Showing posts with label Take. Show all posts
Showing posts with label Take. Show all posts

Tuesday, August 22, 2017

When To Take A Pregnancy Test


Emily Meade My Soul To Take

Emily Meade My Soul To Take


Diabetes latest statistics New Drugs For Diabetic Neuropathy :: diabetes latest statistics - The 3 Step Trick that Reverses Diabetes Permanently in As Little .What's in a Name? What Every Consumer Should Know About Foods and Flavors; 4 Medication Safety Tips for Older Adults; FDA: Cutting-Edge Technology Sheds Light on .2016 Viacom International Inc. All Rights Reserved. Teennick and all related titles, logos and characters are trademarks of Viacom International Inc..


Taupe Leggings

Taupe Leggings

Audi Electric Concept Suv

Audi Electric Concept Suv


2016 Viacom International Inc. All Rights Reserved. Teennick and all related titles, logos and characters are trademarks of Viacom International Inc..Diabetes latest statistics New Drugs For Diabetic Neuropathy :: diabetes latest statistics - The 3 Step Trick that Reverses Diabetes Permanently in As Little .What's in a Name? What Every Consumer Should Know About Foods and Flavors; 4 Medication Safety Tips for Older Adults; FDA: Cutting-Edge Technology Sheds Light .



Monday, August 14, 2017

When To Take A Pregnancy Test Calculator


Taupe Leggings

Taupe Leggings


When should I take a pregnancy test? The pregnancy test calculator forecasts where you are in your menstrual cycle based on last period, ovulation date, and .When should you start testing for pregnancy? You want to know as early as possible, but when is that? Use this calculator to help you decide when to take your first .When to take a pregnancy test, a summary of home tests available, and whether to trust a negative result.Having a pregnancy test calculator can really ease the confusion or just kind of put things in perspective for you, so you know when you can take a pregnancy test .When is the best time to take a pregnancy test, how soon can I take it, and when does it become positive are among important questions to ask when trying to conceive..How Soon Can You Take A Pregnancy Test? Ovulation Calculator; How Soon Can I Take A Pregnancy Test? How Far Along Am I? Due Date Calculator; Pregnancy Pro; Products..Due Date Calculator Pregnancy Test with Weeks Estimator is the FIRST and is intended for the detection of pregnancy. The test detects hCG in some .Due Date Calculator; Pregnancy Complications; Fetal Development; It's time to take a home pregnancy test! Here's everything you need to know about how they work, .Pregnancy tests are used to detect the Pregnancy Calculator The American Pregnancy Association is available to help you in locating a pregnancy test .WebMD explains how pregnancy tests work, when to take most common questions about pregnancy tests. What is a pregnancy test and how Calculator. SLIDESHOW 12 .


Taupe Leggings

Taupe Leggings

Audi Electric Concept Suv

Audi Electric Concept Suv


When should you start testing for pregnancy? You want to know as early as possible, but when is that? Use this calculator to help you decide when to take your first .When should I take a pregnancy test? The pregnancy test calculator forecasts where you are in your menstrual cycle based on last period, ovulation date, and .How Soon Can You Take A Pregnancy Test? Ovulation Calculator; How Soon Can I Take A Pregnancy Test? How Far Along Am I? Due Date Calculator; Pregnancy .Due Date Calculator; Pregnancy Complications; Fetal Development; It's time to take a home pregnancy test! Here's everything you need to know about how they work, .When is the best time to take a pregnancy test, how soon can I take it, and when does it become positive are among important questions to ask when trying to conceive..WebMD explains how pregnancy tests work, when to take most common questions about pregnancy tests. What is a pregnancy test and how Calculator. .Having a pregnancy test calculator can really ease the confusion or just kind of put things in perspective for you, so you know when you can take a pregnancy test .When to take a pregnancy test, a summary of home tests available, and whether to trust a negative result.Pregnancy tests are used to detect the Pregnancy Calculator The American Pregnancy Association is available to help you in locating a pregnancy test .Due Date Calculator Pregnancy Test with Weeks Estimator is the FIRST and is intended for the detection of pregnancy. The test detects hCG in some .



Friday, July 28, 2017

ARTIFICIAL CELLS TAKE THEIR STEPS MOVABLE CYTOSKELETON MEMBRANE FABRICATED FOR THE FIRST TIME




 Using only a few ingredients, the biophysicist Prof. Andreas Bausch and his team at the Technische Universität München (TUM) have successfully implemented a minimalistic model of the cell that can change its shape and move on its own. They describe how they turned this goal into reality in the current edition of the journal Science, where their research is featured as cover story

Cells are complex objects with a sophisticated metabolic system. Their evolutionary ancestors, the primordial cells, were merely composed of a membrane and a few molecules. These were minimalistic yet perfectly functioning systems.
Thus, "back to the origins of the cell" became the motto of the group of TUM-Prof. Andreas Bausch, who is member of the cluster of excellence "Nanosystems Initiative Munich (NIM)" and his international partners. Their dream is to create a simple cell model with a specific function using a few basic ingredients. In this sense they are following the principle of synthetic biology in which individual cellular building blocks are assembled to create artificial biological systems with new characteristics.
The vision of the biophysicists was to create a cell-like model with a biomechanical function. It should be able to move and change its shape without external influences. They explain how they achieved this goal in their latest publication in Science.

