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Combination of human chorionic gonadotropin and clomiphene | RRU – Dove Medical Press

Posted: June 19, 2021 at 1:49 am

Introduction

Male hypogonadism is divided into hypergonadotropic and hypogonadotropic (male hypogonadotropic hypogonadism, MHH). MHH is caused by insufficient secretion of gonadotropins and can be classified into three, namely, congenital, acquired and idiopathic. MHH presents as absent/delayed/arrested sexual maturation and infertility. It has lower prevalence than primary hypogonadism.1 To optimise the management of MHH after confirmation of the disease and consideration of future fertility prospects, the timing and choice of therapeutic intervention are important. Therapy involves the use of testosterone to induce the development of secondary sexual characteristics, which in turn leads to puberty and to the maintenance of secondary sexual characteristics.2 Therapy is likely to be life-long and requires regular monitoring. Thus, choosing a therapy to optimise responses and avoid adverse events is essential. Testosterone can come from exogenous or endogenous sources. Testosterone replacement therapy using exogenous testosterone is good for improving the quality of life and achieving physical benefits, but this therapy is not suitable for those who are currently seeking fertility.3,4 Exogenous testosterone suppresses gonadotropin hormones in the hypothalamuspituitarytestes axis, which is necessary for normal spermatogenesis to occur. To maintain fertility, exogenous testosterone treatment should be stopped.

Gonadotropin replacement therapy (GRT) induces both spermatogenesis and endogenous testosterone. GRT requires either pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropin administration. Gonadotropins can be self-administered subcutaneously and are not inferior to the more costly GnRH.5 Human chorionic gonadotropin (hCG) injection is also an effective therapy for patients with MHH.6 The benefits of hCG treatment for MHH patients instead of testosterone was confirmed in the current review.7 Clomiphene citrate (CC), a selective oestrogen receptor modulator, is being used (offlabel) for testosterone deficiency and does not interfere with spermatogenesis. CC effectively increases serum testosterone with few side effects in men with testosterone deficiency8 and is safe for the longterm management of hypogonadism.9

We believe in the possible synergy of hCG and CC in MHH patients. In this study, we evaluated the efficacy of a short course (12 months) of the combination CC + hCG on MHH patients who wished to preserve their fertility.

This prospective study included 19 azoospermic patients with MHH who were admitted to the Andrology and Fertility Hospital of Hanoi between March 2016 and March 2018.

The MHH diagnosis were made as follows: a male older than or equal to 18 years old without puberty development, with a serum testosterone level <100 ng/dL (3.5 nmol/L) and with a low or normal level of gonadotropins. After MHH diagnosis, the patients were grouped into two, as follows: partial MHH, onset of puberty but not complete (Tanner 3); and total MHH, childhood reproductive organs remaining and no onset of puberty (Tanner stages 1 and 2). The azoospermia diagnosis was made only after the technician had surveyed a minimum of two semen samples obtained at least 2 weeks apart. The entire semen sediment was centrifuged at a rate of 3000 g for 15 min prior to examination, and no spermatozoa were found.

The inclusion criteria were adult MHH patients suffering from azoospermia who seek fertility treatment and who agreed to participate this study. The exclusion criteria included: patients with MHH who are under 18 years old; adult patients with MHH whose tests showed the presence of sperm before the treatment; patients with MHH being treated for acute and sexually transmitted diseases using drugs or chemicals that affect spermatogenesis; patients with MHH who present with other endocrine diseases. Nineteen participants fitted the selection criteria and were enrolled in this study.

This prospective study aimed to evaluate the combination of hCG and CC in the treatment of MHH. The flowchart of study (Figure 1) was shown to clarify the process of this research.

Figure 1 Flowchart of study.

The clinical manifestation, history of medical problems, drug use and family history were recorded at the first visit. The physical examination included age, height, weight, vital signs, Tanner staging (pubic hair), stretch penis length, and testis volume (TV) measured by Prader testicle orchidometer. Laboratory examination included taking peripheral blood tests and measuring gonadotropin level (LH/FSH), total testosterone (TT) level and pituitary/olfactory nerve MRI scans to diagnose the causes of MHH. This study was approved by the ethics committee of the Andrology and Fertility Hospital of Hanoi.

One of the two brands of hCG (Pregnyl, Merck & Co., Inc or IVF-C, LG Lifesciences) was used every 3 days, the dose depended on the response of each patient (from 3000 IU to 10,000 IU) in combination with CC at 25 mg per day until normal testosterone levels are reached. The dose is maintained until spermatozoa appeared in the semen. Supplementation with HMG or FSH was made if the patient wanted to have children, as shown in the following schema (Figure 1).

The primary outcomes were the appearance of spermatozoa in semen after treatment and the total testosterone level. The secondary outcomes were the development of secondary sex characteristics, height, stretch penis length, average bilateral testicular volume, Tanner stage and achievement of childbirth after spermatogenesis (induced treatment).

Patients follow-up was performed once every 6 months for up to 2 years. Medical checks, TT level measurement and semen analysis were conducted every 3 months. The height, testicular volume, penis length and Tanner stage were measured every 6 months in the first year.

