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spineneuro

Dr Paresh Doshi Helps Creating Guidelines for Neurodegenerative Disorders - 0 views

www.briefingwire.com/...or-neurodegenerative-disorders

Dr. Paresh Doshi Best Deep Brain Stimulation Neurosurgeon in India Top 10 Neurosurgeons for DBS in India Top Neurosurgeon at Jaslok Hospital Mumbai Dr Paresh Doshi Jaslok Mumbai

shared by spineneuro on 17 Aug 21 - No Cached
  • spineneuro on 17 Aug 21
     
    Dr. Paresh Doshi top neurosurgeon at Jaslok Hospital Mumbai outlines best practices in the control of these difficult-to-treat disorders.
spineneuro

Best Robotic Spine Surgery Raising Spine Surgery Care in India to A Bold New Level ~ Ne... - 0 views

neuro-and-spine-surgery-in-india.blogspot.com/...india-to-a-bold-new-level.html

Best robotic spine surgery hospitals in India Dr. Mihir Bapat top minimally invasive spine surgeon in Mumbai India

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  • spineneuro on 26 Apr 22
     
    Best robotic spine surgery hospitals in India are being run by world-famous doctors with the knowledge of every guideline of the medical world. Dr. Mihir Bapat is one of the top spine surgeons for minimally invasive surgery in India.
harshitatyagi

IVF Centre in Delhi - Crysta IVF - 0 views

www.igotbiz.com/...-crysta-ivf-listing-31242.aspx

Ivf centre in Delhi best ivf centre in delhi crysta ivf centre in delhi Ivf clinic in delhi ivf center in delhi ivf in delhi

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  • harshitatyagi on 08 Feb 23
     
    If you are troubling find the best IVF centre in Delhi? No worries when Crysta IVF is available for you especially when it is recognized as a one-stop solution for all your infertility problems. From working on govt guidelines to following the amalgamation of cutting-edge technologies with modern ART labs, Crysta IVF has been idealized as the best IVF centre in Delhi. Here the doctors have more than two decades of experience in delivering progressive results so that every individual can get the best possible treatment to plan for a healthy baby.
spineneuro

The Robotic Revolution: Transforming Spine Surgery for a Pain-Free Future - 0 views

www.101pressrelease.com/surgery-for-a-pain-free-future

robotic spine surgery robotic spine surgery cost robotic spine surgery hospital

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  • spineneuro on 26 Dec 23
     
    Best hospitals for robotic spine surgery are equipped with the latest technology and services, and many are led by world-renowned doctors who are well-versed in the ever-evolving medical field's guidelines and standards.
pharmacybiz

Lateral Flow Tests Shortages Bear Customers Wrath - 0 views

www.pharmacy.biz/customers-wrath-warns-industry

Lateral-flow-tests-shortages Pharmacy-Business lateral-flow-tests-shortage-uk NHS-lateral-flow-test Free-lateral-flow-test-kits community-pharmacies-UK

shared by pharmacybiz on 06 Jan 22 - No Cached
  • pharmacybiz on 06 Jan 22
     
    Increased demand and shortages of lateral flow tests are pushing staff at pharmacies to bear the brunt from frustrated customers who are unable to get their free lateral flow tests, Daily Mail reported. Some Britons claimed that they have been unable to get lateral flow tests at their local pharmacies for up to a fortnight while some pharmacies were forced to put up sign warning stating they have run out of free tests. Given the patchy supply of test kits, pharmacy bosses warned that staff are facing 'unfair' and 'abusive' behaviour by customers, the newspaper reported.Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMP), told the newspaper: "Up until yesterday the supply to pharmacies was still patchy. The past few days the situation has not improved. "Pharmacies are having to put up with a lot of abuse and aggressive behaviours by members of the public because of this situation which is unfair. "The demand is still very high now because the governments guidelines put a lot of emphasis on testing as a key out of self isolation, so naturally as Omicron cases are high people are reliant on tests to get on with daily life."
Nathan Goodyear

