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موقع اجابه الجديد لكل سؤال اجابه

2016-11-11T17:40:00.002+02:00

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Nephrotic syndrome

2012-06-18T17:14:00.001+02:00

Nephrotic syndrome

Definition

Nephrotic syndrome Is a clinical syndrome associated with proteinuria in the nephrotic range (3.5mg/m2/24hrs), edema and hyperlipidemia.
Nephrotic syndrome is not due to inflammatory processes but due to direct action of the membrane attack unit of complement on the glomerulus.

Clinical suspicion

It should be suspected when a patient presents with generalized oedema, protein detected in urine, hypoalbuminemia.

Diagnosis

The diagnosis maybe established with proteinuria in the nephrotic range alone without the other criteria.
1. Proteinuria > 3.5 g/m2/day:
On detection of protein in urine a 24 hour urinary protein test is in order. There are two cut off values for this test: 1. increased urinary protein <1.5g/day; this is refered to as isolated proteinuria. 2. >3.5g/day; this establishes nephrotic syndrome.
2. Hypoalbuminaemia
3. Hyperlipidaemia:
As albumen in serum is lost through the kidneys, the liver increases its production of albumen and concomitantly increases the production of cholesterol.
4. Oedema: resulting from loss of intravascular fluid to the extravascular space due decreased intravascular oncotic pressure (decreased albumen).
However, the presence of proteinuria in the nephrotic range (3.5g/day) establishes the diagnosis.
Differential diagnosis: proteinuria

Causes

Once the diagnosis of nephrotic syndrome is established the cause of the syndrome is sought in order to treat accordingly.

Nephrotic syndrome with active sediment (mixed nephrotic/ nephritic)

This denotes the presence of RBC casts (active sediment). Causes include:
1ry glomerular diseases as MPGN (main cause), and 2ry glomerular diseases as SLE (most common presentation of SLE), vasculitis such as Henoch Schonlein purpura, mixed essential cryoglobulinemia.

Nephrotic syndrome with bland sediment (Pure nephrotic)

1ry glomerular diseases such as MCNS, Membranous glomerulonephritis, Focal glomerulosclerosis. As well as 2ry glomerular diseases that result from Diabetes (Klemelsteli-Wilson syndrome) and amyloidosis.

Treatment

Treatment of nephrotic syndrome depends primarily on the cause, however, it frequently involves the use the glucorticoids given over long periods of time. Especially in cases of minimal change disease. Here the role of steroids is to suppress the autoimmune basis for this disease. The use of cytotoxic agents maybe required in some cases (e.g. cyclophosphamide).
Dietary salt control, treatment of hypertension and hypercholestrolemia is also recommended. ACE inhibitors, in addition to controlling blood pressure have also been found to decrease the protein loss. Diuretics may help control the edema and the hypertension.

Acute Renal Failure Causes Diagnosis and Treatment

2012-06-18T17:12:00.001+02:00

Acute Renal Failure Causes Diagnosis and Treatment

Acute Renal Failure

Definition

Renal failure depicts a group of diseases that may be associated with decreased GFR and manifested by retention of BUN and creatinine. Acute renal failure is defined as a rapidly (over a period of days) increasing creatinine level or decreasing urine output.

Causes
Causes of acute renal failure is caused by failure of the kidneys to perform their normal functions due to:

Prerenal - Problems affecting the flow of blood before it reaches the kidneys

Postrenal - Problems affecting the movement of urine out of the kidneys

Renal - Problems with the kidney itself that prevent proper filtration of blood or production of urine

Prerenal failure
This is by far the most common type of acute renal failure. Your kidneys do not receive enough blood to filter. Prerenal failure can be caused by the following conditions:

Dehydration - From vomiting, diarrhea, water pills, or blood loss

Disruption of blood flow to the kidneys - From a variety of causes

Drastic drop in blood pressure - From major surgery, severe injury or burns, or infection in the bloodstream (sepsis)

Blockage or narrowing of a blood vessel leading to the kidneys

Heart failure or heart attacks

Liver failure

There is no actual damage to the kidneys with prerenal failure. With appropriate treatment, it usually can be reversed.

Postrenal failure
Postrenal renal failure is sometimes referred to as obstructive renal failure, since it is often caused by something blocking elimination of urine produced by the kidneys. This problem also can be reversed.
At the ureter level, this condition can be caused by the following:

Kidney stone

Cancer

Medications

At the bladder level, the following conditions can cause obstruction:

Kidney stone

Enlarged prostate (the most common cause)

Blood clot

Bladder cancer

Neurologic disorders of the bladder

Treatment consists of relieving the obstruction. Once the blockage is removed, the kidneys usually recover in 1-2 weeks if there is no infection or other problem.

Renal damage
Primary renal damage is the most complicated cause of renal failure. Renal causes of acute kidney failure can be subdivided into those affecting the filtering system of the kidney, those affecting the blood supply in the kidney, and those affecting kidney tissue.
Some of the kidney problems that can cause kidney failure include the following:

Blood vessel diseases

Blood clot in a vessel in the kidneys

Injury to kidney tissue and cells

Glomerulonephritis

Acute interstitial nephritis

Acute tubular necrosis

Clinical manifestations

ARF passes through two phases 1. Destructive phase: oliguric and non-oliguric 2. Reconstructive phase: could be polyuric.
ARF due to pre-renal or renal causes (esp. ATN) usually presents as oliguric renal failure passing through the 3 phases of pathology:

Intitiation phase: due to the initiating insult on the kidney.

Maintenance phase: maintenance of oliguria (1-2 weeks).

Recovery phase: due to recovery of renal function (polyuria).

ARF due to other causes as partial obstruction may present as polyuria.
ARF due to postrenal obstruction may present as anuria.

Diagnosis

Renal failure is manifested by the rise of serum creatinine. The next step is to identify if chronic or acute renal failure. Then exclude if postrenal then identify if pre-renal or renal. If renal identify what type of intrisic renal disease ? if no diagnosis is reached then by exclusion the diagnosis is ATN.

1. Prerenal azotemia

Urine/plasma creatinine ratio > 40

Urinary Na decreased < 20

Fractional excretion of Na is <1%

Urine osmolarity is > 500

2. Renal azotemia

Urine/plasma creatinine ratio < 20

Urinary Na decreased > 40

Fractional excretion of Na is >1%

Urine osmolarity is > 350

? These findings can be altered by diuretic use and urine sample should be taken before institution of diuretic use.

3. Postrenal azotemia
Post-renal azotemia develops only if the obstruction is bilateral or affects a solitary functioning kidney. During the early stages of obstruction, continued glomerular filtration leads to increased intra-luminal pressure proximal to the site of obstruction. As a result, there is gradual distension of the proximal ureters, renal pelvis and calyces and fall in glomerular filtration which will be evident by renal ultrasound.
N.B.: the level of creatinine in serum has nothing to do with whether the ARF is oliguric, anuric or non-oliguric: it is an indication that tubular function is lost as creatinine is not filtered- it is secreted. K+ and H+ are retained even in nonoliguric renal failure due to the same principal (they are both secreted and not filtered).

Treatment

Treatment of acute renal failure usually should be conservative and largely supportive. It requires careful and precise management. All patients will require close monitoring, many of them within intensive care settings.

