Calculation of Body Surface Area (BSA) for Blood Volume

Calculation of Body Surface Area (BSA) for Blood Volume CHAPTER 25 Calculation of Body Surface Area, Circulating Blood Volume,  Requirement of Blood Products Namita Mishra, Sudha Rawat, Vishva Nath Sharma BODY SURFACE AREA (BSA) Body surface area (BSA) is the area of the external surface of the body, expressed in square meters (m2). In physiology and medicine, the body surface area is the measured or calculated surface of human body. It is used to calculate metabolic, electrolyte, nutritional requirements, drug dosage, and expected pulmonary function measurements. BSA is a measurement used in many medical tasks. For many clinical purposes BSA is a better indicator of metabolic mass than body weight because it is less affected by abnormal adipose mass. Nevertheless, there have been several important critiques of the use of BSA in determining the dosage of medications with a narrow  therapeutic index  like many chemotherapy medications. USES OF THE BSA To gain an appreciation of the true required glomerular filtration rate (GFR) renal clearance is usually divided by the BSA. To calculate a better approximation of the required cardiac output as for example in children, cardiac index is used. Cardiac output = Cardiac Index / BSA Chemotherapy is often dosed according to the patient’s BSA. Glucocorticoid dosing is also expressed in terms of BSA for calculating maintenance doses or to compare high dose use with maintenance requirement. CALCULATION OF BSA It is difficult to actually measure the surface area of the human body so various calculations have been published to arrive at the BSA without direct measurement. The most widely used is the Du Bois formula: BSA = 0.007184 X W0.425 X H0.725 A commonly used and simple one is the Mosteller formula: 0R BSA = ( [ H X W]/ 3600)1/2 Where H = Height W = weight for example : Patient’s weight = 65 Kg Patient’s height = 165 cm BSA = ([65 X 165])/3600)1/2 BSA= 1.72 m2 Recently, a weight-based formula was validated in the pediatric age group that does not include a square root, making it easier to use. It is [4Wkg+7]/[90+Wkg]. AVERAGE VALUES Average BSA for various weights: WEIGHT (Kg) BSA (m2) 1.5 4 0.13 – 0.26 4.1 – 9 0.26 – 0.48 9.1 – 14 0.48 – 0.56 14.1 – 20 0.56 – 0.71 20.1 – 26 0.71 – 0.84 26.1 34 0.84 – 1.0 34.1 – 50 1.0 – 1.4 50.1 66 1.4 – 1.63 Over 66.1 Over 1.63 EFFECTIVE CIRCULATING VOLUME Blood volume is the volume of blood (both red blood cells and plasma) in the circulatory system of any individual. A typical adult has a blood volume of approximately between 4.7 and 5 liters, with females generally having less blood volume than males. Blood volume (BV) can be calculated given the hematocrit (HCT; the fraction of blood that is red blood cells) and plasma volume (PV): BV = PV/ (1-HCT) Diagnostic technologies are commercially available to measure human blood volume. A recent radio nucleotide study called BVA (Blood Volume Analysis)-100, provides a measure of Red Blood Cells and Plasma with 98% accuracy. BLOOD VOLUME ESTIMATION WEIGHT (kg) BLOOD VOLUME ( ml/kg) New born to 10 85 11 to 20 80 21 to 30 75 31 to 40 70 Above 40 65 CIRCULATING VOLUME OF THE CPB CIRCUIT PRIMING VOLUME: the minimum amount of fluid (hemic or non hemic fluid) used to de- air the complete cardiopulmonary bypass (CPB) circuit is called priming volume or the circulating volume of CPB circuit. Priming of the CPB circuit is an important task for the perfusionist. Generally the main objectives of priming are: To deair the CPB circuit To check for any leaks in the circuit To check for any mistake in the assembling