Mutant sperm guide clinicians to new diseases

Disease, DNA, deletions and duplications in human sperm

Human sperm:

Research published today in Nature Genetics shows that some rearrangements of the human genome occur more frequently than previously thought. The work is likely to lead to new identification of genes involved in disease and to improve diagnosis of genomic disease.
The scientists from the Wellcome Trust Sanger Institute looked at four unstable regions in the genome where rearrangements cause genetic diseases, so-called 'genomic disorders', and found that some of these rearrangements were found in sperm much more frequently than expected.
The team, led by Dr Matt Hurles, showed that losses or duplication of 'chunks' of the human genome occurred frequently in apparently healthy people. These losses or gains of DNA regions are called Copy Number Variants (CNVs), and can be found all over the genome in every individual.
Some of the mechanisms thought to produce CNVs would be expected to produce about one duplication for every deletion: however, clinical records for genomic disorders show only a few duplications, compared with hundreds of deletions.

" These are unfortunate accidents of the essential shuffling of our genetic deck of cards, a process essential to human life. "

Dr Matt Hurles

"There was no direct, global measure of the relative rate at which human DNA is gained or lost, a study that requires many thousands of human genomes," explained Dr Matt Hurles, Investigator at the Wellcome Trust Sanger Institute, "so we carried out a study on four clinically important regions using human sperm cells as our population of genomes. 
"Sperm cells give us an unbiased snapshot of CNVs: using our new highly-sensitive assays we can detect one rearrangement in a million cells."
The team looked at regions known to be affected by rearrangement in Williams-Beuren Syndrome, Charcot-Marie-Tooth disease Type 1A, Smith-Magenis Syndrome, and a deletion (AZFa) that causes male infertility. Their study showed that duplications are about half as frequent as deletions. By contrast, the two types of CNV are similarly common in healthy adults, suggesting that some deletions are too detrimental for the genome to tolerate.
"It is likely that deletions are more harmful than duplications, perhaps because a vital gene is removed, and so less likely to survive," explained Dr Hurles. "However, for some of the genomic regions we looked at, duplications can cause milder symptoms. Perhaps we can improve diagnosis with improved understanding of the possible consequences of duplications."
In Williams-Beuren Syndrome, loss of a genomic region (which can vary in size) can have very severe effects, including narrowing of arteries, facial and other skeletal deficiencies and impaired mental development. By contrast, duplications of the same regions have a milder effect, resulting most commonly in delay of speech development. With the results of this study, the team suggest that improved diagnosis might result from examining speech-delay for CNVs in this region.
"Although some of these CNVs arise much more frequently than anyone thought, they are still comfortingly rare: we see them in about 1 in 50,000 sperm cells," explained Dr Hurles. "These are unfortunate accidents of the essential shuffling of our genetic deck of cards, a process essential to human life. We need a new deal for each new person."
The method should also be able to detect rearrangements where none was suspected and to predict new disease-causing variants. Indeed one of the duplications that was detected in sperm has not yet been observed in the clinic, and yet it can be expected to cause disease, because smaller duplications of the same region cause Potocki-Lupski syndrome. Clinical genetics usually proceeds from observations in a patient down a long road to identify the gene involved. The new CNV work opens a new and possibly quicker, route of using new mutations found in sperm to lead to disease-causing mutations in patients.
In their work in 2006, the team has developed the CNV map for apparently healthy people: many of these are unlikely to cause disease. By looking across the entire genome for novel CNVs in human sperm, they will be able to predict where CNVs are likely to play a possible undiscovered role. In this 'reverse genetics', the new methods move from genome to prediction of consequences for patients.

Cough

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Cough - Description

While people can generally cough voluntarily, a cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 mi (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness, chest pain, or breathlessness. In the majority cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks it is considered a chronic cough, and physicians will try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Cough - Causes and Symptoms

In the majority of cases, coughs are caused by respiratory infections, including:

colds or influenza, the most common causes of coughs

bronchitis, an inflammation of the mucous membranes of the bronchial tubes

croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children

whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named

pneumonia, a potentially serious bacterial infection that produces discolored or bloody mucus

tuberculosis, another serious bacterial infection that produces bloody sputum

fungal infections, such as aspergillosis, histoplasmosis, and cryptococcoses.

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to removed it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis, can also result in a cough. Some chronic conditions, such as asthma, chronic bronchitis, emphysema, and cystic fibrosis, are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side-effect of medications that are administered via an inhaler. It can also be a side-effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

Cough - Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum will also help determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Cough - Treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics, an asthma-induced cough may be treated with the use of bronchodialators, or an antihistamine may be administered in the case of an allergy. Physicians prefer not to suppress a productive cough, since it aids the body in clearing respiratory system of infective agents and irritants. However, cough medicines may be given if the patient cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants.

Antitussives

Antitussives are drugs that suppress a cough. Narcotics--primarily codeine--are used as antitussives and work by depressing the cough center in the brain. However, they can cause such side effects as drowsiness, nausea, and constipation. Dextromethorphan, the primary ingredient in many over-the-counter cough remedies, also depresses the brain's cough center, but without the side effects associated with narcotics. Demulcents relieve coughing by coating irritated passageways.

