#Prevention of chronic kidney disease

[tricountyanimal]

Recognizing the Signs of Kidney Failure in Pets

Kidney failure is a serious condition that can affect pets, often catching owners by surprise. The kidneys play a crucial role in filtering waste from the blood and balancing fluids in the body. When they fail, it can lead to severe health issues. Understanding and recognizing the signs of kidney failure in pets is vital for early intervention and effective treatment. At Tri-County Animal Hospital, we are dedicated to providing the best care and information to ensure your pet's well-being.

Understanding Kidney Failure in Pets

What is Kidney Failure?

Kidney failure, or renal failure, occurs when the kidneys lose their ability to function properly. This condition can be acute (sudden onset) or chronic (developing over time). In both cases, it’s crucial to identify the problem early to manage it effectively.

Types of Kidney Failure: Acute vs. Chronic

Acute Kidney Failure: Often caused by toxins, infections, or severe dehydration, this type of kidney failure comes on suddenly and can be reversible with prompt treatment.

Chronic Kidney Failure: This is a progressive condition often associated with aging, underlying diseases, or genetic factors. It’s managed over time rather than cured.

Causes of Kidney Failure in Pets

Common Causes in Dogs and Cats

Several factors can lead to kidney failure in pets, including:

Toxins (e.g., antifreeze, certain medications)

Infections (e.g., leptospirosis)

Trauma to the kidneys

Chronic diseases (e.g., diabetes, high blood pressure)

Genetic Predispositions

Some breeds are more prone to kidney issues due to genetic factors. For instance, Persian cats and certain dog breeds like the Shih Tzu and Bull Terrier are more susceptible to kidney diseases.

Environmental Factors

Environmental toxins and poor diet can also contribute to kidney failure. Ensuring a clean, safe environment and a balanced diet is crucial for kidney health.

Early Signs of Kidney Failure

Recognizing the early signs of kidney failure can make a significant difference in the outcome for your pet.

Behavioral Changes

Increased thirst and urination

Decreased appetite

Lethargy or depression

Physical Symptoms to Watch For

Weight loss

Bad breath with a chemical odor

Vomiting and diarrhea

Poor coat condition

Advanced Symptoms of Kidney Failure

As the condition progresses, symptoms become more severe and require immediate veterinary attention.

Severe Symptoms Indicating Progression

Severe lethargy

Swelling in limbs (edema)

Seizures or disorientation

When to Seek Emergency Vet Care

If you notice any advanced symptoms, contact Tri-County Animal Hospital immediately. Early intervention can prevent further complications and improve the quality of life for your pet.

Diagnosing Kidney Failure

Veterinary Tests and Procedures

Diagnosing kidney failure typically involves:

Blood tests to check for elevated waste products (BUN, creatinine)

Urinalysis to assess kidney function and detect abnormalities

Imaging (ultrasound or X-rays) to view the kidneys

Importance of Early Detection

Early detection is key to managing kidney failure. Regular check-ups at Tri-County Animal Hospital can help catch the disease in its early stages, allowing for more effective treatment options.

Treatment Options 

Medical Treatments

Treatment varies depending on the severity and type of kidney failure but may include:

Medications to manage symptoms and slow disease progression

Antibiotics for infections

Medications to control blood pressure

Dietary Changes

Special diets low in phosphorus and protein can help reduce the workload on the kidneys and manage symptoms.

Fluid Therapy

Hydration is crucial. Subcutaneous or intravenous fluids may be administered to help maintain electrolyte balance and hydration.

Home Care for Pets with Kidney Failure

Daily Care Routines

Ensuring your pet has access to fresh water at all times

Administering medications as prescribed

Providing a comfortable resting area

Monitoring and Adjusting Treatment

Regularly monitor your pet’s symptoms and keep in touch with Tri-County Animal Hospital for follow-up visits and adjustments to the treatment plan as needed.

Preventive Measures

Tips for Preventing Kidney Failure

Maintain a balanced diet for your pet

Ensure regular veterinary check-ups

Avoid exposure to toxins

Importance of Regular Veterinary Check-Ups

Regular visits to Tri-County Animal Hospital allow for early detection and prevention strategies, helping to keep your pet’s kidneys healthy.

Conclusion

Recognizing the signs of kidney failure in pets and seeking timely veterinary care can make a significant difference in your pet’s health and quality of life. At Tri-County Animal Hospital, we are committed to providing comprehensive care and support for pets with kidney failure. By staying informed and proactive, you can help your furry friend live a happy, healthy life.

[reasonsforhope]

"The Biden administration on Thursday [August 15, 2024] released prices for the first 10 prescription drugs that were subject to landmark negotiations between drugmakers and Medicare, a milestone in a controversial process that aims to make costly medications more affordable for older Americans. 

The government estimates that the new negotiated prices for the medications will lead to around $6 billion in net savings for the Medicare program in 2026 alone when they officially go into effect, or 22% net savings overall. That is based on the estimated savings the prices would have produced if they were in effect in 2023, senior administration officials told reporters Wednesday.

The Biden administration also expects the new prices to save Medicare enrollees $1.5 billion in out-of-pocket costs in 2026 alone.

“For so many people, being able to afford these drugs will mean the difference between debilitating illness and living full lives,” Chiquita Brooks-LaSure, administrator for the Centers for Medicare & Medicaid Services, told reporters. “These negotiated prices. They’re not just about costs. They are about helping to make sure that your father, your grandfather or you can live longer, healthier.”

It comes one day before the second anniversary of President Joe Biden’s signature Inflation Reduction Act, which gave Medicare the power to directly hash out drug prices with manufacturers for the first time in the federal program’s nearly 60-year history.

Here are the negotiated prices for a 30-day supply of the 10 drugs, along with their list prices based on 2023 prescription fills, according to a Biden administration fact sheet Thursday.

What Medicare and beneficiaries pay for a drug is often much less than the list price, which is what a wholesaler, distributor or other direct purchaser paid a manufacturer for a medication before any discounts...

The administration unveiled the first set of medications selected for the price talks in August 2023, kicking off a nearly yearlong negotiation period that ended at the beginning of the month.

The final prices give drugmakers, which fiercely oppose the policy, a glimpse of how much revenue they could expect to lose over the next few years. It also sets a precedent for the additional rounds of Medicare drug price negotiations, which will kick off in 2025 and beyond. 

First 10 drugs subject to Medicare price negotiations

Eliquis, made by Bristol Myers Squibb, is used to prevent blood clotting to reduce the risk of stroke. 

Jardiance, made by Boehringer Ingelheim and Eli Lilly, is used to lower blood sugar for people with Type 2 diabetes. 

Xarelto, made by Johnson & Johnson, is used to prevent blood clotting, to reduce the risk of stroke.

Januvia, made by Merck, is used to lower blood sugar for people with Type 2 diabetes.

Farxiga, made by AstraZeneca, is used to treat Type 2 diabetes, heart failure and chronic kidney disease. 

Entresto, made by Novartis, is used to treat certain types of heart failure.

Enbrel, made by Amgen, is used to treat autoimmune diseases such as rheumatoid arthritis. 

Imbruvica, made by AbbVie and J&J, is used to treat different types of blood cancers. 

Stelara, made by Janssen, is used to treat autoimmune diseases such as Crohn’s disease.

Fiasp and NovoLog, insulins made by Novo Nordisk.

In a statement Thursday, Biden called the new negotiated prices a “historic milestone” made possible because of the Inflation Reduction Act. He specifically touted Vice President Kamala Harris’ tiebreaking vote for the law in the Senate in 2022.

Harris, the Democratic presidential nominee, said in a statement that she was proud to cast that deciding vote, adding there is more work to be done to lower health-care costs for Americans.

“Today’s announcement will be lifechanging for so many of our loved ones across the nation, and we are not stopping here,” Harris said in a statement Thursday, noting that additional prescription drugs will be selected for future rounds of negotiations."

