Saturday, March 12, 2011

List of Drugs Affected by Grapefruit

         Grapefruit and grapefruit juice have the potential to interact with numerous drugs. A number of organic compounds, identified as furanocoumarin derivatives, interfere with the hepatic and intestinal enzyme cytochrome P450 isoform CYP3A4 and are therefore primarily responsible for the interaction. However, bioactive compounds in grapefruit juice may also interfere with P-glycoprotein and organic anion transporting polypeptides (OATPs) either increasing or decreasing bio-availability of a number of drugs. Pomelo (the Asian fruit which was crossed with an orange to produce grapefruit) also contains high amounts of furanocoumarin derivatives.
    Certain chemicals that grapefruit products and citrus fruits contain can interfere with the enzymes that break down (metabolize) various medications in your digestive system. As a result, more medication stays in your body. This can increase the potency of your medication to potentially dangerous levels, causing serious side effects.
    Pomelos and Seville oranges, a type of bitter orange often used to make marmalades and compotes, may have a similar effect. Researchers are identifying other foods that also may interact with medications, so check with your doctor or pharmacist if you have any concerns.


    In 1989 a pharmacological study evaluated the possibility of an interaction between ethanol ingestion and medication with the dihydropyridine calcium channel blocker - felodipine. Grapefruit juice was used as a flavouring additive during the test. The results of study showed several-fold increase of felodipine concentrations compared to results obtained in other investigations of the drug. Additionally, there were lower blood pressure readings and more adverse effects compared to the group of subjects on felodipine alone. Further investigations revealed that grapefruit juice strikingly elevated felodipine bioavailability and could influence its other pharmacokinetic and pharmacodynamic properties.


    Drugs affected by grapefruit juice
    Drug class Major Interactions Minor interactions
    Calcium channel antagonists
    Plendil
    Cardene (Nicardipine)
    Procardia (Nifedipine)
    Nimotop
    Sular
    DynaCirc
    Antiarrhythmics Cordarone
    Multaq

    Statins (HMG-CoA reductase inhibitors) Mevacor (Lovastatin) Lipitor
    Baycol (off the market)
    Immunosuppressants
    Sandimmune (Cyclosporine)
    Prograf
    Rapamune
    Mercaptopurine
    Dissociatives Dextromethorphan
    Sedatives, hypnotics, and anxiolytics Buspar Halcion
    Versed
    Valium (Diazepam)
    Sonata (Zaleplon)
    Alprazolam
    Other psychotropics
    Tegretol (Carbamazepine)
    Desyrel
    Serzone
    Seroquel
    Fluvoxamine
    Antihistamines Seldane (off the market)
    Diphenhydramine (partially)
    Hismanal (off the market)
    Claritin (Loratadine)
    HIV protease inhibitors
    Invirase
    Norvir
    Viracept
    Agenerase
    Hormones
    Ortho-Cept (Ethinyl estradiol)
    Depo-Medrol (Methylprednisolone)
    Other drugs
    Viagra
    Propulsid
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    Tuesday, March 8, 2011

    Urinary Tract Infections

    What is a urinary tract infection (UTI)?

              The urinary tract is comprised of the kidneys, ureters, bladder, and urethra A urinary tract infection (UTI) is an infection caused by pathogenic organisms (for eg. bacteria, fungi, or parasites) in any of the structures that comprise the urinary tract. However, this is the broad definition of urinary tract infections; many authors prefer to use more specific terms that localize the urinary tract infection to the major structural segment involved such as
                    -urethritis (urethral infection),
                    -cystitis (bladder infection),
                    -ureter infection, and
                    -pyelonephritis (kidney infection).
    Other structures that eventually connect to or share close anatomic proximity to the urinary tract (for example, prostate, epididymis, and vagina) are sometimes included in the discussion of UTIs because they may either cause or be caused by UTIs.
    UTIs are common, more common in women than men, leading to approximately 8.3 million doctor visits per year. Although some infections go unnoticed, UTIs can cause problems that range from dysuria (pain and/or burning when urinating) to organ damage and even death. The kidneys are the active organs that, during their average production of about 1.5 quarts of urine per day, function to help keep electrolytes and fluids (for example, potassium, sodium, water) in balance, assist removal of waste products (urea), and produce a hormone that aids to form red blood cells. If kidneys are injured or destroyed by infection, these vital functions can be damaged or lost.

