http://sites.google.com/a/clos.net/mini/female-hair-lossFemale Hair Loss
Semin Cutan Med Surg. 2009 Mar;28(1):19-32.Click here to read Links
Hair loss in women.
Camacho-Martínez FM.
Department of Dermatology, School of Medicine, Hospital Universitario Virgen
Macarena, Seville, Spain. camachodp@medynet.com
Female pattern hair loss (FPHL) is a clinical problem that is becoming more
common in women.
Female alopecia with androgen increase is called female androgenetic alopecia
(FAGA) and without androgen increase is called female pattern hair loss.
The clinical picture of typical FAGA begins with a specific "diffuse loss of
hair from the parietal or frontovertical areas with an intact frontal hairline."
Ludwig called this process "rarefaction."
In Ludwig's classification of hair loss in women, progressive type of FAGA, 3
patterns were described: grade I or minimal, grade II or moderate, and grade III
or severe. Ludwig also described female androgenetic alopecia with male pattern
(FAGA.M) that should be subclassified according to Ebling's or
Hamilton-Norwood's classification. FAGA.M may be present in 4 conditions:
persistent adrenarche syndrome, alopecia caused by an adrenal or an ovarian
tumor, posthysterectomy, and as an involutive alopecia.
A more recent classification (Olsen's classification of FPHL) proposes 2 types:
early- and late-onset with or without excess of androgens in each.
The diagnosis of FPHL is made by clinical history, clinical examination, wash
test, dermoscopy, trichoscan, trichograms and laboratory test, especially
androgenic determinations.
Topical treatment of FPHL is with minoxidil, 2-5% twice daily.
When FPHL is associated with high levels of androgens, systemic antiandrogenic
therapy is needed.
Persistent adrenarche syndrome (adrenal SAHA) and alopecia of adrenal
hyperandrogenism is treated with adrenal suppression and antiandrogens.
Adrenal suppression is achieved with glucocorticosteroids.
Antiandrogens therapy includes cyproterone acetate, drospirenone,
spironolactone, flutamide, and finasteride.
Excess release of ovarian androgens (ovarian SAHA) and alopecia of ovarian
hyperandrogenism is treated with ovarian suppression and antiandrogens.
Ovarian suppression includes the use of contraceptives containing an estrogen,
ethinylestradiol, and a progestogen.
Antiandrogens such as cyproterone acetate, always accompanied by tricyclic
contraceptives, are the best choice of antiandrogens to use in patients with
FPHL.
Gonadotropin-releasing hormone agonists such as leuprolide acetate suppress
pituitary and gonadal function through a reduction in luteinizing hormone and
follicle-stimulating hormone levels.
Subsequently, ovarian steroid levels also will be reduced, especially in
patients with polycystic ovary syndrome.
When polycystic ovary syndrome is associated with insulin resistance, metformin
must be considered as treatment.
Hyperprolactinemic SAHA and alopecia of pituitary hyperandrogenism should be
treated with bromocriptine or cabergoline.
*** Postmenopausal alopecia, with previous high levels of androgens or with
prostatic-specific antigen greater than 0.04 ng/mL, improves with finasteride or
dutasteride.
Although we do not know the reason, postmenopausal alopecia in normoandrogenic
women also improves with finasteride or dutasteride at a dose of 2.5 mg per day.
Dermatocosmetic concealment with a hairpiece, hair prosthesis as extensions, or
partial hairpieces can be useful.
Lastly, weight loss undoubtedly improves hair loss in hyperandrogenic women.
http://cme.medscape.com/viewarticle/708355?src=cmempFrom Medscape Medical News CME
Large Waist Size Linked to Asthma in Women CME
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Authors and Disclosures
CME Released: 09/03/2009; Valid for credit through 09/03/2010
* Print This Print This
* Email This Email this
processing....
[ ]
[ ]
CME Information
Target Audience
This article is intended for primary care clinicians, pulmonologists, gynecologists, and other specialists who care for women with obesity or asthma.
Goal
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosures
Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the association between asthma prevalence and body mass index in women.
2. Describe the association between asthma prevalence and severity and waist circumference in women.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
MedscapeCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
MedscapeCME designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape News CME has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2009. Term of approval is for 1 year from this date. (This/Each) (element, volume, issue, monograph, tape, web cast, etc) is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of (this/each) (issue, webcast, etc.)
Note: Total credit is subject to change based on topic selection and article length.
