Tuesday, February 15, 2011

Could Getting More Fiber Help You Live Longer?


By Angela Haupt and Katherine Hobson, USNews.com
Mon, Feb 14, 2011

Hear fiber and you probably think of bran cereal, which doesn’t exactly make you salivate. But new research suggests more fiber could equal more years. Analyzing data from nearly 400,000 men and women ages 50 to 71, researchers found that those who consumed the most fiber were 22 percent less likely to die from any cause during the nine years they were studied. Men were 24 to 56 percent and women 34 to 59 percent less likely to die of heart and infectious or respiratory diseases, according to findings from the National Institutes of Health's AARP Diet and Health Study, published today in the Archives of Internal Medicine.

Why fiber reduces the risk of early death is unclear. Perhaps it's because fiber lowers levels of "bad" LDL cholesterol, improves blood glucose levels, reduces inflammation, and binds to potential cancer-causing agents, helping to flush them out of the body, says lead author Yikyung Park, a staff scientist at the National Cancer Institute.

What is clear, however, is that participants only benefited when fiber came from grains, like oatmeal, cornmeal, and brown rice. Fiber from fruits, vegetables, and beans had no impact on death risk. "Whole grains are rich sources of fiber, but also good sources of vitamins, minerals, and other phytochemicals that may provide health benefits," Park says. And grains have powerful antioxidant and anti-inflammatory properties--another reason researchers say grain fiber is beneficial.

Clearly, "all fibers are not created equal," cautions James Anderson, an endocrinologist at the University of Kentucky-Lexington. "Different fibers have different properties." And while the latest study emphasizes grain fiber, past studies have found that fiber from fruits and vegetables can benefit heart health.

Here's a field guide to fiber sources:

Soluble fiber: Foods high in soluble fiber, so called because of its ability to dissolve readily in liquids--include oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruits, strawberries, and apple pulp, according to the American Heart Association. Soluble fibers have been linked to lower levels of "bad" cholesterol. Viscous fibers found in foods like oat bran and beans seem to work particularly well because they form a gel in the gut that slows down fat formation and absorption, says Joanne Slavin, a professor of food science and nutrition at the University of Minnesota and author of the American Dietetic Association's 2008 position paper on dietary fiber. (The Food and Drug Administration allows heart disease health claims for oats, barley, and psyllium, the fiber found in Metamucil.) Soluble fibers also regulate blood glucose levels, says Anderson. But most soluble fibers, except psyllium, don't have the laxative effects that many people associate with fiber, so don't rely on them for that purpose.

Insoluble fiber: High levels of insoluble fiber, too, have been associated with a lower risk of heart disease--perhaps through other mechanisms. So while there's an ongoing debate over which types of fiber confer which heart-protective benefits, the take-home is that no one should rely solely on soluble fibers to get the maximal heart benefit. The AHA lists whole-wheat breads, wheat cereals, wheat bran, cabbage, beets, carrots, brussels sprouts, turnips, cauliflower, and apple skin as foods high in this type of fiber. Unlike soluble fiber, it doesn't dissolve in liquids or form a gel but instead passes through the digestive tract pretty much unchanged. Because insoluble fiber hustles things along in the digestive tract, it's also a good source of relief if you're constipated. In addition, insoluble fiber (and to some extent, the soluble kind) may help you feel fuller and possibly help weight control.

Resistant starch and others: The starch products not digested in the small intestine "fit the newer definitions of fiber," says Slavin. They're found in legumes as well as starches like potatoes, pasta, and rice that have been cooked and cooled (as in potato or pasta salad, or sushi), and barely ripe bananas. And they're also being added to foods to increase fiber content without affecting taste, as well as to reduce caloric density; a product called Hi-maize, for example, is added to pastas and energy bars. In addition, resistant starch is a "prebiotic" that, when fermented in the large intestine, increases beneficial bacteria, says Hope Warshaw, a nutritionist and author of the Real-Life Guide to Diabetes. (She's also a consultant to National Starch, the maker of Hi-maize.) It doesn't, however, seem to have the cardiovascular effects of other soluble fibers, says Anderson.

Yogurts with added fiber actually contain inulin, a group of simple sugars that are not digested. Inulin occurs naturally in chicory root and other plants and grains and is a form of soluble fiber but, like resistant starches, doesn't have the same anticholesterol effects, says Slavin. It, too, has prebiotic effects.

So what's the bottom line? The federal government's just-released Dietary Guidelines for Americans call for about 25 grams of daily fiber for women and 38 for men, and research shows we are getting only about 15 grams. But because the health benefits of different types of fiber vary--and in many cases are not clear or consistent--the best advice is to eat an array of plant-based foods, including fruits, vegetables, legumes, and whole grains. That's despite the new findings that only fiber from grains is linked to a lower risk of early death. Worry less about targeting specific types of fiber and "get [it] from as many different foods as you can," advises Slavin. And if you are selecting packaged foods on the basis of their fiber content, be sure that they are healthful in and of themselves. Cracklin' Oat Bran, for example, has 6 grams of fiber per serving, but 30 percent of its calories come from sugar and it has 3 grams of saturated fat.

