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Wednesday 30 November 2011

APPENDICITIS


The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in a condition termed appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the rupture of the appendix (perforated or ruptured appendix).
The American Journal of Epidemiology study found that appendicitis was a common condition affecting approximately 6.7% to 8.6% of the population. IN the U.S. 250,000 cases of appendicitis are reported annually. Individuals of any age may be affected, with the highest incidence occurring in the teens and twenties; however, rare cases of neonatal and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating potential cases of appendicitis is critical in the very young and elderly, as this population has a higher rate of complications. Appendicitis is the most common pediatric condition requiring emergency abdominal surgery.


The appendix is a small, worm-like appendage attached to the colon.

The appendix is a small, worm-like appendage attached to the colon.

Appendicitis occurs when bacteria invade and infect the wall of the appendix.

Appendicitis occurs when bacteria invade and infect the wall of the appendix.


A less common complication of appendicitis is blockage of the intestine.

A less common complication of appendicitis is blockage of the intestine.


An example of an infected appendix that has been removed (left) and the resulting incisional scar from an appendectomy (right).

An example of an infected appendix that has been removed and the resulting incisional scar from an appendectomy.

Appendicitis Causes

There is no clear cause of appendicitis. Fecal material is thought to be one possible cause of obstruction of the appendix. Bacteria, viruses, fungi, and parasites can result in infection, leading to the swelling of the tissues of the appendix wall. The various infecting organisms include Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Swelling of the tissue from inflammatory bowel disease such as Crohn's disease also may cause appendicitis. Appendicitis is not a hereditary disease and is not transmittable from person to personThe appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in a condition termed appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the rupture of the appendix (perforated or ruptured appendix).
The American Journal of Epidemiology study found that appendicitis was a common condition affecting approximately 6.7% to 8.6% of the population. IN the U.S. 250,000 cases of appendicitis are reported annually. Individuals of any age may be affected, with the highest incidence occurring in the teens and twenties; however, rare cases of neonatal and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating potential cases of appendicitis is critical in the very young and elderly, as this population has a higher rate of complications. Appendicitis is the most common pediatric condition requiring emergency abdominal surgery.

Appendicitis Causes

There is no clear cause of appendicitis. Fecal material is thought to be one possible cause of obstruction of the appendix. Bacteria, viruses, fungi, and parasites can result in infection, leading to the swelling of the tissues of the appendix wall. The various infecting organisms include Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Swelling of the tissue from inflammatory bowel disease such as Crohn's disease also may cause appendicitis. Appendicitis is not a hereditary disease and is not transmittable from person to person.

Appendicitis Symptoms and Signs

Appendicitis typically begins with a vague pain in the middle of the abdomen often near the navel or "belly button" (umbilicus). The pain slowly moves to the right lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain may be accompanied with nausea, vomiting, lack of appetite, and fever. All of these symptoms, however, occur in fewer than half of people who develop appendicitis. More commonly, people with appendicitis have any combination of these symptoms.

  • Symptoms of appendicitis may take 4-48 hours to develop. During this time, a person developing appendicitis may have varying degrees of loss of appetite, vomiting, and abdominal pain. The person may have constipation or diarrhea, or there may be no change in bowel habits.
  • Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of the stomach and intestines). Many people admitted to the hospital for suspected appendicitis leave the hospital with a diagnosis of gastroenteritis; initially, true appendicitis is often misdiagnosed as gastroenteritis.
  • Children and the elderly often have fewer symptoms, or cannot adequately describe their symptoms, which makes their diagnosis less obvious and the incidence of complications more frequent.



Appendicitis Diagnosis


Appendicitis is diagnosed by the classic symptoms of appendicitis and physical examination (the health care practitioner's examination of the patient's abdomen).
  • Lab work: Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the white blood cell count, which is typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urinalysis may be ordered to exclude urinary tract infection (or pregnancy) as the cause of the patient's symptoms.
  • Imaging tests: Imaging tests are ordered when the diagnosis is not readily apparent. Most medical centers utilize a CT scan of the abdomen and pelvis to assist in evaluating abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is commonly used in small children to test for appendicitis in order to avoid exposing the child to radiation from CT scans.
Other conditions that cause abdominal pain may mimic the symptoms of appendicitis making the diagnosis more difficult. These conditions include kidney stones, urinary tract infections, hernias, gallstones and gallbladder problems, colitis, diverticulitis, and ovarian or testicular problems.

Appendicitis Treatment


Appendicitis Self-Care at Home

There is no home care for appendicitis. If appendicitis is suspected, contact a health care practitioner or go to an emergency department. Avoid eating or drinking as this may complicate or delay surgery. If you are thirsty, you may rinse your mouth with water. Do not use laxatives, antibiotics, or pain medications because these may cause delay in diagnosis that increases the risk of rupture of the appendix or mask the symptoms, which makes diagnosis more difficult.



Surgery (Appendectomy)

The best treatment for appendicitis is surgery to remove the appendix (appendectomy) before the appendix ruptures. While awaiting surgery, the patient will be given IV fluids to keep well hydrated. The patient will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery.
Surgery is commonly performed via laparoscopy, a minimally invasive procedure where small "keyhole" incisions are made in the abdomen and the appendix is removed with the assistance of a small camera guided by the surgeon. However, in some cases it may be necessary to do an open abdominal procedure to remove the appendix.
Occasionally, surgery for appendicitis reveals a non-inflamed appendix (negative appendectomy), with high rates in infants, the elderly, and young women. However, the use of imaging studies (CT scans, ultrasounds) appears to have reduced the negative appendectomy rate to 7%-12%. The difficulty in making a definite diagnosis of this medical problem and the risk of missing an acutely inflamed appendix (and the patient becoming very ill due to perforation) makes a certain rate of misdiagnosis inevitable. Women in particular have a high rate of negative appendectomy as ovarian and uterine problems make the diagnosis more difficult. CT scanning prior to surgery has been shown to decrease this percentage to closer to 7% to 8% in women.