The magic ball
The biophysicists' model comprises a membrane shell, two different kinds of biomolecules and some kind of fuel. The envelope, also known as a vesicle, is made of a double-layered lipid membrane, analogous of natural cell membranes. The scientists filled the vesicals with microtubules, tube-shaped components of the cytoskeleton, and kinesin molecules. In cells, kinesins normally function as molecular motors that transport cellular building blocks along the microtubules. In the experiment, these motors permanently push the tubules alongside each other. For this, kinesins require the energy carrier ATP, which was also available in the experimental setup.

From a physical perspective, the microtubules form a two-dimensional liquid crystal under the membrane, which is in a permanent state of motion. "One can picture the liquid crystal layer as tree logs drifting on the surface of a lake," explains Felix Keber, lead author of the study. "When it becomes too congested, they line up in parallel but can still drift alongside each other."

Migrating faults
Decisive for the deformation of the artificial cell construction is that, even in its state of rest, the liquid crystal must always contain faults. Mathematicians explain these kinds of phenomena by way of the Poincaré-Hopf theorem, figuratively also referred to as the "hairy ball problem." Just as one can't comb a hairy ball flat without creating a cowlick, there will always be some microtubules that cannot lay flat against the membrane surface in a regular pattern. At certain locations the tubules will be oriented somewhat orthogonally to each other -- in a very specific geometry. Since the microtubules in the case of the Munich researchers are in constant motion alongside each other due to the activity of the kinesin molecules, the faults also migrate. Amazingly, they do this in a very uniform and periodic manner, oscillating between two fixed orientations.

Spiked extensions
As long as the vesicle has a spherical shape, the faults have no influence on the external shape of the membrane. However, as soon as water is removed through osmosis, the vesicle starts to change in shape due to the movement within the membrane. As the vesicle loses ever more water, slack in the membrane forms into spiked extensions like those used by single cells for locomotion.
In this process, a fascinating variety of shapes and dynamics come to light. What seems random at first sight is, in fact, following the laws of physics. This is how the international scientists succeeded in deciphering a number of basic principles like the periodic behavior of the vesicles. These principles, in turn, serve as a basis for making predictions in other systems.

"With our synthetic biomolecular model we have created a novel option for developing minimal cell models," explains Bausch. "It is ideally suited to increasing the complexity in a modular fashion in order to reconstruct cellular processes like cell migration or cell division in a controlled manner. That the artificially created system can be comprehensively described from a physical perspective gives us hope that in the next steps we will also be able to uncover the basic principles behind the manifold cell deformations."





Thursday, July 27, 2017

Take my neuropathy seriously please!


This short personal account struck a chord with me because I've often felt exactly the same way as the author and I'm sure many of you have also. It comes from the Neuropathy Association's, Shared Stories and highlights one of neuropathy's most irritating characteristics: you quite often just don't look sick!

Then it becomes a question of being taken seriously and being believed. Most people feel guilty enough not being able to work or take an active part in society through illness but most have some physical signs and proof that all is not well - something the people around them can latch onto and feel sympathy for. In my case, in spite of all the extra things I've had over the years including the HIV, etc, etc...I look outwardly pretty healthy for my age! And yet I'm crippled by this wretched neuropathy that has brought my active life virtually to a halt.

Has that happened to you? Do you feel you always have to convince people that there really is something wrong with you? The trouble is, it's not just your employer, colleagues, social services, or friends and acquaintances who look at you as if you're trying to pull a fast one; it's the medical professionals as well! You very quickly learn to recognise scepticism in the eyes of a new doctor, when you stagger in without obvious injury and looking healthy and begin your tale of pain and misery. You start unconsciously wanting to exaggerate, just to make that person believe you. So when you meet a doctor who greets you with kindness and sympathy, and knows what you're going through, you feel like hugging them there and then! You just don't seem to take comfort in the fact that outwardly, you look fine, which is a plus...right? What's up with all that!



I Just Want My Life Back by K.S.

I was first diagnosed with fibromyalgia and they [my doctors] contributed my foot problems (numbness, pain, tingling, etc.) to the fibromylagia. After a couple of years of getting worse, a neurologist said it was peripheral neuropathy. So, I have constant pain all through body from the fibromyalgia, and my feet prevent me from doing exercises that may give me some relief from fibromyalgia pain.

I feel I always have to tell people about my condition because I do not look sick. My family has seen me living with this for years and know the pain I live with. But at times they still don't really understand how hard it is for me to just walk through the grocery store. I have to explain to people at my children’s school the reasons I cannot volunteer for many things; because to look at me, I look normal, except I struggle to walk normal because of the pain and numbness.

This has totally taken away my life. I can no longer work or even enjoy life anymore. I was denied disability because they do not understand it. At times, it would be easier if I looked as bad as I feel, then people would better understand. But honestly, if I looked as bad as the pain I live with, I would not want to even look into a mirror. So I try to be thankful that it does not destroy my outwardly appearance.

