"INTERNAL MEDICINE"

Introduction to Infections

2009-12-21T02:13:00.000-08:00

Infectious diseases have been the most important concern for the healthcare officials and department.They have been busy since outset for the prevention and treatment of infectious diseases.These are the diseases which are caused by variety of organisms and micro-organisms including bacteria,viruses,parasites,fungi and other protein particles like prions.
People have been busy in treating these infectious diseases and variety of antibiotics have come into existence due to their work.These drugs include antibacterials,anti virals,anti fungals and antiparasitic.
Latest infectious diseases encountered by mankind are bird flu and swine flu,which is caused by influenza virus types.Infectious disease presentation varies from simple fever to hemorrhagic episodes and sepsis.So immediate care and management of these diseases is mandatory or if overlooked may be devastating

MYASTHENIA GRAVIS

2009-12-19T23:27:00.000-08:00

What is Myasthenia Gravis?
It is an autoimmune disorder of neuromuscular junction(NMJ) resulting in decrease in muscle power and easy fatiguability.

What is its incidence?
It is more common in women as compared to men,mostly before 30 yrs of age.

What are the other causes of Myasthenia Crisis?
Aminoglycosides,D penicillamine and Infections can lead to Myasthenia crisis.

What are the sign and symptoms ?
It results in muscular weakness and fatiguability.Most common groups of muscles involved are ocular,muscles of mastication,speech and proximal muscles.
Respiratory muscles involved can lead to respiratory paralysis.
Ocular muscles paralysis results in Diplopia and extraocular in ptosis.

How is it diagnosed?
Basically a clinical diagnosis but few other investigations can be helpful like
Choline receptor specific antibodies,Tensilon test(Edrophonium),Chest X ray,CT scan and MRI chest.
Blood CP and other biochemical profile is normal however RA factor and ANA are raised.

There is not much role of Muscular Biopsy.

How is it managed?
DRUGS:
Pyridostigmine 60 mg 3 to 4 times daily is used to improve the muscular weakness.

Steroids and Azathiopurine are the drugs used for immunosuppression.

THYMECTOMY.

PLASMAPHERESIS.

HEPATITIS

2009-10-25T20:59:00.000-07:00

What is Hepatitis?
Hepatitis implies injury to the liver characterized by the presence of inflammatory cells in the tissue of the organ.

What is its History?
The name is from ancient Greek hepar, the root being hepat, meaning liver, and suffix -itis, meaning "inflammation".The condition can be self-limiting, healing on its own, or can progress to scarring of the liver.

What are the types of hepatitis?
Hepatitis is acute when it lasts less than six months and chronic when it persists longer.

What are the causes of hepatitis?
A group of viruses known as the hepatitis viruses cause most cases of liver damage worldwide.

Hepatitis can also be due to toxins (notably alcohol), other infections or from autoimmune process.
The common virus causing hepatitis are;

Hep A virus
Hep B virus
Hep C virus
Hep D virus
Hep E virus

Hep A and E run an acute course.
Hep B can have both acute and chronic course.
Hep C most of the times is chronic only.
There cannot be an isolated Hep D virus infection,it usually occurs with Hep Bvirus infection.

What is the clinical course of hepatitis?
It may run a subclinical course when the affected person may not feel ill. The patient becomes
unwell and symptomatic when the disease impairs liver functions that include, among other things,removal of harmful substances, regulation of blood composition, and production of bile to help digestion.

Symptoms of acute hepatitis are usually loss of appetite,dark colored urine,feeling of nausea and
vomitting,low grade fever,distaste to smoking,yellowish discoloration of membranes.

Chronic Hepatitis present usually as Chronic Liver Disease or Cirrhosis.
It can be both compensated and decompensated.

How is Hepatitis diagnosed?
Clinical examination leads to further lab investigations which include;
Liver function tests
Serology for specific type of hepatitis
ElISA method
PCR for Hep Viruses

Other relative investigations are :
USG Abdomen
Prothrombin time
Bile salts

What is the treatment?
Hep A and E acute types have no specific treatment,it take 2 to 3 weeks to recover fully,unlooked

rare cases may go into Fulminant hepatitis??

Hep B and C if diagnosed in time can be cured completely by use of interferons and anti viral drugs

for 6 months to 1 yr duration variably.

Vaccine for Hep B is available in market by name of Engirex.It is very helpful for prevention of

Hep B ,no vaccine for Hep C virus inf is available.

Healthy Eating for a Healthy Weight

2009-10-25T09:23:00.001-07:00

A healthy lifestyle involves many choices. Among them, choosing a balanced diet or eating plan. So how do you choose a healthy eating plan? Let's begin by defining what a healthy eating plan is.
According to the Dietary Guidelines for Americans, a healthy eating plan:
• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Includes lean meats, poultry, fish, beans, eggs, and nuts
• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars
• Stays within your daily calorie needs
Eat Healthfully and Enjoy It!
A healthy eating plan that helps you manage your weight includes a variety of foods you may not have considered. If "healthy eating" makes you think about the foods you can't have, try refocusing on all the new foods you can eat—

The Health Effects of Overweight and Obesity

2009-10-25T09:21:00.002-07:00

Research has shown that as weight increases to reach the levels referred to as "overweight" and "obesity,"* the risks for the following conditions also increases:1
• Coronary heart disease
• Type 2 diabetes
• Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and Gallbladder disease
• Sleep apnea and respiratory problems
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Gynecological problems (abnormal menses, infertility)
*Overweight is defined as a body mass index (BMI) of 25 or higher; obesity is defined as a BMI of 30 or higher.

Physical Activity for a Healthy Weight

2009-10-25T09:14:00.000-07:00

Why is physical activity important?
Regular physical activity is important for good health, and it's especially important if you're trying to lose weight or to maintain a healthy weight.
• When losing weight, more physical activity increases the number of calories your body uses for energy or "burns off." The burning of calories through physical activity, combined with reducing the number of calories you eat, creates a "calorie deficit" that results in weight loss.
• Most weight loss occurs because of decreased caloric intake. However, evidence shows the only way to maintain weight loss is to be engaged in regular physical activity.
• Most importantly, physical activity reduces risks of cardiovascular disease and diabetes beyond that produced by weight reduction alone.
Physical activity also helps to–
• Maintain weight.
• Reduce high blood pressure.
• Reduce risk for type 2 diabetes, heart attack, stroke, and several forms of cancer.
• Reduce arthritis pain and associated disability.
• Reduce risk for osteoporosis and falls.
• Reduce symptoms of depression and anxiety.
How much physical activity do I need?
When it comes to weight management, people vary greatly in how much physical activity they need. Here are some guidelines to follow:
To maintain your weight: Work your way up to 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent mix of the two each week. Strong scientific evidence shows that physical activity can help you maintain your weight over time. However, the exact amount of physical activity needed to do this is not clear since it varies greatly from person to person. It's possible that you may need to do more than the equivalent of 150 minutes of moderate-intensity activity a week to maintain your weight.
To lose weight and keep it off: You will need a high amount of physical activity unless you also adjust your diet and reduce the amount of calories you're eating and drinking. Getting to and staying at a healthy weight requires both regular physical activity and a healthy eating plan.
What do moderate- and vigorous-intensity mean?
Moderate: While performing the physical activity, if your breathing and heart rate is noticeably faster but you can still carry on a conversation — it's probably moderately intense. Examples include—
• Walking briskly (a 15-minute mile).
• Light yard work (raking/bagging leaves or using a lawn mower).
• Light snow shoveling.
• Actively playing with children.
• Biking at a casual pace.
Vigorous: Your heart rate is increased substantially and you are breathing too hard and fast to have a conversation, it's probably vigorously intense. Examples include—
• Jogging/running.
• Swimming laps.
• Rollerblading/inline skating at a brisk pace.
• Cross-country skiing.
• Most competitive sports (football, basketball, or soccer).
• Jumping rope.
How many calories are used in typical activities?
The following table shows calories used in common physical activities at both moderate and vigorous levels.
Calories Used per Hour in Common Physical Activities
Moderate Physical Activity Approximate Calories/30 Minutes for a 154 lb Person1 Approximate Calories/Hr for a 154 lb Person1
Hiking 185 370
Light gardening/yard work 165 330
Dancing 165 330
Golf (walking and carrying clubs) 165 330
Bicycling (<10 mph) 145 290
Walking (3.5 mph) 140 280
Weight lifting (general light workout) 110 220
Stretching 90 180
Vigorous Physical Activity Approximate Calories/30 Minutes for a 154 lb Person1 Approximate Calories/Hr for a 154 lb Person1
Running/jogging (5 mph) 295 590
Bicycling (>10 mph) 295 590
Swimming (slow freestyle laps) 255 510
Aerobics 240 480
Walking (4.5 mph) 230 460
Heavy yard work (chopping wood) 220 440
Weight lifting (vigorous effort) 220 440
Basketball (vigorous) 220 440
1Calories burned per hour will be higher for persons who weigh more than 154 lbs (70 kg) and lower for persons who weigh less.

STD Prevention Today

2009-10-25T09:11:00.001-07:00

Despite the fact that a great deal of progress has been made in STD prevention over the past four decades, the United States has the highest rates of STD infection in the industrialized world, making prevention as important as ever.
________________________________________
Preventing STD Infection
The most reliable ways to avoid becoming infected with or transmitting STDs are:
Abstain from sexual intercourse (i.e., oral, vaginal, or anal sex)
Be in a long-term, mutually monogamous relationship with an uninfected partner
Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia 1, gonorrhea 2, and trichomoniasis.3

________________________________________
Reducing Your Risk of STD Infection
All partners should get tested for HIV and other STDs before initiating sexual intercourse. However, if you decide to be sexually active with a partner whose infection status is unknown or who is infected with HIV or another STD, you can reduce your risk of contracting an STD:
 Ask a new sex partner if he or she has an STD, has been exposed to one, or has any unexplained physical symptoms. Do not have unprotected sex if your partner has signs or symptoms of STDs, such as sores, rashes, or discharge from the genital area. Many common STDs have no symptoms but can still be transmitted to a sexual partner. If your partner has had sexual relations with someone else recently, he or she may have an STD, even if there are no symptoms.
 Use a new condom for each act of insertive intercourse. Correct and consistent use of latex condoms and other barriers can reduce the risk of transmission only when the infected area or site of potential exposure is protected.
 Get regular checkups for STDs (even if you show no symptoms), and be familiar with the common symptoms. Most STDs are readily treated, and the earlier treatment is sought and sex partners are notified, the less likely the disease will do irreparable damage.
________________________________________
Prevention and the CDC
The Division of STD Prevention, part of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, coordinates CDC's STD prevention efforts. These efforts include providing national leadership through research, policy development, and support of effective services to prevent sexually transmitted diseases (including HIV infection) and their complications, such as enhanced HIV transmission, infertility, adverse outcomes of pregnancy, and reproductive tract cancer.
CDC's STD Prevention Strategy
The prevention and control of STDs is based on the following five major concepts:
Education and counseling of persons at risk on ways to adopt safer sexual behavior
Identification of infected persons--with or without symptoms--unlikely to seek diagnostic and treatment services
Effective diagnosis and treatment of infected persons
Evaluation, treatment, and counseling of sex partners of persons who are infected with an STD
Pre-exposure vaccination of persons at risk for vaccine-preventable STDs
Primary prevention of STDs begins with changing the sexual behaviors that place persons at risk for infection.4 Moreover, because STD control activities reduce the likelihood of transmission to sex partners, treatment of infected persons constitutes primary prevention of spread within the community.
To enact its strategy, CDC is assisting health departments, healthcare providers, and nongovernmental organizations, and collaborating with other governmental entities, through:
The development, syntheses, translation, and dissemination of timely, science-based information
The development of national goals and science-based policy
The development and support of science-based programs that meet the needs of communities
As the lead agency for STD prevention in the United States, CDC will continue to improve both biomedical and behavioral strategies to combat STDs. Clearly, multiple strategies are required to maintain and improve progress in prevention.

Huma Akram Died Of Multi Organ Failure

2009-10-25T08:12:00.000-07:00

Huma Akram, the wife of former Pakistan captain Wasim Akram died on Sunday. According to reports from Press Trust of India, Huma Akram died at a hospital in Chennai. The wife of Pakistani legendary cricket star was taken to a hospital in Chennai after she suffered multiple organ failure. At the time of her death, Huma Akram was 42 years old. According to reports, on Oct 20, she was admitted at a hospital in Chennai in an emergency situation. The air ambulance carrying Huma had stopped in Chennai after her condition worsened. The air ambulance was going to Singapore from Lahore.

ANESTHETIST

2009-10-23T21:11:00.000-07:00

HISTORY
The word Anesthesia was coined by Oliver Wendell Holmes, Sr. in 1846.

Anesthesia, or anaesthesia , has traditionally meant the condition of having sensation (including the feeling of pain) permanently or temporarily blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience.
Another definition is a "reversible lack of awareness", whether this is a total lack of awareness (e.g. a general anesthetic) or a lack of awareness of a part of the body such as a spinal anesthetic or another nerve block would cause.

DEFINITION
Anesthesia is a pharmacologically induced reversible state of amnesia, analgesia, loss of consciousness, loss of skeletal muscle reflexes and decreased stress response.

ANESTHETIST
Dealer of anesthesia!!!

Hyoglossus

2009-10-23T03:57:00.000-07:00

Hyoglossus Muscle

Origin

It originates from the body and greater horn of hyoid bone

Insertion

It is inserted at the side of the tongue

Action

It retracts and pulls down side of tongue

nerve supply

Its motor nerve supply is by hypoglossal nerve and its sensory nerve supply is by lingual nerve

Flu Shot Girl A hoax !!!!

2009-10-22T20:32:00.000-07:00

Here is a story of a cheer leader which after taking a vaccine of swine flu is now undergoing a serious neurological disorder including dystonias.

Desiree Jennings was a healthy cheerleader for the Washington Redskins.She claims that she developed the disorder Dystonia 10 days after receiving her flu vaccine.

Now among other symptoms she can’t walk forward properly, but (and this is where it gets weird) she can walk backwards or run forwards without any issues. She also has difficulty in talking….

The bizarre nature of her symptoms has left some people believing it’s a hoax, although doctors stress that she’s not putting it on.

Reseacher's are trying to get in depth of the matter.
keep looking!

ASPERGER SYNDROME

2009-10-22T20:29:00.000-07:00

Asperger syndrome is an autism spectrum disorder, and people with it show significant difficulties in social interaction, along with restricted and repetitive patterns of behavior and interests. The difference from other autism disorders is that in it there is relative preservation of linguistic and cognitive development. Physical clumsiness and atypical use of language are frequently reported.

Asperger syndrome is also called Asperger's syndrome,Asperger (or Asperger's) disorder or just Asperger's; it is named after the Austrian pediatrician Hans Asperger .He in 1944, described children in his practice who lacked non verbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy.Fifty years later, it was standardized as a diagnosis, but questions about many aspects remain. For example, there is lingering doubt about whether it is distinct from high functioning autism (HFA);partly because of this, its prevalance is not firmly established. The exact cause is unknown, although research supports the likelihood of a genetic basis; brain imaging techniques have not identified a clear common pathology.

There is no single treatment, and the effectiveness of particular interventions is supported by only limited data. Intervention is aimed at improving symptoms and function. The mainstay of management is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most individuals improve over time, but difficulties with communication, social adjustment continue into adulthood. Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference, rather than a disability that must be treated or cured

Multiorgan Failure of Cricket Super Star Wasim Akram

2009-10-22T02:28:00.000-07:00

Wife of Pakistani former star cricket player Waseem Akram has been admitted to hospital in India due to abject illness meanwhile, Waseem called nation for offering pray for good health of his wife.

According to sources, Waseem Akram, in his message to nation, has called for prays for the early recovery of his wife (Huma Waseem) from illness.

Actually Huma Akram was on her way to Singapore for her permanent therapy of the illness she is undergoing.

Sadly, Huma is not only suffering from brain tumours (she has three tumours in the brain and needs surgery) but some complications relating to kidney have also developed.actually she developed Multi Organ Failure on her way and was shifted to Hospital in Apollo where she is vitally stable now and kidney functions are deranged mildly.

“Besides being a psychologist, Huma (Akram) is also a hypnotherapist, a wonderful, well grounded lady. I think it is Huma who brings stability and continuity to Wasim Akram’s life"

SCOPOLAMINE

2009-10-22T02:08:00.000-07:00

SCOPOLAMINE

PHARMACOLOGIC CATEGORY

Anticholinergic Agent

REASONS NOT TO TAKE THIS MEDICINE?

If you have an allergy to scopolamine or any other part of this medicine. Tell healthcare provider if you are allergic to any medicine. Make sure to tell about the allergy and how it affected you. This includes telling about rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other symptoms involved. If you have any of the following conditions: Fast heartbeat, glaucoma, intestinal blockage, myasthenia gravis, overactive thyroid gland, slow movement through the intestines, or urinary tract blockage.

What is this medicine used for?

This medicine is used to relieve motion sickness.

This medicine is used to treat eye inflammation.

This medicine is used before an eye exam.

This medicine is used to treat irritable bowel syndrome.

This medicine is used to treat muscle spasms of the gastrointestinal tract.

This medicine is used to treat Parkinson's disease.

How does it work?

Scopolamine improves the chemical balance in the brain.

It slows movement through the gastrointestinal tract, decreasing spasms.

It affects the vomiting center in the brain.

It enlarges the pupil of the eye.

How is it best taken?

All forms: Take this medicine with or without food. Take with food if it causes an upset stomach. Drink plenty of noncaffeine-containing liquid unless told to drink less liquid by healthcare provider. If you are taking this medicine for irritable bowel syndrome or spasms of the gastrointestinal tract, take 30-60 minutes before meals.

Eye:

For the eye only.

Take out contact lenses before using medicine. Lenses can be replaced 15 minutes after medicine is given. Do not put contacts back in if eyes are irritated or infected. Do not touch the container tip to the eye, lid, or other skin. Tilt head back and drop medicine into eye. After using medicine, keep your eyes closed. Apply pressure to the inside corner of the eye. Do this for 3-5 minutes. This keeps the medicine in your eye. Separate each eye medicine by 5 minutes.

Skin patch: Use skin patch behind the ear. Use 4 hours before travel starts. Wear only one patch at a time. Wash hands after use. If the patch falls off, replace with a new one. If medicine is needed for more than 3 days, throw away the old patch. Replace with a new one behind the other ear.

What do I do if I miss a dose? (does not apply to patients in the hospital)

Take a missed dose as soon as possible. If it is almost time for the next dose, skip the missed dose and return to your regular schedule. Do not take a double dose or extra doses. Many times this medicine is taken on an as needed basis.

What are the precautions when taking this medicine?

