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Marketing strategy | Understanding and definition of the Marketing strategy

noreply@blogger.com (Unknown) — Sat, 05 Nov 2016 11:34:00 +0000

Marketing strategy is a process that can allow an organization to concentrate its limited resources on the greatest opportunities to increase sales and achieve a sustainable competitive advantage.

Marketing strategies serve as the fundamental underpinning of marketing plans designed to fill market needs and reach marketing objectives. Plans and objectives are generally tested for measurable results. Commonly, marketing strategies are developed as multi-year plans, with a tactical plan detailing specific actions to be accomplished in the current year. Time horizons covered by the marketing plan vary by company, by industry, and by nation, however, time horizons are becoming shorter as the speed of change in the environment increases. Marketing strategies are dynamic and interactive. They are partially planned and partially unplanned. See strategy dynamics.

Marketing strategy involves careful scanning of the internal and external environments which are summarized in a SWOT analysis. Internal environmental factors include the marketing mix, plus performance analysis and strategic constraints. External environmental factors include customer analysis, competitor analysis, target market analysis, as well as evaluation of any elements of the technological, economic, cultural or political/legal environment likely to impact success. A key component of marketing strategy is often to keep marketing in line with a company's overarching mission statement. Besides SWOT analysis, portfolio analyses such as the GE/McKinsey matrix or COPE analysis can be performed to determine the strategic focus.

Once a thorough environmental scan is complete, a strategic plan can be constructed to identify business alternatives, establish challenging goals, determine the optimal marketing mix to attain these goals, and detail implementation. A final step in developing a marketing strategy is to create a plan to monitor progress and a set of contingencies if problems arise in the implementation of the plan.

Marketing strategies may differ depending on the unique situation of the individual business. However there are a number of ways of categorizing some generic strategies. A brief description of the most common categorizing schemes is presented below:

* Strategies based on market dominance - In this scheme, firms are classified based on their market share or dominance of an industry. Typically there are four types of market dominance strategies:

Leader
Challenger
Follower
Nicher

* Porter generic strategies - strategy on the dimensions of strategic scope and strategic strength. Strategic scope refers to the market penetration while strategic strength refers to the firm’s sustainable competitive advantage. The generic strategy framework (porter 1984) comprises two alternatives each with two alternative scopes. These are Differentiation and low-cost leadership each with a dimension of Focus-broad or narrow.

Product differentiation (broad)
Cost leadership (broad)
Market segmentation (narrow)

* Innovation strategies - This deals with the firm's rate of the new product development and business model innovation. It asks whether the company is on the cutting edge of technology and business innovation. There are three types:

Pioneers
Close followers
Late followers

* Growth strategies - In this scheme we ask the question, “How should the firm grow?”. There are a number of different ways of answering that question, but the most common gives four answers:

Horizontal integration
Vertical integration
Diversification
Intensification

A more detailed scheme uses the categories:

Prospector
Analyzer
Defender
Reactor
Marketing warfare strategies - This scheme draws parallels between marketing strategies and military strategies.

Marketing participants often employ strategic models and tools to analyze marketing decisions. When beginning a strategic analysis, the 3Cs can be employed to get a broad understanding of the strategic environment. An Ansoff Matrix is also often used to convey an organization's strategic positioning of their marketing mix. The 4Ps can then be utilized to form a marketing plan to pursue a defined strategy.

There are many companies especially those in the Consumer Package Goods (CPG) market that adopt the theory of running their business centered around Consumer, Shopper & Retailer needs. Their Marketing departments spend quality time looking for "Growth Opportunities" in their categories by identifying relevant insights (both mindsets and behaviors) on their target Consumers, Shoppers and retail partners. These Growth Opportunities emerge from changes in market trends, segment dynamics changing and also internal brand or operational business challenges.The Marketing team can then prioritize these Growth Opportunities and begin to develop strategies to exploit the opportunities that could include new or adapted products, services as well as changes to the 7Ps.

Real-life marketing primarily revolves around the application of a great deal of common-sense; dealing with a limited number of factors, in an environment of imperfect information and limited resources complicated by uncertainty and tight timescales. Use of classical marketing techniques, in these circumstances, is inevitably partial and uneven.

Thus, for example, many new products will emerge from irrational processes and the rational development process may be used (if at all) to screen out the worst non-runners. The design of the advertising, and the packaging, will be the output of the creative minds employed; which management will then screen, often by 'gut-reaction', to ensure that it is reasonable.

For most of their time, marketing managers use intuition and experience to analyze and handle the complex, and unique, situations being faced; without easy reference to theory. This will often be 'flying by the seat of the pants', or 'gut-reaction'; where the overall strategy, coupled with the knowledge of the customer which has been absorbed almost by a process of osmosis, will determine the quality of the marketing employed. This, almost instinctive management, is what is sometimes called 'coarse marketing'; to distinguish it from the refined, aesthetically pleasing, form favored by the theorists.

Understanding and definition of autism

noreply@blogger.com (Unknown) — Fri, 04 Dec 2015 18:02:00 +0000

Autism is a developmental disorder of the nervous system to someone who is mostly caused by heredity and sometimes have been detected since the baby is 6 months old. Detection and treatment as early as possible will make the patient more able to adjust itself to normal. Sometimes therapy should be made for life, yet people are smart enough Autism, Autism after receiving treatment as early as possible, often able to follow the Public School, became a Bachelor and can work meets the required standards, but the understanding of colleagues during school and co-workers often needed, for example, did not answer or did not look at the eyes of the speaker, when spoken to. Characteristics that stand out to someone who suffer from this disorder is difficult to build social relationships, communicate normally and understand the emotions and feelings of others. Autism is a developmental disorder that is part of the Autism Spectrum Disorders or Autism Spectrum Disorders (ASD) and is also one of five types of disorders under the umbrella of Pervasive Development Disorder or Pervasive Development Disorder (PDD). Autism is not a mental illness because it is a disorder that occurs in the brain, causing the brain can not function properly normal brain and this is manifested in the behavior of people with autism. Autism is the heaviest in the PDD.

The symptoms of autism may appear in children starting from the age of thirty months from birth until the age of three years maximum. Patients with autism may also experience problems in learning, communication, and language. Someone said to suffer from autism when experiencing one or more of the following characteristics: difficulties in social interaction qualitatively, the difficulty in communicating qualitatively, show repetitive behaviors, and experience delayed development or abnormal.

Symptoms of AutismHistorically, experts and researchers in the field of autism have difficulty in determining a person as autistic or not. At first, the diagnosis was based on the presence or absence of symptoms, but now scientists agree that autism is more of a continuum. The symptoms of autism can be seen when a child has a particular weakness in three domains, namely social, communication, and repetitive behavior.Aarons and Gittents (1992) recommends for a descriptive approach in diagnosing autism that includes a thorough observations in social settings children themselves. Possible regular mode at school, in the playgrounds or perhaps at home as a child's daily environment where the constraints and difficulties of their apparent among their peers normal.Another problem affecting the accuracy of a diagnosis is often also arise from the fact that the problematic behaviors is an attribute of the lack of proper parenting. These behaviors may be a result of negative family dynamics and not as a symptom of the disorder. The existence of an incorrect interpretation of understanding of the causes why children show behavioral problems capable of causing negative feelings of the parents. The next question then is what can be done to diagnose more accurately and consistently so earnestly autism separately with conditions exacerbated? There needs to be a model of diagnosis which include the entire life of children and evaluate the obstacles and difficulties of children, as well as to the abilities and skills of children themselves. May be appropriate when then recommended that professionals in the field of autism also consider the whole area, for example: the early development of children, the appearance of children, child mobility, control and care of children, sensory functions, the ability to play, the development of basic concepts, capabilities that are sequence, musical ability, and so forth that becomes a whole own child.Children with autism may appear normal in the first year or the second year of his life. The parents are often aware of the delay in language skills and specific ways different when playing and interacting with other people. These children may be very sensitive or even unresponsive to stimuli from the five senses (hearing, touch, smell, taste and sight). Repetitive behaviors (flapping-flapping hands or fingers, shook and repeating words) can also be found. Behavior can be aggressive (either to themselves or others), or is very passive. It is probable, previous behaviors that are considered normal may be additional symptoms. Besides playing repetitive, limited interest and social barriers, some other things are also always attached to people with autism are the responses that are not fair to the sensory information they receive, for example; noises, light, surface or texture of a particular material and the choice of a particular taste in food becomes their favorite.Some or all of the following mentioned characteristics can be observed in persons with autism spectrum along well with the conditions of the lightest to the heaviest.

Barriers in communication, eg speak and understand the language.
Difficulties in dealing with other people or objects in the vicinity as well as linking the events that occurred.
Playing with toys or other objects improperly.
It is difficult to accept change in routine and environment that is recognizable.
Move your body or their repetitive patterns of behavior of certain

Persons with autism and their spectrum is very diverse both in capabilities, intelligence level, and even behavior. Some of them are not 'talk' while others may have limited language that often found repeating words or phrases (echolalia). Those who have high language skills generally use the themes are limited and difficult to understand abstract concepts. Thus, there is always the unique individuality of individuals disabling.Apart from the above characteristics, there are directives and guidelines for parents and practitioners to more waspasa and care for the symptoms are visible. The National Institute of Child Health and Human Development (NICHD) in the United States said five types of behavior that should be watched and the need for further evaluation:

Children are not muttering to 12 months
Children do not demonstrate the ability gestural (pointing, chest, grasping) until the age of 12 months
Children do not say a word until the age of 16 months
The child is not able to use two sentences spontaneously at the age of 24 months
Children lose the ability to speak and the social interaction of a certain age

Their fifth 'red light' in the above does not mean that the child bears the characteristics of autism but because of autism disorders is very diverse, the child must receive a multidisciplinary evaluation can include; Neurologists, psychologists, Pediatric, Speech Therapy, Paedagog and other professions that understand the problem of autism.Specialists are suitable for detecting Autism is a Pediatrician (Sp.A) assisted by Mental Specialist Doctors (Sp.KJ) to determine, among others, the level of intelligence Toddler, Ear Nose Throat Specialist Physician-Surgeon Head neck (Sp.THT- KL) to determine, among others, pendegaran Toddlers Its not / less responsive to noise or even can not speak and can be mistaken for people with autism, but notCauses of AutismUntil now, what causes a person can suffer from autism is not known with certainty. Research conducted by medical experts to produce several hypotheses about the causes of autism. Two things are believed to be the trigger for autism is genetic or hereditary factors and environmental factors such as the influence of chemical substances or vaccines.Factors AutismGenetic factors are believed to have a major role for persons with autism, although not fully believed that autism can only be caused by a gene from the family. Research conducted on autistic children showed that the probability of two identical twins have autism is 60 to 95 percent, while the possibility of two siblings with autism is just 2.5 to 8.5 percent. This is interpreted as a large role gene as a cause of autism because identical twins have the same genes that are 100% while the siblings only have genes that are 50% similar.There have been suggestions that autism is caused by the MMR vaccine routinely given to children in the age at which the symptoms of autism begin to be seen. This concern is due to a chemical called thimerosal that is used to preserve vaccines containing mercury. Elemental mercury is what is considered potentially cause autism in children. However, there is no strong evidence to support that autism is caused by vaccines. The use of thimerosal in vaccines preservation has been dismissed yet autism rates in children is increasing.Treatment of autismThe intensity of treatment behaviors in children with autism is important, but the fundamental problems encountered in Indonesia is crucial to overcome first. Without ignoring other factors, some facts which are relevant to the issue of handling the problem of autism in Indonesia include:

Lack of trained therapists in Indonesia. Parents have always been a pioneer in the process of intervention so that the centers initially intervention for children with autism is built based on the interests of the family to ensure the continuity of their own children's education.
The absence of formal instructions that treatment in Indonesia. Not enough to just implement the instructions teatment external application does not always fit with the culture of the lives of children in Indonesia.
There are still many cases of autism are not detected early so that when the child becomes greater the more complex the problems faced by the elderly intervention. Experts are able to diagnose autism, information about the disorder and the characteristics of autism as well as formal institutions that provide educational services for children with autism have not been spread evenly across all regions in Indonesia.
Not coherence providing education for children with autism in schools.
The final issue is no less important is the lack of knowledge, both clinically and practically supported by empirical data validity (empirically Validated Treatments / EVT) of countermeasures autism problems in Indonesia. Studies and research of autism in addition to requiring large funds should also be supported by empirical data validity, however ethically of course no parent who wants their child to be an experiment of a particular methodology. Certainty and security for the children's education is a major consideration for parents in choosing one type of treatment for their children so that if these doubts can be answered through scientific authorities it is increasingly open to the general public information about the knowledges both clinical and practical in the process of handling the problem of autism in Indonesia.

Autism therapySeveral types of traditional therapies and has been tested over time while other therapies may just appear. Unlike other developmental disorder, not many treatment instructions have been published much less standard procedure in dealing with autism. After all the experts agree that the therapy must be started early and should be directed to the obstacles and delays that are common to every child with autism, for example; communication and problem-persolan behavior. Comprehensive Treatment generally includes; Speech Therapy (Speech Therapy), occupational therapy (Occupational Therapy) and Applied Behavior Analysis (ABA) to change and modify behavior.Here is a simple description of the various existing literature and summaries were not thorough explanation of some of the treatments that are recognized today. It becomes imperative for parents to seek out and identify the chosen treatment directly to those professionals in their field. Most of these techniques are comprehensive programs, while others are tailored towards specific targets into the disabling barriers or difficulties.

Educational Treatment, include but are not limited to: applied behavior analysis (ABA) whose principles are used in research Lovaas so often equated with Discrete Trial Training or Intensive Behavioural Intervention.
The developmental approach that is associated with education, known as Floortime.
TEACCH (Treatment and Education of Autistic and Related Communication - Handicapped Children).
Biological Treatment, include but are not limited to: diet, vitamin and provision of drugs for reducing certain behaviors (aggressiveness, hyperactivity, self-mutilation, etc.).
Speech - Language Therapy (Speech Therapy), including but not limited to business interruption handling associations and auditory processing disorder / auditory.
Communication, improvement of communication capabilities, such as Pécs (Picture Exchange Communication System), sign language, visual strategy using pictures to communicate and supporters other communications.
Autism Intensive Care, covering the work team from different disciplines who provide intervention both at home, school or other social lngkungan.
Sensory Therapy nature, including but not limited to the Occupational Therapy (OT), and Auditory Integration Training (AIT).

With the various types of therapy that can be chosen by the parents, it is very important for them to choose one type of therapy that can improve the functionality of children and reduce interference as well as barriers to autism. It is unfortunate still minimal scientific data that can support various types of therapy that can be selected parents in Indonesia today. The fact that it is very difficult to make a study on autism. Very many variables owned subsidiary, of the severity of the disturbance to the surrounding environment and not to mention ethics in it to make a study it seriously controlled. Very unlikely to control all the variables that exist so that data generated from previous studies may be statistically inaccurate.No single type of therapy that works for all children. Therapy should be tailored to the needs of the child, based on its potential, its shortcomings and of course in accordance with the child's own interests. Therapy should be conducted multidisciplinary, for example using; occupational therapy, speech therapy and behavioral therapy as a base. Experts who work with children should be able to direct your options against various types of therapies that exist today. There is no guarantee whether the therapy chosen by the parents or the family will indeed be effective. However, specify one type of therapy and implemented consistently, if no visible change or a real advance for 3 months can make changes to therapy. Guidance and directives given by the parents must be implemented consistently. When seen significant progress during the three months then other forms of intervention could be added. Remain objective and ask the experts if there is other behavioral changes.

Causes and Prevention of Dengue Hemorrhagic Fever

noreply@blogger.com (Unknown) — Sun, 13 Sep 2015 20:29:00 +0000

Dengue fever or dengue fever (abbreviated DHF) is an infection caused by the dengue virus. Mosquitoes or some types of mosquitoes transmit (or spread) of dengue virus. Dengue fever is also known as "breakbone fever" or "Bonebreak fever" (fever joints), because it can cause fever sufferers experience severe pain as if their bones broken. Some symptoms of dengue fever are fever; headache; skin redness that looks like measles; and sore muscles and joints. In some patients, dengue fever can turn into one of two life-threatening forms. The first is dengue fever, which causes bleeding, leakage of blood vessels (the tube that carries blood), and low levels of blood platelets (which causes blood to clot). The second is renjat dengue syndrome, which causes dangerously low blood pressure.

There are four types of dengue virus. If a person has been infected with one type of virus, usually he becomes immune to the kind of lifetime. However, he only will be protected from the other three types of viruses in a short time. If then he was hit by one of three types of the virus, he might run into serious problems.

There is no vaccine that can prevent a person exposed to the dengue virus. There are a few precautions dengue fever. People can protect themselves from mosquitoes and minimize the number of mosquito bites. Scientists also advocated to reduce mosquito habitat and reduce the number of mosquitoes that exist. If a person is exposed to dengue fever, usually he can recover only by drinking plenty of fluids, as long as the disease is mild or severe. If someone is having a more severe case, he may require intravenous fluid (the fluid that is inserted through a vein, using a needle and pipe infusion), or blood transfusion (given blood from another person).

Since the 1960s, more and more people are exposed to dengue fever. The disease started to cause problems all over the world since the Second World War. The disease is prevalent in more than 110 countries. Each year, approximately 50-100 million people exposed to dengue fever.

Experts are developing drugs to deal with the virus directly. The community did a lot of effort to eradicate mosquitoes.

The first description of a dengue fever was written in 1779. In the early 20th century, scientists learned that the disease caused by the dengue virus, and that the virus is transmitted (or spread) by mosquitoes.

Signs and symptoms

Approximately 80% of patients (or 8 out of 10 patients) were infected with dengue virus have no symptoms, or only mild symptoms (such as the common cold). Approximately 5% of infected people (or 5 out of 100) will experience severe infections. The disease is life-threatening and even fewer of them. In a minority of these patients, the disease is life-threatening. Symptoms will appear between 3 and 14 days after a person is exposed to dengue virus. Often the symptoms appear after 4 to 7 days. Therefore, if someone had just returned from a region that has a lot of cases of dengue, then he has a fever or other symptoms more than 14 days after he returned from the region, the possibility of the disease not dengue.

Often, when children affected by dengue fever, symptoms similar to the symptoms of a cold or gastroenteritis (or stomach flu; for example, vomiting and diarrhea). However, children may experience severe problems due to dengue fever.

Classic symptoms of dengue fever is a fever that occurs suddenly; headache (usually on the back of the eye); rash; muscle aches and joint pain. The nickname "fever joints" for this disease illustrates how the resulting pain can be very severe. Dengue fever occurs in three phases: febrile, critical and recovery.

In the febrile phase, a person usually has a high fever. ("Fever" means that a person has a fever.) Heat the body often reaches 40 degrees Celsius (104 degrees Fahrenheit). Patients also typically suffer from a common illness or headache. Febrile phase usually lasts 2 to 7 days. In this phase, approximately 50 to 80% of patients with symptoms of rash. On the first day or two, it will look like a skin rash that is exposed to hot (red). Subsequently (on day 4 to day 7), the rash will look like measles. Small red spots (petechiae) may appear on the skin. These spots are not lost when the skin is pressed. These spots are caused by broken capillaries. Patients may also experience mild bleeding of mucous membranes of the mouth and nose. Fever itself is likely to be stopped (recovered) and then again for one or two days. However, this pattern varies in each patient.

In some patients, the disease progresses to a critical phase after the fever subsides. The critical phase usually lasts for up to 2 days. During this phase, fluid can accumulate in the chest and abdomen. This happens because the small blood vessels leak. The liquid will be more and more, then stopped circulating fluid in the body. This means that the vital organs (most important) did not get the blood supply as much as usual. Therefore, these organs are not working normally. Patients with the disease may also experience severe bleeding (usually from the gastrointestinal tract.)

Less than 5% of people with experience renjat circulatory dengue, dengue renjat syndrome, and dengue fever. If someone has suffered other types of dengue ("secondary infection"), it is likely they will have serious problems.

In the healing phase, the liquid that comes out of the blood vessel was taken back into the bloodstream. Healing phase usually lasts for 2 to 3 days. Patients usually recover at this stage further. However, they may suffer severe itching and weak heartbeat. During this phase, patients may experience fluid overload conditions (ie, too much fluid is taken back). If the brain is exposed, the liquid can cause seizures or changes in level of consciousness (ie, someone whose mind, consciousness, and behavior is not as usual).

Cause

Dengue fever is caused by the dengue virus. In a scientific system of naming and classifying virus, dengue virus is part of the family Flaviviridae and genus flavivirus. Other viruses are also part of the same family and cause disease in humans. For example, yellow fever virus, West Nile virus, St. Louis encephalitis virus, Japanese encephalitis virus, tick-borne encephalitis virus, Kyasanur forest disease virus, and Omsk hemorrhagic fever viruses all belong to the familyFlaviviridae. Most of Reviews These viruses are spread by mosquitoes or ticks.

Dengue virus is transmitted (or spread) largely by Aedes mosquitoes, particularly Aedes aegypti mosquito types. These mosquitoes usually live between the latitudes of 35 ° North and 35 ° South, below the altitude of 1000 m. The mosquitoes are more likely to bite during the day. One bite can infect humans.

Sometimes, also contracted dengue mosquitoes from humans. If the female mosquito bites an infected person, the mosquito can be infected with the virus. At first live virus in cells towards the digestive tract of mosquitoes. Approximately 8 to 10 the next day, the virus spreads to the mosquito salivary glands, which produce saliva (or "spit"). This means that the saliva produced by these mosquitoes infected with dengue virus. Therefore, when a mosquito bites a human, the infected saliva into the human body and infect the person. The virus does not seem to cause problems on infected mosquitoes, which will continue throughout his life infected. Mosquito Aedes aegypti is the most widely spread dengue. This is because mosquitoes are like living close to humans and feed on humans instead of animals. This mosquito also like to lay their eggs in water containers that were made by humans.

Dengue may also be transmitted through blood products that have been infected and through organ donation. If a person with dengue donate blood or organs, which are then given to another person, that person may be exposed to dengue from blood or organs that are donated. In some countries, such as Singapore, dengue is common. In these countries, between 1.6 and 6 out of every 10,000 blood transfusions transmit dengue. Dengue virus can also be transmitted from mother to child during pregnancy or when the child was born. Dengue is usually not transmitted in other ways.

Compared with adults, infants and young children suffering from dengue more at risk of serious infection. Children tend to be at risk of severe illness if they are classified as children-nourished (if they are healthy and eat nutritious food). (This is different from many other infections, which are usually more severe in children who belonged to malnutrition, unhealthy, or not eating nutritious foods.) Women are more likely attacked more severe pain than men. Dengue can be life-threatening in patients with chronic (long-term), such as diabetes and asthma.

There are two vaccines that have been approved as a vaccine to prevent human to avoid dengue virus. To prevent infection, the World Health Organization (WHO) recommends controlling mosquito populations and protect people from mosquito bites.