We do not know the cause of this. I have a lot of reactions to any medications used to treat this. I visit a pain clinic once a month to be treated for pain control. I just want my life back. Thank you

- K.S.
http://www.neuropathy.org/site/News2?page=NewsArticle&id=6987&news_iv_ctrl=1181

Tuesday, July 18, 2017

Take Neuropathy To The Media


Today's informative post from tampabay.com (see link below) is something we should be seeing much more of and that is media coverage which brings easily understood information to the public at large. We see the figure of 20 million Americans living with neuropathy all over the internet, so it's baffling why the vast majority of the public have no idea what it is, or how it affects people's daily lives. If you get the chance to promote knowledge about neuropathy in the media (social or otherwise) please grab that chance and do it. Local or national media coverage has a huge effect on decision makers' consciousness and will speed up both research and modern treatment for the disease. At the moment, people living with neuropathy are frustrated at the lack of progress in the treatment of nerve damage - blanket media coverage will start a ball rolling as more and more people demand change.


Peripheral neuropathy's pain grips 20 million Americans
Irene Maher, Times Staff Writer Thursday, June 12, 2014

If you've never heard of peripheral neuropathy, just listen to people who have it and you'll begin to understand the misery it causes.

Sara McConnell says her legs — from hips to feet — feel like they're touching the glowing, red-hot burners of an electric stove. At one point, she had to quit working and move in with her mother in Pasco County.

For Bruce Dangremond, it's like having an electrical current running through his body.

"It overwhelmed my brain to where all I could do was go to bed with ice packs,'' the Lutz man said of his first major episode.

Whether severe and disabling or intermittently bothersome, neuropathy affects 20 million Americans, according to the Neuropathy Association.

Half of all diabetics will develop the condition, often after years of not having blood sugar under good control. Smoking, chronic alcoholism, infections such as Lyme disease, toxic medications such as chemotherapy, and traumatic injury can also lead to the condition.

But a third of cases have no known cause.

Usually, longer nerves, which run the length of the arms and legs and end in the fingertips and toes, are affected first. Patients report burning, numbness, tingling and sharp stabbing pain that typically starts in the fingers and toes and works its way up or down the extremities from there.

There's no cure, but people such as McConnell and Dangremond say they cope through a broad spectrum of medical treatment, meditation and support from a group of fellow victims who know their pain.

• • •

Dangremond, 65, said his neuropathy began with nothing but the occasional twinge to herald its arrival.

He woke up one morning in June 2010 with "every nerve in my body firing, pounding with pain."

"It didn't go away for hours,'' he said. For two or three years prior, he had occasional episodes of discomfort he ignored, probably the first signs that nerve damage was under way.

But the episode in 2010 sent him to the doctor, from whom he learned his case was not typical.

"Classic is to get the numbness and tingling below the knees," Dangremond said. "I was also getting it in my back, torso, face and arms."

He was soon diagnosed with idiopathic neuropathy; the symptoms were brought on by nerve damage from an unknown cause.

• • •

"Diabetes is the No. 1 cause of neuropathy in this country," said Dr. Lara Katzin, a neuromuscular specialist and assistant professor of neurology at the University of South Florida's Morsani College of Medicine.

"But 30 to 40 percent of the time, we can't identify a cause and can only help to improve the symptoms."

Knowing and addressing the cause by stopping chemotherapy, getting blood sugar under control or stopping drinking can help, but for most patients, symptoms persist.

"But the progression of the condition may stop," Katzin said, explaining the importance of intervening as early as possible.

By addressing the cause, neuropathy usually "won't get any worse, and a few patients may actually improve, but it doesn't usually go away."

• • •

There are more than 100 types of neuropathy, some more severe than others. McConnell was diagnosed in 2003 with a less common type called small fiber peripheral neuropathy. It affects her nerves of sensation and her autonomic nervous system, which controls involuntary functions such as breathing, digestion and blood pressure.

By 2007, despite treatment, her neuropathy was so severe that she had to quit her job as a Realtor and move in with her mother in San Antonio in Pasco County.

Pain medication helps. "The pain is still there, but it's a little less intense with the long-acting pain medicine. That really gave me my life back," said McConnell, 61, who now works from home a few mornings each week running an online retail business.

Other medications that might bring relief include antiseizure drugs and antidepressants. But they don't work for everyone.

Both McConnell and Dangremond have responded well to practicing meditation regularly. It helps them relax and cope with their symptoms. Attending monthly support group meetings also helps because it reminds members they aren't alone and "they aren't crazy," Dangremond said. "Something really is wrong and it's not just all in your head."

The group meets at USF in Tampa on the first Wednesday of each month.

"Patient education is lacking," said Cindy Tofthagen, a researcher and assistant professor at the USF College of Nursing who has worked with neuropathy patients for eight years. She takes calls from patients all across the country trying to learn how to live with the condition.

Tofthagen, who also is an advanced registered nurse practitioner, facilitates the support group at USF and spearheaded a free clinic to address the unmet needs of patients. Staffed by volunteer medical experts, it is held quarterly in Tampa.

"The patients are so grateful," Tofthagen said. "It's an opportunity for someone to really listen to them and troubleshoot how to meet their needs and resolve their issues.''

"The clinic helps me cope with the disease and gives me helpful tips to get through the chaos," Dangremond said. "I have hope again."

Irene Maher can be reached at imaher@tampabay.com.

