Free Health Clinic

Cervical Cancer

2010-03-27T09:13:00.000-07:00

Is this topic for you?

This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervixgrow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.
You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
Pain during sex.
Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.
Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.
The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
Radiation therapy.
Chemotherapy.

Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.
It’s common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

Can cervical cancer be prevented?

The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.
A vaccine called Gardasil protects against four types of HPV, which together cause most cases of cervical cancer and genital warts. You get three shots over 6 months. The vaccine is recommended for girls 11 to 12 years old. It is also recommended for females 13 to 26 years old who did not get the vaccine when they were younger.
The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

Health and Fitness Tips Using Home Remedies

2010-02-08T02:39:00.000-08:00

You can choose to lead a healthy life or choose to lead an unhealthy one. It is as simple as that. Like any other good thing, it takes a bit of hard work and perseverance, but if you stick to it, you can transform your life to rise above the pitfalls of ill health. Our home remedies on health and fitness will give you some important insights into how you can make your life and that of your family healthier and richer.

Fitness Health Tips

Our bodies are designed so as to be active in the hours of daylight and to rest in the hours of darkness. Although the advent of artificial lighting has ensured that we need not be governed by the motion of the sun, are body's internal clocks still follow their own rule.
Why fight your body? If your job gives you the freedom to do so, it is best to sleep early at night and to wake up early in the morning. This ensures that your body is rested when its energy levels are at its lowest. You will also be amazed by the amount of work and play that you can put in simply by waking up a couple of hours earlier than you normally do.

Home Remedy Tips

The herbs, vegetables and fruits in your kitchen have tremendous unrealized potential. Learn how to harness this potential by reading our home remedies tips so that you can avoid unnecessary medications for simple problems such as a common cold, stomach problems, headaches and muscle cramps.
For common cold, make a delicious soup comprising of six crushed cloves of garlic, a quart of chicken stock, and two egg whites. Fry the cloves in vegetable oil, pour in the stock and bring to a boil. Reduce the heat and add the two egg whites a dash of white vinegar. This tasty soup will help to keep the symptoms of common cold at bay.
Those suffering from stomach aches or flatulence can follow this health tip for a speedy cure.

Dissolve one and a half teaspoons of ground cinnamon in a cup of warm water. Cover the mixture for fifteen minutes and then drink it. This healthy cinnamon tea will take care of your stomach problems once and for all.
The next time you have a headache don't reach for that bottle of aspirin. Try almonds instead.

Eating ten almonds has the same beneficial effects as aspirin with none of the side effects. Similarly applying clove oil to areas that are affected by muscle cramps helps to relieve the soreness.

Tips on health

Obesity is a rampant problem among the youth and many adults. Most people eat far more than they need. Extensive studies provide a direct correlation between overeating and increased risk of various diseases.

Ensuring that you eat a healthy diet and eat less will ensure that you and your family have a better chance of maintaining good health in the years to come. It is better to eat healthy consistently rather than to indulge in food followed by periods of binge dieting. Vegetarianism is also increasing in popularity all over the world as it allows you to obtain the same benefits as eating meat with almost none of the attached risks. Restrict your meals to small portions and drink lots of water. Many times we actually interpret thirst as hunger and end up eating when all our body needs is some water.
Read this section to know more about home remedies, fitness and health care tips for longevity and good health.

Home remedy

2010-02-08T02:38:00.000-08:00

A home remedy is a treatment to cure a disease or ailment that employs certain spices, vegetables, or other common items. Home remedies may or may not have medicinal properties that treat or cure the disease or ailment in question, as they are typically passed along by laypersons (which has been facilitated in recent years by the Internet). Many are merely used as a result of tradition or habit or because they are effective in inducing the placebo effect.^{[citation needed]} A significant number, however, have been demonstrated to effectively treat ailments such as sprains, minor lacerations, headaches, fevers, and even the common cold^[1].

One of the more popular examples of a home remedy is the use of chicken soup to treat respiratory infections such as a cold or mild flu, and according to recent studies, this may actually be effective.^[2] Other examples of medically successful home remedies include willow bark tea to cure headaches and fevers (willow bark contains a form of acetylsalicylic acid, also known as aspirin); duct tape to help with setting broken bones; and duct tape or superglue to treat plantar warts; and Kogel mogel to treat sore throat. Most home remedies are made up of things that are already in your home. One of the most commonly used home remedies used is for coughs. This recipe is as follows: equal parts, honey, lemon juice, and Whiskey. Recommended dosage for children under 12 is 2 tsp. of stated recipe (Miller, 2009). "I am in favor of home remedies if monitored by a physician" (Jackson MD, 2009).

In earlier times mothers were entrusted with all but serious remedies. Historic cookbooks are frequently full of remedies for dyspepsia, fevers, and female complaints.^[3]

Many European liqueurs or digestifs were originally medicinal remedies. In Chinese folk medicine, medicinal congees (long cooked rice soups with herbs), foods, and soups are part of the healing repertoire.^[4]

A common error is to confuse home remedies with homeopathic remedies. In fact, the two concepts are unrelated.

Acne vulgaris

2010-02-08T02:30:00.000-08:00

Acne vulgaris (commonly called acne) is a common human skin disease, characterized by areas of skin with multiple noninflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Acne vulgaris mostly affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.^[1] Acne lesions are commonly referred to as pimples, blemishes, spots, zits, or simply acne. Acne lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes which require androgen stimulation.

Acne occurs most commonly during adolescence, affecting more than 89% of teenagers, and frequently continues into adulthood. In adolescence, acne is usually caused by an increase in male sex hormones, which people of both genders accrue during puberty.^[2] For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties and beyond.^[3]

Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne.^[4] The "cysts," or boils that accompany cystic acne, can appear on the buttocks, groin, and armpit area, and anywhere else where sweat collects in hair follicles and perspiration ducts.^[5] Cystic acne affects deeper skin tissue than does common acne.^[6]

Aside from scarring, its main effects are psychological, such as reduced self-esteem^[7] and, according to at least one study, depression or suicide.^[8] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.^[7]

Terminology

The term acne comes from a corruption of the Greek άκμή (acne in the sense of a skin eruption) in the writings of Aëtius Amidenus. Used by itself, the term "acne" refers to the presence of pustules and papules.^[9] The most common form of acne is known as "acne vulgaris", meaning "common acne". Many teenagers get this type of acne. Use of the term "acne vulgaris" implies the presence of comedones.^[10]

The term "acne rosacea" is a synonym for rosacea, however some individuals may have almost no acne comedones associated with their rosacea and prefer therefore the term rosacea.^[11] Chloracne is associated with exposure to polyhalogenated compounds.

Causes of acne

Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (whitehead). Whiteheads are the direct result of sebaceous glands becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation.^[12]

Primary causes

Acne is known to be partly hereditary, but no particular genetic cause has been identified. Acne is not contagious or infectious. Several factors are known to be linked to acne:

Family/Genetic history. The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.^[13]
Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum.^[14]
Inflammation, skin irritation or scratching of any sort will activate inflammation.
Stress. While the connection between acne and stress has been debated, scientific research indicates that "increased acne severity" is "significantly associated with increased stress levels."^[15] The National Institutes of Health (USA) list stress as a factor that "can cause an acne flare."^[16] A study of adolescents in Singapore "observed a statistically significant positive correlation […] between stress levels and severity of acne."^[17]
Hyperactive sebaceous glands, secondary to the three hormone sources above.
Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing.^[18]
Use of anabolic steroids.^[19]
Exposure to certain chemical compounds. Chloracne is particularly linked to toxic exposure to dioxins, namely Chlorinated dioxins.^{[citation needed]}

Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I).

Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).

Vitamins A and E

Studies have shown that newly diagnosed acne patients tend to have lower levels of vitamin A circulating in their bloodstream than those who are acne free.^[44] In addition people with severe acne also tend to have lower blood levels of vitamin E.^[45]

Hygiene

Acne is not caused by dirt. This misconception probably comes from the fact that blackheads look like dirt stuck in the openings of pores. The black color is not dirt but simply oxidized keratin. In fact, the blockages of keratin that cause acne occur deep within the narrow follicle channel, where it is impossible to wash them away. These plugs are formed by the failure of the cells lining the duct to separate and flow to the surface in the sebum created there by the body. Built-up oil of the skin can block the passages of these pores, so standard washing of the face could wash off old oil and help unblock the pores.

Treatments

Available treatments

There are many products available for the treatment of acne, many of which are without any scientifically proven effects. Generally speaking, successful treatments show little improvement within the first two weeks, instead taking a period of approximately three months to improve and start flattening out.^{[citation needed]} Many treatments that promise big improvements within two weeks are likely to be largely disappointing.^{[citation needed]} However, short bursts of cortisone can give very quick results, and other treatments can rapidly improve some active spots, but usually not all active spots.^{[citation needed]}

Modes of improvement are not necessarily fully understood but in general treatments are believed to work in at least 4 different ways (with many of the best treatments providing multiple simultaneous effects):

normalising shedding into the pore to prevent blockage
killing Propionibacterium acnes
anti-inflammatory effects
hormonal manipulation

A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken. Many people consult with doctors when deciding which treatments to use, especially when considering using any treatments in combination. There are a number of treatments that have been proven effective:

Hygiene

Proper washing and skin care can help to remove bacteria and oils which cause acne. Some anecdotal reports indicate placing a clean towel over one's pillow each night can help prevent contaminating the pillow with the bacteria that causes acne, and reintroducing it to the face. Additionally, cleaning the hands before touching the affected area can prevent transmission of the bacteria from one part of the body to another.^{[citation needed]}

Topical bactericidals

Widely available OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is applied, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2% to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P. acnes. In one study, roughly 70% of participants using a 10% benzoyl peroxide solution experienced a reduction in acne lesions after six weeks.^[46] Unlike antibiotics, benzoyl peroxide has the advantage of being a strong oxidizer and thus does not appear to generate bacterial resistance.^[47] However, it routinely causes dryness, local irritation and redness. A sensible regimen may include the daily use of low-concentration (2.5%) benzoyl peroxide preparations, combined with suitable non-comedogenic moisturisers to help avoid overdrying the skin.

Care must be taken when using benzoyl peroxide, as it can very easily bleach any fabric or hair it comes in contact with.

Other antibacterials that have been used include triclosan, or chlorhexidine gluconate. Though these treatments are often less effective, they also have fewer side-effects.

Products containing azeleic acid are also used in the treatment of P. acnes. It is available in the United States as a 20% concentration and does not generate bacterial resistance.^[47]

Prescription-strength benzoyl peroxide preparations do not necessarily differ with regard to the maximum concentration of the active ingredient (10%), but the drug is made available dissolved in a vehicle that more deeply penetrates the pores of the skin.

Topical antibiotics

Externally applied antibiotics such as erythromycin, clindamycin or tetracycline kill the bacteria that are harbored in the blocked follicles. While topical use of antibiotics is equally as effective as oral use, this method avoids possible side effects including upset stomach and drug interactions (e.g. it will not affect use of the oral contraceptive pill), but may prove inefficient to apply over larger areas than just the face alone.

Oral antibiotics

Oral antibiotics used to treat acne include erythromycin or one of the tetracycline antibiotics (tetracycline, the better absorbed oxytetracycline, or one of the once daily doxycycline, minocycline, or lymecycline). Trimethoprim is also sometimes used (off-label use in UK). However, reducing the P. acnes bacteria will not, in itself, do anything to reduce the oil secretion and abnormal cell behaviour that is the initial cause of the blocked follicles. Additionally the antibiotics are becoming less and less useful as resistant P. acnes are becoming more common. Acne may return soon after the end of treatment—days later in the case of topical applications, and weeks later in the case of oral antibiotics. Furthermore, side effects of tetracycline antibiotics can include yellowing of the teeth and an imbalance of gut flora, so are only recommended after topical products have been ruled out.

It has been found that sub-antimicrobial doses of antibiotics such as minocycline also improve acne. It is believed that minocycline's anti-inflammatory effect also prevents acne.

Hormonal treatments

In females, acne can be improved with hormonal treatments. The common combined estrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen, Cyproterone, in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Diane-35 is not available in the USA, but a newer oral contraceptive containing the progestin drospirenone is now available with fewer side effects than Diane 35 / Dianette. Both can be used where blood tests show abnormally high levels of androgens, but are effective even when this is not the case. Along with this, treatment with low dose spironolactone can have anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.

If a pimple is large and/or does not seem to be affected by other treatments, a dermatologist may administer an injection of cortisone directly into it, which will usually reduce redness and inflammation almost immediately. This has the effect of flattening the pimple, thereby making it easier to cover up with makeup, and can also aid in the healing process. Side effects are minimal, but may include a temporary whitening of the skin around the injection point; and occasionally a small depression forms, which may persist, although often fills eventually. This method also carries a much smaller risk of scarring than surgical removal.

Topical retinoids

A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin), and tazarotene (brand name Tazorac). Like isotretinoin, they are related to vitamin A, but they are administered as topicals and generally have much milder side effects. They can, however, cause significant irritation of the skin. The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and is used in many over-the-counter moisturizers and other topical products. Effective topical retinoids have been in use over 30 years but are available only on prescription so are not as widely used as the other topical treatments. Topical retinoids often cause an initial flare up of acne and facial flushing.

Oral retinoids

Main article: isotretinoin

A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of 4–6 months can cause long-term resolution or reduction of acne. It is believed that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (many of which can be severe). About 25% of patients may relapse after one treatment. In those cases, a second treatment for another 4–6 months may be indicated to obtain desired results. It is often recommended that one lets a few months pass between the two treatments, because the condition can actually improve somewhat in the time after stopping the treatment and waiting a few months also gives the body a chance to recover. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare up of acne within a month or so, which can be severe. There are reports that the drug has damaged the liver of patients. For this reason, it is recommended that patients have blood samples taken and examined before and during treatment. In some cases, treatment is terminated or reduced due to elevated liver enzymes in the blood, which might be related to liver damage. Others claim that the reports of permanent damage to the liver are unsubstantiated, and routine testing is considered unnecessary by some dermatologists. Blood triglycerides also need to be monitored. However, routine testing are part of the official guidelines for the use of the drug in many countries. Some press reports suggest that isotretinoin may cause depression but as of September 2005 there is no agreement in the medical literature as to the risk. The drug also causes birth defects if women become pregnant while taking it or take it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug. Because of this, the drug is supposed to be given to females as a last resort after milder treatments have proven insufficient. Restrictive rules (see iPledge program) for use were put into force in the USA beginning in March 2006 to prevent misuse, causing occasioned widespread editorial comment.^[48]

Sulfur

Sulfur has an inhibitory effect on the growth of Propionibacterium acnes and, when combined with sodium sulfacetamide (5% and 10%, respectively) has been shown to reduce acne with only mild side effects.^[49]

Dermabrasion

Dermabrasion is a cosmetic medical procedure in which the surface of the skin is removed by abrasion (sanding). It is used to remove sun-damaged skin and to remove or lessen scars and dark spots on the skin. The procedure is very painful and usually requires a general anaesthetic or "twilight anaesthesia", in which the patient is still partly conscious^[43] Afterward, the skin is very red and raw-looking, and it takes several months for the skin to regrow and heal. Dermabrasion is useful for scar removal when the scar is raised above the surrounding skin, but is less effective with sunken scars.

In the past, dermabrasion was done using a small, sterilized, electric sander. In the past decade, it has become more common to use a CO₂ or Er:YAG laser. Laser dermabrasion is much easier to control, much easier to gauge, and is practically bloodless compared to classic dermabrasion.

Microdermabrasion comes from the above mentioned technique dermabrasion. Microdermabrasion is a more natural skin care that is a gentler, less invasive technology for doing an exfoliation on the skin. The goal of the microdermabrasion is to eliminate the superficial layer of the skin called the epidermis. If the surface of the abraded skin is touched, a roughness of the skin will be noticed. The roughness is keratinocytes, which are better hydrated than the surface corneocytes. Keratinocytes appear in the basal layer from the proliferation of keratinocyte stem cells. They are pushed up through the cells of the epidermis, experiencing gradual specialization until they reach the stratum corneum where they form a layer of dead, flattened, strongly keratinized cells called squamous cells. This layer creates an efficient barrier to the entry of foreign matter and infectious elements into the body and reduces moisture loss. Keratinocytes are shed and restored continuously from the stratum corneum.

The time of transit from basal layer to shedding is generally one month. Corneocytes are cells derived from keratinocytes in the late stages of terminal specialization of squamous epithelia. The microdermabrasion is done to eliminate some of the corneocytes. These cells are responsible for the impermeability of the skin. The minimizing or elimination of scars, skin lesions, blotchiness and stretch marks from the skin can be an easy process with the use of skin exfoliation. The result depends on how well the procedure known as "skin remodeling" works. Results are optimal and fewer treatments are needed with more recent and/or superficial scars. Still, microdermabrasion can be used on scars that showed up during puberty or many years later.

Phototherapy

'Blue' and red light

Light exposure has long been used as a short term treatment for acne. Recently, visible light has been successfully employed to treat mild to moderate acne (phototherapy or deep penetrating light therapy) - in particular intense violet light (405-420 nm) generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64%^[50] and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by 420 nm and shorter wavelengths of light.^[51] Particularly when applied over several days, these free radicals ultimately kill the bacteria.^[52] Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been licensed by the U.S. FDA.^[53]^[54]

The treatment apparently works even better if used with a mixture of the violet light and red visible light (660 nanometer) resulting in a 76% reduction of lesions after three months of daily treatment for 80% of the patients;^[55] and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments few if any negative side effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive to buy initially, although the total cost of ownership can be similar to many other treatment methods (such as the total cost of benzoyl peroxide, moisturizer, washes) over a couple of years of use.

Photodynamic therapy

In addition, basic science and clinical work by dermatologists Yoram Harth and Alan Shalita and others has produced evidence that intense blue/violet light (405-425 nanometer) can decrease the number of inflammatory acne lesion by 60-70% in four weeks of therapy, particularly when the P. acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins. However this photodynamic therapy is controversial and apparently not published in a peer reviewed journal. A phase II trial, while it showed improvement occurred, failed to show improved response compared to the blue/violet light alone.^[56]

Surgery

For patients with cystic acne, boils can be drained through surgical lancing.^[57]

Subcision

Subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as laser resurfacing, microdermabrasion or chemical peels can be used to smooth out the scarred tissue.

Laser treatment

Laser surgery has been in use for some time to reduce the scars left behind by acne, but research has been done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:

to burn away the follicle sac from which the hair grows
to burn away the sebaceous gland which produces the oil
to induce formation of oxygen in the bacteria, killing them

Since lasers and intense pulsed light sources cause thermal damage to the skin, there are concerns that laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long-term dryness of the skin.