    While some investigators state that UTIs are not transmitted from person to person, other investigators dispute this and say UTIs may be contagious and recommend that sex partners avoid relations until the UTI has cleared. There is no dispute about UTIs caused by sexually transmitted disease (STD) organisms; these infections (gonorrhea, chlamydia) are easily transmitted between sex partners and are very contagious.
    Bacteria cause most urinary tract infections. The urinary tract includes the kidneys, ureters, bladder and urethra. Any part of your urinary tract can become infected, but bladder and urethra infections are the most common.

    Why do women get urinary tract infections more often than men?

    Women tend to get urinary tract infections more often than men because bacteria can reach the bladder more easily in women. The urethra is shorter in women than in men, so bacteria have a shorter distance to travel
    The urethra is also located near the rectum in women. Bacteria from the rectum can easily travel up the urethra and cause infections.
    Having sex may also cause urinary tract infections in women because bacteria can be pushed into the urethra. Using a diaphragm can lead to infections because diaphragms push against the urethra and make it harder to completely empty the bladder. The urine that stays in the bladder is more likely to grow bacteria and cause infections.

    How do I know if I have a urinary tract infection?

    The box below lists possible signs of a urinary tract infection. Nausea, lower back pain and fever may be signs of a more serious kidney infection. Call your doctor if you have any of these symptoms.

    How are urinary tract infections treated?

    If your family doctor thinks you have a urinary tract infection, he or she will probably test a sample of your urine to find out if there are bacteria in it. If you have an infection, your doctor will then prescribe an antibiotic. Usually, symptoms of the infection go away 1 to 2 days after you start taking the medicine. Make sure you take all the medicine, even if you are feeling better.

    Your doctor may also suggest a medicine to numb your urinary tract and make you feel better while the antibiotic starts to work. The medicine makes your urine turn bright orange, so don't be alarmed by the color when you urinate.


    Possible signs of a urinary tract infection

    • A burning sensation when you urinate
    • Feeling like you need to urinate more often than usual
    • Feeling the urge to urinate but not being able to
    • Leaking a little urine
    • Cloudy, dark, smelly or bloody urine

    What can I do if I have frequent infections?

    If you have urinary tract infections often, you can try some of the suggestions in the box below. Talk with your family doctor about what changes would be helpful for you.

    Your doctor also may give you a low dose of medicine for several months or longer to prevent infections from coming back.

    If having sex seems to cause your infections, your doctor may suggest that you take a single low dose antibiotic pill after you have sex to prevent urinary tract infections.


    Tips on preventing urinary tract infections

    • Drink plenty of water to flush out bacteria. Drinking cranberry juice may also help prevent urinary tract infections. However, if you're taking Warfarin, check with your doctor before using cranberry juice to prevent urinary tract infections. Your doctor may need to adjust your warfarin dose or you may need to have more frequent blood tests.
    • Don't hold your urine. Urinate when you feel like you need to.
    • Wipe from front to back after bowel movements.
    • Urinate after having sex to help wash away bacteria.
    • Use enough lubrication during sex. Try using a small amount of lubricant (such as K-Y Jelly) before sex if you're a little dry.
    • If you get urinary tract infections often, you may want to avoid using a diaphragm as a birth control method. Ask your doctor about other birth control choices.

    How serious are urinary tract infections?

    Urinary tract infections can be painful. But medicine can keep them from becoming a serious threat to your health. 
    The kidneys can also be infected, which can be a more serious problem. Kidney infections usually require an antibiotic for a longer period of time and are sometimes treated in the hospital.