of the circuit To meet the need for the extra volume required to prime the CPB circuit as the patient’s blood volume is not sufficient enough to prime the CPB circuit. For achieving sufficient hemodilution. It is a standard practice to use a non blood CPB prime because of the benefits of hemodilution and concerns about blood borne diseases. The total priming volume is determined by the hardware selected for the circuit to be employed. Following are the tables showing the volume required to de-air various oxygenators, arterial filters and tubing. CPB CIRCUIT AND TOTAL PRIMING VOLUME WITH VARIOUS WEIGHT GROUP Weight Group (Kg) Boot Size (inches) Venous line Size (inches) Arterial line Size (inches) Total Priming Volume (ml) 0-4 1/4 1/4 1/4 450 4.1-8 3/8 1/4 1/4 600 8-12 3/8 3/8 1/4 800 12.1-25 3/8 3/8 3/8 1100 >25 1/2 1/2 3/8 1800 TUBING SIZE WITH VOLUME (ml/feet) SIZE (inch) VOLUME (ml/feet) 3/32† 1.8 1/8† 2.5 3/16† 5 1/4† 9.65 3/8† 21.7 1/2† 38.6 SPECIFIC CONSIDERATIONS: In cases where patient is deeply cyanotic the size of the oxygenator and tubing size is selected keeping in mind the requirement of higher degree of hemodilution and higher requirement of arterial blood flows because of the presence of large (or major) aorto-pulmonary collaterals (MAPCA’s). MAPCAs arise from the aorta or its large branches and supply blood to the pulmonary arteries, because of blockade of the main pulmonary arteries. These MAPCAs ‘steal’ part of the cardiac output of the aorta and this results in reduced systemic perfusion and thus increased pump flows are required during CPB in cyanosed patients with MAPCAs to compensate for this ‘stolen’ cardiac output. CACULATION OF BLOOD AND BLOOD PRODUCT REQUIREMENT The hematocrit (HCT), also known as packed cell volume (PCV) or erythrocyte volume fraction (EVF) is the volume percentage (%) of red blood cells in blood. It is normally about 45% for men and 40% for women. It is considered an integral part of a person’s complete blood count along with hemoglobin concentration, white blood cell count, and platelet count. Haemoglobin concentration is reduced as a normal consequence of CPB with hemodilution. Thus the hematocrit that will result from the hemodilution caused due to priming volume of the CPB circuit should be determined. Several calculations are required to assess hemodilution and blood product requirements. To determine the effects of hemodilution, the volume concentration formula is used. C1 X Pt BV = C2 X TVon CPB Where Pt BV = patient’s blood volume ( patient’s body weight X blood volume factor) TVon CPB = total volume on CPB (total priming volume + patient’s total blood volume) C1 = Pre bypass hematocrit of the patient (%) C2 = calculated hemodilutional hematocrit (%) A decision must be made initially regarding the desired hematocrit during cardiopulmonary bypass. Based on the results of the randomized clinical study from Children’s Hospital, Boston ,it seems reasonable to consider a hematocrit of 25% to be the minimal acceptable hematocrit for any cardiopulmonary bypass condition. When the desired hematocrit has been selected the amount of bank blood that must be added to the prime should be calculated. Prime RBC vol = {[C3]x[Pt BV + PV]} {Pt RBC vol} Where Prime RBC vol = volume of blood required in prime C3 = desired HCT on bypass Pt BV = patient’s blood volume ( patients body weight X blood volume factor) PV = total priming volume of the CPB circuit to be used Pt RBC vol = patient’s blood volume X patient’s pre bypass hematocrit For example: Patient’s weight = 5 Kg Pre bypass hematocrit (C1) = 40% Patients blood volume (Pt BV) = 5 X 85 = 425 ml (85 is blood volume factor for 5 Kg) PV (total priming volume of the CPB circuit to be used) = 600ml TVOn CPB = (600 + 425) = 1025ml Calculated hemodilutional HCT (%) (C2) = C1 X Pt BV / TVon CPB = 40 X 425 / 1025 = 16.5 % 16.5 is the hematocrit on bypass. If there is a certain desired hematocrit, then to achieve that hematocrit, the amount packed RBCs if needed for the same patient can be calculated as follows: C3 (desired HCT) = 30 % Pt BV = 425 ml PV = 600 ml TV On CPB = (Pt BV + PV) = (425 + 600) = 1025 ml Pt RBC vol = 425 X 0.40 = 170 Prime RBC vol = {[C3]X [Pt BV + PV]}-{Pt RBC vol} = {[0.30] X [1025]}-{170} = 137.5 Volume of RBCs needed in prime = 137.5 The hematocrit of packed RBCs is 70% thus 137.5/0.70 = 196 ml 196 ml of packed RBCs are needed to achieve a hematocrit of 30%. Thus, 196 ml of the clear prime fluid is removed from the priming volume to account for the added packed RBCs. Therefore the calculation of priming volume now has 196 ml of packed RBCs and 404 ml of prime (crystalloid or colloid). In some cyanotic cases where the patient’s pre bypass hematocrit is more, the blood is diluted to obtain an optimal hematocrit during cardiopulmonary bypass in order to decrease the viscosity of the blood to improve tissue perfusion and to prevent hemolysis. Thus the effect of priming fluid added to dilute the blood can also be calculated as: TVon CPB X C4 = TVon CPB 1 X C5 WHERE TVon CPB = total volume on CPB (total priming volume + patient’s total blood volume) = 1025ml C4 = Hematocrit (of cyanotic patient) on bypass = 0.60 TVon CPB1 = total volume on CPB after adding 500 ml of priming fluid to the CPB circuit. TVon CPB1 = (1025 + 500) = 1525 ml C5 = the new (affected) Hematocrit Thus C5 = (1025 X 0.60) / 1525 = 0.40 40 % is the new hematocrit achieved after adding 500 ml of priming fluid. FIBRINOGEN A critical consideration is plasma fibrinogen dilution. Normal plasma fibrinogen levels are 150-400 mg./dL. The infant/ pediatric patients relative low blood volume with priming requirements of the ECC circuit causes the fibrinogen concentration to be adversely diluted. During CPB, it is desirable to maintain the plasma fibrinogen concentration above 100 mg./dL. in order to prevent impairment of post-CPB hemostasis. Given an example of a 5 Kilogram patient with blood volume of (5 x 85) 425 ml, pre bypass hematocrit of 55%, hematocrit on CPB of 25%, priming volume of 800ml of the circuit to be used for CPB and fibrinogen level of 275 mg/dl. To calculate the effect of priming, patient’s plasma volume is calculated by following formula: BV = PV/ (1-HCT) PV = (1-HCT) X BV Thus PV = (1-0.55) X 425 = 191ml PV = 191ml Patient’s fibrinogen = 191 X 275 mg/100ml = 525 mg Number of milligrams required = (425 + 800 ) X (1.00-0.25) = 9.19 dl If the goal is 100mg/dl, then 919 mg of fibrinogen are needed. Amount of fibrinogen to be added = 919 – 525 = 394mg. 394 mg of fibrinogen must be added to the prime to achieve a goal of 100 mg per dl. FFP usually contains 200 mg of fibrinogen per dl. Thus ml of FPP needed = (394/200) X 100 = 197 ml. Now for the calculation of priming volume the 197ml of the prime fluid (crystalloid or colloid) is replaced by FPP. Thus the clear prime volume becomes 603ml. Suggested reading Jianfeng Wang, Eiji Hihara. A unified formula for calculating body surface area of humans and animal. Eur j Appl Physiol.2004;92:13-17 Dill DB, Costill DL. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J. Appl. Physiol. 1974; 37(2):247-248. Tarazi RC .Pulmonary blood volume. Eur Heart J.1985Oct;6SupplC:43 Tarazi RC . Blood volume.. Eur Heart J.1985;6SupplC:41-42

