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Thursday, April 29, 2010

Baldness

* Definition of Baldness
* Description of Baldness
* Causes and Risk Factors of Baldness
* Treatment of Baldness
* Questions To Ask Your Doctor About Baldness

Definition of Baldness
Common baldness, sometimes called male- or female-pattern baldness, accounts for 99 percent of hair loss in men and women. Although its exact causes are unknown, heredity, hormones and age are contributing factors. Unlike hair loss resulting from disease or other non-hereditary factors, hair loss due to common baldness is permanent.

Male baldness usually begins with thinning at the hairline, followed by the appearance of a thinned or bald spot on the crown of the head.

Women with common baldness rarely develop bald patches. Instead, they experience a diffuse thinning of their hair.

Description of Baldness
Hair is a conspicuous element in many cultural definitions of fashion, youth and sexuality. So, it is not surprising that many cringe at the first sign of thinning hair.

Most people lose between 50 and 100 strands of hair daily, with little impact. As hairs fall out naturally, new hairs grow in. So there is no need to despair if you spot a hair or two in your sink. However, with age this natural regrowth process may slow or stop, and thinning and baldness may occur. If you are concerned about it, see your doctor for an evaluation to find out if your hair loss is due to an underlying medical disorder.

Like your skin and nails, your hair goes through a finely tuned cycle of growth and rest. Excessive hair loss can occur at any time this delicate cycle is upset.

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Causes and Risk Factors of Baldness
Factors such as diet, medications, natural hormones, pregnancy, improper hair care and certain diseases can cause temporary hair loss. Once the underlying cause is pinpointed and eliminated, the hair may grow back. See the Hair Loss report for more detailed causes of temporary hair loss.

Treatment of Baldness
There is no cure for common baldness, but surgical hair replacement can give you back a head of your own hair. Available since the 1950s, surgical hair replacement is a low-risk procedure.

Surgeons remove tiny plugs (grafts) of your hair-bearing skin and transplant them into tiny holes made in your scalp. They take these plugs from the band of hair extending from above your ears around the back of your scalp.

During one session, your surgeon may transplant between 60 and 100 hair plugs, each about the diameter of a pencil eraser. Local anesthesia and mild sedation minimize discomfort during surgery.

Hospitalization usually is unnecessary. Within a few days after the operation, tiny scabs form around each hair graft. When the scabs disappear, the donor hairs usually fall out. New hairs generally start to grow within a few months.

If the baldness and thinning is extensive, one should not expect to walk out of the first surgery with a full, natural-looking head of hair. Even after the transplanted hairs begin growing, these widely scattered clumps may look conspicuous. Additional surgeries may be needed to fill the void. It may take a year or two before you will be pleased with your new appearance.

The quest for a new look may cost in the range of $2,000 for each round of surgery. Typically, it takes three or fours sessions to cover a bald area.

Questions To Ask Your Doctor About Baldness
Is the baldness caused by a medical disorder rather that the regrowth process stopping?

If baldness runs in the family, will the male family members evidently start going bald?

Will certain kinds of medicine cause hair loss?

Do you recommend hair replacement?

Is this procedure successful?

Do you recommend using Rogaine or Propecia?

What are the side effects of using these drugs?

Vitiligo

* Definition of Vitiligo
* Description of Vitiligo
* Causes and Risk Factors of Vitiligo
* Symptoms of Vitiligo
* Diagnosis of Vitiligo
* Treatment of Vitiligo
* Questions To Ask Your Doctor About Vitiligo

Definition of Vitiligo
Vitiligo, also called white spot disease or leukoderma, is a disease in which the skin loses its pigment due to the destruction of melanocytes.

Description of Vitiligo
Melanocytes are pigment cells located in the surface layer of the skin called the epidermis and are responsible for producing melanin. Melanin is a dark pigment that gives skin its color and protects against ultraviolet radiation. When melanocytes stop producing melanin, the skin becomes pale, leaving areas of white patches - this is called vitiligo.

Vitiligo can start at any age, but it often occurs between the ages of 20 and 30. Vitiligo may begin on the face above the eyes, or on the neck, armpits, groin, hands or knees. Vitiligo may appear as a few small pigmented patches or spread over the entire body. In many cases, initial pigment loss will occur, then, after several months, the number and size of the light areas become stable and may remain so for a long time. Episodes of pigment loss may appear again later.

Vitiligo is present in about 1 percent of the population.

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Causes and Risk Factors of Vitiligo
The actual cause of vitiligo is unknown, however researchers believe that there are many factors and/or conditions listed below that contribute to the disease:

* Heredity (over 30 percent of affected persons have reported vitiligo in a parent, sibling, or child)

* Exposure to chemicals such as phenol (disinfectant) or catechol (used in dyeing or tanning)

* Emotional or physical stress

* Autoimmune disorder is which the body may be destroying its own melanocytes

* Autotoxic response is which the melanocytes self-destruct leaving a toxic residue, that, in turn destroys new melanocytes

* Skin injury

* Burns

* Inflammatory skin disorders

* Associative disorders such as diabetes, pernicious anemia, hyper- and hypo-thyroidism, Addison's disease (adrenal insufficiency), uveitis (inflammation of the eyes) or alopecia areata (patches of hair loss).

Symptoms of Vitiligo
The symptoms of vitiligo are:

* Chalk white patches of skin often located symmetrically on both sides of the body

* White hairs within depigmented patches

Diagnosis of Vitiligo
The medical history is important, but diagnosis can usually be made solely by observation of characteristic skin changes. For fair-skinned people, the doctor will use a special light, called a Wood's lamp, to shine on the skin in a dark room to identify the vitiliginous patches. In some cases, a skin biopsy may be required.

Treatment of Vitiligo
Depending on the severity of the condition, the treatment method may vary. Treatment methods include:

* Avoidance of tanning. For fair-skinned individuals, avoiding tanning of normal skin can make the areas of vitiligo almost unnoticeable.

* Use a sunscreen with an SPF of at least 30.

* Use a cosmetic cover-up solution. Make-up, self-tanning compounds with dihydroxyacetone, and dyes (such as Covermark, Walnut Stain, Vita Dye or Dermablend) help temporarily conceal the white patches of vitiligo.

* Repigmentation. The restoration of the normal pigment and can be achieved with repigmentation therapy or corticosteroids. To get repigmentation, new pigment cells must be produced from existing ones, such as ones found at the base of hair follicles, from the edge of the patch or from the patch itself if depigmentation is not complete.

In repigmentation therapy, a patient is given a psoralen drug (orally) and then is exposed to ultraviolet light A (UV-A) in the doctor's office. This therapy is called PUVA. When psoralen drugs are activated by UV-A, they stimulate repigmentation by increasing the availability of color-producing cells at the skin's surface. Psoralen is also available in a topical form that can be applied to the body for patients with small, scattered patches. Topical corticosteroids (such as Temovate or Psorcon) are prescribed for patients with small patches of vitiligo.

* Depigmentation is the destruction of the remaining melanocytes. Patients with vitiligo over half of their exposed body may want to consider using this method. A bleaching chemical called monobenzylether of hydroquinone (Benzoquin) is applied to normally pigmented skin. Treatment may take up to one year.

Questions To Ask Your Doctor About Vitiligo
Is vitiligo contagious?

Could there be an underlying condition causing this?

Will this reoccur?

What treatment method do you recommend?

Vertigo

* Definition of Vertigo
* Description of Vertigo
* Causes and Risk Factors of Vertigo
* Symptoms of Vertigo
* Treatment of Vertigo
* Questions To Ask Your Doctor About Vertigo

Definition of Vertigo
Vertigo is a type of dizziness felt as a shift in a person's relationship to the normal environment (a feeling that the room is spinning is common) or a sense of movement in space.

Although dizziness and vertigo are often used interchangeably, they are not the same thing. While all vertigo is dizziness, not all dizziness is vertigo.

True vertigo, from the Latin "vertere," to turn, is a distinct, often severe form of dizziness that is a movement hallucination.

Description of Vertigo
There are four major types of dizziness - vertigo, presyncope, disequilibrium, and lightheadedness.

Most patients with true vertigo have a peripheral vestibular disorder, such as benign positional vertigo. This is usually associated with tinnitus and hearing loss.

Central disorders, such as brain stem or cerebellar lesions, tend to be more chronic but less intense than peripheral disorders and are not associated with hearing loss. Central disorders account for only 15 percent of patients with vertigo.

Vertigo is the illusion that you - or your surroundings - are moving. You may feel that you are spinning, tilting, rocking, or falling through space. You may vomit or have ringing in the ears (tinnitus). Also, your eyes may uncontrollably jerk back and forth (a condition called nystagmus).

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Causes and Risk Factors of Vertigo
There are several causes of vertigo:

Benign positional paroxysmal vertigo (BPPV) is a disorder of the inner ear. The cause usually is unknown, but an upper respiratory tract infection or a minor blow to the head may be responsible. This type of vertigo occurs abruptly when you move your head up and down, or when you turn over in bed. Symptoms can be distressing but they fade in a few seconds. Avoiding positions that bring this on may reduce its occurrence.

BPPV is the commonest form of vertigo, with attacks lasting 30 to 60 seconds, typically set off when rolling over in bed, moving the head to one side or reaching for something ("top-shelf vertigo"). Sufferers can usually describe specific head movements that trigger it.

Although BPPV often occurs for no apparent reason, it can follow an ear infection, head or ear injury, and is thought to result from the dislodgement of normal crystalline structures in the ear's balance detectors. People with BPPV are often relieved to hear that it is due to an inner ear condition and does not signify some serious disorder such as a stroke or tumor.

Labyrinthitis refers to a variety of conditions within the inner ear. It may be associated with inflammation, an upper respiratory infection or nerve deterioration, but often occurs independently of other problems.

Central nervous system disorders that can cause vertigo as a symptom include multiple sclerosis, epilepsy, neck injuries, certain forms of migraine, acoustic neuroma, cerebellar and brain stem tumors, and TIAS (transient ischemic attacks).

Symptoms of Vertigo
A patient may experience severe vertigo for days or weeks. Nausea, vomiting, and involuntary eye movements are common. The condition gradually improves, but symptoms can persist for weeks or months.

Treatment of Vertigo
Treatment depends on the diagnosis. A complete medical evaluation is recommended for anyone with vertigo. This can reveal the true cause and suggest one or more solutions based upon treating the underlying disorder.

Questions To Ask Your Doctor About Vertigo
Is it true vertigo?

What is the probable cause?

Is it related to a central nervous system disorder?

How can the symptoms be controlled?

Do I need to see a specialist?

Varicella (Chicken Pox)

* Definition of Varicella (Chicken Pox)
* Description of Varicella (Chicken Pox)
* Symptoms of Varicella (Chicken Pox)
* Treatment of Varicella (Chicken Pox)
* Prevention of Varicella (Chicken Pox)
* Questions To Ask Your Doctor About Varicella (Chicken Pox)

Definition of Varicella (Chicken Pox)
Varicella, otherwise known as chicken pox, is a generalized infection caused by the varicella zoster virus. It is an extremely contagious disease that is characterized by a blistery rash. It occurs most frequently in children, between the ages of five and eight. Less than 20 percent of all cases in the U.S. affect people over the age of 15. Chicken pox is transmitted so easily that almost everyone gets the disease.