Testosterone and glucose metabolism in men: current concepts and controversies - 1 views

joe.endocrinology-journals.org/...R37.full

Low T Testosterone metabolic syndrome MetS Diabetes men male glucose hormone hormones g

shared by Nathan Goodyear on 04 Feb 14 - No Cached
  • Around 50% of ageing, obese men presenting to the diabetes clinic have lowered testosterone levels relative to reference ranges based on healthy young men
  • The absence of high-level evidence in this area is illustrated by the Endocrine Society testosterone therapy in men with androgen deficiency clinical practice guidelines (Bhasin et al. 2010), which are appropriate for, but not specific to men with metabolic disorders. All 32 recommendations made in these guidelines are based on either very low or low quality evidence.
  • A key concept relates to making a distinction between replacement and pharmacological testosterone therapy
  • ...59 more annotations...
  • The presence of symptoms was more closely linked to increasing age than to testosterone levels
  • Findings similar to type 2 diabetes were reported for men with the metabolic syndrome, which were associated with reductions in total testosterone of −2.2 nmol/l (95% CI −2.41 to 1.94) and in free testosterone
  • low testosterone is more predictive of the metabolic syndrome in lean men
  • Cross-sectional studies uniformly show that 30–50% of men with type 2 diabetes have lowered circulating testosterone levels, relative to references based on healthy young men
  • In a recent cross-sectional study of 240 middle-aged men (mean age 54 years) with either type 2 diabetes, type 1 diabetes or without diabetes (Ng Tang Fui et al. 2013b), increasing BMI and age were dominant drivers of low total and free testosterone respectively.
  • both diabetes and the metabolic syndrome are associated with a modest reduction in testosterone, in magnitude comparable with the effect of 10 years of ageing
  • In a cross-sectional study of 490 men with type 2 diabetes, there was a strong independent association of low testosterone with anaemia
  • In men, low testosterone is a marker of poor health, and may improve our ability to predict risk
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      probably the most important point made in this article
  • low testosterone identifies men with an adverse metabolic phenotype
  • Diabetic men with low testosterone are significantly more likely to be obese or insulin resistant
  • increased inflammation, evidenced by higher CRP levels
  • Bioavailable but not free testosterone was independently predictive of mortality
  • It remains possible that low testosterone is a consequence of insulin resistance, or simply a biomarker, co-existing because of in-common risk factors.
  • In prospective studies, reviewed in detail elsewhere (Grossmann et al. 2010) the inverse association of low testosterone with metabolic syndrome or diabetes is less consistent for free testosterone compared with total testosterone
  • In a study from the Framingham cohort, SHBG but not testosterone was prospectively and independently associated with incident metabolic syndrome
  • low SHBG (Ding et al. 2009) but not testosterone (Haring et al. 2013) with an increased risk of future diabetes
  • In cross-sectional studies of men with (Grossmann et al. 2008) and without (Bonnet et al. 2013) diabetes, SHBG but not testosterone was inversely associated with worse glycaemic control
  • SHBG may have biological actions beyond serving as a carrier protein for and regulator of circulating sex steroids
  • In men with diabetes, free testosterone, if measured by gold standard equilibrium dialysis (Dhindsa et al. 2004), is reduced
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      expensive, laborious process filled with variables
  • Low free testosterone remains inversely associated with insulin resistance, independent of SHBG (Grossmann et al. 2008). This suggests that the low testosterone–dysglycaemia association is not solely a consequence of low SHBG.
  • Experimental evidence reviewed below suggests that visceral adipose tissue is an important intermediate (rather than a confounder) in the inverse association of testosterone with insulin resistance and metabolic disorders.
  • testosterone promotes the commitment of pluripotent stem cells into the myogenic lineage and inhibits their differentiation into adipocytes
  • testosterone regulates the metabolic functions of mature adipocytes (Xu et al. 1991, Marin et al. 1995) and myocytes (Pitteloud et al. 2005) in ways that reduce insulin resistance.
  • Pre-clinical evidence (reviewed in Rao et al. (2013)) suggests that at the cellular level, testosterone may improve glucose metabolism by modulating the expression of the glucose-transported Glut4 and the insulin receptor, as well as by regulating key enzymes involved in glycolysis.
  • More recently testosterone has been shown to protect murine pancreatic β cells against glucotoxicity-induced apoptosis