-via CNBC, August 15, 2024

[mghospital]

Best Chronic Kidney Disease Treatment in Narasaraopet | Mahathma Gandhi Hospitals

Chronic Kidney Disease (CKD) is a condition that affects millions of people worldwide. It is a serious medical condition that can lead to a number of complications, including heart disease, stroke, and kidney failure. Treatment for CKD can be complex and requires a multidisciplinary approach. In this blog, we will discuss chronic kidney disease treatment at Mahathma Gandhi Hospital in Narasaraopet.

Mahathma Gandhi Hospital is a well-known hospital in Narasaraopet, Andhra Pradesh, which is equipped with modern facilities and infrastructure to provide comprehensive treatment to patients with various ailments. The hospital has a dedicated team of doctors and staff who specialize in treating patients with kidney-related problems, including CKD.

The treatment of CKD at Mahathma Gandhi Hospital is based on the stage of the disease and the individual needs of the patient. The treatment typically involves a combination of medication, lifestyle changes, and in some cases, dialysis or kidney transplant.

Medication: The hospital has a team of experienced nephrologists who prescribe medication to slow down the progression of CKD and manage the associated complications. The medication may include drugs to control blood pressure, reduce cholesterol levels, and treat anemia.

Lifestyle changes: The hospital has a dedicated team of dieticians who provide customized diet plans to patients with CKD. The diet plan aims to reduce the workload on the kidneys by limiting the intake of certain foods and fluids. The hospital also provides counseling services to help patients quit smoking, reduce alcohol consumption, and manage stress.

Dialysis: In some cases, when the kidneys are no longer able to function properly, dialysis may be required. Mahathma Gandhi Hospital has a state-of-the-art dialysis unit that provides high-quality dialysis services to patients with CKD. The hospital has experienced dialysis technicians and nurses who ensure that the dialysis procedure is safe and effective.

Kidney transplant: For patients with end-stage renal disease, kidney transplant is the only viable option. Mahathma Gandhi Hospital has a well-established kidney transplant program that provides comprehensive care to patients before, during, and after the transplant procedure. The hospital has a team of experienced transplant surgeons, nephrologists, and transplant coordinators who work together to ensure a successful transplant procedure.

Mahathma Gandhi Hospital in Narasaraopet is a reliable and trusted hospital for the treatment of CKD. The hospital provides comprehensive care to patients with CKD, including medication, lifestyle changes, dialysis, and kidney transplant. The hospital has a team of experienced doctors and staff who are committed to providing high-quality care to patients with CKD. If you or a loved one is suffering from CKD, consider seeking treatment at Mahathma Gandhi Hospital. 

Get Appointment:

Call: +91 8647230007

Visit: https://mahathmagandhihospitals.com/service/nephrology/

[the-neat-leaf]

Reishi Mushroom

Reishi Mushroom: The Ancient Secret to Immunity, Longevity, and More I am excited to share with you the incredible benefits of the reishi mushroom. This fungus has a long and distinguished history of medical use, and for more than 2,000 years people have valued it for its capacity to better their health. During the Han dynasty, traditional Chinese healers originally used the reishi mushroom,…

[mental-ch-illness]

i grew up with a chronic illness and parents who believed i was ‘milking’ my pain. they said things like ‘it’s not that bad’ and ‘you have to get through it and do what everyone else does’. i never got the chance to know what my limits were because i wasn’t allowed to have any. because of that, i underreported symptoms until my disease became severe. scariest part is that i didn’t even realize i was underreporting. i had just been doubting my own body for years.

i still struggle to accept and seek support for pain. recently, i developed a large kidney stone. as i’m laying in the emergency room, crying from pain, i have a thought like ‘this really isn’t that bad’. and i’m like, ‘oh my god, i’m gaslighting my own pain’. meanwhile, i’m being given morphine and bumped up in triage. these should validate my experience, but suddenly i’m thinking ‘i don’t need this, i’m probably milking it’ because that’s what i’ve been told my entire life.

parents and guardians, take any pain your child reports seriously, especially if they are chronically ill. otherwise, you’re teaching them to ignore their own needs and limits, leading to the worsening of conditions and appearance of easily preventable problems. they’ll be much worse off then they’d be if they missed a day of school for supposedly faking a tummy ache.

[kira-akira]

Bernie Sanders Introduces Long COVID Moonshot Legislation

This legislation "provides $1 billion in mandatory funding per year for 10 years to the National Institutes of Health (NIH) to support Long COVID research, the urgent pursuit of treatments, and the expansion of care for patients across the country." Announcement on Sander's twitter and the Long COVID Moonshot website.

This announcement references the number 22 million for adults affected by Long COVID in the US but that number is certainly much higher; in 2022 the CDC reported that 7.5% of US adults have Long COVID and that number can only have increased.

Here is an article published today on PBS if you need a primer or a refresher on what Long COVID is and why everyone needs to care about it. From the article:

"Long COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include:

Heart disease

Neurologic problems such as cognitive impairment, strokes and dysautonomia. This is a category of disorders that affect the body’s autonomic nervous system – nerves that regulate most of the body’s vital mechanisms such as blood pressure, heart rate and temperature.

Post-exertional malaise, a state of severe exhaustion that may happen after even minor activity — often leaving the patient unable to function for hours, days or weeks

Gastrointestinal disorders

Kidney disease

Metabolic disorders such as diabetes and hyperlipidemia, or a rise in bad cholesterol

Immune dysfunction"

I know it's easy to give into despair but THERE IS HOPE for the future! For decreasing transmission of COVID-19, for developing preventatives against Long COVID, and for treating Long COVID. To highlight just a few of the possible pathways to prevention and treatment being currently researched:

The possibility of using antivirals to treat not just Long COVID but any autoimmune disease

The development of N95 masks that can sense SARS-CoV-2 in exhaled breath using a printed immunosensor

A nasal vaccine that halts transmission of SARS-CoV-2 (though does not stop the user from developing COVID-19)

A Japanese research team is looking to treat COVID-19 by using embryonic stem cells to target the virus

The possibility of using already-developed arthritis drugs to treat Long COVID respiratory symptoms

Researchers just identified a possible protein to target in treating Long COVID fatigue

This is an incredibly small collection of studies researching potential treatments but they themselves and the decades of research they are built on had to be funded. In fact, since the pandemic began, more than 24,000 scientific publications about COVID-19 have been published, making it the most researched health condition in any four years of recorded human history.

So there is hope! But all this research needs money. Money that Long COVID Moonshot will provide. And while we wait for research to bear fruit, that $1 billion per year will also be crucial in caring for those suffering from Long COVID in the meantime.

So What Can You Do?

Keep masking - We've just hit 900,000 new COVID cases per day in the US and this wave is not even at its peak yet (For reference, Fauci stated back in 2021 that getting under 10,000 cases per day would allow for mask mandates and safety measures to relax...)

Go on the Long COVID Moonshot website and write to your legislators in support (You can use their script, it only takes 1 minute!)

Keep yourselves and others informed - On the Moonshot website they also offer handy graphics and facts sheets that you can post wherever you can. Spread the word!

And if you or someone you know has Long COVID, you can write in to the Long COVID Moonshot website about your experience

And remember, no one is safe from Long COVID; your chances of developing Long COVID increase with every reinfection. Until research like what Long COVID Moonshot will fund discovers viable preventatives and treatments, the only way to not get Long COVID is to not get COVID-19 in the first place.

Stay safe, stay hopeful, support Long COVID Moonshot, and mask up!

[scientia-rex]

Good morning! I have a question. When I look up info about vitamin D, I come across many claims that people generally don't get enough of it. In a recent episode of Maintenance Phase, however, the hosts called it a "scam" or overblown, at least (I don't remember the exact wording). So, like, what's the deal with vitamin D? Do Americans get enough of it?

Probably, mostly. At the very least, people should be tested before starting repletion. It probably has a role in osteoporosis treatment and prevention, BUT how much to take and what form and when is HOTLY debated and frequently conclusions are changing.