Supportive care includes stabilizing the patient, monitoring input and output strictly, weighing daily, determining electrolyte values frequently, preventing sepsis via reducing the number of intravenous lines and removing an indwelling urinary.

Therapy for prerenal failure

Rapid volume replacement and treatment of the underlying condition that resulted in prerenal failure are the cornerstones of therapy. Initial fluid administration of isotonic saline (0.9%) or 5% albumin (10 to 20 mL/kg per dose) should be used to restore intravascular volume. This can be both a diagnostic and a therapeutic trial. Fluid administration also can convert oliguric to nonoliguric renal failure in its early stage.

Therapy for postrenal failure

Therapy for postrenal failure includes removal of obstruction by decompression or diversion of the urinary tract, stabilization of electrolyte abnormalities, management of postobstructive diuresis, and therapy for voiding dysfunction and for urinary tract infection. Surgical intervention will require urologic consultation. The site of the obstruction will determine the approach: placement of a Foley catheter, vesicostomy, ureteral catheters (stents), or nephrostomy tubes.

Therapy for established renal failure

Maintaining Balance of Fluid and Electrolytes

In a euvolemic state, fluid intake, including water generated from endogenous metabolism (insensible fluid gain), is balanced by fluid output.

Treating Hypertension

Kidney failure in any form can present as hypertension and hypertensive encephalopathy. It is essential to lower the blood pressure quickly and safely. The blood pressure should be reduced by at least 25% within 1 hour with an antihypertensive medicine whose onset of action is rapid. It is advisable to start with one antihypertensive medicine and increase the dose to its maximum recommended level. Therapy is individualized and needs titration. In most cases, hypertension is the result of sodium and fluid retention, but other factors, such as activation of the renin-aldosterone-angiotensin II and/or the alpha-adrenergic system, may have roles in kidney failure.

New drugs and research for Alzheimer's disease

2012-06-18T17:02:00.001+02:00

New drugs and research for Alzheimer's disease

New drugs and research for Alzheimer's disease

This month witnessed the discovery of two drugs that may help in treating Alzheimer's disease. On the other hand, it has been announced that a large-scale study will be launched next April with the aim of better understanding this disease.

Alzheimer's disease (AD) affects approximately 4.5 million Americans. It is considered the most common cause of dementia in western countries. Approximately 10% of all persons over the age of 70 have significant memory loss; in more than half, the cause is AD. AD is a progressive dementia (that is the dementia keeps getting worse).
The most important risk factors for AD are old age and a positive family history. The frequency of AD increases with each decade of adult life to reach 20 to 40% of the population over the age of 85. A positive family history of dementia suggests a genetic cause of AD.

Mechanism

AD is characterized in the brain by abnormal clumps (amyloid plaques) and tangled bundles of fibers (neurofibrillary tangles) composed of misplaced proteins. Three genes have been discovered that cause early onset (familial) AD. Other genetic mutations that cause excessive accumulation of amyloid protein are associated with age-related (sporadic) AD.
The management of Alzheimer's disease is difficult and frustrating, because there is no specific treatment and no way to slow the progression of the disease. The primary focus is on long-term amelioration of associated behavioral and neurologic problems. Currently there are five FDA-approved drugs that may benefit some people in the early or middle stages of the disease. Tacrine (Cognex) may alleviate some cognitive symptoms. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) may keep some symptoms from becoming worse for a limited time.

"In recent studies, the benefit of these medications were shown to be more effective in the early and middle stages of Alzheimer's and less effective in the last stage", comments Carolyn Merritt, LPN of The Doctors Lounge. "The studies seemed to show it delayed the onset of the third and final stage".

The fifth drug, memantine (Namenda), was recently approved for use in the United States.

US launches major study

In April 2005, researchers will begin recruiting about 800 Americans, ranging from 55 to 90 years old, in an effort to gain a better understanding of the early stages of the disease. This will be part of a major government study to track early Alzheimer's disease.
Researchers will use MRIs of the brain and other tests to track people who have either early-stage disease or a milder type of memory loss known as "mild cognitive impairment." Over the course of five years, they will compare the biological changes that occur within those patients' brains to the aging that takes place in the brains of healthy seniors.

The goal is to find early warning signs that can identify people at highest risk, and markers to help test the effectiveness of new therapies. The study, which will cost approximately $60 million (mostly funded by the government), was unveiled Wednesday by the National Institute on Aging.

How to Improving brain cell survival after brain injury

2012-06-18T16:56:00.000+02:00

How to Improving brain cell survival after brain injury

Scientists at Melbourne's Howard Florey Institute have found a protein in the brain that can save neurons from dying after experiencing traumatic brain injury from incidents such as stroke, car accidents and falls.

The team, led by Professor Seong-Seng Tan, has discovered that this naturally occurring protein, called BP5, is produced more than usual in brain cells after they have experienced traumatic injury.
Prof Tan said that because this protein is "over-expressed", it can prevent the neuron's cells from dying, thus reducing brain damage.
"BP5's pattern of expression indicates that it allows neurons to survive in a stressed environment," Professor Tan said.
"We have tested this hypothesis in mice by expressing BP5 in stressed neurons and this proof-of-principle experiment showed that BP5 can prevent neurons from undergoing cell death.
"BP5 works by using the cell's waste disposal system to flush away toxic and damaged proteins produced after injury, which appears to tip the balance towards nerve cell survival, instead of death," he said.
Professor Tan is the first to show that this mechanism can be fruitfully manipulated to prevent brain cells from dying. For this reason, his work has been published by the Journal of Neuroscience, the peak body journal of the American Society for Neuroscience.
"Now our challenge is to understand how BP5 performs it neuron-saving function and develop drugs that can do the same thing," Professor Tan said.
"Ultimately, we want to deliver the drug to patients suffering brain injury from stroke or trauma so save as many neurons as possible.
"Such a drug would limit damage to the brain after the injury, as well as the subsequent few days when injured nerves release 'suicide factors' that cause surrounding, healthy neurons to die en masse.

Watch Portugal vs Netherlands Euro 2012

2012-06-17T11:11:00.004+02:00

Watch Portugal vs Netherlands Euro 2012

Portugal vs Netherlands, the heavyweight match of Group B (Group of Death) will be on air today from OSK Metalist Stadium where A win can lead them into the quarter final of Euro 2012. But, for, Netherlands it’s quiet tough as they have to beat Portugal by scoring 2-0 goals depending on the results of Germany vs Denmark where Germany have to win.

For Portugal, It’s quiet easy to go into the knockout stage of Euro 2012 as they have already in the second position of Group B. A normal win will turn Portugal into the Quarterfinal of Euro 2012 where top eight teams will be fought with each other.

It’s a great news that both teams have no injury concerns. Portugal coach Paulo Bento might have field that squad which they have field against Denmark and got a win by 3-2. Netherlands boss Bert van Marwijk will be named their top-level squad to beat Portugal and secure them into the safe stage of Euro 2012. Netherlands can do magic as like Greece have done it last night by defeating Russia 1-0.