  • Interestingly, a reciprocal feedback also appears to exist, given that not only chronic (Cameron et al. 1990, Allan 2013) but also, as shown more recently (Iranmanesh et al. 2012, Caronia et al. 2013), acute hyperglycaemia can lower testosterone levels.
  • There is also evidence that testosterone regulates insulin sensitivity directly and acutely
  • In men with prostate cancer commencing androgen deprivation therapy, both total as well as, although not in all studies (Smith 2004), visceral fat mass increases (Hamilton et al. 2011) within 3 months
  • More prolonged (>12 months) androgen deprivation therapy has been associated with increased risk of diabetes in several large observational registry studies
  • Testosterone has also been shown to reduce the concentration of pro-inflammatory cytokines in some, but not all studies, reviewed recently in Kelly & Jones (2013). It is not know whether this effect is independent of testosterone-induced changes in body composition.
  • the observations discussed in this section suggest that it is the decrease in testosterone that causes insulin resistance and diabetes. One important caveat remains: the strongest evidence that low testosterone is the cause rather than consequence of insulin resistance comes from men with prostate cancer (Grossmann & Zajac 2011a) or biochemical castration, and from mice lacking the androgen receptor.
  • Several large prospective studies have shown that weight gain or development of type 2 diabetes is major drivers of the age-related decline in testosterone levels
  • there is increasing evidence that healthy ageing by itself is generally not associated with marked reductions in testosterone
  • Circulating testosterone, on an average 30%, is lower in obese compared with lean men
  • increased visceral fat is an important component in the association of low testosterone and insulin resistance
  • The vast majority of men with metabolic disorders have functional gonadal axis suppression with modest reductions in testosterone levels
  • obesity is a dominant risk factor
  • men with Klinefelter syndrome have an increased risk of metabolic disorders. Interestingly, greater body fat mass is already present before puberty
  • Only 5% of men with type 2 diabetes have elevated LH levels
  • inhibition of the gonadal axis predominantly takes place in the hypothalamus, especially with more severe obesity
  • Metabolic factors, such as leptin, insulin (via deficiency or resistance) and ghrelin are believed to act at the ventromedial and arcuate nuclei of the hypothalamus to inhibit gonadotropin-releasing hormone (GNRH) secretion from GNRH neurons situated in the preoptic area
  • kisspeptin has emerged as one of the most potent secretagogues of GNRH release
  • hypothesis that obesity-mediated inhibition of kisspeptin signalling contributes to the suppression of the HPT axis, infusion of a bioactive kisspeptin fragment has been recently shown to robustly increase LH pulsatility, LH levels and circulating testosterone in hypotestosteronaemic men with type 2 diabetes
  • A smaller study with a similar experimental design found that acute testosterone withdrawal reduced insulin sensitivity independent of body weight, whereas oestradiol withdrawal had no effects
  • suppression of the diabesity-associated HPT axis is functional, and may hence be reversible
  • Obesity and dysglycaemia and associated comorbidities such as obstructive sleep apnoea (Hoyos et al. 2012b) are important contributors to the suppression of the HPT axis
  • weight gain and development of diabetes accelerate the age-related decline in testosterone
  • Modifiable risk factors such as obesity and co-morbidities are more strongly associated with a decline in circulating testosterone levels than age alone
  • 55% of symptomatic androgen deficiency reverted to a normal testosterone or an asymptomatic state after 8-year follow-up, suggesting that androgen deficiency is not a stable state
  • Weight loss can reactivate the hypothalamic–pituitary–testicular axis
  • Leptin treatment resolves hypogonadism in leptin-deficient men
  • The hypothalamic–pituitary–testicular axis remains responsive to treatment with aromatase inhibitors or selective oestrogen receptor modulators in obese men
  • Kisspeptin treatment increases LH secretion, pulse frequency and circulating testosterone levels in hypotestosteronaemic men with type 2 diabetes
  • change in BMI was associated with the change in testosterone (Corona et al. 2013a,b).
  • weight loss can lead to genuine reactivation of the gonadal axis by reversal of obesity-associated hypothalamic suppression
  • There is pre-clinical and observational evidence that chronic hyperglycaemia can inhibit the HPT axis
  • in men who improved their glycaemic control over time, testosterone levels increased. By contrast, in those men in whom glycaemic control worsened, testosterone decreased
  • testosterone levels should be measured after successful weight loss to identify men with an insufficient rise in their testosterone levels. Such men may have HPT axis pathology unrelated to their obesity, which will require appropriate evaluation and management.
  • Nathan Goodyear on 04 Feb 14
     