     Sources:
    http://www.webmd.com/a-to-z-guides/urinary-tract-infections-in-teens-and-adults-topic-overview
    http://www.medicinenet.com/urine_infection/article.htm#what
    http://women.webmd.com/slideshow-urinary-tract-infection-overview
    http://familydoctor.org/online/famdocen/home/women/gen-health/190.html

    Wednesday, March 2, 2011

    Cardiac Rhythms Synchronize with Music

           Music, particularly pieces that contain crescendos or gradual increases in volume, elicits synchronized cardiovascular and respiratory responses in young people that are similar in both musicians and nonmusicians, according to new research.

    It is well-known that music can elicit strong positive or negative emotions, but this new research shows that music is also linked to unconscious physiological responses, said the study's lead author, Luciano Bernardi, MD, professor of internal medicine at Pavia University, in Italy.


    "Here we show, probably for the first time, that there is a continuous interaction between the music dynamics and our cardiovascular system, whether there are conscious emotions or not," Dr. Bernardi said in an interview.
    These findings could have implications for the potential use of music as a therapeutic tool, he added. "We know now that music can affect the cardiovascular system, and if we understand how this works, then we can use it," he said.
    The research was published online June 22 and in the June 30 issue of Circulation.

    Operative Music
    Researchers tracked the cardiovascular and respiratory profile of 24 healthy subjects aged 24 to 26 years old, of whom 12 were experienced choristers and 12 were age- and sex-matched controls with no musical training.

    Hooked up to an electrocardiogram (ECG) and with their eyes closed, the subjects listened to various pieces of music with headphones. The pieces included:
    1. An adagio from Beethoven's Ninth Symphony, a well-known orchestral piece; 
    2. "Nessun dorma," an emotional and lyrical operatic aria from Puccini's Turandot
    3. a solo vocal piece from 1 of Bach's cantatas, a more "intellectual" selection; 
    4. an aria from Verdi's Nabucco, which has rhythmic phrases; 
    5. and another aria from Verdi's La Traviata, also a rhythmic piece. 
    6. The subjects were also exposed to 2 minutes of silence.
    Researchers selected these pieces because they contain several changes in music dynamics — for example, crescendos, decrescendos, pianos, and fortes, etc, said Dr. Bernardi. "This is the ideal type of music to use if you want to see whether the same variation is mirrored in the cardiovascular and respiratory systems," he said. "And of course, operatic music is part of our music tradition in Italy."

    While subjects listened to the music, researchers monitored their ECG, blood pressure, cerebral blood flow, respiration, and skin vasoconstriction. They collected individual data as well as averages for each of the 2 groups separately as well as all 24 subjects together.
    To measure conscious emotional arousal, subjects were asked to rate the intensity of emotion and the novelty and pleasantness of the musical pieces on a 5-point scale. They also reported on whether they felt "chills" or other strong feelings in response to each track.

    No "Chills"
    The researchers found that there was little or no emotional involvement in the music, and none of the subjects reported chills in response to the music.
    But the investigators did find subconscious reflex autonomous responses. Almost every musical crescendo induced progressive skin vasoconstriction along with increases in blood pressure and heart rate.
    Correlations between cardiovascular variables and music profile were particularly evident during the aria "Nessun dorma," which is characterized by 3 progressively stronger crescendos. "We found that there were a lot of correspondences, particularly during the part of the musical track that has those crescendos," said Dr. Bernardi.
    Conversely, during the slower or silent phases, there was progressive skin vasodilation and reductions in heart rate and blood pressure, indicating progressive relaxation.

    Similar Responses
    Although musicians tended to have a greater response than control subjects to more "intellectual" music, for the most part, the cardiac profile of musicians was the same as that of nonmusicians. "Everyone tended to respond in the same way, which suggests that whether you like it [the music] or not, these particular tracks have an effect that is common to everybody," said Dr. Bernardi.
    As for respiration, there tended to be a correlation between music and breathing. For certain pieces, the respiratory signal closely tracked the amplitude of the music "envelope," indicating that the depth of respiration could be influenced tightly by music, at least during crescendos, said the authors. Musicians had a somewhat higher correlation for some musical pieces than nonmusicians.
    Dr. Bernardi surmised that a study using music from other cultures – for example, Chinese or Arabic — would produce similar findings. "I would suggest that pretty much everything would be the same using people with a different musical system because it [physiological reaction] is dependent not on emotions" but rather on the body's reactions that are independent from emotional responses, he said.

