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Dermatomyositis is an inflammatory disease which causes swelling and redness of muscle and skin.
The exact cause of dermatomyositis is not known. It may be an autoimmune disorder. The immune system identifies and attacks viruses and harmful bacteria in your body. An autoimmune disorder means the immune system begins to attack normal, healthy tissue.
An infection may trigger dermatomyositis, such as Coxsackie B virus, group A streptococcus , or echovirus.
Risk Factors
Your chance of developing dermatomyositis is higher if you have an autoimmune disorder such as:
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Scleroderma
- Certain cancers
Dermatomyositis is also associated with certain genes.
Dermatomyositis may cause:
Skin changes such as:
- Violet-colored, bumpy, or scaly skin rash, especially around the eyes (heliotrope rash), upper back, elbows, or knuckles
- Itching, especially the scalp
- Swelling
- Sensitivity to sunlight
- Nail changes
- Skin nodules
problems such as:
- Weakness especially in hips, thighs, arms or neck
- Aching pain in legs, shoulder, arm, or neck
- Tender muscles
- Difficulty swallowing and speaking
- Fever
- Weight loss
- Aching and color changes in fingers, especially in cold temperatures
- Shortness of breath
You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a specialist for further evaluation.
Your bodily fluids and tissues may be tested. This can be done with:
- Blood tests
- Muscle biopsy
Your muscles may be tested. This can be done with an electromyogram (EMG).
Your breathing ability (pulmonary function) may also be tested
Images may be taken of your bodily structures. This can be done with:
There is no cure for dermatomyositis. Treatment is focused on managing the symptoms. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Physical Therapy
You may be referred to a physical therapist. The therapist will help improve or prevent the loss of muscle strength and function. It may include:
- Strength and flexibility exercises
- Guidelines for a general exercise program
- Tips to modify day to day activities if muscle weakness is affecting them
Corticosteroids can suppress your immune system. This will decrease inflammation in the muscle. Steroid medication can also be used on the skin to relieve skin symptoms. Corticosteroids can cause problems, like lower bone density. They can also increase infections. To lower these effects, you will be given the lowest dose needed to control your symptoms. You may also be asked to take supplements like calcium and vitamin D to improve your bone strength.
There are other medication options that can help to suppress the immune system. They may be used with or instead of the corticosteroids.
Intravenous Immune Globulin
Immune globulin has healthy antibodies from several donors. These antibodies can block the unhealthy antibodies associated with dermatomyositis. It is given through an IV.
The infusion needs to be repeated every few weeks.
Lifestyle Changes
Regular exercise can help you develop and maintain muscle strength. Modify the program as needed to prevent irritating your condition. Check with your doctor and physical therapist for exercise guidelines. Rest when needed.
Your skin may also be more sensitive to the sun. Use sunscreen or cover your skin with clothes or a hat.
Revision Information
- Reviewer: Michael Woods, MD
- Review Date: 05/2018 -
- Update Date: 01/10/2018 -


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The treatment and management of infertility in men will depend on the underlying cause or causes of the infertility. Treatment will focus on correcting any structural or hormonal abnormalities that may be influencing infertility. This may be accomplished through medications or surgery. Lifestyle changes and other treatments, such as assisted reproductive technologies (ART), may be used to enhance semen quality and increase the likelihood of fertilization.
The ultimate goal of infertility treatment is a pregnancy ending in the birth of a healthy baby. Infertility treatments can be lengthy and expensive. They are not always covered by medical insurance, and they are not always successful.
Treatment involves the following:Lifestyle changesMedicationsSurgeryAlternative and complementary therapies
Revision Information
- Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
- Review Date: 11/2018 -
- Update Date: 12/20/2014 -


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We've made returns easy! If you're looking to return or exchange an item you purchased directly at GoVacuum.com, just visit returns.govacuum.com and let us know you're wanting a return or exchange and shortly thereafter we'll email you an return authorization number and a prepaid return label so there's there's no cost to you whatsoever!
48 Continental States Policy (excludes Hawaii & Alaska)-
GoVacuum is proud to be the leading discount vacuum cleaner website that offers free shipping to our customers. We also offer a 30 day in home trial for most all new products we sell. *(see below for exclusions) In the event you are not 100% satisfied with your purchase, simply return it and we will even pay the return shipping fee back to us and there's no restocking fee! *(see below for exclusions)
This is the most consumer friendly return and shipping policy in the vacuum industry today. Paired with a 99% customer satisfaction rating from over 50,000 customer reviews, plus toll-free phone and chat support 7 days a week- makes GoVacuum the best place to purchase your vacuum related products from.
We've even streamlined the return process to make is as easy as 1... 2... 3...
You have 60 days from the original purchase date to return your purchase back to us. For a full refund of your purchase price.
Alaska, Hawaii, Puerto Rico, Guam & US Virgin Islands Policy-
The shipping rate to your area is listed above. Please note: We will not provide a return shipping label in the event you are you are returning your purchase, furthermore you are responsible for the return shipping cost back to us. We also offer a 30 day in home trial for most all new products we sell. *(see below for exclusions) In the event you are not 100% satisfied with your purchase, simply return itthere's no restocking fee! *(see below for exclusions)
You have 30 days from the original purchase date to return your purchase back to us. For a full refund of your purchase price.
- Outlet, open stock, refurbished, reconditioned and used items have a 30 day return and exchange policy *(except for products listed below)
- Miele rotary iron, bidets, water filtering products and all commercial machines (vacuums, burnishers, carpet extractors, etc.)- these items are not returnable (in the event they are defective we will work with you on having it replaced, repaired or exchanged as per the manufactures warranty).
- Heaters have a 14 day return and exchange policy
- Used bags, filters & roller brushes can't be returned for sanitary reason
- A restocking fee up to 35% will be applied to machines that are heavily used, shows signs of accidental, misuse or abuse by the consumer. All machines should be returned in like new condition, with the original packaging, manuals, attachments, accessories and in the original box to avoid a restocking fee.
In the event an item is defective or non working we might offer an exclusion on a case by case basis, please contact us in the event this happens.
Please include a copy of the original invoice to ensure your receive credit and ship your return to:
14500G Lee Rd.
Chantilly, VA 20151
Attn: Returns
Have a question about our return policy? Just hit Need Help On Your Screen
GoVacuum's Order Tracking System:
Track any order that's been shipped from GoVacuum here. Orders that were shipped by UPS, FedEx, or The United States Postal Serice may tracked below. If you did not receive the shipment confirmation email, please send us an email, or give us a call, we're happy to help and provide the tracking information over the phone.


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Here's a trend that's repeated itself numerous times this year: Whenever gold prices rise, gold experts come out of the woodwork, telling their brainwashed followers to buy more bullion because gold prices are heading to the moon.
Over the past two years, that poisonous advice has been dead wrong.
Since 2011, there have been nine notable bull traps in gold. Furthermore, all the rallies in gold prices and gold ETFs (GLD) this year have been brief, fooling just enough people into believing that prices are still going up.
In fact, gold's one-day rally of 4.1% on the Federal Reserve's Sept. 18 statement that QE would continue, was just another classic bull trap.
A "bull trap" is defined as an inaccurate measure that shows a decreasing trend in the price of an asset or investment has reversed itself and is now heading upwards, when in fact the asset will resume its decline. Technicians also refer to a bull trap as a "false breakout."
Just days ahead of the most recent bull trap in gold, we alerted our readers of the high profit opportunity. In our Sept. 15 Technical Forecast, we wrote: "Gold bears (shorters) should get a better entry price this week to initiate or add to precious metals shorts."
