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  • Tuberculosis Clinical Care and Treatment During Pregnancy | Tuberculosis (TB)

    Tuberculosis Clinical Care and Treatment During Pregnancy | Tuberculosis (TB)

    Effect on pregnancy outcomes

    Untreated TB disease poses a greater risk to the pregnant woman and fetus than does its treatment. Although the TB drugs used in recommended treatment plans for TB disease cross the placenta, these drugs are not known to have harmful effects on the unborn fetus.

    If the pregnant woman is not treated for TB disease, the infant may be born with a low birth weight. In rare circumstances, the infant may be born with TB disease. TB disease in babies is often severe and may be deadly.

    Helping patients stay well during pregnancy

    Testing for TB infection during pregnancy

    Health care providers should test pregnant women at higher risk of developing TB disease. Generally, pregnant women at higher risk for TB disease (once infected) fall into two categories:

    • Those who are taking certain medications or have health conditions such as diabetes, cancer, or HIV that may weaken their immune system; and
    • Those who have been recently infected with TB bacteria.

    Types of TB tests

    TB blood tests and the TB skin test are safe to use during pregnancy. TB experts are available to help interpret the TB blood test or TB skin test results.

    If a TB blood test or TB skin test result is positive, other tests such as chest radiography may be needed to evaluate for TB disease.

    Treatment options

    Latent TB infection

    Most pregnant women can delay treatment for latent TB infection until two-three months post-partum. It may be reasonable to delay treatment until after delivery to avoid the risk of liver toxicity as an adverse effect of treatment for latent TB infection, which is higher during pregnancy.

    However, pregnant women who are at higher risk for developing TB disease should not delay treatment, even during the first trimester. This includes pregnant women:

    • Who have weakened immune systems, such as a person with HIV and a low CD4 count
    • Who recently spent time with someone with infectious TB disease

    Treatment regimens for latent TB infection

    There are several treatment regimens recommended to treat latent TB infection during pregnancy. Health care providers can consult TB experts for additional information.

    • Four-month daily regimen of rifampin (also called 4R)
    • Three-month daily regimen of isoniazid and rifampin (also called 3HR)
    • Six- or nine-month daily regimen of isoniazid (also called 6H or 9H), with pyridoxine (vitamin B6) supplementation

    Pregnant women taking isoniazid should take 25–50 mg/day of pyridoxine (vitamin B6) to reduce possible adverse effects of isoniazid. Women taking isoniazid in the post-partum period (within three months of delivery) should have blood tests checked for liver function before starting treatment.

    Pregnant women or women expecting to become pregnant during treatment should not take the three-month weekly isoniazid and rifapentine (3HP) regimen. Its safety during pregnancy has not been studied.

    Treatment guidelines for latent TB infection

    MMWR. Recommendations and Reports / Vol. 69 / No. 1 / P. 1–11

    TB disease

    Women who are diagnosed with TB disease during pregnancy should start treatment right away. Health care providers should:

    • Choose TB drugs that are recommended for use during pregnancy,
    • Monitor the pregnant women and fetus during treatment, and
    • Ask the patient if they are having any problems taking the medicine.

    Treatment regimens for TB disease

    Health care providers should evaluate the risks and benefits of prescribing pyrazinamide as part of a treatment regimen on a case-by-case basis and allow patients to make an informed and educated decision.

    For pregnant women with TB disease and HIV, extrapulmonary, or severe TB disease, it may be more beneficial to include pyrazinamide in the treatment regimen. Pyrazinamide is used routinely as part of TB treatment in pregnancy in many other countries.

    If pyrazinamide is excluded from the treatment regimen, a minimum of nine months of isonaizid, rifampin, and ethambutol is used for most pregnant women with drug-susceptible TB disease. It includes:

    • Isoniazid, rifampin, and ethambutol daily for two months, followed by
    • Isoniazid and rifampin daily, or twice weekly for seven months.

    Health care providers can contact their state or local TB program or the TB Centers of Excellence for expert consultation.

    Treatment guidelines for TB disease

    Pregnant women with HIV and TB disease

    Treatment of TB disease for pregnant women with HIV should be the same as for other people with HIV but with particular attention to drug-drug interactions.

