HyperTension

Hypertension: High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140 with a diastolic pressure above 90.
Chronic hypertension is a "silent" condition. Stealthy as a cat, it can cause blood vessel changes in the back of the eye (retina), abnormal thickening of the heart muscle, kidney failure, and brain damage.

Sign and Symptoms


Accelerated hypertension is associated with headache, drowsiness, confusion, vision disorders, nausea, and vomiting symptoms which are collectively referred to as hypertensive encephalopathy.Hypertensive encephalopathy is caused by severe small blood vessel congestion and brain swelling, which is reversible if blood pressure is lowered.

ChildrenSome signs and symptoms are especially important in newborns and infants such as failure to thrive, seizures, irritability, lack of energy, and difficulty breathing.In children, hypertension can cause headache, fatigue, blurred vision, nosebleeds, and facial paralysis.

 Secondary hypertension
hypertension is caused by disorders in hormone regulation. Hypertension combined with obesity distributed on the trunk of the body, accumlated fat on the back of the neck ('buffalo hump'), wide purple marks on the abdomen (abdominal striae), or the recent onset of diabetes suggests that an individual has a hormone disorder known as Cushing's syndrome. Hypertension caused by other hormone disorders such as hyperthyroidism, hypothyroidism, or growth hormone excess will be accompanied by additional symptoms specific to these disorders. For example, hyperthyrodism can cause weight loss, tremors, heart rate abnormalities, reddening of the palms, and increased sweating.Signs and symptoms associated with growth hormone excess include coarsening of facial features, protrusion of the lower jaw, enlargement of the tongue,excessive hair growth, darkening of the skin color, and excessive sweating.Hormone disorders like hyperaldosteronism may cause less specific symptoms such as numbness, excessive urination, excessive sweating.



Pregnancy

 
Hypertension in pregnant women is known as pre-eclampsia. Pre-eclampsia can progress to a life-threatening condition called eclampsia, which is the development of protein in the urine, generalized swelling, and severe seizures. Other symptoms indicating that brain function is becoming impaired may precede these seizures such as nausea, vomiting, headaches, and vision loss.







PREVENTION

# Weight reduction and regular aerobic exercise (e.g., walking): Regular exercise improves blood flow and helps to reduce the resting heart rate and blood pressure.



# Reducing dietary sugar.


# Reducing sodium (salt) in the diet: This step decreases blood pressure in about 33% of people (see above). Many people use a salt substitute to reduce their salt intake.


# Additional dietary changes beneficial to reducing blood pressure include the DASH diet (dietary approaches to stop hypertension) which is rich in fruits and vegetables and low-fat or fat-free dairy products. This diet has been shown to be effective based on research sponsored by the National Heart, Lung, and Blood Institute.In addition, an increase in dietary potassium, which offsets the effect of sodium has been shown to be highly effective in reducing blood pressure.


# Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol or nicotine consumption. Abstaining from cigarette smoking reduces the risk of stroke and heart attack which are associated with hypertension.


# Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation techniques,by reducing environmental stress such as high sound levels and over-illumination can also lower blood pressure. Jacobson's Progressive Muscle Relaxation and biofeedback are also beneficial,such as device-guided paced breathing,although meta-analysis suggests it is not effective unless combined with other relaxation technique.
 
TREATMENT
 
The list of treatments mentioned in various sources for Hypertension includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.



•Lifestyle changes


◦Lose weight - if overweight


◦Low-salt/low-sodium diet


◦DASH diet - Dietary Approaches to Stop Hypertension


◦Exercise                                  

◦Avoid alcohol


◦Quit smoking


◦Low-caffeine diet - though the NHLBI reports that caffeine has usually only a temporary effect and need not be eradicated unless you are sensitive to it.


◦Low-fat diet


•Stress Management


◦Massage


◦Relaxation therapy


◦Biofeedback
 
 
MEDICATION
 
•Anti-hypertensive medications



◦Diuretics - cause the body to excrete more sodium via urine.

◦Amiloride

◦Bendroflumethiazide

◦Benzthiazide

◦Bumetanide

◦Chlorothiazide

◦Chlorthalidone

◦Furosemide

◦Hydrochlorothiazide

◦Hydroflumethiazide

◦Indapamide

◦Methyclothiazide

◦Metolazone

◦Polythiazide

◦Spironolactone

◦Torsemide

◦Triamterene

◦Trichlormethiazide

◦Beta-blockers

◦Acebutolol

◦Atenolol

◦Betaxolol

◦Bisoprolol

◦Carteolol

◦Metoprolol

◦Nadolol

◦Penbutolol

◦Pindolol

◦Propranolol

◦Timolol

◦Angiotensin converting enzyme (ACE) inhibitors

◦Benazepril

◦Captopril

◦Enalapril

◦Fosinopril

◦Lisinopril

◦Moexipril

◦Quinapril

◦Ramipril

◦Trandolapril

◦Angiotensin antagonists

◦Losartan

◦Valsartan

◦Calcium channel blockers (CCBs)

◦Amlodipine

◦Diltiazam

◦Felodipine

◦Isradipine

◦Nicardipine

◦Nifedipine

◦Nisoldipine

◦Verapamil

◦Alpha blockers

◦Doxazosin

◦Prazosin

◦Terazosin

◦Alpha-beta blockers

BaCk PaiN...

How Common Is Back Pain?

Back pain is a very common problem. Up to 9 out of 10 people can expect to suffer from back pain or backache at some point in their lives. Out of these, only a proportion of patients seek medical help. Backache often resolve without treatment or with rest. Some patients may ignore the ongoing pain or learn to live with it.

