The inhalation of insulin into the lungs offers a new method of insulin treatment delivery for people with diabetes.
The same features that make the lung so well suited for gas exchange also make it an ideal organ for absorption of small molecules into the bloodstream. The pulmonary alveolar surface area of the lung is 130 m2, the size of a tennis court, and the pulmonary capillary surface area is nearly as large at 115 m2. With each breath, air flows into nearly 300 million alveoli. Moreover, the alveolar lining cell is just 1 to 2 mcm from the pulmonary capillary lumen, a distance that favors rapid uptake into the bloodstream.
Absorption of a molecule across the alveolar-capillary interface is inversely related to its molecular mass. Small peptides, such as insulin (approximately 6000 Daltons) are readily absorbed across the very thin, vesiculated, permeable membrane. Molecules that make it to the alveolar level have longer residence time there, because mucociliary mechanisms at this level are minimal.
There are several factors affecting lower respiratory deposition of an aerosol or dry powder formulation. One of these is particle size. Particles greater than 5 mcm in diameter impact and are deposited in the pharynx and large airways. Particles 1 to 3 mcm generally reach the lower airways and alveoli. Particle velocity also affects deposition. Flow rates > 35 L/min or < 10 L/min will favor upper airway impaction, while flow rates of 15 to 25 L/min are ideal for lower airway deposition. Even under the best of circumstances, however, only the minority of an aerosol or dry powder usually makes it deep into the lungs
Inhaled Human Insulin
There are several forms of inhaled insulin, either approved or in development. The only inhaled insulin that is approved is Exubera® (insulin human [rDNA origin]) Inhalation Powder. Other forms in development include AERx (NovoNordisk), AIR (Lilly), Spiro (Dura), Technosphere Insulin (MannKind), and Aerodose (Aerogen). Some are not powder but aerosol. Their excipients and medication delivery systems also differ.
Exubera is a dry powder insulin contained in small blisters of 1 mg and 3 mg potency. After the blister is inserted into the base of the inhaler, a vacuum is established by cocking the lever at the base, allowing aerosolization of the powder. The aerosolized particles are then inhaled.[21]
Each actuation of the Exubera inhaler produces 200 mL of a homogeneous powder. This powder contains human (rDNA origin) insulin, and the excipients sodium citrate, glycine, sodium hydroxide (to maintain pH), and mannitol. None of these are known to be immunogenic. Mannitol has been clinically used as an agent in bronchoprovocation testing, but its concentration in Exubera is lower than the lowest dose used in such testing.
There are several forms of inhaled insulin, either approved or in development. The only inhaled insulin that is approved is Exubera® (insulin human [rDNA origin]) Inhalation Powder. Other forms in development include AERx (NovoNordisk), AIR (Lilly), Spiro (Dura), Technosphere Insulin (MannKind), and Aerodose (Aerogen). Some are not powder but aerosol. Their excipients and medication delivery systems also differ.
There are several forms of inhaled insulin, either approved or in development. The only inhaled insulin that is approved is Exubera® (insulin human [rDNA origin]) Inhalation Powder. Other forms in development include AERx (NovoNordisk), AIR (Lilly), Spiro (Dura), Technosphere Insulin (MannKind), and Aerodose (Aerogen). Some are not powder but aerosol. Their excipients and medication delivery systems also differ.
Exubera is a dry powder insulin contained in small blisters of 1 mg and 3 mg potency. After the blister is inserted into the base of the inhaler, a vacuum is established by cocking the lever at the base, allowing aerosolization of the powder. The aerosolized particles are then inhaled.[21]
Each actuation of the Exubera inhaler produces 200 mL of a homogeneous powder. This powder contains human (rDNA origin) insulin, and the excipients sodium citrate, glycine, sodium hydroxide (to maintain pH), and mannitol. None of these are known to be immunogenic. Mannitol has been clinically used as an agent in bronchoprovocation testing, but its concentration in Exubera is lower than the lowest dose used in such testing.
The dose of Exubera that reaches the alveolar level is the "fine particle dose," which consists of particles 3.3 mcm in diameter or smaller. The "fill mass" is the amount of insulin plus excipient in the individual insulin blister. In the case of a 1-mg Exubera blister, there is 0.7 mg of excipient and 1 mg of insulin; on actuation of the inhaler, 0.53 mg of insulin is emitted, of which 0.4 mg is less than 3.3 mcm in diameter. Thus, of the 1-mg insulin in the blister, 0.4 mg or 40% is deposited at the alveolar level. A 3-mg Exubera blister creates a 1.0 mg fine particle dose; hence, 33% is deposited in the alveoli. This explains why 3 1-mg blisters deliver more insulin (1.2 mg) than 1 3-mg blister, which delivers only 1 mg to the alveoli.[21]
Most of the insulin that reaches the distal lung is absorbed. There is no evidence of insulin accumulation in the alveoli. The insulin that is not absorbed undergoes metabolic degradation or slow mucociliary clearance
Smoking.
Insulin absorption studies have looked at the maximum concentration of serum insulin after a dose of insulin (Cmax) as well as the area under the serum insulin vs. time curve (AUC) following that dose. Such studies have shown that active smoking increases absorption of inhaled insulin 2- to 5-fold. The mechanism by which smoking affects inhaled insulin absorption is still unknown. The absorption of subcutaneous insulin is not affected by smoking.[22]
Cessation of smoking is accompanied by a reduction in absorption of inhaled insulin toward normal in as little as days. After a week of abstinence from smoking, inhaled insulin absorption decreases toward normal by as much as 50%. Resumption of smoking for just 3 days increases absorption of the peptide toward levels seen during chronic smoking.[22]
Because of the wide variations in absorption of inhaled insulin observed with smoking, cigarette smoking within the past 6 months has been a contraindication to inhaled insulin use in Phase 2 and 3 studies, and remains a contraindication to use of inhaled insulin.[21]
Passive smoking has been examined experimentally, in a study in which subjects were exposed to smoke in a smoking chamber for 2 hours at concentrations mimicking those found in a smoky bar. Contrary to active smoking, passive smoking appears to decrease inhaled insulin absorption by as much as 20% to 30%.[23] It is not clear how long this effect lasts after subjects are removed from the smoky environment. It is likewise unclear why passive smoking and active smoking have opposite effects on the absorption of inhaled insulin.
Asthma, Chronic Obstructive Pulmonary Disease, and Their Treatment.
Studies have shown that insulin absorption, as measured by area under the curve (AUC) and maximum concentration (Cmax), is 20% to 50% lower in mild to moderate asthmatics than in normals.[23]
In contradistinction to asthmatics, a small cohort of patients with chronic bronchitis and emphysema having a predicted baseline forced expiratory volume in 1 second (FEV1) of 35% to 40% were tested and found to have rates of absorption for inhaled insulin that were 2-fold higher than those of subjects without chronic obstructive pulmonary disease (COPD).[23] Although both asthma and COPD are characterized by small airway inflammation, it is not known why inhaled insulin absorption is affected in opposite ways by these disorders.