That golden opportunity (pun intended) to boost short exposure to precious metals came like a gift from the heavens on the Sept. 18 one-day rally. And while gold bugs like Peter Schiff and James Turk were celebrating their one-day victory, we recognized that another bull trap had been set.
In our time-stamped ETF Weekly Pick to subscribers on Sept. 18, we explained: "Gold miners are a leveraged play on physical metals and if the next leg down in metals prices takes hold, as we suspect, miners should lead the way down. Buy the Direxion Daily Gold Miners Bear 3x Shares (DUST) around $24.60 with a price limit up to $25.25. DUST aims for triple opposite daily performance to mining stocks. A tandem options trade is to buy the GDX Oct 2013 25 put options around $40."
How did our gold trade turn out?
Via intraday alerts to our readers on 9/19 and 9/20 we sold our DUST position for a two-day +16.5% blended profit.
DUST aims for triple opposite daily performance to mining stocks. Our tandem trade in the GDX Oct 2013 25 put options were sold for a two-day gain of +68%.
Despite higher demand in the physical bar and coin category versus lower investment demand, the total aggregate demand for gold bullion has fallen 23% over the past year, according to the World Gold Council.
The only place where fundamental demand for gold is up is among Chinese and Indian consumers. But rather than being a bullish signal, as goldbugs have been tricked into thinking, consumer sentiment — regardless of the continent — is a telltale contrarian signal.
The technical damage done to gold and silver prices in April and June was significant and it will take time to heal. And blindly buying precious metals on the dips as a "long-term" investment has been rendered thoroughly ineffective for two straight years and counting.
For now, we continue to profit from the bull trap in gold, until the judgment day of selling capitulation tells us it's time to go long. (See Ezekiel 7:19.)
The ETF Advisor Pro uses a combination of market sentiment, fundamental/technical analysis, history, and common sense to be on the right side of the market. Since the beginning of the year, 74% of our time stamped ETF picks have turned a profit. (through 9/30/13). Follow us on Twitter @ ETFguide.


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Shoplinks & Catalogue - Helpful Tips
Links to Amazon and iTunes
Catalogue Search Help
1. Amazon
After clicking the Amazon button you will be redirected to the selected Amazon shop and be able to buy the physical product. Often the download version will be available on the same page. In rare cases you may find only second hand offers or no availability at all.
If the Amazon button is not clickable the product is not available in the country you come from. You can search other Amazon shops but we cannot guarantee the availability.
Products on iTunes are available either as Download AAC 256 or as Mastered for iTunes providing an improved audio quality.
If the iTunes button is not clickable the product is not available in the country you come from. You may search other iTunes shops but we cannot guarantee the availablity. Please note: If you want to buy from an iTunes store you have to use a credit card registered in the same country.
3. Browsing (» Back to Index)
Just click the button "search" and page through our latest releases. You don't need to enter any search text! The releases are ordered per month as follows:
- New Recordings
- New DVDs
- New albums of re-released recordings
- New Out-of-print releases
To include releases from the near future, please switch the final dropdown to "Future Releases first".
4. Using the Freetext Search Box (» Back to Index)- clicking into the box
Simply click into this box with your mouse and it will immediately become empty of text in anticipation of your search request.
- several search words
You can put in several search words - simply make a space between the words.
e.g. "karajan mozart symphonies" finds only Mozart Symphonies conducted by Karajan
- a search that also excludes some information
Placing a minus-sign (-) before one word will exclude that word from the search:
e.g. "Karajan symphonies -mozart" finds all Karajan-conducted Symphonies except those by Mozart
- using the album number
If you are looking up information on an album of which you have some details, then use the identification number to find it best.
On older CDs the number is 7 digits long shown usually in the form "415 253-2". You can however type the number in anyway - "415 253-2", "4152532", "415 2532" - all versions will work.
Recently we have started using twelve digits, whereby the first five digits (usually 00289 for CDs and 00440 for DVDs) are not currently recognised by our web catalogue. Please leave these numbers out.
Sometimes local versions of our international releases are manufactured and these have different numbers - except the number written in the barcode which reflects the international number. This number has 12 digits. Ignore the first four digits and the last digit and you have a seven digit number that our web catalogue will recognise. Sorry for this!
5. The Dropdowns (» Back to Index)Use the dropdowns provided in the advanced search to find releases:
- via artist (e.g. Netrebko)
- via composer (e.g. Beethoven)
- via musical Genre (e.g. choral)
- that have won major Awards (e.g. Grammy)
- that have been reviewed in your preferred language
- that are part of internationally released Series (e.g. The Originals)
Combine your searches to narrow down your search result. For example, in the artist dropdown choose "Pollini" and in the composer dropdown "Beethoven".
Don't forget to press "reset" before keying in your next search
6. Genres (» Back to Index)Here are a few terms and their meanings.
- Orchestra = symphonies, tone poems, concertos etc. (piano and violin concertos can also be found via the search for box by entering Piano Concerto or Violin Concerto
- Chamber = chamber music
- Keyboard = solo piano, harpsichord, organ works
- Vocal = vocal works, both solo and small-ensemble (see also Choral)
- Choral = choral works with larger ensembles
- Dramatic = opera, operetta, arias, musical
7. Availability (» Back to Index)
The availability per country of the CDs and downloads presented in this site will broadly reflect the CD and Download release schedules of each country. However, even though some items may not be available as CDs or downloads in the stores of some countries, they may still be available for download here!
We are committed to bringing back ever more out of print releases from our past as downloads from this site.


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Sheets of connective tissue called fascia are located under the skin of the arms and legs. These wrap around groups of muscles, nerves, and blood vessels to create a unit called a compartment. When pressure builds up in these enclosed spaces, it is redirected into the compartment. When pressure reaches a certain point, it disrupts blood flow. Blood vessels may fail and tissue dies. Acute compartment syndrome (ACS) can affect the arms, hands, legs, feet, and buttocks.
Common causes include:
- Vein obstructions in the extremities
- Hemorrhage
- Complication of surgery
Risk Factors
Factors that may increase your chance of ACS include:
Pre-existing condition that could lead to fatal bleeding in cases of trauma, such as:
- Taking anticoagulants
- Having a bleeding disorder such as hemophilia
- Participation in certain collision or contact sports such as football
- Bandages or casts that are worn too tightly or worn for too long
- Recent injury to the area
- Burns
- Swelling of tissues under the skin
ACS may cause:
- Severe pain
- Feeling of tightness or fullness of muscles
- Swollen, pale, shiny skin over affected area
- Numbness or tingling
Symptoms can develop within 30 minutes to 2 hours. In other cases, it may take days.
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids will be tested. This can be done with blood tests.
Imaging tests to evaluate bodily structures may include:
The pressure inside your compartments will be measured. This can be done with:
- Slit catheter
- Tonometer
- Near-infrared spectroscopy
ACS is a medical emergency. Call for emergency medical services right away. Damage can result in serious injury or even death.
Surgery to relieve pressure, called fasciotomy, must be done right away to prevent permanent damage. The doctor makes a long cut into the fascia to open the envelope of tissue and relieve pressure.
ACS is difficult to prevent because there are many causes. But there are some steps you can take to reduce your risk of injury, such as:
- Wearing proper equipment when playing sports
- Making sure that your medical records mention if you have used anticoagulants or if you have blood diseases
- Being aware of the risk of ACS when you are wearing a bandage or cast
Revision Information
- Reviewer: EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
- Review Date: 11/2018 -
- Update Date: 12/20/2014 -


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What is a house stylist?
