SYMPTOMS YOU SHOULD NEVER IGNORE

How do you know if a symptom is serious or not. Symptoms that develop all of a sudden and with increasing intensity should not be taken for granted. Here are some symptoms you should not ignore.

SHORTNESS OF BREATH
If you are unable to catch your breath or gasping for breath, then you need to be evaluated or you must seek emergency care. Shortness of breath could be a sign of severe underlying diseases like asthma, bronchitis, pulmonary embolism, lung and heart disease.

SUDDEN INTENSE HEADACHE
If you are experiencing headache like you’ve never had before. If it happened suddenly and keeps getting worse with no relief, you need to seek urgent care. It could be a sign serious conditions like of ruptured aneurysm, a condition in which a blood vessel in your brain suddenly bursts. It could also be a sign of meningitis.

UNEXPLAINED WEIGHT LOSS
I f you are losing weight without trying, it might be more of a curse than a blessing. If you lose about 10% of your total weight in about 6 months without putting in any effort, you should consult your doctor. Unexplained weight loss could be an indication of diabetes if it is accompanied by frequent urination and extreme thirst, hyperthyroidism if you also experience restlessness and increased appetite, some types of cancers and liver disease. Gastrointestinal diseases like inflammatory bowel movement could also be the cause if you having diarrhea and abdominal pain.

LOWER BACK PAIN
Lower back pain can be from muscle pull or some physical exertion on the back. Persistent back pain accompanied with fever and weight loss and especially if pain is radiating down the leg, could be a sign of some cancers like breast and lung cancers. Aggressive forms of these cancers may spread to the bone and cause lower back pain.

HEAVY PERIODS
Heavy periods known as menorrhagia happens to some women. However if you experience heavy periods during pregnancy it could be a sign of ectopic pregnancy. Fibroid tumors and ovarian cyst may cause heavy periods. Seek medical help.

CHEST PAIN
Chest discomfort, heaviness and pressure may be a signs of heart attack especially if it is accompanied by pain radiating down the arm, shortness of breath, nausea and vomiting and sweating. Women especially experience other symptoms like upper abdominal discomfort and fatigue. Severe upper back pain may be due to tear in the aorta. Other non life threatening conditions such as acid reflux or a peptic ulcer may also cause chest pain. Get to emergency room if you experience these signs.

FAINTING
This is due to transient drop in blood pressure which can happen as a result of the brain not getting enough blood. This usually happens when you sick , tired or scared. Experiencing fainting spells after exercising or lifting heavy things may require medical attention. It could be a sign of stroke or heart problem.

FEVER
Having fever is nothing to worry about so much. Fever is your body’s way of fighting infection. However fever of about 103 degrees and higher may be a source of serious infection like meningitis, endocarditis and so one. Persistent fever may also be a sign of some forms of cancers like lymphoma or sinus infection. Urgent medical care is therefore essential in such cases.

CHANGE IN BOWEL MOVEMENT
Normal bowel habits depends on each person. What is normal for one person might not be normal for anther. When you notice any change in your bowel habits such as persistent diarrhea or constipation, change in shape and color of stool or bloody stool, it is time to contact your physician. It might be a sign of serious infection

UNUSUAL BLEEDING
If you see blood where it’s not suppose to be, then its time to talk to your doctor. Blood in vomit may be a sign of gastric or esophageal cancer. Rectal bleeding may be a sign of colon or rectal cancer and vaginal bleeding may be linked to gynecological cancer. Unusual bleeding can also be linked to non life threatening conditions like hemorrhoids and stomach ulcers. Seek immediate medical care if you experience any of these conditions.

EARLY SATIETY
If you consistently feel full earlier than normal or after having a small meal ,you need to get checked out. If it is accompanied by symptoms such as weight loss or gain bloating, nausea or vomiting ,it could be a sign of reflux disease, commonly known as GERD or life threatening diseases like pancreatic cancer.

SUDDEN CONFUSION
Sudden confusion or inability to concentrate are conditions that need immediate medical care. It could be as a result of brain bleeding or brain tumor. If this condition is accompanied by slurred speech, numbness in face hand or leg and difficulty finding words, then stroke is imminent. Seek medical care immediately to avoid irreversible brain damage.

EDEMA
Swelling in the extremities such as legs warrants medical check up. When heart cannot pump enough blood that the body needs, blood backs up in veins causing accumulation of body fluids. Doctor fear heart failure when both legs are affected and especially when one is experiencing other symptoms like shortness of breath, fatigue and numbness.

SEVERE ABDOMINAL PAIN
This could be as a result of aortic aneurysm which happens in the abdominal area. It could also mean a hole in the stomach or intestines as a result of an ulcer. Another condition that causes this is Intestinal ischemia which is when blood flow to the intestines is stopped or slowed down resulting tissues being oxygen deprived. All these conditions are life threatening and should be taken seriously.

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HYPERHIDROSIS- ARE YOU A SWEATY

By Kemboi Kibet

Excessive sweating also known as hyperhidrosis is sweating for no apparent reason and occurs even when you are not exercising or when temperature is not hot. This condition can be very embarrassing and usually affects palms, soles, feet and underarms.

I SWEAT A LOT??? NOW WHAT!!!!

There are a number of home remedies than can help curb this condition by reducing the sweating.

Antiperspirants : The first step to solving hyperhidrosis is using antiperspirants. Antiperspirants contain aluminium salts which when rolled on the skin can form plugs which block perspiration. It should be noted that deodorant unlike antiperspirants control odor produced by sweating but does not in itself reduce or block perspiration. You can get antiperspirants from over the counter in which case it is less irritating or by prescription from a doctor if the over the counter ones dont work.

Apple Cider Vinegar: This can be applied directly to areas of excessive sweating or it can be taken orally. Apply a combination of apple cider vinegar and lemon juice to the skin at areas of excessive sweating . It can also be taken orally by drinking three glasses of water a day mixed with two teaspoon of cider vinegar and two teaspoons of honey. It is most effective when taken on empty stomach. You can also soak cotton balls in apple cider vinegar or white vinegar and rub underarms to get rid of underarm odor. For sweaty feet apply apple cider vinegar to feet after washing and drying feet.

Tomato Juice : Drink a glass of fresh home-made tomato juice for at least a week. If you see progress you can continue drinking it everyday or every other day.

Bathe Regularly : Bathing frequently helps keep the number of bacteria on the skin low. Bathing with antibacterial soap can also control the bacteria that inhabit areas of the skin prone to hyperhidrosis and cause odor.

Reduce Stress : Stress can trigger perspiration. It is important to engage in relaxation exercises such as yoga and meditation.

