Science Resources

HIV + AIDS = DEATH?

2010-05-20T07:16:00.000-07:00

What is HIV?
HIV stands for: Human Immunodeficiency Virus

HIV is a virus. Viruses such as HIV cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to replicate (make new copies of themselves). The human immune system usually finds and kills viruses fairly quickly, but HIV attacks the immune system itself – the very thing that would normally get rid of a virus.

Healthy Sex and Sex Ethics:
Sex education ensures proper sexual responsibility and behavior. Ignore about sex creates harmful effects and it affects not only the spouse but also the children and society. Absence of scientific knowledge about sex and stretch of imagination are the main causes of abnormality in sexual behaviour. Sex education can be used as a means of solving the problem ofover population and as an important of charcter formation.

What is the connection between HIV and AIDS?
HIV causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.

It takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on the person with HIV having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly.

parts of the world due to a lack of funding.

How is HIV passed on?
HIV is found in the blood and the sexual fluids of an infected person, and in the breast milk of an infected woman. HIV transmission occurs when a sufficient quantity of these fluids get into someone else's bloodstream.

There are various ways a person can become infected with HIV:

.Sexual transmission:
AIDS is primarily sexually transmitted disease. AIDS is acquired mainly through heterosexual contact. Homosexuals are at a higher risk of infection.In India 80% of those who are infected with HIV are in the age group of 15-35 years.

.Blood contact:
HIV enters the body when blood containing HIV is given to a person through blood transfusion. The transfusion of unscreened blood may transmit the virus,

.Surgical Equipments:
AIDS is transmitted if HIV contaminated surgical equipments are used. Intravenous drug users who inject drugs such as heroin into their bodies are at high risk. Any skin piercing (including injections,ear boring, circumcision, tattooing)can transmit the virus if the instruments used have not been sterilised and are infected. Sharing a common razor at the barber's shop carries some risk of spreading HIV.

.Maternal-foetal transmission:
There is every possibility that a HIV infected mother can transmit the virus to her child during pregnancy (through the placenta) or during birth.These babies usually do not live longer than two to four years.
Does HIV have symptoms?
Some people experience a flu-like illness, develop a rash, or get swollen glands for a brief period soon after they become infected with HIV. However, although these are hiv symptoms they are also common symptoms of other less serious illnesses, and do not necessarily mean that a person has HIV.

Often people who are infected with HIV don’t have any symptoms at all. It is important to remember that a person who has HIV can pass on the virus immediately after becoming infected, even if they feel healthy. It’s not possible to tell just by looking if someone has been infected with HIV.

The only way to know for certain if someone is infected with HIV is for them to be tested.

Symptoms of AIDS:
1. Weight loss of at least 10% of the body weight.
2. Chronic diarrhoea for more than onemonth.
3. Prolonged fever for more than one month.
4. Night sweats.
5. Persistent cough for more than one month.
6. General skin disease or skin infection.
7. Oro-Pharyngeal candidiasis (fungal infection in month and throat - thrush).
8. The occurrence of tumours is a symptoms of AIDS. A frequent form of tumour is Kaposi's sarcoma which generally affects the extremities. In AIDS patients scattered purplish lesions or patches, over the chest and abdomen are seen.
9. Loss of memory and intelligence.

Testing for HIV

A sign promoting HIV testing in Livingstone, Zambia
It is important for a person to get an HIV test if they think they may have been at risk of HIV infection.

There are various types of HIV test, but the most commonly used - the antibody or ELISA test - detects HIV antibodies in a person’s blood. It is necessary to wait at least 3 months after the last possible exposure before having an HIV antibody test, to be certain of an accurate result.

The prospect of receiving a positive test result (meaning that a person is infected with HIV) may be daunting, but learning that you are HIV positive is the first step to getting support and staying healthy. HIV testing is also very important for stopping the spread of HIV, as somebody who is aware of their HIV status can take steps to ensure they do not pass on the virus.

How can HIV be prevented?
Despite considerable investment and research, there is currently no vaccine for HIV, and microbicides (designed to prevent HIV being passed on during sex) are still undergoing trials. However, there are other ways that people can protect themselves from HIV infection, which are the basis of HIV prevention efforts around the world.

Education about HIV and how it is spread is an essential part of HIV prevention. HIV education needs to be culturally appropriate and can take place in various settings, for example lessons at school, media campaigns, or peer education.

Preventing sexual transmission of HIV

HIV and AIDS education for Scouts in the Central African Republic
If a person has sexual intercourse with someone who has HIV they can become infected. ‘Safer sex’ refers to things that a person can do to minimise their risk of HIV infection during sexual intercourse; most importantly, using condoms consistently and correctly.

A person can be certain that they are protected against HIV infection by choosing not to have sex at all, or by only doing things that do not involve any blood or sexual fluid from one person getting into another person's body. This kind of sexual activity is the only thing that can be considered ‘safe sex’.

Effective sex education is important for providing young people with the knowledge and skills to protect themselves from sexual transmission of HIV. Comprehensive sex education should develop skills and attitudes that encourage healthy sexual relationships, as well as provide detailed information about how to practise ‘safer sex’.

Preventing transmission of HIV through blood
A person can protect him or herself against HIV infection by ensuring that HIV infected blood does not enter their body.

Injecting drug users who share injecting equipment or works are at risk of HIV infection. Needle exchange programmes can help to prevent HIV transmission among drug users by providing clean needles and disposing of used ones.

Health care workers can be exposed to HIV infected blood while at work. The most effective way to limit their risk of HIV infection is to use universal precautions with every patient, for example washing hands and wearing protective barriers (gloves, aprons, goggles). In the event that a healthcare worker is exposed to potentially HIV infected blood at work, PEP (Post exposure prophylaxis) is recommended as an HIV prevention measure.

Preventing mother to child transmission of HIV

Mother to child transmission of HIV can be prevented by using antiretroviral drugs, which reduce the chances of a child becoming infected with HIV from around 25% to less than 2%. Once a child is born, safer infant feeding practices can also greatly reduce the risk of HIV being passed on from mother to child.

For these precautions to be taken, an HIV positive mother must firstly be aware of her status. This is why HIV testing in pregnancy is a crucial prevention measure.

Chikungunya

2010-01-09T06:08:00.000-08:00

What is Chikungunya:
Chikungunya fever is a viral disease spread by mosquitoes. The symptoms include severe and persistent joint pain and fever similar to dengue fever. It is usually NOT life threatening. But the joint pains can last for a long time and hence full recovery may take months.

History of Chikungunya Disease:
Chikungunya(pronounced as chik’-en-GUN-yah) disease was first detected in 1952 in africa at a place called Makonde Plateau. This is a border area between Tanzania and Mozambique. The name "chikungunya" is from the Makonde language and its meaning is "that which bends up". This is a reference to the Chikungunya symptom where patients walk in a stooped posture due to joint pain. Chikungunya is also known as Chicken guinea, Chicken gunaya and Chickengunya. The presence of the word Chicken has also lead to a lot of misconceptions about the disease.

What causes Chikungunya Fever?
Chikungunya disease is a viral disease transmitted in humans by the bite of infected mosquitoes. Aedes aegypti mosquito (also called yellow fever mosquito) is the primary transmission agent of Chikungunya Virus. This is usually found in tropics and hence the reason why Chikungunya is predominantly seen in asian countries. In recent cases, another mosquito species named Aedes albopictus is found to be a carrier. Aedes aegypti bites during day time and hence day time mosquito bite is the main reason for transmission.

Chikungunya Symptoms:
Chikungunya typically starts with one or more of the following symptoms - chills, fever, vomiting, nausea, head ache and joint pain. The attack is sudden and sometimes it is accompanied with rashes. Severe joint pain is the main and the most problematic symptom of Chikungunya.

Treatment of Chikungunya:
There is no antiviral drug or medicine specifically for Chikungunya. But since chikungunya is cured by immune system in almost all cases there is no need to worry. Treatment usually is for the symptoms and include taking sufficient rest, taking more fluid food and medicines to relieve pain (paracetamol for example). Aspirin should be avoided.

Prevention of Chikungunya:
We are yet to find a vaccine for Chikungunya. Hence the only way to prevent Chikungunya disease to avoid mosquito bites! Chikungunya virus spreads from human to human only through mosquito carrier. Hence mosquito breeding control is the best way to fight Chikungunya.

Treatment of Chikungunya Disease:
There is no antiviral drug or medicine specifically for Chikungunya. But since chikungunya is cured by immune system in almost all cases there is no need to worry. Treatment usually is for the symptoms and include taking sufficient rest, taking more fluid food and medicines to relieve pain (paracetamol for example). Aspirin should be avoided.

Honey and lime mix is found to have soothing effect on the disease. Avoiding specific medicines is actually recommended for quick recovery. Also very mild exercise to joints can help ease the pain.

Currently there is no vaccination against Chikungunya. Research is ongoing on the development of DNA vaccination against Chikungunya.

Usually the disease starts to decrease in intensity after 3 days and it may take up to 2 weeks for recovery. But in elderly the recovery is very slow and may take upto 3 months. In some cases the joint pain can last even upto a year!

BRAIN TUMOR - TUMOR CEREBRAL

2009-12-26T06:52:00.000-08:00

What is a brain tumor?
A brain tumor is a cluster of abnormal cells growing in the brain. Brain tumors can be benign (non-cancerous) or malignant (cancerous). They can start growing in the brain - a primary tumor, or they can be formed when cancer cells from another part of the body travel to the brain - a metastatic brain tumor. Approximately half of all primary brain tumors are benign. All metastatic brain tumors are malignant. More than 110,000 people are diagnosed each year with a brain tumor. Approximately 80,000 of tumors are metastatic. There are more than a dozen different types of brain tumors and they are classified by level of malignancy, size and degree to which the cancer has spread.
First, metastatic brain tumors often are formed when cancers of the lung, breast, colon, prostate and skin spread to the brain. Improvements in treating these diseases have prolonged the life of victims, giving the cancer a greater opportunity to spread. Second, significant advances in diagnosing brain tumors have been made while many brain tumors may have gone undiagnosed in the past.

The Brain

The brain is a soft, spongy mass of tissue. It is protected by:

The bones of the skull

Three thin layers of tissue (meninges)

Watery fluid (cerebrospinal fluid) that flows through spaces between the meninges and through spaces (ventricles) within the brain

The brain directs the things we choose to do (like walking and talking) and the things our body does without thinking (like breathing). The brain is also in charge of our senses (sight, hearing, touch, taste, and smell), memory, emotions, and personality.

A network of nerves carries messages back and forth between the brain and the rest of the body. Some nerves go directly from the brain to the eyes, ears, and other parts of the head. Other nerves run through the spinal cord to connect the brain with the other parts of the body.

Within the brain and spinal cord, glial cells surround nerve cells and hold them in place.

The three major parts of the brain control different activities:

Cerebrum: The cerebrum uses information from our senses to tell us what is going on around us and tells our body how to respond. It controls reading, thinking, learning, speech, and emotions.

The cerebrum is divided into the left and right cerebral hemispheres. The right hemisphere controls the muscles on the left side of the body. The left hemisphere controls the muscles on the right side of the body.

Cerebellum: The cerebellum controls balance for walking and standing, and other complex actions.

Brain stem: The brain stem connects the brain with the spinal cord. It controls breathing, body temperature, blood pressure, and other basic body functions.

Tumor Grades and Types
Tumor Grade
Types of Primary Brain Tumors

When most normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Primary brain tumors can be benign or malignant:

Benign brain tumors do not contain cancer cells:
Usually, benign tumors can be removed, and they seldom grow back.
Benign brain tumors usually have an obvious border or edge. Cells from benign tumors rarely invade tissues around them. They don't spread to other parts of the body. However, benign tumors can press on sensitive areas of the brain and cause serious health problems.
Unlike benign tumors in most other parts of the body, benign brain tumors are sometimes life threatening.
Benign brain tumors may become malignant.

Malignant brain tumors (also called brain cancer) contain cancer cells:
Malignant brain tumors are generally more serious and often are a threat to life.
They are likely to grow rapidly and crowd or invade the nearby healthy brain tissue.
Cancer cells may break away from malignant brain tumors and spread to other parts of the brain or to the spinal cord. They rarely spread to other parts of the body.
Tumor Grade

Doctors group brain tumors by grade. The grade of a tumor refers to the way the cells look under a microscope:

Grade I: The tissue is benign. The cells look nearly like normal brain cells, and they grow slowly.

Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a Grade I tumor.

Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing (anaplastic).

Grade IV: The malignant tissue has cells that look most abnormal and tend to grow quickly.
Cells from low-grade tumors (grades I and II) look more normal and generally grow more slowly than cells from high-grade tumors (grades III and IV).

Over time, a low-grade tumor may become a highgrade tumor. However, the change to a high-grade tumor happens more often among adults than children.

You may want to read the NCI fact sheet Tumor Grade.

Types of Primary Brain Tumors:

There are many types of primary brain tumors. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin. For example, most primary brain tumors begin in glial cells. This type of tumor is called a glioma.

Among adults, the most common types are:

Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. It can be any grade. In adults, an astrocytoma most often arises in the cerebrum.
Grade I or II astrocytoma: It may be called a low-grade glioma.
Grade III astrocytoma: It's sometimes called a high-grade or an anaplastic astrocytoma.
Grade IV astrocytoma: It may be called a glioblastoma or malignant astrocytic glioma.

Meningioma: The tumor arises in the meninges. It can be grade I, II, or III. It's usually benign (grade I) and grows slowly.

Oligodendroglioma: The tumor arises from cells that make the fatty substance that covers and protects nerves. It usually occurs in the cerebrum. It's most common in middle-aged adults. It can be grade II or III.

Among children, the most common types are:

Medulloblastoma: The tumor usually arises in the cerebellum. It's sometimes called a primitive neuroectodermal tumor. It is grade IV.

Grade I or II astrocytoma: In children, this lowgrade tumor occurs anywhere in the brain. The most common astrocytoma among children is juvenile pilocytic astrocytoma. It's grade I.

Ependymoma: The tumor arises from cells that line the ventricles or the central canal of the spinal cord. It's most commonly found in children and young adults. It can be grade I, II, or III.

Brain stem glioma: The tumor occurs in the lowest part of the brain. It can be a low-grade or high-grade tumor. The most common type is diffuse intrinsic pontine glioma .

Symptoms:

The symptoms of a brain tumor depend on tumor size, type, and location. Symptoms may be caused when a tumor presses on a nerve or harms a part of the brain. Also, they may be caused when a tumor blocks the fluid that flows through and around the brain, or when the brain swells because of the buildup of fluid.

These are the most common symptoms of brain tumors:

.Headaches (usually worse in the morning)

.Nausea and vomiting

.Changes in speech, vision, or hearing

.Problems balancing or walking

.Changes in mood, personality, or ability to concentrate

.Problems with memory

.Muscle jerking or twitching (seizures or convulsions)

Numbness or tingling in the arms or legs
Most often, these symptoms are not due to a brain tumor. Another health problem could cause them. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated.

Diagnosis:

If you have symptoms that suggest a brain tumor, your doctor will give you a physical exam and ask about your personal and family health history. You may have one or more of the following tests:

Neurologic exam: Your doctor checks your vision, hearing, alertness, muscle strength, coordination, and reflexes. Your doctor also examines your eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain.

MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your head. Sometimes a special dye (contrast material) is injected into a blood vessel in your arm or hand to help show differences in the tissues of the brain. The pictures can show abnormal areas, such as a tumor.

CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your head. You may receive contrast material by injection into a blood vessel in your arm or hand. The contrast material makes abnormal areas easier to see.

Angiogram: Dye injected into the bloodstream makes blood vessels in the brain show up on an x-ray. If a tumor is present, the x-ray may show the tumor or blood vessels that are feeding into the tumor.

Spinal tap: Your doctor may remove a sample of cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). This procedure is performed with local anesthesia. The doctor uses a long, thin needle to remove fluid from the lower part of the spinal column. A spinal tap takes about 30 minutes. You must lie flat for several hours afterward to keep from getting a headache. A laboratory checks the fluid for cancer cells or other signs of problems.

Biopsy: The removal of tissue to look for tumor cells is called a biopsy. A pathologist looks at the cells under a microscope to check for abnormal cells. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to diagnose a brain tumor, learn what grade it is, and plan treatment.

A person who needs a biopsy may want to ask the doctor the following questions:
Why do I need a biopsy? How will the biopsy results affect my treatment plan?

What kind of biopsy will I have?

How long will it take? Will I be awake? Will it hurt?

What are the chances of infection or bleeding after the biopsy? Are there any other risks?

How soon will I know the results?

If I do have a brain tumor, who will talk with me about treatment? When?

Treatment
Surgery
Radiation Therapy
Chemotherapy

People with brain tumors have several treatment options. The options are surgery, radiation therapy, and chemotherapy. Many people get a combination of treatments.

The choice of treatment depends mainly on the following:

The type and grade of brain tumor

Its location in the brain

Its size

Your age and general health
For some types of brain cancer, the doctor also needs to know whether cancer cells were found in the cerebrospinal fluid.

Your doctor can describe your treatment choices, the expected results, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.

You may want to ask your doctor these questions before you begin treatment:
What type of brain tumor do I have?

Is it benign or malignant?

What is the grade of the tumor?

What are my treatment choices? Which do you recommend for me? Why?

What are the expected benefits of each kind of treatment?

What can I do to prepare for treatment?

Will I need to stay in the hospital? If so, for how long?

What are the risks and possible side effects of each treatment? How can side effects be managed?

What is the treatment likely to cost? Will my insurance cover it?

How will treatment affect my normal activities? What is the chance that I will have to learn how to walk, speak, read, or write after treatment?

Would a research study (clinical trial) be appropriate for me?

Can you recommend other doctors who could give me a second opinion about my treatment options?

How often should I have checkups?

How often should I have checkups?

Surgery:

Surgery is the usual first treatment for most brain tumors. Before surgery begins, you may be given general anesthesia, and your scalp is shaved. You probably won't need your entire head shaved.

Surgery to open the skull is called a craniotomy. The surgeon makes an incision in your scalp and uses a special type of saw to remove a piece of bone from the skull.

You may be awake when the surgeon removes part or all of the brain tumor. The surgeon removes as much tumor as possible. You may be asked to move a leg, count, say the alphabet, or tell a story. Your ability to follow these commands helps the surgeon protect important parts of the brain.

After the tumor is removed, the surgeon covers the opening in the skull with the piece of bone or with a piece of metal or fabric. The surgeon then closes the incision in the scalp.

Sometimes surgery isn't possible. If the tumor is in the brain stem or certain other areas, the surgeon may not be able to remove the tumor without harming normal brain tissue. People who can't have surgery may receive radiation therapy or other treatment. You may have a headache or be uncomfortable for the first few days after surgery. However, medicine can usually control pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, your team can adjust the plan if you need more relief.

You may also feel tired or weak. The time it takes to heal after surgery is different for everyone. You will probably spend a few days in the hospital.

Other, less common problems may occur after surgery for a brain tumor. The brain may swell or fluid may build up within the skull. The health care team will monitor you for signs of swelling or fluid buildup. You may receive steroids to help relieve swelling. A second surgery may be needed to drain the fluid. The surgeon may place a long, thin tube (shunt) in a ventricle of the brain. (For some people, the shunt is placed before performing surgery on the brain tumor.) The tube is threaded under the skin to another part of the body, usually the abdomen. Excess fluid is carried from the brain and drained into the abdomen. Sometimes the fluid is drained into the heart instead.

Infection is another problem that may develop after surgery. If this happens, the health care team will give you an antibiotic.

Brain surgery may harm normal tissue. Brain damage can be a serious problem. It can cause problems with thinking, seeing, or speaking. It can also cause personality changes or seizures. Most of these problems lessen or disappear with time. But sometimes damage to the brain is permanent.

You may want to ask your doctor these questions about surgery:
Do you suggest surgery for me?

How will I feel after the operation?

What will you do for me if I have pain?

How long will I be in the hospital?

Will I have any long-term effects? Will my hair grow back? Are there any side effects from using metal or fabric to replace the bone in the skull?

When can I get back to my normal activities?

What is my chance of a full recovery?

Radiation Therapy

Radiation therapy kills brain tumor cells with high-energy x-rays, gamma rays, or protons.

Radiation therapy usually follows surgery. The radiation kills tumor cells that may remain in the area. Sometimes, people who can't have surgery have radiation therapy instead.

Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.

If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you'll have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In many cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually won't make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with a brain tumor need treatment right away.

Return to healthy eating:

While healthy eating by itself cannot keep cancer from coming back, it can help you regain strength, rebuild tissue, and improve how you feel after treatment ends. Here are some ways to eat well after treatment ends:

.Prepare simple meals that you like and are easy to make.
.Cook 2 or 3 meals at a time. Freeze the extras to eat later on.
.Stock up on frozen dinners.
.Make cooking easy, such as buying cut-up vegetables from a salad bar.
.Eat many different kinds of foods. No single food has all the vitamins and nutrients you need.
.Eat lots of fruits and vegetables. This includes eating raw and cooked vegetables, fruits, and fruit juices. These all have vitamins, minerals, and fiber.
.Eat whole wheat bread, oats, brown rice, or other whole grains and cereals. These have needed complex carbohydrates, vitamins, minerals, and fiber.
.Add beans, peas, and lentils to your diet and eat them often.
.Go easy on fat, salt, sugar, alcohol, and smoked or pickled foods.
.Choose low-fat milk products.
.Eat small portions (about 6 to 7 ounces each day) of lean meat and poultry without skin.
.Use low-fat cooking methods, such as broiling, steaming, grilling, and roasting.

Follow-up Care After Cancer Treatment

.How are follow-up care schedules planned?
The frequency and nature of follow-up care is individualized based on the type of cancer, the type of treatment received, and the person’s overall health, including possible treatment-related problems. In general, people return to the doctor for follow-up appointments every 3 to 4 months during the first 2 to 3 years after treatment, and once or twice a year after that.

At these follow-up appointments, the doctor may recommend tests to check for recurrence or to screen for other types of cancer. In many cases, it is not clear that special follow-up tests improve survival or quality of life. This is why it is important for the doctor to help determine what follow-up care plan is appropriate. The doctor may not need to perform any tests if the person appears to be in good physical condition and does not have any symptoms. It is important for the patient to talk with the doctor about any questions or concerns related to the follow-up care plan.

When planning a follow-up care schedule, patients should consider who will provide the follow-up care and who will provide other medical care. They should select a doctor with whom they feel comfortable. This may be the same doctor who provided the person’s cancer treatment. For other medical care, people should continue to see a family doctor or medical specialist as needed.

Some people might not have a choice in who provides their follow-up care, because some insurance plans pay for follow-up care only with certain doctors and for a set number of visits. In planning follow-up care, patients may want to check their health insurance plan to see what restrictions, if any, apply to them.

What should patients talk to their doctor about once cancer treatment ends?
Every cancer survivor should request a comprehensive care summary and follow-up plan from their doctor once they complete their treatment. Patients should ask their doctor the following questions once cancer treatment ends. The answers can help inform the patient about their care and what to expect next. (See Question 7 for more information about plans for follow-up care.)

.What treatments and drugs have I been given?
.How often should I have a routine visit?
.Which doctor should I see for my follow-up cancer care?
.What are the chances that my cancer will come back or that I will get another type of cancer?
.What follow-up tests, if any, should I have?
.How often will I need these tests?
.What symptoms should I watch for?
.If I develop any of these symptoms, whom should I call?
.What are the common long-term and late effects of the treatment I received?
.What should I do to maintain my health and well-being?
.Will I have trouble getting health insurance or keeping a job because of my cancer?
.Are there support groups I can turn to?
.Many patients find it helpful to write these questions down and take notes or tape record their discussions with the doctor to refer to at a later time.

The Truth about Mental Health Disorders - Psychology

2009-12-12T05:57:00.000-08:00

The Truth about Mental Disorders.

Dr. John Breeding, Ph.D. psychologist discusses how mental disorders are created by the American Psychiatric Association and listed in the DSM (Diagnostic and Statistical manual of Mental Disorders.

Disorders such as bipolar, ADHD, OCD, Anxiety Disorders, etc. are voted into existence by APA committees.

The underlying assumption of biological psychiatry is that mental illness is biologically based despite the fact that no solid science has been able to identify biological markers for mental illnesses.

Acting Out

Defense mechanism. When an inner conflict (most often, frustration) translates into aggression. It involves acting with little or no insight or reflection and in order to attract attention and disrupt other people's cozy lives.

Affect

Affect is how we express our innermost feelings and how other people observe and interpret our expressions. Affect is characterized by the type of emotion involved (sadness, happiness, anger, etc.) and by the intensity of its expression. Some people have flat affect: they maintain "poker faces", monotonous, immobile, apparently unmoved. This is typical of the Schizoid Personality Disorder Others have blunted, constricted, or broad (healthy) affect. Patients with the dramatic (Cluster B) personality disorders - especially the Histrionic and the Borderline - have exaggerate and labile (changeable) affect. They are "drama queens".

In certain mental health disorders, the affect is inappropriate. For instance: such people laugh when they recount a sad or horrifying event or when they find themselves is morbid settings (e.g., in a funeral).

Antisocial Personality Disorder (Psychopath)

APD or AsPD; Formerly called "psychopathy" or, more colloquially, "sociopathy". Some scholars, such as Robert Hare, still distinguish psychopathy from mere antisocial behavior. The disorder appears in early adolescence but criminal behavior and substance abuse often abate with age, usually by the fourth or fifth decade of life. It may have a genetic or hereditary determinant and afflicts mainly men. The diagnosis is controversial and regarded by some scholar as scientifically unfounded.

Their (primitive) defence mechanisms include splitting (they view the world - and people in it - as "all good" or "all evil"), projection (attribute their own shortcomings unto others) and projective identification (force others to behave the way they expect them to).

The psychopath fails to comply with social norms. Hence the criminal acts, the deceitfulness and identity theft, the use of aliases, the constant lying, and the conning of even his nearest and dearest for gain or pleasure. Psychopaths are unreliable and do not honor their undertakings, obligations, contracts, and responsibilities. They rarely hold a job for long or repay their debts. They are vindictive, remorseless, ruthless, driven, dangerous, aggressive, violent, irritable, and, sometimes, prone to magical thinking. They seldom plan for the long and medium terms, believing themselves to be immune to the consequences of their own actions.

Autism

More precisely: autistic thinking and inter-relating (relating to other people). Fantasy-infused thoughts. The patient's cognitions derive from an overarching and all-pervasive fantasy life. Moreover, the patient infuses people and events around him or her with fantastic and completely subjective meanings. The patient regards the external world as an extension or projection of the internal one. He, thus, often withdraws completely and retreats into his inner, private realm, unavailable to communicate and interact with others.

Compulsion

Involuntary repetition of a stereotyped and ritualistic action or movement, usually in connection with a wish or a fear. The patient is aware of the irrationality of the compulsive act (in other words: she knows that there is no real connection between her fears and wishes and what she is repeatedly compelled to do). Most compulsive patients find their compulsions tedious, bothersome, distressing, and unpleasant - but resisting the urge results in mounting anxiety from which only the compulsive act provides much needed relief. Compulsions are common in obsessive-compulsive disorders, the Obsessive-Compulsive Personality Disorder (OCPD), and in certain types of schizophrenia.

Self Help

There are many options in treating mental health disorders. In Great Britain, doctors are known to prescribe self-help books to patients as a first line defense strategy. Medication is given secondary consideration.

There are many therapies that persons can participate in, and some of them are listed below. However, use of psychiatric medications for both adults and children has increased between four and five times in the past decade, some say it has increased seven-fold. This is proving to be true even for children as young as four years old.

There are a number of well-written books that provide useful guidelines, written by physicians and by psychiatrists. Natural Prozac, by Joel Robertson, Prozac Backlash, Dr. Joseph Glenmullen, Rethinking ADHD, by Ruth Neven from Australia, The ADD & ADHD Question and Answer Book by Dr. Susan Ashley, are all helpful references for both depression and ADHD.

Lifestyle changes can help a person to regain and maintain mental balance without having to resort to medications. It takes courage to face one's problems and make changes in one's life and to swim against the current, There is personal responsibility in our decisions and our decisions cannot be relegated to another person, not even to a doctor, family member or other professional.

