Vitamins are the group of organic compounds that can not be synthesized by our body but are essential for our body and must be supplied in the diet (exceptions are vitamin D is synthesized in our skin when exposed to sunlight and small and insufficient quantity of vitamin K is synthesized in the intestine by intestinal flora). Vitamins can not be synthesized but are essential nutrients for us. Vitamins are required by us in very small quantity and fall in the category of micronutrients.

Vitamins do not give us any calorie or energy but helps the body for utilizing other nutrients. Since our body is unable to synthesize vitamins (even if synthesized they are not sufficient), they must be supplied in our diet. A well balanced diet can provide us all the vitamins and other nutrients both major (proteins, fats and carbohydrates) and minor (vitamins, minerals and trace elements or trace minerals).

Vitamins are broadly divided into two groups:

Fat soluble vitamins:

This include vitamin A, D, E and K

Water soluble vitamins:

This include B complex group of vitamins and vitamin C. Vitamin B complex group include vitamin B1 or thiamin (thiamin is the first B complex vitamin to be discovered and named as B1), B2 or riboflavin, B3 or niacin, B6 or pyridoxine, B5 or pantothenic acid, folic acid and vitamin B12, the group also includes choline and flavoniods.

Each of the vitamins has one or more specific functions to perform and deficiency of any of the vitamins can lead to specific deficiency disease (except vitamin E, any deficiency disease is yet to be identified if it is there, but it helps in making the skin glow), e.g. deficiency of vitamin C leads to scurvy (very well known).

The minimum intake of vitamins per day has been determined but the daily optimum intake is still not clear and is still speculative. So the recommended daily allowance of vitamins is in speculative stage.

Image: piyaphantawong / FreeDigitalPhotos.net

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Enlarge Jeff Barnard/AP

Michele Pereira, who questions the schedule of mandatory vaccines, sat with her daughters, Evangeline, 6, right, and Genevieve, 2, at a park in Ashland, Ore., earlier this month.

Jeff Barnard/AP

Michele Pereira, who questions the schedule of mandatory vaccines, sat with her daughters, Evangeline, 6, right, and Genevieve, 2, at a park in Ashland, Ore., earlier this month.

Anxious parents sometimes ask the pediatrician if they can postpone vaccines for young children. And a new survey suggests quite a few doctors go along with the requests, despite standing recommendations they stick to a strict schedule.

In a survey of more than 200 pediatricians in Washington state, 61 percent of the doctors said they are OK with spacing out or delaying some vaccines. That approach flies in the face of the immunization schedule from the Centers for Disease Control and Prevention, the American Academy of Pediatrics and the American Academy of Family Physicians, which calls for each child to get 25 shots in the first 18 months of life.

The study was published in the journal Pediatrics.

There's abundant proof that vaccinations protect children from deadly diseases, such as polio, measles and pertussis. Some parents cringe when they see their 4-month-old getting five different shots at a well-baby visit. That inclination and worries about vaccine side effects has sparked interest in alternative immunization schedules that space the shots out.

Indeed, 1 in 10 parents say they've delayed or skipped some vaccines, according to a survey published in Pediatrics last month.

What's more, a new analysis by the Associated Press finds "that more than half of states have seen at least a slight rise in the rate of exemptions" from vaccine requirements for school attendance in the past five years. And in eight states, more than 1 in 20 kindergartners in public school aren't receiving all the required vaccines.

Exemption rates are highest in in the West and Upper Midwest. In Washington state, 6 percent of public school parents have opted out of vaccination, the AP reports.

There's no evidence that delaying or skipping vaccines benefits children's health. And recent outbreaks of measles among unvaccinated children are clear reminders of the dangers posed by infectious diseases.

The alternative vaccine schedule has been popularized by pediatrician Robert Sears, whose The Vaccine Book: Making the Right Decision for Your Child, was published in 2007.

Many of Sears' claims, such as the one that vaccines cause chronic disease, have no basis in science. Vaccine expert Dr. Paul Offitt rebutted the claims in a 2009 article in Pediatrics: "The Problem With Dr. Bob's Alternative Vaccine Schedule."

Still, as the latest survey shows, more than half of pediatricians said they are willing to try an alternative vaccination schedule if asked. Three-quarters of the doctors said they had been asked to do so. Almost all said the Sears book didn't influence their thinking on vaccine schedules.

The doctors were most likely to consider delaying hepatitis B; varicella (chickenpox), and polio for four months or more.

But the docters balked at delaying Hib, which prevents meningitis and pneumonia caused by a bacteria; pneumococcal immunization, which prevents pneumonia and ear infections; and DTaP, which protects against diphtheria, tetanus, and whooping cough.

