One of my favorite health tips drives my friends nuts when I start preaching about juicing!
Do you have enough time in your day to eat all the recommended fruits and vegetables that will keep you healthy and happy???
It's not easy! But my personal solution is MY JUICE MACHINE!
Look into getting a juicer for your own health boost! A juice machine is the best investment you can make for your health and happiness!
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Lets begin with a bit about what types of hair loss there are. Until someone suffers from hair loss they are unaware of the many different types of hair loss and the factors behind each one.
Male Pattern Baldness:
On average, there are 90,000 to 150,000 hairs on the scalp. The hairs grow from roots called follicles. Blood vessels at the base of each follicle provide nourishment vital for hair and hair growth. Hair growth in each root occurs in a cycle independent of each other. At any time about 90 percent of the hairs on the scalp are in the growth phase, while the other 10 percent are in the resting phase.
What is Male Pattern Baldness?:
Almost all cases of hair loss is the result of Male pattern baldness (or androgenetic alopecia). Male pattern baldness occurs much more frequently in men than in women. Even in mild cases It affects roughly 50 million men in the United States. Balding may begin at any age after puberty. While some types of hair loss is reversible, male pattern baldness tends to be permanent. It occurs in a very typical pattern on the scalp.
Hair loss usually begins at the temples and at the top of the head toward the back, causing a receding hairline and a bald spot. Sometimes progressing further until the two sections become joined,leaving a horseshoe pattern on the sides and back of the head. Male pattern baldness progresses slowly and is not associated with any physical discomfort.
What causes male pattern baldness?
Male pattern baldness is thought to be a combination of hormonal and genetic factors. Testosterone and its more potent derivative dihydrotestosterone or DHT as its known are the contributing factors of the degree of baldness. Whatever the exact causes of male pattern baldness may be, it is hereditary.
A tendency toward baldness on either side of a man's family (mother or father) indicates the speed, pattern and degree of the balding. Usually, the earlier it begins, the more severe the hair loss will be. Wearing a hat does not cause Balding. You can't regrow your hair by massaging or brushing. These are thought to be false. Stress may contribute to a form of hair loss, but normal everyday stress does not contribute to balding.
There are many treatments out there that can make a huge difference to your hair loss problem. However, from my personal experience with hair loss there are also a lot of products out there that either do nothing to help or can have some serious side effects. This is why you need to be careful which products you decide to use. For obvious reasons (don't want to get sued) I am unable to name the products that are useless or can be harmful but if you do some research in the search engines you can usually get some good information on certain hair loss forums.
However, I can tell you that there is one product that has worked for me and many other people including many celebrities. This product has had extensive clinical trials and is 100% natural without side effects. To learn more about the product please visit my website in my author box below.
Fame Ahmed has devoted his life to helping hair loss sufferers is recognised as an expert in the field. To learn more visit: Natural Hair Loss Remedy guide.
As always, before you attempt to self medicate or try a new health regimen or program we suggest you retain the services of a qualified health care professional.
Hair Loss - Natural Remedies Are Very Effective
The subject of hair loss prevention, diligence and knowledge on proper hair care play important roles in avoiding hair loss. However, not all causes of hair loss are within our control, a good majority of the leading reasons for such a condition can be avoided with the correct regimens in caring for our scalp.
If you stick with the basics, you'll have a healthier scalp and can avoid hair loss.
So what are the proper steps for hair loss prevention, you might ask?
One step is to avoid putting too many harsh chemicals on your hair. Hair will grow healthy quite naturally. While shampooing your hair, make sure that you'll give your scalp some good kneading and rubbing, to stimulate the follicles and promote sound hair growth.
An effective hair loss prevention technique is supplementing your diet with the vitamins and nutrients needed for healthy hair growth. Vitamin B6, vitamin E, biotin, amino acids and zinc are essential components for the continual stimulation of the hair follicles. Being able to acquire a daily recommended dosage of these vitamins and nutrients will help you correct any hormonal imbalance that could potentially damage your hair. And since heredity is one of the leading causes of hair loss, balancing your hormones would also ensure that your descendants won't have to suffer the curse of Alopecia.
Treating Hair Loss - Our culture is often quiet on the subject of female hair loss as there are so many jokes and commercials about baldness among man. Moreover, female hair loss is not a social acceptable condition as like that of men. One out of every five females is having thinning hair, but none of them knows the subject of female hair loss.
These are simple steps for hair loss prevention, but they would require some commitment from you. To keep yourself motivated, always remember the fact that no one is spared from the potential of hair loss. Doing something about it today will ensure that your hair will always remain on top, figuratively and literally speaking.
Then more and more of your closest friends notice how your hair is getting thinner. The best hair loss remedies, however, aren't those which you could purchase over the counter. We're talking about natural hair loss remedies that you could employ yourself, wherever you may be, whatever time of the day you wish to observe the same.
Hair loss is primarily caused by one or all of these three factors.
There is a fourth one, that is, hair loss as a consequence of another ailment or disease. For example, hair loss caused by heredity can be remedied through an intake of vitamins A, B6 and E, as well as nutrients such as zinc, biotin and some amino acids can help.
If you're losing your hair because of stress, on the other hand, then giving yourself some time to rest and relax would be the best among the hair loss remedies available to you. Neglect is the easiest to remedy. All you need is to muster enough commitment to employ proper care for your hair. Avoid overexposure under direct sunlight. Keep your hair and scalp moisturized so that they may be fed with the proper pH level that they need to say healthy. Hair loss does not have to be expensive if you look into natural solutions before it becomes a problem. With proper research you can avoid hair loss well in advance.
Dean Shainin is a well known writer. For hair loss prevention, effective hair loss remedies, current news and information on hair loss, visit his site at: Hair Loss Prevention
Hair Loss in Men; Myths and Truths
Hair Loss: one of the most confounding conditions men and women have ever struggled with. People consider their hair as kings consider their crown; an important part of one's identity, an important part of one's self. Hair and hair loss are often considered as indicators of one's youth. People tend to assume that hair loss only occurs to old individuals and though untrue they also often equate hair loss with aging. That is why people are always appalled whenever faced with the possibility of hair loss. Hence we often do whatever they can and believe whatever we hear just to make sure that we get to keep that precious hair of ours as thick and as healthy as can be.
Now, Myth Number One: We often see TV personalities and even some doctors say that stress makes your hair fall out! Although it is unclear whether stress coming from severe life events can cause alopecia, there are case reports indicating that this may be so. It is however very rare and frequently no cause can be found for severe and rapid developing alopecia. Patients who have suffered hair loss following a stressful event may still benefit from specific treatment to assist in hair re-growth.
Myth Number Two: We often hear that bad blood circulation starves the hair follicles which make them fall out. Although patients with poor blood circulation do not appear to be more likely to suffer from alopecia, tight fitting hats and wigs may cause hair loss in a very small minority of people. The mechanism is still unclear but if it occurs, this may be due to the impairment of blood flow in the scalp. That is why extreme care should be taken by alopecia sufferers who wear these garments on their heads.
Myth Number Three: when your hair is dirty it damages the hair and it falls out! Just not true! The worst thing it may do is irritate your scalp and make your hair smell. How many times at school did you have dirty hair and get away with not washing it for a couple of days? Did you lose hair then? Of course not. Myth Number Four: Shaving one's head will cause the hair to grow back thicker. This is just not true. In fact, if you are suffering from androgenic alopecia, this will actually severely quicken your hair loss.