Coaching for those with ADHD or depression is also available. There are organizations that can give you a list of coaches in your area. Some coaches work through the phone. They are there to support you or your child, to give practical suggestions and encouragement. Coaching is less costly and is often used in addition to the role of a therapist, but at times has been used instead of a therapist. The suggestion has been made by one mental health organization, that some who may not want to go on medicine or see a psychologist, might try coaching as a first line of defense.

Some principles and tools for good mental health can be summed up as follows:

.Love

.Purposeful living

.Mental hygiene

.Spiritual hygiene and attention to spiritual needs.

.Physical activity & balance

.Cleanliness & Order

.Mind Strengthening and creative activities

.Art as a natural mood stabilizer

.Honesty & Humility

.Communication concerning the present and past.

.Effort.

Finding good companions and avoiding isolation.
Why a Non-Pharmaceutical Approach?

By taking time to look at lifestyle changes, mental hygiene, possibly physical aspects of one's life, or past experiences that might still be effecting one's emotions, it can give insight into how to overcome mood disorders more permanently.

It does take more effort and time initially for both the person who is experiencing mental health problems, and for professionals who might be working with someone who has mental health problems. It also takes patience and commitment on the part of family members, but in the end a non-pharmaceutical approach to treating mental illness can be more effective. If family members are involved in the treatment plan or counseling, this can result be benifiical.

One psychiatrist stated that diagnosing the illness and prescribing what he felt was appropriate medication, was the easy part, helping people with family issues, employment issues, issues from the past which might still be effecting his emotional or mental state, helping clients adjust lifestyles, was the hard part, it required more time, effort as well as commitment, and it was the more difficult part of his profession.

Lifestyles Changes

It has been found that by addressing lifestyle issues, much can be done in a positive way, that can help a person successfully cope and even overcome many mental health disorders. This is true of not only mild or moderate depression, but also even more serious psychiatric disorders.
By addressing these lifestyle issues, many have found more permanent, long-term, and even immediate relief from mental distresses and mood disorders as well as dealing with such problems with their children. The positive results for some with serious mental health problems have been permanent. Strict mental hygiene is something that many may need to give attention to.

Mental Hygiene

When we floss our teeth, we are surprised how much food is stuck in between. Our teeth looked clean, but daily flossing helps to preserve the life of one's teeth. In the same way, our minds need "mental flossing" quite often, attention to the details of what we are allowing into our mind on a daily basis can work wonders for our mental health. This is true both of adults and children.

The Mind Needs Rest

Our minds need to rest at times. If you were to use a hair dryer, 24 hours a day, it would eventually, or quickly, burn out. the same is true of our minds. A person who is on the go constantly, even in a positive way, needs to find time to recharge the batteries. We need adequate sleep naturally, without pills or alcohol, for the mind to recharge.

By giving attention to lifestyle issues, one may also find that their mental health gradually is restored, and that a person can learn to both cope with these problems and even see them go into remission over time. This isn't a miraculous overnight transition. It is one that takes perseverance and effort and that might take some time to see significant differences in one's mood. But the end result may be a significant improvement or even a full and permanent recovery.

Do you exercise?

When we think of lifestyle changes, we might think of drinking, smoking or using drugs, changes in these areas can all be of benefit in our mental health, but there are also many small changes in one's life that can make a big difference in one's mental health and in that of a child. Some have found relief from depression by maintaining an exercise regimen.

It has been found that brisk walking for exercise, is more effective in treating mild to moderate depression than taking medication, in both the short and long term treatment, as well as with the recurrence rate. In fact, one study by Duke University demonstrated that exercise alone was even more effective than using medication, and more effective than when medicine and exercise were combined. This proved true in both the short and long-term.

Exercise, when practiced regularly, preferably daily, naturally raises the serotonin level and endorphins in one's brain and contributes to better mood; but because it is being accomplished without adding manufactured pharmaceuticals, it is something that can be maintained for one's entire lifetime, in addition to the physical benefits from the exercise itself.

Brisk walking and exercise is said to be a better and more long-lasting treatment for depression than that of medication.

.It helps you to focus
.It stimulates positive emotions
.It contributes to positive self-worth
.It helps stimulate endorphins and opiates in the brain, giving a natural sense of well-being.
.It is gentle, it's positive effects are long-lasting when continued.
.It helps one to be in shape physically and stimulates the heart.
.It contributes to weight loss.
.It can give the mind time to rest, if one walks without music.
.Other forms of exercise also help. One man who at times has experienced depression and overcame it, takes no medication. Instead he swims three or four times a week. He says it is the only thing that keeps him out of depression and medicine-free

Attention to diet and engaging in mind strengthening activities also are of benefit in prevention and in pursuing natural remedies for mental health disorders:

The Importance of Self Esteem

Self esteem is a vital component of a healthy mind. When we see tangible results of our own work, it helps to build a healthy self-esteem. Mind strengthening activities can help. Doing good things for others helps us to build positive feelings about ourselves. Creative endeavors also are of help in building self-esteem. Avoiding self-destructive behavior and having a regular job also build a positive sense of self-worth. Choosing associates who are a source of strength also is of value, rather than those who might be engaging in actions that are self-destructive such as hanging out at bars, drinking, or taking drugs.

Also, we need to get away from an all or nothing way of thinking. We all make mistakes, some of us worse than others, but everyone does. Many people these days are wounded from the past and present. We need to accept our failures, or mistakes, our shortcomings, work at overcoming them, but not to self-flagellate ourselves for past or present problems. We need to accept God's mercy, and look to Him for help. We need to learn to be merciful both to others and ourselves and realize that that is how God looks at things. He is there to help us, not to condemn us.

Art and its value in mental health therapy

Art, is a form of recreation, if it is kept in its proper place, can help calm the mind down in the same way that a tranquilizer does in a natural way. It can help to stabilize the mood of someone suffering with bi-polar disorder, as well as a child suffering with ADHD when it is engaged in regularly. It helps one to establish new thought patterns. It can be a natural mood stabilizer.

Art can strengthen the mind, and helps both children and adults have a healthy form of recreation. It can be a positive force to help one spend less time with TV video games or movies. It can be of assistance in breaking free from pornography. It can also be a tool for building self-esteem. It can be a peaceful healing tool for those who may have suffered from abuse.

Love is an important element of good mental health

Is a key element of good mental health.
Both the giving and recieving love is an essential
part of human emotional needs. Any time that we
spend in giving of ourselves to other people
can help us to have fulfilling and happier lives and can
contribute to healthful thought patterns.

CATALYSIS

2009-11-27T05:19:00.000-08:00

CATALYSIS:

A catalyst is a substance which asters the speed of a chemical reaction without itself undergoing any chemical change and the phenomenon is known as catalysis.

Example:

2KCIO3 ------> 2KCI + 3O2
In the above reaction, MnO2 acts as a catalyst.

GENERAL CHARACTERISTICS OF CATALYTIC REACTIONS:

The following characteristics are generally common to most of the catalytic reactions.
1. The catalyst remains unchanged in mass and in chemical composition at the end of the reaction.
2. Only a small quantity of catalyst is generally needed.
3. A catalyst cannot initiate a reaction. The function of a catalyst is only to alter the speed of the reaction which is already occurring at a particular rate.
4. A catalyst does not alter the position of equilibrium in a reversible reaction.
5. The catalyst is generall specific in its action.

TYPES OF CATALYTIC REACTIONS:

Catalytic reactions are classified into two broad types;

1. Homogeneous catalysis

2. Heterogeneous catalysis.

1. HOMOGENEOUS CATALYSIS:

In these reactions, the reactants and catalyst remain in the same phase. The following are some of the examples of homogeneous catalysis.

i. Oxidation of SO2 to SO3 with oxygen in the presence of nitric oxide as the catalyst in the lead chamber process.

2SO2(g) + O2(g) ------> 2SO3

ii. Hydrolysis of methyl acetate is catalysed by H+ins furnished by hydrochloric acid.

CH3COOCH3(1) + H2O(1) ------> CH3COOH + CH3OH

2. HETEROGENEOUS CATALYSIS:

The catalytic process in which the reactants and the catalyst are in different phases is known as heterogeneous catalysis. Some of the examples of heterogeneous catalysis are given below.

i. Oxidation of SO2 to SO3 in the presence of Pt metal or V2O5 as catalyst in the contact process for the manufacture of sulphuric acid.

2SO2(g) + O2(g) --------> 2SO3

The reactants are in gaseous phase while the catalyst is in solid phase.

ii. Combination between nitrogen and hydrogen to form ammonia in the presence of finely divided iron in Haber's process.

N2(g) + 3H2(g) ---------> 2NH3

The reactants are in gaseous phase while the catalyst is in solid phase.

TYPES OF CATALYSTS:

The catalysts have been divided into different types according to their behaviour and pattern of action.

1. POSITIVE CATALYST:

A catalyst which enhances the speed of the reaction is called positive catalyst and the phenomenon in known as positive catalysis. Various examples are geven below:

i. Decomposition of H2O2 in presence of colloidal platinum

2H2O2 --------> 2H2O + O2

ii. Decomposition of KCIO3 in presence of manganese dioxide.

2KCIO3 ---------> 2KCI + 3O2

2. NEGATIVE CATALYST:

There are certain substances which, when added to the reaction mixture, retard the reaction rate instead of increasing it. These are called negative catalysts or inhibitors and the phenomenon is known as negative catalysis. The examples are given below:

i. The oxidation of sodium sulphite by air is retarded by alcohol.

2Na2SO3 + O2 -------> 2Na2SO4

ii. The decomposition of hydrogen peroside decreases in presence of glycerine.

2H2O2 --------> 2H2O + O2

3.AUTO CATALYST:

In certain reactions, it is observed that one of the products formed during the reaction acts as a catalyst for that reaction. Such type of catalyst is called auto catalyst and the phenomenon is known as auto catalysis.

In the oxidation of oxalic acid by potassium permanganate, one of the products MnSO4 acts as a auto-catalyst because it increases the speed of the reaction.

4. INDUCED CATALYST:

When one reactant influences the rate of other reaction, which does not occur under ordinary conditions, the phenomenon is known as induced catalysis.

Sodium arsenite solution in not oxidised by air. If, however, air is passed through a mixture of the solution of sodium arsenite and sodium sulphite, both of them undergo simultaneous oxidation. Thus sulphite has induced the arsenite and hence is called induced catalyst.

PROMOTERS:

The activity of a catalyst can be increased by addition of a small quantity of a second material. A substance which, though itself not a catalyst, promotes the activity of a catalyst is called a promoter. Some examples of the promoters are given below:

In the Haber's process for the synthesis of ammonia, traces of molybdenum increase the activity of finely divided iron which acts as a catalyst.

CATALYTIC POISONS:

A substance which destroys the activity of the catalyst is called a poison and the process is called catalytic poisoning. Some of the examples are

(i) The platinum catalyst used in the oxidation of SO2 in contact process is poisoned by arsenious oxide.

(ii) The iron catalyst used in the synthesis of ammonia in Haber process is poisoned by H2S.

ACTIVE CENTRES:

The catalytic surface has unbalanced chemical bonds on it. The reactant gaseous molecules are adsorbed on the surface by these free bonds. This accelerates the rate of the reaction. The distribution of free bonds on the catalytic surface is not uniform. These are crowded at the peaks, cracks and corners of the catalyst. The catalytic activity due to adsorption of reacting molecules is maximum at these spots. These are, therefore, referred to as the active centres. If a catalyst has more active centres, them its catalytic activity is ilncreased.

Effects of High Blood Pressure

2009-11-18T06:28:00.000-08:00

You can have high blood pressure (hypertension) for years without a single symptom. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

High blood pressure typically develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Symptoms:

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms typically don't occur until high blood pressure has reached an advanced — even life-threatening — stage.

When to see a doctor
Unless you have symptoms of extremely high blood pressure, there's probably no need to make a special trip to the doctor to have your blood pressure checked. You'll likely have your blood pressure taken as part of a routine doctor's appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age 20. He or she will likely recommend more frequent readings if you've already been diagnosed with high blood pressure, prehypertension or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups.

If you don't regularly see your doctor, but are concerned about your blood pressure, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in drugstores that will measure your blood pressure for free, but these machines aren't often calibrated and can give you inaccurate results.

Causes:

There are two types of high blood pressure.

Primary (essential) hypertension
In 90 to 95 percent of high blood pressure cases in adults, there's no identifiable cause. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

Secondary hypertension
The other 5 to 10 percent of high blood pressure cases are caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

Kidney abnormalities
Tumors of the adrenal gland
Certain congenital heart defects
Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
Illegal drugs, such as cocaine and amphetamines

Risk factors:

High blood pressure has many risk factors. Some you can't control. High blood pressure risk factors include:

Age. The risk of high blood pressure increases as you age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks.
Family history. High blood pressure tends to run in families.
Other risk factors for high blood pressure are within your control.

Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction — and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Using tobacco. Not only does smoking tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure.
Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't consume or retain enough potassium, you may accumulate too much sodium in your blood.
Too little vitamin D in your diet. It's uncertain if having too little vitamin D in your diet can lead to high blood pressure. Researchers think vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure. More studies are necessary to determine vitamin D's role in blood pressure.
Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two or three drinks in a sitting can also temporarily raise your blood pressure, as it may cause your body to release hormones that increase your blood flow and heart rate.
Stress. High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.

Complications:

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to:

Damage to your arteries. This can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
A blocked or ruptured blood vessel in your brain. High blood pressure in the arteries leading to your brain can either slow the blood flow to your brain or cause a blood vessel in your brain to burst, causing a stroke.
Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism — including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or "good," cholesterol, high blood pressure, and high insulin levels. If you have high blood pressure, you're more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure also may affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure.

Tests and diagnosis:

Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

The latest blood pressure guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories:

Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one-third of adults ages 35 to 64 and nearly half the adults age 65 or older develop high blood pressure.
Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
Stage 2 hypertension. The most severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more significant. Isolated systolic hypertension (ISH) — when diastolic pressure is normal but systolic pressure is high — is the most common type of high blood pressure among people older than 50.

Your doctor will likely take two to three blood pressure readings each at two or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day — and sometimes specifically during visits to the doctor, a condition called white-coat hypertension. Your doctor may ask you to record your blood pressure at home and at work to provide additional information. Measuring your blood pressure at home can also help diagnose masked hypertension, a condition in which your blood pressure is lower than it normally is when you visit the doctor's office.

If you have any type of high blood pressure, your doctor may recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram (ECG) — a test that measures your heart's electrical activity. More extensive testing isn't usually needed, at least initially.

Treatments and drugs:

Your blood pressure treatment goal depends on how healthy you are.

Blood pressure treatment goals*
140/90 mm Hg or lower If you are a healthy adult
130/80 mm Hg or lower If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease
120/80 mm Hg or lower If your heart isn't pumping as well as it should (left ventricular dysfunction or heart failure) or you have severe chronic kidney disease
* Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.

If you're an adult age 80 or older and your blood pressure is very high, your doctor may set a target blood pressure goal for you that's slightly higher than 140/90 mm Hg.

Changing your lifestyle can go a long way toward controlling high blood pressure. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. Which category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical problems.

The major types of medication used to control high blood pressure include:

Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. Still, diuretics are often not prescribed. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic.

If you're age 80 or older, a special type of thiazide diuretic, indapamide (Lozol), may be particularly effective in lowering your blood pressure. In this age group, indapamide has been shown to reduce deaths from stroke, heart failure and other cardiovascular disease causes.

Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks — but they're effective when combined with a thiazide diuretic.
Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors don't work as well in blacks when prescribed alone, but they're effective when combined with a thiazide diuretic.
Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure and kidney failure.
Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.
Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a cascade of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. The drug is still being studied to figure out its ideal use and dosage for people with high blood pressure.
If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders.

To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication — or combination of drugs — is a matter of trial and error.

Resistant hypertension: When your blood pressure is difficult to control
If your blood pressure has remained stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.

Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective. You may need to see a hypertension specialist if your primary care doctor isn't able to pinpoint a cause. It may also be that another condition you have that you may not be aware of, such as sleep apnea or kidney problems, is causing your high blood pressure. You may need to be more aggressive in following lifestyle recommendations.

Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. Your doctor may also prescribe other medications, including a more potent or longer acting diuretic if you're not already taking one. Your doctor may also suggest nonthiazide diuretic drugs, such as spironolactone (Aldactone) or eplerenone (Inspra), which change the way your body absorbs sodium and excretes potassium by blocking the hormone aldosterone. People with resistant hypertension often have higher levels of aldosterone.

In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.

If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't alter your treatment without your doctor's guidance.

Lifestyle and home remedies:

Lifestyle changes can help you control and prevent high blood pressure — even if you're taking blood pressure medication. Here's what you can do:

Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
Decrease the salt in your diet. Although 2,400 milligrams (mg) of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 mg a day will have a more dramatic effect on your blood pressure. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners.
Maintain a healthy weight. If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.
Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation — up to one drink a day for women and everyone over age 65, and two drinks a day for men.
Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit.
Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.
Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. If your blood pressure is under control, you may be able to make fewer visits to your doctor if you monitor your blood pressure at home.
Practice relaxation or slow, deep breathing. Do it on your own or try device-guided paced breathing. In some clinical trials, regular use of Resperate — an over-the-counter device approved by the Food and Drug Administration to analyze breathing patterns and help guide inhalation and exhalation — lowered blood pressure. However, some researchers question whether the devices themselves or simply taking 15 minutes to relax are responsible for lowering blood pressure.

Alternative medicine:

Although diet and exercise are the best tactics to lower your blood pressure, some supplements also may help decrease it. These include:

Alpha-linolenic acid (ALA)
Blond psyllium
Calcium
Cocoa
Cod-liver oil
Coenzyme Q-10
Omega-3 fatty acids
Garlic
While it's best to incorporate these supplements in your diet as foods, you can also take supplement pills or capsules. Talk to your doctor before adding any of these supplements to your blood pressure treatment. Some supplements can interact with medications, causing harmful side effects.

You can also practice relaxation techniques, such as yoga or deep breathing to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure.

Introduction to Solid State Chemistry

2009-11-07T06:35:00.000-08:00

Solid-state chemistry is the study of the synthesis, structure, and physical properties of solid materials. It therefore has a strong overlap with solid-state physics, mineralogy, crystallography, ceramics, metallurgy, thermodynamics, materials science and electronics with a focus on the synthesis of novel materials and their characterization.

Abstract:
Mining-related and industrial wastes are primary sources of heavy metal contamination in soils and groundwater. The limitation of such waste in drinking water needs to meet government requirements in order to safeguard human health and environment. Zinc, one of the most preponderant pollutants, is difficult to remove from wastewater rather than other heavy metals (i.e. lead, copper and cadmium). This paper investigates Zn2+ adsorption characteristics of two natural zeolites found in the regions of Gordes and Bigadic, in western Turkey. The results show that the Zn2+ adsorption behavior of both zeolites is highly dependent on the pH. Adsorption dependence on lower pH values (pH < 4) is explained by the dissolution of crystal structure and the competition of the zinc ions with the H+. Between pH 4 and 6, the basic mechanism is the ion exchange process. The results also showed that decrease in grain size does not increase the adsorption capacity of zeolite from Gordes, yet it increases that of zeolite from Bigadic about 23%. The results also reveal that an increase in the initial concentration of Zn2+ in the system causes an increase in the adsorption capacity to a degree, then it becomes more constant at higher concentrations. With this, the removal efficiency of Gordes zeolite is two times higher than that of Bigadic zeolite. Results show that an increase in slurry concentration results in a lower uptake of Zn2+. In the final part of the paper, we compared the experimental data with the Langmuir and Freundlich isotherms. The results show that there is a good fit between the experimental data and empirical isotherms.

Adsorption:

Adsorption is a surface phenomenon. It is observed at the surface of the solution. Adsorption is a phenomenon of concentration of substance on the surface of a liquid or solid.

The condition in which concentration of a substance in the interfacial layers between two phases is greater than in the bulk of either phase,then the substances is said to be adsorbed at the interface and the phenomenon is known as adsorption".

The process of adsorption of gases by solids is a common phenomenon. The charcoal specially coconut charcoal has a great capacity of the adsorption of gases. Silica gel is also utilised for the adsorption of number of gases. The solid that takes up gas or vapour or solute from a given solution is called adsorbent and the solute or gas which is held to surface of solid is known as adsorbate.

Classification of adsorption of gases on solids:

The adsorption of gases on solids has been divided in to two types based on the nature of forces holding the fas molecules to the solids.

1. Physical adsorption (or) Vander waal's adsorption
2. Chemical adsorption (or) chemisorption

Physical adsorption:

This adsorption is due to the operation of forces between solid surface and the adsorbate molecules that are similar to vancer waal's forces between molecules. These forces are generally undirected and relatively non specific. Physical adsorption can also be defined as that type of adsorption where physical forces hold the gas molecules to the solids.

Chemical adsorption:

Chemical adsorption is defined as a type of adsorption in which chemical bonds serve the function of holding gas molecules to the surface. It occurs due to the stronger binding forces, comparable with those leading to formation of chemical compounds. It is generally an irreversible process.

The main differences can be summarised as follows:

PHYSICAL ADSORPTION:
1. It is due to intermoleculaar Vander waal's force.
2. Depends on the nature of gas.
Easily liquefiable gases are adsorbed readily.
3. Heat of adsorption is small
4. Reversible.
5. If occurs rapidly at low temperature and decreases with
increase of temperature.
6. Increase of pressure increases adsorption..
7. Forms multimolecular layers on adsorbent surface.

CHEMICAL ADSORPTION:
1. It is due to chemical bond formation.
2. More specific than the physical adsorption.
3. Heat of adsorption is large.
4. Irreversible.
5. Increases with increase of temperature..
6. Change of pressure has no effect.
7. Forms unimolecular layer.

FACTORS AFFECTING ADSORPTION:

The magnitude of gaseous adsorption depends upon the following factors:

i. Temperature

ii. Pressure

iii. Nature of the gas and

iv. Nature of the adsorbent.

EFFECT OF TEMPERATURE AND PRESSURE:

Adsorption is invariably accompanied by evolution of heat. Therefore, in accordance with Le chatlier's principle, the magnitude of adsorption increases with decrease in temperature. Further, since adsorption of a gas leads to decrease of pressure, the magnitude of adsorption increases with increase in pressure. Thus, decrease of temperature and increase of pressure both tend to cause increase in the magnitude of adsorption of a fas on a solid.

Nature of the gas:

It is observed that the more readily soluble and easily liquefiable gases such as ammonia, chlorine and sulphur dioxide are adsorbed more than the hydrogen, nitrogen and oxygen. The reason is that Vander waal's or intermolecular forces which are involved in adsorption are more predominant in the former than in the latter.

NATURE OF THE ADSORBENT:

Adsorption is a surface phenomenon. Therefore, the greater the surface area per unit mass of the adsorbent, the greater is its capacity for adsorption under the given conditions of temperature and pressure.

Supercooling

2009-10-22T06:46:00.000-07:00

Supercooling is the process of lowering the temperature of a liquid or a gas below its freezing point, without it becoming a solid.

A liquid below its standard freezing point will crystallize in the presence of a seed crystal or nucleus around which a crystal structure can form. However, lacking any such nucleus, the liquid phase can be maintained all the way down to the temperature at which crystal homogeneous nucleation occurs. The homogeneous nucleation can occur above the glass transition where the system is an amorphous (non-crystalline) solid.

Water normally freezes at 273.15 K (0 °C or 32 °F) but it can also be "supercooled" at standard pressure down to its crystal homogeneous nucleation at almost 231 K (−42 °C). If cooled at a rate on the order of 106 K/s, the crystal nucleation can be avoided and water becomes a glass. Its glass transition temperature is much colder and harder to determine, but studies estimate it at about 165 K (−108 °C). Glassy water can be heated up to approximately 150 K (−123 °C). In the range of temperatures between 231 K (−42 °C) and 150 K (−123 °C) experiments find only crystal ice.

Droplets of supercooled water often exist in stratiform and cumulus clouds. They form into ice when they are struck by the wings of passing airplanes and abruptly crystallize. (This causes problems with lift, so aircraft that are expected to fly in such conditions are equipped with a de-icing system.) Freezing rain is also caused by supercooled droplets.

The process opposite to supercooling, the melting of a solid below the freezing point, is much more difficult, and a solid will almost always melt at the same temperature for a given pressure. For this reason, it is the melting point which is usually identified, using melting point apparatus; even when the subject of a paper is "freezing-point determination", the actual methodology is "the principle of observing the disappearance rather than the formation of ice". It is, however, possible, at a given pressure to superheat a liquid above its boiling point without it becoming gaseous.

Constitutional supercooling:
Constitutional supercooling occurs during solidification, is due to compositional changes, and results in cooling a liquid below the freezing point ahead of the solid-liquid interface. When solidifying a liquid, the interface is often unstable, and the velocity of the solid-liquid interface must be small in order to avoid constitutional supercooling.

Supercooled zones are observed when the liquidus temperature gradient at the interface is larger than the temperature gradient.

or

The slope of the liquidus phase boundary on the phase diagram is
The concentration gradient is related to points, CLS and CSL, on the phase diagram:

The minimum thermal gradient necessary to create a stable solid front is as expressed below.

In plants:
Some plants are able to supercool the fluid in their cells cytosol and vacuole and thereby survive temperatures down to -40°C. This is partly achieved through the synthesis of antifreeze proteins that prevent ice nucleation.

Commercialization of supercooling:
One commercial application of supercooling is in refrigeration. For example, there are freezers that cool drink to a supercooled level so that when it is opened it slushes over. Another example is a product that can supercool the beverage in a conventional freezer. Coca-Cola also briefly marketed supercooled Sprite in the UK, which required special vending machines to store the bottles in a supercooled state so that they would turn to slush upon opening.

Other uses of supercooling include commercial hand warmers. The hand warmers contain Sodium Acetate in a supercooled state in a sealed plastic pouch. There is a disk in the pouch that is clicked to stimulate the liquid to turn into a solid. The freezing temperature of the liquid is higher than room temperature, so when the liquid turns into a solid, it releases enough energy to raise its temperature towards its freezing point, which heats the hands. To supercool the liquid again, it must first be heated to the melting temperature again and allowed to cool.

Asthma

2009-10-12T06:41:00.000-07:00

What Is Asthma?
Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

What are the symptoms of asthma?
Asthma may resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. It is often under-diagnosed and many people with the disease do not know they have it. Sometimes, the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

What causes asthma?
The exact cause of asthma is not completely known. It is believed to be partially inherited, but it also involves many other environmental, infectious, and chemical factors.

After a person is exposed to a certain trigger, the body releases histamine and other agents that can cause inflammation in the airways. The body also releases other factors that can cause the muscles of the airways to tighten, or become smaller. There is also an increase in mucus production that may clog the airways.

Some persons have exercise-induced asthma, which is caused by varying degrees of exercise. Symptoms can occur during, or shortly after, exercise. Each person has different triggers that cause the asthma to worsen. You should discuss this with your physician.

The changes that occur in asthma are believed to happen in two phases:

1.An immediate response to the trigger leads to swelling and narrowing of the airways. This makes it initially difficult to breathe.
2.A later response, which can happen four to eight hours after the initial exposure to the allergen, leads to further inflammation of the airways and obstruction of airflow.
Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the risk factors for an asthma attack?
Although anyone may have an asthma attack, it most commonly occurs in the following persons:

.children by the age of 5
.adults in their 30s
.adults older than 65
.people living in urban communities
Other factors include the following:

.family history of asthma
.personal medical history of allergies
Children most susceptible to asthma attacks include the following:

.children with a family history of asthma
.children who have allergies
.children who have exposure to secondhand tobacco smoke

What happens during an asthma attack or asthma exacerbation?
Persons with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.

.The lungs and airways overreact to certain triggers causing:
*the lining of the airways to become inflamed and swollen.
*tightening of the muscles that surround the airways.
*an increased production of mucus.
.Breathing becomes harder and may hurt.
.There may be coughing.
.There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways.
How is asthma diagnosed?
To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination, and laboratory tests, which may include the following:

.spirometry - a spirometer is a device used by your physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:

.to determine how well the lungs receive, hold, and utilize air
.to monitor a lung disease
.to monitor the effectiveness of treatment
.to determine the severity of a lung disease
.to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
.peak flow monitoring (PFM) - a device used to measure the fastest speed in which a person can blow air out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.