SOURCE: emedicinehealth.com

Tuesday 29 November 2011

MIGRAINE


MIGRAINE


What Is a Migraine?

A migraine is a headache with throbbing pain that is usually worse on one side of the head. The pain is often severe enough to hamper daily activities and may last from four hours to three days if untreated. More than one in 10 Americans, including one in 6 women, have migraines, but many have been told mistakenly that they have a sinus or tension headache. Foods, stress, and hormones can be migraine triggers

Migraine Symptoms

Throbbing pain typically occurs on one side near the temples, forehead, and eyes. Migraines can make you very sensitive to light, sound, or mild exertion, such as climbing the stairs. Many people have nausea, vomiting, or vision problems. The pain can be disabling, forcing people to miss work or other activities.

Migraine With Aura

About 20% of people who suffer from migraines will have an aura about 20 minutes to an hour before the pain. They may see flashing lights, wavy lines, or dots, or they may have blurry vision or blind spots. These are called "classic migraines

Migraine Warning Signs

Some people may have a change in mood before a migraine begins. They may become more excitable or irritable or depressed. Others may detect a sensation, such as a funny smell or taste. They may feel more fatigued, yawn frequently, or experience muscle tension. About 1 in 4 people experience this prodrome phase, which can occur as early as 24 hours before any head pain

What Causes a Migraine?

The exact cause of migraines is still not well understood, but the problem is considered to be neurological (related to the nervous system). It is believed that brain chemicals, blood vessels, and nerves of the brain are involved.

Trigger: Flashing Lights

Migraines may be set off by some specific cause, such as flickering lights. This could be a reflection from snow or water or from fluorescent bulbs or television or movie screens. Wearing polarizing sunglasses outside and using daylight spectrum fluorescent bulbs inside may help

Trigger: Anxiety and Stress

Emotional stress is a common trigger of migraines. While it's impossible to completely avoid stress, relaxation exercises can help you cope. Inhale and exhale slowly, letting the air fill you and then deflate like a balloon. Some people find that thinking of a peaceful scene or listening to favorite music can help.

Trigger: Lack of Food or Sleep

It's important for people prone to migraines to have a regular pattern of meals and sleep. Low blood sugar from skipping meals can trigger a migraine. Eating too much sugar also can cause a spike, then a "crash" in blood sugar. Drink water throughout the day to avoid dehydration and sleep at least 6 to 8 hours a night.

Trigger: Hormonal Changes

For many women, migraines are tied to their menstrual cycle, occurring either a few days before or during their period, when estrogen levels drop. Some women may benefit from anti-inflammatory medication before their headaches begin, or hormonal birth control such as pills, patches, or rings. Others may have no benefit or worse migraines with hormonal birth control

Trigger: Headache Foods

Migraine sufferers often report that certain foods trigger their headaches. Common culprits include MSG, red wine, cheese, chocolate, soy sauce, and processed meats. However, scientific studies haven't confirmed any particular food as a migraine trigger.

Trigger: Tyramine

Aged, fermented, and stored foods have higher levels of tyramine, a substance created from the breakdown of the amino acid tyrosine. Tyramine may cause blood vessels to constrict then expand, and it may be a trigger for some migraines. Some headache experts advise limiting fermented or aged foods, such as cheese, soy sauce, pickles, and pepperoni

Caffeine: Help or Hindrance?

When combined with some pain medications, caffeine can help provide relief. Most migraine sufferers can drink a cup or two a day of coffee without any problems. However, too much caffeine can lead to headaches when the stimulant effect wears off.

Tracking Personal Triggers

Find out what triggers your migraines by keeping a headache diary. Each time you suffer from a migraine, make a note about the warning signs (the "prodrome"), triggers, and severity. If you can discover some of your personal triggers, you may be able to avoid future headaches.

Who Gets Migraines?

Women are three times more likely to have migraines than men. If you have a close relative with migraines, you are much more likely to have migraines, too. Experts believe migraines may be related to mutations in genes that affect certain areas of the brain. Migraine is also more common among people who have epilepsy, depression, asthma, anxiety, stroke, and some other neurologic and hereditary disorders.

A doctor talking with a patient.

A headache quiz.

A spoon full of medicine pills.

A woman taking triptan.

A woman using nasal spray.

A woman holding medicine.

A man with medicine in a glass drink.

Pill box.

A woman doing biofeedback and relaxation training.

Acupuncture performed ona man.

A grandmother pushing a child on a swing.

A woman calling the doctor.

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DRY EYES


The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of water, for moisture; oils, for lubrication; mucus, for even spreading; and antibodies and special proteins, for resistance to infection. These components are secreted by special glands located around the eye. When there is an imbalance in this tear system, a person may experience dry eyes.
When tears do not adequately lubricate the eye, a person may experience:
Sometimes, a person with a dry eye will have excess tears running down the cheeks, which may seem confusing. This happens when the eye isn't getting enough lubrication. The eye sends a distress signal through the nervous system for more lubrication. In response, the eye is flooded with tears to try to compensate for the underlying dryness. However, these tears are mostly water and do not have the lubricating qualities or the rich composition of normal tears. They will wash debris away, but they will not coat the eye surface properly.

What Causes Dry Eyes?


In addition to an imbalance in the tear-flow system of the eye, dry eyes can be caused by situations that dry out the tear film. This can be due to dry air from air conditioning, heat, or other environmental conditions. Other conditions that may cause dry eyes are:
  • The natural aging process, especially menopause.
  • Side effects of certain medications such as antihistamines and birth control pills.
  • Diseases that affect the ability to make tears, such as Sjogren's syndrome, rheumatoid arthritis, and collagen vascular diseases.
  • Structural problems with the eye lids that don't allow them to close properly.

