Agoraphobia

Definition:
The word “agoraphobia” is an English adaptation of the Greek words agora (a) and phobos (ß), and literally translates to “a fear of the marketplace.”

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Panic disorder is characterized by repeated and unpredictable attacks of intense fear and anxiety. Agoraphobia, literally “fear of the marketplace”, develops from a panic disorder in more than one-third of cases.

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Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include crowds, wide open spaces or traveling, even short distances. This anxiety is often compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public.

Agoraphobics may experience panic attacks in situations where they feel trapped, insecure, out of control or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to his or her home. Many people with agoraphobia are comfortable seeing visitors in a defined space they feel they can control. Such people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones. If the agoraphobic leaves his or her safety zone, they may experience a panic attack.

It is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to their home, experiencing difficulty traveling from this “safe place.”

Agoraphobia is fear of being in places where help might not be available, and is usually manifested by fear of crowds, bridges, or of being outside alone.

Prevalence:
The one-year prevalence of agoraphobia in the United States is about 5 percent. According to the National Institute of Mental Health, approximately 3.2 million Americans ages 18-54 have agoraphobia at any given time. About one third of people with Panic Disorder progress to develop agoraphobia.

Gender differences
Agoraphobia occurs about twice as commonly among women as it does in men. The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles prescribe women to react to anxiety by engaging in dependent and helpless behaviors. Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia.

Causes :
Agoraphobia often accompanies another anxiety disorder, such as panic disorder or a specific phobia.
If it occurs with panic disorder, the onset is usually in the 20s, and women are affected more often than men. People with this disorder may become housebound for years, which is likely to hurt social and interpersonal relationships.

There is no one single cause associated with agoraphobia.

There is no one single cause associated with agoraphobia. Instead, there are a number of factors that contribute to the development of agoraphobia. These factors include:

Family factors:

*Having an anxious parent role model.

*Being abused as a child
*Having an overly critical parent.
Personality factors:
*High need for approval.
*High need for control.
*Oversensitivity to emotional stimuli.
Biological factors:
*Oversensitivity to hormone changes.
*Oversensitivity to physical stimuli.
*High amounts of sodium lactate in the bloodstream.

.Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation.Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces. Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data.

Some scholars have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.

Symptoms:
*Fear of being alone
*Fear of losing control in a public place
Fear of being in places where escape might be difficult
*Becoming housebound for prolonged periods of time
*Feelings of detachment or estrangement from others
*Feelings of helplessness
*Dependence on others
*Feeling that the body is unreal
*Feeling that the environment is unreal
*Anxiety or panic attack (acute severe anxiety)
*Unusual temper or agitation with trembling or twitching

Additional symptoms that may occur:
*Lightheadedness, near fainting
*Dizziness
*Excessive sweating
*Skin flushing
*Breathing difficulty
*Chest pain
*Heartbeat sensations
*Nausea and vomiting
*Numbness and tingling
*Abdominal distress that occurs when upset
*Confused or disordered thoughts
*Intense fear of going crazy
*Intense fear of dying

Diagnosis:
Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.[16] In rare cases where agoraphobics do not meet the criteria used to diagnose Panic Disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used.

DSM-IV-TR diagnostic criteria
A) Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.

B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.

C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).

D)The individual may have a history of phobias, or family, friends, or the affected person may tell the health care provider about agoraphobic behavior.
The individual may sweat, have a rapid pulse (heart rate), or have high blood pressure.

Treatments:
Agoraphobia can be successfully treated in many cases through a very gradual process of graduated exposure therapy combined with cognitive therapy and sometimes anti-anxiety or antidepressant medications. Treatment options for agoraphobia and panic disorder are similar.
The goal of treatment is to help the phobic person function effectively. The success of treatment usually depends upon the severity of the phobia.
Systematic desensitization is a technique used to treat phobias. The person is asked to relax, then imagine the things that cause the anxiety, working from the least fearful to the most fearful. Graded real-life exposure has also been used with success to help people overcome their fears.

Cognitive behavioral treatments
Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. Similarly, Systematic desensitization may also be used.

Cognitive restructuring has also proved useful in treating agoraphobia. This treatment uses thought replacing with the goal of replacing one’s irrational, counter-factual beliefs with more accurate and beneficial ones.[citation needed]

Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.[citation needed]


Psychopharmaceutical treatments

Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class and include sertraline, paroxetine and fluoxetine. Benzodiazepine tranquilizers, MAO inhibitors and tricyclic antidepressants are also commonly prescribed for treatment of agoraphobia.


Alternative treatments

Eye movement desensitization and reprogramming (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.
Alternative treatments of agoraphobia include hypnotherapy, guided imagery meditation, music therapy, yoga, religious practice and ayurvedic medicine.

.
Additionally, many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided


Prognosis:
Phobias tend to be chronic, but respond well to treatment.

Possible Complications :
Some phobias may affect job performance or social functioning.

When to Contact a Medical Professional:
Call for an appointment with your health care provider if symptoms suggestive of agoraphobia develop.

Prevention:

As with other panic disorders, prevention may not be possible. Early intervention may reduce the severity of the condition.

.Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://en.wikipedia.org/wiki/Agoraphobia

http://www.nlm.nih.gov/medlineplus/ency/article/000931.htm

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Colic

Definition:
Colic is when an otherwise healthy baby cries more that three hours a day, for more than three days a week, between ages three weeks and three months. The crying usually starts suddenly at about the same time each day. This is actually just an arbitrary definition made years ago . By this definition, a surprising number of babies actually would have colic: some experts have even estimated as many as half of all babies!

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If your baby is crying a lot, you should call your doctor. Your pediatrician will want to check your baby to make sure there is no medical reason for the crying. If your baby’s doctor finds no underlying cause, then they will probably say your baby has colic. Colic is perfectly normal, and does not mean there is anything wrong with either baby or parents. Colic can be distressing for both you and your baby. But take comfort in the fact that it’s not permanent. In fact, in a matter of weeks or months — when your baby is happier and sleeping better — you’ll have weathered one of the first major challenges of parenthood.It does not have any lasting effects on the child or the mother in later life.

Signs and symptoms:

The baby’s cry is loud and they may have a red face and a tense, hard belly, because the abdominal muscles tighten with crying. Baby’s legs may be drawn up and fists clenched. This is often just the typical baby crying posture. However, the first time your baby has a long jag of inconsolable crying like this—with a tense, hard belly—you should call your doctor. This can sometimes be a sign of a serious condition that requires medical attention.
A fussy baby doesn’t necessarily have colic. In an otherwise healthy, well-fed baby, signs of colic include:

*Predictable crying episodes. A baby who has colic often cries about the same time every day, usually in the late afternoon or evening. Colic episodes may last anywhere from a few minutes to three hours or more on any given day. The crying usually begins suddenly and for no clear reason. Your baby may have a bowel movement or pass gas near the end of the colic episode.
*Intense or inconsolable crying. Colic crying is intense. Your baby’s face will likely be flushed, and he or she will be extremely difficult — if not impossible — to comfort.