.chest x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

.blood tests - to analyze the amount of carbon dioxide and oxygen in the blood.

.allergy tests
What are the triggers that can cause an asthma attack?
According to the National Institute for Allergy and Infectious Diseases, the American Academy of Allergy, Asthma, and Immunology, and other organizations, triggers for asthma include the following:

Allergens:
.pollen
.mold
.animal protein (dander, urine, oil from skin)
.house dust/dust mites
.cockroaches
.certain foods
Respiratory Infections and Sinusitis:
Infections can cause irritation of the airways, nose, throat, lungs, and sinuses, and worsens asthma.

Irritants;
.strong odors and sprays, such as perfumes, household cleaners, cooking fumes, paints, and varnishes
.chemicals such as coal, chalk dust, or talcum powder
.air pollutants
.changing weather conditions, including changes in temperature, barometric pressure, humidity, and strong winds
.Chemical-exposure on the job, such as occupational vapors, dust, gases, or fumes.
Sensitivity to Medications:
Medications, such as aspirin and sulfites, cause up to 20 percent of adult asthmatic attacks as a result of sensitivities or allergies to them. These medications often include:

.aspirin
.other non-steroidal anti-inflammatory medications, such as ibuprofen, indomethacin, naproxen
.sulfites used as preservatives in food and beverage
Before taking any medication, including over-the-counter medications, consult your physician.

Exercise:
Exercise can trigger an asthma attack, often because of the inhaled cool and dry air. Long-term strenuous activities such as long distance running, are most likely to induce asthma, and swimming is the least likely.
Gastroesophageal reflux:
GERD, a condition characterized by persistent reflux of stomach acids, is common in individuals with asthma. Symptoms may include heartburn, belching, or spitting up in infants.

Smoke:
Tobacco smoke, whether directly or passively inhaled, has been shown to worsen asthma.

Wood smoke from wood-burning heating stoves and fireplaces can release irritating chemicals such as sulfur dioxide.
Emotional Anxiety and Nervous Stress:
Reactions from stress and anxiety are considered to be more of an effect than a cause. They can cause fatigue, which may affect the immune system and, in turn, increase either asthma symptoms or bring on an attack.

Dietary Treatments for Asthma:
Avoid fried and processed foods
Avoid food such as rice, curds, buttermilk, sugar, lentils, heavy milk products like cheese, paneer etc...which has natural tendency to produce the phlegm or to accumulate the mucus
Drink boiled water in plenty
Avoid over eating . Take light dinner one hour before going to bed
Avoid fruits such as guava, papaya, watermelon and banana.

Home remedies for asthma treatment:
1.Take a mixture of 1 tablespoon of water and 2 tablespoon of fresh lemon juice twice a day.
2.Take a teaspoon of fresh ginger juice mixed with a cup of fenugreek decoction and honey to taste.
3.Drink a glass of 2/3 carrot juice, 1/3 spinach juice, 3 times a day.
4.Mix 10 - 15 drops of garlic juice in warm water and take internally.
5.Grind to powder form - 2 gms each of Nagar (Nut grass, Cyperus rotundus) and Bharangi and mix them in water to prepare a paste which should be taken, with warm lukewarm water, twice daily.
6.Mix 1 teaspoon honey with 1 teaspoon of Indian bay leaf (Cinnamomum tamala) powder and have it before going to bed at night. This will help you in preventing the attack of asthma at night.
7.Take 10 cloves of garlic boiled with 30 ml of milk once a day.
8.Make paste of Black resin,dates, long Pippli (Piper longum) and honey, in equal quantity.Take one teaspoonful of it morning and evening with warm milk.

Alzheimer's disease

2009-09-30T06:41:00.000-07:00

Introduction:
Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century since Dr. Alzheimer first drew attention to it. Today we know that Alzheimer’s:

Is a progressive and fatal brain disease. As many as 5.3 million Americans are living with Alzheimer’s disease. Alzheimer's destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause of death in the United States. Learn more: Warning Signs and Stages of Alzheimer’s Disease.

Is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. Learn more: Related Dementias.

Has no current cure. But treatments for symptoms, combined with the right services and support, can make life better for the millions of Americans living with Alzheimer’s. There is an accelerating worldwide effort under way to find better ways to treat the disease, delay its onset, or prevent it from developing.

Alzheimer's and the brain:
Just like the rest of our bodies, our brains change as we age. Most of us notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing.

The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell. Still others tell our muscles when to move. In Alzheimer’s disease, as in other types of dementia, increasing numbers of brain cells deteriorate and die.

The role of plaques and tangles:
Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells. Plaques and tangles were among the abnormalities that Dr. Alois Alzheimer saw in the brain of Auguste D., although he called them different names.

Plaques build up between nerve cells. They contain deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd). Tangles are twisted fibers of another protein called tau (rhymes with “wow”).

Tangles form inside dying cells. Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. The plaques and tangles tend to form in a predictable pattern, beginning in areas important in learning and memory and then spreading to other regions.
Scientists are not absolutely sure what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow block communication among nerve cells and disrupt activities that cells need to survive.

Early-stage and younger-onset Alzheimer's disease:
Early-stage is the early part of Alzheimer’s disease when problems with memory, thinking and concentration may begin to appear in a doctor’s interview or medical tests. Individuals in the early-stage typically need minimal assistance with simple daily routines. At the time of a diagnosis, an individual is not necessarily in the early stage of the disease; he or she may have progressed beyond the early stage.

The term younger-onset refers to Alzheimer's that occurs in a person under age 65. Younger-onset individuals may be employed or have children still living at home. Issues facing families include ensuring financial security, obtaining benefits and helping children cope with the disease. People who have younger-onset dementia may be in any stage of dementia – early, middle or late. Experts estimate that some 500,000 people in their 30s, 40s and 50s have Alzheimer's disease or a related dementia.

About Dr. Alzheimer:
At a scientific meeting in November 1906, German physician Alois Alzheimer presented the case of “Frau Auguste D.,” a 51-year-old woman brought to see him in 1901 by her family. Auguste had developed problems with memory, unfounded suspicions that her husband was unfaithful, and difficulty speaking and understanding what was said to her. Her symptoms rapidly grew worse, and within a few years she was bedridden. She died in Spring 1906.

Dr. Alzheimer had never before seen anyone like Auguste D., and he gained the family’s permission to perform an autopsy. In Auguste’s brain, he saw dramatic shrinkage, especially of the cortex, the outer layer involved in memory, thinking, judgment and speech. Under the microscope, he also saw widespread fatty deposits in small blood vessels, dead and dying brain cells, and abnormal deposits in and around cells.

The condition entered the medical literature in 1907, when Alzheimer published his observations about Auguste D. In 1910, Emil Kraepelin, a psychiatrist noted for his work in naming and classifying brain disorders, proposed that the disease be named after Alzheimer.

Prevention:

Intellectual activities such as playing chess or regular social interaction have been linked to a reduced risk of AD in epidemiological studies, although no causal relationship has been found.At present, there is no definitive evidence to support that any particular measure is effective in preventing AD.studies of measures to prevent or delay the onset of AD have often produced inconsistent results. However, epidemiological studies have proposed relationships between certain modifiable factors, such as diet, cardiovascular risk, pharmaceutical products, or intellectual activities among others, and a population's likelihood of developing AD. Only further research, including clinical trials, will reveal whether these factors can help to prevent AD.
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, E, or folic acid with or without vitamin B12, as preventive or treatment agents in AD. Additionally vitamin E is associated with important health risks.

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 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.[115] Physical activity is also associated with a reduced risk of AD.

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. Electromagnetic fields (EMF) have also been proposed to be related to AD by some experts, but not others. Regarding extremely low frequency EMFs, while a metanalysis found that exposed people had more than two-fold probabilities of having the disease, reviews do not agree on whether studies point towards a relationship, or not. Doubts on how to interpret the statistically significant results of the metaanalysis have been raised.

Allergies-Hypersensitivity

2009-09-19T06:20:00.000-07:00

Allergies: causes and solutions
In simple terms, an allergy is a hyperactive response of the immune system to certain substances which are "foreign" to our bodies. These substances are called "allergens", and they can range from food and pollen to dust and drugs. Allergies are something we acquire throughout life, and some people
are more susceptible than others.

Conventional treatment of allergies is most commonly directed at blocking the immune response, or in more severe cases, at suppressing the entire immune function with steroids, both systemic and topical. While this approach can provide symptomatic relief, it does nothing to address the
underlying cause of the problem. Patients often become dependant on their medication, they suffer from numerous side effects, and more importantly, they worsen their overall health by constantly suppressing their immune system.

What Causes Allergies?
People with allergies have an inherited (genetic) predisposition for developing hypersensitivity to inhaled and ingested substances (allergens) that are harmless to other people.

A healthy immune system is balanced between the activity of 2 types of white blood cells, called Th1 and Th2.

Genetic or environmental factors can cause a Th2 dominated response to develop which can lead to allergies.
The use of immunizations and antibiotic therapies and increased pollution leads to Th2 dominance.
Once an imbalance in T cells develops, it tends to be continued by production of chemicals (cytokines) that keep the imbalance in place.

What Are the Risk Factors for Allergies?
Family or personal history of asthma, eczema, hay fever, or hives.
The total environmental load of toxic substances (environmental pollutants, chemicals, etc.) that we are exposed to in our lifetimes reduces our immune function and leads to an increase in or aggravation of symptoms.
Chronic ingestion of allergenic foods (“food allergies”) weakens our immune function and leads to an increase in or aggravation or symptoms. Dietary sensitivities create a state of hypersensitivity and congestion of the mucus membranes. This congestion decreases the immune function of these tissues.
Histamines, the naturally-occurring chemicals that are involved in allergic reactions, are present in many foods as well as the pollens of trees, grasses, and weeds.
Intake of saturated fat (meat, dairy) and refined foods (sugar, white flour) enhance the inflammatory reaction which is created by histamines.
Chronic stress in any form is detrimental to the immune system. Forms of stress include mental/emotional stress, inadequate nutrition, chronic viral, bacterial, parasitic, or fugal infections, and repeated exposures to antigens in foods, chemicals, pollens, molds. Chronic stress decreases the Th1 response and increases the Th2 response.
Not having been breast-fed may increase the risk of allergies.

What Are the Symptoms of Allergies?
.Runny nose
.Watery eyes
.Itchy nose, eyes and roof of mouth
.Sneezing
.Stuffy nose
.Pressure in the nose and cheeks
.Ear fullness and popping or itching
.Dark circles under the eyes
.Hives
.Sore throat
.Headache
.Fatigue
.Irritability
.Depression
.Cough
.Asthma

How Are Allergies Diagnosed?
.Medical history
.Family history
.Physical examination of ears, nose, throat, sinuses, and lungs
.Skin scratch allergy tests
.Complete Blood Count (CBC)
.Quantitative IgE level
.Serum allergy testing (IgG)
.Serum allergy testing (IgE)

Who is at risk and why?

Allergies can develop at any age, possibly even in the womb. They commonly occur in children but may give rise to symptoms for the first time in adulthood. Asthma may persist in adults while nasal allergies tend to decline in old age.

Why, you may ask, are some people "sensitive" to certain allergens while most are not? Why do allergic persons produce more IgE than those who are non-allergic? The major distinguishing factor appears to be heredity. For some time, it has been known that allergic conditions tend to cluster in families. Your own risk of developing allergies is related to your parents' allergy history. If neither parent is allergic, the chance that you will have allergies is about 15%. If one parent is allergic, your risk increases to 30% and if both are allergic, your risk is greater than 60%.

Although you may inherit the tendency to develop allergies, you may never actually have symptoms. You also do not necessarily inherit the same allergies or the same diseases as your parents. It is unclear what determines which substances will trigger a reaction in an allergic person. Additionally, which diseases might develop or how severe the symptoms might be is unknown.

Another major piece of the allergy puzzle is the environment. It is clear that you must have a genetic tendency and be exposed to an allergen in order to develop an allergy. Additionally, the more intense and repetitive the exposure to an allergen and the earlier in life it occurs, the more likely it is that an allergy will develop.

There are other important influences that may conspire to cause allergic conditions. Some of these include smoking, pollution, infection, and hormones.

Allergic Rhinitis

Allergic rhinitis ("hay fever") is the most common of the allergic diseases and refers to seasonal nasal symptoms that are due to pollens. Year round or perennial allergic rhinitis is usually due to indoor allergens, such as dust mites, animal dander, or molds. It can also be caused by pollens. Symptoms result from the inflammation of the tissues that line the inside of the nose (mucus lining or membranes) after allergens are inhaled. Adjacent areas, such as the ears, sinuses, and throat can also be involved. The most common symptoms include:

Runny nose
Stuffy nose
Sneezing
Nasal itching (rubbing)
Itchy ears and throat
Post nasal drip (throat clearing)
In 1819, an English physician, John Bostock, first described hay fever by detailing his own seasonal nasal symptoms, which he called "summer catarrh." The condition was called hay fever because it was thought to be caused by "new hay."

Asthma

Asthma is a breathing problem that results from the inflammation and spasm of the lung's air passages (bronchial tubes). The inflammation causes a narrowing of the air passages, which limits the flow of air into and out of the lungs. Asthma is most often, but not always, related to allergies. Common symptoms include:

Shortness of breath
Wheezing
Coughing
Chest tightness

Allergic Eyes

Allergic eyes (allergic conjunctivitis) is inflammation of the tissue layers (membranes) that cover the surface of the eyeball and the undersurface of the eyelid. The inflammation occurs as a result of an allergic reaction and may produce the following symptoms:

Redness under the lids and of the eye overall
Watery, itchy eyes
Swelling of the membranes

Conventional Treatment for Allergies:
Avoidance: The preferred treatment is to eliminate the allergen.
.Allergen immunotherapy: Weekly or biweekly allergy shots for desensitization. Must be continued year-round.
.Medications
.Drawbacks of medications
.Do not treat the cause of allergies, but only the symptoms.
.Most allergy medications are associated with a significant worsening of allergic symptoms when they are stopped.
.Associated with significant side-effects such as fatigue, dry mouth, high blood pressure.
.Antihistamines.
.Decongestants
.Cromolyn sodium.
.Nasal steroid sprays.
.Eye drops.

Natural or Alternative Treatment for Allergies:
Reduce Exposure to allergens
The most effective treatment for allergies is to reduce your exposure. There are several ways to do this:

.Clean Up Your Environment
.Mold Allergy Control
.Control of Dog Allergies and Cat Allergies
.Dietary treatments
.Drink enough water.
.Identify and eliminate aggravating factors including food dyes, colorings, preservatives, additives, and food allergies.
.Avoid dietary sources of arachidonic acid (found in animal products) which contribute to the inflammation.
.Consume anti-inflammatory essential fatty acids (Omega 3’s) in the form of fatty fish, walnuts, flax seeds, cod liver oil, fish oil, and flax seed oil.

Clinical Nutrition
Not everyone will need to apply all of these treatments. Consult a nutritionally oriented physician to help specialize treatment for you including selection of nutrients and their doses.

Nutritional Substances that Address Th1/Th2 Balance

Omega 3 fatty acids
Vitamin E
Probiotics
Adaptogenic herbs
Other nutrients useful in the treatment of allergies

Quercetin, a bioflavonoid
N-acetyl cysteine
Vitamin C (Ascorbic Acid)
Selenium, carotenes, vitamin E
Bromelain, a plant-derived enzyme
Botanical Medicine
Herbs such as Feverfew (Tanacetum parthenium), Hawthorne Berry (Crataegus oxyacantha), and Nettle Leaf (Urtica dioica) may be used in the treatment of allergies, depending on the person’s specific allergy symptoms..

Homeopathic Remedies
Allium cepa, Silicea, Hepar sulf, Kali bic are but a few single remedies used in the acute and chronic treatment of rhinitis.

Supplement Quality Is Important
Our intention when we use nutritional and botanical supplements is for these treatments to have a physiological effect and clinical benefit, meaning that they are effective and your health improves.

The quality of nutritional supplements in the general marketplace is suspect. In order to get the maximum benefit to your health, be sure you purchase the highest quality nutritional supplements.

Can Allergies Be Prevented?
Allergies are difficult to prevent because it is so hard to avoid exposure to allergens. However, efforts to address the modifiable risk factors (listed above) should minimize the development of allergies

Allergies

2009-09-18T07:12:00.000-07:00

SWINE FLU OUTBREAK H1N1

2009-08-19T06:15:00.000-07:00

What is the swine flu?

The swine influenza A (H1N1) virus that has infected humans in the U.S. and Mexico is a novel influenza A virus that has not previously been identified in North America. This virus is resistant to the antiviral medications amantadine (Symmetrel) and rimantadine (Flumadine), but is sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Investigations of these cases suggest that on-going human-to-human swine influenza A (H1N1) virus is occurring.

What are the symptoms of swine flu?

Although uncomplicated influenza-like illness (fever, cough or sore throat) has been reported in many cases, mild respiratory illness (nasal congestion, rhinorrhea) without fever and occasional severe disease also has been reported. Other symptoms reported with swine influenza A virus infection include vomiting, diarrhea, myalgia, headache, chills, fatigue, and dyspnea. Conjunctivitis is rare, but has been reported. Severe disease (pneumonia, respiratory failure) and fatal outcomes have been reported with swine influenza A virus infection. The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza A virus infection should be considered.

Is swine flu (H1N1) a cause of an epidemic or pandemic in 2009?

An epidemic is defined as an outbreak of a contagious disease that is rapid and widespread, affecting many individuals at the same time. The swine flu outbreak in Mexico fits this definition. A pandemic is an epidemic that becomes so widespread that it affects a region, continent, or the world. As of April 2009, the H1N1 swine flu outbreak does not meet this definition. However, as of June 11, 2009, WHO officials determined that H1N1 2009 influenza A swine flu reached WHO level 6 criteria (person-to-person transmission in two separate WHO-determined world regions) and declared the first flu pandemic in 41 years. To date, the flu has reached 74 different countries on every continent except Antarctica in about three month's time; fortunately, the severity of the disease has not increased.

Why is swine flu now infecting humans?

Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus. It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus' antigenic makeup over time (usually years).

Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a "mixing pot" for flu RNA segments . Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.

Infection Control:

Recommended Infection Control for a non-hospitalized patient (ER, clinic or home visit):

Separation from others in single room if available until asymptomatic. If the ill person needs to move to another part of the house, they should wear a mask. The ill person should be encouraged to wash hand frequently and follow respiratory hygiene practices. Cups and other utensils used by the ill person should be thoroughly washed with soap and water before use by other persons.

Antiviral Treatment:

Suspected Cases:

Empiric antiviral treatment is recommended for any ill person suspected to have swine influenza A (H1N1) virus infection. Antiviral treatment with either zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine should be initiated as soon as possible after the onset of symptoms. Recommended duration of treatment is five days. Recommendations for use of antivirals may change as data on antiviral susceptibilities become available. Antiviral doses and schedules recommended for treatment of swine influenza A (H1N1) virus infection are the same as those recommended for seasonal influenza:

Confirmed Cases:

For antiviral treatment of a confirmed case of swine influenza A (H1N1) virus infection, either oseltamivir (Tamiflu) or zanamivir (Relenza) may be administered. Recommended duration of treatment is five days. These same antivirals should be considered for treatment of cases that test positive for influenza A but test negative for seasonal influenza viruses H3 and H1 by PCR.

Pregnant Women:

Oseltamivir, zanamivir, amantadine, and rimantadine are all "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Only two cases of amantadine use for severe influenza illness during the third trimester have been reported. However, both amantadine and rimantadine have been demonstrated in animal studies to be teratogenic and embryotoxic when administered at substantially high doses. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, these four drugs should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to such women.

Antiviral Chemoprophylaxis:

For antiviral chemoprophylaxis of swine influenza A (H1N1) virus infection, either oseltamivir or zanamivir are recommended. Duration of antiviral chemoprophylaxis is 7 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. Antiviral dosing and schedules recommended for chemoprophylaxis of swine influenza A (H1N1) virus infection are the same as those recommended for seasonal influenza:

Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals:

Household close contacts who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) of a confirmed or suspected case.

School children who are at high-risk for complications of influenza (persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.

Travelers to Mexico who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).

Border workers (Mexico) who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).

Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A (H1N1) virus infection during the case's infectious period.
Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir can be considered for the following:

Any health care worker who is at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.

Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.

Will a face mask protect me from getting the swine flu, and are there differences in face masks?

Information on the effectiveness of facemasks and respirators for the control of influenza in community settings is extremely limited. Thus, it is difficult to assess their potential effectiveness in controlling swine influenza A (H1N1) virus transmission in these settings. In the absence of clear scientific data, the interim recommendations below have been developed on the basis of public health judgment and the historical use of facemasks and respirators in other settings.

In areas with confirmed human cases of swine influenza A (H1N1) virus infection, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These actions include frequent handwashing, covering coughs, and having ill persons stay home, except to seek medical care, and minimize contact with others in the household. Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable swine influenza cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings.

When it is absolutely necessary to enter a crowded setting or to have close contact3 with persons who might be ill, the time spent in that setting should be as short as possible. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time.

When crowded settings or close contact with others cannot be avoided, the use of facemasks or respirators in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered as follows:

Whenever possible, rather than relying on the use of facemasks or respirators, close contact with people who might be ill and being in crowded settings should be avoided.

Facemasks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others; the time spent in crowded settings should be as short as possible.

Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home.
These interim recommendations will be revised as new information about the use of facemasks and respirators in the current setting becomes available.

What are the types of face masks and respirators?

Unless otherwise specified, the term "facemasks" refers to disposable masks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks. Such facemasks have several designs. One type is affixed to the head with two ties, conforms to the face with the aid of a flexible adjustment for the nose bridge, and may be flat/pleated or duck-billed in shape. Another type of facemask is pre-molded, adheres to the head with a single elastic band, and has a flexible adjustment for the nose bridge. A third type is flat/pleated and affixes to the head with ear loops. Facemasks cleared by the FDA for use as medical devices have been determined to have specific levels of protection from penetration of blood and body fluids.

Unless otherwise specified, "respirator" refers to an N95 or higher filtering facepiece respirator certified by the U.S. National Institute for Occupational Safety and Health (NIOSH).

Three feet has often been used by infection control professionals to define close contact and is based on studies of respiratory infections; however, for practical purposes, this distance may range up to 6 feet. The World Health Organization uses "approximately 1 meter"; the U.S. Occupational Safety and Health Administration uses "within 6 feet." For consistency with these estimates, this document defines close contact as a distance of up to 6 feet.

What is the prognosis (outlook) for patients that get swine flu (H1N1)?

The following is speculation on the prognosis for swine flu (H1N1) because this disease has only been recently diagnosed and the data is changing daily. This section is based on currently available information.

In general, the majority (about 90%-95%) of people that get the disease feel terrible (see symptoms) but recover with no problems, as seen in patients in both Mexico and the U.S. Caution must be taken as the swine flu (H1N1) is still spreading and may become a pandemic. So far, young adults have not done well, and in Mexico, this group currently has the highest mortality rate, but this data could quickly change. The first traceable case in Mexico, termed "patient zero," was a 5-year-old child in Veracruz who has completely recovered. Investigators noted that large pig farms were located close to the boy's home. The first death in the U.S. occurred in a 23-month-old child who was visiting Texas from Mexico but apparently caught the disease in Mexico.

People with depressed immune systems historically have worse outcomes than uncompromised individuals; investigators suspect that as swine flu (H1N1) spreads, the mortality rates may rise and be high in this population. Unfortunately, the problem with the prognosis is still unclear. If the mortality is like the conventional flu that causes mortality rates of about 0.1%, the result would be about 35,000 deaths per year because of the huge number of people that get infected. If the Mexico swine flu (H1N1) ends up with a mortality rate of about 6% and infects the same number of millions of people as conventional flu viruses, the projected numbers could be as high as 2 million deaths in the U.S. alone. This is a bad prognosis for about 2 million people and their families; these potential deaths are major reasons that health officials are so concerned about the spread of this new virus.

Another confounding problem with the prognosis of swine flu (H1N1) is that the disease is occurring and spreading in high numbers at the usual end of the flu season. Most flu outbreaks happen between November to the following April, with peak activity between late December to March. This outbreak is not following the usual flu pattern. Some scientists think that swine flu (H1N1) will quickly die out in the summer and may not ever return, while others think it may die down but return with many more cases in the fall, and still others speculate it will become a pandemic that will resemble the outcomes similar to the 1918 influenza pandemic. Some suggest it may resemble the SARS (severe acute respiratory syndrome caused by a coronavirus strain) outbreak in 2002-2003 in which the disease spread to about 10 countries with over 7,000 cases, over 700 deaths, and a 10% mortality rate. Effective isolation of patients was done in this case, and many investigators think the outbreak was stopped due to this measure. Because swine flu (H1N1) is a new virus and does not seem to be following the usual flu disease pattern, any prognosis is speculative.

How is swine flu (H1N1) diagnosed?

Swine flu is presumptively diagnosed clinically by the patient's history of association with people known to have the disease and their symptoms listed above. Usually, a quick test (for example, nasopharyngeal swab sample) is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types. The test can be negative (no flu infection) or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu (H1N1). If it is positive for type A, the person could have a conventional flu strain or swine flu (H1N1). Swine flu (H1N1) is definitively diagnosed by identifying the particular antigens associated with the virus type. In general, this test is done in a specialized laboratory and is not done by many doctors' offices or hospital laboratories. However, doctors' offices are able to send specimens to specialized laboratories if necessary.

How can swine (H1N1) flu be prevented?

The best way to prevent swine flu would be the same best way to prevent other influenza infections, and that is vaccination. When a safe vaccine is developed (projected to happen in a few months), people should get vaccinated if the disease is still causing infections. The CDC says that a good way to prevent any flu disease is to avoid exposure to the virus; this is done by frequent hand washing, not touching your hands to your face (especially the nose and mouth), and avoiding any close proximity to or touching any person that may have flu symptoms. Since the virus can remain viable and infectious for about 48 hours on many surfaces, good hygiene and cleaning with soap and water or alcohol-based hand disinfectants are also recommended. Some physicians say face masks may help prevent getting airborne flu viruses (for example, from a cough or sneeze), but others think the better use for masks would be on those people who have symptoms and sneeze or cough. The use of Tamiflu or Relenza may help prevent the flu if taken before symptoms develop or reduce symptoms if taken within about 48 hours after symptoms develop. However, taking these drugs is not routinely recommended for prevention because investigators suggest that as occurs with most drugs, flu strains will develop resistance to these medications. Your doctor should be consulted before these drugs are prescribed.

In general, preventive measures to prevent the spread of flu are often undertaken by those people who have symptoms. Symptomatic people should stay at home, avoid crowds, and take off from work or school until the disease improves or medical help is sought. Sneezing, coughing, and nasal secretions need to be kept away from other people; simply using tissues and disposing of them will help others. Quarantining patients is usually not warranted, but such measures depend on the severity of the disease.

Swine Flu Related Articles:
Aches, Pain, Fever, Chronic Cough, Diarrhea, Flu Vaccination ,Headache, Influenza, Nausea and Vomiting, Pneumonia, Seizure, Sore Throat.

Treatment:
Further information: Influenza treatment

Children:
The experts agree that children who are sick should be kept home, especially if they're running flu-like symptoms such as high fever, vomiting or diarrhea. They should also be kept away from other children. While most experts suggest seeking medical care if a child becomes sick, they also stress not to take children with flu-like symptoms to the emergency department. "That's the worst thing. They may not have swine flu but they could get it [there]," one expert stated. Instead of rushing to the emergency department, "people need to call their physicians or call a hotline." They also state that any child who has been sick should be fever-free for at least 24 hours (without the aid of medications) before returning to school.