    Better Explanation
    Music is already being used as a therapy in various fields, but until now little was known about how it works. "We think we can now provide an explanation of how it could work and therefore provide a better way of using it," said Dr. Bernardi.

    Other research has shown that music reduces stress, boosts athletic performance, and enhances motor skills in people with neurological impairments. Music can also provide physical benefits by acting as a distraction so patients may be able to exercise for longer periods of time.
    An earlier study by Dr. Bernardi and his colleagues found that faster tempos resulted in increased breathing, heart rate, and blood pressure, all of which decreased when the music was stopped.
    The next step for his research group is to repeat the current study using an older patient population — those over age 70 years. The selection of musical pieces for this new study will include rock music, said Dr. Bernardi.

    Provocative Findings
    For his part, Barry Franklin, MD, director of cardiac rehabilitation and exercise laboratories at William Beaumont Hospital, in Royal Oak, Michigan, called the study "provocative."

    He said he would like to see similar studies done on coronary patients like the ones he deals with on a daily basis to see whether the physiologic responses are the same. If they are, there may be some huge implications, he said. In patients with tremendous functional deficits, even very small changes in blood pressure, blood flow, heart rate, and so on may produce meaningful adaptations and improvements in those individuals, Dr. Franklin noted.

    Sources:
    http://www.medscape.com/viewarticle/705104
    http://www.theheart.org/article/982997.do
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    Tuesday, March 1, 2011

    The Health Dangers of Aspartame

    Aspartame is a non-saccharine artificial sweetener currently used in over 6,000 diet and low calorie food products. Popular trademark brands of the sweetener in the United States include NutraSweet®, Equal®, and Tropicana Slim®, which are used to sweeten a number of sodas and chewing gums.

    However, research done on aspartame has shown that it may not be completely safe for human consumption, and may cause a number of health complications if taken in large doses. Efforts to revoke FDA approval on aspartame have so far been unsuccessful, so it is advisable to simply avoid these products whenever possible.




    Grant Gochnauer, more or less the obsessive pinnacle of health, sent over a link to a site that represents Victoria Inness-Brown personal experiment with 108 rats over a 2 year and 8 month period, studying the effects of aspartame in them.

    The photo above was one of the rats in the study that had a common side effect of ingesting the aspartame, and that was huge tumors/cancerous growths. The consistency with which aspartame, in the test animals, produced cancerous growths should be disturbing enough to get it pulled from the market.

    Aspartame: What it can do to you
    Aspartame is an NMDA receptor antagonist, which means that it inhibits the release of neurotransmitters that cause pain within the body. NMDA receptor antagonists are often used as a form of anesthesia for animals, but not on humans due to the fact that they often cause brain damage in rodents. The possible side effects of aspartame on humans include headaches, brain tumors, brain lesions, and lymphoma.

    Why Was Aspartame Approved by the FDA?
    You may be wondering why aspartame is approved by the Food and Drug Administration, even though it is suspected to cause brain damage over long periods of time.
    Well, aspartame gained FDA approval while it was owned by Donald Rumsfeld, who was at that time the CEO of the pharmaceutical company G.D. Searle & Company. Rumsfeld earned millions of dollars by marketing the product as NutraSweet, and when medical research into the product confirmed the risk of brain tumors, Rumsfeld simply hired another FDA board member to overturn the ban that the current board had inflicted.

    Did you know? Despite its apparent danger to animals and humans, aspartame has been approved by the FDA a total of 26 times over the last 23 years.

    The Health Effects of Aspartame

    Any further inquiries into aspartame’s health effects have therefore been relegated to independent studies, which often lack the funding to properly advertise their findings. However, the studies completed thus far show overwhelming evidence regarding the apparent dangers of aspartame.