In patients with mild (FEV180% or more) or moderate (FEV180% or less) asthma, the administration of albuterol 30 minutes before taking inhaled insulin resulted in a 25% to 50% increase in systemic insulin absorption compared with administration of inhaled insulin alone. (Data on file) Inhaled fluticasone appears to have no effect on inhaled insulin absorption, but other medications used for asthma and COPD have not been systematically
This slide summarizes how respiratory factors affect inhaled insulin absorption.
Other Factors Affecting Absorption. In clinical studies of Exubera, episodes of viral upper respiratory infection, laryngitis, and acute bronchitis had no discernible effect in either direction on inhaled insulin absorption. There were not enough cases of pneumonia in phase 2/3 studies to be able to comment on the effects of a more severe infection on inhaled
Respiratory Tract Effects of Inhaled Insulin
Symptoms, Adverse Events. Respiratory safety of inhaled insulin has been a concern for several reasons:
1. It is a novel drug substance with novel excipients that is being inhaled.
2. Its administration is chronic.
3. Insulin is a polypeptide with potential for immune response in the lung.
4. Insulin has growth-promoting properties.
Consequently, respiratory side effects have been looked at closely in phase 2/3 studies.
In some studies, cough has been reported in 22% to 30% of patients with diabetes on Exubera compared with 4% to 10% of patients with diabetes on comparator treatment. (Data on file) The cough tended to occur within seconds to minutes after Exubera inhalation, and was generally rated as mild. The cough was rarely productive and rarely occurred
at night. Cough prevalence was greatest in the first month of use, then decreased by 20% to 40% over the next 3 months, and remained constant thereafter. In clinical studies, only 1.2% of patients discontinued Exubera because of cough. Patients who cough while on Exubera do not, on average, have any change in pulmonary function tests (PFTs) that distinguishes them from those who do not cough. Finally, such patients destined to cough cannot be reliably determined beforehand—they have the same mean pretreatment FEV1 as those patients who do not cough.
Shown here are respiratory adverse events reported in >1% of patients receiving inhaled insulin or a comparator drug (oral medications or subcutaneous insulin) in phase 2/3 studies.[21] Dyspnea has been reported by 4% of patients on Exubera and by 1% to 3% of patients on comparator agents. Nearly all cases were reported as mild or moderate; discontinuation of Exubera due to dyspnea was uncommon (0.4%). In clinical studies, patients with dyspnea were more likely to have a reduction in their pulmonary function, whether they were treated with Exubera or a comparator drug. Additionally, on occasion, the cause of dyspnea was another disease process, unrelated to either the Exubera or the comparator treatment.
Chest pain has been reported in 4.7% of patients on Exubera and in 3.2% of patients treated with subcutaneous insulin or oral antidiabetes medications. Of these patients, 90% rated the pain as mild or moderate. There were no differences in the incidence of angina (1%) and myocardial infarction (1%) between those patients treated with Exubera versus other agents.
Other symptoms reported more often in Exubera-treated patients than in comparator-treated patients include:
1. Increased sputum in 3% to 4% (vs. 1% of comparator patients)
2. Epistaxis in 1.2% (vs. 0.4-0.8%)
3. Voice alteration in 1.3% of patients with type 2 diabetes (vs. 0-0.3%)
4. Dry mouth in 2.4% (vs. 0.8%)[21]
Effects on Pulmonary Function. More than 43,000 PFTs have been performed in over 4600 adult subjects taking inhaled insulin. Spirometry, with measurement of FEV1 and forced vital capacity (FVC), has been used to look for the effects of inhaled insulin on airflow and airway function. Lung volumes, and especially carbon monoxide diffusing capacity of the lung (DLCO), have been used to look for any effect of inhaled insulin on pulmonary
Saturday, August 22, 2009
Tuesday, August 18, 2009
foot care for a diabetic-- a ready reckoner
Diabetes mellitus is a metabolic disorder of the pancreatic cells. This is a combination of hereditary factors and lifestyle disturbance.
The general symptoms being Polydipsia(extreme thirst), polyuria (lot of urination) polyphagia increasing need to munch or eat, there are chances of loss of peripheral vision, breathe smells of acetone, weight loss, hyperventilation when it comes to breathing, nausea, vomiting , abdominal pain, glycosuria (sugar in the urine)
What happens here the hormone insulin which regulates the uptake of glucose by the cells reduces in levels, which means the glucose required for cells is reduced.
Diabetic neuropathy is one of the complication diabetes, there is abnormally decreased sensation starting from the feet, and then moves on to the other nerves, it referred to as stocking and glove pattern. If this combines with the damaged blood vessels then we could land with a diabetic foot. This manifests as skin infection, ulcers and may move on gangrene when we are left with no option but to go in for a surgery. In fact diabetic gangrene amputation accounts for the largest non traumatic cause for amputation.
Some common diabetic foot problems
Corns
callus
Ingrown toes
Planter warts
Blisters
Bunion
Hammertoes
Dry cracked skin
Athletes feet
This condition can be avoided by taking proper care of the feet.
The feet have to be checked every day including between the toes.
even if you feel the slightest decrease in sensation to your feet talk to your diabetologist
Cracks, corns, callus of the feet should be brought to the attention of the doctor and not neglected or self medicated.
a moisturising cream can be used on the legs but please avoid using it between the toes it can cause fungal infection
clip your nails following the curve of the nail than straight across, if need be take someone’s help
wash and dry your feet particularly between the toes regularly do it as an evening ritual this will help to gauze the sensation too
never walk barefoot , wear a foot wear even at home
wear comfortable socks when wearing shoes
buying comfortable shoes
Buy a pair that will accommodate abnormalities like bunions or collapsed tarsal plates.
have broad fronts that allow movement and breathing of toes
pick low heels to prevent embarrassing the toes
Have good lace guard or Velcro so that the inner surface does not bruise the skin.
Diabetic foot ulcers are caused by narrowing of the blood vessels and decreased sensation due to peripheral neuropathy, the wound tends to get aggressively infected and necrotic due to the presence of higher blood sugar
For whatever reasons if the foot ulcer does develop then the following care should be taken.
Ulcer should be covered with a dressing
A nurse of a podiatrist should handle the re-dressing till healing is complete
Depending on the size of the ulcer it might require padding to take the pressure off.
Special footwear maybe required to keep the pressure minimum
Antibiotics may be required to keep the infection in control.
If there is cellulites then the puss may have to be drained.
In very severe cases widening of the arteries may be needed.
in all the foot care is essential in a diabetic to prevent amputation of the feet due to development of a diabetic ulcer which in turn is a result of thickened arteries and peripheral neuropathy or loss of sensation in the feet.
Monday, August 17, 2009
Medical ethics
Principles of medical ethicsa physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
A physician shall support access to medical care for all people.
Yet there is an area of grey, decisions and situations demand certain thinking. Hence an entire area of medical ethics and jurisprudence.
Definition:
Is a field of applied science, the study of moral value, judgement as applied to the medicine. As a scholarly discipline, medical ethics encompasses in its practical application in clinical as well as work on its history, philosophy, theology and sociology.
The branch of ethics that examines questions of moral right and wrong arising in the contest of practise of medicine.
History
The field is indebted to the Muslim physician though the antiquity is from the Hippocrates oath. Thomas Percival (1740-1804) used the term medical ethics when he wrote about medical jurisprudence. Eventually it re-invented itself to bioethics.