Myth Number Five: Dandruff causes permanent hair loss. This is simply not true. Dandruff is a condition of the scalp, not the hair. Dandruff occurs because of the excessive shedding of cells on your scalp skin. For dandruff sufferers, the natural process of scalp-cell renewal is accelerated when fighting off P. ovale, a normal fungus found on every human head.
Now what really causes androgenic alopecia or hair loss in men?
Now there are the DHT and the Androgen Receptors. Testosterone is an androgen hormone which is essential for the healthy development of the body and the maintenance of the secondary sexual differences we see between men and women. Testosterone is converted by an enzyme (namely, 5-alpha reductase) to form dihytestosterone or what we know as DHT. This conversion occurs in the peripheral tissues around the body and results in higher levels of DHT in the scalp and in the blood. Although the mechanisms are not quite clear, scientists believe that DHT is plays a major part in the development of androgenetic alopecia.
From puberty onwards, androgens interact with the genetically determined androgen-sensitive hair follicles, resulting in a sequence of events. This process includes gradual miniaturisation of the hair follicles, alteration of the hair growth cycle and eventually results in small thin hair follicles - hence, the patient will experience thinning and loss of hair. To alter the process and redress the balance of hair loss, products that inhibit DHT production, or interfere with the binding of the DHT, along with products that promote hair growth can be used.
When we have the situation detailed above our bodies react by considering these hair follicles as foreign objects that need to be dealt with! This is an auto-immune response. The body then rejects these hair follicles and this exacerbates the situation. Symptoms include itching scalp, tingling and inflammation of the scalp. You should consider the use of a shampoo that treats this irrespective of the hair loss solution you choose.
Hair loss in men or androgenic alopecia can be lessened and reduced, even stopped. All you need to do is know the right information about alopecia and do the right things to combat hair loss. There are lots of hair loss treatment medicines available out there; all you need to do is to know which one is the right one for you, depending on the extent of the hair loss. Remember, that the longer you wait to treat your hair loss, the harder it will be to achieve good results. So if you want to win this hair loss battle, stand up and do it now! The quicker you take action the easier it's going to get.
Increasingly, people are turning to natural hair loss remedies as they seek to combat thinning hair. This has an obvious appeal for many sufferers and there is growing evidence to support the view that some natural remedies may be effective in curtailing hair loss. The most popular ingredients of natural hair loss treatments include ginko biloba, green tea, he shou wu, pygeum, saw palmetto and stinging nettle.
The big question however is, do natural hair loss treatments work? Firstly, hair growth at root level is a living part of the body that depends on sound nutrition, just like any other part of the body. The importance of vitamins, minerals and other nutritional elements in maintaining healthy hair cannot be disputed.
Secondly, the role of herbs and plants in treating numerous ailments is receiving increased recognition after years of neglect, and hair loss is no exception. Many herbal remedies for both internal and external use are offering new hope to people suffering from premature hair loss. Thirdly, traditional hair loss remedies may still have something to offer. Some of the more acceptable traditional approaches are now being incorporated into many potential treatment regimes.
Let's examine some simple, natural and traditional hair loss treatments;
Rosemary Solution - this herb crops up frequently in herbal texts for its ability to cleanse the scalp and stimulate the hair root. Here is one recipe that features rosemary as its core ingredient. Recipe: boil rosemary, sage, peach leaf, nettle and burdock in water. Strain and use to wash hair daily.
Apple Cider Vinegar - this is mentioned often in folk remedies for hair loss. You can find apple cider vinegar from most health food stores. It is believed to exert a normalizing effect on the scalp's oil glands and has a strong cleansing effect. Method: Part hair into sections. Apply two tablespoons of apple cider vinegar directly to the scalp with a moistened cotton ball. Allow between fifteen minutes and three hours before shampooing.
Essential Oils - essential oils distilled from plants have long been recognized for their ability to improve scalp circulation and encourage cell generation. Amongst the most useful are cedarwood, clary sage, eucalyptus, lavender and rosemary. Method: mix ten drops of essential oil with one ounce of carrier oil. Massage it into the scalp for a minimum of fifteen minutes before shampooing. Cayenne Pepper Hair Tonic - the ability of this herb to irritate the skin, increase blood flow and stimulate cell division is well known. Recipe: mix four ounces of cayenne pepper with one pint of one hundred proof vodka or pure alcohol diluted with 20 percent distilled water. Let it stand for two weeks, shaking the mixture once each day. Strain through several layers of fine cloth until the mixture is free of pepper. Once or twice a day, rub a small amount onto the thinning areas of the scalp.
Derek Pliers is a freelance journalist and a contributor to Best hair loss treatments.com
Hair Loss Problems and Best Hair Care Home Remedies!
Our eating habits greatly affect our skin and hair. Hair loss is one such problem that is greatly associated with dietary deficiency. When our hair is shiny and bouncy, we can be sure that our body is in good condition while when our hair looks dull and lifeless, it reflects an overall state of ill health. This is because our hair receives nutrition from the blood stream and grows on the nourishment it receives. Hair growth is also adversely affected by hormones, drugs and waste material. Lets now discuss some frequently asked questions on hair care and hair loss.
Q) What are the nutrients that affect our hair?
Dietary needs vary for proper hair growth. Stress deprives us of a lot of nutrients, especially magnesium. Tobacco neutralizes vitamin C and other anti-radical vitamins. Alcohol interferes with the absorption of vitamin B.
. Our hair is primarily made up of proteins. Thus, a primary necessity for good looking hair is adequate protein intake.
. Fat helps in making the hair look lustrous as linoleic acid stimulates the sebaceous gland. Sebum secreted from the sebaceous glands gives hair its shine.
. Vitamins, minerals, essential fatty acids and essential amino acids are necessary for harmonious cell balance. Therefore, they affect the cells responsible for hair growth.
. Vitamin E and C or beta-carotene, specifically act as anti-oxidants, protecting our hair from free radicals. they help our hair to stand up to pollution, chemicals, cold, sun, stress and medication.
Q) What should we eat to have great looking hair?
A balanced diet is required for healthy hair. This should consist of:
. 55% carbohydrates, especially those of slow assimilation (e.g. pasta, rice, potatoes).
. 30% Lipids, half of which should be mono saturates like olive oil, a quarter should be poly saturates like groundnut oil and sunflower oil and another quarter of saturates like butter, cream, cheese, animal fat etc.
. 15% proteins (found in cereals)
. Fruits and vegetables should represent in volume, half of your foodstuff.
<u>Feed your hair well: Hair Loss due to nutritional deficiency is known as Loose Anagen Syndrome.
Hair fall is common when one does not eat right and besides hair loss, one might find hair with white tip at its head. Falling of hair along with the white tip shows that the root is not strong enough to hold the hair in hair follicle. Dieting is a major reason for hair loss in young women.</u>
Q) My hair becomes rough and unmanageable in summer. Is it because I shampoo it too much?
Wavy hair has a tendency of becoming frizzy in summer due to humidity. Use mild frequent-use shampoos and frizz control products and conditioner.
Summer Natural Skin Care : Best Home Remedies and Products at http://www.weightloss-health.com/fruits_summer.htm
Q) I have extremely dry and rough hair. How do i make it soft? After every wash, i have to oil it.
