Mental Retardation

What is it?

Mental retardation is a developmental disability that can appear from birth through the age of 18. People who are mentally retarded function at an intellectual level that is below average and have difficulties with learning and daily living skills.

Who gets it?

Approximately 2.5 to 3% of the total population are mentally retarded. In most cases, it is a lifelong condition. There is no connection between mental retardation and gender or race.

What causes it?

In many cases, the cause of mental retardation is not found. About 5% of all cases can be linked to heredity. In these instances, the cause is a genetic defect, such as an inherited abnormal gene, gene mutation, or chromosomal defect. In very simple terms, genes are carried on thread-like structures called chromosomes, and determine our individual characteristics, such as how we look. Just one missing or faulty gene or chromosome can cause a birth defect. Two of the most common inherited causes of mental retardation are fragile X syndrome, caused by a defect in the chromosome that determines sex, and Down syndrome, caused by an extra chromosome. Gene defects such as phenylketonuria (PKU) can cause mental retardation if not found and treated early, as can hypothyroidism. Mental retardation can also occur as a result of the mother's behaviors or illnesses during pregnancy. Behaviors that can affect the fetus' developing brain include poor nutrition, excessive alcohol consumption, drug abuse, and cigarette smoking during pregnancy. Mental retardation due to alcohol abuse is called fetal alcohol syndrome. Pregnant women who have infections or illnesses such as rubella (German measles), cytomegalovirus, toxoplasmosis, glandular disorders, high blood pressure, or blood poisoning, or who are exposed to radiation during pregnancy, may have a mentally retarded child.
Some birth defects that affect the head, brain, and central nervous system have mental retardation as a symptom. For example, neural tube defects, where the neural tube that forms the spinal cord does not close completely, can cause cerebrospinal fluid to accumulate on the brain. The pressure causes hydrocephalus, a cause of mental retardation. Difficulties in the birth process can also result in mental retardation. These include premature birth, head injury during birth, or lack of oxygen. Children can be born with normal intelligence but develop mental retardation because of childhood illnesses or injuries. Illnesses that cause mental retardation if not properly treated include chickenpox, measles, whooping cough, hyperthyroidism, or a bacterial infection called Hib disease. Meningitis and encephalitis can cause swelling in the brain that causes brain damage and mental retardation. Children who suffer a traumatic brain injury either accidentally or through abuse that includes violent blows to or shaking of the head may suffer brain damage and mental retardation.
Environmental factors that affect mental development include emotional and physical neglect. Daily stimulation is essential to a child's mental development. Infants who are neglected, as well as those who do not receive adequate nutrition, may suffer irreversible mental setbacks. Small children who live in older apartment buildings and homes painted with lead-based paint are at risk for developing lead poisoning if they put flakes of this paint into their mouths. Lead exposure can also cause mental retardation.

What are the symptoms?

The severity of symptoms of mental retardation and when they appear depend upon the cause. Symptoms appear during infancy if the condition is caused by a genetic disorder or an event during the pregnancy or birth process. A childhood illness or injury that causes a brain injury may suddenly make once easy tasks difficult for the child, and cause learning difficulties. In general, children who are mentally retarded fall behind when it comes to reaching developmental milestones. They may also show signs of aggression and self-injury. As they get older their scores on standardized intelligent quotient (IQ) tests are low and they have difficulties with daily life skills, called adaptive skills. Adaptive skills include basic communication, self-care, social, safety, and work skills. IQ levels are generally used to classify degrees of mental retardation. Children with mild retardation score in the range of 50 to 75. These children may not be diagnosed until they enter school because they develop social and communication skills during their first five years. However, learning difficulties become evident in a formal school setting. These children can learn up to the 6th grade level and can live independently with the support of family, community, and social services. Most children who are mentally retarded are in the mild category. About 10% of those with mental retardation are considered moderately retarded, with IQ scores in the range of 35 to 55. During early childhood, these children are able to learn to talk and communicate, but have poor social skills and awareness. Academically, they have difficulty working past the 2nd grade level. With supervision, they can learn some skills and take care of their personal needs. As these children reach adulthood, they can work well in a supervised setting, such as a group home. Children are classified as severely retarded when their IQ scores fall in the range of 20 to 40. This group accounts for only 3 to 4% of the mentally retarded population. The severely retarded have poor muscle coordination and limited communication and self-care skills during early childhood. By school age, they can learn some basic self-care and communication skills. These children benefit from living in a group home as they reach adulthood, and can perform some self-care under complete supervision.
Profound retardation accounts for 1 to 2% of all mentally retarded people. With IQ scores of 20 to 25, these children have little muscle coordination during early childhood and do not reach developmental milestones, such as walking and talking. As they grow older, they may be able to perform some of the most basic self-care skills and may develop some speech skills. However, the profoundly retarded require skilled nursing care and constant supervision. Studies have shown that those with severe to profound mental retardation have a shortened life expectancy due to diseases that are often associated with these degrees of retardation. The American Association on Mental Retardation (AAMR) classifies degrees of mental retardation by the level of support the individual needs. These are intermittent support, limited support, extensive support, and pervasive (constant) support.

How is it diagnosed?

Early diagnosis of mental retardation is important for developing an individualized plan for learning and life skills. If your doctor suspects mental retardation, he or she will take a complete medical history and perform a physical examination to determine symptoms and their possible cause. You may also need to see a child neurologist or neuropsychologist, who specializes in disorders of the nervous system. If your child is old enough, he or she may be given a standardized test of intelligence (IQ test). Commonly used tests include the Stanford-Binet Intelligence Scale, the Wechsler Intelligence Scales, the Wechsler Preschool and Primary Scale of Intelligence, and the Kaufmann Assessment Battery for Children. Physicians generally use the Bayley Scales of Infant Development to assess developmental skills in younger children. The Woodcock-Johnson Scales of IndependentBehavior and the Vineland Adaptive Behavior Scale (VABS) may also be used. Your doctor will make a diagnosis of mental retardation if your child has below average intellectual skills (an IQ below 70 - 75) and is limited in two or more adaptive skill (life skills) areas. During the 16th to 20th weeks of pregnancy, a small amount of amniotic fluid can be withdrawn from the mother's womb and tested for a number of genetic defects. This test is called amniocentesis. A low level of alpha-fetoprotein in the amniotic fluid or in the mother's blood during pregnancy can indicate Down syndrome in the fetus.

What is the treatment?

Treatment of mental retardation involves developing an individualized plan based upon the child's skills and needs. Early intervention programs are available in many areas to assess the needs of mentally retarded children under the age of three and provide treatment. The federal government mandates that all children between the ages of 3 and 21 who are mentally retarded receive testing and individualized education and skills training, as appropriate, within the public school system at no charge to the child's family. The severity of retardation determines how far the child can go within the school system. The most important component of any treatment program is the love and support of the family. Most families with a mentally retarded child benefit from family therapy and support groups that help the family cope with the day-to-day demands of raising a child with special needs. Older mentally retarded children benefit from occupational therapy to help them develop life skills that will aid them in functioning independently or semi-independently as adults. While there are exceptions, most mentally retarded children will thrive in a loving home environment, rather than a residential facility. All newborns should be screened for phenylketonuria (PKU) and hyperthyroidism. Immediate treatment of these disorders can prevent retardation.

