Medical Information

A to Z Diabetes Melitus - Tipe diabetes, herbal, diagnosis, pencegahan

2024-10-30T00:31:00.000-07:00

Diabetes atau sering juga dikenal sebagai penyakit kencing manis. Diabetes sangat rentan terjadi pada masyarakat usia 50 tahun ke atas terutama, Orang-orang yang mempunyai keturunan diabetes. Diabetes terbagi 2 yaitu : Diabetes tipe I dan Diabetes tipe II

Diabetes tipe I

Diabetes tipe I, terjadi karena pankreas tidak menghasilkan insulin yang di perlukan tubuh untuk mengubah glukosa menjadi energi. Kerusakan pankreas biasanya disebabkan oleh sistem imun tubuh yang secara keliru justru merusak ( menyerang pankreas).

Ketiadaan insulin atau insulin yang tidak cukup memadai didalam tubuh menyebabkan glukosa dalam darah tidak di rubah menjadi energi, sehingga malah menumpuk di dalam darah.

Diabetes tipe ini, bisa menyerang segala usia, baik usia muda maupun dewasa. Namun, karena diabetes tipe ini merupakan diabetes yang berkaitan dengan autoimun dan faktor keturunan. Biasanya sangat dominan sehingga secara populasi penyakit diabetes tipe ini hanya terjadi 5-10℅ dari total penyakit diabetes. Penyakit diabetes tipe ini terjadi karena ketiadaan atau tidak cukupnya jumlah insulin, sehingga pengobatan yang dilakukan adalah memberikan suntikan insulin.

Diabetes tipe II

Diabetes yang paling besar terjadi pada penderita diabetes sekitar 90-95℅. Penyakit diabetes ini terjadi karena kesalahan gaya hidup dan pola makan.

Diabetes ini mulai rentan menyerang pada usia 40 tahun keatas. Konsumsi gula yang berlebihan dan kuranganya olah raga membuat kadar gula dalam darah meningkat. Pada penderita penyakit ini, tubuh masih menghasilkan insulin. Namun, kinerjanya tidak maxsimal ini disebabkan karena jumlah asupan glukosa yang terlalu banyak atau mungkin karena lemak dalam darah menghambat kinerja insulin. Penderita penyakit diabetes tipe ini biasanya tidak diberikan suntik insulin tetapi, obat-obatan untuk meningkatkan kinerja atau produksi insulin. Menghambat pemecahan karbohidrat dari makanan menjadi glukosa dan menghambat penyerapan glukosa dalam tubuh dan lain-lain. Selain pemberian obat-obatan diabetes tipe ini juga bisa dilakukan dengan menjaga pola makan, pola hidup dan olah raga. Obat-obatan yang kita temukan dipasaran (obat-obatan kimia) diabetes juga bisa diobati dengan menggunakan obat-obat alami dan herbal.

Indonesia adalah negara yang kaya dengan varietas karena Indonesia terletak di khatulistiwa yang mendukung pertumbuhan keberagaman flora dan fauna. Berikut ini beberapa obat herbal atau alami yang dapat digunakan untuk membantu mengobati penyakit diabetes dan sangat mudah ditemukan di Indonesia:

1. Pare

Pare merupakan tanaman yang biasa dijadikan sayur dan lalapan di Jawa. Namun, sebagian orang tidak menyukai sayur ini karena rasanya pahit. Didalam pare terdapat 3 zat yang di percaya dapat membantu menurunkan kadar gula dalam darah atau antidiabetik seperti : charanti, vicine dan polypeptide-p. Selain 3 zat tersebut pare juga memiliki kandungan pektin yang bekerja untuk mengurangi nafsu makan. Dengan berkurangnya nafsu makan secara tidak langsung juga akan menurunkan kadar gula dalam darah.

2. Kunyit

Tanaman berimpang ini tidak hanya terkenal sebagai bumbu dapur tetapi juga dimanfaatkan sebagai ramuan mencegah diabetes. Kunyit merupakan tanaman antioksidan tinggi sehingga bisa digunakan untuk mencegah komplikasi dan penyakit diabetes.

Dalam jurnal kesehatan diabetes care disebutkan bahwa mengkonsumsi kunyit 15 gram per hari selama 9 bukan dapat mencegah diabetes. Dengan mengkonsumsi 300mg kunyit dapat menurunkan hampir 18℅ kadar gula darah.

3. Kayu Manis

Penelitian dari jurnal diabetes sience dan teknologi mengkonsumsi kayu manis dapat menurunkan keadaan gula darah dan menekan peradangan akibat diabetes. Konsumsi kayu manis sebesar 1/4 -1/2 sendok teh perhari baik dalam makanan dan minuman. Namun, penggunaan kayu manis sebagai alat alternatif untuk penderita diabetes masih perlu dilakukan lebih lanjut untuk menghasilkan penelitian yang dapat diandalkan dan terpercaya.

4. Lidah Buaya

Sebenarnya Lidah Buaya adalah tanaman yang sangat populer untuk merewat kesehatan kulit dan rambut. Namun, manfaat lain dari lidah Buaya adalah mengurangi kadar gula darah puasa, menurunkan kadar lemak darah dan meringankan pembengkakan serta mempercepat proses penyembuhan luka. Senyawa aktif yang terdapat dalam lidah Buaya antara lain pektin, mannans dan antrakuinon.

Komplikasi Diabetes karena diabetes adalah peningkatan kadar gula dalam darah dimana darah di pompa keseluruh tubuh. Kondisi bisa menimbulkan berbagai macam komplikasi antara lain:

1. Struk

2. Jantung

3. Gagal tingal

4. Neoeopati diabetes

5. Katarak

6. Dimensia

7. Gangguan pendengaran

8. Luka atau infeksi pada kaki yang sulit sembuh

9. Gangren

Pada kondisi hamil dapat menyebabkan :

A. Keguguran

B. Kelebihan berat badan saat lahir

C. Panyakit kuning

D. Prematur

Pencengahan diabetes tipe I merupakan penyakit autoimun sehingga tidak dapat dicegah atau belum diketahui secara pasti pencengahan. Namun, untuk diabetes tipe II dapat dicegah dengan melakukan pola hidup sehat dan olah raga secara teratur.

Beberapa hal yang bisa dilakukan antara lain:

1. Mengatur frekuensi dan menu makanan, perbanyak makan buah, sayur, protein, biji-bijian serta makanan rendah kalori dan lemak.

2. Rutin olah raga dan melakukan aktivitas fisik. Hal ini dimaksudkan agar gula darah yang di dapat dari makanan dapat diubah menjadi energi. Dianjurkan untuk melakukan olah raga setidaknya 150 menit dalam seminggu.

3. Istirahat dan tidur yang cukup.

4. Menghindari minuman alkohol.

5. Hindari stress.

Diagnosis Diabetes

Untuk menentukan seseorang menderita diabetes biasanya dilakukan tes gula darah antara lain:

1. Tes gula darah puasa

Tes ini digunakan untuk mengukur kadar gula dalam darah saat puasa. Biasanya akan dilakukan puasa selama 8 jam sebelum melakukan tes gula darah puasa. Hasil tes gula darah puasa kurang dari 100mg/DL menunjukkan gula darah normal. Hasil 100-125mg/Dl berarti menunjukan rawan diabetes atau pre diabetes. Hasil tes gula darah puasa diatas 126mg/Dl menunjukkan penyakit diabetes.

2. Tes gula darah sewaktu.

Seperti namanya tes ini dilakukan untuk mengukur kadar gula darah sewaktu-waktu atau acak sehingga, tidak diperlukan puasa. Hasil tea gula darah sewaktu 2000mg/Dl dapat dikatakan menderita diabetes.

3. Tes HbA1C

Tes ini dimaksudkan untuk mengukur rata-rata kadar glukosa selama 2-3 bulan terahir. Tes ini di lakukan dengan mengukur kadar gula darah yang terkait dengan hemogoblin. Dalam menjalani tes HbA1c tidak dipelukan puasa. Hasil tes HbA1c tidak puasa. Hasil tes HbA1c normal 5,7% pre diabetes 5,7-6, 4% diabetes diatas diatas 6.5 %.

Hypertension : High Blood Pressure

2012-10-14T00:52:00.004-07:00

In 90% of people with hypertension, the cause of high blood pressure is not known and is referred to as primary or essential hypertension.

While the specific cause is unknown, there are two kinds of risk factors that can contribute to developing high blood pressure.

1. Factors that can not be changed

Age: The older a person is, the greater the likelihood that he or she will develop high blood pressure, especially elevated systolic readings. This is largely due to arteriosclerosis, or "hardening of the arteries."

Race: African Americans develop high blood pressure more often than Caucasians. They develop high blood pressure at a younger age and develop more severe complications sooner in life.

Socioeconomic status: High blood pressure is found more commonly among the less educated and lower socioeconomic groups. Residents of the southeastern United States, both Caucasian and African American, are more likely to have high blood pressure than residents of other regions.

Family history (heredity): The tendency to have high blood pressure appears to run in families.

Gender: Generally men have a greater likelihood of developing high blood pressure than women. This likelihood varies according to age and among various ethnic groups.

2. Factors that can be changed

Blood pressure.
Lifestyle
Obesity: As body weight increases, the blood pressure rises. Obesity is defined as having a body mass index (BMI) greater than 30 kg/m . A BMI of 25-30 kg/m is considered overweight (BMI=weight in pounds x 703/ height in inches ) Being overweight increases the risk of high blood pressure. Health care practitioners recommend that all obese people with high blood pressure lose weight until they are within 15% of their healthy body weight.
Obese people are two to six times more likely to develop high blood pressure than people whose weight is within a healthy range.
Not only the degree of obesity is important, but also the manner in which the body accumulates extra fat. Some people gain weight around their belly (central obesity or "apple-shaped" people), while others store fat around their hips and thighs ("pear-shaped" people). "Apple-shaped" people tend to have greater health risks for high blood pressure than "pear-shaped" people.
Sodium (salt) sensitivity: Some people have high sensitivity to sodium (salt), and their blood pressure increases if they use salt. Reducing sodium intake tends to lower their blood pressure. Americans consume 10-15 times more sodium than they need. Fast foods and processed foods contain particularly high amounts of sodium. Many over-the-counter medicines also contain large amounts of sodium. Read food labels and learn about salt content in foods and other products as a healthy first step to reducing salt intake. Fast food restaurants also make the salt and calorie content of their food available to consumers at their restaurants,
Alcohol use: Drinking more than one to two drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol.
Birth control pills (oral contraceptive use): Some women who take birth control pills develop
ck of exercise (physical inactivity): A sedentary lifestyle contributes to the development of obesity and high blood pressure.
Medications: Certain drugs, such as amphetamines (stimulants), diet pills, and some medications used for cold and allergy symptoms such as pseudoephedrine, tend to raise blood pressure.

