StemCell Therapy

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North Carolinians are increasingly feeling the effects of diabetes as thousands of people suffer from the disease, and many others may have diabetes and not know it! It is estimated that one out of every three children born after 2000 in the United States will be directly affected by diabetes. In the Charlotte Metro area, roughly 170,000 people have diabetes.

That is why the American Diabetes Association's Charlotte office is so committed to educating the public about how to stop diabetes and support those living with the disease.

We are here to help.

We welcome your help.

Your involvement as an American Diabetes Association volunteer whether on a local or national level will help us expand our community outreach and impact, inspire healthy living, intensify our advocacy efforts, raise critical dollars to fund our mission, and uphold our reputation as the moving force and trusted leader in the diabetes community.

Find volunteer opportunities in our area through the Volunteer Center.

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Charlotte, North Carolina American Diabetes Association

Kannapolis Internal Medicine, located in Kannapolis, NC, offers a group of board-certified physicians who are dedicated to providing primary adult care.

As internists affiliated with Carolinas HealthCare System NorthEast, our physicians provide comprehensive care for anyone in your family over the age of 16.

If you need more specialized care, your internist will direct and follow up on your care.

Kannapolis Internal Medicine provides new and existing patients the following forms for download to complete and bring to your appointment:

Kannapolis Internal Medicine, located in Kannapolis, NC, offers a group of board-certified physicians who are dedicated to providing primary adult care.

As internists affiliated with Carolinas HealthCare System NorthEast, our physicians provide comprehensive care for anyone in your family over the age of 16.

If you need more specialized care, your internist will direct and follow up on your care.

Kannapolis Internal Medicine provides new and existing patients the following forms for download to complete and bring to your appointment:

Originally posted here:
Kannapolis Internal Medicine > Kannapolis, NC

Diabetes is a disease in which the body does not produce or properly use insulin (insulin resistance). Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors appear to play roles.

Prediabetes A condition in which blood glucose levels are higher than normal but not high enough to be classified as diabetes is a major risk factor for type 2 diabetes.

Type 1 Also called Juvenile Diabetes, generally develops in children and young people under the age of 30. A person with type 1 diabetes does not produce any insulin and needs insulin injections to control blood glucose levels. For additional information click here.

Type 2 Generally occurs after the age of 30; now increasingly seen among youth and young adults. Over-weight/obesity is a major risk factor for type 2 diabetes, and it is mainly controlled with diet, exercise and medication.

Gestational Occurs in some pregnant women who never had diabetes before but experience high glucose levels during pregnancy. Although gestational diabetes goes away after the baby is born, a women who has had it is more likely to develop type 2 diabetes later in life.

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Diabetes North Carolina

http://www.naturalnews.com/041111_stem_cells_root_canals_dentistry.html

According to The Wall Street Journal, scientists have made advances in restoring tooth pulp, which would negate having to perform root canals. Per the paper:

Several recent studies have demonstrated in animals that procedures involving tooth stem cells appear to regrow the critical, living tooth tissue known as pulp. Treatments that prompt the body to regrow its own tissues and organs are known broadly as regenerative medicine. There is significant interest in figuring out how to implement this knowledge to help the many people with cavities and disease that lead to tooth loss.

Elimination of root canals?

That's important because, according to statistics, half of children in the U.S. have at least one cavity by the time they're 15 years old; in adults, a quarter of those over the age of 65 have lost all their teeth. The Centers for Disease Control and Prevention says that Americans spent $108 billion on dental care in 2010, a figure which includes elective and out-of-pocket care.

Tooth decay occurs when infections or bacteria outstrip a tooth's natural ability to heal or repair itself. If the damage eventually causes too much erosion of the hard, outer enamel shell and penetrates the tooth, eventually the infection can kill off the soft pulp tissue inside, which makes removal of the tooth or a root canal to repair the damage necessary. Pulp is essential in detecting sensation - heat, cold, pressure - and it is where the stem cells ("undifferentiated cells that turn into specialized ones," WSJ reported) that can regenerate tooth tissue are located.

Researchers from all over the world - the U.S., Japan, South Korea and the U.K., among others - have been working to figure out how to make stem cells regenerate pulp. Right now the research is in its early stages, but if a technique can be found "it could mean a reduction or even elimination of the need for painful root canals," the paper said.

Root canals deal with the tooth's infection but they are not a cure-all, per se, WSJ reports:

While the affected tooth remains in the mouth, it is essentially dead, which could impact functions like chewing. That also means no living nerves remain in the tooth to detect further decay or infection. Infection could subsequently spread to surrounding tissue without detection. An estimated 15.1 million root canals are performed in the U.S. annually, according to a 2005-06 survey by the American Dental Association, the most recent data available.

'Public health issue'

"The whole concept of going for pulp regeneration is that you will try and retain a vital tooth, a tooth that is alive," Tony Smith, a professor in oral biology at the University of Birmingham in the U.K., told the paper. "That means the tooth's natural defense mechanisms will still be there."

He adds: "I think we are really just at the opening stages of what is going to be a very exciting time, because we're moving away from traditional root-canal treatments."

Misako Nakashima, DDS, Ph.D., of the National Center for Geriatrics and Gerontology in Obu, Japan, says the dental stem cell research addresses an important "public health issue."

"Dental cavities and inflammation of the surrounding pulp is a challenging public health issue, as tooth decay not only can cause a patient great pain but it also can lead to other serious health issues including heart disease," he told AlphaMed Press.

"Other studies demonstrated the therapeutic effects and safety of mesenchymal stem cells (MSCs) for various diseases. There have been no preclinical reports, however, to support the use of pulp stem cells as a potential treatment for pulpitis in clinical trials," he continued. "We also knew that previous studies involving the spinal cord show that combining G-CSF with stem cells derived from other types of tissues, bone marrow stromal cells, neuronal stem cells and amniotic fluid stem cells had several benefits. So we reasoned that G-CSF might positively impact the pulp stem cells, too."

Though in the early stages, using stem cell therapies to treat dental problems looks promising.

Sources:

http://online.wsj.com

http://www.prweb.com

http://www.ncbi.nlm.nih.gov

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The phrase stem-cell tourism often conjures images of back-alley clinics in distant lands, destinations such as Mexico and China, to which, increasingly, desperate patients are travelling to undergo risky and unproven treatments.

But according to new research, another country is being overlooked in the debate over stem-cell tourism: the United States.

In a study published Thursday by the journal Cell Stem Cell, researchers analyzed the Internet to find that there are 351 businesses in the United States, collectively operating at least 570 stem-cell clinics.

The clinics advertise treatments that involve injecting primitive, undeveloped cells into patients bodies. They also claim to treat a laundry list of problems, from autism and Alzheimers disease to sexual dysfunction, even though clinical trials have not proven that stem-cell treatments are safe or effective for any of these.

But, if the size of the marketplace is any indication, American stem-cell clinics are doing booming business, even attracting patients from Canada, and charging thousands or tens of thousands for their services.

Experts agree that the science is at a tipping point, but it moves slowly and stem-cell therapies arent ready yet for prime time, according to Timothy Caulfield, a University of Alberta professor and Canada research chair in health policy and law.

Caulfield warns that the list of diseases with proven stem-cell treatments is still incredibly short.

Regulators in Canada and the U.S. have, for the most part, approved things such as skin grafts or bone marrow transplants for blood cancers such as leukemia.

These clinics are really leveraging the excitement around the field, Caulfield said. People think there are all these efficacious stem-cell therapies that are available now, and thats really not the case.

In the study, researchers found that stem cell clinics in the U.S. are clustering in certain cities, such as Beverly Hills and New York, and states such as California and Florida

Most advertise autologous stem cells, cells mined from the patients body, typically fat tissue. An estimated one in five clinics claim to use stem cells sourced from amniotic material, placental tissue or umbilical cords. And at least two clinics advertised using bovine amniotic cells.

But because these clinics are not regulated, patients have no way of knowing what they are being injected with, said study co-author Leigh Turner, a bioethicist with the University of Minnesota.

Maybe patients are paying $15,000 for whats effectively a blood transfusion.

He noted that many businesses also advertise the same stem-cell procedure for treating a wide range of highly complex disorders, something that should serve as a warning sign.

Turner believes his study highlights an urgent need for federal regulators to crack down on stem-cell clinics, closing regulatory loopholes that have allowed them to thrive.

Its difficult to see how these could possibly be compliant with federal regulations, Turner said. What we have is rampant marketing of unproven, unapproved stem-cell interventions, all of it happening in the U.S., all of it happening beneath the nose of the FDA.

A main concern, of course, is that these treatments come with unknown risks.

