Thứ Hai, 7 tháng 3, 2016

10 Things to Know About NRTI Dual Backbone Therapy

By Bridget Finnerty
Reviewed by Mark Wainberg, PhD, Director, McGill University AIDS Centre, Montreal, Quebec, Canada

Dual nucleoside reverse transcriptase inhibitors (NRTIs) consist of two coformulated, fixed-dose tablets that prevent HIV viral replication by blocking the activity of HIV reverse transcriptase–an enzyme that converts viral RNA to DNA within an infected cell. Combining NRTIs has a more potent effect and may increase adherence to HIV treatment regimens when compared to the activity of any single NRTI.¹^,²
According to the U.S. Department of Health and Human Services (DHHS), all currently recommended and alternative regimens for antiretroviral therapy (ART) consist of two NRTIs plus a third active drug. The third active drug can include: an integrase strand transfer inhibitor, a non-nucleoside reverse transcriptase inhibitor, or a protease inhibitor with a pharmacokinetic enhancer. Thus, NRTI backbone therapy remains a key component of anti-retroviral therapy (ART) for most HIV-infected patients.³
Here are 10 things that are essential to know when making treatment decisions about NRTI dual backbone therapy:
1. The two currently recommended dual-nucleoside combinations used in initial therapy are abacavir/lamivudine (ABC/3TC) and tenovir/emtricitabine (TDF/FTC).
The DHHS recommends these two NRTI combinations based on the efficacy and durability of virologic response, toxicities, and ease-of-use.³
2. Virologic efficacy has been shown to be comparable in ABC/3TC and TDF/FTC combinations
The HEAT study demonstrated in 688 patients that virologic efficacy is comparable with both ABC/3TC and TDF/FTC NRTI dual backbone regimens. All patients also received LPV/r (a protease inhibitor, where “r” denotes pharmacokinetic enhancement with ritonavir) as a third medication. In a subgroup analysis in patients with HIV RNA ≥100,000 copies/mL, the proportion of patients who achieved HIV RNA <50 copies/Ml was not significantly different at 96 weeks.⁴The rate of virologic failure was shown to be similar for both groups (14%).⁴
3. The ASSERT study showed ABC/3TC to be virologically inferior to TDF/FTC
The ASSERT study was designed to compare ABC/3TC and TDF/FTC NRTI backbone therapies in 385 antiretroviral therapy-naive, HLA B*5701-negative patients. All patients also received efavirenz (EFV), a non-nucleoside reverse transcriptase inhibitor. Renal safety, as measured by estimated glomerular filtration rate (eGFR) of both regimens, was assessed.⁵
While there was no difference in treatment groups in renal function, the results demonstrated that at week 48, the TDF/FTC-treated group had a higher proportion of patients with HIV RNA <50 copies/mL compared with patients treated with ABC/3TC.⁵
4. ABC/3TC is not recommended when viral RNA is ≥100,00 copies/mL
The ACTG 5202 study was a randomized, controlled trial designed to compare the efficacy and safety of ABC/3TC with TDF/FTC, used with either the NNRTI efavirenz or the protease inhibitor atazanavir (ATV/r).⁶At screening, randomization was stratified by HIV RNA level: either <100,000 copies per/mL or ≥100,000 copies/mL.⁶
The study demonstrated that time to protocol-defined virologic failure was significantly shorter in the ABC/3TC arm compared to the TDF/FTC arm in patients with ≥100,000copies/mL. This effect was seen regardless of the third active drug that was used.⁶^,⁷
There was no difference in time to virologic failure in the group with HIV RNA levels <100,000 copies per/mL.⁷
5. ABC NRTI backbone therapies should only be considered in patients who are HLA B*5701 negative
Before the use of HLA-B* 5701 testing was standard, 5% to 8% of patients treated with ABC experienced hypersensitivity reactions. Patients who are positive for the HLA-B*5701 allele are at high risk for hypersensitivity reactions, and testing for this allele should precede initiation of ABC-based therapy.⁸^,⁹