*Posture changes. Curled up legs, clenched fists and tensed abdominal muscles are common during colic episodes.
*Colic may affect up to about 25 percent of babies. Colic usually starts a few weeks after birth and often improves by age 3 months. Although a few babies struggle with colic for months longer, colic ends by age 9 months for 90 percent of babies.

Causes:
No one really knows what causes colic. Researchers have explored a number of possibilities, including allergies, lactose intolerance, an immature digestive system, maternal anxiety, and differences in the way a baby is fed or comforted. This last idea speculates that Baby’s immature nervous system can’t handle the stimuli of everyday life, and that crying is their only way of communicating this “overload.” An opposite hypothesis is that Baby needs more stimulation, and gets it through crying. Colic is mysterious, but not harmful to your baby. et it’s still unclear why some babies have colic and others don’t.

Diagnosis:
Your baby’s doctor will do a physical exam to identify any possible causes for your baby’s distress, such as an intestinal obstruction. If your baby is otherwise healthy, he or she may be diagnosed with colic. Lab tests, X-rays and other diagnostic tests aren’t usually needed.

Treatment:
Colic improves on its own, often by age 3 months. In the meantime, there are few treatment options. Prescription medications such as simethicone (Mylicon) haven’t proved very helpful for colic, and others can have serious side effects.

A study published in January 2007 suggests that treatment with probiotics — substances that help maintain the natural balance of “good” bacteria in the digestive tract — can soothe colic. More research is needed, however, to determine the effects of probiotics on colic.

Consult your baby’s doctor before giving your baby any medication to treat colic.

Risk factors:
Infants of mothers who smoke during pregnancy or after delivery have twice the risk of developing colic.

Many other theories about what makes a child more susceptible to colic have been proposed, but none seem to hold true. Colic doesn’t occur more often among firstborns or formula-fed babies. A breast-feeding mother’s diet isn’t likely to trigger colic. And girls and boys — no matter what their birth order or how they’re fed — experience colic in similar numbers.

Popular Myths related to colic?
Let’s debunk some of the popular myths about colic. Here are the facts:

*Babies do not cry to manipulate their parents.
*Holding babies and picking them up when they cry cannot “spoil” them.
*We do not know whether colicky babies are in pain or not, but they sure seem to be, and that can really stress out parents. Keep in mind that your baby may not actually be in pain or distress, but just doing what they need to do for their immature nervous systems.
*Giving rice cereal does not help solve colic.
*Studies have shown that Simethicone (Mylicon) and lactase (the enzyme that helps digest lactose—the sugar in cow’s milk—which is in breast milk if the mother consumes dairy products) do not help colic. ,
*Sedatives, antihistamines, and motion-sickness medications, like dicyclomine (Bentyl) are NOT safe or effective in treating colic in babies. Often grandparents will suggest these medications. They were commonly used years ago, but now we know better.

Self Care:

Your baby’s doctor may not be able to fix colic or make it go away sooner, but there are many ways you can try to soothe your baby. Consider these suggestions:

  • Feed your baby. If you think your baby may be hungry, try a feeding. Hold your baby as upright as possible, and burp your baby often. Sometimes more frequent — but smaller — feedings are helpful. If you’re breast-feeding, it may help to empty one breast completely before switching sides. This will give your baby more hindmilk, which is richer and potentially more satisfying than the foremilk present at the beginning of a feeding.
  • Offer a pacifier. For many babies, sucking is a soothing activity. Even if you’re breast-feeding, it’s OK to offer a pacifier to help your baby calm down.
  • Hold your baby. Cuddling helps some babies. Others quiet when they’re held closely and swaddled in a lightweight blanket. To give your arms a break, try a baby sling, backpack or other type of baby carrier. Don’t worry about spoiling your baby by holding him or her too much.
  • Keep your baby in motion. Gently rock your baby in your arms or in an infant swing. Lay your baby tummy down on your knees and then sway your knees slowly. Take a walk with your baby, or buckle your baby in the car seat for a drive. Use a vibrating infant seat or vibrating crib.
  • Sing to your baby. A soft tune might soothe your baby. And even if lullabies don’t stop your baby from crying, they can keep you calm and help pass the time while you’re waiting for your baby to settle down. Recorded music may help, too.
  • Turn up the background noise. Some babies cry less when they hear steady background noise. When holding or rocking your baby, try making a continuous “shssss” sound. Turn on a kitchen or bathroom exhaust fan, or play a tape or CD of environmental sounds such as ocean waves, a waterfall or gentle rain. Sometimes the tick of a clock or metronome does the trick.
  • Use gentle heat or touch. Give your baby a warm bath. Softly massage your baby, especially around the tummy.
  • Give your baby some private time. If nothing else seems to work, a brief timeout might help. Put your baby in his or her crib for five to 10 minutes.
  • Mix it up. Experiment to discover what works best for your baby, even if it changes from day to day.
  • Consider dietary changes. If you breast-feed, see if eliminating certain foods from your own diet — such as dairy products, citrus fruits, spicy foods or drinks containing caffeine — has any effect on your baby’s crying. If you use a bottle, a new type of bottle or nipple might help.

If you’re concerned about your baby’s crying or your baby isn’t eating, sleeping or behaving like usual, contact your baby’s doctor. He or she can help you tell the difference between a colic episode and something more serious.

How you can help your baby relieve their colic distress?

Colic usually starts to improve at about six weeks of age, and is generally gone by the time your baby is 12 weeks old. While you are waiting for that magic resolution, try these techniques to help soothe your infant:

  • Respond consistently to your baby’s cries.
  • Don’t panic and don’t worry. If you are worried, bring your baby to their pediatrician.
  • When your baby cries, check to see if they are hungry, tired, in pain, too hot or cold, bored, over-stimulated, or need a diaper change.
  • Some parents find that carrying their baby more reduces colic. You can try different baby carriers to make it easier and free your hands. Many parents (and babies!) love slings once they get the hang of them—but sometimes it takes a little experimentation. One study found carrying babies four to five hours a day resulted in less crying at six weeks of age, as compared to carrying them only two to three hours a day. On the other hand, a later study by the same researcher did not find significantly less crying in babies carried more. So your best bet is just to see if it makes any difference with your baby.
  • Vacuum while wearing your baby in a baby carrier.
  • Rock your baby.
  • Change formula. Talk with your baby’s doctor first.
  • Breastfeeding moms can try changing their diets. In a recent study , researchers found that taking out allergenic foods (cow’s milk, eggs, peanuts, tree nuts, wheat, soy and fish) from the breastfeeding mom’s diet reduced crying and fussing in babies under 6 weeks.
  • Play music and dance with your baby.
  • Talk a walk with your baby in the stroller. This can really help with your stress level, in addition to soothing your baby.
  • Get support from family, friends, your religious community, neighbors, etc. Let them help in any way possible.
  • Take care of yourself and manage your stress. Eating a well-balanced diet, getting sleep and exercise, and having people to talk to can do wonders. If the stress or blues become too much, it’s good idea to get professional help. Your or your baby’s doctor might be able to help you figure out where to start.
  • Nurse your baby every 2-3 hours if you are breastfeeding.
  • Don’t smoke, and don’t allow anyone to smoke around your baby. Babies of smokers cry more, and get sick more often, too. Smoker’s babies also have an increased risk of SIDS.
  • Quitting smoking during pregnancy may reduce the likelihood that your baby will develop colic . in addition to all the other benefits to you and your baby.
  • You could try a device that attaches to the crib. It’s designed to simulate a car ride, but it is not clear that the device actually works. The Sleep Tight Infant Soother consists of a vibration unit that mounts under the crib and a sound unit that attaches to the crib rail. Your pediatrician can tell you whether it would be a good idea to try in your baby’s case. The device is not promoted directly to consumers. Some insurance companies may reimburse the cost if you have a physician prescription. You can reach the manufacturer at 1-800-NO-COLIC or 1-800-662-6542. There is no research to prove that the Sleep Tight works, and some parents have been dissatisfied with it.
  • Provide white noise, such as running the vacuum cleaner, clothes dryer, or hair dryer near your baby while in their car seat. (Do not put your baby on top of the dryer—they could fall off!) White noise machines are also available. White noise simulates the whooshing sound your baby heard constantly while in utero. You can also do your own “whooshing” or “shushing” with your voice as you rock or carry your baby.
  • Go for a car ride.
  • Massage your baby. Find out how to do infant massage for colic. Massage has many benefits for both the baby and the giver of the massage.
  • Some parents have found that herbal tea is helpful. The combination of chamomile, fennel, vervain, licorice, and balm-mint was found to be effective in one study. Other traditional herbs for colic tea include anise, catnip, caraway, mint, fennel, dill, cumin, and ginger root. Gripe water, available in Britain and Canada, is made from dill. These remedies are not produced or regulated in the same standardized ways that medications are—so you don’t know exactly what you are getting. These herbs have not all been studied, and therefore it is not certain that they are all safe. More research is needed to be sure these preparations are safe and effective. If you choose to give herbal tea, start by giving only an ounce, and never give more than four to six ounces per day. Babies who fill up on tea don’t drink enough breast milk or formula and then have trouble growing. Please remember that just because something is “natural”, it is not necessarily safe.

Places where you to get more information about colic:
On the Web:

Recommended reading:

  • The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer, by Harvey Karp
    This book teaches you simple techniques based on other cultures where babies do not get colic, and on the idea a baby’s first three months are like a fourth trimester.
  • Check out the chapter on colic in the book, The Holistic Pediatrician (second edition), by Kathi Kemper.
  • Infant Massage: A Handbook for Loving Parents, by Vimala Schneider McClure
  • Crying Baby: Resource List—recommended books about soothing crying babies.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://www.med.umich.edu/1libr/yourchild/colic.htm

http://www.mayoclinic.com/health/colic/

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Washing Fruits and Vegetables

Washing fruits and vegetables does reduce the risk of food poisoning. However, washing alone may not be enough.

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Studies show that some disease-causing microbes can evade even chemical sanitizers. These bacteria can make their way inside the leaves of lettuce, spinach and other vegetables and fruit, where surface treatments cannot reach them. Microbes can also organize themselves into tightly knit packs called biofilms to protect themselves from harm.

Biofilms can harbor multiple versions of infectious, disease-causing bacteria, such as Salmonella and E. coli.

Researchers suggested that irradiation, a food treatment that exposes food to a source of electron beams, could effectively kill internalized pathogens that are beyond the reach of conventional chemical sanitizers.

Irradiation disrupts the genetic material of living cells, inactivating parasites and destroying pathogens and insects in food.
Sources:
Science Daily April 16, 2008

Diet Treatment Call for Epilepsy

A special high-fat diet helps to control fits in children with epilepsy, a UK trial suggests.

The number of seizures fell by a third in children on the “ketogenic” diet, where previously they had suffered fits every day despite medication.

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Seizures are caused by bursts of electrical activity in the brain

The diet alters the body’s metabolism by mimicking the effects of starvation, the researchers reported in the Lancet Neurology.

The researchers called for the diet to be more widely available on the NHS.

It is the first trial comparing the diet with routine care, even though it has been around since the 1920s.

Children are given a tailored diet very high in fat, low in carbohydrate and with controlled amounts of protein.

It is not exactly clear how it works but it seems that ketones, produced from the breakdown of fat, help to alleviate seizures.

A total of 145 children aged between two and 16 who had failed to respond to treatment with at least two anti-epileptic drugs took part in the study.
“The parents say the first two weeks are quite difficult but then it becomes much easier because you can make foods in bulk and it especially helps if you can see the benefits from it”:…………says Professor Helen Cross

Half started the diet immediately and half waited for three months.

The number of seizures in the children on the diet fell to two-thirds of what they had been, but remained unchanged in those who had not yet started the diet, the researchers reported.

Five children in the diet group saw a seizure reduction of more than 90%.

However, there were some side-effects including constipation, vomiting, lack of energy and hunger.

Availability

Professor Helen Cross, study leader and consultant in neurology at Great Ormond Street Hospital in London, said the diet had been around for a long time but had fallen out of favour because it was thought to be too difficult to stick to.

“The parents say the first two weeks are quite difficult, but then it becomes much easier because you can make foods in bulk and it especially helps if you can see the benefits from it,” she said.

“We have to be sensible about it, in this study we had children who had complex epilepsy.

“If your epilepsy is easily controlled on one medication then I wouldn’t advocate the diet, but if at least two drugs have failed then it should be considered.”

She said national guidelines recommend the diet as a treatment option, but a shortage of dieticians meant it was often unavailable.

A spokesperson for Epilepsy Action said: “The results of this trial add valuable information to what is already known about the diet, presenting evidence that it works for some children with drug-resistant epilepsy.

“In addition to this, however, we also recognise that the ketogenic diet is not without its side-effects, and that the risks and benefits should be considered before prescribing, as with drug treatment.”

She said the results would hopefully encourage wider inclusion of the diet in the management of children with drug-resistant epilepsy.