Description of Varicella (Chicken Pox)
Chicken pox is contracted by touching an infected person's blisters or anything that has been contaminated by contact with them. The virus is also thought to be airborne since it may be caught from an infected person by coughing and sneezing even before the rash develops. Another way to get chicken pox is by exposure to shingles, a localized rash caused by the same virus.

The incubation period (time between exposure to the illness and the appearance of symptoms) of chicken pox is 10 to 21 days. It is contagious for about six to eight days after the rash appears or until all of the blisters have dried out.

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Symptoms of Varicella (Chicken Pox)
There are usually no symptoms before the rash occurs but occasionally there is fatigue and some fever in the 24 hours before the rash is noticed. The typical rash goes through a number of stages:

1. First it appears as flat red splotches

2. They become raised and may resemble small pimples

3. They develop into small blisters, called vesicles, which are very fragile

4. They may look like drops of water on a red base

5. As the vesicles break, the sores become pustular and form a crust - the crust is made of dried serum, and not true pus. The crust falls away between days nine and 13. (Itching is severe in the pustular stage.)

The vesicles tend to appear in crops within two to six days. All stages may be present in the same area. They often appear on the scalp and in the mouth, and then spread to the rest of the body, but they may begin anywhere. They are most numerous over shoulders, chest and back. There may be only a few sores, or there may be hundreds.

The doctor should be called if the rash involves an eye, if fever is higher than 103, if there is much vomiting, or if there are signs of bacterial infection (such as a green or yellow discharge from the blisters, or any blisters with red streaks radiating outwards). Go to the emergency room if there is difficulty breathing or if the person is confused and disoriented or has seizures.

Treatment of Varicella (Chicken Pox)
The major problem in dealing with chicken pox is control of the intense itching and reduction of the fever. Warm baths containing baking soda can help; sometimes cool compresses or cool baths will calm itching.

Aspirin should not be used for children or adolescents with chicken pox because of the associated risk of Reye's syndrome, a rare but life-threatening condition. Fever can be treated with acetaminophen or ibuprofren.

Cut the fingernails or use gloves to prevent skin damage from intense scratching. When lesions occur in the mouth, gargling with salt water may provide comfort. Drink cold fluids, and avoid hot, spicy and acidic foods (orange juice).

Hands should be washed three times a day and all of the skin should be kept gently but scrupulously clean in order to prevent a complicating bacterial infection. A minor bacterial infection will respond to soap and time. If it becomes severe and results in the return of a fever, see a physician.

Scratching and infection can result in permanent scars. A visit to the physician may not be necessary, unless a complication seems possible.

Acyclovir (Zovirax), a drug primarily used for treating herpes simplex infections in adults, is a safe and effective treatment for chicken pox in normal children, especially older children and teenagers, when therapy is initiated during the first 24 hours of a rash. Adverse effects of acyclovir are minimal, the most common being gastrointestinal.

Because chickenpox is extremely contagious, keep children home from daycare or school until the blisters are all crusted over.

Prevention of Varicella (Chicken Pox)
Chicken pox can be prevented through vaccination (now recommended by almost all major national health and public health groups). Recommendations are:

* Children and Adolescents: Healthy children can be vaccinated, optimally at age 12 to 18 months or anytime up until the age of 13, if they have no history of chicken pox. Adolescents 13 years and older who have no history of chicken pox, should receive two doses of vaccine four to eight weeks apart. Duration of immunity after vaccination is not completely known. Re-vaccination with a booster dose may be required to sustain immunity through adulthood.

* Adults: Two doses of varicella vaccine four to eight weeks apart are recommended for healthy adults with no history of chicken pox or previous vaccination. Health care workers, daycare workers, employees of colleges or residential facilities, family members of immunocompromised individuals, and others who live or work in environments in which transmission may be easy are particularly encouraged to receive vaccination.

Questions To Ask Your Doctor About Varicella (Chicken Pox)
Is someone contagious 24 hours prior to having a fever?

At what age is the greatest risk of complications?

Do you recommend calamine lotion to help the itching?

Do you recommend any medications to decrease the severity of this virus?

What are the side effects?

Are showers less likely to spread the disease verses baths?

Can you get chicken pox a second time?

Does having a mild case or a severe case affect your chances of acquiring the virus?

As a parent, what can I do to avoid acquiring chicken pox for the first time or as a repeat?

Does chicken pox increase the chances of developing shingles?

What are some of the complications?

What are the signs and symptoms that should be reported to the doctor?

Are there any measures that can help prevent scarring, such as vitamin E?

Wednesday, April 28, 2010

Birth Control

* Definition of Birth Control
* Description of Birth Control
* Questions To Ask Your Doctor About Birth Control

Definition of Birth Control
Birth control is a term used to describe an artificial or natural means to prevent pregnancy.

Description of Birth Control
There are various methods of birth control available today. The most common artificial methods are male/female condoms, spermicides, sponge, diaphragm, cervical cap, oral contraceptives (birth control pills), injectable contraceptions (Depo-Provera, Lunelle), IUDs and surgical sterilization.

The natural methods include complete abstinence (no sexual intercourse), periodic abstinence and withdrawal.

Male/Female Condom

The male condom (also known as a prophylactic or rubber) is a thin sheath, usually made of latex rubber, that covers the erect penis. When used correctly, a latex condom is about 85 percent effective, both for preventing pregnancy and decreasing the chance of contracting most STDs, including AIDS. Condoms can be made of animal membrane; however, some experts believe that the pores in such natural "skin" condoms may allow the virus to pass through. To be effective, the condom must be undamaged, applied to the erect penis before any genital contact, and must remain intact and snugly in place until completion of the sexual activity.

The female condom is a lubricated sheath with a flexible polyurethane ring on each end. One ring is inserted into the vagina while the other remains outside. The ring outside covers the labia and keeps the condom in place during intercourse. When in place, the vaginal condom lines the vaginal wall and creates a covered passageway for the penis. To be effective, the condom must be undamaged and inserted before any genital contact. It must also remain inside of the vagina until the completion of intercourse. The estimated effectiveness of the female condom is 74 to 79 percent.

Risks and side effects: The risks of using a male or female condom are minimal. Some people can experience a slight irritation and allergic reaction.

Spermicides

Spermicides are available in foam, jelly, gel and suppositories, and work by forming a physical and chemical barrier to sperm. They can be inserted into the vagina on a diaphragm, a cervical cap, a condom or alone, within an hour before sexual intercourse. If intercourse is repeated, more spermicide should be inserted. The estimated effectiveness is about 70 to 80 percent when used with other barrier contraceptives. They are not very effective when used alone. Risks and side effects: The risks of using spermicides are minimal. Some people can experience a slight irritation and allergic reaction.

Sponge

The sponge is made of white polyurethane foam (shaped like a small donut) and contains a spermicide. The sponge is inserted into the vagina to cover the cervix during and after intercourse. It is held in place by the vaginal walls and the dimple covering the cervix. It can be kept in place up to 24 hours. The estimated effectiveness is 72 to 82 percent. Risks and side effects: The risks of using a sponge are minimal. Some people may experience a slight irritation and allergic reaction, difficulty in removal, and very rarely, toxic shock syndrome (a bacterial infection associated with the use of highly absorbent tampons).

Diaphragm

A diaphragm is made of soft rubber and is shaped like a shallow cup. It has a flexible metal spring rim that fits snugly over the cervix. Before insertion, a spermicidial cream or jelly should be applied into the shallow cup. The diaphragm must be fitted by a health professional and the correct size must be prescribed to ensure a snug seal with the vaginal wall. It must be kept in the vagina at least six to eight hours after intercourse. It is most effective when used with a spermicide. The estimated effectiveness is 82 to 94 percent.

Risks and side effects: The risks of using a diaphragm are minimal. Some people may experience a slight irritation, an allergic reaction, a bladder infection and very rarely, toxic shock syndrome (a bacterial infection caused by use of highly absorbent tampons).

Women who have a severely displaced uterus, cystocoele (a protrusion of the bladder through the vaginal wall), fistulas (openings in the vagina), scoliosis (curvature of the spine), spina bifida, chronic urinary tract infections or a history of toxic shock syndrome, should not use a diaphragm.

Cervical Cap

The cervical cap is a thimble-shaped rubber cap that fits snugly over the cervix. Like the diaphragm, it blocks sperm from entering the cervical opening. Usually, a small amount of spermicide is used on the inside of the cap to kill any sperm that may break through the seal. The cervical cap must be fitted by a health professional and the correct size prescribed to ensure a snug seal. It must be kept in the vagina at least six to eight hours after intercourse. It is most effective when used with a spermicide. It has an estimated effectiveness of about 82 percent.

Risks and side effects: The risks of using a cervical cap may include abnormal pap tests, vaginal or cervical infections, and very rarely, toxic shock syndrome.

Women who have a severely displaced uterus, fistulas, scoliosis, spina bifida, chronic urinary tract infections, a history of toxic shock syndrome, cervical erosion or laceration, or an elongated or irregular cervix, should not use a cervical cap.

Oral Contraceptives (Birth Control Pills)

At present, more than 20 brand names and more than twice that number of formulations of oral contraceptives are available. Because they are 98 to 99 percent effective, oral contraceptives offer women the most reliable form of easily reversible contraception (other than abstinence) from sexual intercourse.

Birth control pills use synthetic hormones similar to the ones made in the ovaries. There are two types of pills currently manufactured in the United States: a combination pill, with both synthetic progesterone (progestin) and synthetic estrogen; and mini-pills, which contain only progestin.

Although all oral contraceptives prevent sperm from uniting with an egg, they work in slightly different ways. The combination pill keeps the ovaries from releasing an egg. The mini-pill is less reliable in suppressing egg release, but creates changes in the cervix and uterus that make conception less likely.

The mini-pill is less effective than the combination pill, but does not have the risks attributed to estrogen, such as increased possibility of blood clots and nausea. However, the mini-pill causes more problems with spotting and bleeding between periods and therefore, its use is not widespread.

Combination pills come in two types. One provides the same combined dose of synthetic progestin and synthetic estrogen throughout the entire cycle. Others, sometimes called biphasic or triphasic pills vary the levels of these two hormones to more closely approximate a woman's normal hormonal variations. In some women, these pills have a lower risk of side effects.

The pill essentially works by interfering with a woman's normal fluctuations in hormone levels, which in turn prevents the egg from maturing and being released. It also acts on the climate of the cervix, uterine lining and fallopian tubes, making them all inhospitable for egg, sperm or embryo.

Combination pills are packaged in several ways: the most common is the 21-day pack. One pill is taken each day for 21 days, then none during the next seven days (for the average 28-day cycle during which menstruation occurs). There are also 28-day packs, with 21 active pills followed by seven inactive ones (placebos).

