Month: April 2011

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Ailmemts & Remedies

Diverticular disease

Alternative Name:   Diverticulosis…………..click for picture

Definition:
Over a lifetime, it’s estimated the human gut digests more than 65 tonnes of food and drink. Much of this food will be low in fibre, putting the gut under strain.

One common outcome of this is diverticular disease, a condition affecting the large bowel, or colon, believed to be the result of too little fibre in the diet.

A diet low in fibre creates the ideal conditions for constipation to develop. When this happens, the pressure in the large part of the gut increases, which forces small parts of the gut lining outwards through the muscles surrounding the gut. This causes the lining to form small balloon-like pouches called diverticula..

CLICK & SEE THE PICTURES

Author: U.S. National Institute of Diabetes an...
Author: U.S. National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health (NIH) Source URL: http://win.niddk.nih.gov/publications/gastric.htm Copyright tag: Why? Because it’s from an NIH department. Category:Obesity images (Photo credit: Wikipedia)

Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.

click to see the picture

About one in two adults over 50 is affected, and most adults are affected by the time they reach 80 to 90. Men and women are affected equally.

Diverticular disease is very uncommon in countries such as Africa, where diets are high in fibre. In Western countries, where many people still don’t eat enough fibre, it becomes more common as people get older.

Symptoms:
Signs and symptomsMost people with colonic diverticulosis are unaware of this structural change. When symptoms do appear in a person over 40 years of age it is important to obtain medical advice and exclude more dangerous conditions such as cancer of the colon or rectum.

The clinical forms of colonic diverticulosis are

*Symptomatic colonic diverticulosis………..click to see the picture
This is the most common complication of colonic diverticulosis. This is when the motility (that is, the onward propulsive nature of contractions) of the bowel becomes disorganized. Sometimes, spasm can develop. This results in pain in the left lower abdomen and often is accompanied by the passage of small pelletty stools and slime which relieves the pain. Symptoms can consist of (1) bloating, (2) changes in bowel movements (diarrhea or constipation), (3) Non-specific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain, (4) abdominal pain, often aftick to see the pictureer meals often in the left lower abdomen. If these persist clinical investigation is advised.

*Complicated colonic diverticulosis
This is very uncommon but highly dangerous. The diverticulae may bleed, either rapidly (causing bleeding through the rectum) or slowly (causing anaemia). The diverticulae can become infected and develop abscesses, or even perforate. These are serious complications and medical care is needed. Infected diverticulae and development of abscesses merits the term diverticulitis. First time bleeding from the rectum, especially in individuals aged over age 40, could be due to colon cancer, colonic polyps and inflammatory bowel disease rather than diverticulosis and requires clinical investigation.

Infection in the diverticula, possibly caused by an impacted piece of faeces, is responsible for the inflammation that develops. When this happens – called diverticulitis – the pain is very severe and usually felt in the lower left side of the abdomen.

A person will often feel feverish and have nausea and vomiting. They may pass blood rectally.

Risk factors:
1.increasing age
2.constipation
3.a diet that is low in dietary fiber content or high in fat
4.high intake of meat and red meat
5.connective tissue disorders (such as Marfan syndrome) that may cause weakness in the colon wall.

The exact aetiology of colonic diverticulosis has yet to be fully clarified and many of the claims are only anecdotal.  The modern emphasis on the value of fiber in the diet began with Cleave. A strong case was made by Neil Painter  and Adam Smith  that a deficiency of dietary fiber is the cause of diverticular disease. They argued that the colonic muscles needed to contract strongly in order to transmit and expel the small stool associated with a fiber deficient diet. The increased pressure within the segmented section of bowel over years gave rise to herniation at the vulnerable point where blood vessels enter the colonic wall. Denis Burkitt had suggested that the mechanical properties of the colon may be different in the African and the European subjects. Because Africans eat a diet containing much more fiber than Europeans and use the natural squatting position for defecation, they pass bulky stools, and hence rarely if ever develop colonic diverticulosis. The US National Institutes of Health (NIH) considers the fiber theory “unproven.”

