Medical blog

Gay's meeting in hyderabad

2008-11-26T21:02:00.000-08:00

Today i came to my home town (warangal) from my college ... After coming here i saw a strange new in tv that is "gays meeting in hyderabad" may be its normal in other westren cultured countries ... But its strange and wondering in india ... Hyderabad is capital of andhrapradesh (a state in india) .. Here gayism is not encouraging nor accepted ... But gayism (attraction of a male towards a male) is natural thing so no one can stop it ... According to the news this gay meeting was held to aware the gays about aids n hiv as the "WORLD AIDS DAY " a head ... Most of the ppl belive hiv/aids is spreading mostly by sex and that to by gay sex more ... So this meeting is going to held in hyderabad with name "DARPAN" .... According to news this meeting was hosted by some famous ppl like politicians,film actors etc etc and they expecting 3 thousand gays will attend in this program .... According to me such an programs should be held ... Yes they are also humans like you n me ... They never wantedly went into gayism its natural thing because of hormoe defency even though there is no correct reason for it but they never wantedly doing this ... Im not encouraging nor telling it is bad .. But they should also have some proper education about sexually transmitted diseas ..... I appriate the organisers who hosting such an wonderfull program to aware the gay ppl about aids/hiv

world aids day is ahead

2008-11-23T02:49:00.000-08:00

ADIS ALL OVER WORLD

Today i would like to tlak something about aids and its awareness , as we all that aids is the most important problem in throught out the world more in indai .... what we ca do to stop this adis ? there is no solution for it ? There is a great saying . "prevention is better then cure " this suits excatly for aids .. the main aids tranmission are done by illegal sex {unsafe sex }, unsterilised needles for injections,from mother to kids these are the main cuases of aids ... in india as the sex workers dont encourage for condom use this aids became more in india ... the most wired thing for me is orphans whos parents lost in this adis mishap .. The drug users who use same needles for injecting drung also causes this .... yes i know we all know about it .. even the persons who are getting efectd by aids also know all this but unfortunately they never used any safe methods .... mostly the lory drivers from india getting effected with this aids as they travell milles and milles and state to state they atay at diff place and do sex with diff sexworkewers without using condoms ... 5 years backs there was a women lived beside my house , her husand passed way when she having a small child.. after her husband passed way she have to give daily bread to her son so she became as sex worker as she dont know any other work ... im not critising her here because she doing every thing only for her kid ... but the mistake thing she did unsafe sex .... after some years she attacked with aids ...then she also deaded with aids when her kid is 4 years old ... if she went into prostution proffesion only because of her kid why she cant do safe sex only for kid ? now who will take care of her kid ? the persons who did sex with her after she got infection will probably efffect with it .... so who will take care of there kids ?

Tje reason why she did unsafe sex is because she is aware of adis and sexually tranmissted deasies .... in india ppl feel shy or feel disgusting talking about sex related thigns .. thats the reason most of the ppl aware of such things ... so the government should do more programs to educate ppl about STD

Already they introduced lots of programms but most of them not reaching up tot he normal person ..... but why shoould always government do such things ?? why cant u and me to join in this ? yes thats the problem comming here every onr htinking why should i join .. im not effected .. we are humans we are not animals so thats the reason we should help others ... the pic above showing there are some educated ppl how educating other sex workers.

my ideas to prevent adis are as follows

1.using condoms

2.educating sex workers

3.sex education in colleges and school

4.stop usage of unsterilized needles in hospitals and other places

5.testing the blood before blood transmition

6.providing condoms every where like shops, bustands,railway stations etc etc ..

Weird Animals

2008-11-15T09:27:00.000-08:00

Weird Animals

Blue whale babies weigh up to 7 tonnes at birth.

A female cod can lay up to 9 million eggs.

Snakes can see through their eyelids.

Elephants spend 23 hours a day eating.

Vultures sometimes eat so much they can't take off again.

The Amazon 'Jesus Christ lizard' can run across water.

The biggest Antartic inland animal is a wingless fly measuring about 60 mm long.

Fleas can jump up to 30 cm, twenty times their own body length.

Bluebottle flies can smell meat from distances 7 km away.

Many birds migrate, but the Arctic tern travels furthest. It flies from the Arctic to the Antarctic, and back again, a trip of 32,000 kilometers.

Some animals can regrow parts of their bodies if damaged. Starfish can grow new 'arms.' Slow-worms can regrow broken-off tails. Lizards can grow new tails.

One golden poison-dart frog could kill up to 1500 people with its poison.

The giant squid has the largest eyes of any animal. They can be 39 cm across, which is 16 times wider than a human eye.

The peregrine falcon can spot its prey from more than 8 km away.

The sleepiest mammals are armadillos, sloths and opossums. They spend 80 per cent of their lives sleeping or dozing.

A mayfly only lives one day, but a tortoise can expect to live 100 years.

Stegosaurus was one of the most famous of the dinosaurs and was an impressive 9 metres long. But its brain was the size of a walnut.

Dragons do exist!

2008-11-15T09:23:00.000-08:00

Dragons do exist!

The Komodo dragon is the world's largest flesh-eating lizard and living reptile. This amazing creature is only found in the wild on four small Indonesian islands, where they are vulnerable to disease, volcanic activity, and competition with feral dogs and man. It lives on the islands of Komodo, Rinca, Padar, and Flores.
The Komodo is an endangered species and there are only about 5,000 of them in existence around the world, including a small number kept and bred in zoos.

This giant lizard can grow to 3 meters (10 feet) long, and has an average weight of 70 kg (155 pounds). Komodo dragons are dangerous predators with sharp serrated teeth more like a shark's than a reptile's. Swift runners, they can swim and climb trees, and they can use their tail as a weapon and swing it like a club. They find most of their food by smell. Like shakes they 'taste' the air with their tongues, which are deeply forked and collect scent molecules from the air. They have an acute sense of smell and can detect the scent of decaying remains from up to 5km (3 miles).

While Komodos like to eat dead things, they also prey on wild pigs, water buffalo and deer. They have a huge capacity for food, often eating up to half of their body weight in one meal. They are also cannibalistic, sometimes eating their own kind. They eat almost all of a carcass, consuming flesh, skin and even bones. A large Komodo can swallow a whole wild pig; their jaws expand like a snake's.

Their bite is often lethal because the bacteria in their mouths is so poisonous that wounds often do not heal, and their victim, if it manages to escape, dies in a day or two.

Although often regarded as pests, Komodos are not a serious danger to humans. In order to protect the dragon, the Indonesian government has made the islands of Padar and Rinca into nature reserves for both the lizard and its prey. Commercial trade in specimens or skins is illegal under the Convention on International Trade in Endangered Species.

The Komodo dragon can live up to 40 years. Although often regarded as pests, Komodos are not a serious danger to humans. In order to protect the dragon, the Indonesian government has made the islands of Padar and Rinca into nature reserves for both the lizard and its prey. Commercial trade in specimens or skins is illegal under the Convention on International Trade in Endangered Species.

Vampires that drink blood!

2008-11-15T09:21:00.000-08:00

Vampire bats really do drink blood. They feed on the blood of birds, cattle, horses, and pigs ... and the occasional sleeping human.

They need to consume a few tablespoons of blood every day. If the vampire bat doesn't eat for more than a few days it will starve. They can only be found in Central and South America.

Irish writer of horror tales Bram Stoker was so fascinated by these bats that drink blood, that he incorporated them in his book 'Dracula.'

TOP 10 MEDICAL COLLEGES IN INDIA

2008-11-15T09:08:00.000-08:00

All India Institute of Medical Sciences, Delhi
Address : Ansari Nagar, New Delhi 110029
Phone: 91-11-26588500, 91-11-26588700, 91-11-26589900
Fax : 91-11-26588663, 91-11-26588641
Website: http://www.aiims.edu/
Website: http://www.aiims.ac.in/

Christian Medical College, Vellore
Address : Vellore 632 004, Tamil Nadu, India
Phone: 91-416- 2222102, 2223603, 2222722, 2223977, 2225535, 2222716
Website: http://cmch-vellore.edu/

Armed Forces Medical College, Pune
Address : Pune 41104
Website: www.afmcpune.com

JIPMER, Pondicherry
Address : Dhanvantri Nagar, Gorimedu, Pondicherry - 605 006, India
Phone: (0413) 2272380 - 90 (11 lines)
Fax : (0413) 2272067 (Director), 2272066(Dean), 2272735(M.S.)
E-mail : director@jipmer.edu
Website: http://www.jipmer.edu/

Lady Hardinge Medical College
Address : Bhagat Singh Road, Pin - 110001
New Delhi
Phone: 23343984

Lady Hardinge Medical College
Address : Connaught Place, New Delhi 110 001
Phone : 3363596

Kasturba Medical College Chennai

Maulana Azad Medical College, Delhi
Address : Bahadur Shah Jafar Marg, New Delhi - 110002
Phone: (011) 23239271/ 72/ 73/ 74/ 23231478
E-mail: deanmamc@vsnl.net
Website : http://mamc.ac.in/

Grant Medical College
Address : B25 (ESIS Hospital Quarters)
Mulund (W), Mumbai-400080
Phone: 022-25680861

St John's Medical College, Bangalore
Address : Sarjapur Road
Bangalore - 560 034
Phone: 080-22065000
Fax: 080-25530070
E-mail: sjmch@vsnl.com , stjohns@blr.vsnl.net.in

Bangalore Medical College
Address : Fort, Bangalore – 560 002
Phone: 080-26704342
Fax: 080-26704342
E-mail: bmc-bng@vsnl.net

LIST OF MEDICAL COLLEGES IN ANDHRA PRADESH

2008-11-15T09:00:00.000-08:00

LIST
OF GOVERNMENT MEDICAL COLLEGES IN ANDHRA PRADESH

Sl. No.	Name of the Medical College	No. of Seats to be filled up
1.	Andhra Medical College, Visakhapatnam	200
2.	Guntur Medical College, Guntur	200
3.	Siddartha Medical College, Vijayawada	100
4.	Osmania Medical College, Hyderabad	200
5.	Gandhi Medical College, Secunderabad	150
6.	Rangaraya Medical College, Kakinada	150
7.	S.V. Medical College, Tirupathi	150
8.	Government Medical College, Anantapur	100
9.	Kakatiya Medical College, Warangal	150
10.	Kurnool Medical College, Kurnool	150

LIST OF PRIVATE MEDICAL
COLLEGES IN ANDHRA PRADESH

S.No	Name of the Private Medical College	Total Seats
1.	Deccan College of Medical Sciences, Hyderabad	150
2.	Mamta Medical College, Khammam	100
3.	Kamineni Institute of Medical Sciences, Narketpally, Nalgonda	100
4.	Sri Venkata Sai Medical College, Mahaboobnagar	100
5.	Narayana Medical College, Nellore	100
6.	Alluri Seetha Ramaraju Academy of Medical Sciences, Eluru.	100
7.	MNR Medical College, Fasalwadi, Sangareddy, Medak	100
8.	Prathima Institute of Medical Sciences, Naganur Road, Karimnagar	150
9.	Mediciti Institute of Medical Sciences, Ghanapur, Medchal, R.R.Dist	100
10.	PES Institute of Medical Sciences & Research, Kuppam, Chittoor	150
11.	Katuri Medical College & Hospital, Chinakondurupadu, Guntur	100
12.	Churches of South India Association, Medak Diocese, Dichpally, Nizamabad	100
13.	GSL Educational Society, Rajahmundry	150
14.	Siddhartha Academy of Geni & Tech Education Gannavaram	150
15.	Sri. Rama Educational Society, Vizianagaram.	100
	Total ::	1750

Osteoporosis drugs may prevent future bone growth

2008-11-15T08:54:00.000-08:00

eventually stop regimens of a common class of osteoporosis drugs called bisphosphonates may be unable to benefit from parathyroid hormone (PTH), which can rebuild bone mass lost due to advanced stage osteoporosis. PTH has been proven to increase the volume and strength of the honeycomb-like bone infrastructure, the inner mesh that begins to diminish in old age.

Bisphosphonates, the active ingredient in widely prescribed osteoporosis medications such as Fosamax, Actonel, and Boniva are currently taken by more than thirty million Americans.

"These medicines work by preventing further bone loss," explains Dr. Warren Levy, president and CEO of Unigene Laboratories, Inc. "However, recent reports suggest that some patients using bisphosphonates may be unable to repair or replace older or damaged bone. Furthermore, it has been reported that the prior use of certain bisphosphonates may blunt the effects of PTH, which could render the only currently available bone growth drug ineffective. Since bisphosphonates typically deposit in the bones for years, the use of a bisphosphonate could compromise the ability to grow new bone later in life when it is most needed."

Estrogen alternatives have grown in recent years, including calcitonin, a naturally occurring hormone involved in calcium regulation and bone metabolism. In third-party clinical trials, calcitonin demonstrated a 62% reduction in the incidence of new vertebral fractures for a subgroup of women over seventy-five years of age, one of the most significant reductions demonstrated by any current osteoporosis therapy.

"Calcitonin has a proven, thirty-five-year record of safe human use with virtually no significant side effects and can be taken simultaneously with other medications," said Dr. Levy. "Since it is rapidly cleared by the body, it does not build up in the bone and may allow the patient to effectively employ PTH therapy in subsequent years if necessary."

Although, PTH injections have been shown to reduce the incidence of fractures by restoring bone, the treatment can be very costly and requires daily injections. Unigene and GlaxoSmithKline are jointly developing a low-cost, orally administered PTH treatment, and Unigene is currently performing a Phase I clinical study in the U.S. Twenty-four healthy postmenopausal women are enrolled in the study, which is designed to assess product safety and measure PTH blood levels.

The tablets being tested utilize the improved Enteripep? oral delivery technology. "One pill a day to treat bone fractures would be ideal for patients who need to take this medicine for life," adds Dr. Levy.

http://www.unigene.com

A new method to control bleeding in hemophilia

2008-11-15T08:47:00.000-08:00

Investigators at Children's Research Institute, BloodCenter of Wisconsin's Blood Research Institute and the Medical College of Wisconsin have discovered a new way to help the blood clot by having the missing clotting factor packaged in the patient's own platelets.

In the October 2008 edition of Blood, investigators describe how a gene-modified bone marrow transplant can be used to initiate clotting in hemophilia. This type of approach may work in the 30 to 35 percent of hemophilia patients that have developed inhibitory antibodies against the missing clotting protein.

The bone marrow is removed from the patient and stem cells are treated with Factor VIII, a clotting factor, which is placed in the platelets. The marrow is given back to the patient, who then retains the essential clotting mechanisms to stop bleeding that otherwise would lead to complications.

For people suffering from hemophilia, this research means the potential relief of a constant, burdening disease. People who have hemophilia previously had to be treated every time they bled. Currently, they can receive treatments three times a week, but these are very costly and time consuming. The results from this study provide hope that people with hemophilia could potentially lead a disease-free life.

The scientific community once believed that hemophilia would be treated successfully by gene therapy. Research then showed that gene therapy typically resulted in the patient not retaining a substantial amount of clotting factor, which is integral in preventing serious bleeding.

This research was a collaborative effort that included investigators Qizen Shi, PhD, MD; David A. Wilcox, PhD; and Robert Montgomery, MD.

http://www.chw.org/

copyrites of the blog

2008-09-12T06:22:00.000-07:00

copyrites of the blog:

MOST OF THE ARTICLES POSTED IN THE BBLOG ARE TAKEN FROM DIFF BLOG/WEBS , I DONT HAVE ANY LEGAL COPYRITES OF THE ARTICLES POSTED IN THE BLOG , I JUST TAKEN THEM FROM OTHER BLOG/WEBS ONLY FOR MY BOLOG USERS EASY BROWSE . IF ANY ONE (THE AUTHOR OF THE ARTICLE) THINKS I SHOULDNT POST THERE ARTICLE IN MY BLOG PLEASE MAIL ME WITH THE ORGINAL URL AND THE URL IN MY BLOG OF UR ARTICLES TO DR.DINNY@GMAIL.COM , I PROMISE I WILL DELETE THE POST WITH IN NO TIME

THANK
BEST REGARDS,
DINNY

Smoking: The Thoughts Of Smoking

2008-09-10T22:48:00.002-07:00

Smoking: The Thoughts Of Smoking

We see the affects of it on television commercials, read about it in magazines, see it on bulletin boards, and even hear it on the radio; yet we still manage to find a place for these disgusting "butts" in our daily lives. The very thing that robs our pockets, threatens to kill us, and forces us in a sense to put a gun to our own head, is the very first thing that we run to when the stresses of life knock at our door. Why do we subject ourselves to this slow death, or in even more dramatic terms, prolonged suicide? It is no secret that for every cigarette we put to our lips, our lifespan is shortened. Many people who have tried to quit smoking, but simply can't. No, it is not their fault that they can't stop; but it is their fault for starting the habit after being warned after how many times?

The majority of us do many things that we know we shouldn't; consciously aware of the affects and consequences, but why? If quitting smoking were as simple as not lighting anymore cigarettes, which it is, then why is it so hard to not light anymore? There are countless stories about people who have finally decided to quit, but can't seem to get past that "very last cigarette." The ones who do make it to finally quitting are then introduced to a new struggle--cravings.

Nicotine is definitely part of the problem to be blamed; but after awhile, the addiction to the Nicotine will subside. Some people experience withdrawal symptoms due to nicotine. Some of these include:

Dizziness

Depression

Anger and Frustration

Sleep disturbances

Restlessness

Irritability

Headaches

Tiredness

Increased appetite and weight gain

What about the people who have not smoked for quite some time, yet they still can't keep their mind off wanting to smoke? Could there be something deeper than addiction that keeps a person connected to the stick of death? Of course there is!

A large percentage of people today are stressed to the point where they would rather find ways of not having to deal with their problems, as opposed to tackling them head on. Things such as alcohol and cigarettes are then used as forms of instant stress relief. When a person quits and is use to masking their problems with smoking; a sense of emptiness is most likely felt. Their bodies became dependant on this comfort, and now that it is no longer available, they begin to panic. The problem that most people who quit have is finding a way to fill that void.

The feeling can be closely related to that of a small child who is suddenly left alone in the middle of a huge city. A person often feels lost and doesn't know where or how to start when it comes to dealing with their now uncovered issues. Say for instance they get into an argument with their girlfriend/boyfriend, what do they have to turn to now? Advertisers are always finding brilliant ways to sell us this disillusioned happiness. They have a way of targeting unsatisfied people who are searching for more in life. "When life buries u deep, have cigarette and forget about it!" It may sound corny, but to some people it may trigger something inside, suggesting why not give it a try.

There are benefits to quitting and to some it provides a source of inspiration. Some of these benefits are:

A persons heart rate and blood pressure drops after 20 minutes of quitting

Former smokers live a longer life than continuing smokers

Women who stop smoking before pregnancy reduce their risks of having a low birth weight baby to that of women who never smoked.

The health benefits of quitting far exceed any worried regarding the ten pounds or less weight gain that follows quitting.

Twelve hours after quitting, the carbon monoxide level in your blood drops to normal.

Circulation improves and lung functions increase two weeks to three months after quitting

Coughing and shortness of breath decrease one to nine months after quitting

The excess risk of coronary heart disease is half that of a smoker 's .

Your smoke risk is reduced to that of a non-smoker five to fifteen years after quitting

Ten years after quitting, the lung cancer death rate is about half that of a continuing smokers.

Fifteen years of quitting, the risk of coronary heart disease is that of a non-smoker 's .

There are also immediate visible rewards of quitting. It helps to stop the damaging affects of tobacco on a person 's appearance, which include:

Premature wrinkling of the skin

Bad breath

Stained teeth

Bad smelling clothes and hair

Gum disease

Yellow fingernails

A brave soul is a strong soul.

Health Hazards of Smoking

2008-09-10T22:48:00.001-07:00

Health Hazards of Smoking

Health is the most precious thing a person can have. But we start to value something only when it is lost. When in old age you feel ache of bones and the whole body, regrets about the damage youвЂ™ve made to own health in youth come to light of your mind.

Before the age of 35-40 smokers pay no attention on the harm they do to their body. Young vigorous constitution easily deals with another incoming portion of cigarette smoke, dangerous tar and nicotine, but passing ages give us no new strength. In addition, nicotine and attendant poisons, in time, multiply their concentration, that makes the work of our body more difficult.

This article is a warning to everyone who is still smoking. Stop it! It has to be done today, because tomorrowвЂ¦ what is going to be tomorrow?

Researches, performed in USA, showed that 25% of smokers had never lived so long to celebrate their 70вЂ™s birthday, because of nicotineвЂ™s influence. In highly developed countries smoking causes death of more people, then alcohol, drugs and suicides altogether.

It is said, that two packs of cigarettes contain lethal dose of nicotine. However smokers never receive this dose at once, it is divided into portions, and the fatal effect stays unnoticed. People die not of the nicotine itself, but of the diseases, arising from its influence. Smoking in its cruelty is close to AIDS, they both open the doors of the organism to many diseases.

First of all tobacco smoke attacks the oral cavity. The dental enamel is getting worse, oral mucosa is irritated, activity of salvia glands gets low, bringing down the protective function of salvia, and in addition the bad breath appears. Besides, the cases of lip cancer are not a rarity now. It takes place when smoker holds the cigarette in his teeth, instead of using hands.

Then smoke goes through bronchus, causing their spasm. That leads to breathlessness, and hyper secretion of protective mucus in bronchus. Its mission is cleaning of the incoming air and protecting pulmonary tissue from pathological microorganisms, but the superfluity of protective substance will not improve the cleaning process; on the contrary, it can be stopped at all.

This is the stage, where your body loses another protective barrier.

Smoking decreases the inflow of fresh air. In addition blood hemoglobin connects with carbon of tobacco smoke, and can no longer transport oxygen. Hypooxygenemia develops, causing harm to all systems of vital importance, especially to cardiovascular system.

When smoking, the spasm of the blood vessels happens, this leads to increase of blood pressure. This condition multiplies the load on the heart. As a result, people, who are not giving up smoking raise their risk of a heart attack by 8 times.

Smoking increases the production of stomach juice. Such a run free work leads to ulcer and gastritis.

And in the end вЂ“ awful statistics: only one cigarette a day makes you 7 steps closer to cancer. Smoking more then one pack a day a person makes this distance twice shorter.

What will happen to your organism if you stop smoking?

At the beginning, your body will experience stress вЂ“ dizziness, vomiting and total weakness will be a hard test for you, but in a month things will get better. You will notice your breathing to be easier, memory and muscle tone to come back to norm, the color of your skin and teeth will surpass all expectations. In six months bronchus and the pulmonary tissue will be cleaned from heavy pitches and tobacco dust. In a year the cardiovascular system will be restored. Five years of nonsmoking will totally erase all signs of this bad habit.

Everything that was told is possible only if your diseases are not chronicle yet, if it is so, then smoking cessation is the first thing you should do.

Remember вЂ“ itвЂ™s never late to stop smoking!

About the Author

Stop-Smoke.org website is a seller of Nicocure - effective quit smoking herbal remedy. You are allowed to distribute this article with an active hyperlink to http://www.stop-smoke.org/ only.

New Apple-Derived Treatment Improves Hair Growth Without Side Effects

2008-09-10T22:34:00.001-07:00

New Apple-Derived Treatment Improves Hair Growth Without Side Effects

Japanese researchers have discovered a substance from apples, apple polyphenols or procyanidin B-2, that is effective for regrowing hair. After studying over 1,000 botanical extracts and conducting clinical trials with double-blind studies, the results were quite conclusive.

Of all the substances tested, only two showed positive results. One comes from chardonnay grapes, called proanthocyanidin, and the other from apples, procyanidin B-2. It was this product from apples that was the most effective.

* 78.9% of subjects showed an increase mean value of hair diameter.
* The number of terminal hairs and total hairs was "signficantly increased" compared to the control group.
* The research team concluded that "topical proycanidin B-2 is safe and effective in curing male pattern baldness."

The product has been studied worldwide. One study discovered that procyanidin B-2 nearly doubled the hair growth of minoxidil (Rogaine). The conclusions of another study state, "Procyanidin B-2 shows promise as a cure for male pattern baldness."

More important perhaps is the absence of harmful side effects. In over 80 studies, no side effects have been observed.We've all heard about the benefits of an apple a day, but who knew that apples would also grow hair?

Procyanidin B-2 blocks the production of TGF Beta, a degraded form of DHT. It is actually this TGF Beta that causes the hair follice to shrink and the hair to fall out. TGF Beta is not needed in sexual function. This makes procyanidin B-2 a safe solution for hair loss without the sexual side effects that can occur with other products.

Let 's look at the scientific studies further to better understand what makes procyanidin B-2 so different. The prestigious British Journal of Dermatology concluded that procyanidin B-2 acts to diminish protein kinase C isozymes. These are important in the hair growth cylce.

Your hair follices actually have three cycles: anagen (the active growth phase), telogen (the resting phase), and catagen (the shedding phase). Ideally, you want to prolong the anagen or growth phase and shorten the resting phase. This is was reported in the British Journal of Dermatology. The end result, of course, is increased hair growth.

Up to now the only documented methods to combat hair loss have been minoxidil (Rogaine) and Propecia. Unfortunately, they have a range of unpleasant side effects, including sexual dysfunction. Minoxidil was originally developed as a blood pressure medicine. The product is still absorbed in the body even though applied topically into the scalp.

There are a number of so-called natural treatments, some of which actually contain minoxidil. Unfortunately, many have no proof other than anecdotal claims.

Tsukuba Research Laboratories in Japan conducted a new study that is important. They did a 12 month clinical trial, and several conclusions should be noted.

* No side effects were observed in any subjects.

* After 12 months of use, 71% of the subject showed an increased number of hairs in the designated scalp area relative to pre-trial measurements.

* Procyanidin therapy shows promise as a potential cure for male pattern baldness.

Finally there is an option for those who want a proven substance to grow hair and without side effects.

About the Author

Robert Lansburg has prepared a compilation of the scientific studies about hair growth at http://www.applepoly.com/hairrex.

Hair Transplant Surgery - What Options Do You Have When Considering Hair Transplant Surgery?

2008-09-10T22:34:00.000-07:00

Hair Transplant Surgery - What Options Do You Have When Considering Hair Transplant Surgery?

by ViennaMilley
Hair Transplant surgery is one of the most popular cosmetic procedures chosen by men today.

A hair transplant is when hair in an area that is not prone to balding (such as the sides and back of your head) is taken and transplanted into the balding or thinning areas. This hair then continues to grow throughout your lifetime and can give you a full head of natural looking hair.

A hair transplant is the only real permanent solution for hair loss and balding. However it is a big decision to make and you should have all the facts before deciding to have hair transplant surgery.

So just what are your surgery options? Here 's a brief review of the different types of procedures offered by hair transplant surgeons. (Note that not all surgeons offer all options.)

Options For Hair Transplant Surgery:

In general there are 2 types of transplantation surgery: The FUSS and the FUE method.

Not all doctors perform the FUE method as it is fairly new and much more time-consuming (as well as expensive for the patient).

Some surgeons also offer scar repair surgery (which is surgery to improve the look of a previous hair transplant scar) as well as hair transplant repair (for example to fill in density on a formerly poor transplant or to redo the hairline, etc.) Again, not all surgeons perform this type of surgery so you might have to look around for specialists in each area.

Whichever procedure you choose will also depend on the extent of your personal needs. Your doctor can inform you of the risks, advantages and disadvantages of each method.

#1) FUSS - Follicular Unit Strip Surgery

A narrow strip of hair is taken from the back of your scalp (where you aren't prone to thinning). The grafts are then implanted into the balding area and most will continue to grow throughout your lifetime. The donor area is closed up with sutures or staples. These will be removed in several days or absorbed.

Depending on several factors (including the skill of your surgeon), only minimal scarring will occur in the donor area and approximate downtime can run from 1 week to a month, depending on the situation.

One of the main advantages to FUSS is that it allows many grafts to be transplanted in one session (i.e. up to 4000) so the results can be dramatic. While your surgeon can recommend which method is best for you, in general, the FUSS method works well for medium to large areas of balding.

#2) FUE - Follicular Unit Extraction

This is a new technique that a few surgeons are starting to offer. It mainly consists of harvesting each hair follicule separately from the back and sides of the head (that aren't prone to thinning). Then each follicule is transplanted into the balding area. There is no scalpel cutting or any deep surgery with this method.

The scarring tends to be less when compared to the FUSS method. Also, according to some surgeons, the recovery time can sometimes be shorter with the FUE method (because there isn't the deep surgery as with the FUSS).

While your surgeon can recommend which method is best for you, in general, the FUE method works well for those people who do not wish to have a scar, don't need a lot of grafts, or who want to wear their hair very short.

3) Other Procedures - Scalp Reduction

This surgery is much less common and fewer surgeons still offer it. A scalp reduction is where areas of balding are surgically removed with the rest of the scalp skin pulled together to eliminate the balding skin. Depending on the size of the balding area, this is usually done in stages.

This is probably the most expensive procedure and can run you into the tens of thousands of dollars. Plus there 's also risks like tightness of your scalp leading to thinning of the skin and improper scarring.