The LH, FSH and TT levels were determined by automatic systems (Elecsys 2010 of Roche) based on the sandwich principle and electrochemiluminescence immunoassay. The blood sample was collected at 7:00 am8:00 am. Normal values for males were LH =1.59.3 IU/L, FSH =1.418.1 IU/L and TT =13.423.6 nmol/L. The detection limit for LH was 0.2250 IU/L, that for FSH was 0.1200 IU/L and that for TT was 0.1222 nmol/L.

All patients underwent semen analysis every 3 months according to the 2010 WHO standards10 to analyse the semen volume, sperm density and sperm morphology. Sperm motility was divided into three groups, namely, progressive motility (PR), non-progressive motility (NP) and immotility (IM). Semen was obtained by masturbation and then placed in a neutral plastic vial. Samples were examined by a microscope (20 and 40 objective lens).

The volume of the testes was measured by the Prader orchidometer, and the average volume of bilateral TV was also analysed. The stretch penis length was measured from the pubic bone to the tip of the dorsal part of the stretched flaccid penis.

The R 3.6.2 software was used for the statistical analysis of data. The measurement data, such as normal distribution, were described by the mean standard deviation (X SD). If the distribution was skewed in accordance with the median, then the median was used. The comparison of follow-up data differences from the two groups was examined by the paired t-test or MannWhitneys U-test depending on the distribution of variables. P < 0.05 suggested that the difference was statistically significant. All charts were built with R graphic.

The average age of patients was 30 years old (30.2 5.6). Among them were 10 married patients (52.6%) and nine unmarried patients (47.4%). No significant difference in age, height, basal TV and LH, FSH and TT levels in the partial and total MHH groups (Table 1). However, the difference in penis length was significant (P=0.005) (Figure 2). The causes of MHH in patients include hypopituitarism (47.4%), Kallmann syndrome (26.3%), pituitary adenoma (15.8%), after basilar skull surgery (5.26%) and unknown etiology (5.26%). The average dose of hCG was 5000 IU per dose (5579 1773.7 IU), and the lowest dose was 3000 IU twice a week. The highest dose for hCG was 10,000 IU at 23 times per week. The detailed information followed one patient had 3,00 IU, 15 patients had 5000 IU, one patient had 8000 IU, and two patients had 10,000 IU.

Table 1 Baseline Clinical Data of the 2 Groups of Patients with HH

Figure 2 Penis length and testicular volume. (blueline: partial HH, redline: total HH).

Before treatment, mean TT level was 0.76 1.84 (in the range 0.088.2) nmol/mL. After 6 months with CC and hCG therapy, mean TT level sharply increased to 17.9 6.07 (in the range range 12.134.1) nmol/mL. The mean TT level was 19.6 5.6 (in the range 12.233) nmol/mL after 12 months of treatment. This change was statistically different (p < 0.001). The average testes volume, height and stretch penis length were also statistically increased after treatment. All details are described in Table 2. The change of clinical features in all patients and the total MHH group was statistically significant (P<0.001). In particular, the differences in testosterone hormone levels in the partial MHH group were also noted (P=0.03) (Figures 2 and 3).

Table 2 Features Changes Before and After Treatment

Figure 3 Testosterone level. (blueline: partial HH, redline: total HH).

No adverse event was noted in our study.

Nine patients had sperm in their semen (47.4%).All partial MHH patients (100%) and 37.5% of total MHH patients showed restoration of spermatogenesis. The earliest sperm appearance was 3 months after treatment (Table 3).

Table 3 The Appearance of Sperm in Semen

In the abovementioned nine cases, two had natural conception and childbirth, and two underwent IVF-ICSI; one case achieved children, whereas the other had frozen embryos but did not achieve pregnancy yet. Seven of the nine cases underwent sperm vitrification for fertility purposes in the future. The characteristics of sperm in nine patients was shown in Table 4.The sperm concentration under the combination treatment with hCG and CC was usually less than 5 million/mL. The highest sperm concentration was 24 million/mL, which was achieved in a patient with partial MHH. Evaluation of motility and morphology showed that the average progressive motility rate was below 8%, and the normal morphological rate was 1% or lower.

Table 4 Characteristics of Sperm

Recently, several studies have evaluated the effectiveness of CC in treating male infertility patients. The mechanism of action of CC involves the inhibition of the negative feedback of oestrogen at the level of the hypothalamus and pituitary, thereby increasing FSH and LH concentrations. LH stimulates Leydig cells to increase the secretion of testosterone.11,12 CC has been approved by the FDA to treat ovarian dysfunction and has been shown to have a beneficial effect on male hypogonadism.12 Most randomised controlled clinical trials showed that CC has a significant effect on the concentration of FSH and testosterone in plasma.13,14 In our study, we just only measured FSH before treatment. For that reason, testosterone was measured to evaluate the effect of combination. However, the improvement of semen parameters is controversial. A number of randomised controlled clinical trials suggested that CC does not change the semen parameters.15 Some reports have suggested that CC improves sperm count and pregnancy rate.14,16,17 In our study, the subjects were patients with MHH whose spermatogenesis had not occurred, and thus, increasing hormone levels was an important goal for these patients.

