DaVita Saúde

In this area, you can find important information on how to take care of and maintain your well-being and that of your family, in the form of tips prepared by our medical team.

Our intention is to share knowledge and care for the promotion of your health, in an attempt to contribute to your daily care and habits, thus helping you to prevent possible diseases.

Well being

Time to think about fighting skin cancer

Guess what type of cancer is most frequently diagnosed in Brazil? If you thought about breast, prostate, intestine or lung cancer you did not get it right. The most common malignant tumor in these sunny lands is the non-melanoma skin cancer, especially the types basal cell carcinoma and squamous cell carcinoma, which accounts for one third of all cases of cancer diagnosed in Brazil. According to the National Cancer Institute, last year alone, 165,500 cases were recoded, 85,100 of which having developed in men and 80,100 in women. According to experts, several factors explain the large number of people affected by this disease. With a tropical climate, Brazil is subject to high solar irradiance all year round, which naturally makes the population more vulnerable to this type of tumor. Add to that the fact that many Brazilians have the habit of only using sunscreen when they go to the beach or the pool, and fail to protect themselves on a daily basis, which increases the level of exposure to radiation. Other risk factors include family history - relatives who have had this cancer - and very fair skin. Finally, excessive exposure to sun throughout life also increases the possibility of acquiring this malignant lesion, since the harmful effects of ultraviolet rays A and B (UVA and UVB) to the skin cells are cumulative. Not so long ago, people would use tanning oil at the beach, field workers, construction workers and urban cleaners did not protect themselves with adequate clothes, and even water and outdoor sports practitioners only applied, at most, a layer of cream against rashes on the nose and cheeks. The fact is that culture of photoprotection is rather recent in Brazil because, for a long time, the idea that a tanned skin was  healthy prevailed. For instance, suntan lotion was available in Brazil in the 1960s while products with a sun protection factor (SPF), only became available in the 1980s, initially with protection factors 4, 8 and 15.  Fortunately, the skin tumor is much less lethal than other cancers - except for the melanoma, which, although rarer, has a high mortality rate because it spreads quickly to other organs (link to melanoma article). Even so, both the basal cell and the spinocellular type need to be treated as quickly as possible because they can cause injuries that mutilate or disfigure the skin in exposed areas of the body, which has a major emotional impact on patients. How to recognize the tumor It is evident that protecting yourself from the sun is essential in this context (link to box Prevention against breast cancer ...), but photoprotection is not enough, precisely because of these risk factors. In practice, people should be well aware of their body and the location of spots, patches and other injuries and, above all, pay particular attention to those that appear in areas that are most exposed to the sun, such as face, arms, ears, neck, lips, shoulders, back and the scalp, for those who have little hair.  According to the Brazilian Society of Dermatology (SBD), suspected non-melanoma skin cancer lesions appear as a shiny lump, which can be red, brown and pink, and bleed easily. Patches or wounds that do not heal should also raise the alert, especially if they grow, become itchy, bleed and become crusty. Such signs are sufficient to seek a dermatologist as soon as possible for a detailed evaluation. The diagnosis depends on clinical examination, dermoscopic examination (performed during the consultation) and biopsy of the lesions, that is, removal of tiny fragments for micro and macroscopic examination of the nature of their changes. Treatment options There are several different types of treatment for non-melanoma skin cancer, such as: conventional and laser surgical removal, scraping the lesion and destroying malignant cells by means of curettage and electrocauteryan , freezing the tumor with liquid nitrogen and Mohs micrographic surgery, a technique based on the removal of the compromised tissues and analyzing them under the microscope, several times, until there are no more tumor cells - the healthy tissues are preserved.   Photodynamic therapy is another possibility; it combines the application of a photosensitizing substance (sensitive to light) on the lesion and exposing it to a light source that activates this agent and destroys the malignant cells, with minimal impact on the intact skin. In addition, classical therapies are also used, especially if the tumor is prone to spreading, including chemotherapy and radiotherapy, among others. The best option is chosen on a case-by-case basis, by the dermatologist who takes into account the type and size of the lesion, as well as the location. Like any other type of cancer, the earlier the diagnosis, the greater the chances of cure, without major repercussions on the patient's appearance or even quality of life. Protect your skin all year round and go to a dermatologist regularly. Skin cancer prevention is at your fingertips - Avoid exposure to the sun during the period of high irradiation of ultraviolet (UV) rays, that is, from 10 am to 4 pm, even on overcast days. If you are outdoors, on the beach or by the pool, take shelter in the shade. It should be noted that parasols and nylon tents help very little, since most of the solar radiation passes through this material. If you choose tents, the ideal one is made of canvas or cotton, which absorb at least half of the UV rays. Nonetheless, even in the shade, you can't give up sunscreen on the beach, by the pool, in the countryside or on the street. - Use a product that protects against UVA and UVB rays and with SPF 30, at least. For Afro-descendants, however, the SPF may even be lower, from 15 to 20, since black skin has natural protection, that is, a greater amount of melanin, which acts as a shield against the sun's rays. However, the choice of the ideal SPF should also take into account the skin tone in this group, which varies widely.  - Use sunscreen filter on exposed areas not only on the beach or by the pool, but also on a daily basis and in any outdoor activity, leisure or not, in the four seasons of the year. Those who stay indoors should apply sunscreen before leaving home and repeat application before going out into the street during the day. For those who remain outdoors, application must be repeated every two hours or less, especially in the case of sports, as excessive sweating removes protection. - Learn how to use the sunscreen correctly: apply the product about 30 minutes before sun exposure, so that the skin can absorb it, distributing it evenly on all exposed parts of the body. The ideal amount, according to the Brazilian Dermatology Society, is one teaspoon for each part of the body, on average. Do not forget ears, neck, hands and feet, which are almost always neglected. Reapply the protector every two hours or after excessive sweating and/or entering the water. Such care applies to any skin tone. It is worth noting that the natural barrier of black skin ceases to function if reapplication is not adequate .  - Keep babies protected from the sun, since SPF products can only be applied to children after 6 months of age. The daily sunbath, recommended by pediatricians for the production of vitamin D by the body, should be done without sunscreen, exposing  arms and legs, for at least ten minutes, but always before 9 am. - When outdoors, resort to other types of protection in addition to sunscreen, such as t-shirts, sunglasses, wide-brimmed caps and hats, long-sleeved shirts with sun protection factor and the like. Those who work outdoors, for example, need to be fully covered. - Do a self-examination of your skin, following the ABCDE rule (link to box How to follow the ABCDE rule ). Regardless of the findings, see a dermatologist at least once a year for a general evaluation.  How to apply the ABCDE rule for self-examination of skin In order to make it easier for patients to identify suspicious lesions by themselves, the SBD suggests following the ABCDE rule. Check it out: Letter / What to watch  Characteristic of malignant tumor Characteristic of benign tumor A for asymmetry Asymmetric Symmetrical B for border Irregular Regular C for color Two or more Only one D of diameter Above 6 mm (probably malignant) Below 6 mm (probably benign) E for evolution Grows and changes color (probably malignant) Does not grow or change color (probably benign)   Basal cell or squamous cell carcinoma? Learn the differenceThe classification of the type of non-melanoma skin cancer has to do with the type of cell involved in the lesion. Basal cell, the most common, originates from so-called basal cells, found in the deepest layer of the skin. It usually appears in areas exposed to the sun, such as face, ears, neck, scalp, back and shoulders. Whereas squamous cell carcinoma is formed from squamous cells, which make up most of the upper layers of the skin. This is also more common in exposed regions, but it can appear anywhere on the body. In addition to the sun, it is worth remembering that this type of  tumor is associated with chronic wounds and scars, use of drugs to prevent rejection of transplanted organs and exposure to certain chemicals and other types of radiation.

2/5/2020
Well being

Time to think about fighting skin cancer

Guess what type of cancer is most frequently diagnosed in Brazil? If you thought about breast, prostate, intestine or lung cancer you did not get it right. The most common malignant tumor in these sunny lands is the non-melanoma skin cancer, especially the types basal cell carcinoma and squamous cell carcinoma, which accounts for one third of all cases of cancer diagnosed in Brazil. According to the National Cancer Institute, last year alone, 165,500 cases were recoded, 85,100 of which having developed in men and 80,100 in women. According to experts, several factors explain the large number of people affected by this disease. With a tropical climate, Brazil is subject to high solar irradiance all year round, which naturally makes the population more vulnerable to this type of tumor. Add to that the fact that many Brazilians have the habit of only using sunscreen when they go to the beach or the pool, and fail to protect themselves on a daily basis, which increases the level of exposure to radiation. Other risk factors include family history - relatives who have had this cancer - and very fair skin. Finally, excessive exposure to sun throughout life also increases the possibility of acquiring this malignant lesion, since the harmful effects of ultraviolet rays A and B (UVA and UVB) to the skin cells are cumulative. Not so long ago, people would use tanning oil at the beach, field workers, construction workers and urban cleaners did not protect themselves with adequate clothes, and even water and outdoor sports practitioners only applied, at most, a layer of cream against rashes on the nose and cheeks. The fact is that culture of photoprotection is rather recent in Brazil because, for a long time, the idea that a tanned skin was  healthy prevailed. For instance, suntan lotion was available in Brazil in the 1960s while products with a sun protection factor (SPF), only became available in the 1980s, initially with protection factors 4, 8 and 15.  Fortunately, the skin tumor is much less lethal than other cancers - except for the melanoma, which, although rarer, has a high mortality rate because it spreads quickly to other organs (link to melanoma article). Even so, both the basal cell and the spinocellular type need to be treated as quickly as possible because they can cause injuries that mutilate or disfigure the skin in exposed areas of the body, which has a major emotional impact on patients. How to recognize the tumor It is evident that protecting yourself from the sun is essential in this context (link to box Prevention against breast cancer ...), but photoprotection is not enough, precisely because of these risk factors. In practice, people should be well aware of their body and the location of spots, patches and other injuries and, above all, pay particular attention to those that appear in areas that are most exposed to the sun, such as face, arms, ears, neck, lips, shoulders, back and the scalp, for those who have little hair.  According to the Brazilian Society of Dermatology (SBD), suspected non-melanoma skin cancer lesions appear as a shiny lump, which can be red, brown and pink, and bleed easily. Patches or wounds that do not heal should also raise the alert, especially if they grow, become itchy, bleed and become crusty. Such signs are sufficient to seek a dermatologist as soon as possible for a detailed evaluation. The diagnosis depends on clinical examination, dermoscopic examination (performed during the consultation) and biopsy of the lesions, that is, removal of tiny fragments for micro and macroscopic examination of the nature of their changes. Treatment options There are several different types of treatment for non-melanoma skin cancer, such as: conventional and laser surgical removal, scraping the lesion and destroying malignant cells by means of curettage and electrocauteryan , freezing the tumor with liquid nitrogen and Mohs micrographic surgery, a technique based on the removal of the compromised tissues and analyzing them under the microscope, several times, until there are no more tumor cells - the healthy tissues are preserved.   Photodynamic therapy is another possibility; it combines the application of a photosensitizing substance (sensitive to light) on the lesion and exposing it to a light source that activates this agent and destroys the malignant cells, with minimal impact on the intact skin. In addition, classical therapies are also used, especially if the tumor is prone to spreading, including chemotherapy and radiotherapy, among others. The best option is chosen on a case-by-case basis, by the dermatologist who takes into account the type and size of the lesion, as well as the location. Like any other type of cancer, the earlier the diagnosis, the greater the chances of cure, without major repercussions on the patient's appearance or even quality of life. Protect your skin all year round and go to a dermatologist regularly. Skin cancer prevention is at your fingertips - Avoid exposure to the sun during the period of high irradiation of ultraviolet (UV) rays, that is, from 10 am to 4 pm, even on overcast days. If you are outdoors, on the beach or by the pool, take shelter in the shade. It should be noted that parasols and nylon tents help very little, since most of the solar radiation passes through this material. If you choose tents, the ideal one is made of canvas or cotton, which absorb at least half of the UV rays. Nonetheless, even in the shade, you can't give up sunscreen on the beach, by the pool, in the countryside or on the street. - Use a product that protects against UVA and UVB rays and with SPF 30, at least. For Afro-descendants, however, the SPF may even be lower, from 15 to 20, since black skin has natural protection, that is, a greater amount of melanin, which acts as a shield against the sun's rays. However, the choice of the ideal SPF should also take into account the skin tone in this group, which varies widely.  - Use sunscreen filter on exposed areas not only on the beach or by the pool, but also on a daily basis and in any outdoor activity, leisure or not, in the four seasons of the year. Those who stay indoors should apply sunscreen before leaving home and repeat application before going out into the street during the day. For those who remain outdoors, application must be repeated every two hours or less, especially in the case of sports, as excessive sweating removes protection. - Learn how to use the sunscreen correctly: apply the product about 30 minutes before sun exposure, so that the skin can absorb it, distributing it evenly on all exposed parts of the body. The ideal amount, according to the Brazilian Dermatology Society, is one teaspoon for each part of the body, on average. Do not forget ears, neck, hands and feet, which are almost always neglected. Reapply the protector every two hours or after excessive sweating and/or entering the water. Such care applies to any skin tone. It is worth noting that the natural barrier of black skin ceases to function if reapplication is not adequate .  - Keep babies protected from the sun, since SPF products can only be applied to children after 6 months of age. The daily sunbath, recommended by pediatricians for the production of vitamin D by the body, should be done without sunscreen, exposing  arms and legs, for at least ten minutes, but always before 9 am. - When outdoors, resort to other types of protection in addition to sunscreen, such as t-shirts, sunglasses, wide-brimmed caps and hats, long-sleeved shirts with sun protection factor and the like. Those who work outdoors, for example, need to be fully covered. - Do a self-examination of your skin, following the ABCDE rule (link to box How to follow the ABCDE rule ). Regardless of the findings, see a dermatologist at least once a year for a general evaluation.  How to apply the ABCDE rule for self-examination of skin In order to make it easier for patients to identify suspicious lesions by themselves, the SBD suggests following the ABCDE rule. Check it out: Letter / What to watch  Characteristic of malignant tumor Characteristic of benign tumor A for asymmetry Asymmetric Symmetrical B for border Irregular Regular C for color Two or more Only one D of diameter Above 6 mm (probably malignant) Below 6 mm (probably benign) E for evolution Grows and changes color (probably malignant) Does not grow or change color (probably benign)   Basal cell or squamous cell carcinoma? Learn the differenceThe classification of the type of non-melanoma skin cancer has to do with the type of cell involved in the lesion. Basal cell, the most common, originates from so-called basal cells, found in the deepest layer of the skin. It usually appears in areas exposed to the sun, such as face, ears, neck, scalp, back and shoulders. Whereas squamous cell carcinoma is formed from squamous cells, which make up most of the upper layers of the skin. This is also more common in exposed regions, but it can appear anywhere on the body. In addition to the sun, it is worth remembering that this type of  tumor is associated with chronic wounds and scars, use of drugs to prevent rejection of transplanted organs and exposure to certain chemicals and other types of radiation.

2/5/2020
Prevention

Number of dengue virus infections skyrockets and calls for union of strategies

At the end of the year, before the summer rainy season, the Ministry of Health repeatedly seeks to mobilize the population in order to reduce the proliferation of Aedes aegypti, the mosquito that carries the dengue virus and other diseases caused by arboviruses, that is, arboviral disease- such as chikungunya fever and Zika virus infection. (link to box Learn the difference ...) Particularly this year, the scenario is startling, so much so that the Ministry of Health anticipated to September their advertising campaign to encourage the fight against A. aegypti. According to the latest Epidemiological Bulletin published by the Health Surveillance Department, in the first nine months of 2019, Brazil recorded 1,469,605 cases of dengue virus infections, while 207,400 cases were recorded in the same period of 2018. This is equivalent to an increase of nearly 610%, with 646 deaths caused by the disease already confirmed and 414 other fatalities still under investigation. The fact is that, at this rate, given that cases recorded in the last quarter, which is usually rainiest of all, are yet to be computed, 2019 may break the historical record of 2015, when 1.68 million cases were recorded. The Southeast concentrated most of the occurrences until September, and the state of Minas Gerais ranked first, having recorded most cases, 477.5 thousand, followed very closely by São Paulo, which recorded 440.2 thousand cases, and then the state of Espírito Santo, with 60.6 thousand cases, the fourth Brazilian state with the most people infected. The state of Goiás, in the mid-west region, came third, with 110,800 cases, and Bahia fifth, with 62,100 cases recorded. What explains such boost of dengue virus infections? The Ministry of Health states the great increase in the number of cases is due to a set of factors, which includes the spread of dengue fever throughout Latin America - in September, the Pan American Health Organization activated the epidemiological alert after the region exceeded 2 million individuals infected - the high rainfall volume and the high temperatures recoded this year, the higher number of people susceptible to the disease, since the number of cases had dropped in the two previous years, and, in particular, the change of the virus serotype that is now causing the epidemic. We should remember that the dengue virus has four serotypes (1, 2, 3 and 4), which means that an individual can be infected up to four times, and only then does the body acquire immunity to all of them. Serotype 2 was not recorded in the past decade, when types 1 and 4 prevailed. However, in 2019, until April only, it accounted for 84% of infections, according to the Ministry of Health. In other words, since many people were not immune to serotype 2, the problem  increased substantially. Tropical climate and disorderly growth But this is far from justifying the new dengue fever epidemic. Although the population has the crucial obligation of removing materials that could accumulate water and therefore create breeding grounds (link to What you can do ...), there is, in our country, a combination of aspects that favor the proliferation of mosquitoes. According to experts, added up, the tropical climate (20-40 degrees centigrade), rainfall favoring the reproductive cycle of the A. aegypti, the rather disorganized growth of cities, the accumulation of garbage and the still poor basic sanitation are increasingly distancing health authorities from their goal of eradicating the disease virus vector. The solution definitely requires educating the population on health, this is true, but it equally requires investment in technology, firstly and foremost, for the development of a vaccine that is safe enough for the entire vulnerable population. The immunization currently available covers only two serotypes of the virus and is recommended only for the age group of 9 to 45 years old, provided that the person has already been infected before, otherwise this individual would be susceptible to developing the serious form of disease. This already happens to some people who has been infected by dengue more than once. With this vaccine that protects against two strains only, in the event of another exposure to the virus, the body understands that it was previously infected. At the moment, Instituto Butantan is working on a potentially effective formula against the four serotypes, which has already been tested on 17,000 volunteers and is in the final phase of pharmacological studies. After the tests, this clinical trial will be sent for evaluation by the National Health Surveillance Agency (Anvisa), which, based on evidences of efficacy and safety of the vaccine, will allow its registration, or not. Until then, however, we will have to face the mosquito for a few summer seasons. Self-sustainable strategy against A. aegypti Fortunately, there are other fronts, such as the World Mosquito Program (WMP), that operates in 12 countries and receives investment from local governments and also from the Bill & Melinda Gates Foundation. Coordinated by the Oswaldo Cruz Foundation (Fiocruz) in Brazil, the project consists of introducing the Wolbachia bacterium, already present in 60% of insects, in the mosquito, as this would inhibit the transmission of the virus by A. aegypti. When it came up in Australia, each larva received a micro injection with the bacteria. Today, however, researchers maintain colonies of mosquitoes that carry this agent, which multiply and are used in each region where the WMP is implemented. However, in order to reduce the females’ ability to transmit diseases, Wolbachia mosquitoes of both genders have to be released in nature, so that, little by little, they can predominate in the environment and decrease the number of cases of arboviruses. This is because the crossbreeding of carriers of the bacterium results in offsprings bearing the same characteristic, which also occurs if only the female is a carrier of the Wolbachia. Nonetheless, if the female that does not carry the agent crosses with a male that does, these mosquitoes will cease to breed. It is a self-sustainable strategy that does not require genetic engineering. In Brazil, between August 2015 and January 2016, mosquitoes carrying Wolbachia began to be released in two municipalities in the state of Rio de Janeiro. Today, these mosquitoes are already found in 62 neighborhoods in the capital of Rio de Janeiro and Niterói, the  females continue to bite normally, it is worth noting - in any case, the community of each location involved receives explanations from WMP multipliers. In April, according to Fiocruz, the WMP reached its final stage in Brazil, with the announcement by the Ministry of Health that starting next year, Campo Grande (MS), Belo Horizonte (MG) and Petrolina (PE) will also receive mosquitoes carrying Wolbachia. According to the researchers involved, preliminary data indicates that the initiative has been successful, but the organization has already promised to deliver a first complete study on the project in Rio de Janeiro by 2022. Although these and other actions have been successfully applied across the country, this does not eliminate the need for each citizen to do whatever is within their reach, at least ten minutes every day, according to this year's campaign against dengue, since, in 80% of cases, the mosquito is found in homes, very close to all of us - at least 50 to 100 meters away. Check the tips from the Ministry of Health and get down to work. What can you personally do against the A. aegypti? Get rid of any possible breeding site Cover water tanks and other water reservoirs. Keep bins tightly covered. Clean gutters. Store tires in covered storage areas. Keep empty bottles upside down. Periodically clean drains, ditches and other drainage systems. Cover with screens any drain that has no opening and closing system Thoroughly wash pet drinking bowls with a brush. Remove accumulated water from air conditioning and refrigerator trays, and sanitize them whenever possible, as well as laundry areas - for instance, behind the washing machine, where standing water usually collects. Fill plant pot dishes with sand or clean these items every week. Remove water from plants and trees that collect water, such as bamboo and bromeliads, and also clean them periodically. Keep buckets upside down. Stretch well tarps used to cover objects. Keep pools clean. Store safely or discard any object that collect water: bottle caps, dry leaves, toys, etc.   Eliminate mosquito breeding sites    Wash the edges of containers that collect water with soap and a brush or sponge. Discard larvae found on earth or on dry ground - never on water. For large tanks and other reservoirs of water for human consumption, call a health worker for larvicide application. For containers where larvae were found for which waste or proper disposal is not possible, use products such as washing powder, liquid detergent, disinfectant and swimming pool chlorine, provided such water is not intended for human or animal consumption. Check these parts every week and contact a health worker. Protect yourself from bites Use Anvisa approved insect repellents, following the instructions and precautions featured on the product packaging. Use environmentally friendly insecticides and repellents, provided they are also approved by Anvisa, and also following instructions and recommendations. Learn the difference between dengue, chikungunya and Zika infectionThe viruses from these three infections are transmitted by A. aegypti and cause very similar symptoms, though different in frequency and intensity. For this reason, in the face of any symptoms, it is important to seek a doctor for a clinical evaluation and, if possible, have exams requested to identify the condition. This piece of information is always useful. Anyone who was previously infected by a dengue virus, confirmed by a laboratory, for example, is already aware that they may be infected three more times, and, in such case, the infection could be more severe, and therefore would require greater medical care. Although dengue fever is the infection to cause the highest number of fatalities among these three arboviruses, chikungunya can also have a bad outcome - 72 deaths have already been recorded in Brazil this year - and the main complication resulting from Zika infection is the possibility of microcephaly of fetuses if the mother is infected during pregnancy. Signs and Symptoms  Dengue Zika Chikungunya High fever for 4 to 7 days Absent or low-grade fever, for 1 to 2 days High fever for 2 to 3 days Skin rash In 30-50% of cases In most cases In 50% of cases Muscle pain Intense light/moderate Light  joint pain Light light/moderate moderate/intense Swollen joints Rare  Light moderate/intense Conjunctivitis  Rare  In 50-90% of cases In 30% of cases Itchy skin Light moderate/intense Light Headache Intense light/moderate light/moderate pain behind the eyes  Intense Absent  light/moderate Increased ganglia Light Intense moderate Hemorrhagic disorders Moderate  Absent Light 

2/5/2020
Prevention

The victory of life over the virus: it is possible to go through pregnancy despite being HIV positive

Few are the ways through which one can be infected by HIV virus and develop AIDS, which emerged as a lethal threat in the 1980s and today, thanks to advances in science, has gained the status of chronic disease. That is, it can be treated, but there is no cure for that, as is the case of diabetes, for instance. Transmission can occur through unprotected sex, perforation of skin or mucous membranes with sharp materials contaminated by virus, such as needles, blood transfusions and also contaminated blood products and by means of the so-called vertical transmission, from mother to baby, during pregnancy, through the placenta, during childbirth and breastfeeding.  The first two forms of transmission have well-known prevention strategies and rely heavily on self-care. In the other cases, however, those who are vulnerable have no choice, even though blood transfusions are currently much safer than in the 1980s and 1990s. In pregnancy, in turn, the baby depends exclusively on the mother's responsibility not to be infected, since a medical protocol now in place can minimize the risk of vertical transmission. The fact is that for HIV/AIDS treatment, already so successful, can also be done during pregnancy and, together with other preventive measures, reduces the possibility the child being infected to less than 1%. According to the Joint United Nations Program on HIV and AIDS (Unaids), 82% of pregnant women infected by the virus around the world had access, last year, to antiretroviral drugs, which suppress the amount of virus, or viral load, in the organism, to the point of making it undetectable in the blood.  In Latin America and the Caribbean alone, as a result of this protocol, between 2010 and 2017, nearly 31,000 babies were born without being infected by HIV. In Brazil, between 2007 and 2017, the number of cases of vertical HIV transmission was reduced by 42%, despite the fact that the number of infected pregnant women increased by 21.7% in that same period. How vertical transmission can be avoided There is no big secret. A HIV-positive pregnant woman needs to unrestrictedly adhere to antiretroviral therapy throughout her pregnancy, in order to make HIV undetectable in the circulation. This strategy prevents transmission during pregnancy and may even allow normal labor, although this option also depends on other clinical factors. It all depends on when the woman finds out she is HIV positive. Therefore, the sooner prenatal care begins, the higher the chances of decreasing the amount of virus circulating in the maternal body. At the time of labor or just before C-section, in any case, antiretroviral zidovudine (AZT) is intravenously administered to the mother and, shortly after birth, the same medication is also orally administered to the child - all that aiming at minimizing the possibility of contaminating the baby, who, after all, always ends up exposed to maternal blood at birth, even in the case of a C-section. If the woman did not receive HIV treatment during the prenatal care period, or if her viral load is equal to or greater than 1,000 copies/mL in the last gestational trimester, the preventive scheme for the newborn also includes another antiretroviral, neviparin. Regardless of the drugs used, this therapy will last between four and six weeks.  As the baby carries the mother's anti-HIV antibodies in the first months after birth, tests to indicate a possible contamination in the first months can only be on the viral load, and not the usual serological test, which will be positive at this moment. The determination of the amount of virus should be done two to three times between the first and the second month, or according to pediatric instructions. In case two results present detectable viruses, the child is considered infected and, until the age of 12 months, treatment begins, regardless of the virus load value and CD4 count. After 12 months, the decision to start antiretroviral therapy will depend on the clinical condition and on the result of these tests. The fact is that the postpartum period is equally decisive to complete the scheme aimed at combating vertical transmission. But not all families continue to be monitored. According to Unaids data, of the 1.1 million babies exposed to HIV last year in the 23 countries most affected by HIV/AIDS, only 63% were tested up to 2 months of age.  Regardless of an undetectable viral load, pediatric follow-up must continue because the definitive answer that the baby really has not been infected by the virus comes only after 18 months. If serology is positive after this period, the diagnosis HIV/AIDS is confirmed and antiretroviral therapy is also performed according to the patient's condition and the results of viral load and CD4 count, the defense cell that is the main target of HIV - the greater the amount, the less the immune system is compromise, thus reducing vulnerability to HIV/AIDS complications.   It is worth noting that, since HIV can also be transmitted through breastfeeding, breastfeeding is absolutely contraindicated for HIV positive mothers, even if the virus cannot be detected in the blood. In Brazil, since 1999, children born to HIV-positive mothers are entitled to receive sufficient milk formula to be fed at least up to 6 months of age. The woman, in turn, receives medication to inhibit lactation. Prenatal is everything in the fight against HIV in children To prevent vertical transmission, therefore, it is clear that the pregnant woman needs to be very well monitored throughout the nine months of pregnancy and, evidently, needs support and a lot of information when the baby is born, so she needs to keep going to the doctor’s.  To begin with, ideally, an HIV test should be done still during family planning, together with her partner. This way, if woman is HIV positive, she may try to get pregnant while her viral load is undetectable, and therefore, with the lowest possible risk for the baby.  As this does not frequently happen in reality, it is essential to start prenatal care as soon as possible. The HIV test is requested right at the first consultation and, if it is negative, it is repeated also in the last gestational trimester, so that the medical team can make sure they won’t need to provide special attention during delivery and after birth. If the test is positive at the beginning, the pregnant woman must receive the antiretroviral drugs indicated by the doctor and perform the quantification of viral load, given that the purpose of the treatment is to make the amount of virus undetectable in the blood, and the CD4 count. Tests to measure the functioning of the kidneys and liver, which need to be monitored, are also performed due to the use of these drugs. For all the rest, prenatal care is carried out exactly in the same way as for any pregnant woman. Becoming aware that you are HIV positive right at the beginning of pregnancy can, of course, be difficult news for any woman, but it is the most effective way to protect the baby from this virus, that is so devastating in childhood, and from other sexually transmitted agents, such as Treponema pallidum, which causes congenital syphilis, a very serious disease due to the sequelae that it can cause to the baby born to untreated mothers.  Give your baby your greatest proof of love before it's even conceived. Ask your gynecologist to plan your pregnancy and, above all, go through prenatal care, strictly following your obstetrician's instructions. Seeking to put an end on vertical transmission From 2008 to 2017, 1.6 million children stopped being infected globally thanks to antiretroviral therapy during pregnancy, childbirth and shortly after birth, according to Unaids. But there is a lot to be done. Last year alone, 160,000 children worldwide were diagnosed with HIV/AIDS. Ending the possibility of contamination by those who have no choice to defend themselves is the goal of the World Health Organization (WHO), which has been acknowledging the countries that eliminate this form of transmission. In practice, WHO grants a certification to nations that reduce rates of mother-to-child transmission to levels below 2% - or two cases of HIV in children per every 100 pregnant women infected. Cuba was the first country to receive the document, followed by Thailand, Armenia and Moldova. In Brazil, with its continental dimensions, for the time being only two municipalities with more than 100 thousand inhabitants - a condition for receiving such acknowledgment - have managed to achieve this objective: Curitiba and Umuarama, both in Paraná. It is a beginning. 