Conclusion:

Whatever you decide to do, it 's important to talk to your doctor before making any decisions about your health. Hair transplant surgery is always evolving and improving so it 's also important to interview as many surgeons as you can to get a good idea of what each can do for you.

Keep in mind that doing your research beforehand can ensure you get the most amazing, natural results that you want.

Get rid of cellulite

2008-09-10T22:26:00.000-07:00

How to Get Rid of Your Cellulite Problem

The usually unsightly condition known as cellulite is suffered by woman around the world and is universally hated; the thighs and buttocks might be the main areas that experience this but it can actually be found anywhere.

Most women carry excess fat in thighs and buttocks, but this problem is not confined just to the overweight; women who are naturally slim can also suffer with this unsightly problem.

Cellulite forms just below the surface of the skin in the thighs and buttocks region, where areas of fat collect and force themselves against the tissue creating a puckered look to the surface of the skin.

Health experts have been trying to discover the cause for some time as it is not a condition that affects every woman but they believe it does have some connection to the way the fat cells are made and possibly how toxins enter and are stored within the body.

This problem usually comes naturally with aging and similar to wrinkles that form in the face, it is actually the result of lower levels of collagen and elastin in the skin.

The condition is almost exclusive to women and has been attributed to hormonal changes that take place as a woman gets older as the fat in the thighs and buttocks of men is the same as fat found in other parts of their bodies.

Cellulite often goes unnoticed for the majority of the time for most people and is only seen when a person has their thigh muscles compressed in the case of squatting for example or when the skin is pinched in the thigh area and the puckered skin becomes apparent; when the fatty tissue can be felt but most women suffer with this.

Many factors can influence the buildup; ranging from the sex of the person to their age, genetic make-up, skin type and skin thickness, all have a part to play in its formation.

Currently there isn't one single treatment that can rid a person of this condition because the cause has remained elusive despite considerable research into the area. One method that hides the cellulite quite well by puffing the skin is deep massage and an increasing number of clinics are now offering this therapy.

Perhaps the most drastic therapy is liposuction where fat is literally sucked from the body or the more expensive procedure of injecting certain chemicals in a process called mesotherapy.

Liposuction is rarely that effective with surface based fat like cellulite and is more proficient at removing deeper fats from the body which are not trapped in the cells but none of these treatments offer anything but short term relief only.

There isn't one single therapy or treatment that can rid someone of these fat deposits and even special burning creams provide dubious results; however most of the cream products that are available seem to just hide the effects or offer a temporary fix.

Many people believe that the only realistic way to reduce the amount of fatty tissue a person has is to follow a controlled diet plan and exercise regularly which will gradually burn off much of the body fat including that found in the tissues of the thighs and buttocks.

Many toxins that accumulate in the body can be flushed out with regular amounts of water which some believe is still an effective way to keep the body free of harmful substances including the toxins which help with the formation of cellulite.

How to improve your IQ

2008-09-09T12:14:00.000-07:00

The IQ test is controversial because it supposedly measures how intellectually bright you are in comparison with the rest of the population. The first IQ (Intelligence Quotient) test originated in France and was the work of Alfred Binet who sought to find a way to differentiate between normal children and children who were struggling at school. It was later revised by Lewis Terman in the US and the Stanford-Binet IQ test was born.

Many people misunderstand the IQ scoring system which works on the principle that a score of 100 is average. A higher score means you are above average in comparison with the rest of the population and a score of less than 100 indicates that you are lower than average. It is reckoned that about half of the population will score between 90 and 110 on a standard IQ test. As a rough guide, the following scores indicate your score in relation to the rest of the population.

• Over 130 – Extremely bright, only 2% of the population achieve this score
• Between 120 and 130 – Very bright, probably around 7% of the population
• Between 110 and 120 – Bright, 16% of the population
• Between 90 and 110 – Average, makes up about half the population so 50%
• Between 80 and 90 – Low average, 16%
• Between 70 and 80 – Borderline, 7%
• Lower than 70 – Extremely low, about 2%

A word of warning however, IQs may be a measure of something, even if it’s only one’s ability to sit IQ tests, but are they a true reflection of intelligence per se? Probably not! Intelligence depends on many factors such as environment, community, genetics, background etc. It is worth remembering that Einstein himself was not considered “intelligent” by any standard whilst at school.

Even if we cannot accurately measure intelligence with 100% accuracy, we do know that we can improve it and at the same time increase our potential as a human being. Here’s how.

Give your brain the right fuel

Our brains rely on essential fatty acids to function effectively, particularly Eicosapentaenoic acid (EPA), which is found in oily fish and fish oil. If we don’t get enough EPA then we will rely on inferior fuels that will clog up our brain engine and perhaps even cause it to malfunction. Eating a varied and balanced diet with plenty of fresh fruits and vegetables helps too, along with regular exercise to keep our bodies and our brains in good working order.

Indulge in music

Psychologist Frances Rauscher and her colleagues discovered over 10 years ago that listening to Mozart appeared to improve nerve signalling in the brain leading to increased mental ability. Other research has shown that children who received music lessons scored a few points higher on an IQ test than children who didn’t. If nothing else, music can help you to relax and de-stress which in itself can make you feel better and help your brain to work more efficiently.

Exercise your mind

Keeping your brain active on a regular basis will naturally improve your ability to process information. For example, quizzes, puzzles, even bingo can keep your mental faculties tuned up and in good working order. Some studies have shown that mental workouts can increase IQ scores by up to 8%.

Get enough sleep

Regular good quality sleep is essential for effective brain function. No one can operate to the best of their ability if deprived of sleep for any length of time. Sleeping allows your brain to process information, solve problems and tidy up the mess left behind by all those seemingly insignificant and fleeting thoughts that pass through your mind throughout the day. It is said that Dmitri Mendeleev, the Russian chemist, dreamt the answer to the periodic table of elements one night after spending hours trying to work out the problem during the day so make sure you get enough sleep.

Finally - think positive

Your brain will listen to the messages you give it and take action. If you are telling yourself you are incapable, tired, anxious, fearful, you will fail that test or not get that job and so on, your brain will act accordingly and send out all those signals to your body to perpetuate your state of mind. Imagine then what you could do if you told your brain to send out different messages? Thinking positive works, try it.

Bizarre Diseases

2008-09-09T06:14:00.000-07:00

Bizarre Diseases

We have all heard or read about of incidences of rare diseases, conditions and disorders that are horrific or shocking to say the least and we are naturally, desperately compassionate for anyone who has the misfortune to actually suffer from them.

However, some conditions seem particularly bizarre and which thankfully, are so rare, that most of us will probably never have heard of them. The following represents just some of these strange afflictions.

Alice in Wonderland Syndrome

This syndrome is also known as Micropsia. Individuals appear to have a malfunction in the way their brain processes visual information despite the fact that there is nothing wrong with their eyes. Objects, humans, parts of humans and animals etc. are perceived by the sufferer as being much smaller than what they actually are in reality. For example, imagine looking at your pet dog and seeing it as the size of small mouse or looking at another human who may in fact be six feet tall but who looks tiny and in no way a reflection of their actual size. Strangely, the perception persists even when the sufferer has their eyes closed. Some scholars believe that Lewis Carroll (who wrote Alice in Wonderland) may have suffered from this condition himself.

Jumping Frenchman of Maine Disorder

This is an extremely rare disorder first described by G. M Beard in 1878 and is believed to have been first observed in French Canadian Lumberjacks. Sufferers have a sudden and an abnormal reaction to stimuli. For example, when given a sudden command in a loud enough voice the individual will carry out that command instantly and without a thought, even if you tell them to hit out a loved one, or throw an object. Also, on hearing unfamiliar or foreign phrases they will often repeat them over and over again uncontrollably. Other symptoms include extreme jerky movements whenever a loud noise is heard, hence the “jumping” aspect to this disorder.

Walking Corpse Syndrome

People suffering from this condition may believe that they have lost parts of their bodies or even their souls and some might go as far as to really believe that they are already dead and are indeed a walking corpse, even maintaining that they can smell their own rotting flesh and can feel the worms eating at them. It has also been associated with psychosis linked to drugs such as amphetamines and cocaine and to schizophrenia.

Fish Odour Syndrome

A rare disorder where the body cannot produce a substance known as FM03 or monooxygenase 3 and as a result, its ability to break down Trimethylamine is impaired. The result of this is most unpleasant as it causes the person’s sweat, urine and breath to give off a very strong and fishy odour or a smell like that of rotten eggs.

Alien Hand Syndrome

This unusual neurological disorder is where one hand appears to take on a personality all of its own and acts in such a way that is completely out of control in relation to what the person wants to do. For example the alien hand may unbutton shirts or remove clothing whilst the other hand is trying to button up or get dressed. Sufferers will often attach a personality to their alien hand and will try to punish it for disobedience.

Capgras Syndrome
People suffering from the extremely rare Capgras Syndrome believe that a loved one or a significant other person in their life is being impersonated by an impostor. This can even lead to the sufferer attacking the perceived impostor. Sometimes it extends itself to the sufferer themselves who believe that when they look in the mirror it is not their own reflection staring back at them but the image of an impersonator.

Jerusalem Syndrome

Affecting around 100 tourists a year, it is a form of religious psychosis sparked by a visit to Jerusalem and is not confined to any one religion. Sufferers may believe they are prophets or messengers from the Lord and indulge in behaviours such as parading around delivering their own sermons, obsessing about virtue and cleanliness and will often ask sinners to repent their sins. The syndrome invariably disappears after a few weeks or when the tourist leaves the area.

CONDOM ringtone

2008-09-07T06:22:00.000-07:00

As part of its work to fight the spread of HIV, the BBC World Service Trust has launched a novel ringtone in India designed to break down the social taboo of using condoms. The new advertising campaign, which features a 'condom a cappella' ringtone is also funded by a grant from the Bill & Melinda Gates Foundation.

The strategy is to show social support for condoms, as this has a positive effect on use, and positions condoms as a product that men use to show they are responsible and care about themselves and their families. The creative idea of the ringtone winning approval from men and women of all ages reinforces that condoms mean good sense and those who know it are the real winners in life.

A advert showing the phone ringing out "condom, condom" at a wedding has been produced by the Trust.

Creative director of the BBC World Service Trust, Radharani Mitra, states, ''Ringtones have become such personal statements that a specially created condom ringtone seemed just the right vehicle to define its user as a sensible person. We have always had a strong interactive, response-oriented element in this ongoing campaign. This downloadable ringtone provides yet another opportunity for our target audience to translate the message into an action point.

The very act of downloading and using this ringtone would have a counter effect on the inhibitions and taboos that can be associated with condoms. And it adds an element of fun and comfort to it.''

This original ringtone can be downloaded in India by SMSing ''CONDOM'' to 56887 (download charges apply) or free from anywhere worldwide on the website www.condomcondom.org .if u have any problem in downloading from the above site as it is a flash site u can download the file from http://megashare.com/480719

The BBC World Service Trust is the international charity of the BBC, with an annual turnover of £17.6 million. Founded in October 1999, the trust works in 43 countries around the world using a variety of approaches including television and radio drama, advertisements and journalism training. The BBC World Service Trust focuses on health, governance and human rights, the environment and humanitarian response.

Impotence

2008-05-13T03:09:00.001-07:00

A man who cannot develop or sustain an erection to perform satisfactory sexual intercourse is termed 'impotent'. Unfortunately, this term has serious social consequences and should be used with caution and after due consideration of the complex process of male sexual function.

Besides the inability to sustain erection other factors like loss of desire or libido, inability to ejaculate at the right time, difficulty in achieving orgasms, all coexist in some individuals and contribute to the patient's loss of confidence and inadequacy. Erectile dysfunction occurs in 5% of all males above 40 years of age and this percentage increases with advancing age.

What happens during erection?

The penis consists of large open spaces confined within a tight capsule. These spaces contain blood. Erection is brought about by a complex method of influences that travel from the brain, originating in the hormonal system and acting through the peripheral nerves. These result in the filling up of the spaces with blood, and this blood cannot flow out. This engorgement of the spaces with blood makes the penis rigid. Once the influences are withdrawn, as after orgasm and ejaculation, blood drains out from the spaces making the penis flaccid.

What are the causes of erectile dysfunction?

The causes are most often psychological and may include performance anxiety, guilt, depression or a fear of failure. It is important to rule out the physical causes. Besides progressing age, other factors include diseases like diabetes, high blood pressure and obesity. Smoking, excessive intake of alcohol and lack of physical activity can aggravate the problem. Persons with depression, anxiety, chronic stress and difficult relationships have a higher chance of having erectile dysfunction.

Other diseases that predispose to the condition include decreased thyroid function and kidney failure. Some drugs like anti-depressants, tranquillisers and medicines for high blood pressure may also lead to impotence.

How is it diagnosed?

The doctor will take a detailed medical history to determine whether impotence is due to an physical illness or due to psychological problems. Similarly, a detailed examination of the body including examination of the sexual organs will be done. Blood tests may be done to exclude diabetes or high cholesterol. Specialised tests may be done in specific instances to locate a problem in the structure and function of the penis.

How is it treated?

Erectile dysfunction due to a psychological problem is treated with much care. Usually the problem is due to performance anxiety, guilt, depression or a fear of failure. The patient is explained that this only worsens the problem. Sex education helps correct misinformation and ignorance about normal sexual practice. In married couples, discussing the problem with both partners may help the doctor to arrive at the root cause of anxiety or performance failure. These treatment sessions are usually time-consuming and slow.

The psychological treatment can be supplemented with the help of medicines that stimulate erection. These can be taken orally like sildenafil (viagra) or others that can be injected into the penis like papaverine or alprostadil, a synthetic prostaglandin. For men with low levels of male sex hormone, testosterone, this hormone may need to be supplemented. In some cases that do not satisfactorily respond to medicines, erections can be achieved with the help of appliances like vacuum devices or the insertion of implants into the penis by an operation.

Infertility

2008-05-13T03:09:00.000-07:00

What is infertility?

Infertility is defined as the inability to conceive after at least one year of intercourse while not using any contraceptive method. A normal fertile couple having regular sex and wishing to have a baby have a pregnancy rate of 50% in five months, 75% in 12 months, and 85-90% at end of 24 months.

Who is at fault?

The female partner is responsible for infertility in 40% of cases and the male in another 40%. In a few of the cases both are at fault. However, in 20% cases no cause can be found.

What are the causes of infertility in women?

The ovaries do not produce eggs, or these may be defective.
The fallopian tubes or the tubes that transfer the egg from the ovary to the uterus may be blocked or non-functional. This may happen in cases of infections like tuberculosis, endometriosis, or previous surgery of tubes or ovaries.
The uterus and cervix normally produce a thin discharge. If this mucous is excessively thick or contains substances that kill the sperms, then this prevents sperms from swimming through it into the uterine cavity and then to the tubes.
Distorted or partially blocked uterine cavity as in fibroids.

What are the causes of infertility in males?

Men normally produce at least 20 million sperm per ml of semen. If the sperm count is less than this it may adversely affect fertility.
Of the sperms present in the semen, 50% must be actively moving sperms for conception to occur. A lower percentage of actively moving sperms will be unable to swim through the cervix to meet the egg in the fallopian tube.
If more than 50% sperms are abnormal in shape and function, this can also lead to infertility.
If the testes do not produce sperms or these are unable to come out due to blockage of the vas deferens, the tube which carries the sperms from testis out.
Inability to perform normal intercourse due to difficulties in ejaculation, impotence or structural abnormalities of the penis.

How can the woman know her time of ovulation?

Ovulation is the time when the ovaries produce an egg that enters the fallopian tube. Just before ovulation, the mucous discharge from the vagina increases. In addition, there may be lower abdominal discomfort or pain for a period ranging from half an hour to 24 hours.

If one maintains a basal body temperature chart by taking a daily morning temperature, a rise in temperature by 0.5 degree centigrade around the thirteenth or fourteenth day indicates ovulation. Urine testing kits are also available which help in identifying the time of ovulation by showing a surge of a hormone which is associated with ovulation .

What tests are done for women?

The doctor first takes a detailed clinical history to ascertain the possible cause of infertility. If the problem lies in faulty sexual practice, this can be easily corrected. Structural abnormalities in the sex organs are looked for, and sometimes an ultrasound scan may need to be done. Blood and urine tests may be done to look for infection. A laparoscopy can also be performed for diagnosis, in which a telescope in inserted into the abdomen to visualise the internal organs including the uterus , ovaries and tubes.

The potency of the fallopian tubes is tested by performing a hysterosalpingography or HSG. In this a dye is injected into the uterus and X-rays are take which show the filling up of the tubes. No anaesthesia is required for this test and there is only minimal discomfort.

What tests are done for men?

Men are advised to undergo an analysis of their semen. For this, the semen is collected by masturbation. The man must have abstained from sexual intercourse for 3 to 5 days before giving the semen sample for testing. In semen analysis the sperm count is done and the structure and motility of sperms is assessed. If there is a doubt about the functional status of the testes, a biopsy is taken from the testes, usually under local anaesthesia for testing.

What is the management of infertility?

This depends on the cause of infertility. Every case may need a different approach depending on the nature of the problem and the underlying defect.

Problems with ovulation: If there is a problem with ovulation, certain drugs need to be given to induce ovulation or correct it.
Fallopian tube block: This is treated surgically by a laparoscope or by an open microsurgery technique. In this the blocked segment is excluded and continuity of the patent tubes is re-established. This is a technically demanding procedure. In cases were tubes cannot be corrected by this method, or the procedure fails assisted reproductive procedures (ART) such as in-vitro fertilization (IVF) is undertaken.
Cervical Factor: If the problem lies in the cervix, this can be overcome with procedures such as intrauterine insemination (in which the semen is injected into the uterine cavity) or procedures such as IVF or GIFT (Gamete Intra-Fallopian Transfer ).

Problems in men: Minor problems will respond to medical treatment or to surgery. Intrauterine insemination can help in some of the cases. However, if the problem is not corrected by the above measures then assisted conception by IVF can be offered with considerable success. In cases with very severe sperm deficiency, until a few years ago, the treatment of couple had not been very successful. Micro-manipulation now can be offered to these couples.

Hydrocoele

2008-05-13T03:06:00.000-07:00

What is a hydrocoele?

A hydrocoele is an accumulation of fluid around a testicle on one or both sides.

How is it caused?

A hydrocoele results when fluid accumulates between the two layers covering the testes. Most often there is no cause found. Hydrocoeles can also develop as a result of injury or infection. It may sometimes accompany other problems such as chronic infections or the presence of a tumour in the testicle.

What are the symptoms?
An enlarged scrotum on one or both sides.
A bulging area within the groin.
The condition is usually painless, although sometimes it may cause a dragging sensation or mild pain.
How is the condition diagnosed?

Physical examination by the doctor reveals a non-tender mass within the two layers of the sac around the testes. The fluid in a hydrocoele is clear. A bright light from a torch shone through the scrotum indicates the presence of clear fluid (a process called transillumination). An ultrasound may be done to confirm the diagnosis.

What is the treatment?

Surgical treatment is recommended if:
A hydrocoele that was present at birth remains after the child has reached the age of one year.
It causes pain and discomfort due to its size and is not resolving.
Swelling increases and decreases (suggesting that the opening is big enough to allow fluid to flow freely back and forth between the area of the hydrocoele and the abdominal cavity.
In adults, a hydrocoele can be treated by a process called needle aspiration (a thin needle is used to withdraw the fluid). After this, the chance of recurrence of a hydrocoele is quite high. Another aspiration technique involves removing the fluid and then injecting thickening or hardening medications such as tetracycline, sodium tetradecyl sulphate, or urea to close off the lining of the scrotal sac and prevent reaccumulation of the fluid.

Surgery (Hydrocoelectomy) is the most common form of treatment. This procedure is done under general or spinal anaesthesia. There can be possible complications of surgery which include haematoma (blood clot formation), abscess or injury to the scrotal tissues. Hydrocoelectomy does not however affect sperm or hormone production of the testicles.

Hypertension (High blood pressure)

2008-05-13T03:03:00.000-07:00

What is Blood Pressure?

Blood pressure (BP) is the force exerted by the blood on the walls of the artery which are the blood vessels carrying blood away from the heart.

The contraction of the heart pumps blood through the blood vessels. During the heart contraction, the blood is pushed harder against the walls of the arteries than during the interval between contractions. The pressure of the blood on the arterial walls is greater each time the heart contracts and is known as the systolic pressure. The diastolic pressure is the pressure during the resting phase between contractions and is lower than the systolic pressure. The blood pressure (systolic and diastolic) is measured by an apparatus known as the sphygmomanometer or simply the BP apparatus. It is measured in millimetres of mercury (mm Hg). Normal blood pressure is 120/80 mm hg where 120 is the systolic pressure and 80 is the diastolic pressure. High blood pressure known as hypertension and is defined as a BP greater than 140 mm Hg systolic or a 90 mm Hg diastolic.

High blood pressure is related to dietary intake of salt and fats. High salt intake leads to water retention and increases the volume of blood in the circulation. This leads to an extra load on the heart and it responds by increasing the pumping pressure. The saturated fats in the diet deposit in the blood vessels over time causing them to harden. The heart needs to exert extra pressure to pump blood through them, causing the blood pressure to rise.

What are the risk factors?

The risk factors for high blood pressure include:
Heredity
Obesity
Smoking
Age
Stress
Secondary causes include disease conditions that can result in high blood pressure. These are kidney diseases and hormonal diseases such as hypothyroidism and Cushing’s syndrome.
Use of oral contraceptives in women

How can high BP be controlled?
Stop smoking
Maintain a normal body weight – reduce if over-weight.
Eating too much salt makes high blood pressure worse. Low-sodium diets are prescribed to help control high blood pressure. These limit the amount of sodium in the diet to less than 2 grams per day (about half the amount of sodium in the average diet).
Eat a healthy diet containing soluble fibre, such as fruit and vegetables.
Avoid high fat foods.
Avoid coffee and colas
Do not drink excessive alcohol.
Exercise regularly to keep fit.
Reduce stress and relax after work.
Follow-up regularly with the doctor.

How can the sodium in the diet be reduced?
Use little or no salt to food. Develop a taste for low salt in food. Do not use table salt.
Avoid fast foods and restaurant foods as they use very high salt.
Avoid ketchup, pickles, olives, all sauces, commercially prepared or cured meats or fish, canned foods (eat fresh foods), salted nuts, peanut butter, chips, popcorn and snacks.

Diet suggestions:
Use herbs and spices instead of salt for seasoning. Use onions, garlic, lemon and lime juice and rind, dill weed, basil, curry powder, turmeric, cumin, black pepper, or vinegar to enhance the flavour and aroma of foods. Mushrooms, dhania, red chillies, green chillies, and dried fruits also enhance specific dishes.
Add a pinch of sugar or a squeeze of lemon juice to bring out the flavour in fresh vegetables.
Rinse canned vegetables with tap water before cooking.
Substitute unsalted, polyunsaturated cooking medium for butter or ghee

Haemorrhoids

2008-05-13T03:01:00.001-07:00

What are haemorrhoids?

Haemorrhoids or piles, are an enlarged bunch of blood vessels in and around the anus. They may be associated with pain, bleeding and itching.

What are the causes for their development?

Haemorrhoids are very common in men and women, especially after the age of 50. They are caused due to a raised pressure in the abdomen which may be because of:
a chronic constipation problem
a large uterus as in pregnancy
obesity
heavy lifting jobs

What are the symptoms?

Haemorrhoids are not dangerous and in most cases the symptoms go away in a few days. The most common symptom is fresh bleeding while passing stool. There may be pain and a bulge or lump around the anus. There may also be itching with bleeding.

What are the different kinds of haemorrhoids?

Internal haemorrhoids - are those that are formed inside the rectum. They are generally not painful and are often only noticed when they bleed.

Prolapsed haemorrhoids - are internal haemorrhoids that protrude through the anus when stool is passed or when a person stands or walks. They are usually painful.

External haemorrhoids (perianal haematoma) - are small, painful haemorrhages under the skin around the anus. They form a hard clot after 24 hours. When they resolve, they sometimes leave a small skin tag.

How is the problem diagnosed?

Presence of fresh blood in the stool requires thorough evaluation and diagnosis by the doctor. The doctor may examine the anus and rectum to look for swollen blood vessels, indicative of haemorrhoids. A hollow, lighted tube, known as a proctoscope, may be inserted into the anus to look for internal haemorrhoids.

What is the treatment?
Prevention is the best treatment in the case of haemorrhoids. It is important to get into the habit of answering the ‘call of nature’ so that stools are passed easily without much strain. A diet adequate in fibre, consisting of fresh fruits, vegetables, whole-grain cereals and bran should be taken. Drinking 8 to 10 glasses of fluid daily is advisable.

Gentle cleaning and wiping after each bowel action is recommended.

Special astringent ointments or suppositories may be used on doctor’s advice, to shrink the haemorrhoids.

If the problem persists, injections or surgery (haemorrhoidectomy) may be advised by the doctor in some cases. A number of methods may be used to remove or reduce the size of internal haemorrhoids.

Some of the techniques used for the reduction of the size of haemorrhoids are:
Sclerotherapy : a chemical solution is injected around the blood vessel to shrink the haemorrhoid.
Banding : a tight elastic band is placed around the stalk of the haemorrhoid.
Laser coagulation or infrared photo coagulation : In this case, special devices to block the circulation of haemorrhoidal tissues are used.
Haemorrhoidectomy : In this operation, the bunch of swollen blood vessels is removed. The operation is done under general or spinal anaesthesia. Following the operation, there may be pain on passing stool and some blood for a few days. But this usually resolves quickly. After the operation, constipation must be avoided.

Hernia

2008-05-13T03:01:00.000-07:00

What is a Hernia?

A hernia is a protrusion of an organ or tissue through a weak area in the wall (muscles or tissue) of the cavity that contains it. The commonest hernia is an inguinal or groin hernia. When there is a weak area in the muscles of the lower abdomen it results in the protrusion of fat, intestines or other tissue through this defect. This bulge may on examination be:
Reducible: the fat or tissue can be pushed back into the abdominal cavity and the hernia will flatten and disappear.
Non-reducible: the fat or tissue cannot be pushed back and the hernia will not flatten. This is a situation usually requiring early medical attention.
What are the types of hernias?

Depending upon the body part involved the most common types of hernias are:
Inguinal hernia - Inguinal or groin hernias are more common in males. Normally a tough layer of tissue called the fascia transversalis, surrounds the abdominal cavity. There is a small natural hole in this layer called the internal inguinal ring. If this hole enlarges, the intestines may bulge through the internal inguinal ring. The protruded intestines lie under the skin in a sort of bag, the hernias sac and contents are externally visible as a lump in the groin.

Hiatus hernia - A muscular diaphragm separates structures in the chest from those in the abdomen. The oesophagus, or food pipe, passes through an opening (hiatus) in the diaphragm to enter the abdomen and join the stomach. The stomach is mobile in the abdominal cavity and sometimes slides through the oesophageal hiatus to partly enter the chest. This condition is called a hiatus hernia.

Umbilical hernia - This occurs when protrusion of intestine (or other organs) result because the firm tissue in the navel becomes very thin resulting in a gap.

Incisional hernia - This can occur at the site of a scar from previous surgery. The fat or tissue pushes through a weakness created by the surgical scar. This can occur soon after or months or years after the initial surgery.

Femoral hernia – This presents as a swelling in the upper part of the thigh just below the groin crease. It is not a common hernia.

What are the symptoms?
A lump or bulge that appears when the patient stands or coughs and returns to its normal position with gentle pressure or by lying down.
In abdominal hernias there is a dull ache at the site of hernia.
In hiatus hernia, acid from the stomach may enter the oesophagus and the patient may feel a burning sensation in the middle of the chest. Acid in the oesophagus can cause oesophageal ulcers.
Who is at risk for an abdominal hernia?

A hernia can develop at any age. The following factors can increase an individual’s risk for developing a hernia:
Lifting heavy weights.
Chronic cough.
Obesity.
Straining during bowel movements or while urinating.
Pregnancy.
Persistent sneezing caused by allergies.
Poor muscle tone. All the first six cause rise of pressure in the abdominal cavity.

What can be done to prevent a hernia from worsening?
Lifting, pushing, or pulling heavy objects should be avoided.
Smoking should be stopped to prevent a smoker’s cough.
Eating a high-fibre diet that includes grains, cereals, raw fruits and vegetables and drinking lots of water help relieve constipation.
If allergies are a problem, medication to treat sneezing may help.
What are the complications of hernia?

Sometimes the hernia cannot be pushed back into the abdominal wall by pressure and the bulge may contain intestine that can be trapped, losing its blood supply, a condition called strangulation of the intestine. When this occurs the patient experiences severe pain and vomiting. If surgery is delayed it can lead to gangrene or death of the intestine thus emergency surgery is required.

How is a hernia diagnosed?
In most cases physical examination can easily detect a hernia.
Laboratory tests and X-rays may be asked for if an operation is planned.
What are the methods of treatment?

A supportive truss or belt is used only for those who are unfit for an operation. This is an elastic band that exerts pressure on the defect in the abdomen. Wearing a supportive truss can help stop a hernia from protruding but cannot cure it.

