and mitral E/A ratio ( p< 0.05 ),then participants who did not have the MS.
After different experiment process, high blood pressure ( BP ) and abdominal obesity were the only components of the MS associated with increased LV diameter, only high BP was associated with increased LVmass and prevalence of LV hyper trop( both p < 0.001 ).
The Third National and Nutrition Examination Survey 19- 20
This study was done in Boston (USA) in 2004.
The investigators also used ATP III Criteria to determine the prevalence of MS in the American adolescents (12-19 year-olds) across different ethnic groups. They observed variations across ethnic groups. For example, low HDL and Hypertriglyceridemia were more common in the adult non-Hispanic whites, while they are less common in the non-Hispanic blacks. The investigators also noticed that the incidence of MS was 8 % to 12 % in the non-obese adults, while it is 34 % to 41 % in the obese adults. However, the prevalence of MS was comparable for both boys and girls, as well as across older and younger adolescents.
The Health ABC Study 21
The health ABC Study done by Paul Holvoet et al in Belgium between March 1997 and 1998 looked at the elderly People in the Health, Aging, and Body Composition Cohort (ABC).They used ATP III Criteria, and showed that MS was associated with higher levels of oxLDL due to a higher fraction of oxLDL, but not because of higher cholesterol level. The oxLDL was not the lone predictor of total CHD risk, but high oxLDL showed a greater predisposition to myocardial infarction, suggesting atherothrombotic role.
The Arab American Study 22
The Arab American study done in USA in June 2003 investigated into the prevalence of the MS among Arab Americans. They used both the criteria: ATP III and WHO for the diagnosis of prevalence of MS.
According to ATP III ,this study showed that the rates were similar for men and women aged 20 – 40 years, but higher for women aged >/=50years. According to WHO, this study showed that the rate is higher for men then women aged 20- 49 years, but similar for age >/=50years.
The prevalence of MS based on both this criteria was 23 % (ATP III) and 28 % (WHO). The study also indicated that the prevalence of MS increased with age and BMI. The WHO criteria analysis also showed that glucose intolerance or glucose resistance, as well as high blood pressure were the most common abnormalities in both sexes. However, the ATP III criteria-based analysis showed that low HDL cholesterol was higher in both the sexes. This low HDL is danger for blood vessel, because of the potential for atheroma formation, thereby narrowing and causing arterial stiffness. Therefore, this study suggested that low HDL cholesterol and triglyceride are powerful predictors of insulin resistance than obesity, elevated blood pressure or FPG. However, in the presence of obesity, the risk of coronary heart disease is greatly increased.
The ARIC Study 23
The ARIC study was done in North Carolina (USA) between 1987 and 1989 to determine the prevalence of Coronary Heart Disease and Carotid Arterial thickening. The investigators used ATP III criteria, and studied different racial and age groups. The main findings of this ARIC study were that women alone with MS had a significant association with increasing low density lipoprotein cholesterol. CHD prevalence was 7.4 % compared to 3.6 % prevalence in the comparison subjects ( p < 0.0001 ). In other words, MS patients were 2 times as more likely to have CHD as those without MS. The study also indicated that the average intimal–medial wall thickness of carotid arteries was greater among the MS patients versus those with out MS.
The Greenland Study 24
The prevalence of the MS among the Inuit in Greenland.A Comparison b/w two proposed definition .Study by M.J.Jorgensen et all in Denmark in b/w 1999 and 2001.
They used both the criteria, WHO, ATP III. This study compared WHO Syndrome men with NCEP Syndrome, and found higher mean values of waist circumference, BMI and triglycerides and lower mean values of high – density lipoprotein ( HDL ) Cholesterol.among women,triglycerides were higher NCEP Syndrome.
The study also indicated increased prevalence of D.M, because of impaired tolerance and obesity, together with higher physical inactivity levels. All this may have caused increased insulin resistance. According to WHO definition, 37.9 % did not have MS, while according to NCEP Syndrome definition 28.5 % had MS.
The investigators showed that MS is increased with age in men in both the syndrome and women were affected only when they became older. Men with WHO Syndrome had lower waist circumference and triglyceride levels but HDL cholesterol was higher in women. However, the level of risk is same except from HDL cholesterol, which was higher according to WHO Syndrome.
Glucose abnormality is also higher in women with WHO Syndrome but in NCEP syndrome 72% of women with IGT and 43% of women with Diabetes were not classified as glucose intolerance. Obesity was much higher with WHO than NCEP. Hypertension was high according to NCEP, because of lower thresholds. The study indicated that prevalence of these two syndromes is equal, while abdominal fat seems to be a greater risk factor than obesity. Blood pressure was higher according to WHO. Microalbuminuria was associated with endothelial dysfunction and with increased risk for CVD, both in diabetic or non-diabetic patients. NCEP Syndrome showed increased IHD mortality, while WHO Syndrome showed increased CVD mortality.
This study is done by Marchesini G et al in 1999 in Bologna, Italy. The investigators employed both WHO and ATP III criteria for the definition of the Metabolic Syndrome in patients with Type 2 diabetes. They found that according to WHO criteria microalbumina has the highest specificity (99 %), while visceral obesity has the highest sensitivity (93 %) for MS.
ATP III criteria showed that hypertension was the most sensitive criterion and low HDL-Cholesterol the most specific (95 %). Positive waist circumference and low HDL Cholesterol were both associated with CHD. Based on the WHO criteria, waist circumference is identified in large proportion of males, while based on ATP III criteria visceral adiposity is more common in females.25
3. METABOLIC SYNDROME CAUSE ARTERIAL STIFFNESS
The mechanisms of development of vascular stiffness is largely unknown. 28
In Metabolic Syndrome, mainly two risk factors are important contributors to the development of atherosclerosis. These are High Density Lipoproteins (HDLs) and Low Density Lipoprotein (LDLs).
The formation of an atherosclerotic plaque is some form of damage to arterial wall, and this damages the endothelial cells of the tunica intima. Other contributing risk factors are: smoking, poor diet (high saturated fatty intake such as cholesterol), stress, lifestyle and social factors.26
Schiffrin has shown that arterial stiffness is increased with advance age and other CV risk factors may role in arterial stiffness, such as Hypertension ,MS,Diabetes,Obesity, Hypercholesterolemia and C-reactive protein.27
Arterial Stiffness is related with Insulin resistance in Non Diebetic Hypertensive Older Adult is done by Sendstock DM,et all in university of Michigan.