2/5/2020
Women's health

Still syphilis

  In the same way that AIDS scared the scientific community in the 1980s, by the speed with which it took people infected with the HIV virus to an almost complete deficiency of organic defenses, syphilis stunned doctors in the 16th century, when it spread at an impressive speed in all the social spheres of Europe at the time. It was the first known epidemic of a sexually transmitted infection. The medical literature at that time did not have any records about the disease, which started with a wound in the genital area, that would disappear spontaneously (primary phase), but that, in some months, would be followed by systemic manifestations, such as spots on the body, fever and malaise (secondary phase), which could also regress without any intervention. In a very variable time interval, after an asymptomatic period (latent phase), the condition often culminated in severe neurological and cardiac complications, as well as in lesions in the bones and skin (tertiary phase).  It did not take long for the disease to be associated with the sexual act, but initially the blame for the transmission was attributed only to illicit relationships. Soon it was also observed that infected mothers could deliver sick children, with consequences ranging from malformations, deafness and blindness to spontaneous abortion and death at birth. Those were difficult centuries for many people on the old continent - as well as the new one - since there was no effective treatment. And then, in the early 20th century, the cause of so much damage was discovered. It was the bacterium Treponema pallidum, in fact transmitted in any type of sexual intercourse, but also in blood transfusions, and vertically, from the mother to the baby, during pregnancy or at the moment of delivery, depending on the stage of the pregnant woman's illness. From then on, more effective therapeutic forms emerged, until the discovery of penicillin in 1943, which finally brought the cure for the disease. Current concern With this background, many people think that syphilis is a thing of the past. In fact, that is an honest mistake. The disease has never ceased to exist because, unlike some infectious diseases, an infected person can be cured of the infection and get it again when having unprotected sex. Today, 12 million people around the globe are infected, according to the World Health Organization (WHO). In Brazil, the last Epidemiological Bulletin of Syphilis issued by the Ministry of Health in December last year, with data of 2017, showed that we closed that year with 120 thousand cases of acquired syphilis, 24.6 thousand cases of the congenital form - of children who were born with the disease - and 49 thousand cases in pregnant women. It seems a little when compared to the global contingent, but what has been worrying health authorities is the significant increase in the number of cases. Taking into account only the acquired form, this number grew 29 times in seven years in Brazil, having gone from 2 cases per 100 thousand inhabitants, in 2010, when the infection started to be compulsorily notified, to 58.1 per 100 thousand in 2017. Lack of prevention According to experts, some factors can explain this outbreak. One of them and perhaps the most important one, is the fact that people have relaxed about protecting themselves against sexually transmitted infections. Current generations did not go through the AIDS epidemic, have not seen the successive deaths from complications of the disease, and have already been born under the umbrella of the cocktail of antiretroviral drugs to control the multiplication of the HIV virus. Thus, the use of condoms during sexual intercourse has been neglected, which makes room for syphilis and other sexually transmitted diseases. The most affected group - which helps to justify the growth of the infection in pregnant women and babies - is precisely that of young women, aged 20 to 29, according to the Ministry of Health. At the peak of fertility. Another factor that contributed to this scenario, especially in recent years, was the lack of the antibiotic of choice to fight syphilis, the injection of benzathine benzylpenicillin, between 2016 and 2017, in hospitals and health services. The WHO recognized this problem, which also affected 20 other countries, including the United States, and helped to increase the global number of cases (sic).  It is clear that the disease has spread and is also aggravated by the lack of information on transmission, symptoms and prevention. Many are unaware they are infected by the Treponema pallidum on account of the variation of symptoms in the different stages of the infection, which are interspersed with periods of improvement. Therefore, it is important to learn to recognize the manifestations of syphilis and, in the face of any suspicious evidence, even if doubtful, seek the guidance of a doctor or even seek a Basic Health Unit for a free and rapid test.  Rapid diagnosis In 30 minutes, the rapid screening test can safely remove non-infected people in the event of a negative result, but requires confirmation in positive cases with a different test, which takes longer to provide the result. With the diagnosis having been established, treatment is done with injections of benzathine benzylpenicillin, depending on the stage of the disease, and extended to the infected person's sexual partner, in addition to requiring laboratory follow-up until the tests are negative. The screening for pregnant women occurs in the prenatal period, with the search for syphilis in the three gestational quarters, in order to completely check a possible contamination. If the result of any of them is positive, the pregnant woman and sexual partner are immediately treated to avoid further infection, without waiting for confirmation with another test - given the risk for the fetus. If the infected pregnant woman does not receive adequate treatment for any reason, the baby, at birth, must undergo a number of tests and, with a confirmed diagnosis, must be hospitalized for ten days to receive antibiotics. Even congenital syphilis has the insidious character of the acquired one, since it can manifest by the age of 2. In such a context, the ideal thing to do is to plan the pregnancy ahead and, before any attempts, test for syphilis. The pregnancy should only proceed in case of a negative result, or, in case of a confirmed infection, after treatment and confirmation of the cure. As, in practice, this does not always happen, following prenatal care is the most effective option for the prevention of the congenital form. In order to avoid the acquired form, the rule is to use a male or female condom in any sexual relations, in addition to visiting a doctor periodically for a check-up. Get to know the stages of syphilis and its symptoms PrimaryIt occurs with a wound, usually unique, at the area of entry of the bacterium - any region of the genital tract, cervix, anus, mouth or even skin -, which appears between 10 and 90 days after infection. The wound does not hurt or sting, nor does it itch or oozes pus, and it disappears spontaneously. It can also cause enlarged lymph nodes in the groin.  SecondaryIt occurs between six weeks and six months after the wound heals, with spots on the body, including on the palms and soles, which do not itch. It may be accompanied by a nonspecific systemic condition, with fever, malaise, headache and enlarged lymph nodes. These symptoms can also regress without treatment. TertiaryIt may manifest over a long period of time after the onset of the infection, between 2 and 40 years after the primary stage, with severe manifestations in the heart, the central nervous system, on the skin and in the bones.  LatentIt has no symptoms, even though the bacteria remain in the body, and it is divided into recent latent syphilis, when it has occurred less than two years after the infection, and late latent syphilis, when it has occurred more than two years after the infection. It is interrupted by the onset of the tertiary phase.

2/5/2020
Men's health

Benign hyperplasia is one of the most common prostate problems

Exclusive to the male reproductive system, the prostate is a gland that makes sperm, the fluid that nourishes spermatozoa and that represents about 30% of the semen composition. It is located next to the urinary tract structures, that is, just below the bladder and around the urethra, which carries urine out of the body. Despite its tiny dimensions when compared to other organs - it weighs around 20 grams -, it can cause some discomfort as the years progress.  The prostate cells start to multiply at middle age, a phenomenon which is still not well explained by science, but it seems to stem from aging and a combination of hormonal, genetic and environmental factors. As a result, there is an abnormal enlargement of the gland in most men, which configures the so-called prostate hyperplasia, which, it is worth mentioning, has nothing to do with cancer or increases the risk of cancer. Hyperplasia is a benign lesion, restricted to the gland. In a malignant tumor, cells grow and invade other tissues. Due to the location of the prostate, however, its enlargement puts pressure on the bladder and tightens the urethra. Therefore, the condition can cause obstructive urinary symptoms or urinary storage symptoms - in practice, difficulty in urinating and needing to urinate more frequently. These manifestations may be well tolerated in the beginning, but, as time goes by, they greatly affect the quality of life of men and also increase the risk of urinary infections, severe obstructions, with significant urine retention, urinary stones and even renal insufficiency.  Diagnosing prostate hyperplasia  The diagnosis depends on a clinical examination - digital rectal examination - and a survey of the patient's family history so that the doctor can rule out other urinary problems and find out, for example, if there is use of medications that interfere with the functioning of the bladder, such as antiallergics and diuretics, in addition to excessive intake of liquids and caffeine, which stimulate diuresis. Some additional tests are needed, such as the blood dosage of prostate specific antigen, or PSA, a marker of changes in the gland, which rises slightly in these cases. In turn, a urine test and ultrasound of the urinary tract will help to rule out the possibility of exclusive disorders of the urinary tract. Lastly, there are specific diagnostic methods to measure the force of the urine stream and the emptying of the bladder, among other parameters that support the diagnosis, such as urodynamics and uroflowmetry. Many treatment options Once benign prostatic hyperplasia is detected, specialists tend to treat symptomatic patients only. Otherwise, periodic surveillance of prostate dimensions is maintained, with clinical examination and PSA dosage, at least. For cases ranging from mild to moderate, the problem can be treated with medications. There are now several categories of drugs used for this, which are selected according to the type of symptom presented by the patient, either alone or in combination with each other. According to the Brazilian Society of Urology, alpha-blockers are among the most used drugs, since they reduce urinary complaints over the first few weeks.  However, all classes of drugs have adverse effects that should be discussed between doctor and patient first of all. Furthermore, none of these medications will cure the condition. They are medications to be used on a continuous base, which means that, if their administration is interrupted for any reason, the symptoms will reappear. Patients with a more severe clinical condition or who do not respond to the medication should undergo surgery. Today, surgical treatment is done mainly through less invasive methods, such as endoscopic procedure, which uses a micro camera with a type of claw, that goes from the urethra to the prostate and opens a way for the flow of urine, or  laser intervention, similar in execution, but with less undesirable effects. Conventional surgery, with an abdominal incision, is reserved for a few cases. As in the case of drugs, patients must understand the advantages and disadvantages of surgical treatment. The fact is that no man needs to have his quality of life compromised due to an enlarged prostate. All the more reason to periodically visit a urologist at middle age and not to be caught off guard by the condition. Symptoms of enlarged prostate Storage: - Urgency to urinate; - Increased urination frequency, especially at night; - Urinary incontinence (escape); - Pain when urinating. Obstructive: - Difficulty starting urinating, even when you need to urinate; - Involuntary interruption of urination; - Weak flow of urine; - Feeling like you are not able to fully empty your bladder; - Dribbling after you have finished urinating.   Can you prevent it? As men are getting to live longer, prostate hyperplasia will likely happen some day in the future. However, experts believe that maintaining a healthy lifestyle over the years, with regular physical activity, weight control and intake of vegetables, fruits, fish and nuts, has some effect on preventing the condition. It is worth trying, even because these habits will also prevent many other diseases.

11/7/2019
Children

Children and dogs: the benefits of having the pet

What would be the best present for a child? Something that can entertain him for days on end, provide lessons in unforgettable affection, get him moving around, develop his sense of responsibility… and that also has a positive impact on his health. It is certainly not a new game on his smartphone, nor is it an interactive doll or an electronic skateboard. But what about a present that gets hungry, thirsty and sleepy, that is totally and utterly faithful and, what’s more, loves nothing better than a mess? According to the specialists in behavior, the contact that children have with pets -–not only dogs, it must be pointed out – contributes hugely to their social development, since it allows them to learn how to express affection and to deal with the rules of co-existence.   Even smaller children quickly notice that they should not interfere when their pet is eating and that they have to respect the animal when it is exhausted and needing to rest and does not want to play any longer.    There is also plenty of evidence of the benefit of this co-existence on the physical health of children.   Although there is an association between animals and childhood allergies, research proves that if children are exposed from early on to a pet, they will have less chance of developing not only allergic reactions to hairs but also to pollen, dust and other inhalable allergens.  A recent American study, published in an important Pediatric journal, the JAMA PEDIATRICS, noticed a 13% drop in asthma developing in children who live with dogs in the first year of their lives.  The presence of an animal at home also improves the immunity of the child’s organism, lowering the frequency of colds as well as headaches and gastric problems, according to the specialists.   The available studies show that contact with a pet increases the levels of immunoglobulin A, an antibody found in mucous that prevents viruses and bacteria from proliferating.   Another scientific study stated that ill children get better more quickly when they have contact with a dog or cat or the like.   It is not by chance that, currently, plenty of teams of volunteers all over the world visit pediatric hospitals accompanied by “therapeutic dogs", and the results are excellent. Dogs at home: the responsibilities It all seems to make a lot of sense, but, thinking also of the animal’s well-being, some practical considerations must be made.   Animals live for around 13 to 18 years, and during this time demand a lot of attention from the owners.   They have to have periodic injections, be de-wormed and vaccinated -–for the safety of the children -, have food and fresh water readily available, go out for walks regularly and stay in a safe place when the family is away. For a child to grow up happily with this companion, the parents must ask themselves, first and foremost, if they are up to taking on so much care. However willing they are to share some of the responsibilities with their children – like changing the water, feeding and brushing the pets, etc., it is the adults who end up with most of the duties. Think about these practical questions and talk with the pediatrician about them.

11/7/2019
Women's health

To beat breast cancer

Early detection is a strategy in medicine that allows the identification of a particular health problem at a time when there are still no symptoms. The screening of breast cancer with periodic mammography has precisely this objective, that is, to detect the tumor in its initial stage, when it is still a few millimeters small and is palpable neither to the patient nor to the doctor. Although receiving a diagnosis of cancer is still hard news, breast cancer, when diagnosed early, has a more than 90% chance of cure. The treatment tends to be more conservative, which means removal of only one part of the breast, the so-called quadrantectomy, combined with the use of radiation therapy and hormonal blockade. In addition, breast reconstruction is possible. Don’t leave it for later Despite the advances, the mortality rate for the disease remains high. Brazil recorded 15,403 deaths from breast cancer in 2015, according to the National Cancer Institute. It happens that, in the great majority of fatal cases, the diagnosis is late. Due to lack of access to medical services, ignorance, neglect of their own health or even fear of what can be found, many women discover the disease at a time when it is more evident and therefore more advanced. At this stage, not only is the treatment more radical, with more invasive surgery and chemotherapy, but there is also more chance that the cancer cells migrate to other organs. Breast Cancer Awareness Month just proposes awareness raising so that women never postpone this periodic commitment to their health. To get more information, seek your doctor and have the periodic examinations indicated, so that if you have to face breast cancer, you can do so at an advantage. Go to your gynecologist or mastologist and make an appointment for your screening exams as soon as possible.

11/7/2019
Food

Health risks from obesity

In the Renaissance, obesity was synonymous with wealth. Those who were fat had access to good food and did not need to work. In the 18th century, however, the idea that fat was not just corpulence, but a disorder, began to gain ground. In the following century, the condition came to be considered morbid and associated with health problems. More than 200 years later, this link has become stronger and is really concerning due to the obesity epidemic that has been established all over the world. In Brazil alone, 18.9% of the population is obese and 54% of people are overweight, according to the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), published by the Ministry of Health in May 2018. The concern is justified because, among other damages, being overweight leads the person to become intolerant to insulin, the hormone responsible for putting glucose into the cells. Without treatment, this intolerance turns into type 2 diabetes, which, by damaging the blood vessels, fosters the occurrence of cardiovascular problems. In parallel, obesity is associated with elevated cholesterol and triglycerides in the circulation, which predisposes the formation of fat plaques in the arteries, increases the risk of a stroke, and also causes hypertension, which also damages the circulatory system. All this creates a real time bomb in the body. More recently, it has been alleged that the condition helps on the onset of cancer. According to the World Health Organization (WHO), 13 types of malignant tumors are related to excess body fat, among the most frequent ones in the world population, such as breast cancer, bowel cancer and stomach cancer. Anti-obesity strategies Of course, encouraging physical activity and healthy eating, with more wholegrain food and fruits, needs to be a constant flag, but a piece of information from Vigitel data calls our attention. According to research, obesity has a higher prevalence among young people aged 18 to 24 years, a group in which it increased by an important 110% between 2007 and 2017. It turns out that children are growing up obese and taking this condition into adult life. Data from WHO accounted for 124 million obese people globally in 2016 and another 213 million overweight ones in the 5 to 19 age group. Prevention, therefore, should come from the cradle - literally. Studies indicate that the longer a child is breastfed, the lower the chance of the child gaining too much weight in the pre-school phase. Similarly, researchers point out that the broad access to fruits and vegetables in one’s childhood is related to a healthier body construction, with less fat and more lean mass, i.e., muscles and bones. At the other end, frequent consumption of sugary drinks and juice in early childhood contributes heavily to obesity, according to numerous cases of scientific evidence. Even natural fruit juice is to blame and should be released, very sparingly, only after the age of 1 and should be limited even among teenagers – and what to say about soft drinks. Instead of fruit juice, experts recommend the fruit itself. Here are more tips on how to fight childhood obesity. Being happy with your weight - Pay attention to your child’s signs of hunger and satiety so as not to feed them excessively, especially in the early years. - Do not use food as a reward (for example, eating chocolate) or punishment (eating broccoli). This can lead to eating disorders in adult life. - Serve meals at regular times and keep in the habit of eating with your family. - Serve colorful and varied dishes to offer the little ones all the food groups. -  Take your children to the food market to get to know and taste new fruits and vegetables. - Turn off (TV, tablet and cell phone) screens during meals so that your children pay attention to their food. - Prepare snacks with the least amount of industrialized items (prepare them with homemade cake and biscuits, vegetables and fruits, healthy sandwiches). - Limit video game play time and put kids to play outside and exercise. Pediatrician associations recommend one hour of physical activity a day. - Lastly, watch for the sleep of the little ones. Studies show that not enough sleep can lead to obesity. Finding out if your weight is adequateThe parameters indicated to evaluate the nutritional status of people between 20 and 59 include the body mass index (BMI) and waist circumference. The result of the BMI calculation should be analyzed according to the classification below, as defined by the World Health Organization. For children and adolescents, the evaluation involves other parameters besides BMI. In this case, talk to your pediatrician. BMI Rating BMI Rating < 18,5 Low weight ≥ 18,5 and < 25 Adequate weight ≥ 25 and < 30 Overweight ≥ 30 Obesity

11/7/2019
Prevention

There is light at the end of the tunnel

In contemporary history, various icons from the music, literature, and entertainment industry made the headlines not only because of their work but also because they decided to cut their lives short. They were often at the height of their careers and left the scene, without explanation, with no clue that they would give up. However, these people often had a history of disorders such as depression and chemical dependence in common, even though they might have been abstinent from drugs at the time they took their own lives. Although suicide is considered a public health problem - in Brazil there are 32 deaths of this nature per day, according to the Ministry of Health – there is no better way to prevent them than to speak openly about mental health and show safe help routes for the people who are losing the will to live and for their close friends and relatives. Experts estimate that nine out of ten cases can be prevented. Warning signs First, watch for warning signs. Warning phrases such as ‘I want to disappear’, ‘I’m leaving’ or ‘I can’t take this anymore’ should be given the right importance. Especially in adolescents, among whom the number of cases has been increasing considerably in recent years, although the elderly are the ones at the most risk. Radical changes in behavior, such as not liking something for which there was great interest before, also call for attention. At the other end, a sudden improvement may indicate only simulation and hide a decision already made. Lastly, previous attempts increase the risk. Whoever has tried once is in a more vulnerable position. If you notice any of these behaviors, it is important that the person at risk is not left alone; they need to be listened to and taken to a psychiatrist for evaluation. The Centro de Valorização da Vida (Life Appreciation Center) - CVV, a free Brazilian helpline helping people through the number 188, is also an immediate channel for those who urgently need a friendly shoulder to lie on. Trained to listen, above all, the volunteers of the service are able to offer what is most needed at this time: emotional support and hope. How to help Another important point, within or outside this context, is to talk to the population about the mental problems and dangers of drugs and alcohol in a conflicting mind, especially if that mind is still under development, such as that of a teenager. Depression, the most frequent disorder behind such cases, is a disease and requires multidisciplinary treatment, which can combine medication, psychotherapy, physical activity, and alternative therapies. This is equally true for chemical addiction. Lastly, experts do not recommend leaving anything that is lethal close by, e.g. poisons, pesticides and stockpiles of drugs, or cold or fire weapons.  Better not to make things easy for them. This also applies to home safety strategies, such as keeping bars on windows, and in public areas. You can’t take a person in such conditions to an outdoor location that might pose a risk to them. Such measures help to hinder any attempts and also help the individual to rethink their decision. It is worth remembering that, despite the fact that suicide may have many different causes, it is an impulsive reaction. The next day, almost everything looks simpler. Seek a professional in this area to talk about life.

11/6/2019
Well being

Stress: although you cannot live without it, you can reduce its effects.

The tension caused by a particular situation causes the body to release various substances to face or escape danger, including adrenaline and cortisol, two hormones that may trigger a number of biochemical reactions: accelerated heartbeat, increased blood pressure and increased concentration of energy in the muscles, among others - this is stress. Stress is an organic response well-known to Brazilians, seeing that our country is ranked second among the world's most stressed nations, according to Brazil's International Stress Management Association (Isma-BR). If once this natural reaction would ensure the survival of mankind in face very threatening conditions, today, the constant tension, day after day, may become detrimental to the organism. (link to Your body speaks), for it is no longer possible to vent this state of alert when it comes. Stressing factors are everywhere, especially due to the setbacks we often must deal with, such as divorce, dismissal, death of beloved ones, urban violence and diseases, as well as good events that require adapting our lives to them: pregnancy, birth of a child, marriage and new job. The work, by the way, is the factor that causes the most stress according to a survey by Isma-BR. The demand for results, excessive demands, long-working hours, downsizing and the fear of unemployment, among other aspects, causes the body to see the professional daily life as a true Greco-Roman gladiator arena. To top all that, personal characteristics help make everything tense, such as perfectionism and a desire to do everything at the same time. We also need to pay attention to smaller, but no less important triggers for a body that wakes up ready to face lions, including traffic, queues and bureaucracy stand out; to name a few. What can we do to reduce stress? However, some are stressful situations that can be circumvented with small practical changes and a dose of planning. It is worth trying, for example, to leave half an hour early to escape the traffic, as well as preparing everything that will be worn in the morning, such as clothing, uniform, snack or lunch box, before bed time, thus gaining as much time as possible at the you are in a hurry. If traffic fails to flow, you can always try a Plan B to turn the difficulty into an opportunity - review the test with kids on the way to school or invent a fun game, learn a new foreign language on the way home, listen to interviews. interesting personalities on the way and other different options to take advantage of the hours lost in traffic. Just be careful not to start working on your phone, which will only increase stress. Nonetheless, such prevention, only applies to small stressing factors over which people have control. As for others, we need to learn how to manage them and change the way we face them, in addition to including new habits and activities in our routine to neutralize the effects of biochemical reactions by increasing the body's resistance to them. Only in this way can one prevent chronic stress from developing into anxiety and depression or from contributing to increase the risk of developing other diseases, such as infections and cardiovascular diseases. If you are feeling very worn out, seek medical or psychological help and try to put experts’ suggestions into practice in order to relieve stress. (link to box Tips for de-stressing) The body talks and complains about stressPay attention for it will signal that everyday tension is bad for the body organs and systems: In the cardiovascular system: increased heartbeat, high blood pressure; In the brain: headache, irritability, insomnia or excessive sleep, mood swings, problems with attention, memory and concentration; On the skin: acne, thinning hair, other skin diseases; In the airways: shortness of breath, difficulty to breathe; In the stomach: poor digestion, heartburn, gastritis; In the locomotor system: pain, muscle tension, tingling limbs; In behavior: emotional distress, apathy, decreased libido, altered appetite, loss of interest in things. Tips for De-stressing Every day, set aside a part of the day for an activity you enjoy, even is for a few minutes. You deserve this reward. - Exercise regularly. In addition to all the benefits to the cardiovascular system, which suffers greatly from the effects of stress, this habit is critical and helps producing mood-enhancing neurohormones and well-being. Maintain a healthy diet to help shield your immune system and do not skip meals, especially lunch, often overlooked in the name of multiple tasks and meetings. Also remember to eat calmly to maintain your gastric health. “By the way, use part of your lunch break to rest from your routine for a few minutes, even if you can't get out of your work environment. - When you're done, resist the temptation of checking your emails, WhatsApp group messages, and the business phone. Otherwise, professional demands will not end and will invade your moments of rest and leisure. - Avoid the consumption of stimulants such as coffee, energy drinks, cigarettes and alcohol. - Try doing some different activity that provides relaxation and well-being, such as meditating, painting, coloring, cooking, singing, playing an instrument and gardening, among others, of your choice. - Sleep well. Turn off the lights in your bedroom, turn off electronics, and engage in mind and body rest. - Surround yourself with good relationships and do not give up using some of your time to be with family and friends. - Engage in volunteering. Helping people or joining a cause are initiatives that move the brain's rewarding system, creating good feelings. - Try therapy. External stressing factors lose strength as you get to know yourself better.  

11/6/2019
Women's health

Osteoporosis: causes, symptoms, prevention

Answer quickly: Have you ever thought about your bone health? You should have. Osteoporosis, a clinical condition that makes the skeleton fragile and prone to disabling fractures, affects 200 million people around the world, according to the World Health Organization, 10 million in Brazil alone. As part of the natural aging process, in a world where life expectancy has been increasing globally, more and more people tend to be affected by such condition. Females are mostly affected in their middle age, due to the sudden fall of estrogen, which stimulates calcium fixation in the bones. According to experts, in the five years following menopause, women experience bone loss of 3% every year. Men also undergo this process, but at a much slower pace. By the age of 65, male bone mass drop is estimated at 0.5% a year. By the age of 70, the annual loss is 1% for both sexes. Secondary osteoporosis can also be caused by the chronic use of certain drugs, such as corticosteroids and anticonvulsants, due to various other diseases, by endocrine disorders (diabetes, thyroid dysfunction),  rheumatic conditions (rheumatoid arthritis, systemic lupus erythematosus), hematologic diseases (leukemias, lymphomas), and also by smoking and alcoholism. How does bone loss occur? Whatever the trigger is, bone loss comes from the imbalance between the work of bone cells - osteoclasts and osteoblasts - that participate in our periodic skeletal renewal throughout adulthood. Until the age of 20, the process of bone formation predominates in people, and for most part, it depends on genetics and, to a lesser extent, on physical activity, nutrition and the level of development during puberty. After adolescence, the bone remodeling process prevails, in which osteoclasts remove old bone tissue, opening cavities, and reabsorb the minerals, while osteoblasts fill these spaces with new bone. All of this occurs under hormonal stimulation - including vitamin D, essential for calcium absorption - as well as mechanical stimulation generated by exercise. From middle age, or even earlier, in the case of secondary osteoporosis, such symmetrical work begins to become uncoordinated. The osteoclasts, which degrade the bones, work faster than the osteoblasts, which replenish this tissue. Bone degeneration, however, does not affect everyone in the same way. Those who consumed enough calcium in their youth manage to build up a good reserve (link to box Prevention begins in childhood) and manage to overcome the new bone production deficit. However, those who did not save much of the mineral suffer more the consequences in old age. Fractures as Symptoms The first stage of this degeneration is osteopenia, which, without any intervention, quietly evolves into osteoporosis until a fracture occurs spontaneously as a consequence of a simple effort to cough, for example, or due to minor trauma, usually a fall. Vertebrae injuries are the most common in people with the disease. They can cause chronic pain and deformity, and limit movement and even interfere with our breathing capacity. Another characteristic fracture is that of the femur, which represents the most severe face of osteoporosis, as it requires hospitalization for surgical treatment of the lesion and prolonged immobilization, with the risk of major complications, such as thrombosis, pulmonary embolism and pneumonia, which increase the mortality rate from the disease - not to mention dependence on others for any daily activity and loss of productivity. A recent study, published in March 2019 in the Journal of Medical Economics, revealed that the cost of osteoporosis worldwide due to hospitalization arising from osteoporotic fractures amounts to BRL 19.8 billion per year, more than that of myocardial infarction (BRL 16.7 billion) and stroke (BRL 11.7 billion). Brazil alone spends BRL 1.2 million on the disease, between health and social security costs. Hot to diagnose before a fracture Given this scenario, osteoporosis may be considered a further threat in middle age for women,  and at old age, and needs to be adequately investigated before a fracture occurs. To investigate it, doctors use bone densitometry, a test that measures the femur and spine density and compares the results with those of the average bone mass of a young, same-sex population. The test is universally indicated for women as of the age of 65 and for men as of the age of 70, according to the International Society for Clinical Densitometry, and its frequency varies from person to person. Below this age, it should be performed when there are risk factors, especially previous osteoporotic fracture, a disease associated with decreased bone mass and low weight. Once the initial loss of bone mass is confirmed, the first step is to adjust the diet to the correct intake of calcium and vitamin D or to use supplements of these nutrients. If, however, osteoporosis is already in progress, the basic substrate for bone formation is not enough, and there is a need for specific drugs to prevent degeneration and stimulate bone formation, such as bisphosphonates, calcitonin and biological drugs, made by means of biotechnology. But nobody needs to get to that point. Going to a doctor regularly is essential to also assess bone health and, in parallel, follow the example of children - heavily investing in exercising, eating calcium-rich foods and keeping vitamin D at adequate levels in the body. (link to box Prevention begins in childhood) This is also a guarantee of independence and life quality at old age. Prevention begins in childhoodEven though this is a disease related to middle and old age, osteoporosis should begin to be prevented even in childhood, with the formation of a good bone reserve, which is only possible by keeping dairy, the main source of calcium, in the diet of children and adolescents. Especially from age 14 to 18, the family should ensure that younger kids get 1,300 mg of calcium a day - almost the same intake recommended for postmenopausal women and 1,200 mg, for men over 70 - , the equivalent of five dairy portions, such as a 200-ml glass of milk, a 200-g yogurt pot, or a 50-g slice of white cheese. Another important strategy is the regular practice of physical activity given that, like muscles, the skeleton is strengthened by exercises, especially impact exercises such as running, volleyball, basketball, handball and various other sports where the feet are at some point off the ground. As a complement, experts recommend 20 minutes of daily sun exposure, without protector, at times of lower concentration of ultraviolet rays, i.e. before 10 am and after 4 pm. It turns out that when the sun rays touch the skin, even if not the entire body but only our bare arms and legs, the body produces the vitamin D needed for a day. Through food diet alone, this goal is almost impossible to reach, as few items contain such nutrient. One more reason to leave home and exercise with your kids outdoors, in the park or on a court.

11/6/2019
Children

Technology and children: Less screens, more playtime

Technology brings with it all kinds of advantages:  it gets people together, saves time, etc.....There is a long list of the benefits.  When educating children and adolescents, if well used, it can contribute positively in many ways, as witnessed by educators.  In this group, however the problems lie in lack of supervision and, of course, in using screens far too much.   Who hasn’t already come across a baby who will only eat if he is interacting with a tablet, or a child who only knows how to play if there is a gadget involved, or with a teenager who only has virtual friends?  The fact is that specialists are worried about the impacts that using technology too much has on the mental and social development of children and young people, as, according to the Brazilian Pediatric Society (SBP), too many hours of screen time in this age group increases anxiety, stimulates eating disorders, hinders sleep, lowers school performance and exposes children and teenagers to cyberbullying, sexualization too young and even to getting involved with drugs, among other risk situations.  Therefore, the medical associations, whose purpose is to preserve child health, have been issuing consensuses in this respect.  The SBP itself brought out a publication two years ago for orienting parents, educators and pediatricians about the dangers that too much exposure causes and suggesting what is known as an acceptable media diet.    According to this recommendation, it is ideal for children of up to 2 years of age to have very little or no passive contact at all with screens, not even TV, above all during meals or at bedtime.  This is because, during this phase, children need stimulation that requires the use of all their motor abilities, all five senses, and, most of all, interaction with things and people.  Learning through screens is a solitary and repetitive exercise which, even if it can be of any use later on, does not bring any benefits to this age group. So long as the parents are not glued to their cell phones, it is easy to follow this diet – if not, the children undoubtedly want to copy them.    Then, from 2 to 5 years old, specialists recommend that children spend only one hour a day exposed to screens.  Later on, the time spent can be negotiated, depending on the psychological and cerebral development of each child, but with various safeguards.  Up to the age of 6, for example, keeping children away from violent games and films is highly recommended, since they still cannot clearly distinguish between reality and fantasy.  In fact, games that are full of deaths, accidents and shootings are not advisable at any age.    Another important thing to be careful about before the age of 10 is not putting a TV or computer in children’s bedroom, as this privacy will enable them to access inappropriate content and suffer the consequent risks, such as action by pedophiles, contact with drugs, thoughts about self-harm and games of risk.  Keep an eye on the contents During these early years, not only must the time spent be limited, but supervision must also be permanent, even with content that is suitable for each age group.  Specialists suggest that children should not even have their own devices until the age of 12 but should use their parents’.  This also helps them understand that, just like all the other important areas in their lives, technology is also under the command of the adults.  In the case of teenagers, even with those who have their own gadgets to hand, parents should continue to supervise the content and take part in whatever their children are doing on the networks, so that they can prevent problems and point out risks (see in box/link on safety). Screen hours have to be negotiated and limited in the same way, always alternating with other activities, like sports, outings and time spent in contact with nature.  This is also important because there is a relationship between too much technology and leading a sedentary life, which is a risk factor for cardiovascular diseases in the future.  Yet one more reason for keeping your child away from sitting in front of a screen.    Should you need further reasons, take these guidelines to your pediatrician.  How to protect children from virtual dangers    Warn your children not to give out either virtual passwords, whether to known or unknown people, or any personal data or that of the family.  Establish rules regarding online games and online chats.  If you allow this kind of interaction, make sure you are nearby and show that you are present to whomever is chatting with your children.  Check the indicating classifications on the contents and allow only those that are suitable for the age group.    Teach your children not to post or pass on any messages that, in some way or other, may sound offensive, show prejudice or be threatening, violent or undermining.    Teach your children not to be intimidated by virtual threats or to be taken in by any kind of blackmail from school mates or acquaintances.  Be ready to come into the circuit in these situations and, if needed, involve the law. Set an example by disconnecting whenever you are in the family nucleus, and also avoid exposing too much of your private life on social networks.     