    Article discusses the expanding evidence of low T and Metabolic syndrome.
Nathan Goodyear

Structural and mechanistic insights into bisphenols action provide guidelines for risk ... - 0 views

www.pnas.org/...1203574109.abstract

BPA bisphenol A ER estrogen receptor agonist hormone hormones

shared by Nathan Goodyear on 07 Jan 13 - No Cached
  • Nathan Goodyear on 07 Jan 13
     
    bisphenol A is a estrogen receptor agonist, though partial.
Nathan Goodyear

Endocrinology of the Aging Male - 0 views

www.ncbi.nlm.nih.gov/...PMC3073592

aging male hormone hormones

shared by Nathan Goodyear on 30 Apr 13 - No Cached
  • All steps beyond the formation of pregnenolone take place in the smooth endoplasmic reticulum
  • Cytochrome P450 enzyme, CYP11A is located on the inner mitochondrial membrane and catalyses the rate limiting step of pregnenolone synthesis
  • Estrogen and related steroids, thyroid hormone and insulin increase SHBG levels.
  • ...21 more annotations...
  • SHBG decreases in response to androgens, and in the presence of hypothyroidism, and insulin resistance.
  • Plasma SHBG levels tend to increase with increasing age
  • The apparent metabolic clearance rate of testosterone is decreased in elderly as compared to younger men
  • Testosterone circulates predominantly bound to the plasma proteins SHBG and albumin, with high and low affinity respectively
  • Testosterone is secreted in a pulsatile fashion
  • Current clinical guidelines suggest at least two measurements
  • In adult men, there is a well-documented diurnal variation (particularly in younger subjects) in testosterone levels, which are highest in the early morning and progressively decline throughout the day to a nadir in the evening
  • In older men, the diurnal variation is blunted
  • it is standard practice for samples to be obtained between 0800 and 1100 h.
  • Testosterone and DHEA decline, whereas LH, FSH, and SHBG rise
  • DHT remains constant despite the decline of its precursor testosterone
  • Longitudinal studies show an average annual decline of 1–2% total testosterone levels, with decline in free testosterone more rapid because of increases in SHBG with aging
  • Massachusetts Male Aging Study (MMAS) data show DHEA, DHEAS, and Ae declining at 2–3% per year
  • DHT showed no cross-sectional age trend
  • Androstanediol glucuronide (AAG) declined cross-sectionally with age in the MMAS sample, at 0.6% per year
  • The EMAS data show that, consistent with the longitudinal findings of MMAS (Figure 1), the core hormonal pattern with increasing age is suggestive of incipient primary testicular dysfunction with maintained total testosterone and progressively blunted free testosterone associated with higher LH
    • Nathan Goodyear
      Nathan Goodyear on 01 May 13
       
      This author proves the point in the review of these two studies, that TT may remain constant in aging men, however, FT drops.
  • obesity impairs hypothalamic/pituitary function
  • Androgen deprivation in men with prostate cancer has been associated with increased insulin resistance, worse glycemic control, and a significant increase in risk of incident diabetes
  • Low serum testosterone is associated with the development of metabolic syndrome 116, 117 and type 2 diabetes. 118 SHBG has been inversely correlated with type 2 diabetes
  • Improvement in insulin sensitivity with testosterone treatment has been reported in healthy 121 and diabetic 122 adult men
  • In studies conducted in men with central adiposity, testosterone has been shown to inhibit lipoprotein lipase activity in abdominal adipose tissue leading to decreased triglyceride uptake in central fat depots. 123
  • Nathan Goodyear on 30 Apr 13
     
    great review of hormone changes associated with aging in men.
Nathan Goodyear

SOGC Clinical Practice Guideline. Magn... [J Obstet Gynaecol Can. 2011] - PubMed - NCBI - 0 views

www.ncbi.nlm.nih.gov/...21639972

IV magnesium nutritional therapy cerebral palsy CP neuroprotection IV magnesium

shared by Nathan Goodyear on 07 Feb 13 - No Cached
  • Nathan Goodyear on 07 Feb 13
     
    IV magnesium shown to be neuroprotective in those at risk for cerebral palsy.  How?  NMDA inhibition.
Nathan Goodyear

The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline - 1 views

www.ncbi.nlm.nih.gov/...PMC2605410

salivary saliva cortisol testing cushing's disease syndrome

shared by Nathan Goodyear on 27 Nov 11 - No Cached
  • the diagnostic sensitivity and specificity is said to be excellent (92–100%)
  • Measurement of salivary cortisol by ELISA and LC-MS/MS has been well validated in the United States
  • Nathan Goodyear on 27 Nov 11
     
