LancsLive attended three inquests in late January and early February with a common thread running through them.
All three people who had lost their lives were young, not originally from Blackpool, and died from heroin overdoses.
The three, significantly, suffered from mental health problems and were taking, or had previously been taking, anti-depressants to deal with those problems.
Jack Ellis was a 24-year-old dad of four with severe depression, Savannah Sheila Neill, also 24, had Schizophrenia and anxiety, mother Emily Williams, 31, had depression.
Savannah died after taking a lethal mix of heroin and Tramadol tablets. The strong pain killers were prescribed to the 24-year-old to help her deal with some nerve pain in her leg, back and arm. She was also on a myriad of other drugs to help deal with her mental illnesses but it was the large Tramadol dose plus the heroin that caused her to pass away.
Her sister, Sam Clayton, told LancsLive: "She didn't want to end her life, she didn't get enough help and she self-medicated.
"She was on a cocktail of prescribed drugs and she got off her head. I don't think she realised what the Tramadol would have done to her."
All three inquests recorded the cause of death as 'accidental overdose'.
Jack Ellis suffered with severe depression and was found dead last August after taking large quantities of crack cocaine and heroin. Emily Williams had taken Methadone, heroin and cocaine.
Blackpool is home to some of the most vulnerable people in the country. Of the ten most deprived areas in the UK, eight of them can be found in Blackpool. NHS statistics also show that it has the highest rate of confirmed depression cases in the country, 17% of all adult, or one in six, live with the condition.
That's 24,365 people, as of 2018/2019, who live with depression.
The latest statistics show that Blackpool has the highest rate of heroin and morphine deaths by misuse in the UK as of 2018, with 13.6 per 100,000 people.
That's the highest death rate since 2010 and 2012, the resort had similar rate in 2016 when it recorded 14 deaths per 100,000.
Jessica Johnson runs the Star Blackpool service off her own back and her views on mental health in the town and drug abuse made for bad reading.
She told LancsLive: "People with drug and alcohol problems won't be seen by the mental health team they are first asked to sort out their substance abuse problem.
"But they are taking drugs because of their mental health problem."
Earlier this year, Blackpool Council announced that it would be cutting mental health jobs in a bid to save around £20m in its 2020/21 budget.
As a result, Gloucester Avenue - which provides intensive rehab for people with a whole range of mental health issues - is facing closure.
Emma Cash, co-coordinator at Star, said she fears for the people in town suffering with mental illness if Gloucester Avenue is closed.
“There are more than 24,000 people registered as depressed in Blackpool and the suicide rate is increasing year on year,” she said. “If Gloucester Avenue goes then what happens next?
“How many more deaths will there be?
“Gloucester Avenue have got placements in the building as well as outreach support services.
“We have had members that have been there. A lot of them wouldn’t have been able to access help at that vital stage otherwise.
“Also if it wasn’t for them people would be placed out of town.”
Dr Arif Rajpura, Blackpool Council Director of Public Health, was also keen to comment on the issue, describing it as 'complex'.
He said: “Despite the huge pressures on budgets Blackpool Council continues to provide a range of proactive and supportive services working with several partners to help those with drug dependency and mental health issues.
“We commission the Horizon Drug and Alcohol treatment service to support individuals with addiction.
"The service takes a whole system approach to meet people’s complex needs with access to physical and mental healthcare, along with support for housing and employment. For example, we are providing individual placement support through employment advice and support as part of the drug and alcohol treatment service.
“Other positive work is being undertaken through the Fulfilling Lives complex needs project which started three years ago is working with the most vulnerable client group who are at an increased risk of overdosing.
“We have also agreed a dual diagnosis protocol committing drug treatment and mental health services to work in collaboration, for the benefit of individuals.
"This is a protocol that will operate across the whole of Lancashire.”


The Waterford at Fort Worth senior living services
We customize a plan of care to help you with what you need while remaining as independent as possible. We offer a wide range of service plans that can be tailored to fit your specific needs.
Ideal for seniors who seek a simpler, relaxing lifestyle and can live on their own without daily assistance. Leave chores like laundry, cooking and home maintenance to us while you engage in the passions you enjoy most and discover new ones! We offer:
- 24-hour staffing
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- Access to a third-party, on-site home health agency providing wellness checks
- Emergency call systems in all apartments
Sometimes called a respite care or rehab, temporary stay is available for seniors who need extra support and monitoring for a short period—such as recovering from a surgery or injury, or while a caregiver is away.
This is also a great way to see if a senior living community is right for you. You’ll stay in a spacious, private apartment and have access to all our community’s amenities and services throughout your stay.


Botanical Name: Viola odorata
Manufactoring Method: extracted
Part of Plant: Leaves
Main Components: Unsaturated octadecanoic acids, Palmitic acid, Ethyl linoleate, Nonadienal
INCI: Viola odorata Extract, Alcohol denat.
General Information: Keep away from heat and sunlight. Keep out of reach of children. Avoid contact with eyes and mucous membranes.


Are you seeking how to master marathon 3 hour pace? If so, welcome to Nutrition Geeks. I have run 2:19.35 for the marathon. So, do understand the strategy and tactics that are needed to help you run a sub 3 hour marathon time. No, it will not be easy nor should you expect it to be. There are runners all over the world seeking to run a marathon under 3 hours. My goal as your coach and mentor is to help you achieve your goal. Athletes seeking to break the 3 hr marathon barrier need to sustain 6:52 per mile for 26.2 miles.
Also, run at or below 4:16 per kilometer in order to run a 2.59.59 time. So, you have to work smarter rather than harder to achieve this time barrier. I always recommend to my athletes to focus on a longer build up rather than a shorter training block. The marathon takes time to get right. In addition, is not as simple of an event to master like the 5k or 10k. The only way to get your marathon 3 hour pace to feel easier is to train at higher intensities.
The worlds' top distance runners are running between 35 to 40 percent of their weekly volume at or below goal race pace. Of course, they make it look easy for a reason. They are simply running more quality mileage versus the other runners around the world. In addition, they also pay attention to other fundamentals of running. For example, getting proper sleep and hydrating well before, during and after workouts.
What is the Average Pace for a 3 Hour Marathon?
Marathon 3 hour pace comes out to an average of 6:52 per mile or 4:16 per kilometer. Pace sustainment is one of the biggest challenges for most runners. My top recommendation is to be patient and take your time. Again, a longer build up of a minimum of 16 weeks and preferably 20 to 24 weeks is optimal timing. I would recommend focusing first on running 4 weeks easy and relaxed. Remember, the goal here is to just build easy, aerobic fitness. In addition, doing strides twice per week working on your acceleration and explosiveness.
Strides are short, 50 to 100 meter sprints and are perfect for warm-up drills prior to the start of your workouts. You will have spent several miles or kilometers at sprint paces over a 16 to 24 week marathon build up. Also, these are too short to build up any large amounts of lactic acid. So, you can do these on top of the other workouts you are doing each week.LEARN MORE ABOUT OUR RUNNING COURSES
How Many Miles a Week Should I Run for a Sub 3 Hour Marathon?
Athletes that are seeking to sustain marathon 3 hour pace need to focus on running at or around 70 miles a week. Consistency is everything. One of the top tactics to succeed is to follow a legitimate training plan. I have created training plans ranging from 8 to 24 weeks in length. In addition, also created a course called the Sub 3 Hour Marathon Pro which has helped many runners break the sub 3 hour marathon barrier. You can click on the button above to learn more about that course.
The overall strategy here is to improve the athlete's lactate tolerance. Easy running is still important too. You have to run easy enough on your recovery days in order to adapt to the hard training that you are doing. That being said, too many miles or kilometers run too slow will only make you a superior long, slow runner. Your goal is to run an elite marathon time which is 2.59.59 or faster. So, following a new strategy where you are doing workouts that will yield the highest results is essential.
How Do You Break a 3 Hour Marathon?
The world's top runners are running at a higher percentage of their heart rate each week. So, in order to run a marathon under 6:52 mile or 4:16 kilometer pace you have to run at faster paces. You should be doing 1, vo2 max workout per week. In addition, 1 tempo run and 1 long run each week. I am a big believer in doing faster, varied paced long runs. So, if you really want to drop significant time off of your current marathon PR you need to start running faster during long runs.
I used this tactic to lower my personal best from 2:43:36 to 2:19:35. Below are some examples of the types of long runs I was doing prior to breaking the sub 2:20 marathon barrier. You can change up the paces to fit your own sub 3 hour marathon goal. Again, the training plans and running courses I have created take the guesswork out of your preparation. You will be doing the exact workouts needed in order to run a sub 3 marathon
- 2 mile jog, 5 miles@5:30 mile pace, 2 miles easy, 1 mile in 4:55, 6 miles@6:00 mile pace, 2 miles easy, 1 mile in 5:00, 1 mile jog (20 miles)
- 1 mile jog, 10 miles@5:25 mile pace, 3 miles easy, 1 mile in 5:00, 5 miles@5:45 mile pace, 2 miles easy, 1 mile in 4:55 (23 miles)
Remember, always follow a faster long run like these the next weekend with a very easy and relaxed long run
JOG On Recovery Days
You may need between 2 to 3 days to recover from your harder workouts. So, make sure you are jogging on easy days to ensure you are adapting to the faster training you are doing. I highly recommend investing in a heart rate monitor. I use the Garmin 245 and it helps me to stay at the correct heart rate zones in order to not over train. A common mistake runners make is running too easy, too often. In addition, too fast on easy days.
So, investing in a heart rate monitor will help to ensure that you are training at the proper intensities. Below are the correct heart rate zones you need to be focusing on in training for an athlete with a max heart rate of 170BPM. Of course, you can change the numbers based on your own heart rate.
- Easy: 65-74% of max HR or around 110-125BPM
- Marathon (moderate effort): 75-84% of max HR or around 127-142BPM
- Threshold: 85-89% of max HR or around 144-149BPM
- Interval: 95-100% of max HR or around 161-170BPM
- Fast Repetitions: 105% of max HR or around 178 BPM
Run Longer Tempo Runs
If you are seeking to sustain marathon 3 hour pace longer you need to extend the duration of your tempo runs. We run between 85 to 89 percent of our max heart rate running at the anaerobic threshold. Your anaerobic threshold if the point where lactic acid begins to rise. Again, the end goal is to improve your lactate tolerance. So, the only way to get marathon 3 hour pace to feel easier is to train closer to your 5k to 10k race pace in training.