In the United States, the FDA has approved several companies, such as Candela Corp., to use a cosmetic laser for the treatment of acne. However, efficacy studies have used very small sample sizes (fewer than 100 subjects) for periods of six months or less, and have shown contradictory results.^[58] Also, laser treatment being relatively new, protocols remain subject to experimentation and revision,^[59] and treatment can be quite expensive. Also, some Smoothbeam laser devices had to be recalled due to coolant failure, which resulted in painful burn injuries to patients.^[60]

Less widely used treatments

Aloe vera: there are treatments for acne mentioned in Ayurveda using herbs such as Aloe vera, Neem, Haldi (Turmeric) and Papaya. There is limited evidence from medical studies on these products.^[61] Products from Rubia cordifolia, Curcuma longa (commonly known as Turmeric), Hemidesmus indicus (known as ananthamoola or anantmula), and Azadirachta indica (Neem) have been shown to have anti-inflammatory effects, but not aloe vera.^[62]
Azelaic acid (brand names Azelex, Finevin and Skinoren) is suitable for mild, comedonal acne.^[63]
Calendula used in suspension is used as an anti-inflammatory agent.^[64]
Cortisone injection into spots, also cortisone pills are sometimes used.
Comedo extraction
Heat: local heating may be used to kill the bacteria in a developing pimple and so speed healing.^[65]
Naproxen or ibuprofen^[66] are used for some moderate acne for their anti-inflammatory effect.
Nicotinamide, (Vitamin B3) used topically in the form of a gel, has been shown in a 1995 study to be of comparable efficacy to topical clindamycin topical antibiotic used for comparison.^[67] Topical nicotinamide is available both on prescription and over-the-counter. The property of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also purported to result in increased synthesis of collagen, keratin, involucrin and flaggrin and may also according to a cosmetic company be useful for reducing skin hyperpigmentation (acne scars), increased skin moisture and reducing fine wrinkles.^[68]
Pantothenic acid, (high dosage Vitamin B5)^[69]
Rofecoxib was shown to improve premenstrual acne vulgaris in a placebo controlled study.^[70]
Tea tree oil (melaleuca oil) dissolved in a carrier (5% strength) has been used with some success, where it is comparable to benzoyl peroxide but without excessive drying, kills P. acnes, and has been shown to be an effective anti-inflammatory in skin infections.^[61]^[71]^[72]
Toothpaste is very effective at getting rip of Acne spots by drying up the skin.
Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of inflammatory acne, although less so than tetracyclines.^[73]^[74]

Detoxification is a common method used by alternative medicine practitioners for the treatment of acne, although there have been no studies to prove its success. Detoxification is the process of cleansing the body of toxins purportedly caused by the environment, pharmaceutical drugs, food, and cosmetics.

Hepatitis C

2009-11-02T11:16:00.000-08:00

Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV).^[1] 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.^[1]

The hepatitis C virus (HCV) is spread by blood-to-blood contact. Most people have few, if any symptoms after the initial infection, yet the virus persists in the liver in about 85% of those infected. Persistent infection can be treated with medication, peginterferon and ribavirin being the standard-of-care therapy. 51% are cured overall. Those who develop cirrhosis or liver cancer may require a liver transplant, and the virus universally recurs after transplantation.

An estimated 270-300 million people worldwide are infected with hepatitis C. Hepatitis C is a strictly human disease. It cannot be contracted from or given to any animal. Chimpanzees can be infected with the virus in the laboratory, but do not develop the disease, which has made research more difficult. 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. Spontaneous viral clearance rates are highly variable and between 10–60%^[2] of persons infected with HCV clear the virus from their bodies during the acute phase as shown by normalization in liver enzymes (alanine transaminase (ALT) & aspartate transaminase (AST)), and plasma HCV-RNA clearance (this is known as spontaneous viral clearance). However, persistent infections are common^[3] and most patients develop chronic hepatitis C, i.e., infection lasting more than 6 months.^[4]^[5]^[6]

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.^[7]

Chronic

Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months. Clinically, it is often asymptomatic (without symptoms) and it is mostly discovered accidentally.

The natural course of chronic hepatitis C varies considerably from one person to another. Although almost all people infected with HCV have evidence of inflammation on liver biopsy the rate of progression of liver scarring (fibrosis) shows significant variability among individuals. Accurate estimates of the risk over time are difficult to establish because of the limited time that tests for this virus have been available.

Recent data suggest that among untreated patients, roughly one-third progress to liver cirrhosis in less than 20 years. Another third progress to cirrhosis within 30 years. The remainder of patients appear to progress so slowly that they are unlikely to develop cirrhosis within their lifetimes. In contrast the NIH consensus guidelines state that the risk of progression to cirrhosis over a 20-year period is 3-20 percent.^[8]

Factors that have been reported to influence the rate of HCV disease progression include age (increasing age associated with more rapid progression), gender (males have more rapid disease progression than females), alcohol consumption (associated with an increased rate of disease progression), HIV coinfection (associated with a markedly increased rate of disease progression), and fatty liver (the presence of fat in liver cells has been associated with an increased rate of disease progression).

Symptoms specifically suggestive of liver disease are typically absent until substantial scarring of the liver has occurred. However, hepatitis C is a systemic disease and patients may experience a wide spectrum of clinical manifestations ranging from an absence of symptoms to a more symptomatic illness prior to the development of advanced liver disease. Generalized signs and symptoms associated with chronic hepatitis C include fatigue, flu-like symptoms, joint pains, itching, sleep disturbances, appetite changes, nausea, and depression.

Once chronic hepatitis C has progressed to cirrhosis, signs and symptoms may appear that are generally caused by either decreased liver function or increased pressure in the liver circulation, a condition known as portal hypertension. Possible signs and symptoms of liver cirrhosis include ascites (accumulation of fluid in the abdomen), bruising and bleeding tendency, varices (enlarged veins, especially in the stomach and esophagus), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy. Hepatic encephalopathy is due to the accumulation of ammonia and other substances normally cleared by a healthy liver.

Liver enzyme tests show variable elevation of ALT and AST. Periodically they might show normal results. Usually prothrombin and albumin results are normal, but may become abnormal, once cirrhosis has developed. The level of elevation of liver tests do not correlate well with the amount of liver injury on biopsy. Viral genotype and viral load also do not correlate with the amount of liver injury. Liver biopsy is the best test to determine the amount of scarring and inflammation. Radiographic studies such as ultrasound or CT scan do not always show liver injury until it is fairly advanced. However, non-invasive tests (blood sample) are coming, with FibroTest^[9] and ActiTest, respectively estimating liver fibrosis and necrotico-inflammatory. These tests are validated^[10] and recommended in Europe (FDA procedures initiated in USA)

Chronic hepatitis C, more than other forms of hepatitis, can be associated with extrahepatic manifestations associated with the presence of HCV such as porphyria cutanea tarda, cryoglobulinemia (a form of small-vessel vasculitis)^[11] and glomerulonephritis (inflammation of the kidney), specifically membranoproliferative glomerulonephritis (MPGN).^[12] Hepatitis C is also rarely associated with sicca syndrome (an autoimmune disorder), thrombocytopenia, lichen planus, diabetes mellitus and with B-cell lymphoproliferative disorders.^[13]

Virology

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 sexual exposure. 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 is 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 that causes open sores and bleeding is also present and makes blood contact more likely.^[14].

Transmission

Sexual activities and practices were initially identified as potential sources of exposure to the hepatitis C virus. More recent studies question this route of transmission. Currently it is felt to be a means of rare transmission of hepatitis C infection. These are simply the current known modes of transmission and due to the nature of Hepatitis there may be more ways that it is transmitted than the current known methods.

Injection drug use

Those who currently use or have used drug injection as their delivery route for 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.^[15] 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 USA.

Blood products

Blood transfusion, blood products, or organ transplantation prior to implementation of HCV screening (in the U.S., this would refer to procedures prior to 1992) is a decreasing risk factor for hepatitis C.

The virus was first isolated in 1989 and reliable tests to screen for the virus were not available until 1992. Therefore, those who received blood or blood products prior to the implementation of screening the blood supply for HCV may have been exposed to the virus. Blood products include clotting factors (taken by hemophiliacs), immunoglobulin, Rhogam, platelets, and plasma. In 2001, the Centers for Disease Control and Prevention reported that the risk of HCV infection from a unit of transfused blood in the United States is less than one per million transfused units.

Iatrogenic medical or dental exposure

People can be exposed to HCV via inadequately or improperly sterilized medical or dental equipment. Equipment that may harbor contaminated blood if improperly sterilized includes needles or syringes, hemodialysis equipment, oral hygiene instruments, and jet air guns, etc. Scrupulous use of appropriate sterilization techniques and proper disposal of used equipment can reduce the risk of iatrogenic exposure to HCV to virtually zero.

Occupational exposure to blood

Medical and dental personnel, first responders (e.g., firefighters, paramedics, emergency medical technicians, law enforcement officers), and military combat personnel can be exposed to HCV through accidental exposure to blood through accidental needlesticks or blood spatter to the eyes or open wounds. Universal precautions to protect against such accidental exposures significantly reduce the risk of exposure to HCV.

Recreational exposure to blood

Contact sports and other activities, such as "slam dancing" that may result in accidental blood-to-blood exposure are potential sources of exposure to HCV.^[16]

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.^[17]^[18] 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).^[19] 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).^[20]

Body piercings and tattoos

Tattooing dyes, ink pots, stylets and piercing implements can transmit HCV-infected blood from one person to another if proper sterilization techniques are not followed. Tattoos or piercings performed before the mid 1980s, "underground," or non-professionally are of particular concern since sterile techniques in such settings may have been or be insufficient to prevent disease. Despite these risks, it is rare for tattoos to be directly associated with HCV infection and the U.S. Centers for Disease Control and Prevention's position on this subject states that, "no data exist in the United States indicating that persons with exposures to tattooing alone are at increased risk for HCV infection."^[21]

Shared personal care items

Personal care items such as razors, toothbrushes, cuticle scissors, and other manicuring or pedicuring equipment can easily be contaminated with blood. Sharing such items can potentially lead to exposure to HCV. Appropriate caution should be taken regarding any medical condition which results in bleeding such as canker sores, cold sores, and immediately after flossing.

HCV is not spread through casual contact such as hugging, kissing, or sharing eating or cooking utensils.^[22]

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.

Diagnosis

The diagnosis of "hepatitis C" is rarely made during the acute phase of the disease because the majority of people infected experience no symptoms during this phase of the disease. Those who do experience acute phase symptoms are rarely ill enough to seek medical attention. The diagnosis of chronic phase hepatitis C is also challenging due to the absence or lack of specificity of symptoms until advanced liver disease develops, which may not occur until decades into the disease.

Chronic hepatitis C may be suspected on the basis of the medical history (particularly if there is any history of IV drug abuse or inhaled substance usage such as cocaine), a history of piercings or tattoos, unexplained symptoms, or abnormal liver enzymes or liver function tests found during routine blood testing. Occasionally, hepatitis C is diagnosed as a result of targeted screening such as blood donation (blood donors are screened for numerous blood-borne diseases including hepatitis C) or contact tracing.

Hepatitis C testing begins with serological blood tests used to detect antibodies to HCV. Anti-HCV antibodies can be detected in 80% of patients within 15 weeks after exposure, in >90% within 5 months after exposure, and in >97% by 6 months after exposure. Overall, HCV antibody tests have a strong positive predictive value for exposure to the hepatitis C virus, but may miss patients who have not yet developed antibodies (seroconversion), or have an insufficient level of antibodies to detect. Rarely, people infected with HCV never develop antibodies to the virus and therefore, never test positive using HCV antibody screening. Because of this possibility, RNA testing (see nucleic acid testing methods below) should be considered when antibody testing is negative but suspicion of hepatitis C is high (e.g. because of elevated transaminases in someone with risk factors for hepatitis C).

Anti-HCV antibodies indicate exposure to the virus, but cannot determine if ongoing infection is present. All persons with positive anti-HCV antibody tests must undergo additional testing for the presence of the hepatitis C virus itself to determine whether current infection is present. The presence of the virus is tested for using molecular nucleic acid testing methods such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), or branched DNA (b-DNA). All HCV nucleic acid molecular tests have the capacity to detect not only whether the virus is present, but also to measure the amount of virus present in the blood (the HCV viral load). The HCV viral load is an important factor in determining the probability of response to interferon-based therapy, but does not indicate disease severity nor the likelihood of disease progression.

In people with confirmed HCV infection, genotype testing is generally recommended. HCV genotype testing is used to determine the required length and potential response to interferon-based therapy.

Treatment

There is a very small chance of clearing the virus spontaneously in chronic HCV carriers (0.5% to 0.74% per year).^[23]^[24] However, the majority of patients with chronic hepatitis C will not clear it without treatment.

Current treatment is a combination of Pegylated interferon-alpha-2a or Pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on hepatitis C virus genotype. Treatment is generally recommended for patients with proven hepatitis C virus infection and persistently abnormal liver function tests. Sustained cure rates (sustained viral response) of 75% or better are seen in people with HCV genotypes 2 and 3 with 24 weeks of treatment.^[25] Sustained responses are rarer with other genotypes, at about 50% in patients with HCV genotype 1 given 48 weeks of treatment and 65% in those with genotype 4 given 48 weeks of treatment. Approximately 80% of hepatitis C patients in the United States have genotype 1. Genotype 4 is more common in the Middle East and Africa.

In patients with HCV genotype 1, if treatment with pegylated interferon + ribavirin does not produce a 2-log viral load reduction or complete clearance of RNA (termed "early virological response") after 12 weeks the chance of treatment success is less than 1%. Early virological response is typically not tested in non-genotype 1 patients, as the chances of attaining it are greater than 90%. The mechanism of cure is not entirely clear, because even patients who appear to have a sustained virological response still have actively replicating virus in their liver and peripheral blood mononuclear cells.^[26]

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.^[27] 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.

Host genetic factors influencing treatment response

For genotype 1 hepatitis C treated with Pegylated_interferon-alpha-2a or Pegylated_interferon-alpha-2b (brand names Pegasys or PEG-Intron) combined with ribavirin, it has been shown that genetic polymorphisms near the human IL28B gene, encoding interferon lambda 3, are associated with significant differences in response to the treatment. This finding, originally reported in Nature ^[28], showed that genotype 1 hepatitis C patients carrying certain genetic variant alleles near the IL28B gene are more possibly to achieve sustained sustained virological response after the treatment than others. Later report from Nature ^[29] demonstrated that the same genetic variants are also associated with the natural clearance of the genotype 1 hepatitis C virus.

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 who 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.^[30]

Alternative therapies

Several alternative therapies aim to maintain liver functionality, rather than treat the virus itself, thereby slowing the course of the disease to retain quality of life. As an example, extract of Silybum marianum and Sho-saiko-to are sold for their HCV related effects; the first is said to provide some generic help to hepatic functions, and the second claims to aid in liver health and provide some antiviral effects.^[31]. There has never been any verifiable histologic or virologic benefit demonstrated with any of the alternative therapies.

Experimental treatments

The drug viramidine, which is a prodrug of ribavirin that has better targeting for the liver, and therefore may be more effective against hepatitis C for a given tolerated dose, is in phase III experimental trials against hepatitis C. It will be used in conjunction with interferons^{[disambiguation needed]}, in the same manner as ribavirin. However, this drug is not expected to be active against ribavirin-resistant strains, and the use of the drug against infections which have already failed ribavirin/interferon treatment, is unproven.

There are new drugs under development like the protease inhibitors (including VX 950) and polymerase inhibitors (such as NM 283), but development of some of these is still in the early phase. VX 950, also known as Telaprevir^[32] is currently in Phase 3 Trials. ^[33]^[34] One protease inhibitor, BILN 2061, had to be discontinued due to safety problems early in the clinical testing. Some more modern new drugs that provide some support in treating HCV are Albuferon,^[35] Zadaxin,^[36] and DAPY.^{[citation needed]} Antisense phosphorothioate oligos have been targeted to hepatitis C.^[37] Antisense Morpholino oligos have shown promise in preclinical studies^[38] however, they were found to cause a limited viral load reduction.

Immunoglobulins against the hepatitis C virus exist and newer types are under development. Thus far, their roles have been unclear as they have not been shown to help in clearing chronic infection or in the prevention of infection with acute exposures (e.g. needlesticks). They do have a limited role in transplant patients.

In addition to the standard treatment with interferon and ribavirin, some studies have shown higher success rates when the antiviral drug amantadine (Symmetrel) is added to the regimen. Sometimes called "triple therapy", it involves the addition of 100 mg of amantadine twice a day. Studies indicate that this may be especially helpful for "nonresponders" - patients who have not been successful in previous treatments using interferon and ribavirin only.^[39] Currently, amantadine is not approved for treatment of Hepatitis C, and studies are ongoing to determine when it is most likely to benefit the patient.

Among the more novel treatments under development is the Hemopurifier(R),^[40] a first-in-class medical device that selectively removes infectious viruses and immunosuppressive proteins from the bloodstream. In HCV care, the Hemopurifier(R) inhibits viral replication through selective adsorption of circulating HCV and augments the immune response by removing toxic proteins shed from HCV to kill-off immune cells. Recent clinical data validates the mechanical removal of HCV through blood filtration in combination with SOC therapy can increase HCV cure rates by greater than 50%. Studies are ongoing at the Fortis Hospital in New Dehli, India.

Epidemiology

It is estimated that Hepatitis C has infected nearly 200 million people worldwide, and infects 3-4 million more people per year.^[41]^[42] There are about 35,000 to 185,000 new cases a year in the United States. It is currently a leading cause of cirrhosis, a common cause of hepatocellular carcinoma, and as a result of these conditions it is the leading reason for liver transplantation in the United States. Co-infection with HIV is common and rates among HIV positive populations are higher. 10,000-20,000 deaths a year in the United States are from HCV; expectations are that this mortality rate will increase, as those who were infected by transfusion before HCV testing become apparent. A survey conducted in California showed prevalence of up to 34% among prison inmates;^[43] 82% of subjects diagnosed with hepatitis C have previously been in jail,^[44] and transmission while in prison is well described.^[45]

Prevalence is higher in some countries in Africa and Asia.^[46] Egypt has the highest seroprevalence for HCV, up to 20% in some areas. There is a hypothesis that the high prevalence is linked to a now-discontinued mass-treatment campaign for schistosomiasis, which is endemic in that country.^[47] Regardless of how the epidemic started, a high rate of HCV transmission continues in Egypt, both iatrogenically and within the community and household.

Co-infection with HIV

Approximately 350,000, or 35% of patients in the USA infected with HIV are also infected with the hepatitis C virus, mainly because both viruses are blood-borne and present in similar populations. In other countries co-infection is less common, and this is possibly related to differing drug policies.^{[citation needed]} HCV is the leading cause of chronic liver disease in the USA. It has been demonstrated in clinical studies that HIV infection causes a more rapid progression of chronic hepatitis C to cirrhosis and liver failure. This is not to say treatment is not an option for those living with co-infection.

Prevention

According to Centers for Disease Control, hepatitis C virus is spread by exposure to large quantities of blood, either through the skin or by injection:^[48]

Injection drug use (currently the most common means of HCV transmission in the United States)
Receipt of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
Needlestick injuries in healthcare settings
Birth to an HCV-infected mother

HCV can also be spread infrequently through

Sex with an HCV-infected person (an inefficient means of transmission)
Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also inefficient vectors of transmission)
Other healthcare procedures that involve invasive procedures, such as injections (usually recognized in the context of outbreaks)

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.^[49]

History

In the mid 1970s, Harvey J. Alter, Chief of the Infectious Disease Section in the Department of Transfusion Medicine at the National Institutes of Health, and his research team demonstrated that most post-transfusion hepatitis cases were not due to hepatitis A or B viruses. Despite this discovery, international research efforts to identify the virus, initially called non-A, non-B hepatitis (NANBH), failed for the next decade. In 1987, Michael Houghton, Qui-Lim Choo, and George Kuo at Chiron Corporation, collaborating with Dr. D.W. Bradley from CDC, utilized a novel molecular cloning approach to identify the unknown organism.^[50] In 1988, the virus was confirmed by Alter by verifying its presence in a panel of NANBH specimens. In April of 1989, the discovery of the virus, re-named hepatitis C virus (HCV), was published in two articles in the journal Science. ^[51]^[52]

Chiron filed for several patents on the virus and its diagnosis.^[53] A competing patent application by the CDC was dropped in 1990 after Chiron paid $1.9 million to the CDC and $337,500 to Bradley. In 1994 Bradley sued Chiron, seeking to invalidate the patent, have himself included as a co-inventor, and receive damages and royalty income. He dropped the suit in 1998 after losing before an appeals court.^[54] ^[55]

In 2000, Drs. Alter and Houghton were honored with the Lasker Award for Clinical Medical Research for "pioneering work leading to the discovery of the virus that causes hepatitis C and the development of screening methods that reduced the risk of blood transfusion-associated hepatitis in the U.S. from 30% in 1970 to virtually zero in 2000."^[56]

In 2004 Chiron held 100 patents in 20 countries related to hepatitis C and had successfully sued many companies for infringement. Scientists and competitors have complained that the company hinders the fight against hepatitis C by demanding too much money for its technology

Treatment for depression

2009-11-02T10:55:00.000-08:00

Depression, for the purposes of this article, refers to the mental disorder known as major depressive disorder. This kind of depression is a recognised clinical condition and is becoming a common condition in developed countries, where up to 20% of the population is affected by this disorder at some stage of their lives.^[1] Patients are usually assessed and managed as outpatients, and only admitted to an inpatient mental health unit if they are considered to pose a risk to themselves or others.