First and the most important advice, have a hot oil treatment twice a week. If possible, apply heena, mixing it with 4 tea-spoons of lemon juice and coffee, 2 eggs and enough yoghurt, as well as 2 tea-spoons oil. This will nourish your hair and hence softens it. After shampoo, you should use a conditioner. You can also use a hair gloss. Apply tiny amounts on the palms and then smoothen over hair and leave it on. This will not only keep your hair in place but also make it look less dry.
Q) I have dandruff since many years. I have used many anti-dandruff shampoos, but nothing has worked. How can i get rid of dandruff permanently?
You should use a mild shampoo, twice a week, heat pure coconut oil and apply on the scalp at night. Next morning, apply the juice of lemon and wash your hair after half an hour. Rinse thoroughly with water. Wash your hair three or four times a week, using less shampoo, but rinsing well with water. Have weekly henna treatments. Add 4 tsps each of lemon juice and coffee, 2 raw eggs and enough curd to the henna powder, mixing it into a thick paste. Apply on the hair and wash off after an hour. If you do not wish to use egg, add more curd.
Ashley Green: for http://weightloss-health.com/ your complete and most comprehensive family guide on Health.
Look out for more hair loss home remedies and products, visit us at Best Hair Loss Home Remedies
A common problem
As it happens, we do not even notice when out hair starts to fall out and recede. Surprisingly, we lose and average of fifty to one hundred hairs daily. That is a lot but with recent scientific studies they have found many new hair loss solutions. There are three main ways to save your hair and as you read this article you will better understand everything you need to know about hair loss and how to prevent it.
At the end of this phase, the hair falls out and is replaced by a new hair. This is all a perfectly normal part of the growth cycle. In fact, on a typical day, up to 150 hairs can be lost. Baldness occurs when hair is lost at an unusually high rate and hair replacement occurs at an unusually slow rate and/or when normal hairs are replaced by weaker, smaller ones.
What is Hair Loss?
What is hair loss? Well this is the point in time when your hair starts to shed. This will gradually start to daily. You lose hair but it is not noticeable at first unless you have long hair. The main reason that scientist think hair loss occurs is because your scalp needs to absorb more nutrients and some of your hair will need to move out of the way for it to do that. The other reason would be because your hair may start to die out, new hair is made to come in and replace it.
Preventing Hair Loss
One way to prevent hair loss would be to let nature do its job. Instead of using all that high-tech equipment and all those medicines and creams, you can allow your hair to grow naturally. By treating your hair right from the start your chances of keeping it in place rise dramatically. Who needs those fancy hair loss solutions?
Speak to your doctor
Speaking to your doctor or physician about what types of creams and pills or other hair loss solutions they recommend you use is a good idea. Since all of these items have been made for you to use for your hair, you can go out and buy them right?
Wrong, even though your hair may grow back you may pick up different sicknesses from these items. In order for your hair to successfully grow back the pills or creams interfere with your hair growing hormones. If they possibly interfere with any other hormones, then you are in very big trouble.
The other way to help with hair loss is to go in for laser treatment. The way this works is that the laser technician will remove hair from areas where there is a lot of it. The bad thing about this is that they only have the ability to take out two to four hairs at a time. After the hair is removed, the insertion of it into your scalp begins. That has got to hurt! Using needles to insert the hair is very time consuming and painful; good thing you are knocked out!
These kinds of hair loss solutions cost a lot of money and can even be harmful. The rays of the laser are very strong and could damage your skin so you may want to research other hair loss solutions first. Now that you have learned about hair loss and different hair loss solutions you will hopefully make the right decision on how to restore your hair to its former glory. The saying "beauty takes pain" has come to a whole new level! Are you a man or a worrying about Hair Loss? Are you a woman or a worrying about Hair Loss? Stop worrying and visit http://www.hair-loss-answers-here.com to find the answers that you need.
Are you a man or a worrying about Hair Loss? Are you a woman or a worrying about Hair Loss? Stop worrying and visit http://www.hair-loss-answers-here.com to find the answers that you need.
Looking for more info on Hair Loss??? See Our Related Articles:
Excessive Hair Loss - There are many studies that have shown that seems to be logical reason behind male hair loss. Often it has been stated that this type of male pattern balding is genetically passed on. Male pattern ALOPECIA is often characterized by a receding hairline and or hair loss on the top of the head.
Facing Hair Problems - Hair loss is a very sad occurrence that is experienced by people both young and old. It has been a cause of great distress for people, mostly men, not only because it greatly affects one's appearance negatively but also because it could be an indication of some health problem lying underneath.
Female Hair Loss - Going bald is something that no one wants to deal with. There are however, a lot of adults that do have to face this problem at some point in time. There may even be a few teens that have to face premature hair loss.
Genetic Hair Loss - Hair loss creates baldness. A bald person looks older than his real age. This abnormal hair loss is technically called alopecia. It does not affect our health directly but indirectly it creates problems, such as low self esteem.
Hair Care Readings - Think yourself - there are so many hair loss products on the market, which promise onehundred percent cure for hair loss. But still people are buying different hair loss products and more over most of them are still having hair loss problems.
Hair Loss Articles - A great many people suffer from hair loss problems during their lives, and suffering from thinning hair - particularly at an earlier age - can prove very stressful and traumatic. We often associate hair loss with old age, but the truth is that there are many causes of this problem and it can affect anyone and at any age.
Many Hair Loss - Every human being on the planet wants to make sure that they look their best when attending a party or going out somewhere. This is natural and to some extent look the best possible is subconsciously aimed at attracting or getting noticed by the opposite sex.
Medications Hair Loss - You have probably asked yourself time and time again, what is the best hair loss product available? That question was asked on a Google answers site, and the experts answer? They stated that there is no answer to that question.
More Hair Care - Before solving a problem one must understand the problem. Hair loss is the most common medical problem. Millions of people all over the world are struggling in the endless battle to stop their hair loss.
Most Common Cause - The ordinary kind of hair loss, called hereditary hair loss, can affect both men and women, but women are usually affected less than men. The condition is so common that it nearly can be regarded as a part of the normal aging process.
Weight Loss Plan - As we all know, overweight can lead to a series of health issues such as cardiac problems, diabetes, sleep apnea and hypertension. The only way out of all these troubles is to shed those extra pounds around your waist by embracing some effective lose weight diets programs and a disciplined food habit since then.
Corrective Eye Surgery - As with any surgery, LASIK has a few complications. Scientific studies conducted in the late 1990s depicted that a meager 5% of LASIK eye surgeries resulted in some sort of complication.
More coming soon!
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Lose Weight Automatically - In 1993, Dr. Dean Ornish came out with a book entitled Eat More, Weigh Less. The primary focus of the book was to urge people to boost their consumption of whole grains, fruits, and vegetables while decreasing their consumption of fat.
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Laura Polizoti, a family intervention specialist at Youth Villages talking with “Haley”
Photo credit: Youth Villages
A recent story produced by NPR’s health reporting partnership with Boston’s WBUR and Kaiser Health News examined the youth boarding crisis at hospital Emergency Departments (EDs) in Massachusetts and nationwide, highlighting an innovative approach called ED diversion that could be a model for other states. Youth Villages, recipient of a 2022 Activation Fund grant from The Health Foundation of Central Massachusetts, is one of four agencies contracted by the state to offer related services, such as intensive in-home counseling and support, as an alternative to inpatient psychiatric treatment.