Remember, you will need to first adapt to 3 to 4 mile tempo run before you can move toward 16 kilometers or 10 miles. The longer you can spend training at this intensity the better prepared you are going to be to break the 3 hour barrier. A major mistake runners make is not running long enough at this intensity. In addition, running too many miles or kilometers too slow. The sub 3 hour marathon barrier is not an easy task to achieve. So, in order to break the barrier you have to think more about quality training rather than just volume.
Focus on Speed Development
Athletes seeking to run a sub 3 hour marathon must work on their overall speed development. You should be doing 1, vo2 max workout per week. Examples of vo2 max workouts are track intervals, hill repetitions and fartlek training. It is running at paces so fast you simply can't clear lactic acid faster than it is building up. We run between 95 to 105% of our maximum heart rate running at vo2 max.
Your vo2 max is your body's maximum oxygen uptake. One of the best ways to master marathon 3 hour pace is to train at significantly faster intensities. Sure, you will only be able to spend a few seconds to a few minutes at this intensity. That being said, it will help to make that sub 3 marathon pace to feel easier.
Would you like to keep in touch? If so, make sure to subscribe to the RunDreamAchieve YouTube channel. I focus on making new videos there each week to help runners such as yourself achieve new personal bests. I would also recommend you start adding in mental rehearsal into your routine. Mental training is commonly overlooked. The vast majority of runners only focus on physical training. The world's top runners combine both mental as well as physical training into their routine.
So, start visualizing yourself passing people, running relaxed and getting across the finish line with 2.59.59 on the clock. The best time to conduct mental training is when you first get up in the morning or when you go to bed at night. You don't need to spend more than 10 minutes per day doing this. That being said, over several weeks and months you will be training your subconscious mind to bring you the goal you are aiming for. I hope that this post has been helpful.
Make sure to click on any of the green buttons to learn more about our training plans, monthly coaching and running courses. I am certain that if you follow these fundamentals you are going to eventually run this 2.59.59 you are working toward. Please keep me posted on your progress.LEARN MORE ABOUT OUR PRIVATE, MEMBERSHIP COMMUNITY


Wishbone Grain Free Teriyaki Chicken and Rice Tray Dog Food
Indulge your Dog in this Oriental Favourite!
Take your dog on a dream trip around the world with Wishbone's newest range of Alu-Tray Meals! Made in Australia with the freshest, most natural and tastiest ingredients, each gourmet recipe is a dream come true during meal times.
A mouthwatering recipe that serves up tender australian chicken cooked to perfection in flavorful Terriyaki gravy, Wishbone's Terriyaki Chicken & Rice is a tasty formula that is all-natural and preservatives-free for the Fussiest Dogs.
Flavorful and nutritious for all dogs, Wishbone's Terriyaki Chicken & Rice contains Omega-3 fatty acids that promotes healthy skin and coat, as well as strengthening and balancing the immune system. An oriental tasty formula that your dog will never want to miss it!.
Using the freshest Australian Chicken that are free from BSE and other diseases Powered with Omega-3 for Coat & Vitality NO preservatives, by-products and harmful fillers Store in a cool and dry place. Terriyaki Chicken & Rice is formulated to meet the nutritional levels established by the AAFCO Dog Food Nutrient Profiles for all life stages. Not intended for human consumption
Chicken, Rice, Gravy, Vitamin A Supplement, Vitamin D3 Supplement, Vitamin E Supplement, Vitamin K3 Supplement, Vitamin B1 Supplement, Riboflavin Supplement, Vitamin B6 Supplement, Vitamin B12 Supplement, Vitamin C Supplement, Niacin Supplement, Pantothenic Acid, Folic Acid, Biotin
Crude Protein (min) 9% Crude Fat (min) 3% Crude Fibre (max) 0.1% Moisture (max) 83%


Nursing in public is really uncomfortable especially when you don’t have any nursing cover. Whenever we are in public and Elijah wants to breastfeed, I have to find a place where there are no people so he can breastfeed with no distractions.
I joined contests with Babybond nursing sash giveaways and luckily I won. Thanks to The All-Around Mom for hosting the contest. I was super excited in using the nursing sash the first time I received it. With my new nursing sash, I can now nurse Elijah freely even in public!
About the DESIGNER:
I learned that preverbal skills, eye contact, and attention are vital to cognitive and language development as I trained to become a Speech-Language Pathologist. However, it wasn’t until I became a mother that I fully understood and lived these truths. I believe every experience is a learning experience and that breastfeeding offers infinite opportunity to interact and communicate with your baby. And, although not typical, each of our four children spoke in eight word sentences by age two.
My determination to incorporate breastfeeding into my lifestyle meant nursing in public everywhere. It also taught me a lot about myself. I discovered that refusing to cover my baby’s head while nursing did not leave many options. I did not feel attractive when I lifted my shirt to nurse because I found myself slouching forward and it revealed my postnatal stomach and back. I also felt that by exposing my breasts, the intimacy shared between my husband and me was somehow compromised… I wanted to keep some things just for us. Please understand that these are my feelings based on my experience, and I understand that each of us has our own unique perception.
After having four babies, my closet was full of nursing tops that were not flattering and quite pricey. In December, 2006 during a 2 am feeding, I envisioned a nursing accessory that would cover mom but not her baby. The next morning, I cut and sewed one of my husband’s t-shirts into the prototype for the Slurp & Burp®. Since then, I have designed three product lines to meet the needs of a variety of nursing moms and babies. We have since rebranded to BabyBond™, a name that highlights the primary benefit of our products.
Nursing with BabyBond allows you to bond with your baby and make eye contact since your baby is not covered up by the blanket or nursing cover! It is an innovative design that allows complete coverage of Mommy while keeping Baby completely uncovered.
Three different types of BabyBond:
-is adjustable creating a custom fit as your body changes after baby arrives. A hybrid between nursing top and belly band, it can be worn to nurse from the top or the bottom of your shirt so it works with your entire wardrobe. When worn like a sash, it functions like a nursing top. When worn like a belt, it functions like a belly band. Rolls up into self-storing pouch.
-is worn like a sash, functioning like a nursing top. Nurse from the top of your shirt. Separate the layers of fabric to achieve latch on. Double panel keeps breast covered above & below. Belly & back remain covered with your own shirt. Built-in 9 x 12″ double layer terry velour burp cloth. Stores in matching pouch.
-is worn like a sash, functioning like a nursing top. Nurse from the top of your shirt. Separate the layers of fabric to achieve latch on. Double panel keeps breast covered above & below. Belly & back remain covered with your own shirt. Removable 9 x 12″ double layer terry velour burp cloth. Able to attach any cloth or wear without cloth attached. Stores in matching pouch.


Dasuquin Advanced Joint Health Supplement Soft Chews For Dogs. New products & brands arriving daily. Available in chewable tablets and tasty soft chews for dogs, or sprinkle capsules for cats, dasuquin and dasuquin advanced help inhibit cartilage breakdown and support healthy cartilage matrix.
Dasuquin® advanced with egg shell membrane starts with the exact formula of proprietary ingredients from dasuquin® advanced and adds partially hydrolyzed eggshell membrane, which has been shown to help support a quick response in joint comfort and function for dogs*. Dasuquin advanced is our most complete joint health supplement for dogs. Dasuquin is a daily oral chew that prevents cartilage breakdown to ensure that your furry friend stays active and mobile.
Table of Contents
Labeled For Sale By Veterinarians Only.
Dasuquin for dogs contains glucosamine, chondroitin, msm (methylsulfonylmethane), and asu (avocado/soybean unsaponifiables). They contain proprietary ingredients, which go above and beyond standard glucosamine/chondroitin sulfate supplements. For small to medium dogs (under 60 pounds).
Dasuquin Advanced Soft Chews Are A Complete Joint Health Supplement For Dogs.
If desired, the number of dasuquin ® advanced soft chews may then be reduced to a maintenance level. However, some dogs may respond in a shorter period of time. Dasuquin advanced is our most complete joint health supplement for dogs.
Dasuquin soft chews offer a tasty experience for supporting joint health in dogs. It contains the same trusted ingredients found in dasuquin, the #1 joint health brand recommended by veterinarians*, enhanced with a proprietary blend of ingredients to provide an approach involving several physiological mechanisms helping to support and. New products & brands arriving daily.
A Comprehensive Joint Health Management Formula For Dogs.
Shop skincare, haircare & makeup products. Available in 64 count and 140 count bags. Dasuquin® advanced soft chews joint health supplement for dogs builds on the avocado/soybean unsaponifiables (asu), glucosamine, and chondroitin sulfate, and methylsulfonylmethane (msm) combination in dasuquin® and adds boswellia serrata extract, curcumin longa extract (containing.
Similarly, You May Ask, What Is Dasuquin Advanced?
If desired, the number of dasuquin ® advanced soft chews may then be reduced to a maintenance level. Dasuquin advanced joint health supplement soft chews for small to medium dogs. Dasuquin advanced with egg shell.
Tags: chews, dasuquin, dogs, health
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Narcissists gratify themselves despite the costs to those around them. Alcoholics not in recovery continue drinking even when it hurts loved ones.
While alcoholism is an addiction and extreme narcissism is a personality disorder, narcissists and alcoholics tend to share 11 similarities. Knowing these can help you cope with people in your life who have narcissism or alcoholism.
Narcissism is characterized by iron-clad denial. From a narcissist’s point of view, he or she has no problems and can do no wrong. Bragging and a damn-the-consequences-swagger are essential parts of many narcissists’ personae.
Similarly, denial keeps addiction in place. Denial manifests for alcoholics in many ways, such as saying they can stop drinking anytime they want, lying about when they drank, or refusing to acknowledge that their drinking has costs.
That’s why participants in 12-step programs such as Alcoholics Anonymous introduce themselves with their name and say “I’m an alcoholic.” It’s a step in breaking denial.
Narcissists don’t enter a room saying “Hi, I’m Jack, I’m a narcissist.” However, their dramatic, manipulative or entitled behaviors often announce their narcissism beyond a doubt.
2) Lack of introspection
Few narcissists are interested in self-reflection. Doing so would risk encountering the deep shame and emptiness they carry.