Click to see also:->

Many ‘believe myths’ on epilepsy

Epilepsy took away my childhood

Epilepsy genes ‘may cut seizures

Within days she seemed calmer

Sources: BBC NEWS:3rd. May’08

Abcess

 

Definition
An abscess is an enclosed collection of liquefied tissue, known as pus, somewhere in the body. It is the result of the body’s defensive reaction to foreign material.

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An abscess (Latin: abscessus) is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g. splinters, bullet wounds, or injecting needles). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.

The organisms or foreign materials kill the local cells, resulting in the release of toxins. The toxins trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow.

The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.

Abscesses must be differentiated from empyemas, which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity.

Description
There are two types of abscesses, septic and sterile. Most abscesses are septic, which means that they are the result of an infection. Septic abscesses can occur anywhere in the body. Only a germ and the body’s immune response are required. In response to the invading germ, white blood cells gather at the infected site and begin producing chemicals called enzymes that attack the germ by digesting it. These enzymes act like acid, killing the germs and breaking them down into small pieces that can be picked up by the circulation and eliminated from the body. Unfortunately, these chemicals also digest body tissues. In most cases, the germ produces similar chemicals. The result is a thick, yellow liquid—pus—containing digested germs, digested tissue, white blood cells, and enzymes.

An abscess is the last stage of a tissue infection that begins with a process called inflammation. Initially, as the invading germ activates the body’s immune system, several events occur:

*Blood flow to the area increases.
*The temperature of the area increases due to the increased blood supply.
*The area swells due to the accumulation of water, blood, and other liquids.
*It turns red.
*It hurts, because of the irritation from the swelling and the chemical activity.

These four signs—heat, swelling, redness, and pain— characterize inflammation.

As the process progresses, the tissue begins to turn to liquid, and an abscess forms. It is the nature of an abscess to spread as the chemical digestion liquefies more and more tissue. Furthermore, the spreading follows the path of least resistance—the tissues most easily digested. A good example is an abscess just beneath the skin. It most easily continues along beneath the skin rather than working its way through the skin where it could drain its toxic contents. The contents of the abscess also leak into the general circulation and produce symptoms just like any other infection. These include chills, fever, aching, and general discomfort.

Sterile abscesses are sometimes a milder form of the same process caused not by germs but by non-living irritants such as drugs. If an injected drug like penicillin is not absorbed, it stays where it was injected and may cause enough irritation to generate a sterile abscess— sterile because there is no infection involved. Sterile abscesses are quite likely to turn into hard, solid lumps as they scar, rather than remaining pockets of pus.

Manifestations
The cardinal symptoms and signs of any kind of inflammatory process are redness, heat, swelling, pain and loss of function. Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules (boils) or deep skin abscesses), in the lungs, brain, teeth, kidneys and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death (gangrene). Abscesses in most parts of the body rarely heal themselves, so prompt medical attention is indicated at the first suspicion of an abscess.


Causes and symptoms

Many different agents cause abscesses. The most common are the pus-forming (pyogenic) bacteria like Staphylococcus aureus, which is nearly always the cause of abscesses under the skin. Abscesses near the large bowel, particularly around the anus, may be caused by any of the numerous bacteria found within the large bowel. Brain abscesses and liver abscesses can be caused by any organism that can travel there through the circulation. Bacteria, amoeba, and certain fungi can travel in this fashion. Abscesses in other parts of the body are caused by organisms that normally inhabit nearby structures or that infect them. Some common causes of specific abscesses are:

*skin abscesses by normal skin flora….CLICK & SEE
*dental and throat abscesses by mouth flora....CLICK & SEE
*lung abscesses by normal airway flora, pneumonia germs, or tuberculosis ...CLICK & SEE
*abdominal and anal abscesses by normal bowel flora…..…..CLICK & SEE


Specific types of abscesses

Listed below are some of the more common and important abscesses.

*Carbuncles and other boils. Skin oil glands (sebaceous glands) on the back or the back of the neck are the ones usually infected. The most common germ involved is Staphylococcus aureus. Acne is a similar condition of sebaceous glands on the face and back.
*Pilonidal abscess. Many people have as a birth defect a tiny opening in the skin just above the anus. Fecal bacteria can enter this opening, causing an infection and subsequent abscess.

*Retropharyngeal, parapharyngeal, peritonsillar abscess. As a result of throat infections like strep throat and tonsillitis, bacteria can invade the deeper tissues of the throat and cause an abscess. These abscesses can compromise swallowing and even breathing.

*Lung abscess. During or after pneumonia, whether it’s due to bacteria [common pneumonia], tuberculosis, fungi, parasites, or other germs, abscesses can develop as a complication.

*Liver abscess. Bacteria or amoeba from the intestines can spread through the blood to the liver and cause abscesses.

*Psoas abscess. Deep in the back of the abdomen on either side of the lumbar spine lie the psoas muscles. They flex the hips. An abscess can develop in one of these muscles, usually when it spreads from the appendix, the large bowel, or the fallopian tubes.
Tooth abscess
A tooth abscess or root abscess is pus enclosed in the tissues of the jaw bone at the tip of an infected tooth. Usually the abscess originates from a bacterial infection that has accumulated in the soft pulp of the tooth. This is usually, but not always, associated with a dull, throbbing, excruciating ache.

A tooth abscess typically originates from dead pulp tissue, usually caused by untreated tooth decay, cracked teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess.

There are two types of denta
Diagnosis:
The common findings of inflammation—heat, redness, swelling, and pain—easily identify superficial abscesses. Abscesses in other places may produce only generalized symptoms such as fever and discomfort. If the patient’s symptoms and physical examination do not help, a physician may have to resort to a battery of tests to locate the site of an abscess, but usually something in the initial evaluation directs the search. Recent or chronic disease in an organ suggests it may be the site of an abscess. Dysfunction of an organ or system—for instance, seizures or altered bowel function—may provide the clue. Pain and tenderness on physical examination are common findings. Sometimes a deep abscess will eat a small channel (sinus) to the surface and begin leaking pus. A sterile abscess may cause only a painful lump deep in the buttock where a shot was given.

Treatment

Since skin is very resistant to the spread of infection, it acts as a barrier, often keeping the toxic chemicals of an abscess from escaping the body on their own. Thus, the pus must be drained from the abscess by a physician. The surgeon determines when the abscess is ready for drainage and opens a path to the outside, allowing the pus to escape. Ordinarily, the body handles the remaining infection, sometimes with the help of antibiotics or other drugs. The surgeon may leave a drain (a piece of cloth or rubber) in the abscess cavity to prevent it from closing before all the pus has drained out.

Alternative treatment

If an abscess is directly beneath the skin, it will be slowly working its way through the skin as it is more rapidly working its way elsewhere. Since chemicals work faster at higher temperatures, applications of hot compresses to the skin over the abscess will hasten the digestion of the skin and eventually result in its breaking down, releasing the pus spontaneously. This treatment is best reserved for smaller abscesses in relatively less dangerous areas of the body—limbs, trunk, back of the neck. It is also useful for all superficial abscesses in their very early stages. It will “ripen” them.

