Archive for July, 2011

FYI: New Therapeutic Strategies in Progressive Neuromuscular Disorders such as ALS

July 10th, 2011
DukeClinicalResearch asked:


An educational series from Duke Clinical Research Institute, presented by Richard Bedlack, MD, PhD, MS

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Renal Failure and Proper Nutrition

July 10th, 2011
Jim Duffy asked:




The kidneys are twin organs that are responsible for filtering the blood to remove all waste products. The kidneys also release hormones that regulate the blood pressure and the number of red blood cells. The blood enters the kidneys, with the waste materials diverted and sent via the ureter to the bladder to be eliminated from the body in the act of urination. The blood that has been filtered goes back to the body. The kidneys process over 18 gallons of blood every hour for a total of 432 gallons of blood filtered every day. The kidneys also filter over half of all fluids taken in by the body and release at least two quarts of urine every single day.

The kidneys can be subjected to a number of different disorders including kidney infections, kidney stones and a serious condition called Chronic Kidney Disease (CKD) any of these can grow worse and may lead to renal failure.

Renal failure can be either acute or chronic in nature and are typically detected with increased serum creatinine and decreased glomerular filtration rate. Renal failure may have several symptoms including:

- Increased levels of urea in the blood

- Vomiting or diarrhea which might be severe enough to cause dehydration

- Nausea

- Weight loss

- Nocturnal urination

- Foamy or bubbly urine

- Increased frequency or increased amounts of very pale urine

- Blood in the urine

- Pressure or difficult urination

Renal failure may also cause phosphates in the blood, itching, bone damage and muscle cramps which are caused by the low levels of calcium. Potassium will build up in the blood stream, a condition called hyperkalemia which may cause abnormal heart rhythms and eventual muscle paralysis (Source: surgeryideas.com/renalfailure )

Some of the risk factors for kidney diseases include hypertension, especially when it is untreated, gout, diabetes, prolonged shock and the use of certain drugs.

Chronic kidney disease affects 26 million Americans with millions more at high risk of developing the disease. Early detection is the key to keeping CKD from progressing to kidney failure. Heart disease is the major cause of death for those who have CKD. Hypertension is a major risk factor of CKD, but CKD is a major risk factor for developing hypertension as well. The two can be called interchangeable because they are so linked with one another. Virtually everyone with CKD will have hypertension and the majority of the people with hypertension are at much greater risk for developing CKD.

In addition to high blood pressure, the risk factors for CKD include: diabetes, family history of kidney diseases, and certain ethnic groups. Those of African-American, Hispanic, Pacific Islander or Native American descent are at increased risk for this and other kidney diseases.

Causes of Kidney Failure:

- Hypovolemia (a low blood volume) can result from extreme blood loss

- Dehydration

- The use of diuretics

- The obstruction of renal arteries or veins.

- Sepsis (an overwhelming infection)

- Rhabodmyolysis (significant muscle break down in the body)

- Trauma or crushing accidents

The diseases that affect the kidneys can be either temporary or potentially fatal. Treatment can be as simple as medications or can be as complicated as needing a new kidney. While you can live with only one kidney if something happens to one of them, it is never a good idea to do so because it puts so much stress on the remaining organ. There are three common tests to check for kidney failure including: blood pressure, urine albumin and serum creatinine. High blood pressure can be a symptom of kidney disease because the kidneys secrete hormones to regulate blood pressure.

Dietary Suggestions

Anyone with a chronic condition of any kind should seek the advice of their doctor regarding nutrition and the need for vitamins and minerals. Certain micronutrients can be dangerous to the system that is already over taxed. In addition, there are also some macronutrients that can be harmful to those with CKD or other kidney problems.

People with CKD should limit their protein intake within reason but only under the direction and guidance of a nutritionist (Source: National Kidney and Urological Diseases Information Clearinghouse). Protein is an important part of a healthy diet, but there are some restrictions for those who have kidney disease. It may be important to limit the amount of protein so the protein that you do get should be of high quality and low fat.