Expectorants

Expectorants are drugs that make mucus easier to cough up by thinning it. Guaifenesin and terpin hydrate are the primary ingredients in most over-the-counter expectorants. However, some studies have shown that in acute infections, simply increasing fluid intake has the same thinning effect as taking expectorants.

Cough - Alternative treatment

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with botanical and homeopathic therapies. The choice of remedy will vary and be specific to the type of cough the patient has. Some combination over-the-counter herbal and homeopathic cough formulas can be very effective for cough relief. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Many health practitioners advise increasing fluids and breathing in warm, humidified air as ways of loosening chest congestion. Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu. Various vitamins, such as vitamin C, may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. Avoiding of mucous-producing foods can be effective in healing a cough condition. These mucous-producing foods can vary, based on individual intolerance, but dairy products are a major mucous-producing food for most people.

Cough - Prognosis

Because the majority of coughs are related to the common cold or influenza, most will end in seven to 21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Cough - Prevention

It is important to identify and treat the underlying disease and origin of the cough. Avoid smoking and coming in direct contact with people experiencing cold or flu symptoms. Wash hands frequently during episodes of upper-respiratory illnesses.

Key Terms

Antitussives
Drugs used to suppress coughing.

Expectorant
Drug used to thin mucus.

Gastroesophageal reflux
Condition in which stomach acid backs up into the esophagus.

Glottis
The opening between the vocal cords at the upper part of the larynx.

Larynx
A part of the respiratory tract between the pharynx and the trachea, having walls of cartilage and muscle and containing the vocal cords.

Sputum
The mixture of mucus, irritants, and other substances expelled from the lungs by coughing.

Five reasons to avoid junk food

Junk food is very common now a day’s especially in young youth. People have stopped eating the traditional curry dishes. As every picture has two sides so is same for the junk food. People like junk food as it is readily available always. People think that junk food digest faster than the usual traditional food. But the junk food has also got drawbacks. Following are the 5 major reasons that why one should avoid the junk food:-

Heart diseases

Junk food results in many heart diseases such as cardiac arrest, atherosclerosis and myocardial infraction. The reason that junk food causes these diseases is that junk food contain excess amount of lipoproteins and cholesterol. The lipoproteins and cholesterol deposit on inner linings of blood vessels. So, this results in formation of plaques. And for this reason heart need to put extra effort to pump the blood through the arteries. Junk food also contains excess amount of sugar and salts which result in increased blood pressure.

Liver failure

Liver failure is also due to same reason. The presence of cholesterol and salts in junk food result in liver failure.

Lack of energy

Junk food contains harmful carbohydrates, cholesterol and fats. So, the body having junk food does not get required nutrients and it lack energy.

Diabetes

Junk food ingredients are also harmful in the way that they damage the pancreas and result in IDDM (Insulin-dependent diabetes mellitus).

Poor concentration

Due to excess of oil and fat in the junk food it makes difficult for the body to digest it. So to digest this all body utilizes more enzymes and blood. Person feels drowsy and has less concentration because major portion of blood is diverted to intestine.

West Nile disease

What is it West Nile disease?

West Nile virus is spread through the bite of an infected mosquito. The mosquito can become infected after biting an infected bird and this can then be transmitted from the bird to humans.

There is no evidence to suggest that West Nile virus can be spread from person to person or animal to person.

Where am I at risk?

The West Nile virus was first discovered in the West Nile area of Uganda in 1937.

It is prevalent in North America, where two thirds of the East coast states have had cases. There has even been a case in California.

There have also been cases in Israel, Africa and Asia and parts of Eastern Europe.

There was a UK case of a bird with the antibodies of the West Nile virus, but there have been no human cases.

What are the symptoms?

The patient can incubate the disease for up to a fortnight after being bitten.

Many of the people who become infected will have either no symptoms or mild flu-like symptoms, which last a couple of days.

These can range from fever, headache and body aches to skin rashes on the trunk of the body and swollen lymph glands.

But more serious cases, less than 1% of those who become infected, can result in severe illness such as West Nile encephalitis or meningitis and sometimes lead to death.

Out of about 1,000 people who became infected in Europe recently there were about 40 deaths.

How do I protect myself?

Scientists have developed a vaccine for the disease and it was due to start human trials in late 2002.

But as yet there is no vaccine for travellers to use so the best way to protect yourself is to avoid being bitten by a mosquito.

The mosquitoes which carry this disease bite at dawn, dusk and early evening, so if you are travelling to an area where the disease is prevalent you should either stay indoors, or wear long sleeved shirts and long-trousers and wear insect repellent.

People travelling with young children should ensure that they use a specially prepared insect repellent, rather than the adult version.

Sars

What is Sars?

Sars stands for Severe Acute Respiratory Syndrome. It is a new illness that emerged in the Far East early in 2003, first in southern China, then spreading to Hong Kong, Vietnam, Singapore, Canada and more than 20 other countries.

It is believed to be caused by a new strain of Corona virus - a family of viruses which has been linked to the common cold.