Peripheral neuropathy


Nerves commonly affected

• Sensory: receive sensations such as heat, pain or touch

• Motor: control muscles

• Autonomic: control involuntary functions such as blood pressure, heart rate, digestion

Symptoms, depending on nerves affected, could include:

• Gradual numbness, tingling in feet, hands, legs, arms

• Burning pain

• Sharp jabbing, electriclike pain

• Extreme sensitivity to touch

• Coordination, balance problems

• Muscle weakness, paralysis

• Bowel, bladder, digestive problems

• Dizziness when standing

For help

To book an appointment with the Supportive Care Clinic for People With Peripheral Neuropathy or to learn more about the Tampa Bay Neuropathy Support Group, contact Cindy Tofthagen at neuropathyhelptampa@gmail.com or call (813) 368-9862.

Peripheral neuropathy's pain grips 20 million Americans 06/12/14 [Last modified: Thursday, June 12, 2014 4:21pm] © 2014 Tampa Bay Times


http://www.tampabay.com/news/health/pain-of-peripheral-neuropathy-grips-20-million-americans/2184144

Why Do We Take Extra Vitamin B For Neuropathy


Today's post from onlinelibrary.wiley.com (see link below) is an important one for several reasons, not least of which is how it shows readers how complex medical studies are set up and planned. It also questions the role of Vitamin B (in all its forms) in neuropathy treatment. It is true, wherever you look on the internet, you will see articles blithely recommending vitamin B supplementation as an answer to neuropathy symptoms and this has resulted in patients rushing to health food shops and supermarkets to stock up on vitamin B supplements. The problem is that serious studies into vitamin B supplementation are conspicuous by their absence, although occasionally, you'll see a vague warning not to 'overdose'. The most important lesson from all this is that you should only ever supplement an existing deficiency and how will you know you're deficient in vitamin B unless your doctor tests you for it? 90% of the time, patients look at the disease and wrongly conclude that extra vitamin B is the answer, without finding out the levels in their own bodies. Apart from this; which sort of vitamin B are you going to choose...and why. You'll often see vitamin B12 being recommended; or Bi, B2 etc etc, or combinations of B compounds. You get the picture!
This article refers to a study begun in the middle of last year intended 'to assess the effectiveness and safety of vitamin B supplements for the management of pain and nerve damage in people with diabetic peripheral neuropathy.' It also examines the various sorts of vitamin B and explains their purpose. Pretty important don't you think and hopefully it's just the first of many serious studies into supplements and nerve damage. The problem is that when people exhaust all the standard chemical options and the symptoms continue, their next port of call is the supplement industry and its all too voracious marketing campaigns. There's nothing wrong with that, as long as you do your research first and consult your doctor and then stop the supplement if it's having no effect!! Otherwise you're sticking a pin in the ever-growing supplement list and hoping for the best...never the healthiest option...I'm sure you agree.




Vitamin B for treating diabetic peripheral neuropathy
Hanan Khalil, Helen Chambers, Vivian Khalil, Cynthia D Ang

First published: 8 June 2016
Editorial Group: Cochrane Neuromuscular Group
DOI: 10.1002/14651858.CD012237View/save citation
Cited by: 0 articles


Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effectiveness and safety of vitamin B supplements for the management of pain and nerve damage in people with diabetic peripheral neuropathy.


Background
Description of the condition


Peripheral neuropathy is the most common risk factor for foot ulcers in people with diabetes (Duby 2004). More than 80% of all non-traumatic amputations in diabetic patients are the result of foot ulcers (Singh 2005). In 2010, the estimated world prevalence of diabetes was 285 million, a figure expected to rise to 439 million by 2030 (Shaw 2010). Diabetic peripheral neuropathy (DPN) is then expected to affect around 236 million, constituting a major cause of mortality and morbidity, with a significant associated financial cost (Tesfaye 2012). The annual cost of DPN in the United States was estimated to be USD 10.9 billion in 2010 (Gordois 2003; Zhang 2010).

Diabetic neuropathy can be divided into four broad patterns, depending upon which nerves are affected: DPN, proximal neuropathy, autonomic neuropathy, and focal neuropathies (American Diabetes Association 2014; Boulton 2004). Diabetic neuropathy affects long fibres first, including the feet and distal legs. Proximal neuropathy is often asymmetric and may involve the thighs, hips, or buttocks. Autonomic neuropathy can cause dysfunction of the gastrointestinal system, blood vessels, and urinary system, and sexual dysfunction. Focal neuropathies often occur at common sites of nerve compression and affect nerves such as the ulnar and median nerves in the arm, the peroneal nerve in the leg, nerves of the thoracic and lumbar regions, and specific cranial nerves (Boulton 2004).

The American Diabetes Association has defined DPN as “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes” (American Diabetes Association 2014). Symptoms of DPN include numbness or reduced ability to feel pain, muscle weakness, difficulty walking, and serious foot problems (Boulton 1998; Hughes 2002; Huskisson 1974).

No gold standard for diagnosing DPN exists; the history and physical examination are key, as the diagnosis remains clinical (American Diabetes Association 2014). Supportive semi-quantitative testing, such as monofilament testing (using von Frey hairs), nerve conduction studies, electromyography, and quantitative sensory testing, can also be used (Bril 2013). Exclusion of non-diabetic causes should also be undertaken, again through history, examination, and the judicious use of investigations such as serum vitamin B₁₂, thyroid function tests, blood urea nitrogen, and serum creatinine (Perkins 2001).

Early diagnosis and management of DPN are crucial for the prevention of amputations, foot ulcers, and other injuries. Successful diagnosis and management require early screening for high-risk individuals (American Diabetes Association 2014; Khalil 2013a).