    Endocrine society clinical  practice guideline's state proves validity of salivary cortisol testing.  Statement: "the diagnostic sensitivity and specificity is said to be excellent (92-100%)" and " Measurement of salivary cortisol by ELISA and LC-MS/MS has been well validated in the United States"
Nathan Goodyear

Ascorbic Acid infusion in the resuscitation of burn patients - 0 views

www.surgicalcriticalcare.net/...ascorbic%20acid.pdf

IV intravenous vitamin C burn patients sepsis ascorbic acid

shared by Nathan Goodyear on 29 Feb 12 - No Cached
  • Nathan Goodyear on 29 Feb 12
     
    review of the literature and scientific evidence finds high dose IV vitamin C to be beneficial in burn patients. Additionally, glucose testing (not serum) should be considered inaccurate for upto 36 hours following IV.
Nathan Goodyear

The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic ... - 0 views

cid.oxfordjournals.org/...1089.full

lyme CDC treatment disease

shared by Nathan Goodyear on 23 Sep 13 - No Cached
  • Nathan Goodyear on 23 Sep 13
     
    CDC recommendations on lyme treatment
Nathan Goodyear

Testosterone and the Cardiovascular System: A Comprehensive Review of the Clinical Lite... - 0 views

jaha.ahajournals.org/...e000272.full

Testosterone men male cardiovascular disease low T

shared by Nathan Goodyear on 20 Nov 13 - No Cached
  • Low endogenous bioavailable testosterone levels have been shown to be associated with higher rates of all‐cause and cardiovascular‐related mortality.39,41,46–47 Patients suffering from CAD,13–18 CHF,137 T2DM,25–26 and obesity27–28
  • have all been shown to have lower levels of endogenous testosterone compared with those in healthy controls. In addition, the severity of CAD15,17,29–30 and CHF137 correlates with the degree of testosterone deficiency
  • In patients with CHF, testosterone replacement therapy has been shown to significantly improve exercise tolerance while having no effect on LVEF
  • ...66 more annotations...
  • testosterone therapy causes a shift in the skeletal muscle of CHF patients toward a higher concentration of type I muscle fibers
  • Testosterone replacement therapy has also been shown to improve the homeostatic model of insulin resistance and hemoglobin A1c in diabetics26,68–69 and to lower the BMI in obese patients.
  • Lower levels of endogenous testosterone have been associated with longer duration of the QTc interval
  • testosterone replacement has been shown to shorten the QTc interval
  • negative correlation has been demonstrated between endogenous testosterone levels and IMT of the carotid arteries, abdominal aorta, and thoracic aorta
  • These findings suggest that men with lower levels of endogenous testosterone may be at a higher risk of developing atherosclerosis.
  • Current guidelines from the Endocrine Society make no recommendations on whether patients with heart disease should be screened for hypogonadism and do not recommend supplementing patients with heart disease to improve survival.
  • The Massachusetts Male Aging Study also projects ≈481 000 new cases of hypogonadism annually in US men within the same age group
  • since 1993 prescriptions for testosterone, regardless of the formulation, have increased nearly 500%
  • Testosterone levels are lower in patients with chronic illnesses such as end‐stage renal disease, human immunodeficiency virus, chronic obstructive pulmonary disease, type 2 diabetes mellitus (T2DM), obesity, and several genetic conditions such as Klinefelter syndrome
  • A growing body of evidence suggests that men with lower levels of endogenous testosterone are more prone to develop CAD during their lifetimes
  • There are 2 major potential confounding factors that the older studies generally failed to account for. These factors are the subfraction of testosterone used to perform the analysis and the method used to account for subclinical CAD.
  • The biologically inactive form of testosterone is tightly bound to SHBG and is therefore unable to bind to androgen receptors
  • The biologically inactive fraction of testosterone comprises nearly 68% of the total testosterone in human serum
  • The biologically active subfraction of testosterone, also referred to as bioavailable testosterone, is either loosely bound to albumin or circulates freely in the blood, the latter referred to as free testosterone
  • It is estimated that ≈30% of total serum testosterone is bound to albumin, whereas the remaining 1% to 3% circulates as free testosterone
  • it can be argued that using the biologically active form of testosterone to evaluate the association with CAD will produce the most reliable results
  • English et al14 found statistically significant lower levels of bioavailable testosterone, free testosterone, and free androgen index in patients with catheterization‐proven CAD compared with controls with normal coronary arteries
  • patients with catheterization‐proven CAD had statistically significant lower levels of bioavailable testosterone
  • In conclusion, existing evidence suggests that men with CAD have lower levels of endogenous testosterone,13–18 and more specifically lower levels of bioavailable testosterone
  • low testosterone levels are associated with risk factors for CAD such as T2DM25–26 and obesity
  • In a meta‐analysis of these 7 population‐based studies, Araujo et al41 showed a trend toward increased cardiovascular mortality associated with lower levels of total testosterone, but statistical significance was not achieved (RR, 1.25
  • the authors showed that a decrease of 2.1 standard deviations in levels of total testosterone was associated with a 25% increase in the risk of cardiovascular mortality
  • the relative risk of all‐cause mortality in men with lower levels of total testosterone was calculated to be 1.35
  • higher risk of cardiovascular mortality is associated with lower levels of bioavailable testosterone
  • Existing evidence seems to suggest that lower levels of endogenous testosterone are associated with higher rates of all‐cause mortality and cardiovascular mortality
  • studies have shown that lower levels of endogenous bioavailable testosterone are associated with higher rates of all‐cause and cardiovascular mortality
  • It may be possible that using bioavailable testosterone to perform mortality analysis will yield more accurate results because it prevents the biologically inactive subfraction of testosterone from playing a potential confounding role in the analysis
  • The earliest published material on this matter dates to the late 1930s
  • the concept that testosterone replacement therapy improves angina has yet to be proven wrong