By the middle of April, it had killed more than 150 people worldwide and infected more than 3,000 more.

What are the symptoms, and how is it treated?

The most obvious symptoms of Sars are breathing problems. Patients develop a high temperature (more than 38 degrees), dry cough, and severe respiratory symptoms follow swiftly.

Some patients need to be put on a ventilator to keep them breathing while their bodies fight the infection. Four in every hundred people who develop Sars do not survive.

Most of those who have died have been older, or had pre-existing health problems which increased their vulnerability - but some younger, healthy people have died.

Patients suspected of having Sars are given a combination of antibiotics and antiviral drugs, which have produced an improvement in some patients, although their precise effectiveness is uncertain.

There is no vaccine for the virus that causes Sars, although a diagnostic test has been developed.

How can I catch it?

The virus appears to be transmitted less easily than conventional influenza - although the resulting illness can become more severe.

It appears to be passed on by "close contact" with an infected person, perhaps carried in large droplets thrown out when the infected person sneezes or coughs.

There has been concern about transmission within passenger aircraft. The latest advice suggests that those at risk of infection would need to be seated within a couple of rows of the infected person, with no evidence of risk to people sitting elsewhere on the plane.

People in the Far East have attempted to protect themselves by wearing face masks - it is uncertain how much genuine protection these offer against the virus.

Should I avoid any particular areas?

The areas worst hit by Sars are Hong Kong, and the Guangdong province of southern China.

In late March 2003, the World Health Organization advised people to restrict non-essential travel to Hong Kong or Guangdong. The UK government agreed with this advice. This was only intended to be temporary advice until outbreaks in these locations were under control.

Travellers should check the websites of the World Health Organization and, in the UK, either the Health Protection Agency or Foreign and Commonwealth Office for the latest advice.

All travellers to areas heavily affected by Sars should be aware of this and take account of the problem in their travel plans. Some countries have been screening passengers arriving from Sars-hit areas for early signs of the illness.

I have some of these symptoms. What should I do?

If you have recently returned from South East Asia and suffer from any of the following symptoms - sudden onset of fever (>38° C), together with respiratory symptoms such as cough, sore throat, shortness of breath or difficulty breathing within 10 days of return

Rabies

What is rabies?

Rabies is an encephalitis, or brain disease, which is caused by the rabies virus.

It is a fatal condition caused after being bitten by an infected animal, usually a rabid dog or a bat.

There is a vaccination against the disease, but once symptoms of rabies have developed the condition is almost always fatal - and the few people who have survived have suffered serious long-term disabilities.

Which countries am I most at risk?

Most countries of the world have rabies and there are only a few, including Britain, the Antarctic and Australia, which have been declared rabies free.

But anyone bitten by a bat in the UK should still seek medical advice.

The last case of rabies in the UK was in November 2002, when a conservation worker was bitten by a rabid bat.

But there have been no cases in the UK of rabies being transmitted by a dog over the last 100 years.

Travelling in developing countries is the most risky, particularly the more remote areas, as clinics do not always have supplies of the vaccine. The vaccine can be successful after a person has been bitten, if it is taken early enough.

What are the symptoms?

Rabies affects the central nervous system.

Initial symptoms can include anxiety, headaches and fever. As the condition progresses the patient will have spasms of their swallowing muscles, a fear of water and respiratory failure will set in.

How can I avoid rabies?

Travellers going to countries where rabies is endemic are advised to have the rabies vaccine. This is a safe and effective jab and should be considered by anyone who is bitten or scratched by a warm blooded animal in a country with rabies.

Travellers abroad are advised to steer clear of animals, particularly stray or unattended dogs.

Lyme disease

How would I get Lyme disease?

Lyme disease is caused by a bacteria, called Borrelia burgdorferi, and is transmitted to humans through the bites of a tick.

The ticks are found either on animals such as deer and mice, or they jump onto the human when they brush past them in tall grass, shrubs or low trees.

Where am I most at risk?

America, particularly the forested areas of New England, has the most cases of Lyme disease - here the numbers of those infected run into hundreds of thousands each year.

Russia is also quite badly affected. But there are also cases of Lyme disease in the UK. Doctors usually see a few hundred cases of it each year.

And recent climate changes have been blamed for an increase in the infection.

What are the symptoms?

There are a variety of symptoms linked to Lyme disease. The first is an expanding rash or bruise which starts at the bite mark, usually a week after the person has been bitten.

It can appear as either a single red blotch, or as a "bullseye" shape with a widening ring around its central point.

The mark can feel warm to the touch, but might not itch or cause pain.

After the rash appears sufferers may also start to suffer joint pains, fever, fatigue, stiff neck and facial paralysis or tingling as the bacteria starts to spread around the body.

More serious symptoms can include severe headaches, painful arthritis, joint swelling and heart problems.

Some patients even suffer mental disorders such as short term memory loss and difficulty concentrating.

But if the disease is caught early enough it can be treated with antibiotics, although later stage Lyme does not respond as well.

What should I do to protect myself?

Anyone in an area where Lyme disease is thought to be prevalent should check themselves regularly to ensure that they have not been bitten.

