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Uso de mindfulness no tratamento da migrânea

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Técnica de mindfulness contra migrânea

A migrânea, uma forma de cefaleia (dor de cabeça) popularmente conhecida como “enxaqueca”, é uma condição relativamente comum e incapacitante, sendo 2 vezes mais prevalente em mulheres do que em homens. Apesar disso, muitos pacientes consideram o tratamento farmacológico desafiador, visto que não é isento de efeitos colaterais. Por isso, alguns grupos vêm pesquisando abordagens não farmacológicas para as cefaleias. Este é o caso de um artigo recentemente publicado no JAMA Internal Medicine e citado no Medscape (referências na bibliografia) e que pretende avaliar a eficácia de uma técnica de mindfulness sobre esta condição. O estudo proposto é um ensaio clínico randomizado que compara o tratamento baseado em mindfulness com um programa educativo sobre cefaleia.

Características da técnica

A técnica testada chama-se Mindfulness-based stress reduction (MBSR), que significa, em tradução livre, “redução do estresse baseado em mindfulness”. Ela inclui práticas de atenção plena e meditação, que envolvem o escaneamento corporal e promovem a concentração em diferentes partes do corpo. Essa modalidade pode guardar semelhanças com algumas práticas de yoga. Tal abordagem já parece aliviar quadros de dores crônicas e de estresse, sendo este último um dos principais gatilhos da migrânea.

A população estudada era de adultos que sofriam entre 4 e 20 episódios de migrânea por mês ao longo de 1 ano.  Os autores definiram que um dia com migrânea era aquele em que apresentavam cefaleia de moderada a grave, com nível de intensidade da dor entre 6 e 10 (numa escala que varia de 0 a 10), e duração superior a 4 horas ou com tratamento medicamentosos agudo. Os participantes foram randomizados entre 2 grupos: um grupo recebeu a terapia baseada em mindfulness e o outro, um programa educativo sobre cefaleias.

Características dos pacientes

Apesar de 96 participantes terem sido selecionados, 89 frequentaram pelo menos 1 aula e completaram ao menos 1 registro sobre a cefaleia. A amostra foi composta por participantes majoritariamente do sexo feminino (92%), de etnia branca (89%) e com ensino superior (94%). Cerca de 71% das pessoas do grupo controle e 40% do grupo de intervenção usavam alguma forma de medicação profilática para as crises. Em ambos os grupos pode-se encontrar comorbidades psiquiátricas, principalmente depressão (43%) e alguma forma de transtorno ansioso (38%).

O grupo que participou da intervenção com mindfulness foi submetido a 2 horas semanais de exercício ao longo de 8 semanas e também recebeu áudios eletrônicos, sendo encorajados a ouvi-los por 30 minutos diariamente. Já o grupo que recebeu o programa educativo sobre cefaleia teve um tempo de intervenção similar, mas durante o qual recebeu informações sobre a fisiopatologia, gatilhos, tratamentos, dentre outras informações sobre cefaleia. O acompanhamento de ambos os grupos ocorreu com 12, 24 e 36 semanas e os participantes deveriam fazer registros diários sobre cefaleia (se tiveram dor de cabeça, sua intensidade, duração, sintomas, desconforto e uso de medicação).

Desfechos

O desfecho primário avaliado era a mudança no número de dias por mês com migrânea entre a data de início do estudo e a 12ª semana, enquanto os desfechos secundários estavam relacionados com dor, qualidade de vida, incapacidade, sintomas depressivos e ansiosos. Para tais avaliações foram usados instrumentos apropriados, como o PHQ-9 (para depressão), o GAD-7 (para ansiedade), MIDAS (para incapacidade), dentre outros. A cada avaliação os pesquisadores optaram também por testar a dor com um dispositivo térmico de forma a avaliar o desconforto e a intensidade da dor associada.

Após 12 semanas, ambos os grupos apresentaram uma redução no número de dias com migrânea por mês, sem que houvesse diferença estatisticamente significativa entre eles. Segundo uma das autoras, apesar de não ser esperado que o grupo de controle (que recebeu o programa educativo) apresentasse tal redução, isso poderia indicar que a educação sobre o assunto provavelmente forneceu informações que fizeram a diferença para os participantes. Ela ainda enfatiza que o uso de medicação profilática não influenciou a diferença entre os resultados.

No entanto, no que diz respeito aos efeitos secundários, o grupo de intervenção (que recebeu a técnica baseada em mindfulness) apresentou melhoras estatisticamente significativas em relação à melhora dos sintomas relacionados à incapacidade pela cefaleia e qualidade de vida. Houve também melhora comparativa no que diz respeito à dor e aos níveis de depressão, com efeito observado até a 36ª semana. Estes participantes também apresentaram menor percepção de desconforto e intensidade da dor no teste de dor realizado, enquanto o grupo de controle não apresentou diferenças significativas. Um dos autores sugere que os praticantes de mindfulness talvez possam aprender a perceber e processar a dor de outras formas ou que tenham desenvolvido novas maneiras para responder ao estresse.

Conclusão

Apesar deste estudo não ter observado diferenças importantes no desfecho primário, ou seja, não foi encontrada nenhuma alteração significativa no número de dias com migrânea, os resultados dos desfechos secundários foram positivos e podem trazer o questionamento sobre que tipos de desfechos devem ser priorizados em estudos não farmacológicos como este. Afinal, foram descritas melhora na qualidade de vida, incapacidade, dor e nos sintomas depressivos após até 36 semanas. Apesar de serem necessários outros tipos de trabalhos neste sentido, a terapia com mindfulness talvez possa se tornar uma aliada no tratamento destes pacientes, diminuindo o impacto negativo desta condição em suas vidas.

Autor(a):

Paula Benevenuto Hartmann

Psiquiatra pela UFF ⦁ Graduação em Medicina pela UFF

Referências bibliográficas:

  • Kowacs F, Macedo DDP, Silva-Néto RP, et al. Classificação Internacional de Cefaléias, 3a Edição. Comitê De Classificação das Cefaleias da Sociedade Internacional de Cefaleia. Tradução da Sociedade Brasileira de Cefaleia com Autorização da Sociedade Internacional de Cefaleia. São Paulo; 2019.
  • Wells RE, O´Connell N, Pierce CR, et al. Effectiveness of Mindfulness Meditation vs Headache Education for Adults With Migraine – A Randomized Clinical Trial. JAMA Internal Medicine, December 14th, 2020. doi:10.1001/jamainternmed.2020.7090
  • Anderson P. ‘Dramatic Impact’ of Mindfulness on Migraine. Medscape Psychiatry, December 17th, 2020.

Esta entrada foi postada em artigos médicos, medicina natural, Neurologia, psiquiatria.

Colesterol: cómo recomendar la levadura roja de arroz

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Respetar la dosis, evitar interacciones y definir su uso en función del perfil CV son algunas de las pautas para optimizar esta ‘estatina natural’.

La levadura roja de arroz es considerada como la "estatina natural".
La levadura roja de arroz es considerada como la “estatina natural”.

Poco a poco la levadura roja de arroz se ha ido posicionando como una alternativa  frente a las estatinas, el grupo de fármacos de referencia para el tratamiento de la hipercolesterolemia. Según Antonio Miguel Martín Almendros, secretario del Grupo de Trabajo de Fitoterapia de la Sociedad Española de Médicos de Atención Primaria (Semergen), “las numerosas investigaciones sobre esta sustancia muestran una evidencia clara acerca de su efecto hipocolesterolemiante en la salud cardiovascular”, abriendo, así, un nuevo enfoque en el abordaje de la hipercolesterolemia (niveles de colesterol por encima de 200 mg/dl), un problema que, según datos de la Fundación Española del Corazón (FEC), afecta al 50,5% de la población adulta española y es uno de los principales factores de riesgo de enfermedad cardiovascular.