They recruited 60 to 80 year age ,and measuring pulse pressure and carotid – femoral pulse wave velocity to find out arterial stiffness ,they say that PWVand PP were negatively correlated with SI,and after multiple regression analysis .PWV and PP remained independtly correlated with SI .( P< 0.005 ).28
TECHNIQUE FOR ARTERIAL STIFFNESS MEASUREMENT
Metabolic Syndrome can be diagnosed with invariable investigation is done by tap measure and a few simple blood test6,and also for to find out the cause of arterial stiffness, we take pulse pressure and carotid – femoral pulse wave velocity and different BP reading ,systolic and diastolic with the help of sphygmomanometer.27
In supine position connect EKG lead and record heart rhythm continuously. Pulse pressures (PP) was calculated by subtracting these measurements. We marked mid point of manubrium to locate maximal impulse of the right common carotid and right common femoral artieries pulses. To approximate the length of the descending aorta, the distance from the midpoint of the manubrium maximal pulse of the right carotid artery was subtracted from the distance from the midpoint of the manubrium to the maximal pulse of the right femoral artery ‘1 aorta (mm)’.A hand –held high-fidelity tometer (SPC-301,Millar instruments, Houston.TX ) placed over the maximal impulse of the carotid artery to achieve a pressure wave contour with a consistent baseline, contour, and amplitude. A twenty – second time span of these carotid pulse contours were recorded ( At Cor version 7.0 ).The average time ‘t C ( msec )’between each R-wave on the EKG and the food of the corresponding carotid pressure waveform was calculated. Similarly, the tonometer was placed over the maximal impulse of the right common femoral artery to calculate ‘tf ( msec )’.PWV ( m / sec) was then calculated by the equation PWV =1 aorta / ( tf-tC).
A measurement was excluded if the pressure contour was of poor quality or if a significant difference (>15%) in the heart rate was found between the carotid and femoral measurements.28
References
1. IMJ November / December 2004 Volume 97 Number 10 .www.imj.ie
2. The Claveland ClinicHealth Information Center;
http//www.clavelandclinic.org/health-info/does/300/3057/aspp?index
10783, 18.02.05.
3. Sarah D, de Ferranti, KG, David SL, Ellis JN. Prevalence of the metabolic
syndrome in American Adolescents). Finding from the third National Health
and Nutrition examination Survey. Circulation 2004; 110: 2494-2497.
4. Derived from WHO
www.theses.ulaval.ca/2004/222151/ch01.html,22/02/05.
5. Jaber LAB, Hammad A, Zhu Q, Hermen WH. The prevalence of the
Metabolic Syndrome among Arab Americans. Care 2004; 27(1):234- 8.
6. MayoClinic Medical Service,Heart Center,March 09,2004.
7. The Pritikin Longevity Center & Spa Welcome You. February 2005.
8. Claveland Clinic.org health / health.info / docs / 3000 / 3057 asp ?index =
10783 page 1 and 3, 18/02/05.
9. Oxford Hand Book Of Clinical Medicine, page no = 567,fourth edition.
10. MayoClinic.com-Metabolic Syndrome. March 09,2004.31/01/2005.
11. Statistical fact sheet Risk factors (American Heart Association)
12. The Pritikin Longevity Center & Spa Welcomes You.
http//pritikin.com/eperspective/janfeb05/metabolicMess.stml?OVRAW= metabolic%..18/02/05.
13. Ralph A.Defronzo.(Medical Clinics of North America).
Doi:10.1016/j.mena 2004.04.013.
14. Minghan Wang, ( Role of Glucocorticoide in M.S ),
Received Nov=18,2004.acept2005.
15. Medical Clinics of North American. Med clin Nam 88 (2004)787-835.
16. http//www.theses.ulaval.ca/2004/22151/chol.html.22/02/05
17. http//www.Clavelandclinic.org/health/health–info/docs/3000/3057;asp?index=10783=18/02/05.
18. Marcello C, Devereux RB, Howard BV, et al. Comparison of cardiac structure and function in
American Indians with and with out the Metabolic Syndrome,
THE STRONG HEART STUDY.Am J Cardiol 2004; 93(1): 40.
19. Sarah D, de Ferranti, Kimberlee G, et al. Prevention of the Metabolic
Syndrome in American adolescents: Findings from the Third National Health
and Nutrition Examination Survey. Preventive Cardiology 2004; 110: 2494-2497.
20. Meigs JB, Wilson PW, Nathan DM, et al. Prevalence of the Metabolic
Syndrome in the Sa Antonio Heart and Framingham offspring studies.
Diabetes 2003; 52 (8): 2160-7.
21. Paul H, Stephen BK, Russell PT, et al. The Metabolic Syndrome, circulating
Oxidized LDL,and risk of Myocardial Infarction in well functioning Elderly
People in the Health, Aging, and Body composition Cohort.
Diabetes 2004; 53:
22 Jaber LA, Brown MD, Hammad A, Zhu Q, Herman WH. The prevalence of
the Metabolic Syndrome among Arab Americans. Care 2004; 27 (1): 234-8.
23. McNeill AM, Rosamond WD, Girman CJ, et al. Prevalence of Coronary Heart
Disease and carotid \rterial thickening in patients with the Metabolic
Syndrome (The ARIC Study).Am J Cardiol 2004; 94:1249-1254.
24. JØrgensen ME, Bjerregaard P, Gyntelberg F, Borch–Johnsen K. Prevalence of
the Metabolic Syndrome among the Inuit in Greenland .A comparison between
two proposed definitions. Diabetes 2004; 21: 1237-42.
25. Marchesini G, Forlani G, Cerrelli F, et al. WHO and ATP III proposals for the
definition of the Metabolic Syndrome in patients with Type 2 Diabet
Med.2004; 21 (4): 383 – 7.
26. Douglas BM, Glasgow U.K. In: Principles of Physiology, 1996.
27. Ernesto LS. Vascular stiffening and arterial compliance: Implications for
systolic blood pressure. Am J Hypertension 2004; 17(12) Supplement 1, S39 - S48.