Ticks can attach themselves anywhere on the body, but prefer creases like the armpit, groin or back of the knee.

Walkers should wear light coloured clothing and gardeners' light gloves, so they can see the ticks.

The ticks spread their disease slowly, so the quicker they are spotted the less chance there is of someone becoming infected.

The best way to remove a tick is by tweezers, although you should be careful to pull the tick out directly without jerking or twisting it. Antiseptic should then be put on the wound.

Leishmaniasis

What is it?

Leishmaniasis is a parasitic disease spread through bites from sandflies.

It affects about 12 million people globally, most of them in south or central America, Africa and the Middle East.

There are three sorts of leishmaniasis, which vary in severity.

The most dangerous is "visceral leishmaniasis", which is also known as black fever. This is nearly always fatal if it is left untreated.

It spreads into the spleen, bone marrow and liver and attacks and destroys the immune system.

Another type, "mucocutaneous leishmaniasis", produces disfiguring lesions which destroy the mucous membranes of the nose, mouth and throat.

"Cutaneous leishmaniasis" tends to cause sores on the skin. Some people have had up to 100 and these can vary in size from 2cm to 3cm in diameter.

How can I avoid it?

As the disease is spread by the sandfly the best way to avoid it, is to avoid getting bitten.

The sandfly bites mainly at night so travellers should use a good insect repellent, they should also sleep under insect nets with a very fine mesh.

Leishmaniasis is prevalent in about 90 tropical and subtropical countries around the world.

What do I do if I get it?

Anyone suffering from the symptoms of leishmaniasis, who has just returned from an area in which it is prevalent, should contact their GP immediately.

It is vital that people going to their doctor tell him where they have been travelling so that he can make an accurate diagnosis.

What is the treatment?

The treatment involves a series of about 30 days worth of injections, using a toxic drug to kill the parasite. The patient has to stay in hospital for the duration of their treatment.

Deer Disease

Aim

The aim of this guide is to describe “notifiable” diseases, for which there is a legal responsibility to act and to outline what steps need to be taken if such a disease is suspected. This guide also aims to provide information on diagnosing and preventing infections in order to safeguard the health of humans, livestock, the wild deer population and other wild animals.

Notifiable Diseases

The following table describes the main ‘notifiable’ diseases, for which there is a legal responsibility to act.

• Inform the Divisional Veterinary Manager1 immediately where any of the following diseases are suspected.
• The Tuberculosis (Deer) Order 1989 makes it a legal requirement to notify suspicions of TB to the Divisional Veterinary Manager2, and provides powers for the veterinary inspector to carry out an investigation and to restrict movements on affected or suspicious deer.

Confirmation of a Notifiable Disease in wild deer is unlikely to lead to legal restrictions on the management of wild deer, but it may be relevant to the control of domestic livestock or farmed deer in the area, so it is mandatory information for the Divisionary Veterinary Manager.1

Safeguarding human health

A small number of diseases are also transmissible to humans either through direct transmission (e.g. Bovine TB) or indirect transmission (e.g. Lyme disease** from ticks).
Specifically in relation to Bovine TB, transmission to humans through eating venison from infected deer is very unlikely and there is no recorded case. The meat from infected animals can even be passed as ‘fit for human consumption’ (after the removal of the affected tissue) unless the carcass is generally emaciated. Those coming in contact with tuberculosis should consult their own doctor immediately.

• Even apparently healthy deer may be infected with a disease transmissible to man so that care should always be taken to minimise the potential for disease spread by carrying out good hygiene practices when handling carcasses.***

Prevention of disease

Preventing introduction of disease from outside the UK

• If importing live animals, hunting trophies or foodstuffs (animal and human), ensure that all UK disease prevention laws are complied with.
• Take care to ensure that those who have been in contact with deer overseas or walking in infected areas do not arrive with clothes or boots contaminated with mud or blood (e.g. Chronic Wasting Disease could be introduced in this way from North America).

Reducing risk of disease in wild deer

Stress (for example, malnutrition) can lower an individual’s ability to resist disease and parasites, and deer found in higher densities and concentrations are more likely to transmit and contract infectious diseases and parasites.

• Maximise quality of forage and shelter available throughout year to reduce the risk of malnutrition.
• Avoid/ minimise situations where deer are artificially concentrated in close proximity to each other (such as feed sites) to prevent transmission.

Notifiable diseases and prevalence

Bovine Tuberculosis (Mycobacterium bovis)

As Bovine Tuberculosis (bTB) is potentially a serious risk to livestock and may pose a threat to human health, the disease is notifiable. Wild deer can contract bTB. Fortunately, there is currently a low incidence of bTB in domestic livestock in Scotland. Only four cases of bovine TB in wild deer have been recorded since 1989.
The symptoms and signs for bTB overlap with two related diseases which can also be contracted: Avian Tuberculosis (aTB) (Mycobacterium avium avium) and Johne’s disease (Mycobacterium avium paratuberculosis). aTB and Johne’s disease (not notifiable) are more commonly found in wild deer.
Lesions of bTB are indistinguishable from those of aTB. The two infections can only be separated by culturing the bacteria from lesions in the laboratory and characterising their DNA. This usually takes at least 6 weeks.