In the present study, we aimed to assess the efficacy of combined therapy (CC + hCG) in spermatogenesis. We conducted this study to find out if adding CC to hCG treatment would be beneficial. Objectively, we found that such a combination of hCG + CC was effective in restoring normal hormone secretion, especially testosterone serum levels, after 12 months. The effect of stimulating sperm production with hCG + CC in our study after 12 months was 9 (47.4%).This was considerably low, because the follow-up time in our study was not long enough. Indeed, in Vietnam, detection is often late for men who are infertile due to secondary hypogonadism, and the treatment is often long and difficult, resulting in high costs and failed results. Couples desire to have children as soon as possible. In some cases in our study, when no sperm was found in the semen after 12 months, the couple refused the subsequent treatment, instead switching to an alternative regimen and accepting donor sperm for the next steps. With early sperm production time and 6 months follow-up period, Lin et al reported that GnRH infused subcutaneously was a preferred method than the combination of hCG and human menopausal gonadotropin.18 In our study, we did not have a control group, but we used CC, which has been proven as effective in improving the sperm count, sperm motility and the morphology of the sperms (to a certain extent).19 It effectively led to spermatogenesis.

In our study, spermatogenesis differed between the two subgroups of MHH. The rate of sperm appearance in the semen of the total MHH group was 7/16 (43.75%), whereas this was 100% in the partial MHH group. These results were in line with those obtained by a study showing that hCG can complete the spermatogenesis in men with partial gonadotropin deficiency.20 No difference in hormonal profile was found between the two groups but the differences in height, penis length and testicular volume were statistically significant, showing that we can use clinical evaluation to predict the success rate as in some previous studies, in which the response to hCG of patients with MHH was predicted (especially in terms of the testicular volume).20,21 In our study, the testicular volume of most unsuccessful cases ranged from 1 mL to 2 mL. Larger testicular volume was a useful prognostic indicator of response and was a predictor of fertility outcome.22 The quality of sperm recovered in our study was low with 7/9 (77.7%) showing deformed morphology. There were two cases with normal morphology, but they differed in etiology, concentration and motility.

In our study, one special patient was classified into the total MHH group even if he had puberty symptoms (Tanner 3) at initial evaluation, ie, Tanner 2 according to the testicular volume (5 mL) and Tanner 4 according to the hair distribution, because he had been using testosterone therapy for 12 consecutive years. Sperm appeared in his semen after 13 months of follow-up.

In accordance with spermatogenesis, secondary sex characteristics also developed. After treatment, a steadily increasing trend with statistically significance in height, penis length and testicular volume was observed in the total MHH group in particular. However, such a trend was not shown in the partial MHH group. We also noted that the oldest person (37 years old) was still growing (up to 5 cm). Moreover, the tallest height reached (up to 8 cm) was observed in a 24-year-old patient. Testicular volume was increased by about two times after 12 months. Our therapy increased serum testosterone level, which in turn induced and maintained secondary sex characteristics and also improved the quality of life and wellbeing, especially in patients aiming to become fertile.23

Testosterone level increased by approximately 25 times (mean) and was at a normal range at 12 months after treatment. Mean TT level was 0.76 1.84 nmol/mL (at baseline), which increased to 17.9 6.07 nmol/mL at 6 months after treatment and to 19.6 5.6 nmol/mL after 12 months of treatment. Testosterone level increased quickly and was maintained after 12 months of treatment with the combination of hCG and CC. Such combination therapy was effective for normalising testosterone level. When the testosterone level became normal, the development of sex characteristics was enhanced. Gonadotropin normalised testosterone level; spermatogenesis began even without the use of exogenous testosterone.

The most important issue when using hCG to treat MHH and to achieve the desired outcomes was the dose and duration of treatment.24 In the present study, the group was treated with CC at 25 mg daily and hCG at an average dose of 5000 IU administered twice weekly (i.m. or s.c.). To support endogenous testosterone production for the period of infertility treatment, hCG treatment can be administered at the appropriate dosage to prevent serum FSH level suppression.25 In this situation, through a negative feedback mechanism, CC supported the effect of hCG and optimised the treatment.

The hormone hCG induces testosterone production by stimulating Leydig cells directly. Its effect is similar to that of LH, but its elimination half-life is longer than that of LH, thereby avoiding the need for daily injections. The level of testicular testosterone increased, thereby inducing the onset of spermatogenesis21,26 and stimulating Sertoli cell maturation and proliferation.21,27 Kobori et al reported that by using hCG, spermatogenesis was restored in five of the seven patients with adult-onset idiopathic hypogonadotropic hypogonadism.28 FSH was not considered for MHH treatment because the role of FSH in stimulating spermatogenesis is not fully adequate and need further studies.21,29 Thus, using FSH alone as initial therapy did not show a good outcome.29 In addition, FSH treatment is expensive and is not appropriate for developing countries like Vietnam.

CC is an orally active nonsteroidal agent distantly related to diethylstilboestrol.30 CC induces the Leydig cells in the testes to produce testosterone, which together with FSH induces spermatogenesis.19 Moreover, masculinisation of the brain during development and maintenance of sexual behaviour in adult males were also noted in rats31 when CC was administered. Published data suggested that CC may be an appropriate alternative treatment for male hypogonadism, because it is safe, cheap and effective for improving serum testosterone levels in men who wish to preserve their fertility.8,9 Da Ros et al concluded that CC should be considered as a therapy for men with symptomatic hypogonadism.32 However, few studies have investigated the use of CC in MHH treatment. Available data suggested that clomiphene is an efficient and convenient alternative to testosterone replacement therapy in a substantial subset of patients with late-onset hypogonadotropic hypogonadism (at 68 weeks following initiation of treatment).33 Our study supported these results with the use of 25 mg CC combined with hCG in the treatment of MHH. As the same effect of hCG, a daily dose of 25 mg CC could given the contribution that resulted in increased posttreatment testosterone levels and improvement of the quality of life. Moreover, using CC also has economic benefits. Taylor and Levine found that CC was a less expensive option with minor side effects for men with hypogonadism.30 In addition, it had no effect on the change of prostate-specific antigen or haematocrit values34 thereby helping us evaluate the side effect of hCG23 with minimal bias.