A house stylist is trained in interior design but has a flair for real estate and for making a property live up to its full potential and appeal to a broad market.
Buying a home is an emotional and aspirational task. Professional house stylists harness that emotion by creating a blank space that potential buyers fall in love with.
Traditionally, the basics of presenting your home for sale are to clean, tidy, neaten the garden, complete small maintenance jobs internally and to get rid of any funny odours.
A house stylist goes that much further. A property stylist will fill your home with quality furnishings such as cushions, art, books, plants, lighting or furniture pieces that will make the very most of what the property has to offer and help your property reach its optimum selling price on auction day.
Book your complimentary consultation with Jim's Interior Design here.
A Jim's Interior Design house stylist is an expert in
- Making the function of each room in a home very clear. In large or small spaces, a stylist can demonstrate how furniture can be positioned to make the most of what is on offer.
- Masking unattractive rooms,
- Taking unusual nooks and crannies and using creative styling to display the best possible function of a space
- Creating beautiful spaces through the use of complimentary colours, textures and interior accents
What are the benefits in using a house stylist?
The biggest benefit in using a house stylist is that house styling can add a substantial boost to the value of your home. Australian studies by the Institute of Home Staging have reported that property styling can add 7 – 17% to your property sale price.
Adding to that it is proven that well styled properties sell faster and attract more bidders at auction. The home stands out when compared to similar properties and looks really impressive online and in printed marketing and promotional materials.
What do Jim's Interior Design offer?
Jim's Interior Design offer three interior design packages, put together by property stylists to showcase a suite of property styles and audiences.
Mod Oz is a modern take on furniture and furnishings. It appeals to family buyers and is open, light and welcoming in its presentation.
Nordic Coastal is a fusion of current Scandinavian and Hampton design trends – natural and highly textural it suits a more sophisticated, fashion forward palette.
Global luxe is all about understated elegance, a bit moody, a touch of the eclectic.
Read more about Jim's Interior Design's interiors packages – Mod Oz, Nordic Coastal and Global Luxe.
Jim's Interior Design also offer a layby option so you can concentrate on saving your money for any other jobs you need to do to get your property ready to go to market.
Looking to sell your home for more? Don't hesitate, talk to the experts at Jim's Interior Design on 131 546 now.
* Data has been gathered using local and international studies on the Home Staging Industry by the Institute of Home Staging.
TIP – Use a Vendor's AdvocateAdvice on Vendor Advocacy from Melbourne's Property Styling Experts If you are time poor consider using a Vendor Advocate. They will generally charge you percentage of the sale price or other similar fee structure. It's certainly not necessary ...
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Tips – How long does it take to stage your home?How long does it take to stage your home for sale? There are known peaks and troughs in the real estate market. 'Everyone' wants to sell in spring and summer, but not too near Christmas, or a long weekend and make sure your auction isn't raine...
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Tip – Property Research to help you sell your home confidentlyTips from Melbourne's Expert Property Stylists - Property Research will Help you Sell your Home with Confidence. There are a couple of paths to go down here. When you aren't relying on Agents, your Neighbour, your Father in Law or someone from ...
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Tip – Find and retain the best real estate agentsTips from an Expert Property Stylist on how to Find the Best Real Estate Agent - for you! Meet with some agents and invite them to do an appraisal on your property for free. Keep in mind the Agent suggesting the highest achievable price for your ...
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Supplement Forms/Alternate Names
- B. bifidus
- Bifidobacterium
- L. acidophilus
- L. bulgaricus
- L. casei
- L. gasseri
- L. reuteri
- L. plantarum
- L. sakei
- Lactobacillus
- Lactobacillus GG
- Lactobacillus LB
- Probiotics
- S. salivarius
- S. thermophilus
- Saccharomyces boulardii
Principal Proposed Uses
- Various Forms of Diarrhea , Including "Travelers Diarrhea," Diarrhea Caused by Antibiotics, and Viral Diarrhea (in Children)
- Gastrointestinal Side Effects of Cancer Therapy
- Irritable Bowel Syndrome
- Ulcers (as an Adjunct to Standard Therapy)
Other Proposed Uses
- Allergic Rhinitis
- Behcet's Syndrome
- Canker Sores
- Colds (Prevention)
- Colon Cancer (Prevention)
- Constipation (Chronic)
- Diverticular Disease
- Dyspepsia
- Eczema
- High Cholesterol
- Immune Support
- Inflammatory Bowel Disease ( Ulcerative Colitis and Crohn's Disease )
- Insomnia
- Liver Disease
- Milk Allergies
- Probiotics
- Rheumatoid Arthritis
- Ulcers
- Vaginal Infection
- Ventilator-associated Pneumonia
- Yeast Hypersensitivity Syndrome
Lactobacillus acidophilus is a "friendly" strain of bacteria used to make yogurt and cheese. Although we are born without it, acidophilus soon establishes itself in our intestines and helps prevent intestinal infections. Acidophilus also flourishes in the vagina, where it protects women against yeast infections.
Acidophilus is one of several microbes known collectively as probiotics (literally, "pro life," indicating that they are bacteria and yeasts that help rather than harm). Others include the bacteria L. bulgaricus , L. reuteri , L. plantarum , L. casei , B. bifidus , S. salivarius , and S. thermophilus and the yeast Saccharomyces boulardii . Your digestive tract is like a rain forest ecosystem with billions of bacteria and yeasts rather than trees, frogs, and leopards. Some of these internal inhabitants are more helpful to your body than others. Acidophilus and related probiotics not only help the digestive tract function, they also reduce the presence of less healthful organisms by competing with them for the limited space available. For this reason, use of probiotics can help prevent infectious diarrhea.
Antibiotics can disturb the balance of your "inner rain forest" by killing friendly bacteria. When this happens, harmful bacteria and yeasts can move in and flourish. This can lead to vaginal yeast infections. Conversely, it appears that the regular use of probiotics can help prevent vaginal infections and generally improve the health of the gastrointestinal system. Whenever you take antibiotics, you should probably take probiotics as well and continue them for some time after you are done with the course of treatment.
Although we believe that they are helpful and perhaps even necessary for human health, we don't have a daily requirement for probiotic bacteria. They are living creatures, not chemicals, so they can sustain themselves in your body unless something comes along to damage them, such as antibiotics.
Cultured dairy products, such as yogurt and kefir, are good sources of acidophilus and other probiotic bacteria. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural food stores both carry milk that contains live acidophilus. In addition to probiotics, related substances known as prebiotics may enhance the colonization of healthy bacteria in the intestinal tract. 140
Therapeutic Dosages
Dosages of acidophilus are expressed not in grams or milligrams, but in billions of organisms. A typical daily dose should supply about 3 to 5 billion live organisms. Other probiotic bacteria are used similarly. The typical dose of S. boulardii yeast is 500 mg twice daily (standardized to provide 3 x 10 10 -colony-forming units per gram), to be taken while traveling or at the start of using antibiotics, and continued for a few days after antibiotics are stopped.
Because probiotics are not drugs, but rather living organisms that you are trying to transplant to your digestive tract, it is necessary to take the treatment regularly. Each time you do, you reinforce the beneficial bacterial colonies in your body, which may gradually push out harmful bacteria and yeasts growing there.
The downside of using a living organism is that probiotics may die on the shelf. In fact, a study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus. 1 The situation has improved in subsequent evaluations, but still some products are substandard. 99 The container label should guarantee living organisms at the time of purchase, not just at the time of manufacture. Another approach is to eat acidophilus-rich foods such as yogurt, in which the bacteria are most likely still alive.