Surgery is the only definitive cure for a hernia. The operation may be done under general, spinal or local anaesthesia. Various operations can be done for hernia repair. The repair may either use the surrounding muscles and structures to strengthen the defect in the abdominal wall or a nylon mesh may be used for the repair.

The operation is quite safe and takes about an hour.

More recently, the hernia repair is being done by laparoscopy. This is a surgical procedure for hernia repair in which a viewing tube and special instruments are used to repair the hernia from within the abdomen through a small opening.

Gynaecomastia

2008-05-13T02:57:00.001-07:00

What is gynaecomastia?

Gynaecomastia is a condition in which firm breast tissues develop in males. The breast tissue is usually less than 1-1/2 inches across and is located directly under the nipple. Gynaecomastia may be present on one side or on both sides. This condition may make the breast tender. Some men and boys have fat on their chests that makes it look like they have breasts. This condition is called pseudogynaecomastia (false gynaecomastia). It is not the same thing as gynaecomastia.

What causes gynaecomastia?

Gynaecomastia is usually caused by changes in hormones at puberty or as part of ageing. Gynaecomastia may be caused by changes in the balance of two hormones, oestrogen and testosterone. In rare cases, gynaecomastia is caused by prescription drugs, over-the-counter medicines, illegal drugs, tumours or disease. Gynaecomastia is not a disease but a symptom of an underlying condition or problem. It occurs as a result of an increase in the ratio of oestrogens (female hormone) to androgens (male hormone) in men.

How is gynaecomastia diagnosed?

The doctor will ask questions about the symptoms, such as how long the patient has had the breast tissue, and whether or not the area is tender. The doctor will also ask about the illnesses the person has had in the past, the medicines taken, and other matters relating to health. Then there is a physical examination. Whether one needs tests depends on the age, medical history and physical examination. If one is a teenager, tests are not needed, since gynaecomastia is common in teenage boys.

What is the treatment?

In most cases, no treatment is needed. The doctor checks the size of the breast tissue every few months. In 90% of teenage boys, gynaecomastia goes away in less than 3 years. Sometimes the problem can be solved if one stops taking a medicine or an illegal drug that is causing gynaecomastia. Occasionally, medicines may be used to treat gynaecomastia, especially if tenderness is a problem. The medicine will make the extra breast tissue go away. Rarely, surgery may be necessary to remove the extra breast tissue. Treatment is necessary if gynaecomastia is caused by a disease or a tumour. If it is due to a disease, the disease itself will need to be treated.

Could it be cancer?

Breast cancer is very rare in males. The doctor will be able to tell whether the lump is cancer. Breast cancer feels different than the breast tissue of gynaecomastia.

Exercise

2008-05-13T02:57:00.000-07:00

Exercise has been defined as a rhythmical activity for the purpose of improving fitness or health.

What are the different types of exercise?

Physical activity includes all forms of activity (occupational, recreational, or sports-related) performed without the specific purpose of fitness or health.
Aerobic (e.g. walking, swimming)
Anaerobic (e.g. sprinting)
Isometric (e.g. lifting weights)
Resistance training involves providing some form of resistance to the contracting muscles to stimulate the body for increased strength. Equipment used for resistance training takes multiple forms, including hand weights, pulleys, hydraulic, elastic, rubber, fibreglass, and magnetic equipment.
Strength or resistance training is very important to improve ones functionality and reduce the risk of injury. As people age, the lean tissue (i.e. muscle) declines more from lack of use than from ageing itself. Performing some type of resistance training on a regular basis is essential.

Safety Since the demand on the heart is generally less while strength training than when walking at a moderate pace, resistance training is regarded as safe for patients with heart conditions. It is advisable never to strain or hold breath in an attempt to lift something. Straining can adversely affect blood flow to the heart.

What are the goals of exercise?

The goals of exercise are to:
The goals of exercise are to:
Improve oxygen delivery and metabolic processes
Build strength and endurance
Decrease body fat
Improve movement in joints and muscles
Improve sense of well-being.
Slows down ageing process.
Rules for exercises:

Do not eat for two hours before vigorous exercise
Drink plenty of fluids before, during, and after a workout
Adjust activity according to the weather and reduce it when fatigued or ill.
Be realistic in your goals.
Combine exercises with any pleasurable activity.
When exercising, one is advised to listen to the body’s warning symptoms, and consult a physician if exercise induces chest pain, irregular heartbeat, undue fatigue, nausea, unexpected breathlessness, or light-headedness.

Warm-Up and Cool-Down Period. Warming up and cooling down are important parts of any exercise routine. They aid the body in making the transition from rest to activity and back again and can help prevent soreness or injury, especially in older people.

Warm-up exercises should be practised for five to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Low-level aerobic exercise, such as walking briskly, swinging the arms, or jogging in place are the best

To cool down, one should walk slowly until the heart rate is 10 to 15 beats above resting rate. Stopping too suddenly can sharply reduce blood pressure. This is a danger for older people, and may also cause muscle cramping. Breathe deeply during the cool off phase.

Stretching is appropriate for the cooling down period, but not for warming up because it can injure cold muscles. Particular exercises may require stretching specific muscles. For example, a jogger or biker might emphasise stretching the hamstrings, calves, groin, and quadriceps, while swimmers would focus on the groin, shoulders, and back. Stretching is best done when joints are lose and flexible that is in the afternoons or evenings.
1. Aerobic (Endurance) training:

Aerobic exercises are those that require a steady supply of oxygen, to sustain the energy giving powers of the muscles .An aerobic exercise is any activity performed for a minimum of 20 minutes maintaining a heart rate between 70%-80% of maximum heart rate with chief energy sources being oxygen and body fat.

Aerobic exercise is usually categorised as high or low impact.

Low to moderate impact exercises: such as walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low to moderate impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.

High impact exercises: such as running, dance exercise, tennis, squash etc. High-impact exercises should be performed no more than every other day and less for those who are overweight, elderly, out of condition, or have an injury or other medical problem that would preclude high-impact.

Benefits of aerobic exercise

Regular aerobic exercise provides the following benefits:
Builds endurance
Keeps the heart pumping at a steady and elevated rate for an extended period, boosts HDL (the good) cholesterol levels, and helps control blood pressure
Strengthens the bones in the spine
Helps maintain normal weight.
Circuit Training: Circuit Training is one of the best forms of aerobic exercise .You need to choose that fits your goal. For example, circuit training for endurance, weight loss, muscle building will be different Since this includes a full body work out and uses all muscles, you will feel refreshed and less sore as this helps the body to remove toxins which build up in the body after vigorous activity and your muscles recuperate faster because of the increased blood flow.

2. Strength or Resistance training:

Types of muscle contractions: There are three types of muscle contractions involved in strength training:
Isometric contractions. There is no change in the length of the muscle. For example, pushing against a wall.
Concentric contractions. These movements shorten muscles (for example, the up phase of when the bicep curls up while lifting weights).
Eccentric contractions. These movements lengthen muscles (the down phase as the weights are lowered).
To build muscle strength, steadily increase the weight that a muscle resists. If you are in the middle age group or old age group, take care, as there can be a sudden rise in the blood pressure due to unaccustomed effort. Weight training is safe when properly supervised and controlled.

Benefits of strength exercise

While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:
Builds muscle strength while burning fat
Helps maintain bone density
Improves digestion
It appears to lower LDL (the ‘bad’) cholesterol levels
Improves neuromuscular coordination.
Increases flexibility and speed.
Increases utilization of glucose in the body and reduces the possibility of adult onset diabetes.
Beginners should always start with low weights irrespective of their goals. For fitness, use lightweights and many repetitions. For bodybuilding, you need to use higher weights.

Breathe easily while lifting weights. Breathe out while lifting. Breathe in while bringing a weight back. Eat sensibly. Take a meal within an hour of your workout. Take time to see a change in your body. Be prepared for this. Each person takes a different time to get used to a particular exercise routine. So do not compare and be discouraged.

3. Flexibility training (Stretching):

It is now recommended that one should perform stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

When stretching, exhale and extend the muscles to the not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5 to 10 second stretch)
Breath evenly and constantly while holding the stretch
Inhale when returning to a relaxed position. (Holding ones breath defeats the purpose; it causes muscle contraction and raises blood pressure.)
It is important when doing stretches that involve the back to relax the spine, to keep the lower back flush with the mat, and to work only the muscles required for changing position, often only the abdomen.
Avoid doing stretches the first thing in the morning. They are best done when the joints are loose and flexible, that is in the afternoon or evening.
Benefits of flexibility training

Flexibility training uses stretching exercises for the following benefits:
Preventing cramps, stiffness, and injuries
Allowing a wider range of motion (i.e., the amount of movement a joint and muscle has)
Certain stretching exercises are particularly beneficial for the back
Specific exercise tips for older people:

Any elderly person should have a complete physical and medical examination and professional instruction before starting an exercise programme.
For sedentary, old people one or more of the following programmes may be helpful and safe: low impact aerobics, gait training, balance exercises, self-paced walking, and lower extremity resistance training using elastic tubing or ankle weights.
Strength training assumes even more importance as one ages, because after the age of 30 everyone undergoes a slow process of muscular erosion. The effect can be reduced or even reversed by adding resistance training to an exercise programme. As little as one day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health and general well being.
Power training, which aims for the fastest rate at which a muscle or muscle group can perform work, may be particularly helpful for older women in strengthening muscles and preventing falls.
Flexibility exercises promote healthy muscle growth and help reduce the stiffness and loss of balance that accompanies ageing.

Erectile dysfunction

2008-05-13T02:54:00.001-07:00

Delayed ejaculation

2008-05-13T02:54:00.000-07:00

What is delayed ejaculation?

Delayed ejaculation refers to an inhibition of ejaculation. The man is unable to ejaculate, either during intercourse, or with manual stimulation in the presence of a partner.

What is the cause?

Most men ejaculate within 2 to 4 minutes after onset of active thrusting in intercourse. Men with retarded ejaculation may be entirely unable to ejaculate in some circumstances (for example, during intercourse), or may only be able to ejaculate with great effort and after prolonged intercourse (for example 30 to 45 minutes). The most common causes are psychological. Common psychological causes include:

A strict religious background causing the person to view sex as sinful
Lack of attraction for a partner
Conditioning caused by unique or atypical masturbation patterns
Traumatic events (for example learning that one's partner is having an affair)
Organic causes are also possible; a variety of drugs may sometimes impair ejaculation.
Neurological diseases may also cause delayed or an inability to ejaculate such as strokes and nerve damage to the spinal cord or back.
How is it diagnosed?

If the man is unable to ejaculate in a reasonable length of time with some form of stimulation (as with masturbation), it is a good indicator that organic factors are likely to play a role in the problem. Stimulation of the penis may determine if an underlying physical often neurological problem exists. A neurological examination may uncover other neurological defects associated with delayed ejaculation.

What is the treatment?

If the man has never ejaculated through any form of stimulation (such as wet dreams, masturbation, or intercourse) in his life, a urologist should be consulted to determine if there is a congenital or physical abnormality. If, however, he is able to ejaculate in a reasonable period of time by some form of stimulation, he should seek sex therapy from a therapist specialising in this area. Treatment usually includes both partners. This includes educating the couple about the fundamentals of sexual response and how to communicate and guide the partner to provide ideal stimulation, rather than trying to force a sexual response to occur.

Therapy then commonly involves a series of homework assignments wherein the couple, in the privacy of their home, engage in sexual activities that minimise performance pressure and maximise focusing on pleasure. Typically, sexual intercourse will be prohibited for a limited period of time, while the couple gradually enhance their ability to enjoy ejaculation through other types of stimulation.

In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step.

Self-treatment of this problem will probably be unsuccessful in most cases. If a medication is believed to be the cause of the problem, the man's physician should review other medication options. This may be difficult in certain instances, especially when the medication is working appropriately to solve a pre-existing medical or a psychological problem.

What is the prognosis?

Outpatient treatment generally requires about 12 to 18 sessions with an average success rate in the range of 70 to 80%. A more positive outcome is associated with having a previous history of satisfying sexual experiences, a short duration of the problem, feelings of sexual desire, feelings of love toward one's sexual partner, motivation for treatment, and absence of serious psychological problems.

If medications are the source of the problem, a full recovery should be expected if the physician is able to switch or discontinue the medication.

Can it be prevented?

Healthy attitudes toward sexuality and one's own genitals helps prevent delayed ejaculation. It is also vitally important to realise that one cannot always control a sexual response, just as you cannot force yourself to go to sleep or to perspire. The harder one tries to have a certain sexual response, the more it becomes inhibited.

To minimise the pressure, a man should absorb himself in the pleasure of the moment, without worrying about whether or when he will ejaculate. The partner should create a relaxed atmosphere, free of pressure. Finally, any fears or anxieties, such as fear of pregnancy or disease, should be openly discussed.

Coronary heart disease

2008-05-13T02:50:00.001-07:00

What is coronary heart disease?

Coronary heart disease (CHD) or coronary artery disease is the narrowing of the small blood vessels (coronary arteries) that supply blood and oxygen to the heart. Coronary disease usually results from the build up of fatty material and plaque (atherosclerosis). As the coronary arteries narrow, the flow of blood to the heart can slow or stop. This results in chest pain (angina), shortness of breath, heart attack, or other symptoms.

What are the causes?

CHD can run in the family. It might develop as one gets older or if one is overweight, has high blood pressure, high cholesterol or diabetes. Unhealthy habits, like smoking, eating a diet high in fat and not exercising enough, can also cause CHD.
Risk factors for CHD include the following:

Family history of coronary heart disease (especially before age 50)
Male gender
Age (65 and greater)
Tobacco smoking
High blood pressure
Diabetes
High cholesterol levels (specifically high LDL cholesterol and low HDL cholesterol)
Lack of physical activity or exercise
Obesity
High blood homocysteine levels
Menopause in women

What are the symptoms?

The symptoms associated with coronary heart disease may be pronounced, but it can also be present without any noticeable symptoms.

(Chest pain (angina)) - This is the most common symptom, and it results from the heart not getting enough blood or oxygen. The intensity of the pain varies from person to person. Chest pain may be typical or atypical. Typical chest pain is felt under the sternum (breast bone) and is characterised by a heavy or squeezing feeling. It is precipitated by exertion or emotion, and it is relieved by rest or nitroglycerin. Atypical chest pain can be located in the left chest, abdomen, back, or arm and is fleeting or sharp. Atypical chest pain is unrelated to exercise and is not relieved by rest or nitroglycerin. Atypical chest pain is more common in women.

Other symptoms include:

(Shortness of breath) - This is usually a symptom of congestive heart failure. The heart at this point is weak because of the long-term lack of blood and oxygen, or sometimes from a recent or past heart attack. If the heart is not pumping enough blood to circulate in the body, shortness of breath may be accompanied by swollen feet and ankles.

(Heart attack) - In some cases, the first sign of CHD is a heart attack. This occurs when atherosclerotic plaque or a blood clot blocks the blood flow of the coronary artery to the heart. The coronary artery was likely already narrowed from CHD. The pain associated with a heart attack is usually severe, lasts longer than the chest pain described above, and is not relieved by resting or nitroglycerin.

How is it diagnosed?

There are many tests that may help to diagnose CHD. Usually, more than one test will be done before a definitive diagnosis can be made. Some of the tests include:
Electrocardiogram (ECG)
Exercise stress test
Echocardiogram
Nuclear scan
Coronary angiography
Electron-beam computed tomography (EBCT) - the purpose of this test is to identify calcium within the plaque found in the arteries. The more calcium seen, the higher the likelihood for CHD.

What is the treatment?

The treatment for CHD varies depending on the symptoms and how much the disease has progressed. General treatments include lifestyle changes, medications, and sometimes surgery.

Lifestyle changes may include:

A weight reduction programme
A low saturated fat, low cholesterol diet to help reduce cholesterol
Reducing sodium (i.e. salt) ingestion to keep high blood pressure under control
A routine exercise regimen
Permanently discontinuing cigarette smoking

Medications may include:
Cholesterol-lowering medication
Antiplatelet agents such as aspirin, ticlopidine, or clopidogrel to reduce the risk of blood clots
Glycoprotein inhibitors to reduce the risk of blood clots
Antithrombin agents such as blood-thinners (low-molecular heparin, unfractionated heparin), to reduce the risk of blood clots
Beta-blockers to decrease heart rate and to lower oxygen consumption by the heart
Nitrates such as nitroglycerin to dilate the coronary arteries and improve blood supply to the heart
Calcium-channel blockers to relax the coronary arteries and all systemic arteries and, thus, reduce the workload for the heart
ACE inhibitors, diuretics, or other medications to lower blood pressure
Interventions may include:
Percutaneous Coronary Interventions (PCI's):
Coronary angioplasty
Coronary atherectomy
Catheter-based thrombolysis
Coronary radiation implant
Coronary stenting (placing a tube in the artery to keep it open).

Surgical Interventions:
Coronary artery bypass surgery
Minimally invasive heart surgery
What is the prognosis?

The outcome is variable. Some people can maintain a healthy life by changing diet, stopping smoking, and taking medications as long as they are closely monitored. Others may require more drastic measures, such as surgery. It is necessary to detect CHD early and treat it appropriately.

What can one do to lower the risk of CHD?
Do not smoke
Lower cholesterol levels by eating a low-fat diet
Eat well-balanced meals that include several daily servings of fruits and vegetables
Control blood pressure
Develop a routine exercise regimen. Short, frequent sessions of exercise are preferable to a complete sedentary lifestyle. Walking instead of driving, taking the stairs instead of the elevator, are all measures that most people can incorporate into their busy routines
Keep blood pressure under control
Maintain weight appropriate to the frame and build
Doctor should be consulted about vitamins. Vitamin E has been shown to lower the risk of a heart attack. Vitamin B may also protect against CHD.

Circumcision

2008-05-13T02:50:00.000-07:00

What is circumcision?

Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.

What are the functions of the foreskin?

The foreskin serves three functions: protective, sensory, and sexual. In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper period, the foreskin protects against abrasion from diapers and faeces. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury. Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialised nerve endings enhance sexual pleasure and control. The inner foreskin (mucosa) is the skin directly against the glans. The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other.

What are some reasons that circumcision is performed?

Phimosis is the inability to retract the foreskin fully. In babies and young boys this is normal. As the baby grows older, the foreskin separates from the underlying glans penis. In some individuals, this separation does not happen fully or due to repeated infection in that area the skin becomes scarred. It might also happen later in life. When the foreskin does not retract, it predisposes to repeated infection in that area. Also, sexual intercourse may become painful and result in bleeding. The only treatment at that stage is a minor operation called circumcision, in which the foreskin is surgically removed.

Is circumcision painful?

When done without pain medicine, circumcision is painful. There are pain medicines available that are safe and effective. It is recommended that they be used to reduce pain from circumcision. Local anaesthetics can be injected into the penis to lower pain and stress in infants. There are also topical creams that can help. Problems with using pain medicine are rare and usually not serious.

What to expect after the procedure?

After the circumcision, the tip of the penis may seem raw or yellowish. If there is a bandage, it should be changed with each diapering to reduce the risk of the penis becoming infected. The plastic ring that is left on the tip of the penis usually drops off within five to eight days. For both newborns and older children, circumcision is considered a very safe procedure with complete healing expected.

What are the health benefits?

Possible benefits of circumcision include:
Circumcision prevents infection and inflammation of the foreskin. And it may decrease the risk of penile cancer.

It might play a role in reducing the risk of sexually transmitted diseases. Practicing safe sex, however, is a far more important factor in preventing these diseases than whether a man is circumcised.

Infants who are not circumcised may be more likely to develop urinary tract infections. These infections early in life may lead to kidney problems later in life. Infants who have kidney or bladder abnormalities are at higher risk of urinary tract infections, so circumcision may be advised for these babies.

In rare circumstances problems can occur with the uncircumcised penis that may require circumcision at an older age. These problems include inflammation of the foreskin or adherence of the foreskin to the tip of the penis. Circumcision during infancy eliminates the possible need for the procedure at an older age.

Circumcision makes it easy to keep the end of the penis clean. However, the shedding skin cells that naturally accumulate on the glans of an uncircumcised boy are not harmful. Do not try to force the foreskin back to clean the penis of an infant or young boy. Washing externally with mild soap and water is all that is necessary.

Possible risks:

Like any minor surgery, circumcision poses some risk to the newborn:
Circumcision may cause excessive bleeding or infection, but this is rare.
Circumcision does cause pain. Local anaesthesia is frequently used. If you decide to have your son circumcised, you should to talk to your doctor about whether local anaesthesia will be used.
Circumcision is a preventive measure but is by no means a guarantee that medical issues will not develop later in life at the tip of the penis

Baldness

2008-05-13T02:47:00.001-07:00

There are on an average 100,000 to 150,000 hairs on the human scalp. Hairs grow from follicles that are sac like structures under the skin. At any time 90% of the hair are in the growth phase, which lasts an average of 4 to 5 years, after which it enters the resting phase, which lasts for 2 to 4 months. At the end of the resting phase, the hair falls out naturally and is replaced by a new hair. Some hair loss, 50 to 150 per day, is normal.

What is baldness?

Baldness or alopecia results when hair loss occurs at an abnormally high rate, replacement occurs at an abnormally slow rate or when normal hairs are replaced by thinner, shorter ones.

What are the types of baldness?
Androgenic alopecia also known as male pattern baldness is the most common type of hair loss. It occurs more frequently in men than in women. It is a permanent type of hair loss and occurs in a characteristic pattern on the scalp. The hair loss begins at the temples and at the top of the head towards the back, causing a receding hairline and a bald spot. Balding may begin at any age after puberty and can range from partial loss to complete baldness. Hormonal imbalance, mainly testosterone, and genetic factors are responsible for this type of hair loss.

Alopecia areata leads to patchy hair loss on the scalp. The exact cause is not known, but it is thought to be the result of the body’s immune system attacking the hair follicles.

Traction alopecia is caused due to long-term pulling on the hair. This is caused by certain hairstyles, such as tight braids. The hair loss is usually reversible once the cause of the pulling is eliminated.

What are the causes of baldness?

Heredity and aging.
Hormonal changes.
A serious illness or fever.
Medication such as cancer chemotherapy or too much Vitamin A.
Emotional or physical stress.
A self-induced reduction of hair by pulling it out (traction alopecia).
Poor nutrition.

How is the cause of hair loss diagnosed?

The doctor first asks if there is a family history of baldness. He may also examine a few hairs under a microscope or check the scalp for signs of skin damage. Other questions related to the person’s diet, hair-care procedures, medications taken and recent illness, if any, may be asked. In some cases the doctor may order blood tests or a skin biopsy to help make a diagnosis.

What are the treatment options in case of baldness?
Hair transplantation

This involves the transplantation of hair follicles from areas of the scalp where hair is still growing to areas where it is not. This carries a low risk for skin infections and may cause minor scarring in the donor areas.

Local application of drugs

A drug called minoxidil, when applied to thinning areas of the scalp daily, is believed to be effective in preventing further hair loss and in growing new hair. The drug helps in dilating the blood vessels, thereby affecting the blood supply and the supply of hormones to those areas of the scalp that are losing hair.

Another drug called finasteride taken in a pill form daily, helps in preventing further hair loss in most cases and growing new hair in some cases.

The use of such drugs may help to reduce hair fall but it is generally seen that when the application is stopped, regrown hair fall out. Side effects such as irritation of the scalp are also quite common.

Cosmetic treatments

Synthetic hair: A hairpiece can be custom made to cover a balding area. It is important not to neglect the scalp under the hairpiece, which should continue to be washed regularly. Another option is a weave, in which synthetic hair is sewn into existing hair.

Hair products: Hair-care products that claim to thicken and straighten hair should be used with caution because most of the time they simply create an illusion of thickening, by building a layer of wax or oil.

Cholesterol

2008-05-13T02:47:00.000-07:00

What is cholesterol?

Cholesterol is a waxy substance, present in many body tissues. It is an essential nutrient necessary for healthy cell membranes, as well as synthesis of vitamin D and some hormones. It is made in the liver from digested fats and is carried in the blood. Cholesterol is also present in certain foods, such as egg yolk and liver.

Blood cholesterol level is affected by the diet, since cholesterol is present in certain foods and is manufactured in the body from digested fats. High levels of cholesterol in the blood are associated with hardened arteries (known as atherosclerosis), coronary artery disease (heart attack), and stroke.

What is "bad" and "good" cholesterol?

There are many types of cholesterol. LDL or Low-density lipoprotein is the "bad" cholesterol, as it blocks the arteries. HDL or High-density lipoprotein is the "good" cholesterol, as it protects the arteries from clogging.

What are normal cholesterol levels?

Blood can be tested for the cholesterol level. The total cholesterol in the blood includes both HDL and LDL cholesterol. A total cholesterol level of less than 250 mg% is considered normal. High HDL levels (more than 60 mg%) reduce the risk for heart disease and low levels (less than 35 mg%) increase the risk.

How to control cholesterol?

Cholesterol levels can be kept in the normal range by eating a balanced diet and exercising regularly. It is important to eat the right foods (low cholesterol) to keep a healthy weight.

Avoid foods that contain a lot of cholesterol like meats and egg yellow. Eat less fat especially saturated fats, generally obtained from animal sources. Avoid fried foodstuff especially snacks and fast foods.

Eat more of fresh fruits, grains, vegetables and salads avoiding oil-based dressings, which can be substituted with vinegar or lemon-based dressings. Cook vegetables with herbs or spices instead of cooking oil or ghee. Use oils like sunflower, safflower, olive or corn oil. Avoid palm or coconut oil. Eat egg whites instead of whole eggs. Use low-fat dairy products like skimmed milk, low-fat yoghurt or cottage cheese instead of cream or processed cheese.

What is the treatment for high cholesterol levels?

There are drugs known as statins that inhibit the liver enzyme used in the manufacture of cholesterol. They are the most effective drugs for the treatment of high cholesterol. They are recommended for most patients with high cholesterol levels, particularly those with diabetes, existing heart disease, or both.

Ageing

2008-05-13T02:43:00.001-07:00

Ageing is an inevitable part of growing older. There are certain factors that can minimise this process like the appearance of blotchy skin, age spots, wrinkles etc. It can be difficult for older people to maintain self-confidence, stay active and involved, and feel useful and needed, especially with the physical limitations age can impose. But the better they feel about themselves, the more likely it is that they will be able to cope with the minor health problems of ageing.

What are some ways to combat the signs of ageing?

Regular exercises and a healthy diet will always contribute positively to one’s health. As one ages, exercise tends to become more difficult yet more important. It is especially important to stretch regularly to keep the muscles relaxed, but active, and to keep the joints flexible. Regular exercise can improve some diseases and disabilities in older people who already have them. It can improve mood and relieve depression, too.

Limit alcohol
Quit smoking
Avoid crash diets
Manage stress
Get regular exercise
Avoid harsh skin products
Get enough rest
Use sunscreen
Stay out of tanning booths
Drink plenty of water
Does ageing slow down one’s metabolism?

As the body ages, there are also unique nutritional concerns. Cholesterol intake should be monitored due to an increased risk of cardiovascular disease (heart diseases and stroke.) High blood pressure can be controlled through a low-fat and low-salt diet. Fruits and vegetables are known to combat the risk of cancer, and can help regulate one’s digestive system. In addition, post-menopausal women should consult their doctor regarding calcium supplements to prevent osteoporosis. While it is true that older women need fewer than the recommended calories/day, no one should consume fewer than 1,500 calories per day.

How to fight against osteoporosis?

Osteoporosis occurs when one’s bones are excessively fragile and break easily. Women are four times more likely than men to develop this condition because of the loss of oestrogen at menopause. Drugs to treat osteoporosis have been shown to preserve or increase bone masses and maintain bone quality to reduce the risk of fractures. There has been significant recent advances in treatment. A healthy diet with plenty of calcium and vitamin D is prescribed. Calcium tablets and oral vitamin D preparations may be given if the oral intake is inadequate. Routine exercises are recommended.

If one becomes forgetful, is it Alzheimer’s disease?

It is natural to lose some mental acuity as one ages. So one’s minds can at times experience something that feels like overload, and it is easy to forget some of life’s details. Serious memory loss, however, is more rare. As many as 1% of people over the age of 60 suffer from some form of dementia which is characterised by significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning.

Alzheimer’s disease (AD) is the most common cause of dementia in older people. It begins slowly. At first, the only symptom may be mild forgetfulness. People with AD may have trouble remembering recent events, activities, or the names of familiar people or things. There is no cure for it. Doctors may prescribe certain medication in an attempt to slow the progression of the disease. People with AD should go to their doctor regularly. The doctor will check to see how the disease is progressing and treat any other illnesses that occur. The doctor and other health professionals also can offer help and support to patients and their families. Currently, there is on-going research into preventing and curing Alzheimer’s disease.

Does ageing necessarily mean bad eyesight?