Treatment of DPN is multifaceted: components include stable glucose control; regular physical check-ups including foot care; patient education; and specialist care when needed (Callaghan 2012). Pain management includes the use of medications such as, for example, pregabalin, sodium valproate, dextromethorphan, tramadol, opioids and, in some cases, topical capsaicin and lidocaine (Khalil 2013b).


Description of the intervention

The B vitamins comprise eight water-soluble compounds that have essential roles in cell metabolism: vitamin B₁ (thiamine), vitamin B₂ (riboflavin), vitamin B₃ (niacin, niacinamide, or nicotinic acid), vitamin B₅ (pantothenic acid), vitamin B₆ (pyridoxine, pyridoxal, pyridoxamine, or pyridoxine hydrochloride), vitamin B₇ (biotin), vitamin B₉ (folic acid) and vitamin B₁₂ (hydroxycobalamins, cobalamins). Each one of these components has a different physical and chemical structure and completes an essential function in the human body (Chaney 1992; Olson 1996).

Vitamins B₁, B₂, B₃, and biotin are involved in energy production; vitamin B₆ is required for amino acid metabolism. Thiamine is converted to thiamine pyrophosphate which has a role in carbohydrate metabolism. Thiamine pyrophosphate also plays a role in the transmission of nerve impulses. Riboflavin is converted into flavin mononucleotide and flavin adenine dinucleotide that serve as coenzymes for respiratory flavoproteins. The active forms of nicotinic acid are coenzymes for proteins that catalyse oxidation-reduction reactions in tissue respiration (Chaney 1992; van Boxtel 2001).

Vitamin B₆ is converted to pyridoxal phosphate and is involved in the metabolic transformations of amino acids and in the metabolism of sulphur-containing and hydroxyl-amino acids. Pyridoxal phosphate is required for the synthesis of sphingolipids for myelin formation. Vitamin B₁₂ has several congeners: cyanocobalamin, hydroxocobalamin, methylcobalamin, and 5’-deoxyadenosylcobalamin. Vitamin B₁₂ and folic acid facilitate essential steps in cell division (Chaney 1992; Hillman 1996).

Common vitamin B deficiency features include peripheral neuropathy, depression, mental confusion, lack of motor co-ordination, and malaise. Vitamin B deficiencies cause various diseases in humans such as beriberi (thiamine deficiency), pellagra (nicotinamide deficiency), megaloblastic anaemia (folic acid deficiency), and pernicious anaemia (cobalamin deficiency) (De-Regil 2010; Lassi 2013; Rodríguez-Martín 2001). The therapeutic doses for the various forms of vitamin B complex range widely, from 3 μg/day for vitamin B₁₂ to 18 mg/day for vitamin B₃ in adult males (Chaney 1992; Hillman 1996).


How the intervention might work

The mechanisms by which neuropathic pain develops in diabetes are unclear; mechanisms postulated include alteration in peripheral blood flow, increased vascularity, oxidative stress, and autonomic dysfunction (Edwards 2008; Tesfaye 2011). Overall, there is a paucity of evidence on the role of B vitamins in diabetes. Several studies found lower than normal levels of thiamine in people with diabetes, thought to be due to high renal clearance of thiamine and increased albuminuria in diabetes (Thornalley 2005). Moreover, vitamin B₁₂ deficiency has also been observed in patients with diabetes, partially explained by metformin-induced vitamin B₁₂ deficiency, particularly among people on high doses of metformin (Kibirige 2013). Mecobalamin is a derivative of vitamin B₁₂ involved in processes essential to myelin repair (Sun 2005).


Why it is important to do this review

Untreated DPN is not only associated with a significant cost to the health care system, but has a serious impact on a person's quality of life and general health. If left untreated, serious complications such as loss of function and amputations can occur. To date, evidence on the effectiveness and safety of vitamin B supplements for the treatment of DPN as an additional or alternative option to current treatments have not been fully evaluated. This review will address these issues (Rolim 2009).


Objectives

To assess the effectiveness and safety of vitamin B supplements for the management of pain and nerve damage in people with diabetic peripheral neuropathy.
Methods
Criteria for considering studies for this review


Types of studies

We will include randomised controlled trials (RCTs) and quasi-RCTs (studies that allocate participants to groups by methods that are partially systematic, for example by allocation, case record number or date of birth). We will apply no language limitations. We will include studies completed but not fully reported to reduce the risk of publication bias.


Types of participants

We will include trials of adults, children, or both, with a diagnosis of DPN based on symptoms, abnormal physiological test results, or both. For the purpose of this review, we will use the definitions of diabetes and DPN set by the American Diabetes Association (American Diabetes Association 2014). We will exclude participants with other types of neuropathy. We will exclude people who are vitamin B depleted and taking supplements for replenishment. Participants should not have taken B vitamins in the six months before the start of treatment.


Types of interventions

We will consider trials for inclusion where the intervention is any dose and type of vitamin B supplement (thiamine (B₁), riboflavin (B₂), nicotinic acid (B₃), pyridoxine (B₆), and methylcobalamin, cyanocobalamin, hydroxycobalamin, methylcobalamin, or 5’-deoxyadenosylcobalamin (B₁₂), given by any route, singly or in combination as vitamin B complexes, in comparison to placebo, no treatment, or any comparators for a minimum period of 12 weeks. We will consider trials of vitamin B complexes so long as details of the components are provided.