The mini-pills must be taken at the same time (within three hours) every day.

In addition to effectiveness in preventing conception, oral contraceptives offer other benefits. Menstrual periods are usually lighter, making iron deficiency less likely, and there may be less cramping. Ovarian cysts, ovarian cancer, and perhaps endometrial cancer occur less often among pill users. In addition, ectopic pregnancy occurs less frequently among pill users (in the rare instance when pregnancy occurs at all).

Risks and side effects: Minor side effects include headaches, sore breasts, weight gain, feeling sick to your stomach, irregular bleeding, and depression. Serious possible side effects are more likely to occur in women over the age of 35. These include an increased risk of heart attack, stroke and formation of blood clots in the veins (thrombosis). These side effects are even more likely to occur among women who smoke; thus, the pill is not recommended for women who smoke. Women with a history of blood clots, high blood pressure, severe diabetes, or breast or uterine cancer, should not take the pill.

Possible Interactions: There is a possibility that the herb St. John’s wort may interfere with the pill’s effectiveness, therefore it is best not to take this herb at the same time that you are on the pill. Also, several antibiotics can interfere with the effectiveness of the birth control pill. It is best to consult with a pharmacist or your doctor to determine if any medication you are taking might interfere with the pill.

Ortho Evra, Contraceptive Patch

The Contraceptive Patch has the similar properties as the oral birth control pill, but is applied to the skin of the lower abdomen, buttocks, upper arm or upper body. It is worn continuously for 7 days and then replaced with another patch every week for 3 weeks, followed by one week without a patch. Estrogen levels are higher with the patch than with birth control pills. In theory, higher estrogen levels may increase the risk of blood clots. It is currently unclear if women who use the patch have higher risks of blood clots when compared to women who use birth control pills.

Risks and side effects: Side effects of the Contraceptive Patch may include nausea or breast tenderness, and rare risks of blood clots, heart attack and stroke, particularly if women smoke while using the contraceptive.

Contraceptive Vaginal Ring

The contraceptive vaginal ring or NuvaRing is a plastic ring coated with both estrogen and progesterone. It has similar properties to birth control pills but it is inserted in the vagina. It is worn continuously for three weeks followed by one week without the ring. Lower doses of hormones are released from the NuvaRing than from birth control pills.

Risks and side effects: Side effects of the vaginal ring may include nausea or breast tenderness, and rare risks of blood clots, heart attack and stroke, particularly if women smoke while using the contraceptive.

Depo-Provera

Depo-Provera is an injectable form of a progestin (like the oral minipill). Each injection provides contraceptive protection for 14 weeks. It is injected every three months into a muscle in the buttocks or arm. Its estimated effectiveness is 99 percent.

Risks and side effects: The risks of using Depo-Provera may include menstrual cycle irregularity, headaches, nervousness, depression, nausea, dizziness, change of appetite, breast tenderness, weight gain, enlargement of ovaries and/or fallopian tubes, excessive growth of body and facial hair. Depo-Provera can also cause bone loss. Women who use this method for two years or longer should get a special X-ray to measure the strength of their bones.

Implanon

Implanon is a progesterone-only implant. It lasts for three years and is effective within 24 hours of insertion. It is inserted in the upper arm in a doctor’s office using local numbing medicine. It is made to gradually release progesterone. Its estimated effectiveness is 99 percent.

Risks and side effects: The risks of using Implanon are rare but may include rash, infection or movement of the rod in the arm. Other effects may include menstrual cycle irregularity, change of appetite, breast tenderness, and weight gain.

The Morning After Pill (Emergency Contraceptive)

The morning after pill (MAP) is an increasingly accepted means of contraception. It is best used in situations when intercourse happens infrequently or unexpectedly. The MAP is a special formulation of the same (or similar) hormones used in birth control pills. It is given in one or two doses. To be effective, the first dose must be taken within 72 hours of intercourse, the sooner the better.

Risks and side effects: It can cause nausea and breast tenderness, and it can disrupt the regularity of the menstrual cycle.

RU486

Approved in the U.S. in September 2000, RU486 (mifepristone) causes the uterine lining to shed after an egg is implanted. It is taken as a series of pills over the course of a few weeks and will interrupt a very early pregnancy. It is very widely used in Europe and has been approved in the U.S. since September 2000. It is best to have this pill prescribed by a physician or health care setting that is familiar with its use and can follow users carefully to assure optimal outcomes.

Risks and side effects: Possible side effects include weight gain, sore breasts, menstrual cycle irregularity, and very rarely life-threatening infection.

IUDs

IUDs are small devices that fit inside the uterus. Some contain copper or synthetic progesterone; others are made of white plastic. One or more strings are usually attached to IUDs. When the IUD is in place, these strings extend into the upper vagina. The IUD alters the uterine and tubal fluids, which inhibits the transport of sperm through the cervical mucus and uterus. Its estimated effectiveness is 96 percent.

Risks and side effects: The risks of using IUDs are cramps, bleeding, pelvic inflammatory disease (PID) an infection of the uterus and fallopian tubes, infertility, and very rarely, perforation of the uterus.

IUDs should not be used by women who are pregnant, who have an active/recent or recurrent pelvic infection, acute cervicitis, vaginitis, abnormal pap tests, irregular or abnormal pelvic bleeding, disorders of the blood, endometriosis, exposure to DES in utero, an abortion within the last three months that led to an infection, diabetes, sickle cell anemia, anemia, bicornate uterus, cervical stenosis, endometrial polyps, severe menstrual cramps or bleeding, small uterus or valvular heart disease.

Surgical Sterilization

Female sterilization (tubal ligation) involves either cutting, constricting, clipping cutting or blocking the fallopian tubes to prevent the male sperm from reaching the ova. This can be done with a laparoscope (camera through the belly button) or hysteroscope (camera through the vaginal to the uterus). Male sterilization (vasectomy) involves cutting the two vas deferens (the ducts that carry sperm from the testes to the seminal vesicles).

Both of these procedures are about 99 percent effective.

Risks and side effects: Both of these have the normal risks associated with surgery, including infection or bleeding after the operation.

Complete Abstinence and Periodic Abstinence

Complete abstinence is not engaging in any type of sexual intercourse. Periodic abstinence is not having sexual intercourse during a woman's fertile period. Also called "natural family planning" or the "rhythm method", periodic abstinence is dependent on the ability to identify the approximate 10 days in each menstrual cycle that a woman is fertile. Its estimated effectiveness varies from 53 to 86 percent. However, it is important to recognize that many experts in family planning feel that the actual effectiveness of this method is much lower. This is because many women vary from month to month with respect to when they are most fertile.

Withdrawal

Withdrawal involves removing the penis from the vagina just before ejaculation so that the sperm is deposited outside the vagina and away from the lips of the vagina, as well. Withdrawal is not very effective, because the drops of fluid that come out of the penis right after it becomes erect can contain enough sperm to cause pregnancy.

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Questions To Ask Your Doctor About Birth Control
Which birth control method do you recommend?

If the condom is recommended, which is more effective - the male or female condom?

What should be done if the condom breaks during intercourse without our knowledge?

If sponges, diaphragms or cervical caps are recommended, how will I know if they are inserted correctly?

Which birth control pill do you recommend?

What happens if I miss a pill?

How long can a woman remain on the pill?

What are the side effects?

Can I have a prescription for the morning after pill, just in case I need it?

Attention Deficit/Hyperactivity Disorder

* Description of Attention Deficit/Hyperactivity Disorder
* Causes and Risk Factors of Attention Deficit/Hyperactivity Disorder
* Symptoms of Attention Deficit/Hyperactivity Disorder
* Diagnosis of Attention Deficit/Hyperactivity Disorder
* Treatment of Attention Deficit/Hyperactivity Disorder
* AlternativeAttention Deficit/Hyperactivity Disorder
* Questions To Ask Your Doctor About Attention Deficit/Hyperactivity Disorder

Description of Attention Deficit/Hyperactivity Disorder
Attention Deficit/Hyperactivity Disorder (ADHD) is a genetically determined hereditary disorder. It is a syndrome characterized by chronic behavior patterns of inattentiveness, lack of impulse control and excess energy (hyperactivity). The symptoms may be mild or severe and are associated with functional deviations of the central nervous system without signs of major neurologic or psychiatric disturbance.

Inattentiveness is when the child is easily distracted and has difficulty focusing or concentrating on a task.

Lack of impulse control is when the child may get into frequent fights or act aggressively toward others with little cause.

Hyperactivity is when the child seems to fidget, squirm and move about constantly and can't sit still for any length of time.

It is important for parents, teachers and caregivers to understand that ADHD is not caused by poor parenting or a chaotic home environment. ADHD affects approximately 3 to 5 percent of all American children. The syndrome is 4 to 6 times more likely to occur in males than in females. In about half the cases, the age of onset occurs before age 4.

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Causes and Risk Factors of Attention Deficit/Hyperactivity Disorder
A single biologic model to explain the syndrome has not been established. Some researchers believe that ADHD is due to a genetic defect that results in altered brain biochemistry. Differences in biochemistry are considered to be the cause of poor regulation of attention, impulsivity and motor activity.

In 1990, the New England Journal of Medicine published a landmark study by researchers at the National Institute for Mental Health which documented the neurobiological effects of ADHD through brain imaging. The rate at which the brain uses glucose, its main energy source, was shown to be lower in persons with ADHD, especially in the portion of the brain that is responsible for attention, handwriting, motor control and inhibition responses.

Additionally, some researchers suggest that prenatal conditions such as maternal alcohol or drug abuse and birth complications may contribute in some cases.

Symptoms of Attention Deficit/Hyperactivity Disorder
ADHD characteristics often arise in early childhood. The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) lists the following symptoms for Childhood ADHD:

Inattention

* often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

* often has difficulty sustaining attention in tasks or play activities

* often does not seem to listen when spoken to directly

* often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

* often has difficulty organizing tasks and activities

* often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

* often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)

* often easily distracted by extraneous stimuli

* often forgetful in daily activities

Hyperactivity-Impulsivity

* often fidgets with hands or feet or squirms in seat

* often leaves seat in classroom or in other situations in which remaining seated is expected

* often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

* often has difficulty playing or engaging in leisure activities quietly

* is often "on the go" or often acts as "driven by a motor"

* often talks excessively

* often blurts out answers before questions have been completed

* often has difficulty awaiting turn

* often interrupts or intrudes on others

Diagnosis of Attention Deficit/Hyperactivity Disorder
The fact that the child exhibits ADHD-like behaviors does not prove that they are suffering from this disorder. It is quite possible that some other problem is causing these symptoms. In order to correctly diagnose ADHD, the doctor must first rule out these "look-alike" factors by conducting a thorough physical examination and administering laboratory and other diagnostic tests:

Medical conditions. Allergy and effects of allergy medication, hearing loss, thyroid disorders, visual disturbances, genetic disorders (such as Fragile X syndrome), seizure disorders and chronic medical conditions.

Mental disorders. Anxiety disorders, conduct disorder, depressive disorders, oppositional defiant disorder, pervasive development disorder or Tourette's syndrome.

