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By: X. Jorn, M.B. B.CH., M.B.B.Ch., Ph.D.
Clinical Director, Philadelphia College of Osteopathic Medicine
Three broad categories of studies would be useful in either confirming the suitability of present sports nutrition guidelines or developing separate recommendations for female athletes: (i) studies in which female subjects have been included within the group outcomes without distinguishing any differences based on sex; (ii) studies that focus on female subjects alone birth control for women with depression purchase 0.15 mg levlen free shipping, and (iii) research in which direct comparisons have been made between the response of male and female subjects to birth control knee pain discount levlen 0.15mg with amex a sports nutrition intervention birth control for women love order levlen pills in toronto. It is clear, notwithstanding the difficulties of undertaking such research, that these types of studies are underrepresented in the literature and should be encouraged. There are several issues that might explain or call for differences in recommendations for sports nutrition for female athletes. The first is the different hormonal environment and its changes over the menstrual cycle experienced by females. The small number of factors in which this has been investigated in terms of exercise metabolism. This issue is covered to some extent in that old sports nutrition recommendations for absolute nutrient amounts have been replaced with targets expressed relative to body mass. A final consideration is the observation that many female athletes consume diets that are low in energy availability; apart from impairing health and function, this can indirectly alter nutritional requirements. Low energy availability An inadequate intake of energy in relation to the energy cost of exercise prevents the body from 32 Chapter 4 having sufficient energy to fuel the functions underpinning optimal health and performance. This situation, termed low energy availability, is frequently observed among female athletes related to their management of optimal body mass/ physique. However, it can also occur when appetite or opportunities to consume food fail to adapt to an increase in training/competition load. The chapter on the female athlete triad (Chapter 9) describes the causes and outcomes of this syndrome in more detail. Here, we will quickly consider the effects of low energy availability on sports nutrition requirements. Although the clear objective is for female athletes to avoid scenarios of energy deficiency, there are some situations in which some reduction in energy availability may be required or tolerated. An outcome of the reduction in energy intake below energy expenditure is an adjustment to physiological function to conserve energy and preserve against starvation. In these cases, nutritional counseling of the female athlete may need to take into account a current energy requirement below predicted/healthy levels. A gradual intake in energy may be required to help restore energy availability, metabolic rate, and health. Even when this takes place, however, the female athlete will need to make sound dietary choices from a range of nutrientdense foods to ensure that all requirements for micronutrients and beneficial food constituents are met from a restricted energy budget. Older studies of female athletes and carbohydrate loading made observations that they are less efficient at storing glycogen than their male counterparts. More recent research has shown that this finding is related to energy deficiency and females can store glycogen effectively when they consume adequate energy intake. Alternatively, when carbohydrate intake is below the targets identified for optimal refueling, the addition of protein (20 g) to the meal/snack enhances glycogen storage. Meanwhile, although protein targets can be set for meals and snacks to optimize protein synthesis in response to exercise over the day, recent studies show that these targets need to be increased even when energy availability is reduced by amounts normally considered to be "safe" for weight loss (30 kcal/kg fatfree mass). Sports nutrition guidelines have changed from recommending that all athletes consume "high carbohydrate diets" per se to considering carbohydrate intake in relation to the fuel cost of training and refueling ("carbohydrate availability"). The guidelines recommend that for days/scenarios where the training program calls for high-intensity, high-quality or techniquebased workouts, athletes should consume carbohydrate over the day and in relation to the workout to provide high carbohydrate availability (carbohydrate targets met). Meanwhile, in other scenarios, carbohydrate availability may not be crucial for training outcomes, and the athlete can allow carbohydrate intake to be below theoretical exercise costs. In fact, there are even potential advantages to periodizing training to include some sessions involving low carbohydrate availability (training after an overnight fast, training with low glycogen stores, etc. Muscle protein synthesis is a desired response to an exercise session, with the specific stimulus Nutritional guidelines for female athletes 33 Table 4. There is a greater increase in myofibrillar proteins in response to resistance training, while endurance athletes are interested in an increase in the mitochondrial or sarcolemmal proteins that underpin metabolic goals. Insights from the latest protein research have moved guidelines away from a focus on over daily protein intake targets or the concept of nitrogen balance, to targets for chronically maximizing the protein synthetic response to training or competition. A proteinrich snack prior to bed will also assist with overnight protein synthesis. Lean meats, eggs, and lowfat dairy products provide a good source of such protein, as well as other micronutrients such as iron and calcium that can be in short supply in the diets of many female athletes.