28. Sengstock DM, Vaitkevicius PV, Supiano MA. Arterial stiffness is related to
insulin resistance in Non Diabetic Hypertensive Older Adults. J Clin
Endocrinol Metab 2005; Feb 22 (epub).
COPYRIGHT 2009
(Syndrome X/ Insulin Resistance Syndrome)
Dr.ISHRAT ALI SIDDIQUI . PROF.J FEELY.
TRINITY COLLEGE RESEARCH CENTRE
PHARMACOLOGY AND THEAPEUTIC
ST ;JAMES HOSPITAL ,
DUBLIN 8 , IRELAND
Definition: Metabolic Syndrome is a cluster of disorders of the body metabolism. Its characteristic including, glucose intolerance hyperinsulinemia hypertriglycermia hypertensin reduced concentration of HDL-cholesterol, and central Obesity are the predominant components.1
This is a review study on metabolic syndrome (MS), with the following objectives:
Study objectives:
1- To assess the utility of clinical definitions of metabolic syndrome (MS)
2 - To identify individuals with increased cardiovascular risk.
3 - To assess the association between MS and arterial stiffness
1. Utility of clinical definitions of MS
For MS definition, the two most commonly used criteria: Are the ATP III (ADULT TREATMENT PANEL III), and the WHO (WORLD HEALTH ORGANIZATION) criteria. 1 At the outset, a brief background into MS (both epidemiological and clinico-pathological profile) is given.
ATP III (Adult Treatment Panel III):
The ATP IIII criterion describes MS, if any three of the following five criteria is present: 3
1 - Hypertension
2 - Excessive Waist Circumference.
3 - High fasting glucose
4 - Hypertriglyceridemia
5 - Low HDL
WHO clinical criteria:
Insulin resistance is identified by 1 of the following criteria:,4
1- Type II D.M
2 - Impaired fasting glucose
3 - Impaired Glucose tolerance.
4 - For those with normal fasting glucose levels (< 110 mg/dl). For back ground population under investigation under hyperinsulinemic, euglycemic conditions.
Plus any 2 of the following criteria:
1 - Antihypertensive medication and / or high blood pressure
(=>140 mmHg systolic or =>90mmHg diastolic)
2 - Plasma triglycerides (=>150mg/dl/=>1.7mmol/l)
3 - HDL Cholesterol (< 35 mg/dl / < 0.9 mmol/l in Men
Or < 39 mg / dl /1.0 mmol/l in Women)
4 - BMI (> 30 Kg /msquare and / or Waist hip ratio > 0.9 in Men or > 0.85 in Women)
5 - Urinary albumin excretion rate (=> 20 μg / min) or albumin: creatinine ratio (=> 30 mg /g/)
0r
WHO.
1 - Diabetes.IFG, or HOMA – IR
2 - Blood pressure (=> 160 systolic or=> 90 diastolic mmHg).
3 - Hypertriglyceridemia (=> 150 mg/dl )
4 - Low HDL ( Men < 35: Women < 39 mg/dl )
5 - Obesity (waist to hip ratio: Men >0.9, Women >0.85 )5
NCEP ATP III clinical criteria for MS:
Risk factors, such as:
1 - Abdominal obesity (waist circumference:
Men > 102 cm (> 40 inches Women > 88 cm (> 35 inches)
2 - Triglycerides (=> 150 mg /dl/=>1.7 mmol/l)
3 - HDL Cholesterol;
Men < 40 mg /dl (< 1.0 mmol/l) Women < 50 mg/dl (< 1.3mmol/l)
4 - Blood pressure (=> 130 mmHg systolic or => 85 mmHg diastolic)
5 - Fasting Glucose (=> 110 mg/dl /=>6.1 mmol/l )
Incidence of MS:
In America, the incidence of MS is increasing over the past ten years, and has reached 61%. One in four adults below the age of forty years has MS.6
Definition of MS: 7
1 - This is the association of insulin resistance in tissues, with hyperinsulinaemia (fasting insulin > 89.4 pmol/L)
2 - Abdominal obesity or central obesity; Waist measure,
Men = 40inches or more (102cm) Women=35inches or more (88 cm).
3 - Hypertension;
Systolic BP = 135 mm Hg
Diastolic BP = 85 mm Hg.
4 - Hyperglycaemia or Fasting Glucose Level = 110 mg/dl or more.
5 - Increase Plasma Triglyceride Level = 150 mg/dl or more
6 - Decrease HDL OR Low HDL [ good ] Cholesterol below;
Men = 40 mg/ dl. Women = 50 mg/ dl.
It has also been argued that MS is not a disease, but a cluster of disorders of our body metabolism. 8 There are five clusters, and the presence of any three will qualify a patient to have MS. These include:
1- High Blood Pressure
2- High Insulin Level
3 -Excessive Body Weight
4-Abnormal Cholesterol Level
5-Low HDL Level and High HDL
Causes of MS:
The exact cause of MS is not known,8 but few factors are associated with MS. They are:9
1 - Obesity
2 - Hypertension.
3 - Pregnancy.
4 - Asian Origin
5 - Acute and Chronic Renal Failure.
6 - Acromegaly
7 - NIDDM
8 - Sympathetic tone Increase
9 - Cystic fibrosis
10-Poly Cystic Ovaries.
11-Ataxia telangiectasia.
Risk factors for MS:
A few risk factors associated with MS have been identified. They are:
Age:
Less than 10% of the patients in their 20s are diagnosed with MS, while 40% are in their 60s.10
Race:
MS is more common in blacks and in Mexican – Americans than among Caucasians.
Also, black women are affected more relative to black men, while white men are relatively more affected.11
Obesity:
1 - Genetically.
2 - Excessive taking fatty meal.
3 - Less Physical work.
4 - Because of Disease.
5 - Excessive Calorie in take 12
History of Diabetes Mellitus (DM):
MS is more common in the following categories of patients:
1 - Family history of type II DM
2 - History of DM during pregnancy (gestational DM)
Others:
1 - Hypertension
2 - Cardiovascular Disease.
3 - PCO.(Polycystic ovary syndrome)
PATHOGENESIS OF MS:
The most of the body glucose is derived from liver and then kidney produce less glucose.13
And this glucose production is used in the brain and all body tissues in the shape of insulin.