Chronic Wasting Disease (CWD)

Chronic Wasting Disease (CWD) has been reported in several deer species in the USA. Although not strictly listed as a Notifiable Disease, CWD is a member of a group of transmissible spongiform encephalopathies (TSEs) to which scrapie of sheep and bovine spongiform encephalopathy (which is a Notifiable Disease) belong. TSEs have not been diagnosed in British deer although Europe wide surveillance is in place.

Foot and Mouth Disease

Foot and Mouth Disease (FMD): experimental work has demonstrated that red, fallow, roe and sika can all contract FMD. During the 2001 and 2007 epidemics no deer were confirmed to have had FMD despite very close contact with infected cattle and sheep.

Bluetongue

Bluetongue and Epizootic Haemorrhagic Disease (EHD): Epizootic haemorrhagic disease which affects deer is clinically and pathologically similar to Bluetongue. Both diseases are caused by a related but different virus. Bluetongue is now present in the UK having spread to livestock in England in 2007. Further spread of the disease will depend on environmental conditions allowing the virus to multiply in midges that transmit the disease. Although there have been a small number of cases of Bluetongue in deer in Europe, there have been no confirmed cases in deer in the UK. EHD has never been recorded in the UK.

Asthma

Asthma is a lung disease that causes obstruction of the airways. It is an overreaction of the body’s immune system usually caused by exposure to an allergen, a substance that the body perceives as foreign and dangerous.

During an asthma attack, spasms in the muscles surrounding the bronchi (small airways in the lungs) constrict, impeding the outward passage of air. Asthma sufferers often describe this plight as “starving for air”. Typical symptoms of an asthma attack are coughing, wheezing, a feeling of tightness in the chest, and difficulty breathing. An attack can last for a few minutes or several hours.

The spasms characterizing an acute attack are not the cause of the disorder, but a result of chronic inflammation and hypersensitivity of the airways to certain stimuli. An attack can be triggered if a susceptible individual is exposed to an allergen, but irritants, infection, stress, exercise, use of aspirin, ibuprofen, naproxen, or other NSAIDs – or even rapid changes in weather and humidity- can trigger an attack.

Common asthma provoking allergens include animal dander, cockroach allergens, pollens, mold, pet dander, chemicals, drugs, dust mites, environmental pollutants, feathers, food additives ( such as monosodium glutamate, sulfites such as sodium metabisulfite), sea food, dairy products, nuts, yeast-based food, fumes, mold, and tobacco smoke.

Factors that can trigger non allergic asthma include adrenal disorders, anxiety, temperature changes, exercise, extremes of dryness or humidity, fear, laughing, low blood sugar, and stress. A respiratory infection like bronchitis is the most common provoker. Whatever the particular instigator, the bronchial tubes swell and become plugged with mucus. This inflammation further irritates the airways, resulting in even greater sensitivity. The attacks become more frequent and the inflammation more severe.

Asthma epidemics related to atmospheric contamination – situations in which dust and chemical particles are abundant, especially in enclosed environments- are well known. Occupational exposure to certain substances, such as urethrane and polyurethrane, used in the adhesives and plastic industry, along with rubber epoxy resins from paint, textile cleaner’s fumes, dry cleaning chemicals, and others also may be major risk factors.

Asthma symptoms may resemble those of other diseases, such as emphysema, bronchitis, heart burn, and lower respiratory infections.

Common signs and symptoms of asthma include: recurrent wheezing, coughing, trouble breathing, chest tightness, symptoms that occur or worsen at night, symptoms that are triggered by cold air, exercise or exposure to allergens.

Wheezing — high-pitched whistling sounds when you breathe out — is one of the main signs of asthma and indicates obstructed airways.

Although your symptoms, medical history and physical examination may suggest that you have asthma, lung (pulmonary) function tests may be needed to confirm an asthma diagnosis. Lung function tests may include one or more of the following tests:

a. Spirometry

This noninvasive test measures how well you breathe. During spirometry, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. Spirometry testing reveals two measurements that are important in diagnosing asthma:

Forced vital capacity (FVC), which is the maximum amount of air you can inhale and exhale.

Forced expiratory volume (FEV-1), which is the maximum amount of air you can exhale in one second.

The two measurements are compared. If certain key measurements are below normal for a person your age, it may be a sign that your airways are obstructed. Your doctor may ask you to inhale a bronchodilator drug used in asthma treatment to open obstructed air passages and then try the test again. If your measurements improve significantly, it's likely that you have asthma. Your doctor may still suspect that you have asthma even if your initial spirometry measurements are normal. If so, you may need additional tests.

b. Challenge test

During this test, your doctor deliberately tries to trigger airway obstruction and asthma symptoms by having you inhale an airway-constricting substance or take several breaths of cold air. If you appear to have exercise-induced asthma, you may be asked to do vigorous physical activity to trigger symptoms.

After triggering your symptoms, you retake the spirometry test. If your spirometry measurements are still normal, it's likely that you don't have asthma. But if your measurements have fallen significantly, it may mean you have asthma.