Just to take you on a spin through the most recent Cochrane reviews (THESE ARE NOT SINGLE STUDIES, in case any of the research-naive out there want to get pissy about them; look up what a Cochrane review actually is before trying to shit on it; also note that I did NOT say this will cover every fucking person and every hypothetical they can come up with, jesus CHRIST):

No role for vitamin D in asthma

Insufficient evidence to recommend it in sickle cell

Raising vitamin D levels in cystic fibrosis patients is not beneficial

No evidence of benefit of vitamin D in MS

Supplementing vitamin D in pregnancy may have small benefits but also risk of harms

No clinically significant benefit from vitamin D supplementation in chronic pain

Insufficient data on vitamin D in inflammatory bowel disease, but no evidence of benefit

No evidence of benefit of vitamin D supplementation in liver disease

Vitamin D does not appear to prevent cancer in general population

No evidence for benefit in supplementation of vitamin D in premenopausal women to prevent bone density loss

Possible small mortality benefit of D3, but not D2, in elderly patients, but also increased risk of kidney stones and hypercalcemia

Vitamin D alone ineffective, but combined with calcium may be effective, in preventing bone fractures in older adults

Insufficient evidence for vitamin D improving COVID-19 outcomes

Now, vitamin D plus calcium in people who have post-menopausal bone density loss does seem to prevent fractures. This is why doctors routinely recommend it. However, dosage and formulation are still debated as data are insufficient, and uncertainty still large.

So, do you need to supplement? Probably not. There is some fairly weak evidence that vitamin D supplementation may help with depression, but I would argue that it's going to be most relevant in people with pre-existing deficiencies, which Medicare is just hellbent on not letting me test for anymore. They've narrowed the coverage codes for testing so now even know vitamin D deficiency isn't considered a good enough reason to test. So Medicare has very clearly decided it's not relevant, for whatever that's worth, I spit on their graves, etc. Of course, then you get into the question of what counts as a deficiency, which we also really don't know.

And to be clear, I wasn't looking through the Cochrane review results with an angle--those are most of the first page of search results on their site, with the only one skipped being similar to another one I mentioned, and I stopped when I got bored. These should not be paywalled, as I am not logged into anything and I can read it all, so try clicking the side menu on the right if you have trouble getting into the weeds.

If anything, running through this little exercise has made me less likely to recommend vitamin D supplementation, so do with that what you will.

[ashswordsman859]

the effects of the gases used by the bigger bodied smiling critters

Bobby bear hug: rose helps with stress, seizers, aging, and diabetes. (Nurse?)

Hoppy hopscotch: peppermint helps with pain management, digestive issues, common cold, sinus infection, and headaches. (Child care?)

Kicken chicken: ylang ylang is good for anxiety, depression,mood enhancement, and cognitive function. (Councilor?)

Craftycorn: jasmine is useful for immune support, blood circulation, optimizing hormone levels and relieving stress. (Nurse?)

Picky piggy: citrus is useful for heart health, help maintain cell health in brain tissue, prevents heart disease, kidney stones, brain dysfunction, and emotional regulation. (Food?)

Bubba bubbaphant: lemon grass helps with menstrual issues, improve digestion, nausea, headaches, muscle cramps, spasms, rheumatism (joint pain), high cholesterol, anti-inflammatory, bloating, and boosting red blood cell counts. (Child care for kids with chronic issues?)

Dogday: vanilla as said before helps relax and calm people by reducing anxiety and calms the nerves but also helps with fevers, spasms,blood clotting, although from what I found large amounts can lead to sleep issues but I don't know how accurate that is so take that with a grain of salt. (Kid care?)

Catnap: poppy flower as known does cause a fatigue affect but also has traces of opioids, along with that it also analgesia (inability to feel pain.), euphoria (the laughter), respiratory depression (breath shallow leading to build up of carbon dioxide in the blood.), decreased gastrointestinal mobility (digestive problems resulted when nerves or muscles in the gut do not work in a coordinated way.), and physical & psychological dependency.

eat your heart out au makers!

[mariacallous]

On a recent Thursday afternoon, researchers Lanuza Faccioli and Zhiping Hu wheeled an inconspicuous black and white plastic cooler from an operating room at a hospital in downtown Pittsburgh. Inside was a badly scarred liver, just removed from a 47-year-old man undergoing a transplant to receive a new one from a donor.

But what if patients could avoid that fate? Faccioli and Hu are part of a University of Pittsburgh team led by Alejandro Soto-Gutiérrez attempting to revive badly damaged livers like these—as well as kidneys, hearts, and lungs. Using messenger RNA, the same technology used in some of the Covid-19 vaccines, they’re aiming to reprogram terminally ill organs to be fit and functioning again. With donor livers in short supply, they think mRNA could one day provide an alternative to transplants. The team plans to begin a clinical trial next year to test the idea in people with end-stage liver disease.

Alcohol use, hepatitis infection, and a buildup of fat in the liver can cause scarring over time. When there’s too much damage, the liver starts to fail. “Right now, if you get end-stage liver disease, it’s irreversible,” Soto-Gutiérrez says. “Well, we found that is not true. It is reversible.”

Soto-Gutiérrez and his team have been experimenting on rats and organs taken from people undergoing transplants at the University of Pittsburgh Medical Center, one of the busiest transplant centers in the US. To help design the mRNA and figure out how to deliver it to the human liver, they’ve partnered with Drew Weissman, a physician and immunologist at the University of Pennsylvania who won the 2023 Nobel Prize in Physiology or Medicine for his pioneering work on mRNA. Together, Soto-Gutiérrez and Weissman lead the Center for Transcriptional Medicine, launched in April with the goal of bringing these medicines to patients.

On the day I visited, I followed Faccioli and Hu through a maze of hallways until they deposited the freshly explanted liver at a pathology lab, where a team of scientists was anticipating the special delivery. After infusing the liver with an experimental mRNA therapy, they placed the organ in an oxygenated bath meant to maintain its function for several days.

A healthy liver is spongy and reddish-brown in color with a smooth appearance. But when the surgeons took this one out of the cooler, it was hard, marbled, and covered in bumps—evidence of cirrhosis, a type of end-stage liver disease. Over time, the man’s healthy liver cells had been replaced by scar tissue, and eventually, his liver stopped working. His only option was to get a new one.

Livers are the second most in-demand organ. In 2023, a record 10,660 liver transplants were performed in the US, driven in part by a steadily growing number of living donors. In a living liver transplant, a piece is taken from a healthy person’s liver and transplanted into a recipient. But even with this uptick in transplants, not everyone who needs a new liver receives one. Patients may have other health problems that disqualify them from a transplant, and others may die while waiting for one. In 2022, the latest year for which data is available, the Centers for Disease Control and Prevention recorded nearly 55,000 deaths due to chronic liver disease.

Living donor transplants are possible because of the liver’s unique capacity to regenerate itself—more so than any other organ in the body. In a healthy person, the liver can regrow to its normal size even after up to 90 percent of it has been removed. But disease and lifestyle factors can cause permanent damage, rendering the liver unable to repair itself.

When Soto-Gutiérrez was studying medicine at the University of Guadalajara in Mexico, his uncle died of liver disease. From then on, he became dedicated to finding a treatment for patients like his uncle. In the early years of his medical career, he noticed that some patients with scarred livers were bound to a hospital bed waiting for a transplant, while other people with cirrhosis were walking around, seemingly living normal lives. He figured there must be cellular differences in these livers.

He teamed up with UPMC transplant surgeon Ira Fox to look for transcription factors—master regulators that can dial up or down the expression of groups of genes—that can potentially reprogram injured organs. Genes rely on transcription factors to perform many essential functions in organs. Together, Soto-Gutiérrez and Fox have analyzed more than 400 failing livers donated by transplant patients. When they compared them with dozens of normal donated livers that acted as controls, they identified eight transcription factors essential for organ development and function.

They zeroed in on one in particular, HNF4 alpha, that seems to act like a main control panel, regulating much of the gene expression in liver cells. In healthy liver cells, levels of HNF4 alpha were turned up, and so were other proteins it controls. But in the cirrhotic livers they examined, HNF4 alpha was almost nonexistent.

The team needed a way to get the transcription factor into liver cells, so they turned to mRNA technology. Used in some of the Covid-19 vaccines, mRNA is a molecule that carries instructions for making proteins, including transcription factors. In the Covid vaccines, the mRNA codes for a part of the virus known as the spike protein. When injected into a person’s arm, the mRNA enters cells and kicks off the protein-making process. The body recognizes these spike proteins as foreign and generates antibodies and other defenders against it.