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Watch France vs Ukraine Euro 2012

2012-06-15T16:52:00.000+02:00

Watch France vs Ukraine Euro 2012

Watch France vs Ukraine Euro 2012

Ukraine vs France Live Stream Euro 2012 Online - 14 June 2012Ukraine have a great match and they were ready to France . The first match is drawn between the two of the best teams England and France in the last match. Ukraine have some of the best players and they have done well in the last match and win their match against the team of the Sweden. This week France will have to win their match to win the game against the Ukraine.Ukraine the Group D team have 3 points in the Group table and they have no issues to lose this match because if they win the match they will qualified for the Euro 2012 Quarter Finals. France have show a good performance...

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Depression and Anxiety

2012-05-04T21:55:00.004+02:00

Depression and Anxiety

Depression and anxiety appear to be two different emotional responses humans are capable of having. We do not usually associate these two disorders with each other. But research has shown that depression and anxiety do in fact co-exist, much to the detriment of their sufferers.
When you picture someone with depression you think of all the normal symptoms associated with it: Despair, hopelessness, anger, fatigue, an unwillingness to be a part of society and a feeling of being overwhelmed by everyday life. A depressed person withdraws into themselves and seek to sever all ties with the outside world.
Anxiety attacks on the other hand seem to happen for no reason at all. Feelings of fear and panic happen in situations in which most people would be perfectly calm. These anxiety attacks come on suddenly with no warning and with no outright reason for them to happen. After awhile a sufferer of these attacks begins to live in fear of the attacks themselves, wondering when the next one is going to happen. Before long, and without treatment, both anxiety attacks and depression can begin to affect the sufferers lives in negative ways by not allowing them to hold a job, have a relationship, or even go out into society
What many sufferers of these two diseases do not realize is that either one can lead to the other. Being depressed can weigh heavily on the mind leading the depressed person through a maze of different emotions. This in itself can lead to anxiety and eventually panic attacks. Panic attacks signify a loss of control and when this happens more and more often the sufferer can become depressed with their situation of not knowing if and when the next attack will occur
Why these two disorders seem to occur at the same time is still largely unknown. But many studies show that major depression is often accompanied by an anxiety disorder. Both are likely caused by an imbalance in brain chemistry, but exactly why the two seemingly opposite disorders can coexist in the same person is not completely understood. What is understood about anxiety disorder is that the fight-or-flight reaction in the brain does not work the way it is supposed to. It can go off at any time, even in seemingly peaceful situations. Those who have anxiety disorder always feel that they are in danger.
One thing that psychologist agree on is that having a combination depression and anxiety is much more debilitating than having just one or the other. It can take patients with both disorders a much longer amount of time to resolve their depression which makes treating them much harder. It has also been shown that people who suffer from anxiety and depression both have a much higher suicide rate.
While this sounds bad their are options for treating both these conditions. Anti-depressant medications can be used to treat both depression and anxiety. When these medications are used in conjunction with behavioral therapy there is a high success rate of treating depression accompanied by anxiety

2012 Best Toy Story Room Décor

2012-05-01T19:57:00.004+02:00

2012 Best Toy Story Room Décor

The best way to find some direction for decoration, is to simply check out other people’s rooms. Since you can’t go door to door looking for Toy Story rooms, browsing through online photos is the next best thing. You may even be able to come up with your own decorating plan after getting some ideas from other people’s photos online. In the end your room should be and include everything you wanted it to be, otherwise it just becomes another room in your house.

Carpets for children's rooms 2012

2012-05-01T19:47:00.001+02:00

Carpets for children's rooms 2012

Carpets for children's rooms 2012

Modern Decor Ultimate 2012

2012-05-01T19:37:00.000+02:00

Modern Decor Ultimate 2012

Modern Decor Ultimate 2012

ديكورات مودرن 2012

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Diabetes and Woman's Sexual Health

2012-04-29T18:33:00.003+02:00

Diabetes and Woman's Sexual Health

Sex is good for diabetes. It's good for the heart and circulation, helps sleep, and improves mood. So why are many women with diabetes not enjoying sex?

The reason, of course, is that although sex may be good for diabetes, having diabetes is not always good for sex. Nerve damage, or neuropathy, can make it difficult to have orgasms, and can cause vaginal dryness, making intercourse painful. Bruising from injections and fears about blood sugar plummeting can zap your self-confidence. And if you wear an insulin pump, where does it fit into intimacy?

Diabetes-related issues may seem overwhelming, but they're solvable, experts say. "Many times I've heard people say, 'I'm done with sex,'" says Janis Roszler, RD, a diabetes educator and coauthor of Sex and Diabetes (American Diabetes Association, 2007). "It's sad because there's so much that can be done."

As with most diabetes complications, high blood sugar levels are often the cause of sexual side effects, so keeping them under control is the No. 1 strategy. But even women with tight control of their blood sugars can face some sexual challenges. Here are some common problems and ways to conquer them.

Sex and Diabetes: Dealing with Vaginal Dryness

Experts say that for women, vaginal dryness is the most common sexual side effect of diabetes. Emotional issues such as depression, or damage to the nerves responsible for vaginal lubrication can cause vaginal dryness.

Vaginal dryness can become a painful cycle. "If a woman has pain during sex because of inadequate lubrication, she may anticipate pain the next time, and then have it because she tenses up," Roszler says.

Diabetes-related vaginal dryness can also be due to yeast infections associated with poor blood sugar control, especially in women with type 1 diabetes. In older women, menopause and hormonal swings may also play a role.

If you have symptoms of a yeast infection, such as vaginal itching, burning, or pain during intercourse or while urinating, an over-the-counter topical antifungal medication may help but speak with your health care provider first.

For other vaginal dryness, water-based vaginal lubricants can help. Some lubricants may also help with sexual arousal. If you plan to become pregnant, be sure to ask your obstetrician for advice on choosing a lubricant, because some can affect conception.

"Estrogen replacement, including vaginal estrogen, can be helpful in post-menopausal women," says Vivian Fonseca, MD, FRCP, chief of endocrinology at Tulane University School of Medicine in New Orleans and president-elect of medicine and science for the American Diabetes Association.

Although hormone replacement therapy may increase risk of breast cancer and stroke, using estrogen in a vaginal cream or ring is thought to be a lower-risk treatment. That's because it's used at a lower dose and is only applied in the vagina. You and your doctor can weigh the risks and benefits for you.

Blood Sugar, Insulin Pumps, and Spontaneity

For some women with diabetes, worrying about low blood sugar, or hypoglycemia, during sex makes it difficult to live in the moment. "Hypoglycemic events during sex are a real buzz kill," says Kerri Morrone Sparling, who blogs about her life with type 1 diabetes from her home in Providence, R.I. "Your body just shuts down during a low, so it crushes the enjoyment."

Lois Jovanovic, MD, FACE, CEO and chief scientific officer of Sansum Diabetes Research Institute in Santa Barbara, Calif., suggests that women who are concerned about low blood sugar eat a hard candy or a little ice cream before getting intimate. "Or if you have surprise sex in the middle of the night, afterward have something with sustained sugar, like juice with the fruit pulp in it or milk," she adds.