Home treatment remedies:
The Mayo Clinic and Medline list a number of ways to help ease symptoms, including adequate liquid intake and rest, soup to ease congestion, and over-the-counter drugs to relieve pain. Aspirin, for instance, "is very effective for treating fever in adults" although in children and adolescents, aspirin is not usually given due to the risk of Reye's syndrome. While over-the-counter drugs relieve symptoms, they do not kill the virus. Most patients were expected to recover without medical attention, although those with pre-existing or underlying medical conditions were more prone to complications.

Antiviral drugs:
Recommended usage and availability
According to the CDC, antiviral drugs can be given to treat those who become severely ill, two of which are recommended for swine flu symptoms: oseltamivir (Tamiflu) and zanamivir (Relenza). To be most useful, they must be taken within 2 days of showing symptoms. They work by deactivating an enzyme the virus needs to grow and spread. Therefore, when taken soon after symptoms are noticed, "they may shorten the illness by a day or so," according to the Mayo Clinic. Oseltamivir is an oral medication, but zanamivir is inhaled through a device similar to an asthma inhaler and shouldn't be used by anyone with respiratory conditions, such as asthma and lung disease.

Furthermore, as the flu spreads, there could be temporary shortages of these drugs. The U.S. CDC therefore recommends Tamiflu treatment primarily for people hospitalized with swine flu; people at risk of serious flu complications due to underlying medical conditions; patients at risk of serious flu complications because they are pregnant, under age 5, or over age 65; and to prevent infection of people at risk of serious flu complications who have been exposed to someone with swine flu.

Anti-viral resistance risk:
Marie-Paule Kiely, WHO vaccine research director, said that it was "almost a given" that the new strain would undergo reassortment with resistant seasonal flu viruses and acquire resistance, but it was not yet known at what level resistance would appear. If the virus develops oseltamivir resistance, the "world’s Tamiflu stockpiles will be all but worthless," and doctors would have to switch to the more expensive and harder to take, Relenza. At least five recent instances of Tamiflu-resistant viruses were reported in July. There have also been reports of summer camps urging children to bring the antiviral drug Tamiflu and take it as a preventative measure, but that has concerned the CDC since widespread use could also lead to increased resistance. Currently, almost all seasonal flu strains are resistant to the drug and the genes for such resistance could be very easily transmitted to the new virus, the CDC warns.

Possible side effects:
Both medications can cause side effects, including lightheadedness, nausea, vomiting, loss of appetite and trouble breathing and it is recommended that patients discuss possible side effects with their doctor before starting any antiviral medication. The Food and Drug Administration (FDA) has required the maker of Tamiflu to include a warning that people with the flu, particularly children, may be at increased risk of self-injury and confusion after taking Tamiflu and that individuals with the flu who take Tamiflu be closely monitored for signs of unusual behavior.

Genetics and Common Diseases

2009-08-04T07:01:00.000-07:00

Genetic Basic:

Genetics is the scientific study of how living organisms pass on their features from one generation to the next. This word was ¡¥invented¡¦ in 1906 by the British biologist William Bateson. Since the discovery of the genetic code in 1966, research into this view has broadened our understanding of the structure of life, and in controlling protein production in modern biology and biotechnology.

Chromosomes, DNA and Genes :

Every one of us, except identical twins or clones, has a unique set of DNA, or a genome, which in part is what makes us separate individuals. Inside each of our cells¡¦ nuclei, we have 23 pairs of chromosomes, and one in each pair is inherited from one of our parents. The thread-like chromosomes contain all our genetic information. DNA (deoxyribonucleic acid) molecules make up most of a chromosome and are the genetic material for all cellular organisms and most viruses. They act as the message carriers of chemical sequences governing the production of proteins. Such patterns are the genes, and all together they make up the blueprint of life.

DNA has the spiral shape of the famous ¡¥double helix¡¦. Like a ladder, it consists of two strands made up of sugars and phosphate groups, connected with base pairs (the rungs). There are four nucleotide bases, and adenine (A) will only combine with thymine (T); cytosine (C) always with guanine (G). Such base pairing means that the two strands are complementary. (e.g. the complementary strand of A-A-G would be T-T-C). DNA strands has a ¡¥beginning¡¦ and an ¡¥end¡¦. One side has a phosphate, and is called the 5¡¦ end, while the other side without the phosphate is the 3¡¦ end. Each strand goes in opposite directions, i.e. they are antiparallel. These (the bases) letters of the DNA alphabet arrange themselves in DNA and RNA in three-letter-words, called codons. Codons instruct the cell into the production of specific amino acids, which form into proteins, the basic material of life.

In a human cell, each DNA molecule contains about 3 billion base pairs, or genes, paving the way for countless genetic instruction groups. Scientists define a gene as ¡¥the discrete instructions for making a single protein¡¦. In detail, a gene is the DNA sequence encoding a protein; starting with a ¡¥start¡¦ codon and ending with a ¡¥stop¡¦ codon.

RNA and central dogma

RNA, another nucleic acid commonly found in the cytoplasm, is a ribonucleic acid sequence created from DNA, and is nearly identical to one of the strands of DNA. This is the strand of DNA that serves as a template to both its own replication and also the production of messenger RNA (mRNA), the process of which is known as transcription. The only difference between mRNA and the template DNA is that in kRibonucleic Acid, thymine is replace by uracil. RNA is produced from DNA by an enzyme called RNA polymerase.

The mRNA moves from the nucleus to the ribosome of the cell. Translation, the synthesis of proteins from mRNA, will then occur in the ribosome. The transfer RNA (tRNA) binds the specific amino acids to the corresponding codons. The ribosome helps bind the amino acids into a chain ¡V and a protein is formed.

What are genetic disorders?
Both environmental and genetic factors have roles in the development of any disease. A genetic disorder is a disease caused by abnormalities in an individual’s genetic material (genome). The four different types of genetic disorders are(1) single-gene, (2) multifactorial, (3) chromosomal, and (4) mitochondrial.

(1) Single-gene (also called Mendelian or monogenic) - This type is caused by changes or mutations that occur in the DNA sequence of one gene. Genes code for proteins, the molecules that carry out most of the work, perform most life functions, and even make up the majority of cellular structures. When a gene is mutated so that its protein product can no longer carry out its normal function, a disorder can result. There are more than 6,000 known single-gene disorders, which occur in about 1 out of every 200 births. Some examples are cystic fibrosis, sickle cell anemia, Marfan syndrome, Huntington’s disease, and hereditary hemochromatosis.

Single-gene disorders are inherited in recognizable patterns: autosomal dominant, autosomal recessive, and X-linked. More information on the different modes of inheritance is available from the following Web sites:

Inheritance of Single Gene Defects - From the The Merck Manual of Diagnosis and Therapy.
Inheritance Patterns of Monogenic Disorders - From the Genetic Interest Group in the U.K.
Genetics - From the Medical Encyclopedia at MEDLINEplus.
(2) Multifactorial (also called complex or polygenic) - This type is caused by a combination of environmental factors and mutations in multiple genes. For example, different genes that influence breast cancer susceptibility have been found on chromosomes 6, 11, 13, 14, 15, 17, and 22. Its more complicated nature makes it much more difficult to analyze than single-gene or chromosomal disorders. Some of the most common chronic disorders are multifactorial. Examples include heart disease, high blood pressure, Alzheimer’s disease, arthritis, diabetes, cancer, and obesity. Multifactorial inheritance also is associated with heritable traits such as fingerprint patterns, height, eye color, and skin color.

(3) Chromosomal - Chromosomes, distinct structures made up of DNA and protein, are located in the nucleus of each cell. Because chromosomes are carriers of genetic material, such abnormalities in chromosome structure as missing or extra copies or gross breaks and rejoinings (translocations) can result in disease. Some types of major chromosomal abnormalities can be detected by microscopic examination. Down syndrome or trisomy 21 is a common disorder that occurs when a person has three copies of chromosome 21.

(4) Mitochondrial - This relatively rare type of genetic disorder is caused by mutations in the nonchromosomal DNA of mitochondria. Mitochondria are small round or rod-like organelles involved in cellular respiration and found in the cytoplasm of plant and animal cells. Each mitochondrion may contain 5 to 10 circular pieces of DNA.

Where can I learn more about different kinds of genetic disorders?

Genetic Disorder Guide -- Find overviews of genetic disorders, Web portals and directories, bibliographic databases, support groups, genetic health professionals, genetic testing laboratories, and clinical trials information. This resource is part of Gene Gateway, a Web-based guide to learning more about the genes, traits, and disorders included on the Human Genome Landmarks poster. Order a print copy of this poster or view it online.
National Organization for Rare Disorders -- NORD, a nonprofit organization, serves as an international clearinghouse of information on over 5,000 rare disorders. Refer to their Contact NORD page for telephone, TDD, and other contact information.
Genetic Alliance -- non-profit organization dedicated to helping individuals and families who have genetic disorders. Tel: 202-966-5557, Fax: 202-966-8553, info@geneticalliance.org

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Why do we have genes that cause genetic disorders?
Many genes are named for the disorders to which they have been linked. This can be very confusing. For example, the gene associated with hereditary hemochromatosis is called the “hemochromatosis gene.” This name implies that the gene exists for the sole purpose of causing disease, which of course is not the case. The normal function of a gene is to encode a protein, not cause illness. Disease occurs when genes are unable to work properly. The hemochromatosis gene actually codes for a membrane protein that works with other proteins to regulate iron absorption in cells. Like other single-gene disorders, hemochromatosis occurs when a gene is mutated in a way that prevents it from encoding a normal, functional protein product. See hereditary hemochromatosis disorder and gene profiles for more information about this condition.

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Where can I learn more about genes associated with genetic disorders?
Gene and Protein Database Guide -- A guide to resources for learning about genes and the proteins they encode. Access gene databases, nucleotide and protein sequence databases, sequence-similarity search tools, mutation resources, and molecular structure databases. Find step-by-step instructions for using some of these resources at the Bioinformatics Tools page.
NIH Genetic Disorders Topical Index -- List of resources by disorder.
NIH Office of Rare Diseases / Genetic and Rare Diseases Information Center --Information on genetic and rare diseases for patients, families, health care professionals, and biomedical researchers.

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How does one interpret the diagnosis of a genetic disease? What does it really mean for everyday life?
If you have been diagnosed with a genetic disease or have been recommended for genetic testing, your doctor should refer you to a genetic counselor or medical geneticist. With specialized backgrounds in medical genetics and counseling, genetic counselors work with medical personnel (usually M.D. medical geneticists) to give information, answer questions, and offer support to persons and families who have genetic disorders, are undergoing gene testing, or may be at risk for inheriting genetic disorders. They conduct one-on-one counseling in helping people understand the disease, its implications for their lives and the lives of family members, and their testing and treatment options. For more about what genetic counselors do, see the Human Genome Project Genetic Counseling page or What is a Genetics Consultation? provided by GeneTests.

No field of science has changed more, or changed the world more, in the last 50 years than genetics - the study of how our physical and behavioural traits are inherited.

The field's crowning achievement may have been the spelling out of our genetic secrets by the human genome project, but scientific and technological advances in genetics have forever transformed agriculture, biology, medicine, zoology, and even fields such as anthropology and forensic science.

Why certain features of parents and even more distant relatives appear or do not appear in individual people, plants, parasites and protozoa has fascinated and confused people for millennia. This observation has also spawned a remarkable variety of theories of heredity, from pangenesis to Lamarckism. Modern genetics, however, can trace its lineage to pea plants in the garden of an Augustinian monk, Gregor Mendel. By studying the inheritance of traits such as plant height and wrinkly peas, he discovered that most hereditary traits are carried by discrete factors, later called genes.

Dominant and recessive
These experiments illuminated many of the key principles of genetics. For example, they revealed that most organisms have two copies of each gene, one from each parent, and that a gene comes in a variety of different forms, or alleles.

A purebred tall pea plant has two tall alleles of a gene for height (often abbreviated as TT), and the short plants have two short alleles (tt). Their offspring have one of each (Tt). This first generation is tall because the tall allele is dominant.

Recessive traits, such as shortness in pea plants, are only expressed when two recessive alleles meet up. This is also a good example of how organisms of the same appearance, or phenotype (the tall parent and their offspring), can have different genotypes, or combinations of genes (TT versus Tt).

It was nearly 100 years after Mendel published his work that scientists discovered genes are composed of the double-helical molecule DNA, which is built from four chemical letters, or bases: adenine, thymine, cytosine and guanine. The discovery of the structure of DNA in 1953 immediately suggested a simple mechanism for DNA replication: the two strands of the helix could unzip and allow enzymes to enter and synthesise two new strands.

The goal of the human genome project was to use DNA sequencing to reveal all three billion DNA letters in our chromosomes and find all our genes. By comparing our genetic make-up to the genomes of mice, chimps and a menagerie of other species (rats, chickens, dogs, pufferfish, the microscopic worm Caenorhabditis elegans, the fruit fly Drosophila melanogaster and many bacteria), scientists have learned a great deal about how genes evolve over time, and gained insights into human diseases.

Another powerful technology leading the genetics revolution is the polymerase chain reaction (PCR), which allows large quantities of DNA sequence information to be derived from tiny and highly damaged samples.

PCR has become the linchpin in many criminal investigations, now that traces of blood, semen or skin left at a crime scene (even decades previously) can condemn a criminal or exonerate innocent suspects. This technology is also reshaping notions of both human ancestry and the evolutionary history of many species, by harvesting genes from ancient remains, including fossil DNA. Other new techniques could prove even faster than PCR.

Life's instruction manual:
Here's how genes work. When a gene is switched on, one of its strands is copied into the related chemical RNA, a process known as transcription. For most known genes this "messenger" or mRNA is then shuttled off to a ribosome of a cell where its translation into a protein sequence occurs. Ribosomes decipher the sequence of an mRNA with the help of small cloverleaf shaped molecules called "transfer" or tRNA.

Some mRNAs also contain introns, extra sequences that do not encode protein and must be spliced out before they journey to the ribosome. The protein-coding portions of these mRNAs are called exons.

In inherited diseases, some part of this process has gone awry due to a mutation, or change in the DNA sequence. Cystic fibrosis, achondroplasia, phenylketonuria and Huntington's disease are each caused by simple changes in the sequence of a single gene.

Other diseases with a more complex genetic component include diabetes and epilepsy. Down's syndrome, haemophilia, fragile X syndrome, sickle-cell anaemia, thalassaemia and a plethora of other disorders are also down to genetic defects.

The runaway replication of cancer cells can also traced to genetic causes - mutations that remove the normal controls on cell growth.

In our cells, many hundreds of genes are joined end-to-end on DNA strands and tightly packed into sausage-shaped structures called chromosomes which are stored in a cell's nucleus. A locus is the position of a gene on a chromosome. Chromosomes also possess physical features which protect their genetic cargo. Telomeres at their ends act as caps to prevent biochemical wear and tear, while the cell choreographs the movement of chromosomes by grabbing hold of its centromere handle.

The dance of chromosomes is tightly controlled during cell replication to preserve the genetic makeup of cells. During normal growth, cells replicate through mitosis and each "daughter" inherits the same number of chromosomes and genes as its parent. But sperm and eggs contain half the number of chromosomes because they form through a different process called meiosis. Then when sperm and egg fuse to make a zygote, it contains the same number of genes and chromosomes as its parents.

Sex and linkage:
Many human genes are inherited exactly as Mendel envisaged, with one copy from each parent. Human blood type falls into this category of Mendelian inheritance. But heredity can also be more complicated. DNA sequences that lie near each other on chromosomes exhibit gene linkage and are usually inherited together, even though they may be unrelated in function. Another exception are so-called sex-linked traits, encoded on the sex chromosomes.

Men inherit one X and one Y chromosome (which encodes the gene for maleness), so they are more likely to express recessive traits from the X, such as colour blindness and haemophilia. Women are more protected, because they have two X chromosomes. Finally, the mitochondria - the energy powerhouse of the cell - contains its own small parcel of mitochondrial DNA which is inherited exclusively from the egg, and therefore the mother.

The genetic variation of individual DNA sequences in a population is called its genetic diversity. Diversity results from the re-assortment of genes during meiosis and genetic mutation. Genetic variation drives evolution by creating a range of phenotypes that might give individuals a competitive edge in different environments.

Those individuals with the fittest combination of alleles produce more offspring. Inbreeding can be dangerous for a population because it removes variation and the ability to adapt to new environments. While natural selection favours the accumulation of fit alleles of beneficial genes, the majority of chromosomes in many organisms are composed of "selfish DNA", which does not benefit its host and seems to play no other role other than ensuring its own replication.

Genetic engineering
The most powerful aspect of the new genetics is genetic engineering - the ability to design new genetic sequences and insert them into viruses, bacteria, flies, plants, mice and other animals. This has been a boon for research, and led to the birth of biotechnology and many practical applications.

Doctors have been experimenting with gene therapy to supply healthy copies of a gene to patients suffering from a genetic defect. Genetically engineered vaccines incorporate genetic pieces of a deadly microbe to stimulate the immune system, without the danger of infection. And companies are using genetic modification to create hardier plants and animals that resist disease, grow faster or produce healthier food.

But critics warn that genetic engineering has a dark side too, and could lead to designer babies or the release of dangerous DNA sequences into the gene pool, with dire environmental consequences.

Science Resources

2009-07-28T07:29:00.001-07:00

Science Resources

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breast cancer

2009-07-21T07:17:00.000-07:00

Breast cancer is a cancer that starts in the breast, usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup. With best treatment, 10-year disease-free survival varies from 98% to 10%. Treatment is selected from surgery, drugs (chemotherapy), and radiation.

Introduction to breast cancer:

Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U.S. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump or change in consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and a resultant improvement in survival rates. Still, breast cancer is the most common cause of death in women between the ages of 45 and 55. Although breast cancer in women is a common form of cancer, male breast cancer does occur and accounts for about 1% of all cancer deaths in men.

Research has yielded much information about the causes of breast cancers, and it is now believed that genetic and/or hormonal factors are the primary risk factors for breast cancer. Staging systems have been developed to allow doctors to characterize the extent to which a particular cancer has spread and to make decisions concerning treatment options. Breast cancer treatment depends upon many factors, including thee type of cancer and the extent to which it has spread. Treatment options for breast cancer may involve surgery (removal of the cancer alone or, in some cases, mastectomy), radiation therapy, hormonal therapy, and/or chemotherapy.

With advances in screening, diagnosis, and treatment, the death rate for breast cancer has declined by about 20% over the past decade, and research is ongoing to develop even more effective screening and treatment programs.

How is the breast designed?

The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.

The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances.

What is the cancer process?

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:

Benign tumors are rarely life-threatening.

Generally, benign tumors can be removed. They usually do not grow back.

Cells from benign tumors do not invade the tissues around them.

Cells from benign tumors do not spread to other parts of the body.

Malignant tumors are cancer:

Malignant tumors are generally more serious than benign tumors. They may be life-threatening.

Malignant tumors often can be removed. But sometimes they grow back.

Cells from malignant tumors can invade and damage nearby tissues and organs.

Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.

What are risk factors for breast cancer?

No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for breast cancer:

Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.

Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.

Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.

Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.

Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes.

Reproductive and menstrual history:

The older a woman is when she has her first child, the greater her chance of breast cancer.

Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.

Women who went through menopause after age 55 are at an increased risk of breast cancer.

Women who never had children are at an increased risk of breast cancer.

Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.

Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.

Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.

Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.

Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.

Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.

Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.

Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.

Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.
Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.

But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.

If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

What are the symptoms of breast cancer?

Common symptoms of breast cancer include:

.A change in how the breast or nipple feels

.A lump or thickening in or near the breast or in the underarm area

.Nipple tenderness

.A change in how the breast or nipple looks

.A change in the size or shape of the breast

.A nipple turned inward into the breast

.The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange.

Nipple discharge (fluid)
Early breast cancer usually does not cause pain. Still, a woman should see her health care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not due to cancer. Other health problems may also cause them. Any woman with these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

How is breast cancer diagnosed?

If you have a symptom or screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order a mammogram or other imaging procedure. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.

Clinical breast exam:
Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture. Your doctor will also check to see if it moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.

Diagnostic mammogram:

Diagnostic mammograms are x-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram. Doctors use them to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues. A computer uses the echoes to create a picture. Your doctor can view these pictures on a monitor. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.

Magnetic resonance imaging :

Magnetic resonance imaging (MRI) uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.

Biopsy

Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. Fluid or tissue is removed from your breast to help find out if there is cancer.

Some suspicious areas can be seen on a mammogram but cannot be felt during a clinical breast exam. Doctors can use imaging procedures to help see the area and remove tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy.

Doctors can remove tissue from the breast in different ways:

Fine-needle aspiration: Your doctor uses a thin needle to remove fluid from a breast lump. If the fluid appears to contain cells, a pathologist at a lab checks them for cancer with a microscope. If the fluid is clear, it may not need to be checked by a lab.

Core biopsy: Your doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.

Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells.

An incisional biopsy takes a sample of a lump or abnormal area.
An excisional biopsy takes the entire lump or area.
If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. Abnormal cells are found in the lining of the ducts. Lobular carcinoma is another type. Abnormal cells are found in the lobules.

You may want to ask your doctor the following questions before having a biopsy:

.What kind of biopsy will I have? Why?
.How long will it take? Will I be awake? Will it hurt? Will I have anesthesia? What kind?
.Are there any risks? What are the chances of infection or bleeding after the biopsy?
.How soon will I know the results?
.If I do have cancer, who will talk with me about the next steps? When?

Additional tests

If you are diagnosed with cancer, your doctor may order special lab tests on the breast tissue that was removed. These tests help your doctor learn more about the cancer and plan treatment:

Hormone receptor test: This test shows whether the tissue has certain hormone receptors. Tissue with these receptors needs hormones (estrogen or progesterone) to grow.

HER2 test: This test shows whether the tissue has a protein called human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. Having too much protein or too many copies of the gene in the tissue may increase the chance that the breast cancer will come back after treatment.
How is breast cancer staging determined?

To plan your treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on the size of the tumor and whether the cancer has spread. Staging may involve x-rays and lab tests. These tests can show whether the cancer has spread and, if so, to what parts of your body. When breast cancer spreads, cancer cells are often found in lymph nodes under the arm (axillary lymph nodes). The stage often is not known until after surgery to remove the tumor in your breast and the lymph nodes under your arm.

These are the stages of breast cancer:

Stage 0 is carcinoma in situ.

Lobular carcinoma in situ (LCIS): Abnormal cells are in the lining of a lobule. LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer for both breasts.

Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.

Stage I is an early stage of invasive breast cancer. The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have not spread beyond the breast.

Stage II is one of the following:

The tumor in the breast is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm.

The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer may have spread to the lymph nodes under the arm.

The tumor is larger than 5 centimeters (2 inches). The cancer has not spread to the lymph nodes under the arm.

Stage III is locally advanced cancer. It is divided into Stage IIIA, IIIB, and IIIC.

Stage IIIA is one of the following:

The tumor in the breast is smaller than 5 centimeters (2 inches). The cancer has spread to underarm lymph nodes that are attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.

The tumor is more than 5 centimeters across. The cancer has spread to the underarm lymph nodes that are either alone or attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.

Stage IIIB is a tumor of any size that has grown into the chest wall or the skin of the breast. It may be associated with swelling of the breast or with nodules (lumps) in the breast skin.

The cancer may have spread to lymph nodes under the arm.

The cancer may have spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone.

Inflammatory breast cancer is a rare type of breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When a doctor diagnoses inflammatory breast cancer, it is at least Stage IIIB, but it could be more advanced.

Stage IIIC is a tumor of any size. It has spread in one of the following ways:

The cancer has spread to the lymph nodes behind the breastbone and under the arm.

The cancer has spread to the lymph nodes under or above the collarbone.

Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body.

Recurrent cancer is cancer that has come back (recurred) after a period of time when it could not be detected. It may recur locally in the breast or chest wall. Or it may recur in any other part of the body, such as the bone, liver, or lungs.

What are the methods for treating breast cancer?

Many women with breast cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. Knowing more about breast cancer helps many women cope.

Shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon.

Getting a second opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. You may have to gather your mammogram films, biopsy slides, pathology report, and proposed treatment plan. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with breast cancer need treatment right away.

There are a number of ways to find a doctor for a second opinion:

Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.

NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can provide online assistance through LiveHelp at http://www.cancer.gov/cis.

A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.

The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries. Also, ABMS offers this information at http://www.abms.org. (Click on "Who's Certified.")

NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment Facility If You Have Cancer."
Treatment methods

Women with breast cancer have many treatment options. These include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. These options are described below. Many women receive more than one type of treatment.

The choice of treatment depends mainly on the stage of the disease. Treatment options by stage are described below.

Your doctor can describe your treatment choices and the expected results. You may want to know how treatment may change your normal activities. You may want to know how you will look during and after treatment. You and your doctor can work together to develop a treatment plan that reflects your medical needs and personal values.

Cancer treatment is either local therapy or systemic therapy:

Local therapy: Surgery and radiation therapy are local treatments. They remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic therapy: Chemotherapy, hormone therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic treatments also are used for cancer that has spread.
Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.

Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods.

You may want to ask your doctor these questions before your treatment begins:

.What did the hormone receptor test show? What did other lab tests show?
.Do any lymph nodes show signs of cancer?
.What is the stage of the disease? Has the cancer spread?
.What is the goal of treatment? What are my treatment choices? Which do you recommend for me? Why?
.What are the expected benefits of each kind of treatment?
.What are the risks and possible side effects of each treatment? How can side effects be managed?
.What can I do to prepare for treatment?
.Will I need to stay in the hospital? If so, for how long?
.What is the treatment likely to cost? Will my insurance cover the cost?
.How will treatment affect my normal activities?
.Would a clinical trial be appropriate for me?

What about follow-up care?

Follow-up care after treatment for breast cancer is important. Recovery is different for each woman. Your recovery depends on your treatment, whether the disease has spread, and other factors.

Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer.

You should report any changes in the treated area or in your other breast to the doctor right away. Tell your doctor about any health problems, such as pain, loss of appetite or weight, changes in menstrual cycles, unusual vaginal bleeding, or blurred vision. Also talk to your doctor about headaches, dizziness, shortness of breath, coughing or hoarseness, backaches, or digestive problems that seem unusual or that don't go away. Such problems may arise months or years after treatment. They may suggest that the cancer has returned, but they can also be symptoms of other health problems. It is important to share your concerns with your doctor so problems can be diagnosed and treated as soon as possible.

Follow-up exams usually include the breasts, chest, neck, and underarm areas. Since you are at risk of getting cancer again, you should have mammograms of your preserved breast and your other breast. You probably will not need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. Your doctor may order other imaging procedures or lab tests.

What about support for women with breast cancer?

Learning you have breast cancer can change your life and the lives of those close to you. These changes can be hard to handle. It is normal for you, your family, and your friends to have many different and sometimes confusing feelings.

You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

Friends and relatives can be very supportive. Also, you may find it helps to discuss your concerns with others who have cancer. Women with breast cancer often get together in support groups to share what they have learned about coping with their disease and the effects of their treatment. It is important to keep in mind, however, that each woman is different. Ways that one woman deals with cancer may not be right for another. You may want to ask your health care provider about advice you receive from other women with breast cancer.

Several organizations offer special programs for women with breast cancer. Women who have had the disease serve as trained volunteers. They may talk with or visit women with breast cancer, provide information, and lend emotional support. They often share their experiences with breast cancer treatment, breast reconstruction, and recovery.

You may be afraid that changes to your body will affect not only how you look but also how other people feel about you. You may worry that breast cancer and its treatment will affect your sexual relationships. Many couples find it helps to talk about their concerns. Some find that counseling or a couples' support group can be helpful.

What is being done to better understand and prevent breast cancer?

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new ways to prevent, detect, diagnose, and treat breast cancer. Some are also studying therapies that may improve the quality of life for women during or after cancer treatment.

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances and researchers continue to search for more effective methods for dealing with cancer.

Women who join clinical trials may be among the first to benefit if a new approach is effective. And even if people in a trial do not benefit directly, they still make an important contribution by helping doctors learn more about breast cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

If you are interested in being part of a clinical trial, talk with your doctor. Trials are available for all stages of breast cancer.

Research on prevention

Scientists are looking for drugs that may prevent breast cancer. For example, they are testing several different drugs that lower hormone levels or prevent a hormone's effect on breast cells.