High Blood Pressure Symptoms

High blood pressure usually causes no symptoms and high blood pressure often is labeled "the silent killer." People who have high blood pressure typically don't know it until their blood pressure is measured.

Sometimes people with markedly elevated blood pressure may develop:

headache, dizziness, blurred vision, nausea and vomiting, chest pain and shortness of breath.

People ussually do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure.

The following types of organ damage are commonly seen in chronic high blood pressure :

Heart attack
Heart failure
Stroke or transient ischemic attack (TIA)
Kidney failure
Eye damage with progressive vision loss
Peripheral arterial disease causing leg pain with walking (claudication)
Outpouchings of the aorta, called aneurysms

About 1% of people with high blood pressure do not seek medical care until the high blood pressure is very severe, a condition known as malignant hypertension.

In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg.

Malignant hypertension may be associated with headache, lightheadedness, nausea, vomiting, and stroke like symptoms

Malignant hypertension requires emergency intervention and lowering of blood pressure to prevent brain hemorrhage or stroke.

It is of utmost importance to realize that high blood pressure can be unrecognized for years, causing no symptoms but causing progressive damage to the heart, other organs, and blood vessels.

High Blood Pressure Diagnosis

Blood pressure is measured with a blood pressure cuff (sphygmomanometer).

This may be done using a stethoscope and a cuff and gauge or by an automatic machine. It is a routine part of the physical examination and one of the vital signs often recorded for a patient visit. Other vital signs include pulse rate, respiratory rate (breathing rate), temperature, and weight.

When discussing blood pressure issues, the health care practitioner may ask questions about past medical history, family history, and medication use, including prescriptions, over-the-counter medications, herbal remedies, and food additives. Other questions may include lifestyle habits, including activity levels, smoking, alcohol consumption, and illegal drug use.

Physical examination may include listening to the heart and lungs, feeling for pulse in the wrist and ankles, and feeling and listening to the abdomen looking for signs of an enlarged aorta. Eye examination with an ophthalmoscope may be helpful by looking at the small blood vessels on the retina in the back of the eyeball.

Human Blood Pressure

Normal Blood Pressure : Systolic less than 120 mm Hg; diastolic less than 80 mm Hg
Prehypertension : Systolic 120-139 or diastolic 80-89 mm Hg
High Blood Pressure :

Stage 1: Systolic 140-159; diastolic 90-99 mm Hg
Stage 2: Systolic more than 160; diastolic more than 100 mm Hg

Blood tests may be considered to assess risk factors for heart disease and stroke as well as looking for complications of hypertension.

These include complete blood count (CBC), electrolytes, BUN (blood urea nitrogen), and creatinine and GFR (glomerular filtration rate) to measure kidney function.

A fasting lipid profile will measure cholesterol and triglyceride levels in the blood. If appropriate, blood tests may be considered to look for an underlying cause of high blood pressure including abnormal thyroid or adrenal gland function.

Electrocardiogram (ECG) may help evaluate heart rate and rhythm. It is a screening test to help assess heart muscle thickness. If hypertension is long-standing, the heart muscle has to hypertrophy, or get larger, to push blood against the increased pressure within the arteries of the body.
Echocardiogram is an ultrasound examination of the heart It is used to evaluate the anatomy and the function of the heart. A cardiologist is required to interpret this test and can evaluate the heart muscle and determine how thick it is, whether it moves appropriately, and how efficiently it can push blood out to the rest of the body. The echocardiogram can also assess heart valves, looking for narrowing (stenosis) and leaking (insufficiency or regurgitation). A chest X-ray may be used as a screening test to look for heart size, the shape of the aorta, and to assess the lungs.
Doppler ultrasound is used to check blood flow through arteries at pulse points in your arms, legs, hands, and feet. This is an accurate way to detect peripheral vascular disease, which can be associated with high blood pressure. It also can measure blood flow in the arteries to both kidneys and sometimes depicts narrowings that can lead to high blood pressure in a minority of patients.

High Blood Pressure Treatment

Blood pressure control is a lifelong challenge. Hypertension can progress through the years, and treatments that worked earlier in life may need to be adjusted over time.

Blood pressure control may involve a stepwise approach beginning with diet, weight loss, and lifestyle changes and eventually adding medications as required.

In some situations, medications may be recommended immediately. As with many diseases, the health care practitioner and patient work together as a team to find the treatment plan that will work for that specific individual.

Self-Care at Home

The management and control of high blood pressure involves two major options, lifestyle modification and medication.

Lifestyle Modifications to Manage High Blood Pressure
Weight Control
Aim for a healthy weight range for your height and body type. Your health care practitioner can help you calculate a healthy target weight. Even a small amount of weight loss can make a major difference in lowering or preventing high blood pressure.
You must burn more calories than you take in to lose weight.
Crash or fad diets are not helpful and may be dangerous.
Some weight loss medications also carry major risks and may even elevate blood pressure, and great caution is advised in using these drugs. Please ask your health care practitioner or pharmacist for help in deciding if a weight loss medication is appropriate for your situation.
Exercise or Increase Physical Activity
Physical activity reduces total cholesterol and bad cholesterol (low density lipoprotein or LDL) and raises the good cholesterol (high density lipoprotein or HDL).
Both the American Heart Association (AHA) and the U.S. Surgeon General recommend 30 minutes of physical activity on most days of the week.
Physical activity includes many daily activities such as cleaning the house, raking the lawn, and walking. Other possible sources of activity can include using the stairs instead of an elevator or escalator, walking for errands instead of driving a car, and participating in a sport or social activity such dancing.

High Blood Pressure Medications

It may take trial and error to find the proper medication or combination of medications that will help control hypertension in each case. It is important to take the medications as prescribed and only discontinue them on the advice of your health care practitioner.

Water Pills (diuretics)

Diuretics are used very widely to control mildly high blood pressure, and are often used in combination with other medications. They increase sodium excretion and urine output and decrease blood volume. The sensitivity to the effect of other hormones in your body is decreased.

One example of a diuretic is hydrochlorothiazide

The most commonly used diuretics to treat hypertension include:

hydrochlorothiazide (HydroDIURIL),
the loop diuretics furosemide (Lasix) and torsemide (Demadex),
the combination of triamterene and hydrochlorothiazide (Dyazide), and metolazone (Zaroxolyn).

Beta-Blockers

Beta-blockers reduce heart rate and decrease the force of heart contraction by blocking the action of adrenaline receptors. Beta blockers are widely prescribed and effective but can cause increased fatigue and decreased exercise tolerance because they prevent an increased heart rate as a normal response to physical activity. Beta-Blockers also prescribed for people who have associated heart disease, angina, or history of a heart attack.

Examples of beta blockers include: carvedilol (Coreg), metoprolol (Lopressor), atenolol (Tenormin)

Calcium Channel Blockers (CCBs)

Calcium channel blocking agents work by relaxing the muscle in artery walls and by therefore reducing the force of contraction of heart muscle.

Example of calcium channel blockers include, nifedipine (Procardia), diltiazem (Cardizem), verapamil (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc), and felodipine (Plendil)

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors stop the production in the body of a chemical called angiotensin II, which causes blood vessels to contract. Narrower blood vessels are associated with increased blood pressure. Relaxing artery walls leads to lower blood pressure.

Examples of ACE inhibitors include Captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), quinapril (Accupril), and fosinopril (Monopril)

Angiotensin Receptor Blockers (ARBs)

ARBs work block angiotensin II receptors and prevent vasoconstriction, or narrowing of blood vessels.

Examples of ARBs include losartan (Cozaar), valsartan (Diovan), candesartan (Atacand), and irbesartan (Avapro)

Blockers of Central Sympathetic (autonomic nervous) System

These agents block messages from the brain's autonomic nervous system that contract blood vessels. The autonomic nervous system is the part of the unconscious nervous system of the body that controls heart rate, breathing rate, and other basic functions. These medications relax blood vessels, thus lowering blood pressure.

An example is clonidine (Catapres)

Direct Vasodilators

Direct vasodilators relax (dilate) the blood vessels to allow blood to flow under lower pressure.

These medications are most often used in times of hypertensive crisis and are injected intravenously to quickly lower blood pressure readings.

Examples include nitroprusside (Nitropress), and diazoxide (Hyperstat).

Other Therapy

Alternative therapies may be helpful to people trying to control their blood pressure.

Acupuncture and biofeedback are well-accepted alternative techniques that may help some people with high blood pressure.

Techniques that induce relaxation and reduce stress are recommended. These include meditation, yoga, and relaxation training.

These techniques alone may not control high blood pressure for many people. They should not be used as a substitute for medical therapy without first consulting with your health care practitioner.

Dietary supplements and alternative medications and therapies are sometimes recommended for high blood pressure.

Examples include vitamins, garlic, fish oil, L-arginine, soy, coenzyme Q10, herbs, phytosterols, and chelation therapy.

While these substances may be beneficial, the exact nature of their benefits is not known.

Scientific studies have produced no evidence that these therapies lower blood pressure or prevent the complications of high blood pressure.

Most of these substances are harmless if taken in moderate doses. Most people can take them without problems.

Talk to your health care practitioner if you are considering any of these treatments. Substituting these therapies for medical therapies that have been shown to lower blood pressure and the risk of complications may have a harmful effect on your health.

