Neighbourhood design ignores the need of children to get out and play. We should be lobbying the city we live in to require safe space for play for children.
Schools are not always so good at activity. They should not keep kids in from recess to catch up on homework. Turn off the screens and get out and walk, or play in the park. The more you do that the healthier the kids will be and likely you as well. Cook healthier meals, don’t go out to eat more than once per week, have fruit and vegetables available at every meal.
Lobby the schools to be better at activity. Lobby the city to design active neighbourhoods. Alex on The Latest Canadian Infant Nutrition Guidelines-Birth to 6 Months of Age-What Parents Need To KnowDawid on Handling Long Weekend Diet Land Mines – Part 2Rajesh on Thank You Dr. Spider veins and varicose veinsSpider veins and varicose veins are practically a rite of passage. To provide even greater transparency and choice, we are working on a number of other cookie-related enhancements. Flesh eating disease or flesh eating bacteria is a rare yet serious bacterial infection of the deep skin layers that begin in the subcutaneous tissues and spreads along the flat fascial layers of tissue, separating different layers of soft tissue, like muscle and fat. It is a common belief that eating even low amounts of carbohydrates increases body weight, whether the carbs are from sugar, bread, fruits or vegetables. In reality, the amount of fat you gain while consuming carbohydrates depends more heavily on their type. On the other hand, refined carbohydrates (white bread, refined grains, pastries, sugared drinks) are easily digested and may contribute to weight gain and promote diabetes and heart disease. Carbohydrates which you will get from foods of these non-refined groups will not turn to fat nearly so readily. Find Us On YouTube!Subscribe today to check out our free Daily Knowledge Youtube video series! Blue and Green Pigments Don’t Exist in the Human Iris, So How Do Some People Have Blue and Green Eyes? The spectrum of foot infections in diabetes ranges from simple superficial cellulitis to chronic osteomyelitis. In terms of the infecting microorganisms and the likelihood of successful treatment with antimicrobial therapy, acute osteomyelitis in people with diabetes is essentially the same as in those without diabetes. Patients with diabetes also can have a combined infection involving bone and soft tissue called fetid foot. Individuals with diabetes may also have peripheral vascular disease that involves the large vessels, in addition to microvascular and capillary disease that results in peripheral vascular disease with gangrene. Except for chronic osteomyelitis, infections in patients with diabetes are caused by the same microorganisms that can infect the extremities of those without diabetes. In chronic osteomyelitis, a sequestrum and involucrum form; these represent islands of infected bone. Cellulitis may involve tender and erythematous nonraised skin lesions on the lower extremity that may or may not be accompanied by lymphangitis. If bullae are present, Staphylococcus aureus is the most likely pathogen, but group A streptococci occasionally causes bullous lesions. Patients with deep skin and soft tissue infections may be acutely ill, with painful induration of the soft tissues in the extremity. These infections are particularly common in the thigh area, but they may be seen anywhere on the leg or foot. Extreme pain and tenderness indicate the possibility of a compartment syndrome, which may be diagnosed with the aid of a CT scan. Unless peripheral neuropathy is present, the patient has pain at the site of the involved bone.
The deep penetrating ulcers and sinuses are usually located between the toes or on the plantar surface of the foot. In patients with diabetes, chronic osteomyelitis usually does not occur on the medial malleoli, shins, or heels. Importantly, deep penetrating foot ulcers or deep sinus tracts are diagnostic of chronic osteomyelitis. The microbiologic features of diabetic foot infections vary according to the tissue infected. In patients with diabetes, superficial skin infections such as cellulitis are caused by the same organisms as those in healthy hosts, namely group A streptococci and S aureus. Group B streptococcal cellulitis is uncommon in healthy hosts and not uncommon in patients with diabetes.
In patients with diabetes, deep soft tissue infections can be associated with gas-producing gram-negative bacilli. Acute osteomyelitis usually occurs as a result of foot trauma in an individual with diabetes. In chronic osteomyelitis, the pathogens are group A and group B streptococci, aerobic gram-negative bacilli, and Bacteroides fragilis, among others. Pseudomonas aeruginosa is generally not a pathogen in chronic osteomyelitis in patients with diabetes.
