Measles

Measles Symptoms Signs Definition Infectious Diseases Tips Facts Health Fitness Care Healthy Measles Symptoms Children

Measles, a highly infectious disease, is very common in childhood. It is so common at this stage of life that nearly all children everywhere in the world go through this brief period of red spots. The disease appears in epidemic form, often in the winter season.

Measles Symptoms Signs:-

(1) The first symptoms which appear during 7 to 14 days after exposure to the virus are feverishness, cold, watering of the eyes and dry cough.

(2) Rashes appear on the skin in three to five days after the onset of these signs.

(3) These rashes, which consist of small rounded spots with reddened skin in between, initially appear on the sides of the face and the neck and then gradually spread all over the body, appearing last on the extremities. Initially pink in color, these rashes grow darker as time passes.

(4) Measles is usually accompanied with slight fever and diarrhea. In rare cases of great severity, high fever and delirium may occur.

(5) Complications which can arise from this disease include pneumonia, bronchitis, and ear abscess. One serious but rare complication is the inflammation of the brain.

Your Appropriate Blood Pressure

The traditional reading for a “normal” blood pressure” is 120/80. Anything above it is considered high blood pressure. For example, if your reading is 140/90, your doctor would prescribe blood pressure tablets (or medication) in an effort to bring your blood pressure back down to 120/80. Many developed countries have since made an adjustment to the 120/80 criteria; unfortunately the U.K sticks to 120/80 as the criteria.

I disagree with 120/80 as the criteria. To put a patient on prescribed medication (blood pressure pills) simply because his blood pressure chart is 140/90 without investigating if it was his/her appropriate blood pressure is definitely wrong.

 Your blood pressure can be as high as 160/100 and if it is your appropriate blood pressure, do not do anything to disrupt it or try to bring it down with drugs (prescribed medication) What I am trying to say is this: If your chart reads 160/100 and you also have other complications, you should have it checked out by your doctor. True high blood pressure must be attended to by your G.P or specialist until such time you are able to adjust your life style with dietary adjustments and supplements.

 High blood pressure and if it is not your appropriate blood pressure can be extremely dangerous; it can cause stroke and other health complications. Bear in mind too that here is also such a thing as secondary high blood pressure. This usually happens when the kidneys are not well or that there is a general hardening of the renal artery. Also, if there is hypothyroidism, there is a tendency to have secondary high blood pressure. Therefore, it is wrong diagnosis to automatically put a patient on high blood pressure medication without first ascertaining if it was secondary high blood pressure to start with! Space & time does not allow us to write more on secondary high blood pressure.

To reinforce the point, let me cite an example. There is no such thing that if you are 5 feet 8”, you must be ten stone in weight. Our body density and bone mass varies from one individual to another; again it can vary from sex to race.

Your appropriate pulse pressure.
 We place more emphasis on pulse pressure than high blood pressure. Pulse pressure is the true measurement of how far gone your arteries are. The higher it is the stiffer your arteries are; the more strain on your heart, hence the higher likelihood of health problems.

Measurement of pulse pressure
Subtract your bottom blood pressure number (diastolic pressure) from the top number (systolic pressure).

"Say your blood pressure is 170/110 and Ray is 170/70. Ray is likely to have cardiac failure. (Heart failure, stroke or some other adverse event). In this example your pulse pressure would be 60 Ray would be an alarming 100."

What’s normal pulse pressure?
40 or lower is fine. Higher reading to that can be indicated as having stiff arteries. Conventional blood measurements are ideal for selling drugs. In order to reduce your pulse pressure meaningfully all you need is physical exercise, generous intake of fish oil alpha lipoic acid, folic acid, vitamin b3,   L-Arginine and intelectol. These supplements’ will only make your arteries softer and reduce the pulse pressure but will give you a general feeling of well being and good health. Intelectol is a powerful memory enhancer that will increase blood flow to your brain.

Cholesterol
Most people would hurry to take prescription drugs to lower their cholesterol upon learning that that they have high cholesterol. This is a gross mistake and a folly. Not all cholesterol is bad – unfortunately, space limit does not enable me to delve into details. Suffice to add, not all fats are bad. There are the saturated fats ( bad fats) and unsaturated fats (good fats) Most people and even doctors do not realize that cholesterol is essential to the body for many functions. It forms part of the cell membrane, the outer layer of every cell in your body. It helps transport and packs the major components of the cell membrane, called “phospholipids” that are made from essential fatty acids (EFAs). Without sufficient cholesterol, we would die because our tissues are constantly being repaired and replaced with new cells. Our body produces several thousand milligrams of cholesterol per day to carry out these essential functions, and each day the excess of cholesterol is supposed to be naturally recycled. If your body does not have sufficient new cholesterol each day, you cannot repair and replace your cell membrane and they will eventually degenerate.

 

The Dangers of Cholesterol lowering drugs.
Serious side effects have been reported for most cholesterol lowering drugs – the so called STATINS. The prescription of these drugs is based on the discredited hypothesis that high cholesterol can cause heart attacks.

This is false and misleading! Read on! The cholesterol myth has been one of the most long lived falsehood around – probably it has been excellent business for the big pharma - drug industry (“Big Pharma” for short)

Side Effects
In an article that appeared in “Life After Lipitor” in the newspaper “Tahoe World” on January 27th, 2004, Tahoe City (California) resident Doug Peterson began having serious neuromuscular problems after taking Statins for two years. He began losing muscular co-ordination and slurring words when he spoke. Then he lost balance, followed by loss of fine motor skills – he also had difficulty writing! These adverse side effects have begun appearing in peer-reviewed medical journals and numerous people have reported similar symptoms at public adverse websites such as medications.com. People have reported trouble at swallowing, trouble talking, feeling fatigued all the time, motor neuropathy which mimics ALS, nausea, vertigo, disorientation, memory loss, extremely dry eyes, muscle pain and so on.

How could Statins and the other cholesterol lowering drugs have so much of side effects? Statin drugs inhibit the production of cholesterol in order to lower LDL cholesterol counts. By limiting the production of cholesterol, statins may be directly causing membrane degeneration in neural and muscle tissues. Plus, statins may also inhibit of the liver to produce good cholesterol.
There are twenty million people in the U.S alone on all types of statin drugs. Statin drugs can actually increase heart disease and can cause extensive damage to one’s liver!

Your doctor could have advised you that, 2000 – 3000 milligrams of good vitamin C plus Fish oil in higher dosage could be the answer to lowering bad cholesterol without the side effects. L-Arginine besides helping to boost sex drive would complement Vitamin C to help reduce bad cholesterol.

Recommended Nutritional Therapy:  Depending on your weight,  We recommend Esterol, Ester C or a good brand of Vitamin C with bioflavonoid. Supplemented this with Eskimo 3(a good fish oil), Niacin (Vitamin B3) and also L’Arginine.  Alpha Lipoic acid will also help.

Anti-depressant drugs: On December 13th, 2006, the FDA announced that anti-depressant drugs prescribed to young adults are risky. Besides the enormous side effects, they cause suicidal thoughts in young adults. The Agency proposed a change to include a new label warning with a suggestion that patients of all age groups be carefully monitored, particularly when starting antidepressant treatment.


Urinary Incontinence: Cymbalta and some types of anti depressant drugs have been used by doctors for chronic liver diseases and urinary incontinence.  On October 17th 2005, Eli Lilly expanded its warning about liver related problems with the use of its drug, Cymbalta and cautioned doctors about using it for chronic liver disease. The warning came after a review of cymbalta found that 11 of nearly 9000 women taking it for urinary incontinence tried to commit suicide. But the lists of side effects are too many to mention.
The FDA approved of cymbalta in August of 2004 as an anti-depressant but it is not approved in the United States to treat urinary incontinence.