Therefore, current DHHS guidelines recommend that only HLA-B* 5701-negative patients should be initiated with ABC/3TC dual backbone therapy.³
6. Use of ABC as part of dual NRTI therapy should proceed with caution in patients with known cardiovascular risk
The initial report of an association between ABC use and myocardial infarction (MI) came from the D:A:D study. This large, multinational observational study group found that patients who were currently using or had used ABC within the previous 6 months were at increased risk of MI. The risk was increased in patients who had other cardiac risk factors.¹⁰
Subsequent to the D:A:D report, there have been conflicting results regarding the association between cardiovascular risk and ABC-based backbone therapy, with only some studies having confirmed CV risk.¹¹^-¹³Other studies have failed to establish an association.¹⁴^-¹⁶
Based on conflicting evidence, the DHHS recommends avoiding ABC/3TC backbone therapy or using it with caution in patients with cardiovascular risk factors.³
7. NRTI dual backbone therapycan be associated with mitochondrial dysfunction, particularly with the “d” NRTIs [didanosone (ddI) and stavudine (d4T)].
Mitochondria have their own DNA with 16,000 bases; the replication, recombination and repair of mitochondrial DNA (mtDNA) is achieved by human gamma-polymerase.¹⁷ In addition to impairing HIV replication, NRTIs also inhibit human gamma-polymerase. This results in the decline or depletion of mtDNA, resulting in mitochondrial toxicity and associated mitochondrial disorders.¹⁷
MtDNA depletion is both time and dose-dependent, with the “d” NRTIs (ddI, d4T, and zalcitabine [ddC], which are rarely used) having the highest affinity to inhibit gamma-polymerase.
In fact, ddI and d4T are not currently recommended as dual NRTI backbone therapy due to a high incidence of toxicities, in particular peripheral neuropathy, pancreatitis and lactic acidosis. In addition, ddI and TDF are not recommended in combination due to a synergistic increase in ddI concentrations—leading to increased risk of pancreatitis and lactic acidosis.³
NRTI mitochondrial toxicity can accumulate in various tissues and can include the following manifestations:¹⁷ hepatotoxicity (increased lipid deposits in the liver, which can be associated with micro or macrovasular steatosis and elevated liver transaminases. In rare cases, steatohepatatitis can progress to liver failure and lactic acidosis); elevation in serum lactate; mitochondrial myopathy (manifested as skeletal weakness); cardiomyopathy; peripheral neuropathy; lipodystrophy (can lead to insulin resistance and hypercholesterolemia); pancreatitis; lymphopenia and anemia; impaired ATP production may elevate serum urate production; renal dysfunction; osteopenia.
8. Use TDF/FTC to treat HIV/hepatitis B (HBV) coinfection
TDF, FTC, and 3TC are active against both HIV and HBV. The use of TDF /FTC or TDF/3TC is recommended wherever possible in patients who are coinfected with HBV and HIV.³
9. FTC and 3TC Have similar resistance profiles and are not recommended as dual NRTI backbone therapy
These two NRTI drugs have been shown to have minimal additive effects and have similar resistance profiles. Therefore, the benefit of decreased risk of resistance with dual therapy is lost with this combination.³
10. Stavudine (d4T) and zidovudine (ZDV) have demonstrated antagonism in combination both in vivo and in vitro
Patients receiving ZDV in combination with d4T showed progressive declines in CD4 cell counts. By 16 weeks, there was a median of 22 cells/mm³. Intracellular levels of d4T-triphosphate in 6 patients were consistent with in vitro studies that demonstrated antagonism between d4T and ZVD.¹⁸^,¹⁹