To gain deeper insight on the topic of “ED boarding,” WBUR’s Martha Bebinger joined Youth Villages staff for visits with teens and their families who have experienced the life-saving impact of the program first-hand.
ED boarding occurs when individuals go to a hospital ED in a mental health crisis and experience waiting periods of days or weeks before being admitted in a psychiatric unit due to a lack of available beds. According to a report by the Massachusetts Health and Hospital Association, the problem has been growing in Massachusetts and across the country for years and has been exacerbated by the effects of the pandemic and increased need for behavioral health services. As many as 247 children and teens were boarding in Massachusetts EDs as of March 2022. Numbers have decreased since then, and early results indicate that ED diversion programs like the one operated by Youth Villages are working— keeping youth safe while helping families avoid costly inpatient treatment and providing relief for overburdened hospital staff.
The Youth Villages model, Intercept for ED Diversion, was adapted from a well-established program for foster children that has undergone rigorous evaluation at the University of Chicago, validating the clinical model and evaluation methods. It involves a partnership with hospitals for referrals followed by development of a personalized treatment plan, which could include outpatient treatment, intensive in-home support for a minimum of 90 days, including 24/7 crisis response, and connection to other community resources as needed. The program began in 2021 as a pilot project with one hospital in the southeast region of Massachusetts, and has grown to serve youth statewide through 22 hospitals in less than two years.
In September 2022, the Foundation awarded Youth Villages an Activation Fund grant of $68,000 for upfront costs associated with hiring and training staff to expand the capacity of its Intercept for ED Diversion program in Central Massachusetts. The organization reports that this funding has enabled it to double the number of youth served through the program in Worcester County on a daily basis. This year, Youth Villages was among 11 organizations selected by the Office of the Attorney General to receive grants totaling $2.9 million for mental health diversionary services.
“We are incredibly proud of the success this program has seen and are hopeful for sustained funding that will help us provide children and families with the treatment they need in their own homes. The program not only helps change families’ course of involvement with the behavioral health system by avoiding unnecessary out of home placements, but also realizes cost savings to the system overall. We want to help as many children and families in Massachusetts as possible,” said Matt Stone, Executive Director of Youth Villages Massachusetts and New Hampshire.
“This grant to Youth Villages is an excellent example of the type of support the Activation Fund is designed to offer, which is to help an organization increase its capacity to improve health in a way that can be sustained over time,” said Dr. Amie Shei, President and CEO of the Foundation. “The Foundation is pleased to be able to support this innovative program which is having a direct impact on youth and families in Central Massachusetts.”
Now accepting applications for the 2023 grant cycle, the Activation Fund provides support for discrete projects aimed to help community organizations build capacity and/or enhance effectiveness. While the Foundation defines health broadly and does not name priority issues, it has a long history of investing in mental and behavioral health given the great need, and it has provided more than $6.9 million in grants to organizations working to address mental health needs in children and adults since 2000.
For more information on the Activation Fund and past grants, please click here.


Do you experience Anxiety? Do you spend time thinking What If this happens or What If that happens? Do you find your anxiety gets in the way of making decisions or moving forward?
Anxiety can sometimes lead to feeling isolated which can itself lead to actual isolation.
Talking with a therapist about your anxiety, what it is like to be anxious and how your experience can get in your way can be the beginnings of a less anxious life.
In therapy you get clearer about your anxiety, what the triggers are, what the affects are. We will explore how you talk to yourself which can impact your self esteem and bring on anxiety.
As you get to know more about your anxiety so you will earn ways of interrupting the critical part of you and improve your self esteem.
If you are willing and wanting to explore your anxiety then therapy can help you.
Is anxiety just worry?
Anxiety is relentless worry and fear. It is when worry and fear come together and really get in our way.
A degree of fear can be helpful. It can keep us safe. It can keep us from crossing a road in front of moving cars, it can keep us from putting our hand in a flame.
Worry too can be information, it can be our gut feeling telling us something isn’t right for us.
So, we can use fear and worry to our benefit.
Then there is anxiety which has a different quality to it. It is intense worry and fear, it can lead to panic and feeling that we can’t breath which can intensify the fear and so on.
Anxiety is real. Anxiety can be debilitating. Anxiety can be crazy making. Anxiety can leave us feeling ashamed. Anxiety can keep us stuck. Anxiety can get in our way of taking a new or next step.
Whilst you may be feeling anxiety now, it may be related to past experiences. You can hear the conversation “everything is fine now, I have what I want in life so why do I feel so anxious?” There is a clue to the anxiety you are feeling being born of an earlier experience.
Whatever the origin, be it past or current, if you want to manage your experience differently and feel less anxious and more satisfied then therapy can help.
If I sit in a room talking about my anxiety that will make me feel more anxious so what’s the point?
In my experience, this expectation keeps us away from talking about our anxiety.
You may feel anxious talking about your anxiety and you may feel some relief being heard. It is the beginning of the process.
Many people feel ashamed of feeling anxious so suffer in silence and avoid acknowledging it. An antidote to shame is talking, an antidote to anxiety is talking too.
It isn’t easy sharing our silences but it isn’t easy living with anxiety either so give yourself a choice.
What difference could therapy make?
Therapy can teach you ways to manage your anxiety by bringing you back to the hear and the now.
Anxiety is fearing loss of control and therapy can help you get to know what you are in control of and what you aren’t.
You can get clearer about what the triggers and and what the fear is. Often the fears become so big that we lose the sense of ourselves and our own resources.
You can learn how to use your own resources to support you in your anxiety and to then minimize your anxiety.
You can be in charge of your anxiety rather than it be in charge of you.


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- Historical record-setting trends in IUD use in the United States.Contraception. 2018; 98 (Dec): 467-470https://doi.org/10.1016/j.contraception.2018.05.016
- Trends in oral contraceptive and intrauterine device use among reproductive-aged women in the US from 1999 to 2017.Cancer Causes Control. 2021; 32: 587-595https://doi.org/10.1007/S10552-021-01410-8
Sternman J, Brauer A, Nejman A. As reports of IUD breakages piled up, maker changed label but many women still unaware. https://abcnews4.com/news/nation-world/as-reports-of-iud-breakage-piled-up-maker-changed-label-but-many-women-still-unaware. [accessed 14 January 2022].
- The duration of use, causes of discontinuation, and problems during removal in women admitted for removal of IUD.Contraception. 2005; 71: 149-152https://doi.org/10.1016/j.contraception.2004.08.015
- Controversies in family planning: how to manage a fractured IUD.Contraception. 2013; 88: 599https://doi.org/10.1016/j.contraception.2013.07.007
- Fractured copper intrauterine device (IUD) retained in the uterine wall leading to hysterectomy: a case report.Case Rep Womens Health. 2021; 29: e00287https://doi.org/10.1016/j.crwh.2021.e00287
- Etonogestrel implant migration to the vasculature, chest wall, and distant body sites: cases from a pharmacovigilance database.Contraception. 2017; 96 (2017): 439-445https://doi.org/10.1016/j.contraception.2017.08.009
Food and Drug Administration. FDA AEs reporting system (FAERS) public dashboard. https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/ucm070093.htm. accessed Feb 20, 2022
- Benefits and strengths of the disproportionality analysis for identification of adverse drug reactions in a pharmacovigilance database.Br J Clin Pharmacol. 2011; 72 (2011): 905https://doi.org/10.1111/j.1365-2125.2011.04037.x
National Center for Health Statistics (NCHS). 2017-2019 National Survey of Family Growth Public-Use Data and Documentation. Hyattsville, MD: CDC National Center for Health Statistics. https://www.cdc.gov/nchs/nsfg/index.htm. accessed Oct 10, 2022.