Herbal Tea: Sage herbal tea is particularly essential in curbing hyperhidrosis. Sage contains vitamin B and magnesium which reduces sweat gland activity and thereby reduces sweating. Boil a teaspoon of dried sage leaves and set it aside to cool down. Apply the mixture to feet , sole , palms and underarm after thoroughly washing and drying. You can also add the herb to diet such as soup. It is also known that having green tea everyday can also eliminate hyperhidrosis.

Potato Slices : Slice potato and rub them underarm to get rid of excessive sweating. This is an effective way of getting rid of hyperhidrosis.

Wheat Grass Juice : Wheat grass extract is effective in reducing excessive sweating. One glass a day of this juice helps neutralize and dilute toxins in the blood. It is also a very good source of protein, vitamin C, vitamin B-12, folic acid, and vitamin B-6.

Witch Hazel : This is a natural perspirant for the face . It gently dries skin and prevents infection.

Tea Tree Oil : Apply oil directly to affected areas such as foot, armpit and hands to reduce hyperhidrosis.

Tea Bag : Tannic acid in tea has astringent properties that act as a natural antiperspirant. Soak about 5 tea bags in hot water and let it cool. Soak hands and feet in it for about 30 minutes and notice the difference.

Cornstarch and Baking Soda : Clean underarm thoroughly then apply cornstarch and baking soda. Wait for about 30 minutes and then wash off.

Anti Sweat Diet : Foods such as strawberries, almonds and onions contain silicon which is effective in reducing hyperhidrosis. It is also important to stay well hydrated because water removes the toxins that causes odor from sweat.Vitamin B rich foods also reduces sweating. It should also be noted that spicy foods and alcohol makes you sweat and so does hot drinks like tea and coffee. Magnesium deficiency is also known to cause hyperhidrosis. Taking magnesium supplement daily can get rid of this condition.

Wear Breathable Clothing : Choose fabrics such as cotton wool or silk which makes your skin breathe. It is also crucial to wear wool and cotton soaks. These absorb moisture and keep the feet dry.

Kemboi Kibet

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Down Syndrome – Your Health Is Your Wealth

 

Down syndrome is also known as Trisomy 21. It is a genetic disorder in which an extra copy of chromosome 21 causes life long mental retardation, developmental delays and other problems. It is the most common genetic cause of learning disabilities in children. It affects 1 in every 800 babies born in the United States. Severity of the disease range from mild or  moderate to serious with some children needing more medical attention than others. People with Down Syndrome may have other health issues like heart disease, intestinal abnormalities, seizure disorders, respiratory problems, obesity and  an increased susceptibility to infections. There is no way of preventing this disease but research shows that the chance of having a child with down syndrome increases with age. This disease cannot be cured but resources are available to make life comfortable for both victims and caregivers. Down syndrome is not inherited. It is caused by abnormal cell division during egg cell and sperm cell development.

CAUSES

Babies normally inherit  genetic material from both parents. Human cells have 23 pairs of chromosomes. One chromosome in each pair comes from the mother and the other from the father. In some cases a baby may inherit an extra copy of chromosome 21 and this results in the baby having the disease thus the name trisomy 21.

TYPES

Down syndrome may be divided into three types depending on how the extra genetic material is acquired.

Trisomy 21 : This is the most common affecting about 95% of individuals. The child has 3 copies of chromosome 21 instead of the usual 2. It is caused by abnormal division during egg cell and sperm cell division.

Mosaic down syndrome : This is a rare form. It occurs when a child inherits an extra copy of chromosome 21 in some cells but not others.  These individuals may not have all the typical features of people with trisomy 21 and their condition may not be as severe. This type is caused by abnormal division after fertilization.

Translocation down syndrome : These individuals do not inherit the entire chromosome 21. They just inherit some extra chromosome 21 attached to another chromosome usually chromosome 14. This type is uncommon.

RISK FACTORS

Some people are at a higher risk of having children with Down Syndrome than others.

The main risk factor of having a child with the disease is advanced maternal age. A woman’s risk of having a baby with Down Syndrome increases because older eggs  are more likely to experience improper chromosomal cell division.

  • 25 years 1 in 1,250
  • 30  years 1 in 1,000
  • 35 years 1 in 400
  • 40 years 1 in 100
  • 45 years 1 in 30

If you already have a child with Down Syndrome, there is the likelihood of having  another baby with the disease. Also parents can pass on the genetic translocation for Down Syndrome to their children if they are carriers.

SYMPTOMS

Most children with Down Syndrome have distinct physical characteristics. These include the following :

  • flattened facial features
  • short neck
  • protruding tongue
  • upward slanting eyes that may have small skin folds at the inner corner
  • unusually shaped ears
  • small head
  • poor muscle tone and loose ligaments
  • relatively short fingers
  • broad short hands with a single crease in the palm
  • white spots on the colored part of the eye
  • excessive flexibility

Development and growth may usually be delayed. They are usually shorter than children of the same age. They usually reach  milestones such as sitting, crawling and walking later than other children. They have delays in speech and self-care such as feeding, toileting and dressing.

TEST AND DIANGONSIS

The  American Congress of Obstetrician and Gynecologists recommends offering various screening tests for Down Syndrome to all pregnant women regardless of their age. This helps parents make important decisions and prepare for caring for a child with special needs. It should be noted that these tests are not 100 % accurate. Some of these tests may also cause a miscarriage.

Ultrasound : It is used to measure a  specific region on the back of a baby’s neck. More fluid than usual tends to collect in these tissues when abnormalities exist. This test is known as nuchal translucency screening test.

Blood Test : It measures the  levels of pregnancy-associated plasma protein-A (PAPP-A)  and human chorionic gonadotropin (HCG). Abnormal levels may indicate a problem with the baby.

Amniocentesis : It is performed between 16 and 20 weeks of pregnancy. A thin needle is inserted through the abdominal wall and a small  sample of amniotic fluid is taken. The sample is then used to analyze the chromosomes of the fetus. This procedure carries a  risk of miscarriage.

Chorionic villus sampling (CVS) : This is usually done at 11-12 weeks of pregnancy. Collection  of  chorionic villus cell sample from the placenta  is done to  analyze fetal chromosome deviations. This test also carries a risk of miscarriage.

Percutaneous umbilical blood sampling (PUBS) : Fetal blood is taken from  the umbilical cord. The procedure is done by  inserting a needle  through the abdominal wall. The procedure is usually done around 18 weeks of pregnancy. It carries a greater risk of miscarriage than amniocentesis and CVS. It is done when previous test results are not clear.

At birth, the initial diagnosis of Down Syndrome is usually based on baby’s facial appearance. You  doctor will order chromosomal karyotype to confirm Down Syndrome.

