-MrSafe-

Henry Golding and Sharifah Amani teaches Breast self familiarization for breast cancer awareness

2010-03-10T06:27:00.000-08:00

Please Extra CArefull When You Handle A Machine

2010-03-04T21:26:00.000-08:00

Working at Height in Indonesia ( Do U Dare? )

2010-02-24T15:38:00.000-08:00

Caution.....

2009-10-20T19:49:00.000-07:00

Caution.....The following images may cause serious discomfort for some...Viewers discretion is advised!!!

Do not stand behind a crane when it is in operation...otherwise this might happen to you

Effects of Sleep Deprivation

2009-08-09T13:33:00.000-07:00

Swine Flu (H1N1)

2009-07-27T13:43:00.000-07:00

What is H1N1 (swine flu)?
H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

Why is this new 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 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 avian genes and human genes. Scientists call this a “quadruple reassortant” virus.

Novel H1N1 Flu in Humans

Are there human infections with this H1N1 virus in the U.S.?
Yes. Cases of human infection with this H1N1 influenza virus were first confirmed in the U.S. in Southern California and near Guadalupe County, Texas. The outbreak intensified rapidly from that time and more and more states have been reporting cases of illness from this virus. An updated case count of confirmed novel H1N1 flu infections in the United States is kept at http://www.cdc.gov/h1n1flu/investigation.htm. CDC and local and state health agencies are working together to investigate this situation.

Is this new H1N1 virus contagious?
CDC has determined that this new H1N1 virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

What are the signs and symptoms of this virus in people?
The symptoms of this new H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.

How severe is illness associated with this new H1N1 virus?
It’s not known at this time how severe this virus will be in the general population. CDC is studying the medical histories of people who have been infected with this virus to determine whether some people may be at greater risk from infection, serious illness or hospitalization from the virus. In seasonal flu, there are certain people that are at higher risk of serious flu-related complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with chronic medical conditions. It’s unknown at this time whether certain groups of people are at greater risk of serious flu-related complications from infection with this new virus. CDC also is conducting laboratory studies to see if certain people might have natural immunity to this virus, depending on their age.

How does this new H1N1 virus spread?
Spread of this H1N1 virus 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 by people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How long can an infected person spread this virus to others?
At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. CDC is studying the virus and its capabilities to try to learn more and will provide more information as it becomes available.
Exposures Not Thought to Spread New H1N1 Flu

Can I get infected with this new H1N1 virus from eating or preparing pork?
No. H1N1 viruses are not spread by food. You cannot get this new 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 the novel 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 novel 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 the new 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 the 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 novel H1N1 virus would also be similarly disinfected by chlorine.

Can 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 novel 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.
Prevention & Treatment

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against this new H1N1 virus. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

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, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread this way.
* Try to avoid close contact with sick people.
* Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

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, tissues and other related items might could be useful and help 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, limit your contact with other people as much as possible. If you are sick, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. 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.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. 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 should I do if I get sick?
If you live in areas where people have been identified with new H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people, except to seek medical care.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

* Fast breathing or trouble breathing
* Bluish or gray skin color
* Not drinking enough fluids
* Severe or persistent vomiting
* 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

In adults, emergency warning signs that need urgent medical attention include:

* Difficulty breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting
* Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat infection with this new virus?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with the new H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current outbreak, the priority use for influenza antiviral drugs during is to treat severe influenza illness.
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 up to 2-8 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. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

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.

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 up to 2-8 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. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

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.

More....http://www.cdc.gov/h1n1flu/antiviral.htm

Accident In Work Place

2009-07-10T11:48:00.000-07:00

Anorectal Infections

2009-06-06T08:37:00.001-07:00

DESCRIPTION

* These are infections of the anal and rectal tissues, causing the tissues in these areas to become inflamed. It is usually sexually transmitted, with the highest risk from anal intercourse.

SYMPTOMS

* Anorectal pain
* Severe rectal pain after a bowel movement
* Rectal discharge
* Constipation
* Anorectal itching/burning

CAUSE

* Neisseria gonorrhoeae (Gonorrhea)
* Treponema pallidum (syphilis)
* Chlamydia trachomatis (Chlamydia)
* Herpes Simplex virus
* Human papillomavirus

HOW THE DIAGNOSIS IS MADE

* Examination -- findings that may be present:

1. Redness of anal area
2. Pus expressed from crypts in anus
3. Chancre (painless ulcer) present in syphilis
4. Condylomata lata (moist warty patches) present in syphilis
5. Genital ulcers
6. Enlarged lymph nodes in groin
7. Blister lesions in anal or genital area
8. Warty areas (hard and thickened)

* Laboratory Tests:

1. Swab and culture of anal canal
2. Urethral or cervical cultures may be helpful
3. Dark-field microscopy (test for syphilis)
4. VDRL or RPR blood test for syphilis
5. Rectal biopsy
6. Viral culture or antigen detection of herpes lesions

TREATMENT

* Gonorrhea -- Ceftriaxone, ciprofloxacin
* Syphilis -- Penicillin G (injection), tetracycline, azithromycin
* Chlamydia -- Tetracycline, erythromycin, trimethoprim-sulfamethoxazole, azithromycin
* Herpes Simplex -- Acyclovir, Valtrex, Famvir
* Venereal Warts (human papillomavirus) -- topical Podophyllum resin, laser surgery, cryosurgery (freezing)

SIMILAR CONDITIONS

* Perianal Abscess
* Ulcerative Colitis
* Crohn's Disease

Anorexia Nervosa

2009-06-06T08:33:00.001-07:00

ALSO KNOWN AS

Eating disorder

DESCRIPTION

* In this condition, the individual has a distorted body image of normal weight. He/she may also have a fear of becoming fat. The individual uses starvation and/or exercise in order to achieve abnormally low weight.