Study co-author Paul Knoepfler points out scientists still dont understand the harms that could arise from stem-cell injections, both short and long term.

Maybe theres a moderate risk, but it doesnt manifest until 10 to 20 years later, he said.

Some of these risks, such as blood clots, have been documented by the scientific literature.

There have been high profile disasters: patients in Florida and Europe who have died after stem-cell treatments, or a California woman who developed bone fragments in her eyelids after undergoing a stem-cell facelift.

One woman who participated in a clinical trial in Portugal developed a growth in her spine, a growth that had nasal tissue and bits of bone in it.

The New York Times recently reported the horrifying story of a stroke victim who spent $300,000 on stem-cell injections, only to develop a huge mass in his spinal column, which has left him paralyzed from the neck down.

His doctors have no idea how to stop the mass from growing.

You can get the wrong type of tissue growing in the wrong place, said Knoepfler, a professor with the University of California, Davis.

And, if a stem-cell transplant goes wrong, thats a living thing, you know?

There might not be a way to undo that.

Stem-cell tourism is largely driven by patients who describe seemingly miraculous cures. These people can be celebrities such as Gordie Howe, who lend their star power to the stem-cell industry, or ordinary patients such as Tina Kapel, a 49-year-old woman from Stouffville, Ont., who has Parkinsons disease.

Kapel said she has refused the drugs recommended by doctors because she distrusts pharmaceutical companies and doesnt like the side effects. Instead, she has turned to a Paleo diet, acupuncture and naturopathy.

Last year, she stumbled on stem-cell treatments after Googling terms such as reversing Parkinsons and natural cures. At the urging of her naturopath, she flew to California for a stem-cell procedure.

The procedure cost $14,995 U.S., which she paid using lines of credit and loans from friends and family. She is unable to work because of her Parkinsons and finds herself in a horrible position financially, but says she would do it all over again.

Im better than I was before the transplant, she says, adding she hopes to get another treatment, and is now trying to raise money online for more injections. When you live in a Parkinsons body, the reality is Im willing to take the chance.

Knoepfler and Turner hear from patients all the time. But they said that, without good clinical trials for treatments, its impossible to know whats really going on with them. Is there something else the patient is doing that might account for the improvements? Could they be experiencing a placebo effect, an undeniably powerful force, especially when patients are desperate and have invested tens of thousands of dollars?

Or perhaps the treatments do work. The only way to know for certain is through research, not relying on anecdotes, Caulfield said.

For now, stem-cell clinics and their claims should be treated with extreme caution, he said.

If it was that easy to translate this stuff into treatments, that would be happening; the best scientists in the world are working on it, Caulfield said.

We all want it to work . . . if only it was that easy.

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U.S. overlooked in debate over stem-cell tourism ...

Treatment for Erectile Dysfunction or ED is also called treatment for impotence. ED is generally defined as repeated inability to have or keep an erection for sexual intercourse. The actual term impotence can also be sometimes used to describe other physical issues that can interfere with regular sexual intercourse or reproduction. Erectile dysfunction is a very specific diagnosis that makes it clear that other problems such as premature ejaculation and emotional barriers are not involved. Often time our clients report damage to blood arteries, muscles,nerves or tissues in the reproduction area which usually lead to diagnosis of penile dysfunction. Stem Cells to treat EDcan help solve the issues naturally and at its root via non-surgical stem cell regeneration therapy.

Nearly 80% of all ED (Erectile Dysfunction) diagnosis can be attributed to the following medical conditions and are treatable with our stem cell treatment for erectile dysfunction:

Almost 62% of all men with Type 1 or 2 Diabetes experience some form of erectile dysfunction frequently. ED is usually a side-effect of a more serious health problem that can have a large impact on the happiness and overall quality of life for men and their sexual partners. Fortunately, thanks to modern medicine, there is finally hope for treatment using Stem Cells to treat Erectile Dysfunction. Please note that our doctors will look the treat the cause of your ED so any underlying medical conditions such as Diabetes would have to be treated first/alongside your treatment protocol for ED.

Pharma based treatments for ED are unsafe for long term use. Research has shown that popular oral PDE5 phosphodiesterase inhibitors are not effective over the long term and may cause serious side-effects or even sudden death (heart attacks). The failure of Pharmaceutical based PDE5 inhibitors is especially common for patients with diabetes who also have a sparing radical prostatectomy (non-nerve).

Not Again!

Clinical DiagnosisRequired

Today the treatment options for ED are mostly limited to hormone replacement therapy or other stimulant-based fixes that come loaded with negative side effects such as strokes,hypertension and heart diseases. These ED medications are also just a temporary fix and need to be taken throughout your entire life. The financial and physical costs associated with frequent hormone replacements or repeat use drugs such as Cialis or Viagra are a dangerous game of russian roulette. Researchers at the prestigious Cedars-Sinai Medical Center recently reported a high number of fatalities and negative cardiovascular events associated with the use of the drug Viagra. The College of Cardiologists also reported a total of 1,473 major adverse cardiac events last year in which almost 560 people died after taking ED medicine such as Cialis or Viagra (most from sudden heart attacks).

Your tolerance for these ED medicines will increase overtime requiring much higher doses to try to produce the same effects you had when you first took them. Our 2 step programis a permanent solution that will never require another pills again!

Today we are pleased to offer our clients a better solution with Stem Cell Erectile Dysfunction Treatment. Our unique therapy usesStem Cells from the patients own blood derived and/or adipose fat derived MSC stem cells.

Our Cell Therapiesworks to fix the root of the ED problem which is usually attributed to improper proper blood circulation in the penile area. Our Thai ED specialists have worked wonders by creating new blood vessels for our clients suffering though ED through a natural process called Angiogenesis. Angiogenesis or creating new blood vessels in the penis is very similar to the decades old cord blood stem cell therapyfor patients suffering from CAD ( coronary artery disease), CHF congestive heart failure,PAD or Peripheral Vascular Disease and cardiomyopathy. The medical data has proven that MSC CD34+ stem cells injected locally & through IV drip is very effective for near and long-term improvement in blood circulation,libido,sleep,appetite and an overall sense of well-being. The effects achieved with Thai Medical are permanent and are 100% safe and without any side-effects.

Previous research has proven the benefits forCell Therapy for ED and the data is substantiated in the scientific literature for stem cells of MSC mesenchymal origin. Your Blood and Fat are the most abundant source of MSC stem cells in the body. MSC stem cells from the blood can be easily extracted from your body and expanded in our state of the art stem cell lab, without any moral or ethical concerns. We do not use or offer embryonic derived or animal derived Live Cells for any stem cell treatment we offer.

The MSC stem cells can be harvested from your blood or fat without the need of any invasive surgery (as is required in bone marrow stem cells) and there is no risk of any rejection since the cells are Autologous (from your own body). Our unique stem cell treatment protocol calls for Expansion of your MSC stem cells that helps increase healing capacity by 200 to 300%.

To learn more aboutClinical Studies to treatErectile Dysfunction with Stem Cellspleasevisit the following government website:

Our Multi-StepTreatment for ED package requires 10-14nights in Bangkok. All of our stem cell treatments use the patients own stem cells (Autologous) without the need for any additional medicines or chemicals or hormones.

The Thai Medical Treatment for ED Overview:

Please note that not everyone is a good candidate for thestem cell therapies.Patients requesting treatments must be clinically diagnosed with ED form a urologist in their home or in Thailand. Patients with severe conditions or multiple dysfunctions that limit travel may also not qualify. Please contact us for more information.

The treatments require natural formation for blood vessels that normally takes 4-6 weeks to finalize after the initial treatment. The results for our natural treatment for ED are all permanent. Please note that your MSC stem cells can also be stored for over 20 years (additional cost) in our cryogenic stem cell bank in Bangkok. Your stored stem cells are essentially an insurance policy against any future injuries or diseases that occur naturally. Prices for our EnrichedCD34+ Stem Cell Transplants to treatErectile Dysfunction in Thailand depends on the patients medical needs especially if they have a pre-existing medical condition such as diabetes or heart disease. Our medical review takes 5-7 business days. Once the review is complete we can know for certain if the patient is a candidate and what the total and fixed medical costs will be. We can offer all-inclusive medical vacation packages that include hotels and transportation upon request. Please note this treatment is availablein Bangkok only.

TMV is a trusted organization that will help guide you every step of the way. Thai Medical groupoffer the most advanced non-surgical regenerative medical solutions in the Kingdom.Our stem cell doctors are all licensed by the Thai Medical board and we alsooffer assistance on many non-medical aspects of your medical tripat no additional cost.