Which Part Of The Back Is Most Commonly Affected?

Pain can involve the whole of the back but most commonly it is the lower back which is affected. One of the main reasons for this is that lower back bears more weight of the body compared to the rest of the back and hence, is under more stress during most of the day.

What Are The Different Types Of Back Pain?

Back pain can be classified according to the duration of pain from which the individual is suffering.

Acute back pain:

This type of back pain lasts about 6-8 weeks. It is characterized by sharp or dull ache which can be easily localized or pointed out by the patient and is usually felt in the lower back. It may be constant or intermittent. The cause is often a recent event or injury and treatment often results in successful recovery.

Chronic back pain:

Chronic back pain is characterized by a duration of more than 2 months. The patient may complain of deep aching, burning or dull pain which may be localized or sometimes also felt spreading down the legs. A tingling sensation or numbness may be felt, suggesting some nerve involvement. It can affect daily activities and tends to be more difficult to treat with standard options.


What Are The Causes Of Back Pain?

Back pain may arise from the skin, muscles, nerves, vertebral bones or other organs which are in close proximity to the back. As a result, backache may not always be due to a problem in the back itself. Some possible causes of backache include:

Poor posture.
Trauma.
Muscle strain.
Muscle spasm.
Pressure on a nerve root.
Tears to the ligaments supporting the back.
Fractures.
Poor alignment of the vertebrae.
Arthritis.
Osteoporosis.
Viral infections.
Bacterial infections.
Skin infections.
Bladder or kidney infection.
Gynecological problems in women (Endometriosis, Ovarian cysts).
Ruptured or herniated vertebral disc.
Spinal stenosis (narrowing of the spinal canal).
Spine curvatures (Scoliosis or Kyphosis).
tumors of bones.

How Is Back Pain Assessed?

A good history and a careful examination will often give a good idea of the cause of back pain. Some useful investigations that may also be done where appropriate include:

Complete blood count.
X-rays of spine.
CT scan of spine.
MRI of spine.
Bone scan.
Investigations for other possible causes like tumors and gynecological problems.

How Can Back Pain Be Treated?

The treatment of back pain should be directed at both the pain as well as the underlying cause. Some possible options for treatment of backache include:

Conservative treatment:

Complete bed rest which is very helpful in many cases of acute backache.
Stopping strenuous activity which may be causing or aggravating backache.
Heat therapy.
Cold therapy.
Massage therapy.
Analgesics (painkillers) and anti-inflammatory medications like NSAID’s.
Muscle relaxants.
injections of steroids in severe pain only.
Lifestyle modification:
Stop heavy weight lifting or other heavy work.
Weight reduction.
Improve standing, sitting and lying postures.
Avoid long periods of standing.
Taking breaks during prolonged driving or other sitting activities.
Use supportive stools and pillows.
Do relaxing exercises.
Avoid falls and injuries.
Avoid rough sports like Soccer, Rugby, Hockey, Wrestling and other physical games.
Improve back flexibility by regular stretching exercises.
Physiotherapy and exercises to strengthen the muscles of back.

Surgical Treatment:

When conservative methods and lifestyle modifications do not help, surgical options may have to be considered.

Urinary Tract Infection.

WHAT CAUSES URINARY TRACT INFECTION




UTI is commonly caused by bacteria that also are present in the normal flora in and around body openings and in the digestive tract, as for example the bacterium Escherichia Coli. Most often the bacteria enter the urinary tract through the urethral opening. Women more easily get urinary tract infection because they have a shorter urethra so that the bacteria have a shorter way to get into the bladder.

The diseases Chlamydia, Gonorrhea, Syphilis are normally not called UTI, even though these infections often affect the urinary tract.



Defects in the urinary system can make a person susceptible for UTI, like strictures or valve-like structures in the urethra and defects causing reflux from the bladder up through the ureters. Physical damages in the urinary tract can also make it more easy for bacteria to colonize and make infections.



Use of catheters or other instruments in the urinary tract can introduce bacteria and also cause damages that give the bacteria an easy opportunity to infect.

THE SYMPTOMS OF URINARY TRACT INFECTION



UTI can occur acutely with very distinct symptoms. UTI can also develop slowly and chronically with only small symptoms for a long time.



The symptoms by lower UTI are:



- Itching during urination.

- Pain in the bladder region.

- Urge to urinate, even though there is little urine in the bladder.

- Need to urinate during nights.

- Fever, usually mild.

- Cloudy urine with a bad smell.

- Pus discharged from the urethra or blended with the urine.

- Sometimes blood in the urine.



By upper urinary tract infection the same symptoms often occur, and in addition these symptoms will be felt:



- Nausea and vomiting.

- Pain in the sides of the back and sides of the stomach, at the height of the kidneys, and often downwards towards the bladder region.

- Feeling of pressure in the stomach region.

- High fever with chills and shaking.

- Strong fatigue.



Symptoms of UTI must always be investigated, especially blood in the urine, since the cause can be a more serious disease.





COMPLICATIONS CAUSED BY URINARY TRACT INFECTION



By upper UTI, the infection can spread deep into the kidney tissues and destroy the structures that excrete urine. This process can gradually lead to kidney failure. The infection can cause growth of scar tissue in the urinary tract, for example in the urethra, that causes obstruction and problems with urination.



By men the infection can spread to the prostate and into the reproductive organs and destroy the function of the reproductive system.



When a pregnant woman suffers from UTI, the child tend to be born with a too low birth weight.