    Health care providers can contact their state or local TB program or the TB Centers of Excellence for expert consultation.

    Health care providers may also consult Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV: Mycobacterium tuberculosis Infection and Disease.

    Contraindications

    Antituberculosis drugs contraindicated during pregnancy include:

    • Streptomycin
    • Amikacin
    • Capreomycin

    Fluoroquinolones

    Fluoroquinolones (including moxifloxacin and levofloxacin) are not routinely used for standard treatment of TB disease in pregnancy but may be used for treatment of drug-resistant TB, severe TB disease, or treatment-intolerant TB disease, with discussion about benefits and risks.

    Drug-resistant TB disease

    There are known and unknown risks of medications for drug-resistant TB disease. Pregnant women diagnosed with drug-resistant TB disease should receive counseling about both the benefits of TB treatment and the possible risk to the pregnancy.

    Treatment guidelines for drug-resistant TB disease

    Potential impacts for breastfeeding

    Women taking first-line antituberculosis drugs may continue to breastfeed their newborn. The concentrations of these drugs in breast milk are too small to produce toxicity in the nursing newborn. For the same reason, TB drugs in breast milk are not an effective treatment for TB disease or latent TB infection in a nursing newborn.

    Rifampin can cause orange discoloration of body fluids, including breast milk This discoloration is normal, harmless, and goes away after stopping rifampin.

    Resources

    This page provides a list of selected clinical guidelines related to tuberculosis (TB) topics.

    U.S. state and local health departments are responsible for preventing and controlling tuberculosis.

    TB Centers of Excellence for Training, Education, and Medical Consultation support TB activities.

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  • RFK Jr. Is Giving Families ‘False Hope’ By Claiming He’ll Figure Out Cause of Autism by September, Former FDA Vaccine Head Warns

    RFK Jr. Is Giving Families ‘False Hope’ By Claiming He’ll Figure Out Cause of Autism by September, Former FDA Vaccine Head Warns

    Dr. Peter Marks, the former top vaccine official at the U.S. Food and Drug Administration (FDA), has criticized Health and Human Services Secretary Robert F. Kennedy Jr. for giving what he called “false hope” to families by claiming that the Trump administration will identify the cause of autism by September.

    Marks, who resigned earlier this month amid mounting frustration with Kennedy’s promotion of vaccine misinformation, appeared on CBS’s Face the Nation to challenge Kennedy’s recent assertion that a massive federal research initiative would soon pinpoint and eliminate the root causes of autism.


    Kennedy announced the effort through the National Institutes of Health. “By September we will know what has caused the autism epidemic and we will be able to eliminate those exposures,” he promised.

    “Giving people false hope is something you should never do,” Marks said in response to Kennedy’s announcement.

    “I don’t see any possible way [to get the answer that quickly],” Marks continued. “Autism is an incredibly complicated issue.”

    Kennedy, a longtime vaccine skeptic, has implied that vaccines may be among the environmental toxins driving autism rates. However, Marks dismissed that notion, citing the overwhelming body of research showing no link between vaccines and autism. “We’ve studied them in so many millions of children,” he said.

    The controversy comes amid a deadly resurgence of measles in the US, with three unvaccinated individuals—including two young girls from Seminole, Texas—dying in recent weeks. Measles had been declared eliminated from the U.S. in 2000, but new outbreaks have developed in certain under-vaccinated communities.

    Kennedy has offered only tepid support for the measles vaccine, telling CBS that “people should get the measles vaccine” but reiterating his opposition to mandates. He has also promoted unproven alternatives like vitamins and cod-liver oil.

    Marks blamed the recent pediatric measles deaths on Kennedy and his staff, describing it as “the epitome of an absolute needless death.”

    “These kids should get vaccinated—that’s how you prevent people from dying of measles,” Marks emphasized.

    In his resignation letter, Marks criticized Kennedy for spreading misinformation and undermining public trust in safe and effective vaccines.

    “Truth and transparency are not desired by the secretary,” Marks wrote. “He wishes subservient confirmation of his misinformation and lies.”

    Originally published on Latin Times



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  • ‘Tell That to a Diabetic’

    ‘Tell That to a Diabetic’

    As Dr. Mehmet Oz was sworn in as head of the Medicare and Medicaid Services, he encouraged Americans to reduce drug spending by simply staying healthy.