WHO recommends a program to prevent dengue (called the program "Integrated Vector Control") that includes five different sections:

Advocacy, mobilize communities, and legislation (laws) should be used so that public health organizations and communities become stronger.

All sections of society must work together. This includes the public sector (such as government), private sector (such as bisnisperusahaan), and the health care field.

All the way to control the disease must be must be integrated (or collected), so that available resources can deliver the greatest results.

Decisions must be based on evidence. It will help ensure that interventions (actions taken to tackle dengue) is useful.

The area where dengue problem should be given assistance, so that they can improve their ability to respond with either disease with their own efforts.

WHO also recommends some specific measures to control and prevent mosquito bites. The best way to control mosquito "Aedes aegypti" is to get rid of their habitat. Society must empty the water container is open (so that mosquitoes can not lay eggs in the open containers). Insecticides or biological control agents can also be used to control mosquitoes in these areas. Scientists found organophosphate or pyrethroid insecticide spraying is not helpful. Water silent (no flow) must be discarded because the water attracts mosquitoes, and also because people may be exposed to health problems if insecticide pooled in the water silently. To prevent mosquito bites, people can wear clothes that cover their skin completely. They can also use mosquito repellent (such as mosquito sprays), which helps keep mosquitoes. (DEET most potent.) People can also use mosquito nets at rest.

Scientists continue to conduct research for the prevention and treatment of dengue way. People are also trying to control mosquitoes, making the vaccine, and making drugs to combat the virus.

Many simple things have been done to control mosquitoes. Some of them have been successful. For example, guppies (Poecilia reticulata) or copepod can be placed in standing water to eat the larvae (eggs) mosquitoes.

Scientists are attempting to create a vaccine to protect humans from the four types of dengue. Some scientists worry that the vaccine may increase the risk of disease severity through antibody-dependent enhancement (ADE). The best vaccine that can be used usually has several different qualities. First, the vaccine is safe. Second, the vaccine will work after one or two injections (or injections). Third, the vaccine will melawa all types of dengue virus. Fourth, the vaccine will not cause ADE. Fifth, the vaccine will be easy to move (move) and stored (stored until needed. Sixth, low cost and effective vaccine (based on costs). Several vaccines have been tested in 2009. The scientists hope that the first vaccine (or vaccine) will be available commercially (can be purchased) in 2015.

Scientists also continue to work to make antiviral drugs to treat attacks of dengue fever and prevent humans are not exposed to severe complications. They are also trying to figure out how viral proteins are arranged. It might help them to make drugs that work effectively treat dengue.

Causes and prevention of breast cancer

noreply@blogger.com (Unknown) — Sun, 13 Sep 2015 20:27:00 +0000

Breast cancer is cancer of the tissue payudara.Ini is the most common type of cancer suffered by women. Men also can develop breast cancer, although less likely than 1 in 1000. The most common treatment is surgery and if necessary followed by chemotherapy and radiation.

Cancer is a condition where cells have lost control and the normal mechanism, so that the growth of abnormal, rapid and uncontrolled.

In addition, breast cancer (mammary carcinoma) is defined as a disease of malignant neoplasm derived from the parenchyma. This disease by the World Health Organization (WHO) included in the International Classification of Diseases (ICD)

Cancer cells formed from normal cells in a complex process called transformation, which consists of initiation and promotion stages.

At the initiation stage there is a change in the genetic material of cells that provoke the cells become malignant. Changes in the genetic material of these cells is caused by an agent called carcinogens, which can include chemicals, viruses, radiation (radiation) or sunlight. But not all cells have the same sensitivity to a carcinogen. Genetic abnormalities in cells or other materials, called a promoter, causing the cells more susceptible to a carcinogen. Even physical disorder menahunpun can make cells more sensitive to experience a malignancy.

Progesterone, a hormone that induces side-branching ductal breast glands and lobualveologenesis in breast epithelial cells, is expected to act as an activator trajectory tumorigenesis in breast cells induced by carcinogens. Progestin will induce the transcription of cell cycle regulator cyclin D1 for a secreted form of epithelial cells. Secretion can be improved about 5 to 7-fold with stimulation of estrogen, therefore estrogen is the hormone progesterone activates the expression of perceiving the epithelial cells. In addition, calcitonin secretion of progesterone also induces luminal cells and gland morphogenesis.

In the promotion phase, a cell that has undergone initiation will become malignant. Cells that have not passed the stage of initiation will not be affected by the promotion. Because it takes several factors for the occurrence of malignancies (a combination of cells that are sensitive and a carcinogen).

Usually a painless lump in the breast. The first bump is small, the longer it will be even greater, then attached to the skin or cause a change in the breast skin or nipple.

Skin or nipple had become interested in (retraction), pink or brownish to be edema until the skin looks like orange peel (peau d'orange), shrink, or arising ulcers (ulcers) in the breast. Ulcers that the longer the greater and deeper so that it can destroy the entire breast, often fetid, and bleed easily. Other characteristics include:

Bleeding on the nipple.

Pain or pain in general only emerged when the tumor is already large, has raised ulcers, or if it appears metastases to the bones.

Then comes the enlarged lymph nodes in the armpit, swelling (edema) in the arm, and the spread of cancer throughout the body (Handoyo, 1990).

Advanced breast cancer is very easily recognizable by knowing operbilitas Heagensen the following criteria:

There are extensive edema of the breast skin (over 1/3 wide breast skin);

presence of satellite nodules on the skin of the breast;

karsinimatosa types of mastitis breast cancer;

There are models parasternal;

There supraclavicular nodes;

edema arm;

presence of distant metastases;

and there are two of the signs of locally advanced, namely skin ulceration, skin edema, skin fixed to the wall of the thoracic, axillary lymph nodes than 2.5 cm in diameter, and axillary lymph nodes attached to each other.

Nipple discharge is a discharge from the nipple spontaneously and not normal. The discharge is normal if it occurs in women who are pregnant, breastfeeding and contraceptive pill users. A woman had to be alert when on the bloody nipple discharge, watery fluid with red or brown, out on his own without having to massage the nipples, continues, only in one breast (unilateral), and liquids other than breast milk.

According Moningkey and Kodim, the specific causes of breast cancer are still unknown, but there are many factors that are expected to have an influence on the occurrence of breast cancer include:

Reproductive factors: reproductive characteristics associated with risk of breast cancer is nulliparity, menarche at a young age, menopause at an older age, and first pregnancy at older ages. The main risk of breast cancer is increasing age. It is estimated, the period between the occurrence of the first period with the age at first pregnancy is a window of initiation of breast cancer development. Anatomically and functionally, the breasts will undergo atrophy with age. Less than 25% of breast cancers occur in the period before the onset of menopause it is estimated that tumors occur long before clinical changes.

The use of hormones: estrogen hormone associated with breast cancer. Reports from the Harvard School of Public Health states that there is a significant increase in breast cancer in users of estrogen replacement therapy. A meta-analysis states that although there is the risk of breast cancer in oral contraceptive users, women who use these drugs for a long time have a higher risk for breast cancer before menopause. Cells that are sensitive to hormonal stimulation may undergo changes benign or become malignant degeneration.

Fibrocystic disease: In women with adenosis, fibroadenoma, and fibrosis, there is no increased risk of breast cancer. At hiperplasis and papilloma, slightly increased risk of 1.5 to 2 times. Whereas in atypical hyperplasia, the risk increases up to 5 times.

Obesity: There is a positive relationship between body weight and body shape with breast cancer in postmenopausal women. Variations on the incidence of this cancer in Western countries and not the West as well as the frequency changes after migration indicates that there is the influence of diet on the occurrence of this malignancy.

Consumption of fat: fat consumption is estimated as a risk factor for breast cancer. Willet et al. conducted a prospective study for 8 years about fat and fiber intake in relation to breast cancer risk in women aged 34 to 59 years.

Radiation: Exposure to ionizing radiation during or after puberty increases the risk of breast cancer. Of the few studies conducted concluded that the cancer risk of radiation is linearly related to dose and exposure time of the age.

Family history and genetic factors: Family history is an important component in the history of the patient to be implemented screening for breast cancer. There is an increased risk of malignancy in women with breast cancer families. In the genetic studies found that breast cancer is associated with a particular gene. If there BRCA 1, which is a susceptibility gene for breast cancer, the probability for the case of breast cancer by 60% at age 50 and by 85% at the age of 70 years. The age factor is very influential -> about 60% of breast cancers occur in the age of 60 years. The greatest risk of age 75 years

Peyudara cancer can occur due to some genetic factors inherited from parent to child. Genetic factors referred to is the presence of mutations in several genes that play an important role in the formation of breast cancer genes in question are some of the genes are oncogenes and tumor suppressing genes that nature.

Pensupresi tumor genes that play an important role in the formation of breast cancer include BRCA1 and BRCA2 genes.

There are several breast cancer treatment whose application depends a lot on clinical stage of disease (Tjindarbumi, 1994), namely:

Mastectomy is the surgical removal of the breast. There are 3 types of mastectomy (Hirshaut & Pressman, 1992):

Modified Radical Mastectomy, the surgical removal of the entire breast, the breast tissue in the sternum, collarbone and ribs, and lump around the armpit.

Total (Simple) Mastectomy, the surgical removal of the entire breast, but not the nodes in the armpit.

Radical Mastectomy, the surgical removal of part of the breast. Typically called a lumpectomy, the removal is only in tissues that contain cancer cells, not the whole breast. This operation is always followed by administration of radiotherapy. Lumpectomy is usually recommended in patients with large tumors less than 2 cm and located at the edge of the breast.

Irradiation / radiation is the process of irradiating the affected area of cancer using X-rays and gamma rays are aimed at killing any remaining cancer cells in the breast after surgery (Denton, 1996). The effect of this treatment the body becomes weak, decreased appetite, color of skin around the breast to black, as well as hemoglobin and leukocytes tended to decline as a result of radiation.

Chemotherapy is the administration of anti-cancer drugs or cytokines in the form of a pill or capsule or liquid through the infusion aimed at killing cancer cells through mechanisms of chemotaxis. Not only in breast cancer cells, but also in the whole body (Denton, 1996). The effects of chemotherapy is that patients experience nausea and vomiting and hair loss due to the influence of drugs given during chemotherapy.

Primary prevention of breast cancer is one form of health promotion as is done in the "healthy" through efforts to avoid exposure to various risk factors and implementing a healthy lifestyle. Pencagahan primer can also be an examination of BSE (breast self-examination) are conducted regularly so that it can reduce the risk factors for breast cancer.

Secondary prevention is done on individuals who are at risk for breast cancer. Every woman is normal and have a normal menstrual cycle is a population at risk of breast cancer. Secondary prevention by early detection. Some early detection methods had been developed. Screening through mammography has a claimed accuracy of 90% of all breast cancer patients, but the exposure is constantly on mammography in healthy women is one risk factor for breast cancer. Therefore, screening with mammography can still be carried out by a number of considerations, among others:

Women who have reached the age of 40 years are encouraged to cancer risk assessement survey.

In women with risk factors received Reference for mammography done every year.

Normal woman gets Reference mammography every two years until they reach the age of 50 years.

Foster and Constanta found that breast cancer death by less in women who did breast self examination (Breast Self-Examination) than those who did not. Although the sensitivity of BSE to detect breast cancer is only 26%, when combined with the sensitivity of mammography is early detection to 75%

Tertiary prevention is usually directed at individuals who have positive breast cancer. Proper treatment of breast cancer patients according to the stage will be able to reduce kecatatan and prolong survival. Tertiary prevention is essential to improve the quality of life of patients and prevent complications of the disease and continue treatment. Measures of treatment may include surgery although no effect on the survival of patients. If the cancer has metastasized far, chemotherapy with sitostatika action. At a certain stage, treatment is given only a symptomatic and encouraged to seek alternative treatment of breast cancer with herbal remedies.

Heart Attack Symptoms

noreply@blogger.com (Unknown) — Tue, 11 Aug 2015 02:23:00 +0000

A heart attack is a condition when the damage suffered by the part of the heart muscle (myocardium) due to sudden severely reduced blood supply to the heart muscle. Reduced blood supply to the heart is suddenly may occur when one of the coronary arteries being blockaded for some time, either due to spasm - mengencangnya coronary arteries - or as a result of a blood clot - thrombus. Part of the heart muscle that is normally supplied by the pulse being blockaded stops functioning properly immediately after splasme subside by itself, the symptoms disappear completely and cardiac muscle function truly normal again. This is often called crescendo angina or coronary insufficiency. Conversely, when the blood supply to the heart stopped altogether, the relevant cells undergo permanent change in just a few hours and the said part of the heart muscle is severely degraded or permanently damaged. Dead muscle is called infarction.

These symptoms can be different for each person. A heart attack may begin with a vague pain, vague discomfort, or a feeling of tightness in the middle of the chest. Sometimes, a heart attack caused only mild discomfort at all, so often misinterpreted as acid reflux, or even escape the attention at all.

Heart conditions can be divided into four categories:

First, healthy can work heavy and light.

Second, it can work when it's heavy and tired does not need to stop doing the activity, but simply reduce the intensity / severity of work and when it felt fit within a two-minute work intensity can be increased again, and so on.

Third, can not work hard, but can do light work everyday, if fatigue should immediately stop the activity and rest a minute or two, good by lying, but if you're shooting went, then the rest can be done with silent stand alone.

Fourth, already severe, to walk a few meters has been exhausted, it is sometimes necessary being carried.

There are two conditions that cause blockage rather difficult early detection of heart disorders by observing the symptoms Clinically conditions:

Coronary Blockage, Coronary Blood Vessels (Large) clogged temporary and usually cause severe pain, although perhaps only briefly.

Small blood vessel blockage (ischemia), caused by cholesterol and diabetes where the latter disease causing rigidity of blood vessels, so that blood can not flow to the maximum, the small blood vessels that disrupted numerous and occur throughout the body.

If it is severe, then the heart disturbance can be recognized from clinical symptoms alone, but if it is still mild and the new are likely to experience heart problems, then treadmill test that can be performed in a specific Clinical Laboratory under the supervision of Doctor Heart is one way to detect where accuracy is reached 85 percent, while the ECG / EKG (Electro cardiogram) only 15 percent accuracy, because testnya without loading and electrodes are also less than the Treadmill Test, so it can not detect heart problems that are still mild. Treadmill Test with loading will be able to detect new blockages bit, because the graph of each electrode results will be compared and if not uniform in these places certainly no interference. Treadmill Test can detect ischemia in addition to also detect heart rhythm disorders (arrhythmias) and also determine the level of Body Fitness We are, for example, often sport or not, and any sport can still be done and how long. Unfortunately Treadmill Test five times more expensive than the ECG, but there is no other way other than the treadmill test is more accurate, because it is recommended for those who have aged 50 years, even without any complaint and inspection can be performed on younger, if there is a history of illness The family's heart, high cholesterol, diabetes and hypertension.

On the other hand, a heart attack may bring the worst pain ever experienced - an incredible tightness or a feeling pinched in the chest, throat or stomach. Could also heat or cold sweat, legs ached once and fear that the end is approaching. May also feel more comfortable when sitting than when lying down and possibly shortness of breath so that can not be relaxed. Nausea and dizziness and even vomiting, even worse is when to collapse and fainting.

There are some more specific symptoms, such as:

Pain. If the muscle is not getting enough blood (a condition called ischemia), then insufficient oxygen and the metabolism of excessive lead to cramps or spasms. Angina is a feeling of tightness in the chest or a feeling of chest squeezing, which occurs when the heart muscle does not get enough blood. The type and severity of pain or discomfort varies in each person. Some people who experience a lack of blood flow can not feel pain at all (a condition called silent ischemia).

Shortness of breath is a common symptom found in heart failure. Shortness is the result of the entry of fluid into the air cavities in the lungs (pulmonary congestion or pulmonary edema).

Tiredness or fatigue. If the heart is not pumping effectively, blood flow to muscles during activity will be reduced, causing the patient to feel weak and tired. These symptoms are often mild. To overcome this, the patient usually gradually reduce its activity or thought these symptoms as part of aging.

Palpitations (heart palpitations)

Dizziness and fainting. Decreased blood flow due to rate or abnormal heart rhythm or because of poor pumping ability, can cause dizziness and fainting.

Risk Factors

Entering the age of 45 years for men.

It's important for men to realize their vulnerability and take positive action to prevent any future heart disease.

For women, entered the age of 55 years or premature menopause (as a result of the operation).

Women began to overtake men in terms of heart disease risk after experiencing menopause.

Family history of heart disease.

A history of heart attack in the family is often the result of abnormal cholesterol profile.

Diabetes.

Most people with diabetes die not because of the increased blood sugar level, but due to the condition of their heart complications.

Smoking.

The risk of heart disease from smoking is equivalent to 100 pounds overweight - so it is not possible to equate the two.

High blood pressure (hypertension).

Overweight (obesity).

Central obesity (potbelly) is a form of obesity. Although all obese people tend to have an increased risk of heart disease, people with central obesity even more.

Poor lifestyle.

Bad lifestyle is one of the root causes of heart disease - and replace it with physical activity is one of the most radical measures that can be taken.

Stress.

Many studies have shown that, when faced with a tense situation, there can be life-threatening heart arithmias.

Physical therapy | Understanding and definition of Physical therapy

noreply@blogger.com (Unknown) — Tue, 04 Aug 2015 20:14:00 +0000

Physical therapy (or physiotherapy), often abbreviated PT, is a health care profession which aims the physical treatment and management of disease or condition which enables people to reach their maximum potential. 'Physical therapists' (or physiotherapists) are primary healthcare professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions, illnesses, or injuries that limit their abilities to move and perform functional activities as well as they would like in their daily lives. Physical therapists examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Functional movement is central to what it means to be healthy.

Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social well being. Physical therapy involves the interaction between physical therapist, patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists. Physical therapy is performed by a physical therapist (PT) or physiotherapist (physio), and sometimes services are provided by an assistant (PTA) acting under their direction.

PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be of assistance. PT management commonly includes prescription of or assistance with specific exercises, manual therapy, education, manipulation and other interventions.

Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics, to name some of the more common areas. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.

Physical therapists also practice in non-patient care roles such as health policy, health insurance, health care administration and as health care executives. Physical therapists are involved in the medical-legal field serving as experts, performing peer review and independent medical examinations.

Education qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others requiring masters or doctoral degrees.

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 B.C. After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.

The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The Swedish word for physical therapist is “sjukgymnast” = “sick-gymnast.” In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare.

Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy. The School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."

Modern physical therapy was established in Britain towards the end of the 19th century. Soon following American orthopedic surgeons began treating children with disabilities and began employing women trained in physical education, massage, and remedial exercise. These treatments were applied and promoted further during the Polio outbreak of 1916. During the First World War women were recruited to work with and restore physical function to injured soldiers, and the field of physical therapy was institutionalized. In 1918 the term "Reconstruction Aide" was used to refer to individuals practicing physical therapy. The first school of physical therapy was established at Walter Reed Army Hospital in Washtington D.C. following the outbreak of World War I.

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in "The PT Review." In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio.

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s. Later that decade, physical therapists started to move beyond hospital-based practice to outpatient orthopedic clinics, public schools, colleges/universities, geriatric settings (skilled nursing facilities), rehabilitation centers and medical centers.

In 1921 in the United States physical therapists formed the first professional association called the American Women's Physical Therapeutic Association. This gave birth to what is known today as the APTA (American Physical Therapy Association), and currently represents approximately 76,000 members throughout the United States. The APTA defines physical therapy as: "clinical applications in the restoration, maintenance, and promotion of optimal physical function."

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Physical Therapists was formed, which has ever since played an important role in advancing manual therapy worldwide.

World Confederation of Physical Therapy (WCPT) recognises there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners, that may work in collaboration with other members of the health care team.

Causes and symptoms of gastritis | how to cope with heartburn

noreply@blogger.com (Unknown) — Tue, 04 Aug 2015 20:09:00 +0000

Gastritis or inflammation of the stomach or gastric ulcer is a disease that attacks the stomach symptoms occur because of injury or inflammation of the stomach that causes pain, heartburn, and abdominal tenderness.

Broadly speaking, there are two types of ulcer disease, namely:

Acute Gastritis

Acute ulcer disease is inflammation (the body's reaction against microorganisms and foreign bodies marked by heat, swelling, pain, and impaired organ function) infection of the stomach, and is usually limited to muklosa. Acute ulcer disease can occur without any known cause.

Chronic Gastritits

Chronic gastric ulcer disease patients may experience inflammation (the body's reaction against microorganisms and foreign bodies marked by heat, swelling, pain, and impaired organ function) of certain chronic disorders of this type, which causes gastritis of specific types namely gastritis kronisa.

Type of ulcer disease is seen based on the severity, can be divided into:

Mild ulcer

Mild ulcer is still relatively mild stage where usually everybody was at this stage, if the examination will look excess stomach acid in the wall.

Maag was

Maag at this stage already causing pain, nausea and painful illness.

Chronic gastritis

Chronic ulcer is an ulcer that has severe intensity compared to the usual ulcer.

Stomach cancer

Stomach cancer caused by harmful microorganisms, namely Helycobacter pylori.

The reason could be because people eat irregularly, there are harmful microorganisms, taking certain medications, or other causes such as alcohol, irregular sleep patterns and stress. Maag also can occur when the patient is late to eat, then while eating the meal ulcer patients with portions that are too much. For patients who have severe gastritis, ulcer disease is very dangerous and can cause death.

Symptom

Pain during defecation
Nausea and vomiting
Often feel hungry
Flatulence
Stinging pain in the abdomen and chest
Frequent burping

Prevention and treatment

Gastritis can be cured but can not fully healed ulcer is a disease that can recur if the patient is not eating properly, too much eating, or other reasons. Usually to relieve or cure the patient should take the drug if necessary. But the ulcer can be prevented, that is by eating regularly, eat, wash hands before eating and do not snack at random.

Medicines for heartburn are generally eaten two hours before a meal and two hours after meals. As for the purpose of drug consumed two hours before a meal which is to neutralize stomach acid, because at that time the accumulation of stomach acid is very much in the stomach and patients must have been minor injuries which when exposed to acid will feel sore. Then the drugs taken two hours after eating aim to protect the stomach wall of the acid continues to be produced. Finally, two hours after eating, the acid in the stomach will be used to digest food so it is neutralized and will not hurt the stomach wall.

Drugs that are commonly used:

Antacids (Neutralize stomach acid and relieve pain)

Proton pump prevention of bacterial growth (Stopping production of stomach acid and inhibit bacterial infection helicobacter pylori)

Cytoprotektif agent (Protecting the mucosal tissue of the stomach and small intestine)

Anti-secretory drugs (Able to suppress acid secretion)

Pankreatin (Helps digestion of fats, carbohydrates, proteins, and overcome the pain digestive disorders such as flatulence, nausea, and often out of gas)

Ranitidine (Treating stomach ulcers)

Cimetidine (Treating dyspepsia)

Besides the disease is believed to have several types of drinks and food is not good for consumption.

Drinks that stimulate gastric acid expenditures include: coffee, white wine, citrus juice, and milk.

