1. What are Abdominal Adhesions?

Abdominal adhesions are bands of tissue that form between abdominal tissues and organs. Normally, internal
tissues and organs have slippery surfaces, which allow them to shift easily as the body moves. Adhesions cause
tissues and organs to stick together. Although most adhesions cause no symptoms or problems, others cause
chronic abdominal or pelvic pain. Adhesions are also a major cause of intestinal obstruction and female
infertility.
Abdominal surgery is the most frequent cause of abdominal adhesions. Almost everyone who undergoes
abdominal surgery develops adhesions; however, the risk is greater after operations on the lower abdomen and
pelvis, including bowel and gynecological surgeries. Adhesions can become larger and tighter as time passes,
causing problems years after surgery.
Surgery-induced causes of abdominal adhesions include

tissue incisions, especially those involving internal organs

the handling of internal organs

the drying out of internal organs and tissues

contact of internal tissues with foreign materials, such as gauze, surgical gloves, and stitches

blood or blood clots that were not rinsed out during surgery

A less common cause of abdominal adhesions is inflammation from sources not related to surgery, including

appendicitisin particular, appendix rupture

radiation treatment for cancer

gynecological infections

abdominal infections

How can abdominal adhesions cause intestinal obstruction?

Abdominal adhesions can kink, twist, or pull the intestines out of place, causing an intestinal obstruction. An
intestinal obstruction partially or completely restricts the movement of food or stool through the intestines. A
complete intestinal obstruction is life threatening and requires immediate medical attention and often surgery.

What are the symptoms of abdominal adhesions?

Although most abdominal adhesions go unnoticed, the most common symptom is chronic abdominal or pelvic
pain. The pain often mimics that of other conditions, including appendicitis, endometriosis, and diverticulitis.

How can abdominal adhesions cause female infertility?

Abdominal adhesions cause female infertility by preventing fertilized eggs from reaching the uterus, where fetal
development takes place. Adhesions can kink, twist, or pull out of place the fallopian tubes, which carry eggs
from the ovarieswhere eggs are stored and releasedto the uterus.
What are the symptoms of an intestinal obstruction?
Symptoms of an intestinal obstruction include

severe abdominal pain or cramping

vomiting

bloating

loud bowel sounds

swelling of the abdomen

inability to pass gas

constipation

How are abdominal adhesions and intestinal obstructions treated?

Treatment for abdominal adhesions is usually not necessary, as most do not cause problems. Surgery is currently
the only way to break adhesions that cause pain, intestinal obstruction, or fertility problems. More surgery,
however, carries the risk of additional adhesions and is avoided when possible.
A complete intestinal obstruction usually requires immediate surgery. A partial obstruction can sometimes be
relieved with a liquid or low-residue diet. A low-residue diet is high in dairy products, low in fiber, and more
easily broken down into smaller particles by the digestive system.
Can abdominal adhesions be prevented?
Abdominal adhesions are difficult to prevent; however, surgical technique can minimize adhesions.
Laparoscopic surgery avoids opening up the abdomen with a large incision. Instead, the abdomen is inflated
with gas while special surgical tools and a video camera are threaded through a few, small abdominal incisions.
Inflating the abdomen gives the surgeon room to operate.
If a large abdominal incision is required, a special filmlike material (Seprafilm) can be inserted between organs
or between the organs and the abdominal incision at the end of surgery. The filmlike material, which looks
similar to wax paper, is absorbed by the body in about a week.
Other steps during surgery to reduce adhesion formation include using starch- and latex-free gloves, handling
tissues and organs gently, shortening surgery time, and not allowing tissues to dry out.
Points to Remember

Abdominal adhesions are bands of tissue that form between abdominal tissues and organs, causing
tissues and organs to stick together.

Although most adhesions cause no symptoms or problems, others cause chronic abdominal or pelvic
pain, bowel obstruction, or female infertility.

Abdominal surgery is the most frequent cause of abdominal adhesions.

Abdominal adhesions can kink, twist, or pull the intestines out of place, causing an intestinal
obstruction.

A complete intestinal obstruction is life threatening and requires immediate medical attention and often
surgery.

Abdominal adhesions cause female infertility by preventing fertilized eggs from reaching the uterus,
where fetal development takes place.

No tests are available to diagnose adhesions, and adhesions cannot be seen through imaging techniques
such as x rays or ultrasound.

An intestinal obstruction can be seen through abdominal x rays, barium contrast studiesalso called a
lower GI seriesand computerized tomography.

Surgery is currently the only way to break adhesions that cause pain, intestinal obstruction, or fertility
problems.

2.
What is Acne?
Acne occurs when the oil glands of the skin become plugged. It is more common in people with oily skin. Acne
occurs in adolescents and young adults. In acne there are blackheads (the plugs found in blocked-off oil glands),
whiteheads (pimples), or red bumps on the face, neck, and shoulders.

What is the cause?

Acne is due to over activity and plugging of the oil glands. The main underlying cause of acne is increased
levels of hormones during adolescence. Acne is not caused by diet. A person who has acne does not have to
avoid eating fried foods, chocolates, or any other food.
Acne is not caused by sexual activity. It is not caused by dirt nor by not washing the face often enough. The tops
of blackheads are black because of the chemical reaction of the oil plug with the air. Acne usually lasts until the
age of 20 or sometimes 25. It is rare for acne to leave any scars, and people worry needlessly about this.
How to take care of acne?
Good skin care can keep acne under control and at a mild level.

* Wash the skin twice a day using a mild soap, especially after exercise. Avoid scrubbing the skin. Hard
scrubbing of the skin is harmful because it irritates the openings of the oil glands and can cause them to be more
tightly closed.
* Avoid putting any oily or greasy substances on the face. Oily and greasy substances make acne worse by
blocking oil glands. If unavoidable, use water-based cover-up cosmetics, and wash them off at bedtime.
* Shampoo the hair daily. Avoid hair tonics or hair creams especially greasy ones. These substances spread to
the face and aggravate the acne.
* Avoid picking blackheads as this delays healing. In general, it is better not to "pop" pimples.
* Exercise regularly and keep fit.
* Don't stop the acne medicine too soon. It may take up to 8 weeks for a good response.
What are the types of acne?
Acne can be classified into four main types: purely comedonal i.e. non-inflammatory acne; mild papular;
scarring papular and nodular or scarring acne.
Comedonal acne: It is the non-inflammatory acne, which is the mildest form of disease but can be the hardest to
treat. Comedones are usually firmly seated in the follicle.
Inflammatory acne: It is the mild papulopustular acne, which rarely results in scarring and typically is
responsive to aggressive, twice daily, topical treatment.
What is the treatment?
Many doctors seem tempted to use as many as five or six treatments. Most acne can be treated effectively with
two drugs, or at most three, at any one time. Failure to respond to a regimen within four to eight weeks should
prompt a substantial change in drugs, not merely the addition of another product.
Tretinoin, isotretinoin, adapalene, and tazarotene are topical retinoids which, if applied daily, inhibit formation
of comedones and usually clear even severe comedonal acne within a few months. The only major drawback is
irritation, which is greatest after a few weeks, but the irritation usually requires no more than simple
moisturising. Azelaic acid is a dicarboxylic acid with modest antibacterial and comedolytic effects. It is the least
irritating preparation. The side effects: in dark skinned patients, inflammation results in hyperpigmentation,
which could otherwise remain for weeks or months.
Usually, two drugs are prescribed an antibacterial and a comedolytic. Benzoyl peroxide 2.5-10% is extremely
effective against this type of acnes. Its major disadvantage is irritation, which can be minimised by using lower
concentrations in a cream vehicle. Topical erythromycin and clindamycin are available as alcoholic solutions,
lotions, creams, and gels, all of which are about equally effective. A combination of clindamycin and benzoyl
peroxide in gel form is superior to a topical antibiotic alone. Azelaic acid 20% cream is also an effective
alternative. Failure to respond to topical treatment within four to eight weeks should automatically prompt a
change in treatment. Other options for resistant P acnes include oral antibiotics and isotretinoin.
Solutions for acne that is resistant to treatment:
Investigate compliance
Increase frequency of topical treatment
Begin or increase oral antibiotic dosage

Search for hormonal derangement

Begin oral isotretinoin therapy
Oral treatment:
Acne that is resistant to topical treatment requires oral antibiotics. Many of the antibiotics useful in acne also
have an anti-inflammatory activity, which is nearly as important as their effect on the P acnes itself. Oral
erythromycin used to be a common treatment for acne, but the rise of resistance has greatly reduced its utility. It
is necessary to begin the treatment with doxycycline or minocylcine. Acquired resistance to minocycline and
doxycycline is less common than to erythromycin but is still a concern, and use of these drugs should be limited
to those patients who truly need them. Patients are instructed to take the drug with food this minimises stomach
complaints and maximises compliance. If minocycline or doxycycline cannot be used, alternatives include cotrimoxazole and ciprofloxacin. Risk of acquiring resistance to these drugs after long-term use has not been
studied, but the use of these drugs should be minimised. In general, cephalosporins and penicillins are not very
effective in treating acne. The increased cost of some of these newer drugs may make using isotretinoin an
attractive option in the long-term treatment.
Hormonal treatment:
It is wrong to assume that any woman with acne have a hormonal derangement. In fact, androgen levels do not
correlate with acne severity among people with acne. Acne resistant to treatment, especially in a woman with
irregular menses, should be investigated. Measurements of total and free testosterone as well as
dehydroepiandrosterone sulphate. If these levels are raised, four approaches may be taken: suppression with low
dose oral corticosteroid, oral contraception, cyproterone acetate or spironolactone.
Isotretinoin revolutionised the treatment of severe acne. It is used in case of severe nodular acne, but it is
commonly used for severe acne that is resistant to oral antibiotics as well. Patients should be monitored
routinely.
Acne and pregnancy:
Erythromycin, topical or oral, is safe in pregnancy, although oral erythromycin is often poorly tolerated in
patients whose lower oesophageal sphincter is already relaxed by pregnancy. Benzoyl peroxide is also safe.
Topical tretinoin in pregnancy is theoretically safe as circulating vitamin A. No increase in foetal abnormalities
has been seen in women using topical tretinoin while pregnant.

3. What is Aids ?
AIDS (Acquired Immunodeficiency Syndrome or Acquired Immune Deficiency Syndrome, sometimes written
Aids) is a human disease characterized by progressive destruction of the body's immune system. It is widely
accepted that AIDS results from infection with HIV (Human Immunodeficiency Virus). AIDS is currently
considered incurable; where treatments are unavailable (mostly in poorer countries) most sufferers die within a
few years of diagnosis. In developed countries, treatment has improved greatly over the past decade, and people
have lived with AIDS for ten to twenty years. In 2003, it was estimated that 40 million were infected with HIV
and 5 million contracted AIDS.
AIDS was first noticed among homosexual men and intravenous drug users in the 1980s. By the 1990s the
syndrome had become a global epidemic and in 2004, 58% of those with AIDS were women. While homosexual
men continue to suffer higher per capita AIDS rates, the majority of victims are currently heterosexual women

and men, and children, in developing countries.

Symptoms
HIV is transmitted by bodily fluids, such as blood, semenSemen or ejaculate is the fluid discharged from the
penis during ejaculation, usually at the time of orgasm. Like blood, semen consists of two compartments, the
cellular compartment spermatozoa , and noncellular compartment seminal plasma . Thus, it conta, breast
milkBreast milk usually refers to the milk produced by a human female which is usually fed to infants by
breastfeeding. It provides the primary source of nutrition for newborns, before they are able to digest more
diverse foods. Production Under the influence, and vaginal secretions. It causes disease by infecting CD4+ T
cellT cells are a subset of lymphocytes that play a large role in the primary immune response. The abbreviation
"T" stands for thymus, the organ in which their final stage of their development occurs. There are many types of
T cells: Cytotoxic T cells (CD8+)s, a type of leukocyte (white blood cell) that normally coordinates the immune
response to infectionInfection" is also the title of an episode of the television series Babylon 5; see Infection
(Babylon 5). An infection is the detrimental colonization of a host organism by a foreign species. The colonizing
organism interferes with the normal functioning and cancerFor other meanings of Cancer: see Cancer
(disambiguation . apoptosis; cancer cells, however, avoid apoptosis. Cancer is a group of related diseases
characterized by uncontrolled cell division. Currently, it is believed that cancers arise from both genetic. When a
person's CD4+ T cellT cells are a subset of lymphocytes that play a large role in the primary immune response.
The abbreviation "T" stands for thymus, the organ in which their final stage of their development occurs. There
are many types of T cells: Cytotoxic T cells (CD8+) count decreases sufficiently he or she is prone to a range of
diseases that a healthy person's body is normally able to fight. These diseases include cancers and opportunistic
infections, which are usually the cause of death in persons with AIDS. HIV also infects brain cells, causing
some neurological disorders.
Originally AIDS was diagnosed based on the opportunistic diseases affecting the patient. Today, diagnosis is
based on CD4+ T cell counts. This allows for earlier diagnosis and better representation of women.
How are they diagnosed?
The diagnosis of a cancer can be suspected on the symptoms and the results of the physical examination.
Kaposi's sarcoma is diagnosed by a biopsy of any purple patch or sore on the skin or mucous membrane.
Lymphoma and the other cancers require a biopsy of the affected lymph nodes.
What is the treatment?
Treatment for AIDS-associated cancers include:
Chemotherapy: This uses drugs that kill the tumour cells.
Radiotherapy: is also used to destroy cancerous growths and slow
their spread.
Combination therapy: Treatment includes a combination of surgery,
chemotherapy and radiotherapy.
How can AIDS be prevented?
Avoid sexual contact with HIV infected individuals or use a condom during sex.
Ensure the barber doesn't reuse blades.
Intravenous drug users shouldn't share needles.
HIV infected individuals should not donate blood, semen, or body
parts.
Breast feeding should be avoided because the virus can be
transmitted to the infant.

What is allergy?
Allergy is a condition characterised by a level of sensitivity greater than normal to a specific
substance or group of substances. These substances, called allergens, trigger a response in
susceptible individuals. They can enter the body through various routes like inhalation, ingestion,
injection, and external skin contact. They react with antibodies in a susceptible person, causing the
release of histamine (a chemical mediator in allergic reactions) and other chemical substances that
cause various symptoms. This creates a chain response known as the allergic response.
What is the cause?
Allergic reactions may be caused by many factors. These include the most common allergy 'triggers' like
pollen grains, dust, moulds and foodstuffs. Other triggers include animal proteins from hair, and fur and
substances that cause skin allergic reactions such as certain oils found in plants, drugs, cosmetics, chemicals
etc. The allergies can be classified as seasonal allergies and perennial allergies.

1. Seasonal

allergies
Seasonal allergies occur during certain seasons of the year. They are caused by inhaling microscopic
particles in the air and substances like pollen released by plants, grasses and weeds. This can lead to
a
sustained
allergic
response.

2. Perennial

allergies
Perennial allergies occur throughout the year. They occur due to mould, fungi and dust found
indoors. Perennial allergies can be caused by fur from cats and dogs and other pets.

An exaggerated response to specific food allergens is termed food allergy or hypersensitivity and such foods
include milk, eggs, chocolate, nuts, corn, pork, prawns and beef. Histamine and its related substances are
responsible for mediating the allergic response and causing the characteristic symptoms of allergy.

What are the symptoms?

Breathing problems and skin irritations are the common allergic responses. Sneezing, running nose, watery
eyes, wheezing, skin redness, and skin itching and rashes are common symptoms. Allergic rhinitis is a term
that is used to describe a thin, watery trickle from the nose accompanied by sneezing, as in common colds.
Severe allergies can cause anaphylactic shock, a life threatening reaction to some allergens where there may
be a sudden and dramatic drop in blood pressure. Anaphylactic shock may also cause closure of air passages
and result in death. Anaphylactic reactions may be caused by bee stings, drugs like penicillin and also some
types of food substances. When an individual's allergies are triggered, there is swelling of the nasal linings,
which results in sinus blockage and infection.
How is the diagnosis made?
A family history of allergy and allergy-related diseases is important in the assessment of allergies.
Reactions occurring with regularity at certain times each year may be due to seasonal allergies,
while those that manifest throughout the year are perennial. If the symptoms improve with antiallergy drugs, then an allergic component to the problems is believed to be present. There are also
a
variety
of
tests
that
help
in
the
diagnosis
of
allergies.
n-Vivo testing- The basic principle in this method is to demonstrate an actual allergic reaction in
the
patient
by
using
micro
doses
of
the
suspected
allergen.
In-Vitro testing- It is based on identifying the antibody proteins (chemicals produced in the body
due to an immune response) produced by the individual during an allergic reaction.
Nasal smear testing- In this a sample of nasal secretions is collected and analysed in a laboratory.
Eosinophils (a type of cell present in the body) are produced during an allergic reaction, and these

are observed under a microscope in the nasal specimens obtained.

What is the treatment?
Since the allergic reaction is due to histamine and its related substances that trigger the full-blown
allergic reaction, drugs called antihistamines are used to treat allergies. They block the activity of
histamine and relieve symptoms. Their most common side effect is drowsiness. Some
antihistamines are non-sedating, and do not cause drowsiness. Antihistamines in the form of nasal
sprays work relatively rapidly once sprayed into the nose. Antihistaminic sprays avoid some of the
unpleasant side effects of oral antihistamines. Steroids are the most potent drugs for allergies. They
help by decreasing the inflammation seen in the allergic reaction. Prolonged use of steroids can
have serious adverse effects, so they should be taken on a limited, short-term basis to provide
relief. Steroid sprays are relatively safer than oral steroids. If environmental controls and
medications have failed to provide adequate relief, allergy shots (allergen immunotherapy or
desensitization) can be used.
What is the prevention?
The best way to avoid symptoms of allergy is prevention. This means avoiding exposure to agents
that trigger the allergic response. Being aware of common allergens like pollen, dust, fur, drugs,
specific foods etc, and avoiding them is absolutely essential in preventing an allergic reaction.
Patients, who have suffered from an anaphylactic reaction in the past, should carry an injectable
shot of a drug called epinephrine that can be administered in an emergency. Prompt treatment of
severe allergic reactions, especially anaphylactic reactions, is essential.

5
What is anaemia?
Anaemia is a condition in which the number of red blood cells (RBC) or the amount of haemoglobin in the
blood is below normal for age and sex of the individual. It is thus defined as a decrease in the red cell mass and
is usually discovered and quantified by measurement of the RBC count, haemoglobin (Hb) concentration, and
haematocrit (Hct). Anaemia is suggested in males with Hb levels less than 13 g/dl and in females with Hb levels
less than 12 g/dl (less than 11.5 g/dl in pregnant women).
What is the cause?
The 3 broad categories of anaemia are due to: a) decreased production of red blood cells, b) loss of blood
(haemorrhage) or c) break-down of red blood cells (haemolysis) and a number of causes and diseases can be
listed under each of these. Anaemia is a symptom of disease that requires investigation to determine the
underlying cause. Mere treatment of anaemia will result in recurrence unless the condition causing it is treated.
It is twice as common in women as in men, especially during the childbearing years, due to menstrual blood loss
and multiple pregnancies. Anaemia is also very common in children due to their rapid growth, poor nutrition,
food fads and presence of chronic illness. Nutritional anemia due to dietary lack of iron is the most common
cause of anaemia women and children in our country, as iron is required to make haemoglobin. This deficiency
is often exacerbated by concurrent excessive loss of iron from the body.
Decreased production of red blood cells may be due to the lack of vitamin B12 or folic acid in the diet, diseases
affecting the bone marrow like some viral infections or drugs, inherited blood diseases like thalassaemia or
sickle cell anemia, chronic disease of kidney or joints, chronic infections, some hormonal disorders and cancers
like leukemia. Blood loss may be due to gynaecological diseases in women, chronic worms in children, diseases
of the gastro-intestinal tract like ulcers or polyps etc. Drugs or infection like malaria most commonly causes red
cell breakdown.

What are the symptoms?

The symptoms of anaemia depend on its severity, its rate of occurrence and presence of co-existing diseases. If
it occurs gradually (chronic anaemia) as in nutritional deficiency or chronic disease, the body is able to adapt
itself and the person may be able to function even with a low haemoglobin level. On the other hand, if anaemia
occurs in a short period of time (acute anaemia) due to bleeding or red cell breakdown, the symptoms appear
rapidly. There is usually a feeling of tiredness, lack of stamina, light-headedness and shortness of breath. The
skin may appear pale along with pale palms, gums, eyes, and nails. There may be associated rapid heartbeat and
chest pain. When anaemia results from break down of the red blood cells, there may also be jaundice, which
causes a yellowing of the skin and eyes.
How is it diagnosed?
The symptoms of anaemia are not distinct or specific while findings like paleness of skin and eyes are quite
subjective. A simple blood test can confirm it. The work-up includes not just the estimation of haemoglobin but
a complete blood count (which includes the red cell indices), estimation of reticulocyte count and a peripheral
smear examination. This helps to quantify anaemia, suggest a cause and direct further investigations.
What is the treatment?
The treatment of anaemia depends on the underlying cause.
In case of iron deficiency, treatment is with iron tablets. The cheapest and most effective form is ferrous iron.
The side effects experienced on taking iron tablet are proportional to the amount of iron available for absorption.
The iron preparation you take should contain between 30-100 mg elemental iron. Avoid enteric-coated or
prolonged-release preparations. The dose you take should be sufficient to provide between 150-200 mg
elemental iron per day and the tablet may be taken 2 to 3 times a day about 1 hour before meals. A glass of fruit
juice aids in iron absorption.
Though ferrous sulphate is recommended to treat iron deficiency, often patients complain of gastrointestinal
discomfort, bloating and other distress. Ferrous gluconate, which is roughly equivalent in cost, produces fewer
problems, and is preferable as the initial treatment of iron deficiency. Polysaccharide-iron complex is a more
recent option and most patients tolerate this form of iron better than the iron salts, even though the 150 mg of
elemental iron per tablet is substantially greater than that provided by iron salts (50 to 70 mg per tablet).
The treatment should be continued for 3 months after the haemoglobin has returned to normal so that the body
iron stores are replenished. Response to treatment is confirmed by doing a reticulocyte count after 10-12 days of
treatment and the rate of rise of haemoglobin (with adequate dose of iron about 1 g/dl per week).
How to take care?
Follow the doctor's advice for treating anaemia and any underlying cause:
* Take the medication for as long as advised.
* Iron-deficiency anaemia is often caused by consuming diets low in iron. Most iron is obtained from foods in
our diet, but only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. A person unable to have a
balanced iron-rich diet may suffer from some degree of iron-deficiency anaemia.
* Absorption of iron from food is influenced by many factors. One important factor is the form of the dietary
iron. The iron found in animal sources is called haeme (ferrous, Fe 2+) while that obtained from plant sources is
non-haeme (ferric Fe 3+) iron.
* Haeme iron (meat and meat products) is highly available for absorption and usually 20-30% of it is absorbed
from the diet. The level of haeme iron absorption is relatively unaffected by other dietary factors.