How Are Dry Eyes Treated?


Though dry eyes cannot be cured, there are a number of steps that can be taken to treat them. You should discuss treatment options with an ophthalmologist. Treatments for dry eyes may include:
  • Artificial tear drops and ointments. The use of artificial teardrops is the primary treatment for dry eye. Artificial teardrops are available over the counter. No one drop works for everyone, so you might have to experiment to find the drop that works for you. If you have chronic dry eye, it is important to use the drops even when your eyes feel fine, to keep them lubricated. If your eyes dry out while you sleep, you can use a thicker lubricant, such as an ointment, at night.
  • Temporary punctal occlusion. Sometimes it is necessary to close the ducts that drain tears out of the eye. This is first done via a painless test where a plug that will dissolve over a few days is inserted into the tear drain of the lower eyelid to determine whether permanent plugs can provide an adequate supply of tears.
  • Permanent punctal occlusion. If temporary plugging of the tear drains works well, then silicone plugs (punctal occlusion) may be used. The plugs will hold tears around the eyes as long as they are in place. They can be removed. Rarely, the plugs may come out spontaneously or migrate down the tear drain. Many patients find that the plugs improve comfort and reduce the need for artificial tears.
  • Restasis. In 2002, the FDA approved the prescription eye drop Restasis for the treatment of chronic dry eye. It is currently the only prescription eye drop that helps your eyes increase their own tear production with continued use.
  • Other medications. Other medications, including topical steroids, may also be beneficial in some cases.
  • Surgery. If needed, the ducts that drain tears into the nose can be permanently closed to allow more tears to remain around the eye. This is done with local anesthetic on an outpatient basis. There are no limitations in activity after having this surgery.
  • SOURCE: medicinenet.com

Monday 28 November 2011

ANEMIA


Anemia describes the condition in which the number of red blood cells in the blood is low. For this reason, doctors sometimes describe someone with anemia as having a low blood count. A person who has anemia is called anemic.
Blood is comprised of two parts; a liquid part called the plasma and a cellular part. The cellular part contains several different cell types. One of the most important and most numerous types and the most numerous cell type are red blood cells. The other cell types are the white blood cells and platelets. Only red blood cells are discussed in this article. The purpose of the red blood cell is to deliver oxygen from the lungs to other parts of the body.
Red blood cells are produced through a series of complex and specific steps. They are made in the bone marrow (inner part of some bones that make most of the cells in the blood), and when all the proper steps in their maturation are complete, they are released into the blood stream. The hemoglobin molecule is the functional unit of the red blood cells and is a complex protein structure that is inside the red blood cells. Contrary to most cells in the human body, red blood cells do not have a nucleus (metabolic center of a cell).
Even though the red blood cells (or RBCs) are made within the bone marrow, many other factors are involved in their production. For example, iron is a very important component of the hemoglobin molecule; erythropoietin, a molecule secreted by the kidneys, promotes the formation of red blood cells in the bone marrow.
The following are some key points summarizing anemia and red blood cells:
  • Having the correct number of red blood cells and prevention of anemia requires cooperation among the kidneys, the bone marrow, and nutrients within the body. If the kidneys or bone marrow are not functioning, or the body is poorly nourished, then normal red blood cell count and function may be difficult to maintain.

  • Anemia is actually a sign of a disease process rather than a disease itself. It is usually classified as either chronic or acute. Chronic anemia occurs over a long period of time. Acute anemia occurs quickly. Determining whether anemia has been present for a long time or whether it is something new, assists doctors in finding the cause. This also helps predict how severe the symptoms of anemia may be. In chronic anemia, symptoms typically begin slowly and progress gradually; whereas in acute anemia symptoms can be abrupt and more distressing.

  • Red blood cells live about 100 days, so the body is constantly trying to replace them. In adults, red blood cell production occurs in the bone marrow. Doctors try to determine if a low red blood cell count is caused by increased blood loss of red blood cells or from decreased production of them in the bone marrow. Knowing whether the number of white blood cells and/or platelets have changed also helps determine the cause of anemia.

  • In the United States, 2% to 10% of people have anemia. Other countries have even higher rates of anemia. Young women are twice as likely to have anemia than young men because of regular menstrual bleeding. Anemia occurs in both young people and in old people, but anemia in older people is more likely to cause symptoms because they typically have additional medical problems.

  • In general, there are three major types of anemia, classified according to the size of the red blood cells:

    1. If the red blood cells are smaller than normal, this is called microcytic anemia. The major causes of this type are iron deficiency (low level iron) anemia and thalassemia (inherited disorders of hemoglobin).

    2. If the red blood cells size are normal in size (but low in number), this is called normocytic anemia, such as anemia that accompanies chronic disease or anemia related to kidney disease.

    3. If red blood cells are larger than normal, then it is called macrocytic anemia. Major causes of this type are pernicious anemia and anemia related to alcoholism
    4. Anemia Causes

      Many medical conditions cause anemia. Common causes of anemia include the following:
      • Anemia from active bleeding: Loss of blood through heavy menstrual bleeding or, wounds can cause anemia. Gastrointestinal ulcers or cancers such as cancer of the colon may slowly ooze blood and can also cause anemia.

      • Iron deficiency anemia: The bone marrow needs iron to make red blood cells. Iron plays an important role in the proper structure of the hemoglobin molecule. If iron intake is limited or inadequate due to poor dietary intake, anemia may occur as a result. This is called iron deficiency anemia. Iron deficiency anemia can also occur when there are stomach ulcers or other sources of slow, chronic bleeding (colon cancer, uterine cancer, intestinal polyps, hemorrhoids, etc). In these kinds of scenarios, because of ongoing, chronic slow blood loss, iron is also lost from the body (as a part of blood) at a higher rate than normal and can result in iron deficiency anemia.