Human Papillomavirus

2012-09-10T21:51:00.001-07:00

Human papillomavirus (HPV) is the most common sexually transmitted infection (STD),Over 90 different types of HPV have been identified and fully sequenced, and There are about 40 types of HPV that can infect the genitals and reproductive organs of men and women. HPV infection is by far the most significant risk factor for cervical cancer. Relative risks usually exceed 100 in case control studies and are usually in the range of 10 to 20 in prospective studies (REF).

How Do I Keep From Getting Human papillomavirus

Here are some strategies to reduce your chances of getting HPV

Having sex with only one partner who only has sex with you (mutual monogamy)
HPV vaccine is recommended for women and men under 26 years old
Using condoms is an excellent prevention strategy for HPV or other sexually transmitted infections

How to Cure Human Papillomavirus

Cryotherapy. This involves freezing the abnormal cells with liquid nitrogen.
Conization. This procedure, also known as a cone biopsy, removes the abnormal areas.
LEEP or Loop Electrosurgical Excision Procedure. The abnormal cells are removed with an electrical current.
Visible warts can be removed with medications that you can apply yourself, or with treatments performed by a healthcare provider. Once you have been diagnosed with HPV, it’s important to get frequent check-ups to make sure the abnormal cells do not come back.

Children's Oral and Dental Health

2012-09-05T07:46:00.002-07:00

Oral and dental health are integral parts of good overall health, and dental caries is the most common chronic infectious disease of childhood. Here are some tips for helping your child have good dental health.

Infants: Steps can be taken to support your child’s oral health even before the first teeth appear. Wipe your baby’s mouth and gums with a clean, damp cloth after feedings and before bed. Start brushing with a soft infant brush and water when the first tooth comes in and start flossing when two teeth start to touch or when all the baby teeth are in – usually around 2-2½ years. It is best to introduce cups starting around 6 months of age. Cups with a “no-spill” valve (often called sippy cups) are more like bottles – so to help your child learn the new skill of drinking from a cup, look for a cup without the no-spill feature.

Toddlers: Wean from a bottle by around 12-24 months. Don’t let your child walk around with a cup or bottle – especially if it contains milk, juice, or other sweet drinks. This causes sugar to remain on teeth longer, increasing the risk of decay. If your child uses a cup or a bottle at bedtime or naps, put only water in it at that time.

Preschoolers: Preschoolers and older children should brush their teeth at least twice a day and floss once a day. Start by using a pea-sized amount of fluoride toothpaste when your child is around age two. Encourage your child to help brush his or her own teeth, but remember that children are still developing fine motor skills, so they might need your help. Supervise closely to make sure your child spits out, rather than swallows, the toothpaste. In between meals and snacks, offer water instead of milk, juice, or sweetened drinks.

School Age: Children typically need help brushing their teeth until around age 8 as this is when children gain the fine motor skills necessary to do the job well. After children begin to lose their baby teeth around age 6, their permanent teeth begin to come in so encourage children to pick healthy snacks and limit sugary snacks and drinks. School-age children are also often starting to participate in sports and other physical activities and it is important that they are using mouth guards and other protective equipment to prevent injury.

ETIOLOGIC FACTORS AND PREVENTION OF DENTAL CARIES

Dental caries is a dietary carbohydrate-modified infectious disease. It is the most common chronic infectious disease of childhood, with a prevalence of more than 40% by age 6 years in the primary dentition and more than 85% by age 17 years in the permanent dentition. Caries typically is described as a multifactorial process, involving specific oral microflora, diet, and a susceptible host. Prevention of dental caries therefore is aimed at

Reducing cariogenic microbes in the oral cavity;
Reducing the exposure of these microbes to a cariogenic substrate;
Increasing the decay resistance of the tooth. A combination of dietary advice, coupled with mechanical plaque removal (e.g., brushing and flossing) and adequate fluoride exposure, is sufficient to control dental disease in most patients.

Recommendations to parents:

Do not put the infant to sleep with a bottle containing any liquid other than water. Infants who fall asleep while breastfeeding may be at higher risk for caries. Wean the infant from the bottle by 14 months of age. Avoid prolonged consumption of sweetened beverages or low-pH fruit juices from a bottle or "tippy" cup. Do not dip pacifiers in sweetened solutions or honey.

Monitor the child's diet for the amount and frequency of exposure to fermentable carbohydrates. Restrict intake of sweets to mealtimes, when salivary flow is greater. Substitute less-cariogenic foods as snacks.

Clean the child's teeth after the intake of medications flavored with sucrose.

Whooping Cough

2012-09-03T23:07:00.002-07:00

What is whooping cough?
Whooping cough is an infection ((caused by a bacterium, Bordetella pertussis) of the nose and throat and lungs which causes long bursts of coughing. In young children the coughing spell often ends in a ‘whooping’ noise when the child can finally take a breath in. Children can have several coughing spells each hour, including while they are sleeping. They can also go on having coughing spells for many weeks (up to about three months for some). Older children and adults can have whooping cough without the ‘whooping’ sound. Immunisation against whooping cough can be very effective in protecting children.

How does it spread?

The infection spreads by droplets that are coughed or sneezed out. These droplets can be breathed in or they can be carried to the nose by hands which come in contact with the droplets (e.g. through handling used

tissues or by touching surfaces which have the droplets on them). Whooping cough is very easy to catch. 70% to 100% of people living in the same house as someone with whooping cough will get the infection unless they have been immunised.

Who is most at risk?

Any one who is not protected (by recent immunisation or by having had the infection before) can get whooping cough, including older children and adults. More than 60% of people who get the infection in Australia are over ten years of age. Adults and children over ten can get the infection even when they have been immunised as a baby. Babies are at most risk of having severe health problems from whooping cough. About one in 200 babies who get whooping cough before they are six months old will die from the infection. How long does it take to develop? A child or adult who catches whooping coughwill usually start to be unwell about seven to ten days after being exposed to the infection.

Signs and symptoms of whooping cough

The illness usually starts like a ‘cold’ with runny nose and a cough which is not like the spells of coughing later in the illness. After several days the long spells of coughing start, causing difficulty breathing during the spells. The child will have many quick coughs in one spell. There can be several spells of coughing each hour (with an average of 25 coughing spells per day). Young children often have a whoop after the coughing spell (when they can finally breathe in). They might vomit any food or drink that they have recently swallowed, during the cough or soon afterwards. Very young babies may not cough, but they may just stop breathing for a minute or longer many times per day. If they cough there might not be the whoop.

Adults and older children may not whoop, but they will have coughing spells and they may feel tired (the coughing can interfere with sleeping), and generally unwell. It can be many weeks before it is recognised that the older child or adult has whooping cough. Finally, after several weeks or more, the coughing spells start happening less often and they stop happening about two to three weeks later. If the person gets a cold soon after having whooping cough, the coughing can start again for a while (much shorter than the original illness).

What can you do?

It is important to check often that the child is eating and drinking enough. It seems that feeding a young child immediately after a coughing spell may mean the food and drink stays down. Feeding seems to trigger a coughing spell if the child has not coughed recently, but soon after a coughing spell, food and drink usually does not trigger another coughing spell. Children who are coughing often will be tired and uncomfortable (coughing can cause tummy pain from overused muscles). Some paracetamol or ibuprofen may help with aching muscles. The topic ‘Feeling sick’ has more ideas and Immunisation of babies against whooping cough protects most children. (source www.health.wa.gov.au)

How To Improve Your Chances of Getting Pregnant

2012-08-30T07:35:00.000-07:00

If you are a newly-couple, you are probably looking for information on how to increase your chances of getting pregnant. The best way is having sex regularly. To improve your chances of getting pregnant, consider the following:

Calendar Method

The calendar method looks at the 28-day cycle and mid cycle as the proper time for ovulation. Although this has the possibility compared to just selecting any day, it is by no means precise. Sometimes the females do not ovulate on the 14th day. Use the more accurate methods in predicting the proper time as the prediction kits, charts or watching clues for fertilization

Eat healthily

A healthy diet will help ensure your body is healthy enough to become pregnant, it also can help to keep sperm production at optimum levels. Good eat and diet can make you less likely to become pregnant. The government also recommends that all women trying for a baby should take 400mcg of folic acid a day to help prevent conditions such as spina bifida in your child.

Exercise regularly

Regular, moderate exercise of around 30 minutes a day helps to maximise your fitness and keep your weight in check. It also boosts levels of endorphins, the body’s own ‘happy hormones’, which may help to reduce stress. Some people find relaxation techniques or complementary therapies also help them relax.

Drink wisely and Quit smoking

Alcohol may affect fertility and sperm quality, so do limit your drinking to the Government’s ‘Sensible drinking’ guideline of a maximum of two - three units a day for women and three - four units a day for men. Smoking has been linked to infertility and early menopause in women, and to sperm problems in men. It is also a factor in premature or low birth-weight babies.

Medication and drugs

Some prescription medication can lessen your changes of conceiving, so if you are taking regular medication and trying for a baby, talk to your doctor about alternatives that might be more appropriate.

Lung Cancer

2012-08-24T09:19:00.002-07:00

The Lung Cancer

Currently the number of people who suffered or died by lung cancer is increasing every year, so be aware and prepare your self to identify the symptoms of lung cancer as it is conducive to the treatment.

The lung cancer is one of the most common primary malignant tumors of the human lung, which mostly originates in bronchial epithelium, so lung cancer can also be called bronchial lung cancer.

The Causes

Inhaled carcinogens substances are primarily mentioned as the causes, for example that 85% of case in smoker cause of the benzopyrene content in cigarette smoke. Occupational carcinogens such as asbestos or substances containing arsenic may also be the cause. Genetic predisposition also indicate plays a role.

The Symptoms

There are usually no symptoms or warning signs in the early stages, thus it is easily ignored, resulting in delay of treatment.

1. Cough
There are about two thirds of patients have cough, which is the most common symptom of early lung cancer. It can be manifested as mild dry cough, severe cough, cough with high frequency or cough at night.