DIAGNOSIS OF URINARY TRACT INFECTION



UTI is diagnosed by a urine specimen. The specimen is analyzed for substances produces by the disease process, like nitrites, leukocytes or leukocyte esterase. One also performs urine culture to confirm the presence of the bacteria.



When children have been diagnosed with UTI, in is useful to perform urine flow studies and radiologic studies of the urinary tract afterwards to see if there is urine reflux up to the bladder or other abnormalities in the urinary tract. This is sometimes done also by adults if UTI often recur.





STANDARD TREATMENT OF URINARY TRACT INFECTION



Urinary tract infection is commonly treated with antibiotica, like: trimethoprim, cephalosporins, nitrofurantoin, or a fluoroquinolone (ciprofloxacin, levofloxacin).



Children that have been diagnosed with some urinary tract defect are often given long term treatment with small doses of antibiotics, but recent studies have thrown doubt upon the validity of this regime.





ALTERNATIVE TREATMENT OF URINARY TRACT INFECTION



Although standard treatment is usually effective, it does no always manage to beat down a chronic UTI. Treatment with low doses of antibiotics to prevent new outbreaks of UTI can give side effects and is neither always effective.



Alternative measures for treatment can therefore be useful in addition to the standard drugs, and the same alternatives can be useful to prevent new outbreaks of UTI.



Cranberry and blueberry can help against UTI by eliminating the bacteria causing UTI. These herbs can be taken as juice or as tea made from dried berries, and they are also found as concentrates in capsules.



The sugar type D-mannose also seems to help eliminating infectious bacteria from the urinary tract.



Cranberry, blueberry and D-mannose seem to help by sticking to the bacteria or to the inside lining of the urinary tract and make it difficult for the bacteria to adhere to the inside walls and infect the tissues. Instead the bacteria are flushed out by the urine.



Goldenseal root and Uva ursi also have effects against bacteria infecting the urinary tract.



Remedies that alter the PH of the urine to be more acidic or more alkaline also seem to counteract infectious bacteria. It seems that the bacteria thrive only in a very narrow Ph range. Mineral supplements that contain citrate alter the Ph in an alkaline direction, and can be used for this purpose. Cranberry seems to give a more acidic urine and helps also this way.



Some studies indicate that acupuncture can help to hinder new outbreak of urinary tract infection.







LIFESTYLE MEASURES TO PREVENT URINARY TRACT INFECTION



Many lifestyle measures can be used to prevent the outbreak of UTI and help to cure UTI.



- Wearing clothes that hinders the lower body to get cold is useful by many peoples experience.



- Drinking much water causes the infectious bacteria to be flushed out much easier.



- To urinate after intercourse and cleaning the urethral opening eliminates infectious bacteria transmitted by the sexual act before they can invade the urinary tract.



- Using condoms by anal intercourse can hinder infectious bacteria in the rectum to enter a mans urethra.



- After anal intercourse, vaginal intercourse should be avoided without a good wash first.



- Having a good intimate hygiene, and wiping from the front and backwards by toilet visits can hinder bacteria from entering the urinary tract.



- Warm sitting baths without soap that can irritate can ameliorate the pain during, UTI and may enhance the healing process.

CrAniOToMY...

Definition


A craniotomy is a procedure to remove a lesion in the brain through an opening in the skull (cranium).



Purpose

A craniotomy is a type of brain surgery. It is the most commonly performed surgery for brain tumor removal . It also may be done to remove a blood clot (hematoma), to control hemorrhage from a weak, leaking blood vessel (cerebral aneurysm), to repair arteriovenous malformations (abnormal connections of blood vessels), to drain a brain abscess, to relieve pressure inside the skull, to perform a biopsy, or to inspect the brain.



Demographics

Because craniotomy is a procedure that is utilized for several conditions and diseases, statistical information for the procedure itself is not available. However, because craniotomy is most commonly performed to remove a brain tumor, statistics concerning this condition are given. Approximately 90% of primary brain cancers occur in adults, more commonly in males between 55 and 65 years of age. Tumors in children peak between the ages of three and 12. Brain tumors are presently the most common cancer in children (four out of 100,000).

Description

There are two methods commonly utilized by surgeons to open the skull. Either an incision is made at the nape of the neck around the bone at the back (occipital bone) or a curving incision is made in front of the ear that arches above the eye. The incision penetrates as far as the thin membrane covering the skull bone. During skin incision the surgeon must seal off many small blood vessels because the scalp has a rich blood supply.

The scalp tissue is then folded back to expose the bone. Using a high-speed drill, the surgeon drills a pattern of holes through the cranium (skull) and uses a fine wire saw to connect the holes until a segment of bone (bone flap) can be removed. This gives the surgeon access to the inside of the skill and allows him to proceed with surgery inside the brain. After removal of the internal brain lesion or other procedure is completed, the bone is replaced and secured into position with soft wire. Membranes, muscle, and skin are sutured into position. If the lesion is an aneurysm, the affected artery is sealed at the leak. If there is a tumor, as much of it as possible is resected (removed). For arteriovenous malformations, the abnormality is clipped and the repair redirects the blood flow to normal vessels.

Diagnosis/Preparation

Since the lesion is in the brain, the surgeon uses imaging studies to definitively identify it. Neuroimaging is usually accomplished by the following:

• CT (computed tomography, uses x-rays and injection of an intravenous dye to visualize the lesion)

• MRI ( magnetic resonance imaging , uses magnetic fields and radio waves to visualize a lesion)

In a craniotomy, the skin over a part of the skull is cut and pulled back (A). Small holes are drilled into the skull (B), and a special saw is used to cut the bone between the holes (C). The bone is removed, and a tumor or other defect is visualized and repaired (D). The bone is replaced (E), and the skin closed (F). (

Illustration by GGS Inc.