Contrast hydrotherapy, alternating hot and cold compresses, can also help assist the body in resorption of the abscess. There are two homeopathic remedies that work to rebalance the body in relation to abscess formation, Silica and Hepar sulphuris. In cases of septic abscesses, bentonite clay packs (bentonite clay and a small amount of Hydrastis powder) can be used to draw the infection from the area.

Prognosis
Once the abscess is properly drained, the prognosis is excellent for the condition itself. The reason for the abscess (other diseases the patient has) will determine the overall outcome. If, on the other hand, the abscess ruptures into neighboring areas or permits the infectious agent to spill into the bloodstream, serious or fatal consequences are likely. Abscesses in and around the nasal sinuses, face, ears, and scalp may work their way into the brain. Abscesses within an abdominal organ such as the liver may rupture into the abdominal cavity. In either case, the result is life threatening. Blood poisoning is a term commonly used to describe an infection that has spilled into the blood stream and spread throughout the body from a localized origin. Blood poisoning, known to physicians as septicemia, is also life threatening.

Of special note, abscesses in the hand are more serious than they might appear. Due to the intricate structure and the overriding importance of the hand, any hand infection must be treated promptly and competently.

Prevention

Infections that are treated early with heat (if superficial) or antibiotics will often resolve without the formation of an abscess. It is even better to avoid infections altogether by taking prompt care of open injuries, particularly puncture wounds. Bites are the most dangerous of all, even more so because they often occur on the hand.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:http://www.healthline.com/galecontent/abscess-1

http://en.wikipedia.org/wiki/Tooth_abscess

 

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Thyroid-Related Fatigue

Not all fatigue or tiredness is due to thyroid malfunction, so how do you tell the difference?....CLICK & SEE

Thyroid-related fatigue begins to appear when you cannot sustain energy long enough, especially when compared to a past level of fitness or ability. If your thyroid foundation is weak, sustaining energy output is difficult. You will notice you just don’t seem to have the energy to do the things you used to be able to do.

Some of the key symptoms of thyroid fatigue include:

*Feeling like you don’t have the energy to exercise, and typically not exercising on a consistent basis.

*A heavy or tired head, especially in the afternoon, as your head is a very sensitive indicator of thyroid hormone status.

*Falling asleep as soon as you sit down and don’t have to do anything.

.If you wake up energized, maintain decent energy throughout the day, are able to maintain mental alertness/sharpness, have energy as needed to meet demands, and your muscles feel fit, you do not have thyroid-related fatigue. However, the more you do not feel like this, the greater chance there is a thyroid-related problem.
Sources:
The Environmental Illness Resource April 18, 2008

Diabetics Can Reverse Their Atherosclerosis

Aggressive measures to lower cholesterol and blood pressure levels below current targets can help to prevent — and potentially even reverse — hardening of the arteries in adults with type 2 diabetes. Hardening of the arteries, also known as atherosclerosis, is the number one cause of heart disease.

CLICK & SEE

A three-year study of nearly 500 participants was the first to compare two treatment targets for LDL (“bad”) cholesterol and systolic blood pressure levels in people with diabetes.

To assess the impact of treatments on the participants’ cardiovascular health, researchers used ultrasound to measure the thickness of their carotid (neck) arteries. Ultrasound was also used to measure the size and function of the left ventricle, which is the heart’s main pumping chamber. Among participants who were given aggressive treatment, carotid artery thickness measurements were significantly lower.

Aggressive treatment measures included Food and Drug Administration-approved blood pressure and cholesterol medications. Participants were also encouraged to follow lifestyle approaches — such as following a heart-healthy eating plan, being physically active, maintaining a healthy weight, and not smoking — to lower their blood pressure and cholesterol.
Sources:
Science Daily April 9, 2008
Journal of the American Medical Association (JAMA) April 9, 2008; 299[14]:1678-1689

Testosterone Matters

If a woman is stressed out during conception or has a dominating nature, she is most likely to have a son, say scientists. T.V. Jayan reports

………………………………

Is it a boy or a girl? This is perhaps the most intriguing question every expectant mother ponders over, particularly in countries where pre-natal sex determination is not allowed legally. Now a study from New Zealand says that the gender of a newborn is more than a matter of the toss of a coin and that the emotional status of the mother at the time of conception may have a role to play.

The controversial theory, put forward by Valerie Grant and her colleagues at the University of Auckland, says that if a woman is stressed out at the time of conception, the chances of her delivering a male baby are relatively high. This would also be true if she is of a dominating nature, the scientists point out.

Evolutionary and reproductive biologists as well as demographers, at least a section of them, have always thought that sex selection of the offspring is much more than a matter of chance — that is, whether a sperm bearing a male sex chromosome or one bearing a female sex chromosome reaches the ovum first. Their hunch stems mainly from the evidence they gathered in recent years to support their view that within many mammalian species, including humans, the sex ratio of the offspring can vary significantly. For instance, during the world wars, they found that there was an increase in the number of male children born.

The Kiwi scientists, who used cow embryos for the latest study, reached this conclusion by measuring the levels of testosterone (the male sex hormone) in the fluid (or follicular fluid) that surrounds the ovum and correlating it with the sex of the offspring. High levels of testosterone in women are strongly linked to either stress or their dominating nature, they argue.

“In women, testosterone is a barometer of stress levels. We know for sure that chronic stress elevates their testosterone levels,” says Larry Chamley, a co-author of the paper that appeared in the May 2008 issue of the journal Biology of Reproduction.

According to Grant, there is a biological reason for that. While in males testosterone is produced by the testes, in females it is generated in the peripheral tissues that are controlled by the adrenal glands. “When stressed, the testes put a brake on testosterone production, whereas the adrenal gland — associated with the production of the stress hormone, cortisol — releases more testosterone as a reaction to stress,” Grant told KnowHow.

The study has found that bovine female eggs exposed to high levels of testosterone are more likely to produce male embryos when fertilised in test tubes. The scientists assume that this could be because eggs under the influence of testosterone would choose to fertilise with a sperm that carries a Y-chromosome (male sex chromosome) rather than one carrying an X-chromosome.

But what is the mechanism behind such a choice? It is not yet very clear, Grant admits.

A dominant section of reproductive biologists, however, is not convinced. “Whatever they have shown has been done under laboratory conditions. In nature, it doesn’t work that way,” says Atmaram Bandivdekar, a scientist with the National Institute for Research in Reproductive Health, Mumbai.