Sparling, who wears an insulin pump, has found a way to deal with her diabetes so that "spontaneity is never an issue." She wears a continuous glucose monitor (CGM), which she can simply consult to see if she's "in a decent range" to get romantic. She often wears her infusion set on her thigh because, she says, she feels sexier when it's adhered, working, and out of sight.

Sparling removes her pump before sex, as she does when she exercises. (Pumps can be safely disconnected for 45 minutes to an hour.) Afterward, she checks her blood sugar again and takes a dose of insulin if her blood sugar is high or has a snack if it's low. "I don't know other people who have so many cookies by the bed," she says.

"For me, this works," Sparling says. "But just like everything else, you need to find what works for you and to not be afraid to go through a trial-and-error period."

Problems With Libido and Orgasm

Difficulties with sexual arousal -- whether from loss of interest in sex or problems having orgasms -- are more common, and can be more complicated for women with diabetes.

Poor blood sugar control can drag down a woman's libido. So can depression, which is more common in women than in men. Some antidepressants may also dampen sex drive.

If you've been depressed or anxious for more than a couple of weeks, talk to your doctor. Counseling, medication, or stress reduction can help. If you are already taking a depression medication and think it may be lowering your interest in sex, talk to your doctor about finding one that is less likely to cause sexual side effects.

Some women with diabetes may need more time and stimulation to climax. Whether the cause is nerve damage or emotional issues, problems with sexual arousal are a good reason to make foreplay part of your sexual experience, if it isn't already.

Oral stimulation, sex toys, caressing, and cuddling can help arouse women and men, especially as they age. "Self-stimulation, or masturbation, can also help a woman get to know her body better," Roszler says.

If you are unable to climax because of significant nerve damage, counseling can help you learn to make sex an enjoyable experience without orgasm.

4 Tips for Better Sex

Along with strategies for specific sexual issues, these tips can help keep your sex life strong with diabetes:

Limit alcohol. A little alcohol may increase sexual desire, but drinking can also make your blood sugar level drop quickly. If you drink alcohol, stick with one drink. Have it with a meal or snack to limit its effects on blood sugar.
Be honest with your partner. Trying to deny or hide your diabetes only makes you more uncomfortable during sex, Sparling says. When she was dating, she made a point of getting to know boyfriends well before she got intimate with them, and they got to know her -- and her pump. "I never had a partner reject me because of diabetes," she says. "If anything, it brought us closer together."
Nurture your relationship. Little things like taking walks, working out together, or even doing chores for each other are important to keeping a couple's romantic life fresh and loving, Roszler says. Conversely, neglecting your love life may damage other aspects of your relationship. "When couples have difficulty in the bedroom, it spreads throughout their relationship," she says. "If you're angry with your partner, you're less likely to do things to take care of him or her."
Get help. If you are uncomfortable talking to your doctor about sex, ask for a referral to a gynecologist or other doctor with expertise in sexual issues. "If you don't get the answers or help you need, don't give up," Roszler says. "You can have a great sex life with diabetes."

Eczema Symptoms and Treatment

2012-04-19T09:30:00.001+02:00

Eczema Symptoms and Treatment

Eczema, or dermatitis is a term used to describe inflammatory diseases of the skin. It is composed of many variable clinical and histological findings and is the final common expression for a number of disorders which include atopic dermatitis, allergic contact and irritant contact dermatitis, dyshidrotic eczema, nummular eczema, lichen simplex chronicus, asteatotic eczema, and seborrheic dermatitis.

Classification

Atopic dermatitis
Contact dermatitis
Dyshidrotic eczema
Nummular eczema
Lichen simplex chronicus
Asteatotic eczema
Seborrheic dermatitis

Symptoms and clinical manifestations

Depending on the causes and type of dermatitis symptoms can arise acutely (hours) or subacutely (days).

Primary lesions (the disease appearance at the very start) may include papules, erythematous macules, and vesicles, which can coalesce to form blisters, patches and plaques. This is usually associated with intense itching (pruritus).

In severe eczema, secondary lesions (the disease appearance later on) from infection or excoriation, marked by weeping and crusting, may predominate.

Long-standing (chronic) dermatitis is often dry and is characterized by thickened, scaling skin (lichenification). This usually results from repetitive itching in subacute cases.

Treatment

It is important to identify any possible contact allergens as well as the type of dermatitis (see above).
For acute cases treatment consists of frequent cool wet dressings, oral corticosteroids to control the inflammation. Antihistamines are given to control the itching. Co-existing infection can be treated with oral antibiotics.
Subacute cases can be treated with topical corticosteroids, emollients for dry skin, antihistamines for pruritus and oral antibiotics for those with infection. Coal tar agents can be used in cases that are resistant to treatment.
Chronic cases are treated using topical corticosteroids. Some cases that do not respond may require intralesional steroid injections. Emollients are used to treat the dry skin.

Acne Causes and Treatments

2012-04-19T09:26:00.001+02:00

Acne Causes and Treatments

Acne

Acne is a pustular infection of the skin, caused by changes in the sebaceous glands. Excessive secretion of oils from the glands combine with naturally occurring dead skin cells to block the hair follicles. Oil secretions build up beneath the blocked pore, providing a perfect environment for the skin bacteria Propionibacterium acnes to multiply uncontrolled. In response, the skin inflames, producing the visible lesion. The face, chest, back and upper arms are especially exposed.
The infection is common in puberty as a result of an abnormal response to normal levels of the male hormone testosterone. The response for most people diminishes over time and acne thus tends to disappear, or at least decrease, after one reaches early adulthood. There is, however, no way to predict how long it will take for it to disappear entirely, and some individuals will continue to suffer from acne decades later, into their thirties and forties and even beyond.
Acne affects a large percentage of humans at some stage in life. Aside from scarring its main effects are psychological, such as reduced self-esteem and depression. Acne usually appears during adolescence, when people already tend to be at their most socially-insecure. For this reason acne should be treated if severe.

Causes for acne

Exactly why some people get acne and some do not is not fully known. It is known to be partly hereditary. Several factors are known to cause acne:

Hormonal activity
Hyperactive sebaceous glands
Accumulation of dead skin cells
Bacteria in the pores
Skin irritation or scratching of any sort
Anabolic steroids
Birth control pills, however many women have reported reduced acne while on the pill
Those exposed to high levels of chlorine compounds, particularly chlorinated dioxins, often develop severe, long-lasting acne, known as Chloracne.

Not causes for acne

Since the medical knowledge about acne is still relatively small, many misconceptions and rumours about what causes acne exits:

Diet. It is not impossible that a changed diet can help clear acne for a certain individual. But no general correlation has been found. Chocolate, chips, sugar, milk and seafood among others have not been shown to effect acne.
Deficient personal hygiene. Acne is not caused by dirt. This misconception probably comes from the fact that blackheads by their nature are black and the acne infected skin, therefore, looks dirty.
Sex. Rumours have had it that both celibacy and masturbation are causes for acne. This is not the case.
Treatments
There is a myriad of products sold for the treatment of acne, many of them without any scientifically proven effects. However, a combination of treatments can usually prevent acne in all but the most severe cases. Generally there are three types of treatments that have been proven effective:
Killing the bacteria that are caused by the blocked follicles. This is done either by the intake of antibiotics like tetracyclines, or by treating the affected areas externally with bactericidal substances like benzoyl peroxide. However, reducing the p.acnes bacteria will not, in itself, do anything to reduce the oil secretion that is the initial cause of the blocked follicles. Therefore, acne will generally reappear quite soon after the end of treatment ? days later in the case of topical applications, and weeks later in the case of oral antibiotics.
Reducing the secretion of oils from the glands. This is done by a great daily intake of Vitamin A derivates like isotretinoin over a period of a few months. The product is sold by Roche under the names Accutane in USA and Roaccutane in Europe. Isotretinoin has been shown to be very effective in treating severe acne and is effective in up to 80% of the patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical examination by a dermatologist since the drug has many known side effects. The most common are dry skin and nosebleed. It can also permanently damage the liver and cause depression. The drug also causes birth defects if women become pregnant while taking it.