  • In more recent studies, 3 randomized, placebo‐controlled trials demonstrated that administration of testosterone improves myocardial ischemia in men with CAD
  • The improvement in myocardial ischemia was shown to occur in response to both acute and chronic testosterone therapy and seemed to be independent of whether an intravenous or transdermal formulation of testosterone was used.
  • testosterone had no effect on endothelial nitric oxide activity
  • There is growing evidence from in vivo animal models and in vitro models that testosterone induces coronary vasodilation by modulating the activity of ion channels, such as potassium and calcium channels, on the surface of vascular smooth muscle cells
  • Experimental studies suggest that the most likely mechanism of action for testosterone on vascular smooth muscle cells is via modulation of action of non‐ATP‐sensitive potassium ion channels, calcium‐activated potassium ion channels, voltage‐sensitive potassium ion channels, and finally L‐type calcium ion channels
  • Corona et al confirmed those results by demonstrating that not only total testosterone levels are lower among diabetics, but also the levels of free testosterone and SHBG are lower in diabetic patients
  • Laaksonen et al65 followed 702 Finnish men for 11 years and demonstrated that men in the lowest quartile of total testosterone, free testosterone, and SHBG were more likely to develop T2DM and metabolic syndrome.
  • Vikan et al followed 1454 Swedish men for 11 years and discovered that men in the highest quartile of total testosterone were significantly less likely to develop T2DM
  • authors demonstrated a statistically significant increase in the incidence of T2DM in subjects receiving gonadotropin‐releasing hormone antagonist therapy. In addition, a significant increase in the rate of myocardial infarction, stroke, sudden cardiac death, and development of cardiovascular disease was noted in patients receiving antiandrogen therapy.67
  • Several authors have demonstrated that the administration of testosterone in diabetic men improves the homeostatic model of insulin resistance, hemoglobin A1c, and fasting plasma glucose
  • Existing evidence strongly suggests that the levels of total and free testosterone are lower among diabetic patients compared with those in nondiabetics
  • insulin seems to be acting as a stimulant for the hypothalamus to secret gonadotropin‐releasing hormone, which consequently results in increased testosterone production. It can be argued that decreased stimulation of the hypothalamus in diabetics secondary to insulin deficiency could result in hypogonadotropic hypogonadism
  • BMI has been shown to be inversely associated with testosterone levels
  • This interaction may be a result of the promotion of lipolysis in abdominal adipose tissue by testosterone, which may in turn cause reduced abdominal adiposity. On the other hand, given that adipose tissue has a higher concentration of the enzyme aromatase, it could be that increased adipose tissue results in more testosterone being converted to estrogen, thereby causing hypogonadism. Third, increased abdominal obesity may cause reduced testosterone secretion by negatively affecting the hypothalamus‐pituitary‐testicular axis. Finally, testosterone may be the key factor in activating the enzyme 11‐hydroxysteroid dehydrogenase in adipose tissue, which transforms glucocorticoids into their inactive form.
  • increasing age may alter the association between testosterone and CRP. Another possible explanation for the association between testosterone level and CRP is central obesity and waist circumference
  • Bai et al have provided convincing evidence that testosterone might be able to shorten the QTc interval by augmenting the activity of slowly activating delayed rectifier potassium channels while simultaneously slowing the activity of L‐type calcium channels
  • consistent evidence that supplemental testosterone shortens the QTc interval.
  • Intima‐media thickness (IMT) of the carotid artery is considered a marker for preclinical atherosclerosis
  • Studies have shown that levels of endogenous testosterone are inversely associated with IMT of the carotid artery,126–128,32,129–130 as well as both the thoracic134 and the abdominal aorta
  • 1 study has demonstrated that lower levels of free testosterone are associated with accelerated progression of carotid artery IMT
  • another study has reported that decreased levels of total and bioavailable testosterone are associated with progression of atherosclerosis in the abdominal aorta
  • These findings suggest that normal physiologic testosterone levels may help to protect men from the development of atherosclerosis
  • Czesla et al successfully demonstrated that the muscle specimens that were exposed to metenolone had a significant shift in their composition toward type I muscle fibers
  • Type I muscle fibers, also known as slow‐twitch or oxidative fibers, are associated with enhanced strength and physical capability
  • It has been shown that those with advanced CHF have a higher percentage of type II muscle fibers, based on muscle biopsy
  • Studies have shown that men with CHF suffer from reduced levels of total and free testosterone.137 It has also been shown that reduced testosterone levels in men with CHF portends a poor prognosis and is associated with increased CHF mortality.138 Reduced testosterone has also been shown to correlate negatively with exercise capacity in CHF patients.
  • Testosterone replacement therapy has been shown to significantly improve exercise capacity, without affecting LVEF
  • the results of the 3 meta‐analyses seem to indicate that testosterone replacement therapy does not cause an increase in the rate of adverse cardiovascular events
  • Data from 3 meta‐analyses seem to contradict the commonly held belief that testosterone administration may increase the risk of developing prostate cancer
  • One meta‐analysis reported an increase in all prostate‐related adverse events with testosterone administration.146 However, when each prostate‐related event, including prostate cancer and a rise in PSA, was analyzed separately, no differences were observed between the testosterone group and the placebo group
  • the existing data from the 3 meta‐analyses seem to indicate that testosterone replacement therapy does not increase the risk of adverse cardiovascular events
  • the authors correctly point out the weaknesses of their study which include retrospective study design and lack of randomization, small sample size at extremes of follow‐up, lack of outcome validation by chart review and poor generalizability of the results given that only male veterans with CAD were included in this study
    • Nathan Goodyear
      Nathan Goodyear on 04 Dec 13
       