If you are 65 or older, use this medicine with caution. You could have more side effects. May contain conducting metal. Remove patch before MRI. If you have kidney disease, talk with healthcare provider. If you have liver disease, talk with healthcare provider. If you have lung disease, talk with healthcare provider. If you are a male with problems urinating, talk with healthcare provider. Check medicines with healthcare provider. This medicine may not mix well with other medicines. You may not be alert. Avoid driving, doing other tasks or activities until you see how this medicine affects you. Avoid alcohol (includes wine, beer, and liquor) or other medicines and natural products that slow your actions and reactions. These include sedatives, tranquilizers, mood stabilizers, antihistamines, and other pain medicine. You can get sunburned more easily. Avoid sun, sunlamps, and tanning beds. Use sunscreen; wear protective clothing and eyewear. Be careful in hot weather. Drink plenty of fluids to prevent dehydration. Tell healthcare provider if you are pregnant or plan on getting pregnant. Tell healthcare provider if you are breast-feeding.

What are some possible side effects of this medicine?

Feeling lightheaded, sleepy, having blurred vision, or a change in thinking clearly. Avoid driving, doing other tasks or activities that require you to be alert or have clear vision until you see how this medicine affects you. Constipation. More liquids, regular exercise, or a fiber-containing diet may help. Talk with healthcare provider about a stool softener or laxative. Dry mouth. Frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.

What should I monitor?

Change in condition being treated. Is it better, worse, or about the same? Dry mouth may cause an increase in cavities. Take good care of your teeth. See a dentist regularly. Follow up with healthcare provider.

REASONS TO CALL HEALTHCARE PROVIDER IMMEDIATELY

If you suspect an overdose, call your local poison control center or emergency department immediately. Signs of a life-threatening reaction. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat. Severe dizziness or passing out. Significant change in thinking clearly and logically. Unable to pass urine. Sudden change in vision, eye pain or irritation. Any rash. No improvement in condition or feeling worse.

How should I store this medicine? Store at room temperature. Protect tablets from moisture. Do not store in a bathroom or kitchen.

GENERAL STATEMENTS If you have a life-threatening allergy, wear allergy identification at all times. Do not share your medicine with others and do not take anyone else's medicine. Keep all medicine out of the reach of children and pets. Keep a list of all your medicines (prescription, natural products, supplements, vitamins, over-the-counter) with you. Talk with healthcare provider before starting any new medicine, including over-the-counter, natural products, or vitamins.

SARDINIAN DIET

2009-10-21T10:11:00.001-07:00

Interestingly, it's cheese that makes up a large part of the diet. The cheese that's eaten in Sardinia is made from cattle which is fed on grass and is much higher in omega-3 fatty acids than any other cheese. And omega-3s are beneficial against inflammation throughout the body and reducing cholesterol in blood.

Red wine is also a staple of the Sardinian diet -- but it's not some wimpy rose or even pinot. The wine consumed in Sardinia is so dark that it's referred to as "vino nero" or "black wine." Since it's so dark it's loaded with antioxidants which are also beneficial.

Fresh fruits, vegetables and nuts are a staple of the diet and meat is an occasional luxury.

The point of the Sardinian diet is not weight loss (although this will be a side effect) but longevity.

VACCINE H1N1 LOCATIONS AND QUESTION ANSWER SESSION!!

2009-10-20T00:12:00.000-07:00

The long-awaited H1N1 vaccine is expected to arrive next week. At least three vaccine makers have begun shipping to undisclosed distribution centers.

Clinical trials to test the effectiveness and safety of the H1N1 vaccine have been under way for 6 months.

Two types of the vaccine are available: the flu shot, it is an inactivated vaccine containing fragments of killed influenza virus, and a nasal spray, which is made using a weakened live flu virus. The nasal spray will be the first to be widely distributed, however certain groups, including pregnant women, young children and people with compromised immune systems, cannot receive the nasal spray.

No serious side effects are seen and the study subjects who have been immunized have generated a good response.

Vaccine is recommended for certain high-priority groups because they are more likely to have serious complications if they develop swine flu. These groups include: pregnant women; caregivers and household contacts of children younger than 6 months; everyone between the ages of 6 months and 24 years; and people ages 25 to 64 with existing health problems.

Even people who are not in these groups can get the vaccine.

While the first supplies of the H1N1 vaccine are due out next week, that doesn't necessarily mean it will be available in your city. Since only 6 million to 7 million doses are expected next week, you might have to look around for it at the beginning. However, within the next few months there will be plenty of vaccine to go around; 75 million doses will be produced before the end of the year.

LOCATION

Check with your doctor, your children 's school and your local public health department. Right now there's no central list of locations where swine flu vaccine will be offered.

REQUIREMENT OF VACCINE??

It's not a crime to say no to the H1N1 flu vaccine. You won't go to jail, nor will you be fined by the federal government if you decide not to get it. If you're in the military, however, you will be required to get the vaccine, according to the American Forces Press Service. In New York, the state government is requiring the vaccine for health care workers, but there are no penalties built into the law if a worker doesn't comply. Some workers fear they'll lose their jobs if they don't get the vaccine.

I AM A PARENT OF 7 YRS OLD CHILD,DO I NEED THE VACCINATION TOO WITH MY CHILD?

Technically, you, as a parent, don't "need" an H1N1 vaccine because you don't fall into one of the five high-risk groups.However, the team of experts we consulted were unanimous that if there's enough vaccine available, go ahead and get one if you want -- they say it won't hurt you, it will protect you from the flu, and it could help protect your child as well because you won't be bringing the virus home to your child. "If there's plenty of vaccine, it just makes sense to get it,"

VACCINE AND THIMEROSAL?

Some H1N1 shots will contain the preservative thimerosal, and others won't. You'll have to ask your doctor (or the clinic administering the shots) which type you're getting. Some people worry about thimerosal for children because it's mercury-based, but there's no scientific evidence the preservative is harmful.

PREGNANCY AND VACCINATION?

So far, the NIH has vaccinated more than 60 pregnant women as part of a study to see whether the H1N1 vaccine is safe and effective. There have been no reports of serious side effects,

Every pregnant woman needs to decide for herself whether she wants the H1N1 vaccine. The swine flu virus has been particularly dangerous for pregnant women; 6 percent of the people who've died from H1N1 since April have been pregnant women.

Why are pregnant women more vulnerable to H1N1 flu? "It's partly because pregnant women have some degree of compromise of their immune system, and their ability to fight off even fairly common illnesses such as the flu appears to be much lower.

In addition to protecting pregnant women, studies show vaccines give immunity to a newborn for at least a few months as antibodies cross the placenta and reach the fetus. This is especially important since babies cannot get an H1N1 vaccine themselves until they're 6 months old.

By the way, pregnant women and children under age 2 can't get the nasal spray -- the shot is their only option.

The safety/risk profile is the same for EVERY TYPE OF VACCINE ?

A flu shot is a flu shot is a flu shot, according to the Food and Drug Administration, which licenses companies to make vaccines. "All flu vaccine manufacturers use essentially the same technique to produce the seasonal and H1N1 vaccines. They each produce a slightly different version of the vaccine, but all versions adhere to the FDA's stringent standards for safety and effectiveness.

WORLD OSTEOPOROSIS DAY 2OTH OCT

2009-10-19T21:26:00.000-07:00

World Osteoporosis Day provides an all-important focal point for informing and educating the general public and policy makers about the prevention of a disease which still suffers from poor general awareness. With the number of participating countries and scheduled events increasing steadily year by year, the impact of WORLD OSTEOPOROSIS DAY has grown significantly.
WE CARE FOR BONE HEALTH !!

World Osteoporosis Day 2009 (October 20) is the second year of a 'call to action' campaign which seeks to mobilize the power of millions of concerned citizens to work for better osteoporosis healthcare policies in government healthcare systems, private insurance companies, and corporate healthcare networks.

World Osteoporosis Day calls on government health officials across all regions to recognize osteoporosis as a health priority; spread the message that more needs to be done by national governments and health insurers to promote early detection and offer reimbursement of much needed therapy for those with osteoporosis; and to call on individuals to take responsibility for their bone health and to support the work and advocacy efforts of their national osteoporosis societies.

"Stand Tall, Speak Out: Take action to promote osteoporosis policy change"
Calling for change

Osteoporotic fractures are a major cause of suffering, disability and death in the older population and their costs to healthcare services exceed those of many other major chronic diseases. Furthermore, because of the increasing number of elderly people in the population, the number of fractures due to osteoporosis is set to increase two- to three-fold over the next few decades. This imminent increase in the number of people affected poses a major challenge to healthcare systems throughout the world.
Despite significant advances in science and medicine, the reality today is that:

* Between twelve to twenty percent of people die within one year following a hip fracture.
* It is estimated that 80% of those who are at high risk of osteoporosis, and have suffered at least one fracture, have neither been identified nor treated for the disease.
* Many national governments do not treat osteoporosis as a major health priority and fail to provide adequate resources for its detection and treatment.
* Many health insurance schemes (private and public) will not cover diagnosis and treatment prior to the first fracture – even when it is cost effective to do so.

YOU AND SWINE FLU

2009-10-19T09:41:00.000-07:00

You and "Swine Flu"
What is 2009 H1N1 (swine flu)?
2009 H1N1 (sometimes called “swine flu”) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.
Why is 2009 H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a "quadruple reassortant" virus.

Are there human infections with 2009 H1N1 virus in the U.S.?
Yes. Human infections with 2009 H1N1 are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.

Is 2009 H1N1 virus contagious?
The 2009 H1N1 virus is contagious and is spreading from human to human.
How does 2009 H1N1 virus spread?
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and deaths have occurred as a result of illness associated with this virus.
How severe is illness associated with 2009 H1N1 flu virus?
Illness with 2009 H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.
In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.
Young children are also at high risk of serious complications from 2009 H1N1, just as they are from seasonal flu. And while people 65 and older are the least likely to be infected with 2009 H1N1 flu, if they get sick, they are also at “high risk” of developing
How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.
Prevention & Treatment

What can I do to protect myself from getting sick?
This season, there is a seasonal flu vaccine to protect against seasonal flu viruses and a 2009 H1N1 vaccine to protect against the 2009 H1N1 influenza virus (sometimes called “swine flu”). A flu vaccine is the first and most important step in protecting against flu infection. There are also everyday actions that can help prevent the spread of germs that cause respiratory illnesses like the flu.
Take these everyday steps to protect your health:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, CDC(Centers for Disease Control and Prevention) recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.
Other important actions that you can take are:
• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs * (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public while you are sick and contagious.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.
If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including covering their coughs and sneezes and washing their hands often with soap and water, especially after they cough or sneeze. If soap and water are not available, they should use an alcohol-based hand rub.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral
What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.* You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.
What are “emergency warning signs” that should signal anyone to seek medical care urgently?
In children:
• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash
In adults:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
Are there medicines to treat 2009 H1N1 infection?
Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
Contamination & Cleaning

How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.
What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.
*What if soap and water are not available and alcohol-based products are not allowed in my facility?
If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.
What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid "hugging" laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.
Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Can I get infected with 2009 H1N1 virus from eating or preparing pork?
No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.
Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.
Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

MENINGITIS

2009-10-19T09:14:00.001-07:00

Meningitis
Q: What is meningitis?
A: Meningitis is an inflammation of the membranes that cover the brain and spinal cord. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ depending on the cause. Viral meningitis is generally less severe and clears up without specific treatment. But bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disabilities. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis. Hib vaccine is now given to all children as part of their routine immunizations. This vaccine has reduced the number of cases of Hib infection and the number of related meningitis cases. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis.
Q: What are the signs and symptoms of meningitis?
A: High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect. Infants with meningitis may appear slow or inactive, have vomiting, be irritable, or be feeding poorly. As the disease progresses, patients of any age may have seizures.
Bacterial Meningitis
Q: How is bacterial meningitis diagnosed?
A: Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately. The diagnosis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by performing a spinal tap, in which a needle is inserted into an area in the lower back where fluid in the spinal canal can be collected. Identification of the type of bacteria responsible is important for selection of correct antibiotics.
Q: Can bacterial meningitis be treated?
A: Bacterial meningitis can be treated with a number of effective antibiotics. It is important, however, that treatment be started early in the course of the disease. Appropriate antibiotic treatment of most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.
Q: Is bacterial meningitis contagious?
A: Yes, some forms of bacterial meningitis are contagious. The bacteria can mainly be spread from person to person through the exchange of respiratory and throat secretions. This can occur through coughing, kissing, and sneezing. Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been.
However, sometimes the bacteria that cause meningitis have spread to other people who have had close or prolonged contact with a patient with meningitis caused by Neisseria meningitidis (also called meningococcal meningitis) or Hib. People in the same household or daycare center, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of getting the infection. People who qualify as close contacts of a person with meningitis caused by N. meningitidis should receive antibiotics to prevent them from getting the disease. This is known as prophylaxis. Prophylaxis for household contacts of someone with Hib disease is only recommended if there is 1 household contact younger than 48 months who has not been fully immunized against Hib or an immunocompromised child (a child with a weakened immune system) of any age is in the household. The entire household, regardless of age, should receive prophylaxis in these cases.
Q: Are there vaccines against bacterial meningitis?
A: Yes, there are vaccines against Hib, against some serogroups of N. meningitidis and many types of Streptococcus pneumoniae. The vaccines are safe and highly effective.
The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of all persons aged 11-18 years of age with 1 dose of MCV4, the meningococcal conjugate vaccine known as Menactra®, at the earliest opportunity. Pre-teens who are 11-12 years old should be routinely vaccinated at the 11-12 year old check-up as recommended by ACIP. This visit is the best time for adolescents to receive MCV4. Also, since the occurrence of meningococcal disease increases during adolescence, health-care providers should vaccinate previously unvaccinated pre-teens and teens aged 11-18 years with MCV4 at the earliest possible health-care visit.
College freshmen living in dormitories are at increased risk for meningococcal disease and should be vaccinated with MCV4 before college entry if they have not previously been vaccinated. The risk for meningococcal disease among nonfreshmen college students is similar to that for the general population of similar age (age 18-24 years). However, since the vaccines are safe and produce immunity, they can be provided to nonfreshmen college students who want to reduce their risk for meningococcal disease.
Routine vaccination also is recommended for certain persons who have increased risk for meningococcal disease. Use of MCV4 is preferred among people aged 2-55 years; however, use of MPSV4, the meningococcal polysaccharide vaccine known as Menomune®, is recommended among adults over 55 years of age.
There are also vaccines to prevent meningitis due to S. pneumoniae (also called pneumococcal meningitis), which can also prevent other forms of infection due to S. pneumoniae. The pneumococcal polysaccharide vaccine (PPV23) is recommended for all persons over 65 years of age and younger persons at least 2 years old with certain chronic medical problems. There is a vaccine (pneumococcal conjugate vaccine, or PCV7) that is effective in infants for the prevention of pneumococcal infections and is routinely recommended for all children younger than 2 years of age.

Viral Meningitis
Q: What is viral meningitis?
A: Meningitis is an inflammation of the membranes ("meninges") that cover the brain and spinal cord. Viral infections are the most common cause of meningitis; bacterial infections are the second most common cause. Other, rarer causes of meningitis include fungi, parasites, and non-infectious causes, including those that are related to drugs.
Meningitis caused by viral infections is sometimes called "aseptic meningitis."
Q: Is viral meningitis a serious disease?
A: Viral ("aseptic") meningitis is serious but rarely fatal in people with normal immune systems. Usually, the symptoms last from 7 to 10 days and the patient recovers completely. Bacterial meningitis, on the other hand, can be very serious and result in disability or death if not treated promptly. Often, the symptoms of viral meningitis and bacterial meningitis are the same. For this reason, if you think you or your child has meningitis, see your doctor as soon as possible.
Q: What causes viral meningitis?
A: Different viral infections can lead to viral meningitis. But most cases in the United States, particularly during the summer and fall months, are caused by enteroviruses (which include enteroviruses, coxsackieviruses, and echoviruses). Most people who are infected with enteroviruses either have no symptoms or only get a cold, rash, or mouth sores with low-grade fever. And, only a small number of people with enterovirus infections go on to develop meningitis.
Other viral infections that can lead to meningitis include mumps, herpesvirus (such as Epstein-Barr virus, herpes simplex viruses, and varicella-zoster virus—the cause of chickenpox and shingles), measles, and influenza.
Arboviruses, which mosquitoes and other insects spread, can also cause infections that can lead to viral meningitis. And lymphocytic choriomeningitis virus, which is spread by rodents, is a rare cause of viral meningitis.
Q: What are the signs and symptoms of viral meningitis?
A: Symptoms can appear quickly or they can also take several days to appear, usually after a cold or runny nose, diarrhea, vomiting, or other signs of infection show up. Symptoms in adults may differ from those in children:
• Common in infants
o Fever
o Irritability
o Poor eating
o Hard to awaken
• Common in older children and adults
o High fever
o Severe headache
o Stiff neck
o Sensitivity to bright light
o Sleepiness or trouble waking up
o Nausea, vomiting
o Lack of appetite
Q: How is viral meningitis diagnosed?
A: Viral meningitis is usually diagnosed by laboratory tests of a patient’s spinal. The test can reveal whether the patient is infected with a virus or a bacterium. The exact cause of viral meningitis can sometimes be found through tests that show which virus has infected a patient; however, identifying the exact virus causing meningitis may be difficult.
Because the symptoms of viral meningitis are similar to those of bacterial meningitis, which is usually more severe and can be fatal, it is important for people suspected of having meningitis to seek medical care and have their spinal fluid tested. A hospital stay may be necessary in more severe cases or for people with weak immune systems.
Q: How is viral meningitis treated?
A: There is no specific treatment for viral meningitis. Most patients completely recover on their own within 2 weeks. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Doctors often will recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.
A hospital stay may be necessary in more severe cases or for people with weak immune systems.
Q: How is the virus spread?
A: Different viruses that cause viral meningitis are spread in different ways. Enteroviruses, the most common cause of viral meningitis, are most often spread through direct contact with an infected person’s stool. The virus is spread through this route mainly among small children who are not yet toilet trained. It can also be spread this way to adults changing the diapers of an infected infant.
Enteroviruses and other viruses (such as mumps and varicella-zoster virus) can also be spread through direct or indirect contact with respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. This usually happens through kissing or shaking hands with an infected person or by touching something they have handled and then rubbing your own nose or mouth. The viruses can also stay on surfaces for days and can be transferred from objects. Viruses also can spread directly when infected people cough or sneeze and send droplets containing the virus into the air we breathe.
The time from when a person is infected until they develop symtoms (incubation period) is usually between 3 and 7 days for enteroviruses. An infected person is usually contagious from the time they develop symptoms until the symptoms go away. Young children and people with low immune systems may spread the infection even after symptoms have resolved.
Q: Can I get viral meningitis if I’m around someone who has it?
A: If you are around someone with viral meningitis, you may be at risk of becoming infected with the virus that made them sick. But you have only a small chance of developing meningitis as a complication of the illness.
Q: How can I reduce my chances of becoming infected with viruses that can lead to viral meningitis?
A: Viral meningitis most commonly results from infection with enteroviruses. But there are other causes, such as measles, mumps, and chickenpox. Viral meningitis can also be caused by viruses that are spread by mosquitoes and other insects that bite people.
The specific measures for preventing or reducing your risk for viral meningitis depend on the cause.
• Following good hygiene practices can reduce the spread of viruses, such as enteroviruses, herpesviruses, and measles and mumps viruses. Preventing the spread of virus can be difficult, especially since sometimes people are infected with a virus (like an enterovirus) but do not appear sick. In such cases, infected people can still spread the virus to others. Thus, it is important to always practice good hygiene to help reduce your chances of becoming infected with a virus or of passing one on to someone else:
o Wash your hands thoroughly and often. This is especially important after changing diapers, using the toilet, or coughing or blowing your nose in a tissue.
o Cleaning contaminated surfaces, such as handles and doorknobs or the TV remote control, with soap and water and then disinfecting them with a dilute solution of chlorine-containing bleach also may decrease the spread of viruses. This solution can be made by mixing ¼ cup of bleach with 1 gallon (16 cups) of water.
o Cover your cough. The viruses that cause viral meningitis can be spread by direct and indirect contact with respiratory secretions, so it is important to cover your cough with a tissue or, if you do not have a tissue, to cough into your upper arm. After using a tissue, place it in the trash and wash your hands.
o Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.
• Receiving vaccinations included in the childhood vaccination schedule can protect children against some diseases that can lead to viral meningitis. These include vaccines against measles and mumps (the MMR vaccine) and chickenpox (the varicella-zoster vaccine).
• Avoiding bites from mosquitoes and other insects that carry diseases that can infect humans may help reduce your risk for viral meningitis.