Exfoliating the skin. The topical treatment salicylic acid for example encourages the peeling of the top layer of skin to prevent a build-up of dead skin cells which combine with skin oil to block pores. It also helps to unblock clogged pores.
Popping a pimple or any physical acne treatment should not be attempted by anyone but a qualified dermatologist. Pimple popping irritates skin, can spread the infection deeper into the skin and can cause permanent scarring.

Acne scars
Severe acne often leaves nasty scars where the skin gets a "volcanic" shape. Acne scars are very hard (and expensive) to treat and it is unusual for the scars to be successfully removed completely. In those cases, scar treatment may be appropriate. The most commonly used forms of scar treatments are:
Dermabrasion. The top layer of the skin is removed to make the scar look less pitted. It makes the scar less visible but does not remove it completely. Multiple treatments may be necessary to get the desired results.
Laser resurfacing. A laser is used to burn off the top layer of the skin.
Punch excision. The scar is excised with a punch tool and the edges are sutured together.
Chemical peels. Different types of acid are applied to the skin so that a smoother layer can surface.
Subcision. The scar is detached from deeper tissue, allowing a pool of blood to form under the scar which helps form a connective tissue under the scar, leveling it with the surface

Breast cancer

2012-04-04T18:22:00.001+02:00

Breast cancer

Incidence

Carcinoma of the breast is the most common cancer in women in the United States (32%) and is second only to lung cancer as a cause of cancer death in women (15%).
Estimated new cases and deaths from breast cancer (women only) in the United States in 2005:

New cases: 211,240.
Deaths: 40,410.

The lifetime risk for women of being diagnosed with breast cancer is currently about 1 in 8.

Gender

Breast cancer is relatively uncommon in men; the female-to-male ratio is approximately 100:1.

Age

The risk of developing breast cancer increases with age. Only about 0.8% of breast cancers occur in women < 30 years old and approximately 6.5% develop in women between 30 and 40 years old. Most cases occur in patients over 40 years of age.

Race and ethnicity

White women have a higher overall rate of breast cancer than African-American women; however, this difference is not apparent until after menopause. American Asian and Hispanic women have approximately half the incidence of American Caucasian women. Native-American women extremely low risk of developing breast cancer.

Geography

The incidence of breast cancer is significantly higher in the United States and European countries such as the United Kingdom, Denmark, the Netherlands, New Zealand and Switzerland than in India, Japan, Thailand, Nigeria. It has been suggested that these trends in breast cancer incidence may be related to dietary fat consumption.

Nephrotic syndrome and Treatment

2012-04-04T17:53:00.001+02:00

Nephrotic syndrome and Treatment

Nephrotic syndrome and Treatment

Definition

Nephrotic syndrome Is a clinical syndrome associated with proteinuria in the nephrotic range (3.5mg/m2/24hrs), edema and hyperlipidemia.

Nephrotic syndrome is not due to inflammatory processes but due to direct action of the membrane attack unit of complement on the glomerulus.

Clinical suspicion

It should be suspected when a patient presents with generalized oedema, protein detected in urine, hypoalbuminemia.

Diagnosis

The diagnosis maybe established with proteinuria in the nephrotic range alone without the other criteria.

1. Proteinuria > 3.5 g/m2/day:
On detection of protein in urine a 24 hour urinary protein test is in order. There are two cut off values for this test: 1. increased urinary protein <1.5g/day; this is refered to as isolated proteinuria. 2. >3.5g/day; this establishes nephrotic syndrome.

2. Hypoalbuminaemia

3. Hyperlipidaemia:
As albumen in serum is lost through the kidneys, the liver increases its production of albumen and concomitantly increases the production of cholesterol.

4. Oedema: resulting from loss of intravascular fluid to the extravascular space due decreased intravascular oncotic pressure (decreased albumen).

However, the presence of proteinuria in the nephrotic range (3.5g/day) establishes the diagnosis.

Differential diagnosis: proteinuria

Causes

Once the diagnosis of nephrotic syndrome is established the cause of the syndrome is sought in order to treat accordingly.

Nephrotic syndrome with active sediment (mixed nephrotic/ nephritic)

This denotes the presence of RBC casts (active sediment). Causes include:

1ry glomerular diseases as MPGN (main cause), and 2ry glomerular diseases as SLE (most common presentation of SLE), vasculitis such as Henoch Schonlein purpura, mixed essential cryoglobulinemia.

Nephrotic syndrome with bland sediment (Pure nephrotic)

Treatment

Acute Renal Failure

2012-04-04T17:50:00.000+02:00

Acute Renal Failure

Definition-Causes-Diagnosis

Definition

Renal failure depicts a group of diseases that may be associated with decreased GFR and manifested by retention of BUN and creatinine. Acute renal failure is defined as a rapidly (over a period of days) increasing creatinine level or decreasing urine output.

Causes

Causes of acute renal failure is caused by failure of the kidneys to perform their normal functions due to:

Prerenal - Problems affecting the flow of blood before it reaches the kidneys
Postrenal - Problems affecting the movement of urine out of the kidneys
Renal - Problems with the kidney itself that prevent proper filtration of blood or production of urine

Prerenal failure

This is by far the most common type of acute renal failure. Your kidneys do not receive enough blood to filter. Prerenal failure can be caused by the following conditions:

Dehydration - From vomiting, diarrhea, water pills, or blood loss
Disruption of blood flow to the kidneys - From a variety of causes
- Drastic drop in blood pressure - From major surgery, severe injury or burns, or infection in the bloodstream (sepsis)
- Blockage or narrowing of a blood vessel leading to the kidneys
- Heart failure or heart attacks
- Liver failure

There is no actual damage to the kidneys with prerenal failure. With appropriate treatment, it usually can be reversed.

Postrenal failure

Postrenal renal failure is sometimes referred to as obstructive renal failure, since it is often caused by something blocking elimination of urine produced by the kidneys. This problem also can be reversed.
At the ureter level, this condition can be caused by the following:

Kidney stone
Cancer
Medications

At the bladder level, the following conditions can cause obstruction:

Kidney stone
Enlarged prostate (the most common cause)
Blood clot
Bladder cancer
Neurologic disorders of the bladder

Treatment consists of relieving the obstruction. Once the blockage is removed, the kidneys usually recover in 1-2 weeks if there is no infection or other problem.