      The authors here present Total Testosterone as a "confounding" value
    • Nathan Goodyear
      Nathan Goodyear on 09 Dec 13
       
      This would be HSD-II
  • the studies that failed to find an association between testosterone and CRP used an older population group
  • low testosterone may influence the severity of CAD by adversely affecting the mediators of the inflammatory response such as high‐sensitivity C‐reactive protein, interleukin‐6, and tumor necrosis factor–α
  • Nathan Goodyear on 20 Nov 13
     
    Good review of Testosterone and CHD.  Low T is associated with increased all cause mortality and cardiovascular mortality, CAD, CHF, type II diabetes, obesity, increased IMT,  increased severity of CAD and CHF.  Testosterone replacement in men with low T has been shown to improve exercise tolerance in CHF, improve insulin resistance, improve HgbA1c and lower BMI in the obese.
Nathan Goodyear

Management of Helicobacter pylori Infection | American College of Gastroenterology - 0 views

gi.org/...-helicobacter-pylori-infection

H. Pylori helicobacter pylori

shared by Nathan Goodyear on 29 Sep 14 - No Cached
  • Nathan Goodyear on 29 Sep 14
     
    American college of Gastroenterology review on H.pylori.  The treatment regimens are significant issues as tetracycline is no longer available.
wheelchairindia9