What gives? The study authors suggest that doctors are engaged in a tricky balancing act. "Primary care physicians should be recognized for seeking to immunize their patients against common and devastating diseases of infancy while maintaining a therapeutic alliance with parents," the authors wrote.

In other words: We'll bend a bit so we don't alienate parents. But we're going to make darned sure kids get their shots.

When it comes to their own kids, 96 percent of the surveyed pediatricians said they would stick to the recommended vaccination schedule.

Health insurance doesn’t have to be expensive, and there are policies out there to suit all needs and budgets. Here are five important reasons why you should always shop around for a UK health insurance policy.

1) The NHS Postcode Lottery

The NHS Postcode Lottery describes the huge variation in the National Health Service (NHS) across the UK. Whilst some hospitals give fantastic service, others are performing badly.

Health insurance is designed to supplement the service provided by the NHS, so before shopping for health insurance you should research your local NHS hospital to see where it could improve. If it has long waiting lists for tests and scans, choose a health insurance policy which offers speedy diagnosis.

2) Customise your policy

Before you start looking for health insurance, make a list of the things you want covered and the things that are less important to you- are you interested in quick diagnosis, staying in a particular private hospital, or access to expensive cancer drugs?

Many insurers are now offering adaptable health insurance policies, which you can customise to suit your needs and budget. True health insurance comparison websites will show you all the options from each provider so you can make an informed choice.

3) Reduce your premiums

As with all insurance, your premiums will directly affect your level of cover. Cheap health insurance may seem like good value for money at the time, but you may not be covered for certain drugs and treatments in the future.

There are many ways you can reduce your premiums when purchasing health insurance without sacrificing on cover. Increasing your excess is an easy way of dramatically cutting costs. By choosing an excess of £200, you will pay a maximum of £200 towards your annual claims, and will have significantly lower monthly premiums.

4) Check the small print
Sometimes companies place a limit on the maximum amount they will pay out, particularly when it comes to cancer drugs. Customers might also be unaware that health insurers don’t cover certain procedures, like cosmetic surgery.

Before you purchase health insurance, make sure you are happy with the terms and conditions. If you are not satisfied with the small print, continue to shop around.

5) Beware of unethical companies

Searching through health insurance policies can often be complicated. Comparison websites are an easy way to find a health insurance quote in minutes. However, there are many companies out there who will simply take your personal details and sell them on.

True health insurance comparison websites will be FSA regulated, with a registration number at the bottom of their homepage. These companies should also offer a demonstration of the comparison service they provide.

This is a guest post by Chloe, who writes on health insurance for www.activequote.com, the true health insurance comparison website in the UK.

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Enlarge iStockphoto.com

Right this way, ladies and germs.

iStockphoto.com

Right this way, ladies and germs.

Turns out Howard Hughes was right. The world is a very germy place, especially public restrooms.

The reclusive billionaire, who had the world's most notorious case of so-called germophobia, would go to just about any length to avoid contamination. He wore tissue boxes on his feet. He burned his clothing if someone near him got sick. He wrote careful instructions to his staff on how to open a can of peaches without contaminating them.

And now a study funded in part by his legacy foundation, the Howard Hughes Medical Institute, provides what may be one of the most thorough assessments so far of the germs that lurk in public restrooms.

Researchers swabbed surfaces in a dozen public johns on the University of Colorado campus in Boulder. They came up with 19 different bacterial phyla, or types.

Some came from soil tracked in on people's shoes. Some of those germs ended up on flush handles, probably because some cautious people used their feet to push down on the handles. But the source of the vast majority of the bacteria was human skin.

Now, it's hardly a surprise that restrooms are full of germs. But this study, which appears in the online journal PLoS-ONE (the acronym stands for Public Library of Science), adds two types of granularity to the "biogeography" of public restrooms, as the scientists term it.

First, previous studies relied on the ability of researchers to culture, or grow bacteria from collected samples. And most microorganisms are not easily cultivated. So the new study, which uses so-called bar-coding of a gene common to viritually all bacteria, gives a more complete picture of the highly diverse types of bacteria lurking in these common spaces.

Second, by tracking the types of bacteria found on different surfaces, the study gives a more complete â€" and disturbing â€" picture of how germs spread all over the place. A restroom user can hardly avoid contacting contaminated surfaces.

As study authors put it, bacterial types associated with human skin, such as staph and strep bacteria, "were abundant on all surfaces."

The surfaces sampled included door handles (into and out of the restroom), stall handles (inside and out), toilet seats, flush handles, faucets, soap dispensers and the floor around the sink. (Ever put your bag on the floor while you washed your hands? I thought so.)