If your prescribed medication for depression and urinary incontinence is not mentioned in the list here, you can take it from me that they still carry an enormous amount of side effects. Please refer to the internet; all you need to do is to click onto the name of the drug. Google is a better search engine. Also all prescribed drugs for urinary incontinence carries with it an enormous amount of side effects.

It is my view that all anti depressant drugs can be habit forming. In addition, they blur the brain. For those taking statin drugs, proper blood testing is of paramount importance because an excessive dose and abusive use can cause permanent muscle and liver damage

In general, most forms of prescribed medication can deplete nutrients in the body. Classic example of this are diuretic drugs used to treat hypertension (blood pressure) whilst diuretic drugs are cost effective in reducing blood pressure, they deplete the body of essential minerals like magnesium and potassium.

As the side effects of urinary incontinence drugs are enormous and the list too many to mention, I would encourage you to research the internet for further information.

A further Word of caution:  Coumadin is a drug prescribed by cardiologists to prevent blood clots. Prednisone one of the NSAID (Non Steroid Anti-Inflammatory drug) is prescribed by doctors to relieve an inflammatory process for example, asthma and other flu like conditions.  Lupron is prescribed for prostate problems. Abusive use of each of these drugs can deplete bone mineral density but when all three are taken together, rapid osteoporosis can be induced.

The harsh reality today is that today’s large pharmacies sell anything that is legal. They are in the business to make money – they are not in the business to better humankind.

If you are observant, just pay attention to those who frequent the pharmacies. They look sickly; on the other hand if you pay close attention to those who frequents a health food shop, they look better and healthier. Do not trust your doctor to know everything about nutrition, nutritional therapy is usually not within the scope of their training. If you pay close attention to many of our obese doctors and nurses with a pot belly and who light up in the hospital’s corridors or car parks, you would know what I mean. This comment is not intended to discourage you from staying away from your doctor.

Recommended Supplements for a depressive disorder:  Before I start talking about heart problems and cancer, I want to let you know that 5 HTP which improves the serotonin level in your blood can be very effective in mood balancing. It may also help you to sleep better. It has virtually no side effects. When I lost my mother almost four years ago, I was on 5HTP nightly @ 50 mg per capsule x 4 (200 mg) for almost a year to help me get over with the extremely difficult period of my life. Another most advanced mood elevating therapy available today is SAMe (S-Adenosylmethionine).

We carry 5HTP but not SAMe but we can order it for you. SAMe has shown efficacy to relieving depressive symptoms but can also help in fighting liver’s disease, relieving arthritis pain and even supporting healthy endothelial functions. Never take sleeping pills or anti-histamine to help you sleep. If you wish, you may try 5HTP and melatonin together. It will help you sleep very soundly.

          


Heart Problems: When we hear about a sudden cardiac (heart) death in an adult, it is generally linked to atherosclerosis or clogging of the arteries. During vigorous exercises, if the blood flow to the heart muscle becomes blocked, the heart can stop working resulting in death. In children, however, the problem is usually due to a congenital abnormality of the heart muscle. A child may play sports for many years without any apparent problem. But these defects which often involve abnormal rhythm can cause the heart to stop pumping at anytime – particularly during heavy exercises. I would recommend that all young children be given an EKG (electro cardiogram) – the typical examination by your doctor using a mere stethoscope won’t be able to detect most congenital heart defects. Here at our Clinic, we use both the stethoscope and The Chinese pulse diagnosis. If we are uncertain, we would refer the client back to his G.P with an explanation that he/she should be referred to a cardiologist.

Having said that, we have seen many patients who are needlessly prescribed heart tablets. When we examine the patient, we often find that the patient has heart burn, acid reflux or aortic aneurysm and these conditions often transmit a false signal that there is a heart problem. These may include distant murmurs, irregular heartbeats and angina. Before we forget, oral chelation is extremely effective in removing a blockage in a heart artery or any arteries. We do not stock chelation tablets but we shall be happy to order it for you.

Recommended Nutritional Therapy for the heart:  Again, it’s good fish oil (Eskimo 3), Co-Enzyme Q 10, at least 100 mg per day, alpha lipoic acid, Vitamin E & L’Arginine, folic acid, niacin. Oral Chelation is a very effective therapy.

On the co-relationship between cholesterol and heart problems, do bear in mind that the majority of people who have heart attacks have normal cholesterol levels. Cholesterol in itself doesn’t cause heart disease and it won’t stop a heart attack.  It has never been conclusively shown that lowering of cholesterol saves lives. In fact, several studies have shown that that lowering cholesterol into the range currently recommended is co-related with an increased risk of dying, especially of cancer.

Prevention Of Suicide

It saddens us to learn that there are many people in the U.K crippled with pain and who are contemplating assisted suicide. It seems to us that most types of pain are inadequately treated and that morphine and pain killers are not the only solutions.

This chapter does not delve into the ethics of assisted suicide; such discussions are outside the ambit of what we are trying to achieve. Death is inevitable. But if we can minimise some of the pain and help somebody improve his quality of life that would in itself be a great privilege and our greatest satisfaction.

It seems to us that the United States is the only country in the World where a patient's ability to pay will determine his access to the quality of health care. Assisted suicide in Switzerland is not a cheap thing either; although we have no knowledge of the precise figures, common sense suggests that it will cost several thousand pounds. But there is another emotional aspect to it. Such patients are also deprived and denied of the satisfaction of dying in one's home. First of all, it involves a trip to Switzerland with the full knowledge that one is going there to die! Given a choice, most if not all would prefer to pass away peacefully in the comfort of one's home.

We also appreciate that there is no magic bullet or universally accepted formula for the relief of pain and suffering but it is also true that many doctors are not sufficiently trained to handle the emotional aspect of it all! Therefore, if terminally ill people are given adequate treatment which includes the emotional aspect, requests for physician assisted suicide can be greatly reduced.

It also saddens us to know that the greater majority of conventionally trained physicians only know how to prescribe pain killers and are either very concerned with their addictions or show a callous attitude towards them. Two of the pain killers with extremely addictive properties are morphine and heroin. We know with a fair degree of certainty that many people would want to continue living if their pain is almost manageable and with emotional encouragement would want to continue to live. There is another aspect to it. Pain killers which cause addictions and side effects are not the only solutions.

Megaloblastic Anemia

Pernicious anemia refers to a type of autoimmune anemia . In addition to the cells being large, the inner contents of each cell are not completely developed. The disease was named pernicious anemia because it was fatal before treatment became available, first as liver therapy and, subsequently, as purified vitamin B-12. The term pernicious is no longer appropriate, but it is retained for historical reasons. Diseases of the small intestine that cause malabsorption may cause vitamin B12 deficiency. Vegans (individuals who consume absolutely no foods of animal origin) are at risk of vitamin B12 deficiency due insufficiency of this vitamin in their diet. But it takes a long time to deplete all the vitamin B12 that is stored in the liver. There is a congenital form of pernicious anemia due to defect of intrinsic factor at birth that is clearly inherited as an autosomal recessive trait with the affected child having received two copies of the gene, one from each parent. Vitamin B12 helps in this shrinking process. Without vitamin B12, there are insufficient numbers of red blood cells, and those that are in the circulation are large and quickly become damaged. This leads to anemia, meaning that there is a deficiency of normal red blood cells. Symptoms, which usually begin gradually, include loss of appetite, diarrhea , paleness, fatigue, and headache. Tingling of the hands and feet, as well as the onset of spastic movements, may indicate that the nervous system has been affected. The word "pernicious" means highly injurious, destructive, or deadly. "Pernicious" comes from the Latin root "nex" meaning "violent death." Pernicious anemia was once quite deadly.
Megaloblastic anemia is a type of anemia characterized by very large red blood cells.xThe patient often has antibodies in the blood called intrinsic factor and parietal cell antibodies While the term pernicious anemia is reserved for patients with vitamin B-12 deficiency due to a lack of production of IF in the stomach, vitamin B-12 absorption is complex and other causes of vitamin B-12 deficiency exist and are described briefly in this article. They combine in the stomach and pass into the small intestine where the intrinsic factor helps the vitamin B12 get absorbed into the circulation. Doctors diagnose pernicious anemia when a patient with a low red blood cell count has large red blood cells and white blood cells with large, multi-lobed nuclei. Through the circulation, the vitamin is transported to the liver where it is stored, being released back into the circulation as needed. Without intrinsic factor, vitamin B12 is not absorbed and pernicious anemia occurs. Enlargement of liver and spleen (hepatosplenomegaly) may also occur, accompanied by yellow discoloration of the skin (jaundice) or pallor. Weakness, heart palpitations, difficulty breathing, as well as pain in the limbs are other possible symptoms. Mouth and tongue infection may also occur. Neurological lesions , irritability, and abnormal feelings (e.g. of heat and cold) may also be present. Megaloblastosis can also be caused by disorders in which cobalamin and folate uptake and metabolism are not affected. Myeloproliferative syndromes and viral infections (eg, HIV) can lead to megaloblastosis by disrupting DNA synthesis.
Causes of Megaloblastic Anemia
There are many factors which may cause Anemia, some common causes are listed below:

• Inadequate intake e.g. Elderly people
• Malabsorption in digestive system
• Chronic alcoholism
• Abdominal or intestinal surgery that affects intrinsic factor production or absorption
• Crohn's disease
  decreased production of intrinsic factor (this disease entity is called pernicious anemia)
• intestinal malabsorption (due to an enteritis, celiac disease or other causes)
  Intestinal malabsorption disorders
• Fish tape worm
• Disorders of terminal illness e.g cancers

Causes of Folic Acid Deficiency

• Atrophy or loss of gastric mucosa (eg, pernicious anemia, gastrectomy, ingestion of caustic material, hypochlorhydria, histamine 2 [H2] blockers).
• Inadequate proteolysis of dietary Cbl .
• Insufficient pancreatic protease (eg, chronic pancreatitis, Zollinger-Ellison syndrome).
• immune hemolytic anemia - drug-induced.
• Administration of folate will correct the anaemia but will not reverse any neurological disease - approximately 5% show no other symptoms but neurological disorder.
• Certain medications, specifically ones that prevent seizures, such as phenytoin, primidone, and phenobarbital, can impair the absorption of folic acid
• Folic acid is present in foods such as green vegetables, liver, and yeast.
• Dysfunctional uptake and use of cobalamin by cells (eg, defects in cellular deoxyadenosylcobalamin [AdoCbl] and methylcobalamin [MeCbl] synthesis).

Symptoms of Megaloblastic Anemia

The following are the most common symptoms of megaloblastic anemia. However, each child may experience symptoms differently. Symptoms may include:

• abnormal paleness or lack of color of the skin
• decreased appetite
• irritability
• lack of energy or tiring easily (fatigue)
• diarrhea
• difficulty walking
• numbness or tingling in hands and feet
• smooth and tender tongue
• weak muscles

The symptoms of megaloblastic anemia may resemble other blood conditions or medical problems. Always consult your child's physician for a diagnosis.

Treatment of Megaloblastic Anemia

Here is the list of the methods for treating Megaloblastic Anemia :

• To establish that the patient has Cbl deficiency
• Monitor the reticulocyte count (should return to normal in 2-3 weeks) and the Hb concentration (20-30g/L rise every week until normal)
• Intramuscular hydroxy-cobalamin daily for a week (regime will depend on the cause of the anaemia)
• You can treat vitamin B-12 deficiency related to a poor diet with changes in your diet along with vitamin B-12 supplementation, under a doctor's supervision.
• To confirm the diagnosis by documenting that specific therapy is effective
• your child's tolerance for specific medications, procedures, or therapies
• In some cases, blood transfusions and the medication erythropoeitin will correct anemia.
• To ensure administration of adequate quantities of Cbl for the lifespan of the patient
• your opinion or preference

Hemolytic Anemia

Hemolytic anemia is anemia due to hemolysis , the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). The mechanism by which the immune system mistakes the red blood cells for a "foreign invader" varies somewhat according to the cause. It usually involves adherence of the offending agent (parasite, drug or toxin) to the surface of the red blood cells.Autoimmune hemolytic anemia can also be caused by or occur with another disease, such as systemic lupus erythematosus, and rarely it follows the use of certain drugs, such as penicillin. Though much attention has been given recently to AIHA due to evidence linking the process of vaccinating with the manifestation of this sometimes life-threatening disease, immunization is only one potential cause for this condition. In particular, a form of damaged red blood cell known as a spherocyte occurs. Finding spherocytes on a blood smear almost guarantees that some form of hemolytic anemia is occurring Blood transfusions can be used in dogs with IMHA if necessary but they can make the condition worse so most vets reserve this approach for dogs that appear to be in imminent danger of dying due to severe anemia. It is necessary to treat most dogs for a fairly long time to prevent recurrence of the disease and some dogs seem to require lifelong use of corticosteroids or other immunosuppressants. Splenectomy is done in resistant cases since it is a major site of red blood cell destruction.
Idiopathic autoimmune hemolytic anemia results from an abnormality of the immune system that destroys red blood cells prematurely. It has numerous possible causes, ranging from relatively harmless to life-threatening. The immune system wishes to attack the offending agent, but manages to injure the red blood cells as well. When the spleen and the rest of the immune system is working to rid the body of the old, diseased or damaged red blood cells, it is doing its job properly. Whenever hemolytic anemia is present it is wise to carefully rule out initiating causes that might be treatable. Examples of problems that can lead to hemolytic anemia include ehrlichiosis (a blood parasite), reactions to sulfa antiseptics or penicillin antibiotics, zinc toxicosis - which can occur due to the ingestion of pennies. In some people, the destruction may stop after a period of time; whereas in other people, it persists and becomes chronic. There are two main types of autoimmune hemolytic anemia: warm antibody hemolytic anemia and cold antibody hemolytic anemia. In acquired hemolytic anemia, the person develops the condition from some other cause. Hemolytic anemia can begin rapidly or come on gradually and can range from mild to severe.

Causes of Hemolytic Anemia

The common Causes of Hemolytic Anemia :

• Autoimmune disorders, such as systemic lupus erythematous (SLE, or lupus), rheumatoid arthritis, Wiskott-Aldrich syndrome, or ulcerative colitis
• Drugs such as penicillin, antimalaria medications, sulfa medications or acetaminophen
• surgery, radiotherapy, chemotherapy and/or immunotherapy...
• Blood loss excessive bleeding such as hemorrhages or abnormal menstrual bleeding.
• Penicillin and its derivatives .
• Cephalosporins.
• Levodopa.
• Tumors.
• AIHA and hereditary spherocytosis are classified as examples of extravascular hemolysis because the RBCs are destroyed in the spleen and other reticuloendothelial organs.
• Hereditary spherocytosis.

Symptoms of Hemolytic Anemia

Some are common Symptoms of Hemolytic Anemia :

• Abnormal paleness or lack of color of the skin.
• Jaundice, or yellowing of the skin, eyes, and mouth.
• weakness.
• Dizziness.
• Pale color.
• Dark urine.
• Rapid heartbeat.
• Enlarged spleen.
• Confusion.
• Heart murmur.

Treatment of Hemolytic Anemia

• your age, overall health, and medical history
• vitamin and mineral supplements
• extent of the disease
• Surgical removal of the spleen generally is reserved for children who do not respond to other therapies.
• Administer packed RBC slowly to avoid cardiac stress.
• Corticosteroid medications, which are synthetic versions of natural hormones produced by the body's adrenal glands
• Blood transfusions are given with caution, if indicated for severe anemia , because of the potential that blood may not be compatible and may bring on a reaction.
• corticosteroid medications
• splenectomy - surgery to remove the spleen.
• Administer folic acid because active hemolysis may consume folate and cause megaloblastosis.