Published: 12/21/2015
References:

Chủ Nhật, 6 tháng 3, 2016

Tự kiểm tra vú để phát hiện sớm những bất thường nếu có

Thứ Bảy, 5 tháng 3, 2016

The ABCs of an A1C Test: A Big-Picture Look at Diabetes Control

By Everyday Health Guest Contributor

Published Jan 6, 2015

By Jo-Anne M. Rizzotto, MEd, RD, LDN,CDE, Special to Everyday Health
If you are talking with someone about diabetes, you may hear the term “A1C.” But what exactly does A1C mean? And why is your A1C important for diabetes management?
The A1C, otherwise known as a glycohemoglobin or hemoglobin A1C test, provides a picture of your average blood glucose control for the two to three months before you take the test. The A1C measures the glucose that clings to hemoglobin molecules in your red blood cells. The higher the glucose levels in your blood, the more glucose clings to the hemoglobin, and thus the higher your A1C level will be. Red blood cells are renewed every 120 days. By measuring the percentage of hemoglobin molecules that have glucose attached to them, healthcare providers can see how much extra glucose you have had in your bloodstream over the past few months.
The A1C test is done every three to six months, often during a regular diabetes care visit. It does not require fasting, can be done any time of day, and requires only a small sample of blood taken from a finger stick or drawn from your arm.

How to Use Your A1C Results to Manage Your Diabetes

Why is the A1C test essential for diabetes management? It gives you an overall picture of your diabetes, rather than a reflection of what is happening in one day, and helps you evaluate your diabetes care and make changes.
An A1C test can help you manage your diabetes by:

verifying self-testing or other blood test results with your healthcare provider
determining whether your treatment plan is working
demonstrating how healthy food choices and being physically active affect diabetes control

An A1C reading of less than 7 percent may be a good goal for many people, but make sure to ask your provider what your A1C target should be. It’s helpful to remember that the closer you get to your goal, the better you’ll feel today and tomorrow. According to Joslin Diabetes Center’s Clinical Guidelines, we recommend that patients aim for an A1C value of less than 7 percent, as long as achieving this goal does not increase your risk for developing low blood glucose (or blood sugar), otherwise known as hypoglycemia. The best way to determine your target A1C is to speak with your healthcare provider.
The higher your A1C, the greater your risk for developing complications, such as heart attacks, strokes, kidney disease, and neuropathy and circulation problems. To help lower your risk for diabetes complications, keep your blood glucose levels in your target range by self-monitoring and making adjustments with medicine (insulin, pills, or both), meal planning, and scheduled physical activity.
Jo-Anne M. Rizzotto, MEd, RD, LDN,CDE is a registered dietitian and certified diabetes educator and Director of Educational Services at the Joslin Diabetes Center in Boston. She earned a BS in Food and Nutrition from SimmonsCollege in Boston, and an MEd in Instructional Design from the University of Massachusetts. She manages an educator staff of 14 professionals including nurses, dietitians, and exercise physiologists.

Thứ Năm, 3 tháng 3, 2016

10 Myths and Facts About Water

By Wyatt Myers | Medically reviewed by Niya Jones MD, MPH

We all need water to live, but how much do we really know about it? From the truth about drinking eight glasses of water per day to refilling plastic bottles, here's what you should know about water benefits.

For something so seemingly simple and essential as drinking water, plenty of myths and misconceptions exist about possible water benefits and harms.
Learn how to separate the myths from the facts about drinking water.
1. Everyone needs to drink eight glasses of water a day.
Myth. Though water is the easiest and most economical fluid to keep you hydrated, the latest Institute of Medicine recommendation is that women should strive for about two liters or eight glasses a day and men should aim for three liters or 12 glasses a day of any fluid, not just water. “No one can figure out where this ‘eight glasses of water’ came from, but I believe it came from the old RDA [recommended daily allowance] for water that matched water requirements to calorie requirements,” notes Georgia Chavent, MS, RD, director of the Nutrition and Dietetics Program at the University of New Haven in West Haven, Conn. “The new requirement from the Institute of Medicine is much more generous and includes recommendations for total beverage consumption, not just water.”