Restroom bacteria cluster in three different communities, the researchers say: those on toilet surfaces, those on the floor and those on door handles and hand-washing appliances.

Those around the toilet were types that live in the human gut, "suggesting fecal contamination of these surfaces...either via direct contact (with feces or unclean hands), or indirectly as a toilet is flushed and water splashes or is aerosolized."

Yes, I know, very unappealing. But I thought you should know.

Interestingly, at least for some people, there was a somewhat different mix of bacteria in women's restrooms compared to men's. Some were germs that prefer female genital tracts.

The bottom line â€" er, grand conclusion â€" is that "routine use of toilets results in the dispersal of urine- and fecal-associated bacteria throughout the restroom."

So wash your hands thoroughly, for Pete's sake! And when you do, try to avoid recontaminating them as you leave.

Addendum: It's possible these particular University of Colorado restrooms were dirtier than most. "Previous studies have documented that college students...are not always the most diligent of hand-washers," the study notes.

But you never know.

Health insurance doesn’t have to be expensive, and there are policies out there to suit all needs and budgets. Here are five important reasons why you should always shop around for a UK health insurance policy.

1) The NHS Postcode Lottery

The NHS Postcode Lottery describes the huge variation in the National Health Service (NHS) across the UK. Whilst some hospitals give fantastic service, others are performing badly.

Health insurance is designed to supplement the service provided by the NHS, so before shopping for health insurance you should research your local NHS hospital to see where it could improve. If it has long waiting lists for tests and scans, choose a health insurance policy which offers speedy diagnosis.

2) Customise your policy

Before you start looking for health insurance, make a list of the things you want covered and the things that are less important to you- are you interested in quick diagnosis, staying in a particular private hospital, or access to expensive cancer drugs?

Many insurers are now offering adaptable health insurance policies, which you can customise to suit your needs and budget. True health insurance comparison websites will show you all the options from each provider so you can make an informed choice.

3) Reduce your premiums

As with all insurance, your premiums will directly affect your level of cover. Cheap health insurance may seem like good value for money at the time, but you may not be covered for certain drugs and treatments in the future.

There are many ways you can reduce your premiums when purchasing health insurance without sacrificing on cover. Increasing your excess is an easy way of dramatically cutting costs. By choosing an excess of £200, you will pay a maximum of £200 towards your annual claims, and will have significantly lower monthly premiums.

4) Check the small print
Sometimes companies place a limit on the maximum amount they will pay out, particularly when it comes to cancer drugs. Customers might also be unaware that health insurers don’t cover certain procedures, like cosmetic surgery.

Before you purchase health insurance, make sure you are happy with the terms and conditions. If you are not satisfied with the small print, continue to shop around.

5) Beware of unethical companies

Searching through health insurance policies can often be complicated. Comparison websites are an easy way to find a health insurance quote in minutes. However, there are many companies out there who will simply take your personal details and sell them on.

True health insurance comparison websites will be FSA regulated, with a registration number at the bottom of their homepage. These companies should also offer a demonstration of the comparison service they provide.

This is a guest post by Chloe, who writes on health insurance for www.activequote.com, the true health insurance comparison website in the UK.

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Why you should have Health Insurance?

Are you planning to buy Health Insurance?

Should You Buy Travel Insurance?

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Emergency Loans in Health Care

Health Reasons of Quitting Smoking

Find a Doctor Online

Enlarge iStockphoto.com

Right this way, ladies and germs.

iStockphoto.com

Right this way, ladies and germs.

Turns out Howard Hughes was right. The world is a very germy place, especially public restrooms.

The reclusive billionaire, who had the world's most notorious case of so-called germophobia, would go to just about any length to avoid contamination. He wore tissue boxes on his feet. He burned his clothing if someone near him got sick. He wrote careful instructions to his staff on how to open a can of peaches without contaminating them.

And now a study funded in part by his legacy foundation, the Howard Hughes Medical Institute, provides what may be one of the most thorough assessments so far of the germs that lurk in public restrooms.

Researchers swabbed surfaces in a dozen public johns on the University of Colorado campus in Boulder. They came up with 19 different bacterial phyla, or types.

Some came from soil tracked in on people's shoes. Some of those germs ended up on flush handles, probably because some cautious people used their feet to push down on the handles. But the source of the vast majority of the bacteria was human skin.

Now, it's hardly a surprise that restrooms are full of germs. But this study, which appears in the online journal PLoS-ONE (the acronym stands for Public Library of Science), adds two types of granularity to the "biogeography" of public restrooms, as the scientists term it.