* In contrast, non-haeme iron of vegetable sources (cereals, green vegetables, pulses, dried fruits etc.) is
relatively poorly absorbed (usually less than 10% of dietary intake and often under 5%). Its absorption is
markedly influenced by an individuals iron status and dietary factors that can either inhibit or enhance it.
Vegetarians thus need more iron in their diets than non-vegetarians and should choose several iron-rich plant
foods daily. Grains, beans and lentils, vegetables (green-leafy ones, tomato, potato, green & red chillies etc),
fruits, nuts and seeds are rich sources of non-haeme iron. The absorption of non-haeme iron can be improved
when a source of haeme iron meat/fish/poultry is consumed in the same meal or iron absorption enhancing
foods like fruits/fruit juices are consumed. But coffee/tea and calcium if consumed along with a meal impair
iron absorption.
* Females, particularly those with heavy menstrual periods, must have a higher intake of iron to prevent
anaemia.
* Iron deficiency in infants can cause problems in development affecting growth, memory and behavior. After
weaning a child, used iron fortified products, iron supplements and add items rich in iron to the diet. Early
introduction of cows milk and its consumption of more than 700 ml per day after the age of 1-year increase the
risk of iron deficiency as this milk is low in iron content and may replace foods with higher iron content.

6
What is Anthrax?
Anthrax is a disease primarily found in animals, caused by the bacterium Bacillus
anthracis. Humans can be infected with it when they are exposed to infected animals,
tissue from infected animals or exposed to the spores of the bacterium.
What is the cause?
The bacterium, Bacillus anthracis, is the causative organism. Under a microscope with
appropriate staining, the bacteria look like small rods. The spores are usually spherical
structures, smaller than the bacteria, and are the dormant form of the bacteria. They can
survive in the soil for years, and can withstand hot or cold temperatures.
What are the spores of anthrax?
Spores are the hardy form of the bacteria and can survive for years in the dry form. They
can withstand boiling for 10 minutes and can resist most disinfectants. A high
temperature of 120F for at least 15 minutes (autoclaving) can be used to inactivate
them.
Where does it occur?
Anthrax is found globally but infection in man is not very common. It is most common in
farming regions in developing countries in South and Central America, Southern and
Eastern Europe, Asia, Africa, the Caribbean and the Middle East.
Does it occur in India?
A few sporadic cases and outbreaks of anthrax have occurred in India. Detailed
information collected for three southern Indian states, Andhra Pradesh, Karnataka, and
Tamil Nadu, has confirmed the endemic nature of anthrax. During the last two decades,
about 70 cases of human anthrax have been encountered at Christian Medical College,
Vellore, including 26 cases of cutaneous anthrax. Recent outbreak of human anthrax has
been reported from Jawaharlal Institute of Postgraduate Medical Education and Research

(JIPMER), Pondicherry (1998-2001), during which 25 cases of cutaneous anthrax and a

few cases of anthrax meningitis (brain) were recorded.
How is it transmitted?
Humans can get infected through the skin, by inhaling it, and rarely by eating or drinking
the spores. Infection occurs by handling products from infected animals or by inhaling
the spores from contaminated animal products. Anthrax can also be spread by eating
undercooked meat from infected animals.
Since it is not contagious, it is extremely unlikely to spread from an infected person to
others.
What is the infective dose?
It should be remembered that cattle or sheep (together with guinea pigs) are extremely
susceptible to infection, as few as 110 spores being sufficient to produce the disease.
The infective dose for humans ranges from 100,000 to 1000 spores. It is estimated that
inhalation of 100,000 spores would infect 50% of the people exposed to the spores.
What are the symptoms?
The symptoms vary depending on the route of infection. Symptoms usually appear within
seven days.
1. Cutaneous anthrax: Most anthrax infections (about 95 percent) occur when the
bacteria or spores enter a cut or scrape on the skin. Skin infection begins as a raised,
itchy bump that resembles an insect bite but within 1-2 days develops into a vesicle and
then a painless ulcer, usually 1-3 cm. in diameter, with a characteristic black necrotic
(dying) area called the eschar in the center. The nearby lymph glands swell. About 20
percent of untreated cases of cutaneous anthrax are fatal, but death is rare when it is
treated.
2. Inhalation anthrax: It is also known as woolsorters disease. The initial symptoms
may resemble a common cold. Later on the symptoms may progress to breathing
problems and shock. Untreated inhalation anthrax is usually fatal.
3. Intestinal anthrax: The intestinal form is rare and is characterized by swelling of the
intestines. The initial symptoms include nausea, loss of appetite, vomiting and fever,
followed by abdominal pain, vomiting of blood, and severe diarrhoea. Intestinal anthrax
may be fatal in 25-60 percent of cases.
Can it be prevented?
An effective vaccine is available - about 93 percent effective in protecting against
anthrax. But supplies are limited, and are usually used to immunize the armed forces.
Taking antibiotics as a preventative measure is foolish. It will do more harm than good to
take antibiotics without medical supervision. The antibiotics commonly used for
treatment are effective against other illnesses also and their misuse may lead to
development of resistance and consequently they will not work against other diseases.
Prophylaxis for asymptomatic patients with suspected exposure to anthrax spores can be

achieved with a 6-week course of doxycycline or ciprofloxacin.

How is it diagnosed?
The diagnosis can be made at most microbiology laboratories by smear examination and
isolating the bacteria from the blood, skin lesions, or respiratory secretions by culture.
Bacillus anthracis is an organism which is very easy to culture and identify.
The anthraxin skin test, consisting of subdermal injection of a commercially produced
chemical extract of an attenuated strain of B. anthracis, is available for the diagnosis of
acute and previous cases of anthrax. It can also be diagnosed by looking for specific
antibodies in the blood or by molecular biology techniques like PCR.
How is it treated?
Antibiotics like Penicillin, Ciprofloxacin or Doxycycline are used for treatment and are
effective in most cases if treatment is started in the early stages. These broad-spectrum
antibiotics are used for other illnesses too. Cutaneous anthrax lesions should be covered
with sterile dressings that should be changed regularly. Soiled dressings should be
autoclaved and properly disposed of.
Can anthrax spores be used as a biological weapon?
Anthrax spores have several characteristics suitable for a biological weapon such as low
visibility, high potency, accessibility, and relatively easy delivery, and could be used not
only in war but also during terrorist activities. A millionth of a gram of anthrax spores
constitutes a lethal inhalation dose; a kilogram, depending on meteorologic conditions
and means of delivery, has the potential to kill hundreds of thousands of people in a
metropolitan area. Vaccine may not protect against some rare B. anthracis strains. It is
possible to produce B. anthracis that are resistant to antibiotics.

8
What is asthma?
Asthma is a lung condition that causes wheezing, coughing, and shortness of breath. It is triggered by irritants or
some allergen, like - cold air, viruses, tobacco smoke, dust, pollen, moulds, and animal dander. Some people
have coughing or wheezing only during exercise (called exercise-induced asthma).
An asthma attack may last a few minutes or for days. Attacks can happen anywhere and at any time. It is very
important to get treatment for asthma to live a healthy, active life.
How does it occur?
In asthma, the lining of the airways in the lungs is swollen, even when there are no symptoms. When exposed to
irritants or allergens, the airways become more swollen and begin to make excess mucus. The tiny muscles in
the walls of the airways begin to contract. These reactions decrease the airway openings, making it harder for air
to move in and out. The whistling sound of air moving through the narrowed air passages is called wheezing.
The extra mucus in the airways causes coughing.
What are the symptoms?
The patient has difficulty in breathing, wheezing, coughing, shortness of breath and tightness in the chest.

what the types of asthma?

Exercise-induced asthma (EIA) Individuals who suffer from exercise-induced

asthma experience symptoms during or after periods of exercise or exertion. EIA is
triggered when strain is placed on the lungs during exercise.

Allergic (extrinsic) asthma The most common type of asthma, allergic asthma, is
triggered by reactions to specific environmental allergens. Typical triggers include
pollen, ragweed, pet dander and cigarette smoke.

Nocturnal asthma Nocturnal asthma affects patients between the hours of 10 p.m.
and 2 a.m. Symptoms typically prevent sleep and are the result of a hormone dip,
which interrupts the bodys natural sleep rhythm.

Cough variant asthma Cough variant asthma exhibits a unique set of symptoms
from other types of asthma. Instead of wheezing or tightness in the chest, patients tend
to experience a dry or nonproductive cough. Cough variant asthma can be exercise
related or caused by a virus.

Occupation asthma Occupation asthma refers to asthma symptoms that

are a
direct result of exposure to triggers in the workplace. Typically, animal breeders,
hairdressers, nurses and other professionals experience this type of asthma. Symptoms
flare up while sufferers are at work and lessen when they go home

How is it treated?
The aim of treatment is for asthmatics to have a normal, active life. The treatment will include medicines and
the removal of any allergy-causing substances or irritants from the environment. Two types of medications are
used to control asthma fast acting medicines called bronchodilators and preventive medicines.
Bronchodilators relax the muscles in the airways. When the muscles are relaxed, the airways become larger and
allow more space for air to move in and out. This medicine is taken by inhaling it - breathing it into the lungs
while spraying it into the mouth. People prone to asthma, should always have a bronchodilator with them.
Taking the inhaler before exercise can prevent exercise-induced asthma. Salbutamol is the generic name of the
most widely used fast-acting bronchodilator delivered by an inhaler or a nebulizer.
The preventive medicines are now considered the best and safest way to control asthma. These medicines
prevent asthma attacks and chronic asthma symptoms, such as shortness of breath, allowing people with asthma
to live active lives, including participation in sports. The common preventive medicines are a long-acting
bronchodilator called salmeterol and inhaled steroids, such as betamethasone.
Additional types of preventive medicines include theophylline, a pill often taken at bedtime to prevent wheezing
at night and chromoglycate which is inhaled three to four times a day. In addition to using a quick-acting
bronchodilator during an asthma attack, different types of preventive medicines may be combined for the best
control of wheezing.
For the right treatment, the asthmatics need to work closely with their doctor. The inhaler should be used
correctly by reading the directions that come with it. Most inhalers work best when held 1 to 2 inches in front of
the mouth during use. If the mouth is closed around the inhaler, less amount of the medicine will reach the
lungs. A spacer tube or spacehaler can be used for better delivery of the medicine to the lungs. One end of the
spacer is attached to the inhaler and the other end is put in the mouth. This allows the asthmatic to breathe in
slowly and fully and to inhale more of the asthma medicine. This is especially useful in asthmatic children who
can have a problem in coordinating the inhaler with their breathing.

What care should be taken at home?

These guidelines may help to keep asthma under control:
* Avoid smoke, especially cigarette smoke, vapours and chemical fumes.
* Stay indoors during the humid season or the change of seasons especially when the pollen count is high.
* Do not use fans in closed and dusty places.
* Cover mattresses and pillows with plastic covers. Wash the bedding in hot water every week.
* Do not use a vaporizer or humidifier unless it is thoroughly cleaned.
* Do not have close contact with pets. Pet owners should bathe their pet weekly.
* The cleaning of the house or the surroundings should be done by wet mopping rather than sweeping, wherever
possible. This avoids the generation of allergen aerosols which could act as a triggering factor.
* The doctor should be contacted in case the medicines are not effective in keeping the breathing comfortable.
How long will the effects of asthma last?
Asthma is a chronic condition, even though there might not be any symptoms for decades. Asthma is more
common in children than in adults. People who had asthma as children often have no symptoms once they
become adults, but the symptoms may come back later in life. Asthma that develops for the first time in mid or
late life usually continues to be a problem later on in life. But, with proper treatment, the affected person can
lead a healthy and active life.

Atherosclerosis is a disease of arterial blood vessels. Venous vessels are not involved
unless surgically moved to function as an artery. Atherosclerosis is commonly referred to
as a "hardening of blood vessels", but this is an over-simplification. Vascular lesions
known as atheromatous plaques or atheromata (singular: atheroma) are formed in the
vessel wall, and in late stages may reduce or restrict blood flow in the lumen. When the
inner covering of an unstable atheroma breaks, compromising the structural integrity of
the internal artery wall, the break may allow hemorrhage into the plaque, generate
stenosis, embolism, (very rarely even hemorrhage beyond the artery wall), sometimes
leading to severe morbidity and even death.
The resident cells within the artery wall seem to signal an intrusion, "call for help", an
inflammation response. Monocytes, one of the 5 main types of white blood cells
circulating in the blood, enter the artery wall. Within tissues, monocytes change
characteristics and are called macrophages. The macrophages ingest oxidized
cholesterol, slowly turning into large "foam cells" so described because of the
appearance numerous vesicles take on to accommodate their high lipid content. The
early stages are called fatty streaks. Foam cells eventually die, and further propagate the
inflammatory process.
Intracellular micro calcification deposits form within vascular smooth muscle cells of the
surrounding muscular layer, specifically in the muscle cells adjacent to the atheromas. In
time, as cells die, this leads to extracellular calcium deposits between the muscular wall
and outer portion of the atheromatous plaques.
Cholesterol is delivered into the wall by LDL particles ( low density lipoprotein), especially
by the smaller LDL particles, if they are plentiful, because they can pass through the
intracellular gaps between the intima lining cells more easily. To attract and stimulate
macrophages, the cholesterol must be released from the LDL particles and oxidized, a

key step in the ongoing inflammatory process. Additionally, the macrophages must be
unable to remove excess cholesterol fast enough, into functioning HDL particles ( high
density lipoprotein) to avoid becoming foam cells and dying. To date, the only known
mechanism by which macrophages can export excess lipid is into HDL particles.
A protective fibrous cap normally forms between the fatty deposits and the artery lining
(the intima). These capped fatty deposits (called atheromas) produce enzymes which
cause the artery to enlarge over time. As long as the artery enlarges sufficiently to
compensate for the extra thickness of the atheroma, then no narrowing, stenosis, of the
opening, lumen, occurs. The artery becomes expanded and egg shaped, still with a
circular opening. If the enlargement is beyond proportion to the atheroma thickness, then
an aneurysm is created.
This process of atheroma formation and progressive artery enlargement, or remodeling,
usually starts in childhood and continues for many decades, thereby masking either
symptoms or any evidence of the disease by any detection methods, such as
angiography, which only evaluate the artery lumen.
In effect, small aneurysms of the muscular portion of the artery wall form aneurysms just
large enough to hold the atheroma which are present. The muscular portion of artery
walls usually remain strong, even after they have remodeled to compensate for the
atheromatous plaques.
However, atheromas within the vessel wall are soft and fragile with little elasticity.
Arteries constantly expand and contract with each heartbeat, i.e. the pulse. In addition,
the calcification deposits between the outer portion of the atheroma and the muscular
wall, as they progress, lead to a loss of elasticity, stiffening, of the artery as a whole.
The calcification deposits, after they have become sufficiently advanced, are partially
visible by some high resolution X-Ray imaging systems as rings of increased radiographic
density forming halos around the outer edges of the atheromatous plaques, within the
artery wall. On CT, >130 units on the Hounsfield scale {some argue for 90 units) has
been the radiographic density usually accepted as clearly representing tissue
calcification within arteries. These deposits demonstrate unequivocal evidence of the
disease, relatively advanced, even though the lumen of the artery is often still normal by
angiographic or IVUS imaging.
Although the disease process tends to be slowly progressive over decades, in later
stages, it also becomes unstable with repetitive sudden problems, most without obvious
symptoms at the time of occurrence but some producing sudden major debility or death.
These problems result from instability of the newer, soft atheromas.
If the fibrous cap separating a soft atheroma from the bloodstream within the artery
ruptures, atheroma tissue fragments are exposed and released. Atheroma tissue
fragments are very clot promoting; they attract blood platelet accumulation and activate
the blood clotting system proteins. This leads to a temporary patch covering and
narrowing ( stenosis) within the artery lumen. Though this is often a repetitive and
progressive process over time, it is typically without symptoms until a severe enough
event, in a critical enough area occurs.
Fibrous cap ruptures usually result in only a partial narrowing, stenosis, of the artery
lumen, a narrowing which usually partially re-opens with healing and regrowth of the

intimal lining. However, sometimes the combination of atheroma material release,

bleeding into the atheroma bed, platelet accumulation and accumulation of blood
clotting proteins suddenly builds to the point of creating a complete, or near complete
obstruction. The obstruction, either at the site of rupture, or as a result of debris sent
downstream, prevents adequate blood flow to cells downstream. Cells starved for
adequate blood supply are injured and may die.
Areas of severe narrowing, stenosis, detectable by angiography, and to a lesser extent "
stress testing" have long been the focus of human diagnostic techniques for heart
disease and cardiovascular disease in general. However, these methods focus only on
detecting severe narrowing, not the underlying atherosclerosis disease. As demonstrated
by human clinical studies, most severe events occur in locations with heavy plaque yet
little or no lumen narrowing present before debilitating events suddenly occur. Plaque
rupture can lead to artery lumen occlusion within seconds to minutes, and potential
permanent debility and sometimes sudden death.
75% lumen stenosis used to be considered by cardiologists as the hallmark of clinically
significant disease because it is only at this severity of narrowing of the larger heart
arteries that recurring episodes of angina and detectable abnormalities by stress testing
methods are seen. However, clinical trials have shown that only about 14% of clinically
debilitating events occur at locations with this, or greater severity of narrowing. The
majority of events occur due to atheroma plaque rupture at areas without narrowing
sufficient enough to produce any angina or stress test abnormalities. Thus, as of the later
1990s, greater attention has been focused on the vulnerable plaque.
Though any artery in the body can be involved, usually only severe narrowing or
obstruction of some arteries, those which supply more critically important organs, are
recognized. Obstruction of arteries supplying the heart muscle result in a heart attack.
Obstruction of arteries supplying the brain result in a stroke. These events are life
changing, and often result in irreversible loss of function because lost heart muscle and
brain cells do not grow back to any significant extent.

9
What is autism?
Autism is a spectrum disorder. Also known as ASD, autism is a developmental and bioneurological disorder.
A child with autism has difficulties primarily with social interaction and spoken
communication. No two children with autism are alike. The signs and characteristics
present themselves in varying permutations and combinations and can range from mild
to severe.
The disorder is evident usually before the child is 30 months old, when age - appropriate
social and communication skills, like making and sustaining eye contact, smiling in
response to another person or responding when spoken to do not appear in time, or
when the child has difficulties in relating to people, plays differently, or displays unusual
responses to the environment.
There may be hypersensitivity or hyposensitivity to any one or more of the following:

light, sound, smell, taste, pressure, pain, temperature, light touch, vestibular (sense of
balance) or proprioceptive sensations (subconscious awareness of body position). In
other words the child would be under-reactive or over- reactive to stimulation in these
areas.
Few Examples:
* Suddenly closing eyes to light, which could be due to hyper-sensitivity to a particular
light.
* Shutting ears to specific sounds or screaming. Hypersensitivity to the particular sound,
which could be hurting to the ears.
* Smelling or tasting things that are inappropriate. The child could be hyposensitive to
smell or taste.
* Recoiling from touch, screaming when hair or nails are cut.
* Hypersensitive to touch, feeling pain on the slightest touch.
Other signs include craving for or recoiling from movement, flapping hands, spinning
around, uneven gross and fine motor skills, spinning objects, unusual attachment to
certain objects.
Children with autism play differently. Their play is more stereotypic in nature (like
arranging cars in a line). A marked feature of autism is the lack of pretend play.
Children with autism may prefer to be alone rather than in a group, withdraw from social
contact, and appear to be living in a world of their own. They may smile or cry for no
apparent reason. An inability to relate to other people and to respond appropriately to
stimuli in the environment can also be observed. They may insist on sameness and
routines, which seem to give comfort.
Behaviours like aggression, frustration, or withdrawal, which seem inappropriate, are
often due to the childrens sensory integrative dysfunction, which they are unable to
articulate and express through spoken communication. Sensory input is not integrated or
organised appropriately in the brain. This produces varying degrees of problems in
development, information - processing and behaviour.
Persons with autism have differing intellectual abilities. These abilities lie masked under a
more obvious social communication disorder. When viewed through the lens of Multiple
Intelligences the potential shows up. There may be evidence of musical, bodilykinesthetic, visualspatial, logical- mathematical or intra-personal intelligence.
Some children with autism may have mental retardation or learning disabilities.
Good observation and assessment results in charting the individual profile, which enables
attention to be focused on both abilities and special needs, so that the child is enabled to
function optimally.
Aspergers syndrome (at the high end of the ASD) can be identified when the child is
intelligent, verbal but with marked difficulties in social communication, has a
preoccupation with a particular area of interest, shows insistence on routines and has
certain compulsive behaviors.
How is autism caused?

Autism is not a mental illness, as it was previously believed to be. It is also not a result of
bad parenting. However, the exact cause of the disorder is not known.
In autism, as in all developmental disorders, there appears to be damage to the
developing brain, affecting both structure and function.
Possible causes cited range from genetic factors, maternal health, physical or emotional
factors during pregnancy, complications during pregnancy, difficulties during birth and
infections in the early developmental period, including the highly-debated adverse
affects of vaccines in creating metal toxicity in the brain.
What is of great concern is the recent increase in numbers of children with autism.
The disorder results in sensory integrative dysfunction. The dysfunction affects
information- processing and behavior adversely, which in turn, permeates different areas
of development.
What are the signs and symptoms?
The characteristics of autism are also the symptoms of autism. The most commonly seen
symptoms in an autistic child are:
* Avoidance of eye contact: for example, sometimes the child may give the feeling of
"looking through you".
* Withdrawal from people, by turning away face or body.
* Hypersensitivity to sounds - the child may cover his ears or try and burrow under
pillows to block out sounds. The child may show extreme reactions to sounds like the
whirring of a car engine in the distance or the ringing of the telephone. (Similarly with
other senses)
* Difficulties with speech - Some children with autism are verbal others are not. Even
those who are verbal use speech functionally. In some cases a child may begin to speak
at the appropriate age, but regress around 16 to 18 months and stop speaking
altogether. There may be reversal of pronouns (substitution of "you" for "I"), continuous
repetition of previously heard words (echolalia) and a flat tone of voice.
* The child may also show stereotypic or repeated actions. The child may spin or twirl
objects with intense concentration, and any attempt to disengage him from it may lead
to a tantrum.
* There is a marked absence of pointing to objects in young children with autism. If a
child wants to reach out for an object, he may grab an adult's hand near him and then try
and pick the object.
* A child with autism typically does not show emotions or reactions to situations
outwardly.
* He may not cry when hurt and may not show sadness when his parents are not near
him. (This does not mean the child does not experience emotions).
* The child may not like to be picked up and may stiffen whenever there is an attempt to
cuddle him.
* Generally, he does not play with other children and does not desire company.
How is it diagnosed?
There are no blood tests or X-rays to detect autism. It is usually the parents who are able
to detect the first signs of their child being different. A psychiatrist or child psychologist

diagnoses it after a series of tests and observations in different environments to evaluate

the child's social behavior and language skills. If possible, expert opinion should be
sought.
More than formal testing, in which a child with autism would not function optimally,
observations, play-based assessments and interviewing the parents will help the
specialist assess the child.
How is it treated?
There is no medical cure for autism. The aim of treatment is to enable the childs
potential to develop, minimize disruptive behaviors (by attending to the underlying
causes for the behavior) and to include the child effectively in mainstream society. In
order to achieve this, the treatment approach is multi-faceted. The earlier the treatment
starts, the greater the chances of the child being effectively adjusted into society. Early
intervention programs that focus on possible diet allergies, sensory integration therapy,
communication and holistic development are vital. The early years constitute a critical
developmental period and the childs experiences at this stage have a lasting impact on
future development.
Children with autism process information differently. They are often visual learners and
need alternate teaching strategies. They benefit from a clear structure and regular
routines.
Treatment modalities suggested are:
* ABA (Applied Behavior Analysis)
* The TEACH method (Treatment and Education of Autistic and Related Communication
Handicapped Children)
* The CFGF diet (Casein- Free, Gluten- Free diet)
* Vitamin /Mineral therapy
* The LOVAAS method
* THE DELACATO method
* Sensory Integration Therapy
* PECS (picture exchange communication system)
* Use of social stories
* Use of facilitated communication
Each method has something to offer. However the condition calls for an eclectic approach
to treatment that combines biomedical, sensory integration therapies and learning paced
at the childs level. The childs needs and abilities must outweigh the selection of any one
specific methodology.
Early intervention with parents, understanding and empathizing with their childs
condition, and helping him through his sensory difficulties are vital.
Caregivers may focus on changing the outward behaviours, which are socially
inappropriate. They need information which enables them to understand the underlying
deep sensory need that finds expression only through these behaviours.