TREATMENT

There is no cure for Down Syndrome. Early intervention programs and regular medical check-ups for associated health issues may help one manage the disease well.

Children with the disease should be enrolled in specialized programs that will  help  them develop their sensory, motor and cognitive skills .  Early intervention programs  include physical  therapy, occupational therapy and speech therapy. They should also be included in family activities.

Corrective surgery may be done for heart defects and other associated health issues that  the child may have.

Regular check-ups to screen the child for other diseases is also essential.

COMPLICATIONS

People with Down Syndrome may have a wide variety of complications, some of which include the following :

  • heart defects
  • leukemia
  • obesity
  • dementia
  • infectious disease
  • respiratory infections
  • sleep apnea
  • seizures
  • hearing loss
  • poor vision

PREVENTION

There is no way of preventing Down Syndrome. If you fall into the high risk category of having a child with the disease, it is better to consult a genetic counselor before getting pregnant. The genetic counselor will explain to you prenatal testing available for the  disease and what to expects when you have a child with the disease

Morning Sickness

  By Kemboi Kibet

Morning sickness is nausea that occurs during pregnancy. Though it is called morning sickness, it can occur at any time of the day. This condition is more common during the first trimester but in some cases it may linger throughout the whole pregnancy. Treatment is not necessary but there are certain tips that can help you contain the condition better.In severe cases of morning sickness known as hyperemesis gravidarum, patient may need to be hospitalized  and treated with intravenous (IV) fluids and medications. This however is very rare.

TIPS TO EASE MORNING SICKNESS

There is no guarantee that you can prevent morning sickness altogether. There are however steps you can take to reduce the frequency and severity of this condition.

Keep some snacks such as crackers by your bedside. Before you get out of bed in the morning, nibble on some crackers. This will prevent your blood sugar from getting low and absorb your stomach acid.

Get out of bed slowly and then nibble on some more crackers slowly. This will help your stomach settle and prevent queasiness when you walk around.

Eat small meals about every two to three hours instead of eating three large meals. This helps to prevent your blood sugar from going low. You need to always have some kind of food in your stomach otherwise your stomach acid will work on your stomach wall causing nausea.

Keep snacks such as crackers, vegetables sticks, fruits and Cheerios by you all day and snack on them to keep your blood sugar up.

Avoid foods that trigger morning sickness such as fried and greasy foods, sweets and caffeine.

Drink lot of fluids such as water and or ginger ale. It helps also helps suck on some ice chips.Staying hydrated is also essential for baby’s growth.

Avoid foods and smells that make your nausea worse.

If taking prenatal vitamins makes you queasy, it will be better to take them at night with food . If that doesn’t help, ask your doctor for chewable prenatals.

Avoid large amounts of water and beverages during a meal.

Make time to rest. Fatigue, worry and stress exacerbate morning sickness symptoms. Try taking naps during the day.

Fresh air may help. Take short walks or sleep with windows open if  weather permits.

Eating or drinking something sour like lemon may also help.

Fresh ginger is used to battle morning sickness. Add  a 2-inch piece of ginger root, peeled and sliced to tea and boiling water and let it stand for about 15-20 minutes. strain and then drink.

After eating sit down so that the gravity helps to keep food in your stomach.

Dont brush your teeth immediately after eating because this can cause you to vomit.

Avoid fatty or spicy foods. Avoid alcohol as well.

Wear lose and comfortable clothing. Tight clothing may exacerbate the symptoms of morning sickness.

Food Poisoning

by Kemboi Kibet  

Food poisoning happens after consuming a contaminated food or drink. It also called food borne disease. Different types of organisms such as different types of bacteria, viruses and parasites and their toxins usually cause food poisoning. Food poisoning can be mild or deadly and depending on the organisms that cause it. Victims may be symptom free or have symptoms such as diarrhea, nausea , vomiting, cramping, fever and chills. Food contamination can occur  during food processing and production or can even happen at home when food is manhandled.

 

CAUSES

Food poisoning can be caused by infectious agents such as viruses, bacteria and parasites or toxic agents such as pesticides on fruits. Food contamination can happen from growing, harvesting, processing, storing, shipping or preparing.

Some of the most common bacteria  that cause food poisoning  are:

  • Salmonella
  • Listeria
  • Campylobacter
  • E. coli

 

SYMPTOMS

Symptoms of food poisoning vary depending the type of contaminant but most  types present one or more of these common symptoms. They include the following :

  • nausea
  • vomiting
  • fever
  • watery diarrhea
  • abdominal pain and cramps

Food poisoning is usually mild and may run its course for 24-48 hours .In severe cases however symptoms may last longer and patient may need to be hospitalised. Symptoms can develop quickly within an hour or may be slow and worsen with time.

 

RISK FACTORS

Groups of people or conditions that put one at a higher risk of getting food poisoning include the following:

Pregnant Women : Changes in metabolism and increased circulation may increase your risk of catching food poisoning. Their symptoms may be severe. It is however rare for your baby to get sick from it.

Children : These group face the risk of getting food poisoning because their immune system is not fully developed.

Elderly : The elderly usually have compromised immune system due to their age or illness making it difficult for them to fight infection.

People With Chronic Diseases : Diseases such as HIV and diabetes reduces the effect of your immune system to fight diseases.

 

TEST AND DIAGNOSIS

Your doctor will ask you detailed questions to help diagnose food poisoning. These include what your symptoms are, how long you’ve been sick, what foods you’ve eaten and so on.Doctor may also check you for dehydration and may also check your blood pressure, pulse, breathing rate and temperature. In some cases stool samples will be sent to the lab to identify the toxin causing symptoms. Blood test may also be done to check for seriousness of the sickness.

 

TREATMENT

Most cases of food poisoning may resolve on its own but some may need to be treated. Treatment depends on severity of disease and organism causing the symptoms.

Replacing Lost Fluids : During diarrhea the body loses essential electrolytes and fluids and these need to be replaced to avoid dehydration. Patients may need to be hospitalised and nutrients and fluid replaced through an IV. Giving fluid and electrolyte through an IV is faster than oral hydration.

 

Antibiotics : Pregnant women with food poisoning may need to be treated with antibiotics to prevent baby from getting infected. Some organisms like listeria need to be treated with antibiotics.

Doctor may also treat fever with medications and may also give anti vomiting medication to control vomiting. He may also treat diarrhea with medications

 

SELF CARE

These self-care or home remedies makes patients more comfortable and prevent dehydration.

Let your stomach settle. Do not eat or drink for a few hours.

Small frequent sips of water helps keep you hydrated.

Avoid alcoholic, caffeinated, or sugary drinks.

Get enough rest.