Similarly, addiction can cover inner conflicts and uncomfortable feelings. As long as an addict uses, those feelings go unaddressed. The longer the feelings are unaddressed, the more daunting it can become to look inward and face them.


Drug treatment Category page Create Classic editor Talk0 This page needs content. You can help by adding a sentence or a photo. Add to this page!orSearch for "Drug treatment" “Assessment| Biopsychology| Comparative| Cognitive| Developmental| Language| Individual... Treatment barriers in substance abuse treatment Pages in category "Drug treatment" This category contains only the following page. T Treatment barriers in substance abuse treatment Retrieved from "http://psychology.wikia.com/wiki/Category:Drug_treatment"


As runners, we have extraordinary foundations and various explanations behind getting into the game. The accompanying seven propensities are ways of behaving the most profoundly powerful runner, not the quickest runner share for all intents and purposes, and practice consistently. To run quicker, you should consolidate speed exercises like rhythm runs and also fartlek. You can likewise attempt weight lifting and slope rushes to work on your speed. Generally, to turn into a quicker and more grounded sprinter, it’s critical to remain steady with the preparation plan.
Besides that, if you are trying to hit the gym to start some exercise make sure to get comfortable gym workout clothes first. Elite sports gym attire is easy-going and is available at an affordable price too.
In today’s blog, I will be discussing the seven effective habits of the effective runner. You too can adopt these habits if you want to become a world-class runner. So, just keep on reading the article and remain consistent.
Top 7 Habits Of Highly Effective Runners
Several Types Of Goals
Objectives differ and will probably change when you improve and acquire running experience. The runners who are newbies might need just to finish the distance interestingly, while more trained runners might be centered around running an individual best or hitting an ideal time. No matter what your expectations are, there are two kinds of objectives: result objectives and cycle objectives. Exceptionally powerful runners perceive the significance of both.
Ordinary running for novices implies getting out something like double seven days. It is smarter to run double seven days consistently than to run multiple times multi-week and afterward do not run for the following four weeks. By getting some coherence in your running preparation, your running will improve as the body adjusts to the steady preparation boost.
Aerobic fortitude is your capacity to practice at moderate force for expanded time frames, such as significant distance swimming, running, and marathons. Your body depends on your cardiorespiratory framework to work effectively during supported action to supply supplements and oxygen for muscles working. Vigorous preparation explicitly builds the number of vessels in your muscle’s fibers. It additionally further develops how proficiently you can convey oxygen to fuel the muscle functioning and how rapidly they can eliminate the waste items like lactic acid.
Also, make sure that when you are setting the goals they should be obtainable. Your running objectives should have the option to be reachable. Try not to set something that you’re not going to have the option to accomplish because that will cripple you. If you are running in your neighborhood, a half long-distance race would be a reachable objective, while a main 20 completion in that race may not.
Enjoy The Idea Of Success
Numerous runners commit the error of just putting forth result objectives and accomplishing for them or delight pivots after achieving an ideal time in exercises or races or getting a specific putting on race day. This can incite superfluous tension and lead to dissatisfaction and sensations of disappointment if these objectives are not accomplished, hence killing the tomfoolery variable of one of the number one exercises.
Recommended: What Does First-Aid Include?
Along with that, if you are an athlete searching for gym workout clothes be sure that they should be sweat-absorbing. Elite sports gym workout clothes are stylish, have anti-wicking properties, and are designed suitably for every type of workout.
Focus On Having a Healthy Diet
The runner must incorporate a healthy diet plan which must consist of the appropriate amount of carbs, proteins, and fats. By zeroing in on eating a lot of foods grown from the ground, individuals will commonly eat an adequate number of micronutrients. These incorporate nutrients and minerals which will help the bodywork and recuperate from exercises.
Successful runners take care about the consumption of a healthy diet to maximize their workout.
Learn From The Mistakes
There are several mistakes that effective runners make in the beginning but afterward, with time, they tend to learn from the previous mistakes and avoid them in the future. The common mistakes that most runners do are not performing warm-ups, running too fast, wearing old running shoes, not caring about physical injuries/ wounds, and not performing cross-training.
The world-class runners run consistently with full determination. For example, if you need to cover some distance in a race you need to practice for several weeks and need to enhance your mileage too by enhancing some distances so that you can easily cover that required distance which you need to cover during the race. So, how can you cover that distance easily? Obviously by training consistently.
It’s the secret key to success to keep yourself motivated. The force of prizes doesn’t stop at youth so try to give a reward to yourself after some achievement. Bring down your base time, Keep a solid weight.
Dress cutely for your exercise and also keep yourself hydrated.


The Comparison of Effects of State and Trait Anxiety on the Components of Sleep Quality
Background and ObjectiveCollege students suffer from sleep problems. The implications of sleep problems can affect different areas of students’ life, and this, in turn, can be influenced by other psychological characteristics such as anxiety. The aim of this study was to investigate the relationship between state and trait anxiety with components of students' sleep quality.
Materials and MethodsIn this descriptive cross-sectional study, 365 students of Kermanshah University of Medical Sciences, Kermanshah, Iran, in 2018, were selected randomly and evaluated by two questionnaires: Pittsburgh Sleep Quality Index (PSQI) and Spielberger's State-Trait Anxiety Inventory (STAI) with ethical considerations.
ResultsThere was a significant difference in sleep quality between different age groups (P < 0.001). As the age of study participants increased, the quality of sleep became poorer. The prevalence of poor sleep in students was about 63%. The highest level of correlation of state and trait anxiety was observed with the sleep latency, and the lowest level of correlation of trait anxiety was observed with the use of sleep medications.
ConclusionSleep quality is more influenced by trait anxiety and the use of sleep medications is more influenced by state anxiety. It can also be said that the anxiety of the state and trait together predict more subjective sleep quality and contribute less to the prediction of sleep duration.
Journal of Sleep Sciences, Volume:3 Issue:3, 2019
95 - 101
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Ashok K Gupta
ABSTRACT Endoscopic sinus surgery plays an integral role in the management of CRS. There are welldocumented benefits in both symptoms and quality of life. The local complications such as synechiae formation, middle turbinate lateralization, and mucosal edema can impede postoperative healing and ultimately compromise long-term surgical outcomes are reported to be less than 5%. Hobson et al evaluated the utility of middle meatal packing in reducing the risk of scarring.
Shrinath D Kamath Patla, Pretty Rathnakar, Vadisha S Bhat, Jayaramesh
ABSTRACT Aim: (a) To study the variations in the superior attachment of uncinate process. (b) Incidence of pneumatization of uncinate process was also studied. Materials and methods: A total 200 sides of 100 CT scans of paranasal sinuses coronal section were studied for variations in the superior insertion of uncinate process using Landsberg and Friedman classification. Incidence of pneumatization of uncinate process was also studied. Results: In our study out of 200 sides, type 6 attachment was commonest (41%) followed by types 1 and 2. Pneumatization of the uncinate was seen in very small percentage of cases. Conclusion: Lateral insertion of uncinate (lamina papyracea + aggar nassi) is the commonest variant followed by the insertion into the skulbase. Pneumatization of uncinate is rare. Clinical significance: Though the inferior attachment of the uncinate is almost constant the superior attachment has several variations, the knowledge of which is very important for the endoscopic surgeon to avoid intraoperative complications. Keywords: Aggar nasi, Cribriform plate, Lamina papyracea, Middle turbinate, Pneumatization, Uncinate process. How to cite this article: Patla SDK, Rathnakar P, Bhat VS, Jayaramesh. A Radiological Study of Anatomical Variations of Uncinate Process. Clin Rhinol An Int J 2016;9(2):59-61. Source of support: Nil Conflict of interest: None
Vinit K Sharma, Rohit Sharma, Ashish Mehrotra, Zafar Iqbal, Kunal Nigam
ABSTRACT Erosion of bone with or without extension of disease into adjacent anatomic spaces is observed among some patients with fungal rhinosinusitis (FRS). Preoperative computed tomographies is very important to determine the sites of bony erosion. Patients with bony erosions are classified based on the involved subsite and the extent of erosion. Bony erosions was seen in 37.5% cases. Six patients were having bone erosions on CT scan. 40 % erosions were present in patients belonging to younger age group. Erosion of sinus boundaries were more common in male patients (60%). The ethmoid sinus complex was most commonly involved (46.6%). This was followed in frequency of involvement by the maxillary sinus (26.6%), the sphenoid sinus (20%) and the frontal sinus (6.6%). The most common site of erosion was the lamina papyracea (33.3%), followed by the medial maxillary wall(20%). Bony erosions due to FRS were mainly due to long-term mechanical compression by the fungal mass. A case of chronic rhinosinusitis with bony erosions in CT scan may indicate a fungal etiology. Keywords: Bony erosions, Fungal rhinosinusitis, Fungal rhinosinusitis. How to cite this article: Sharma VK, Sharma R, Mehrotra A, Iqbal Z, Nigam K. A Retrospective Study of Bony Erosion Patterns in Cases of Fungal Rhinosinusitis. Clin Rhinol An Int J 2016;9(2):62-64. Source of support: Nil Conflict of interest: None