Many older people have relatively good eyesight into there eighties and beyond. Growing older does not always mean one sees poorly. But age brings changes that can weaken the eyes, making reading, in particular, more difficult. There are some easy things to try when these changes happen. One might add brighter lights in more places around the house, like at work counters, stairways, and favourite reading places. This may help one to see better and can sometimes prevent accidents caused by weak eyesight. One might need prescription glasses for reading, or simple reading glasses might be enough.

Cataracts are common among older people. Cataracts are cloudy areas in part or all of the eye lens. The lens is usually clear and lets light through. Cataracts keep light from easily passing through the lens, and this causes loss of eyesight. Cataracts often form slowly and cause no pain, redness, or tearing in the eye. If a cataract becomes large or thick, it can be removed by surgery. Glaucoma is another common eye disease. This is the result of too much fluid pressure inside the eye. It can lead to vision loss and blindness. It is important to see the doctor regularly to check on one’s eyesight and other related problems.

What can one do about hearing loss?

As people get older they have hearing problems. They may mistake words in a conversation, miss musical notes at a concert, or leave a ringing doorbell unanswered. Hearing problems can be small (missing certain sounds) or large (more serious deafness). However, one can get help. Special training, hearing aids, certain medicines, and surgery are some of the choices that help people with hearing problems.

Does getting older mean not having a sex life?

Women can enjoy sex well into their senior years. Women may notice changes in the shape and flexibility of the vagina, however. These changes do not usually mean a serious loss in the ability to enjoy sex. Most women will have a decrease in vaginal lubrication that affects sexual pleasure. There are lots of over-the-counter vaginal lubricants availlable. Sexuality is often a delicate balance of emotional as well as physical issues.

Older men may fear that impotence will become a more frequent problem as they age. As a woman ages, she may become more anxious about her appearance. This emphasis on youthful physical beauty or sexual powers can interfere with a man or woman’s ability to enjoy sex.

Older couples may have the same problems that affect people at any age. But they may also have added concerns of age, retirement and other lifestyle changes, and chronic illness. These problems can cause sexual difficulties. It is important to talk openly with the doctor or see a therapist. It is also important to discuss these issues and worries openly with one’s mate.

Are there any benefits to ageing?

Ageing men and women face many changes mentally, physically, and emotionally. Many of these changes offer new opportunities in life and a new outlook. It is important to maintain an optimistic and active life-style. There are many ageing societies, which help seniors remain active and involved.

Alcohol dependence

2008-05-13T02:43:00.000-07:00

What is alcoholism?

Alcohol abuse is a condition in which a person drinks to the point that this habit interferes with his or her life. Alcohol dependence describes a more severe condition marked by physical symptoms and loss of control to the point, that maintaining the addiction to alcohol becomes the main focus of a person’s life. The physical dependence on alcohol is continued despite the knowledge of its harmful consequences.

Physical dependence on alcohol is continued despite the harmful consequences. There is an inability to limit the drinking despite continued efforts. The person drinks more and more alcohol to achieve a particular state of mind (colloq. 'high’). He may also drink more to lessen depressive feelings, which are worse when the person is not under the influence of alcohol. Signs of physical dependence include bodily changes, such as shakes, ‘delirium tremens’ (withdrawal symptoms), or sweats on cessation of drinking.

Alcoholism is a common illness. It is especially serious in older people, since other medical problems are made worse by alcohol.

How does it occur?

Many factors may lead to alcohol dependence. These can include genetic factors, family environment, ongoing stress, self medication for emotional problems such as depression or anxiety and the nature of alcohol. Grief, loneliness, depression, or boredom could lead to drinking late in life.

What are the symptoms?

Alcohol dependence can manifest itself in different patterns. Drinking may range from daily excessive drinking to binge drinking. Tolerance refers to the fact that many alcoholics drink ever-larger amounts of alcohol before feeling or getting drunk. By the time one has progressed from alcohol abuse to alcohol dependence, it is necessary to consume the same to avoid withdrawal symptoms.

People who are dependent on alcohol may try to hide evidence of drinking and promise to give up the habit. They may drink stronger alcoholic beverages and have long periods of drunkenness. Alcohol dependents may have frequent episodes of blackouts – times when they do not remember what happened during the drinking episode.

Additionally, there may be problems at work (like disinterest, missing work). Interest in food is decreased. There may be mood changes (angry, irritable, violent) and personality changes (jealous, distrustful). People with alcohol dependence may scarcely care for personal or social rules. They repeatedly drive while drunk, and may hurt themselves or others. They are careless about their appearance, confused and have memory problems, losing the ability to think quickly or concentrate, and often have money problems.

Typical physical symptoms include nausea or tremors in the morning, stomach pain or ulcers, cramps or diarrhoea. They can have numbness, tingling or weakness in the hands and legs, red eyes, face, or palms. The walk may be unsteady and the person may fall frequently. Alcohol is toxic to the brain, the heart, liver, kidneys, stomach and intestines, muscles, eyes and the sexual organs. This toxicity leads to many medical problems.

How is it diagnosed?

The doctor will take a careful medical history of the symptoms including the pattern of use of alcohol. The doctor will ask about the history of using other drugs as well. Other important questions relate to the ability to function socially, work history, family history, prior and current emotional or mental problems and thoughts of suicide.

The doctor will examine to look for medical problems caused by alcohol use. Lab tests of urine and blood may be done. The most frequent and severe effects of alcoholism are problems with emotions, relationships, accidents and work, and medical problems such as cirrhosis of liver.

How is it treated?

The aim of treatment is to stop the person from drinking alcohol completely, referred to as abstinence. People who are mild alcohol abusers can stop or reduce alcohol drinking on their own. But people who have gone as far as becoming alcohol dependent must be assisted to become, and more importantly, remain abstinent. Relapse to drinking is common in the early period of recovery. The patient must be helped to limit these slips and get back to abstinence as soon as possible. Patients who are alcohol dependent may also go through a unique phase of denial – where they feel that they will be able to stop drinking whenever they want to. This prevents them from seeking professional help to sort out their problem.

Psychotherapy and social rehabilitation help in recovery. Family members should be included in the treatment program. After immediate withdrawal from alcohol (detoxification), long-term rehabilitative treatment is needed. Initially hospital based treatment followed by outpatient treatment at de-addiction clinics is required. A support program for rehabilitation plays a very important role in treatment.

Support groups like “The Alcoholics Anonymous” in India and abroad, form a key part of rehabilitation of patients with alcohol dependence. One of the most important aspects of alcohol counselling and treatment is to learn the behaviour patterns that lead to drinking. It is important to recognize these patterns and change them. Health related problems can often be controlled or prevented by stopping drinking. However, severe damage to the liver or pancreas can be long-lasting and ultimately fatal.

Abnormal sexual behaviour

2008-05-13T02:32:00.000-07:00

What is abnormal sexual behaviour?

Sexual behaviour that is not common and is considered unnatural comprises an important group of sexual problems. Though not sexual problems in the strictest sense, these behaviours reflect distortion of an individual’s sexual identity. In most cases, this behaviour does not include any physical manifestation of the disorder.

Abnormal sexual behaviour may not only be socially inappropriate, but also offensive or injurious to the self and to others. Some of these include – exhibitionism, voyeurism, bestiality, fetishism, sodomy, sadism and masochism.

What are the various types of such behaviours?

Exhibitionism – is a deliberate sexual urge in a person to expose his genitals to others in public to obtain sexual pleasure. The person’s thoughts are dominated by fantasies of exposing himself to others. It is more commonly seen in males who often expose themselves before children or women. The most common cause of the disorder is a social or psychological impairment in the individual. In India, this act is punishable by law with imprisonment upto 3 months and a fine.

Fetishism – is an obsession with non-living objects like women’s garments, which provides sexual satisfaction. These things do not normally have any sexual influence on the mind. A fetish can also be associated with any part of the body. For example, a person with foot fetishism may get sexually excited by looking at another person’s feet. This disorder is due to faulty associations of neutral objects with sexually stimulating thoughts.

Frotteurism – it is the urge to rub against or establish physical contact with a non-consenting individual to obtain sexual pleasure. Many such people are unable to have normal sexual relations due to impotence.

Bestiality – sexual intercourse between a human and an animal is called bestiality. Most acts of bestiality take place with people who are in close contact with domesticated animals on farms etc. This is a crime punishable by law.

Voyeurism – is the derivation of sexual pleasure by watching another person undress or perform sexual intercourse. The individual usually masturbates while watching the sex act. These persons are usually unable to maintain normal sexual relations due to impotence.

Sadism and Masochism - these are sexual fantasies involving the use of force in order to obtain sexual satisfaction. A sadist derives sexual pleasure by physically hurting his sexual partner. A masochist, on the contrary, derives sexual satisfaction by being beaten, hurt or made to suffer.

How is abnormal sexual behaviour diagnosed?

Most sexually aberrant behaviour is not diagnosed till it is brought to notice usually by the police authorities or the relatives of the victim. Since this behaviour is also a crime that is punishable by law, it is diagnosed when investigations for the crime are being done. The diagnosis is made by a psychiatrist or a psychologist after conducting a series of psychological tests.

What is the treatment?

Psycho-sexual disorders like the above are treated with the help of psychiatric methods over a period of time. They cannot be treated with one specific medication since they are not diseases. They are mental conditions which need a thorough background research and consistent follow-up by the doctor.

lung cancer pics

2008-05-09T05:39:00.000-07:00

Small cell carcinoma (oat cell) of the lung in a smoker.
This photo of lung cancer is of Squamous cell carcinoma arising centrally in the lung.
normal lung
Centrilobular type Emphysema. The enlarged air spaces result from loss of lung tissue from smoking.

Squamous cell carcinoma of the lung in a smoker, gross

Hydrocele

2008-05-09T04:55:00.000-07:00

Senile Vaginitis

2008-05-09T03:58:00.001-07:00

What is senile vaginitis?

Senile or atrophic vaginitis is an inflammation or irritation of the vagina caused by thinning and shrinking of the tissues of the vagina and decreased lubrication of the vaginal walls. This is due to a lack of oestrogen. This condition is common in post menopausal women.

What is the cause?

Senile vaginitis is typically caused by a decrease in oestrogen, as normally occurs after menopause. The disorder may occur in younger women who have had surgery to remove their ovaries. Some women experience it immediately after childbirth or while breastfeeding, since oestrogen levels are lower at these times.

The factors that increase the risk include:
Menopause
Decreased ovarian functioning
Radiation therapy
Chemotherapy
Immune disorder
Elevated prolactin level during lactation
Medications containing anti oestrogen properties
Natural oestrogen deficiency before menopause
Smoking

What are the symptoms?

Senile vaginitis is characterised by:
Vaginal soreness - an itching or burning sensation.
Slight vaginal discharge.
Burning on urination.
Light bleeding after intercourse.
Painful sexual intercourse

How is it diagnosed?

A pelvic examination reveals thin, pale vaginal walls. A wet preparation (microscopic evaluation of the vaginal discharge) may be done to rule out other causes of vaginitis. Hormonal studies may be done if the menopausal status is uncertain.

Laboratory tests include:
Wet preparation/cytological smear of cells from the vagina

Ultrasonography of the uterine lining

Serum hormone concentration

Vaginal pH

What is the treatment?

The lack of circulating, natural oestrogens being the primary cause of atrophic vaginitis, hormone replacement therapy is the most logical treatment and has proved to be effective. Topical oestrogen creams or tablets may be used in the vagina or oral oestrogen replacement therapy may be initiated. Usually this is effective in overcoming the problem. Painful sexual intercourse may be helped by using water-soluble vaginal lubricants. Relief is usually achieved by implementing one or more of the treatments outlined. It is necessary to get medical help in women who are experiencing vaginal soreness, burning, itching, or painful sexual intercourse even after using lubricants.

What is the prevention?

For post-menopausal women in particular, regular sexual activity, with or without a partner, is recommended. Sexual activity improves blood circulation in the vagina, which helps maintain the tissue.

Rubella (German Measles)

2008-05-09T03:56:00.000-07:00

What are Torch infections?

TORCH is an acronym for a special group of infections. These may be acquired by a woman during pregnancy. "TORCH" stands for the following infections:

Toxoplasma infection, also called toxoplasmosis
Other infections, such as hepatitis B, syphilis, and herpes zoster, (the virus that causes chickenpox)
Rubella, the virus that causes German measles
Cytomegalovirus, or CMV
Herpes simplex virus, the cause of genital herpes
What is rubella?

Rubella and measles are contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either of the illnesses. However, rubella isn't as infectious as measles and is usually not as severe, which is why it is also called the three-day measles. But if a pregnant woman contracts rubella, especially during her first trimester, the virus can cause miscarriage, stillbirth or serious birth defects in the developing fetus — a condition known as congenital rubella syndrome. These defects can include deafness, growth retardation and heart problems.

What are the causes?

Rubella is caused by a virus that passes from person to person hence spreading the disease. It can spread when an infected person coughs or sneezes, or by direct contact with an infected person's respiratory secretions, such as mucus. It can also be transmitted from a pregnant woman to her unborn child. A person with rubella is contagious from one week before the onset of the rash until about one to two weeks after the rash disappears.

What are the symptoms?

The signs and symptoms of rubella are so mild that they're hard to notice, especially in children. The signs and symptoms generally appear between two and three weeks after the exposure to the virus. They last for about two to three days and may include:

Mild fever
Headache
Stuffy or runny nose
Inflamed, red eyes
Enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears
Pink rash that begins on the face and quickly spreads to the trunk and then to the arms and legs, before disappearing in the same sequence
Aching joints, especially in young women
What is the diagnosis?

The rubella rash looks like many other viral rashes. Doctors usually confirm rubella with the help of laboratory tests.

If the doctor suspects that the patient has rubella, virus culture or a blood test can be done, which can detect the presence of different types of rubella antibodies in the blood. These antibodies indicate whether a person had a recent or past infection, or a rubella vaccine.

What is the treatment?

No treatment can shorten the course of rubella infection. Most of the time the symptoms are so mild that treatment usually isn't necessary. However, doctors often recommend isolation from others — especially pregnant women — during the infectious period.

If a woman contracts rubella while she is pregnant, she should discuss the risks to the baby with the doctor. If the woman wishes to continue her pregnancy, she may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce the symptoms but does not eliminate the possibility of the baby developing congenital rubella syndrome.

Treatment for congenital rubella syndrome varies depending on the extent of the infant's problems. Children with multiple complications may require early treatment from specialists.

How can care be taken at home?

In rare instances when a child or adult is infected with rubella, simple self-care measures are required:

Rest in bed as necessary
Take acetaminophen to relieve discomfort from fever and aches
Tell friends, family and co-workers — especially pregnant women — about the diagnosis if they may have been exposed to the disease
Don't give aspirin to children who have a viral illness. Aspirin in children has been associated with Reye's syndrome — a rare, but serious illness that can affect the blood, liver and brain of children and teenagers after a viral infection.
Can rubella be prevented?

The rubella vaccine is usually given as a combined measles-mumps-rubella (MMR) vaccine, which contains the safest and most effective form of each vaccine. Children should receive the MMR vaccine between 12 and 15 months of age, and again between 3 and 6 years of age — before entering school. It is particularly important that girls receive the vaccine to prevent rubella during future pregnancies.

Usually babies are protected from rubella for six to eight months after birth because of the immunity passed on from their mothers. But if a child requires protection from rubella before 12 months of age — for example, for certain foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.

Menstrual problems

2008-05-09T03:51:00.000-07:00

Menstruation is a normal part of a woman’s reproductive cycle. The ovary periodically releases an egg. It also releases a hormone called oestrogen, which stimulates the lining of the uterus to grow and get prepared to receive the fertilized egg. If, however, the egg does not get fertilized, the uterus sheds its lining resulting in menstrual flow. This flow repeats itself in a cycle of approximately 28 days until a woman gets pregnant or has approached menopause.

A slight discomfort or pain associated with menstruation is quite normal but if it becomes severe, a doctor should be consulted for problems that may not be really visible. The three main problems associated with menstruation are:

Lack of periods- amenorrhoea
Painful periods- dysmenorrhoea
Heavy periods- menorrhagia
Premenstrual Syndrome (PMS or PMT)

Amenorrhoea

Amenorrhoea is the absence or abnormal stoppage of menstruation. It can be of a primary or secondary nature. It can be due to normal physiological reasons like pregnancy, breast feeding or menopause. Infact, the commonest cause of physiological amenorrhoea is pregnancy. The abnormal (pathological) causes are:

Girls who have attained the age of 16 years and still not started getting their periods are said to have primary amenorrhoea. Secondary amenorrhoea occurs when a woman who was having normal periods suddenly stops menstruating for more than 6 months.

It can be due to a hormonal imbalance or a developmental problem. Stress, severe dieting, increased levels of exercise or chronic illness could also add to the problem. Most often women do not give importance to this but it needs to be dealt with more cautiously as it may be a sign of an underlying problem- imbalance in the production of reproductive hormones or even uterine cancers.

Dysmenorrhoea

Dysmenorrhoea or pain during the periods may be quite normal in most of the cases. Primary dysmenorrhoea is more common in teens and is not caused by a disease. It is because of the production of a hormone called prostaglandins in large quantities leading to nausea, headaches, diarrhoea and severe cramps. These symptoms last only for a day or two.

Secondary dysmenorrhoea is pain caused by some physical condition like fibroids in the uterus, infections in the pelvic region or growth of tissues normally found only in the uterus outside the uterus-the ovaries, fallopian tubes or other parts of the pelvic cavity, a condition called endometriosis.

Menorrhagia

A heavy period is one that lasts longer than eight days, saturates napkins within an hour or includes large clots of blood in the menstrual flow. It is very common in adolescents because of slight hormonal imbalances at their age. An imbalance in the levels of oestrogen and progesterone hormones allows the uterine wall to keep building up resulting in bleeding that is very heavy. In some cases it can also be due to fibroids, vaginal infections or thyroid problems.

Premenstrual Syndrome

PMS refers to a combination of physical and emotional symptoms experienced by all women during the menstrual cycle, usually just before menstrual bleeding begins. The intensity and range of symptoms vary from person to person. These include:
Temporary weight gain, due to accumulation of water in the body.
Headaches and cramps.
Painful breasts.
Tension and depression, irritability and stress.
PMS is usually at its worst 7 days before the period starts and disappears before it begins. Diet that is low in sodium and salt, increased fluids, high fibre, high complex carbohydrates, low fat and low sugar may be taken. Exercise, massage, relaxation techniques may help in relieving the symptoms.

What to do if the problem is suspected?

A visit to the doctor becomes important
if a girl has not started her periods till the age of 16 or is having irregular periods. The most likely cause could be a hormonal imbalance. Unhealthy eating habits can also lead to the same.
if she stops getting her periods or it becomes irregular after being regular for 6 months or longer. Severe dieting can cause this problem.
if she has extremely heavy or long periods that are painful and associated with anaemia. This could be a sign of growth in the uterus, thyroid condition or some kind of infection.
How can a doctor help?

To diagnose the problem:
the doctor will do a thorough pelvic examination.
blood tests(to check hormone levels).
sometimes even urine and stool tests.
an ultrasound or CAT scan may be performed with the tests to arrive at a correct diagnosis.
If a fibroid or other such growths is identified medicines or surgery as suggested by the doctor would be required. Hormone therapy to rectify the imbalance in the production of hormones can also be suggested. Severe menstrual pain with no underlying medical cause can be treated by medicines like ibuprofen or acetaminophen.

Does self management work?

Several things that can be done on a self help basis to combat the problem. These include:
A balanced diet with lots of fresh fruits and vegetables.
Cutting down on salty processed foods to check water retention.
Reducing caffeine intake to maintain emotional calm.
According to a recent study, increasing the amount of calcium in the diet reduces the severity of PMS symptoms.
Above all a brisk walk that helps in the release of endorphins (chemicals in the body that make one feel good) or a warm bath are suggested to keep fresh and relieved.

Menopause

2008-05-09T03:49:00.000-07:00

What is menopause?

Menstruation is a process during which women normally shed the lining of the uterus at regular intervals under the influence of the female sex hormone, oestrogen. At about the age of 45 to 50 the ovaries stop making oestrogen and the withdrawal of the hormone results in stoppage of the monthly menstrual periods. This is called menopause and it happens naturally to all women sooner or later but may also be induced if the ovaries are removed or stop functioning for any other reason.

What does oestrogen do?

Oestrogen along with another female sex hormone, progesterone plays an important role in developing the female body and its functions, most notably pregnancy. Development of breasts, broadening of hips and functions of the vagina, uterus and other female organs depend on oestrogen. With progesterone, it maintains the cyclical periods and prepares the uterus for pregnancy.

Other beneficial effects include maintaining bone growth and protecting the heart by increasing the good cholesterol (HDL) and lowering the bad cholesterol (LDL). This is why women are less prone to heart attacks before menopause. This protective effect is lost after menopause.

What are the symptoms of menopause?

The majority of women will observe some symptoms during menopause, but the intensity of these varies in different women.

Irregular bleeding - Menstrual periods have three normal patterns of stopping: they may suddenly stop, they may come on time, but keep reducing in the quantity of flow till they finally stop or they may keep getting delayed till they finally stop. Heavy or frequent periods are NOT normal.
Hot flushes - This is the most prominent symptom. There is a sudden sensation of heat that spreads to various parts of the body, particularly the face. Flushing and sweating may occur. These flashes of warmth last a few seconds or minutes. These are more common in the first few years after menopause but may continue for many more years. If they occur very frequently, they can be the cause of social embarrassment. These flashes may be brought on in hot and humid weather, by drinking caffeine or alcohol or eating spicy foods.
Vaginal thinning and dryness - Due to oestrogen withdrawal, the vagina becomes thinner and dry. This makes sexual intercourse painful. There may be associated itching and irritation. Regular sexual intercourse may help keep the vagina moist and toned.
Mood changes - Women become irritable and anxious around menopause. There may be loss of memory and concentration and lack of energy. Depression may also be present. These symptoms may not be a direct effect of oestrogen withdrawal, but may be compounded by career pressures, sexual inadequacies and loss of fertility and body image.
Sexuality - Several factors adversely effect the libido or sex drive. Besides the mechanical factor of vaginal dryness that makes intercourse painful, mood fluctuations and lack of energy all contribute to a poor sex drive.
Osteoporosis - Bones become thin, weak and are more likely to break. This happens because the oestrogen that helps reduce bone absorption is no longer available. Osteoporosis is more likely in Asian women, and those that are slim built. Cigarette smoking increases the risk of developing osteoporosis.
Heart disease - Women lose the protective effect of oestrogen in preventing heart disease after menopause. They then become susceptible to heart attack as much as men. This risk is increased if the woman is obese, has high blood pressure or diabetes, smokes cigarettes and does not do any physical activity regularly.

What can be done?
Menopause happens to all women and cannot be prevented. The bad effects can be minimized by hormone replacement therapy (HRT). In this, oestrogen along with progesterone is given around the time of menopause. These reduce the symptoms of menopause, prevent bone loss and reduce the risk of heart attack. However, HRT is not without its risks, which may include cancer of the breast or the uterus. The risks and benefits of HRT must be fully discussed with the doctor before starting treatment.

Mastectomy

2008-05-09T03:47:00.000-07:00

What is mastectomy?

Mastectomy is the surgical removal of the breast, usually to remove a malignant tumour. It is also done in other conditions like cystic breast disease or in case a lump is too big to be removed by lumpectomy. Mastectomy involves removal of the whole breast (simple mastectomy) or a part of it depending on the extent of infection (segmental mastectomy). More often, in cases of cancer, the whole breast along with adjacent muscles is removed (radical mastectomy). It is best performed when the cancer is in its earliest stages.

When is it done?

The procedure is usually done to remove cancerous growths in the breasts. Women, and in some cases men, may require mastectomy.

What happens during the procedure?

The operation is performed under general anaesthesia. The skin around the breast is cleansed with an antiseptic to prevent any infection. A cut is made in the breast around the nipple and the areola to expose the underlying tissues. The entire breast tissue along with the tumour is nobilised. The chest muscles are removed along with the breast in most cases of cancer. After the tumour is removed, the incision is sutured. Antibiotics may be prescribed to avoid post operative infection.

What happens after the procedure?

After the operation, the patient usually has an intravenous tube and an oxygen tube attached to her. Anaesthesia may result in a slightly sore throat when the patient awakens. The doctor may ask the patient to cough out vigorously and breathe deeply so as to clear the lungs.

The patient may receive antibiotics to prevent infection. The patient may be discharged as soon as she feels strong enough which is usually in a week's time. Many women may feel depressed after a mastectomy due to concerns about their looks and sexuality. Mastectomy leaves the woman's chest flat which may cause cosmetic concerns.

However, there are many ways in which the deformity may be disguised, e.g., by wearing padded brassiers or with silicone breast implants. These procedures are being widely used throughout the world.

What can be the post-operative complications?
There may be fluid infection under the skin due to faulty drainage. This may lead to the destruction of cells.
Some women may experience pain in the chest region. This is called post-mastectomy pain syndrome.
Infection in the lymph nodes may cause swelling on the operated side of the arm, called lymphoedema.

Fibroadenoma (Breast lump)

2008-05-09T03:45:00.000-07:00

What is fibroadenoma?

Fibroadenomas are benign breast tumours commonly found in young women. Fibroadenoma means a tumour composed of glandular (related to gland) and fibrous (containing fibres) tissues. Breast fibroadenomas, abnormal growths of glandular and fibrous tissues, are most common between the ages of 15 and 30. They are found rarely in postmenopausal women. Described as feeling like marbles, these firm, round, movable, and rubbery lumps range from 1 cm-5 cm in size. Giant fibroadenomas are larger, lemon-sized lumps. Usually single, nearly 10-15% of women have more than one. While some types of breast lumps come and go during the menstrual cycle, fibroadenomas typically do not disappear after a woman's period, and should be checked by a doctor.

What are the causes?

The cause of breast fibroadenomas is unknown. They may be dependent upon oestrogen, because they are common in premenopausal women, can be found in postmenopausal women taking oestrogen, and because they grow larger in pregnant women.

What are the symptoms?

Fibroadenomas usually cause no symptoms and may be discovered during breast self-examination, or during a routine check-up.

How is the diagnosis made?

When the doctor takes a complete medical history, they will ask when the lump was first noticed, if there were any symptoms or changes in lump size, and if there is any personal or family history of breast disease. The doctor thoroughly feels the breasts. Tests are done, usually including mammography or ultrasound scans, or surgical removal of cells or tissue for examination under the microscope (biopsy).

Diagnostic tests include:
Mammogram - an x-ray examination of the breast
Ultrasound scan - a technique that uses sound waves to display a two-dimensional image of the breast, showing whether a lump is solid or fluid-filled (cystic)
Fine-needle aspiration biopsy - a minor procedure wherein fluid or cells are drawn out of the lump through a small needle
Core biopsy - a procedure wherein a larger piece of tissue is withdrawn from the lump through a larger needle
Incisional biopsy - a surgical procedure wherein a piece of the lump is removed through an cut or incision
Excisional biopsy - a surgical procedure wherein the entire lump is removed through an cut or incision

What is the treatment?

Breast fibroadenomas are removed by lumpectomy, or surgical excision under local or general anaesthesia. Sometimes lumps in younger women are not removed but are monitored by self-examination, yearly doctor check-ups, and mammograms. Surgery is generally recommended for women over 30, and for lumps that are painful or enlarging.

It is recommended to include a low-fat, high-fibre, vegetarian-type diet, a reduction in caffeine intake, supplementation with fish oil and vitamins E and C and the application of hot compresses to the breast.

What is the prognosis?

Breast fibroadenomas are not cancerous. The lumps recur in up to 20% of women.

What is the prevention?

Breast fibroadenomas cannot be prevented. They can be discovered early by regular breast self-examination

Birth control pills (Oral Contraceptives)

2008-05-09T03:42:00.001-07:00

What are birth control pills?

Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. If a woman does not ovulate she cannot get pregnant because there is no egg to be fertilized. The cervix also produces less and thicker mucous so that sperm cannot easily enter the uterus. In addition, the lining of the uterus becomes thinner, so it would be more difficult for a fertilized egg to stay in the uterus.

What are the types?

The most commonly used pills are "combined" pills. They contain man-made forms of 2 hormones: oestrogen and progesterone. There is also a progesterone-only pill (the mini-pill), but it is not as effective and causes a lot of blood spotting between menstrual periods.

How are the pills used?

The combined pills usually come in a package of 28 pills. They are also available in 21-pill packs. The doctor decides which type of package is best suited for a person. She will probably advise one to start taking the pills on the Sunday after the period has started or on the first day of the next period, depending on one’s preference.

If one is using the 21-pill pack, it is necessary to take 1 pill every day for 3 weeks. One should stop taking the pills for 7 days and then start a new pack.

If one is using the 28-day package, it is necessary to take 1 pill every day for 4 weeks and then start a new package the next day. The last 7 pills contain no medication for birth control; they just keep one in the habit of taking a pill every day. It is important to try to take the pills at approximately the same time every day. The period will usually occur soon after the last hormone-containing pill is taken.

Some antibiotics can affect the way birth control pills work in one’s body. If one is taking antibiotics, it is necessary to tell the doctor. One may need to use an additional form of birth control while one is taking antibiotics.