We will exclude studies using supplements in combination with other vitamins or drugs unless the other vitamins or drugs are administered at the same dose in both intervention and control groups.
Types of outcome measures


Primary outcomes

For painful neuropathy: short-term (three months or less) change in pain intensity, measured as the number of participants with more than a 30% improvement in pain intensity.

For non-painful neuropathy: short-term change in impairment measured by a validated scale, e.g. neuropathy impairment score (NIS) (Dyck 2005).


Secondary outcomes

Long-term (after more than three months) change in pain intensity, measured as the number of participants with more than a 30% improvement in pain.

Long-term (after more than three months) change in impairment measured by a validated scale as for the primary outcome.

3. Change in quality of life measured by a validated scale (e.g. Short-Form 36 Health Survey (SF-36)).

4. Adverse events, reported as all adverse events, adverse events which led to cessation of treatment, and serious adverse events which were life-threatening, fatal, or required or prolonged hospitalisation.
Search methods for identification of studies


Electronic searches

We will identify trials from the Cochrane Neuromuscular Specialized Register, which is maintained by the Information Specialist for the Group. The Information Specialist will search the Cochrane Central Register of Controlled Trials (CENTRAL) (current issue in The Cochrane Library), MEDLINE (January 1966 to current), EMBASE (January 1980 to current), and CINAHL Plus (January 1937 to current). We will adapt the draft MEDLINE strategy in Appendix 1 to search the other databases.

We will also search the US National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/). We will search all databases from inception to present.


Searching other resources

We will search reference lists of all primary studies and review articles to identify additional references. We will search relevant manufacturers' websites for trial information. We will search for errata or retractions of included trials.
Data collection and analysis


Selection of studies

Three review authors (HK, CA, and VK) will independently screen titles and abstracts of references from the literature searches and code them as either 'retrieve' (eligible or potentially eligible/unclear) or 'do not retrieve'. We will retrieve the full-text study reports or publications and three review authors (HK, CA and VK) will independently screen the full text and identify studies for inclusion. The review authors will identify and record reasons for exclusion of ineligible studies. We will resolve any disagreement through discussion or, if required, we will consult a third person (HC). We will identify and exclude duplicates and collate multiple reports of the same study so that each study rather than each report is the unit of interest in the review. We will record the selection process in sufficient detail to complete a PRISMA flow diagram and 'Characteristics of excluded studies' table. The review authors will not assess trials in which they are investigators.


Data extraction and management

We will use a data extraction form, which has been piloted on at least one study in the review, for study characteristics and outcome data. Two review authors (VK and HK) will extract study characteristics from included studies.

 We will extract the following study characteristics.

Methods: study design, total duration of study, details of any 'run in' period, number of study centres and location, study setting, withdrawals, and date of study.

Participants: N, mean age, age range, gender, severity of condition, diagnostic criteria, baseline characteristics, inclusion criteria, and exclusion criteria.

Interventions:
intervention, comparison, concomitant medications, and excluded medications.

Outcomes: primary and secondary outcomes specified and collected, and time points reported.

Notes: funding for trial, and notable conflicts of interest of trial authors.

Two review authors (CA and HK) will independently extract outcome data from included studies. We will note in the 'Characteristics of included studies' table if the trial report did not provide usable outcome data. We will resolve disagreements by consensus or by involving a third person (VK). One review author (HK) will transfer data into Review Manager (RevMan 2014). A second author will check the outcome data entries. A second review author (CA) will spot-check study characteristics for accuracy against the trial report.
Assessment of risk of bias in included studies

Two review authors (HK and CA) will independently assess risk of bias in each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). We will resolve any disagreements by discussion or by involving another author (VK). We will assess the risk of bias according to the following domains.

Random sequence generation.

Allocation concealment.

Blinding of participants and personnel.

Blinding of outcome assessment.

Incomplete outcome data.

Selective outcome reporting.

Other bias.


We will grade each potential source of bias as high, low or unclear and provide a quote from the study report together with a justification for our judgment in the 'Risk of bias' table. We will summarise the 'Risk of bias' judgments across the included studies for each of the domains listed. We will consider blinding separately for different key outcomes (e.g. for unblinded outcome assessment, risk of bias for all-cause mortality may be very different than for a patient-reported pain scale). Where information on risk of bias relates to unpublished data or correspondence with a trialist, we will note this in the 'Risk of bias' table.

When considering treatment effects, we will take into account the risk of bias for the studies that contribute to that outcome.
Assesment of bias in conducting the systematic review

We will conduct the review according to this published protocol and report any deviations from it in the 'Differences between protocol and review' section of the Cochrane review.


Measures of treatment effect

We will analyse dichotomous data as risk ratios and continuous data as mean difference, or standardised mean difference for results across studies with outcomes that are conceptually the same but measured in different ways. We will enter data presented as a scale with a consistent direction of effect. We will combine all the data for the outcomes measures provided that the intervention lasted for 12 weeks or more irrespective of the differences in times at which outcomes are calculated between trials.

We will undertake meta-analyses only where this is meaningful, i.e. if the treatments, participants and the underlying clinical question are similar enough for pooling to make sense. We will narratively describe skewed data reported as medians and interquartile ranges.


Unit of analysis issues

The unit of analysis is based on the individual participant (unit to be randomised for interventions to be compared), that is the number of observations in the analysis should match the number of individuals randomised (Higgins 2003).