Grant has been studying the subject of sex selection of embryos for at least three decades. Another hypothesis she put forward nearly 10 years ago argues that there is a strong correlation between the mother’s nature and the sex of her baby. In other words, women who are more confident, assertive, influential and with a strong sense of self have high levels of testosterone and would most likely produce sons, whereas mothers who tend to be more nurturing, empathic and tolerant would have daughters.

Interestingly, she found, the latter have lower testosterone levels.

So it is not without reason that the primary sex ratio (the sex ratio at the embryo stage) is tilted towards males – a healthy average sex ratio being 110 male embryos to 100 female ones. This is because males are more vulnerable than their female counterparts. “Hence, this is Nature’s way of maintaining a healthy sex ratio at the reproductive age,” Grant observes.

In her book Maternal Personality, Evolution and the Sex Ratio: Do Mothers Control the Sex of the Infant, published in 1998, she argued that dominance is a core personality trait whose biological basis is testosterone. The action of this hormone within the reproductive system leads to the favouring of sperm carrying male chromosomes. Thus the mother bears the gender that she is most suited to raise. Grant has all along been arguing that female testosterone levels play a role — albeit a small one – in determining the sex of the offspring.

Reproductive biologists may take years to resolve their differences relating to the sex selection of embryos. In the meanwhile, those children who want their next sibling to be a sister can try out something: don’t aggravate your mother!

Clock to see also:->

FortuneBaby.com

What is the Sex? Boy or Girl

..Boy Or Girl

Sources: The Telegraph (Kolkata, India)

Some Medical Questions And Answers By Dr.Gita Mathai

How much can I drink?


Q: I like my drink in the evening and I don’t think it does any harm to me or anyone else. However, I do not want to wind up an alcoholic. What are the safe limits? Some guidelines say one drink, some two. The exact quantity (small or large pegs) is not specified.

A:
Current guidelines state that men should consume no more than three or four units of alcohol a day; women should consume no more than two or three units. The limits for women are less than for men because their body composition is different with more fat and less muscle. Some physicians feel that these limits are too high. They think it should be reduced to three units a day for men and two units a day for women. Two days a week should be drink free.

A unit is not the same as a drink. Most alcoholic drinks contain more than one unit. A premium pint of lager, bitter or cider (5 per cent alcohol), contains 3 units. A large 250 ml glass of wine (12 per cent) contains 3 units, a large double measure of spirits (2 x 35ml at 40 per cent) contains 3 units.

The long-term effects of uncontrolled drinking include cirrhosis and mouth, esophageal, liver and breast cancer. The risks are increased if drinking is combined with smoking.

Also, even controlled drinking takes its toll on the wallet. Your family may not be happy with the money you spend on your “social drinking”. Always remember, no matter how sober you feel, drinking and driving can be a fatal combination.

Itchy vagina

Q: I have repeated attacks of itching in my vagina. I am 27 years old. Please advise.

A: You probably have an infection caused by an yeast called Candida. It tends to occur in overweight people, in pregnancy, or if you or your partner have diabetes or HIV (human immunodeficiency virus) infection. It occurs if the normal bacterial flora of the vagina changes. This can take place after treatment with certain antibiotics, corticosteroids or hormones. It occurs in some women when they take oral contraceptive pills.

Correction of any underlying precipitating factor will reduce the recurrences. Treatment of the infection is simple. Oral antifungal agents (usually single dose therapy) can be used. Vaginal tablets or pesssaries can deliver the medication directly to the source of infection.

Giddiness



Q: I feel giddy and dizzy and sometimes I feel I am going to vomit or lose my balance and fall down. I am very worried.

A: I think you are describing vertigo, a sense that the room is spinning around you. It can occur normally if you suddenly change the position of your head relative to your body. If it is frequent and recurrent you need to have it evaluated by an ENT (ear nose and throat) physician. You also need to have an X-ray of your neck bones. A physician can also do relevant blood tests to rule out anaemia.

There are several possibilities like benign positional vertigo, inner or middle ear infections or Meniere’s disease. Some of these require medication. Others need positional exercises.

Treatment of the disease will remove the precipitating factor and cure you.

You may click to see also:->An article on Giddiness

Dry, itchy skin

Q: I have very dry skin that is also very itchy. If I scratch, it sometimes bleeds and becomes infected. The dermatologist says I have icthyosis and that I must apply oil. If I stop, my skin becomes dry and itchy all over again.

A: Icthyosis is a hereditary condition of the skin. It can be mild or severe. You need to apply oil regularly as your skin requires a lot more oil than those of other people. A small quantity of a mixture of 500 ml of coconut oil, 500 ml of sesame oil and 100 ml of olive oil can be applied half an hour before bathing. A tablespoon of coconut oil can also be put in the bath water. A non-drying emollient soap like Dove or a glycerine-based soap like Pears will help to keep the skin moist. Baby oil or Vaseline can be applied at night. Both these will not stain the bed clothes.

You may also click to see:->

Winterizing Dry Itchy Skin

8 Home Remedies for Dry Skin

Sources: The Telegraph (Kolkata, India)

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Meningitis

Definition;
Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Meningitis may develop in response to a number of causes, most prominently bacteria, viruses and other infectious agents, but also physical injury, cancer, or certain drugs. While some forms of meningitis are mild and resolve on their own, meningitis is a potentially serious condition due to the proximity of the inflammation to the brain and spinal cord. The potential for serious neurological damage or even death necessitates prompt medical attention and evaluation. Infectious meningitis, the most common form, is typically treated with antibiotics and requires close observation. Some forms of meningitis (such as those associated with meningococcus, mumps virus or pneumococcus infections) may be prevented with immunization.

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Anatomy of the brain. In meningitis, the meninges that line the brain become swollen and inflamed.

Signs and symptoms
Severe headache is the most common symptom of meningitis (87 percent) followed by nuchal rigidity (“neck stiffness”, 83 percent). The classic triad of diagnostic signs consists of nuchal rigidity (being unable to flex the neck forward), sudden High fever[1] and altered mental status. All three features are present in only 44% of all cases of infectious meningitis.[2] Other signs commonly associated with meningitis are photophobia (inability to tolerate bright light), phonophobia (inability to tolerate loud noises), irritability and delirium (in small children) and seizures (in 20-40% of cases). In infants (0-6 months), swelling of the fontanelle (soft spot) may be present.

Nuchal rigidity is typically assessed with the patient lying supine, and both hips and knees flexed. If pain is elicited when the knees are passively extended (Kernig’s sign), this indicates nuchal rigidity and meningitis. In infants, forward flexion of the neck may cause involuntary knee and hip flexion (Brudzinski’s sign). Although commonly tested, the sensitivity and specificity of Kernig’s and Brudzinski’s tests are uncertain.[3]

In “meningococcal” meningitis (i.e. meningitis caused by the bacteria Neisseria meningitidis), a rapidly-spreading petechial rash is typical, and may precede other symptoms. The rash consists of numerous small, irregular purple or red spots on the trunk, lower extremities, mucous membranes, conjunctiva, and occasionally on the palms of hands and soles of feet. Other clues to the nature of the cause may be the skin signs of hand, foot and mouth disease and genital herpes, both of which may be associated with viral meningitis.