Glucocorticoids are also involved in metabolic inflammatory, cardiovascular and in behavioural process. The cause of action in MS has not been appreciated, but clinical findings suggest that glucocorticoids may play an important role.14
Following glucose ingestion, plasma glucose concentration increases, which stimulate Insulin release and may give rise to Hyper-insulinemia and Hyperglycemia.15
Genes may also play role in MS, because MS is reported to be clustered in a family. 16
When insulin hormone is excreted from pancreas, the pancreas loses its ability to absorb glucose from blood. This blood glucose uses body for energy, and because of excessive dietary intake pancreas releases a high level of insulin in the blood stream. However, loss of insulin production may be genetic or secondary to high fat level with fatty deposits in the pancreas.17
2. Studies on the cardiovascular risk pattern for MS
The STRONG HEART STUDY 18
The strong heart study done by Chinali and colleagues in North Dakota in American Indians (USA) between July 1989 and January 1992 used the ATP III criteria .Their main conclusions were .In Women MS is ( p< 0.001 ) more found with similar aged compare with those with out the MS.
After controlling for confounders, the participants with MS had great dimessio, mass and relative wall thickness, and left atrial diameter ( all p < 0.05 ),mid wall shortening ( p < 0.001 ) and mitral E/A ratio ( p< 0.05 ),then participants who did not have the MS.
After different experiment process, high blood pressure ( BP ) and abdominal obesity were the only components of the MS associated with increased LV diameter, only high BP was associated with increased LVmass and prevalence of LV hyper trop( both p < 0.001 ).
The Third National and Nutrition Examination Survey 19- 20
This study was done in Boston (USA) in 2004.
The investigators also used ATP III Criteria to determine the prevalence of MS in the American adolescents (12-19 year-olds) across different ethnic groups. They observed variations across ethnic groups. For example, low HDL and Hypertriglyceridemia were more common in the adult non-Hispanic whites, while they are less common in the non-Hispanic blacks. The investigators also noticed that the incidence of MS was 8 % to 12 % in the non-obese adults, while it is 34 % to 41 % in the obese adults. However, the prevalence of MS was comparable for both boys and girls, as well as across older and younger adolescents.
The Health ABC Study 21
The health ABC Study done by Paul Holvoet et al in Belgium between March 1997 and 1998 looked at the elderly People in the Health, Aging, and Body Composition Cohort (ABC).They used ATP III Criteria, and showed that MS was associated with higher levels of oxLDL due to a higher fraction of oxLDL, but not because of higher cholesterol level. The oxLDL was not the lone predictor of total CHD risk, but high oxLDL showed a greater predisposition to myocardial infarction, suggesting atherothrombotic role.
The Arab American Study 22
The Arab American study done in USA in June 2003 investigated into the prevalence of the MS among Arab Americans. They used both the criteria: ATP III and WHO for the diagnosis of prevalence of MS.
According to ATP III ,this study showed that the rates were similar for men and women aged 20 – 40 years, but higher for women aged >/=50years. According to WHO, this study showed that the rate is higher for men then women aged 20- 49 years, but similar for age >/=50years.
The prevalence of MS based on both this criteria was 23 % (ATP III) and 28 % (WHO). The study also indicated that the prevalence of MS increased with age and BMI. The WHO criteria analysis also showed that glucose intolerance or glucose resistance, as well as high blood pressure were the most common abnormalities in both sexes. However, the ATP III criteria-based analysis showed that low HDL cholesterol was higher in both the sexes. This low HDL is danger for blood vessel, because of the potential for atheroma formation, thereby narrowing and causing arterial stiffness. Therefore, this study suggested that low HDL cholesterol and triglyceride are powerful predictors of insulin resistance than obesity, elevated blood pressure or FPG. However, in the presence of obesity, the risk of coronary heart disease is greatly increased.
The ARIC Study 23
The ARIC study was done in North Carolina (USA) between 1987 and 1989 to determine the prevalence of Coronary Heart Disease and Carotid Arterial thickening. The investigators used ATP III criteria, and studied different racial and age groups. The main findings of this ARIC study were that women alone with MS had a significant association with increasing low density lipoprotein cholesterol. CHD prevalence was 7.4 % compared to 3.6 % prevalence in the comparison subjects ( p < 0.0001 ). In other words, MS patients were 2 times as more likely to have CHD as those without MS. The study also indicated that the average intimal–medial wall thickness of carotid arteries was greater among the MS patients versus those with out MS.
The Greenland Study 24
The prevalence of the MS among the Inuit in Greenland.A Comparison b/w two proposed definition .Study by M.J.Jorgensen et all in Denmark in b/w 1999 and 2001.
They used both the criteria, WHO, ATP III. This study compared WHO Syndrome men with NCEP Syndrome, and found higher mean values of waist circumference, BMI and triglycerides and lower mean values of high – density lipoprotein ( HDL ) Cholesterol.among women,triglycerides were higher NCEP Syndrome.
The study also indicated increased prevalence of D.M, because of impaired tolerance and obesity, together with higher physical inactivity levels. All this may have caused increased insulin resistance. According to WHO definition, 37.9 % did not have MS, while according to NCEP Syndrome definition 28.5 % had MS.
The investigators showed that MS is increased with age in men in both the syndrome and women were affected only when they became older. Men with WHO Syndrome had lower waist circumference and triglyceride levels but HDL cholesterol was higher in women. However, the level of risk is same except from HDL cholesterol, which was higher according to WHO Syndrome.
Glucose abnormality is also higher in women with WHO Syndrome but in NCEP syndrome 72% of women with IGT and 43% of women with Diabetes were not classified as glucose intolerance. Obesity was much higher with WHO than NCEP. Hypertension was high according to NCEP, because of lower thresholds. The study indicated that prevalence of these two syndromes is equal, while abdominal fat seems to be a greater risk factor than obesity. Blood pressure was higher according to WHO. Microalbuminuria was associated with endothelial dysfunction and with increased risk for CVD, both in diabetic or non-diabetic patients. NCEP Syndrome showed increased IHD mortality, while WHO Syndrome showed increased CVD mortality.