The three most commonly indicated treatments for depression are psychotherapy, psychiatric medication, and electroconvulsive therapy. Psychotherapy is the treatment of choice in those under the age of 18, with medication offered only in conjunction with the former and generally not as a first line agent. Furthermore, pathology in the parents may need to be looked for and addressed in parallel.^[2]

Psychotherapy

There are a number of different psychotherapies for depression, which may be provided to individuals or groups. Psychotherapy can be delivered by a variety of mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers, counselors, and psychiatric nurses. With more complex and chronic forms of depression the most effective treatment is often considered to be a combination of medication and psychotherapy.^[3] Psychotherapy is the treatment of choice in people under 18; medication is offered only in conjunction with the former and generally not as a first line agent. ^[2]

The most studied form of psychotherapy for depression is cognitive behavioral therapy (CBT), thought to work by teaching clients to learn a set of cognitive and behavioral skills, which they can employ on their own. Earlier research suggested that cognitive-behavioral therapy was not as effective as antidepressant medication in the treatment of depression; however, more recent research suggests that it can perform as well as antidepressants in treating patients with moderate to severe depression.^[4]

For the treatment of adolescent depression, CBT performed no better than placebo, and significantly worse than the antidepressant fluoxetine.^[5] Combining fluoxetine with CBT appeared to bring no additional benefit^[6]^[7] or, at the most, only marginal benefit.^[8]

A review of four studies on the effectiveness of mindfulness-based cognitive therapy (MBCT), a recently developed class-based program designed to prevent relapse, suggests that MBCT may have an additive effect when provided with the usual care in patients who have had three or more depressive episodes, although the usual care did not include antidepressant treatment or any psychotherapy, and the improvement observed may have reflected non-specific or placebo effects.^[9]

Interpersonal psychotherapy focuses on the social and interpersonal triggers that may cause depression. There is evidence that it is an effective treatment for depression. Here, the therapy takes a structured course with a set number of weekly sessions (often 12) as in the case of CBT, however the focus is on relationships with others. Therapy can be used to help a person develop or improve interpersonal skills in order to allow him or her to communicate more effectively and reduce stress.^[10]

Psychoanalysis, a school of thought founded by Sigmund Freud that emphasizes the resolution of unconscious mental conflicts,^[11] is used by its practitioners to treat clients presenting with major depression.^[12] A more widely practiced, eclectic technique, called psychodynamic psychotherapy, is loosely based on psychoanalysis and has an additional social and interpersonal focus.^[13] In a meta-analysis of three controlled trials, psychodynamic psychotherapy was found to be as effective as medication for mild to moderate depression.^[14]

Medication

Main article: Antidepressant

To find the most effective pharmaceutical treatment, the dosages of medications must often be adjusted, different combinations of antidepressants tried, or antidepressant changed. Response rates to the first agent administered may be as low as 50%.^[15] It may take anywhere from three to eight weeks after the start of medication before its therapeutic effects can be fully discovered. Patients are generally advised not to stop taking an antidepressant suddenly and to continue its use for at least four months to prevent the chance of recurrence. People with chronic depression need to take the medication for the rest of their lives.^[16]

Isoniazid, the first compound called antidepressant

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine, and citalopram are the primary medications considered, due to their relatively mild side effects and broad effect on the symptoms of depression and anxiety. Those who do not respond to the first SSRI tried can be switched to another; such a switch results in improvement in almost 50% of cases.^[17] Another popular option is to switch to the atypical antidepressant bupropion (Wellbutrin) or to add bupropion to the existing therapy;^[18] this strategy is possibly more effective.^[19]^[20] It is not uncommon for SSRIs to cause or worsen insomnia; the sedating antidepressant mirtazapine (Zispin, Remeron) can be used in such cases.^[21]^[22]^[23] Venlafaxine (Effexor) may be moderately more effective than SSRIs;^[24] however, it is not recommended as a first-line treatment because of the higher rate of side effects,^[25] and its use is specifically discouraged in children and adolescents.^[26] Fluoxetine is the only antidepressant recommended for people under the age of 18.^[26]

Tricyclic antidepressants have more side effects than SSRIs and are usually reserved for the treatment of inpatients, for whom the tricyclic antidepressant amitriptyline, in particular, appears to be more effective.^[27]^[28] A different class of antidepressants, the monoamine oxidase inhibitors, have historically been plagued by questionable efficacy and life-threatening adverse effects. They are still used only rarely, although newer agents of this class (RIMA), with a better side effect profile, have been developed.^[29]

Augmentation

Physicians often add a medication with a different mode of action to bolster the effect of an antidepressant in cases of treatment resistance; a 2002 large community study of 244,859 depressed Veterans Administration patients found that 22% had received a second agent, most commonly a second antidepressant.^[30] Lithium has been used to augment antidepressant therapy in those who have failed to respond to antidepressants alone.^[31] Furthermore, lithium dramatically decreases the suicide risk in recurrent depression.^[32] Addition of atypical antipsychotics when the patient has not responded to an antidepressant is also known to increase the effectiveness of antidepressant drugs, albeit at the cost of more frequent side effects.^[33] There is some evidence for the addition of a thyroid hormone, triiodothyronine, in patients with normal thyroid function.^[34]

Efficacy of medication and psychotherapy

Two recent meta-analyses of clinical trial results submitted to the FDA concluded that antidepressants are statistically superior to placebo but their overall effect is low-to-moderate. In that respect they often did not exceed the National Institute for Health and Clinical Excellence criteria for a "clinically significant" effect. In particular, the effect size was very small for moderate depression but increased with severity reaching "clinical significance" for very severe depression.^[35]^[36] These result were consistent with the earlier clinical studies in which only patients with severe depression benefited from either psychotherapy or treatment with an antidepressant, imipramine, more than from the placebo treatment.^[37]^[38]^[39] Despite obtaining similar results, the authors argued about their interpretation. One author concluded that there "seems little evidence to support the prescription of antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide benefit."^[35] The other author agreed that "antidepressant 'glass' is far from full" but disagreed "that it is completely empty". He pointed out that the first-line alternative to medication is psychotherapy, which does not have superior efficacy.^[40]

Antidepressants in general are as effective as psychotherapy for major depression, and this conclusion holds true for both severe and mild forms of MDD.^[41]^[42] In contrast, medication gives better results for dysthymia.^[41]^[42] The subgroup of SSRIs may be slightly more efficacious than psychotherapy. On the other hand, significantly more patients drop off from the antidepressant treatment than from psychotherapy, likely because of the side effects of antidepressants.^[41] Successful psychotherapy appears to prevent the recurrence of depression even after it has been terminated or replaced by occasional "booster" sessions. The same degree of prevention can be achieved by continuing antidepressant treatment.^[42]

Two studies suggest that the combination of psychotherapy and medication is the most effective way to treat depression in adolescents. Both TADS (Treatment of Adolescents with Depression Study) and TORDIA (Treatment of Resistant Depression in Adolescents)showed very similar results. TADS resulted in 71 percent of their teen subjects having a “much” or “very much” improvement in mood over the 60.6 with medication alone and the 43.2 with CBT alone ^[43]. Similarly, TORDIA showed a 54.8 percent improvement with CBT and drugs verses a 40.5 percent with drug therapy alone ^[44].

Other medications

There are numerous alternative treatments for depression, whether medications or other kinds of intervention.

Opiates

Various Opiates were commonly used as antidepressants until the mid-1950s, when they fell out of favor with medical orthodoxy due to their addictive nature, tolerance buildup issues and their side-effect profile. Today the use of opioids in treating depression is a large taboo in the medical field due to associations with drug abuse; hence, research has proceeded at a very slow rate. A small clinical trial conducted at Harvard Medical School in 1995,^[45] demonstrated that a majority of treatment-refractory, unipolar, non-psychotic, major depression patients could be successfully treated with an opioid medication called Buprenorphine, which is a partial mu agonist and potent kappa antagonist. The exact mechanism of its action in depression is not known, as kappa (κ) antagonists are antidepressants in their own right.

In 2006, The Journal of European Neuropsychopharmacology published a follow-up study to the 1995 Harvard experiment, with results consistent with the original Harvard findings. Eleven severely depressed patients, refractory to all the conventional depression treatments, were given small doses of buprenorphine. Most of these patients found the buprenorphine to be of significant benefit. The researchers theorized that "Possibly, the response to opiates describes a special subtype of depressive disorders e.g. corresponding to a dysregulation of the endogenous opioid system and not of the monaminergic system."^[46]

Another scientific paper was published in the American Journal of Psychiatry in 1999, detailing how researchers found Oxycodone/Oxymorphone to help 5 out of 6 'incurable' refractory severe depression patients.^[47]

While opioids have been proven to substantially relieve symptoms of depression for a large class of patients, re-acceptance of this fact has been severely hampered by governmental narcotic prohibition efforts^{[citation needed]}, and the (until buprenorphine) lack of alternatives with low risk of tolerance and addiction. Buprenorphine is generally preferred as the first-line opiate in depression treatment^{[citation needed]}, as managing the tolerance buildup of other opiates can be complicated.^{[citation needed]}

Opiorphin is a very recently discovered substance that increases the effectiveness of endorphins, meaning that it has effects similar to opioid agonists without the addiction and withdrawal effects. While it has been shown to be extremely effective for analgesia, any ability to treat depression or the presence of an abuse potential are largely informed guesswork at this stage.

Other treatments

Gamma-Hydroxybutyric acid (GHB) has been used by some as an antidepressant. Claude Rifat, a French biologist, conducted some early research into GHB's antidepressant potential. Rifat noted that GHB did not cause the emotional blunting effects caused by conventional antidepressants, but instead intensified pleasurable and rewarding feelings in the user while powerfully suppressing depression.^[48] However, GHB has now been outlawed, except for use as a prescription treatment for narcolepsy.
NMDA antagonists such as ketamine and dextromethorphan have recently gained some interest in this field as their apparent ability to reverse opioid tolerance, and can give fast-acting dramatic effects. However, their acute psychoactive effects have been a problem.^[49]
Memantine, a moderate affinity NMDA antagonist, has been used to avoid tolerance buildup, and has seen use in opioid tolerance reversal. Proglumide is used to induce acute reversal of tolerance prior to this maintenance strategy; it does not work by itself in the long term, due to tolerance to its effects.
Marijuana - The use of marijuana, in moderation, has shown to be of benefit in severely depressed patients. Many people that do not respond well to the use of traditional antidepressants, or who do not like the many unpleasant side effects, prove to do rather well using this plant in moderation.

Electroconvulsive therapy

Main article: Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a treatment where seizures are electrically induced in anesthetized patients for therapeutic effect. ECT is most often used as a "last resort" (from the perspective of hospital psychiatrists) for severe major depression which has not responded to trials of antidepressant or, less often, psychotherapy or supportive interventions.^[50] It has a quicker effect than antidepressant therapy, and thus may be the treatment of choice in emergencies such as catatonic depression where the patient has ceased oral intake of fluid or nutrients, or where there is severe suicidality.^[50] Some evidence suggests it is the most effective treatment for depression in the short-term^[51] and one study, without a comparison group or assessment of additional treatments given, suggested that in the minority who remit it may be related to improved self-rated quality of life in both the short-term (which was correlated with the degree of amnesia) and after six months.^[52] However, the first systematic documentation of the effectiveness of ECT in community practice in the 65 years of its use found much lower remission rates than in prior research, and most of those relapsed.^[53] ECT on its own does not usually have a sustained benefit, as virtually all those who remit end up relapsing within 6 months following a course, even when given a placebo.^[54] The relapse rate in the first six months may be reduced by the use of psychatric medications or further ECT (though the latter is not recommended by some authorities, such as NICE), but remains high.^[55]^[56] Short-term memory loss, disorientation, headache and other adverse effects are common, as are long-term memory^[57] and other neurocognitive deficits, which may persist. The American Psychiatric Association and the National Institute for Health and Clinical Excellence have concluded that the evidence they had suggested that the procedure, when administered according to their standards and without complications, does not cause brain damage in adults.^[58]^[59]

Other conventional methods of treatment

St John's wort

St John's wort extract is used extensively in Europe to treat mild and moderate depression. It is a prescription antidepressant in several European countries but is classified as an herbal supplement and sold over the counter in the U.S. Opinions on its efficacy for major depression differ. A systematic meta-analysis of 37 trials conducted by Cochrane Collaboration indicated statistically significant weak-to-moderate effect as compared to placebo. The same meta-analysis found that St John's wort efficacy for major depression is not different from prescription antidepressants.^[60] NCCAM and other NIH-affiliated organizations hold that St John's wort has minimal or no effects beyond placebo in the treatment of major depression, based primarily on one study with negative outcome conducted by NCCAM.^[61]^[62]

SAMe

S-Adenosyl methionine (SAMe) is available as a prescription antidepressant in Europe and an over-the-counter dietary supplement in the United States. Fairly strong evidence from 16 clinical trials suggests it to be more effective than placebo and as effective as standard antidepressant medication for the treatment of major depression.^[63]^[64]^[65]

Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) use in treatment-resistant depression is supported by multiple controlled studies, and it has been approved for this indication in Europe, Canada and Australia, but not in the U.S.^[66] A 2008 meta-analysis based on 32 trials found a robust effect of this method on depression, and it appeared similarly effective for both uncomplicated depression and depression resistant to medication.^[67] However, it was inferior to ECT in a side-by-side randomized trial.^[68]

Vagus nerve stimulation

Vagus nerve stimulation (VNS) uses an implanted electrode and generator to deliver electrical pulses to the vagus nerve, one of the primary nerves emanating from the brain. It is an approved therapy for treatment-resistant depression and is sometimes used as an adjunct to existing antidepressant treatment. The support for this method comes mainly from open-label trials, which indicate that several months may be required to see a benefit.^[66] The only large double-blind trial conducted lasted only 10 weeks and yielded inconclusive results; VNS failed to show superiority over a sham treatment on the primary efficacy outcome, but the results were more favorable for the secondary outcome.^[69]

Alternative treatment methods

Bright light therapy

Bright light therapy is sometimes used to treat depression, especially in its seasonal form.

A meta-analysis of bright light therapy commissioned by the American Psychiatric Association found it to be more effective than placebo—usually, dim light—for both seasonal affective disorder and for nonseasonal depression, with effect sizes similar to those for conventional antidepressants. For non-seasonal depression, adding light therapy to the standard antidepressant treatment was not effective.^[70] A meta-analysis of light therapy for non-seasonal depression conducted by Cochrane Collaboration, studied a different set of trials, where light was used mostly as an addition to medication or sleep deprivation. A moderate statistically significant effect of light therapy was found; however, it disappeared if a different statistical technique was used.^[71] Both analyses noted poor quality of most studies and their small size, and urged caution in the interpretation of their results. The short 1–2 weeks duration of most trials makes it unclear whether the effect of light therapy could be sustained in the longer term.

Acupuncture

A 2004 Cochrane Review concluded that based on the low quality of the evidence base there is "insufficient evidence to determine whether acupuncture is effective in the management of depression."^[72] Clinical trials have shown the effect of acupuncture to be comparable with amitriptyline; in addition, specifically Electroacupuncture has been found to be more effective in depressive patients with decreased excretion of 3-methyl-4-hydroxy-phenylglycol (the principal metabolite of the central neurotransmitter norepinephrine), while amitriptyline is more effective for those with inhibition in the dexamethasone suppression test.^[73] Acupuncture has also been proven to prompt the body to produce greater levels of endorphins.^[74]

Exercise

"A 2001 study by the Duke University in North Carolina found that exercise is a more effective treatment for depression than antidepressants, with fewer relapses and a higher recovery rate."^[75] An earlier Duke study likewise found patients who completed 30 minutes of brisk exercise at least three times a week had a significantly lower incidence of relapse; "Only 8 percent of patients in the exercise group had their depression return, while 38 percent of the drug-only group and 31 percent of the exercise-plus-drug group relapsed."^[76]

Vigorous exercise has significant physiological effects which help to reduce stress and counter depression. Also, by improving fitness and self-esteem, exercise may enable the sufferer to cope better with demanding events and situations and so reduce the likelihood of depressing failure.^[77]

Exercise in natural surroundings such as the countryside or parks is especially recommended because contact with nature and green spaces has a positive effect upon mental health.^[78] Gardening is an ideal activity of this sort, providing mental, practical and social benefits.^[79]

Deep Brain Stimulation

The support for the use of deep brain stimulation in treatment-resistant depression comes from a handful of case studies, and this treatment is still in a very early investigational stage.^[66]

Tryptophan

Although tryptophan and 5-hydroxytryptophan may be more effective than placebo in alleviating depression according to the Cochrane Collaboration meta-analysis, only 2 out of 108 trials were of sufficient quality to be included in this analysis. The reviewers concluded that they were unable to recommend the drugs for use in major depression.^[80]

Tryptophan is the precursor of the neurotransmitter serotonin. It has shown some promise as an antidepressant alone^[81] and as an augmenter of antidepressant drugs.^[81]^[82] Foods rich in tryptophan include chickpeas, milk products, eggs, pork, beef, chicken, fish, oats, dates, mangoes, seeds, nuts and spirulina.

Low fructose diet

Fructose malabsorption is poor absorption of fructose and fructans in the intestines. Subjects with this condition show a significantly higher score in the Beck Depression Inventory than normal fructose absorbers.^[83] Some minerals and amino acids (among others, tryptophan) are also poorly absorbed. Because of the inadequate supply of precursor molecules, some hormones and neurotransmitters (among others, serotonin) may not be synthesized in sufficient quantities.^[84] Treatment is a diet that is low in fructose, fructans and sorbitol. Depression scores were reduced by 65.2% after four weeks on this diet.^[85]

Omega-3 fatty acids

Omega-3 fatty acids have been studied in clinical trials for major depression primarily as an adjunctive to antidepressant therapy. A meta-analysis of eight such trials indicated a statistically significant superiority of combinations with omega-3 fatty acids over single antidepressants; however, the authors warned that, due to multiple problems with these trials, a reliable conclusion is difficult to achieve.^[86]

Omega-3 fatty acids have been shown to help many people with depression, the theory being that Omega-3 helps nourish brain cells that release serotonin into the brain. Omega-3 fatty acids are present, for example, in cold-water fish such as salmon, in flax seed, in fish oil capsules and in flax seed capsules.