Too much protein in the diet, changes the process of the metabolism to a state of ketosis. Ketosis occurs when the body stops burning carbohydrates for energy and reverts to burning fat instead. The fat is broken down into molecules of carbon that are called ketones. These ketones are released into the blood stream. Ketosis can be problematic because it suppresses the appetite while it increases the urinary output. The combination of the two can lead to dehydration, an electrolyte imbalance and osteoporosis (Source: Osterweil)

The American Heart Association suggests that the amount of protein in the diet be no more than 35% of the daily calories, however this may be too much for those who have beginning or worsening kidney disease. It is important to make sure that the doctors and nutritionists work to find the right amount of all three macronutrients, protein, fat and carbohydrates that will work with the kidney disease. The proteins that are eaten should be of the healthy, low fat variety including plant proteins.

Kidney Stones

In addition to the serious kidney conditions listed above, there are kidney stones as well. One of the most painful urologic disorders is suffering from kidney stones. It is also one of the most common as well. While most of the kidney stones that a person might develop will pass without medical intervention at all, some may actually need to have some treatment.

The most common type of stones are the calcium oxalate or the phosphate oxalate stone with a few other less common types that can develop as well. Kidney stones are most common in Caucasian men between the ages of 40-70. The threat of kidney stones in women peaks at the age of 50. Your chances of kidney stones go up: with family history, frequent UTIs, if you have cystic kidney disease, and certain metabolic disorders. Cystinuria and hyperoxaluria are both rare, inherited metabolic disorders that may often cause kidney stones. Hypercalciuria (high calcium in the blood) is also inherited and may be the cause of half of the kidney stones. Other causes: gout, excess Vitamin D, blockage of the urinary tract and the use of diuretics. (Source: surgeryideas.com/kidneystones)

Symptoms of Kidney Stones — There are a number of symptoms: extreme pain, sharp cramping pain in the back, nausea and vomiting, pink urine, frequent urination, burning upon urination, fever, chills. Most kidney stones are found by X-ray, CT scan or intravenous pyelogram in the course of ruling out other conditions.

References

The American Heart Association

Neil Osterweil The Benefits of Protein WebMd

The National Kidney and Urologic Disorders Information Clearinghouse

surgeryideas.com/kidneystones

surgeryideas.com/renalfailure

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Botulism Recall – What You Need to Know

July 10th, 2011
Angela Edwards asked:




Although most foodborne illness is called “Food poisoning” by the common man, most sickness caused by food is not “poisoning,” per se, but bacterial infections that are ingested by eating affected food. However, there has been recent news of a bona fide food poisoning outbreak. Four victims have been sickened with suspected botulism after ingesting hot dog chili sauce thought to contain the toxin. 10-ounce cans of Castleberry’s, Austex and Kroger brands of hot dog chili sauce with “best by” dates from April 30, 2009, through May 22, 2009 are suspected to be the ones affected, according to the Food and Drug Administration.

It is extremely rare for a commercially canned product to contain the botulism toxin, which is so deadly that one drop of pure toxin can kill 20 people. Centers for Disease Control and Prevention medical epidemiologist Dr. Michael Lynch said the last such U.S. case dates to the 1970s. The approximately 25 cases reported each year to the CDC usually involved home-canned foods, Lynch said.

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. There are three types of botulism: foodborne botulism, wound botulism, and infant botulism. From the CDC website:

Clostridium botulinum is the name of a group of bacteria commonly found in soil. These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores which allow them to survive in a dormant state until exposed to conditions that can support their growth. There are seven types of botulism toxin designated by the letters A through G; only types A, B, E and F cause illness in humans.

About 110 cases of botulism are reported each year in the United States. Of these, only 25% are foodborne. Foodborne botulism usually results from improperly home canned foods, especially foods with a lower acid content, such as such as asparagus, green beans, beets and corn. Higher acidity in foods can help prevent foodborne infections and toxins.

Botulism can be prevented. Home canners should always follow strict hygienic procedures to reduce contamination of foods. If home canners have any questions about home canning procedures, they should obtain instructions for safe canning from county extension offices or the U.S. Department of Agriculture. Oils infused with garlic or herbs should be refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure that it is safe.

Honey can contain spores of Clostridium botulinum and this toxin has known to be a source of infection for infants; therefore children less than 12 months old should not be fed honey. Honey is safe for individuals 12 months of age and older. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.

Foodborne botulism is most commonly found in foods that have been canned; therefore it is vital that not only do home canners regard food safety most highly, but that commercial cans that are bulging, severely dented, or severely rusted are discarded and not used. If foodborne illness is suspected, a person should seek medical care immediately. From the CDC website:

The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.

The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. Currently, antitoxin is not routinely given for treatment of infant botulism.

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