10
What is backache?
Backache is a pain in the back caused by degenerative changes, injury, swelling or rarely, cancer. Usually the
lower part of the back is involved and the pain worsens when a person bends forward. The muscles of the back
may become weak and tender. Backache because of age-related changes may radiate to the legs due to pressure
on the spinal nerves.
How is it caused?
Backaches usually indicate a strain of the back muscles. There are nearly 200 muscles in the back that maintain
the upright posture. The triggering event could be the carrying of a heavy weight, lifting from an awkward
position, or overexertion of the back muscles. A direct injury to the back or degenerative changes in the bones of
the spinal cord, due to age, could also cause backache.
Backache Causes:
1)Acute Backache;
-> Back strain due to lifting of a heavy object, a fall, a violent jerk (as in case of a sudden car brake).
->Injury, road accident, fall of a heavy object, fracture of the spine, dislocation of a vertebral disk.
2)Chronic Backache;
Spondylosis: A vertebra slips forward on the lower one, usually just above the hip bone.
Slipped Disk: These disks act as cushions between two vertebral bones, the reason may be an injury to the spine
which is forgotten, degeneration of the disk due to old age or other reasons.
Posture: Wrong Posture is the front runner as a cause of chronic back pain. (long hours sitting on chairs in the
wrong posture, for example- as you may be sitting watching this screen, watching TV slumped in the couch).
Undetermined Cause: A whole variety of conditions called as lumbago, in which sprains in the muscles of the
back is held to responsible.
Gynecological problem : Chronic Infection, Pregnancy.

How long does the pain last?

The pain and discomfort usually take a couple of weeks to disappear. Recurrences are common and require a
combination of rest, medicines and physiotherapy.
What is the treatment?
Pain relief medicines like ibuprofen or paracetamol, reduce the swelling and are usually given three to four
times a day. Local application of heat by a hot water bottle or heating pad helps to relieve pain. Physiotherapy in
the form of diathermy or ultrasound may help in pain relief.
Complete bed rest is not required but exercise and exertion must be avoided until completely well. The sleeping
position that is most comfortable is usually on the side. The mattress or bedding should provide a firm support
or should be reinforced with a board.
How can backaches be prevented?

The best way to prevent backaches is to care for the back by keeping the back muscles in excellent physical
condition. This requires back and abdominal exercises as a daily regiment. Sit-ups, leg raises, flattening the back
and tucking the legs to the chest strengthen the muscles. These exercises should be avoided during active back
pain, but the stretching exercises can be continued.
How should things be lifted?
Dos:
* Heavy objects must be held close to the body rather than away from it.
* The feet must be about shoulder-width apart. A wide, solid base of support is important. Holding the feet too
close together will be unstable; too far apart will make movement difficult.
* Legs must be bent at the knees while lifting weights from floor level and the back must be kept straight. The
stomach muscles must be pulled in. This will support the back in a good lifting position and will help prevent
excessive force on the spine.
* Push up with the legs. The legs are much stronger than the back muscles.
* If an object is too heavy, or awkward in shape get someone to help you lift.
Don'ts:
* Sudden and awkward movements while holding something heavy must be avoided.
* The back should never be bent to pick something up.
* Don't twist or bend. A person should face in the direction he or she is walking.

11
Lungs are the respiratory organs of the human body which help a person in breathing, by
taking in oxygen and giving out carbon dioxide . Lungs contain tube like structures called
the bronchial tubes or airways through which the air passes. When the airways are
exposed to tobacco, dust or other chemical substances for a long period of time, it is
likely that a person may develop bronchitis.
There are two types of bronchitis, namely acute bronchitis and chronic bronchitis. Acute
bronchitis is a milder form of bronchitis, mostly caused by virus or bacteria and goes
away with or without minimal treatment. However, chronic bronchitis is a more severe
disease which stays with a person for a long time. The most common cause of chronic
bronchitis is cigarette smoking. It is also found in people who work in places where they
come in contact with harmful substances like dust, chemical fumes, etc. Besides this,
people who are exposed to pollution in the environment and who have weak immune
systems are also at the risk of getting affected by chronic bronchitis. As a result when
such people breathe, these dangerous substances are also taken in. When this continues
for many years, the bronchial tubes develop some kind of inflammation or irritation,
leading to the development of thick mucus inside it. When airways get filled up with
mucus, it blocks the passage of the air to the lungs, leading to chronic bronchitis. It is
also common to find chronic bronchitis with other diseases like asthma, sinus, pulmonary
emphysema, upper respiratory infections, pneumonia, pulmonary fibrosis and
tuberculosis.
Chronic bronchitis gives rise to very severe symptoms in a person who is affected by it.
Let us look at some of the them and also the treatment for chronic bronchitis.

Effects of Chronic Bronchitis

The most common effect of chronic bronchitis in individuals is excessive and continuous
coughing. The person may go into bouts of coughing for a long time and may also spit
mucus with it. Coughing found in chronic bronchitis may remain with the person for many
months or even for a year.
As chronic bronchitis is a respiratory disorder, the person affected by it has difficulty in
breathing. This especially occurs when the person does some physical exercise or
activities like climbing the stairs or even walking for a short distance. The chances of a
person with chronic bronchitis getting affected by asthma are high.
When a person has chronic bronchitis, the lungs and airways become weak and due to
this the individual becomes more susceptible to various other infections and ailments like
fever. Moreover, a person with severe chronic bronchitis can also develop pneumonia,
though this is mostly seen in old people. Individuals who continue to smoke even after
being diagnosed with chronic bronchitis, are vulnerable to developing lung cancer.
The effects of chronic bronchitis are serious but it can be cured with proper treatment.
Usually medication is given to treat a person with chronic bronchitis. One of the
medicines used for chronic bronchitis is bronchodilator, which is available in the form of
an inhaler. Physicians may also prescribe other medicines like theophylline and steroids
for this disease. However, one must remember that more than medicines, avoiding
cigarette smoking totally would help in one's quick recovery

12
Traumatic Brain Injury
Traumatic Brain Injury is also called acquired brain injury, or simply put head injury and occurs when a
sudden trauma occurs in the brain, damaging it or parts of it. Injury can result when an object suddenly pierces
through the skull and enters into the brain tissue or when the head hits an object violently.
Symptoms of TBI can vary from mild to moderate and even severe, depending on the extent of damage done to
the brain. A person suffering from milder symptoms may experience unconsciousness for a few seconds or
minutes or may remain unconscious for a period of time. Other classic symptoms of TBI include severe
headaches, lightheadedness, blurred vision, confusion, dizziness, tired eyes, bad taste in the mouth, ringing in
the ears, lethargy, fatigue, mood swings, behavioral pattern changes, change in sleeping patterns and even
trouble with concentration, memory, thinking and attention.
A person suffering from moderate to severe symptoms will show all of the above symptoms, but in addition,
will also complain of a severe headache that appears to get worse or just does not go away. Apart from this, the
other symptoms are nausea and vomiting, seizures or convulsions, inability to awaken from sleep, dilation of the
pupils, weakness, numbness in the extremities, slurred speech, increased confusion, loss of coordination,
agitation or restlessness.
What are the Treatment Options?
Anyone showing signs and symptoms of moderate to severe TBI should always receive immediate medical
attention. Since very little can be done to reverse the adverse effects of the initial brain damage that is caused by
the trauma, medical professionals generally try to stabilize the concerned individual and instead focus on
preventing any further damage or injury.
Primary concerns may include ensuring that there is proper supply of oxygen running to the brain and the rest of
the body at all times, controlling blood pressure and maintaining adequate blood flow.

There are imaging tests that help to determine the prognosis and diagnosis of the patient. Patients suffering from
mild to moderate symptoms may receive neck and skull X-rays to check for spinal instability or for any bone
fractures. For moderate to severe injuries, the imaging test held is a computed tomography (CT Scan). Patients
with such moderate or severe injures will be subjected to rehabilitation that would involve individually tailored
treatment courses and programs in areas like occupational therapy, physical therapy, speech therapy, psychology,
physiatry, and social support.
Prognosis
More than half of the patients suffering from severe TBI will need immediate surgery in order to repair or
remove the ruptured blood vessels or hematomas or the bruised brain tissues or contusions. Disabilities that
result from a Traumatic Brain Injury entirely depend on the severity of the injury, the general health of the
patient, the age of the person, and the location of the injury.
Some common disabilities are problems with sensory processing (sight, touch, smell, hearing and taste),
cognition (memory, reasoning and thinking), mental health or behavior (depression, aggression, anxiety, social
inappropriateness, and personality changes), and communication (understanding and expressing).
Some of the more serious injuries can result in unresponsive behavior, a kind of stupor although the individual
can be immediately aroused with the help of a strong stimulus like sharp pain. The patient will appear to be in a
comatose state and will appear to be completely unresponsive, unconscious, unarousable and unaware. It is a
sort of a vegetative state, in which the individual will be completely unaware and unconscious of his
surroundings, but will continue to have brief periods of awareness, a regular sleep and wake cycle and will
constantly be in a vegetative state for maybe more than a month this is known as the persistent vegetative state
(PVS).
What Research is Being Carried out?
The NINDS or the National Institute of Neurological Disorders and Stroke has been conducting experiments
and research for Traumatic Brain Injuries at its laboratories at the NIH or National Institutes of Health. It also
supports research for TBI by donating grants to other major medical institutions all over the country.
The research carried out includes studies performed in clinical settings and laboratories. Research is carried out
to better understand TBI and the underlying biological mechanisms that result from damage made to the brain.
This research allows scientists to develop new and interesting interventions and strategies to limit the primary as
well as secondary damage that may occur within a few days of the injury. It also helps to devise new therapies to
help treat head injuries and to improve long-term recovery of body functions.

13
What is bird flu?
"Bird flu", or avian influenza, is an infectious disease of animals caused by viruses that normally infect birds
and, less commonly, pigs. While all bird species are thought to be susceptible to infection, domestic poultry
flocks are especially vulnerable to infections that can rapidly reach epidemic proportions.
What are the types?
The disease in birds has two forms. The first causes mild illness, sometimes expressed only as ruffled feathers or
reduced egg production. Of greater concern is the second form, known as highly pathogenic avian influenza.
This form is highly infectious in birds and is rapidly fatal, with a mortality approaching 100%. Birds can die on
the same day that symptoms first appear.
What are the symptoms?
The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g.,
fever, cough, sore throat and muscle aches) to eye infections, pneumonia, acute respiratory distress, viral
pneumonia, and other severe and life-threatening complications.

Most influenza viruses cause no symptoms, or only mild ones in wild birds; however, the range of symptoms in
birds vary greatly depending on the strain of virus and the type of bird. Infection with certain avian influenza A
viruses (for example, some H5 and H7 strains) can cause widespread disease and death among some species of
wild and especially domesticated birds such as chickens and turkeys.
Certain water birds act as hosts of influenza viruses by carrying the virus in their intestines and shedding it.
Infected birds shed virus in saliva, nasal secretions and faeces. Avian influenza viruses spread among susceptible
birds when they have contact with contaminated nasal, respiratory and faecal material from infected birds;
however, faecal-to-oral transmission is the most common mode of spread.
What are the control measures in birds?
The most important control measures are rapid destruction (culling or stamping out) of all infected or
exposed birds, proper disposal of carcasses, and the quarantining and rigorous disinfection of farms. The virus is
killed by heat (56 degrees C for 3 hours or 60 degrees C for 30 minutes) and common disinfectants, such as
formalin and iodine compounds. The virus can survive, at cool temperatures, in contaminated manure for at least
three months. In water, the virus can survive for up to four days at 22 degrees C and more than 30 days at 0
degrees C. For the highly pathogenic form, studies have shown that a single gram of contaminated manure can
contain enough virus to infect 1 million birds. Restrictions on the movement of live poultry, both within and
between countries, is another important control measure.
How does it spread within a country?
Within a country, the disease spreads easily from farm to farm. Large amounts of virus are secreted in bird
droppings, contaminating dust and soil. Airborne virus can spread the disease from bird to bird, causing
infection when the virus is inhaled. Contaminated equipment, vehicles, feed, cages or clothing, especially shoes,
can carry the virus from farm to farm. The virus can also be carried on the feet and bodies of animals, such as
rodents, which act as mechanical vectors for spreading the disease.
Droppings from infected wild birds can introduce the virus into both commercial and backyard poultry flocks.
The risk that infection will be transmitted from wild birds to domestic poultry is greatest where domestic birds
roam freely, share a water supply with wild birds, or use a water supply that might become contaminated by
droppings from infected wild-bird carriers. Also the risk of transmission of bird flu is mainly for the animal
handlers and people in close vicinity. Eggs should not be taken in a raw form, not only for bird flu but also to
prevent salmonella infections.
How does it spread from one country to another?
The disease can spread from country to country through international trade in live poultry. Migratory birds,
including wild waterfowl, sea birds, and shore birds, can carry the virus for long distances and have, in the past,
been implicated in the international spread of highly pathogenic avian influenza. Migratory waterfowl - most
notably wild ducks are the natural reservoir of bird flu viruses, and these birds are also the most resistant to
infection. They can carry the virus over great distances, and excrete it in their droppings, yet develop only mild
and short-lived illness.
Domestic ducks, however, are susceptible to lethal infections, as are turkeys, geese, and several other species
raised on commercial or backyard farms.
What is the present situation?
Since mid-December 2003, a growing number of Asian countries have reported outbreaks of highly pathogenic
avian influenza in chickens and ducks. Infections in several species of wild birds and in pigs have also been
reported. India has not reported any case of bird flu as yet.
Particularly alarming, in terms of risks for human health, is the detection of a highly pathogenic strain, known as
H5N1, as the cause of most of these outbreaks. H5N1 has jumped the species barrier, causing severe disease

in humans, on two occasions in the recent past and is now doing so again, in gradually growing numbers, in
Vietnam and Thailand.
Is there a vaccine effective against H5N1 in humans?
There are currently no available vaccines to protect against disease caused by the H5N1 influenza virus strain in
humans. WHO is urgently working together with laboratories to develop a prototype H5N1 virus for use by
leading vaccine manufacturers.
Are there drugs available for prevention and treatment?
Two classes of drugs are available. These are the M2 inhibitors (amantadine and rimantadine) and the
neuraminidase inhibitors (oseltamivir and zanimivir). These drugs have been licensed for the prevention and
treatment of human influenza in some countries, and are thought to be effective regardless of the causative
strain.
However, initial analyses of viruses isolated from the recently fatal cases in Vietnam indicate that the viruses are
invariably resistant to the M2 inhibitors. Further testing is under way to confirm the resistance of amantadine.
Network laboratories are also conducting studies to confirm the effectiveness of neuraminidase inhibitors
against the current H5N1 strains.
Are presently available vaccines useful?
Yes, but in a precisely targeted way. Current vaccines, when administered to high-risk groups, such as poultry
cullers, protect against circulating human strains and thus reduce the risk that humans at high risk of exposure to
the bird flu virus might become infected with human and avian viruses at the same time. Such dual infections
give the avian and human viruses an opportunity to exchange genes, possibly resulting in a new influenza virus
subtype with pandemic potential.
Annual vaccines are produced for routine use in protecting humans during seasonal epidemics of influenza.
However, they offer no protection against infection with the H5N1 avian virus. WHO has issued guidelines for
the vaccination of groups considered at high risk of exposure, using the current trivalent influenza vaccine, in
countries experiencing outbreaks of highly pathogenic H5N1 avian influenza in poultry.

14
What is cancer?
Cancer is the generic term used to describe a group of disorders caused by an uncontrolled multiplication of
cells, which usually resulting in the destruction of neighbouring tissues. Gradually, these tissues and organs stop
functioning and death may occur.
The reasons for cells to start multiplying is unknown in most cases. They may have some inbuilt abnormality or
may be affected by external influences.
What are the common terms associated with cancer?
Since cancer is a group of disorders, there are some terms commonly used in the description of the disease.
1. Oncology onco meaning cancer, oncology is the study of various types of cancers.
2. Tumour a lump resulting from an uncontrolled growth of cells which may be malignant or benign.
3. Malignant a growth of cells that destroys the surrounding tissue and spreads to other parts of the body.
4. Benign a growth of cells that is not cancerous.
Both benign and malignant growths are unwanted multiplications of cells, but whereas a benign growth does not
generally leave the place of its origin, a malignant growth usually destroys not only the tissue of its origin but

also the surrounding ones. This is why cancers are caused due to malignant growths, which spread to all areas of
the body.
5. Carcinoma a term synonymously used with cancer. But carcinomas are specifically malignant tumours
mostly forming on the outlines (epithelium) of the affected organ. It is the most frequently occurring form of
cancer.
6. Sarcoma another form of cancer where specifically the connective tissue (that which supports the various
parts of the body), is affected. It is a malignant form and cancers of the blood, lymphatic system, bone and the
like, fall under this category.
What are the symptoms?
Cancers appear in many different ways. Most often they are noticed as a lump or growth in some part of the
body. This is the case with tumours that form on the outlines of organs. When the cancerous growth is not
physically identifiable, there may be other revealing symptoms depending on the form of cancer and the affected
organ.
Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and memory
problems. Tumours of the intestine can present problems in bowel movements and pain in the stomach. Lung
cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are detected as a painless
lump. There may also be some deformity of one or both breasts in some cases.
Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example, cancer of
the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when the patient passes
blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer. It only occurs in some
cases where a nerve is pressed due to rapid enlargement of a tumour.
Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of weight,
general feeling of weakness and fatigue and increased proneness to infections.
How is it diagnosed?
In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a biopsy of the
affected organ is done. In this procedure, a small part of the tissue is taken for laboratory testing to detect the
presence of cancerous cells.
In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken. CT
scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind the patients
previous medical history.
What is the treatment?
Treatment is most effective if the cancer is detected early. Chemotherapy is the most common method of
treatment for cancer that has spread to other parts of the body. In this procedure, the malignant cells are
destroyed with the help of powerful chemicals like methotrexate and vincristine which are given intra-venously
i.e. directly injected into the veins. This procedure requires a hospital stay for the duration of therapy. It is also
associated with various side effects like loss of hair, nausea, vomiting, loss of appetite and weakness for some
days.
For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the cells are
destroyed with the help of strong radioactive waves. The exact position of the tumour is marked and the area is
exposed to radiation under strictly controlled conditions. This treatment is given in breaks and in pre-determined
doses.
Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be treated
with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-hormone drugs are

given. This treatment scores over chemotherapy because it usually has less severe side effects. But the doctor
decides the best course of treatment depending on the diagnosis of the form of cancer.

15
What is cholesterol?
Cholesterol is a waxy substance, present in many body tissues. It is an essential nutrient necessary for healthy
cell membranes, as well as synthesis of vitamin D and some hormones. It is made in the liver from digested fats
and is carried in the blood. Cholesterol is also present in certain foods, such as egg yolk and liver.
Blood cholesterol level is affected by the diet, since cholesterol is present in certain foods and is manufactured
in the body from digested fats. High levels of cholesterol in the blood are associated with hardened arteries
(known as atherosclerosis), coronary artery disease (heart attack) (heart attack), and stroke.
What is "bad" and "good" cholesterol?
There are many types of cholesterol. LDL or Low-density lipoprotein is the "bad" cholesterol, as it blocks the
arteries. HDL or High-density lipoprotein is the "good" cholesterol, as it protects the arteries from clogging.
What are normal cholesterol levels?
Blood can be tested for the cholesterol level. The total cholesterol in the blood includes both HDL and LDL
cholesterol. A total cholesterol level of less than 250 mg% is considered normal. High HDL levels (more than 60
mg%) reduce the risk for heart disease and low levels (less than 35 mg%) increase the risk.
How to control cholesterol?
Cholesterol levels can be kept in the normal range by eating a balanced diet and exercising regularly. It is
important to eat the right foods (low cholesterol) to keep a healthy weight.
Avoid foods that contain a lot of cholesterol like meats and egg yellow. Eat less fat especially saturated fats,
generally obtained from animal sources. Avoid fried foodstuff especially snacks and fast foods.
Eat more of fresh fruits, grains, vegetables and salads avoiding oil-based dressings, which can be substituted
with vinegar or lemon-based dressings. Cook vegetables with herbs or spices instead of cooking oil or ghee. Use
oils like sunflower, safflower, olive or corn oil. Avoid palm or coconut oil. Eat egg whites instead of whole eggs.
Use low-fat dairy products like skimmed milk, low-fat yogurt or cottage cheese instead of cream or processed
cheese.
What is the treatment for high cholesterol levels?
There are drugs known as statins that inhibit the liver enzyme used in the manufacture of cholesterol. They are
the most effective drugs for the treatment of high cholesterol. They are recommended for most patients with
high cholesterol levels, particularly those with diabetes, existing heart disease, or both.

16
What is depression?
Clinical depression is a medical condition where a person feels very low or sad over a
long period of time. It is more severe than the general feeling of hopelessness that a
person may feel after a particularly stressful event in her life and often results in a
change in the person's functioning. During bouts of depression, a person feels extremely

dejected and has feelings of inadequacy or low self esteem. They take a gloomy outlook
upon life.
How is it caused?
It is now believed that depression is caused by a combination of genetic factors and
exposure to a stressful life event. In other words, the chance of a person having the
condition increases considerably if one or more family members has it. It is also fairly
well established that a change in the activity of certain chemicals in the brain is
associated with depression. Clinical depression is seen more in women than in men.
Women in their child bearing years are more vulnerable to it.
There are many causes for clinical depression:
* It can be inherited i.e., the chance of a person having the condition increases
considerably if one or more family members have it.

* Environmental factors like the death of a parent can cause a depressive episode.

* Physical illnesses like cancer and heart disease may be followed by depression. There
may also be conditions like Parkinsons disease, whose symptoms include depression.

* Depression can also be a side effect of certain drugs used to treat hypertension.

* Some people have personality traits that make them more susceptible to depression.
These people view themselves as losers and have a negative attitude towards
themselves.
What are the symptoms?
A patient with depression may have physical symptoms in addition to psychological ones.
The most commonly seen symptoms are:

*
*
*
*
*
*
*
*
*
*
*
*
*
*

Sleep disturbance, either excessive sleep or insomnia (lack of sleep)

Continuous fatigue and tiredness
Headache
Feeling of irritability and excessive crying
Loss of appetite
Loss of interest in any activity
Vague pains in the body
Fluctuation in weight
Constipation
Decrease in sexual urge
Poor concentration
Poor co-ordination of limbs
Feelings of worthlessness, helplessness and guilt
Suicidal thoughts sometimes culminating in suicide attempts.