Renal damage

Primary renal damage is the most complicated cause of renal failure. Renal causes of acute kidney failure can be subdivided into those affecting the filtering system of the kidney, those affecting the blood supply in the kidney, and those affecting kidney tissue.
Some of the kidney problems that can cause kidney failure include the following:

Blood vessel diseases
Blood clot in a vessel in the kidneys
Injury to kidney tissue and cells
Glomerulonephritis
Acute interstitial nephritis
Acute tubular necrosis

Clinical manifestations

ARF passes through two phases 1. Destructive phase: oliguric and non-oliguric 2. Reconstructive phase: could be polyuric.

ARF due to pre-renal or renal causes (esp. ATN) usually presents as oliguric renal failure passing through the 3 phases of pathology:

Intitiation phase: due to the initiating insult on the kidney.
Maintenance phase: maintenance of oliguria (1-2 weeks).
Recovery phase: due to recovery of renal function (polyuria).

ARF due to other causes as partial obstruction may present as polyuria.
ARF due to postrenal obstruction may present as anuria.

Diagnosis

Renal failure is manifested by the rise of serum creatinine. The next step is to identify if chronic or acute renal failure. Then exclude if postrenal then identify if pre-renal or renal. If renal identify what type of intrisic renal disease ? if no diagnosis is reached then by exclusion the diagnosis is ATN.

1. Prerenal azotemia

Urine/plasma creatinine ratio > 40
Urinary Na decreased < 20
Fractional excretion of Na is <1%
Urine osmolarity is > 500

2. Renal azotemia

Urine/plasma creatinine ratio < 20
Urinary Na decreased > 40
Fractional excretion of Na is >1%
Urine osmolarity is > 350

? These findings can be altered by diuretic use and urine sample should be taken before institution of diuretic use.

3. Postrenal azotemia

Post-renal azotemia develops only if the obstruction is bilateral or affects a solitary functioning kidney. During the early stages of obstruction, continued glomerular filtration leads to increased intra-luminal pressure proximal to the site of obstruction. As a result, there is gradual distension of the proximal ureters, renal pelvis and calyces and fall in glomerular filtration which will be evident by renal ultrasound.
N.B.: the level of creatinine in serum has nothing to do with whether the ARF is oliguric, anuric or non-oliguric: it is an indication that tubular function is lost as creatinine is not filtered- it is secreted. K+ and H+ are retained even in nonoliguric renal failure due to the same principal (they are both secreted and not filtered).

Treatment

Treatment of acute renal failure usually should be conservative and largely supportive. It requires careful and precise management. All patients will require close monitoring, many of them within intensive care settings.
Supportive care includes stabilizing the patient, monitoring input and output strictly, weighing daily, determining electrolyte values frequently, preventing sepsis via reducing the number of intravenous lines and removing an indwelling urinary.

Therapy for prerenal failure

Rapid volume replacement and treatment of the underlying condition that resulted in prerenal failure are the cornerstones of therapy. Initial fluid administration of isotonic saline (0.9%) or 5% albumin (10 to 20 mL/kg per dose) should be used to restore intravascular volume. This can be both a diagnostic and a therapeutic trial. Fluid administration also can convert oliguric to nonoliguric renal failure in its early stage.

Therapy for postrenal failure

Therapy for postrenal failure includes removal of obstruction by decompression or diversion of the urinary tract, stabilization of electrolyte abnormalities, management of postobstructive diuresis, and therapy for voiding dysfunction and for urinary tract infection. Surgical intervention will require urologic consultation. The site of the obstruction will determine the approach: placement of a Foley catheter, vesicostomy, ureteral catheters (stents), or nephrostomy tubes.

Therapy for established renal failure

Maintaining Balance of Fluid and Electrolytes

In a euvolemic state, fluid intake, including water generated from endogenous metabolism (insensible fluid gain), is balanced by fluid output.

Treating Hypertension

Kidney failure in any form can present as hypertension and hypertensive encephalopathy. It is essential to lower the blood pressure quickly and safely. The blood pressure should be reduced by at least 25% within 1 hour with an antihypertensive medicine whose onset of action is rapid. It is advisable to start with one antihypertensive medicine and increase the dose to its maximum recommended level. Therapy is individualized and needs titration. In most cases, hypertension is the result of sodium and fluid retention, but other factors, such as activation of the renin-aldosterone-angiotensin II and/or the alpha-adrenergic system, may have roles in kidney failure.

Improved survival in AML with higher anthracycline doses

2012-04-01T08:07:00.000+02:00

Improved survival in AML with higher anthracycline doses

Younger patients with acute myeloid leukemia (AML) that receive higher doses of anthracyclines during induction chemotherapy are reported to have better complete remission rates in most studies. As of yet, studies have failed to show an improved surivival when compared to the standard doses of the “7 and 3” regimen. This article reviews the results of a new randomized controlled trial exploring the effects of higher doses of anthracyclines on overall survival.

With the exception of the use of all trans-retinoic acid (ATRA) for patients with acute pro-myelocytic leukemia (APL), relatively few changes in the therapy of acute myeloid leukemia (AML) have been made since the introduction of the so-called “7 and 3” regimen in 1973.^{1, 2} The regimen is made up of 3 daily doses of daunorubicin at a dose of 45 mg/m2 combined with cytarabine for seven continuous daily doses at 100 mg/m2.^{1, 2}

The outcome to current therapy is suboptimal with only 60-70% of patients achieving their first complete remission. The median survival of patients who achieve remission is 12-24 months and the five year survival is achieved in only 20% of those patients.³ Attempts to find a superior alternative or improve the 7 and 3 induction regimen have been disappointing.^{4, 5} Both, the intensification of cytarabine dose^6-8 and the addition of other drugs, have failed to improve outcome when compared to “7 and 3”.⁹

That all changed this week, with the publication of the first conclusive evidence for better overall survival in patients receiving higher doses of daunorubicin (90 mg/m2) compared to the conventional dose (45 mg/m2) regimen. The Eastern Cooperative Oncology Group (ECOG) study, which appears this week in the New England Journal of Medicine,¹⁰ assigned 657 patients between the ages of 17 and 60 years with newly diagnosed AML to receive either the 7 and 3 induction regimen with conventional dose of daunorubicin versus the higher dose. Those that achieved a complete remission were then given post remission therapy according to their risk stratification as well as the availability of an HLA matched sibling. Patients with unfavorable or intermediate risk profile were offered allogeneic transplant if they had an HLA matched sibling.^{11,
12} The remainder were offered high dose cytarabine with or without gemtuzumab ozgamicin, followed by an autologous transplant.¹³

An intention to treat analysis, with a median follow up of 25.2 months, revealed that 90 mg/m2 daunorubicin resulted in higher complete remission rates (70.6% vs. 57.3%, P=0.001) as well as improved median survival (23.7 vs. 15.7 months, P=0.003).

Interestingly, the rates of serious (grade 3 to 5) adverse events were similar in the two groups. Serious cardiac toxicity was observed in 7.2% in the standard dose arm compared to 7.9% in the high dose arm. A reduced left ventricular ejection fraction was observed in 1.3% of patients in the high dose group and none of the standard regimen group. The rate of treatment related mortality was 4.5% in the standard arm compared to 5.5% in the high dose arm (P=0.60). The most common cause of death was from infections and pulmonary failure.