Lung abscess

lung abscess is a pus-filled cavity in the lung surrounded by inflamed tissue and caused by an infection. A common mechanism is aspiration of stomach contents by vomiting and aspiration of part of the vomitus with all the bacteria from the pharynx, or gastrointestinal tract. Infections and neoplasms are the most common causes. The formation of multiple small (<2 cm) abscesses is occasionally referred to as necrotizing pneumonia or lung gangrene. Before the availability of antibiotics, the etiology of a typical abscess was complications after oral surgical procedures (ie, tonsillectomy), resulting in aspiration of infected material into the lungs. Both lung abscess and necrotizing pneumonia are manifestations of a similar pathologic process. The process is usually surrounded by a fibrous reaction, forming the abscess wall. Multiple small abscess formation may occur and is sometimes referred to as necrotising pneumonia. In children, the most vulnerable patients are those with weakened immune systems, malnutrition , or blunt injuries to the chest.
Lung Abscess is defined as a localized suppurative necrotizing collection occurring within the pulmonary parenchyma. Acute abscesses are less than 4-6 weeks old, whereas chronic abscesses are of longer duration. Several processes, either respiratory or systemic, can lead to abscess formation. Most abscesses are primary, meaning they result from necrosis in an existing parenchymal process (usually an infectious pneumonia). Lung abscesses can be classified based on the duration and the likely etiology. Aspiration into the lungs may be due to impaired normal swallowing mechanisms, esophageal disorders (e.g., acid Reflux ), altered consciousness levels, or absent gag reflex. Signs and symptoms usually begin at least 2 weeks before presentation and include cough, hemoptysis, fever, chills, night sweats, anorexia, pleuritic chest pain, and weight loss. The availability of effective antibiotic therapy for primary lung abscess has drastically modified the natural history of the disease and diminished the role of surgery. A pneumonitis develops which progresses to abscess formation over a period of 1–2 weeks.

Causes of Lung Abscess

The comman causes of Lung Abscess include the following :

• A lung abscess is usually caused by bacteria that normally live in the mouth or throat and that are inhaled into the lungs, resulting in an infection.
• Choking/near-drowning/ aspiration.
• Individuals with an inability to protect their airways because of an absent gag reflex, such as during coma, loss of consciousness, or general anesthesia and sedation.
• Severe periodontal disease.
• The remaining cases are caused by a mixture of anaerobic and aerobic (air breathing) bacteria.
• An abscess may occur secondary to carcinoma of the bronchus; the bronchial obstruction causes postobstructive pneumonia, which may lead to abscess formation.
• Stroke / cerebral palsy /cognitive impairment/impaired consciousness leading to increased risk of aspiration.

Symptoms of Lung Abscess

Some sign and symptoms related to Lung Abscess are as follows :

• The patient usually is sick for several weeks or months with a lack of appetite and the resulting weight loss.
• Cough with foul smelling sputum.
• Coughing pus.
• Poor dental hygiene is common.
• Chills and fever.
• Sweating.
• Productive cough.
• Rapid pulse ( heart rate).
• Foul-smelling cough.
• Bluish discoloration of the skin caused by lack of oxygen.

Treatment of Lung Abscess

Here is list of the methods for treating Lung Abscess:

• Lung abscess is treated with a combination of antibiotic drugs, oxygen therapy, and surgery.
• Penicillin intravenously.
• Cefoxitin is a second-generation cephalosporin that has gram-positive, gram-negative, and anaerobic coverage. This agent may be used when a polymicrobial infection is suspected as cause of lung abscess.
• Clindamycin intravenously.
• Standard treatment of an anaerobic lung infection is clindamycin (600 mg IV q8h followed by 150-300 mg PO qid).
• Patients may receive special antibiotics to treat organisms that may live in the mouth.
• Surgery is very rarely required for patients with uncomplicated lung abscesses.

Pleural effusion

Pleural effusion is defined as an abnormal accumulation of fluid in the pleural space. The pleura produces a fluid which acts as a lubricant that helps you to breathe easily, allowing the lungs to move in and out smoothly. The most common causes are disease of the heart or lungs, and inflammation or infection of the pleura. A pleural effusion is an accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity. Approximately 1 million pleural effusions are diagnosed in the United States each year. Pleural effusion itself is not a disease as much as a result of many different diseases. If blood is in the accumulating fluid, the condition is called "hemothorax"; if pus is present, it is called "empyema"; if air enters the space, it is called "pneumothorax"; and if there is chyle (milky fluid consisting of lymph and fat), it is called "chylothorax." When certain disorders occur, excessive pleural fluid may accumulate and cause pulmonary signs and symptoms. Effusions may be the presenting sign of cancer or they may develop after the cancer is diagnosed.
Parietal pleurae cover the inner surface of the thoracic cavity, including the mediastinum, diaphragm, and ribs. Any extra fluid is taken up by blood and lymph vessels, maintaining a balance. A pulmonary embolism is a blood clot that has floated through the bloodstream and lodged in the lungs. There are two types of pleural effusion: the transudate and the exudate. When either too much fluid forms or something prevents its removal, the result is an excess of pleural fluid--an effusion. Thus, there are in fact two layers of pleura between the outer surface of the lung and the chest wall. One is adherent to the lung, whereas the other layer follows the outline of the chest wall. The two layers press up against one another, and in the healthy chest, there is no air or significant fluid between them. Cancer is responsible for 40% of all pleural effusions, which are then called malignant pleural effusions. Blood in the pleural space (hemothorax) usually results from a chest injury. Rarely, a blood vessel ruptures into the pleural space when no injury has occurred, or a bulging area in the aorta (aortic aneurysm) leaks blood into the pleural space. Any significant increase in the quantity of pleural fluid is a pleural effusion.

Causes of Pleural Effusion

• Pericarditis. This is an inflammation of the pericardium, the membrane covering the heart.
• Cirrhosis (hepatic hydrothorax).
• Autoimmune disease such as systemic lupus erythematosus , bleeding (often due to chest trauma), chylothorax (most commonly caused by trauma), and accidental infusion of fluids.
• Intraabdominal abscess.
• The most common causes of transudative pleural effusions in the United States are left ventricular failure , pulmonary embolism , and cirrhosis.
• Asbestos pleural effusion.
• Atelectasis (which may be due to malignancy or pulmonary embolism).
• The most common causes of exudative pleural effusions are bacterial pneumonia , cancer (with lung cancer , breast cancer), viral infection, and pulmonary embolism .

Symptoms of Pleural Effusion

Some sign and symptoms related to Pleural Effusion are as follows:

• The key symptom of a pleural effusion is shortness of breath.
• Hemoptysis.
• Fever and chills, depending on the cause.
• Weight loss.
• The pain may start and remain in one specific area of the chest wall, or it may spread to the shoulder or back.
• Breathlessness.
• A cough that brings up small amounts of blood.
• Hiccups.
• Night sweats.
• Rapid breathing.
• Swelling in several joints.

Treatment of Pleural Effusion

Here is list of the methods for treating Pleural Effusion:

• Rheumatic fever is treated with antibiotics (usually penicillin) to kill strep bacteria, together with aspirin or other anti-inflammatory drugs to reduce inflammation.
• Large pleural effusions, causing severe breathlessness, are drained, by needle in an acute emergency, or otherwise by chest drain inserted under local anaesthetic.
• Tube thoracostomy. A tube is inserted through the chest and into the pleural space to drain pleural fluid. When used alone, recurrence is very common.
• A small pulmonary embolism can be treated with anticoagulants, drugs that thin the blood and prevent future blood clots.
• Therapeutic thoracentesis may be done if the fluid collection is large and causing pressure or shortness of breath.
• Surgical intervention is most often required for parapneumonic effusions.