Shilpam Sharma, Abhinav Srivastava, Chander Mohan Sharma
ABSTRACT Introduction: The correlation between middle ear pathology due to Eustachian tube dysfunction and nasal allergy has been a topic of debate since long. Studies of the pathogenesis of otitis media have identified interactions among infection, allergic reactions and Eustachian tube dysfunction. AIMS- The aim of this study was to evaluate the relationship between Eustachian tube dysfunction and nasal allergy and to evaluate the efficacy of oral steroids and intranasal steroidal spray on Eustachian tube dysfunction. Materials and methods: The patients were diagnosed according to the diagnostic criteria of allergic rhinitis. A total of 50 patients having moderate/severe symptoms who had not taken any treatment for allergic rhinitis in the past 6 weeks with deranged middle ear function were included in the study. Group I patients were given Prednisolone, 30 mg once daily for 10 days in tapering dose along with intranasal steroid spray for 6 weeks. Group II patients were given only intranasal steroid spray for 6 weeks. Impedance audiometry was repeated at the end of 6 weeks and results were statistically analyzed. Result: This study demonstrated the outcome of systemic steroids and intranasal steroidal spray in the treatment of middle ear dysfunction. In our study impedance audiometry was done at the start of study and showed type B tympanogram in 36% ears in group I and 21% in group II and type C tympanogram in 60% in group I and 50% in group II. Impedance audiometry was repeated at 10 days of treatment and showed reversal to type A curve in 26% of ears in group I and 14% of ears in group II. Impedance audiometry at the end of treatment demonstrated reversal to type A tympanogram in 64% of ears in group I and 48 % of ears in group II. Keywords: Allergic rhinitis, Intranasal steroidal spray, Middle ear dysfunction, Oral steroids. How to cite this article: Sharma S, Srivastava A, Sharma CM. Middle Ear Dysfunction: Connection to Allergic Rhinitis. Clin Rhinol An Int J 2016;9(2):65-67. Source of support: Nil Conflict of interest: None
Hemanth Vamanshankar, Satish C Kumar, AP Preetham, Musarrat Feshan
ABSTRACT Introduction: This study compares the nasal mucociliary clearance time of patients with chronic sinusitis (pre- and postoperatively) and smokers, with controls, attending the ear, nose, and throat outpatient department at Southern Railway Headquarters Hospital, Perambur, Chennai. Materials and methods: Saccharin granule was used to study mucociliary clearance as it is safe, easy, fast, and reliable. A total of 32 patients in each group were studied. In chronic rhinosinusitis patients, the test was done preoperatively and 4 weeks postoperatively. Results: The average mucociliary clearance time pre- and postoperatively in chronic rhinosinusitis patients was 29.54 ± 28.68 and 12.17 ± 5.84 respectively. Cigarette smokers had a longer mucociliary clearance time (27.63 ± 21.11) compared with beedi smokers (24.04 ± 24.93). Controls had the fastest mucociliary clearance rate of 9.67 ± 4.62 among the study subjects. Conclusion: Surgery for chronic rhinosinusitis improves both the overall symptoms of chronic rhinosinusitis and the protective functions of the nose and paranasal sinuses. Smokers had an impaired clearance rate compared with normals. As age advances, the mucociliary clearance rate becomes slower. Keywords: Chronic rhinosinusitis, Mucociliary clearance, Sacchain, Smokers. How to cite this article: Vamanshankar H, Kumar SC, Preetham AP, Feshan M. Mucociliary Function: Its Variations with Disease. Clin Rhinol An Int J 2016;9(2):68-73. Source of support: Nil Conflict of interest: None
Vinish K Agarwal, Mamta Goyal, Sampan S Bist
ABSTRACT Introduction: Allergic rhinitis (AR) is a global health problem that significantly alters patients’ social life and affects learning at school and work productivity. Materials and methods: A total of 150 patients suggestive of a history of AR were included in this study. The patients underwent a thorough history, clinical examination, diagnostic nasal endoscopic evaluation, and radiological imaging. Results: Out of 150 patients, 65% were male, whereas 35% were female ranging from age 14 to 70 years; 30% of both male and female were between 21 and 25 years; and 85% belonged to urban area, whereas 15% were rural inhabitants. The most significant complaints of patients were mainly paroxysmal sneezing, nasal obstruction, and watery nasal discharge. In the present study, 21% of patients had first-degree relatives with a complaint of AR; 72% of male patients and 75% of female patients had swollen turbinate; 59% of male patients and 62% of female patients had pale edematous nasal mucosa; 68% of male patients and 56% of female patients had granular pharyngitis; and 25% of male patients and 40% of female patients had complications of AR. Conclusion: Allergic rhinitis is a disease of youth that affects mostly people in the age group of 21 to 25 years, and it is paroxysmal sneezing that concerns most of the patients and brings them to hospital. About 60% of the patients have a history of contact with the AR patients. Clinical significance: Allergic rhinitis involves nearly 600 million people all over the world. Our study suggests three cardinal signs of AR, viz., swollen turbinate, pale and edematous nasal mucosa, and granular pharyngitis. This study also signifies female preponderance for complications of AR. Keywords: Allergic rhinitis, Complication, First-degree relatives, Paroxysmal sneezing, Swollen turbinate. How to cite this article: Agarwal VK, Goyal M, Bist SS. Study of Predisposing Factor, Clinical Profile, and Complications of Allergic Rhinitis. Clin Rhinol An Int J 2016;9(2):74-76. Source of support: Nil Conflict of interest: None
Santosh B Mane, Kalpana S Dasgupta
ABSTRACT Objective/hypothesis: Nasal and paranasal sinus disease can cause Eustachian tube (ET) dysfunction leading to middle ear (ME) hypoventilation. Persistent ME hypoventilation can result in ME conditions like retraction of tympanic membrane, otitis media with effusion, and chronic ME disease. Aim: Aim of this study was to evaluate the ET function in cases of sinonasal polyposis. Evaluation was done by doing tympanometry. Materials and methods: This was a hospital-based prospective study consisting of 42 patients (84 ears) of nasal polyposis, of which 27 patients had antrochoanal (AC) polyp and 15 patients had ethmoidal polypi. After thorough history and detail clinical examination, tympanometry was done in all patients 1 day prior to surgery and 4 to 6 weeks after surgery. Results: Preoperatively in 30 ears (15 patients) of ethmoidal polypi had normal tympanogram (A type) in 40% ears and abnormal tympanogram (B and C) in 60% ears. Postoperatively 80% had A tympanograms and 20% had abnormal tympanogram. There was significant improvement on removal of polypi (p = 0.004). Preoperatively 54 ears (27 patients) of AC polyp had normal tympanogram (type A) in 55.56% ears and abnormal tympanogram (B and C) in 44.44% ears. Postoperatively normal tympanogram was seen in 81.48% and abnormal tympanogram in 18.52% ears, so there was significant improvement after functional endoscopic sinus surgery (p = 0.007). Conclusion: Eustachian tube dysfunction was present preoperatively in 60 and 44.44% in ethmoidal and AC polypi respectively, while in postoperative period dysfunction was 20 and 18.52%. So function improves on removal of polyp. Keywords: Eustachian tube, Nasal polyp, Otitis media with effusion, Tympanogram, Tympanometry. How to cite this article: Mane SB, Dasgupta KS. Sinonasal Polyposis and Its Effect on Eustachian Tube Function. Clin Rhinol An Int J 2016;9(2):77-80. Source of support: Nil Conflict of interest: None
Pankaj Gupta, Suruchi Gupta, Amit Poredi, Zoramthara Zadeng
ABSTRACT Background: Hyaluronidase belongs to a family of enzymes that degrades hyaluronic acid, which is a constituent of the extracellular matrix. The property of hyaluronidase to help relieve tissue adhesions has found implications in epidural neuroplasty, failed back surgery syndrome, abdominal adhesions, and in prevention of formation of adhesions postoperatively in laparoscopic ventral hernia repair. There is no previous study supporting the role of hyaluronidase in relieving the adhesions around the orbital masses and aiding in their delivery. This article intends to discuss the utility of hyaluronidase in orbital mass excision by relieving adhesions around the mass. Aim: The purpose of this article is to describe the successful use of hyaluronidase intraoperatively for excision of orbital cavernous hemangioma. This patient had an orbital cavernous hemangioma of 8 years’ duration. Materials and methods: This report describes a patient who presented with unilateral proptosis of long-standing duration and visual diminution of 6 months’ duration. Radiological imaging showed presence of intraconal cavernous hemangioma in the right orbit. The patient underwent transconjunctival orbitotomy for orbital mass excision. Intraoperatively, 5 mL of injection hyaluronidase 300 IU/mL diluted in balanced salt solution was injected around the mass for adhesiolysis using a 25-gauge cannula. Conclusion: The intraoperative use of hyaluronidase helped in relieving the adhesions around the mass and helped in its easy delivery without undue manipulation. Clinical significance: Hyaluronidase is helpful in adhesiolysis around the orbital masses and promotes their easy delivery. This helps in early recovery and decreased postoperative tissue edema. This is first such report implicating the role of hyaluronidase in orbital mass excision. Keywords: Hyaluronidase, Orbital mass, Orbitotomy. How to cite this article: Gupta P, Gupta S, Poredi A, Zadeng Z. Role of Hyaluronidase in Orbital Mass Excision. Clin Rhinol An Int J 2016;9(2):81-83. Source of support: Nil Conflict of interest: None