Studies have investigated the side effects of CC medication. Side effects of the drug include headache, dizziness, gynecomastia and exacerbation of mental illness. However, according to this study, CC is generally considered to be safe and well-tolerated.11 Side effects of hCG are reportedly mild even with prolonged use and high doses. Some side effects include the following: headache; feeling restless or irritable; mild swelling or water weight gain; depression; feeling tired; breast tenderness or swelling; pain; hypertension; polycythaemia; increased haematocrit; and acne. To avoid these side effects, we used a combination of hCG and CC to reduce the dose of hCG and increase the effectiveness of the treatment. In our study, 19 patients with MHH did not report any drug side effects.

hCG and/or CC treatments protect the testis.35 The effectiveness of hCG alone or in combination with CC has been reported.36 The combination of hCG + CC is a safe, low-cost and effective treatment that can be used to preserve fertility capacity. We have not been able to demonstrate that the dose of hCG is reduced in the combination of CC and hCG due to the small and rare number of samples. Further studies are required to evaluate a larger population. Society should focus on patients with hypogonadism who need access to healthcare earlier, because monitoring the impact of the condition on long-term health and psychosocial function is necessary.

The main limitation of the present study was that we did not have a control group. This was considered impossible, because all the enrolled participants wished to maintain their fertility.

In conclusion, a combination of hCG and CC may be an option for MHH patients who desired to restore their fertility. After 12 months, 52.63% of patients showed the restoration of spermatogenesis, and spermatozoa appeared in semen. Testosterone level increased by approximately 25 times by mean and was in the normal range at 12 months after treatment. Secondary sexual characteristics improved significantly, especially the increase in body height and penile length, even in the patients over 18 years old. This therapy was considered safe because no adverse event was noted.

MHH, male hypogonadotropic hypogonadism; total HH, total hypogonadotropic hypogonadism; partial HH, partial hypogonadotropic hypogonadism; CC, clomiphene citrate; hCG, human chorionic gonadotropin.

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

The Ethics Committee of Vietnam Military Medical University approved the study protocol (QD/HVQY) and authorized its conduct and follow-up. The study was in line with the Declaration of Helsinki. Individual patient consent for inclusion in the study was obtained. Before treatment, written informed consent was provided to all participants after a thorough explanation of the purpose of this study. Patients had signed in written informed consent. Patients had the right to discontinue at any time during the study.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

There is no funding to report.

The authors declare that they have no conflicts of interest for this work.

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Combination of human chorionic gonadotropin and clomiphene | RRU - Dove Medical Press

Testosterone Replacement Therapy Market Trend, Forecast, Drivers, Restraints, Company Profiles and Key Players Analysis by 2027 KSU | The Sentinel…

Posted: June 19, 2021 at 1:49 am

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One Major Side Effect of Eating Peaches, Say Science | Eat This Not That – Eat This, Not That

Posted: June 19, 2021 at 1:48 am

Let's make sure we're very clear about one thing right off the bat: Peaches are an excellent source of several key nutrients. Boasting various vitamins, minerals, and antioxidants, the fuzzy fruit can be enjoyed by itself as a snack, sliced and put on top of a salad, or incorporated into a dessert.

However, there's one pitfall (get it?) to peaches that may affect some groups of people more so than others. Since peaches are so sweet, they're a bit higher in fructose (sugar) than some other fruits, which also means they're considered a high-FODMAP food. FODMAP stands for Fermentable Oligo-, Di-, Mono-saccharides, and Polyolsaka the scientific names for carbs that could cause gastrointestinal distress.

This is more of a concern for people who have irritable bowel syndrome (IBS), especially those who are just learning they have it and are trying to figure out which foods trigger symptoms. When someone first learns they have the functional gut disorder, a physician may suggest they follow a low-FODMAP diet for a few weeks. Essentially, this diet calls for the elimination of all foods that are considered high in FODMAPS, including garlic, onion, wheat, apples, cherries, and ice cream, just to name a few.

RELATED: The Best Low-FODMAP Foods (and What Foods to Avoid)

However, this diet can be very restrictive and can also cause you to miss out on some high-fiber, prebiotic-rich foods. That's why it's extremely important for you to slowly begin to reintroduce healthy high-FODMAP foods back into your diet. This way, you'll be able to pinpoint which foods are actually triggering symptoms. For some people, it may just be a few foods that are causing bloating, diarrhea, gas, or constipation.

Another group of people that should steer clear of peaches are those who have an allergy to stone fruits. Fruits that have a hard seed or pit such as peaches, apricots, plums, and nectarines are considered stone fruits. If you eat a peach and feel itchy or swollen on your face, lips, mouth, throat, or tongue, it's possible you have a mild allergy. More severe symptoms include coughing, skin rash, and vomiting, for example.