Self-care tips

If you are pregnant, you can help prevent mental retardation in your unborn child by getting good prenatal care, avoiding alcohol and cigarette smoking, following a healthy diet that is rich in green leafy vegetables, and taking prenatal vitamins, as recommended by your healthcare provider. Having your child immunized against diseases such as measles and Hib can also prevent the types of illnesses that can cause mental retardation. If you have mentally retarded child, seek the support of family and community. Your healthcare provider can put you in touch with a local agency that can help provide you with the resources you need to keep your family strong.

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What is Rabies ?
Rabies is a serious viral disease that affects the central nervous system of mammals. The disease typically spreads by way of the saliva of infected animals - often, but not always, through a bite.
Once you're infected, the virus spreads from peripheral nerves to your spinal cord and brain. From initial flu-like signs and symptoms, the illness can progress to convulsions, paralysis or breathing failure. Death can occur if you don't seek treatment immediately after exposure.
Your risk of exposure to rabies is greater when you come into contact with a wild animal. Domesticated animals such as cats, dogs and cattle account for less than 10 percent of reported rabies cases. Most pets and domesticated animals receive vaccinations against rabies.
Your chances of exposure to the rabies virus are much greater than are your chances of dying from it. Treatment consists of a series of rabies shots, which prevent symptoms and death.


Rabies doesn't cause any signs or symptoms until late in the disease, often just days before death. Signs and symptoms may include:

• Fever
• Headache
• Agitation
• Anxiety
• Confusion
• Difficulty swallowing
• Excessive salivation
• Fear of water (hydrophobia) because of the difficulty in swallowing
• Hallucinations
• Insomnia
• Partial paralysis

Rabies infection is caused by the rabies virus. The virus is spread through the saliva of infected animals. Infected animals can spread the virus by biting another animal or person. In rare cases, rabies can be spread when infected saliva gets into an open wound or the mucous membranes, such as the mouth or eyes. This could occur if an infected animal were to lick an open cut on your skin.
Animals that can transmit the rabies virus
Any mammal can transmit the rabies virus. The animals most likely to transmit the rabies virus to people include:
Pets and farm animals

• Cats
• Cows
• Dogs
• Ferrets
• Goats
• Horses
• Rabbits

Wild animals

• Bats
• Beavers
• Coyotes
• Foxes
• Monkeys
• Raccoons
• Skunks
• Woodchucks

Screening and diagnosis

If you've been bitten or have had contact with an animal that may have rabies, taking note of certain information may help your doctor determine your risk of contracting rabies and how to treat you. Take note of the following:

• Where the incident occurred

• The type of animal

• If you were bitten, whether the animal was provoked or confronted

• The vaccination status of a domesticated animal

• Whether the animal can be safely captured to be tested for rabies

Once a potentially rabid animal is captured, health professionals conduct tests on the animal's brain tissue to determine whether it has rabies. Testing can be done quickly, but only after the animal is dead.
Testing humans to identify or rule out rabies infection requires a number of tests using blood, saliva, spinal fluid and skin biopsies taken from the nape of the neck. Human testing takes longer than animal testing.

Treatment

If your doctor determines that you likely were exposed to rabies, treatment begins at once. The sooner you begin treatment, the greater your chance of recovery.
Treatment for rabies after an animal bite, treatment — called post-exposure prophylaxis — consists of one dose of rabies immunoglobulin and five doses of rabies vaccine over a 28-day period. Rabies immunoglobulin and the first dose of rabies vaccine are administered as soon as possible after you've been exposed and have reported the exposure to your doctor. You're given the immunoglobulin by injection around the site of the bite, and you receive injections of the vaccine into your upper arm muscle.
Immunoglobulins are disease-fighting proteins that provide you with temporary antibodies. The rabies vaccine helps your body start producing its own antibodies. Antibody production takes time, but the antibodies produced by your body provide longer-lasting protection than do the ones contained in rabies immunoglobulin.

The three types of rabies vaccines are all made from killed rabies virus:

• Human diploid cell rabies vaccine (HDCV), the most commonly used vaccine

• Rabies vaccine adsorbed (RVA)

• Purified chick embryo cell vaccine (PCEC)

You might have a mild physical reaction to the vaccines. Watch for reactions such as swelling or redness where the injection occurred. Headache, fever, nausea, muscle aches and dizziness are other possible side effects. Contact your doctor if side effects cause you discomfort.

What is Tetanus?

Tetanus is the result of an infection that affects the muscles and nerves, usually
due to a contaminated wound. Tetanus is a serious bacterial infection that leads to stiffness of your jaw and other muscles. It can cause severe muscle spasms, make breathing difficult and, ultimately, threaten your life.

A cut, puncture wound, bite or other wound, even if minor, can lead to a tetanus infection in someone without immunity to the infection. Spores of the tetanus bacteria, Clostridium tetani, usually are found in the soil but can occur virtually anywhere. If they enter a wound beyond the reach of oxygen, they produce a toxin that interferes with the nerves controlling your muscles.

Treatment is available, but the process is lengthy and not uniformly effective. Tetanus may be fatal despite treatment. A small number of those result in death. The number of cases and of resulting deaths is far higher in developing countries. The best defense against tetanus is prevention.

Where do tetanus bacteria grow in the body?

Contaminated wounds are the sites where tetanus bacteria multiply. Deep wounds or those with devitalized (dead) tissue are particularly prone to tetanus infection.
Puncture wounds such as those caused by nails, splinters, or insect bites are favorite locations of entry for the bacteria. The bacteria can also be introduced through burns, any break in the skin, and injection-drug sites. Tetanus can also be a hazard to both the mother and newborn child (by means of the uterus after delivery and through the umbilical cord stump).
The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm in this disease.

How does the tetanus toxin cause damage to the body?

The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates. This region is called the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate. Of note, because of tetanus vaccination programs, only three cases of neonatal tetanus have been reported since 1990, and in each of these cases, the mothers were incompletely immunized.

What is the incubation period for tetanus?

The incubation period between exposure to the bacteria in a contaminated wound and development of the initial symptoms of tetanus ranges from two days to two months, but it's commonly within 14 days of injury.

Causes

The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The effect of the toxin on your nerves can cause muscle stiffness and spasms — the major signs of tetanus.

Signs and symptoms of tetanus may include:
Stiffness of the jaw, neck and other muscles
Irritability
Spasms of your jaw and neck muscles
Painful muscle spasms

Some people may experience only pain and tingling at the wound site and some spasms in nearby muscles. But as the toxin spreads to nerves supplying muscles, most people have stiffness of the jaw and neck, difficulty swallowing and irritability. Facial and jaw muscles are most often affected by strong spasms. This is why tetanus is commonly referred to as lockjaw.