This study is done by Marchesini G et al in 1999 in Bologna, Italy. The investigators employed both WHO and ATP III criteria for the definition of the Metabolic Syndrome in patients with Type 2 diabetes. They found that according to WHO criteria microalbumina has the highest specificity (99 %), while visceral obesity has the highest sensitivity (93 %) for MS.
ATP III criteria showed that hypertension was the most sensitive criterion and low HDL-Cholesterol the most specific (95 %). Positive waist circumference and low HDL Cholesterol were both associated with CHD. Based on the WHO criteria, waist circumference is identified in large proportion of males, while based on ATP III criteria visceral adiposity is more common in females.25
3. METABOLIC SYNDROME CAUSE ARTERIAL STIFFNESS
The mechanisms of development of vascular stiffness is largely unknown. 28
In Metabolic Syndrome, mainly two risk factors are important contributors to the development of atherosclerosis. These are High Density Lipoproteins (HDLs) and Low Density Lipoprotein (LDLs).
The formation of an atherosclerotic plaque is some form of damage to arterial wall, and this damages the endothelial cells of the tunica intima. Other contributing risk factors are: smoking, poor diet (high saturated fatty intake such as cholesterol), stress, lifestyle and social factors.26
Schiffrin has shown that arterial stiffness is increased with advance age and other CV risk factors may role in arterial stiffness, such as Hypertension ,MS,Diabetes,Obesity, Hypercholesterolemia and C-reactive protein.27
Arterial Stiffness is related with Insulin resistance in Non Diebetic Hypertensive Older Adult is done by Sendstock DM,et all in university of Michigan.
They recruited 60 to 80 year age ,and measuring pulse pressure and carotid – femoral pulse wave velocity to find out arterial stiffness ,they say that PWVand PP were negatively correlated with SI,and after multiple regression analysis .PWV and PP remained independtly correlated with SI .( P< 0.005 ).28
TECHNIQUE FOR ARTERIAL STIFFNESS MEASUREMENT
Metabolic Syndrome can be diagnosed with invariable investigation is done by tap measure and a few simple blood test6,and also for to find out the cause of arterial stiffness, we take pulse pressure and carotid – femoral pulse wave velocity and different BP reading ,systolic and diastolic with the help of sphygmomanometer.27
In supine position connect EKG lead and record heart rhythm continuously. Pulse pressures (PP) was calculated by subtracting these measurements. We marked mid point of manubrium to locate maximal impulse of the right common carotid and right common femoral artieries pulses. To approximate the length of the descending aorta, the distance from the midpoint of the manubrium maximal pulse of the right carotid artery was subtracted from the distance from the midpoint of the manubrium to the maximal pulse of the right femoral artery ‘1 aorta (mm)’.A hand –held high-fidelity tometer (SPC-301,Millar instruments, Houston.TX ) placed over the maximal impulse of the carotid artery to achieve a pressure wave contour with a consistent baseline, contour, and amplitude. A twenty – second time span of these carotid pulse contours were recorded ( At Cor version 7.0 ).The average time ‘t C ( msec )’between each R-wave on the EKG and the food of the corresponding carotid pressure waveform was calculated. Similarly, the tonometer was placed over the maximal impulse of the right common femoral artery to calculate ‘tf ( msec )’.PWV ( m / sec) was then calculated by the equation PWV =1 aorta / ( tf-tC).
A measurement was excluded if the pressure contour was of poor quality or if a significant difference (>15%) in the heart rate was found between the carotid and femoral measurements.28
References
1. IMJ November / December 2004 Volume 97 Number 10 .www.imj.ie
2. The Claveland ClinicHealth Information Center;
http//www.clavelandclinic.org/health-info/does/300/3057/aspp?index
10783, 18.02.05.
3. Sarah D, de Ferranti, KG, David SL, Ellis JN. Prevalence of the metabolic
syndrome in American Adolescents). Finding from the third National Health
and Nutrition examination Survey. Circulation 2004; 110: 2494-2497.
4. Derived from WHO
www.theses.ulaval.ca/2004/222151/ch01.html,22/02/05.
5. Jaber LAB, Hammad A, Zhu Q, Hermen WH. The prevalence of the
Metabolic Syndrome among Arab Americans. Care 2004; 27(1):234- 8.
6. MayoClinic Medical Service,Heart Center,March 09,2004.
7. The Pritikin Longevity Center & Spa Welcome You. February 2005.
8. Claveland Clinic.org health / health.info / docs / 3000 / 3057 asp ?index =
10783 page 1 and 3, 18/02/05.
9. Oxford Hand Book Of Clinical Medicine, page no = 567,fourth edition.
10. MayoClinic.com-Metabolic Syndrome. March 09,2004.31/01/2005.
11. Statistical fact sheet Risk factors (American Heart Association)
12. The Pritikin Longevity Center & Spa Welcomes You.
http//pritikin.com/eperspective/janfeb05/metabolicMess.stml?OVRAW= metabolic%..18/02/05.
13. Ralph A.Defronzo.(Medical Clinics of North America).
Doi:10.1016/j.mena 2004.04.013.
14. Minghan Wang, ( Role of Glucocorticoide in M.S ),
Received Nov=18,2004.acept2005.
15. Medical Clinics of North American. Med clin Nam 88 (2004)787-835.
16. http//www.theses.ulaval.ca/2004/22151/chol.html.22/02/05
17. http//www.Clavelandclinic.org/health/health–info/docs/3000/3057;asp?index=10783=18/02/05.
18. Marcello C, Devereux RB, Howard BV, et al. Comparison of cardiac structure and function in
American Indians with and with out the Metabolic Syndrome,
THE STRONG HEART STUDY.Am J Cardiol 2004; 93(1): 40.
19. Sarah D, de Ferranti, Kimberlee G, et al. Prevention of the Metabolic
Syndrome in American adolescents: Findings from the Third National Health
and Nutrition Examination Survey. Preventive Cardiology 2004; 110: 2494-2497.
20. Meigs JB, Wilson PW, Nathan DM, et al. Prevalence of the Metabolic
Syndrome in the Sa Antonio Heart and Framingham offspring studies.
Diabetes 2003; 52 (8): 2160-7.
21. Paul H, Stephen BK, Russell PT, et al. The Metabolic Syndrome, circulating
Oxidized LDL,and risk of Myocardial Infarction in well functioning Elderly
People in the Health, Aging, and Body composition Cohort.