It was pioneered by Rabbi Immanuel Jacob in 1950. Since this is based on the rabbinic law of halalhah it deeply based in the Jewish faith.
Scope:
Is based on the 4 principles
Autonomy
Beneficence
Nonmaleficience
Justice
Autonomy sanctity of human life is of infinite value.
The religious precept to preserve health is not optional but is mandatory. A patient’s consent is required to perform live saving surgery,
Duty of procreate—abortions, contraception, sterilization are only allowed under emergencies that is to save the mother’s life. Mother’s life more relevant until child birth after which the child is considered as life.
Sanctity of marriage bond precludes any generation of human life outside it. This includes donor insemination or fertilization.
Duty to alleviate pain. It is mandatory to secure relief from pain a person does not own his body, he is only the custodian, cosmetic operations are allowed to promote legitimate end like marriage or employment prospects.
Respect for the dead autopsies is done only if findings can save another human life. Minimum organ transplants are allowed. The cadaver has to be interred with as many organs intact as possible.
Islamic ethics.
Are based on the Koran
Human life is valuable.
A physician takes an oath to protect life at all stages. And rescue it from death, malady, pain and anxiety. To all the way an instrument to Allah’s mercy extending medical care to near and far, virtuous and sinner and friend an enemy.
Contemporary ethics.
Autonomy is the right of an individual to self determination
Beneficence in medical terms means taking action to serve the best interest of the patients there are scholars who feel this claims only a focus on medicine then this takes precedence over autonomy. Cosmetic surgery, contraception, and euthanasia fall beyond its purview.
Non malefiecence is the concept of do no harm it more important not to harm the patient than do them good.
Justice is the patients right to dignity.
Informed consent is when the doctor explains the pros and cons of the patient, his current health scenario and the consequences of treatment. An informed patient then takes his decision.
Confidentiality between the doctor and patient this is privileged information. The doctor can refuse to disclose it even under an oath.
A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
A physician shall support access to medical care for all people.
Yet there is an area of grey, decisions and situations demand certain thinking. Hence an entire area of medical ethics and jurisprudence.
Definition:
Is a field of applied science, the study of moral value, judgement as applied to the medicine. As a scholarly discipline, medical ethics encompasses in its practical application in clinical as well as work on its history, philosophy, theology and sociology.
The branch of ethics that examines questions of moral right and wrong arising in the contest of practise of medicine.
History
The field is indebted to the Muslim physician though the antiquity is from the Hippocrates oath. Thomas Percival (1740-1804) used the term medical ethics when he wrote about medical jurisprudence. Eventually it re-invented itself to bioethics.
It was pioneered by Rabbi Immanuel Jacob in 1950. Since this is based on the rabbinic law of halalhah it deeply based in the Jewish faith.
Scope:
Is based on the 4 principles
Autonomy
Beneficence
Nonmaleficience
Justice
Autonomy sanctity of human life is of infinite value.
The religious precept to preserve health is not optional but is mandatory. A patient’s consent is required to perform live saving surgery,
Duty of procreate—abortions, contraception, sterilization are only allowed under emergencies that is to save the mother’s life. Mother’s life more relevant until child birth after which the child is considered as life.
Sanctity of marriage bond precludes any generation of human life outside it. This includes donor insemination or fertilization.
Duty to alleviate pain. It is mandatory to secure relief from pain a person does not own his body, he is only the custodian, cosmetic operations are allowed to promote legitimate end like marriage or employment prospects.
Respect for the dead autopsies is done only if findings can save another human life. Minimum organ transplants are allowed. The cadaver has to be interred with as many organs intact as possible.
Islamic ethics.
Are based on the Koran
Human life is valuable.
A physician takes an oath to protect life at all stages. And rescue it from death, malady, pain and anxiety. To all the way an instrument to Allah’s mercy extending medical care to near and far, virtuous and sinner and friend an enemy.
Contemporary ethics.
Autonomy is the right of an individual to self determination
Beneficence in medical terms means taking action to serve the best interest of the patients there are scholars who feel this claims only a focus on medicine then this takes precedence over autonomy. Cosmetic surgery, contraception, and euthanasia fall beyond its purview.
Non malefiecence is the concept of do no harm it more important not to harm the patient than do them good.
Justice is the patients right to dignity.
Informed consent is when the doctor explains the pros and cons of the patient, his current health scenario and the consequences of treatment. An informed patient then takes his decision.
Confidentiality between the doctor and patient this is privileged information. The doctor can refuse to disclose it even under an oath.
Saturday, August 15, 2009
Cancer Update from Johns Hopkins
AFTER YEARS OF TELLING PEOPLE CHEMOTHERAPY IS THE ONLY WAY TO TRY (TRY THE KEYWORD) AND ELIMINATE CANCER, JOHNS HOPKINS IS FINALLY STARTING TO TELL YOU THERE IS AN ALTERNATIVE WAY .
1. Every person has cancer cells in the body. These cancer cells do not show up in the standard Tests until they have multiplied to a few billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are unable to detect the cancer cells because they have not reached the detectable size.
2. Cancer cells occur between 6 to more than 10 times in a person's life time.
3. When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumors.
4.. When a person has cancer it indicates the person has multiple nutritional deficiencies. These could be due to genetic, environmental, food and lifestyle (lack of sleep) factors.
5. To overcome the multiple nutritional deficiencies, changing diet and including supplements will strengthen the immune system.
6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow, gastro-intestinaltract etc, and can cause organ damage, like liver, kidneys, heart, lungs etc.
7. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.
8... Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not result in more tumor destruction.
9 When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed, hence the person can succumb to various kinds of infections and complications.....
10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy. Surgery can also cause cancer cells to spread to other sites.
11. An effective way to battle cancer is to starve the cancer cells by not feeding it with the foods it needs to multiply.
CANCER CELLS FEED ON:
A. Sugar is a cancer-feeder... By cutting off sugar it cuts off one important food supply to the cancer cells. Sugar substitutes like NutraSweet, Equal, Spoonful, etc are made with Aspartame and it is harmful. A better natural substitute would be Manuka honey or molasses but only in very small amounts. Table salt has a chemical added to make it white in color. Better alternative is Bragg's aminos or sea salt.
B. Milk causes the body to produce mucus, especially in the gastro-intestinaltract. Cancer feeds on mucus. By cutting off milk and substituting with unsweetened soya milk cancer cells are being starved.
C. Cancer cells thrive in an acid environment. A meat-based diet is acidic and it is best to eat fish, and a little chicken rather than beef or pork. Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially to people with cancer.
D. A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and a little fruits help put the body into an alkaline environment... About 20% can be from cooked food including beans.. Fresh vegetable juices provide live enzymes that are easily absorbed and reach down to cellular levels within 15 minutes to nourish and enhance growth of healthy cells. To obtain live enzymes for building healthy cells, try and drink fresh vegetable juice (most vegetables including bean sprouts) and eat some raw vegetables 2 or 3 times a day. Enzymes are destroyed at temperatures of 104 degrees F (40 degrees C).