Results

For those patients with a favorable cytogenetic profile that received the high dose, the median survival had not been reached at the time of the final analysis (median follow up of 25.2 months); thus, exceeding the current median survival of 12-24 months in patients who achieve remission.³ The largest difference was seen in those with intermediate risk who received the daunorubicin 90 mg/m2. Patients with unfavorable cytogenetic profile, however, did not experience any benefit from higher doses.

Conclusion

Patients with low and intermediate risk de novo AML should be offered 7 and 3 induction therapy with daunorubicin dose intensification at 90 mg/m2. This is both safe and effective in these patients but not associated with any benefit in patients with poor prognostic features. However, as the authors note, it is not yet clear what the optimal dose of intensification is. Whether 90 mg/m2 is better than 60 mg/m2, requires further study.

Conflict of interest statement

No financial conflicts or disclosures to report.

CITE THIS ARTICLE:
Tamer M. Fouad, M.D.. Improved survival in AML with higher anthracycline doses. Doctors Lounge Website. Available at: http://www.doctorslounge.com/index.php/articles/page/300. Accessed April 01 2012.

Iron deficiency anemia in pregnancy

2012-04-01T08:00:00.002+02:00

Iron deficiency anemia in pregnancy

Anemia in pregnancy is defined as hemoglobin concentration < 10 g/dl during pregnancy and puerperium.

Introduction

The pregnant woman needs 1000 mg iron all through pregnancy i.e. a daily amount of 3.5 mg to maintain iron balance. The iron requirement in the latter half of pregnancy and for several weeks after delivery increases to about 6-7 mg/day.
It is the most common form of anemia encountered during pregnancy. The incidence is higher in poorly nourished women of low socioeconomic standard.

Causes

Depletion of iron stores as occurs in non-supplementation of diet.
Multifetal pregnancy
Deficient absorption e.g. achlorhydria
Bleeding with pregnancy or ankylostoma infestation

Diagnosis

Symptoms

Weakness, loss of concentration
Headache and loss of appetite
Dyspnea and palpitations

Examination

Pallor (nails, lips, conjunctiva)
Pulse: tachycardia and waterhammer pulse
Cardiac examination: systolic murmurs
Abdominal examination: splenomegaly

Investigations

Complete blood picture shows a picture of hypochromic microcytic anemia:

Low RBC count and hemoglobin
Color index and MCHC are decreased
WBC and platelets are normal

Serum iron is decreased

New cause of sexual dysfunction in women revealed

2012-04-01T07:56:00.004+02:00

New cause of sexual dysfunction in women revealed

Researchers at Yale School of Medicine and the Albert Einstein College of Medicine have found that female sexual dysfunction (FSD) affects 48.2 percent of women in a new study and that these women had decreased sensation in the clitoris, which increased the risk of sexual dysfunction.

"There is a paucity of data available on FSD and this study brings attention to the possibility of a neurological cause for the dysfunction," said lead author Kathleen Connell, M.D., assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine.
Connell said previous epidemiological studies have shown that about 10 million women between the ages of 50 and 74 report abnormal sexual complaints, including decreased desire, inability to reach orgasm and increased pain with intercourse. In contrast to data on men, Connell said clinical trials evaluating the physiologic mechanisms responsible for sexual function in women are few, despite reports of other investigators, which suggest that sexual dysfunctions may be more common in women than men.
"The sexual response is complex and involves interaction between the nervous system, the vascular system and the musculoskeletal system," said Connell. "Alterations in any of these systems could potentially cause FSD."
The trial was conducted while Connell was at the Albert Einstein College of Medicine. The team studied the pudenal nerve, which provides nerve fibers to the pelvic floor muscles and is also responsible for sensation in the genital region. They evaluated the role of genital neurological integrity and sexual function in 56 women. They used a validated screening questionnaire to identify women between ages 18 and 68 with FSD and tested vibratory and pressure sensation in the genital region.
The team found that almost half of the women studied reported sexual dysfunction. Of the women with FSD, 23.2 percent had more than one form of sexual dysfunction. Those with sexual dysfunction had decreased sensation in the clitoris compared to asymptomatic women.

Chest pain in young females Causes and diagnosis

2012-04-01T07:51:00.001+02:00

Chest pain in young females Causes and diagnosis

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Chest pain is one of the common complaints heard in medical OPDs as well as at the GP?s clinic. Chest pain causes a lot of anxiety in the patient as it is many a time related to ?heart attack? or angina and people are quite aware of the serious consequences of the symptom. Anyone having a chest pain would first think of the heart and would like to know if he/she is having a ?heart attack?.

However not all times is a chest pain necessarily originating from or caused by diseases of the heart. There are plenty of other structures in the thoracic cavity and a systematic approach is needed to arrive at the correct diagnosis or in other words to find out the ?real culprit? causing the chest pain.
Of special importance is the issue of chest pain in women, as this group is less liable to get heart disease till menopause. Estrogen is said to confer a protective effect and prevents the development of atherosclerosis. Myocardial infarction or Coronary artery disease (CAD) is very rare in menstruating women. As menopause approaches and estrogen levels go down, the probability of development of CAD catches up with those in men.
Even then, there are lots of young to middle aged, menstruating women complaining of chest pain and quite distressed about it. Before I highlight the special features of this particular issue lets first review the differential diagnosis of chest pain.

Differential Diagnosis of Chest Pain

1. Angina Pectoris/Myocardial Infarction
2. Other Cardiovascular Causes

a. Possibly Ischemic Pain

1) Aortic Stenosis
2) Hypertrophic Cardiomyopathy
3) Severe Systemic Hypertension
4) Severe Right Ventricular Hypertension
5) Aortic Regurgitation
6) Severe Anemia/hypoxia
b. Non Ischemic in Origin

1) Aortic Dissection
2) Pericarditis
3) Mitral Valve Prolapse

3. Gastrointestinal

a. Esophageal Spasm
b. Esophageal Reflux
c. Esophageal Rupture
d. Peptic Ulcer Disease

4. Psychogenic

a. Anxiety
b. Depression
c. Cardiac Psychosis
d. Self Gain

5. Neuromusculoskeletal

a. Thoracic Outlet syndrome
b. Lesions of Cervical/Thoracic Spine
c. Costochondritis[Tietze?s Syndrome]
d. Herpes Zoster
e. Chest wall pain

6. Pulmonary

a. Pulmonary Embolus/Infarction
b. Pneumothorax
c. Pneumonia with pleural involvement

7. Pleurisy
As most patients are anxious of their chest pain being that of Heart origin, we shall first have a look at the features of Cardiac Pain.

The World of Web Hosting

2012-03-24T19:35:00.001+02:00

The World of Web Hosting

Web hosting service is a kind of internet service that deals with all websites owners and organizations, allowing their own sites accessible via the World Wide Web. Web host providers are business entities that accommodate space on their own server for their customers as well as providing them with an Internet connection. Hosting services have different types depending on the kind of service being offered to clients.