The first step in your treatment is contacting us. We will respond to your inquiry in less than 24 hours and help you with the basic information needed such as estimated plan, travel details, and other necessary medically relevant information about having Stem Cell therapyto treat Erectile Dysfunction. To learn more please contact us today.

The Journey of a Thousand Miles Starts with a Single Step

HERE IS STEP ONE:

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Stem Cell Therapy for Erectile Dysfunction with Angiogenesis

Preventive Medicine, Integrative Medicine and the Health of the Public by David L. Katz, Ather Ali - IOM , 2009 This paper explores the overlap and potential synergies of integrative medicine and preventive medicine in the context of the levels of prevention, acknowledging the deficiency of research on the effectiveness of practice-based integrative care. (4224 views)

Guide to Clinical Preventive Services - U.S. Preventive Services Task Force , 2009 Use this book to quickly determine the most appropriate preventative care for your patients. Although quite voluminous, it does provide quick access as well as a thorough review of the recommended screening guidelines for health care maintenance. (4681 views)

Preventing Chronic Diseases: A Vital Investment - World Health Organization , 2005 WHO is launching a global report on chronic diseases, which presents the latest scientific information and makes the case for increased and urgent action for chronic disease prevention and control. The report reviews the burden of chronic diseases. (9399 views)

Preventing Drug Abuse among Children and Adolescents - National Institutes of Health , 2003 This edition presents the updated prevention principles, an overview of program planning, and critical steps for those learning about prevention. It is an introduction to research-based prevention for those new to the field of drug abuse prevention. (6894 views)

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Preventive Medicine - Free E-Books

Nir Barzilai, M.D. Director of the Institute for Aging

Research Director of the Nathan Shock Center of Excellence in the Basic Biology of Aging

Ingeborg and Ira Leon Rennert Chair of Aging Research

Dr. Barzilai's bio / cv

Watch video

Request an Interview with Dr. Barzilai

Watch Dr. Barzilai in The Healthspan Imperative

The Longevity Genes Project

What if people could live to be 100 and beyond and still be healthy, active and engaged?

What if there were a way to age without a slow and painful decline?

In the Longevity Genes Project at Albert Einstein College of Medicine, Dr. Nir Barzilai and his team conducted genetic research on more than 500 healthy elderly people between the ages of 95 and 112 and on their children.

The identification of longevity genes by Einstein researchers could lead to new drug therapies that might help people live longer, healthier lives and avoid or significantly delay age-related diseases such as Alzheimer's disease, type 2 diabetes and cardiovascular disease.

The Longevity Genes Project Video Series

This video series includes informative interviews with Dr. Nir Barzilai, who leads the Einstein longevity research efforts, and with four study participants whose diverse and compelling stories will inspire you. We invite you to view all of the videos and leave comments. Click on the links below to view each segment.

Research: Dr. Nir Barzilai

Personal Profiles: Lilly Port: Age 96 | Harold Laufman: Age 98 | Irma Daniel: Age 103 | Irving Kahn: Age 104

Longevity and Longenity Information and preliminary results of Einstein's search for longevity genes in the Jewish Ashkenazi population and genotypes and phenotypes for exceptional longevity.

Why Ashkenazi Jews? Information about the "founder effect" and the historically unique Ashkenazi Jewish population.

More:
Longevity Genes Project | Institute for Aging Research ...

Preventive Medicine offers rewarding, plentiful, diverse and challenging careers, plus:

Our Graduate Education & Careers section features descriptions of ACPM's activities in support of graduate medical education, a directory of all preventive medicine residency programs, and specific information for Residency Program Directors, current preventive medicine residents, and prospective preventive medicine residents.

OVERVIEW OF RESIDENCY TRAINING IN PREVENTIVE MEDICINEPreventive Medicine is an exciting specialty that links the knowledge and skills of clinical medicine with the special skill sets of medical management, research, and population health. Specialists work in diverse settings to promote health and to modify or eliminate the risks of disease, injury, disability, and death. Career paths include managed care, public health, occupational medicine, aerospace medicine, clinical medicine, informatics, policy development, academic medicine, international medicine, and research, covering all levels of government, educational institutions, organized medical care programs in industry, as well as voluntary health agencies and professional health organizations.

Preventive medicine is one of 24 recognized board certifications represented in the American Board of Medical Specialties (ABMS). Completion of residency training in preventive medicine is an essential step to become certified in one or more of the preventive medicine specialty areas: General Preventive Medicine/Public Health (referred to throughout the directory as GPM), Occupational Medicine (OM), and Aerospace Medicine (AM). There are currently 73 accredited Preventive Medicine residency training programs in the United States. Generally, programs are located in schools of medicine, schools of public health, state or local health departments, and in federal agencies (i.e., Centers for Disease Control) and military bases (i.e., Walter Reed Army Institute of Research). These programs are usually small and take an individualized approach to training. There are approximately 350 residents in training every year.

Residency program accreditation is accomplished through the Preventive Medicine Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME). The ACGME-RRC is the body which establishes accreditation requirements for residency programs and which reviews the programs to determine their compliance with the requirements.

Board certification is offered through the American Board of Preventive Medicine (ABPM). Established in 1948, ABPM is the body with responsibility for determining physician eligibility for certification and recertification in preventive medicine.

STRUCTURE OF AN ACCREDITED RESIDENCY PROGRAM IN PREVENTIVE MEDICINEIn addition to the knowledge of basic clinical sciences and skills common to all physicians, the distinctive aspects of preventive medicine include knowledge of and competence in these seven areas:

1) Application of biostatistical principles in methodology;

2)Recognition of epidemiological principles in methodology;

3)Planning, administration, and evaluation of health andmedical programs and the evaluation of outcomes ofhealth behavior and medical care;

4)Recognition, assessment, and control of environmentalhazards to health, including those of occupationalenvironments;

5)Recognition of the social, cultural, and behavioralfactors in medicine;

6)Application and evaluation of primary, secondary, andtertiary prevention, with specificity of these skills varying between General Preventive Medicine, Occupational Medicine and Aerospace Medicine; and

7)Assessment of population and individual health needs.

Prior to appointment in the program, residents must have successfully completed at least 12 months of clinical education in a residency program accredited by the ACGME, Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada. Resident experience must include at least 11 months of direct patient care in both inpatient and outpatient settings.

Residents should develop competency in the following fundamental clinical skills during this experience:

1) Obtaining a comprehensive medical history;

2) Performing a comprehensive physical examination;

3) Assessing a patients medical conditions;

4) Making appropriate use of diagnostic studies and tests;

5) Integrating information to develop a differential diagnosis; and

6) Developing, implementing, and evaluating a treatment plan.

The two year PM residency training includes didactics, clinical training, research, public health, and other population-based experiences.

The didactic training includes both residency-lead seminars, as well as the acquisition of a Masters in Public health or equivalent degree. Those residents entering with an appropriate degree enhance their didactics with additional coursework. Whether through a Masters in Public Health or other equivalent degree, prior to completion of the residency program, all residents must complete graduate level courses in epidemiology; biostatistics; health services management and administration; environmental health; and the behavioral aspects of health.

The practicum experiences take place across the two years of the residency, and include acquisition of skills in clinical and population prevention medicine. Examples of practicum experiences include: local, state and federal health departments, health maintenance organizations, peer review organizations, community and migrant health centers, occupational health clinics, industrial sites, regulatory agencies, NASA, and OSHA, research settings, to name a few. Please see "Examples of Preventive Medicine Training Opportunities" for more information.

COMBINED RESIDENCY TRAINING IN PREVENTIVE MEDICINE AND OTHER SPECIALTIESCombined residency training is designed to lead to board certification in each of the medical specialties providing training. Sometimes, combined training will reduce the length of training for both specialties by as much as one year. Since 1993, ABPM and the American Board of Internal Medicine (ABIM) have had in place formal, approved guidelines for combined training. This training is designed to lead to board certification in both preventive medicine and internal medicine, following four years of accredited residency training. Several programs also offer approved Family Medicine/Preventive Medicine training opportunities across four years.

Residencies which offer combined training programs must maintain their accreditation status through each specialty RRC. The ACGME does not accredit combined training programs of any kind.

RESIDENCY PROGRAM APPLICATION PROCESSYou should contact programs directly for further information and for application instructions. The program directors may also be able to provide you with names of specialists whom you could contact for information. For a list of Preventive Medicine (Public Health, General, Occupational and Aerospace) programs that participate in the Electronic Residency Application Service (ERAS) visit https://services.aamc.org/eras/erasstats/par/index.cfm.

Read more:
Resources for Medical Students - American College of ...

