Advantages of Using Biochemic Homeopathic Medicines

We are all familiar with homeopathic medicines, are not we? Based on a simple science of stimulating the body from within to recover and cure the diseases, homeopathy uses medicines that are not harmful to the body. Even in case of chronic illnesses, homeopathic medicine will always be a safer option as there is no risk of damaging the body. Today, homeopathic medicine offers cure for several types of diseases. This cure is effective, pain-free, long lasting, apart from coming with a guarantee of zero side effects.

Biochemic medicine is also a branch of homeopathy. This was introduced by Dr. Schuessler way back in the year 1873. Being a homeopath was also well versed with the body's natural ability to heal. However, during his research, he formulated a theory. According to this theory, every disease that is troubling the human body is a result of lack of one of the basic organic salts in the cells. The simplest approach to cure the disease was to complete this requirement of organic salts. In his theory, he claimed, the body works properly if there is a balance of 12 organic salts. Later on, he also identified 12 homeopathic medicines that qualified to be used as biochemic medicine.

Here is a brief preview of relying on biochemical drugs to cure the body:

1. It's safe: Since biochemical has originated as a branch of homeopathy, it comes with a guarantee of being safe and secure. The dosage that you take does not pose any type of threat to the other organs of your body.

2. It's not expensive: Biochemic drugs are not cheap. However, when compared to the allopathic cure options, this treatment does not focus on drilling a hole into the customer's pocket. In the simple terms, this treatment is affordable across echelons of the society.

3. Stimulates the immune system: When patients are treated with biochemical drugs, their body is not pumped with alternative compounds. Instead, the doctors start the immune system to initiate the healing process. This ensures greater effectiveness and also guarantees better cure.

4. All age groups can rely on it: whether you are young or old, this type of medicine will not affect your body adversely. This comes in handy for the old people who sometimes find it difficult to rely on allopathic medicines. In fact, even children can safely consume this medicine without being worried about any side-effects.

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Reasons for My Love/Hate Relationship With My Electrolysis

How many circumstances have you been in that you are lying on your back and your legs are wide open in front of a stranger? I'm not referring to your love life and friends; I'm talking about something that for many women is especially important.

From a cautious distance it is a very captivating formality that we put ourselves through. It is a very awkward feeling; take off your pants, lay back, and let someone rip out the relentless hair that is unwanted from a region that is generally much disguised. The most awkward part of the whole experience for me had to have been so open with a woman you barely know, although, as time passes you develop a close relationship with this person.

Here is how the process works: first thing you do is lay flat on a chair, your body is horizontal and in a hopeless position. Later, your electrolysis will take a small needle into the root of your hair and then zap it. If you have very difficult hair it may be required for you to use a varying amount of electricity.

Even though some women may be able to tolerate pain, in my case I am as much resistant as a dandelion to a heavy wind. As time passed and I began to go to my electrolysis the sessions became easier. Even though my electrolysis would see me through all my emotional outbursts she remained to stay committed and calm.

As time passes my eyebrows were not the only things that were under her authority, soon so did my bikini line, which was probably the most challenging part of our relationship. Wich become huge.

As I grew older and moved to college, I advised myself that I was going to be happy with a long break away from my electrolysis, but as time progressed I soon realized how much I needed her. Over a short period of time I then started to visit her every chance I had. The sessions then began to go more smoothly when I discovered a new way of going to see her.

Some may think I am crazy for thinking this but, I figured why not go through this painful process inebriated? With the assistance of a designated driver and several shots of alcohol I am now able to see my electrolysis and we had a great bond over time.

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What Is an Independent Medical Examination or IME?

An independent medical examination or an “IME” is an evaluation of a person's injury or medical condition by a physician that has no prior relationship with the patient. Independent medical examinations are often associated with work or accident related injuries where liability is at issue. Sometimes a third party evaluation may be needed for worker's compensation or insurance purposes.

Often times an independent medical examination (IME) will be requested by an employer or insurance carrier when an injury claim by an employee is in question of legitimacy. The physician performing the assessment is responsible for conducting a thorough assessment, and ultimately providing insight into the extent to which the injury in question is work or accident-related. An evaluation of a person's injury should be as thorough and objective as possible by a qualified physician in order to give an unbiased and professional assessment.

5 Questions to Consider When Looking for a Doctor to Conduct an Independent Medical Evaluation

When choosing a physician to conduct an IME, it is important to find a practitioner that is able to provide a thorough and accurate assessment. Here are a few helpful questions to consider when looking for a physician to perform this special type of evaluation:

  1. Does the physician have the necessary medical expertise? A board or double board certified physician is a practitioner that has been evaluated in the area of ​​their expertise by completing written, oral, and practical observations to demonstrate his or her mastery of a specified field. A board certified physician has the knowledge and skill set to perform independent medical examinations at the highest professional level.
  2. How current is the physician's knowledge and experience? When considering a physician to conduct an independent medical examination, it's beneficial to be examined by a practitioner who is up-to-date with all the latest medical practices and information. A physician who has been retired or out-of-practice for some time may not be as capable of offering the most thorough and informed opinion of a person's injuries or health status. Choosing a physician who still actively practices medicine may be beneficial when seeking an IME.
  3. Does the physician have a sound professional reputation? Because independent medical examinations need to be unbiased and objective in order to give a fair report of the injuries involved, the physician conducting the evaluation should be well known in the pioneer medical community for practicing with the highest level of integrity and ethical standards possible.
  4. How much prior experience does the physician have with conducting independent medical examinations (IMEs)? A physician may be able to perform an IME, but that does not guarantee that he or she will be able to give the best report possible. To receive the best professional opinion, it is advisable to choose a medical practitioner who specializes in this type of assessment and has years of experience evaluating a wide variety of injuries objectively and thoroughly.
  5. How long will it take to schedule an appointment and receive the evaluation? If you need an independent medical examination, chances are timing is extremely important. Some doctors may have a long wait period to conduct an examination while others may offer priority scheduling to individuals seeking an IME.

An independent medical examination should be performed by a physician who can give an objective, non-partial medical opinion by implementing best practices. While there are numerous physicians to choose from, finding a highly qualified physician that prioritizes independent medical examinations may provide you with just the information you need in a timely and professional manner.