Additional information:
Benzodiazepines (often taken with alcohol) are commonly taken in an overdose birth control pills good for hair purchase cheap levlen online, but are seldom fatal if taken in isolation birth control cramps buy levlen with paypal. Around 75% of deaths from overdose occur outside hospital birth control for women chicago order levlen paypal, with the mortality of those treated in hospital being less than 1%. The majority of cases of self-poisoning fall into the psychological classification of suicidal gestures (or a cry for help). However, the prescription of potent drugs with a low therapeutic ratio can cause death from an apparently trivial overdose. Following an immediate assessment of vital functions, as full a history as possible should be obtained from the patient, relatives, companions and ambulance drivers, as appropriate. A knowledge of the drugs or chemicals that were available to the patient is invaluable. A psychiatric history, particularly of depressive illness, previous suicide attempts or drug dependency, is relevant. If semiconscious with effective gag reflex, place the patient in the head-down, left-lateral position. Confirm that the tube is in the stomach (not the trachea) by auscultation of blowing air into the stomach; save the first sample of aspirate for possible future toxicological analysis (and possible direct identification of tablets/capsules) 5. Drug screens are often requested, although they are rarely indicated as an emergency. In these, emergency measurement of the plasma concentration can lead to life-saving treatment. For example, in the early stages, patients with paracetamol overdoses are often asymptomatic, and although it only rarely causes coma acutely, patients may have combined paracetamol with alcohol, a hypnosedative or an opioid. As such, an effective antidote (acetylcysteine) is available, it is recommended that the paracetamol concentration should be measured in all unconscious patients who present as cases of drug overdose. When there is doubt about the diagnosis, especially in coma, samples of blood, urine and (when available) gastric aspirate should be collected. Subsequent toxicological screening may be necessary if the cause of the coma does not become apparent or recovery does not occur. Avoidable morbidity is more commonly due to a missed diagnosis, such as head injury, than to failure to diagnose drug-induced coma. Gastric aspiration and lavage should only be performed if the patient presents within one hour of ingestion of a potentially fatal overdose. If there is any suppression of the gag reflex, a cuffed endotracheal tube is mandatory. It should only be performed by experienced personnel with efficient suction apparatus close at hand (see Table 54. If the patient is uncooperative and refuses to give consent, this procedure cannot be performed. Gastric lavage is usually contraindicated following ingestion of corrosives and acids, due to the risk of oesophageal perforation and following ingestion of hydrocarbons, such as white spirit and petrol, due to the risk of aspiration pneumonia. An increasingly popular method of reducing drug/toxin absorption is by means of oral activated charcoal, which adsorbs drug in the gut. To be effective, large amounts of charcoal are required, typically ten times the amount of poison ingested, and again timing is critical, with maximum effectiveness being obtained soon after ingestion. Aspiration is a potential risk in a patient who subsequently loses consciousness or fits and vomits. The use of repeated doses of activated charcoal may be indicated after ingestion of sustained-release medications or drugs with a relatively small volume of distribution, and prolonged elimination half-life. The rationale is that these drugs will diffuse passively from the bloodstream if charcoal is present in sufficient amounts in the gut or to trap drug that has been eliminated in bile from being re-absorbed (see below). Whole bowel irrigation using non-absorbable polyethylene glycol solution may be useful when large amounts of sustained-release preparations, iron or lithium tablets or packets of smuggled narcotics have been taken. This is usually due to peripheral vasodilatation, but may be secondary to myocardial depression following, for example, -blocker, tricyclic antidepressant or dextropropoxyphine poisoning. If dysrhythmias occur any hypoxia or hypokalaemia should be corrected, but anti-dysrhythmic drugs should only be administered in life-threatening situations. Since the underlying cardiac tissue is usually healthy (unlike cardiac arrests following myocardial infarction), prolonged external cardiopulmonary resuscitation whilst the toxic drug is excreted is indicated.