Treatment

The following treatments are usually administered concurrently to achieve the most rapid resolution of the exacerbation.

Oxygen. To achieve arterial oxygen saturation of a 90% (a 95% in children), oxygen should be administered by nasal cannulae, by mask, or rarely by head box in some infants. PaCO2 may worsen in some patients on 100 percent oxygen, especially those with more severe airflow

Obstruction. Oxygen therapy should be titrated against pulse oximetry to maintain a satisfactory oxygen saturation.

Rapid-acting inhaled ß2–agonists. Rapid-acting inhaled beta2-agonists should be administered at regular intervals. Although most rapid-acting beta2-agonists have a short duration of effect, the long-acting bronchodilator formoterol, which has both a rapid onset of action and a long duration of effect, has been shown to be equally effective without increasing side effects, though it is considerably more expensive.

The importance of this feature of formoterol is that it provides support and reassurance regarding the use of a combination of formoterol and budesonide early in asthma exacerbations. A modestly greater bronchodilator effect has been shown with levabuterol compared to racemic albuterol in both adults and children with an asthma exacerbation. In a large study of acute asthma in children and in adults not previously treated with glucocorticosteroid, levabuterol

treatment resulted in lower hospitalization rates compared to racemic albuterol treatment, but in children the length of hospital stay was no different.

Studies of intermittent versus continuous nebulized shortacting beta2-agonists in acute asthma provide conflicting results. In a systematic review of six studies, there were no significant differences in bronchodilator effect or hospital admissions between the two treatments. In

patients who require hospitalization, one study found that intermittent on-demand therapy led to a significantly shorter hospital stay, fewer nebulizations, and fewer palpitations when compared with intermittent therapy given every 4 hours. A reasonable approach to inhaled therapy

in exacerbations, therefore, would be the initial use of continuous therapy, followed by intermittent on-demand therapy for hospitalized patients. There is no evidence to support the routine use of intravenous beta2-agonists in patients with severe asthma exacerbations.

Epinephrine. A subcutaneous or intramuscular injection of epinephrine (adrenaline) may be indicated for acute treatment of anaphylaxis and angioedema, but is not routinely indicated during asthma exacerbations.

Additional bronchodilators.

Ipratropium bromide. A combination of nebulized beta2- agonist with an anticholinergic (ipratropium bromide) may produce better bronchodilation than either drug alone and should be administered before methylxanthines are considered. Combination beta2- agonist/anticholinergic therapy is associated with lower hospitalization rates and greater improvement in PEF and FEV1. Similar data have been reported in the pediatric literature . However, once children with asthma are hospitalized following intensive emergency department treatment, the addition of nebulized ipratropium bromide to nebulized beta2-agonist and systemic glucocorticosteroids appears to confer no extra benefit.

Theophylline. In view of the effectiveness and relative safety of rapid-acting beta2-agonists, theophylline has a minimal role in the management of acute asthma. Its use is associated with severe and potentially fatal side effects, particularly in those on long-term therapy with

sustained-release theophylline, and their bronchodilator effect is less than that of beta2-agonists. The benefit asadd-on treatment in adults with severe asthma exacerbations has not been demonstrated. However, in one study of children with near-fatal asthma, intravenous

theophylline provided additional benefit to patients also receiving an aggressive regimen of inhaled and intravenous beta2-agonists, inhaled ipatropium bromide, and intravenous systemic glucocorticosteroids.

Systemic glucocorticosteroids. Systemic glucocorticosteroids speed resolution of xacerbations and should be utilized in the all but the mildest exacerbations, especially if:

• The initial rapid-acting inhaled beta2-agonist therapy fails to achieve lasting improvement

• The exacerbation develops even though the patient was already taking oral glucocorticosteroids

• Previous exacerbations required oral glucocorticosteroids.

Oral glucocorticosteroids are usually as effective as those administered intravenously and are preferred because this route of delivery is less invasive and less expensive.

If vomiting has occurred shortly after administration of oral glucocorticosteroids, then an equivalent dose should be re-administered intravenously. In patients discharged from the emergency department, intramuscular administration may be helpful, especially if there are concerns about compliance with oral therapy. Oral glucocorticosteroids require at least 4 hours to produce clinical improvement.

Daily doses of systemic glucocorticosteroids equivalent to 60-80 mg methylprednisolone as a single dose, or 300-400 mg hydrocortisone in divided doses, are adequate for hospitalized patients, and 40 mg methylprednisolone or 200 mg hydrocortisone is probably adequate in most

cases. An oral glucocorticosteroid dose of 1 mg/kg daily is adequate for treatment of exacer-bations in children with mild persistent asthma. A 7-day course in adults has been found to be as effective as a 14-day course, and a 3- to 5-day course in children is usually considered appro-priate. Current evidence suggests that there is no benefit to tapering the dose of oral glucocorticosteroids, either in the short-term or over several weeks.