Most web hosting services offered are the following: free web hosting, shared hosting, clustered hosting, reseller hosting, software or services related to e-commerce and a lot more. There are a lot of free and "for-fee-service" providers that are offering these kinds of services. To search for a new company provider one must exercise extreme caution for some of the reviews are very biased and the people promoting the provider are employed or affiliates. There are also cheap but reliable web hosting providers that offer acceptable services.
Web hosting providers offers full service, including all the necessary facilities and activities like web site design, programming and internet facilities. Whenever the client intends to use their own software and servers is also a viable option that can be agreed upon by both parties.

Web hosting is constantly changing. There is a tremendous demand from clients that web page providers should be able to handle without sacrificing the speed and accessibility of the system. Uptime guarantee which refers to the time the web site is accessible or available via the web. Customers should check about these concerns including the policies of hosting providers to avoid undue disruptions and violations of the agreed terms of the services provided. There are also a lot of security and non-security factors that should be considered.
Web hosting services are really significant in the World Wide Web. The service is an essential part of the intangible world or often called cyberspace. It creates a bridge that connects all people beyond borders and races, enjoying as well as using the best of what the technology has to offer. Like tangible and household utilities, web hosting service will become an integral part of the worldwide community. And people from all walks of life are affected positively with its growth whether directly or indirectly. Private Internet users like students and common people are the number one beneficiaries of this kind of service, since they are the end of the Internet link or the end user of most Internet endeavors.

How to Find Affordable Web Design

2012-03-24T19:26:00.003+02:00

How to Find Affordable Web Design

Web designing is a tedious task. It may take days before one can complete a web design. This is probably the reason why some web designs are expensive. In addition to that, a web design can become all the more expensive if it requires a lot of graphics, images, and other intricate, elaborate details. Without web designing your website will be boring. Therefore, in order to attract internet users and future customers you will need to make your website as attractive as possible. However, if you are just starting an affordable web design is probably the only option you have.
However, an affordable web design may be hard to find because not everybody is adept at web designing and only a few know how. Then again if you are intent in finding an affordable web design here are some ideas:
a. Online. Searching online can help you find an affordable web design this is because web designers create web designs online. However, do not expect these web designs to be elaborate but it may be good enough for your website. It is not bad to be particular even when you are just looking for an affordable web design.
b. Affordable web designers may have their own website, offering their services. Not all web designers are expensive. Some web designers offer their services at an affordable price. If you are looking for an affordable web design then try looking for these affordable web designers site.
c. Ask a friend. If you have a friend who is adept at web designing then you can try to ask him if he is willing to lend his services and a friendly fee. It may sound like a long shot but it is worth a try.
d. Check out classified ads. Web designers also post ads on local newspapers. If you are looking for an affordable web design then you might want to check out the classified section of your local paper.

An affordable web design is ideal for people who do not have the money yet for expensive designs. However, just because it is an affordable web design does not mean it should be of low quality. When looking for an affordable web design, do not forget to consider the quality.

How to Avoid Mistakes in Building New Website

2012-03-24T19:23:00.001+02:00

How to Avoid Mistakes in Building New Website

When you first start out online, the task of search engine optimization is one that cannot be avoided. Because search engines are constantly changing their algorithms, what may have worked years ago may not work today or tomorrow. However, instead of letting the thought of search engine optimization get you down, there are many newbie mistakes that you can avoid the first time around when it comes to building your website.
Perform keyword research

One of the biggest mistakes that many newcomers to search engine optimization make is not performing adequate keyword research. Keyword research will make the difference between your pages being found or lost in a sea of millions of webpages. If you go after keywords that are too competitive, especially if you are just starting out, this could hurt your efforts to drive traffic to your website. However, if you go after keywords with little competition, you stand to receive traffic if you put in the effort to optimize your website for these keywords.
Avoid flash websites

As pretty as flash websites look, they are not the most search engine friendly option. Because website crawlers cannot read flash, this makes the building a website in flash a poor choice. If search engine crawlers cannot read or interpret information on your website, they then cannot properly classify your website. Instead of using flash, consider building your website in a more common language such as HTML.
Optimize your tags

If you are not familiar with tags and their relationship to your website, your SEO efforts will be in vain. Title tags are important to your website because they tell search engines what your page is about. Additionally, title tags also show up in search engine results and therefore, they are crucial to describing your website in search engine results pages (SERPs).
Create link worthy content

If your content reads like the millions of other webpages in your niche, you will have a hard time keeping traffic and visitors on your website. By creating link to worthy content, this means that you have taken the time to perform diligent research and insightful content for your readers. By doing so, you ensure that you have created content that your readers will want to share with others. In turn, this helps you build natural links to your content.

By following these simple steps, you are light years ahead of your competition who may be committing the same mistakes. SEO is an ongoing process and as it continues to change, you must learn to adapt and adjust your website accordingly.

Curtains New Cedar 2012

2012-03-23T10:03:00.002+02:00

Curtains New Cedar 2012

lifestyle

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Nephrotic syndrome

Nephrotic syndrome

Definition

Clinical suspicion

Diagnosis

Causes

Nephrotic syndrome with active sediment (mixed nephrotic/ nephritic)

Nephrotic syndrome with bland sediment (Pure nephrotic)

Treatment

Acute Renal Failure Causes Diagnosis and Treatment

Acute Renal Failure Causes Diagnosis and Treatment

Acute Renal Failure

Definition

Causes

Prerenal failure

Postrenal failure

Renal damage

Clinical manifestations

Diagnosis

1. Prerenal azotemia

2. Renal azotemia

3. Postrenal azotemia

Treatment

Therapy for prerenal failure

Therapy for postrenal failure

Therapy for established renal failure

New drugs and research for Alzheimer's disease

This month witnessed the discovery of two drugs that may help in treating Alzheimer's disease. On the other hand, it has been announced that a large-scale study will be launched next April with the aim of better understanding this disease.

Mechanism

US launches major study

How to Improving brain cell survival after brain injury

Scientists at Melbourne's Howard Florey Institute have found a protein in the brain that can save neurons from dying after experiencing traumatic brain injury from incidents such as stroke, car accidents and falls.

Watch Portugal vs Netherlands Euro 2012

Watch France vs Ukraine Euro 2012

Depression and Anxiety

Depression and Anxiety

2012 Best Toy Story Room Décor

2012 Best Toy Story Room Décor

2012 Best Toy Story Room Décor

Carpets for children's rooms 2012

Modern Decor Ultimate 2012

Diabetes and Woman's Sexual Health

Diabetes and Woman's Sexual Health

Sex and Diabetes: Dealing with Vaginal Dryness

Blood Sugar, Insulin Pumps, and Spontaneity

Problems With Libido and Orgasm

4 Tips for Better Sex

Eczema Symptoms and Treatment

Classification

Symptoms and clinical manifestations

Treatment

Acne Causes and Treatments

Acne

Causes for acne

Not causes for acne

Treatments

Acne scars

Breast cancer

Incidence

Gender

Age

Race and ethnicity

Geography

Nephrotic syndrome and Treatment

Definition

Clinical suspicion

Diagnosis

Causes

Nephrotic syndrome with active sediment (mixed nephrotic/ nephritic)

Nephrotic syndrome with bland sediment (Pure nephrotic)

Treatment

Acute Renal Failure

Acute Renal Failure

Definition

Causes

Prerenal failure

Postrenal failure

Renal damage