The duration of therapy depends on the nature of the infection and response to birth control pills ratings buy levlen overnight delivery treatment birth control pills refill cheap levlen 0.15 mg online. The British National Formulary provides a good guide to birth control pills symptoms trusted levlen 0.15mg initial treatments for common bacterial infections. In view of regional variations in patterns of bacterial resistance, these may be modified according to local guidelines. Close liaison with the local microbiology laboratory provides information on local prevalence of organisms and sensitivities. It is the minimal concentration of a particular agent below which bacterial growth is not prevented. No No antibiotic treatment Treat with most appropriate antibiotic according to predominant causative organism(s) and sensitivities (including local sensitivity patterns) Consider other measures. Antimicrobial resistance is particularly common in intensive care units and transplant units, where the use of antimicrobial agents is frequent and the patients may be immunocompromised. Thus the incidence of drug resistance is related to the prescription of that drug. Overuse of antibiotics will lead to a future where infectious disease has the same impact as in in the pre-antibiotic era. The dates on tombstones in Victorian cemeteries should be required reading for over-enthusiastic prescribers and medical students! In this way, transfer of genetic information concerning drug resistance (frequently to a group of several antibiotics simultaneously) may occur between species. In such patients, all dental procedures involving dento-gingival manipulation will require antibiotic prophylaxis, as will certain genito-urinary, gastrointestinal, respiratory or obstetric/gynaecological procedures. Intravenous antibiotics are no longer recommended unless the patient cannot take oral antibiotics. The latest guidelines (2006) by the Working Party of the British Society for Antimicrobial Chemotherapy can be found at jac. For dental procedures, in addition to prophylactic antibiotics, the use of chlorhexidine 0. Prophylaxis should be restricted to cases where the procedure commonly leads to infection, or where infection, although rare, would have devastating results. The antimicrobial agent should preferably be bactericidal and directed against the likely pathogen. The aim is to provide high plasma and tissue concentrations of an appropriate drug at the time of bacterial contamination. Intramuscular injections can usually be given with the premedication or intravenous injections at the time of induction. Local hospital drug and therapeutics committees can help considerably by instituting sensible guidelines on the duration of prophylactic antibiotics. If continued administration is necessary, change to oral therapy post-operatively wherever possible. The British National Formulary provides a good summary of the use of antibacterial drugs preoperatively, which may be varied according to local guidelines based on regional patterns of bacterial susceptibility/resistance. This can be broken down by -lactamase enzymes produced by bacteria, notably by many strains of Staphylococcus and Haemophilus influenzae, which are thereby resistant. This interaction may be used therapeutically to produce higher and more prolonged blood concentrations of penicillin. Antibiotics in this group include the penicillins, monobactams, carbapenems and cephalosporins. Amoxicillin is somewhat more potent than ampicillin, penetrates tissues better and is given three rather than four times daily. Use Benzylpenicillin (penicillin G) is the drug of choice for streptococcal, pneumococcal, gonococcal and meningococcal infections, and is also useful for treatment of anthrax, diphtheria, gas gangrene, leptospirosis, syphilis, tetanus, yaws and Lyme disease in children. It is acid labile and so must be given parenterally (inactivated in gastric acid). Two preparations with similar antibacterial spectra are used to overcome the problems of acid lability/frequent injection: 1.