In one large study, the drug tamoxifen reduced the number of new cases of breast cancer among women who were at an increased risk of the disease. Doctors are studying whether the drug raloxifene is as effective as tamoxifen. This study is called STAR (Study of Tamoxifen and Raloxifene).

Shrink Fibroids

2009-07-14T06:31:00.000-07:00

How To Shrink Fibroids Naturally:
Many women think that the only way to get rid of fibroids is by surgery. However, this is not the case and there are methods which will teach you How To Shrink Fibroids Naturally using a simple 7 Step Action Plan without resorting to surgery or drugs. in addition, you can find details of herbal remedies for fibroids below.

FibroidClear Is Formulated To:

* Naturally reduce the estrogen excess that causes fibroids to grow
* Shrink benign tumors such as fibroids
* Prevent further growth of uterine fibroids naturally
* Reduce blood clotting and control excessive menstrual bleeding
* Raise progesterone levels to help shrink fibroids and ease menstruation
* Reduce the symptoms of Pre Menstrual Tension
* Regulate the menstrual cycle and balance hormones
* Strengthen and tone the uterine muscles, and reduce cramps and spasms
* Assist the body in replenishing nutrients lost due to heavy menstruation
* Reduce tiredness and anemia caused by heavy periods
* Keep the tissues that surround the reproductive organs healthy
* Manage the energy levels throughout the month
* Reduce fluid retention, bloating and inflammation
* Strengthen the immune system and keep the uterus free of infection

Traditionally, the treatments offered by doctors include leaving the fibroids alone if they are not causing symptoms which are too debilitating or surgery, which carries inherent risks and can have a long recovery time. In addition, with the exception of a hysterectomy, many women do not realize that the fibroids can regrow after surgery as nothing is done to treat the causes. Drug treatment is sometimes used to shrink fibroids, but this is normally only used to reduce the size prior to surgery as the side effects of these drugs mean that they can only be used for short periods of time. The drugs effectively put women into the menopause, albeit temporarily, and therefore symptoms including night sweats and bone-thinning are likely to occur.

Natural ways to shrink fibroids not only take into account how to reduce the size and symptoms of fibroids, but also treat the causes of fibroids to prevent them returning. In addition, good natural treatments are likely to enhance the overall well being of the body.

To understand how to shrink fibroids naturally, it is important to appreciate that this method may involve some time and effort of your part. It is not a "quick-fix" method, although you will definitely begin to see results quickly and certain symptoms which are associated with fibroids will go within days. To shrink large fibroids significantly will take weeks but is should be noted that this will still not be as long as the recovery time from surgery and it will be long lasting and will pay huge dividends.

Although doctors are not fully aware of all the causes of fibroids, it it thought that there are a few probable reasons for their growth. Some women are prone to inflammatory conditions of the body and that this could be hereditary. For these women, eating foods which naturally calm inflammation, such as the spice cumin or the herb rosemary can help. For others, an excess of the hormone estrogen is thought to cause fibroids. As estrogen is directly related to fat cells, it makes sense to keep to a healthy weight and to eat a healthy low fat diet. In addition, it is thought that certain pollutants can mimic the action of estrogen in the body so a good detox can help eliminate this.

As fibroids are very rarely a dangerous or life-threatening condition, treating them using natural methods is a sensible option before committing to surgery or drug treatment. The vast majority of women are amazed and delighted at the results.

Science Resources: Uterine Fibroid Tumors

2009-07-06T07:14:00.001-07:00

Science Resources: Uterine Fibroid Tumors

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Uterine Fibroid Tumors

2009-07-03T08:19:00.000-07:00

Fibroid Tumors Uterine Fibroid Tumors:
Information about the causes, symptoms, diagnosis, and treatment of fibroid tumors. Includes alternatives to hysterectomy such as myomectomy and uterine artery embalization, as well as hormonal options for treating fibroid tumors.

What are Uterine Fibroid Tumors?
Answer: Uterine fibroid tumors, or leiomyomatas, develop within the wall of the uterus. While it's possible for only one uterine fibroid tumor, or leiomyoma, to occur, they more frequently occur as multiple nodules of smooth muscle cells and fibrous connective tissues. The size of uterine fibroid tumors varies significantly from as small as 1 mm to over 20 cm or 8 inches in diameter. Uterine fibroid tumors may grow inside the wall of the uterus or they may project toward the uterine interior cavity or out towards the uterine surface. Rarely, uterine fibroid tumors grow on stalks, or peduncles, extending from the surface of the uterus.

How Do I Know if I Have Fibroid Tumors of the Uterus?
Answer: How do you know if you have uterine fibroids? It's not likely that you do know when you have fibroid tumors of the uterus. Most uterine fibroids do not cause any symptoms and do not require treatment other than regular observation by a physician. Fibroids may be discovered during routine gynecologic examination or during prenatal care.
Some women who have uterine fibroids may experience symptoms such as excessive or painful bleeding during menstruation, bleeding between periods, a feeling of fullness in the lower abdomen, frequent urination resulting from a fibroid that compresses the bladder, pain during sexual intercourse, or low back pain. Although reproductive symptoms such as infertility, recurrent spontaneous abortion, and early onset of labor during pregnancy have been attributed to fibroids to any of these symptoms. In rare cases, a fibroid can compress and block the fallopian tube, preventing fertilization and migration of the ovum or egg; after surgical removal of the fibroid, fertility is generally restored.

What Causes Uterine Fibroid Tumors?
Answer: The factors that initiate fibroid growth are not known. The vast majority of fibroids occur in women of reproductive age, and according to some estimates, they are diagnosed in black women two to three times more frequently than in white women. They are seldom seen in young women who have not begun menarche (menstruation) and they usually stabilize or regress in women who have passed menopause

Are Uterine Fibroid Tumors Cancerous?
Answer: Fibroids are the most frequently diagnosed tumor of the female pelvis. It is important to know that these are benign tumors. They are not associated with cancer, they virtually never develop into cancer, and they do not increase a woman's risk for uterine cancer.

Who is at Risk for Uterine Fibroid Tumors?
Answer: No risk factors have been found for uterine fibroids other than being a female of reproductive age. However, some factors have been described that seem to be protective. In some studies, again of small numbers of women, investigators found that as a group, women who have had two liveborn children have one-half the risk of having uterine fibroids compared to women who have had no liveborn children. It could not be discerned whether having children actually protects a woman from developing fibroids or whether fibroids contributed to the infertility of women who had no children.

What are the Symptoms of Uterine Fibroid Tumors?
Answer: Most fibroids do not cause any symptoms and do not require treatment other than regular observation by a physician. Fibroids may be discovered during routine gynecologic examination or during prenatal care. Some women who have uterine fibroids may experience symptoms such as excessive or painful bleeding during menstruation, bleeding between periods, a feeling of fullness in the lower abdomen, frequent urination resulting from a fibroid that compresses the bladder, pain during sexual intercourse, or low back pain. Although reproductive symptoms such as infertility, recurrent spontaneous abortion, and early onset of labor during pregnancy have been attributed to fibroids to any of these symptoms. In rare cases, a fibroid can compress and block the fallopian tube, preventing fertilization and migration of the ovum (egg) after surgical removal of the fibroid, fertility is generally restored.

What are fibroids?
Fibroid tumors are usually benign (non-cancerous) tumors found, most often, in the uterus of women in their 30's and 40's, although they occasionally develop on other organs which contain smooth muscle cells.
Fibroid tumors are solid tumors which are made of fibrous tissue, hence the name 'fibroid' tumor. Most often fibroids occur as multiple tumor masses which are slow-growing and often cause no symptoms.

The size of fibroids varies immensely among women and some are so small that a microscope is required to see them. However some women experience a single large fibroid tumor the size of a grapefruit or a fibroid which is so large it encompasses the entire abdominal area. Such large tumors can weigh as much as 50 pounds; the largest, reported, fibroid ever recorded weighed in at 140 pounds.

No one is sure why fibroid tumors develop, but some facts are quite clear-- they do not develop before the body begins producing estrogen during the onset of menstruation-- estrogen, such as in birth control pills and taken for menopausal symptoms, does cause fibroid tumors to grow and fibroid tumors will grow very quickly during pregnancy when the body is producing extra estrogen-- they often shrink and disappear after menopause when the body stops producing estrogen--a woman will almost never develop fibroid tumors after menopause.

The estrogen connection appears to be quite clear, although there are still some who doubt the role estrogen plays in the development of fibroid tumors because women with fibroids often have blood levels which reveal normal amounts of estrogen.

Types of Fibroid Tumors:
Submucous Fibroids:
These fibroids occur just below the lining of the uterus and can cause menstrual problems, including pain as they grow and move around the pelvic area.

Intramural Fibroids:

A round fibroid most often within the uterine wall which can cause enlargement of the uterus as they grow.

Subserous Fibroids:

This fibroid grows on the outer wall of the uterus and usually causes no symptoms until it grows large enough to interfere with other organs.

Pedunculated Fibroids:

These fibroids develop when a subserous fibroid grows a peduncle (stalk), as they grow larger they may become twisted and cause severe pain.

Interligamentous Fibroid:

A fibroid which grows sideways between the ligaments which support the uterus in the abdominal region. This type of fibroid is especially difficult to remove without the possibility of interfering with the blood supply or other organs.

Parasitic Fibroid:

The rarest form of fibroid tumor occurs when a fibroid attaches itself to another organ.

Diagnosis of Fibroid Tumors:
Diagnosis of fibroids is generally made by your physician during your annual gynecological exam when your physician feels a mass, they often are found when your physician is looking for something else or may never be discovered if you do not experience symptoms. However larger fibroids may make examination of your ovaries impossible if they grow near your ovaries.

An ultrasound scan is often ordered when such masses are felt by your physician to determine the cause of the mass, however some fibroids appear on sonograms as ovarian tumors and surgery is the only way an accurate diagnosis can be made.

Although most fibroids cause no symptoms, the estimated 25 percent of women who do have symptoms may have abnormal bleeding, pain during menstruation, and as the fibroid tumors grow larger, women will often experience a swollen abdomen.

Larger fibroids may cause frequent urination or an inability to control your bladder, either the ability to control the urge or in severe cases, a women may find that she is unable to urinate at all. If a fibroid extends towards a woman's back it may push on the bowels, causing constipation and a backache.

What Is the Treatment for Uterine Fibroid Tumors?
Answer: Until very recently, a woman with growing uterine fibroids was considered a candidate for hysterectomy (removal of the uterus). However, treatment by hysterectomy in a woman of reproductive age means that she will no longer be able to bear children and hysterectomy may have other effects, both physical and psychological, as well. A woman considering hysterectomy should discuss the pros and cons thoroughly with her physicians. More and more, physicians are beginning to realize that uterine fibroids may not require any intervention or, at most, limited treatment. For a woman with uterine fibroids that are not symptomatic the best therapy may be watchful waiting. Some women never exhibit any symptoms or have any problems associated with fibroids, in which case no treatment is necessary. For women who experience occasional pelvic pain or discomfort, a mild, over-the counter anti-inflammatory or painkilling drug often will be effective. More bothersome cases may require stronger drugs available by prescription.

If your fibroid tumors are severe enough that they cause certain symptoms, surgery is often, the required treatment. Symptoms which justify surgery include: extremely heavy bleeding during your menstrual cycle, which causes anemia that does not respond to treatment; pain, which has become intolerable to the woman or discomfort caused by the pressure of the fibroids on another organ; or when the location of the tumors is likely to cause further problems.

Surgery for fibroid tumors includes, myomectomy and hysterectomy. Myomectomy is the surgical removal of each individual tumor without damage to the uterus, preserving a woman's ability to conceive. However, fibroids will often grow back and although it is possible to have a myomectomy repeated, multiple myomectomies can cause other problems such as the walls of the uterus sticking together due to scarring.

Women should also consider uterine artery embalization. Uterine artery embalization leaves the uterus intact in a non-surgical procedure. Polyvinyl particles are placed into the uterine artery at a point just before the nexis of vessels spread out into the uterine tissue. The particles flow into the vessels and clog them. This prevents the fibroids from receiving the constant blood supply they require and causes the fibroids shrink overtime. However, almost immediately the symptoms of heavy bleeding and pelvic pain are significantly reduced.

The sad fact is that because fibroids do grow back, most women will eventually have to face a hysterectomy. Removing the uterus is the only permanent way to effectively relieve most women of fibroids.

Hysterectomy is, most often, the procedure of choice for fibroid tumors when a women with severe symptoms, has completed her family and her uterus has grown to the size of a uterus at twelve weeks of pregnancy; a women has excessively large fibroid tumors; severe abnormal bleeding occurs; or when the fibroids are causing problems with other organs such as the bladder and bowels.

Science is starting to evaluate other options for treating fibroids, including the use of Lupron which may be beneficial for those who want to become pregnant or for women approaching menopause when fibroids often shrink naturally. Lupron shrinks fibroids in most women with continued use, but one drawback is that the fibroids will quickly grow back once treatment is stopped.

If you have fibroid tumors, investigate your options before deciding what treatment you want to try. There are many alternatives to hysterectomy currently available, and science is creating more options for women everyday.

Science Resources: Benign Prostatic Hyperplasia

2009-06-25T07:57:00.001-07:00

Science Resources: Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

2009-06-21T06:52:00.000-07:00

.Prostate Enlargement: Benign Prostatic Hyperplasia
.The Prostate Gland
.Benign Prostatic Hyperplasia: A Common Part of Aging
.Why BPH Occurs
.Symptoms
.Diagnosis
.Treatment
.Your Recovery After Surgery in the Hospital
.Do's and Don'ts
.Getting Back to Normal
.Sexual Function After Surgery
.Is Further Treatment Needed?
.Hope through Research
.Additional Reading
.Glossary

The Prostate Gland:
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.

Scientists do not know all the prostate's functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.

Benign Prostatic Hyperplasia: A Common Part of Aging
It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.

Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to physicians for BPH.

Why BPH Occurs:

The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.

Throughout their lives, men produce both testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done on animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth.

Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood's testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH.

Some researchers suggest that BPH may develop as a result of “instructions” given to cells early in life. According to this theory, BPH occurs because cells in one section of the gland follow these instructions and “reawaken” later in life. These “reawakened” cells then deliver signals to other cells in the gland, instructing them to grow or making them more sensitive to hormones that influence growth.

Symptoms:
Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as

a hesitant, interrupted, weak stream
urgency and leaking or dribbling
more frequent urination, especially at night
The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.

Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.

It is important to tell your doctor about urinary problems such as those described above. In eight out of 10 cases, these symptoms suggest BPH, but they also can signal other, more serious conditions that require prompt treatment. These conditions, including prostate cancer, can be ruled out only by a doctor's examination.

Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence—the inability to control urination. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications.

Diagnosis:
You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide whether surgery is needed. The tests vary from patient to patient, but the following are the most common.

Digital Rectal Examination (DRE):

This examination is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.

Prostate-Specific Antigen (PSA) Blood Test
To rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer. The U.S. Food and Drug Administration (FDA) has approved a PSA test for use in conjunction with a digital rectal examination to help detect prostate cancer in men who are age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about the interpretation of PSA levels, the test's ability to discriminate cancer from benign prostate conditions, and the best course of action following a finding of elevated PSA.

A fact sheet titled “The Prostate-Specific Antigen (PSA) Test: Questions and Answers” can be found on the National Cancer Institute website at www.cancer.gov/cancertopics/factsheet/Detection/PSA.

Rectal Ultrasound and Prostate Biopsy:

If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen. To determine whether an abnormal-looking area is indeed a tumor, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumor. The needle collects a few pieces of prostate tissue for examination with a microscope.

Urine Flow Study:

Your doctor may ask you to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Cystoscopy:
In this examination, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system that help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment:

Men who have BPH with symptoms usually need some kind of treatment at some time. However, a number of researchers have questioned the need for early treatment when the gland is just mildly enlarged. The results of their studies indicate that early treatment may not be needed because the symptoms of BPH clear up without treatment in as many as one-third of all mild cases. Instead of immediate treatment, they suggest regular checkups to watch for early problems. If the condition begins to pose a danger to the patient's health or causes a major inconvenience to him, treatment is usually recommended.

Since BPH can cause urinary tract infections, a doctor will usually clear up any infection with antibiotics before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk.

The following section describes the types of treatment that are most commonly used for BPH.

Drug Treatment:

Over the years, researchers have tried to find a way to shrink or at least stop the growth of the prostate without using surgery. The FDA has approved six drugs to relieve common symptoms associated with an enlarged prostate.

Finasteride (Proscar), FDA-approved in 1992, and dutasteride (Avodart), FDA-approved in 2001, inhibit production of the hormone DHT, which is involved with prostate enlargement. The use of either of these drugs can either prevent progression of growth of the prostate or actually shrink the prostate in some men.

The FDA also approved the drugs terazosin (Hytrin) in 1993, doxazosin (Cardura) in 1995, tamsulosin (Flomax) in 1997, and alfuzosin (Uroxatral) in 2003 for the treatment of BPH. All four drugs act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction. The four drugs belong to the class known as alpha blockers. Terazosin and doxazosin were developed first to treat high blood pressure. Tamsulosin and alfuzosin were developed specifically to treat BPH.

The Medical Therapy of Prostatic Symptoms (MTOPS) Trial, supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), recently found that using finasteride and doxazosin together is more effective than using either drug alone to relieve symptoms and prevent BPH progression. The two-drug regimen reduced the risk of BPH progression by 67 percent, compared with 39 percent for doxazosin alone and 34 percent for finasteride alone.

Minimally Invasive Therapy:

Because drug treatment is not effective in all cases, researchers in recent years have developed a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery.

Transurethral microwave procedures. In 1996, the FDA approved a device that uses microwaves to heat and destroy excess prostate tissue. In the procedure called transurethral microwave thermotherapy (TUMT), the device sends computer-regulated microwaves through a catheter to heat selected portions of the prostate to at least 111 degrees Fahrenheit. A cooling system protects the urinary tract during the procedure.

The procedure takes about 1 hour and can be performed on an outpatient basis without general anesthesia. TUMT has not been reported to lead to erectile dysfunction or incontinence.

Although microwave therapy does not cure BPH, it reduces urinary frequency, urgency, straining, and intermittent flow. It does not correct the problem of incomplete emptying of the bladder. Ongoing research will determine any long-term effects of microwave therapy and who might benefit most from this therapy.

Transurethral needle ablation. Also in 1996, the FDA approved the minimally invasive transurethral needle ablation (TUNA) system for the treatment of BPH.

The TUNA system delivers low-level radiofrequency energy through twin needles to burn away a well-defined region of the enlarged prostate. Shields protect the urethra from heat damage. The TUNA system improves urine flow and relieves symptoms with fewer side effects when compared with transurethral resection of the prostate (TURP). No incontinence or impotence has been observed.

Water-induced thermotherapy. This therapy uses heated water to destroy excess tissue in the prostate. A catheter containing multiple shafts is positioned in the urethra so that a treatment balloon rests in the middle of the prostate. A computer controls the temperature of the water, which flows into the balloon and heats the surrounding prostate tissue. The system focuses the heat in a precise region of the prostate. Surrounding tissues in the urethra and bladder are protected. Destroyed tissue either escapes with urine through the urethra or is reabsorbed by the body.

High-intensity focused ultrasound. The use of ultrasound waves to destroy prostate tissue is still undergoing clinical trials in the United States. The FDA has not yet approved high-intensity focused ultrasound.

Surgical Treatment:
Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH. The following section describes the types of surgery that are used.

Transurethral surgery. In this type of surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an instrument through the urethra.

A procedure called transurethral resection of the prostate (TURP) is used for 90 percent of all prostate surgeries done for BPH. With TURP, an instrument called a resectoscope is inserted through the penis. The resectoscope, which is about 12 inches long and 1/2 inch in diameter, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels.

During the 90-minute operation, the surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.

Most doctors suggest using TURP whenever possible. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period. One possible side effect of TURP is retrograde, or backward, ejaculation. In this condition, semen flows backward into the bladder during climax instead of out the urethra.

Another surgical procedure is called transurethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this procedure widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself. Although some people believe that TUIP gives the same relief as TURP with less risk of side effects such as retrograde ejaculation, its advantages and long-term side effects have not been clearly established.

Open surgery. In the few cases when a transurethral procedure cannot be used, open surgery, which requires an external incision, may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. The location of the enlargement within the gland and the patient's general health help the surgeon decide which of the three open procedures to use.

With all the open procedures, anesthesia is given and an incision is made. Once the surgeon reaches the prostate capsule, he or she scoops out the enlarged tissue from inside the gland.

Laser surgery. In March 1996, the FDA approved a surgical procedure that employs side-firing laser fibers and Nd: YAG lasers to vaporize obstructing prostate tissue. The doctor passes the laser fiber through the urethra into the prostate using a cystoscope and then delivers several bursts of energy lasting 30 to 60 seconds. The laser energy destroys prostate tissue and causes shrinkage. As with TURP, laser surgery requires anesthesia and a hospital stay. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. Laser surgery also allows for a quicker recovery time. But laser surgery may not be effective on larger prostates. The long-term effectiveness of laser surgery is not known.

Newer procedures that use laser technology can be performed on an outpatient basis.

Photoselective vaporization of the prostate (PVP). PVP uses a high-energy laser to destroy prostate tissue and seal the treated area.

Interstitial laser coagulation. Unlike other laser procedures, interstitial laser coagulation places the tip of the fiberoptic probe directly into the prostate tissue to destroy it.

Your Recovery After Surgery in the Hospital
The amount of time you will stay in the hospital depends on the type of surgery you had and how quickly you recover.

Foley catheter:

At the end of surgery, a special catheter is inserted through the opening of the penis to drain urine from the bladder into a collection bag. Called a Foley catheter, this device has a water-filled balloon on the end that is put in the bladder, which keeps it in place.

This catheter is usually left in place for several days. Sometimes, the catheter causes recurring painful bladder spasms the day after surgery. These spasms may be difficult to control, but they will eventually disappear.

You may also be given antibiotics while you are in the hospital. Many doctors start giving this medicine before or soon after surgery to prevent infection. However, some recent studies suggest that antibiotics may not be needed in every case, and your doctor may prefer to wait until an infection is present to give them.

After surgery, you will probably notice some blood or clots in your urine as the wound starts to heal. If your bladder is being irrigated (flushed with water), you may notice that your urine becomes red once the irrigation is stopped. Some bleeding is normal, and it should clear up by the time you leave the hospital. During your recovery, it is important to drink a lot of water (up to 8 cups a day) to help flush out the bladder and speed healing.

Do's and Don'ts:

Take it easy the first few weeks after you get home. You may not have any pain, but you still have an incision that is healing—even with transurethral surgery, where the incision can't be seen. Since many people try to do too much at the beginning and then have a setback, it is a good idea to talk with your doctor before resuming your normal routine. During this initial period of recovery at home, avoid any straining or sudden movements that could tear the incision. Here are some guidelines:

.Continue drinking a lot of water to flush the bladder.
.Avoid straining when having a bowel movement.
.Eat a balanced diet to prevent constipation. If constipation occurs, ask your doctor if you can take a laxative.
.Don't do any heavy lifting.
.Don't drive or operate machinery.

Getting Back to Normal After Surgery:

Even though you should feel much better by the time you leave the hospital, it will probably take a couple of months for you to heal completely. During the recovery period, the following are some common problems that can occur.

Problems Urinating:

You may notice that your urinary stream is stronger right after surgery, but it may take awhile before you can urinate completely normally again. After the catheter is removed, urine will pass over the surgical wound on the prostate, and you may initially have some discomfort or feel a sense of urgency when you urinate. This problem will gradually lessen, and after a couple of months you should be able to urinate less frequently and more easily.

Incontinence:

As the bladder returns to normal, you may have some temporary problems controlling urination, but long-term incontinence rarely occurs. Doctors find that the longer problems existed before surgery, the longer it takes for the bladder to regain its full function after the operation.

Bleeding:

In the first few weeks after transurethral surgery, the scab inside the bladder may loosen, and blood may suddenly appear in the urine. Although this can be alarming, the bleeding usually stops with a short period of resting in bed and drinking fluids. However, if your urine is so red that it is difficult to see through or if it contains clots or if you feel any discomfort, be sure to contact your doctor.

Sexual Function After Surgery:

Many men worry about whether surgery for BPH will affect their ability to enjoy sex. Some sources state that sexual function is rarely affected, while others claim that it can cause problems in up to 30 percent of cases. However, most doctors say that even though it takes awhile for sexual function to return fully, with time, most men are able to enjoy sex again.

Complete recovery of sexual function may take up to 1 year, lagging behind a person's general recovery. The exact length of time depends on how long after symptoms appeared that BPH surgery was done and on the type of surgery. Following is a summary of how surgery is likely to affect the following aspects of sexual function.

Erections:

Most doctors agree that if you were able to maintain an erection shortly before surgery, you will probably be able to have erections afterward. Surgery rarely causes a loss of erectile function. However, surgery cannot usually restore function that was lost before the operation.

Ejaculation:

Although most men are able to continue having erections after surgery, a prostate procedure frequently makes them sterile (unable to father children) by causing a condition called retrograde ejaculation or dry climax.

During sexual activity, sperm from the testes enters the urethra near the opening of the bladder. Normally, a muscle blocks off the entrance to the bladder, and the semen is expelled through the penis. However, the coring action of prostate surgery cuts this muscle as it widens the neck of the bladder. Following surgery, the semen takes the path of least resistance and enters the wider opening to the bladder rather than being expelled through the penis. Later it is harmlessly flushed out with urine. In some cases, this condition can be treated with a drug called pseudoephedrine, found in many cold medicines, or imipramine. These drugs improve muscle tone at the bladder neck and keep semen from entering the bladder.

Orgasm:

Most men find little or no difference in the sensation of orgasm, or sexual climax, before and after surgery. Although it may take some time to get used to retrograde ejaculation, you should eventually find sex as pleasurable after surgery as before.

Many people have found that concerns about sexual function can interfere with sex as much as the operation itself. Understanding the surgical procedure and talking over any worries with the doctor before surgery often help men regain sexual function earlier. Many men also find it helpful to talk with a counselor during the adjustment period after surgery.

Is Further Treatment Needed?:

In the years after your surgery, it is important to continue having a rectal examination once a year and to have any symptoms checked by your doctor.

Since surgery for BPH leaves behind a good part of the gland, it is still possible for prostate problems, including BPH, to develop again. However, surgery usually offers relief from BPH for at least 15 years. Only 10 percent of the men who have surgery for BPH eventually need a second operation for enlargement. Usually these are men who had the first surgery at an early age.

Sometimes, scar tissue resulting from surgery requires treatment in the year after surgery. Rarely, the opening of the bladder becomes scarred and shrinks, causing obstruction. This problem may require a surgical procedure similar to transurethral incision (see section on Surgical Treatment). More often, scar tissue may form in the urethra and cause narrowing. The doctor can solve this problem during an office visit by stretching the urethra.

Prostatic Stents:

A stent is a small device that is inserted through the urethra to the narrowed area and allowed to expand, like a spring. The stent pushes back the prostatic tissue, widening the urethra. It is designed to relieve urinary obstruction in men and improve the ability to urinate. The device is approved for use in men for whom other standard surgical procedures to correct urinary obstruction have failed.

BPH and Prostate Cancer: No Apparent Relation:

Although some of the signs of BPH and prostate cancer are the same, having BPH does not seem to increase the chances of getting prostate cancer. Nevertheless, a man who has BPH may have undetected prostate cancer at the same time or may develop prostate cancer in the future. For this reason, the National Cancer Institute and the American Cancer Society recommend that all men over 40 have a rectal examination once a year to screen for prostate cancer.

After BPH surgery, the tissue removed is routinely checked for hidden cancer cells. In about one out of 10 cases, some cancer tissue is found, but often it is limited to a few cells of a nonaggressive type of cancer, and no treatment is needed.

Liver Cancer

2009-06-12T07:13:00.000-07:00

What is liver cancer (hepatocellular carcinoma, HCC)?

Liver cancer (hepatocellular carcinoma) is a cancer arising from the liver. It is also known as primary liver cancer or hepatoma. The liver is made up of different cell types (for example, bile ducts, blood vessels, and fat-storing cells). However, liver cells (hepatocytes) make up 80% of the liver tissue. Thus, the majority of primary liver cancers (over 90 to 95%) arises from liver cells and is called hepatocellular cancer or carcinoma.