Gradually begin to eat bland, easy-to-digest foods, such as soda crackers and banana.

Don’t use anti-diarrheal medications.They may slow elimination of toxins from the body.

 

PREVENTION

Cook foods to a safe temperature. Use meat themometer.

  • Cook ground meats to 160 F (71 C)
  • Cook ground poultry to 165 F (74 C)
  • Cook beef, veal, and lamb steaks, roasts and chops to 145 F (63 C)
  • Cook all cuts of fresh pork to 160 F (71 C).
  • Whole poultry should reach 180 F (82 C) in the thigh; breasts 170 F (76.6 C).

Defrost food safely. Safe way to defrost food is to use refrigerator or microwave.

Never leave food out for more than two hours.

Keep hot foods hot and cold foods cold.

Wash before and after handling raw food.

keep raw foods such as poultry away from other foods to prevent cross contamination.

keep surfaces and cooking items clean.

Store perishable foods immediately in refrigerator.

When not sure of food safety, throw away.

 

COMPLICATIONS

Food poisoning can cause dehydration which can be fatal. It is essential to stay hydrated by taking frequent sips of water or getting hydrated through IV if need be.

TtINNITUS

Tinnitus

Introduction

Tinnitus is the perception of sound in the absence of external stimuli. The term comes from the Latin term tinnere which means ringing, but is used to describe sounds that are buzzing, roaring, pulsatile, or clicking in nature. The sound may be perceived as either unilateral or bilateral. Tinnitus may be the first or only symptom of a disease process which threatens the patient’s health or well being.
It is estimated that 40 million people in the United States suffer from tinnitus with 10 million of those severely affected. The prevalence is highest in 40-70 year-olds and it is more common in men than in women. Tinnitus can have a great impact on a patient’s quality of life. Ludwig Von Beethoven described his experience with tinnitus in a letter to a friend in 1801, “only my ears whistle and buzz continuously day and night. I can say I am living a wretched life.”
Tinnitus may be classified as either objective tinnitus, which may be heard by an examiner, or subjective tinnitus in which the sound is only perceived by the patient. Subjective tinnitus is much more common than objective tinnitus. Tinnitus may also be classified as pulsatile or nonpulsatile, with pulsatile usually indicating a vascular etiology.

Objective Tinnitus

Objective tinnitus is the patient perceiving sound produced by paraauditory structures which may be heard by an examiner. It may be either pulsatile or nonpulsatile in nature. Take a careful history from the patient including the relationship of the sound to the heartbeat, the quality of the sound, aggravating/relieving factors, associated hearing loss, and whether the sound is unilateral or bilateral. Possible etiologies include vascular abnormalities, Eustachian tube dysfunction, or muscle spasm.

Vascular Abnormalities

Tinnitus which is described by a patient as pulsatile or with a rushing sound may be of vascular origin. The sound is produced by the flow of blood through paraauditory structures. Vascular tinnitus may be either objective or subjective. Possible causes are arteriovenous malformations, vascular tumors, venous hum, atherosclerosis, ectopic carotid artery, persistent stapedial artery, dehiscent jugular bulb, vascular loops, cardiac murmurs, increased cardiac output (pregnancy, anemia, hyperthyroidism), Paget’s disease, and benign intracranial hypertension.
Arteriovenous malformations are congenital lesions. Types include communication of the occipital artery and the transverse sinus, the internal carotid artery and the verterbral arteries, the middle meningeal artery and the greater superficial petrosal artery, and those of the mandible, brain parenchyma, or dura. Pulsatile tinnitus may be the initial symptom, but AVMs can also be associated with headache, papilledema, or discoloration of skin or mucosa.
Vascular tumors which can cause tinnitus include glomus tympanicum and glomus jugulare. These are paragangliomas which arise in the middle ear or jugular bulb respectively. A glomus jugulare may extend up into the middle ear. When the mass involves the middle ear it may be seen as a reddish mass behind the tympanic membrane.
A venous hum may be present from increased or turbulent flow through the venous system. Possible causes include a dehiscent jugular bulb, transverse sinus obstruction, benign intracranial hypertension, or increased cardiac output from pregnancy, anemia, or thyrotoxicosis. A dehiscent jugular bulb may be seen on otomicroscopy as a bluish mass in the middle ear. Patients with benign intracranial hypertension are usually female, overweight and have symptoms of hearing loss, aural fullness, dizziness, headaches, and visual disturbances.

Patulous Eustachian Tube

In patients with Eustachian tube dysfunction in which the tube remains open abnormally, it is called a patulous Eustachian tube. Patients may describe the sound as an ocean roar in the ear which changes with respiration. They may have relief with lying down or putting the head in a dependent position. A tympanogram may show motion of the tympanic membrane with respiration.

Muscle Spasm

Palatal myoclonus is a muscular cause of tinnitus. It is caused by contraction of tensor palatini, levator veli palatini, tensor tympani, salpinopharyngeal, or superior constrictor muscles. It is described as a clicking sound which is rapid (60-200 beats per minute), repetitive, and intermittent. It is associated with multiple sclerosis, small vessel disease, tumor, and degenerative neurological disorders. The muscle spasms may be seen either transorally or transnasally. A plot of compliance as a function of time on tympanometry will show the rhythmic change in compliance of the tympanic membrane corresponding to the muscle contraction.
Idiopathic stapedial muscle spasm induced tinnitus is described as a rough, rumbling, or crackling noise which may be exacerbated by outside sounds. The tinnitus tends to follow a sound stimulus, is brief and intermittent.

Subjective Tinnitus

Subjective tinnitus is not able to be heard by an examiner. It is more common than objective tinnitus and is usually nonpulsatile in nature. Subjective tinnitus is associated with presbycusis, noise exposure, Meniere’s disease, otosclerosis, head trauma, acoustic neuroma, drugs, middle ear effusion, temporomandibular joint problems depression, hyperlipidemia, meningitis, and syphilis.
Conditions which result in a conductive hearing loss, such as middle ear effusion, otosclerosis, or cerumen impaction may decrease the level of external sound to the point where the patient is able to hear normal skull sounds. In these cases, treatment of the cause of the conductive hearing loss may alleviate the tinnitus.
Tinnitus which is sensorineural in origin does not have a clear physiologic explanation. It may be caused by abnormalities of the cochlea, cochlear nerve, ascending auditory pathway, or auditory cortex. Many theories of the origin of tinnitis have been proposed which generally involve hyperactive hair cells or nerve fibers activated by a chemical imbalance across cell membranes or decoupling of stereocilia. A neurophysiologic model of tinnitus has been proposed by Jastreboff. In this theory, tinnitus emerges as the result of interaction of a number of subsystems in the nervous system, with auditory pathways playing a role in the development and appearance of tinnitus as sound perception, with the limbic system responsible for the development of tinnitus annoyance. The perception of tinnitus provides negative reinforcement which enhances the perception of tinnitus and the perception of time the person is aware of its presence. This model has led to the development of tinnitus retraining therapy to habituate the patient to the tinnitus.
Depression has been shown to be more prevalent in patients with chronic tinnitus than in people who do not complain of tinnitus. Folmer et al have reported their finding that patients with depression and tinnitus rated their tinnitus severity higher than patients with tinnitus who did not have depression.