SYMPTOMS

* Loss of sexual interest
* Extensive exercise habits
* Elaborate eating rituals
* Decline in cognitive functions, exemplified by learning difficulties in school
* Social isolation
* Blotchy skin
* Refusal to maintain body weight
* 25% or more weight loss
* Distorted body image
* Cold intolerance
* Constipation

CAUSE

* Distorted body image
* Fear of weight gain
* Fear of loss of control over food intake
* Depression
* Models/actresses as the standard for "normal" (who themselves are often anorexic)

HOW THE DIAGNOSIS IS MADE

* Dental cavities
* Depression may be identified
* Body weight 15% below expected
* Emaciation
* In females, absence of three consecutive menstrual cycles
* Low heart rate
* Low basal body temperature
* Loss of body fat
* Dry Scaly Skin
* Increased lanugo (fine "baby" hair)
* Enlargement of glands in front of ears (parotid gland enlargement)
* Leg swelling
* Laboratory work up may include a Complete blood count with differential (may show white blood cells and a low CD4/CD8 ratio and anemia), chemistry panel (may show abnormal liver enzymes and high cholesterol), hormone levels (Low T3, low FSH, low LH, low leptin, high growth hormone, high vasopressin and Cortisol levels), urine analysis, and EKG (prolonged Q-T interval).

TREATMENT

* Psychiatric/behavioral team experienced with anorexia
* Hospitalization may be necessary.
* Antidepressants may be considered.
* Intravenous nutritional support if Malnutrition is severe

SIMILAR CONDITIONS

* Bulimia Nervosa
* Addison's Disease
* Hyperthyroidism
* Diabetes Mellitus
* Celiac Sprue
* Crohn's Disease
* Lymphoma
* Tuberculosis
* Pituitary disorder

MISCELLANEOUS

* Social Considerations

1. Current societal admiration for thinness as a sign of beauty/attractiveness has contributed to the problems of distorted body image held by many anorexic women. Thirty years ago, most of the actresses/models of today would be considered "tomboyish" and "masculine."
2. The phenomenon of anorexia (and bulimia) is a strong indication of the need to empower individuals not to have their bodies and souls controlled by fluctuating and illogical standards, as dictated and fostered by the media.

Anorectal Abscess

2009-06-06T08:28:00.000-07:00

ALSO KNOWN AS

Perianal abscess, anal abscess, or rectal abscess

DESCRIPTION

* Stool formed in the colon or large intestine empties into the rectum and the anal canal then exits through the anus. Perianal refers to the structures around the anus (skin) and within the anal canal. The walls of the anal canal above the anus contain anal glands that secrete lubricants. Stool contains waste material and many bacteria. If there is a cut or scratch in the skin around the anus or the walls of the anal canal, bacteria can enter and cause an infection. The infection then causes local swelling, irritation, tissue damage, and fluid buildup (abscess).

SYMPTOMS

* Unable to sit comfortably
* Difficulty or pain with passing stool
* Redness or pain around anus
* Abscess felt around anus or within anal canal
* Peri-rectal swelling
* Pain may be throbbing, sharp, or dull
* Fever may be seen in severe case
* Bleeding or discharge if abscess is drained or accidentally ruptures.
* In elderly there maybe no fever only lower abdominal pain
* If the abscess ruptures and leaves a fissure that opens into the anal canal, a fistula is formed.

CAUSE

* Bacteria:

1. Staphylococcus
2. E.coli
3. Streptococci

* Proteus vulgaris
* Pseudemonas aeruginosa
* Bacterides
* Usually a mixture of above

HOW THE DIAGNOSIS IS MADE

* Need examination by a doctor
* If abscess is in the canal, the doctor may need to insert his index finger in the canal (digital rectal exam) and feel for it.
* If fever is present and the patient appears sick, blood samples may be taken to assess the severity of infection.
* Barium Enema -- an enema used to pour a chalky substance called barium through the anus into the rectum for X-raying. This will help if the abscess cannot be felt, or if a fistula is present.
* Sigmoidoscopy -- a rigid tube inserted into the rectum allows the doctor to look inside.

RISK FACTORS

* Cuts:

1. From food such as egg shell and fish bone
2. Swallowed objects, such as rings, coins, paperclips

* Penetrating injuries:

1. Constipation
2. Enema
3. Vibrators
4. Anal sex
5. Light bulbs
6. Bottles
7. Surgical injection of hemorrhoids

* Diseases:

1. Hemorrhoids (hang out from the anus opening)
2. Inflammatory Bowel Disease
3. Granulomatous diseases such as Sarcoidosis
4. Weakened immune system (body's defenses) -- cancer (specially of blood), AIDS, etc.

TREATMENT

* May need admission to the hospital if very sick, elderly, have other diseases or need surgery.
* Pain medication -- Tylenol, Motrin, Codeine.
* Stool softeners or laxatives to prevent Constipation.
* Good diet with high fiber diet -- adequate amount of oil, fruits, vegetables, and fruits.
* Avoid enemas and rectal temperature.
* Antibiotics may be administered intravenously (through veins).
* Surgery:

1. Local small abscesses can be cut and drained on an outpatient basis.
2. Deeper abscess and fistulas need to be opened, drained, and removed in the hospital under general anesthesia.
3. The wound is then packed with gauze soaked in Iodoform, an anti-bacterial agent for 24-48 hours.
4. Sitz baths are recommended every 2-4 hours to remove debris.
5. Warm compresses help with pain.

IF YOU SUSPECT THIS CONDITION

* See your doctor for a digital rectal exam.