Spasms of your jaw or facial muscles progress to spasms and rigidity of your neck, abdominal and back muscles. Finally, severe spasms can affect respiratory muscles and make it difficult for you to breathe. You're usually awake and alert throughout the disease.


Treatment

Tetanus may be mild and its effects limited to one part of your body if you have a partial immunity to tetanus. Recovery can occur without treatment. However, mild forms of tetanus aren't common. In most cases of tetanus, the illness is severe and widespread, and there's a risk of death despite treatment.

Treatment may include use of an antibody, tetanus immune globulin (TIG), and tetanus antitoxin. However, the antitoxin can only neutralize toxin that hasn't yet combined with nerve tissue. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.

Tetanus infection usually requires a long period of treatment in an intensive care setting. Drugs will be used to sedate you and to paralyze your muscles so that breathing must be supported temporarily by a ventilator. In some cases, you may need to use a ventilator for 2 to 3 weeks.

Death may result from constriction of airways, pneumonia or instability in the autonomic nervous system. The autonomic nervous system is the part of your nervous system that controls your heart muscles, other involuntary muscles and glands. People who recover from tetanus sometimes have lasting effects, including defects in the nervous system and psychological problems that may require psychotherapy.

How is tetanus prevented?

Active immunization ("tetanus shots") plays an essential role in preventing tetanus. Preventative measures to protect the skin from being penetrated by the tetanus bacteria are also important. For instance, precautions should be taken to avoid stepping on nails by wearing shoes. If a penetrating wound should occur, it should be thoroughly cleansed with soap and water and medical attention should be sought. Finally, passive immunization can be administered in selected cases (with specialized immunoglobulin).

Fibromyalgia is a chronic condition that causes pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, chronic fatigue, anxiety, depression, and disturbances in bowel function. Fibromyalgia is sometimes referred to as fibromyalgia syndrome and abbreviated FMS. Fibromyalgia was formerly known as fibrositis.

While fibromyalgia is one of the most common diseases affecting the muscles, its cause is currently unknown. The painful tissues involved are not accompanied by tissue inflammation. Therefore, despite potentially disabling body pain, patients with fibromyalgia do not develop body damage or deformity. Fibromyalgia also does not cause damage to internal body organs. In this sense, fibromyalgia is different from many other rheumatic conditions (such as rheumatoid arthritis, systemic lupus, and polymyositis). In those diseases, tissue inflammation is the major cause of pain, stiffness, and tenderness of the joints, tendons and muscles, and it can lead to joint deformity and damage to the internal organs or muscles.

Causes

Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:

• Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
• Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
• Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Why does it hurt?
Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.
Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

Tests and Investigation

The American College of Rheumatology has established two criteria for the diagnosis of fibromyalgia:

• Widespread pain lasting at least three months
• At least 11 positive tender points — out of a total possible of 18

Tender points
During your physical exam, your doctor may check specific places on your body for tenderness. The amount of pressure used during this exam is usually just enough to whiten the doctor's fingernail bed. These 18 tender points are a hallmark for fibromyalgia.
Blood tests
While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:

• Complete blood count
• Erythrocyte sedimentation rate
• Thyroid function tests

What is the treatment for fibromyalgia?

Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs must be individualized for each patient. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan.

 

Stroke is a cardiovascular disease. It affects the blood vessels that supply blood to the brain. When blood flow to the brain is impaired, oxygen and important nutrients cannot be delivered. The result is abnormal brain function. Blood flow to the brain can be disrupted by either a blockage or rupture of an artery to the brain. There are many causes for a stroke. This is a medical emergency. Prompt treatment could mean the difference between life and death. Early treatment can also minimize damage to your brain and potential disability.
Stroke is the third leading cause of death and the leading cause of adult disability; only cardiovascular disease and cancer cause more deaths annually

Types of Strokes

 There are two major kinds of stroke, ischemic and hemorrhagic.
In an ischemic stroke a blood vessel becomes blocked, usually by a blood clot and a portion of the brain becomes deprived of oxygen and will stop functioning.
Ischemic strokes account for 80% of all strokes. Rapid diagnosis and treatment of acute ischemic strokes is essential to reduce death and disability from stroke. That's why learning the FAST acronym is so important:

• F = Face: Is one side of the face drooping down?
• A = Arm: Can the person raise both arms, or is one arm weak?
• S = Speech: Is speech slurred or confusing?
• T = Time: Time is critical!! Call 9-1-1 immediately!

Hemorrhagic Stroke

A hemorrhagic stroke occurs when a blood vessel that carries oxygen and nutrients to the brain burst and spills blood into the brain. When this happens, a portion of the brain becomes deprived of oxygen and will stop functioning. Hemorrhagic stroke accounts for about 20% of strokes. The most common signs of a hemorrhagic stroke are:

• Sudden severe headache with no known cause, often described as "the worst headache of my life"
• Partial or total loss of consciousness
• Vomiting or severe nausea, when combined with other symptoms
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

Transient Ischemic Attacks

Transient Ischemic Attacks (TIAs) are often called mini-strokes. The symptoms are the same as for a major stroke. In a TIA, the blood clot that is blocking the flow of blood in the brain breaks up on its own and the symptoms disappear after a short period of time. TIAs generally don't cause severe brain damage, but they are a warning sign of a future stroke and should be taken seriously. Even if symptoms disappear quickly, it is important to seek medical care immediately to prevent a future major stroke.

What are stroke symptoms?

When brain cells are deprived of oxygen, they cease to perform their usual tasks. The symptoms that follow a stroke depend on the area of the brain that has been affected and the amount of brain tissue damage.
Small strokes may not cause any symptoms, but can still damage brain tissue. These strokes that do not cause symptoms are referred to as silent strokes. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), these are the five major signs of stroke:

1. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may an associated tingling sensation in the affected area.
   
2. Sudden confusion or trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling.
3. Sudden trouble seeing in one or both eyes
4. Sudden trouble walking, dizziness, loss of balance or coordination
5. Sudden, severe headache with no known cause 

Causes

A stroke disrupts the flow of blood through your brain and damages brain tissue. There are two chief types of stroke. The most common type — ischemic stroke — results from blockage in an artery. The other type — hemorrhagic stroke — occurs when a blood vessel leaks or bursts. A transient ischemic attack (TIA) — sometimes called a ministroke — temporarily disrupts blood flow through your brain.
Ischemic stroke
Almost 90 percent of strokes are ischemic strokes. They occur when the arteries to your brain are narrowed or blocked, causing severely reduced blood flow (ischemia). Lack of blood flow deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. The most common ischemic strokes are:

• Thrombotic stroke. This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot usually forms in areas damaged by atherosclerosis — a disease in which the arteries are clogged by fatty deposits (plaques). This process can occur within one of the two carotid (kuh-ROT-id) arteries of your neck that carry blood to your brain, as well as in other arteries of the neck or brain.
• Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms in a blood vessel away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. It's often caused by irregular beating in the heart's two upper chambers (atrial fibrillation). This abnormal heart rhythm can lead to pooling of blood in the heart and the formation of blood clots that travel elsewhere in the body.