Highly acidic foods such as vinegar or spicy, chili, and pepper (food that stimulates the stomach and can damage the stomach wall).

The food is difficult to digest and can slow gastric emptying. As this can cause an increase in stomach stretching which can eventually increase stomach acid include fatty foods, cake, chocolate, and cheese.

Food down the esophagus valve weakens, causing gastric fluid can go up into the esophagus such as alcohol, chocolate, high-fat foods, and fried foods.

Food and drinks that contain lots of gas and also that too much fiber, among others:

Certain vegetables like lettuce and cabbage

Certain fruits such as jackfruit and banana

Certain high-fiber foods such as kedondong and dried fruit

Drinks containing gas (such as soft drinks).

In addition, activities that can improve the gas in the stomach should also be avoided, such as eating candy, especially chewing gum and smoking.

Brain tumor | Understanding and definition of Brain tumor | Symptoms of Brain tumor

noreply@blogger.com (Unknown) — Tue, 04 Aug 2015 19:56:00 +0000

A brain tumor (or brain tumour) is an intracranial solid neoplasm, a tumor (defined as an abnormal growth of cells) within the brain or the central spinal canal.

Brain tumors include all tumors inside the cranium or in the central spinal canal. They are created by an abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells, myelin-producing Schwann cells), lymphatic tissue, blood vessels), in the cranial nerves, in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).

Any brain tumor is inherently serious and life-threatening because of its invasive and infiltrative character in the limited space of the intracranial cavity. However, brain tumors (even malignant ones) are not invariably fatal. Brain tumors or intracranial neoplasms can be cancerous (malignant) or non-cancerous (benign); however, the definitions of malignant or benign neoplasms differs from those commonly used in other types of cancerous or non-cancerous neoplasms in the body. Its threat level depends on the combination of factors like the type of tumor, its location, its size and its state of development. Because the brain is well protected by the skull, the early detection of a brain tumor only occurs when diagnostic tools are directed at the intracranial cavity. Usually detection occurs in advanced stages when the presence of the tumor has caused unexplained symptoms.

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain.

The prognosis of brain cancer varies based on the type of cancer. Medulloblastoma has a good prognosis with chemotherapy, radiotherapy, and surgical resection while glioblastoma multiforme has a median survival of only 12 months even with aggressive chemoradiotherapy and surgery. Brainstem gliomas have the poorest prognosis of any form of brain cancer, with most patients dying within one year, even with therapy that typically consists of radiation to the tumor along with corticosteroids. However, one type of brainstem glioma, a focal seems open to exceptional prognosis and long-term survival has frequently been reported.

Tumors have characteristics that allow pathologists to determine how dangerous a tumor is/was for the patient, how it will evolve and it will allow the medical team to determine the management plan for the patient.

Anaplasia: or dedifferentiation; loss of differentiation of cells and of their orientation to one another and blood vessels, a characteristic of anaplastic tumor tissue. Anaplastic cells have lost total control of their normal functions and many have deteriorated cell structures. Anaplastic cells often have abnormally high nuclear-to-cytoplasmic ratios, and many are multinucleated. Additionally, the nuclei of anaplastic cells are usually unnaturally shaped or oversized nuclei. Cells can become anaplastic in two ways: neoplastic tumor cells can dedifferentiate to become anaplasias (the dedifferentiation causes the cells to lose all of their normal structure/function), or cancer stem cells can increase in their capacity to multiply (i.e., uncontrollable growth due to failure of differentiation).

Atypia: is an indication of abnormality of a cell (which may be indicative for malignancy). Significance of the abnormality is highly dependent on context.

Neoplasia: is the (uncontrolled) division of cells; as such neoplasia is not problematic but its consequences are: the uncontrolled division of cells means that the mass of a neoplasm increases in size, and in a confined space such as the intracranial cavity this quickly becomes problematic because the mass invades the space of the brain pushing it aside, leading to compression of the brain tissue and increased intracranial pressure and destruction of brain parenchyma. Increased Intracranial pressure (ICP) may be attributable to the direct mass effect of the tumor, increased blood volume, or increased cerebrospinal fluid (CSF) volume may in turn have secondary symptoms

Necrosis: is the (premature) death of cells, caused by external factors such as infection, toxin or trauma. Necrotic cells send the wrong chemical signals which prevents phagocytes from disposing of the dead cells, leading to a build up of dead tissue, cell debris and toxins at or near the site of the necrotic cells.

Arterial and venous hypoxia, or the deprivation of adequate oxygen supply to certain areas of the brain, occurs when a tumor makes use of nearby blood vessels for its supply of blood and the neoplasm enters into competition for nutrients with the surrounding brain tissue.

More generally a neoplasm may cause release of metabolic end products (e.g., free radicals, altered electrolytes, neurotransmitters), and release and recruitment of cellular mediators (e.g., cytokines) that disrupt normal parenchymal function.

The visibility of signs and symptoms of brain tumors mainly depends on two factors: tumor size (volume) and tumor location. The moment that symptoms will become apparent, either to the person or people around him (symptom onset) is an important milestone in the course of the diagnosis and treatment of the tumor. The symptom onset - in the timeline of the development of the neoplasm - depends in many cases on the nature of the tumor but in many cases is also related to the change of the neoplasm from "benign" (i.e. slow-growing/late symptom onset) to more malignant (fast growing/early symptom onset).

Symptoms of solid neoplasms of the brain (primary brain tumors and secondary tumors alike) can be divided in 3 main categories :

Consequences of intracranial hypertension : The symptoms that often occur first are those that are the consequences of increased intracranial pressure: Large tumors or tumors with extensive perifocal swelling (edema) inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic eye examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In very young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.
Dysfunction : depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment (including impaired judgment, memory loss, lack of recognition, spatial orientation disorders), personality or emotional changes, hemiparesis, hypoesthesia, aphasia, ataxia, visual field impairment, impaired sense of smell, impaired hearing, facial paralysis, double vision, dizziness, but more severe symptoms might occur too such as: paralysis on one side of the body hemiplegia or impairment to swallow . These symptoms are not specific for brain tumors — they may be caused by a large variety of neurologic conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects. A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.
Irritation : abnormal fatigue, weariness, absences and tremors, but also epileptic seizures.

The above symptoms are true for ALL types of neoplasm of the brain (including secondary tumors). It is common that a person carry a primary benign neoplasm for several years and have no visible symptoms at all. Many present some vague and intermittent symptoms like headaches and occasional vomiting or weariness, which can be easily mistaken for gastritis or gastroenteritis. It might seem strange that despite having a mass in his skull exercising pressure on the brain the patient feels no pain, but as anyone who has suffered a concussion can attest, pain is felt on the outside of the skull and not in the brain itself. The brain has no nerve sensors in the meninges (outer surface) with which to feel or transmit pain to the brain's pain center; it cannot signal pain without a sensory input. That is why secondary symptoms like those described above should alert doctors to the possible diagnosis of a neoplasm of the brain.

Although there is no specific or singular clinical symptom or sign for any brain tumors, the presence of a combination of symptoms and the lack of corresponding clinical indications of infections or other causes can be an indicator to redirect diagnostic investigation towards the possibility of an intracranial neoplasm.

The diagnosis will often start with an interrogation of the patient to get a clear view of his medical antecedents, and his current symptoms. Clinical and laboratory investigations will serve to exclude infections as the cause of the symptoms. Examinations in this stage may include ophtamological, otolaryngological (or ENT) and/or electrophysiological exams. The use of electroencephalography (EEG) often plays a role in the diagnosis of brain tumors.

Swelling, or obstruction of the passage of cerebrospinal fluid (CSF) from the brain may cause (early) signs of increased intracranial pressure which translates clinically into headaches, vomiting, or an altered state of consciousness, and in children changes to the diameter of the skull and bulging of the fontanelles. More complex symptoms such as endocrine dysfunctions should alarm doctors not to exclude brain tumors.

A bilateral temporal visual field defect (due to compression of the optic chiasm) or dilatation of the pupil, and the occurrence of either slowly evolving or the sudden onset of focal neurologic symptoms, such as cognitive and behavioral impairment (including impaired judgment, memory loss, lack of recognition, spatial orientation disorders), personality or emotional changes, hemiparesis, hypoesthesia, aphasia, ataxia, visual field impairment, impaired sense of smell, impaired hearing, facial paralysis, double vision, or more severe symptoms such as tremors, paralysis on one side of the body hemiplegia, or (epileptic) seizures in a patient with a negative history for epilepsy, should raise the possibility of a brain tumor.

The goal of radiation therapy is to selectively kill tumor cells while leaving normal brain tissue unharmed. In standard external beam radiation therapy, multiple treatments of standard-dose "fractions" of radiation are applied to the brain. This process is repeated for a total of 10 to 30 treatments, depending on the type of tumor. This additional treatment provides some patients with improved outcomes and longer survival rates.

Radiosurgery is a treatment method that uses computerized calculations to focus radiation at the site of the tumor while minimizing the radiation dose to the surrounding brain. Radiosurgery may be an adjunct to other treatments, or it may represent the primary treatment technique for some tumors.

Radiotherapy may be used following, or in some cases in place of, resection of the tumor. Forms of radiotherapy used for brain cancer include external beam radiation therapy, brachytherapy, and in more difficult cases, stereotactic radiosurgery, such as Gamma knife, Cyberknife or Novalis Tx radiosurgery.

Radiotherapy is the most common treatment for secondary brain tumors. The amount of radiotherapy depends on the size of the area of the brain affected by cancer. Conventional external beam 'whole brain radiotherapy treatment' (WBRT) or 'whole brain irradiation' may be suggested if there is a risk that other secondary tumors will develop in the future. Stereotactic radiotherapy is usually recommended in cases involving fewer than three small secondary brain tumors.

Occurrence of Brain Tumors

The incidence of low-grade astrocytoma has not been shown to vary significantly with nationality. However, studies examining the incidence of malignant CNS tumors have shown some variation with national origin. Since some of these high-grade lesions arise from low-grade tumors, these trends are worth mentioning. Specifically, the incidence of CNS tumors in the United States, Israel, and the Nordic countries is relatively high, while Japan and Asian countries have a lower incidence. These differences probably reflect some biological differences as well as differences in pathologic diagnosis and reporting.

Worldwide data on incidence of cancer can be found at the WHO (world health organisation) and is handled by the AIRC (Agency for Interanctional Research on Cancer) located in France.

Figures for incidences of cancers of the brain show a significant difference between more and less developed countries (i.e. the lesser developed countries have less incidences of tumors of the brain) this could be explained by undiagnosed tumor-related deaths (patient in extreme poor situations don't get diagnosed simply because they don't have access to the modern diagnostic facilities required to diagnose a brain tumor) and by deaths caused by other poverty related causes that preempt a patients life before tumors develop or tumors become life threatening. Nevertheless studies have been made that certain forms of primary brain tumors are more prevalent among certain groups of the population.

Hepatitis | Understanding and definition of Hepatitis

noreply@blogger.com (Unknown) — Tue, 04 Aug 2015 19:55:00 +0000

Hepatitis (plural hepatitides) is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat-, meaning liver, and suffix -itis, meaning "inflammation" (c. 1727). The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis.

Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide, but it can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants), other infections and autoimmune diseases.

Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort. Physical findings are usually minimal, apart from jaundice in a third and tender hepatomegaly (swelling of the liver) in about 10%. Some exhibit lymphadenopathy (enlarged lymph nodes, in 5%) or splenomegaly (enlargement of the spleen, in 5%).

Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks.

A small proportion of people with acute hepatitis progress to acute liver failure, in which the liver is unable to clear harmful substances from the circulation (leading to confusion and coma due to hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding). This may become life-threatening and occasionally requires a liver transplant.

Chronic hepatitis often leads to nonspecific symptoms such as malaise, tiredness and weakness, and often leads to no symptoms at all. It is commonly identified on blood tests performed either for screening or to evaluate nonspecific symptoms. The occurrence of jaundice indicates advanced liver damage. On physical examination there may be enlargement of the liver.

Extensive damage and scarring of liver (i.e. cirrhosis) leads to weight loss, easy bruising and bleeding tendencies, peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the abdominal cavity). Eventually, cirrhosis may lead to various complications: esophageal varices (enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction).

Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.

Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset.

Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C. The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis.

Non-alcoholic fatty liver disease (NAFLD) is the occurrence of fatty liver in people who have no history of alcohol use. It is most commonly associated with obesity (80% of all obese people have fatty liver). It is more common in women. Severe NAFLD leads to inflammation, a state referred to as non-alcoholic steatohepatitis (NASH), which on biopsy of the liver resembles alcoholic hepatitis (with fat droplets and inflammatory cells, but usually no Mallory bodies).

The diagnosis depends on medical history, physical exam, blood tests, radiological imaging and sometimes a liver biopsy. The initial evaluation to identify the presence of fatty infiltration of the liver is medical imaging, including such ultrasound, computed tomography (CT), or magnetic resonance (MRI). However, imaging cannot readily identify inflammation in the liver. Therefore, the differentiation between steatosis and NASH often requires a liver biopsy. It can also be difficult to distinguish NASH from alcoholic hepatitis when the patient has a history of alcohol consumption. Sometimes in such cases a trial of abstinence from alcohol along with follow-up blood tests and a repeated liver biopsy are required.

NASH is becoming recognized as the most important cause of liver disease second only to hepatitis C in numbers of patients going on to cirrhosis.

Ischemic hepatitis is caused by decreased circulation to the liver cells. Usually this is due to decreased blood pressure (or shock), leading to the equivalent term "shock liver". Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver (such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells). Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT), which may exceed 1000 U/L. The elevation in these blood tests is usually transient (lasting 7 to 10 days). It is rare that liver function will be affected by ischemic hepatitis.

Eye pterygium | Understanding and defisini of pterygium Eye | Dust is one of the causes of Pterygium

noreply@blogger.com (Unknown) — Tue, 04 Aug 2015 19:53:00 +0000

Pterygium (Surfer's Eye) most often refers to a benign growth of the conjunctiva. A pterygium commonly grows from the nasal side of the sclera. It is usually present in the palpebral fissure. It is associated with, and thought to be caused by ultraviolet-light exposure (e.g., sunlight), low humidity, and dust. The predominance of pterygia on the nasal side is possibly a result of the sun's rays passing laterally through the cornea, where it undergoes refraction and becomes focused on the limbic area. Sunlight passes unobstructed from the lateral side of the eye, focusing on the medial limbus after passing through the cornea. On the contralateral (medial) side, however, the shadow of the nose medially reduces the intensity of sunlight focused on the lateral/temporal limbus.

Pterygium in the conjunctiva is characterized by elastotic degeneration of collagen (actinic elastosis) and fibrovascular proliferation. It has an advancing portion called the head of the pterygium, which is connected to the main body of the pterygium by the neck. Sometimes a line of iron deposition can be seen adjacent to the head of the pterygium called Stocker's line. The location of the line can give an indication of the pattern of growth.

The exact cause is unknown, but it is associated with excessive exposure to wind, sunlight, or sand. Therefore, it is more likely to occur in populations that inhabit the areas near the equator, as well as windy locations. In addition, pterygia are twice as likely to occur in men than women.

Some research also suggests a genetic predisposition due to an expression of vimentin, which indicates cellular migration by the keratoblasts embryological development, which are the cells that give rise to the layers of the cornea. These cells also exhibit an increased P53 expression likely due to a deficit in the tumor suppressor gene. These indications give the impression of a migrating limbus because the cellular origin of the pterygium is actually initiated by the limbal epithelium.

The pterygium is composed of several segments:

Fuchs' Patches (minute gray blemishes that disperse near the pterygium head)
Stocker's Line (a brownish line composed of iron deposits)
Hood (fibrous nonvascular portion of the pterygium)
Head (apex of the pterygium, typically raised and highly vascular)
Body (fleshy elevated portion congested with tortuous vessels)
Superior Edge (upper edge of the triangular or wing-shaped portion of the pterygium)
Inferior Edge (lower edge of the triangular or wing-shaped portion of the ptyerygium).

As it is associated with excessive sun or wind exposure, wearing protective sunglasses with side shields and/or wide brimmed hats and using artificial tears throughout the day may help prevent their formation or stop further growth. Surfers and other water-sport athletes should wear eye protection that blocks 100% of the UV rays from the water, as is often used by snow-sport athletes.

Symptoms of pterygium include persistent redness, inflammation, foreign body sensation, tearing, which can cause bleeding, dry and itchy eyes. In advanced cases the pterygium can affect vision as it invades the cornea with the potential of obscuring the optical center of the cornea and inducing' astigmatismand corneal scarring.

Some of the irritating symptoms can be addressed with artificial tears. However, no reliable medical treatment exists to reduce or even prevent pterygium progression. Definitive treatment is achieved only by surgical removal. Long-term follow up is required as pterygium may recur even after complete surgical correction.

If there is recurrence after surgery or if recurrence of pterygium is thought to be vision threatening, it is possible to use strontium (90Sr) plaque therapy. 90Sr is a radioactive substance that produces beta particles, which penetrate a very short distance into the cornea at the site of the operation. It suppresses the regrowth of blood vessels that occur with return of the pterygium. The treatment requires some local anaesthetic in the eye and is best done at the time of, or on the same day as the pterygium excision.

The 90Sr plaque is a concave metal disc about 1-1.5 cm in diameter that is hollow and filled with an insoluble strontium salt. The side placed on the eye is a very thin and delicate silver film that will contain the strontium but allow the beta particles to escape. The dose of radiation to the conjunctiva is controlled by the time that the plaque is left in contact with the surface. The integrity of the plaque surfaces is paramount to prevent exposure to patients and so is wipe tested to see if radioactive matter is escaping. Obviously this test must be done very very gently.

Conjunctival auto-grafting is a surgical technique that is effective and safe procedure for pterygium removal. When the pterygium is removed, the tissue that covers the sclera known as the conjunctiva is also extracted. Auto-grafting replaces the bare sclera with tissue that is surgically removed from the inside of the patients’ upper eyelid. That “self-tissue” is then transplanted to the bare sclera and is fixated using sutures, tissue adhesive, or glue adhesive.

Amniotic membrane transplantation is an effective and safe procedure for pterygium removal. Amniotic membrane transplantation offers practical alternative to conjunctival auto graft transplantation for extensive pterygium removal. Amniotic membrane transplantation is tissue that is acquired from the innermost layer of the human placenta and has been used to replace and heal damaged mucosal surfaces including successful reconstruction of the ocular surface. It has been used as a surgical material since the 1940s, and has been shown to have a strong anti-adhesive effect. Using an amniotic graft facilitates epithelialization, and has anti-inflammatory as well as surface rejuvenation properties. Amniotic membrane transplantation can also be fixated to the sclera using sutures, or glue adhesive. Amniotic membrane transplantation with Tisseel glue application and Mitomycin-C has shown excellent cosmetic outcomes with a surface free of redness, stitching, or patches, which makes the ocular surface suitable for vision correction surgery sooner.

Understanding and definition of Alzheimer's | Causes and prevention of Alzheimer's

noreply@blogger.com (Unknown) — Tue, 04 Aug 2015 19:51:00 +0000

Alzheimer's disease (AD), also called Alzheimer disease, senile dementia of the Alzheimer type, primary degenerative dementia of the Alzheimer's type, or simply Alzheimer's, is the most common form of dementia. This incurable, degenerative, and terminal disease was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was named after him. Most often, it is diagnosed in people over 65 years of age, although the less-prevalent early-onset Alzheimer's can occur much earlier. In 2006, there were 26.6 million sufferers worldwide. Alzheimer's is predicted to affect 1 in 85 people globally by 2050.

Although the course of Alzheimer's disease is unique for every individual, there are many common symptoms. The earliest observable symptoms are often mistakenly thought to be 'age-related' concerns, or manifestations of stress. In the early stages, the most common symptom is inability to acquire new memories, observed as difficulty in recalling recently observed events. When AD is suspected, the diagnosis is usually confirmed with behavioural assessments and cognitive tests, often followed by a brain scan if available.

As the disease advances, symptoms include confusion, irritability and aggression, mood swings, language breakdown, long-term memory loss, and the general withdrawal of the sufferer as their senses decline. Gradually, bodily functions are lost, ultimately leading to death. Individual prognosis is difficult to assess, as the duration of the disease varies. AD develops for an indeterminate period of time before becoming fully apparent, and it can progress undiagnosed for years. The mean life expectancy following diagnosis is approximately seven years. Fewer than three percent of individuals live more than fourteen years after diagnosis.

The cause and progression of Alzheimer's disease are not well understood. Research indicates that the disease is associated with plaques and tangles in the brain. Currently used treatments offer a small symptomatic benefit; no treatments to delay or halt the progression of the disease are, as of yet, available. As of 2008[update], more than 500 clinical trials have been conducted for identification of a possible treatment for AD, but it is unknown if any of the tested intervention strategies will show promising results. A number of non-invasive, life-style habits have been suggested for the prevention of Alzheimer's disease, but there is a lack of adequate evidence for a link between these recommendations and reduced degeneration. Mental stimulation, exercise, and a balanced diet are suggested, as both a possible prevention and a sensible way of managing the disease.

Because AD cannot be cured and is degenerative, management of patients is essential. The role of the main caregiver is often taken by the spouse or a close relative. Alzheimer's disease is known for placing a great burden on caregivers; the pressures can be wide-ranging, involving social, psychological, physical, and economic elements of the caregiver's life. In developed countries, AD is one of the most costly diseases to society.

The first symptoms are often mistakenly attributed to aging or stress. Detailed neuropsychological testing can reveal mild cognitive difficulties up to eight years before a person fulfills the clinical criteria for diagnosis of AD. These early symptoms can affect the most complex daily living activities. The most noticeable deficit is memory loss, which shows up as difficulty in remembering recently learned facts and inability to acquire new information.

Subtle problems with the executive functions of attentiveness, planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of meanings, and concept relationships) can also be symptomatic of the early stages of AD. Apathy can be observed at this stage, and remains the most persistent neuropsychiatric symptom throughout the course of the disease. The preclinical stage of the disease has also been termed mild cognitive impairment, but whether this term corresponds to a different diagnostic stage or identifies the first step of AD is a matter of dispute.

Early

In people with AD the increasing impairment of learning and memory eventually leads to a definitive diagnosis. In a small portion of them, difficulties with language, executive functions, perception (agnosia), or execution of movements (apraxia) are more prominent than memory problems. AD does not affect all memory capacities equally. Older memories of the person's life (episodic memory), facts learned (semantic memory), and implicit memory (the memory of the body on how to do things, such as using a fork to eat) are affected to a lesser degree than new facts or memories.

Language problems are mainly characterised by a shrinking vocabulary and decreased word fluency, which lead to a general impoverishment of oral and written language. In this stage, the person with Alzheimer's is usually capable of adequately communicating basic ideas. While performing fine motor tasks such as writing, drawing or dressing, certain movement coordination and planning difficulties (apraxia) may be present but they are commonly unnoticed. As the disease progresses, people with AD can often continue to perform many tasks independently, but may need assistance or supervision with the most cognitively demanding activities.

