Condet

Qassim F Baker MBChB Diploma (Gen Surgery)

• FRCS
• Clinical tutor
• Iraqi Board of Medical Specialisation
• Assistant professor, Baghdad College of
• Medicine, Baghdad
• Formerly Consultant surgeon
• Baghdad Teaching Hospital, Baghdad, Iraq

Other data suggest that physical activity is related to perceived improvement in physical function in activities of daily living impotence mayo clinic quality super p-force oral jelly 160 mg. However impotence in the sun also rises order 160mg super p-force oral jelly otc, there is a limit 141 Physical Activity and Health to this effect valium causes erectile dysfunction order super p-force oral jelly 160mg amex, since sedentary people can usually do their daily tasks erectile dysfunction treatment delhi cheap super p-force oral jelly 160mg on-line. The growing body of literature on this topic indicates that patients whose physical function is compromised by heart disease (Ewart 1989) or arthritis (Fisher et al. Exceptions include a randomized clinical trial involving healthy elderly persons (Stewart, King, Haskell 1993) and a 2-year observational study of persons with chronic disease (Stewart et al. In the clinical trial, healthy persons who were assigned to endurance exercise had better self-reported ratings of their physical functioning and health (e. Participants who have lower levels of mental or physical health may have the most to gain from physical activity (Lennox, Bedell, Stone 1990; Morgan et al. A relatively small number of cross-sectional studies have shown a strong positive association between regular physical activity and cognitive and neuropsychological performance on tasks such as math, acuity, and reaction time (Dustman, Emmerson, Shearer 1994; Thomas et al. However, longer-term training studies (2 or more years) are required to confirm whether aerobic exercise has a pronounced effect on cognitive function. Also unclear are whether the effects of lowintensity physical activity are similar to those of aerobic exercise and whether objective measures of cognitive function can elucidate the perceived cognitive function of participants (Dustman, Emmerson, Shearer 1994). Among people compromised by ill health, physical activity appears to improve their ability to perform activities of daily living. Adverse Effects of Physical Activity Although physical activity has numerous health benefits, its potential adverse effects must also be considered. Listing the potential risks associated with physical activity is a straightforward matter. It is much more difficult to determine how commonly they occur among people who are physically active. Types of Adverse Effects Musculoskeletal Injuries Acute stress from sudden forceful movement can cause strains, tears, and even fractures. For example, a vigorous swing of a baseball bat can lead to a dislocated shoulder. Injuries like these can result from any activity, exercise, or sport that features sudden movements, such as those that can occur in professional or amateur track and field, racquet sports, basketball, baseball, football, soccer, and golf. Collisions with equipment, other participants, and surfaces can also produce severe injury. Children and adolescents with developing bodies are at special risk of permanent physical damage if injury occurs to the growth plates of long bones or to other bone or connective tissue structures. Activities that involve repetitive motions, sometimes with traumatic contact with a ground surface or ball, are associated with other musculoskeletal injuries. An extensive literature describes injuries related to jogging and running (Hoeberigs 1992; Rolf 1995; Van Mechelen 1992). Lower-extremity injuries appear to be the most common; of these, 142 the Effects of Physical Activity on Health and Disease the knee, ankle, and foot have the highest proportions of injuries (e. Metabolic Abnormalities Severe exertion, particularly of prolonged duration and under hot or humid conditions, can lead to hyperthermia, electrolyte imbalance, and dehydration (England et al. Timely fluid intake and replacement, with proper electrolyte and caloric composition, can prevent or ameliorate such metabolic upsets. Hypothermia is a risk in many water sports and for any activities undertaken in cold weather (or even cool weather if inadequate clothing is worn). Extreme endurance training regimens can lead to endocrine system alterations, sometimes resulting in anovulation and amenorrhea in females, in association with a decrease in body weight below a critical lean mass, as well as with a decrease in bone mass (Shangold 1984). Hypoglycemia can occur in people with diabetes if they do not develop a routine of regular activity in conjunction with regular monitoring of their blood sugar (and adjustment of their medication accordingly). Hematologic and Body Organ Abnormalities Anemia is reported in athletes vigorously engaged in sports such as long-distance running; hemoglobinuria can occur secondary to breakage of red blood cells during the repetitive impact of distance running, and hematuria can occur when distance running traumatizes the bladder or other structures in the genitourinary system. Rhabdomyolysis, the leakage of contents of muscle cells, can occur as a result of strenuous activity, such as weight lifting or military basic training, and can lead to renal failure (Kuipers 1994; Sinert et al. Hazards Cyclists, runners, and walkers often face risks associated with travel on roadways-collisions with motor vehicles, injuries from falls secondary to uneven surfaces, and attacks by animals or humans. Baseball players may be struck by a thrown or batted ball or injured by a spike-soled shoe.