Hemorrhagic stroke
Hemorrhage is the medical term for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) — an abnormal tangle of thin-walled blood vessels, present at birth. There are two types of hemorrhagic stroke:

• Intracerebral hemorrhage. In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure is the most common cause of this type of hemorrhagic stroke. Over time, high blood pressure can cause small arteries inside your brain to become brittle and susceptible to cracking and rupture.
• Subarachnoid hemorrhage. In this type of stroke, bleeding starts in an artery on or near the surface of the brain and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe "thunderclap" headache. This type of stroke is commonly caused by the rupture of an aneurysm, which can develop with age or be present from birth. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow to parts of your brain.

Transient ischemic attack (TIA)
A transient ischemic attack (TIA) — sometimes called a ministroke — is a brief episode of symptoms similar to those you'd have in a stroke. The cause of a transient ischemic attack is a temporary decrease in blood supply to part of your brain. Many TIAs last less than five minutes.
Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. But unlike a stroke, which involves a more prolonged lack of blood supply and causes permanent tissue damage, a TIA doesn't leave lasting effects because the blockage is temporary.
Seek emergency care even if your symptoms seem to clear up. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain, putting you at a greater risk of a full-blown stroke that could cause permanent damage later. And it's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Up to half of those whose symptoms appear to go away are actually having a stroke that's causing brain damage.

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 long-term nursing home care may be required. 

Preventing Strokes

Reducing Stroke Risk

All persons can take steps to reduce their risk for stroke by knowing their own risk factors for stroke and taking action to reduce those risks. Talk to your doctor about what you can do to reduce your risk for stroke.

1. High Blood Pressure or Hypertension (leading cause of stroke)  
2. Carotid or Coronary Artery Disease
3. Atrial Fibrilation (Irregular Heart Beat)
4. Diabetes
5. Tobacco Use
6. Prior Transient Ischemic Accident (TIA) or Stroke
7. Elevated levels of cholesterol
8. Excessive Alcohol use
9. Genetics

REFERENCES:

del Zoppo GJ, et al. Expansion of the Time Window for Treatment of Acute Ischemic Stroke with Intravenous Tisse Plasminogen Activator: A Science Advisory from the AMerican Heart Association/American Stroke Association. Stroke 2009;40;2945-2948.
Goldtein, Larry. B. et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Jun;37(6):1583-633. Epub 2006 May 4.
Johnston SC. et al. National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol. 2006 Sep;60(3):301-13.
Liferidge AT. et al. Ability of laypersons to use the Cincinnati Prehospital Stroke Scale. Prehosp Emerg Care. 2004 Oct-Dec:8(4):384-7.

what is Sore Throat?
A sore throat is pain, scratchiness or irritation of the throat that often worsens when you swallow.
A sore throat is the primary symptom of pharyngitis — inflammation of the pharynx, or throat. But the terms "sore throat" and "pharyngitis" are often used interchangeably.
The most common cause of a sore throat is a viral infection, such as a cold or the flu. A sore throat caused by a virus usually resolves on its own with at-home care. A bacterial infection, a less common cause of sore throat, requires additional treatment with antibiotic drugs.
Other less common causes of sore throat may require more complex treatment.

What causes a sore throat?

A sore throat can have many causes including:

1. Common viruses, and even the viruses that cause mononucleosis (mono) and the flu, can cause a sore throat. Some viruses can also produce blisters in the mouth and throat ("aphthous stomatitis").
2. Breathing through the mouth can produce throat dryness and soreness.
3. Sinus drainage (post nasal drip) may cause a sore throat.
4. A sore throat can also be caused by bacteria. The two most common bacteria to cause a sore throat are Streptococcus (which causes strep throat) and Arcanobacterium haemolyticum. Arcanobacterium causes sore throats mainly in young adults and is sometimes associated with a fine red rash.
5. Sore throat appearing after treatment with antibiotics, chemotherapy, or other immune-compromising medications may be due to Candida, commonly known as "thrush."
6. A sore throat lasting for more than two weeks can be a sign of a serious illness, such as throat cancer or AIDS

 Sign & Symptoms
Symptoms of a sore throat may vary depending on the cause. Signs and symptoms may include:

• Pain or a scratchy sensation in the throat
• Pain that worsens with swallowing or talking
• Difficulty swallowing
• Dry throat
• Sore, swollen glands in your neck or jaw
• Swollen, red tonsils
• White patches or pus on your tonsils
• Hoarse or muffled voice
• Refusal to eat (infants and toddlers)

Common infections causing a sore throat may result in other accompanying signs and symptoms:

• Fever
• Chills
• Cough
• Runny nose
• Sneezing
• Body aches
• Headache
• Nausea or vomiting

Dignosis

Your doctor will start with a physical exam that is generally the same for children and adults. The exam will include:

• Using a lighted instrument to look at your throat, and likely your ears and nasal passages
• Gently feeling (palpating) your neck to check for swollen glands (lymph nodes)
• Listening to your breathing with a stethoscope

Throat swab
With this simple test, the doctor rubs a sterile swab over the back of your throat to get a sample of secretions. The sample will be checked in a lab for streptococcal bacteria, the cause of strep throat. Many clinics are equipped with a lab that can get a test result within a few minutes. However, a second more reliable test is usually sent out to a lab that can return results within 24 to 48 hours.
If the rapid, in-clinic test comes back positive, then you almost certainly have a bacterial infection. If the test comes back negative, then you likely have a viral infection. Your doctor will wait, however, for the more reliable, out-of-clinic lab test to determine the cause of the infection.
Other tests or referrals

• Complete blood cell count (CBC). Your doctor may order a CBC with a small sample of your blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what's elevated, what's normal or what's below normal can indicate whether an infection is more likely caused by a bacterial or viral agent.
• Allergy tests. If your doctor suspects your sore throat is related to an allergy, you may be referred to an allergist for additional tests.
• Other referrals. You may be referred to an otolaryngologist or other specialist if you have chronic or frequent sore throat or if there are any signs or symptoms that suggest a serious condition other than a common viral or bacterial infection.

A sore throat caused by viral infection — the most common cause — usually lasts five to seven days and doesn't require medical treatment.
Treating bacterial infections
If your sore throat is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for infections such as strep throat. If you're allergic to penicillin, your doctor will prescribe an alternative antibiotic.
You must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics to treat strep throat can, in particular, increase a child's risk of rheumatic fever and serious kidney inflammation.
Talk to your doctor or pharmacist about what to do if you forget to take a dose.
Other treatments
If a sore throat is a symptom of a condition other than a viral or bacterial infection, other treatments will likely be considered depending on the diagnosis.

