Antipsychotic drug combinations are often given to patients early in treatment

Patients with schizophrenia and other mental illnesses are commonly prescribed high-dose combinations of antipsychotic drugs earlier than recommended by some guidelines, finds a new study in the March issue of General Hospital Psychiatry.

Antipsychotic polypharmacy (APP) is the co-prescription of more than one antipsychotic drug for one patient. APP is not unusual, but there is scarce evidence about how these drugs interact and whether combining them increases the risk of chronic side effects such as diabetes.

"The use of multiple antipsychotic drugs has become a common practice mostly based on practitioners' own experiences. That's because only a few published studies show contradictory outcomes," said lead author Amaia López de Torre, PharmD, with Galdakao-Usansolo Hospital, Galdakao in Spain. She said that until further clinical trials are available, practitioners should be aware of potential adverse effects and interactions derived from APP, especially in elderly patients.

Thomas N. Wise, M.D., professor of psychiatry at Johns Hopkins University School of Medicine and chairman of Inova Fairfax Hospital's department of psychiatry, said, "The study is excellent, and relevant and transfers to our experiences too, that antipsychotic drugs are often given in combination."

The researchers collected data over one day when 201 patients were admitted to the Hospital Psiquiatrico de Alava, a psychiatric hospital in Vitoria-Gasteiz, Spain. Of the 201 patients, 172 patients had been prescribed antipsychotics. 47 per cent of those patients were prescribed more than one drug. Four of the most common two-drug combinations had no supporting clinical evidence for their use. The researchers could find no supporting data for three-drug combinations which were prescribed to 19 patients. Moreover, 12 patients were prescribed drug combinations with known negative interactions.

The authors explained several possible rationales for APP. For example, prescribing lower doses of different drugs may relieve symptoms with fewer side effects than when a higher-dose single drug, or monotherapy, is used. The researchers also concluded that obtaining detailed patient histories, informed consent from patients/representatives and careful drug and side-effect monitoring is recommended before and following polypharmacy treatment.

Wise cautioned, "There is a myth that monotherapy may be a better approach than giving a combination of antipsychotic drugs to a patient. That may be true in an ideal world. Still, in the real world, where treatment efficacy and effectiveness are mandatory, a combination of drugs is often necessary because each has different properties."

More information: Querejazu, A.L., et al. (2012). Antipsychotic polypharmacy: a needle in a haystack? General Hospital Psychiatry.

Provided by Health Behavior News Service

"Antipsychotic drug combinations are often given to patients early in treatment." March 16th, 2012. http://medicalxpress.com/news/2012-03-antipsychotic-drug-combinations-patients-early.html

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Robert Karl Stonjek

The next decade of mental health drugs

Numb. Credit: Ten Thirty Nine from Flickr.

Academics advocate for changes to how we development better treatments for mental health.

Leading international academics are advocating for new approaches to drug development for mental health diseases.  Their comment article, published today (15 March) in the journal Nature, highlights the critical lack of new treatments for mental health disorders, to include Alzheimer’s, depression, and schizophrenia.

Professor Barbara Sahakian, of the Department of Psychiatry and MRC/Wellcome Trust Behavioral and Clinical Neuroscience Institute at the University of Cambridge, and Dr. Thomas Insel, Director of the National Institute of Mental Health in the United States, were leaders on the comment piece after a Royal Society meeting held to address the ‘pharmacological impasse’ concluded that the lack of viable new treatments ‘calls for a fundamental change in nearly every aspect of translational research in mental health’.

Despite nearly 40% of the population being affected by mental health issues, which includes everything from depression and dementia to anxiety and schizophrenia, the researchers say there is a crisis in the development of new treatments for these disorders.

Professor Sahakian explains part of the problem, “The pharmaceutical industry has in part withdrawn, either because they struggled to translate research into a viable drug or because of financial pressures.  Although some have remained, there are still insufficient resources being focused on diseases which affect a disproportionate percentage of the population.”

In the comment article, they cite genetics as providing fertile ground for drug exploration, highlighting the impact it has had on other medical treatments. Additionally, they propose having academics investigate compounds industry has abandoned.

Professor Sahakian added, “We need to reassess how we identify and validate new drugs, and should consider open access drug development which involves both industry and academia.”