11/6/2019
Women's health

Cervical cancer: attention to prevention

The Breast Cancer Awareness Month campaign was created to raise awareness among women on the importance of breast cancer screening, but we would like to take the opportunity to extend this campaign to prevent other very recurring diseases among the female population, such as cervical cancer, the third most common cancer to affect women, according to the National Cancer Institute. Predominantly, cervical cancer is associated with the sexually transmitted human papillomavirus, HPV. Genital infection caused by this virus is very frequent among the population in general and may even regress spontaneously. However, depending on each person's immunity, combined with other risk factors (see box), HPV can cause cell changes in uterine tissue at risk of developing cancer. This transformation, however, usually takes a few years. For this reason, women are recommended to undergo a cytology-based screening, also known as Pap Test or Pap Smear, after the onset of sexual life, which can early detect these cancer precursor lesions early and, thus, allowing them to be treated and preventing their progression. In general, the periodicity of the evaluation is annual, as is the case of screening for breast tumors, but each woman can receive bespoke guidelines. Currently, girls are still recommended be immunized against HPV before the onset of sexual activity, from 9 to 14 years old, and boys, from 11 to 14 years old. The tetravalent vaccine protects against the most frequent subtypes of the virus, two of them associated with genital warts, which can also affect men, and two related to no less than 70% of cases of cervical cancer. Due to immunization, chances are that future generations of women will be less affected by cervical cancer, but for the time being, this strategy does not replace other prevention measures, which, in addition to the Pap Test, require the neutralization and/or risk reduction, as well as using condom in all sexual relations. Although condoms provide only partial protection against HPV, one should also remember that it prevents the contamination by other agents of sexually transmitted diseases. Seek your gynecologist this month and make sure your health is on track!   Learn about the risk factors associated with cervical cancer - HPV infection - Multiple sexual partners - Early onset of sexual activity - Smoking - Prolonged use of contraceptive pill - Decline in immunity (due to illness or treatment)

11/5/2019
Well being

Overcoming depression

An epidemic of depression has spread around the world. According to the World Health Organization (WHO), this disorder affects 4.4% of the global population, which today totals around 340 million people, and it is the fourth leading cause of disability in any social class. Although it most often occurs in areas where winter is very harsh - due to social isolation and lack of sunlight, such as Finland - Brazil, a typically tropical country, holds the title of the nation with the most cases of depression in Latin America, with almost 6% of the population suffering from this disorder, or 12.6 million Brazilians, according to current figures from the Brazilian Institute of Geography and Statistics. Unlike sadness, which is part of human nature, has known reasons and ceases in the short term, depression is a chronic psychiatric disorder, associated with a strong genetic predisposition and is caused by a biochemical imbalance in the brain, which reduces the production of humor and well-being related neurotransmitters, such as serotonin, noradrenaline and dopamine, among others. These substances transmit impulses among the brain cells, and form various neural pathways that result in cognition, interest, and will. So you can understand why the lower supply of these neurotransmitters leads to a picture of deep unhappiness, general disinterest and lack of vitality (link to How depression manifests itself), often for no reason, although there may be some triggers, as we will see below. In addition, the condition increases an individual’s vulnerability to physical illness, as it undermines their natural defenses and favors the inflammatory state of the body. This explains, for example, its relationship with cardiovascular diseases, chronic pain and recurrent infections. Why is the world depressed? According to experts, several reasons may justify these figures. As first, it is worth noting that depression has been diagnosed more frequently. This disorder has always existed, it is true, but not only were few health professionals able to detect it, but patients, for lack of information, kept their symptoms and signs secret, fearing misinterpretation. Another factor that strongly contributes to increase its incidence is stress (link to the story on stress), which today affects most people around the globe, exposed to strenuous work, urban violence, fear of unemployment, traffic, endless lines, weather conditions, etc. This daily tension disturbs our mental health as much as smoking is bad for the heart and brain arteries, and causes lung damage. Such uncontrolled tension eventually culminates in mood disorders, including depression. Consumption of alcohol, illicit drugs and even certain medicines can also lead to the development of this condition, which has been increasing worldwide, especially among younger people. Some health conditions still favor this condition, such as hypothyroidism and other hormonal dysfunctions, obesity, heart diseases, neurodegenerative diseases, cancer, physical and psychological trauma, chronic migraine, among others. Lastly, natural facts of daily life may trigger depressive conditions, especially for those who already have a family history of mood swings, such as divorce, dismissal and loss of a loved one, as well as certain behaviors, such as the excessive use of social networking - the depressed, more often than any other, feel that everyone else has a better life than their own, which includes travels, fun, and perfect friends and relationships. Depression treatment through therapy and drugs It is important to note that depression is not a self-limiting disease that can be sorted out by itself - as opposed to a state of mind such as anger, disappointment and sadness. It can last from months to years and requires constant treatment and attention. If people can live with mild depression, living each day at a time, more severe depression can be paralyzing and have a bad outcome, which includes suicidal behavior. The fact is that one cannot neglect the condition or classify it as a character flaw or even consider it as normal behavior based on one’s age, notably among young and old people, who tend to isolate themselves. Medical help should be sought when early signs and symptoms become apparent, preferably help from a psychiatrist, and all their therapeutic recommendations should be strictly followed. After all, anyone who has had a first crisis, according to experts, has a 50% chance of going through a second one and this percentage increases as the episodes recur. Treatment usually combines psychotherapy and medications. In milder cases, it may be restricted to the psychological approach. Antidepressants, however, are critical in moderate to severe conditions, with the aim of getting the person out of the crisis. However, drugs do not work quickly, taking from two to four weeks to start showing some result, and often cause some side effects. Therefore, in the beginning, patients require very frequent medical and psychological attention to start their medications and psychotherapeutic sessions. Physical activity is highly recommended at any degree of depression, as exercise makes the body release endorphins and other substances related to one’s well-being. Finally, the support and welcoming of family and friends is of particular importance in this context. Family members should get informed about the disease, pay attention to the patient's complaints and participate in their treatment, trying to understand that they are facing a chronic health condition like any other - which is demanding and can present its ups and downs. At the same time, they need to serve as a reference to help the patient maintain certain standards, such as eating at the right times and healthily, taking care of their personal hygiene and interacting with others in the household. Being melancholic all the time is not normal. If you are losing interest in things, seek psychiatric advice or ask for help from a doctor you trust and from your family members. It is worth insisting: depression is a disease and it can be treated. Depression symptoms- Anguish - Anxiety - Low self-esteem - Exaggerated tiredness - Compulsive behaviors - Difficulty concentrating - Chronic pain - Weakness - Unintentional weight gain or loss - Irritability - Suicidal thoughts - Loss or reduction of interest and pleasure in life - Pessimism - Sexual problems - Feeling unable to perform daily activities - Excessive sleep or insomnia Can you prevent depression?Some precautions can help prevent the onset of the biochemical imbalance that characterizes depression: - Do activities that free the mind from distress and harmful thoughts, such as hobbies: reading, courses, painting, gardening, music, singing, etc. - Control stress. Manage those factors you can handle, such as avoiding peak hours in traffic, malls, public offices, etc., and learn how to deal with those over which you have no control. Do physical activities regularly as they help your body produce chemical properties that are essential for maintaining your mood. Not to mention that they help you keep fit, which improves your self-esteem. - Keep a healthy diet based on Mediterranean foods such as olive oil, nuts, fish, fruits and vegetables, which are rich in fats and antioxidants that are very good for the health of your neurons. Avoid alcohol and drugs as they are devastating to the brain and can cause depressive states.

11/5/2019
Well being

Living organ and tissue donation: how to help those who need bone marrow

Among the organs and tissues that can be donated by a living donor is the bone marrow, found inside the bones, which contains the haematopoietic stem cells, or progenitor cells, responsible for producing the elements that make up the blood - leukocytes, which defend the body, red blood cells, which carry oxygen throughout the body, and platelets, which act on blood clotting. Bone marrow transplant is often the only hope of cure for patients with hematologic diseases such as sickle cell disease and the leukemias. The first alternative, when seeking a donor, is to search the individual's own family, which has a 25% probability of success, especially between siblings, as there must be full genetic compatibility between donor and recipient. When the possibilities are exhausted, one turns to the unrelated, when the chance of finding a compatible person is only 1 in 100 thousand. This is why it is so important to have a large number of individuals among whom a donor can be found. Since 1993, Brazil has maintained the National Registry of Volunteer Bone Marrow Donors, the Redome, a registry coordinated by the National Cancer Institute that today has more than 4.6 million registered volunteers, according to the Ministry of Health, second only to the United States and Germany. Patients in need are not restricted to donors in their state, but can enjoy the global search throughout the national territory, as well as in international banks, since Brazil also has a partnership with a worldwide network, the Worldwide Network For Blood & Marrow Transplantation. Despite this good performance, Redome is always looking for new volunteers to increase the chances of those who can no longer afford to wait long. To register as a donor, you must be between 18 and 55 years old and in good health without any infectious diseases, haematological diseases or those from the immune system, as well as cancer and disabling illnesses. When these criteria are met, simply go to the nearest blood center, fill out an identification form and have your blood tested for histocompatibility, also called HLA typing, which provides the volunteer’s genetic characteristics. From the moment this data enters the system, the donor's genetic information is cross-referenced with that of all recipients awaiting transplantation. Once the compatible volunteer is found, he or she is immediately contacted to confirm their interest in donating their bone marrow and called upon to retest and undergo an assessment of their health. If all is well, the doctors then decide the best way to perform the procedure, taking into account the needs of the recipient and the characteristics of the donor. How is the donation made? The collection of marrow progenitor cells can be performed by four to eight needle punctures in the pelvic bones under general or epidural anesthesia in the operating room. Although this is a rapid intervention of about 90 minutes, the donor remains in hospital for 24 hours. Another form is the apheresis donation, in which the volunteer takes medication for five days to increase the number of stem cells in the circulation. On the day of the procedure, which lasts about four hours, a machine collects the blood, separates these cells and returns the other blood elements to the donor, using only venous access, without sedation or hospitalization. Whatever the case may be, the donor marrow fully recomposes in about 15 days and they can donate part of their progenitor cells again if another compatible receptor comes up in the future. The risks of donation in the operating room are few, related to the use of anesthesia. Volunteers may also feel some discomfort at the extraction point, which ceases with painkillers, and are advised to resume normal activities only after one week. Apheresis donation can only cause body pain during the period of use of the drug, similar to that caused by the flu, but releases the person for their assignments as early as the next day. For the patients, the transplant is simpler than any other, much like a blood transfusion, and takes only two hours. The injected cells circulate in their body and lodge in the bone marrow, where it is expected that some time later they will start producing red blood cells, white blood cells and platelets normally and in sufficient quantity. Until the new marrow is accepted by the body, the patients remain hospitalized and isolated because, at that time, they are susceptible to infections and bleeding, among other complications. Update your data After registering with Redome, months and even years may pass without anything happening, given the small chance of finding a matching donor among unrelated ones. For this reason, it is essential for volunteers to update the registration when changing their cellphone number or jobs, or when moving home. According to experts, a third of bone marrow transplants cease to occur due to lack of data update. Nothing sadder for the patient and family, including the medical staff, to know that there is a compatible person somewhere and not being able to locate them. Anyone who becomes a voluntary bone marrow donor should therefore always be accessible. When you least expect it, your phone can ring announcing the invitation to save a life. To learn more, please visit: http://redome.inca.gov.br/

11/5/2019
Well being

Those who donate organs, promote life

In 2012, Jemima, a British girl, was helping to prepare her mother's birthday party when she suddenly passed out. Taken to Bristol Hospital in England, she was diagnosed with a brain aneurysm and died four days later. As she was healthy before the event, several of her organs could be donated. And so it was done. Her parents authorized the procedures, and thus her heart, pancreas, lungs, kidneys, small intestine, and liver, divided into two parts, changed the fate of eight people - a record -, five of whom were children. Today, Jemima's family heads the NGO The Jemima Layzell Trust, which is dedicated to encouraging organ donation, among other causes. Organ donation of the deceased still represents a controversial issue, so much so that the Brazilian rate of refusal remains at around 40% for years, according to the Brazilian Association of Organ Transplants (ABTO). It is understandable, as the situation always involves a family going through a moment of suffering. Jemima's own mother admitted to the UK press that she hesitated a lot before making a decision, but was eventually motivated by a report showing the difficulty and low life expectancy of children who needed a heart transplant. In Brazil, to be a donor, you just need to notify your family members, and there is no need to leave any written documents. This is why it is so important to talk about it naturally and to express this wish so as to make it easier for your loved ones to decide at such a painful time, even because the donation depends on their permission. Not all countries, however, follow the same legislation. The Netherlands, for example, has recently passed a law that makes all citizens automatically donors unless they register as non-donors. Organ Procurement Of course, the organs can only be removed from the donor after brain death has been confirmed, which means complete and irreversible loss of brain function, with no chance of recovery. Regulated by the Federal Council of Medicine, the diagnosis of brain death in our country is made by clinical examinations, repeated at certain intervals by doctors who are not connected to the transplant team, along with other tests, such as electroencephalogram, which measures brain activity, and cerebral angiography, which checks for blood flow in the brain. In the meantime, the potential donor is attached to a ventilator, a machine that allows oxygen to be delivered to the organs, including the heart - hence why the heartbeat continues even after death - so that they remain viable for donation. In addition to the kidneys, lungs, liver, intestines, heart and pancreas, other parts of the body, such as bones, tendons, heart valves, skin and corneas can be used in other patients. Regardless of the case, the organ and/or tissue is removed by surgery like any other, such as the removal of the appendix or gallbladder, and the donor’s body is not deformed as a result of the procedure. Still a long wait Brazil has advanced in this area, although there are still a significant number of individuals awaiting transplant. According to ABTO data, the number of people on the transplant waiting list amounted to over 33,400 people, most of them waiting for kidneys or corneas. Not all of them could be attended to, but even so, more than 26,500 procedures were performed, according to the Ministry of Health, a little less than the total of 2017, when our country accounted for around 27,400 transplants, but significantly higher than the 18,900 transplants in 2008. For the experts, the increase in the number of donors is mainly due to staff training within hospitals to communicate the possibility of donation to the family of the deceased. According to the Brazilian Alliance for Organ and Tissue Donation, scientific evidence from around the world have shown that the increase in donation rates, with an appropriate approach, can reach 500%. But there are other supporting features in the main story. Since June 2016, Brazil has maintained a Brazilian Air Force aircraft  reserved only for transporting organs. In addition, a 2017 decree established that any qualified physician can report brain death - up until then only a neurologist was allowed to do so, and in their absence, the opportunity for a transplant was often missed. Living donation Remember that this noble act does not always happen in a painful moment. Organs from living patients are also valuable in this context. In 2018, of the 5,999 kidney transplants performed, 17.6% were made possible by living people, who can still donate part of their liver, part of the lung and bone marrow. Specific legislation is also in place for these cases. The Brazilian one allows donation up to fourth degree relatives and to spouses. If donor and recipient are unrelated, transplant is subject to court authorization - with the exception of bone marrow (link to bone marrow donation story), whereby legal endorsement is not necessary for people who are unrelated and there is a specific register and separate management. To be a living donor, you must be in good health conditions, with no risk that the procedure will compromise your vital skills, and you must be emancipated if underage, and legally capable. Lastly, there must be a recipient with a formal transplant indication. With these criteria met, the donor must perform compatibility tests with the patient in need. If both are compatible, a multidisciplinary team will follow the case to arrange consultations and other examinations, scheduling the day of the procedure. To learn more, please visit:  http://www.saude.gov.br/saude-de-a-z/doacao-de-orgaos

11/5/2019
Well being

In search of healthy aging

The world is aging due to the global increase in life expectancy and falling fertility levels. Therefore, the World Health Organization (WHO) estimates that by 2050, people over 60 will add to 2 billion on the planet. In Brazil, the Brazilian Institute of Geography and Statistics estimates that by 2060, the elderly will be 32% of our population - the current percentage is around 13%. According to the statistics, those still far from middle age will live a long life, with a good chance of living over the age of 80. But the path to getting there is still being planned. According to surveys made by the Ministry of Health, 25.1% of elderly Brazilians have diabetes, 18.7% are obese, 57.1% have high blood pressure, and 66.8% are overweight - all of these conditions are risk factors for cardiovascular diseases, the ones that cause the most morbidity and death in our country. With the aging of the population, cases of dementias are also going up, with 55,000 new cases each year in Brazil, especially of Alzheimer’s disease, according to the Brazilian Society of Geriatrics and Gerontology. In view of such scenario, the challenge is not to blow seven, eight or nine dozen candles, but to celebrate these birthdays with the greatest possible body and mind. Studies estimate that life-long habits, good and bad, account for more than two-thirds of our health at old age. The rest comes from what we inherited from our parents. Thus, we have a great responsibility for what comes to us in the third part of our lives. So, in a world that is turning gray, the buzz word should be planning. You can't start thinking about it at 60, experts teach, so there is an increasing need to provide children and young people with the right tools to for them to reach middle and old age in good condition, not only physically and emotionally but also socially and financially. This implies pursuing a healthy lifestyle from an early age that includes controlling stress, using the available means to prevent diseases, namely medical follow-ups, periodic examinations, vaccination, engaging in regular physical activity, keeping your mind busy, having a network of relationships, and of course trying to save some money during your economically active life, among other measures that we describe below. (link to Longevity and Health) Sticking to this precautionary primer can make it easier to live well past the age of 60. Even if genetics bring some surprise, it is always less complicated to face a health problem when there are no other associated diseases caused by bad habits. Start setting the stage today for you to experience all the experiences you dream of in the future. Guidance for longevity and health The care we need to have to grow old in a healthy manner is almost the same as the care we must have at any age to enjoy a healthy life. Your body - Do not smoke. It is worth remembering that the smoke from cigarettes liberates more than 4,700 toxic substances and causes various diseases, including various types of cancer. - Drink responsibly, always preferring red wine to other drinks as it is rich in resveratrol, an antioxidant. Just don't exceed one cup a day. - Keep the ideal weight for your age and gender. - Exercise regularly, at least 150 minutes of moderate activity per week, as recommended by the WHO. - Do not take any medicine without a prescription. - Respect your body's need for a good night’s sleep. - Take care of your oral and teeth health, by brushing after meals and visiting your dentist regularly. - Take all vaccines indicated for your age. When in doubt, consult the National Vaccination Calendar: http://www.saude.gov.br/saude-de-az/vacinacao/calendario-vacinacao - Go to the doctor at least once a year. Both men and women must undergo preventive tests to screen the most prevalent diseases, the early diagnosis of which increases the chances of cure. Your food - Keep a diet rich in fruits, vegetables, cereals, lean meats and skimmed milk. - Avoid the consumption of whole milk and its derivatives, frozen industrialized foods, ultra-processed foods, sausages, offal, fatty meat, crustaceans, bacon, lard and hydrogenated vegetable fat, among others of the same kind. - Try baked or cooked food, avoiding fried foods as much as possible. - At least twice or three times a week, go for skinless chicken or fish instead of red meat. - Consume as little sodium as possible by looking at labels and replacing table salt with herbs, for example, and keep an eye on your blood pressure. - Eat about 25 to 35 grams of fiber a day to help the intestines function well, prevent bowel cancer and control your cholesterol. - Replace candy with fruit as a dessert. Take in small amounts of sugar and control your blood sugar levels, especially if you have a family history of type 2 diabetes. Avoid cakes, pastas, sodas and sweets. Sugar is very harmful to health. Your mind and brain - Get organized on a daily basis to avoid stressful situations and learn how to deal with stress that you cannot control. You can try psychotherapy or any relaxing activity to relieve tension. - Try to have a hobby, do something you really enjoy and help you disconnect from the world for a few moments. Prioritize this in your routine. - Try not to be alone. Build friendships and affective relationships and stay connected with family members. - Try to study as much as you can throughout your life. The more the brain is challenged, the lower the risk of developing Alzheimer's disease. - Exercise your neurons with hobbies, video games, movies and books. At any age, don't be idle if you're unemployed or retired. The feeling of being useless is an invitation to depression and other illnesses, as well as to exaggerations that can endanger years of care

11/4/2019
Prevention

Alzheimer: causes, symptoms and how to avoid

Concerns surrounding the diagnosis of dementia pose the patient's family with numerous questions: For how long will they remember us? How are we going to take care of them? Can we afford special care and medications? Will we need to put them away in a care home? These and other questions have not only crossed the minds of relatives of the world's more than 50 million Alzheimer's patients, a figure that is expected to triple in 30 years, according to the World Health Organization (WHO), but also the minds of the health authorities, since aging is one of the major risk factors for developing the condition. The longer the world's population lives - and estimates show that the elderly will exceed 2 billion across the globe by 2050 - the higher the number of people with the disease will be. In view of this epidemic ahead, the WHO launched a Global Action Plan on Dementia two years ago, which runs until 2025 and suggests actions in seven areas that lack initiatives: prioritization in public health; risk reduction; diagnosis, treatment and support; raising awareness and creating user-friendly associations to patients; support for caregivers; disclosure of information; research and innovation. For an idea of how much still needs to be done in all these fields, the WHO compared scientific researches on mental issues with researches on other diseases. In 2016, 7,000 studies on Alzheimer's were published in scientific journals. At first glance, it looks like a good number, but this figure has not reached half of the 15,000 papers published in the same year on diabetes, nor was it even close to the 99,000 on cancer. What happens in the brain of someone with Alzheimer's Considered the most common dementia, Alzheimer's disease is caused by the deposition of two proteins in the brain: amyloid beta, which accumulates in plaques in the spaces between neurons; and tau, which concentrates within them. As a consequence of this process, there is a progressive loss of neurons in the hippocampus, which governs memory, and in the cerebral cortex, which is also essential for memories, but equally for language and articulation, the recognition of stimuli related to the five senses and abstract thinking. The death of neuronal cells in these areas causes cognitive decline, that is, people unlearn the knowledge they have acquired throughout their lives, and forget their memories, from the most recent to the most distant ones. The condition progresses with disorientation regarding time and space and difficulty in communicating and reasoning, which leads to total dependence (link to How the disease manifests). Early diagnosis makes all the difference Unfortunately, there is no cure for dementia yet. The patient requires, as soon as possible, the help of a multidisciplinary team that includes a physician, a speech therapist, a psychologist and others. Treatment includes drugs that help safeguard brain function longer, such as rivastigmine, also available in the form of a better tolerated patch, including in the public health network. In addition, medications can be used to control diseases that are usually associated with the condition, such as insomnia and mood disorders. The sooner this approach begins, the better for the patient - and also for their caregivers. One of the first symptoms of Alzheimer's is precisely short-term memory loss. When in doubt between the usual forgetfulness associated with stress and the one resulting from a dementia syndrome, seeking a neurologist for clarification becomes indispensable. The diagnosis is clinical, made in a doctor’s office through neuropsychological assessment, which is a test for the individual to memorize details and repeat them after minutes, and through neurological examination, which measures strength and reflexes. Complementary imaging studies, such as MRIs and CT scans of the skull, are often requested to rule out other causes such as stroke and brain tumors. More recently, the measurement of amyloid beta and phospho-tau proteins in the cerebrospinal fluid, which occupies the space between the brain and the meninges, has also been employed in research, although any changes in the results alone do not confirm the diagnosis and should be associated with the symptoms. Effort to shield memory If science still can't explain exactly what causes protein plaque deposits in the brain, studies have already shown that environmental factors can contribute to increasing the risk of Alzheimer’s, including the same ones that increase the chances of developing cardiovascular diseases and cancer, such as a sedentary lifestyle, obesity, diabetes, smoking and excessive consumption of alcohol. Therefore, although the effort made by some in their middle age to aging well does not prevent the disease, it is also valid for the maintenance of brain health. Low education level is also related to the development of Alzheimer's. The wealth of connections that arise from intellectual activity helps nerve impulses have more ways to get around brain damage and slows the onset of the symptoms. Therefore, keeping an activity that stimulates brain work is highly recommended. Do take some time in challenging the brain with readings, traditional and electronic games, crossword puzzles, courses and learning new things. Get started now! How Alzheimer manifestsAccording to the Brazilian Alzheimer’s Association, the symptoms of the disease are divided into three phases: mild, moderate and severe: Mild phase - Short-term memory loss - Difficulty finding words and making decisions - Disorientation regarding time and space - the patient does not know where they are and what day it is - Lack of initiative - General demotivation - Signs of mood disorders - Aggressiveness - Distractions and lack of interest in activities Moderate phase - Greater impairment of memory, forgetfulness of relevant events and names of close people - Major dependence on others, including for personal hygiene and self-care - Increased difficulty in speaking and expressing themselves- Aggressiveness, irritability and restlessness - Distrust and jealousy - Visual and auditory hallucinations Severe phase- Short-term and long-term memory loss, with difficulty in retrieving information from the past and recognizing people and places - Difficulty in eating and swallowing - Low ability to understand what's going on around them- Disorientation within their own home - Possible urinary and fecal incontinence - Motor impairment, with a need of help to move around, leading to wheelchair use - Need to stay bedridden, which usually leads to recurrent infections such as pneumonia  

11/4/2019
Prevention

Taking good care of your heart

Despite the advances in science to prevent and identify health problems, cardiovascular diseases - such as acute myocardial infarction and stroke - still show the highest mortality rates on the planet, especially in developed and emerging nations. In Brazil, they cause 300,000 deaths per year, according to the Ministry of Health. The fact is that, if traditional risks, such as such as smoking, were not enough, the current way of life, especially in big cities, is causing the heart to become more vulnerable. People are more sedentary because they work sitting for long periods and move in automotive vehicles; children hardly ever go to or return from school on foot and have exchanged playing in the street play for the commands of their video games; homemade food is often traded for processed foods and snacks that cause arteries to shivering. But all that can be modified with a little willpower. Basically, all one needs to do is exercise regularly and eat right, and extend these habits to their close ones, staying away from tobacco and excess alcohol and balancing work or study hours with leisure time to reduce stress. The impact of workout Regular physical activity, done at least half an hour a day, five times a week, not only allows for better functioning of the circulatory system, but also improves metabolism, helping to lower blood cholesterol and blood glucose levels. Furthermore, the exercises help to relax body and mind, reducing stress, and avoiding overweight and obesity, also a cardiovascular risk factor for diabetes and also high blood pressure. Healthy dish Dietary habits should include plenty of whole grains, fruits, vegetables, lean meat and good fats and, at the same time, be poor in processed foods, saturated fats, sugar and sodium, which known enemies of the heart. The large amount of fiber present in this option gives satiety for longer, helping to maintain optimal body weight, delays the transfer of glucose into cells and further reduces the absorption of fats and cholesterol into the bloodstream. Organized routine Stress control is essential because this condition, when chronic, also aggravates important risk factors for cardiovascular diseases, such as hypertension, and exerts a negative influence on the other choices that help shield the heart. Stressed people do not always stop work for lunch or find time to exercise. It is therefore worth choosing relaxing activities - in addition to exercising - and organizing the routine. Often, waking up 15 minutes early can be the difference between a chaotic day and a quiet day. The role of the doctor These changes are within the reach of anyone, but it is easy to remember that some conditions affecting the heart are silent and require clinical evaluation for them to be discovered and treated. This is the case of high blood pressure, high cholesterol and diabetes itself. Therefore, at least once a year, even if you are not feeling anything, do make an appointment for a general clinical evaluation and do the laboratory tests requested on the opportunity. This will provide complete protection against cardiovascular diseases.    

9/23/2019
Children

What to do when the baby does not want to nurse

Throughout pregnancy, women receive guidance on the importance of breastfeeding, as breast milk not only nourishes the baby, but also protects against diseases, stimulates brain development, and calms down the child – besides being extremely convenient for the mother.  All perfect in theory, were it not for a minor detail that can happen soon after birth: the baby refuses to nurse. What to do? Calm down. According to experts, the child comes into the world with a food reserve for the first two to three days. Therefore, the baby may be simply tired of labor as well as mother.  In this case, the most advisable is to snuggle it and soothe it.  Even so, you have to try again, as many times as necessary.  First, check if holding is adequate. The child has to face the mother, belly touching belly, and be stimulated to open the mouth.  With the hand in the form of letter C - and never with fingers placed as scissors - the mother should take the breast to the open mouth of the child, so that it reaches the areola, which is the part where there is more milk.  Thus, the baby does not have to make as much effort and nurses without hurting the mother. Problems and solutions for nursing time But it cannot be that simple. The hungrier the baby gets, the more agitated the little one gets - and, not rarely, the more the mother despairs.  A good tip is milking a little milk in a very small cup - usually these utensils are available at the maternity - and offering the liquid slowly into the baby's mouth.  And, then, start the process over. After eating a little, the chance of successfully feeding the baby will grow.  Another possibility is that the baby does expect the milk flow to be so fast, despite the hunger.  In this situation, the baby begins to suck and chokes, and ends up scared to try again. To avoid discomfort, the mother should remove some of the milk so that the flow is not as strong.   The nose obstructed by nasal discharge can also interfere, as well as the lack of strength to suck.  In the first case, it is recommended cleaning the baby’s nostrils before feeding, and in the second, feed the baby with milk milked into little a cup until it gains weight and becomes stronger.  Bottle nipples and pacifiers are not recommended as they can disrupt suction. If the child gets to know the bottle, the probability not wanting to nurse increases. It is worth considering that refusal, when accompanied by symptoms such as vomiting, diarrhea and excessive drowsiness, among others, should be treated as a medical emergency because this indicates that the baby may be sick.  On the other hand, in the absence of worrying signs, the persistence of failure should not lead the mother to give up something so important for the health of the child.  Today there are breastfeeding consultants and milk banks who can help. Above all, count on the pediatrician's support.

9/23/2019
Prevention

Multiple sclerosis: diagnosis, symptoms, treatment

A lot of people who have not even come close to middle age go through such a grueling routine of work and personal demands that, in the face of any different but transient symptom, they think that everything is due to stress. For sure a part of that may even result from the day-to-day tribulations, but not everything. There are symptoms that really need to be valued. That’s where the difficulty related to multiple sclerosis lies, a chronic, autoimmune neurological disease in which the immune system attacks the myelin sheath that surrounds the axons, the nerve fibers responsible for conducting electrical impulses, causing lesions in the brain, in the optic nerve and in the spinal cord. In most cases, the condition occurs in outbreaks – in a remitting-recurrent manner - but it can also be progressive. The problem is that the disease, which affects 2.5 million people around the world, according to the World Health Organization, begins with very subtle symptoms, such as blurred vision, weakness in the legs or a small urinary incontinence, which appear at any moment, without being associated with any event, and disappear quickly in a few days. Hence the possibility that these ephemeral complaints do not get enough attention or, for example, are associated with a more exhausting week. This light condition can then last for two to three years until it evolves more rampantly. According to the Brazilian Academy of Neurology, almost half of the initial clinical manifestations include spinal signs and symptoms, such as those involving weakness in the legs, tingling, sexual dysfunction and urinary incontinence. In addition, about 20% begin with visual problems, such as blurred vision, and a minor part of 10%, with complaints related to the brainstem, such as imbalance, dizziness and lack of motor coordination. The rest of the patients have a combination of all of them. Fatigue and mood disorders, such as depression, are also common. With the evolution of multiple sclerosis, the loss of the myelin compromises and even interrupts the transmission of electrical impulses, causing these manifestations to gain magnitude, although they still continue as outbreaks. After 20 to 25 years of diagnosis, the picture often culminates in a severe disability, which, according to experts, affects up to 90% of patients. Medications and support therapies In isolation, the symptoms of the disease may be confused with those of other neurological disorders. But the way in which they appear turns out to be typical. As a consequence, neurologists are able to make the diagnosis clinically by examining the patient’s history and neurological examination in the office with the support of complementary tests such as magnetic resonance imaging of the brain and analysis of the cerebrospinal fluid found in the brain and spinal cord, among others. The disease does not yet have a cure, but there is treatment that aims to attenuate the intensity of symptoms and increase the space between one outbreak and the other. Today, to prevent recurrence, immunomodulants and immunosuppressants are used - which control and/or reduce the activity of the immune system to prevent attacks on the myelin sheath - as well as monoclonal antibodies. Corticosteroids, on the other hand, given in high doses, account for the reduction of symptoms during seizures. In any case, the patient often needs other symptomatic medications to alleviate the problems arising from the illness, such as urinary incontinence, as well as physiotherapy, physical strengthening through an exercise program and emotional support. Also because the disease affects young people, especially women between 20 and 40 - that is, at the peak of their personal and professional life. The good news is that early diagnosis helps a lot to prevent outbreaks and therefore to have quality of life, although the imminence of an outbreak always exists. When in doubt, talk to a neurologist as soon as possible.