      • Anemia of chronic disease: Any long-term medical condition can lead to anemia. The exact mechanism of this process in unknown, but any long-standing and ongoing medical condition such as a chronic infection or a cancer may cause this type of anemia.

      • Anemia related to kidney disease: The kidneys release a hormone called the erythropoietin that helps the bone marrow make red blood cells. In people with chronic (long-standing) kidney disease, the production of this hormone is diminished, and this in turn diminishes the production of red blood cells, causing anemia. This is called anemia related to chronic kidney disease.

      • Anemia related to pregnancy: Water weight gain during pregnancy dilutes the blood, which may be reflected as anemia.

      • Anemia related to poor nutrition: Vitamins and minerals are required to make red blood cells. In addition to iron, vitamin B12 and folate are required for the proper production of hemoglobin. Deficiency in any of these may cause anemia because of inadequate production of red blood cells. Poor dietary intake is an important cause of low folate and low vitamin B12 levels. Strict vegetarians who do not take sufficient vitamins are at risk to develop vitamin B12 deficiency.

      • Pernicious Anemia: There also may be a problem in the stomach or the intestines leading to poor absorption of vitamin B12. This may lead to anemia because of vitamin B12 deficiency known as pernicious anemia.

      • Sickle cell anemia: In some individuals, the problem may be related to production of abnormal hemoglobin molecules. In this condition the hemoglobin problem is qualitative, or functional. Abnormal hemoglobin molecules may cause problems in the integrity of the red blood cell structure and they may become crescent-shaped (sickle cells). There are different types of sickle call anemia with different severity levels. This is typically hereditary and is more common in those of African, Middle Eastern, and Mediterranean ancestry.

      • Thalassemia: This is another group of hemoglobin-related causes of anemia. There are many types of thalassemia, which vary in severity from mild (thalassemia minor) to severe (thalassemia major). These are also hereditary, but they cause quantitative hemoglobin abnormalities, meaning an insufficient amount of the correct hemoglobin type molecules is made. Thalassemia is more common in people from African, Mediterranean, and Southeast Asian ancestries.

      • Alcoholism: Poor nutrition and deficiencies of vitamins and minerals are associated with alcoholism. Alcohol itself may also be toxic to the bone marrow and may slow down the red blood cell production. The combination of these factors may lead to anemia in alcoholics.

      • Bone marrow-related anemia: Anemia may be related to diseases involving the bone marrow. Some blood cancers such as leukemia or lymphomas can alter the production of red blood cells and result in anemia. Other processes may be related to a cancer from another organ spreading to the bone marrow.

      • Aplastic anemia: Occasionally some viral infections may severely affect the bone marrow and significantly diminish production of all blood cells. Chemotherapy (cancer medications) and some other medications may pose the same problems.

      • Hemolytic anemia: The normal red blood cell shape is important for its function. Hemolytic anemia is a type of anemia in which the red blood cells rupture (known as hemolysis) and become dysfunctional. This could happen due to a variety of reasons. Some forms of hemolytic anemia can be hereditary with constant destruction and rapid reproduction of red blood cells (for example, as in hereditary spherocytosis, hereditary elliptocytosis, and glucose-6-phosphate dehydrogenase or G6GD deficiency) . This type of destruction may also happen to normal red blood cells in certain conditions, for example, with abnormal heart valves damaging the blood cells or certain medications that disrupt the red blood cell structure.

      • Anemia related to medications: Many common medications can occasionally cause anemia as a side effect in some individuals. The mechanisms by which medications can cause anemia are numerous (hemolysis, bone marrow toxicity) and are specific to the medication. Medications that most frequently cause anemia are chemotherapy drugs used to treat cancers. Other common medications that can cause anemia include some seizure medications, transplant medications, HIV medications, some malaria medications, some antibiotics (penicillin, chloramphenicol), antifungal medications, and antihistamines.

      • Other less common causes of anemia include thyroid problems, cancers, liver disease, autoimmune diseases (lupus), paroxysmal nocturnal hemoglobinuria (PNH), lead poisoning, AIDS, malaria, viral hepatitis, mononucleosis, parasitic infections (hookworm), bleeding disorders, and insecticide exposure. It is noteworthy that there are many other potential causes of anemia that are not included in this list as these are only some of the more common and important ones.
      • Anemia Symptoms

        Because a low red blood cell count decreases oxygen delivery to every tissue in the body, anemia may cause a variety of signs and symptoms. It can also make almost any other underlying medical condition worse. If anemia is mild, it may not cause any symptoms. If anemia is slowly ongoing (chronic), the body may adapt and compensate for the change; in this case there may not be any symptoms until the anemia becomes more severe.
        Symptoms of anemia may include the following:
        • Fatigue

        • decreased energy

        • weakness

        • shortness of breath

        • lightheadedness

        • palpitations (feeling of the heart racing or beating irregularly)

        • looking pale
        Symptoms of severe anemia may include:
        Some of the signs that may indicate anemia in an individual may include:
        • Change in stool color, including black and tarry stools (sticky and foul smelling), maroon-colored, or visibly bloody stools if the anemia is due to blood loss through the gastrointestinal tract.