2. Hemoptysis (Coughing up blood)
It is also a symptom of early lung cancer and it is more obvious in male smokers. It is manifested as coughing up phlegm with blood or intermittent bloody sputum, and having repeated infections somewhere in the region of lungs.

3. Chest pain
It is a symptom in about 30 percent of people with lung cancer. If the tumor is close to lung membrane, the pain can be dull or vague and cough intensifies when breathing or coughing. If cancer has invaded lung membrane, persistent pain can be caused.

4. Fever
Fever due to lung cancer is a kind of cancerous heat which is mostly caused by inflammation that tumor blocks bronchus of lung, causing inadequate drainage. The fever is generally below 38 degree, ineffective to antibiotic treatment, and tends to develop repeatedly.

5. Chest distress and shortness of breath
They are most common symptoms of early lung cancer. They usually result from a blockage to the flow of air in part of the lung, collection of fluid around the lung (pleural effusion), or the spread of tumor throughout the lungs.

6. Clubbed finger
Known as drum hammer finger, it is manifested as enlargement of the first joint of fingers and toes, protruded and curved of nails, and pain. If you find yourself having those signs, you need to pay attention to prevent lung cancer.

7. Arthritis
It is manifested as wandering and burning pain of the joint of elbow, knee, ankle, wrist, and finger, inability to use the hand or walk.

Lung Cancer Treatment

There treatment for lung cancer are mainly surgery, the other treatment options such as radiotherapy, chemotherapy, immunotherapy, traditional medicine treatment, etc.

1.Surgery
　　Surgery is applied to remove tumors, including radical resection and palliative resection. But only patients with early and middle lung cancer are applicable to radical resection, which only accounts for less than 40% of the total patients with lung cancer.
　　Currently, surgery is still one of the major options for lung cancer treatment. The indications and types of surgery are determined by location, involved region of tumor and patient's general condition especially cardiopulmonary function reserve. The principle of surgery is to completely remove lesions and maximally preserve healthy lung tissues.

2. Radiation therapy
　　Radiation therapy includes irradiation in cavity and irradiation in vitro. The devices include radium, X-ray machine, cobalt bomb, accelerator which are mostly used and post-installed machine, "photon knife" which are developed in recent years.
　　Radiotherapy can be also used as adjunctive therapy before and after surgery so as to increase resection rate and long-term survival rate after surgery, besides, radiotherapy is also applicable to squamous cell carcinoma that cannot be treated by surgery or that are recurrent and metastatic.
　　Radiotherapy can be divided into simple radiotherapy and comprehensive radiotherapy. Simple radiotherapy consists of radical radiotherapy and palliative radiotherapy. To choose which kind of radiotherapy should be in accordance with pathological types, extent, and metastatic situation of lung cancer, lung function and systemic conditions. Comprehensive radiotherapy combines radiotherapy with surgery and chemotherapy, which has higher survival rate than any other single treatment.

3.Treatment of Advanced Lung Cancer
　　For patients with advanced lung cancer, surgery should be tried to remove primary cancer and metastatic lymph nodes, supplementing with radiotherapy and chemotherapy and other lung cancer treatment methods.

All About Psoriasis

2012-08-22T17:31:00.000-07:00

Psoriasis is a chronic skin disease of scaling and inflammation that affecting about 2% of the population. It occurs equally in men and women, at any age (primarily affects adults), and tends to come and go unpredictably. It is not infectious, and does not scar the skin.

What cause Psoriasis?

The skin is a complex organ made up of several different layers. Psoriasis is a skin disorder driven by the immune system, especially involving a type of white blood cell called a T cell. Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells.

In practice, People with psoriasis may notice that there are times when their skin worsens, called flares, then improves, no obvious cause can be detected. Usually, sunlight improves psoriasis, though occasionally it makes it worse (especially if the skin gets burned). A high alcohol intake and smoking can worsen psoriasis too. Also, certain medicines, including beta-blockers, which are prescribed for high blood pressure, and lithium may trigger an outbreak or worsen the disease.

What are the symptoms of psoriasis?

The main problem with psoriasis for many people lies in the way it looks, This can affect their quality of life. Psoriasis can itch and the affected skin can split, which may be painful. Some people with psoriasis may develop stiff and painful joints, which can be due to a form of arthritis associated with psoriasis called psoriatic arthritis. The joints most commonly affected are the fingers, toes, wrists, knees and ankles.

Types Of Psoriasis

Plaque psoriasis (psoriasis vulgaris) appears as dry, scaly patches of skin and is the most common form of the disease
Guttate psoriasis emerges as pink to red drop-like plaques which may form a scale
Inverse psoriasis appears as smooth, red plaques and is found primarily in the armpits, groin, and skin folds
Pustular psoriasis appears as white, pus-filled blisters
Erythrodermic psoriasis develops over large areas of the body; skin is red with excess shedding of fine scales

Psoriasis Treatment

Treatment for Psoriasis based on the severity of the disease, size of the areas involved, type of psoriasis, and the patient’s response to initial treatments. This is sometimes called the “1-2-3” approach. In step 1, Topical treatment (Corticosteroids, Calcipotriene, Retinoid, Anthralin, Clobetasol propionate). Step 2 phototherapy (Psoralen and ultraviolet A phototherapy (PUVA), Ultraviolet B (UVB) phototherapy). Step 3 called systemic therapy (Antibiotics, Retinoids, Biologic response modifiers).

Acne

2012-08-21T18:12:00.001-07:00

What Causes Acne

According to the American Academy of Dermatology, acne develops when hormonal shifts (like the kind that occur during puberty, and in women, before a menstrual cycle and sometimes prior to menopause) cause an overproduction of oil and cells inside a skin follicle. Together, they form a kind of biological traffic jam that plugs the opening of the pore and causes the follicle beneath to swell.

This allows for the overgrowth of bacteria found normally on skin -- Propionibacterium acnes (P. acnes) -- producing irritating chemical substances, which further fuel the inflammation. The end result is acne.

"It can be characterized by anything from whiteheads and blackheads, to tiny hard pimples you barely see, to pus-filled nodules, even fluid-filled cysts with roots deep in the skin," says Sumayah Jamal, MD, PhD, an assistant professor of dermatology and microbiology at the NYU Medical Center in New York City.

Signs and Symptoms:

There are several types of acne lesions:

Closed comedone (whitehead) -- a clogged follicle. Whiteheads usually appear on the skin as small, round, white bumps
Open comedone (blackhead) -- a plugged follicle that opens and turns dark at the surface of the skin. Blackheads do not indicate the presence of dirt.
Papules -- inflamed lesions that appear as small, pink bumps on the skin.
Pustules (pimples) -- inflamed pus filled lesions that are red at the base.
Cysts and nodules -- large, inflamed, pus filled lesions deep under the skin that can cause pain and scarring.

Lesions can cause scars ranging from small, sunken pits to large elevated blemishes, depending on how severe the acne is and what your skin type is.

Acne Trearment
The newest over-the-counter acne treatment is not a cream or lotion, but a device -- a tiny electronic pimple "zapper" with the high-tech name of "Zeno."

Recently cleared by the FDA, Zeno resembles a tiny cell phone or a large cigarette lighter. It purportedly works by supplying a small amount of controlled heat directly to the acne lesion for two to three minutes, causing the bacteria to self-destruct and ultimately the pimple to clear.

According to the manufacturer, most zits require a single treatment and are completely gone in just hours. Others, they say, may require up to three treatments in 24 hours to see results.

It sounds impressive, but does it work?

"If the lesion is not too large -- and not too severely inflamed -- it can work. But it's not for widespread acne, or moderate to severe breakouts," says Jamal. She says it's best for the occasional pimple and perfect for zit-phobes who want to keep their skin blemish-free without having to run to the dermatologist every week.

The Zeno device sells for about $215, and the company offers a free 30-day trial.
New Laser Treatments

But what if your acne is causing more than just an occasional pimple? Then you may be a candidate for one of several new laser treatments -- professional medical procedures that use laser light to heat up and destroy bacteria, as well as shut down excess oil production.

"One type of laser works to inhibit the growth of 'bugs' -- the bacteria that cause acne; the second type shrinks the oil glands and has an 'Accutane-like' effect, but without the side effects," says Goldberg. Both lasers also have antiaging benefits including encouraging collagen production, making it an excellent treatment for midlife acne.

Although treatment is pretty much painless, it is expensive, costing between $500 and $800 per session, with at least five to seven treatments necessary to see results. Moreover, those results are frequently not permanent.

"The laser that works on the bugs, usually requires five or six treatments, which may need to be repeated in about two months; the lasers that work on the oil glands have a longer-lasting effect, but flare-ups do generally occur again within six months to a year," Goldberg tells WebMD.

Jamal says because they are so costly, lasers should only be used when topical antibiotic preparations aren't enough.

"The lasers don't do a better job than the topical treatments, and they are more expensive. I use them only as an adjunct, when the topicals alone don't work, or to treat large areas such as the back," she says.

Salt Intake and Cardiovascular Disease

2012-01-15T19:40:00.000-08:00

Salt is made up of 40 percent sodium and 60 percent chloride. Sodium helps to maintain your blood's water content, serves to balance the acids and bases in your blood, and is necessary for the movement of electrical charges in the nerves that move our muscles.

Salt intake has been correlated directly with blood pressure and the relationship between chronic high salt intake, high Blood Pressure, and cardiovascular disease is very strong. The totality of the evidence for salt is more robust than for any other dietary variables considered to be important in the prevention of cardiovascular disease. recommended salt intake is <5 br="br" day.="day." g="g">

The increased cardiac work induced by the combination of the higher salt intake and the further augmentation in afterload was associated with increased systolic indices of ventricular contractility accompanied by nonsuppressed tissue levels of Ang II and AT1 receptor protein. Evidence of downregulation of AT1 receptor mRNA in the heart of salt-loaded SHR may reflect a tissue response to the activated circulatory and nonsuppressed cardiac Ang II, providing further supporting evidence of inappropriately high Ang II activity in different models of salt-sensitive hypertension [Liang and Leenen, 2007; Zhu et al. 2004; Sumida et al. 1998; Kreutz et al. 1995].