P aeruginosa is frequently cultured from samples obtained from a draining sinus tract or deep penetrating ulcers in patients with diabetes. Because Pseudomonas organisms are water-borne, superficial ulcers may be contaminated by bacteria in wet socks or dressings. Bone biopsy performed under aseptic conditions in the operating room reveals that chronic osteomyelitis in patients with diabetes is not due to P aeruginosa. B fragilis is an important bone pathogen in chronic osteomyelitis in patients with diabetes. Other pathogens implicated in chronic osteomyelitis in patients with diabetes include Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae.
Fetid foot represents a combined deep skin and soft tissue infection caused by pathogens involved in chronic osteomyelitis.
The CBC count and erythrocyte sedimentation rate (ESR) are slightly or moderately elevated in cellulitis. If bullae are present, Gram stain and culture results in aspirated exudate from a bullous lesion may provide clues to the etiology of the infection. In a patient with diabetes considered to have a deep soft tissue infection, plain radiography, CT scan, or MRI may be performed to rule out a compartment syndrome and to demonstrate the presence of gas or a foreign body in the deep tissues. A finding of excessive gas signifies a mixed aerobic-anaerobic infection in contrast to gas gangrene (clostridial myonecrosis). A bone scan is preferred to gallium or indium scans in the assessment of acute osteomyelitis. Gallium or indium scans offer no additional information, and the findings are not more specific than those of bone scans in the diagnosis of osteomyelitis. Bone scans are usually unnecessary unless diagnostic confusion exists with another disorder. A bone tumor is best differentiated from chronic osteomyelitis with the aid of bone scanning or MRI prior to definitive bone biopsy. Patients with diabetic foot infections and peripheral vascular disease may benefit from vascular surgical evaluation to bypass large-vessel occlusive disease. Aspiration of a sample from the leading edge of the erythematous border in a patient with cellulitis is usually not necessary, but a sample may be aspirated if the likely organism must be identified on initial presentation. Aside from blood culturing, radiography, and nuclear imaging studies, bone biopsy is not necessary in acute osteomyelitis because the pathogens are predictable. Bone biopsy performed under aseptic conditions in the operating room is the preferred way to identify the causative pathogen in chronic osteomyelitis.
A general or vascular surgeon should be consulted for the debridement or decompression of compartment syndromes in patients with deep skin and soft tissue infections. An infectious disease specialist should be consulted in the treatment of all patients with diabetic foot infections to optimize the antimicrobial therapy. In patients with diabetes, cellulitis is generally caused by group A and group B streptococci and, occasionally, S aureus.
In patients with diabetes, deep skin and severe soft tissue infections are usually due to mixed aerobic and anaerobic organisms.
Acute osteomyelitis, which usually is due to S aureus, may be treated with cefazolin, clindamycin, and an antistaphylococcal penicillin (eg, nafcillin). In chronic osteomyelitis, coverage must be directed against S aureus, group A and group B streptococci, aerobic gram-negative bacilli (excluding P aeruginosa), and B fragilis. First-generation semisynthetic cephalosporin that arrests bacterial cell-wall synthesis, inhibiting bacterial growth.
Lincosamide for the treatment of serious skin and soft tissue staphylococcal infections.Also effective against aerobic and anaerobic streptococci, except enterococci. Initial therapy for suspected penicillin G–resistant streptococcal or staphylococcal infections.
Bactericidal activity results from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin binding proteins.
Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma. People with longstanding obesity from childhood face the risk of heart disease, diabetes, strokes, sleep apnea among other illnesses.
As we age, many of us find the jagged purple lines or swollen bluish cords spreading along our thighs and calves. It is intended for general information purposes only and does not address individual circumstances. Also referred to as Necrotizing Fasciitis (NF), this disease can be easily found in the legs, arms and abdominal wall, and is critical in 30-40% of cases.
The reason for this misconception may be that eating carbohydrates raises insulin, which then lowers blood sugar. Foods containing carbohydrates can’t be cut off a healthy diet because they provide fiber, sugars, and starches, which supply energy to the body in the form of glucose (blood sugar), which is the energy source for human cells, tissues, and organs. Man-made carbs are digested quicker compared to natural carbs, because the more the number of processing steps a carb-heavy food has to go through,during the refining process, the easier it gets digested in the body (basically the less “steps” the body has to go through to break it down as the work has already been done during the refining process).