        • rapid heart rate

        • low blood pressure

        • rapid breathing

        • pale or cold skin

        • yellow skin called jaundice if anemia is due to red blood cell breakdown

        • heart murmur

        • enlargement of the spleen with certain causes of anemia
        •  

          Anemia Diagnosis

          Doctors can easily detect anemia by drawing a blood sample for a complete blood count. Based on the results of the test and thorough evaluation of the patient, the doctor may order more tests to determine the exact cause of anemia. The complete blood count may be done as part of a routine general check-up or based upon the presence of signs and symptoms that can be related to anemia.
          Physical examination and medical history also play a crucial role in diagnosing causes of anemia. Some of the important features in medical history cover questions about family history, previous personal history of anemia or other chronic conditions, medications, color of stool and urine, bleeding problems, and occupation and social habits (such as alcohol intake). While performing a complete physical examination, the physician may particularly focus on general appearance (signs of fatigue, paleness), jaundice (yellow skin and eyes), paleness of the nail beds, enlarged spleen (splenomegaly) or liver (hepatomegaly), heart sounds, and lymph nodes.
          Because anemia is only a symptom of another disease, doctors will want to determine what condition is causing the anemia. Some people may need many additional tests, and others may need very few. For example, an anemic person with known stomach ulcers may not need multiple blood tests but, may need to have his or her stomach visually evaluated and have the ulcers treated. On the other hand, a person with a family history of anemia and without an obvious source of blood loss may need multiple laboratory tests and other types of testing. Doctors also take into consideration the severity of the anemia when deciding the tests to order. When a person has severe anemia, the cause must be determined rapidly so that it can be treated appropriately.
          Lab tests for anemia may include the following:
          • Complete blood count (CBC): Determines the severity and type of anemia (microcytic anemia or small sized red blood cells, normocytic anemia or normal sized red blood cells, or macrocytic anemia or large sized red blood cells) and is typically the first test ordered. Information about other blood cells (white cells and platelets) are also included in the CBC report.

          • Stool hemoglobin test: Tests for blood in stool which may detect bleeding from the stomach or the intestines (stool Guaiac test or stool occult blood test).

          • Peripheral blood smear: Looks at the red blood cells under a microscope to determine the size, shape, number, and color as well as evaluate other cells in the blood.

          • Iron level: An iron level may tell the doctor whether anemia may be related to iron deficiency or not. This test is usually accompanied by other tests that measure the body's iron storage capacity, such as transferrin level and ferritin level.

          • Transferrin level: Evaluates a protein that carries iron around the body.

          • Ferritin: Evaluates at the total iron available in the body.

          • Folate: A vitamin needed to produce red blood cells, which is low in people with poor eating habits.

          • Vitamin B12: A vitamin needed to produce red blood cells, low in people with poor eating habits or in pernicious anemia.

          • Bilirubin: Useful to determine if the red blood cells are being destroyed within the body which may be a sign of hemolytic anemia.

          • Lead level: Lead toxicity used to be one of the more common causes of anemia in children.

          • Hemoglobin electrophoresis: Sometimes used when a person has a family history of anemia; this test provides information on sickle cell anemia or thalassemia.

          • Reticulocyte count: A measure of new red blood cells produced by the bone marrow

          • Liver function tests: A common test to determine how the liver is working, which may give a clue to other underlying disease causing anemia.

          • Kidney function test: A test that is very routine and can help determine whether any kidney dysfunction exists.

          • Bone marrow biopsy: Evaluates production of red blood cells and may be done when a bone marrow problem is suspected.
          • Anemia Treatment


            Self-Care at Home

            Very little can be done to self-treat anemia and medical treatment is generally needed. It is important to continue to take any medication that is prescribed for other chronic (long-lasting) medical problems. If the reason for anemia is known, then measures to keep it under control are very important. For example, if anemia is caused by a stomach ulcer, then medications such as aspirin or ibuprofen should be avoided, unless otherwise directed by a doctor.

            Medications

            Medications and treatments that correct the common underlying causes of anemia include the following:
            • Iron may be taken during pregnancy and when iron levels are low. It is important to determine the cause of iron deficiency and treat it properly.

            • Vitamin supplements may replace folate and vitamin B12 in people with poor eating habits. In people with pernicious anemia who are unable to absorb sufficient amounts of vitamin B12, monthly injections of vitamin B12 are commonly used to replete the vitamin B 12 levels and correct the anemia.

            • epoetin alfa (Procrit or Epogen) injection can be used to increase red blood cell production in people with kidney problems. The production of erythropoietin is reduced in people with advanced kidney disease, as described earlier.

            • Stopping a medication that may be the cause of anemia may also reverse anemia after consultation with a physician.

            • If alcohol is the cause of anemia, then in addition to taking vitamins and maintaining adequate nutrition, alcohol consumption needs to be stopped.
            •  

              Anemia Prevention

              Some common forms of anemia are most easily prevented by eating a healthy diet and limiting alcohol use. All types of anemia are best avoided by seeing a doctor regularly and when problems arise. In the elderly, routine blood work ordered by the doctor, even if there are no symptoms, may detect anemia and prompt the doctor to look for the underlying causes.
              Source: emedicinehealth.com

ANATOMY OF CENTRAL NERVOUS SYSTEM


Central Nervous System Overview

The central nervous system consists of the brain and spinal cord (see Multimedia File 1).
  • The brain plays a central role in the control of most bodily functions, including awareness, movements, sensations, thoughts, speech, and memory. Some reflex movements can occur via spinal cord pathways without the participation of brain structures. 
  • The spinal cord is connected to a section of the brain called the brainstem and runs through the spinal canal. Cranial nerves exit the brainstem. Nerve roots exit the spinal cord to both sides of the body. The spinal cord carries signals (messages) back and forth between the brain and the peripheral nerves.
Cerebrospinal fluid surrounds the brain and the spinal cord and also circulates within the cavities (called ventricles) of the central nervous system. The leptomeninges surround the brain and the spinal cord. The cerebrospinal fluid circulates between 2 meningeal layers called the pia matter and the arachnoid (or pia-arachnoid membranes). The outer, thicker layer serves the role of a protective shield and is called the dura matter.
The basic unit of the central nervous system is the neuron (nerve cell). Billions of neurons allow the different parts of the body to communicate with each other via the brain and the spinal cord. A fatty material called myelin coats nerve cells to insulate them and to allow nerves to communicate quickly.