SIMILAR CONDITIONS

* Crohn's Disease
* Rectal tumors or cancers
* Infections:

1. Syphilis lesions or ulcers
2. Tuberculous ulceration

Ankylosing Spondylitis

2009-06-06T08:24:00.000-07:00

ALSO KNOWN AS

Marie-Strumpell disease or rheumatoid spondylitis

DESCRIPTION

* Ankylosing spondylitis is a chronic inflammatory disease of the joints of the spine and those connecting to the spine, such as the sacroiliac joint. This is an arthritic condition involving stiffness in joints, with resultant pain and stiffness in the back and hips, and difficulty taking deep breaths, due to rib connection to spine. The underlying cause is thought to involve the autoimmune response (the body's immune system mistakenly attacks these joints). The age of onset is usually late teens or early 20's, with a male predominance.

SYMPTOMS

* Morning stiffness
* Hip and shoulder pain
* Stiffness improves with activity
* Intermittent bouts of lower back pain (that may radiate to thighs)
* Progressive limitation of back motion
* Difficulty with chest expansion ("taking a deep breath") -- pleuritic chest pain is common
* Arthritis (stiffness and/or pain) in other joints such as hips, shoulders, and knees
* Uveitis (blurred vision, tearing, and light causes eye pain)
* Rarely, heart and lungs may be affected.
* Aortic root dilation
* Aortic Regurgitation

CAUSE

* Probable autoimmune (explained above)
* Genetic predisposition in those who carry the HLA-B27 gene

HOW THE DIAGNOSIS IS MADE

* Laboratory Tests:

1. Elevated Erythrocyte sedimentation rate (ESR)
2. Mild Anemia
3. HLA-B27 positive in 90% of cases
4. Absent Rheumatoid factor

* Imaging

1. Sacroiliac joint (spine connection to pelvic bone) is abnormal on X-Ray and CT scan
2. Spine X-Rays are abnormal ("bamboo spine" appearance)

TREATMENT

* Educational/emotional support
* Physical and occupational therapy
* Nonsteroidal anti-inflammatories, especially indomethacin
* Sulfasalazine

SIMILAR CONDITIONS

* Reiter's Syndrome
* Rheumatoid Arthritis
* Osteoporosis
* Herniated disc(s) of spine
* Back Injury
* Lumbar Spinal Stenosis

Ankle Sprain and Ankle Fracture

2009-06-06T08:21:00.000-07:00

DESCRIPTION

* Ligaments are like ropes that connect the bones. When the ligaments in the bones of the ankle are injured, this is called an ankle sprain. The Injury is usually a tear in a ligament. An ankle sprain usually occurs on the outside of ankle joints.
* An ankle Fracture occurs when the bones in the ankle are broken or cracked. Fractures account for about 10%-15% of injuries in children.

SYMPTOMS

* Sensation that ankle gave way
* Ankle pain
* Painful to bear weight on the ankle
* Ankle is bruised or swollen
* Tenderness of the ankle

CAUSE

* Sprain: Stretched or torn ligament caused by a twist Injury of the ankle, in which the foot is twisted underneath the ankle.
* Fracture:

1. A fall
2. Child Abuse
3. Bone disease

HOW THE DIAGNOSIS IS MADE

* X-ray, if Fracture is suspected

TREATMENT

* Rest
* Compression and elevation
* Ice first 24-48 hours
* Wrap for support
* If the sprain is moderate-severe, use crutches to avoid bearing weight.
* Pain medications
* If Fracture is present, immobilization and orthopedic evaluation are needed.

COMPLICATIONS

* Growth arrest
* Residual deformities
* Progressive deformities

Ankle Injury

2009-06-06T08:16:00.000-07:00

DESCRIPTION

* Including ankle sprains and fractures:

1. Ligaments are like ropes that connect bones together. When the ligaments in the bones of the ankle are injured, this is called an ankle sprain. The injury is usually a tear in the ligament. This commonly occurs after a twist injury of the ankle, in which the foot is inverted underneath the ankle.
2. An ankle fracture occurs when the bones in the ankle are broken (or cracked).

SYMPTOMS

* Lessening of sensation in the ankle
* Ankle pain
* Painful to bear weight on the ankle
* Ankle is bruised or swollen
* Tenderness of the ankle

HOW THE DIAGNOSIS IS MADE

* X-Ray check if fracture is suspected

TREATMENT

* Ice for first 24-48 hours
* Ace wrap for support
* If moderate-to-severe, use crutches to avoid bearing weight
* Pain medications
* If fracture is present, immobilization and orthopedic evaluation is needed

Animal Bites

2009-06-06T08:04:00.000-07:00

ALSO KNOWN AS

Also see Rabies

DESCRIPTION

* An infection that affects the central nervous system (brain, spinal cord, and cranial nerves) of animals and humans

SYMPTOMS

* Symptoms may develop 30-50 days after the bite.
* Often there is only pain and local swelling at the bite site.
* Fever
* Headache
* Numbness or tingling at the bite site
* Swallowing difficulty
* Anxiety and restlessness
* Declining mental function
* Sore throat
* Nausea
* Muscle stiffness
* Excessive salivation (not real foaming at the mouth, but increased saliva)
* Itching at the site of the bite
* Muscle Cramps
* Tingling and numbness of the skin in other parts of the body
* Paralysis of muscles including respiratory muscles (breathing)
* In severe cases:

1. Hydrophobia -- fear of water because liquids can cause spasm in the throat and make swallowing difficult
2. Aerophobia -- in some, air can also trigger spasm in the respiratory (breathing) muscles
3. Excitement and agitation followed by periods of calm
4. Drooling
5. Gasping for air
6. Convulsions, Seizures, Coma, and death
7. Death occurs due to heart or respiratory failure
8. Only 7 people worldwide have been known to survive untreated Rabies (i.e., did not receive the series vaccination for Rabies after being bitten or exposed to a rabid animal).