AAFP Accreditation Questions
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME Released: 09/03/2009; Valid for credit through 09/03/2010
Instructions for Participation and Credit
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
1. Read the target audience, learning objectives, and author disclosures.
2. Study the educational content online or printed out.
3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
Hardware/Software Requirements
MedscapeCME is accessible using the following browsers: Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash, Adobe Acrobat, or Microsoft PowerPoint.
September 3, 2009 — Large waist size is associated with increased asthma prevalence, even among women considered to have normal body weight, according to results from the California Teachers Study cohort reported online in the August 25 issue of Thorax.
"Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation," write J. Von Behren, MPH, from Northern California Cancer Center in Berkeley, California, and colleagues. "A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers."
Questionnaires were completed in 1995, 1997, 2000, and 2005. Allowing adjustment for age, smoking, and race/ethnicity, multivariable linear modeling was used to calculate prevalence odds ratios (ORs) for current asthma. At baseline, 11,500 (13%) of 88,304 women studied from the cohort were obese, defined as BMI of more than 30 kg/m2, and 1334 were extremely obese, defined as BMI of more than 40 kg/m2.
The adjusted OR for adult-onset asthma was 1.40 (95% confidence interval [CI], 1.31 - 1.49) for overweight women vs those of normal weight and 3.30 (95% CI, 2.85 - 3.82) for extremely obese women. Even among women with normal BMI, large waist circumference (WC; > 88 cm) was linked to increased prevalence of asthma (OR, 1.37; 95% CI, 1.18 - 1.59).
Compared with obese women whose waist was 88 cm or less, obese women who also had abdominal obesity had a greater risk for asthma (OR, 2.36 vs 1.57). The risk for severe asthma episodes, reflected in urgent medical visits and hospital admissions, was also greater in obese and overweight women.
"This study confirms the association between excess weight and asthma severity and prevalence, and showed that a large waist was associated with increased asthma prevalence even among women considered to have normal body weight," the study authors write. "All measures of obesity were strongly associated with increased asthma prevalence. Even being modestly overweight was associated with higher asthma prevalence in this population."
Limitations of this study include lack of data on several recognized risk factors for asthma, mostly cross-sectional data, reliance on self-report for physician diagnosis of asthma, and possible selection bias or participation bias.
"These findings are particularly troubling because a majority of American adults are now overweight or obese," the study authors conclude. "In the next phase of this study we will prospectively ascertain new asthma cases and will be able to evaluate BMI, waist size and weight change as risk factors for incident asthma in women."
The National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships.
Thorax. Published online August 25, 2009. Abstract
http://sites.google.com/a/clos.net/mini/80-percent-gastric-bypass-patients-vit-d-defficient80% of Gastric Bypass patients Vitamin D Defficient
Obes Surg. 2009 May;19(5):590-4. Epub 2008 Oct 11.
Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery.
Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M.
Saint Vincent Charity Hospital, 2351 East 22nd St., Cleveland, OH, 44115, USA.
BACKGROUND: Literature regarding the effect of Roux-en-Y gastric bypass (RYGBP) on vitamin D level shows contradictory findings.
Our goal was to determine preoperatively vitamin D levels, to evaluate the efficacy of therapeutic and prophylactic doses of vitamin D and to assess the relationship of 25-OH vitamin D level and body mass index (BMI).
METHODS: We conducted a retrospective cross-sectional study of 72 patients who underwent RYGBP from April 2007 to October 2007 in Bariatric Surgery Department at Saint Vincent Charity Hospital.
RESULTS:
Our study demonstrated that ** 80% ** of the obese patients undergoing RYGBP had serum 25-OH vitamin D levels of less than 32 ng/ml.
(many laboratories currently have listed their normal range as 32-150 ng/ml)
Postoperative data show that 45% of these patients continue being vitamin D insufficient despite the treatment.
We demonstrated that a statistically significant inverse correlation between BMI and 25-OH vitamin D levels (r = 0.464, p = 0.01) exists.
I.e. Heavier patients = Lower Vitamin D
CONCLUSION: Our finding strongly supports the need for aggressive monitoring of vitamin D levels for long-term prevention of complications of vitamin D deficiency in gastric bypass patients.
Identifying the factors that predict patient's responses to vitamin D supplementation requires larger-scale studies and further analysis of these tendencies suggested by our findings.
PMID: 18850253 [PubMed - in proces
http://www.ncbi.nlm.nih.gov/pubmed/18850253
New Study:
Revision Surgery after RNY Gastric Bypass
Only Leads to 18 lb Weight Loss!
http://ping.fm/WBzVLOne of the common long-term problems with the RNY is weight regain
Revision surgery of the RNY led to only 18 lb weight loss.