)

• arteriogram (an x-ray of blood vessels injected with a dye to visualize a tumor or cerebral aneurysm)

Before surgery the patient may be given medication to ease anxiety and to decrease the risk of seizures, swelling, and infection after surgery. Blood thinners (Coumadin, heparin, aspirin ) and nonsteroidal anti-inflammatory drugs (ibuprofen, Motrin, Advil, aspirin, Naprosyn, Daypro) have been correlated with an increase in blood clot formation after surgery. These medications must be discontinued at least seven days before the surgery to reverse any blood thinning effects. Additionally, the surgeon will order routine or special laboratory tests as needed. The patient should not eat or drink after midnight the day of surgery. The patient's scalp is shaved in the operating room just before the surgery begins.



Aftercare

Craniotomy is a major surgical procedure performed under general anesthesia. Immediately after surgery, the pa tient's pupil reactions are tested, mental status is assessed after anesthesia, and movement of the limbs (arms/legs) is evaluated. Shortly after surgery, breathing exercises are started to clear the lungs. Typically, after surgery patients are given medications to control pain, swelling, and seizures. Codeine may be prescribed to relive headache. Special leg stockings are used to prevent blood clot formation after surgery. Patients can usually get out of bed in about a day after surgery and usually are hospitalized for five to 14 days after surgery. The bandages on the skull are be removed and replaced regularly. The sutures closing the scalp are removed by the surgeon, but the soft wires used to reattach the portion of the skull that was removed are permanent and require no further attention. Patients should keep the scalp dry until the sutures are removed. If required (depending on area of brain involved), occupational therapists and physical therapist assess the patient's status postoperatively and help the patient improve strength, daily living skills and capabilities, and speech. Full recovery may take up to two months, since it is common for patients to feel fatigued for up to eight weeks after surgery.

Risks

The surgeon will discuss potential risks associated with the procedure. Neurosurgical procedures may result in bleeding, blood clots, retention of fluid causing swelling (edema), or unintended injury to normal nerve tissues. Some patients may develop infections. Damage to normal brain tissue may cause damage to an area and subsequent loss of brain function. Loss of function in specific areas can cause memory impairment. Some other examples of potential damage that may result from this procedure include deafness, double vision, numbness, paralysis, blindness, or loss of the sense of smell.



Normal results

Normal results depend on the cause for surgery and the patient's overall health status and age. If the operation was successful and uncomplicated recovery is quick, since there is a rich blood supply to the area. Recovery could take up to eight weeks, but patients are usually fully functioning in less time.



Morbidity and mortality rates

There is no information about the rates of diseases and death specifically related to craniotomy. The operation is performed as a neurosurgical intervention for several different diseases and conditions.



Alternatives

There are no alternative treatments if a neurosurgeon deems this procedure as necessary.

OVARIAN CYST....

Introduction


Background

An ovarian cyst is a fluid-filled sac in an ovary. They can develop from the neonatal period to postmenopause. Most ovarian cysts occur during infancy and adolescence, which are hormonally active periods of development. Most are functional in nature and resolve with minimal treatment. However, ovarian cysts can herald an underlying malignant process or, possibly, distract the emergency clinician from a more dangerous condition, such as ectopic pregnancy, ovarian torsion, or appendicitis. When ovarian cysts are large, persistent, or painful, surgery may be required, sometimes resulting in removal of the ovary. With the more frequent use of ultrasonography in recent years, the diagnosis of ovarian cysts has become more common.



A large ovarian cyst is shown in the images below.

A 24-cm diameter multilocular right ovarian cyst is seen with adjacent fallopian tube and uterus. The infundibulopelvic ligament carrying the ovarian artery and vein has been divided.

Transabdominal sonogram of the cyst in multimedia file 2 demonstrating a large, complex, cystic mass with septations. Color Doppler image shows vascularity within the septations. Red and blue colors show blood flow toward and away from the transducer. The resistive index was low. Histology reported a mucinous cystadenocarcinoma of low malignant potential. Courtesy of Patrick O'Kane, MD.

The cyst in multimedia files 2-3 has been removed and cut open. It has a smooth surface and a multicystic internal structure.



Abdominal pain in the female can be one of the most difficult cases to diagnose correctly in the emergency department (ED). The spectrum of gynecological disease is broad, spanning all age ranges and representing various degrees of severity, from benign cysts that eventually resolve on their own to ruptured ectopic pregnancy that causes life-threatening hemorrhage.

When presented with this scenario, the goal of the emergency physician is to rule out acute causes of abdominal pain associated with high morbidity and mortality, such as appendicitis or ectopic pregnancy, to assess for the possibility of neoplasm or malignancy, and either to refer the patient to the appropriate consultant or to discharge them with a clear plan for follow-up with an obstetrician/gynecologist.

Pathophysiology

The median menstrual cycle lasts 28 days, beginning with the first day of menstrual bleeding and ending just before the subsequent menstrual period. The variable first half of this cycle is termed the follicular phase and is characterized by increasing follicle-stimulating hormone (FSH) production, leading to the selection of a dominant follicle that is primed for release from the ovary. In a normally functioning ovary, simultaneous estrogen production from the dominant follicle leads to a surge of leuteinizing hormone (LH), resulting in ovulation and release of the dominant follicle from the ovary and commencing the leuteinizing phase of ovulation.