            An analysis done using MEDLINE showed that 92% of non-industry sponsored studies reported one or more problems with aspartame in terms of its effects on health. These studies reported a range of side effects including fibromyalgia, brain tumors, memory loss, lymphoma, leukemia, and peripheral nerve cancer. 
     Headaches and migraine symptoms are one of the most common side effects of aspartame.

           An article published in the July 2007 issue of Science magazine featured 12 prominent health experts who support a ban on aspartame. It also featured a letter to U.S. Food and Drug Administration Commissioner Dr. Andrew Von Eschenbach requesting approval of the sweetener to be revoked due to extensive evidence that it causes cancer. Approval status has not changed yet due to the influence of lobbyists on politicians, and ongoing conflicts between capitalism and environmentalism.

    Aspartame can create a number of serious health conditions if ingested regularly. It has the potential to cause cancer, brain damage, and eventually death. It is wise to make healthy choices when purchasing food and beverages, and strive to buy whole, natural, organic products whenever possible. Aspartame with the help of public outcry, will hopefully be restricted by the FDA in the near future in order to minimize its effects on the population.

    For organic and natural sweeteners, I recommend agave nectar, raw locally harvested honey or xylitol.


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    Monday, February 21, 2011

    Recommended Adult Immunization Schedule - 2011



























    1. Influenza vaccination
    Annual vaccination against influenza is recommended for all persons aged 6 months and older, including all adults. Healthy, nonpregnant adults aged less than 50 years without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine (FluMist), or inactivated vaccine. Other persons should receive the inactivated vaccine. Adults aged 65 years and older can receive the standard influenza vaccine or the high-dose (Fluzone) influenza vaccine. Additional information about influenza vaccination is available at http://www.cdc.gov/vaccines/vpd-vac/flu/default.htm.
    2. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
    Administer a one-time dose of Tdap to adults aged less than 65 years who have not received Tdap previously or for whom vaccine status is unknown to replace one of the 10-year Td boosters, and as soon as feasible to all 1) postpartum women, 2) close contacts of infants younger than age 12 months (e.g., grandparents and child-care providers), and 3) healthcare personnel with direct patient contact. Adults aged 65 years and older who have not previously received Tdap and who have close contact with an infant aged less than 12 months also should be vaccinated. Other adults aged 65 years and older may receive Tdap. Tdap can be administered regardless of interval since the most recent tetanus or diphtheria-containing vaccine.
    Adults with uncertain or incomplete history of completing a 3-dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series. For unvaccinated adults, administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second. If incompletely vaccinated (i.e., less than 3 doses), administer remaining doses. Substitute a one-time dose of Tdap for one of the doses of Td, either in the primary series or for the routine booster, whichever comes first.
    If a woman is pregnant and received the most recent Td vaccination 10 or more years previously, administer Td during the second or third trimester. If the woman received the most recent Td vaccination less than 10 years previously, administer Tdap during the immediate postpartum period. At the clinician’s discretion, Td may be deferred during pregnancy and Tdap substituted in the immediate postpartum period, or Tdap may be administered instead of Td to a pregnant woman after an informed discussion with the woman.
    The ACIP statement for recommendations for administering Td as prophylaxis in wound management is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
    3. Varicella vaccinationAll adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or a second dose if they have received only 1 dose, unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., healthcare personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers; child-care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
    Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for healthcare personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of varicella by a healthcare provider (for a patient reporting a history of or having an atypical case, a mild case, or both, healthcare providers should seek either an epidemiologic link with a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on diagnosis or
    verification of herpes zoster by a healthcare provider; or 5) laboratory evidence of immunity or laboratory confirmation of disease.
    Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. The second dose should be administered 4–8 weeks after the first dose.
    4. Human papillomavirus (HPV) vaccination
    HPV vaccination with either quadrivalent (HPV4) vaccine or bivalent vaccine (HPV2) is recommended for females at age 11 or 12 years and catch-up vaccination for females aged 13 through 26 years.
    Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, females who are sexually active should still be vaccinated consistent with age-based recommendations. Sexually active females who have not been infected with any of the four HPV vaccine types (types 6, 11, 16, and 18, all of which HPV4 prevents) or any of the two HPV vaccine types (types 16 and 18, both of which HPV2 prevents) receive the full benefit of the vaccination. Vaccination is less beneficial for females who have already been infected with one or more of the HPV vaccine types. HPV4 or HPV2 can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test, because these conditions are not evidence of previous infection with all vaccine HPV types.
    HPV4 may be administered to males aged 9 through 26 years to reduce their likelihood of genital warts. HPV4 would be most effective when administered before exposure to HPV
    through sexual contact.
    A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 1–2 months after the first dose; the third dose should be administered 6 months after the first dose.
    Although HPV vaccination is not specifically recommended for persons with the medical indications described in Figure 2, “Vaccines that might be indicated for adults based on medical and other indications,” it may be administered to these persons because the HPV vaccine is not a live-virus vaccine. However, the immune response and vaccine