Behavioral and neurologic conditions. Articulation problems, coordination problems, encopresis (a type of soiling problem whereby children defecate in inappropriate places), enuresis (bed-wetting), night terrors and sleep difficulties.

Learning and language disabilities. Difficulties with listening, speaking, thinking, reading, writing, reasoning and performing mathematical calculations.

Additionally, the doctor will take a thorough medical history and consult rating scales to confirm ADHD. The history should include a family, birth and general medical history gathered from family as well as school and day-care (if applicable) workers.

Children suspected of having ADHD can be evaluated at the school’s expense and, if found to be eligible, provided services under either of two federal laws: (1) the Individuals with Disabilities Education Act (IDEA), or (2) Section 504 of the Rehabilitation Act of 1973.

Treatment of Attention Deficit/Hyperactivity Disorder
Most ADHD therapy today involves a "biopsychosocial" approach - "bio" refers to medication, "psycho" refers to counseling and psychotherapy and "social" refers to instruction in self-management and training in social skills.

Medications

For decades, medications have been used to treat the symptoms of ADD. Medications in the class of drugs known as stimulants seem to be the most effective in both children and adults. These are methylphenidate (Ritalin, Methlyn), mixed salts of single entity amphetamine product (Adderall), and dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). Cylert may cause serious liver damage.

For many people, these medicines dramatically reduce the hyperactivity and improve their ability to focus, work and learn. The medications may also improve physical coordination, such as handwriting and ability in sports.

Stimulants are not appropriate for every child with attention disorder. For instance, they are not intended for anyone with a primary psychiatric illness (such as schizophrenia, in which the person loses touch with reality) because they can worsen the disturbances. They can aggravate emotional problems, such as anxiety. They can bring out tics (involuntary movements) in a patient with a family history of tics.

Even a correctly administered stimulant can cause adverse effects, for no drug is completely without risk. The side effects most frequently reported are decreased appetite and insomnia. Less common are drowsiness, hypersensitivity, weight loss, headache, nausea, and blood pressure changes.

Whether a child should be given stimulants is a case-by-case decision in which the benefits are weighed against the risks. In the past, most stimulant treatments for ADHD were prescribed only for two to three years and only for children. But today, treatment may extend over longer periods and may be given to adolescents and adults. Stimulants clearly are not intended to be the sole treatment.

Other medications prescribed for symptoms of ADHD include clonidine (Catapres) and tricyclic antidepressants.

Behavior Modification

Parents and children can be instructed in positive reinforcement techniques for rewarding desirable behavior and reducing negative behavior. Here are some strategies:

o Discipline can best be maintained by establishing a few consistent rules with immediate consequences whenever each rule is broken. Rules should be phrased positively in terms of what the child should do. Praise the child and reward him or her for good behavior.

o Structure a system of rewards for good behavior. This system encourages the child to work to earn privileges or rewards he or she wants by accumulating points for desired behaviors and removing points for undesirable behaviors.

o Make a written agreement (a contract) with the child in which the child agrees to do his or her homework every night or to demonstrate other desired behavior in return for a privilege.

o Provide a specified time-out location for when the child is out of control. This should not be seen as a place of punishment but as a "calm down" spot.

o Set up a study area away from distractions and establish a specific time each day to do homework.

o Have the teacher make a checklist of homework to be done.

o Put up a calendar of long-term assignments and other tasks.

o Avoid emotional reactions such as anger, sarcasm and ridicule.

Counseling and Psychotherapy

There are three different types of psychotherapy available: individual psychotherapy, cognitive behavioral therapy and family therapy.

Individual therapy helps children with anxiety, difficulties with self-esteem, depression and other emotional problems. Cognitive behavioral therapy teaches children to modify their behavior by correcting the way they think about it. Family therapy assists the child and his or her family in understanding the condition.

Close communication between the physician and school personnel is essential.

Self-management/Social Skills

Self-management and training in social skills helps children curb aggressive, impulsive and socially maladaptive behaviors.

AlternativeAttention Deficit/Hyperactivity Disorder
There is no evidence to support the use of dietary management. Megavitamins, restriction of sugar, and supplementary trace minerals do not appear effective. Diets low in food additives or coloring are not effective.

Questions To Ask Your Doctor About Attention Deficit/Hyperactivity Disorder
Can my child have ADHD and not be hyperactive?

How do you diagnose a hyperactive child?

How do you know the child's disorder is caused by deviations of the central nervous system versus just environmental discipline problems?

Would you prescribe a medication for part of the treatment?

What are the side effects?

How should I expect the child's behavior to change after starting the medication?

How long will the medication have to be taken?

Are there any drug-free treatments for ADHD?

What can be done to prevent social and emotional problems?

Does eliminating sugar and caffeine products help reduce hyperactivity?

What kind of behavior therapy will be planned?

And will someone be able to work with the family and teachers to follow the behavioral plan?

Does my child qualify for special education or other assistance from his/her school?

With medications and behavior-modification techniques, when should we start to see a change in the child's behavior and learning problems?

Angina Pectoris

* Definition of Angina Pectoris
* Description of Angina Pectoris
* Causes and Risk Factors of Angina Pectoris
* Symptoms of Angina Pectoris
* Diagnosis of Angina Pectoris
* Treatment of Angina Pectoris
* Questions To Ask Your Doctor About Angina Pectoris

Definition of Angina Pectoris
Angina pectoris is a term that describes chest pain caused by myocardial ischemia - a condition in which the amount of oxygen getting to the heart muscle is insufficient. It usually occurs on exertion and is relieved by rest. Angina generally is a symptom of coronary artery disease. In most severe cases, it may occur with minimal effort or at rest.

Description of Angina Pectoris
Angina pectoris is a common manifestation of coronary artery disease. The pain is caused by reduced blood flow to a segment of heart muscle (myocardial ischemia). It usually lasts for only a few minutes, and an attack is usually quickly relieved by rest or drugs (such as nitroglycerin). Also, it is possible to have myocardial ischemia without experiencing angina.

Typically, angina is described as a "pressure" or "squeezing" pain that starts in the center of the chest and may spread to the shoulders or arms (most often on the left side, although either or both sides may be involved), the neck, jaw or back. It is usually triggered by extra demand on the heart: exercise, an emotional upset, exposure to cold, digesting a heavy meal are common examples.

Some people experience angina while sleeping or at rest. This type of angina may be caused by a spasm in a coronary artery, which most commonly occurs at the site of atherosclerotic plaque in a diseased vessel.

Most people with angina learn to adjust their lives to minimize attacks. There are cases, however, when the attacks come frequently and without provocation - a condition known as unstable angina. This is often a prelude to a heart attack and requires special treatment, primarily with drugs. Angina affects both men and women, usually in middle age. Men are much more likely than women to experience it before age 60. It may develop weeks, months or even years before a heart attack, or may be experienced only after a heart attack has occurred.
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Causes and Risk Factors of Angina Pectoris
The two main causes of angina are coronary artery spasm, and atherosclerotic plaque buildup which causes critical blockage of the coronary artery.

The risk factors include:

* smoking

* sedentary lifestyle

* high blood pressure, or hypertension

* high blood fats or cholesterol

* hypercholesterolemia

* diabetes

* family history of premature ischemic heart disease

Men are at higher risk than women.

Symptoms of Angina Pectoris
Classic or typical angina occurs predictably with physical exertion or strong emotional reactions, and goes away just as predictably with rest. Starting immediately behind the sternum (breast bone), the pain may radiate to the left arm and shoulder or up to the jaw.

Most people describe the pain as a kind of squeezing pressure, tightness or heaviness.

There may be anxiety, increased or irregular heart rate, paleness and cold sweat, and a feeling of doom. The symptoms are like the ones for a heart attack.

In some instances, chest pain results from other types of heart problems, including diseases that affect the heart muscle itself or the valves that control blood flow through the heart. Occasionally, ulcers, gallstones, abnormal contractions of the esophagus or severe anxiety and panic attacks can cause chest pain. However, if you do experience these symptoms, your best plan of action is to get immediate help. Stop doing whatever is causing the symptoms and call 911. Lie down with your head slightly elevated. If you are not allergic to it, take one adult aspirin.

Diagnosis of Angina Pectoris
Diagnosis of angina is based upon the classic history of chest pain on exertion and by means of tests, demonstrating the presence of coronary artery disease.

Treatment of Angina Pectoris
In most instances, drugs are recommended for the treatment of angina before surgery is considered. The major classes of drugs used to treat angina include the following:

Nitrates. These come in several forms: nitroglycerine tablets to be slipped under the tongue during or in anticipation of an attack; ointment to be absorbed through the skin; long-acting medicated skin discs; or long-acting tablets. The latter three forms are used mostly to prevent rather than relieve attacks. The nitrates work by reducing the oxygen requirements of the heart muscle.

Beta-blocking Drugs. These agents act by blocking the effect of the sympathetic nervous system on the heart, slowing heart rate, decreasing blood pressure, and thereby, reducing the oxygen demand of the heart. Recent studies have found that these drugs also can reduce the chances of dying or suffering a recurrent heart attack if they are started shortly after suffering a heart attack and continued for two years.

Calcium-channel Blocking Drugs. These drugs are prescribed to treat angina that is thought to be caused by coronary artery spasm. They can also be effective for stable angina associated with exercise. All muscles need varying amounts of calcium in order to contract. By reducing the amount of calcium that enters the muscle cells in the coronary artery walls, the spasms can be prevented. Some calcium-channel blocking drugs also decrease the workload of the heart and some lower the heart rate as well.

Questions To Ask Your Doctor About Angina Pectoris
Could the chest pain be the result of any other disorder other than heart disease?

What is the cause of the angina?

Are there any tests recommended to determine the degree of heart disease?

What is the procedure for this test?

What medications will be prescribed?

What are the side effects?

Do the medications just relieve the symptoms or do they help relieve the cause?

What are the chances that surgery will be needed?

What other procedures are used to alleviate the coronary problem?

What preventive measures can be taken to decrease the risk of angina and the chance of a heart attack?

If angina is brought on by exercise, then what form of physical activity can be done to decrease heart disease and keep me healthy?

Angina Pectoris

* Definition of Angina Pectoris
* Description of Angina Pectoris
* Causes and Risk Factors of Angina Pectoris
* Symptoms of Angina Pectoris
* Diagnosis of Angina Pectoris
* Treatment of Angina Pectoris
* Questions To Ask Your Doctor About Angina Pectoris

Definition of Angina Pectoris
Angina pectoris is a term that describes chest pain caused by myocardial ischemia - a condition in which the amount of oxygen getting to the heart muscle is insufficient. It usually occurs on exertion and is relieved by rest. Angina generally is a symptom of coronary artery disease. In most severe cases, it may occur with minimal effort or at rest.

Description of Angina Pectoris
Angina pectoris is a common manifestation of coronary artery disease. The pain is caused by reduced blood flow to a segment of heart muscle (myocardial ischemia). It usually lasts for only a few minutes, and an attack is usually quickly relieved by rest or drugs (such as nitroglycerin). Also, it is possible to have myocardial ischemia without experiencing angina.