After ovulation, the follicular remnants form a corpus luteum, which produces progesterone. This, in turn, supports the released ovum and inhibits FSH and LH production. As luteal degeneration occurs in the absence of pregnancy, the progesterone levels decline, while the FSH and LH levels begin to rise before the onset of the next menstrual period.

Different kinds of functional ovarian cysts can form during this cycle. In the follicular phase, follicular cysts may result from a lack of physiological release of the ovum due to excessive FSH stimulation or lack of the normal LH surge at mid cycle just before ovulation. Hormonal stimulation causes these cysts to continue to grow. Follicular cysts are typically larger than 2.5 cm in diameter and manifest as pelvic discomfort and heaviness. Granulosa cells that line the follicle may also persist, leading to excess estradiol production, which, in turn, leads to decreased frequency of menstruation and menorrhagia.1

In the absence of pregnancy, the lifespan of the corpus luteum is 14 days. If the ovum is fertilized, the corpus luteum continues to secrete progesterone for 5-9 weeks until its eventual dissolution in 14 weeks time, when the cyst undergoes central hemorrhage. Failure of dissolution to occur may result in a corpus luteal cyst, which is arbitrarily defined as a corpus luteum that grows to 3 cm in diameter. The cyst can cause dull, unilateral pelvic pain and may be complicated by rupture, which causes acute pain and possibly massive blood loss.

Theca lutein cysts are caused by luteinization and hypertrophy of the theca interna cell layer in response to excessive stimulation of beta-human chorionic gonadotropin (bhCG). This type of cyst can occur in the setting of gestational trophoblastic disease, multiple gestation, or exogenous ovarian hyperstimulation. These cysts are associated with maternal androgen excess in up to 30% of cases but usually resolve spontaneously as the bhCG level falls. Theca lutein cysts are usually bilateral and result in massive ovarian enlargement, a condition termed hyperreactio luteinalis.2





Theca lutein cysts replacing an ovary in a patient with a molar pregnancy. Despite their size, these cysts are benign and usually resolve after treatment of the underlying disease.



Frequency

United States

Ovarian cysts are extremely prevalent, affecting an estimated 7% of premenopausal and postmenopausal woman. Furthermore, up to 4% of women will be admitted to the hospital with a primary diagnosis of ovarian cysts3 ; 1%-4% of pregnant women are diagnosed with an adnexal mass, with ovarian cysts accounting for most.4 Ovarian cysts are the most common fetal and infant tumor, with a prevalence exceeding 30%.5

Mortality/Morbidity

• Ovarian cysts can result in pain and other morbidity, including menorrhagia, an increased intermenstrual interval, dysmenorrhea, pelvic discomfort, and abdominal distention.

• Approximately 3% of theca lutein cysts are complicated by torsion or hemorrhage, and approximately 30% of these cysts can cause maternal androgen excess.2

• Follicular cysts can cause excess estradiol production, leading to metrorrhagia and menorrhagia.

• Ovarian cysts, and more specifically corpus luteal cysts, can rupture, causing hemoperitoneum, hypotension, and peritonitis. This can be exacerbated in women with bleeding dyscrasias, such as those with von Willebrand disease and those receiving anticoagulation therapy.

• Ovarian torsion can complicate ovarian cysts and can result in ovarian infarction, necrosis, infertility, premature ovarian menopause, and preterm labor.6

Race

No racial discrepancies regarding ovarian cysts are reported in the literature. This disease affects all racial groups.

Age

Ovarian cysts affect all age ranges of females, from those in utero to postmenopausal women. Even benign-appearing ovarian cysts in postmenopausal patients may require aggressive treatment owing to the increased risk of malignancy in this population.

WOMEN's HEALTH...

Living life as a woman comes with plenty of perks - such as great clothes and a fantastic sense of intuition (among other things). Unfortunately, being a woman also means having specific health needs, which should not be over-looked. From body image issues to breast and ovarian cancer to menstruation, pregnancy, menopause and beyond, women need to be educated about gender-specific health issues.


Women and men share many of the same diseases, but have very different experiences of them. Women also tend to suffer from certain diseases at a higher rate than men. These diseases include osteoarthritis, obesity, depression and fibromyalgia. In fact, women are more prone to autoimmune conditions like Sjogren's Syndrome, Lupus and Hypothyroidism than their male counterparts.

Perhaps one of the reasons that women struggle with health-related issues more than men has to do with the fact that they tend to be the caretakers of others, especially their families. Some women may ignore a health challenge or 'tough it out' because they have too much to do - most likely because someone else's needs take precedence over their own.

Women need to learn to take care of themselves first and foremost. They should follow a healthy eating plan, get plenty of rest and exercise regularly. Planned pregnancies are generally healthier pregnancies and good pre-natal (and post-natal) care is tantamount for both mother and child. Females should also receive regular checkups - a physical every other year is normal for a healthy person under the age of 35. After that, it may be best to have an annual exam.

Women should have regular screenings for cervical, breast and ovarian cancer. Early detection is the best weapon in fighting these diseases.

Some general guidelines include:

• Pap smear and pelvic exam: A woman should get one as soon as she becomes sexually active. She should have one annually for the next three years and then can skip a year in-betwen provided those prior results were all normal.

• Colonoscopy: Beginning at the age of 50, once every 10 years UNLESS there's a family history or history of colon polyps.

• Skin cancer screening: Annually after the age of 50 or sooner if you notice discolored moles, beauty marks or other abnormalities.