Este complemento alimenticio se obtiene a partir de una levadura (Monascus purpureus) que, como explica Rocío Narbaiza, vocal de Alimentación del Colegio Oficial de Farmacéuticos de Guipúzcoa, contiene catorce compuestos activos denominados monacolinas. “La monacolina K actúa de forma similar a la lovastatina (un tipo de estatina), inhibiendo la síntesis hepática de colesterol por el bloqueo de la HMG-CoA reductasa. Además, produce un incremento de la actividad de los receptores LDL, de manera que se facilita la unión de las LDL-C al receptor, eliminándolas de la circulación. Por tanto, y debido a esta acción de la monacolina K que contienen, los productos de levadura roja de arroz contribuyen a mantener las concentraciones normales de colesterol sanguíneo”.

Estos productos tienen otras sustancias, como los fitoesteroles (sitosterol, campesterol y estigmasterol) y los policosanoles de caña de azúcar, “unos compuestos que también producen una modulación de la actividad de la enzima HMG-CoA y de la expresión de la misma, reduciendo su síntesis hasta en un 50%”, dice Narbaiza.

Leves o moderados

Los resultados de las investigaciones realizadas sobre este producto han ido definiendo el tipo de pacientes en los que su acción está más indicada: aquellos con hipercolesterolemia leve o moderada que no estén recibiendo tratamiento farmacológico. Pero, en opinión de Martín Almendros, más que hablar de niveles concretos de hipercolesterolemia a partir de los cuales está recomendada esta opción, lo más determinante es definir el riesgo cardiovascular en cada caso concreto. “El nivel de colesterol en sangre es un valor que por sí mismo se queda corto a la hora de proporcionarnos a los médicos de Atención Primaria un criterio para tratar o no tratar al paciente. Lo que valoramos son factores modificables y no modificables que inciden sobre un paciente aumentando o disminuyendo el riesgo que puede suponer para la salud cardiovascular un valor absoluto de colesterol en sangre. Para ello usamos calculadoras (Score o Regicor) de las que se obtiene un porcentaje que indica el riesgo que realmente tiene un paciente de sufrir un evento cardiovascular en los próximos diez años. Cuando este riesgo es leve o moderado, la indicación terapéutica es el consejo dietético, la actividad deportiva y la normalización de hábitos saludables, y en este contexto es donde estaría aconsejado el uso de los complementos dietéticos de la levadura roja de arroz”.

Martín Almendros: “Recomendar  levadura roja de arroz debe hacerse dentro de unas pautas de hábitos de vida buenos”

Por el contrario, según Martín Almendros, este complemento no se debe usar en pacientes con un Score o Regicor alto o muy alto en prevención primaria cardiovascular, “ya que en estas situaciones, lo que corresponde es el uso de estatinas de síntesis”.

En cuanto a sus efectos concretos sobre el colesterol plasmático, el experto de Semergen comenta que cada uno de los estudios que se publican en este sentido arrojan unas cifras diferentes, “pero en general se puede hablar de una reducción promedio en los valores del colesterol total del 22% y en los de LDL del 29%, tras dos meses de utilización del producto, aunque en la práctica clínica el tiempo en el que se consiguen estos valores depende del paciente”.

Los estudios también han demostrado un efecto positivo sobre los triglicéridos, pero según Martín Almendros, no está producido por la levadura roja de arroz en sí misma, que no tiene un efecto específico sobre este parámetro, sino por los principios activos hipotrigliceridemiantes con los que suele asociarse en muchos de los productos que hay en el mercado, principalmente los policosanoles de la caña de azúcar y los ácidos grasos polinsaturados omega 3.

Además de la reducción de los niveles de colesterol y los triglicéridos, con el efecto cardioprotector que ello supone, se han atribuido otros beneficios a esta sustancia. “Algunos estudios sugieren que tiene también cierto efecto antioxidante y hepatoprotector”, afirma Narbaiza. En la misma línea, Martín Almendros señala que el extracto que se usa de la levadura roja de arroz tiene principios activos antinflamatorios, como la monascina y la ankaflavina, que ejercen un efecto antinflamatorio primario en el endotelio vascular, actuando sobre una de las bases fisiológicas de la formación de la placa de ateroma. “Además, posee efectos antioxidantes debido a otros principios activos como el DMA, los taninos, la dihidromankolina MV…”.

Ventajas y similitudes

Para la vocal de Alimentación del COF de Guipúzcoa, teniendo en cuenta que este complemento alimenticio y las estatinas se dirigen a cumplir el mismo objetivo –la reducción de los niveles elevados de colesterol en sangre-, la principal ventaja de la levadura roja de arroz respecto a las estatinas es que alrededor del 20% de los pacientes tratados con estos fármacos desarrollan mialgias, efectos adversos de tipo muscular e incluso otros efectos secundarios importantes, como hepatotoxicidad y neuropatía periférica. “Todo ello, a su vez, puede conllevar una mala adherencia al tratamiento, con el consiguiente incremento de las dislipemias. La levadura de arroz carece de este tipo de efectos secundarios”, confirma la farmacéutica.

En cuanto a la posología recomendada, comenta que, según los diferentes estudios realizados al respecto, la dosis efectiva sería de 10 mg de monacolina K en personas diagnosticadas de hipercolesterolemia.

A la hora de recomendar un complemento de levadura roja de arroz en la farmacia hay que tener en cuenta una serie de cuestiones. La primera y más importante es que, como afirma Martín Almendros, el hecho de que se trate de un preparado de extracción natural y no de síntesis no le exime de las interacciones farmacológicas. Entre las posibles interacciones asociadas a esta sustancia están los fármacos como gemfibrozil o la ciclosporina, el hipérico y medicamentos que inhiben el citocromo P450 3A4. “Tampoco está indicado su uso en los casos de uso abusivo de alcohol, ya que puede potenciar el daño hepático”, dice el experto, quien recuerda también que no se debe tomar junto a las estatinas de síntesis, ya que la acción de la monacolina K podría potenciar su efecto lesivo sobre el miocito (una fibra muscular cuya estructura puede verse alterada como daño colateral de las estatinas). “Además -añade el facultativo-, no tendría sentido usar en un paciente dos estatinas diferentes (aunque una sea natural y la otra de síntesis)”.

La levadura roja de arroz no tiene los efectos secundarios de las estatinas, pero si se abusa de ella puede llegar a tenerlos

Por otro lado, tal y como demostró un estudio llevado a cabo en el Departamento de Fisiología y Farmacología de la Universidad de la Sapienza, en Roma, y publicado en el British Journal of Clinical Pharmacology, la ingesta de estos suplementos, sobre todo si se excede la dosis recomendada, puede dar lugar a efectos secundarios similares a los que se asocian a las estatinas (problemas musculares y hepáticos, principalmente). En relación con esta evidencia, otro informe reciente, emitido por el Instituto Federal Alemán para la Evaluación de Riesgos (BfR), recomienda consumir este complemento alimenticio siempre bajo consejo y supervisión médica.  

“Asimismo, hay que tener en cuenta que cuando se consume levadura roja de arroz también se inhibe la síntesis de CoQ10, aunque en menor medida que  ocurre con las estatinas, por lo que sería interesante suplementarla”, afirma Narbaiza. La dosis ideal sería de 30 a 50 mg de esta sustancia al día, aunque la farmacéutica recuerda que la coenzima Q10 también está presente en las semillas, los frutos secos, las legumbres y los cereales integrales, “por lo que llevar una dieta equilibrada va a ayudar a mantener unos niveles adecuados, compensando, así, un posible déficit”.

El cuándo importa

Y para optimizar la ingesta de la levadura roja de arroz, Narbaiza insiste en recomendar a los pacientes que, al igual que ocurre con las estatinas, lo ideal es tomar estos suplementos por la noche, ya que es el momento en el que el hígado sintetiza el colesterol.

Martín Almendros, por su parte, recuerda que la recomendación de este complemento no se hace de forma aislada, sino que se encuadra en una estrategia que incluye pautas de alimentación y hábitos de vida, “y en la medida en la que el paciente siga estos consejos, sus cifras de colesterol evolucionarán a mejor (o a peor)”.

Esta entrada foi postada em artigos médicos, Cardiologia, farmácia, medicina, medicina natural.