How is it diagnosed?

The first thing that any doctor will do is take a detailed and thorough history and rule out
the possibility of a physical illness giving rise to these complaints. This may include blood
tests to detect anaemia or thyroid problems. Once physical illness is ruled out a
psychiatrist can make the diagnosis based on the cluster of symptoms commonly
associated with the depressive condition. The doctor confirms over a two week period
that the episode is not due to a temporary stressful event. Once all other causes are
eliminated, the diagnosis is confirmed.
Initially a person seeks medical help when she is depressed for most of the time during
the day. The psychiatrist then diagnoses the condition based on the symptoms
associated with the depressive condition. In case the doctor sees the main symptoms of
the condition like sleeplessness, apathy, lack of interest and loss of appetite and a
constant feeling of fatigue, depression is short listed as a possible cause.
What is the treatment?
Drug treatment is the most common method of treatment. Antidepressants are
prescribed in adequate doses. These generally include oral medication from a group of
drugs known as tricyclic antidepressants. These have a calming effect on the patient and
also help in reducing sleep problems.
Therapy to improve the patients outlook towards events is begun in conjunction with the
drug treatment. The person is encouraged to think positively and to shun thoughts of
worthlessness, guilt and suicide.
In severe cases, shock treatment (Electro Convulsive therapy) is given. It is mostly
resorted to when the patient cannot wait for the drugs to become effective or when she
goes into deeper depression and stops reacting completely to situations, a condition
known as depressive stupor. A combination of treatment measures is usually helpful in
bringing depressive episodes under control.

17
What is dehydration?
The human body needs water to maintain enough blood and other fluids to function properly. If the body loses
much
more
fluid
than
what
is
consumed,
dehydration
occurs.
Fluids are lost from the body during the following:

urination

vomit

sweat

breathing,

overexertion

or

lose

especially

in

during

hot

stools

rapid

or

humid

breathing

weather

fever

Along with the fluids, the body also loses electrolytes (mineral salts).

What is the cause?

The usual causes of dehydration are diarrhoea and vomiting. Dehydration can also occur if one does not eat or
drink much during an illness or if one does not drink enough during or after strenuous exercise. Medications
that control excess body fluid (diuretics) by causing fluid loss are a common long-term cause. Although
anyone can become dehydrated, those who become dehydrated the most easily are:

babies

the

anyone

people in hot weather

less

than

year

old

elderly

who

has

fever

What are the symptoms?

Symptoms of early or mild dehydration include:

flushed

face

extreme

thirst

dry,

small

dizziness

weakness

cramping

warm

amounts

made

in

of

worse

the

skin

dark,

when

arms

yellow

urine

one

stands

and

legs

crying

headache

dry mouth with thick saliva

with

few

or

no

tears

Symptoms of moderate to severe dehydration include:

low

fainting

severe

convulsions

sunken

lack of skin elasticity (a bit of skin lifted up takes a long time to go back to its normal position)

rapid and deep breathing

blood

muscle

contractions

pressure

in

the

arms,

legs,

bloated

eyes

with

stomach,

and

back

stomach

few

or

no

tears

What is the treatment?

If there is mild dehydration, one needs to drink enough liquid to replace the fluids lost. Also, the electrolytes
need to be replaced. Drinking sips of water slowly, along with eating a balanced diet, high in salt, will replace
fluids and salts lost. Nonprescription medicines are available that help replenish fluids and electrolytes. Fluids
and electrolytes can be replaced by drinking oral rehydration solutions (ORS). Packets of oral rehydration
salts are widely available. One needs to just mix the contents of a packet with 1 litre of drinking water.
An oral rehydration solution can be made at home using the following recipe: To 1 litre of drinking water or
boiled water, add the following:

1/4

tablespoons

teaspoon

sugar

salt

1/4 teaspoon baking soda (bicarbonate of soda)

If baking soda is not available, add another 1/4 teaspoon of salt. If possible, add 1/2 cup orange juice or some
mashed banana to improve the taste and provide some potassium. Drink sips of the ORS every 5 minutes until
urination becomes normal. Adults and older children should drink at least 3 litres of ORS a day until they are
well.
If
there
is
vomiting,
keep
trying
to
drink
the
ORS.
In case of severe dehydration, one needs to go to an emergency room or other health care facility to get
intravenous
(IV)
fluids.
If
possible
,
continue
drinking
the
ORS
too.

How long will the effects last?

If dehydration is not treated, it can cause death. If it is treated in time, recovery is usually complete.
How to prevent dehydration?
If a person has diarrhoea or vomiting or is not drinking enough fluids, then he must be forced to drink more
liquids before he becomes dehydrated. If someone is becoming dehydrated, follow these guidelines:

Give

Remember that a dehydrated person will have less appetite. Encourage him to eat and drink small
amounts
of
food
and
liquids
5
to
7
times
a
day.

Watch for signs of severe dehydration and get medical help as soon as possible.

more

liquids

than

usual.

18
What is diabetes mellitus?
Diabetes mellitus (DM) is a condition in which he the most widely recognised problem is the body's inability to
regulate the level of glucose in the blood. Glucose is the main form of sugar in the body. The body breaks down
food into glucose and uses it as a source of energy. In healthy people insulin helps to regulate the glucose
(sugar) levels. Insulin is a hormone produced by the pancreas (a long, thin organ located behind the stomach
against the back).
In diabetics, the body does not produce enough insulin or does not use the produced insulin effectively. This
results in a high level of glucose in the blood ("hyperglycaemia").
There are four main types of diabetes mellitus:
a) Type 1, earlier known as insulin dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus.
People with this type of diabetes make little or no insulin in their body, and need regular insulin injections for
survival and management of diabetes. It usually starts in childhood, but can occur at any age.

b) Type 2 (DM2), earlier known as non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes.
This is the most common form of diabetes, and is strongly associated with genetic tendency and obesity. The
body produces normal or even high levels of insulin, but certain factors make its utilization ineffective ("insulin
resistance"). Sedentary lifestyle, unhealthy dietary patterns, and the consequent obesity are common causes. It
usually starts in adulthood, but is beginning to be seen in obese adolescents also.
c) Gestational diabetes mellitus, or pregnancy-induced diabetes.
d) Secondary diabetes mellitus, caused by genetic conditions, pancreatic diseases (e.g. inflammation, surgery or
malignancy of the pancreas, etc.), drugs (e.g. steroids like prednisolone, pentamidine, excess thyroid hormone,
etc.) or other medical conditions (acromegaly, Cushing syndrome, pheochromocytoma, hyperthyroidism,
congenital rubella, etc). Medications such as thiazide diuretics or oral contraceptives can precipitate diabetes in
a person predisposed to get it later.
What are the symptoms?
Symptoms depend on the type and duration of diabetes. Some of the signs and symptoms are related to the high
blood sugar levels. These include:
* Increased urination
* Increased thirst
* Hunger
Other common symptoms:
* Fatigue
* Blurred vision
* Urinary and vaginal infections
* Skin infections, especially fungal or more serious bacterial infections
* Frequently upset stomach, stomach pains, nausea and vomiting
There may be weight loss, especially if the amount of insulin made by the body is decreasing. If insulin
deficiency is marked, the person can become drowsy and then go into coma. This is called Ketoacidosis, and
usually occurs in DM1. Rarely, if the diabetes is completely out of control, it can also occur in DM2. Other
symptoms of ketoacidosis include:
* Deep rapid breathing, sometimes with a fruity odour to the breath
* Pain in the stomach, with nausea and vomiting
What is the diagnosis?
Diabetes mellitus is diagnosed based on a high level of glucose or sugar in the blood. The doctor may suspect
diabetes mellitus after taking the medical history and doing a physical examination. There are several blood
sugar tests used for diagnosis:

1. Fasting plasma glucose test: In this test, a person is asked to fast overnight, at least 8 hours, and the level of

glucose in the blood is then checked. Normal fasting plasma glucose levels are less than 110 mg/dl. A fasting
plasma glucose level of more than 126 mg/dl usually indicates diabetes mellitus. A level of 110-125 mg/dl is
called "impaired fasting glucose".

2. Post prandial (PP) plasma glucose: This is tested two hours after having a meal, which serves as a challenge
for the body to regulate the blood sugar. Normal PP levels are <140 mg/dl; a glucose level of more than 200
mg/dl indicates diabetes mellitus, while a level between 140-199 mg/ dl is called "impaired glucose tolerance".

3. Random plasma glucose test: is that which is done at any other time. A level of 200 mg/dl or higher generally
indicates the presence of diabetes.

4. Oral glucose challenge test (oGTT): The blood glucose is tested 2 hours after giving 75 gm glucose by mouth.
This is useful for detecting borderline diabetes and a condition called "impaired glucose tolerance".

5. Oral glucose tolerance test: is the preferred way to diagnose pregnancy-induced diabetes. Ideally all pregnant
women in India should have a blood glucose test done 30 minutes after taking 50 gm gluocse (screening test). If
this is abnormal, the lady should undergo an oGTT: with 100 gm glucose (not the conventional 75 gm). Blood
samples are then drawn at intervals of one hour upto 3 hours (ie at 1, 2 and 3 hours post-glucose).
What is the treatment?
The treatment of diabetes depends on the type of diabetes. It is aimed to decrease symptoms and prevent
complications such as low blood sugar levels (hypoglycemia), eye problems, kidney disease, and nerve damage.
DM1 needs treatment with insulin injections to replace the insulin that is not produced in the body. There are
several types of insulin available. The most commonly used are the genetically engineered that are similar to
human insulin. The difference in the various types of insulin is the times at which they "peak" or are most
effective. Insulin schedule depends upon the meal pattern of the individual. This is required to avoid low blood
glucose levels, causing hypoglycaemia. Insulin is administered with a syringe, and newer devices such as insulin
pens and insulin pumps. The latter devices control diabetes more efficiently.
DM2 (earlier called NIDDM) is initially treated with weight reduction, diet control and regular exercises. When
these measures fail to control the blood sugar levels, oral medicines are used. Sulphonylureas are a group of
drugs that stimulate the release of insulin from the pancreas. Metformin reduces insulin resistance, and the
production of glucose by the liver. Thiazolidenediones also increase insulin efficiency and sensitivity. Acarbose
delays the absorption of glucose by the intestines. When the action of oral drugs is insufficient, insulin injections
are added.
Exercise: It is an important component of diabetes therapy. Exercise utilizes blood sugar and makes the body
more sensitive to insulin. It also reduces high blood pressure and high lipid levels, which are often associated
with diabetes.
Diet: There is no such thing as a "diabetic diet". Persons with diabetes should eat a normal, balanced diet, which
is designed to meet their nutritional requirements, maintain normal blood sugar levels and at the same time to
help in achieving appropriate weight (i.e. reduction in case of obese persons, regain in case of very lean
persons). It is also important to eat meals at regular time intervals, especially if insulin is used.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a

number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet,
medication, and exercise are working together to control your diabetes. It can help your doctor prevent
complications.
The American Diabetes Association recommends keeping blood sugar levels in a range based on your age.
Discuss these goals with your doctor and diabetes educator.
Before meals:
70 - 130 mg/dL for adults
100 - 180 mg/dL for children under age 6
90 - 180 mg/dL for children 6 - 12 years old
90 - 130 mg/dL for children 13 - 19 years old
At bedtime:
Less than 180 mg/dL for adults
110 - 200 mg/dL for children under age 6
100 - 180 mg/dL for children 6 - 12 years old
90 - 150 mg/dL for children 13 - 19 years old

19
Drug Abuse and Addiction
Many people do not understand why individuals become addicted to drugs or how drugs change the brain to
foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and
may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be
able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate
is the complexity of drug addictionthat it is a disease that impacts the brain and because of that, stopping drug
abuse is not simply a matter of willpower. Through scientific advances we now know much more about how
exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people
stop abusing drugs and resume their productive lives.
What is drug addiction?
Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite
harmful consequences to the individual that is addicted and to those around them. Drug addiction is a brain
disease because the abuse of drugs leads to changes in the structure and function of the brain. Although it is true
that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by
repeated drug abuse can affect a person's self control and ability to make sound decisions, and at the same time
send intense impulses to take drugs.
It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing
drugs. Fortunately, there are treatments that help people to counteract addiction's powerful disruptive effects and
regain control. Research shows that combining addiction treatment medications, if available, with behavioral
therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each
patient's drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to
sustained recovery and a life without drug abuse.
Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be
managed successfully. And, as with other chronic diseases, it is not uncommon for a person to relapse and begin
abusing drugs again. Relapse, however, does not signal failurerather, it indicates that treatment should be
reinstated, adjusted, or that alternate treatment is needed to help the individual regain control and recover.

What happens to your brain when you take drugs?

Drugs are chemicals that tap into the brain's communication system and disrupt the way nerve cells normally
send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by
imitating the brain's natural chemical messengers, and/or (2) by over stimulating the "reward circuit" of the
brain.
Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers, called
neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to
"fool" the brain's receptors and activate nerve cells to send abnormal messages.
Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large
amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which is needed
to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately
disrupts normal communication patterns.
Nearly all drugs, directly or indirectly, target the brain's reward system by flooding the circuit with dopamine.
Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and
feelings of pleasure. The over stimulation of this system, which normally responds to natural behaviors that are
linked to survival (eating, spending time with loved ones, etc), produces euphoric effects in response to the
drugs. This reaction sets in motion a pattern that "teaches" people to repeat the behavior of abusing drugs.
As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing
less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine's
impact on the reward circuit is lessened, reducing the abuser's ability to enjoy the drugs and the things that
previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to
attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug
than they first did to achieve the dopamine highan effect known as tolerance.
Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a
neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of
glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function.
Drugs of abuse facilitate non-conscious (conditioned) learning, which leads the user to experience
uncontrollable cravings when they see a place or person they associate with the drug experience, even when the
drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the
brain that are critical to judgment, decision making, learning and memory, and behavior control. Together, these
changes can drive an abuser to seek out and take drugs compulsively despite adverse consequencesin other
words, to become addicted to drugs.

20
What is Epilepsy?
Epilepsy is a disorder of the nervous system in which seizures (also called fits) or convulsions occur repeatedly
in a person. These seizures are caused due to the abnormal release of an electric charge in the brain. Information
between the nerve cells are transmitted in the form of electric impulses. Sometimes when these charges become
too large, a seizure occurs.
What are the kind of seizures?
Epileptic seizures are of several types. People with epilepsy may have predominantly one type of seizure, but
the degree of the attack may vary and some may have more than one type.
1. Grand mal seizures (generalised tonic clonic seizures) they are violent seizures that cause whole body
convulsions. All major portions of the body are affected and the patient may lose consciousness for sometime.

Breathing may stop for some time and the face may become pale. The patient may bite her cheek or tongue
during the attack and may lose control over her urinary bladder. Such attacks are often preceded by a loud cry
due to spasm of vocal cord.
2. Petit mal (absence) seizures these are milder seizures and are characterised by a temporary loss of
consciousness. Thus, the patient may just stare, stop what he/she is doing and not be aware of what others are
saying. There may be repeated blinking of the eye accompanied by a sudden loss of awareness. The attack lasts
10-25 seconds and may occur several times a day. Characteristic of this absence is that the patient is not aware
that she is going to get an attack and after the attack is quite normal immediately. There is another form of
absence where the patient feels some warning, then is absent for some while and then would like to sleep for 510 minutes. This is called Atypical absence. Absence seizures were called Petit mal earlier.
3. Simple focal seizures these seizures affect a particular part of the body. There are recurrent muscle
contractions in that part of the body. This is usually associated with nausea, vomiting and sweating. There is no
loss of consciousness. At times an attack can start focally at one part of the body and get generalised and so look
like grand mal seizure. When it gets generalised the patient loses consciousness.
4. Complex partial seizures these seizures are characterised by confusion and an inability to remember the last
few minutes. The patient may also get a prior indication of the fit. Warnings are of different types. There may be
a smell, or a sound or seeing objects, which are not there. There may be a warning like a sense of fear or
confusion or giddiness or a funny feeling in the stomach. The warning is followed by the fit. The fit may be like
a usual grand mal or it may be unusual. The child might turn round and round, or run in some direction, or
become violent. The person may not be aware of what is happening during the attack, she may not remember
what happened after the attack and the attack is brief usually less than 10 minutes.
5. Myoclonic fit. Here there is a sudden involuntary shock like contraction of the limbs. If it affects the hands,
objects appear to be thrown out and if it affects the legs the patient may fall and then get up by herself. In
children it may affect the trunk and cause falling.
How is it caused?
Most cases of epilepsy are said to be idiopathic i.e. doctors cannot find a clear cause. Thus, 60% of grand mal is
"idiopathic" and nearly 100% of classic absence is idiopathic. Partial seizures are always due to focal brain
disease.
The ones where doctors find a cause are called symptomatic i.e. the fit is a symptom of some brain damage.
Among such cases are brain tumour, strokes, head injury, cerebral infection and errors of development that are
present since birth. Biochemical cause like low sugar, low calcium, very high sugar and high blood pressure,
and less circulation of blood to brain may cause seizures.
Idiopathic only means that the doctors are unable to locate the exact cause. However, the cause may be genetic
or development abnormalities which are at microscope levels and cannot be seen by the MRI Scan.
What are the symptoms?
Seizures of any of the above type are the main symptoms of epilepsy. Epilepsy in most cases is also associated
with some intellectual impairment, though it is not always present. During the seizure, there may also be
frothing at the mouth and rolling back of the eyes.
How is it diagnosed?
Epilepsy is essentially diagnosed by taking a careful history of what happens during an attack. This is best taken
from one who has observed the attack. It is only rarely that a doctor can see an attack but if he does he should be
able to diagnose. The two conditions, which are most likely to be confused are faints (which are brief losses of
consciousness with no jerking and which are known to come under certain circumstances) and a patient who is
faking a fit to try and gain sympathy, attention etc. The EEG is a record of the electrical activity of the brain and
is often helpful but as the record lasts only 15-30 minutes, it may be normal in a patient whose fits are
uncommon (1 EEG is normal in 30-40% of epileptics).
Once a diagnosis of epilepsy is made one tries to find a cause either by history or by tests. A CT Scan or MRI is

very useful to look for a structural lesion. Blood tests may find biochemical causes low sugar, low calcium etc.
Examination of the cerebro-spinal fluid is done if infection is thought to be the cause. In India, one infection
particularly known to cause epilepsy is cysticercosis. It often shows a small ring like lesion on the CT Scan or
MRI.
What is the treatment?
Epilepsy may be treated with the help of anti-convulsant drugs like phenytoin, sodium valporate,
phenobarbitone, carbamazepine, lamotrigine, gabapentin and topiramate. The patient may be able to identify
certain materials (which might be some food products) that aggravate the symptoms of the condition. The use of
such materials called triggers, must be avoided. The seizures may also be minimized or stopped by treating the
underlying cause such as removal of a brain tumour.
With the use of one drug, given in proper dose and gradually increased, 65% of all epileptics can be controlled.
By adding a second drug and sometimes a third, upto 80% of cases can be fully controlled. For the remaining
there are now newer drugs e.g. clobazam, tamotrigene, Vigabatrine.
For myoclonic epilepsy, absence and idiopathic grand mal Sodium Valproate is the most commonly used drug.
For focal epilepsy phenytoin and carbamezapine is the first choice drug. Phenobarbitone is a cheap and very
effective drug and is the mainstay at our Public Health Centers.
Surgery may be useful in some partial epilepsies. The important thing in treatment is that drug be continued for
3 years after the last fit and then slowly tapered. Stopping after 6 months - 2 years is a cause of relapse and leads
the patient to believe there is no effective treatment and then he seeks other medicines and faith healers. The
drugs are very useful if well used.
What first aid can be provided?
In case a patient is having an epileptic seizure, the following should be done to provide relief:
* The patient should be made to lie down in a comfortable position on her side, so that the saliva can flow out of
the side of the mouth and the person does not gag.
* All the clothing of the patient must be loosened so that she is able to breathe easily.
* No hard object like a spoon should be inserted in the mouth of the patient. To prevent her from biting her
tongue, she can be made to clamp her teeth on a piece of cloth or a handkerchief.
* The person should not be made to drink water or any other liquid during the seizure as she may choke.
* If the patient falls asleep immediately after the seizure, she should be allowed to rest and not be made to move
or walk. In simple terms a fit will subside by itself in 1-10 minutes and the attendant only needs to see that the
patient does not hurt himself.
* After the attack is over she should see a doctor or if she is already a known epileptic she should take an extra
dose of his usual medicine as the occurrence of a fit implies the dose is inadequate.

21
Common Eye Problem
Most of us will experience temporary eye problems from time to time, including itching, blurriness or fatigue.
Most of these conditions are short-lived and will probably go away on their own with no complications.
However, sudden eye problems and those that last for more than a couple of days should be checked by an eye
doctor. The following is a list of common eye problems and their possible causes.
Common Eye Disorders

What are some common eye disorders?

The following list provides a brief description of several common eye disorders. Consult your physician or an
ophthalmologist for more information.
Age-Related Macular Degeneration is the breaking down, or degeneration, of the macula area of the retina of
the eye.
Amblyopia is reduction or dimming of vision in an eye that appears to be normal.
Astigmatism is a condition in which an abnormal curvature of the cornea can cause two focal points to fall in
two different locations - making objects up close and at a distance appear blurry.
Blepharitis is an inflammation of the edges of the eyelids involving hair follicles and glands that open onto the
surface.
Cataract is a condition in which the lens of the eye becomes dense or opaque and does not properly transmit
light.
Chalazion is a small bump that develops on the upper or lower eyelid. It is caused by inflamed meibomian
glands that produce the oil in tears.
Conjunctivitis, sometimes called pink eye, is an inflammation of the blood vessels in the conjunctiva, the
membrane that covers the sclera and inside of the eyelids. Conjunctivitis may be caused by bacteria or viruses,
making it very contagious.
Diabetic Retinopathy is a disorder of the retina resulting from changes in the eye blood vessels and found in
some people who have diabetes.
Dry Eye occurs when there is not enough moisture in the eye, causing it to feel dry, hot, sandy, and gritty. Dry
eye may be caused by low humidity, smoke, aging, certain diseases, and certain medications (i.e.,
antihistamines, decongestants).
Floaters appear as spots, dots, or lines and affect or interrupt vision. Floaters are usually caused by bits of
debris in the vitreus humor.
Glaucoma is a disease that impairs the optic nerve when fluid and pressure build up in the eye and damage the
optic nerve.
Hyperopia, or farsightedness, means a person has trouble seeing clearly up close.
Iritis is an inflammation of the iris of the eye.
Myopia, or nearsightedness, means a person has trouble seeing clearly in the distance.
Presbyopia is another type of farsightedness and is caused when the center of the eye lens hardens making it
unable to accommodate near vision.
Retina Detachment is the separation of the retina from the back of the eye.
Retinitis Pigmentosa is actually the name given to a group of hereditary eye disorders, all of which involve the
eye's retina, the light-sensitive nerve layer that lines the back of the eye, and all of which cause a gradual, yet
progressive, loss or reduction in visual ability.