Moderate

Progressive deterioration eventually hinders independence; with subjects being unable to perform most common activities of daily living. Speech difficulties become evident due to an inability to recall vocabulary, which leads to frequent incorrect word substitutions (paraphasias). Reading and writing skills are also progressively lost. Complex motor sequences become less coordinated as time passes and AD progresses, so the risk of falling increases. During this phase, memory problems worsen, and the person may fail to recognise close relatives. Long-term memory, which was previously intact, becomes impaired.

Behavioural and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and labile affect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving. Sundowning can also appear. Approximately 30% of patients develop illusionary misidentifications and other delusional symptoms. Subjects also lose insight of their disease process and limitations (anosognosia). Urinary incontinence can develop. These symptoms create stress for relatives and caretakers, which can be reduced by moving the person from home care to other long-term care facilities.

Advanced

During this last stage of AD, the patient is completely dependent upon caregivers. Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech. Despite the loss of verbal language abilities, patients can often understand and return emotional signals. Although aggressiveness can still be present, extreme apathy and exhaustion are much more common results. Patients will ultimately not be able to perform even the simplest tasks without assistance. Muscle mass and mobility deteriorate to the point where they are bedridden, and they lose the ability to feed themselves. AD is a terminal illness, with the cause of death typically being an external factor, such as infection of pressure ulcers or pneumonia, not the disease itself.

Several competing hypotheses exist trying to explain the cause of the disease. The oldest, on which most currently available drug therapies are based, is the cholinergic hypothesis, which proposes that AD is caused by reduced synthesis of the neurotransmitter acetylcholine. The cholinergic hypothesis has not maintained widespread support, largely because medications intended to treat acetylcholine deficiency have not been very effective. Other cholinergic effects have also been proposed, for example, initiation of large-scale aggregation of amyloid, leading to generalised neuroinflammation.

In 1991, the amyloid hypothesis postulated that amyloid beta (Aβ) deposits are the fundamental cause of the disease. Support for this postulate comes from the location of the gene for the amyloid beta precursor protein (APP) on chromosome 21, together with the fact that people with trisomy 21 (Down Syndrome) who have an extra gene copy almost universally exhibit AD by 40 years of age. Also APOE4, the major genetic risk factor for AD, leads to excess amyloid buildup in the brain before AD symptoms arise. Thus, Aβ deposition precedes clinical AD. Further evidence comes from the finding that transgenic mice that express a mutant form of the human APP gene develop fibrillar amyloid plaques and Alzheimer's-like brain pathology with spatial learning deficits.

An experimental vaccine was found to clear the amyloid plaques in early human trials, but it did not have any significant effect on dementia. Researchers have been led to suspect non-plaque Aβ oligomers (aggregates of many monomers) as the primary pathogenic form of Aβ. These toxic oligomers, also referred to as amyloid-derived diffusible ligands (ADDLs), bind to a surface receptor on neurons and change the structure of the synapse, thereby disrupting neuronal communication. One receptor for Aβ oligomers may be the prion protein, the same protein that has been linked to mad cow disease and the related human condition, Creutzfeldt-Jakob disease, thus potentially linking the underlying mechanism of these neurodegenerative disorders with that of Alzheimer's disease.

In 2009, this theory was updated, suggesting that a close relative of the beta-amyloid protein, and not necessarily the beta-amyloid itself, may be a major culprit in the disease. The theory holds that an amyloid-related mechanism that prunes neuronal connections in the brain in the fast-growth phase of early life may be triggered by aging-related processes in later life to cause the neuronal withering of Alzheimer's disease. N-APP, a fragment of APP from the peptide's N-terminus, is adjacent to beta-amyloid and is cleaved from APP by one of the same enzymes. N-APP triggers the self-destruct pathway by binding to a neuronal receptor called death receptor 6 (DR6, also known as TNFRSF21). DR6 is highly expressed in the human brain regions most affected by Alzheimer's, so it is possible that the N-APP/DR6 pathway might be hijacked in the aging brain to cause damage. In this model, beta-amyloid plays a complementary role, by depressing synaptic function.

A 2004 study found that deposition of amyloid plaques does not correlate well with neuron loss. This observation supports the tau hypothesis, the idea that tau protein abnormalities initiate the disease cascade. In this model, hyperphosphorylated tau begins to pair with other threads of tau. Eventually, they form neurofibrillary tangles inside nerve cell bodies. When this occurs, the microtubules disintegrate, collapsing the neuron's transport system. This may result first in malfunctions in biochemical communication between neurons and later in the death of the cells. Herpes simplex virus type 1 has also been proposed to play a causative role in people carrying the susceptible versions of the apoE gene.

Another hypothesis asserts that the disease may be caused by age-related myelin breakdown in the brain. Demyelination leads to axonal transport disruptions, leading to loss of neurons that become stale. Iron released during myelin breakdown is hypothesized to cause further damage. Homeostatic myelin repair processes contribute to the development of proteinaceous deposits such as amyloid-beta and tau.

Oxidative stress and dys-homeostasis of biometal (biology) metabolism may be significant in the formation of the pathology.

AD individuals show 70% loss of locus coeruleus cells that provide norepinephrine (in addition to its neurotransmitter role) that locally diffuses from "varicosities" as an endogenous antiinflammatory agent in the microenvironment around the neurons, glial cells, and blood vessels in the neocortex and hippocampus. It has been shown that norepinephrine stimulates mouse microglia to suppress Aβ-induced production of cytokines and their phagocytosis of Aβ. This suggests that degeneration of the locus ceruleus might be responsible for increased Aβ deposition in AD brains.

Alzheimer's disease is characterised by loss of neurons and synapses in the cerebral cortex and certain subcortical regions. This loss results in gross atrophy of the affected regions, including degeneration in the temporal lobe and parietal lobe, and parts of the frontal cortex and cingulate gyrus. Studies using MRI and PET have documented reductions in the size of specific brain regions in patients as they progressed from mild cognitive impairment to Alzheimer's disease, and in comparison with similar images from healthy older adults.

Both amyloid plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those afflicted by AD. Plaques are dense, mostly insoluble deposits of amyloid-beta peptide and cellular material outside and around neurons. Tangles (neurofibrillary tangles) are aggregates of the microtubule-associated protein tau which has become hyperphosphorylated and accumulate inside the cells themselves. Although many older individuals develop some plaques and tangles as a consequence of aging, the brains of AD patients have a greater number of them in specific brain regions such as the temporal lobe. Lewy bodies are not rare in AD patient's brains.

Alzheimer's disease has been identified as a protein misfolding disease (proteopathy), caused by accumulation of abnormally folded A-beta and tau proteins in the brain. Plaques are made up of small peptides, 39–43 amino acids in length, called beta-amyloid (also written as A-beta or Aβ). Beta-amyloid is a fragment from a larger protein called amyloid precursor protein (APP), a transmembrane protein that penetrates through the neuron's membrane. APP is critical to neuron growth, survival and post-injury repair. In Alzheimer's disease, an unknown process causes APP to be divided into smaller fragments by enzymes through proteolysis. One of these fragments gives rise to fibrils of beta-amyloid, which form clumps that deposit outside neurons in dense formations known as senile plaques.

AD is also considered a tauopathy due to abnormal aggregation of the tau protein. Every neuron has a cytoskeleton, an internal support structure partly made up of structures called microtubules. These microtubules act like tracks, guiding nutrients and molecules from the body of the cell to the ends of the axon and back. A protein called tau stabilizes the microtubules when phosphorylated, and is therefore called a microtubule-associated protein. In AD, tau undergoes chemical changes, becoming hyperphosphorylated; it then begins to pair with other threads, creating neurofibrillary tangles and disintegrating the neuron's transport system.

Exactly how disturbances of production and aggregation of the beta amyloid peptide gives rise to the pathology of AD is not known. The amyloid hypothesis traditionally points to the accumulation of beta amyloid peptides as the central event triggering neuron degeneration. Accumulation of aggregated amyloid fibrils, which are believed to be the toxic form of the protein responsible for disrupting the cell's calcium ion homeostasis, induces programmed cell death (apoptosis). It is also known that Aβ selectively builds up in the mitochondria in the cells of Alzheimer's-affected brains, and it also inhibits certain enzyme functions and the utilisation of glucose by neurons.

Various inflammatory processes and cytokines may also have a role in the pathology of Alzheimer's disease. Inflammation is a general marker of tissue damage in any disease, and may be either secondary to tissue damage in AD or a marker of an immunological response.

Alterations in the distribution of different neurotrophic factors and in the expression of their receptors such as the brain derived neurotrophic factor (BDNF) have been described in AD.

The vast majority of cases of Alzheimer's disease are sporadic, meaning that they are not genetically inherited although some genes may act as risk factors. On the other hand, around 0.1% of the cases are familial forms of autosomal-dominant inheritance, which usually have an onset before age 65.

Most of autosomal dominant familial AD can be attributed to mutations in one of three genes: amyloid precursor protein (APP) and presenilins 1 and 2. Most mutations in the APP and presenilin genes increase the production of a small protein called Aβ42, which is the main component of senile plaques. Some of the mutations merely alter the ratio between Aβ42 and the other major forms—e.g., Aβ40—without increasing Aβ42 levels. This suggests that presenilin mutations can cause disease even if they lower the total amount of Aβ produced and may point to other roles of presenilin or a role for alterations in the function of APP and/or its fragments other than Aβ.

Most cases of Alzheimer's disease do not exhibit autosomal-dominant inheritance and are termed sporadic AD. Nevertheless genetic differences may act as risk factors. The best known genetic risk factor is the inheritance of the ε4 allele of the apolipoprotein E (APOE). Between 40 and 80% of patients with AD possess at least one apoE4 allele. The APOE4 allele increases the risk of the disease by three times in heterozygotes and by 15 times in homozygotes. Geneticists agree that numerous other genes also act as risk factors or have protective effects that influence the development of late onset Alzheimer's disease. Over 400 genes have been tested for association with late-onset sporadic AD, most with null results.

Alzheimer's disease is usually diagnosed clinically from the patient history, collateral history from relatives, and clinical observations, based on the presence of characteristic neurological and neuropsychological features and the absence of alternative conditions. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), and with single photon emission computed tomography (SPECT) or positron emission tomography (PET) can be used to help exclude other cerebral pathology or subtypes of dementia. Moreover, it may predict conversion from prodromal stages (mild cognitive impairment) to Alzheimer's disease.

Assessment of intellectual functioning including memory testing can further characterise the state of the disease. Medical organisations have created diagnostic criteria to ease and standardise the diagnostic process for practicing physicians. The diagnosis can be confirmed with very high accuracy post-mortem when brain material is available and can be examined histologically.

The National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's Disease and Related Disorders Association (ADRDA, now known as the Alzheimer's Association) established the most commonly used NINCDS-ADRDA Alzheimer's Criteria for diagnosis in 1984, extensively updated in 2007. These criteria require that the presence of cognitive impairment, and a suspected dementia syndrome, be confirmed by neuropsychological testing for a clinical diagnosis of possible or probable AD. A histopathologic confirmation including a microscopic examination of brain tissue is required for a definitive diagnosis. Good statistical reliability and validity have been shown between the diagnostic criteria and definitive histopathological confirmation. Eight cognitive domains are most commonly impaired in AD—memory, language, perceptual skills, attention, constructive abilities, orientation, problem solving and functional abilities. These domains are equivalent to the NINCDS-ADRDA Alzheimer's Criteria as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) published by the American Psychiatric Association.

Although cardiovascular risk factors, such as hypercholesterolemia, hypertension, diabetes, and smoking, are associated with a higher risk of onset and course of AD, statins, which are cholesterol lowering drugs, have not been effective in preventing or improving the course of the disease. The components of a Mediterranean diet, which include fruit and vegetables, bread, wheat and other cereals, olive oil, fish, and red wine, may all individually or together reduce the risk and course of Alzheimer's disease. Its beneficial cardiovascular effect has been proposed as the mechanism of action. There is limited evidence that light to moderate use of alcohol, particularly red wine, is associated with lower risk of AD.

Reviews on the use of vitamins have not found enough evidence of efficacy to recommend vitamin C, or folic acid with or without vitamin B12, as preventive or treatment agents in AD. Additionally vitamin E is associated with important health risks. Trials examining folic acid (B9) and other B vitamins failed to show any significant association with cognitive decline. Docosahexaenoic acid, an Omega 3 fatty acid, has not been found to slow decline.

Long-term usage of non-steroidal anti-inflammatory drug (NSAIDs) is associated with a reduced likelihood of developing AD. Human postmortem studies, in animal models, or in vitro investigations also support the notion that NSAIDs can reduce inflammation related to amyloid plaques. However trials investigating their use as palliative treatment have failed to show positive results while no prevention trial has been completed. Curcumin from the curry spice turmeric has shown some effectiveness in preventing brain damage in mouse models due to its anti-inflammatory properties. Hormone replacement therapy, although previously used, is no longer thought to prevent dementia and in some cases may even be related to it. There is inconsistent and unconvincing evidence that ginkgo has any positive effect on cognitive impairment and dementia, and a recent study concludes that it has no effect in reducing the rate of AD incidence. A 21-year study found that coffee drinkers of 3–5 cups per day at midlife had a 65% reduction in risk of dementia in late-life.

People who engage in intellectual activities such as reading, playing board games, completing crossword puzzles, playing musical instruments, or regular social interaction show a reduced risk for Alzheimer's disease. This is compatible with the cognitive reserve theory, which states that some life experiences result in more efficient neural functioning providing the individual a cognitive reserve that delays the onset of dementia manifestations. Education delays the onset of AD syndrome, but is not related to earlier death after diagnosis. Learning a second language even later in life seems to delay getting Alzheimer disease. Physical activity is also associated with a reduced risk of AD.

Medical marijuana appears to be effective in delaying Alzheimer's Disease. The active ingredient in marijuana, THC, prevents the formation of deposits in the brain associated with Alzheimer's disease. THC was found to inhibit acetylcholinesterase more effectively than commercially marketed drugs. THC was also found to delay amylogenesis.

Some studies have shown an increased risk of developing AD with environmental factors such the intake of metals, particularly aluminium, or exposure to solvents. The quality of some of these studies has been criticised, and other studies have concluded that there is no relationship between these environmental factors and the development of AD.

While some studies suggest that extremely low frequency electromagnetic fields may increase the risk for Alzheimer's disease, reviewers found that further epidemiological and laboratory investigations of this hypothesis are needed. Smoking is a significant AD risk factor. Systemic markers of the innate immune system are risk factors for late-onset AD.

Pharmacy | Understanding and Science Pharmacy | History of Pharmacy | Online pharmacy

noreply@blogger.com (Unknown) — Tue, 04 Aug 2015 19:47:00 +0000

Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from the Greek: φάρμακον (pharmakon), meaning "drug" or "medicine" (the earliest form of the word is the Mycenaean Greek pa-ma-ko, attested in Linear B syllabic script).

The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes.

An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy, chemist's or (in the United States) drug store. US drug stores commonly sell not only medicines, but also miscellaneous items such as candy (sweets), cosmetics, and magazines, as well as light refreshments or groceries.

The word pharmacy is derived from its root word pharma which was a term used since the 15th–17th centuries. In addition to pharma responsibilities, the pharma offered general medical advice and a range of services that are now performed solely by other specialist practitioners, such as surgery and midwifery. The pharma (as it was referred to) often operated through a retail shop which, in addition to ingredients for medicines, sold tobacco and patent medicines. The pharmas also used many other herbs not listed.

In its investigation of herbal and chemical ingredients, the work of the pharma may be regarded as a precursor of the modern sciences of chemistry and pharmacology, prior to the formulation of the scientific method.

Pharmacists are highly qualified, highly trained and skilled healthcare professionals who perform various roles to ensure optimal health outcomes for their patients. Many pharmacists are also small-business proprietors, owning the pharmacy in which they practice. Since pharmacists know about the chemical synthesis mode of action of a particular drug, and its metabolism and physiological effects on human body in great detail, they play a very important role in optimisation of a drug threatment for an individual.

Pharmacists are represented internationally by the International Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the Royal Pharmaceutical Society (RPS), the Pharmacy Guild of Australia (PGA), the American Pharmacists Association (APhA) and the Pakistan Pharmacists Society (PPS). See also: List of pharmacy associations.

In some cases, the representative body is also the registering body, which is responsible for the ethics of the profession.

History of pharmacy

The history of pharmacy as an independent science is relatively young. The origins of historiography pharmaceutical back to the first third of the s. XIX which is when the first historiographies that while not touching all aspects of pharmaceutical history is the starting point for the final start of this science.

Until the birth of pharmacy as an independent science, there is a historical evolution from antiquity to the present day that marks the course of this science, always connected to the medicine.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article.

In Ancient Greece, according to Edward Kremers and Glenn Sonnedecker, "before, during and after the time of Hippocrates there was a group of experts in medicinal plants. Probably the most important representative of these rhizotomoi was Diocles of Carystus (4th century BC). He is considered to be the source for all Greek pharmacotherapeutic treatises between the time of Theophrastus and Dioscorides." The Greek physician Pedanius Dioscorides is famous for writing a five volume book in his native Greek Περί ύλης ιατρικής in the 1st century AD. The Latin translation De Materia Medica (Concerning medical substances) was used a basis for many medieval texts, and was built upon by many middle eastern scientists during the Islamic Golden Age. The title coined the term materia medica.

In Japan, at the end of the Asuka period (538-710) and the early Nara period (710-794), the men who fulfilled roles similar to those of modern pharmacists were highly respected. The place of pharmacists in society was expressly defined in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists—and even pharmacist assistants—were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.

There is a stone sign for a pharmacy with a tripod, a mortar, and a pestle opposite one for a doctor in the Arcadian Way in Ephesus near Kusadasi in Turkey. The current Ephesus dates back to 400BC and was the site of the Temple of Artemis one of the seven wonders of the world, the home of Mark Anthony and Cleopatra, Mary Magdalen and where St Paul read his letter to the Ephesians.

In Baghdad the first pharmacies, or drug stores, were established in 754, under the Abbasid Caliphate during the Islamic Golden Age. By the 9th century, these pharmacies were state-regulated.

The advances made in the Middle East in botany and chemistry led medicine in medieval Islam substantially to develop pharmacology. Muhammad ibn Zakarīya Rāzi (Rhazes) (865-915), for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi (Abulcasis) (936-1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs then generally used. Sabur Ibn Sahl (d 869), was, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailments. Al-Biruni (973-1050) wrote one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah (The Book of Drugs), where he gave detailed knowledge of the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Ibn Sina (Avicenna), too, described no less than 700 preparations, their properties, mode of action and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine. Of great impact were also the works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008–1074), both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by `Mesue' the younger, and the Medicamentis simplicibus by `Abenguefit'. Peter of Abano (1250–1316) translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are also pioneering. Living in the 10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxide, and being acquainted with silicic acid. He made clear distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of copper compounds, especially copper vitriol, and also lead compounds. He also describes the distillation of sea-water for drinking.

In Europe pharmacy-like shops began to appear during the 12th century. In 1240 emperor Frederic II issued a decree by which the physician's and the apothecary's professions were separated. The first pharmacy in Europe (still working) was opened in 1241 in Trier, Germany.

In Europe there are old pharmacies still operating in Dubrovnik, Croatia located inside the Franciscan monastery, opened in 1317 ; and one in the Town Hall Square of Tallinn, Estonia dating from at least 1422.

The oldest is claimed to be set up in 1221 in the Church of Santa Maria Novella in Florence, Italy, which now houses a perfume museum. The medieval Esteve Pharmacy, located in Llívia, a Catalan enclave close to Puigcerdà, is also now a museum dating back to the 15th century, keeping albarellos from the 16th and 17th centuries, old prescription books and antique drugs.

Until the birth of pharmacy as an independent science, there is a historical evolution from antiquity to the present day that marks the course of this science, always connected to the medicine.

Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues.

Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of medications (i.e., drug interactions) and patient compliance issues (in the hospital and at home) many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize in hematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anti-coagulation clinics, herbal medicine, neurology/epilepsy management, pediatrics, neonatal pharmacists and more.

Hospital pharmacies can often be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding. The high cost of medications and drug-related technology, combined with the potential impact of medications and pharmacy services on patient-care outcomes and patient safety, make it imperative that hospital pharmacies perform at the highest level possible.

Hospital pharmacy

A hospital pharmacy is concerned with pharmacy service to all types of hospital and differs considerably from a community pharmacy.

Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues. Because of the complexity of the medication use system, many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area.

Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized and investigational medications (medicines that are being studied, but have not yet been approved), than would be feasible in the community setting. Hospital pharmacies typically provide medications for the hospitalized patients only, and are not retail establishments. They typically do not provide prescription service to the public. Some hospitals do have retail pharmacies within them (see illustration), which sell over-the-counter as well as prescription medications to the public, but these are not the actual hospital pharmacy.

Clinical pharmacists provide direct patient care services that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often collaborate with physicians and other healthcare professionals to improve pharmaceutical care. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They work collaboratively with physicians, nurses and other healthcare personnel in various medical and surgical areas. They often participate in patient care rounds and drug product selection. In most hospitals in the United States, potentially dangerous drugs that require close monitoring are dosed and managed by clinical pharmacists.

Clinical pharmacy

Clinical pharmacy is the branch of Pharmacy where pharmacists and pharmaconomists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists and clinical pharmaconomists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists/pharmaconomists often collaborate with physicians and other healthcare professionals.

Clinical pharmacists and clinical pharmaconomists have extensive education in the biomedical, pharmaceutical, sociobehavioral and clinical sciences. Most clinical pharmacists have a Doctor of Pharmacy (Pharm.D.) degree and many have completed one or more years of post-graduate training (e.g. a general and/or specialty pharmacy residency). Many clinical pharmacists also choose to become Board Certified through the Board of Pharmaceutical Specialties (BPS) which was organized in 1976 as an independent certification agency of APhA (American Pharmacists Association). A pharmacist may become a Board Certified Pharmacotherapy Specialist (BCPS), a Board Certified Oncology Pharmacist (BCOP), Board Certified Nuclear Pharmacist (BCNP), Board Certified Nutrition Support Pharmacist (BCNSP), or a Board Certified Psychiatric Pharmacist (BCPP) through the Board of Pharmaceutical Specialities (BPS). There are also subspecialties within the Pharmacotherapy specialty: Cardiology and Infectious Disease. It is denoted as an "Added Qualification" or AQ. In order to obtain one of these specialties you must first be a Board Certified Pharmacotherapy Specialist and then submit a portfolio to the Board of Pharmaceutical Specialties for review to determine if they will grant you the added qualifications. An up-to-date explanation of pharmacy education leading to the Doctor of Pharmacy degree and Specialty Board Certification can be viewed at: http://www.youtube.com/watch?v=MvPb5peBnAY.

Within the system of health care, clinical pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy evaluations and recommendations to patients and other health care professionals. Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications. Clinical pharmacists are also making themselves more readily available to the public. In the past, access to a clinical pharmacist was limited to hospitals, clinics, or educational institutions. However, clinical pharmacists are making themselves available through a medication information hotline, and reviewing medication lists, all in an effort to prevent medication errors in the foreseeable future.

