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Wednesday, 29 June 2016

Poised to skip town with no action on Zika virus

Maybe you've used some of these excuses, though likely not about Zika: "No need for this smelly bug spray" or "I lived here for years and never got chikungunya, why would I get Zika?" or even, "It's not like I'm planning to have a baby any time soon."

Zika is usually a mild virus, and people rarely die from it. For pregnant women, though, it's more serious, as Zika can cause microcephaly and other severe fetal brain defects.

On Wednesday, the Senate did act on one crisis, giving preliminary approval to a plan to save debt-stricken Puerto Rico from defaulting this week on a $2 billion debt payment, with final passage expected Thursday.

However, following the terror massacre inside an Orlando, Fla., nightclub, the Senate was unable to strike a compromise on dueling gun control measures, sparking additional finger-pointing and outcry from Americans about an ineffectual Congress.

On the Zika issue, Obama requested $1.9 billion back in February. But the Republicans controlling Congress instead forced the administration to redirect more than $500 million in unspent Ebola-fighting funds to combat Zika.

The failed House-Senate measure matched the $1.1 billion proposal passed last month by the Senate except for the added provisions and the attachment of companion spending cuts to defray its cost.

Democrats particularly opposed a provision that restricts the use of $95 million worth of federal grants to provide services such as birth control to women in Puerto Rico threatened by the virus. Democrats charged that the restrictions were targeted at clinic on the island run by Planned Parenthood, a group loathed by many anti-abortion Republicans. 

In addition to the limits on Planned Parenthood, the bill would temporarily lift Clean Water Act permitting requirements on pesticide spraying for municipalities and other large-scale users.

Sunday, 26 June 2016

Acne vulgaris Treatments

Many things are sold to treat acne, the most popular being benzoyl peroxide. Many of these things have not been scientifically proven to help acne. However, a mix of commercial and homemade treatments can help with acne for various reasons.

Killing the bacteria that grow in the blocked follicles. This can be done by ingesting antibiotic medication, or by putting antibiotics on the skin. Antibiotics act quickly and are a powerful way of temporarily getting rid of acne. When the body develops a resistance to the antibiotics, the bacteria returns stronger than before.
Removing oil on the skin can be done by taking drugs that contain Vitamin A. Accutane is the name of the most famous treatment using massive quantities of Vitamin A.
Removing dead skin cells can be done by treatment with salicylic acid. This encourages the skin to peel away the top layer of cells.
Popping a pimple should not be done by anyone but a qualified dermatologist. Pimple popping irritates skin, can make the bacteria spread, and can cause scars. If you must pop a pimple yourself, it is advised to apply warm water to the area before popping it and to wash your hand thoroughly before beginning so as to avoid spreading bacteria via the hands. Applying hot water will open up the pores and reduce the damage because it will require less force to pop it.
Treating acne can improve physical symptoms, in addition to improving self-esteem or lessening acne-related anxiety and depression.

Some medications may take 4 to 8 weeks to take effect, so it is important to adhere to a treatment plan agreed upon by you and your medical provider, even if you do not observe immediate results. Even after results become noticeable, continuing to pursue treatment can help prevent further breakouts.

Cases of mild acne can often be treated with over-the-counter medications. Products containing benzoyl peroxide (Brevoxyl or Triaz) or salicylic acid (Propa pH or Stridex) help to clear up skin. Gently cleansing with warm water and mild soap (Dove, or Cetaphil) can also help clear up mild acne.

Acne that may be caused by hormonal flare-ups prior to menstruation may also be controlled with low-dose birth control pills containing estrogen.

If these treatments for mild acne are not effective, you may need stronger prescription medications or a combination of several different therapies. Mild to moderate acne can be treated by:

Draining large pimples and cysts by a medical provider
Using prescription antibiotic gels, creams, or lotions applied to the affected area
Using prescription retinoids applied to the affected area
Applying azelaic acid to the affected area
Taking oral antibiotics
Taking oral retinoids (isotretinoin) – this is the only medication approved for severe cystic acne, but has serious side effects such as mood disorders, depression, and suicidal ideation
Antibiotics that have been successful in treating acne include doxycycline, minocycline, tetracycline, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim, and azithromycin.