Sunday, October 31, 2010

Lupus Nephritis


What is lupus nephritis?
Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system. SLE typically causes harm to the skin, joints, kidneys, and brain.
The causes of SLE are unknown. Many factors may play a role, including
  • gender—SLE is more common in women than men
  • heredity—a gene passed down by a parent
  • infections
  • viruses
  • environmental causes

What are the symptoms of lupus nephritis?

Lupus nephritis may cause weight gain, high blood pressure, dark urine, or swelling around the eyes, legs, ankles, or fingers. However, some people with SLE have no overt symptoms of kidney disease, which must be diagnosed by blood and urine tests.

How is lupus nephritis diagnosed?

Diagnosis may require urine and blood tests as well as a kidney biopsy.
·         Urine test: Blood or protein in the urine is a sign of kidney damage.
·         Blood test: The kidneys remove waste materials like creatinine and urea from the blood. If the blood contains high levels of these substances, kidney function is declining. Your doctor should estimate your glomerular filtration rate based on your creatinine score.
·         Kidney biopsy: A biopsy is a procedure to obtain a tissue sample for examination with a microscope. To obtain a sample of your kidney tissue, your doctor will insert a long needle through the skin. Examining the tissue with a microscope can confirm the diagnosis of lupus nephritis and help to determine how far the disease has progressed.

How is lupus nephritis treated?

Treatment depends on the symptoms and test results. Medicines called corticosteroids can decrease swelling and inflammation by suppressing the immune system. Additional immunosuppressive drugs related to cancer and drugs used to prevent rejection of organ transplants may also be used. In severe cases, your doctor may prescribe cyclophosphamide (Cytoxan, Neosar) or mycophenolate (CellCept). Newer experimental treatments include a drug called rituximab (Rituxan).
You may need one or more medicines to control your blood pressure.
You may need to limit protein, sodium, and potassium in your diet.
(The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.)

Lupus nephritis is also classified as a glomerular disease.


What is Dengue Fever?


Dengue Fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.

Dengue (pronounced DENG-gay) strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.

Dengue goes by other names, including “breakbone” or "dandy fever." Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait.

Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.




What areas are at high risk for contracting dengue fever?

Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Cases have also been imported via tourists returning from areas with widespread dengue, including Tahiti, Singapore, the South Pacific, Southeast Asia, the West Indies, India, and the Middle East (similar in distribution to the areas of the world that harbor malaria and yellow fever). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia.

A 2009 outbreak of dengue fever in Key West, Florida, showed that three patients who did not travel outside of the U.S. contracted the virus. Subsequent testing of the population of Key West has shown that up to 55 of the people living in the area have antibodies to dengue. As of July 17, 2010, 17 individuals have been identified that acquired dengue in Key West in 2010.

Dengue fever is common, and statistics show it may be increasing in Southeast Asia. Thailand, Vietnam, Singapore, and Malaysia have all reported an increase in cases. According to the U.S. Centers for Disease Control and Prevention (CDC), there are an estimated 100 million cases of dengue fever with several hundred thousand cases of dengue hemorrhagic fever requiring hospitalization each year. Nearly 40% of the world's population lives in an area endemic with dengue.







How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can inflict the disease.

The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway.


What are dengue fever symptoms and signs?

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen.

Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.
What is the treatment for dengue fever?

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic). Rest and fluid intake for adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory drugs should only be taken under a doctor's supervision because of the possibility of worsening hemorrhagic complications. Acetaminophen (Tylenol) and codeine may be given for severe headache and for the joint and muscle pain (myalgia).

What is the prognosis for typical dengue fever?

Typical dengue is fatal in less than 1% of cases. The acute phase of the illness with fever and myalgias lasts about one to two weeks. Convalescence is accompanied by a feeling of weakness (asthenia), and full recovery often takes several weeks.

What is dengue hemorrhagic fever?

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.

DHF starts abruptly with high continuous fever and headache. There are respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis).
In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.

Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.

The mortality (death) rate with DHF is significant. It ranges from 6%-30%. Most deaths occur in children. Infants under a year of age are especially at risk of dying from DHF.


How can dengue fever be prevented?

The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious.

The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective.



To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.

There is currently no vaccine available for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective. Early results of clinical trials show that a vaccine may be available by 2012.




Where can people get more information on dengue fever?
"Dengue," Centers for Disease Control and Prevention

http://www.cdc.gov/Dengue/








Dengue Fever At A Glance

  • Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes.
  • Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever.
  • Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America.
  • Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is purely concerned with relief of the symptoms (symptomatic).
  • The acute phase of the illness with fever and myalgias lasts about one to two weeks.
  • Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).
  • The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.
  • There is currently no vaccine available for dengue fever.