However, change in the strength of the colonic wall with age may be an aetiological factor. Connective tissue is a significant contributor to the strength of the colonic wall. The mechanical properties of connective tissue depend on a wide variety of factors, the type of tissue and its age, the nature of the intramolecular and intermolecular covalent cross links and the quantity of the glycosaminoglycans associated with the collagen fibrils. The submucosa of the colon is composed almost entirely of collagen, both type I and type III. Several layers of collagen fibres make up the submucosa of the human colon. The collagen fibril diameters and fibril counts are different between the left and right colon and change with age and in colonic diverticulosis,. The implication being that changes which are normally associated with ageing are more pronounced in colonic diverticulosis. Iwasaki found that the tensil strength of the Japanese colon obtained at postmortem declined with age. Similarly the mechanical properties of the colon are stronger in African than European subjects. However, this race-based claim is contradicted by the virtually identical incidence of diverticular disease in black and white Americans.

The strength of the colon decreases with age in all parts of the colon, except the ascending colon. The fall in tensile strength with age is due to a decrease in the integrity of connective tissue. Cross linkage of collagen is increased in colonic diverticulosis. The mucosal layer is possibly more elastic and it is likely that the stiffer external layers break and allow the elastic mucosa to herniate through forming a diverticulum. Collagen has intermolecular and intramolecular cross links which stabilise and give strength to the tissue in which it is located. Accumulation of covalently linked sugar molecules and related increasing cross linking products are found in a variety of tissues with ageing, skin, vascular tissue, the cordae tendinae of heart valves and the colon.  This reduces the strength and pliability of the collagen. Colonic diverticulosis increases in frequency with age.  There is a reduction in the strength of the colonic mucosa with age, and that increased contractions in the descending and sigmoid colon secondary to an insufficient fibre content of the diet cause protrusion through this weakened wall. Colonic diverticulosis is in general a benign condition of the bowel which uncommonly becomes symptomatic and even less commonly becomes a truly clinical complicated problem.

Diagnosis:
In cases of asymptomatic Diverticulosis, the diagnosis is usually made as an incidental finding on other investigations.

While a good history is often sufficient to form a diagnosis of Diverticulosis or Diverticulitis, it is important to confirm the diagnosis and rule out other pathology (notably colorectal cancer) and complications.

Investigations:-

*Plain Abdominal X-ray may show signs of a thickened wall, ileus, constipation, small bowel obstruction or free air in the case of perforation. Plain X-rays are insufficient to diagnose Diverticular Disease.

*Contrast CT is the investigation of choice in acute episodes of Diverticulitis and where complications exist.

*Colonoscopy will show the diverticulum and rule out malignancy. A Colonoscopy should be performed 4–6 weeks after an acute episode.

*Barium enema is inferior to colonoscopy in terms of image quality and is usually only performed if the patient has strictures or an excessively tortuous sigmoid colon where colonoscopy is difficult or dangerous.

*MRI provides a clear picture of the soft tissue of the abdomen, however its expense often outweighs the benefits when compared to contrast CT or colonoscopy.

*There is no blood test for Diverticulosis.

It is important to note that both Barium enema and Colonoscopy are contraindicated during acute episodes of diverticulitis.

Management  & Treatment:
Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high-fiber diet and fiber supplements are advisable to prevent constipation  . The American Dietetic Association recommends 20-35 grams each day. Wheat bran has much to commend it as this has been shown to reduce intra colonic pressure  Ispaghula is also effective at 1-2 grams a day. Colonic stimulants should be avoided. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says foods such as nuts, popcorn hulls, sunflower seeds, pumpkin seeds, caraway seeds, and sesame seeds have traditionally been labelled as problem foods for people with this condition; however, no scientific data exists to prove this hypothesis. The seeds in tomatoes, zucchini, cucumbers, strawberries, raspberries, and poppy seeds, are not considered harmful by the NIDDK. Treatments, like some colon cleansers, that cause hard stools, constipation, and straining, are not recommended. Some doctors also recommend avoidance of fried foods, nuts, corn, and seeds to prevent complications of diverticulosis. Whether these diet restrictions are beneficial is uncertain; recent studies have stated that nuts and popcorn do not contribute positively or negatively to patients with diverticulosis or diverticular complications. When the spasm pain is troublesome the use of peppermint oil (1 drop in 50 ml water), or peppermint tablets (e.g., colpermin), can be helpful. Complicated diverticulosis requires treatment of the complication. These complications are often grouped under a single diagnosis of diverticulitis and require skilled medical care of the infection, bleeding and perforation which may include intensive antibiotic treatment, intravenous fluids and surgery. Complications are more common in patients who are taking NSAIDS or aspirin. As diverticulosis occurs in an older population such complications are serious events.