A Preventive Medicine specialist focuses on the health of individuals and defined populations in order to protect, promote and maintain health and well-being, and to prevent disease, disability and premature death. They may be a specialist in General Preventive Medicine, Public Health, Occupational Medicine or Aerospace Medicine. The distinctive components of Preventive Medicine include:

Specialty training required prior to Board Certification: Three years

To become certified in a particular subspecialty, a physician must be Board Certified by the American Board of Preventive Medicine and complete additional training as specified by the Member Board.

Addiction Medicine A Preventive Medicine physician who specializes in Addition Medicine is concerned with the prevention, evaluation, diagnosis, and treatment of persons with the disease of addiction, of those with substance-related health conditions, and of people who show unhealthy use of substances including nicotine, alcohol, prescription medications and other licit and illicit drugs. Physicians specializing in this field also help family members whose health and functioning are affected by a loved ones substance use or addiction.

Excerpt from:
American Board of Preventive Medicine

The University of Michigan School of Public Health houses one of the oldest Preventive Medicine Residency programs in the country, dating back to 1969.

The central mission of the School of Public Health's residency in General Preventive Medicine and Public Health is to train highly-qualified physicians for careers in clinical preventive medicine and public health.

The mission is accomplished through the provision of rigorous academic course work resulting in a Master of Public Health degree in one of the following core areas of public health:

This mission is also accomplished by the provision of broad practicum experiences with concentrations in applied epidemiology, public health practice, and clinical preventive medicine, which are typically provided for populations with high levels of unmet health care needs.

The Public Health and General Preventive Medicine Program is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME) and prepares physicians for board eligibility by the American Board of Preventive Medicine.

Our resident, Dr. Courtland Keteyian (right), working in 2014 with Dr. Patricia Abott (left), the Director of Hillman Scholars in Nursing Innovation Program, on an MCubed project that combines sensor based technology into disease self-management interventions.

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Preventive Medicine Residency at the University of Michigan ...

The University of Maryland Baltimores (UMB) Preventive Medicine Residency (PMR) bears a history as one of the oldest and well-respected PMR programs. It is housed in the Department of Epidemiology and Public Health (EPH), previously Department of Epidemiology and Preventive Medicine, where a multidisciplinary team of outstanding physician experts is dedicated to training medical students, graduate students, and health professionals to improve the health of the public through the practice of preventive medicine.

The first department of preventive medicine in the United States was established at the University of Maryland at Baltimore (UMB) in 1833, and has been at the juncture of important events in the national and global history of preventive medicine. The (PMR) was established in 1965 to fill the aforementioned need to train physicians in preventive medicine and continues to train highly- qualified preventive medicine specialists, as demonstrated by the 100% passing rate on boards.

In the two-year PMR program, residents complete didactic, research, teaching, and field rotation activities, and earn a Master of Public Health (MPH) degree Epidemiology track. Both academic and practicum phases of the PMR are accredited by the Accreditation Council for Graduate Medical Education (ACGME) and fulfill the requirements for certification by the American Board of Preventive Medicine.

Distinguishing features of UMBs PMR program are 1) a research apprenticeship experience, in which residents assume progressive responsibility for planning, executing, and evaluating one or more research projects under close faculty supervision; and 2) a curriculum in Integrative Medicine incorporated in the training.

Our trained physicians, upon graduation, quickly assume leadership roles in health departments, federal agencies, and academic institutions.

Link:
Preventive Medicine Residency Program: Epidemiology ...

Whats the secret to living longer? Scientists have been pondering this for some time now and while we understand that various lifestyle and environmental factors contribute to our longevity, it is also evident that genetics plays a role. In fact, family studies have indicated that genetic factors account for around 20-30% of the variation in adult lifespan. So what are these genetic secrets to longevity? A new study, published in Aging Cell, may have some answers.

Previous work identified a couple of candidate genes that researchers suspect may play a role in longevity. The genes identified were apolipoprotein E (APOE), which transports cholesterol around the body, and FOXO3A which may affect insulin sensitivity. Variations in these genes were found to be associated with longevity; however, neither had a large influence, which left scientists suspecting that there must be other factors at play.

To find out more, researchers from the Spanish National Cancer Research Center scoured the protein-coding genes, or exomes, of members of three separate families that all had exceptionally long-lived members. Three of the individuals sequenced lived to be 103 or older, and their siblings lived to be 97 or older. They then compared these with sequence data from 800 other people that acted as controls.

They found that rare variants in one particular gene cropped up in all three familiesapolipoprotein B (APOB). Like the APOE protein, APOB is a cholesterol transporter. APOB helps to carry bad cholesterol, or low-density lipoprotein (LDL), in the blood. While our bodies need cholesterol, LDL has a bad rep because it can build up along the walls of blood vessels, blocking arteries and eventually leading to heart attacks in some.

Its possible that these genetic variations reduce the levels of LDL in the blood, an idea that the researchers are now investigating. According to lead author Timothy Cash, if the long-lived individuals do have lower cholesterol levels, it would reinforce the idea that cardiovascular health is an important factor in the aging process. Interestingly, variations in APOE are also known risk factors for cardiovascular disease, which is likely due to elevated lipid levels.

[ViaNew ScientistandAging Cell]

Excerpt from:
Genetic Secrets Of Longevity Discovered | IFLScience

Longevity, i.e., the property of being long-lived, has its natural limitation in the aging process. Longevity has a strong genetic component, as has become apparent from studies with a variety of organisms, from yeast to humans. Genetic screening efforts with invertebrates have unraveled multiple genetic pathways that suggest longevity is promoted through the manipulation of metabolism and the resistance to oxidative stress. To some extent, these same mechanisms appear to act in mammals also, despite considerable divergence during evolution. Thus far, evidence from population-based studies with humans suggests the importance of genes involved in cardiovascular disease as important determinants of longevity. The challenge is to test if the candidate longevity genes that have emerged from studies with model organisms exhibit genetic variation for life span in human populations. Future investigations are likely to involve large-scale case-control studies, in which large numbers of genes, corresponding to entire gene functional modules, will be assessed for all possible sequence variation and associated with detailed phenotypic information on each individual over extended periods of time. This should eventually unravel the genetic factors that contribute to each particular aging phenotype.

See more here:
Genetics of longevity and aging.

What Is Gene Therapy?

Explore the what's and why's of gene therapy research, includingan in-depth look at the genetic disorder cystic fibrosis and how gene therapy could potentially be used to treat it.

Gene Delivery: Tools of the Trade

Explore the methods for delivering genes into cells.

Space Doctor

You are the doctor! Design and test gene therapy treatments with ailing aliens.

Challenges In Gene Therapy

Researchers hoping to bring gene therapy to the clinic face unique challenges.

Approaches To Gene Therapy

Beyond adding a working copy of a broken gene, gene therapy can also repair or eliminate broken genes.

Gene Therapy Successes

The future of gene therapy is bright. Learn about some of its most encouraging success stories.

Gene Therapy Case Study: Cystic Fibrosis

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Genetic Science Learning Center. (2012, December 1) Gene Therapy. Retrieved August 09, 2016, from http://learn.genetics.utah.edu/content/genetherapy/

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Gene Therapy [Internet]. Salt Lake City (UT): Genetic Science Learning Center; 2012 [cited 2016 Aug 9] Available from http://learn.genetics.utah.edu/content/genetherapy/

Chicago format:

Genetic Science Learning Center. "Gene Therapy." Learn.Genetics. December 1, 2012. Accessed August 9, 2016. http://learn.genetics.utah.edu/content/genetherapy/.

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Alabamians and Mississippians are increasingly feeling the effects of diabetes as thousands of people suffer from the disease, and many others may have diabetes and not know it! It is estimated that one out of every three children born after 2000 in the United States will be directly affected by diabetes.

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Being diagnosed with diabetes can be overwhelming and many people don't know where to start. That's why the Living With Type 2 Diabetes program offers people with diabetes an opportunity to learn more about diabetes and how to live well with diabetes over a 12-month period. Please visit http://www.diabetes.org/living to sign up today for free!

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Your involvement as an American Diabetes Association volunteer whether on a local or national level will help us expand our community outreach and impact, inspire healthy living, intensify our advocacy efforts, raise critical dollars to fund our mission, and uphold our reputation as the moving force and trusted leader in the diabetes community.

Find volunteer opportunities in our area through the Volunteer Center.