What to do
Each country should adopt a coherent and workable strategy to reduce salt intake. In most developed countries, ~80% of salt is hidden in foods, i.e. added by the food industry. It is therefore vital to persuade the food industry to make a gradual and sustained reduction in the amount of salt they add to foods. Several countries, e.g. Finland and the UK, have successfully carried out salt reduction programmes and salt intake has already fallen. Many other countries, e.g. Australia, Canada, and the USA, are also stepping up their activities to reduce salt intake. In many developing countries, where most of the salt consumed comes from salt either added during cooking or from sauces, public health campaigns are needed to encourage consumers to use less salt. A modest reduction in population salt intake worldwide would result in a major improvement in public health.

Buying low-sodium foods and Avoiding high-sodium foods
Going on a low-sodium diet

Homeopathic Treatment of Hypertension

2012-01-08T17:50:00.000-08:00

Hypertension is one of the most common diseases in the world and become important public health challenge, A man with successive blood pressure readings above 130/80 within a short duration needs to be examined and treated without delay. High blood pressure can initiate much early in life and most of the time goes unnoticed for many years. Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries, which carry the blood throughout the body. Blood pressure refers to the pressure within the arterial walls and adjusts according to the body’s changeable need for amount of oxygen and nutrients. Hypertension is also the most important modifiable risk factor for coronary heart disease, stroke, congestive heart failure, end-stage renal disease, and peripheral vascular disease.

Hypertension is hazardous because it makes the heart work harder to pump blood to the body and it contributes to hardening of the arteries and further developing heart failure.
Familiarize yourself with the blood pressure numbers:
•    Normal Blood pressure is 120/80 or less.
•    Prehypertension is 120-139/80-89.
•    Stage 1 hypertension is 140-159/90-99.
•    Stage 2 hypertension is 160/100 and above

Correct Measuring Blood Pressure Technique
•         Ensure patient comfortable and has rested for some time.
•         Choose appropriate bladder cuff size.
•         Support arm at level of heart.
•         Express results to nearest 2mm Hg
•         Deflate at rate of 2mm per second
•         Measure at least twice at each visit and consider both arms.
•         Try and measure at the same time of day
•         Advise no smoking or caffeine for 30 mins prior to measurement
•         Measure standing levels in elderly if suspecting postural drop
•         Maintain and service equipment regularly

Causes of Hypertension:

•    Genetic.
•    Lack of physical activity, improper diet, smoking and alcohol.
•    Overweight.
•    Stress.
•    Old age.
•    Heavy metal toxicity.
•    Food sensitivities.
•    Hyper calcemia (high calcium levels).
•    Hormonal changes.
•    Kidney, adrenal (gland above the kidney) and thyroid diseases.
•    Certain medications like birth control pills, antidepressants, steroids, non-steroidal anti-inflammatory drugs and many more.

Symptoms of Hypertension:
•    Headache, dizziness and mental confusion.
•    Low energy levels with excessive sweating.
•    Face flushed.
•    Vision problems.
•    Nosebleed.
•    Chest pain, palpitation and irregular heartbeat.
•    Difficulty breathing.
•    Frequency of urination and/or blood in urine.
•    Sleep apnea.
•    Hardening and narrowing of arteries in the body (Atherosclerosis).
•    Stroke.
•    Kidney disease.
•    Damage blood vessels in the retina of the eye (Retinopathy).
•    Erectile Dysfunction (impotence in men).

Homeopathic approach to Hypertension:
Constitutional Homeopathic treatment is an incomparable option to treat Hypertension. Homeopathic remedies dilate the blood vessels and increase the amount of blood flow to the kidneys, thereby, increasing urination and lowering blood pressure. Homeopathic remedies promote your entire circulatory system, relax and increase the elasticity of arteries, allowing blood to flow with less pressure, hence, lowering blood pressure naturally, balancing the blood flow and relieving the stress so you can calm down. Based on the classical approach of Homeopathy a Homeopathic practitioner looks at the person holistically, that is mind, body and emotion together and not just at the symptoms of the illness.

Self-care measures for Hypertension:
•    Monitor blood pressure regularly.
•    Carry out regular investigations concerning blood sugar, lipid and renal profile.
•    Eat a diet low in salt and saturated fat.
•    Eat more fruits, vegetables, whole grain products, fish and nuts.
•    Eat foods that are rich in magnesium, potassium and calcium.
•    Eating two cloves of garlic every morning can help reduce blood pressure naturally.
•    Celery is also known to reduce blood pressure.
•    Avoid red meat and desserts.
•    Exercise and increase your physical activity.
•    Avoid smoking and alcohol.
•    Control anger, irritability.
•    Drink at least a gallon of water daily.
A restructured lifestyle with Homeopathic intervention can help treat your Hypertension. Hence, to make a commitment to healthy living and to take the pressures off Hypertension consider Homeopathy and you will notice a difference not just in your blood pressure, but also in every aspect of your life.

Meningitis

2011-11-25T10:35:00.000-08:00

Meningitis is inflammation of the membranes that surround the brain and spinal cord. Meningitis is contracted by either a bacterial or a viral infection. It also may be caused by a fungal infection, a reaction to certain medications and environmental toxins, or a traumatic injury to the head or spine.

What Are Meningitis Symptoms?

The usual symptoms of meningitis are low-grade fever, headache and a stiff neck. In other patients, symptoms are nausea, vomiting, aversion to bright lights, confusion and drowsiness. In infants younger than 2 years, the standard symptoms may be impossible or difficult to distinguish, and the child may only appear sluggish or motionless, or may seem ill-tempered, may have been vomiting or may show a loss of appetite. Seizures may occur at a later stage in any age if treatment is not sought.

The symptoms of Meningitis are as follows:

Meningitis symptoms in babies:

* Fever which can be accompanied by coldness in the hands and feet

* Refusing feeds or vomiting

* High pitched moaning cry or whimpering

* Dislike of being handled and fretful

* Neck retraction with arching of back

* Blank and staring expression

* Child is difficult to wake or lethargic

* Pale blotchy complexion

Meningitis Symptoms in children and adults:

* Vomiting

* High temperature and fever

* Violent or severe headache

* Neck stiffness

* Drowsiness and lethargy

* Joint pains

* Fainting

Meningitis Treatment

Early diagnosis and treatment of meningitis is vital to recovery. Once symptoms appear, a doctor and treatment should be sought immediately. Usually, meningitis is diagnosed by removing a sample of spinal fluid from the lower back of the child, a process called a spinal tap, and then growing bacteria from the acquired sample. Once again, discovering the type of bacterium that has caused the infection is vital to selecting the right antibiotics to treat the infection and prevent a reccurrence. The earlier the child is diagnosed, the better the chance of a full recovery. Correct antibiotic treatment reduces the chance of death from common bacterial meningitis to below 15 percent in children. Because meningitis is contagious, people should practice good hygiene (wash hands frequently and thoroughly). The organisms are spread by breathing them in; they are rarely contracted by touching contaminated surfaces.

Types of Meningitis (Most common meningitis)

Bacterial meningitis

Bacterial meningitis occurs in about 3,000-5,000 people in the US every year. Approximately 20-25% of the time. The most common bacteria that cause bacterial meningitis is Streptococcus pneumonia. If bacterial meningitis progresses rapidly, in 24 hours or less, death may occur in more than half of those who develop it, even with proper medical treatment. Bacterial meningitis risk factors, age (>60 or <5 yr), People with alcoholism, sickle cell anemia, cancer, IV drug users.

Viral meningitis (aseptic meningitis)

Determining how many people get viral meningitis is difficult because it often remains undiagnosed and is easily confused with the flu. The prognosis for viral meningitis is much better than that for bacterial meningitis, with most people recovering completely with simple treatment of the symptoms. Because antibiotics do not help viral infections, they are not useful in the treatment of viral meningitis.

Hypersplenism

2011-11-11T09:46:00.000-08:00

Hypersplenism is Various disorder that causes the spleen to rapidly and prematurelydestroy blood cells.Hypersplenism may be caused by a variety of disorders. Sometimes, it is brought on by a problem within the spleen itself and is referred to as primary hypersplenism. Secondary hypersplenism results from another disease such as chronic malaria, rheumatoid arthritis, tuberculosis, or polycythemia vera, a blood disorder. Spleen disorders in general are almost always secondary in nature. Hypersplenism may also be caused by tumors.

The difference between splenomegaly and hypersplenism. Splenomegaly is enlargement of the spleen Hypersplenism: is increase in the function of the spleen, so macrophages inside the spleen attack both normal and abnormal cells.

Etiology

Abnormalities of the spleen are almost always secondary to primary disorders elsewhere. Lymphoproliferative, myeloproliferative and connective tissue diseases are the most commonly encountered causes in temperate climates, while infectious diseases such as malaria, kala-azar and the like, are predominant in the tropics. Unsuspected hepatic cirrhoris or portal or splenic vein thrombosis resulting in congestive splenomegaly is uniformly distributed and a frequent cause of idiopathic splenomegaly.

Pathogenesis

Although sporadic data

Hypersplenism Symptoms and Signs

Most of the presenting symptoms and signs may be those of the underlying disease. Besides palpable splenomegaly, the following may be encountered

1. Left upper quadrant abdominal pain associated with splenic friction rubs indicates splenic infraction, a common concomitant of marked splenomegaly.

2. Epigastric and splenic bruits secondary to inordinate blood return from massively enlarge spleens may presage bleeding esophageal varices.

3. Early feeding satiety may be caused by encroachment on the stomach by the enlarged spleen.

4. Purpura and manifestation of mucosal bleeding may occur.

Vulvitis Treatment and Symptoms

2011-10-26T13:16:00.000-07:00

Medical information about Vulvitis treatment and symptoms. Vulvitis is inflammation of the vulva that may caused by trauma (mechanical and chemical irritations), hygienic neglect, urinary or vaginal contamination, local allergic to clothing, detergent or drugs. In adult women, vulvitis are frequent caused by trichomonal vaginits and mycotic infections. There are two types of vulvitis; Acute vulvitis and Chronic Vulvitis.