Previous research has shown that mental disorders disproportionately affect the young, with 75% of illnesses having onset before the age of 24.  As a result, the academics also advocate for earlier intervention and preventative therapies.

But not all of the new treatments they advocate are pharmacological.  They highlight the effectiveness of treatments which integrate medications and psychosocial approaches.  Novel approaches could include the use of emerging technology such as the use of video games to help children with autism interact socially by increasing eye contact.

Provided by University of Cambridge

"The next decade of mental health drugs." March 16th, 2012. http://medicalxpress.com/news/2012-03-decade-mental-health-drugs.html

Posted by
Robert Karl Stonjek

New tools to answer timeless questions

Alan Jasanoff. Credit: Allegra Boverman

After finishing his PhD in molecular biophysics, Alan Jasanoff decided to veer away from that field and try looking into some of the biggest questions in neuroscience: How do we perceive things? What happens in our brains when we make decisions?

After a few months, however, he realized that he didn’t have the tools he wanted to use — so he decided to start making his own.

Jasanoff, who recently earned tenure in MIT’s Department of Biological Engineering, now specializes in developing novel brain-imaging agents that can reveal information more detailed than other human brain-imaging techniques such as fMRI and PET, and more comprehensive than traditional neuroscience measurements such as microscopy and electrode recordings. With the new tools, he is also beginning to explore some of the fundamental questions that first drew him into neuroscience.

Neuroscientists commonly use fMRI, which measures blood flow in the brain, as a proxy for neural activity. In the past several years, Jasanoff has developed sensors that can be used with fMRI to image brain activity more directly, by measuring levels of neurotransmitters (the chemicals that carry messages between neurons) and calcium, which enters neurons when they fire.

Using those sensors, Jasanoff has started exploring how positive reinforcement influences behavior and decision making in animals. His work could also be applicable to fields outside of neuroscience, because intracellular signaling molecules such as calcium “are really ubiquitous — not just in neuronal signaling but signaling throughout the body, during development, immune-cell activity and so on,” says Jasanoff, who is an associate member of MIT’s McGovern Institute for Brain Research and an associate professor of biological engineering, nuclear science and engineering, and brain and cognitive sciences.

[Video at the Website]

‘Timeless questions’

As a teenager, Jasanoff had a strong interest in science and two role models for a career in academia — his parents, both social scientists. Jasanoff spent his childhood first in Cambridge, Mass., where his father taught at Harvard University, then Ithaca, N.Y., where both parents were professors at Cornell University. His parents, Jay and Sheila Sen Jasanoff, have since returned to Harvard. “My sister Maya is also a professor at Harvard, so I’m the black sheep,” Jasanoff jokes.

While a senior in high school, Jasanoff got his start in science with a part-time job washing test tubes in a lab at Cornell. “That wasn’t a very technically sophisticated job, but I occasionally would hit up the local grad students and postdocs for slightly more scientific insight into what was going on,” he says.

As an undergraduate at Harvard, Jasanoff studied biochemical sciences and had a strong interest in structural biology, using the techniques of X-ray crystallography and nuclear magnetic resonance (NMR) to study molecules far too small to examine with the naked eye. “I like molecules,” he says, adding, “My mother always says it’s an outgrowth of my fascination with LEGO.”

He stayed at Harvard to get his PhD in biophysics, then went to MIT’s Whitehead Institute to begin independent research as a Whitehead Fellow. With a growing interest in some of the “timeless questions” of neuroscience, he began working on molecular-level neuroimaging — trading the relative predictability of structural biology for the complexity of a field “famous among many for its unanswerable questions,” he says.

Direct measurements

Functional MRI, or fMRI, currently one of the best ways to try to address those questions, provides an indirect view of what’s happening inside the brain, and can only reveal average activity in large regions. Meanwhile, traditional neuroscience techniques such as optical imaging provide a precise record of activity at the cellular level but cannot be done non-invasively over large areas of the brain.

Jasanoff wanted to find a way to have the best of both worlds — imaging large brain regions non-invasively, but with cellular precision.

He spent several years as a postdoc trying to achieve that in flies, until he realized that to be successful, he would have to develop his own molecular tools. “I tried one after another failed or weak experiments,” he recalls. “I sort of hoped there were off-the-shelf chemicals and reagents that could be useful for this, and that was probably foolhardy.”