ABSTRACT Sinonasal inverted papilloma is a benign neoplasm of epithelial origin, which represents 0.5 to 4% of all sinonasal tumors. Despite the histological benign nature of this type of tumor, it has a high rate of recurrence after surgical resection and significant malignant potential. Sinonasal inverted papilloma is treated as a locally aggressive tumor. The aggressive surgical approaches, such as en bloc resection via external excision or extensive mucosal stripping of the ipsilateral sinuses are replaced by less invasive intranasal endoscopic approaches. This creates a need for a very accurate preoperative assessment of the location of the tumor on computed tomography (CT) scan and identifies the location of the primary changes. Determination of the primary location of inverted papilloma is especially important for a radical resection of the tumor, because the tumor recurs mostly in the same location as the primary lesion. The aim of this study was to determine the relationship between changes in the preoperative CT scan of the paranasal sinuses and the location of papilloma by histological examination of surgical material. In this study, we evaluated the changes in the preoperative CT scans in the form of focal hyperostosis and erosion of the walls of the paranasal sinuses. Examined groups consisted of 12 people diagnosed with inverted papilloma and 15 peoples diagnosed with preinverted papilloma. Focal hyperostosis occurred in 83% of cases of inverted papilloma. Their location corresponded to 90% of the primal attachment of the tumor. Among the preinverted papillomas, focal hyperostosis occurred in less than 7% of the cases and did not correspond to the location of papilloma inverted. The analysis of remodeling and erosion of bone walls of the sinuses showed their presence in 67% of cases of inverted papilloma and 40% of cases of preinverted papilloma. However, their overlap with the location of the tumor was 50% for the inverted papilloma and 33% for the preinverted papilloma. Erosion and sinus bone destruction do not coincide closely with the primary location of the papilloma, because it is more the result of bone compression by the growing mass than bone invasion. The sites of focal hyperostosis closely coincide with the place of origin of the inverted papilloma, but the pathophysiological mechanism of this phenomenon is not fully understood. The relationship between the sites of focal hyperostosis and the location of the primary tumor can be used when planning surgery for accurate resection. Keywords: Computed tomography, Inverted papilloma, Site of attachment. How to cite this article: Salwa A. Sinonasal Inverted Papilloma: Evaluating the Effectiveness of Prediction of the Site of Attachment based on Computed Tomography Scans. Clin Rhinol An Int J 2016;9(2):84-86. Source of support: Nil Conflict of interest: None
Arvind Soni, Anchal Duggal
ABSTRACT A cerebrospinal fluid (CSF) leak is an escape of the fluid that surrounds the brain and spinal cord. Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. Most commonly, the leak is known to occur from the nose (CSF rhinorrhea) or through the ears (CSF otorrhea). Also, etiology is posttraumatic in majority. However, idiopathic CSF leakage from the eyes is extremely uncommon. Keywords: Cerebrospinal fluid oculorrhea, Cerebrospinal fluid rhinorrhea, Lamina papyracea. How to cite this article: Soni A, Duggal A. Idiopathic Cerebrospinal Fluid Oculorrhea: An Unusual Case Report. Clin Rhinol An Int J 2016;9(2):87-89. Source of support: Nil Conflict of interest: None
Tamoghna Jana, Moushumi Sengupta, Saumik Das, Asok K Saha, Subhasis Saha
ABSTRACT Retinoblastoma is the most common intraocular tumor during childhood. These tumors though respond to treatment are prone to develop second malignancy, recurrence and metastasis which may present as sinonasal mass. We are presenting a rare case of metastatic retinoblastoma of sinonasal region in a 3-year-old male child. The mode of presentation and management of the case is presented along with a review of the literature. Keywords: Metastatic, Retinoblastoma, Sinonasal. How to cite this article: Jana T, Sengupta M, Das S, Saha AK, Saha S. An Unusual ENT Presentation of Retinoblastoma: A Diagnostic Dilemma. Clin Rhinol An Int J 2016;9(2):90-93. Source of support: Nil Conflict of interest: None
Shruti Bansal, Arpit Sharma, JP Dabholkar
ABSTRACT Introduction: Maffucci syndrome is a congenital nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. Less than 200 cases of Maffucci syndrome have been published in the English literature. These lesions most commonly occur in the limb bones, especially in the hands and feet. Rarely, patients of Maffucci syndrome may present with mesodermal dysplasia involving head and neck region with nasal septum enchondromas reported only in two cases till now. Aim: To report a rare case of nasal enchondroma in a patient of Maffucci syndrome. Case description: A 15-year-old girl diagnosed with Maffucci syndrome 2 years back was referred to our ENT department with symptoms of left-sided nasal obstruction and epiphora. On thorough clinical examination and proper investigation, she was diagnosed to have nasal enchondroma. She successfully underwent endonasal endoscopic resection of nasal enchondroma. Conclusion: Maffucci syndrome is a rare entity characterized by multiple enchondromas and hemangiomas, especially in the extremities. A manifestation in the head and neck region is rare and cartilaginous tumors of nasal septum are even rarer; however, differential of nasal cartilaginous tumors should be borne in mind in patients with underlying mesodermal dysplastic disorders like Maffucci syndrome. Clinical significance: Patients of Maffucci syndrome with enchondromas are at high risk of undergoing malignant transformation, especially chondrosarcomas. These patients need vigilant and close follow-up. Despite their rarity, chondromas should be taken into consideration in the differential diagnosis of nasal tumors, especially those arising from the nasal septum. Keywords: Maffucci syndrome, Mesodermal dysplasia, Nasal enchondromas. How to cite this article: Bansal S, Sharma A, Dabholkar JP. Maffucci Syndrome with Nasal Enchondroma: A Rare Entity. Clin Rhinol An Int J 2016;9(2):94-97. Source of support: Nil Conflict of interest: None
Rijuneeta Gupta, Varun Nabh, Uma Nahar, Ashok K Gupta
ABSTRACT Mucormycosis is an opportunistic fulminant fungal infection usually noted in immunocompromised individuals like diabetic and AIDS patients, patients receiving systemic corticosteroid therapy, cancer chemotherapy, and organ transplant patients. The disease is very rare to affect healthy individuals. Here we report a case of a 21-year-old immunocompetent young male presented with cheek swelling and hard palate ulcer. Clinically, radiologically, and histologically, the diagnosis of maxillary mucormycosis was made. Keywords: Diabetic, Fungi, Immunocompetent, Mucormycosis, Necrosis. How to cite this article: Gupta R, Nabh V, Nahar U, Gupta AK. Mucormycosis Maxilla: Behavior of Disease in an Immunocompetent Young Male Patient. Clin Rhinol An Int J 2016;9(2):98-101. Source of support: Nil Conflict of interest: None
Saurabh Varshney, Manu Malhotra, Navjot Kaur, Priyanka Gairola
ABSTRACT We report a case of a 15-year-old girl presenting with left lacrimal abscess with chronic osteomyelitis of frontal bone, a rare sequelae, that of lacrimal adenitis. If lacrimal adenitis is left untreated, abscess formation can occur and can also lead to osteomyelitis. If lacrimal adenitis/abscess is diagnosed early in the disease process by understanding typical signs, conservative management can accomplish resolution without the complications and need for surgical exploration and the cosmetic implications of facial surgery. Keywords: Frontal bone, Lacrimal abscess, Osteomyelitis. How to cite this article: Varshney S, Malhotra M, Kaur N, Gairola P. Lacrimal Gland Abscess leading to Frontal Bone Chronic Osteomyelitis: A Rare Case Report. Clin Rhinol An Int J 2016;9(2):102-104. Source of support: Nil Conflict of interest: None
Damandeep K Mundi, Sanjeev Bhagat, Manjit Singh, Kushaldeep Gill
ABSTRACT Fibrous dysplasia (FD) is a benign skeletal disorder in which abnormally overgrowing bony lesion replaces the normal bone. It can affect one bone (monostotic form) or multiple bones (polyostotic form). The craniofacial bones are involved in about 10% of subjects with monostotic FD. Among FD of the head and neck, the maxilla and mandible are the most frequent sites to be involved. However, its occurrence in the sinonasal tract is very rare. We report a case of a large monostotic FD of the ethmoid bone in a 29-year-old woman. The lesion was removed by lateral rhinotomy approach and pathology proved to be FD. Keywords: Ethmoid bone, Fibrous dysplasia, Monostotic. How to cite this article: Mundi DK, Bhagat S, Singh M, Gill K. Fibrous Dysplasia of Ethmoid. Clin Rhinol An Int J 2016;9(2): 105-107. Source of support: Nil Conflict of interest: None
Ashok K Gupta
ABSTRACT There has been a major advancement in managing chronic sinusitis and other sinonasal diseases. In this changing scenario of indications for endoscopic sinus surgeries, detailed knowledge of sinonasal anatomy is of paramount importance. It is of utmost importance to master the relevant anatomy and its variations before one embarks upon endoscopic sinus surgery. So, we have tried to cover the anatomy and its variations for endoscopic sinus surgery in brief for the young and budding rhinologists in this supplement of the journal.
Ramesh C Deka
ABSTRACT In late 1970s, allergic fungal rhinosinusitis (AFRS) was discovered a clinically distinct, but immunologically similar entity to allergic bronchopulmonary aspergillosis. Both these diseases were considered as a result of noninvasive immunologic reaction toward fungal antigen. However, AFRS has been a subject of controversy and debate right from the beginning. In the initial period, it was considered as a precursor to invasive fungal sinusitis and, hence, surgical debridement followed by antifungal agents were advocated. Later studies, such as those by Manning et al and Feger et al, proved by immunologic and histologic methods that AFRS represents an immunologically-mediated disorder rather than an early stage of invasive fungal disease. In 1994, Bent and Kuhn put forward diagnostic criteria for AFRS which included type I hypersensitivity, nasal polyposis, characteristic computed tomographic (CT) findings, positive fungal stain or culture and allergic mucin. Later, further doubt in the role of fungus as an etiological agent for AFRS was created when, in 1999, Ponikau et al demonstrated the presence of fungus in 93% of patients with chronic rhinosinusitis and 100% of normal control groups.
ABSTRACT It is with immense pleasure and pride that I acknowledge that All India Rhinology Society is bringing forth this supplement on ‘fungal rhinosinusitis’ in which a management protocol has been proposed. As far as my knowledge permits, fungal rhinosinusitis is endemic to our country and such a protocol which deals with the workup, management and follow-up of such patients is the need of the hour. I truly believe that the Department of Otolaryngology and Head and Neck Surgery of our institute has immense experience in this field and the proposed protocol would help many surgeons all over the nation to treat these patients efficiently.