Vulvitis Symptoms

Acute vulvitis symptoms, acute vulvitis presents with marked edema and erythema of the vulva, burning and pruritis. Pain may be so severe that the patient can neither sit nor walk. Ulceration, postules or vesical formation may be present.

Chronoc Vulvitis Symptoms, in chronic vulvitis the inflammatory reaction is less severe. Edema may be minimal or elephantiasis. With intractable pruritis, excoriation and secondary infection are common. Ulcerative lesion may destroy the vulva or produce a pappilary fungating lesion.

Vulvitis Treatment

The treatment for vulvitis depend on the cause, specific symptoms, age, general health and medical history.

Acute Vulvitis Treatment,

Cold compresses may give immediate relief of acute vulvitis
Hot compresses if inflammatory predominant
Wear loose cloth, absorbent clothing
Oral Anti histamine to reduce inflammation and allergy
Topical or systemic corticosteroids are useful in treating inflammation and pruritus.
The vulvitis causal factor should be treated correctly (bacterial or fungus infection)

Chronic Vulvitis Treatment

Hydrocortisone cream or ointment is usually help

Prolonged treatment is required in addition to correcting the underlying pathologic state and encouraging cleanliness.

Since a premaligant or malignant lesion may be present, prompt biopsy may be useful

How is vulvitis diagnosed

General physical examination, blood test, and urinalysis are necessary to determine if you have vulvitis.

Myocardial Infarction

2011-10-24T21:00:00.000-07:00

Ischemic myocardial necrosis usually resulting from abrupt reduction in coronary flow to a segment of myocardium. Myocardial infarction clinical condition is characterized by precordial pain similar to, but usually more intense and prolonged than, Angina pectoris and Left ventricular dysfunction.

Etiology

Atherosclerosis of the coronary arteries is the common denominator in most patients with myocardial infarction. Angiographic studies reveal that segmental abnormalities of myocardial infarction contractility representing old infarction correlate reasonably well with artery supplying disease. Abnormalities in platelet aggregation in the patient with pre-existing coronary disease may contribute to variable changes in coronary perfusion. However, infarction can occur in the absence of coronary occlusion artery disease or occlusion, and if adequate collaterals are present, coronary occlusion can develop without subsequent infarction. Myocardial infarction may occur in the absence of coronary artery disease because of coronary artery spasm or because of coronary embolization complicating endocarditis, left atrial thrombosis, or rheumatic heart disease. Myocardial Infarction is predominantly a disease of the left ventricle but the damaged area may extend into the right ventricle or the atria.

The first symptoms of acute myocardial infarction is the development of deep, substernal, visceral pain described as aching or pressure. The myocardial pain is similar to angina pectoris but usually more severe and relieved little, or only temporarily. In severe episodes the patient becomes apprehensive and may develop a sense of impending doom. Symptoms of left ventricular failure, pulmonary edema, shock or significant arrhythmia may develops and dominate the clinical picture.

Treatment

Myocardial infarction treatment usually designed to relieve the patient's distress, reduce cardiac work, prevent myocardial possible complications, and furthermore treatment complications.

Next Myocardial Infarction Complication

Essential Hypertension Definition

2011-10-23T21:05:00.000-07:00

Definition of High blood pressure or Hypertension is the elevation of systolic and or diastolic blood pressure greater than 150/90 mm Hg. There are two types of hypertension; Essential hypertension (primary hypertension) and inessential hypertension (commonly known as secondary hypertension). Essential Hypertension (about 90 percent of all hypertension cases), most people with essential hypertension show heightened vascular and cardiac reactions to sympathetic stimuli. Whether this hyper responsiveness resides in the sympathetic nervous system, its receptors, or the tissue that it innervates is not know. Secondary hypertension is associated with bilateral renal parenchymal disease or with such potentially curable disorders as pheochromocytoma, Cushing's syndrome, primary aldosteronism, hyperthyroidism, myxedema, coarctation of the aortha, renal vascular disease, and unilateral renal disease.

Pathology

No pathologic changes occur early in essential hypertension. Ultimately, generalized arteriolar sclerosis develops. Its particularly apparent in kidney and is characterized by intimal hyalinization and medical hypertrophy. Nephrosclerosis in the hallmark of primary hypertension. Left ventricular hypertrophy and, eventually, dilation develops gradually. Coronary, cerebral, aortic, renal and peripheral atherosclerosis are more common and more severe in hypertensives since hypertension accelerates atherogenesis.

Maligant hypertension is characterized by widespread necrotizing arteriolitis with fibrinoid changes and proliferative endarteritis, especially in, but nor confine to, the kidney.

Pathophysiology

Not all patients with essential hypertension have normal cardiac output and increased peripheral resistance. Cardiac output is increased and peripheral resistance is inappropriately normal for the level cardiac output in the early labile phase of essential hypertension. Peripheral resistance increases and the cardiac output returns to normal after a period of time, probably because of auto-regulation. Patients with high fixed diastolic pressures often have decreased cardiac output. The role of the large veins in the pathophysiology of essential hypertension has largely been ignored, but venoconstriction early in the course of the disease may contribute to the increased cardiac output.

Relationship between Hypertension and Plasma Volume

Plasma volume tends to decrease as Blood pressure increases, although some people with primary hypertension have expanded plasma volumes. Plasma renin activity is usually normal but may be suppressed in some and elevated in others. The accelerated malignant phase of hypertension is usually accompanied by elevated plasma renin activity.

Systolic Hypertension

Systolic hypertension with normal diastolic pressure is not a discrete entity. This conditions often result of increased cardiac output or stroke volume, in the elderly (with normal or low cardiac output), systolic hypertension usually reflects inelasticity of the aorta and its major branches.

Symptoms and Signs

Primary hypertension is asymptomatic until complications develop. Hypertension symptoms and signs are nonspecific and arise from complications in target organ. Non complication hypertension may cause dizziness, flushed facies, headache, fatigue, epistaxis and nervousness. Hypertension with complications include left ventricular failure, atherosclerotic heart disease, retinal hemorrhages, and vascular accidents.

What is Myxedema

2011-10-22T02:17:00.006-07:00

Myxedema also known as Myxoedema is the characteristic reaction to thyroid hormone deficiency in the adult. it may result form radioiodine therapy, surgical excision, or primary atrophy or the thyroid or may develop secondary to hypofunction of the anterior pituitary or the hypothalamus.

Myxedema Symptoms and Signs

There is a gradual change in patients personality, coupled with the characteristic myxedematous facies, large tongue, slow and deep toned speech, thickened edomatous skin, puffiness of the hands and face, especially about the eyelids, drowsiness. In several cases, depressive psychosis or dementia may be stimulated. In prepuberal cases, menarche may be delayed, after puberty, menorrhagia is a frequent symptom. Deafness is observed occasionally. Cardiac enlargement and abnormal heart sounds may represent pericardial myxedema. The deep tendon reflexes oftern have a slow relaxation phase. The laggard achilles tendon reflex may be helpful in diagnosis.

Myxedema Diagnosis

The puffy facies is sometimes mistaken for the facial edema of acute nephritis Menorrhagia and anemia may lead to a false diagnosis of uterine tumor. serum T4, T3 resin uptak and thyroidal radioactive iodine uptake are low, while serum TSH is elevated. Serum cholesterol, carotene and total protein in blood and CSF are often elevated.

Myxedema Treatment

Recovery following administration of thyroid hormon is usually excelent, but therapy must be continued for life. In older patients with heart disease, the level of any thyroid hormon should be increased very slowly. In panhypopituitarism, Thyroid hormone therapy should be started after adrenocortical replacement therapy has begun.

What Causes Myxedema

Exophthalmos in particular results from TSH receptor stimulation on fibroblasts behind the eyes which leads to increased glycosaminoglycan deposition. It is thought that many cells responsible for forming connective tissue react to increases in TSH levels.
Secondarily, in autoimmune thyroid diseases lymphocytes react to the TSH receptor. Thus, in addition to the inflammation within the thyroid, any cell that expresses the TSH receptor will likely experience lymphocytic infiltrates as well. The inflammation can cause tissue damage and scar tissue formation, explaining the deposition of glycosaminoglycans.

The increased deposition of glycosaminoglycans causes an osmotic edema and fluid collection. Hashimoto's thyroiditis is the most common cause of myxedema in the United States.

Orthostatic Hypotension Definition and Symptoms

2011-10-21T19:44:00.004-07:00

This condition is not a disease entity itself, but a manisfestation in normal Blood Pressure regulation. The definition of Orthostatic Hypotension is an excessive fall in blood preassure on assuming the erect position. On arising to the erect position there is normally considerable pooling of blood in the dependent venous capacitance vessels. The subsequent transient decrease in venous return and cardiac output results in a reduction of blood pressure, which sensed by the baroreceptor mechanisms of the aortic and carotid sinus area. Autonomic reflexes result in rapid restoration of systolic blood pressure to normal, a slight overshoot in diastolic, pressure, and tachycardia.

These changes are primarily mediated through increased sympathetic discharge resulting in augmented vasomotor tone of the capacitance veins and an increase in myocardial rate and contractile force to enhance cardiac output. Peripheral arterial tone is also increased by similar mechanisms.

Orthostatic Hypotension Etiology

The most common cause of symptomatic orthostatic hypotension is the cause of drugs that impair autonomic reflexes. Vasodilator therapy for hypertension usually is not associated with a greater blood pressure reduction in the standing position since autonomic reflexes remain intact, and the use of diuretics is associated with significant orthostatic hypotension only drugs (phentolamine and phenoxybenzamine, indicated only for hypertension due to pheochromocytoma, may also produce orthostatic hypotension.

Several groups of drugs used in nervous and mental disorders reduce blood pressure in the standing position as an important side effect. Monoamine oxidase inhibitors that used in depression may also reduce blood pressure with symptoms of orthostatic hypotension. Less commonly the tricyclic antidepressants may reduce blood pressure in standing position, additional drugs that may occasionally cause orthostatic hypotension include barbiturates and alcohol.