9/23/2019
Children

Below are ten benefits from breastfeeding

Breast milk has everything a baby needs for it to be healthy and well fed.  But the benefits of breastfeeding go way beyond. DaVita has selected ten reasons for mothers to throw themselves into this noble task for as long as possible. After all, the longer the breastfeeding continues, the better the results for the whole family nucleus. It is worth bearing in mind that the World Health Organization recommends breastfeeding until the child is at least 2 years old, and exclusively on breast milk for the first 6 months and, after that, interspersed with other foods. It allows the baby to gain wait at the right rate and the mother to lose weight.  According to specialists, in order to produce one liter of milk the woman’s organism uses up around 700 calories, which contributes toward losing the weight gained during the pregnancy faster. Whilst the baby gains the proper amount of weight on only breast milk. No more, no less. This happens because the amount of fat from the feed varies during breastfeeding and reaches its highest point right at the end of the feed, and this satisfies the baby and causes it to stop suckling naturally, unlike what happens with artificial formulas – the feeling of satisfaction may take longer to happen, making the baby suck more that is necessary, because the level of fat remains the same throughout.   It protects babies against allergies, respiratory infections and diarrhea.    As it contains a number of immunological factors that act against infectious agents and help avoid exaggerated inflammatory reactions – allergic reactions – breast milk literally acts as a preventive elixir for the baby. According to a study by the World Health Organization, the lower rate of diarrhea in breastfed babies, compared to non-breastfed ones, reaches 63% in those younger than 6 months, while a lower rate of pneumonias reaches one third in those who are less than 2 years old. The likelihood of developing allergic rhinitis also falls by 21% in the first five months of life in breastfed babies.   It contributes toward the intellectual development of the child. Breast milk is made up of substances that help the neurons to develop and to make connections between each other, or synapses, in the first three years of life – which is when 90% of an individual’s  brain synapses occur. Studies done in New Zealand and Ireland also show that children who are exclusively breastfed till 6 months of age perform better at school. A similar conclusion was found in a study published in the scientific magazine, the Lancet, in 2015.  Children and adolescents who had been fed on breast milk scored 3.4 points higher in intelligence quotient (IQ) tests than non-breastfed ones.    It prevents type 2 diabetes, overweight and obesity in all stages of life.  Breastfed children are 26% less likely to risk being overweight or obese in childhood, adolescence and in adult life, and are also 35% less likely to develop type 2 diabetes over the years, according to a study published in 2015 in the scientific supplement, Acta Paediatrica.   When babies are exclusively breastfed till 6 months old, they do not ingest any extra calories than are needed at this phase of the baby’s development, and they do not gain any more weight than they should. Furthermore, breast milk contains substances that contribute toward regulating the appetite and the metabolism of foods throughout one’s life.   It helps strengthen the jaws and other craniofacial structures of the baby.   Breastfeeding is essential for babies’ oral and facial development.  This is because, when suckling, the baby exercises the mouth, the teeth, the face muscles and the lower and upper jaw. According to a study published in 2015 in the Acta Paediatrica, two thirds of the irregularities found with milk teeth could be avoided simply by breastfeeding.  In another study that came out in the newspaper, BMC Public Health, in 2012, the researchers observed that children who were breastfed for 12 months or more showed a better chewing function than those who were breastfed for a shorter time.   It helps the woman with postpartum recovery and acts as a temporary method of contraception. Breastfeeding contributes toward the uterus resuming its normal size and shape more quickly and prevents intense bleeding and any consequent anemia. As if that were not enough, by exclusive regular breastfeeding during the first six months, the woman does not ovulate or menstruate. However, as the feeds lessen, as a result of being alternated with other foods, the menstrual cycles return and, with them, the need to use contraception if another pregnancy is not wanted.    It is a protective factor against breast cancer and other female tumors.   Since there are no menstrual cycles while exclusively breastfeeding, the woman is not exposed to estrogen, the hormone associated with breast cancer. What is more, when the baby suckles, it promotes exfoliation of the mammary tissue, and this contributes toward local cellular renovation. In fact, according to a large study published by the Lancet in 2001, which involved more than 146 thousand women from 30 countries, the risk of developing a breast tumor falls by 4.3% for every 12 months of breastfeeding. The more breastfed children, therefore, the greater the protection. In another work published by the Lancet in 2016, the authors calculated that breastfeeding prevents 19 thousand deaths from breast cancer each year in 75 average and low income countries, and they also maintain that a further 22 thousand deaths could be prevented if breastfeeding were prolonged to 12 months in richer countries and to 24 months in poorer ones.   This practice also is a factor that protects against ovarian cancer – a 2% lower risk of the disease for each month of breastfeeding – and against endometrium cancer.     It reduces the risk of type 2 diabetes in women.  In order to make milk, the organism takes 50 grams of sugar out of the blood circulation every day. A woman who is breastfeeding also uses up a lot of calories in order to breastfeed (link to benefit 1). There is evidence that prolactin, the hormone circulating in the body during the breastfeeding phase, would preserve the beta-pancreatic cells, which are precisely the ones that make insulin, which is the hormone responsible for taking the glucose out of the blood and nourishing the cells. It is a combination of these mechanisms that helps explain why the risk of developing type 2 diabetes falls by almost half in women who breastfeed for at least 6 months, according to the findings of a study published in the newspaper, Jama Internal Medicine, that followed 1238 women for 30 years. It helps mother and baby to bond.   During breastfeeding, the link between mother and baby gets stronger because of the visual and skin contact between them. As babies have difficulty focusing on images at a distance, the position they are in while breastfeeding, about 30 centimeters from the mother’s face, enables them to stare at the mother perfectly, and this contributes toward strengthening this bond.   The affection also grows because, while the baby is suckling, the milk is expelled by the action of oxytocin, the love hormone, and this outflow brings about complete relaxation and good feelings for the woman. Specialists state that this bond helps to facilitate relationships the baby will have with other people in the future.   It saves money and natural resources. Have you thought of that? There is research by the American Association of Pediatrics that shows that mothers who breastfeed exclusively in the first six months of their baby’s life avoid spending a thousand dollars on baby formulas and feeding bottles. This is in terms of personal savings. But, in terms of the public savings, a study published in the Lancet in 2016 pointed out that an increase of only 10% in the rate of breastfeeding for up to 6 months of age or continued breastfeeding for up to 12 or 24 months would be capable of reducing, by 1.8 million dollars, the annual costs of treating diseases in children in Brazil. Besides making a difference in the public health bills, all this saving would have a positive impact on the environment, in as much as the waste created by milk tins, feeding bottles, medicines and medical supplies used in hospitalizations would cease to exist if breastfeeding were practiced in this way. Therefore, breastfeeding is also a sustainable practice.

9/23/2019
Prevention

The good side of quitting smoking

No one argues that smoking is bad for one’s health. Including the 10.1% of Brazilians who continue smoking nonchalantly, even with the medical warnings and the many snags of society today. As a result, DaVita Serviços Médicos wants to explore the good side of quitting smoking.  Fun fact: according to a study carried out in the UK, those who quit this habit are proven to gain more years in their lives.  And the sooner the decision is made, the greater the increase. The British researchers found that whoever quits smoking at age 60 gets another three years in life expectancy. And those who stop at 40 are expected to live another nine years. The gain stems directly from improved health. According to data from the Ministry of Health, a person who stops smoking before age 50 has a 50% reduction in the risk of death from diseases associated with smoking such as cancer, stroke and heart attacks after 16 years of withdrawal. In fact, the risk of being affected by cardiovascular problems is cut down in half in the first year alone without smoking. This also means less spending on medications and medical procedures. There are other benefits that impact quality of life in a more subtle but no less significant way, such as improving self-esteem, breath, skin and teeth. Living with people who do not smoke helps a lot - think of a couple, for example - as well as one’s performance in activities that involve some physical conditioning. Enough of being the last one on the track!  For your decision to be successful, be sure to seek medical advice. Currently, there are interesting therapeutic strategies for those who, in fact, want to quit smoking. How does the body of a former smoker work without cigarettes? The first day may even be difficult, since the dependence on smoking is both chemical and psychological. But while the individual controls the will to light a cigarette in the most critical period, their body will reap almost immediate benefits. Write it down: After 20 minutes without smoking Blood pressure and heart rate go back to normal.  After two hours without smoking Blood circulation is free of nicotine. After eight hours Oxygen level in the blood, which was reduced, normalizes. After two days Tasting and smelling improve, revealing a world of flavors and odors. After three weeks The blood circulates better through the veins, favoring breathing.

9/23/2019

Have you ever heard of cystic fibrosis?

Mucus is a biological fluid that has the role of protecting surfaces in living beings, or that works as a lubricant. Like everything in nature, if altered by any phenomenon, it will cause imbalance. This is what happens in cystic fibrosis, also known as mucoviscidosis, a genetic disease that compromises the functioning of the glands that produce mucus, sweat and pancreatic enzymes, making them thicker, with important effects in the lungs, pancreas and digestive system. Basically, in the respiratory tract, the modified secretion – from 30 to 60 times thicker than normal – favors the accumulation of infectious agents and, in the pancreas and organs of the gastrointestinal tract, it compromises the absorption of nutrients.  Caused by defect in the genetically inherited CFTR gene, cystic fibrosis can cause symptoms such as recurrent lung infections, frequent coughing with phlegm, chronic bronchitis, wheezing, shortness of breath, low weight and height gain, bulky and fatty stools, diarrhea, dehydration and presence of salty sweat - a sign that can be perceived in the baby in the first days of life and gives the condition the popular nickname of salty kiss disease. Evidently, the intensity of the symptoms varies among the carriers.  In Brazil, it is possible to notice the disease at birth, since every child has the right to undergo the neonatal heel prick, which checks for this and other genetic diseases, in addition to some inborn errors of metabolism. Despite of that, healthcare associations and family members of cystic fibrosis patients estimate that many individuals are undiagnosed. All in all, the neonatal heel prick is just a screening test. To confirm the diagnosis, investigation needs to be continued through the sweat test - since whoever has the disease loses more chloride and salt through the skin – or through genetic research, that seeks mutations in the CFTR gene.   Cystic fibrosis: the importance of an early diagnosis The sooner the disease is diagnosed, the sooner measures will be taken to strengthen the child against lung infections, prevent malnutrition and ensure their growth and development, even though there are no obvious symptoms. The treatment includes the use of antibiotics and anti-inflammatory drugs to avoid pulmonary complications, digestive enzymes to allow the absorption of nutrients, bronchodilators to improve breathing, mucolytics to dilute the mucus, and some vitamins, and also involves a multidisciplinary team of healthcare professionals.  In 2009, a law established the National Cystic Fibrosis Awareness Day on September 5, to corroborate the importance of early diagnosis, inform the population about the availability of treatment in the public health network and raise awareness about the disease. After all, it is estimated that 5% of the population carries the defective gene asymptomatically. If a man and a woman in this condition start a family, this couple will have a 25% chance of generating a cystic fibrosis carrier in each pregnancy. Even rarely, this can happen in any family. Seek medical advice.

9/23/2019
Women's health

Lymphoma, a cancer of the lymphatic system

In recent years, lymphoma has made headlines in the mainstream media after some public people announced they had received such a diagnosis. Even so, the condition remains unknown to many, although it is not a rare disease. Just to give you an idea, in 2018, the National Cancer Institute (INCA) estimated nearly 13,000 new cases per year in Brazil, which most often affect males and the elderly population. A group of several cancers formed by the body's defense cells, lymphoma classically is divided into Hodgkin and non-Hodgkin - the name of the English pathologist who first described the disease in 1832, Thomas Hodgkin. The difference between the two is based on the characteristics of the cells that generate the tumor and also in the prognosis. While the former involves a specific cell type, known as Reed-Sternberg, and has a better clinical outcome, the latter may arise from any cell in the lymphatic system (link to Box Learn about the lymphatic system) and are less likely to be cured. So much so that INCA accounted for 4,394 deaths due to non-Hodgkin’s lymphoma in 2015, in contrast with 562 deaths from Hodgkin’s lymphoma in the same year. In both cases, however, the disease develops in the same way. A defense cell, for unknown reasons most of the time, undergoes malignant transformation and then splits in a disordered manner and multiplies uncontrollably within the lymph nodes - also called lymph glands - and may affect different parts of the body, given that lymphatic circulation travels throughout the body. The main clinical manifestation is the painless enlargement of these lymph nodes, especially on the sides of the neck, armpits, groin and above the clavicle. Unlike those lymph nodes that appear during infection, lymphoma lymph nodes grow rapidly, have a rubbery consistency, can often be seen and felt by touch, and persist for weeks. Not all patients report the same symptoms, but in addition to the lymph nodes, the disease is likely to cause complaints common to other conditions, especially fever, unexplained weight loss, and night sweats that wet the bedding. As lymphoma can affect many organs, sometimes it also happens that specific manifestations occur involving, for example, the digestive system (abdominal pain, nausea and vomiting), the skin (red spots and itching) and the central nervous system (headache and changes in vision, motor coordination and behavior). The origin of lymphoma Although the factor explaining the onset of lymphoma is not fully known, the risk is increased in smokers, those who spend a lot of time exposed to chemicals, especially agricultural products, in people with diseases that affect the immune system, such as HIV/AIDS, and in people who use immunosuppressive drugs. Some infectious agents may also be associated with the development of this cancer - although having infections caused by them does not necessarily determine the occurrence of the disease - such as the Epstein-Barr virus, which is behind mononucleosis, the HTLV-1 virus, a kind of cousin to HIV, as it behaves similarly, and the Helicobacter pylori bacterium, involved in cases of gastritis and ulcers. From one’s clinical history, the diagnosis is confirmed through a biopsy of the lymph node and through an anatomopathological study, which analyzes the nature of its tissues. Imaging tests are often required to evaluate the extent of the lymphoma. Until recently, the treatment did not differ from that of any cancer, with chemotherapy associated with radiotherapy. Today, however, the most modern protocols use chemotherapy agents combined with smarter drugs that act exclusively on the diseased cells, either by attacking them directly or by blocking pathways that allow the disease progression. Prevention is restricted to avoiding situations that increase the risk of lymphoma, such as smoking, chemical exposure and unprotected sex, which can lead to sexually transmitted infections associated with the onset of the condition. In any case, knowing your body well helps you notice any different signs, suspected of enlarged lymph node, which is especially true for those who already have health problems that compromise the immune system or those who take medicines that undermine the defenses.  When in doubt, the most important thing is to seek medical advice as soon as possible, since early diagnosis always increases the possibilities of cure.   Learn about the lymphatic systemWorking in conjunction with the immune system, the lymphatic system fights infections and eliminates microorganisms and other impurities from the body. To do so, it has lymphatic vessels that travel the same path of blood circulation, through which the lymph flows, a transparent fluid resulting from a small fraction of plasma, the fluid component of the blood. The lymph collects all the organic waste from the tissues and deposits it in the lymph nodes, where the defense cells can then take action.  

9/23/2019
Well being

What is true and false about blood donation

With the arrival of the school break, blood stocks at blood banks drop nearly 30%. How about taking some time off to revert this scenario and change the fate of up to four people?  You can be a donor if you are between 16 and 69, weigh at least 50 kg, find yourself in good health condition, are well fed and have slept well.  Many people meet these requirements, but still hesitate to take this important step because they believe in some myths surrounding blood donation. Time has come to check whether they are true or not. Will my body need the blood I donate? Not at all. Blood reposition will naturally start within the first 24 hours of the donation. In any case, the quantity donated (450ml) corresponds to less than 10% of the total volume of an adult’s blood, which is five liters. You can’t feel the difference. Are there any risks of contracting infectious diseases during the procedure?No, not at all. Donating blood offers no risk whatsoever of contracting any infectious disease, as the material used in the procedure is sterile and disposable.  If the donor is informed that they have some sort of ailment, they need to understand this refers to the results of the tests carried out with the material for the screening of infections before the blood is used in patients in need.  Can my blood structure get thicker or thinner after the donation?No. The procedure does not make your blood thicker or thinner, or even weaker. Again, it is worth pointing out that your body starts replacing the blood donated in a few hours. Is it possible to feel pain when the blood is being collected?If we consider the needle prick, the answer can be affirmative for those who are more sensitive. From the moment the blood starts being collected, however, everything flows smoothly, with no discomfort for the donor. When donating blood once, do I have to return periodically to the blood center?  No, you don’t. But those who enjoyed the experience are always welcome back. Men can donate up to four times a year, two months apart between donations, and women three times a year,  three months apart. In women, the replacement of their iron stocks takes a little longer because of their monthly period. Can women donate during their period?Yes, they can. Their period should not be a hindrance to the donation because it is a loss that a woman’s body is ready for, and furthermore, the volume of blood lost is reduced. Can smokers donate blood?Despite the problems cigarettes can cause to a smoker’s health, smoking should not prevent blood donation. However, to be able to donate, a smoker needs to keep away from smoking for two hours before the procedure. Also, it is recommended that smokers should not light a cigarette soon after the collection, at the risk of dizziness or fainting. To find out more about this, please click here

9/9/2019
Prevention

Let’s talk about rabies

When you take your pet to get anti-rabies shots, rarely will you remember that not only is immunization against rabies proper care for your pet’s welfare, it is also a very important public health measure for the general population. After all, rabies is a very serious and potentially lethal infectious disease. As it is transmitted by the biting of contaminated mammals, notably dogs and bats, rabies is considered a zoonosis. The virus of the genus Lyssavirus penetrates the skin through a lesion and circulates through the peripheral nerves, being attracted by the cells of the central nervous system. When it reaches that part of the body, after a period of incubation and the appearance of nonspecific signs present in any infection, it triggers acute encephalitis that can hardly be cured, with characteristic neurological symptoms such as excessive salivation, delirium, convulsions and aggressiveness. Despite the severity of the disease, there are currently effective strategies to combat it. One of them is the vaccination of people who may be exposed to the virus in some way. In Brazil, given the situation of animal rabies control (see box), rabies immunization is only recommended to biologists, veterinarians, agrotechnicians, professionals involved in capturing and studying animals suspected of rabies, virology laboratory teams, and individuals who work with wild animals. Other than in these situations, the ordinary Brazilian should only be vaccinated if they travel to countries in which the problem has not yet been solved, such as India. After the bite Another strategy is the so-called post-exposure prophylaxis, carried out after the attack, with a different protocol for each type of situation. When in doubt, the patient should begin to receive the treatment as if they had been attacked by a contaminated animal, because time, in this context, is a crucial factor to prevent the infection. Briefly speaking, prophylaxis includes, in addition to a vaccination schedule, the infusion of antibodies that help the body to fight the rabies virus. In practice, it is essential to consider any animal bite or scratch important. First, wash the area with soap and water to reduce the risk of local contamination by bacteria present in the saliva or nail of the animal and quickly seek a doctor’s office so that a general practitioner or infectologist can assess the need to start the post-exposure treatment.    Keep on vaccinating your petThe low incidence of rabies in our country is due to immunization programs of dogs and cats, which have caused a fall in the number of cases of the disease in people and animals. And this is relatively recent. According to the Ministry of Health, while in 1999 Brazil accounted for 1,200 contaminated dogs, in 2017 the number of cases of canine rabies declined to 13. As far as human rabies is concerned, there were 574 cases of the disease between 1990 and 2009, against 25 records from 2010 to 2017. Of the notifications made last year, it is worth noting that all of them involved bats. This is great news for the more than 52 million dogs and 22 million cats that live in Brazilian households, according to IBGE data.

9/4/2019
Prevention

How is your thyroid?

For some people it might be a little difficult to answer this question without looking it up on the internet, because not everyone even knows that they have this little gland, in the shape of a butterfly, just below the pharynx.   This lack of awareness of the thyroid happens precisely because it works silently, producing tri-iodothyronine hormones (T3) and thyroxin (T4), whose function is to regulate the metabolism, or rather, the way in which the body stores and uses energy, and this ensures balance in all the systems of the body.     This harmony, however, can be interrupted by the gland malfunctioning, either because it starts to produce fewer hormones, a situation known as hypothyroidism, or because it starts to work too much and makes more hormones than are needed, which is the case in hyperthyroidism.   In both cases, when extreme, the organism feels it in several ways. After all, the thyroid hormones act on vital organs and take part in various organic processes, such as fertility, menstrual cycles, growth – in the case of children and adolescents -, concentration, mood swings and memory, among, other things.     Low hormones in hypothyroidism  According to the Brazilian Society for Endocrinology and Metabolism, hypothyroidism is  the most common malfunction of the thyroid and mostly affects women over sixty-nine, especially those with a family history of the condition.   One of the main causes is Hashimoto disease, which is an autoimmune problem in which the organism produces autoantibodies that attack the gland, cause inflammation and sometimes increase the size and reduce its activity.   The problem can also be caused by prior treatment of any organ using radioactive iodine, which destroys the thyroid cells, and by a local operation – removal of a nodule, for example.   In this situation of not enough thyroid hormones, everything in the organism becomes slower, as if the fuel were running out.   Thus, symptoms can include - besides characteristic slowness - over tiredness, feeling cold, constipation, irregular menstruation, depression, insomnia, reduced memory, slower heartbeat and muscular and join ache, among other things.   What is more, there is usually slight weight gain, as well as increased levels of cholesterol in the blood. Hypothyroidism is treated by T4 replacement, which is done by taking the synthetic hormone, levothyroxine, daily at an appropriate dose for each person, and this varies a great deal from individual to individual.  Specialists warn that lack of treatment lowers physical and mental performance and increases the likelihood of heart disease.   In pregnant women, there should be double the attention given, as the mother’s problem may harm the development of the fetus. Therefore, proper functioning of the thyroid needs to be ensured during pregnancy.  It is worth remembering that at birth babies are also tested for congenital hypothyroidism by way of the heel prick test, which ensures early diagnosis and treatment of the condition, and this is an essential measure because thyroid hormone deficiency compromises the neurological development of the child.     Too many hormones in hyperthyroidism At the other end of the scale, hyperthyroidism produces too much hormone by an overactive thyroid and, therefore, is the opposite of hypothyroidism.   The heart beats too fast and irregularly, the intestine over functions, the person seems to be running on two charged batteries, talking and gesticulating a lot.   They will also complain of the heat, of increased sweating, of shaky hands, of eye irritation, irritability, anxiety , fatigue and weight loss. Infertility can also be caused by this condition.   However, people with slight increases in thyroid hormones, like the elderly, may not have any symptoms at all. The main cause of hyperthyroidism is also an autoimmune problem –Graves’ disease -, which is a chronic illness whereby autoantibodies attack the gland and cause it to increase in size and this leads to above-normal hormone production.   Less often, inflammation and nodules may give rise to the condition.   The treatment of this malfunction depends on the cause, on the patient’s state of health and age and, of course, on the degree of the symptoms.   The endocrinologist chooses the therapeutic strategy carefully, in a way that is tailor-made for the patient, among which there are antithyroid medicines that reduce the amount of hormones, betablocker drugs that control the palpitations and some more serious measures, like surgical removal of the thyroid or by applying radioactive iodine, both of which cause consequent hypothyroidism and a later need for daily replacement of T4 by taking levothyroxine.   Thyroid malfunctions are democratic.   They appear in any age bracket, in both sexes, without being able to count on primary preventive measures, as happens with cardiovascular diseases.   The fact is that, as symptoms of these disturbances are unspecific, regular visits to the doctor and having examinations done that measure thyroid activity (link to Getting to know how the thyroid functions) are recommended, and then it will be possible to make an early diagnosis before the condition detected can bring about more discomfort or a more serious health problem.      To get to know how the thyroid functions  The work of the thyroid is controlled by the hypophysis, a gland that is also part of the endocrine system and produces the hormone that stimulates the thyroid (TSH), which, as the name suggests, induces it to produce T4 and T3.  So, diagnoses of hyperthyroidism and of hypothyroidism only depend on the laboratory dosage of these hormones in the blood.  In clinical practice, however, it is enough to know the levels of TSH and T4 to reach a verdict.   A result of high TSH with low T4 means hypothyroidism – the thyroid is found to be stimulated, but, as it is ill, cannot produce the right amount of hormone.   Whereas, a result of low TSH with high T4 means hyperthyroidism – the gland is not stimulated but, even so, there is too much hormone on account of the pathological process.   In the same way, these examinations serve to accompany the treatment and to adjust the dose of levothyroxine accordingly. Of course, to look for the causes of each situation, some other tests are needed, including even some image ones, but the dose of TSH and T4 are the basis for detecting thyroid malfunction.     

9/2/2019
Prevention

Newborn heel prick test

More than just a diagnosis, it is an opportunity to live a full life Besides the Apgar test, whereby the new-born baby is evaluated regarding certain factors like heart rate, respiration, muscle tone, reflexes and skin color a few hours after being born, the baby goes through some other evaluations, some of which are compulsory and others that are recommended.  Among the compulsory ones is neonatal triage, better known as the heel prick test. The examination involves collecting, on filter paper, a few drops of blood from the baby’s heel when it is 3 to 5 days old, which is enough time for the little one’s organism to be working on its own. The aim of this is to search for important congenital diseases that harm the physical and mental health of the baby well before any symptoms can be seen, which enables doctors to intervene in plenty of time.    In the public health system, the test has been available free since 1992 and investigates six diseases that are most prevalent in new born babies: Congenital hypothyroidism, cystic fibrosis, sickle cell anaemia and other hemoglobinopathies, phenylketonuria, congenital adrenal hyperplasia and biotinidase deficiency.  The sample is sent to a reputable service for this type of analysis.   In Sao Paulo, it is sent to the Association of Parents and Friends of the Disabled (Apae), which is the entity that implemented the method in Brazil in 1976. If there are any alterations in the triage, the family is called in so that a specific examination for the suspected condition can be done on the baby, the purpose of which is to confirm it or not. Once the diagnosis has been made, the pediatrician is able to set up the correct conduct quickly, which, for the babies, can make the difference between normal development and some degree of physical or mental retardation.   In the case of phenylketonuria, for example, the remedy is to adopt a diet that is low in phenylalanine, which is an amino acid found in protein foods.    Children who are born with this disease accumulate this substance and, if the correct diet is not set up before they are three months old, they end up presenting some global retardation in neuro-psycho-motor development, intellectual deficiency, hyperactivity or autism, convulsions or skin problems. Although a person who has the condition must spend their life controlling what they eat and resorting to special formulae, having information like this as soon as one is born is inestimably beneficial and it totally justifies carrying out this screening on all newborns.    Wider triage: what is the difference?  It is as a result of this reasoning that the private sector has been offering, for a few decades, wider versions of the test, which screen for from 10 to 53 serious conditions that are quite common at birth, including metabolic, congenital and infectious conditions.  Recently the triages have begun to include screening for some innate defects in immunity, called primary immunodeficiencies, which generally present an extremely bad prognosis when identified too late. Even though these illnesses are – fortunately – not very frequent, early diagnosis and treatment of any one of them may change the destiny of the child, giving him or her the chance to live a healthy life with almost no limitations.    If you are planning to increase your family or are already about to have an heir, do not fail to talk to your doctor about the available options for neonatal triage.     Which diseases are screened for by the heel prick test? Sickle cell anaemia and other hemoglobinopathies:  Abnormal alterations of hemoglobin, a protein that transports oxygen in the blood, which make circulation and the subsequent oxygenation of the cells difficult. This can cause retarded growth and generalized infections.   It requires frequent accompaniment from a multidisciplinary team to adopt therapeutic measures that depend on each individual need, such as transfusions.      Biotinidase deficiency: a metabolic disease characterized by a biotinidase enzyme defect that is responsible for absorbing biotin from foods, which is a vitamin found in various foods in a normal diet.   When not corrected, it causes neurological disturbances and skin problems. However, the treatment is simple and is based on taking biotin daily.    Phenylketonuria: derives from a defect in producing the phenylalanine hydroxylase enzyme, and this causes the sufferer to accumulate phenylalanine amino acid.    Early diagnosis enables there to be early conduct, in a way that, as soon as the baby stops breastfeeding, it is fed formula containing low content of phenylalanine, and so does not run the risk of being neurologically compromised.     Cystic fibrosis:  a genetic illness that affects how the glands producing mucous, sweat and pancreatic enzymes function, which makes these secretions thicker, and there are important repercussions for the lungs, pancreas and digestive system. The treatment consists of taking medicines, especially those for reducing lung complications and ensuring that nutrients are absorbed.   Congenital hypothyroidism:  occurs when the baby’s thyroid gland does not produce enough thyroid hormones – T3 and T4 – which, if not treated by replacement with the synthetic hormone levothyroxine, results in permanent neurological damage.   Congenital adrenal hyperplasia: an alteration in the adrenal gland that is the result of defective enzymes and causes a lack of the cortisol and aldosterone hormones, which are fundamental for growth and mineral balance in the organism.   The most serious form results in an extreme loss of salt, and thus is an emergency in Pediatrics. The condition is treated with glycol-corticoids to rectify the lack of cortisol and with mineral-corticoids to balance the mineral salts.       

8/27/2019
Well being

Psychologist: a specialist in promoting mental health

We live in a world in which technological advances, by flooding us with information about facts and people at all times, give way to assumptions and concerns that can culminate in emotional disturbances and mood disorders or even exacerbate existing ones. There is where the figure of the psychologist gets in, an increasingly important professional in this scenario of overexposure and superinformation, as they are able to help each individual to find their balance and to seek the answers within themselves. In Brazil, according to the Federal Council of Psychology, we have about 343 thousand psychologists today. But of course, not everyone works in the clinical area. Today these professionals are in companies, sports clubs, schools, associations dedicated to the education of children with special needs, institutions linked to traffic and social centers, such as shelters and nursing homes, to name a few, always seeking to get the best out of people’s potential. The fact is that wherever they work, psychologists contribute directly to promoting mental health and thereby improving the world.  DaVita’s Tribute to Psychologists on their Day, August 27.  

8/26/2019
Prevention

Pay attention to the health of your eyes

It is estimated that 80% of human contact with the outside world is done through the sense of sight, according to the Brazilian project Olhar Brasil, of the Ministry of Education and the Ministry of Health. Despite that, we often only realize the importance of this sense when something hurts it. And this is not a rare case. According to data from the Brazilian Council of Ophthalmology and the International Agency for the Prevention of Blindness, 253 million people around the world are blind or have great difficulty seeing. Fortunately, according to the World Health Organization (WHO), most of these cases can be prevented by means of preventive treatments or strategies. Prevention of eye diseases requires some day-to-day care, most of which is easily accessible, but depends on regular visits to the ophthalmologist, given that the first signs of illness that result in loss of vision, if left untreated, can only be detected in such consultations. Likewise, this specialist is able to identify refractive errors, such as myopia and astigmatism, and provide the pathway to correct such problems - the prescription of eyeglasses or contact lenses or even surgery. In practice, it is recommended that children be taken annually to the ophthalmologist until the age of 8, especially due to refractive errors that they cannot verbalize and that, most frequently, may be behind a learning disability, for example, or a constant complaint of headache. From 8 to 40 years of age, the gap between consultations may be longer, every two years or according to medical recommendation, provided there are no symptoms or history of eye diseases in the family.  From the age of 40 onwards, however, annual eye tests should be resumed. In this phase, other complaints often arise, such as the difficulty of reading closely, which characterizes presbyopia, usually corrected with reading glasses. Even when there is nothing unusual with the eyes, from that age the ophthalmologist needs to measure the intraocular pressure, to detect and stop the progress of glaucoma, and to evaluate the state of the structures of the fundus of the eye, seeking to diagnose diseases such as cataract, macular degeneration and diabetic retinopathy, which together with glaucoma are among the main causes of blindness in adults and the elderly in Brazil. The fact is that regularity of ocular checkup can prevent and resolve, if not all, the majority of the causes of blindness and low visual acuity. Therefore, do not forget to prioritize this need in your health agenda and never get used to any visual complaints, however mundane they may seem.  Eye CareIf only the ophthalmologist can observe changes in the eyes that we are unable to perceive, in our daily routine there are several measures that we can adopt for the maintenance of our eye health:  - Protect your eyes from sun exposure, which worsens the effects of cataract and can cause irreversible damage to the retina cells. To do so, wear sunglasses with lenses that have a protective factor against ultraviolet rays, even on cloudy days. - Do not make use of eye drops without a prescription, and even when indicated, only apply the medication for the time recommended by the ophthalmologist. Especially those containing corticosteroids can raise intraocular pressure and give rise to secondary glaucoma. - Choose hypoallergenic make-up for the eye area and even so, always remove it before bed so it will not clog the hair follicles, which can cause painful styes. Avoid cosmetic products for cleansing. Neutral baby shampoo and water are enough. - Do not scratch your eyes. This will aggravate irritation and can lead to infectious agents that cause not only eye diseases, such as conjunctivitis, but also problems in the airways – colds and the flu, for example. - Do not try to remove any foreign body from your eyes with tweezers or other sharp instruments, even if it is a simple eyelash. Seek emergency ophthalmologic assistance. - If you work with activities that may release particles or droplets that could compromise the health of your eyes, wear eye protectors. - Avoid diabetes. Follow a healthy diet, do regular physical activity and keep the ideal weight for your height and gender. - Take breaks in the use of computer and mobile devices to rest your eyes from the brightness of the screens. Visual problems symptoms: when to look for an ophthalmologist?In addition to routine appointments, depending on your age group, always seek an ophthalmologist when the following occurs: - Lacrimation during or after visual effort;- Dry eye sensation;- Secretion;- Red eyes;- Crusty eyelashes;- Need to tighten or even open your eyes wide to see;- Need to get a lot closer to see and read;- Need to move an object or text away so that it can be viewed;- Need to tilt the head to see and read;- Blurry vision;- Sensitivity to light;- Headaches;- Double vision;- Ocular deviation.  