Typically, angina is described as a "pressure" or "squeezing" pain that starts in the center of the chest and may spread to the shoulders or arms (most often on the left side, although either or both sides may be involved), the neck, jaw or back. It is usually triggered by extra demand on the heart: exercise, an emotional upset, exposure to cold, digesting a heavy meal are common examples.

Some people experience angina while sleeping or at rest. This type of angina may be caused by a spasm in a coronary artery, which most commonly occurs at the site of atherosclerotic plaque in a diseased vessel.

Most people with angina learn to adjust their lives to minimize attacks. There are cases, however, when the attacks come frequently and without provocation - a condition known as unstable angina. This is often a prelude to a heart attack and requires special treatment, primarily with drugs. Angina affects both men and women, usually in middle age. Men are much more likely than women to experience it before age 60. It may develop weeks, months or even years before a heart attack, or may be experienced only after a heart attack has occurred.
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Causes and Risk Factors of Angina Pectoris
The two main causes of angina are coronary artery spasm, and atherosclerotic plaque buildup which causes critical blockage of the coronary artery.

The risk factors include:

* smoking

* sedentary lifestyle

* high blood pressure, or hypertension

* high blood fats or cholesterol

* hypercholesterolemia

* diabetes

* family history of premature ischemic heart disease

Men are at higher risk than women.

Symptoms of Angina Pectoris
Classic or typical angina occurs predictably with physical exertion or strong emotional reactions, and goes away just as predictably with rest. Starting immediately behind the sternum (breast bone), the pain may radiate to the left arm and shoulder or up to the jaw.

Most people describe the pain as a kind of squeezing pressure, tightness or heaviness.

There may be anxiety, increased or irregular heart rate, paleness and cold sweat, and a feeling of doom. The symptoms are like the ones for a heart attack.

In some instances, chest pain results from other types of heart problems, including diseases that affect the heart muscle itself or the valves that control blood flow through the heart. Occasionally, ulcers, gallstones, abnormal contractions of the esophagus or severe anxiety and panic attacks can cause chest pain. However, if you do experience these symptoms, your best plan of action is to get immediate help. Stop doing whatever is causing the symptoms and call 911. Lie down with your head slightly elevated. If you are not allergic to it, take one adult aspirin.

Diagnosis of Angina Pectoris
Diagnosis of angina is based upon the classic history of chest pain on exertion and by means of tests, demonstrating the presence of coronary artery disease.

Treatment of Angina Pectoris
In most instances, drugs are recommended for the treatment of angina before surgery is considered. The major classes of drugs used to treat angina include the following:

Nitrates. These come in several forms: nitroglycerine tablets to be slipped under the tongue during or in anticipation of an attack; ointment to be absorbed through the skin; long-acting medicated skin discs; or long-acting tablets. The latter three forms are used mostly to prevent rather than relieve attacks. The nitrates work by reducing the oxygen requirements of the heart muscle.

Beta-blocking Drugs. These agents act by blocking the effect of the sympathetic nervous system on the heart, slowing heart rate, decreasing blood pressure, and thereby, reducing the oxygen demand of the heart. Recent studies have found that these drugs also can reduce the chances of dying or suffering a recurrent heart attack if they are started shortly after suffering a heart attack and continued for two years.

Calcium-channel Blocking Drugs. These drugs are prescribed to treat angina that is thought to be caused by coronary artery spasm. They can also be effective for stable angina associated with exercise. All muscles need varying amounts of calcium in order to contract. By reducing the amount of calcium that enters the muscle cells in the coronary artery walls, the spasms can be prevented. Some calcium-channel blocking drugs also decrease the workload of the heart and some lower the heart rate as well.

Questions To Ask Your Doctor About Angina Pectoris
Could the chest pain be the result of any other disorder other than heart disease?

What is the cause of the angina?

Are there any tests recommended to determine the degree of heart disease?

What is the procedure for this test?

What medications will be prescribed?

What are the side effects?

Do the medications just relieve the symptoms or do they help relieve the cause?

What are the chances that surgery will be needed?

What other procedures are used to alleviate the coronary problem?

What preventive measures can be taken to decrease the risk of angina and the chance of a heart attack?

If angina is brought on by exercise, then what form of physical activity can be done to decrease heart disease and keep me healthy?

Jaundice In Newborns

* Definition of Jaundice In Newborns
* Description of Jaundice In Newborns
* Causes and Risk Factors of Jaundice In Newborns
* Diagnosis of Jaundice In Newborns
* Treatment of Jaundice In Newborns
* Questions To Ask Your Doctor About Jaundice In Newborns

Definition of Jaundice In Newborns
The cause of jaundice is a yellow bile pigment called bilirubin, which is carried in the blood and deposited in the skin, mucous membranes, and sclera (whites of the eyes). The result is that these areas of the body turn yellow.

Anything that causes a significant increase in the amount of bilirubin in the blood will lead to jaundice.

Description of Jaundice In Newborns
More than 25 percent of all healthy, full-term newborns become slightly jaundiced, usually on the third or fourth day of life. In premature babies the incidence of jaundice is higher.

The exact level of bilirubin in the blood is determined by a simple blood test.

No one can predict with certainty whether a newborn will develop jaundice, but Asian and Native American babies tend to have higher bilirubin levels than white babies, who have higher levels than black infants.

Breastfed babies are more likely to develop jaundice than those who are fed formula, although researchers are not certain why. Some older studies have suggested that breastmilk contains a hormone that inhibits the liver's ability to process bilirubin, but more recent research has shown no link between hormones in breast milk and liver function. Still, in many instances, if breastfeeding is discontinued for 24 hours and formula is substituted, bilirubin levels decline and "breastfeeding jaundice" clears up more rapidly.

The frequency of bowel movements also has been associated with jaundice. An infant's stool contains bilirubin, and if he passes stool too infrequently, some of the pigment is reabsorbed into the bloodstream and must be reprocessed by the liver, prolonging the symptoms of jaundice.

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Causes and Risk Factors of Jaundice In Newborns
The two most common causes of jaundice in the newborn are an immaturity of the baby's liver, which is known as physiologic jaundice, and blood-group incompatibilities. There are many other, less common causes of jaundice in the newborn.

Diagnosis of Jaundice In Newborns
Doctors diagnose jaundice through a simple blood test. A bilirubin level of less than 12 milligrams per deciliter of blood in the first few weeks of life is generally considered normal for a healthy, full-term baby.

Doctors determine whether a newborn needs treatment for jaundice based “risk factors” and the baby’s age. Risk factors include jaundice in the first day of life, gestational age less than 38 weeks, mothers and babies blood being incompatible, brother or sister had jaundice after birth, male, collection of blood under the scalp, mother more than 25 years old, high blood counts, east Asian ethnicity and very high birth weight. Recommendations are:

Low risk: No risk factors - phototherapy should be started if bilirubin is greater than 12 (24 hours), 15 (48 hours), or 18 (72 hours) mg/dL

Medium risk: Term baby with risk factors or less than 38 weeks with no risk factors - phototherapy should be started if bilirubin is greater than 10 (24 hours), 13 (48 hours), or 15 (72 hours) mg/dL

High risk: Baby 35-37 weeks gestation with risk factors - phototherapy should be started if bilirubin greater than 8 (24 hours), 11 (48 hours), or 13 (72 hours) mg/dL

Treatment of Jaundice In Newborns
A major concern with jaundice is the risk of very high concentrations of bilirubin reaching the brain and causing damage. But studies show that most babies who suffer such brain damage have underlying illnesses or conditions, such as complete inability of the liver to process bilirubin.

Doctors usually use phototherapy, or light treatment, to bring down bilirubin levels. The infant is placed under special fluorescent lamps that convert the excess bilirubin into a water-soluble form that can be excreted in bile and urine. The infant receives treatment usually in an incubator, for approximately two to three days. During that period, parents can take the baby out of the incubator for feeding, or they can reach in and touch their child.

In some instances, hospitals are able to arrange for parents to rent home phototherapy equipment - long fluorescent lights that hang over the crib. Some hospitals are offering a fiber-optic "blanket" - a sheet of plastic that has fiber-optic tubing running through it so that the entire blanket becomes a light source. Many parents prefer the blanket because they are able to hold and cuddle their baby during treatment. Doctors will decide based on the baby’s risk factors and bilirubin levels if treatment at home is safe.

If bilirubin levels remain high or doctors are concerned that the baby will be at risk for worsening jaundice, they may recommend “intensive phototherapy” that includes the entire baby’s body. In very severe cases, they have to perform an exchange transfusion (remove some of the baby’s blood and replace it with a transfusion).

During phototherapy, it is very important to ensure the baby received plenty of fluids in the form of breast milk or formula or IV fluids. He should also where protective eye wear.

Questions To Ask Your Doctor About Jaundice In Newborns
Why does the baby have jaundice?

What is the bilirubin level?

What is the probable cause?

Should breastfeeding be avoided or discontinued?

Should the baby have light treatment?

Can we do this at home?

Autism

* Definition of Autism
* Description of Autism
* Causes and Risk Factors of Autism
* Symptoms of Autism
* Diagnosis of Autism
* Treatment of Autism
* Questions To Ask Your Doctor About Autism

Definition of Autism
Autistic disorder (known also as infantile autism or childhood autism) almost always develops before the age of three and is characterized by impaired verbal and non-verbal communication, social interaction, some form of repetitive and restricted stereotyped interest, ritual, or other behavior.

Description of Autism
Children with autism often have extreme difficulty developing normal relationships with others. They tend not to share in the interests their peers have. In many cases these children are not able to interpret non-verbal cues of communication like facial expressions. Most people with autism have some impairment in language and many never speak at all.

About 8.7 of every 10,000 children are autistic, and more than 1 in 300 children have some form of pervasive developmental disorder (PDD). PDD means that some, but not all, symptoms of autism are present.

Autism is a lifelong disease that ranges in severity from mild cases in which the autistic person can live independently, to severe forms in which the patient requires social support and medical supervision throughout his or her life.

Causes and Risk Factors of Autism
There are physical bases for autism's development including genetic, infectious, and traumatic factors. Viral infection including rubella during the first trimester of pregnancy, have been studied as possible causes of autism. Children with Fragile X syndrome or tuberous sclerosis have higher rates of autism than the general population.

Autism affects males four times more often than females, and there is a genetic basis for the disease.

Contrary to previous notions, autism is not caused by upbringing.

Symptoms of Autism
The symptoms vary greatly but follow a general pattern. Not all symptoms are present in all autistic children.

Autistic infants may act relatively normal during their first few months of life before becoming less responsive to their parents and other stimuli. They may have difficulty with feeding or toilet training; may not smile in recognition of their parents' faces, and may put up resistance to being cuddled.

As they enter toddlerhood, it becomes increasingly apparent that these children have a world of their own. They do not play with other children or toys in the normal manner, rather they remain aloof and prefer to play alone. Parents often mention that their child is so undemanding that he or she is “too good”.