Diabetes 2004; 53:
22 Jaber LA, Brown MD, Hammad A, Zhu Q, Herman WH. The prevalence of
the Metabolic Syndrome among Arab Americans. Care 2004; 27 (1): 234-8.
23. McNeill AM, Rosamond WD, Girman CJ, et al. Prevalence of Coronary Heart
Disease and carotid \rterial thickening in patients with the Metabolic
Syndrome (The ARIC Study).Am J Cardiol 2004; 94:1249-1254.
24. JØrgensen ME, Bjerregaard P, Gyntelberg F, Borch–Johnsen K. Prevalence of
the Metabolic Syndrome among the Inuit in Greenland .A comparison between
two proposed definitions. Diabetes 2004; 21: 1237-42.
25. Marchesini G, Forlani G, Cerrelli F, et al. WHO and ATP III proposals for the
definition of the Metabolic Syndrome in patients with Type 2 Diabet
Med.2004; 21 (4): 383 – 7.
26. Douglas BM, Glasgow U.K. In: Principles of Physiology, 1996.
27. Ernesto LS. Vascular stiffening and arterial compliance: Implications for
systolic blood pressure. Am J Hypertension 2004; 17(12) Supplement 1, S39 - S48.
28. Sengstock DM, Vaitkevicius PV, Supiano MA. Arterial stiffness is related to
insulin resistance in Non Diabetic Hypertensive Older Adults. J Clin
Endocrinol Metab 2005; Feb 22 (epub).
COPYRIGHT 2009
Sunday, September 20, 2009
Friday, September 18, 2009
INTERSETING ! FRUITS AND HUMAN BODY
SLICE a carrot and it looks just like an eye, right down to the pattern of the iris. It’s a clear clue to the importance this everyday veg has for vision. Carrots get their orange colour from a plant chemical called betacarotene, which reduces the risk of developing cataracts. The chemical also protects against macular degeneration an age-related sight problem that affects one in four over-65s. It is the most common cause of blindness in Britain. But popping a betacarotene pill doesn’t have the same effect, say scientists at Johns Hopkins Hospital in Baltimore
THE gnarled folds of a walnut mimic the appearance of a human brain - and provide a clue to the benefits. Walnuts are the only nuts which contain significant amounts of omega-3 fatty acids. They may also help head off dementia. An American study found that walnut extract broke down the protein-based plaques associated with Alzheimer’s disease. Researchers at Tufts University in Boston found walnuts reversed some signs of brain ageing in rats. Dr James Joseph, who headed the study, said walnuts also appear to enhance signalling within the brain and encourage new messaging links between brain cells.
TOMATO – HEART
A TOMATO is red and usually has four chambers, just like our heart. Tomatoes are also a great source of lycopene, a plant chemical that reduces the risk of heart disease and several cancers. The Women’s Health Study — an American research programme which tracks the health of 40,000 women — found women with the highest blood levels of lycopene had 30 per cent less heart disease than women who had very little lycopene. Lab experiments have also shown that lycopene helps counter the effect of unhealthy LDL cholesterol. One Canadian study, published in the journal Experimental Biology and Medicine, said there was “convincing vidence’ that lycopene prevented coronary heart disease.
Close-up, the tiny green tips on a broccoli head look like hundreds of cancer cells. Now scientists know this disease-busting veg can play a crucial role in preventing the disease. Last year, a team of researchers at the US National Cancer Institute found just a weekly serving of broccoli was enough to reduce the risk of prostate cancer by 45 per cent. In Britain, prostate cancer kills one man every hour.
OUR lungs are made up of branches of ever-smaller airways that finish up with tiny bunches of tissue called alveoli. These structures, which resemble bunches of grapes, allow oxygen to pass from the lungs to the blood stream. One reason that very premature babies struggle to survive is that these alveoli do not begin to form until week 23 or 24 of pregnancy. A diet high in fresh fruit, such as grapes, has been shown to reduce the risk of lung cancer and emphysema. Grape seeds also contain a chemical called proanthocyanidin, which appears to reduce the severity of asthma triggered by allergy.
A nice ‘holey’ cheese, like Emmenthal, is not just good for your bones, it even resembles their internal structure. And like most cheeses, it is a rich source of calcium, a vital ingredient for strong bones and reducing the risk of osteoporosis later in life. Together with another mineral called phosphate, it provides the main strength in bones but also helps to ‘power’ muscles. Getting enough calcium in the diet during childhood is crucial for strong bones. A study at Columbia University in New York showed teens who increased calcium intake from 800mg a day to 1200mg – equal to an extra two slices of cheddar - boosted their bone density by six per cent.
Root ginger, commonly sold in supermarkets, often looks just like the stomach. So it’s interesting that one of its biggest benefits is aiding digestion. The Chinese have been using it for over 2,000 years to calm the stomach and cure nausea, while it is also a popular remedy for motion sickness. But the benefits could go much further.
Tests on mice at the University of Minnesota found injecting the chemical that gives ginger its flavour slowed down the growth rate of bowel tumours
Cheer yourself up and put a smile on your face by eating a banana. The popular fruit contains a protein called tryptophan. Once it has been digested, tryptophan then gets converted in a chemical neurotransmitter called serotonin. This is one of the most important mood-regulating chemicals in the brain and most anti-depressant drugs work by adjusting levels of serotonin production. Higher levels are associated with better moods.
Slice a mushroom in half and it resembles the shape of the human ear. And guess what? Adding it to your cooking could actually improve your hearing. That’s because mushrooms are one of the few foods in our diet that contain vitamin D. This particular vitamin is important for healthy bones, even the tiny ones in the ear that transmit sound to the brain.
Wednesday, September 16, 2009
On Request of a Patients's relative
Consultant Gastroenterologist / Liver specialist at
Aga Khan Hospital Karachi.
For consultant's contact details Click here
Tuesday, September 15, 2009
Eczema Quick Fact Sheet
What is Eczema?