#Le #yoga pour gérer les #symptômes de la FA

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Jaipur, Inda – Le yoga fait de plus en plus la preuve de son intérêt chez les patients présentant une pathologie cardiovasculaire et le Dr Naresh Sen (HG SMS hospital, Jaipur, Inde) en fait une nouvelle fois la démonstration. Après avoir montré le bénéfice du yoga dans le post-infarctus, il démontre cette année que la pratique du yoga peut aider les patients souffrant de fibrillation atriale à gérer leurs symptômes. L’abstract est présenté cette année au congrès virtuel de l’European Congress of Cardiology (ESC2020)[1].

La fibrillation atriale (FA) est l’un des plus fréquents troubles du rythme cardiaque. En Europe et aux Etats-Unis, un adulte sur quatre d’âge moyen est susceptible de souffrir de FA, à l’origine de 20 à 30% des accidents vasculaires cérébraux, et qui augmente le risque de décès par 1,5 chez les hommes et multiplie ce risque par 2 chez les femmes.La qualité de vie est souvent altérée et la FA est responsable de l’hospitalisation de 10 à 40% des patients chaque année.

Asana et pranayama

Les symptômes de la FA qui incluent des palpitations, des irrégularités du rythme, de la fatigue, des douleurs dans la poitrine et des vertiges, sont potentiellement stressants pour les patients. « Ils vont et viennent, rendant les patients anxieux et limitant leur vie quotidienne » considère le Dr Naresh Sen, auteur principal de l’étude.

L’étude a recherché si le yoga pouvait calmer les symptômes chez les patients atteints de FA. Elle a inclus 538 patients entre 2012 et 2017. Les patients étaient leur propre contrôle. Pendant 12 semaines, ils ne pratiquaient pas le yoga, puis pendant 16 semaines, ils suivaient des séances de yoga de 30 minutes tous les 2 jours.

Pendant la période de yoga, les patients étaient encouragés à pratiquer postures (asana) et respiration (pranayama) à un rythme quotidien. Pendant toute la période de l’étude, les symptômes et les épisodes de FA étaient notifiés dans un agenda. Certains patients ont aussi porté un enregistreur cardiaque pour vérifier les épisodes de FA.

Les patients remplissaient également un questionnaire portant sur leurs signes anxieux et dépressifs de façon à évaluer leur capacité à effectuer leurs activités quotidiennes, à interagir avec les autres, leurs niveaux d’énergie et leur humeur.

A proposer en complément des thérapeutiques habituelles 

Le rythme cardiaque et la pression artérielle ont été mesurés. Les chercheurs ont ensuite comparé les résultats entre les périodes yoga versus non yoga et montré que sur les périodes de 16 semaines pendant lesquelles les patients pratiquaient le yoga, les améliorations significatives étaient notées dans tous les domaines évalués par rapport à la période de 12 semaines où ils ne pratiquaient pas.

Par exemple, pendant la période de non-yoga, les patients ont expérimenté une moyenne de 15 épisodes symptomatiques de FA versus 8 en période « yoga » (p<0,005). La pression artérielle, quant à elle, était abaissée de11±3 mmHg pour la PAS et de 6±2 mmHg pour la PADaprès les séances de yoga (p<0,002).

Pour le Dr Sen, « notre étude suggère que le yoga procure un large panel de bénéfices physiques et mentaux aux patients souffrant de FA, et pourrait être proposé en complément des thérapeutiques habituelles ».

 

 

 

 

 

 

 

 

Esta publicação foi postada em artigos médicos, Cardiologia, Medicina de Família, medicina natural e marcada , .

#Can honey relieve cough and cold symptoms?

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A recent review and meta-analysis asks whether honey is an effective treatment for a cough and other symptoms of upper respiratory tract infections. Overall, the authors conclude, honey is “superior to usual care for the improvement of symptoms.” However, because data are sparse, questions remain.

A photo of bees with honeycomb to accompany the news article, "Can honey relieve cough and cold symptoms?"
Honey may improve symptoms of a cold, though supporting data are lacking.

Upper respiratory tract infections (URTIs), including the common cold, are highly prevalent.

According to the scientists behind the recent review, which appears in the journal BMJ Evidence-Based Medicine, URTIs are “the most frequent reason for antibiotic prescription.”

However, the majority of URTIs are viral, and antibiotics, therefore, cannot help. The rhinovirus alone accounts for an estimated 80% of all respiratory infections during peak seasons.

In the era of antibiotic resistance, a lack of effective treatments for URTIs is a pressing concern. The World Health Organization (WHO) consider antibiotic resistance to be “one of the biggest threats to global health, food security, and development today.” For this reason, there is an urgent need for alternative approaches to these and other infections.

The common cold is far from life-threatening, but treating it successfully could hinder the “slow-motion pandemic” of antibiotic resistance.

Could honey be the answer?

While enduring a cough or cold, many people seek solace in honey. Although this treatment is popular, scientific evidence of its effectiveness is largely lacking.

The recent systematic review and meta-analysis attempts to fill this gap in research.

To put honey through its paces, the team delved into existing findings. They selected relevant studies that involved humans of any age and in any setting. All of the included studies compared honey with at least one other intervention: no treatment, usual care, or a placebo.

In their analysis, the authors defined URTIs as “acute infections of the respiratory tract, including acute cough, colds, and influenza-like illness, but excluding bronchitis or other infections of the lower respiratory tract.”

Does honey work?

In all, the search for papers yielded only 14 relevant studies; of the 14, data from just 12 studies could be combined in a meta-analysis. Alongside the scientists’ data analysis, they also assessed each study’s risk of bias.

The results of the meta-analysis were generally positive but by no means conclusive. When attempting to assess the effects of honey versus a placebo, the authors write:

“Two of the three studies comparing honey with placebo indicated a beneficial effect of honey, but overall, we do not have a strong evidence base from comparisons of honey against matched placebo.”

However, when honey was compared with usual care, the results were slightly clearer. According to the authors, “Honey was associated with a significantly greater reduction in combined symptom score, cough frequency, and cough severity.”

The authors also conclude that, although the methods of usual care varied widely among the studies, they were all “similarly ineffective.”

A number of limitations

A range of factors hindered this study’s ability to draw firm conclusions. Overall, the problems did not concern the methods of this research, but the quality of the studies available for the team to analyze.

For instance, when they investigated the included studies’ risk of bias, nine of the 14 were at risk of at least one type of bias; and seven of those were at risk of more than one type of bias.

Aside from this, nine of the studies had only recruited children as participants, so the results might not apply to adults.

Also, a significant number of the included studies did not use pure honey: One used Honitus syrup, which has a honey base but includes herbs; two used Grintuss syrup, which is a cough suppressant that includes honey; two combined honey with coffee; and one combined honey, coffee, and milk.

Designing a placebo intervention also caused some difficulties. Researchers need to ensure that participants cannot tell whether they are receiving a placebo or the experimental intervention, which in this case was honey.

If the physical properties of honey help reduce symptoms, such as a cough, any similar compound might also soothe symptoms, making it a poor placebo.

Overall, the clearest point that this analysis makes is that we need to see more research before we can reach conclusions about honey and URTIs. Although URTIs are, in the global scheme of things, relatively mild, their relationship with antibiotic overprescribing makes honey worthy of further scrutiny.

And because honey is widely available, natural, and safe for most adults and children older than 1, if using it reduces the number of antibiotic prescriptions, it would be an all-around win.

# In the site Medical News Today

Esta entrada foi postada em artigos médicos, Imunologia, medicina natural, nutrição, Pneumologia, Saúde Publica.

#Acupuntura pode prevenir náuseas e vômitos pós-operatórios em videolaparoscopias?

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Acupuntura pode prevenir náuseas e vômitos pós-operatórios em videolaparoscopias?

Náuseas e vômitos pós-operatórios (NVPO) são uma complicação bastante comum, chegando a uma estatística de até 70% dos pacientes submetidos a procedimentos cirúrgicos. Está relacionada a efeitos negativos, como maior tempo de internação e insatisfação do paciente, além de complicações clínicas, como desidratação, perda de eletrólitos, sangramento, deiscência de sutura e aspiração do conteúdo gástrico.