Inhaled glucocorticosteroids. Inhaled glucocorticosteroids are effective as part of therapy for asthma exacerbations. In one study, the combination of high-dose inhaled glucocorticosteroids and salbutamol in acute asthma provided greater bronchodilation than salbutamol alone, and conferred greater benefit than the addition of systemic glucocorticosteroids across all parameters, including hospitalizations, especially for patients with more severe attacks. Inhaled glucocorticosteroids can be as effective as oral glucocorticosteroids at preventing relapses. Patients discharged from the emergency department on prednisone and inhaled budesonide have a lower rate of relapse than

those on prednisone alone. A high-dose of inhaled glucocorticosteroid (2.4 mg budesonide daily in

four divided doses) achieves a relapse rate similar to 40 mg oral prednisone daily.

Cost is a significant factor in the use of such high-doses of inhaled glucocorticosteroids, and further studies are required to document their potential benefits, especially cost effectiveness, in acute asthma.

Magnesium. Intravenous magnesium sulphate (usually given as a single 2 g infusion over 20 minutes) is not recommended for routine use in asthma exacerbations, but can help reduce hospital admission rates in certain patients, including adults with FEV1 25-30% predicted at presentation, adults and children who fail to respond to initial treatment, and children whose FEV1 fails to improve

above 60% predicted after 1 hour of care. Nebulized salbutamol administered in isotonic magnesium sulfate provides greater benefit than if it is delivered in normal saline. Intravenous magnesium sulphate has not been studied in young children.

Helium oxygen therapy. A systematic survey of studies that have evaluated the effect of a combination of helium and oxygen, compared to helium alone, suggests there is no routine role for this intervention. It might be considered for patients who do not respond to standard therapy.

Leukotriene modifiers. There is little data to suggest a role for leukotriene modifiers in acute asthma.

Sedatives. Sedation should be strictly avoided during exacerbations of asthma because of the respiratory depressant effect of anxiolytic and hypnotic drugs. An association between the use of these drugs and avoidable asthma deaths has been demonstrated.

The following are the nutrients, herbs, and other recommendations beneficial to thwart atherosclerosis:

NUTRIENTS

Supplement	Suggested Dosage	Comments
Essential
Pantothenic acid (Vit B6)	50 mg 3x a day	The anti stress vitamin
Quercitin-C from Ecological Formulas plus bromelain	500 mg 3x a day 100 mg 3x a day	Powerful immunostimulants. Antihistamine effect
Vitamin C with bioflavonoids	1500 mg 3x a day (avoid high doses when with kidney stones)	Needed to protect lung tissue and keep down infection. Also increases air flow and fights inflammation
Zinc lozenges	Do not take over 100 mg daily	Can shorten an attack or halt one before it becomes severe.
Very Important
Betaine HCl with pepsin	As directed on label, or as prescribed	Combats malabsorption problems
Coenzyme Q	100 mg daily	Has the ability to counter histamine
Magnesium plus calcium	750 mg daily 1500 mg daily	May stop the acute asthmatic episode by increasing the vital capacity of the lungs. Has a dilating effect on the bronchial muscles. Use chelate forms
Multivitamin and mineral complex with Selenium Vitamin B12	As directed on the label 200 mcg daily 2000 mcg daily	Necessary for enhanced immune function. Use a high potency formula. Destroys radicals from air pollutants

Herbs

Lobelia extract is helpful during an asthma attack attack; it is a bronchial soothing muscle relaxant and expectorant. Do not take long term.

Boswellia, an Indian herb (also known as frankincense), in studies was shown to reduce the number of asthma attacks.

Mullein oil is said to be a powerful remedy for bronchial congestion. The oil stops cough, unclogs bronchial tubes, and helps clear up asthma attacks. Users say that when they take it in tea or fruit juice, the effect is almost immediate.

Proponents of the East Indian mind-body-earth philosophy called Ayurveda recommend the following herbs for people with asthma: vasaka (Adhatoda vasica) relieves cough, bronchitis, and other asthmatic symptoms; boswellia (Boswellia serrata), to relieve pain or inflammation; and tylophora (Tylophora indica) for respiratory relief.

Other herbs beneficial for asthma include Echinacea, licorice root, and slippery elm bark tablets. Licorice root, ginger root, and elderberry open up the respiratory tract.

Caution: Do not take Echinacea if you have an autoiimune disorder. Do not use licorice on a daily basis for more than seven days in a row, and avoid it completely if you have high blood pressure.

Recommendations:

Homeopathic use of belladonna have been shown to relax the bronchioles in the lungs which alleviates the wheezing symptoms in an asthma attack.

Eat a diet consisting primarily of fresh fruits and vegetables, oatmeal, brown rice, and whole grains. The diet should be relatively high in protein, low in carbohydrate, and contain no sugar.

Include garlic and oinions in your diet. These food contain quercatin and mustard oils, which have been shown to inhibit an enzyme that aids in releasing inflammatory chemicals.

Avoid gas-producing foods, such as beans, brassicas ( broccoli, cauliflower, and cabbage) and large amounts of bran. Gas can aggravate an asthmatic condition by putting pressure in the diaphragm.

Do not eat ice cream or drink extremely cold liquids. Cold can shock the bronchial tubes into spasms.