Atopic dermatitis is the most severe and chronic (long-lasting) kind of eczema. Atopic dermatitis is a disease that causes itchy, inflamed skin. It almost always begins in childhood, usually during infancy. Physicians estimate that 65 percent of eczema patients are diagnosed in the first year of life and 90 percent of patients experience it before age five. Often the symptoms fade during childhood, though “most” will have AD for life. It is estimated that atopic dermatitis affects over 30 million Americans. It typically affects the insides of the elbows, backs of the knees, and the face but can cover most of the body. Atopic dermatitis falls into a category of diseases called atopy, a term originally used to describe the allergic conditions asthma and hay fever. Atopic dermatitis was included in the atopy category because it often affects people who either suffer from asthma and/or hay fever or have family members who do; but now have been genetically connected. Physicians often refer to these three diseases as the “atopy triad”. The disease by its very nature can be episodic. People with atopic dermatitis tend to have high staph levels on their skin, although atopic dermatitis is not infectious to other people.
Contact Dermatitis (Allergic or Irritant)
Contact dermatitis is a reaction that can occur when the skin comes in contact with certain substances, which can cause skin inflammation. Irritants are substances that cause burning, itching or redness. Common irritants include solvents, industrial chemicals, detergents, fumes, tobacco smoke, paints, bleach, woolen fabrics, acidic foods, astringents and other alcohol (excluding cetyl alcohol) containing skin care products, and some soaps and fragrances. Allergens are usually animal or vegetable proteins from foods, pollens, or pets. Contact dermatitis is most often seen around the hands or parts of the body that touched the irritant/allergen.
Dyshidrotic Dermatitis (Pompholyx)
This is a blistering type of eczema, which is twice as common in women. It is limited to the fingers, palms and soles of the feet. Your hands may have itchy, scaly patches of skin that flake constantly or become red cracked and painful.
Nummular Dermatitis (Discoid)
Dry skin in the winter months can cause dry non-itchy round patches. It can affect any part of the body particularly the lower leg. One or many patches appear, and may persist for weeks or months. Discoid eczema does not run in families, and unlike atopic dermatitis, it is not associated with asthma. It does not result from food allergy. It is not infectious to other people, although bacteria sometimes secondarily infect it. Discoid eczema is more common in males.
Seborrheic Dermatitis
Red, scaly, itchy rash in various locations on the body. The scalp, sides of the nose, eyebrows, eyelids, and the skin behind the ears and middle of the chest are the most common areas affected. Dandruff (as seborrheic, is caused by a fungal infection) appears as scaling on the scalp without redness. Seborrhea is oiliness of the skin, especially of the scalp and face, without redness or scaling. Seborrheic Dermatitis has both redness and scaling.
Over-the-counter (OTC) medications are available without a prescription because they contain the lowest potency of active ingredients. They are not designed to treat the causes of a disease, but to give some relief of symptoms. Many good moisturizers are available as OTC products. They are important in terms of prevention and maintenance to reduce eczema’s impact. Regular use of these products may reduce the frequency of flare-ups. Prescription medicines, by contrast, are usually much more powerful in providing some relief of the symptoms. They are closely regulated in the U.S. by the Food and Drug Administration (FDA), and are approved for use in treating a specific disease only after they have demonstrated effectiveness and safety. No prescription drug is free of side effects, and FDA approval is given to drugs with the understanding that they must be used with caution to avoid the negative effects which could result in something worse than the disease itself. Consequently, these drugs must be administered under the watchful eye of a licensed prescriber-a doctor, or in some states, a nurse practitioner.
Eczema is a general term for any type of dermatitis or “itchy rash”. There are several skin diseases that are eczemas; a partial list of eczemas includes:
- atopic dermatitis
- contact dermatitis
- dyshidrotic eczema
- nummular eczema
- seborrheic dermatitis
All types of eczemas cause itching and redness and some will blister, weep or peel.
Atopic Dermatitis (AD)Atopic dermatitis is the most severe and chronic (long-lasting) kind of eczema. Atopic dermatitis is a disease that causes itchy, inflamed skin. It almost always begins in childhood, usually during infancy. Physicians estimate that 65 percent of eczema patients are diagnosed in the first year of life and 90 percent of patients experience it before age five. Often the symptoms fade during childhood, though “most” will have AD for life. It is estimated that atopic dermatitis affects over 30 million Americans. It typically affects the insides of the elbows, backs of the knees, and the face but can cover most of the body. Atopic dermatitis falls into a category of diseases called atopy, a term originally used to describe the allergic conditions asthma and hay fever. Atopic dermatitis was included in the atopy category because it often affects people who either suffer from asthma and/or hay fever or have family members who do; but now have been genetically connected. Physicians often refer to these three diseases as the “atopy triad”. The disease by its very nature can be episodic. People with atopic dermatitis tend to have high staph levels on their skin, although atopic dermatitis is not infectious to other people.
Contact Dermatitis (Allergic or Irritant)
Contact dermatitis is a reaction that can occur when the skin comes in contact with certain substances, which can cause skin inflammation. Irritants are substances that cause burning, itching or redness. Common irritants include solvents, industrial chemicals, detergents, fumes, tobacco smoke, paints, bleach, woolen fabrics, acidic foods, astringents and other alcohol (excluding cetyl alcohol) containing skin care products, and some soaps and fragrances. Allergens are usually animal or vegetable proteins from foods, pollens, or pets. Contact dermatitis is most often seen around the hands or parts of the body that touched the irritant/allergen.
Dyshidrotic Dermatitis (Pompholyx)
This is a blistering type of eczema, which is twice as common in women. It is limited to the fingers, palms and soles of the feet. Your hands may have itchy, scaly patches of skin that flake constantly or become red cracked and painful.
Nummular Dermatitis (Discoid)
Dry skin in the winter months can cause dry non-itchy round patches. It can affect any part of the body particularly the lower leg. One or many patches appear, and may persist for weeks or months. Discoid eczema does not run in families, and unlike atopic dermatitis, it is not associated with asthma. It does not result from food allergy. It is not infectious to other people, although bacteria sometimes secondarily infect it. Discoid eczema is more common in males.
Seborrheic Dermatitis
Red, scaly, itchy rash in various locations on the body. The scalp, sides of the nose, eyebrows, eyelids, and the skin behind the ears and middle of the chest are the most common areas affected. Dandruff (as seborrheic, is caused by a fungal infection) appears as scaling on the scalp without redness. Seborrhea is oiliness of the skin, especially of the scalp and face, without redness or scaling. Seborrheic Dermatitis has both redness and scaling.