Hypotension

Hypotension and shock are not synonymous. While shock is always associated with low BP, a previously hypertensive patient may be in shock despite BP being within normal limits. Hypotension may occur in the absence of shock. Many people who have low blood pressure (hypotension) are healthy and have no signs or symptoms related to lower than normal readings. But for others, low blood pressure can cause dizziness and fainting or indicate serious heart, endocrine or neurological disorders. Hypotension is a medical concern only if it causes signs and/or symptoms such as dizziness, fainting, or, in extreme cases, shock .
Shock is defined as the state of widespread serious reduction of tissue blood flow, which if prolonged leads to generalised reduction of cell functions. Postprandial hypotension can cause dizziness, light-headedness, faintness, and falls. If an older person experiences these symptoms after eating, doctors measure blood pressure before and after meals to determine if postprandial hypotension is the cause. Hypotensive drugs include blood pressure drugs, diuretics (water pills), heart medications (especially calcium antagonists- nifedipine Procardia, beta blockers-propranolol Inderal and others), depression medications (such as amitriptyline Elavil), and alcohol. For example, vital organs (particularly the brain) may be starved of oxygen and nutrients if the blood pressure is too low for that particular individual.
Low blood pressure is an abnormal condition in which a person's blood pressure (the pressure of the blood against the walls of the blood vessels during and after each beat of the heart) is much lower than usual. Just a few decades ago, doctors thought a blood pressure reading of 160/95 millimeters of mercury (mm Hg) was an acceptable target rate for most Americans. Hypotension, or low blood pressure, means that the pressure of blood circulating around the body is lower than normal, or lower than expected, given the environmental conditions. It may be caused by hypovolemia (a decreased amount of blood in the body), resulting from the excessive use of diuretics, vasodilators, or other types of drugs, dehydration, or prolonged bed rest. The disorder may be associated with Addison's disease, atherosclerosis (build-up of fatty deposits in the arteries), diabetes, and certain neurological disorders including Shy-Drager syndrome and other dysautonomias.
Orthostatic hypotension is particularly common among older people. Is more likely to occur in people who have high blood pressure or disorders that impair the brain centers controlling the autonomic nervous system (which regulates internal body processes). For example, it rises during physical exertion and drops in extreme heat. Hypotension, or low blood pressure, means that the pressure of blood circulating around the body is lower than normal, or lower than expected, given the environmental conditions. Neurologic conditions that can lead to low blood pressure include changing position from lying to more vertical (postural hypotension), stroke , shock, lightheadedness after urinating or defecating, Parkinson's disease, neuropathy and simply fright. For some people, walking after a meal helps improve blood flow, but blood pressure may fall when they stop walking.

Causes of Hypotension

The common Causes of Hypotension :

• Medications used for surgery
• Anti-anxiety agents
• Treatment for high blood pressure or coronary heart disease (CHD)
• Heart failure
• Involvement of the intermediolateral cell column with the loss of small sympathetic neurons has been observed in some patients.
• Heart attack
• Some antidepressants
• Narcotic analgesics
• Alcohol
• Heart medicines
• Allergic reaction to certain drugs or chemicals
• Histopathologically, alpha-synuclein immunostaining demonstrates glial cytoplasmic inclusions.
• Addison's disease (where the adrenal glands fail to produce sufficient blood pressure-maintaining hormones).

Symptoms of Hypotension

Some are common Symptoms of Hypotension :

• Weakness
• Blurred vision
• Nausea
• Dizziness or lightheadedness
• Cold, clammy, pale skin
• Rapid, shallow breathing
• Depression
• Fatigue
• Confusion
• Feeling faint or weak

Treatment of Hypotension

Here is the list of the methods for treating Hypotension :

• Discontinue antihypertensive medications and other medications known to lower blood pressure, if feasible.
• Slowly and gradually performing positional changes, such as standing up.
• Other pharmacologic treatment options are directed toward symptomatic relief only (See Medication section below).
• Low blood pressure symptoms that do not go away very quickly upon sitting or lying down can be a medical emergency, and immediate medical attention is needed
• Stopping a medicine or changing the dose if the medicine is causing the hypotension.
• These garments drive blood from the legs to the heart and brain and help blood circulate through the body.
• Doctors traditionally have used the drug midodrine to raise standing blood pressure levels in people with orthostatic hypotension.

Parkinsons Disease

Parkinsons Disease is a condition of abnormal posture, tremor and involuntary movements which makes its appearance in mid-adult life. Parkinson's disease, one of the most common crippling diseases in the United States, affects men more often than women. According to current statistics, it strikes 1 in every 100 people over age 60. It runs a gradual, progressive and prolonged course. Parkinson's results from the degeneration of dopamine-producing nerve cells in the brain, specifically in the substantia nigra and the locus coeruleus. But although Parkinson's disease may eventually be disabling, the disease often progresses gradually, and most people have many years of productive living after a diagnosis. The risk of PD increases with age, so analysts expect the financial and public health impact of this disease to increase as the population gets older. Parkinson's disease patients have lost 80% or more of their dopamine-producing cells by the time symptoms appear.
Parkinsons Disease is a degenerative disease occurring in the basal ganglia of the brain and a decrease in a biochemical compound called dopamine of which the cause is unknown. Parkinson's disease (also known as shaking palsy) characteristically produces progressive muscle rigidity, akinesia, and involuntary tremor. Deterioration is a progressive process. Death may result from complications, such as aspiration pneumonia or some other infection.
Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. People with Parkinson's disease often experience trembling, muscle rigidity, difficulty walking, problems with balance and slowed movements. It was first described in 1817 by James Parkinson, a British physician who published a paper on what he called "the shaking palsy." The primary symptoms are the results of excessive muscle contraction, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. These symptoms usually develop after age 60, although some people affected by Parkinson's disease are younger than age 50.
Parkinson's disease (PD) is a degenerative disorder of the central nervous system. It is often characterized by muscle rigidity, tremor, a slowing of physical movement ( bradykinesia ), and in extreme cases, a loss of physical movement ( akinesia ). Parkinson's disease is called idiopathic Parkinson's because the cause is unknown. Parkinson's disease is progressive, meaning the signs and symptoms become worse over time. PD is also called "primary parkinsonism" or "idiopathic PD" ("idiopathic" meaning of no known cause). The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions. While most forms of parkinsonism are idiopathic, there are some cases where the symptoms may result from toxicity, drugs, genetic mutation, head trauma, or other medical disorders. Therefore the diagnosis is based on medical history and a neurological examination. Another involves an implanted device that stimulates the brain. Other approaches involve surgery. Meanwhile, research into other treatments continues.

Causes of Parkinsons Disease

The common Causes of Parkinsons Disease :

• Pesticides, toxins, chemicals
• Genetic factors
• Although these studies are beginning to provide some answers, experts do not know the exact cause of the disease.
• Head trauma.
• Parkinsonism may be caused by other disorders (such as secondary parkinsonism ) or certain medications used to treat schizophrenia.
• Most believe that it is a combination of genetic and environmental factors, but no definitive data exist.
• Parkinsonism may be caused by other disorders or by external factors ( secondary parkinsonism ) like certain medications used to treat schizophrenia .