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We Are All the Victims of Medication Errors

It puzzles me that with all of healthcare's advances and technology, that medication errors are still a part of its grand scheme. There are millions of people who have been affected, through their own experience or a loved one's circumstances, by medication errors. Medication inaccuracies are not only cost to the healthcare system, but are costly to patients and families in our nation.
Medication errors can come from hospital care, a pharmacy, or ourselves. We need clear and consistent education and prevention tactics to make sure that medication errors decrease in our country. Medication mistakes can lead to unpleasant side effects, hospitalizations, or even death.

I know of many pharmacists that work very long hours and do not get the proper rest that they need in order to perform their jobs effectively. I spoke to a pharmacist in a large retail chain and she said that for two days she had to work back to back 12-hour shifts. We are all human, but I do not know anyone that can work for 12 hours straight two days in a row and be effective. I am NOT saying that it can not be done, but to let a pharmacist do it? These are the people, along with hospital staff and doctors, that we entrust our lives no matter what the state of our health. However because we are human and those humans are subjected to long hours, it will be our health and welfare that is affected along with our loved ones.

I go to a small pharmacy because I like the intimate setting and the fact that my pharmacist is someone I can trust. She will counsel me about all of my medications, how they work, and how they will affect me. When she made a medication error concerning me, it was as if I was probably affected. My sweet, darling pharmacist made a mistake that cost me a lot of unpleasantness in dealing with side effects from the medication with which she made an error. Apparently, she had read my doctor's prescription and entered it into her computer incorrectly. But do I blame her, or the long hours that she works? Not only that, she has to be the pharmacist and the business woman at her facility.

I think the question comes down to who do we blame? The doctor, the hospital staff, the pharmacist, or ourselves? With medication errors, it could be any one of these parties.

That's why it is of vital importance that we, as consumers of health care, act as our own advocates to make sure we are not affected by a medication error. We must ask our doctors the questions about our medications, whether old or new. We must make sure there are medicines during a hospital stay are correct, and are given in the right doses. If you can not do that yourself, have a proxy, family member or other party do it for you. We, as patients consuming these medicines, must manage them with strict vigilance. We must read labels and make sure they are for the correct person, the correct dosage and the correct doctor. Ask your pharmacist about any side effects, and what to do if we experience them.

It is all of our responsibility to make sure that medication errors decrease. None of us want to be a statistic.

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Corporate Wellness, Executive Physicals and Concierge Medicine

The corporate world today is accompanied by so much stress, levels that end up affecting your health. Employees are an important asset in any organization. With the work that comes with being in a business or employed in a firm, your health is bound to deteriorate. This is because the daily routine of reporting to work leaves you with little time to exercise and take care of your body. This is a common problem among the working American population. Your day starts very early in the morning and you are expected to report to work by eight o'clock. From there you are in the office the entire day with probably only an hour of lunch break. Your entire day therefore revolves around work and by the time you are done for the day, you are too exhausted and have no energy left to engage in exercises.

This is the same case with the diet. Because of the stress that comes with work, exercise and a proper diet is not part of that routine. Now it is common knowledge that most health problems start with lack of a healthy diet and exercise. Without exercise and a god diet, you are bound to become overweight. What work does is that it exposes you to high levels of stress due to the many difficult decisions you are entitled to make each day. Now this is bound to cause some health problems to such people. Lack of proper exercises and diet has been shown to be a causative of overweight problems in a good number of Americans. Over weight is the leading cause of chronic diseases, high blood pressure and even in some cases stroke. This not only affects the employees but the entire organization. Low productivity and absenteeism are some of the consequences of an unhealthy working force. The company loses a lot in this case and lay-offs are inevitable because let's face it as an executive, you want a working force that can bring profits to your company.

Corporate Wellness

Employees are the most important assets in any organization. They are the reasons the company exists and they must be at their best at work. Due to the competitive nature of the corporate world, employees are always bombarded with so much work and so many decisions to make at work. Because of the demands of work, many forget to take care of their healthy. They are not able to eat a proper diet and there is little time to exercise.

This leads to diseases and thereby low productivity at work. Employers have realized the need to have a healthy working force and that is why most companies are investing on corporate awareness programs. This involves practices that ensures an employee's health wellness both at home and work. The wellness programs involve such things as disease screening and testing, health education, lifestyle coaching, health development and health programs implementation. This translates to overall health of the working force and theseby high productivity at work.

Executive Physicals

When you are in the corporate world it is very difficult for you to make decisions that are meant for your benefit. You are not able to take proper care of your healthy in terms of taking the proper diet and exercising regularly. Health is the most important thing for all of us. Most employers have come to realize just how important it is to have a healthy working force. Executive physicals involve testing for illnesses in employees and employers alike. It also tests for levels of stress in an individual and providing them with the necessary ways of dealing with the stress. Individuals are also provided with counseling on all aspects of life.

Concierge Medicine

With the stress that comes with work, you have little time to check on what you eat and above all you have little time on your hands to do exercises. This is why so many people suffer from lifestyle diseases like cancer, diabetes, high blood pressure, heart diseases and above all obesity. This is the reason why so many corporate institutions are introducing concierge medicine.

These practices personal and high quality medical care to employees and employers alike. Personal physicians are able to interact with individuals on a personal level and this way they learn your lifestyle. Afterward they are able to provide you with healthy medical care that is in line with the kind of lifestyle you lead.

At AwareMed we understand that your healthy is your asset and the importance of a healthy generation. You too can be part of this success journey in life transformation by visiting http://www.awaremed.com today.

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Energy and Vibrational Medicine – The Medicine of Tomorrow

Everything that exists is energy in itself. A vibrational field refers to that interconnected dynamic system that consist of energy. The same system redirects this energy in its various forms. A vibrational field may exist in an individual, collective level or as a system or within other systems. The body system is arranged in a molecular way which is purely a network of energy field interwoven together to form one system.

This network of energy is coordinated and nourished by small energy systems. These energy systems coordinate various functions in the physical body like cellular and hormonal functions. From these direct energy levels health as well and illnesses emerges. These energy levels influence growth patterns in all directions both negative and positive.

This is the aspect from which vibrational medicine originates. This method of healing operates on the fact that the vibrational energy that we absorb is highly into our bodies will in most cases affect the vibration field inside our bodies.

Vibrational medicine

Vibrational medicine involves the application of different frequencies and forms of energy in the process of healing. It is a promising area in the field of medicine that seeks to improve the lives of patients. It works by combining different modalities of healing that have been known to be more powerful than even surgery or drugs. One concern in vibrational medicine is the use of different frequencies and forms of electro-magnetic fields in healing.