    “It is your patriotic duty — I’ll say it again — the patriotic duty of all Americans to take care of themselves,” Oz said during the ceremony on Friday. “It’s important for serving in the military but also important because healthy people don’t consume healthcare resources.”



    “The best way to reduce drug spending is to use less drugs, because you don’t need them because you’re healthy,” he continued. “And it feels a lot better as well.”

    Critics disparaged the former TV doctor and Senate candidate for what many characterized as a tone-deaf suggestion detached from the reality of chronic illness, disability and structural inequalities that limit access to the resources self-care requires.

    “Tell that to a diabetic!” one user wrote on X, echoing hundreds of frustrated replies. Others accused Oz of promoting a fantasy in which good health is simply a matter of willpower or patriotism.


    “So don’t get sick is what you are saying?” asked one commenter, with another quipping, “Why didn’t we think of that?” Another rephrased his words, “Simply put, the best way to reduce drug spending is to just DIE.”

    Many pointed to Oz’s controversial history of promoting claims and healthcare products that are not supported by scientific research, calling him a “snake oil salesman,” or asking “what vitamin is he selling now?”

    “So, is he suggesting replacing fish oil and kale for my heart meds?” another user inquired sarcastically.


    Oz’s comment has sparked outrage particularly among patients with lifelong or genetically inherited illnesses such as diabetes, heart disease and autoimmune conditions, for whom daily medication is a necessity, not a choice.

    Originally published on Latin Times



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  • The Healing Wave

    The Healing Wave

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  • The 4 Qualities of a Good Listener

    The 4 Qualities of a Good Listener

    A good listener not only focuses on your words, but what’s on your mind. Do you have the following qualities of a good listener?

    When we’re constantly fixated on what we’re going to say next, or how people have interpreted what we’ve already said, we forget that honing the qualities of a good listener is equally important to the conversation. This video from The London School of Life reminds us how a good listener inspires quietly instead of nagging endlessly.

    4 Qualities of a Good Listener

    1) A good listener asks: “What’s on your mind?”

    When we’re trying to make tough decisions, a good listener uses gentle encouragement to help tease out what’s really at the heart of our anxieties.

    It’s not always easy for us to know what’s bothering us—a gentle and constructive push with a good question can encourage us to explore what’s on our minds, and help clarify what might be causing us trouble.

    2) Good listeners go beyond anecdotes

    It’s hard to find the root of where our feelings comes from, but easy to simply mention that something is lovely or terrible, nice or annoying.

    A good listener can help us clarify it.

    They look for the bigger picture by taking your piecemeal thought or complaint and turning it into solid ideas by connecting it with your broader history, bringing anecdotal thoughts up against underlying issues.

    3) The good listener is acutely aware of how unique we all are

    Good listeners allow us to be vulnerable—they don’t invite us to open up and then immediately reject us for our follies.

    Instead, their skillful and useful small feedback can make tense moments of dialogue easier. For example, the little positive strategic sounds, like “MMMMMM……” that delicately signals sympathy without intruding on what we’re trying to say.

    Good listeners allow us to be vulnerable—they don’t invite us to open up and then immediately reject us for our follies.

    Without judgement and criticism, we can feel free and safe to express our feelings without worrying about losing our dignity—or a friendship.

    4) Good listeners separate disagreement from criticism

    A friend who possesses the qualities of a good listener is willing to build a safe environment for you and help you to be yourself. You don’t need to be afraid losing them if you have any disagreement with them—they make it clear that their company is not dependent upon an unattainable state of perfection.



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  • The Risks vs. Benefits of Angioplasty and Heart Stents 

    The Risks vs. Benefits of Angioplasty and Heart Stents 

    What do physicians and stent companies have to say for themselves, given that they promote expensive, risky procedures with no benefit?