Symptoms of Parkinsons Disease

Some common Symptoms of Parkinsons Disease :

• Less frequent blinking and swallowing
• Gait (walking pattern) changes
• Increased oily skin
• Slow movements
• Anxiety
• Decreased facial expression
• A variety of gastrointestinal symptoms, mainly constipation.
• Difficulty initiating any voluntary movement
• Unstable, stooped, or slumped-over posture
• Fatigue and aching
• Decline in intellectual function (may occur, can be severe)

Treatment of Parkinsons Disease

Here is the list of the methods for treating Parkinsons Disease :

• Deprenyl may provide some improvement to mildly affected patients.
• acts like a dopamine replacement drug but works on different sites in the brain. It can cause side-effects such as sedation at high doses.
• Amantadine or anticholinergic medications may be used to reduce early or mild tremors.
• Entacapone is a medication used to prevent the breakdown of levodopa.
• Physiotherapy, speech therapy, and occupational therapy can help with movement, speech, and overcoming difficulties performing everyday tasks. Brain surgery may be performed to destroy the part of the brain causing tremor, or to implant a pacemaker in the brain to regulate nerve cell action
• Pramipexole and ropinirole are dopamine medications used before or together with levodopa.
• Medications should not be accessible to the person once or if confusion becomes part of the symptoms.
• Drugs which mimic the action of dopamine – eg. bromocriptine. Using these early on in the course of Parkinson's disease may delay the long-term problems of the dopamine replacement drugs.

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.

Hemorrhage Stroke

A hemorrhagic stroke is damage to brain tissue resulting from bleeding inside the skull.

• There are two main types of hemorrhagic strokes: intracerebral hemorrhage and subarachnoid hemorrhage.
• Intracerebral hemorrhage occur within the brain while subarachnoid hemorrhage occur within a space between pia and arachnoid mater of the tissue covering the brain (meninges).
• Bleeding inside the skull can also result in epidural and subdural hematomas, which are usually caused by a head injury and cause different symptoms.

Intracerebral Hemorrhage

An intracerebral hemorrhage is bleeding within the brain.

• Intracerebral hemorrhage accounts for about 10% of all strokes but for a much higher percentage of death due to stroke.
• Among people older than 60, intracerebral hemorrhage is more common than subarachnoid hemorrhage.
• Causes of intracerebral hemorrhage include high blood pressure and in older people, fragile blood vessels.
• Bleeding disorders and use of anticoagulants increase the risk of dying from an intracerebral hemorrhage.

Symptoms and Diagnosis

• An intracerebral hemorrhage begin abruptly. In about half of the people, it begins with a severe headache.
• Neurologic symptoms develop and steadily worsen. They include weakness, paralysis, numbness, loss of speech or vision, and confusion.
• Symptoms worsen as the hemorrhage expands. Nausea, vomiting, seizures, and loss of consciousness are common and may occur within seconds to minutes.
• Doctor can often diagnose intracerebral hemorrhages on the basic of symptoms and the results of a physical examination.
• However, CT or MRI scan is usually performed when a stroke is suspected. Both procedures can help doctors distinguish a hemorrhagic stroke from an ischemic stroke. The procedures can also detect how much brain tissue has been damaged and whether pressure is increased in other areas of the brain.
• A lumbar puncture (LP) is not usually performed. LP cab cause herniation of the brain, a life threatening disorder.

Treatment and Prognosis.

• Treatment of hemorrhagic stroke differs from that of an ischemic stroke.
• Anticoagulants, thrombolytic drugs, and anti-platelet drugs (such as aspirin) are not given, and surgery may save the person's life.
• The goal of surgery is to remove blood that has accumulated in the brain and to relieve the resulting increased pressure.
• Stroke due to intracerebral hemorrhage is more dangerous that ischemic stroke. The stroke is usually large and catastrophic, especially in people who have chronic high blood pressure.
• More than have of the people who have large hemorrhages die within a few days. Those who survive usually recover consciousness and some bran function as the body absorbs the leaked blood.
• Ever after surgery, many people continue to have some neurologic symptoms. The symptoms may include weakness, paralysis, loss of sensation on one side of the body, or difficulty understanding and using language (aphasia).
• However, people with small hemorrhages recover to a remarkable degree.

Subarachnoid Hemorrhage

A subarachnoid hemorrhage is sudden bleeding into the space (subarachnoid space) between the inner layer (pia mater) and middle layer (arachnoid mater) of the meninges.

• Usually, the cause is the sudden rupture of an aneurysm in a cerebral artery or blood vessel (atriovenous) malformation of the arteries or veins in or around the brain.
• An aneurysm may rupture because of the pressure of blood inside the artery; hemorrhage and stroke may result.
• An arteriovenous malformation may be present at birth, but it is identified only if symptoms develop, it may cause bleeding, usually during adolescence or young adulthood, and sudden collapse, stroke, and death may result.
• Rarely, atherosclerosis or a bacterial infection damage a blood vessel, causing it to rupture. Ruptures can occur in people of any age of 25 and 50. A subarachnoid hemorrhage can also result from a head injury.
• A subarachnoid hemorrhage is the only one type of stroke more common among women than among men.

Symptoms and Diagnosis

• Before rupturing, aneurysms that cause subarachnoid hemorrhages usually produce no symptoms. However, aneurysm sometimes press on a nerve or leak small amounts of blood before a major rupture, thereby producing warning signs, such as headache, facial pain, double vision, or other visual problems.
• The warning signs can occur minutes to weeks before the rupture. People should always report such symptoms to a doctor immediately, because steps may be taken to prevent a massive hemorrhage.
• A rupture usually produces a sudden, severe headache, often followed by a brief loss of consciousness. Some people remain in a coma, but more people wake up, feeling confused and sleepy.
• Blood and cerebrospinal fluid around the brain irritate the layers of tissue covering the brain (meninges), producing dizziness.
• Frequent fluctuations in the heart rate and in the breathing rate often occur, sometimes accompanied by seizures. Within hours or even minutes, people may again become sleepy and confused.
• About 25% of people have neurologic symptoms, usually paralysis on one side of the body.
• A subarachnoid hemorrhage can usually be diagnosed by CT scan, which pinpoints the site of bleeding.
• LP if necessary can detect any blood in the CSF.
• Cerebral angiography is usually performed within 72 hours to confirm the diagnosis and to identify the site of the aneurysm or arteriovenous malformation causing the bleeding, so that surgery can be performed.

Treatment and Prognosis

• People who may have had a subarachnoid hemorrhage are hospitalized immediately and instructed to avoid exertion.
• Analgesics such as opioids (but not aspirin or other NSAID) are given to control the severe headaches.
• Occasionally, a drainage tube may be placed in the brain to relieve pressure.
• Nimodipine, a calcium channel blocker, is usually given to prevent spasm of an artery. This drug helps prevent late spasm and ischemic stroke.
• For people who have an aneurysm, surgery that isolates, blocks off, or supports the walls of the weak artery reduce the risk of fatal bleeding later. These procedures are difficult, and regardless of which one is used, the risk of death is high, especially for people whoa are in a stupor or coma.
• The best time for surgery is somewhat controversial and must be decided based on the person's situation.
• Most neurosurgeon recommend operating within 3 days of the start of symptoms, before the brain becomes swollen and inflamed.
• Delaying in operation 10 or more days reduces the risk of surgery, but bleeding is more likely to recur in the longer interim.
• A common procedure is placement of a metal clip across the aneurysm, which prevents blood from entering the aneurysm and thus eliminates the risk of rupture. People who have clips remains on place permanently.
• People who had clips placed years ago cannot undergo MRI: newer clips are not affected by the magnetic forces.
• An alternative procedure, called neuroendovascular surgery, involves the insertion of coiled wires into the aneurysm. The coils are placed using a catheter inserted into an artery and threaded to the aneurysm. Thus, this procedure does not require that the skull be opened. By slowing blood flow, the coils promote clot formation, which seals of the aneurysm.
• About 35% if people who have a subarachnoid hemorrhage due to an aneurysm die during the first episode because of extensive brain damage.
• Another 15% die within a few weeks because of subsequent bleeding.
• People who survive for 6 months but who do not have surgery for the aneurysm may have a 3% chance of another rupture each year.
• The outlook is better when the cause is an arteriovenous malformation. Occasionally, the hemorrhage is caused by a small defect that is not detected by cerebral angiography becayse it has already sealed itself off. In such cases, the outlook is very good.
• Many people recover most or all mental and physical function after a subarachnoid hemorrhage.
• However, neurologic symptoms, such as weakness, paralysis, loss of sensation on one side of the body, or difficulty in understanding and using language (aphases) sometimes persist.