First, previous studies relied on the ability of researchers to culture, or grow bacteria from collected samples. And most microorganisms are not easily cultivated. So the new study, which uses so-called bar-coding of a gene common to viritually all bacteria, gives a more complete picture of the highly diverse types of bacteria lurking in these common spaces.

Second, by tracking the types of bacteria found on different surfaces, the study gives a more complete â€" and disturbing â€" picture of how germs spread all over the place. A restroom user can hardly avoid contacting contaminated surfaces.

As study authors put it, bacterial types associated with human skin, such as staph and strep bacteria, "were abundant on all surfaces."

The surfaces sampled included door handles (into and out of the restroom), stall handles (inside and out), toilet seats, flush handles, faucets, soap dispensers and the floor around the sink. (Ever put your bag on the floor while you washed your hands? I thought so.)

Restroom bacteria cluster in three different communities, the researchers say: those on toilet surfaces, those on the floor and those on door handles and hand-washing appliances.

Those around the toilet were types that live in the human gut, "suggesting fecal contamination of these surfaces...either via direct contact (with feces or unclean hands), or indirectly as a toilet is flushed and water splashes or is aerosolized."

Yes, I know, very unappealing. But I thought you should know.

Interestingly, at least for some people, there was a somewhat different mix of bacteria in women's restrooms compared to men's. Some were germs that prefer female genital tracts.

The bottom line â€" er, grand conclusion â€" is that "routine use of toilets results in the dispersal of urine- and fecal-associated bacteria throughout the restroom."

So wash your hands thoroughly, for Pete's sake! And when you do, try to avoid recontaminating them as you leave.

Addendum: It's possible these particular University of Colorado restrooms were dirtier than most. "Previous studies have documented that college students...are not always the most diligent of hand-washers," the study notes.

But you never know.

Health insurance doesn’t have to be expensive, and there are policies out there to suit all needs and budgets. Here are five important reasons why you should always shop around for a UK health insurance policy.

1) The NHS Postcode Lottery

The NHS Postcode Lottery describes the huge variation in the National Health Service (NHS) across the UK. Whilst some hospitals give fantastic service, others are performing badly.

Health insurance is designed to supplement the service provided by the NHS, so before shopping for health insurance you should research your local NHS hospital to see where it could improve. If it has long waiting lists for tests and scans, choose a health insurance policy which offers speedy diagnosis.

2) Customise your policy

Before you start looking for health insurance, make a list of the things you want covered and the things that are less important to you- are you interested in quick diagnosis, staying in a particular private hospital, or access to expensive cancer drugs?

Many insurers are now offering adaptable health insurance policies, which you can customise to suit your needs and budget. True health insurance comparison websites will show you all the options from each provider so you can make an informed choice.

3) Reduce your premiums

As with all insurance, your premiums will directly affect your level of cover. Cheap health insurance may seem like good value for money at the time, but you may not be covered for certain drugs and treatments in the future.

There are many ways you can reduce your premiums when purchasing health insurance without sacrificing on cover. Increasing your excess is an easy way of dramatically cutting costs. By choosing an excess of £200, you will pay a maximum of £200 towards your annual claims, and will have significantly lower monthly premiums.

4) Check the small print
Sometimes companies place a limit on the maximum amount they will pay out, particularly when it comes to cancer drugs. Customers might also be unaware that health insurers don’t cover certain procedures, like cosmetic surgery.

Before you purchase health insurance, make sure you are happy with the terms and conditions. If you are not satisfied with the small print, continue to shop around.

5) Beware of unethical companies

Searching through health insurance policies can often be complicated. Comparison websites are an easy way to find a health insurance quote in minutes. However, there are many companies out there who will simply take your personal details and sell them on.

True health insurance comparison websites will be FSA regulated, with a registration number at the bottom of their homepage. These companies should also offer a demonstration of the comparison service they provide.

This is a guest post by Chloe, who writes on health insurance for www.activequote.com, the true health insurance comparison website in the UK.

Related posts:

How to get Affordable Health Insurance?

Health Insurance for Visitors

Why you should have Health Insurance?

Are you planning to buy Health Insurance?

Should You Buy Travel Insurance?

Going for a Trip? Did you Buy Travel Insurance?

Importance of Travel Insurance

Emergency Loans in Health Care

Health Reasons of Quitting Smoking

Find a Doctor Online

Narcotic painkillers are among the most commonly prescribed drugs in the U.S., with more than 244 million prescriptions dispensed in 2010.

The drugs help ease the pain of tens of millions of people each year. But the potent narcotics also carry serious risks that can be heightened by chronic use or abuse.