Since joining the MIT faculty in 2004, Jasanoff has developed sensors that can be used with fMRI to monitor the neurotransmitters dopamine and serotonin, as well as calcium and other signaling molecules. The sensors, which currently can only be used in animals, include a section that binds to the target molecule, as well as a magnetic component that allows them to become visible with MRI.

Dopamine holds great interest for neuroscientists because of its role in reward, addiction and neurodegenerative disorders such as Parkinson’s disease. Jasanoff’s lab is now focusing on the role of rewards, or positive reinforcement of behavior, in decision making.

“This is one of the areas of neuroscience where I think we can make a difference relatively soon, just because we’ve got the tools for it,” Jasanoff says. “We’re also hard at work on sensors for a range of other molecular targets; our vision is to have a whole set of these probes available for ‘dissecting’ multiple aspects of neural function in living, intact brains.”

Provided by Massachusetts Institute of Technology

This story is republished courtesy of MIT News (http://web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.

"New tools to answer timeless questions." March 16th, 2012. http://medicalxpress.com/news/2012-03-tools-timeless.html

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Robert Karl Stonjek

Wooden Chip Art by Sergei Bobkov

Inviting Auspiciousness

“By offering good tidings and wishing for all good things to happen, it was as if the people invited auspiciousness to the scene. Rama and Lakshmana then left with the sage.” (Janaki Mangala, 31) hohiṃ saguna subha mangala janu kahi dīnheu | rāma lakhana muni sātha gavana taba kīnheu || In the Vedic tradition, it is important to keep an eye out for signs of auspiciousness. A long time ago, while the king of Hastinapura ruled over his kingdom after victory in a very bloody war, he began to notice auspicious signs. There was no quarrel anywhere, and greed and fierce competition were not allowed entry into the city. The subsequent inauspiciousness followed the introduction of these unwanted elements in society. Once the bad omens were noticed, that the Supreme Lord had left the phenomenal plane to return to His spiritual abode was evident. As the Lord’s absence represents the most inauspicious condition, King Yudhishthira knew that the immediate future wasn’t so bright. Many thousands of years prior, however, the same Supreme Lord was in the process of leaving from a local town, but instead of relying on the external signs around them, the people of the town offered such nice prayers that auspiciousness personified arrived on the scene as an invited guest. How does this work exactly? How can you create auspiciousness just by uttering a few words? Whether someone likes me or hates me, does it really matter in the end? If my boss says negative things behind my back or praises me to the hilltops, in the end all that matters is what he pays me. This is especially true if the relationship is based squarely on a business arrangement, where remuneration is expected. Isn’t every relationship the same way? How then can auspicious signs be found when the conditions speak otherwise? Are not the external circumstances the harbinger of things to come? The outside signals are paid attention to in the Vedic tradition, which is the oldest system of spirituality in existence. Spirituality is an all-encompassing field. From knowledge of the internal comes the ability to cope with the external. It doesn’t work the same way when the order is reversed. I may know how to maintain a shirt and coat, but this doesn’t mean that I can automatically take care of myself. On the other hand, if I feed myself regularly, go to bed on time, and properly treat illnesses, I can then figure out how to get dressed properly and wear the clothes appropriate to the situation. “As the embodied soul continually passes, in this body, from boyhood to youth to old age, the soul similarly passes into another body at death. The self-realized soul is not bewildered by such a change.”  (Lord Krishna, Bhagavad-gita, 2.13) Spirituality deals with the internal spark at the lowest level, the tiny but powerful force of spirit localized within the body. The fact that spirituality is considered separate from any other endeavor or narrow in scope shows just how much attention the external gets. The Vedas provide the first instruction that we are spirit soul, not part and parcel of the body. Our current dwelling changes constantly, from boyhood to youth to old age. However, the spirit soul’s fortunes can be shaped by how this body is utilized. To be put to the best use, the body must take actions under the proper conditions. Every collection of matter has an ideal utilization. If that property is violated, the item is not put to its proper use. Think of driving your car in the snow or using a fork to eat soup. With the duties prescribed to each member of society based on their specific order, there is a proper time and circumstance for action. When marriage arrangements take place, members of the priestly class determine an auspicious sign based on the qualities of the participants and the specific alignment of stars. If the conditions are not conducive to a future full of wedded bliss, the marriage ceremony will not be held at that time. On a larger scale, the outside conditions at any given time can portend good or bad things for the future. For a group of citizens a long time ago, their desire for future auspiciousness was so strong that they did not worry about the external circumstances. Instead, they gave everything - body, mind and soul - over to their beloved Lord Ramaand His younger brother Lakshmana, who were on their way out of the town to escort a venerable rishi in his travels through the forests. Why were the townspeople so enamored with Rama? Why not offer the same dedication to their own children? Shri Rama is the soul of all creatures, the original life force. From one have sprung many, and that one is supporting all the many at the same time. Because of His inherent qualities, every single life form is naturally attracted to Him. In the