E.. Avoid coffee, tea, and chocolate, which have high caffeine. Green tea is a better alternative and has cancer-fighting properties... Water -- best to drink purified water, or filtered, to avoid known toxins and heavy metals in tapwater.. Distilled water is acidic, avoid it. 12. Meat protein is difficult to digest and requires a lot of digestive enzymes. Undigested meat remaining in the intestines become putrified and leads to more toxic buildup. 13. Cancer cell walls have a tough protein covering. By refraining from or eating less meat it frees more enzymes to attack the protein walls of cancer cells and allows the body's killer cells to destroy the cancer cells. 14. Some supplements build up the immune system (IP6, Flor-ssence, Essiac, anti-oxidants, vitamins, minerals, EFAs, etc.) to enable the body's own killer cells to destroy cancer cells.. Other supplements like vitamin E are known to cause apoptosis, or programmed cell death, the body's normal method of disposing of damaged, unwanted, or unneeded cells... 15. Cancer is a disease of the mind, body, and spirit.. A proactive and positive spirit will help the cancer warrior be a survivor. Anger, unforgiveness and bitterness put the body into a stressful and acidic environment. Learn to have a loving and forgiving spirit. Learn to relax and enjoy life. 16. Cancer cells cannot thrive in an oxygenated environment.. Exercising daily, and deep breathing help to get more oxygen down to the cellular level. Oxygen therapy is another means employed to destroy cancer cells.
(PLEASE FORWARD IT TO PEOPLE YOU CARE ABOUT) CANCER UPDATE FROM JOHNS HOPKINS HOSPITAL
1. No plastic containers in micro.
2. No water bottles in freezer.
3. No plastic wrap in microwave...
Johns Hopkins has recently sent this out in its newsletters.. This information is being circulated at Walter Reed Army Medical Center as well.Dioxin chemicals causes cancer, especially breast cancer.Dioxins are highly poisonous to the cells of our bodies..Don't freeze your plastic bottles with water in them as this releases dioxins from the plastic. Recently, Dr. Edward Fujimoto, Wellness Program Manager at Castle Hospital , was on a TV program to explain this health hazard. He talked about dioxins and how bad they are for us. He said that we should not be heating our food in the microwave using plastic containers.This especially applies to foods that contain fat. He said that the combination of fat, high heat, and plastics releases dioxin into the food and ultimately into the cells of the body. Instead, he recommends using glass, such as CorningWare, Pyrex or ceramic containers for heating food. You get the same results, only without the dioxin. So such things as TV dinners, instant and soups, etc.., should be removed from the container and heated in something else.Paper isn't bad but you don't know what is in the paper. It's just safer to use tempered glass, Corning Ware, etc... He reminded us that a while ago some of the fast food restaurants moved away from the foam containers to paper. The dioxin problem is one of the reasons. Also, he pointed out that plastic wrap, such as Saran, is just as dangerous when placed over foods to be cooked in the microwave. As the food is nuked, the high heat causes poisonous toxins to actually melt out of the plastic wrap and drip into the food. Cover food with a paper towel instead.
1. Every person has cancer cells in the body. These cancer cells do not show up in the standard Tests until they have multiplied to a few billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are unable to detect the cancer cells because they have not reached the detectable size.
2. Cancer cells occur between 6 to more than 10 times in a person's life time.
3. When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumors.
4.. When a person has cancer it indicates the person has multiple nutritional deficiencies. These could be due to genetic, environmental, food and lifestyle (lack of sleep) factors.
5. To overcome the multiple nutritional deficiencies, changing diet and including supplements will strengthen the immune system.
6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow, gastro-intestinaltract etc, and can cause organ damage, like liver, kidneys, heart, lungs etc.
7. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.
8... Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not result in more tumor destruction.
9 When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed, hence the person can succumb to various kinds of infections and complications.....
10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy. Surgery can also cause cancer cells to spread to other sites.
11. An effective way to battle cancer is to starve the cancer cells by not feeding it with the foods it needs to multiply.
CANCER CELLS FEED ON:
A. Sugar is a cancer-feeder... By cutting off sugar it cuts off one important food supply to the cancer cells. Sugar substitutes like NutraSweet, Equal, Spoonful, etc are made with Aspartame and it is harmful. A better natural substitute would be Manuka honey or molasses but only in very small amounts. Table salt has a chemical added to make it white in color. Better alternative is Bragg's aminos or sea salt.
B. Milk causes the body to produce mucus, especially in the gastro-intestinaltract. Cancer feeds on mucus. By cutting off milk and substituting with unsweetened soya milk cancer cells are being starved.
C. Cancer cells thrive in an acid environment. A meat-based diet is acidic and it is best to eat fish, and a little chicken rather than beef or pork. Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially to people with cancer.
D. A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and a little fruits help put the body into an alkaline environment... About 20% can be from cooked food including beans.. Fresh vegetable juices provide live enzymes that are easily absorbed and reach down to cellular levels within 15 minutes to nourish and enhance growth of healthy cells. To obtain live enzymes for building healthy cells, try and drink fresh vegetable juice (most vegetables including bean sprouts) and eat some raw vegetables 2 or 3 times a day. Enzymes are destroyed at temperatures of 104 degrees F (40 degrees C).
E.. Avoid coffee, tea, and chocolate, which have high caffeine. Green tea is a better alternative and has cancer-fighting properties... Water -- best to drink purified water, or filtered, to avoid known toxins and heavy metals in tapwater.. Distilled water is acidic, avoid it. 12. Meat protein is difficult to digest and requires a lot of digestive enzymes. Undigested meat remaining in the intestines become putrified and leads to more toxic buildup. 13. Cancer cell walls have a tough protein covering. By refraining from or eating less meat it frees more enzymes to attack the protein walls of cancer cells and allows the body's killer cells to destroy the cancer cells. 14. Some supplements build up the immune system (IP6, Flor-ssence, Essiac, anti-oxidants, vitamins, minerals, EFAs, etc.) to enable the body's own killer cells to destroy cancer cells.. Other supplements like vitamin E are known to cause apoptosis, or programmed cell death, the body's normal method of disposing of damaged, unwanted, or unneeded cells... 15. Cancer is a disease of the mind, body, and spirit.. A proactive and positive spirit will help the cancer warrior be a survivor. Anger, unforgiveness and bitterness put the body into a stressful and acidic environment. Learn to have a loving and forgiving spirit. Learn to relax and enjoy life. 16. Cancer cells cannot thrive in an oxygenated environment.. Exercising daily, and deep breathing help to get more oxygen down to the cellular level. Oxygen therapy is another means employed to destroy cancer cells.