The other concern with vibrational medicine is the fact that you have to deal with different frequencies of energy. Vibrational medicine involves using different healing aspects like spiritual healing, Therapeutic Touch, homeopathic remedies, color therapy, photo therapy, sound therapy among others. These aspects of healing are considered to be more life changing than any other form of healing.

Vibrational medicine is the first form of healing that combines the aspects of spiritual and science healing. This form of healing not only looks at human beings as just the physical body of just flesh and blood but more of the combination of body, spirit and mind. The healing in vibrational medicine involves correcting the problems that occur in these three levels.

Vibrational medicine allows not only the healing of the physical body but it also works with the emotional and mental levels. In short it touches on all aspects of the human body by combining the healing of the body, mind and emotional aspects of a human being. It is a promising field that will touch on all aspects of a human being.

Modalities of vibrational medicine

Vibrational medicine targets all aspects of a human being form the physical body, mental all the way to spiritual. In short it is an all-round form of healing. Due to this, vibrational medicine combines different modalities of healing that are being used in America.

Phototherapy

Studies have shown that light causes the body's healing process to accelerate. It is common knowledge that the sun is the ultimate source of light. The rates of prostate cancer are on the increase not only in America but the entire world. In regard to this, the deficiency in vitamin D is today the leading form or nutritional deficiency.

The sun is the source of vitamin D and this natural energy has been shown to reverse breast cancer and also prostate cancer as well as clinical depression. It also improves blood circulation, accelerates healing of wounds, enhance the density of bones and a whole load of other health benefits.

Phototherapy applies the use of sunlight to reverse the effects of certain diseases. The best time to benefit from the sun's energy in form of vitamin D is in the morning and evening.

Sound therapy

This is another aspect of vibrational medicine that involves the use of sound waves to manipulate energy fields in the body as well as tissues. It is a promising area in the field of vibrational medicine that changes the fluctuations that occur in the tissues and energy fields. One part of sound therapy is exposure to music.

Color Therapy

It involves use of a selection of wavelengths from the sun. This creates psychological, physiological and energetic responses in the patient.

Homeopathy

This involves use of water memory to store in the patient the healing properties of the substance selected for healing. This approach targets the emotional aspect of a patient.

Spiritual healing

This is all about the power of prayer, harnessing it in order to change the health of the patient. It targets the spiritual aspect of a patient.

Vibrational medicine is truly the medicine of tomorrow. It heals all aspects of a human being giving a more inclusive healing process. In addition, it is essential in targeting diseases like cancer. For more information about this topic visit http://www.Awaremed.com today.

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How to Talk to Your Family Medicine Doctor About Sensitive Issues

The fact of the matter is, some healthcare issues are more sensitive, or even down right embarrassing, to discuss with your family medicine doctor. Far too often, people go to the doctor with specific questions in mind about their ailment, and end up never asking their doctor the question. No matter how touchy, gross, or embarrassing the subject may be to you, there is no excuse for failing to get your medical concerns addressed by your physician. Here is your guide to talking with your family doctor about your most sensitive healthcare issues.

Practice first

One way to kill the embargoment before it prevails you from approaching your doctor about these sensitive topics is to simply get some practice asking those embarrassing questions. Whether you are talking about bodily functions, or specific aches and pains in some of your nether regions, simply hearing yourself say the words out loud has a way of making them less embarrassing and scary. This can be especially helpful for folks who have been around a while and are not used to say certain words out of fear of being impolite. Practicing saying these words aloud will make it all the easier when you arrive at your doctor's office.

Use humor

One way many people overcome embarrassment when discussing their private, and sometimes taboo, health issues is to simply own the embargo. Start the conversation with your doctor by saying something like, “I'm embarrassed to ask this, but …” or “This topic is a little strange, but …” By owning your embarassment and being willing to laugh at your self and your own embarrassrment you will go a long way to making it easier to talk with your doctor about some of the more off-color topics.

Write your questions down

You should also keep in mind that your doctor has gone through years of training, and may have acquired a specialized language of medical jargon while in medical school. This can make it difficult for patients to bring up their issues for fear of saying the wrong words or not quite describing the problem. Ultimately, as a patient, your job is to communicate with your doctor. It does not matter if you know the fancy medical terms or not, but you must get your questions and concerns out there. One way to make sure this gets completed is to go to your doctor's office with a list of questions and concerns in hand.

Remember that your family medicine doctor has heard it all

One last thing to keep in mind before your big doctor's appointment, is that your doctor, being the highly trained professional that he or she is, has probably seen or heard cases very similar to yours regularly in the past. While it may seem embarrassing and scary to talk about these issues for you, chances are your doctor will not bat an eye when you mention even the most embarrassing of ailments.

Find the Right Person to Ask

Finally, while we have discussed several different ways for you to broach sensitive topics and issues with your medical doctor, another thing to keep in mind, is that your doctor may not always be the best person to ask. If you have a good relationship and established rapport with the nurse or physician's assistant, then by all means ask them your question. Even if they do not have a readily available answer for you, there is a good chance that they can find it, and save you the embarrassment of asking someone you do not know as well.

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5 Facts All Parents Need to Know About Concussions and Concussion Recovery

Concusions can be a very scary subject for parents, since the paternal instinct to protect the child's head is very strong, and because discussions can happen and go unnoticed if you do not know the symptoms. Kids are very active, and spend a lot of time outside playing, doing sports, and other activities that open them up to injury. Concusions can have varying effects on a child, but the best thing is to catch them as soon as possible to ensure that there will be no lasting damage or risk for disability. Here are 5 facts about concussions and concussion recovery that all parents need to know:

1) You do not have to be knocked unconscious to get a conversation. If a child is knocked unconscious by a fall or an accident the situations that they may have a conversation are high, but any injury to the head can cause a conversation, even minor falls or slight head injuries. This is why it's important to know the signs and symptoms of a conversation, because they may not be obvious unless you know what to look for. The child should be monitored after any head injury or traumatic jostling for sign of a conversation, even if they feel fine. If there is any indication at all of a discussion, you should see a doctor right away.

2) A discussion can be caused by any sudden traumatic movement, either a fall, whiplash, or direct hit to the head. This is due to the fact that the brain is made of soft tissue and is cushioned by fluid from the spine, and the skull surrounding the brain is hard, so when jarring movement happens the brain can actually move around inside the skull and be damaged by the sides. This causes the brain to potentially bruise, tear blood vessels, or damage nerves inside the brain.