Drugs

Many drugs have been linked to tinnitus. Although almost any medication can be a possible cause of tinnitus the most frequently implicated drugs are the antinflammatories, antibiotics, and antidepressants. Both aspirin and quinine are associated with tinnitus. This tinnitus is high frequency, tonal in nature, and accompanied by a temporary threshold shift. The tinnitus is reversible with cessation of the medication. Aminoglycoside antibiotics are also often implicated as the cause of drug-induced tinnitus. Other medications include loop diuretics and chemotherapeutic agents such as cisplatin and vincristine. Any of the heterocycline antidepressants (i.e. amitriptyline, imipramine) can cause tinnitus. This is interesting because antidepressants have also been investigated for the treatment of tinnitus.

Evaluation

The evaluation of a patient with tinnitus should start with a carefully taken history. The patient’s description of the tinnitus is very important, it can provide key information during the initial evaluation. The quality of the sound, especially whether it is pulsatile or nonpulsatile, the perceived location, the pitch, the loudness, constant or episodic, onset, alleviating/aggravating factors, history of infection or trauma, noise exposure, medication usage, medical history, associated hearing loss/vertigo, family history of hearing loss and associated pain should all be topics of inquiry. Another very important factor is the impact of the tinnitus on the patient. There are several tinnitus-specific self assessment tools available for evaluating the perceived severity of the tinnitus to the patient. The Tinnitus Handicap Inventory is a 25 item survey that provides a total score and three subscale scores for functional, emotional, and catastrophic impact on the patient.
After a thorough history is taken a complete head and neck exam, as well as a general physical exam should be performed. Otomicroscopy should be performed to look for a middle ear mass or motion of the tympanic membrane with respiration. A glomus tympanicum can be seen as a reddish mass in the middle ear or a dehiscent jugular bulb may be seen as a bluish mass. With a history of pulsatile tinnitus, the physician should search for an audible bruit by auscultating the external canal with a Toynbee tube, and over the orbit, mastoid process, skull, and neck using the bell and diaphragm of a stethoscope. The heart should be auscultated for murmurs. The patient should perform light exercise to see if this increases the pulsatile tinnitus. Tinnitus of arterial origin will often worsen with exercise. Venous induced tinnitus may decrease with light pressure on the neck, turning the head, or with the Valsalva maneuver.
All patients may undergo audiometric testing including pure tone audiometry, speech discrimination, tympanometry, and acoustic reflex measurements. The pitch of the tinnitus may be matched by the patient to an administered pure tone. The loudness of the tinnitus may be estimated by having the patient adjust the level of a pure tone to the loudness of their tinnitus. The minimal masking level is the number of decibels required to mask the tinnitus. In the case of vascular or palatomyoclonus induced tinnitus, a graph of tympanic membrane compliance versus time will show changes in compliance which correspond to the pulse or palatal movement respectively. Patulous Eustachian tube induced tinnitus can be diagnosed by a change in the compliance which corresponds to respiration. Unilateral high-frequency sensorineural hearing loss associated with tinnitus and asymmetric speech discrimination scores suggests an acoustic neuroma. Patients with unilateral symptoms may undergo auditory brainstem evoked response testing. These patients should undergo an acoustic protocol MRI to evaluate for acoustic neuroma, which will be further discussed below.
Laboratory studies may be obtained as indicated by the history and physical exam. Possible studies include hematocrit, fluorescent treponemal antibody absorption tests, blood chemistries, thyroid studies, and a lipid battery.
Weissman and Hirsch recently reviewed the imaging of tinnitus. They recommend contrast-enhanced computed tomography of the temporal bones and skull base as the first line
study for evaluating pulsatile tinnitus. The diagnosis of glomus tympanicum tumors is made on the bone algorithm scans which best shows the extent of the mass. It is usually not possible to see enhancement of a small tumor confined to the middle ear on a CT study. Either T1-weighted MRI with gadolinium enhancement or T2 weighted images will show the tumor enhancement. The earliest detectable abnormality on CT of glomus jugulare tumors is erosion of the lateral and anterior walls of the osseous jugular fossa. These tumors enhance significantly with contrast material, it may not be possible to differentiate the internal jugular vein from tumor. As with glomus tympanicum tumors T1-weighted MRI with gadolinium or T2-weighted images will show tumor enhancement. The classical characteristic MRI pattern is a “salt and pepper” appearance. Extracranial arteriovnous malformations as well as brain parenechymal AVMs are usually readily identified on contrast CT and MR studies. A patient with pulsatile tinnitus and a normal otoscopic exam may have a dural AVM or AVF. These lesions are often invisible on CT and MRI. Conventional angiography may be the only study to show the abnormality. Other abnormalities which can be identified on contrast enhanced CT include an aberrant carotid artery, a dehiscent carotid artery, dehiscent jugular bulb, and a persistent stapedial artery. CT findings of a persistent stapedial artery are the appearance of soft tissue on the promontory, enlargement of the facial nerve canal, and absence of the foramen spinosum.
Unilateral tinnitus or asymmetric sensorineural hearing loss is an indication for MRI to evaluate for an acoustic neuroma. A gadolinium enhanced MRI of the cerebellopontine angle is the study of choice to diagnose these lesions.