The Pitt team is using mRNA instead to essentially turn back time in injured organs. “What we’re proposing to do with mRNA is use it to deliver proteins that have the capacity to repair those damaged liver cells,” Weissman says. “Our hope is that we can treat end-stage liver disease and turn the livers around, maybe forever, or at least until patients can get a transplanted organ liver.” Instead of delivering instructions for a foreign protein to generate an immune response, they’re delivering the genetic code for producing a transcription factor—HNF4 alpha.

In a paper published in 2021, the approach revived human liver cells in lab dishes. The researchers have since tested the mRNA therapy in rats with cirrhosis and liver failure. They treated a group of rats every three days for three weeks while a second group served as a control. The animals that were receiving the injection of HNF4 alpha started being more active. The untreated rats continued to decline and eventually died, the expected result at their stage of disease. Some of the treated rats were still living six weeks after receiving the mRNA medicine. Those results have not yet been published in a peer reviewed journal.

The team is also testing the mRNA infusions in human livers removed from patients undergoing transplants—the process I got to observe. Unlike live rats, explanted human livers can’t be observed for weeks on end. Livers have to be retrieved quickly and infused with the mRNA treatment soon after they’re removed from the body. They stay fresh for just four days or so in a preservation fluid. Six hours after the mRNA infusion, levels of HNF4 alpha start going up and last for two to three days. When HNF4 alpha peaks, other essential liver proteins, such as albumin, start to increase as well. That’s important, Soto-Gutiérrez says, because maintaining those protein levels could mean the difference between a patient needing a transplant or not.

Ideally, Soto-Gutiérrez says the mRNA therapy would be something patients could get once a week or every other week in an outpatient facility and go back home. But initially, they’ll need to test the experimental treatment in very sick patients, likely ones that are hospitalized, to make sure it’s safe. The team is gathering data from the rat and human liver experiments to submit a clinical trial application to the Food and Drug Administration in the coming months.

While livers are the first target, Fox thinks other injured organs may be amenable to this approach. “We’ve been wondering whether the same process might be taking place in other organs,” he says. Currently, the team is searching for similar transcription factors in lungs with chronic obstructive pulmonary disease and kidneys with chronic kidney disease.

Josh Levitsky, a liver transplant specialist at Northwestern University who isn’t involved in the work, says new treatments for chronic liver disease are sorely needed. Current therapies can help slow down scar tissue buildup and ease symptoms but don’t address the underlying disease. “The concept of reprogramming and being able to reverse liver failure could be really game changing if it were to pan out in clinical studies,” he says.

But lots of questions remain. How much damage could be reversed? Would patients need to be on the therapy indefinitely? Or would their livers rebound enough to go off it? Could a liver ever be restored back to normal?

“It certainly has a lot of promise,” Levitsky says, “but the clinical development is going to take a long time.”

[covid-safer-hotties]

Long COVID: Lasting effects of COVID-19 - Mayo Clinic - Published Aug 25, 2024

After any coronavirus disease 2019 (COVID-19) illness, no matter how serious, some people report that symptoms stay for months. This lingering illness has often been called long COVID or post-COVID-19 syndrome. You might hear it called long-haul COVID or post-acute sequelae of SARS-CoV-2 (PASC).

There is no universal definition of long COVID right now.

In the U.S., some experts have defined long COVID as a long-lasting, called chronic, condition triggered by the virus that causes COVID-19. (1p31) The medical term for this is an infection-associated chronic condition.

As researchers learn more about long COVID, this definition may change.

What are the most common symptoms of long COVID? In research studies, more than 200 symptoms have been linked to long COVID. Symptoms may stay the same over time, get worse, or go away and come back.

Common symptoms of long COVID include:

Extreme tiredness, especially after activity. Problems with memory, often called brain fog. A feeling of being lightheaded or dizzy. Problems with taste or smell. Other symptoms of long COVID include:

Sleep problems. Shortness of breath. Cough. Headache. Fast or irregular heartbeat. Digestion problems, such as loose stools, constipation or bloating. Some people with long COVID may have other illnesses. Diseases caused or made worse by long COVID include migraine, lung disease, autoimmune disease and chronic kidney disease.

Diseases that people may be diagnosed with due to long COVID include:

Heart disease. Mood disorders. Anxiety. Stroke or blood clots. Postural orthostatic tachycardia syndrome, also called POTS. Myalgic encephalomyelitis-chronic fatigue syndrome, also called ME-CFS. Mast cell activation syndrome. Fibromyalgia. Diabetes. Hyperlipidemia. People can get long COVID symptoms after catching the COVID-19 virus even if they never had COVID-19 symptoms. Also, long COVID symptoms can show up weeks or months after a person seems to have recovered.

And while the COVID-19 virus spreads from person to person, long COVID is not contagious and doesn't spread between people.

Why does COVID-19 cause ongoing health problems? Current research has found that long COVID is a chronic condition triggered by the virus that causes COVID-19. The medical term for this is an infection-associated chronic condition.

Researchers don't know exactly how COVID-19 causes long-term illness, but they have some ideas. Theories include:

The virus that causes COVID-19 upsets immune system communication. This could lead immune cells to mistake the body's own cells as a threat and react to them, called an autoimmune reaction. Having COVID-19 awakens viruses that haven't been cleared out of the body. The coronavirus infection upsets the gut's ecosystem. The virus may be able to survive in the gut and spread from there. The virus affects the cells that line blood vessels. The virus damages communication in the brain stem or a nerve that controls automatic functions in the body, called the vagus nerve. Because the virus that causes COVID-19 continues to change, researchers can't say how many people have been affected by long COVID. Some researchers have estimated that 10% to 35% of people who have had COVID-19 went on to have long COVID.

What are the risk factors for long COVID? Risk factors for long COVID are just starting to be known. In general, most research finds that long COVID is diagnosed more often in females of any age than in males. The long COVID risk also may be higher for people who have cardiovascular disease before getting sick.

Some research also shows that getting a COVID-19 vaccine may help prevent long COVID.

Many other factors may raise or lower your risk of long COVID, but research is still ongoing.

What should I do if I have long COVID symptoms? See a healthcare professional if you have long COVID symptoms. Part of long COVID's definition is symptoms that last for three months.

But at this time, no test can say whether you have long COVID. Since you may not have symptoms if you have an infection with the COVID-19 virus, you may not know you had it. Some people have mild symptoms and don't take a COVID-19 test. Others may have had COVID-19 before testing was common.

Long COVID symptoms may come and go or be constant. They also can start any time after you had COVID-19. But symptoms still need to be documented for at least three months in order for a health care professional to diagnose long COVID.

Healthcare professionals may treat your symptoms or conditions before a long COVID-19 diagnosis. And they may work to rule out other conditions over the time you start having symptoms.

Your healthcare team might do lab tests, such as a complete blood count or liver function test. You might have other tests or procedures, such as chest X-rays, based on your symptoms.

The information you give and any test results can help your healthcare professional come up with a treatment plan.

Care for long COVID It can be hard to get care for long COVID. Treatment may be delayed while you work with healthcare professionals. And people with long COVID may have their health problems dismissed by others, including healthcare professionals, family members or employers.

For people with cultural or language barriers, getting a long COVID diagnosis can be even harder. Pulling together information about symptoms and timing can be a challenge too. This is especially true when medical history is fragmented or when someone is managing symptoms related to memory or that affect the thought process.

Underdiagnosis may be more common among people who have less access to healthcare or who have limited financial resources.

If you're having long COVID symptoms, talk with your healthcare professional. It can help to have your medical records available before the appointment if you are starting to get care at a new medical office.

To prepare for your appointment, write down:

When your symptoms started and if they come and go. What makes your symptoms worse. How your symptoms affect your activities. Questions you have about your illness. List medicines and anything else you take, including nutrition supplements and pain medicine that you can get without a prescription. Some people find it helpful to bring a trusted person to the appointment to take notes.