(PLEASE FORWARD IT TO PEOPLE YOU CARE ABOUT) CANCER UPDATE FROM JOHNS HOPKINS HOSPITAL
1. No plastic containers in micro.
2. No water bottles in freezer.
3. No plastic wrap in microwave...
Johns Hopkins has recently sent this out in its newsletters.. This information is being circulated at Walter Reed Army Medical Center as well.Dioxin chemicals causes cancer, especially breast cancer.Dioxins are highly poisonous to the cells of our bodies..Don't freeze your plastic bottles with water in them as this releases dioxins from the plastic. Recently, Dr. Edward Fujimoto, Wellness Program Manager at Castle Hospital , was on a TV program to explain this health hazard. He talked about dioxins and how bad they are for us. He said that we should not be heating our food in the microwave using plastic containers.This especially applies to foods that contain fat. He said that the combination of fat, high heat, and plastics releases dioxin into the food and ultimately into the cells of the body. Instead, he recommends using glass, such as CorningWare, Pyrex or ceramic containers for heating food. You get the same results, only without the dioxin. So such things as TV dinners, instant and soups, etc.., should be removed from the container and heated in something else.Paper isn't bad but you don't know what is in the paper. It's just safer to use tempered glass, Corning Ware, etc... He reminded us that a while ago some of the fast food restaurants moved away from the foam containers to paper. The dioxin problem is one of the reasons. Also, he pointed out that plastic wrap, such as Saran, is just as dangerous when placed over foods to be cooked in the microwave. As the food is nuked, the high heat causes poisonous toxins to actually melt out of the plastic wrap and drip into the food. Cover food with a paper towel instead.
Wednesday, August 5, 2009
ADIPONECTINE AND DIABETES
~JClinical Endocrinol Metab.2008 27,(Epub ahead of print.)
ABSTRACT
Adiponectine is protein produced by and secreted exclusively by adipocytes. It regulates the metabolism of lipids and glucose. It influences the body response to insulin. It has antiflammatory action on the cells lining the walls of the blood vessels. Increase in Adiponectine decreases risks of heart attacks. The article looks t\at the tests and the conclusion drawn by various researching bodies.
INTRODUCTION
Decreased, Adiponectine levels particularly the heavy molecular weight (HMW) is not only an early indicator of gestation diabetes(GDM) with a potential to progressive diabetes mellitus. higher levels of Adiponectine particularly HMW is associated with type1 diabetes mellitus(T1DM) , and type 2 diabetes mellitus(T2DM) though relation was found between severity of retinopathy and nephropathy but not neuropathy.
Diabetes mellitus:
Diabetes Mellitus (DM) Better known just as "diabetes" -- a chronic disease associated with abnormally high levels of the sugar glucose in the blood. Diabetes is due to one of two mechanisms:(1) Inadequate production of insulin (which is made by the pancreas and lowers blood glucose) or(2) Inadequate sensitivity of cells to the action of insulin.The two main types of diabetes correspond to these two mechanisms and are called insulin dependent (type 1) and non-insulin dependent (type 2) diabetes.. Gestation diabetes mellitus(GDM) is a condition seen in women during pregnancy where there is frank hyperglycemia and glycosuria.
Adiponectine:
Orthologs
Human
Mouse
Entrez
9370
11450
Ensembl
ENSG00000181092
ENSMUSG00000022878
Uniprot
Q15848
Q6GTX4
Refseq
NM_004797 (mRNA)NP_004788 (protein)
NM_009605 (mRNA)NP_033735 (protein)
Location
Chr 3: 188.04 - 188.06 Mb
Chr 16: 23.06 - 23.07 Mb
Symbols--ADIPOQ,ACDC,ACrP30,APM-1 APM1,GBP28,
History -- Adiponectine first characterized in mice as a transcript the human analogue was found in adipose and was found to decrease obesity despite of being created by the adipose cell. The cell was localized to chromosome 3p27 region affecting susceptibility to T2DM and obesity.
Function:
It regulates the metabolism of lipids and glucose.
It influences the body response to insulin
It has antiflammatory action on the cells lining the walls of the blood vessel
Increase Adiponectine decrease risks of heart attacks.
Association of diabetes mellitus and Adiponectine
T1DM is associated with higher levels than healthy subjects. Increase is associated with HMW sub form and is unaffected by gender and diabetic kidney disease.—
T2DM shows higher HMW Adiponectine this is also associated with renal insufficiency
A correlation to HMW Adiponectine was found between severity of retinopathy and nephropathy but not with neuropathy in T2DM
HMW Adiponectine was an independent risk factor for progressive T2DM particularly the HMW isoform
HMW Adiponectine is decreased in GDM deficiency of HMW may indicate an early event in natural T2DM.
RESEARCH
Adiponectine and T1DM
In type 1 diabetes there is no insulin or not enough of it.
T1DM is per se associated with higher Adiponectine level as compared to healthy individuals—a study conducted by Tarnow I,Rosssing P, Parving HH, Flybjerg A. at the medical research laboratories Clinical Institute,Aaarlus university hospital, steno diabetes center Gentofle, department. Of endocrinology, Righshospital University of Copenhagen
Aim: to investigate the distribution of the three molecular subforms of Adiponectine in well characterized group of T1DM with varying degrees of nephropathy and healthy control patients.
The presentation of Adiponectine was seen in 3 isoform.
High molecular weight(HMW) which was a primary active form
Medium molecular weight (MMW) a subforms
Low molecular weight(LMW) an unresolved molecular form
Study-207 patients were studied. The patient distribution was thus.
58 with normal albuminuria
46 with micro albuminuria
46 with macro albuminuria
57 matched control.
A fast protein liquid chromatography was done and results measured with immunoflorometric assay. the results observed where:
The relative concentration of total Adiponectine and all subforms were higher in T1DM that healthy controls.
Relative fractions when up regulated where.
P<0.001 in HMW subforms
P<0.001 in MMW subforms
P<0.05 in LMW subforms.
Levels of total and HMW were unaffected by nephropathy status defined by albumin excretion rate
Unaffected by gender
Unaffected by kidney; disease.
ADIPONECTIN AND T2DM
In type 2 diabetes, there is generally enough insulin but the cells upon it should act are not normally sensitive to its action
The serum HMW Adiponectin concentrations are higher in T2DM with nephropathy and lese levels are also associated with renal insufficiency---is the conclusion drawn by a study conducted by Komba H, Igaki N, Goto S, Yokota K, Doi H, Take moto T, Kohmo , Hirosue Y at the department of internal medicine Takasago Municipal hospital, Japan(hkomba@med.kobe-u.ac.jp )
Aim: was to study if the HMW complex of Adiponectin is associated with renal insufficiency in T2DM
Method: a total of 179 T2DM patients were selected from the outpatient. These patients where then divided to 4 groups depending on the albumin: creatine ratio (n).
Normal albuminuria n=86
Micro albuminuria n=44
Macro albuminuria n= 23
Hemodialysis n=26
This was then specifically assayed for HMW Adiponectin with a commercially available enzyme-linked immunosorbent assay kit.
Results:
Patient condition
Adiponectin level microgms/ml
hemodialysis
17.1+/-8.2
Macroalbuminuria
14.3+/-8.7
Microalbuminuria
10.8+/-7.0
Glomerular filtration rate related negatively with Adiponectin concentrations (r=0.42,p<0’001) in normalalbuminuria, microalbuminuria, and macroalbuminuria when univariate linear regression analysis was done.
pioglitazone therapy, gender differences and systolic blood pressure were independently associated with associated with HMW Adiponectin levels when multiple stepwise regression analysis was disclosed.
With reference to retinopathy and nephropathy in T2DM total Adiponectin and HMW Adiponectin are positively correlated, but not with neuropathy.
~are the results of the study conducted by Kato K, Osawa H, Ochi M, Kusunoki Y, Ebisui O, Ohno K, Ohashi J, ShimizuI, Fuiji Y, Tanimoto M, Makino H of Ehime Prefectural Hospital, Ehime Japan on serum total and high molecular weight Adiponectin levels and correlation with severity of diabetic retinopathy and nephropathy.