CAUSE

* Virus -- RNA virus is transmitted via the saliva of the infected animal.
* The virus in the saliva enters a wound (after a bite) or skin cut, and travels via the nerves to the central nervous system, where it can multiply in the gray matter of the brain. Then the virus spreads out along certain nerves to infect many other tissues.

* The time between the bite and the onset of symptoms (incubation period) may range from days to years, but in most cases it is between 3-12 weeks.

HOW THE DIAGNOSIS IS MADE

* History of the bite, occupation, illnesses, travels, allergies, surgeries, habits, and vaccination history of the patient (i.e., Rabies, Tetanus, etc.) and his pets are helpful.
* Medical exam will reveal:

1. Bite mark
2. Fever
3. Agitation
4. Numbness
5. Paralysis

* Tests:

1. The virus needs to be found in the saliva or brain tissues, including the spinal fluid (CSF).
2. Fluorescent antibody (protein associated with Rabies) test will be positive in the infected animal.
3. The rabid animal should be captured if possible, terminated, and tested for the virus.

RISK FACTORS

* Animal bite from wild or unvaccinated pets
* All warm-blooded animals (Mammals) can carry the virus.
* Bats (most common in the US), dogs, cats, foxes, raccoons, and skunks
* Veterinarians
* Laboratory workers
* Animal handlers
* Travel to areas with high rate of Rabies in animals

TREATMENT

* Clean the wound
* Support the blood pressure, breathing, and heart if affected
* Immunoglobulins (HRIG) are protective Proteins that are given right away to fight the infection.
* The patient receives a vaccine to develop his or her own protective immunoglobulins down the road. Vaccines can be any of the following (HDCV, RVA, and PCEC).
* Report to the doctor if you have allergies, especially to eggs.
* In those who have been vaccinated prior to exposure, two booster shots (to provide more protection) of the vaccine are recommended.
* Tetanus vaccine, if not updated, is often given.

IF YOU SUSPECT THIS CONDITION

* Get to your doctor as soon as you can. If there is difficulty breathing, Seizures, confusion, or Coma -- call 911.

PREVENTION

* Vaccinate your pets -- dogs need Rabies vaccinations every 2 years, especially in areas with wild animals.
* Avoid contact with wild animals
(e. g., feeding, petting, etc.).
* If bitten, wash the site with soap and water and contact your physician and local health department immediately. Delay in treatment can result in death. Treatment after the bite from an animal with Rabies is with the Rabies vaccination series, which must begin soon after the rabid bite.
* Vector control and contact your doctor
* If traveling to an area known for Rabies, you must receive a vaccine (HDCV, RVA, and PCEC) before leaving. Vaccination is important for high-risk occupations.

SIMILAR CONDITIONS

* Other Infections:

1. Encephalitis
2. Tetanus
3. Guillain-Barre Syndrome

Fearful accident

2009-04-21T16:25:00.000-07:00

Breast Cancer

2009-04-15T14:33:00.000-07:00

Description

1. Breast cancer, the most common type of cancer in women, is second only to lung cancer as a cause of cancer death among women. It is the leading cause of death for women aged 35 to 50 in the United States. An individual woman's risk of developing breast cancer in this country is about 1 in 10.
2. More than 180,000 women are diagnosed with breast cancer each year. The United States has a very high rate of breast cancer relative to many other countries. Though many factors may play a role, a clear cause, such as diet, has not been found.

3. When cancer arises in breast tissue and spreads (metastasizes) outside the breast, cancer cells are often found in the lymph nodes under the arm. If the cancer has reached these nodes, it means that cancer cells may have spread to other parts of the body-other lymph nodes and other organs, such as the bones, liver, or lungs. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor.

Risk factors

1. Family history of breast cancer in mother, sister, or daughter
2. Previous endometrial (uterine) cancer
3. Previous breast cancer
4. Carrier of BRCA1 or BRCA2 genes (especially prominent in Ashkenazi Jews)
5. Menstrual periods started before age 12
6. Menopause after age 50
7. No children
8. Estrogen replacement therapy

Symptoms

1. Breast lump
2. Nipple discharge
3. Retracted nipple
4. Red/inflamed nipple
5. Breast enlargement
6. Breast shrinkage
7. Breast becomes hard
8. Bone pain
9. Back pain

Diagnosis

1. Examination
2. Breast lump
3. Nipple discharge
4. Skin changes on breast
5. Hardened breast
6. Enlarged lymph glands
7. Above clavicles (collar bone)
8. Armpits
9. Sides of center bone in chest
10. Mammogram
11. Ultrasound
12. Bone Scan-checks for spread to bones
13. CAT scan/MRI to check for spread to brain
14. Tests:
# Needle aspiration
# Mammatome test:
special type of needle biopsy with special x-ray techniques to localize deep lumps
# Open surgical biopsy: Lump is removed and sent to lab for analysis.
# Lymph node dissection: Multiple lymph nodes are removed to check for cancer spread.
# Sentinel lymph node dissection: A new technique in which only a few lymph nodes need to be biopsied rather than the traditional lymph node dissection.