"Several epidemiological studies suggest covariation between seafood consumption and rates of mood disorders. Biological marker studies indicate deficits in omega-3 fatty acids in people with depressive disorders, while several treatment studies indicate therapeutic benefits from omega-3 supplementation. A similar contribution of omega-3 fatty acids to coronary artery disease may explain the well-described links between coronary artery disease and depression. Deficits in omega-3 fatty acids have been identified as a contributing factor to mood disorders and offer a potential rational treatment approach." (American Journal of Psychiatry 163:969-978, June 2006)^[87]

DHEA

Dehydroepiandrosterone (DHEA), a metabolic precursor for several hormones including estrogen and testosterone, has been promoted as a remedy for many ailments. Sold in the 1970s and 1980s as a weight-loss aid, it was subsequently banned for over-the-counter sale, but then unbanned, and is currently available as a supplement in the US. It has been shown to be more effective than placebo in two small double-blind trials: in one as an adjunct to antidepressant treatment,^[88] and as monotherapy in another.^[89] However, a larger placebo-controlled randomized clinical trial reported in the New England Journal of Medicine in 2006 found that DHEA supplementation in elderly men and women had no beneficial effects on quality of life.^[90]

Chromium picolinate

Chromium picolinate was found to be equivalent to placebo for atypical depression overall but possibly efficacious in the sub-group of patients with severe carbohydrate craving.^[91]

Zinc

Zinc supplementation was found in a small study to augment the effect of antidepressants.^[92]

Serum levels of zinc are found to be low in depressed patients and supplementation with zinc has been demonstrated to be of benefit.^[93] Most of the zinc found in the human body are located in the brain, mainly in the hippocampus and cerebral cortex area. Lack of zinc influences zinc homeostasis and leads to a change in learning, behavior, mood swings, mental function and epilepsy. Zinc is found in beans, meat, nuts, oysters, whole grains and seeds.

Lithium

In the late 1800s there was a vogue for consumption of lithia water which contained a significant quantity of lithium. Some claimed that this cured depression, but its effectiveness is not clear.^[94]

In May 2009, the BBC reported that a Japanese study of lithium in drinking water in the Japan prefecture of Oita, which has a population of more than one million, revealed that the suicide rate was significantly lower in those areas with the highest levels of lithium.^[95]

Lithium is also used as the standard drug to treat different mood disorders including depression. See Lithium_pharmacology.

Magnesium

Magnesium deficiency is common and may cause depression. Supplementation or changes in diet may therefore be helpful.^[96] Foodstuffs rich in magnesium include whole grains, beans and seeds, halibut and spinach.

Cranial electrotherapy stimulation

Cranial electrotherapy stimulation (CES, electrosleep) devices currently on the market have been granted marketing authorization by the FDA based on the legacy waver, that is because a sufficiently similar device had been marketed before 1976, when the new regulations requiring controlled testing were introduced.^[97] The FDA considers them to be the class III devices—"devices for which insufficient information exists to ... provide reasonable assurance of safety and effectiveness"^[98] The effects of CES on depression were inconclusive or negative in multiple double-blind studies of psychiatric patients.^[99]^[100]^[100]^[101]^[102]^[103] In one of them, four out of six clinically depressed patients dropped out of the study because of the massive worsening of depressive symptoms, with two of them becoming actively suicidal.^[103] One of the authors of the latter study cautioned that CES “should not be used as a treatment of choice” for the patients with the primary diagnosis of depression, “and should be used with caution if this diagnosis is suspected.”^[104] Nevertheless, the CES practitioners continue to employ it as a treatment of choice for depression.^[105]^[106]

Eleuthero

Eleutherococcus senticosus is used in Traditional Chinese Medicine and is now used in the West as Eleuthero or Siberian Ginseng. The plant is an adaptogen or tonic and has been shown to have significant antidepressant effects in rats.^[107]^[108]

Saffron

Saffron, the flowers of Crocus sativus have been shown to have antidepressant properties.^[109] Two of the active ingredients are crocin and safranal.^[109]

Inositol (Vitamin B₈)

Inositol or vitamin B₈ has been shown to be an effective treatment for depression, bipolar disorder and obsessive-compulsive disorder^[110]^[111]^[112] and panic attacks. The therapeutic dosage of inositol seems to be between 6-20 g/day, with 12-18 g/day being more likely an effective dosage.^[113]

Kanna

Kanna (Sceletium tortuosum) is a succulent herb commonly found in South Africa. In doses as low as 50 mg, users have reported improvements in mood, decreased anxiety, relaxation and a sense of well-being. It contains about 1-1.5% alkaloids and those which are believed to be psychoactive include mesembrine, mesembrenone, mesembrenol and tortuosamine.^[114]

There is about 0.3% mesembrine in the leaves and 0.86% in the stems of the plant.^[115] This has been shown to be a potent serotonin reuptake inhibitor.^[116]

Flower remedies

Bach flower remedies and Australian bush flower essences are prepared from various flowers. Current clinical evidence does not support any hypothesized action or efficacy beyond placebo effects.^[117]

Four Bach flower remedies are described in connection with depression: gentian for very mild depression or pessimism; gorse for more serious depression; sweet chestnut for severe depression; and mustard for depression that comes from within and is not related to external circumstances.^[118]^[119]^[120] Two Australian bush flower essences are described in connection with depression: waratah for depression; and Sunshine Wattle for pessimism and defeatism, especially after a long run of bad luck.^[121]

Potassium phosphate

The homeopathic dilution of potassium phosphate is claimed to bring some short-term relief to depressed patients.^[122]

Meditation

Mindfulness Meditation has been shown to be of medical benefit in a number of ways, including lowering blood pressure and stress levels. The most helpful and gentle form of meditation for a clinically depressed person may be the repetition—silently or aloud—of a mantra.^[123]^[124]

Neurofeedback

Neurofeedback is a form of biofeedback therapy in which brain activity is monitored using an EEG. The output is presented to the patient who is then able to see any variation in the brain waves associated with depression and may then develop some ability to reduce them, so improving their mood. The resulting direct control of mental state is thought to be similar to that achieved by the mental exercises of yoga.^[125]^[126]

Reiki

Reiki is a form of energy medicine originated in 1922 by Mikao Usui. In the UK, it has been recommended as a complementary medicine for pain management, anxiety and depression by NHS Trusts and Princess of Wales's Foundation of Integrative Medicine, but there is no evidence of its efficacy in the treatment of any disorder^[127].

Religion

Numerous studies and clinical trials have looked at the relationship between religion and depression. These have looked at the matter from Buddhist, Christian and Muslim perspectives. These indicate that religious faith helps to prevent the onset of depression and assists recovery if depression should still occur.^[128]

Sleep

Depression is commonly associated with poor sleep - difficulty going to sleep, early waking and general lassitude during the day. The two interact to worsen the condition of each other. Good sleep hygiene is therefore important to help break this vicious circle.^[129] This would include measures such as regular bed times, avoidance of stimulants such as caffeine and management of disturbances such as sleep apnea. Ironically, sleep deprivation is also a temporary treatment for depression.

Chi Kung

The traditional Chinese exercise of Chi Kung and related martial arts such as Tai Chi can help to prevent and relieve depression.^[130]

Cold Shower

Taking cold showers according to a study led by Nikolai Shevchuk may be an effective way to help treat depression. Shevchuck believes the biological explanation as to why cold showers help with depression involves the stimulation of locus ceruleus oe blue spot which is the brain's primary source of norepinephrine. Also affected are beta-endorphin levels. Adapted cold shower as a potential treatment for depression☆ Medical Hypotheses , Volume 70 , Issue 5 , Pages 995 - 1001 N . Shevchuk Med Hypotheses. 2008;70(5):995-1001. Epub 2007 Nov 13 http://www.ncbi.nlm.nih.gov/pubmed/17993252

Music Therapy

Studies have demonstrated that music can bring about different moods, conditioned by different emotional states. Music has the property of facilitating self-expression and in this way giving vent to disturbing emotional upheavals and dissipating them. Music has been proven that it can reach the sub-cortical centers of the brain and thereby helps to integrate the personality that is being disrupted by unhealthy emotions. Researchers have shown that music therapy is effective in patients. It has been shown that clinically depressed patients who were made to listen to soft, dissonant-free, melodic music gradually became more emotional and rhythmical. ^[131]

Wake therapy

Wake therapy is a form of sleep deprivation used as a treatment for depression

Brain hemorrhage

2009-11-02T10:49:00.000-08:00

Cerebral hemorrhage

A cerebral hemorrhage (or intracerebral hemorrhage, ICH), is a subtype of intracranial hemorrhage that occurs within the brain tissue itself. Intracerebral hemorrhage can be caused by brain trauma, or it can occur spontaneously in hemorrhagic stroke. Non-traumatic intracerebral hemorrhage is a spontaneous bleeding into the brain tissue.^[1]

A cerebral hemorrhage is an intra-axial hemorrhage; that is, it occurs within the brain tissue rather than outside of it. The other category of intracranial hemorrhage is extra-axial hemorrhage, such as epidural, subdural, and subarachnoid hematomas, which all occur within the skull but outside of the brain tissue. There are two main kinds of intra-axial hemorrhages: intraparenchymal hemorrhage and intraventricular hemorrhages. As with other types of hemorrhages within the skull, intraparenchymal bleeds are a serious medical emergency because they can increase intracranial pressure. The mortality rate for intraparenchymal bleeds is over 40%

Prevalence

It accounts for 20% of all cases of cerebrovascular disease in the US, behind cerebral thrombosis (40%) and cerebral embolism (30%).^[3]

It is two or more times more prevalent in African-American patients.^[4]

Causes

Intracerebral bleeds are the second most common cause of stroke, accounting for 30–60% of hospital admissions for stroke.^[1] High blood pressure raises the risk of spontaneous intracerebral hemorrhage by two to six times.^[1] More common in adults than in children, intraparenchymal bleeds due to trauma are usually due to penetrating head trauma, but can also be due to depressed skull fractures, acceleration-deceleration trauma,^[5]^[6]^[7] rupture of an aneurysm or arteriovenous malformation (AVM), and bleeding within a tumor. A very small proportion is due to cerebral venous sinus thrombosis.

Risk factors

Risk factors for ICH include:^[8]

Hypertension
Diabetes
Menopause
Current cigarette smoking
Alcoholic drinks (≥2/day)
Caffeine

Symptoms

Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed.^[9] Other symptoms include those that indicate a rise in intracranial pressure due to a large mass putting pressure on the brain.^[9] Intracerebral hemorrhages are often misdiagnosed as Subarachnoid hemorrhages due to the similarity in symptoms and signs.

Diagnosis

Intraparenchymal hemorrhage can be recognized on CT scans because blood appears brighter than other tissue and is separated from the inner table of the skull by brain tissue. The tissue surrounding a bleed is often less dense than the rest of the brain due to edema, and therefore shows up lighter on the CT scan.

Treatment

Treatment depends substantially of the type of ICH. Rapid CT scan and other diagnostic measures are used to choose proper treatment, which may include both medication and surgery.

Medication

Giving Factor VIIa within 4 hours limits the bleeding and formation of an hematoma However, it also increases the risk of thromboembolism. ^[10]
Antihypertensives are given to stabilize the mean arterial pressure at below 130 mmHg, but without causing excessive hypotension. ^[10]
- Mannitol is effective in acutely reducing raised intracranial pressure.
Acetaminophen may be needed to avoid hyperthermia, and to relieve headache.^[10]
Frozen plasma, vitamin K, protamine, or platelet transfusions are given in case of a coagulopathy.^[10]
Fosphenytoin or other anticonvulsant is given in case of seizures or lobar hemorrhage.^[10]
Antacids are given to prevent gastric ulcers, a condition somehow linked with ICH.^[10]
Corticosteroids, in concert with antihypertensives, reduces swelling. ^[11]

Surgery

Surgery is required if the hematoma is greater than 3 cm, if there is a structural vascular lesion or lobar hemorrhage in a young patient.^[10]

A catheter may be passed into the brain vasculature to close off or dilate blood vessels, avoiding rather invasive surgical procedures.^[12]
Aspiration by stereotactic surgery or endoscopic drainage may be used in basal ganglia hemorrhages, although successful reports are limited.^[10]

Other treatment

Tracheal intubation is indicated in patients with decreased level of consciousness or other risk of airway obstruction.^[10]
IV fluids are given to maintain fluid balance, using normotonic rather than hypotonic fluids.^[10]

Prognosis

The risk of death from an intraparenchymal bleed in traumatic brain injury is especially high when the injury occurs in the brain stem.^[2] Intraparenchymal bleeds within the medulla oblongata are almost always fatal, because they cause damage to cranial nerve X, the vagus nerve, which plays an important role in blood circulation and breathing.^[5] This kind of hemorrhage can also occur in the cortex or subcortical areas, usually in the frontal or temporal lobes when due to head injury, and sometimes in the cerebellum.^[5]^[13]

For spontaneous ICH seen on CT scan, the death rate (mortality) is 34–50% by 30 days after the insult.

Kidney failure

2009-10-12T12:21:00.000-07:00

Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. It is divided into acute and chronic forms; either form may be due to a large number of other medical problems.

Biochemically, it is typically detected by an elevated serum creatinine. In the science of physiology, renal failure is described as a decrease in the glomerular filtration rate. When the kidneys malfunction, problems frequently encountered are abnormal fluid levels in the body, deranged acid levels, abnormal levels of potassium, calcium, phosphate, hematuria (blood in the urine) and (in the longer term) anemia. Long-term kidney problems have significant repercussions on other diseases, such as cardiovascular disease.

Classification

Renal failure can broadly be divided into two categories: acute or chronic renal failure. The type of renal failure is determined by the trend in the serum creatinine. Other factors which may help differentiate acute and chronic kidney disease include the presence of anemia and the kidney size on ultrasound. Chronic kidney disease generally leads to anemia and small kidney size.

Acute renal failure

Main article: Acute renal failure

Acute renal failure (ARF) is a rapidly progressive loss of renal function, generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults,^[1] less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); body water and body fluids disturbances; and electrolyte derangement. An underlying cause must be identified to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes. ARF can result from a large number of causes.

Chronic kidney disease

Main article: Chronic kidney disease

Stage 5 Chronic Kidney Disease (CKD) can develop slowly and show few initial symptoms, be the long term result of irreversible acute disease or be part of a disease progression.

Acute on chronic renal failure

Acute renal failure can be present on top of chronic renal failure. This is called acute-on-chronic renal failure (AoCRF). The acute part of AoCRF may be reversible and the aim of treatment, as with ARF, is to return the patient to their baseline renal function, which is typically measured by serum creatinine. AoCRF, like ARF, can be difficult to distinguish from chronic renal failure, if the patient has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.

Symptoms

Symptoms of kidney disease can vary from person to person. Some people with kidney disease may not even feel sick, or they may not notice their symptoms. If the kidney function fails, the waste products accumulate in the blood and the body, termed azotaemia. Very mild levels of azotaemia may produce little or no symptoms, but if the kidney failure continues then symptoms will become noticeable. If the kidney (or renal) failure is of sufficient degree to cause symptoms. Renal failure accompanied with noticeable symptoms is termed uraemia.^[2]

Symptoms of kidney failure include:^[2]^[3]^[4]^[5]

High levels of urea in the blood, which can result in:

Vomiting and/or diarrhea, which may lead to dehydration

Nausea

Weight loss

Nocturnal urination

Foamy or bubbly urine

More frequent urination, or in greater amounts than usual, with pale urine

Less frequent urination, or in smaller amounts than usual, with dark coloured urine

Blood in the urine

Pressure, or difficulty urinating

A build up of phosphates in the blood that diseased kidneys cannot filter out may cause:

Itching

Bone damage

Muscle cramps (caused by low levels of calcium which can cause hypocalcaemia)

A build up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:

Abnormal heart rhythms

Muscle paralysis^[6]

Failure of kidneys to remove excess fluid may cause:

Swelling of the legs, ankles, feet, face and/or hands

Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)

Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:

Pain in the back or side

Healthy kidneys produce the hormone erythropoietin which stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail they produce less erythropoietin resulting in less red blood cells being produced to replace the natural breakdown of old red blood cells. As a result the blood carries less haemoglobin, which is known as anemia. This can result in:

Feeling tired and/or weak

Memory problems

Difficulty concentrating

Dizziness

Low blood pressure

Other symptoms include:

Appetite loss, a bad taste in the mouth

Difficulty sleeping

Darkening of the skin

Causes

Causes of acute renal failure

Acute kidney failure usually occurs as the result of a sudden interruption in the blood supply to the kidney, or as a result of a toxic overload of the kidneys. Some causes of acute failure include accidents, injuries or complications from surgery where the kidneys are deprived of normal blood flow for an extended period of time. Heart-bypass surgery is an example of a situation in which the kidneys receive reduced blood flow.

Drug overdoses, whether accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney failure. Unlike in chronic kidney disease, however, the kidneys can often recover from acute failure, allowing the patient to resume a normal life. People suffering from acute failure require supportive treatment until their kidneys recover function, and they often remain at an increased risk of developing future kidney failure.^[7]

Causes of chronic kidney disease

There are many causes of CKD. The most common cause is diabetes mellitus. The second most common cause is long-standing, uncontrolled, hypertension. Polycystic kidney disease is also a well known cause of chronic kidney disease. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Many other genetic illnesses also affect kidney function. Overuse of some common drugs, such as aspirin, ibuprofen, cocaine and acetaminophen can also cause chronic kidney damage.^[8]

Investigation

Methods of Measurement for CKD

Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive.Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.

Glomerular filtration rate

A normal GFR varies according to many factors, including sex, age, body size and ethnicity. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function. ^[9]The National Kidney Foundation offers an easy to use on-line GFR calculator.^[10] for anyone who is interested in knowing their glomerular filtration rate.(A serum creatinine level, a simple blood test, is needed to use the calculator).

Use of the term uremia

Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term used to describe the contamination of the blood with urine. Starting around 1847, this term was used to describe reduced urine output, that was thought to be caused by the urine mixing with the blood instead of being voided through the urethra.^{[citation needed]} The term uremia is now used to loosely describe the illness accompanying kidney failure

Laser Hair Removal Washington

2009-09-09T15:22:00.000-07:00

Laser hair removal in Washington DC is quickly becoming one of the most popular cosmetic procedures for both men and women. If you are sick and tired of shaving, waxing, or tweezing unwanted hair on a daily or weekly basis, and are looking for a more permanent solution, we have exactly what you need. Many men and women are turning to the latest trend in hair removal - the laser. For those interested in our revolutionary non-invasive procedure, here are all the facts that you need to know before you go under the light. This procedure has been hyped around the globe as the permanent solution to unwanted hair removal and has shown great promise in delivering on that claim. However, before investing your valuable time and hard earned money into Laser Hair Removal treatments, we suggest you do a little research.

The effect of removing unwanted hair by laser was first discovered by dermatologists in the late 1960s. Dermatologists discovered that during treatment for skin conditions with lasers, the removal of hair in the treatment area happened to be a side effect and because of this, lasers have been studied extensively for years for their hair removal effectiveness. Many different types of lasers have since been approved by the FDA and now professional treatments for Laser Hair Removal in Washington DC are available to all interested residents.

Today, Laser Hair Removal in Washington DC is one of the fastest growing non-invasive cosmetic procedures on the market. Last year alone, over one million individuals underwent laser treatments around the globe. At our Washington DC clinic, all of the technicians are trained and certified on the latest laser hair removal equipment; this guarantees professional Laser Hair Removal treatments each and every time you visit. To learn more about our approach to this extraordinary treatment, come in for a free and confidential consultation. We’ll give you all the information you need and get you set up for a series of Laser Hair Removal treatments at our Washington DC clinic that will leave you with nothing but hair free skin!