When patients or physicians speak of liver cancer, however, they are often referring to cancer that has spread to the liver, having originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More specifically, this type of liver cancer is called metastatic liver disease (cancer) or secondary liver cancer. Thus, the term liver cancer actually can refer to either metastatic liver cancer or hepatocellular cancer. The subject of this article is hepatocellular carcinoma, which I will refer to as liver cancer.

What is the scope of the liver cancer problem?

Liver cancer is the fifth most common cancer in the world. A deadly cancer, liver cancer will kill almost all patients who have it within a year. In 1990, the World Health Organization estimated that there were about 430,000 new cases of liver cancer worldwide, and a similar number of patients died as a result of this disease. About three quarters of the cases of liver cancer are found in Southeast Asia (China, Hong Kong, Taiwan, Korea, and Japan). Liver cancer is also very common in sub-Saharan Africa (Mozambique and South Africa).

The frequency of liver cancer in Southeast Asia and sub-Saharan Africa is greater than 20 cases per 100,000 population. In contrast, the frequency of liver cancer in North America and Western Europe is much lower, less than five per 100,000 population. However, the frequency of liver cancer among native Alaskans is comparable to that seen in Southeast Asia. Moreover, recent data show that the frequency of liver cancer in the U.S. overall is rising. This increase is due primarily to chronic hepatitis C, an infection of the liver that causes liver cancer.

What are the population characteristics (epidemiology) of liver cancer?

In the U.S. the highest frequency of liver cancer occurs in immigrants from Asian countries, where liver cancer is common. The frequency of liver cancer among Caucasians is the lowest, whereas among African-Americans and Hispanics, it is intermediate. The frequency of liver cancer is high among Asians because liver cancer is closely linked to chronic hepatitis B infection. This is especially so in individuals who have been infected with chronic hepatitis B for most of their lives. If you take a world map depicting the frequency of chronic hepatitis B infection, you can easily superimpose that map on a map showing the frequency of liver cancer.

The initial presentation (symptoms) of liver cancer in patients in areas of high liver cancer frequency is quite different from that seen in low frequency areas. Patients from high frequency areas usually start developing liver cancer in their 40s, and the cancer is usually more aggressive. That is, the liver cancer presents with severe symptoms and is inoperable (too advanced for surgery) at the time of diagnosis. Also, in these areas, the frequency of liver cancer is three to four times higher in men than in women, and most of these patients are infected with chronic hepatitis B. In contrast, liver cancer in lower risk areas occurs in patients in their 50s and 60s and the predominance of men is less striking.

What are the risk factors for liver cancer?

Hepatitis B infection:

The role of hepatitis B virus (HBV) infection in causing liver cancer is well established. Several lines of evidence point to this strong association. As noted earlier, the frequency of liver cancer relates to (correlates with) the frequency of chronic hepatitis B virus infection. In addition, the patients with hepatitis B virus who are at greatest risk for liver cancer are men with hepatitis B virus cirrhosis (scarring of the liver) and a family history of liver cancer. Perhaps the most convincing evidence, however, comes from a prospective (looking forward in time) study done in the 1970's in Taiwan involving male government employees over the age of 40. In this study, the investigators found that the risk of developing liver cancer was 200 times higher among employees who had chronic hepatitis B virus as compared to employees without chronic hepatitis B virus!

Studies in animals also have provided evidence that hepatitis B virus can cause liver cancer. For example, we have learned that liver cancer develops in other mammals that are naturally infected with hepatitis B virus-related viruses. Finally, by infecting transgenic mice with certain parts of the hepatitis B virus, scientists caused liver cancer to develop in mice that do not usually develop liver cancer. (Transgenic mice are mice that have been injected with new or foreign genetic material.)

How does chronic hepatitis B virus cause liver cancer? In patients with both chronic hepatitis B virus and liver cancer, the genetic material of hepatitis B virus is frequently found to be part of the genetic material of the cancer cells. It is thought, therefore, that specific regions of the hepatitis B virus genome (genetic code) enter the genetic material of the liver cells. This hepatitis B virus genetic material may then disrupt the normal genetic material in the liver cells, thereby causing the liver cells to become cancerous.

The vast majority of liver cancer that is associated with chronic hepatitis B virus occurs in individuals who have been infected most of their lives. In areas where hepatitis B virus is not always present (endemic) in the community (for example, the U.S.), liver cancer is relatively uncommon. The reason for this is that most of the people with chronic hepatitis B virus in these areas acquired the infection as adults. However, liver cancer can develop in individuals who acquired chronic hepatitis B virus in adulthood if there are other risk factors, such as chronic alcohol use or co-infection with chronic hepatitis C virus infection.

Hepatitis C infection:

Hepatitis C virus (HCV) infection is also associated with the development of liver cancer. In fact, in Japan, hepatitis C virus is present in up to 75% of cases of liver cancer. As with hepatitis B virus, the majority of hepatitis C virus patients with liver cancer have associated cirrhosis (liver scarring). In several retrospective-prospective studies (looking backward and forward in time) of the natural history of hepatitis C, the average time to develop liver cancer after exposure to hepatitis C virus was about 28 years. The liver cancer occurred about eight to 10 years after the development of cirrhosis in these patients with hepatitis C. Several prospective European studies report that the annual incidence (occurrence over time) of liver cancer in cirrhotic hepatitis C virus patients ranges from 1.4 to 2.5% per year.

In hepatitis C virus patients, the risk factors for developing liver cancer include the presence of cirrhosis, older age, male gender, elevated baseline alpha-fetoprotein level (a blood tumor marker), alcohol use, and co-infection with hepatitis B virus. Some earlier studies suggested that hepatitis C virus genotype 1b (a common genotype in the U.S.) may be a risk factor, but more recent studies do not support this finding.

The way in which hepatitis C virus causes liver cancer is not well understood. Unlike hepatitis B virus, the genetic material of hepatitis C virus is not inserted directly into the genetic material of the liver cells. It is known, however, that cirrhosis from any cause is a risk factor for the development of liver cancer. It has been argued, therefore, that hepatitis C virus, which causes cirrhosis of the liver, is an indirect cause of liver cancer.

On the other hand, there are some chronic hepatitis C virus infected individuals who have liver cancer without cirrhosis. So, it has been suggested that the core (central) protein of hepatitis C virus is the culprit in the development of liver cancer. The core protein itself (a part of the hepatitis C virus) is thought to impede the natural process of cell death or interfere with the function of a normal tumor suppressor (inhibitor) gene (the p53 gene). The result of these actions is that the liver cells go on living and reproducing without the normal restraints, which is what happens in cancer.

Alcohol :

Cirrhosis caused by chronic alcohol consumption is the most common association of liver cancer in the developed world. Actually, we now understand that many of these cases are also infected with chronic hepatitis C virus. The usual setting is an individual with alcoholic cirrhosis who has stopped drinking for ten years, and then develops liver cancer. It is somewhat unusual for an actively drinking alcoholic to develop liver cancer. What happens is that when the drinking is stopped, the liver cells try to heal by regenerating (reproducing). It is during this active regeneration that a cancer-producing genetic change (mutation) can occur, which explains the occurrence of liver cancer after the drinking has been stopped.

Patients who are actively drinking are more likely to die from non-cancer related complications of alcoholic liver disease (for example, liver failure). Indeed, patients with alcoholic cirrhosis who die of liver cancer are about 10 years older than patients who die of non-cancer causes. Finally, as noted above, alcohol adds to the risk of developing liver cancer in patients with chronic hepatitis C virus or hepatitis B virus infections.

Aflatoxin B1:

Aflatoxin B1 is the most potent liver cancer-forming chemical known. It is a product of a mold called Aspergillus flavus, which is found in food that has been stored in a hot and humid environment. This mold is found in such foods as peanuts, rice, soybeans, corn, and wheat. Aflatoxin B1 has been implicated in the development of liver cancer in Southern China and Sub-Saharan Africa. It is thought to cause cancer by producing changes (mutations) in the p53 gene. These mutations work by interfering with the gene's important tumor suppressing (inhibiting) functions.

Drugs, medications, and chemicals :

There are no medications that cause liver cancer, but female hormones (estrogens) and protein-building (anabolic) steroids are associated with the development of hepatic adenomas. These are benign liver tumors that may have the potential to become malignant (cancerous). Thus, in some individuals, hepatic adenoma can evolve into cancer.

Certain chemicals are associated with other types of cancers found in the liver. For example, thorotrast, a previously used contrast agent for imaging, caused a cancer of the blood vessels in the liver called hepatic angiosarcoma. Also, vinyl chloride, a compound used in the plastics industry, can cause hepatic angiosarcomas that appear many years after the exposure.

Hemochromatosis:

Liver cancer will develop in up to 30% of patients with hereditary hemochromatosis. Patients at the greatest risk are those who develop cirrhosis with their hemochromatosis. Unfortunately, once cirrhosis is established, effective removal of excess iron (the treatment for hemochromatosis) will not reduce the risk of developing liver cancer.

Cirrhosis:

Individuals with most types of cirrhosis of the liver are at an increased risk of developing liver cancer. In addition to the conditions described above (hepatitis B, hepatitis C, alcohol, and hemochromatosis), alpha 1 anti-trypsin deficiency, a hereditary condition that can cause emphysema and cirrhosis, may lead to liver cancer. Liver cancer is also strongly associated with hereditary tyrosinemia, a childhood biochemical abnormality that results in early cirrhosis.

Certain causes of cirrhosis are less frequently associated with liver cancer than are other causes. For example, liver cancer is rarely seen with the cirrhosis in Wilson's disease (abnormal copper metabolism) or primary sclerosing cholangitis (chronic scarring and narrowing of the bile ducts). It used to be thought that liver cancer is rarely found in primary biliary cirrhosis (PBC) as well. Recent studies, however, show that the frequency of liver cancer in PBC is comparable to that in other forms of cirrhosis.

How is liver cancer diagnosed?

Blood tests:

Liver cancer is not diagnosed by routine blood tests, including a standard panel of liver tests. This is why the diagnosis of liver cancer depends so much on the vigilance of the physician screening with a tumor marker (alpha-fetoprotein) in the blood and radiological imaging studies. Since most patients with liver cancer have associated liver disease (cirrhosis), their liver blood tests may not be normal to begin with. If these blood tests become abnormal or worsen due to liver cancer, this usually signifies extensive cancerous involvement of the liver. At that time, any medical or surgical treatment would be too late.

Sometimes, however, other abnormal blood tests can indicate the presence of liver cancer. Remember that each cell type in the body contains the full complement of genetic information. What differentiates one cell type from another is the particular set of genes that are turned on or off in that cell. When cells become cancerous, certain of the cell's genes that were turned off may become turned on. Thus, in liver cancer, the cancerous liver cells may take on the characteristics of other types of cells. For example, liver cancer cells sometimes can produce hormones that are ordinarily produced in other body systems. These hormones then can cause certain abnormal blood tests, such as a high red blood count (erythrocytosis), low blood sugar (hypoglycemia) and high blood calcium (hypercalcemia).

Another abnormal blood test, high serum cholesterol (hypercholesterolemia), is seen in up to 10% of patients from Africa with liver cancer. The high cholesterol occurs because the liver cancer cells are not able to turn off (inhibit) their production of cholesterol. (Normal cells are able to turn off their production of cholesterol.)

There is no reliable or accurate screening blood test for liver cancer. The most widely used biochemical blood test is alpha-fetoprotein (AFP), which is a protein normally made by the immature liver cells in the fetus. At birth, infants have relatively high levels of AFP, which fall to normal adult levels by the first year of life. Also, pregnant women carrying babies with neural tube defects may have high levels of AFP. (A neural tube defect is an abnormal fetal brain or spinal cord that is caused by folic acid deficiency during pregnancy.)

In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:

Liver cancer
Germ cell tumors (cancer of the testes and ovaries)
Metastatic cancer in the liver (originating in other organs)
Several assays (tests) for measuring AFP are available. Generally, normal levels of AFP are below 10 ng/ml. Moderate levels of AFP (even almost up to 500 ng/ml) can be seen in patients with chronic hepatitis. Moreover, many patients with various types of acute and chronic liver diseases without documentable liver cancer can have mild or even moderate elevations of AFP.

The sensitivity of AFP for liver cancer is about 60%. In other words, an elevated AFP blood test is seen in about 60% of liver cancer patients. That leaves 40% of patients with liver cancer who have normal AFP levels. Therefore, a normal AFP does not exclude liver cancer. Also, as noted above, an abnormal AFP does not mean that a patient has liver cancer. It is important to note, however, that patients with cirrhosis and an abnormal AFP, despite having no documentable liver cancer, still are at very high risk of developing liver cancer. Thus, any patient with cirrhosis and an elevated AFP, particularly with steadily rising blood levels, will either most likely develop liver cancer or actually already have an undiscovered liver cancer.

An AFP greater than 500 ng/ml is very suggestive of liver cancer. In fact, the blood level of AFP loosely relates to (correlates with) the size of the liver cancer. Finally, in patients with liver cancer and abnormal AFP levels, the AFP may be used as a marker of response to treatment. For example, an elevated AFP is expected to fall to normal in a patient whose liver cancer is successfully removed surgically (resected).

There are a number of other liver cancer tumor markers that currently are research tools and not generally available. These include des-gamma-carboxyprothrombin (DCP), a variant of the gamma-glutamyltransferase enzymes, and variants of other enzymes (for example, alpha-L-fucosidase), which are produced by normal liver cells. (Enzymes are proteins that speed up biochemical reactions.) Potentially, these blood tests, used in conjunction with AFP, could be very helpful in diagnosing more cases of liver cancer than with AFP alone.

What are the treatment options for liver cancer?

The treatment options are dictated by the stage of liver cancer and the overall condition of the patient. The only proven cure for liver cancer is liver transplantation for a solitary, small (<3cm) tumor. Now, many physicians may dispute this statement. They may argue that a small tumor can be surgically removed (partial hepatic resection) without the need for a liver transplantation. Moreover, they may claim that the one and three year survival rates for resection are perhaps comparable to those for liver transplantation.

However, most patients with liver cancer also have cirrhosis of the liver and would not tolerate liver resection surgery. But, they probably could tolerate the transplantation operation, which involves removal of the patient's entire diseased liver just prior to transplanting a donor liver. Furthermore, many patients who undergo hepatic resections will develop a recurrence of liver cancer elsewhere in the liver within several years. In fact, some experts believe that once a liver develops liver cancer, there is a tendency for that liver to develop other tumors at the same time (synchronous multicentric occurrence) or at a later time (metachronous multicentric occurrence).

The results of the various medical treatments (chemotherapy, chemoembolization, ablation, and proton beam therapy) remain disappointing. Moreover, for reasons noted earlier (primarily the variability in natural history), there have been no systematic study comparisons of the different treatments. As a result, individual patients will find that the various treatment options available to them depend largely on the local expertise.

How do we know if a particular treatment worked for a particular patient? Well, hopefully, the patient will feel better. However, a clinical response to treatment is usually defined more objectively. Thus, a response is defined as a decrease in the size of the tumor on imaging studies along with a reduction of the alpha-fetoprotein in the blood, if the level was elevated prior to treatment.

Low-fat diet may protect against liver cancer:

Switching over to a low-fat diet might provide protection against liver cancer, finds a new study.

The research team from University of Pennsylvania School of Medicine and Case Western Reserve University found that a high-fat diet predisposed the cancer-susceptible strain to liver cancer, and that by switching to a low-fat diet early in the experiment, the same high-risk mice avoided the malignancy.

Senior co-author Dr John Lambris, the Dr. Ralph and Sallie Weaver Professor of Research Medicine at Penn believes that a similar change in diet may have important implications for preventing liver cancers in humans.

"The connection between obesity and cancer is not well understood at this point," said Lambris.

The team hopes that the results will lead to the development of blood tests that can detect precancerous conditions related to diet.

The investigators focussed their study on hepatocellular carcinoma (HCC), a type of liver cancer that is one of the leading causes of cancer death worldwide.

They tested the long-term effects of high-fat and low-fat diets on males of two inbred strains of mice and discovered that one strain, named C57BL/6J, was susceptible to non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma on a high-fat, but not a low-fat diet.

The other strain, called A/J, was not susceptible to disease on a high-fat diet. The mice were fed their respective diets for close to 500 days, weighed periodically, and then analyzed for the presence of disease.

At the end of the experiment, mice susceptible to cancer showed characteristics of NASH such as inflammation and fibrosis, and, in some cases, cirrhosis as well as hepatocellular carcinoma, in their livers.

A switch from a high-fat to a low-fat diet reversed these outcomes in groups of C57BL/6J mice that were fed a high-fat diet early in the experiment.

The switched mice were lean rather than obese and had healthy livers at the end of the study.

Hepatitis C: From A to Z

2009-06-01T08:29:00.000-07:00

Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer.

The hepatitis C virus (HCV) is spread by blood-to-blood contact. Most people have few symptoms after the initial infection, yet the virus persists in the liver in about 80% of those infected. Persistent infection can be treated with medication, such as interferon and ribavirin, and currently over half are cured overall. Those who develop cirrhosis or liver cancer may require a liver transplant, although the virus generally recurs after transplantation.

An estimated 150-200 million people worldwide are infected with hepatitis C. Apart from humans, it only infects chimpanzees. No vaccine against hepatitis C is available. The existence of hepatitis C (originally "non-A non-B hepatitis") was postulated in the 1970s and proved conclusively in 1989. It is one of five known hepatitis viruses: A, B, C, D, and E

Signs and symptoms:

Acute:
Acute hepatitis C refers to the first 6 months after infection with HCV. Between 60% to 70% of people infected develop no symptoms during the acute phase. In the minority of patients who experience acute phase symptoms, they are generally mild and nonspecific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms.

The hepatitis C virus is usually detectable in the blood within one to three weeks after infection by PCR, and antibodies to the virus are generally detectable within 3 to 15 weeks. Approximately 15-40% of persons infected with HCV clear the virus from their bodies during the acute phase as shown by normalization in liver function tests (LFTs) such as alanine transaminase (ALT) & aspartate transaminase (AST) normalization, as well as plasma HCV-RNA clearance (this is known as spontaneous viral clearance). The remaining 60-85% of patients infected with HCV develop chronic hepatitis C, i.e., infection lasting more than 6 months.

Previous practice was to not treat acute infections to see if the person would spontaneously clear; recent studies have shown that treatment during the acute phase of genotype 1 infections has a greater than 90% success rate with half the treatment time required for chronic infections.

Virology:

Hepatitis C infection in the US by source. (CDC,n.d.[dead link])Main article: Hepatitis C virus:
The Hepatitis C virus (HCV) is a small (50 nm in size), enveloped, single-stranded, positive sense RNA virus. It is the only known member of the hepacivirus genus in the family Flaviviridae. There are six major genotypes of the hepatitis C virus, which are indicated numerically (e.g., genotype 1, genotype 2, etc.).

The hepatitis C virus (HCV) is transmitted by blood-to-blood contact. In developed countries, it is estimated that 90% of persons with chronic HCV infection were infected through transfusion of unscreened blood or blood products or via injecting drug use or, by inhalational drug use. In developing countries, the primary sources of HCV infection are unsterilized injection equipment and infusion of inadequately screened blood and blood products. There has not been a documented transfusion-related case of hepatitis C in the United States for over a decade as the blood supply is vigorously screened with both EIA and PCR technologies.

Although injection drug use and inhalational drugs are the most common routes of HCV infection, any practice, activity, or situation that involves blood-to-blood exposure can potentially be a source of HCV infection. The virus may be sexually transmitted, although this is rare, and usually only occurs when an STD (like HIV) is also present and makes blood contact more likely.

Injection drug use:
Those who currently use or have used drug injection as their delivery route for illicit drugs are at increased risk for getting hepatitis C because they may be sharing needles or other drug paraphernalia (includes cookers, cotton, spoons, water, etc.), which may be contaminated with HCV-infected blood. An estimated 60% to 80% of intravenous recreational drug users in the United States have been infected with HCV. Harm reduction strategies are encouraged in many countries to reduce the spread of hepatitis C, through education, provision of clean needles and syringes, and safer injecting techniques. For reasons that are not clear transmission by this route currently appears to be declining in the US.

Sexual exposure:
Sexual transmission of HCV is considered to be rare. Studies show the risk of sexual transmission in heterosexual, monogamous relationships is extremely rare or even null. The CDC does not recommend the use of condoms between long-term monogamous discordant couples (where one partner is positive and the other is negative).[16] However, because of the high prevalence of hepatitis C, this small risk may translate into a non-trivial number of cases transmitted by sexual routes. Vaginal penetrative sex is believed to have a lower risk of transmission than sexual practices that involve higher levels of trauma to anogenital mucosa (anal penetrative sex, fisting, use of sex toys).

Vertical transmission:
Vertical transmission refers to the transmission of a communicable disease from an infected mother to her child during the birth process. Mother-to-child transmission of hepatitis C has been well described, but occurs relatively infrequently. Transmission occurs only among women who are HCV RNA positive at the time of delivery; the risk of transmission in this setting is approximately 6 out of 100. Among women who are both HCV and HIV positive at the time of delivery, the risk of transmitting HCV is increased to approximately 25 out of 100.

The risk of vertical transmission of HCV does not appear to be associated with method of delivery or breastfeeding.

Treatment:
There is a very small chance of clearing the virus spontaneously in chronic HCV carriers (0.5 to 0.74% per year), however, the majority of patients with chronic hepatitis C will not clear it without treatment.

Current treatment is a combination of pegylated interferon alpha (brand names Pegasys and PEG-Intron) and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on genotype. Indications for treatment include patients with proven hepatitis C virus infection and persistent abnormal liver function tests. Sustained cure rates (sustained viral response) of 75% or better occur in people with genotypes HCV 2 and 3 in 24 weeks of treatment, about 50% in those with genotype 1 with 48 weeks of treatment and 65% for those with genotype 4 in 48 weeks of treatment. About 80% of hepatitis C patients in the United States have genotype 1. Genotype 4 is more common in the Middle East and Africa. Should treatment with pegylated ribivirin-interferon not return a 2-log viral reduction or complete clearance of RNA (termed early virological response) after 12 weeks for genotype 1, the chance of treatment success is less than 1%. Early virological response is typically not tested for in non-genotype 1 patients, as the chances of attaining it are greater than 90%. The mechanism of action is not entirely clear, because even patients who appear to have had a sustained virological response still have actively replicating virus in their liver and peripheral blood mononuclear cells.

The evidence for treatment in genotype 6 disease is currently sparse, and the evidence that exists is for 48 weeks of treatment at the same doses as are used for genotype 1 disease.[24] Physicians considering shorter durations of treatment (e.g., 24 weeks) should do so within the context of a clinical trial.

Treatment during the acute infection phase has much higher success rates (greater than 90%) with a shorter duration of treatment; however, this must be balanced against the 15-40% chance of spontaneous clearance without treatment (see Acute Hepatitis C section above).

Those with low initial viral loads respond much better to treatment than those with higher viral loads (greater than 400,000 IU/mL). Current combination therapy is usually supervised by physicians in the fields of gastroenterology, hepatology or infectious disease.

The treatment may be physically demanding, particularly for those with a prior history of drug or alcohol abuse. It can qualify for temporary disability in some cases. A substantial proportion of patients will experience a panoply of side effects ranging from a 'flu-like' syndrome (the most common, experienced for a few days after the weekly injection of interferon) to severe adverse events including anemia, cardiovascular events and psychiatric problems such as suicide or suicidal ideation. The latter are exacerbated by the general physiological stress experienced by the patient.

Current guidelines strongly recommend that hepatitis C patients be vaccinated for hepatitis A and B if they have not yet been exposed to these viruses, as infection with a second virus could worsen their liver disease.

Alcoholic beverage consumption accelerates HCV associated fibrosis and cirrhosis, and makes liver cancer more likely; insulin resistance and metabolic syndrome may similarly worsen the hepatic prognosis. There is also evidence that smoking increases the fibrosis (scarring) rate.

During pregnancy and breastfeeding:
If a woman who is pregnant has risk factors for hepatitis C, she should be tested for antibodies against HCV. About 4% infants born to HCV infected women become infected. There is no treatment that can prevent this from happening. There is a high chance of the baby ridding the HCV in the first 12 months.

In a mother that also has HIV, the rate of transmission can be as high as 19%. There are currently no data to determine whether antiviral therapy reduces perinatal transmission. Ribavirin and interferons are contraindicated during pregnancy. However, avoiding fetal scalp monitoring and prolonged labor after rupture of membranes may reduce the risk of transmission to the infant.

HCV antibodies from the mother may persist in infants until 15 months of age. If an early diagnosis is desired, testing for HCV RNA can be performed between the ages of 2 and 6 months, with a repeat test done independent of the first test result. If a later diagnosis is preferred, an anti-HCV test can performed after 15 months of age. Most infants infected with HCV at the time of birth have no symptoms and do well during childhood. There is no evidence that breast-feeding spreads HCV. To be cautious, an infected mother should avoid breastfeeding if her nipples are cracked and bleeding.

Prevention:
The following guidelines will prevent infection with the hepatitis C virus, which is spread by blood:

.Avoid sharing drug needles or any other drug paraphernalia including works for injection or bills or straws
.Avoid unsanitary tattoo methods
.Avoid unsanitary body piercing methods
.Avoid unsanitary acupuncture
.Avoid needlestick injury
.Avoid sharing personal items such as toothbrushes, razors, and nail clippers.
.Use latex condoms correctly and every time you have sex if not in a long-term monogamous relationship.
Proponents of harm reduction believe that strategies such as the provision of new needles and syringes, and education about safer drug injection procedures, greatly decreases the risk of hepatitis C spreading between injecting drug users.

No vaccine protects against contracting hepatitis C, or helps to treat it. Vaccines are under development and some have shown encouraging results.

Pollution increases risk of liver disease:
Environmental pollution is likely to increase the risk of liver disease among the adult population, something which was unknown earlier, says a new study.

This work builds upon the groups' previous research demonstrating liver disease in highly-exposed chemical workers.

'Our study found that greater than one in three US adults had liver disease, even after excluding those with traditional risk factors such as alcoholism and viral hepatitis,' said Matthew Cave, a professor at the University of Louisville (UL).

'Our study shows that some of these cases may be attributable to environmental pollution, even after adjusting for obesity, which is another major risk factor for liver disease,' he said.

Using the 2003-2004 National Health and Nutrition Examination Survey (NHANES), UL researchers examined chronic low-level exposure to 111 common pollutants including lead, mercury and pesticides and their association with otherwise unexplained liver disease in adults.

The specific pollutants included were detectable in 60 percent or more of the 4,500 study subjects, said a UL release.

Cave will present these data in Chicago at the Digestive Disease Week 2009 (DDW), the largest international gathering of physicians and researchers in gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

SIX Natural Cures for Cancer

2009-05-31T09:02:00.000-07:00

There's a lot of misconception about cancer. We have been told by the so called 'experts' who work in accordance with the big pharmaceutical businesses that there is NO known way to cure or even pr...
There's a lot of misconception about cancer. We have been told by the so called 'experts' who work in accordance with the big pharmaceutical businesses that there is NO known way to cure or even prevent it, and instead they advise us to take their chemo & radio treatments for it which, quite clearly, either cause more damage than there actually is or have no effect on the cancer at all!

However, there are people out there (Rick Simpson, Jim Humble, just to name a few) who have discovered natural, safe and more effective substances to combat cancer. Hundreds, if not thousands of people worldwide have used these substances and claimed to have successfully cured themselves of various forms of cancer, including terminal, and others claim to have cured themselves of other illnesses like arthritis, migraines, MS, anxiety, depression and even AIDS & malaria by using them. But the mainstream media will not promulgate any of this, and the big pharmaceutical companies will not endorse them. Why? Maybe it's because they're not as profitable as their own made drugs!

The big pharmaceutical industry invests so much money by manufacturing and selling their medication drugs and by deluding the public into thinking that there is no other alternative medicine. If the people found out about these substances, the whole of this monopoly may well just fall apart.