Similar conditions

1. Fibroadenoma
2. Fibrocystic breast disease
3. Breast abscess

Treatment

1. Breast cancer treatment depends on three major factors: A) if a woman is pre- or postmenopausal, B) the extent that breast cancer has spread, and C) cell type of the breast cancer. Extent of spread of the cancer can be explained in the following categories: 1) localized to the breast, 2) spread to the lymph nodes, 3) spread to muscle deep in the breast, 4) spread to the other breast, and 5) spread to other organs such as bone or brain. In terms of cell types, there are more aggressive and less aggressive cell types. In addition, there are receptors on the cells (for example estrogen-receptors) that make a breast cancer more responsive to treatment. Specific treatments are as follows:
2. Lumpectomy with radiation treatment
3. Modified radical mastectomy: removal of breast, muscles below it and lymph glands in axilla
4. Ovarian ablation: This treatment makes the ovaries inactive so they do not produce hormones that may stimulate breast cancer growth. This is not commonly done, but new medical literature suggests it may be helpful in some cases.
5. Medications:
6. Tamoxifen
7. CMF chemotherapy

Prevention

1. Monthly self-breast examination
2. Yearly exam by a physician
3. Mammograms: Baseline at 35-40 years old, every 1-2 years between age 40 and 49 depending on risk factors, and every year after age 50. Mammograms may be recommended in certain high-risk younger women.
4. Vitamin D: There is some evidence that Vitamin D may offer protection against breast cancer. A dose of 400 I.U. daily is appropriate.
5. Tamoxifen: Some studies have shown Tamoxifen to prevent breast cancer in high-risk women. Tamoxifen does have side effects, including rare serious eye problems and an increased risk of endometrial cancer.

Breast-feeding and Breast Care

2009-04-15T14:30:00.000-07:00

Description

1. Human milk is best for babies.
2. Breast-fed premature babies, evaluated at 1.5 and 7.5 years of age and compared to similar premature babies that received formula feeding, had higher IQs, according to one trial.
3. 65% of women with augmentation mammoplasty have lactation insufficiency.
4. Most drugs given to the mother are secreted in breast milk.

Those who cannot breast-feed

1. Women with cytomegalo virus (CMV) infection
2. Women with chronic hepatitis B infection
3. Women with AIDS (HIV infection)

Breast-feeding inhibition condition

1. Oral Contraceptives
2. Smoking

Care of the breasts and nipples

1. Breasts: A massage with a warm towel can relieve breast pain due to breast engorgement.
2. Nipples: Because dried milk around nipple can irritate nipples, cleaning of nipple and areola with warm water is recommended. Inverted nipples or retracted nipples can be pulled out with breast shield and gentle exercises during pregnancy.

Adenomyosis

2009-04-15T14:28:00.000-07:00

Also known as

Internal endometriosis

Description

Adenomyosis is a benign condition characterized by ingrowth of the endometrium (inner lining of the uterus) into the uterine muscle layer or myometrium. The incidence may approach 60% in women 40 to 50 years of age. Symptomatic adenomyosis usually presents in women 35 to 50 years of age. Two out of three women with adenomyosis have coexistent pelvic pathology, most commonly myomas (fibroids) but also endometriosis and endometrial hyperplasia. A typical uterus with adenomyosis is uniformly enlarged and weighs more than 100 grams (normal uterus weighs 80-100 grams). Adenomyosis occurs more frequently in women who have had several children.

Causes

1. The cause of adenomyosis is unknown.
2. Adenomyosis usually occurs in women over 30 years of age who have borne children.

Symptoms

1. Secondary painful menstruation
2. Prolonged, irregular menstrual bleeding
3. Painful intercourse
4. Pelvic pain
5. The majority of women have no symptoms or minimal symptoms.

Diagnosis

1. Pathological examination of uterus (can only be done after hysterectomy)
2. Pelvic examination finds an enlarged, softened uterus.
3. Abdominal MRI
4. Pelvic ultrasonography

Treatment

1. Pain medications
2. GnRH (gonadotropin-releasing hormone) agonists to prevent menstrual cycles and, thus, pain
3. Most treatment attempts with hormones, such as birth control pills or Depo-Provera, have been unsuccessful.
4. Hysterectomy is the definitive treatment if appropriate for the women's age, parity, and future childbearing plans.

Benign Breast Disease

2009-04-15T14:26:00.000-07:00

Description

Common benign breast changes fall into several broad categories. These include generalized breast changes, solitary lumps, nipple discharge, and infection or inflammation. From the time a girl begins to menstruate, her breasts undergo regular changes each month. Many doctors believe that nearly all breasts develop some lasting changes, beginning when the woman is about 30 years old. Eventually, about half of all women will experience symptoms such as lumps, pain, or nipple discharge.

Fibrocystic changes

These are fluid filled sacs. Fibrocystic changes are the most common benign breast condition. They are found in at least one out of three women during breast examinations. They occur most often in women 20 to 50 years of age, and cysts often enlarge and become tender and painful just before a woman"s menstrual period. Fibrocystics changes are an exaggerated response to the cyclic levels of ovarian hormones. Cysts are usually found in both breasts. Some cysts are so small they cannot be felt; rarely, they may be several inches in diameter. Cysts show up clearly on ultrasound, an examination that uses sound waves to produce a picture of tissues inside the breast. Management of cysts usually consists of observation or fine-needle aspiration, a procedure whereby fluid is withdrawn via a needle.

Fibroadenomas

These are benign tumors of the breast tissues. Usually, these solid, round lumps are painless and most often found by women themselves. Fibroadenomas feel rubbery and can be moved around easily. They are the most common type of tumors in adolescents and women in their twenties, and they occur twice as often in African-American women as they do in other American women. Although fibroadenomas do not become malignant, they can enlarge with pregnancy and breast-feeding. Fibroadenomas have a typically benign appearance on mammography (breast x-rays), and they can sometimes be diagnosed with fine-needle aspiration. Most surgeons believe that it is a good idea to remove fibroadenomas to make certain they are benign.

Fat necrosis

This is a firm, tender, indurated, ill-defined mass formed by damaged and disintegrating fatty tissues. This condition typically occurs in obese women with very large breasts. It often develops in response to a bruise or blow to the breast, even though the woman may not remember the specific injury. Fat necrosis can easily be mistaken for cancer, so such lumps are removed during a surgical biopsy.

Sclerosing adenosis

This condition involves the excessive growth of tissues in the breast"s lobules. It frequently causes breast pain. Usually the changes are microscopic. However, adenosis can produce lumps, and it can show up on mammography, often as calcifications, small deposits of calcium in tissue. Because adenosis is often difficult to distinguish from cancer, doctors usually perform a surgical biopsy to diagnose and treat this condition.