Verbal and nonverbal communication skills, such as speech and facial expressions, develop peculiarly. Symptoms range from mutism to prolonged use of echoing or stilted language. When language is present, it is often concrete, unimaginative, and immature.

Another symptom of autism is an extreme resistance to change of any kind. Autistic children tend to want to maintain established behavior patterns and a set environment. They develop rituals in play, oppose change (such as moving furniture), and may become obsessed with one particular topic.

Other behavioral abnormalities that may be present are: staring at hands or flapping arms and hands, walking on tiptoe, rocking, tantrums, strange postures, unpredictable behavior and hyperactivity.

An autistic child has poor judgment and is therefore always at risk for danger. For instance, an autistic child may run into a busy street without any sign of fear.

Diagnosis of Autism
Properly diagnosing autism is very important, since confusion may result from inappropriate and ineffective treatment.

Deafness is often the first suspected diagnosis, since autistic children may not respond normally to sounds and often do not speak.

The children's appearance and muscle coordination are often normal.

Occasionally, an autistic child has an outstanding skill (splinter skills), such as an incredible rote memory or musical ability. Such children may be referred to as "autistic savants", and occur in almost 10% of cases of autism. These skills can be quite astonishing. One example is the ability to play a piece of music almost perfectly after hearing it one time.

Many children with autism have a second psychiatric disorder or a neurologic disorder. Mental retardation and seizure disorders are very common in autistic children and a thorough neurologic and psychiatric evaluation is necessary in every case of autism to ensure all the child’s medical problems are being addressed.

Treatment of Autism
Appropriate early intervention is important. Once the diagnosis has been made, the parents, physicians, and specialists should discuss what is best for the child. In most cases, parents are encouraged to take care of the child at home.

Special education classes are available for autistic children. Structured, behaviorally-based programs, geared to the patient's developmental level have shown some promise.

Most behavioral treatment programs include:

* clear instructions to the child

* prompting to perform specific behaviors

* immediate praise and rewards for performing those behaviors

* a gradual increase in the complexity of reinforced behaviors

* definite distinctions of when and when not to perform the learned behaviors

Parents should be educated in behavioral techniques so they can participate in all aspects of the child's care and treatment. The more specialized instruction and behavior therapy the child receives, the more likely it is that the condition will improve.

Medication can be recommended to treat specific symptoms such as seizures, hyperactivity, extreme mood changes, or self-injurious behaviors.

The autistic child requires much of the parents' attention, often affecting the other children in the family. Counseling and support may be helpful for the parents.

The outlook for each child depends on his or her intelligence and language ability. Some people with autism become independent adults. A majority can be taught to live in community-based homes, although they may require supervision throughout adulthood.

Questions To Ask Your Doctor About Autism
When will the symptoms appear?

What type of symptoms will there be?

What if the child just likes to be left alone as opposed to being autistic?

What type of test is given to diagnose autism?

Where is testing done?

How accurate is the test?

Is the autism mild or severe?

Will the child be able to attend public school if they have mild autism?

Is there a cure?

Dementia

* Definition of Dementia
* Description of Dementia
* Causes and Risk Factors of Dementia
* Symptoms of Dementia
* Diagnosis of Dementia
* Treatment of Dementia
* Questions To Ask Your Doctor About Dementia

Definition of Dementia
Dementia is a permanent decline in cognitive function and memory from a previous level of function.

Description of Dementia
Dementia is a brain disorder with permanent loss of memory or other higher cognitive function.. Dementia can either be progressive, such as in Alzheimer's disease, or may remain stable, as can be seen after a stroke or head injury. Different types of dementia can affect various cognitive functions such as memory, personality, or executive function.

By definition, dementia is permanent. A brief change in cognitive function is more often called a "delirium". Different types of dementia can affect different abilities. Some patients may get lost, have trouble remembering things, become unable to remember names of objects and people, or have trouble calculating numbers, among other problems.

In many cases, dementia may progress very slowly and it is difficult to determine when the problem precisely began. In some cases, such as when a patient has a stroke, the beginning is very sudden and noticeable.
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Causes and Risk Factors of Dementia
Physicians generally recognize two broad categories of dementia:

Primary dementias are those like Alzheimer's in which the dementia itself is the major sign of an organic brain disease not directly related to any other organic illness.

Secondary dementias are those caused by, or closely related to, some other recognizable disease - such as AIDS, head injury, stroke, multiple sclerosis, or one of numerous other identifiable mental conditions.

Pseudodementia is another category of dementia that, as the name implies, is not a true dementia but rather a set of similar symptoms that mimic the condition, often seen in patients with depression.

Symptoms of Dementia
All dementias - whether primary or secondary, treatable or untreatable - share a few clinical characteristics in common. Loss of memory and inability to perform routine tasks - such as losing one's way in the neighborhood, difficulties in job performance, language problems - are particularly common.

The most recent memories are lost sooner than older ones, and new memories, perhaps of something that happened minutes earlier, are difficult to retain. For example, a woman might ask her husband when they are scheduled to visit their children. "Saturday," he might reply. Just minutes later, she might ask the identical question. In the early stages of the dementia, however, she probably will have no difficulty identifying photos of the children, or even of casual friends, taken 30 years earlier.

In certain forms of dementia, behavioral changes (such as increased aggressiveness), may be prominent.

As the disease progresses, patients lose the ability to function independently and become increasingly disoriented to time and place. Wandering may become a significant problem. Patients become unable to care for themselves and grooming and dressing standards deteriorate rapidly. Patients often dress inappropriately for the season and confuse underwear with outer garments.

In the progressive dementias, recent memory, retention and attention span deteriorate steadily. Language skills, particularly ability to name objects (anomia) or generate a word list decline until a patient can no longer use full sentences.

Diagnosis of Dementia
The diagnosis of dementia is based upon a good clinical history and an examination to determine the nature of the organic or non-organic cause of mental confusion. Often, a physician may perform a simple group of memory tests called the "mini mental status examination". In some cases, special neuropsychological testing may be necessary to confirm dementia, as opposed to effects of normal aging. Blood work and a picture of the brain (CAT scan or MRI) are useful to exclude any treatable condition.

Treatment of Dementia
In some cases, blood tests or imaging studies may reveal a condition responsible for the cognitive decline. Disorders such as vitamin deficiency, infection, or hydrocephalus can be treated with specific therapies that can reverse the symptoms in some cases.

In most of the progressive dementias, such as Alzheimer's disease, a specific cure is lacking. However, there are several agents available which have been proven to slow the progression of cognitive decline. These agents also enable patients to maintain their independence for a longer period of time. These medications also reduce burden on the caregiver. However, these drugs do not stop the progressive nature of the disorder and patients eventually decline further.

Questions To Ask Your Doctor About Dementia
What is the cause of the dementia?

Is the dementia secondary to some other disease?

Is the person with dementia safe to be left alone or is supervision always necessary?

What medications or other therapy may help improve function?

What treatments are available?

How can we best cope?

What is the prognosis - what can we expect?

Alzheimer's Disease

* Definition of Alzheimer's Disease
* Description of Alzheimer's Disease
* Causes and Risk Factors of Alzheimer's Disease
* Symptoms of Alzheimer's Disease
* Diagnosis of Alzheimer's Disease
* Treatment of Alzheimer's Disease
* Self Care
* Questions To Ask Your Doctor About Alzheimer's Disease

Definition of Alzheimer's Disease
Alzheimer's disease is a group disorders involving the parts of the brain that control thought, memory, and language. It is marked by progressive deterioration, which affects both the memory and reasoning capabilities of an individual.

Description of Alzheimer's Disease
Alzheimer's disease is the most common form of dementia (mental deterioration of memory and thought processes) among the elderly. It is estimated that 4.5 million Americans over the age of 65 are affected with this condition. After the age of 65, the incidence of the disease doubles every five (5) years and, by age 85, it will affect nearly half of the population.

Alzheimer's disease was first described in 1906 by German neurologist Alois Alzheimer. The disease causes irreversible changes in the nerve cells of certain vulnerable areas of the brain. It is characterized by nerve-cell loss, abnormal tangles within nerve cells and deficiencies of several chemicals, which are essential for the transmission of nerve messages.

The disorder leads to behavioral and personality changes, forgetfulness, confusion, inability to learn new material, paranoia and motor activity problems. Language difficulties also are common in people with Alzheimer's disease. The disease typically progresses to the stage where it is difficult for the patient to be understood by others or to understand others, and in the final stages, the patient is bedridden.

Although nearly half of those over 85 may have Alzheimer's disease, it is not a 'normal' part of aging.
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Causes and Risk Factors of Alzheimer's Disease
The cause of Alzheimer's disease has yet to be determined, but there are five (5) theories that warrant further investigation:

1. Chemical Theories

A. Chemical Deficiencies. One of the ways in which brain cells communicate with one another is through chemicals called neurotransmitters. Studies of Alzheimer's diseased brains have uncovered diminished levels of various neurotransmitters that are thought to influence intellectual functioning and behavior.

B. Toxic Chemical Excesses. Increased deposits of aluminum have been found in Alzheimer's disease brains.

2. Genetic Theory.

Researchers have linked late-onset Alzheimer's to the inheritance of a gene that directs production of apolipoprotein (ApoE). In early-onset Alzheimer's, researchers identified a mutation on chromosome 14, which accounts for 10 percent of Alzheimer's cases. Additionally, a mutation was found on chromosomes 1 and 21. In 1997, researchers found another mutation on chromosome 12 that is linked to late-onset Alzheimer's.

3. Autoimmune Theory.

The body's immune system, which protects against potentially harmful invaders, may erroneously begin to attack its own tissues, producing antibodies to its own essential cells.

4. Slow Virus Theory.

A slow-acting virus has been identified as a cause of some brain disorders that closely resemble Alzheimer's.

5. Blood Vessel Theory.

Defects in blood vessels supplying blood to the brain are being studied as a possible cause of Alzheimer's.

The chances of getting Alzheimer's disease increases with age and it usually occurs after the age of 65, after which the chances of getting the disease double every five years.

There are only two definite factors that increase the risk for Alzheimer's disease before age 65: a family history of dementia or Alzheimer's, and Down syndrome. Down syndrome is a combination of physical abnormalities and mental retardation characterized by a genetic defect in chromosome pair 21.

Symptoms of Alzheimer's Disease
The U.S. Agency for Health Care Policy Research provided this list of questions to help recognize the condition:

* Learning and retaining new information. Does the person misplace objects and/or have trouble remembering appointments or recent conversations? Is the person repetitive in conversation?

* Handling complex tasks. Do familiar activities like balancing a checkbook, cooking a meal, or other tasks that involve a complex train of thought, become increasingly difficult?

* Ability to reason. Does the person find it difficult to respond appropriately to everyday problems, such as a flat tire? Does a previously well-adjusted person disregard rules of social conduct?

* Spatial ability and orientation. Does driving and finding one's way in familiar surroundings become impossible? Does the person have problems recognizing familiar objects?