Involvement of peripheral joints is usually oligoarticular but rarely polyarthritis may be present erectile dysfunction treatment online 160mg super p-force oral jelly amex. Definite ankylosing spondylitis is present if the radiological criterion is associated with at least one clinical criterion (Table 2) erectile dysfunction statistics 2014 generic 160mg super p-force oral jelly mastercard. As the duration and levels increase medication that causes erectile dysfunction cheap super p-force oral jelly 160mg without prescription, inflammation and gradually structural damage occurs in the joints (F1igure 2) erectile dysfunction doctor manila buy super p-force oral jelly 160mg low cost. However gout may present as oligoarthritis involving the midtarsal, ankle, knee, wrist or elbow joints. Acute septic arthritis presents with a single hot, swollen, red and tender joint is shown in Figure 3. Gonococcal infection is by far the most common cause of monoarthritis or oligoarthritis in young sexually active adults, with a female/male ratio of 3:1. Gonococcal arthritis results from blood dissemination of Neisseria gonorrhoeae from primary sexually acquired mucosal infection. Clinical characteristics of gonococcal and nongonococcal arthritis are summarized in Table 3. Diagnostic clue may be provided by acute phase reactants, leucocytosis but definitive diagnosis needs joint aspiration and direct identification of the culprit bacteria. Infectious arthritis should be considered in any acute monoarticular joint involvement, especially in the presence of fever. Primary tumors and tumor like disorders of synovium are uncommon but should be considered in the differential diagnoses of monoarticular joint disease. In addition, metastases to bone and primary bone tumors adjacent to a joint may produce joint symptoms. Synovial chondromatosis is another disorder characterized by multiple focal metaplastic growths of cartilage in the synovium or tendon sheaths. Varied presentation involving the musculoskeletal systems may be seen in other multisystemic diseases like polymyositis, scleroderma, overlap syndromes, sarcoidosis and systemic vasculitis. An American Collage of Rheumatology/European League Against Rheumatism Collaborative Initiative. Table of contents: Measures of Rheumatoid Arthritis Disease Activity Measures of Adult Shoulder Function Measures of Physical Performance Assessment Measures of Self-Efficacy Adult Measures of general Health and Health-Related Quality of Life Measures of Health Status and Quality of Life in Juvenile Rheumatoid Arthritis Measures of Knee Function Measures of Juvenile Fibromyalgia Measures of Disability Measures of Adult Pain Measures of Health-Related Quality of Life in Pediatric Systemic Lupus Erythematosus Measures of Fatigue Measures of General Pediatric Quality of Life Measures of Anxiety the Future of Measuring Patient-Reported Outcomes in Rheumatology Measures of Pediatric Function Measures of Disease Activity and Damage in Pediatric Systemic Lupus Erythematosus Measures of Pediatric Pain Measures of Functional Status and Quality of Life in Rheumatoid Arthritis Measures of Psoriatic Arthritis Measures of Hip Function and Symptoms Measures of Sleep in Rheumatologic Diseases Measures of Hand Function Measures of Systemic Sclerosis (Scleroderma) Measures of Adult and Juvenile Dermatomyositis, Polymyositis, and Inclusion Body Myositis Measures of Foot Function, Foot Health, and Foot Pain Measures of Adult Systemic Lupus Erythematosus Measures of Depression and Depressive Symptoms Measures of Function in Low Back Pain/Disorders Measures of Work Disability and Productivity Gout Measures Measures of Adult General Functional Status Measures of Social Function and Participation in Musculoskeletal Populations Measures of Fibromyalgia Health-Related Quality of Life Measurement in Adult Systemic Lupus Erythematosus Measures of Symptoms and Disease Status in Ankylosing Spondylitis 2 25 40 61 74 104 112 133 140 157 170 178 202 213 219 224 236 242 252 262 284 292 302 313 327 367 378 388 401 417 430 435 446 458 470 477 Arthritis Care & Research Vol. The psychometric data related to these tools have been published over the course of decades and across numerous journals. Consequently, the majority of this information remains inaccessible to practicing and academic rheumatologists alike. More recent measurement tools with inadequately published data, such as the Global Arthritis Score, may ultiSupported in part by the American College of Rheumatology. Time to complete each measure was divided into 1) time for patient completion without assistance from providers; 2) time for provider completion, including the time required to score the measure; and 3) time required for laboratory studies. Continuous composite indices producing a single score have an advantage over the interpretation of individual components of disease activity as they provide clinically meaningful and reliable estimates of disease activity with interpretation of multiple data points simultaneously and are more responsive to change than single items (2). On the other hand, simple visual analog scales are widely used and may be the most feasible method for disease activity monitoring in clinical settings. Unfortunately, no publications yet exist comparing the remission cutoffs for each measurement tool to these new criteria. It is important to recognize that for all of the disease activity measurement tools discussed, it is possible for a patient to meet low disease activity or remission cutoffs and still exhibit residual active disease. The most important concern threatening the validity and reproducibility of both measures is the lack of uniformity regarding the wording of patient and provider instructions and of anchors. Patient-derived measures without acute-phase reactant values have been shown to be reliable and sensitive (96); however, they may be influenced by patient education level (97). Leeb, Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, A-2000 Stockerau, Austria.