  • The Brain


Anatomy of the brain.
The Cerebrum
The cerebrum is the largest part of the brain and controls voluntary actions, speech, senses, thought, and memory.
The surface of the cerebral cortex has grooves or infoldings (called sulci), the largest of which are termed fissures. Some fissures separate lobes.
The convolutions of the cortex give it a wormy appearance. Each convolution is delimited by two sulci and is also called a gyrus (gyri in plural). The cerebrum is divided into two halves, known as the right and left hemispheres. A mass of fibers called the corpus callosum links the hemispheres. The right hemisphere controls voluntary limb movements on the left side of the body, and the left hemisphere controls voluntary limb movements on the right side of the body. Almost every person has one dominant hemisphere. Each hemisphere is divided into four lobes, or areas, which are interconnected.
  • The frontal lobes are located in the front of the brain and are responsible for voluntary movement and, via their connections with other lobes, participate in the execution of sequential tasks; speech output; organizational skills; and certain aspects of behavior, mood, and memory.
  • The parietal lobes are located behind the frontal lobes and in front of the occipital lobes. They process sensory information such as temperature, pain, taste, and touch. In addition, the processing includes information about numbers, attentiveness to the position of one’s body parts, the space around one’s body, and one's relationship to this space.
  • The temporal lobes are located on each side of the brain. They process memory and auditory (hearing) information and speech and language functions.
  • The occipital lobes are located at the back of the brain. They receive and process visual information.
The cortex, also called gray matter, is the most external layer of the brain and predominantly contains neuronal bodies (the part of the neurons where the DNA-containing cell nucleus is located). The gray matter participates actively in the storage and processing of information. An isolated clump of nerve cell bodies in the gray matter is termed a nucleus (to be differentiated from a cell nucleus). The cells in the gray matter extend their projections, called axons, to other areas of the brain.
Fibers that leave the cortex to conduct impulses toward other areas are termed efferent fibers, and fibers that approach the cortex from other areas of the nervous system are termed afferent (nerves or pathways). Fibers that go from the motor cortex to the brainstem (for example, the pons) or the spinal cord receive a name that generally reflects the connections (that is, corticopontine tract for the former and corticospinal tract for the latter). Axons are surrounded in their course outside the gray matter by myelin, which has a glistening whitish appearance and thus gives rise to the term white matter.
Cortical areas receive their names according to their general function or lobe name. If in charge of motor function, the area is called the motor cortex. If in charge of sensory function, the area is called a sensory or somesthetic cortex. The calcarine or visual cortex is located in the occipital lobe (also termed occipital cortex) and receives visual input. The auditory cortex, localized in the temporal lobe, processes sounds or verbal input. Knowledge of the anatomical projection of fibers of the different tracts and the relative representation of body regions in the cortex often enables doctors to correctly locate an injury and its relative size, sometimes with great precision.
Central Structures of the Brain
The central structures of the brain include the thalamus, hypothalamus, and pituitary gland. The hippocampus is located in the temporal lobe but participates in the processing of memory and emotions and is interconnected with central structures. Other structures are the basal ganglia, which are made up of gray matter and include the amygdala (localized in the temporal lobe), the caudate nucleus, and the lenticular nucleus (putamen and globus pallidus). Because the caudate and putamen are structurally similar, neuropathologists have coined for them the collective term striatum.
  • The thalamus integrates and relays sensory information to the cortex of the parietal, temporal, and occipital lobes. The thalamus is located in the lower central part of the brain (that is, upper part of the brainstem) and is located medially to the basal ganglia. The brain hemispheres lie on the thalamus. Other roles of the thalamus include motor and memory control.
  • The hypothalamus, located below the thalamus, regulates automatic functions such as appetite, thirst, and body temperature. It also secretes hormones that stimulate or suppress the release of hormones (for example, growth hormones) in the pituitary gland.
  • The pituitary gland is located at the base of the brain. The pituitary gland produces hormones that control many functions of other endocrine glands. It regulates the production of many hormones that have a role in growth, metabolism, sexual response, fluid and mineral balance, and the stress response.
  • The ventricles are cerebrospinal fluid-filled cavities in the interior of the cerebral hemispheres.  
  • For more information, see Anatomy of the Endocrine System.
The Base of the Brain
The base of the brain contains the cerebellum and the brainstem. These structures serve complex functions. Below is a simplified version of these roles:
  • Traditionally, the cerebellum has been known to control equilibrium and coordination and contributes to the generation of muscle tone. It has more recently become evident, however, that the cerebellum plays more diverse roles such as participating in some types of memory and exerting a complex influence on musical and mathematical skills.
  • The brainstem connects the brain with the spinal cord. It includes the midbrain, the pons, and the medulla oblongata. It is a compact structure in which multiple pathways traverse from the brain to the spinal cord and vice versa. For instance, nerves that arise from cranial nerve nuclei are involved with eye movements and exit the brainstem at several levels. Damage to the brainstem can therefore affect a number of bodily functions. For instance, if the corticospinal tract is injured, a loss of motor function (paralysis) occurs, and it may be accompanied by other neurologic deficits, such as eye movement abnormalities, which are reflective of injury to cranial nerves or their pathways in the brainstem.