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Dental considerations in patients with liver disease 2015 Oral health in patients with liver cirrhosis. Eur J Gastroenterol Hepatol.2015 Jul;27(7):834-9. doi: 10.1097/MEG.0000000000000356. Grnkjr LL1,Vilstrup H. Abstract OBJECTIVE:The aim of this study was to describe the oral care habits and self-perceived oral health in patients with liver cirrhosis, as well as to evaluate the impact of oral health on well-being and the relation to nutritional status.

PARTICIPANTS AND METHODS:From October 2012 to May 2013, we carried out a prospective study on patients with liver cirrhosis. Questions on oral care habits and self-perceived oral health were answered, and the Oral Health Impact Profile questionnaire (OHIP-14) provided information on oral conditions. The findings were compared with The Danish Institute for Health Services Research report on the Danish population's dental status.

RESULTS:One hundred and seven patients participated. Their oral care habits and self-perceived oral health were poorer than the Danish population; the patients had fewer teeth (on average 19 vs. 26, P = 0.0001), attended the dentist less frequently (P = 0.001), more rarely brushed teeth (P = 0.001) and had problems with oral dryness (68 vs. 14%, P = 0.0001). The patients' mean OHIP score was 5.21 7.2, with the most commonly reported problems being related to taste and food intake. An association was observed between the OHIP score and the patients' nutritional risk score (P = 0.01).

CONCLUSION:Our results showed that cirrhosis patients cared less for oral health than the background population. Their resulting problems may be contributing factors to their nutritional risk and decreased well-being. Oral health problems may thus have adverse prognostic importance. Our results emphasize the need for measures to protect and improve the oral health of cirrhosis patients.

Aug 18 2014 Getting Dental Work with Hepatitis C and Cirrhosis Getting Dental Work withHepatitis Cand Cirrhosis is important. A good dentist ..

2014 Oral Conditions Might Cause Severe Outcomes in Patients With Viral Hepatitis Infection Nima Mahboobi 1, * ; and Seyed Moayed Alavian 2 1 Department of Oral and Maxillofacial Surgery, Tehran University of Medical Sciences, Tehran, IR Iran2 Middle East Liver Diseases Center (MELD Center), Tehran, IR Iran *Corresponding Author: Nima Mahboobi, Department of Oral and Maxillofacial Surgery, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188989161, E-mail: nima.mahboobi@gmail.com. Hepatitis Monthly. 14(12): e25866 , DOI: 10.5812/hepatmon.25866 Article Type: Editorial; Received: Dec 8, 2014; Revised: Dec 8, 2014; Accepted: Nov 13, 2014; epub: Dec 25, 2014; collection: Dec 2014 Keywords: Health; Infection; Hepatitis

The world health organization (WHO) has defined health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. It is easy to express that complete health and wellness is merely impossible without oral health (1). After tooth decay in humans known as the most common infectious disease in the globe, periodontal diseases including gingivitis and periodontitis are among the most common oral diseases. The periodontal diseases are a group of chronic inflammatory diseases, involving the soft tissue and bone surrounding the teeth in the jaws, known as periodontium. Periodontal diseases are mainly caused by bacterial infection (2, 3). Although a review article published in 2008 showed a possible trend of a lower prevalence of periodontitis in the last 30 years, the authors of the paper recommended more research in the area to approve the evidence (4). To date, the association of various conditions and periodontal diseases has been acknowledged. A long list including overweight/obesity, hypertension, metabolic syndrome, diabetes mellitus, child preterm birth and low birth weight, rheumatoid arthritis and chronic obstructive pulmonary disease can be mentioned (5-7). Therefore, a hypothesis of association between either viral hepatitis infection or its progression and periodontal diseases seems quite close to mind. Previously, the association of several oral diseases including oral lichen planus, Sjogrens syndrome and pemphigus vulgaris with viral hepatitis infection was documented (8, 9).

A study performed by Nagao et al. (10) and published in the current issue is noteworthy from different aspects. Little has been dedicated to reveal the association between periodontal diseases and outcomes of viral hepatitis infection. According to their self-claimed statement of being the first study evaluating periodontal disease and patients with liver diseases resulting from viral hepatitis infection, the results were shocking. The conclusion states that periodontitis might be associated with progression of liver disease in patients with viral hepatitis, hence, control of oral diseases is essential for the prevention and management of liver fibrosis. This conclusion draws the attention of researchers to possible confounding factors never focused before. While performing different research projects on various links between hepatitis and dental setting in the past years, we reflected lack of data experience repeatedly. The conditions that made us urge researchers to develop research on oral fluid and viral hepatitis, viral hepatitis transmission risk during dental treatments and now the role of oral diseases on viral hepatitis have never been acknowledged. However, there are inconsistencies that must be noted before establishing new research. The methodology for studies on periodontal diseases remains elusive. A fundamental prerequisite for any epidemiological study is an accurate definition of the disease under investigation. Unfortunately in periodontal research, uniform criteria have not been established so far. Because of methodological problems the data used to assess treatment needs for periodontal diseases have been of questionable value and are not comparable (11). References and source

2012 Sept2012 Dental and Orofacial Health and Hepatitis CPrior to treating HCV it is important that any active dentaldisease be managed. Non-urgent dental treatment may need to be postponeduntil HCV treatment has ceased. Unfortunately, dental problems areknown to delay the onset of treatment for HCV. Dentaltreatment during anti-HCV therapy should be undertaken following consultation withmedical specialists. Blood tests and further investigations may beappropriate and in some cases in-patient care may be required. Immunocompromised patients, particularly those with neutropaenia, are at risk ofsepsis. If emergency dental treatment is necessary, consultation withmedical specialists is recommended. If the patient is anaemic, coagulopathic or thrombocytopaenic precautions may be needed. Pre-treatment optimisation and comprehensive post-operative care may berequired. Particular attention must be given to haemostasis....Download PDF Here..

Received:23/06/2010 Accepted: 16/01/2011

Abstract Introduction: Liver diseases are very common, and the main underlying causes are viralinfections, alcohol abuse and lipid and carbohydrate metabolic disorders. The liver has a broad range of functions inmaintaining homeos- tasis andhealth, and moreover metabolizes many drug substances. Objective: An update is provided on the oral manifestationsseen in patients with viral hepatitis, alcoholic and non-alcoholic liverdisease, cirrhosis and hepa-tocellular carcinoma, and on the dental management of such patients. Material and methods:

A Medline-PubMed search was conducted of the literature over the last 15 years using the keywords: hepatitis, alcoholic hepatitis, fatty liver, cirrhosis and hepatocellular carcinoma. A total of 28 articles were reviewed, comprising 20 lite- rature reviews,a clinical guide, three clinical trials and four case series.

Results: Oral clinical manifestations can be observed reflecting liver dysfunction, such as bleeding disorders, jaundice, foetorhepaticus, cheilitis, smooth tongue,xerostomia, bruxism and crusted perioral rash. In the case of infection causedby hepatitis C virus (HCV), the most frequent extrahepatic manifestations mostly affect the oral region in the form of lichen planus, xerostomia, Sjgrens syndrome and sialadenitis. The main complications of the patient with liverdisease are risk of contagion (for healthcarepersonnel and other patients), the risk of bleeding and the risk of toxicitydue to alteration of the metabolism of certain drugs.

Keywords: Hepatitis, alcoholic hepatitis, fatty liver, cirrosis, hepatocellular carcinoma. Cruz-Pamplona M,Margaix-Muoz M, Gracia Sarrin-Prez MG.Dentalconsiderations in patients with liver disease. J Clin Exp Dent. 2011;3(2):e127-34.

http://www.medicinaoral.com/odo/volumenes/v3i2/jcedv3i2p127.pdf Article Number: 50340 http://www.medicinaoral.com/odo/indice.htm Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488 eMail: jced@jced.es Introduction Liver diseases are very common and can beclassified as acute (characterized by rapid resolution andcomplete restitution of organ structure and function once theun-derlying cause has been eliminated) or chronic (charac- terized by persistent damage, with progressivelyimpai-red organ function secondary to the increase in livercell damage). Based on the extent and origin of thedamage, chronic liver disease ranges from steatosis or fatty liver to hepatocellular carcinoma, and includes hepatitis, fi-brosis and cirrhosis. Liver diseases can also beclassified as infectious (hepatitis A, B, C, D and E viruses, infec-tious mononucleosis, or secondary syphilis andtubercu- losis) or non-infectious (substance abuse such asalcohol and drugs, e.g., paracetamol, halothane, ketoconazole, methyldopa and methotrexate) (1).