Acute or semi-acute severe reduction in intravascular volume may result in moderate to severe orthostatic hypotension due to the decrease in cardiac output despite intact autonomic reflexes. Acute hemorrhage, severe vomiting, diarrhea, excessive use of diuretics all may lead to marked volume contraction, dehydration, and orthostatic hypotension unless there is adequate fluid and electrolyte replacement.Similarly, adrenocortical insufficiency may lead to hypovolemic orthostatic hypotension in the absence of adequate salt intake.

Neuropathic disorders may interrupt the sympathetic reflex arc at one of several sites with consequent impairment of the normal adrenergic responses to standing. Diseases commonly associated with orthostatic hypotension are diabetes mellitus, porphyria, tabes dorsalis, pernicious anemia, uremia, and parkinson's syndrome. Surgical sympathectomy in the treatment of severe hypertension, vasospastic disorders, or peripheral vascular insufficiency also reduce in reduction of blood pressure in the standing position.

Symptoms

Mild to moderate acute reductions in cerebral blood flow may resut in a feeling of faint less, lightheadedness, and mental or visual blurring, and more severe reductions produce sudden syncope and even generalized seizures. Many other phenomena may appear as a symptoms in orthostatic hypotension. The orthostatic hypotension symptoms usually relate to specific disorder causing the condition. The diagnosis is made on the basis of symptoms suggestive of hypotension and the demonstration of marked reduction in blood pressure in the standing position. A specific etiologic diagnosis based upon each patient's presenting circumstances.

Renovascular Hypertension

2011-10-21T00:59:00.002-07:00

What is renovascular hypertension? its an acute or chronic elevation of systemic blood pressure caused by partial or complete occlusion of one or more renal arteries or their branches.

Etiology and Pathophysiology of Renovascular Hypertension

Renovascular hypertension is the clinical consequence of renin angiotensin aldosterone (RAA) activation. Stenosis or occlusion of one or both main renal arteries or their branches or an accesory renal artery or its branches can cause hypertension by inciting the release of the enzyme renin from the juxtaglomerular cells of the affected kidney. Presumably, the decrease in pulse amplitude rather than the decrease in blood flow stimulates renin secretion. The area of the lumen must be decreased by at least 65% before the occlusion is hemodynamically significant. In patients over 50 years old and usually men, the most frequent cause of renal arterial stenosis is atherosclerosis. In younger patients (usually women), it is one of the fibrous dysplasis. Rarer cause of renal arterial stenosis or obstruction include emboli, trauma, inadvertent ligation during surgery, and extrinsic compression of the renal pedicle by tumors.

Renovascular Hypertension symptoms and Diagnosis

Renovascular hypertension should be suspected when hypertension first develops in patient under 30 or over 50 year of age or whenever previously stable hypertension abruptly accelerates. Rapid progression to malignant hypertension within 6 month of onset is suggestive of renal artery disease.

An epigastric bruit transmitted to one or both upper quadrants is the most important physical symptoms and is especially significant if there is a diastolic component. About 50 percents of patient with renovascular hypertension, however, do not have bruits. Trauma to the back or flank or acute pain in this region with or without hematuria should alert the patient to possibility of renovascular hypertension, but this historic features are rare. Renovascular hypertension is characterized by both high cardic output and high peripheral resistance. Both renovascular and primary hypertension are usually asymptomatic, and only difference in history.

Renovascular Hypertension Epidemiology

Mortality. Patients with hypertension, the atherosclerotic renal artery disease is would increased mortality relative to the general population. Renovascular Hypertension in the setting of renal dysfunction is associated cause the greatest mortality.
Race, in particular, Renovascular Hypertension are less common among the black than the white population.
Sex, Renovascular Hypertension is most common in younger women and older men.
Age, The onset of Renovascular Hypertension tends to occur in patients under 30 years or over 50 years of age.

Neurologic Defects

2011-10-19T10:01:00.000-07:00

of the many neurologic defects that can occur in the development of the nervous system, some of the most serious such as anencephaly, enchephalocele, and spinabifida, take place in the first two of gestation and represent defects in neural tube formation (dysraphia). Others, such as hydranencephaly and porencephaly, occur later and appear to be secondary to destructive processes of the brain after it has formed. Some defects are relatively benign.

Reasonably accurate in utero detection of many CNS malformations is now possible. Genetic counseling for parents with major neurologic abnormality is important, since the risk of subsequent child having such a defect is high. These parents also need psychologic help and support.

Anenchephaly is absence of the cerebral hemispheres. The absent brain is sometimes replaced with malformed cystic neural tissue which may either be exposed or covered with skin. Varying portions of the brainstem and spinal cord may be missing or malformed.
Encephalocele is a prostrusion of brain or heterotopic nervous tissue along with meninges through a skull defect, is associated with incomplete closure of the cranial vault or cranium bifidum. Enchephalocele usually occurs in the midline and is nasal or occipital but can be asymmetrically frontal or parietal. Small encephaloceles may resemble cephalhematomas. Most encephaloceles should be repaired, since even large ones may contain only heterotropic nerve tissue which can be removed without any residual functional disability. When the defect is associated with other serious malformations, the decision to repair may be more difficult. The hydrocephalus often associated with encephalocele requires definition by ventriculography.
Porencephaly is cerebral cysts or cavities involving cortical tissue, which usually penetrate the white matter and communicate with a ventricle, may occur prenatally or postnatal. The Porencephaly may be caused by a developmental anomaly or ischemia and resulting infarction. The ischemia may be due to birth trauma or vascular thromboses. Usually, the neurologic examination is abnormal and the transillumination
Hydranencephaly is an extreme form of porencephaly in which the cerebral hemispheres are almost totally absent. Usually, the cerebellum and brainstem are formed normally and the basal ganglia are intact. The meninges , bones, and skin over the cranial vault are normal. Neurologic examination in the newborn period may be normal or abnormal, but the infant fails to develop normally. Externally, the head appears to be normal. When it is transilluminated, however light shines completely through it.
Dandy-walker cysts are developmental malformations in which the outlets of the 4th ventricle do not open and the 4th ventricle itself becomes cystic.

Tips For Newborn Baby Care

2011-09-18T02:14:00.000-07:00

Every parent must delighted when their new baby born, especially for mom. What to do well when you have a newborn baby:
•   Prevention of disease through routine immunization and parent education (nutrition, accident prevention, and sanitation)
•   Early detection of disease through physical examination and screening procedures
•   Treatment of disease in its early course
•   Provision of guidance in child rearing to afford optimal conditions for normal emotional and intellectual development.
To meet these objectives, child and mother are seen at regular intervals throughout the early years of life. The frequency of these visits and their content of education are determined by the age of the child and the physician’s opinion of their value.
Inquires as to the infants intellectual and psychosocial development should considered an aspect of preventive health care. Baby mental development can be estimated using the Denver Developmental Screening Test or known as Denver Scale (The scale reflects what percentage of a certain age child is able to perform a certain task). Routine test should be started at age 4 or 6 month and can be repeated into early childhood.
Assessing the parents perception of their child and the interactions between parents and infant cannot be accomplished easily by any convenient, standardized method. Nonetheless, the physician should attempt to determine the parents feeling and attitudes toward their child. This should be begin with the first contact in the hospital, when the parents and the physician can discuss the vicissitudes of raising children. Parental attitudes may be identified tactfully by determining how the parents feel they are being affected by caring for a new baby, how they handle difficult situations, or how easily they can obtain help when feeling tired or short-tempered. In establishing good parent-child interactions, the physician is performing an ongoing, integral responsibility which requires individualized attention.

Newborn Baby Tests
Screening of newbaby is important for identifying a number of physical anomalies and diseases. A complete physical should be performed and the family history of each parent and the mothers pregnancy history should be reviewed. Screening for baby metabolic and hematologic disorders should also be undertaken especially for the following conditions.

Metabolic Disease: at the time of hospital discharge , the newborn baby should have capillary blood specimens taken In order to screen for a number of diseases.

Anemia: blood loss during birth process or in the neonatal observation period may cause anemia. Determining the Hct or Hb level at the time of discharge provides a baseline value for tests taken later in infancy.

Hearing: profound hearing loss may be suspected by parents if their infant does not respond to ordinary household sounds. Parents observations, particularly if corroborated by the physician, are as good as or better than any presently available mechanical hearing test. The infants response to sharp noises made at his side or from behind gives some indication of auditory acuity in the 8 to 12 month old infant.

Vision: the parents observations are of great importance. By age 6 week, the infant should begin to follow the parent with his eyes. Strabismus which persists after age 6 month may cause loss of visual acuity and an ophthalmologist should be consulted.

Renal Structure and Function

2011-09-12T20:04:00.000-07:00

The kidneys control the volume, composition and pressure of body fluids by regulating the excreation of water and solutes. Kidneys also influence red cell production and blood pressure by hormonal mechanisms. Urine is formed in the kidneys as an aqueous solution containing metabolic waste products, foreign substances and water soluble constituents of the body in quantities depending upon homeostatic needs. The kidneys are bilateral, retroperitoneal structures, each consisting of an outer cortex and an inner medulla. The medulla is arranged into several cone-shaped or pyramidal projections separated from each other by sections of cortex called renal columns and the cortex contains glomeruli and tubules.

The kidneys possess numerous blood vessels and because of their low vascular resistance receive approximately 1200ml of blood or 25% of cardiac output each minute. The major resistance to blood flow occurs in the glomerular capillary bed and is produced by a relatively high resistance in the efferent arterioles.

The basic functional unit of the kidney is the neprhon, a long tubular structure made up of successive segments of diverse structure and transport functions. It includes renal corpuscle, proximal tubule, hairpin loop, distal tubule, and a collecting duct system. There are approximately one million nephrons in each human kidney.

The glomerulus acts as an ultrafilter, allowing passage of water, electrilytes, and small organic molecules such as glucose, but not blood cells and large protein melecules. The ultrafilter produced by the glomeruli of both kidneys amounts to about 70 ml/min/sq m or 150 L/day/sq m. A principal function of the kidney is to remove various solutes from the blood which are not essential to the body, and to conserve those that the body requires. A solute is never totally removed from the blood in any one passage through the kidneys.