Intraductal papilloma

Intraductal papilloma is a small growth that projects into breast ducts near the nipple. The predominant symptom is spontaneous, bloody discharge from one nipple, although the discharge can be any color. Mammography is indicated in any patient with an intraductal papilloma, regardless of age. If the discharge becomes bothersome, the diseased duct can be removed surgically without damaging the appearance of the breast. If multiple ducts are involved, a diagnosis of carcinoma is more likely.

Breast Cancer Detection

2009-04-15T14:22:00.000-07:00

Description

American Cancer Society Recommendations for Early Breast Cancer Detection: Doctors recommend you begin practicing breast self-examination (BSE) as soon as your breasts start developing. This will help you become familiar with your normal breast structure and to learn to notice any unusual changes. If you have no breast cancer symptoms, your doctor should examine your breasts every 3 years if you are between 20 and 40 years of age and every year for those over the age of 40. Women should have a baseline screening mammogram by age 40, and a follow-up mammogram every 1-2 years from age 40-49 and every year for women age 50 and over.

Women with a personal or family history of breast cancer should consult their physician about more frequent exams or mammograms.
If a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness on the nipple or breast skin, or a discharge other than breast milk, you should see your health care provider as soon as possible for evaluation.
Experienced health care professionals can examine the breast and determine whether the changes you have noticed are most likely benign or whether there is a possibility they may be due to breast cancer. They can determine when additional tests are appropriate to rule out a cancer and when follow-up exams are the best strategy. If there is any suspicion of cancer, a biopsy will be recommended.

Self-examination

The best time for a BSE is about a week after your menstrual period starts, because your breasts are not tender or swollen at that time.
# Lie down, put a pillow under your right shoulder, and your right hand behind your head. Gently massage and feel your breast for lumps or other changes.
# Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Press firmly enough to know how your breast feels. A firm ridge in the lower curve of each breast is normal. If you are not sure how hard to press, talk with your doctor or nurse.
# Repeat with towel under left shoulder with left hand behind head.
# Stand in front of a mirror. Look for any changes such as puckering, changes in size or shape, dimpling, or changes in your skin texture.
# Look for changes to the shape or texture of your nipples. Gently squeeze each nipple and look for discharge or blood.
# Repeat these steps with your hands on your hips, over your head, and at your side.
# Raise your right arm and examine every part of your left breast. Move in increasingly smaller circles, from the outside in, using the pads of your index and middle fingers.
# Gently press and feel for lumps or thickenings of the breast area and outside your breast, such as under your arm.
# Using body cream, if necessary, continue to circle and gently massage the area outside your breast and under your arm.
# Repeat with your left arm and right breast.

Candida Vaginitis

2009-04-15T14:19:00.000-07:00

Also known as

Yeast infection

Description

1. One of the most common infections causing vaginal discharge is Candidiasis.
2. Candidiasis or 'yeast infection' is a fungus. The vast majority of cases are caused by Candida albicans; the Candida species normally resides in the vaginal flora of approximately 25% of women.
3. Many bacteria normally live in the vagina. Under normal circumstances, there is a balance among the different types of bacteria. If the balance is disrupted, an overgrowth of one of the organisms may occur. When the balance tips in favor of Candida, a vaginal yeast infection may occur. Antibiotics can kill off the good bacteria in the vagina, and antibiotics are a common cause of yeast infections. Also, anything that stresses the immune system, such as diabetes, may also cause a yeast infection.

Causes

1. Suppressed immune system
2. Antibiotics
3. Diabetes
4. Hormonal factors
5. Stress
6. Steroid use
7. Pregnancy
8. Obesity

Symptoms

1. Cottage cheese-type discharge, white or whitish-grey
2. Vaginal itching
3. Redness and burning on the outside of vagina
4. Painful intercourse
5. Painful urination

Diagnosis

1. KOH (fungal) slide shows yeast
2. Fungal culture

Similar conditions

1. Bacterial vaginosis
2. Chlamydia
3. Gonorrhea
4. Trichomoniasis

Treatment

1. Vaginal suppositories, e.g., Monistat, Lotrimin, Femstat, Terazol
2. Diflucan-one or two doses by mouth
3. Recurrent cases: Gentian violet 1%, boric acid, Povidone-iodine douching, dietary changes

Cervical Cancer

2009-04-15T13:40:00.000-07:00

Description

1. The cervix is the lower portion of the uterus and includes the opening the uterus, called the os.
2. Cervical cancer is the third most common type of cancer in women, accounting for about 4% of all cancers found in women. 3. Slow abnormal changes of the cervical cells, called dysplasia, can lead to cancer.

3. Slow abnormal changes of the cervical cells, called dysplasia, can lead to cancer.
4. Usually it takes several years to develop cancer, but sometimes they changes can evolve into cancer in less than a year.
5. For some women, these pre-cancerous changes may go away without any treatment.
6. There are two main types of cervical cancers: squamous cell carcinoma and adenocarcinoma.
7. About 85%-90% of cervical cancers are squamous cells carcinoma.
8. It can be curable when detected early with a Pap smear. This is why Pap smears are recommended for all women, beginning at age 18 or at the age when a woman first becomes sexually active.