Most of them provide the body with fuel it needs for physical activity and for proper organ function being an important part of a healthy diet.
Some studies suggest that this happens because of a decrease in blood sugar that stimulates hunger. The truth is that combined with calorie control, a dairy-rich diet can nearly double body-fat reduction and help prevent weight gain.
These individuals are predisposed to foot infections because of a compromised vascular supply secondary to diabetes. Infections in patients with diabetes are difficult to treat because these patients have impaired microvascular circulation, which limits the access of phagocytic cells to the infected area and results in a poor concentration of antibiotics in the infected tissues. Chronic osteomyelitis in patients with diabetes mellitus is the most difficult infection to cure. Dry gangrene is usually managed with expectant care, and gross infection is usually not present. Gas gangrene is conspicuous because of its low incidence in patients with diabetes, but deep skin and soft tissue infections, which are due to gas-producing organisms, frequently occur in patients with diabetes. In the extremities, microvascular disease due to "sugar-coated capillaries" limits the blood supply to the superficial and deep structures. Most diabetic foot infections occur in the setting of good dorsalis pedis pulses; this finding indicates that the primary problem in diabetic foot infections is microvascular compromise. In mixed infections that may involve anaerobes, crepitation may be noted over the afflicted area. Similarly, extreme pain may be an indication of infection with clostridial species (ie, gas gangrene).
However, in unusual epidemiologic circumstances, organisms such as Pasteurella multocida (eg, from dog or cat bites or scratches) may be noted and should always be considered.
Clinically, these infections appear as necrotizing fasciitis, compartment syndrome, or myositis.
The distribution of organisms is the same as in an individual without diabetes who has acute osteomyelitis. However, these organisms are superficial colonizers and are generally not the cause of the bone infection.
To the author's knowledge, no well-documented cases of biopsy-proven P aeruginosa infection have been reported in patients with chronic osteomyelitis. Soft tissue swelling and periosteal elevation are the earliest signs of acute osteomyelitis on a plain radiograph. However, large-vessel bypass does not cure the microvascular component of diabetic foot infections. Because surgical debridement is critical in treating chronic osteomyelitis, bone biopsy specimens are usually not obtained during the surgical debridement procedure. Cellulitis may be treated with single antibiotics that have the appropriate spectrum or with combination therapy that covers the appropriate organisms. Although gram-negative organisms are the unusual causes of cellulitis, even in diabetes, if they are suspected, a fluoroquinolone (eg, levofloxacin) may be used in conjunction with clindamycin.
These infections may be treated with monotherapy involving meropenem or piperacillin and tazobactam. Monotherapy for chronic osteomyelitis may include ampicillin and sulbactam, piperacillin and tazobactam, or meropenem. Inhibits biosynthesis of cell wall mucopeptide and is effective during the active multiplication stage.
Primarily active against skin flora, including S aureus.Typically used alone for skin and skin-structure coverage. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, arresting RNA-dependent protein synthesis. Fluoroquinolones should be used empirically in patients likely to develop exacerbation due to resistant organisms to other antibiotics. Initially, use parenteral therapy in severe infections; change to PO therapy as condition warrants. Inhibits bacterial protein translation by binding to 30S ribosomal subunit and blocks entry of amino-acyl tRNA molecules in ribosome A site. Stable against hydrolysis by various beta-lactamases, including penicillinases, cephalosporinases, and extended spectrum beta-lactamases. Binds to bacterial membranes and causes rapid membrane potential depolarization, thereby inhibiting protein, DNA, and RNA synthesis, and ultimately causing cell death.Indicated to treat complicated skin and skin structure infections caused by S aureus (including methicillin-resistant strains), S pyogenes, S agalactiae, S dysgalactiae, and E faecalis (vancomycin-susceptible strains only). Indeed we are seeing children at the age of 8 years old showing signs of stiffening of the arteries in their necks from obesity. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Common symptoms include swelling, redness, pain and blisters in the affected area, fever, vomiting, nausea and other flulike signs. The digestion of a particular carbohydrate depends upon the complexity of its molecular structure. That is why it is smart to choose fruits over processed fruit juices and whole grain bread over refined white bread.