What is sporotrichosis?

Sporotrichosis is a fungal infection caused by a fungus called Sporothrix schenckii. It usually infects the skin.

Who gets sporotrichosis?

Persons handling thorny plants, sphagnum moss, or baled hay are at increased risk of getting sporotrichosis. Outbreaks have occurred among nursery workers handling sphagnum moss, rose gardeners, children playing on baled hay, and greenhouse workers handling bayberry thorns contaminated by the fungus. A number of cases have recently occurred among nursery workers, especially workers handling sphagnum moss topiaries.

How is sporotrichosis diagnosed?

Sporotrichosis can be confirmed when a doctor obtains a swab or a biopsy of a freshly opened skin nodule and submits it to a laboratory for fungal culture.

How is sporotrichosis treated?

Sporotrichosis is generally treated with potassium iodide, taken by mouth in droplet form. A new drug, called itraconazole (Sporanox), is available for treatment, but experience with this drug is still limited. Treatment is often extended over a number of weeks, until the skin lesions are completely healed.

Prevented

Control measures include wearing gloves and long sleeves when handling pine seedlings, rose bushes, hay bales or other plants that may cause minor skin breaks. In addition, it may be prudent to use pine seedling packing materials other than sphagnum moss, which has been implicated as a source of the fungus in a number of outbreaks.

 

 

What is scabies?

Scabies is an itchy, highly contagious skin condition caused by an infestation by the itch mite Sarcoptes scabiei. Mites are small eight-legged parasites (in contrast to insects, which have six legs). They are tiny, just 1/3 millimeter long, and burrow into the skin to produce intense itching, which tends to be worse at night. The mites that infest humans are female and are 0.3 mm-0.4 mm long; the males are about half this size. Scabies mites can be seen with a magnifying glass or microscope. The scabies mites crawl but are unable to fly or jump. They are immobile at temperatures below 20 C, although they may survive for prolonged periods at these temperatures.
Scabies infestation occurs worldwide and is very common. It has been estimated that worldwide, about 300 million cases occur each year. Human scabies has been reported for over 2,500 years. Scabies has been reported to occur in epidemics in nursing homes, hospitals, long-term care facilities, and other institutions. In the U.S., it is seen frequently in the homeless population but occurs episodically in other populations of all socioeconomic groups as well.

How is scabies spread?

Direct skin-to-skin contact is the mode of transmission. Scabies mites are very sensitive to their environment. They can only live off of a host body for 24-36 hours under most conditions. Transmission of the mites involves close person-to-person contact of the skin-to-skin variety. It is hard, if not impossible, to catch scabies by shaking hands, hanging your coat next to someone who has it, or even sharing bedclothes that had mites in them the night before. Sexual physical contact, however, can transmit the disease. In fact, sexual contact is the most common form of transmission among sexually active young people, and scabies has been considered by many to be a sexually transmitted disease (STD). However, other forms of physical contact, such as mothers hugging their children, are sufficient to spread the mites. Over time, close friends and relatives can contract it this way, too. School settings typically do not provide the level of prolonged personal contact necessary for transmission of the mites.

 signs and symptoms

Scabies signs and symptoms include:

• Itching, often severe and usually worse at night
• Thin, irregular burrow tracks made up of tiny blisters or bumps on your skin

The burrows or tracks typically appear in folds of your skin. Though almost any part of your body may be involved, in adults scabies is most often found:

• Between fingers
• In armpits
• Around your waist
• Along the insides of wrists
• On your inner elbow
• On the soles of your feet
• Around breasts
• Around the male genital area
• On buttocks
• On knees
• On shoulder blades

In children, common sites of infestation include the:

• Scalp
• Face
• Neck
• Palms of the hands 
• Soles of the feet

 Causes

The eight-legged mite that causes scabies in humans is microscopic. The female mite burrows just beneath your skin and produces a tunnel in which it deposits eggs. The eggs mature in 21 days, and the new mites work their way to the surface of your skin, where they mature and can spread to other areas of your skin or to the skin of other people. The itching of scabies results from your body's allergic reaction to the mites, their eggs and their waste.
Close physical contact and, less often, sharing clothing or bedding with an infected person can spread the mites.
Dogs, cats and humans all are affected by their own distinct species of mite. Each species of mite prefers one specific type of host and doesn't live long away from that preferred host. So humans may have a temporary skin reaction from contact with the animal scabies mite. But people are unlikely to develop full-blown scabies from this source, as they might from contact with the human scabies mite.

 Dignosis:

To diagnose scabies, your doctor examines your skin, looking for signs of mites, including the characteristic burrows. When your doctor locates a mite burrow, he or she may take a scraping from that area of your skin to examine under a microscope. The microscopic examination can determine the presence of mites or their eggs.

Treatment:

Skin lotions containing permethrin, lindane or crotamiton are available through a physician's prescription for the treatment of scabies. The lotions are applied to the whole body except the head and neck. Sometimes, itching may persist but should not be regarded as treatment failure or reinfestation. Persons who have had skin contact with an infested person (including family members, roommates, direct care providers and sexual contacts) should also be treated.

 Prevention:

Avoid physical contact with infested individuals and their belongings, especially clothing and bedding. Health education on the life history of scabies, proper treatment and the need for early diagnosis and treatment of infested individuals and contacts is extremely important.

REFERENCES:

Chosidow, O. "Clinical Practices. Scabies." N Engl J Med 354.16 Apr. 2006: 1718-1727.
Dourmishev, A.L., L.A. Dourmishev, and R.A. Schwartz. "Ivermectin: Pharmacology and Application in Dermatology." Int J Dermatol 44.12 Dec. 2005: 981-988.
McCroskey, Amy L., and Adam J. Rosh. "Scabies." eMedicine.com. Apr. 5, 2010. <http://emedicine.medscape.com/article/785873-overview>.
United States. Centers for Disease Control and Prevention. "Scabies." Nov. 10, 2008. <http://www.cdc.gov/scabies/index.html>.

What Is Endometriosis?