So-called pill mills have drawn fire for enabling abuse of such drugs as Oxycontin and Vicodin. And some prominent doctors have called for a re-think of narcotics to treat chronic pain, citing a lack of evidence for that practice and serious problems with misuse.

In the latest NPR-Thomson Reuters Health Poll, we asked Americans about their experience with narcotic painkillers and their views about the drugs. Half the respondents said they had been prescribed a narcotic painkiller at least once. More than three-quarters said the drugs are linked to addiction.

 

Among those who said they'd received a painkiller, about 31 percent said they'd received a medicine to relieve chronic pain. Some 88 percent said they'd been prescribed a narcotic to help with acute pain caused by such things as injuries and surgery. (Some people had been prescribed narcotics for both types of pain.)

A little more than a third of respondents who have used they medicines said they had concerns about them. The top issues were side effects (45 percent) and fear of addiction (27 percent).

About 30 percent of those who said they hadn't used the painkillers said they had concerns about them. The fear of addiction was the top worry (38 percent) followed by narcotics' association with drug abuse (25 percent).

Finally, 31 percent of people polled said they'd questioned or refused a doctor's recommendation of painkillers.

Since the discovery of narcotic painkillers, "there's been a swinging pendulum" of opinion about them, said Dr. Gregory Terman, a professor of anesthesiology at the University of Washington School of Medicine. At one extreme people are afraid of the drugs, he told Shots, and at the other people see them as a panacea.

"All medications have side effects, and it sound like the people who have used the medication are very aware of the side effects," he said of the poll's findings.

Addiction is a legitimate concern, he said, but it's "a side effect that affects a small fraction of people" who have a predisposition for abuse or develop a preference for recreational use of the drugs.

He stressed the importance of keeping the "medications in the hands of patients who are doing better" because of them while minimizing the diversion of the drugs for misuse and abuse.

The telephone poll was conducted during the first half of October. The margin for error is plus or minus 1.8 percentage points. Click here to read the questions and full results. You can find the previous polls here.

Prediabetes is a condition where blood glucose level is higher than normal but not high enough to diagnose it as diabetes. Studies has shown that majority of prediabetics develop type-2 diabetes within 10 years. It is therefore important to find out if you are prediabetics, because it is possible to delay/prevent development of type-2 diabetes if proper preventive measures are taken.

Why should I know if I have prediabetes?

The simple reason for knowing if you have prediabetes is that, majority of prediabetics will develop type-2 diabetes within 10 years and it is possible to delay/prevent development of diabetes from prediabetes by taking appropriate measures such as lifestyle modification (daily physical exercise of approximately 30 minutes), adopting healthy eating habits with lots of fresh fruits and vegetables. If you know you have prediabetes you can take measures to prevent diabetes. There are also some oral hypoglycemic drugs which can help in preventing diabetes.

Should I get tested for prediabetes?

Everybody does not need to get tested for prediabetes. Test for prediabetes is generally recommended if you are overweight/obese and above 45 years of age. You also need to be tested for prediabetes if you have any risk factors of developing diabetes, such as family history of diabetes, if you are a female and gave birth to a large baby, you belong to some ethnic group with high prevalence of diabetes, unfavorable lipid profile (high LDL or low density lipoprotein and low HDL or high density lipoprotein) etc. So, next time when you go for routine medical check up, ask your doctor if you need to get tested for prediabetes/diabetes.

Can I have prediabetes if I do not have any risk factors mentioned above?

Yes, you can have prediabetes or even diabetes without having any of the risk factors mentioned above. Because prediabetes do not suffer from any symptoms and some diabetes (especially in early stage) also may not have any symptoms. Sometimes five years or more may lapse before diabetes is diagnosed and the disease may have already progressed and started causing complications.

How prediabetes is diagnosed?

It is diagnosed by any of the three methods, namely (1) Fasting plasma glucose test, (2) oral glucose tolerance test or OGTT and (3) by testing hemoglobin A1C.

What is the treatment for prediabetes?

The treatment for prediabetes is mainly aimed at preventing/delaying development of type-2 diabetes. Regular physical exercise such as brisk walking for 30 minutes a day, 5 days a week is recommended. Change your dietary habits (and have diet for diabetes) to include more fresh fruits and vegetables. Exercise and diet will help reduce body weight if you are obese or overweight. Weight loss of 5-10% can make a huge difference.

Image: vitasamb2001 / FreeDigitalPhotos.net

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NIDA

Research that found a third of popular songs contain drug references, led to headlines like, "Study: Music Has Drug References, Pope Is Catholic" a few years back.