The liver has a broad range of functions inmaintaining homeostasis and health: it synthesizes mostessential serum proteins (albumin, transporter proteins,blood coagulation factors V, VII, IX and X, prothrombin and fibrinogen (1), as well as many hormone and growth factors), produces bile and its transporters (bile acids, cholesterol, lecithin, phospholipids), intervenes in the regulation of nutrients (glucose, glycogen, lipids, cho- lesterol, amino acids), and metabolizes and conjugates lipophilic compounds (bilirubin, cations, drugs) to faci- litate their excretion in bile or urine.

Liverdysfunction alters the metabolism of carbohydrates, lipids,proteins, drugs, bilirubin and hormones (2). Accordingly, liver di- sease is characterized by a series of aspects that mustbe taken into account in the context of medical and dental care (3).

Since many drug substances are metabolized in the liver, it is essential for the clinician to compile a complete me- dical history, evaluating all body systems and themedi-cation used by the patient. The patient drug metabolizing capacity can be evaluated based on the analysis ofenzy-mes such as alanine aminotransferase (ALT) oraspartate aminotransferase (AST), and other liver functiontests (2, 4).

In situations of advanced liver disease, the vitamin K le-vels can be significantly lowered, thus giving rise to a re- duction in the production of blood coagulation factors. In addition, portal hypertension can scavenge platelets for- med in the spleen, thus giving rise to thrombocytopenia.This in turn can lead to an excessive bleeding tendency, which is one of the main adverse effects seen during the treatment of patients with impaired liver function (4). Dentists are particularly at risk of hepatitis B and Ccon- tagion, due to the transmission routes of these viruses, since these professionals are exposed to the bloodand oral secretions of potentially infected individuals (5) particularly in the case of accidents with sharp or cutting instruments.

VIRAL HEPATITIS Hepatitis of viral origin comprises aheterogeneous group of diseases caused by at least 6 different types of viruses: A, B, C, D, E and G (2).

Five million new cases of viral hepatitis are documented each year throughout the world, and a study published by Chandler-Gutirrez et al. (6) estimates the prevalence in Spain to be 3.7%. - Hepatitis A Hepatitis A is caused by the hepatitis A virus(HAV), an RNA picornavirus (3) endemic in many developing countries. Its estimated prevalence is 1.1% (6). This vi- rus is transmitted via the enteral (oral-fecal) route (5), as a result of the ingestion of contaminated water or food (mollusks), though intrafamilial contagion has also been described, as well as contagion in closed institutions and secondary to sexual intercourse.

The disease is typically mild and self-limiting, and is cha- racterized by the sudden onset of nonspecific symptoms. There is no carrier state. In children or young indivi- duals the disease tends to be asymptomatic, while adults typically present fever, fatigue, abdominal discomfort, diarrhea, nausea and/or jaundice. The patient is able to transmit the infection during the incubation period (2-6 weeks) and until the appearance of symptoms. The diagnosis is based on the signs and symptoms and on serological testing for anti-HAV IgM and IgG anti- bodies (3). Host response in the form of anti-HAV anti- bodies affords lifelong immunity, protecting the patient against future HAV infection.

The risk of nosocomial contagion among healthcare per- sonnel is quite low (3). Vaccines are available that offer immunity against HAV (Havrix, Vaqta) for people at risk (i.e., subjects traveling to endemic areas, drug abusers, patients with chronic liver disease and subjects with occupational risk factors) (2, 3). - Hepatitis B The hepatitis B virus (HBV) is an encapsulatedDNA virus that replicates within the hepatocyte (3). Hepatitis B is a worldwide health problem, with an estimated 400 million carriers of the virus (5). It has been calculated that 1.53% of all patients reporting to the dental clinic are HBV carriers (6). The transmission routes comprise sexual contact, intra- venous drug use and blood transfusions. In Asia perinatal transmission is common (3). An important consideration among dental professionals is the risk of percutaneous transmission through punctures or cuts with instruments infected from HBV-positive patients, or absorption through the mucosal surfaces (eyes, oral cavity). Trans- mission through saliva can occur as a result of absorp- tion from mucosal surfaces (2). Some studies have re- ported the presence of HBsAg in saliva and crevicular fluid of HBV-positive patients. Dental professionals, particularly those dedicated to oral surgery (7), have athree- to four-fold greater risk of HBV infection than the general population (3), though vaccines and barrier methods have contributed to lessen the risk (2, 7). Fo- llowing inoculation, the seroconversion risk is 30% (8). The incubation period lasts 2-6 months. Over 50% of all infections are subclinical and are not associated with jaundice. In this context, since the disease may prove asymptomatic, many people are unaware that they have suffered the infection in the past (5). Approximately 90% of all HBV-infected adults show complete healing, but 5-10% develop chronic hepatitis with complications in the form of cirrhosis and hepatocellular carcinoma (3, 4), resulting in 5000-6000 deaths a year due to liver fa- ilure (4).

The disease is diagnosed by quantifying the levels of HBV DNA, HBsAg and the antigen / antibody ratio. Vaccines have been developed that induce an effective immune response against the virus in most patients. If a non-immunized individual becomes exposed to HBV, immunoglobulincan be administered to afford protec-tion afterexposure. The current management protocols include HBV immunization as part of the pediatric vac-cinationprogram (3)

HepatitisC Hepatitis C virus (HCV) infection is the main cause of chronic liverdisease (9, 10) and of liver-related morbi-dity and mortality worldwide (9). It has been estimated that 8000 to10,000 deaths a year are attributable to HCV (4), and thelatter represents the main indication for li- ver transplantation in Europe and the United States (9).The estimatedglobal prevalence of the disease is 2.2%, representing approximately 130 million infected indivi-duals in the world (10). Great geographical variabilityis observed(9), possibly as a result of immunogenetic factors. Thelowest prevalences are found in the Uni- ted Kingdom and Scandinavia, and the highest in Egypt (11). HCV is an RNA virus mainly transmitted via the paren- teral routefrom infected blood (3, 9, 12). The sources of contagion include blood transfusion (although the risk has beenminimized since donor blood tests and controls are made (12)), percutaneous exposure through contami- natedinstruments, and occupational exposure to blood (9). The individuals at greatest risk are hemophiliacs,patients ondialysis and parenteral drug abusers.

Other transmission routes are sexual contact and perinatal and idiopathiccontagion (3). The prevalence of the infection among dentalprofessionals is similar to that found in the generalpopulation, though epidemiological studies suggest that dentists constitute a risk group for HCV in- fection (12). Following inoculation, the estimated seroconversion risk is 1.8% (8). The incubation period is long (up to three months), and 85% of all patients with HCV in- fection developchronic hepatitis. In those cases wheresymptoms areobserved, these tend to be mild, and most subjects remain relatively asymptomatic during the first two decades after infection with the virus (4). The morbidity associated to HCV infection is due not only to theconsequences of chronic liver disease but also to the extrahepatic manifestations (11). The best documented condition associated to hepatitis C is cryo- glubulinemia, a multisystemic disorder often characte- rized bypurpura, weakness and joint pain, and which may precede thedevelopment of B-cell non-Hodgkin lymphoma or membrane proliferative glomerulonephri- tis (12).

Otherrelated disorders are porphyria cutanea tarda, lichenplanus, sialadenitis, thyroid gland dys-function, diabetes mellitus and peripheral neuropathy (11). Over 74% of all HCV-infected patients ultimately developextrahepatic manifestations in the course of theinfection (10).

Different enzyme-linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA) techniques have been developed for the diagnosis of HCV infection, though thediagnostic gold standard remains detection of the viral genome using real time polymerase chain reaction (RT-PCR) technology (3, 12). No effective vaccine against HCV has yet been deve- loped, and spontaneous resolution is unusual (12). The existing therapy comprises combination treatment with interferon and ribavirin, which offers a sustained res- ponse rate of 30-40% (3). CHRONIC HEPATITIS Chronic hepatitis is a diffuse inflammatory disorder of the liver witha duration of over 6 months in which the underlying cause can be infectious (mainly hepatitis C virus and, to a lesser extent, hepatitis B and D viruses), pharmacological or immunological. The disease can develop in the absence of symptoms or withnonspecific manifestations such as fatigue, nausea or abdominal pain. The course is normally slow and pro- gressive, and symptoms typically do not manifest until years after the initial causal event (e.g., infection). Some patientsdevelop the disorder without significant liver damage, while others rapidly progress towards cirrhosis and possible hepatocarcinoma. Chronic hepatitis due to HCV infection is the principal cause of cirrhosis and he- patocellular carcinoma (3).

