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By Q. Kan. Berklee College of Music.

A systematic review concluded that the discrepancy in the findings may be a result of differences in the populations studied geriforte syrup 100 caps online, with only high-risk individuals benefiting from increasing their fish consumption (55) order geriforte syrup 100 caps amex. It was estimated that in high-risk populations cheap geriforte syrup 100caps with mastercard, an optimum fish consumption of 40--60 g per day would lead to approximately a 50% reduction in death from coronary heart disease. In a diet and reinfarction trial, 2-year mortality was reduced by 29% in survivors of a first myocardial infarction in persons receiving advice to consume fatty fish at least twice a week (56). Several large epidemiological studies have demonstrated that frequent consumption of nuts was associated with decreased risk of coronary heart disease (58, 59). Most of these studies considered nuts as a group, combining many different types of nuts. Nuts are high in unsaturated fatty acids and low in saturated fats, and contribute to cholesterol lowering by altering the fatty acid profile of the diet as a whole. However, because of the high energy content of nuts, advice to include them in the diet must be tempered in accordance with the desired energy balance. Several trials indicate that soy has a beneficial effect on plasma lipids (60, 61). Soy is rich in isoflavones, compounds that are structurally and functionally similar to estrogen. Several animal experiments suggest that the intake of these isoflavones may provide protection against coronary heart disease, but human data on efficacy and safety are still awaited. There is convincing evidence that low to moderate alcohol consumption lowers the risk of coronary heart disease. In a systematic review of ecological, case--control and cohort studies in which specific associations were available between risk of coronary heart-disease and consumption of beer, wine and spirits, it was found that all alcoholic drinks are linked with lower risk (63). However, other cardiovascular and health risks associated with alcohol do not favour a general recommendation for its use. The amount of cafestol in the cup depends on the brewing method: it is zero for paper-filtered drip coffee, and high in the unfiltered coffee still widely drunk in, for example, in Greece, the Middle East and Turkey. Intake of large amounts of unfiltered coffee markedly raises serum cholesterol and has been associated with coronary heart disease in Norway (64). A shift from unfiltered, boiled coffee to filtered coffee has contributed significantly to the decline in serum cholesterol in Finland (65). Fats Dietary intake of fats strongly influences the risk of cardiovascular diseases such as coronary heart disease and stroke, through effects on 87 blood lipids, thrombosis, blood pressure, arterial (endothelial) function, arrythmogenesis and inflammation. However, the qualitative composi- tion of fats in the diet has a significant role to play in modifying this risk. The evidence shows that intake of saturated fatty acids is directly related to cardiovascular risk. The traditional target is to restrict the intake of saturated fatty acids to less than 10%, of daily energy intake and less than 7% for high-risk groups. If populations are consuming less than 10%, they should not increase that level of intake. Within these limits, intake of foods rich in myristic and palmitic acids should be replaced by fats with a lower content of these particular fatty acids. The amount and quality of fat supply has to be considered keeping in mind the need to meet energy requirements. Specific sources of saturated fat, such as coconut and palm oil, provide low-cost energy and may be an important source of energy for the poor. This implies that the fatty acid composition of the fat source 88 shouldbeexamined. Aspopulationsprogressinthenutritiontransitionand energy excess becomes a potential problem, restricting certain fatty acids becomes progressively more relevant to ensuring cardiovascular health. To promote cardiovascular health, diets should provide a very low intake of trans fatty acids (hydrogenated oils and fats). This recommendation is especially relevant in developing countries where low-cost hydrogenated fat is frequently consumed. The potential effect of human consumption of hydrogenated oils of unknown physiological effects (e. Intake of oleic acid, a monounsaturated fatty acid, should make up the rest of the daily energy intake from fats, to give a daily total fat intake ranging from 15% up to 30% of daily energy intake. Recommendations for total fat intake may be based on current levels of population consumption in different regions and modified to take account of age, activity and ideal body weight. Where obesity is prevalent, for example, an intake in the lower part of the range is preferable in order to achieve a lower energy intake. It should be noted that highly active groups with diets rich in vegetables, legumes, fruits and wholegrain cereals will limit the risk of unhealthy weight gain on a diet comprising a total fat intake of up to 35%. These dietary goals can be met by limiting the intake of fat from dairy and meat sources, avoiding the use of hydrogenated oils and fats in cooking and manufacture of food products, using appropriate edible vegetable oils in small amounts, and ensuring a regular intake of fish (one to two times per week) or plant sources of a-linolenic acid. Preference should be given to food preparation practices that employ non-frying methods. Fruits and vegetables Fruits and vegetables contribute to cardiovascular health through the variety of phytonutrients, potassium and fibre that they contain. Daily intake of fresh fruit and vegetables (including berries, green leafy and cruciferous vegetables and legumes), in an adequate quantity (400-- 500 g per day), is recommended to reduce the risk of coronary heart disease, stroke and high blood pressure. Limitation of dietary sodium intake to meet these goals should be achieved by restricting daily salt (sodium chloride) intake to less than 5 g per day. This should take into account total sodium intake from all dietary sources, for example additives such as monosodium glutamate and preservatives.