GENITAL HERPES

2009-10-19T08:18:00.000-07:00

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.

Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. Over the past decade, the percent of Americans with genital herpes infection in the U.S. has decreased.
Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of eight). This may be due to male-to-female transmission being more likely than female-to-male transmission.

HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to have a sore. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.
HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called “fever blisters.” HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.

Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. However, most individuals with HSV-2 infection never have sores, or they have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.
People diagnosed with a first episode of genital herpes can expect to have several (typically four or five) outbreaks (symptomatic recurrences) within a year. Over time these recurrences usually decrease in frequency. It is possible that a person becomes aware of the “first episode” years after the infection is acquired.

Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital HSV can lead to potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.
Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.

The signs and symptoms associated with HSV-2 can vary greatly. Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be diagnosed between outbreaks by the use of a blood test. Blood tests, which detect antibodies to HSV-1 or HSV-2 infection, can be helpful, although the results are not always clear-cut.

There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.

The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes.
Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.

BIRD FLU

2009-10-19T08:17:00.000-07:00

Avian Influenza (Bird Flu)

How is avian influenza detected in humans?

Avian influenza cannot be diagnosed by symptoms alone, so a laboratory test is required. Avian influenza is usually diagnosed by collecting a swab from the nose or throat during the first few days of illness. This swab is then sent to a laboratory, where they will either look for avian influenza virus using a molecular test, or they will try to grow the virus. Growing avian influenza viruses should only be done in laboratories with high levels of protection. If it is late in the illness, it may be difficult to find an avian influenza virus directly using these methods. If this is the case, it may still be possible to diagnose avian influenza by looking for evidence of the body's response to the virus. This is not always an option because it requires two blood specimens (one taken during the first few days of illness and another taken some weeks later), and it can take several weeks to verify the results.

What are the implications of avian influenza to human health?

Two main risks for human health from avian influenza are 1) the risk of direct infection when the virus passes from the infected bird to humans, sometimes resulting in severe disease; and 2) the risk that the virus – if given enough opportunities – will change into a form that is highly infectious for humans and spreads easily from person to person.

Does seasonal influenza vaccine protect against avian influenza infection in people?

No. Seasonal influenza vaccine does not provide protection against avian influenza.

Should I wear a surgical mask to prevent exposure to avian influenza?

Currently, wearing a mask is not recommended for routine use (e.g., in public) for preventing influenza exposure. In the United States, disposable surgical and procedure masks have been widely used in health-care settings to prevent exposure to respiratory infections, but the masks have not been used commonly in community settings, such as schools, businesses, and public gatherings.

Can I get avian influenza from eating or preparing poultry or eggs?

You cannot get avian influenza from properly handled and cooked poultry and eggs.

There currently is no scientific evidence that people have been infected with bird flu by eating safely handled and properly cooked poultry or eggs.

Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry or surfaces contaminated with secretions and excretions from infected birds. Even if poultry and eggs were to be contaminated with the virus, proper cooking would kill it. In fact, recent studies have shown that the cooking methods that are already recommended by the U.S. Department of Agriculture (USDA) and the Food and Drug Administration (FDA) for poultry and eggs to prevent other infections will destroy influenza viruses as well.

So to stay safe, the advice is the same for protecting against any infection from poultry:

Wash your hands with soap and warm water for at least 20 seconds before and after handling raw poultry and eggs.
Clean cutting boards and other utensils with soap and hot water to keep raw poultry from contaminating other foods.
Use a food thermometer to make sure you cook poultry to a temperature of at least 165 degrees Fahrenheit Consumers may wish to cook poultry to a higher temperature for personal preference.
Cook eggs until whites and yolks are firm.

The U.S. government carefully controls domestic and imported food products, and in 2004 issued a ban on importation of poultry from countries affected by avian influenza viruses, including the H5N1 strain. This ban still is in place.

We have a small flock of chickens. Is it safe to keep them?

Yes. In the United States there is no need at present to remove a flock of chickens because of concerns regarding avian influenza. The U.S. Department of Agriculture monitors potential infection of poultry and poultry products by avian influenza viruses and other infectious disease agents.

Human infection with avian influenza viruses

There are many different subtypes of type A influenza viruses. These subtypes differ because of changes in certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 known HA subtypes and 9 known NA subtypes of influenza A viruses. Many different combinations of HA and NA proteins are possible. Each combination represents a different subtype. All known subtypes of influenza A viruses can be found in birds.

Usually, “avian influenza virus” refers to influenza A viruses found chiefly in birds, but infections with these viruses can occur in humans. The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans. However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997. Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds. The spread of avian influenza viruses from one ill person to another has been reported very rarely, and has been limited, inefficient and unsustained.

INFLUENZA VIRUS:

“Human influenza virus” usually refers to those subtypes that spread widely among humans. There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans. It is likely that some genetic parts of current human influenza A viruses came from birds originally. Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans.

Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them. H5N1 virus does not usually infect people, but infections with these viruses have occurred in humans. Most of these cases have resulted from people having direct or close contact with H5N1-infected poultry or H5N1-contaminated surfaces.

AT RISK:

During an outbreak of avian influenza among poultry, there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds.

SYMPTOMS:

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which virus caused the infection.

Treatment and vaccination for H5N1 virus in humans

Studies done in laboratories suggest that some of the prescription medicines approved in the United States for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to demonstrate the effectiveness of these medicines.

The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamivir and zanamivir, would probably work to treat influenza caused by H5N1 virus, but additional studies still need to be done to demonstrate their effectiveness.

Smoking and TB!

2009-10-19T02:07:00.000-07:00

Smokers are twice as likely to develop active tuberculosis compared to people who have never smoked, prompting a call for policymakers to be tougher on smoking.

One thirds of the world’s population is infected with TB, but 90 percent of these remain latent . The remaining 10 percent develop active TB at some point of life because of weak immunity. Many people who are infected with HIV/AIDS fall sick and die from TB.TB is still the leading cause of death in the world. There were 9.3 million new cases of TB in 2007 and 1.8 million deaths,according to a study. The World Health Organization aims to bring the incidence of TB down to one case per million each year by 2050.

17,699 participants above 12 years of age were studied in Taiwan to investigate the association between cigarette smoking and active tuberculosis in the general population. The participants were tracked three years. Out of 17,699 participants, 3,893 were current smokers, 552 were former smokers and 13,254 had never smoked. Data regarding the sex, age, living in a crowded home, household income, marital status, alcohol use and employment of participants was also collected.

Fifty-seven new cases of active TB were diagnosed at the end of the three-year follow-up. It was found that current smokers had a higher risk of developing active TB. Current smokers had a two-fold higher risk of active TB compared with those who had never smoked, and 17 percent of active TB cases in this population were due to smoking.

The researchers concluded that smokers have a decreased ability to fight infections, such as TB, and suggested policymakers and public health personnel to consider addressing tobacco cessation as part of tuberculosis control.

Relenza saves a life

2009-10-19T00:50:00.000-07:00

In Britain doctors have saved the life of a woman with severe swine flu after giving her an intravenous form of GlaxoSmithKline's drug Relenza.

Relenza, or zanamivir, is currently only approved as an inhaled medicine. This version, however, did not work in the 22-year-old patient, whose immune system was impaired due to recent chemotherapy.

She also did not respond to Tamiflu, or oseltamivir, which is given as a pill.

Doctors at University College London therefore decided to try intravenous Relenza in combination with high-dose corticosteroids and her condition improved within 2 days.

"Although this is a single case report and direct cause and effect cannot be confirmed, the improvement in clinical status following intravenous Relenza encourages prompt further investigation."

The new H1N1 swine flu was declared a pandemic in June and has been spreading globally since then.

Other flu drugs are under development to deal with seasonal and pandemic influenza. One that has shown promise in intravenous form is Peramivir.

ASBESTOSIS

2009-10-19T00:40:00.000-07:00

For miners who are always around asbestos, there is always a higher risk of lung cancer. Especially a certain type of lung cancer including pleura, called mesothelioma. However, there is another lung abnormality that asbestos workers get as well, which is called asbestosis. Asbestosis is the inflammation of the parenchymal tissue of the lungs. It results in shortness of breath and a higher chance of lung cancer.

After inhaling asbestos ,lung tissue will scar, this scarring causes the inflammation in the lung that is asbestosis. The asbestos fibers will activate the body’s own natural immune system to attack, and this causes inflammation in the lung cavities. It is a slow and chronic condition. It contributes to scar tissue, which will build up and restrict the lungs activity. It reduces the oxygen flow and inhibits carbon dioxide removal. This is where oxygen therapy can help with the breathing difficulties and the shortness of breath.

Signs and Symptoms

There are not many signs to having asbestosis other than shortness of breath. After a prolonged and advanced case of asbestosis there may be cough and respiratory failure. Like mesothelioma, asbestosis can take a decade or so after first exposure to the asbestos. There can be a very long dormant period from exposure to symptoms, however whenever there is breathing and respiratory problems in anyone who has ever had exposure to asbestos should be considered viable hosts for asbestosis or mesothelioma.

Management

Currently there is not much treatment that is widely available for asbestosis. Some things that may help are long term oxygen therapy. Oxygen therapy can help with the breathing difficulties and increase the concentration of oxygen in the body.

Other items include postural drainage of the lungs to take out any liquid secretions and increase lung capacity and breathing. Some form of nebulizers, like those used in COPD and asthma sufferers, can also be prescribed so that the secretions in the lungs can be diluted and patients may be able to breathe better from this as well.

Because of so many asbestos related conditions such as asbestosis and mesothelioma, legal cases have been being fought in our courts since 1929. Liability for asbestos and working near asbestos is a serious business, in both the cost to companies that try to skirt the system and by the healthcare costs to their employees. Asbestos specialty lawyers command top dollar due to the payouts in those types of cases.

CO PEPTIN A BENEFICIAL BIOMARKER IN ACUTE MI

2009-10-18T22:57:00.001-07:00

New biochemical markers significantly improve the early detection of acute myocardial infarction (AMI). Recent studies reveal a promising way for doctors to conclusively ensure that a patient is having or not having an AMI in a timely and accurate manner earning time and money.

In patients presenting with chest pain and suspected AMI doctors rely on detailed patient assessment, the ECG, and the measurement of cardiac troponins(T and I) (specific markers for dying cells in the heart). AMI is the cause of death in more persons worldwide than any other disease. With effective treatment within our grasp, accurate and rapid diagnosis is of major medical and economic importance. With the development of blood tests depicting either cardiac troponin I or cardiac troponin T, the only current biomarkers thought to be unique to the heart, the diagnosis of AMI has been veritably revolutionised. In a patient presenting with chest pain, a rise in cardiac troponin has become a mandatory feature for the clinical diagnosis of AMI. Unfortunately, current cardiac troponin assays have one major limitation in common with their predecessor (CK-MB): it takes 3𔃂 hours after symptom onset until cardiac troponin becomes detectable. This is a major problem for doctors and causes diagnostic uncertainty particularly in patients presenting within the first hours from chest pain onset.

Recently, data from large multicenter studies have become available that demonstrate for the first time the impact of two novel biomarkers and therefore two novel approaches in the early diagnosis of AMI: sensitive cardiac troponin assays and copeptin, a marker of endogenous stress, in combination with standard cardiac troponin. Both approaches seem to largely overcome the sensitivity deficit of current standard cardiac troponin.

The more sensitive the cardiac troponin assay used, the smaller the number of dying myocardial cells necessary for this signal to be detected. Recent studies have clearly shown that sensitive cardiac troponin assays have a significantly higher diagnostic accuracy for the diagnosis of AMI and enable doctors to detect AMI already at presentation to the emergency department in the vast majority of patients.

A rapid diagnosis of AMI may reduce complications by allowing for earlier revascularization, earlier transfer to the coronary care unit, and earlier initiation of evidence-based treatment for AMI. In addition, the sensitive cardiac troponin assays may make it possible to reliably rule out the diagnosis of AMI in many patients on the basis of the initial measurement. The negative predictive value of the 99th percentile of the sensitive cardiac troponin assays, used as a single variable, was 97 to 99%. When sensitive cardiac troponin assays are used in conjunction with a clinical assessment and ECG, they will substantially reduce the percentage of patients in whom the diagnosis is uncertain after the first cardiac troponin measurement and for whom continuous ECG monitoring and serial blood sampling is necessary. The cost savings associated with this increase in early diagnostic accuracy might be substantial.

Similar findings were reported for the combination of copeptin and standard cardiac troponin. Copeptin, the C-terminal part of the vasopressin prohormone, is a marker of acute endogenous stress. If a patient suffering chest pains tested negative at presentation for both standard cardiac troponin and copeptin, which was the case in two-thirds of all patients studied, then there was a 99% probability that the patient was not having AMI, the study found. Only in the remaining minority of patients testing positive for either marker or both, would it be necessary to go the usual route of staying in the emergency room, monitoring and retesting a few hours later.

By looking at the copeptin levels in blood as a marker of acute endogenous stress, Tobias Reichlin, M.D., and co-workers from the Department of Internal Medicine, University Hospital Basel, Switzerland, sought to determine the incremental value of copeptin for a rapid rule out of AMI. Since the onset of chest pain associated with AMI is an enormous stress for the patient, copeptin levels were highest in patients presenting very early after the onset of symptoms.

IS IT FLU OR SWINE FLU?

2009-10-18T22:46:00.000-07:00

Many people who get the flu this season will never know what strain they have because there will not be widespread testing.

That means people could have swine flu — or H1N1 — and never know it.

But health officials say flu is the flu and whatever strain you have it’s all treated the same.

“Now that we know (H1N1) is here, we don’t have to test everyone, just those who are hospitalized,” said Bill Furney, communication coordinator for N.C. Public Health preparedness and response. “(Now) we track it from a big picture point-of-view.”

Furney said when the virus first hit, officials didn’t know what the virus would do.

“We didn’t know if it was going to be a large percentage of people getting sick or very sick,” he said.

State officials said it was important to do large-scale testing at first. But now they track H1N1 just like the seasonal flu.

“This was a novel virus,” he said. “Now we know what the characteristics are and know that it’s here.”

Sentinel sites

There are 93 sentinel sites around the state, said Dorothea Wyant, nursing director with the Cleveland County Health Department. Those sites are made up of hospitals, colleges and universities health programs, private practitioners and health departments, she added.

“They test people who have flu-like symptoms,” Wyant said.

Wyant said if these sentinel sites around the state are seeing an increase in the H1N1 virus, it doesn’t mean that everyone with flu-like symptoms has it.

“We do know they are seeing more in these sentinel sites, but you can’t assume that it’s H1N1 unless you test for it,” she said.

Furney said these sites provide estimations of what strain is seen the most. Testing everyone with flu-like symptoms to see if they have H1N1 is not necessary.

“The hard numbers are not what’s important,” he said. “It’s the trending number.”

Testing

Furney said when the H1N1 virus first appeared state labs were the only labs to confirm cases.

But things have changed in recent months.

“There have since been private labs that have the ability to test and confirm,” Furney said.

What doesn’t confirm the H1N1 virus, he said, is rapid testing.

“There are rapid tests that exist and those are not entirely accurate and should not be used as a confirmation,” he said.

What to do?

If people have flu-like symptoms there are things they can do to prevent affecting others.

“You want to make sure you stay home,” Wyant said.

Wyant said it is important to cover your mouth when you sneeze, wash your hands and drink lots of fluids.

The H1N1 vaccination could be available to Cleveland County residents as early as mid-October. But health officials said they don’t know how many they will receive or when the state will send them.

If residents choose to get an H1N1 vaccination they can also get a regular flu vaccination as well, Wyant said. They treat two different strains of the flu.

2009-10-17T21:00:00.001-07:00

October 16th is United Nations World Food Day,observed annually.

In 2008, 923 million people suffered from hunger on a regular basis. Environmental factors, access to markets, and increases in food prices are just some of the contributing factors. Since last year, an additional 105 million people, for a total of more than one billion people, suffer from chronic hunger.

Nearly 70 percent of the world's hungry, the majority of whom are women, live and work on small-scale farms. Often unable to produce enough to feed themselves, many of these people cannot afford to purchase food for their families.

In response to the food crisis, the U.S. Government is working as part of a collaborative global effort centered around country-led processes to improve food security. At the 2009 L’Aquila G-8 Summit, President Barack Obama pledged the United States would invest 3.5 billion dollars in agriculture-led economic growth to combat hunger. This commitment helped garner more than 16 billion dollars from other donors to support this new approach to advance agricultural development and reduce hunger around the world. This investment is in addition to our commitment to emergency food assistance.

The United States believes that food security is a foundation for building social and economic development. It means that all people in a society have access, at all times, to enough food for an active and healthy life. That is why President Obama said, during his inaugural speech: "To the people of poor nations, we pledge to work alongside you to make your farms flourish and let clean waters flow; to nourish starved bodies and feed hungry minds.”

BREAST CANCER

2009-10-17T18:25:00.000-07:00

BREAST CANCER AWARENESS !!
According to the Disease control center, with the exception of certain types of skin cancer, breast cancer is the most common cancer in women, regardless of race or ethnicity. Breast cancer, is the most common cause of death from cancer among Hispanic women, and the second most common cause of death from cancer among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.