• Thyroid Hormone test: Every 5 years beginning at the age 35. Sooner and more often if you have symptoms of a thyroid condition or a family history of it.

• Bone mineral density test: At the onset of menopause or the age of 65. This test will be repeated at your doctor's discretion.

tRAcHEoStOMy...

What is a tracheostomy?


A tracheostomy is a surgically created opening in the neck leading directly to the trachea (the breathing tube). It is maintained open with a hollow tube called a tracheostomy tube.

Why is a tracheostomy performed?

A tracheostomy is usually done for one of three reasons:

(1) to bypass an obstructed upper airway (an object obstructing the upper airway will prevent oxygen from the mouth to reach the lungs)

(2) to clean and remove secretions from the airway

(3) to more easily, and usually more safely, deliver oxygen to the lungs.

What are risks and complications of tracheostomy?

It is important to understand that a tracheostomy, as with all surgeries, involves potential complications and possible injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or potential complications. Tracheostomies are usually performed during emergency situations or on very ill patients. This patient population is, therefore, at higher risk for a complication during and after the procedure

The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is listed here for information only in order to provide a greater awareness and knowledge concerning the tracheostomy procedure.

• Airway obstruction and aspiration of secretions (rare).

• Bleeding. In very rare situations, the need for blood products or a blood transfusion.

• Damage to the larynx (voice box) or airway with resultant permanent change in voice (rare).

• Need for further and more aggressive surgery

• Infection

• Air trapping in the surrounding tissues or chest. In rare situations, a chest tube may be required

• Scarring of the airway or erosion of the tube into the surrounding structures (rare).

• Need for a permanent tracheostomy. This is most likely the result of the disease process which made the a tracheostomy necessary, and not from the actual procedure itself.

• Impaired swallowing and vocal function

• Scarring of the neck

Obviously, many of the types of patients who undergo a tracheostomy are seriously ill and have multiple organ-system problems. The doctors will decide on the ideal timing for the tracheostomy based on the patient's status and underlying medical conditions

LiFe AnD HeaLtH BASicS: A LiFeTimE oF HeALthY WeiGHt.

Weight loss isn’t easy.


Obesity research shows that the best way to obtain and maintain a healthy weight is to replace bad habits with good habits and that means changing the way we think about food and activity. Successful losers develop a plan for long-term, lifetime healthy weight, not just short-term weight loss; and they retrain their brains to think like a thin person.

That takes effort, but the effort pays off in better health and quality of life and increased likelihood of longevity as well. Each of us has only one body and we must take care of it by eating well and staying active.

The National Weight Control Registry (NWCR) is an on-going study that monitors the habits of thousands of people who have achieved and maintained a healthy weight for several years and have won the battle against obesity. Research findings from the registry are regularly published in leading health journals and are a valuable resource for those wishing to lose weight.

The following advice on reaching and maintaining healthy weight goals is culled from this obesity research as well as from other sources.

• Get plenty of sleep. Metabolic hormones are influenced by sleep patterns, which affect body mass index (BMI). A lack of sleep decreases leptin (an appetite suppressant) and increases ghrelin (an appetite trigger). Studies have shown that increased BMI corresponded directly to decreased sleep (defined as less than eight hours per night).



• Eat only when you’re hungry—when you think of food, take 90 seconds to think about why you want to eat. Pay attention to what your body is telling you. You may find that you are eating out of boredom or habit, or for emotional reasons. Rethink food in terms of fuel and energy for your body. Think about what your body needs and train your brain to look at food in a new way.

• Eat a variety of fresh foods daily, and these should be in their whole form—closest to their form in nature —whenever possible. Though whole foods, especially fresh fruits and vegetables, usually contain relatively few calories, they will fill you up, and they are loaded with fiber. In addition to macronutrients (vitamins and minerals), these foods contain many micronutrients (phytochemicals, enzymes, and more) that researchers are only beginning to understand. These are essential to good health and cannot be found in refined, processed foods that are then “enriched” with some of the macronutrients that have been removed. Processed foods and fast foods usually have more unhealthy fats and more sodium than is recommended for good health and healthy weight.

• Replace refined white flours and grains with whole grain alternatives. The extra fiber and nutrition in whole grains will help you feel satisfied longer and will help regulate your blood sugar levels. Avoid refined sugars like sucrose, dextrose, fructose and glucose. Anything ending in “-ose” that you see in an ingredient list is a sugar. Read and understand food labels—in one form or another sugar and refined flours are ubiquitous in processed foods.

• Move—exercise instead of sitting and watching television. Take a walk for an hour. Walking is the favored exercise of long-term successful former obesity statistics on the NWCR. They also tend to limit television viewing to 10 hours per week or less—an important strategy since obesity research shows that exercise is a major key to healthy weight loss and maintenance.

• Eat at a table and use a smaller plate, proper utensils and proper etiquette. No more two-fisted eating—chips or crisps in one hand and burger in the other. And standing at the cupboard eating chocolate chips out of the bag or mindlessly munching through a barrel of popcorn at the theater should be a thing of the past. Breaking detrimental old habits will help you become aware of what and how much you are consuming.



• Take smaller portions and savor the flavors. Remember that the taste will never be better than that first bite. Eat slowly, chew well and stop when you are no longer hungry. Be aware of internal clues like hunger, as opposed to external clues like an empty plate or bowl.



• Keep a food diary—write down everything you eat and how much of it you eat every day. This can encourage you to think twice before snacking, and will increase your awareness of portion sizes. It’s not unusual for people to underestimate their calorie consumption by hundreds of calories per day, a mistake which can create a huge calorie overload and a huge weight gain over time.