Being The One Who Cares: A Good Teacher Essay -- essays research paper

Being The One Who Cares: A Good Teacher   Ã‚  Ã‚  Ã‚  Ã‚  In order to be a good teacher I feel that one needs to be open and understanding of different events that might take place in the classroom. Students today are not treated the same as they were during the beginning of education and we have a variety of students which attend our public schools. There are girls, blacks, whites, Hispanic, and Native Americans and a number of other different races participating in our classroom studies. This is a wonderful accomplishment in our society. The variety of backgrounds which are found in the classrooms gives our young students a better understanding of different races and nationalities. However, with growth there are always problems. Because there are students from different backgrounds, we must cater to all their needs. There may be students in our classroom with completely different religious beliefs or no beliefs at all. Teachers must understand each student and their personal beliefs to make their learning environment comfortable. Every aspect of our society has changed, we live in a more promiscuous society. Our children are having children. We as teachers must educate our student to the deadly effects of unprotected sex. I feel as teachers earn tenure, they are more likely to effect the students in a more personably manner. Having a stable and open classroom, I feel the students will learn more and be a respected citizen in our society. In this project I will discuss, prayer in the classroom, AIDS and tenure.   Ã‚  Ã‚  Ã‚  Ã‚  Prayer in school is a controversial issue that must be considered and dealt with as quickly as possible. All people should feel free to worship and have loyalties to whichever religion they choose. If no religion is chosen, then the feelings of the person should be considered as will. Everyone has an opinion on this subject, but everyones opinion should not become an issue. Rather, the opinion should be offered in order to be accepted or rejected by the individual. I feel that a time should be set aside during the day to allow for mediation or introspection. This time could be used by the students for thinking, prayer, meditation or for private reflection. Therefore, those who choose to participate can do so privately. Since it is a quiet time, no religion is stressed, so whichever seems to be more importa... ...find out that the students which I have taught remembered me for the excellent job I have done.   Ã‚  Ã‚  Ã‚  Ã‚  I feel that the student teacher relationship is an important relationship. If the student respects the teacher they will receive the best education possible. If the communication is lost, some students may stray from the classroom activities and loose the sense of the nature of a good student.   Ã‚  Ã‚  Ã‚  Ã‚  If the teacher is a veteran teacher then the students are more likely to come to them regarding any problem. It may be a problem with their studies, a problem with another teacher, or even a domestic problem. Whatever it may be, we as teachers should act In Loco Parentis.   Ã‚  Ã‚  Ã‚  Ã‚  I can relate to the problems in today's classroom. I feel its important for respected teachers to earn tenure, not only for themselves but for the students as well. Familiar teachers become the students friends, and topics such as sex, AIDS, teenage pregnancy and religion might not be so difficult to discuss. We need personal discussion in our classroom. What goes on inside the classroom directly affect what will happen inside the classroom.

The Life and Work of Robert Browning :: essays papers

The Life and Work of Robert Browning Robert Browning was born on May 7, 1812, in Camberwell, which is now a part of London. He had no real formal education so he was largely self educated. His father was a smart man with an extensive library. His mother was kindly, religious minded woman, who loved music and her brilliant son. He lived at his parents house almost until the time of his marriage. He attended a boarding school near Camberwell and spent a little bit of his time traveling to places like Russia and Italy. But he preferred to have his education at home, where he was tutored in foreign languages, boxing, music, and horsemanship, and where he read "omnivorously." At the age of 14 he first discovered Percy Shelly works and was strongly influenced by it. After reading Shelly, He made the decision to be an atheist and a liberal. But in a few years he grew away from atheism and the extreme phases of his liberalism. The things he learned from the books he read would largely influence his poems later in his life. His earlier poetry was regarded with indifference and largely misunderstood. It was not until the 1860's that he would at last gain publicity and would even be compared with Alfred Lord Tennyson, another very famous poet of the time. Some of his early poetry was influenced by his unusual education. The poet also had an anxious desire to avoid exposing himself explicitly to his readers. The first poem he wrote called Pauline, was written in 1883 at the age of twenty-one, but he did not sign it because of his fear of exposing himself to the public too much. Since Browning did not want to expose himself too personally, he decided to try his hand at writing plays. He was encouraged by the actor W.C. Macready. Browning began work on his first play, Strafford, a historical tragedy. Unfortunately, the play only lasted four nights when it was first put on in London in 1837. For ten more years, the young writer would continue to struggle to produce a play that would better hold the attention of the audience, but they all remained failures. Not only did Browning profit from this otherwise disheartening experience, but writing the dialogue for the characters helped him explore the "dramatic dialogue." The dramatic dialogue, "enabled him to, through imaginary speakers, to avoid explicit autobiography and yet did not demand that these speakers act out the story with the speed or simplifications that a stage production demands.