    “Percutaneous coronary intervention (PCI)”—angioplasty and stent placement—“continues to be frequently performed for patients with stable [non-emergency] coronary artery disease, despite clear evidence that it provides minimal benefit…” The procedure does not prevent heart attacks or death for patients with stable angina pectoris, for example, yet nearly nine out of ten patients mistakenly believed that it would reduce their chances of having a heart attack. “At the same time, the cardiologists who referred them for PCI and those who performed the procedure generally did not believe that PCI reduces the risk for MI [myocardial infarction or heart attack] in stable angina.” Then why on earth were they doing it?

    “Focus groups of cardiologists have documented a chasm between knowledge and behavior; while aware of the results of clinical trials”—that is, evidence to the contrary—“they recommend and perform PCI because they believe that it helps in some ill-defined way.” “Physicians tended to justify a non-evidence-based approach (‘I know the data shows there is no benefit, but’) by focusing on the ease of PCI and belief that an open artery was better”—even if it doesn’t actually affect outcomes—“while minimizing the risks of PCI.” The procedure only kills 1 in 150, so some are blaming the patients for not listening, but maybe the physicians are the ones who are ignoring the evidence.

    Or “physicians may have too poor a grasp of relevant statistics to adequately inform their patients.” Regardless, what we have is “a failure to communicate.” So, tools have been developed. For example, a sample informed consent document lays out the potential benefits and risks, even laying out how many procedures doctors have performed and any out-of-pocket costs. As you can see below and at 1:58 in my video Angioplasty Heart Stent Risks vs. Benefits, there are a lot of blanks to be filled in. What are some concrete numbers? 

    As you can see below and at 2:20 in my video, the Mayo Clinic came up with some prototype decision-making tools. In terms of benefits, “Will having a stent placed in my heart prevent heart attacks or death? No. Stents will not lower the risk of heart attack or death,” but a week later those getting stents report they feel better—though, a year later, even the symptomatic-relief benefit appears to disappear. Nevertheless, there appeared to be a benefit of temporary relief of chest pain. What about the risks? 

    As shown below and at 2:53 in my video, during the stent procedure, out of a hundred people, two will have bleeding or damage to a blood vessel and one will have a more serious complication, such as heart attack, stroke, or death. Then, during the first year after the stent placement, three will have a bleeding event because of the blood thinners that must be taken because of the foreign material in the heart, but that doesn’t always work, so two people will have their stent clog off, leading to a heart attack. 

    What does the world’s number one stent manufacturer have to say for itself? It acknowledges that the evidence shows that stents don’t make people live longer, but the manufacturer thinks living longer is overrated. If we only cared about living longer, in medicine, “entire disciplines would dwindle or even disappear, such as dermatology, ophthalmology, orthopedic surgery, and dentistry.” So why go to the dentist? Of course, the difference is that 80 percent of people don’t believe that getting a cavity filled is going to save their life, like they mistakenly do for stents, as shown here and at 3:18 in my video, and there isn’t a one in a hundred chance you won’t make it out of the dentist chair. 

    The stent companies actively misinform with ads making heart-warming copy. “Open your heart and your life.” “When you open up your heart, you open up your life. LIFE WIDE OPEN.” “Freedom begins here.” Their TV ads mention a few side effects, but it turns out they missed a few. More importantly, they’re giving the false impression that stents are more than just expensive, risky band-aids for temporary symptom relief. But what’s wrong with symptom relief? Even if the benefits are only symptomatic and won’t last long, what’s the problem if people think that outweighs the risk?

    What if I told you that even the symptom relief might just be an elaborate placebo effect, and you could get the same relief from a fake surgery, so there really aren’t any benefits at all? We’ll see what the science says—next. 



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  • What Repeated Antibiotic Use Could Be Doing To Your Child’s Health

    What Repeated Antibiotic Use Could Be Doing To Your Child’s Health

    Antibiotics have long been hailed as life-saving medications, helping the body fight everything from mild colds to life-threatening infections like pneumonia. However, researchers now caution that repeated use of antibiotics, especially during early childhood, may come at a cost.

    In a new study published in the Journal of Infectious Diseases, researchers tried to investigate how antibiotic use might be connected to the development of chronic health conditions in children. To do this, they analyzed health records from more than one million babies in the United Kingdom, tracking diagnoses of various long-term pediatric conditions up to the age of 12.