8/19/2019
Prevention

Do you know the difference between a walk-in center and an emergency room?

Walk-in centers are ready to attend to patients with sudden acute clinical conditions and diseases, which cannot wait for a booked appointment, but which is not a medical emergency. Examples of such cases include sore throats, colds and the flu, back pain, symptoms such as high fever, cough, diarrhea and vomiting, minor injuries and orthopedic injuries. In the face of symptoms or suspicion of conditions that present any risk of permanent damage or even imminent life threat, the most indicated service is an emergency room, which has the staff and structure to provide intensive care. This category includes clinical situations such as chest pain, loss of consciousness, seizures, fractures, decompensated diabetes, hemorrhages, shortness of breath, traffic and occupational accidents, poisonous animals’ bites and stings and deep injuries, among others. Understanding this difference is critical so that, under one circumstance or the other, you can quickly get the most efficient and appropriate care to improve your condition.   How can a walk-in center help you? A walk-in center is the type of service that can provide care to patients with acute health problems, those that may evolve if we do not seek medical care, but which do not represent major health problems.  Some examples of acute conditions include: Back pain crisis Colds and flu  Sore throats Earaches Persistent cough  Minor injuries Diarrhea and vomiting In situations of risk, seek an emergency room. In the event of symptoms or suspected serious illnesses, which involve life-threatening or permanent damage, only an emergency room can provide the care that situations like these require.  Some examples of emergencies are: Chest pain Loss of consciousness Hemorrhage Deep wounds Traffic accidents Occupational accidents  Poisonous animals’ stings and bites Shortness of breath Fractures Knowing the difference between these two services helps you save time, at a time when it can be so precious, and allows you to receive the most appropriate care for your condition.

8/13/2019
Prevention

What causes jaundice?

Yellow. This is the color of jaundice, and is a symptom of various illness, not a pathologicalcondition in itself, and it tints skin, mucous and the whites of the eyes, called sclera. Theyellow look comes from the unnaturally elevated amount of a pigment in the blood stream,called bilirubin, which is the result of red globules in the blood having died.In normal situations, the liver takes this pigment out of the blood stream after the red bloodcells have died and processes it. Just to have an idea of the uninterrupted nature of this work,the red cells are renewed every 120 days. After being metabolized, the bilirubin is stored in thebile ducts and then excreted via the intestine, together with the bile.In abnormal situations, however, either the amount of bilirubin produced is too much for theliver to be able to process because of the accelerated destruction of the red globules, ormetabolism of the pigment has been damaged by some alteration in the liver or in the bileducts. Bilirubin that does not get out of the bodyIn practice, the liver may have its capacity to gather bilirubin and process it compromised as aresult of hepatitis caused by virus, by medicines and by alcoholism, by hepatic cirrhosis, yellowfever and rare genetic illnesses, such as Crigler-Najjar syndrome and Gilbert syndrome.Whereas abnormal degradation of red globules occurs in hemolytic anemia, in which there isincreased and early destruction of these cells, especially with sickle cell anemia, and also withinfectious diseases like malaria, which makes the amount of pigment in the blood streamincrease significantly, without the liver being able to cope with the sheer volume.In the end, the bilirubin, after being metabolized, may not find an unobstructed route in thebile ducts to get to the intestine. This occurs in the gall stone, in tumors or narrowing in thisregion and in primary bile cholangitis, an autoimmune disease in which the organism producesautoantibodies that cause inflammation and obstruction in the bile ducts.The fact is that with all these conditions the pigment is unable to get out and ends upaccumulating in the skin, mucous and eyes. What there is behind the yellow of jaundiceAs it is an outer clinical sign, the presence of jaundice may lead naturally to a medicalconsultation, especially if it is accompanied by other manifestations linked to an increase inbilirubin, like dark urine, whitish feces and itching, which often attract the patient’s attentionmore than the skin tone. The clinical history already provides the doctor with clues for him to suspect one of theillnesses that cause jaundice, but the initial investigation cannot do without blood tests to measure the amount of bilirubin and red globules and to see how the liver is functioning.Depending on the results, further tests are generally needed for the diagnosis. A raised level ofcertain enzymes in the liver, for instance, might suggest inflammation and, therefore, lead thedoctor to look into viral hepatitis. The aim of the treatment is to combat the cause of the jaundice, which, once got rid of, endsthe yellowness once and for all. However, specialists also recommend other protectivemeasures, like keeping the body more hydrated, eating less fatty foods and usingantihistamines to combat itching. Yellowish skin tone is not normal. Even if you do not feel anything, seek medical advice. My baby has jaundice. What shall I do?Neonatal jaundice usually arises in up to 60% of babies, generally when they are three daysold, having been picked up by the clinical examination and confirmed by the dosage ofbilirubin in the blood. But, most of the time, it is the result of an immature functioning of theliver, which is unable to cope with metabolizing the pigment; that is why it is known asphysiological jaundice. The condition is not usually worrying, but does need controlling toavoid any complications, and this is done with phototherapy while still in maternity. When it isnot physiological, it may arise from the mother’s and baby’s blood not being compatible,genetic syndromes, obstruction of the bile ducts, hemolytic anemia or infections by virus orbacteria, among some other less frequent causes in this group.

8/12/2019
Well being

Healthy habits: routine changes to gain health 

It is true that science is striding in the development of solutions to increase health and find the cure for diseases that, a little more than a few decades ago, sounded like almost invincible threats. However, a pill capable of prolonging human life with quality, which prevents most diseases, has not yet come out of pharmaceutical or university laboratories. One of the most effective ways to achieve part of this apparent miracle is to adopt healthy habits or, for those who struggle to do so, to change their lifestyle. Take cancer as an example. Even though there are risk factors that we cannot change, such as age and a family history, all the others can be changed. So much so that the American Cancer Society attributes one-third of the deaths caused by cancer to the maintenance of unbalanced diets and the lack of physical activity. Likewise, several studies have already shown the association between the reduction of heart disease and the combination of regular physical exercise, adoption of the Mediterranean diet - rich in fish, nuts and extra virgin olive oil -, weight control and, of course, keeping away from smoking.  Besides these habits, other actions, some more laborious than others, are behind the maintenance of good health and the prevention of diseases and organic imbalances, even if momentary. The good news is that many times a single change can bring various benefits. When we sleep better, not only do we manage to be more willing to face the challenges of the following day, with less stress, but we can also help improve metabolism and prevent obesity, which among other damages, causes diabetes, a disease associated with cardiovascular events, such as acute myocardial infarction. The fact is that the daily incorporation of healthy habits has a positive systemic effect on the body. Talk to your physician and start working on your health right now. If you need help, seek psychological help.    Tips to be healthy - Do not smoke.  Cigarettes gather about 4,700 harmful substances and are connected to cardiovascular problems, several types of cancer and lung diseases, such as chronic obstructive pulmonary disease, and others. - Stop leading a sedentary life.  The World Health Organization recommends a minimum of 150 minutes of moderate physical activity per week. Whenever possible, walk or cycle to places. Regular exercise helps you lose weight, boosts your self-esteem, prevents diseases, and improves your mood. - Eat healthy food. Go for real food, prepared at home, with fresh food items. Processed products such as frozen preparations, instant noodles, soup and cake mixes, ready sauces and spices, or ultra-processed food, like cold cuts, sausages and nuggets, carry a lot of salt, sugar and fats which are harmful to the body. - Cut down on salt. Excess sodium, which is present in salt, is related to arterial hypertension and chronic kidney disease. Read product labels, avoid bringing the ones that are rich in sodium, and exchange some of the salt in your recipes for herbs. Important note: do not bring your saltshaker to the table. - Drink water. As a parameter, instead of using liters or cups to measure your intake of water, some experts prefer to recommend an intake of enough water to leave your urine light yellow.  Just avoid drinking water and other liquids over meals so as not to dilate your stomach, which will make you eat more than what you really need.  - Avoid sodas. Avoid even sugar-free sodas, and eat fruit, instead of making them into juice. It takes long for the body to metabolize the sucrose from the pieces of fruit, which delays the feeling of satiety, and the fibers ingested help the bowel to work better. - In fact, eat fibers. Men should eat 34 grams of fibers a day whereas women should ingest 28 grams, according to the National Association for Diabetes Care. In addition to being found in fruit, fibers are also found in vegetables and whole grains. They are important for the health of the digestive system, help lower cholesterol and control weight and help prevent bowel cancer. - Avoid alcohol. Giving the go ahead for alcohol consumption is a bit far-fetched, given the harm of alcoholism to the physical and mental health of the dependent and their family, but wine alone has some qualities, since it has resveratrol, an antioxidant that protects against cardiovascular disease. However, do not take more than a glass a day.  - Wash your hands. It is essential to keep this habit, especially before eating and cooking, as well as after using the toilet, to avoid contamination with possible infectious agents. - Control you stress.  One of the main factors in this regard is to manage time well, dividing it better between work and leisure activities and your routine at home.  In addition, find a way to let off steam. Physical activity usually helps and adds other benefits. - Take care of your affective and social ties. Keep a circle of people, friends and relatives on whom you can count to share your problems, celebrate your achievements, and get distracted. - Sleep well.  Not enough sleep alters the metabolism and may end up resulting in overweight and resistance to insulin, a hormone that puts energy into the body cells, with a consequent risk of progression to diabetes. To have a good night’s sleep, do not overeat at night or exercise before going to bed. When you go to bed, turn off all the electronics, dim the lights and turn down any volume. - Wear sunscreen. Light-skinned people should wear at least SPF 30, and for people of African descent, SPF 15. In addition, exposure to the sun should occur at the hours of least ultraviolet radiation (before 10 am and after 4 pm). - Go to the doctor periodically. Do a check-up once a year or according to your physician’s instructions. If you have any symptoms between consultations, go to a doctor or to an emergency room.

8/5/2019
Sex life

Viral hepatitis: what is it? How to protect yourself? 

The liver has multiple functions. It produces bile, which helps to digest fats, stores glucose, synthesizes cholesterol, gets rid of old red blood cells, manufactures and metabolizes proteins, acts as a defense against pathogens, and lastly, detoxifies the body. It is not by chance that the problems around it are a cause of concern among physicians, because of the systemic imbalance generated, and also among the health authorities, because of their high incidence and high mortality rate.  Among the most common liver diseases are viral hepatitis, which consist of an inflammation caused by HAV, HBV, HCV, HDV, or delta-virus, and HVE viruses. In Brazil, adding all these agents, there were no less than 40,100 cases of hepatitis in 2017, according to data from the Ministry of Health.  Although the prognosis is very different among the types of viral hepatitis, they all show similar symptoms, evidently when they arise, such as vomiting, nausea, dizziness, tiredness, fever, discomfort, yellowish skin and eyes - a condition known as jaundice - pain in the abdomen, light stools and dark urine. However, the symptoms may go unnoticed or even be confused with those of other viruses that affect the digestive system.  To get an idea, 7.2 million people have the hepatitis C virus in the Americas, but three out of four are unaware that they are infected, according to the Pan American Health Organization. Not coincidentally, the disease caused by the HCV virus is the most lethal, even in Brazil, despite the current well-advanced form of treatment.  The fact is that we can only know exactly the agent involved through blood tests, which is essential information for doctors to plan the therapeutic strategy and avoid hepatic impairment, which occurs when hepatitis becomes chronic. According to data from the World Health Organization, 1.75 million people die every year around the world due to complications of these diseases, in particular those caused by the HBV and the HCV viruses. If you do not know if you have ever had contact with any hepatitis virus, talk to your doctor for testing and, if applicable, take the necessary steps to treat and prevent it as soon as possible. Out of the five most common types of viral hepatitis, three can be prevented by vaccination.   Learn how to treat each type of hepatitis Hepatitis A: it usually heals spontaneously, with the emergence of the antibodies after a few weeks of the onset of symptoms, and it only requires rest and dieting for the improvement of your general conditions. Even so, it requires specialized medical attention. In very rare cases, the HAV can cause fulminant hepatitis and acute liver failure.  Hepatitis B: it is also usually quelled by the organism, with the same type of treatment, but in a few cases,  it can become silently chronic, and it has no cure. These patients need frequent and long-term clinical monitoring and medications to control the multiplication of the HBV virus to avoid liver cell damage. In the absence of treatment for this form of the disease, there is a risk of cirrhosis of the liver, with replacement of healthy liver tissue for fibrosis areas - such as scars - that prevent the liver from performing its functions, and of liver cancer.  Hepatitis C: in at least 80% of cases, the disease becomes chronic and, given the constant presence of the agent in the liver, with the risk of fibrosis areas and cancer arising. Not too long ago, the disease was treated with a combination of drugs, used according to the HCV genotype. Recently, direct-acting antivirals have emerged that inhibit essential enzymes for the virus to multiply and have been associated with other therapeutic options, raising the possibility of cure to more than 90%. The major problem with hepatitis C, and what makes it one of the most dangerous types, is that people do not know they carry the virus. Hepatitis D (delta): this agent depends on the preexistence of HBV to occur. When the acute infection occurs simultaneously, there is no specific treatment, but only the need to rest and dieting until the body can eliminate the two pathogens. However, if the patient already has the chronic form of hepatitis B and acquires the delta virus, the disease takes on a more serious character, requiring combinations of drugs to control the replication of both viruses. More common in northern Brazil, hepatitis D is the leading cause of cirrhosis of the liver in children and young adults in the Amazon region.  Hepatitis E: it also heals spontaneously, as soon as the body has developed defenses against the HEV. Like the others, patients need a better diet and to rest for the complete restoration of their health.   Where it comes from and how to prevent each type of hepatitis Hepatitis Forms of transmission How to prevent A - Direct contact with infected people (the virus survives up to four hours on people’s hands)- Intake of water or food contaminated with fecal material containing the virus- Unprotected sex (through contact with feces residues imperceptible to the naked eye) - Take the hepatitis A vaccine. - Take care of your personal hygiene, especially after using the toilet and before meals or cooking, as well as before sex. - Properly sanitize foods that will be eaten raw. - Do not eat undercooked seafood, especially mussels and oysters.- Do not eat raw or undercooked pork. - Drink chlorinated or boiled water in places with no basic sanitation.- Do not eat or drink anything of unknown origin. B - Unprotected sex- From mother to child during pregnancy, delivery or breastfeeding- Sharing of cutting instruments (syringes and needles, razors and shavers, tattooing and piercing materials)- Blood transfusion (rare in Brazil because of the high-quality control at blood banks) - Take the hepatitis B vaccine. - Wear a condom when having sex. - Do not share personal objects or sharp objects. - Do not get exposed to risky situations, such as alcohol use and drugs of abuse, which impair your judgment and prevent self-care. - If you are pregnant, follow prenatal care to avoid transmitting the disease to the baby. C - Blood transfusion (common before the 1990s, but now rare in Brazil because of the high-quality control at blood banks)- Sharing of cutting instruments (syringes and needles, razors and shavers, tattooing and piercing materials)- From the infected mother to the child during pregnancy (rarer)- Unprotected sex (rare) - Do not share personal objects or sharp objects.- Do not get exposed to risky situations, such as alcohol use and drugs of abuse, which impair your judgment and prevent self-care. - If you are pregnant, follow prenatal care to avoid transmitting the disease to the baby.- Wear a condom when having sex. D - - Unprotected sex- From mother to child during pregnancy, delivery or breastfeeding- Sharing of cutting instruments (syringes and needles, razors and shavers, tattooing and piercing materials)- Blood transfusion (rare in Brazil because of the high-quality control at blood banks) - Take the vaccine against hepatitis B as the delta-virus is incomplete and depends on the surface antigen of HBV to multiply.- Wear a condom when having sex. - Do not share personal objects or sharp objects.- Do not get exposed to risky situations, such as alcohol use and drugs of abuse, which impair your judgment and prevent self-care. E - Intake of water or food contaminated with fecal material containing the virus - Take care of your personal hygiene, especially after using the toilet and before meals or cooking, as well as before sex. - Properly sanitize foods that will be eaten raw. - Do not eat undercooked seafood, especially mussels and oysters. - Do not eat raw or undercooked pork. - Drink chlorinated or boiled water in places with no basic sanitation.- Do not eat or drink anything of unknown origin. Source: Department of Surveillance, Prevention and Control of STIs, HIV / AIDS and Viral Hepatitis.

7/29/2019
Prevention

Do you know the difference between the flu and a cold?

In the face of any manifestation involving the airways, people often report that they have the flu. Who’s never done that? But although they may have similar symptoms, such as fever, cough and body ache, the flu and colds differ in their clinical condition and severity.  Colds are caused by more than 200 different viruses, especially those in the rhinovirus family. They start slowly, with symptoms emerging gradually, and usually heal quickly, requiring only medications to relieve the symptoms, such as analgesics and antipyretics. The body itself gets rid of the infection after a few days, developing defenses to fight the virus.  In the most vulnerable people, of course, complications can occur. Babies, when infected with the respiratory syncytial virus, for example, are at risk of developing bronchiolitis, an inflammation of the bronchioles that requires close medical attention. The flu requires more care The flu comes from the action of the influenza virus, which has three types: A, with two subtypes currently in circulation, according to the Ministry of Health, one of which is the H1N1, which causes the swine flu, as well as types  B and C. It starts with a sudden high fever accompanied by dry cough and general malaise.  Although it can also be quelled by the immune system, due to the aggressiveness of the symptoms and the risk of progression to severe acute respiratory syndrome, the prescription of antiviral drugs for the treatment of patients with the flu is quite common, preferably in the first 48 hours after the onset of symptoms. In these cases, the infection caused by the influenza virus must be detected first. To do so, there are rapid tests today, through methods of molecular biology, that can give that answer in a few hours. How to prevent the flu It is easy to remember that the flu can be prevented by vaccination, which needs to be applied annually because circulating influenza strains change every season. Every year, in September, the World Health Organization recommends the strains that are to be used in the manufacture of the immunizers for the next year in the Southern Hemisphere.  Colds do not have this feature, but the number of episodes can be reduced by following some steps, such as frequently washing your hands, eating well, maintaining adequate body hydration, having a restful sleep and avoiding closed spaces in the cold, in which the infectious agents are transmitted more easily, among other measures.     

7/22/2019
Food

Learn the difference between good and bad cholesterol

Anyone who is older than 20 and goes to the doctor periodically should have already had a blood test to measure cholesterol, the fat that integrates the membrane of all cells and that, when in excess in circulation, can cause cardiovascular diseases. Most of the cholesterol found in the body is produced by the liver and this substance plays a key role in cellular health. The rest comes from food, especially from foods of animal origin, such as milk and dairy products, eggs and meat, especially red meat.  To distribute cholesterol to all cells, there are two lipoproteins, one of low density, called LDL-cholesterol, as in low density lipoprotein, and another one of high density, HDL-cholesterol, as in high density lipoprotein.  LDL is the most important carrier of this fat through the circulation. However, when it is high, it ends up deposited on the walls of the blood vessels, narrowing their diameter or obstructing them. As it happens, together with other substances, it forms plaques, which can break and cause serious cardiovascular problems: if the rupture occurs in an artery of the heart, for example, there is a risk of acute myocardial infarction; if it is in a cerebral vessel, there is a risk of stroke.  In view of this non-fortuitous association, LDL has gained the nickname of bad cholesterol and, to coexist peacefully with it, it is expected that its concentration in the blood always be below the reference values. This, however, is determined individually by physicians, according to the cardiovascular risk of each patient. HDL, on the other hand, does the opposite of LDL by removing excess cholesterol from the circulation and transporting it back to the liver, which results in a protective effect particularly on the arteries of the heart and brain. Thus, HDL appears as the good cholesterol, and should always be above 40 mg/dL, as recommended by the Brazilian Society of Cardiology.   How to reverse high LDL and improve HDL levels The basis for cardiovascular prevention is the maintenance of LDL and HDL in the right amount, an adequate diet, weight loss, physical exercises, etc. Those who smoke should also rethink this habit. Choosing low-cholesterol foods can make a big difference in lowering LDL concentration, while physical activities impact the increase of HDL the most, especially aerobic activities, such as walking, cycling and running. However, when someone’s level of LDL is quite high, and even with exercises and a good diet, they cannot get good results, some medication can be introduced to specifically decrease this type of molecule, which - it is important to stress - must be associated with the other measures for the control of cholesterol by the length of time determined by a doctor.  Statins are the most commonly used drugs to reduce LDL, but there are already new things in this area, such as the inhibitors of the PCSK9 protein, which degrades bad cholesterol receptors in the liver. If this protein stops working, the excess of LDL can get out of the circulation and return to its starting point. This new class of drugs is usually prescribed for those who do not respond to statins and other conventional drugs, as well as to those with familial hypercholesterolemia, in which the elevation of cholesterol results from mutations in genes, greatly increasing the risk of cardiovascular disease. Before thinking about treatment, however, there is a long way to go, which begins with an appointment with your doctor, even if you have been before, and may end up simply in diet adjustment and physical activity. Take that first step right away. The drop of LDL in the crosshairs According to the cardiovascular risk of each patient, the doctor determines the LDL-cholesterol target, which should be reached with dieting and weight loss and, when this is not enough, also with medication:   Cardiovascular risk: LDL target: Individuals with low risk Below 130 mg/dLIndividuals with average risk Below 100 mg/dLIndividuals with high risk  Below 70 mg/dLIndividuals with very high risk Below 50 mg/dLSource: Brazilian Cardiology Society What to change in your diet to lower cholesterol levelsFor those who have low cardiovascular risk, such as a person who has already had a stroke or who has familial hypercholesterolemia, it is possible to lower blood LDL levels with changes in their diet. In addition to doubling fiber intake, in the form of grains, whole grains, fruit and vegetables, it is worth promoting the following changes:   Instead of: Try: Ordinary bread, rice and pasta Wholegrain bread, rice and pasta Milk and dairy products Skimmed milk and dairy products Red meat Lean white meat (skinless chicken and fish)  and pork loin Snacks and biscuits Chestnuts and nuts Mozzarella pizza Vegetable pizza (zucchini, eggplant, chicory) Yellow cheese White cheese, ricotta, cottage Seafood Salmon Creamy sweets Fresh fruit or fruit jams White sauce, four cheese Homemade tomato sauce Butter Margarine with phytosterols Milk chocolate and white chocolate Dark chocolate

7/15/2019
Prevention

Sickle cell anemia

When the problem lies on the form of the blood cell One of the most common genetic diseases in Brazil, sickle cell anemia is characterized by a change in red blood cells that, due to a genetic defect, hemoglobin (protein that carries oxygen through the circulation), acquires a sickle shape, or half-moon, instead of the traditional rounded shape. Sickle cells, unlike normal ones, are poorly flexible and cannot pass adequately through the smaller blood vessels, obstructing them in different organs of the body. In addition to causing anemia from birth, due to poor distribution of oxygen to the body by defective hemoglobin - hemoglobin S -, the disease causes jaundice, that yellowish aspect of the skin and eyes, due to the early death of the blood cells, and pain in bones, muscles and joints, due to the occlusion of the vessels, also called sickling crises. If that were not enough, these crises are still caused by exposure to cold temperatures and by dehydration, as the patient of such condition usually loses more water than normal because they cannot concentrate urine.  Vulnerability to infections is another hallmark of sickle cell disease. As it happens, the destruction of the vessels brutally affects the spleen, an important organ that produces antibodies and lymphocytes, and it undermines its function, which opens space for any invader to proliferate. Therefore, the onset of fever is a warning sign, especially in the little ones, given that infections are the leading cause of death in children with this condition. Clogging of the capillaries, veins and arteries by sickle cells can still lead to serious complications, such as acute myocardial infarction, chronic kidney disease, pulmonary embolism and stroke, and it can impact other organs.   Early diagnosis to prevent complications The clinical condition of sickle cell anemia appears in the first year of life, with susceptibility to infections due to malfunction of the spleen, which justifies its investigation at birth. Not by chance, the disease is tracked in all newborns in the national territory by the newborn heel prick test (link to the article on newborn heel prick test). If there is any alteration in this screening, the family is called for a confirmatory blood test in the baby, called hemoglobin electrophoresis. Once the diagnosis has been made, the patient needs to be looked after to reduce the consequences of anemia, pain crises and susceptibility to infection. In practice, this includes good nutrition, not only with food, but with folic acid supplementation, to control anemia, use of antibiotics, both to prevent and treat infections, maintenance of proper hydration and protection against adverse temperatures. Treatment may still require other measures, depending on the progression of the condition in each patient, such as regular blood transfusions. The cure depends on allogeneic bone marrow transplantation.  The difficulty, however, is to find a compatible donor and ensure that the patient is in good health to for the procedure to be performed.  In the future, gene therapy is believed to be able to bring good prospects for this group, as this disease derives from a genetic mutation that causes the hemoglobin defect.  To be a carrier of this failure the person has to inherit the altered gene from his/her mother and father. If only one of the parents transmits the change, the person will have the sickle trait passed onto his/her offspring, but the condition will not be manifested. Sickle cell anemia is considered a public health problem around the world, precisely because it affects the poorest countries.  According to the World Health Organization, 300,000 children around the globe are born with this condition each year, mostly in sub-Saharan Africa.  In Brazil, based on data from the newborn heel prick test, the Ministry of Health estimates an annual incidence of 3,500 new cases, mainly in Bahia, Minas Gerais and Rio de Janeiro. When doing your family planning, talk to your doctor about the possibility of tracking this and other genetic diseases even before conception.

7/8/2019
Food

Food allergy: causes and symptoms 

It is very common to find allergic people, as according to the Brazilian Association of Allergy and Immunology (Asbai), at least 30% of the Brazilian population suffers from some type of allergy.  This disease is the exaggerated response of the defense system to an allergen, which can be caused by domestic dust or pollen, in cases of respiratory allergy, or the protein of a given food in the case of a food allergy. According to Asbai, food allergy, which affects 6-8% of children and 2-3% of adults, is an adverse reaction that occurs after ingestion of certain foods or food additives.  It can trigger reactions on the skin, affect the respiratory and the digestive system or even involve several organs of the body, and culminate in what is called an anaphylactic reaction, which is a serious condition that needs to be reversed immediately.  Any food has the potential to cause allergy, but cow's milk, egg, soybeans, crustaceans, wheat and fish are the ones most commonly known to cause reactions.  Moreover, there is also the possibility of cross reactions. Whoever is known to be allergic to prawns may also not tolerate shellfish, oysters and the like. Likewise, the sensitivity to peanuts quite frequently comprehends grains such as soybeans, peas, and beans.  Adverse reactions to preservatives, dyes and other food additives are infrequent, but they should be observed carefully.  Among the most common agents of this group, it is worth mentioning tartrazine dye, used in artificial juices, gelatins and candies, as well as monosodium glutamate, which is added to savory foods, such as seasonings, and sulfites, used to preserve dehydrated fruits, wines and juices, in addition to being added to some medications. The allergic reaction always occurs right after the food ingestion? An allergist usually makes the diagnosis by means of a detailed history of the patient, which includes a report of the food frequently and occasionally consumed in order to associate the symptoms to the intake as well as physical examination.  Children are mostly affected by milk and eggs, while for adults, prawns are the most common cause of allergy. In any case, reactions do not always occur soon after consumption, which makes it difficult to identify the disease. In order to help elucidate the condition, the specialist may a request skin-prick and a blood test to determine the allergy. The treatment consists of taking antihistamines to control the symptoms and stopping intake of the food causing allergy; always with due care to duly replace it to avoid nutritional deficiencies - which is crucial for children to avoid impairing their full development.  The patient and family members are advised to avoid repeating contact with the allergenic agent and to get used to reading labels for the presence of such food and associated names, such as milk, butter, serum, lactalbumin or caseinate.  This mission has been simplified by Anvisa Resolution RDC 26/2015, which requires manufacturers to report on the product label the existence of up to 17 potentially allergenic foods.  The same rule also requires labels to display warnings that they may contain traces of these foods. This is because some industrialized products, even if they do not include any of them, are manufactured in machines that process products that effectively take such items into their composition.  A biscuit made with water, flour and salt, for example, can be produced using the same machine as another one made with eggs and milk, and thus presenting the possibility of cross-contamination.   What to do when the allergy occurs due to an accidental exposure? Despite precautions, completely excluding an item from the diet is not an easy task and, according to experts, accidental exposure ends up happening very often.  In these cases, mild reactions can be controlled with antihistamines or until they disappear spontaneously. However, for those with a history of more severe reactions are recommended to always carry with them the specific medicines to reverse the symptoms - an adrenaline auto injector (adrenaline pens).  Even so, these people should be referred to a medical service after exposure due to the risk of a second delayed reaction. Fortunately, the prognosis is usually good in food allergy According to Asbai, about 85% of children stop responding to most foods that cause them allergies between the ages of 3 and 5, especially eggs, milk, wheat and soybeans, which, after all, are found in industrialized products and in the most common menus.  To this end, the specialist gradually reintroduces the food in the diet. Sensitivity to peanuts, walnuts, crustaceans and fish, however, tend to last a lifetime. How to prevent food allergy in early childhood? As this is a type of disease that affects children, it seems reasonable to identify the one prone to such condition, especially in early childhood, when cow's milk accounts for much of the diet.  But, in practice, families of people suffering from allergy should be mainly concerned, as, according to Asbai, 50% to 70% of patients whose parents suffer from food allergy are also subject to the same problem.  Additionally, if both the father and the mother present any type of allergic condition, the chance of generating a child with food allergy reaches 75%. Therefore, for this group, specialists encourage breastfeeding even further, as well as the late introduction of foods mostly associated with allergy symptoms:  Solid foods can only be given after the sixth month of life, cow's milk after 1 year of age, eggs at 2 years and peanuts, nuts and fish only after 3 years of age.    If you believe there could be any connection between food intake and adverse reactions, seek an allergist to clarify the condition. Get to know the symptoms of food allergy Skin reactions:  Bumps or plaques (wheals) on the surface of the body (hives), swelling, itching, and skin inflammation (atopic dermatitis). Gastrointestinal reactions:  diarrhea, vomiting, abdominal pain and, in children, blood in the stool, with consequent anemia and delayed growth. Respiratory reactions:  coughing, wheezing, and hoarseness.  Nasal obstruction may also occur, but rarely. Anaphylactic reaction: generalized itching, bloating, difficult breathing, diarrhea and vomiting, abdominal pain, throat and chest tightness, blood pressure drop, mismatching heart rate and vascular system unable to irrigate all body tissues (vascular shock ).  