Laser Hair Removal Information

Being informed about the different methods of hair removal will help you make the best decision. Read below to find out the facts about hair removal.
LASER HAIR REMOVAL:
The lasers on the market today come in all shapes and sizes. There are also different lasers that use different wavelengths of light. Some utilize a cooling device and some do not. All laser systems emit a gentle beam of light that passes through the skin to the hair follicle where it is absorbed by the hair. The laser energy is then transformed into heat that can disable the follicle. Today individuals with white or dark/tan skin can utilize lasers to remove their unwanted hair with positive results. Lasers that utilize a cooling device will help protect the skin by cooling the upper layers providing the patient with increased comfort. This cooling selectivity helps to protect the skin while effectively treating the unwanted hair
ELECTROLYSIS:
Electrolysis is the only permanent method of hair removal. Each individual hair is treated by inserting a tiny surgical probe into the hair follicle and directing a split second impulse of energy down to the hair root. Electrolysis is only as good as the technician though. Also, electrolysis is a series of treatments. It is not one treatment and the hair is gone forever. This means that it is a weakening process. After an electrolysis treatment the hair should grow back thinner and finer. It also depends how thick or thin the unwanted hair is. For instance, someone who has been waxing or tweezing will need more treatments than someone who has not tampered with the area.

Brain tumor

2009-09-08T08:20:00.000-07:00

A brain tumor is an abnormal growth of cells within the brain or inside the skull, which can be cancerous or non-cancerous (benign).

It is defined as any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).

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

In the United States in the year 2005, it was estimated there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005–2006),^[1] which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths,^[2] and 20–25 percent of pediatric cancers.^[2]^[3] Ultimately, it is estimated there are 13,000 deaths per year in the United States alone as a result of brain tumors.^[1]

Signs and symptoms

Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor ("benign", i.e. slow-growing/late symptom onset, or malignant, fast growing/early symptom onset) is a frequent reason for seeking medical attention in brain tumor cases.

Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.

Depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment, personality changes, hemiparesis, hypesthesia, aphasia, ataxia, visual field impairment, facial paralysis, double vision, tremor etc. These symptoms are not specific for brain tumors—they may be caused by a large variety of neurologic conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects.

A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

Diagnosis

Although there is no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, sudden intracranial hypertension (this may be due to bleeding within the tumor, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Glioblastoma multiforme and anaplastic astrocytoma have been associated in case reports on PubMed^[who?] with the genetic acute hepatic porphyrias (PCT, AIP, HCP and VP), including positive testing associated with drug refractory seizures. Unexplained complications associated with drug treatments with these tumors should alert physicians to an undiagnosed neurological porphyria.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is because these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histological examination is essential for determining the appropriate treatment and the correct prognosis. This examination, performed by a pathologist, typically has three stages: interoperative examination of fresh tissue, preliminary microscopic examination of prepared tissues, and followup examination of prepared tissues after immunohistochemical staining or genetic analysis.

Another possible diagnosis would be neurofibromatosis which can be in type one or type two.

Treatment and prognosis

Many meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically. In more difficult cases, stereotactic radiosurgery, such as Gamma knife, Cyberknife or Novalis Tx radiosurgery, remains a viable option.^[4]

Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases.^[5] However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Several current research studies aim to improve the surgical removal of brain tumors by labeling tumor cells with a chemical (5-aminolevulinic acid) that causes them to fluoresce ^[6]. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors.^[7]

UCLA Neuro-Oncology publishes real-time survival data for patients with this diagnosis. They are the only institution in the United States that shows how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high grade glioma tumors.

Patients with benign gliomas may survive for many years,^[8]^[9] while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosis if treatment is ignored.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery (SRS), such as Gamma Knife, Cyberknife or Novalis Tx, radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

Radiotherapy is the most common treatment for secondary cancer brain tumors. The amount of radiotherapy depends on the size of the area of the brain affected by cancer. Conventional external beam whole brain radiotherapy treatment (WBRT) or 'whole brain irradiation' may be suggested if there is a risk that other secondary tumors will develop in the future.^[10] Stereotactic radiotherapy is usually recommended in cases of under three small secondary brain tumors.

In 2008 a study published by the University of Texas M. D. Anderson Cancer Center indicated that cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone.^[11]^[12]

A shunt operation is used not as a cure but to relieve the symptoms.[2] The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

Research to treatment with the vesicular stomatitis virus

In 2000, researchers at the University of Ottawa, led by John Bell PhD., have discovered that the vesicular stomatitis virus, or VSV, can infect and kill cancer cells, without affecting healthy cells if coadministered with interferon. ^[13]

The initial discovery of the virus' oncolytic properties were limited to only a few types of cancer. Several independent studies have indentified many more types susceptible to the virus, including glioblastoma multiforme cancer cells, which account for the majority of brain tumors.

In 2008, researchers artificially engineered strains of VSV that were less cytotoxic to normal cells. This advance allows administration of the virus without coadministration with interferon. Consequently administration of the virus can be given intravenously or through the olfactory nerve. In the research, a human brain tumor was implanted into mice brains. The VSV was injected via their tails and within 3 days all tumor cells were either dead or dying.

Research on virus treatment like this has been conducted for some years, but no other viruses have been shown to be as efficient or specific as the VSV mutant strains. Future research will focus on the risks of this treatment, before it can be applied to humans.

Brain tumors in infants and children

In the US, about 2000 children and adolescents younger than 20 years of age are diagnosed with malignant brain tumors each year. Higher incidence rates were reported in 1975–83 than in 1985–94. There is some debate as to the reasons; one theory is that the trend is the result of improved diagnosis and reporting, since the jump occurred at the same time that MRIs became available widely, and there was no coincident jump in mortality. The CNS cancer survival rate in children is approximately 60%. The rate varies with the type of cancer and the age of onset: younger patients have higher mortality.^[15]

In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-grade glioma. Less commonly, and seen usually in infants, are teratoma and atypical teratoid rhabdoid tumor.^[16] Germ cell tumors, including teratoma, make up just 3% of pediatric primary brain tumors, but the worldwide incidence varies significantly.

Causes of acne

2009-08-17T11:39:00.000-07:00

Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (whitehead). Whiteheads are the direct result of skin pores becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation.

Primary causes

The root causes of why some people get acne and some do not are not fully known.^{[citation needed]} It is known to be partly hereditary. Several factors are known to be linked to acne:

Family/Genetic history. The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.^[11]
Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the follicular glands to get larger and make more sebum.^[12]
Inflammation, skin irritation or scratching of any sort will activate inflammation. Anti-inflammatories are known to improve acne.^{[citation needed]}
Stress, through increased output of hormones from the adrenal (stress) glands.^{[citation needed]} While the connection between acne and stress has been debated, scientific research indicates that "increased acne severity" is "significantly associated with increased stress levels."^[13] The National Institutes of Health list stress as a factor that "can cause an acne flare."^[14] A study of adolescents in Singapore "observed a statistically significant positive correlation […] between stress levels and severity of acne."^[15]
Hyperactive sebaceous glands, secondary to the three hormone sources above.
Accumulation of dead skin cells that block or cover pores.^{[citation needed]}
Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing.^[16]
Use of anabolic steroids.^[17]
Any medication containing lithium, barbiturates or androgens.^{[citation needed]}
Exposure to certain chemical compounds. Chloracne is particularly linked to toxic exposure to dioxins, namely Chlorinated dioxins.^{[citation needed]}
Exposure to halogens. Halogen acne is linked to exposure to halogens (e.g. iodides, chlorides, bromides, fluorides).^{[citation needed]}
Chronic use of amphetamines or other similar drugs.^[18]

Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). In addition, acne-prone skin has been shown to be insulin resistant.^{[citation needed]}

Diet

Chocolate

The popular belief that consumption of chocolate can cause acne is not supported by scientific studies.^[19]^[20] As discussed below, various studies point not to chocolate, but to the high glycemic nature of certain foods containing simple carbohydrates as a cause of acne. Chocolate itself has a low glycemic index.^[21]

Milk

Recently, three epidemiological studies from the same group of scientists found an association between acne and consumption of partially skimmed milk, instant breakfast drink, sherbet, cottage cheese, and cream cheese.^[22]^[23]^[24] The researchers hypothesize that the association may be caused by hormones (such as several sex hormones and bovine insulin-like growth factor 1 (IGF-1)) or even iodine^[25] present in cow milk.

Carbohydrates

The long-held belief that there is no link between diets high in refined sugars and processed foods, and acne, has recently been challenged.^[26] The previous belief was based on earlier studies (some using chocolate and Coca Cola) that were methodologically flawed.^[26]^[27]^[28] The recent low glycemic-load hypothesis postulates that rapidly digested carbohydrate foods (such as soft drinks, sweets, white bread) produce an overload in blood glucose (hyperglycemia) that stimulates the secretion of insulin, which in turn triggers the release of IGF-1.^[26] IGF-1 has direct effects on the pilosebaceous unit (and insulin at high concentrations can also bind to the IGF-1 receptor)^[29] and has been shown to stimulate hyperkeratosis and epidermal hyperplasia.^[30] These events facilitate acne formation. Sugar consumption might also influence the activity of androgens via a decrease in sex hormone-binding globulin concentration.^[31]^[32]

In support of this hypothesis, a randomized controlled trial of a low glycemic-load diet improved acne and reduced weight, androgen activity and levels of insulin-like growth factor binding protein-1.^[33] High IGF-1 levels and mild insulin resistance (which causes higher levels of insulin) had previously been observed in patients with acne.^[34]^[35]^[36] High levels of insulin and acne are also both features of polycystic ovarian syndrome.^[26]

According to this hypothesis, the absence of acne in some non-Westernized societies could be explained by the low glycemic index of these cultures' diets.^[37] It is possible that genetic reasons account for there being no acne in these populations, although similar populations (such as South American Indians or Pacific Islanders) do develop acne.^[38]^[39] Note also that the populations studied consumed no milk or other dairy products.^[40]

Further research is necessary to establish whether a reduced consumption of high-glycemic foods, or treatment that results in increased insulin sensitivity (like metformin) can significantly alleviate acne, though consumption of high-glycemic foods should in any case be kept to a minimum, for general health reasons.^[41] Avoidance of "junk food" with its high fat and sugar content is also recommended.^[42]

Vitamins A and E

Studies have shown that newly diagnosed acne patients tend to have lower levels of vitamin A circulating in their bloodstream than those who are acne free.^[43] In addition people with severe acne also tend to have lower blood levels of vitamin E.^[44]

Hygiene

Acne is not caused by dirt. This misconception probably comes from the fact that blackheads look like dirt stuck in the openings of pores. The black color is not dirt but simply oxidised keratin. In fact, the blockages of keratin that cause acne occur deep within the narrow follicle channel, where it is impossible to wash them away. These plugs are formed by the failure of the cells lining the duct to separate and flow to the surface in the sebum created there by the body. Built-up oil of the skin can block the passages of these pores, so standard washing of the face could wash off old oil and help unblock the pores.

Treatments

Available treatments

normalising shedding into the pore to prevent blockage
killing Propionibacterium acnes
anti-inflammatory effects
hormonal manipulation

Topical bactericidals

Widely available OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2 to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P. acnes. In one study, roughly 70% of participants using a 10% benzoyl peroxide solution experienced a reduction in acne lesions after six weeks.^[45] Unlike antibiotics, benzoyl peroxide has the advantage of being a strong oxidizer and thus does not appear to generate bacterial resistance. However, it routinely causes dryness, local irritation and redness. A sensible regimen may include the daily use of low-concentration (2.5%) benzoyl peroxide preparations, combined with suitable non-comedogenic moisturisers to help avoid overdrying the skin.

Care must be taken when using benzoyl peroxide, as it can very easily bleach any fabric or hair it comes in contact with.

Other antibacterials that have been used include triclosan, or chlorhexidine gluconate. Though these treatments are often less effective, they also have fewer side-effects.

Topical antibiotics

Externally applied antibiotics such as erythromycin, clindamycin, azelaic acid or tetracycline kill the bacteria that are harbored in the blocked follicles. While topical use of antibiotics is equally as effective as oral use, this method avoids possible side effects including upset stomach and drug interactions (e.g. it will not affect use of the oral contraceptive pill), but may prove awkward to apply over larger areas than just the face alone.

Oral antibiotics

It has been found that sub-antimicrobial doses of antibiotics such as minocycline also improve acne. It is believed that minocycline's anti-inflammatory effect also prevents acne.

Hormonal treatments

In females, acne can be improved with hormonal treatments. The common combined oestrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen, Cyproterone, in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Diane-35 is not available in the USA, but a newer oral contraceptive containing the progestin drospirenone is now available with fewer side effects than Diane 35 / Dianette. Both can be used where blood tests show abnormally high levels of androgens, but are effective even when this is not the case. Along with this, treatment with low dose spironolactone can have anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.

Topical retinoids

Oral retinoids

Main article: isotretinoin

Phototherapy

'Blue' and red light

Light exposure has long been used as a short term treatment for acne. Recently, visible light has been successfully employed to treat mild to moderate acne (phototherapy or deep penetrating light therapy) - in particular intense violet light (405-420 nm) generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64%^[47] and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by 420 nm and shorter wavelengths of light.^[48] Particularly when applied over several days, these free radicals ultimately kill the bacteria.^[49] Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been licensed by the U.S. FDA.^[50]^[51]

The treatment apparently works even better if used with a mixture of the violet light and red visible light (660 nanometer) resulting in a 76% reduction of lesions after three months of daily treatment for 80% of the patients;^[52] and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments few if any negative side effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive to buy initially, although the total cost of ownership can be similar to many other treatment methods (such as the total cost of benzoyl peroxide, moisturizer, washes) over a couple of years of use.

Photodynamic therapy

Laser treatment

to burn away the follicle sac from which the hair grows
to burn away the sebaceous gland which produces the oil
to induce formation of oxygen in the bacteria, killing them

In the United States, the FDA has approved several companies, such as Candela Corp., to use a cosmetic laser for the treatment of acne. However, efficacy studies have used very small sample sizes (fewer than 100 subjects) for periods of six months or less, and have shown contradictory results.^[54] Also, laser treatment being relatively new, protocols remain subject to experimentation and revision,^[55] and treatment can be quite expensive. Also, some Smoothbeam laser devices had to be recalled due to coolant failure, which resulted in painful burn injuries to patients.^[56]

Less widely used treatments

Aloe vera: there are treatments for acne mentioned in Ayurveda using herbs such as Aloe vera, Neem, Haldi (Turmeric) and Papaya. There is limited evidence from medical studies on these products.^[57] Products from Rubia cordifolia, Curcuma longa (commonly known as Turmeric), Hemidesmus indicus (known as ananthamoola or anantmula), and Azadirachta indica (Neem) have been shown to have anti-inflammatory effects, but not aloe vera.^[58]
Azelaic acid (brand names Azelex, Finevin and Skinoren) is suitable for mild, comedonal acne.^[59]
Calendula used in suspension is used as an anti-inflammatory agent.^[60]
Cortisone injection into spots, also cortisone pills are sometimes used.
Heat: local heating may be used to kill the bacteria in a developing pimple and so speed healing.^[61]
Naproxen or ibuprofen^[62] are used for some moderate acne for their anti-inflammatory effect.
Nicotinamide, (Vitamin B3) used topically in the form of a gel, has been shown in a 1995 study to be of comparable efficacy to topical clindamycin topical antibiotic used for comparison.^[63] Topical nicotinamide is available both on prescription and over-the-counter. The property of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also purported to result in increased synthesis of collagen, keratin, involucrin and flaggrin and may also according to a cosmetic company be useful for reducing skin hyperpigmentation (acne scars), increased skin moisture and reducing fine wrinkles.^[64]
Tea tree oil (melaleuca oil) dissolved in a carrier (5% strength) has been used with some success, where it is comparable to benzoyl peroxide but without excessive drying, kills P. acnes, and has been shown to be an effective anti-inflammatory in skin infections.^[57]^[65]^[66]
Rofecoxib was shown to improve premenstrual acne vulgaris in a placebo controlled study.^[67]
Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of inflammatory acne, although less so than tetracyclines.^[68]^[69]
Comedo extraction
Pantothenic acid, (high dosage Vitamin B5)^[70]
Detoxification is a common method used by alternative medicine practitioners for the treatment of acne, although there have been no studies to prove its success. Detoxification is the process of cleansing the body of toxins purportedly caused by the environment, pharmaceutical drugs, food, and cosmetics.

Acne

2009-08-17T11:34:00.000-07:00

Acne vulgaris (commonly called acne) is a common skin condition, caused by changes in the pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland via androgen stimulation. It is characterized by noninflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Acne vulgaris affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.^[1] Acne lesions are commonly referred to as pimples, blemishes, spots, zits, or acne.

Acne is most common during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood. The cause in adolescence is generally an increase in male sex hormones, which people of both genders accrue during puberty.^[2] For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties and beyond.^[3]

The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules. Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne.^[4]

Aside from scarring, its main effects are psychological, such as reduced self-esteem^[5] and, according to at least one study, depression or suicide.^[6] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.

Terminology

The term acne comes from a corruption of the Greek άκμή (acne in the sense of a skin eruption) in the writings of Aëtius Amidenus. Used by itself, the term "acne" refers to the presence of pustules and papules.^[7] The most common form of acne is known as "acne vulgaris", meaning "common acne". Many teenagers get this type of acne. Use of the term "acne vulgaris" implies the presence of comedones.^[8]

Weight loss

2009-08-13T12:09:00.000-07:00

Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. It can occur unintentionally due to an underlying disease or can arise from a conscious effort to improve a perceived overweight or obese state.

Unintentional weight loss

Poor management of type 1 diabetes mellitus, also known as insulin-dependent diabetes mellitus (IDDM), leads to an excessive amount of glucose and an insufficient amount of insulin in the bloodstream. This triggers the release of triglycerides from adipose (fat) tissue and catabolism (breakdown) of amino acids in muscle tissue. This results in a loss of both fat and lean mass, leading to a significant reduction in total body weight. Note that untreated type 1 diabetes mellitus will usually not produce weight loss, as these patients get acutely ill before they would have had time to lose weight.

Myriad additional scientific considerations are applicable to weight loss: physiological and exercise sciences, nutrition science, behavioral sciences, and other sciences.

One area involves the science of bioenergetics including biochemical and physiological energy production and utilization systems, that is frequently evidence of diabetes, and ketone bodies, acetone particles occurring in body fluids and tissues involved in acidosis, also known as ketosis, somewhat common in severe diabetes.

In addition to weight loss due to a reduction in fat and lean mass, illnesses such as diabetes, certain medications, lack of fluid intake and other factors can trigger fluid loss. And fluid loss in addition to a reduction in fat and lean mass exacerbates the risk for cachexia.

Infections such as HIV may alter metabolism, leading to weight loss.^[1]

Hormonal disruptions, such as an overactive thyroid (hyperthyroidism), may also exhibit as weight loss.^[2]

Recent research has shown fidgeting to result in significant weight loss.

Intentional weight loss

Intentional weight loss refers to the loss of total body mass in an effort to improve fitness, health, and/or appearance.

Therapeutic weightloss, in individuals who are overweight or obese, can decrease the likelihood of developing diseases such as diabetes,^[4] heart disease, high blood pressure, stroke, osteoarthritis,^[5] and certain types of cancer.