Drugs and music. The two just seem to go together. Often, though, in a more tragic way than artists would like to let on. Compare Amy Winehouse's defiant lyrics to her reality: the singer who said "no, no, no" to rehab lost her very public struggle with alcohol last summer.

There are countless other examples. But some artists and organizations aren't content with the status quo.

The National Institute on Drug Abuse has teamed up with MusiCares and the Grammy Foundation to sponsor a music contest to raise teen awareness of substance abuse.

 

Young songwriters submit original compositions that either celebrate a healthful lifestyle or accurately depict drug abuse.

The result is a series of honest, heartbreaking and hopeful songs from young people whose lives had been altered by substance abuse and addiction.

Unlike motivational speakers and celebrities, who have usually already slain their demons and are talking about their drug use in retrospect, these young people are sharing their stories from the thick of things.

When the winners were named recently, the top songwriting team was identified only as Harvie and Amanda. Both are currently in treatment, and their full names won't be released until they finish their program.

"The winning song reflects the hope that treatment brings, especially to young people who have so much potential to change their life course," NIDA Director Nora Volkow said in a statement. "This songwriting team brought incredible emotion to their personal journey that hopefully will encourage others to seek treatment for substance abuse problems."

Kevin Simmons, who took second place, also wrote his composition during a stay in a rehabilitation center. His rap number My Life chronicles a drug habit that started in fifth grade and landed Simmons in both jail and rehab by the time he was in high school.

Creative endeavors can be an important outlet for those trying to overcome an addiction, and the strategy also works for those dealing with a loved one's addiction.

Fifteen-year-old Grant Davis has been involved in music for 5 years. He took up singing when his sister's drug use started taking over his family life. "I needed a way to cope," Davis told Shots.

Last year, he tried his hand at songwriting. His first effort, "Just a Child" won third place in this year's contest.

Davis said that before he wrote the song, he was struggling to understand his sister's addiction and why she couldn't just get better. The song was an exercise in seeing things from her point of view and realizing how much of a battle she faced.

The song became a collaborative project, with many members of the family and others who knew Davis' sister contributing and shaping the lyrics. As he asked for help with his musical endeavor, Davis was also reaching out to his family and friends and opening up more communication between them. "It was my first real song," Davis told Shots. "I wanted to make sure that it was good enough for me and for my sister."

When asked about the message behind his song, Davis said "drugs take away your dreams and take all control. You have no choice any longer."

His advice to other teens? It's important to find an expressive outlet, a way to cope with substance abuse, whether it's your own, or that of a family member. "It's a place where you can find peace," Davis said of music.

All the contest winners will get to go backstage during the rehearsals for the Grammy awards next February, and their songs will be aired on various websites including Grammy 365, MTV, and the Above the Influence Campaign.

Vitamin A is widely distributed among animal and plant sources of our food. In animal foods vitamin A is present as preformed vitamin A (retinol) and in plant foods vitamin A is present as provitamin (carotenes, such as beta carotene).

The vitamin A value of food is expressed as retinol activity equivalent (RAE). One RAE is equivalent of 1 mcg (microgram) of retinol, 12 mcg of beta carotene, and 24 mcg of other provitamin-A carotenoids.

Animal Sources of Vitamin A:

Liver, egg and fish are excellent source of vitamin A (preformed vitamin A). Other rich sources of vitamin A of animal origin include butter, cheese, meat etc. The richest natural source of vitamin A is fish liver oil (cod liver oil, halibut liver oil etc.), but fish liver oil is generally used as dietary supplement for vitamin A deficiency, rather than as diet or food source of vitamin A. Presence of fat in the diet aid absorption of vitamin A as it is fat soluble vitamin.

Plant Sources of Vitamin A:

Very cheap and rich plant source of vitamin A are green leafy vegetables such as spinach, amaranth, cabbage etc. Other rich plant sources of vitamin A include colored vegetables (tomato, pumpkin, carrots, beet root etc.) and fruits like papaya, orange, mango, pineapple, brown grapes etc. The darker the vegetable generally the better is the vitamin A content of the vegetable. Moderate cooking of vegetables enhances carotenoid release for uptake in the gut and help in absorption of vitamin from gut due to higher availability.

Fortified Foods for Vitamin A:

Foods fortified with vitamin A are also very important sources of vitamin A. Vitamin A fortification of foods is done for providing adequate (recommended amount) vitamin A to general population. Food fortification (with vitamin A) is done for milk, cooking oils, ghee, butter etc.