Bottom line: Peaches can be enjoyed safely by most individuals. However, if you suspect you have IBS or get an itchy throat after consuming stone fruits like dark cherries and mangoes, it may be best to pick another fruit to munch on this summer.

For more, be sure to check out8 Low-Carb Fruits For Weight Loss.

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One Major Side Effect of Eating Peaches, Say Science | Eat This Not That - Eat This, Not That

Weight loss: Can you follow Keto and Intermittent Fasting together? Can it speed up weight loss? – Times of India

Posted: June 19, 2021 at 1:48 am

It's important to remember that both Keto and Intermittent Fasting do have their fair share of pros and cons. So, following two diets at once could also mean that you end up at the risk of double the side-effects, especially if you are a beginner.

Experiencing low blood sugar, nausea, mood swings, fatigue, constipation can also be common in the starting days. More so, do remember that trying the two diets together also requires a lot more patience and commitment, since it's a narrow way of eating.

If you do try the diets, the best would be to ease into them, rather than going all-in. Add foods in your diet which release energy slowly, and don't completely quit out carbs. If you have a history of eating disorders, trying this method out wouldn't be wise.

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Weight loss: Can you follow Keto and Intermittent Fasting together? Can it speed up weight loss? - Times of India

Flying Treats: Can Dogs and Cats Snack Safely on Cicadas? – The New York Times

Posted: June 19, 2021 at 1:48 am

Dogs eat lots of stuff they will paw open a pantry and eat five pounds of dog food before owners catch them, Dr. Hohenhaus said. One dog puked up a shark toy. So if you have a dog who goes to the country for the weekend and eats horse poop, hell have diarrhea on Monday morning.

As for those pets who have hoovered up cicadas and landed in the vet E.R., she said, cause and effect are not necessarily obvious. I dont know if the cicada shells made the dog sick or it was the Kleenexes and trash the dog ate out of the bathroom basket.

Cicadas can, however, incite some cats and especially dogs to binge. (Think potato chips: Can you eat just one?)

Because cicadas are so easy to catch, some animals are going to town eating them, said Dr. Klippen, who sees perhaps a handful of dogs a week for this reason. The risks are not from the bugs, she said, but from dehydration related to vomiting and diarrhea, or from having absorbed pesticide sprayed on the cicadas.

For dogs who cant quit cicadas, consider a basket muzzle, Dr. Klippen said. Its beneficial and doesnt prevent dogs from panting and drinking.

Also try walking your dog at dawn and dusk, Dr. Wismer advised, when cicadas are least active. Since cicadas are found in and around mature trees, avoid routes that include them.

The heebie-jeebies over pets and cicadas springs mostly from the alignment of several factors. Theres the once-in-nearly-two-decades emergence of the bugs. And the heightened attachment and overprotectiveness that owners developed toward their pets in the past year during lockdown. Moreover, veterinarians said, peoples concerns are being revved by the internet and, er, the news media.

But basically, its something for us to talk about other than the coronavirus, Dr. Klippen said.

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Flying Treats: Can Dogs and Cats Snack Safely on Cicadas? - The New York Times

Side Effects of Hand Sanitizer, Risks, and How to Use It Safely – Healthline

Posted: June 19, 2021 at 1:48 am

Hand sanitizer has become more popular than ever, in large part due to its effectiveness during the COVID-19 pandemic. Portable hand sanitizer products kill germs on your hands and other surfaces on contact, helping to slow the spread of transmissible diseases like COVID-19.

Hand sanitizer has proven itself useful in killing germs, but using it can have side effects. Overuse of hand sanitizer can lead to dry, cracked skin as well as redness or discoloration, and flaking. It can also pose a risk if its ingested or gets into your eyes.

Lets cover everything you need to know about using hand sanitizer safely.

The side effects of your hand sanitizer will come down to the formulas youre using. Hand sanitizer typically contains a high amount of alcohol (between 60 and 95 percent) meant to kill germs on your hands. Even if the alcohol content is low, your hand sanitizer may also contain other antiseptic ingredients that have been known to cause side effects.

Alcohol is an effective antiseptic, meaning that its proven to kill bacteria and viruses on organic surfaces. But alcohol is also known to have a drying effect on your skin.

When youre applying hand sanitizer to your hands multiple times each day, the product is taking moisture out of your skin. This can result in skin thats dry, flaky, and sensitive to the touch. In addition to being uncomfortable, the American Academy of Dermatology Association says that having dry skin can actually increase your chances of picking up germs.

You may notice that after hand sanitizer dries on your hands, itchy and red or discolored eczema patches tend to appear. Thats because if you have eczema, the chemicals can actually make your symptoms worse. Whether you use a foam, liquid, or a gel-based hand sanitizer, you may see increased eczema symptoms after use.

Hand sanitizer sometimes contains an ingredient called triclosan. According to the FDA, Triclosan is intended to kill bacteria, and has been used in products from toothpaste to body wash. The FDA also says some studies have indicated that high exposure to triclosan may disrupt natural hormone cycles and even impact fertility. More research is needed to fully understand triclosans impact on people, but the ingredient has already been banned from several types of products.

The FDA says that triclosan is intended to kill bacteria, but overuse of this ingredient in consumer products may be contributing to the rise in antibiotic-resistant bacteria. A 2015 research review of how triclosan is contributing to antibiotic resistance concluded that more research is necessary to determine how this chemical is actually impacting human health.