O arsenal farmacológico terapêutico é bastante vasto, porém as medicações utilizadas não estão isentas de efeitos colaterais, além de aumentar o custo da internação. Devido a isso, surge a necessidade de terapias alternativas, sem efeitos colaterais, como a acupuntura, para melhor tratamento desses pacientes. Alguns fatores contribuem para uma maior incidência de NVPO, como fatores relacionados ao paciente e fatores relacionados ao tipo de cirurgia.

A cirurgia de colecistectomia videolaparoscópica é uma das cirurgias com maiores índices de NVPO. Esse estudo visou entender se o uso da auriculoacupuntura em pacientes submetidos à colecistectomia por videolaparoscopia é benéfico para a profilaxia de NVPO.

Acupuntura para náuseas e vômitos pós-operatórios

O estudo prospectivo, duplo-cego, randomizado e controlado por placebo foi realizado após todo o protocolo de regulamentação e consentimento das sociedades envolvidas. Foram avaliados o total de 68 pacientes no período de dezembro de 2016 a setembro de 2017, submetidos a colecistectomia por videolaparoscopia e divididos em dois grupos: grupo controle com 33 pacientes e grupo AA com 35 pacientes.

Os critérios de inclusão foram pacientes do sexo feminino entre 18-70 anos com IMC < 35 e ASA 1 e 2. Pacientes com complicações cirúrgicas ou anestésicas e que apresentaram náuseas e vômitos no período pré-operatório ou que fizeram uso de anti-heméticos 12 horas antes da cirurgia ou eram dependentes de drogas foram excluídos do estudo, assim como cirurgias com tempo superior a 90 minutos.

Nos pacientes do grupo AA foi realizada auriculoacupuntura com agulhas de aço 316 L, inseridas perpendicularmente a pele em uma profundidade de 3 mm no ponto de gatilho durante 20 minutos em uma única sessão. No grupo controle foi colocado esparadrapos sem semente em todos os pontos auriculares responsáveis pelo estímulo hemético. Toda a técnica foi orientada por um acupunturista sênior. Foi utilizado a escala visual analógica para medir a intensidade da náusea e vômitos.

A anestesia foi realizada com uma sedação prévia com 5 mg de midazolan e a indução com 2 mg/kg de propofol, 5 mcg/kg de fentanil e 0,6 mg/kg de rocurônio em todos os pacientes. Também foi administrado 2 g de cefazolina sódica profilática e 2 g de dipirona, 40 mg de paracetamol e 10 mg de metoclopramida (motivos éticos) no início da cirurgia. Para analgesia pós-operatória foi realizado infiltração de todos os sítios de incisão dos trocateres com ropivacaína 0,75% na dose máxima de 150 mg além de 100 mg de cetoprofeno EV de 12/12 horas e 2 g de dipirona EV de 8/8 horas. Nos casos de náuseas e vômitos de grande intensidade foi realizado 4 mg de ondansetrona EV.

Os dados coletados foram realizados no período de seis horas após o fim do procedimento. Os pacientes foram acompanhados por um examinador cego à randomização nos períodos: imediatamente após a extubação, periodicamente de forma contínua até a segunda hora após a extubação e na quarta e sexta horas seguintes.

Náuseas e vômitos foram avaliados segundo a escala visual. Náuseas foram definidas como percepção iminente e desagradável de necessidade de vomitar e vômitos como contrações abdominais involuntárias resultando em eliminação do conteúdo gástrico.

Resultados

Todas as pacientes obtiveram alta 24 horas após a realização do procedimento e não houve complicações nem lesões relacionadas ao agulhamento.

O grupo AA apresentou menos episódios de NVPO do que o grupo controle (16/35 vs 27/33). Diferença bastante significativa.

Apresentou menores dados. No tempo zero (imediatamente após a extubação), quatro pacientes do grupo controle contra 1 paciente do grupo AA apresentaram náusea de intensidade grave. Na segunda hora, sete pacientes do grupo controle contra zero pacientes do grupo AA (o que fez necessidade de uso de ondansetrona nos pacientes do grupo controle) e na sexta hora sete pacientes do grupo controle contra um paciente do grupo AA apresentaram náuseas e vômitos de grande intensidade.

No total, a diferença de incidência de náuseas e vômitos entre os grupos foi bem significante, sendo 2% no grupo AA contra 21% no grupo controle.

Discussão

A cirurgia de colecistectomia por videolaparoscopia ocorre com uma incidência grande na população em geral por conta dos casos de colelitíase e sabe-se que a incidência de NVPO nesse procedimento pode atingir 30% dos casos, tornando o pós operatório mais demorado, desconfortável e dispendioso. Sabe-se também que a terapia farmacológica para prevenção de NVPO além de gerar efeitos colaterais nem sempre é efetiva, devendo-se lançar mão de estratégias alternativas.

A acupuntura é mundialmente conhecida e bem conceituada na Medicina Tradicional Chinesa e vem sendo utilizada por séculos no diagnóstico e tratamento de diversas patologias, além disso é uma terapia alternativa de baixo custo, fácil realização e de pouquíssimas complicações e efeitos colaterais. A base do tratamento consiste na promoção do equilíbrio de substâncias neuroquímicas no sistema nervoso central e na recuperação e manutenção da hemostasia via estímulo elétrico de baixa frequência pela pele.

Alguns trabalhos foram realizados utilizando a acupuntura como forma alternativa de tratamento anti-hemético e analgésico pós-cirúrgico principalmente em cirurgias de histerectomia, com resultados satisfatórios. Apenas esse estudo foi encontrado para a análise desses fatores em cirurgias de colecistectomia videolaparoscópica.

Apesar do estudo apresentar algumas limitações, como número baixo de pacientes escolhidos e tipo de amostragem, uma vez que fatores de risco para NVPO foram excluídos do mesmo, além de não ter havido controle após a sexta hora de pós-operatório, evidenciou-se que o grupo que recebeu a terapia alternativa apresentou menor incidência de NVPO, significativamente falando, do que os que não receberam.

Concluindo, dentro dessas variáveis pode-se afirmar que o emprego da auriculoacupuntura pode ajudar a prevenir a incidência de NVPO em pacientes submetidos a colecistectomia por videolaparoscopia sem complicações, porém maiores estudos com maior número de pacientes, devem ser realizados para concretização dessa técnica.

PebMed

Autora:

Referências bibliográficas:

  • Miranda LE, et all. Efeitos da acupuntura para a prevenção de náuseas e vômitos após colecistectomia laparoscopica: um estudo clínico e randomizado.Brazilian Journal of Anesthesiology Available online 30 July 2020
  • Kong Y, et all. Opioid receptor mu 1 (OPRM1) A118G polymorphism (rs1799971) and postoperative nausea and vomiting.Am J Transl Res 2018;10(9):2764-2780
  • Shin HC et all. The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy: A meta-analysis and systematic review.Laryngoscope. 2016 Aug;126(8):1761-7
  • Chengwey F et all. Acupuncture therapy on postoperative nausea and vomiting in abdominal operation.Medicine: June 05, 2020 – Volume 99 – Issue 23 – p e20301.

Esta entrada foi postada em artigos médicos, medicina, medicina natural, Medicinas alternativas.

#Beber chá pode estar associado a maior longevidade e menos doenças

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Fonte de imagem: TodayShow

Um estudo desenvolvido na Academia Chinesa de Ciências Médicas em Pequim revela que beber chá, pelo menos três vezes por semana, pode aumentar a longevidade e proteger contra problemas de saúde.

Xinyan Wang, autor principal, explica que o consumo habitual de chá está associado a menos riscos de doença cardiovascular e de morte por qualquer causa. Os efeitos benéficos são mais predominantes no consumo de chá verde e de longa duração.

A análise para este estudo incluiu 100.902 participantes chineses sem historial de ataque cardíaco, AVC ou cancro que foram divididos em dois grupos: os que bebem chá pelo menos três vezes por semana e aqueles que não bebem chá ou bebem esporadicamente.