Causes

1. HPV (human papilloma virus) is the major cause of cervical cancer and dysplasia.
2. High-risk factors:
# Multiple sexual partners
# Early onset of sexual activity (less than 18 years of age)
# Early childbearing (less than 16 years)
# Sexually transmitted diseases
# Genital warts
# HPV infection, HIV infection
# Genital herpes
# Smoking
# DES exposure
# Weakened immune system

Symptoms

There are often no symptoms other than an abnormal Pap smear.
1. In very late stages, the symptoms include:
# Abnormal vaginal bleeding or spotting between periods
# Persistent vaginal discharge that is pale, watery, pink, brown or blood-streaked
2. Bleeding after intercourse
# Pain in the pelvic area
3. Advanced stages can result in:
# Anemia
# Appetite and weight loss
# Fatigue, back pain and/or leg pain
# Pain in the abdomen, leakage of urine and feces through the vagina

Diagnosis

# 1. Pap smear Colposcopy
# Cervical biopsy

Treatment

1. Cervical conization - removing the part of the cervix containing the cancer
2. Hysterectomy
3. Radiation therapy
4. Chemotherapy

Choriocarcinoma

2009-04-15T13:32:00.000-07:00

Description

1. Choriocarcinoma is a cancer that originates in trophoblastic cells of the placenta (afterbirth). The technical term given to the abnormal growth of trophoblastic cells is gestational trophoblastic neoplasia. Gestational trophoblastic neoplasia is classified into three types (1) hydatiform mole, that stays in the uterus, (2) invasive hydatiform mole, that invades locally, and the gravest (3) choriocarcinoma, that may spread throughout the body

2. Cure rates are high for choriocarcinoma, if treated aggressively.
3. Gestational trophoblastic neoplasia usually begins early in pregnancy when the embryo or fetus does not develop but the placental tissue continues to grow.
4. The villi of the placenta are made up these trophoblastic cells. As these trophoblasts grow, the villi swell and multiply becoming visible to the naked eye.
5. Half of the cases of choriocarcinoma have a history of recent hydatidiform mole.
6. The trophoblastic cells produce the pregnancy hormone, human chorionic gonadotropin, HCG. HCG levels are used to track the effectiveness of treatment for all types of gestational trophoblastic neoplasia.
7. In the United States, choriocarcinoma occurs in 1 out of 40,000 pregnancies.

Causes

1. Genetic, more common in Asians than Blacks, and least common in Caucasians
2. Older women, particularly those older than 40 years
3. Multiple pregnancies
4. Hydatidiform mole
5. Pregnancy
6. Abortion
7. Ectopic pregnancy
8. History of other tumors of the female reproductive tract

Symptoms

1. Vaginal spotting, bleeding
2. Abnormal discharge, e.g., passage of villi (cystic grape-like clusters)
3. Lower abdominal pain
4. Nausea and/or vomiting
5. Abnormal nipple discharge
6. Swelling of the lower abdomen due to enlarged uterus
7. Uterus that does not decrease in size after pregnancy
8. Absent fetal heart tones

Diagnosis

1. Ultrasound
2. Chest x-ray
3. HCG hormone level
4. MRI

Treatment

1. Dilation of the cervical opening followed by removal of uterine contents with suction and curettage (see section on Dilation and Curettage)
2. Serial blood tests to determine HCG hormone levels
3. Chemotherapy
4. Radiation therapy

Chronic Pelvic Pain

2009-04-15T13:29:00.000-07:00

Description

1. Chronic pelvic pain (CCP) is defined as any ache or pain in the pelvic area that lasts at least 6 months. Chronic pelvic pain may be a steady pain or a pain that comes and goes, perhaps with a woman's menstrual cycle. The pain may be bad enough to interfere with normal daily activities. Numerous conditions can cause CPP, and the pain can take many forms. It may be dull or sharp, mild or extreme, or constant or intermittent. The pain might peak during intercourse or bowel movements, or it might flare up every time the woman sits down. It could become more intense during certain times in the menstrual cycle. The pain may wash over the entire pelvic area (roughly the zone under the belly button and between the hips), although it can also stay focused in one spot or shift from place to place. Depending on the condition, other symptoms may be present: heavy or irregular periods, vaginal discharge, or stomach cramps or discomfort, combined with alternating bouts of constipation or diarrhea.

Causes 2. Reproductive organ disease (70%): pelvic inflammatory disease, pelvic adhesions, and uterine displacement, infections, and endometriosis
3. Musculoskeletal-neurological (8%): poor posture, scoliosis, unilateral standing habits, lumbar lordosis, leg-length discrepancy, abnormal gait, abdominal wall trigger points, or history of low back trauma
4. Myofascial (7%)
5. Urologic (5%) urethral syndrome, interstitial cystitis
6. Gastrointestinal (10%): irritable bowel syndrome, chronic constipation, diverticulitis and irritable bowel syndrome
7. Psychological issues were present in 80% of these patients.

Symptoms

1. Pain is present for 6 months or longer
2. There has been very little relief from conventional, medical, or surgical treatment.
3. Pain is not necessarily proportional to tissue damage.
4. Vegetative signs of depression (sleep disturbances, constipation, slow body movements) are present.
5. Limitations have been placed on physical activity.
6. Emotional symptoms

Diagnosis

1. Physical exam
2. Psychometric test
3. Lab test

Treatment

1. Pain relief may be achieved with the scheduled dosing of a nonsteroidal anti-inflammatory drug (ibuprofen, Anaprox).
2. Trigger point injections: Bupivacaine, Triamcinolone
3. Tricyclic antidepressants (Tofranil, Elavil)
4. Relaxation techniques, stress management
5. Irritable bowel syndrome: daily psyllium supplements and increased dietary fiber
6. Surgical management: diagnostic laparoscopy, lysis of adhesions, uterine suspension, treatment of infections or endometriosis

Clinical Depression

2009-04-15T13:27:00.000-07:00

Description

Feeling down or depressed once in awhile is a normal for most people. However, if these feelings become very intense and persist for a very long period of time, hampering normal daily activities, clinical depression has set in, an abnormality that must be treated. Depression is not a temporary setback in emotions or a result of emotional weakness, but it is a real mental illness that cannot be overcome by sheer will. It brings many difficulties occupationally, socially, and physically. Unlike sadness or sorrow, depression does not resolve with a change in circumstance (good news, for instance), and unlike the gradual recovery from mourning a loved one's death, it does not get better. If depression is not treated, it can persist for several years, hampering relationships, reducing productivity at work, undermining confidence and self-esteem, and, ultimately, even leading to suicide. A depression sufferer is not able to solve his/her problem on his/her own. It is a mental illness that requires professional treatment. With proper treatment, depression is relatively easily treated and has a success rate as high as 80%.