Risk of breast cancer increases with age, so if you are 40yrs old or older getting an annual mammogram (ask your doctor about a digital mammogram; they’re reportedly more accurate) is a must. It’s also important to maintain a healthy diet and weight, exercise regularly, limit your alcohol intake, and perform a self-breast-exam.

The most common symptoms of breast cancer are a change in the look or feel of the breast, a change in the look or feel of the nipple and nipple discharge.

MIGRAINE AND BREAST CANCER!!

Female migraine sufferers are at a significantly lower risk of breast cancer,according to a study.

Research has shown that women with a history of the severe, recurrent headaches have a 30% lower risk of breast cancer compared to women who do not suffer such attacks.

The study, conducted by Fred Hutchinson Cancer Research Centre, in Seattle, US, looked at the histories of more than 3,000 women from the region, nearly 2,000 of whom had a history of breast cancer. The results are published in this month's issue of Cancer Epidemiology, Biomarkers and Prevention.

Dr Christopher Li said the researchers suspected the association between breast cancer and migraines was linked to fluctuations in levels of circulating hormones.

Oestrogen is known to stimulate hormonally sensitive breast cancer. He said in late pregnancy, where oestrogen levels are high, 80% of migraine sufferers do not have the headaches.

"Migraines seem to have a hormonal component in that they occur more frequently in women than in men, and some of their known triggers are associated with hormones," he said.

He added: "While these results need to be interpreted with caution, they point to a possible new factor that may be related to breast-cancer risk.

"This gives us a new avenue to explore the biology behind risk reduction. Hopefully this could help stimulate other ideas and extend what we know about the biology of the disease."

Researchers combined data from two studies of 3,412 Seattle-area postmenopausal women, 1,938 of whom had been diagnosed with breast cancer and 1,474 of whom had no history of breast cancer.

The study comes after research published earlier this year showed migraines may increase the risk of heart attacks and strokes in women.

TUBERCULOSIS

2009-10-17T05:54:00.000-07:00

Tuberculosis
The greatest killer in the history
of mankind

ALERT !!
Tuberculosis can involve almost every system of the body and it is essential that doctor belonging to all specialties particularly in developing world should have
skill to diagnose and treat
this common condition
in the most appropriate manner

EPIDEMIOLOGY
1/3rd of world population is infected
8.3 million new cases in 2000
95% cases in developing world
98% of TB deaths in developing world
75% of TB cases in productive age group
TB contribute 25% of avoidable deaths

What causes Tuberculosis ?
Tubercle bacilli : why called so ?
M.tuberculosis ( majority)
M. bovis
M.africanum
Can remain dormant and persist for many years
Sources of Infection
Coughing patient of pulmonary TB
Single cough: 3000 droplets nuclei
Also spread by talking, sneezing, spitting , singing
Direct sunlight kill AFB in 5 minutes
Transmission is mostly indoor
Risks of exposure; concentration of droplet nuclei and the time spent in contaminated air
Bovine TB: cervical lymph node/ intestinal TB

Is TB transmitted by following?
Food
Water
Sexual intercourse
Blood transfusion
mosquitoes
NO
Individual’s Risk of Infection
Extent of exposure
Susceptibility of individual
Transmission
Highest from smear positive TB,
less from smear negative,
least from extra-pulmonary TB

Infection to disease
90% of infected individuals do not develop disease
Only evidence of infection is positive tuberculin test
Chances of disease are higher soon after infection
Higher in infants and children
Emotional and physical stress
HIV infection

Natural History of TB
If Untreated: then by 5 years
50%: will be dead
25%: cured by their immune system
25%: become chronic

PULMONARY TBVs EXTRAPULMONARY TB

Pulmonary TB constitutes 80% of cases.
Major concern for health professionals
and community due to infectiousness.

DIAGNOSIS OF PULMONARY TUBERCULOSIS
Diagnosis: Clinical Suspicion

Cough for more than 2-3 weeks
Sputum production
Weight loss
Night sweats
Fatigue & tiredness
No sign is specific

Diagnosis: Lab Tests

Detection of AFBs Smears
Culturing of AFB & sensitivity
Chest X-ray
Tuberculin Skin Test ?
ESR ???

AAFB/ AFB
Acid and alcohol fast bacilli
Simply called AFB
Waxy coat of bacilli retains an aniline dye (carbol fuchsin) even after decolorization with acid and alcohol

SPUTUM SAMPLING
At least three isolated samples
Sputum and not saliva
Early morning samples preferable
If no cough:
Assisted cough
Induced Sputum
Alternate to sputum
Gastric washings
Bronchial washings

Fluorochrome Stain
Phenolic auramine/ auramine/ rhodamine
Needs fluorecence microscope
Quick scan/ Low magnification
Confirmation by ZN stain if positive PRACTICAL POINT
Sputum smear microscopy for tubercle
Is positive when there are at least 1000
organisms present per ml of sputum

Slide reportingUsing 1000x magnification

Number of bacilli Result reported
No AFB 0
1-9 AFB per 100 oil immersion fields Scanty
10-99 AFB per 100 oil immersion fields +
1-10 AFB per oil immersion field ++
1-10 AFB per oil immersion field +++

Interpretation
Smear positive
At least 2 smears examined and both positive for AFB
Smear Negative
At least 02 smears reported as negative
Indeterminate
Only one smear examined
03 smears examined and only one reported as positive

FALSE POSITIVE SMEARS

Red stain retained by scratches on the slide
Accidental transfer of AFBs from positive slide
Contamination of slide / smear by atypical mycobateria
Various particles which are acid fast like food particles, other microorganisms

FALSE NEGATIVE SMEARS

Problem of sputum collection
Inadequate samples
Inappropriate sputum container
Sputum stored too long
Problem of sputum processing
Problem of interpreting slides
Administrative errors

MYCOBACTERIAL CULTURES
Growing AFB on culture confirms diagnosis
AFB grown can be tested for their sensitivity against various drugs
Methods
Lowenstein Jensen
Liquid media
Bactec
Limitations: 6-8 weeks, skilled lab,

Tuberculin Test

Tuberculin: purified protein derivative
Mechanism:
Following infection: hypersensitivity to Tuberculin
Techniques
Mantoux Test
Multipuncture Tests
Heaf Test
Tine Test

Puncture scars without
indurations

3 or > 3
indurations

Coalescence of
indurations to form ring

central infilling forming
Disc of about 1cm

Extended indurations
1cm with or without
Vesiculation/ or ulceration

Tuberculin Skin Test
In population with high prevalence of TB, skin test is of little diagnostic value
Does not distinguish disease from infection

Heaf Grade Mantoux Interpretation Explanation
0-1 0-5mm Negative No immunity
2 5-14 mm positive Previous BCG
Exposure to environmental mycobacterium
3-4 >15 mm Strongly positive Prior exposure to MTB
Active TB
Rarely after BCG

Positive Mantoux ( 5mm or > 5mm induration
HIV positive
Recent contact with individual with active TB
Patients with fibrotic changes on chest x-ray consistent with TB
Patients with immune suppression having > 15 mg prednisone

? Mantoux Test
RELIABILITY OF TUBERCULIN TESTING
Sensitivity
LTBI and normal immune responsiveness, test sensitivity approaches 100%
In patients presenting with newly diagnosed pulmonary TB - approximately 29-80 %

Specificity
90%

In whom to carry out TST?
Close contacts of a person with infectious TB
Persons from areas with high prevalence rates
Groups with high rates of M. tuberculosis transmission, such as homeless persons, injection drug users and persons with HIV infection
Persons who work or reside with people who are at high risk for TB in facilities or institutions such as hospitals, homeless shelters, nursing homes, and residential homes for those with HIV
Other immune suppressants - e.g., Infliximab, methotrexate

Positive Mantoux ( 10 mm or > 10mm induration
Recent immigrant ( <> 10% below IBW, jejunal bypass, DM, CRF, Silicosis, Lekaemias, lymphomas,

Mantoux ( > 15 mm )
Persons with no risk factors for TB

Positive Tuberculin Test

Active TB
Previous TB
Previous BCG vaccination
Atypical mycobacteria
Sarcoidosis ( in less than 30%)

False Negative Tuberculin Test

HIV infection
Malnuitrition
Immunosupressive drugs like steroids
Severe bacterial infection
Milliary TB/ Fulminant TB
Viral infections like measles, chicken pox, glandular fever
Cancer
Incorrect injection of PPD
TUBERCULIN (PPD) TESTS
Indicates infection and not disease
False Positive
False Negative
Less of value in adults
More of value in children
Role in contacts
Role in medical staff

QuantiFERON®-TB Gold
Detection of ?-IF after incubating blood sample with MTB antigens
Unaffected by BCG
Other mycobacteria
Single visit
Result within a day

ESR AND TB
It can not be relied upon for the diagnosis of Tuberculosis and should not be advised in routine.
Not recommended by WHO and by local guidelines

Role of Chest x-ray
There is no radiological findings which can be diagnostic of Pulmonary Tuberculosis

But

There are certain typical patterns, where TB can be strongly suspected

TREATMENT OF TUBERCULOSIS

Isoniazid-----
Rifampicin------
Pyrazinamide-------
Streptomycin-----
Ethambutol----

2 HRZE / 4 HR
2 (HR)ZE / 4 (HR)

CANCER -- GENERAL DISCUSSION

2009-10-15T10:05:00.001-07:00

WHAT IS CANCER?

Neoplasia	New growth: includes benign disease
Tumour	Swelling: includes benign/inflammatory disease
Cancer, carcinoma	Malignancy of epithelial cell origin
Sarcoma	Malignancy of mesothelial cell origin
Lymphoma	Malignancy of lymphoid organs (usually glands)
Leukaemia	Malignancy of white blood cells

INCIDENCE

Malignancy is common, developing at some time in the life of more than one-third of the population. It is the second most common cause of death in the Western world, after cardiovascular disease Amongst the more common solid tumours such as lung and breast cancer, the incidence is often higher in developed countries. The incidence of lung cancer is four times higher in the UK than in India, although it is becoming increasingly common throughout the world. Breast cancer accounts for around 20-25% of all female cancers in both India and the UK, but the incidence in the UK per 100 000 women is three times higher than in Mumbai. In contrast, carcinoma of the cervix is the second most common cause of cancer death in women in the Caribbean, with an incidence almost four times higher than in the UK.

FACTORS

It is clear from many studies that the risk of breast cancer is related to a woman's lifetime oestrogen exposure, and this has given some possibilities for therapeutic intervention. Premature menopause, iatrogenic or otherwise, reduces the risk of developing breast cancer but is associated with a number of other unwanted consequences such as osteoporosis. Therapeutic intervention using, for example, tamoxifen (see below) has been shown to reduce the incidence of breast cancer but not mortality, and is not without toxicity. An alternative is prophylactic surgery, such as mastectomy or colectomy, in those at high risk of developing cancers in these tissues, but this is clearly not an option for a whole population.

Even if the key to reducing the death rate from cancer is preventing it in the first place, earlier diagnosis creates the potential to cure more patients. When patients are diagnosed with a cancer on the basis of symptoms, the cancer may have already spread in a significant proportion, so that loco-regional treatment (usually surgical) may be insufficient for a cure. Earlier identification of a cancer in an asymptomatic population could therefore 'catch' more cancers before they spread, rendering more patients curable by loco-regional treatment alone. This is the concept behind screening for malignancy, which has now been successfully applied to two major cancers in many developed countries

11.3 CANCERS WITH POTENTIAL FOR SCREENING

Malignancy	Method of screening	Benefits	National programmes?
Breast cancer	Mammography	Reduced mortality	Yes-many countries
Cervical cancer	Cervical smear cytology	?Reduced mortality (indirectly inferred)	Yes-many countries
Prostate cancer	Serum prostate-specific antigen(PSA) level	Possible reduced mortality	No
Colorectal cancer	Single flexible sigmoidoscopy Faecal occult blood test	Possible reduced mortalityNone	Some No

CANCER IN OLD AGE

Incidence: around 50% of cancers occur in the 15% of thepopulation aged over 65 years.
Screening: women aged over 65 in the UK are not invited to breast cancer screening but can request it. Uptake is low despite increasing incidence with age.
Presentation: may be later for some cancers. When symptoms are non-specific, patients (and their doctors) may initially attribute them to age alone.
Life expectancy: an 80-year-old woman can expect to live 8 years, so cancer may still shorten life and an active approach remains appropriate.
Prognosis: histology, stage at presentation and observation for a brief period are better guides to outcome than age alone.
Rate of progression: malignancy may have a more indolent course. This is poorly understood but may be due to reduced effectiveness of angiogenesis with age, inhibiting the development of metastases.
Response to treatment: equivalent to that in younger people. This is well documented for a range of cancers and for surgery, radiotherapy, chemotherapy and hormonal therapy.
Treatment selection: chronological age is of minor importance compared to comorbid illness and patient choice. Although older patients can be treated effectively and safely, aggressive intervention is not appropriate for all individuals. Symptom control may be all that is possible or desired by the patient.

CLINICAL ASSESSMENT

In order to plan the management of a patient with malignancy, the following information is required:

the nature of the primary malignancy (site, type, pathology)
the extent of the disease (stage)
the patient's general condition and comorbidity
the available treatment options.

The presentation of a malignancy can involve both local and systemic features . The local signs or symptoms are usually due to mass effect or invasion of local tissues. In contrast, systemic features may be the result of metastases or the non-metastatic manifestations of malignant disease.

LOCAL FEATURES OF MALIGNANT DESEASE

Symptom	Site/tumour
Haemorrhage	Stomach, colon, bronchus, endometrium, bladder, kidney
Lump	Breast, lymph node (any site), testicle
Pain	Bone (primary sarcoma, secondary)
Skin abnormality	Melanoma, basal cell carcinoma (rodent ulcer)
Ulcer	Oesophagus, stomach, anus, skin
Obstruction Pain, cough, recurrent infection Odynophagia, dysphagia, early satiety, vomiting Altered bowel habit, pain, distension	Bronchus Gastro-oesophageal Colon, rectum
Abdominal swelling (ascites)	Ovary, gastric cancer
Fracture	Metastatic cancer (breast, prostate, kidney, bronchus, thyroid)

11.7 NON-METASTATIC MANIFESTATIONS OF MALIGNANT DISEASE

Feature	Common associations
Weight loss and anorexia	Gastrointestinal tumours
Fatigue	Any
Hypercalcaemia	Myeloma, breast, renal tumours
Prothrombotic tendency	Pancreas and other gastrointestinal tumours
Hormonal effects
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)	Small-cell lung cancer
Ectopic adrenocorticotrophic hormone (ACTH)	Small-cell lung cancer
Neuropathies and myopathies
Eaton-Lambert myasthenia-like syndrome	Small-cell lung cancer
Subacute cerebellar degeneration	Small-cell lung cancer
Skin abnormalities
Acanthosis nigricans	Gastro-oesophageal tumours
Dermatomyositis/polymyositis	Gastric, lung tumours

In breast cancer, family history, early menarche, late menopause and benign breast disease are associated with increased risk, while early full-term pregnancy reduces risk. An impression of the rate of development of the disease may help determine prognosis and treatment. A thorough clinical examination is essential to identify sites of metastases, and to identify any other conditions that may have a bearing on the management plan.

The overall fitness of a patient can be evaluated using a variety of scales. One of the most common is the Eastern Cooperative Oncology Group (ECOG) performance scale .The outcome for patients with a performance status of 3 or 4 is worse in almost all malignancies than for those with a status of 0 to 2. Treatment decisions must take such assessments into account.
EASTERN COOPERATIVE ONCOLOGY GROUP (ECOG) PERFORMANCE STATUS SCALE

0 Fully active, able to carry on all usual activities without restriction and without the aid of analgesics
1 Restricted in strenuous activity but ambulatory and able to carry out light work or pursue a sedentary occupation. This group also contains patients who are fully active, as in grade 0, but only with the aid of analgesics
2 Ambulatory and capable of all self-care but unable to work. Up and about more than 50% of waking hours
3 Capable of only limited self-care, confined to bed or chair more than 50% of waking hours
4 Completely disabled, unable to carry out any self-care and confined totally to bed or chair

INVESTIGATIONS

Tumour imaging and sampling are required. Sampling may be achieved under direct vision as at endoscopy, bronchoscopy or colonoscopy, or with ultrasound or computed tomography (CT) guidance. Superficial masses or lesions may be biopsied or fine needle aspirates may be taken. In cases where treatment is initially or largely non-surgical, precise measurement of initial tumour size helps to assess subsequent response to therapy.

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11.10 TUMOUR MARKERS IN BLOOD

Name	Fetal antigen?	Normally detected?	Tumours
Carcinoembryonic antigen (CEA)	Yes	Yes	Gastrointestinal tract, lung, breast
CA-125	Yes	Yes	Ovary
β-Fetoprotein (AFP)	Yes	Yes (very low)	Hepatocellular carcinoma and malignant teratoma
Lactate dehydrogenase (LDH)	No	Yes	Most, reflecting tumour burden or necrosis
Prostate-specific antigen (PSA)	No	Yes	Prostate, some breast cancers
Human chorionic gonadotrophin (HCG)	No	Only in pregnancy	Malignant teratoma, seminoma, choriocarcinoma, gastrointestinal tumours

Staging is the determination of the extent of the malignancy.One of the most commonly used systems is the T (tumour), N (regional lymph nodes) and M (metastatic sites).

STAGING TESTS

Primary	Common	Less common/geographical variation
Breast	Chest X-ray, bone scan	Bone marrow, CT of abdomen/thorax
Lymphoma	CT abdomen and thorax, bone marrow	Bone scan
Prostate	Bone scan, CT pelvis
Colon	Ultrasound, CT liver
Lung	Chest X-ray, CT chest and upper abdomen	Bone marrow, bone scan

TREATMENT

Treatment for cancer can be divided into:

Curative treatment
Palliative treatment-given to alleviate symptoms, with an emphasis on quality rather than quantity of life. However, sometimes the best way of achieving symptomatic control is to reduce the amount of cancer with systemic anti-cancer treatment.
Adjuvant treatments-given after primary therapy such as surgery, when there is no known residual disease but a defined risk of recurrence which can be reduced by another treatment . For example, radiotherapy, chemotherapy and hormonal therapy each incrementally reduce the risk of recurrent breast cancer.

GOALS OF NON-SURGICAL TREATMENT

Curative

Choriocarcinoma
Teratoma
Seminoma
High-grade lymphoma
Cervical cancer
Head and neck cancer

Radical, occasionally curative

Small-cell lung cancer
Stage III ovarian cancer

Adjuvant (with surgery)

Breast cancer
Stage I-II ovarian cancer
Colorectal cancer
Osteogenic sarcoma

Palliative

Metastatic breast cancer
Stage IV varian cancer
Advanced gastrointestinal ancers
Metastatic sarcoma
Metastatic prostate cancer
Advanced lung cancer

WANT TO GET SMARTER N SMARTER????