In some states, clinical pharmacists are given prescriptive authority under protocol with a medical provider (i.e., MD or DO), and their scope of practice is constantly evolving.

Since about the year 2000, a growing number of internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as Online Pharmacies) are also recommended to some patients by their physicians if they are homebound.

While most internet pharmacies sell prescription drugs and require a valid prescription, some internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication. There also have been reports of such pharmacies dispensing substandard products.

Of particular concern with internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship. There are many instances where a practitioner issues a prescription, brokered by an internet server, for a controlled substance to a "patient" s/he has never met. In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.

Canada is home to dozens of licensed internet pharmacies, many of which sell their lower-cost prescription drugs to U.S. consumers, who pay one of the world's highest drug prices. In recent years, many consumers in the US and in other countries with high drug costs, have turned to licensed internet pharmacies in India, Israel and the UK, which often have even lower prices than in Canada.

In the United States, there has been a push to legalize importation of medications from Canada and other countries, in order to reduce consumer costs. While in most cases importation of prescription medications violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.

Recently developed online services like Australia's Medicine Name Finder and the Walgreens' Drug Info Search provide information about pharmaceutical products but do not offer prescriptions or drug dispensations. These services often promote generic drug alternatives by offering comparative information on price and effectiveness.

Online pharmacy

Online pharmacies, or Internet pharmacies, are pharmacies that operate over the Internet. Many such pharmacies are, in some ways, similar to community pharmacies; the primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient than traveling to a community drugstore, in the same way as ordering goods online rather than going to a shop.

While many internet pharmacies sell prescription drugs only with a prescription, some do not require a pre-written prescription. In some countries, this is because prescriptions are not required. Some customers order drugs from such pharmacies to avoid the inconvenience of visiting a doctor or to obtain medications their doctors were unwilling to prescribe. People living in the United States and other countries where prescription medications are very expensive may turn to online pharmacies to save money. Many of these websites employ their own in-house physicians to review the medication request and write a prescription accordingly. Some websites offer medications without a prescription or a doctor review. This practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and the suitability of a medication for a specific individual. Pharmacies offering medication without requiring a prescription and doctor review or supervision are sometimes fraudulent and may supply counterfeit—and ineffective and possibly dangerous—medicines.

In the United States, there has been a push to legalize importation of medications from Canada and several European countries to reduce consumer costs. Although importation of prescription medication usually violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. Often Americans purchase lower-cost foreign drugs by driving to Canadian or Mexican pharmacies, buying their medications when traveling abroad on vacation, or, buying by mail from foreign pharmacies.

Health education | Understanding and definition of Health education

noreply@blogger.com (Unknown) — Mon, 03 Aug 2015 22:47:00 +0000

Health education is the profession of educating people about health. Areas within this profession encompass environmental health, physical health, social health, emotional health, intellectual health, and spiritual health. It can be defined as the principle by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance, or restoration of health. However, as there are multiple definitions of health, there are also multiple definitions of health education. The Joint Committee on Health Education and Promotion Terminology of 2001 defined Health Education as "any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions." The World Health Organization defined Health Education as "compris[ing] [of] consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health."
The Role of the Health Educator

From the late nineteenth to the mid-twentieth century, the aim of public health was controlling the harm from infectious diseases, which were largely under control by the 1950s. By the mid 1970s it was clear that reducing illness, death, and rising health care costs could best be achieved through a focus on health promotion and disease prevention. At the heart of the new approach was the role of a health educator A health educator is “a professionally prepared individual who serves in a variety of roles and is specifically trained to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups, and communities” (Joint Committee on Terminology, 2001, p. 100). In January 1979 the Role Delineation Project was put into place, in order to define the basic roles and responsibilities for the health educator. The result was a Framework for the Development of Competency-Based Curricula for Entry Level Health Educators (NCHEC, 1985). A second result was a revised version of A Competency-Based Framework for the Professional Development of Certified Health Education Specialists (NCHEC,1996). These documents outlined the seven areas of responsibilities which are shown below.

Health education is also an effective tool that helps improve health in developing nations. It not only teaches prevention and basic health knowledge but also conditions ideas that re-shape everyday habits of people with unhealthy lifestyles in developing countries. This type of conditioning not only affects the immediate recipients of such education but also future generations will benefit from an improved and properly cultivated ideas about health that will eventually be ingrained with widely spread health education. Moreover, besides physical health prevention, health education can also provide more aid and help people deal healthier with situations of extreme stress, anxiety, depression or other emotional disturbances to lessen the impact of these sorts of mental and emotional constituents, which can consequently lead to detrimental physical effects.

Teaching

In the United States some forty states require the teaching of health education. A comprehensive health education curriculum consists of planned learning experiences which will help students achieve desirable attitudes and practices related to critical health issues. Some of these are: emotional health and a positive self image; appreciation, respect for, and care of the human body and its vital organs; physical fitness; health issues of alcohol, tobacco, drug use and abuse; health misconceptions and myths; effects of exercise on the body systems and on general well being; nutrition and weight control; sexual relationships and sexuality, the scientific, social, and economic aspects of community and ecological health; communicable and degenerative diseases including sexually transmitted diseases; disaster preparedness; safety and driver education; factors in the environment and how those factors affect an individual's or population's Environmental health (ex: air quality, water quality, food sanitation); life skills; choosing professional medical and health services; and choices of health careers.

Health Education Code of Ethics

The Health Education Code of Ethics has been a work in progress since approximately 1976, begun by the Society of Public Health Education (SOPHE). Various Public Health and Health Education organizations such as the American Association of Health Education (AAHE), the Coalition of National Health Education Organizations (CNHEO), SOPHE, and others collaborated year after year to devise a unified standard of ethics that health educators would be held accountable to professionally. In 1995, the National Commission for Health Education Credentialing, Inc. (NCHEC) proposed a profession-wide standard at the conference: Health Education Profession in the Twenty-First Century: Setting the Stage. Post-conference, an ethics task force was developed with the purpose of solidifying and unifying proposed ethical standards. The document was eventually unanimously approved and ratified by all involved organizations in November 1999 and has since then been used as the standard for practicing health educators.

National Organizations for Public Health/Health Education

American Public Health Association (APHA) APHA is the main voice for public health advocacy that is the oldest organization of public health sine 1872. The American Public Health Association aims to “protect all Americans and their communities from preventable, serious health threats and strives to assure community-based health promotion and disease preventions.” Any individual can become a member and benefit in online access and monthly printed issues of The Nation’s Health and the American Journal of Public Health

Society for Public Health Education (SOPHE) The mission of SOPHE is to provide global leadership to the profession of health education and health promotion and to promote the health of society through advances in health education theory and research, excellence in professional preparation and practice, and advocacy for public policies conducive to health, and the achievement of health equity for all. Membership is open to all who have an interest in health education and or work in health education in schools, medical care settings, worksites, community based organizations, state/local government, and international agencies. Founded in 1950, SOPHE publishes 2 indexed, peer-reviewed journals, Health Education & Behavior and Health Promotion Practice.

American School Health Association (ASHA) The American School Health Association was founded in 1972 by a group of physicians that already belonged to the American Public Health Association. This group specializes in school-aged health specifically. Over the years it has snowballed and now includes any person that can be a part of a child’s life, from dentists, to counselors and school nurses. The American School Health Association mission “is to protect and promote the health of children and youth by supporting coordinated school health programs as a foundation for school success."

American Association of Health Education/American Alliance for Health, Physical Education, Recreation, and Dance (AAHE/AAHPERD) The AAHE/AAHPERD is said to be the largest organization of professionals that supports physical education; which includes leisure, fitness, dance, and health promotion. That is only a few; this incorporates all that is physical movement. This organization is an alliance with five national associations and six districts and is there to provide a comprehensive and coordinated array of resources to help support practitioners to improve their skills and always be learning new things. This organization was first stated in November 1885. William Gilbert Anderson had been out of medical school for two years and was working with many other people that were in the gymnastic field. He wanted them to get together to discuss their field and this organization was created. Today AAHPERD serves 25,000 members and has its headquarters in Reston, Virginia.

Eta Sigma Gamma (ESG) The Eta Sigma Gamma is a national health education organization founded in 1967 by three professor from Ball tate University. The mission of the ESG to promote public health education by improving the standards, ideals, capability, and ethics of public health education professionals. The three key points of the organization are to teach, research, and provide service to the members of the public health professionals. Some of the goals that the Eta Stigma Gamma targets are support planning and evaluation of future and existing health education programs, support and promote scientific research, support advocacy of health education issues, and promote professional ethics.

American College Health Association (ACHA) The American College Health Association originally began as a student health association in 1920, but then in 1948 the association changed the name to what its known today. The principal interest of the ACHA is to promote advocacy and leadership to colleges and universities around the country. Other part of the mission's association is to encourage education, communication, and services to students and campus community in general. The association also promotes advocacy and research. The American College Health Association has three types of membership: institutions of higher education, individual members who are interested in the public health profession, and susbtain members which are profitable and non-profitable organization. The ACHA is connected to 11 organizations located in six regions around the country. Currently, the American College Health Association serves 900 educative institutions and about 2400 individual members in the United States.

Directors of Health Promotion and Education (DHPE) Founded in 1946 as one of the professional groups of the Health Education Profession. The main goal of the HEPE is to improve the health education standards in any public health agency. As well, build networking opportunities among all public health professionals as a media to communicate ideas for implementing health programs, and to keep accurate information about the latest health news. The DHPE also focus to increase public awareness of health education and promotion by creating and expanding methods of existing health programs that will improve the quality of health. The Directors of Health Promotion and Education is linked to the Association of State and Territorial Health Officials (ASTHO) to "work on health promotion and disease prevention".

Antibacterial | Understanding and definition of antibiotic

noreply@blogger.com (Unknown) — Mon, 03 Aug 2015 22:46:00 +0000

An antibacterial is a compound or substance that kills or slows down the growth of bacteria. The term is often used synonymously with the term antibiotic(s); today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic(s) has come to denote a broader range of antimicrobial compounds, including anti-fungal and other compounds.

The term "antibiotic" was coined by Selman Waksman in 1942 to describe any substance produced by a microorganism that is antagonistic to the growth of other microorganisms in high dilution. This definition excluded substances that kill bacteria but are not produced by microorganisms (such as gastric juices and hydrogen peroxide). It also excluded synthetic antibacterial compounds such as the sulfonamides. Many antibacterial compounds are relatively small molecules with a molecular weight of less than 2000 atomic mass units.

With advances in medicinal chemistry, most of today's antibacterials chemically are semisynthetic modifications of various natural compounds. These include, for example, the beta-lactam antibacterials, which include the penicillins (produced by fungi in the genus 'Penicillium'), the cephalosporins, and the carbapenems. Compounds that are still isolated from living organisms are the aminoglycosides, whereas other antibacterials—for example, the sulfonamides, the quinolones, and the oxazolidinones—are produced solely by chemical synthesis. Accordingly, many antibacterial compounds are classified on the basis of chemical/biosynthetic origin into natural, semisynthetic, and synthetic. Another classification system is based on biological activity; in this classification antibacterials are divided into two broad groups according to their biological effect on microorganisms: bactericidal agents kill bacteria, and bacteriostatic agents slow down or stall bacterial growth.

Before the early twentieth century, treatments for infections were based primarily on medicinal folklore. Mixtures with antimicrobial properties that were used in treatments of infections were described over 2000 years ago. Many ancient cultures, including the ancient Egyptians and ancient Greeks used specially selected mold and plant materials and extracts to treat infections. More recent observations made in the laboratory of antibiosis between micro-organisms led to the discovery of natural antibacterials produced by microorganisms. Louis Pasteur observed that, "if we could intervene in the antagonism observed between some bacteria, it would offer perhaps the greatest hopes for therapeutics".

Florey and Chain succeeded in purifying penicillin. Purified penicillin displayed potent antibacterial activity against a wide range of bacteria and had low toxicity in humans. Furthermore, its activity was not inhibited by biological constituents such as pus, unlike the synthetic sulfonamides. The discovery of such a powerful antibiotic was unprecedented, and the development of penicillin led to renewed interest in the search for antibiotic compounds with similar efficacy and safety. For their discovery and development of penicillin as a therapeutic drug, Ernst Chain, Howard Florey, and Alexander Fleming shared the 1945 Nobel Prize in Medicine. Florey credited Dubos with pioneering the approach of deliberately and systematically searching for antibacterial compounds, which had led to the discovery of gramicidin and had revived Florey's research in penicillin.

The successful outcome of antimicrobial therapy with antibacterial compounds depends on several factors. These include host defense mechanisms, the location of infection, and the pharmacokinetic and pharmacodynamic properties of the antibacterial. A bactericidal activity of antibacterials may depend on the bacterial growth phase, and it often requires ongoing metabolic activity and division of bacterial cells. These findings are based on laboratory studies, and in clinical settings have also been shown to eliminate bacterial infection. Since the activity of antibacterials depends frequently on its concentration, in vitro characterization of antibacterial activity commonly includes the determination of the minimum inhibitory concentration and minimum bactericidal concentration of an antibacterial. To predict clinical outcome, the antimicrobial activity of an antibacterial is usually combined with its pharmacokinetic profile, and several pharmacological parameters are used as markers of drug efficacy.

Like antibiotics, antibacterials are commonly classified based on their mechanism of action, chemical structure, or spectrum of activity. Most antibacterial antibiotics target bacterial functions or growth processes. Antibiotics that target the bacterial cell wall (such as penicillins and cephalosporins), or cell membrane (for example, polymixins), or interfere with essential bacterial enzymes (such as quinolones and sulfonamides) have bactericidal activities. Those that target protein synthesis, such as the aminoglycosides, macrolides, and tetracyclines, are usually bacteriostatic. Further categorization is based on their target specificity. "Narrow-spectrum" antibacterial antibiotics target specific types of bacteria, such as Gram-negative or Gram-positive bacteria, whereas broad-spectrum antibiotics affect a wide range of bacteria. Following a 40-year hiatus in discovering new classes of antibacterial compounds, three new classes of antibiotics have been brought into clinical use. These new antibacterials are cyclic lipopeptides (including daptomycin), glycylcyclines (e.g., tigecycline), and oxazolidinones (including linezolid).

Since the first pioneering efforts of Florey and Chain in 1939, the importance of antibiotics, including antibacterials, to medicine has led to intense research into producing antibacterials at large scales. Following screening of antibacterials against a wide range of bacteria, production of the active compounds is carried out using fermentation, usually in strongly aerobic conditions.

Antibacterials are screened for any negative effects on humans or other mammals before approval for clinical use and are usually considered safe and most are well-tolerated. However, some antibacterials have been associated with a range of adverse effects. Side-effects range from mild to very serious depending on the antibiotics used, the microbial organisms targeted, and the individual patient. Safety profiles of newer drugs are often not as well established as for those that have a long history of use. Adverse effects range from fever and nausea to major allergic reactions including photodermatitis and anaphylaxis. Common side-effects include diarrhea, resulting from disruption of the species composition in the intestinal flora, resulting, for example, in overgrowth of pathogenic bacteria, such as Clostridium difficile. Antibacterials can also affect the vaginal flora, and may lead to overgrowth of yeast species of the genus Candida in the vulvo-vaginal area. Additional side-effects can result from interaction with other drugs, such as elevated risk of tendon damage from administration of a quinolone antibiotic with a systemic corticosteroid.

The majority of studies indicate that antibiotics do not interfere with contraceptive pills, such as clinical studies that suggest that the failure rate of contraceptive pills caused by antibiotics is very low (about 1%). In cases where antibacterials have been suggested to affect the efficiency of birth control pills, such as for the broad-spectrum antibacterial rifampicin, these cases may be due to an increase in the activities of hepatic liver enzymes causing increased breakdown of the pill's active ingredients. Effects on the intestinal flora, which might result in reduced absorption of estrogens in the colon, have also been suggested, but such suggestions have been inconclusive and controversial. Clinicians have recommended that extra contraceptive measures are applied during therapies using antibacterials that are suspected to interact with oral contraceptives.

Several molecular mechanisms of antibacterial resistance exist. Intrinsic antibacterial resistance may be part of the genetic makeup of bacterial strains. For example, an antibiotic target may be absent from the bacterial genome. Acquired resistance results from a mutation in the bacterial chromosome or the acquisition of extra-chromosomal DNA. Antibacterial-producing bacteria have evolved resistance mechanisms that have been shown to be similar to, and may have been transferred to, antibacterial-resistant strains. The spread of antibacterial resistance often occurs through vertical transmission of mutations during growth and by genetic recombination of DNA by horizontal genetic exchange. For instance, antibacterial resistance genes can be exchanged between different bacterial strains or species via plasmids that carry these resistance genes. Plasmids that carry several different resistance genes can confer resistance to multiple antibacterials. Cross-resistance to several antibacterials may also occur when a resistance mechanism encoded by a single gene conveys resistance to more than one antibacterial compound.

Antibacterial-resistant strains and species, sometimes referred to as "superbugs", now contribute to the emergence of diseases which were for a while well-controlled. For example, emergent bacterial strains causing tuberculosis (TB) that are resistant to previously effective antibacterial treatments pose many therapeutic challenges. Every year, nearly half a million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur worldwide. For example, NDM-1 is a newly identified enzyme conveying bacterial resistance to a broad range of beta-lactam antibacterials. United Kingdom Health Protection Agency has stated that "most isolates with NDM-1 enzyme are resistant to all standard intravenous antibiotics for treatment of severe infections."

Inappropriate antibacterial treatment and overuse of antibiotics have contributed to the emergence of antibacterial-resistant bacteria. Self prescription of antibacterials and their use as growth promoters in agriculture are additional examples of misuse. Many antibacterials are frequently prescribed to treat symptoms or diseases that do not respond to antibacterial therapy or are likely to resolve without treatment, or incorrect or sub-optimal antibacterials are prescribed for certain bacterial infections. The overuse of antibacterials, like penicillin and erythromycin, have been associated with emerging antibacterial resistance since the 1950s. Widespread usage of antibacterial drugs in hospitals has also been associated with increases in bacterial strains and species that no longer respond to treatment with the most common antibacterials.

Common forms of antibacterial misuse include excessive use of prophylactic antibiotics in travelers and failure of medical professionals to prescribe the correct dosage of antibacterials on the basis of the patient's weight and history of prior use. Other forms of misuse include failure to take the entire prescribed course of the antibacterial, incorrect dosage and administration, or failure to rest for sufficient recovery. Inappropriate antibacterial treatment, for example, is the prescription of antibacterials to treat viral infections such as the common cold. One study on respiratory tract infections found "physicians were more likely to prescribe antibiotics to patients who appeared to expect them". Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescription of antibiotics.

In agriculture, antibacterials are often used to promote weight gain in livestock animals. More than 70% of the antibacterials used in U.S. are given to livestock animals in the absence of infectious diseases. This practice has been associated with the emergence of antibacterial-resistant strains of bacteria including Salmonella spp., Campylobacter spp., Escherichia coli, and Enterococcus spp. The emergence of antibacterial resistance has prompted restrictions on antibacterial use in the UK in 1970 (Swann report 1969), and the EU has banned the use of antibacterials as growth-promotional agents since 2003. Moreover, several organizations (e.g., The American Society for Microbiology (ASM), American Public Health Association (APHA) and the American Medical Association (AMA)) have called for restrictions on antibiotic use in food animal production and an end to all non-therapeutic uses. However, commonly there are delays in regulatory and legislative actions to limit the use of antibacterials, partly attributable to resistance against such regulation by industries using or selling antibacterials, and to the time required for research to test causal links between antibacterial use and resistance. Two federal bills (S.742 and H.R. 2562) aimed at phasing out non-therapeutic use of antibacterials in US food animals were proposed but have not passed. These bills were endorsed by public health and medical organizations, including the American Holistic Nurses’ Association, the American Medical Association, and the American Public Health Association (APHA).

Amnesia | Understanding and definition of Amnesia | History and causes of Amnesia

noreply@blogger.com (Unknown) — Mon, 03 Aug 2015 22:45:00 +0000

Amnesia is a condition in which memory is disturbed or lost. The causes of amnesia have traditionally been divided into categories. Functional causes are psychological factors, such as mental disorder, post-traumatic stress or, in psychoanalytic terms, defense mechanisms. Amnesia may also appear as spontaneous episodes, in the case of transient global amnesia.

Anterograde amnesia

Anterograde amnesia is a loss of the ability to create new memories after the event that caused the amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event remain intact. Anterograde amnesia and retrograde amnesia, where memories created prior to the event are lost, can occur together in the same patient. To a large degree, anterograde amnesia remains a mysterious ailment because the precise mechanism of storing memories is not yet well understood, although it is known that the regions involved are certain sites in the temporal cortex, especially in the hippocampus and nearby subcortical regions.

Retrograde amnesia

Retrograde amnesia (RA) is a loss of access to events and information of the past after the onset of disease or injury . RA is often temporally graded, consistent with Ribot's Law: more recent memories closer to the traumatic incident are more likely to be forgotten than more remote memories.

However, there are different types of memory, for example procedural memory (i.e. automated skills) and declarative memory (personal episodes or abstract facts), and often only one type is impaired. For example, a person may forget the details of personal identity, but still retain a learned skill such as the ability to play the piano.

In addition, the terms are used to categorize patterns of symptoms rather than to indicate a particular cause (etiology). Both categories of amnesia can occur together in the same patient, and commonly result from drug effects or damage to the brain regions most closely associated with episodic memory: the medial temporal lobes and especially the hippocampus.

An example of mixed retrograde and anterograde amnesia may be a motorcyclist unable to recall driving his motorbike prior to his head injury (retrograde amnesia), nor can he recall the hospital ward where he is told he had conversations with family over the next two days (anterograde amnesia).

The effects of amnesia can last long after the condition has passed. Some sufferers claim that their amnesia changes from a neurological condition to also being a psychological condition, whereby they lose confidence and faith in their own memory and accounts of past events.

Another effect of some forms of amnesia may be impaired ability to imagine future events. A 2006 study showed that future experiences imagined by amnesiacs with bilaterally damaged hippocampus lacked spatial coherence, and the authors speculated that the hippocampus may bind different elements of experience together in the process of re-experiencing the past or imagining the future.

There are two types of amnesia: retrograde amnesia (loss of memories that were formed shortly before the injury) and anterograde amnesia (problems with creating new memories after the injury has taken place). Both retrograde and anterograde forms may be referred to as PTA, or the term may be used to refer only to anterograde amnesia.

Frequently the last symptom to ameliorate after a loss of consciousness, anterograde amnesia may not develop until hours after the injury. A common example in sports concussion is the quarterback who was able to conduct the complicated mental tasks of leading a football team after a concussion, but has no recollection the next day of the part of the game that took place after the injury. Retrograde amnesia sufferers may partially regain memory later, but memories are not regained with anterograde amnesia because they were not encoded properly.