When a woman has endometriosis, tissue that looks and acts like the lining of the uterus starts growing in places other than the inside of the uterus. The most common locations for these growths — called endometrial implants — are the outside surface of the uterus, the ovaries, the fallopian tubes, the ligaments that support the uterus, the intestines, the bladder, the internal area between the vagina and rectum, and the lining of the pelvic cavity.
It is not known exactly how many women have endometriosis, but it is believed that more than 5 million American women, including teen girls, are affected. It's not always diagnosed right away in teens because at first they or their doctors assume that their painful periods are a normal part of menstruating, or that their abdominal pain is due to another problem. But continuing, excessive pain that limits activity isn't normal and should always be taken seriously. Because severe endometriosis can make it harder for a girl to have children in the future, it's a good idea to get medical help for endometriosis and not wait too long.
To understand why endometriosis causes problems, it helps to have a basic understanding of how the monthly menstrual cycle works: During the course of each cycle, the lining of a woman's uterus builds up with blood vessels and tissue. This happens because the uterus is getting ready to receive the egg that will be released from one of the ovaries. If the egg isn't fertilized by sperm, the uterus sheds the tissue and blood; this is the menstrual period. This entire process is controlled by the female sex hormones and usually takes about 28 to 30 days.
Because the abnormal growths associated with endometriosis are made up of the same kind of tissue and blood vessels found in the uterine lining, any endometrial implants will act just like the endometrium in the uterus. That means they respond in the same way to the hormonal changes of the menstrual cycle.
However, in the uterus, if the egg isn't fertilized, the extra tissue and blood leave a girl's body in the form of menstrual fluid. With endometriosis, though, there's nowhere for the accumulating blood and tissue to go once the implants start to break down. This causes irritation of the surrounding body parts, which can cause pain. With continued build up and irritation, the symptoms of endometriosis tend to become more painful over time.

• Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
• Occasional heavy periods or bleeding between periods (menometrorrhagia).
• Pelvic pain during ovulation.
• Sharp pain deep in the pelvis during intercourse.
• Pain during bowel movements or urination.
• Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

• Abdominal pain
• IBS
• Infertility, female
• Infertility, male
• Painful periods

• constipation
• Diarrhea
• Irritable bowel syndrome (IBS)

A process called retrograde menstruation is a likely explanation for endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of the menstrual cycle.
Retrograde menstruation alone may not cause endometriosis, though. Instead, the condition may develop when one or more small areas of the abdominal lining turns into endometrial tissue. This is possible because the cells lining the abdominal and pelvic cavities are descended from embryonic cells with the potential to specialize and take on the structure and function of endometrial cells. What activates that potential remains unknown.

• Infertility, female
• Infertility, male
• Ovarian cancer
  
  
  
  

  How is endometriosis diagnosed?

  Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office. Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.
  Unfortunately, neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but still cannot definitively diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.
  As a result, the only accurate way of diagnosing endometriosis is at the time of surgery, either by opening the belly with large-incision laparotomy or small-incision laparoscopy.
  Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia, or in some cases under local anesthesia. It is usually performed as an out-patient procedure (the patient going home the same day). Laparoscopy is performed by first inflating the abdomen with carbon dioxide through a small incision in the navel. A long, thin viewing instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis. Endometrial implants can then be directly seen.
  During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed for a diagnosis. Sometimes biopsies obtained during laparoscopy show endometriosis even though no endometrial implants are seen during laparoscopy.
  Pelvic ultrasound and laparoscopy are also important in excluding malignancies (such as ovarian cancer) that can cause symptoms that mimic endometriosis symptoms.
  
  

  Treatments and Pharmacology

  Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.
  Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
  Pain medications
  Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin, others), to help ease painful menstrual cramps. However, if you find that taking the maximum dose doesn't provide full relief, you may need to try another treatment approach to manage your signs and symptoms.
  Hormone therapy
  Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. That's because the rise and fall of hormones during a woman's menstrual cycle causes endometrial implants to thicken, break down and bleed.
  Hormonal therapies used to treat endometriosis include:
  
• Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — can reduce or eliminate the pain of mild to moderate endometriosis.
• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones. This action prevents menstruation and dramatically lowers estrogen levels, causing endometrial implants to shrink. Gn-RH agonists and antagonists can force endometriosis into remission during the time of treatment and sometimes for months or years afterward. These drugs create an artificial menopause that can sometimes lead to troublesome side effects, such as hot flashes and vaginal dryness. Taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease such side effects. If Gn-RH agonists don't relieve your pain, it's unlikely that endometriosis is responsible for your symptoms.
• Danazol. Another drug that blocks the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis, is danazol. In addition, it suppresses the growth of the endometrium. However, danazol may not be the first choice because it can cause unwanted side effects, such as acne and facial hair.
• Medroxyprogesterone (Depo-Provera). This injectable drug is effective in halting menstruation and the growth of endometrial implants, thereby relieving the signs and symptoms of endometriosis. Its side effects can include weight gain, decreased bone production and depressed mood.
• Aromatase inhibitors. Although not specifically approved for the treatment of endometriosis, studies suggest that aromatase inhibitors may significantly reduce endometriosis-related pain. Aromatase inhibitors work by blocking the conversion of hormones such as androstenedione and testosterone into estrogen and by blocking the production of estrogen from endometrial implants themselves. This deprives endometriosis of the estrogen it needs to grow. To reduce the risk of side effects, such as bone loss and follicular cysts, aromatase inhibitors must be taken in combination with a Gn-RH agonist or an oral estrogen-progestin contraceptive.

Hormonal therapies aren't a permanent fix for endometriosis. It's possible that you could experience a recurrence of your symptoms after stopping treatment.
Conservative surgery
If you have endometriosis and are trying to become pregnant, surgery to remove endometrial implants may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery.
Conservative surgery removes endometrial growths, scar tissue and adhesions without removing your reproductive organs. Your doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases. In laparoscopic surgery, a slender viewing instrument (laparoscope) is inserted through a small incision near your navel. Guided by the laparoscope, your doctor inserts other instruments through another small incision to remove endometrial implants. Such instruments might include a laser, small surgical instruments or a cautery — an instrument that destroys tissue with heat.
Assisted reproductive technologies to help you become pregnant are sometimes preferable to conservative surgery, and doctors often suggest these approaches if conservative surgery is ineffective.
Hysterectomy
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. Hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. Surgery is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy.


REFERENCES:
eMedicine.com. Endometriosis.
<http://emedicine.medscape.com/article/271899-overview>
Van Gorp T; Amant F; Neven P; Vergote I; Moerman P. Endometriosis and the development of malignant tumours of the pelvis. A review of literature. Best Pract Res Clin Obstet Gynaecol 2004 Apr;18(2):349-71.

What Is Pneumonia?

Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages.  Signs of pneumonia can include coughing, fever, fatigue, nausea, vomiting, rapid breathing or shortness of breath, chills, or chest pain. Certain people are more likely to become ill with pneumonia. This includes adults 65 years of age or older and children less than 5 years of age. People up through 64 years of age who have underlying medical conditions (like diabetes or HIV/AIDS) and people 19 through 64 who smoke cigarettes or have asthma are also at increased risk for getting pneumonia.


Pneumonia symptoms can vary greatly, depending on any underlying conditions you may have and the type of organism causing the infection. Pneumonia often mimics the flu, beginning with a cough and a fever, so you may not realize you have a more serious condition.
Common signs and symptoms of pneumonia may include:

• Fever
• Cough
• Shortness of breath
• Sweating
• Shaking chills
• Chest pain that fluctuates with breathing (pleurisy)
• Headache
• Muscle pain
• Fatigue

Ironically, people in high-risk groups such as older adults and people with chronic illnesses or weakened immune systems may have fewer or milder symptoms than less vulnerable people do. And instead of having the high fever that often characterizes pneumonia, older adults may even have a lower than normal temperature.