What if one forgets to take a pill?

If one forgets to take some of the pills, one will have menstrual bleeding at unpredictable times and one may get pregnant.

If one forgets to take a pill, it is necessary to take it as soon as one remembers and take the next pill at the usual time. If one misses 2 consecutive pills, one should take 2 pills each day for 2 days and then go back to the regular schedule.

If one misses 3 or more pills, stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.

If one has forgotten to take 2 or more pills and have missed a period, one might be pregnant. One should stop taking the pills and use other forms of birth control until pregnancy is ruled out. One should not stop taking the pills if one has taken them correctly.

When to start taking the pills after having a baby?

If one is breast feeding the baby, one should not take oral contraceptives until one has a good milk supply. This will take about 4 to 6 weeks after the birth. Then, a low-dose pill or progesterone-only pill may possibly be used. It is necessary to talk to the doctor about when one can start the pills again. Also, one should remember that breast feeding is not a sure protection against pregnancy, so one should use another form of birth control before one starts taking birth control pills again.

If one is not breast feeding the baby, one may be able to start taking birth control pills 1 to 2 weeks after the birth or when one begin menstruating again. It is necessary to check with a doctor before one starts taking birth control pills again.

What are the benefits?

The main benefit of birth control pills is that they are effective in preventing pregnancy but do not interrupt sexual intercourse. The pills also may decrease the risk of uterine and ovarian cancer, ovarian cysts, rheumatoid arthritis, and ectopic (tubal) pregnancy. Also, when one uses birth control pills, the periods become regular, lighter, and less painful. There is also a lower incidence of pelvic inflammatory disease (PID), fibrocystic changes in the breasts, and fibroadenoma (benign tumours) of the breast.

Generally, women who have no gynaecologic problems before they start taking oral contraceptives have no trouble becoming pregnant after they stop taking birth control pills, regardless of how long they have been taking them. There is no advantage to "taking a break" from birth control pills unless one has problems specifically related to the pills. When one wishes to get pregnant, it is recommended that one waits until one has had at least 2 normal menstrual periods after stopping the pills.

What are the disadvantages?

One disadvantage of birth control pills is that one must remember to take a pill every day.

Problems one may have while taking birth control pills include:
irregular bleeding for the first few months
nausea and vomiting
weight gain
breast swelling and tenderness
increased appetite
depression
headaches
scant or missed periods
high blood pressure
dizziness
Women who take birth control pills and smoke, especially those over 35 years old, have an increased risk of severe problems such as heart disease and blood clots. The heart disease could cause a heart attack. The blood clots may cause leg pain or swelling, chest pain, stroke, or death.

It is necessary to monitor one’s blood pressure after one has taken the pills for 3 months. Birth control pills do not protect one from sexually transmitted diseases such as AIDS. Latex condoms are the only safe way to protect against AIDS.

It is necessary to consult a doctor if one experiences:
leg pain or swelling
loss of vision or double vision
bleeding irregularities
more headaches than usual
numbness of arms, legs, or any other part of your body

Agoraphobia

2008-05-09T03:42:00.000-07:00

What is agoraphobia?

Agoraphobia is an anxiety disorder. The people with agoraphobia avoid being in certain places or situations. They are afraid about having no way to escape or be overwhelmed with panic and having no help. An intense fear of driving, flying, crossing bridges, or being in shops are examples. The patients may become afraid of their reactions to these situations and this fear in itself can be disabling. In extreme cases, the agoraphobic person may never leave home.

Agoraphobia is often the end stage of panic disorder. Panic disorder is characterized by severe frequent panic attacks marked by a sense of impending doom. A person may be called agoraphobic when he/she tries to avoid situations, which he/she feels might trigger a panic attack.

How does it occur?

The exact cause is unknown. As with other types of mental illness, both genetic and environmental factors play a role.

What are the symptoms?

Agoraphobia may be the cause if a person often avoids going to places or doing things because of the fear of having no way to escape. Typical symptoms of panic attack may be:
Palpitations or suddenly fast heartbeat
Sweating even when it is not hot
Trembling or shaking
Shortness of breath, feeling of not getting enough air
Feeling of choking or chest pain
Nausea
Dizziness
Fear of going crazy, losing control of body functions or of dying
Numbness or detachment
Chills or hot flashes.

Panic attacks may occur several times a day, or the attacks may be scattered, occurring only occasionally. Even occasional attacks can lead to fear of returning to a place or doing something associated with a past attack. A panic attack may last 10-15 minutes, or longer, after which the person may be exhausted.

Women Women have agoraphobia two to four times more often than men. The condition tends to run in families. Agoraphobia may cause a person to avoid going places or doing things because of the fear of having a panic attack, of having no way to escape.

How is it diagnosed?

The doctor will enquire about the symptoms. Other common causes of the symptoms, such as a medical illness or a drug or alcohol problem should be ruled out. This requires a medical examination and tests.

What is the treatment?

The treatment depends on how the disorder interferes with the routine life. Agoraphobia can be treated by various therapies. These include behaviour therapy, relaxation therapy, cognitive therapy, visual imagery techniques and medications (antidepressants and anti-anxiety drugs) to prevent panic attacks. The most effective treatments usually require that the person be exposed to the feared situation repeatedly, perhaps accompanied by a trusted companion, until they learn that the experience (such as crossing a bridge or riding in an elevator) is not dangerous.

How long does agoraphobia last?

Without treatment agoraphobia can last for many years, even for a lifetime.

What can be done to help?

Discuss the issue with a doctor who is knowledgeable about the condition. Realise that the anxiety problem can be overcome. Do not use alcohol or other drugs to overcome anxiety. Learn as much as possible about agoraphobia, anxiety, and panic. Join a support group of others with similar problems, and share experiences and solutions.

Abortion

2008-05-09T03:37:00.000-07:00

What is abortion?

Abortion is the termination of pregnancy by any method (spontaneous or induced) before the fetus is viable (less than 20 weeks of pregnancy) to survive independently.

Induced abortion:

Out of almost 35 million abortions, which take place annually in the world, more than half of them are illegal and performed by untrained, unskilled personnel under highly unhygienic conditions.

1. Abortion in the first three months of pregnancy

By Cervical dilatation followed by evacuation of uterus or
Menstrual aspiration (MR)
Surgical methods in the first three months
Medical methods

The main drugs used today are a group of drugs known as prostaglandin, which can be used orally or through injection intramuscularly / intravenously, or vaginally. These drugs are used by themselves or in combination with other drugs.
The methotrexate – misoprostol method: A woman receives an injection of methotrexate. Between five to seven days later she returns and inserts suppositories of misoprostol into her vagina.
The mifepristone – misoprostol method: Mifepristone also known, as RU-486 is an antiprogesterone. A woman swallows a dose of mifepristone. She returns in five to seven days and inserts suppositories of misoprostol into her vagina.
Risks:
Mifepristone, Methotrexate and misoprostol cause nausea and diarrhoea.
Incomplete abortion may require surgical evacuation.
Heavy bleeding may continue up to 7 days.

2. Abortion in the second three months of pregnancy:

Methods of second trimester abortion (13 – 20 week)

What are Medical methods?
Ethacridine lactate.
Prostaglandin

What are the Surgical methods?
Aspirotomy
Hysterotomy
Hysterectomy

Medical methods:
Ethacradine lactate:
This drug is introduced through a sterile catheter through the vagina into the uterine cavity and placed behind the pregnancy sac. This procedure is not painful. A maximum of 150 ml is installed. It takes between 48 to 72 hours to abort. The procedure is safe, cheap and easily available. To hasten the abortion, ethacridine can be used along with prostaglandin or oxytocin (a naturally available drug to increase uterine contractions).
Prostaglandin:
PG-E2: A gel of prostaglandin is inserted into the cervix at the clinic and the patient is asked to lie down for about half an hour and then allowed to go home. Early the following morning in the hospital a drip of oxytocin is started intravenously. Abortion is usually achieved in less than 24 hours and the abortion is complete
Misoprostol: It is available in tablet form and given orally or can be inserted vaginally. Two tablets of Mifepristone are given 24 hours later by an oral or vaginal dose of misoprostol. The uterus contracts causing cramping followed by the expulsion of the fetus. The cramps and the bleeding stops after the products have been expelled
Others: Drugs like urea, hypertonic saline, glucose, which are introduced into the pregnant sac have all been done away with in favour of the above mentioned methods.
Risks:

One needs to be at a hospital up to 3 days
Infection
Increased bleeding
Retained products, which may need surgical evacuation.

Surgical methods:

Anaesthesia:
General anaesthesia can be given depending on the pain threshold/apprehension of the patient.

Procedure:
Aspirotomy.
Hysterotomy.
Hysterectomy.

Aspirotomy:
Aspirotomy is a procedure similar to what is done in the first trimester. This method can be employed between 13-20 weeks of pregnancy. Prostaglandins might be used to help in dilatation of the cervix.

Hysterotomy:
Hysterotomy is a major operating procedure where the abdomen is opened. In hysterotomy, the uterus is opened and the contents of the uterus are removed directly under vision. This is like a caesarean.

Hysterectomy:
In hysterectomy, the uterus along with the pregnancy is removed in toto. At times hysterotomy or hysterectomy may be necessary because of a failure of a medical induction during the second trimester.

In the second trimester of pregnancy, medical methods are followed rather than surgical methods. This is because the risks and the convenience of the medical methods are far less than surgical termination.

An early diagnosis of pregnancy with early termination is safer in the second trimester.

What is the Indian MTP Act?

To avoid the misuse of induced abortions, laws have been enacted all over the world so that only qualified gynaecologists can perform MTP for definite indications at clinics or hospitals that are approved. The Medical Termination of Pregnancy Act was enacted in 1971 and was again revised in 1975.

It lays down the conditions under which a pregnancy can be terminated and the people and places authorised to do so.

Indications for an MTP, under the act, are:
When pregnant woman has a serious disease and continuation of pregnancy could endanger her life:

Heart disease
Severe hypertension
Uncontrolled vomiting during pregnancy
cancer of the cervix or breast
Diabetes mellitus with eye complication (retinopathy)
Epilepsy
Psychiatric disorder

Where the continuation of pregnancy could lead to substantial risk to the newborn causing serious physical or mental handicap:

Chromosomal abnormalities.
Rubella (German measles) infection in the mother during first three months
Congenital abnormalities in earlier births
Rh iso-immunisation
Exposure of the foetus to irradiation.
Pregnancy resulting from rape.
Conditions where the socio-economic status of the mother (family) hampers the progress of a healthy pregnancy and the birth of a healthy child.
Failure of a contraception, irrespective of the method used (natural or barrier or hormonal)
Consent:

Married: her own written consent; husband’s consent not necessary
Unmarried and over 18 years: her own written consent
Below 18 years or mentally unstable: written consent of guardian
Consent signifies and assures the clinician performing the procedure that the woman:

has chosen abortion of her own free will
has been informed about all her options
has been counseled regarding the procedure (risks involved and care to be taken following it)
Who are the person(s) qualified to do MTP?

Any qualified registered medical practitioner who has assisted in 25 MTPs
A house surgeon who has done six months posting in Obstetrics and Gynaecology
A person who has a diploma/degree in Obstetrics and Gynaecology
Three years of practice in Obstetrics and Gynaecology for those doctors registered before the 1971 MTP Act was passed.
One year of practice in Obstetrics and Gynaecology for those doctors registered on or after the date of commencement of the Act.
Whenever the pregnancy exceeds 12 weeks but is less than 20 weeks, opinion of two registered medical practitioners is mandatory

What are the approved places where MTP can be performed?

Any institution licensed by the Government to perform MTP. The certificate issued by the Government has to be prominently displayed at a site readily visible to persons visiting the place.

Why is counselling done?

Counselling is normally done by the attending doctor with the aim of helping her come to a decision as to the need of continuation or termination of the pregnancy and to resolve it in the direction that she chooses.
The purpose of counselling is to:
Relieve the anxiety of the patient who intends to undergo abortion.
Provide information about the methods, safety and risks.
Screen for guilt, or any psychiatric ailment.
Help the patient understand and cope with her feelings.
Help her to prevent future unplanned pregnancy.

Serious complications arising from abortions before 13 weeks are quite unusual. About 89% of the women who obtain abortions are less than 13 weeks pregnant. Of these women, 97% report no complications; 2.5% have minor complications that can be handled in the OPD or abortion facility; and less than 0.5% require some additional surgical procedure and/or hospitalisation. Complication rates are higher for abortions performed between 13 and 24 weeks. General anaesthesia, which is sometimes used in abortion, carries its own risks.

In addition to the duration of the pregnancy, significant factors that affect the possibility of complications include:
Technical expertise of the provider;
Anaesthetic risk;
General health of the woman
Method employed

What are the complications from legal abortion?

Possible complications from a surgical abortion procedure include:

Blood clots accumulating in the uterus, requiring another suctioning procedure, which occurs in less than 1% of cases;
Infections, most of which are easily identified and treated if the woman carefully observes instructions, which occur in less than 3% of cases;
Tear in the cervix, which may be repaired with stitches, which occurs in less than 1% of cases;
Perforation in of the wall of the uterus and/or other organs, which might heal on its own or require surgical repair or, rarely, hysterectomy, which occurs in less than 1/2 of 1% of cases;
Missed abortion, which does not end the pregnancy and requires the abortion to be repeated, which occurs less than 1/2 of 1% of cases;
Incomplete abortion, in which the tissue from the pregnancy remains in the uterus, and requires the abortion to be repeated, which occurs in less than 1% of cases;
Excessive bleeding caused by failure of the uterus to contract, which might require blood transfusion that occurs in less than 1% of cases.

What are the signs of a Post - Abortion Complication?

If a woman has any of the following symptoms after an abortion, she should contact the facility that provided the abortion immediately:
Severe pain;
Chills or fever with a temperature of 100.4 0F or more;
Bleeding that is heavier than the heaviest day of her normal menstrual period or that soaks through more than one sanitary pad in an hour;
Foul-smelling discharge from her vagina
Continuing symptoms of pregnancy.

How to prevent complications?

Women can certain things to lower their risks of complications. The most important thing is not to delay the abortion procedure. After six weeks from LMP, the earlier the abortion, the safer it is.

It's important to ask. Just as with any medical procedure, the more relaxed a person is and the more she understands what to expect, the better and safer her experience will be.

In addition, any woman choosing abortion should:

Find a good clinic or a qualified, licensed practitioner
Inform the practitioner of any health problems, current medications or; allergies to medications or anaesthetics;
Follow post-operative instructions;
Return for a follow-up examination.

Kidney failure

2008-05-09T03:36:00.001-07:00

What is kidney failure?

The main function of the kidneys is to eliminate excess fluid and waste material from the blood. When the kidneys lose this filtering ability, dangerous levels of fluid and waste accumulate in the body leading to a condition known as kidney or renal failure. This may be due to various factors including infections, autoimmune diseases, and other endocrine disorders, cancer, and toxic chemicals. Kidney failure usually occurs in the late stages of the disease processes. Once kidney failure occurs, it requires immediate management and even then prognosis is often not satisfactory unless kidney transplantation is done.

What is the cause?

There are two main types of kidney failure:

Acute renal failure (ARF)

This is characterised by a sudden impairment of renal function marked by rapid, and steadily increasing accumulation of toxic products in the blood, normally excreted by the kidneys. The causes of acute kidney failure include:
factors that interfere with renal blood flow (for example: fluid and electrolyte depletion, haemorrhage, severe infections, cardiac or liver failure, heat stroke, fluid depletion due to burns).
factors that cause obstruction (for example enlarged prostate and kidney stones can also lead to acute kidney failure).
other causes are factors that impair the renal function directly (for example acute tubular injury or acute glomerulonephritis, which is an inflammatory disorder of the kidney).

Chronic renal failure (CRF)

This is characterised by a slow and irreversible impairment of the excretory and regulatory functions of the kidneys. The causes of CRF include:
Chronic disease of the kidneys like glomerulonephritis
Chronic infection like tuberculosis
Anomalies of the kidneys that are present since birth
Vascular disease like hypertension
Endocrine disease like diabetes
Obstructive processes in the kidneys such as kidney stones
Nephrotoxins (toxic chemicals that affect the kidneys)

What are the symptoms?

The symptoms and signs of kidney failure depend upon the type of failure. In acute kidney failure, the patient may have oliguria (reduced urine output) along with generalised swelling (oedema) of the body together with high blood pressure. Sometimes there may be blood in the urine. In the early stages of chronic kidney failure, the patient may merely have increasing fatigue and tiredness and symptoms like nocturia (increased frequency of urination at night). Vomiting, oedema and high blood pressure eventually develop. There is also loss of appetite. Other symptoms depend upon the cause of the failure. For example, if there are kidney stones, then there may be excruciating groin pain or if there is severe haemorrhage or diarrhoea there may be signs of shock. Complications in renal failure include pulmonary oedema (presence of fluid in the lungs), severe sustained increase in blood pressure, acidosis, hyperkalaemia (increased level of potassium in the blood), and infection. If untreated, the last stage of kidney failure is almost invariably fatal.

How is the diagnosis made?

Urine examination is done to determine the presence of protein, sugar, casts and crystals, pH and specific gravity and the quantity of sodium. This gives an idea as to the cause of the failure. Blood tests include tests of renal function like
Blood urea nitrogen
Serum creatinine
Serum electrolytes.
Creatinine clearance is also an important index of renal function.

Blood counts and the haemoglobin levels are also useful. An ultrasound of the abdomen or a CT-scan needs to be taken to assess kidney size with grossly shrunken kidneys indicating a more advanced disease. End-stage renal disease is diagnosed when blood tests consistently show very high levels of urea and creatinine, a sign that kidney function has been severely and permanently damaged.

What is the treatment?

In acute kidney failure, general treatment measures include avoiding drugs that require renal excretion, balancing fluid intake with output, high carbohydrate and low-protein diet, essential amino acid replacement and at least 100gms of glucose per day, decreased intake of salt and potassium, vitamin supplements, prevention of injury or infection, weight management, electrolytes monitoring, and monitoring of vital signs, cardiac status, and mental status. Peritoneal or haemodialysis is the treatment of choice when other measures fail. Drugs are used to reduce the blood pressure; diuretics (drugs that increase urine output) are used in some cases to increase blood flow unless oliguria is present. Antibiotics may be needed to treat associated infections (predominantly only antibiotics excreted by the liver are used if there is no liver disease).

In chronic kidney failure, general treatment measures include a diet low in sodium, potassium, and phosphate, but high in calories and supplemented with essential amino acids. Other measures include balanced fluid intake, and monitoring weight changes, vital signs, electrolyte balance, cardiac and mental status.

Drug therapy: This includes antihypertensives for hypertension, diuretics for oedema and hypertension, phosphate binders for hyperphosphataemia (increased phosphate levels in the body), antibiotics, anticonvulsants for seizures, antiemetics (drugs that prevent vomiting) for nausea, laxatives for constipation, calcium, iron, and vitamin supplements.

Dialysis: Peritoneal dialysis or haemodialysis is often required for end-stage disease.

Surgery: Kidney transplantation is the solution for several patients as dialysis is often a measure that cannot be done indefinitely. The results of transplantation are now extremely good with substantial five-year survival rates.

What is the prevention?

Prevention of the causative factors, wherever possible, may help in preventing the development of the disease. Control of blood sugar in diabetics is of great importance. After the disease has developed, drug therapy may help and dialysis and kidney transplantation are increasingly being performed with excellent results. Control of blood pressure and avoiding smoking, alcohol, and drug abuse are also necessary. Proper diet and exercise also help in delaying the progress of the disease.

Kidney failure

2008-05-09T03:36:00.000-07:00

Nephrotic syndrome

2008-05-09T03:33:00.000-07:00

What is Nephrotic syndrome?

Nephrotic syndrome is a condition marked by very high levels of protein in the urine (proteinuria); low levels of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol. Nephrotic syndrome results from damage to the kidneys' glomeruli, which are tiny blood vessels that filter waste and excess water from the blood and send them to the bladder as urine. Nephrotic syndrome can occur with many diseases, including the kidney diseases caused by diabetes mellitus, but some causes are unknown.

Nephrotic syndrome can affect all age groups. In children, it is most common from the age of 2 to 6 years. Males are slightly more likely to be affected than females.

What is the cause?

Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the basement membrane of the glomerulus. This immediately causes abnormal excretion of protein in the urine. The most common cause in children is minimal change disease, while membranous glomerulonephritis is the most common cause in adults.

This condition can also occur as a result of infection, drug exposure, malignancy, hereditary disorders, immune disorders, or diseases that affect multiple body systems including diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis. It can accompany kidney disorders, including glomerulonephritis, focal and segmental glomerulosclerosis, and mesangiocapillary glomerulonephritis.

What are the symptoms?

Swelling (oedema): general, around the eyes, in the extremities, especially the feet and ankles
Swollen abdomen
Facial swelling
Foamy appearance of the urine
Weight gain (unintentional) from fluid retention
Poor appetite
High blood pressure
How is it diagnosed?

Physical examination can detect some symptoms. Other symptoms and signs of causative disorders can also be found with examination. Urinalysis reveals large amounts of urine protein. Fats are often also present in the urine. Tests to rule out various causes may include the following:

Glucose tolerance test
Antinuclear antibody
Rheumatoid factor
Cryoglobulins
Complement levels
Hepatitis B and C antibodies
VDRL serology
Serum protein electrophoresis
Kidney biopsy
Nephrotic syndrome can also alter the results of the following tests:
Urinary casts
Triglyceride
Protein electrophoresis - urine
Serum iron
Cholesterol
Albumin
What is the treatment?

The goals of treatment are to relieve symptoms, prevent complications and delay progressive kidney damage. Treatment of the causative disorder is necessary to control nephrotic syndrome. Corticosteroid, immunosuppressive, antihypertensive, and diuretic medications may help control symptoms. Antibiotics may be needed to control infections. Angiotensin converting enzyme (ACE) inhibitors may significantly reduce the degree of protein loss in the urine and are therefore frequently prescribed for treatment of nephrotic syndrome.

If hypertension occurs, it must be treated vigorously. Treatment of high blood cholesterol and triglyceride levels is also recommended to reduce the risk of atherosclerosis. Dietary limitation of cholesterol and saturated fats may be of little benefit, as the high levels which accompany this condition seem to be the result of overproduction by the liver rather than from excessive fat intake. Medications to reduce cholesterol and triglycerides may be recommended.

In many patients, reducing the amount of protein in the diet produces a decrease in urine protein. In most cases, a moderate-protein diet is usually recommended. Sodium (salt) may be restricted to help control swelling. Vitamin D may need to be replaced if nephrotic syndrome is chronic and unresponsive to therapy.

Nephrotic syndrome may go away once the underlying cause, if known, has been treated. In children, 80 percent of cases of nephrotic syndrome are caused by minimal change disease, which can be successfully treated with prednisone. However, in adults, most of the time the underlying cause is a kidney disease such as membranous nephropathy or focal segmental glomerulonephritis, and these diseases often persist even with treatment. In these cases, the kidneys may gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the patient will need dialysis or a kidney transplant.

What is the prognosis?

The outcome varies; the syndrome may be acute and short-term or chronic and unresponsive to therapy. The cause and development of complications also affects the outcome.

What are the complications?

Atherosclerosis and related heart diseases
Renal vein thrombosis
Chronic and acute renal failure
Infections, including pneumococcal pneumonia
Malnutrition
Fluid overload, congestive heart failure, pulmonary oedema

Can it be prevented?

Treatment of causative disorders may prevent the development of nephrotic syndrome.

Retinal detachment

2008-05-09T03:31:00.000-07:00

What is retinal detachment?

A retinal detachment is a medical emergency requiring immediate treatment. In this separation of the light sensitive membrane in the back of the eye (retina) becomes separated from its supporting layers (the outermost pigment layer).

Who is at risk for retinal detachment?

Those at risk for developing retinal detachment include:

Nearsighted (myopic) adults
People over 50 years of age
Those who have had an eye injury
After cataract surgery
People with a family history of retinal detachment

What are the causes of retinal detachment?

The following conditions may cause retinal detachment:

Scarring or shrinkage of the vitreous (the jelly like substance in the eye) can pull the retina inward.
Small tears in the retina allow liquid to seep behind the retina and push it forward.
Injury to the eye can knock the retina loose.
Bleeding behind the retina, most often due to diabetic retinopathy or injury, can push it forward.
Retinal detachment may be spontaneous, which occurs most often in the elderly or in very near sighted (myopic) eyes.
Tumours.

What are the symptoms of retinal detachment?

Retinal detachment causes a sudden defect in vision; it appears as though a shadow has fallen across the eye. There may be bright flashes of light, in the peripheral areas of vision. Sometimes, translucent specks of various shapes (floaters) are seen in the eye. The vision may become blurred.

How are retinal detachments diagnosed?

If the eye is clear, a detachment can be seen by looking into the eye with a hand-held instrument called an ophthalmoscope. Other special lenses also may be used to examine the back of the eyes. The commonest instrument used for examination is a binocular indirect ophthalmoscope.

What is the treatment of retinal detachment?

The treatment of retinal detachment is by surgery. Several procedures are available. Laser can be used to seal the tears or holes in the retina that generally precede retinal detachment. The application of intense cold with an ice probe (known as cryopexy) leads to the formation of a scar that holds the retina to the underlying layer. Surgical reattachment involves indentation of the sclera to relieve pressure on the retina, allowing it to re-attach. This procedure is called scleral buckling.

Sometimes, the eye may have to be entered to pump in air or gas to force the retina outward against the sclera. This is called pneumatic retinopexy, can generally be done under local anaesthesia and causes minimum discomfort. Sixty to 90% patients with retinal detachment can be treated by this method. If these methods are unsuccessful, or if there is disease in the vitreous, the vitreous may have to be removed and replaced with saline through a procedure called vitrectomy.

What is the outcome of retinal detachment?

The outcome depends upon the location and extent of the detachment and its early treatment. If the macula (the central, most sensitive part of the retina) has not detached, the results of treatment can be excellent. 5 to 10% of people will not get back their vision.

How can retinal detachment be prevented?

Regular eye examinations are important for patients with high myopia who are more prone to detachment. In diseases with a high incidence of retinal problem, such as diabetes, routine eye examinations can detect early changes in the eye that a patient himself may not sense.

Diabetes trivia

2008-05-09T03:29:00.000-07:00

Some interesting, but lesser known facts about Diabetes.

Did you know that…
Insulin, was discovered by Dr. Frederick Banting and Dr. Charles Best in 1921 at the University of Toronto.
In 1924, a 14 year old boy Leonard Thompson was the first human with diabetes to receive insulin.
Eli Lilly was the first company to make insulin available commercially.
Almost 1 in 17 people worldwide are diabetic. More than 1800 cases of diabetes are diagnosed everyday.
India has the largest number of diabetics in the world; a total of 10 million.
Vitamin D reduces the risk of diabetes.
Research on insulin inhalers is going on which will make treatment of diabetes simple and pain-free.

Some famous personalities (both past and present) with diabetes:

Sportsmen

Wasim Akram; Craig McMillan – Cricket
Arthur Ashe; Billy Jean King – Tennis

Actors

Elizabeth Taylor; Vanessa Williams

Musicians

Syd Barrett; Nusrat Fateh Ali Khan; Tommy Lee (Motley Crew); Elvis Presley; Neil Young; B.B. King; Meatloaf

Leaders

Mikhail Gorbachev; Winnie Mandela

Authors

Ernest Hemingway; Linda Goodman; Mario Puzo; H.G. Wells

Scientist

Thomas Alva Edison

Travel tips for diabetics

2008-05-09T03:26:00.000-07:00

Diabetes is a chronic illness and needs to be continuously managed. However, it does not mean that diabetics cannot travel or will have any problems while on a trip. There are only some tips that the patient needs to keep in mind to have a tension-free and safe holiday.
Get the location and duration of the trip approved by the treating physician.
If possible, get the doctor to prescribe medication that may be required during the travel period. The medications may include not only those used to treat diabetes, but also ones for preventing nausea, vomiting, diarrhoea etc.
Make preparations for getting your blood sugar checked at the destination. You should also try to identify medical services in the vicinity of your area for any emergency.

Travel tips:
Apart from the medical services available at the place of your stay, it is also necessary to be alert and make preparations thereof, during the duration of your journey. Some tips for the journey are:

Keep the insulin or the oral anti-diabetic drugs handy; carry it in hand baggage in the plane or train.
Protect the insulin from extreme heat or cold.
Maintain your food habits even when your routine is different. Eat at regular intervals and do not overeat.
Keep candies or toffees handy in case of a sudden drop in blood sugar.