3) When a child gets a conversation, they often fully recover within one to two weeks without a risk of future health problems, but in order to do so they must follow certain precedencies that the doctor will recommend. The precautions can include a short hiatus from sports, and avoidance of certain activities that might make the symptoms of the concussion worse.

4) Symptoms of a conversation may not happen right away, and can develop 24 to 72 hours after the impact. Symptoms to watch out for include physical symptoms such as headache, dizziness, nausea, vomiting, inability to balance, trouble with coordination, and blurry vision. Other types of symptoms can be emotional, such as feelings of anxiety or irritability, or an increase in sadness or being more emotional than usual. There can be cognitive symptoms such as feeling dazed or confused, having a hard time concentrating or making decisions, trouble with memory, typically of remembering the time right before or right after the injury, and slurred speech, or saying sentences that do not make sense. Another big one to watch out for is change in sleep habits, either sleeping more than usual, or having difficulty sleeping or falling asleep.

5) After and concussion comes concussion recovery. This mainly includes constant monitoring of the child, and rest. The child must rest both physically and cognitively, and stay away from things that might worsen the symptoms of the concussion. Before anything though, be sure you see a doctor to diagnose the concussion, then you can receive proper instruction on how to help your child recover.

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Pharmacist’s Summary: ‘A Particular Macrolide’ and the Risk of Cardiovascular Death

Azithromycin is a macrolide antibiotic commonly used to treat infections of the respiratory tract. Cases of cardiac toxicity following administration of oral azithromycin have been reported. This study was a statewide, retrospective multigroup cohort performed on Tennessee residents enrolled in Medicaid who had been prescribed azithromycin. Its objective was to determine if azithromycin ingestion increased risk of cardiovascular disease compared to using amoxicillin, ciprofloxacin, levofloxacin, or no antibiotic at all. Funding was from a grant by the National Heart, Lung, and Blood Institute, and a cooperative agreement from the Agency for Healthcare Research and Quality Centers for Education and Research on Therapeutics.

Patient data (death certificates, statewide hospital-discharge database, Medicaid enrollment medical car receivers, dates, antibiotics, and other medications, and causes of death) were obtained from the Tennessee Medicaid program, and then de-identified. Prescriptions for azithromycin created between 1992 and 2006 were obtained for patients who had: no life-threatening non-cardiovascular disease, diagnosis of drug abuse, residence in a nursing home in the previous year, hospitalization or antibiotic use in the previous 30 days. Patients also had to have at least 365 days of enrollment in Medicaid, and were excluded if they had a high risk of death from causes unrelated to short-term effects of proarrhythmic medications (full exclusion criteria are available in the Supplement Appendix, which was not accessible).

Since the study was not controlled, 153 covariates were used to create propensity scores to increase the likelihood that similar patients were compared. Patients who had been prescribed a 5-day regimen of azithromycin were compared to those had also received a 10-day regimen of amoxicillin, ciprofloxacin, and levofloxacin, or a control period with no antibiotic use. The same patient could have been received more than one intervention; patients assigned to a control group could not have used antibiotics in the last 30 days. Repeated-measures analysis and stratification of propensity-score deciles were done to test the validity of the assumptions.

The outcomes studied were cardiovascular disease (defined in the Supplement Appendix) and death from any cause. Among the cardiovascular diseases, sudden cardiac death was measured, which was defined as a sudden pulseless condition (arrest) that was immediately fatal and consistent with a ventricular tachyarrhythmia that occurred in the absence of a known non-cardiac condition as the proximate cause of death. The endpoints were measured over 10 days for all interventions, with day 1 being the date the prescription was prescribed.

In total, there were 1,391,180 control periods, 347,795 prescriptions for azithromycin, 1,348,672 for amoxicillin, 264,626 for ciprofloxacin, and 193,906 for levofloxacin. After matching patients by propensity scores, their baseline characteristics were similar, except those prescribed ciprofloxacin or levofloxacin were more likely to have diabetes complications (specified in article), incontinence, and wheelchair or walker use. Azithromycin users were mostly women (77.5%) and on average, 48.6 years old. Unfortunately, I can only include text here on EzineArticles so please refer to the original article to view tables.

Results for cumulative incidences of cardiovascular disease and sudden cardiac death, and cardiovascular death and death from any cause during days 1-10 are given (two-sided p-value, 95% confidence interval). During days 1-5, there was no significant difference in cardiovascular death or death from any cause between azithromycin and levofloxacin, and in death from any cause between azithromycin and ciprofloxacin. For all days 1-10, there was no significant difference in death from any cause between any comparisons. In regards to cardiovascular death, there was no significant difference between azithromycin and levofloxacin. The repeated-measures analysis and stratification of propensity scores by deciles yielded similar results (in Table 11 of Supplement Appendix).

The authors believe there is a small absolute increase in risk of cardiovascular death with 5-day course of azithromycin, but no increase in risk of non-cardiovascular death. The risk of cardiovascular disease was significantly higher with azithromycin than with any intervention, except levofloxacin. The increased risk of cardiovascular death did not persist beyond the 5-day regimen of azithromycin therapy. The authors attribute this finding to the decline in serum concentration within 24 hours. There was also an increased risk in other, out-of-hospital cardiovascular deaths. Based on their prior study, they claim up to 25% of deaths could have misclassified as having other cardiovascular causes, or that azithromycin could have potentiated these cases.

References:
1. Poluzzi E, Raschi E, Moretti U, et al. Drug-induced torsades de pointses: data mining of the public version of the FDA Adverse Event Reporting System (AERS). Pharmacoepidemiol Drug Saf. 2009; 18: 512-8.
2. Ray WA, Murray KT, Hall K, et al. Azithromycin and the risk of cardiovascular disease. N Engl J Med. 2012; 366: 1881-90.

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Pharmaceutical Granulation Put Simply

When you have an ailment, or ache or pain, the first port of call is to go to the medicine cabinet or first aid box and hunt for something that will help relieve your pain. The most common form of pain relief is in the tablet form. They are small, easy to carry round, and relatively cheap and effortless to purchase, so it's no wonder why they are now such a common sight to see. Nonetheless, do we really know what is in these tiny little tablets which seem to help so much, and how on earth have they become so effective? The science behind the tablets is simply mind-blowing, so here is a much simpler version of what these tablets are about.