Causes
When bacteria, viruses or, rarely, fungi living in your nose, mouth, sinuses, or the environment spread to your lungs, you can develop pneumonia or other infections. You can catch the bacteria or viruses from people who are infected with them, whether they are sick or not.

How is pneumonia diagnosed?

Pneumonia may be suspected when the doctor examines the patient and hears coarse breathing or crackling sounds when listening to a portion of the chest with a stethoscope. There may be wheezing, or the sounds of breathing may be faint in a particular area of the chest. A chest X-ray is usually ordered to confirm the diagnosis of pneumonia. The lungs have several segments referred to as lobes, usually two on the left and three on the right. When the pneumonia affects one of these lobes, it is often referred to as lobar pneumonia. Some pneumonias have a more patchy distribution that does not involve specific lobes. In the past, when both lungs were involved in the infection, the term "double pneumonia" was used. This term is rarely used today.
Sputum samples can be collected and examined under the microscope. If the pneumonia is caused by bacteria or fungi, the organisms can often be detected by this examination. A sample of the sputum can be grown in special incubators, and the offending organism can be subsequently identified. It is important to understand that the sputum specimen must contain little saliva from the mouth and be delivered to the laboratory fairly quickly. Otherwise, overgrowth of noninfecting bacteria may predominate. As we have used antibiotics in a broader uncontrolled fashion, more organisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directed more appropriate therapy.
A blood test that measures white blood cell count (WBC) may be performed. An individual's white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, is seen in bacterial infections, whereas an increase in lymphocytes, another type of WBC, is seen in viral infections, fungal infections, and some bacterial infections (like tuberculosis).
Bronchoscopy is a procedure in which a thin, flexible, lighted viewing tube is inserted into the nose or mouth after a local anesthetic is administered. The breathing passages can then be directly examined by the doctor, and specimens from the infected part of the lung can be obtained.
Sometimes, fluid collects in the pleural space around the lung as a result of the inflammation from pneumonia. This fluid is called a pleural effusion. If a significant amount of fluid develops, it can be removed. Usually this is done by inserting a needle into the chest cavity and withdrawing the fluid with a syringe in a procedure called a thoracentesis. Often ultrasound is used to prevent complications from this procedure. In some cases, this fluid can become severely inflamed (parapneumonic effusion) or infected (empyema) and may need to be removed by more aggressive surgical procedures. Today, most often, this involves surgery through a tube or thoracoscope. This is referred to as video-assisted thoracoscopic surgery or VATS.

Types of Pneumonia

You may have heard of community-acquired pneumonia (CAP). When someone who hasn't recently been in the hospital or another healthcare facility develops pneumonia, it's called community-acquired.
Pneumonia is associated with healthcare when someone gets the infection during or following a stay in a healthcare facility (like hospitals, long-term care facilities, and dialysis centers). These infections are labeled healthcare-associated pneumonias, which includes healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).
In the U.S., the most common bacterial cause of pneumonia is Streptococcus pneumoniae (pneumococcus) and the most common viral causes are influenza, parainfluenza, and respiratory syncytial viruses. In children less than 1 year of age, respiratory syncytial virus (RSV) is the most common cause of pneumonia. Other common bacterial and viral causes of pneumonia in the U.S. include Staphylococcus aureus and adenovirus. Pneumocystis jirovecii, a fungus formerly known as Pneumocystis carinii, is a common cause of pneumonia in patients with AIDS.

Treatment

Treatments for pneumonia vary, depending on the severity of your symptoms and the type of pneumonia you have.

• Bacterial. Doctors usually treat bacterial pneumonia with antibiotics. Although you may start to feel better shortly after beginning your medication, be sure to complete your entire course of antibiotics. Stopping medication too soon may cause your pneumonia to return. It also helps create strains of bacteria that are resistant to antibiotics — an increasingly serious problem. In fact, in the past decade the number of antibiotic-resistant strains of bacteria has risen dramatically. In 1994, approximately 6 percent of bacteria that caused pneumonia were resistant to antibiotics. Just 6 years later, in the year 2000, that number had jumped to 34 percent.
• Viral. Antibiotics aren't effective against viral forms of pneumonia. And although a few viral pneumonias may be treated with antiviral medications, the recommended treatment is the same as for the flu — rest and plenty of fluids. Overall, it may take you longer to recover from viral pneumonia than from bacterial pneumonia.
• Mycoplasma.  Mycoplasma pneumonias are treated with antibiotics. Even so, recovery may not be immediate — it may take four to six weeks for you to recover completely if your pneumonia is serious. In some cases fatigue may continue long after the infection itself has cleared.

• Fatigue

In addition to these treatments, your doctor may recommend over-the-counter medications to reduce fever, treat your aches and pains, and soothe the cough associated with pneumonia. You don't want to suppress your cough completely, though, since coughing helps clear your lungs. If you must use a cough suppressant, use the lowest dose that helps you get some rest.

If you have serious pneumonia — if your breathing is very labored, for instance — you may be hospitalized and treated with intravenous antibiotics or put on oxygen. Some studies seem to show, however, that you may recover as quickly at home with oral antibiotics as in the hospital, especially if you have access to qualified home health care. Sometimes you may spend three or four days in the hospital receiving intravenous antibiotics and then continue to recover at home with oral medication. 

Prevention

You usually don't "catch" pneumonia from someone else. Instead, you develop the disease because your own immunity is temporarily weakened, often for no known reason. The following suggestions can help keep you healthy:

• Get vaccinated. Because pneumonia can be a complication of the flu, getting a yearly flu shot is a good way to prevent pneumonia. In addition, get a vaccination against pneumococcal pneumonia at least once after age 65. Talk to your doctor about the pneumonia vaccine if you have a chronic illness such as lung or cardiovascular disease, diabetes or sickle cell anemia, if your immune system is compromised or you've had your spleen removed for any reason. A vaccine known as Prevnar can also help protect young children against pneumonia. It's recommended for all children under age 2 and for children 2 years and older who are at particular risk of pneumococcal disease, such as those with an immune system deficiency, cancer, cardiovascular disease or sickle cell anemia. Side effects of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the injection site.
• Wash your hands. Your hands come in daily contact with germs that can cause pneumonia. These germs enter your body when you touch your eyes or rub your nose. Washing your hands thoroughly and often can help reduce your risk.
• Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections.
• Take care of yourself. Proper rest and a diet rich in fruits, vegetables and whole grains along with moderate exercise all help keep your immune system strong.
• Protect others from infection. If you have pneumonia, try to stay away from anyone with a compromised immune system. When that isn't possible, you can help protect others by wearing a face mask and always coughing into a tissue. 