Keep visit summaries and your notes in one place. That can help you track what actions you need to take or what you've already tried to treat your symptoms.

Also, you might find it helpful to connect with others in a support group and share resources.

How long can long COVID last? The conditions linked as part of long COVID may get better over months or may last for years.

What treatment is available for long COVID? Healthcare professionals treat long COVID based on the symptoms. For tiredness, your healthcare professional may suggest that you be active only as long as your symptoms stay stable. If you start to feel worse, rest and don't push through your tiredness.

For symptoms of pain, breathlessness or brain fog, work with your healthcare professional to find a treatment plan that works for you. That may include medicine you can get without a prescription for pain, prescription medicine, supplements and referrals to other healthcare team members.

For loss of taste or smell, a process to retrain the nerves involved in those processes may help some people. The process is called olfactory training. For people with POTS or a fast heartbeat, the healthcare professional may suggest prescription medicine as well as a plan to stay hydrated.

Treatment for other long COVID symptoms may be available so contact your healthcare professional for options.

Next steps for Long COVID Long COVID makes life more difficult for many people. To provide better options for care, research is going on to better understand this illness. In the meantime, adults or children with long COVID may be able to get support for daily activities affected by the illness.

[naamahdarling]

Special Pickle Man update!

This little potato boy had his 5-year CKD anniversary last month, and I want to celebrate his continued existence on this earth with you.

Five years ago he was diagnosed with CKD, chronic kidney disease. We have been extraordinarily lucky that even though we didn't catch it early, he responded well to pretty minimal maintenance treatment and despite some bad scares has stayed with us for an astonishing FIVE YEARS.

I NEVER expected this. Every day with him is a stolen gift, and I adore him so much. Even when he is being a little bastard.

All I would ask for, if you want to celebrate this with us, is that you try in the next year to get your cat a checkup and have their numbers run. I know money is always a concern because hellscape, but if you CAN, a little preventive bloodwork can make a huge difference.

[megpricephotography]

Poor Flynnie has to have an ultrasound scan on Thursday :( He is STILL having some pretty severe gut problems, 2 months after they started... Plus, the most recent blood test we did showed up some slightly “off” results, nothing major but various levels were a bit higher, or lower than they should be - including some stuff related to kidney function.

After seeing the results, the vet asked me to get a urine sample. It turns out Flynn’s losing protein in his urine & his urine is also too dilute. High protein levels in urine often happens because a dog has chronic kidney disease but it can also be a temporary issue, due to infection/inflammation, (or other illnesses... like cancer, which I hope is very unlikely to be the cause here). Regardless of the reason it is happening, it puts a strain on the kidneys. Or, in Flynn’s case, a strain on his kidney. Singular. Flynn only has 1 kidney... so we really can’t mess around with this. He’s now on a “renal diet” & if it’s safe, may start on ACE inhibitors to reduce strain on his kidney. The ultrasound will look at both Flynn’s gut & his kidney, so I guess we’ll just have to wait & see if anything shows up. 

I lost Barney, less than 3 weeks ago - after he’d had the exact same infection as Flynn. Barney went from having mild kidney disease, to being in kidney failure in the space of less than a month. Barney was very elderly, of course... but, still... I don’t know what is going on with Flynn. He’s been treated twice for giardia infection, we’ve been manically cleaning to prevent reinfection, he’s on probiotics & was on GI food. He is an apparently otherwise healthy dog & he really should be getting better by now & instead, if anything he seems in some ways worse than he was 6-8 weeks ago. Argh, I am so stressed. My poor little guy :( 

[mghospital]

How to Prevent Yourself From Getting Infected Immune System | Mahathma Gandhi Hospitals

How to prevent yourself from getting infected?

The following are some of the preventive steps to reduce the risk of infection:

CDC recommends constantly washing the hands with soap and water for 20 seconds. Also, avoid touching your face, eyes, mouth, and nose with dirty and unwashed hands. 

Stay away from people who are constantly sneezing and coughing. Regularly disinfecting frequently touched surfaces, such as the doorknobs and handles helps too .

Staying warm, eating a balanced diet, and keeping yourself hydrated also help keep  infections at bay.

When to seek medical advice?

You should immediately contact your healthcare provider if you experience any of the following symptoms:

Troubled breathing

Constant chest or abdominal pain

Extreme muscle pain or weakness

Seizures

Troubled urinating

Recurrent fever and coughs

Constant lightheadedness or confusion

Worsening of existing chronic medical condition

Cold weather calls for hot beverages and warm clothes and blankets. It also demands you take preventive measures, such as staying warm, eating healthy food, staying away from people with infections , handwashing and keeping yourself hydrated. These measures may save you from respiratory tract infections in the winter. 

Get Appointment:

Call: 08647-230 007, 230008

Visit: https://mahathmagandhihospitals.com/service/pulmonology/

[fooltemps]

Leukemia and Lymphoma Awareness Flags!!

This flag was designed by us, as we currently have a family member with Leukemia and wish to bring awareness to this kind of cancer.

color meaning:

#FF2D34: Myeloma

#00DC0E: Non-Hodgkin Lymphoma

#FF8C2E: Leukemia

#D12DFF: Hodgkin Lymphoma

Below is information all about Leukemia and Lymphoma Cancers.

Leukemia and Lymphoma are both cancers that are not associated with a tumor. Lymphomas are cancers that affect the lymph system and start in cells called lymphocytes. Leukemia is a cancer of the early blood-forming tissues, including your bone marrow and lymph system.

There are many types of lymphoma. Some grow and spread slowly and some are more aggressive. There are two main types of Lymphoma:

1. Hodgkin Lymphoma is cancer that starts in the B lymphocytes (B cells) of the lymph system. Your lymph system helps you fight infection and control the fluids in your body.

2. Non-Hodgkin Lymphoma (NHL) is cancer that starts in the lymphocytes anywhere lymph tissue is found:

Lymph nodes

Spleen

Bone marrow

Thymus

Adenoids and tonsils, or

The digestive track.

Leukemia typically involves white blood cells, the cells that are your infection fighters. Leukemia can be divided into categories: fast growing (acute) and slow growing (chronic); and by which white blood cells are affected:

Acute lymphocytic leukemia (ALL)

Acute myelogenous leukemia (AML)

Chronic lymphocytic leukemia (CLL

Chronic myelogenous leukemia (CML)

A screening test is used to detect cancers in people who may be at higher risk for developing the disease. With leukemia and lymphoma, there are no early detection tests. The best way to find them is to be aware of the symptoms:

Swollen lymph nodes which can appear as a lump in the neck, armpit or groin;

Fever

Night sweats

Weight loss without trying, and

Fatigue.

Leukemia can have similar symptoms but also can include:

Easy bleeding or bruising;

Recurring nosebleeds; and

Bone pain or tenderness

Myeloma is cancer of the plasma cells. Plasma cells are white blood cells that produce disease- and infection-fighting antibodies in your body. Myeloma cells prevent the normal production of antibodies, leaving your body's immune system weakened and susceptible to infection. The multiplication of myeloma cells also interferes with the normal production and function of red and white blood cells. An abnormally high amount of these dysfunctional antibodies in the bloodstream can cause kidney damage. Additionally, the myeloma cells commonly produce substances that cause bone destruction, leading to bone pain and/or fractures.

Myeloma cells are produced in the bone marrow, the soft tissue inside your bones. Sometimes myeloma cells will travel through your blood stream and collect in other bones in your body. Because myeloma frequently occurs at many sites in the bone marrow, it is often referred to as multiple myeloma.

Signs and symptoms of myeloma include the following:

Hypercalcemia (excessive calcium in the blood)

Anemia (shortage or reduced function of red blood cells)

Renal damage (kidney failure)

Susceptibility to infection

Osteoporosis, bone pain, bone swelling, or fracture

High protein levels in the blood and/or urine

Weight loss

In 2022, more than 62,650 people are expected to be diagnosed with leukemia. In addition:

Leukemia accounts for 3.6% of all new cancer cases.

The overall 5-year survival rate for leukemia has more than quadrupled since 1960.

62.7% of leukemia patients survive 5 years or more.