The part of the tablet that actually attacks your pain is called the active ingredient. This is in a powdered form, and contains various drugs which are extremely harmful if taken on their own. In order to make the drug user friendly, they are mixed with inert ingredients, or excipients. These are other ingredients which are added to the active ingredient to help with various elements such as; color; shape; flavorings; binding; disintegration ability; and protection. All in all, the excipients help the drug to be taken to the correct place without being damaged by stomach acid, and likewise, the excipients protect our bodies from the harsh chemicals in the active ingredient. However, combining the active ingredient with the excipients is not just a case of putting all the ingredients into a mold for a tablet. The various ingredients must be tested together separately before going into production. Different excipients work with different active ingredients, and some do not work with others, causing the active ingredient not to work.

Once the all of the ingredients have been selected, the process of pharmaceutical granulation can begin. Firstly, the active ingredient needs to be in a powdered form. Smaller granules are combined together to make larger granules, which are then easier for other products to bind to. This powder is then combined with the inert excipients. There are two ways of combining the products, which is dependent on their sensitivity to heat and moisture. If they are sensitive to heat and moisture, the product must undergo dry granulation -no liquid is used to combine the products. Instead, they are compressed and compacted in order to create the tablet. The other form of granulation is wet granulation, where a non-toxic liquid is used to combine the ingredients. The liquid dries and leaves a binding agent which allows all of the products to conglomerate to form the tablet.

The tablets are then coated, and sealed in the foiled packaging which protects the tablets when being thrown into bags, glove boxes, drawers and cabinets. The machines used for this process are able to be purchased or rented for your own use, for a batch of any size.

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Failed Hip Replacement Treatment

Case report

This lady underwent the first hip replacement 24 years ago for a hip fraction. A total hip replacement was done but left the leg shorter as the hip was cited high above the center of rotation by the surgeon. She managed for twenty four years but this hip began to fail and she was unable to walk by the middle of 2014.

She underwent a revision hip replacement in a city hospital in June 2014. But again the surgeon failed to recognize that the previous hip was positioned abnormally. He repeated the same mistake of placing the socket way above the normal center of rotation. Additionally, years of plastic wear and an erroneous revision surgery had left a gaping hole in her pelvis. The revision hip replacement that had the twin problems of abnormal position and lack of bone support.

The result was that this elderly but highly motivated lady was bedridden for three months after the second hip operation in June 2014.

Her case was shown to many doctors in the city but all refused to intervene and suggested to the family members that the lady be bound to a wheel-chair for the rest of her life.

This was unacceptable to her US based daughters. Despite the previous two failed hip replacements, the family was convinced that the elderly lady had nothing to lose by another attempt to restore her mobility.

Analysis of the x rays and additional 3 D CT scans indicated that there was gross bony deficiency in the left half of the pelvis and the socket was mal-positioned.The surgeon developed a pre-operative plan based on his analysis. He implemented the procedure arduously. He reconstructed the hip with the help of allograft bone and implants made of a special material known as Trabecular metal. This material allows ingrowth of host bone into it quickly.

The operation was a success.

After three months of recumbency and physical therapy, this lady is able to walk again.

Re revision hip replacements are very rare as most patients do not live very long after a first hip replacement. Even if it is required, most people are scared to get their elderly parents be operated in old age. It is also rare to find patients sufficiently motivated to undergo a heroic surgery and heactic rehabilitation process. This charming lady had the courage and confidence to go through a third hip replacement and the result is a new lease of mobility and life.

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Tailor-Made Knee Replacement

The 'I-Assist' is a surgical guidance system designed to improve the accuracy of a total knee replacement. It not just asserts the surgeon in aligning knee implants to each person's unique anatomy but also provides a personalized fit and strictly tailor-made total knee replacement. The output is very predictable as perfect alignment is achieved intra operatively. The implants themselves are not custom built.

How it works:

This electronic device incorporates latest guidance technologies into a half palm sized electronic display. Some of these technologies are also inbuilt in latest smart phones. The LED lights on the display are similar to traffic signals. A green light means the position is acceptable and a red one indicates scope for improvement. Thus the surgeon can align and validate implant positioning during total knee replacement. As the device is anchored in the operating field itself, it does not require shifting of the surgeon's gaze. He does not have to remove his visual focus from the operating field. Early navigation systems require the back and forth transfer of the surgeon's gaze from the operating field to a computer monitor elsewhere, several times intra-operatively.

The device integrates into the operation by requiring no complex imaging equipment and additional surgical incisions. It is compatible with the company's own product line of primary knee replacements.

History of navigation systems in total knee replacement

The goal of the surgeon during a total knee replacement is to get neutral alignment .. However, studies have shown that even experienced surgeons do not always achieve this perfection.

Here computer navigation systems were introduced about a decade ago to achieve perfect alignment. In this system, pins were drilled in the thigh and leg bones away from the knee. These pins were attached to sensors. The sensors relayed information to a processor located elsewhere. The monitor of the processor displayed the accuracy of the bony cuts and bony alignment. Based on these, the surgeon could intra-operatively fine tune the cuts and positioning to get perfect alignment. As mentioned previously the surgeon had to shift his gaze back and forth from the operating field to the computer monitor located elsewhere. This computer navigation system also requires intensive capital investment.

A different approach towards this goal was adopted with 'Patient specific instruments (PSI)'. This required additional pre-operative imaging. The images were transferred electronically to engineers elsewhere. The engineers used Computer aided design to manufacture custom fit cutting tool for each patient. These patient specific instruments were shipped to the surgeon after an interval of a few weeks. There is a time lag involved between the planning and execution in this process. Many patients do not want to wait. This is where the new technology comes into picture.

The I-Assist system improves on previous navigation technology .

The main component of the I-Assist knee guidance system is a disposable device that can be procured as needed. No capital equipment investment by the hospital is necessary.

Its features are

· It intuitively integrates with the surgeons' conventional instrumentation for total knee replacement.

· No pre-operative imaging is required.

· No wait time for the patient and the hospital.

· Less invasive procedure to the patient.

Who benefits?

It benefits everyone involved:

· Surgeons' benefit as it saves them more time unlike prior navigation technology.

· Hospitals save on additional costs by eliminating pre-operational imaging and capital investment.

· For the patient , it is less invasive and guarantees accuracy.

Which type of knee replacement patients' benefit most from this technology ?

It is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon any other factors, the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement right. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.

A sizeable number of young patients have additional complications in the leg that make a knee replacement difficult. Patients from Asia and Africa present with malunited thigh and leg fractures secondary to a previous accident. They have developed post traumatic knee arthritis as a result of these accidents. Bony deformities within the knee and outside preclude use of all previous modes of instrumentation.

· The use of conventional instruments which rely on intact straight bones is impossible.