perverted version of that natural desire, the love turns to hate, but the attraction is still there. Even in apathy the attraction leads to association with the external feature of the Lord known as material nature. With the residents of Ayodhya during the Treta Yuga, the personal presence of that original person was available. Everyone made the most of that opportunity by offering their love purely, without motive. An absence of motive means that there is no desire for personal benefit. I work at the office so that I can get paid. I go to school so that I’ll get an education. I give money to the poor so that I won’t feel as bad about their situation. I offer help to someone because I am afraid of the negative consequences that will come from not offering that help. The residents of Ayodhya had no such motives or fears. They were tied in a bond of affection to the eldest son of King Dasharatha. Rama was a boy of less than twelve years of age when He had to leave the town for a short while. Vishvamitra Muni, a member of the priestly class, previously faced harassment in the forests from a Rakshasa named Maricha. That demon had fellow night-rangers with him to help in attacking the priests. Rama was a member of a royal family, so He was trained in the military arts. Vishvamitra knew that Dasharatha’s eldest son could protect him. Rama took Lakshmana with Him because the younger brother could not live without Rama. Lakshmana was equally as capable a fighter, with the duo combining to have a fire and wind effect. Fire can only burn the local area, but if combined with wind, it can spread across a much greater distance. With Lakshmana by His side, Rama could extend the reach of His protection to all the saints residing in the forest. “Rama’s younger brother, Lakshmana, has reddish eyes and a voice that resounds like a kettledrum. His strength matches that of Rama’s, and his face shines like a full moon. Just as wind gives aid to a raging fire, Lakshmana has joined forces with his brother. It is that best of kings, Shriman Rama, who has brought down the Rakshasas fighting in Janasthana.” (Akampana speaking to Ravana,Valmiki Ramayana, Aranya Kand, 31.16-17) Now that we have this information, the behavior of the residents seems odd. On the one side you have a mature adult approaching the king of the town for help in getting protection against the wickedest terrorists in the world. The rishi came to Ayodhya only to ask for this young boy to protect him. Meanwhile, the residents of the town viewed the same youth as helpless. Therefore when Rama was walking away, they prayed for His welfare. They asked God that Rama return successful and that He not as much have a single hair removed from His head while taking a bath. Can we imagine such purity in emotion? They prayed to God for God’s welfare. It seems silly to do this, but this behavior actually represents the height of devotion. It is the embodiment of selflessness. Goswami Tulsidas very much appreciated these sentiments. In the above referenced verse from his Janaki Mangala, we see that the poet has personified mangala, or auspiciousness, and said that through their offerings of good tidings the residents essentially invited auspiciousness to the area. Omens be damned, what they offered to Rama was better than any external sign of nature. It was during these conditions that Rama and Lakshmana walked away with Vishvamitra. The same practice has been followed ever since that time by sincere devotees. In temples where God is worshiped, the deities are awakened to the chanting of the holy names. Auspiciousness is invited to the scene by first offering prayers to Tulasi Devi, the Lord’s beloved servant. Next, the spiritual master is honored, for he is the Lord’s representative. With the blessings from Tulasi Devi and the guru, the proper mood of worship is created, allowing the further proceedings to have lasting effects. Though there are different methods of religion, and even smaller sub-religions that meet targeted goals, nothing can be higher than the mood of worship shown by the residents of Ayodhya. They prayed to God for God to be safe, and the same type of prayer can be invoked by reciting the maha-mantra, “Hare Krishna Hare Krishna, Krishna Krishna, Hare Hare, Hare Rama Hare Rama, Rama Rama, Hare Hare”. Not to be confused with a prayer asking for personal wealth, the elimination of distress, or the perfection of mysticism, the sacred syllables uttered in the most wonderful prayer ask God and His energy for the benediction of being able to continue in service to Him. Yet the innocent people of Ayodhya didn’t even ask for that. They just wanted Rama and Lakshmana to be okay. Of course the duo would always be in good spirits, and their vision would remain in the minds of the sweethearts protected by King Dasharatha. The boys would protect Vishvamitra well, and they would have the pleasure of escorting him to Videha, where a grand sacrifice was taking place. The auspicious conditions under which Rama and Lakshmana left were matched with the wonderful atmosphere of their return, when Sita Devi, the goddess of fortune herself, came to Ayodhya as Rama’s wife. Just as the residents did not worry about outside conditions, time or circumstance when praying for Rama’s welfare, the sincere devotee does not have to pay much concern to the circumstance when reciting the holy names. The sound vibration representation of the same Shri Rama can be invoked, honored, cherished, and held on to for sustenance at any moment. Correspondingly, Shri Rama’s association, including the vision of His beautiful form leaving Ayodhya with His younger brother Lakshmana, can be created at any moment, even right at this very second, should we so choose. In Closing: When sadness upon the residents of Ayodhya fell, Their worries for Rama’s welfare God they did tell. Typically, future guessed from outside omens’ sight, But residents decided auspiciousness to invite. For proper time and circumstance why wait? Insisted that brothers live in pleasurable state. Let them successful in protecting sage return, Then their eyes fruit of existence to earn. Chant holy names at any time, For auspiciousness to find.