The term "posttraumatic amnesia" was first used in 1928 in a paper by Symonds to refer to the period between the injury and the return of full, continuous memory, including any time during which the patient was unconscious.

Psychogenic amnesia, also known as functional amnesia or dissociative amnesia, is a memory disorder characterized by extreme memory loss that is caused by extensive psychological stress and that cannot be attributed to a known neurobiological cause. Psychogenic amnesia is defined by (a) the presence of retrograde amnesia (the inability to retrieve stored memories leading up to the onset of amnesia), and (b) an absence of anterograde amnesia (the inability to form new long term memories). Dissociative amnesia is due to psychological rather than physiological causes and can sometimes be helped by therapy.

There are two types of psychogenic amnesia, global and situation-specific. Global amnesia, also known as fugue state, refers to a sudden loss of personal identity that lasts a few hours to days, and is typically preceded by severe stress and/or depressed mood. Fugue state is very rare, and usually resolves over time, often helped by therapy. In most cases, patients lose their autobiographical memory and personal identity even though they are able to learn new information and perform everyday functions normally. Other times, there may be a loss of basic semantic knowledge and procedural skills such as reading and writing. Situation-specific amnesia occurs as a result of a severely stressful event, as in post-traumatic stress disorder, child sex abuse, military combat or witnessing a family member's murder or suicide, and is somewhat common in cases of severe and/or repeated trauma.

Repressed memory is a hypothetical concept used to describe a significant memory, usually of a traumatic nature, that has become unavailable for recall; also called motivated forgetting in which a subject blocks out painful or traumatic times in one's life. This is not the same as amnesia, which is a term for any instance in which memories are either not stored in the first place (such as with traumatic head injuries when short term memory does not transfer to long term memory) or forgotten.

The term is used to describe memories that have been dissociated from awareness as well as those that have been repressed without dissociation. Repressed memory syndrome, the clinical term used to describe repressed memories, is often compared to psychogenic amnesia, and some sources compare the two as equivalent.

According to proponents of the hypothesis, repressed memories may sometimes be recovered years or decades after the event, most often spontaneously, triggered by a particular smell, taste, or other identifier related to the lost memory, or via suggestion during psychotherapy.

The existence of repressed memories is a controversial topic in psychology; some studies have concluded that it can occur in victims of trauma, while others dispute it. According to the American Psychological Association, it is not currently possible to distinguish a true repressed memory from a false one without corroborating evidence.

A fugue state, formally dissociative fugue or psychogenic fugue (DSM-IV Dissociative Disorders 300.13), is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality. The state is usually short-lived (hours to days), but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. After recovery from fugue, previous memories usually return intact, but there is complete amnesia for the fugue episode. Additionally, an episode is not characterized as a fugue if it can be related to the ingestion of psychotropic substances, to physical trauma, to a general medical condition, or to psychiatric conditions such as delirium, dementia, bipolar disorder or depression. Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (Dissociative Amnesia).

Lacunar amnesia is the loss of memory about one specific event. It is a type of amnesia that leaves a lacuna (a gap) in the record of memory.

According to Steven Johnson, (the author of Mind Wide Open: Your Brain and the Neuroscience of Everyday Life):

"Scientists believe memories are captured and stored by two separate parts of the brain, the hippocampus, the normal seat of memory, and the amygdala, one of the brain's emotional centers. People who, due to hippocampus damage, are incapable of forming long-term memories can still form subconscious memories of traumatic events if their amygdala is intact. Someone suffering from the Memento condition would likely have a feeling of general unease encountering a person who had harmed them in the past, though they wouldn't be able to put their finger on why. As the plot of Eternal Sunshine correctly suggests, the brain is designed to preserve emotionally strong memories. Even amnesiacs, under the right circumstances, can remember their past feelings."

Furthermore, according to Alex Chadwick speaking on NPR:

"Some scientists now believe that memories effectively get rewritten every time they're activated. Studies on rats suggest that if you block a crucial chemical process during the execution of a learned behavior - pushing a lever to get food, for instance - the learned behavior disappears. The rat stops remembering. Theoretically, if you could block that chemical reaction in a human brain while triggering a specific memory, you could make a targeted erasure. Think of a dreadful fight with your girlfriend while blocking that chemical reaction, and zap! The memory's gone."

Daniel Goleman, in his book Vital Lies, Simple Truths, defines a lacuna as :

"... lacuna, from the Latin for gap or hole, to refer to the sort of mental apparatus that diversionary schemas represent. A lacuna is, then, the attentional mechanism that creates a defensive gap in awareness. Lacunas, in short, create blind spots "

Childhood amnesia (also known as infantile amnesia) is the common inability to remember events from one's own childhood. Sigmund Freud notoriously attributed this to sexual repression, while modern scientific approaches generally attribute it to aspects of brain development or developmental psychology, including language development

Transient global amnesia (TGA) is "one of the most striking syndromes in clinical neurology" whose key defining characteristic is temporary but almost total disruption of short-term memory with a range of problems accessing older memories. A person in a state of TGA exhibits no other signs of impaired cognitive functioning but recalls only the last few moments of consciousness plus deeply-encoded facts of the individual’s past, such as his or her own name.

Source amnesia is a memory disorder in which someone can recall certain information, but they do not know where or how they obtained the information.

Memory distrust syndrome is a term coined by Gísli Guðjónsson and James MacKeith in 1982, to describe those who distrust their own memories and are motivated to rely on external (non-self) sources to verify the accuracy of memories.

Memory distrust syndrome is associated with source amnesia, which prohibits full recollection of how one acquired a specific memory. Additionally, memory distrust syndrome involves confusion concerning the content or context of events, a highly attributable factor to confabulation in brain disease.

The overwhelming propensity to accept information from external sources (i.e. an interrogator) based on the influence of susceptibility has led to well documented false confessions. In addition, the credibility of a witness account who suffers from memory distrust syndrome is more questionable. In a parallel situation, amnesic individuals may have a greater propensity to have their memory manipulated and perhaps perform non-advantageous acts on the "direction" of external sources and have difficulty in differentiating imaginary and real experiences. Since the criminal law system considers source amnesia pathology to be an identified and natural occurrence, psychiatrists should increasingly take assessment and identification measures to isolate such a disorder in accused individuals and eye-witnesses.

A blackout is a phenomenon caused by the intake of alcohol or other substance in which long term memory creation is impaired or there is a complete inability to recall the past. Blackouts are frequently described as having effects similar to that of anterograde amnesia, in which the subject cannot create memories after the event that caused amnesia. 'Blacking out' is not to be confused with the mutually exclusive act of 'passing out', which means loss of consciousness. Research on alcohol blackouts was begun by E. M. Jellinek in the 1940s. Using data from a survey of Alcoholics Anonymous (AA) members, he came to believe that blackouts would be a good predictor of alcoholism. However, there are conflicting views as to whether this is true.

Korsakoff's syndrome (also called Korsakov's syndrome, Korsakoff's psychosis, or amnesic-confabulatory syndrome), is a neurological disorder caused by the lack of thiamine (vitamin B1) in the brain. The syndrome is named after Sergei Korsakoff, the neuropsychiatrist who popularized the theory.

Drug-induced amnesia is intentionally caused by injection of an amnesiac drug to help a patient forget surgery or medical procedures, particularly those not performed under full anesthesia, or likely to be particularly traumatic. Such drugs are also referred to as "premedicants." Most commonly a 2'-halogenated benzodiazepine such as midazolam or flunitrazepam is the drug of choice, although other strongly amnestic drugs such as propofol or scopolamine may also be used for this application. Memories of the short time frame in which the procedure was performed are permanently lost or at least substantially reduced, but once the drug wears off, memory is no longer affected.

Electroconvulsive therapy (ECT), formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown. Today, ECT is most often recommended for use as a treatment for severe depression which has not responded to other treatment, and is also used in the treatment of mania and catatonia. It was first introduced in 1938 and gained widespread use as a form of treatment in the 1940s and 1950s.

Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and positive outcomes. After treatment, drug therapy is usually continued, and some patients receive continuation/maintenance ECT. In the United Kingdom and Ireland, drug therapy is continued during ECT.

Informed consent is a standard of modern electroconvulsive therapy. According to the Surgeon General, involuntary treatment is uncommon in the United States and is typically only used in cases of great extremity, and only when all other treatment options have been exhausted and the use of ECT is believed to be a potentially life saving treatment. However, caution must be exercised in interpreting this assertion as, in an American context, there does not appear to have been any attempt to survey at national level the usage of ECT as either an elective or involuntary procedure in almost twenty years. In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent.

Despite the fact that the majority of psychiatric clinicians regard ECT as a safe and effective procedure, surveys of public opinion, the testimony of former patients, legal restrictions on its use and disputes as to the efficacy, ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial. This is reflected in the recent decision by the FDA's Neurological Devices Advisory Panel to maintain ECT devices in the Class III device category for high risk devices except for patients suffering from catatonia. This will result in the manufacturers of such devices having to do controlled trials on their safety and efficacy for the first time. In justifying their position panelists referred to the memory loss associated with ECT and the lack of long-term data.

Prosopamnesia is a rare neuropsychological deficit defined by an inability to remember faces. It can be subdivided into two different types, including a 'congenital' and 'acquired' version.

Congenital (developmental) prosopamnesia involves an inborn difficulty in remembering faces, but having intact facial recognition and perception abilities. These abilities can be tested using the Cambridge Face Perception and Cambridge Facial Memory Test, available online. A case report of congenital prosopamnesia demonstrated a subject's inability to neurologically "adapt" to images of faces using functional Magnetic Resonance Imaging (fMRI). The authors relate this deficiency to the brain's inability to maintain a stable perception of the face long enough to encode it into long-term memory.

Prosopamnesia should not be confused with the similar condition prosopagnosia, which is characterized by a difficulty perceiving faces. An inability to "see" faces in such a manner will naturally be associated with prosopamnesia, as a facial memory trace cannot be formed without an ability to initially see the face.

Depression | Understanding and definition of Depression | Symptoms of Depresi

noreply@blogger.com (Unknown) — Mon, 03 Aug 2015 22:41:00 +0000

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and physical well-being. It may include feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, irritability, or restlessness.

Depressed people may lose interest in activities that once were pleasurable, or suffer cognitive impairments (e.g., difficulty concentrating, remembering details, making decisions). They may contemplate or attempt suicide. Their weight may change dramatically. Insomnia, excessive sleeping, change in sleep patterns (e.g., waking in the middle of the night or early in the morning and being unable to fall asleep again), fatigue, loss of energy, and aches, pains or digestive problems that are resistant to treatment may be present.

Depressed mood is a normal reaction to certain life events, a symptom of many medical conditions (e.g., Addison's disease, hypothyroidism), and a feature of certain psychiatric syndromes.

A number of psychiatric syndromes feature depressed mood as a main symptom. Mood disorders are a group of disorders considered to be primary disturbances of mood. Within them, major depressive disorder (MDD), commonly called "major depression" or "clinical depression", is a condition where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all daily activities. People suffering bipolar disorder may also experience major depressive episodes. Dysthymia is a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Outside the mood disorders, moderate chronic depressed mood is also commonly a feature of borderline personality disorder. Adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode.

Depressed mood can be the result of a number of infectious diseases and physiological problems. For example, mononucleosis (glandular fever), which can be caused by two different viral infections, often results in symptoms that mimic a depressive psychiatric disorder; and depression is often one of the early symptoms of hypothyroidism (reduced activity of the thyroid gland). For a discussion of non-psychiatric medical illnesses that can cause depressed mood, see Depression (differential diagnoses).

Depression from life events can cause a dangerous feedback loop, and thus a self-fulfilling prophecy, where sad memories come to mind and cause deeper depression, all the while hurting the patient's abilities to problem solve and take initiative. A depressive mood from life events is a main focus of the field of positive psychology.

A 2010 Centers for Disease Control and Prevention survey investigated current depression in the United States during 2006 and 2008. Current depression was defined as either major depression or "other depression" during the 2 weeks preceding the survey. Among 235,067 adults (in 45 states, the District of Columbia [DC], Puerto Rico, and the U.S. Virgin Islands), 9.0% met the criteria for current depression, including 3.4% who met the criteria for major depression. By state, age-standardized estimates for current depression ranged from 4.8% in North Dakota to 14.8% in Mississippi.

A full patient medical history, physical assessment, and thorough evaluation of symptoms helps determine the cause of the depression. Standardized questionnaires can be helpful such as the Hamilton Rating Scale for Depression, and the Beck Depression Inventory.

A doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism; basic electrolytes and serum calcium to rule out a metabolic disturbance; and a full blood count including ESR to rule out a systemic infection or chronic disease. Adverse affective reactions to medications or alcohol misuse are often ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism, a cause of depression in men.

Subjective cognitive complaints appear in depressed people, but they can also be indicative of the onset of a dementing disorder, such as Alzheimer's disease. Cognitive testing and brain imaging can help distinguish depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. Investigations are not generally repeated for a subsequent episode unless there is a medical indication.

What will work to treat a person's depression depends on the cause. This means there are a wide variety of possible solutions, and it can be exceptionally difficult for doctors, psychiatrists and psychologists to know which one is needed. All of this is only harder for non-professionals, and so depressed individuals are advised to talk to professionals.

Although depression is a highly treatable condition, some forms of depression may not be preventable. That's because depression may be triggered by a chemical malfunctioning in the brain. However, the latest medical studies confirm that depression may often be alleviated or sometimes prevented with good health habits.

Proper diet, exercise, taking time out for fun and relaxation, not overworking, and saving time to do things you enjoy may work together to prevent a depressed mood.

Colorectal cancer | Understanding and definition of colorectal cancer

noreply@blogger.com (Unknown) — Mon, 03 Aug 2015 22:40:00 +0000

Colorectal cancer, less formally known as bowel cancer, is a cancer characterized by neoplasia in the colon, rectum, or vermiform appendix. Colorectal cancer is clinically distinct from anal cancer, which affects the anus.

Colorectal cancers start in the lining of the bowel. If left untreated, it can grow into the muscle layers underneath, and then through the bowel wall. Most begin as a small growth on the bowel wall: a colorectal polyp or adenoma. These mushroom-shaped growths are usually benign, but some develop into cancer over time. Localized bowel cancer is usually diagnosed through colonoscopy.

Invasive cancers that are confined within the wall of the colon (TNM stages I and II) are often curable with surgery, For example, in England and Wales over 90% of patients diagnosed at this stage will survive the disease beyond 5 years. If left untreated, they spread to regional lymph nodes (stage III). In England and Wales, around 48% of patients diagnosed at this stage survive the disease beyond five years. Cancer that metastasizes to distant sites (stage IV) is usually not curable; approximately 7% of patients in England and Wales diagnosed at this stage survive beyond five years.

Colorectal cancer is the third most commonly diagnosed cancer in the world, but it is more common in developed countries. More than half of the people who die of colorectal cancer live in a developed region of the world. GLOBOCAN estimated that, in 2008, 1.23 million new cases of colorectal cancer were clinically diagnosed, and that this type of cancer killed more than 600,000 people.

The symptoms of colorectal cancer depend on the location of tumor in the bowel, and whether it has spread elsewhere in the body (metastasis). Most of the symptoms may occur in other diseases as well, and hence none of the symptoms mentioned here is diagnostic of colorectal cancer. Symptoms and signs are divided into local, constitutional (affecting the whole body) and metastatic (caused by spread to other organs).

If a tumor has caused chronic occult bleeding, iron deficiency anemia may occur; this may be experienced as fatigue, palpitations and noticed as pallor (pale appearance of the skin). Colorectal cancer may also lead to weight loss, generally due to a decreased appetite.

More unusual constitutional symptoms are an unexplained fever and one of several paraneoplastic syndromes. The most common paraneoplastic syndrome is thrombosis, usually deep vein thrombosis.

The WCRF panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence "convincing" that alcoholic drinks increase the risk of colorectal cancer in men.

The NIAAA reports that: "Epidemiologic studies have found a small but consistent dose-dependent association between alcohol consumption and colorectal cancer even when controlling for fiber and other dietary factors. Despite the large number of studies, however, causality cannot be determined from the available data."

"Heavy alcohol use may also increase the risk of colorectal cancer" (NCI). One study found that "People who drink more than 30 grams of alcohol per day (and especially those who drink more than 45 grams per day) appear to have a slightly higher risk for colorectal cancer." Another found that "The consumption of one or more alcoholic beverages a day at baseline was associated with approximately a 70% greater risk of colon cancer."

One study found "While there was a more than twofold increased risk of significant colorectal neoplasia in people who drink spirits and beer, people who drank wine had a lower risk. In our sample, people who drank more than eight servings of beer or spirits per week had at least a one in five chance of having significant colorectal neoplasia detected by screening colonoscopy.".

Other research suggests "to minimize your risk of developing colorectal cancer, it's best to drink in moderation."

On its colorectal cancer page, the National Cancer Institute does not list alcohol as a risk factor; however, on another page it states, "Heavy alcohol use may also increase the risk of colorectal cancer".

Drinking may be a cause of earlier onset of colorectal cancer.

Pathogenesis

Colorectal cancer is a disease originating from the epithelial cells lining the colon or rectum of the gastrointestinal tract, most frequently as a result of mutations in the Wnt signaling pathway that artificially increase signaling activity. The mutations can be inherited or are acquired, and must probably occur in the intestinal crypt stem cell. The most commonly mutated gene in all colorectal cancer is the APC gene, which produces the APC protein. The APC protein is a "brake" on the accumulation of β-catenin protein; without APC, β-catenin accumulates to high levels and translocates (moves) into the nucleus, binds to DNA, and activates the transcription of genes that are normally important for stem cell renewal and differentiation but when inappropriately expressed at high levels can cause cancer. While APC is mutated in most colon cancers, some cancers have increased β-catenin because of mutations in β-catenin (CTNNB1) that block its degradation, or they have mutation(s) or other genes with function analogous to APC such as AXIN1, AXIN2, TCF7L2, or the Naked cuticle (Nkd) gene NKD1.

Beyond the defects in the Wnt-APC-beta-catenin signaling pathway, other mutations must occur for the cell to become cancerous. The p53 protein, produced by the TP53 gene, normally monitors cell division and kills cells if they have Wnt pathway defects. Eventually, a cell line acquires a mutation in the TP53 gene and transforms the tissue from an adenoma into an invasive carcinoma. (Sometimes the gene encoding p53 is not mutated, but another protective protein named BAX is.)

Other apoptotic proteins commonly deactivated in colorectal cancers are TGF-β and DCC (Deleted in Colorectal Cancer). TGF-β has a deactivating mutation in at least half of colorectal cancers. Sometimes TGF-β is not deactivated, but a downstream protein named SMAD is. DCC commonly has deletion of its chromosome segment in colorectal cancer.

Some genes are oncogenes - they are overexpressed in colorectal cancer. For example, genes encoding the proteins KRAS, RAF, and PI3K, which normally stimulate the cell to divide in response to growth factors, can acquire mutations that result in over-activation of cell proliferation. The chronological order of mutations is sometimes important, with a primary KRAS mutation generally leading to a self-limiting hyperplastic or borderline lesion, but if occurring after a previous APC mutation it often progresses to cancer. PTEN, a tumor suppressor, normally inhibits PI3K, but can sometimes become mutated and deactivated.

The pathology of the tumor is usually reported from the analysis of tissue taken from a biopsy or surgery. A pathology report will usually contain a description of cell type and grade. The most common colon cancer cell type is adenocarcinoma which accounts for 95% of cases. Other, rarer types include lymphoma and squamous cell carcinoma.

Cancers on the right side (ascending colon and cecum) tend to be exophytic, that is, the tumour grows outwards from one location in the bowel wall. This very rarely causes obstruction of feces, and presents with symptoms such as anemia. Left-sided tumours tend to be circumferential, and can obstruct the bowel much like a napkin ring.

Adenocarcinoma is a malignant epithelial tumor, originating from glandular epithelium of the colorectal mucosa. It invades the wall, infiltrating the muscularis mucosae, the submucosa and thence the muscularis propria. Tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma ("back to back" aspect). Sometimes, tumor cells are discohesive and secrete mucus, which invades the interstitium producing large pools of mucus/colloid (optically "empty" spaces) - mucinous (colloid) adenocarcinoma, poorly differentiated. If the mucus remains inside the tumor cell, it pushes the nucleus at the periphery - "signet-ring cell." Depending on glandular architecture, cellular pleomorphism, and mucosecretion of the predominant pattern, adenocarcinoma may present three degrees of differentiation: well, moderately, and poorly differentiated.

Most colorectal cancer tumors are thought to be cyclooxygenase-2 (COX-2) positive. This enzyme is generally not found in healthy colon tissue, but is thought to fuel abnormal cell growth.

Most colorectal cancers arise from adenomatous polyps. These lesions can be detected and removed during colonoscopy. Studies show this procedure would decrease by > 80% the risk of cancer death, provided it is started by the age of 50, and repeated every 5 or 10 years.

The comparison of colorectal cancer incidence in various countries strongly suggests that sedentarity, overeating (i.e., high caloric intake), and perhaps a diet high in meat (red or processed) could increase the risk of colorectal cancer. In contrast, a healthy body weight, physical fitness, and good nutrition decreases cancer risk in general. Accordingly, lifestyle changes could decrease the risk of colorectal cancer as much as 60-80%.

More than 200 agents, including the above cited phytochemicals, and other food components like calcium or folic acid (a B vitamin), and NSAIDs like aspirin, are able to decrease carcinogenesis in pre-clinical development models: Some studies show full inhibition of carcinogen-induced tumours in the colon of rats. Other studies show strong inhibition of spontaneous intestinal polyps in mutated mice (Min mice). Chemoprevention clinical trials in human volunteers have shown smaller prevention, but few intervention studies have been completed today. The "chemoprevention database" shows the results of all published scientific studies of chemopreventive agents, in people and in animals.

A scientific review undertaken by the National Cancer Institute found that vitamin D was beneficial in preventing colorectal cancer, which showed an inverse relationship with blood levels of 80 nmol/L or higher associated with a 72% risk reduction compared with lower than 50 nmol/L. A possible mechanism is inhibition of Hedgehog signal transduction.

The treatment depends on the stage of the cancer. When colorectal cancer is caught at early stages (with little spread), it can be curable. However, when it is detected at later stages (when distant metastases are present), it is less likely to be curable.

Surgery remains the primary treatment, while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors.

Because colon cancer primarily affects the elderly, it can be a challenge to determine how aggressively to treat a particular patient, especially after surgery. Clinical trials suggest "otherwise fit" elderly patients fare well if they have adjuvant chemotherapy after surgery, so chronological age alone should not be a contraindication to aggressive management.

Breastfeeding | The benefits and advantages Breastfeeding

noreply@blogger.com (Unknown) — Mon, 03 Aug 2015 22:39:00 +0000

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e., via lactation) rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or more, without the addition of infant formula or solid food. After the addition of solid food, mothers are advised to continue breast-feeding up to a year, and can continue until two years.