Mechanism Acute intake of caffeine raises blood pressure erectile dysfunction quick remedy discount 160mg super p-force oral jelly amex, but some tolerance to this effect might possibly develop with regular consumption erectile dysfunction diet pills super p-force oral jelly 160mg cheap. Polyphenolics in tea might improve endothelial function erectile dysfunction causes mental generic super p-force oral jelly 160mg overnight delivery, and might therefore lower blood pressure free erectile dysfunction drugs 160mg super p-force oral jelly overnight delivery. Importance and management the evidence presented here is conflicting, and it is not possible to be conclusive about the long-term effect of tea intake (green or black) on blood pressure. On acute intake, both green and black (fermented) teas and some herbal supplements (particularly if they contain caffeine) might increase blood pressure, although, from the limited information above, these increases appear to be small and not necessarily sustained during long-term intake. Bear this in mind in patients with poorly controlled hypertension who frequently consume tea, particularly in large quantities. However, note that similar effects are known to occur with caffeine alone, see Caffeine + Antihypertensives, page 99. Short- and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease. Acute effects of tea on fasting and postprandial vascular function and blood pressure in humans. The effect of an herbal supplement containing black tea and caffeine on metabolic parameters in humans. T Tea + Antihypertensives Both black and green tea may cause a modest increase in blood pressure, which may be detrimental to the treatment of hypertension. Clinical evidence There is a possibility that the effect of tea on blood pressure might differ from that of pure caffeine. There are few data on the effect of tea on blood pressure in patients treated with antihypertensives. This effect was similar to the increase seen with a single dose of 200-mg of caffeine. Drinking 900 mL of black tea daily for 4 weeks had no significant effect on blood pressure. However, the acute effects of tea remained: systolic blood pressure was still increased by 5 mmHg two hours after the patients drank 450 mL of black tea. In one meta-analysis of 5 randomised studies of the effect of tea consumption for at least 7 days (median 4 weeks) on blood pressure, tea consumption was associated with no 384 Tea inflammation: a double-blind placebo controlled trial. Effect of acute and chronic tea consumption on platelet aggregation in patients with coronary artery disease. Hirano-Ohmori R, Takahashi R, Momiyama Y, Taniguchi H, Yonemura A, Tamai S, Umegaki K, Nakamura H, Kondo K, Ohsuzu F. Antithrombotic activities of green tea catechins and (-)-epigallocatechin gallate. Antiplatelet effect of green tea catechins: a possible mechanism through arachidonic acid pathway. Tea + Antiplatelet drugs Tea, particularly green tea catechins, may have some antiplatelet effects, which may be additive to those of conventional antiplatelet drugs. Clinical evidence (a) Pharmacodynamic effects In studies in healthy medication-free subjects, neither acute1,2 nor chronic3 tea consumption of black (fermented) tea (with or without added milk) affected platelet aggregation, whereas two studies did report a reduction in platelet activation with chronic tea intake. The authors note that this result may have been influenced by the high temperature of the tea and an alkaline pH, both of which can increase the dissolution rate of aspirin. Experimental evidence Green tea catechins have been reported to inhibit platelet aggregation in mice and in vitro, in a dose-dependent manner. Importance and management In general the evidence appears to suggest that black (fermented) tea does not have a clinically relevant effect on platelet aggregation. However, experimental studies using green tea catechins have found an antiplatelet effect, and this effect may, in theory, be additive to those of conventional antiplatelet drugs. Concurrent use need not be avoided (indeed combinations of antiplatelet drugs are often prescribed together) but it may be prudent to be aware of the potential for increased bleeding if green tea extracts, particularly in high doses, are given with other antiplatelet drugs such as aspirin and clopidogrel. Acute effects of ingestion of black tea on postprandial platelet aggregation in human subjects. Effect of black tea on (iso-)prostaglandins and platelet aggregation in healthy volunteers. Effects of regular ingestion of black tea on haemostasis and cell adhesion molecules in humans.