Also, science has proven time and time again that the cause of cancer is due to under nutrition, especially due to a lack of nutrients like vitamins C & B17, and due to an acidic body. This is because the nutrients & enzymes we consume, from say a diet consisting of raw foods like fruits & vegetables, neutralize unhealthy acidic cells in the body, like cancer cells, and protect the body against the cancer causing agents that we pick up in our everyday lives from cigarette smoke, mobile phones, food & drink additives, and pollution in general. If our bodies became nutrient deficient, these carcinogens will accumulate inside of us, destroy tissues and eventually form cancers. This is why cancer is so common in todays world, as most people's diets consist of nutrient depleted, processed foods. So the obvious way to prevent or possibly cure cancer is... simply by having a healthy diet! Drink clean water, eat more raw fruits & vegetables that make your body alkaline, unlike meat and dairy that makes it acid and cancerous!

If we all started eating more healthily by growing our own food instead of buying the carcinogen loaded, genetically altered crap from the supermarkets, and used, say stone-fruit seeds, MMS, cannabis & mangosteens as alternative medicines, this planet could almost be disease free. Who needs pharmaceuticals when the solution was already here?

Immune therapies finally working against cancer:

Researchers are reporting their first big successes in getting the immune system to fight cancer, after 30 years of false starts.

The method is called a cancer vaccine, although it's used to treat cancer rather than prevent it.

Doctors say one of those vaccines, which is made by Biovest International Inc., can keep a common form of lymphoma from getting worse for more than a year compared to standard treatments. It's the fourth time in about a month doctors have had success with such vaccines.

The Nitrogen Cycle

2009-05-30T08:25:00.000-07:00

(s). The Nitrogen Cycle

The nitrogen cycle represents one of the most important nutrient cycles found in terrestrial ecosystems (Figure 9s-1). Nitrogen is used by living organisms to produce a number of complex organic molecules like amino acids, proteins, and nucleic acids. The store of nitrogen found in the atmosphere, where it exists as a gas (mainly N2), plays an important role for life. This store is about one million times larger than the total nitrogen contained in living organisms. Other major stores of nitrogen include organic matter in soil and the oceans. Despite its abundance in the atmosphere, nitrogen is often the most limiting nutrient for plant growth. This problem occurs because most plants can only take up nitrogen in two solid forms: ammonium ion (NH4+ ) and the ion nitrate (NO3- ). Most plants obtain the nitrogen they need as inorganic nitrate from the soil solution. Ammonium is used less by plants for uptake because in large concentrations it is extremely toxic. Animals receive the required nitrogen they need for metabolism, growth, and reproduction by the consumption of living or dead organic matter containing molecules composed partially of nitrogen.

In most ecosystems nitrogen is primarily stored in living and dead organic matter. This organic nitrogen is converted into inorganic forms when it re-enters the biogeochemical cycle via decomposition. Decomposers, found in the upper soil layer, chemically modify the nitrogen found in organic matter from ammonia (NH3 ) to ammonium salts (NH4+ ). This process is known as mineralization and it is carried out by a variety of bacteria, actinomycetes, and fungi.

Nitrogen in the form of ammonium can be absorbed onto the surfaces of clay particles in the soil. The ion of ammonium has a positive molecular charge is normally held by soil colloids. This process is sometimes called micelle fixation Ammonium is released from the colloids by way of cation exchange. When released, most of the ammonium is often chemically altered by a specific type of autotrophic bacteria (bacteria that belong to the genus Nitrosomonas) into nitrite (NO2- ). Further modification by another type of bacteria (belonging to the genus Nitrobacter) converts the nitrite to nitrate (NO3- ). Both of these processes involve chemical oxidation and are known as nitrification. However, nitrate is very soluble and it is easily lost from the soil system by leaching. Some of this leached nitrate flows through the hydrologic system until it reaches the oceans where it can be returned to the atmosphere by denitrification. Denitrification is also common in anaerobic soils and is carried out by heterotrophic bacteria. The process of denitrification involves the metabolic reduction of nitrate (NO3- ) into nitrogen (N2) or nitrous oxide (N2O) gas. Both of these gases then diffuse into the atmosphere.

Almost all of the nitrogen found in any terrestrial ecosystem originally came from the atmosphere. Significant amounts enter the soil in rainfall or through the effects of lightning. The majority, however, is biochemically fixed within the soil by specialized micro-organisms like bacteria, actinomycetes, and cyanobacteria. Members of the bean family (legumes) and some other kinds of plants form mutualistic symbiotic relationships with nitrogen fixing bacteria. In exchange for some nitrogen, the bacteria receive from the plants carbohydrates and special structures (nodules) in roots where they can exist in a moist environment. Scientists estimate that biological fixation globally adds approximately 140 million metric tons of nitrogen to ecosystems every year.

The activities of humans have severely altered the nitrogen cycle. Some of the major processes involved in this alteration include:

The application of nitrogen fertilizers to crops has caused increased rates of denitrification and leaching of nitrate into groundwater. The additional nitrogen entering the groundwater system eventually flows into streams, rivers, lakes, and estuaries. In these systems, the added nitrogen can lead to eutrophication.
Increased deposition of nitrogen from atmospheric sources because of fossil fuel combustion and forest burning. Both of these processes release a variety of solid forms of nitrogen through combustion.
Livestock ranching. Livestock release a large amounts of ammonia into the environment from their wastes. This nitrogen enters the soil system and then the hydrologic system through leaching, groundwater flow, and runoff.
Sewage waste and septic tank leaching.

Rutherford's Experiment: Nuclear Atom

2009-05-30T07:37:00.000-07:00

Rutherford's Nuclear Atom Experiment:
In 1910, Rutherford and his coworkers were studying the angles at which alpha particles were scattered as they passed through a thin gold foil. Most particles passed through undeflected, though a few were found to be scattered at large, some even in the direction they had come. This meant they had collided with an object much more massive than the particle itself, but so small that only a few aplha particles encountered them. Showing that the atom was composed of a small dense massive center surrounded by low mass electrons.

Rutherford’s experiment:

Now you can present a more advanced exposition of the experiment. Why did Rutherford ask for the experiment to be done? Experiments on the absorption of b particles had also shown that sometimes the b particles were ‘back scattered’. Rutherford suggested that Geiger and Marsden should try looking for similar behaviour with a particles. Rutherford thought it was highly unlikely; because a particles are relatively massive compared with electrons, it was predicted that the as would simply suffer a series of small deflections. They were expected to travel more or less straight through the absorber.However, Rutherford’s main concern was to give Geiger & Marsden something to do that would occupy them and get them some useful hands-on experience, rather than expecting them to get any very exciting results.

Show a diagram of the apparatus. The absorber was a thin gold metal foil. Why use gold? (Thin gold foils, typically 250 atoms thick, were easy to make and readily available.) Why thin? (as are easily absorbed.)

As expected, virtually all the as went straight through, but about 1:8000 were turned through large angles (reflected or back-scattered). An 8 kBq a source gives one large-angle scattering per second.

The chance of a series of small deflections resulting in a reflection is far too small to account for what was observed.

Rutherford was astonished at the result: “It was quite the most incredible event that ever happened to me in my life. It was as incredible as if you fired a 15-inch shell at a piece of tissue paper and it came back and hit you!” (You may find other versions of this quote, because Rutherford described his experience on many different occasions.)

Demonstration:

Collisions and momentum:

Use colliding balls to show what happens to a projectile particle hitting a target particle; as the target ball mass gets bigger, the follow through by the projectile gets less. Use a selection of ball bearings, marbles etc on some curtain track, or trolleys loaded with different weights. When the target mass is small relative to the projectile mass, the missile follows through. For equal masses the projectile stops and the target sets off with the speed of the projectile. If the target mass is large, the projectile rebounds. (If your students have already studied momentum, they should be able to predict the outcome of each of these demonstrations.)

The back scattering of as through large angles implies (i) all the positive charge is concentrated together, and (ii) the mass of the concentrated positive charge must be quite a bit larger than of an a particle.

Rutherford scattering and Coulomb’s Law:

Rutherford assumed that (i) Coulomb’s Law was obeyed down to very small distances, and that (ii) most of the mass of the nucleus was concentrated into a very small volume – the nuclear atom that resembles a miniature solar system. (Because the analysis works, we can take this as ‘proof’’ that Coulomb’s Law is valid down to distances about the size of a nucleus.)

Show a diagram to explain how the terms impact parameter p and scattering angle f are defined. Ask: how would you expect the number of as scattered through angle f to depend upon (i) the impact parameter p, (ii) the charge on the target nucleus Z, and (iii) the kinetic energy of the a particles? (As p increases f decreases (force weaker); as Z increases f increases (greater repulsive force); as energy increases, f decreases (less ‘interaction’ time).)

DENTAL FILLING SURGERY CURES TEETH CAVITIES.

2009-05-25T08:02:00.000-07:00

Dental Fillings:

Dental fillings are used to fill cavities in teeth which have decayed or to treat cracked or broken teeth. They are the most common dental work that a dentist will perform and typically consist of a white composite resin or silver-colored amalgam.

Dental fillings will generally be needed when one experiences tooth ache where excessive consumption of sugary foods and/or poor oral hygiene has resulted in the decaying of the associated tooth. The dentist will remove the bad part of the tooth and then fill the void with the amalgam. An anesthetic (injection) is usually administered as the area will likely be sensitive once the dentist starts the cleanout.

Procedure information:

The dentist will start by numbing the area around the tooth with a local anesthetic. A drill and abrasion instrument is then typically used to remove the decayed material – lasers are also used by some dentists depending on the amount to be removed as well as the competence of the dentist and how much they have invested in their surgery. The dentist will then probe and pick at the cavity to remove the last of the decay, after which he/she will proceed to polish and protect the root and nerves before applying the filling.

The tooth-colored material is then applied in layers to the cavity and an ultraviolet light is used to cure each layer. After the successive layers have been completed and hardened, the dentist will then finish off with shaping and polishing.

Recovery time:

There is no real recovery time after having dental fillings, apart from waiting for the pain to subside, and not biting down too hard on the treated area for at least 24 hours to allow the composite to fully cure.

Fillings need to be maintained like normal teeth by brushing twice daily for at least two minutes at a time using fluoride-containing toothpaste. One should also floss at least once a day.

stronger dental filling material with ingredients from human body:

Washington, May 25 (ANI): Scientists in Canada and China have come up with a new dental filling material that contains natural ingredients from the human body.

Julian X.X. Zhu and colleagues said that the new material is stronger, long lasting and has the potential for reducing painful filling cracks and emergency visits to the dentist.

They pointed out that dentists are increasingly using white fillings made from plastic, rather than 'silver' dental fillings.

Those traditional fillings contain mercury, which has raised health concerns among some consumers and environmental issues in its production.

However, many plastic fillings contain controversial ingredients (such as BisGMA) linked to premature cracking of fillings and slowly release bisphenol A, a substance considered as potentially toxic to humans and to the environment.

Now, scientists have developed a dental composite that does not contain these ingredients.

Instead, it uses 'bile acids,' natural substances produced by the liver and stored in the gallbladder that help digest fats.

The researchers showed in laboratory studies that the bile acid-derived resins form a hard, durable plastic that resists cracking better than existing composites.

Bacteria cause most dental problems

2009-05-25T07:12:00.000-07:00

Bacteria Are True Cause of Most Common Dental Health Problems:

Do you remember when it seemed like all common dental health problems seemed somehow linked to candy or sugar in one way or another? Pediatric dental health professionals continue to advise the use of sugarless gums and similar products as a way of preventing tooth decay in our youth. Halloween has seemingly become a night of dread for some parents because of this relentless assault against sugar. However, dental health and oral hygiene crusades against sugar is only a small part of the story because it is bacteria-not sugar-that you really need to worry about when it comes to preventing tooth decay.

Indeed, it is bacteria that can ruin adult and kids dental health. Everything from cavities to severe periodontal disease is ultimately caused by these harmful microorganisms. Unfortunately, there is no way to actually cure any of these oral health concerns because these bacteria are always present in your mouth. Therefore, dental health and oral hygiene should be concentrated upon fighting these bacteria rather than sugar.

The crevices in our teeth are where these harmful bacteria tend to settle. By themselves, there is little these bacteria can do to cause cavities. But, when food particles also settle in these crevices, the bacteria populations grow as they feed on them. And yes, bacteria love sugar because they are ready sources of high energy but they will feed on any organic particles in your mouth.

When feeding, the bacteria produce an acid by-product that will damage and ultimately destroy the very enamel that is supposed to protect your teeth. Once this layer of enamel has been breeched, no amount of dental health products can stop the formation of a cavity. However, practicing good oral hygiene will help control the bacteria population and thus slow the development of a cavity.

So, what can be done about these harmful bacteria that cause tooth decay? Well, dental health products made with fluoride and some form of anti-bacterial agent are recommended. However, be careful of mouth washes or other products made with alcohol or other chemicals as they may lead to dehydration and actually increase the bacteria population. Anything that lowers the level of saliva in your mouth is actually hurting your oral health-not helping!

Saliva can help control the bacteria population because it is loaded with enzymes that help with the production of antibodies that neutralize the harmful microbes. Thus, adult and kids dental health is ultimately compromised by behaviors that cause dehydration and lower the level of saliva in your mouth. Some common sources of dehydration include:

.Drinking alcohol or any caffeinated beverage
.Using laxatives
.Taking dietary supplements
.Smoking

Therefore, it is bacteria and not sugar that is the true source of cavities and other oral health problems like advanced periodontal disease. And it is saliva, complemented with alcohol-free dental health products, that will help you best prevent those common dental health problems that can cause us all so much grief!

Treatment:

Dental restoration and Tooth extraction:

Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level.[1] For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth.

Generally, early treatment is less painful and less expensive than treatment of extensive decay. Anesthetics — local, nitrous oxide ("laughing gas"), or other prescription medications — may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatmen. A dental handpiece ("drill") is used to remove large portions of decayed material from a tooth. A spoon is a dental instrument used to remove decay carefully and is sometimes employed when the decay in dentin reaches near the pulp. Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to functionality and aesthetic condition.

Restorative materials include dental amalgam, composite resin, porcelain, and gold. Composite resin and porcelain can be made to match the color of a patient's natural teeth and are thus used more frequently when aesthetics are a concern. Composite restorations are not as strong as dental amalgam and gold; some dentists consider the latter as the only advisable restoration for posterior areas where chewing forces are great. When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.

In certain cases, root canal therapy may be necessary for the restoration of a tooth. Root canal therapy, also called "endodontic therapy", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha. The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue.

An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth. Extractions may also be preferred by patients unable or unwilling to undergo the expense or difficulties in restoring the tooth.

Other preventive measures:
The use of dental sealants is a means of prevention. A sealant is a thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents food being trapped inside pits and fissures in grooves under chewing pressure ao resident plaque bacteria are deprived of carbohydrate that they change to acid demineralisation and thus prevents the formation of pit and fissure caries, the most common form of dental caries. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants, but their dental history and likelihood of caries formation are usually taken into consideration.

Fluoride therapy is often recommended to protect against dental caries. It has been demonstrated that water fluoridation and fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel. The incorporated fluoride makes enamel more resistant to demineralization and, thus, resistant to decay. Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions as part of routine visits

Virtual heart pumps up the realism

2009-05-23T06:57:00.000-07:00

This super-realistic computer model makes it possible to explore the heart's anatomy in ways not possible in real patients.

Created by a team of doctors from the Heart Hospital in London and computer animators from post-production company Glassworks, the beating heart can be manipulated via a computer mouse or keyboard (see video).

The viewer can rotate the virtual organ around any axis and view it from both inside and outside. The heart can also be set to beat normally, or mirror the effects of various conditions and diseases.

SWINE FLU H1N1

2009-05-18T08:05:00.000-07:00

What is swine flu?
Like people, pigs can get influenza (flu), but swine flu viruses aren't the same as human flu viruses. Swine flu doesn't often infect people, and the rare human cases that have occurred in the past have mainly affected people who had direct contact with pigs. But the current swine flu outbreak is different. It's caused by a new swine flu virus that has changed in ways that allow it to spread from person to person -- and it's happening among people who haven't had any contact with pigs.

What are swine flu symptoms?
Symptoms of swine flu are like regular flu symptoms and include fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. Many people with swine flu have had diarrhea and vomiting. Nearly everyone with flu has at least two of these symptoms. But these symptoms can also be caused by many other conditions. That means that you and your doctor can't know, just based on your symptoms, if you've got swine flu. It takes a lab test to tell whether it's swine flu or some other condition.

Who is at highest risk from H1N1 swine flu?
Most U.S. cases of H1N1 swine flu have been in older children and young adults. It's not clear why, and it's not clear whether this will change.

But certain groups are at particularly high risk of severe disease or bad outcomes if they get the flu:

Pregnant women
.Young children, especially those under 12 months of age
.People with heart disease or risk factors for heart disease
.People with HIV infection
.People with chronic diseases
.People taking immune suppressing drugs, such as cancer chemotherapy or anti-rejection drugs for transplants
People in these groups should seek medical care as soon as they get flu symptoms.

If I think I have swine flu, what should I do? When should I see my doctor?
If you have flu symptoms, stay home, and when you cough or sneeze, cover your mouth and nose with a tissue. Afterward, throw the tissue in the trash and wash your hands. That will help prevent your flu from spreading.

If you've got flu symptoms, and you live in or recently visited an area where H1N1 swine flu cases have been identified, CDC officials recommend that you see your doctor. If you have flu symptoms but you haven't been in a high-risk area, you can still see a doctor -- that's your call.

Keep in mind that your doctor will not be able to determine whether you have swine flu, but he or she may take a sample from you and send it to a state health department lab for testing to see if it's swine flu. If your doctor suspects swine flu, he or she would be able to write you a prescription for Tamiflu or Relenza. Those drugs aren't a question of life or death for the vast majority of people. Most U.S. swine flu patients have made a full recovery without antiviral drugs.

But there are emergency warning signs.

Children should be given urgent medical attention if they:

• Have fast breathing or trouble breathing

• Have bluish or gray skin color

• Are not drinking enough fluids

• Are not waking up or not interacting

• Are so irritable that the child does not want to be held

• Have flu-like symptoms that improve but then return with fever and a worse cough

• Have fever with a rash

Adults should seek urgent medical attention if they have:

• Difficulty breathing or shortness of breath

• Pain or pressure in the chest or abdomen

• Sudden dizziness

• Confusion

• Severe or persistent vomiting

How does swine flu spread? Is it airborne?
The new swine flu virus apparently spreads just like regular flu. You could pick up germs directly from an infected person, or by touching an object they recently touched, and then touching your eyes, mouth, or nose, delivering their germs for your own infection. That's why you should make washing your hands a habit, even when you're not ill. Infected people can start spreading flu germs up to a day before symptoms start, and for up to seven days after getting sick, according to the CDC.

The swine flu virus can become airborne if you cough or sneeze without covering your nose and mouth, sending germs into the air.

The U.S. residents infected with swine flu virus had no direct contact with pigs. The CDC says it's likely that the infections represent widely separated cycles of human-to-human infections.

How is swine flu treated?
The new swine flu virus is sensitive to the antiviral drugs Tamiflu and Relenza. The CDC recommends those drugs to prevent or treat swine flu; the drugs are most effective when taken within 48 hours of the start of flu symptoms. But not everyone needs those drugs; many of the first people in the U.S. with lab-confirmed swine flu recovered without treatment. The Department of Homeland Security has released 25% of its stockpile of Tamiflu and Relenza to states. Health officials have asked people not to hoard Tamiflu or Relenza

Swine Flu Special Report

2009-04-30T06:21:00.000-07:00

Mexico's health secretary may have thought he was allaying fears about swine flu when he suggested that the nation's swine flu death rate was 6 or 7 percent. In reality, that would mean a monstrous killer virus — and no experts are close to saying that. The secretary's comment reflects how much remains unknown about the new flu virus — most notably how lethal it is and why it seems so much deadlier in Mexico than anywhere else.

American health officials believe they are getting closer to answering those questions, or, at least, to ruling out wrong-headed theories.

"We've begun to knock off hypotheses," said Dr. Scott F. Dowell, director of global disease detection with the U.S. Centers for Disease Control and Prevention.

Among the factors disease detectives have discounted are Mexico's air pollution, secondary infections and poor health care. But they still do not know why so many Mexicans have died, although it could be because many more people actually have had the virus than health officials realize.

In Mexico, the virus is suspected of killing more than 150 people and sickening more than 2,400. Recent information suggests swine flu-related hospital admissions and deaths may have peaked and are declining, but no other country has shown any numbers close to those seen in Mexico.

The only other country to report a swine flu death is the United States, and that involved a toddler from Mexico who was visiting Texas with his family.

The leading theory remains that the virus itself is not significantly different in Mexico, but that the outbreak has for some reason just hit harder there, infecting more people overall. The more people who are infected, the more likely there will be severe cases and even deaths.

When the Mexican health secretary spoke this week about a 6 or 7 percent death rate, his figures were based on the number of deaths divided by the number of suspected infections. But authorities cannot be certain how many people have been infected, especially those who suffered only mild symptoms.

Mexican authorities have not tried to count mild cases, focusing instead on the severely ill and the dead. So the death rate may be much lower than 6 or 7 percent — and probably is, according to some experts.

A 6 to 7 percent death rate would make the Mexican swine flu nearly three times deadlier than the worst flu pandemic in the last 100 years — the 1918 Spanish flu, which killed an estimated 20 million to 50 million people worldwide.

That seems unbelievably high for this new virus, said Richard Webby, a flu researcher at St. Jude Children's Research Hospital in Memphis.

Webby and others do not believe the swine flu in Mexico is different from what's been seen in U.S. patients. The virus samples in both countries match.

The CDC sent four epidemiologists and one lab scientist to Mexico over the weekend to investigate the disease there, and the agency expects to send a half-dozen more people this week, said Dowell, of the CDC.

Among the hypotheses being ruled out as explanations for Mexico's higher death rate:
A second infection complicating the flu cases. A common danger in flu is that the patient is co-infected with pneumonia or other bacteria, which can lead to death. But lab tests of 33 Mexican patients, including seven who died, did not find that problem.

Low-quality health care. CDC investigators have not seen any obvious problem. They have found capable doctors and well-equipped, high-quality hospitals, Dowell said.

A medicine is compounding the problem. Investigators have looked into whether patients who got sick had taken some over-the-counter medicine or folk remedy that actually made things worse.

Such a problem has sometimes occurs in children recovering from flu who are given aspirin — a severe illness called Reye's syndrome, which causes vomiting, lethargy and even seizures. But there's no evidence of something like that in Mexico, Dowell said.

Altitude or air pollution: Mexico City's altitude and its infamous air pollution have raised speculation that those factors may have made people more susceptible to the virus. But severe cases are being reported over much of Mexico, including coastal communities and places with cleaner air, making that theory unlikely.

The CDC has also been investigating when the swine flu first hit Mexico.

Some have wondered whether it's possible people have been getting sick with the virus for months, but the illness went undetected because special swine flu tests were not used to diagnose patients.

But CDC officials say no, the flu probably did not hit Mexico until March at the earliest. An analysis of hundreds of samples from Mexico that were collected from January to March never turned up the swine flu virus, Dowell said.

There's also the question of where it started — a standard inquiry of public health investigations since at least the mid-19th century.

One of the heroes of public health history is John Snow, a London physician who helped end an 1854 cholera outbreak by determining that cases were clustered around a water pump and that the disease was spread through water. The pump handle was removed, and the cholera deaths subsided.

But flu is different because it's spread by human-to-human contact. Scientists know it's more difficult to pin down the origin of a novel strain of influenza to a specific country, let alone a village or pig farm.

Knowledge of the origin is also less useful than in a cholera outbreak.

"Flu, unlike cholera, spreads around the world in a matter of weeks. You can't remove the pump handle" to stop the epidemic, said Dr. Andrew Pavia, a University of Utah pediatrics professor who leads the Infectious Diseases Society of America's pandemic flu task force.

A current theory is that the outbreak started in the town of La Gloria on the eastern coast of Mexico, because a 5-year-old boy was the first known case. He first suffered flu-like symptoms in late March. However, Mexican health officials have downplayed claims the outbreak started in La Gloria, because mucous samples of other patients from there found nothing.

Dowell said the place of origin is a secondary concern at the moment.

"That probably will be useful in the long term. But for the present, our team in the field is focused on things that will make the most difference for mitigation" of the outbreak,

Five Health Tips to Avoid Swine Flu:
The U.S. government declared "swine flu" a public health emergency so that people are more aware and prepared to take action steps to keep themselves and their families healthy and safe.

Any flu virus is particularly life-threatening to the very young, elderly and those battling disease, infection, etc. Ninety-one people in the U.S. have been sickened by the swine influenza and there's been one death so far, according to the Centers for Disease Control and Prevention (CDC), so it's important that we keep it in check.

Take time to review the CDC's five, flu-safety tips, which will help you avoid swine flu (or any flu). They'll also help to ensure that the virus doesn't spread needlessly.

Tip #1: Stay home if you're sick.
Tip #2: Avoid close contact with people who are sick.
Tip #3: Wash your hands often and avoid touching your eyes, nose and mouth.
Tip #4: Cover your mouth or nose with a tissue when coughing or sneezing.
Tip #5: Keep up with health information in your own community.

Do these tips sound familiar? Flu-safety basics are the exact same whether you get the human flu or the swine flu. The swine flu is a respiratory disease of pigs caused by type A influenza viruses that cause regular outbreaks in pigs. People don’t usually get swine flu but infections can and do occur.

This virus spreads the exact same way that regular flu viruses spread -- person-to-person transmission through coughing, sneezing and touching of infected people or surfaces: door knobs, shopping carts, countertops, etc. So, it’s also a good idea to carry your alcohol-based, disinfecting wipes, sprays and gels with you, as well.

There is some good news: First, there are antiviral medicines to prevent and treat swine flu. They may also prevent serious flu complications. Second, swine influenza viruses are not spread by food. So, you don’t need to throw away or stop eating your pork or pork products. Eating properly handled and cooked pork products is still safe.

Now, if you live in areas where swine influenza have been identified (California, Kansas, New York City, Ohio or Texas), contact a health care provider, particularly if you are worried about your symptoms. The influenza-like symptoms include: fever, body aches, runny nose, sore throat, nausea, vomiting or diarrhea.Your health care provider will determine whether influenza testing or treatment is needed.

By practicing these flu-safety basics, you’ll lower your chances of getting a host of illnesses, including the swine flu.

Signs and symptoms:

Main symptoms of swine flu in humans.
See also:The Centers for Disease Control and Prevention (CDC): Symptoms of Swine Flu in YouTubeAccording to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of swine flu are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. The 2009 outbreak has shown an increased percentage of patients reporting diarrhea and vomiting.

Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms but also a high likelihood of swine flu due to the person's recent history. For example, during the 2009 swine flu outbreak in the United States, CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset. A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).

Schizophrenia

2009-04-24T06:51:00.000-07:00

Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disease of the brain (central nervous system) that often impairs motor skills, speech, and other functions.

Parkinson's disease belongs to a group of conditions called movement disorders. It is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia). The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. Secondary symptoms may include high level cognitive dysfunction and subtle language problems.

Signs and symptoms:
Parkinson disease affects movement (motor symptoms). Other typical symptoms include disorders of mood, behavior, thinking, and sensation (non-motor symptoms). Patients' individual symptoms may be quite dissimilar and progression of the disease is also distinctly individual.