Aim: was to determine the relation between serum total or HMW Adiponectin and diabetic microangiopathy.
As Adiponectin is secreted by adipocytes and it improves insulin sensitivity its high molecular weight isoform should be more effective.
Design
Number of patients analyzed 198
Criteria – T2DM patients whose fasting serum samples were available
ELISA(enzyme-linked immunosorbent assay) was used to measure serum total and HMW Adiponectin.
Results:
Increased total serum Adiponectin was seen both in retinopathy and nephropathy.
Serum Adiponectin level in Retinopathy
Mg/l
P<0.004
Serum Adiponectin level in nephropathy
Mg/l
P<0.001
Mean+/-none
Stage I- 7,0+/-0.3
6.9+/- simple
stageII ,7.7+/-0.5
8.3+/-1.0 preproliferate
stageIII 9.5+/-0.9
8.4+/-0.8 proliferative
Stage IV 16+/-4.5
12+/-1.1
Increased HMW Adiponectin was seen both in retinopathy and nephropathy.
Serum HMW Level in retinopathy
Mg/l
P=0.005
Serum HMW level in nephropathy
Mg/l
P=0.007
4.6+/ 0.5
3.7+/0.2
4.6+/0.6
4.3+/0.4
8.4+/0.8
5.3+/0.7
7.9+/2.2
Neuropathy was correlated to neither total Adiponectin nor HMW Adiponectin.
HMW ; total Adiponectin ratio did not correlate to microangiopathy
In retinopathy and nephropathy stage total Adiponectin and HMW Adiponectin were independent factor.
Retinopathy
P=
Nephropathy
P=
0.0055
0.0003
0.0027
0.0018
Other factors that effect independently are age, gender, body mass index, duration of T2DM .these are even more important when serum creatinine, and hypertension are added.
Thiazolidinediones do not affect.
Decreased total Adiponectin is an independent risk factor for the progression to T2DM and HMW is more closely associated
~is the conclusion drawn by Nakashima R,Kamei N, Yamane K, Nakanishi S, Nakashima A, Kohno N.—dept of molecular and internal medicine, graduate school of biomedical sciences, Hiroshima University, 1-2-3 Kauum I Minami_ku, hishoshima city 734-8552 Japan.
Aim: of the study was to assess whether decreased total and HMW Adiponectine are independent risk factors for the development of T2DM
Design.
Japanese-American patients of Hawaii- Los Angels -Hiroshima were enrolled between 1992-2002.
Average follow up was 5.4yrs.
Study demo graph 321 men 445 women
Observation:
112 developed into T2DM had decreased total Adiponectin and HMW Adiponectin level(P<0.001)
In a Cox proportional hazards model, both decreased Adiponectin and HMW Adiponectin were independent factors for progressive diabetic risk after tabulation of waist hip ratio, age, gender, BMI homeostasis and glucose tolerance tests/
Hazards ration
Total 0.600 P=0.018
HMW 0.614 P=0.001
Lowest vs. highest dividing teritiles of Adiponectin and hazard ration were
Total 1,787 (95% confidence interval,1.006-3.173)
HMW 2.493(95% confidence interval, 1.342 – 4.632)
Gestation diabetes mellitus(GDM)
Deficiency of serum HMW Adiponectin may be an early event in the natural history of T2DM--This is the conclusion drawn by Retnakumar R, Connelly PW, Maguire G, Sermer M, Zinman B, Hanner A,- of the division of Endocrinology university of Toronto Canada rretnakumar@mtsinai.on.ca after their study high molecular weight Adiponectin in gestational diabetes. and implication for the patho-physiology of T2DM.
AIM: to determine if low serum levels of HMW was a feature of GDM
Antidiabetic activity of Adiponectin has been conclusive by various recent studies.
Circulatory levels of the HMW were found low in T2DM patients so it could be mediating the antidiabetic action.
GDM identifies a population of women who are at high risk in the future for T2DM.
The study focused to correlate them.
Method:
A total of 121 women were studied at Oral Glucose Tolerance Test (OGTT)
Based on the OGTT 40 women with GDM and 80 women were studied.
The serum was then immunoassayed and measured for HMW isoforms.
Results:
Median HMW was lower in women with GDM (3.5mircogm/ml) as compared to women without (5.5 microgm/ml)(p<0.0001)
After adjusting the covariates the HMW Adiponectin was still lower in GDM women 3.6 vs. 5.3 microgm/l, p<0.001
Insulin sensitivity IS(OGTT) was directly proportional to HMW Adiponectin in the blood r=0.38, p<0.0001
Pancreatic B-cells function is directly proportional to the serum HMW Adiponectin. The insulin sensitivity index shows r = 0.33,p<0.0002
Blood glucose levels including area- under the glucose curve during OGTT was inversely proportional r=0.31,p=0.0007
Multiple linear analysis shows HMW Adiponectin is an independent determinant of AUC (glucose),IS(OGTT) ISSI respectively.
CONCLUSION
Adiponectine is protein produced by and secreted exclusively by adipocytes. It regulates the metabolism of lipids and glucose. It influences the body response to insulin. It has antiflammatory action on the cells lining the walls of the blood vessels. Increase in Adiponectine decreases risks of heart attacks.
REFERENCES
Medicine Net.com
Wikipedia
~JClinical Endocrinol Metab.2008 27,(Epub ahead of print.)
ABSTRACT
Adiponectine is protein produced by and secreted exclusively by adipocytes. It regulates the metabolism of lipids and glucose. It influences the body response to insulin. It has antiflammatory action on the cells lining the walls of the blood vessels. Increase in Adiponectine decreases risks of heart attacks. The article looks t\at the tests and the conclusion drawn by various researching bodies.
INTRODUCTION
Decreased, Adiponectine levels particularly the heavy molecular weight (HMW) is not only an early indicator of gestation diabetes(GDM) with a potential to progressive diabetes mellitus. higher levels of Adiponectine particularly HMW is associated with type1 diabetes mellitus(T1DM) , and type 2 diabetes mellitus(T2DM) though relation was found between severity of retinopathy and nephropathy but not neuropathy.
Diabetes mellitus:
Diabetes Mellitus (DM) Better known just as "diabetes" -- a chronic disease associated with abnormally high levels of the sugar glucose in the blood. Diabetes is due to one of two mechanisms:(1) Inadequate production of insulin (which is made by the pancreas and lowers blood glucose) or(2) Inadequate sensitivity of cells to the action of insulin.The two main types of diabetes correspond to these two mechanisms and are called insulin dependent (type 1) and non-insulin dependent (type 2) diabetes.. Gestation diabetes mellitus(GDM) is a condition seen in women during pregnancy where there is frank hyperglycemia and glycosuria.