How to take an insulin shot

2008-05-09T03:19:00.000-07:00

Diabetes is of two types. Type I is also known as insulin dependent diabetes mellitus, IDDM, or juvenile-onset diabetes mellitus. People with this type of diabetes mellitus make little or no insulin in their body, and need regular insulin injections to manage the problem. Patients with IDDM have to take insulin shots or injections whenever their blood glucose level increases. Most such patients have to learn to inject themselves with insulin, which is a simple procedure. Following are the steps involved in preparing and giving an insulin shot:

Wash your hands thoroughly with soap and water.
Mix the insulin in the ampoule gently by rotating the bottle between your palms or by inverting it slowly from end to end.
Take off the cap and clean the top with sterilised cotton/gauze swab soaked in spirit.
Remove the cover from the needle and pull the plunger back till the marking corresponding to your insulin dose. The syringe should be filled with air and NOT the insulin at this time.
Push the needle into the insulin bottle and release the air inside without taking in any of the insulin.
Invert the insulin ampoule and insert the tip of the needle into the insulin. Now pull the plunger back till the marking of your dose to suck in the required amount of insulin. Take care to avoid sucking in any air bubbles. If you can see air bubbles inside the syringe, discard the dose and repeat the procedure.
If any extra amount of insulin is sucked in, carefully discard the extra amount outside the bottle. Do NOT inject the insulin back into the bottle.
Choose the site for the shot carefully. The sites can be discussed with the doctor beforehand.
Clean the skin at the site of injection with an alcohol swab.
Pinch up an area of the skin and insert the needle at a right angle fully into the skin.
Release the plunger and push it all the way down to inject the insulin into your body. Release the pinched skin.
Pull the needle out and pat the area with the swab. Do not rub the site of injection.
Dispose off the needle after use.

Though the procedure seems fairly easy and becomes a routine after some practice, it should always be practised first in front of the doctor.

Diabetes mellitus

2008-05-09T03:14:00.000-07:00

Diabetes mellitus (DM) is a condition in which he the most widely recognized problem is the body's inability to regulate the level of glucose in the blood. Glucose is the main form of sugar in the body. The body breaks down food into glucose and uses it as a source of energy. In healthy people insulin helps to regulate the glucose (sugar) levels. Insulin is a hormone produced by the pancreas (a long, thin organ located behind the stomach against the back).

In diabetics, the body does not produce enough insulin or does not use the produced insulin effectively. This results in a high level of glucose in the blood ("hyperglycemia").

There are four main types of diabetes mellitus:

a) Type 1, earlier known as insulin dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus. People with this type of diabetes make little or no insulin in their body, and need regular insulin injections for survival and management of diabetes. It usually starts in childhood, but can occur at any age.

b) Type 2 (DM2), earlier known as non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. This is the most common form of diabetes, and is strongly associated with genetic tendency and obesity. The body produces normal or even high levels of insulin, but certain factors make its utilization ineffective ("insulin resistance"). Sedentary lifestyle, unhealthy dietary patterns, and the consequent obesity are common causes. It usually starts in adulthood, but is beginning to be seen in obese adolescents also.

c) Gestational diabetes mellitus, or pregnancy-induced diabetes.

d) Secondary diabetes mellitus, caused by genetic conditions, pancreatic diseases (e.g. inflammation, surgery or malignancy of the pancreas, etc.), drugs (e.g. steroids like prednisolone, pentamidine, excess thyroid hormone, etc.) or other medical conditions (acromegaly, Cushing syndrome, pheochromocytoma, hyperthyroidism, congenital rubella, etc). Medications such as thiazide diuretics or oral contraceptives can precipitate diabetes in a person predisposed to get it later.

Symptoms depend on the type and duration of diabetes. Some of the signs and symptoms are related to the high blood sugar levels. These include:
Increased urination,
Increased thirst and
Hunger.
Other common symptoms:
Fatigue,
Blurred vision,
Urinary and vaginal infections
Skin infections, especially fungal or more serious bacterial infections.
Frequently upset stomach, stomach pains, nausea and vomiting

There may be weight loss, especially if the amount of insulin made by the body is decreasing. If insulin deficiency is marked, the person can become drowsy and then go into coma. This is called Ketoacidosis, and usually occurs in DM1. Rarely, if the diabetes is completely out of control, it can also occur in DM2. Other symptoms of ketoacidosis include:
Deep rapid breathing, sometimes with a fruity odour to the breath
Pain in the stomach, with nausea and vomiting.
Diabetes affects all organs of the body. The long-term effects include:

Retinopathy: damage to the retina of the eye that can cause blindness.
Nephropathy: damage to the kidneys that can lead to kidney failure.
Peripheral neuropathy: damage to the nerves in the limbs, which causes numbness, tingling (eg feeling like crawling of ants over the skin) and pain in the feet, legs and hands.
Autonomic neuropathy: damage to the nerves of the internal organs, resulting in problems with digestion, diarrhoea, impotence, fast heartbeat ("tachycardia") and altered blood pressure.
Atherosclerosis: hardening or blockage of arteries, that can lead to heart attack and stroke ("Brain attack").
Peripheral vascular disease: damage to the arteries causes poor
circulation in the legs and feet. This poor circulation, along with nerve damage, can result in serious foot and leg infections that may require amputation.
Skin infections, especially fungal infections such as ringworm, jock itch, and athlete's foot. Other bacterial infections are also common and can occasionally be life threatening.
Vaginal infections, as high levels of sugar encourage the growth of yeast
Urinary tract infections.
Diabetes mellitus is diagnosed based on a high level of glucose or sugar in the blood. The doctor may suspect diabetes mellitus after taking the medical history and doing a physical examination. There are several blood sugar tests used for diagnosis:

Fasting plasma glucose test: In this test, a person is asked to fast overnight, at least 8 hours, and the level of glucose in the blood is then checked. Normal fasting plasma glucose levels are less than 110 mg/dl. A fasting plasma glucose level of more than 126 mg/dl usually indicates diabetes mellitus. A level of 110-125 mg/dl is called "impaired fasting glucose".

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

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

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

Oral glucose tolerance test: is the preferred way to diagnose pregnancy-induced diabetes. Ideally all pregnant women in India should have a blood glucose test done 30 minutes after taking 50 gm gluocse (screening test). If this is abnormal, the lady should undergo an oGTT: with 100 gm glucose (not the conventional 75 gm). Blood samples are then drawn at intervals of one hour upto 3 hours (ie at 1, 2 and 3 hours post-glucose).

The treatment of diabetes depends on the type of diabetes. It is aimed to decrease symptoms and prevent complications such as low blood sugar levels (hypoglycemia), eye problems, kidney disease, and nerve damage.

DM1 needs treatment with insulin injections to replace the insulin that is not produced in the body. There are several types of insulin available. The most commonly used are the genetically engineered that are similar to human insulin. The difference in the various types of insulin is the times at which they "peak" or are most effective. Insulin schedule depends upon the meal pattern of the individual. This is required to avoid low blood glucose levels, causing hypoglycaemia. Insulin is administered with a syringe, and newer devices such as insulin pens and insulin pumps. The latter devices control diabetes more efficiently.

DM2 (earlier called NIDDM) is initially treated with weight reduction, diet control and regular exercises. When these measures fail to control the blood sugar levels, oral medicines are used. Sulphonylureas are a group of drugs that stimulate the release of insulin from the pancreas. Metformin reduces insulin resistance, and the production of glucose by the liver. Thiazolidenediones also increase insulin efficiency and sensitivity. Acarbose delays the absorption of glucose by the intestines. When the action of oral drugs is insufficient, insulin injections are added.

Exercise: It is an important component of diabetes therapy. Exercise utilizes blood sugar and makes the body more sensitive to insulin. It also reduces high blood pressure and high lipid levels, which are often associated with diabetes.

Diet: There is no such thing as a "diabetic diet". Persons with diabetes should eat a normal, balanced diet, which is designed to meet their nutritional requirements, maintain normal blood sugar levels and at the same time to help in achieving appropriate weight (i.e. reduction in case of obese persons, regain in case of very lean persons). It is also important to eat meals at regular time intervals, especially if insulin is used.

Blood glucose test

2008-05-09T03:01:00.000-07:00

Why is a blood sugar test done?

Diabetes mellitus is diagnosed based on a high level of glucose (sugar) in the blood. Blood sugar test, done fasting and 2 hours after breakfast, is used for the diagnosis of diabetes.

How is the test done?

Fasting blood glucose: In this test, a person is asked to fast overnight, at least 8 hours, and the level of glucose in the blood is then checked.
Post prandial (PP) blood glucose: This is tested two hours after having a
meal. It serves as a challenge for the body to regulate the blood sugar
after a meal. Random blood sugar or glucose test is that which is done at any other time. The blood glucose can also be tested after giving 75 gm glucose by mouth (glucose challenge test). This is useful for detecting borderline diabetes and a condition called "impaired glucose tolerance".

Blood glucose tests are also needed for checking the control in diabetes.

What are the normal values?

Normal fasting plasma glucose levels are less than 110 mg/dl.
Normal PP plasma glucose levels are less than 140 mg/dl.

What are the abnormal values?

A fasting plasma glucose level of more than 126 mg/dl indicates diabetes mellitus. A level between 110-125 mg/ dl is called "impaired fasting glucose". A PP or random plasma glucose level of more than 200 mg/dl indicates diabetes mellitus.A level between 140-199 mg/ dl is called "impaired glucose tolerance". A blood sugar exceeding the level of 200 mg/dl or higher generally indicates the presence of diabetes.

What is the role of insulin?

The body breaks down food into glucose (sugar) and uses it as a source of energy. Insulin helps the cells of the body to utilize this glucose for
energy, and to store the excess in the liver for later use. Thus insulin
regulates the blood glucose (sugar) levels.
In diabetics, the body does not produce enough insulin or does not use the produced insulin effectively. This results in a high level of glucose in the blood ("hyperglycemia").

Lung cancer

2008-05-08T01:49:00.000-07:00

What is lung cancer?

Primary lung cancer is the uncontrolled proliferation of malignant cells in the airways and air sacs of the lungs. Lung cancer is an aggressive cancer that can spread to other parts of the body.

Lung cancer is of two basic types – non-small cell (NSCLC) and small cell lung cancer (SCLC). Of these the non small cell lung cancer accounts for a majority of cases of lung cancer. it grows and spreads more slowly than small cell cancer. The small cell lung cancer grows and spreads very rapidly to other parts of the body.

How is it caused?

The exact cause of lung cancer is not determined. But there are certain risk factors that predispose an individual to lung cancer. Some of them are:

The majority of lung cancers are caused due to excessive cigarette smoking. Research shows that in some cases, passive smoking is also harmful than.
In India, excessive exposure to pollution which may contain poisonous chemicals is the next most common risk factor.
Exposure to harmful radiation over a long period of time alters the natural make-up of cells causing cancer.
People working in areas related to asbestos manufacture are more at risk. Increased risk of lung cancer is an occupational hazard for people working in asbestos factories.

What are the symptoms?

Some symptoms of lung cancer are general and might not come to a person’s notice immediately. It is only when the symptoms either worsen, or occur simultaneously that they are noticed. Some common symptoms are:

Persistent cough
Spit or phlegm stained with blood
Chest pain sometimes associated with difficulty in breathing
Difficulty in swallowing
Persistent low grade fever with paleness of the skin. Sometimes the skin may become grey and dry.
Loss of weight
Loss of appetite

How is it diagnosed?

The doctor examines the chest area with a stethoscope in which a persistent wheezing sound acts as an alarm. Localized wheezing may be noticed, which is the low almost musical sound emitted when there is partial blockage in the air passages of the lungs. A chest X-ray is usually advised, which can show the cancerous lesions in the lungs. Sometimes, fluid may accumulated in the chest, and a sample of the fluid from the lungs may be taken for testing. A needle is inserted through the chest wall and some of the fluid is extracted. A sample of the sputum may also be taken to check for malignant cells.

Bronchoscopy is a procedure in which a thin lighted tube, called the bronchoscope, is passed through the mouth, via the wind pipe (trachea) into the lungs to examine the inside of the air passages. If a lesion is seen in chest X-ray or bronchoscopy, a small amount of the lung tissue is taken or biopsied for laboratory testing.

What is treatment?

Since lung cancer tends to spread throughout the body, chemotherapy is the most common form of treatment. Chemotherapy drugs include doxorubicin or adriamycin, vincristine,and etoposide. Radiation therapy may be used if the exact area of the origin of the tumour is located.

In some cases, surgery of the lungs may have to be carried out. The procedure involves the removal of only the tumour, a lobe of the lungs or the whole lung, depending on the location of the tumour and the extent of damage. Lung surgery is a major operation and the patient may need to be in hospital for several days following surgery. The patient must breathe deeply and frequently to expand the lung tissue which aids in recovery.

Are there any side effects?

Treatment for lung cancer may have side effects like:

Hair loss
Redness and swelling of the food pipe
Lowered blood counts and increased risk to infections
Injuries to the lungs
Nausea and vomiting.

Liver cancer

2008-05-08T01:48:00.002-07:00

What is liver cancer?

Liver cancer is an abnormal, uncontrolled growth of cells in the liver.
The liver is the largest internal organ of the body. It helps to regulate and store blood glucose (sugar). It helps get rid of drugs and toxins and produces important proteins. The liver also produces bile, which helps the body process fats and get rid of waste products.

There are two types of liver cancer: primary and secondary.

Primary liver cancer starts from the cells of the liver. The two most common forms of primary liver cancer are:

Hepatoma, which is often associated with cirrhosis and hepatitis B or C infections
Cholangiocarcinoma, a rare tumour developing in bile ducts cells.

Secondary liver cancer occurs when a cancer starts someplace else and spreads to the liver. A secondary liver tumour may not be found until it causes symptoms.

What is the cause?

Although the exact cause of liver cancer is not known, the contributing factors include:

Heavy alcohol drinking
Hepatitis B and C infections, cirrhosis, and other chronic liver ailments
Chronic liver disease
Haemochromatosis
What are the symptoms?

Symptoms of liver cancer are:

Pain, especially in the abdominal area or around the right shoulder blade
Loss of weight
Loss of appetite
Pain or swelling in the abdomen
Jaundice (yellowing of the skin and whites of eyes)
How is the diagnosis made?

To diagnose liver cancer, the physician notes the symptoms, checks for weight loss, malnutrition, weakness, examines for enlargement of the liver and other signs. Certain tests required include:

Blood tests for anaemia and liver functions
Alpha-fetoprotein level (a protein that sometimes occurs in the blood when liver cancer is present)
Ultrasound exam of the liver
CT scan
Hepatic artery angiogram (a process in which a local anaesthetic is given and the person is injected with a dye-like substance; a series of x-ray pictures are then taken and examined for signs of any abnormal growths in the liver)
Biopsy (a procedure in which a local anaesthetic is given and then a small sample of tissue from the liver is obtained through the skin with a hollow needle)
What is the treatment?

The treatment depends on the stage of the disease and whether it is primary or secondary liver cancer.

The following may be recommended:
Surgery to remove all the tumour along with a part of the liver
Anti-cancer drugs (chemotherapy).
If a liver tumour (hepatoma) is detected at an early stage, surgery may result in a cure if there is no cirrhosis. However, surgery may not be a good option if the tumour is large or if the liver is not working well or if there is cirrhosis. Chemotherapy does not cure the cancer, but it may shrink the tumour. This helps prevent some symptoms, including pain. Another possible treatment is hyperthermia therapy, which uses heat to kill cancer cells.

The effects of liver cancer vary depending on the stage at which the tumour is detected and when treatment begins. Age and physical condition of the patient are also important because some treatments are not recommended for the elderly. They may get infections more easily because chemotherapy can lower the body's resistance. The more the cancer has spread before diagnosis, the less are the chances for cure. Survival after diagnosis is often only several months but may be longer.

How can it be prevented from spreading or recurring?

This can be achieved by following these guidelines:

Consult the doctor if a return of any previous symptoms is noticed
Avoid alcoholic drinks
Eat small, frequent, well-balanced meals throughout the day. Take vitamin and mineral supplements with iron, folic acid, and thiamine, if recommended by the doctor
Make sure that restaurants and grocery stores where you buy food, and areas where you prepare food, are safe and clean
Exercise according to your doctor's recommendation and observe good health practices
Do not use illegal drugs
What are the complications?

Gastrointestinal bleeding
Liver failure
Spread (metastasis) of the carcinoma

Leukaemia

2008-05-08T01:48:00.001-07:00

What is leukaemia?

Leukaemia is a type of cancer that affects the white blood cells called leukocytes. Blood contains three types of cells – red blood cells or RBC’s that carry oxygen, leukocytes or white blood cells, WBC’s that help to protect the body against infections and platelets cells that help in blood clotting. These blood cells are produced in the bone marrow that is present in the cavities in bones. The leukocytes are of different kinds and various types of leukaemia are named after the kind of leukocyte affected.

What are the different types of leukaemia?

Leukaemia may be acute or chronic. The former develops suddenly and with rapidly worsening symptoms, and the latter spreads slowly over a period of time. Examples of acute leukaemia are:

Acute myelocytic leukaemia (AML) – it occurs in adults and in children less than a year old. Caused by a rapid increase in immature WBC’s, AML is characterised by bleeding from the gums and nose, proneness to fatigue and joint pain. Due to decrease in the production of RBC’s by the marrow, anaemia may occur. Patients often have enlarged lymph nodes.
Acute lymphocytic leukaemia (ALL) – this is the most common form of leukaemia in children aged 3 to 7 years. It is a progressively harmful disease where the WBC’s do not mature fully and thus are unable to carry out their functions properly. These cells multiply and replace the normal cells till finally bone marrow failure occurs. The child is prone to infections due to lowered immunity and bleeds easily if injured due to the blood’s decreased capacity to clot. He may also get tired very easily hampering his normal routine.

Examples of chronic leukaemia are:

Chronic lymphocytic leukaemia (CLL) – this is the commonest variety of leukaemia and occurs mostly in people over the age of 50. The symptoms are not very sudden and are usually vague, so the person may not seek treatment till very late. It is usually detected in a routine blood test since the person may not show any symptoms. It is caused due to a slow but steady increase in the number of WBC’s in the blood.
Chronic myelogenous leukaemia (CML) – associated with a chromosomal abnormality, CML commonly occurs in people between the ages of 35 and 60 years and is characterised by a chronic phase which can turn acute suddenly. There is no known prevention at this time but chemotherapy is started as soon as the disease is identified.

How is leukaemia caused?

The causes of most types of leukaemia are not clearly known. Some of the possible causes may be:

Exposure to harmful radiation in large doses
Exposure to certain chemicals like benzene over a long period of time
Certain genetic defects
Exposure to certain viruses (called retroviruses) that may cause leukaemia.

What are the symptoms?

The symptoms in chronic forms of leukaemia may not appear for a long time and the person may be able to lead a normal life. However, acute leukaemia presents with symptoms like:

Fatigue associated with anaemia due to the lowered number of cells which carry oxygen
Paleness of the face
Continuous low grade fever
Bleeding from gums or nose due to decrease in the number of platelets
Vulnerability to infection due to lowered immunity
Appearance of small red marks or petechiae (blood clots in the skin)
Abnormal menstruation in women
Unexpected loss of weight with loss of appetite.

How is it diagnosed?

Chronic leukaemias are diagnosed mostly when the patient goes in for a routine blood test and the sample shows an abnormal amount of WBC’s. Subsequently, specialised tests may be done to determine the exact type of leukaemia. A bone marrow biopsy in which the bone marrow is sampled using a needle, confirms the presence of leukaemia.

In acute forms, the patient may seek medical help when he feels excessively tired and loses appetite. The above tests confirm the diagnosis.

What is the treatment?

The treatment of leukaemia usually involves intensive chemotherapy using drugs that kill the cancerous cells. The drugs are given as injections into the veins or by mouth; they are given at regular intervals over a period of time. They are very powerful and result in loss of hair and symptoms like nausea and loss of appetite.

In some cases of leukaemia, especially in children, bone marrow transplant may be done. This is an expensive procedure where a person’s diseased marrow is replaced by a healthy marrow from a matching donor. This matching is very important since the body rejects foreign marrow very easily.

What are the side effects of treatment?

Chemotherapy is a very powerful form of therapy and results in loss of hair. It also damages normal cells in the bone marrow thus making it weak and highly prone to infections. Sometimes these infections can be life threatening. The person may also bleed very easily due to the destruction of platelets. Other associated symptoms like nausea, tiredness and anaemia are also common.

After treatment, the patient may recover normal functioning depending on the severity of the disease. 50% of the patients lead a normal and disease free life after a bone marrow transplant. However, the disease can recur any time and thus regular monitoring is required. This monitoring will reduce in frequency as time passes and the patient ceases to show any symptoms of recurrence of the condition.

Leishmaniasis

2008-05-08T01:46:00.001-07:00

What is it?

Leishmaniasis is a parasitic disease spread by a species of sandfly, the female phlebotomine sandfly. The disease has two main forms – the cutaneous form which affects the skin and the visceral form that affects the internal organs. Cutaneous leishmaniasis is seen when lesions form on the skin weeks to months after the possible insect bite. Visceral leishmaniasis causes swelling and enlargement of the spleen and liver in addition to anaemia.

Leishmaniasis is a disease that usually takes on epidemic proportions when it occurs. Kala-azar (visceral leishmaniasis) is the commonest form found in India and the last major epidemic occurred in 1977 when more than 100,000 cases were reported from Bihar. However, the states of both Bihar and West Bengal regularly report cases of Kala-azar.

What are the causes and risk conditions?

Leishmaniasis is a protozoal infection transmitted by the bite of the female phlebotomine sandfly. The sandfly needs the Leishmania parasites to obtain a protein necessary to develop her eggs. This parasite grows inside the fly and when it next bites a human being, the infection is transmitted. The incubation period i.e., the time lapse between the actual infection and the manifestation of symptoms, is usually 1-4 months but may range from 10 days to upto 2 years.

The disease occurs twice as many times in men as in women. It occurs most commonly among the lower socio-economic status and in migrant populations. People who work in open places in close proximity with animals are more prone to sandfly stings and thus the infection.

What are the symptoms?

Cutaneous leishmaniasis – this is the form of leishmaniasis that manifests itself in the form of lesions on the skin. These lesions may be open or closed and may sometimes be confused with leprotic lesions. The ulcers may be painful and may reduce an individual's ability to work. The main symptoms for this form are:
Painful ulceration of skin
The main ulcer surrounded by smaller lesions that may itch and pain
Discolouration of skin in some cases.

Visceral leishmaniasis (kala-azar) – this is the form that affects the internal organs like the liver and spleen causing a variety of symptoms like:
Swelling and enlargement of the spleen and liver
Persistent fever
Fatigue, weakness and loss of appetite
Persistent abdominal discomfort
Nausea and vomiting
Unexplained weight loss
Darkening of skin of face, hands, feet and abdomen (kala-azar = black illness).

How is it diagnosed?

The disease is diagnosed by a series of laboratory tests. Various skin tests may be done:
The Montenegro skin test – result based on skin reaction
Biopsy of the spleen
Lymph node biopsy
Bone marrow biopsy
Aldehyde test widely used in India for the diagnosis of Kala-azar
Serological tests – ELISA and IFAT (Indirect Fluorescent Antibody Test) are the commonly done diagnostic tests.
Other complementary tests are:
Complete blood count (CBC)
Haemoglobin check
Serum albumin
Serum protein

What is the treatment?

Once the disease is contracted, it can be treated with a tight vaccination schedule which involves a daily injection of sodium stibogluconate for 20 days for adults. To patients who do not respond to this form of therapy, a stronger and more toxic compound is administered under supervision. For cutaneous leishmaniasis, Amphotericin B, a potent antibiotic, is also used as a measure of treatment. However, since this drug is very toxic and has to be carefully administered, it is used only when the patient fails to respond to any other form of treatment.

However, the best method of treatment of the condition is prevention. Sandflies should be controlled with the help of insecticides, with DDT being sprayed at regular intervals. Insect repellents should be lit in the room at night. Popel who are more prone to insect stings can try rubbing insect repellant gels on the exposed parts of their body. Sanitation should be maintained in the neighbourhood with elimination of breeding places like garbage, rodent burrows, bricks or rubbish near houses and the like.

Animal reservoirs like dogs should be inoculated regularly. Health education becomes a necessary tool to be acquired to cope with the disease. Since once contracted, the disease has a high mortality rate, utmost care should be taken to avoid the breakout of Leishmaniasis.

Kidney failure

2008-05-08T01:46:00.000-07:00

Haemoptysis

2008-05-08T01:43:00.000-07:00

What is haemoptysis?

Haemoptysis is defined as coughing out of blood originating in the lower respiratory tracts that is trachea, bronchi and lungs. It includes coughing out of blood and blood streaked sputum. It is a symptom of a disease and not a disease. If the coughed up blood is more than 600-800 ml in 24 hours, urgent medical treatment may be needed.

What are the common causes?

The common causes for haemoptysis include infections of the lungs like tuberculosis, bronchitis, pneumonia, bronchiectasis or an abscess in the lungs. Cancer of the bronchi or lungs may also be present with haemoptysis. Other causes may be injury to the chest causing lung contusions. Irritation of the throat with violent coughing may also result in haemoptysis.

How is the condition diagnosed?

Detailed clinical history and physical examination of the chest and lungs is done to diagnose the underlying condition. The doctor may ask for diagnostic tests including X-ray of the chest, complete blood count, sputum culture, bronchoscopy, lung scan and lung biopsy. In bronchoscopy, a lighted tube is passed into the air passages that allows visualisation of the lining of the airways. Through this a biopsy of any suspicious area can also be taken.

What is the treatment?

Treatment may depend on the cause. Cough suppressants may be used in case of irritation of the throat from violent coughing but it is best to avoid them as they have the effect of allowing blood clot to accumulate in the bronchi. Haemoptysis usually stops spontaneously and nothing but reassurance is necessary. A sedative may be given to allay anxiety. If the underlying cause is infective, antibiotics may need to be given, sometimes even intravenously.

In case of severe blood loss, blood transfusion may be necessary. Control of bleeding by surgical measures is occasionally required. In this a portion of the lung or the whole diseased lung may have to be removed.

Gall bladder cancer

2008-05-08T01:42:00.000-07:00

What is gall bladder cancer?

Gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. Its main function is to store bile; a fluid that helps digest fats and carries cholesterol and toxins from the body. Cancers of the gallbladder and bile duct (the gallbladder and bile duct together are called the biliary tract) seldom produce symptoms in the early stages. In fact, early gallbladder cancer is often discovered only when the gallbladder is removed as a treatment for gallstones. Otherwise, biliary tract cancers are often quite advanced by the time they are diagnosed.

What are the symptoms?

Gallbladder cancer rarely produces signs and symptoms in the early stages. When symptoms do appear, they often resemble those of other, more common, gallbladder problems, such as gallstones or infection.

The signs and symptoms include:
Abdominal pain
Nausea and vomiting
Jaundice results from high blood levels of bilirubin. Normally, bilirubin is metabolised in the liver and eliminated through the bile ducts. But a blocked bile duct can cause bilirubin to accumulate in the blood.
Loss of appetite or weight
Jaundice is the most common initial sign of bile duct cancer (cholangiocarcinoma). Other signs and symptoms include:

Enlarged gallbladder
Intense itching (pruritus)
Brown coloured urine
Loss of appetite and weight
White or clay-coloured stools
Fever
How is the diagnosis made?

Many gallbladder cancers are discovered when a pathologist examines a gallbladder that has been removed for symptoms of gallstones. But many gallbladder and most bile duct cancers are found only after related signs and symptoms appear. The doctor conducts a physical exam and the following tests:

Blood tests: This is to check for elevated levels of bilirubin or the enzyme alkaline phosphatase.

Ultrasound: Ultrasound is usually one of the first tests done in the evaluation of patients with jaundice and is especially good at diagnosing the presence of gallstones and obstructed bile ducts. It can also show the presence and extent of tumours.

CT scan: This helps determine if cancerous cells have spread to the common bile duct, lymph nodes or the liver.

MRI: This test uses a powerful magnetic field and radio waves to create images and can help determine whether the flow of bile is blocked or a tumour has invaded the liver.

Endoscopic retrograde cholangiopancreatiography (ERCP): This test is most sensitive for detecting an obstruction of the bile ducts and its cause, and can also be used in preparation for surgery. ERCP can also allow a biopsy to be performed, confirming a diagnosis.

Laparoscopy: This is often used to confirm how far the cancer has spread.

Biopsy: In this procedure, a small sample of tissue is removed and examined for cancerous cells under a microscope. It is the only way to make a definitive diagnosis of cancer.
What is the treatment?

Treatment for biliary tract cancers depends on the type and stage of cancer as well as on the patient’s age and overall health. The goal of treatment is to completely eliminate the cancer. Unfortunately, this is often not possible and the focus may need to be changed to treating the signs and symptoms the cancer is causing or preventing the tumour from causing more harm.

For gallbladder cancer: Surgical removal of the gallbladder usually offers the best hope for people with gallbladder cancer. If the tumour is very small and has not spread to the deeper layers of the gallbladder tissue, the surgeon may perform a simple cholecystectomy, which removes only the gallbladder. If the cancer is more advanced, some liver tissue and nearby lymph nodes are removed along with the gallbladder.

For bile duct cancer: Surgery usually offers the best chance for people with bile duct cancer. But the type of surgery varies depending on the location of the cancer and how extensive it is. For example, removing the affected part of the liver treats tumours that are within the liver. Tumours that develop where the hepatic duct leaves the liver (perihilar tumours) are usually treated by surgically removing a portion of the bile duct, the gallbladder, and parts of the liver, pancreas and the small intestine.
What are the complications?