7/1/2019
Prevention

Occupational accidents, a health problem and a society problem

In a classic scene of the Modern Times movie, Charlie Chaplin in his Little Tramp persona as a factory worker starts to tighten screws frantically and is swallowed by the production machine. A joke and, at the same time, a criticism that, still today, says a lot about the man’s relation with work since the advent of the Industrial Revolution. According to the International Labor Organization (ILO), 2.3 million people die and more than 300 million are injured each year across the globe as a result of occupational accidents, which include not only typical incidents with injuries of different degrees, but, also, occupational diseases and work-related illnesses. Occupational diseases are associated to the occupation, as a teacher who develops bursitis on the shoulder due to years of writing on the blackboard, while the work-related illnesses are associated to the environment in which work is performed, as a worker who loses his/her hearing because of the constant exposure to noise in the production line in which he/she worked. Such occurrences, in addition to impacting so many families as a result of lives lost, irreversible physical sequelae and damage to the physical and even the mental integrity of the workers, also have a very high cost to society, which amounts to nearly 4% of Global GDP, according to the ILO, when considering days of work lost, payment of pensions and expenses related to treatment, rehabilitation and reintegration of those injured. Brazil is ranked fourth in number of occurrences Unfortunately Brazil is ranked fourth among the countries with more occupational accidents, only behind China, India and Indonesia. According to data from the Social Security Yearbook of Labor Statistics, between 2012 and 2016, 3.5 million Brazilians were injured in the national territory while performing their work activity or as a result of it, which represents an average of 700 thousand cases per year. This number includes serious accidents, such as fractures and lacerations, exposures to biological material and intoxications, as well as occupational diseases, such as Repetitive Strain Injury/ Work-Related Musculoskeletal Disorders known as RSI/WRMD, hearing loss, dermatosis, pneumoconiosis and the one known as occupational cancer. Not to mention commuting accidents, which occur from the residence to the workplace and back, regardless of the vehicle used by the worker for transportation. And, unfortunately, some cases are fatal. From January 2017 to February 2018, the Digital Observatory for Occupational Health and Safety recorded 2,351 deaths under these circumstances.  According to experts, the numbers described here represent only the tip of the iceberg, as many cases are not reported, and are due to poor safety practices at work and lack of individual protection equipment, both the business’s fault, as well as due to carelessness and exhaustion of the worker. In Brazil, the general view is that accidents cease to be a problem of the employer to become a social security problem. However, the responsibility falls on everyone, the Public Authorities, the employers and the employees, insofar as an occupational accident or work-related illness, not only affects the individual's well-being and health, but also generates costs paid by every taxpayer; a sum that could be invested in other benefits to society. Between 2012 and 2017, the now much-discussed Social Security disbursed BRL 26.2 bn for the payment of illness allowance and accident allowance, disability pensions and death benefits to dependents of the deceased worker. For all these reasons, do not put yourself in a risky situation. Protect yourself on day-to-day work, demand superiors to take measures and tell your doctor if you have any complaints or exposure to risk related to your professional activity. Help prevent occupational accidents For the employee: Request and use personal protective equipment such as gloves, goggles, helmets, ear protectors and others. Be aware of the need to replace these items. Double your attention when performing any risky activity within the scope of your work. Try to attend safety training frequently. If the company does not offer safety training, go over the standards with your superiors. Try to determine and remedy risky situations within the work environment, from a slippery floor to a machine failure. Get help from a technician if you do not know how to handle a machine or equipment. Take breaks during your occupational activity, especially if you perform repetitive movements. At the office, make sure your body is perfectly adapted to the furniture and the workstation. Otherwise, seek guidance from a health and safety team. If you operate machines and drive cars as part of your job, try to get a good night's sleep and advise colleagues and superiors if you feel you are not duly fit to perform your activity. If you drive to and from work, do so carefully and observe the traffic laws. Leave your car in the garage if you are too tired. For the employers: Create a safety policy, providing your employees with a document stating clear rules to prevent accidents, as well as instructions in case of any occurrence. The riskier the company's activity, the stricter must be the rules. Allocate an exclusive manager – such as a health and safety manager - to check if the rules are being observed and establish a safety culture at the company. Identify and correct possible accident hazards by involving your employees in this work, and keep tools nearby to quickly eliminate any problems, if required. Hold regular security training sessions, including fire-fighting training, so that people are well aware of escape routes and are able to identify who can lead them in these situations - brigades. Always keep a first-aid kit in an easily accessible location to prevent an injury to from getting worse. Record and analyze each accident, and assess what could have been done to prevent it and design a prevention plan. Identify possible hazards at the working environment with signaling boards, for example. - Make sure that all areas of the company are well illumined, including the office, and invest in ergonomic furniture.

6/24/2019
Prevention

Asthma under control

One of the most common respiratory diseases, asthma affects 5% of the general population, according to the Brazilian Society of Allergy and Immunology, and 10% of children. It is characterized by an exaggerated inflammatory reaction of the organism, which, when exposed to an irritant agent, closes the bronchi, the ramifications of which transport the air to the pulmonary alveoli, where gas exchange occurs - the exit of carbon dioxide and the entrance of oxygen, which falls into circulation. Therefore, during an asthma attack, the inspiration and, above all, the expiration are compromised, which causes breathlessness, wheezing, coughing and fast and short breathing. These manifestations worsen at night, disrupting sleep, and in the early hours of the morning, including after physical or day-to-day activities. This suffocation stems from a combination of genetic factors, that is, a predisposition to allergies, inherited from one’s parents, and environmental factors, such as exposure to domestic dust, dust mites, pollen and fungi, among other allergens, exposure to strong odors, sudden changes in temperature and infections caused by viruses. In practice, therefore, a child is already born with this propensity and, when coming in contact with one or more of these stimuli, they have their first attack, and despite the fact these attacks can be controlled with medication, they end up repeating themselves whenever the affected person faces the same triggers, at any age. The diagnosis is clinical, based on history and symptoms, and can count on the support of some respiratory tests, except in young children, such as the bronchoprovocation test, which quantifies the response of the organism to a stimulus, and spirometry, which measures lung function, since the disease can lead to changes in lung function. Since most cases are allergic in origin, blood tests or skin tests can also be performed to screen the allergens that trigger the attacks. Many asthmatics cannot tolerate animal hairs, for example, but not all have the same sensitivity. Medications and education to treat asthma Asthma treatment requires bronchodilators to reduce the reflex of the lung muscles from contracting the bronchi, combined with inhaled corticosteroids to reduce inflammation, which, as if that were not enough, still produces a lot of mucus to hinder the airways to the pulmonary alveoli. The well-known inhalers today associate the two categories of medicines. The doses of the drugs are usually increased during the attacks and reduced when they are only aimed at keeping the disease under control.  Experts prefer to say that asthma has no cure, but control. Given the genetic predisposition and the permanent exposure to irritants - even if some are avoided, those who live in large cities, for example, will always be exposed to pollution and dust - the possibility of having an attack may persist throughout one’s life.  Thus, it is imperative that the treatment include educational measures and management of the factors that aggravate the disease (link to Avoiding wheezing) so that the individual can live well with asthma and can reduce the dependence on the medicines. In addition, both the family and the patient need to learn how to manage the attacks so that they are able to identify them before they happen, make the necessary arrangements before the symptoms worsen and, if they do not deliver the expected results, seek emergency services (link to When to look for an emergency room). As in any disease that affects respiration, one of the vital processes for the body, you cannot waste time in these cases. Always follow medical guidance and do not hesitate to seek professional help if you have any questions in-between consultations. Avoiding wheezing   Prevent yourself from catching colds and the flu by always washing your hands with soap and water or using alcohol at 70%, but especially when you come in contact with contaminated people or surfaces. Also take the annual flu vaccine against the influenza virus, available on the public health system for people with asthma. Stay away from cigarettes and smokers. In a family of asthmatics, the habit of smoking is a very bad idea. Keep the environment where you live clean and airy, free of dust and dust mites. Getting rid of items that accumulate a lot of dust, such as curtains and rugs, especially in the bedroom of an asthmatic, is advisable. Use anti-allergic mattresses, pillows and blankets. In case these are not available, the good old habit of exposing these items to sun light on a daily basis helps eliminate mites. The possibility of having a dog or cat should be reconsidered. In addition to their hairs, which can serve as a trigger for attacks, skin desquamation, saliva and urine of animals also work as irritants for asthmatics. Other inhalants can trigger attacks, such as the smell of paint and solvents, cleaning or personal hygiene products, perfumes, in addition to smoke. Try not to have contact with these possible irritants. Avoid sudden changes in temperature. For example, do not step out of a hot shower onto the street on a cold day, or step in an overcooled environment on a hot summer day. Wear warm clothes in the cold and do not breathe through your mouth when you are walking on the street. Breathing through your nose will warm the air that reaches your lungs. Try to exercise every day, always in a moderate way, with medical supervision. Activities that exercise the respiratory muscles, such as swimming, are particularly recommended. Drink plenty of fluids, about two liters a day, to help dilute the bronchial secretion and facilitate clearing the mucus from your lungs. Invest in a healthy, high-fiber diet that helps control weight and reduce inflammatory processes in the body, including those behind asthma. Try to control anxiety and panic when having an attack, as this condition may exacerbate the defense reaction of the lung muscles.   When to look for an emergency room in an asthma attack   When the symptoms are more intense than the usual; When your speech is broken; In case of inadequate use of inhalers given the intensity of your shortage of breath; When inhalers have a short effect and the symptoms return quickly; When there is a feeling of exhaustion and restlessness; In case of bluish nails and lips (cyanosis).   

6/21/2019
Prevention

Get ready for the typical winter diseases

The arrival of the cold winter wind coincides with the great demand of people for health services, in search of relief from the symptoms of the typical diseases of the season, such as coryza, cough, sneezing, fever, body aches and general malaise, among others, due to the flu, colds and allergies. The truth is that it is not easy to escape a respiratory infection or even an allergic crisis in the coldest months of the year. Those who have children at home know that a good part of the 8 to 12 colds that they have each year, according to experts, happen during this season.  Of course there are technical explanations for this phenomenon. The low humidity of the air between June and September, combined with a higher concentration of pollutants in the atmosphere in big cities, makes the airways drier and more unprotected, especially the nose and throat. With less ability to block unwanted visitors, viruses and bacteria, as well as irritants such as mites and fungi – which are terrible for allergic people - they can enter the respiratory system more easily. And all this in the midst of a fall in immunity, given that in the cold, the body is more concerned with getting warm and naturally devotes less time to fighting the invaders. If they already have a more accessible and poorly guarded entryway, disease-causing microorganisms get back up to their team at this time of year, as winter pushes people to remain indoors, which facilitates proliferation of infectious agents. To get an idea, a single sneeze can contain up to 40,000 droplets, some with the ability to come out of the nose at 45 meters per second, according to a paper published in the Journal of the Royal Society Interface. With such power, it can contaminate an enclosed space for up to six hours. It is not by chance that it is so common to get a cold in a classroom or in a subway car.  Temperature variations can increase winter diseases To top it all, sudden changes in temperature also cause people to get respiratory diseases because of the body's shifting focus - the priority is to keep warm, remember? However, according to researchers at the University of São Paulo who have carried out a study on this relationship, people who suffer from allergic diseases, such as rhinitis and asthma, suffer more on the sudden arrival of a cold front after a relatively hot day. For an asthmatic patient, for example, it is very likely that sudden climatic variations would mean a greater need for medication and, quite often, for emergency room visits due to uncontrolled attacks. Asthma In any case, people most affected by this combination of winter disease triggers are either children under the age of five on the one hand and the elderly on the other because of the fragility of their defense system, which can even turn colds into more serious problems, such as sinusitis and pneumonia. The fact is that, in these groups, the symptoms cannot be expected to disappear with rest and symptomatic medication, especially when there is fever and productive cough. In such cases, it is worth seeing a family trusted doctor or going to the nearest emergency room. Learn more about the difference between the flu and a cold In the face of any manifestation involving the airways, people often report that they have the flu. Who’s never done that? But although they may have similar symptoms, the flu and colds differ in their clinical condition and severity.  Colds are caused by more than 200 different viruses, especially those in the rhinovirus family. They start slowly, with symptoms emerging gradually, and usually heal quickly, requiring only medications to relieve the symptoms, such as analgesics and antipyretics. The body itself gets rid of the infection after a few days, developing defenses to fight the virus. In the most vulnerable people, of course, complications can occur. Babies, when infected with the respiratory syncytial virus, for example, are at risk of developing bronchiolitis, an inflammation of the bronchioles that requires close medical attention. The flu comes from the action of the influenza virus, which has three types: A - with two subtypes currently in circulation, according to the Ministry of Health, one of which is the H1N1, which causes the swine flu -, B and C. It starts with a sudden high fever accompanied by dry cough and general malaise. Although it can also be quelled by the immune system, due to the aggressiveness of the symptoms and the risk of progression to severe acute respiratory syndrome, it is not uncommon to prescribe antiviral drugs for the treatment of patients - preferably, in the first 48 hours after the onset of symptoms. In these cases, the infection caused by the influenza virus must be detected first. To do so, there are rapid tests today, through methods of molecular biology, that can give that answer in a few hours. It is easy to remember that influenza can be prevented by vaccination, which needs to be applied annually because circulating influenza strains change every season. Every year, in September, the World Health Organization recommends the strains that are to be used in the manufacture of the immunizers for the next year in the Southern Hemisphere. Cold, on the other hand, don’t have this resource, but the number of cases can be reduced with some care. Tips to protect yourself from winter diseases   Take the flu jab every year. The Brazilian Society of Immunizations recommends the vaccine for everyone from 6 months of age, regardless of their vulnerability. In the public health system, children aged 6 months to 5 years, the elderly, people with chronic and immunosuppressed diseases, among other special groups, have priority. Often wash your hands with soap and water. This prosaic care is vital to taking away viruses that have been transmitted by people or contaminated surfaces. Drink plenty of water to hydrate the airways, always enough to leave the urine light yellow. Eat foods rich in vitamin C – citric fruits, cabbage and broccoli, as well as products enriched with this nutrient. Wash the nostrils daily with saline solution. Increase humidity by using basins with water and wet towels in the rooms. An air humidifier is an option, but it requires impeccable maintenance. Without good cleaning, the device may spread more infectious agents around the house. Take good care of your immunity with a healthy diet and sleep well. Avoid staying indoors where there are too many people. It is healthier to go to a park on a sunny cold day than to a movie session packed with people. Wear warm clothes when leaving the house and cover your mouth and nose to warm up the air that will enter the airways – a warm scarf does the trick. Keep the house clean and free from dust, especially rooms where the most vulnerable people sleep. Do not send children to school if they have a fever and other typical flu and cold symptoms. In a closed classroom, it is high the risk of contagion. If you have any symptoms, cover your cough or sneeze with a tissue or even with your hands, and wash them well afterwards. In case of the H1N1 flu, it may be advisable to wear a mask until there is no further possibility of transmission of the agent.

6/14/2019
Well being

Blood donation, an act of citizenship

In Brazil, blood donation campaigns often focus on periods leading up to large holidays or school holidays, when a significant drop in blood bank stocks is accompanied paradoxically by increased demand. After all, with the great concentration of vehicles on the roads, there are more accidents and, therefore, more people who need blood transfusions or blood components. The donation, however, does not only benefit the injured. A single blood bag helps up to four people because all blood elements - red blood cells, platelets and plasma - are used in a variety of situations, such as multiple surgeries not arising from trauma, organ transplants, chemotherapies, coagulation disorders, anemia and burns , among others. The extent of this act of citizenship is therefore vast. If you intend to donate, simply go to the collection center closest to your home or place of work, such as the various blood centers around Brazil, Hemointo, linked to the National Institute of Traumatology and Orthopedics of the Ministry of Health, the  Pro-Health Foundation centers and the Hemotherapy Service of the National Cancer Institute, just to name a few, provided you meet some basic requirements:   To be between 16 and 69 years old (or up to 60 years old, if it is the first donation); To weigh at least 50 kg; Not to be on an empty stomach (avoiding greasy food in the three hours prior to the donation); To have slept a minimum of six hours the night before the donation; To be in good health conditions; To present an original identity document with photo and, for people under the age of 18, to present an authorization form signed by a legal guardian.   Before taking this step, however, you should check the list of temporary and permanent deferrals (link to boxes of deferrals) and, if there are any extra doubts, please call a collection center to avoid wasting your time.  The chronic use of medications, for example, needs to be evaluated on a case-by-case basis. How to donate blood: what happens at a blood center The act of donating blood is simple, safe and painless, taking only about 40 minutes. This period includes the applicant’s registration, the measurement of their vital signs, such as body temperature, weight, blood pressure and heart rate, an anemia test - for the safety of the donor, who cannot have their blood stock reduced if they are anemic - and clinical screening, which includes an interview on the individual’s health history.  If no screening impairment is detected, the next step is to collect the 450 ml blood donor bag and to perform tests for hepatitis B and C, syphilis, Chagas disease, HIV/AIDS and HTLV-I and II virus infections, as determined by current legislation. Obviously, the material collected is only used by the blood bank after the test results have confirmed the absence of these diseases, but there are other conditions that can harm the patient who will receive the blood and are not caught by these tests. Therefore, it is crucial to be absolutely honest during your interview.  After the donation, the donor receives a snack still at the collection center, so that they don’t feel weak or dizzy, and are instructed not to make great efforts for 12 hours, including practicing extreme sports and professional activities involving some risk. In addition to these instructions, the donor should not smoke for two hours or drink alcohol for 12 hours and drink plenty of water to help the body replenish its blood supply - the body can do that within 24 hours after the donation. A bandage cover over the puncture needs to be maintained for at least four hours.  The benefit for those receiving blood is hard to measure. For the donor, there is a feeling of satisfaction to find that their attitude has helped someone survive a surgery or an accident, or else breathed new life into the health of so many people who often rely on transfusions for life quality. The fact is that it is worth embracing this cause. If you have any questions regarding your health condition or even your deferrals to donate, you should first consult with a doctor you trust. Temporary deferrals: when you have to wait to donate Condition/situation Waiting time before donation Colds and the flu 7 days after the symptoms have disappeared Pregnancy 90 days after vaginal delivery180 days after a cesarean section Breast-feeding Up to 12 months after delivery Intake of alcoholic drinks 12 hours Tattoo or piercing* 12 months Dental extraction 72 hours Various surgeries From 3 to 6 months, depending on the type of intervention Blood transfusion 12 months after receipt of blood and blood components Vaccination From 3 to 4 weeks after attenuated vaccines 48 hours after inactivated vaccines Risky exposure to sexually transmitted infections (unprotected sex, multiple partners, sexually transmitted infection partner and other related conditions) 12 months Endoscopic examinations (colonoscopy, endoscopy, etc.) 6 months * If the stud is in the oral cavity or in the genitals, the deferral is permanent. Permanent deferrals: when it is not possible to donate   Hepatitis diagnosed after 11 years of age Clinical or laboratory diagnosis of hepatitis B or C, HIV/AIDS, diseases linked to HTLV-I and II viruses, and Chagas disease Current or past malaria Use of injection drugs Previous diagnosis of any type of cancer Piercing of the oral cavity or genitals     For additional information access: http://portalms.saude.gov.br/saude-de-a-z/doacao-de-sangue    

6/10/2019
Children

Vaccinating children: protection that applies to everyone

Is there any reason why not to vaccinate the child population? According to experts, there is no reasonable justification for denying such a prevention to a healthy child, given that immunizers teach the immune system to naturally defend itself against pathogens that cause major infectious-contagious diseases. Thus, when the organism comes into contact with the pathogens, it already has an immune memory that allows it to produce antibodies to kill the infectious agent. The fact is that vaccination is a highly efficient preventive strategy, in addition to preventing children from going through the suffering imposed by the disease, however benign it may be - which, let's face it, is priceless. Whoever had chickenpox in childhood knows well the discomfort of being covered with vesicles that ache and itch, and leave scars. From the point of view of public health, prevention comes out much cheaper than cure. Outbreaks of infectious diseases, in the not too distant past, crammed the pediatric wings of hospitals, burdening the health system as a whole. In addition, the more people vaccinated against these diseases, fewer people are contaminated even among those who have not been immunized for any reason, given the low circulation of viruses and bacteria. Even though the protection seems individual, it is extended to the whole community. As a consequence, experts argue that not vaccinating children is a negligence, which, moreover, puts the population of a particular location at risk, as it brings the possibility of the reintroduction of eradicated diseases, such as measles. The disease had been wiped out of Brazil in 2016, but ended up returning to the country because of an uncontrolled outbreak in Venezuela. The case revealed a worrying reality: vaccine coverage against this and other vaccine-preventable diseases was low in our country and caught us off guard. Even with the initiatives of the Ministry of Health to immunize children, we had 10,374 cases of measles between February 2018 and February 2019, a good part in infants up to the age of 1.  Keep an eye on the vaccination card What is gone is gone. It is now time we rushed to stop the growth of this threat - which, worldwide, has already registered a 300%- growth only in the first three months of 2019, according to the World Health Organization, and prevent the problem from happening again with other uncontrolled infectious diseases, such as tetanus, whooping cough and diphtheria, but controlled through the National Immunization Program (PNI).  If, on the side of the health authorities, this is done through campaigns and the constant encouragement of immunization, on the citizen’s side, you just need to follow the National Vaccination Calendar, according to each age group. The vaccines offered by the program are available at Basic Health Units throughout the country and are free of charge. Concern about safety at the immunization  Made with particles of microorganisms, which are weakened or inactivated and therefore unable to provoke infection, the vaccines are very safe and undergo many tests before being used by the National Sanitary Surveillance Agency. In Brazil, 96% of the doses used by PNI are produced within our own country by institutions recognized for their quality, such as the Butantan Institute (SP) and the Institute of Technology in Immunobiological Bio-Manguinhos, of the Oswaldo Cruz Foundation (RJ). Adverse effects may occur, but are generally limited to pain and fever, which can be ceased with the use of analgesic and antipyretic, respectively. It is important to note that in childhood, most immunizers require the application of more than one dose and that children are not protected if only one is received - something that was also observed in the analysis of the justifications for the low vaccination coverage of the infants during the measles outbreak. Therefore, pay close attention to the National Vaccination Calendar and, most importantly, do not forget to follow up with your pediatrician, especially in the first years of life. One of the objectives of childcare consultations (link for childcare) is also to verify that children are being vaccinated correctly.   Vaccination only loses its meaning when the disease is eradicated In the 1950s, smallpox was still a cause of hospitalization and death of adults and children in Brazil, but thanks to mass vaccination it was eradicated from the Americas in 1971 and from the world in 1977. Today we do not need to immunize children against this disease anymore. Brazil got rid of polio in the same way, using the Sabin vaccine, which is administered orally. The last case was registered in 1990 in the country. However, as the disease continues to exist in some countries, the need for immunization remains, today with the injectable formula combined with a booster dose with the oral formula.    

6/10/2019
Prevention

Hemophilia: when blood does not clot

In cases where some part of the body is injured and begins to bleed, proteins - which are the elements responsible for the growth and development of all body tissues - come into action to stop the bleeding. This process is called coagulation. People with hemophilia, a genetic disease with which they were born, do not have these proteins and therefore bleed more than the usual.  There are several blood clotting factors that act in a determined sequence so that in the end the clot is formed and bleeding is interrupted. In a person with hemophilia, one of these factors does not work and therefore the clot does not form and bleeding continues. When factor VIII of this sequence is missing, we have hemophilia A; if factor IX is missing, hemophilia B. Blood tests that accurately measure these coagulation factors are used to diagnose the disease. Bleeding can often be spontaneous or derive from minor external trauma, such as cuts in the skin and bleeding gums or nose, or internal, especially in joints – the most affected ones are knees, ankles and elbows – and muscles, causing swelling, pain and difficulty to move. Lastly, joint deformities may occur.  It is possible to cure hemophilia The treatment of this disease, which, according to the World Federation of Hemophilia, affects around 12 thousand people in Brazil today, mainly males, has evolved a lot and is based on the replacement of the coagulation factors with the use of concentrates of plasma origin, made of purified and inactive human plasma, or concentrates of recombinant origin, produced in laboratories by means of biotechnology.  When using the medication, hemophiliacs have all the coagulation factors present again, which allows the blood to coagulate normally. After being diagnosed, people who have the mildest form of the disease can do this therapy on demand, when they have some trauma or when they know they are going to expose themselves to some risk. In general, however, the earlier the therapy begins, the fewer the patients have bleedings and sequelae - especially joint deformities – mainly in the more severe forms of the disease. Hemophilia can be mild, moderate, or severe. Some hemophiliacs do not have the coagulation factor in their blood. Others have some, but not enough to stop all bleeding. There are hemophiliacs who have hemorrhages every week, others every month, and some only once a year. The frequency with which a hemophiliac has hemorrhages depends on the amount of factors in the blood. As a result, experts advocate the so-called primary prophylaxis. As hemophilia can be diagnosed very early (box/link), replacement is indicated before the first bleeding episode, if the condition is confirmed, even before there is a second complaint. For these cases, families are encouraged to learn to infuse the concentrate in the child, who, as they grow, will also train themselves in the future, so that the family nucleus becomes less dependent on the blood center. Thus, patients and their families only need to collect the daily doses of the medication, which is provided free of charge by the Ministry of Health, and a few more for emergencies - accidents may happen and hemophilia patients need to be prepared.  If in doubt, consult a hematologist.   Watch hemophilia symptoms in your children   Please watch for the appearance of many purple spots on your baby when they start to walk or hit their limbs in the crib. Hematomas may be a sign of hemophilia. If your young child starts bleeding frequently, and the bleeding is much larger than the size of the wound, please seek medical assistance. Once the diagnosis has been made and treatment started, encourage your child to lead a normal life by studying and playing like other children. In fact, doing sports is a fundamental recommendation for hemophiliacs in order to strengthen the muscles. You should only avoid judo and soccer, for the greater possibility of traumas. Lastly, you should be aware that each hemophiliac is unique and each body reacts in its own way. For example: two young people with severe hemophilia who do the same sport, in the same way, one may have hemorrhage, but not the other one.    

6/3/2019
Prevention

You can’t be too careful when avoiding burns

Too much sunlight? Have you spilled boiling milk over your arms? Have you been burned by the flames from a barbecue? These incidents, believe me, are a public health problem in Brazil. The Ministry of Health estimates that around 1 million cases of burns occur each year, of which 100 thousand require hospital care. In addition, 2,500 people are reported dead annually in Brazil due to complications of these accidents, mainly infections. The risk of infection increases according to the depth of the burn, that is, according to the number of layers of skin affected, as well as the subcutaneous tissues and other structures involved, such as nerve endings, blood vessels and even muscles and bones. It happens that without the protection of the largest organ of the human body, the skin, the body becomes very susceptible to the action of infectious agents. Far Beyond Fire When it comes to burns, it is natural to think only of sources of heat as a cause, such as fire, the sun, and superheated surfaces and liquids. But they can also be caused by chemicals, by radioactive agents, by electric discharges and by contact with certain animals and plants - jellyfish, for example - as well as from cold sources. Regarding the distribution of these occurrences in the population, children represent 40% of the burnings in the Country, according to the Brazilian Society of Burns (SBQ). Among children under 6 years of age, accidents occur mainly with hot liquids, including bath water, and among the older ones, with flammable substances, especially liquid alcohol, used for cleaning. In addition to being life-threatening when 10% of a child’s body is burned, the injuries can leave scars and motor sequelae that affect the social, intellectual and psychological development of children. Prevention at home Unlike other public health problems, the prevention of burns depends heavily on basic safety precautions, especially when children are involved - curious by nature, they do not know how to calculate hazards on the stove or in wiring, for example. Even more, according to data from the SBQ, 80% of cases occur at home. (link to box Be careful not to get burned...) Domestic measures, however, do not exempt health authorities from fulfilling their role in educating the population for prevention and encouraging the creation of laws that may reduce the risks to the population. After all, the cost of remedying is higher for everyone, i.e., for patients and the healthcare system. To get an idea, between June 2013 and June 2014, the government spent about R$ 44 million with 43,6 thousand hospitalizations due to burns in children and young adults from 0 to 24 years of age. Superlative numbers that, to a great extent, can be avoided. Please, do your share. Be careful not to get burned Flammable sources Change liquid alcohol for gel alcohol, which not only has a higher germicidal power, since it takes longer to evaporate from the surfaces, but also offers a very reduced risk of explosion. Keep your gas bottle outside, away from any source of heat, and turn off the gas switch whenever you finish cooking. Watch out for any leaks. Heat sources Do not allow children to be in the kitchen while using the stove. Leave pots and pans in the back hob, keeping their handles to the back or to the side, so that the little ones cannot pull them. In addition, keep pan handles in good condition, so that they do not come loose and cause accidents with liquids or fuming preparations. Do not leave matches and lighters in the reach of children. Do not spread candles around the house, and if you really need to use any sort of flame, keep it away from fabrics such as curtains, towels and carpets, and keep an eye on it. Never light a barbecue by using alcohol and keep children away from the grill and fire, as well as from bonfires. Prevent children from fiddling with fireworks or being close to places where these artifacts are used, as they are a frequent cause of burns during June celebrations in Brazil. When ironing, keep children away and keep the iron standing at intervals between one movement and another. Test the water temperature before putting the children under the shower. In the tub, place your forearm, which is quite sensitive, or use a proper thermometer for this purpose. The temperature should be between 36 and 37oC so as not to burn the skin of babies. Use sunscreen and do not expose yourself to sunlight during periods of high incidence of ultraviolet rays, between 10 a.m. and 4 p.m. Do not smoke. In addition to being bad for your health, cigarettes can cause fires.   Electrical sources   Instruct children not to fly kites near transmission towers, lampposts or high voltage cables, or not to attempt to retrieve a kite that has been caught up in an electric wire.  Unplug electronics that are not being used to avoid accidents with small children and animals. Use protection socket covers and do not leave bare wires around the house. Disconnect any spark-releasing appliance immediately and call an electrician. First aidWhat to do?   Remove the source causing the burn. Wash the affected area with running water until it is cooled. Take the victim to the closest health service. If you need to cover the burned area on the way to the emergency room, use a clean, damp cloth. If there is no emergency room nearby, call an ambulance (192) or the Fire Department (193).     What not to do?   Do not put homemade preparations or ointments on the affected area as this may increase the risk of infection. Do not burst the blisters caused by the burn. If clothing or foreign bodies are stuck in the wound, do not attempt to remove them. Try to remove bracelets, rings and other accessories from the injured person as the body becomes swollen after a burn and these items can become trapped.    

6/3/2019
Lifestyle

It's time to act against pollution

In the Pixar-Disney Wall-e computer-animated film, a robot lives alone on a planet Earth covered in trash and pollution after decades of mass consumerism. In the fiction film, human beings were compulsorily transported to a spacecraft after the air on Earth became unbreathable in the year 2110.    In fact, things do not go very well for the planet and mankind. Air pollution kills 7 million people annually around the globe, according to a report released last year by the World Health Organization (WHO). Nine out of ten people chronically inhale particles with high levels of pollutants that penetrate the lungs and the cardiovascular system, which cause problems in the airways, such as respiratory infections and chronic obstructive pulmonary disease, lung cancer, heart disease and stroke.   The report also points out that, in addition to environmental pollution, caused mainly by the burning of fuels by motor vehicles, thermoelectric plants and industries in general, internal pollution also contributes to the occurrence of these deaths. Around the world, more than 3 billion people - especially women and children from poorer countries - are exposed to smoke from the use of coal and wood for cooking, as well as the use of kerosene to heat their homes. This is because they have no access to electricity or clean kitchen solutions.   Unfortunately we do not have a spacecraft waiting for us. The solution, according to the WHO, is the development of clean technologies for housing, industries and means of transport, stimulating the construction of more energy efficient homes and improving urban planning, which includes, for example, more green areas.  It seems perfect, but all this requires the creation of public policies, in addition to a lot of investment. Consequently, this will take time. Ordinary people cannot interfere with these major problems, but on the other hand, they can demand initiatives from the governments and, of course, try not to aggravate the situation of the planet with their lifestyle and consumption habits. (link to the box What to do to reduce pollution?)   Here in Brazil, according to a study conducted by the University of São Paulo, cars, buses and motorcycles account for 60% of pollution in large cities - with the exception of those that are industrial poles, in which factories lead the rank of pollutants - followed by garbage, which accounts for 25%, and by the pollutants emitted by the factories, which account for the remaining 15%. These figures indicate, in a practical way, that there is room for individual contribution towards improving air quality and the environment as a whole. Start right now.    What to do to reduce pollution? Less garbage   Use all foods well. Stalks, leaves, seeds and peels, for example, have high nutritional value and can be used in different recipes. Put just what you are going to eat on your plate and do not overload the refrigerator with perishable foods. You will not be able to cook all of them and the food will end up in the trash can. Separate organic waste from recyclables and give them a purpose. There are companies that buy the material that can be recycled, as long as it is separate and clean. Overall, you should consume less. Upcycle old clothes and accessories and avoid buying items you do not need or impulse purchasing. Give preference to consumer products that contain less packaging or are packed in containers that can be reused. When going to the supermarket, take an ecological bag or a shopping trolley Consider the destination of furniture or appliances you want to discard, which can always be repaired or remodeled to serve other people. Keep in mind that the garbage collection service does not collect bulky items.  Dispose of batteries and medicines, which can contaminate soil and groundwater, at designated collection locations.     Less energy   Avoid using too many appliances at times of peak power consumption. Use natural lighting, avoiding turning on the lights during the day. Do not overload power outlets with multiple sockets connected at the same time. In addition to spending more power, this can also cause a short circuit. Unplug appliances that are not in use. Always choose fluorescent lamps, which use up to five times less energy. Always check that the refrigerator door is well sealed and do not overload the shelves. Wash as many clothes as possible at a time, depending on the capacity of your washing machine, and also iron them in one go. Take quick showers and turn off the shower when soaping up. User pressure cookers more often, as they shorten the preparation time and use much less gas.   Fewer pollutants   Leave your car at home as much as possible. For short distances, walk or cycle, as this change of habits will improve your health. If you cannot use public transportation, for whatever reason, try to set up a carpooling system. Each day a co-worker becomes the designated driver for three or four people. Plant trees and grow ornamental plants, spices etc. In your building or indoors, these natural allies improve air quality.  