Dynamics

Depression is a common disorder occurring in 15% of the men and 25% of the women during their lifetimes. Presumably, women have a higher tendency to suffer depression than men because of the extra societal pressures put upon them and the hormonal roller coaster they go through during pregnancy and delivery. Generally, the first episode of depression happens in the mid-twenties, and then again during menopause for women, and after retirement in men. Although depression is a relatively easily treated disease, without prompt and proper care, it can become chronic or recurrent.

Types

Depression, just like other diseases, can appear in many different forms. It is divided into three major groupings: major depression, dysthymia, and manic-depressive. The most serious of the three types, major depression, affects the body physical, emotions, thought, and all aspects of behavior. Thus, work performance suffers and even daily activities such as sleep and eating can be affected. Dysthymia is a relatively mild form of depression in which unhappiness lingers on for a long period of time bringing sub-par performance in daily activities. Sometimes, patients with dysthymia also exhibit symptoms of major depression. Manic-depressive depression does not occur as frequently as the others, however, it is important nonetheless. Here, the patient is seen to alternate from a state of depression and mania, forming a periodic cycle. Mania can be described as a condition of being restless, occupied in thought, and unnecessarily busy in behavior. In contrast, depression is a submergence of feeling, a settling of thought and behavior, which together with its antithesis, mania, comprise manic-depressive. The depressive cycle of manic-depressive depression often appears in the form of major depression, as discussed above. In all three types of depression, the number, severity, and duration of the symptoms will vary depending on the individual.

Causes

There are many different causes of depression. First, physiologically, neurotransmitters, the substance that links nerves to nerve may be the source of the problem. It is believed that the brain's activity, namely our thoughts and emotions, arise out of the change in the properties of these neurotransmitters. In the case of depression, it is believed that a decline in the activities of the neurotransmitters, norepinephrine and serotonin, are involved in the disorder. Secondly, heredity can play a factor in depression. If a close relative (parents, brothers and sisters, or children) suffers from depression, the chances of falling into major depression are 2-3 times greater. Although heredity is an influential factor in causing depressions, it does not necessitate it. Thirdly, there are environmental, psychological, and societal factors that can also drive a person into depression. A person with low self-esteem, a strong superego, weak social interaction, and a very dependent personality will be more susceptible to these external pressures, whether it may be due to divorce, failure, or family discord.

Symptoms

The most notable symptoms of depression are gloominess, loss of interest and pleasures, fatigue, and loss of vigor. In addition, there are other symptoms such as loss of concentration and attentiveness, loss of self-respect and self-confidence, guilt, lack of self-worth, hopelessness, thoughts of suicide, insomnia, and a loss of appetite. Sometimes, these symptoms may occur due to the accumulation of unexpressed anger, emotions, or personal preferences bottled up by peer-pressure, societal rules and customs, resulting in a redirected expression of these emotions in the form of various psychosomatic symptoms such as loss of appetite and sexual desire, insomnia, etc. For teenagers, anger or other misgivings may be expressed with truancy, by smoking, drinking, getting into fights, or leaving home. Menopausal women may exhibit symptoms of 'being on pins and needles' and become anxious and irritable.

Treatment

The treatment of depression can be divided as follows: medication, psychotherapy, and electroconvulsive therapy. Some people are cured by psychotherapy or taking medications. Most people, however, choose to take advantage of both, benefiting from the fast acting power of medications and the know-how of coping with daily problems acquired from psychotherapy. The important point here is that most people can be treated for depression with proper attention. In rare cases, electroconvulsive therapy is used to treat extreme depression.
1. Antidepressants
# Traditionally, depression has been treated through the use of three types of antidepressants, namely tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAO inhibitors), and selective serotonin reuptake inhibitors (SSRIs). However, TCAs are encumbered by side effects such as dry mouth, constipation, drowsiness, and a decrease in sexual performance, and MAO inhibitors have the inconvenience of having to avoid certain foods such as cheese and wine. Recent additions to the antidepressant lineup do not have such side effects. These include the new class of antidepressants called SSRIs. Since antidepressants take 2 to 6 weeks to take effect, it is important that drug use be maintained for a reasonable amount of time before deciding to quit. If any difficulties arise, consult the prescribing doctor immediately. Alcohol and other medications can interfere with the potency of antidepressants and must be avoided.
2. Psychotherapy
# Psychotherapy aids the patient by identifying and resolving her problems through consultations with the psychiatrist, and helps the patient get a better understanding of her mental illness. Behavioral therapy involves directing the individual to gain satisfaction and initiative by her own actions, and helping her to understand ways to avoid behaviors that may lead to depression. It also teaches her to adjust to her environment, becoming a master of her environment rather than a slave to it. Personal relations therapy and human-behavioral therapy are also helpful. Personal relations therapy rectifies the wrongs of personal behavior that contribute to depression, and human-behavioral therapy eliminates the patient's negative behavior and frame of mind that is associated with depression. Retrogressive psychotherapy focuses on the psychological problems of childhood as the center stage for resolving conflicts in the patient's current mental state.
3. Electroconvulsive therapy
# Electroconvulsive therapy is useful in treating very severe depression accompanied by suicidal tendencies, as well as those patients incapable of taking antidepressants. Also it is very effective in treating patients who have not completely recovered after using antidepressants.