- Under-reporting of adverse drug reactions: a systematic review.Drug Saf. 2006; 29: 385-396https://doi.org/10.2165/00002018-200629050-00003
☆Publication disclosure: This manuscript and its abstract have never been published in any peer-reviewed journal.
☆☆Conflicts of interest: None of the authors have financial conflicts of interest related to this research.
☆☆☆Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Can A Male Take Diflucan
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Medicine Overview of Numlotor Tablet
Numlotor 2.5 mg/10 mg Tablet is used in the treatment of high blood pressure with high cholesterol.
Nausea, Stomach pain, Headache, Dizziness, Weakness, Edema, Constipation, Muscle pain, Increased glucose level in blood, Numbness of extremity, Flushing of skin, Decreased blood pressure, Increased liver enzymes.
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Numlotor 2.5 mg/10 mg Tablet may be taken with or without food, but it is better to take it at a fixed time.
Numlotor 2.5 mg/10 mg Tablet is a combination of two medicines: Amlodipine and atorvastatin which treat high blood pressure associated with high cholesterol levels. Amlodipine is a calcium channel blocker (CCB). It works by relaxing blood vessels which makes the heart more efficient at pumping blood throughout the body. Atorvastatin is a lipid-lowering medication which works by blocking an enzyme (HMG-CoA-reductase) that is required in the body to make cholesterol. It thus lowers "bad" cholesterol (LDL), triglycerides and raises "good" cholesterol (HDL). Together they reduce the risk of heart diseases.
In Depth Information on Numlotor Tablet
Numlotor Tablet related warnings
Taking Atorvastatin with alcohol may increase the risk of liver damage.
Numlotor 2.5 mg/10 mg Tablet is highly unsafe to use during pregnancy.
Human and animal studies have shown significant adverse effects on the foetus. Please consult your doctor.
Numlotor 2.5 mg/10 mg Tablet is probably safe to use during lactation.
Limited human data suggests that the drug does not represent a significant risk to the baby.
Do not drive unless you are feeling well.
Numlotor 2.5 mg/10 mg Tablet may cause side effects such as dizziness, headaches, nausea or tiredness, all of which could affect your ability to concentrate and drive.
Numlotor 2.5 mg/10 mg Tablet is safe to use in patients with kidney disease. No dose adjustment of Numlotor 2.5 mg/10 mg Tablet is recommended.
However, inform your doctor if you have any underlying kidney disease.
Numlotor 2.5 mg/10 mg Tablet should be used with caution in patients with liver disease. Dose adjustment of Numlotor 2.5 mg/10 mg Tablet may be needed. Please consult your doctor.
Use of Numlotor 2.5 mg/10 mg Tablet is not recommended in patients with severe liver disease and active liver disease.
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As the TV commercial opens, a mature couple, holding hands and looking lovingly at each other, are walking in a woodland. They are smiling as the voiceover talks about the medication, adalimumab (Humira), that the woman is taking to manage her rheumatoid arthritis (RA). The commercial is factual, even to the point of including the serpentine list of side effects as it fades to closing.
Yes, the medication may work if the woman faithfully continues with her regimen as directed and for long as is necessary. But will she?
A year ago, a study that looked at the large database Consortium of Rheumatology Researchers of North America (CORRONA) found that among patients with RA who were treated with tumor necrosis factor-alpha (TNF-a) inhibitors, 68.2% stayed the course at six months but only 52.2% did so at two years. In other words, more than half of RA patients had stopped taking their biologic medications within two years.
Statistics on nonadherence to biologics are hard to come by. IMS Health says that responsible use of these medications could eliminate at least $213 billion in avoidable costs each year — totaling nearly 8% of the nation’s health care spending that could be avoided.
The World Health Organization suggests that less than 50% of patients with chronic illness take their therapies as prescribed, and up to 30% of prescriptions in the United States are never filled. And AARP cautions that spending on expensive biologic drugs is growing more than 10 times faster than spending on traditionally developed small-molecule drugs.
Nonadherence as defined for oral medications means, among other things, failing to fill or pick up a prescription at the pharmacy and failure to continue the medication as prescribed. For a biologic like trastuzumab (Herceptin), it can also refer to a patient not showing up for an infusion.
“Biologics can go on for a long time,” says Rebecca Bechhold, MD, a practicing medical oncologist at Bethesda North Hospital and Christ Hospital, in Cincinnati. “I have had patients on Herceptin for seven or eight years. But then the patient is feeling better or is tired of the regimen — the time [required] to visit the physician and get the medication — and so when the patient feels well, she says ‘I don’t need this medication.’”
“Many patients do not have enough money for a lengthy regimen, and having to take a biologic for several years simply adds up to too much cost,” says Rebecca Bechhold, MD, a practicing oncologist.
That scenario also holds true for other biologic treatments for chronic diseases — like adalimumab for RA, Crohn’s, or psoriasis — that continue over several years. A recent study by Pengxiang Li and colleagues at the University of Pennsylvania examined adherence to RA biologics among Medicaid enrollees in three large state Medicaid programs whose combined enrollment represents about one third of the total Medicaid enrollment in the U.S. The findings showed that enrollees not only discontinued therapy prematurely, but also chose not to switch to another RA biologic.
Role of self-discipline
Self-management, or some say self-discipline, plays a major role. Patients tend to dislike or fear self-injection or an infusion. Often they do not fully understand the root causes or seriousness of their disease and when they begin to feel better, think they can stop their regimen. And although cancer patients have a relatively higher rate of adherence to medication — about 62% by some counts — they too will abandon their regimen when they feel better.
Success sometimes backfires
Many patients cannot find the time to follow their regimens for various reasons, and for older patients, the effort to go to a physician’s office or health center for injection or infusion can be daunting. But for many patients, as Bechhold remarks, improvement in a patient’s condition is a deterrent to adherence. Several studies have attested to patents dropping their medication regimen when they begin to see positive results, but also when they experience uncomfortable side effects.
“Cost, too, is definitely a factor,” says Bechhold. “Many patients do not have enough money for a lengthy regimen, and having to take a biologic for several years simply adds up to too much cost.”
Patients taking a biologic for a chronic disease face issues with health plans, which have prior authorization or step therapy requirements and higher copayments and coinsurance costs.
On the other hand, as is the case with the oral medications, there is no strong evidence that simply reducing the cost of a treatment regimen would lead to better patient adherence.
Are patients being educated about their illness and the treatment regimen? “Absolutely,” says Bechhold. A nurse in Bechhold’s office calls each patient to remind that treatment is due or to follow up on treatment taken. These efforts work up to a point, says Bechhold, because a reminder is not going to get the patient over to the physician’s office or to a local clinic or health center for injection or infusion services or for a follow-up on the patient’s progress.
Indeed, the onus often is put on the physician for nonadherence. Physicians counter that they do what they can with the time they have to spend with each patient and use nurse resources to assist, but they cannot force patients to comply with their regimen.
Health plans have put in place various patient-contact programs that make use of online and mail services to remind patients of their medical appointments or to simply jog the patient to take their prescribed medication, but these are mainly for the oral meds.