Love in The Beauty and the Beast and Shrek Essay -- Movies Fairytales

Love in The Beauty and the Beast and Shrek Love is a common theme not only in the entertainment industry, but as well as in life. Love sells, and people in the movie industries understand this and gain from the profit. Movies often portray love between two people who are both beautiful, and not always the best person they can be on the inside. In Disney’s The Beauty and the Beast and Dreamworks’ Shrek not only do they have two people fall in love, but also they show how love is blind. When Lord Farquaad condemned all of the fairy tale creatures to Shrek’s (an ogre) swamp, he makes his way to the castle, with his trusty side-kick Donkey, to demand their removal. While there, he won a fight against the best knights of the land, and won the chance to go on a quest for Lord Farquaad. The quest was to go save Princess Fiona from the highest tower, where a dragon was guarding her. After successfully rescuing the princess, it was time for Shrek to deliver her to Lord Farquaad. During the journey back, both Princess Fiona and Shrek fall for each other. After over hearing a conversation between the princess and Donkey, Shrek felt betrayed and unloved. During the wedding, Shrek found out that she too is an ogre, though only at night, and that she loved him for who he is. Shrek interrupts the wedding to give Princess Fiona, true loves first kiss, which turns her into an ogre forever. The two fall in love and get married. Not only did they fall in love, but Donkey and the Dragon fell in love as well. Love was the major theme for Beauty and the Beast. The love for a father, a beast/ man, and for one’s self. Papa, an inventor that does not yet have a following, took a wrong turn and came upon a ca... ...he could not. As well Lord Farquaad did not ever love Fiona but just wanted to marry her in order to become a king and not just a lord, and when Shrek expressed his love for Fiona and their wedding, Lord Farquaad could not understand how a Princess could fall in love with an ogre. Love conquered all things in both movies. Nothing could stand in the way of love, no one no matter what the circumstance could come between Bell and the Beast, and Shrek and Princess Fiona. Though when their love was revealed both the Beast and Princess Fiona changed to take true love’s form, they loved and were loved for whom they were. The movies show a good example in life, how we should not date someone just because of what they look like, looks fade, but personalities are forever.

Frankenstein as a Symbol of Struggle Between Enlightened and Romantic P

Potential explanations or answers to current philosophical dilemmas are often presented through temporally relevant works of literature. The Romantic Era of the late eighteenth and early nineteenth century is characterized as a time in history in which aristocratic social and political norms of the Enlightened Era were radically investigated and questioned. For Enlightened thinkers, the idea of â€Å"being† was composed of three essential parts, the true, the beautiful, and the good. Isaac Newton’s contributions to scientific method were fascinating in the respect that they seemed to provide truths regarding quantitative matter. Yet his science failed to provide us with knowledge of all qualitative matters, such as morals and aesthetics. With Newton’s laws held in such high regard, the model of being was decomposed to simply the â€Å"true,† or scientific knowledge which is recognized and confirmed through his laws of motion, proceeding to exclude all matt ers which Newton’s lens could not be pointed. It is obvious that problems would arise as a result of Newton’s advancements. Qualitative matters could not be explained through Newton’s science, creating a sense of bewilderment. People began to question whether certain quantitative matters actually pertained to all aspects of life. Rousseau, whose writings contributed immensely to Romanticism, proposes a new model of â€Å"being,† which is later confirmed by Kant and Schiller. His new model strengthened the enlightened ideas of being, and allowed for the application of â€Å"being† to both the quantitative and qualitative. Mary Shelley’s â€Å"Frankenstein† provides an explanation to the struggle over â€Å"true being† between Enlightened and Romantic thinkers while exemplifying Romantic thought on pursuing p... ...he significance of the philosophical dilemma between Enlightened and Romantic thinkers is exemplified through Mary Shelley’s Frankenstein. This symbolic literary work provides readers with insight to the problem philosophers of the time faced when dealing with the idea of true being. Through the monster, the townspeople, and Walton, we are able to gain a complete understanding of the situation Rousseau, Kant, and Schiller dealt with. In the end, it is clear that in order to experience true being and beauty one must not rely solely on Newton’s scientific lens, but must also understand the quantitative matters such as morals and ethics. Works Cited Rousseau, Jean-Jacques, Angela Scholar, and Patrick Coleman. Confessions. Oxford: Oxford UP, 2000. Print. Shelley, Mary Wollstonecraft, and Joseph Pearce. Frankenstein. San Francisco: Ignatius, 2008. Print.

Causes of the Great War :: World War I History

Causes of the Great War The impact of the First World War is still with us. In many respects the events of modern Europe are a direct result of what happened during World War I. Adolph Hitler himself was a product of the First World War. World War I also gave Russian communists opportunity to overthrow the government in Russia and proclaim communism. The events that took place in "No Mans Land" definetly had an impact on the wars to come. The First World War had many causes. The spark of the Great War was the assassination of the Archduke Franz Ferdinand, soon to be at the throne of Austria-Hungary, and his wife by a Serbian nationalist, while traveling through Sarajevo. The Archduke was chosen as a target because Serbians feared that after he was at the throne, he would continue the persecution of Serbs living within the Austria-Hungary Empire. The Serbian terrorist organization, the Black Hand, had to carry out the assassination. The Arms Race is the second cause. Britain at that time was the largest empire in the world, and it also had the largest navy. The navy was so big and strong because the British needed to protect their empire and maintain the sea routes between the different colonies. Kaiser William of Germany hated and envied Britain for having a stronger navy than his. He increased the German navy and built many warships. Britain responded with building more ships and increasing its navy too. This started a race for building more and better warships and it created tension and competition between those two countries. The system of alliance were another major cause of the War. There was a feud between France and Germany about controlling the colonies, which leads to a greater conflict, the Great War. Europe at that time was divided into two rival alliance systems: Triple Entente that included Great Britain, France, and Russia and the Triple Alliance, which included the Central Powers of Austria- Hungary, Germany, and eventually the Turkish Empire. In order to balance the power, France and Russia signed an alliance. Russia saw itself as the 'protector of Slavs' in the war, and immediately mobilized. When the war began, the German decision that if they were going to have to fight Russia and France, they would strike at France first according to the Schlieffen Plan, and then turn West to Russia.