Treatment

The multiple etiologies and poorly understood mechanisms of tinnitus have led to the attempt at multiple treatment modalities. These include diet modification, medications, habituation, masking, electrical stimulation, acupuncture, hypnosis, and surgery. Some patients need only reassurance that the tinnitus is not a sign of a serious medical disease. Having a physician acknowledge that their symptoms are real and receiving follow up appointments, possibly with repeat audiogram to allay fears of worsening deafness may be of benefit to some patients. Avoidance of stimulants such as coffee, tea, chocolate, cola, and other caffeine containing medications as well as smoking cessation may help some patients. Patients should be instructed to avoid medications, which are known to cause tinnitus such as aspirin and NSAIDs. The use of white noise from a radio or a home masking machine is also helpful in some cases.
Many medications have been researched for the treatment of tinnitus, including lidocaine, tocainide, carbamazepine, benzodiazepines, tricyclic antidepressants, and ginko biloba. Lidocaine administered intravenously has been shown to improve tinnitus but is impractical to use clinically. Tocainide is an oral compound closely related to lidocaine, it has been shown to be ineffective in the treatment of tinnitus. Several randomized-controlled trials have also shown that carbamazepine is ineffective and may cause bone marrow suppression. Johnson et al performed a double-blind, placebo-controlled study of the effectiveness of the benzodiazepine alprazolam and found 76% of patients had improvement in their tinnitus. The risk of dependency to this medication is a significant risk of its use. Interestingly, given that tricyclic antidepressants are implicated as a possible cause of some tinnitus, is that nortriptyline has been
shown to be more effective than placebo. Ginko biloba has also shown some benefit in the reduction of tinnitus in some studies.
Hearing aids, maskers, or combinations of the two may help some patients. If the patient has some hearing loss, amplification of background noise by a hearing aid can decrease tinnitus. A masker produces sound to mask the tinnitus and decrease the annoyance to the patient. There are combination hearing aids/maskers which can be used which are called tinnitus instruments.
Tinnitus retraining therapy is a technique of habituation using a combination of masking with low level broadband noise and counseling to achieve habituation of the reaction to tinnitus and the perception of the tinnitus signal itself. In a study of 32 patients Berry et al found a significant improvement in the Tinnitus Handicap Inventory scores of tinnitus patients following six months of tinnitus retraining therapy.
Electrical stimulation of the cochlea has been studied for the treatment of tinnitus. Transcutaneous, round window, and promontory stimulation of the cochlea have shown some benfit. Direct currents may produce permanent damage and cannot be used clinically. Steenerson and Cronin used transcutaneous stimulation of the auricle and tragus to decrease tinnitus in 53% of 500 patients treated in this manner. Cochlear implants have also shown some promise in the relief of tinnitus. Ito and Sakakihara reported 77% of 26 patients with tinnitus who underwent cochlear implantation had relief of their tinnitus and 8% had aggravation of their tinnitus.
Surgical treatment of tinnitus is used in the treatment of arteriovenous malformations ,vascular tumors, otosclersosis, and acoustic neuroma. Some authors have reported success with cochlear nerve section in patients with intractable tinnitus that is recalcitrant to all other treatment modalities, however this is not advocated by most otologists.
Other treatments that have been studied are biofeedback, hypnosis, magnetic stimulation and acupuncture. Studies of these modalities have shown conflicting results as to their benefit.

Conclusion

Tinnitus is a symptom that can be classified as objective or subjective. The majority of patients have subjective tinnitus associated with presbycusis. The impact of tinnitus on the patient’s well being and quality of life is an important factor in deciding upon treatment. As we are faced with the aging of the population in the United States, tinnitus will surely become even more prevalent. Continued research into the mechanism and treatment of tinnitus is necessary to make progress in relieving the suffering of our patients.
References
1. Hazell, JP, Jastreboff PJ. Tinnitus. I: Auditory mechanisms: a model for tinnitus and hearing impairment. J. Otolaryngology 1990;19:1-5.
2. Ator GA, Lambert PR. Tinnitus. In: Canalis RF, Lambert PR, eds. The Ear: Comprehensive Otology. Philadelphia, Lippincott Williams & Wilkins, 2000:559-570.
3. Schleuning AJ, Martin WH. Tinnitus : Bailey BJ, ed. Head and Neck Surgery-Otolaryngology, Third Edition. Philadelphia, Lippincott Williams & Wilkins, 2001:1925-1931.
4. Tyler RS, Babin RW. Tinnitus. In: Cummings CW, ed. Otolaryngology-Head and Neck Surgery, Second Edition. St. Louis, Mosby-Year Book, 1993:3031-3053.
5. Seidman MD, Jacobson GP. Update on tinnitus. Otolaryngologic Clinics of North America 1996;29(3):455-465.
6. Sismanis A, Smoker W. Pulsatile Tinnitus: Recent advances in diagnosis. Laryngoscope 1994;104:681-688.
7. Lockwood AH et al. Tinnitus. N Eng J Med 2002;347(12):904-910.
8. Folmer RL et al. Tinnitus severity, loudness, and depression. Otolaryngology-Head and Neck Surgery1999;121(1):48-51.
9. Jastreboff PJ et al. Neurophysiological approach to tinnitus patients. The American Journal of Otology 1996;17(2):236-240.
10. Weissman JL, Hirsch BE. Imaging of tinnitus: a review. Radiology 2000;216:342-349.
11. Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope 1999;109:1202-1211.
12. Pulec JL. Cochlear nerve section for intractable tinnitus. ENT Journal 1995;74(7):468-476.
13. Steenerson RL, Cronin GW. Treatment of tinnitus with electrical stimulation. Otolaryngology-Head and Neck Surgery 1999;121(5):511-513.
14. Ito J, Sakakihara J. Tinnitus suppression by electrical stimulation of the cochlear wall and by cochlear implantation. Laryngoscope 1994;104:752-754.
15. Araujo MF et al. Radilogy quiz case I: persistent stapedial artery. Arch Otolaryngol Head Neck Surg 2002;128:456-458.
16. Berry JA et al. Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy. Arch Otolaryngol Head Neck Surg 2002;128:1153-1157.
17. Johnson RM et al. Use of alprazolam for relief of tinnitus. Arch Otolaryngol Head Neck Surg 1993;119:842-845.

Erectile Dysfunction – ed (Impotence)

Kemboi Kibet

Erectile dysfunction is when a man cannot get an erection firm enough for satisfactory sexual intercourse. He may not have an erection at all or may lose erection during intercourse. Inability to get an erection may happen once in a while but if it happens all the time, then it is erectile dysfunction. Erectile dysfunction can occur at any age but it’s more common in men age 45 and above. An erection problem can damage a man’s self-esteem and destroy a relationship.

You should note that male infertility is different from erectile dysfunction. Male infertility is when you are unable to produce sperms that can fertilise an egg. You can however get an erection. People with erectile dysfunction however may be able to produce sperm that can fertilise an egg. Premature ejaculation which is reaching orgasm too quickly is also not the same as impotence.

If impotence is caused by underlying disease such as diabetes, treating the disease may reverse the condition. There are also other treatment methods available if your impotence is not caused by underlying disease.

CAUSES

Sexual arousal in men is a complex situation that involves the brain, nerves, hormones and blood vessels. Anything that interferes with their normal function can lead to erectile problems. Psychological issues like stress and depression can also cause impotence.