Adiponectine:
Orthologs
Human
Mouse
Entrez
9370
11450
Ensembl
ENSG00000181092
ENSMUSG00000022878
Uniprot
Q15848
Q6GTX4
Refseq
NM_004797 (mRNA)NP_004788 (protein)
NM_009605 (mRNA)NP_033735 (protein)
Location
Chr 3: 188.04 - 188.06 Mb
Chr 16: 23.06 - 23.07 Mb
Symbols--ADIPOQ,ACDC,ACrP30,APM-1 APM1,GBP28,
History -- Adiponectine first characterized in mice as a transcript the human analogue was found in adipose and was found to decrease obesity despite of being created by the adipose cell. The cell was localized to chromosome 3p27 region affecting susceptibility to T2DM and obesity.
Function:
It regulates the metabolism of lipids and glucose.
It influences the body response to insulin
It has antiflammatory action on the cells lining the walls of the blood vessel
Increase Adiponectine decrease risks of heart attacks.
Association of diabetes mellitus and Adiponectine
T1DM is associated with higher levels than healthy subjects. Increase is associated with HMW sub form and is unaffected by gender and diabetic kidney disease.—
T2DM shows higher HMW Adiponectine this is also associated with renal insufficiency
A correlation to HMW Adiponectine was found between severity of retinopathy and nephropathy but not with neuropathy in T2DM
HMW Adiponectine was an independent risk factor for progressive T2DM particularly the HMW isoform
HMW Adiponectine is decreased in GDM deficiency of HMW may indicate an early event in natural T2DM.
RESEARCH
Adiponectine and T1DM
In type 1 diabetes there is no insulin or not enough of it.
T1DM is per se associated with higher Adiponectine level as compared to healthy individuals—a study conducted by Tarnow I,Rosssing P, Parving HH, Flybjerg A. at the medical research laboratories Clinical Institute,Aaarlus university hospital, steno diabetes center Gentofle, department. Of endocrinology, Righshospital University of Copenhagen
Aim: to investigate the distribution of the three molecular subforms of Adiponectine in well characterized group of T1DM with varying degrees of nephropathy and healthy control patients.
The presentation of Adiponectine was seen in 3 isoform.
High molecular weight(HMW) which was a primary active form
Medium molecular weight (MMW) a subforms
Low molecular weight(LMW) an unresolved molecular form
Study-207 patients were studied. The patient distribution was thus.
58 with normal albuminuria
46 with micro albuminuria
46 with macro albuminuria
57 matched control.
A fast protein liquid chromatography was done and results measured with immunoflorometric assay. the results observed where:
The relative concentration of total Adiponectine and all subforms were higher in T1DM that healthy controls.
Relative fractions when up regulated where.
P<0.001 in HMW subforms
P<0.001 in MMW subforms
P<0.05 in LMW subforms.
Levels of total and HMW were unaffected by nephropathy status defined by albumin excretion rate
Unaffected by gender
Unaffected by kidney; disease.
ADIPONECTIN AND T2DM
In type 2 diabetes, there is generally enough insulin but the cells upon it should act are not normally sensitive to its action
The serum HMW Adiponectin concentrations are higher in T2DM with nephropathy and lese levels are also associated with renal insufficiency---is the conclusion drawn by a study conducted by Komba H, Igaki N, Goto S, Yokota K, Doi H, Take moto T, Kohmo , Hirosue Y at the department of internal medicine Takasago Municipal hospital, Japan(hkomba@med.kobe-u.ac.jp )
Aim: was to study if the HMW complex of Adiponectin is associated with renal insufficiency in T2DM
Method: a total of 179 T2DM patients were selected from the outpatient. These patients where then divided to 4 groups depending on the albumin: creatine ratio (n).
Normal albuminuria n=86
Micro albuminuria n=44
Macro albuminuria n= 23
Hemodialysis n=26
This was then specifically assayed for HMW Adiponectin with a commercially available enzyme-linked immunosorbent assay kit.
Results:
Patient condition
Adiponectin level microgms/ml
hemodialysis
17.1+/-8.2
Macroalbuminuria
14.3+/-8.7
Microalbuminuria
10.8+/-7.0
Glomerular filtration rate related negatively with Adiponectin concentrations (r=0.42,p<0’001) in normalalbuminuria, microalbuminuria, and macroalbuminuria when univariate linear regression analysis was done.
pioglitazone therapy, gender differences and systolic blood pressure were independently associated with associated with HMW Adiponectin levels when multiple stepwise regression analysis was disclosed.
With reference to retinopathy and nephropathy in T2DM total Adiponectin and HMW Adiponectin are positively correlated, but not with neuropathy.
~are the results of the study conducted by Kato K, Osawa H, Ochi M, Kusunoki Y, Ebisui O, Ohno K, Ohashi J, ShimizuI, Fuiji Y, Tanimoto M, Makino H of Ehime Prefectural Hospital, Ehime Japan on serum total and high molecular weight Adiponectin levels and correlation with severity of diabetic retinopathy and nephropathy.
Aim: was to determine the relation between serum total or HMW Adiponectin and diabetic microangiopathy.
As Adiponectin is secreted by adipocytes and it improves insulin sensitivity its high molecular weight isoform should be more effective.
Design
Number of patients analyzed 198
Criteria – T2DM patients whose fasting serum samples were available
ELISA(enzyme-linked immunosorbent assay) was used to measure serum total and HMW Adiponectin.
Results:
Increased total serum Adiponectin was seen both in retinopathy and nephropathy.
Serum Adiponectin level in Retinopathy
Mg/l
P<0.004
Serum Adiponectin level in nephropathy
Mg/l
P<0.001
Mean+/-none
Stage I- 7,0+/-0.3
6.9+/- simple
stageII ,7.7+/-0.5
8.3+/-1.0 preproliferate
stageIII 9.5+/-0.9
8.4+/-0.8 proliferative
Stage IV 16+/-4.5
12+/-1.1
Increased HMW Adiponectin was seen both in retinopathy and nephropathy.
Serum HMW Level in retinopathy
Mg/l
P=0.005
Serum HMW level in nephropathy
Mg/l
P=0.007
4.6+/ 0.5
3.7+/0.2
4.6+/0.6
4.3+/0.4
8.4+/0.8
5.3+/0.7
7.9+/2.2
Neuropathy was correlated to neither total Adiponectin nor HMW Adiponectin.
HMW ; total Adiponectin ratio did not correlate to microangiopathy
In retinopathy and nephropathy stage total Adiponectin and HMW Adiponectin were independent factor.
Retinopathy
P=
Nephropathy
P=
0.0055
0.0003
0.0027
0.0018
Other factors that effect independently are age, gender, body mass index, duration of T2DM .these are even more important when serum creatinine, and hypertension are added.
Thiazolidinediones do not affect.
Decreased total Adiponectin is an independent risk factor for the progression to T2DM and HMW is more closely associated
~is the conclusion drawn by Nakashima R,Kamei N, Yamane K, Nakanishi S, Nakashima A, Kohno N.—dept of molecular and internal medicine, graduate school of biomedical sciences, Hiroshima University, 1-2-3 Kauum I Minami_ku, hishoshima city 734-8552 Japan.
Aim: of the study was to assess whether decreased total and HMW Adiponectine are independent risk factors for the development of T2DM
Design.
Japanese-American patients of Hawaii- Los Angels -Hiroshima were enrolled between 1992-2002.
Average follow up was 5.4yrs.