    The researchers found that frequent antibiotic exposure in children could disrupt the delicate balance of gut microbes, setting the stage for a range of allergic conditions later in life, including asthma, food allergies, and hay fever. The study also noted a connection between antibiotic use and the risk for intellectual disabilities, but researchers cautioned that further studies are needed to confirm these associations.

    “Antibiotics play a critical role in combatting bacterial infections, but physicians should be judicious when prescribing antibiotics to children under 2, as frequent use may affect long-term health outcomes,” said Daniel Horton, the lead author of the study in a news release.

    However, the study also found that not all pediatric health conditions were linked to antibiotic use. For example, there was no significant association between antibiotics and the risk of developing autoimmune diseases like celiac disease, inflammatory bowel disease, or juvenile idiopathic arthritis. Similarly, the researchers found no strong links to neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD).

    The link between antibiotics use and health risk was also found to be course depended, meaning, more courses of antibiotics children took, the stronger the risk. Even when comparing siblings where one took antibiotics early and the other did not the results were similar, which makes the findings more reliable.

    “Antibiotics are important and sometimes life-saving medicines, but not all infections in young kids need to be treated with antibiotics. Parents should continue to consult with their children’s doctors on the best course of care,” said Horton, who is also an associate professor of pediatrics and epidemiology at Rutgers Robert Wood Johnson Medical School and Rutgers School of Public Health.

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  • How To Walk For A Steady Beat

    How To Walk For A Steady Beat

    Walking is considered one of the best forms of exercise for heart health. Researchers now say, it’s not just how much you walk but the pace at which you stride also counts when it comes to heart rhythms.

    A recent study published in the journal Heart suggests that not just walking but walking briskly and for sustained periods, may significantly lower the risk of developing heart rhythm disorders. These include atrial fibrillation, a common condition that causes an irregular and often rapid heartbeat; tachycardia, where the heart beats too fast; and bradycardia, where it slows down more than it should.

    In a large-scale study that looked at the walking pace and heart rhythm disorders of 420,925 participants of the UK Biobank, researchers found that people who walked at an average pace (3–4 miles per hour) or brisk pace (over 4 miles per hour) had up to a 43% lower risk of developing heart rhythm issues compared to slow walkers (under 3 miles per hour). Specifically, brisk walkers saw a 46% drop in risk for atrial fibrillation and a 39% lower risk for other arrhythmias.

    Participants who walked briskly were generally younger, more likely to be White and male, and had healthier lifestyles. They also displayed lower risk factors such as smaller waists, reduced body weight, better grip strength, and lower levels of metabolic risk factors, including blood fats, fasting glucose, and inflammation.

    The researchers also noted that 36% of the association between walking pace and heart rhythm abnormalities was influenced by metabolic and inflammatory factors. The association between walking pace and heart health was strongest among women, those under 60, non-obese individuals, those with high blood pressure, and those with two or more long-term conditions.

    Another notable finding was that spending more time walking at a brisk or average pace was associated with a 27% lower risk of heart rhythm abnormalities, while slow walking showed no such benefit in reducing the risk.

    “This study is the first to explore the pathways underpinning the association between walking pace and arrhythmias, and to provide evidence that metabolic and inflammatory factors may have a role: walking faster decreased the risk of obesity and inflammation, which, in turn, reduced the risk of arrhythmia,” the researchers wrote.

    The researchers caution that, as an observational study, it cannot prove cause and effect. They also note some limitations, including reliance on self-reported data and a study population that did not represent a wide range of ages and ethnic backgrounds.

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  • Anxiovita

    Anxiovita

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  • A Forgiveness Meditation to Connect With Your Heart

    A Forgiveness Meditation to Connect With Your Heart

    In this guided meditation, Will Schneider walks us through a three-step meditation to offer forgiveness to ourselves and others.

    Forgiveness is a cornerstone practice of mindfulness, and it’s also one of the most difficult.

    Extending forgiveness to others and to ourselves requires a kind of awareness and vulnerability that can feel deeply uncomfortable, especially if we are carrying heavy stories of shame, anger, or resentment connected to that experience.

    In today’s guided practice, Will Schneider from Men Talking Mindfulness walks us through a forgiveness meditation filled with kindness, grace, and surrender that’s designed to help us walk a little lighter in the world.