There are risks for using hand sanitizer, especially if you use it in ways other than instructed on the package instructions. These risks can typically be avoided by sticking to external use of hand sanitizer and avoiding contact with your eyes.

The high amounts of alcohol and other ingredients make hand sanitizer unsafe for human consumption. Texas Medical Center says that anyone who swallows a significant quantity of hand sanitizer can get sick with symptoms that resemble alcohol poisoning.

Hand sanitizer is meant for external use only. If you or someone you know has ingested it, call the Poison Control Hotline at 800-222-1222.

Its easy enough to apply hand sanitizer and accidentally touch your eye shortly afterward. But the high levels of alcohol in hand sanitizer can actually cause chemical burns on the outer layer of your eye. Typically, damage caused by hand sanitizer to your eyes will completely heal, but you may experience the following symptoms while it heals:

Theres a reason that doctors recommend washing your hands with soap and water over using hand sanitizer. Its because its very simple to accidentally overdo it with hand sanitizer and cause dry skin and other side effects.

In fact, if you use hand sanitizer so much that your hands get dried out, it may be easier for your hands to pick up germs from other surfaces.

Additionally, your skin may start to crack or bleed. Skin thats dried out and cracked may also be more susceptible to bacteria.

Read ingredient labels before you buy hand sanitizer and limit how much you use it to the product labels recommendations. For best results:

When used properly, hand sanitizer does have benefits, including:

To use hand sanitizer correctly, you should only use it when your hands are free from visible dirt. Use only a dime-sized amount (or less) and rub your hands together until the hand sanitizer has completely absorbed. For best results (and healthy skin), apply a moisturizer as soon as possible after the hand sanitizer has dried. This will help prevent some of the less than desirable side effects.

When hand sanitizer is used correctly, side effects and risks are minimal. When you overuse the product, it can cause dry hands and cracked skin. Some ingredients in hand sanitizer, such as triclosan, may cause health complications if you are exposed to them in large amounts. Always read ingredient labels before you buy and only use hand sanitizer according to the guidance on the product label.

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Side Effects of Hand Sanitizer, Risks, and How to Use It Safely - Healthline

Health and Wellness: Getting and staying fit when you’re over 50 – Seacoastonline.com

Posted: June 19, 2021 at 1:48 am

Carrie Jose| Portsmouth Herald

The importance of being healthy and fit has taken center stage these last 18 months, but especially for the over 50 crowd. Most people aged 50-plus who want to get and stay fit struggle, because what might work for someone in their 20s or 30s just doesnt make sense for them in their 50s. As you age, both your needs andyour priorities change.

Once you hit age 50, people start to suffer from things like arthritis, degenerative and aging joints, and more back and knee pain. And if you arent suffering from them yet, youre worried about when you will. First, let me just tell you that it is 100% possible to get and stay fit after 50. Many folks who are 50 and over arethe healthiest theyve ever been in their lives. So whats their secret?

Here are fivehabits those over 50 stick to sothey can get and stay fit.

Get enough sleep

The myth that you dont need as much sleep as you get older is false. Most research indicates that even when youre over 50, you should still be aiming for seven to ninehours of sleep per night. When you dont get enough sleep, it catches up to you. You lack energy, making you less motivated to exercise and more likely to eat sugary, unhealthy foods. Lack of sleep lowers your immune system, affects your memory and ability to focus, impacts your balance, and increases your chance of high blood pressure. In general, lack of sleep is going to significantly impact your ability to eat well and exercise, two essential ingredients for getting and staying fit after age 50.

Keep Nutrition Simple

If youre over age 50, youve likely seen every cleanse, crash diet, health shake, weight loss pill, or gimmick known to man.There literally isnt a trick left in the book you havent seen. At age 50-plusyou also typically arent in the mood to be a nutritional extremist either. Its a good idea to just keep things simple. Focus on eating nutritious whole foods (things that are unprocessed) and drink plenty of water. Start your day with an 8-ounceglass of water and then aim to drink at least threemore bottles after that. When youre planning meals, make your plate up with half vegetables, one quarter protein, and one quarter whole grains. Adding a little bit of healthy fat consisting of plant oils is a good idea too. Good nutritional habits give you the energy and stamina you need to get and stay fit.

Lift Weights

I cant tell you how often I get asked is it safe to be lifting heavy weights at my age? People worry that lifting heavy weights could be bad for their spine or knees once they reach 50. Lifting weights is not only good for you, but perfectly safe when done correctly. But its important that your workout is customized and takes into account any injuries or ailments you may have. Arthritis in your joints, bulgingdiscs, and even meniscus tears are all normal things that occur as you age, but you want to make sure your strength training routine reflects this. As a physical therapist, the two biggest things I look at when Im examining someones strength routine are form and loading strategies. Good and proper form is critical to protect your joints and back. Loading refers to how much weight you lift and how often (reps). This changes as you age because the integrity of your soft tissue (muscles and ligaments) is different. Loading strategies also need to be adapted if youre injured or in pain. A good strength coach and physical therapist, especially when working together, can make sure that you have a strength training routine that is not only safe but perfect for your age and ability.