Strabismus is crossed eyes.

Stye is a noncontagious, bacterial infection of one of the sebaceous glands of the eyelid. A stye looks like a
small, red bump either on the eyelid or on the edge of the eyelid.
Uveitis is a condition that occurs in the uvea, or the middle coat of the eye. Because the uvea contains the blood
vessels that supply nutrients to the eye, any form of uveitis may be serious and may be a symptom for other
serious conditions.

22
What is flu (Influenza) ?
Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract. Although
the flu affects both sexes and all age groups, kids tend to get it more often than adults. The illness even has its
own season from November to April, with most cases occurring between late December and early March.
Signs and Symptoms
The flu is often confused with the common cold, but flu symptoms are usually more severe than the typical
sneezing and stuffiness of a cold.
Symptoms of the flu may include:
* fever
* chills
* headache
* muscle aches
* dizziness
* loss of appetite
* tiredness
* cough
* sore throat
* runny nose
* nausea or vomiting
* weakness
* ear pain
* diarrhea
Infants with the flu may simply seem sick all of a sudden or "just don't look right." The flu discussed here is not
the same strain of virus as the avian flu.
Duration
After 5 days, fever and other symptoms have usually disappeared, but a cough and weakness may continue. All
symptoms are usually gone within a week or two. However, it's important to treat the flu seriously because it can
lead to pneumonia and other life-threatening complications, particularly in infants, senior citizens, and people
with long-term health problems.
Contagiousness
Spread by virus-infected droplets that are coughed or sneezed into the air, the flu is contagious. People infected
with the flu are contagious from a day before they feel sick until their symptoms have resolved (usually about 1
week for adults, but can be up to 2 weeks for young kids).

Preventing the Flu From Spreading

There's no guaranteed way including being vaccinated to prevent anyone from getting the flu. Avoiding
large crowds can help, but it's often impossible to keep kids cooped up.
Here are some practical ways to help prevent the spread of the flu:
* Wash your hands thoroughly and frequently.
* Never pick up used tissues.
* Never share cups and eating utensils
* Stay home from work or school when you're sick with the flu.
* Cover your mouth and nose with a tissue when you cough or sneeze.
Treatment
Cases of the flu rarely require specific medical treatment. But some kids with chronic medical conditions may
become sicker with the flu and need to be hospitalized, and flu in an infant can also be dangerous. For a severely
ill child or one with other special circumstances, a doctor may prescribe an antiviral medicine that can ease flu
symptoms, but only if it's given within 48 hours of the onset of the flu.
These at-home tips can help most otherwise healthy kids cope with the flu. Have them:
* drink lots of fluids to prevent dehydration
* get plenty of sleep and take it easy
* take acetaminophen or ibuprofen to relieve fever and aches (but do not give aspirin unless your doctor
instructs you to do so)
* wear layers, since the flu often makes them cold one minute and hot the next (wearing layers like a T-shirt,
sweatshirt, and robe makes it easy to add or subtract clothes as needed)
When to Call the Doctor
Call the doctor if your child:
* has flu symptoms
* has a high temperature
* seems to get better, but then feels worse than before
* has any trouble breathing, seems confused, or seems to be getting worse
For the most part, though, the flu is usually gone in a week or two with a little rest and tender loving care.

23

What Is Haemophilia?
Haemophilia is a rare inherited bleeding disorder in which the blood does not clot normally. Persons with
haemophilia may bleed for a longer time than others after an injury or accident. They also may bleed internally,
especially in the joints (knees, ankles, and elbows).
Babies born with haemophilia are missing or have a low level of a protein needed for normal blood clotting or
blood coagulation. The protein is called a clotting factor.
Haemophilia usually occurs only in males (with very rare exceptions).

A person with haemophilia has a problem with certain proteins in the blood called clotting factors. Haemophilia
can be due to:
A low level of one of the clotting factors
A clotting factor that is completely missing
When clotting factors are missing, or your body does not have enough of these factors, it can take a long time
for your blood to clot after an injury or accident.
Types of Haemophilia
The two main types of haemophilia are:
Haemophilia A: Clotting factor VIII (8) is low or missing. About 9 of 10 people with haemophilia have type
A.
Haemophilia B: Clotting factor IX (9) is low or missing.
Haemophilia also can be acquired when antibodies to these clotting factors form and block their function. Only
inherited haemophilia is discussed here.
Haemophilia can be:
Mild
Moderate
Severe
Mild, moderate, or severe haemophilia is determined by the amount of clotting factor in the blood. About 7 of
10 people with haemophilia A have the severe form. Normal persons have a factor VIII activity of 100 percent;
persons with severe haemophilia A have a factor VIII activity of less than 1 percent.
Other Names for Haemophilia
Haemophilia A
Classic haemophilia
Factor VIII deficiency
Haemophilia B
Christmas disease
Factor IX deficiency
What Causes Haemophilia?
Haemophilia is an inherited disorder. It is caused by a defect in the genes that determine how the body makes
blood clotting factors VIII and IX. These genes are located on the X chromosomes (KRO-muh-somz), which
determine whether a baby is a boy or girl.
Chromosomes come in pairs. Females have two X chromosomes, while males have one X and one Y
chromosome. A woman is a carrier if she has a defective gene for factor VIII or factor IX on one of her X
chromosomes. She can pass the defective gene on to her children.
If she has a son, there is a one in two (50 percent) chance that he will have haemophilia.
If she has a daughter, there is a one in two (50 percent) chance that the daughter will be a carrier.
A man who has haemophilia cannot pass the disorder on to his sons. All of his daughters, however, will be
carriers.

Very rarely, a girl is born with haemophilia. This can happen if her father has haemophilia and her mother is a
carrier.
Some males with the disorder are born to mothers who are not carriers. In these cases, a random change
(mutation) occurs in the gene as it is passed to the child.
What Are the Signs and Symptoms of Haemophilia?
The major signs and symptoms of haemophilia are:
Bleeding
Bruising
Internal bleeding is common in people with severe haemophilia. If not treated promptly, internal bleeding can
lead to damaged joints, muscles, or other parts of the body.
The extent of bleeding depends on the type and severity of the condition:
Children with very mild haemophilia may not have noticeable symptoms for years. Often, the first sign is
heavy bleeding from a dental procedure, an accident, or surgery.
Children with mild to moderate haemophilia may not have any signs or symptoms at birth.
Males with severe haemophilia may bleed heavily after circumcision.
In most children, the first signs are:
Heavy bruising and bleeding from the gums as they cut their baby teeth
Bumps and bruises from frequent falls as they learn to walk
Swelling and bruising from bleeding in the joints, soft tissue, and muscles
Females who are carriers usually have enough clotting factors from their one normal gene to prevent serious
bleeding problems.
The most common signs or symptoms in older children and adults are:
Bleeding in the joints (hemarthrosis (HE-mar-thro-sis))
Bleeding and bruising in the soft tissue and muscles
Bleeding in the mouth from a cut or bite or loss of a tooth
Nosebleeds for no obvious reason
Blood in the urine (from bleeding in the kidneys or bladder)
Blood in the stool (from bleeding in the intestines or stomach)
Bleeding in the joints is the most common problem in persons with severe haemophilia. Bleeding often occurs
without an injury. It can go on for days if not treated. However, people with haemophilia can learn to recognise
early symptoms of bleeding in the joints and get treatment quickly. Early treatment can help limit damage to the
joints.
Although bleeding can occur in any joint, the most common places are the:
Knees
Elbows
Ankles
The signs and symptoms of bleeding in the joints are:
Tightness in the joint with no real pain is usually the first sign.
Tightness and pain may occur before any visible signs of bleeding.
The joint becomes swollen and hot to touch as time passes. Bending or extending the joint is painful.
Swelling continues as bleeding continues, and all movement in the joint is lost. Pain can be severe.
The bleeding slows after several days when the joint is full of blood.

If not treated, the bleeding can lead to disabling arthritis in the joints.
Bleeding in the brain, a very serious complication of haemophilia, requires emergency treatment. This bleeding
can happen after a simple bump on the head or a more serious injury. The signs and symptoms are:
Long-lasting painful headaches
Vomiting many times
Changes in behaviour or being very sleepy
Sudden weakness or clumsiness of the arm or leg
Neck pain or stiffness
Double vision
Difficulty walking
Conv

24
Head Injury Causes
All types of head injuries can be caused by trauma. In adults in the United States such injuries commonly result
from motor vehicle accidents, assaults, and falls. In children falls are the most common cause followed by
recreational activities such as biking, skating, or skateboarding. A small but significant number of head injuries
in children are from violence and abuse.
Penetrating trauma: Missiles such as bullets or sharp instruments (such as knives, screwdrivers, or ice picks)
may penetrate the skull. The result is called a penetrating head injury. Penetrating injuries often require surgery
to remove debris from the brain tissue. The initial injury itself may cause immediate death, especially if from a
high-energy missile such as a bullet.
Blunt head trauma: These injuries may be from a direct blow (a club or large missile) or from a rapid
deceleration force (a fall or striking the windshield in a car accident).
Head Injury Treatment
Emergency medical personnel should immediately treat any serious or potentially serious head injury.
Minor head injuries may be cared for at home.

Bleeding under the scalp, but outside the skull, creates "goose eggs" or large bruises at the site of a
head injury. They are common and will go away on their own with time. Using ice immediately after
the trauma may help decrease their size

o Do not apply ice directly to the skin. Ice should be applied for 20-30 minutes at a
time and can be repeated about every 2-4 hours as needed.
o Use a light washcloth as a barrier and wrap the ice in it. You can also use a bag of
frozen vegetables wrapped in cloth. This conforms nicely to the shape of the head.

o Make your own ice pack by adding 1/3 cup of 70% isopropyl alcohol (the greencolored kind is best to help identify it later) to 2/3 cup of water in a zip-lock-style
bag (double bag it to prevent leaking). The mixture turns into "slush." Freeze this
homemade ice pack for use when needed. Caution: If you have small children in
your home, watch them carefully when using the ice pack. Drinking the mixture can
be poisonous.
o Commercially available ice packs use chemicals to create cold. They are designed
to be kept in a first-aid kit and need not be kept frozen. These can be applied be
directly to the skin, although a barrier can also be used if bleeding is present. They
must disposed of after a single use but can be handy in case of emergencies.

When a minor head injury results from a fall onto carpet or other soft surface and the height of the fall
is less than the height of the person who fell and there is no loss of consciousness (in other words, the
person was not "knocked out"), a doctor's visit is not usually needed. Apply ice to lessen swelling.

25

What is a headache?
Headache is defined as pain in the head or upper neck. It is one of the most common locations of pain in the
body and has many causes.
How are headaches classified?
Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated
classification system for headache. Because so many people suffer from headaches, and because treatment is
sometimes difficult, the new classification system allows health care practitioners to understand a specific
diagnosis more completely to provide better and more effective treatment regimens.
There are three major categories of headaches:
1. primary headaches,
2. secondary headaches, and
3. cranial neuralgias, facial pain, and other headaches
What are primary headaches?
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common
types of headache.
Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will
have tension headaches. Tension headaches are more common among women than men.

What causes tension headaches?

While tension headaches are the most frequently occurring type of headache, their cause is not known. The most
likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed,
they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the
neck inserts, the temple where muscles that assist the jaw to move are located, and the forehead.
There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of
physical or emotional stress placed on the body. Physical stress that may cause tension headaches include
difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time Emotional stress
may also cause tension headaches by causing the muscles surrounding the skull to contract.
What can you do to help yourself?
If the doctor has examined you without finding any serious cause for the headaches, these tips should prove
helpful:
avoid excessive use of alcohol and tobacco.
engage in correct posture while sitting and working. The type of chair you use is important. It should be one
that maximises comfort and good posture and may need to be adjusted to suit your needs.
perform relaxation techniques on a consistent basis.
get plenty of fresh air and exercise.
some people find that taking the natural herbal treatment Feverfew is very effective at reducing or preventing
their headaches occurring. This needs to be taken daily even if no headache is present to have an effect.
Consult your GP before starting this.
For migraine headaches, symptoms may be reduced by:
resting in a quiet room with the lights turned off.
avoiding food or drink in your diet that have been identified as having possible factors associated with
migraine headaches.

26
About heart attacks
Heart disease is the most common cause of death in the UK. In 2006, about 113,000 people had a heart attack
for the first time. Heart attacks become more common with increasing age and are generally more common in
men than women.
You can have a heart attack at any time of the day or night, when you're either resting or being active.
Occasionally, a heart attack can be brought on by doing energetic activity that you aren't used to, or by intense
physical or emotional stress.
You're more likely to have a heart attack if you:

smoke

have a family history of heart disease

lead an inactive lifestyle (doing less than 30 minutes physical activity per day, on most days)

have diabetes

are overweight or obese

have high blood pressure

have high blood cholesterol

Symptoms of a heart attack

If you have a heart attack, you will most likely feel severe pain in the centre of your chest. This central chest
pain is often described as heaviness, squeezing or crushing, and may come on suddenly causing you to collapse.
The pain sometimes feels like severe indigestion. Other symptoms include:

pain spreading to the arms, neck, jaw, back or stomach

feeling sweaty and breathless

feeling sick or vomiting

The symptoms of a heart attack can come on suddenly, but sometimes the pain develops more slowly. If you
already have angina (narrowing of your coronary arteries without complete blockage), you will find that the
pain of a heart attack won't completely respond to your usual medicine (eg glyceryl trinitrate, or GTN). Heartattack pain continues for longer than angina and can last for hours.
Sometimes you may not have any symptoms at all, especially if you're elderly or have diabetes.
During a heart attack, life-threatening heart rhythms may develop, which is why a heart attack is a medical
emergency.
If you suspect you're having a heart attack, call for emergency help immediately.
Complications of a heart attack
Once the initial discomfort of a heart attack has settled (usually within 24 to 48 hours) there are often no
complications afterwards. However, in the first few days after surviving a heart attack, your heart may beat in
irregular, unusually fast or slow rhythms - these are known as arrhythmias.

After having a heart attack, your heart may not be able to pump blood around your body as efficiently as before.
This is called heart failure. The larger the area of your heart muscle affected by a heart attack, the more likely
you are to have heart failure.
Other, rarer complications include blood clots in the lungs, stroke, inflammation of the membrane covering the
heart (pericarditis), or a bulging weakness in the heart muscle (aneurysm).
Causes of a heart attack
The underlying cause of most heart attacks is atherosclerosis - this is where the coronary arteries become
narrowed over many years by fatty deposits (plaques). These plaques are thought to split open (rupture),
releasing substances that cause the blood flowing in the coronary artery to clot. The plaque and blood clot
(thrombus) can together completely block the coronary artery, stopping blood flow to your heart and causing a
heart attack.
Diagnosis of a heart attack
When you get to hospital, a doctor and nurse will assess your symptoms and medical history. You will have:

a physical examination - this involves measuring your blood pressure and monitoring your heart rate

an ECG (electrocardiogram) - this checks the electrical activity of your heart and helps to diagnose any
partial or complete blockages of the coronary arteries

blood tests to check for any damage to your heart muscle

Treatment of a heart attack

Emergency medical treatment is vital - getting to a hospital quickly and receiving specialist care greatly
improves your chances of survival. If you can swallow, chew a single aspirin tablet, unless you know that you're
allergic to it. Aspirin thins the blood and can help to prevent the clot that is blocking the coronary artery from
spreading.
In response to an emergency call for a suspected heart attack, the ambulance service will send a paramedic as
quickly as possible. His/her job is to stabilise you and provide transport to a hospital quickly and safely for
further treatment. A paramedic may have to provide oxygen and pain-relieving medicine. Some paramedics,
especially in rural areas, are also trained to give patients clot-dissolving drugs (also known as "clot-busters" or
thrombolytics) before reaching the hospital.
During a heart attack, there may be disturbances in your heart rhythm. The most serious form of this is called
ventricular fibrillation. This is when the electrical activity of the heart becomes so erratic that it stops pumping
and quivers or 'fibrillates' instead (known as cardiac arrest). If this happens, the paramedic may need to use a
defibrillator, which gives a large electric shock through the wall of your chest and can restore a regular heartbeat
(resuscitation).
Hospital treatment
At hospital, you will usually be given an injection of a thrombolytic to dissolve the clot in your coronary artery.
This increases your risk of bleeding so it won't be given if it could cause problems, for example if you have
recently had surgery. Your chances of making a full recovery from your heart attack are much better if the clot is
dissolved.
In some hospitals you may be taken on admission for immediate angioplasty (see Surgery), as this treatment is

increasingly used.
Other medicines, such as beta-blockers (eg atenolol) or GTN, may be given to increase the blood supply to your
heart by widening your blood vessels.
Surgery
If your arteries are narrowed, you can sometimes be treated with angioplasty or a coronary artery bypass graft
(CABG).
Angioplasty involves widening your artery by inflating a balloon in the narrowed coronary artery. A wire mesh
tube called a stent is sometimes inserted to hold it open.
CABG surgery involves redirecting your blood around the affected artery. This is done either using a
replacement section of a blood vessel (a graft), which is usually taken from a leg vein or by diverting another
artery in the chest wall (the internal mammary artery).

27
Hemophilia

Definition of Hemophilia
Hemophilia is one of several disorders of the blood clotting process that greatly prolong coagulation (clotting)
time.
Description of Hemophilia
Coagulation, or clotting, is the body's mechanism to halt bleeding. It involves at least 14 sequential steps, each
requiring a specific plasma protein or "factor" normally found in the blood. In hemophilia, one of the factors
required for the clotting sequence is deficient or absent. The condition known as hemophilia has been
recognized for thousands of years.
The two most common forms of hemophilia are hemophilia A and hemophilia B. Hemophilia A and B have
similar symptoms and were not recognized as separate disorders until 1952.
Hemophilia A (classic hemophilia), is caused by the deficiency of Factor VIII.
Hemophilia B (also called Christmas disease, for the name of the family the disorder was first observed in), is
caused by the deficiency of factor IX.
Hemophilia A is four times as common, with an estimated incidence of 1 in 10,000 males, while hemophilia B is
estimated to occur in one in 40,000 males. Approximately 1 woman in 5,000 is a carrier for hemophilia A, and 1
in 20,000 is a carrier of hemophilia B.
Hemophilia is typically divided into three classes: severe, moderate and mild, based on the level of clotting
factor in the blood. In severe hemophilia, there is less than 1 percent of normal clotting factor. The degree of
severity tends to be consistent from generation to generation.
Contrary to popular belief, minor cuts and wounds do not usually present a threat to hemophiliacs. Rather, the
greatest danger comes from spontaneous bleeding that may occur in joints and muscles. This is most prone to
occur during years of rapid growth, typically between the ages of 5 and 15 years.
Repeated spontaneous bleeding in joints may cause arthritis, and adjacent muscles become weakened. Pressure

on nerves caused by the accumulation of blood may result in pain, numbness, and temporary inability to move
the affected area. In the past, this led to permanent crippling disability by adulthood.
The development of purified clotting factors in the 1970s, isolated from donated blood, significantly improved
the long-term outlook for hemophiliacs. Severe hemophiliacs require transfusions of clotting factors as
frequently as once a week.
Symptoms of Hemophilia
Patients with hemophilia may present with bleeding anywhere, but most commonly into joints (knees, ankles,
elbows), into muscles, and from the digestive tract. Those with severe hemophilia may bleed spontaneously.
Diagnosis of Hemophilia
Blood tests to determine the effectiveness of clotting and the levels of clotting factors will be abnormal.
Treatment of Hemophilia
Early prophylactic use of clotting factors with severe hemophilia is gaining acceptance as a way to prevent pain
and morbidity associated with bleeding disorders. Treatment of severe hemophilia A or B consists of
administration of plasma-derived or recombinant clotting factor concentrates.
The plasma-derived concentrates have saved lives and prevented disability. However, their use in the past has
been complicated by infection with viral pathogens particularly the human immunodeficiency virus and the
hepatitis viruses. Monoclonal antibody purification techniques, heat inactivation, and virucidal detergent
treatments have rendered plasma-derived concentrates relatively safe. Recombinant DNA technology has
provided a series of synthetic products.
A genetically engineered clotting factor to treat people with hemophilia has been licensed by the FDA. The
product, antihemophilic factor (recombinant) is used for preventing and controlling excessive bleeding and for
preparing people with hemophilia A for surgery. The brand name is Kogenate. Kogenate is the second
recombinant DNA-derived clotting factor for people with hemophilia A. The first product, Recombinate, was
licensed in late 1992.
Previously, patients were given factor VIII concentrates pooled from thousands of plasma donations. Kogenate
is made using baby hamster kidney cells that have been altered by recombinant DNA technology to produce
factor VIII. The resulting factor is highly purified, eliminating any possibility of transmission of virus from
plasma.
Hemophilia B is managed with factor IX concentrates. Factor VIII concentrates are ineffectual in this type of
hemophilia. The use of Factor IX concentrate are to maintain a patient through a major surgical procedure.
Factor levels should be measured to ensure that expected levels are achieved and that an inhibitor is nor present.
Factor IX concentrates contain a number of other proteins, including activated coagulating factors that appear to
contribute to a risk of thrombosis with recurrent usage of Factor IX concentrates. Because of the risk of
thrombosis, more care is needed in deciding to use these concentrates.

28

Hepatitis Overview
Hepatitis is a general term that means inflammation of the liver. Inflammation of the liver can result from
infection, from exposure to alcohol, certain medications, chemicals, or poisons, or from a disorder of the
immune system.
Hepatitis is most commonly caused by one of three viruses:
1.
the hepatitis A virus
2.
the hepatitis B virus
3.
the hepatitis C virus

In some rare cases, the Epstein Barr Virus (which causesmononucleosis) can also result in hepatitis because it
can cause inflammation of the liver. Other viruses and bacteria that also can cause hepatitis include hepatitis D
and E, chickenpox, andcytomegalovirus (CMV).
Hepatitis A
In children, the most common form of hepatitis is hepatitis A (also called infectious hepatitis). This form is
caused by the hepatitis A virus (HAV), which lives in the stools (feces or poop) of infected individuals. Infected
stool can be present in small amounts in food and on objects (from doorknobs to diapers).
HAV is spread:
when someone ingests anything that's contaminated with HAV-infected stool (this makes it easy for the virus to
spread in overcrowded, unsanitary living conditions)
in water, milk, and foods, especially in shellfish
Because hepatitis A can be a mild infection, particularly in children, it's possible for some people to be unaware
that they have had the illness. In fact, although medical tests show that about 40% of urban Americans have had
hepatitis A, only about 5% recall being sick. Although the hepatitis A virus can cause prolonged illness up to 6
months, it typically only causes short-lived illnesses and it does not cause chronic liver disease.
Hepatitis B
Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide
spectrum of symptoms ranging from general malaise to chronic liver disease that can lead to liver cancer.
HBV spreads through:
infected body fluids, such as blood, saliva, semen, vaginal fluids, tears, and urine
a contaminated blood transfusion (uncommon in the United States)
shared contaminated needles or syringes for injecting drugs
sexual activity with an HBV-infected person
transmission from HBV-infected mothers to their new born babies.