Study demo graph 321 men 445 women
Observation:
112 developed into T2DM had decreased total Adiponectin and HMW Adiponectin level(P<0.001)
In a Cox proportional hazards model, both decreased Adiponectin and HMW Adiponectin were independent factors for progressive diabetic risk after tabulation of waist hip ratio, age, gender, BMI homeostasis and glucose tolerance tests/
Hazards ration
Total 0.600 P=0.018
HMW 0.614 P=0.001
Lowest vs. highest dividing teritiles of Adiponectin and hazard ration were
Total 1,787 (95% confidence interval,1.006-3.173)
HMW 2.493(95% confidence interval, 1.342 – 4.632)
Gestation diabetes mellitus(GDM)
Deficiency of serum HMW Adiponectin may be an early event in the natural history of T2DM--This is the conclusion drawn by Retnakumar R, Connelly PW, Maguire G, Sermer M, Zinman B, Hanner A,- of the division of Endocrinology university of Toronto Canada rretnakumar@mtsinai.on.ca after their study high molecular weight Adiponectin in gestational diabetes. and implication for the patho-physiology of T2DM.
AIM: to determine if low serum levels of HMW was a feature of GDM
Antidiabetic activity of Adiponectin has been conclusive by various recent studies.
Circulatory levels of the HMW were found low in T2DM patients so it could be mediating the antidiabetic action.
GDM identifies a population of women who are at high risk in the future for T2DM.
The study focused to correlate them.
Method:
A total of 121 women were studied at Oral Glucose Tolerance Test (OGTT)
Based on the OGTT 40 women with GDM and 80 women were studied.
The serum was then immunoassayed and measured for HMW isoforms.
Results:
Median HMW was lower in women with GDM (3.5mircogm/ml) as compared to women without (5.5 microgm/ml)(p<0.0001)
After adjusting the covariates the HMW Adiponectin was still lower in GDM women 3.6 vs. 5.3 microgm/l, p<0.001
Insulin sensitivity IS(OGTT) was directly proportional to HMW Adiponectin in the blood r=0.38, p<0.0001
Pancreatic B-cells function is directly proportional to the serum HMW Adiponectin. The insulin sensitivity index shows r = 0.33,p<0.0002
Blood glucose levels including area- under the glucose curve during OGTT was inversely proportional r=0.31,p=0.0007
Multiple linear analysis shows HMW Adiponectin is an independent determinant of AUC (glucose),IS(OGTT) ISSI respectively.
CONCLUSION
Adiponectine is protein produced by and secreted exclusively by adipocytes. It regulates the metabolism of lipids and glucose. It influences the body response to insulin. It has antiflammatory action on the cells lining the walls of the blood vessels. Increase in Adiponectine decreases risks of heart attacks.
REFERENCES
Medicine Net.com
Wikipedia
Tuesday, August 4, 2009
An introduction to homeopathy.
Inputs from Dr.Arvind kothePrincipal Kamaxi homeopathy college
Shiroda Goa.
Homeopathy is an individualistic mode of drug therapy based on the law of seemlier
This essentially means that the portrait of the drug and the portrait of the disease should match. The history of the patient is taken and matched with the remedy.
The study of the drug portrait is such that it should match the portrait of the disease and then the drug is administrated this is essentially homeopathy defined.
In practice also seemlier also deals with individuality what is individuality in this context?
Disease is the response of individual to unfavorable environment. E.g. The temperature increase may be tolerated by some, while some find the need to turn on the fan while others would require the air cooler.
The reaction to unfavorable condition manifests as signs and symptoms. The symptoms manifested can be physical emotional or mental level. When collected adequately we get an aggregate of symptoms.
This aggregate is then shifted to pinpoint the causative.
The patient might manifest symptoms that do not match with the general portrait of the disease. This long side with constitution of the person (things like physical build, temperature etc. Helps to create a profile. Peculiar symptoms + constitution f the man + body build +body temperature +relation to environment makes the homelier.
Homelier + history + ingrained past history=> totality
Learning medicine is necessary as unless you know the normal it is not possible to perceive the abnormal, the study of the mind becomes essential for physiology +psychology is what helps you to achieve the totality.
The detail proforma of the patient is drawn by detailed history; taking. There are times it could take an hour or two. (standard proforma has been evolved by the Kamaxi homeopathy college.
Homeopathy also as a concept called potenstiastion which is unique to it. Here it is percolations to the minimum dose.
The source of medication like all other systems are plant, mineral and animal. This is diluted by 99% in sugar/alcohol.
This dilution is conducted to the limit where it becomes an energy form such that it stimulates the system and acts on the body. There is strengthening the immune system. Hence the prescription is a total systemic cure and not disease focused. This term as monopharmacy—where multiple symptoms ar not treated wit multiple drugs but a single medication is administered.
Homeopathy is excellent option when it comes to
Pediatrics
Dermatology
Psycho-somatic disorders.
This does not mean it is restricted to these. Homeopathy can independently treat a lot of diseases, and act as an alley to others.
Being an young stream, it has picked the best from the existing streams.
On the flip side clinical trails are just being standardized and acknowledged. Various research centers are just getting acceptability.
Shiroda Goa.
Homeopathy is an individualistic mode of drug therapy based on the law of seemlier
This essentially means that the portrait of the drug and the portrait of the disease should match. The history of the patient is taken and matched with the remedy.
The study of the drug portrait is such that it should match the portrait of the disease and then the drug is administrated this is essentially homeopathy defined.
In practice also seemlier also deals with individuality what is individuality in this context?
Disease is the response of individual to unfavorable environment. E.g. The temperature increase may be tolerated by some, while some find the need to turn on the fan while others would require the air cooler.
The reaction to unfavorable condition manifests as signs and symptoms. The symptoms manifested can be physical emotional or mental level. When collected adequately we get an aggregate of symptoms.
This aggregate is then shifted to pinpoint the causative.
The patient might manifest symptoms that do not match with the general portrait of the disease. This long side with constitution of the person (things like physical build, temperature etc. Helps to create a profile. Peculiar symptoms + constitution f the man + body build +body temperature +relation to environment makes the homelier.
Homelier + history + ingrained past history=> totality
Learning medicine is necessary as unless you know the normal it is not possible to perceive the abnormal, the study of the mind becomes essential for physiology +psychology is what helps you to achieve the totality.
The detail proforma of the patient is drawn by detailed history; taking. There are times it could take an hour or two. (standard proforma has been evolved by the Kamaxi homeopathy college.
Homeopathy also as a concept called potenstiastion which is unique to it. Here it is percolations to the minimum dose.
The source of medication like all other systems are plant, mineral and animal. This is diluted by 99% in sugar/alcohol.
This dilution is conducted to the limit where it becomes an energy form such that it stimulates the system and acts on the body. There is strengthening the immune system. Hence the prescription is a total systemic cure and not disease focused. This term as monopharmacy—where multiple symptoms ar not treated wit multiple drugs but a single medication is administered.
Homeopathy is excellent option when it comes to
Pediatrics
Dermatology
Psycho-somatic disorders.
This does not mean it is restricted to these. Homeopathy can independently treat a lot of diseases, and act as an alley to others.
Being an young stream, it has picked the best from the existing streams.
On the flip side clinical trails are just being standardized and acknowledged. Various research centers are just getting acceptability.
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