Strengthen your Core

After age 50 things like balance and reaction times start to become more compromised, and the likelihood of back pain increases. Maintaining good core strength helps with all of this and becomes more important than ever at age 50. The biggest problem I see with people trying to strengthen their core is that they just dont know how to do it properly. They may be doing all the right things, but with all the wrong muscles. If youre new to core strengthening, or perhaps youve been doing it awhile but your core strength still isnt where you want it to be, consider trying Pilates. Its long been known as the staple of core strengthening because it requires you to perform very controlled and precise movements while focusing on your breath. Having proper control over your breath, body, and movement are the cardinal signs of a truly functioning and strong core.

Address Pain

This may seem obvious but I cant tell you how many people either ignore, or work around their pain. When you ignore your pain you risk developing other problems due to your body compensating. These compensation strategies may last you for a short time but eventually catch up to you. When youre over 50, recovering from injury is harder and takes longer. So although preventing injury is your best strategy, dont just ignore pain if youre experiencing it. When you work around pain, its impossible to get the most you can out of your workouts and this delays your ability to get and stay fit. If youre always having to modify exercise or compensate for pain, not only is this frustrating, but you delay getting to the root cause of your problem. Simply put, if youre experiencing musculoskeletal pain, get it addressed.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or register for our Getting Fit After 50 Masterclass, email her atinfo@cjphysicaltherapy.comor visit our website.

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Health and Wellness: Getting and staying fit when you're over 50 - Seacoastonline.com

Ballyclare dad speaks out on cost of feeding kids a nutritious diet – Belfast Live

Posted: June 19, 2021 at 1:48 am

A Ballyclare dad has told how he and his wife had to turn to foodbanks and family help to provide their kids with a healthy diet on a tight budget after a job loss.

It comes as new research from safe food and the Food Standards Agency in NI has revealed how a healthy food basket could cost some families as much as 46% of their weekly income.

Craig, a dad-of-two, has spoken out to highlight this for a Consumer Council film on the issue called 'Hand to Mouth: Accessing healthy, affordable food on a low income' which aims to help highlight the issues facing some low-income families across Northern Ireland.

Craig said: "When my partner lost her job, it was a bit daunting, and I felt I had no back up. The whole thing was a complete disaster. We had to cut down and make changes.

"Some days I had to rely on family members and brought my children to their house for dinner. Last year was so tough especially with the cold weather and having to buy oil just after Christmas. But I got help from a food bank, they actually delivered food to my home."

The cost of eating a healthy balanced diet for a family of four living on benefits with two adults and two children in primary and secondary school is 162 per week (46% of their household income) while a healthy food basket for a single parent living on minimum wage with two children in pre-primary and primary school would cost 105 per week (25% their household income).

For a pensioner living on their own it would cost 61 per week to eat a healthy balanced diet (32% of their household income).

Research highlights the challenges facing low-income families in eating a healthy, balanced diet while meeting other essential household expenses and shows how low-income families in Northern Ireland now need to spend up to almost half (46%) of their weekly income to afford a healthy food basket that meets basic nutritional needs.

It also found that households dependent on benefits spent up to 14% more of their income on food than households where one adult was in employment.

Typically, households on a low-income tend to eat less well and this can contribute to higher levels of excess weight and its health complications like heart disease and Type 2 diabetes. The research also found that food costs were highest for a low-income household with an older child of post primary school age, costing approximately one third more than a similar household with younger children.

Introducing the report, Joana Da Silva, Chief Specialist in Nutrition, safe food said: "Managing on a tight budget means that families with children, single parents and pensioners have to make stark choices in how they spend their money. Food spending is the flexible element of the household budget and people often fill up on cheap food thats nutritionally poor when prioritising other bills that need to be paid."

FSA Northern Ireland Dietary Health policy lead, Fionnuala Close continued: "While many families across Northern Ireland can enjoy a healthy diet, other households on a low-income struggle to make a limited budget go further and tend to eat less well, which can lead to health inequalities. The 2020 Food Basket research builds on an evidence base that is helping to shape Northern Irelands policies to address food need amongst the most vulnerable in our society."

Data from the Northern Ireland Statistics and Research Agency showed that from 2019-2020 almost 1 in 6 (17%) of the Northern Ireland population were in relative poverty with 13% in absolute poverty.

Food poverty is an issue that encompasses both the lack of access to a nutritionally adequate diet and the impact this has on health as well as the ability to participate socially through food.

Philippa McKeown-Brown, Head of Food Policy at The Consumer Council added: "The Consumer Council was keen to produce a short film Hand to Mouth to accompany the Minimum Essential Food Basket research, which explores the difficulties people can face accessing a healthy, affordable and enjoyable diet on a limited budget.

"In the film we hear from parents affected by a loss of income due to the Coronavirus pandemic, and the added strain of feeding their kids around the clock whilst schools were shut. With the summer school holidays just around the corner, there will be a lot of families again worried about making the food go further."

The report What is the cost of a healthy food basket in Northern Ireland in 2020 i s available to download from: http://www.safefood.net.

The Consumer Council film Hand to Mouth: Accessing healthy, affordable food on a low income is available to view from: http://www.consumercouncil.org.uk/foodpoverty

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Ballyclare dad speaks out on cost of feeding kids a nutritious diet - Belfast Live

Botox and COVID Vaccine: Is It Safe to Get Both? – Healthline

Posted: June 19, 2021 at 1:48 am

If you have or are considering Botox or dermal fillers, you may have some extra questions about the COVID-19 vaccine. These questions are most likely the result of a side effect reported specifically from the Moderna vaccine.