Attention to diet in particular can be extremely beneficial in reducing the impact of diabetes and other health risks of an expanding waist.

Weight loss occurs when an individual is in a state of negative energy balance. When the body is consuming more energy (i.e. in work and heat) than it is gaining (i.e. from food or other nutritional supplements), it will use stored reserves from fat or muscle, gradually leading to weight loss.^{[citation needed]}

It is not uncommon for some people who are currently at their ideal body weight to seek additional weight loss in order to improve athletic performance, and/or meet required weight classification for participation in a sport. However, others may be driven by achieving a more attractive body image. Consequently, being underweight is associated with health risks such as difficulty fighting off infection, osteoporosis, decreased muscle strength, trouble regulating body temperature and even increased risk of death.

Therapeutic weight loss techniques

See also: Obesity#Management and Bariatrics

The least intrusive weight loss methods, and those most often recommended by physicians, are adjustments to eating patterns and increased physical activity, generally in the form of exercise. Physicians will usually recommend that their overweight patients combine a reduction of processed^[7] and caloric content of the diet with an increase in physical activity.^[8]

Other methods of losing weight include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume. Green tea and hoodia gordonii are often advertised as weight loss supplements. Medicines with herbs such as Fucus vesiculosus are popular.^[9] Weight Loss Coaching is rapidly growing in popularity in the United States, with the number of available coaches nearly doubling since 2000. Finally, surgery (i.e. bariatric surgery) may be used in more severe cases to artificially reduce the size of the stomach, thus limiting the intake of food energy.

Crash dieting

A crash diet refers to willful nutritional restriction (except water) for more than 12 hours. The desired result is to have the body burn fat for energy with the goal of losing a significant amount of weight in a short time. However, the body reacts by preserving fat stores and burning lean muscle tissue, such that this is a poor strategy for intentional weight loss.^{[citation needed]}

Crash dieting is not the same as intermittent fasting, in which the individual periodically abstains from food (e.g., every other day)

Weight loss industry

There is a substantial market for products which promise to make weight loss easier, quicker, cheaper, more reliable, or less painful. These include books, CDs, cremes, lotions, pills, rings and earrings, body wraps, body belts and other materials, not to mention fitness centers, personal coaches, weight loss groups, and food products and supplements. US residents in 1992 spent an estimated $30 billion a year on all types of diet programs and products, including diet foods and drinks.^[10]

Between $33 billion and $55 billion is spent annually on weight loss products and services, including medical procedures and pharmaceuticals, with weight loss centers garnering between 6 percent and 12 percent of total annual expenditure. About 70 percent of Americans' dieting attempts are of a self-help nature. Although often short-lived, these diet fads are a positive trend for this sector as Americans ultimately turn to professionals to help them meet their weight loss goals

Safe Sex Tips

2009-08-13T11:48:00.000-07:00

Safe sex (also called safer sex or protected sex) is the practice of sexual activity in a manner that reduces the risk of infection with sexually transmitted diseases (STDs). Conversely, unsafe sex is the practice of sexual intercourse or other sexual contact without regard for prevention of STDs.

Safe sex practices became more prominent in the late 1980s as a result of the AIDS epidemic. Promoting safe sex is now a principal aim of sex education. From the viewpoint of society, safe sex can be regarded as a harm reduction strategy. The goal of safer sex is risk reduction through education.

The risk reduction of safe sex is not absolute: the reduced risk to the receptive partner of acquiring HIV from HIV seropositive partners not wearing condoms to compared to when they wear them is estimated to be about a four- to five-fold.^[1]

In contrast to protected sex is unprotected sex, which can refer to:

The practice of sex without protection from pregnancy
The practice of sex without protection from STDs

Although safe sex practices can be used as a form of family planning, the term refers to efforts made to prevent infection as well as conception. Many effective forms of contraception do not offer protection against STDs.

Terminology

Recently, and mostly within Canada and the United States, the use of the term safer sex rather than safe sex has gained greater use by health workers, with the realization the grounds that risk of transmission of sexually transmitted infections in various sexual activities is a continuum rather than a simple dichotomy between risky and safe. However, in most other countries, including the United Kingdom and Australia, the term safe sex is still mainly used by sex educators.

Focus on HIV/AIDS

Much attention has focused on controlling HIV, the virus that causes AIDS, through the use of condoms. However, as many STDs can be transmitted through other activities, some sex educators recommend that barrier protection be used for all sexual activities which have the potential for disease transmission, such as manual penetration of the anal or vaginal cavities, or oral stimulation of the genitals.

Safe sex precautions

Sex by yourself

Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating one's own genitalia, is safe so long as contact is not made with other people's discharged bodily fluids. However, some practices, such as self-bondage and autoerotic asphyxia, are made considerably more dangerous by the absence of people who can intervene if something goes wrong.

Modern technology does permit some activities, such as "phone sex" and "cybersex", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids.

Non-penetrative sex

A range of sex acts, sometimes called "outercourse", can be enjoyed by lovers with significantly reduced risks of infection and pregnancy. U.S. President Bill Clinton's surgeon general, Dr. Joycelyn Elders, tried to encourage the use of these practices among young people, but her position encountered opposition from a number of outlets, including the White House itself, and resulted in her being fired by President Clinton in December 1994

Limiting fluid exchange

Various devices are used to avoid contact with blood, vaginal fluid, and semen during sexual activity:

Condoms cover the penis during sexual activity. They are most frequently made of latex, but can also be made out of polyurethane. Polyurethane is thought to be a safe material for use in condoms, since it is nonporous and viruses cannot pass through it. However, there is less research on its effectiveness than there is on latex.
Female condoms are inserted into the vagina prior to intercourse. They may also be used for anal sex, although they are less effective.
A dental dam (originally used in dentistry) is a sheet of latex used for protection when engaging in oral sex. It is typically used as a barrier between the mouth and the vulva during cunnilingus or between the mouth and the anus during anilingus.
Medical gloves made out of latex, vinyl, nitrile, or polyurethane may be used as an makeshift dental dam during oral sex, or to protect the hands during mutual masturbation. Hands may have invisible cuts on them that may admit pathogens that are found in the semen or the vaginal fluids of STD infectees. Although the risk of infection in this manner is thought to be low^{[citation needed]}, gloves can be used as an extra precaution.
Another way to avoid contact with blood and semen is penetration, but not by the penis, such as using (properly cleaned) dildos or other sex toys. If a sex toy is to be used in more than one orifice, a condom can be used over it and changed when the toy is moved. Fisting (penetration by the hand), has its own risks, but the risk of HIV transfer can be reduced by latex gloves or a condom. Pegging, female-to-male anal sex with a strap-on dildo, as promoted by sex educator Carol Queen does not involve fluid transfer.

If a latex barrier is being used, any lubrication must not be oil based, as this can break down the structure of the latex and undo the protection it gives.

Condoms (male or female) may be used along with other forms of contraception to protect against STDs and improve contraceptive effectiveness. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users.^[5] However, two condoms should not be used simultaneously (male condom on top of male condom, or male condom inside female condom), since this increases the chance of condom failure

Other Precautions

Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex recommend that some of the following methods be used to minimize the risks of STD transmission and unwanted pregnancy.

Circumcision is now backed by the World Health Organization as a preventative measure against HIV. African studies have found that circumcision can reduce the transmission rate of HIV by up to 60%^[8]. Some advocacy groups dispute these findings.^[9]^[10]
Periodic STD testing has been used to reduce STD infections in Cuba and among pornographic film actors. Cuba implemented a program of mandatory testing and quarantine early in the AIDS epidemic. ^[11] In the US pornographic film industry in the US, many production companies will not hire actors without tests for Chlamydia, HIV and Gonorrhea that are no more than 30 days old-and tests for other STD's no more than 6 months old. AIM Medical foundation claims that program of testing has reduced the incidence of STD infection to 20% of that of the general population.
Soap and water can reduce infectivity of HIV on devices, such as barrier contraceptives^[12]. Douching with soap and water should be avoided because it has not been studied and by disrupting the vaginal flora it might increase risk of infection.^[12]
Monogamy or polyfidelity, practiced faithfully, is very safe (as far as STDs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually transmitted diseases by partners who are sexually unfaithful, have used injection drugs, or were infected by previous sexual partners; the same risks apply to polyfidelitous people, who face slightly higher risks depending on how many people are in the polyfidelitous group.
For those who are not monogamous, reducing the number of one's sexual partners, particularly anonymous sexual partners, may also reduce one's potential exposure to STDs. Similarly, one may restrict one's sexual contact to a community of trusted individuals - this is the approach taken by some pornographic actors and other non-monogamous people.
Communication with one's sexual partner(s) makes for greater safety. Before initiating sexual activities, partners may discuss what activities they will and will not engage in, and what precautions they will take. This can reduce the chance of risky decisions being made "in the heat of passion".
Refraining from the use of recreational drugs, including alcohol, before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness.
If a person is sexually active with a number of partners, it is important that they get regular sexual health check-ups from a doctor. Anyone noticing unusual symptoms should get medical advice quickly as HIV is sometimes asymptomatic or symptoms will have a nonspecific nature and can even be misdiagnosed

Limitations

While the use of condoms can reduce HIV transmission, it does not do so completely. One study has suggested it might be around by a factor of 85% to 95% and questioned that effectiveness beyond 95% would be unlikely because of slippage, breakage, and incorrect use.^[15] It also noted "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".^[15]^{p. 40.}

The risk of the receptive partner acquiring HIV from HIV seropositive partners not wearing condoms is 0.82% and from those wearing condoms is 0.18%, a four- to five-fold reduction.^[1] Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners.

Ineffective methods

Note that most methods of contraception other than the barrier methods mentioned above are not effective at preventing the spread of STDs. This includes the "rhythm method".

The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STD transmission. However a recent study by the World Health Organization ^[16] has shown that Nonoxynol-9 is an irritant and can produce tiny tears in mucous membranes, which may increase the risk of transmission by offering pathogens more easy points of entry into the system. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.

Coitus interruptus (or "pulling out"), in which the penis is removed from the vagina, anus, or mouth before ejaculation, is not safe sex and can result in STD transmission. This is because of the formation of pre-ejaculate, a fluid that oozes from the urethra before actual ejaculation. In opposition to conventional wisdom, some recent studies awaiting confirmation suggest that pre-ejaculate may not contain sperm^{[citation needed]}; it can, however, contain pathogens such as HIV.^[17]^[18]

If you keep ejaculate fluid out of any orifices this will do a great deal to help protect pregnancy and diseases. Especially important to note if you have cuts in your mouth. In addition, open sores on either partner can permit transmission, as can microscopic breaks in the skin which arise due to friction, or other irregularities in the skin of either partners genitalia or other body parts.

International Conference on Population and Development (ICPD), 1994

2009-08-13T11:47:00.000-07:00

The International Conference on Population and Development (ICPD) was held in Cairo, Egypt, from 5 to 13 September 1994. Delegations from 179 States took part in negotiations to finalize a Programme of Action on population and development for the next 20 years. Some 20,000 delegates from various governments, UN agencies, NGOs, and the media gathered for a discussion of a variety of population issues, including immigration, infant mortality, birth control, family planning, and the education of women.

The ICPD Program of Action endorses a new strategy which emphasizes the numerous linkages between population and development and focuses on meeting the needs of individual women and men rather than on achieving demographic targets.^[4] The ICPD achieved consensus on four qualitative and quantitative goals for the international community, the final two of which have particular relevance for reproductive health:

Reduction of maternal mortality: A reduction of maternal mortality rates and a narrowing of disparities in maternal mortality within countries and between geographical regions, socio-economic and ethnic groups.
Access to reproductive and sexual health services including family planning: Family planning counseling, pre-natal care, safe delivery and post-natal care, prevention and appropriate treatment of infertility, prevention of abortion and the management of the consequences of abortion, treatment of reproductive tract infections, sexually transmitted diseases and other reproductive health conditions; and education, counseling, as appropriate, on human sexuality, reproductive health and responsible parenthood. Services regarding HIV/AIDS, breast cancer, infertility, delivery and abortion should be made available. Active discouragement of female genital mutilation (FGM).

Key to this new approach is empowering women and providing them with more choices through expanded access to education and health services and promoting skill development and employment. The Programme advocates making family planning universally available by 2015, or sooner, as part of a broadened approach to reproductive health and rights, provides estimates of the levels of national resources and international assistance that will be required, and calls on Governments to make these resources available.

Childbearing and health

2009-08-13T11:46:00.000-07:00

Waiting until mother is at least 18 years old before trying to have children improves maternal and child health.^[3]

If an additional child is desired, it is considered healthier for mother, as well as for the succeeding child, to wait at least 2 years after previous birth before attempting to conceive (but not more than 5 years).^[3] After a miscarriage or abortion, it is healthier to wait at least 6 months.

Reproductive health

2009-08-13T11:43:00.000-07:00

Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system at all stages of life.^[1] Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

According to the WHO, "Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women, and 14% for men

Types of Bipolar Diseases

2009-07-26T06:07:00.000-07:00

Bipolar disorder is also called bipolar mood disorder, manic-depressive illness, manic depression, bipolar affective disorder and manic-depressive disorder. People with the disorder experience unusual shifting of energy, mood, behavior and the ability to function normally. These mood swings are from high periods of mania to low episodes of depression. The disorder can be either mild or severe and the mood swings can be frequent or infrequent. Depending on the symptoms manifested by the person affected, the disorders can be diagnosed according to its different types such as bipolar disorder 1, bipolar disorder 2, cyclothymic disorder and bipolar disorder not otherwise specified.

# 1 Bipolar Disorder 1

Most people suffering from this type of disorder, sometimes called bipolar 1 disorder, experience both the mania and depression. This type of disorder is distinguished from disorder 2 in terms of the duration and severity of the manic phase, which could last anywhere from weeks to a couple of months.

# 2 Bipolar Disorder 2

People with this type of disorder suffer from periods of severe depression that is occasionally accompanied with episodes of mild mania known as hypomania. No delusions are experienced in bipolar disorder 2 but there is still impaired mental functioning.

# 3 Cyclothymic Disorder

People with cyclothymic disorder experience alternate attacks of mild depression and hypomania. It lasts longer than the disorders 1 and 2 with no break in the manifestation of symptoms but is not as severe.

# 4 Bipolar Disorder Not Otherwise Specified (NOS)

This type includes those symptoms and features that don't meet any of the categories of bipolar disorder, such as very rapid alternation between depressive symptoms and manic symptoms, recurrent episodes of hypomanic phase without depression, and hypomanic episodes that are associated with chronic depression.

Of all the types of disorders, bipolar 1 disorder is the most severe type. If left untreated, it will possibly have a high rate of recurrence. It has an estimated rate of about 15% death risk by suicide. Also, it is considered as the third leading cause of death among people aged fifteen to twenty-four years old. It tends to run in families and is a lifelong disorder. Aside from being a hereditary disorder, other factors that can cause this type of disorder are certain illnesses such as hyperthyroidism, brain tumor, and multiple sclerosis, and certain environmental factors such as giving birth, stressful life events, sleep deprivation, stimulants, electroconvulsive therapy, antipsychotic medication and antidepressant medication.

Symptoms

Since disorder 1 involves both the manic and depression phases, the symptoms are just the common ones such as unusual happiness and sadness, grandiose delusions, change in eating and sleep patterns, pressured speech and suicidal attempts.

Bipolar 1 Treatments

Most commonly used medications used to control the symptoms of this type of disorder are anti-psychotics, antidepressants, and mood stabilizers. Other medications may also be prescribed to help manage restlessness, anxiety, and insomnia. Psychotherapy is also the treatment of choice in some cases.

Having a bipolar disorder, especially bipolar disorder 1 is something that should not be taken for granted since it can really lead to death due to suicide if left untreated. Prompt treatment should be sought once the symptoms occur.

Different Types of Mesothelioma

2009-07-26T05:48:00.000-07:00

A disease that has only started to come to light in recent years, mesothelioma is a cancer that normally presents itself in malignant form and results in tumours in and around vital organs of the body. The definition of the word mesothelioma is literally cancer of the mesothelium (-oma being a medical term for cancer). The mesothelium is the sac that lines and protects vital organs such as the heart and the lungs, and this disease causes the cells of the lining to become abnormal and malignant.

The result of asbestos exposure, mesothelioma comes in three forms: pleural mesothelioma; peritoneal mesothelioma; and pericardial mesothelioma. All three types have a variety of associated symptoms, and there are some symptoms that are common to all three types of the disease. In all cases of the disease, sufferers are unlikely to even realise that there is a problem until many years after they have actually contracted mesothelioma from regular exposure to asbestos.

The symptoms of all types of mesothelioma do not generally manifest for several decades after contraction. This can make the disease difficult to diagnose and all too often is too late to save the patient by the time a diagnosis is made.

Pleural Mesothelioma:

The most common form of mesothelioma is pleural mesothelioma. This is where the cancer affects the lungs and the protective lining and cavity of the lungs. The symptoms of pleural mesothelioma result from pleural effusion, which is a build up of fluid between the lung lining and the chest cavity. Sufferers of pleural mesothelioma may experience some or all of the following symptoms: difficulty in breathing, difficulty in swallowing, shortness of breath, persistent coughing, weight loss, fever, coughing up of blood, and rasping.
(Click Here For More Information On Pleural Mesothelioma)

Peritoneal Mesothelioma:

A rarer form of mesothelioma is peritoneal mesothelioma. This is where the cancer affects the stomach and abdomen. The cancer can start in the abdominal area and spread to other parts of the body, but the tumours that press against the wall of the abdomen can cause some or all of the following symptoms: abdominal pain, abdominal swelling, nausea, loss of appetite, vomiting, breathing problems, chest pain, bowel obstruction, anaemia, fever, and blood clotting abnormalities.
(Click Here For More Information On Peritoneal Mesothelioma)

Pericardial Mesothelioma:

The last and the rarest of the mesothelioma types is pericardial mesothelioma. This is where the cancer affects the heart and the cavity that surrounds the heart. The tumours affecting pericardial mesothelioma patients can cause some or all of these symptoms: chest pain, shortness of breath, trouble breathing, persistent coughing, and palpitations.
(Click Here For More Information On Pericardial Mesothelioma)

There are also cases of other asbestos related diseases such as asbestosis and respiratory problems that have stemmed from exposure to this potentially fatal material. Anyone that has worked with asbestos should see their doctor if they have any onset of this type of problem or if they are concerned and have doubts.

As you can see, the symptoms for all three types of mesothelioma are non-specific, which means that they could be the result of a number of more common diseases that are associated with the same symptoms. Many of the symptoms are the same as those displayed by viral pneumonia patients, and the disease if often mistaken for something else.

If your doctor is unaware that you have been exposed to asbestos, he or she is unlikely to assume that you may have mesothelioma and will instead test for a number of other more common diseases that are associated with your symptoms. People who have worked with asbestos or who have close contact with someone that works with asbestos should therefore always be vigilant in looking out for any of these symptoms and seeking medical advice if any or all of the symptoms manifest. They should also make their doctor aware that they have worked with asbestos so that no further time is wasted in testing for other types of disease. Much of the delay in diagnosing mesothelioma comes from lack of information and awareness on both the part of the doctor and the patient.

However, it is up to the patient, who is aware of the asbestos exposure, to increase the chances of a speedy diagnosis by making the doctor aware of the circumstances and keeping an eye out of any tell tale signs that mesothelioma may be present.