5/27/2019
Prevention

There is a remedy for smoking

To be perfectly clear:  smoking is a chronic illness caused by dependence on nicotine, which is found in products made with tobacco, and cigarettes are the product that is consumed the most.  Therefore, do not believe it when people say people don’t stop smoking because they don’t want to. Smokers who endeavor to give up smoking do in fact suffer discomfort that is not only psychological but also physical, and they need concrete help to stick to their good intention.    As it happens, nicotine, when inhaled, alters the central nervous system and modifies the emotional state and behavior of the user.  This effect causes abuse and dependence, which is characterized by tolerance to cigarettes, abstinence crises when the packet has finished and the compulsion to smoke the next one, and this sets up a user habit, even though the smoker is fully aware of the health risks involved;  which are not few.     According to the National Institute of Cancer (Inca), cigarettes kill 428 Brazilians a day, mostly as a result of cardiac diseases, chronic obstructive pulmonary diseases and, of course, several types of cancer, as well as being behind various other illnesses.  Inca has commented that the economic data is also gloomy.  Around 56.9 billion real is lost every year on medical expenses and on people being unproductive, and this culminates in a serious public health problem.  But there is a solution.   How is the stop-smoking treatment carried out?   A public health program is offering treatment to those interested in giving up smoking that consists of cognitive-behavioral therapy for a year, done either individually or in groups, together with taking bupropiona – an antidepressant for reducing the symptoms of abstinence – and what is called NRT (nicotine replacement therapy), using patches or chewing gum to help the organism to gradually get used to doing without this substance.  Some research done in 2013 by the Pan-American Organization of Health revealed that this type of approach contributes toward giving up smoking in one out of three smokers.   Another therapeutic option - a much more recent one that is not available on SUS (Brazilian National Health System) – is the use of vareniclina, which is a medicine that interferes with how the nicotine receptors in the brain function, thus reducing the amount of satisfaction gained from each inhale.  That is correct, the person gets less and less pleasure from smoking and, at the same time, the abstinence symptoms are also reduced as fewer and fewer cigarettes are smoked. As this drug acts more strongly on the central nervous system, specialists recommend first treating any mood disturbances, like depression,  before choosing this line of therapy.   It must be remembered that, although the treatment with vareniclina begins some time before the individual has stopped smoking, taking bupropiona together with NRT requires the person not to smoke, since taking the products for replacing nicotine together with cigarettes can be dangerous for the organism.    Several fronts  Whatever the option, and the treatments can even be combined, always in accordance with medical recommendation, one cannot expect miracles from the medicines used to stop smoking.  It is the smoker who beats the vice, not the medicine. That is why, the remedy must be together with other fronts including - besides therapy - physical activity, suitable eating habits, support from family and friends and professional accompaniment from a multi-disciplinary team.   The specialists that most handle the treatment to give up smoking are currently pneumologists, cardiologists and psychiatrists, but nothing need stop you being under the care of a doctor you trust to begin talking about the matter.  It is a step in the right direction.    

5/27/2019
Prevention

How to have good digestion

The digestive tract processes everything we swallow in order to obtain nutrients for maintaining the health of the organism.  To ensure good digestion, the first step is to have a balanced diet of highly nutritious food that includes vegetables, fruit, cereals and leaner proteins like fish and chicken, as well as drinking at least six glasses of water per day – preferably in between the mail meals so as not to make the stomach swell and cause a false sense of fullness.   This does not mean that foods rich in fats and sugars should be totally excluded from the menu.  It all depends on the frequency and size of the portion and when. Filling one’s plate with beans in our short lunch breaks and rushing back to work can be a challenge for the digestive system.  It is better to choose a day when there is more time to eat in and always in small amounts.   The way to eat  Another essential thing to pay very careful attention to is what is eaten and how.   Lunch, dinner or breakfast should not be had in automatic mode, with an eye on the cell phone, on the TV or laptop screen, or even during work, as so many people do today. Digestion depends a lot on meals being eaten slowly, 20 to 40 minutes, in a peaceful atmosphere.      One reason for this is the fact that the digestive process already starts in the mouth.  Therefore, people who swallow their food very quickly are already losing out right at the beginning of the game.  As it happens, chewing produces enzymes that are found in the saliva – the salivary amylases that partially digest the starch – which is found in carbohydrates, like bread, pasta, potatoes, etc.    Even though these enzymes do not digest any other food groups, chewing helps to grind up the foods and makes the next stage of the digestive process easier, when the stomach produces pepsin enzymes for breaking up protein molecules.  That being said, not chewing a piece of meat enough, for example, makes the work of the pepsin much more difficult and prolongs the feeling of that succulent steak from lunch still being in the stomach. A  As, in practice, few people think of counting each chew to reach a total of  30 to 50 times - according to what is recommended by the specialists – a tip for making this process longer is to put our cutlery down on the plate every time food is taken to the mouth.  This does not just increase the length of time between mouthfuls, but also allows more attention to be paid to the flavor of what is being eaten.     Do not skip meals    Together with the right food and correct chewing, maintaining good digestion also depends on how the meals are split up:  besides the main ones, with smaller portions, one should have three small snacks between them, eating fresh fruit or oily seeds like nuts.  This avoids that feeling of hunger that makes us eat more food more quickly than we need to at the next meal.    Not eating anything at breakfast, lunch or dinner is also a very bad habit for our health.  If one does not eat any food, the stomach still produces gastric juices, and this can harm the mucous and cause problems like gastritis.  As if that were not enough, the organism understands that it is going through a period of food shortage and, in order to save energy, slows down the metabolism.  Even if they are small, it is always more recommended, therefore, to have all your meals.   If you take these precautions, the aim of having good digestion is within everyone’s reach.  However, if you suffer from heartburn, constipation or any other gastric problems, even if they are mild, do not take antacids or other medication and do not just get used to these symptoms.  Go and see a gastroenterologist.   So that your stomach does not complain   Do not smoke.  Apart from harming several organic systems, cigarettes hinder digestion and increase the risk of gastric diseases.  Too much alcohol also causes these effects. Therefore, do not smoke and drink only a little occasionally.   Wash your hands before eating and after going to the toilet to avoid contamination from viruses, bacteria and protozoa that might affect the stomach and intestine.   Do not go barefoot in places where you are not sure of the sanitary conditions, as worms can enter your body through your feet.  And worms also cause symptoms of bad digestion.   Do not share toothbrushes, straws, cups, bottles or cutlery which might transmit, from one person to another, pathogenic agents that may potentially cause gastric problems.   A healthy digestive system requires other chronic diseases that impact on the stomach and/or intestine to be controlled, such as diabetes, hyperthyroidism, heart failure and infections, etc.    Do not ignore any gastrointestinal discomfort, especially if you have relatives that have been diagnosed with stomach cancer or intestinal cancer.    Do not prescribe yourself with any medication.  Anti-inflammatories are usually harmful to the gastric walls. When absolutely necessary, only a doctor can prescribe them and give guidance on the correct way to take them.   Reduce stress as much as possible, improve the quality of your sleep and do not lead a sedentary life.  Not being in control of these factors causes bad eating habits and, as a result, gastric complaints arise.     

5/20/2019
Prevention

Know how to prevent the risk of glaucoma

When you go to your doctor’s office, your physical examination usually includes blood pressure measurement. At an ophthalmologist’s, however, the pressure that this specialist checks is intraocular, measured by means of an examination called tonometry. High pressure inside the eyes raises the alarm for the presence of glaucoma, a disease that affects 65 million people around the globe, among whom 1 million Brazilians, according to the World Health Organization, and is considered the leading cause of irreversible blindness in the world. Behind the increased pressure is an imbalance between the production of aqueous, liquid humor that exists in the eye to lubricate and nourish the cornea and lens, and the flow of that substance. This drainage problem can be caused by changes in the anatomy of the eye itself - the most common cause of open-angle glaucoma -, by hereditary factors, infections, trauma, and misuse of medications, especially corticosteroid eye drops.  In practice, therefore, the accumulation of aqueous humor in the eyes elevates intraocular pressure, which in turn will slowly and silently damage the optic nerve, a structure that takes the visual information captured by the retina to the brain to be decodified and thus allow vision to happen.   Attention to the eye pressure The major problem with glaucoma is that, in most cases, there are no symptoms at the onset of the disease. Visual manifestations arise only when the optic nerve is already severely compromised.  Against this, screening is the only thing that works for the early identification of glaucoma. People over 35 or with other risk factors, such as African descent, family history of glaucoma, and diabetes, should see an ophthalmologist at least once a year for intraocular pressure measurement with tonometry and a comprehensive dilated eye exam, which looks for lesions in the cells of the optic nerve at the back of the eye. If the diagnosis is made, the treatment initially requires eye drops that help decrease the production of aqueous humor or stimulate its drainage. In the most common form of glaucoma, which is chronic, these medications need to be used without interruption, and evidently, you should keep your regular visits to the ophthalmologist. Constant monitoring is indispensable because the eye drops used can stop working and the intraocular pressure may rise again and injure the optic nerve. In such cases, the next step is to resort to surgery to create an alternative pathway to drain the aqueous humor. In addition to the conventional technique, called trabeculectomy, and the less invasive laser procedure, micro-implants have recently been used, which, placed in the filtration area of the eye, help to restore drainage of the fluid. As important as the need to go to the ophthalmologist periodically is to adhere to the treatment when the diagnosis is confirmed. One should never stop using eye drops without a doctor’s opinion. The surgery helps drain the fluid, but does not correct the damage done to the optic nerve. Before making any hasty decision, talk to your ophthalmologist.    

5/20/2019
Women's health

Diabetes during pregnancy: diagnosis, risks, treatment

During pregnancy, several hormonal changes occur that affect the functioning of women’s body. The metabolism of carbohydrates also changes during this period and reduces the action of insulin, the hormone responsible for putting energy from food into cells. In most pregnant women, the pancreas is able to produce more of this substance to compensate for the reduction. However, the Brazilian Diabetes Society estimates that in 3% to 25% of pregnant women, there is an excess of glucose in the circulation, which characterizes what is known as gestational diabetes.  Experts say that the emergence of this condition, therefore, is regardless of the prevalence of diabetes before pregnancy and can affect any woman. However, some factors increase this possibility, such as high weight gain, overweight or even obesity in the ongoing pregnancy, age greater than 35, short stature, first-degree diabetic relatives, excessive fetal growth, preeclampsia, polycystic ovary syndrome and history of spontaneous abortion, malformations and gestational diabetes in other pregnancies. Without diagnosis and without control, this type of diabetes carries risks for both the woman and the baby. The mother becomes more likely to develop diabetes in the future and getting it again in another pregnancy. Since excess glucose in the circulation crosses the placenta, the baby may be born with excess weight, which already predisposes it to obesity in adolescence and in adult life, and still have important complications at birth, such as drop in levels of glucose, since it was accustomed to high rates of sugar in the intrauterine environment, and difficulty passing through the birth canal due to the fitting of the fetal shoulder in the mother’s pubic bone - the so-called shoulder dystocia.  These complications, together with the risks brought by this disease in adulthood, have led to the creation of a consensus that provides for the investigation of gestational diabetes already in the first prenatal visit, either with a simple blood test to check the glucose level, or with the glycemic curve test, in which fasting glucose is measured, and after a glucose solution is ingested, or both - it depends on the time prenatal care begin. The fact is that these tests allow the doctor to diagnose the condition or even know if the excess glucose in the blood had occurred previously and thus adopt the most appropriate therapeutic course.  In general, gestational diabetes can be controlled with a balanced diet (link/box) and exercise, in most cases - indeed, the same recommended strategies to prevent diabetes in general population. If this is not enough to keep the glucose at safe levels for the expectant woman and the baby, the obstetrician has the option of associating such measures with medication.  Please do your part to avoid diabetes during gestation and do not miss your prenatal appointments.   Tips to keep diabetes away   Control your weight by eating at most 200-300 calories over a normally recommended diet, especially in the second and third quarters. If you do not have any contraindications, do regular physical exercises, always with the approval of your obstetrician (link to exercise article).  Maintain a high-fiber filling diet that stabilizes blood glucose levels. They are present in vegetables, legumes (beans, lentils) and whole grains. Eat fresh fruits. As they have a lot of fructose, turning them into juices or creams causes the energy of these foods to be absorbed very quickly by the body. Try to ingest carbohydrates always with some protein - cheese on toast, cereal with milk, and other such combinations - to slow their absorption.  

5/13/2019
Prevention

Masters of Care

Before, during and after medical care, nursing professionals are the ones to provide care in a health service, looking after not only the prescription, and following the technical and scientific procedures, but also taking into account the needs of each specific patient.   Thus, they don’t shy away from repeating an orientation as often as necessary to reassure a more afflicted individual, make their best to obtain a child's collaboration in a procedure, draw on great empathy in a moment of pain, and of course are thrilled with the patient in the face of improvement of the clinical case. In addition to participating in all stages of care, nurses, as well as nursing technicians and nursing assistants, are now involved in many other initiatives that help promote health for the community, such as research, prevention programs, entrepreneurship, occupational health and academic activities, just to name a few. The work of professionals in this area, currently more than 2 million in Brazil, according to the Federal Nursing Council, has been increasing more and more, without ever leaving aside the human essence of care, which makes so much difference in the lives of millions of people every day, anywhere in the world.  At DaVita Serviços Médicos, we value excellence in patient care and this reflects in our nursing team, who is always ready to attend and take care of our own patients when necessary.  That is why we would like to thank and honor those professionals that, day in day out, dedicate themselves to always offer the best treatment our patients could want.  Our warmest thank you to all Nursing professionals! DaVita Tribute to International Nurses Day - May 12

5/6/2019
Prevention

How and why to keep your hand clean

In the 1840s, impressed by the number of deaths of women by puerperal fever, Hungarian physician Ignaz Philipp Semmelweis began looking for the causes of the problem at the maternity ward of the Vienna Hospital where he used to work and found that patients died more in the ward in which they were attended by doctors and students than in the ward where they were assisted by midwives. After observing that the faster the delivery, the less the parturient women would become ill, the doctor concluded that it was not an epidemic, but an endemic cause, that is, from within the institution. His reasoning was already approaching the solution when a professor of Legal Medicine came to die after having contracted an infection from a wound caused by his students during the autopsies. When comparing the clinical profile of the colleague with that of the women who had the postpartum infection, Semmelweis realized that he was facing a common cause. The hands of doctors and students carried bacteria from the corpses to the pregnant women, the same ones that infected the professor. Therefore, the obstetrician determined that all medical and nursing staff, including students, would use a chlorine solution for hand washing after autopsies and before examining the pregnant women. In a short time, mortality plummeted from 12.2% to 1.2%. Today, almost 200 years later, proper hand hygiene remains the most important measure to prevent infections in health services - and therefore, to save lives - including those caused by multiresistant microorganisms that do not respond to classical treatments. The chlorine solution was replaced by products of proven efficiency against pathogens such as antiseptic soap, alcohol and chlorhexidine, just to name the best ones known. But the truth is that the topic has since never left the daily agenda in the healthcare environment (link to the box When to wash your hands). Against epidemics Outside the health services, the recommendation is the same to keep the family safe from illness - wash your hands properly (link What is the best way to wash your hands?), only with soap and water. The Pan American Health Organization recommends this should be taught early as part of education, at home and at school, so that children take this life-long habit and remain protected from infections, as they are the target of many of the diseases caused by neglect of this recommendation. Just to get an idea, 50% of deaths from diarrhea and 25% of deaths from respiratory infections in the population under 5 years of age can be avoided by washing hands with soap and water before meals and after using the toilet, according to data of the United Nations Children’s Fund (Unicef). Proper hand hygiene also prevents 41% of newborn deaths, according to Unicef, and it is recognized by the World Health Organization as the most effective anti-epidemic approach. So what are you waiting for to be safe? When to wash your hands At health care venues: Before and after being in contact with a patient; Before carrying out a procedure; After exposure to a patient’s body fluids; After being in contact with areas close to a patient. On your daily routine: Before and after preparing food; Before every meal; Before and after handling any injuries, especially in children; Before and after being in contact with sick people; After using the bathroom; When you get home.   Handwashing – step by step   Turn on the tap and wet your hands. Use soap, or detergent. Rub the palms of your hands, by rubbing the one on the right against the back of the one on the left and vice-versa, as well as interlacing the fingers. Rub fingertips, fingernails, thumbs and wrists. Rinse your hands and remove any soap residue. Dry your hands thoroughly with a clean towel or cloth or paper towel.    

5/6/2019
Women's health

How to maintain a well-nourished pregnancy

Long is gone the time when being pregnant was an excuse to eat for two. With an obesity and diabetes epidemic around the planet, more than ever health officials recommend a healthy diet not from the cradle but soon after conception. Experts warn that, over the pregnancy period, the consumption of inflammatory foods, such as sugar and refined flour, which quickly convert into glucose in the mother’s body, will likely lead to obese babies and to diabetic adults, with increased risk of the development of cardiovascular diseases in the future. Of course, energy needs increase in this period, but in caloric terms no more than about 200-300 calories a day, on average, especially in the second and third quarters - just as a comparison, this would mean like adding a glass of skimmed milk and a serving of fruit salad to the menu. In addition, research suggests that a mother’s diet habits can alter the function of the genes responsible for repairing mutations, as indicated in a 2015 publication in the scientific journal Genome Biology. The supply of good nutrients, according to this study, would ensure the integrity of the baby’s genetic material, while the lack of these would silence these protective genes, which would raise the predisposition to diseases in one’s adult life. Instead of thinking of quantity, therefore, pregnant women should worry about food quality to maintain their own health and allow the baby to have all the nutrients they need for their full development. To do so, pregnant women must eat good sources of energy, proteins, good fats - especially omega-3 -, vitamins and minerals, notably calcium, which helps to build the fetal skeleton, and iron, which forms the hemoglobin, the oxygen carrier protein in the blood. Eat without exaggeration during pregnancy According to nutritionists, with the exception of alcoholic beverages, no food is prohibited during pregnancy, unless an obstetrician has given explicit directions otherwise. However, in addition to reducing the consumption of simple carbohydrates, pregnant women only benefit when some items are excluded from their diets. Among them, dried meat and cod, because they contain a lot of sodium; carbonated drinks, as they cause bloating; stimulant drinks, because they are rich in caffeine; and cold cuts, because of their high preservative content, as well as processed and nutrient-poor foods desserts, which are filled with sodium, sugar and harmful fats (link/box). On the other hand, care must be taken not to emphasize the concern about food, to the point of turning the nine months of pregnancy into extended dieting, due to the fear of gaining weight. This is going to happen anyway. For women who have standard weight when they get pregnant, a 11 to 15-kilo gain is expected throughout pregnancy. Therefore, an overly restrictive diet, which will not allow them to gain adequate weight, may prevent the baby from receiving the necessary support for a healthy intrauterine life. In practice, good sense, which does not mean giving up the pleasure of eating, should guide their choices. Please, see what experts say and be sure to bring this matter up for discussion right at the start of your prenatal consultations. A pregnant woman’s menu Have a meal every three hours, keeping lunch and dinner, always eat moderate portions and have a variety of colors and flavors. The rice-bean mixture continues to be excellent during pregnancy. A better choice would be whole grain rice and other legumes instead of beans, such as soybeans, chickpeas and lentils, all of which rich in fiber and protein. Go for fruits and vegetables, great allies in this phase because they contain water, fibers, vitamins and minerals. Dark green leafs and vegetables are sources of folic acid, essential for the formation of the baby’s neural tube. Fruits also have slower-absorption carbohydrates, as long as they are eaten fresh. Choose poultry, fish and lean cuts of red meat and always eat them very well cooked to prevent occasional contamination by bacteria and protozoa. Please avoid industrialized food. This group includes processed meats such as sausages and frankfurters, frozen food, cake mixes, dry soup mixes, sandwich cookies, instant noodles, instant jelly mixes, artificial juices, packet snacks and foods alike.    As much as the excess of sweet is harmful in pregnancy, just change regular sugar for some sweetener when approved by your obstetrician. Cut down on coffee and chocolate drinks because of the caffeine contained in them, which should be limited to 300 mg/day - the equivalent to two cups of espresso. Milk and dairy products, such as cheese and yogurts, should be consumed on a daily basis, especially low-fat or skimmed ones. Drink about two liters of water a day, but avoid doing so during meals to avoid heartburn. Hydrating the body contributes to preserving the placenta and amniotic fluid, as well as to good intestinal work. Lastly, a practical tip to reduce sickness: eat dry foods as soon as you wake up, such as a crackers or toast.   Sources: Brazilian Association for the Study of Obesity and Metabolic Syndrome

4/29/2019
Sleep

Take care of your children's sleep

Modern life stimuli are stealing our hours of rest as well as those of children. If less than two decades ago sleep competed with TV shows, with the advent of children’s channels, now there is always a small screen available for the little ones, with numerous possibilities for entertainment and interaction. Along with that comes people’s current lifestyle. Parents work till late and when they get back home, they want to make up for the time away from their children. The fact is that the day begins quite early and ends far too late in most homes. Children pay a high price for this routine.  Experts unanimously state that the lack of restful sleep is associated with the development of health and behavioral problems, including poor school performance and learning difficulties, childhood obesity, attention deficit hyperactivity disorder (ADHD), immunity decline, mood swings and even depression. But how does one prevent home from becoming a real center of attractions at night and bedtime from turning into a struggle? Faced with the attempts of their parents, children are reluctant, regardless of age. Some won’t  finish their homework without their mom’s help; others won’t turn off their cellphones even when in bed; the youngest one kicks and cries at the possibility of being alone in the cradle, and a few hours of protest later, they run into mommy’s bed. The key to improving the quantity and quality of sleep for children is to start early on the so-called sleep hygiene, a set of behavioral and environmental measures that helps to provide quality nighttime sleep. The process should begin as early as the second week of a baby's life, experts say, in order to prevent bedtime problems later on. The good thing is that adults suffering from insomnia can also put this strategy into practice. Get started today and keep your kids’ pediatrician informed of the results. Children’s sleep hygiene   Determine a time for your child to go to bed and follow this routine even on weekends, with a maximum variation of 30 minutes. Also set a time to turn off all electronics, at least 30 minutes before bedtime. Be careful not to change electronic devices for very stimulating game-like activities. Create a pre-sleep ritual, which helps the child understand that it's time to slow down. Having them shower, brush their teeth, put on their pajamas and telling them a story are good examples. Make the environment conducive to rest. Turn off the main bedroom light, turn on a lamp, and maintain a cozy temperature, warm when it is cold and cool when it is hot. The house doesn’t have to be in silent mode, but it is worth lowering the volumes. Don’t let children fall asleep in any place other than their bedroom. Take them to bed while they are still awake so that they understand they have a place of their own for that. So, if they wake up at night, they will feel safe to go back to sleep. Don’t prolong the afternoon sleep of those who are still into napping, and at night don’t wake the child for nursing unless they are too small or their pediatrician has made that recommendation.    

4/29/2019
Prevention

Hansen's disease still exists. Know the symptoms

Hansen's disease is an infectious disease that has occurred since ancient times. According to the Brazilian Society of Dermatology, the earliest possible account of Hansen's disease date back to more than 4,000 years in countries such as India, China and Egypt. But do not think that this problem has been vanished. Brazil, believe it or not, still reports about 30,000 cases per year, ranking only behind India in the world rank. Previously known as leprosy, the disease is caused by the Mycobacterium leprae bacterium, or Hansen's bacillus, in reference to Armauer Hansen, the scientist who discovered this microorganism in 1873. Although it is a skin disease, the bacillus is not transmitted by physical contact with patients, but by droplets of saliva and sneezing, which might happen more easily when in case of prolonged coexistence with a patient who is not aware of his/her condition. For an example, the incubation period between contamination and the onset of symptoms ranges from six months to five years. The current high prevalence is due to the fact that many people still live under poor sanitation conditions around the world, which is why experts consider Hansen's disease to be a typical illness in developing countries. In the United States and European countries, for example, the disease was eradicated in the last century after the quality of life of their populations improved. When should Hansen's disease be suspected? How’s the diagnosis and treatment? Hansen’s desiase causes clear, red and even dark spots, with imprecise limits. Clinical and dermatological examinations reveal a decrease or even loss of sensation in the affected areas – one can touch a very hot surface with the affected area and feel nothing - associated with the loss of hair and absence of perspiration. This is because M. leprae affects nerves and muscles. Other symptoms include numbness and muscle weakness, finger retraction, and even physical disability. During the acute phase, colder parts of the body, such as ears, hands, elbows, and feet may feature lumps and/or become swollen. A physician will usually makes the diagnosis through physical or skin examination, but, when in doubt, he/she will request the collection of moist secretions from ears, elbows and skin in general, which will be sent for laboratory analysis, as well as skin biopsy, which consists of collecting tiny fragments from the lesioned areas for anatomopathological study, an examination that macroscopically and microscopically verifies the nature of the alterations. Once the Hansen bacillus infection has been confirmed, the patient undergoes a long-term treatment, from six months to one year, with a combination of antibiotics that are provided free of charge by the Brazilian Single Health System (SUS, the acronym in Portuguese). The risk of transmission is eliminated after the first dose, but healing only comes after the end of the therapy. Should you detect any spot on the skin, it is advisable to seek clarification from a dermatologist and, in case of constant contact with a leprosy patient, it is necessary to have the BCG vaccine, also available from the public health network, which provides essential care to prevent the contamination and dissemination of the bacillus. If you have any question, consult a dermatologist.

4/22/2019
Prevention

Learn to take care of your voice

Just like any other structure in the body, the voice also needs attention paid to it if it is not going to suffer from alterations, early aging - yes, it changes as the years go by – or impacts from upsets to the vocal apparatus, the most common of which are calluses, or nodules, on the vocal chords.    This mission requires, apart from discipline, a healthy lifestyle. According to the Brazilian Society for Speech Therapy, smoking and alcohol compromise vocal health. Cigarettes affect the tissue of the larynx, which is precisely where the vocal chords are, and increase the risk of cancer in this cavity.  Alcoholic drinks, in turn, cause an anesthetizing effect at first and possibility even mitigate problems.  But just like cigarettes, they are irritants and even lower control over the voice, which can result in vocal abuse like speaking loudly and shouting do.   Exposure to air conditioning can also be harmful, not because of the colder temperature but because of the lack of humidity, and this affects the vocal apparatus.  The solution, many specialists say, is to drink plenty of water, which hydrates the vocal chords and reduces the force needed for producing the sounds of speech. The recommendation to eat apple to complement the care being taken is not a myth.  Speech therapists and ear nose and throat specialists recommend eating this fruit because of its astringent properties – or rather, it helps clean the mouth and the larynx, which improves the resonance of the voice.  What’s more, the chewing that is needed loosens up the muscles that are responsible for articulating words. Still within the question of food, it is worth remembering that extremes in temperature irritate the larynx, according to the specialists, and compromise vocal health.  Very hot things, especially, are also bad for the throat. So, the safest thing is to opt for foods and liquids that are neither too cold nor too hot. Trained voice   Besides all this, the way the voice is used needs to be trained.  Since constantly shouting causes strong friction between the vocal chords, it ends up causing lesions in the region.  Who has never woken up hoarse after getting over enthusiastic at a show or football match? On the other hand, whispering too much causes impact on the vocal apparatus because, in order to let out the whisper, tension is needed to block out the natural sound of the voice.  In practice, one should seek balance; or rather, speaking without forcing and opening the mouth wide to articulate each word. Avoiding very noisy environments, which result in vocal abuse, is recommended. The care being taken might have to be even more intense if the voice is, let’s say, an instrument of work.  Actors, lawyers, presenters, journalists, radio announcers, teachers, singers, politicians and, more recently, lecturers, telemarketing operators and youtubers, among many others, make full use of words every day to defend their ideas and to sell new ones.  For these people, the realization that voice exercise with a speech therapist might help keep their voce beautiful and minimize the risk of lesions. How to deal with complaints   So far, we have been dealing with prevention.  But if there are already any complaints, these steps alone will not be enough.  According to the specialists, any difficulties should be taken seriously. These range from any noticeable changes in the voice – it has become higher deeper or breaking up – through speech becoming ‘tired’, hemming and coughing up to hoarseness and pain when swallowing.  It is worth observing whether these things increase when using the voice too much or get less when resting the voice. In these cases, go straight away to an ear nose and throat specialist and do not fall into the temptation of relying on homemade remedies, like gargling, which might even worsen the situation.    