Immune Role in Brain Disorder?

Replacing immune cells in a mouse model of Rett syndrome, a developmental brain disorder, improved symptoms, suggesting a new target for treatment.

By Hannah Waters | 

Microglia (green) and neurons (red). Wikimedia Commons, Gerry Shaw/Encor Biotech

Rett syndrome is a devastating genetic disease in which brain development—along with communication and motor skills—regresses after about 18 months of normal development. While previous work on this disease has focused on its neurological basis, new research published online yesterday (March 18) in Nature suggests that the immune system may be a target worth investigating: in a mouse model of the disease, bone marrow transplants significantly improved symptoms, extending lifespan far and beyond what was expected, increasing size and reducing tremors.

“It’s a very interesting, very provocative paper that could potentially be very important both for the basic biology of the disease as well as translational aspects of it,” said Qiang Chang, who studies the molecular mechanisms of Rett syndrome at the University of Wisconsin and was not involved in the new study. “But I think this is the type of work that probably raises more questions than it answers.”

Rett syndrome is caused by many different mutations in the Mecp2 gene, which lies on the X-chromosome and regulates thousands of other genes by binding to and altering methylation marks attached to DNA. Posing a further challenge to understanding the disease’s mechanism, Mecp2 is expressed in many tissues in the body. “Every cell type has methylation, but the methylation patterns may be different cell to cell,” said Zhaolan Zhou, who studies epigenetics and Rett syndrome at the University of Pennsylvania and did not participate in the research. “If that’s the case, Mecp2 may regulate and participate in different pathways in different cells.”

However, because Rett syndrome is a brain disorder, most of the research has focused on Mecp2’s activity in neurons—and not without good reason. “It’s extremely highly expressed in neurons, and it’s thought that the protein plays an important role in the maturation of neurons and brain circuit,” said Chang. Children with Rett syndrome are born essentially “normal” with symptoms showing up some 18 months later, and “that’s the window whenMecp2 is dramatically upregulated” in the brain, he added.

But the new research suggests that brain cells may not present the full picture. After reading a paper published a decade ago about how Mecp2mutations slow T-cell growth, neuroimmunologists Noël Derecki and Jonathan Kipnis from the University of Virginia School of Medicine decided to further investigate immune system interactions with Rett syndrome.