• Replace sweetened beverages with water. Your body is composed of about 60 percent water and it is vital for healthy living. Also, a glass of water has no calories and helps you feel satisfied. Sometimes, thirst is mistaken for hunger, so if you’re feeling hungry try drinking a glass of water first. How much? There’s no magic formula—more if it’s hot and dry and if you’re exercising; less if it’s cool and you’re sedentary. Drink when you’re thirsty, or better yet, before you get thirsty. Remember those internal clues.

• And finally, don’t despair if the scale doesn’t show immediate results, and don’t give up if you slip and gain a pound or two. Just keep following the above tips and understand that it is normal for your weight to fluctuate from time to time. Your goal is life-long healthy weight and that takes time—the better part of a lifetime.

ALICE ABLER

SmOkiNG aNd MeNTaL HeALtH...

The effects of smoking on physical health are well-documented—for example, oral and lung cancers, plus diseases of the respiratory system—but new research is shedding light on the effects of smoking and tobacco use on mental health.


One study, headed by Professor Mark Weiser of Tel Aviv University’s Department of Psychiatry, compared the IQs of more than 20,000 healthy 18- to 21-year-old males enlisted in the Israeli Army. This study, the largest of its kind, showed that the men who smoked scored about seven points lower on average than their nonsmoking peers. Especially interesting was the comparison between siblings where one smoked and the other did not. In most cases, the nonsmoking brother was found to have a higher IQ.

Although this study showed a connection between smoking and lower IQs, it did not show that smoking resulted in a lower IQ. However, research led by Debapriya Ghosh and Anirban Basu of the Indian National Brain Research Centre (NBRC) seems to indicate a distinct connection between smoking and brain damage. Their test results (both in vitro and in vivo) showed that NNK, a procarcinogen commonly found in tobacco, promotes an inflammatory condition of the brain and “inflicts subsequent neuronal damage.” The researchers suggest that NNK causes the brain’s immune cells (microglia) to attack healthy cells instead of damaged or unhealthy cells.

Such damage can be caused by tobacco, whether smoked or chewed. Even second-hand smoke carries NNK, which can cause nerve or brain damage.

The unborn are also affected by tobacco. Known long-term effects from exposure to maternal smoking include increased risk for ear infections, asthma and other respiratory diseases. But Finnish researcher Mikael Ekblad (of Turku University Hospital in Finland) and his colleagues conducted a study “to evaluate the association between maternal smoking during pregnancy and both brain volumes and head circumference in very-low-birth-weight/very-low-gestational-age infants.”

The study, published in the February 2010 Journal of Pediatrics, concluded, “Prenatal smoking exposure was associated with significantly smaller frontal lobe and cerebellar volumes in the brains of preterm infants. This is consistent with reports showing an association between prenatal smoking exposure and impairments in frontal lobe and cerebellar functions such as emotion, impulse control, and attention.”

Ekblad and others also analyzed health records of babies born in Finland between 1987 and 1989 as well as the health records of the babies’ mothers.

Results of these studies (presented at the 2009 Pediatric Academic Societies annual meeting in Vancouver, British Columbia, Canada) show that the use of psychotropic medication was highest in the young adults whose mothers smoked while pregnant. Such exposure increased the risk for use of all such drugs, including those used to treat ADHD, addiction and depression. Of the young adults whose mothers had smoked more than 10 cigarettes per day during their pregnancy, more than 10 percent used drugs to treat depression. “Young adults exposed to prenatal smoking had a significantly increased risk for use of psychiatric drugs than unexposed young adults.” The authors added, “Our study suggests that preventing prenatal smoking exposure could reduce psychiatric problems in young adults.”

Sleep problems are sometimes associated with behavioral problems and depression in children, so there may be a connection between the Finnish studies and a study headed by Kristen Stone (of the Brown Center for the Study of Children at Risk, Women and Infants Hospital, Providence, Rhode Island). The authors concluded, “Prenatal exposure to nicotine was positively associated with children's sleep problems persisting throughout the first 12 years of life. Targeting of this group of children for educational and behavioral efforts to prevent and treat sleep problems is merited given that good sleep may serve as a protective factor for other developmental outcomes.”

Sadly, it is too late for these children to have the best possible start for a healthy life, and the researchers recommend that they be given extra help to compensate for the shortfall. Perhaps their mothers did not understand that using tobacco while pregnant exposed their unborn children to unnecessary physical and mental health risks. But those who use tobacco by choice (whether through smoking or chewing) are also choosing to increase their own risks of damaged physical and mental health.

These studies and tests reinforce what we have known about the physical dangers of tobacco use and add a more cerebral level of concern for the mental health of those exposed to tobacco. The smart conclusion would be to avoid tobacco use altogether.

ALICE ABLER

What is PSORIASIS

 What i psoriasis

Psoriasis is a medical condition that occurs when skin cells grow too quickly. Faulty signals in the immune system cause new skin cells to form in days rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and lesions form. 

 





   signs and symptoms?

•  The lesions vary in appearance with the type of psoriasis. There are five types of psoriasis: 

         *Plaque, guttate, pustular, inverse, and erythrodermic. About 80% of   

           people living with psoriasis have plaque (plak) psoriasis, also called “  

           psoriasis vulgaris.”

• Plaque psoriasis causes patches of thick, scaly skin that may be white, silvery, or red. Called plaques (plax), these patches can develop anywhere on the skin. The most common areas to find plaques are the elbows, knees, lower back, and scalp. 