Higher risk for Adverse Events, especially serious type 1 reactions, with iron dextran therapy than and suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
Nephrol Dial Transplant. 2005 Jul;20(7):1443-9. Epub 2005 Apr 26.Click here to read Links
Hypersensitivity reactions and deaths associated with intravenous iron preparations.
Bailie GR, Clark JA, Lane CE, Lane PL.
Albany Nephrology Pharmacy (ANephRx) Group, Albany, NY, USA. bailieg@acp.edu
BACKGROUND:
Parenteral iron therapy is an accepted adjunctive management of anaemia in kidney disease.
Newer agents may have fewer severe hypersensitivity adverse events (AE) compared with iron dextrans (ID).
The rate of type 1 adverse events to iron sucrose (IS) and sodium ferric gluconate (SFG) relative to iron dextran is unclear.
We used the US Food and Drug Administration's Freedom of Information (FOI) surveillance database to compare the type 1 adverse events profiles for the three intravenous iron preparations available in the United States.
METHODS: We tabulated reports received by the FOI database between January 1997 and September 2002, and calculated 100 mg dose equivalents for the treated population for each agent.
We developed four clinical categories describing hypersensitivity adverse events (anaphylaxis, anaphylactoid reaction, urticaria and angioedema) and an algorithm describing anaphylaxis, for specific analyses.
RESULTS:
All-event reporting rates were
29.2, 10.5 and 4.2 reports/million 100 mg dose equivalents,
while all-fatal-event reporting rates were 1.4, 0.6 and 0.0 reports/million 100 mg dose equivalents
for Iron Dextran, sodium ferric gluconate (Ferrlecit) and Iron Sucrose (Venofer),
respectively.
Iron dextran had the highest reporting rates in all four clinical categories and the anaphylaxis algorithm.
Sodium ferric gluconate (Ferrlecit) had intermediate reporting rates for urticaria, anaphylactoid reaction and the anaphylaxis algorithm, and a zero reporting rate for the anaphylaxis clinical category.
Iron sucrose (Venofer) had either the lowest or a zero reporting rate in all clinical categories/algorithm.
CONCLUSIONS:
These findings confirm a higher risk for AE, especially serious type 1 reactions, with iron dextran therapy than with newer intravenous iron products and also suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
http://sites.google.com/a/clos.net/mini/mortality-rate-sleeve-gastrectomy-over-1-per-100Mortality Rate Sleeve Gastrectomy Over 1 per 100
National Study Mortality Rate Sleeve Gastrectomy Over 1 per 100 (1.4%)!
New Study of All Sleeve Gastrectomies in Germany
Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany.
Results
The total study contains 3,122 patients.
From January 2006 to December 2007,
144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study.
The mean body mass index (BMI) of patients undergoing SG was 54.5 kg/m2.
The complication rate after SG was 14.1%, and
the surgical complication rate was 9.4%.
The postoperative mortality rate was 1.4%.
Conclusions
`The complication rate during the first 2 years after SG in Germany is similar to that published in the literature.`
Kim commented:
"My husband, brother in law, and 3 best friends had MGB. My dad and sister had Lap band. No comparison between the two. If you want to throw up everyday....and feel like you have something hung up in your throat, get the lap band. The results with MGB are superior!!
http://sites.google.com/a/clos.net/mini/high-fructose-corn-syrup-deadly-soupHigh-Fructose Corn Syrup: Deadly Soup
Over 10% of Americans' daily calories from fructose.
Fructose accelerates the progression of chronic kidney disease
Fructose causes the Metabolic Syndrome
Beware High Fructose Corn Syrup
Green tea, Carnitine, Quercetin, Soy and other foods/supplements may help
Read on....
New Patient Application from Amy in Oregon:
Had LapBand in Mexico, now weighs 300 lbs. Coming for an MGB
http://mgb.fm/From a new MGB patient: "No I have had no previous weight loss surgery. My wife, Teresa, had the MGB on December 12, 2008. I watch her get healthier every day! Sign me up."
http://ping.fm/dsvkHBand vs Bypass: Easy vs Effective
Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding
In a high quality new study comparing the band to the RNY bypass the authors conclude that the RNY gets better weight loss but at the expense of more complications
Wouldn't it be great if there was a short simple safe operation that led to excellent weight loss...
Like the Mini (sleeve) Gastric Bypass