Chocolate vs. coffee Essay

A. There are many people who drink coffee every day. But do they live a healthy life? One of my relations – my father- is ‚coffee addicted‘. (Almost) Every morning, except of pure water or some fresh juice, he drinks coffee. Also, in every restaurant he goes to the first thing he orders is piccolo coffee with milk. That’s far from enough, don’t you think so? I’m really afraid about his health, especially because he is extreme smoker also. And so I’ll try to persuade at least you, that drinking coffee more then 3 times a day is unbelievably unhealthy. It’s because: B. Coffee is quite popular drink, however. There are further arguments for the coffee, for example it can lower the risk of Parkinson’s disease, diabetes and colon cancer and it prevents cavities. But it’s not a hundred percent sure. The fact is that if you drink more then 3 little cups of coffee per day it is more harmful then healthful. And it’s not healthy to drink coffee if you didn’t reach 18 years, until this age it has only few beneficial effects. But I think its good argument and really supporting fact. I was really surprised and quite shocked when I read the information I found on one webpage: â€Å"People who smoke and are heavy drinkers have less heart disease and liver damage when they regularly consume large amounts of coffee compared to those who don’t, â€Å"(http://men. webmd. com/features/coffee-new-health-food). That was really surprising for me; I never thought that something like this can be true. I’m really delighted to this and I’m happy that something like this was proved. Thanks to this I’ll support my father in drinking of this caffeine drink. There’s also some idea that coffee helps to control attacks of asthma when medication isn’t available. That’s a valid point, but it wasn’t proved yet, so it doesn’t have to be true. Another argument for coffee may be proved by anyone who drinks coffee quite often: Coffee improves our mood. I can prove this also eve I don’t drink coffee very often. And if we won’t drink too much of it, it can give us the appropriate amount of energy we need to finish the project, even we are really tired. To reach these effects, we have to drink 2 cups of coffee at least. C. But even coffee has many effective beneficial effects on our health, chocolate it much better (I think). There are further arguments against coffee, for example, even thought coffee is a drink, you will be even thirstier after drinking it. Chocolate is good for our arteries while coffee (at least the amount of caffeine it contains) damages them. Chocolate contains cocoa flavonoids (natural antioxidants) which keep the blood from making too thick and sticky and raise our good cholesterol, I think this negligible benefit. Some studies shown, that chocolate also lowers person’s blood pressure and so the risk of heart attack and heart diseases decreases. It’s also generally known chocolate helps our body to produce endorphins. The healthiest type of chocolate is dark chocolate. White chocolate is not very healthy at all. And I don’t like it. It tastes like vanilla and in many cases it’s really tasteless. Also milk chocolate isn’t so healthy; even it’s my favorite one. But back, to the dark chocolate. It lowers high blood pressure. Dark chocolate is also essential antioxidant. Studies have shown that milk can interfere with the absorption of vitamins and antioxidants from dark chocolate. D. At the end of this writing my state of view is different in some way, but I always prefer chocolate. But I really didn’t think that coffee has so many beneficial effects and that it’s so helpful. I just thought its only tasty mould. But I found out, it is also quite healthy. But anyway, chocolate is better. It tastes better and it helps us produce endorphins better then coffee. And another benefit is that you can take it anywhere you want. With coffee it’s a little problem. But don’t forget that there is a limit for everything. BIBLIOGRAPHY http://men. webmd. com/features/coffee-new-health-food http://www. webmd. com/diet/news/20030827/dark-chocolate-is-healthy- chocolate http://www. sciencenews. org/articles/20040529/food. asp.