Certain therapies can be combined in the treatment of acne, such as combination of oral antibiotics and topical retinoids.

Severe acne may leave scars. Although some scars go away with time on their own, scars can be removed via laser resurfacing, dermabrasion, or other treatment by a dermatologist or plastic surgeon.

Acne vulgaris

Acne vulgaris (or simply acne) is a long-term skin disease that occurs when hair follicles become clogged with dead skin cells and oil from the skin. Acne is characterized by areas of blackheads, whiteheads, pimples, and greasy skin, and may result in scarring. The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide.

Genetics is thought to be the cause in 80% of cases. The role of diet and cigarette smoking is unclear and neither cleanliness nor sunlight appear to be involved. Acne primarily affects skin with a greater number of oil glands, including the face, upper part of the chest, and back.During puberty, in both sexes, acne is often brought on by an increase in androgens such as testosterone. Excessive growth of the bacteria Propionibacterium acnes, which is normally present on the skin, is often involved.

Many treatment options are available to improve the appearance of acne, including lifestyle changes, procedures, and medications. Eating fewer simple carbohydrates like sugar may help. Topical azelaic acid, benzoyl peroxide, and salicylic acid are commonly used treatments. Antibiotics and retinoids are available in both topical and oral formulations to treat acne. However, resistance to antibiotics may develop. A number of birth control pills may be useful for preventing acne in women.Oral isotretinoin is usually reserved for severe acne due to greater potential side effects. Early and aggressive treatment is advocated by some to lessen the overall long-term impact to individuals.

In 2013, acne was estimated to affect 660 million people globally, making it the 8th most common disease worldwide. Acne occurs most commonly during adolescence, affecting an estimated 80–90% of teenagers in the Western world. Lower rates are reported in some rural societies. People may also be affected before and after puberty. Though it becomes less common in adulthood than in adolescence, nearly half of people in their twenties and thirties continue to have acne. About 4% continue to have difficulties into their forties.

Many different treatments exist for acne, including alpha hydroxy acid, anti-androgen medications, antibiotics, antiseborrheic medications, azelaic acid, benzoyl peroxide, hormonal treatments, keratolytic soaps, nicotinamide, retinoids, and salicylic acid. They are believed to work in at least four different ways, including the following: anti-inflammatory effects, hormonal manipulation, killing P. acnes, and normalizing skin cell shedding and sebum production in the pore to prevent blockage.

Commonly used medical treatments include topical therapies such as antibiotics, benzoyl peroxide, and retinoids, and systemic therapies including antibiotics, hormonal agents, and oral retinoids. Procedures such as light therapy and laser therapy are not considered to be first-line treatments and typically have an adjunctive role due to their high cost and the limited evidence of their efficacy.

The social and economic costs of treating acne vulgaris are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over $2.5 billion each year in direct costs. Similarly, acne vulgaris is responsible for 3.5 million doctor visits each year in the United Kingdom.

Misperceptions about acne's causative and aggravating factors are common and those affected by acne are often blamed for their condition. Such blame can worsen the affected person's sense of self-esteem. Acne vulgaris and its resultant scars have been associated with significant social difficulties that can last into adulthood.

Efforts are underway to better understand the mechanisms involved in sebum production. The aim of this research is to develop medications targeting hormones known to increase sebum production (e.g., IGF-1 and alpha-melanocyte-stimulating hormone). Additional sebum-lowering medications being researched include topical antiandrogens and PPAR modulators. Another avenue of early-stage research has focused on how to best use laser and light therapy to selectively destroy sebaceous glands in the skin's hair follicles to reduce sebum production and improve acne appearance.

The use of antimicrobial peptides against P. acnes is also under investigation as a novel method of treating acne and overcoming antibiotic resistance. In 2007, the first genome sequencing of a P. acnes bacteriophage (PA6) was reported. The authors proposed applying this research toward development of bacteriophage therapy as an acne treatment in order to overcome the problems associated with long-term antibiotic therapy, such as bacterial resistance. Oral and topical probiotics are also being evaluated as treatments for acne. Probiotics have been hypothesized to have therapeutic effects for those affected by acne due to their ability to decrease skin inflammation and improve skin moisture by increasing the skin's ceramide content. As of 2014, studies examining the effects of probiotics on acne in humans were limited.