Some foods with vitamin A content in micrograms/100 gram:

• Halibut liver oil- 900,000 mcg/100 grams
• Cod liver oil- 18,000 mcg/100 grams
• Liver (beef) â€" 16,500 mcg/100 grams
• Egg- 140 mcg/100 grams
• Butter- 825 mcg/100 grams
• Cheese- 350 mcg/100 grams
• Milk (cow) â€" 38 mcg/100 grams
• Fish- 40 mcg/100 grams
• Carrot- 1167 mcg/100 grams
• Spinach- 607 mcg/100 grams
• Green leaves- 300 mcg/100 grams
• Amaranth- 515 mcg/100 grams
• Tomato- 84 mcg/100 grams
• Mango- 313 mcg/100 grams
• Orange- 25 mcg/100 grams

The liver is the store house for vitamin A in humans and other animals, so liver is a rich source of vitamin A. Vitamin A is stored in liver in the form of retinol palmitate. In normal person the store in liver can supply vitamin A requirement for 6-9 months or more. So in general vitamin deficiency means, it is long term deficiency.

Image: luigi diamanti / FreeDigitalPhotos.net

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Enlarge Keith Weller/Courtesy of Johns Hopkins Medicine

Striking a pose like Hamlet, Kofi Boahene, a surgeon at Johns Hopkins Hospital, peers through the natural opening under the cheekbone and above the jaw that he uses for surgery.

Keith Weller/Courtesy of Johns Hopkins Medicine

Striking a pose like Hamlet, Kofi Boahene, a surgeon at Johns Hopkins Hospital, peers through the natural opening under the cheekbone and above the jaw that he uses for surgery.

Add minimally invasive surgery through an opening between the cheek and jaw to the list of procedures I'm happy exist and that I hope I'll never have to endure.

A Johns Hopkins surgeon who is pretty handy with an endoscope has figured out how to operate in some hard-to-reach spots at the base of the skull through a natural opening that's above the jawbone, behind the back teeth and just below the cheekbone.

It requires a small incision inside the cheek, sure, but that's no biggie, really.

 

Dr. Kofi Boahene, an assistant professor of facial plastic and reconstructive surgery at Hopkins, has tried the technique in a handful of patients. The results from four cases were described in the journal The Laryngoscope last month.

The base of the skull is a tough place for an operation because of all the nerves and blood vessels there. The usual approach to removing tumors or dealing with other problems in the infratemporal fossa and parapharyngeal space, if you're interested in the particulars, is invasive and can be disfiguring.

The new, endoscopic technique seems pretty slick but also a little tricky. Can other surgeons do it? I emailed Boahene about that. He replied: "The procedure can be widely done. I have already taught another surgeon in another hospital who has done one case."

So far the patients have fared well. One patient had temporary trouble swallowing after the operation, another had some numbness in the lower lip that soon went away, the recently published paper says. The other two patients had no reported complications.

Next month, the approach will be taught to more surgeons at a Hopkins conference. "The surgical skill set required for this can be made widely available quickly," Boahene wrote. His peers already have the equipment and comfortable using it, he added.

Discovery of ORS (oral rehydration salt or solution) is one of the greatest discoveries in the field of medical science in recent time. It has saved (still saving and will continue to save) more lives than any other medicine (e.g. penicillin). Discovery of penicillin is considered one of the greatest discoveries of medical science, but simple ORS has saved more lives than penicillin. Every year ORS is saving millions of lives (infants, children and adults alike) around the world, especially in developing countries.

Diarrhea is responsible for mortality, morbidity, social inconvenience, loss of work productivity, and consumption of medical resources of all nations. More than one billion individuals are affected by one or more episodes of diarrhea worldwide every year. It is estimated that globally (mostly in developing countries) approximately 3 million deaths occur due to diarrhea every year, mostly children and infants. But a greater (>3 million) number of deaths are averted by use of ORS in developing countries, which is cheap, easily available and can even be made at home with available ingredients (homemade ORS).

When ORS should be used?

ORS should be used in case of mild to moderate dehydration. If fluid loss due to diarrhea (sometimes due to vomiting also) is 5% to 7% of body weight, it is considered mild dehydration and fluid loss of 7% to 10% of body weight is moderate dehydration. Fluid loss of more than 10% (severe dehydration) needs treatment with intravenous fluid. For example, if body weight of a baby is 10 kilo, loss of 500 ml of body fluid is 5% fluid loss. Ideally correction of dehydration should start from the beginning of diarrhea.

How much ORS should be used for treatment?

The aim of treatment (correction of dehydration) with ORS is to replace the lost body fluid in 2 to 4 hours. For example if a baby has body weight of 10 kilo and has mild dehydration (loss of approximately 5% fluid), the lost fluid i.e. approximately 500 ml (5% of 10 kilo) should be replaced in 2 to 4 hours. In simple words, 500 ml of ORS should be given to the baby in 2 to 4 hours.