To treat or prevent vaginal infections, mix 2 tablespoons of yogurt or the contents of a couple of capsules of acidophilus with warm water and use as a douche.
Finally, in addition to increasing your intake of probiotics, you can take fructo-oligosaccharides, supplements that can promote thriving colonies of helpful bacteria in the digestive tract. (Fructo-oligosaccharides are carbohydrates found in fruit. Fructo means "fruit," and an oligosaccharide is a type of carbohydrate.) Taking this supplement is like putting manure in a garden; it is thought to foster a healthy environment for the bacteria you want to have inside you. The typical daily dose of fructo-oligosaccharides is between 2 g and 8 g.
Therapeutic Uses
Evidence from many but not all double-blind, placebo-controlled trials suggests that probiotics may be helpful for many types of diarrhea , as well as for irritable bowel syndrome . 2 28,53-57,68,70,71,130,144,156,157,171,214,215,216,220,223
Additionally, probiotics have shown some promise for preventing or treating eczema . 29,30,51,52, 125, 126,139,203,205,242
Probiotics may be helpful for controlling symptoms and maintaining remission in ulcerative colitis . 37-39,82,204,222 However, probiotics may be less useful for inducing remission; when probiotics were added to standard medications used for induction of remission, no additional benefits were seen in a study of people with mild-to-moderate ulcerative colitis. 155
Probiotics might help prevent colds , 43 possibly by improving immunity . 40-42,83,164 On a related note, one small, double-blind study found evidence that use of the probiotic bacteria Lactobacillus fermentum improved the effectiveness of the influenza vaccine. 135 (The probiotic supplement was taken in two doses. One was taken two weeks before the vaccine, and the other was taken two weeks after.)
Although probiotics are widely used to prevent or treat vaginal yeast infections ( Candida albicans ), evidence regarding potential benefit remains incomplete and inconsistent. 31-36,48,84-85 A small trial of 55 women with vulvovaginal candidiasis did demonstrate that daily Lactobacillus rhamnosus and L. reuteri supplementation for 4 weeks combined with single dose fluconazole (an anti-fungal medication) decreased symptoms compared to fluconazole alone. 202 Another large, well-designed trial, however, failed to find a Lactobacillus preparation helpful for preventing yeast infections caused by antibiotics. 86 One study did find that probiotics might reduce levels of Candida albicans in the mouth. 132
The bacteria Gardnerella vaginalis can cause a different type of vaginal infections ; as with vaginal yeast infections, probiotics have shown some promise for this condition, but evidence remains inconclusive. 145,158,175,190 A trial of 64 women taking a single dose of tinidazole for bacterial vaginosis suggests that women who also took daily probiotics capsules had better cure rates at 4 weeks. 195 A larger trial involving 120 women with a history of bacterial vagninosis found that taking one capsule daily of the probiotics Lactobacillus rhamnosus , acidophilus, and Streptococcus thermophilus reduced recurrence. 209
The bacteria Helicobacter pylori is the main cause of ulcers in the stomach and duodenum. Antibiotics can kill H. pylori , but more than one must be used at the same time, and, even then, the bacteria is not necessarily eradicated. Probiotics may be helpful. Evidence suggests that various probiotics can inhibit the growth of H. pylori . 65-67,87,169 While this effect does not appear to be strong enough for probiotic treatment to eradicate H. pylori on its own, preliminary evidence, including several small double-blind trials, suggest that various probiotics may help standard antibiotic therapy work better, reducing side effects and possibly increasing rate of eradication. 47,55,58,60,63,65,67,87,88, 97,98,131,148,149,162,185 For example, over a 2-week period, 82 adults with dyspepsia and H. pylori infection were randomized to receive lansoprazole (30 mg), amoxicillin (1,000 mg), clarithromycin (500 mg), plus kefir (a cultured dairy product rich in probiotics) or the medications plus placebo. Those in the kefir group experienced a better rate of H. pylori eradication and an improvement in their symptoms (eg, diarrhea, nausea, abdominal pain) compared to the placebo group. 217
Some, but not, all preliminary double-blind trials suggest that probiotics might improve cholesterol profile. 44-46,100-101,137 In addition, milk fermented by probiotics may slightly improve blood pressure levels. 104-106
Various probiotics might be helpful for allergic rhinitis (hay fever). 102-103,142 While there is some evidence that probiotics can help reduce symptoms of milk allergies, 49 one study found that adding probiotics to infant cow's milk formula was not helpful. 176 One interesting study found that the use of probiotics during pregnancy and breastfeeding may decrease the likelihood that a highly allergic mother will pass her allergic tendencies to her breastfed infant. 180
One double-blind, placebo-controlled study of 70 people with chronic constipation found some evidence of benefit with Lactobacillus casei Shirota . 89 Another study found that Lactobacillus rhamnosus was helpful for chronic constipation in children. 141 A small trial also found benefits in children, this time with a mixture of bifidobacteria and lactobacilli . 151 In another study, a combination of B. lactis and B. longus showed promise for improving bowel regularity in nursing home residents. 146 Finally, in a 6-week double-blind, placebo-controlled trial of 274 people with constipation-predominant irritable bowel syndrome, use of a probiotic formula containing B. animalis significantly improved stool frequency. 144
A preliminary double-blind, placebo-controlled study found evidence that Lactobacillus GG might potentially be helpful for treating antibiotic-resistant bacteria. 138 This small study followed 23 people with severe kidney disease who tested positive for vancomycin-resistant bacteria in the stool. (Vancomycin is one of the main "last-ditch" antibiotics for treatment of resistant bacteria.) Use of a yogurt product containing L. rhamnosus appeared to be more effective at ridding the gastrointestinal tract of these bacteria than placebo. However, the study suffered from a number of flaws, especially its small size. Note also that participants in this study did not have active infection with antibiotic-resistant bacteria; they were carriers for it. Do not attempt to use probiotics as sole treatment for active infection with resistant bacteria.
On a related note, preventive use of probiotics does not appear to help prevent the development of resistant bacterial strains that may arise during antibiotic treatment. 96,111
Probiotic treatment has also been proposed as a treatment for canker sores and as a preventative measure against colon cancer , but there is no solid evidence that it is effective.
Probiotics have shown some promise for helping to prevent cavities by antagonizing cavity-causing bacteria. 90
One study found that giving probiotics to certain critically ill people could help prevent multiple organ failure. 133
One small, placebo-controlled study found that use of L. helveticus might improve sleep quality in seniors, for reasons that are not at all clear. 152
An open study found hints that probiotics might be helpful for mouth sores caused by Behcet's syndrome. 147
As noted above, probiotics have shown some promise in the treatment of infections with the yeast Candida albicans . Probiotics are also proposed for the treatment of a theoretically related, but markedly controversial condition, known as yeast hypersensitivity syndrome (also known as chronic candidiasis, chronic candida, systemic candidiasis, or just candida ). As described by some alternative medicine practitioners, yeast hypersensitivity syndrome is a common problem that consists of a population explosion of the normally benign candida yeast that live in the vagina and elsewhere in the body, coupled with a type of allergic sensitivity to it. Probiotic supplements are widely recommended for this proposed condition because they establish large, healthy populations of friendly bacteria that compete with the candida that is trying to take up residence. However, there is no evidence that yeast hypersensitivity is a common problem, and virtually none that it exists at all.