Heavy Duty Wheelchair - 0 views

www.wheelchairindia.com/...HEAVY-DUTY-WHEELCHAIR

complex power wheelchairs mobility device system include postural support reduces downward sliding good flat pavements wheels and castors light weight power wheehair providing optimal mobility and function

shared by wheelchairindia9 on 11 May 15 - No Cached
  • wheelchairindia9 on 11 May 15
     
    Bariatric wheelchairs (often referred to as extra wide wheelchairs or heavy duty wheelchairs) are strong enough to accommodate almost any user. Just like lighter manual chairs, bariatric wheelchairs are all foldable and feature armrests and swing-away footrests - but they differ quite a bit in their construction. While lightweight wheelchairs often employ materials like aluminum or titanium alloy, a bariatric wheelchair is usually fashioned from steel. Karma 8020 X Heavy Duty Wheelchair: It comes with detachable swing away footrests. The wheel chair has flip-back armrests. It comes with centre of gravity adjustment. The wheel chair has wide profile casters. Seat Size 20'' inch & 22'' inch Total Weight 17 K.G. Heavy duty wheelchairs (often referred to as extra wide wheelchairs or bariatric wheelchairs) are sturdy enough to accommodate almost any user. Just their lighter cousins, manual chairs, heavy duty models all fold and feature arm rests and swing-away footrests - but they differ quite a bit in their construction. Heavy duty wheelchairs require more strength to push by the caregiver and by the user, if the chair is self-propelled. In some cases, it may be wise for the caregiver to ask for assistance from another person in order to push the wheelchair safely. Karma 8520 Heavy Duty Wheelchair: It comes with detachable swing away footrests. The wheel chair has flip-back armrests. It comes with centre of gravity adjustment. The wheel chair has wide profile casters. Seat Size 20'' inch & 22'' inch Total Weight 17 K.G. Features: Dual, reinforced steel cross braces. Supports individuals maximum weight. Reinforced steel frame provides added support. Heavy duty, nylon reinforced upholstery with a back carry pouch. Removable, reversible desk length arms. Adjustable leg support.
Nathan Goodyear

Clinical controversies in screening women for thyr... [J Midwifery Womens Health. 2006 ... - 0 views

www.ncbi.nlm.nih.gov/...16647667

TSH screening

shared by Nathan Goodyear on 16 Dec 10 - No Cached
  • In November 2002, the American Association of Clinical Endocrinologists (AACE) released new guidelines for clinical practice for the diagnosis and treatment of hyperthyroidism and hypothyroidism, which includes a new thyroid-stimulating hormone (TSH) reference range of 0.3 to 3.0 mIU/
  • Nathan Goodyear on 16 Dec 10
     
    TSH "screening" needs to be between 0.3 and 3 according to American Association of Clinical Endocrinologists
Nathan Goodyear

Occupational Safety and Health Guideline for Xylene - 0 views

www.osha.gov/...recognition.html

xylene

shared by Nathan Goodyear on 23 Feb 11 - No Cached
  • * Signs and symptoms of exposure
  • EXPOSURE SOURCES AND CONTROL METHODS
  • Nathan Goodyear on 23 Feb 11
     
    everything you wanted to know about the toxin xylene
Nathan Goodyear

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Te... - 0 views

onlinelibrary.wiley.com/...full

CVD cholesterol mortality norwegian hunt study 2

shared by Nathan Goodyear on 26 Oct 11 - No Cached
  • Nathan Goodyear on 26 Oct 11
     
    here is the full article on the need for change in how we view cholesterol.  This is from the Norwegian HUNT 2 study that showed that cholesterol up to 270 reduced cardiovascular disease mortality
Nathan Goodyear

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Te... - 0 views

onlinelibrary.wiley.com/...abstract

cholesterol heart disease risk CVD atherosclerosis hyperlipidemia mortality

shared by Nathan Goodyear on 26 Oct 11 - No Cached
  • Nathan Goodyear on 26 Oct 11
     
    new study of 52,087 shows cholesterol up to 270 actually lowers heart disease mortality
Nathan Goodyear

Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guidel... - 0 views

press.endocrine.org/...jc.2014-2260

Testosterone women female hormone hormones

shared by Nathan Goodyear on 05 Nov 14 - No Cached
  • Nathan Goodyear on 05 Nov 14
     
    A recommendation that I agree with: Very little data available for Testosterone in women requires significant restraint and recommendation to limit use of Testosterone in women.
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