• Psoriasis also can affect the nails. About 50% of people who develop psoriasis see changes in their fingernails and/or toenails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellowish-orange color, this could be a sign of psoriatic arthritis.

What causes PSORIASIS

• Stress
• Sunlight
• Excessive alcohol consumption
• seasonal changes
• Hormonal changes
• infection
• because of certain drug withdraw with corticosteroid,lithium,choroquine.

Psoriasis is not contagious. You cannot get psoriasis from touching someone who has psoriasis, swimming in the same pool, or even intimate contact. Psoriasis is much more complex. 

Causing new skin cells to form in days rather than weeks. The reason T cells trigger this reaction seems to lie in our DNA. People who develop psoriasis inherit genes that cause psoriasis. Unlike some autoimmune conditions, it appears that many genes are involved in psoriasis.

Side Effected

When psoriasis flares, it can cause severe itching and pain. Sometimes the skin cracks and bleeds. When trying to sleep, cracking and bleeding skin can wake a person frequently and cause sleep deprivation.

A lack of sleep can make it difficult to focus at school or work. Sometimes a flare-up requires a visit to a dermatologist for additional treatment. Time must be taken from school or work to visit the doctor and get treatment. 

English Grammar assignment

Simple past Tense.

-Used to indicate an action in present time or when it refer to habitual actions or universal truth.


The Present continouse Tense

- Used to indicate an action in present time that is incomplete or still going on.

 The Present Prefect Tense

-Indicate to use past action wher time is not given or in indicate past event that still affect the presen to  
  indicate the action that have begun in the past that are still continuing the present.

 The simple Past Tense

-To indicate the action completed in the past or former habits.


Verbs
-A word that represent an action or state of being.go, strike, travel, and exist are examples of
verbs.Verb is the essential part of the predicate of a sentence. The grammatical forms of verbs
include number, person, and tense.

articles 
- in grammar the words a, an, and the, which precede a noun or its modifier. The is the definite
   article, a and an are indefinite articles.

Conjuction
- A word that is used to join other word, phrases, clauses, and sentences.
   example :  that,for,while,or,but,with,which

Preposition
-show a relationship between places, people and things.

  example :of,to,at,on,in


Adjective
Many
their
Gutter of mising formation,
playground for irresponsible individu,
young
diffrent
expensive
involved
this
one
Net
In
Fast
Accessible
Smooth,
evel
inaccurate
larger
irresponsible
incorrect
net
explicit
material
adults
both
selfish
unidentified
japanese
mailing
graphic
violence
ignore



Noun

mankind
internet
users
account
salesperson
audience
fingertips
next
anger
handle
deeds
understanding
tool
levels
government
schools
parents
children
equilibrium
today
minor
can
up
webpage
ideas
dog
business
environment
characters
but
reputation
companies
nation
stake
top
information
net
virus
damage
organisation
crimes
comission
justification
reached


Adverb

virtually
never
before
co
time
too
as
that
overall
in
all
around
however
more
even
up
their
own
regardless
how
where
only
constantly
when
buy
out


Verbs

define
have
has
been
source
brought
increase
gives
generated
reached
even
set
up
own
publish
idea
gets
eat
are
can
post
circulate
threaten
engulf
net
affect
champion
causes


Conjuction

where
only
but
which
than
while
that
however
before
or
and


Present Contineous Tense

Gaining
Understanding
Handling

Glaucoma....

What is Glaucoma?


Glaucoma is a group of eye diseases that gradually steal sight without warning. In the early stages of the disease, there may be no symptoms. Experts estimate that half of the people affected by glaucoma may not know they have it.

Vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires. It is responsible for carrying images from the eye to the brain.

There is no cure for glaucoma—yet. However, medication or surgery can slow or prevent further vision loss. The appropriate treatment depends upon the type of glaucoma among other factors. Early detection is vital to stopping the progress of the disease.

It was once thought that high pressure within the eye, also known as intraocular pressure or IOP, is the main cause of this optic nerve damage. Although IOP is clearly a risk factor, we now know that other factors must also be involved because even people with “normal” levels of pressure can experience vision loss from glaucoma.

Adult glaucoma falls into two categories—open angle glaucoma and closed angle glaucoma.

Types of Glaucoma

The two main types of glaucoma are primary open angle glaucoma (POAG), and angle closure glaucoma. These are marked by an increase of intraocular pressure (IOP), or pressure inside the eye. When optic nerve damage has occurred despite a normal IOP, this is called normal tension glaucoma. Secondary glaucoma refers to any case in which another disease causes or contributes to increased eye pressure, resulting in optic nerve damage and vision loss.

How common is glaucoma?

Worldwide, glaucoma is the leading cause of irreversible blindness. In fact, as many as 6 million individuals are blind in both eyes from this disease. In the United States alone, according to one estimate, over 3 million people have glaucoma. As many as half of the individuals with glaucoma, however, may not know that they have the disease. The reason they are unaware is that glaucoma initially causes no symptoms, and the loss of vision on the side (periphery) is hardly noticeable.

What are the risk factors for glaucoma?

• Age over 45 years

• Family history of glaucoma

• Black racial ancestry

• Diabetes

• History of elevated intraocular pressure

• Nearsightedness (high degree of myopia), which is the inability to see distant objects clearly

• History of injury to the eye

• Use of cortisone (steroids), either in the eye or systemically (orally or injected)

• Farsightedness (hyperopia), which is seeing distant objects better than close ones (Farsighted people may have narrow filtering angles, which predispose them to acute (sudden) attacks of closed-angle glaucoma