The diagnosis of leukemia requires specific blood tests, including an examination of cells in the blood and marrow.

Treatment and prognosis depend on the type of blood cell affected and whether the leukemia is acute or chronic. Chemotherapy and blood and marrow transplant are often used to treat leukemia.

If you wish to read more about Leukemia and Lymphoma cancer, please visit this website!

[xtruss]

Credit: Dana Smith

Understanding The Sudden Rise of Type 2 Diabetes In Children

The Metabolic Disorder Was Long Known as a Disease of Adulthood. Now, It’s Spiking in Kids and Teens, With Worrisome Consequences.

— By Charlotte Huff | July 31, 2024

The appearance of type 2 diabetes in children and teens puzzled physicians from the start. Fida Bacha recalls working as a pediatric endocrinology fellow in Pittsburgh shortly after 2000 when young, overweight and obese patients began to arrive at the clinic, some describing increased thirst, more frequent trips to the bathroom and other symptoms of what was then called adult-onset diabetes.

“It was a new realization that we are dealing with a disease that used to be only an adult disease that is now becoming a disease of childhood,” says Bacha, who practices at Texas Children’s Hospital in Houston.

More than two decades later, physicians and researchers are still trying to unravel what’s driving the emergence and proliferation of youth-onset disease, particularly among marginalized communities including Hispanics/Latinos. The increasing prevalence of obesity among young people is clearly one contributor, but researchers are also scrutinizing the potential influence of other lifestyle and environmental factors — everything from exposure to chronic stress and air pollution to sugar-rich diets. Along with physiological factors, such as where they carry excess fat, youths from lower socioeconomic levels may be vulnerable due to aspects of daily life beyond their control, such as more limited access to healthy food and opportunities to safely exercise in less-polluted neighborhoods.

As researchers try to sort out the interplay among genetics, metabolic factors and environmental influences in Hispanic and other populations, their goal is to answer this key question: Why do some seemingly at-risk adolescents progress to diabetes while others do not?

Long-term, the challenges and health stakes are significant. When type 2 diabetes first emerged in youths, clinicians initially thought its progression would mirror that in adults and thus could be treated accordingly. That hasn’t panned out, says Barbara Linder, a pediatric endocrinologist and senior advisor for childhood diabetes research at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). For instance, researchers have determined that metformin, a commonly prescribed oral antidiabetic medication in adults, doesn’t work as well in young people.

“We know that the disease is very aggressive in youth and very difficult to treat,” Linder says. “So it’s really imperative that we develop effective approaches to prevention. And to do this we obviously need to be able to effectively identify which youth are at the highest risk.”

Even with treatment, young people develop other medical problems related to diabetes faster than adults, according to a study that followed 500 youths, more than one-third of them Hispanic. Sixty percent developed at least one complication within about 15 years after diagnosis, when just in their 20s.

“It’s really alarming,” says Luisa Rodriguez, a pediatric endocrinologist who studies type 2 diabetes and obesity in children at the University of Texas Health Science Center at San Antonio. For every 10 adolescents with youth-onset diabetes, she points out, “six of them, within a decade span, are going to develop a significant comorbidity that will highly impact their lifespan and quality of life.”

Complications of diabetes appear more quickly in young people than in older adults. Researchers studied 500 overweight adolescents, aged 10 to 17, who had been diagnosed with type 2 diabetes. Within 15 years of their diagnosis, 60 percent of the participants had developed at least one medical complication of diabetes, and 28 percent had developed two or more.

Insulin Resistance

In type 2 diabetes, the body struggles to use insulin effectively. This vital hormone, made by beta cells in the pancreas, helps glucose in the bloodstream enter cells in muscle, fat and the liver, where it’s used for energy. But sometimes those cells gradually lose their ability to respond to insulin, forcing the beta cells to pump out more and more of it. If the beta cells can’t keep up, blood glucose levels will begin to rise, leading to a diagnosis of prediabetes and, eventually, diabetes.

In the past, type 2 diabetes typically didn’t arise until well into adulthood. But now, cases in US youths ages 10 to 19 are rising fast. Since 2002-2003, overall diagnoses have doubled from 9 per 100,000 youths to 17.9 per 100,000 in 2017-2018, particularly among Asians, Pacific Islanders, Blacks and Hispanics. If those rising rates persist, the number of type 2 diabetes cases in young people is projected to skyrocket from 28,000 in 2017 to 220,000 by 2060.

Various factors have been linked to insulin resistance in childhood or adolescence, including obesity, inactivity and genetics, according to a review of the causes of type 2 diabetes in youths published in the 2022 Annual Review of Medicine. The disease tends to run in families regardless of race or ethnicity, which suggests that genes matter. Among US Hispanics, adults of Mexican or Puerto Rican heritage are most likely to be diagnosed, followed by Central and South Americans and Cubans.

Obesity is also a contributing factor: Slightly more than one-fourth of Hispanic youths are obese, a higher percentage than for any other major racial or ethnic group. Children also are more likely to develop type 2 diabetes if their mother has the disease or developed gestational diabetes during pregnancy. One theory is that fetal exposure to maternal diabetes while in the womb can spur metabolic changes following birth.

Puberty is also highly influential — most cases are diagnosed after its onset. During puberty, youths temporarily experience insulin resistance, due in large part to an increase in hormones, Linder says. Most youths offset that transient resistance by secreting more insulin, she says. But for reasons that are still unclear, a subpopulation of adolescents does not. “When they’re faced with this stress test of puberty, they can’t increase their insulin secretion enough to compensate,” Linder says. “And that’s probably why they develop type 2 diabetes.”

One analysis, which looked at type 2 diabetes trends from 2002 to 2018, identified the peak age for diagnosis as 16 years in boys and girls. The sole exception involved Black youths, in whom diagnoses peaked at 13 years, and possibly earlier among Black girls, which may be linked to an earlier start of menstruation.

American Diabetes Association guidelines recommend that clinicians screen overweight or obese youths for the disease starting at age 10 or once puberty starts, whichever is earlier, if they have one or more risk factors. These include a family history of the disease, signs of insulin resistance or affiliation with certain racial/ethnic groups, including Hispanic/Latino.

During checkups, clinicians can look for a visible sign of insulin resistance, an associated skin condition called acanthosis nigricans, says Paulina Cruz Bravo, a physician and diabetes researcher at Washington University School of Medicine in St. Louis. The skin changes tend to appear in the neck area or along folds in the skin, including in the armpits and on the elbows and knees, she says. “The top layer of the skin gets thickened. It’s described as a velvety appearance of the skin — it’s darker compared to the skin in other places.”

The thickened, darker, velvety skin shown here, known as acanthosis nigricans, is a potential warning sign of developing type 2 diabetes. The condition is likely to appear on the neck, elbows, knees and other areas where the skin folds. People who notice acanthosis nigricans on themselves or their children should bring it to a doctor’s attention. Credit: S. Dulebohn/Statpearls 2024

Where an adolescent carries any excess pounds also matters, as insulin resistance has been associated with a type of fat called visceral fat, says Alaina Vidmar, a pediatric endocrinologist at Children’s Hospital Los Angeles. Unlike the more common type of fat, called subcutaneous and felt by pinching around the waistline, visceral fat surrounds the liver and other vital organs, increasing the risk for type 2 diabetes, fatty liver disease and other conditions.

“You really need the liver to process glucose to be able to utilize your insulin well,” Vidmar says. “And if it is full of fat, you are unable to do that.” Fatty liver disease, which has been associated both with obesity and type 2 diabetes, is most common in Hispanic adults, followed by white adults and Black adults, according to a meta-analysis looking at 34 studies.

Imaging scans would be the ideal way to identify the extent and location of visceral fat in adolescents, Vidmar says. But given that routine scanning would be costly, clinicians can instead measure an adolescent’s waist circumference, “a great surrogate marker,” she says.

Diabetes risk depends not just on how much fat you carry, but where you carry it. People with an “apple” body shape, with much of their fat in the abdomen, are at higher risk of diabetes than those with a “pear” body shape, who carry their fat under the skin, especially on the hips.