    • The midbrain is located below the hypothalamus. Some cranial nerves that are also responsible for eye muscle control exit the midbrain.
    • The pons serves as a bridge between the midbrain and the medulla oblongata. The pons also contains the nuclei and fibers of nerves that serve eye muscle control, facial muscle strength, and other functions.
    • The medulla oblongata is the lowest part of the brainstem and is interconnected with the cervical spinal cord. The medulla oblongata also helps control involuntary actions, including vital processes, such as heart rate, blood pressure, and respiration, and it carries the corticospinal (that is, motor function) tract toward the spinal cord
    • SPINAL CORD
    • The spinal cord is an extension of the brain and is surrounded by the vertebral bodies that form the spinal column (see Multimedia File 3). The central structures of the spinal cord are made up of gray matter (nerve cell bodies), and the external or surrounding tissues are made up of white matter.
    • Within the spinal cord are 30 segments that belong to 4 sections (cervical, thoracic, lumbar, sacral), based on their location: 

      • Eight cervical segments: These transmit signals from or to areas of the head, neck, shoulders, arms, and hands.  
      • Twelve thoracic segments: These transmit signals from or to part of the arms and the anterior and posterior chest and abdominal areas. 
      • Five lumbar segments: These transmit signals from or to the legs and feet and some pelvic organs. 
      • Five sacral segments: These transmit signals from or to the lower back and buttocks, pelvic organs and genital areas, and some areas in the legs and feet. 
      • A coccygeal remnant is located at the bottom of the spinal cord
      • Source:emedicinehealth.com


ALZHEIMER'S DISEASE


What is Alzheimer's disease?


Alzheimer's disease is a progressive and fatal brain disorder that gradually destroys a person's memory and ability to learn, reason, communicate, and make judgments.

Who gets Alzheimer's disease?


  • Approximately 5.3 million Americans and more than 30 million people worldwide have Alzheimer's disease.
  • The disease affects all races and ethnic groups.
  • Alzheimer's disease seems to affect more women than men.
  • Alzheimer's disease mainly affects people aged 60 years and older. The risk of developing Alzheimer's disease increases with age.

What causes Alzheimer's disease?


What exactly causes Alzheimer's disease is not known in most cases. Most often, a number of factors, rather than a single cause, come together in certain people to cause the disease.
Two forms of Alzheimer's disease have been recognized.
  • In familial Alzheimer's disease, a person's genes directly cause the disease. This form of disease is very rare; only a few hundred families worldwide include individuals with the genes that cause this form of Alzheimer's disease. However, individuals who inherit these genes will almost certainly develop the disease, usually when younger than 65 years and sometimes as young as 30 years. At least three different genes have been found to be related early-onset or familial Alzheimer's disease.
  • In sporadic Alzheimer's disease, the more common form of the disease, genes do not cause the disease; however, certain genetic mutations have been shown to increase an individual's risk of developing the condition. Cases of sporadic Alzheimer's disease occur in a less predictable manner than familial Alzheimer's disease, and usually not as many members in the same family acquire it compared to families with familial Alzheimer's disease
  • What are symptoms of Alzheimer's disease?

While Alzheimer's disease progresses at different rates in different people, three general stages of Alzheimer's disease have been described.
  • In the early stage (pre-clinical), symptoms of Alzheimer's disease are subtle. The main symptom is memory loss.
  • In the middle, or intermediate, stage (mild cognitive impairment), individuals begin to lose their ability to think and reason clearly, judge situations, communicate, understand new information, and take care of themselves.
  • As the disease progresses to the late stage (Alzheimer's' disease), individuals may experience changes in personality and behavior, anxiety, agitation, disorientation, paranoia, severe memory loss, loss of mobility, delusions, and hallucinations
  • How can Alzheimer's disease be diagnosed?