They also have been experimenting with discount programs for those patients who adhere to their regimens and engage in healthy lifestyle activities, but these programs have not as yet been applied to patients taking injections or infusions.
Is social media an answer? IMS, in January, issued the results of a study — “Engaging Patients Through Social Media” — that found that among the top 50 pharma companies, half participate in social media on Facebook, Twitter, or YouTube, but only 10 of those companies use all three for health care topics.
And there is no solid evidence, yet, that social media have abetted adherence to oral medications, let alone a biologic regimen. Medical monitoring devices are touted as a way of getting patients to adhere, but Bechhold doubts this would work for patients on cancer biologics, as an example: “It’s like wearing a pedometer — it won’t work if the patient doesn’t wear it.”
Health care reform and the changing medical system landscape will most likely push for better medication adherence as a way to control and even drive down costs. In a white paper, “The Evolution of Patient Adherence Programs,” Frost and Sullivan, the consulting company, points out that significant evidence is now emerging for the value that patient adherence programs can have on a product’s bottom line. The paper describes a program that calls for financial incentives to gain loyalty for a “true patient-specific relationship marketing program.”
Health reform’s changes to the medical landscape may result in a push for better adherence as a way to control costs.
Other efforts are also taking place, such as so-called intelligent diagnostics linked to patient monitoring facilities, an effort being tested for patients with diabetes. Payers are looking at various patient support programs to be implemented in satellite clinics where a nurse educator can work with patients to provide adherence guidance.
Patients need help
“The onus is squarely on the patient,” Bechhold says. It has been said that what patients want is lack of complexity; i.e. simple health regimens, convenience and, of course, low cost. The woman in the RA ad needs all the help she can get.
Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.


State of the Region's Health Report 2002 - Focus on Asthma - Chapter Three
Asthma Risk Factors and Triggers.
- Risk factors for asthma include family history of asthma and atopy, and early exposure to dust mites, tobacco smoke and other airborne substances. Risk factors increase the likelihood asthma will develop.
- Colds or infections, exercise, tobacco smoke, dust and pollen were the top five asthma triggers in a national study conducted in 1996-97.
Chapter Three - Asthma Risk Factors and Triggers (PDF file 87 KB)


Roxadustat for the treatment of anaemia in chronic kidney disease patients not on dialysis: a phase 3, randomised, open-label, active-controlled study (DOLOMITES)
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2021
BACKGROUND Roxadustat, an orally administered hypoxia-inducible factor prolyl hydroxylase inhibitor, is being evaluated for treatment of anaemia of chronic kidney disease (CKD). METHODS This randomised, open-label, active-controlled phase 3 study compared roxadustat versus darbepoetin alfa (DA) in non-dialysis-dependent (NDD) CKD patients with anaemia for ≤104 weeks. Doses were titrated to correct and maintain haemoglobin within 10.0-12.0 g/dL. The primary endpoint was haemoglobin response in the full analysis set (FAS), defined as haemoglobin ≥11.0 g/dL and haemoglobin change from baseline (CFB) ≥1.0 g/dL in patients with baseline haemoglobin >8.0 g/dL or CFB ≥2.0 g/dL in patients with baseline haemoglobin ≤8.0 g/dL during the first 24 weeks of treatment without rescue therapy (noninferiority margin, -15%). Key secondary endpoints included change in low-density lipoprotein (LDL), time to first intravenous iron use, change in mean arterial pressure (MAP), and time to hypertension occurrence. Adverse events were assessed. RESULTS Of 616 randomised patients (roxadustat, 323; DA, 293), 424 completed treatment (roxadustat, 215; DA, 209). Haemoglobin response with roxadustat was noninferior to DA (roxadustat: 256/286, 89.5% vs. DA: 213/273, 78.0%, difference 11.51%, 95% confidence interval, 5.66-17.36%). Roxadustat maintained haemoglobin for up to 2 years. Roxadustat was noninferior to DA for change in MAP and time to occurrence of hypertension and superior for change in LDL and time to first intravenous iron use. Safety profiles were comparable between groups. Findings suggest that there was no difference between groups regarding the composite endpoints major adverse cardiovascular events (MACE) and MACE + (MACE: 0.81 [0.52, 1.25], P = 0.339; MACE+: 0.90 [0.61, 1.32], P = 0.583). CONCLUSION Roxadustat is a viable option to treat anaemia in NDD CKD patients maintaining haemoglobin levels for up to 104 weeks.
Prolonged Blood Storage and Risk of Posttransfusion Acute Kidney Injury
BACKGROUND Erythrocyte transfusions are independently associated with acute kidney injury. Kidney injury may be consequent to the progressive hematologic changes that develop during storage. This study therefore tested the hypothesis that prolonged erythrocyte storage increases posttransfusion acute kidney injury. METHODS The Informing Fresh versus Old Red Cell Management (INFORM) trial randomized 31,497 patients to receive either the freshest or oldest available matching erythrocyte units and showed comparable mortality with both. This a priori substudy compared the incidence of posttransfusion acute kidney injury in the randomized groups. Acute kidney injury was defined by the creatinine component of the Kidney Disease: Improving Global Outcomes criteria. RESULTS The 14,461 patients included in this substudy received 40,077 erythrocyte units. For patients who received more than one unit, the mean age of the blood units was used as the exposure. The median of the mean age of blood units transfused per patient was 11 days [interquartile range, 8, 15] in the freshest available blood group and 23 days [interquartile range, 17, 30] in the oldest available blood group. In the primary analysis, posttransfusion acute kidney injury was observed in 688 of 4,777 (14.4%) patients given the freshest available blood and 1,487 of 9,684 (15.4%) patients given the oldest available blood, with an estimated relative risk (95% CI) of 0.94 (0.86 to 1.02; P = 0.132). The secondary analysis treated blood age as a continuous variable (defined as duration of storage in days), with an estimated relative risk (95% CI) of 1.00 (0.96 to 1.04; P = 0.978) for a 10-day increase in the mean age of erythrocyte units. CONCLUSIONS In a population of patients without severely impaired baseline renal function receiving fewer than 10 erythrocyte units, duration of blood storage had no effect on the incidence of posttransfusion acute kidney injury.
Hospitalized patients enrolled across four countries in the Informing Fresh versus Old Red Cell Management (INFORM) trial (n= 14,461).
Transfusion with freshest available erythrocyte units (n= 4,777).
Transfusion with oldest available erythrocyte units (n= 9,684).
The median of the mean age of blood units transfused per patient was 11 days in the freshest available blood group and 23 days in the oldest available blood group. In the primary analysis, post-transfusion acute kidney injury was observed in 688 of 4,777 (14.4%) patients given the freshest available blood and 1,487 of 9,684 (15.4%) patients given the oldest available blood, with an estimated relative risk of 0.94.