Esophagus

Anatomy

•  The esophagus develops from the cranial portion of the foregut and is recognizable by the 3rd week of gestation. 
• The normal esophagus is a hollow, highly distensible muscular tube that extends from the epiglottis in the pharynx, at about the level of C6 vertebra, to the gastroesophageal junction at the level of the T11 or T12. 
• Measuring between 10 and 11 cm in the newborn, it grows to a length of about 25 cm in the adult.
• For the endoscopist, the esophagus is recorded as the anatomic distance  between  15 and 40 cm from the incisor teeth, with the gastroesophageal junction located at the 40-cm point.
• Several points of luminal narrowing can be identified along its course-proximally at the cricoid cartilage, midway in its course alongside the aortic arch and at the anterior crossing of the left main bronchus and left atrium, and distally where it pierces the diaphragm.
• Although the pressure in the esophageal lumen is negative compared with the atmosphere, manometric recordings of intraluminal pressures have identified two higher-pressure areas that remain relatively contracted in the resting phase.
• A 3-cm segment in the proximal esophagus at the level of the cricopharyngeus muscle is referred to as the upper esophageal sphincter (UES).
• The 2- to 4-cm segment just proximal to the anatomic gastroesophageal junction, at the level of the diaphragm, is referred to as the lower esophageal sphincter (LES). Both 'sphincters' are physiologic, in that there are no anatomic landmarks that delineate these higher-pressure regions from the intervening esophageal musculature.

Wall of esophagus

Taken from www.mc.vanderbilt.edu

• The wall of the esophagus consists of a mucosa, submucosa, muscularis propria/externa, and adventitia, reflecting the general structural organization of the gastrointestinal tract.
• The mucosa has a smooth, glistening , and pink-tan surface. It has three components;
1. a non-keratinizing stratified squamous epithelial layer,
2. lamina popria,
3. muscularis mucosa

1. The epithelial layer has mature squamous cells overlying  basal cells. The basal cells, constituting 10% to 15% of the mucosal thickness, are reserve cells with great proliferative potential.
   
   • A small number of specialized cell type, such as melanocytes, endocrine cells, dendritic cells, and lymphocytes, are present in the deeper  portion of the epithelial layer.
2.  The lamina propria is the non-epithelial portion of the epithelial layer, above the muscularis  mucosae.
•  It consists of areolar connective tissue and contain vascular structures and scattered leukocytes.
•  Finger-like extensions of the lamina propria, called papillae, extend into the epithelial layer. 
3. The muscularis mucosa is a delicate layer of longitudinally oriented smooth-muscle bundles.

• The submucosa consists of loose connective tissue containing;
• blood vessels, 
• a rich network of lymphatics, 
• a sprinkling of leukocytes with occasional lymphoid follicles, 
• nerve fibers (including the ganglia of Meissner plexus), and
• submucosal glands.
• Submucosal glands connected to the lumen by squamous epithelium-line ducts are scattered along the entire esophagus but are more concentrated in the upper and loweer portions. Their mucin-containing fluid secretions help lubricate the esophagus
• As is true throughout the alimentary tract, the muscularis propria/externa consists of an inner circular and an outer longitudinal coat of smooth muscle with an intervening, well-developed myenteric plexus (Auerbach plexus).
• The muscularis propria striated muscle fibers from the cricopharyngeus muscle.
• Besides creating a unique histologic interplay of smooth muscle and skeletal muscle fibers, this feature explains why skeletal muscle disorder can cause upper esophageal dysfunction.

• In sharp contrast to the rest of the gastrointestinal tract, the esophagus is mostly devoid of a serosal coat. Only small segments of the intra-abdominal esophagus are covered by serosa; the thoracic esophagus is surrounded by fascia that condenses around the esophagus to form a sheath like structure.
• In the upper mediasternum, the esophagus is supported by this fascial tissue, which forms a similar sheath around adjacent structures, the great vessels and the tracheobronchial tree. This intimate anatomic proximity to important throracic viscera is of significance in permitting the ready and widespread dissemination of infections and tumors of the esophagus into the posterior mediasternum. The rich network of mucosal and submucosal lymphatics that runs longitudinally along the esophagus further facilitates spread.
• As a summary, wall of esophagus composed of;
1. Mucosa
1. epithelial cells (non-keratinized stratified columnar epithelium)
2. lamina popria
3. muscularis mucosa (longitudinal smooth muscle)
2. Submucosa
1. submucosal plexus (Myentric's)
3. Muscularis externa/popria
1. inner circular smooth muscle
1. Meissner plexus (Auerbach's)
2. outer longitudinal muscle
4. Adventitia

Physiology of esophagus

• The main functions of the esophagus are;
1. to conduct food and fluids from the pharynx to the stomach, 
2. to prevent passive diffusion from the  pharynx to the stomach, 
3. to prevent passive diffusion of substances from the food into the blood, and 
4. to prevent reflux of gastric contents into the esophagus.
• These functions require motor activity  coordinated with swallowing, namely a wave of peristaltic contraction, relaxation of the LES in anticipation of the peristaltic wave, and closure of the LES after the swallowing reflex. The mechanisms governing this motor function are complex, involving both extrinsic and intrinsic innervation, humoral regulation and properties of the muscle wall itself.
• The control of the lower esophageal sphincter (LES) is critical to esophageal function. Maintenance of sphincter tone is necessary to prevent reflux of gastric contents, which are under positive pressure relative to the esophagus.
• During deglutition, both active inhibition of the muscularis propria muscle fibers by inhibitory nonadrenergic/noncholinergic neurons and cessation of tonix excitation by cholinergeic neurons enable the LES to relax. 
• Many chemical agents (eg gastrin, acetylcholine, serotonin, prostaglandin F20, motilin, substance P, histamine and pancreatic polypeptide)l decrease the tone. However, their precise roles in normal esophageal function remain unclear.

Rhinitis

 

Rhinitis is inflammation and swelling of the mucous membrane of the nose, characterised by a runny nose and stuffiness and usually caused by the common cold or and an allergy.

The nose is the most commonly infected part of the upper airways. Rhinitis may be acute or chronic. Acute rhinitis commonly results from viral infections but may also be a result of allergies or other causes. Chronic rhinitis usually occurs with chronic sinusitis (chronic rhinosinusitis).

Viral Rhinitis

• Acute viral rhinitis (the common cold) can be caused by a variety of viruses
• Symptoms consists of runny nose, congestion, post nasal drip, cough, and a  low-grade fever.
• Stuffiness can be relieved by taking phenylephrine as a nasal spray or pseudphedrine by mouth. These drugs, available by over the counter, cause the blood vessels of the nasal mucous membrane to constrict. Nasal spray should only be used for only 3 or 4 days because  after that period of time, when the effects of the drugs wear off, the mucous membrane often swells even more that before. This phenomena is called as rebound congestion.
• Antihistamines help  control runny nose but cause drowsiness and other problems, especially in older people.
• Antibiotics are not effective for acute viral rhinitis.