Fact. Though water doesn’t necessarily neutralize toxins, the kidneys do use water to get rid of certain waste products. If you don’t drink enough water, your kidneys don’t have the amount of fluid they need to do their job properly. “If the body does not have sufficient water, then metabolic wastes will not be removed as efficiently as they should,” explains Amy Hess-Fischl, RD, CDE, of the University of Chicago Kovler Diabetes Center. “In essence, the body would be holding in toxins instead of expelling them, as is required for proper health.”
3. Bottled water can cause tooth decay.
Myth. Bottled water in and of itself doesn’t cause the teeth to decay, but it usually doesn’t contain any fluoride, which is added to tap water to help prevent tooth decay. “Fluoride is an important element in the mineralization of bone and teeth,” says Constance Brown-Riggs, RD, CDE, author of The African American Guide To Living Well With Diabetes and a nutritionist and certified diabetes educator in New York City. “With the increased consumption of bottled water, which is not fluoridated, there has been an increase in dental caries [cavities].”
4. Drinking water can help keep your skin moist.

Myth. While it used to be believed that staying properly hydrated led to youthful, vibrant skin, the reality is that the amount of water you drink probably has very little to do with what your skin looks like. “Unless the individual is severely dehydrated, drinking large quantities of water will not prevent dry skin,” Hess-Fischl says. “Basically, the moisture level of skin is not determined by internal factors. Instead, external factors such as skin cleansing, the environment, the number of oil glands, and the functioning of these oil-producing glands determine how dry the skin is or will become. The water that is consumed internally will not reach the epidermis [the top layer of the skin].”
5. Drinking water helps you lose weight.
Fact. Drinking water won’t specifically trigger weight loss, but it can aid in the process. Water replaces other calorie-laden beverages in the diet, causing you to reduce your overall number of calories. Plus, it can make you feel fuller, so you may eat less at each meal. Water, particularly cold water, may even play a role in increasing your metabolism. “A new study seems to indicate that drinking water actually speeds up weight loss,” says Tanya Zuckerbrot, MS, RD, owner of Tanya Zuckerbrot Nutrition, LLC, in New York City. “Researchers in Germany found that subjects of the study increased their metabolic rates [or the rate at which calories are burned] by 30 percent after drinking approximately 17 ounces of water.”
6. Yellow urine is a sign of dehydration.
Myth. It can be, but not all yellow urine is cause for alarm. “Dark yellow urine may be a sign of dehydration,” says Zuckerbrot. “The kidneys filter waste products and reabsorb water and other useful substances from the blood, so they control the volume and concentration of urine output. Dehydration leads to increased urine concentration, turning your urine dark yellow. Ideally your urine should be straw yellow in color.” Other factors, though, such as taking a multivitamin, can also lead to yellow urine.
7. If you’re thirsty, you are already dehydrated.
Myth. If you start to feel thirsty, then you are headed in the wrong direction and should grab a drink of water, but thirst doesn’t necessarily mean you’re dehydrated. “Thirst begins when the concentration of [substances in the] blood has risen by less than 2 percent, whereas most experts would define dehydration as beginning when that concentration has risen by at least 5 percent,” notes Hess-Fischl.
8. You need sports drinks, not water, to function at a high level in athletics.
Myth. Sports drinks may have fancier advertising campaigns, but water is really all you need to get the fluid necessary to participate in most athletic endeavors. “Adequate fluid, especially water, is most important for athletes of all ages as it is the single most important way the body has to transport nutrients and energy and remove heat during exercise,” says Chavent. “A sports or vitamin beverage may taste better, but is not necessary for hydration and is expensive.” Keep in mind though that people who run marathons or compete in highly strenuous activites may need to supplement their water intake with sports drinks to offset the salt they lose due to heavy sweating over long periods of time. This doesn’t apply to most people who are simply exercising to get fit at the gym, for instance.
9. It’s possible to drink too much water.
Fact. People with certain health conditions can put themselves at risk of complications if they drink too much water. “People with some heart conditions, high blood pressure, or swelling of the lower legs [edema] need to avoid excess water,” says Hess-Fischl. “If you have a history of kidney problems, especially if you have had a transplant, consult your doctor before increasing your fluid intake.” Hess-Fischl adds that you shouldn't drink too much water while eating, as it dilutes your stomach acid and can cause digestion problems.
10. You should not reuse plastic water bottles.
Fact. Plastic water bottles can present a couple of risks to people who drink their contents and then fill them up time and again. “These bottles leach chemicals into your water after multiple uses,” Hess-Fischl explains. “The bottle, if not properly cleaned, may also harbor bacteria from your mouth.”
Water is essential to survival — use these facts to figure out if you need to increase your intake or feel reassured that you’re drinking enough.