Efficacy and safety of vadadustat compared with darbepoetin alfa in japanese anemic patients on hemodialysis: A phase 3, multicenter, randomized, double-blind study
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2021
BACKGROUND Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis. METHODS The efficacy and safety of vadadustat, compared with darbepoetin alfa, was determined in a phase 3 double-blind study in Japanese anemic patients on hemodialysis. Patients receiving erythropoiesis-stimulating agents (ESAs) were randomized and switched to either vadadustat or darbepoetin alfa for 52 weeks. Doses were adjusted to maintain a hemoglobin level of 10.0-12.0 g/dL. The primary endpoint was average hemoglobin level at weeks 20 and 24. RESULTS Of 323 randomized patients, 120 and 135 completed the 52-week treatment period in the vadadustat and darbepoetin alfa groups, respectively. The average hemoglobin levels at weeks 20 and 24 (least square mean [LSM] and 95% confidence interval [CI]) were 10.61 (10.45-10.76) and 10.65 (10.50-10.80) g/dL in the vadadustat and darbepoetin alfa groups, respectively, demonstrating vadadustat's non-inferiority to darbepoetin alfa (difference, -0.05 g/dL; 95% CI, -0.26-0.17). In both groups, the mean hemoglobin levels were maintained within the target range for 52 weeks. Furthermore, irrespective of patient backgrounds, the LSMs at week 52 were within the target range. The most common adverse events were nasopharyngitis, diarrhea, and shunt stenosis, which occurred at similar frequencies in both groups. No new safety concerns were identified. CONCLUSIONS Vadadustat was as well tolerated and effective as darbepoetin alfa in maintaining hemoglobin levels within the target range. The findings suggest that vadadustat can be an alternative to ESA in the management of anemia in Japanese hemodialysis patients receiving ESA (Clinical Trials.gov, NCT03439137).
Daprodustat Compared with Epoetin Beta Pegol for Anemia in Japanese Patients Not on Dialysis: A 52-Week Randomized Open-Label Phase 3 Trial
American journal of nephrology. 2021;:1-10
BACKGROUND Daprodustat is an oral agent that stimulates erythropoiesis by inhibiting the prolyl hydroxylases which mark hypoxia-inducible factor for degradation through hydroxylation. Its safety and efficacy (noninferiority) were assessed in this 52-week, open-label study. METHODS Japanese patients not on dialysis (ND) (N = 299) with anemia of CKD (stages G3, G4, and G5) with iron parameters of ferritin >100 ng/mL or transferrin saturation >20% at screening were randomized to daprodustat or epoetin beta pegol (continuous erythropoietin receptor activator [CERA], also known as methoxy polyethylene glycol-epoetin beta). After initiation of the study, the daprodustat starting dose for erythropoiesis-stimulating agent (ESA)-naïve participants was revised, and daprodustat was started at 2 or 4 mg once daily depending on baseline hemoglobin. ESA users switched to daprodustat 4 mg once daily. CERA was started at 25 μg every 2 weeks for ESA-naïve patients and 25-250 μg every 4 weeks for ESA users based on previous ESA dose. In both treatment groups, dose was adjusted every 4 weeks based on hemoglobin level and changed according to a prespecified algorithm. The primary endpoint was mean hemoglobin level during weeks 40-52 in the intention-to-treat (ITT) population. ESA-naïve patients who entered before the protocol amendment revising the daprodustat starting dose were excluded from the ITT population. RESULTS Mean hemoglobin levels during weeks 40-52 were 12.0 g/dL in the daprodustat group (n = 108; 95% confidence interval [CI], 11.8-12.1) and 11.9 g/dL for CERA (n = 109; 95% CI 11.7-12.0); the difference between the groups was 0.1 g/dL (95% CI -0.1 to 0.3 g/dL). The lower limit of the 95% CI of the difference was greater than the prespecified margin of -1.0 g/dL. The mean hemoglobin level was within the target range (11.0-13.0 g/dL) during weeks 40-52 for 92% of participants in both groups. There was no meaningful difference in the frequencies of adverse events. CONCLUSIONS Oral daprodustat was noninferior to CERA in achieving and maintaining target hemoglobin levels in Japanese ND patients. Daprodustat was well tolerated, with no new safety concerns identified.
The comparative effects of intravenous iron on oxidative stress and inflammation in patients with chronic kidney disease and iron deficiency: a randomized controlled pilot study
Kidney research and clinical practice. 2021
BACKGROUND Concerns exist regarding the pro-oxidant and inflammatory potential of intravenous (IV) iron due to labile plasma iron (LPI) generation. This IRON-CKD trial compared the effects of different IV irons on oxidative stress and inflammation. METHODS In this randomized open-label explorative single-center study in the United Kingdom, non-dialysis-dependent chronic kidney disease (CKD) patients with iron deficiency were randomized (1:1:1:1) to receive a single infusion of 200 mg iron dextran, or 200 mg iron sucrose (IS), or 200 mg or 1,000 mg ferric derisomaltose (FDI) and were followed up for 3 months. The primary outcomes measured were induction of oxidative stress and inflammation. Secondarily, efficacy, vascular function, quality of life, and safety were monitored. RESULTS Forty patients were enrolled. No significant rise in oxidative stress existed, regardless of preparation or dose. There was a significant rise in LPI with 1,000 mg FDI at 2 hours that normalized within a week, not impacting oxidative stress or inflammation. A delayed rise in C-reactive protein was noted with IS. High-dose FDI produced a sustained serum ferritin increase (mean ± standard error of the mean of predose: 69.1 ± 18.4 μg/L, 3 months: 271.0 ± 83.3 μg/L; p = 0.007). Hemoglobin remained stable throughout. No adverse drug reactions were recorded during the study. CONCLUSION A single dose of IV iron in CKD patients does not trigger oxidative stress or inflammation biomarkers. Third-generation IV irons have a reassuring safety profile, and high-dose FDI produced a sustained serum ferritin rise and more efficient iron repletion, with no significant pro-oxidant or inflammatory signals when compared to a lower dose and other IV irons.
Effects of the route of erythropoietin administration on hemoglobin variability and cardiovascular events in hemodialysis patients
Kidney research and clinical practice. 2021
INTRODUCTION Despite of the routine use of erythropoietin in hemodialysis patients to correct anemia, its administration route's effects on hemoglobin variability and cardiovascular events remain elusive. Herein, we determined different erythropoietin administration routes' effects on hemoglobin variability in hemodialysis patients and the associated factors of hemoglobin variability and cardiovascular events. METHODS This is a post hoc analysis of a prospective, controlled, randomized, unblinded study with 78 Korean hemodialysis patients receiving intravenous (n = 40) or subcutaneous (n = 38) erythropoietin therapy. We evaluated hemoglobin variability by calculating the frequency of hemoglobin measurements outside the target range during all visits. The high-frequency group was defined by those with hemoglobin variability over the median value (25%) while the low-frequency group was defined by those with hemoglobin variability of <25%. RESULTS In this analysis, 37 patients (51.1%) were males, and the mean age was 50.6 ± 12.5 years. The frequency of the value being outside the target hemoglobin range was higher in the subcutaneous group compared to the intravenous group (p = 0.03). The low-frequency group required significantly lower erythropoietin doses compared to the high-frequency group. In the adjusted Cox analysis, the parameter high group was a significant independent risk factor for cardiovascular events (p = 0.03). CONCLUSION The risk out of the target hemoglobin range increased with subcutaneous administration compared with intravenous erythropoietin administration in hemodialysis patients. An increased frequency of the value being outside the target hemoglobin range was also associated with an increased risk of cardiovascular events.