Still, obesity accounts for only a portion of the type 2 risk profile, reflecting the complexities involved in understanding the pathophysiology of youth-onset disease. Roughly one-fourth of youths with type 2 diabetes are not obese, according to a meta-analysis published in 2022 in JAMA Network Open. Asian youths are least likely to be obese; roughly one-third don’t meet the criteria for obesity.

Moreover, while obesity and insulin resistance boost the risk of developing diabetes, those factors alone don’t predict whether an adolescent is eventually diagnosed with the disease, according to the authors of the Annual Review of Medicine overview. Instead, they point to the role of impaired beta cell function.

In one study involving 699 youths with type 2 diabetes, the standard antidiabetic drug metformin controlled blood glucose levels in only about half the participants. (The medication was least effective among Black youths, for reasons that are unclear, according to the researchers.) Another analysis of the same study population identified a 20 percent to 35 percent decline in beta function each year in diabetic youths, compared with prior studies showing about a 7 percent to 11 percent annual decline in diabetic adults.

“What we see in the youth is that beta cell function fails very rapidly,” Linder says, adding that the beta cell decline tends to correlate with the lack of response to metformin.

It’s unknown whether specific racial or ethnic groups are more vulnerable to loss of beta cell function, says Linder, who hopes that a new large-scale NIDDK study launching this summer will identify any such physiological and other differences among populations. The study, called Discovery of Risk Factors for Type 2 Diabetes in Youth Consortium, aims to enroll 3,600 overweight or obese adolescent boys and girls, 36 percent of them Hispanic. Bacha and other investigators on the project plan to follow the youths through puberty, looking at genetic and physiological markers such as insulin resistance and beta cell function. Their goal is to track who develops type 2 diabetes and what factors precipitate the disease.

In addition, researchers will learn about the participants’ mental health, lifestyles and social determinants of health, Linder says. To that end, families will be asked to share details about nutrition, physical activity and sleep, as well as food insecurity, exposure to racism and other stressors.

“Stress induces certain hormones that antagonize insulin, so they create more insulin resistance,” Linder says. “Stress also is associated with chronic inflammation in the body, which affects the ability of the body to respond normally.”

Young people experience many of the risk factors that predispose people to type 2 diabetes, such as prenatal exposures, junk food, sedentary lifestyles and high levels of stress.

Zooming in on Risk Factors in Hispanic Kids

Already, researchers who have studied at-risk Hispanic youths and their families have begun to flesh out environmental and other influences rooted in daily life that can boost the likelihood of obesity or diabetes. Michael Goran, a child obesity researcher at Children’s Hospital Los Angeles, has led a research project called the Study of Latino Adolescents at Risk (SOLAR), which tracked 328 Hispanic/Latino youths considered at highest risk of youth-onset diabetes based on their body mass index and family history of the disease. The participants, recruited in two waves between 2000 and 2015, completed health questionnaires and underwent annual exams, including imaging scans and other measurements.

One analysis found that Hispanic youths who lived in neighborhoods with higher levels of air pollution were more likely to experience a breakdown in beta cell function. “Which we weren’t necessarily expecting — we don’t know the mechanism of that,” says Goran, who coauthored a close look at pediatric insulin resistance in the 2005 Annual Review of Nutrition.

In more recent years, he’s turned his attention to studying nutrition shortly after birth, with a focus on infant formulas that contain corn syrup. Those formulas are more likely to spike blood sugar than are lactose-based formulas, he says. “If you’re spiking blood glucose with corn syrup in babies,” he says, “you can see how that would be problematic for long-term control of blood sugars.”

In one study, Goran and colleagues looked at obesity trends in 15,246 children who received formula through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Babies who consumed any formula with corn syrup were 10 percent more likely to be obese by age 2 than babies who didn’t. Nearly 90 percent of the study’s participants were Hispanic.

In other research, epidemiologist Carmen Isasi of the Albert Einstein College of Medicine in New York helped lead the Study of Latinos (SOL) Youth study, which delved into the extent to which a child’s family circumstances contribute to obesity and metabolic changes that may boost risk of youth-onset diabetes. Isasi and colleagues found chronic stress to be pervasive. Three-quarters of parents and caregivers reported stress and 29 percent detailed three or more stressors related to health, work or relationships. The higher the number of parental stressors, the more likely the child was to be obese.

Isasi also has looked at the relationship between food insecurity and metabolic health. Hispanic youths raised in households with the highest levels of food insecurity had significantly worse metabolic results, including elevated blood glucose and triglycerides, a type of cholesterol. Families dealing with food insecurity, Isasi says, probably have a lower-quality diet and skimp on costlier protein and fresh produce.

Preventing diabetes has proved challenging. A review paper looking at diet-related and other lifestyle initiatives targeting Hispanic youths found few studies to date that have shown improvements in body mass index or blood glucose levels.

Adolescents of lower socioeconomic status may also shoulder responsibilities that can undercut efforts to stay healthy, says Erica Soltero, a behavioral scientist at Houston’s Baylor College of Medicine, who works with Hispanic youths. For instance, older teens may struggle to attend an exercise class if they have an after-school job or must pick up younger siblings or start dinner. Technology, Soltero says, may be a better way to reach busy Hispanic teens; she’s piloting a study that will provide text-based lifestyle guidance to Hispanic teens with obesity.

Approved medication options remain limited for children and teens. If metformin doesn’t work, the alternative is insulin, and parents may resist giving injections because of the difficulties involved, Rodriguez says. She’s involved with an ongoing study in youths with type 2 diabetes to study the effectiveness of oral semaglutide, one of the newer diabetes drugs that also has achieved notable weight loss. Rodriguez estimates the results will be available by 2026.

The new NIDDK study won’t assess medication treatments, as it’s an observational study. But researchers involved are bullish that study-related insights could lead to better prevention and treatment approaches. “If someone is predisposed to beta cell dysfunction, should we be much more aggressive in treating their overweight/obesity,” Bacha says, “so that this beta cell function is preserved for a longer period of time?” Doctors could, for example, decide to start treatment earlier, she says.

Neither are researchers like Soltero deterred by the long-standing difficulties involved with revamping lifestyle habits. Soltero, who has worked with overweight and obese Hispanic adolescents to improve exercise and make dietary changes, describes them as often highly motivated given the damage they’ve seen the disease inflict on their own families.

“A lot of times they’ll have a touch point with a relative who’s on dialysis and maybe had a digit amputated,” Soltero says. Or “they’ll say, ‘I don’t want to prick myself every day like my Uncle So-and-So.’ Or ‘I don’t want to be on medicine for the rest of my life like my grandma.’ ”

[dr-smita-goel-homeopathy-clinic]

*Dr. Smita Goel Homeopathy Clinic*

www.thehomeopathyclinic.co.in

A person with short stature, or restricted growth, does not grow as tall as other people of the same gender, age, and ethnicity. The person's height is below the 3rd percentile.

Short stature can be a variant of normal growth, or it may indicate a disorder or condition.

Growth rate is an important indicator of overall health. Children who do not reach the 5th percentile by the age of 5 years are said to be small for gestational age (SGA). A pediatrician will look out for signs of "failure to thrive."

Early intervention can prevent future problems in many cases.

Normally, at 8 years of age, a child's arm span is around the same as their height. If these measurements are out of proportion, this may be a sign of disproportionate short stature (DSS), sometimes known as "dwarfism."

Fast facts on short stature

Here are some key points about short stature. More detail is in the main article.

• Short stature can happen for a wide range of reasons, including having small parents, malnutrition, and genetic conditions such as achondroplasia.

• Proportionate short stature (PSS) is when the person is small, but all the parts are in the usual proportions. In disproportionate short stature (DSS), the limbs may be small compared with the trunk.

• If short stature results from a growth hormone (GH) deficiency, GH treatment can often boost growth.

• Some people may experience long-term medical complications, but intelligence is not usually affected.

Causes

Growth depends on a complex range of factors, including genetic makeup, nutrition, and hormonal influences.

The most common cause of short stature is having parents whose height is below average, but around 5 percent of children with short stature have a medical condition.