Ashok K Gupta, Sandeep Bansal, Daisy Sahini
ABSTRACT There has been a major advancement in managing chronic sinusitis and other sinonasal diseases. There has been a remarkable change in the surgical approach to inflammatory pathology of paranasal sinuses since the time, Messerklinger introduced endoscopic sinus surgery. In this changing scenario of indications for endoscopic sinus surgeries, detailed knowledge of sinonasal anatomy is of paramount importance. It is of utmost importance to master the relevant anatomy and its variations before one embarks upon endoscopic sinus surgery. Various cadaveric and radiological studies have been done to know about the important landmarks and anatomical variations. With increasing horizon of sinus surgery, where more of optic nerve and anterior and middle cranial fossa lesions are being dealt with endoscopically; surgeon needs to be more familiar with various variations in the anatomy of the important structures as even a small mistake can be detrimental to the vision and life of the patient. Keywords:Anatomy, Endoscopic sinus surgery, Cadaveric dissection, Anatomical variations. How to cite this article: Gupta AK, Bansal S, Sahini D. Anatomy and Its Variations for Endoscopic Sinus Surgery. Clin Rhinol An Int J 2012;5(2):55-62. Source of support: Nil Conflict of interest: None declared
Ashok K Gupta, Sandeep Bansal, Rijuneeta, Bhumika Gupta
ABSTRACT Invasive sinus Aspergillus infection has been reported in the last decade with increased frequency, most commonly in the setting of hematologic malignancy, neutropenia, HIV infection and other states of immunosuppression. Fungal rhinosinusitis can be broadly classified into two varieties—invasive and noninvasive on the basis of tissue invasion. Invasive fungal sinusitis are acute invasive, chronic invasive (both granulomatous and nongranulomatous forms), whereas noninvasive are fungus balls and allergic fungal sinusitis. Invasive fungal sinusitis is one of the most challenging forms of sinonasal pathology to manage, most commonly presenting in immunocompromised individuals. Chronic invasive being sinus aspergillosis (CISA) is being reported in immunocompetent patients at an increasing rate while most of these cases are being reported from the India subcontinent and middle east. Invasive fungal sinusitis is on the rise worldwide and especially in north India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality. This entity needs to be picked up early by spreading awareness among the family physicians, internists, otolaryngologists, ophthalmologists, neurosurgeons, pulmonary physicians, critical care specialists so that an early management can initiated to achieve better control over the disease. This review is an attempt to initiate an interdisciplinary approach to achieve a better outcome. Keywords: Rhinosinusitis, Fungal sinusitis, Invasive, Nose and paranasal sinuses. How to cite this article: Gupta AK, Bansal S, Rijuneeta, Gupta B. Invasive Fungal Sinusitis. Clin Rhinol An Int J 2012;5(2): 63-71. Source of support: Nil Conflict of interest: None declared
Ashok K Gupta, Nishit Shah, Mohan Kameswaran, Davinder Rai, TN Janakiram, Hemant Chopra, Ravi Nayar, Arvind Soni, NK Mohindroo, C Madhu Sudana Rao, Sandeep Bansal, KR Meghnadh, Neelam Vaid, Hetal Marfatia Patel, Sanjay Sood, Sunita Kanojia, Kshitij Charaya, SC Pandhi, SBS Mann
ABSTRACT Allergic fungal rhinosinusitis (AFRS) has always remained a topic of discussion at all rhinology meets. Despite so much of literature available, the nature of this disease, its diagnosis, pathogenesis, classification and appropriate management continue to generate debate and controversy even after three decades of research and investigation. AFRS is an endemic disease in North and South India. In spite of this, there has been no optimal management protocol for this disease being followed in India yet. To overcome this, a national panel was conducted on AFRS at the ENT Surgical Update 2011, held at Postgraduate Institute of Medical Education and Research, Chandigarh with experts from all over the country so that a consensus can be achieved regarding the workup and management of AFRS. Keywords: Rhinosinusitis, Allergic fungal sinusitis, Management protocol. How to cite this article: Gupta AK, Shah N, Kameswaran M, Rai D, Janakiram TN, Chopra H, Nayar R, Soni A, Mohindroo NK, Rao CMS, Bansal S, Meghnadh KR, Vaid N, Patel HM, Sood S, Kanojia S, Charaya K, Pandhi SC, Mann SBS. Allergic Fungal Rhinosinusitis. Clin Rhinol An Int J 2012;5(2): 72-86. Source of support: Nil Conflict of interest: None declared
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Feasibility of ExAblate MRI Guided High Intensity Focused Ultrasound Tx of Soft Tissue Tumors
Trial ID: NCT01965002
The goal of this project is to evaluate the safety and preliminary efficacy of ExAblate magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) surgery in the treatment of soft tissue tumors of the extremities.
A Feasibility Study to Evaluate the Safety and Effectiveness of ExAblate Magnetic Resonance Imaging Guided High Intensity Focused Ultrasound Treatment of Soft Tissue Tumors of the Extremities
- ≥ 10 years of age.
- Benign or malignant soft tissue tumors of the extremities, flanks, pelvis, or
shoulders requiring surgical intervention.
- Tumor must not have been treated previously with radiation.
- Targeted tumor(s) are accessible to the ExAblate device
- Targeted volume within the tumor is located deeper than 1 cm from the skin
- Targeted tumor is clearly visible by non-contrast magnetic resonance imaging (MRI)
- Karnofsky Performance Status > 60
- Normal platelet count and coagulation profile
- Glomerular filtration rate > 60 mL/min
- Able to safely undergo MRI exam and receive mild sedation for the treatment.
- Able to tolerate being in the MRI scanner for the duration of the study.
- Able and willing to give consent (or consent + assent where applicable), and able to
attend all study visits.
- Previous radiation treatment to the tumor.
- Currently receiving dialysis.
- Acute medical condition (eg, pneumonia, sepsis) expected to hinder completion of the
- Unstable cardiac status including:
- Unstable angina pectoris on medication
- Patients with documented myocardial infarction within six months of protocol
- Congestive heart failure requiring medication (other than diuretic)
- Patients on anti-arrhythmic drugs
- Severe hypertension (diastolic BP > 100 on medication)
- Contraindication for MR imaging such as implanted metallic devices that are not
MRI-safe, size limitations, etc
- Severe hematologic, neurologic, or other uncontrolled disease
- Known intolerance or allergy to medications used for sedation (midazolam), analgesia
(fentanyl), and local and regional anesthesia (lidocaine, bupivacaine, and
- Known intolerance or allergy to MR contrast agent (gadolinium chelates) including
advanced kidney disease
- Pregnant and nursing
- Karnofsky Performance Score < 60
- Severe cerebrovascular disease [cardiovascular accident (CVA) within 6 months]
- Not able or not willing to tolerate the required prolonged stationary position during
treatment (up to 5 hrs of total table time)
- Target volume in tumor is less than 1 cm from neurovascular bundles, major blood
vessels, bowel, or bladder.
- Targeted tumors:
- NOT visible by non-contrast MRI, OR
- NOT accessible to ExAblate device
- Not a candidate for either regional anesthesia or mild sedation
- Not be participating in another trial testing other investigational agents or devices
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This acne ingredient is used to treat mild to moderate acne and can be used in combination with other acne treatment ingredients, like sulfur and salicylic acid. Since benzoyl peroxide dries out the skin, it's best to use this ingredient as a spot treatment.
This ingredient helps with: Whiteheads, blackheads, breakouts, congestion, general acne
Where to find this ingredient: Breakout Control
New studies suggest that probiotics can play an important role in clearing your acne as well. Probiotics are a crucial element of your diet AND your skin care. They have antimicrobial properties which helps them kill off acne causing bacteria and inflammation – making probiotics one of the best acne ingredients to clear your complexion. Probiotics also help other forms of inflammation, like rosacea. Even the AAD has stated that "skin prone to acne or rosacea has shown improvement with daily probiotic use".
This ingredient helps with: Rosacea, whiteheads, blackheads, breakouts, congestion, general acne, wrinkles, fine lines, premature aging, irritation
Where to find this ingredient: Probiotic Anti-Aging Serum
Bioelements Oxygenation is formulated with pharmaceutical-grade hydrogen peroxide that expands the creme to 22x its volume and creates pressure. This pressure "pushes" oxygen gas into the skin which helps purify problem pores. It can also be used on top of acne treatments to help "push" active ingredients even deeper into your skin.
This ingredient helps with: Whiteheads, blackheads, breakouts, congestion, general acne, dull skin, stressed skin
Where to find this ingredient: Oxygenation
Looking to minimize post acne marks? See the best ingredients for acne scars here.
While there are plenty of great acne fighting ingredients, there are also acne ingredients to avoid. Traditionally, alcohol was used to treat acne, but you should avoid it if you want a clear face! While many DIY acne treatments include rubbing alcohol, this ingredient can excessively dry and irritate your skin and also cause even more blemishes.
There are certain ingredients that may also cause acne, like artificial fragrances and dyes.
If you have any questions about acne ingredients, sign up for our email newsletter or comment below!
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What Causes Loose Skin to Develop?
When an individual gains weight, the skin stretches to accommodate increased layers of fat that lie below its surface. The increased fat keeps the skin tight and smooth.
Tired of loose skin? Thermage can help smooth your skin by delivering radiofrequency energy to targeted treatment areas to heat the layers below the surface, producing more collagen and pulling skin tighter. The results? Smoother skin and a more shapely appearance. But does Thermage last?
How Long Does Thermage Last?
You can think of Thermage as "resetting the clock" on your skin. Your skin will age from a new starting point. How fast it ages depends on the factors below.
Summer is just around the corner. If you’re anything like us, you are already considering your summer vacation options. If you’re thinking about hitting the beach, but don’t feel ready for bikini season- don’t worry. First of all, you’re not alone. Second, you have options. No, we are not suggesting that you start a twice a day workout routine or a crazy fad diet. If you want to resculpt and reshape in time for summer, Innovations Medical can help. Dr. Johnson offers SmartLipo, Thermage, and Cellushock Therapy for patients looking to put their best body forward on the beach or at the pool.
SmartLipo SmartLipo is a smart choice for patients wanting a shapely new physique. SmartLipo is a minimally invasive tumescent liposuction procedure that allows patients to stay awake, avoiding general anesthesia. Aside from targeting unwanted fat, SmartLipo increases collagen productions that tighten the skin in the treated area. This tightening yields a shapelier final result to show off in your swimsuit this season.
Thermage Thermage is a noninvasive skin tightening option that tightens sagging skin by heating up the collagen found in the skin’s layers. Collagen is the most abundant protein in the body and plays a huge role in the skin’s ability to stretch and contract. Thermage heats the skin to 45 degrees, causing collagen to contract and the skin to tighten. Thermage is an excellent choice because of its ability to treat the areas that patients want to tighten quickly. Thermage patients see immediate results of their treatment. It is an excellent option to tighten skin on the face and neck, upper arms, and midsection and even the knees.
Do you want to look as young as you feel? Dr. Johnson of Innovations Medical explains some procedures that can take years off of your appearance with little or no downtime.
Several things are happening when women age that makes their bodies look older. One of them is loss of collagen and the supporting proteins that support your skin, that’s why you get wrinkles and sagging. Also, the placement of fat changes as you get older. A woman that weighs the same at 20 that she does at 50 can still see an increase in her waist size. That happens naturally and it’s just the way we age. Also, the fat itself looses a lot of supporting protein, that’s why as you get older your breasts, buttocks, arms and thighs can sag.
Say hello to summer and endless sunbathing on the beach. Wearing a swimsuit, for some, takes a lot of courage and coaxing though. Because even if we’re eager to hit the beach, being in a swimsuit shows all your defects - stomach, thighs, arms, and other areas where you don’t have enough shape. In this video, Dr. Johnson explains the various procedures that Innovations Medical offers to make your body swimsuit ready.