Where multiple trial arms are reported in a single trial, we will include only the arms relevant to this review. If two or more comparisons (e.g. drug A versus drug B versus placebo) are suitable for inclusion in the same meta-analysis we will combine the relevant intervention groups together or relevant control groups together, or both, as appropriate to create a single pair-wise comparison as recommended in Chapter 16 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). If this is not possible we will follow alternative methods described in the same chapter.

We will consider only first period data from eligible randomised cross-over studies.


Dealing with missing data

We will report drop-out rates in the 'Characteristics of included studies' table and we will use intention-to-treat analysis (Higgins 2011). We plan to contact trial authors for missing data.


Assessment of heterogeneity

We will consider clinical heterogeneity before making a decision whether to pool studies. We will only perform meta-analysis if participants, interventions and comparisons are sufficiently similar. We will use the I² statistic to measure statistical heterogeneity among the trials in each analysis. If we identify substantial unexplained heterogeneity we will report it and explore possible causes by prespecified subgroup analysis. We will use the following thresholds as a rough guide for interpretation of I², as described in Higgins 2011.

0% to 40%: might not be important.

30% to 60%: may represent moderate heterogeneity.

50% to 90%: may represent substantial heterogeneity.

75% to 100%: considerable heterogeneity.
Assessment of reporting biases

If we are able to pool more than 10 trials, we will create and examine a funnel plot to explore possible small study biases.


Data synthesis

We will use a fixed-effect model in meta-analysis and if heterogeneity is present, compare these results with a those of a random-effects analysis. If the review includes more than one comparison that cannot be included in a single analysis, we will report results for each comparison separately. If the studies have significant heterogeneity and cannot be combined, we will report findings in a narrative form.

We will consider studies of vitamin B complexes as one supplement for the purposes of meta-analysis, taking into account the potential heterogeneity and indirectness of evidence from such analyses when we assess the quality of the evidence.


'Summary of findings' tables

We will create 'Summary of findings' tables using the primary and secondary outcomes. We will use the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of a body of evidence (studies that contribute data for the prespecified outcomes). We will use methods and recommendations described in Section 8.5 and Chapter 12 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) using GRADEproGDT software (GRADEpro 2014). We will justify decisions to downgrade or upgrade the quality of the evidence using footnotes and where necessary we will make comments to aid readers' understanding of the review.
Subgroup analysis and investigation of heterogeneity

We plan to carry out the following subgroup analyses.


Types of vitamin B supplement.


Children under 18 and adults.

We will use the primary outcome in subgroup analyses in Review Manager (RevMan 2014).
Sensitivity analysis

We plan to perform the following sensitivity analyses.

Repeat the analysis excluding studies at high risk of bias (from randomisation or blinding of participants).

If there is one or more very large study, repeat the analysis excluding them to determine how much they dominate the results.

Repeat the analysis using a random-effects model if heterogeneity is present.
Reaching conclusions

We will base our conclusions only on findings from the quantitative or narrative synthesis of included studies. Our implications for research will suggest priorities for future research and outline what the remaining uncertainties are in the area.
Acknowledgements

The authors would like to acknowledge the editorial support from Cochrane Neuromuscular and the Information Specialist (Angela Gunn) who developed the search strategy in collaboration with the review authors.

Some sections of the review are based on Ang 2008 and on a protocol template originally developed by Cochrane Airways and adapted by Cochrane Neuromuscular.

This project was supported by the National Institute for Health Research (NIHR) via Cochrane Infrastructure funding to Cochrane Neuromuscular. The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service, or the Department of Health. Cochrane Neuromuscular is also supported by the MRC Centre for Neuromuscular Diseases.


Appendices
Appendix 1. DRAFT MEDLINE (OvidSP) search strategy

Database: Ovid MEDLINE(R) <1946 2014="" 4="" october="" to="" week="">
Search Strategy:
--------------------------------------------------------------------------------
1 randomized controlled trial.pt. (397786)
2 controlled clinical trial.pt. (90503)
3 randomized.ab. (293092)
4 placebo.ab. (154196)
5 drug therapy.fs. (1777958)
6 randomly.ab. (205733)
7 trial.ab. (305213)
8 groups.ab. (1307610)
9 or/1-8 (3350308)
10 exp animals/ not humans.sh. (4082107)
11 9 not 10 (2854354)
12 exp Diabetes Mellitus/ (328635)
13 diabet$.mp. (462274)
14 12 or 13 (463642)
15 exp Peripheral Nervous System Diseases/ (119617)
16 15 or (neuropath$ or polyneuropath$).mp. (182081)
17 14 and 16 (20728)
18 Diabetic Neuropathies/ (12459)
19 17 or 18 (20728)
20 exp Vitamin B Complex/tu [Therapeutic Use] (23726)
21 (aminonicotinamide or cobamide$1 or cyanocobalamin or flavin mononucleutide or flavin adenine dinucleotide or fursultiamin or hydroxycobalamin or hydroxocobalamine).mp. (7678)
22 (methylcobalamin or nicorandil or nicotinic acid or nikethamide or pyridoxal or pyridoxamine or pyridoxine or riboflavin or thiamine or vitamin b complex).mp. (54422)
23 or/20-22 (74266)
24 11 and 19 and 23 (203)
25 remove duplicates from 24 (199)
Contributions of authors
HK drafted the protocol. All the other authors provided feedback on it.
Declarations of interest
None known.
Sources of support
Internal sources