Os investigadores concluíram que o consumo habitual de chá estava associado a mais anos de vida e saudáveis.

Por exemplo, foi estimado que alguém na casa dos 50 anos, habitual consumidor de chá, desenvolveria doença coronária 1,41 anos mais tarde e teria mais 1,26 anos de vida que os não consumidores de chá.

Os consumidores de chá teriam ainda 20% menos risco de incidência de doença cardíaca e AVC, 22% menos de risco de morte por estes problemas e 15% menos risco de morte por qualquer causa.

Foram ainda comparados os comportamentos de consumo regular e casual num subgrupo de 14.081 participantes.

Os consumidores habituais de chá que mantiveram o consumo regular durante os 8 anos do estudo tinham 56% menos risco de morte por problemas cardíacos ou AVC e menos 29% de risco de morte por qualquer causa, comparando com os não consumidores ou consumidores não habituais.

O tipo de chá mais benéfico analisado foi o chá verde, em comparação com chá preto. Os compostos bioativos presentes no chá não são armazenados no corpo, pelo que só um consumo regular protege ao longo do tempo.

 

Banco da Saúde

Esta entrada foi postada em artigos médicos, medicina natural.

#Mindfulness for #Hypertension Worth Contemplating

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Mindfulness training can significantly reduce blood pressure and stress levels in hypertensive patients, early research shows.

Investigators found mindfulness was associated with a significant decrease in systolic blood pressure at 1 year and had other gains including better adherence to a recommended diet, lower salt intake, reduced alcohol consumption, and increased physical activity.

“Mindfulness training may improve blood pressure,” lead investigator Eric Loucks, PhD, director of the Mindfulness Center at Brown University, Providence, Rhode Island, told Medscape Medical News.

“We know enough about hypertension that we can theoretically control it in everybody — yet in about half of all people diagnosed it is still out of control, Mindfulness may represent another approach to helping these people bring their blood pressure down, by allowing them to understand what’s happening in their minds and bodies,” he noted in a statement.

The study was published online December 4 in PLoS ONE.

Custom-Made Intervention

Estimates from 2014 show the annual costs associated with high blood pressure in the United States topped out at $53.2 billion. In addition, it is estimated elimination of hypertension would have a larger impact on cardiovascular disease (CVD) mortality than the removal of any other risk factor in females and, with the exception of smoking, any risk factor in males, the investigators note. They add that only about half of US patients with hypertension have it under control.

In 2017, as reported by Medscape Medical News, the American Heart Association issued the first scientific statement endorsing meditation to reduce cardiovascular risk, suggesting it be included as an adjunct to current medical and lifestyle interventions.

Although there is some research to suggest mindfulness meditation has the potential to reduce blood pressure levels, investigators note that the evidence is “equivocal.”

For example, a small, but significant, improvement in blood pressure emerged in a 2014 systematic review and meta-analysis. However, when researchers excluded the study showing the greatest benefit, the results were no longer significant. Furthermore, none of the mindfulness interventions included in the analysis was specifically designed to address hypertension.

For the current pilot study, investigators modified the well-known Mindfulness-Based Stress Reduction (MSBR) program to specifically target hypertension.

The result was the Mindfulness-Based Blood Pressure Reduction (MB-BP) intervention, a 10-session program that teaches attention control, emotional regulation, and self-awareness of healthy and unhealthy habits to mitigate hypertension risk factors.

The study population included 48 participants. Of these, 61% were women and 96% were white. The cohort had a mean age of 60 years (range, 26-83 years). Approximately 60% of participants were taking antihypertensive medication at baseline.

Hypertension was defined as a baseline systolic blood pressure ≥ 120 mmHg or a diastolic blood pressure ≥ 80 mmHg.

Dose-Dependent Effect

The final analysis was based on data from 43 participants who had attended at least seven of the 10 MB-BP classes. Based on focus groups and one-on-one feedback, researchers found the intervention was feasible and well accepted by study participants.

At 1-year, investigators found patients with stage 2 uncontrolled hypertension, defined as a systolic blood pressure ≥ 140 mmHg, experienced a mean 15.1-mmHg reduction in blood pressure.

In addition, self-awareness, attention, and emotion regulation had all improved at the 1-year follow-up.

Researchers also found there was a dose-dependent effect. Results of a post hoc analysis revealed that participants who spent a median 18 hours a week outside of class practicing mindfulness experienced a mean 15.2-mmHg decrease in blood pressure at 3 months and an 11.4-mmHg decrease at 1 year.

In contrast, those who reported a mean of 0 hours spent practicing mindfulness experienced a mean 4.4-mmHg decrease at 3 months and a 6.0-mmHg decrease at 1 year.

The 1-year follow-up and use of a mindfulness program “grounded in both the evidence-based MBSR as well as in hypertension etiology and treatment” were among the strengths of the study, the researchers note. The single-arm design without a control condition was a potential limitation.

More search is warranted and randomized controlled trials will be key to validating the findings, Loucks told Medscape Medical News.

He added that his team is currently training instructors in MB-BP adding there is an NIH-funded study underway to test the intervention in more than 200 participants.

This trial will assess blood pressure and lifestyle changes in participants randomized to receive MB-BP or enhanced usual care, with results expected by mid-2020.

‘Cautious Optimism’

Commenting on the study for Medscape Medical News, Glenn Levine, MD, director of the cardiac care unit at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, described the preliminary findings as “exciting.”

Levine, who served as chair of the writing group of the 2017 AHA scientific statement on meditation, applauded the researchers for the “careful manner in which they enrolled, educated, tracked, and later evaluated patients and endpoints.”

He said that the findings on the potential benefits of a mindfulness-based intervention program on measurable factors — including those associated with positive psychological health, as well as the harder endpoint of blood pressure and blood pressure reduction — were notable.

He agreed that a large randomized trial is necessary as the next step. However, he added that in the meantime the current results provide reason for “cautious optimism to those who believe that we need to begin to further explore the effects of mind-heart-body interventions on cardiovascular health.”

The study is a “great step” in the direction of expanding research beyond disease, drugs, and devices, Levine added. Going forward, the focus should also be “on interventions that actually improve the physical and psychological wellness” of patients.

PLoS ONE. Published online December 4, 2019. Full text

Esta publicação foi postada em artigos médicos, Cardiologia, Emergência, farmácia, medicina, medicina natural, Medicinas alternativas e marcada , .

#30 of the Best Foods for Fighting Disease

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30 of the Best Foods for Fighting Disease

There have been improvements in treatments for eradicating cancer from the body. However, there are also ways to lower the chance of getting cancer whatsoever. Exercise is one of the best ways to reduce your risks, but your diet can make a difference too.

Eating healthy can help your body to fight off horrible diseases, even one as virulent as cancer. Here are 30 of the best cancer-fighting foods on the market that you should start including in your diet. These foods are also healthy for you in general and readily available.

https://www.simplyrecipes.com

1. Broccoli

That small tree-like vegetable that everyone used to hate eating as a kid. “Eat your broccoli, and then you can get dessert,” your parents may have told you at some point. Well, now is a great time to start liking broccoli, as it’s full of sulforaphane. Tests have shown that this compound, when ingested, has reduced the number and size of breast cancer cells and even kills off prostate cancer cells.

Also, because broccoli is also high in fiber, keeping you regular reduces the chances of colon cancer cells forming. Include just a few sprigs of broccoli in your meals each week to start experiencing the benefits. If you are having a hard time bringing yourself to bite some broccoli, try drizzling some cheese on it.

https://www.organicfacts.net

2. Carrots

Carrots are rich in vitamin A, which is said to be good for your eyesight. However, more recent studies have shown that having carrots regularly reduces the risks of certain types of cancers. Did you know there are also variations of carrots that are yellow?

Incorporate some carrots into your meals or just have carrot sticks as a healthy snack when your feeling hunger pains between meals. You can also enjoy them in soups and chicken pot pies, even though the raw version is a bit healthier. Just remember not to eat too many daily as vitamin A is fat soluble, so it takes longer to leave the body.

https://www.healthline.com

3. Beans

Beans, beans! They’re good for your heart, among other things. High in fiber, beans come in many shapes, forms, and varieties. It’s because they’re so rich in fiber that they help to prevent colorectal tumors from forming.