A tumour that blocks the bile duct can cause pain, jaundice, nausea and vomiting. Tumours located where the pancreatic duct enters the small intestine may block the small intestine, preventing normal passage of food. Tumours may make it difficult to digest and absorb nutrients from the food by blocking the flow of the pancreatic enzymes. The most serious complication of biliary tract cancer is metastasis. Since biliary tract cancers are rarely discovered in the early stages, they often tend to spread to the other organs around the gall bladder, including liver, stomach, pancreas and intestines or to the nearby lymph nodes.

Colorectal cancer

2008-05-08T01:41:00.001-07:00

What is it?

The colon and the rectum are parts of the large intestine. The intestine is an organ that helps in digestion and excretion. Digestion is mainly carried out by the small intestine, while excretion is the major function of the large intestine. A malignant growth of cells in the large intestine is called colorectal cancer. Separately, the cancer may be of the colon (colon cancer) or the rectum (rectal cancer).

What are the causes?

Like most cancers, the exact cause of colorectal cancer is not known. However, there are certain risk factors that predispose an individual to it. These are:

Age – risk increases with age.
A diet high in fat but low in fibre.
The presence of some kinds of polyps, which are benign growths in the intestine. These growths present on the wall of the intestine are not harmful by themselves, but if present in large numbers may be a leading cause of colorectal cancer.
As with all cancers, a family history of colorectal cancer.
A condition affecting the colon called ulcerative colitis, in which the colon becomes red and inflamed.

What are the symptoms?

Colorectal cancers may produce no symptoms till the disease is advanced. However, the most frequently noted symptoms that may be indicative of the disease are:

Passage of bright red or dark coloured blood in the stools
Change in bowel habits with frequent diarrhoea or constipation
Change in the appearance of stools
Constant feeling of fullness or gas in the stomach
Persistent feeling that the bowel is not being cleared fully
Unexplained loss of weight sometimes accompanied by anaemia
Fatigue and tiredness.

How is it diagnosed?

A thorough examination of the patient’s medical history is done in addition to a physical check-up. The doctor may also prescribe certain tests for confirmation. An X-ray of the intestine, called a barium enema, helps the doctor to detect the presence of any abnormal growths or cysts.

Colonoscopy or sigmoidoscopy may be done which allow the doctor to see inside the colon and the rectum for detection of polyps or cysts. A thin, flexible tube-like telescope is inserted through the rectum into the intestine. A small sample of the area may be taken for biopsy with the helps of forceps attached to the instrument. In some cases, any polyps that are detected may also be removed simultaneously by burning them.

What is the treatment?

Surgery to remove the tumour is the most common form of treatment. If the tumour has not spread to other parts of the organ, it can be easily removed. Mostly some healthy parts of the intestine are also removed to reduce the risk of recurrence. Sometimes, a surgical procedure called colostomy is performed. This is done if the surgeon, after removing parts of the colon is unable to join it back with the rectum. In this, the colon opens in the skin of the abdomen, to allow faecal matter to drain and be collected in a bag. This procedure may be temporary or permanent.

In some cases with wide-spread disease, chemotherapy is given to destroy the cancer cells. Radiation therapy may also be done in some cases if the tumour is localized.

Treatment may have side effects like pain in the area after partial removal of the colon. The usual side effects of chemotherapy like hair loss, nausea and vomiting may also be present. There may also be loss of appetite and loss of weight after the treatment procedures.

Cervical cancer

2008-05-08T01:41:00.000-07:00

What is cervical cancer?

Cervical cancer is a disease caused by the abnormal growth and division of cells that make up the cervix (the portion of the uterus attached to the top of the vagina). Ninety percent of the cervical cancers arise from the flattened or squamous cells covering the cervix. Most of the remaining 10% arise from the glandular, mucous-secreting cells of the cervical canal leading into the uterus.

What are the causes?

The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form it is 100% treatable, usually without the need for a hysterectomy (surgical removal of the uterus). Dysplasia, depending on its severity, can resolve without treatment, particularly in young women. However, it often progresses to actual cancer called ‘carcinoma in situ’ (CIS) if it has not spread, or ‘microinvasive’ if it has spread only a few millimeters into the surrounding tissue but not into the lymph channels or blood vessels.

The risk factors for cervical cancer are:
Infection with the virus that causes genital warts (human papilloma virus or HPV) may increase the risk of developing dysplasia and subsequent cancer. Fortunately, not all women who have had HPV infection or genital warts develop cervical cancer. Other factors, such as smoking, may increase the risk of developing cervical cancer in those who have had HPV
Early age at first sexual intercourse
Multiple sexual partners or partners who have multiple partners
There is a small increased risk of abnormal Pap smears among women who take birth control pills. It is because such women are more sexually active, are less likely to use condoms, and have more frequent Pap smears in order to be prescribed the birth control pill
Women whose immune systems are weakened - such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system - may be at a higher risk
Infections with genital herpes or chronic chlamydia infections, both sexually transmitted diseases, may increase risk

What are the symptoms?

Most often, cervical cancer in its earliest and most treatable stages does not cause any symptoms. When there are symptoms, the most common are:
Persistent vaginal discharge, which may be pale, watery, pink, brown, blood streaked, or dark and foul-smelling
Abnormal vaginal bleeding, especially between menstrual periods, after intercourse or douching, and after menopause, which gradually becomes heavier and longer
Symptoms of advanced cervical cancer may include:
Loss of appetite, weight loss, fatigue
Pelvic, back, or leg pain
Leaking of urine or faeces from the vagina
Bone fracture

How is the diagnosis made?

Invasive cervical cancer often appears as an irregular fleshy growth, often firm or hard, that tends to bleed easily. But even on pelvic examination by a doctor, pre-cancers and even early cancers of the cervix are often not visible to the naked eye. Special tests are necessary to diagnose cervical pre-cancers and cancers:
Pap smears screen for cervical pre-cancers and cancers. The Pap smear test consists of cells wiped or brushed off the cervix and placed on a microscope slide. This is usually done at the time of a pelvic examination, though not every pelvic exam includes a Pap smear.
Colposcopy is an examination of the cervix under magnification in order to locate an abnormality of the cervix
Biopsy, colposcopy, or sometimes the use of LASER (a loop electrode) or other instrument allows a diagnosis to be made
When cervical cancer is found, additional tests - such as X-rays, using an instrument to look into the bladder (cystoscopy), and rectum and colon (colonoscopy) - are used to determine how far the cancer has spread and what stage the disease is in
What is the treatment?

Treatment of cervical cancer depends on the type of cancer, the stage, the size and shape of the tumour, the age and general health of the woman, and her desire for future childbearing.

In its earliest stages, the disease is curable by removing or destroying the pre-cancerous or cancerous tissue. This can often be done in various ways without removing the uterus or damaging the cervix so that a woman is still capable of having children.

In other cases, a removal of the uterus (hysterectomy) is performed, with or without removal of the ovaries. In more advanced disease, a radical hysterectomy may be performed which removes the uterus and much of the surrounding tissues, including internal lymph nodes. In the most extreme surgery, called a pelvic exenteration, all of the organs of the pelvis, including the urinary bladder and rectum, are removed.

Radiation or chemotherapy may be used to treat cancer that has spread beyond the pelvis, or has recurred. A variety of chemotherapeutic drugs, or combinations of them, are used. Sometimes radiation and chemotherapy are used before or after surgery.

What is the prevention?

There are two ways to prevent cervical cancer - the first is to prevent infections with HPV, the second is to get regular Pap smears that will detect pre-cancerous conditions and HPV. Both of these can be treated and the progression to cervical cancer be arrested.

Precancers are completely curable when followed up properly. To reduce the chances of cervical cancer, girls less than 18 years of age should avoid sexual activity or always use condoms. HPV infection causes genital warts. These may be barely visible or several inches across. If a woman sees warts on her partner's genitals, she should avoid intercourse. To further reduce the risk of cervical cancer, women should limit the number of their sexual partners, avoid sexually promiscuous partners, and discontinue any tobacco use. Condoms may help prevent the transmission of HPV.

Annual pelvic examinations, including a pap smear, should begin when a woman becomes sexually active, or by the age of 20 in a non-sexually active woman. All abnormal findings should be followed up with colposcopy and biopsy.

Cancer pain

2008-05-08T01:39:00.000-07:00

Two thirds of patients with cancer have pain that is severe enough to prevent them from doing their activities of daily living. Poor appreciation of this problem and the inability to assess pain was the reason why pain was poorly relieved in these patients.

The aim of cancer pain management are to:
Minimize pain and suffering
Improve quality of life
Provide psychological support for patients and their families

What are the common misconceptions about cancer pain?

Cancer causes intolerable pain that cannot be relieved - in fact some patients with cancer pain never have pain. For those who do, cancer pain can be relieved.
Pain means that cancer is getting worse - Pain can be due to cancer or the effects of cancer treatment, Sometimes the pain is unrelated to cancer.
“Shots” or injections will be needed to control cancer pain - at least 90% of cancer pain can be effectively relieved by simple medications that are taken by mouth. “Shots” are almost never necessary.
Patients who use narcotics will become addicted - patients who take narcotics for pain rarely, if ever, become addicted.
If strong narcotics like morphine are used too early in the treatment, they will not work later if the pain gets worse - strong medications like morphine stay effective as long as they are needed. If pain increases, the medication dose can be increased.

What causes cancer pain?

Not all people with cancer have pain, and those who do, do not necessarily have it all the time, nor is it always severe. Pain associated with cancer usually comes from one of three sources. The cancer itself may be the cause of the pain if it pushes against bones, nerves, or organs in the body. Sometimes, pain can be caused by cancer therapy. In addition, pain may be unrelated to the cancer but is aggravated by it.

How is cancer pain relieved?

Although the doctor will help ease the pain, there are some things the patients can do to make things a little better. Changing some habits in the lifestyle may help.

Coffee intake must be reduced. Caffeine in coffee increases adrenaline levels that increase the sensitivity to pain. Similarly, cigarettes also stimulate adrenalin. Toning the body by regular exercises strengthen the muscles so that the bouts of pain can be better handled. While the exercise may not feel good at first, in the long run, it helps. A healthy diet, avoiding unhealthy junk foods keeps the body supplied with essential nutrients. Laughing is good physically; and it helps to increases the amount of oxygen in the blood. It also helps to relax the muscles. It provides some relief from the stress and anxiety that often accompany illness.

One of the most important ways doctors work to control pain is to raise the threshold of an individual to pain. This is the level at which pain is felt. The idea is to build up a resistance to pain so that one doesn't feel it so much when it occurs. Patients may learn methods of resisting pain such as by hypnosis. Hypnosis is effective because it trains the mind to attack pain stimuli automatically without having to think about it. Hypnosis can be made convenient for most patients under the supervision of a professional and by using hypnotic tapes that can be played at home. Although not everyone will respond to hypnosis, anyone who has pain can help to control it by reducing stress in his or her life. Stress makes pain hurt more, and reducing stress automatically raises the pain threshold. The family can be a strong source of support if the patient is experiencing the discomfort associated with cancer.

The use of analgesics or pain relieving medicines and pain management is not synonymous. Not only is pain a complex experience, but also all pain does not respond equally to narcotic analgesic. Use of analgesics is regarded as a part of multimodal approach to treatment. They should not be reserved for terminal care as they are safe, well tolerated and effective at all stages of the disease.

In some cases helper drugs may be required. These may include:

Anti-depressants for neuropathic pain, concurrent depression, and pain related sleep disturbances
Anti-convulsants for neuropathic pain
Anti-emetics to control morphine related nausea and vomiting
Anti-anxiety drugs for sleep deprivation
Local anaesthetic to block the nerves

Cancer Chemotherapy

2008-05-08T01:37:00.000-07:00

What is chemotherapy?

Chemotherapy is the use of medications to treat cancer. It has played a major role in cancer treatment for half a century. Years of testing and research have proved chemotherapy to be an effective cancer treatment. It may be the only treatment, or it may be used in combination with other treatments, such as surgery and radiation therapy.

Chemotherapy works by killing rapidly dividing cells. These cells include cancer cells, which continuously divide to form more cells, and healthy cells that divide quickly, such as those in the bone marrow, gastrointestinal tract, reproductive system and hair follicles. Healthy cells usually recover shortly after chemotherapy is complete.

What is chemotherapy used for?

The main advantages of chemotherapy are that unlike radiation, which treats only the area of the body exposed to the radiation, chemotherapy treats the entire body. As a result, any cells that may have escaped from the original cancer are treated.
Depending on what type of cancer a person has, the doctor may use chemotherapy to:
Eliminate all cancer cells in the body, even when cancer is widespread
Prolong the life by controlling cancer growth and spread
Relieve symptoms and enhance the quality of life
In some cases, chemotherapy may be the only treatment. But more often, it is used in conjunction with other treatments, such as surgery, radiation or a bone marrow transplant, to improve results. For example:

Neoadjuvant therapy: The goal of neoadjuvant therapy is to reduce the size of a tumour before surgery or radiation therapy.
Adjuvant therapy: This is given after surgery or radiation. The goal of adjuvant therapy is to eliminate any cancer cells that might linger in the body after earlier treatments.

What are the types of chemotherapy?

Chemotherapy may not be limited to a single drug. Most chemotherapy is given as a combination of drugs that work together to kill cancer cells. Combining drugs that have different actions at the cellular level may help destroy a greater number of cancer cells and might reduce the risk of cancer developing resistance to one particular drug. The doctor will recommend drug combinations that have been tested in people with similar conditions and have been shown to have some effect against the particular type of cancer.

What chemical the doctor recommends is generally based on the type, stage and grade of the cancer, as well as the person's age, general health and willingness to tolerate certain temporary side effects.

Some types of chemotherapy medications commonly used to treat cancer include:

Alkylating agents: These medications interfere with the growth of cancer cells by blocking the replication of DNA. Example: Mechlorethamine
Antimetabolites: These drugs block the enzymes needed by cancer cells to live and grow. Example: Methotrexate.
Anti-tumour antibiotics: These antibiotics are different from those used to treat bacterial infections and interfere with DNA, blocking certain enzymes and cell division and changing cell membranes. Example: Doxorubicin
Mitotic inhibitors: These drugs inhibit cell division or hinder certain enzymes necessary in the cell reproduction process. Example: Etoposide and Vinorelbine
Nitrosoureas: These medications impede enzymes that repair DNA. Example: Cisplatin and Cisplatinum.
How is chemotherapy given?

One usually receives chemotherapy in cycles, depending on the condition and the type of drugs used. Cycles may include taking the drugs daily, weekly or monthly for a few months or several months, with a recovery period after each treatment. Recovery period allows the body to rest and produce new, healthy cells.

Chemotherapy drugs can be taken in a number of forms. The treating doctor determines what form(s) to use primarily based on what type of cancer a person has and what drug(s) will best treat the cancer. Chemotherapy is given through the following methods:
Intravenous (IV): Chemotherapy is injected into a vein, using a needle inserted through the skin. This allows rapid distribution of the chemotherapy throughout the body.
Oral: The patient swallows this kind of chemotherapy as a pill.
Topical: This type of drug is applied to the skin to treat localised skin cancers.
Injection: The doctor injects the drug directly into the muscle using a needle on the skin or into a cancerous area on the skin.
Chemotherapy medications, regardless of how they're given, generally travel in the bloodstream and throughout the body. The intravenous route is the most common, allowing chemotherapy drugs to spread quickly through the system. In cases where the doctor wants to direct chemotherapy to a more confined area, for example, to ensure a tumour is exposed to more of the drug, he may insert a catheter directly into that area or into a blood vessel supplying the tumour.

What are the various side effects of chemotherapy?

Since chemotherapy drugs can affect healthy cells, one of their disadvantages is that the person may experience side effects, some temporary and some long term. Not every drug will cause every side effect. The treating doctor can tell what to expect from the drugs.

Temporary side effects might include:
Hair loss
Dry mouth
Mouth sores (stomatitis)
Difficult or painful swallowing (oesophagitis)
Nausea
Vomiting
Diarrhoea
Constipation
Fatigue
Bleeding
Susceptibility to infection
Infertility
Loss of appetite
Changes in the way food tastes
Cognitive impairment, sometimes referred to as chemo brain
Liver damage
How long these temporary side effects last, depends on what drug(s) are being taken and for how long. Most side effects subside shortly after the chemotherapy treatment is stopped. Most short-term side effects can be minimised with medication. For example, the doctor can give medications to help relieve nausea or build up the blood counts. One must always tell the doctor if one is uncomfortable with a side effect. If the side effects are more than one is willing to endure, one can change treatments.

As people with cancer are living longer after treatment, doctors have discovered that some treatments cause long-lasting side effects or side effects that become apparent long after treatment ends. These long-term side effects are rare. Before one begins treatment, one must discuss with the doctor about the long-term effects. Some chemotherapy drugs can cause:
Organ damage, including problems with heart, lungs and kidneys
Nerve damage
Blood in urine (haemorrhagic cystitis)
Another cancer, including Hodgkin's disease and non-Hodgkin's lymphoma, leukaemia and some tumours
Infertility
The doctor can explain about the signs and symptoms to watch for after the treatment. Knowing what long-term side effects to watch for can help one stay healthy after treatment.

While beginning chemotherapy can be frightening, one must know that new medications are helping reduce unpleasant side effects. But chemotherapy will always cause some significant side effects. One must keep in mind that many people with cancer are living longer than ever — thanks partly to chemotherapy.

Cancer

2008-05-08T01:35:00.001-07:00

What is cancer?

Cancer is the generic term used to describe a group of disorders caused by an uncontrolled multiplication of cells, which usually resulting in the destruction of neighbouring tissues. Gradually, these tissues and organs stop functioning and death may occur.

The reasons for cells to start multiplying is unknown in most cases. They may have some inbuilt abnormality or may be affected by external influences.

What are the common terms associated with cancer?

Since cancer is a group of disorders, there are some terms commonly used in the description of the disease.

Oncology – ‘onco’ meaning ‘cancer’, oncology is the study of various types of cancers.
Tumour – a lump resulting from an uncontrolled growth of cells which may be malignant or benign.
Malignant – a growth of cells that destroys the surrounding tissue and spreads to other parts of the body.
Benign – a growth of cells that is not cancerous.
Both benign and malignant growths are unwanted multiplications of cells, but whereas a benign growth does not generally leave the place of its origin, a malignant growth usually destroys not only the tissue of its origin but also the surrounding ones. This is why cancers are caused due to malignant growths which spread to all areas of the body.
Carcinoma – a term synonymously used with cancer. But carcinomas are specifically malignant tumours mostly forming on the outlines (epithelium) of the affected organ. It is the most frequently occurring form of cancer.
Sarcoma – another form of cancer where specifically the connective tissue (that which supports the various parts of the body), is affected. It is a malignant form and cancers of the blood, lymphatic system, bone and the like, fall under this category.

What are the symptoms?

Cancers appear in many different ways. Most often they are noticed as a lump or growth in some part of the body. This is the case with tumours that form on the outlines of organs. When the cancerous growth is not physically identifiable, there may be other revealing symptoms depending on the form of cancer and the affected organ.

Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and memory problems. Tumours of the intestine can present problems in bowel movements and pain in the stomach. Lung cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are detected as a painless lump. There may also be some deformity of one or both breasts in some cases.

Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example, cancer of the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when the patient passes blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer. It only occurs in some cases where a nerve is pressed due to rapid enlargement of a tumour.

Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of weight, general feeling of weakness and fatigue and increased proneness to infections.

How is it diagnosed?

In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a biopsy of the affected organ is done. In this procedure, a small part of the tissue is taken for laboratory testing to detect the presence of cancerous cells.

In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken. CT scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind the patient’s previous medical history.

What is the treatment?

Treatment is most effective if the cancer is detected early. Chemotherapy is the most common method of treatment for cancer that has spread to other parts of the body. In this procedure, the malignant cells are destroyed with the help of powerful chemicals like methotrexate and vincristine which are given intra-venously i.e. directly injected into the veins. This procedure requires a hospital stay for the duration of therapy. It is also associated with various side effects like loss of hair, nausea, vomiting, loss of appetite and weakness for some days.

For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the cells are destroyed with the help of strong radio active waves. The exact position of the tumour is marked and the area is exposed to radiation under strictly controlled conditions. This treatment is given in breaks and in pre-determined doses.

Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be treated with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-hormone drugs are given. This treatment scores over chemotherapy because it usually has less severe side effects. But the doctor decides the best course of treatment depending on the diagnosis of the form of cancer.

Breast cancer

2008-05-08T01:35:00.000-07:00

What is breast cancer?

Breast cancer is the uncontrolled malignant growth of cells in the breast tissue. There are many types of breast cancers, those that form in the milk glands, in the ducts that carry milk, in the fatty area or in the connective tissue of the breast.

Cancer of the milk ducts is the most commonly occurring form of breast cancer. Usually only one breast is affected. There is a rare type of breast cancer in which the breast becomes red and swollen and resembles infection of the breast.

How is it caused?

The exact reason for the cancerous growth of cells is not known. There are certain factors that do not cause cancers by themselves, but make a person more at risk for the development of cancer. These risk factors may be genetic or environmental in nature:

Cancer tends to run in families. The risk for cancer increases for a person if one or more of his family members suffer from the disease.
Genetic predisposition that is, a person may carry genes that make certain normal cells cancerous.
Women who begin menstruating before the age of 12 years or stop after 55 years are more at risk for developing breast cancer.
Women who have not borne children or have had children late in their life (usually after the age of 30) are also more at risk.
Obesity or overweight is a condition that is associated with an increased risk of breast cancer.
Other factors like excessive drinking of alcohol and lack of exercise are also risk factors for breast cancer.
Environmental factors like exposure to harmful radiation, cigarette smoke over a long period of time and pesticides also increases the risk.
In some cases, women who undergo hormone replacement therapy have an increased risk of cancer of the breast.

What are the symptoms?

The most common symptom of cancer of the breast is the presence of a lump in the breast. The lump is often detected by the patient herself either accidentally or during a routine self examination. The lump is usually painless and hard. Sometimes, there may be changes in the shape and size of the breast and the nipple.

A dimple in the skin overlying the breast accompanied with dryness and scaling should be a cause for concern. There may be discharge of blood stained fluid from the nipple along with dryness and cracking of the skin of the nipple.

How is it diagnosed?

A breast lump is usually first detected by a woman on self examination. This procedure should be regularly done by all women over the age of 40 years. In this procedure, the woman lies down, raises the arm on the side of the breast and feels the breast with the other hand. Any difference from in the normal feel of the breast is noted. The woman may then look at herself in the mirror and note any changes in the shape and size of her breasts. Any change should be brought to the doctor’s notice.

The doctor may palpate or feel the breast for any unusual lumps or any other signs. In case a lump is detected by the doctor, mammography may be done. This is a special X-ray of the breast. It can detect early breast cancers and gives a fairly accurate picture of any changes in the breast. Any spots that show up in the mammogram are then further analysed by a biopsy. In this procedure, a small part of the lump tissue is taken for laboratory testing. The biopsy can also be done in many ways. In some cases, a small needle may be inserted into the lump and a small portion of the fluid may be taken.

In another form of biopsy, a small cut may be made on the breast to get to the lump, a piece of which is then taken for testing. In some cases, the entire lump may be removed. The procedure followed is decided by the doctor keeping in mind the patient’s history.

In case cancer of the breast is confirmed, other tests may be done to look for spread of the disease. These include blood tests, X-rays and ultrasound scan of the abdomen. In some cases a bone scan may be done.

What is the treatment?

Since the breast is not an organ that is necessary for survival, it is generally removed by a surgical procedure called mastectomy. In some cases only the lump is removed, in others the whole breast is removed.

Later, the patient may be given radiotherapy. This procedure helps to destroy the cancerous cells without harming the neighbouring tissue. If the cancer has spread to other parts of the body as well, chemotherapy using drugs like vincritine, adriamycin and cyclophosphamide is done. In some cases, hormonal treatment using tamoxifen is advised. Usually a combination of all of these procedures is followed for complete treatment. In most cases, if the cancer is detected early and treated appropriately, breast cancer patients can usually lead a cancer free life.

Brain tumour

2008-05-08T01:31:00.001-07:00

What is brain tumour?

A brain tumour, like a tumour anywhere else in the body, is a result of an abnormal proliferation of cells in the brain. A primary brain tumour is one where the tumour originates from the brain cells. Secondary brain tumours are cancers originating elsewhere in the body and spreading to the brain through the blood stream. It may be mentioned that some chronic infections like tuberculosis and fungal infections often produce a tumour like moss in the brain which may mimic a cancerous lesion. A brain tumour may directly destroy brain cells or it may cause brain dysfunction by various other means.

The skull is a hard bony structure and thus provides only limited space to the structures within. Since the brain does not have any space to expand, a space-occupying tumour may be especially dangerous. Brain tumours can cause indirect damage by compressing brain tissue, inflammation of the brain (cerebral oedema) and increasing the pressure within the brain (intracranial pressure) by interfering with the circulation of brain fluid (cerebrospinal fluid or CSF).

Though most tumours are classified as 'malignant' or 'benign', brain tumours are usually classified as "high grade" or rapidly growing and "low grade" or slow growing. This is because even non-cancerous brain tumours may be life threatening since they do not have space to grow and thus endanger other parts of the brain.

What are the various kinds of tumours?

Brain tumours are basically of two kinds – those that originate from the layers covering the brain (meninges) and those that originate from the brain cells. The former are called meningiomas. They are almost always non-cancerous and are easy to remove surgically. The tumours arising from the supportive tissues of the brain are called gliomas. They are more common in adults and are more dangerous, since they are usually malignant and can often not be completely removed.

The most commonly occurring tumours in adults are gliomas, while in children, tumours usually arise near the brain stem (medulloblastoma).

What are the causes?

The exact cause of tumours is not known. However, there is a higher risk of tumours in:
Children and elderly
People with certain rare congenital abnormalities like Li-Fraumeni syndrome, tuberous sclerosis etc.
People with disorders of the immune system or auto-immune disorders like AIDS
People who are exposed to X-rays of the head
People who work in certain industries like oil refining, drug and rubber manufacturing.

What are the symptoms of tumours?

Symptoms of brain tumours are usually non-specific in the beginning. They also depend on the size and location of the tumour in the brain. The symptoms of a brain tumour may be varied since they may affect different functioning capacities of the brain. For example, a tumour that causes swelling of the brain may exhibit different symptoms than that which compresses the tissues of the brain.

Some of the common symptoms indicating a tumour in the brain are:
Frequent headaches that vary in intensity and time of the day. These headaches are usually intense in the mornings and ease out during the day.
Nausea or vomiting
Epileptic seizures or convulsions
Visual disturbances due to compression of the optic nerve or oedema of the optic disc (papilloedema)
Changes in memory functions
Changes in speech
Drowsiness and bouts of incoherence
Partial or local paralysis. Neurological deficits like weakness or paralysis of some parts of the body, loss of sensation, unsteadiness of gait (ataxia), etc.

How is it diagnosed?

The doctor first conducts a thorough physical examination of the patient and takes his medical and family history. The physical examination includes a detailed neurological examination. The latter consists of examinations for alertness, muscle strength, coordination, reflexes and response to pain. Any swelling of the eyes and visual disturbances is also ascertained.

The doctor may ask for tests like CT or MRI scan to study the tissues of the brain. These procedures help to identify any changes in the brain tissues, and outline any abnormal growth. Other tests that may be requested by the doctor are EEG, angiogram and a skull X-ray.

When should the doctor be consulted urgently?

Persistent or increasing frequency of headache specially if it is associated with vomiting, blurring or double vision, weakness of any part of the body, epileptic fits, difficulty in speaking, instability of gait. Change of behaviour, memory impairment with or without the above symptoms should also prompt expert consultation.

What is the treatment?

Depending on the type of tumour, its location, and the extent of its spread, the treatment may be surgery, chemotherapy and/or radiation therapy. These procedures may be used exclusively or in combination. Before treatment begins, patients are usually given steroid treatment to reduce brain swelling. They may also be given medication to keep the seizures (epileptic fits) under control.
Surgery - The most common form of treatment of brain tumours is removal of the cancerous mass. The neurosurgeon makes a hole in the skull and reaches the site of the tumour through that. The procedure is called craniotomy. As far as possible, the entire tumour is removed. This is usually possible to achieve in case of benign tumours like meningiomas, neuro fibromas, etc. Gliomas on the other hand, cannot be excised completely as they do not have clearly defined limits. However, the doctor is careful not to damage any vital tissues of the brain, and thus in cases where the whole tumour cannot be removed, partial removal is done. This helps to relieve the pressure within the skull and leaves a smaller portion of the tumour to be treated through radiation and/or chemotherapy.
Chemotherapy – it is the destruction of cancerous cells with the help of powerful drugs. Drugs are usually given orally or as injections into the vein.
Radiation therapy – in this high power rays are used to kill cancerous cells and prevent them from proliferating. Radiotherapy is given for a short period of time followed by a break. The period of therapy depends on the age of the patient, the site of the tumour and its size. The radiation is given with pin point accuracy, so that the surrounding healthy brain tissue is protected.