Hepatitis C
The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. The symptoms of the
hepatitis C virus can be very similar to those of the hepatitis A and B viruses. However, infection with HCV can
lead to chronic liver disease and is the leading reason for liver transplant in the United States.
The hepatitis C virus can be spread by:
sharing drug needles.
getting a tattoo or body piercing with unsterilized tools
blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been
routinely screened for the disease) transmission from mother to newborn
sexual contact (although this is less common)
Hepatitis C is also a common threat in kidney dialysis centers. Rarely, people living with an infected person can
contract the disease by sharing items that might contain that person's blood, such as razors or toothbrushes.
* People who are infected can start spreading the infection about 1 week after their own exposure. People who
do not have symptoms can still spread the virus. Infection with HAV is known to occur throughout the world.

The risk of infection is greatest in developing countries with poor sanitation or poor personal hygiene
standards.

Infection rates are also higher in areas where direct fecal-oral transmission is likely to occur, such as
daycare centers, prisons, and mental institutions.

* People at increased risk for hepatitis A infection

Household contacts of people infected with HAV

Sexual partners of people infected with HAV

International travelers, especially to developing countries

Military personnel stationed abroad, especially in developing countries

Men who have sex with other men

Users of illegal drugs (injected or non-injected)

People who may come into contact with HAV at work

* Workers in professions such as health care, food preparation, and sewage and waste water management are not
at greater risk of infection than the general public.
* People who live or work in close quarters, such as dormitories, prisons, and residential facilities, or work in or
attend daycare facilities are at increased risk only if strict personal hygiene measures are not observed.

29

HIV

The Basics
HIV is a virus that infects and destroys CD4 cells. CD4 cells are part of the bodys immune system. The immune
system protects the body from invaders. When the immune system loses too many CD4 cells, it becomes weak
and is unable to fight off germs. At this point, you are at risk of getting AIDS-related opportunistic infections
(OIs) that can cause serious illness or death.
HIV Treatments
Scientists have developed drugs that block HIV from reproducing (multiplying). These drugs are grouped into
classes. Each class of drugs works to stop HIV at a certain point in its life cycle. So far there are five classes of
drugs:

Entry inhibitors (includes fusion inhibitors and CCR5 antagonists)

Integrase inhibitors

Nucleoside/nucleotide reverse transcriptase inhibitors (nukes or NRTIs)

Non-nucleoside reverse transcriptase inhibitors (non-nukes or NNRTIs)

Protease inhibitors (PIs)

HIV drugs are always used in combination to attack the virus at different points in its life cycle. This usually
means using drugs from at least two classes. Combining HIV drugs is the best way to reduce the amount of HIV
in your blood ( viral load).

Baseline Blood Tests

Before you start HIV treatment, your health care provider should have you take a number of blood tests. These
are your baseline tests. Future test results will be compared to your baseline results to check how you are doing
and how your treatment is working.
1.CD4 cell (T-cell) count: The CD4 count checks the strength of your immune system. After you start HIV
treatment, you should see your CD4 count go up. Your CD4 count should be checked every 3-4 months, if
possible.
2.Viral load test: The viral load test measures the amount of HIV in your blood. After you start HIV treatment,
you should see your viral load go down. Your viral load should be checked about a month after you start or
change HIV drugs. After that, it should be checked every 3-4 months.
3.Resistance test: The resistance test helps determine which drugs are likely to work for you. Experts
recommend that everyone should get a resistance test before starting or changing HIV treatments, even if you do
not plan to start HIV treatment for a while.
4.Other tests to check your overall health: These include complete blood count (CBC), chemistry screen, lipid
profile, and glucose. Your health care provider should talk with you about how often these tests need to be done.

30
What Is Hypertension?
Hypertension, or high blood pressure, is defined as a reading of 140/90 on three
consecutive measurements at least six hours apart. The definition varies for pregnant
women, where hypertension is defined as 140/90 on two consecutive measurements six
hours apart. Consistently high blood pressure causes the heart to work harder than it
should and can damage the coronary arteries, the brain, the kidneys, and the eyes.
Hypertension is a major cause of stroke .A kidney (left) and a cross-section of a heart
(right) that were affected by hypertension. The heart shows signs of advanced
atherosclerosis, one possible complication arising from hypertension.
Types of Hypertension
Hypertension is classified as either primary (or essential ) hypertension or secondary
hypertension. Primary hypertension has no specific origin but is strongly associated with
lifestyle. It is responsible for 90 to 95 percent of diagnosed hypertension and is treated
with stress management, changes in diet , increased physical activity, and medication (if
needed). Secondary hypertension is responsible for 5 to 10 percent of diagnosed
hypertension. It is caused by a preexisting medical condition such as congestive heart
failure, kidney failure, liver failure, or damage to the endocrine ( hormone ) system.
Pregnancy-induced hypertension (PIH) may appear in otherwise healthy women after the
twentieth week of pregnancy. It is more likely to occur in women who are overweight or
obese . PIH may be mild or severe, and it is accompanied by water retention and protein
in the urine. About 5 percent of PIH cases progress to preeclampsia. Preeclampsia is
characterized by dizziness, headache, visual disturbance, abdominal pain, facial edema ,
poor appetite, nausea , and vomiting. Severe preeclampsia affects the mother's blood
system, kidneys, brain, and other organs.
In rare cases, the woman can die. Preeclampsia is more likely to occur during first
pregnancies, multiple fetuses, in women with existing hypertension, and in women
younger than twenty-five years old or over thirty-five years old. If convulsions occur with

PIH, it is called eclampsia. PIH disappears within a few weeks after birth.
Causes of Hypertension
Many prescription and over-the-counter drugs can cause or exacerbate hypertension . For
example, corticosteroids and immunosuppressive drugs increase blood pressure in most
solid-organ transplant recipients. Medication taken for pain and inflammation such as
nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors
may raise blood pressure since their antiprostaglandin properties affect the kidneys.
Tobacco products (cigarettes, cigars, smokeless tobacco) contain nicotine, which
temporarily increases blood pressure (for about thirty minutes or less). The blood
pressure of smokers should be rechecked after thirty minutes if initial readings are high.
Nicotine patches that are used for smoking cessation do not appear to increase blood
pressure.
There does not appear to be a direct relationship between caffeine and chronic
hypertension, even though caffeine intake can cause an acute (rapid but brief) increase
in blood pressure. This may be due to the fact that tolerance to caffeine develops rapidly.
Chronic overuse of alcohol is a potentially reversible cause of hypertension. Five percent
of hypertension is due to alcohol consumption and 30 to 60 percent of alcoholics have
hypertension. Alcohol-induced hypertension is more likely to occur in women than men.

Pharmacological Treatment of Hypertension

Hypertension is commonly treated with medication, and a combination of two or more
drugs is common. Patients are usually given a diuretic to help them excrete excess fluids.
However, most diuretics also cause excretion of potassium in the urine, and individuals
on diuretics should monitor their potassium intakes. Drugs used to control hyertension
include beta-blockers (e.g., atenolol [Tenorim]) which act to slow heart rate and cause
some vasodilation (widening of the lumen, or interior, of blood vessels). Drugs that
contain calcium channel blockers (e.g., amlopidine [Norvasc]) or angiotensinconverting
enzyme (ACE) inhibitors also cause vasodilation.

31

What is schizophrenia?
Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history.
About 1 percent of Americans have this illness.1
People with the disorder may hear voices other people don't hear. They may believe other people are reading
their minds, controlling their thoughts, or plotting to harm them. This can terrify people with the illness and
make them withdrawn or extremely agitated.
People with schizophrenia may not make sense when they talk. They may sit for hours without moving or
talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are really
thinking.
Families and society are affected by schizophrenia too. Many people with schizophrenia have difficulty holding

a job or caring for themselves, so they rely on others for help.

Treatment helps relieve many symptoms of schizophrenia, but most people who have the disorder cope with
symptoms throughout their lives. However, many people with schizophrenia can lead rewarding and meaningful
lives in their communities. Researchers are developing more effective medications and using new research tools
to understand the causes of schizophrenia. In the years to come, this work may help prevent and better treat the
illness.
When does schizophrenia start and who gets it?
Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world.
Symptoms such as hallucinations and delusions usually start between ages 16 and 30. Men tend to experience
symptoms a little earlier than women. Most of the time, people do not get schizophrenia after age 45.3
Schizophrenia rarely occurs in children, but awareness of childhood-onset schizophrenia is increasing.4,5
It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of
friends, a drop in grades, sleep problems, and irritabilitybehaviors that are common among teens. A
combination of factors can predict schizophrenia in up to 80 percent of youth who are at high risk of developing
the illness. These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts
and suspicions, and a family history of psychosis.6 In young people who develop the disease, this stage of the
disorder is called the "prodromal" period.
What causes schizophrenia?
Experts think schizophrenia is caused by several factors.
Genes and environment. Scientists have long known that schizophrenia runs in families. The illness occurs in 1
percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the
disorder, such as a parent, brother, or sister. People who have second-degree relatives (aunts, uncles,
grandparents, or cousins) with the disease also develop schizophrenia more often than the general population.
The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65 percent chance
of developing the disorder.15
We inherit our genes from both parents. Scientists believe several genes are associated with an increased risk of
schizophrenia, but that no gene causes the disease by itself.16 In fact, recent research has found that people with
schizophrenia tend to have higher rates of rare genetic mutations. These genetic differences involve hundreds of
different genes and probably disrupt brain development.17
Other recent studies suggest that schizophrenia may result in part when a certain gene that is key to making
important brain chemicals malfunctions. This problem may affect the part of the brain involved in developing
higher functioning skills.18 Research into this gene is ongoing, so it is not yet possible to use the genetic
information to predict who will develop the disease.
Despite this, tests that scan a person's genes can be bought without a prescription or a health professional's
advice. Ads for the tests suggest that with a saliva sample, a company can determine if a client is at risk for
developing specific diseases, including schizophrenia. However, scientists don't yet know all of the gene
variations that contribute to schizophrenia. Those that are known raise the risk only by very small amounts.
Therefore, these "genome scans" are unlikely to provide a complete picture of a person's risk for developing a
mental disorder like schizophrenia.
In addition, it probably takes more than genes to cause the disorder. Scientists think interactions between genes
and the environment are necessary for schizophrenia to develop. Many environmental factors may be involved,
such as exposure to viruses or malnutrition before birth, problems during birth, and other not yet known
psychosocial factors.
How is schizophrenia treated?
Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the
disease. Treatments include antipsychotic medications and various psychosocial treatments.
Antipsychotic medications
Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or
"typical" antipsychotics. Some of the more commonly used typical medications include:

Chlorpromazine (Thorazine)

Haloperidol (Haldol)

Perphenazine (Etrafon, Trilafon)

Fluphenazine (Prolixin).

One of these medications, clozapine (Clozaril) is an effective medication that treats psychotic symptoms,
hallucinations, and breaks with reality. But clozapine can sometimes cause a serious problem called
agranulocytosis, which is a loss of the white blood cells that help a person fight infection. People who take
clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood
tests make treatment with clozapine difficult for many people. But clozapine is potentially helpful for people
who do not respond to other antipsychotic medications.19
Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples include.

Risperidone (Risperdal)

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Ziprasidone (Geodon)

Aripiprazole (Abilify)

Paliperidone (Invega).

32

What is Scleroderma
cleroderma, or systemic sclerosis, is a chronic connective tissue disease generally classified as one of the
autoimmune rheumatic diseases.
The word scleroderma comes from two Greek words: sclero meaning hard, and derma meaning skin.
Hardening of the skin is one of the most visible manifestations of the disease. The disease has been called
progressive systemic sclerosis, but the use of that term has been discouraged since it has been found that
scleroderma is not necessarily progressive. The disease may take several forms which will be explained later.
There is also much variability among patients.
What causes scleroderma?
The exact cause or causes of scleroderma are still unknown, but scientists and medical investigators in a wide
variety of fields are working hard to make those determinations. It is known that scleroderma involves
overproduction of collagen.
what are the symptom?
Some types of scleroderma affect only the skin, while others affect the whole body.

*Localized scleroderma usually affects only the skin on the hands and face. It develops slowly, and rarely, if
ever, spreads throughout the body or causes serious complications.
*Systemic scleroderma, or sclerosis, may affect large areas of skin and organs such as the heart, lungs, or
kidneys. There are two main types of systemic scleroderma: Limited disease (CREST syndrome) and diffuse
disease.
Skin symptoms of scleroderma may include:
*Fingers or toes that turn blue or white in response to hot and cold temperatures (See: Raynaud's phenomenon)
*Hair loss
*Skin hardness
*Skin that is abnormally dark or light
*Skin thickening, stiffness, and tightness of fingers, hands, and forearm
*Small white lumps beneath the skin, sometimes oozing a white substance that looks like toothpaste
*Sores (ulcers) on the fingertips or toes
*Tight and mask-like skin on the face
Bone and muscle symptoms may include:
*Joint pain
*Numbness and pain in the feet
*Pain, stiffness, and swelling of fingers and joints
*Wrist pain
Breathing problems may result from scarring in the lungs and can include:
*Dry cough
*Shortness of breath
*Wheezing
*Digestive tract problems may include:
*Bloating after meals
*Constipation
*Diarrhea
*Difficulty swallowing
*Esophageal reflux or heartburn
*Problems controlling stools (fecal incontinence)
what are the Signs and tests to be done?
The health care provider will perform a physical exam. The exam may show hard, tight, thick skin.
Your blood pressure will be checked. Scleroderma can cause severe inflammation of small blood vessels, such
as those in the kidneys. Problems with your kidneys can lead to high blood pressure.
Blood tests may include:
*Antinuclear antibody (ANA) panel
*Antibody testing
*ESR (sed rate)
*Rheumatoid factor
Other tests may include:
*Chest x-ray
*CT scan of the lungs
*Echocardiogram
*Urinalysis
*Tests to see how well your lungs and gastrointestinal (GI) tract are working
*Skin biopsy
How serious is scleroderma?

Any chronic disease can be serious. The symptoms of scleroderma vary greatly from individual to individual,
and the effects of scleroderma can range from very mild to life-threatening. The seriousness will depend on what
parts of the body are affected and the extent to which they are affected. A mild case can become more serious if
not properly treated. Prompt and proper diagnosis and treatment by qualified physicians may minimize the
symptoms of scleroderma and lessen the chance for irreversible damage.
What is the treatment for scleroderma?
At the present time, there is no cure for scleroderma, but there are many treatments available. Some are directed
at particular symptoms like heartburn, which can be controlled by medications called proton pump inhibitors or
medicine to improve the motion of the bowel. Some treatments are directed at decreasing the activity of the
immune system. Some people with mild disease may not need medication at all and occasionally people can go
off treatment when their scleroderma is no longer active. Because there is so much variation from one person to
another there is great variation in the treatments prescribed.
what are the Preventive measures?
There is no known prevention. Reducing your exposure to silica dust and polyvinyl chloride may lower your
risk for this disease

33
What problems are caused by smoking?
By smoking, you can cause health problems not only for yourself but also for those around you.
Hurting Yourself
Smoking is an addiction. Tobacco contains nicotine, a drug that is addictive. The nicotine, therefore, makes it
very difficult (although not impossible) to quit. In fact, since the U.S. Surgeon General's 1964 report on the
dangers of smoking, millions of Americans have quit. Still, approximately 440,000 deaths occur in the U.S. each
year from smoking-related illnesses; this represents almost 1 out of every 5 deaths. The reason for these deaths
is that smoking greatly increases the risk of getting lung cancer, heart attack, chronic lung disease, stroke, and
many other cancers. Moreover, smoking is perhaps the most preventable cause of breathing (respiratory)
diseases within the USA.
Hurting Others
Smoking harms not just the smoker, but also family members, coworkers, and others who breathe the smoker's
cigarette smoke, called secondhand smoke or passive smoke. Among infants up to 18 months of age,
secondhand smoke is associated with as many as 300,000 cases of chronic bronchitis and pneumonia each year.
In addition, secondhand smoke from a parent's cigarette increases a child's chances for middle ear problems,
causes coughing and wheezing, worsens asthma, and increases an infant's risk of dying from sudden infant death
syndrome (SIDS).
Smoking is also harmful to the unborn fetus. If a pregnant woman smokes, her fetus is at an increased risk of
miscarriage, early delivery (prematurity), stillbirth, infant death, and low birth weight. In fact, it has been
estimated that if all women quit smoking during pregnancy, about 4,000 new babies would not die each year.
Exposure to passive smoke can also cause cancer. Research has shown that non-smokers who reside with a
smoker have a 24% increase in risk for developing lung cancer when compared with other non-smokers. An
estimated 3,000 lung cancer deaths occur each year in the U.S. that are attributable to passive smoking.
Secondhand smoke also increases the risk of stroke and heart disease. If both parents smoke, a teenager is more
than twice as likely to smoke as a teenager whose parents are both nonsmokers. Even in households where only
one parent smokes, young people are more likely to start smoking.

What is addictive disease and why is smoking considered an addictive disease?

The term addictive disease or addiction describes a persistent habit that is harmful to the person. Thus, addiction
is a chronic (long duration) disease with reliance on the substance causing the addiction. The addictive
substance also causes the accompanying deterioration of a person's physical and psychological health.
Psychologically, an individual's behavior pattern establishes how the addictive substance is used. One type of
behavior is compulsive behavior, which is an overwhelming and irresistible interest in use of the substance. For
example, the compulsive addict makes sure that the substance is always available. Another type of behavior is
habitual behavior, which is using the substance regularly or occasionally for the desirable effects. Physically,
continuous use of the substance leads to dependence on the drug by the body. This dependence means that when
the drug is discontinued, symptoms of withdrawal or distress occur.
Nicotine is the component of cigarettes that addicts. Almost immediately upon inhalation, the body responds to
the nicotine. An individual feels relaxed, calmer, and happier than before the inhalation. These pleasant feelings
reflect the physical side of addiction; but then, not smoking cigarettes causes a craving for more cigarettes,
irritability, impatience, anxiety, and other unpleasant symptoms. Indeed, these symptoms are the symptoms of
withdrawal from cigarettes. Moreover, with time, more and more nicotine is desired to produce the favorable
effects and to avoid the symptoms of withdrawal.
What are the signs of cigarette addiction?
The signs of addiction to cigarettes include:
smoking more than seven cigarettes per day;
inhaling deeply and frequently;
smoking cigarettes containing nicotine levels more than 0.9mg;
smoking within 30 minutes of awakening in the morning;
finding it difficult to eliminate the first cigarette in the morning;
smoking frequently during the morning;
finding it difficult to avoid smoking in smoking-restricted areas; and
needing to smoke even if sick and in bed.

34
What is the stomach?
The stomach is an organ of digestion. It has a saclike shape and is located between the esophagus and the
intestines. Almost every animal has a stomach.
The human stomach is a muscular, elastic, pear-shaped bag, lying crosswise in the abdominal cavity beneath the
diaphragm. It changes size and shape according to is position of the body and the amount of food inside. The
stomach is about 12 inches (30.5 cm) long and is 6 inches. (15.2 cm) wide at its widest point. The stomach's
capacity is about 1 qt (0.94 liters) in an adult.

Food enters the stomach from the esophagus. The connection between the stomach and the esophagus is called
the cardiac sphincter. The cardiac sphincter prevents food from passing back to the esophagus. Heart burn is the
sensation when stomach juices (gastric juice) is allowed to seep through the sphincter into the esophagus. Once
the food enters the stomach, gastric juices are used to break down the food. Some substances are absorbed
muscle lining of the stomach. One of the substances the stomach absorbs is alcohol.
The other end of the stomach empties into the duodenum. The duodenum is the first section of the small
intestine. The pyloric sphincter separates the stomach from the duodenum.
The stomach is composed of five layers. Starting from the inside and working our way out, the innermost layer
is called the mucosa. Stomach acid and digestive juices are made in the mucosa layer. The next layer is called
the submucosa. The submucosa is surrounded by the muscularis, a layer of muscle that moves and mixes the
stomach contents. The next two layers, the subserosa and the serosa are the wrapping for the stomach. The
serosa is the outermost layer of the stomach.
What Is Stomach Cancer?
Stomach cancer is a disease in which normal cells in the stomach tissues become cancerous and grow out of
control.
Experts have been unable to define one primary cause for stomach cancer, but many factors seem to be
involved. Some research suggests that stomach ulcers or stomach polyps can lead to cancer.
Stomach ulcers are raw or inflamed areas of the stomach lining and also are called gastric ulcers
Stomach polyps are noncancerous round growths that project into the stomach cavity
Environmental factors or infection by the bacteria Helicobacter pylori may be possible causes. Poor diet has also
been implicated.
The symptoms of stomach cancer in the early stages can be vague and include indigestion, discomfort, nausea,
or heartburn. Early symptoms are also symptomatic of many other gastrointestinal conditions (pertaining to the
digestive tract), so having symptoms does not necessarily mean stomach cancer.
Treatment varies by individual, but may include surgery, chemotherapy, radiation, biological therapy, or
participation in clinical trials.

35
What is a stroke?
Brain cell function requires a constant delivery of oxygen and glucose from the
bloodstream. A stroke, or cerebrovascular accident (CVA), occurs when blood supply to
part of the brain is disrupted, causing brain cells to die. Blood flow can be compromised
by a variety of mechanisms.
What causes a stroke?
Blockage of an artery
The blockage of an artery in the brain by a clot (thrombosis) is the most common cause
of a stroke. The part of the brain that is supplied by the clotted blood vessel is then
deprived of blood and oxygen. As a result of the deprived blood and oxygen, the cells of

that part of the brain die and the part of the body that it controls stops working. Typically,
a cholesterol plaque in a small blood vessel within the brain that has gradually caused
blood vessel narrowing ruptures and starts the process of forming a small blood clot.
Risk factors for narrowed blood vessels in the brain are the same as those that cause
narrowing blood vessels in the heart and heart attack (myocardial infarction). These risk
factors include:
high blood pressure (hypertension),
high cholesterol,
diabetes, and
smoking.
What is the treatment of a stroke?
Tissue plasminogen activator (TPA)
There is opportunity to use alteplase (TPA) as a clot-buster drug to dissolve the blood clot
that is causing the stroke. There is a narrow window of opportunity to use this drug. The
earlier that it is given, the better the result and the less potential for the complication of
bleeding into the brain.
Present American Heart Association guidelines recommend that if used, TPA must be
given within 4 1/2 hours after the onset of symptoms. for patients who waken from sleep
with symptoms of stroke, the clock starts when they were last seen in a normal state.
TPA is injected into a vein in the arm but, the time frame for its use may be extended to
six hours if it is dripped directly into the blood vessel that is blocked requiring
angiography, which is performed by an interventional radiologist. Not all hospitals have
access to this technology.
TPA may reverse stroke symptoms in more than one-third of patients, but may also cause
bleeding in 6% patients, potentially making the stroke worse.
For posterior circulation strokes that involve the vertebrobasilar system, the time frame
for treatment with TPA may be extended even further to 18 hours.
Heparin and aspirin
Drugs to thin the blood (anticoagulation; for example, heparin) are also sometimes used
in treating stroke patients in the hopes of improving the patient's recovery. It is unclear,
however, whether the use of anticoagulation improves the outcome from the current
stroke or simply helps to prevent subsequent strokes (see below). In certain patients,
aspirin given after the onset of a stroke does have a small, but measurable effect on
recovery. The treating doctor will determine the medications to be used based upon a
patient's specific needs.
Managing other Medical Problems
Blood pressure will be tightly controlled often using intravenous medication to prevent
stroke symptoms from progressing. This is true whether the stroke is ischemic or
hemorrhagic.