* Language. Does the person have difficulty following or participating in conversations? Does the person have trouble finding the words to express what they want to say?

* Behavior. Does the person seem more passive or less responsive than usual or more suspicious or irritable? Does the person have trouble paying attention?

The onset and symptoms of Alzheimer's disease are usually very slow and gradual, seldom occurring before the age of 65. It occurs in the following three (3) stages:

Stage 1: forgetfulness, poor insight, mild difficulties with word-finding, personality changes, difficulties with calculations, losing or misplacing things, repetition of questions or statements and a minor degree of disorientation

Stage 2: memory worsens, words are used more and more inappropriately, basic self-care skills are lost, personality changes, agitation develops, can't recognize distant family or friends, has difficulty communicating, wanders off, becomes deluded and may experience hallucinations

Stage 3: bedridden, incontinent, uncomprehending and mute

Diagnosis of Alzheimer's Disease
An estimated 5 to 10 percent of all mental deterioration in persons over the age of 65 is due to reversible conditions, such as depression, underlying physical disease (metabolic disorders, cardiovascular disease or pernicious anemia), excessive and inappropriate drug use, loss of social support or change in social environment. Therefore, it is important to diagnose Alzheimer's disease to ensure that any mental impairment is not reversible.

In order to diagnose Alzheimer's disease, a physician must:

* take a detailed medical history

* conduct physical and neurological examinations

* consult the diagnostic criteria stated below

* conduct laboratory examinations, such as urine tests, a CAT scan, magnetic resonance imaging (MRI) or positron emission tomography (PET) to detect structural abnormalities of the head and brain

* conduct a functional and mental status assessment test

* do a complete inventory of any prescription and over-the-counter drugs the patient is taking

The diagnostic criteria for dementia and Alzheimer's disease is as follows:

Dementia

A. Multiple cognitive deficits manifested by both 1 and 2

1. Impaired short- or long-term memory

2. One or more of the following cognitive disturbances:

* Impaired language ability

* Impaired ability to carry out motor activities

* Impaired ability to recognize objects

* Impaired abstract thinking (e.g., planning and organizing)

B. Deficits in A are sufficient to interfere with work or social activities and represent a significant decline in function.

C. Deficits do not occur exclusively during the course of delirium.

Alzheimer's disease

Dementia as determined by A through C (stated above), plus:

D. Disease course is characterized by gradual onset and continuing cognitive decline.

E. Cognitive deficits are not caused by any of the following:

* Another progressive central nervous system disorder (e.g., Parkinson's or Huntington's disease)

* A systemic condition (e.g., hypothyroidism or niacin deficiency)

* A substance-induced condition

F. Disturbance is not better explained by another disorder (e.g., major depressive disorder or schizophrenia).

Treatment of Alzheimer's Disease
Although there is currently no cure for Alzheimer's disease, a great deal can be done to manage it. There are four (4) approaches to managing the disease. The approaches and solutions are:

* Relieve behavioral symptoms associated with dementia, including depression, agitation and psychosis. Medications, called cholinesterase inhibitors, such as tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon) or galantamine (Reminyl), enhance the effectiveness of acetylcholine (the chemical messenger found in the neurotransmitter system which coordinates memory and learning) by slowing its breakdown. Unfortunately, these medications only temporally improve the symptoms associated with Alzheimer's. The effects of the drugs will fade as the deterioration of brain cells progresses. More recently, memantine (Namenda) was approved by the FDA. Memantine blocks the effects of a different chemical, glutamate, which is felt to overstimulate nerve cells and cause their degeneration. Additionally, doctors may prescribe antidepressants, antipsychotics, anticonvulsants, beta blockers, benzodiazepines, serotonin reuptake inhibitors, and drugs such as Desyrel, BuSpar, and Eldepryl, to control the agitation, psychosis, depressive features, anxious features, apathy and disturbances in sleep and appetite.

* Relieve cognitive dysfunction to improve memory, language, attention and orientation. Doctors may prescribe precursors, cholinesterase inhibitors and cholinergic receptor agents.

* Slow the rate of illness progression, thereby preserving quality of life and independence.

* Delay the time of onset of illness. Medications and therapies to combat these problems are still in the development and clinical trial stages. For instance, the research shows that vitamin E slows the progress of some consequences of Alzheimer’s for about 7 months, and scientists are investigating whether ginkgo biloba can delay or prevent dementia in older people, and if estrogen can prevent Aalzheimer’s in women with a family history of the disease. Researchers are looking at methods to enhance cerebral metabolism, stabilize membranes, promote neuronal sprouting, decrease inflammation, neurotoxins and excitatory amino acids, as well as alter metabolism of key proteins.

In addition to the pharmaceutical approaches, conservation methods also can be beneficial to the management of Alzheimer's disease, such as:

* eating a proper diet

* getting daily exercise

* continuing intellectual stimulation and social contact

* implementing memory aids, such as a prominent calendar, lists of daily tasks and labels on frequently used items that can help compensate for memory loss and confusion

* providing a comfortable and stimulating environment and always trying to give simple and easy to understand instructions

* participating in support groups

Self Care
The physical, emotional and financial burdens of caring for a person with Alzheimer's disease can be enormous. Family members and other caregivers may become exhausted and demoralized by the all-consuming task. They lose freedom and privacy and sacrifice their own needs, often without receiving much gratitude or even acknowledgment. Any resentment they feel may be heightened by fear of inheriting the disease and compounded by guilt - about their anger, past mistakes, lying to the patient in small ways or denying the patient's wishes.

Existing family problems may be intensified and old family conflicts revived. A formerly passive husband or wife may find it difficult to make decisions for the patient. It is not surprising that caregivers have a higher rate of depression than patients with Alzheimer's disease themselves.

Some caregivers join support groups to relieve their isolation, comfort one another and exchange advice. These groups are organized by local chapters of the Alzheimer's Association (http://www.alz.org).

Most of all, caregivers need time to lead their own lives. This can be made possible by respite care: housekeepers, home attendants, visiting nurses, day care centers, senior citizen programs, day hospitals and case managers who can coordinate services. Unfortunately, many families know too little about these services or are too shy or proud to seek help.

At any given time, family members care for most people with Alzheimer's disease, but the demands eventually become too great for even the most devoted wife, daughter, husband or son. Most Americans with this disease ultimately end up in nursing homes. Researchers have recently estimated that 40 percent of people who turn 65 will eventually enter a nursing home; 25 percent will stay for at least a year and nearly 10 percent for five years or more. The average age of the 1.5 million patients in these homes is 86. More than two-thirds of these patients are women, and at least two-thirds have Alzheimer's disease.

About two-thirds of all people placed in nursing homes die within three years, mainly because many families take this step only after their resources are exhausted and the demented person is near death. Families sometimes wait too long and have to be persuaded by outsiders to acknowledge the need. To avoid having to make a hasty decision during a crisis, it is better to start investigating the options as soon as the patient begins to need supervision.

Questions To Ask Your Doctor About Alzheimer's Disease
What tests need to be done to accurately diagnose this condition?

Does the individual have Alzheimer's or could it be some other condition or disorder?

Can it be cured?

Must it necessarily become progressively worse or can deterioration be halted?

Can mental or thinking abilities be improved?

Can motor activities be improved?

Is there a special diet that may help?

How can the family get help to cope with this disease?

Definition of Animal Bites

* Definition of Animal Bites
* Questions To Ask Your Doctor About Animal Bites

Definition of Animal Bites
Bite wounds can become infected with bacteria or other organisms in the saliva or mouth of the biting animal. Bites can cause everything from mild, local infections to generalized serious and sometimes fatal illness.


Questions To Ask Your Doctor About Animal Bites
What is the extent of the injury caused by the cat?

Is there any sign of infection?

Is it cat-scratch disease?

Should antibiotics be taken?

Is there any possibility of exposure to rabies?

Are any preventive measures called for?

AIDS and HIV Infection

Definition of AIDS and HIV Infection
AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a serious condition that weakens the body's immune system, leaving it unable to fight off illness.

AIDS is the last stage in a progression of diseases resulting from a viral infection known as the Human Immunodeficiency Virus (HIV or AIDS virus). The diseases include a number of unusual and severe infections, cancers and debilitating illnesses, resulting in severe weight loss or wasting away, and diseases affecting the brain and central nervous system.

There is no cure for HIV infection or AIDS nor is there a vaccine to prevent HIV infection. However, new medications not only can slow the progression of the infection, but can also markedly suppress the virus, thereby restoring the body’s immune function and permitting many HIV-infected individuals to lead a normal, disease-free life.

Description of AIDS and HIV Infection
The immune system is a network of cells, organs and proteins that work together to defend and protect the body from potentially harmful, infectious microorganisms (microscopic life-forms), such as bacteria, viruses, parasites and fungi. The immune system also plays a critical role in preventing the development and spread of many types of cancer.

When the immune system is missing one or more of its components, the result is an immunodeficiency disorder. AIDS is an immunodeficiency disorder.

Lymphocytes (white blood cells) are one of the main types of immune cells that make up the immune system. There are two types of lymphocytes: B cells and T cells. (T cells are also called CD4 cells, CD4 T cells, or CD4 cell lymphocytes). B cells secrete antibodies (proteins) into the body's fluids to ambush and attack antigens (foreign proteins such as bacteria, viruses or fungi). T cells directly attack and destroy infected or malignant cells in the body.

There are two types of T cells: helper T cells and killer T cells. Helper T cells recognize the antigen and activate the killer T cells. Killer T cells then destroy the antigen.

When HIV is introduced into the body, this virus is too strong for the helper T cells and killer T cells. The virus then invades these cells and starts to reproduce itself, thereby not only killing the CD4 T cells, but also spreading to infect otherwise healthy cells.

The HIV virus cannot be destroyed and lives in the body undetected for months or years before any sign of illness appears. Gradually, over many years or even decades, as the T cells become progressively destroyed or inactivated, other viruses, parasites or cancer cells (called "opportunistic diseases") which would not have been able to get past a healthy body's defense, can multiply within the body without fear of destruction. Commonly seen opportunistic diseases in persons with HIV infection include: pneumocystis carinii pneumonia, tuberculosis, candida (yeast) infection of the mouth, throat or vagina, shingles, cytomegalovirus retinitis and Kaposi's sarcoma.
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Causes and Risk Factors of AIDS and HIV Infection
AIDS is transmitted via three main routes:

* The most common mode of transmission is the transfer of body secretions through sexual contact. This is accomplished through exposure of mucous membranes of the rectum, vagina or mouth to blood, semen or vaginal secretions containing the HIV virus.

* Blood or blood products can transmit the virus, most often through the sharing of contaminated syringes and needles.

* HIV can be spread during pregnancy from mother to fetus.

You cannot get AIDS/HIV from touching someone or sharing items, such as cups or pencils, or through coughing and sneezing. Additionally, HIV is not spread through routine contact in restaurants, the workplace or school. However, sharing a razor does pose a small risk in that blood from a minor nick can be transmitted from one person to another.