What are the side effects of treatment?

Brain tumour treatment may leave many side effects which may become less with time. Since craniotomy is a major procedure, there may be side effects like coordination difficulties, problems in comprehension and memory and personality changes. This is caused due to some damage to normal tissues surrounding the tumour.

Post surgery complications include cerebral oedema and seizures. Other side effects depend upon the location and extent of the tumour. In case there is no neurological deficit before operation, post-operatively also there should be no defect. In a large majority of cases even pre-operative deficit improves. However if tumour removed is delayed or the deficit is already severe this may not recover fully.

Side effects of radiation and chemotherapy include nausea, vomiting, weight loss, loss of hair and allergic reactions of the skin. Children who have had radiation therapy for brain tumours may have learning difficulties and visual problems. There may also be growth deficiencies in some children due to hormonal imbalance.

Some anticancer drugs may cause infertility. Women on anticancer drugs may experience menopausal symptoms like hot flashes and vaginal dryness. Some drugs may also cause kidney damage. A common condition is the formation of blood clots, usually in the leg, after the drug treatment.

What are the long term effects?

Early treatment of the tumour is necessary for better chances of recovery. The prognosis is grim for patients in whom the tumour is not completely removed. Although the inevitable is delayed with medication, survival chances are very low. The average life expectancy is about 6 months in case of a malignant tumour. In cases of benign tumours, and those which are completely removed, the prognosis is good and the patient can gain full recovery. The side effects of treatment lessen with time and the patient can resume his normal routine. Physiotherapy and rehabilitative therapy may be given to minimise the residual effects. There are various support groups that are working in the area of rehabilitation of cancer patients and they may provide the much needed support.

Bone marrow transplant

2008-05-08T01:31:00.000-07:00

What is bone marrow transplant?

Bone marrow transplant is a procedure in which healthy bone marrow is transplanted into a patient whose bone marrow is not functioning properly. Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer. This procedure can also be done to correct hereditary blood diseases. The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor (allograft).

What is bone marrow?

Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells called stem cells that produce blood cells. There are three types of blood cells: white blood cells, which fight infection; red blood cells, which carry oxygen to and from organs and tissues; and platelets, which enable the blood to clot.

Why is it done?

If a patient develops a disease of the blood cells, especially cancers such as leukaemia, he may require high doses of chemotherapy to destroy the cancer. However, this also destroys normal blood cells.

Alternatively, hereditary or acquired disorders may cause abnormal blood cell production. In these cases, transplantation of healthy bone marrow may save a patient's life. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.

What is the procedure?

Bone marrow transplant patients are usually treated in specialised centres and the patient stays in a special nursing unit (a bone marrow transplant unit) to limit exposure to infections. The hospitalisation period is from 4 to 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection and/or bleeding.

Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor. Donors are matched through special blood tests called HLA tissue typing.

Bone marrow is taken from the donor in the operating room while one is unconscious and pain-free (under general anaesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Then, transplant material is transfused into the patient through a vein and is naturally transported back into the bone cavities where it grows to replace the old bone marrow.

Alternatively, blood cell precursors, called stem cells, can be induced to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis.

The patient is prepared for transplantation by administering high doses of chemotherapy or radiation (conditioning). This serves two purposes. First, it destroys the patient's abnormal blood cells or cancer. Second, it inhibits the patient's immune response against the donor bone marrow (graft rejection).

Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 to 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.

What are the indications?

Bone marrow transplant may be recommended for:
Bone marrow deficiency disease caused by:
abnormal red blood cell production, such as thalassaemia or sickle cell disease
aggressive cancer treatments (chemotherapy, radiation therapy), especially for leukaemia or lymphoma
lack of normal blood cell production (aplastic anaemia)
Immune system disorders (immunodeficiency) such as:
congenital neutropenia
severe combined immunodeficiency syndrome
Bone marrow transplant is not recommended for:
patients with heart, kidney, lungs, or liver disorders
patients with other diseases that may limit survival

What are the risks?

The risks for any anaesthesia are:
reactions to medications
problems breathing
Chemotherapy given prior to bone marrow transplant (conditioning) can cause significant toxicity, such as mouth sores, diarrhoea, liver damage, or lung damage. While waiting for bone marrow to grow, the patient is at high risk for infection as also bleeding.

The major problem with bone marrow transplants (when the marrow comes from a donor, not the patient) is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as though they were foreign organisms. In this case, drugs to suppress the immune system must be taken, but this also decreases the body's ability to fight infections.

Other significant problems with a bone marrow transplant are those of all major organ transplants - finding a donor and the cost. The donor is usually a sibling with compatible tissue. The more siblings the patient has, the more chances there are of finding a compatible donor.

What is the prognosis?

Bone marrow transplant prolongs the life of a patient who would otherwise die. Relatively normal activities can be resumed as soon as the patient feels well enough and after consulting with the doctor.

The patient will require attentive follow-up care for 2 to 3 months after discharge from the hospital. It may take 6 months to a year for the immune system to fully recover from this procedure.

Birth control pills (Oral Contraceptives)

2008-05-08T01:28:00.001-07:00

Antioxidants

2008-05-08T01:28:00.000-07:00

What are antioxidants?

Antioxidants are substances that may protect cells from the damage caused by unstable molecules known as free radicals. Damage due to free radicals damage may lead to cancer. Antioxidants interact with and stabilise free radicals and may prevent some of the damage free radicals otherwise might cause. Examples of antioxidants include beta-carotene, lycopene, vitamins C, E, and A, and other substances.

Which foods are rich in antioxidants?

Fruits and vegetables provide a range of antioxidants, vitamins A, C and E, carotenoids and flavonoids. Fruits and vegetables that have comparatively high levels of antioxidants include apples, grapefruit, green grapes, oranges, peach, red plums, strawberries, beetroot, sprouts cauliflower, green cabbage, lettuce, onion, spinach and tomatoes. Antioxidants are abundant in other foods including nuts, grains and some meats, poultry and fish.
Beta-carotene is found in many foods that are orange in colour, including sweet potatoes, carrots, apricots, pumpkin, and mangoes. Some green leafy vegetables including spinach, are also rich in beta-carotene
Lutein, best known for its association with healthy eyes, is abundant in green, leafy vegetable, spinach etc.
Lycopene is a potent antioxidant found in tomatoes, watermelon, guava, papaya, apricots, pink grapefruit, oranges, and other foods
Selenium is a mineral, not an antioxidant nutrient. However, it is a component of antioxidant enzymes. The amount of selenium in soil, which varies by region, determines the amount of selenium in the foods grown in that soil. Animals that eat grains or plants grown in selenium-rich soil have higher levels of selenium in their muscle
Vitamin A is found in three main forms: retinol (Vitamin A1), 3,4-didehydroretinol (Vitamin A2), and 3-hydroxy-retinol (Vitamin A3). Foods rich in vitamin A include liver, sweet potatoes, carrots, milk, egg yolks and mozzarella cheese
Vitamin C is also called ascorbic acid, and can be found in high abundance in many fruits and vegetables and is also found in cereals, beef, poultry and fish
Vitamin E, also known as alpha-tocopherol, is found in almonds, in many oils including wheat germ, safflower, corn and soybean oils, and also found in mangoes, nuts, broccoli and other foods

What are the uses?

Antioxidants help to reduce the risk of cancer, heart attack and stroke.

Protection against heart disease:

Deficiencies in Vitamins A, C, E and beta carotene have been linked to heart disease. All of these nutrients have antioxidant effects and other properties that may benefit the heart.
Vitamin E: eating foods rich in natural vitamin E may be protective. Vitamin E may prevent blood clots and the formation of fatty plaques and cell proliferation on the walls of the arteries
Vitamin C: Vitamin C appears to maintain blood vessel flexibility and to improve circulation in the arteries
Folate, Vitamin B6, and Vitamin B12. Several important studies have demonstrated a link between deficiencies in the B vitamins folate, B6, and B12 and elevated blood levels of homocysteine, an amino acid believed to be a risk factor for atherosclerosis. Both B12 and folate reduce homocysteine levels, and evidence is increasing that this effect may protect the heart.
Vitamin B3. Niacin (vitamin B3) is used for lowering unhealthy cholesterol levels
Carotenoids and heart protection: a high intake of fruits and vegetables containing beta carotene, lycopene, and other carotenoids may reduce the risk of heart attack
Phytochemicals and heart protection: Flavonoids, particularly those found in both black and green tea, onions, red wine or red grape juice, and apples, may protect against damage done by cholesterol and help prevent blood clots

Protection against stroke:
Vitamin C. There is a lower risk for stroke in subjects with the highest blood levels of vitamin C. Studies have found protection in foods rich in vitamin C, although supplements do not appear to offer any advantage.
B Vitamins: Vitamins B6, B12, and folate are important for the production of neurotransmitters, the chemical messengers in the brain that regulate mood and concentration. Deficiencies in these vitamins have been observed in people with depression and dementia. People who have higher blood levels of folic acid have a lower than average risk for stroke
Carotenoids and stroke protection: Studies have reported a lower risk of stroke from carotenoids, including beta carotene and lycopene.

Protection against cancer:

Many fresh fruits and vegetables contain chemicals that may fight many cancers, including lung, breast, colon, and prostate cancers. Examples of important cancer-fighting foods include the following:
Cruciferous vegetables (e.g., cabbage, sprouts, broccoli)
Tomatoes (which contain lycopene)
Carrots (which contain alpha and beta carotene)

There is some evidence that antioxidants may enhance the anticancer effects of chemotherapy. Antioxidant nutrients that may have properties that may help reduce the side effects of chemotherapy include vitamins E and C, beta carotene, isoflavones found in soy, and quercetin (found in red wine and purple grape juice).

Vitamins and cancer protection.

Although supplements of vitamins A, C, and E appear to have no advantages, studies have reported an association between low blood levels of these antioxidant vitamins and a higher risk for cancer.

Vitamin D. Some studies have suggested that certain vitamin D compounds may inhibit certain cancer cells, specifically prostate cancer, from proliferating.
Folate and B12. These B vitamins helps prevent cells from becoming malignant. Folic acid supplements may provide some protection against cervical and colon cancer and may reduce the risk for breast cancer among women who regularly drink alcohol
Carotenoids and cancer protection. A number of studies have reported that fruits and vegetables rich in carotenoids are associated with protection against many cancers. Lycopene, found in tomatoes, may have particular value in protection against prostate, colon, lung, and bladder cancer.

Protection against other diseases include: Alzheimer's Disease, asthma, eye disorders, skin disorders, wrinkles, osteoporosis, gall stones and menstrual disorders.

Acid phosphatase

2008-05-08T01:26:00.000-07:00

What is acid phosphatase?

Acid phosphatase is an enzyme present in the cells throughout the body. It is present in especially high concentrations in the prostate and semen in men. Prostatic diseases result in its release in the blood. A blood test can measure the enzyme acid phosphatase. Drugs and substances that can interfere with the test include fluorides, oxalates, clofibrate, and alcohol.

Why is the test done?

This test is usually done to check an abnormality of the prostate gland, prostate cancer, or to monitor the response of cancer to treatment. This is a good blood test to test for prostate cancer (accurate in half to three fourths of cases), but a physical examination is much more reliable.

How is the test done?

Blood is drawn from a vein, usually from the inside of the elbow. No special preparation is required for the test.

What are the normal values?

Normal values range from 0 to 0.8 U/L (units per litre)

What do the abnormal results (high levels) lead to?
Prostatitis (swelling or infection in the prostate)
Prostate cancer with spread to bones
Paget's disease of bones (thicker and softer bones)
Hyperparathyroidism
Stimulation of the prostate during colonoscopy, enemas or prostate examination
Multiple myeloma

AIDS-associated tumours

2008-05-08T01:25:00.000-07:00

What are AIDS-associated tumours?

AIDS (acquired immunodeficiency syndrome) caused by HIV (Human immunodeficiency virus) attacks the body's immune system. In AIDS, the body can no longer fight off disease successfully. As a result, certain cancers, infections, diseases of the nervous system and muscles occur more easily in individuals infected with HIV compared to healthy people. Cancers seen more frequently in AIDS include Kaposi's sarcoma, lymphomas, cancers of the cervix and the anus. Kapsoi's sarcoma often manifests itself as raised purplish-red bumps on the skin. These bumps can vary greatly in size. Lymph nodes, the intestines and the lungs can also be affected. In fact, any part of the body can be affected by this tumour. Several kinds of lymphomas can occur including those which involve the brain exclusively.

What are the symptoms?

The symptoms of AIDS-associated cancers relate to the affected organs like the skin, internal organs of the body, or the lymphatic system.

How are they diagnosed?

The diagnosis of a cancer can be suspected on the symptoms and the results of the physical examination. Kaposi's sarcoma is diagnosed by a biopsy of any purple patch or sore on the skin or mucous membrane. Lymphoma and the other cancers require a biopsy of the affected lymph nodes.

What is the treatment?

Treatment for AIDS-associated cancers include:
Chemotherapy: This uses drugs that kill the tumour cells.
Radiotherapy: is also used to destroy cancerous growths and slow
their spread.
Combination therapy: Treatment includes a combination of surgery,
chemotherapy and radiotherapy.
How can AIDS be prevented?
Avoid sexual contact with HIV infected individuals or use a condom during sex.
Ensure the barber doesn't reuse blades.
Intravenous drug users shouldn't share needles.
HIV infected individuals should not donate blood, semen, or body
parts.
Breast feeding should be avoided because the virus can be
transmitted to the infant.

Vaginitis

2008-05-08T01:24:00.000-07:00

What is vaginitis?

Vaginitis is the swelling or discomfort caused by vaginal infections in females. It is commonly caused by certain microorganisms – parasites like trichomonas, yeasts like candida or certain bacteria. Some vaginal infections are transmitted through sexual contact, but not others such as candidiasis (yeast infections). They are a frequent cause of distress and discomfort in adult women.

What are the symptoms?

Vaginitis is characterised by a yellowish-white discharge from the vagina, irritating and sometimes itching. The character of the discharge or pain differs according to the causative agent. In case of bacterial vaginosis, the discharge is thin and has a fishy smell. Trichomoniasis is characterised by heavy yellow or grey discharge, discomfort during intercourse, vaginal smell and painful urination. Yeast or candida infection has a thick curdy white discharge, which stick to the vagina.

How is the diagnosis of vaginitis made?

The cause of vaginitis cannot be determined solely on the basis of symptoms or a physical examination. Laboratory tests that allow a microscopic examination of the vaginal discharge are required for a correct diagnosis.

What is the treatment?

Vaginitis should be treated with an appropriate course of antibiotics. It is very important to treat the male partner even if he does not have symptoms, otherwise the infection keeps recurring in the woman. If the full treatment is not taken, the infection can recur. In case of trichomoniasis, it is preferable to eliminate the parasite. Metronidazole is the best drug for the treatment of trichomoniasis. People taking this drug should avoid taking alcohol as a severe reaction with nausea and vomiting can occur. For candida infection, the doctor may prescribe tablets that may need to be placed in the vagina (pessaries).

How can it be prevented?

Condoms and diaphragms may be helpful in preventing the spread of trichomoniasis. Spermicides or medicines that kill sperms are not very effective in reducing the risk of these diseases. In fact the frequent use of the spermicides (more than three times a week) may cause vaginal inflammation (chemical vaginitis). Maintaining good personal hygiene is important. In case of diabetics, who are prone to the vaginal yeast infection, the control of blood sugar is important

Sildenafil (Viagra)

2008-05-08T01:22:00.001-07:00

Sildenafil has recently been introduced for the treatment of impotence or erectile dysfunction. Although it has been on the world market since March 1998, it has only recently become available in India.

What is Sildenafil?

Sildenafil is a drug that has helped many men suffering from the problem of erection of the penis (erectile dysfunction). Erectile dysfunction refers to the inability to get an erection, sufficient for satisfactory sexual activity. Taking this drug helps a man who is sexually aroused to get and maintain an erection by increasing the blood flow to the penis. If however, a man takes Sildenafil but is not sexually stimulated he will not get an erection.

Sildenafil is not a hormone or an aphrodisiac (a drug that arouses sexual desire). It is a prescription medicine, which aims at improving the problems of erection in men. Its use for the treatment of sexual dysfunction in women is still being investigated.

How well does Sildenafil work?

Sildenafil improves erections in 4 out of 5 men who take it, regardless of how long they have had erectile dysfunction and what caused it. It is to be taken about 1 hour before engaging in sexual activity. In most cases, it helps get an erection in 30 minutes that lasts for around 4 hours if a man is sexually excited. If sexual stimulation is absent then nothing will happen.

What is the frequency and dosage of the drug?

Sildenafil comes in different doses of 25mg, 50mg and 100mg. The recommended dosage is one tablet a day. For most people it should not be taken more than once a day. It is advisable to go by the doctor’s prescription regarding the dose to be taken as it will vary from person to person.

Who should not take Sildenafil?

It should never be taken by men who are using nitrate drugs, like nitroglycerine that is used for the treatment of chest pains due to heart disease. This could lead to a sudden drop in the blood pressure to unsafe levels. This includes the use of nitroglycerines in any form such as sprays, ointments and chewable tablets.

There are additional warnings about the use of the drug by individuals with cardiovascular disease. Caution is specifically advised for men who have had a stroke or heart attack or life-threatening arrhythmia in the past 6 months, those with low or high blood pressure or those suffering from a disease causing degeneration of the retina.

What has been the success rate of Sildenafil?

It has been found that 82% of the men who have taken Sildenafil, have experienced an improvement in their erections. It has helped men having mild erectile dysfunction. Those who have severe impotence problems have had less success with the drug. Men who have undergone surgery for prostate removal have also not experienced significant success.

Are there any side effects of Sildenafil?

The drug has some side effects, which last for a few minutes to a few hours after taking the drug. These include dilation of the blood vessels in other parts of the body, causing headaches and fainting. Other side effects such as facial flushing, upset stomach, blurred vision and sensitivity to light usually occur with high doses.

What care should be taken while taking the drug for effective results?
Drinking alcohol may temporarily impair the ability to get an erection. It is therefore advisable not to drink large amounts of alcohol before taking Sildenafil.
Taking Sildenafil after a meal rich in fats may cause the drug to take a longer time to start working. It is best to have a balanced meal before the drug is taken for increased effectiveness.
The tablet should be stored at room temperature; away from heat, moisture and direct light.

Sexually transmitted infections

2008-05-08T01:22:00.000-07:00

What are sexually transmitted infections?

STIs are diseases that you get by having sexual intercourse (vaginal, oral or anal) with someone who already has an STI. There are more than 20 kinds of STIs that affect both men and women.

What causes STIs?

Bacteria and viruses cause STIs. Those caused by bacteria include chlamydia, gonorrhoea, trichomoniasis and syphilis. These can be treated and cured with antibiotics.
STIs caused by viruses include HIV/AIDS, genital herpes, genital warts and cytomegalovirus. These STIs can be controlled but not cured.

What are the various types of STIs?

HIV Infection and AIDS

AIDS (Acquired Immune Deficiency Syndrome) is a disease that weakens the body's ability to protect itself from getting sick. The virus that causes it is HIV (Human Immunodeficiency Virus), which is found mainly in blood but occurs in other body fluids such as semen, vaginal secretions and breast milk. The main sources of infection are shared needles and syringes, unsafe sex, and mother-to-child transmission during pregnancy.

People with HIV infections may not have symptoms for years. When however, they develop certain infections because of their depressed immunity they are said to have AIDS. Symptoms include fever for a long duration, weight loss without a cause, extreme fatigue and prolonged diarrhoea and the symptoms associated with opportunistic infections.

A blood test is usually used to detect the HIV virus. Although there is no cure for HIV infections, a combination of drug therapy, healthy diet, exercise, stress reduction and prompt treatment of opportunistic infections can delay the onset of AIDS.

Gonorrhoea

This is an infection easily transmitted by sexual contact. The causative organism can infect the throat, producing severe soreness; the urethra, causing burning, painful urination and it may also infect the anus and the rectum. Untreated gonorrhoea may lead to urinary tract infections and ultimately kidney failure.

The most common initial symptom is a thick discharge from the urethra which may be white or yellow. There may be painful urination. Gonorrhoea is often associated with the presence of other sexually transmitted diseases.

Safer sex behaviour may reduce the risk. The affected person should be given adequate treatment with antibiotics. It is also important to locate and test all the other sexual contacts and treat them to prevent re-infection of the primary patient and further spread of the disease.

Syphilis

Syphilis is an infectious disease caused by the bacterium Treponema pallidum, which penetrates broken skin or mucous membranes. It can also be transmitted to the foetus via the placenta.

In the initial stages, skin rashes may appear which are very infectious. If the disease is not treated, bacteria continue to invade the body and infect the internal organs, the bones, the heart and the brain.

Safer sexual practices need to be adopted to curb the spread of STIs.

Chlamydia

It is one of the most common sexually transmitted diseases. The majority of genital chlamydia infections are without symptoms until complications appear.

Infection with chlamydia leads to pelvic inflammatory disease which can cause scarring of the fallopian tubes and sterility. The symptoms include burning with urination, discharge from the end of the penis, tenderness or pain in the testicles, fever and chills. Chlamydia infection is often found in conjunction with gonorrhoea.

The use of condoms during sex and limiting the number of sex partners may help in reducing the risk of developing the infection. It can be treated and cured with antibiotics.

Herpes

This is an infection caused by the Herpes simplex virus type 1 (HSV-l) which is associated with infections of the lips, mouth and face. HSV-2 is associated with genital lesions and is transmitted by sexual contact. HSV-2 can be transmitted to a newborn during vaginal delivery if the mother is actively infected.

Infection occurs after exposure to the virus through a break in the skin, or through mucous membranes. The virus spreads to nerve cells within the body and then to other skin surfaces. The symptoms include genital lesions, fever, vaginal discharge, sore throat and in some cases memory loss.

Avoiding direct contact with an open lesion will lower the risk of infection. Safer sex behaviours including the use of condoms may further lower the risk of infection.

Genital warts

Genital warts are caused by the Human papilloma virus (HPV) which causes small growths on the skin and mucous membranes. They grow best in moist genital areas and are flesh-coloured tumours appearing singly or in clusters. In women, HPV can invade the vagina and cervix and may lead to cancerous changes in the cervix.

Symptoms include “warty” tumours on the genitals, genital sores, itching of the genital areas and increased vaginal discharge.

Topical treatments to eradicate the lesions include trichloroacetic acid and podophyllum. Sex abstinence or use of condoms should be practiced until both partners are free of the disease.

What can be done to prevent STIS?
Having a mutually monogamous sexual relationship with an uninfected partner.
Correctly and consistently using a condom greatly reduces the chance of acquiring an STI.
Using clean needles if injecting intravenous drugs.
Having regular check ups for STIs even in the absence of symptoms.
Anyone diagnosed as having an STI should:
Be treated to reduce the risk of transmitting an STI, especially a pregnant woman to an infant.
Follow the full course of medicine.
Avoid sexual activity while being treated for an STI.
Ensure that the partner is also diagnosed and treated.

Sexual abuse in children

2008-05-08T01:20:00.000-07:00

What is sexual abuse?

Sexual abuse in children is a term used when the offender, who may or may not be a member of the family, uses a child for his sexual gratification. Very young children as well as older teenagers may be victimized.

What does sexual abuse include?

Sexual abuse can be physical, verbal or emotional and includes:
Touching and fondling with sexual intent.
Exposing children to adult sexual activity or pornographic material.
Having children pose, undress or perform in a sexual fashion on film or in person.
“Peeping” into bathrooms or bedrooms to spy on a child.
Rape or attempted rape.
The perpetrator may use force, tricks, bribes or threats to involve a child into sexual activity. But the use of physical force is rarely necessary because children, who wish to seek adults love and approval, believe that they are always right and thus become vulnerable at the hands of such people.

What are the signs of sexual abuse?

Children generally do not tell if they are being sexually abused because they may be afraid of the perpetrator. The abuser may threaten to harm the child or any member of her family if she told them. In cases, where the abuser is known to the child, he may ask her not to divulge “their little secret” to anyone else.

Parents or guardians must be vigilant towards their children since there are certain general behaviour changes that may occur in children if they are experiencing such a problem.
Sleep disturbances.
School problems.
Withdrawal from family, friends or usual activities.
Other problems may include depression, anxiety, discipline problems, drug or alcohol problems, hostility or aggression and in some cases running away.
Children who have been sexually abused frequently have more specific symptoms like displaying sexual knowledge or behaviour that is beyond what is normal for their age; copying adult sexual behaviour; unexplained pain, swelling, bleeding or irritation of the mouth; urinary infections and sexually transmitted diseases.

How does a sexually abused child feel?

A sexually abused child may feel different emotions like fear of the abuser or of being different; anger at other adults around her who did not protect her; isolation, sadness, guilt, confusion and shame.

What should parents do?

As concerned adults, parents should teach the children:
that they are loved, valued and are most precious for them.
the difference between safe and unsafe touches.
that their bodies belong to them and nobody has the right to touch or hurt them.
to tell anything about which they might feel uncomfortable to their parents.
If a child trusts the parents and tells them about the incident, they should help by providing positive support.

Some dos:
Keep calm.
Believe the child.
Give positive messages such as “I know you could not help it”, “I’m proud that you trusted me”.
Respect the child’s privacy and never discuss the topic in front of others.
Take the child for a medical check up to make sure that no permanent damage has occurred.
Some don’ts:
Never panic or overreact as the child needs help and support to make it through this difficult time.
Never confront the offender in the child’s presence.
Do not blame the child because sexual abuse is never the child’s fault.

Sexual intercourse

2008-05-08T01:17:00.000-07:00

Sexual intercourse is not merely a physical act with your partner. It is important that both of you are ready for it and enjoy it for fulfilment. It is, therefore, necessary that the mood be right and both partners be adequately aroused sexually. Arousal can be heightened by foreplay, which is an important part of intercourse.

In foreplay, the partners fondle and kiss each other, and stroke each other's genitals. This increases the sexual urges and also lubricates the sex organs to facilitate a pain-free intercourse. As a result of the sexual arousal during foreplay, the man’s penis becomes filled with blood, causing it to become erect. This process is called an erection.

Sexual intercourse involves the male inserting his erect penis into the vagina of the woman. This must be done slowly and gently so as not to cause much discomfort to the woman. In a virgin, the initial insertion can be extremely painful, and this discomfort may be reduced with the help of lubricating creams. After this, the penis is moved forward and backwards in the vagina without withdrawing it completely. This rhythmic motion is continued till both partners reach their orgasm. An orgasm is a feeling of extreme pleasure that starts from the genital region and washes over the whole body. It ends in a climax, which is a state of heightened pleasure for both the partners.

In the male, the orgasm is usually reached with the discharge of semen. In the female, there is a white discharge from the vagina. After an orgasm is reached, the male’s penis becomes deflated again and comes out of the vagina easily.

Newly weds must be aware of the contraceptive devices that are available. Unwanted pregnancy may be avoided with the help of condoms or contraceptive pills for which a doctor must be consulted. Condoms are also extremely important to reduce the chances of contracting sexually transmitted diseases including AIDS. While using condoms you must be careful of the following:

The condom must be rolled onto a fully erect penis
While rolling the condom care must be taken to press out all the air that may collect inside
After the act, the condom must be carefully taken out of the vagina along with the erect penis
The condom must never be reused.

Lesbianism

2008-05-08T01:15:00.000-07:00

What is meant by lesbianism?

Lesbianism is a term, which describes women whose primary sexual and emotional attractions are fulfilled by other women. Many myths exist concerning lesbianism. It is believed that women become lesbians because of bad experiences with men. It is also said that the lesbians are very masculine.

Are lesbians different people?

Like heterosexuals, lesbians also range in size, shape and appearance and have been found to be no different from them in relationships with parents and friends, drinking, self-esteem and many other issues. Lesbianism is simply the way a minority of our population expresses human love and sexuality. Studies on the mental health of lesbians show that they function like heterosexuals as far as their judgement, stability and adaptiveness are concerned.

What is the basic cause for lesbianism?

Research suggests that the homosexual orientation is decided very early in life. It is therefore unethical to change a person’s sexual orientation through therapy. Psychological techniques like psychotherapy may only help them in becoming comfortable with their sexual orientation.

What is homophobia and heterosexism?

Within our society, there is an irrational fear of homosexuality. This aversion to gay or lesbian people is called homophobia. Heterosexism is a term used to define prejudice and discrimination against gays and lesbians.

Homophobia can be called a health hazard because the prejudice from society may cause an individual to turn inward and become depressed. The fear of stigma from the society may lead to a refusal to seek medical attention when needed, ultimately resulting in poor health for the lesbian.

What could be done to help this important minority?

An attitudinal and behavioural change is required towards this group as a whole. Lesbianism says loving another woman is good, exciting and healthy. Therefore, the people need to be more informed in order to encourage a healthy approach.

An open forum is required where such people can meet, exchange their feelings and become more vocal with regard to issues that affect them.

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