They focused on microglia, which are “classic immune cells that happen to live in the brain,” said Derecki. Microglia taken from the brains of mice lacking Mecp2 were less able to respond to invaders and “were very much impaired in a number of their functions,” he said. “If the immune system, including the microglia, was functioning in an impaired way, replacing the impaired immune system with a normal immune system might improve the disease somewhat.”

The researchers irradiated 4-week old male mice that lacked Mecp2 to kill off their immune cells—including microglia—and then injected their bones with marrow from normal mice. The idea was that the non-mutated stem cells in bone marrow would generate normal immune cells that then could migrate into and repopulate the brain.

Because male mice only have one X-chromosome, if their single copy of Mecp2 is missing, they are incredibly sick: they live just 8 weeks on average, are small, and have tremors and breathing irregularities. But the mice that received bone marrow transplants survived much longer—“the oldest mouse at this point is just under a year,” said Derecki—and they looked and acted much more like normal mice.

The mice weren’t cured, however; while some of their symptoms  were reduced, the brain cells still carried the mutant copy of Mecp2. “It certainly is a disease of neurons, and the neurons still have their own problems—but it’s also likely a disease of many other cell types,” said Derecki. “We don’t think microglia cause the disease, but we think that when they malfunction, they make the disease much worse.”

But the research doesn’t mean that children with Rett syndrome should start getting bone marrow transplants, the researchers added. “[A bone marrow transplant is] a huge thing to do for a kid who is already sick,” said Kipnis. “But this study shows for the first time that there are targets other than neurons.”

And the immune system is a particularly appealing target for disease treatment because it’s “much more feasible to target than any other target so far,” added Kipnis. “You don’t have to deal with the brain and delivering drugs across the blood-brain barrier.”

Both Chang and Zhou want to know more about the possible mechanism and to see the results replicated in other labs, but they are intrigued. “The paper suggests that Mecp2 is important for every cell type,” said Zhou. “It’s created a fascinating biological problem to work out.”

The next step is to identify some of the genes that are regulated by Mecp2 in the immune system. “It could be thousands of them; we have no idea how big this mountain is,” said Derecki.

N. Derecki et al., “Wild-type microglia arrest pathology in a mouse model of Rett syndrome,” Nature, doi: 10.1038/nature10907, 2012.

Source: TheScientist
http://the-scientist.com/2012/03/19/immune-role-in-brain-disorder/

Posted by
Robert Karl Stonjek

Home Remedies for SNORING

SNORING Snoring is the sound produced, while sleeping, due to the vibration in the respiratory structures. In this situation, the air movement gets obstructed while breathing, resulting in the sound. The throat or pharynx is a muscular tube that relaxes and decreases in size when a person is sleeping. For some people, this narrowing is enough to cause vibration of soft tissues in the pharynx. Some of the causes of snoring include muscle tone of the tongue, blockage of airway, age factor, alcoholic beverages, certain medications and sheer physical exhaustion. While the sound produced while sleeping is the only symptom of snoring, it is, at times, accompanied by heavy breathing as well. Snoring can, however, be treated at home also. Read onto get some natural remedies for curing snoring.Home Remedy For Snoring One of the best ways to stop snoring would be to lose weight. This might surprise you, but weight loss reduces and even ends snoring. Another way to stop snoring would be to lessen, better stop, smoking. It is said that smoking causes increased nasal congestion and mucous in the throat area. Alcohol causes relaxation in the soft tissues and muscles in the throat, leading to snoring. Reducing the intake of alcohol can lessen, or even stop, snoring. The ideal posture while sleeping would be on the sides. This would reduce the intensity of sound created while snoring. Olive oil is said to reduce snoring. Take 2 to 3 sips of it before going to bed. This would lessen the noise and also stop snoring after some time. Follow a regular sleep routine. Sleep at fixed times and get up at the same time. This is believed to reduce snoring. In boiling water, place a bunch of sage and let it steep. Allow it to cool. Before going to bed, strain this mixture and gargle with the liquid. This will prove effective in reducing snoring. Avoid having heavy meals or foods that are too spicy or oily, in dinner. They tend to aggravate the problem of snoring. Causes & Symptoms of Snoring One of the most annoying health conditions, snoring, more than being a disorder, is a source of embarrassment for the affected person. It is most commonly noticed in adults, though young people cannot be completely excluded from the potential list of people affected by it. Snoring occurs when air flows past the relaxed tissues in your throat, causing the tissues to vibrate as you breathe. This leads to the production of hoarse or harsh sounds. Loud sounds, followed by heavy breathing, make up the only symptom found during snoring. There are various reasons due to which a person snores. To know more about the causes and symptoms of snoring, go through the following lines.Causes Of Snoring Mouth anatomy Overweight Alcohol consumption Nasal problems Deviated nasal septum Sleep apnea Narrowing of the area at the back of the throat Sleeping on the back Excessive smoking Asthma Cold or flu Receding lower jaw Blocked nose Having a large uvula or enlarged tonsils Having low levels of thyroid hormone Menopause Inflammation and irritation to the nostrils and throat Allergies Symptoms Of Snoring Loud sounds, followed by heavy breathing    Warning: The reader of this article should exercise all precautionary measures while following instructions on the home remedies from this article. Avoid using any of these products if you are allergic to it. The responsibility lies with the reader and not with the site or the writer.