Kidney diseases

2009-07-26T05:42:00.000-07:00

Polycystic kidney disease

Polycystic kidney disease is a condition where cysts (cavities) form in the kidney. Some of the cysts do not cause any progressive kidney failure. Other cysts are of the inherited type, which may enlarge and slowly crowd out the normal kidney. Eventually, after a long period of time, the patient may need artificial kidney treatment or transplantation. Symptoms of this disease range from no symptoms at all to blood appearing in the urine.

The inherited type of this disease is autosomal dominant. This means that if one parent has the gene in his/her family there is a 50% chance that each child will develop the disorder. However, even if the child does develop it, there are cases when the condition can be so mild that it would not be detected and would have no significant effect on the patient's health throughout life.

Pyelonephritis

Pyelonephritis refers to infection of the kidney. It is usually caused by a bacterial infection, but it can also be caused by viruses. Most of these can be treated with medication taken in the right dosage for the full time. There are many potential causes of pyelonephritis. The most common cause is some form of obstruction to urine flow. The obstruction could be in the ureter (the tube connecting the kidney to the bladder) or to the outflow of urine from the bladder. Other causes of obstruction include stones, swelling and scarring of the ureter, chronic infection, and tumors. Recurrent infections can also occur when the organisms causing your discomfort become resistant to the drugs that usually destroy them, particularly if patients do not take all of the medication prescribed. If the medication is not taken for the full length of time it was prescribed, it may not kill off the heartiest organisms. These organisms will become even more resistant and the symptoms will come back.

Kidney reflux

Reflux refers to a condition where the urine in the bladder passes back up the ureter to the kidney instead of out through the urethra during the process of urination. The muscles that usually close off the ureter to the bladder do not function normally. The process itself has no specific symptoms. If there is a bladder infection, reflux could cause a kidney infection, which may result in back pain. Reflux is usually not associated with incontinence unless there is associated urinary tract infection, congenital abnormalities associated with the drainage of the kidney, or problems with bladder function.

Systemic lupus and the kidneys

Systemic lupus (an autoimmune disorder) can cause the body to produce antibodies directed against the kidney membranes. Normally, the filtering membranes do not permit albumin and other blood proteins to be lost in the urine. However, when systemic lupus attacks the kidney, the filtering membranes are disrupted, resulting in the finding of protein in the urine. This antibody production can be altered by using immune suppressive drugs such as steroids, immuran, and cytoxine.

Renal acidosis

Renal acidosis refers to the accumulation of acid products in the blood that are not being properly excreted by the kidney. As the acid products accumulate the acidity of the blood goes up. This stimulates the receptors in the brain to speed up the rate of breathing. This can cause the sensation of shortness of breath. It also speeds up the heart rate so the pulse goes up. These are two of the most common symptoms and signs of metabolic acidosis caused by kidney failure.

Mesangial proliferative glomerulonephritis

This disease is noted to be present, but without symptoms, for long periods of time. It is important to have routine urine tests done at least once a year, as well as your blood pressure checked. Less than 30% of patients with this diagnosis progress to end stage renal disease. There are excellent treatments for high blood pressure, swelling, and anemia, all signs that may relate to glomerulonephritis. When such therapy is started early there is good evidence that they are very effective in delaying progression of the kidney disease. Therapies include diet, weight control, progressing on to artificial kidney or transplant over a long time period.

Membranoproliferative glomerulonephritis

Membranoproliferative glomerulonephritis is a form of glomerulonephritis that is classified as an autoimmune disease. Antibodies to some unknown protein, called an antigen, get trapped in the filtering bed of the kidney, called the glomerulus. Once there, this antigen sets up a reaction in the normal cells that activates the so-called "killer cells." These cells are very destructive and result in walling off the antigen. This produces a scar, which destroys the normal architecture of the glomerulus. This condition can be treated with immunosuppressive drugs.

Hemangiomas

Hemangiomas are common tumors usually found on the skin and commonly called 'birth marks'. They can occur in any organ or tissue. When they are located in the kidney they may cause hematuria (visible blood in the urine). This, in turn, may cause the dipstick test for protein to show a very weakly positive reaction that should not need investigating.

Parenchymal kidney disease

Renal parenchymal disease as seen by ultrasound means that the kidney is damaged and scarred and has lost part of its ability to function. There are many, many types of kidney disease that lead to scarring. Any time that scar tissue forms, kidney function in that area is lost and cannot be regained. Consultation with a nephrologist is very important in order to find out the cause the kidney disease, how severe the damage is, and what can be done to prevent the loss of any more kidney function.

The diagnosis of this disease by ultrasound is confirmed by elevated blood urea nitrogen concentration and serum creatinine concentrations (BUN normal range 10-20 mg%, creatinine .9-1.2 mg%). However, diagnosis is sometimes delayed because there are several types of parenchymal kidney diseases that are very silent in their progression. Some of these diseases are reversible; others can be treated to stop further progression.

Alport's Disease

Alport's disease is believed to be a form of auto-immune disease. The patient's immune system has set up antibodies that act on the tissues of the capillaries in the kidney. Alport's disease goes under other names also. The 2 most typical are Berger's Disease and IgA Nephropathy. The diagnosis of which form of Alport's disease a patient has can only be made from studies of kidney tissue removed by biopsy. The treatment is immuno-suppressive therapy, which is usually very effective in controlling the progression of the disease.

Diabetes Insipidus

Diabetes Insipidus is a disease that has symptoms that resemble diabetes mellitus but it is a far different condition. Its major symptom is very frequent urination. This condition may be the result of a deficiency of anti-diuretic hormone (ADH), a hormone that causes the kidney to retain water during times of dehydration. However, it may also be the result of kidney failure to respond to ADH. Under these circumstances, the individual was born without the biochemical receptors in the kidney that respond to the hormone. The disease is treatable. With proper management patients with this problem can lead a normal life.

What are Different Types of Heart Disease?

2009-07-26T05:26:00.000-07:00

Heart disease is a huge term that can describe many different conditions. All of these conditions have some effect on the heart or the blood vessels that supply the heart. It’s certainly possible to have several types of heart disease at the same time, which can make it difficult to think of these numerous diseases as separate. The fact that the heart is part of the circulatory system means that disease in one part of the system will have an affect on how all parts work.

Some disease is classified by its effect on the different components of the heart. In broad strokes the heart has four chambers (two ventricles and two atria), muscle, lining, an electrical system, valves, and coronary arteries and veins. Heart disease may be defined by what part of the heart it mostly affects.

Disease of the chambers include many forms of congenital heart disease where a chamber may be missing vital parts like separating walls or can be smaller than normal. Other diseases of the chambers can include an enlarged right ventricle, called cor pulmonale. Congestive heart failure is usually considered a chamber disease, and can be loosely describes as the heart failing to pump enough blood to supply the body.

Muscle heart disease can include many conditions that result in enlarged heart. Most forms of cardiomyopathy fall under this heading. Myocarditis, defined as inflammation of the heart muscle and which can result from things like virus and bacterial infection, is also a heart muscle disease.

The outside of the heart is covered with lining called the pericardium, and the inside is lined with the endocardium. Certain heart disease types specifically affect one of these areas. Most often these are pericarditis and endocarditis. Some forms of endocarditis can be a complication of bacterial infections and those most at risk have usually had heart surgery or have some form of heart disease. To protect against bacterial endocarditis, most people must use antibiotic treatments prior to seeing the dentist or having any type of oral surgery.

There can be many heart disease types that affect the electrical system of the heart. Most of these conditions create unusual heart rhythms. Some don’t require treatment while others need significant medical intervention. Forms of electrical system disease include: heart block, long QT syndrome, tachycardia, atrial flutter, and ventricular fibrillation.

The heart valves include the pulmonary, aortic, tricuspid and mitral valves. The tricuspid and mitral valves are located inside of the heart between ventricles and atria (right and left respectively), and the pulmonary and aortic valves are located right outside the heart.

Diseases involving these valves can include narrowing (stenosis), absence or such significant narrowing that the valves produce no blood flow (atresia), and poor valve function (insufficiency). Valve regurgitation can occur in any valve and means some of the blood leaks back in the wrong direction. Another common valvular heart disease is mitral valve prolapse.

Some of the most common heart diseases are located in coronary arteries and veins. These include angina, atherosclerosis, ischemic heart disease, and the interruption of blood flow to the heart through a coronary artery which results in heart attack (myocardial infarction). Ischemia and the atherosclerosis pose great risk for not only heart attack but also stroke.

A few other conditions that affect the heart but aren’t located specifically within or directly outside of the heart, include high blood pressure or hypertension, and peripheral arterial disease. As previously stated, conditions may be present together. A person can have angina, and hypertension for instance or narrowing of coronary arteries ultimately leads to heart attack. Not all conditions are preventable, especially not those conditions resulting from birth defects. However, most people know that some heart disease can be prevented through pursuing a healthy diet and exercise program, and not smoking at all or drinking to excess.

How is the lifespan of a human divided?

2009-07-25T10:47:00.000-07:00

Age is measured by years in life and every birthday is a sign of the age attained by a person and the years gone by since birth. One of the most important points telling on a person age is their years of life other than the visible manifestation of age, say for example, wrinkles and

Acne Tips

2009-07-25T09:55:00.000-07:00

Accutane Treatment for Acne Control

Accutane is considered the most advanced and powerful form of treatment for acne to date. It is highly effective in controlling and healing severe acne especially the ones that leave scars and ugly spots on the face. Accutane is a derivative of Vitamin A and comes in the form of a pill. Accutane treatment lasts

Tips to Reduce Acne for Clearer Skin

A clear and blemish-free skin does not only make a person look good but also boost self-confidence. But because of varying skin types among individuals across different age groups and nationalities, skin care can also vary, sometimes to a great extent. Factors such as genetic, hormonal and lifestyle can cause skin problems. The following tips

Tips to Prevent Acne with Diet and hygiene tips

Having a smooth and blemish-free skin is every person’s concern for the fact that it boosts self-confidence and it makes you feel and look good. There are some people who are prone to acne and they are bombarded with skin problems ranging from mild to severe skin breakouts. Prevent acne effectively by following practical methods

Diet for People with Acne

With the number of skin care products available in the market, each one promising unique features and benefits, it is quite hard to make the right choice. An acne-prone skin requires specialized treatment and most of the time; a product that works for one person does not give the same results to another. One of

Acne during Pregnancy

Acne during pregnancy is a common problem among women. Pregnant women, especially those in their first trimester of pregnancy, are prone to skin outbreaks. Hormones play a huge role in this occurrence. Even women gifted with clear skin all their life may suffer from acne outbreaks during the first three months of pregnancy. The good

Positive and Negative Effects of Benzoyl Peroxide

Benzoyl Peroxide is commonly used to treat acne. It has a formulation of two parts benzoyl and one part peroxide. It is used topically to treat acne and is generally found to be effective. However, its efficacy varies from person to person. The use of benzoyl peroxide is also governed by some precautions.
Benzoyl Peroxide

Tips for Choosing an Ideal Acne Face Wash

Keeping skin clear of impurities, make-up and dirt is the ideal solution to get rid of acne and keep skin healthy-looking. Cleansing the skin with a gentle and effective acne face wash is the first step in treating acne. This prepares the skin for application of topical medications.
In choosing an acne face wash, it

Using the Right Acne Cream ideal for your Skin Type

There are a lot of acne creams available in the market and each one promise unique features and benefits to effectively treat acne-prone skin. Making the right choice of acne cream can be difficult due to the number of choices. The best way to find an ideal acne cream is by assessing your skin type.

Home

2009-06-25T05:56:00.000-07:00

Ghaffar Health Clinic is the website which publish important articles that encourage systems thinking, offer thorough scientific approaches for solving tough health care problems and diseases, and address policy implications. The pages uses an interdisciplinary approach, coating such topics as Diet, Fitness, HIV/AIDS, Cancer, Heart Disease.

providing a single forum for researchers, Students, practitioners of health care services and management, the journal fosters the development and exchange of new ideas and the discussion of important findings in the field. Moreover, it disseminates knowledge rapidly across traditional disciplinary boundaries.

Personality Disorder

2009-06-25T05:52:00.000-07:00

Definition

Personality disorder is a general term for a type of mental illness in which your ways of thinking, perceiving situations and relating to others are dysfunctional. There are many specific types of personality disorders.

In general, having a personality disorder means you have a rigid and potentially self-destructive or self-denigrating pattern of thinking and behaving no matter what the situation. This leads to distress in your life or impairment of your ability to go about routine functions at work, school or social situations. In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you, and you may blame others for your circumstances

Symptoms

General symptoms of a personality disorder
General signs and symptoms that may indicate a personality disorder include:

Frequent mood swings
Stormy relationships
Social isolation
Angry outbursts
Suspicion and mistrust of others
Difficulty making friends
A need for instant gratification
Poor impulse control
Alcohol or substance abuse

Specific types of personality disorders
The specific types of personality disorders are grouped into three clusters based on similar characteristics and symptoms.

Cluster A. These are personality disorders characterized by odd, eccentric thinking or behavior and include:

Paranoid personality disorder

Distrust and suspicion of others
Believing that others are trying to harm you
Emotional detachment
Hostility

Schizoid personality disorder

Lack of interest in social relationships
Limited range of emotional expression
Inability to pick up normal social cues
Appearing dull or indifferent to others

Schizotypal personality disorder

Peculiar dress, thinking, beliefs or behavior
Perceptual alterations, such as those affecting touch
Discomfort in close relationships
Flat emotions or inappropriate emotional responses
Indifference to others
"Magical thinking" — believing you can influence people and events with your thoughts
Believing that messages are hidden for you in public speeches or displays

Cluster B. These are personality disorders characterized by dramatic, overly emotional thinking or behavior and include:

Antisocial (formerly, sociopathic) personality disorder

Disregard for others
Persistent lying or stealing
Recurring difficulties with the law
Repeatedly violating the rights of others
Aggressive, often violent behavior
Disregard for the safety of self or others

Borderline personality disorder

Impulsive and risky behavior
Volatile relationships
Unstable mood
Suicidal behavior
Fear of being alone

Histrionic personality disorder

Constantly seeking attention
Excessively emotional
Extreme sensitivity to others' approval
Unstable mood
Excessive concern with physical appearance

Narcissistic personality disorder

Believing that you're better than others
Fantasizing about power, success and attractiveness
Exaggerating your achievements or talents
Expecting constant praise and admiration
Failing to recognize other people's emotions and feelings

Cluster C. These are personality disorders characterized by anxious, fearful thinking or behavior and include:

Avoidant personality disorder

Hypersensitivity to criticism or rejection
Feeling inadequate
Social isolation
Extreme shyness in social situations
Timidity

Dependent personality disorder

Excessive dependence on others
Submissiveness toward others
A desire to be taken care of
Tolerance of poor or abusive treatment
Urgent need to start a new relationship when one has ended

Obsessive-compulsive personality disorder

Preoccupation with orderliness and rules
Extreme perfectionism
Desire to be in control of situations
Inability to discard broken or worthless objects
Inflexibility

Obsessive-compulsive personality disorder isn't the same as obsessive-compulsive disorder, a type of anxiety disorder.

When to see a doctor
If you have any signs or symptoms of a personality disorder, see your doctor, mental health provider or other health care professional. If untreated, personality disorders can cause significant problems in your life, and they may get worse.

Helping a loved one
If you have a loved one who you think may have symptoms of a personality disorder, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help

Asthma

2009-06-25T05:51:00.000-07:00

Defination

Asthma is a chronic disease of the lungs. In New York State (NYS), more than 1.1 million adults have asthma ¹. Asthma occurs at any age but is more common in children than adults. Nationally, nearly one in 13 school-age children have asthma, and that rate is rising more rapidly in preschool-aged children and those living in urban inner cities than in any other group. Although there is no cure for asthma, asthma attacks can be prevented and controlled with proper care. New York is actively working with health care providers, community coalitions, schools, families and many others to fight asthma so people with asthma can live a full and active life.

This web site is designed to provide accurate, current and useful information for people with asthma and for the people who care for them. New resources will be added often. Please check back frequently.

Sexuality

2009-06-25T05:47:00.000-07:00

Defination
Sexuality is often defined simply in terms of sex, but sexuality encompasses many different aspects of our lives beyond just sex alone. Sexuality is determined in part by our genetics and in part by the social expression of our underlining heredity and interaction with others. Three common ways in which sexuality has been described are in terms of: sexual behavior, sexual orientation, and sexual identity. However sexuality like many other aspects of our lives can be best understood holistically whereby both the internal (i.e. sexual identity, sexual orientation, etc.) and external (i.e. gender socialization, voluntary celibacy, etc.) factors that influence sexuality can be addressed.

The majority of educational resources available on sexuality focus on internal factors such as sexual behavior, sexual identity, and sexual orientation. These factors are important to sexuality given that they are responsible for influencing how we think, feel, and act out our unconscious expressions of sexuality. Although the internal factors related to sexuality are in part genetically determined (also referred to as biological determinism), human beings are rational beings and therefore have the ability to exercise choice in determining whether or not these internal factors get expressed publicly. Moreover, internal factors are not necessarily static and thus can change over time as we age and experience new places, situations, and people.
However what often gets neglected in discussions on sexuality is a dialogue on the diversity of external influences on sexuality. The most well known external influence on sexuality is gender socialization, which occurs in almost all aspects of our community including our family, school, media, and even politics. Some external influences that are less often associated to the development and expression of sexuality are sexual abuse, sexual exploitation, the presence of conflict or war, and spirituality, which could be thought of as both internally and externally influencing.

Of course the two greatest influencing factors on sexuality throughout history have been culture and religion. Culture is one of the central ways human beings define and express themselves including in terms of how we develop sexually. Cross-culturally sexuality means different things, and the expression of sexuality has different restrictions (or none at all) depending on where you go and who you talk to. Generally speaking, culture carries the most weight in sanctioning the expression, suppression, misuse, and even loving gesture of sexuality.
Despite what some people might think religion’s influence over sexuality is not about restrictions instead religion acts as a means by which sexuality can be channeled for the purposes of expression and even celebration. Although different religious doctrines propose a diversity of mandates when it comes to the ways in which sexuality should be channeled, most religions produce specifications on the basis of martial status, sex, and one’s personal spiritual growth.

Over the years as sexual expression has increased in many parts of the world so has the use of sexuality for the purposes of abuse. Project Respect (http://www.yesmeansyes.com) is a non-profit organization that focuses on educating youth, young adults, and adults on various means of prevention with concern to sexual violence (i.e. rape, sexual assault) and on the sharing of prevention strategies with the rest of the community. The ultimate goal of this organization is to erase the presence of violence in sexuality and to promote a world of sexual expression without fear of harm.

Heart Attack

2009-06-25T05:45:00.000-07:00

Definition

A heart attack usually occurs when a blood clot blocks the flow of blood through a coronary artery — a blood vessel that feeds blood to a part of the heart muscle. Interrupted blood flow to your heart can damage or destroy a part of the heart muscle.

Years ago, a heart attack was often fatal. Thanks to better awareness of heart attack signs and symptoms and improved treatments, most people who have a heart attack now survive.

Your overall lifestyle — what you eat, how often you exercise and the way you deal with stress — plays a role in your recovery from a heart attack. In addition, a healthy lifestyle can help you prevent a first or subsequent heart attack by controlling risk factors that contribute to the narrowing of the coronary arteries that supply blood to your heart.