2009-10-10T07:09:00.001-07:00

YOU ARE AT THE RIGHT PLACE!!!

Obesity is a major international problem and Americans are among the heaviest people in the world. For instance, the percentage of obese people in the United States has risen steadily from 14 percent in the 1976 to 1980 survey to 33.5 percent in the 1999 to 2000 survey .

CONSEQUENCES OF OBESITY

1.Obesity is associated with many medical problems, most of which improve with weight loss
2.Both men and women with obesity are at increased risk for the following:
i.Reduced life expectancy
ii.Diabetes mellitus
iii.Gallstones
iv.Hypertension (high blood pressure)
v.Osteoarthritis
vi.Coronary heart disease
vii.Abnormal blood lipids
viii.Stroke
ix.Sleep apnea
x.Cancer (colon and prostate cancer in men; uterine and gallbladder cancer in women)

3.Many people find that they initially lose weight by dieting, although they quickly regain the weight after the diet ends. Because long-term weight reduction is so difficult, it is important to have as much information and support as possible before starting. People who are ready to lose weight and who believe that their body weight can be controlled long-term are usually the most successful.

STARTING A WEIGHT LOSS PROGRAM

1.Before beginning a weight loss program, you should speak with a healthcare provider so that he/she can help to choose the appropriate treatment, monitor your progress, and provide advice and support along the way.

2.Determining the severity of the weight problem — In order to know what treatment (or combination of treatments) will work best, a healthcare provider should determine your degree of obesity and distribution of body fat. This can be done by measuring your body mass index (BMI) and waist circumference (measurement).

3.The BMI is calculated from a person's height and weight as follows:

BMI = body weight (in kilograms) / height (in meters) squared.
4.A BMI between 25 and 30 kg/m2 is considered overweight. A BMI greater than 30 kg/m2 is considered to be obese.

5.A waist circumference greater than 35 inches (88 cm) in women and 40 inches (102 cm) in men indicates that there is an excessive amount of fat in the abdominal area.

Determining the risk for heart disease

1.The healthcare provider also needs to consider your risk for heart disease before choosing a treatment.

2.A person with a BMI of 20 to 25 kg/m2 has little or no increased risk for heart disease from obesity unless they have excessive fat in the abdominal area or have gained more than 22 pounds since age 18.

3.A person with a BMI of 25 to 30 kg/m2 has a low risk

4.A person with a BMI of 30 to 35 kg/m2 has a moderate risk

5.A person with a BMI of 35 kg/m2 and above has a high risk

6.Regardless of a person's BMI, health risks increase if a person:
i.Has excess abdominal fat
ii.Has high blood pressure
iiiHas high levels of cholesterol in the blood
ivHas heart disease
v.Has a strong family history of diabetes
vi. Is male Was obese before age 40

7.People with the highest risk of heart disease should use the most aggressive weight loss program.

Types of treatment — Depending upon a person's risk factors, BMI, waist circumference, and personal preferences, a healthcare provider will suggest a combination of behavior modification, exercise, dieting, and, in some cases, medications. Surgery is reserved for people with severe obesity who have not responded to other treatments.

SETTING WEIGHT LOSS GOALS

1.It is important to set a realistic goal for weight loss.

2.The first goal should be to prevent further weight gain and maintain the current weight (within 5 percent). The healthcare provider can help to identify a realistic weight-loss goal. Many people have a "dream" weight that is difficult or impossible to achieve.

3.A realistic goal — A person at high risk for developing diabetes mellitus who loses 5 percent of their body weight and maintains this weight will reduce their risk for diabetes by about 50 percent. This is a success. Losing more than 15 percent of initial body weight and maintaining this loss is an extremely good result, even if the person never reaches his or her "dream" or "ideal" weight.

BEHAVIOR CHANGES

1. Behavior change (modification) programs are usually run by psychologists or other trained behavioral professionals. The goals of behavior modification are to help people change their eating habits, increase physical activity, and become more conscious of both of these activities, thereby helping to make healthier choices.

2.This type of treatment can be broken down into three components: The triggers that make a person want to eat The behavior of eating The consequences of eating

Triggers to eat — Determining what triggers a person to eat involves identifying the foods that a person eats and the settings in which eating occurs. To determine triggers, keep a record for a few days of everything you eat, the places where you eat, how often you eat, and the emotions you were feeling when you ate.

For some people, the trigger is related to a certain time of the day or night. For others, the trigger is related to a certain place, like sitting at a desk working.

Behavior of eating — This component uses stimulus control to break the chain of events between the trigger for eating and eating itself. There are many ways to provide stimulus control. For instance, a person can: Restrict or limit the places they eat Restrict the number of utensils (eg, only a fork) used for eating Drink a sip of water between each bite Chew the food a defined number of times Get up and stop eating every few minutes.

Consequences of eating — This component involves rewarding good eating behaviors. This is not a reward for weight loss; instead, it is a reward for changing unhealthy behaviors.

3.Food should never be used as a reward. Some people find money, clothing, or personal care (eg, a hair cut, manicure, or massage) to be effective rewards. The reward should be given immediately after the improved behavior to reinforce the value of the good behavior.

4.Behavior goals need to be clearly defined, and there must be an agreed-upon timeframe for achieving goals. It is often important to reward small changes along the way to the final goal.

5.Other factors that contribute to successful weight loss — Behavior modification is more than just changing unhealthy eating habits; it also includes developing an internal and external support system, reducing stress, and learning to be assertive. Establishing a "buddy" system — Having a friend or family member available to provide support and reinforce good behavior changes is very helpful. The support person needs to be sympathetic to the person's goals and can be trained by the program director or the person losing weight.
6.Learning to be assertive — It is important to provide opportunities for role-playing in difficult situations. For instance, people trying to lose weight need to learn how to refuse food offered at parties and social gatherings. One strategy is to use assertiveness training, a technique for learning how to say "no" and continuing to say no when urged to eat. Role playing can be done with a partner or in a group.
7.Develop a support system — Having a support system is helpful when losing weight. This is why many commercial groups are successful. Family support is also essential, since negative attitudes about losing weight can slow or even prevent success.
8.Positive thinking — People often have conversations with themselves in their head; these conversations can be positive or negative. If a person eats a piece of cake that is not on their weight loss program, they may respond by thinking, "Oh, you stupid idiot, you've blown your diet!" and, as a result they may eat more cake. A positive thought for the same event could be, "Well, I have eaten cake when it was not on my plan and now I should do something to get back on track." This positive approach is much more likely to be successful than negative, self-deprecatory thoughts.
9.Stress reduction — Although stress is a part of everyday life, it can trigger uncontrolled eating in some people. It is important to find a way to get through these difficult times without eating or by eating low-calorie food, like raw vegetables. It may be helpful to identify a relaxing place that allows a temporary escape from stress. With deep breaths and closed eyes, the person can imagine this relaxing place for a few minutes.
10.Self-help programs — Self-help programs like Weight Watchers, Overeaters Anonymous, and Take Off Pounds Sensibly (TOPS), work for some people. However, these programs have a high drop-out rate. Psychotherapy — Behavioral treatments, including individual psychoanalysis, family or couples training, and self-help groups can help with weight loss efforts.

DIET THERAPY —
1.A calorie is a unit of energy found in food. The body needs calories to function. If a person takes in more calories than they use, approximately 75 percent of the extra calories are stored as fat and the remaining 25 percent as lean tissue. The goal of any diet is to burn up more calories than are taken in, which results in weight loss.

2.The rate at which a person loses weight can vary: the heavier the person, the quicker the weight loss on any given diet. Weight loss also can be influenced by age and sex. Men lose more weight than women of similar height and weight when dieting because they have more lean body mass and, therefore, use more energy. Older people have a slower metabolism than young people, and thus lose weight at a slower rate.

3.Conventional diets — Conventional weight reduction diets provide at least 800 calories a day, but less than what the body requires. These diets fall into four groups: Balanced low-calorie diets / portion-controlled diets Low-carbohydrate diets Low-fat diets Fad diets (these are diets that involve unusual food combinations or eating certain foods in a particular order)

4.Diets in the range of 1,200 to 1,500 calories are suitable for most people; men should eat a diet with close to 1,500 calories per day while women should eat a diet with close to 1,200 calories per day.

5.Balanced low-calorie diets — When starting a diet, it is important to determine an appropriate calorie level, as well as a combination of foods, to meet an individual weight loss goal. It is best to choose foods that contain adequate protein, carbohydrates, essential fatty acids, and vitamins. Alcohol, sugar-containing beverages, and most highly concentrated sweets (candy, cakes, cookies) should be eliminated from weight-loss diets since they rarely contain adequate amounts of nutrients other than calories.

6.Portion-controlled diets — One simple way to diet is to buy packaged foods, like frozen low-calorie meals. This can be supplemented with formula diets using powdered or liquid drinks. A typical meal plan for one day may include a formula diet or breakfast bar for breakfast, a formula diet or a frozen meal for lunch, and a frozen calorie-controlled entree for dinner. This would give the person 1,000 to 1,500 calories per day.

7.Low-fat diets — High fat diets, especially diets that are high in saturated and trans fat foods, increase the risk of obesity, heart disease, and certain forms of cancer, among other adverse effects. Almost all dietary guidelines recommend limiting fat intake to 30 percent of total calories or less.

A low-fat diet can be implemented in two ways. First, a dietitian can provide a specific menu plans that emphasizes the use of reduced fat foods. As one guideline, if a food "melts" in the mouth, it probably has fat in it. Second, a person can learn how to count fat grams. Many experts recommend keeping calories from fat to below 30 percent of total calories. For a 1500 calorie diet, this would mean about 45 g or less of fat, which can be counted using the nutrition information labels on food packages.

8.Low-carbohydrate diets — Carbohydrates are found in fruits, vegetables and grains (including breads, rice, pasta, and cereal), alcoholic beverages, and in dairy products. Meat and fish do not contain carbohydrates. Low-carbohydrate diets (eg. Atkins diet, South Beach Diet) have become extremely popular as a way to lose weight quickly. With a low-carbohydrate diet, between zero and 60 grams of carbohydrates are eaten per day (as compared to a standard adult diet which contains approximately 200 to 300 grams of carbohydrates).

Very low carbohydrate diets may be associated with more frequent side effects than low-fat diets. In one clinical trial, constipation, headache, bad breath, muscle cramps, diarrhea, general weakness, and rash occurred significantly more frequently in the low-carbohydrate compared to the low-fat diet group [3] .

9.Diet comparison — One trial compared four different diets: (very low-carbohydrate [Atkins], macronutrient balance controlling glycemic load [Zone], calorie restriction [Weight Watchers], and very low-fat [Ornish]) [4] . Average weight loss at one year for those who completed the study was approximately 4 to 7 kg (8.8 to 15.4 lbs), and was not different between the four diets.

Higher dropout rates were noted after one year with the very low-carbohydrate and very low-fat diets compared to the more moderate diets (48 percent for Atkins, 50 percent for Ornish, and 35 percent for Weight Watchers and Zone).

10.Fad diets — Fad diets often promise quick weight loss (more than 1 to 2 pounds per week), claim that it's unnecessary to exercise or give up favorite foods, limit food choices, or require the person to pay large amounts of money for seminars or pills. They generally lack any scientific evidence that they are safe and effective, but instead rely on "before" and "after" photos.

11.Diets that sound too good to be true usually are; these plans are a waste of time and money and are not recommended. A healthcare provider or nutritionist can help determine a safe and effective way to lose weight and keep it off.

WEIGHT LOSS MEDICATIONS —
1.Drug therapy may be helpful for some obese people when used in combination with diet, exercise, and behavior modification. People who are overweight who want to start a weight loss medication must carefully evaluate the risks and benefits with a healthcare provider. There are situations in which drug therapy is appropriate; as an example: People who are obese (BMI > 30 kg/m2) (show calculator) Overweight people (BMI between 27 and 30 kg/m2) who have other medical problems such as diabetes, high cholesterol, or high blood pressure, which further increase the risk of heart disease.

Goals of drug therapy — The goals of any weight loss program, including drug therapy, must be realistic: It is unrealistic to expect body weight to return to "normal". Weight loss should be greater than 2 kg (approximately 5 pounds) during the first month of drug therapy in order for it to be continued. Weight loss of 10 to 15 percent is considered a good response; weight loss exceeding 15 percent is considered an excellent response.

There are two drugs available for the long-term treatment of obesity; a third drug is in the final stages of becoming approved.

Sibutramine — Sibutramine (Meridia®, Reductil®) is an appetite suppressant that is effective for many people. The recommended starting dose is 5 to 10 mg per day; doses above 15 mg per day are not recommended. In people who complete one year of therapy, the average weight loss is 10 percent of the initial body weight (5 percent more than those who took a placebo treatment).

Side effects include insomnia, dry mouth, and constipation. Increases in blood pressure can occur. Therefore, the blood pressure is usually monitored during treatment. Sibutramine is not recommended for people with a history of heart disease or stroke. There is no evidence that sibutramine causes cardiac valve abnormalities or pulmonary hypertension (like dexfenfluramine and fenfluramine (Phen/Fen)).

Orlistat — Orlistat (Xenical® 120 mg capsules) is a medication that reduces fat absorption and helps some obese people to lose weight. A lower dose version is now available without a prescription (Alli® 60 mg capsules) in many countries, including the United States. The medication is recommended three times per day, taken with a meal; a dose may be skipped if a meal is skipped or if the meal contains no fat.

After one year of treatment with orlistat, the average weight loss is approximately 8 to 10 percent of initial body weight (4 percent more than those who took a placebo). Cholesterol levels often improve and blood pressure sometimes fall. In people with diabetes, orlistat may help control blood glucose levels.

Side effects occur in 15 to 10 percent of people, and may include stomach cramps, gas, diarrhea, leakage of stool, or oily stools. These problems are more likely when orlistat is taken with a high fat meal (if more than 30 percent of calories in the meal are from fat). Side effects are usually mild and subside as people learn how to avoid these problems by avoiding high fat diets and sticking to the recommended intake of no more than 30 percent fat.

Rimonabant — Rimonabant (Accomplia®) is a cannabinoid receptor antagonist. It was developed based upon the idea that people who smoke marijuana (cannabis) often develop extreme hunger. Rimonabant blocks cannabis receptors in the brain, which reduces appetite. In one clinical study, it produced 8 to 9 percent weight loss after one year (5 percent better than placebo). Blood pressure, HDL-cholesterol, triglycerides, and metabolic syndrome typically improve during treatment.

Side effects of rimonabant can include anxiety and depression. It is available in Europe but is not yet available in the United States.

Diet supplements — Over-the-counter dietary supplements are widely used by people who are trying to lose weight, although the safety and efficacy of these supplements are unproven. Examples of dietary supplements include ephedra (described below, no longer available), green tea, chromium, chitosan, and wheat dextrin. Ephedra, a compound related to ephedrine, is no longer available in the United States due to safety concerns. Many over-the-counter diet pills previously contained ephedra. Although some studies have shown that ephedra sometimes helps with weight loss, there can be serious side effects (psychiatric symptoms, palpitations, and gastrointestinal symptoms), including death. Chitosan and wheat dextrin are ineffective for weight loss, and their use is not recommended. There are not enough data regarding the safety and efficacy of chromium, ginseng, glucomannan, green tea, hydroxycitric acid, L carnitine, psyllium, pyruvate supplements, St. Johns wort, and conjugated linoleic acid. Until more information is available, these supplements are not recommended for the purpose of weight loss. Two compounded dietary supplements imported from Brazil, Emagrace Sim (also known as the Brazilian diet pill) and Herbathin dietary supplement, have been shown to contain prescription drugs. The Food and Drug Administration has warned of the potential danger of this supplement. Hoodia gordonii, a dietary supplement derived from a desert plant in South Africa, is marketed and sold as an appetite suppressant. However, it has not been proven safe or effective.

CARCINOMA PROSTATE --R U FREE OF IT??

2009-10-10T07:02:00.000-07:00

CARCINOMA PROSTATE

INCIDEDNCE

Prostate cancer is the leading cancer diagnosis and the second most common cause of cancer-related death in men in the United States. Worldwide, prostate cancer is the fourth most common cancer in men, with incidence and mortality rates that vary markedly among and within different countries. African-American men have the highest incidence of prostate cancer in the United States

RISK FACTORS

Although the specific causes of prostate cancer initiation and progression are not yet known, considerable evidence suggests that both genetics and environment play a role in the evolution of this disease. Classic and molecular epidemiology studies have identified a number of potential risk factors associated with the development of prostate cancer.

Hereditary Prostate Cancer

A number of case-control studies have demonstrated familial clustering of prostate cancer, suggesting that some prostate cancers may be inherited. Men with one first-degree relative with prostate cancer had a twofold risk of developing prostate cancer, while men with two or three affected first-degree relatives had a 5- to 11-fold risk, respectively.

Androgen

the degree to which androgen or androgen metabolites contribute to prostate cancer risk remains a contentious issue

VITAMIN D

Vitamin D (i.e., 1,25(OH)2 D) is a steroid hormone that can inhibit proliferation and induce differentiation of prostate cancer cell lines.

FAT

Giovannucci and colleagues (1993) prospectively studied the relationship between diet and prostate cancer in men enrolled in the Health Professionals Follow-Up Study. Men who consumed a high-fat diet had an increased risk of developing advanced prostate cancer. In summary, although many epidemiologic and biologic studies support the hypothesis that high dietary fat intake is a risk factor for prostate cancer, additional epidemiologic studies are needed to prove this definitively.

VITAMIN E

. A prospective Finnish trial designed to test the effect of vitamin E supplements on lung cancer incidence in smokers showed a 32% decrease in prostate cancer incidence and a 41% decrease in prostate cancer mortality compared with placebo

Sexual Activity, Smoking, Height and Weight, and Alcohol Consumption

A number of genetic (height and weight) and environmental (sexual activity, smoking, and alcohol consumption) exposures have been hypothesized to modulate prostate cancer risk. In general, no consistent relationship between these factors and prostate cancer has been established. Sexual activity, for example, is hypothesized to expose the prostate to infectious agents, which may increase the risk of prostate cancer, akin to the causal relationship between human papillomavirus (HPV) and cervical cancer in women. Although some studies have found a link among early sexual intercourse, number of sexual partners, and prostate cancer ([103] Honda et al, 1988), these results have not been consistent ([53] Ewings & Bowie, 1996). Studies have also not consistently identified HPV or other pathogens (i.e., chlamydia) in prostate cancer tissue ([236] Wideroff et al, 1996).

Cigarette smoking is a common risk factor for lung, bladder, and other epithelial cancers. There is little agreement over the role of cigarette smoking in prostate cancer risk. Both positive ([106] Hsing et al, 1990b; [101] Hiatt et al, 1994) and negative ([1] Adami et al, 1996; [50] Engeland et al, 1996) prospective studies have been reported. One study suggested that smokers have a worse prognosis than nonsmokers, perhaps related to an increase in androgens associated with smoking ([43] Daniell, 1995; [71] Giovannucci et al, 1999).