    A Forgiveness Meditation to Connect With Your Heart

    Read and practice the guided meditation script below, pausing after each paragraph. Or listen to the audio practice.

    1. As you work through this meditation, please note that we’re not trying to force forgiveness in any way. Please do this within your comfort zone. You do not need to go into the deepest and darkest places that need forgiveness. On a scale of one to 10, choose something that feels about in a four to six range. This meditation is going to be very helpful to release the energy of stress and anxiety or depression, and really help to relax your body, relax your mind, and help you to be more present in this moment, instead of encumbered with the shame and the guilt that might be associated with events that have occurred in your life.
    2. To begin, find a comfortable position. You can also do this lying down, but make sure you’re not going to fall asleep. If you choose to sit, then sit up in an upright, dignified position.
    3. There will be three parts to this forgiveness meditation. Do the best you can to work from a heart-centric, heartfelt place deep within you. Let go of expectations and try to work from a vulnerable and authentic state of being.  
    4. Start by using your breath to help just naturally drop a little bit deeper into this moment. Maybe even bring a hand over top of your heart so you can begin to access your heart energy, which really helps to empower this forgiveness. Make some movements in your shoulders and your head to help to relax tension. Find several deeper breaths just to calm your nervous system down, drop into this moment. Bring your breath, your awareness down to your breath into your belly. Inhale really big. Exhale, soft and slow. Maybe you’ve got to wiggle your jaw a little side to side, or just take these first several breath moments to just create a little bit more comfort in your body and kind of get out of your head and into your body and into this moment by being aware of your breath and being aware of the sensations of your body without judgment.
    5. Bring to mind a moment that you harmed someone else. Again, it doesn’t have to be so deeply personal. It could just be someone that you cut off in traffic or were a little curt with at the grocery store or something like that. Stay in that four to six range. In your mind’s eye, being specific, bring up this particular person that you would like to offer or ask for forgiveness. Clearly seeing that person in your mind’s eye, repeat to yourself from this heartfelt space to this other person, I am sorry. Please allow me to be imperfect. Please allow me to make mistakes. Please allow me to be a learner, still learning life’s lessons. Please forgive me. Please forgive me. If you could not forgive me now, please try to forgive me sometime in the future. I’m sorry. Please forgive me.
    6. Sit with that for a couple of heartbeats, a couple breaths. Use the breath as a way to let go, detaching energetically. Feeling your heart once again.
    7. Next, let’s shift to a way in which someone has harmed you. Again, keep this in that four to six range, something minor, but that definitely was an experience. Repeat to them through this heartfelt space, Just as I am willing to allow myself to be imperfect, I allow you to be imperfect. I allow you also to make mistakes. I allow you to be a learner, still learning life’s lessons. I forgive you. I forgive you. If I cannot forgive you now, may I forgive you sometime in the future. If I cannot forgive you now, may I forgive you sometime in the future.
    8. Sit with your breath for a few moments again. Bring your hand over top of your heart and feel more of that heartfelt experience. Again, use the breath to relax and to release this energy.
    9. Finally, let’s bring forgiveness to ourselves. Think of ways you have harmed yourself. Again, start with something small. Extend forgiveness to yourself by expressing these heartfelt words to yourself: I allow myself to be imperfect. I allow myself to be imperfect. I allow myself to make mistakes. I allow myself to make mistakes. I allow myself to be a learner, still learning life’s lessons. Really feel that. I allow myself to be a learner, still learning life’s lessons. I forgive myself. I forgive myself. If I cannot forgive myself now, may I forgive myself sometime in the future. I forgive myself.
    10. Be with your breath for another few moments here, taking some bigger breaths. Filling with forgiveness, filling with love for yourself, filling with the opportunity to release and let go. Let it all go. It doesn’t need to be a part of you anymore. Take a couple more breaths in. Feel it and flow with it and fall with it. And let go.  
    11. I hope you’re feeling a little lighter after this meditation. Slowly come out on your own time. It’s a wonderful exercise to realize that you don’t need to hold on to all that stuff that gets in the way of your brilliance. All that love that you are. Thank you for meditating. Thank you for being the light that you are and bringing that light to more people in the world. Have an incredible day.



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