Three studies have held constant both total amount of activity and intensity of activity while daily pattern was varied (one long session versus shorter erectile dysfunction over 50 160 mg super p-force oral jelly for sale, more frequent sessions) erectile dysfunction pump implant discount super p-force oral jelly 160 mg with visa. Two studies showed equivalent increases in cardiorespiratory fitness (Jakicic et al wellbutrin xl impotence buy super p-force oral jelly 160mg without a prescription. One study showed gains in cardiorespiratory fitness for both the "short bout" and "long bout" groups erectile dysfunction band discount 160 mg super p-force oral jelly visa, although on one of three measures (maximal oxygen uptake versus treadmill test duration and heart rate at submaximal exercise), the gain in fitness was significantly greater in the long bout group (DeBusk et al. These observations give rise to the notion that intermittent episodes of activity accumulated in the course of a day may have cardiorespiratory fitness benefits comparable to one longer continuous episode. Whether this assumption holds true for the outcomes of disease occurrence and death remains to be determined. This information, together with evidence that some people may adhere better to an exercise recommendation that allows for accumulating short episodes of activity as an alternative to one longer episode per day (Jakicic et al. Although more research is clearly needed to better define the differential effects of various patterns of activity, experts have agreed that intermittent episodes of activity are more beneficial than remaining sedentary. Conclusions the findings reviewed in this chapter form the basis for concluding that moderate amounts of activity can protect against several diseases. A greater degree of protection can be achieved by increasing the amount of activity, which can be accomplished by increasing intensity, frequency, or duration. Nonetheless, modest increases in physical activity are likely to be more achievable and sustainable for sedentary people than are more drastic changes, and it is sedentary people who are at greatest risk for poor health related to inactivity. Thus the public health emphasis should be on encouraging those who are inactive to become moderately active. The recommendations also encourage those 148 the Effects of Physical Activity on Health and Disease who are already moderately active to become more active to achieve additional health benefits, by increasing the intensity, duration, or frequency of physical activity. Further study is needed to determine which combinations of these interrelated factors are most important for specific health benefits. Encouraging sedentary people to become moderately active is likely to reduce the burden of unnecessary suffering and death only if the activity can be sustained on a daily basis for many years. Higher levels of regular physical activity are associated with lower mortality rates for both older and younger adults. Even those who are moderately active on a regular basis have lower mortality rates than those who are least active. Chapter Summary Despite the variety of methods used to measure and classify physical activity, the imprecision of these measures, and the considerable variation in study designs and analytic sophistication, several findings consistently emerge from the epidemiologic literature on physical activity and health. Findings are highly suggestive that endurance-type physical activity may reduce the risk of developing obesity, osteoporosis, and depression and may improve psychological well-being and quality of life. There is promising evidence that muscle strengthening (resistance) exercise reduces the risk of falling and fractures among the elderly. Furthermore, there appears to be a dose-response relationship between physical activity and disease prevention: higher levels of activity appear to have the most benefit, but lower levels have demonstrable benefits for some diseases as well. Existing data are not conclusive regarding a relationship between physical activity and stroke. Regular physical activity prevents or delays the development of high blood pressure, and exercise reduces blood pressure in people with hypertension. Data are too sparse to draw conclusions regarding a relationship between physical activity and endometrial, ovarian, or testicular cancers. Regular physical activity is necessary for maintaining normal muscle strength, joint structure, and joint function. In the range recommended for health, physical activity is not associated with joint damage or development of osteoarthritis and may be beneficial for many people with arthritis. Competitive athletics may be associated with the development of osteoarthritis later in life, but sports-related injuries are the likely cause. Physical activity appears to improve healthrelated quality of life by enhancing psychological well-being and by improving physical functioning in persons compromised by poor health. Most musculoskeletal injuries related to physical activity are believed to be preventable by gradually working up to a desired level of activity and by avoiding excessive amounts of activity. Serious cardiovascular events can occur with physical exertion, but the net effect of regular physical activity is a lower risk of mortality from cardiovascular disease. Weight-bearing physical activity is essential for normal skeletal development during childhood and adolescence and for achieving and maintaining peak bone mass in young adults. Delineate the most important features or combinations of features of physical activity (total amount, intensity, duration, frequency, pattern, or type) that confer specific health benefits.

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