In fact, one study showed that after rats were feed beans and then induced with colon cancer cells, they were less likely to develop cancer by 75%. That’s definitely not something to turn your nose up at, even if beans do tend to make people a bit gassy. Bean soups are a great way to include them in your diet or making bean dips regularly.

https://www.dictionary.com

4. Berries

Besides veggies and beans, there are a number of healthy fruits that can help fight cancer. The great thing about berries is that they can be added to just about anything. Yogurt, waffles, pies — oh my! The possibilities are endless. That is a good thing because berries of all kinds are rich in antioxidants, which are responsible for preventing many forms of cancer.

Include a serving or two of berries in your meals at least once a day to inhibit the development of cancer cells. Toss them in the blender to make some tasty smoothies or fresh juices if you don’t enjoy eating them whole.

https://draxe.com

5. Cinnamon

Another tasty item on this list that isn’t so to difficult to incorporate into your diet. Cinnamon has a wide range of health benefits, including reducing blood sugar and inflammation of the joints and muscles.

Tests on animals have also shown that it also blocks the spread of cancer cells throughout the body, and can lead to the death of the cancer cells altogether. In tumors already developed, cinnamon oil decreased their size and prevented them from spreading. However, there is no evidence to show that cinnamon has the same effect on humans.

https://www.whitleyspeanut.com

6. Nuts

Do you like eating peanuts, cashews, or other types of nuts? Healthy varieties that are rich in oil are a good source of protein and good for the joints; however, they’re also linked to lowering the risk of certain types of cancer. These cancers include colorectal, pancreatic, and endometrial. Still, other kinds of nuts are protective against other forms of cancer.

Brazil nuts, for example, are quite high in selenium, which is known to help the body fight off lung cancers. Walnuts, on the other hand, have shown to decrease the growth of breast cancer cells. Tumors were reduced by at least 60 percent as well.

https://atasteofolive.com

7. Olive Oil

Olive oil is one of the staples of Mediterranean cuisine and for excellent reasons. Several studies have shown that a daily intake of this oil can protect against cancer. Those in the study who had the highest consumption of olive oil had the lowest risks of developing breast cancer and cancer of the digestive tract.

You can cook with it, but don’t resort to frying with it all the time. Add some seasonings to it and drizzle it onto your salads and cooked vegetables. And remember, a little olive oil goes a long way!

https://www.webmd.com

8. Fatty Fish

Servings of fatty and oily fish are not only good for your joints and brain power, but they’re also helpful at keeping cancer away. They’re great for reducing the risk of digestive tract cancer as well as colorectal cancer. Try grilled salmon opposed to deep-fried cod.

Fatty fish also promotes the absorption of vitamin D in the body, which is also known to reduce the risk of cancer. Exchange the meat of at least two meals throughout the week with fish over hamburger or other types of meat in order to help your body start its fight against cancer.

https://nuts.com

9. Flaxseed

In addition to eliminating the risk of cancer, flaxseed is also high in fiber, keeping the body regular. In women, flaxseed has proven to reduce specific markers of breast cancer, reducing the risk of developing breast cancer. The same can also be said for prostate cancer in men.

Although you might not realize it, there are several ways to add this healthy food to your diet. Consider sprinkling it onto your cereal and yogurt. You can also consume flaxseed and not even realize it by making it an ingredient in your baked goods.

https://www.livescience.com

10. Citrus Fruits

Citrus fruits are known to strengthen the protective walls of the cells within the body, thereby making them stronger against the invasion of cancer cells. They’re particularly beneficial against cancers of the upper respiratory tracts and digestive tract.

Having just a few citrus fruits in your diet each week is enough to minimize your risks for the rest of your life. You can eat fruits raw, squeeze them for juices, dry them in a dehydrator. Top your cereals, waffles, and even pies with them! Just don’t go overboard because they are quite acidic.

https://naturallivingfamily.com

11. Turmeric

As you noticed, there are many spices and seasonings that are extremely healthy for you. Tumeric is a popular Indian spice that has a lot of beneficial health properties. Its most active ingredient is curcumin, which is responsible for reducing inflammation and has antioxidant properties that reduce cancer.

You should have at least ½ to 3 teaspoons of ground turmeric per day, which is actually pretty easy to do. You can add it to any culinary dish, and they even have turmeric tea bags you can add to boiling water to create a beneficial tea.

https://www.organicfacts.net

12. Garlic

Garlic is filled with a beneficial compound called allicin, which has been shown to kill off cancer cells. Studies have proven that it reduces stomach cancer in those who consumed allium-rich vegetables regularly.

Although garlic may give you undesirable breath, it’s still good to include it in your cooking, especially in dishes with meat. Don’t like garlic? Onions, shallots, or leeks contain the same thing, so you can use them instead if you prefer. Just keep some gum or mouth wash near by if you can’t brush your teeth directly after consuming garlic.

 

 

 

https://www.healthline.com

13. Tomatoes

Is it a vegetable? Is it a fruit? It doesn’t matter! Tomatoes are rich in lycopene, which is the compound responsible for its vibrant red color. However, it’s also what gives these red plants their anti-cancer properties.

Tomatoes are pretty good at reducing prostate cancer, whether in raw or cooked form. If you’re not keen on eating salads, then tomato sauce on pasta still does the trick. A serving or two of tomatoes each day is enough to provide your body with the means to help fight off cancer.

 

 

https://www.gimmesomeoven.com

14. Artichokes

Artichokes are chock-full of silymarin, which is an antioxidant that is used to fight skin cancer. Although they look forbidding, they’re pretty easy to prepare and are also an excellent source of fiber and other minerals.

Just peel off the woody outer leaves at the bottom, and cut off both the tops and bottoms. You can steam them for about 45 minutes, boil them, or lightly fry them. Add some vinaigrette for an added extra flavor you’ll enjoy. One of the most popular appetizers is spinach and artichoke dip.

https://therealfoodrds.com

15. Sauerkraut

Many people turn their noses up at fermented cabbage, but it’s quite rich in antioxidants. This abundance is due to the fermentation process itself, which produces sulforaphane, ITCs (isothiocyanates), and indoles. All three of these help your immune system to fight off cancer.

Add it to a sandwich or a stir fry for that boost in flavor. If you’re buying the jarred variety, you might want to rinse it off first as it can have quite high levels of sodium. If you see some sauerkraut and sausage at your next breakfast buffet or wedding dinner, give it a try.

https://www.telegraph.co.uk

16. Tea

Tea is beneficial for the mind as well as the body. There are so many different kinds available; some are good for one thing whereas another flavor is ideal for a different ailment. With that being said, did you know that two cups of black tea a day is beneficial for preventing ovarian cancer? That’s because of the presence of flavonoids, which are antioxidants.

It doesn’t matter whether it’s hot or cold tea either. That makes tea very versatile for the summer months or when you need a hot drink to warm up during winter. Whether you want to sit in a rocking chair during a sunny afternoon and sip ice cold tea or wrap up in a cozy blanket and a movie with a hot cup is up to you.

https://foodrevolution.org

17. Avocado

It seems like avocados are everywhere these days! Although more and more people are enjoying guacamole, you’ll want to lean more towards fresh avocado. Slicing it up a raw one and adding it to a salad is a great way to help your body absorb other antioxidants such as lycopene and beta-carotene.

Be wary of the high-fat content of an avocado, however. It consists of “good fats” as people call them, but overeating can still start to pack on the pounds. Only enjoy this yummy green food on special occasions, like taco Tuesdays.

https://www.naturalfoodseries.com

18. Bean Sprouts

Bean sprouts are another rich source of sulforaphane, which is a rich anti-cancer compound. The sprouts themselves contain 50 times more of this compound than mature beans.