Thứ Tư, 2 tháng 3, 2016

9 xét nghiệm đàn ông không nên bỏ qua

26/02/2016

Tùy thuộc vào lứa tuổi, lối sống, tình trạng bệnh lý, tiền sử mắc bệnh của gia đình, nam giới nên thực hiện các xét nghiệm tầm soát bệnh để phòng ngừa bệnh tật.

Phòng bệnh hơn chữa bệnh luôn đúng với mọi lứa tuổi, mọi giới, đây là việc làm cần thiết để bảo vệ sức khỏe của mỗi người. Tầm soát bệnh trước khi xuất hiện các triệu chứng đầu tiên bao giờ cũng đem lại hiệu quả điều trị cao nhất, giảm thiểu biến chứng, giảm tối đa chi phí điều trị cho người bệnh.

Đối với nam giới việc làm các xét nghiệm gì, tầm soát ra sao vẫn còn là một câu hỏi thường trực. Dưới đây là một số xét nghiệm nam giới có thể làm để phòng bệnh.

Ung thư tuyến tiền liệt

Tại Mỹ, ung thư tuyến tiền liệt là loại ung thư phổ biến nhất sau ung thư da. Ung thư tuyến tiền liệt thường phát triển chậm, bác sĩ có thể khám để tìm bệnh sớm, trước cả khi triệu chứng xuất hiện.

Nam giới nên nói chuyện với bác sĩ về xét nghiệm tiền liệt tuyến.
- Từ 50 tuổi trở lên nên xét nghiệm ung thư tiền liệt tuyến
- Nam giới 45 tuổi nên xét nghiệm nếu có nguy cơ cao như là người Mỹ gốc Phi.
- Nếu gia đình có người mắc ung thư tiền liệt tuyến, nên làm xét nghiệm này từ tuổi 40.

Ung thư tinh hoàn

Ung thư tinh hoàn là bệnh rất phổ biến, đây là loại ung thư ở tuyến sản sinh ra tinh trùng. Hầu hết các trường hợp ung thư tinh hoàn từ 20 – 54 tuổi. Hiệp hội Ung thư Mỹ khuyến cáo, nếu trong gia đình có người mắc ung thư tinh hoàn, hoặc người có tinh hoàn ẩn, 1 tinh hoàn có nguy cơ cao bị ung thư hơn những người khác.

Các bác sĩ khuyên nam giới nên thường xuyên kiểm tra các bất thường ở tinh hoàn, nếu thấy xuất hiện u cục cứng, cảm thấy nặng, tức hoặc đau ở khu vực bìu, hoặc tinh hoàn thay đổi hình dạng kích thước bất thường nên đi khám ngay.

Ung thư đại trực tràng

Đây là nguyên nhân ung thư gây tử vong thứ hai. Đàn ông có nguy cơ mắc ung thư đại trực tràng cao hơn phụ nữ. Đa số các bệnh ung thư đại trực tràng thường phát triển chậm, do sự phát triển bất thường của các polyp ở đại tràng: tăng trưởng trên bề mặt bên trong của ruột.

Sau khi ung thư phát triển, nó có thể xâm nhập, hoặc lây lan đến các bộ phận khác của cơ thể. Cách để ngăn ngừa ung thư đại trực tràng là tìm và loại bỏ các polyp ở khu vực đại trực tràng từ khi mới xuẩt hiện, không để chúng phát triển thành ung thư.

Nam giới nên khám đại trực tràng từ 50 tuổi. Nội soi đại trực tràng là một phương pháp đơn giản, nhưng hiệu quả trong việc phát hiện sớm các polyp hoặc ung thư đại trực tràng.

Ung thư da

Với những người hay phải làm việc dưới ánh nắng mặt trời có nguy cơ cao mắc ung thư da. Khi xuất hiện những đám da đổi màu hay các bất thường của nốt ruồi, người bệnh cần đến các cơ sở y tế. Tỷ lệ phụ nữ xuất hiện các đám sắc tố da cao, nhưng việc các đám sắc tố này phát triển thành u ác tính ở nam giới cao hơn 2-3 lần.