Diagnosis:

Investigations
Suspicion of meningitis is generally based on the nature of the symptoms and findings on physical examination. Meningitis is a medical emergency, and referral to hospital is indicated. If meningitis is suspected based on clinical examination, early administration of antibiotics is recommended, as the condition may deteriorate rapidly. In the hospital setting, initial management consists of stabilization (e.g. securing the airway in a depressed level of consciousness, administration of intravenous fluids in hypotension or shock), followed by antibiotics if not already administered.

Investigations include blood tests (electrolytes, liver and kidney function, inflammatory markers and a complete blood count) and usually X-ray examination of the chest. The most important test in identifying or ruling out meningitis is analysis of the cerebrospinal fluid (fluid that envelops the brain and the spinal cord) through lumbar puncture (LP). However, if the patient is at risk for a cerebral mass lesion or elevated intracranial pressure (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a lumbar puncture may be contraindicated because of the possibility of fatal brain herniation. In such cases a CT or MRI scan is generally performed prior to the lumbar puncture to exclude this possibility. Otherwise, the CT or MRI should be performed after the LP, with MRI preferred over CT due to its superiority in demonstrating areas of cerebral edema, ischemia, and meningeal inflammation.

During the lumbar puncture procedure, the opening pressure is measured. A pressure of over 180 mm H2O is indicative of bacterial meningitis.

The cerebrospinal fluid (CSF) sample is examined for white blood cells (and which subtypes), red blood cells, protein content and glucose level. Gram staining of the sample may demonstrate bacteria in bacterial meningitis, but absence of bacteria does not exclude bacterial meningitis; microbiological culture of the sample may still yield a causative organism. The type of white blood cell predominantly present predicts whether meningitis is due to bacterial or viral infection. Other tests performed on the CSF sample include latex agglutination test, limulus lysates, or polymerase chain reaction (PCR) for bacterial or viral DNA. If the patient is immunocompromised, testing the CSF for toxoplasmosis, Epstein-Barr virus, cytomegalovirus, JC virus and fungal infection may be performed.

CSF finding in different conditions:-
Condition……………………………..Glucose…………Protein…………….. Cells
Acute bacterial meningitis…………. Low high…… high………….. often > 300/mm³
Acute viral meningitis…………….. Normal normal or high mononuclear,……< 300/mm³
Tuberculous meningitis…………….. Low……….. high pleocytosis, mixed < 300/mm³
Fungal meningitis…………………. Low…………high………………. < 300/mm³
Malignant meningitis………………. Low…………high usually mononuclear
Subarachnoid hemorrhage……………..Normal normal, or high Erythrocytes

In bacterial meningitis, the CSF glucose to serum glucose ratio is < 0.4. The Gram stain is positive in >60% of cases, and culture in >80%. Latex agglutination may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli, Group B Streptococci. Limulus lysates may be positive in Gram-negative meningitis.

Cultures are often negative if CSF is taken after the administration of antibiotics. In these patients, PCR can be helpful in arriving at a diagnosis. It has been suggested that CSF cortisol measurement may be helpful.

Aseptic meningitis refers to non-bacterial causes of meningitis and includes infective etiologies such as viruses and fungi, neoplastic etiologies such as carcinomatous and lymphomatous meningitis, inflammatory causes such as sarcoidosis (neurosarcoidosis)) and chemical causes such as meningitis secondary to the intrathecal introduction of contrast media.

Although the term “viral meningitis” is often used in any patient with a mild meningeal illness with appropriate CSF findings, certain patients will present with clinical and CSF features of viral meningitis, yet ultimately be diagnosed with one of the other conditions categorized as “aseptic meningitis”. This may be prevented by performing polymerase chain reaction or serology on CSF or blood for common viral causes of meningitis (enterovirus, herpes simplex virus 2 and mumps in those not vaccinated for this).

A related diagnostic and therapeutic conundrum is the “partially treated meningitis”, i.e. meningitis symptoms in patients who have already been receiving antibiotics (such as for presumptive sinusitis). In these patients, CSF findings may resemble those of viral meningitis, but antibiotic treatment may need to be continued until there is definitive positive evidence of a viral cause (e.g. a positive enterovirus PCR).

Prediction rules
The Bacterial Meningitis Score predicts reliably whether a child (older than two months) may have infectious meningitis. In children with at least 1 risk factor (positive CSF Gram stain, CSF absolute neutrophil count = 1000 cell/µL, CSF protein = 80 mg/dL, peripheral blood absolute neutrophil count = 10,000 cell/µL, history of seizure before or at presentation time) it had a sensitivity of 100%, specificity of 63.5%, and negative predictive value of 100%

Causes
Most cases of meningitis are caused by microorganisms, such as viruses, bacteria, fungi, or parasites, that spread into the blood and into the cerebrospinal fluid (CSF).[8] Non-infectious causes include cancers, systemic lupus erythematosus and certain drugs. The most common cause of meningitis is viral, and often runs its course within a few days. Bacterial meningitis is the second most frequent type and can be serious and life-threatening. Numerous microorganisms may cause bacterial meningitis, but Neisseria meningitidis (“meningococcus”) and Streptococcus pneumoniae (“pneumococcus”) are the most common pathogens in patients without immune deficiency, with meningococcal disease being more common in children. Staphylococcus aureus may complicate neurosurgical operations, and Listeria monocytogenes is associated with poor nutritional state and alcoholism. Haemophilus influenzae (type B) incidence has been much reduced by immunization in many countries. Mycobacterium tuberculosis (the causative agent of tuberculosis) rarely causes meningitis in Western countries but is common and feared in countries where tuberculosis is endemic.

Treatment
Bacterial meningitis
Bacterial meningitis is a medical emergency and has a high mortality rate if untreated.[9] All suspected cases, however mild, need emergency medical attention. Empiric antibiotics must be started immediately, even before the results of the lumbar puncture and CSF analysis are known. Antibiotics started within 4 hours of lumbar puncture will not significantly affect lab results. Adjuvant treatment with corticosteroids reduces rates of mortality, severe hearing loss and neurological sequelae in adults, specifically when the causative agent is Pneumococcus.