ALCOHOLIC LIVER DISEASE Alcoholic liver disease is one of the 10 most common causes of death in the industrialized world, and is res- ponsible for 3% of all fatalities. The epidemiological data indicate a threshold of 80 g of alcohol in males and 20 g infemales, consumed on a daily basis during 10-12 years, in order to cause the corresponding liver damage. Ten grams of pure ethanol are equivalent to a glass of wine or a beer,while a glass of whiskey doubles that amount. Factors such as chronic hepatitis C infection, obesity andgenetic factors can accelerate the develop

NON-ALCOHOLIC FATTY LIVER Non-alcoholic fatty liver is defined as the accumulation of fat (mainly triglycerides) in the liver, representing over 5% of the weight of the organ (5), in the absence of alcohol consumption in excess of 10 g a day (15).The observedliver damage ranges greatly from simple steatosis (accumulation of fat in the liver) to steatohepatitis(fat accumulation with added inflammation), advan- ced fibrosisand cirrhosis (16). This disorder is mainly associated to obesity, diabetes, hyperlipidemia and insulin resistance. There is a strong correlation between insulin resistance and excessive triglyceride accumulation within the liver cells (15). However, 16.4% of all patients with non-alcoholic fatty liver presentnone of these predisposing factors (17) The condition ispotentially reversible after eliminating or minimizingthe aforementioned causal factors (14). No clear treatments have been established to date for non-alcoholic fatty liver, though interventions such as bariatricsurgery (in the case of obese individuals) and oral antidiabetic drugs (glitazones) in patients with type 2 diabetes have shown encouraging results (15).

CIRRHOSIS Liver cirrhosis is very common in our setting, with well defined morphopathological characteristics that lead to destruction of the liver parenchyma. The disease is accompanied by a series of extrahepatic manifestations in other body organs and system (18). Liver cirrhosis is irreversible, and is characterized by the formation of fibrous scarring in the liver, with the formation of rege-neration nodules that increase resistance to blood flow through theorgan. The resulting deficient liver perfu- sion damages vital structures in the organ and adversely affects its physiological functions (19). The main cau-ses of liver cirrhosis are hepatitis B and C infection and alcohol abuse.Other potential causes are non-alcoholic steatohepatitis, genetic alterations and autoimmune di-sorders (3). The maincomplications of cirrhosis are portal hyperten- sion,hepatocellular carcinoma and organ function loss. Cirrhosis in itself constitutes a risk factor for the develo- pment of hepatocellular carcinoma (16). The treatment options comprise suppression of the cau- sal stimulus, antiviral therapy and liver transplantation in the endstages of cirrhotic disease (3).

HEPATOCELLULAR CARCINOMA Hepatocellularcarcinoma is the fifth most frequent can-cer worldwide (16). As such, it constitutes an important public health problem, and is one of the most common and life-threatening malignancies in the world with a survival rate after two years of only about 2% (3). It has been estimated that HBV and HCV are responsible for over 80% of all hepatocarcinomas. The other cau- ses are alcoholic and non-alcoholic steatohepatitis. Most patients with hepatocellular carcinoma have a history of cirrhosis, which in itself constitutes a preneoplastic con- dition (12, 16). Liver cirrhosis has a prolonged natural course, and pro- duces symptoms only in the advanced stages of the di-sease, when no healing treatment options are available. The main treatment for hepatocellular carcinoma is sur- gery (in thosecases where the tumor proves resectable), though unfortunately many cases are non-operable due to theproximity of vital structures, the presence of me- tastases, or other comorbidities (3). Objectives The present study offers a literature review of the oral manifestations that can be found in patients with viral hepatitis, alcoholic and non-alcoholic liver disease, cirr- hosis and hepatocellular carcinoma, and the dental ma-nagement of patients with these liver disorders.

Material and Methods A literature search was made of the articles indexed in the PubMed Medline database, using the following MeSH validated key words: hepatitis, alcoholic hepati- tis, fatty liver, cirrhosis and hepatocellular carcinoma. The search was limited to articles in English or Spanish published overthe last 15 years. A total of 28 articles were reviewed, comprising 20 literature reviews, a clini- cal guide, three clinical trials and four case series.

Results 1. ORALCLINICAL MANIFESTATIONS The oral cavity can reflect liver dysfunction in the form of mucosal membrane jaundice, bleeding disorders, pe-techiae, increased vulnerability to bruising, gingivitis, gingival bleeding (even in response to minimum trau-ma) (3, 19),foetor hepaticus (a characteristic odor of advanced liver disease), cheilitis, smooth and atrophic tongue, xerostomia, bruxism and crusted perioral rash (1).

In these patients, chronic periodontal disease is a common finding. Patients with alcoholic hepatitis can present glossitis, angle cheilitis and gingivitis, particularly in combination withnutritional deficiencies (3, 20). Some patients who consume largeamounts of alcohol for prolonged periods of time can develop sialadenosis. As commented by Frie- dlander (20), this is believed to be the result of ethanol- induced peripheral autonomic neuropathy giving rise to alterations insalivary metabolism and secretion.

Patients with advanced cirrhosis tend to present defi-cient oral hygiene, particularly in those cases where the liver impairment is associated to alcohol abuse. Bagn et al. (18) reported worsened dental conditions in patients with livercirrhosis, in coincidence with other authors such as Novacek et al. (21), who considered that due to the severity and characteristics of cirrhosis, patients tend to neglect care of the oral cavity (18). In a recent study, Grossmann et al (9). found many patients with HCV infection to present poor dental health a situation that contributes to worsen their quality of life. Extrahepatic manifestations have been reported in 74% of all HCV-infected individuals (19), and some of these conditions predominantly or exclusively affect the oral region (10). The main disorders associated with HCV infection are xerostomia, Sjgrens syndrome (SS), sia-ladenitis and particularly lichen planus (LP) (9). Xerostomia increases patient vulnerability to caries andoral softtissue disorders (9) which, in combination with deficient hygiene, in turn facilitate the development of candidiasis. It has not yet been demonstrated whether HCV infection causes disease similar to primary Sjgrens syndrome or whether itis directly responsible for development of Sjgrens syndrome in certain types of patients. Howe-ver, it isnotorious that some subjects can present a triple association of HCV infection, Sjgrens syndrome and sialadenitis orsalivary gland lymphoma (10).

Although bacteria are the main cause of sialadenitis, vi- ruses such as HCV have been implicated as causes of sialadenitis associated to xerostomia (19). Epidemiological evidence suggests that lichen planus may be significantly associated to HCV infection, though the existing data are controversial (22). This association appears to be dependent upon the geographical setting, being more common in Mediterranean countries and in Japan (22). Bagn et al. (23) found the prevalence of HCV infection to be greater in patients with oral lichen planus (OLP) than in the control group. Although further studies are needed, recent data suggest that patients are most likely first infected with HCV and posteriorly de- velop lichen planus (24) though the way in which this

2. DENTAL MANAGEMENT

Liver disease has important implications for patients receiving dental treatment (3). The most frequent pro-blems associated with liver disease in clinical practice refer to the risk of viral contagion on the part of the den-tal professionals and rest of patients (cross-infection),the risk of bleeding in patients with serious liver disease,and alterations in the metabolism of certain drug subs-tances (1) which increases the risk of toxicity. HCV has been detected on different surfaces within the dental clinic after treating patients with hepatitis C, and the virus moreover is able to remain stable at room tem-perature for over 5 days (12). Strict sterilization mea-sures are therefore required, since deficient sterilizationcan expose both the dentist and other patients to hepa-titis infection (5). The universal protective measures areapplicable in order to prevent cross-infection, i.e., theuse of barrier methods, with correct sterilization and di-sinfection measures (1). It has been demonstrated thatconventional sterilization techniques eliminate specificproteins and nucleic acids (HBV DNA and HCV RNA)from dental instruments previously infected with HBVand HCV.

x

Although there are no data confirming theirefficacy in lessening the risk of contagion, the measuresre commended in the case of accidental perforation of the skin with instruments or needles comprise careful was-hing of the wound (without rubbing, as this may inocula-te the virus into deeper tissues) for several minutes withsoap and water, or using a disinfectant of established efficacy against the virus (iodine solutions or chlorine formulations). In turn, pressure should be applied benea-th the level of the wound in order to induce bleeding and thus help evacuate any possible infectious material.If exposure through some mucosal membrane has oc-curred, abundant irrigation with tap water, sterile saline solution or sterile water is advised, for several minutes. The rationale behind these measures is to reduce the number of viral units to below the threshold count nee-ded to cause infection (i.e., the infectious dose). In this sense, dilution with water may lower the viral count to below this threshold (8). Whenever possible, the hepa-titis antigen status of the patient should be determined.In the event of parenteral exposure to hepatitis virus-positive antigens, the dentist should receive treatment with anti-hepatitis B immunoglobulin (5). Table 1 offers a schematic description of the steps to be followed. The compilation of a detailed clinical history is essen-tial before dental treatment in order to identify patientsposing possible risks (5), together with a thorough oralexploration. Interconsultation with the patient physicianor specialist is advisable in order to establish a safe andadequate treatment plan adapted to the medical condi-tion of the patient (3), considering the degree of liver functional impairment involved (1).