Symptoms

Common signs and symptoms of a heart attack include:

Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
Increasing episodes of chest pain
Prolonged pain in the upper abdomen
Shortness of breath
Sweating
Impending sense of doom
Fainting
Nausea and vomiting

Signs and symptoms of a heart attack in women may be different or less noticeable than heart attack symptoms in men. In addition to the symptoms above, heart attack symptoms in women can include:

Abdominal pain or "heartburn"
Clammy skin
Lightheadedness or dizziness
Unusual or unexplained fatigue

Not all people who have heart attacks experience the same ones or experience them to the same degree. Many heart attacks aren't as dramatic as the ones you've seen on TV. Some people have no symptoms at all. Still, the more signs and symptoms you have, the greater the likelihood that you may be having a heart attack.

A heart attack can occur anytime — at work or play, while you're resting, or while you're in motion. Some heart attacks strike suddenly, but many people who experience a heart attack have warning signs and symptoms hours, days or weeks in advance. The earliest predictor of an attack may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by temporary, insufficient blood flow to the heart, also known as "cardiac ischemia."

Back Ache

2009-06-25T05:44:00.000-07:00

Definition

Back pain is a common complaint. Four out of five people in the United States will experience low back pain at least once during their lives. It's one of the most common reasons people go to the doctor or miss work.

On the bright side, you can prevent most back pain. If prevention fails, simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back pain.

Causes

Your back is an intricate structure composed of bones, muscles, ligaments, tendons and disks — the cartilage-like pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these component parts. In some people, no specific cause for their back pain can be found.

Strains
Back pain most often occurs from strained muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain.

Structural problems
In some cases, back pain may be caused by structural problems, such as:

Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. But many people who have bulging or herniated disks experience no pain from the condition.
Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg.
Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain.
Osteoporosis. Compression fractures of your spine's vertebrae can occur if your bones become porous and brittle.

Rare but serious conditions
In rare cases, back pain may be related to:

Cauda equina syndrome. This is a serious neurological problem affecting a bundle of nerve roots that serve your lower back and legs. It can cause weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control.
Cancer in the spine. A tumor on the spine can press on a nerve, causing back pain.
Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection.

cancer

2009-06-25T05:40:00.000-07:00

Definition

Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer also has the ability to spread throughout your body.

Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected. Some general signs and symptoms associated with, but not specific to, cancer include:

Fatigue
Fever
Lump or thickening that can be felt under the skin
Pain
Weight changes, including unintended loss or gain
Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal, or changes to existing moles
Changes in bowel or bladder habits
Persistent cough
Difficulty swallowing
Hoarseness
Persistent indigestion or discomfort after eating

Causes

Cancer is caused by damage (mutations) to the DNA within cells. Your DNA contains a set of instructions for your cells, telling them how to grow and divide. Normal cells often develop mutations in their DNA, but they have the ability to repair most of these mutations. Or, if they can't make the repairs, the cells often die. However, certain mutations aren't repaired, causing the cells to grow and become cancerous. Mutations also cause cancer cells to live beyond their normal cell life span. This causes the cancerous cells to accumulate.

In some cancers, accumulating cells form a tumor. But not all cancers form tumors. For example, leukemia is a cancer that involves blood, bone marrow, the lymphatic system and the spleen, but doesn't form a single mass or tumor.

The initial genetic mutation is just the beginning of the process by which cancer develops. Scientists believe you need a number of changes within a cell in order to develop cancer, including:

An initiator to cause a genetic mutation. Sometimes you're born with this genetic mutation. Other times a genetic mutation is caused by forces within your body, such as hormones, viruses and chronic inflammation. Genetic mutations can also be caused by forces outside of your body, such as ultraviolet (UV) light from the sun or cancer-causing chemicals (carcinogens) in your environment.
A promoter to cause rapid cell growth. Promoters take advantage of genetic mutations created by initiators. Promoters cause cells to divide more rapidly. This could lead to an accumulation of cells, such as a tumor. Promoters could be inherited, could come from inside your body or could come from outside your body.
A progressor to cause cancer to become aggressive and spread. Without a progressor a tumor may remain benign and localized. Progressors make cancers more aggressive, more likely to invade and destroy nearby tissue, and more likely to spread to other parts of your body. Like initiators and promoters, progressors could be inherited or they could come from environmental sources.

Your genetic makeup, forces within your body, your lifestyle choices and your environment can all set the stage for cancer or help complete the process once it's started. For instance, if you've inherited a genetic mutation that predisposes you to cancer, you may be more likely than other people to develop cancer when exposed to a certain cancer-causing substance. The genetic mutation begins the cancer process, and the cancer-causing substance could play a role in further cancer development. Likewise, smokers who work with asbestos are more likely to develop lung cancer than are smokers who don't work with asbestos. That's because tobacco smoke and asbestos both play roles in cancer development.

Food poisoning

2009-06-25T05:38:00.000-07:00

Definition

Food poisoning, also referred to as food-borne illness, is a gastrointestinal disorder that results from eating contaminated food. Infectious organisms — including various bacteria, viruses and parasites — are the most common cause of food poisoning. Harmful toxins and chemicals (noninfectious agents) also can cause illnesses, but this is less common.

Infectious organisms can contaminate food at any point during its processing or production. Contamination can also occur at home if food is incorrectly handled, improperly cooked or inadequately stored. Whether you become sick after eating contaminated food depends on the organism in the food, the amount of exposure you've had to it, your age and your health.

Food poisoning symptoms include nausea, vomiting and diarrhea, which can start just hours after eating the food. Most often, food poisoning is mild and resolves without treatment. But some cases can be severe, requiring hospitalization.

What can you do to prevent food poisoning? Keep hot food hot and cold food cold. And keep everything — especially your hands — clean. If you follow these basic rules, you'll be less likely to become ill from food poisoning.

HIV/AIDS

2009-06-25T05:35:00.000-07:00

HIV/AIDS

“When the history of our times is written, will we be remembered as the generation that turned our backs in a moment of a global crisis or will it be recorded that we did the right thing?” - Nelson Mandela
HIV stands for Human Immunodeficiency Virus. This virus is transferred from person to person when an HIV positive individual’s blood, semen, vaginal fluids, or breast milk comes in contact with another person’s bloodstream (through the mouth, throat, or breaks in the skin). This viral infection usually occurs during unprotected sexual activity, but can also occur between an HIV/AIDS positive mother and her child, through an unsecure blood transfusion, and by sharing used needles.
Once infected it takes as long as 8 to 10 years for the Human Immunodeficiency Virus to effectively breakdown the bodies’ natural immune defences, which leads to the Acquired Immune Deficiency Syndrome or AIDS for short. Although scientists around the world have been working hard to obtain a cure or even a vaccine for the HIV, none are currently available.

According to the United Nations Programme on HIV/AIDS (2007), about 33.2 million people are infected with HIV worldwide (which is 16% lower than 2006 estimates. So, far 2.1 million people have lost their lives to AIDS. Youth are particularly at risk as young people between the ages of 15 to 24 account for more than 40% of new HIV infections. Young women are also more at risk for contracting HIV; three times more likely than males in Sub-Saharan Africa and almost two times more likely in the Caribbean.

The most devastating effect on the world’s youth, as a result of the spread of the HIV/AIDS virus around the world, has been the alarming increase in the number of children and young people who have been orphaned by the disease. In 2007, there was an estimated 11.4 million AIDS orphans in sub-Saharan Africa.

The new face of HIV/AIDS is undoubtedly global leadership or more importantly youth leadership and education. Youth leaders are raising their voices on the issue of HIV/AIDS all over the world while spreading a message of change and healing among their young peers. For example groups such as “The Young Women of Color Leadership Council” who are striving to educate at-risk youth of color on issues of HIV prevention and community leadership; “Youth Visioning” who aim to encourage and support young leaders living on small islands around the world to propose and implement projects that will effectively impact how youth experience and understand HIV/AIDS; and the “Rural Sensitization Campaign in Cameroon” who is actively challenging youth to learn and be trained on healthy sexual practices, HIV prevention and transmission, testing, and treatment, in addition to targeting young women and men, this campaign aims to involve parents and children HIV/AIDS educational programmes.

There are several other factors that contribute to the spread of HIV/AIDS and the marginalization of people living with HIV/AIDS, which include high levels of: Severe poverty, unemployment, inadequate medical care, and risky sexual activity. However an additional factor that often goes unnoticed is the presence of stigma that becomes associated to people living with aids (PLWA) and who have openly revealed their HIV/AIDS status in their community. Stigma may result in isolation, physical and verbal abuse, and even in the premature death of PLWA. The spread of stigma among PLWA is preventable, but it requires the community and grassroots organizations to work together to minimize the fear and the overemphasis on the problems associated to HIV/AIDS when spreading awareness about the disease.

Arthritis

2009-06-25T05:34:00.000-07:00

Arthritis

The New York State Arthritis Program was created to help New Yorkers learn how to better manage their disease. The program has partnered with a variety of organizations to better inform the public about arthritis and how to live with the disease more effectively and comfortably. In New York State, approximately 3.7 million (26.1%) adults live with arthritis and, of those, nearly 56% of New York adults aged 65 years and older, or 1.4 million, have arthritis. In 2003, the total direct and indirect costs of arthritis care in New York were $8.7 billion. These numbers are expected to increase as the state's population continues to age.

Flat Feed

2009-06-25T05:31:00.000-07:00

Definition

If you have flatfeet, the arch on the inside of your feet is flattened. It's a common and generally painless condition. Sometimes, flatfeet occur because your arches don't develop during childhood. In other cases, flatfeet may occur as you age or after you've had a pregnancy.

While flatfeet usually won't cause any problems, if the condition causes your ankles to turn inward, you may have problems in your feet, ankles and knees. Simple corrective devices are available that can help you prevent some of the complications of flatfeet.

Pregnancy

2009-06-25T05:24:00.000-07:00

Definition

The classic signs and symptoms of pregnancy — tender breasts, nausea, fatigue, weight gain — probably come as no surprise. But what about itchy skin? In late pregnancy, a condition known as cholestasis of pregnancy may trigger intense itching, particularly on the hands and feet.

By definition, cholestasis is any condition in which the flow of bile — a digestive fluid — from the liver is blocked. Extrahepatic cholestasis occurs outside the liver. Intrahepatic cholestasis occurs inside the liver. Pregnancy is one of many possible causes of intrahepatic cholestasis. Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.

Other than intense itching, cholestasis of pregnancy poses few problems for mothers. Cholestasis of pregnancy can be dangerous for a developing baby, however. Early delivery is usually recommended.

Symptoms

Signs and symptoms of cholestasis of pregnancy may include:

Intense itching
Dark-colored urine
Light-colored bowel movements
Yellow eyes or skin
Abdominal pain

Often, however, intense itching — particularly on the palms of the hands and the soles of the feet — is the only symptom of cholestasis of pregnancy. The itching may be worse, even intolerable, at night. The itching is most common during the third trimester of pregnancy, but sometimes

Cosmetic Surgery

2009-06-25T05:19:00.000-07:00

Plastic surgery

Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. While famous for aesthetic surgery, plastic surgery also includes two main fields: plastic and reconstructive surgery. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic.

Techniques and procedures

In plastic surgery the transfer of skin tissue (skin grafting) is one of the most common procedures. (In traditional surgery a "graft" is a piece of living tissue, organ, etc., that is transplanted).

Autografts: Skin grafts taken from the recipient. If absent or deficient of natural tissue, alternatives can be:
- Cultured Sheets of epithelial cells in vitro.
- Synthetic compounds (e.g., Integra—a 2 layered dermal substitute consisting superficially of silicone and deeply of bovine tendon collagen with glycosaminoglycans).
Allografts: Skin grafts taken from a donor of the same species.
Xenografts: Skin grafts taken from a donor of a different species.

Usually, good results are expected from plastic surgery that emphasizes:

Careful planning of incisions so that they fall in the line of natural skin folds or lines.
Appropriate choice of wound closure.
Use of best available suture materials.
Early removal of exposed sutures so that the wound is held closed by buried sutures.

Reconstructive Surgery

"Reconstructive" redirects here. For other uses, see Reconstruction.

Reconstructive Plastic Surgery is performed to correct functional impairments caused by:

burns
traumatic injuries, such as facial bone fractures
congenital abnormalities, such as cleft lip, or cleft palate
developmental abnormalities
infection or disease
removal of cancers or tumours, such as a mastectomy for a breast cancer, a head or neck cancer or an abdominal invasion by a colon cancer

Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance.

Common reconstructive surgical procedures are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, creating a new outer ear when one is congenitally absent, and closing skin and mucosa defects after removal of tumors in the head and neck region.

Plastic surgeons developed the use of microsurgery to transfer tissue for coverage of a defect when no local tissue is available. tissue flaps of skin, muscle, bone, fat or a combination, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing arteries and veins as small as 1-2 mm in diameter.

The most common reconstructive procedures are tumor removal, laceration repair, scar repair, hand surgery and breast reduction. According to the American Society of Plastic Surgeons, the number of reconstructive breast reductions for women increased in 2007 by 2 percent from the year before. Breast reduction in men also increased in 2007 by 7 percent.

Cosmetic or Aesthetic Surgery

Main article: Aesthetic cosmetic surgery

Aesthetic Surgery involves techniques intended for the "enhancement" of appearance through surgical and medical techniques, and is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal.

In 2006, nearly 11 million cosmetic surgeries were performed in the United States alone. The number of cosmetic sprocedures performed in the United States has increased over 50 percent since the start of the century. Nearly 12 million cosmetic surgeries were performed in 2007, with the five most common being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The increased use of cosmetic surgery crosses racial and ethnic lines in the U.S., with increases seen among African-Americans and Hispanic Americans as well as Caucasian Americans. In Europe, the second largest market for cosmetic procedures, cosmetic surgery is a $2.2 billion business. ^[8]

The most prevalent aesthetic/cosmetic procedures are listed below. Most of these types of surgery are more commonly known by their "common names." These are also listed when pertinent.

Abdominoplasty (or "tummy tuck"): reshaping and firming of the abdomen
Blepharoplasty (or "eyelid surgery"): Reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
Mammoplasty
- Breast augmentation ("breast enlargement" or "boob job"): Augmentation of the breasts. This can involve either fat grafting, saline or silicone gel prosthetics. Initially performed to women with micromastia
- Breast reduction: Removal of skin and glandular tissue. Indicated to reduce back and shoulder pain in women with gigantomastia and/or for psychological benefit in women with gigantomastia/macromastia and men with gynecomastia.
- Breast lift (Mastopexy): Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue or scarless Serdev suture technique ^[9]
Buttock Augmentation (or "butt augmentation" or "butt implants"): Enhancement of the buttocks. This procedure can be performed by using silicone implants or fat grafting and transfer from other areas of the body.
Buttock lift (or "butt lift" or "brazilian butt lift"): Lifting, projection, tightening of the buttocks. This procedure can be performed by using the scarless Serdev suture technique without implants. ^[10]
Chemical peel: Minimizing the appearance of acne, pock, and other scars as well as wrinkles (depending on concentration and type of agent used, except for deep furrows), solar lentigines (age spots, freckles), and photodamage in general. Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acid (TCA), glycolic acid (AHA), or salicylic acid (BHA) as the active agent.
Labiaplasty: Surgical reduction and reshaping of the labia
Rhinoplasty (or "nose job"): Reshaping of the nose
Otoplasty (or ear surgery): Reshaping of the ear. Most often done by pinning the ear closer to the head.
Rhytidectomy (or "face lift"): Removal of wrinkles and signs of aging from the face
Suction-Assisted Lipectomy (or liposuction): Removal of fat from the body
Brow lift: higher brow position by surgical or scarless Serdev suture
Chin augmentation: Augmentation of the chin with an implant (e.g. silicone) by sliding genioplasty of the jawbone or by suture of the soft tissue.
Cheek augmentation by suture Serdev suture
Cheek lift/Midface lift using scarless suture technique.
Collagen, fat, and other tissue filler injections (e.g. hyaluronic acid)
Laser skin resurfacing
Hilotherapy a therapy that provides relief from heamatoma, pain and swelling post-surgery without the dangers of Frostbite and Skin Necrosis

Plastic surgery sub-specialities

Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic Surgery includes mastery of the following as well:

Craniofacial surgery is divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, oral and maxillofacial surgeons, speech therapists, occupational therapists and geneticists. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction) along with orthognathic surgery. Craniofacial surgery is an integral part of all plastic surgery training programs, and further training is frequently obtained via a craniofacial fellowship for additional expertise.
Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. Most Hand surgeons will opt to complete a fellowship in Hand Surgery. The Hand surgery field is also practiced by orthopedic surgeons and general surgeons (see Hand surgeon).
Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
Burn surgery generally takes place in two phases. Acute burn surgery is the treatment immediately after a burn. Reconstructive burn surgery takes place after the burn wounds have healed. Reconstructive surgery generally involves plastic surgery.
Pediatric plastic surgery. Children often face medical issues unique from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate and congenital hand deformities.

Fever

2009-06-25T05:14:00.000-07:00

Definition

A fever isn't an illness itself, but it's usually a sign that something out of the ordinary is going on in your body. Fevers aren't necessarily bad. In fact, fevers seem to play a key role in helping your body fight off a number of infections.

If you're an adult, a fever may be uncomfortable, but it usually isn't dangerous unless it measures 103 F or higher. For very young children and infants, however, even slightly elevated temperatures may indicate a serious infection.

Because a fever can occur with many different conditions, other signs and symptoms can often help identify the cause.

Most fevers go away in a relatively short time — usually within a few days. Not all fevers need treatment with medications. And it's possible for fever medications to have side effects, especially for the very young.

Diseases

2009-06-25T05:08:00.000-07:00

Curing attitudes of stigmatization,
A disease is an illness that affects the body (a single area or the whole system) and/or mind within a single organism (World Health Organization). Basically when a person is in a diseased state, they are no longer classified by modern and traditional medical diagnosis as “healthy”. Some examples of common diseases worldwide are: Influenza A virus, Asthma, HIV/AIDS, HPV, Malaria, and Sickle Cell Anemia. In addition, diseases are generally classified into three categories, which include: Genetic, infectious, and non-infectious.

As is the case with most marginalized groups, people living with a disease(s) are often discriminated against on the basis of their illness. Some researchers have linked negative cultural perceptions of diseased individuals to the common occurrence of discrimination among the ill. The validity of the previous claim remains to be confirmed, however research has shown that cultural differences between the treatment of the ill within traditional and modern societies do exist.

One way to reduce stigma and discrimination of the ill is through education and improvement of community health services and networks. Yet stigma and discrimination of the ill has existed throughout human history in almost all societies and civilizations around the globe, so eradicating its practice is no easy task.

When some of us think of disease we immediately associate it with death and rarely associate disease with life. Although this may appear to be just a matter of commonsense, having a disease does not automatically mean a death sentence. In fact many people who have suffered from a debilitating illness have accredited their disease to teaching them the true meaning of survival. Disease-related advocacy campaigns around the world have focused on survival as their central theme and message because survival signifies hope not just for a future cure but also for life itself. In the end, whether we are diseased or healthy we are all fighting to survive.

In 2006 the World Heart Federation (WHF) leaped from the dreams of a handful of global youth leaders and partners into a fruitful reality as one of the leading disease advocacy organizations in the world specializing in youth advocacy. With chapters in several nations around the world, WHF has taken their advocacy projects from national to local levels of change. Some of their project areas include: Tobacco control, developing advocacy skills, and poor diets and physical inactivity.
Of course beyond the efforts of global civil society agents, youth have also been impacted negatively by disease as in the case of millions of orphans as a result of the global HIV/AIDS epidemic, the hundreds of thousands of children who die each year from Malaria and other preventable diseases, and the growing number of acquired diseases among youth in heavily polluted developed nations. As young people we may not be immune to disease, but we can work to prevent discrimination of the ill and celebrate their survival.