First on the list is thermage, which uses radio frequency energy to tighten loose skin without surgery. The tool used creates heat in your tissue and shrinks the collagen, which tightens your skin real time. About 80% of patients see tighter and smoother skin right after the procedure. What’s even better is the further skin tightening effect, which happens 3 to 6 months after the procedure. If you decide to undergo this procedure, there’s no downtime and you can go home the same day.
From sexy bikinis and belly shirts, to sleeveless dresses and cropped blouses, these outfits will make sure you’re comfortable and smoking hot during the summer season. But are you confident enough to bare your stomach? If you have a little bit of wrinkling or need some serious shaping, Innovations Medical has the right procedure for you and this video will tell you all about it.
Using a thermometer-like scale, Dr. Johnson starts with the most non-invasive procedure for people that needs just a little bit of help. For wrinkling and a little bit of droopiness, Thermage is a great go-to process. It uses radio frequency energy to tighten loose skin without the need for surgery. Some instant tightening will be noticed right after the procedure, but the benefits will continue months after. Because of the heating, three to four times more collagen will be produced and these will mature after three to six months. It will cause further skin tightening or collagen remodeling. There’s also no downtime so you can just go back to work the next day.
In the movie Steel Magnolias, Dolly Parton’s character Truvy says, “Honey, time marches on and eventually you realize it is marchin’ across your face.” The character speaks truth, because our skin and body will definitely look different as we age. Wrinkles will appear. Skins will sag and that is the truth.
In this video, Dr. Johnson discusses the different procedures and approaches used to combat skin aging. In treating a condition, multiple treatments have to be done. You may have been directed by your doctor to lose weight, exercise and take in 2-3 medications. For cancer cases, usually there would be surgery, radiation and chemotherapy. The reason for these multiple treatments is because the problem must be approached from different directions. The same goes for anti-aging treatments.
In the movie “Death Becomes Her,” Meryl Streep drinks a potion and becomes young again. Don’t we all wish to turn back the clock and be young again as easy as that? With recent innovations, this dream can be made into reality. In this video, Dr. Johnson discusses procedures and products that can turn back the clock.
Dr. Johnson opens the discussion with an explanation of multi-modal therapy. This involves addressing the different modalities of a person in order to treat a disease like high-blood pressure or diabetes. Each of these modalities is like pieces of a puzzle and requires a different approach. This is the reason why we are given two or three medications in order to treat an ailment. The same goes with procedures in order to care for our body.
In the National Lampoon’s Christmas Vacation movie, Clark Griswoll was very disappointed when he didn't get the work bonus he had anticipated for so long. That sounds like a nightmare Christmas, right? After a year of working hard, everyone deserves to feel happy and be pampered during the holidays. If you’re looking to get some cosmetic procedures done during your vacation, Innovations Medical has a lot of options that you can do without taking any time off from work.
One popular procedure is Thermage, which is the non-surgical tightening of loose skin. It uses radio frequency to tighten loose skin. The heat produced makes your skin tighter and smoother. If you do this a day after Christmas, you can go back to work the next day. In addition to the face, this procedure can also be done on the tummy, face, arms and leg.
It’s the Christmas season once again and it’s time for gift giving. This year, instead of the usual present delivered in a package, why not give your man something different? Consider cosmetic surgery and he’ll thank you for making his fine lines and droopy eyes go away.
In this video, Dr. Johnson discusses some great procedures that guys love. For men who are a bit shy about having a procedure done, thermage would be an option. It’s a procedure that uses radio frequency to tighten loose skin without the need for surgery.
If you want a new you for Christmas, now is the time to make your list of dream cosmetic procedures. Why do it now? Because, most procedures take several weeks or months to see the best results.
One of the go-to-outfits during the holidays is the sleeveless shirt. And in order to rock this dress, you need nice arms. But saggy and crepey-looking arms can quickly damper your holiday cheer.
What do celebrities like Gwyneth Paltrow and Demi Moore have in common with Good Morning Texas Host Amy Vanderoef? Well, they’ve all had thermage. Innovations Medical is one of the most experienced thermage practices in this country and in a recent GMT interview, Dr. Bill Johnson explained how thermage can make a huge difference in your appearance.
Here's a full transcript of the video
DR. J: Good morning!
In Channing Tatum’s movie, Magic Mike, women swoon over muscled men with six packs. Although some men won't admit it, a fit-looking physique is important for them too. In fact, a lot of guys are open to the idea of cosmetic surgery to give them the six packs of their dreams. In this video, Dr. Johnson shares the various cosmetic procedures that men can take advantage of.
Two common issues that guys want to get rid off are their flabby stomachs and love handles. Even those with the not-so-flabby abdomen want their midsection sculpted as well. They too would like to be confident in wearing their swim suits. These can be easily taken care of through liposuction. It can be done in the office under local anesthesia. There is less downtime and the patient can go home the same day.
In this video, Dr. Johnson showcases the progress of 47 year old New Beginnings Makeover Winner, Karen Halicke. Karen won a 1 year makeover journey with Innovations Medical and her before and after pictures demonstrate how effective the treatments have been. Karen came to the studio to physically show the amazing transformations in her body.
On her face, Thermage and SmartXide Dot was performed. Thermage is a non-surgical procedure that tightens the collagen in your skin. The process also fuels your body to produce new collagen, which continues to give you results over the next few months. There is no downtime and this can also be performed on your abdomen, arms or legs.
Summer means sunbathing in the sun with your bikinis on, but for those with shape and texture issues on their thighs, wearing a bikini or shorts can be a bit of a challenge. With new treatments that promise faster recoveries and safer procedures, these issues are slowly becoming a thing of the past.
In this video, Dr. Johnson explains the options available for you to show off those legs with confidence.
Getting the body swimsuit-ready before spring arrives is one of the main concerns for a lot of women, but this should be a matter to look into all year round. Essentially, it is important to be in shape so you can look your best all the time.
Thanks to revolutionary methods, you don’t have to sweat it out in the gym in order to get that coveted figure. There are various procedures you can undergo that are definitely safe and have minimal downtime. Dr. Johnson will give in-depth details and benefits about those procedures in this video.
In this episode, Dr. Bill Johnson serves as an engaging game show host of the game, “Guess Their Age,” with Good Morning Texas hosts, Carrie McClure and Amy Vanderoef, as competing players.
Pictures of four women were displayed, all of whom had received anti-aging procedures, more specifically Thermage, Smartxide Dot, Facial Fat Transfer, and / or Botox, at Innovations Medical.
Being in a swimsuit can be a challenge for many, because it doesn’t allow you to hide anything. The arms, stomach, legs, breasts, buttocks and thighs are the most common problem areas for a lot of people. Women after pregnancy or weight loss are usually the ones having these issues. These can be addressed by either shaping up or filling out those problem areas.
In this video, Dr. Bill Johnson explains some of the available options and a talks about their benefits.


Role of Bcl-2 family members in 4-hydroxynonenal (HNE) mediated apoptosis
Bodur, Çağrı and Kütük, O. and Poli, G. and Başağa, Hüveyda (2009) Role of Bcl-2 family members in 4-hydroxynonenal (HNE) mediated apoptosis. In: Annual Meeting of the Society-for-Free-Radicals-Research-Europe, Rome, Italy
Full text not available from this repository.
4-Hydroxynonenal (HNE), a very reactive lipid peroxidation product, was shown to induce oxidative stress and apoptosis in a dose-dependent manner in a variety of cells Our recent data showed that FINE triggered caspase-9 and 3 activation and PARP cleavage in monocytic cell line U937. Following 10 mu M HNE treatment, levels of phosphorylated JNK, ERK1/2 and p38 MAP kinases increased significantly in 2 and 4 h Our results indicate a time-dependent decrease in Bcl-2 expression in response to HNE treatment. We observed a slight decrease in Bcl-X-L expression, while Mcl-1 amount remained unchanged Pro-apoptotic Bax and Bak expressions did not change; but truncated form of Bax disapperared Just after HNE treatment Our preliminary studies conducted by specific inhibitors of MAP kinase proteins indicate that phosphorylation of p38, JNK or ERK 1/2 proteins regulate the activation of Bcl-2 proteins, effecting the cellular outcome such as apoptosis
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Clinical nuclear medicine includes sam cme certified content that is designed to meet the educational needs of its readers for more information on cnm sam cme educational offerings visit the lippincott cmeconnection portal to register online and take advantage of the free cnm sam cme opportunities. Nuclear medicine involves the use of small amounts of radioactive materials or tracers to help diagnose and treat a variety of diseases nuclear medicine determines the cause of the medical problem based on the function of the organ tissue or bone. The division is committed to teaching the multiple facets of nuclear medicine including topics of clinical imaging techniques and image interpretation radionuclide therapy instrumentation nuclear medicine physics and radiopharmacy to medical students diagnostic radiology residents nuclear medicine residents nuclear radiology fellows and . Nuclear medicine imaging involves dosing the patient with a very small amount of a gamma ray emitting radioisotope the location and distribution of the radioisotope within the body is then detected with a gamma camera a device specifically designed to collimate and detect gamma rays
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You're probably already giving your skin some love, for instance, using natural skincare products or eating an organic diet. However, you might also be engaging in harmful habits, some without knowing.
Here's our list of the top 9 things you should stop doing to enjoy glowing skin.
1. Consuming excess sugar
In 2013, researchers looked at the relationship between blood sugar levels and aging. Those participants with higher blood sugar levels rated higher on the 'looking older' scale.
2. Skipping hydrating
You've heard it countless times- the benefits of drinking water to maintain health. Water helps in various body functions, like transporting nutrients to the muscles and organs. Others are eliminating impurities and keeping the skin supple.
3. Toxic laundry detergents
How does this affect the skin? Detergents with harmful chemicals contribute to cancer, lung damage, and hormone disruption. When you wash your bedding and clothes, some of the substances remain and come into contact with the skin.
4. Alcohol in skin care products
Alcohols in skin care products act as preservatives, help the ingredients combine, and temporarily shrink your pores.
Unfortunately, some of these alcohols are irritating, drying, and damaging to your skin, and many contain petroleum by-products. Use natural alternatives like aloe juice instead.