They’re also pretty tasty too. Add this veggie to a salad or garnish your soup with bean sprouts. Chop them up and add them to a tuna salad sandwich for a little extra fiber. You’ll be surprised at all the new ways you can add bean sprouts to every meal.

https://www.forbes.com

19. Coffee

Not everyone is willing to give up coffee, knowing how bad a caffeine addiction can be. But as long as you’re drinking at least one cup a day, then you’ll be better protected against the risk of cancer. That’s because it reduces the risk of colon cancer, as well as the risk of basal cell carcinoma.

Just don’t overload your coffee with too much sugar. As lovely as this can taste, you’ll be giving yourself unnecessary calories; you don’t want to start packing on the pounds. You certainly won’t mind keeping coffee on your grocery list.

https://www.delish.com

20. Corn

Corn is one of those summer staples that everyone likes to bring to a barbecue. Some studies have shown that corn contains too much sugar and is generally undigestable by the body. However, what many people don’t know is that it has a phenolic compound called ferulic acid, which inhibits cancer-causing substances.

If you’re not a fan of corn on the cob, you can mix the kernels into your hamburger patty before tossing it onto the grill. It will add some much-needed flavor, and you’ll be making yourself healthy at the same time. This food is probably one of the easier ones to incorporate to your everyday meals with the family.

https://www.organicfacts.net

21. Dates

Round out your sweet tooth at the end of the day by adding some dates to the menu. They have the highest amounts of polyphenol than any other fruit or vegetable on the market. This notion is because they grow in the desert; the harsh environment forces the date to protect itself against oxidative stress.

It’s these polyphenols that are good at preventing cancer, and dates are also a rich source of fiber and vitamin B6. There is a plethora of ways you can consume dates from baking them in cookies to wrapping them in bacon. You can toss them in a fruit cake or stuff them with goat cheese — take your pick!

https://www.delish.com

22. Eggs

We’re not just talking about just the whites or the yolks; we’re talking about the entire egg. Although egg yolks are considered to be high in cholesterol, they contain a decent amount of vitamin D. This vitamin not only helps with the absorption of calcium, but it also reduces the risks of some cancers, as well as heart disease and diabetes.

One or two eggs a day should be okay, as long as you’re watching the rest of your diet throughout the day. Besides, breakfast is the most important meal of the day. Instead of having a runny egg yolk to eat though, a hard-boiled egg on top of a salad is a great way to get your daily amount.

https://draxe.com

23. Ginger

Ginger is one of those spices that’s not used very often in cooking, but you’re probably going to change your mind about using it after this article. Several studies have shown that ginger can cause ovarian cancer cells to die, as well as reducing inflammation of the colon.

When given ginger, the tumors in laboratory animals grew at a much slower rate. So sip on some ginger tea, eat a few pieces of candied ginger a day, or sprinkle some powdered ginger on your mashed sweet potatoes. Not only does it taste yummy, but it is healthy for you, too!

https://www.healthline.com

24. Kale

Last year, kale was the superfood that everyone was raving about, remember? This leafy green is packed with vitamins and minerals that the human body needs. Thankfully, kale is also rich in indoles, which are compounds that battle cancers resulting from various levels of estrogen. That makes them very beneficial for both men and women who are prone to certain types of cancers.

You can easily add kale to any salad, or layer chopped kale on top of a salad. Pour seasoned olive oil over the kale to magnify the flavor of this healthy vegetable.

https://www.foodnetwork.com

25. Mushrooms

White and portobello mushrooms are especially good sources of selenium, which is a great compound to have in fighting against prostate cancer. They’re also rich with complicated chemicals that can reduce the risk of breast cancer in Korean and Chinese women.

Having them stuffed with other ingredients, making a soup, or adding them to a salad are great ways to add some mushrooms to your diet. Even putting them on homemade pizza is better than nothing, so don’t turn up your nose and consider adding this fungus to your daily diet.

https://www.medicalnewstoday.com

26. Pomegranate Juice

Pomegranates are supposed to be incredibly healthy for you. However, they’re such a hassle to eat. Instead of scooping it by hand with a spoon, consider drinking pomegranate juice instead. You’ll wonder why you didn’t think to do it that way sooner!

The real fruit juice is rich with antioxidants and reduces the levels of prostate-specific antigen that can lead to prostate cancer. For men, you can reduce the risk of an enlarged prostate in the future. Drinking at least 8 ounces of pomegranate juice a day can provide you with these essential benefits.

https://www.medicalnewstoday.com

27. Spinach

It’s Popeye’s favorite vegetable, and it should be yours too. Obviously, spinach is good for you, but why? It has high levels of lutein, which is a compound that is good for your eyes as well as an antioxidant. You definitely need to add this veggie to your grocery list.

These leafy greens also filled with carotenoids that are responsible for removing free radicals from the body that run the risk of becoming cancer cells. Other green leafy vegetables contain these compounds too, so it’s not a bad idea to include them in your salads and meals more often. Spinach smoothies are also an option if you are tired of eating them with salads or frying them as a side.

https://snaped.fns.usda.gov

28. Sweet Potatoes

Just like spinach, sweet potatoes also contain carotenoids that remove free radicals. Carotenoids work by regulating cell growth and repair; it bolsters their functions to fight off diseases and manipulative cancer cells. In a study conducted on women, those who had higher levels of beta-carotene in their blood had a 17% less risk of developing certain kinds of breast cancer. So add those sweet potatoes to your meals.

Roast them in the oven, boil them, or mash them up. Instead of salty fries, try sweet mashed potatoes! You’ll love the sweetness! Not only that, you’re strengthening your cells while you feast. However you eat regular potatoes, simply make sweet potato versions instead!

https://geneticliteracyproject.org

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29. Fortified Organic Milk

Milk alternatives such as cashew and almond milk are great for those who are lactose-intolerant or who just want to avoid the dangers of cow’s milk, but unless these alternatives are fortified with vitamin D, then they’re not worth it. It would be best if you had vitamin D to help your body fight off infections, and is especially useful against colon and ovarian cancers.

Drinking it every day is a great idea. However, if you don’t want to drink it straight every single time, you can add a splash of it to your coffee or tea to reap the same benefits. Likewise, pouring fortified organic milk over cereal is a healthy alternative. You can also blend up in a smoothie with fresh fruit. It’s not as bad as you think!

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30. Cauliflower

The “alternative” to broccoli, cauliflower is being used in more and more vegetarian dishes as replacements for other ingredients, such as rice and potatoes. When cauliflower is broken down, whether it’s chopped or through the digestion process, glucosinolates are broken down to form indoles and isothiocyanates.

These latter two compounds are great at preventing the development of breast cancer, and cancers of the stomach, liver, lung, and colon. Consider adding more cauliflower to your meals at least once a day. It tastes great, and this veggie is pretty easy to season without it becoming too overpowering. Browse for cauliflower recipes so you don’t get tired of eating the same thing over and over. You can even make cauliflower pizza — a favorite on the menu of those who like to eat healthy!

 

 

MedicalNews

Esta entrada foi postada em artigos médicos, medicina natural, nutrição.

#Everything you need to know about gout

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By James McIntosh
Reviewed by 
Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint. It usually affects the joint in the big toe.

Gout attacks can come on quickly and keep returning over time, slowly harming tissues in the region of the inflammation, and can be extremely painful. Hypertension, cardiovascular, and obesityare risk factors for gout.

It is the most common form of inflammatory arthritis in men, and although it is more likely to affect men, women become more susceptible to it after the menopause.

The Centers for Disease Control and Prevention (CDC) report that 8.3 million Americans were affected by gout between 2007 to 2008.

Fast facts on goutHere are some key points about gout. More detail and supporting information is in the main article.

  • Gout is a form of arthritis caused by excess uric acid in the bloodstream.
  • The symptoms of gout are due to the formation of uric acid crystals in the joints and the body’s response to them.
  • Gout most classically affects the joint in the base of the big toe.
  • Gout attacks often occur without warning in the middle of the night.
  • Most gout cases are treated with specific medications.

Treatment

person with gout

Gout patients often have acute inflammation around their joints.

The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones and the development of tophi.

Commonly used medications include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are usually taken orally.

Medications can also be used to either reduce the production of uric acid (xanthine oxidase inhibitors such as allopurinol) or improve the kidney’s ability to remove uric acid from the body (probenecid).