Symptoms of AIDS and HIV Infection
Immediately following infection with HIV, most individuals develop a brief, nonspecific “viral illness” consisting of low grade fever, rash, muscle aches, headache and/or fatigue. Like any other viral illness, these symptoms resolve over a period of five to 10 days. Then for a period of several years (sometimes as long as several decades), people infected with HIV are asymptomatic (no symptoms). However, their immune system is gradually being destroyed by the virus. When this destruction has progressed to a critical point, symptoms of AIDS appear. These symptoms are as follows:

* extreme fatigue

* rapid weight loss from an unknown cause (more than 10 lbs. in two months for no reason)

* appearance of swollen or tender glands in the neck, armpits or groin, for no apparent reason, lasting for more than four weeks

* unexplained shortness of breath, frequently accompanied by a dry cough, not due to allergies or smoking

* persistent diarrhea

* intermittent high fever or soaking night sweats of unknown origin

* a marked change in an illness pattern, either in frequency, severity, or length of sickness

* appearance of one or more purple spots on the surface of the skin, inside the mouth, anus or nasal passages

* whitish coating on the tongue, throat or vagina

* forgetfulness, confusion and other signs of mental deterioration

It can take as short as a year to as long as 10 to 15 years to go from being infected with HIV to "full-blown" AIDS.

According to the Center for Disease Control and Prevention, a person is considered to have AIDS when they have a T cell count (also called CD4 cell count) of 200 or less (healthy T cell levels range from 500 to 1500) or they have an AIDS-defining condition. The AIDS-defining conditions are:

· Candidiasis

· Cervical cancer (invasive)

· Coccidioidomycosis, Cryptococcosis, Cryptosporidiosis

· Cytomegalovirus disease

· Encephalopathy (HIV-related)

· Herpes simplex (severe infection)

· Histoplasmosis

· Isosporiasis

· Kaposi's sarcoma

· Lymphoma (certain types)

· Mycobacterium avium complex

· Pneumocystis carinii pneumonia

· Pneumonia (recurrent)

· Progressive multifocal leukoencephalopathy

· Salmonella septicemia (recurrent)

· Toxoplasmosis of the brain

· Tuberculosis

· Wasting syndrome

People who are not infected with HIV may also develop these diseases; the presence of any one of these conditions does not mean the person has AIDS. To be diagnosed with AIDS, a person must be infected with HIV.

Some people infected with HIV may develop a disease that is less serious than AIDS, referred to as AIDS Related Complex (ARC). ARC is a condition caused by the AIDS virus in which the patient tests positive for AIDS infection and has a specific set of clinical symptoms. However, ARC patients' symptoms are often less severe than those with classic AIDS because the degree of destruction of the immune system has not progressed as far as it has in patients with classic AIDS.

Symptoms of ARC may include loss of appetite, weight loss, fever, night sweats, skin rashes, diarrhea, tiredness, lack of resistance to infection or swollen lymph nodes.

Note: Not everyone who has been infected with HIV develops AIDS. Very rarely, some individuals can be infected with HIV yet maintain normal immune function and general good health even after 20 years of infection.

Diagnosis of AIDS and HIV Infection
Screening for HIV infection is most commonly done by testing blood for HIV antibodies. A newer test, the Orasure test, involves collecting secretions between the cheek and gum and evaluating them for HIV antibodies. Orasure is essentially as accurate as a blood test, and, because it doesn't involve a needle stick, it is favored by many individuals. Orasure is available through physicians’ offices and many public health clinics. Finally, a new urine test available for screening, although if the test is positive, blood tests need to be performed for confirmation of the presence of HIV.

In 1996, a home HIV blood test (called Home Access) became available to the public. These home kits are available in pharmacies and by mail. The kit contains a few sharp tools called lancets, a piece of blotting paper marked with a unique identification number and a prepaid return envelope with a protective pouch. After pricking the finger with the lancet, a few drops of blood are blotted onto the paper, sealed into the envelope and sent to the address on the envelope. In about a week, the person calls a toll-free number to get the results of the test.

Treatment of AIDS and HIV Infection
Anti-HIV (also called antiretroviral) medications are used to control the reproduction of the virus and to slow or halt the progression of HIV-related disease. When used in combinations, these medications are termed Highly Active Antiretroviral Therapy (HAART). HAART combines three or more anti-HIV medications in a daily regimen, sometimes referred to as a "cocktail". Anti-HIV medications do not cure HIV infection and individuals taking these medications can still transmit HIV to others. Anti-HIV medications approved by the U.S. Food and Drug Administration (FDA) fall into four classes:

1. Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs), such as nevirappine (Viramune) and efavirenz (Sustiva), bind to and block the action of reverse transcriptase, a protein that HIV needs to reproduce.

2. Nucleoside Reverse Transcriptase Inhibitors (NRTIs), such as zidovudine (Retrovir), tenofovir DF (Viread), and stavudine (Zerit), are faulty versions of building blocks that HIV needs to make more copies of itself. When HIV uses an NRTI instead of a normal building block, reproduction of the virus is stalled.

3. Protease Inhibitors (PIs), such as lopinavir/ritonavir (Kaletra), disable protease, a protein that HIV needs reproduce itself.

4. Fusion Inhibitors, such as enfuvirtide (Fuzeon ), are newer treatments that work by blocking HIV entry into cells.

(View more complete list of HIV drugs).

How many pills you will need to take and how often you will take them depends on what medications you and your doctor choose.

There is no one "best" regimen. You and your doctor will decide which medications are right for you. For people taking HAART for the first time, the recommended regimens are:

* Sustiva + Truvada, Sustiva + Epzicom, or Atripla

* Kaletra + Truvada, Kaletra + Epzicom, or Kaletra + Combivir

In general, taking only one or two drugs is not recommended because any decrease in viral load is almost always temporary without three or more drugs. The exception is the recommendation for pregnant women, who may take Combivir plus nevirapine to reduce the risk of passing HIV to their infants. If you are pregnant or considering becoming pregnant, there are additional treatment considerations. Recently, a number of drugs have been developed that combine two or even three separate medications in a single pill. Some of these, such as Truvada (emtricitabine + tenofovir) and Epzicom (abacavir + lamivudine) need be taken only once daily. Atripla (emtricitabine + tenofovir + efavirenz) combines three drugs in one pill and needs to be taken only once daily, thereby providing a complete HAART regimen with one pill once daily.

The treatment of HIV infection and AIDS is in a highly dynamic state. Individuals with this condition are advised to seek out experts in their local community who are current with the latest modes of therapy and ongoing clinical trials for evaluating newer therapies.

The following is a partial list of drugs approved for the treatment of HIV infection.

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Delavirdine (Rescriptor, DLV) Pfizer

Efavirenz (Sustiva, EFV) Bristol-Myers Squibb

Nevirapine (Viramune, NVP) Boehringer Ingelheim

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Abacavir (Ziagen, ABC) GlaxoSmithKline

Abacavir,Lamivudine, Zidovudine (Trizivir) GlaxoSmithKline

Didanosine (Videx, ddI, Videx EC) Bristol-Myers Squibb

Emtricitabine (Emtriva, FTC, Coviracil) Gilead Sciences

Lamivudine (Epivir, 3TC) GlaxoSmithKline

Lamivudine, Zidovudine (Combivir) GlaxoSmithKline

Stavudine ( Zerit, d4T) Bristol-Myers Squibb

Tenofovir DF (Viread, TDF) Gilead Sciences

Zalcitabine (Hivid, ddC) Hoffmann-La Roche

Atripla (tenofovir, emtricitabine, efavirenz) Gilead Sciences

Zidovudine (Retrovir, AZT, ZDV) GlaxoSmithKline

Protease Inhibitors (PIs)

Amprenavir (Agenerase, APV) GlaxoSmithKline, Vertex Pharmaceuticals

Atazanavir (Reyataz, ATV) Bristol-Myers Squibb

Fosamprenavir (Lexiva, FPV) GlaxoSmithKline, Vertex Pharmaceuticals

Indinavir (Crixivan, IDV) Merck

Lopinavir, Ritonavir (Kaletra, LPV/r) Abbott Laboratories

Nelfinavir (Viracept, NFV) Agouron Pharmaceuticals

Ritonavir (Norvir, RTV) Abbott Laboratories

Saquinavir (Fortovase, SQV) Invirase Hoffmann-La Roche

Tipranavir (Aptivus) Boehringer-Ingelheim

Darunavir (Prezista) Tibotec Therapeutics

Fusion Inhibitors

Enfuvirtide (Fuzeon, T-20) Hoffmann-La Roche, Trimeris

Prevention of AIDS and HIV Infection
The only way to protect from contracting AIDS sexually is to abstain from sex outside of a mutually faithful relationship with a partner whom the person knows is not infected with the AIDS virus. Otherwise, risks can be minimized if they:

* Don't have sexual contact with anyone who has symptoms of AIDS or who is a member of a high risk group for AIDS.

* Avoid sexual contact with anyone who has had sex with people at risk of getting AIDS.

* Don't have sex with prostitutes.

* Avoid having sex with anyone who has multiple and/or anonymous sexual partners.

* Avoid oral, genital and anal contact with partner's blood, semen, vaginal secretions, feces or urine. Unless they know with absolute certainty that their partner is not infected, a latex condom should be used during each sexual act, from start to finish. The use of a spermicidal agent may provide additional protection.

* Avoid anal intercourse altogether.

* Don't share toothbrushes, razors or other implements that could become contaminated with the blood of anyone who is or might be infected with the AIDS virus.

* Exercise caution regarding procedures, such as acupuncture, tattooing, ear piercing, etc., in which needles or other nonsterile instruments may be used repeatedly to pierce the skin and/or mucous membranes.

Such procedures are safe if proper sterilization methods are employed or disposable needles are used. Ask what precautions are taken before undergoing such procedures.

* If an individual is scheduling surgery in the near future, and is able, they could consider donating blood for their own use. This will eliminate completely the already very small risk of contracting AIDS through a blood transfusion. It will also eliminate the risk of contracting other bloodborne diseases (such as hepatitis) from a transfusion.

If a person is an IV drug user, adhere to the prevention tips mentioned earlier, as well as:

* Get professional help for terminating the drug habit.

* Do not share needles or syringes. Be aware that some street sellers are resealing previously used needles and selling them as new.

* Clean the needle before using.

Some people apparently remain well after infection of the AIDS virus. They may have no physically apparent symptoms of illness. However, if proper precautions are not used with sexual contacts and/or intravenous drug use, these infected individuals can spread the virus to others.

Anyone who thinks he or she is infected, or who is involved in high-risk behaviors, should not donate his/her blood, organs, tissues, or sperm as they may now contain the AIDS virus.

Questions To Ask Your Doctor About AIDS and HIV Infection
What tests need to be done to diagnose this condition?

How accurate is the test?

Does a positive test mean AIDS?

What type of treatment will you be recommending?

How successful is it?

Will you be prescribing any medications to prevent the development of some AIDS related infections?

Are there any alternative treatments available?

Are there experimental protocols in which I might participate?

What are the chances of remaining well?

For how long?

Are there any support groups in the area?