5. Skin addiction
Our skin gets used to what we put on it. One common ingredient that skin gets addicted to is benzoyl peroxide. Medical professionals prescribe it for acne. It kills bacteria and reduces oil production, thus clearing up the skin. Over time it is extremely drying for most skin types.
THE SKIN DETOX PROCESS
Alkaline benzoyl peroxide disturbs your skin's acid protective layer, which should be at a pH of between 4.5-5.5. When you stop using it, your skin starts to return to its natural pH. This detox process causes many people to break out.
6. Unnatural makeup
There's nothing wrong with wearing makeup to enhance your looks, but doing it every day could be making your skin less healthy. How is that?
THE PROBLEM WITH CHEMICAL MAKEUP
Most makeup brands use potentially harmful ingredients. Unnatural makeup products can irritate your skin, clog your pores, and create a barrier that keeps your skin from breathing. In the long term, your skin gets worse as you use the products.
We recommend natural mineral makeup with no synthetic preservatives and fragrances.
7. Sleeping with your makeup on
No matter how tired you are, never go to bed without washing off your makeup. This is even more important if you're wearing chemical makeup brands.
Also, ensure you remove your makeup before working out. When your pores open up during exercise, makeup, dirt, and oil will get in there.
8. Eating processed foods
A big part of healthy skin is your diet. Your skin is an indicator of what's happening inside the body.
STICK WITH WHOLE FOODS
It's time-consuming to prepare whole foods from scratch, but it's one way to keep your skin healthy. At least you're sure about what's on your plate.
Begin by taking a salad or smoothie every day to increase your intake of vegetables, raw fruits, and nuts. Make it fun by including different colored produce on your plate to boost your appetite for healthy meals.
9. Not exfoliating
As we get older, our skin needs help in removing old, dead cells. Regular exfoliation does the trick.
Remember to maintain balance; otherwise, over-exfoliating will harm your skin. Once or twice a week is enough.
If you have sensitive or oily skin, use gentle exfoliating products and methods.
Healthy, radiant skin is within your reach! Replace these bad habits with healthy ones, and your skin will thank you.
The Sole Toscana Beauty Team


10+ Drinks to Clean Your Liver Naturally
Did you know that Chronic Liver Disease kills over 100,000 people every year? The sad part is that a lot of these deaths are avoidable. There are many ways to keep your liver healthy and functioning well, these all natural drinks are good for your liver and the rest of your body too:
1- Carrot Juice
Carrots are high in vitamin A which helps to prevent liver disease. They are also full of beta-carotene and flavonoids. This is one vegetable that is good for your whole body! Carrots can be consumed in any form, except adding sugar. Because they are a sweet root vegetable they make a great addition to bitter greens in juice. Your taste buds will thank you.


This month is American Diabetes Month, a time to beat a severe disease. Diabetes is one of the most common disease and this occurs when the body fails to process sugar properly. This year's color for diabetes awareness is blue. I support this cause since my grandmother have died from this and I'm also at risk. This month I will make a commitment to only wear blue on Whyville, for all the men & women who have diabetes and are at risk. You to can also demonstrate your support by wearing blue in Whyville. Just think about the people who are dying every single day due to diabetes. Remember: every 20 seconds, 4,320 people are diagnosed with diabetes.
Three Interesting Facts:
1. Approximately, twenty-four million adults & children in the United States live with diabetes.
2. 1 in 5 Americans are at risk for diabetes. That's 20% of the population.
3. 1 out of every 3 children born today in the U.S. will encounter diabetes in the future.


common in chronic sinus
Welcome to Health care magic.
I have gone through your query and I understand your concern regarding ammonia like odor only when bending down.
I am suspecting chronic sinus infection to be the cause of this as it is one of the common causes of parosmia (change in sense of smell).
Infections due to anaerobic bacteria usually is the culprit.
Exposure to smoke does not seem to be relevant in this case.
I suggest you get an ENT consult for sinus examination, and get a nasal swab tested for culture and sensitivity to rule out anaerobic infection.
I hope I have helped you with this answer.
Please let me know if I can assist you further.


Behavior modification As A Principle Betterhelp Reivews…
Behavior therapy, likewise called behavioral modification, uses people’s actions on the planet as the access point for solving a range of problems– not just behavioral issues but likewise issues including feelings and thoughts. Behavioral psychologists presume that problem behaviors are triggered by interactions in between individuals and their environments. Problems happen when an individual’s environment rewards destructive behaviors; gradually, these habits become habits.
Behavior modification is utilized to treat such harmful practices as smoking, substance use, eating conditions, sleeping disorders, and the inability to handle tension efficiently. Behavior therapy can also be used to treat larger psychological disorders, consisting of obsessive-compulsive condition, schizophrenia, bipolar illness, psychotic conditions, character, anxiety, and stress and anxiety conditions.
Is BetterHelp counseling or therapy?
To help a customer with obsessive-compulsive disorder, a behavioral therapist might teach that specific, little by little, to tolerate an affordable amount of dirt in their environment or to refrain from continuously washing their hands. This strategy is called exposure therapy..
Behavior modification can also be utilized to boost favorable habits, such as organization, involvement in sports, and border forming. Betterhelp Reivews
Origins Of Behavior Therapy In Psychology.
Habits treatment can be traced to the research of Russian psychologist Ivan Pavlov, which was published in the 1920s and 1930s. In a famous experiment, Pavlov classically conditioned canines to salivate when he rang a bell due to the fact that the pets discovered to associate the existence of food with the sound of the bell.
Behavior therapy is likewise associated with the work of US psychologist B.F. Skinner, who studied operant conditioning in the 1930s. Operant conditioning indicates finding out behavior through benefits and punishments. While working with patients in a psychiatric hospital, Skinner discovered that behaviors could be “shaped” (slowly altered) when positive habits were followed by desirable effects and unfavorable habits were followed by unwanted effects.
Behavior modification was later established as a treatment approach when the work of psychologists such as Aaron Beck and Albert Ellis resulted in Cognitive Behavior modification ( CBT). CBT is based upon the theory that people’s thoughts identify both their emotions and their habits. Therefore, when therapists help people change their thoughts, they can help them alter their lives.
Significance Of Behavior Therapy.
Behavior therapy is based on the belief that we are influenced by and gain from our environment. Behavioral therapists help customers change unhealthy habits by focusing on observable actions, rather than on what is happening in the mind. Behavior therapy likewise concentrates on concrete changes in the present rather than on insight into the past.
Parts Of Behavioral Therapy Techniques.
Specific types of behavior therapy include the following:.
I went through a duration of extreme separation anxiety when my parents first got separated, then ended up being frightened of whatever (rollercoasters, frightening motion pictures, bees, movie theaters, you name it). I was primarily able to deal with it, however in 7th grade, my stress and anxiety all of a sudden got so much even worse.
I was continuously on edge and persuaded something terrible was going to take place, and had trouble sleeping because I told myself that the 2nd I closed my eyes a fire would begin, somebody would break in, or something bad would happen to somebody I loved. I ended up being compulsive about examining the locks on windows and doors, the range, and established an unreasonable fear of getting gastrointestinal disorder. After viewing a motion picture on the Black Plague in school, I became extremely paranoid about germs and anxious about them continuously. Due to the fact that, it got to the point where I simply wanted to sleep all the time.
Can Medical Insurance Offer Protection For Treatment Visits?
Updated January 22, 2022.
Clinically Examined By: Dawn Brown.
What is psychological health protection? When it pertains to therapy, individuals generally question just how much it costs with or without a health insurance and how to pay for it. Health care systems and marketplaces can be complicated, however people look for mental health treatment every day, and we’re here to walk you through the many psychological health benefits offered.
Get Fast, Cost Effective Counseling With BetterHelp.
Register To Be Personally Matched To A Licensed Therapist.
Can BetterHelp prescribe medication? Betterhelp Reivews
Therapy Covered With Insurance Coverage: Protection Tips To Know.
What Sort Of Insurance Coverage Plans Are There For Therapy?
There are lots of methods to spend for mental health treatment. What is covered by health insurance and what isn’t can be confusing in the beginning? The Mental Health Parity Act belongs of the Affordable Care Act that needs big medical insurance companies and health insurance to supply equivalent protection for mental illness (including drug abuse coverage and treatment). Contact your insurance supplier to learn more..
What Various Kinds Of Therapies Does Insurance Coverage Cover?
There are no fast and easy responses to the concern of whether your health insurance plan will cover your treatment sessions or psychological health services. The law does not mandate small health insurance companies with less than fifty staff members to have health insurance cover the expense of therapy. A therapist’s workplace can also assist with these questions and you can always contact your health insurance advantages department or insurer to verify what level of psychological health coverage you have.
Typical Protection Concerns.
Numerous business that aren’t governed by the Affordable Care Act or the Mental Health Parity Act choose to supply psychological health protection for their workers. Psychological health advantages can be confusing, so we’ll detail a few things to try to find. Before seeing a therapist, it is necessary to see if the company takes your medical insurance. One way to learn is to give your provider the information revealed on your insurance plan..
For relative, it might work to check out a Kid’s Health Insurance Program, CHIP. Individuals with identified mental disorders, substance use condition, or other mental illnesses can discover their important health advantages might look for more details with the Consumer Help Program..
Medicaid programs are a great option for relative, particularly those with a diagnosable disorder, psychological health condition, pre-existing condition, or those looking for a children’s medical insurance program/CHIP. Discover more about these programs at Healthcare.gov..
If you’re interested in minimizing expenses, you may seek in-office talk therapy that is covered by your insurance coverage. Many online treatment choices ( which might not be included in some market plans) can be much more affordable than even in-network choices..
Concerns To Ask Your Insurance.
Exist specific mental health services/therapists that my medical insurance plan does not cover?
Am I covered for therapy/therapists if I have a pre-existing condition?
What is the variety of treatment sessions my health insurance covers per year?
Do I have a deductible to pay prior to my health insurance cover services under my medical insurance strategy?
Exists a copay required by specific or group health insurance plans?
Do I need a referral from my medical care medical professional for a therapist?
Insurance Network Providers.
A network provider is a service provider who accepts medical insurance as a form of payment. In this case, that medical insurance partly spends for mental healthcare. They might accept insurance coverage for mental health protection, a network company is “within” your health plan’s network..
Insurance Coverage Coverage & Deductibles. Betterhelp Reivews