Age group Causes
Neonates Group B Streptococci, Escherichia coli, Listeria monocytogenes
Infants Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae
Children N. meningitidis, S. pneumoniae
Adults S. pneumoniae, N. meningitidis, Mycobacteria, Cryptococci
The choice of antibiotic depends on local advice. In most of the developed world, the most common organisms involved are Streptococcus pneumoniae and Neisseria meningitidis: first line treatment in the UK is a third-generation cephalosporin (such as ceftriaxone or cefotaxime). In those under 3 years of age, over 50 years of age, or immunocompromised, ampicillin should be added to cover Listeria monocytogenes.[11] In the U.S. and other countries with high levels of penicillin resistance, the first line choice of antibiotics is vancomycin and a carbapenem (such as meropenem). In sub-Saharan Africa, oily chloramphenicol or ceftriaxone are often used because only a single dose is needed in most cases.

Staphylococci and gram-negative bacilli are common infective agents in patients who have just had a neurosurgical procedure. Again, the choice of antibiotic depends on local patterns of infection: cefotaxime and ceftriaxone remain good choices in many situations, but ceftazidime is used when Pseudomonas aeruginosa is a problem, and intraventricular vancomycin is used for those patients with intraventricular shunts because of high rates of staphylococcal infection. In patients with intracerebral prosthetic material (metal plates, electrodes or implants, etc.) then sometimes chloramphenicol is the only antibiotic that will adequately cover infection by Staphylococcus aureus (cephalosporins and carbapenems are inadequate under these circumstances).

Once the results of the CSF analysis are known along with the Gram-stain and culture, empiric therapy may be switched to therapy targeted to the specific causative organism and its sensitivities.[citation needed]

*Neisseria meningitidis (Meningococcus) can usually be treated with a 7-day course of IV antibiotics:
*Penicillin-sensitive — penicillin G or ampicillin
*Penicillin-resistant — ceftriaxone or cefotaxime
*Prophylaxis for close contacts (contact with oral secretions) — rifampin 600 mg bid for 2 days (adults) or 10 mg/kg bid (children). Rifampin is not recommended in pregnancy and as such, these patients should be treated with single doses of ciprofloxacin, azithromycin, or ceftriaxone
*Streptococcus pneumoniae (Pneumococcus) can usually be treated with a 2-week course of IV antibiotics:
*Penicillin-sensitive — penicillin G
*Penicillin-intermediate — ceftriaxone or cefotaxime
*Penicillin-resistant — ceftriaxone or cefotaxime + vancomycin
*Listeria monocytogenes is treated with a 3-week course of IV ampicillin + gentamicin.
*Gram negative bacilli — ceftriaxone or cefotaxime
*Pseudomonas aeruginosa — ceftazidime
*Staphylococcus aureus
*Methicillin-sensitive — nafcillin
*Methicillin-resistant — vancomycin
*Streptococcus agalactiae — penicillin G or ampicillin
*Haemophilus influenzae — ceftriaxone or cefotaxime

Viral meningitis
Patients diagnosed with mild viral meningitis may improve quickly enough to not require admission to a hospital, while others may be hospitalized for many more days for observation and supportive care. Overall, the illness is usually much less severe than bacterial meningitis.

Unlike bacteria, viruses cannot be killed by antibiotics although drugs such as acyclovir may be employed, especially if herpes virus infection is either suspected or demonstrated.[4]

Fungal meningitis
This form of meningitis is rare in otherwise healthy people but is a higher risk in those who have AIDS, other forms of immunodeficiency (an immune system that does not respond adequately to infections) and immunosuppression (immune system malfunction as a result of medical treatment). In AIDS, Cryptococcus neoformans is the most common cause of fungal meningitis; it requires Indian ink staining of the CSF sample for identification of this capsulated yeast. Fungal meningitis is treated with long courses of highly dosed antifungals.

Complications
In children there are several potential disabilities which result from damage to the nervous system. These include sensorineural hearing loss, epilepsy, diffuse brain swelling, hydrocephalus, cerebral vein thrombosis, intra cerebral bleeding and cerebral palsy. Acute neurological complications may lead to adverse consequences. In childhood acute bacterial meningitis deafness is the most common serious complication. Sensorineural hearing loss often develops during first few days of the illness as a result of inner ear dysfunction, but permanent deafness is rare and can be prevented by prompt treatment of meningitis.

Those that contract the disease during the neonatal period and those infected by S. pneumoniae and gram negative bacilli are at greater risk of developing neurological, auditory, or intellectual impairments or functionally important behaviour or learning disorders which can manifest as poor school performance.

In adults central nervous system complications include brain infarction, brain swelling, hydrocephalus, intracerebral bleeding; systemic complications are dominated by septic shock, adult respiratory distress syndrome and disseminated intravascular coagulation. Those who have underlying predisposing conditions e.g. head injury may develop recurrent meningitis.Case-fatality ratio is highest for gram-negative etiology and lowest for meningitis caused by H. influenzae (also a gram negative bacilli). Fatal outcome in patients over 60 years of age is more likely to be from systemic complications e.g. pneumonia, sepsis, cardio-respiratory failure; however in younger individuals it is usually associated with neurological complications. Age more than 60, low Glasgow coma scale at presentation and seizure within 24 hours increase the risk of death among community acquired meningitis.

Prevention

Immunization
Vaccinations against Haemophilus influenzae (Hib) have decreased early childhood meningitis significantly.

Vaccines against type A and C Neisseria meningitidis, the kind that causes most disease in preschool children and teenagers in the United States, have also been around for a while. Type A is also prevalent in sub-Sahara Africa and W135 outbreaks have affected those on the Hajj pilgrimage to Mecca. Immunisation with the ACW135Y vaccine against four strains is now a visa requirement for taking part in the Hajj.

Vaccines against Type B Neisseria meningitidis are much harder to produce, as its capsule is very weakly immunogenic masking its antigenic proteins. There is also a risk of autoimmune response, and the porA and porB proteins on Type B resemble neuronal molecules. A vaccine called MeNZB for a specific strain of type B Neisseria meningitidis prevalent in New Zealand has completed trials and is being given to many people in the country under the age of 20 free of charge. There is also a vaccine, MenBVac, for the specific strain of type B meningoccocal disease prevalent in Norway, and another specific vaccine for the strain prevalent in Cuba.

Pneumococcal polysaccharide vaccine against Streptococcus pneumoniae is recommended for all people 65 years of age or older. Pneumococcal conjugate vaccine is recommended for all newborns starting at 6 weeks – 2 months, according to American Association of Pediatrics (AAP) recommendations.

Mumps vaccination has led to a sharp decline in mumps virus associated meningitis, which prior to vaccination occurred in 15% of all cases of mumps.

Prophylaxis
In cases of meningococcal meningitis, prophylactic treatment of close relatives with antibiotics (e.g. rifampicin, ciprofloxacin or ceftriaxone) may reduce the risk of further cases.

Click to learn more about Meningitis……………………….(1)…..(2).…….(3)……(4)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Sources:http://en.wikipedia.org/wiki/Meningitis

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