4/22/2019
Prevention

Hypertension: be careful with salt consumption

You have probably heard that salt is associated with an increase in systolic and diastolic pressure in the arteries and that too much of it contributes toward arterial hypertension, which is a condition characterized by pressure indexes that are equal to or above 140/90 millimeters of mercury – or 14 over 9 –, which is an important risk factor for cerebral vascular accident and renal insufficiency.   This relationship really does exist, and it is due to the action of sodium chloride, which is an element found in salt.  When we eat very salty foods, what happens is that the sodium accumulates not only in the bloodstream, but also in the fluids that are outside the cells.  As it attracts water molecules, the organism then retains liquid in order to keep up the balance between the hydric volume in the extracellular space and in the blood, the amount of which being circulated then increases.     With more blood inside the veins, the pressure that it makes in order to flow through the circulatory system is higher, as naturally the arteries offer some resistance to its flow – it is as if the flow from a tap had been opened up and the water started to go through the inside of the pipe violently.  If this happens in a chronic manner, arterial hypertension has been established. Prevention requires less salt on the plate and on the shelves   As it is a silent disease that usually causes any symptoms only when the organism has already been considerably exposed to the effects of high pressure, it can take a while before a person knows they are hypertense, especially if they do not go to the doctor on a regular basis.  Therefore, reducing consumption of salt to acceptable levels is an effective way of preventing an increase in blood pressure - even though hypertension also has other causes.   However, one should not cut out salt completely because sodium chloride has important functions in the body, seeing as it balances water, is involved in muscle contractions and provides energy.  So, according to the World Health Organization, the daily requirement of sodium is 2.000 mg – equivalent to 5 g of salt. Brazilians, however, consume more than twice this amount, around 1 2 g, according to the Ministry of Health.  And most of the time we do this by force of habit. For instance, data from the Family Budget Research by the Brazilian Institute of Geography ad Statistics has shown that the food industry is answerable for 23.8% of sodium consumed in Brazil, while the rest,  76.2%, is added as a spice when preparing food. Play your part in controlling the consumption of salt and make sure you go to the doctor periodically to check your blood pressure.   Tips for reducing consumption of sodium   Take salt off the table.   Cook without any salt and then add only the recommended amount, especially if you have hypertension.   Use a lot of herbs and natural spices – garlic, onion, oregano, parsley, basil, lemon, ginger, etc. - instead of salt.   Eat more fresh food, like meat, fruit and vegetable.   When eating out, choose establishments that serve lightly spiced food and kilo restaurants as they offer a wider choice of fresh food. Before buying industrialized foods, read the label and choose only things that have a low salt content.   Avoid ultra-processed foods, like sausages and bacon, and ready sauces, like mayonnaise, soy sauce, ketchup and mustard.   Other causes of arterial hypertension   Besides consuming too much salt, some other factors contribute toward a person becoming hypertense:   Family history of the disease (the only unchangeable one) Alcoholic drinks   Cigarettes Obesity Stress High levels of cholesterol   Lack of physical activity  

4/15/2019
Women's health

Your lifestyle and breast cancer

Several aspects are related to the onset of breast cancer, including biological, hormonal, genetic and behavioral factors, but many of those aspects, such as age, cannot be altered. Four out of every five cases of neoplasia are diagnosed in patients after 50 years of age. However, as far as women are concerned, a lot can indeed be done to prevent the disease from developing - this is what doctors call primary prevention. The National Cancer Institute (Inca) estimates that the risk can be reduced by up to 30% with some lifestyle changes. Check this out: Weight Control Keeping the optimum weight is a very important prevention strategy, especially during menopause. Excess fats produce excessive estrogen, right when women need less of it because ovaries have stopped working. Estrogen produced by the fatty tissue stimulates the proliferation of mammary cells. This, added to the chronic inflammatory state caused by obesity, creates the scenario for a disordered multiplication of malignant mammary cells. Do physical activities Exercising brings benefits the whole body and helps preventing several other diseases, in addition to breast cancer. Physical activity, when done regularly and under supervision, is an essential component for maintaining the optimum weight and, thus, preventing the establishment of an environment conducive to the development of malignant mammary cells. In addition to preventing cellular aging. Refrain from drinking Alcohol consumption is increasingly associated with breast cancer. European and American researchers have found that the ingestion of one single dose a day of any drink with more than 10 grams of alcohol - a glass of wine, for instance - already increases the risk of premenopausal and menopausal breast cancer by 5% and 9%, respectively. Researchers reckon that the factor behind this relationship is, yet again, the excessive production of estrogen. It is worth mentioning that alcohol also affects other body organs, causes traffic accidents and brings numerous social losses when chronically consumed. Maintain a balanced diet Population studies indicate that a diet based on fruits, vegetables and whole grains reduces the risk of developing breast cancer, and such risk is reduced even further when this habit starts during adolescence - another reason for girls not to reject their salad! Also, these foods are rich in fibers, which contributes to satiety and weight control. It is worth remembering that, according to the Inca (National Cancer Institute), such a diet also reduces the risk of other types of cancer, such as intestines, esophagus, prostate and stomach cancer. Breastfeed   If you get pregnant, do your very best to breastfeed. In addition to providing numerous benefits to the baby, this practice is considered a protective factor for breast health. Accordingto information from the Ministry of Health, the risk of having breast cancer falls by 4.3% for each year breastfeeding. The protective mechanism is not quite clear, but it is believed that, since women do not ovulate during this period, they become less exposed to the action of estrogen. After all, this hormone is related to most cases of breast cancer. Do not smoke Smoking is related to the development of various types of cancer and cardiovascular problems. Regarding breast tumors, evidence shows that smoking contributes to increasing the risk, but results are still contradictory, according to Inca. In any case, it is also important to stay well away from such habit in order to prevent diseases.  

4/15/2019
Prevention

Get to know how our patient’s safety is guaranteed

When you use any health service, you expect your doctor and nursing staff to understand your clinical complaints and provide you with a solution to alleviate them, whether it is guidance, a more invasive procedure, a blood or imaging test, or administration or prescription of medicinal products. Although health institutions also expect everything to work to the full, there is always a small risk of what experts call an adverse event, that is, any incident that results in harm to the patient, from failure to identifying the patient, to bruising after blood collection or infusion of medications, and even errors in surgical procedures. According to ANVISA - National Agency of Sanitary Surveillance, Brazil still has a high incidence of these problems, close to 10%, according to recent studies.  In order to reduce the number of adverse events in the country, the Ministry of Health launched the National Patient Safety Program in 2013, following the model of the World Health Organization, which maintains the World Alliance on Patient Safety. The objective of the initiative is to reduce, to an acceptable minimum level, the risk of harm to anyone receiving any kind of health care, anywhere in the Brazilian territory.  In addition to continuously establishing various safety protocols, Anvisa has determined, within the program, the creation of Patient Safety Centers, a mandatory body in both public and private services to promote actions aimed at ensuring patient safety. Together with prevention activities, this structure must control and mitigate risks, integrate work sectors and manage processes and information that impact any assisted individual.   April: Patient safety month As the program was created on April 1, 2013, many health care institutions dedicate that month to strengthen procedures to ensure patient safety and thus improve the quality of the service as a whole. Among the subjects revisited on such occasions may be, for example, the protocols for handling and disposal of sharp objects and those dealing with surgical safety, just to name a few topics on focus (link to the box What can affect a patient’s safety). For Anvisa, this contributes to the qualification of care processes and the provision of services in establishments in Brazil, which allows greater safety not only for those who receive the assistance, but also for those who provide it and for the whole environment in which care occurs.   What can affect a patient’s safetyHere are some of the issues that deserve the deepest attention of those who work in health care to avoid adverse events: Hand hygiene Aspects related to surgeries Prescription, use and administration of medicines Blood and blood components transfusions Use of equipment and materials  Preventing falls  Prevention of infections related to health care  

4/8/2019
Physical activity

Stay away from anabolic steroids

Bodybuilding is now the second most practiced physical activity in Brazil, according to research Vigitel, of the Ministry of Health. In fact, this modality is intended for young adults, adults and the elderly, as it promotes an improvement in strength, circulation and balance. As muscles use a lot of energy, doing resistance exercises still leads to caloric expenditure and, in the end, brings an increase in muscle mass, also called lean mass. With this last benefit in mind, many men are not happy with the results obtained with training and most commonly resort to anabolic steroids, as well as to the growth hormone. To get an idea of how often these are used, one in every 16 students has already used such substances, according to a survey conducted by the Brazilian Society of Endocrinology and Metabolism. The hormones, which are made from the testosterone hormone, cause muscular hypertrophy, but they have a number of paradoxical effects, that is, contrary to what would be expected of a male hormone, such as breast growth, reduction of the testicles, erectile dysfunction and decrease in the sperm count. This is because, when it gets too much artificial testosterone, the body turns it into estrogen, a female hormone, through a process called aromatization, commanded by an enzyme. The excess of this anabolic type also blocks the secretion of two hormones that stimulate the testicles to produce sperm and natural testosterone. The effects, however, are not restricted to the reproductive and endocrine systems, but are spread throughout the body. Steroids still cause major acne, baldness and liver problems, including tumors, as well as effects that favor cardiovascular disease, such as increased blood pressure, elevated cholesterol, fluid retention in the body and clot formation, changes in behavior, such as aggressiveness and hallucinations. Synthetic growth hormone (GH) based anabolic steroids, also known as somatropin, produce increased lean mass and fat burning, but also at the expense of relevant risks. Experts warn that, in practice, its effects range from the onset of type 2 diabetes and severe allergic reactions to the development of malignant tumors.   Clinical use It is important to note that synthetic testosterone can be used clinically, but in very specific conditions. Among them, we can highlight the cases of deficiency of the male hormone, of severe malnutrition that causes very rapid weight loss and in the postoperative period of major surgeries that cause physical exhaustion, among other (few) situations. GH, in turn, is only used in patients with deficiency in the production of this hormone in childhood and in certain genetic syndromes where they can promote better growth for children. For the purpose of muscular hypertrophy, we should emphasize, doctors prescribe neither steroids nor GH. However, it is possible to associate the ingestion of dietary supplements with training, which will stimulate the muscles without causing damage to the body, provided they are used correctly, or, better yet, to follow a diet with foods that have proven to help to form lean mass. Talk to your doctor or a nutritionist and find out what to do to achieve your goals in bodybuilding workouts.  

4/8/2019
Women's health

Breast self-exam does not replace mammogram

Those who are already in their 30s and 40s probably remember the explanatory leaflets that showed, a few decades ago, the step-by-step for the self-exam in campaigns on breast cancer prevention. At that time, this procedure was recommended as an essential strategy for earlydetection of the disease. But, the advances in Diagnostic Medicine have come, especially in imaging. With the advent of mammogram, which can detect minute tumors, still at an early stage, for a low cost, health authorities began to be more sparing regarding the recommendation of self-exam. After all, when compared to a mammogram, this practice can only identify visible signs or palpable masses, which, if confirmed as the manifestation of a malignant tumor, may already correspond to cancer at a later stage. But that does not mean that self-exam has left the scene. Experts agree that women should regularly take some time to check for any internal or external changes on their breasts, even a slight asymmetry, through a thorough palpation and detailed observation. This can make a difference, for example, in the interval between one mammogram and another - usually one year - even in a region with little availability of health services. The fact is that self-exam remains important as long as it integrates a breast cancer screening program. When isolated, it does not reduce mortality from the disease, as evidenced by international studies involving thousands of women. Thus, medical associations do not discourage the strategy, but make it clear that, in order to track breast tumors, it is essential to undergo a clinical examination of the breasts during the consultation with a gynecologist or mastologist, as well as make of use the imaging methods indicated for each woman, notably the mammogram. Self-test is valid, but if part of that package.   Seek a gynecologist or mastologist and learn more.  

4/1/2019
Physical activity

Exercise also improves mental health

It is no secret that physical activity has a thousand and one uses relating to health.  Doing regular exercise plays a significant role in preventing cardiovascular diseases - which are the main cause of death throughout the whole world - promotes more harmonious functioning of all the organs and, of course, improves one’s figure and disposition (link to box), among many other benefits to the body.      So, it is not surprising that the purpose of most people when they begin a training program is to lose weight or to treat – yes, that’s right – to treat other illnesses.  For example, together with a balanced diet, regular exercise can keep the rates of blood glucose under control in patients with the type 2 diabetes, and this lessens the need for medicines.  In the same way, with people who have osteoporosis, doing physical activity is essential for helping to form new bone cells.      If these effects are incontestable, working on the body is being ever more associated with good mental health.  Apart from the fact that physical activity makes the brain produce endorphins – the “happiness hormone” – and other neurotransmitters associated with wellbeing, exercise, according to the specialists, seems to stimulate the growth of nerve cells in the hippocampus, which is the area that regulates mood and which, in patients with depression, is lower when looked at in image examinations.  However, if producing substances that provide satisfaction occurs straight after training sessions, then the impact of physical training on neuronal regeneration of a depressed brain depends on how regularly it is done. Exercises as an antidote for depression These lines of research also demonstrate that exercise not only contributes to treating, but also to preventing mood disorders.  A study published by the The American Journal of Psychiatry last year showed that moving the body produces a protecting effect against depression in healthy individuals, irrespective of the age of the person or the geographical region they live in.  Carried out by researchers from four Brazilian universities and seven foreign ones, this study brought together information from 49 studies and analyzed data from 265 thousand people from 20 countries. Although the scientists have not yet investigated how much activity is needed to obtain this protection, six out of the 49 studies analyzed suggest that the amount of exercise recommended by the World Health Organization is 150 minutes of moderate activity per week, which would be enough to lower by about one third the risk of depression arising throughout one’s life. Other benefits of exercise Besides the neuronal and biochemical mechanisms, exercise interferes with other factors as well that impact mental health.  It reduces the effects of day-to-day stress, which requires no explanation, and improves the quality of sleep, which allows the individual to enter the deeper phases and enables them to wake up feeling more rested and willing and able.     Last but not least, doing physical activities is also good for one’s self esteem, in that it shapes the body and, when done in groups, enables interaction with other people, taking the individual out of isolation.  A bunch of reasons for being at peace with life. Always remember to go to the doctor before beginning to do exercise. The effects of physical activity on the body It contributes to the organs functioning well, above all the cardiorespiratory system.   Helps the intestine to function well.    Prevents illnesses, such as cardiovascular problems, diabetes, osteoporosis and rheumatism, among others, as well as helping to treat them.   Contributes toward losing body fat and gaining muscle mass.   Helps balance calorie ingestion and energy expenditure.

4/1/2019
Prevention

Cancer: know all about the disease

The human body is made up of trillions of living cells, which grow, have an orderly division, and die. In adulthood, most of them split to replace worn-out cells or repair damage. How cancer begins Cancer results from disordered cell multiplication. This growth is different from normal because, instead of dying, the cells continue to form abnormal units. These cancer cells grow and invade other tissues, something the normal ones do not do. In addition, they are able to form new blood vessels to receive oxygen and nutrients and fool our immune system. Some even detach themselves from this initial tumor, fall into the bloodstream or lymphatic vessels and give rise to new tumors in distant organs, which doctors call metastases. Why cancer develops The disordered multiplication of cells can be triggered by internal biological reasons, such as genetic inheritance, cell aging or diseases of the organism itself, or by external reasons, such as the environment. In many cases, what causes cancer is unknown and the disease can develop in any tissue or organ. According to the National Cancer Institute (INCA), sunlight exposure, smoking, sedentary lifestyle and inadequate diets are the main environmental factors that favor the development of tumors. New perspectives Based on INCA data, approximately 600,000 new cases of cancer were estimated in Brazil in 2018. The importance of an early diagnosis, with clinical exams and routine screening, can cause a more favorable outcome most of the time, with better results in the treatment and, in many cases, even the cure. Therefore, the need for periodic medical follow-up and specific tests makes all the difference in a patient’s life. The role of genetics In about 10% of the cases, the factor that alters the genetic material, which leads to the predisposition to the onset of cancer, is inherited from the father, mother or both, who in turn inherit it from previous generations. These are hereditary cancers, which include some cases of breast, ovarian, intestinal, thyroid and kidney tumors, to name a few. With the evolution of Genetic Medicine, changes in certain genes can now be identified through DNA tests. Detection of these mutations allows us to intervene in the course of the disease and, in some circumstances, even prevent its onset. As an example, we can refer to breast and ovary cancer, in which mutations are observed in BRCA1 and BRCA2 genes. Therapeutic breakthroughs Knowing cancer in depth makes it possible to choose the best treatment for patients. Traditionally, the treatment of various types of cancer is based on chemotherapy, radiotherapy and surgeries. While chemotherapy, created in 1970, attacks all fast-growing cells in the body, which brings results far below expectations, with painful side effects for patients, the emergence of new therapeutic modalities has changed this scenario, with surprisingly superior results when compared to chemotherapy and even with immensely minor side effects, promoting exceptional life quality. They are: - Antiangiogenic agents, which block tumor blood vessels, preventing their growth. - Immunotherapeutic agents, which stimulate the immune system to specifically attack cancer cells and have been prominent in some types of cancer, such as melanoma, kidney and lung. - And, what appears to be the greatest of current advances, the emergence of personalized treatment for each type of cancer, called target-therapy.  This is a modality that emerged through a better understanding of how genes, proteins and molecules present in tumor cells act. In practice, these drugs identify and attack specific features of cancer cells, blocking the growth and spread of cancer. Some examples of the application of this therapy: Breast cancer - About 20% to 25% of cases of the disease have the protein called Human Epidermal growth factor Receptor-type 2 (HER2), which stimulates the growth of tumor cells. Thus, in invasive breast cancer patients, it is recommended that HER2 tests be performed. If the results show that the tumor is positive for this protein, several drugs can be used as treatment options. Colorectal cancer – Medications that block the epidermal growth factor receptor (EGFR), which is often overproduced in this type of cancer, may be effective in stopping or slowing the growth of colorectal tumor, as long as it does not have a mutation in the KRAS gene. In addition, the target therapy may be targeted to vascular endothelial growth factor (VEGF), a protein that helps to form new blood vessels. Lung cancer – Drugs that block the EGFR may be effective in stopping or delaying the growth of this type of cancer, especially if the EGFR gene presents certain mutations. Target therapy is also available to treat lung tumor driven by the mutated ALK gene. Melanoma – Approximately 50% of melanomas have a mutant or activated BRAF gene. Recent research has shown that specific changes in this gene work as good targets for drugs. Chronic myeloid leukemia – It is caused by a specific genetic lesion, called BCR-ABL or Philadelphia chromosome. Several drugs have been created to specifically target this genetic disorder, such as imatinib, dasatinib and nilotinib. Notably, these treatments can be administered orally, have few side effects and some patients can be effectively cured.   Although the cancer treatment scenario is changing every year, it is also important to seek a healthy lifestyle, not to smoke, drink alcohol very sparingly, maintain a balanced diet, eat foods that are high in fiber and fresh, control your weight, do regular exercise and protect yourself from the sun. This set of measures, according to Inca, can help prevent at least a portion of all cases of cancer that occur each year. Please, do your share.   Sources: AC Camargo National Cancer Institute Oncoguia

3/28/2019
Children

My child doesn’t want to eat. What shall I do?

If medical societies are worried, on the one hand, about the growing rate of obesity, on the other hand, many pediatricians are faced with parents in the doctor’s consulting room frequently complaining:  “My son doesn’t eat, doctor. He doesn’t eat anything”. Mealtimes, which should be pleasant and happy moments for the family, are becoming a battle field. But this complaint should not keep parents awake at night (quite so much) -–especially mothers, who have an intrinsic need to feed their children because that is what they have done since birth, by breastfeeding.   This is because, according to the specialists, the energy demands of little children really changes as time goes by. In the first year of life, babies eat a lot because they are developing very fast.   At 5 months old, their weight, generally speaking, is twice what it was at birth and it is three times greater between 11 and 12 months old.  In the second year of life, growth continues to be fast, but it will be slowing down until it reaches a much slower rate, from the ages of 3 to 10.   Children’s appetites, therefore, accompany this need that the organism has. Quality versus quantity So, if your child does not eat - pediatricians say that they always eat something, whether it is from their feeding bottles or whether it is little snacks - and carries on growing suitably, just relax! Continue offering things naturally, but taking into account that it is up to the parents to decide the quality - or rather on what the little ones should eat and when - but the one who decides how much is the child.   As they grow older, they will become crabby and make a fuss and get restless if they are forced to eat. Obviously, some says will be better than others, depending on the menu and the taste preferences of the child. There’s no point falling into the temptation of always making only what they like because this tactic, besides being tiring, will create phobias for anything new and will also lower the quality of the diet.   After all, a diet with little variety in it does not provide all the nutrients necessary. Therefore, the main meals should be made up of small portions that contain all the food groups, by which we mean carbohydrates, vegetables, proteins, leafy vegetables, root vegetables and fruits; all of which, it must be pointed out, enable  wide variety throughout the week. If little ones eat one spoonful of each portion, you can be sure that one day’s battle has been won. See here for other tips and, if there are any questions regarding the causes of lack of appetite in children, ask the pediatrician.     How to develop a good relationship with food From 6 months old upwards, make the child part of the main (or possible) meals together with the rest of the family.   The ideal space between each meal is three to four hours. Adjust the little one’s seat to fit at the dinner table, in a way that it fits appropriately into this space – it could be a highchair, if he is a baby. Switch off any electronic distractions. Bean soup cannot compete with a character reacting to stimuli on the tablet! Offer the child whatever the family is eating and leave him to his own devices. Try putting pieces of food within the baby’s reach – if he puts everything in his mouth, why wouldn't he do the same with foods? For children who already eat using cutlery, serve small portions no bigger than the child’s fist.   Offer new foods all the time. Specialists recommend offering novelties to children many times - 10 to 15 times - before giving up.   Don’t let meals last for more than half an hour and don’t mind the mess After all, it will be for a very good cause.   The World Health Organization recommends just breastfeeding for babies of up to 6 months old.  

3/28/2019
Well being

It is possible to live well with epilepsy

What do the Brazilian writer Machado de Assis, the French heroine Joan of Arc, the Russian writer Fiódor Dostoiévski, the Dutch painter Vincent van Gogh, and the French writer Gustave Flaubert have in common? There are reports showing they all lived with epilepsy, a neurological disease characterized by abnormal and excessive electrical discharges in the brain that triggered sudden crises, with changes or loss of consciousness, stupor, hallucinations, and seizures – with muscular contractions and involuntary movements. If they were still alive, these celebrities would be part of the 50 million people who suffer from this disease worldwide according to the World Health Organization (WHO) - 3 million of them in Brazil. They try to live normally; despite the stigma they carry on due to epilepsy. After all, since ancient times the condition relates to supernatural forces and spirit possession, insanity, and even contagious diseases. Believe it, access to restaurants, theaters, recreation centers, and other public places was not allowed to these people in the United States until the 1970's. Still today, some countries reflect the lack of laws and customs. According to the WHO, China and India, for example, allow marriage annulment if a spouse pleads the spouse's epilepsy as the reason to do so. But why all that? The disease undermines the sense of self-control we think we have. Although sometimes anticipated by some factors, the crisis may be sudden and completely subjugate the patient. It is not uncommon for people around to be scared due to ignorance on the subject, and often they do not know what to do (link to box).   Other times Today we know that epilepsy is a complex disease. It is in fact a dysfunction in the communication between nerve cells due to factors such as genetic predisposition, trauma during or after birth, malformations, and even sequelae of strokes or infections such as meningitis. In a regular situation, neurons communicate and organize using their excitatory and inhibitory properties. During the crisis, however, there is an accelerated process of excitement spreading from one neuron to the other without interruption as if they were ‘rebels’. In the past there were few therapeutic attempts, but now things have improved greatly. According to the Brazilian League Against Epilepsy, 70% of cases can be treated successfully with medications. After a variable treatment time, medication may even be suspended in some cases depending on the type of epilepsy. The diagnosis also evolved, although the classic electroencephalogram - an exam capturing the rhythm of brain waves - remains the method of choice to assess these patients. The point is that thanks to science discoveries neurologists already know that each type of epilepsy responds better to a given drug, allowing individualized prescriptions, which can be the selected from more than two dozen existing anticonvulsants. In any case, drug-resistant cases persist, in which surgery is usually an option. The fact is that something can always be tried when seeking expert medical help. What is unacceptable in the present day is isolation and not enjoying life because of the condition.   Living life at its best The patient who keeps epilepsy well under control can do everything anyone does: study, work, play sports, date, have a family... They should only avoid what favors crises, such as sleep deprivation, strobe lights used in nightclubs, and alcohol intake, even during treatment. In Brazil, driving is permitted by the State Traffic Police Department, as long as corroborated by a medical report certificating that the person is free from crises for 12 months without anticonvulsant, or when the patient does not take any more medicine, and was free from crises for two years before stopping the medication. In the latter case, stopping the medication should be for at least six months - and, of course, without any crisis during that period. Pregnancy is also allowed, but according to experts it should be planned one year ahead and rely on great interaction between the obstetrician and neurologist. Some anticonvulsants can cause fetal malformations, and in order to reduce it changing the medication or reducing the dose may be required, which must always to be done before conception. Similarly, the use of folic acid to prevent neural tube defects in the baby is usually implemented in this phase prior to pregnancy. Practicing physical activity is strongly recommended for people who suffers from this disease. A research at Universidade Estadual de Campinas showed that exercises increase self-esteem, resilience and quality of life of these individuals, as well as reduce depression symptoms common to people with epilepsy (link to the article about Physical activity and mood). Only water sports should be practiced with an instructor. Extreme sports are not encouraged because even when exercising in pairs the risk of accidents in case of crisis is not ruled out. For further information, see a neurologist.   What to do when witnessing a crisis Keep calm and try to calm down those around you. If possible, prevent the person from falling abruptly on the floor; place them in a place where they cannot be injured, but do not try to prevent involuntary movements. Put something soft under the person's head. Try to turn the patient to the side so that there is no risk of aspiration of excessive saliva or vomiting. Do not put your hand on the person's mouth to unroll the tongue. This is a myth, and you can end up being bitten. When the episode ends, tell what happened and offer to call a relative. If the crisis does not cease within five minutes, search for medical help.

3/19/2019
Women's health

Learn about mammogram myths and truths

As breast cancer is the second most common cancer diagnosed in women, the Breast Cancer Awareness Month campaign emerged in the 1990s, aiming at talking about the disease and encouraging the female population to seek health services for consultations and screening tests. Among other tests, mammogram is main one, as it provenly reduces breast cancer mortality, for it allows detecting the tumor at an early stage, at a time when the chances of cure are higher. In Brazil, the National Cancer Institute and the Ministry of Health recommend that women with more than 50 years of age, with no family history of the disease, be screened for cancer, while the Brazilian College of Radiology recommends after the age of 40 for the first screening. In practice, however, your doctor's recommendation is the one that matters. Although a mammogram is a simple, non-invasive examination, the subject still raises doubts, which DaVita helps clarify here. I do not have nodules or changes in my breasts, so I don't have to undergo cancer screening.Myth. Mammogram precisely seeks minute alterations, which may correspond to early stage breast cancer, when the chances of cure are greater. When the nodule is palpable or the breast is visibly altered, chances are that the tumor will be at a more advanced stage and, therefore, more difficult to be treated. I do not need to undergo screening because no one in my family has had breast cancer.Myth. Most cases of breast cancer are not hereditary. Therefore, any woman can develop the disease and, therefore, every woman should undergo screening to detect it as soon as possible. I maintain a healthy lifestyle and there is no need for me to worry about the risk of this cancer.Myth. Despite the importance of good life habits to reduce the risk of any tumor, this is not enough to prevent breast neoplasm, the appearance of which is also related to genetic and hormonal factors, over which we have little or no control. The radiation emitted by the examination can be harmful. Myth. Contraindications are only in the case of pregnancy, a very rare condition among the age group for which mammogram is recommended. Apart from this condition, the screening is released because the radiation emitted is quite low and insufficient to cause problems to other organs of the body. Mammogram causes discomfort.Truth. Although not invasive, during screening breasts are compressed between two plates, which, for certain women, causes discomfort, although tolerable. However, it is possible to make the mammogram less uncomfortable, by scheduling it to be performed at the beginning of the menstrual cycle, when the breasts are less sensitive. Some doctors recommend taking a simple analgesic before the test. Talk to your doctor and see what he/she recommends in that regard. The exam will be painful because I have small breasts.Myth. Any potential discomfort due to the compression of the breasts is not related to size, but to the individual sensitivity of each woman. The mammary prosthesis makes the mammogram less effective. Truth. But it does not mean that the examination should not be done, but, rather, possibly being supplemented by another imaging method, if so required by the doctor. If you have more questions, please, do clarify them with a gynecologist or mastologist before the next mammogram.

3/14/2019
Children

For an active childhood

At any social level, screens have come to be children's favorite form of entertainment.  In the school playground, in the classroom, in the streets, in the park, on public transport or in cars, children and teenagers permanently have their eyes down and their fingers fiddling with their cell phones, tablets and games of all sorts.  Specialists warn that, apart from encouraging a sedentary lifestyle, which is a risk factor for various illnesses in adult life, this behavior compromises getting along together socially and leads to isolation. Worried by this scenario, since 7.3% of Brazilian children under five are overweight, the Brazilian Pediatric Society launched, in 2017,  a guidance manual for promoting physical activity in childhood and adolescence and for helping doctors and teachers, as well as parents, to encourage these young people to do daily physical exercise.   According to the document, up to the age of 2, children need to be stimulated to move a lot several times a day - crawling, fetching objects and moving their limbs.  Electronic devices – including TV’s – are not advisable for this age group. From 3 to 5, games and activities of any intensity should take up at least 180 minutes each day, including riding bicycles, playing hide and seek, catch, ball, etc. In this phase, activities like fighting (as a sport), dancing and swimming can already start to be introduced. From 6 to 19, one hour a day is recommended for doing sports and more intensive exercise that require a bit more cardio-respiratory capacity.  Depending on the type of sport, it is advisable to ask the pediatrician about the need for any prior medical assessment. It is very good for teenagers to do bodybuilding up to three times a week, as long it is being accompanied by a physical education teacher.   Of course, Brazil does not always have the time or even the financial resources to help children fulfil these goals.  Very often, just the demands of school fill up the diaries of children and teenagers. However, confronted with the broad access to electronic devices, the great hindrance, rather frequently, is to manage to get children and young people to join in when they finally are free to do so.  In order to change this routine, check out the tips below and take advantage of the next appointment with the pediatrician to talk about this. Tips for getting the kids off the sofa Establish a maximum time limit of 2 hours sitting in front of screens, including television, and change the way children use them, alternating from one  to the other. It is during these between times that other activities can be inserted Make the most of the advantages of electronic devices. Use apps with children that motivate the progress in certain exercises – like the step counter on the cell phone – and electronic games based on movements, like sports and dance.   Open up a space for playing inside the house. Set aside some days - especially rainy ones – to transform the living room into an obstacle course, going through tunnels made of cardboard boxes, jumping on cushions, doing somersaults on mattresses and so forth.  All of it being supervised, of course. If they can invite some friends round, so much the better. Afterwards, get everyone tidying up the mess as that also uses up energy. By the way, dole out some domestic tasks. Cooperating in domestic routine is important for developing a sense of responsibility in little ones and for helping build autonomy.  And, additionally, it makes the child move around the house. Example is much more effective than a thousand words. If you exercise regularly, it shows children that there is nothing that ever stops you from doing exercise. In this way, from a young age they will be aware that physical activity has its own place in the family routine and will naturally stick to an active life.   Whenever possible, leave the car in the garage and go around on foot with the children and teenagers.  Pupils who walk to and from school are already fulfilling a large part of the weekly activity goal recommended by the specialists.

2/14/2019
Prevention

It’s sun time

It is known that excessive sunlight exposure causes burns, skin cancer and premature aging. According to data from the National Cancer Institute (Inca), 30% of malignant tumors in Brazil are skin cancer, with an estimated 165,500 new cases of non-melanoma tumor between 2018 and 2019. But despite the care it inspires, the sun is far from being a villain for health. One of the most important benefits provided by sunlight is the production of vitamin D, essential for consolidating calcium absorption and keeping bones healthy. Few foods are rich in this nutrient, and in theory, its greatest source is sunlight exposure for 20 minutes, without sunscreen protection - always in the periods of lower incidence of UVA and UVB rays, that is, before 10 a.m. and after 4 p.m., which allows the absorption of 10,000 units of vitamin D, the daily goal for an adult. Sunbathing also helps to strengthen the immune system, also by the action of the polyvalent vitamin D, and acts as an adjuvant in the treatment of skin diseases, such as vitiligo, as sunrays stimulate the production of pigment cells, which do not work well in patients with this disease. As far as mental health is concerned, sunlight also offers help in controlling depression. This is because, when exposed to the sun, the brain reduces the production of melatonin, a hormone that causes relaxation and drowsiness, and which, in excess, can lead people to be locked in themselves. Likewise, the sun promotes an increase in the synthesis of serotonin, a neurotransmitter associated with well-being, which improves one’s mood. Photoprotection Despite these qualities, you shouldn’t give up on photoprotection. Although going without sunscreen to get the daily vitamin D intake in those few minutes is allowed, the Brazilian Society of Dermatology recommends the use of SPF 30 in all other occasions, both to go out on the street and for longer expositions, on the beach, pool or field, and in such cases with reapplications every two hours or after going into water or perspiring too much. This recommendation applies not only to people with lighter skin but also to dark-skinned individuals. However, because they contain a greater amount of melanin, which works as a natural protection, afro-descendants can use a product with lower SPF, but never less than 15. Sunscreen should be used in babies only from 6 months of age, in the form of products specific to the child’s skin, prescribed by a pediatrician or dermatologist. It is important to remember that photoprotection awareness should begin from childhood and adolescence to avoid the harmful effects of sun exposure over the years. In addition to sunscreen, the Brazilian Society of Dermatology recommends the use of other accessories to protect from sunlight, such as caps and hats, as well as cotton t-shirts in outdoor activities, as these clothes block most of the ultraviolet radiation. Sunglasses are also essential to prevent cataracts and other eye diseases. On the beach, it is still worth using canvas or cotton tents, which absorb at least half of the ultraviolet radiation, according to the entity.   In any case, even with sunscreen and the necessary proper clothing, wherever the scenery is, it is invariably safer to face sunlight before 10 a.m. and after 4 p.m., in addition to staying under a shade whenever possible. For those who want to get a tan, this goal will be achieved in the same way, but without any aggression to the skin or risk of a malignant injury. Please seek a dermatologist at least once a year for a skin checkup or whenever you have a complaint.