In one small, 12-week study, Lactobacillus GG failed to prove more effective than placebo for the treatment of rheumatoid arthritis . 91
A study failed to find Lactobacillus GG helpful for dyspepsia (stomach discomfort of unknown origin) in children. 130
Evidence for the effectiveness of probiotics in preventing urinary tract infections (UTI) has been mixed. A year-long open trial of 150 women, for example, failed to find Lactobacillus probiotics effective for preventing urinary tract infections as compared to cranberry juice or no treatment. 50 And a randomized trial involving 252 postmenopausal women found that Lactobacilli rhamnosus did not reduce the number of urinary tract infections compared to antibiotics. 226 Other studies, however, including a large (453-participant), 3-month, double-blind, placebo-controlled study of a special healthy E. coli probiotic, did find benefits. 107,175
A review of 9 randomized trials with 735 patients found that probiotics did not prevent recurrent UTIs in adults and children any better than no therapy, placebo, or other preventive methods.243
A substantial study failed to find a mixture of L. casei , L. bulgaricus , and S. thermophilus in yogurt and milk helpful for asthma in children. 142 But, another study found that the combination of a probiotic ( Bifidobacterium breve ) and a prebiotic (galacto/fructo-oligosaccharide) may help reduce wheezing in infants with eczema. 206
Probiotics have also been studied as possible treatment for liver disease . In one such study, 84 adults (aged 18-65) with liver disease ( cirrhosis or hepatitis ) were randomized to receive yogurt (1 cup, 3 times daily) with or without the probiotics B. bifidus , L. acidophilus , L. bulgaricus , and S. thermophilus . 212 After 2 weeks, the people in the probiotics group experienced an improvement in their symptoms (eg, improved food intake and appetite). Chronic liver disease with cirrhosis can lead to a potentially life-threatening brain abnormality, called hepatic encephalopathy. A 2011 review of 7 randomized trials involving 550 people found inconclusive evidence to support the use of probiotics as a treatment for this condition. 218
What Is the Scientific Evidence for Acidophilus and Other Probiotics?
Traveler's Diarrhea
According to several studies, it appears that regular use of acidophilus and other probiotics can help prevent "traveler's diarrhea" (an illness caused by eating contaminated food, usually in developing countries). 4,12 One double-blind, placebo-controlled study followed 820 people traveling to southern Turkey, and found that use of Lactobacillus GG significantly protected against intestinal infection. 7
Other studies using S. boulardii have found similar benefits, 11,13,14 including a double-blind, placebo-controlled trial enrolling 3,000 Austrian travelers. 14 The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted that the benefit depended on consistent use of the product, and that a dosage of 1,000 mg daily was more effective than 250 mg daily.
Infectious Diarrhea
Probiotics may also help prevent or treat acute infectious diarrhea in children and adults.
A 2001 review found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children; 10 of these trials involved treatment and 3 involved prevention. 71 Overall, the evidence suggests that probiotics can significantly reduce the duration of diarrhea and perhaps help prevent it. The evidence is strongest for the probiotic Lactobacillus GG and for infection with a particular virus called rotavirus, which causes severe diarrhea in children.
Another more recent review of 63 trials involving over 8,000 people (mainly infants and children) found that probiotics reduced how long the episode of diarrhea lasted. 210 However, the authors concluded that more research needs to be done to determine which probiotics work best for infectious diarrhea.
And, in a subsequent smaller review focusing on persistent diarrhea (lasting for 2 weeks or longer), researchers concluded that probiotics are capable of reducing both the duration of the diarrhea episode as well as the stool frequency. 211 Another study that was part of this same review suggested that probiotics may help to reduce how long a child is hospitalized due to diarrhea.
One double-blind, placebo-controlled trial of 269 children (ages 1 month to 3 years) with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given placebo. 22 The best results were seen among children with rotavirus infection. Similar results with Lactobacillus GG were seen in a double-blind study of 71 children. 59 However, 224 young Chinese children with severe, acute diarrhea found no benefit from lactose-free formula supplemented with Bifidobacteria and S. thermophilus , suggesting that probiotics may not be as useful for cases of severe, dehydrating diarrhea. 170 Also, Lactobacillus rhamnosus GG is not always associated with improvement. When given for 10 days to 229 infants from rural India hospitalized with acute diarrhea it did not reduce the severity of the diarrhea during that time period. 198
In addition, a double-blind study evaluated the possible benefits of the probiotic L. reuteri in 66 children with rotavirus diarrhea. 5 The study found that treatment shortened the duration of symptoms, and the higher the dose, the better the effect. Similar benefits were seen in a placebo-controlled trial of 151 infants and children given the probiotic Escherichia coli Nissle 1917 (a safe strain of E. coli ) for 21 days for nonspecific (presumably viral) cases of mild to moderate diarrhea. 181 In another randomized trial of 74 children receiving oral rehydration solution for mild to moderate dehydration, L. reuteri reduced the frequency, duration, and relapse rate of acute diarrhea compared to placebo. 230
A double-blind, placebo-controlled study of 81 hospitalized children found that treatment with Lactobacillus GG reduced the risk of developing diarrhea, particularly rotavirus infection. 61 A double-blind, placebo-controlled study found that Lactobacillus GG helped prevent diarrhea in 204 undernourished children. 62
Other studies, though not entirely consistent, generally indicate that the probiotics B. bifidum , S. thermophilus, L. casei , Lactobacillus LB , and S. boulardii —both individually and combined with L. reuteri and L. rhamnosus —may also help prevent or treat diarrhea in infants and children. 8,9,11,15,23,26,56,57,92-93,108-109,150,183,220 One study found that bacteria in the B. bifidum family can kill numerous bacteria that cause diarrhea. 69
Researchers also studied whether adding Lactobacillus fermentum could have preventive benefits. 221 Two hundred and fifteen healthy infants were randomized to receive formula with prebiotics plus L. fermentum or the formula and prebiotics only. The infants in the L. fermentum group had fewer cases of gastrointestinal and upper respiratory infection.
Prophylactic use of probiotics was found to be effective at preventing C. difficile -induced diarrhea in a review of 20 randomized trials with 3,421 patients (including three trials with 605 children) when compared to placebo or no treatment. The most effective probiotics were S. boulardii and L. acidophilus combined with L. casei . 228
Keep in mind that diarrhea in young children can be serious. If it persists for more than a day, consult a physician.
A large (211-participant), double-blind, placebo-controlled study found that adults with diarrhea can benefit from probiotic treatment as well. 26 Another study found that regular use of probiotics could help prevent gastrointestinal infections in adults. 110
Antibiotic-related Diarrhea
The results of many, but not all, double-blind and open trials suggest that probiotics, especially S. boulardii and Lactobacillus GG , may help prevent or treat antibiotic-related diarrhea. 10,11,16 18,25 28,75,76,94-95, 97-98,143,183,215 For example, one study evaluated 180 people, who received either placebo or 1,000 mg of saccharomyces daily along with their antibiotic treatment, and found that the treated group developed diarrhea significantly less often. 16 A similar study of 193 people also found benefit. 18 Three additional studies involving adults found that various species of Lactobacillus , taken either alone in combination, to be beneficial, 174,207 even in cases of Clostridium difficile , the most serious cause of antibiotic-induced diarrhea. 208
A review of 16 randomized trials further adds to this evidence. 219 This review included many different strains of probiotics (eg, Lactobacilli , Lactococcus , Bifidobacterium ), which were used alone or in combination. Bacteria that appeared to lack evidence of benefit included L. rhamnosus , L. sporogenes , B. lactis , and S. thermophilus . Like the earlier review, the pooled results of 34 randomized trials also found evidence to support the use of probiotics for the prevention of antibiotic-associated diarrhea in both children and adults. 225
On the other hand, a study of 302 people found no benefit with Lactobacillus GG . 25 And, a review of four probiotic studies found insufficient evidence for their effectiveness in the treatment of Clostridium difficile , the most serious cause of antibiotic-induced diarrhea. 159 Prophylactic use of Lactobacillus acidophilus LA-5 plus Bifidobacterium BB-12 (in combination with antibiotic treatment) was not associated with reduced incidence of diarrhea when compared to placebo. However, the probiotic reduced the duration time with diarrhea. 236
Although taking probiotic organisms in the proper concentration may be beneficial for antibiotic-induced diarrhea, at least one study found that consuming fresh yogurt during antibiotic treatments had no significant effect on the incidence of diarrhea. 160
Note: Diarrhea that occurs in the context of antibiotics may be dangerous; for this reason, physician consultation is essential.