Human breast milk is the healthiest form of milk for babies. There are few exceptions, such as when the mother is taking certain drugs or is infected with human T-lymphotropic virus, HIV, or has active untreated tuberculosis. Breastfeeding promotes health and helps to prevent disease. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries. Experts agree that breastfeeding is beneficial, but have conflicting views about how long breastfeeding remains beneficial. They also express concerns about the risks of using artificial formulas.

The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life and then supplemented breastfeeding for at least one year and up to two years or more. While recognizing the superiority of breastfeeding, regulating authorities also work to minimize the risks of artificial feeding.

During breastfeeding, antibodies pass to the baby. This is one of the most important features of colostrum, the breast milk created for newborns. Breast milk contains several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria) and immunoglobulin A protecting against microorganisms.

Fewer infections

Among the studies showing that breastfed infants have a lower risk of infection than non-breastfed infants are:

In a 1993 University of Texas Medical Branch study, a longer period of breastfeeding was associated with a shorter duration of some middle ear infections (otitis media with effusion) in the first two years of life.
A 1995 study of 87 infants found that breastfed babies had half the incidence of diarrheal illness, 19% fewer cases of any otitis media infection, and 80% fewer prolonged cases of otitis media than formula fed babies in the first twelve months of life.
Breastfeeding appeared to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital in a 2002 study of 39 infants.
A 2004 case-control study found that breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months of age, with the protection strongest immediately after birth.
The 2007 review for AHRQ found that breastfeeding reduced the risk of acute otitis media, non-specific gastroenteritis, and severe lower respiratory tract infections.

Higher intelligence

Studies have examined whether breastfeeding in infants is associated with higher intelligence later in life. Many have found a connection:

Horwood, Darlow and Mogridge (2001) tested the intelligence quotient (IQ) scores of 280 low birthweight children at seven or eight years of age. Those who were breastfed for more than eight months had verbal IQ scores 6 points higher (which was significantly higher) than comparable children breastfed for less time. They concluded "These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development."
A 2005 study using data on 2,734 sibling pairs from the National Longitudinal Study of Adolescent Health "provide[d] persuasive evidence of a causal connection between breastfeeding and intelligence." The same data "also suggests that nonexperimental studies of breastfeeding overstate some of [breastfeeding's] other long-term benefits, even if controls are included for race, ethnicity, income, and education."
The 2007 review for the WHO "suggests that breastfeeding is associated with increased cognitive development in childhood." The review also states that "The issue remains of whether the association is related to the properties of breastmilk itself, or whether breastfeeding enhances the bonding between mother and child, and thus contributes to intellectual development."
* Two initial cohort studies published in 2007 suggest babies with a specific version of the FADS2 gene demonstrated an IQ averaging 7 points higher if breastfed, compared with babies with a less common version of the gene who showed no improvement when breastfed. FADS2 affects the metabolism of polyunsaturated fatty acids found in human breast milk, such as docosahexaenoic acid and arachidonic acid, which are known to be linked to early brain development. The researchers were quoted as saying "Our findings support the idea that the nutritional content of breast milk accounts for the differences seen in human IQ. But it's not a simple all-or-none connection: it depends to some extent on the genetic makeup of each infant." The researchers wrote "further investigation to replicate and explain this specific gene–environment interaction is warranted."
In "the largest randomized trial ever conducted in the area of human lactation," between 1996 and 1997 maternity hospitals and polyclinics in Belarus were randomized to receive or not receive breastfeeding promotion modeled on the Baby Friendly Hospital Initiative. Of 13,889 infants born at these hospitals and polyclinics and followed up in 2002-2005, those who had been born in hospitals and polyclinics receiving breastfeeding promotion had IQs that were 2.9-7.5 points higher (which was significantly higher). Since (among other reasons) a randomized trial should control for maternal IQ, the authors concluded in a 2008 paper that the data "provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development."

However, some have not found a connection:

In 2006, Der and colleagues, having performed a prospective cohort study, sibling pairs analysis, and meta-analysis, concluded that "Breast feeding has little or no effect on intelligence in children." The researchers found that "Most of the observed association between breast feeding and cognitive development is the result of confounding by maternal intelligence."
The 2007 review for the AHRQ found "no relationship between breastfeeding in term infants and cognitive performance."

Less diabetes

Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods. Breastfeeding also appears to protect against diabetes mellitus type 2, at least in part due to its effects on the child's weight.

Less childhood obesity

Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months. The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding. A study has also shown that infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are breastfed. "Bottle-feeding, regardless of the type of milk, is distinct from feeding at the breast in its effect on infants' self-regulation of milk intake." According to the study, this may be due to one of three possible factors, including that when bottle feeding, parents may encourage an infant to finish the contents of the bottle whereas when breastfeeding, an infant naturally developes self-regulation of milk intake.

Less tendency to develop allergic diseases (atopy)

In children who are at risk for developing allergic diseases (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age. However, the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding. Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.

Less necrotizing enterocolitis in premature infants

Necrotizing enterocolitis (NEC) is an acute inflammatory disease in the intestines of infants. Necrosis or death of intestinal tissue may follow. It is mainly found in premature births. In one study of 926 preterm infants, NEC developed in 51 infants (5.5%). The death rate from necrotizing enterocolitis was 26%. NEC was found to be six to ten times more common in infants fed formula exclusively, and three times more common in infants fed a mixture of breast milk and formula, compared with exclusive breastfeeding. In infants born at more than 30 weeks, NEC was twenty times more common in infants fed exclusively on formula. A 2007 meta-analysis of four randomized controlled trials found "a marginally statistically significant association" between breastfeeding and a reduction in the risk of NEC.

Other long term health effects

In one study, breastfeeding did not appear to offer protection against allergies. However, another study showed breastfeeding to have lowered the risk of asthma, protect against allergies, and provide improved protection for babies against respiratory and intestinal infections.

A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offered life-long protection.

An initial study at the University of Wisconsin found that women who were breast fed in infancy may have a lower risk of developing breast cancer than those who were not breast fed.

Breastfeeding may decrease the risk of cardiovascular disease in later life, as indicated by lower cholesterol and C-reactive protein levels in adult women who had been breastfed as infants. Although a 2001 study suggested that adults who had been breastfed as infants had lower arterial distensibility than adults who had not been breastfed as infants, the 2007 review for the WHO concluded that breastfed infants "experienced lower mean blood pressure" later in life. A 2007 review for the AHRQ found that "there is an association between a history of breastfeeding during infancy and a small reduction in adult blood pressure, but the clinical or public health implication of this finding is unclear". A 2006 study found that breastfed babies are better able to cope with stress later in life.

Less overweight

Doctors have long known that breast-fed infants are less likely to become overweight. A study in Today's Pediatrics associates solid food given too early to Formula-fed babies before 4 months old will make them 6 times as likely to become obese by age 3. It does not happen if the babies were given solid foods with breast feeding.

Benefits for mothers

Breastfeeding is a cost effective way of feeding an infant, providing nourishment for a child at a small cost to the mother. Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control. During breastfeeding beneficial hormones are released into the mother's body and the maternal bond can be strengthened. Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point.

Bonding

Hormones released during breastfeeding help to strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates. Support for a mother while breastfeeding can assist in familial bonds and help build a paternal bond between father and child.

If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk. The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. To be successful, the mother must produce and store enough milk to feed the child for the time she is away, and the feeding caregiver must be comfortable in handling breast milk.

Hormone release

Breastfeeding releases oxytocin and prolactin, hormones that relax the mother and make her feel more nurturing toward her baby. Breastfeeding soon after giving birth increases the mother's oxytocin levels, making her uterus contract more quickly and reducing bleeding. Pitocin, a synthetic hormone used to make the uterus contract during and after labour, is structurally modelled on oxytocin. Syntocinon, another synthetic oxytocic, is commonly used in Australia and the UK rather than Pitocin.

Weight loss

As the fat accumulated during pregnancy is used to produce milk, extended breastfeeding—at least 6 months—can help mothers lose weight. However, weight loss is highly variable among lactating women; monitoring the diet and increasing the amount/intensity of exercise are more reliable ways of losing weight. The 2007 review for the AHRQ found "The effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear."

Natural postpartum infertility

Breastfeeding may delay the return to fertility for some women by suppressing ovulation. A breastfeeding woman may not ovulate, or have regular periods, during the entire lactation period. The period in which ovulation is absent differs for each woman. This lactational amenorrhea has been used as an imperfect form of natural contraception, with greater than 98% effectiveness during the first six months after birth if specific nursing behaviors are followed. It is possible for women to ovulate within two months after birth while fully breastfeeding and get pregnant again.

Long-term health effects

For breastfeeding women, long-term health benefits include:

Less risk of breast cancer, ovarian cancer, and endometrial cancer.
A 2009 study indicated that lactation for at least 24 months is associated with a 23% lower risk of coronary heart disease.
Although the 2007 review for the AHRQ found "no relationship between a history of lactation and the risk of osteoporosis", mothers who breastfeed longer than eight months benefit from bone re-mineralisation.
Breastfeeding diabetic mothers require less insulin.
Reduced risk of metabolic syndrome
Reduced risk of post-partum bleeding.
According to a Malmö University study published in 2009, women who breast fed for a longer duration have a lower risk for contracting rheumatoid arthritis than women who breast fed for a shorter duration or who had never breast fed.

Health effects

Priscilla Colletto stated in Beyond Toddlerhood: The Breastfeeding Relationship Continues, “The adverse health effects of weaning a child before or during toddlerhood are well documented for Third World countries such as Guinea-Bissau, where children who were no longer breastfed at ages 12-35 months had a 3.5 times higher mortality rate than did their peers who continued to breastfeed.” Dr. Laurence Grummer-Strawn observed that breastfeeding is protective against diarrheal diseases and other infections, breastfed children aged 12 to 36 months in Indonesia have much greater mid-arm circumference than children who have been weaned, and the incidences of malnourishment in breastfed Indonesian children are 3-5% less common than generally encountered in Indonesian clinics. Studies suggest that extended breastfeeding may reduce the chances of otitis media allergies, leukemia, and lymphoma for the toddler, and premenopausal breast cancer in the mother. This is attributed to the fact that the levels of lysozyme, lactoferrin, and secretory IgA are stable and even increase in the breast milk of mothers who are breastfeeding for over 1 year. (Stein 1507). In one study, artificially-fed infants had 2 to 3 times as many episodes of significant illnesses (defined as “otitis media, lower respiratory disease, significant vomiting or diarrhea, and any illness requiring hospital admission”). However, there are also some studied risks involved in extended breastfeeding. Breastfeeding could impair a child's growth if they are not taught to eat other foods as well. Breast milk alone is not enough for children over 6 months of age and some have observed that children that have been breastfed longer than the norm have less of an appetite for added foods. Stein says that “As long as a toddler is eating a variety of grains, vegetables, fruits, and foods or supplements that provide adequate iron and vitamin D, nutrition will be adequate and appropriate growth and development will be ensured.”

Psychological effects

In A Time to Wean by Katherine Dettwyler, it states that “Western, industrialized societies can compensate for some (but not all) of the immunological benefits of breastfeeding with antibiotics, vaccines and improved sanitation. But the physical, cognitive, and emotional needs of the young child persist.” Many children who are breast-fed into their toddler years use the milk as a comforting, bonding moment with their mothers. In a 1974 survey of 152 mothers, 17% said that the security their toddlers obtained through extended breastfeeding helped them become more independent, 14% said that extended breastfeeding created a strong mother-child bond, and 14.6% said that extended breastfeeding strengthened their abilities as a mother. Four mothers said that they felt their child was too dependent and one mother considered her child a poor eater. Dr. Stein said that “A mother in my practice who breastfed 2 children until 2 years of age explained that she would slowdown and give her undivided attention to her child several times each day when breastfeeding. Her children knew that she always had time for those moments each day. This time was also important to the mother for relaxing and unwinding....For many nursing toddlers, the breast comes to serve the same function as a favorite blanket or stuffed animal in providing comfort and a sense of security.” One issue with extended breastfeeding is the ability of the mother and the child to separate. Some say that the desire for extended breastfeeding comes from the mother's inability to let go of “her baby”. Baldwin refutes this statement, saying that the child is the one who chooses when they are weaned, as it is very difficult to force a child to breastfeed.(source:wikipedia.org)

Bipolar disorder | Understanding and definition of Bipolar disorder | Bipolar disorder symptoms and prevention

noreply@blogger.com (Unknown) — Wed, 06 Jul 2011 11:52:00 +0000

Bipolar disorder or manic-depressive disorder, also referred to as bipolar affective disorder or manic depression, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes, or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of "normal" mood; but, in some individuals, depression and mania may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to such psychotic symptoms as delusions and hallucinations. The disorder has been subdivided into bipolar I, bipolar II, cyclothymia, and other types, based on the nature and severity of mood episodes experienced; the range is often described as the bipolar spectrum.

Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizing medications and, sometimes, other psychiatric drugs. Psychotherapy also has a role, often when there has been some recovery of the subject's stability. In serious cases, in which there is a risk of harm to oneself or others, involuntary commitment may be used. These cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder. People with bipolar disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having schizophrenia, another serious mental illness.

The current term "bipolar disorder" is of fairly recent origin and refers to the cycling between high and low episodes (poles). A relationship between mania and melancholia had long been observed, although the basis of the current conceptualisation can be traced back to French psychiatrists in the 1850s. The term "manic-depressive illness" or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all kinds of mood disorder. German psychiatrist Karl Leonhard split the classification again in 1957, employing the terms unipolar disorder (major depressive disorder) and bipolar disorder.

Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and, in many cases, abnormally depressed states for periods of time in a way that interferes with functioning. Not everyone's symptoms are the same, and there is no simple physiological test to confirm the disorder. Bipolar disorder can appear to be unipolar depression. Diagnosing bipolar disorder is often difficult, even for mental health professionals. What distinguishes bipolar disorder from unipolar depression is that the affected person experiences states of mania and depression. Often bipolar is inconsistent among patients because some people feel depressed more often than not and experience little mania whereas others experience predominantly manic symptoms. Additionally, the younger the age of onset—bipolar disorder starts in childhood or early adulthood in most patients—the more likely the first few episodes are to be depression. Because a bipolar diagnosis requires a manic or hypomanic episode, many patients are initially diagnosed and treated as having major depression.

Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation. In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant. A major depressive episode persists for at least two weeks, and may continue for over six months if left untreated.

The causes of bipolar disorder likely vary between individuals. Twin studies have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For bipolar I, the (probandwise) concordance rates in modern studies have been consistently put at around 40% in monozygotic twins (same genes), compared to 0 to 10% in dizygotic twins. A combination of bipolar I, II and cyclothymia produced concordance rates of 42% vs 11%, with a relatively lower ratio for bipolar II that likely reflects heterogeneity. The overall heritability of the bipolar spectrum has been put at 0.71. There is overlap with unipolar depression and if this is also counted in the co-twin the concordance with bipolar disorder rises to 67% in monozigotic twins and 19% in dizigotic. The relatively low concordance between dizygotic twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes.

Abnormalities in the structure and/or function of certain brain circuits could underlie bipolar. Two meta-analyses of MRI studies in bipolar disorder report a increase in the volume of the lateral ventricles, globus pallidus and increase in the rates of deep white matter hyperintensities.

The "kindling" theory asserts that people who are genetically predisposed toward bipolar disorder can experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, a mood episode can start (and become recurrent) by itself. There is evidence of hypothalamic-pituitary-adrenal axis (HPA axis) abnormalities in bipolar disorder due to stress.

Other brain components which have been proposed to play a role are the mitochondria, and a sodium ATPase pump, causing cyclical periods of poor neuron firing (depression) and hypersensitive neuron firing (mania). This may only apply for type one, but type two apparently results from a large confluence of factors. Circadian rhythms and melatonin activity also seem to be altered.

Evidence suggests that environmental factors play a significant role in the development and course of bipolar disorder, and that individual psychosocial variables may interact with genetic dispositions. There is fairly consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, as they do for onsets and recurrences of unipolar depression. There have been repeated findings that between a third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated on average with earlier onset, a worse course, and more co-occurring disorders such as PTSD. The total number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without, particularly events stemming from a harsh environment rather than from the child's own behavior. Early experiences of adversity and conflict are likely to make subsequent developmental challenges in adolescence more difficult, and are likely a potentiating factor in those at risk of developing bipolar disorder.

Criteria and subtypes

There is no clear consensus as to how many types of bipolar disorder exist. In DSM-IV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists three specific subtypes and one for non-specified:

Bipolar I disorder : One or more manic episodes. Subcategories specify whether there has been more than one episode, and the type of the most recent episode. A depressive or hypomanic episode is not required for diagnosis, but it frequently occurs.
Bipolar II disorder : No manic episodes, but one or more hypomanic episodes and one or more major depressive episode. However, a bipolar II diagnosis is not a guarantee that they will not eventually suffer from such an episode in the future. Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without psychosis), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.
Cyclothymia : A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. There is a low-grade cycling of mood which appears to the observer as a personality trait, and interferes with functioning.
Bipolar Disorder NOS (Not Otherwise Specified) : This is a catchall category, diagnosed when the disorder does not fall within a specific subtype. Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.

There are a number of pharmacological and psychotherapeutic techniques used to treat bipolar disorder. Individuals may use self-help and pursue recovery.

Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (if mental health legislation allows and varying state-to-state regulations in the USA) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although these can still occur. Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment and patient-led support groups, intensive outpatient programs. These are sometimes referred to partial-inpatient programs.

The mainstay of treatment is a mood stabilizers such as lithium carbonate or lamotrigine. Lamotrigine has been found to be best for preventing depressions, while lithium is the only drug proven to reduce suicide in people with bipolar disorder. These two drugs comprise several unrelated compounds which have been shown to be effective in preventing relapses of manic, or in the one case, depressive episodes. The first known and "gold standard" mood stabilizer is lithium, while almost as widely used is sodium valproate, also used as an anticonvulsant. Other anticonvulsants used in bipolar disorder include carbamazepine, reportedly more effective in rapid cycling bipolar disorder, and lamotrigine, which is the first anticonvulsant shown to be of benefit in bipolar depression. Depending on the severity of the case, anti-convulsants may be used in combination with lithium-based products or on their own.

Atypical antipsychotics have been found to be effective in managing mania associated with bipolar disorder. Antidepressants have not been found to be of any benefit over that found with mood stabilizers.

Omega 3 fatty acids, in addition to normal pharmacological treatment, may have beneficial effects on depressive symptoms, although studies have been scarce and of variable quality. The effectiveness of topiramate is unknown.

Prognosis depends on many factors such as the right medicines and dosage, comprehensive knowledge of the disease and its effects; a positive relationship with a competent medical doctor and therapist; and good physical health, which includes exercise, nutrition, and a regulated stress level. There are other factors that lead to a good prognosis, such as being very aware of small changes in a person's energy, mood, sleep and eating behaviors.

A recent 20-year prospective study on bipolar I and II found that functioning varied over time along a spectrum from good to fair to poor. During periods of major depression or mania (in BPI), functioning was on average poor, with depression being more persistently associated with disability than mania. Functioning between episodes was on average good — more or less normal. Subthreshold symptoms were generally still substantially impairing, however, except for hypomania (below or above threshold) which was associated with improved functioning.

Hearing aid | Tools to Assist Hearing

noreply@blogger.com (Unknown) — Wed, 06 Jul 2011 11:50:00 +0000

Hearing Aid

Hearing aids are an electric acoustic devices that can be used by people with impaired hearing function of the ear. Usually, this tool can be mounted on a portion of the human ear or in part around the ear. Hearing aids were created to strengthen the stimulus portion of the sensory cells of the inner ear are damaged to the stimulus sound and the sounds from outside. Hearing aid is an electronic device that uses batteries which in its use there is a microphone that converts the sound waves into electrical energy which is then received by amplifier that can increase volume and sends it to the speaker who is on the inside of the ear. If you want to use a hearing aid it is necessary first to examine the threshold of hearing with a tool called an audiogram. Only then can be determined what type and model suitable for cases of hearing damage suffered.

The basic form of hearing aids

Tools with models in the ear (In the ear aids (ITC) can be used for people with hearing loss categories from mild to medium category. This tool provides more comfort to the wearer because it is located on the inside and not visible from outside. In this equipment components mounted telecoil, which is a small magnetic coil that can enable users of hearing aids is to be more comfortable in her phone.

Models behind the ear (BTE)

This type is mounted on the back telinga.dapat use on condition of ear damage from mild to severe category. This tool uses mold components that serves as a purifier ears sound.

Forms canal

Canal shape consists of two types namely ITC and ICC. ITC hearing aid type of shape and size can be adjusted by users. The tools of this type are relatively small. Another type is the ICC. This tool is located inside the ear canal. Both these tools are very convenient to use because of its small size. But for both kinds of lat aid has only a little space that can be used to store spare batteries and a built-in microphone. This tool is not recommended for patients with fairly severe hearing loss and also less is recommended for use by children.

Stethoscope | History Inventors Stethoscope | Stethoscope Definition and Purpose

noreply@blogger.com (Unknown) — Wed, 06 Jul 2011 11:48:00 +0000

Stethoscope

Stethoscope (Greek: stethos, chest and skopeein, check) is an acoustic medical device for checking the sound in the body. He used to hear heart sounds and breathing, although he also used to hear the intestine and blood flow in the arteries and the "vein".

Stethoscope found in France in 1816 by René-Théophile-Hyacinthe Laennec. It consists of empty wooden tube. It is said he invented the stethoscope so that he would not have put his ear on her breasts France. It is unclear whether Laennec try to avoid it, or to avoid the embarrassment of the patient. However, people say that "Necessity is the mother of invention."

The most common acoustic stethoscope is used, and operated by channeling the sound from the chest, through an empty tube containing the-air, to the listener's ear. Section "chestpiece" usually consists of two sides that can be diletakaan in the patient's body to clarify the sound; sebuaah diaphgram (plastic disc) or "bell" (empty bowl). When diaphgram placed on the patient, body sounds vibrate the diaphgram, creating acoustic pressure waves that run through the tube into the listener's ear. When the "bell" is placed in the patient's body getarakn skin directly produce acoustic pressure wave that runs into the listener's ear. Bell's low frequency sound channel, whereas channel diaphgram higher sound frequencies. Two-sided stethoscope was invented by Rappaport and Sprague in the early 20th century. The problem with acoustic stethoscopes is the sound level is very low, making diagnosis difficult.

Electronic stethoscopes overcome the low sound levels by strengthening the body's voice. Right now, there has been some companies offer electronic stethoscopes, and maybe in a few years, the electronic stethoscope will be more common than an acoustic stethoscope.

Stethoscope is used as a tool to diagnose certain diseases. Stethoscope to a particular voice channel and eliminate the other voices. Before the stethoscope was found, doctors put his ear close to the patient's body in hopes to hear something.

Stethoscope is often regarded as a symbol of physician work, because doctors often seen or depicted with a stethoscope hanging around his neck.

Stethoscope is also used by mechanics to isolate specific sounds from the machine for diagnosis.