ஒரு பெண் ஆணிடம் எதிர்ப்பார்ப்பது..

ஒரு ஆணின் கவர்ச்சியாக பெண் நினைப்பது எதுவெனக் கேட்டால், அந்த கேள்விக்கான பதில் பெண்ணுக்கு பெண் வேறுபடும்... சராசரியாக பெண்கள் ஆண்களின் கவர்ச்சியாக எதை நினைக்கிறார்கள், அவர்களை கவர்வது எது, அவர்கள் எதிர்பார்ப்புகள் என்ன என ஆராய்ந்து, ஒரு ஆணின் கவர்ச்சி என்ன என்பதை இங்கு சொல்கிறேன் … ஒரு பெண்ணின் கவர்ச்சி என்ன என்பதற்கு பல ஆண்களின் பதில் ஒரே வரியில், ஒரே மாதிரியான பதிலாயிருந்தாலும், ஆண்களின் கவர்ச்சி என்ன என்பதை ஒரே வரியில் பதிலளிக்க இயலாது, ஏனென்றால் ஆண்களின் கவர்ச்சியில் பல வகைகள் உள்ளன. நிறம்: ஒரு ஆண் சிவந்த மேனியாக இருக்க வேண்டும் என fair complexion உள்ள பெண்கள் கூட எதிர்பார்ப்பதில்லை. ஒரு ஆணின் வசீகரம் அவனின் நிறத்தில் அல்ல என்பதே பெண்களின் கருத்து. முகத் தோற்றம்: ஆணின் நிறத்திற்கு முக்கியத்துவம் கொடுக்காத பெண்கள் கூட, அவர்கள் மீசைக்கு முக்கியத்துவம் கொடுக்கிறார்கள். மீசை ஒரு ஆணுக்கு அழகு, கம்பீரம் என்பது அவர்கள் கருத்து. மீசையை பிடிக்கும் பல பெண்களுக்கு ஏனோ  தாடி பிடிப்பதில்லை. காரணம் நம்மூர் ஆண்களுக்கு தாடி வளர்த்தால் அதை ஒழுங்காக பராமரிக்கத் தெரிவதில்லை என்பதுதான். சரியாக டிரிம் பண்ணாமல் காடு மாதிரி வளர்ந்த தாடி ஒரு ஆணை சோகமாகவும், நோய் வாய்ப்பட்டது போலவும் தோற்றமளிக்க செய்துவிடும். உடை அலங்காரம்: பொதுவாக பெண்கள் தங்கள் உடை அலங்காரத்திற்கு அதிக அக்கறை எடுத்துக் கொள்வார்கள், அதனால் நல்ல ட்ரெஸ் ஸென்ஸ் ஆணிடமும் எதிர்பார்க்கிறார்கள். பேன்ட்டின்  நிறத்திற்கு கொஞ்சம் கூட சம்பந்தமே இல்லாத கலரில் ஷர்ட் அணிவது, சரியான அளவில் ஷர்ட் போடாமல், தொழ தொழ என நீளமான ஷர்ட் அணிவது, போன்றவை பெண்களுக்கு பிடிப்பதில்லை. இன்றைய ஆண்களின் கவர்ச்சி உடையாக அதிக பெண்கள் கருதுவது ஜீன்ஸ்- டி ஷர்ட். இடத்திற்குத் தகுந்தாற் போல் உடை அணிய வேண்டும். சுத்தமான, நல்ல கலர் சென்ஸுடன் உடை அணிந்தால் பெண்களின் மனதில் சீக்கிரமாக இடம் பிடித்து விடலாம். பேச்சுத் திறன்: முதன் முறையாக ஒரு பெண்ணிடம் பேசும்போது, லொட லொடவென சொந்தக் கதை, சோகக் கதை எல்லாம் பேசக்கூடாது. அதே சமயம் அந்தப் பெண்ணிடமும் அவளைப் பற்றின சொந்த விஷயங்களை நோண்டி நோண்டிக்  கேட்க கூடாது. அவளுக்கும் பேச சந்தர்ப்பம் கொடுத்து, அவள் பேசும் போது கூர்ந்து கவனிக்க வேண்டும் (அவள் முகத்தை மட்டும்!). முதல் நாளிலேயே பெரும்பான்மையான பெண்கள் நன்றாக பேசி பழகமாட்டாகள், அதனால் அவர்கள் பேசும் ஒரிரு வரிகளிலிருந்தே உங்கள் உரையாடலை வளர்த்துக் கொள்வது உங்கள் சாமர்த்தியம். இவை அனைத்தும் பல பெண்களின் சில சில எதிர்பார்ப்புகளே, ஏற்கனவே சொன்ன மாதிரி எதிர்பார்ப்புகளும், ஆசைகளும் பெண்ணுக்கு பெண் வேறுபடும்.