Other Forms of Diarrhea
Two double-blind, placebo-controlled studies enrolling a total of almost 700 people undergoing radiation therapy for cancer found that use of probiotics significantly improved radiation-induced diarrhea. 79,136 Similar evidence supports the use of Lactobacillus rhamnosus , 153 as well as a special, nonpathogenic form of E. coli . 78 However, of 85 women receiving pelvic radiation for cervical or uterine cancer, those who consumed a liquid yogurt preparation enriched with Lactobacillus casei had no less diarrhea than those who took a placebo drink. 161
Small double-blind studies suggest S. boulardii might be helpful for treating chronic diarrhea in people with HIV, hospitalized patients being tube-fed, and people with Crohn's disease. 11,19 21
Premature infants weighing less than 2,500 grams (5.5 pounds) are at risk for a life-threatening intestinal condition called necrotizing enterocolitis (NEC). In a study that pooled the results of 9 randomized, placebo-controlled trials involving 1,425 infants, probiotic supplementation significantly reduced the occurrence of NEC and death associated with it. 177 A subsequent study found similar benefits in very low birth weight infants weighing less than 1,500 grams (3.3 pounds). 189 For one probiotic strain, L. reuteri , there may be other benefits, as well. In another study involving 249 premature infants, those treated with L. reuteri experienced fewer gastrointestinal symptoms, received fewer antibiotics, and were hospitalized less frequently than those treated with L. rhamnosus or no probiotic. 213
Benefits of probiotics for NEC was further supported in three reviews that evaluated 24 randomized trials involving infants at risk of developing NEC. Prophylactic enteral probiotic supplementation was compared to placebo or no treatment in infants who were preterm (less than 37 weeks gestation), had low birth weight (2,500 grams or 5.5 pounds), or both. Probiotics were associated with reduced incidence of severe NEC in 20 trials with 5,529 infants, fewer infant deaths for any cause in 17 trials with 5,112 infants, and fewer infant deaths related to NEC in 7 trials with 2,755 infants. 235
Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease)
The conditions Crohn's disease and ulcerative colitis fall into the family of conditions known as inflammatory bowel disease. Chronic diarrhea is a common feature of these conditions.
A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine. 37 The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials, as well. 38,82,112 For example, a 2011 review of 4 randomized trials with a total of 587 patients seemed to support the use of probiotics to reduce the relapse rates in people with ulcerative colitis. 222 The authors, though, pointed out the need for better designed trials.
One preliminary study found S. boulardii helpful for mild diarrhea in stable Crohn's disease. 20 However, two studies failed to find benefit with Lactobacillus probiotics, 113-114 and in an analysis of 8 randomized, placebo-controlled studies, probiotics were ineffective at maintaining remission in Crohn's disease patients. 165
Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such people frequently develop a complication called pouchitis, inflammation of part of the remaining intestine. A 9-month, double-blind trial of 40 people found that a combination of three probiotic bacteria could significantly reduce the risk of a pouchitis flare-up in people with chronic pouchitis. 39 Participants were given either placebo or a mixture of various probiotics, including four strains of Lactobacilli , three strains of Bifidobacteria , and one strain of Streptococcus salivarius . The results showed that treated people were far less likely to have relapses of pouchitis. Another study found that probiotics used right after surgery can help prevent pouchitis from developing at all. 80 One study, however, failed to find benefit with Lactobacillus johnsonii in people with Crohn's disease who have undergone a similar operation. 129
Finally, some evidence hints that probiotics might reduce the joint pain that commonly occurs in people with either kind of inflammatory bowel disease. 115
Irritable Bowel Syndrome
People with irritable bowel syndrome (IBS) experience crampy digestive pain as well as alternating diarrhea and constipation and other symptoms. Although the cause of irritable bowel syndrome is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS, with some success.
For example, in a 6-week double-blind, placebo-controlled trial of 274 people with constipation-predominant irritable bowel syndrome, use of a probiotic formula containing Bifidobacterium animalis significantly reduced discomfort and increased stool frequency. 144 In another trial of 298 IBS patients, 8 weeks of treatment with beneficial Escherichia coli reduced typical symptoms compared to placebo. 200 In a review of 3 randomized trials, Lactobacillus rhamnosus GG was associated with improvement in symptom, especially a reduction in abdominal pain, among 393 children with IBS. 223 And finally, a 4-week randomized trial involving 122 people with IBS found evidence that B. bifidum improved symptoms and quality of life compared to placebo. 224
Benefits have also been seen in small, double-blind trials using L. plantarum , 2,53,70L. acidophilus , 3,163L. rhamnosus , 130L. salivarus and Bifidobacterium , 116,188 in addition to proprietary probiotic combinations including various strains. 54,117,156,187 One such combination, called VSL#3, contains B. longum , B. infantis , L. acidophilus , L. plantarum , L. casei , L. bulgaricus , and Streptococcus thermophilus . In a double-blind, crossover trial , 59 children aged 5-18 years old were randomized to receive VSL#3 or placebo for 6 weeks. 214 After a 2-week "wash-out" period, the children were switched to the other treatment. VSL#3 was associated with a reduction in symptoms, including abdominal pain, bloating, and gas. Benefits have also been seen with combination prebiotic /probiotic formulas 118, 182, 199 and prebiotics alone. 197
Of course, other studies have failed to find probiotics more effective than placebo. 68,119,172 One randomized trial involving 90 people with diarrhea-predominant IBS found Saccharomyces boulardii to be more effective than placebo at improving quality of life. 216 But, the probiotic did not seem to improve the actual symptoms of IBS. Two studies that pooled previous randomized trials on the use of probiotics for IBS came to similar conclusions: probiotics appear to offer some benefit, most notably for global symptoms and abdominal discomfort. However, these two studies were unable to determine which probiotic species were most effective. 178,179
Lactobacillus plantarum 299v failed to provide significant improvements in abdominal pain, bloating, or quality of life when compared to placebo in a randomized trial with 81 adults over an 8 week period. 239
Probiotics Lactobacillus, Bifidobacterium, Escherichia , and Streptococcus (alone or in combination) were evaluated in a review of 37 randomized trials. Priobiotics were associated with fewer global symptoms, abdominal pain, bloating, and flatulence when compared to placebo. There were no differences found in urgency-related symptoms. Although probiotic therapy appears effective, the right combination of strains remains unknown. 238
Use of probiotics during pregnancy and after childbirth may reduce risk of childhood eczema . In a very large, long-term, double-blind study, 1,223 pregnant women were given either placebo or a probiotic mixture (containing Lactobacilli and Bifidobacteria ) beginning 2-4 weeks before delivery. 125 Their newborn children then received either probiotics or placebo for six months. The results showed that the probiotics mixture markedly reduced the incidence of eczema (though not of other allergic diseases). However, in a follow-up to this study, researchers found that the probiotic supplementation was not associated with reduced eczema in children followed through age 5. The probiotics also had no effect on allergic rhinitis or asthma. 193
Another study also yielded marginal results, 139 and a third study involving only lactobacillus found no benefit at all for the prevention of eczema. This latter study actually demonstrated a modestly increased the risk of wheezing bronchitis in infants who took the probiotic. 168 But, some probiotics combined with prebiotics may help to reduce wheezing in infants with eczema. For example, Bifidobacterium breve and a galacto-/fructo-oligosaccharide mixture (Immunofortis) showed benefit in one randomized study involving 90 infants. 206
Bifidobacterium longum and Lactobacillus rhamnosus supplementation did not reduce incidence of eczema atopic dermatitis or allergic sensitization at 12 months among Asian infants at risk of allergic diseases. 196
Researchers in another study concluded that not all probiotics are created equal. In this placebo-controlled study involving pregnant women and their infants, Lactobacillus rhamnosus reduced the incidence of eczema in the children, but a strain of Bifidobacterium animalis did not. 186
Lactobacillus plantarum was effective in reducing the severity of eczema symptoms. The randomized trial included 118 children aged 1-13 years with eczema comparing L. plantarum to placebo for 12 weeks. 227
According to some but not all studies, infants who already have eczema may benefit from probiotics. 30,51,52,77,120-121,128,154,166 However, a careful review of 12 studies involving a total of 781 children found no convincing evidence that probiotics can effectively treat eczema in this age group. 191