Babies should be given ORS every 10-15 minutes with spoon. Thirst due to lost fluid provides adequate driving force for the baby to drink ORS. Once the lost fluid is replaced, it can be left to demand of the baby (patient), but it should cover at least the fluid lost due to diarrhea.

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Principles of Management of Acute Diarrhea

Treatment of Rotavirus Diarrhea

Treat Acute Diarrhea Promptly

Few Important Aspects about Rota Virus

The Global Burden of Diarrhea

Some Important Questions About Rotavirus

What are the Symptoms of rotavirus infection?

Dietary Advice for Diarrhea

Treat and Prevent Rotavirus Diarrhea at home

Diet Plan for Diarrhea

Enlarge George Heyer/Three Lions/Getty Images

A nurse burps a baby after he's been fed, circa 1955. Doctors say that for babies with extreme reflux, off-label use of heartburn drugs can sometimes help. But frequently changes to the mother's diet can be a simpler fix.

George Heyer/Three Lions/Getty Images

A nurse burps a baby after he's been fed, circa 1955. Doctors say that for babies with extreme reflux, off-label use of heartburn drugs can sometimes help. But frequently changes to the mother's diet can be a simpler fix.

Babies have been crying and spitting up since time immemorial. But these days many parents ask: Isn't there a drug for that?

"Parents come in often demanding medication" says Eric Hassall, a pediatric gastroenterologist at Sutter Pacific Medical Foundation in San Francisco.

Prescriptions for acid-suppressing medicines for infants have increased dramatically. Hassall says some parents have picked up on the idea that heavily advertised medicines for reflux in adults can help fussy babies who spit up a lot.

 

He documented a 16-fold increase in prescriptions of one proton pump inhibitor, or PPI, Prevacid, which comes in a child-friendly formulation. A Food and Drug Administration review also found an 11-fold increase in number of new prescriptions dispensed between 2002 and 2009.

These medicines aren't approved for infants with reflux, or GERD. Still, some doctors have been prescribing them off-label anyway. Doctors generally agree this practice is OK when babies really need the medicine, such as when they're spitting up so much they're not gaining weight.

"The great majority of infants spit up and cry" says Hassall. "But very, very few of them actually have reflux disease and deserve medication." Hassall has researched the effectiveness of the drugs and he has received clinical study grants from AstraZeneca, the maker of the popular acid-suppressing medicine Nexium.

The results of four clinical trials show that these medicines work no better than a placebo in treating infants with reflux. "My point is that there hasn't been a sudden 16-fold increase in the incidence of reflux disease" says Hassall. "It hasn't suddenly become the scourge of otherwise healthy infants."

Hassall recommends dietary changes to the parents of inconsolable babies who spit up after feedings. This strategy has helped many of his patients, including Tara Cree of Vancouver, B.C., who had a rough go with her daughter.

"She was incredibly irritable" recalls Cree. "There was a lot of crying and it just didn't seem right."

The worst of it came just after breast-feedings. When she described the symptoms to Hassall, he told Cree to change her diet to remove certain proteins from her breast-milk.

"So I eliminated dairy, soy and wheat from my diet," Cree says. It was a radical change, since almost all processed foods include some diary, soy or wheat. But she stuck with it because it was so effective. "By day 3 or 4 [of the diet] she was a different baby," says Cree.

Now, not every baby will get the same relief from a mother's diet change, or by switching to a non-dairy baby formula. But Hassall says it's a good approach to try before turning to medication.

Specialists in pediatric gastroenterology have guidelines to help educate pediatricians and families on the treatment of reflux. "There are infants who do benefit from these drugs." says Benjamin Gold, a gastroenterologist in Atlanta, Ga., who has been a paid consultant to AstraZeneca. "It's a small proportion," he says.

But he says with all the discussion about the escalation in prescriptions, he says he doesn't want parents to get the wrong message. "We have to be careful that we don't swing the pendulum back the other way by saying, 'Oh, these drugs are all bad.' "

Gold says what's needed are better diagnostic tools to determine which babies truly need the medicine â€" and that will require more research. For now, he says sometimes you have to try a baby on the medicine.

"The problem is we can't determine [in advance] which children are going to benefit and which are not," Gold says.

Advisers to the FDA have been looking at this issue. They say the limited data in infants suggest the medicines are fairly safe, but there are reports of intestinal inflammation and one study found a slightly increased risk of pneumonia.

The upshot, according to the their review, is that the medicines should be reserved for infants who've been diagnosed with serous problems, such as erosive esophagitis â€" a condition that afflicts relatively few babies.