Hiệp hội Ung thư Mỹ và Viện Da liễu Mỹ khuyên nam giới thường xuyên tự kiểm tra, nếu thấy bất kỳ thay đổi hay dấu hiệu nào trên làn da như bất thường về hình dạng, màu sắc, kích thước trên da nên tìm gặp các chuyên gia da liễu để khám sàng lọc. Nếu phát hiện sớm điều trị ung thư da rất hiệu quả.

Tăng huyết áp

Nguy cơ tăng huyết áp tăng theo lứa tuổi. Đây là bệnh liên quan đến trọng lượng và lối sống. Nếu bị tăng huyết áp có thể dẫn đến những biến chứng nghiêm trọng như các bệnh tim mạch, đột quỵ, suy thận.... Điều quan trọng là cần phát hiện sớm và điều trị đúng phác đồ. Tăng huyết áp được xác định khi trị số huyết áp từ 140/90mm Hg trở lên. Nếu mắc bệnh tăng huyết áp, người bệnh cần được đi khám và uống thuốc điều trị lâu dài để phòng biến chứng của tăng huyết áp.

Xét nghiệm cholesterol

Trong các xét nghiệm thông thường, người ta thường thấy có 2 loại cholesterol, một loại là cholesterol tốt HDL, cholesterol xấu là LDL và triglycerides – mức mỡ trong máu. Cholesterol LDL và triglycerides cao vượt mức bình thường sẽ làm tăng nguy cơ mắc bệnh tim, gây ra các mảng bám trong động mạch, gây xơ cứng mạch, hẹp động mạch, từ đó gây nguy cơ cao bị đau tim hay đột quỵ.

Theo các chuyên gia y tế, nam giới từ 20 tuổi nên được khám sàng lọc để kiểm tra cholesterol, từ đó phát hiện sớm nguy cơ mắc các bệnh tim mạch. Từ 35 tuổi trở lên nên được kiểm tra cholesterol thường xuyên.

Xét nghiệm tiểu đường

Theo thống kê, 1/3 người dân Mỹ mắc bệnh tiểu đường mà không biết. Bệnh tiểu đường sẽ trở nên nguy hiểm nếu bệnh nhân không biết mình mắc bệnh, có thể dẫn đến những biến chứng tim mạch, mắt, tổn thương thận, thần kinh hay đột quỵ. Nếu bệnh được phát hiện sớm, người bệnh có thể kiểm soát mức đường huyết của mình bằng thuốc, phối hợp với chế độ ăn uống, luyện tập sẽ tránh được những biến chứng nguy hiểm đến sức khỏe.

Xét nghiệm đường huyết rất đơn giản, chỉ bằng thử máu lúc đói. Theo khuyến cáo, người lớn từ 45 tuổi trở lên nên xét nghiệm đường máu mỗi 3 năm. Nếu bạn thuộc nhóm có nguy cơ cao như cholesterol cao, tăng huyết áp nên được xét nghiệm sớm và thường xuyên hơn.

Xét nghiệm HIV

Đây là xét nghiệm nên được thực hiện ở những người có quan hệ tình dục cởi mở hoặc nghi ngờ mình nhiễm bệnh. Bệnh lây truyền qua đường tình dục, đường máu và từ mẹ sang con. Nếu nam giới có nhiều bạn tình hoặc quan hệ với những người có nguy cơ mắc bệnh như gái mại dâm, nên đi xét nghiệm HIV.

Để phòng lây nhiễm HIV, nên sử dụng bao cao su khi quan hệ tình dục, không dùng chung bơm kim tiêm.

Bệnh glaucoma

Tổ chức Y tế thế giới (WHO) đã xếp nhóm bệnh glaucoma – bệnh thiên đầu thống, là bệnh gây mù phổ biến thứ 2 thế giới. Đây là loại bệnh gây tổn hại thần kinh thị giác dẫn đến mù lòa. Thế giới hiện có khoảng gần 5 triệu người bị mù do glaucoma, nếu bị mù, bệnh không thể phục hồi được. Do đó cần khám sàng lọc và điều trị ở giai đoạn sớm.