A multicentre prospective double blinded randomised controlled trial of intravenous iron (ferric Derisomaltose (FDI)) in Iron deficient but not anaemic patients with chronic kidney disease on functional status
BMC nephrology. 2021;22(1):115
BACKGROUND Iron deficiency (ID) is common in patients with chronic kidney disease (CKD). Intravenous (IV) iron in heart failure leads to improvement in exercise capacity and improvement in quality-of-life measurements; however, data in patients with CKD are lacking. METHODS The Iron and the Heart Study was a prospective double blinded randomised study in non-anaemic CKD stages 3b-5 patients with ID which investigated whether 1000 mg of IV iron (ferric derisomaltose (FDI)) could improve exercise capacity in comparison to placebo measured at 1 and 3 months post infusion. Secondary objectives included effects on haematinic profiles and haemoglobin, safety analysis and quality of life questionnaires (QoL). RESULTS We randomly assigned 54 patients mean (SD) age for FDI (n = 26) 61.6 (10.1) years vs placebo (n = 28; 57.8 (12.9) years) and mean eGFR (33.2 (9.3) vs. 29.1 (9.6) ml/min/1.73m(2)) at baseline, respectively. Adjusting for baseline measurements, six-minute walk test (6MWT) showed no statistically significant difference between arms at 1 month (p = 0.736), or 3 months (p = 0.741). There were non-significant increases in 6MWT from baseline to 1 and 3 months in the FDI arm. Haemoglobin (Hb) at 1 and 3 months remained stable. There were statistically significant increases in ferritin (SF) and transferrin saturation (TSAT) at 1 and 3 months (p < 0.001). There was a modest numerical improvement in QoL parameters. There were no adverse events attributable to IV iron. CONCLUSION This study demonstrated a short-term beneficial effect of FDI on exercise capacity, but it was not significant despite improvements in parameters of iron status, maintenance of Hb concentration, and numerical increases in functional capacity and quality of life scores. A larger study will be required to confirm if intravenous iron is beneficial in iron deficient non-anaemic non-dialysis CKD patients without heart failure to improve the 6MWT. TRIAL REGISTRATION European Clinical Trials Database (EudraCT) No: 2014-004133-16 REC no: 14/YH/1209 Date First Registered: 2015-02-17 and date of end of trail 2015-05-23 Sponsor ref R1766 and Protocol No: IHI 141.
A randomized trial of albumin infusion to prevent intradialytic hypotension in hospitalized hypoalbuminemic patients
Critical care (London, England). 2021;25(1):18
BACKGROUND Intradialytic hypotension (IDH) is a frequent complication of intermittent hemodialysis (IHD), occurring from 15 to 50% of ambulatory sessions, and is more frequent among hospitalized patients with hypoalbuminemia. IDH limits adequate fluid removal and increases the risk for vascular access thrombosis, early hemodialysis (HD) termination, and mortality. Albumin infusion before and during therapy has been used for treating IDH with the varying results. We evaluated the efficacy of albumin infusion in preventing IDH during IHD in hypoalbuminemic inpatients. METHODS A randomized, crossover trial was performed in 65 AKI or ESKD patients with hypoalbuminemia (albumin < 3 g/dl) who required HD during hospitalization. Patients were randomized to receive 100 ml of either 0.9%sodium chloride or 25% albumin intravenously at the initiation of each dialysis. These two solutions were alternated for up to six sessions. Patients' vital signs and ultrafiltration removal rate were recorded every 15 to 30 min during dialysis. IDH was assessed by different definitions reported in the literature. All symptoms associated with a noted hypotensive event as well as interventions during the dialysis were recorded. RESULTS Sixty-five patients were submitted to 249 sessions; the mean age was 58 ([Formula: see text] 12), and 46 (70%) were male with a mean weight of 76 ([Formula: see text] 18) kg. The presence of IDH was lower during albumin sessions based on all definitions. The hypotension risk was significantly decreased based on the Kidney Disease Outcomes Quality Initiative definition; (15% with NS vs. 7% with albumin, p = 0.002). The lowest intradialytic SBP was significantly worse in patients who received 0.9% sodium chloride than albumin (NS 83 vs. albumin 90 mmHg, p = 0.035). Overall ultrafiltration rate was significantly higher in the albumin therapies [NS - 8.25 ml/kg/h (- 11.18 5.80) vs. 8.27 ml/kg/h (- 12.22 to 5.53) with albumin, p = 0.011]. CONCLUSION In hypoalbuminemic patients who need HD, albumin administration before the dialysis results in fewer episodes of hypotension and improves fluid removal. Albumin infusion may be of benefit to improve the safety of HD and achievement of fluid balance in these high-risk patients. ClinicalTrials.gov Identifier: NCT04522635.
Hyperoncotic Albumin Solution in Continuous Renal Replacement Therapy Patients
Blood purification. 2021;:1-10
AIM: The aim of this study was to investigate the association of hyperoncotic (20%) human albumin solution (HAS) with outcomes among critically ill patients receiving continuous renal replacement therapy (RRT). METHODS Analysis of the Randomized Evaluation of Normal versus Augmented Level (RENAL) RRT trial data. RESULTS Of 1,508 patients, 771 (51%) received albumin. Of these, 345 (45%) received 4% HAS only, 155 (20%) received 20% HAS only, and 271 (35%) received both. Patients who received combined 4% and 20% HAS were more severely ill, received more days of RENAL trial therapy and required mechanical ventilation for longer. Mean daily fluid balance was -288 mL (-904 to 261) with 20% HAS only versus 245 mL (-248 to 1,050) with 4% HAS only (p < 0.001). On Cox proportional hazards regression, 20% HAS exposure was not associated with greater 90-day mortality (odds ratio 1.12, 95% confidence interval [CI]: 0.77-1.62; p = 0.55) or longer recovery to RRT independence (sub-hazard ratio 1.04, 95% CI: 0.84-1.30; p = 0.70) compared to those who received 4% HAS only. CONCLUSIONS RENAL trial patients commonly received albumin in varying concentrations. The administration of 20% HAS was associated with a more negative fluid balance but was not independently associated with increased mortality or RRT dependence when compared to 4% HAS only.
Role of Intravenous Ascorbic Acid in the Management of Anemia in Hemodialysis Patients
Indian journal of nephrology. 2021;31(3):230-234
INTRODUCTION Patients with end-stage kidney disease (ESKD) suffer from functional iron deficiency where despite the presence of sufficient iron stores in the body, adequate iron is unavailable for heme synthesis. This study hypothesis was that in patients undergoing hemodialysis (HD), administration of intravenous (IV) ascorbic acid (AA) exerts a good effect on the management of anemia, either by increasing the mobilization of iron from tissue stores or acting as an antioxidant to overcome the inflammatory block and increase the erythropoietin sensitivity. METHODS Fifty patients with ESRD who were on regular HD were included in the study. Patients' ferritin levels ranged from 500 to 1200 ng/mL with transferrin saturation of 30% or more. However, all patients were anemic and received erythropoietin therapy. Iron therapy was discontinued in the first group, whereas it was continued in the second group that received IV AA. RESULTS A significant increase in the levels of Hb was observed in the second group after 6 months despite the decrease in ferritin levels in both the groups. Transferrin saturation decreased in both groups, the decrease being more in the first group. The levels of C-reactive protein (CRP) decreased in the second group, whereas these increased in the first group. CONCLUSIONS Intravenous AA as an adjuvant therapy with iron exerts a favorable and significant effect on the Hb, serum ferritin, and CRP levels in patients with ESKD having anemia. The discontinuation of iron therapy only decreases the serum ferritin levels and does not improve the Hb or CRP levels.


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