    Source:
    http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm
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    Recommended Immunization Schedule for Persons Aged 7 - 18 Years— 2011



    This schedule includes recommendations in effect as of December 21, 2010. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines.
    Considerations should include provider assessment, patient preference, and the potential for adverse events. 

    1. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap).
    (Minimum age: 10 years for Boostrix and 11 years for Adacel))
    • Persons aged 11 through 18 years who have not received Tdap should receive a dose followed by Td booster doses every 10 years thereafter.
    • Persons aged 7 through 10 years who are not fully immunized against pertussis (including those never vaccinated or with unknown pertussis vaccination status) should receive a single dose of Tdap. Refer to the catch-up schedule if additional doses of tetanus and diphtheria toxoid–containing vaccine are needed.
    • Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid–containing vaccine.

    2. Human papillomavirus vaccine (HPV). (Minimum age: 9 years)
    • Quadrivalent HPV vaccine (HPV4) or bivalent HPV vaccine (HPV2) is recommended for the prevention of cervical precancers and cancers in females.
    • HPV4 is recommended for prevention of cervical precancers, cancers, and genital warts in females.
    • HPV4 may be administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of genital warts.
    • Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose).

    3. Meningococcal conjugate vaccine, quadrivalent (MCV4). (Minimum age: 2 years)
    • Administer MCV4 at age 11 through 12 years with a booster dose at age 16 years.
    • Administer 1 dose at age 13 through 18 years if not previously vaccinated.
    • Persons who received their first dose at age 13 through 15 years should receive a booster dose at age 16 through 18 years.
    • Administer 1 dose to previously unvaccinated college freshmen living in a dormitory.
    • Administer 2 doses at least 8 weeks apart to children aged 2 through 10 years with persistent complement component deficiency and anatomic or functional asplenia, and 1 dose every 5 years thereafter.
    • Persons with HIV infection who are vaccinated with MCV4 should receive 2 doses at least 8 weeks apart.
    • Administer 1 dose of MCV4 to children aged 2 through 10 years who travel to countries with highly endemic or epidemic disease and during outbreaks caused by a vaccine serogroup.
    • Administer MCV4 to children at continued risk for meningococcal disease who were previously vaccinated with MCV4 or meningococcal polysaccharide vaccine after 3 years (if first dose administered at age 2 through 6 years) or after 5 years (if first dose administered at age 7 years or older).

    4. Influenza vaccine (seasonal).
    • For healthy nonpregnant persons aged 7 through 18 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used.
    • Administer 2 doses (separated by at least 4 weeks) to children aged 6 months through 8 years who are receiving seasonal influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.
    • Children 6 months through 8 years of age who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2010-2011 seasonal influenza vaccine. See MMWR 2010;59(No. RR-8):33–34.

    5. Pneumococcal vaccines.
    • A single dose of 13-valent pneumococcal conjugate vaccine (PCV13) may be administered to children aged 6 through 18 years who have functional or anatomic asplenia, HIV infection or other immunocompromising condition, cochlear implant or CSF leak. See MMWR 2010;59(No. RR-11).
    • The dose of PCV13 should be administered at least 8 weeks after the previous dose of PCV7.
    • Administer pneumococcal polysaccharide vaccine at least 8 weeks after the last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after 5 years to children with functional or anatomic asplenia or an immunocompromising condition.