· Conventional computer navigation is also inapplicable as it requires intact bone within the knee joint.

· PSI is also impossible to design with bone loss and extra articular deformities.

It is vital to get perfect alignment as there is a positive correlation between accuracy and long term survivorship of the implant.

The ' I-Assist ' system is the only system that allows accurate alignment in these complicated and difficult cases.

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I-Assist Guided Verilast Knee Replacement – Knee Replacement That Lasts for 30 Years

Case Report

Ms Payal, a thirty two year lady from Gujarat was suffering from a rare condition called 'Avascular necrosis' of the knee and had suffered extensive damage. Although, she was very young for a knee replacement, the amount of the damage left no option for the surgeon.

He decided to go ahead with a knee replacement procedure using the Verilast CR knee and the I-Assist. It was for the first time in the world that the I-Assist tool was used to implant a Verilast knee. The I-Assist tool uses electronic components in a palm sized device. With this, the surgeon can align and validate implant position during the knee replacement.

After the procedure, the patient was very happy with the results.

About the Verilast Knee Technology

The durability of the Legion CR knee with Verilast technology is based on laboratory testing.

In a laboratory, the LEGION CR knee with VERILAST Technology was compared with a similar knee made from conventional materials (cobalt chrome and standard plastic). The results showed that after five million cycles, or simulated steps, the LEGION CR knee reduced 98 percent of the wear experienced by the other knee made of conventional materials. After 45 million cycles, it was noted with the LEGION CR knee with Verilast technology, that the wear reduced to 81% in comparison to the conventional knee implant. That's equal to around 30 years of actual use.

VERILAST technology uses advanced, low-friction surfaces on both sides of the joint, the femur bone of the thigh, and the tibia bone of the leg. It combines Smith & Nephew's award-winning OXINIUM Oxidized Zirconium metal alloy and a “cross-linked” plastic component (XLPE), which together has been proved in the laboratory to double the wear of a conventional knee.

OXINIUM ™, Oxidized Zirconium is a tough, smooth metal with a ceramic surface 4,900 times more abrasion resistant and 20 percent lighter than the cobalt chrome metal used in conventional implants.

· The ceramic surface is created through a manufacturing process where oxygen is naturally diffused into the zirconium metal as it is heated in air. The original metal surface is transformed into a ceramic coating which is integrated with and part of the underlying metal; It is not an externally applied coating.

· With no detectable amount of nickel, the metal most associated with allergies, OXINIUM ™ is a biocompatible material for implants.

· This proprietary material has been used in more than 250,000 knee implants.

About the I-Assist Smart Tool

'I-Assist' is a smart tool designed to improve the accuracy of a total knee replacement. It assists the surgeon in aligning knee implants to each person's unique anatomy. The income is very predictable as perfect alignment is achieved intraoperatively and raises the chances of favorable outcomes. Perfect alignment correlates positively with survivorship or durability of the implant.

Which type of knee replacement patients' benefit most from this combined technology ?

It is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement perfectly aligned. There is a correlation between the alignment and survivorship of the implant. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.

In addition, a sizeable number of these young patients have additional complications that make a knee replacement difficult. Mal-united thigh and leg fractures secondary to previous accidents rule out the use of traditional instruments. Bony deformities inside and outside the knee prelude use of all other modes of instrumentation and navigation.

Before this novel procedure, surgeons used “Patient specific instruments' and 'computer navigation' to implant the Verilast knee.

The 'I-Assist' system is the only system that allows accurate alignment in these complicated and difficult cases.

In summary, the I-Assist tool allows the full survivorship potential of the Verilast CR Oxinium ™ knee to be harnessed in primary and difficult cases. Young patients can return to their normal lives without the fear of a redo or revision surgery later on in their lives.

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Advice for After Anesthesia

During the first 24 hours after anesthesia or after any pain medicine that makes you drowsy the following apply:

1. Your breathing, balance, coordination, memory, concentration and judgment may be impaired. For these reasons, a responsible adult should stay with you for the first 12 – 24 hours after receiving anesthesia.

2. Do NOT drive a motor vehicle or travel alone on public transportation. You will not be allowed to drive yourself home after anesthesia. You must arrange for a driver. Taxis or bus transport after anesthesia is not acceptable.

3. Do NOT use machinery or sharp items (lawn mower, power saw, kitchen knife etc).

4. Do NOT absorb sole care of an infant, young child or other dependent.

5. Do NOT make important legal or financial decisions.

6. Do NOT drink alcoholic beverages. The combination of alcohol with residual medications can be deadly.Use caution with cold medicines, anti-histamines, pain medications and anxiety medications because you may be more sensitive to their sedating effects. Combinations of these medications can cause deadly effects on your breathing.

7. Patients at risk for sleep apnea should always wear their CPAP or BiPAP mask while sleeping day or night. If you do not have access to CPAP / BiPAP or the location of your surgical incision makes use of the mask impossible, you should sleep in an upright position and / or on your side rather than on your back to improve your breathing.

Post-operative Pain

Your pain should be tolerable, but do not expect to be completely without discomfort. The amount of pain you experience depends on the type of procedure, your genetic makeup, and your emotional state. After surgery, rest in a relaxing environment surrounded by supportive family or friends. Do not be afraid to use pain medicine prescribed by your surgeon as instructed. There is very low risk of becoming addicted to pain medicine during short-term post-operative use. Generally speaking, reducing pain will allow for more activity which helps maintain lung function and prevent dangerous blood clots.

Post-endoscopy Pain

Your pain should be tolerable, but do not expect to be completely without discomfort. The amount of pain you experience depends on the type of procedure, your genetic makeup, and your emotional state. Medical gas is often gently blown into the gastrointestinal system during endoscopy. Most of the discomfort from the procedure can be relieved by passing this gas. Light activity is helpful in accomplishing this.

Nausea or Vomiting

The chance of nausea and vomiting (N / V) is highest in nonsmoking females with a history of motion sickness, but anesthesia and pain medicines can contribute to N / V in anyone. You can reduce your risk of N / V by taking pain medicines with food, avoiding quick movements, and avoiding milk products in the early time period after anesthesia. If you are experiencing N / V, try to drink clear liquids in small quantities until the symptoms resolve. Gradually, advance your diet with low-fat, bland foods.