If probiotics are beneficial for childhood eczema, they are probably more effective at preventing the condition rather than treating it. A carefully conducted review of numerous studies cautiously concluded that probiotics may help reduce the risk of eczema in infants and children, particularly those at high risk. 154 And two subsequent reviews found that probiotics were more effective at preventing childhood eczema, particularly when given both to mother (before birth) and infant. 166,173
A number of studies suggest that various probiotics can enhance immune function . One 12-week, double-blind, placebo-controlled trial evaluated 25 healthy elderly people, half of whom were given milk containing a particular strain of Bifidobacterium lactis , the others milk alone. 42 The results showed various changes in immune parameters which the researchers took as possibly indicating improved immune function. Another double-blind, placebo-controlled study of 50 people using B. lactis had similar results. 41
A 7-month, double-blind, placebo-controlled study of 571 children in daycare centers in Finland found that use of milk fortified with Lactobacillus GG reduced the number and severity of respiratory infections. 43 In another controlled trial, probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb-12) given daily to infants in their formula significantly reduced the risk of acute otitis media and recurrent respiratory infections during the first year of life compared to placebo. 192
Benefits were seen in three other large studies, in which probiotics combined with multivitamins and minerals helped prevent colds (or reduce their duration and severity) in adults. 122-124 However, a smaller and shorter study failed to find any effect on respiratory infections. 81 Similarly, Lactobacillus fermentum given to 20 healthy elite distance runners over a 4-month period during winter training was significantly more effective at reducing the number and severity of respiratory symptoms compared with a placebo. 164
One study found that Lactobacillus GG or L. acidophilus may improve the immune response to vaccinations. 83
A review of 13 randomized trials with 3,780 children, adults, and older adults compared different probiotics to either placebo or no treatment for prevention of colds. Probiotic use was associated with lower risk of number of colds and shorter duration of cold. Several types of probiotics were used in the trials, including: 240
- Actimel with L. paracasei (L. casei) , Streptococcus thermophilus , and Lactobacillus bulgaricus
- L. plantarum HEAL 9 plus L. paracasei 8700:2
- Lactobacillus rhamnosus strain GG
- L. rhamnosus plus Bifidobacterium lactis Bb-12
- Lactobacillus acidophilus plus Bifidobacterium bifidum
- L. acidophilus plus L. casei
An 8-week, double-blind, placebo-controlled trial of 70 overweight people found that a probiotic treatment containing S. thermophilus and Enterococcus faecium could reduce LDL ("bad") cholesterol by about 8%. 45 Similarly positive results were seen in other short-term trials of various probiotics. 44,46,73,74,100-101 However, a 6-month, double-blind, placebo-controlled trial found no long-term benefit. 72 Researchers speculate that participants stopped using the product regularly toward the later parts of the study.
The addition of the probiotic Lactobacillus rhamnosus to regular was no better than than placebo in 77 patients with chronic rhinosinusitis. 201
Ventilator-associated Pneumonia
Critical illnesses can result in changes to gut bacteria, leading to a loss of healthy bacteria and overgrowth of harmful bacteria. This change in bacteria may affect the immune system, affecting overall health. Certain strains of probiotics may restore balance to the to the intestinal tract, which can help with overall immunity. Probiotics were analyzed in 2 reviews of 31 randomized trial with 3,236 critically ill patients. When compared to placebo or no treatment, probiotics were associated with fewer cases of ventilator-associated pneumonia (VAP), less risk of VAP, and other serious complications resulting from infection. Some data suggested probiotics may also be connected to fewer intensive care deaths. Although the results of these reviews are promising, more research needs to be done to make firm conclusions. 237
Supplementation for Infant Growth and Development
A review of 25 randomized trials with 2,971 infants did not find sufficient evidence to support supplementation of infant formula with synbiotics, probiotics, or prebiotics. There were no significant effects on growth, crying, colic, regurgitation, or restlessness compared to conventional infant formula. Synbiotics and prebiotics were associated with increased stool frequency.
Probiotics may play a role in balancing bacteria in the gut, but not all probiotics may be helpful.
A randomized trial of 82 breastfed infants with colic compared supplementation with oral Lactobacillus reuteri (L. reuteri) to placebo for 21 days. A reduction in more that 50% in mean crying time was seen in all infants who received L. reuteri compared to 63% of infants in placebo group. L. reuteri supplement and was also associated with a larger decrease in the amount of daily crying and better family quality of life scores. 231
In another randomized trial of 50 exclusively breastfed infants with colic, supplementation with L. reuteri for 21 days was associated with a 50% reduction in daily crying time when compared with placebo. 234
A second randomized trial with 90 infants found a similar decrease in crying time with L. reuteri , but there were no significant differences in crying time found in a small trial of 18 infants when Lactobacillus rhamnosus and Propionibacterium freudenreichii were compared to placebo. 232
L. reuteri was also found to have significantly better reduction in crying time compared to simethicone in randomized trial of 82 infants with colic. After 28 days, median crying time was reduced from 197 minutes a day to 51 minutes a day with L. reuteri supplemention compared to 145 minutes a day with simethicone. Crying time decreased by 50% or more in 95% of infants taking L. reuteri compared to 7% of infants taking simethicone. 233
However, L. reuteri in formula-fed infants 6 weeks old or less had the opposite effect. The probiotic was associated with an increase in fussing time (not crying, but awake and not content) compared to placebo. Probiotics were used for one month and the infants were followed for six months. L. reuteri showed no benefit for infants that were exclusively breastfed. 241
Safety Issues
Probiotics may occasionally cause a temporary increase in digestive gas. But, beyond that, they do not present any known risks for most people. In one trial of 140 healthy infants, formula supplemented with long-chain polyunsaturated fatty acids and probiotics appeared as safe as standard formula, and did not have any effect on infant growth by the end of the 7-month trial. 194
However, individuals who are immunosuppressed could conceivably be at risk for developing a dangerous infection with the probiotic organism itself; at least one person taking immunosuppressive medications has died in this manner. 31
In a detailed review of four studies, researchers concluded that the use probiotics did not benefit patients with severe acute pancreatitis. 184 Furthermore, according to one study, the use of probiotics led to an increased risk of mortality in patients with severe acute pancreatitis, and should, therefore, be avoided under these circumstances. 167
Interactions You Should Know About
- If you are taking antibiotics : It may be beneficial to take probiotic supplements at the same time, and to continue them for a couple of weeks after you have finished the course of drug treatment. This will help restore the balance of natural bacteria in your digestive tract.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 07/06/2016 -


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text: Wednesday, September 19, 2012 APTA Educates Legislators on Benefits of Therapy for Veterans With TBI Yesterday, Rep Mike Michaud (D-ME), ranking member of the House Veterans Affairs Subcommittee on Health, hosted an APTA-cosponsored briefing on traumatic brain injury (TBI). The Capitol Hill event, held for legislators and their staff, addressed how physical therapy, occupational therapy, and speech-language pathology are helping wounded warriors and veterans recover and rehabilitate from TBI and reintegrate into society. Aaron Eaton, PT, DPT, and Heather Malecki, PT, DPT, served as panelists with Paul R. Rao, PhD, CCC-SLP, chief operating officer for inpatient services at the National Rehabilitation Hospital in Washington, DC, and Tracey Ellis OTR/L, MPH, CEO of International Diagnostic Solutions and Ellis Therapeutic Consultants. Eaton shared his experiences as a former employee of the National Naval Medical Center (now Walter Reed National Military Medical Center) and member of the team that was responsible for physical therapy services for soldiers with war-related injuries, namely those with polytrauma, who had arrived from Landstuhl, Germany. Many of these patients also had TBIs. Malecki, rehabilitation and polytrauma coordinator at the Washington, DC, VA Medical Center, also provided insight on the needs of soldiers with TBI. She highlighted the benefits of coordination and cooperation among physical therapy, occupational therapy, and speech-language pathology. The American Occupational Therapy Association and the American Speech-Language-Hearing Association cosponsored the briefing. Find out more about APTA's efforts with wounded warriors at www.apta.org/TBI/WoundedWarriors/.