During the phase 3 trial for the Moderna vaccine, 15,184 trial participants were given the vaccine. Out of those participants, three subjects who had had dermal fillers experienced mild facial swelling within 2 days of their vaccine dose.

Two of the subjects experienced swelling in the general area of their face, while one experienced lip swelling. None of the subjects with dermal fillers who were given the placebo experienced this side effect. The swelling went away completely with treatment at home for all three participants.

Before we go further, remember that Botox and dermal fillers are not the same things. Botox is an injectable muscle relaxer, while dermal fillers are synthetic materials meant to add volume and structure to your face. The people in the Moderna vaccine trial had dermal fillers.

Based on what we know so far, doctors still strongly recommend everyone who can get the COVID-19 vaccine should do so. A history of getting Botox and dermal fillers is not considered a reason to opt out. The protection offered from the vaccine is still believed to far outweigh the slight risk of swelling for people with dermal fillers.

The American Academy of Plastic Surgeons says that people with dermal fillers should not be discouraged from getting the COVID-19 vaccine. Thats because these side effects are considered rare. Even in the cases where these side effects were reported, they resolved quickly and didnt have long-term health complications.

With that being said, the Moderna trial cases are not the only examples of swelling associated with dermal fillers and the COVID-19 vaccine.

A study published in February 2021 mentions isolated, rare cases of swelling that seemed to have occurred in connection to the Moderna vaccine as well as the Pfizer vaccine. The study theorizes that this is the result of how the unique spike proteins in COVID-19 behave within your body.

These case studies let us know that these side effects are possible, but not at all likely. All of the cases of swelling were connected to dermal fillers that contained hyaluronic acid, and each of them resolved on their own, just like the Moderna trial participants.

Finally, keep in mind that contracting the coronavirus itself has been connected to facial swelling in people with dermal fillers in at least one case. You may choose to avoid the COVID-19 vaccine because of its connection to swelling side effects, but that would mean that you are more vulnerable to contracting the virus, which can carry the same rare side effect.

There is no official guideline that recommends avoiding fillers or Botox after your COVID-19 vaccine.

That doesnt mean that we wont find out more about this in the future. There may be clearer guidelines to come from plastic surgeons and dermatologists about when you should get fillers or Botox after the COVID-19 vaccine.

For now, you can play it safe and wait until the vaccine has taken full effect until you get your next round of dermal fillers or Botox. It takes about 2 weeks after your second dose of the Pfizer or Moderna vaccines in order for the vaccine to take its full effect.

This is not the first time that a link between dermal fillers, exposure to a virus, and symptoms of temporary facial swelling have been linked.

During the Moderna trial, the same participant with dermal fillers who experienced swelling in the lip area reported that they had experienced a similar reaction after getting the flu shot. In the past, people receiving other types of vaccines were seen to have an increased risk of swelling side effects from dermal fillers. This has to do with how these vaccines activate your immune system.

A 2019 paper noted increasing evidence that showed people who recently had the flu had a higher risk of delayed side effects, including swelling, from dermal fillers that contain hyaluronic acid. Its possible that vaccines and recent virus exposure can cause your immune system to see the fillers as a pathogen, triggering an attack response on the filler material from your T cells.

Finally, its important to remember that temporary facial swelling is not an uncommon reaction for people that have had any type of fillers.

There have been some reports of people with dermal fillers experiencing facial swelling as a side effect of the Pfizer and Moderna COVID-19 vaccines. So far, reports of this side effect are extremely rare, and they are not long term. As of now, doctors and medical experts emphasize that the low risk of temporary swelling is far outweighed by the benefits of protection from COVID-19 vaccines.

Before you get your COVID-19 vaccine, speak to a medical professional about any concerns or questions that you have. Your primary physician should be able to evaluate your health history and give you the most up-to-date information on how the COVID-19 vaccines may affect you.

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Botox and COVID Vaccine: Is It Safe to Get Both? - Healthline

5 critical water safety skills, other ways you can save lives at the pool – ABC15 Arizona

Posted: June 19, 2021 at 1:48 am

Taking a dip in the cool water is one of the few ways to beat the summer heat, but are you doing it safely? Everyone can play an important role in saving lives around water.

The Red Cross says 85% of Americans say they can swim, but a survey found that just over half of self-described swimmers are actually able to complete five critical water safety skills that could keep you alive.

Those five skills include getting in water deeper than your head, being able to tread water or float for one minute, and then getting to an exit safely.

Drownings by the numbers

In the first six months of 2021, there have been at least two dozen drowning or near-drowning incidents in the Phoenix area.

Of those incidents, 19 of them have involved children and several have been deadly.

Five adults have also lost their lives in the water so far this year. According to the Drowning Prevention Coalition of Arizona, more adults drown every year than children in our state.

Phoenix Fire Department says drowning incidents occur more often in the West Valley where backyard pools are more prevalent, and there are more renters, visitors, and multi-generational households.

RELATED: Is your backyard pool safe?

If you see someone in distress in the water, be sure to:

Addressing the drowning crisis in the Valley

Other water safety tips

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5 critical water safety skills, other ways you can save lives at the pool - ABC15 Arizona


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