None, Other.
External sources

No sources of support supplied

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012237/full

Friday, June 30, 2017

Should Older People Take Advantage Of Available Vaccines


Today's post from bgdailynews.com (see link below) may seem slightly off-topic as far as this blog is concerned but actually, very little publicity is given to the fact that vaccinations can be very useful for adults with other conditions, as well as children. It's important to know which vaccinations are available and whether they're available in your area. As far as neuropathy patients are concerned, the so-called shingles vaccine is generally available to older people but possibly not publicised because of rising costs in health sectors - nevertheless, it's an important vaccine if you've had or are susceptible to shingles and/or neuropathy. Other vaccines mentioned here may also be of interest to people living with neuropathy - discuss it with your doctor.
 

Vaccines important for adults to lower exposure to diseases  
By ALYSSA HARVEY aharvey@bgdailynews.com Aug 23, 2015

When many people think of immunizations, they automatically assume they are strictly for kids, but adults need them as well.

According to the U.S. Centers for Disease Control and Prevention, the more people who are vaccinated, the lower the possible risk of anyone’s exposure to vaccine-preventable diseases.

“The challenge is keeping up with vaccines that you’ve had. People forget it’s important to keep track,” said Julie Anderson, practice manager at the Glasser Clinic.

“That’s one of the advantages of having a family doctor because we keep track of that.”

Being immunized is important even as people grow older, said Dr. Jayashree Seshadri, an internist and employee health physician at The Medical Center.

“As you get older your immunity comes down and you’re susceptible to all kinds of illnesses,” she said.

Many vaccinations will provide a booster effect, Anderson said.

“The immunity doesn’t always last forever,” she said.

World travelers need to be immunized, Anderson said.

“If somebody’s traveling to an area of the world where they might have more or different diseases than we have here then you can get vaccinations for them,” she said.

A lot of people are asking for the whooping cough vaccine, Anderson said. The whooping cough immunization, which is part of the tetanus, diphtheria and pertussis vaccine, also known as Tdap, is recommended by the CDC to be gotten in one dose and then a booster dose every 10 years.

“Sometimes kids get whooping cough, but we have a mild infection and give it to kids who have not been immunized,” said Seshadri. “It’s very important when you’re around a newborn child you are immunized for the whooping cough.”

People also ask about the shingles vaccine, Anderson said.

“If you’ve had chicken pox as a child, you’re more prone to get shingles as an adult. (Vaccines) may prevent that. No vaccination is 100 percent guaranteed,” she said. “Check with your insurance carrier to see what vaccinations they cover. Medicare covers shingles vaccine in a pharmacy setting only, and that’s in an attempt to save costs. You have to have a prescription for that.”

The shingles vaccine is recommended for people 60 and older, but the U.S. Food and Drug Administration has approved them for ages 50 and older, Seshadri said.

“The only problem is that it is a live virus vaccine, so you have to talk to your doctor about whether or not to get it,” she said.

Fever and stress can cause the dormant chicken pox to become shingles. Complications from shingles include painful lesions and nerve pain called neuropathy that lasts after the lesions heal.

“The older you get, the opportunity of getting shingles is higher. The vaccine is designed to prevent the flare ups,” she said.

“Even if you get the flare ups they’re not as severe as they could be.”

Another vaccine elderly people over 65 should think about is for pneumonia, which can cause complications and death. Younger people with certain health conditions – including diabetes, heart failure, sickle cell disease and HIV – may also be recommended to be immunized. The vaccine is given in two doses, Seshadri said. One of them has been developed in the last two years.

“Even if you were vaccinated with the old vaccine, it’s important to think about the new vaccine,” she said.

It is vital to have flu shots every year, Seshadri and Anderson agreed.

“We know that flu is a contagious infection,” she said. “It can be mild or severe and sometimes causes death.”

Other vaccines Seshadri recommended include a tetanus shot every 10 years; the meningitis shot, particularly for those who will live in a college residence hall; and the human papillomavirus shot.

“We’re trying to catch them as kids, but if you are not vaccinated you can get them as adults,” she said of the human papillomavirus vaccine.

— For more information about adult vaccination schedules, visit the CDC website at cdc.gov.

— Follow features reporter Alyssa Harvey on Twitter at twitter.com/bgdnfeatures or visit bgdailynews.com.

http://www.bgdailynews.com/news/vaccines-important-for-adults-to-lower-exposure-to-diseases/article_8a4fd809-f808-533e-8a0a-7b705220814a.html

Friday, June 23, 2017

Friday, June 9, 2017

Can You Take A Pregnancy Test On Your Period


Koh Phangan Thong Nai Pan

Koh Phangan Thong Nai Pan


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Koh Phangan Thong Nai Pan

Koh Phangan Thong Nai Pan

Zac Efron

Zac Efron


Can Diabetes Be Cured If Your A1c Is 5 5 Can Diabetes Be Cured If Your A1c Is 5 5 :: diabetes can cause - The 3 Step Trick that Reverses Diabetes Permanently .How Can You Tell If Your Diabetic Treatment Diabetes Alternative Diabetes Treatment How Can You Tell If Your Diabetic ::The 3 Step Trick that Reverses .