Decreased levels of retinoic acid in the skin may contribute to comedone formation. To address this deficiency, and potentially replace the use of irritating topical retinoids, methods to increase the skin's production of retinoid acid are being explored. A vaccine against inflammatory acne has been tested successfully in mice, but has not yet been proven to be effective in humans. Other workers have voiced concerns related to creating a vaccine designed to neutralize a stable community of normal skin bacteria that is known to protect the skin from colonization by more harmful microorganisms.

Friday, 24 June 2016

Behavior Modification after Heart Surgery

After surgery, the relief of living and having fixed hearts is not enough for many patients. Instead, many patients are bombarded by difficult thoughts relative to pain, complications and ultimately, a challenged recovery. That said, these thoughts can manifest in emotional and behavioral changes after heart surgery.

In my own research, I learned that 30%-75% of patients report feeling anxious or depressed after heart surgery. That’s a pretty significant number. Personally, I experienced both emotional and behavioral changes following my valve replacements. I was moody. I was irritable. I was fatigued. I was tired of the pain.

Most recovery times range from one to three weeks for laparoscopic gastric bypass surgery and two to six weeks after gastric bypass surgery. There are many different habits after surgery that the patient will have to modify. Diet The patient cannot eat normally after the surgery and will have to take protein supplements and multivitamins to avoid nutritional deficiencies. Immediately after surgery, the patient will be on a liquid diet. This diet may include tea, broth, or electrolyte beverages such as Gatorade. Patients also have to avoid drinking from a straw or a bottle and should gingerly sip from a cup. Using this method will help the patient to avoid swallowing too much air and avoiding extreme discomfort. Carbonated beverages are also to be avoided. If they aren�t, the carbonation can expand the newly-formed pouch in the stomach. Staying hydrated is essential. However, a patient can not drink and eat at the same time as the liquid will expand the stomach and not enough food will be eaten and absorbed since the patient will feel too full to eat the correct amount of food to stay healthy. Examples of pureed foods that are accepted for the post-operative diet are: Protein shakes Broth only Blended poultry Low-fat yogurt or milk Mashed bananas After a couple of months, patients can move on towards a more solid diet of pureed substances. Most patients at this point can tolerate approximately 16 to 24 ounces a day. Dumping Syndrome If a patient strays from the correct diet and neglects to follow the modifications in his or her diet, then a symptom know as �dumping� can occur. If the patient eats foods that are too sugary or high in fat, or too much artificial sweetener, he or she can experience numerous maladies: Nausea Chest pain Vomiting Diarrhea Sweating Drinking Alcohol It is recommended that patients not drink alcohol for at least six months after surgery because it is high in calories, sugar, and low in nutritional value. Not only that, alcohol will actually deplete the body of nutrients. Pregnancy Doctors do not recommend that female patients get pregnant within a year after surgery because of injury that may be suffered to the mother and thereby injuring the fetus. This means that sexually active females should use some form of birth control for at least one year after surgery. Pain Medication Patients will have to avoid medication like NSAIDs (including aspirin and ibuprofen). Instead, patients are safe to take acetaminophen. The doctor should be consulted if the patient is not sure if a pain medication is safe. Exercise It is very important to maintain an exercise regimen after surgery to maintain a healthy weight and decrease weight gain. This exercise begins one to two days after surgery, which may seem odd, but movement of the legs helps to decrease the chances of acquiring deep vein thrombosis (a blood clot in the legs). Specific exercise plans will be drawn up by the doctor, which will begin with a low-impact program that will increase over time to more physical challenging exercises. Lifetime Diet It will always be important to maintain a very, low-fat and sugar free diet for the rest of a patient�s life. Good foods that doctors recommend are: Lean meat (chicken, turkey, pork) Fish Low-fat cottage cheese Tofu Whole grains Cheese Soft pasta Bariatric surgery requires extreme dedication from the patient undergoing the surgery to be diligent about the pre- and post-surgery instructions. By not following these directions, the person can suffer malnutrition, gain back weight, or worse, suffer