Heavy alcohol use is known to increase estrogen production and decrease testosterone levels and might be predicted to lower prostate cancer risk ([19] Breslow et al, 1999). Despite this hypothesis, no relationship between alcohol use and prostate cancer has been established ([173] Pollack et al,

Prevention

Screening For High-Risk Individuals

Ten percent of prostate cancers are inherited. In addition, inherited polymorphisms may contribute to prostate cancer risk in many individuals with sporadic tumors. Elevated levels of IGF may also indicate an increased risk of prostate cancer. These findings suggest that genetic or serum testing may play a role in prostate cancer prevention strategies.

Dietary Intervention

There is strong evidence that diet contributes to prostate cancer risk. It is reasonable to infer that dietary interventions might prevent prostate cancer initiation or alter the natural history of prostate cancer once established.

Fat

High-fat diets are linked to an increased risk of prostate cancer. Reducing dietary fat can slow the growth of human prostate cancer xenografts

Soy Isoflavones

One of the major differences between Asian and Western diets is the consumption of soy products. Soy contains a number of constituents that have weak estrogenic activity. These phytoestrogens, or isoflavones, are hypothesized to have anticarcinogenic properties. Genistein, the most abundant isoflavone in soy products, is of particular interest because it is a natural inhibitor of tyrosine kinase receptors such as EGFR and her-2/neu, both implicated in prostate carcinogenesis ([42] Dalu et al, 1998). Genistein has been shown to inhibit the proliferation of cancer cells, including prostate cancer, both in vitro and in vivo ([153] Messina et al, 1994; [9] Barnes, 1995).

Vitamin E

Long-term dietary supplementation with -tocopherol (vitamin E) reduced prostate cancer incidence in male smokers ([96] Heinonen et al, 1998).

Green Tea

Another difference between Western and Asian diets is the consumption of green tea. Green tea contains polyphenols, particularly epigallocatechin-3-gallate (EGCG), that are known to possess strong antioxidant activity. EGCG induces apoptosis in both androgen-dependent and androgen-independent prostate cancer cell lines ([2] Ahmad et al, 1997; [167] Paschka et al, 1998). EGCG has also been shown to inhibit activity of ornithine decarboxylase, an enzyme associated with prostate cancer proliferation ([89] Gupta et al, 1999). These results suggest that green tea may have potential as a preventive agent in prostate cancer.

Vitamin D Analogues

Vitamin D has potent growth-inhibiting and differentiating effects on various normal and malignant tissues and cells ([16] Bouillon et al, 1995).

TREATMENT

Treatment options for men with organ-confined prostate cancer include radical prostatectomy, external-beam radiation therapy, and interstitial radiotherapy (brachytherapy).

1.For radical prostatectomy, the overall 5-year freedom from PSA progression is 61–87% in several published series (Urol Clin North Am 20:713, 1993). Overall, 10-year disease-specific survival following radical prostatectomy for clinically localized prostate cancer is 85% (81–87%, 95% confidence interval) (JAMA 276: 615, 1996).

2.External-beam radiotherapy achieves disease-free rates of 45–85% for localized disease (N Engl J Med 331:996, 1994).

3.Technical improvements in dosimetry and implantation combined with reports of low morbidity have led to a renewed interest in brachytherapy. Some authors have suggested that brachytherapy alone may have a higher rate of PSA progression than other treatment modalities (Urology 51:884, 1998). The optimal form of treatment for clinically localized prostate cancer has not been conclusively determined.

4.Hormonal therapy with either bilateral orchiectomy or luteinizing hormone–releasing hormone agonists usually is reserved for men with locally advanced or metastatic disease.

5.Watchful waiting is appropriate for men with a life expectancy of fewer than 10 years and low-stage, low-grade prostate cancer (J Urol 159:1431, 1998).

HEALTHY DIET

2009-10-09T22:42:00.000-07:00

HEALTHY DIET

The food choices we make can have an important impact on our health..

FRUITS AND VEGETABLES :

1.A number of studies have demonstrated important health benefits of eating fruits and vegetables. These foods decrease the risk of cardiovascular diseases including coronary heart disease (CHD) and stroke ; eating up to six servings per day appears to provide the most benefit.

2.Cruciferous vegetables (ie, broccoli, cabbage, cauliflower, brussel sprouts), green leafy vegetables, citrus fruits, and vitamin C-rich fruit and vegetables may lower the risk of cardiovascular disease to the greatest extent.

3.High intake of fruits and vegetables also reduces the risk of developing certain kinds of cancer (including lung cancer and cancer of the gastrointestinal system). As an example, it is estimated that for every additional serving of fruit and vegetables per day there is a 5 percent reduction in the risk of lung cancer .

4.The National Cancer Institute recommends a goal of five servings of fruits or vegetables per day.

FIBER

1.Eating a diet that is high in fiber can decrease the risk of coronary heart disease and stroke by 40 to 50 percent .

2.Eating fiber also protects against type 2 diabetes, and eating soluble fiber (such as that found in vegetables, fruits, and especially legumes) may help control blood sugar in people who already have diabetes.

3.The recommended amount of dietary fiber is 20 to 35 grams of fiber per day.

FAT

1.High blood cholesterol levels increase the risk of coronary heart disease. Eating foods lower in certain types of fat and cutting back on foods that contain cholesterol can lower cholesterol levels and reduce the risk of coronary heart disease.

2.The type of fat consumed appears to be more important than the amount of total fat

3.Saturated fats and trans fats should be avoided. Trans fats are those that are solid at room temperature, and are found in many margarines and in other fats labeled "partially hydrogenated."

4.Another major source is oils that are maintained at high temperature for a long period. such as in fast food restaurants. Saturated fats come mainly from animal products, such as cheese, butter, and red meat.

5.When considering a low fat diet, it is important not to replace fat with carbohydrates. Increases in carbohydrate intake may lower levels of high density lipoprotein (HDL) cholesterol (good cholesterol), which actually increases the risk of coronary heart disease.

FOLATE

1.Folate is a type of B vitamin that is important in the production of red blood cells.

2.Low levels of folate in pregnant women have been linked to a group of birth defects

called neural tube defects, which includes spina bifida and anencephaly.

3.Vitamins containing folate and breakfast cereal fortified with folate are recommended as the best ways to ensure adequate folate intake.

4.However, supplements containing folate (called folic acid) are no longer recommended to reduce the risk of colon cancer or heart disease.

CALCIUM AND VITAMIN D

1. Adequate calcium and vitamin D intake are important, particularly in women, to reduce the risk of osteoporosis.

2.Calcium from food sources and supplements appears to slightly increase the risk of prostate cancer, although it may help to protect against colon cancer.

3.Although the optimal level has not been clearly established, experts recommend that premenopausal women and men consume at least 1000 mg per day and postmenopausal women should consume 1500 mg per day. No more than 2000 mg of calcium should be consumed per day

4.Experts recommend that adults consume a total of 800 International Units (IU) of vitamin D each day. This dose appears to reduce bone loss and the number of bone fractures in older women and men. Milk is the primary dietary source of dietary vitamin D, containing approximately 100 IU per cup. Infants and children also need vitamin D.

ALCOHOL

1.Moderate alcohol intake may reduce the risk of heart disease. However, it is not clear what amount of alcohol is best.

2.There are some risks associated with alcohol use, including breast cancer in women; cancers of the mouth, esophagus, throat, larynx, and liver; other illnesses such as cirrhosis and alcoholism; and injuries and other trauma-related problems, particularly in men

3.Based on the trade-off between these risks and benefits, the United States Dietary Guidelines recommend alcohol intake in moderation, if at all. This means no more than one drink per day for women, and up to 2 drinks per day for men.

4.Drinking is discouraged for those under 40 years who are at low risk of cardiovascular disease because the risks are likely to outweigh the benefits in this group.

CALORIE RECOMMENDATIONS

1.The total number of calories a person needs depends upon the following factors: Weight Age, Gender, Height, Activity level

2.For example, a 25-year old woman who is 5 feet, 5 inches tall and 140 pounds and is moderately active needs approximately 2100 calories per day to maintain her weight. A woman who is older, shorter, weighs less, or is less active would need fewer calories per day while a woman who is taller, younger, weighs more, or is more active would need more calories per day to maintain her weight.

3.The American Cancer Society provides a calculator that estimates the number of calories that a person should consume per day based upon their current (or target) weight, gender, and activity level. It is available online at the following web site: www.cancer.org/docroot/PED/content/PED_6_1x_Calorie_Calculator.asp

SUMMARY

1.Eat a lot of vegetables, fruits, whole grains, and a limited amount of red meat. Eat at least five servings a day of fruits and vegetables. More is even better. Tips for achieving this goal include: Make fruits and vegetables part of every meal. Frozen or canned products can be used when fresh products are not convenient or unavailable. Add fruit to cereal. Eat vegetables as snacks. Leave a bowl of fruit out all the time for adults and children to eat as snacks

2.Trans fats and saturated fats should be avoided. Monounsaturated and polyunsaturated fats should be used instead. Tips to accomplish this include: Choose chicken, fish, or beans instead of red meat and cheese. Cook with oils that contain a lot of polyunsaturated and monounsaturated fats, like olive and canola oil. Choose margarines that do not have partially hydrogenated oils. Soft margarines (especially squeeze margarines) have less trans fats than stick margarines. Eat fewer store-bought baked goods that may contain partially hydrogenated fats, such as crackers, cookies, and cupcakes. When eating at fast food restaurants, choose items like broiled chicken.

3.Get enough folate every day (400 micrograms per day). Tips for achieving this goal include: Take a daily multivitamin containing 400 micrograms of folate. This is especially important for women in the childbearing years. Eat breakfast cereal that is fortified with folate. Eat fruits and vegetables that are rich in folate, like oranges, orange juice, and green leafy vegetables.

4.Avoid excessive alcohol intake. Tips for achieving this goal include: Choose non-alcoholic beverages, like juices and sodas, at meals and parties. Avoid occasions centered around alcohol. Avoid making alcohol an essential part of family gatherings.

ACNE VULGARIS

2009-10-08T21:22:00.000-07:00

WANT TO KNOW ABOUT YOUR ACNE VULGARIS ?

Acne is almost ubiquitous in the teenage years, differences between individuals being a matter of severity of disease and facility with which scarring develops. Peak severity is in the late teenage years but acne may persist into the third decade and beyond, particularly in females. The main clinical issues relate to under-treatment and lack of clinical interest or insight into the patient's condition.

HOW IT HAPPENS?
There are three pathogenetic factors
• The first is elevated sebum excretion. There is a clear relation between severity of acne and sebum excretion rate. In the complete absence of sebum, acne does not occur. The converse, however, is not true; acne may improve in the third and fourth decades despite high sebum excretion. Sebum excretion is therefore necessary for the development of acne but is not sufficient to cause acne on its own. The main determinants of sebum excretion are hormonal, accounting for the onset of acne in the teenage years. Androgens are the principal sebotrophic hormones but progestogens also increase sebum excretion whilst oestrogens reduce it. In the absence of other suggestive clinical features or frank virilism the vast majority of patients with acne have a completely normal circulating endocrine profile.
• The second factor in the pathogenesis of acne is infection with Propionibacterium acnes. This bacterium colonises the pilosebaceous ducts and acts on lipids to produce a number of pro-inflammatory factors.
• The third factor is occlusion or blockage of the pilosebaceous unit.
Whilst there is some evidence for a familial component for sebum excretion the genetics and epidemiology of acne have been little studied.

HOW IT PRESENTS?

1.Lesions are usually limited to the face, shoulders, upper chest and back. Seborrhoea (greasy skin) is often clinically obvious.

2.Open comedones (blackheads) due to plugging by keratin and sebum of the pilosebaceous orifice, or closed comedones (whiteheads) due to accretions of sebum and keratin deeper in the pilosebaceous ducts, are usually evident.

3.Inflammatory papules, nodules and cysts occur with one or two types of lesion predominating. Scarring may follow.
SOME TERMS

1.Conglobate acne refers to severe acne with many abscesses and cysts, marked scarring and sinus formation.
2.Acne fulminans refers to the presence of severe acne accompanied by fever, joint pains and markers of systemic inflammation such as a raised ESR.
3.Acne excoriée refers to the effects of scratching or picking, principally on the face of teenage girls with acne.
4.Infantile acne is rare and is thought to be due to the sebotrophic effects of maternal hormones on the infant.

WHAT ARE THE ASSOCIATIONS?

1.A mild form of acne dominated by the presence of comedones may be due to exogenous substances such as tars, chlorinated hydrocarbons or oily cosmetics.
2.A primarily pustular rash may also be seen in those being treated with corticosteroids, lithium, oral contraceptives and anticonvulsants. These forms of acne are usually clinically distinct from the usual variety developing in adolescence.

3.Individuals with moderate or even severe acne very rarely have any other systemic disorder.

4.Individuals with polycystic ovary syndrome are more likely to have severe acne, and clinical hints-for instance, menstrual irregularities-require investigation. If there is associated cutaneous virilism or other features of an androgen-secreting tumour, further investigations and expert endocrinological assessment are warranted.

DO YOU NEED INVESTIGATIONS?

Investigations are rarely required. It is important, however, to enquire about the details of previous treatments and particularly about their duration; for example, antibiotics are commonly prescribed for too short a period of time.

WHAT IS THE TREATMENT?

1.The advent of systemic retinoids revolutionised the therapy of acne, which is now more straightforward and rewarding. In individuals with fairly minor disease, particularly dominated by the presence of comedones, topical agents such as benzoyl peroxide or tretinoin should be used. Both these substances have irritant activities, a factor which may be important in their therapeutic effect, and instructions should be given on how to use them. They may initially be applied for short intervals of time and the strength and duration gradually increased.

2.Although a number of other topical remedies, including washes, soaps and antiseptics, are recommended, evidence for their effectiveness is not convincing.

3.Patients with anything but minor degrees of acne require therapy with antibiotics, either systemic or local. Local antibiotics (clindamycin or erythromycin) are used more widely than previously; their use should be considered prior to systemic antibiotics or in persons with relatively minor disease, and in combination with other topical agents.
The principal oral antibiotic is oxytetracycline, taken on an empty stomach not with food, in a dose of up to 1.5 g a day if tolerated. In general, oxytetracycline has a good safety profile even with long-term use. Minocycline may be used if the response to oxytetracycline is inadequate or because of the ease of dosing. It is, however, associated with autoimmune hepatitis and remains a second- rather than first-choice drug.
Before an antibiotic is deemed not to have worked, the individual must be treated continuously for up to 3 months. If after 3 months there is little response to oxytetracycline the patient should be changed to erythromycin up to 1 g per day in divided doses. Patients need to remain under review.

4. In women, oestrogen-containing oral contraceptives can be a useful adjunct in therapy. There is a small reduction in sebum secretion with oral oestrogens. An oral anti-oestrogen, cyproterone acetate, is occasionally added in doses of 50-100 mg daily on days 5-14 of the cycle to enhance the effects of sebum reduction. If these topical and systemic agents fail to produce an adequate clinical response within 3-6 months the patient should be referred for specialist opinion and consideration for treatment with isotretinoin

5.Isotretinoin has revolutionised the treatment of severe or moderate acne in patients unresponsive to other therapy. When used at a dose of 0.5-1 mg/kg this drug inhibits sebum excretion by > 90% over 4 months. Although sebum excretion gradually returns to normal over the course of the year after the drug is stopped, the clinical benefit is prolonged for much longer. Many patients with acne will not require any further treatment but in a minority a second course of isotretinoin may be required.

6.Side-effects, especially drying of the skin and mucous membranes, are common but well tolerated and relate to the drug's effects on the function of modified sebaceous glands on the lips, and on lipid biosynthesis in interfollicular epidermis. Rarely, abnormalities of liver function occur and limit treatment. Isotretinoin may elevate serum triglycerides; levels should be checked before therapy and monitored during it. Depression and suicide have been reported, although it is difficult to disentangle the role of the drug from that of the underlying disease and age groups at risk; it is currently under investigation. The major consideration before the drug is prescribed is that, like all systemic retinoids, isotretinoin is highly teratogenic; females must have a negative pregnancy test before treatment and monthly checks, and must be on effective contraception for at least 1 month before the course begins, during the course and for 1 month after it finishes.

7.Physical measures :
Cysts can be incised and drained under local anaesthetic. Intralesional injections of triamcinolone acetonide (0.1-0.2 ml of a 10 mg/ml solution) hasten the resolution of stubborn cysts. Scarring following acne is seen a lot less commonly if patients receive adequate care. Small, deep acne scars can be excised and other forms of more extensive but shallower scars can be treated by carbon dioxide laser.

THINGS YOU MUST KNOW?

External factors
1.Cosmetics may contribute to the development of acne. Oils, greases, or dyes in hair products and cosmetic creams can exacerbate the skin lesions, while water-based products are less comedogenic

2.Soaps, detergents, and astringents remove sebum from the skin surface but do not alter sebum production. Repetitive mechanical trauma caused by scrubbing with these agents may worsen the disorder by promoting the development of inflammatory lesions . Similarly, turtlenecks, bra straps, shoulder pads, orthopedic casts, and sports helmets may all cause acne mechanica. Thus, patients with acne should avoid occlusive clothing and refrain from rubbing their faces or picking their skin.

3.Environmental factors such as humidity and heavy sweating also can exacerbate acne. Chloracne is caused by exposure to halogenated hydrocarbons, including dioxin, via percutaneous contact, inhalation, or ingestion. These chemicals are found in industrial products such as cutting oils and herbicides, in chemical warfare, and in contaminated food products. Clinically, chloracne is characterized by large monomorphic comedones with evolution into severely inflammatory and scarring lesions.

Diet

1.A potential role for diet in acne is controversial . A study of 47,355 women in the Nurses' Health Study that used a retrospective collection of data on diet during high school found an association between acne and intake of milk . The authors suggest that natural hormonal components of milk and/or other bioactive molecules in milk could exacerbate acne.

2.Other studies have suggested that insulin-like growth factor (IGF) may play a role in acne. IGF is increased by ingestion of high glycemic loads and so could potentially link diet and acne. A 12-week randomized trial that compared low and high glycemic load diets in 43 male patients with acne found a greater reduction in lesion counts with the low glycemic load diet . However, the participants on that diet also lost more weight than those on the high glycemic load diet, so it is possible that the results were due to changes in weight rather than the composition of the diet.

Stress

1.Patients and medical providers commonly believe that psychological stress can exacerbate acne . A prospective cohort study in 94 secondary school students compared acne severity and sebum production at times of high stress (midterm examinations) and low stress (summer holidays) . Sebum production did not appear to be related to stress, but acne severity, as assessed by an examiner blinded to the hypothesis of the study, did appear to be associated with stress, particularly in boys.