Table 1

x

Exploration of the oral cavity should assess any signs alerting to the exis-tence of systemic disease. The patient should receive an explanation of the risks associated with treatment, and informed consent is to be obtained.In patients with acute-phase viral hepatitis, only emer-gency treatment should be considered. In subjects with chronic hepatitis it is important to determine the pos-sible existence of associated disorders (autoimmuneprocesses, diabetes, etc.) in order to prevent their direct complications and problems derived from specific me-dication use (corticosteroids and/or immune suppres-sors). Evaluation is also required of the possible medical conditions associated to HCV contagion, fundamentally blood transmitted infections (HIV, HBV).It also must be taken into account that liver disease is often associated with a decrease in plasma coagulation factor concentrations (2, 3). In a patient with liver di-sease, the surgical risk is related to the severity of the disease, the type of surgery planned, and the presence of comorbidities. Surgery is contraindicated in patients with certain conditions such as acute hepatitis, acute li-ver failure or alcoholic hepatitis (25). If invasive mea-sures are required, prior coagulation and hemostasistests are required: complete blood count, bleeding time,prothrombin time / international normalized ratio (INR),thrombin time, thromboplastin time and liver bioche-mistry (GOT, GPT and GGT) (1, 26). Table 2 reports the normal coagulation test values. In the event altered test values are detected, the hematologist or liver spe-cialist should be consulted (3), with the postponement of elective treatment. Any emergency treatments should be provided in the hospital setting.

In the event of surgery, trauma should be minimized (3) in order to optimize hemostasis, with a careful surgical technique,applying pressure to control bleeding and using hemos-tatic agents (2). Based on the laboratory test findings and the treatment to be carried out, local hemostatic agents may be advisable (oxidized and regenerated cellulose),as well as antifibrinolytic agents (tranexamic acid), fresh plasma, platelets and vitamin K (1, 26). Antibiotic pro-phylaxis is suggested, since liver dysfunction is associa-ted to diminished immune competence (2).Liver disease may result in alterations in the metabolism of certain drugs. The physician treating the patient the-refore should be consulted in order to establish which drugs are used, their doses and possible interactions(3). The administration of certain analgesics, antibioticsand local anesthetics is generally well tolerated by pa-tients with mild to moderate liver dysfunction, though modifications may prove necessary in individuals with advanced stage liver disease (2). In this context, drugs metabolized in the liver may have to be used with cau-tion or their doses reduced (1, 26) (Table 3), and certain substances such as erythromycin, metronidazole or te-tracyclines must be avoided entirely (3). Most of the an-tibiotics prescribed for oral and maxillofacial infections can be used in patients with chronic liver disease, and in general the beta-lactams can be administered. Amino-glycosides can increase the risk of liver toxicity in pa-tients with liver disease, and so should be avoided. Themetabolism of clindamycin in turn is prolonged in suchpatients, and different studies suggest that it contribu-tes to liver degeneration (27).

Nonsteroidal antiinflam-matory drugs (NSAIDs) should be used with caution oravoided, due to the risk of gastrointestinal bleeding andgastritis usually associated to liver disease. Prophylaxiscan be provided in the form of antacids or histamine re-ceptor antagonists (2, 3). Acetaminophen (paracetamol)is to be avoided in patients with serious liver disease (4),and aspirin and NSAIDs are not indicated in patientswith altered hemostasis (4). Authors such as Douglas etal. (27) describe acetaminophen as a safe alternative toaspirin or NSAIDs that can be administered at doses ofup to 4 g/day during two weeks without adverse liver effects, warning patients to avoid alcohol consumption while receiving treatment with the drug. In patients using benzodiazepines, the dose should be lowered, withprolongation of the interval between doses. Local anes-thetics are generally safe provided the total dosage doesnot exceed 7 mg/kg, combined with epinephrine (27).Table 4 shows the drugs that are contraindicated and those that can be used with caution. Although some of these substances are metabolized in the liver, the doses at which they are used in dental practice are considered to be acceptable unless the patient suffers very severe liver dysfunction.

Table 4 shows the drugs that are contraindicated and those that can be used withcaution.

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Dental considerations in patients with liver disease ...

Understanding Cancer -- Diagnosis and Treatment How Is Cancer Diagnosed?

The earlier cancer is diagnosed and treated, the better the chance of its being cured. Some types of cancer -- such as those of the skin, breast, mouth, testicles, prostate, and rectum -- may be detected by routine self-exam or other screening measures before the symptoms become serious. Most cases of cancer are detected and diagnosed after a tumor can be felt or when other symptoms develop. In a few cases, cancer is diagnosed incidentally as a result of evaluating or treating other medical conditions.

Cancer diagnosis begins with a thorough physical exam and a complete medical history. Laboratory studies of blood, urine, and stool can detect abnormalities that may indicate cancer. When a tumor is suspected, imaging tests such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and fiber-optic endoscopy examinations help doctors determine the cancer's location and size. To confirm the diagnosis of most cancers , a biopsy needs to be performed in which a tissue sample is removed from the suspected tumor and studied under a microscope to check for cancer cells.

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Cancer Center: Types, Symptoms, Causes, Tests, and ...

Integrative medicine, sometimes referred to as holistic medicine or complementary medicine, combines conventional and alternative approaches to address the biological, psychological, social and spiritual aspects of health and illness. Our services are available for both adults and children.

Beaumont's Integrative Medicine Program focuses on healing the whole person, with the goal of improving quality of life for patients, their families and others close to them.

We offer clinical massage, acupuncture, naturopathy, guided imagery, reflexology, energy balancing with Reiki, scar therapy, lymphatic wellness massage, Indian Head Massage, hydrotherapy, Cranial Sacral Therapy, neuromuscular therapy, meditation and yoga which combine the best of Eastern traditions while complimenting traditional Western medical practice.

The goal of any successful integrative medicine program is to truly "integrate" allopathic medicine with mind-body-spirit modalities with the ultimate goal of helping patients adapt to traditional medical treatments. Our modalities directly affect the body's physiological healing process while gently awakening the mind-body-spirit connection needed to enhance the healing process.

Beaumont is also one of only a few centers in the United States who offers oncology/hospital massage training. This graduate program, overseen by Beaumont's integrative medicine department is offered through Beaumont's School of Allied Health.

Patients, their caregivers and the hospital staff need both private and group programs therefore we have structured our offerings around their stated needs. Individual treatments (regardless of hospital affiliation) include:

Our Medical Director, Maureen Anderson M.D., is board certified by the American Board of Integrative and Holistic Medicine, with additional education in the functional medicine approach. Her primary training and board certifications are in emergency medicine and general pediatrics. Over the years, Dr. Anderson has cared for patients of every age, presenting with a whole constellation of symptoms and diseases.

The wisdom and experience gained during years as an emergency physician have afforded her a unique and broad perspective, which nicely complements her integrative medicine skills and expertise. Dr. Anderson brings all of this, along with a passion for wellness, and a genuine interest in the total well-being of others to her integrative medicine practice

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Integrative Medicine - Beaumont Health System

Nanomedicine - a 'Fantastic Voyage'?

Many of us will remember the miniature submarine in which Rachel Welch travelled through the human body to zap a bloodclot in the film Fantastic Voyage. Some will be disappointed to know that this is not going to be possible and will never happen. But the good news is that nanotechnology may be able to help do the job of targeting and zapping diseases in our body much better than the Proteus ever could, and without the risk of becoming submarine-sized halfway to finishing the job!

Some of the more exciting developments which may be enabled, or made cheaper and more accessible by nano may also give rise to some social and ethical issues. How much do we really want to know now about what diseases we may get in the future? What are the implications of enhancing our minds or bodies to make us smarter or live longer?

Go to our Social and Ethical section and explore some more

Nanotechnologies may have the greatest impact in the medical and healthcare fields. There are some nano-enabled uses at the moment, with others not so far away. However many of the much talked about applications - creating artificial body parts or remotely diagnosing and delivering drugs may be a long way off, or may not even be possible.

The most notable changes will come from improvements in diagnosing illnesses more easily and treating them by better targeting of drugs. It will also make existing medical applications much cheaper and easier to use in different settings like GP surgeries and homes.

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Nano & Me - Nano Products - Nano in Medicine