Management of Eczema
Do I want to use prescription drugs or over the counter medications?Over-the-counter (OTC) medications are available without a prescription because they contain the lowest potency of active ingredients. They are not designed to treat the causes of a disease, but to give some relief of symptoms. Many good moisturizers are available as OTC products. They are important in terms of prevention and maintenance to reduce eczema’s impact. Regular use of these products may reduce the frequency of flare-ups. Prescription medicines, by contrast, are usually much more powerful in providing some relief of the symptoms. They are closely regulated in the U.S. by the Food and Drug Administration (FDA), and are approved for use in treating a specific disease only after they have demonstrated effectiveness and safety. No prescription drug is free of side effects, and FDA approval is given to drugs with the understanding that they must be used with caution to avoid the negative effects which could result in something worse than the disease itself. Consequently, these drugs must be administered under the watchful eye of a licensed prescriber-a doctor, or in some states, a nurse practitioner.
What are FDA approved prescription therapies?
Topical steroids have been the standard treatment for eczema, with oral steroids being prescribed only for severe flare-ups. Recently, however, the FDA has approved a new class of drugs called Topical Immunomodulators (TIMs). At this time there are two FDA approved non-steroid drugs: tacrolimus and pimecrolimus. Topical anesthetics, antibiotics, antihistamines, antibacterial, antifungal and anti-inflammatory drugs are available in creams, gels, ointments, lotions and solutions. Most of these classes of drugs can also be administered orally.
Topical steroids have been the standard treatment for eczema, with oral steroids being prescribed only for severe flare-ups. Recently, however, the FDA has approved a new class of drugs called Topical Immunomodulators (TIMs). At this time there are two FDA approved non-steroid drugs: tacrolimus and pimecrolimus. Topical anesthetics, antibiotics, antihistamines, antibacterial, antifungal and anti-inflammatory drugs are available in creams, gels, ointments, lotions and solutions. Most of these classes of drugs can also be administered orally.
What about alternative or complimentary medication?
Alternative medications also have ingredients that may have irritating or allergenic effects for some people, as with any treatments. It is important to discuss with your physician any alternative medication that you may purchase at a health food store as it may have an adverse reaction to your eczema or another medication you may be taking.
Alternative medications also have ingredients that may have irritating or allergenic effects for some people, as with any treatments. It is important to discuss with your physician any alternative medication that you may purchase at a health food store as it may have an adverse reaction to your eczema or another medication you may be taking.
Are there plants and vegetables to avoid?
Everyone knows about obvious culprits like poison ivy, poison oak and stinging nettles, but for people with eczema trying to avoid any plants with fuzzy leaves and stems is a good idea. Alliums, which include garlic, onions, chives, and leeks, tend to contain allergens that are more irritant than allergen. Citric fruits like lemons, limes and oranges may cause phototoxicity problems. You can get a severe rash from contact with a mango rind. The saps of certain trees are also phototoxic. Daisies (member of a family which includes dandelions, artichokes, chrysanthemum, sunflowers and yarrow) contain a variety of the allergens called sesquiterpene lactones in their stems, leaves, and flowers. If handled, they can produce a localized rash, and they (particularly dried ragweed) may also cause airborne contact dermatitis. Tulips contain an allergen called tuliposideA that often causes a fissured, fingertip dermatitis called “tulip fingers”. Poinsettias are also very irritating mostly because of a sticky sap it exudes. Handle all plants diligently (or with latex free gloves).
Everyone knows about obvious culprits like poison ivy, poison oak and stinging nettles, but for people with eczema trying to avoid any plants with fuzzy leaves and stems is a good idea. Alliums, which include garlic, onions, chives, and leeks, tend to contain allergens that are more irritant than allergen. Citric fruits like lemons, limes and oranges may cause phototoxicity problems. You can get a severe rash from contact with a mango rind. The saps of certain trees are also phototoxic. Daisies (member of a family which includes dandelions, artichokes, chrysanthemum, sunflowers and yarrow) contain a variety of the allergens called sesquiterpene lactones in their stems, leaves, and flowers. If handled, they can produce a localized rash, and they (particularly dried ragweed) may also cause airborne contact dermatitis. Tulips contain an allergen called tuliposideA that often causes a fissured, fingertip dermatitis called “tulip fingers”. Poinsettias are also very irritating mostly because of a sticky sap it exudes. Handle all plants diligently (or with latex free gloves).
UNDER EYE BAGS
This is a hereditary problem which adds years to the skin and pouches appear under the eye. This usually starts to appear during the thirties. Some pouches are caused due to other reasons also like due to sinus, kidney ailments and urinary tract infection.
Kidneys help in removing the waste matter and toxins from the body and to keep the kidneys in good shape, drink at least 6-8 glass of water daily. Decrease the coffee and the tea intake and make it a habit to drink a glass of warm water with the juice of fresh lemon everyday in the morning.
Skin around the eyes is very thin and delicate and has very little resilience and hence, when it stretches, it begins to sag. Stubborn eye bags can be removed with the help of cosmetic surgery. Never use heavy eye creams in the delicate region around the eyes and don 't keep them applied for long durations as this results in puffy and swollen eyes.
Potato extracts and cucumber juice are used to reduce the puffiness of the eyes.
Kidneys help in removing the waste matter and toxins from the body and to keep the kidneys in good shape, drink at least 6-8 glass of water daily. Decrease the coffee and the tea intake and make it a habit to drink a glass of warm water with the juice of fresh lemon everyday in the morning.
Skin around the eyes is very thin and delicate and has very little resilience and hence, when it stretches, it begins to sag. Stubborn eye bags can be removed with the help of cosmetic surgery. Never use heavy eye creams in the delicate region around the eyes and don 't keep them applied for long durations as this results in puffy and swollen eyes.
Potato extracts and cucumber juice are used to reduce the puffiness of the eyes.
Monday, September 14, 2009
How to Stay Young Forever
Anyone want to stay young in any age. Regular exercise tones your body muscles, reduce body fat, fight disease and relieve depression, tension and stress. Eat well and exercise regularly and within a few months and you will be able to see some results. Your muscles will be stronger, your joints and mobility improve, and your heart will be stronger, pumping more blood with less strain on your body.
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