Physical Causes of Erection Problems

diseases such as diabetes, heart disease, multiple sclerosis, high blood pressure, thyroid problems, Parkinson’s disease, atherosclerosis etc.
obesity
high cholesterol
alcohol, tobacco or cocaine use
spinal cord injury
low testosterone
treatment for prostate cancer and enlarged prostate
surgery or injury to the pelvic area
medications such as blood pressure medications especially beta blocker, heart medication especially digoxin, antidepressants, sleeping pills etc

Psychological Causes of Erection Problems

anxiety, depression and other mental heath problems
stress
low self-esteem
fear of sexual failure

Physical causes of impotence is more common in older men. Younger men usually experience impotence associated with psychological problems.

SYMPTOMS

Erectile dysfunction may present symptoms like the following :

trouble having an erection

trouble keeping an erection

reduced sexual desire

TEST AND DIAGNOSIS

A physical exam and medical history may be enough to diagnose impotence. However, in some cases where an underlying problem or condition is the cause of the erectile dysfunction, further testing may be needed.

Blood test : Blood sample is sent to the lab to check for diseases like diabetes, cardiovascular problems, low testosterone and so on. It also checks for the levels of various hormones in your body (hormone profiling).

Physical Exam. This is done to check the penis and testicles for any abnormalities. Your nerves for feeling may also be checked.

Urine test : This is done to check for diabetes and other health problems.

Penile ultrasound : It creates a video image that helps your doctor check for blood flow to your penis.

Nocturnal penile tumescence (NPT) : It checks for night-time erection. If it is found out that you do have night-time erection, then your impotence may be psychological and not physical.

Psychological exam : Your doctor will screen you for depression, anxiety and other psychological problems.

TREATMENT

First treatment for erectile dysfunction is to treat the underlying medical condition.

Other treatment options for impotence depends on the severity and type of underlying condition causing the erectile problem. They include the following :

Oral Medications : This includes Sildenafil (Viagra),Tadalafil (Cialis) and Vardenafil (Levitra, Staxyn). They are called phosphodiesterase-5 (PDE5). They increase blood flow to the penis and only work when you are sexually aroused. Do not use these drugs with medications such as nitroglycerin as they can cause a drop in blood pressure. Ask your doctor before using these medications because they can cause problems if you have heart disease, uncontrolled diabetes, very low blood pressure and other health problems.

Testosterone replacement uses skin patches, gel or injections into the muscle . This option is for people with low testesterone levels.

Alprostadil self-injection – Medication is injected into the penis to improve blood flow to the penis. It works better than oral medication. The medication can also be inserted into the urethra, in which case it is called Alprostadil penis suppository.

Penile implants: It involves surgically placing devices into the two sides of the penis. It is usually the last resort if other treatment options do not work.

Penis pumps : A penis pump is placed over your penis. This creates a vacuum that pulls blood into your penis.

Psychotherapy : This is done if stress, anxiety, depression and other psychological issues are the cause of your erectile problems.

NATURAL REMEDIES

Alternative treatment for erectile dysfunction include :

Acupuncture
Korean red ginseng (Panax ginseng) is known to increase energy, stamina, and sexual function.
L-arginine signals smooth muscle surrounding blood vessels to relax and dilate increasing blood flow.
Ginkgo is used especially in people who experience sexual dysfunction as a side effect of antidepressant drugs. It relaxes smooth muscle and enhance blood flow to the penis.

COMPLICATIONS

Erectile dysfunction can lead to :

low self-esteem
marital or relationship problems
poor sex life

PREVENTION

The following steps can help prevent impotence.

Maintain a healthy weight.
Do not smoke, drink alcohol in excess or abuse street drugs.
Manage your health conditions like diabetes, heart diseases and so on.
Exercise regularly
Minimize your stress level and get help for depression and anxiety.

SUDDEN INFANT DEATH SYNDROME (SIDS)

Kemboi Kibet

Sudden infant death syndrome (SIDS) is a sudden unexplained death of infants under one year of age. This usually occurs during sleep and hence the name crib death. The cause of SIDS is unknown although some researchers believe it is due to abnormalities in the portion of the infant’s brain that control breathing and arousal from sleep. All babies (healthy or sick) are at risk and certain sleep environment also increases your infant’s risk. It is important to remove blankets, pillows and toys from the crib to reduce the risk of SIDS. Also placing baby on the back to sleep and using a firm crib mattress may all help to prevent SIDS.
CAUSES
The main cause of SIDS is unknown although doctors believe it may be related to a combination of sleep environmental and physical factors.
Sleep environmental factors – A baby’s sleeping position, crib toys and a lot of physical factors can greatly increase the baby’s risk of SIDS. A baby may have difficulty breathing if place on their stomach or side to sleep than those placed on their back. Blankets, pillows, quilts and crib toys placed in a baby’s crib may cause suffocation if they are not kept away from the baby’s face. Also laying your baby on a soft fluffy surface can block the baby’s airways. The risk of SIDS is reduced in babies who sleep in the same room as their parents however, sleeping on the same bed as their parents is dangeruous because they are more exposed to a tremendous amount of soft surface which will in turn impair their breathing.
Physical factors – These include brain abnormalities, respiratory infections and low birth weight. In some babies the portion of the brain that controls arousal from sleep and breathing does not work properly and this makes them more susceptible to develop SIDS. Respiratory infection like colds may cause SIDS in infants due to difficulty breathing. Babies with low birth weight (eg multiple birth babies) and premature babies generally have brains that are not well developed to control breathing and heart rate and hence more likely to develop SIDS.
RISK FACTORS
Cetain factors increases a baby’s risk of SIDS. SIDS is more likely to occur between ages 2-4 months although it could occur later (up to 1 year old). Boys are at increased risk of SIDS than girls. Other risk factors include:

Baby sleepin on the stomach or side
Baby sleeping on a soft bedding in the crib
Race – Black, american indian or eskimo babys are more likely to develop SIDS
Premature birth
Multiple birth babies (twins and triplets)
Family history of SIDS
Inadequate prenatal care
Alcohol or illegal drug use during pregnancy
Smoking during pregnancy
Short time periods betweeen pregnancies
Babies born to teenage mothers
Poverty

SYMPTOMS
SIDS occur with no signs or symptoms. It happens when your baby is thought to be sleeping.
TEST AND DIAGNOSIS
An autopsy will not confirm the cause of death but may give additive knowledge about SIDS.
PREVENTION
There is no sure way to prevent a baby from developing SIDS but some measures can be taken to reduce a baby’s risk. These include:
Placing baby on the back to sleep instead of on his side or stomach
Placing baby to sleep on a firm sleep surface
Keeping soft objects, toys and loose beddings out of the baby’s sleep area.
Keeping your baby’s room at a tempreture comfortable for adults and dressing them in light sleeping clothes to prevent overheating.
Offering your baby a pacifier at naptime and bedtime may reduce the risk of SIDS.
Avoid co-sleeping with your baby. A baby sleeping on an adult bed may become trapped in headboard slates, sheets and other loose beddings and this will cause suffocation.