Other Discomforts

You may experience dry mouth or sore throat after a procedure. You can ease throttle discomfort with ice chips or gargling with lightly salted lukewarm water. Over-the-counter throat lozenges or topical spray can also be helpful. Occidentally, patients experience mild to moderate neck or jaw discomfort. This can be due to positioning during the procedure to keep your airway open while you sleep. A small number of patients may experience a temporary all-over muscle soreness. This muscle soreness may feel similar to the soreness experienced the day after an intense session at the gym. It is caused by one of the medications used in anesthesia. These discomforts are self-limited and usually resolve within 72 hours. Bruising, redness or tenderness may occur near the former site of the intravenous (IV). Place an ice pack over the site for 30 minutes if this occurs. If the symptoms worsen, please contact your procedural physician's office.

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Hereditary Hemochromatosis: Missed Diagnosis or Misdiagnosis?

Introduction:

Elevated iron study results are a frequent laboratory finding that can be a clue to a common genetic disorder. Hereditary hemochromatosis is an inherited disorder of iron metabolism that can cause organ damage from the accumulation of excess iron (1, 2). The most common form of hereditary hemochromatosis (“hemochromatosis type 1”) results from mutations in the gene known as HFE. The specific mutations associated with hereditary hemochromatosis are the substitution of a tyrosine for cysteine ​​at amino acid 282 (C282Y) and the substitution of aspartic acid for histidine at amino acid 63 (H63D) (1, 2). Individuals who are homozygous for the C282Y mutation or who have single copies of both the C282Y and H63D mutations (compound heterozygotes) are susceptible to developing iron overload, with 85% to 90% of hemochromatosis cases occurring in C282Y homozygotes and the reminder occurring in compound heterozygotes (1, 3, 4). In contrast, simple C282Y heterozygotes and H63D heterozygotes and homozygotes are not at risk for hereditary hemochromatosis (2, 4, 5). Additional forms of primary iron overload (hemochromatosis types 2-4) caused by mutations in iron-regulatory genes other than HFE are now recognized (1, 2) but genetic testing is not routinely available.

Multiple conditions can be associated with abnormal iron study results in the absence of an inherited defect in iron metabolism (6). Secondary abnormalities of iron tests are frequently seen in the context of hematologic diseases, in particular hemolytic anemias, anemia secondary to ineffective erythropoiesis, and disorders treated with multiple transfusions, and in several common types of chronic liver disease. Among the latter group, increased iron studies are seen in up to 50% of patients with alcoholic liver disease, nonalcoholic fatty liver disease, or chronic viral hepatitis (4). In this setting, elevations in transferrin saturation or serum ferritin levels do not invariably reflect the presence of excess iron in the liver or other organs. The clinical significance of elevated iron study results and hemosiderosis in liver disease-and whether this condition requires treatment-remains controversial (6). This contrasts with hereditary hemochromatosis and transfusive iron overload, in which there is consensus that heavy iron loading causes organ damage and that removal of excess iron can prevent these complications (7, 8, 9). Thus, correct identification of the cause of iron test abnormalities is required to determine appropriate treatment.

The identification of the HFE mutations in 1996 was a major step towards improving the accuracy of diagnosis of hereditary hemochromatosis (7). In view of the high prevalence of conditions associated with secondary abnormalities of iron metabolism, HFE genotyping is a useful tool to distinguish hereditary hemochromatosis from these secondary abnormalities. The aims of this study were to investigate the approach of physicians to elevated iron study results at an academic medical center, to assess the accuracy of their diagnoses of hereditary hemochromatosis, and to identify factors that contribute to misdiagnosis.

Material & Methods:

The institutional review board of the University of Iowa approved this study. A list of patients seen at the University of Iowa between January 2002 and May 2006 and between January 2009 and May 2012 with the International Classification of Diseases (ICD) 9th Revision code 275 “disorders of iron metabolism” as a primary or secondary diagnosis was obtained . Patients seen between 2006 and 2009 were not included because transition to a new electronic medical record occurred during this period. A systematic review of the electronic medical records was then performed. Patients with iron deficiency were excluded.

Subjects with no mention of iron overload and no findings in their records suggesting abnormal iron metabolism were considered to be miscoded and were likewise excluded from the study. For patients included in the study, the following data was collected: age at diagnosis, gender, family history of hereditary hemochromatosis, HFE genotype, history of multiple transfusions or known hematologic disease, or evidence of chronic liver disease. Diagnoses of cirrhosis or hepatocellular carcinoma based on clinical findings or imaging or pathology results, and recommendations for or records of phlebotomies were tabulated. The specialty of the diagnosing provider, the year of diagnosis, and the laboratory studies corresponding to that visit were recorded. Laboratory studies included iron levels, total iron-binding capacity, transferrin saturation, ferritin level, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, and total bilirubin.

The 2011 practice guidelines of the American Association for the Study of Liver Disease were used to assess the appropriate diagnostic strategy and management of hereditary hemochromatosis.4 Transferrin saturation level> 45% and ferritin level> 250 ng / mL in women and> 300 ng / mL in men were considered elevated. Aspartate aminotransferase and alanine aminotransferase> 1.5 times the upper limit of normal, which corresponds to 50 U / L in our facility, were considered elevated.

An analysis was done to compare the characteristics of those diagnosed between 2002 and 2006 with those diagnosed between 2009 and 2012. Because the continuous data were not normally distributed, we presented them as medians and interquartile range and used the Wilcoxon rank-sum test to detect statistical significance. For categorical variables, the chi-square test was used. Statistical significance was set at P 45% or increased ferritin (4). One third of patients meeting these criteria in our study did not have a documented HFE genotype. Several factors may contribute to the failure to obtain genetic testing. One is the presence of an obvious cause of secondary iron test abnormalities, which was present in many of the patients who were not genotyped. Whatever a decision to forego genotyping in this situation is justified depends on the clinical context, but this does not account for the lack of HFE genotyping in those patients without an obvious cause of secondary iron test abnormalities. Another possibility may be the misconception that elevated iron parameters are unquestionably to be a sign of hemochromatosis in the absence of the classic findings of “bronze diabetes,” which are rarely seen (7). Ultimately, the finding that 35% of the patients without a documented HFE genotype were nonetheless diagnosed with hereditary hemochromatosis reflects a knowledge deficiency regarding the diagnostic criteria for this condition. Although genetic testing may have been performed elsewhere in some cases, it is doubtful that this was a frequent occurrence, given that either information nor external genotyping results were documented in the chart, despite a decision to initiate treatment. These findings are consistent with a previous report suggesting that primary care physicians use HFE testing less frequently than do subspecialty doctors (10).