Similarly, a study of 22 university students found that in a multivariate analysis, acne severity did appear to have some correlation with stress around the time of school examinations.

RAYNAUD'S DISEASE

2009-10-07T11:07:00.000-07:00

DO YOU HAVE RAYNAUDS DISEASE?

BACKGROUND:

It is named for Maurice Raynaud (1834 - 1881),a French physician who first described it in 1862

WHAT IS RAYNAUDS DISEASE?:

It is a vascular disorder^[1] that affects blood flow to the extremities (the fingers, toes, nose and ears) when exposed to cold temperatures or in response to psychological stress.

WHAT IS THE FREQUENCY AND COMMON AGE GROUP?:

Raynaud's disease affects 5-10% of young women in temperate climates. The condition is often familial and usually appears between the ages of 15 and 30 years.

WHAT ARE THE USUAL SYMPTOMS?

The symptoms include several cyclic color changes:

On exposure to cold temperatures, the blood supply to the fingers or toes, and in some cases the nose or earlobes, is markedly reduced; the skin turns pale or white (called pallor), and becomes cold and numb.
When the oxygen supply is depleted, the skin colour turns blue (called cyanosis).
These events are episodic, and when the episode subsides or the area is warmed, the blood flow returns and the skin colour first turns red (rubor), and then back to normal, often accompanied by swelling and tingling.

All three colour changes are observed in classic Raynaud's disease. However, not all patients see all of the aforementioned colour changes in all episodes, especially in milder cases of the condition. Symptoms are thought to be due to reactive hyperemias of the areas deprived of blood flow.

WHAT IS PRIMARY RAYNAUDS PHENOMENON?

This is also called Raynaud's disease.It does not progress to ulceration or infarction and significant pain is unusual. No investigation is necessary and the patient should be reassured and advised to avoid exposure to cold, in the first instance. Treatment with a long-acting preparation of nifedipine may also be helpful. The underlying cause is unclear. Sympathectomy is not indicated.

WHAT IS SECONDARY RAYNAUDS DISEASE?

This is also known as Raynaud's syndrome and tends to occur in older people in association with connective tissue disease (most commonly systemic sclerosis or the CREST syndrome, vibration-induced injury (from the use of power tools) and thoracic outlet obstruction (e.g. cervical rib). In contrast to primary disease the condition is associated with fixed obstruction of the digital arteries; fingertip ulceration and necrosis are often present and pain is usual. The fingers must be protected from cold and trauma, infection requires treatment with antibiotics, and surgery should be avoided if possible. Vasoactive drugs have no clear benefit. Sympathectomy helps for a year or two. Prostacyclin infusions are sometimes beneficial.

HOW CAN YOU PREVENT?

Patients with Raynaud's disease should keep their extremities warm by wearing gloves and socks. Patients are advised to avoid stressful situations, touching of cold objects, and artificially cold environments, such as refrigerated or highly air conditioned spaces. Patients are also advised to avoid medications and foods that can constrict blood vessels, such as decongestants and caffeinated beverages, as well as smoking.

WHAT IS THE TREATMENT?

The severity of the disease runs from mild to severe. In people with mild cases, it may be just an annoyance. HeatBands and hand warmers may be used on the wrists to warm the blood flowing to the hands. More serious cases can require medical intervention due to the risks of gangrene and possible digital amputation.

A more recent treatment for severe Raynaud's is the use of Botox. The 2009 article ^[2] studied 19 patients ranging in age from 15 to 72 years with severe Raynaud's phenomenon of which 16 patients (84%) reported pain reduction at rest. 13 patients reported immediate pain relief, 3 more had gradual pain reduction over 1-2 months. All 13 patients with chronic finger ulcers healed within 60 days. Only 21% of the patients required repeated injections.

A 2007 article ^[3] describes similar improvement in a series of 11 patients. All patients had significant relief of pain.

Treatment for Raynaud's disease may include prescription medicines that dilate blood vessels, such as calcium channel blockers (nifedipine) or diltiazem. Fluoxetine, a selective serotonin reuptake inhibitor, and other antidepressant medications may reduce the frequency and severity of episodes.

Milder cases of Raynaud's can often be addressed by biofeedback^[4] or other techniques to help control involuntary body functions like skin temperature. In severe cases, a sympathectomy procedure can be performed. Here, the nerves that signal the blood vessels of the fingertips to constrict are surgically cut. Microvascular surgery of the affected areas is another possible therapy.

REFERENCES

1.^ Raynaud disease at Dorland's Medical Dictionary

2. ^ Anderson JE, Held N, Wright K (2004). Pediatrics 113 (4): 360–364. PMID 15060268.

3.^ Kumar, Vinay; Nelso Fausto, Abul Abbas (2004). Robbins & Cotran Pathologic Basis of Desease. Saunders. pp. 542. ISBN 0721601871.

4.^ Berlin, Al, Pehr K (2004). J Am Acad Dermatol 50 (3): 456–60. PMID 14988692.

DIABETES MELLITUS

2009-10-06T01:52:00.000-07:00

What is Diabetes Mellitus?
Diabetes mellitus is a state of chronic hyperglycaemia sufficient to cause long-term damage to specific tissues,notably the retinae,kidneys,nerves and arteries and is often accompanied by other clinical and biochemical abnormalities.

How is it classified?
Type-1
(5-15 %).
Genetic(30 % ) :-1.IDDM1;Chromosome 6 MHCII receptor site of Th lymphocytes. 2.IDDM2 gene (insulin gene) on Chromosome 11.
Environment Factors:

Type-2
(85-90%)
Genetic:- Low / inappropriate insulin secretion.
Environmental factors:-Obesity (Syndrome X:- HTN, DM,dyslipidaemia & truncal obesity).

What are the other causes of Diabetes Mellitus?

Viruses ; Coxsackie, CMV,rubella& retroviruses.

b.Bovine albumin-cow milk.

c:Toxins:-nitrosourea streptozotocin etc
Autoimmune: ICA,GAD ,IAA antibodies.
Pregnancy, intercurrent illnesses & drugs.
Low birthweight.
Lack of exercise.

What is the clinical picture of diabetes mellitus?

Classical :- Polyurea,polydypsia & polyphagia.
Loss of weight/ DM1 - obesity in / DM2.
Blurred vision.
Infections:-Skin,genital candidial & UTI.
Malaise,tiredness,lack of energy and muscle weakness(DM1).
Screening.

How diabetes is diagnosed or what is the diagnostic criteria of DM?

Diabetes mellitus :Fasting venous plasma glucose greater than 7.0Mmol/l(126mg/dl) on more than one occasions or a value exceeding 11.1 mmol/l(200mg/dl) at 2h in oral glucose tolerance test with 75 Gm or in random sample. ALL BASAL VALUES.
Impaired Glucose Tolerance (IGT):FPG <> 6 mmol or RPG(02h in OGTT) between 7.8-11.1 mmol/l.Risk of IHD.
Impaired Fasting Glucose(IFG):FPG 6.1 to 6.9mmol /l (110-124mg/dl).IHD Risk.

What are the Investigations carried out for diagnosis,monitoring and control of diabetes?

Diagnosis:-

Fasting Plasma Glucose,Random Plasma Glucose,Oral Glucose Tolerance Test.

Control:-

Urine,Fasting Plasma Glucose,02Hour Post Prandial &HbA1c

Complications:-

1.Proteinurea:- Microalbuminaemia &24 hrs- protein.urea,creatinine,Na &K
2.ECG,Lipids ,ETT,Echo &angio.
3.Doppler studies.
4.Fluorescein angiography retina.
5.Nerve conduction studies:(NCS)

What is the general management of Diabetes Mellitus?
LIFESTYLE THERAPY:

Diet - Less sugar- Carbohydrates 55% soluble fibres ( cereals,vegetables &fruits) preference of less glycaemic index (cereals,pulses).Total sucrose <50>

WEIGHT i.e Standard for age ,sex &body habitus. By diet (600 Cal less/day),exercise,drugs & surgery at times(>40kg/m2) -gastric banding or by-pass.

Exercise:-GLUT-4 in muscles &fats.

NO Smoking.

Minimum Alcohol.
Goal :-Preprandial;4-6/& Bed time;6-8 -ideal ,Postprandial <10mmol-reasonable.prenancy;>

Oral Hypoglycaemics

Sulphonylurea :- Insulin secretogogues, lower glucose by > 2-4mmol/l.

Repaglinide :-Non-sulphonylurea part of glibenclamide).
Biguanides :- Gluconeogenesis inhibitors(2-4 mmol/l).
Thiozoladinediones :-Insulin sensitizers (Rosiglitazones & pioglitazones) 2-3 mmol/l <>

Acarbose :-Glucosidase inhibitors (1-2 mmol/l)

Insulins

Bovines &Porcine :-Pure,purified &highly purified(monocomponent)-immune reaction.

Human:- Recombinant DNA on yeast-faster and shorter than bovine or porcine’s. Humann Analogues:-Modified at C-terminal act faster.

Injections S/C,pumps(s/c & intraperitoneal), pressure,aerosols,pancreatic transplant.

Complications

Acute Coma--Ketoacidosis, Hyoerosmolar Non Ketotic coma,CVA,Uremia & hypoglycaemia

Chronic a.

Macrovascular:- Athersclerosis ; CVA, IHD,peripheral vascular disease.

b.Microvascular :- Retinopathy,nephropathy & neuropathy. Diabetic Ketoacidosis Antibiotics.

Insulin:- .1U/kg/hr (I/V-6U/hr or 10U/2h i/m). Hydration:- 100 ml/ kg -Saline For cardiac,renal or cirrhotic 01 L/08h -measure CVP. If glucose <10>5.mol/l.

Complications:-Shock,cerebral odema, ARDS, gastroparesis &hypothermia.

Chronic Complications

Cause:-Advanced Glycation Endproducts (AGE) interfere with tissue structure.
Polyols:- Sorbitol and myoinositol Microvasculopathy.

Retinopathy

Neuropathy

Diffuse Symmetrical Polyneuropathy:- Sensory &motor -Glove &stocking.
Diffuse Small Fibre(pain,temp &autonomic)
Acute mononeuropathy/mononeuritis multiplex.
Amyotrophy.
Pressure palsies.
Insulin neuritis :-Transient after insulin start-pain ,dysthesia.

Nephropathy

Glomerular basement membrane(GBM) thickening
UAER(Urinary albumin excretion rate):- 30-300 mg/day -microalbuminuria or incipient nephropathy,overt albuminuria or clinical nephropathy(0.5 gm/day) or uaer 300mg/day.
ACR(Albumin : creatinine ratio).

Examination of a Diabetic Patient -At Least Annual.
Thorough Physical Exam.
Feet:- Crack ,crevices,callosity,interdigital & sensation.
CNS :- Pain,temp,&vibration& jerks.
Face,Scalp, Oedema& Genitalia.
Eyes:-Visual acuity,fundoscopy &Slit lamp.
CVS:- B.P,Pulses & signs of heart failure

HYPERTENSION

2009-10-03T11:32:00.000-07:00

HYPERTENSION

Definitions:

1. Within population, blood pressure like weight and height, is normally distributed. For an individual person, normal blood pressure is the one that is not associated with any cardiovascular risk. Based on a long term follow up of a large number of individuals, blood pressure has been categorized as follows: -

Category Systolic Diastolic

(mm Hg) (mm Hg)

Normal < style="mso-tab-count: 2"> <>

High normal 130-139 85-89

Hypertension

Mild 140 – 159 90 – 99

Moderate 160 – 179 100 – 109

Severe 180 – 209 110 – 119

Very severe > 210 > 120

2. These definitions apply to adults who are not taking any antihypertensive drugs and who are not acutely ill. When systolic and diastolic blood pressures fall into different categories, the higher category should be selected to classify the individual’s blood pressure status. Patients with high normal blood pressure may be at increased risk and should be counseled to follow better health habits in the hope of slowing the progression towards definite hypertension.

3. Isolated systolic hypertension is defined as a systolic B.P of more than 140 mm Hg and a diastolic B.P less than 90 mm Hg.

4. In about 95% of patients with hypertension, no specific cause can be identified. This condition is termed ‘essential’ or ‘primary’ hypertension. In approximately 5% of hypertensive patients, a specific cause can be identified. Such patients are said to be suffering from secondary hypertension.

Blood Pressure Measurements:

5. It is unfortunate that uncomplicated hypertension is almost always asymptomatic. Therefore, the only way to diagnose hypertension is to measure the B.P as a routine in any patient who reports to the MRC or to the consultant who may be a physician, surgeon or a skin specialist. This is how a great majority of patients will be detected and managed properly.

6. For diagnosis, at least 3 sets of recordings should be obtained, at least a day apart at varying times. On each occasion 2 readings should be taken separated by 5 minutes. Initially blood pressure should be measured in both arms. If pressure differs, arm with higher pressure should be used.

7. Blood pressure should be measured in a quiet and warm setting with no tea or coffee for the preceding one hour and no smoking for the preceding 15 minutes. The patient should sit quietly with back supported for 5 minutes and arm supported at the level of heart. Cuff should encircle and cover 2/3^rd of the length of arm. Bladder should be inflated to a pressure 20 mm Hg above the systolic B.P. recognized by the disappearance of radial pulse. Then bladder should be deflated by 3 mm Hg every second. Korot-Koff phase v (disappearance of sounds) should be recorded for measurement of diastolic B.P.

Evaluation of the Patient:

8. Once a serving soldier is suspected to be suffering from hypertension, he must be admitted for further evaluation and disposal. A detailed history should be recorded which should provide information about other risk factors like smoking, D.M, family history of hypertension or IHD. In the physical examination, the idea should be not only to look for evidence of target organ damage but also to detect any secondary cause of hypertension which may be treatable. Therefore, search should be made to detect radio femoral delay (coarctation of aorta), enlarged kidneys (polycystic kidney disease), abdominal bruits (renal artery stenosis) and the characteristic facies and habitus of Cushing’s syndrome.

Target Organ Damage:

9. Target organ damage means any complication of hypertension that principally involves the heart, kidneys, retina and central nervous system.

a. Heart : Coronary artery disease, left ventricular hypertrophy,

cardiac failure.

b. Kidneys: Azotaemia, renal failure.

c. Retina: More than grade I changes of hypertensive retinopathy.

d. C.N.S: TIAs, CVAs.

Investigations:

10. Clinical evaluation of the patient should guide how much extensively a patient be investigated.

Basic Investigations:

11. Following investigations should be carried out in all hypertensive patients with a view to detecting any secondary cause or target organ damage or any associated risk factors.

a. Urine RE.

b. Serum Urea, electrolytes, creatinine.

c. Blood sugar.

d. Serum lipid profile.

e. Serum uric acid.

f. E.C.G.

g. CXR PA.

Specific Investigations:

12. Following specific investigations should be carried out in selected patients in whom clinical examination and basic investigations suggested either a secondary cause of hypertension or target organ damage.

Echocardiography: Left ventricular hypertrophy.

Exercise tolerance test: Coronary artery disease.

Ultrasound abdomen: Renal and suprarenal masses.

Renal angiography: Renal artery stenosis.

Aortogram: Coarctation of aorta.

Urinary catecholamines: Phaeochromocytoma.

Plasma renin activity and aldosterone: Primary aldosteronism.

Treatment:

13. The goal of treatment is to reduce mortality and morbidity in the form of cerebral strokes, acute myocardial infarctions, congestive cardiac failure and renal failure. The benefits of treatment have to be weighed against side effects and inconvenience, so it is important to treat the whole patient, not just the blood pressure.

Non Drug Therapy:

14. Non drug therapy include weight reduction, regular physical exercise, salt restriction, avoidance of smoking and abstinence from alcohol. These measures alone should be employed in patients with diastolic BP between 90-94 mm Hg with no evidence of target organ damage or risk of developing coronary artery disease.

Drug Therapy:

15. Drug therapy should be started in patients with a diastolic BP more than 94 mm Hg or in those with diastolic BP between 90-94 mm Hg with evidence of target organ damage or risk of developing coronary artery disease. In such patients benefits of drug therapy outweigh its risks or side effects.

16. Drug therapy should be tailored to the specific needs of the individual patient particularly if there are complicating medical conditions e.g. coronary artery disease, congestive cardiac failure, asthma, vascular disease or diabetes mellitus. It should be started with a single anti-hypertensive agent, the choice of which should be determined by its safety, cost, convenience and freedom from side effects. One drug should be added at a time, stepwise, in sufficient does to achieve the goal of therapy i.e. to reduce the BP to less than 140/90 mm Hg. A brief description of commonly used antihypertensive drugs is as follows.

Thiazide and other diuretics:

17. Thiazide diuretics have been used widely in the treatment of essential hypertension for many years. Mechanism of their hypotensive action remains unclear. Initially plasma volume and cardiac output may be reduced but these values later normalize. Hydrocholrothiazide may be given in a dose of 25-200 mg daily or bendrofluomethiazide 5-20 mg daily. Combination of a thiazide with a potassium sparing diuretic amiloride can also be used. These drugs are used in a single dose. The dose should be adjusted according to the response. Hypokalaemia must be avoided by supplementing potassium containing diets or synthetic potassium preparations. Thiazide diuretics may cause hyperuricaemia (precipitating gout) and glucose intolerance, but seldom cause postural hypotension. More potent loop diuretics such as frusemide (40 mg daily) or bumetanide (1 mg daily) have few advantages over thiazides in the treatment of hypertension unless there is substantial renal impairment or they are used in conjunction with an ACE inhibitor.

Beta blockers:

18. Beta blockers lower BP by competitive inhibition of stimulant effects of catecholamines on beta receptors in the heart or in the blood vessels. Both non selective (propranolol 10-120 mg three times daily) and cardioselective (atenolol 50-100 mg daily, metoprolol 100-200 mg daily) beta blockers are effective antihypertensive agents. They are widely used and are especially useful in the presence of angina. They may aggravate asthma, heart failure and peripheral vascular disease. However, when given in very small incremental doses to patients with heart failure, they diminish the effects of sympathetic stimulation on the heart and improve symptoms.

Calcium channel blockers:

19. Calcium channel blockers are effective and usually well tolerated antihypertensive drugs. These are particularly useful in the presence of angina. The dihydropyridine group including nifedipine (30-90 mg/daily) or amlodipine (5-10 mg daily) produces peripheral vasodilatation by inhibiting the entry of calcium ions in the vascular smooth muscle. Side effects include headache, flushing and ankle swelling. The phenylalkylamine group such as verapamil (80-120 mg thrice daily) or deltiaziem (60-120 mg thrice daily) act more on myocardium, reducing its contractility and cause bradycardia. Thus, they reduce myocardial oxygen demand. They aggravate cardiac failure.