COPD – Chronic obstructive pulmonary disease

Kemboi Kibet

COPD comprises a group of lung diseases which includes chronic asthmatic bronchitis and emphysema. Most people with COPD have a combination of both conditions. These conditions make it difficult to breathe by obstructing air flow through the airways and out of the lungs. It eventually interferes with exchange of oxygen and carbon dioxide in the lungs. This condition is permanent and may progress overtime. There may be periods of exacerbations when symptoms get worse and may be life threatening. COPD is the most common lung disease and the leading cause of death worldwide. Damage done to the lungs by the disease cannot be reversed. Treatment is aimed at relieving signs and symptoms.

Chronic Asthmatic Bronchitis : It causes inflammation and narrowing of the airways that leads to narrowing and obstruction of these airways. It may result in long-term cough with mucus and wheezing.

Emphysema : This involves lung destruction over time. Damage occurs in the tiny air sacs in your lungs called the alveoli. Emphysema may gradually destroy the inner walls of the alveoli thereby reducing the surface area available for gas exchange. It may also weaken the alveoli wall, making it less elastic. These walls collapse during exhalation and trap air in the alveoli.

STAGES

STAGE I : Minimal shortness of breath with or without cough and mucus. The disease is considered mild.

STAGE II : At this moderate stage, shortness of breath may be severe with or without cough and mucus. Medical attention is usually sought at this stage.

STAGE III : It is considered severe. It is accompanied by severe shortness of breath with or without cough and sputum, fatigue, reduced exercise capacity and repeated exacerbations .

STAGE IV : At this stage, the disease is very severe, quality of life is affected and exacerbations may be life threatening.

CAUSES

Smoking is the leading cause of COPD. The more a person smokes, the higher his risk of getting this disease. Non smokers may also get this condition and so does long periods of exposure to dust, chemical fumes and air pollutants.

RISK FACTORS

Some factors may put one at high risk of this disease than others. These factors include the following:

Smoking : Long term exposure to tobacco smoke puts you at high risk of getting this disease. Your risk of this disease is increased by the number of years and packs you smoke. Second hand smoking also puts you at risk.

Age : COPD usually occur in people 40 years and older.

Genetics : A rare genetic disorder known as alpha-1-antitrypsin deficiency is the source of some new cases of COPD.

Long-term exposure to chemical fumes, vapors and dusts can also inflame and irritate your lungs. Frequent use of cooking fire without proper ventilation may also be a contributing factor.

SYMPTOMS

Some typical signs and symptoms of COPD include the following:
•shortness of breadth (dyspnea)
•cough with or without mucus
•wheezing
•chest tightness
•fatigue
•respiratory infections
•fever

In severe cases patients may experience headache, weight loss, cyanosis (bluish discoloration of the lips and nail beds) and pulmonary hypertension (elevated pressure in the blood vessels of the lungs ).

TEST AND DIAGNOSIS

Doctors diagnose COPD based on questions about medical history , symptoms and physical examinations. Typical tests to diagnose this disease include :

Imaging Test : Chest x-ray may be done to rule out other lung problems, such as lung cancer or heart failure. The x-ray can also show an enlarged chest cavity and decreased lung markings which may indicate lung tissue destruction. Computerized tomography (CT) accurately shows the abnormal lung tissue and airways in COPD. It gives detailed cross-sectional areas of internal organs.

Arterial blood gas : This blood test measures how well oxygen goes to the blood and carbon dioxide is eliminated from the blood. It also determines the acidity (pH) of your blood.

Sputum examination : Mucus that come up when you cough is taken to the lab to be analysed for bacteria pathogens. This helps rule out other possible causes of your symptoms.

Lung function test : Spirometry is the best lung function test for COPD. Your lung capacity is checked by blowing out as much as possible into a large tube connected to a spirometer. The spirometer measures how much air your lungs can hold and how fast you can blow the air out of your lungs.

TREATMENT

There is no cure for COPD. Treatment is aimed at relieving symptoms and reducing your risk of exacerbations and complications.

Smoking cessation is the most essential step in treating COPD. This may prevent further damage to the lungs and prevent the disease from getting worse.

Medications may also be used to treat COPD and these include the following :

Bronchodilators : They are used to open the airways by relaxing the muscles around them. They usually come in the form of inhalers. Examples include ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol. Broncholdialators makes breathing easier.

Inhaled steroids : They make you breath better by reducing inflammation in the lungs. They are usually reserved for people with moderate to severe COPD because of it’s potentially serious side effects.

Antibiotics : They are used when necessary to fight bacterial infection of the upper respiratory tract. These infections such as pneumonia and influenza may aggravate COPD symptoms.

Anti-inflammatory medications such as montelukast (Singulair) and roflimulast may also be used.

Other treatment options for this disease include:

Oxygen therapy : This include using lightweight portable devices to deliver oxygen to the lungs.

Pulmonary rehabilitation program : It teaches you to breathe in a different way so you can stay active. It also includes education, exercise training, nutrition advice and counselling.

In severe cases when medications alone are not enough, surgery may be needed.
•Lung volume reduction surgery creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently .
•Lung transplant can improve your ability to breathe and be active.

Even with treatment, there may be times when symptoms may get worse. This is called acute exacerbation. Seek immediate medical attention when this happens.

COMPLICATIONS

COPD can present these serious complications.
•heart problems such as arrhythmia
•respiratory infections such as pneumonia
•severe weight loss
•osteoporosis
•high blood pressure

PREVENTION

The best way to prevent this disease is to stop smoking. Don’t start smoking if you haven’t already. Don’t sit in a smoking zone when you go out because second hand smoking can be as harmful. It is also important to protects yourself from lung irritant and chemicals at work by wearing mask .

Nota Bene

Hi all!

Today I’d like to talk about the future. About a not-so-glamorous future of mass cyber-attacks on things like nuclear power stations, energy supply and transportation control facilities, financial and telecommunications systems, and all the other installations deemed “critically important”. Or you could think back to Die Hard 4 – where an attack on infrastructure plunged pretty much the whole country into chaos.

Alas, John McClane isn’t around to solve the problem of vulnerable industrial systems, and even if he were – his usual methods of choice wouldn’t work. So it comes down to KL to save the world, naturally! We’re developing a secure operating system for protecting key information systems (industrial control systems (ICS)) used in industry/infrastructure. Quite a few rumors about this project have appeared already on the Internet, so I guess it’s time to lift the curtain (a little) on our secret project and…

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