THREE WAYS TO TAKE YOUR BUSINESS TO THE NEXT LEVEL

Sometimes its difficult to see the way forward or how to expand. These quick tips will rejuvenate your business and help you go from mediocre to amazing. Get the 3 strategies here!

INC shares…

Dealing with the same old growth problems? You may not be thinking big enough. Follow these “must do” steps to grow your company to millions in revenue.

1. Evaluate your financing, and ready your business for expansion.

“Women come into our program thinking about getting to 25 or 30 million,” says Engert. “We want them to get to 100 million and beyond.” He notes that access to capital and funding alternatives and how a business owner navigates and negotiates that process is one of the biggest issues facing entrepreneurs today, especially women. “We try to connect women in the program by tapping into our larger ecosystem,” he says. “There’s lots of capital out there to be deployed.”

Lisa Bair, founder and president of Hobart Group Holdings, a healthcare marketing and advertising agency, participated in Entrepreneurial Winning Women. She says: “To be honest, before Entrepreneurial Winning Women, I was so involved in running the business on a day-to-day basis, I hadn’t thought about its life cycle beyond $20 million in annual revenue—and we will cross that line this year. I completely revised my business plan after the Strategic Growth Forum.”

Engert recognizes that access to angel investors, small business loans, and a greater variety of financing alternatives are crucial for entrepreneurs. “It’s important to leverage your networks and advisory boards,” he says. “Tap into the variety of resources available, like larger organizations that would be teaming partners to you and your company. All large organizations are looking to tap into innovative entrepreneurial businesses these days, so explore that avenue.

2. Think big and be bold.

“Thinking big boils down to part confidence and part awareness,” says Engert. He advises that business owners step outside the box and think about where they can take their business. “Think about scaling, not only your service and product offerings, but also vertical opportunities that you could move into. Think outside the box about partners that you could team with to be innovative. There are a lot of conversions happening across sectors, don’t think in only your one particular sector or about just your product and services. Lots of large companies want to include young, innovative companies in their collaborative innovation networks.”

Bair put managing directors in place at the head of her marketing services businesses in New York and New Jersey and formed a third company devoted solely on product development. “I am now 100 percent focused on a three-to-five year vision,” she explains, “that includes building out our expertise, the possible acquisition of complementary companies and investment capital to allow us to scale.”

3. Build a public profile.

Studies based on past award winners show that women tend to be modest about their achievements. Many of the applicants for the Entrepreneurial Winning Women Program have company websites that don’t include anything about the leader. Revise your site to include information on your achievements, vision and insights. Press can put you on the map, what are you doing to increase your visibility?

Get more information at INC!