Supplemental oxygen is often provided.

In patients with diabetes, the blood sugar (glucose) level is often elevated after a stroke.
Controlling the glucose level in these patients may minimize the size of a stroke.
Patients who have suffered a transient ischemic attacks, the patient may be discharged
with blood pressure and cholesterol medications even if the blood pressure and
cholesterol levels are within acceptable levels. Smoking cessation is mandatory.
Rehabilitation
When a patient is no longer acutely ill after a stroke, the health care staff focuses on
maximizing the individuals functional abilities. This is most often done in an inpatient
rehabilitation hospital or in a special area of a general hospital. Rehabilitation can also
take place at a nursing facility.
The rehabilitation process can include some or all of the following:
1. speech therapy to relearn talking and swallowing;
2. occupational therapy to regain as much function dexterity in the arms and hands as
possible;
3. physical therapy to improve strength and walking; and
4. family education to orient them in caring for their loved one at home and the
challenges they will face.
The goal is for the patient to resume as many, if not all, of their pre-stroke activities and
functions. Since a stroke involves the permanent loss of brain cells, a total return to the
patient's pre-stroke status is not necessarily a realistic goal in many cases. However,
many stroke patients can return to vibrant independent lives.
Depending upon the severity of the stroke, some patients are transferred from the acute
care hospital setting to a skilled nursing facility to be monitored and continue physical
and occupational therapy.
Many times, home health providers can assess the home living situation and make
recommendations to ease the transition home. Unfortunately, some stroke patients have
such significant nursing needs that they cannot be met by relatives and friends and longterm nursing home care may be required

36

Description
Kleptomania is a complex disorder characterized by repeated, failed attempts to stop stealing. It is often seen in
patients who are chemically dependent or who have a coexisting mood, anxiety, or eating disorder. Other
coexisting mental disorders may include major depression, panic attacks, social phobia , anorexia nervosa ,
bulimia nervosa , substance abuse, and obsessive-compulsive disorder . People with this disorder have an
overwhelming urge to steal and get a thrill from doing so. The recurrent act of stealing may be restricted to

specific objects and settings, but the affected person may or may not describe these special preferences. People
with this disorder usually exhibit guilt after the theft.
Detection of kleptomania, even by significant others, is difficult and the disorder often proceeds undetected.
There may be preferred objects and environments where theft occurs. One theory proposes that the thrill of
stealing helps to alleviate symptoms in persons who are clinically depressed.
Demographics
Studies suggest that 0.6% of the general population may have this disorder and that it is more common in
females. In patients who have histories of obsessive-compulsive disorder, some studies suggest a 7% correlation
with kleptomania. Other studies have reported a particularly high (65%) correlation of kleptomania in patients
with bulimia.
Diagnosis
Diagnosing kleptomania is usually difficult since patients do not seek medical help for this complaint, and initial
psychological assessments may not detect it. The disorder is often diagnosed when patients seek help for another
reason, such as depression, bulimia, or for feeling emotionally unstable (labile) or unhappy in general
(dysphoric). Initial psychological evaluations may detect a history of poor parenting, relationship conflicts, or
acute stressorsabrupt occurrences that cause stress, such as moving from one home to another. The recurrent
act of stealing may be restricted to specific objects and settings, but the patient may or may not describe these
special preferences.
Treatments
Once the disorder is suspected and verified by an extensive psychological interview, therapy is normally
directed towards impulse control, as well as any accompanying mental disorder(s). Relapse prevention
strategies, with a clear understanding of specific triggers, should be stressed. Treatment may include
psychotherapies such as cognitive-behavioral therapy and rational emotive therapy . Recent studies have
indicated that fluoxetine (Prozac) and naltrexone (Revia) may also be helpful.

37
What is Lupus?
Lupus is an autoimmune disease where the body's immune system becomes hyperactive and attacks normal,
healthy tissue. This results in symptoms such as inflammation, swelling, and damage to joints, skin, kidneys,
blood, the heart, and lungs.
Under normal function, the immune system makes proteins called antibodies in order to protect and fight against
antigens such as viruses and bacteria. Lupus makes the immune system unable to differentiate between antigens
and healthy tissue. This leads the immune system to direct antibodies against the healthy tissue - not just
antigens - causing swelling, pain, and tissue damage.
(An antigen is a substance capable of inducing a specific immune response.)
What are the different types of lupus?
Several different kinds of lupus have been identified, but the type that we refer to simply as lupus is known as
systemic lupus erythematosus or SLE. Other types include discoid (cutaneous), drug-induced, and neonatal.

Patients with discoid lupus have a version of the disease that is limited to
the skin. It is characterized by a rash that appears on the face, neck, and
scalp, and it does not affect internal organs. Less than 10% of patients with
discoid lupus progress into the systemic form of the disease, but there is no
way to predict or prevent the path of the disease.
SLE is more severe than discoid lupus because it can affect any of the
body's organs or organ systems. Some people may present inflammation or other problems with only skin and
joints, while other SLE sufferers will see joints, lungs, kidneys, blood, and/or the heart affected. This type of
lupus is also often characterized by periods of flare (when the disease is active) and periods of remission (when
the disease is dormant).
Drug-induced lupus is caused by a reaction with certain prescription drugs and causes symptoms very similar to
SLE. The drugs most commonly associated with this form of lupus are a hypertension medication called
hydralazine and a heart arrhythmia medication called procainamide, but there are some 400 other drugs that can
also cause the condition. Drug-induced lupus is known to subside after the patient stops taking the triggering
medication.
A rare condition, neonatal lupus occurs when a mother passes autoantibodies to a fetus. The unborn and
newborn child can have skin rashes and other complications with the heart and blood. Usually a rash appears but
eventually fades within the first six months of the child's life.
Who is affected by lupus?
According to the Lupus Foundation of America (LFA), 1.5 to 2 million Americans have some form of lupus.
The prevalence is about 40 cases per 100,000 persons among Northern Europeans and 200 per 100,000 persons
among blacks. Although the disease affects both males and females, women are diagnosed 9 times more often
than men, usually between the ages of 15 and 45. African-American women suffer from more severe symptoms
and a higher mortality rate.
Other risk factors include exposure to sunlight, certain prescription medications, infection with Epstein-Barr
virus, and exposure to certain chemicals.
What causes lupus?
Although doctors are do not know exactly what causes lupus and other autoimmune diseases, most believe that
lupus results from both genetic and environmental stimuli.
Since lupus is known to occur within families, doctors believe that it is possible to inherit a genetic
predisposition to lupus. There are no known genes, however, that directly cause the illness. It is probable that
having an inherited predisposition for lupus makes the disease more likely only after coming into contact with
some environmental trigger.
The higher number of lupus cases in females than in males may indicate that the disease can be triggered by
certain hormones. Physicians believe that hormones such as estrogen regulate the progression of the disease
because symptoms tend to flare before menstrual periods and/or during pregnancy.
Certain environmental factors have been known to cause lupus symptoms. These include:
Extreme stress
Exposure to ultraviolet light, usually from sunlight
Smoking
Some medications and antibiotics, especially those in the sulfa and penicillin groups

Some infections, such as cytomegalovirus (CMV), parvovirus (such as fifth disease), hepatitis C infections,
and the Epstein-Barr virus (in children)
Chemical exposure to compounds such as trichloroethylene in well water and dust
What are the symptoms of lupus?
Since no two cases of lupus are exactly alike, there is a wide range of symptoms that are known to affect many
parts of the body. Sometimes symptoms develop slowly or appear suddenly; they can be mild, severe,
temporary, or permanent. Most people with lupus experience symptoms in only a few organs, but more serious
cases can lead to problems with kidneys, the heart, the lungs, blood, or the nervous system.
Lupus episodes, or flares, are usually noted by a worsening of some of the following symptoms:
Achy joints (arthralgia), arthritis, and swollen joints, especially in wrists, small joints of the hands, elbows,
knees, and ankles
Swelling of the hands and feet due to kidney problems
Fever of more than 100 degrees F (38 degrees C)
Prolonged or extreme fatigue
Skin lesions or rashes, especially on the arms, hands, face, neck, or back
Butterfly-shaped rash (malar rash) across the cheeks and nose
Anemia (oxygen carrying deficiency of red blood cells)
Pain in the chest on deep breathing or shortness of breath
Sun or light sensitivity (photosensitivity)
Hair loss or alopecia
Abnormal blood clotting problems
Raynaud's phenomenon: fingers turn white and/or blue or red in the cold
Seizures
Mouth or nose ulcers
Weight loss or gain
Dry eyes
Easy bruising
Anxiety, depression, headaches, and memory loss
Lupus can also lead to complications in several areas of the body. These include:
Kidneys - serious kidney damage is a primary cause of death for lupus sufferers.
Central nervous system - lupus can cause headaches, dizziness, memory problems, seizures, and behavioral
changes.
Blood and vessels - lupus causes an increased risk of anemia, bleeding, blood clotting, and vessel inflammation
Lungs - noninfectious pneumonia and difficulty breathing due to inflammation of the chest cavity are more
likely with lupus
Heart - heart muscle and artery inflammation are more likely with the disease, and lupus increases the chances
of cardiovascular disease and heart attacks.
Infection - lupus treatments tend to depress the immune system making your body more vulnerable to
infection.
Cancer - lupus increases the risk of cancer, especially of non-Hodgkin's lymphoma, lung cancer, and liver
cancer

Bone tissue death - a lower blood supply to bone tissue leads to tiny breaks and eventual death of bone. This is
most common in the hip bone.
Pregnancy - lupus increases the risk of miscarriage, hypertension during pregnancy, and preterm birth.

38
What is Malaria?
Malaria disease is a parasitic disease. This means that it is caused by
a parasite, a tiny organism that lives in or on other organisms called a
host. This parasites host is a mosquito. The parasite is transferred to a potential victim
when he or she is bitten by a mosquito.
Causes of Malaria Disease
Malaria is caused by a parasite that has infected the saliva glands of a female mosquito.
Once a mosquito that has been infected by the parasite that has grown to a certain stage
of development bites a someone then that person gets Malaria, then if a female Mosquito
(Genus: Anopheles) then bites that Malaria Disease victim the second mosquito can pass
it to other people without being infected itself (that mosquito is called a vector).
Signs and Symptoms
The symptoms of Malaria can vary greatly, from no symptoms at all or mild to extremely
serious and may even result in death. Malaria is often put into two different Categories.
One is Uncomplicated and the other is Complicated.
Incubation period - depending on the type of parasite the incubation period can range
anywhere from 7-30 days. People who have traveled to Malaria prone areas should tell
their doctor that they have done so, because even with the antimalarial drugs, some
types of Malaria can delay onset of symptoms for up to one year.
1. Uncomplicated Malaria
The general (but very infrequent) attack of Malaria usually continues 6-10 hours. There
are three phases to this and these usually return every 2 to 3 days depending upon the
type of parasite (there are 4 types).
A. The cold phase (shivering, feeling cold)
B. The hot phase (vomiting, fever, headache; convulsions in children)
C. The Sweating phase (sweating, normal temperature, sleepiness)
However, more frequently the patient usually has the following signs and symptoms:
chills, fever, nausea and vomiting, headache, general uncomfortable ness, and body
aches.
There may also be: Enlarged spleen, fever, perspiration, general weakness.
In P. falciparum Malaria there may be these added findings:Enlarged Liver, mild
jaundices, and increase respiratory rate.
Depending upon the country and the frequency that Malaria is experienced the patient
will either self-medicate; as we do here in America with a cold or they will seek
professional help after improper medications fail to take effect.

2. Complicated Malaria
This usually occurs where there is either low or no immunity to this disease, including
locations where Malaria Disease is rare or immunity is low because of other health risks.
Complicated Malaria results in blood and organ disorders, including fluid on the lung, and
loss of Kidney function.
In all areas of the world complicated Malaria Disease is an emergency and should be
treated as quickly and as intensely as possible because without treatment other major
medical problems appear and eventually death does occur. As with other conditions
pregnancy is complicated by the disease resulting in possibly early termination of the
pregnancy if the disease is severe enough.
In addition, relapses are also known to happen, even months and years after the first
attack. This is due to one genus of parasites having dormant stages that have been
known to reactivate long after the disease has been cured. There are medications that
are able to prevent this and should be started as soon after the first attack as possible.
Treatment of Malaria Disease
Laboratory tests should be performed and diagnosis of Malaria Disease should be
confirmed before any treatment is started. Not doing this should be reserved only for
special cases, limiting it to those situations where clear suspicion of a very extreme case
is determined and lack of facilities necessitates doing so.
Treatment is determined by three specifications:
1. The species of infecting parasite-this is for three different reasons.
a. P. falciparum causes a severe and quickly progressing illness or death, while the other
three species rarely are this severe.
b. P. Vivax and P. ovale demand treatment for forms that remain dormant and can induce
repeat infections.
c. P. Falciparum and P. Vivax are known for different resistance levels in different
geographic areas where infections occur. For P. Falciparum rapid beginning of
treatment is extremely necessary.
2. The physical state of the infected person.
3. The resistance level of the parasites determined by the place the person
was
when infected.
4. In addition other things to remember about the drug treatment
a. Other ailments the patient has.
b. Pregnancy
c. Drug allergies and sensitivities.

39
Memory loss

How does the brain store information?

Information is stored in different parts of your memory. Information stored in recent
memory may include what you ate for breakfast this morning. Information stored in the
short-term memory may include the name of a person you met moments ago.
Information stored in the remote or long-term memory includes things that you stored in
your memory years ago, such as memories of childhood.
How does aging change the brain?
When you're in your 20s, you begin to lose brain cells a few at a time. Your body also
starts to make less of the chemicals your brain cells need to work. The older you are, the
more these changes can affect your memory.
Aging may affect memory by changing the way the brain stores information and by
making it harder to recall stored information.
Your short-term and remote memories aren't usually affected by aging. But your recent
memory may be affected. For example, you may forget names of people you've met
today or where you set your keys. These are normal changes.

What are some other causes of memory problems?

Many things other than aging alone can cause memory problems. These include
depression, dementia (severe problems with memory and thinking, such as Alzheimer's
disease), side effects of drugs, strokes, head injury and alcoholism

40
What is neck pain? What causes neck pain?
Pain located in the neck is a common medical condition. Neck pain can come from a
number of disorders and diseases of any tissues in the neck, such as degenerative disc
disease, neck strain, whiplash, a herniated disc, or a pinched nerve. Neck pain is also
referred to as cervical pain.
What are other symptoms that are associated with neck pain?
Neck pain is commonly associated with dull aching. Sometimes pain in the neck is
worsened with movement of the neck. Other symptoms associated with some forms of
neck pain include numbness, tingling, tenderness, sharp shooting pain, fullness, difficulty
swallowing, pulsations, swishing sounds in the head, dizziness or lightheadedness, and
gland swelling.
Risk factors for neck pain include:
Age. The neck is often affected by the wear-and-tear variety of arthritis (osteoarthritis),
which becomes more common with age.
Occupation. Your risk of neck pain may be higher if your job requires your neck to be
held in one position for prolonged periods of time. Examples include driving and
computer work.
Most neck pain is associated with poor posture on top of age-related wear and tear. To
help prevent neck pain, keep your head centered over your spine, so gravity works with
your neck instead of against it. Some simple changes in your daily routine may help.
Consider trying to:

 Take frequent breaks if you drive long distances or work long hours at your computer.
Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your
teeth.
Adjust your desk, chair and computer so the monitor is at eye level. Knees should be
slightly lower than hips. Use your chair's armrests.
Avoid tucking the phone between your ear and shoulder when you talk. If you use the
phone a lot, get a headset.
Stretch frequently if you work at a desk. Shrug your shoulders up and down. Pull your
shoulder blades together and then relax. Pull your shoulders down while leaning your
head to each side to stretch your neck muscles.
Balance your base. Stretching the front chest wall muscles and strengthening the
muscles around the shoulder blade and back of the shoulder can promote a balanced
base of support for the neck.
Avoid sleeping on your stomach. This position puts stress on your neck. Choose a pillow
that supports the natural curve of your neck.
How is neck pain treated?
The treatment of neck pain depends on its precise cause. Treatment options include rest,
heat/ice applications, traction, soft collar, traction, physical therapy (ultrasound,
massage, manipulation), local injections of cortisone or anesthetics, topical anesthetic
creams, topical pain patches, muscle relaxants, analgesics, and surgical procedure.
41

What is Pancreatitis
Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the
duodenumthe first part of the small intestine. The pancreas secretes digestive juices, or enzymes, into the
duodenum through a tube called the pancreatic duct. Pancreatic enzymes join with bilea liquid produced in
the liver and stored in the gallbladderto digest food. The pancreas also releases the hormones insulin and
glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy.
Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine.
But when the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them.
Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases,
bleeding, infection, and permanent tissue damage may occur.
What is acute pancreatitis?
Acute pancreatitis is inflammation of the pancreas that occurs suddenly and usually resolves in a few days with
treatment. Acute pancreatitis can be a life-threatening illness with severe complications. Each year, about
210,000 people in the United States are admitted to the hospital with acute pancreatitis.1 The most common
cause of acute pancreatitis is the presence of gallstonessmall, pebble-like substances made of hardened bile
that cause inflammation in the pancreas as they pass through the common bile duct. Chronic, heavy alcohol use
is also a common cause. Acute pancreatitis can occur within hours or as long as 2 days after consuming alcohol.
Other causes of acute pancreatitis include abdominal trauma, medications, infections, tumors, and genetic
abnormalities of the pancreas.
How common is pancreatitis in children?
Chronic pancreatitis in children is rare. Trauma to the pancreas and hereditary pancreatitis are two known causes
of childhood pancreatitis. Children with cystic fibrosisa progressive and incurable lung diseasemay be at

risk of developing pancreatitis. But more often the cause of pancreatitis in children is unknown.
Treatment
Treatment for chronic pancreatitis may require hospitalization for pain management, IV hydration, and
nutritional support. Nasogastric feedings may be necessary for several weeks if the person continues to lose
weight.
When a normal diet is resumed, the doctor may prescribe synthetic pancreatic enzymes if the pancreas does not
secrete enough of its own. The enzymes should be taken with every meal to help the person digest food and
regain some weight. The next step is to plan a nutritious diet that is low in fat and includes small, frequent
meals. A dietitian can assist in developing a meal plan. Drinking plenty of fluids and limiting caffeinated
beverages is also important.
People with chronic pancreatitis are strongly advised not to smoke or consume alcoholic beverages, even if the
pancreatitis is mild or in the early stages

42
What Is Pneumonia?
Pneumonia is an inflammation or infection of the lungs most commonly caused by a bacteria or virus.
Pneumonia can also be caused by inhaling vomit or other foreign substances.In all cases, the lungs' air sacs fill
with pus , mucous, and other liquids and cannot function properly. This means oxygen cannot reach the blood
and the cells of the body.
Types of pneumonia
Most pneumonias are caused by bacterial infections.

The most common infectious cause of pneumonia in the United States is the bacteria Streptococcus
pneumoniae.

Other bacteria, as well as certain viruses, may also cause pneumonia. Since these infections may not
cause all of the classic pneumonia symptoms, they are often called "atypical pneumonias."

Aspiration (or inhalation) pneumonia is a swelling and irritation of the lungs caused by breathing in
vomit, fumes from such chemicals as bug sprays, pool cleaners, gasoline, or other substances. This
kind of pneumonia cannot be spread to other people.

What Causes Pneumonia?

There are about 30 different causes of pneumonia. However, they all fall into one of these categories:

Infective pneumonia: Inflammation and infection of the lungs and bronchial tubes that occurs when a
bacteria (bacterial pneumonia) or virus (viral pneumonia) gets into the lungs and starts to reproduce.

Aspiration pneumonia: An inflammation of the lungs and bronchial tubes caused by inhaling vomit,
mucous, or other bodily fluids. Aspiration pneumonia can also be caused by inhaling certain chemicals.

How Is Pneumonia Treated?

Treatment depends on the cause and severity of the pneumonia. Antibiotics are used to treat bacterial pneumonia
but are ineffective against viral pneumonia.
Treating Infective Pneumonia
Although the treatment for infective pneumonia depends on the cause of the condition, some simple steps can
help speed recovery from pneumonia:

Medications should be taken exactly as prescribed by a physician. If it is not helping, call the doctor.
Do not quit taking it unless told to do so by a doctor.

Take over-the-counter medicines such as acetaminophen or ibuprofen to help control pain and fever.

Use a cool-mist humidifier or vaporizer to increase air moisture and to make it easier to breathe. DO
NOT use hot steam.

Rest in bed until body core temperature returns to normal and chest pains and breathing problems are
gone. Drink six to eight glasses of liquids daily to help keep mucous thin and easy to cough up

43
What is Rabies
Rabies infections in people are rare in the United States. However, worldwide about 50,000 people die from
rabies each year, mostly in developing countries where programs for vaccinating dogs against rabies don't exist.
But the good news is that problems can be prevented if the exposed person receives treatment before symptoms
of the infection develop.
Rabies is a virus that in the U.S. is usually transmitted by a bite from a wild infected animal, such as a bat,
raccoon, skunk, or fox. If a bite from a rabid animal goes untreated and an infection develops, it is almost
always fatal.
If you suspect that your child has been bitten by a rabid animal, go to the emergency department immediately.
Any animal bites even those that don't involve rabies can lead to infections and other medical problems.
As a precaution, call your doctor any time your child has been bitten.
Signs and Symptoms
The first symptoms can appear from a few days to more than a year after the bite occurs.
One of the most distinctive signs of a rabies infection is a tingling or twitching sensation around the area of the
animal bite. It is often accompanied by a fever, headache, muscle aches, loss of appetite, nausea, and fatigue.
As the infection progresses, someone infected with rabies may develop any of these symptoms:

irritability

excessive movements or agitation

confusion

hallucinations

aggressiveness

bizarre or abnormal thoughts

muscle spasms

abnormal postures

seizures (convulsions)

weakness or paralysis (when a person cannot move some part of the body)

extreme sensitivity to bright lights, sounds, or touch

increased production of saliva or tears

difficulty speaking

In the advanced stage of the infection, as it spreads to other parts of the nervous system, these symptoms may
develop:

double vision

problems moving facial muscles

abnormal movements of the diaphragm and muscles that control breathing

difficulty swallowing and increased production of saliva, causing the "foaming at the mouth" usually
associated with a rabies infection

Treatment
At the hospital, it is likely that the doctor will first clean the wound thoroughly and make sure that your child's
tetanus immunizations are current.
To keep any potential infection from spreading, the doctor may decide to start treating your child right away
with shots of human rabies immune globulin to the wound site and vaccine shots in the arm. This decision is
usually based on the circumstances of the bite (provoked or unprovoked), the type of animal (species, wild or
domestic), the animal's health history (vaccinated or not), and the recommendations of local health authorities.