Education and Medical Profession in Indonesia

noreply@blogger.com (Unknown) — Wed, 06 Jul 2011 11:47:00 +0000

Medical education is the process of medical education to be implemented in the community.

Education and training of medical science in each country varies, but in almost all education is opened starting from medical school or faculty of medicine at the university level during the specified time.

In Indonesia, medical education was opened at the university medical school. Students must be educated strata-1 for about 3.5 years to earn a Bachelor of Medicine (Sked). After that to become a doctor, students must follow the doctor's professional education for 1.5 years. When it has taken the oath, a doctor recommended the temporary employees (PTT) government to be deployed to the area during a specified time. A general practitioner may take appropriate pilihannya.Saat education specialization is curriculum of medical education in Indonesia adopted a learning system based on an issue or problem based learning (PBL).

Certificate of Competency for Physicians

Certificate of Competency for Doctors graduates need to be made before 29 April 2007 and has not filed manufacture Registration Certificate (STR) to the Medical Council of Indonesia (KKI). Certificate of Competency-making process is only valid until October 29, 2007 (the latest date the filing STRs to KKI by letter KKI No. KK. 01.03/KKI/Reg/IV/301). Certificate of Competence will be sent to the correspondence address listed in the registration form by Registered Post.

About of Celgene | History of Celgene

noreply@blogger.com (Unknown) — Wed, 06 Jul 2011 11:45:00 +0000

Celgene Corporation is a manufacturer of drug therapies for cancer and inflammatory disorders. It is incorporated in Delaware and headquartered in Summit, New Jersey. The company's major products are THALOMID (thalidomide), which is approved for the acute treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum ("ENL"), as well as in combination with dexamethasone for patients with newly diagnosed multiple myeloma, and REVLIMID (lenalidomide), for which the company has received FDA and EMEA approval in combination with dexamethasone for the treatment of multiple myeloma patients who have received at least one prior therapy. REVLIMID is also approved in the United States for the treatment of patients with transfusion-dependent anemia due to Low- or Intermediate-1-risk MDS associated with a deletion 5q cytogenetic abnormality with or without additional cytogenetic abnormalities. Both THALOMID and REVLIMID are sold through proprietary risk-management distribution programs to ensure safe and appropriate use of these pharmaceuticals. Celgene also receives royalties from Novartis Pharma AG on sales of the entire RITALIN family of drugs, which are widely used to treat Attention Deficit Hyperactivity Disorder (ADHD).

Celgene Cellular Therapeutics, a subsidiary, is a public cord blood bank.

History

In 1986, Celgene, originally a unit of the Celanese Corporation, was spun off as an independent company following the merger of Celanese Corporation with American Hoechst Corporation.

In July 1998, Celgene received approval from the FDA to market THALOMID for the acute treatment of the cutaneous manifestations of moderate to severe ENL.

In April 2000, Celgene reached an agreement with Novartis Pharma AG to license d-MPH, Celgene's chirally pure version of RITALIN. The FDA subsequently granted approval to market d-MPH, or FOCALIN, in November 2001.

In August 2000, Celgene acquired Signal Pharmaceuticals, Inc., a privately held company that searches for and develops pharmaceuticals that regulate disease-related genes. Signal Pharmaceuticals, Inc. now operates as Celgene Research San Diego, a wholly owned subsidiary of Celgene Corporation.

In December 2002, Celgene acquired Anthrogenesis, a privately held New Jersey-based biotherapeutics company and cord blood banking business, which is developing technology for the recovery of stem cells from placental tissues following the completion of full-term successful pregnancies. Anthrogenesis now operates as Celgene Cellular Therapeutics, a wholly owned subsidiary of Celgene.

In December 2005, Celgene received approval from the FDA to market REVLIMID for the treatment of patients with transfusion-dependent anemia due to Low- or Intermediate-1-risk MDS associated with a deletion 5q cytogenetic abnormality with or without additional cytogenetic abnormalities.

In May 2006, Celgene received approval for THALOMID in combination with dexamethasone for the treatment of patients with newly diagnosed multiple myeloma.

In June 2007, Celgene received full marketing authorization for REVLIMID in combination with dexamethasone as a treatment for patients with multiple myeloma who have received at least one prior therapy by the European Commission.

In March 2008, Celgene closed its $2.9 billion acquisition of Pharmion Corporation.

In December 2009, Celgene announced the acquisition of Gloucester Pharmaceuticals. .

In June 2010 Celgene Corporation and Abraxis BioScience Inc. jointly announced the signing of a definitive merger agreement in which Celgene has agreed to acquire Abraxis BioScience.

Myocardial infarction | Understanding and definition of myocardial infarction

noreply@blogger.com (Unknown) — Wed, 06 Jul 2011 11:42:00 +0000

Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).

Classical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom). Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue. Approximately one quarter of all myocardial infarctions are "silent", without chest pain or other symptoms.

Among the diagnostic tests available to detect heart muscle damage are an electrocardiogram (ECG), echocardiography, and various blood tests. The most often used markers are the creatine kinase-MB (CK-MB) fraction and the troponin levels. Immediate treatment for suspected acute myocardial infarction includes oxygen, aspirin, and sublingual nitroglycerin.

Most cases of STEMI (ST elevation MI) are treated with thrombolysis or percutaneous coronary intervention (PCI). NSTEMI (non-ST elevation MI) should be managed with medication, although PCI is often performed during hospital admission. In people who have multiple blockages and who are relatively stable, or in a few emergency cases, bypass surgery may be an option.

Heart attacks are the leading cause of death for both men and women worldwide. Important risk factors are previous cardiovascular disease, older age, tobacco smoking, high blood levels of certain lipids (triglycerides, low-density lipoprotein) and low levels of high density lipoprotein (HDL), diabetes, high blood pressure, obesity, chronic kidney disease, heart failure, excessive alcohol consumption, the abuse of certain drugs (such as cocaine and methamphetamine), and chronic high stress levels.

Classification

There are two basic types of acute myocardial infarction:

Transmural: associated with atherosclerosis involving major coronary artery. It can be subclassified into anterior, posterior, or inferior. Transmural infarcts extend through the whole thickness of the heart muscle and are usually a result of complete occlusion of the area's blood supply.
Subendocardial: involving a small area in the subendocardial wall of the left ventricle, ventricular septum, or papillary muscles. Subendocardial infarcts are thought to be a result of locally decreased blood supply, possibly from a narrowing of the coronary arteries. The subendocardial area is farthest from the heart's blood supply and is more susceptible to this type of pathology.

The phrase "heart attack" is sometimes used incorrectly to describe sudden cardiac death, which may or may not be the result of acute myocardial infarction. A heart attack is different from, but can be the cause of cardiac arrest, which is the stopping of the heartbeat, and cardiac arrhythmia, an abnormal heartbeat. It is also distinct from heart failure, in which the pumping action of the heart is impaired; severe myocardial infarction may lead to heart failure, but not necessarily.

A 2007 consensus document classifies myocardial infarction into five main types:

Type 1 – Spontaneous myocardial infarction related to ischaemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection
Type 2 – Myocardial infarction secondary to ischaemia due to either increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anaemia, arrhythmias, hypertension, or hypotension
Type 3 – Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischaemia, accompanied by presumably new ST elevation, or new LBBB, or evidence of fresh thrombus in a coronary artery by angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood
Type 4 – Associated with coronary angioplasty or stents: *) Type 4a – Myocardial infarction associated with PCI; *) Type 4b – Myocardial infarction associated with stent thrombosis as documented by angiography or at autopsy
Type 5 – Myocardial infarction associated with CABG

The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous. Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and epigastrium, where it may mimic heartburn. Levine's sign, in which the patient localizes the chest pain by clenching their fist over the sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed that it had a poor positive predictive value.

Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating), weakness, light-headedness, nausea, vomiting, and palpitations. These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system which occurs in response to pain and the hemodynamic abnormalities that result from cardiac dysfunction. Loss of consciousness (due to inadequate cerebral perfusion and cardiogenic shock) and sudden death (frequently due to the development of ventricular fibrillation) can occur in myocardial infarctions.

Women and older patients report atypical symptoms more frequently than their male and younger counterparts. Women also report more numerous symptoms compared with men (2.6 on average vs 1.8 symptoms in men). The most common symptoms of MI in women include dyspnea (shortness of breath), weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been reported as frequently occurring symptoms which may manifest as long as one month before the actual clinically manifested ischemic event. In women, chest pain may be less predictive of coronary ischemia than in men.

Approximately one fourth of all myocardial infarctions are silent, without chest pain or other symptoms. These cases can be discovered later on electrocardiograms, using blood enzyme tests or at autopsy without a prior history of related complaints. A silent course is more common in the elderly, in patients with diabetes mellitus and after heart transplantation, probably because the donor heart is not fully innervated by the nervous system of the recipient. In diabetics, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms.

Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are called an acute coronary syndrome.

The differential diagnosis includes other catastrophic causes of chest pain, such as pulmonary embolism, aortic dissection, pericardial effusion causing cardiac tamponade, tension pneumothorax, and esophageal rupture. Other non-catastrophic differentials include gastroesophageal reflux and Tietze's syndrome.

Heart attack rates are higher in association with intense exertion, be it psychological stress or physical exertion, especially if the exertion is more intense than the individual usually performs. Quantitatively, the period of intense exercise and subsequent recovery is associated with about a 6-fold higher myocardial infarction rate (compared with other more relaxed time frames) for people who are physically very fit. For those in poor physical condition, the rate differential is over 35-fold higher. One observed mechanism for this phenomenon is the increased arterial pulse pressure stretching and relaxation of arteries with each heart beat which, as has been observed with intravascular ultrasound, increases mechanical "shear stress" on atheromas and the likelihood of plaque rupture.

Acute severe infection, such as pneumonia, can trigger myocardial infarction. A more controversial link is that between Chlamydophila pneumoniae infection and atherosclerosis. While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor. Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases.

There is an association of an increased incidence of a heart attack in the morning hours, more specifically around 9 a.m. Some investigators have noticed that the ability of platelets to aggregate varies according to a circadian rhythm, although they have not proven causation.

The diagnosis of myocardial infarction can be made after assessing patient's complaints and physical status. ECG changes, coronary angiogram and levels of cardiac markers help to confirm the diagnosis. ECG gives valuable clues to identify the site of myocardial damage while coronary angiogram allows visualization of narrowing or obstructions in the heart vessels. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathological findings.

A chest radiograph and routine blood tests may indicate complications or precipitating causes and are often performed upon arrival to an emergency department. New regional wall motion abnormalities on an echocardiogram are also suggestive of a myocardial infarction. Echo may be performed in equivocal cases by the on-call cardiologist. In stable patients whose symptoms have resolved by the time of evaluation, Technetium (99mTc) sestamibi (i.e. a "MIBI scan") or thallium-201 chloride can be used in nuclear medicine to visualize areas of reduced blood flow in conjunction with physiologic or pharmocologic stress. Thallium may also be used to determine viability of tissue, distinguishing whether non-functional myocardium is actually dead or merely in a state of hibernation or of being stunned.

WHO criteria formulated in 1979 have classically been used to diagnose MI; a patient is diagnosed with myocardial infarction if two (probable) or three (definite) of the following criteria are satisfied:

Clinical history of ischaemic type chest pain lasting for more than 20 minutes
Changes in serial ECG tracings
Rise and fall of serum cardiac biomarkers such as creatine kinase-MB fraction and troponin

The WHO criteria were refined in 2000 to give more prominence to cardiac biomarkers. According to the new guidelines, a cardiac troponin rise accompanied by either typical symptoms, pathological Q waves, ST elevation or depression or coronary intervention are diagnostic of MI.

Complications may occur immediately following the heart attack (in the acute phase), or may need time to develop (a chronic problem). Acute complications may include heart failure if the damaged heart is no longer able to adequately pump blood around the body; aneurysm or rupture of the myocardium; mitral regurgitation, particularly if the infarction causes dysfunction of the papillary muscle; and arrhythmias, such as ventricular fibrillation, ventricular tachycardia, atrial fibrillation and heart block. Longer-term complications include heart failure, atrial fibrillation, and the increased risk of a second myocardial infarction.

The prognosis post myocardial infarction varies greatly, depending on a person's health, the extent of the heart damage and the treatment given. For the period 2005 – 2008 in the United States the median mortality at 30 days was 16.6% with a range from 10.9% to 24.9% depending on the hospital. Using variables available in the emergency room, people with a higher risk of adverse outcome can be identified. One study found that 0.4% of patients with a low risk profile died after 90 days, whereas in high risk people it was 21.1%.

Some of the more reproduced risk stratifying factors include: age, hemodynamic parameters (such as heart failure, cardiac arrest on admission, systolic blood pressure, or Killip class of two or greater), ST-segment deviation, diabetes, serum creatinine, peripheral vascular disease and elevation of cardiac markers. Assessment of left ventricular ejection fraction may increase the predictive power. The prognostic importance of Q-waves is debated. Prognosis is significantly worsened if a mechanical complication such as papillary muscle or myocardial free wall rupture occur. Morbidity and mortality from myocardial infarction has improved over the years due to better treatment.

Toxoplasmosis | Understanding and definition of Toxoplasmosis

noreply@blogger.com (Unknown) — Wed, 06 Jul 2011 11:39:00 +0000

Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. The parasite infects most genera of warm-blooded animals, including humans, but the primary host is the felid (cat) family. Animals are infected by eating infected meat, by ingestion of feces of a cat that has itself recently been infected, or by transmission from mother to fetus. Although cats are often blamed for spreading toxoplasmosis, contact with raw meat is a more significant source of human infections in Africa and fecal contamination of hands is a greater risk factor.

Up to one third of the world's human population is estimated to carry a Toxoplasma infection. The Centers for Disease Control and Prevention notes that overall seroprevalence in the United States as determined with specimens collected by the National Health and Nutritional Examination Survey (NHANES) between 1999 and 2004 was found to be 10.8%, with seroprevalence among women of childbearing age (15 to 44 years) 11%.

During the first few weeks post-exposure, the infection typically causes a mild flu-like illness or no illness. Thereafter, the parasite rarely causes any symptoms in otherwise healthy adults. However, those with a weakened immune system, such as AIDS patients or pregnant women, may become seriously ill, and it can occasionally be fatal. The parasite can cause encephalitis (inflammation of the brain) and neurologic diseases, and can affect the heart, liver, inner ears, and eyes (chorioretinitis).

During acute toxoplasmosis, symptoms are often influenza-like: swollen lymph nodes, or muscle aches and pains that last for a month or more. Rarely, a patient with a fully functioning immune system may develop eye damage from toxoplasmosis. Young children and immunocompromised patients, such as those with HIV/AIDS, those taking certain types of chemotherapy, or those who have recently received an organ transplant, may develop severe toxoplasmosis. This can cause damage to the brain (encephalitis) or the eyes (necrotizing retinochoroiditis). Infants infected via placental transmission may be born with either of these problems, or with nasal malformations, although these complications are rare in newborns.

Swollen lymph nodes are more commonly found in the neck followed by axillae and then groin. Swelling may occur at different times after the initial infection, persist, and/or recur for various times independently of antiparasitic treatment. It is usually found at single sites in adults, but in children multiple sites may be more common. Enlarged lymph nodes will resolve within one to two months in 60% of patients. However, a quarter of patients take 2–4 months to return to normal and 8% take 4–6 months. A substantial number of patients (6%) do not return to normal until much later.

Toxoplasmosis can be difficult to distinguish from that of primary central nervous system lymphoma, and , as a result, the diagnosis is either made by a trail of therapy (pyrimethamine, sulfadiazine + leucovorin. If treatment fails, brain biopsy is indicated.

Detection of Toxoplasma gondii in human blood samples may also be achieved by using the polymerase chain reaction (PCR). Inactive cysts may exist in a host which would evade detection.

Toxoplasmosis can't be detected with immunostaining. Lymph nodes affected by toxoplasma have characteristic changes, including poorly demarcated reactive germinal centers, clusters of monocytoid B cells and scattered epithelioid histiocytes.

Transmission may occur through:

Ingestion of raw or partly cooked meat, especially pork, lamb, or venison containing Toxoplasma cysts. Infection prevalence in countries where undercooked meat is traditionally eaten has been related to this transmission method. Oocysts may also be ingested during hand-to-mouth contact after handling undercooked meat, or from using knives, utensils, or cutting boards contaminated by raw meat.
Ingestion of contaminated cat feces. This can occur through hand-to-mouth contact following gardening, cleaning a cat's litter box, contact with children's sandpits, or touching leach, and can survive in the environment for over a year. It is, however, susceptible to high temperatures—above 66 degrees Celsius (150 degrees Fahrenheit), and is thus killed by thorough cooking, and would be killed by 24 hours in a typical domestic freezer.

Cats excrete the pathogen in their feces for a number of weeks after contracting the disease, generally by eating an infected rodent. Even then, cat faeces are not generally contagious for the first day or two after excretion, after which the cyst 'ripens' and becomes potentially pathogenic. Studies have shown that only about 2% of cats are shedding oocysts at any one time, and that oocyst shedding does not recur even after repeated exposure to the parasite. Although the pathogen has been detected on the fur of cats, it has not been found in an infectious form, and direct infection from handling cats is generally believed to be very rare.

Congenital toxoplasmosis is a special form in which an unborn child is infected via the placenta. A positive antibody titer indicates previous exposure and immunity and largely ensures the unborn baby's safety. A simple blood draw at the first pre-natal doctor visit can determine whether or not the woman has had previous exposure and therefore whether or not she is at risk. If a woman receives her first exposure to toxoplasmosis while pregnant, the baby is at particular risk. A woman with no previous exposure should avoid handling raw meat, exposure to cat feces, and gardening (cat feces are common in garden soil). Most cats are not actively shedding oocysts and so are not a danger, but the risk may be reduced further by having the litterbox emptied daily (oocysts require longer than a single day to become infective), and by having someone else empty the litterbox. However, while risks can be minimized, they cannot be eliminated. For pregnant women with negative antibody titer, indicating no previous exposure to T. gondii, as frequent as monthly serology testing is advisable as treatment during pregnancy for those women exposed to T. gondii for the first time decreases dramatically the risk of passing the parasite to the fetus.

Despite these risks, pregnant women are not routinely screened for toxoplasmosis in most countries (Portugal, France, Austria, Uruguay, and Italy being the exceptions) for reasons of cost-effectiveness and the high number of false positives generated. As invasive prenatal testing incurs some risk to the fetus (18.5 pregnancy losses per toxoplasmosis case prevented), postnatal or neonatal screening is preferred. The exceptions are cases where fetal abnormalities are noted, and thus screening can be targeted.

Some regional screening programmes operate in Germany, Switzerland and Belgium.

Treatment is very important for recently infected pregnant women, to prevent infection of the fetus. Since a baby's immune system does not develop fully for the first year of life, and the resilient cysts that form throughout the body are very difficult to eradicate with anti-protozoans, an infection can be very serious in the young.

A recent study has indicated toxoplasmosis correlates strongly with an increase in male births in humans. According to the researchers, "depending on the antibody concentration, the probability of the birth of a boy can increase up to a value of 0.72 ... which means that for every 260 boys born, 100 girls are born." The study also notes a mean rate of 0.608 (as opposed to the normal 0.51) for Toxoplasma-positive mothers. The study explains that this effect may not significantly influence the actual sex ratio of children born in countries with high rates of latent toxoplasmosis infection because "In high-prevalence countries, most women of reproductive age have already been infected for a long time and therefore have only low titres of anti-Toxoplasma antibodies. Our results suggest that low-titre women have similar sex ratios to Toxoplasma-negative women."

It has been found that the parasite has the ability to change the behaviour of its host: infected rats and mice are less fearful of cats—in fact, some of the infected rats seek out cat-urine-marked areas. This effect is advantageous to the parasite, which will be able to proliferate as a cat could eat the infected rat and later reproduce. The mechanism for this change is not completely understood, but there is evidence that toxoplasmosis infection raises dopamine levels and concentrates in the amygdala in infected mice.

The findings of behavioural alteration in rats and mice have led some scientists to speculate that Toxoplasma may have similar effects in humans, even in the latent phase that had previously been considered asymptomatic. Toxoplasma is one of a number of parasites that may alter their host's behaviour as a part of their life cycle. The behaviors observed, if caused by the parasite, are likely due to infection and low-grade encephalitis, which is marked by the presence of cysts in the human brain, which may produce or induce production of a neurotransmitter, possibly dopamine, therefore acting similarly to dopamine reuptake inhibitor type antidepressants and stimulants.

Correlations have been found between latent Toxoplasma infections and various characteristics:

Decreased novelty seeking behaviour
Slower reactions
Lower rule-consciousness and greater jealousy (in men)
Greater warmth, conscientiousness and moralistic behavior (in women)

The evidence for behavioral effects on humans is controversial. No prospective research has been done on the topic, e.g., testing people before and after infection to ensure that the proposed behavior arises only afterwards. Although some researchers have found potentially important associations with Toxoplasma, the causal relationship, if any, is unknown, i.e., it is possible that these associations merely reflect factors that predispose certain types of people to infection. However, many of the neurobehavioral symptoms that are postulated to be due to toxoplasmosis correlate to the general function of dopamine in the human brain, and the fact that toxoplasma encodes the dopamine synthetic enzyme tyrosine hydroxylase enzymes makes it likely that neurobehavioral symptoms can result from infection.

Studies have found that toxoplasmosis is associated with an increased car accident rate in people with Rh-negative blood. The chance of an accident relative to uninfected people is increased roughly 2.5 times.

This may be due to the slowed reaction times that are associated with infection. "If our data are true then about a million people a year die just because they are infected with Toxoplasma," the researcher Jaroslav Flegr told The Guardian. The data shows that the risk decreases with time after infection, but is not due to age. Ruth Gilbert, medical coordinator of the European Multicentre Study on Congenital Toxoplasmosis, told BBC News Online these findings could be due to chance, or due to social and cultural factors associated with Toxoplasma infection. However there is also evidence of a delayed effect which increases reaction times.

Other studies suggest that the parasite may influence personality. There are claims of Toxoplasma causing antisocial attitudes in men and promiscuity (or even "signs of higher intelligence" ) in women, and greater susceptibility to schizophrenia and bipolar disorder in all infected persons. A 2004 study found that Toxoplasma "probably induce[s] a decrease of novelty seeking."

According to Sydney University of Technology infectious disease researcher Nicky Boulter in an article that appeared in the January/February 2007 edition of Australasian Science magazine, Toxoplasma infections lead to changes depending on the sex of the infected person.

The study suggests that male carriers have shorter attention spans, a greater likelihood of breaking rules and taking risks, and are more independent, anti-social, suspicious, jealous and morose. It also suggests that these men are deemed less attractive to women. Female carriers are suggested to be more outgoing, friendly, more promiscuous, and are considered more attractive to men compared with non-infected controls. The results are shown to be true when tested on mice, though it is still inconclusive. A few scientists have suggested that, if these effects are genuine, prevalence of toxoplasmosis could be a major determinant of cultural differences.