Motor symptoms :
The cardinal symptoms are (mnemonic "TRAP"):

Tremor: normally 4–6 Hz tremor, maximal when the limb is at rest, and decreased with voluntary movement. It is typically unilateral at onset. This is the most apparent and well-known symptom, though an estimated 30% of patients have little perceptible tremor; these are classified as akinetic-rigid.
Rigidity: stiffness; increased muscle tone. In combination with a resting tremor, this produces a ratchety, "cogwheel" rigidity when the limb is passively moved.
Akinesia/bradykinesia: absence of movement and slowness, respectively. Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude.
Postural instability: failure of postural reflexes, which leads to impaired balance and falls.
Other motor symptoms include:

Gait and posture disturbances:
Shuffling: gait is characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to cause the patient to trip.
Decreased arm-swing.
Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
Stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk (camptocormia).
Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
Gait freezing: "freezing" is a manifestation of akinesia (an inability to move). Gait freezing is characterized by an inability to move the feet which may worsen in tight, cluttered spaces or when attempting to initiate gait.
Dystonia (in about 20% of cases): abnormal, sustained, painful twisting muscle contractions, often affecting the foot and ankle (mainly toe flexion and foot inversion) which often interferes with gait.
Speech and swallowing disturbances.
Hypophonia: soft speech. Speech quality tends to be soft, hoarse, and monotonous. Some people with Parkinson's disease claim that their tongue is "heavy" or have cluttered speech.
Monotonic speech.
Festinating speech: excessively rapid, soft, poorly-intelligible speech.
Drooling: most likely caused by a weak, infrequent swallow and stooped posture.
Dysphagia: impaired ability to swallow. Can lead to aspiration pneumonia.
Other motor symptoms:
Fatigue (up to 50% of cases);
Masked faces (a mask-like face also known as hypomimia), with infrequent blinking;
Difficulty rolling in bed or rising from a seated position;
Micrographia (small, cramped handwriting);
Impaired fine motor dexterity and motor coordination;
Impaired gross motor coordination;
Akathisia, the inability to sit still.

Causes:
Most people with Parkinson's disease are described as having idiopathic Parkinson's disease (having no specific known cause). There are far less common causes of Parkinson's disease including genetic, toxins, head trauma, cerebral anoxia, and drug-induced Parkinson's disease.

Diagnosis:

18F PET scan shows decreased dopamine activity in the basal ganglia, a pattern which aids in diagnosing Parkinson's disease.Typically, the diagnosis is based on medical history and neurological examination conducted by interviewing and observing the patient in person using the Unified Parkinson's Disease Rating Scale. A radiotracer for SPECT scanning machines called DaTSCAN and made by General Electric is specialized for diagnosing Parkinson's Disease, but it is only marketed in Europe. Due to this, the disease can be difficult to diagnose accurately, especially in its early stages. Due to symptom overlap with other diseases, only 75% of clinical diagnoses of PD are confirmed to be idiopathic PD at autopsy. Early signs and symptoms of PD may sometimes be dismissed as the effects of normal aging. The physician may need to observe the person for some time until it is apparent that the symptoms are consistently present. Usually doctors look for shuffling of feet and lack of swing in the arms. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases. However, CT and MRI brain scans of people with PD usually appear normal.

Clinical practice guidelines introduced in the UK in 2006 state that the diagnosis and follow-up of Parkinson's disease should be done by a specialist in the disease, usually a neurologist or geriatrician with an interest in movement disorders.

Treatment:
Parkinson's disease is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, physiotherapy, exercise, and nutrition. At present, there is no cure for PD, but medications or surgery can provide relief from the symptoms.

Parkinson's Disease Dementia

2009-04-24T06:09:00.000-07:00

Classification:
"Parkinson's disease" is the synonym of "primary parkinsonism", i.e. isolated parkinsonism due to a neurodegenerative process without any secondary systemic cause. In some cases, it would be inaccurate to say that the cause is "unknown", because a small proportion is caused by genetic mutations. It is possible for a patient to be initially diagnosed with Parkinson's disease but then to develop additional features, requiring revision of the diagnosis.

There are other disorders that are called Parkinson-plus diseases. These include: multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Some include dementia with Lewy bodies (DLB)—while idiopathic Parkinson's disease patients also have Lewy bodies— abnormal aggregates of protein that develop inside nerve cells — in their brain tissue, the distribution is denser and more widespread in DLB. Even so, the relationship between Parkinson disease, Parkinson disease with dementia (PDD), and dementia with Lewy bodies (DLB) might be most accurately conceptualized as a spectrum, with a discrete area of overlap between each of the three disorders. The natural history and role of Lewy bodies is little understood.

These Parkinson-plus diseases may progress more quickly than typical idiopathic Parkinson disease. If cognitive dysfunction occurs before or very early in the course of the movement disorder then DLBD may be suspected. Early postural instability with minimal tremor especially in the context of ophthalmoparesis should suggest PSP. Early autonomic dysfunction including erectile dysfunction and syncope may suggest MSA. The presence of extreme asymmetry with patchy cortical cognitive defects such as dysphasia and apraxias especially with "alien limb" phenomena should suggest CBD.

The usual anti-Parkinson's medications are typically either less effective or not effective at all in controlling symptoms; patients may be exquisitely sensitive to neuroleptic medications like haloperidol. Additionally, the cholinesterase inhibiting medications have shown preliminary efficacy in treating the cognitive, psychiatric, and behavioral aspects of the disease, so correct differential diagnosis is important.

Essential tremor may be mistaken for Parkinson's disease but lacks all other features besides tremor, and has particular characteristics distinguishing it from Parkinson's, such as improvement with beta blockers and alcoholic beverages.

Wilson's disease (hereditary copper accumulation) may present with parkinsonian features; young patients presenting with parkinsonism or any other movement disorder are frequently screened for this rare condition, because it may respond to medical treatment. Typical tests are liver function, slit lamp examination for Kayser-Fleischer rings, and serum ceruloplasmin levels.

Signs and symptoms:
Parkinson disease affects movement (motor symptoms). Other typical symptoms include disorders of mood, behavior, thinking, and sensation (non-motor symptoms). Patients' individual symptoms may be quite dissimilar and progression of the disease is also distinctly individual.

Motor symptoms:
The cardinal symptoms are (mnemonic "TRAP"):[1]

Tremor: normally 4–6 Hz tremor, maximal when the limb is at rest, and decreased with voluntary movement. It is typically unilateral at onset. This is the most apparent and well-known symptom, though an estimated 30% of patients have little perceptible tremor; these are classified as akinetic-rigid.
Rigidity: stiffness; increased muscle tone. In combination with a resting tremor, this produces a ratchety, "cogwheel" rigidity when the limb is passively moved.
Akinesia/bradykinesia: absence of movement and slowness, respectively. Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude.
Postural instability: failure of postural reflexes, which leads to impaired balance and falls.
Other motor symptoms include:

Gait and posture disturbances:
Shuffling: gait is characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to cause the patient to trip.
Decreased arm-swing.
Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
Stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk (camptocormia).
Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
Gait freezing: "freezing" is a manifestation of akinesia (an inability to move). Gait freezing is characterized by an inability to move the feet which may worsen in tight, cluttered spaces or when attempting to initiate gait.
Dystonia (in about 20% of cases): abnormal, sustained, painful twisting muscle contractions, often affecting the foot and ankle (mainly toe flexion and foot inversion) which often interferes with gait.
Speech and swallowing disturbances.
Hypophonia: soft speech. Speech quality tends to be soft, hoarse, and monotonous. Some people with Parkinson's disease claim that their tongue is "heavy" or have cluttered speech.
Monotonic speech.
Festinating speech: excessively rapid, soft, poorly-intelligible speech.
Drooling: most likely caused by a weak, infrequent swallow and stooped posture.
Dysphagia: impaired ability to swallow. Can lead to aspiration pneumonia.
Other motor symptoms:
Fatigue (up to 50% of cases);
Masked faces (a mask-like face also known as hypomimia), with infrequent blinking;
Difficulty rolling in bed or rising from a seated position;
Micrographia (small, cramped handwriting);
Impaired fine motor dexterity and motor coordination;
Impaired gross motor coordination;
Akathisia, the inability to sit still.

Neuropsychiatric
PD causes cognitive and mood disturbances, being in many cases related.

Estimated prevalence rates of depression vary widely according to the population sampled and methodology used. Reviews of depression estimate its occurrence in anywhere from 20–80% of cases.[6] Estimates from community samples tend to find lower rates than from specialist centres. Most studies use self-report questionnaires such as the Beck Depression Inventory, which may overinflate scores due to physical symptoms. Studies using diagnostic interviews by trained psychiatrists also report lower rates of depression. More generally, there is an increased risk for any individual with depression to go on to develop Parkinson's disease at a later date. Seventy percent of individuals with Parkinson's disease diagnosed with pre-existing depression go on to develop anxiety. Ninety percent of Parkinson's disease patients with pre-existing anxiety subsequently develop depression; apathy or abulia.

Cognitive disturbances include:

Slowed reaction time; both voluntary and involuntary motor responses are significantly slowed.
Executive dysfunction, characterized by difficulties in: differential allocation of attention, impulse control, set shifting, prioritizing, evaluating the salience of ambient data, interpreting social cues, and subjective time awareness. This complex is present to some degree in most Parkinson's patients; it may progress to:
Dementia: a later development in approximately 20-40% of all patients, typically starting with slowing of thought and progressing to difficulties with abstract thought, memory, and behavioral regulation. Hallucinations, delusions and paranoia may develop.
Short term memory loss; procedural memory is more impaired than declarative memory. Prompting elicits improved recall.
Non-motor causes of speech/language disturbance in both expressive and receptive language: these include decreased verbal fluency and cognitive disturbance especially related to comprehension of emotional content of speech and of facial expression.
Medication effects: some of the above cognitive disturbances are improved by dopaminergic medications, while others are actually worsened.

Sleep:
Excessive daytime somnolence
Initial, intermediate, and terminal insomnia
Disturbances in REM sleep: disturbingly vivid dreams, and REM Sleep Disorder, characterized by acting out of dream content—can occur years prior to diagnosis

Perception:
Impaired visual contrast sensitivity, spatial reasoning, color discrimination, convergence insufficiency (characterized by double vision) and oculomotor control
Dizziness and fainting; usually attributable orthostatic hypotension, a failure of the autonomic nervous system to adjust blood pressure in response to changes in body position
Impaired proprioception (the awareness of bodily position in three-dimensional space)
Reduction or loss of sense of smell (hyposmia or anosmia) - can occur years prior to diagnosis
pain: neuropathic, muscle, joints, and tendons, attributable to tension, dystonia, rigidity, joint stiffness, and injuries associated with attempts at accommodation

Autonomic:
Oily skin and seborrheic dermatitis
Urinary incontinence, typically in later disease progression
Nocturia (getting up in the night to pass urine)—up to 60% of cases
Constipation and gastric dysmotility that is severe enough to endanger comfort and even health
Altered sexual function: characterized by profound impairment of sexual arousal, behavior, orgasm, and drive is found in mid and late Parkinson disease. Current data addresses male sexual function almost exclusively.
Weight loss, which is significant over a period of ten years.

Causes:
Most people with Parkinson's disease are described as having idiopathic Parkinson's disease (having no specific known cause). There are far less common causes of Parkinson's disease including genetic, toxins, head trauma, cerebral anoxia, and drug-induced Parkinson's disease.

Genetic:
In recent years, a number of specific genetic mutations causing Parkinson's disease have been discovered, including in certain populations (Contursi, Italy). These account for a small minority of cases of Parkinson's disease. Someone who has Parkinson's disease is more likely to have relatives that also have Parkinson's disease. However, this does not mean that the disorder has been passed on genetically.

Toxins:
One theory holds that the disease may result in many or even most cases from the combination of a genetically determined vulnerability to environmental toxins along with exposure to those toxins.This hypothesis is consistent with the fact that Parkinson's disease is not distributed homogeneously throughout the population; its incidence varies geographically. However, the fact that the first appearance of the syndrome predates the first synthesis of the compounds often attributed to causing Parkinson's disease indicates that these recently synthesized compounds cannot be the sole cause of Parkinsonism. The toxins most strongly suspected at present are certain pesticides and transition-series metals such as manganese or iron, especially those that generate reactive oxygen species, and/or bind to neuromelanin, as originally suggested by G.C. Cotzias. In the Cancer Prevention Study II Nutrition Cohort, a longitudinal investigation, individuals who were exposed to pesticides had a 70% higher incidence of PD than individuals who were not exposed.

The tragedy of a group of drug addicts in California in the early 1980s who consumed a contaminated and illicitly produced batch of the synthetic opiate MPPP brought to light MPTP (pro-toxin N-methyl-4-phenyl-1,2,3,6-tetrahydropyidine) as a specific cause of Parkinson symptoms. This made it possible to develop the first animal model for Parkinson's. MPTP's toxicity likely comes from the generation of reactive oxygen species through tyrosine hydroxylation. The Case of the Frozen Addicts by J. William Langston (Vintage, New York, June 25, 1996) documents this tragedy and describes the first attempts at fetal brain tissue transplants to treat PD.

Other toxin-based models employ PCBs, paraquat(a herbicide) in combination with maneb (a fungicide), rotenone (an insecticide), and specific organochlorine pesticides including dieldrinand lindane. Rotenone is an inhibitor of complex 1 of the electron transport chain. It easily crosses membranes due to its extremely hydrophobic properties. Rotenone, therefore, does not rely on the dopamine transporter to enter into the cytoplasm. Numerous studies have found an increase in PD in persons who consume rural well water; researchers theorize that water consumption is a proxy measure of pesticide exposure. In agreement with this hypothesis are studies which have found a dose-dependent increase in PD in persons exposed to agricultural chemicals.

Head trauma:
Past episodes of head trauma are reported more frequently by individuals with Parkinson's disease than by others in the population. A recent methodologically strong retrospective study found that those who have experienced a head injury are four times more likely to develop Parkinson’s disease than those who have never suffered a head injury. The risk of developing Parkinson’s increases eightfold for patients who have had head trauma requiring hospitalization, and it increases 11-fold for patients who had experienced severe head injury. The authors comment that since head trauma is a rare event, the contribution to PD incidence is slight. They express further concern that their results may be biased by recall, i.e., the PD patients because they reflect upon the causes of their illness, may remember head trauma better than the non-ill control subjects. These limitations were overcome recently by Tanner and colleagues, who found a similar risk of 3.8, with increasing risk associated with more severe injury and hospitalization. However, whether the head trauma actually contributed to Parkinson's disease development or the early symptoms of clumsiness associated with Parkinson's causes individuals to have more head trauma is still unknown.

Treatment:
Parkinson's disease is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, physiotherapy, exercise, and nutrition. At present, there is no cure for PD, but medications or surgery can provide relief from the symptoms.

Levodopa:

Stalevo for treatment of Parkinson's diseaseThe most widely used form of treatment is L-dopa in various forms. L-dopa is transformed into dopamine in the dopaminergic neurons by L-aromatic amino acid decarboxylase (often known by its former name dopa-decarboxylase). However, only 1-5% of L-dopa enters the dopaminergic neurons. The remaining L-dopa is often metabolised to dopamine elsewhere, causing a wide variety of side effects. Due to feedback inhibition, L-dopa results in a reduction in the endogenous formation of L-dopa, and so eventually becomes counterproductive.

Carbidopa and benserazide are dopa decarboxylase inhibitors. They help to prevent the metabolism of L-dopa before it reaches the dopaminergic neurons and are generally given as combination preparations of carbidopa/levodopa (co-careldopa) (e.g. Sinemet, Parcopa) and benserazide/levodopa (co-beneldopa) (e.g. Madopar). There are also controlled release versions of Sinemet and Madopar that spread out the effect of the L-dopa. Duodopa is a combination of levodopa and carbidopa, dispersed as a viscous gel. Using a patient-operated portable pump, the drug is continuously delivered via a tube directly into the upper small intestine, where it is rapidly absorbed. There is also Stalevo (Carbidopa, Levodopa and Entacapone).

Le Chatelier CoCl2 Equilibrium Demonstration

2009-04-22T03:24:00.000-07:00

Key Concepts:
In 1884, the French Chemist Henri Le Chatelier suggested that equilibrium systems tend to compensate for the effects of perturbing influences.
When a system at equilibrium is disturbed, the equilibrium position will shift in the direction which tends to minimise, or counteract, the effect of the disturbance.

If the concentration of a solute reactant is increased, the equilibrium position shifts to use up the added reactants by producing more products.

If the pressure on an equilibrium system is increased, then the equilibrium position shifts to reduce the pressure.

If the volume of a gaseous equilibrium system is reduced (equivalent to an increase in pressure) then the equilibrium position shifts to increase the volume (equivalent to a decrease in pressure)

If the temperature of an endothermic equilibrium system is increased, the equilibrium position shifts to use up the heat by producing more products.

If the temperature of an exothermic equilibrium system is increased, the equilibrium position shifts to use up the heat by producing more reactants.
Examples
Changes in Concentration.
Consider the following system at equilibrium:
Fe3+(aq) + SCN-(aq)
(colourless)
FeSCN2+(aq)
(red)

Increasing the concentration of either Fe3+(aq) or SCN-(aq) will result in the equilibrium position moving to the right, using up the some of the additional reactants and producing more FeSCN2+(aq).
The solution will become a darker red colour.

Removing some of the Fe3+(aq) or SCN-(aq) will result in the equilibrium position moving to the left to produce more Fe3+(aq) and SCN-(aq).
The solution will become less red as FeSCN2+(aq) is consumed.

Increasing the concentration of FeSCN2+(aq) will result in the equilibrium position moving to the left to use up some of the additional FeSCN2+(aq) and producing more Fe3+(aq) and SCN-(aq).
The solution will become less red.

Removing some of the FeSCN2+(aq) will result in the equilibrium position moving to the right to produce more FeSCN2+(aq)
which will lead the solution to become a darker red colour.

Changes in Pressure of Gaseous Equilibrium Systems:
Gas pressure is related to the number of gas particles in the system, more gas particles means more gas pressure.

Consider the following gaseous equilibrium system: 2NO2(g)
(red-brown)
N2O4(g)
(colourless)

Increasing the pressure on this equilibrium system will result in the equilibrium position shifting to reduce the pressure, that is, to the side that has the least number of gas particles.
There are 2 gas particles on the left hand side of the reaction and 1 gas particle on the right hand side of the reaction.
Increasing the pressure on this system results in the equilibrium position moving to the right, consuming NO2(g) and producing more N2O4(g).
The system will become a lighter red-brown colour.

Reducing the pressure on this equilibrium system will result in the equilibrium position moving to the left, that is, to the side that has the most gas particles, in order to increase the pressure.
The red-brown colour of the system becomes darker.
Consider the following equilibrium system: C(s) + H2O(g) CO(g) + H2(g)

Increasing the pressure on this equilibrium system results in the equilibrium position shifting to the left, CO(g) and H2(g) are consumed to produce more C(s) and H2O(g).
There is only 1 gas particle on the left of the equation (H2O) and 2 gas particles on the right hand side of the equation (CO(g) + H2(g)), so the equilibrium position moves to the side that has the least number of gas particles to reduce the pressure, that is, to the left.

Reducing the pressure on this equilibrium system results in the equilibrium position shifting to the side that has the most gas particles in order to increase the pressure, that is, to the right.
C(s) and H2O(g) are consumed to produce more CO(g) and H2(g).

Changes in Volume of Gaseous Equilibrium Systems
Gas volume is related to gas pressure, a gas at reduced volume has a higher pressure, a gas at increased volume has a lower pressure.

Consider the following gaseous equilibrium system: 2NO2(g)
(colourless)
N2O4(g)
(red-brown)

Increasing the volume of this equilibrium system is equivalent to reducing the pressure, so the equilibrium position moves to the side of the reaction that has the most gas particles in order to increase the pressure.
The equilibrium position shifts to the left producing more NO2(g) by consuming N2O4(g).
The system becomes less red-brown in colour.

Reducing the volume of this equilibrium system is equivalent to increasing the pressure, so the equilibrium position moves to the side of the reaction that has the least gas particles in order to reduce the pressure.
The equilibrium position shifts to the right producing more N2O4(g) by consuming more NO2(g).
The system becomes a darker red-brown.

Changes in Temperature

In an endothermic reaction, energy can be considered as a reactant of the reaction.

In an exothermic reaction, energy can be considered as a product of the reaction.

Endothermic Equilibrium Systems
Consider the following reaction at equilibrium: H2(g)
(colourless) +
I2(s)
(purple)
2HI(g)
(colourless) H = + 52 kJ mol-1

This reaction can also be written with the energy term incorporated into the equation on the side with the reactants: H2(g)
(colourless) +
I2(s)
(purple) + 52 kJ

2HI(g)
(colourless)

Increasing the temperature of the equilibrium system will shift the equilibrium position to the side that does not include the energy term in order to reduce the temperature, that is to the right. The increased heat will be consumed to produce more HI(g) product, since H2(g) and I2(s) will be consumed, there will be less purple solid in the reaction vessel.

Reducing the temperature of the equilibrium system will shift the equilibrium to the left in order to produce more heat. HI(g) will be consumed in order to produce more H2(g) and I2(s). The amount of purple solid will increase.

Exothermic Equilibrium Systems
Consider the following reaction at equilibrium: Ag+(aq) + Cl-(aq)
(colourless)
AgCl(s)
(white) H = -112 kJ mol-1

This reaction can also be written with the energy term incorporated into the equation on the side with the the products: Ag+(aq) + Cl-(aq)
(colourless)
AgCl(s)
(white) + 112 kJ

Increasing the temperature of this equilibrium system shifts the equilibrium position to the left, consuming some of the energy and products to produce more reactants. There will be less white AgCl(s) in the reaction vessel.

Reducing the temperature of this equilibrium system shifts the equilibrium position to the right, producing more heat and more white AgCl(s).

The Haber Process

2009-04-21T22:23:00.000-07:00

Key Concepts:
In 1909 Fritz Haber established the conditions under which nitrogen, N2(g), and hydrogen, H2(g), would combine using

medium temperature (~500oC)

very high pressure (~250 atmospheres, ~351kPa)

a catalyst (a porous iron catalyst prepared by reducing magnetite, Fe3O4).
Osmium is a much better catalyst for the reaction but is very expensive.
This process produces an ammonia, NH3(g), yield of approximately 10-20%.

The Haber synthesis was developed into an industrial process by Carl Bosch.

The reaction between nitrogen gas and hydrogen gas to produce ammonia gas is exothermic, releasing 92.4kJ/mol of energy at 298K (25oC).

N2(g)
nitrogen + 3H2(g)
hydrogen heat, pressure, catalyst
2NH3(g)
ammonia H = -92.4 kJ mol-1

OR

N2(g)
nitrogen + 3H2(g)
hydrogen heat, pressure, catalyst
2NH3(g)
ammonia + 92.4 kJ mol-1

By Le Chetalier's Principle:

increasing the pressure causes the equilibrium position to move to the right resulting in a higher yeild of ammonia since there are more gas molecules on the left hand side of the equation (4 in total) than there are on the right hand side of the equation (2). Increasing the pressure means the system adjusts to reduce the effect of the change, that is, to reduce the pressure by having fewer gas molecules.

decreasing the temperature causes the equilibrium position to move to the right resulting in a higher yield of ammonia since the reaction is exothermic (releases heat). Reducing the temperature means the system will adjust to minimise the effect of the change, that is, it will produce more heat since energy is a product of the reaction, and will therefore produce more ammonia gas as well
However, the rate of the reaction at lower temperatures is extremely slow, so a higher temperature must be used to speed up the reaction which results in a lower yield of ammonia.
The equilibrium expression for this reaction is: Keq = [NH3]2

--------------------------------------------------------------------------------

[N2][H2]3

As the temperature increases, the equilibrium constant decreases as the yield of ammonia decreases. Temperature (oC) Keq
25 6.4 x 102

--------------------------------------------------------------------------------

200 4.4 x 10-1

--------------------------------------------------------------------------------

300 4.3 x 10-3

--------------------------------------------------------------------------------

400 1.6 x 10-4

--------------------------------------------------------------------------------

500 1.5 x 10-5

Rate considerations:

A catalyst such as an iron catalyst is used to speed up the reaction by lowering the activation energy so that the N2 bonds and H2 bonds can be more readily broken.

Increased temperature means more reactant molecules have sufficient energy to overcome the energy barrier to reacting (activation energy) so the reaction is faster at higher temperatures (but the yield of ammonia is lower as discussed above).
A temperature range of 400-500oC is a compromise designed to achieve an acceptable yield of ammonia (10-20%) within an acceptable time period.
At 200oC and pressures above 750atm there is an almost 100% conversion of reactants to the ammonia product.

Since there are difficulties associated with containing larger amounts of materials at this high pressure, lower pressures of around 200 atm are used industrially.

By using a pressure of around 200atm and a temperature of about 500oC, the yield of ammonia is 10-20%, while costs and safety concerns in the biulding and during operation of the plant are minimised

During industrial production of ammonia, the reaction never reaches equilibrium as the gas mixture leaving the reactor is cooled to liquefy and remove the ammonia. The remaining mixture of reactant gases are recycled through the reactor. The heat released by the reaction is removed and used to heat the incoming gas mixture.

Uses of Ammonia:
Industry Use
Fertilser production of:
ammonium sulfate, (NH4)2SO4

ammonium phosphate, (NH4)3PO4

ammonium nitrate, NH4NO3

urea, (NH2)2CO,also used in the production of barbiturates (sedatives), is made by the reaction of ammonia with carbon dioxide

CO2
carbon dioxide + 2NH3
ammonia H2NCOONH4
ammonium carbonate heat, pressure
(NH2)2CO
urea

--------------------------------------------------------------------------------

Chemicals synthesis of:

nitric acid, HNO3, which is used in making explosives such as TNT (2,4,6-trinitrotoluene), nitroglycerine which is also used as a vasodilator (a substance that dilates blood vessels) and PETN (pentaerythritol nitrate).

sodium hydrogen carbonate (sodium bicarbonate), NaHCO3

sodium carbonate, Na2CO3

hydrogen cyanide (hydrocyanic acid), HCN

hydrazine, N2H4 (used in rocket propulsion systems)

--------------------------------------------------------------------------------

Explosives ammonium nitrate, NH4NO3

--------------------------------------------------------------------------------

Fibres and Plastics nylon, -[(CH2)4-CO-NH-(CH2)6-NH-CO]-,and other polyamides

--------------------------------------------------------------------------------

Refrigeration used for making ice, large scale refrigeration plants, air-conditioning units in buildings and plants

--------------------------------------------------------------------------------

Pharmaceuticals used in the manufacture of drugs such as sulfonamide which inhibit the growth and multiplication of bacteria that require p-aminobenzoic acid (PABA) for the biosynthesis of folic acids, anti-malarials and vitamins such as the B vitamins nicotinamide (niacinamide) and thiamine.

--------------------------------------------------------------------------------

Pulp and Paper ammonium hydrogen sulfite, NH4HSO3, enables some hardwoods to be used

--------------------------------------------------------------------------------

Mining and Metallurgy used in nitriding (bright annealing) steel,
used in zinc and nickel extraction

--------------------------------------------------------------------------------

Cleaning ammonia in solution is used as a cleaning agent such as in 'cloudy ammonia'

A Brief History:
At the beginning of the 20th century there was a shortage of naturally occurring, nitrogen-rich fertilisers, such as Chile saltpetre, which prompted the German Chemist Fritz Haber, and others, to look for ways of combining the nitrogen in the air with hydrogen to form ammonia, which is a convenient starting point in the manufacture of fertilisers.This process was also of interest to the German chemical industry as Germany was preparing for World War I and nitrogen compounds were needed for explosives.

The hydrogen for the ammonia synthesis was made by the water-gas process (a Carl Bosch invention) which involves blowing steam through a bed of red hot coke resulting in the separation of hydrogen from oxygen. The nitrogen was obtained by distillation of liquid air, then by cooling and compressing air.

These days, the hydrogen is produced by reforming light petroleum fractions or natural gas (methane, CH4) by adding steam:

CH4(g) + H2O(g) Ni catalyst
---------->
700oC CO(g) + 3H2(g)

Enough steam is used to react with about 45% of the methane (CH4), the rest of the methane is reacted with air:

2CH4(g) + O2(g) + 4N2(g)
(air) Ni catalyst
---------> 2CO(g) + 4H2(g) + 4N2(g)

All the carbon monoxide (CO) in the mixture is oxidised to CO2 using steam and an iron oxide catalyst:

CO(g) + H2O(g) iron oxide catalyst
------------------> H2(g) + CO2(g)

The carbon dioxide (CO2) is removed using a suitable base so that only the nitrogen gas (N2) and hydrogen gas (H2) remain and are used in the production of ammonia (NH3).

In ammonia production the hydrogen and nitrogen are mixed together in a ratio of 3:1 by volume and compressed to around 200 times atmospheric pressure.