    The neurodegenerative disorders in the brain that result in Alzheimer's disease start years, probably decades, before the beginning of clinical symptoms. This long period of time between the beginning of the pathological changes and the early symptoms opens a window of opportunity for early diagnosis and treatment. Unfortunately, at the present time no treatment is available to stop the progression of the disease.
    There are two main changes in brain tissue that are associated with Alzheimer's disease.
    1. The abundant presence of the so-called "senile plaques." These plaques are the result of the extracellular deposit of a protein fragment that is naturally produced inside the brain, known as amyloid A-beta 1-42. This protein accumulates in the parenchyma of the brain, that is, the area outside the nerve cells. The reason for this excessive accumulation is not clear but it is considered one of the landmarks of Alzheimer's disease.
    2. The presence (different from the plaques) of abnormal deposit of substances inside the cells of the brain. These intracellular deposits are called "neurofibrillary tangles" and "neuropil threads." The latter are composed of a protein called "Tau protein."
    Traditionally it was accepted that only a brain biopsy or an autopsy was able to confirm the diagnosis of Alzheimer's disease. This is still valid today; however the past 20 to 25 years have seen an increase in the study and evaluation of methods that can help to diagnose Alzheimer's disease in individuals before clinical symptoms are observed. The goal is to identify the persons that will develop Alzheimer's disease in the preclinical stages in order to be able to treat them before the disease develops to the clinical stage.
    There are functional and structural changes in the areas of the brain were the senile plaques and the neurofibrillary tangles deposit. These structural changes as well as the functional changes can be documented by specific imaging tests.
    Among these tests are those that measure structural changes in the brain like a CT scan and MRI; those that measure functional changes like brain glucose metabolism, as is the case with Positron Emission Tomography (FDG-PET), and more recently those tests that can specifically measure biochemical changes that are related to Alzheimer's disease as is the deposition of amyloid in the brain with special markers (PET PIB).
    Besides, new studies in biological fluids, specifically in the cerebrospinal fluid (CSF) have also added useful information that might help to predict who may develop Alzheimer's disease.
    Brain MRIs or CT scans might show brain changes such as diffuse or focal atrophy, while not diagnostic of Alzheimer disease, are considered a valid biomarker of Alzheimer disease neuropathology.
    Functional MRI (fMRI) evaluates the brain function by measuring the level of oxygenated hemoglobin in the brain. In Alzheimer's disease, fMRI shows areas in the brain with decreased activity that are associated with Alzheimer's disease
    PET requires the administration, usually intravenously, of a radioactive tracer. This test allows the measurement of metabolic function, brain metabolism, and binding to specific receptors in the brain. One of the most common tracers is fluorodeoxyglucose (FDG), which is glucose marked with a radioactive material [18 F]. FDG PET may detect changes in the brain in individuals prone to have Alzheimer's disease before they develop clinical symptoms of Alzheimer's disease.
    Another radioactive material that can be used as a tracer is known as Pittsburgh Compound B (PIB). This tracer has affinity with the amyloid protein. The PET PIB study might be of great utility to determine the extension of the deposits of beta amyloid in the brain.
    In addition ot their locations within the brain, the amyloid A beta 1-42 as well as the Tau proteins are also found in the liquid that bathes the surface of the brain, the cerebrospinal fluid (CSF). Samples of CSF can be easily obtained with a lumbar puncture or spinal tap. This is a relatively simple and safe procedure that consists of inserting a needle through the space between the lumbar vertebrae in the lower back. In general no anesthesia is needed, but sometimes a mild sedative is more than enough to perform the procedure. The analysis of the amyloid A beta 1-42 protein and the Tau protein in the CSF may yield important information regarding Alzheimer's disease.
    Studies of the CSF have shown that a pattern of low level of amyloid A beta 1-42 protein combined with high level of the Tau and phosphorylated Tau protein was detected in the majority (90%) of persons with clinical Alzheimer's disease; however, the same pattern was found in 39% of normal individuals. In persons with mild cognitive impairment (MCI) but no clear Alzheimer's disease the presence of the same pattern correctly identified the people that later on would develop Alzheimer's disease.
    However other clinical conditions might also produce similar results. For example deposits of amyloid A beta 1-42 can be seen in Parkinson's disease, in another form of dementia called Lewy Body disease, and also in cognitively normal individuals. Furthermore, a high concentration of Tau proteins may be seen after acute stroke or traumatic brain injuries.
    Some studies also suggest that these biomarkers may have prognostic value. The rate of deterioration may be faster in those with extremely abnormal results.
    In summary the radiological tests as well as measuring amyloid A beta 1-42 protein and Tau protein in the CSF, even while not diagnostic of Alzheimer's disease, may become an important addition to other clinical information in the diagnosis and prognosis of Alzheimer's disease.
    Who should get the tests?
    The answer is not clear and an individual should consult with their doctor about the convenience of having these tests performed. Some physicians recommend the test when the diagnosis of Alzheimer disease will have important consequences, for example, when making decisions about lifestyle, end of life treatments, etc.
    These tests can also help in the differential diagnosis with other forms of dementia that might have specific treatments available, such as normal pressure hydrocephalus or vascular dementia, or conditions that simulate dementia, as may be the case with severe clinical depression. However this should not be a common indication since in most instances these conditions can be diagnosed clinically or with other available methods.
    At the present time these diagnostic tests will not change the prognosis of the disorder since no treatment is available. However if a treatment becomes available these tests would become very important and useful

How can Alzheimer's disease be treated?


There is no cure for Alzheimer's disease. Treatment focuses on relieving and slowing down the progress of the symptoms, behavior changes, and complications.
Individuals with Alzheimer's disease should remain physically, mentally, and socially active for as long as they are able.

  • Daily physical exercise, even a short walk, helps maximize body and mind functions and helps individuals maintain a healthy weight. A balanced diet that includes low-fat protein foods and lots of fruits and vegetables will help prevent malnutrition and maintain a healthy weight. Also, people with Alzheimer's disease should not smoke, both for health and safety reasons.
  • Some studies suggest that mental activity might slow the progression of Alzheimer's disease, so engaging in as much mental activity as an individual can handle is important. Puzzles, games, reading, writing, and safe crafts are examples of mental activities. These activities should be of an appropriate level of difficulty that the individual is challenged but does not become frustrated.
  • Social interaction is also important. Stimulating and enjoyable activities in which a person is engaged with others help to keep the mind active, which can decrease symptoms in most people with early or intermediate Alzheimer's disease. Most senior centers or community centers have scheduled activities that are suitable for those with Alzheimer's disease and other forms of dementia.

The symptoms of Alzheimer's disease can sometimes be relieved, at least temporarily, with medication. Many different types of medications have been or are being tried in dementia. The medications that have worked the best so far are cholinesterase inhibitors. Others include anti-inflammatory medications and vitamin E

  • How can Alzheimer's disease be prevented?


    There is no known way to prevent Alzheimer's disease; however, being watchful for its symptoms and signs may allow earlier diagnosis and treatment. Appropriate treatment can slow or relieve symptoms and behavior problems in some people.
    Although some risk factors, such as age and genetics, can't be controlled, Alzheimer's disease may at least be delayed.
    Healthy lifestyle
    One way to reduce risk factors is to live a healthy lifestyle. Risk factors for Alzheimer's disease include heart disease, high blood pressure, and stroke. Brain health is linked to heart health, and if the heart has a hard time pumping blood, the brain won't get all the blood it needs. Research has found that people with high cholesterol and high blood pressure were six times as likely to develop Alzheimer's disease as those without elevated blood pressure and high cholesterol levels. With a healthy diet, the risk of developing heart disease, high cholesterol levels, and high blood pressure is reduced, and both the heart and brain are healthier.
    Keep active
    Keeping active - physically, mentally, and socially - may also help prevent Alzheimer's disease.
    • Physical exercise is important. It prevents muscle weakness, maintains the overall fitness of the body and has also a positive effect on the cardiovascular system.
    • Mental exercise - keeping the brain active -  might helps keep brain cells and the connections between them strong, further protecting against mental decline. Crossword puzzles, games, reading, writing, attending community classes, and watching educational programs can help a person stay mentally active.
    • Research shows that people aged 75 years and older who regularly participate in social activities have a lower risk for developing certain types of dementia. The risk for those who participate in social activities that combine mental and physical activity is even lower. 
    • Source: emedicinehealth.com