Allergic Rhinitis

• Allergic rhinitis is caused by a reaction of the body's immune system to an enviromental trigger. The most common environmental triggers include dust, molds, pollens, grasses, trees, and animals.
• Symptoms include sneezing, runny nose, stuffiness, and itchy, watery eyes.
• A doctor may diagnose  allergic rhinitis based on a person's history of symptoms. Often, the person has a family history of allergies.More detailed information may be obtained using blood tests or skin testing.
• Avoiding the substance that triggers the allergy prevents symptoms but is often not possible.
• Nasal corticosteroid sprays decrease nasal inflammation caused by many sources and are relatively safe for long-term use.
• Antihistamine help prevent the allergy reaction and thus symptoms.
• Antihistamines dry the mucous membrane of the nose but many of them also cause sleepiness and other problems, especially in older  people.
• Never ones require a prescription but do not have these side effects.
• Allergy shots (desensitization) help to build long therm tolerance to specific  environmental triggers, but they may take months  or years to become fully effective.
• Antibiotic do not relieve the symptoms of allergic rhinitis.

Atrophic Rhinitis

• Atrophic rhinitis is a form of chronic rhinitis in which  the mucous membrane thins (atropies) and hardens, causing the nasal passages to widen and dry out.
• The cells normally found in the mucous membrane of the nose - cells that secrete mucus and have hairlike projections to move dirt particles out - are replaced by cells like those normally found in the skin.
• The disorder can develop in someone who had sinus surgery in which a significant amount of intranasal structures and mucous membranes were removed. 
• A prolong bacterial infection of the lining of the nose is also a factor.
• Crust form inside  the nose, and an offensive odour develops.
• A person may have recurring severe nosebleeds and can lose his sense of smell (anosmia).
• Treatment is aimed at reducing the crusting, elimination the odour, and reducing infections. 
• Topical antibiotics, such as bacitracin applied  inside the nose, kill bacteria.
• Estrogens and vitamins A and D sprayed into the nose or taken by mouth may reduce crusting by promoting mucosal secretions.
• Other antibiotics, given by mouth or intravenously, may also be helpful.
• Surgery to narrow the nasal passages may reduce crusting became the decreased airflow prevents drying if the thinned mucous membrane

Vasomotor Rhinitis

• Vasomotor rhinitis is a form of chronic rhinitis.
• Nasal stuffiness, sneezing, and a runny nose - common allergic symptoms - occur when allergies do not appear to be present.
• In some people, the nose reacts strongly to irritants, perfumes, and pollution.
• The disorder comes and goes but is worsened by dry air.
• The swollen mucous membrane varies fro bright red to purple.
• Sometimes, people also have slight inflammation of the sinuses.
• When persistent, endoscopy of the nose or CT scan of the sinus is not significant.
• Treatment is aimed at relieving symptoms.
• Avoiding smoke and irritants and using a humidified central heating system or vaporizer to increase humidity may be beneficial.

Heart Diseases

Introduction - Heart disease is the name given to a whole collection of heart conditions that affect people on a daily basis and a term that people across the world are most certainly familiar with. To really understand what heart disease is all about, you need to know what each of the conditions are, and what they do to your body if you are unlucky enough to suffer from one of them.
It’s a killer disease that affects a vast portion of the world population, but few people know the facts related to heart disease. Heart disease is actually an umbrella term for many different types of afflictions affecting the heart and below we have listed a few conditions that affect the heart; however, this does not represent the full scope of the many specific medical conditions that make up heart disease.

What is Heart Disease? - Coronary Heart Disease

Coronary heart disease is the build up of atheromatous plaque (inflamed tissue) within the arteries that pump blood into the heart; this can build up over time and restrict the flow of blood to the heart causing heart failure. If this does not happen then there is also the possibility that the plaques can rupture causing blood to clot and restrict blood flowing to the heart. The disease progresses over time, and symptoms are often non-existent until the condition manifests itself in the form of a heart attack.
When the plaque builds up to a point where the blood flow to the heart is reduced or cut off, serious consequences can result. Those with an advanced case of coronary heart disease may experience frequent and painful chest pains, due to a symptom known as ‘angina’. The best way of preventing a case of coronary heart disease involves engaging in an active lifestyle, watching what you eat and avoid smoking.
What is Heart Disease?- Ischemic (or ischaemic) heart disease
Those who suffer from Ischemic heart disease experience a decreased flow of blood to the heart. Angina may also occur when a case of Ischemic heart disease is present. Just like Coronary Heart Disease this type of heart disease is very serious and can be prevented by maintaining a healthy lifestyle.
‘Ischaemia’   means an "inadequate blood supply". The only supply of blood to the heart muscle is through the coronary arteries, so any obstruction in the coronary arteries will reduce the supply of blood to the heart muscle.
Atherosclerosis is one of the most common cause of ischemic heart disease and may even exist when the artery lumens appear normal by angiography.
Possible consequences of Ischemic heart disease can be:
v Temporary damage and pain (ischemia)
v Permanent heart muscle damage, heart muscle does not grow back (acute myocardial infarction /infarct)
v Loss of muscle activity (acute heart failure)
v Long term loss of heart muscle activity (chronic heart failure)
v Cardiac arrhythmias: irregular heartbeat which can be fatal. Most death is due to arrhythmias, usually tachyarrhythmias.
v Other structural damage to the heart including damaged heart valves, actual perforation of the heart and a thin walled fibrous floppy heart.

What is Heart Disease? - Cardiovascular Heart Disease

Cardiovascular disease - is a term that represents a number of different types of heart disease. These types of heart disease often affect the blood vessels of the heart. With over 71.3 million citizens of the United States alone affected by a form of cardiovascular disease, it is a common type of illness that can also be avoided by staying healthy.
Pulmonary heart disease - is a very serious form of heart disease. If there is a change in the structure of the right ventricle located in the heart, due to respiratory problems. The affect this has on the right ventricle is great; it can cause increased pressure in the right ventricle, which will eventually lead to the right ventricle stretching through dilation or additional muscle growth in the ventricle to help add strength to the contractions needed for the increase in pressure.
This will add a lot of strain to the heart and will eventually lead to heart failure, and in some cases swelling in the legs.

What is Heart Disease? - Hypertensive Heart Disease

Hypertensive heart disease is related to hypertension, which is commonly known as high blood pressure and affects a large group of people worldwide.
High blood pressure means the heart has produced an elevated amount of pressure to pump the blood around the body, this can, overtime cause a strain on the heart leading to heart failure or an aortic arterial aneurysm.
An aortic arterial aneurysm is the bulging of a blood vessel in the artery, which will increase to the point that it bursts causing severe pain, and without immediate medical assistance, death.
If found early then surgical intervention can take place and an artificial tube sewn into the aorta and the aneurysm closed so it wont rupture causing a massive internal hemorrhage. This surgery is very invasive so the medical profession will not carry out the surgery unless it is deemed necessary. When arterial hypertension is occurring within the heart, the disease takes over, causing fatigue, an irregular pulse, and a swelling of the feet. The condition can lead to cases of congestive heart failure, and it is a leading cause of death in western society. 

What is Heart Disease? - V alvular Heart Disease
There are valves in the heart which assist the bloods journey through the labyrinth of channels that keep the heart functioning. Sometimes there are problems with these valves thus impeding the flow of blood.
The valves in the heart are the tricuspid valve and pulmonic valve, which are both found in the right side of the heart and the mitral valve and aortic valve, which are found in the left side of the heart.
There are a great number of medical conditions that affect the valves in different ways but they all generally involve one or more of the valves being too narrow, wide or loose causing regurgitation of the blood.

What is Heart Disease? - Summary

Now that you know more about the different types of heart disease, you’ll be better able to draw parallels when it comes to acting in a preventative matter and keeping a healthy heart.
By knowing all that you can about:
v coronary heart disease,
v ischaemic heart disease,
v cardiovascular disease,
v pulmonary heart disease
v valvular heart disease
v hypertensive heart disease,
you’ll be better suited than most when it comes to staying healthy, recognizing symptoms and avoiding a visit to the  A & E of your nearest hospital .
As you can see the causes and affects vary greatly, and it is due to this that we need to be diligent and understand heart disease better, after all it is one of the biggest killers of the present day.