    6. Hepatitis A vaccine (HepA).
    • Administer 2 doses at least 6 months apart.
    • HepA is recommended for children aged older than 23 months who live in areas where vaccination programs target older children, or who are at increased risk for infection, or for whom immunity against hepatitis A is desired.

    7. Hepatitis B vaccine (HepB).
    • Administer the 3-dose series to those not previously vaccinated. For those with incomplete vaccination, follow the catch-up schedule.
    • A 2-dose series (separated by at least 4 months) of adult formulation Recombivax HB is licensed for children aged 11 through 15 years.

    8. Inactivated poliovirus vaccine (IPV).
    • The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.
    • If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.

    9. Measles, mumps, and rubella vaccine (MMR).
    • The minimum interval between the 2 doses of MMR is 4 weeks.

    10. Varicella vaccine.
    • For persons aged 7 through 18 years without evidence of immunity (see MMWR 2007;56[No. RR-4]), administer 2 doses if not previously vaccinated or the second dose if only 1 dose has been administered.
    • For persons aged 7 through 12 years, the recommended minimum interval between doses is 3 months. However, if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid.
    • For persons aged 13 years and older, the minimum interval between doses is 4 weeks.


    Providers should consult the relevant Advisory Committee on Immunization Practices statement for detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967.
    Sources:
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    Friday, February 18, 2011

    10 Habits for a Stronger Heart

    Men's Health .The smartest plan for attacking a heart attack is, of course, preventing one from ever happening. Choose three of the following strategies and make them a habit. The closer to the top, the more you reduce your risk of heart disease.


    1. Convince Your Wife to Stop Smoking
    Nonsmoking husbands of smoking wives face a 92 % increase in their risk of heart attack. Breathing secondhand smoke boosts bad cholesterol levels, decreases good cholesterol, and increases your blood's tendency to clot.

    2. Work Out for 30 Minutes, Four Times a Week
    Middle-aged men who exercise vigorously for 2 or more hours cumulatively per week have 60 percent less risk of heart attack than inactive men do.

    3. Lose 10 - 20 Pounds
    If you're overweight, dropping 10 to 20 pounds lowers your risk of dying from a heart attack. A 10-year study found that overweight people had heart attacks 8.2 years earlier than normal-weight victims.

    4. Drink 5 Glasses of Water a Day
    Men who drink that many 8-ounce glasses are 54 % less likely to have a fatal heart attack than those who drink two or fewer. Researchers say the water dilutes the blood, making it less likely to clot.

    5. Switch from Coffee to Tea
    A recent study found that people who drink three cups of tea a day have half the risk of heart attack of those who don't drink tea at all. Potent antioxidants, called flavonoids, provide a protective effect.

    6. Eat Salmon on Saturday, Tuna on Tuesday
    Researchers at the Harvard School of Public Health say that eating fish at least twice a week lowers heart-disease risk by more than 30 percent. The magic ingredient is the omega-3 fatty acids.

    7. Ask Your Doctor About Vitamin E and Aspirin
    Men who take both cut the plaque in clogged arteries by more than 80%, according to a recent University of Pennsylvania study.

    8. Eat a Cup of Total Corn Flakes for Breakfast
    This cereal contains one of the highest concentrations of folate (675 micrograms) of any cereal. Taking in that much folic acid daily cuts your risk of cardiovascular disease by 13 percent, according to researchers.

    9. Count to 10
    Creating a 10-second buffer before reacting to a stressful situation may be enough to cool you down. Men who respond with anger are three times more likely to have heart disease and five times more likely to have a heart attack before turning 55.

    10. Eat Watermelon
    It contains about 40 % more lycopene than is found in raw tomatoes, and a new study shows that your body absorbs it at higher levels due to the melon's high water content. Half a wedge can boost heart-disease prevention by 30%.
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