HFE genotyping is frequently misinterpreted. In our series, hereditary hemochromatosis was diagnosed incorrectly in more than half of the patients with nonhereditary hemochromatosis genotypes. More than two thirds of these misdiagnoses were made by nonspecialists, indicating confusion in the interpretation of HFE genotyping. Several factors may contribute to this confusion. At our institution, HFE genotyping returns with a fairly lengthy description of the testing methodology and its interpretation. Some providers may fail to read the entire report and interpret the presence of a single mutation as diagnostic of hemochromatosis. Further compounding the potential for misdiagnosis is the fact that even in the heterozygous state, the C282Y and H63D mutations can be associated with modest increases in iron parameters (11). Thus, without specific knowledge that these genotypes are not causes of hereditary hemochromatosis, misdiagnosis of hemochromatosis in these circumstances is an understandable error.

Awareness of common causes of secondary iron test abnormalities, in particular chronic liver disease, is low. Patients with nonhereditary hemochromatosis genotypes who present with abnormal iron study results should be carefully investigated for secondary causes of abnormal iron metabolism (4). Non-HFE hereditary hemochromatosis (hemochromatosis type 2-4) should be on the differential in those patients, although these conditions are rare. Among the patients with nonhereditary hemochromatosis genotypes in whom hemochromatosis was correctly ruled out, approximately 90% had a well-defined cause for abnormal iron study results. On the other hand, we were able to retrospectively identify an explanation for abnormal iron study results in approximately three quarters of the misdiagnosed group. In almost all of those cases, risk factors for chronic liver disease were present, but chronic liver disease had not been recognized as a potential cause of iron test abnormalities. Of note, hematologic causes of secondary iron overload posed little confusion, and most cases of hemolytic anemia, anemia secondary to ineffective erythropoiesis, and history of multiple transfusions were readily recognized as causes of abnormal iron study results. Chronic liver disease was far more common in this study than were hematologic disorders. It seems that many primary care providers may be unaware of the association of elevated iron study results with chronic liver disease. Further compounding the potential for misdiagnosis, iron studies are commonly obtained in the course of evaluation of elevated aminotransferases. In this setting, elevated iron parameters are frequently included to be the cause, rather than the consequence, of the underlining liver disease. However, hereditary hemochromatosis is not commonly associated with increased level of liver enzymes, as demonstrated by a recent study showing that the probability of diagnosing hemochromatosis in patients with hyperferritinemia decreases with increased aspartate aminotransferase and alanine aminotransferase levels (12). Our observation that only 18% of patients with hereditary hemochromatosis alone had abnormal liver enzymes is consistent with these findings.

Consequences of Misdiagnosis

Some 38% of the patients with nonhereditary hemochromatosis genotypes and an unknown proportion of those who were not genotyped were treated inappropriately with phlebotomy. Not only is de-ironing not indicated in the absence of an appropriate hereditary hemochromatosis genotype with evidence of expanded body iron stores (4, 13) but also the aggressive phlebotomy regimens used in the treatment of hemochromatosis are potentially harmful. Phlebotomy is not without risks and, if used inappropriately, can cause iron deficiency anemia and fatigue, in addition to psychological and financial burdens. Of equal importance, an incorrect diagnosis of hereditary hemochromatosis can be a distraction that precedes identification of the actual cause of abnormal iron study results, thereby delaying appropriate treatment.

Conclusions

The appropriate evaluation and management of abnormal iron study results is an area that requires better understanding and knowledge, especially among nonspecialists. Patients with elevated transferrin saturation or ferritin without an obvious cause should be tested for HFE mutations. The HFE genotypes that can cause hereditary hemochromatosis with manifestations of iron overload are C282Y / C282Y and C282Y / H63D (7). All patients in whom the diagnosis of hereditary hemochromatosis is considered should have an HFE genotype documented before treatment with phlebotomy. We suggest that this information be required by the phlebotomy centers before initiation of treatment. Patients with abnormal iron study results and nonhereditary hemochromatosis genotypes should be investigated for other causes of abnormal iron metabolism with particular attention to chronic liver diseases, which are a frequently unrecognized cause of abnormal iron study results. Specialist consultation should be cared for assistance with diagnosis and management.

References

1. Pietrangelo, A. Hereditary hemochromatosis: pathogenesis, diagnosis, and treatment. Gastroenterology. 2010; 139: 393-408

2. Pietrangelo, A. Hereditary hemochromatosis. Annu Rev Nutr. 2006; 26: 251-270

3. Adams, PC and Barton, JC Haemochromatosis. Lancet. 2007; 370: 1855-1860

4. Bacon, BR, Adams, PC, Kowdley, KV et al. Diagnosis and management of hemochromatosis: 2011 practice guide by the American Association for the Study of Liver Diseases. Hepatology. 2011; 54: 328-343

5. Pointon, JJ, Wallace, D., Merryweather-Clarke, AT, and Robson, KJ Uncommon mutations and polymorphisms in the hemochromatosis gene. Genet Test. 2000; 4: 151-161

6. Beaton, MD and Adams, PC Treatment of hyperferritinemia. Ann Hepatol. 2012; 11: 294-300

7. Pietrangelo, A. Hereditary hemochromatosis-a new look at an old disease. N Engl J Med. 2004; 350: 2383-2397

8. Falize, L., Guillygomarc'h, A., Perrin, M. et al. Reversibility of hepatic fibrosis in treated genetic hemochromatosis: a study of 36 cases. Hepatology. 2006; 44: 472-477

9. Flaten, TP, Aaseth, J., Andersen, O., and Kontoghiorghes, GJ Iron mobilization using chelation and phlebotomy. J Trace Elem Med Biol. 2012; 26: 127-130

10. Acton, RT and Barton, JC HFE genotype redundancies in consconse reference laboratory specimens: comparisons among referral sources and association with initial diagnosis. Genet Test. 2001; 5: 299-306

11. Beutler, E., Felitti, V., Gelbart, T., and Ho, N. The effect of HFE genotypes on measurements of iron overload in patients attending a health evaluation clinic. Ann Intern Med. 2000; 133: 329-337

12. Adams, PC, Speechley, M., Barton, JC et al. Probability of C282Y homozygosity decreases as liver transaminase activities increase in participants with hyperferritinemia in the hemochromatosis and iron overload screening study. Hepatology. 2012; 55: 1722-1726

13. Siddique, A. and Kowdley, KV Review article: the iron overload syndromes. Aliment Pharmacol Ther. 2012; 35: 876-893

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