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These views require moving the quire additional images particularly in large patients cheap geriforte syrup 100 caps on-line. In injured shoulder rather than the patient generic geriforte syrup 100caps amex, and are some- the case of paired long bones (the leg or forearm) generic geriforte syrup 100caps visa, the de- times difficult to obtain. They are more readily obtained tection of the fracture of a single bone should always by technologists than scapular-Y views. Sternoclavicular dislocations la as well as the precise location of the humeral head with may be anterior or posterior; of these, posterior disloca- respect to the glenoid. Fractures of the scapula, which Elbow may extend to the glenoid process and become intra-ar- ticular, are commonly seen in younger patients who have Conventional radiographic imaging of the elbow should sustained severe trauma. Displacement and elevation of these fat pads is a reliable Dislocations occurring commonly at the shoulder in- sign of intra-articular fluid. In the setting of trauma, the clude acromioclavicular joint separations; these may re- presence of displaced anterior and posterior fat pads at quire stress radiographs when initial images show no sep- the elbow should be considered presumptive evidence of aration at the acromioclavicular joint. Comminuted fractures of the radial neck may be determine the appropriate alignment. The coracoclavicu- associated with radial shortening and malalignment at the lar distance may be assessed by comparison to the oppo- distal radial ulnar joint. These may be associated with fractures of the Fractures of the coronoid process of the ulna are an- greater tuberosity or with compression fractures of the other common fracture at the elbow. These are almost al- posterolateral aspect of the humeral head (Hill-Sachs de- ways seen in association with or following posterior dis- formity). Fractures of the olecranon are of- (bony Bankart deformity) may also be identified; these ten displaced and readily identified, but some olecranon are best seen on axillary views of the shoulder. Knowledge of the normal rela- ly missed; it is estimated that nearly half are missed on tionship of the anterior cortex of the humerus to the the initial evaluation. A line drawn along the ante- illary view, or scapular-Y view facilitates diagnosis. On the in- sects the anterior third of the condyle, there may be a pos- ternal and external views, a clue may arise from the fact teriorly displaced supracondylar fracture. Fractures of the that the technologist is unable to obtain images in exter- lateral condyle and medial epicondyle are also common. Compression fractures of the anteromedial The most common dislocation of the adult elbow is the aspect of the humeral head are found in association with posterior dislocation. These are usually quite obvious and posterior dislocations, analogous to the Hill-Sachs defect not difficult to diagnose. These compression de- the Monteggia fracture-dislocation, in which an angulat- formities of the anteromedial aspect of the humeral head ed or displaced fracture of the proximal ulna is associat- present as a trough in the humeral head and are often best ed with a radial head dislocation. A line tremely valuable to determine that a dislocation is present drawn along the long axis of the radial neck should in- and to assess fracture of the humeral head. The history tersect the capitellum in every projection (radio-capitel- may be helpful in patients with posterior dislocations, lar line). Dislocations at the wrist include perilunate and lu- Radiographic examination of the wrist usually consists of nate dislocations. Additional views, including angle views of the trans-scaphoid perilunate dislocation). Virtually all per- scaphoid (with ulnar deviation), a “clenched fist” view, ilunate dislocations are dorsal. Lunate dislocations, in and carpal tunnel views, may be helpful in specific situ- contrast, are virtually all volar in direction and are rarely ations. Recently, a semisupinated oblique view was rec- seen in association with other fractures at the wrist. Scapho-lunate dissociation (rotary subluxation of the The most common fracture at the wrist in the adult scaphoid) results in abnormal rotation of the scaphoid population is the Colles fracture, which is much more fre- and is due to a disruption in the scapho-lunate and volar quent in elderly women than in men. This may occur alone or be part of oth- is a resultant dorsal tilt to the distal radial articular sur- er more complex injuries about the lunate axis [7]. Subtle injuries may be difficult to detect when dis- The Galeazzi fracture is a fracture is of the distal radi- placement is minimal; these may be recognized only by al shaft associated with a dislocation at the distal radial the loss of the normal volar tilt to the distal radial artic- ulnar joint (i. Fractures of the distal radius are frequently Isolated dislocations at the distal radioulnar joint are ex- associated with injuries to the ulnar side of the wrist, in- tremely difficult to diagnose because slight degrees of ro- cluding tears of the triangular fibrocartilage, dislocation tation of the wrist from the lateral projection may cause of the distal radio-ulnar joint and fractures of the ulnar difficulty. In the carpus, fracture of the scaphoid is by far the Less common injuries at the wrist include fractures of most common fracture, accounting for approximately the hook of the hamate and of the pisiform or capitate. The internal tients with negative X-rays in whom there is a strong clin- oblique view may detect fractures that were overlooked or ical suspicion of a scaphoid fracture [9]. The diagnosis significantly underestimated on standard views of the can be made with a brief limited examination. While most of these fractures are identified mon the complications of osteonecrosis and non-union. This Fractures at the bases of the metacarpals occur but are is usually identified only on the lateral image. Another much less common than shaft fractures, except for the fracture along the dorsal surface of the carpus is that of thumb metacarpal. This fracture is commonly seen following metacarpal are typically associated with a dislocation and carpometacarpal dislocations. These include The dorsal fragment almost always remains in place sec- torus fractures, which can be identified by a buckling of ondary to its strong attachments (Bennett’s fracture); the cortex (usually dorsal) of the distal radius. The de- tures, that is, those not demonstrable on conventional radi- gree of displacement is best appreciated on this image. The so-called baseball finger or mallet finger abnormalities about the hip that are responsible for the is a fracture of the dorsal aspect of the base of the distal symptoms. Volar plate fractures are quite (fatigue fractures) or in the elderly with osteoporosis or common and are seen at the volar aspect of the base of other underlying disease (insufficiency fractures) [15].