Recent research published in the Journal of American Medical Association shows that people following a diet low in fat and high in fruits, vegetables, and grains actually tended to lose weight, despite their heavy carb intake. Even fans of low carb diets agree that the carbohydrate level should be adjusted to the individual. One of the reasons for this is the hormone calcitriol in dairy products which helps conserve calcium for stronger bones while telling fat cells to convert less sugar to fat. For this reason, cellulitis is the most easily treatable and reversible form of foot infections in patients with diabetes. Adequate surgical debridement, in addition to antimicrobial therapy, is necessary to cure chronic osteomyelitis. In general, people with diabetes have infections that are more severe and take longer to cure than equivalent infections in other people. Pressure due to ill-fitting shoes or trauma further compromises the local blood supply at the microvascular level, predisposing the patient to infection.
Impaired microvascular circulation hinders white cell migration into the area of infection and limits the ability of antibiotics to reach the site of infection in an effective concentration. Administered antibiotics do not penetrate the devascularized infected bone fragments; they can enter the area of osteomyelitis only via the remaining blood supply. In chronic osteomyelitis, antimicrobial therapy without adequate debridement does not eliminate the infection. Has slightly increased activity against gram-negative species and slightly decreased activity against staphylococci and streptococci compared with imipenem. Because of thrombophlebitis, particularly in elderly patients, use parenteral administration only for a short term (1-2 d); change to PO route as clinically indicated. Indicated for complicated skin and skin structure infections caused by E coli, E faecalis (vancomycin-susceptible isolates only), S aureus (methicillin-susceptible and -resistant isolates), S agalactiae, S anginosus grp (includes S anginosus, S intermedius, S constellatus), S pyogenes, and B fragilis. Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. These symptoms develop quite rapidly within a day’s time of the wound allowing the bacteria to invade the tissues underneath the skin.
Considering this, some people advocate significant reduction of carbohydrates in their diet. The more complex this structure is, the harder the digestive system works to break it down and absorb it into the bloodstream. For reference, most experts recommend that 45% to 65% of the diet can be carbohydrates depending upon the individual.
For additional information, see Medscape’s Diabetic Microvascular Complications Resource Center. Deep skin and soft tissue infections are also usually curable, but they can be life threatening and result in substantial long-term morbidity.
Therefore, antibiotic therapy alone cannot cure patients with chronic osteomyelitis without surgical debridement to remove these isolated infected elements.
Structurally similar to beta-lactam antibiotics, but not related to beta-lactam drugs in terms of hypersensitivity. Good monotherapy with extended coverage against Pseudomonas species, as well as excellent activity against pneumococci. We never used to see any Type 2 diabetes (the type due to obesity) in children when I was training. And eating out on the way or coming back from activities is typically unhealthy and erases the benefit of the activity. But diets low in carbohydrates are likely to lack essential nutrients from plant foods, so people may not get enough vitamins, minerals and fiber.
So, depending on their chemical structure, there are simple (natural) and complex (man-made) carbohydrates. Serotonin (a hormone in the pineal gland, blood platelets, the digestive tract, and the brain) helps people to feel less pain, anxiety and stress while improving mood by increasing relaxation. This may allow for incidental trauma that goes unrecognized (eg, blistering, penetrating foreign body).
Surgical debridement is essential to remove the infected bony fragments that the antibiotics cannot reach so that affected areas can be treated with antimicrobial therapy. Carbapenems and monobactams do not cross-react in patients who are allergic to penicillin, even those who have an anaphylactic reaction to penicillin.
Cook large amounts once or twice a week and then freeze dinners you can simply heat up readily and easily. Also see original before-and-after pictures that have not been altered and that meet BootsWebMD's editorial standards. Athletes often follow a carbohydrate-loading diet, which involves increasing the amount of carbohydrates for several days before a high-intensity endurance athletic event.