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http://www.sbnation.com/nfl-mock-draft/ ... ker-tryout
Silberman's first kick went only 16 yards and she appeared to injure herself on the kick. She took another kick, but that one was even worse, flying just 14 yards.
A former soccer player, Silberman had never played football before. She hoped that the time she spent with video games would give her an advantage, but the 28-year-old never really got a chance to kick due to her injury and will not make an NFL team right now.
Tough break and all that. I admire her ambition, but if you can't make ONE punt without injuring yourself, it's probably not meant to be.
Also, video games? Really?


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Job Information
Allied Universal AllyO Test Requisition 3 - DO NOT APPLY - TESTING ONLY in Santa Ana, California
Allied Universal is seeking Professional Security Officers. Our Security Officers allow us to contribute to our company's core purpose of providing unparalleled service, systems and solutions to serve, secure and care for the people and businesses of our communities.
Be at least 18 years of age with high school diploma or equivalent
Possess effective written and oral communication and interpersonal skills with ability to deal with all levels of personnel and the general public in a professional and effective manner
Able to obtain a valid guard card/license, as required in the state for which you are applying.
As a condition of employment, employee must successfully complete a background investigation and a drug screen in accordance with all federal, state, and local laws
Display exceptional customer service and communication skills
Have intermediate computer skills to operate innovative, wireless technology at client specific sites
Ability to handle crisis situations at the client site, calmly and efficiently
Able to:
Work in various environments such as cold weather, rain/snow or heat
Occasionally lift or carry up to 40 pounds
Climb stairs, ramps, or ladders occasionally during shift
Stand or walk on various surfaces for long periods of time
Allied Universal is an Equal Opportunity Employer committed to hiring a diverse workforce. Allied Universal will provide qualified individuals with reasonable accommodations pursuant to the Americans with Disabilities Act and/or any other applicable state or local laws. We are committed to hiring veterans and reservists. Since 2013, we have hired over 25,000 heroes.
Job ID: 2019-271210
Location: United States-California-Santa Ana
Job Category: Security Officer


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Today marks my third visit to Russia, the last being in 2006 when I had the privilege of meeting President Putin to talk about the freedoms with which NGOs can operate in this country. In a curious turn of events, and some six years later, both Putin and freedoms are still very much in the news.
You can take your pick from any number of scandals currently making headlines in Russia: planned legislation aimed at hampering NGO activity and the right to protest, draconian laws aimed at internet censorship – even the fallout from the recent performance by punk group Pussy Riot, which has garnered international attention.
What is different, between my last visit and now, however, is the scale and unbridled nature of the public's response. Russians have taken to the streets en masse to protest the shrinking democratic space in their country – up to 100,000 at various times in Moscow alone to speak out against Putin's rule. It's clear that Russians are no longer prepared to tolerate civil injustices and are increasingly prepared to speak up fearlessly in their own defense.
Amid this atmosphere, I am here to address the shrinking democratic space surrounding organisations like ours, but also to bring to people's attention an outrage of a different sort; one that goes beyond Russian borders to a plight much more epic – that of our shared Arctic.
I've said elsewhere that the quest to save the Arctic is one of the defining battles of our time, neatly bringing together the tensions between economy and ecology that exist in our modern world.
Russia today is a country in the midst of much welcomed growth and expansion – yet progress is happening at such a rapid rate that it has become reckless; short term interests are being vigorously pursued, yet the more pertinent question of longer term impacts is rarely addressed.
At Greenpeace we're campaigning for a halt to the senseless destruction of the Arctic in the quest for oil. We seek preservation of this pristine wilderness, and a focus instead on the many abundant sources of renewable energy that exist, and are viable alternatives, today.
When I confronted Arctic destruction by occupying the Leiv Eiriksson oil rig last year, I took with me 50,000 signatures in opposition. This year, we count well over 1.3 million voices from around the world (a great many of them Russian too); they are people who are prepared to be counted as they say No to the willful destruction of our planet.
I am here to say No to environmental destruction as much as I say No to limits on freedom of expression and assembly. History teaches us that in all major struggles, whether it's women's rights, apartheid, or the US civil rights movement, that it's only when people rise in peaceful acts of civil disobedience that the course of history changes.
Born in 1965 and hailing from South Africa, Kumi Naidoo was Greenpeace's International Executive Director from November 2009 until December 2015.
(Unregistered) GREEN Savior
Whatever Greenpeace would be doing for Pussy Riot - it would put the work of Greenpeace Russia in danger, and make situation for the girls rather wors...
Whatever Greenpeace would be doing for Pussy Riot - it would put the work of Greenpeace Russia in danger, and make situation for the girls rather worse.
Pussy Riot is at the beginning of a career, they just saved rights on their name, there is T-Shirts sold, I wouldnt wonder if one of the girls is becoming a model...
There was cyber-activists hacking the website of Moscow-court putting a video on it showing a video by a GAY Bulgarian punk band on it singing 'Putin lights the fire' - according to Putin homosexuals are perverts - I love it :)
Putin is said not being able to visit concerts of his favorite Band 'Deep Purple' anymore without having to fear them wearing Pussy Riot- T-shirts...
Question: what else could Greenpeace do besides risking already hard work in Russia being made even harder or nearly impossible.
Let Madonna and Sir Walrus take care of this problem... Greenpeace is needed in the Russian Arctic, Baikal - I do not want to know where else.
Pussy Riot will appreciate and understand it!
22 August, 2012 at 16:50
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As a foreigner and i think Putin will decide to listen to the people and stop Arctic drilling
17 September, 2012 at 14:35
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