Tubular Function

Transport or movement of solutes and water across tubular cells is one of the principal activities of the renal tubules. Transport is termed resorption when it proceeds from the tubular lumen to the interstitial fluid and secretion when it proceeds in the reverse direction. Many solutes are transported in both directions simultaneously, but one direction usually dominates and the resultant is termed.

Granular cells of juxtaglomerular apparatus secret renin in response to; low [Na+] in plasma, low e.c.f. volume or low BP (all stimuli that require aldosterone to plasma volume). Note renin is stored as prorenin). Renin acts enzymically, activating angiotensinogen (plasma protein produced by liver, present in [high]) into angiotensin I (AT I), a 10 amino acid polypeptide with no known physiological function. ACE is present mainly on pulmonary vasculature (also renal). As AT I passes these sites it is converted by ACE ® angiotensin II (8 amino acid polypeptide). If [K+] is high, levels of AT II (\ aldosterone \ Na+/K+ exchange in late DCT \ lose excess K+ ). AT 2 has several important functions related to the low fluid level;

Vasoconstrictor, affected Blood Preassure
Dipsogenic stimulus (makes you thirsty, \ fluid volume).
The 1o stimulus for aldosterone release by adrenal cortex. Leads to Na+ reabsorption in exchange for K+ in DCT. Aldosterone increases the number of Na+ pumps (by gene expression) in the membrane hence Na+ reabsorption, and K+ (or H+) secretion into the tubule. Atrial natriuretic peptide is released in response to high BP, [NaCl] or e.c.f. volume; it increases Na+ loss & \ water loss & inhibits RAA system.

Describe the factors influencing the Renal Artery Aneurysm (RAA) system. Comprehend the renal baroreceptor & macula densa mechanisms for renin release, the influence of renal nerve activity, catecholamines, Angiotensin II & ADH; the action of K+ & ACTH on aldosterone release. Describe the actions of the RAA system. Be aware of the influence of renin on the generation of angiotensin I, & all the subsequent events including renal Na+ & K+ handling & fluid intake.

Pharmacological Treatment for Alzheimer's Disease

2011-06-06T18:10:00.000-07:00

Neuroleptic

Antipsychotic medications are prescribed frequently for patients with Alzheimer's disease to reduce behavioural disturbance. Many neuroleptics possess anticholinergic activity and it is probable that this accelerates cognitive impairment. Elderly patients are particularly susceptible to the adverse consequences of neuroleptics and those with lewly body dementia even more so. In practice antipsychotic medication is an essential component of a management strategy to control otherwise intractable behavioural disturbance but should be used cautiosly, start low, increase slowly.

Antidepressants

Depression in dementia is treatable, although assessment of response is difficult. Older tricyclic antidepressants possess significant anticholinergic action and their theoretical effects on cognitive decline (predicted to hasten) and poor tolerability in the elderly. Relatively few trials of antidepressants in dementia have been conducted.

Sleep Hygiene

Sleep can be disturbed by many factors, including physical causes such as musculoskeletal pain and nocturia, and psychological causes such as depression and anxiety, in additon to the change in sleep/wake cycle that is intrinsic to many cases of Alzheimer's disease. Before considering pharmacological treatments a thorough search should be made for the causes of sleep loss. Behavioural approaches to treatment include sleep hygiene management which addresses:

Time of sleep, A routine appropriate to age should be followed. Six hours of sleep is more than enough for most elderly people and the patient should be encouraged to retire at an appropriate time and expect to wake 6 hours later.
Daytime sleeping should be avoided
Place of sleep. Bedrooms should be quiet, dark and for sleep only. Not for napping during the day, watching TV or eating meals.

Symptoms of Alzheimer's Disease

2011-05-27T17:30:00.001-07:00

When considering the clinical phenomenology of Alzheimer's Disease (AD), it is useful to distinguish between symptoms, syndromes and diseases. The patient presents with symptoms and it is the clinician's task to describe the syndrome in the first instance and then, with appropriate futher investigations, make a disease specific diagnosis. In the dementia field, symptoms, syndromes and diagnoses are sometimes used interchangeably and this adversely affect patient management, especially now that described below occur in different syndromes including the demetia syndrome, delirium and simple amnesia.

Amnesia

Amnesia or memory loss, is invariable and is often the most prominent symptom and one of the earliest. Amnesia is most pronounced for recent events, resulting in the available memories being predominantly distant or remote. It is not clear why remote memories are relatively resistant to deterioration, or possibly recent memories fail because of storage impairment. In the practice, a patient will often recall precise details of childhood or early adulthood and be unable to recall events of the last day.

The earliest signs of memory impairment overlap with normal phenomena and often are recognised only in retrospect. Forgetting the names of recently introduced people, missing the odd appointment and mislaying items are all common to the human experience. However, with incipient AD these phenomena become more pervasive dan more severe.

Language Disorders

Difficulties with speech are common in AD but predominate in the some other dementias, especially the fronto-temproral dementias where relatively early mutism can occur. In AD the symptoms is more often word finding difficulty. These can be assessed by asking the patient to name simple objects and is used in some screening istruments. for example the MMSE which requires the patient to name a pen and a watch. More detailed word finding ability can be tested by asking the patient to name items of clothing and then parts of clothing, for example collar, lapel, sleeve.

Dyspraxia

Difficulties with complex tasks are one of the major determinants of long term care of patients with AD. Difficulties with preparing food, dressing and other such activities of daily living should be assessed carefully both by direct observation and by informant interview. The earliest signs of dyspraxia include subtle changes in dress - the normally immaculately turned out patient appearing somewhat more dishevelled. As the disorder progresses the patient needs prompting and the help to dress.

Depression

Detecting and treating depression in alzheimer disease (AD) is difficult but by no means impossible. Symptoms of depression are common and probably frequent in the early stages but are less often detected in the later stages. Studies of mood in dementia reflect the difficulty of determining when symptoms of depression amount to a depression syndrome: some studies have found rate as low as 25% in patients with AD whilst others have reported rates as AD is not refactory to treatment. However a particular problem arises as many of the older antidepressants exhibit significant anticholinergic activity.

Psychotic Symptoms

Mistaken beliefs are common in AD and these frequently amount to frank delusions. Prevalence rates between 10% and 30% have been reported in different studies. Most frequently encountered in clinical practice are simple delusions of a persecutory nature, often of theft. Patients will believe they have had something stolen and often identify specific persons as the culprits. If the identified person is a relative or carer this can have serious consequences for the provision of good quality care.

Hallucinations are even more difficult to assess because of difficulties in interpreting the experiences of patients with dementia. Visual Hallucinations have a special importance because they constitute one part of the triad of symptoms associated with lewy body dementia.

Personailty and Behavioural Changes

In the earlier stages of the illness personality remains intact, although there may be accentuation of long-standing traits, the acquisiton of new characteristics or acute changes in behaviour. Behavioural disturbance per se is perhaps the most difficult symptoms for carers to cope with, and is often the reason for consulting clinicians at all stages of the illness. Abnormal behaviours do not have a direct relationship to severity and can be transient. The most usual behavioural trait, present from the very earliest stage, is a narrowing of interests and activities.

About Dyspnea - Definition, Pathophysiology and Types of Dyspnea

2011-05-27T16:43:00.000-07:00

Definition

Dyspnea is an upleasant subjective complaint involving the patient's perception of breathing difficulty or discomfort. Dyspnea :Breathlessness; shortness of breath; the sensation of difficult, labored, or uncomfortable breathing.

Pathophysiology

Dyspnea may refer to a single sensation caused by a single mechanism or to several sensations combined in the one term. The following are probably different sensations:

The profound hyperpnea that occurs during and after severe exercise.
The sensation arising from bronchial or bronchiolar obstruction in patients with asthma and bronchitis.
The breathlessness that may occur with inappropriately slight exertion in patients with heart disease or severe anemia
The sensation that compels breathing after breath holding

The amount of ventilation and the sensation of dyspnea are influenced by the affect of arterial hypoxia on the carotid and aortic bodies and of CO2 on the respiratory centers in the medulla (visceral, neural and emotional stimuli may also involved). No single mechanism explains all instances of dyspnea, but some useful relationships have emerged. Dyspnea depends on the amount of ventilation required by the individual's physiologic state (resting, exercising, hypercapnic) and on the capacity of his lungs and thorax to deliver this ventilation efficiently. The amount of ventilation required may be less than 5 L/min at rest and more than 100 L/min after severe exercise, a trained athlete may be able to exceed 200 L/min.

Types of Dyspnea

Nocturnal Dyspnea, occurs only at night and may be paroxysmal as in patients with heart failure.
Orthopnea, occurs when a patient liesdown as in cases with heart failure, asthma and chronic obstructive disease of the lungs.
Trepopnea, breathlessness only in the left or right lateral lying position. This does not occur When a patient is In the supine position. This occurs in patients with heart disease.
Platypnea, occurs only in the upright position.

Assessment of dyspnea

The treatment of shortness of breath depends upon the cause, so there are some necessary tests. A chest X-ray to look for fluid, infection, tumor, or collapse of the lung will always be done. Often the blood is checked for anemia or infection. If the heart is suspected of being a contributing cause, an electrocardiogram may be done. Measuring the level of oxygen in the blood is a way of determining how effectively the lungs are working. This can be done simply by checking the oxygen saturation in the venous blood with a clothes-peg-like apparatus worn on the finger.

If an accurate measure of oxygen in the arterial blood is needed, (for example, if a blood clot in the lung, called pulmonary embolus, is suspected) then a sample of blood is taken from the artery in the wrist. If the cause of the dyspnea is not obvious from these tests, breathing assessment tests, called pulmonary function tests, or special radioactive scans looking for blood clots in the lung may need to be done. If a collection of fluid between the lung and the ribcage (pleural effusion) is seen, a sample of the fluid may be useful in looking for the reason why the fluid has collected. In palliative care, where the common causes of shortness of breath are tumors in the lung, infection, collections of fluid secondary to tumors, or chronic lung or heart damage, the cause of the shortness of breath is often known and exhaustive tests are not necessary.