REFERENCE: Hoare, Zara, and Wei Shen Lim. "Pneumonia: Update on Diagnosis and Management." BMJ 332 May 6, 2006: 1077-1079.

What Is Asthma?

Asthma (pronounced: az-muh) is a lung condition that causes a person to have difficulty breathing. Asthma is a common condition: More than 6 million kids and teens have it.
Asthma affects a person's bronchial (pronounced: brahn-kee-ul) tubes, also known as airways. When a person breathes normally, air is taken in through the nose or mouth and then goes into the trachea (windpipe), passing through the bronchial tubes, into the lungs, and finally back out again. But people with asthma have airways that are inflamed. This means that they swell and produce lots of thick mucus. They are also overly sensitive, or hyperreactive, to certain things, like exercise, dust, or cigarette smoke. This hyperreactivity causes the smooth muscle that surrounds the airways to tighten up. The combination of airway inflammation and muscle tightening narrows the airways and makes it difficult for air to move through.
In most people with asthma, the difficulty breathing happens periodically. When it does happen, it is known as an asthma flare-up also known as an asthma attack, flare, episode, or exacerbation.

 Sign And Symptoms

Asthma symptoms range from minor to severe and vary from person to person. You may have mild symptoms and asthma attacks may be infrequent. Between asthma flare-ups you may feel normal and have no trouble breathing. You may have symptoms primarily at night, during exercise or when you're exposed to specific triggers. Or you may have asthma symptoms all the time. Asthma signs and symptoms include:

• Shortness of breath
• Chest tightness or pain
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• An audible whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
• Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu

Signs that your asthma is probably getting worse include:

• More frequent and bothersome asthma signs and symptoms
• Increasing difficulty breathing (this can be measured by a peak flow meter, a simple device used to check how well your lungs are working)
• An increasingly frequent need to use a quick-relief inhaler

For some people, asthma symptoms flare up in certain situations:

• Exercise-induced asthma occurs during exercise. For many people, exercise-induced asthma is worse when the air is cold and dry.
• Occupational asthma is asthma that's caused or worsened by breathing in a workplace irritant such as chemical fumes, gases or dust.
• Allergy-induced asthma. Some people have asthma symptoms that are triggered by particular allergens, such as pet dander, cockroaches or pollen.

Causes

It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic (inherited) factors.
Asthma triggers are different from person to person. Exposure to a number of different allergens and irritants can trigger signs and symptoms of asthma, including:

• Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
• Respiratory infections, such as the common cold
• Physical activity (exercise-induced asthma)
• Cold air
• Air pollutants and irritants, such as smoke
• Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs
• Strong emotions and stress
• Sulfites, preservatives added to some types of foods and beverages
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat
• Menstrual cycle in some women
• Allergic reactions to some foods, such as peanuts or shellfish

 HowDiagnose Asthma?

Many people with asthma are diagnosed with the condition when they're kids, but some don't find out that they have it until their teen years or even later. In diagnosing asthma, a doctor will ask about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.
The doctor will also perform a physical exam. He or she may recommend that you take some tests. Tests that doctors use to diagnose asthma include spirometry (pronounced: spye-rah-muh-tree) and peak flow meter tests, which involve blowing into devices that can measure how well your lungs are performing. Your doctor may also recommend allergy tests to see if allergies are causing your symptoms, or special exercise tests to see whether your asthma symptoms may be brought on by physical activity. Doctors occasionally use X-rays in diagnosing asthma, but these are usually only to rule out other possible problems.
Your family doctor may refer you to a specialist for allergy diagnosis and treatment. Doctors who specialize in the treatment of asthma include those who have been trained in the fields of allergy, immunology (how the immune system works), and pulmonology (conditions that affect the lungs).

Asthma Treatment

There's no cure for asthma, but the condition can usually be managed and flare-ups can be prevented. Asthma is treated in two ways: by avoiding potential triggers and with medication.
Teens who have asthma need to avoid the things that can cause their symptoms. Of course, some things that can cause symptoms can't be completely avoided (like catching a cold!), but people can control their exposure to some triggers, such as pet dander, for example.
In the case of exercise-induced asthma, the trigger (physical activity) needs to be managed rather than avoided. Exercise can help a person stay healthier overall, and doctors can help athletes find treatments that allow them to them participate in their sports.
Doctors treat every asthma case individually because the severity of each person's asthma and what triggers the symptoms are different. For this reason, doctors have a variety of treatment medications at their disposal. Most asthma medications are inhaled (which means that a person takes the medication by breathing it into the lungs), but asthma medications can also take the form of pills or liquids. They fall into two categories:

• Rescue medications that act quickly to halt asthma symptoms once they start. Some medications can be used as needed to stop asthma symptoms (such as wheezing, coughing, and shortness of breath) when a person first notices them. These medications act fast to stop the symptoms, but they're not long lasting. They are also known as "reliever," "quick-relief, " or "fast-acting" medications.
• Controller medications to manage asthma and prevent symptoms from occurring in the first place. Many people with asthma need to take medication every day to control the condition overall. Controller medications (also called "preventive" or "maintenance" medications) work differently from rescue medications. They treat the problem of airway inflammation instead of the symptoms (coughing, wheezing, etc.) that it causes. Controller medications are slow acting and can take days or even weeks to begin working. Although you may not notice them working in the same way as rescue medications, regular use of controller medications should lessen your need for the rescue medications. Doctors also prescribe controller medications as a way to minimize any permanent lung changes that may be associated with having asthma.

Some people with asthma rely only on rescue medications; others use rescue medications together with controller medications to keep their asthma in check overall. Each person needs to work closely with a doctor to create an asthma action plan that's right for them.

Monitoring

In addition to avoiding triggers and treating symptoms, people with asthma usually need to monitor their condition to prevent flare-ups and help their doctors adjust medications if necessary. Two of the tools doctors give people to do this are:

• Peak flow meter. This handheld device measures how well a person can blow out air from the lungs. A peak flow meter reading that falls in the meter's green (or good) zone means the airways are open. A reading in the yellow zone means there's potential for an asthma flare-up. A reading in the red zone means the flare-up is serious and could mean that a person needs medication or treatment immediately - maybe even a trip to the doctor or emergency room. Teens who take daily medicine to control their asthma symptoms should use a peak flow meter at least one to two times a day and whenever they are having symptoms.
• Asthma diary. Keeping a diary can also be an effective way to help prevent problems. A daily log of peak flow meter readings, times when symptoms occur, and when medications are taken can help a doctor develop the most appropriate treatment methods.

• Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.
• Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
• Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter.
• Identify and treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an impending attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.
• Take your medication as prescribed. Just because your asthma seems to be improving, don't change anything without first talking to your doctor. It's a good idea to bring your medications with you to each doctor visit, so your doctor can double-check that you're using your medications correctly and taking the right dose.
• Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler such as albuterol, your asthma isn't under control. See your doctor about adjusting your treatment.