Without treatment, an acute gout attack will be at its worst between 12 and 24 hours after it began. A person can expect to recover within 1 to 2 weeks without treatment, but there may be significant pain during this period.

Tests and diagnosis

Gout can be tricky to diagnose, as its symptoms, when they do appear, are similar to those of other conditions. While hyperuricemia occurs in the majority of people that develop gout, it may not be present during a flare. On top of that, the majority of people with hyperuricemia do not develop gout.

One diagnostic test that doctors can carry out is the joint fluid test, where fluid is extracted from the affected joint with a needle. The fluid is then examined to see if any urate crystals are present.

As joint infections can also cause similar symptoms to gout, a doctor can look for bacteria when carrying out a joint fluid test in order to rule a bacterial cause. The fluid may need to be sent to a lab, where it can take several days to analyze.

Doctors can also do a blood test to measure the levels of uric acid in the blood, but, as mentioned, people with high uric acid levels do not always experience gout. Equally, some people can develop the symptoms of gout without having increased levels of uric acid in the blood.

Finally, doctors can search for urate crystals around joints or within a tophus using ultrasound scan. X-rays cannot detect gout, but may be used to rule out other causes.

Types

There are various stages through which gout progresses, and these are sometimes referred to as different types of gout.

Asymptomatic hyperuricemia

It is possible for a person to have elevated uric acid levels without any outward symptoms. At this stage, treatment is not required, though urate crystals may deposit in tissue and cause slight damage.

People with asymptomatic hyperuricemia may be advised to take steps to address any possible factors contributing to uric acid build-up.

Acute gout

This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain. This sudden attack is referred to as a “flare” and will normally subside within 3 to 10 days. Flares can sometimes be triggered by stressful events, alcohol and drugs, as well as cold weather.

Interval or intercritical gout

This stage is the period in between attacks of acute gout. Subsequent flares may not occur for months or years, though if not treated, over time, they can last longer and occur more frequently. During this interval, further urate crystals are being deposited in tissue.

Chronic tophaceous gout

Chronic tophaceous gout is the most debilitating type of gout. Permanent damage may have occurred in the joints and the kidneys. The patient can suffer from chronic arthritis and develop tophi, big lumps of urate crystals, in cooler areas of the body such as the joints of the fingers.

It takes a long time without treatment to reach the stage of chronic tophaceous gout – around 10 years. It is very unlikely that a patient receiving proper treatment would progress to this stage.

Pseudogout

One condition that is easily confused with gout is pseudogout. The symptoms of pseudogout are very similar to those of gout, although thr flare-ups are usually less severe.

The major difference between gout and pseudogout is that the joints are irritated by calciumpyrophosphate crystals rather than urate crystals. Pseudogout requires different treatment to gout.

Pictures

The following images show the appearance of gout when it develops.

gout on foot

gout on elbows

foot and heel gout

gout on hands

1of4

Causes

Gout is caused initially by an excess of uric acid in the blood, or hyperuricemia. Uric acid is produced in the body during the breakdown of purines – chemical compounds that are found in high amounts in certain foods such as meat, poultry, and seafood.

Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced, or not enough is excreted, it can build up and form needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.

Risk factors

There are a number of factors that can increase the likelihood of hyperuricemia, and therefore gout:

Age and gender: Men produce more uric acid than women, though women’s levels of uric acid approach those of men after the menopause.

Genetics: A family history of gout increases the likelihood of the condition developing.

Lifestyle choices: Alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body.

Lead exposure: Chronic lead exposure has been linked to some cases of gout.

Medications: Certain medications can increase the levels of uric acid in the body; these include some diuretics and drugs containing salicylate.

Weight: Being overweight increases the risk of gout as there is more turnover of body tissue, which means more production of uric acid as a metabolic waste product. Higher levels of body fat also increase levels of systemic inflammation as fat cells produce pro-inflammatory cytokines.

Recent trauma or surgery: Increases risk.

Other health problems: Renal insufficiency and other kidney problems can reduce the body’s ability to efficiently remove waste products, leading to elevated uric acid levels. Other conditions associated with gout include high blood pressure and diabetes.

Symptoms

Gout usually becomes symptomatic suddenly without warning, often in the middle of the night.

The main symptoms are intense joint pain that subsides to discomfort, inflammation, and redness.

Gout frequently affects the large joint of the big toe, but can also affect the forefoot, ankles, knees, elbows, wrists, and fingers.

The pain can be excruciating. A veteran visiting a Hospital in Birmingham, AL, said:

“I’ve been shot, beat up, stabbed, and thrown out of a helicopter, but none of that compared to the gout.”

Complications

In some cases, gout can develop into more serious conditions, such as:

  • Kidney stones: If urate crystals collect in the urinary tract, they can become kidney stones.
  • Recurrent gout: Some people only ever have one flare up; others may have regular recurrences, causing gradual damage to the joints and surrounding tissue.

Prevention tips

There are many lifestyle and dietary guidelines that can be tried to protect against flares or prevent gout from occurring in the first instance:

  • maintain a high fluid intake of around 2 to 4 liters a day
  • avoid alcohol
  • maintain a healthy body weight

Home remedies

Individuals with gout can manage flare-ups by moderating their diet. A balanced diet can help reduce symptoms.

Decreasing foods that are high in purines, to ensure that the levels of uric acid in the blood do not get too high, is reasonable to try. Here is a list of high-purine foods to be wary of:

  • anchovies
  • asparagus
  • beef kidneys
  • brains
  • dried beans and peas
  • game meats
  • gravy
  • herring
  • liver
  • mackerel
  • mushrooms
  • sardines
  • scallops
  • sweetbreads

While it is reasonable to decrease or avoid these foods, it has been found that a high purine-rich diet does not increase the risk of gout, or aggrevate symptoms in research studies.

Asparagus, beans, some other plant-based foods, and mushrooms are also sources of purines, but research suggests that these do not trigger gout attacks and do not impact uric acid levels.

Various epidemiological studies have shown that purine-rich vegetables, whole grains, nuts and legumes, and less sugary fruits, coffee, and vitamin C supplements lower blood uric acid levels, but do not decrease the risk of gout. Red meat, fructose-containing beverages, and alcohol can increase the risk.

The role of uric acid in gout has been clearly defined and understood. As a result of this and the wide availability of relevant medications, gout is a very controllable form of arthritis.

MedicalNewsToday

Esta entrada foi postada em artigos médicos, medicina, Medicina de Família, medicina natural, nutrição, Reumatologia, Saúde Publica.

#Las #bayas de saúco no son transparentes

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Nuevo caso de falta de rigor científico en investigaciones con remedios naturales.

Bayas de saúco, usadas para aliviar varias dolencias leves.

Una obligación, comercial, legal y ética, de las empresas dedicadas a la salud es investigar a fondo la eficacia y seguridad de sus productos. Y luego informar verazmente de los resultados. Como es sabido, esto no siempre se cumple: la eficacia a veces se exagera, los resultados negativos se esconden y en ocasiones los positivos se inventan. Un ejemplo reciente ha tenido como escenario la Universidad australiana de Sidney: tras las denuncias de los periódicos The Age y The Sydney Morning Herald, ha tenido que retractarse de un estudio aparecido en su web y difundido ampliamente que aseguraba que las bayas de saúco ayudan a combatir la gripe. En primer lugar ocultó en la nota de prensa que el estudio estaba financiado en parte por Pharmacare, que vende remedios para la gripe a base de saúco (Sambucol). Después tuvo que reconocer que no había pruebas sólidas que respaldaran a esas bayas como antigripales: el análisis se había efectuado en células humanas regadas con zumo de saúco; ni siquiera se había ensayado en ratones. No es ningún desdoro que las universidades acepten fondos privados para investigar sus productos, pero no parece muy honrado que los disfracen hasta la falsedad ni que se avergüencen de citar a los patrocinadores. Un caso más que debe animar a la transparencia y a la ética investigadora.

Esta publicação foi postada em artigos médicos, farmácia, medicina, medicina natural e marcada .