Nên đi kiểm tra mắt, nhất là với bệnh nhân bị tăng nhãn áp:
- Dưới 40 tuổi: Mỗi 2-4 năm
- Từ 40-54 tuổi: Mỗi 1-3 năm
- Từ 55-64 tuổi: Mỗi 1-2 năm
- Từ 65 trở lên: Mỗi 6-12 tháng

Theo các bác sĩ nhãn khoa, người bệnh nên khám sàng lọc thường xuyên hơn nếu bạn có nguy cơ cao như những người có tiền sử gia đình có người bị tăng nhãn áp, chấn thương mắt, hoặc sử dụng thuốc steroid trị các bệnh về mắt.

Nguồn SKĐS

What to Eat if You Have Type 2 Diabetes

By Abigail Libers
Reviewed by Maureen Namkoong,

Eating the right foods can help keep your blood sugar levels in check. Here’s exactly what to put on your plate.

Jeff Wasserman/Stocksy

High in protein and heart-healthy omega-3 fatty acids, salmon is a great pick for people with diabetes.

Snack
Ideal Snack: 6 whole-grain crackers + 1 tbsp nut butter
Why it’s diabetes-friendly: Nut butters are packed with protein. Go for almond butter, which research shows can help with weight management. Just be sure to keep portions in check (stick to 1 tbsp) since nut butters are high in fat. As a general rule of thumb, fats should only provide about 25 to 35 percent of your daily calorie intake. For more diabetes-friendly snack ideas, check out these tasty ideas.
Dinner
Ideal Meal: 4-oz grilled salmon filet + a small sweet potato, baked + 1 cup steamed broccoli
Why it’s diabetes-friendly: Salmon is an excellent source of protein and heart-healthy omega-3 fatty acids. The sweet potato provides filling fiber and a type of carb that's less likely to spike your blood glucose levels than regular potatoes. Broccoli also provides fiber and is an excellent source of vitamin C. When planning dinner meals in general, aim for 45 to 60 g of carbohydrates, 3 to 4 oz of protein (21 to 28 g), and 10 to 15 g of unsaturated fat, says Palinski-Wade. Looking for more diabetes-friendly dinner ideas? Try these 15 delicious recipes!

Thứ Ba, 1 tháng 3, 2016

Facts About the Female Climax

By Dennis Thompson, Jr. | Medically reviewed by Lindsey Marcellin, MD, MP

Women can achieve orgasm through a number of different means and types of stimulation

The female orgasm continues to be the subject of intense scientific debate. Doctors puzzle over the different means by which women can achieve orgasm, and the things that can prevent orgasm in women.
When women do achieve orgasm, "There are changes throughout the whole body, a head-to-toe kind of experience," says Sandra Leiblum, PhD, a sex therapist and director of psychological services at the New Jersey Center for Sexual Wellness in Bedminster.
How Women Achieve Orgasm
Women achieve orgasm through a four-step process first described by sex researchers William Masters and Virginia Johnson decades ago:

Excitement. The woman initiates or agrees to sex, and as it commences she finds herself focusing mainly on sexual stimuli. Blood begins to engorge the clitoris, vagina, and nipples, and creates a full body sexual blush. Heart rate and blood pressure increases.
Plateau. Sexual tension builds as a precursor to orgasm. The outer one-third of the vagina becomes particularly engorged with blood, creating what researchers refer to as "the orgasmic platform." Focus on sexual stimuli drowns out all other sensations. Heart rate, blood pressure, and respiration continue to increase.
Orgasm. A series of rhythmic contractions occur in the uterus, vagina, and pelvic floor muscles. The sexual tension caused by lovemaking releases, and muscles throughout the body may contract. A feeling of warmth usually emanates from the pelvis and spreads throughout the entire body.
Resolution. The body relaxes, with blood flowing away from the engorged sexual organs. Heart rate, blood pressure, and respiration return to normal.

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