Simple carbohydrates include natural food sugars (fruits, vegetables, milk products) and sugars added during food processing (cakes, sweets, sweet drinks) and refining. What are spider veins?Spider veins are small, twisted blood vessels that are visible through the skin. Complex carbohydrates include whole grain breads and cereals, starchy vegetables and legumes.
A healthy diet would mean not cutting off all carbohydrates, but to avoid foods with added sugars as they are usually high in calories and low in nutrients. What are varicose veins?Varicose veins are larger blood vessels that have become swollen and twisted.
Varicose veins can develop anywhere in the body, but usually appear on the legs and ankles. These valves allow blood to flow in the right direction from superficial veins to deeper veins and to the heart. Depending on the size of the blood vessel and extent of swelling, the result is a spider vein or varicose vein. The problem is also more common in people with jobs that keep them on their feet, including nurses and teachers. Other factors that may contribute include ageing, obesity, pregnancy, prior trauma, surgery to the leg and a genetic predisposition.
Severely swollen veins can be tender to the touch and may reduce circulation, leading to itchy, swollen ankles.
They can also produce chronic skin and tissue changes such as discolouration and ulceration of the skin. Occasionally, they may cause ulcers – large sores in the skin – especially near the ankles. Most spider veins and varicose veins don't need to be treated, unless they result in symptoms, ulcers, bleeding, or phlebitis, or because you want them removed for cosmetic reasons. If the veins are causing pain, soreness, and muscle fatigue or cramping, there are steps you can take at home to help reduce the symptoms. Treatment: Support stockingsThe simplest treatment for spider veins and varicose veins is to pull on a pair of support stockings.
Sometimes called compression stockings, they may help improve circulation and relieve pain and discomfort in the legs.
Treatment: Lifestyle changesLosing weight and walking regularly can ease the symptoms of spider veins and varicose veins. Whenever possible, prop up your legs with a pillow or reclining chair, so they rest at or above the level of your heart.
Treatment: SclerotherapyIf home remedies don't yield enough improvement, there are medical procedures to eliminate spider veins and varicose veins. A doctor injects a chemical solution directly into the abnormal vein that irritates and scars the vein closing it off so it disappears. A thorough evaluation prior to the treatment is necessary to reduce the risk of side effects such as discolouration, or the likelihood of new, superficial tiny blood vessels forming.
Sclerotherapy: Before and afterAfter treatment with sclerotherapy, spider veins generally disappear in three to six weeks, while varicose veins may take three to four months to respond.
Once gone, the veins do not reappear, but you will probably develop new spider veins at the same rate as before.
Treatment: Laser therapyLaser therapy and intense light pulse (ILP) therapy destroys tiny spider veins and small varicose veins with heat. Side effects may include minor discomfort in the treated area, skin discolouration, and the formation of blisters. More than one session is usually needed to get results, and it can take a year or two for the vein to disappear completely.
Treatment: Vein surgeryFor varicose veins that are too large to respond to sclerotherapy or laser therapy, surgery is an option. The standard procedure is ligation and stripping - tying off a vein and removing the problematic segment. If the vein is near the skin’s surface, it may be possible to remove it through a tiny incision that does not need stitches. Vein surgery: Before and afterVein ligation and stripping successfully removes varicose veins in nine out of 10 people. The procedure does not usually require a hospital stay, but you may need between one and three weeks before returning to work, depending on the type of work you do. It's important to consider that surgery done for cosmetic reasons is rarely available on the NHS, so you will usually have to pay for it privately. Treatment: Endovenous laserEndovenous laser is a new alternative for veins that were once only treatable by surgery.
A small laser fibre is placed inside the vein, pressure is placed on the vein, and the laser delivers pulses of laser light.
Treatment: Radiofrequency ablationRadiofrequency ablation is another option for large varicose veins. A small catheter delivers radiofrequency energy (instead of laser energy) directly into the vein wall, causing it to heat up and collapse. Treatment: Suction removalThis treatment is also known as transilluminated powered phlebectomy. Any affected veins are sucked out using special equipment inserted through one or two small cuts in the skin. Exercise helps keep your weight under control and your leg muscles toned, so your blood will flow freely.
If your job keeps you on your feet, stretch your leg muscles often to increase circulation.
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