Conditions that can underlie short stature include:

• Undernutrition, due to a disease or lack of nutrients

• Hypothyroidism, leading to a lack of growth hormone

• A tumor in the pituitary gland

• Diseases of the lungs, heart, kidneys, liver, or gastrointestinal tract

• Conditions that affect the production of collagen and other proteins

• Some chronic diseases, such as celiac disease and other inflammatory disorders

• Mitochondrial disease, which can affect the body in different ways, including growth

Sometimes, an injury to the head during childhood can lead to reduced growth.

A lack of growth hormone can also lead to delayed or absent sexual development.

Rheumatologic diseases, such as arthritis, are linked to short stature. This may happen because of the disease, or as a result of the glucocorticoid treatment, which can affect the release of growth hormone.

Disproportionate short stature (DSS) usually stems from a genetic mutation that affects the development of bone and cartilage and undermines physical growth.

The parents may not have short stature, but they may pass on a condition that is linked to DSS, such as achondroplasia, mucopolysaccharide disease, and spondyloepiphyseal dysplasia (SED).

Types

There are different types and causes of short stature, or restricted growth, and they will present differently. Because the range of conditions is so broad, restricted growth can be classified in various ways.

One categorization is:

• Variant restricted growth

• Proportionate short stature (PSS)

• Disproportionate short stature (DSS)

Each of these categories includes a number of types and causes of short stature.

Variant restricted growth

Sometimes a person is small but otherwise healthy. This can be referred to as variant restricted growth. It may happen for genetic or hormonal reasons.

If the parents are also small, this can be called familial short stature (FSS). If it stems from a hormonal issue, it is a constitutional delay in growth and adolescence (CDGA).

The limbs and the head develop in proportion with the spine, and the individual is otherwise healthy.

Growth happens throughout the body, so the legs, for example, are in proportion with the spine.

In most cases, the individual's parents are also small, but sometimes small stature happens because the body does not produce enough growth hormone (GH), or the body does not process growth hormone properly. This is known as GH insensitivity. Hypothyrodism can lead to low hormone production.

Growth hormone treatment during childhood may help.

Proportionate short stature (PSS)

Sometimes, overall growth is restricted, but the person's body is in proportion, and the individual has a related health problem. This is known as proportionate short stature (PSS).

If the individual is heavy for their height, this can suggest a hormone problem. The problem could be hypothyroidism, excess glucorticoid production, or too little GH.

A person who is small and their weight is low for their height may be experiencing malnutrition, or they may have a disorder that leads to malabsorption.

Whatever the underlying reason, if it affects overall growth, it may impact development in at least one body system, so treatment is needed.

During adulthood, a person with this type of restricted growth is more likely to experience:

• osteoporosis

• cardiovascular problems

• reduced muscle strength

Rarely, there may be cognitive problems, or problems with thinking. This depends on the cause of the short stature.

Disproportionate short stature (DSS)

Disproportionate short stature (DSS) is linked to a genetic mutation. The parents are usually of average height. As with other types of short stature, a range underlying causes is possible.

An individual with DSS will be small in height, and they will have other unusual physical features. These may be visible at birth, or they may develop in time as the infant develops.

Most individuals will have an average-sized trunk and short limbs, but some people may have a very short trunk and shortened, but disproportionately large limbs. Head size may be disproportionately large.

Intelligence or cognitive abilities are unlikely to be affected unless the person has hydrocephalus, or too much fluid around the brain.

Achondroplasia underlies around 70 percent of cases of DSS. It affects around 1 in 15,000 to 1 in 40,000 people.

Features include:

• an average-sized trunk

• short limbs, especially the upper arms and legs

• short fingers, possibly with a wide space between the middle and ring fingers

• limited mobility in the elbows

• a large head with a prominent forehead and flattened bridge of the nose

• bowed legs

• lordosis, a progressive development of a swayed lower back

• average adult height of 4 feet, or 122 cm

Hypochondroplasia is a mild form of achondroplasia. It may be difficult to differentiate between familial short stature and achondroplasia.

Achondroplasia and hypochondroplasia result from a genetic mutation.

Genetic conditions, such as Turner syndrome, Down syndrome, or Prader Willi syndrome, are also linked to DSS.

Diagnosis

Some types of short stature can be diagnosed at birth. In other cases, routine visits to a pediatrician should reveal any abnormal growth pattern.

The doctor will record the child's head circumference, height, and weight.

If the doctor suspects restricted growth, they will carry out a physical examination, look at the child's medical and family history, and possibly carry out some tests.

These may include:

An x-ray, to assess for problems with bone development

An insulin tolerance test, to check for a deficiency in the growth hormone insulin-like growth factor-1 (IGF-1).

In this test, insulin is injected into a vein, causing blood glucose levels to drop. Normally, this would trigger the pituitary gland to release growth hormone (GH). If GH levels are lower than normal, there may be a GH deficiency.

Other tests include:

• a thyroid-stimulating hormone test, to check for hypothyroidism

• a complete blood count, to test for anemia

• metabolic tests, to assess liver and kidney function

• erythrocyte sedimentation and C-reactive protein tests, to assess for inflammatory bowel disease

• urine tests can check for enzyme deficiency disorders

• tissue transglutinase and immunoglobulin A tests, for celiac disease

• imaging scans, such as an x-ray of the skeleton and the skull or an MRI, can detect problems with the pituitary gland or hypothalamus

• bone marrow or skin biopsies may help confirm conditions associated with short stature

Treatment

Treatment will depend on the cause of the short stature.

If there are signs of malnutrition, the child may need nutritional supplements or treatment for a bowel disorder or other condition that is preventing them from absorbing nutrients.

If growth is restricted or delayed because of a hormonal problem, GH treatment may be necessary.

Pediatric hormone treatment: In children who produce too little GH, a daily injection of hormone treatment may stimulate physical growth later in life. Medications, such as somatropin, may eventually add 4 inches, or 10 centimeters, to adult height.

Adult hormone treatment

: Treatment for adults can help protect against complications, for example, cardiovascular disease and low bone mineral density.

Somatropin, also known as recombinant GH, might be recommended for people who:

• have a severe growth hormone deficiency

• experience impaired quality of life

• are already receiving treatment for another pituitary hormone deficiency

Adult patients generally self-administer daily with an injection.

Adverse effects of somatropin include headache, muscle pain, edema, or fluid retention, problems with eyesight, joint pain, vomiting, and nausea.

The patient may receive treatment to control chronic conditions, such as heart disease, lung disease, and arthritis.

Treatment for DSS

As DSS often stems from a genetic disorder, treatment focuses mainly on the complications.

Some patients with very short legs may undergo leg lengthening. The leg bone is broken and then fixed into a special frame. The frame is adjusted daily to lengthen the bone.

This does not always work, it takes a long time, and there is a risk of complications, including:

• pain

• the bone forming badly or at an inappropriate rate

• infection

• deep vein thrombosis (DVT), a blood clot in a vein

Other possible surgical treatments include:

• use of growth plates, where metal staples are inserted into the ends of long bones where growth takes place, to help bones grow in the right direction

• inserting staples or rods to help the spine form the right shape

• increasing the size of the opening in the bones of the spine to reduce pressure on the spinal cord

Regular monitoring can reduce the risk of complications.

Complications

A person with DSS may experience a number of complications.

These include:

• arthritis later in life

• delayed mobility development

• dental problems

• bowed legs

• hearing problems and otitis media

• hydrocephalus, or too much fluid in the brain cavities

• hunching of the back

• limb problems

• swaying of the back

• narrowing of the channel in the lower spine during adulthood and other spine problem

• sleep apnea

• weight gain

• speech and language problems

Individuals with proportionate short stature (PSS) may have poorly developed organs and pregnancy complications, such as respiratory problems. Delivery will normally be by cesarean section.

Outlook

Most people with short stature will have a normal life expectancy, and 90 percent of children who are small for their age at 2 years will "catch up" by adulthood.

The 10 percent who do not catch up are likely to have a condition such as fetal alcohol, Prader-Willi, or Down syndrome.

A person with achondroplasia can also expect a normal lifespan.

However, some serious conditions that are linked to some cases of short stature can be fatal.