Use a juice fast, a fast using distilled water or lemon juice or a combination of both for three days each month to help rid the body of toxins and mucus.

Eat lightly- a large meal can cause shortness of breath by making the stomach put pressure on the diaphragm

Practice methods to relieve stress as they can trigger an attack.

WORLD ON ALERT AS URBAN TAPEWORMS GROW IN POWER

There are perhaps no animals more frightening to humanity than a tapeworm. Combining the creepy crawly nature of common earthworms and the almost primordial fear of snakes, living in the human body and ever growing, the tapeworm is an embodiment of some of our worst fears. Most commonly borne from
tainted beef or fish, some species of tapeworm can grow up to 100 feet long inside the body of a mammal, causing various types of sometimes fatal diseases.

Most common in tropical third world countries, tapeworm and flatworm infections have recently started to migrate into the human population in first world urban centres such as Chicago and Tokyo. Concerns have been raised across Asia, North America, and Europe as incidents of urban tapeworm sightings have become more and more common. Experts are as yet hesitant to issue global warnings about the increased incidents but are carefully watching outbreaks and beginning to monitor borders for any sign of illegal crossings by worm shaped animals.

“The increasing popularity of dishes such as sushi and sashimi as well as decreasing standards of cleanliness at restaurants across the United States has led to the phenomenon we are seeing. The most common source of transmission is from fish to humans when the food is either uncooked or undercooked. It also occurs when a person preparing food has become infected by say coming in contact with animal feces,” said Dr. Edward Ghent of the CDC. “That it part is the reason for the move into urban areas where food like sushi is common and dog owners are reticent to pick up after their pets. Those two circumstances have led to a perfect storm that is the perfect environment for tapeworms to thrive and they are taking full advantage of the opportunities with which we are presenting.”

Doctors recommend eating sushi and other uncooked fish from reputable establishments and asking before ordering if the chefs have been handling animal feces and not washing. In cases of the latter officials are recommending that if people receive even remotely suspicious answers they should go to another restaurant.

“Like many other diseases our modern indulgences like sushi and dog feces have become our undoing. Similar to our desire to efficient movement through airport security led to the events of 9/11, our apathy in asking simple questions in order to expedite delivery of food into our
mouths has put at risk and potentially created a situation that may never be fully resolved,” said Scrape TV Health analyst Rebecca Phelps. “There’s really no way of telling how far tapeworms have penetrated into our culture and society. Much like Al Qaeda Tapeworms have no real central organization and each cell operates more or less independently leaving us with no clear idea of where and when they might strike next. That makes them at least as dangerous as terror cells if not more due to the fact that everyone needs to eat.”

Governments across the world are starting to develop contingency plans should a massive tapeworm infection break out amongst the urban population. The World Health Organization, fresh off its Phase 6 Swine Flu success, is flirting with the idea of adding tapeworms to their watch list.

“The really horrible thing about this enemy is that it can live inside us for years, decades even, without us knowing. We handle our feces and then cook dinner for our family and all of a sudden you have infections in every neighbourhood in every city in the civilized world,” continued Phelps. “There is a real danger here of mass infection and though it’s unlikely that a tapeworm infection will undo human society as we know it there is always the distinct possibility especially if we completely ignore the threat.”

Health officials are also recommending people not ingest animal or human feces unless it is properly cooked.

French chipmunks carrying potentially fatal diseases ready to invade Britain

Beware: The chipmunks could bring Lyme disease and rabies to Britain

It may look cute and cuddly, but this little rodent is dangerous - and heading our way.

Thousands of chipmunks carrying potentially fatal diseases have been spreading west across Europe and have reached Paris.

Many carry ticks infected with the Borrelia bacterium that causes Lyme disease, a nerve illness that can disable and even kills victims if not treated early enough.

French experts warn that the animals, which can also carry rabies, could soon reach Calais and sneak aboard vehicles and vessels heading to Britain.

Officials have also warned tourists not to smuggle them into the UK as pets.

Some unscrupulous French pet shops are offering chipmunks for less than £10 each, despite repeated warnings of the danger.

Naturalist Guy Bruel said: 'Everything is being done to control this rodent, but the public must be on its guard at all times.

'There is a particular problem in the woods around Paris, attributed mainly to people who bought the animals as family pets and then got rid of them. This is just the type of behaviour that will lead to the chipmunk getting to Britain in huge numbers, possibly as early as this summer.'

Wildlife experts are pressing the French government to ban such sales.

Researcher Jean Louis Chapuis said: 'They should not be up for sale. Lyme disease is a terrible condition, and the chipmunks are a major carrier.

'These rodents are not shy, and in fact very approachable.'

Although everything has been done to control the Siberian chipmunk - Tamias sibiricus - in the UK, they spread very rapidly once established.

They were first imported from Asia in the 1970s and are now on the European Union's list of 100 most-invasive species.

In 1980 17 chipmunks were released at a park in Brussels. They bred in the wild and in 20 years numbered nearly 20,000.

The number in northern France is currently estimated at more than 100,000.

With the British coastline just 22 miles away at the nearest point, the situation is becoming critical.