ACE inhibitors:

20. Angiotensin converting enzyme inhibitors are effective in all grades and types of hypertension. They inhibit the conversion of angiotensin I to angiotensin II. They cause a fall in BP by reducing systemic vascular resistance. They are particularly useful in patients with heart failure. Here, they interrupt the vicious cycle of neurohumoral activation that is characteristic of moderate and severe heart failure. When started immediately after acute myocardial infarction, they prevent left ventricular dilatation and progression to heart failure. They should be used with particular care in patients with impaired renal function or renal artery stenosis as they can precipitate renal failure in these patients. Captopril is given in a daily dose of 25-50 mg TDS, enalapril 10-20 mg/day and lisinopril 10-20 mg/day. Side effects include first dose hypotension, cough, rash, metallic taste, hyperkalaemia, proteinuria and rarely angioneurotic edema.

Angiotensin II receptor antagonists:

21. These are relatively new drugs (losartan 50-100 daily, valsartan 40-160 mg daily) which appear to be effective in lowering blood pressure. They are costly but relatively free from side effects. Unlike ACE inhibitors, they do not cause cough, because they do not interfere with bradykinin degradation.

Alpha one adrenoceptor antagonists:

22. These include prazosin (0.5-20 mg daily in divided doses) and doxazocin (1-4 mg daily). They have marked arteriolar and venous vasodilator effects. Initial dose may produce profound hypotension. For this reason, the first dose should be taken on retiring to bed and the dosage gradually increased over a period of several weeks.

Vascular smooth muscle relaxants:

23. Vascular smooth muscle relaxants such as hydralazine (25-100 mg 12 hourly) and minoxidil (10-50 mg daily) are not used as first line therapy. Hydralazine can cause fluid retention and therefore should be combined with a diuretic. SLE like syndrome can occur when used in large doses. Minoxidil causes increased facial hair and is therefore unsuitable for female patients. These drugs are not suitable in patients with IHD.

Centrally acting drugs:

24. Methyl dopa (250-500 mg 8 hourly) is an effective antihypertensive drug and cost effective. However, the side effects must be kept in mind, enquired about and looked for in the patient. Clonidie (0.05-0.6 mg 8 hourly) is not in common use because of rebound hypertension on sudden withdrawal.

Logical antihypertensive combination:

25. Diuretic Plus Beta blocker or ACE inhibitor.

Beta blocker Plus Diuretic or Ca antagonist or alpha blocker.

ACE inhibitor Plus Diuretic or Ca antagonist.

Resistant Hypertension:

26. In resistant hypertension, there is failure of diastolic BP to fall below 90 mm Hg despite the use of 3 or more anti-hypertensive drugs. The patient should be treated with adequate doses of a diuretic, calcium channel blocker and an ACE inhibitor. Any secondary cause of hypertension should be looked for and non compliance should be ruled out.

Hypertensive Emergencies:

27. Accelerated phase or ‘malignant’ hypertension is associated with a rise in diastolic B.P more than 130 mm Hg causing acute arteriolar damage characterized by retinal haemorrhages or exudates (accelerated phase) and frequently papilloedema (malignant). A surge in cerebral blood flow may rapidly lead to cerebral encephalopathy. Other circumstances requiring urgent treatment of hypertension include left ventricular failure, Aortic dissection, intracerebral or subarachnoid haemorrhage and eclampsia. It is unwise to lower B.P too rapidly as this may compromise tissue perfusion and can cause tissue damage including occipital blindness and precipitate coronary or renal insufficiency. A controlled reduction in B.P to a level of 150/90 mm Hg over a period of 24-36 hours in required.

28. Parenteral drugs for the treatment of hypertensive emergencies:

a. I.V nitroglycerin 0.6-1.2 mg/hour infusion or I.V isosorbide dinitrate 2.5-5mg/hour infusion. They may cause tachycardia, flushing, headache and vomiting.

b. I.V nitroprusside 0.25-10 micrograms/Kg/minute infusion. It may cause nausea, vomiting, muscle twitching and sweating.

c. I.V metoprolol 5 mg every 5 minutes to a total of 15 mg or I.V labetolol (combined alpha and beta blocker) 20-80 mg I.V bolus every 10 minutes followed by 2 mg/minute I.V infusion. I.V labetolol can cause vomiting, scalp tingling, burning in the throat and postural hypotension.

d. I.V Hydralazine 10 mg I.V every 10-15 minutes until desired result has been obtained or a total of 50 mg has been administered. It can the be given 6 hourly I.V or I.M. It can cause tachycardia and aggravate angina.

e. I.V phentolamine: 5-10 mg I.V. It can cause tachycardia and flushing.

f. I.V methyl dopa: 500 mg in 100 – 200 ml of 5% dextrose I.V over 40 minutes, 2^nd dose can be repeated after 2-4 hours. Additional I.V doses can be given 6 hourly. It is not preferred in patients with encephalopathy.

g. I.V frusemide 40-80 mg every 6 hourly.

29. Sub-Lingual drugs for the treatment of hypertensive emergencies:

a. Capsule nifedipine 10 mg.

b. Tablet captopril 25 mg.

DEPRESSION

2009-10-03T00:16:00.000-07:00

AFFECTIVE/MOOD DISORDER

The types of affective disorder are;

1. MANIC EPISODE

2. BIPOLAR AFFECTIVE DISORDER

3. DEPRESSIVE EPISODE

DEPRESSION

It is further categorised as;

Depressive Episode can be;

Mild, Moderate, Severe

Recurrent Depression

Persisitent Mood Disordermay present as ;

Cylothymia, Dysthymia

AETIOLOGY of DEPRESSION

The factors playing role in depression are

BIOLOGICAL

Serotonin, Noradrenaline

Polymorphic genes

Physical illness

Mesial Frontal Cortex

PSYCHOLOGICAL

Learnt helplessness

Negative cognitive triad

ENVIRONMENTAL

Adverse childhood

Adverse life events

HOW DOES IT FEEL TO BE DEPRESSED?

THE CLINICAL FEATURES:

Masked Depression

Fatigue

Inability to Cope

Vague, Unexplained Somatic Complaints

“Dyspepsia”, “Gas”

“Dizziness”

“Low Blood Pressure”

Intractable Pain

Smiling Depression

Reckless Decisions

Depressed Mood and/or Anhedonia is often Masked

The Face of Depression

Depressed mood

Diminished Pleasure

Change in Sleep, Appetite, Libido, Weight

Inability to Cope

Fatigue

Feelings of Hopelessness Suicidal intent

Psychomotor agitation

More than 2 weeks

S U I C I D E

Emotional

Social

Economic

___Physical

MANAGEMENT......

PSYCHOSOCIAL INTERVENTIONS

Informational Care:

Patient

Family

Psychotherapy

‘Parhez’

BIOLOGICAL INTERVENTIONS

1. Drug Treatment

Tricyclics: Imipramine 75-150 mg

SSRIs: Fluoxetine 20mg

SNRIs: Venlafaxine 75-150 mg

2. Electroplexy

ALCOHALISM

2009-10-03T00:06:00.000-07:00

ALCOHOLISM REASONS

Has become a symbol of prestige and success.

No society can withstand the trend when coupled with heavy pressure to drink in gatherings/ parties.

The real cost has gone down in most parts of the world in spite of increased taxation.

Production of alcohol has increased.

In Pakistan, in spite of law, it is still available.

SOME DEFINITIONS

ALCOHOLIC;

“who is unable to break his addiction”

HEAVY DRINKER;

“ who drinks because he likes”

ALCOHOLICS

Those excessive drinkers whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with their bodily and mental health, their inter-personal relations and their smooth social and economic functioning; or who show the prodromal signs of such development.

CAUSES

Drinking companions

Receptions

Frustration at work

Disappointment in love

Psychiatric illness

Social gatherings

Failure of ambitions

Domestic disharmony

Serious emotional work

ALCOHOL-RELATED PROBLEMS

Crimes

Traffic accidents

Absenteeism

Low productivity

Cirrhosis

Heart diseases

Secondary poverty

Cancers

Resistance to infections

Tuberculosis

Mentally retarded progeny

Malnutrition in children

CRIMES ASSOCIATED WITH ALCOHOLISM

Rapes

Assaults

Homicides

prostitution

PREVENTIVE MEASURES

AT PERSONAL LEVEL

Religious education ( all divine religions), Psychotherapy.

AT COMMUNITY LEVEL

Cooperation, compulsory rehabilitation

AT NATIONAL LEVEL;

Political commitment

Legislation

AT INTERNATIONAL LEVEL

Restrict or stop import or sale

WORLD AIDS DAY

2009-10-02T18:35:00.000-07:00

What is HIV?

HIV stands for "Human Immunodeficiency Virus".Basically name indicates that it means that this retrovirus has the characteristic of decreasing the immunity of the individual by some means.It does so

How many types of HIV are there?

There are 2 types of HIV:

HIV 1

HIV 2

HIV 1--it a human retrovirus that infects predominantly lymphocytes that bear the CD 4 surface protein,as well as the coreceptors belonging to chemokine receptor family.

HIV 2--it is endemic in West Africa and it takes a longer time to develop AIDS.

How much time does it take to develop AIDS after HIV infection?

It takes almost 10 yrs or so.

What is AIDS?

AIDS is " Acquired immunodeficiency syndrome".

How does it present or what are the common signs and symptoms of AIDS?

AIDS usually presents with viral co infections,previous opportunistic Infections,depression,substance abuse.In assessing individuals with AIDS family and social support assessment must be carried out.

Which persons are high risk for AIDS?

Persons having high risk of getting HIv infection are;

IV drug users,homosexual and bisexual men,sexual partners of these men,people receiving blood from 1977 to 1985,persons involved in sex trading and sexual partners of these persons,persons engaging in unprotected intercourse,pregnant women,patients with active tuberculosis,hospitalized pts between 15 and 45 yrs of age,donors of blood ,semen and organs,health care providers.

How is the screening of AIDS carried out?

Screening of AIDS is carried out with ELISA(enzyme linked immunoassay absorbant).In USA a combined kit for both HIV 1 and HIV 2,enzyme immunoassay.Kit is sensitive to both.

How the positive screening test is confirmed?

A positive screening test is confirmed by a repeat positive ELISA and a positive Western Blot(presence of atleast 2 of the following bands:p24,gp41,gp120/160).An isolated positive ELISA result should not be mentioned to the patient until this result is confirmed by a Western blot.

Is there any rapid test for HIV screening?

Yes ,rapid HIV 1 antibody test is available and i s approved by US Food and Drug administration.

What are the investigations in the laboratory to be carried out in case of AIDS diagnosis and monitoring?

The investigations to be carried out are;

Complete blood count,CD4 cell count and CD4 percentage,Virologic markers,reverse transcriptase polymerase chain reaction assay is most widely used these days.

Other investigations to be carried out are;

Tuberculin skin test,Rapid plasma reagin(RPR)test,toxoplasma and cytomegalovirus IgG,HBsAg and AntiHCV,cervical pap smear.

What is the management of HIV infection/AIDS?

The management of HIV / AIDS is carried out as under;

Supportive

Definitive

How the disease is monitored?

Plasma HIV RNA load is used for monitoring of therapy.When the ultrasensitve HIV RNA becomes undetecable and the pt is on stable regimen,then monitoring can be done every three months.

What is HIV resistance testing?

It is done using two different types of assays:

Genotypic

Phenotypic.

Results of resistance testing can be used to guide ART.

A NEW CONCEPT OF ANTI ASTHMATIC TREATMENT

2009-09-29T05:05:00.000-07:00

"Taking daily medicine for mild asthma may not help more than taking it only when symptoms flare up."

A new study shows people who use an inhaler occasionally fare about the same as people who take a daily pill or dose from the inhaler. Researchers said both groups had the same number of severe asthma attacks and changes in lung function and reported similar quality of life.

But lead researcher Homer Boushey said people should consult their doctor before halting regular medication. Still, he said doing so would could spare patients the inconvenience and the expense of taking daily medicine. The study estimated that patients could save up to $150 a month by using medication only during flareups.

The results of the yearlong, six-city study of more than 200 asthmatics is published in Thursday's edition of the New England Journal of Medicine.

About 20 million Americans have asthma. One-fourth of them are classified as having a mild form. Symptoms of mild asthma are wheezing, coughing, or chest tightness two to six days a week, or awakening because of asthma two or three times a month.

Treatment for mild asthma usually includes two prescribed drugs: an inhaler for immediate relief, and a daily pill or dose from an inhaler to reduce airway inflammation.

The National Asthma Education and Prevention Program is expected to release updated treatment guidelines in 2006, and this study -- along with other asthma studies -- will be taken into consideration.

ADVERSE EFFECTS---ALBUTEROL

2009-09-29T04:41:00.000-07:00

SIDE EFFECTS OF BETA 2 AGONISTS:

FINE TREMOR PARTICULARLY IN HANDS

NERVOUS TENSION

HEADACHE

MUSCLE CRAMPS

PALPITAION

OTHER SIDE EFFECTS

TACHYCARDIA

ARRHYTHMIAS

PERIPHERAL VASODILATATION

MYOCARDIAL ISCHEMIA

DISTURBANCES OF SLEEP AND BEHAVIOUR

HYPOKALEMIA

LEARN CHEST X RAY WITH VARITY OF FILMS

2009-09-28T11:10:00.000-07:00

VIRAL INFECTIONS

2009-09-26T13:30:00.000-07:00

VIRAL INFECTIONS

HERPES VIRUS GROUP

• Large DNA virus (180-250 nm)

• Intra-nuclear replication producing intra nuclear inclusions

• Absence of virus elimination following clinical recovery

HERPES VIRUSES

8 MEMBERS

• Herpes simplex virus type 1

• Herpes simplex virus type 2

• Varicella zoster virus

• Human cytomegalovirus (CMV)

• Epstein-Barr virus (EBV)

• Human herpes virus 6

• Human herpes virus 7

• Human herpes virus 8

HERPES SIMPLEX

• One of the commonest infections of humans worldwide

• HSV 1 is classically associated with facial infections

• HSV 2 is typically genital

• TRANSMISSION: Direct contact or droplets from infected secretions

• Transmission Rate: 4-30% annually for genital herpes

• Persistence of virus in sensory nerve ganglia after primary infection

• Peripheral travel of virus along the nerve fibre - > Replication in skin & mucous membrane - > Recurrent disease

PRIMARY INFECTION

PRIMARY HSV 1 INFECTION

• Sub clinical often

• Rarely produces a painful vesicular stomatitis

PRIMARY HSV 2 INFECTION

• More commonly symptomatic

HERPETIC GINGIVOSTOMATITIS

• Most common clinical manifestation of primary infection by HSV 1

• Most commonly seen in children between 1-5 years of age

• Incubation period: 5 days

• Symptoms: Constitutional symptoms - fever, malaise, restlessness, excessive dribbling of saliva

• Vesicles & erosions present on the tongue, pharynx, palate & buccal mucosa

• Regional lymph nodes can be enlarged

• Recovery in 2 weeks

• Primary herpetic gingivo-stomatitis in a child

HERPES GENITALIS

• It is a sexually transmitted disease

• Most commonly due to HSV 2

• There are painful papulo-vesicular confluent lesions on the glans, prepuce & shaft of penis

• Lasts for 2-3 weeks, if untreated

• HIV infected individuals – Chronic ulceration

• Females: similar lesions on external genitalia & mucosae of vulva, vagina & cervix

• RECURRENCE: 2/3 of cases have recurrences 2-6/year

HERPETIC KERATOCONJUNCTIVITIS

• Severe purulent conjuctivitis

• Superficial ulceration of the cornea

• May be vesicles on the surrounding skin

RECURRENT INFECTON

• Seen in:

• 30-50% cases of oral herpes

• 50-90% cases of genital herpes

Triggering factors:

• minor trauma

• febrile illnesses

• surgical procedures

• dermabrasion

Asymptomatic shedding of HSV 2 is more frequent than HSV 1

COMPLICATIONS

• Headache & meningism

• Disseminated or systemic infection

• Encephalitis

• Hepatitis

• Pneumonia

• Radiculopathy

• Eczema herpeticum

• Erythema multiforme

• Bell’s Palsy

• Eczema herpeticum

ERYTHEMA MULTIFORME

DIAGNOSIS

• Tzanck smear

• Serology

• Culture

• PCR

• Electron microscopy

TREATMENT

• Mild uncomplicated herpes simplex: no treatment

• Acyclovir: 200 mg 5 times daily for 5 or more days 5 mg/kg i.v. 8 hrly

VARICELLA (CHICKEN POX)

• Transmitted by droplet infection from naso-pharynx

• Vesicle fluid contains large amount of virus

• Dry scabs are not infectious

• Maternal varicella occurring first 20 weeks of pregnancy 2% risk of fetal damage central nervous system and ocular defects, and limb hypoplasia; neonatal death

• Maternal zoster in pregnancy is not associated with intrauterine infection

• Mothers having varicella within 4 days before to 2 days after term neonate at risk of severe varicella with a mortality rate up to 30% in the absence of treatment

CLINICAL FEATURES

• Incubation period: 14-17 days

• Symptoms: Fever and malaise 1-2 days

• Development of papules rapidly becoming tense, clear, turbid then pustular

• Vesicles appear in crops hence polymorphic lesions

• Distribution is centripetal most numerous on the trunk, then on the face and scalp and on the limbs.

• Mucous membranes: Vesicles in the mouth, palate, including the conjunctiva & on anal mucosa they may be followed by painful ulcers.

COMPLICATIONS

• Encephalitis

• Secondary infection (Varicella gangrenosa)

• Pneumonia: most common cause of mortality

• Thrombocytopenic purpura

• Hepatitis

• Rhabdomyolysis

• Varicella arthritis

• Steven Johnsons syndrome

HERPES ZOSTER

Reactivation of virus within the posterior root ganglia of the spinal cord or within the cranial nerve root ganglia

SYMPTOMS:

• Pain may be accompanied by fever, headache, malaise and tenderness localized to areas of one or more dorsal roots.

• Closely grouped red papules, rapidly becoming vesicular and then pustular, develop in a continuous or interrupted band in the area of one, or occasionally two contiguous dermatomes.

RECOVERY:

• Uncomplicated cases in 2-3 weeks in children and young adults, and 3-4 weeks in older patients.

• Post-herpetic neuralgia: defined as persistence or recurrence of pain more than a month after the onset of zoster

TREATMENT

• Only symptomatic treatment in otherwise healthy children for chicken pox

• Secondary bacterial infection will require antibiotics

• Antiviral for severe varicella or zoster infections at any age in the immunocompromised

• Aciclovir : 800 mg 5 times a day – 1 week

• Post-herpetic neuralgia: Pain killers, but opiates should be avoided

• Amitriptyline or clomipramine or doxepin

PREVENTION

• Pre-exposure: A live attenuated vaccine two doses of vaccine, 3 months apart

• Post-exposure: Specific zoster immune globulin (ZIG) administered within 10 days of contact given to neonates whose mothers develop varicella within the period from 7 days before to 7 days after delivery