44

Teething Overview
Teething refers to the process of new teeth rising or erupting through the gums.
Teething can begin in infants as young as 2 months of age, even though the first tooth usually does not appear
until about age 6 months of age. Some dentists have noted a family pattern of "early," "average," or "late"
teethers. Usually, the first tooth to erupt is one of the lower, central incisors. Some children will have a pattern
of serial eruption of their teeth. Others will have multiple dental eruptions at the same time. As the tooth
penetrates the gums, the area may appear slightly red or swollen over the tooth. Sometimes a fluid-filled area
similar to a "blood blister" may be seen over the erupting tooth.
Some teeth may be more sensitive than others when they erupt. The first tooth to erupt may be the most
sensitive. Sometimes, the larger molars cause more discomfort due to their larger surface area that can't "slice"
through the gum tissue as an erupting incisor is capable of doing.
Teething Symptoms
Many children have little or no problem with teething, while others may have significant discomfort. Usually,
the pain with teething comes and goes and may seem to ease after several minutes.
Teething may cause the following symptoms:
increased drooling;
restless or decreased sleeping due to gum discomfort;
refusal of food due to soreness of the gum region;
fussiness that comes and goes;
bringing the hands to the mouth;
mild rash around the mouth due to skin irritation secondary to excessive drooling; and
rubbing the cheek or ear region as a consequence of referred pain during eruption of the molars.
Teething has not been shown to cause the following:
fever (especially over 101 degrees);
diarrhea, runny nose and cough;
prolonged fussiness; and
rashes on the body.
When to Seek Medical Care
Because teething is so common and other symptoms such as fever, fussiness, colds, and diarrhea are also
common, both conditions may often occur at the same time. Teething may not be causing these symptoms. Other
illnesses or disorders (for example, viral infections) are much more likely to be causing fever, fussiness, nasal
congestion with cough, and diarrhea. It is important to contact your doctor if these or other symptoms seem
concerning to you. Do not assume that they are just from the teething.
Teething should not require emergency care. If there is concern that something other than teething may be
causing symptoms, contact your health-care provider.
Exams and Tests
The diagnosis of teething is made based on the presence of the signs and symptoms.
Teething Treatment
Self-Care at Home
Often, the infant's gums feel better when gentle pressure is placed on the gums. For this reason, many doctors
recommend gently rubbing the gums with a clean finger or having the child bite down on a clean washcloth.
If the pain seems to be causing feeding problems, sometimes a different-shaped nipple or use of a cup may
reduce discomfort and improve feeding.

Cold objects may help reduce the inflammation as well. Veteran parents have discovered the usefulness of
frozen washcloths and ice cubes for this purpose. Be careful to avoid having prolonged contact of very cold
objects on the gums. Also, never put anything into a child's mouth that might cause the child to choke.
Use of pain medications: Some controversy surrounds the use of pain medicines for teething.
Medicines that can be placed on the gums: Certain over-the-counter medicines can be placed directly on the
gums to help relieve pain. They contain medicines that temporarily numb the gum. They may help for brief
periods of time, but they have a taste and sensation that many children do not like. It is important not to let the
medicine numb the throat because this may interfere with the normal gag reflex and may make it possible for
food to be aspirated and get into the lungs. For this reason, many doctors do not recommend the use of these
medicines. While some parents endorse topical medications, studies have not consistently shown their benefit.
Medicines that are taken by mouth to help reduce the pain: Acetaminophen (Children's Tylenol) or ibuprofen
(Children's Advil or Motrin) may also help with pain. Ibuprofen should not be administered to infants younger
than 6 months of age. Medications should be used only for the few times when the other home-care methods do
not help. Caution should be taken not to overmedicate for teething. The medicine may mask significant
symptoms that could be important to know about. Do not give children products containing aspirin.

45
What is tinnitus?
Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases it
is not a serious problem, but rather a nuisance that eventually resolves.
It is not a single disease, but a symptom of an underlying condition. Nearly 36 million Americans suffer from
this disorder. In almost all cases, only the patient can hear the noise.
What causes tinnitus?
Tinnitus can arise in any of the following areas: the outer ear, the middle ear, the inner ear, or by abnormailities
in the brain. Some tinnitus or head noise is normal. If one goes into a sound proof booth and normal outside
noise is diminished, one becomes aware of these normal sounds. We are usually not aware of these normal body
sounds, because outside noise masks them. Anything, such as wax or a foreign body in the external ear, that
blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or
disease of the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.
One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the
inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and
consequently tinnitus. Today, loud noise exposure is a very common cause of tinnitus, and it often damages
hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud
noise, firearms, and high intensity music. Some medications (for example, aspirin) and other diseases of the
inner ear (Meniere's syndrome) can cause tinnitus. Tinnitus can in very rare situations be a symptom of such
serious problems as an aneurysm or a brain tumor (acoustic tumor).

There are two main types of tinnitus?

1)Pulsatile (like a heartbeat) tinnitus is often caused by sounds created by muscle movements near the ear,
changes in the ear canal, or blood flow (vascular) problems in the face or neck. You may hear sounds such as
your own pulse or the contractions of your muscles.

2)Non-pulsatile tinnitus is caused by problems in the nerves involved with hearing. You may hear sounds in one
or both ears. Sometimes this type of tinnitus is described as coming from inside the head.
The most common cause of tinnitus is hearing loss that occurs with aging (presbycusis), but it can also be
caused by living or working around loud noises (acoustic trauma). Tinnitus can occur with all types of hearing
loss and may be a symptom of almost any ear disorder.
Other possible causes of tinnitus include:
A build-up of earwax.
Medicines, especially antibiotics or large amounts of aspirin.
Drinking an excessive amount of alcohol or caffeinated beverages.
Ear infections or eardrum rupture.
Dental or other problems affecting the mouth, such as temporomandibular (TM) problems.
Injuries, such as whiplash or a direct blow to the ear or head.
Injury to the inner ear following surgery or radiation therapy to the head or neck.
A rapid change in environmental pressure (barotraumas).
Severe weight loss from malnutrition or excessive dieting.
Repeated exercise with the neck in a hyper extended position, such as when bicycle riding.
Blood flow (vascular) problems, such as carotid atherosclerosis, AV malformations, and high blood pressure
(hypertension).
Nerve problems (neurological disorders), such as multiple sclerosis or migraine headache.
Other diseases. These may include:
Acoustic neuroma.
Anemia.
Labyrinthitis.
Menieres disease.
Otosclerosis.
Thyroid disease.
Most tinnitus that comes and goes does not require medical treatment. You may need to see your doctor if
tinnitus occurs with other symptoms, does not get better or go away, or is in only one ear. There may not be a
cure for tinnitus, but your doctor can help you learn how to live with the problem and make sure a more serious
problem is not causing your symptoms.
How is tinnitus evaluated?
A medical history, physical examination, and a series of special tests can help determine precisely where the
tinnitus is originating. It is helpful for the doctor to know if the tinnitus is constant, intermittent or pulsating
(synchronous with the heart beat), or is it associated with hearing loss or loss of balance (vertigo). All patients
with persisting unexplained tinnitus need a hearing test (audiogram). Patterns of hearing loss may lead the
doctor to the diagnosis.
Other tests, such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain
pathways, computer tomography scan (CT scan) or, magnetic resonance imaging (MRI scan) may be needed to
rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus.
What is the treatment of tinnitus?
After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make
recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is
your own understanding of the tinnitus (what has caused it, and your options for treatment).
In many cases, there is no specific treatment for tinnitus. It may simply go away on its own, or it may be a
permanent disability that the patient will have to "live with." Some otolaryngology's have recommended niacin

to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may
cause problems with skin flushing.

46
What is Trachoma?
Trachoma (Ancient Greek: "rough eye") is an infectious eye disease, and the leading
cause of the world's infectious blindness. Globally, 84 million people suffer from active
infection and nearly 8 million people are visually impaired as a result of this disease.
Globally this disease results in considerable disability.
Trachoma Symptoms
The bacterium has an incubation period of 5 to 12 days, after which the affected
individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye."
Blinding endemic trachoma results from multiple episodes of reinfection that maintains
the intense inflammation in the conjunctiva. Without reinfection, the inflammation will
gradually subside. The Simplified WHO Grading System is summarized below:
Trachomatous inflammation, follicular (TF) Five or more follicles of >0.5 mm on the
upper tarsal conjunctiva
Trachomatous inflammation, intense (TI) Papillary hypertrophy and inflammatory
thickening of the upper tarsal conjunctiva obscuring more than half the deep tarsal
vessels
Trachomatous trichiasis (TT) At least one ingrown eyelash touching the globe, or
evidence of epilation (eyelash removal)
Corneal opacity (CO) Corneal opacity blurring part of the pupil margin
Further symptoms include:
Eye discharge
Swollen eyelids
Trichiasis (turned-in eyelashes)
Swelling of lymph nodes in front of the ears
Corneal scarring
Further ear, nose and throat complications.
Trachoma Causes
Trachoma is caused by ''Chlamydia trachomatis'' and it is spread by direct contact with
eye, nose, and throat secretions from affected individuals, or contact with fomites
(inanimate objects), such as towels and/or washcloths, that have had similar contact with
these secretions. Flies can also be a route of mechanical transmission. Untreated,
repeated trachoma infections result in entropiona painful form of permanent blindness
when the eyelids turn inward, causing the eyelashes to scratch the cornea. Children are
the most susceptible to infection due to their tendency to easily get dirty, but the
blinding effects or more severe symptoms are often not felt until adulthood.

Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many
factors are indirectly linked to the presence of trachoma including lack of water, absence
of latrines or toilets, poverty in general, flies, close proximity to cattle, crowding and so
forth. However, the final common pathway seems to be the presence of dirty faces in
children that facilitates the frequent exchange of infected ocular discharge from one
childs face to another. Most transmission of trachoma occurs within the family.
Without intervention, trachoma keeps families shackled within a cycle of poverty, as the
disease and its long-term effects are passed from one generation to the next.
National governments in collaboration with numerous non-profit organizations implement
trachoma control programs using the WHO-recommended SAFE strategy, which includes:
Surgery to correct advanced stages of the disease;
Antibiotics to treat active infection, using Zithromax (azithromycin) donated by Pfizer
Inc through the International Trachoma Initiative;
Facial cleanliness to reduce disease transmission;
Environmental change to increase access to clean water and improved sanitation.
Surgery: For individuals with trichiasis, a bilamellar tarsal rotation procedure is
warranted to direct the lashes away from the globe. Early intervention is beneficial as the
rate of recurrence is higher in more advanced disease.
Antibiotic therapy: WHO Guidelines recommend that a region should receive
community-based, mass antibiotic treatment when the prevalence of active trachoma
among one to nine year-old children is greater than 10 percent. Subsequent annual
treatment should be administered for three years, at which time the prevalence should
be reassessed. Annual treatment should continue until the prevalence drops below five
percent. At lower prevalences, antibiotic treatment should be family-based.
Antibiotic selection: (single oral dose of 20 mg/kg) or topical tetracycline (one percent
eye ointment twice a day for six weeks). Azithromycin is preferred because it is used as a
single oral dose. Although it is expensive, it is generally used as part of the international
donation program organized by Pfizer through the International Trachoma Initiative.
Azithromycin can be used in children from the age of six months and in pregnancy.
In 1913, President Woodrow Wilson signed an act designating funds for the eradication of
the disease. The people that went through Ellis Island had to be checked for trachoma.
By the late 1930s, a number of ophthalmologists reported success in treating trachoma
with sulfonamide antibiotics. In 1948, Vincent Tabone (who was later to become the
President of Malta) was entrusted with the supervision of a campaign in Malta to treat
trachoma using sulfonamide tablets and drops.
Although by the 1950s, trachoma had virtually disappeared from the industrialized world,
thanks to improved sanitation and overall living conditions, it continues to plague the
developing world. This potentially blinding disease remains endemic in the poorest
regions of Africa, Asia, and the Middle East and in some parts of Latin America and
Australia. Currently, 8 million people are visually impaired as a result of trachoma, and 84
million suffer from active infection.

47
What is Typhoid
Typhoid is a severe, contagious and life-threatening disease. It is caused by contaminated food, drinks and water
by bacteria called S.typhi, which may result in fever with severe complications.
How is it Transmitted
Typhoid fever is transmitted in several ways. The bacteria are disseminated by typhoid patients and carriers in
large quantities through stools and vomit. The bacteria then find their way to food, drinks and water through
house-flies and other insects. These contaminated food or drinks, when consumed, causes typhoid fever.
Raw vegetables grown on sewage-irrigated fields also act as a source of infection.
The bacteria can survive in soil and water for several months. They grow rapidly in milk and milk-products.
Typhoid carriers can harbor the bacteria for many years, posing a potential danger to healthy individuals.
Unhygienic conditions in our surroundings are mainly responsible for the widespread infection.
Symptoms
In the initial stages: high fever, persistent headache, abdominal discomfort, constipation, diarrhoea, nasal
bleeding, weakness, dizziness and nausea.
In later stages: Constant high fever, diarrhoea and constipation, variable degrees of unconsciousness.
Typhoid often displays several misleading symptoms, thus making it difficult to diagnose.
Signs and Tests
An elevated white blood cell count in blood
A blood culture during first week of the fever can show S. typhi bacteria
A stool culture
An ELISA test on urine may show Vi antigen specific for the bacteria
A platelet count (decreased platelets )
A fluorescent antibody study (demonstrates Vi antigen, which is specific for typhoid)
Carriers
A carrier is a person infected with S.typhi, and may infect others, as the bacteria remain in the body for months.
3-5% of typhoid patients remain chronic carriers despite treatment.
Complications
Most common complications are intestinal bleeding and perforation.
Treatment
Appropriate antibiotics have to be used. There is a growing incidence of resistant strains of the bacteria. Hence
prevention is the best remedy.
Prevention
Clean hygienic habits, drinking only purified water, abstaining from eating raw leafy vegetables and food left in
the open. Vaccination is also necessary to prevent the disease: a single injection given 2 years onwards gives
protection against typhoid for 3 years.

48
What causes tetanus?
Tetanus is caused by a toxin (poison) produced by a bacterium, Clostridium tetani. The C.

tetani bacteria cannot survive in the presence of oxygen. They produce spores that are
very difficult to kill as they are resistant to heat and many chemical agents.
How does tetanus spread?
C. tetani spores can be found in the soil and in the intestines and feces of many
household and farm animals. The bacteria usually enter the human body through a
puncture (in the presence of anerobic [low oxygen] conditions, the spores will
germinate).
Tetanus is not spread from person to person.
How long does it take to show signs of tetanus after being exposed?
The incubation period varies from 3-21 days, with an average of eight days. The further
the injury site from the central nervous system, the longer the incubation period. The
shorter the incubation period, the higher the risk of death.
What are the symptoms of tetanus?
The symptoms of tetanus are caused by the tetanus toxin acting on the central nervous
system. In the most common form of tetanus, the first sign is a locked jaw, followed by
stiffness of the neck, difficulty in swallowing, and stiffness of the abdominal muscles.
Other signs include fever, sweating, elevated blood pressure, and rapid heart rate.
Spasms often occur, which may last for several minutes and continue for 3-4 weeks.
Complete recovery, if it occurs, may take months.
How serious is tetanus?
Tetanus has a high fatality rate: approximately 30% of reported cases result in death. As
there is no good treatment for tetanus, the percentage of infected individuals dying from
the disease has remained constant over the years in the United States.
What are possible complications from tetanus?
Laryngospasm (spasm of the vocal cords) is a complication that can lead to interference
with breathing. Patients can also break their spine or long bones from convulsions. Other
possible complications include hypertension, abnormal heart rhythm, and secondary
infections, which are common because of prolonged hospital stays.
Obviously, the high possibility of death is a major complication.
How is tetanus diagnosed?
The diagnosis of tetanus is based on the clinical signs and symptoms only. Laboratory
diagnosis is not useful as the C. tetani bacteria often cannot be recovered from the
wound of an individual who has tetanus, and conversely, can be isolated from the skin of
an individual who does not have tetanus.
What kind of injuries might allow tetanus to enter the body?
Tetanus bacilli live in the soil, so the most dangerous kind of injury involves possible
contamination with dirt, animal feces, and manure.
Although we have traditionally worried about deep puncture wounds, in reality many
types of injuries can allow tetanus bacilli to enter the body. In recent years, a higher
proportion of cases had minor wounds than had major ones, probably because severe
wounds were more likely to be properly managed. People have become infected with
tetanus following surgery, burns, lacerations, abrasions, crush wounds, ear infections,
dental infections, animal bites, abortion, pregnancy, body piercing and tattooing, and

injection drug use. People can also get tetanus from splinters.
I stepped on a nail in our yard. What should I do?
Any wound that may involve contamination with tetanus bacilli should be attended to as
soon as possible. Treatment depends on your vaccination status and the nature of the
wound. In all cases, the wound should be cleaned. Seek treatment immediately and bring
your immunization record with you.
With wounds that involve the possibility of tetanus contamination, a patient with an
unknown or incomplete history of tetanus vaccination needs a tetanus/diphtheria shot
(Td) and a dose of tetanus immune globulin (TIG) as soon as possible.
A person with a documented series of three Td (tetanus/diphtheria) doses who has
received a booster dose within the last ten years should be protected. However, to
ensure adequate protection, a booster dose of vaccine may still be given if it has been
more than five years since the last dose and the wound is other than clean and minor.
Is there a treatment for tetanus?
There is no "cure" for tetanus once a person develops symptoms, just supportive
treatment and management of complications. The best "treatment" is prevention through
immunization.
How common is tetanus in the United States?
Tetanus first became a notifiable disease in the late 1940s. At that time, there were 500600 cases reported per year. After the introduction of the tetanus vaccine in the mid1940s, reported cases of tetanus dropped steadily. In recent years, about 40 cases have
occurred each year in the United States.
Most cases have been among persons 50 years of age or older, although recently an
increasing number of cases have been reported in younger persons, primarily injecting
drug users.
Almost all cases of tetanus are in persons who have never been vaccinated, or who
completed their childhood series, but did not have a booster dose in the preceding 10
years.
What is neonatal tetanus?
Neonatal tetanus is a form of tetanus that occurs in newborn infants, most often through
the use of an unsterile cutting instrument on the unhealed umbilical stump. These babies
usually have no temporary immunity passed on from their mother because their mother
hasn't been vaccinated and therefore has no immunity.
Neonatal tetanus is very rare in the United States (two cases reported since 1989), but is
common in some developing countries. It causes more than 270,000 deaths worldwide
per year.
Can you get tetanus more than once?
Yes! Tetanus disease does not cause immunity because so little of the potent toxin is
required to cause the disease. Persons recovering from tetanus should begin or complete
the vaccination series.

49
What is Weight loss
In today's world, where everybody is getting conscious about looking good, it has
become all the more necessary to keep oneself in shape. If you have a good figure, not
only it enables you to flaunt your body, but also it helps in boosting your confidence
level. For some people, obesity becomes a serious cause of concern, thus affecting their
mental fitness.
There are several reasons as why some people are overweight. It is interesting to know
that your metabolism rate has a major impact on your weight loss program. People with
low metabolism have a hard time in losing weight because of their slow metabolism fat
gets stored in their bodies. There are some people who suffer from the problem of
hormonal imbalance, but one of the major causes of obesity in people is their unhealthy
eating habits and inadequate exercising.
Healthy Weight Loss
Guided by simple dieting principles, the healthy weight loss concept reveals the way to
lasting weight loss success.
Professional and expert weight loss information, support, and dieting solutions are
presented in simple and easy to follow instructions...for free.
This site is more than just good diet plans. We will show you the keys to losing weight,
and keeping it off. We give you the information you need to lose fat, not muscle.
Think of this as your place for finding a cure to your weight problem. A free weight loss
resource for helping you to finally experience lasting success.
Weight Loss Tips
Food Factors
When it comes to finding quick weight loss diet tips that work, selecting your foods for
your diet can be a real balancing act. You have to lose some of what youve grown
accustomed to and add some items that may be new to you. Heres some quick weight
loss tips that experts recommend to promote weight loss.
Reduce fat.
With regard to fat, the research is clear: Diets too high in fat promote overweight and
obesity. You should strive to consume no more than 25 percent of your calories from fat
and that fat should the non-saturated type.
Dont be so sweet.
Numerous studies have linked table sugar to increased calorie consumption. While sugar
doesnt do as much dietary damage as fat, youll find that when you eat sweets, you
simply want to eat more of everything. Not only that, but sugar also makes your body
excrete chromium, and chromium is a mineral that helps your body build calorie-burning
lean tissue so you want to keep your chromium levels up.
Drink up.
If people want to keep their nutrients in balance, they need to drink plenty of plain,
unflavored water every day, says Judy Dodd, R.D., past president of the American
Dietetic Association. Water not only acts as a solvent for many vitamins and minerals but

also is responsible for carrying nutrients into and wastes out of cells, so the body
functions properly. As a rule of thumb, you should drink a half-ounce of water for every
pound of body weight daily, unless youre very active, in which case you should increase
your water intake to two-thirds of an ounce per pound of body weight daily. So if you
weigh 100 pounds, you should drink 50 ounces of water a day as a minimum
Get treatment for food allergies.
Some researchers believe that being overweight is the result of people craving foods that
they are allergic to. For these people, weight loss is extremely difficult until they figure
out what those trigger foods are and eliminate them from their diets.
There are specific food allergies that trigger uncontrollable craving and bingeing, says
Joseph D. Beasley, M.D., director of Comprehensive Medical Care in Amityville, New York.
Its a common problem in overeaters.
If you suspect that food allergies might be part of your problem, ask your doctor to help
you identify the offending items. Your doctor may recommend that you see an allergy
specialist.

50

What is Osteoporosis
Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and
resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a
sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones.
Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are
affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone
to fracture. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a
compression fracture of the vertebrae of the spine). The spine, hips, ribs, and wrists are common areas of bone
fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.
How is osteoporosis diagnosed?
A routine X-ray can reveal osteoporosis of the bone because the bones appear much thinner and lighter than
normal bones. Unfortunately, by the time X-rays can detect osteoporosis, at least 30% of the bone has already
been lost. In addition, X-rays are not accurate indicators of bone density. Thus, the appearance of the bone on Xray often is affected by variations in the degree of exposure of the X-ray film.
The National Osteoporosis Foundation, the American Medical Association, and other major medical
organizations recommend a dual-energy X-ray absorptiometry scan (DXA, formerly known as DEXA) for
diagnosing osteoporosis. DXA measures bone density in the hip and the spine. The test takes only five to 15
minutes to perform, exposes patients to very little radiation (less than one-tenth to one-hundredth of the amount
used on a standard chest X-ray), and is quite precise.
The bone density of the patient is compared to the average peak bone density of young adults of the same sex
and race. This score is called the "T score," and it expresses the bone density in terms of the number of standard
deviations (SD) below peak young adult bone mass.
How is osteoporosis treated and prevented?

The goal of treatment of osteoporosis is the prevention of bone fractures by reducing bone loss or, preferably, by
increasing bone density and strength. Although early detection and timely treatment of osteoporosis can
substantially decrease the risk of future fractures, none of the available treatments for osteoporosis are complete
cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis.
Therefore, prevention of osteoporosis is as important as treatment. Osteoporosis treatment and prevention
measures are
1. lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol intake, exercising
regularly, and consuming a balanced diet with adequate calcium and vitamin D;
2. medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate
(Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast);
3. medications that increase bone formation such as teriparatide (Forteo).