Someone with diverticulitis may be treated at home with painkillers, antibiotics, laxatives and dietary advice. But diverticulitis is often severe, and can need hospital treatment with antibiotics and fluids given through a drip.

In some cases, the bowel may perforate, become obstructed or bleed heavily. When this happens, the situation becomes an emergency and an operation may be needed.

Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there’s little or no response to medication. Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.

Surgical treatment for diverticulitis removes the diseased part of the colon, most commonly, the left or sigmoid colon. Often the colon is hooked up or “anastomosed” again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks. In emergency surgeries, patients may require a temporary colostomy bag. Patients are encouraged to seek medical attention for abdominal symptoms early to help avoid complications.

Complications:
Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis (NIDDK website). Tears in the colon leading to bleeding or perforations may occur; intestinal obstruction may occur (constipation or diarrhea does not rule this possibility out); and peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation are also possible occurrences. Rarely, an enterolith may form.

Low fiber, high fat diet, constipation and use of stimulant laxatives increase the risk of bleeding, also history of diverticulitis increases the chance to bleed.

Infection of a diverticulum often occurs as a result of stool collecting in a diverticulum.

More than 10% of the US population over the age of 40 and half over the age of 60 has diverticulosis. This disease is common in the US, Britain, Australia, Canada, and is uncommon in Asia and Africa . Large-mouth diverticula are associated with scleroderma.

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.bbc.co.uk/health/physical_health/conditions/diverticulardisease1.shtml
http://en.wikipedia.org/wiki/Diverticulosis
http://www.fascrs.org/patients/conditions/diverticular_disease/

http://www.procto-med.com/images/2009/05/diverticular-disease.gif

Understanding Diverticular Disease

http://www.advgastro.com/diverticulitis.htm

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News on Health & Science

Why Krill Oil Is The Ultimate Heart And Brain Nutrient

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Medical research has identified a source of omega-3 fatty acids that’s been shown superior to fish oil supplements in head-to-head testing. It’s found to be healthier, safer, more potent and more absorbable. It’s called krill oil.

Krill is a shrimp-like crustacean that abounds in the ocean. In fact, this tiny sea creature is a favorite food of marine life, including Beluga whales. Krill are almost 100 percent free of heavy metals and other toxins. By contrast, large predatory fish are often “filled to the gills” with dangerous toxins.

The reason krill oil is more effective than other marine oils is the amount of omega-3 fatty acids, phospholipids and extremely potent antioxidants it contains. It’s the unique combination of these essential ingredients that provide the greatest health benefits.

Krill oil has been shown to outperform fish oil supplements when it comes to lowering your bad low-density lipoprotein (LDL) cholesterol levels. Patients who took 1 to 1.5 grams (g) of krill oil a day—compared to three times the dose of fish oil—showed a significantly greater decrease in bad cholesterol than the fish oil patients.
In an Oxygen Radical Absorbance Capacity (ORAC) test, krill oil was shown to contain 300 times the amount of vitamin A and E, plus 48 times the antioxidant power of standard omega-3 fish oils.

Omega-3 fatty acids are essential for your diet—and should be supplemented since your body doesn’t produce them on its own. These fatty acids are the best source to help prevent blood clotting, lower blood pressure and relieve inflammation.

Krill oil contains a healthy balance of omega-3 fatty acids and omega-6 fatty acids—which help fight infection. These two fatty acids need each other and work together to prevent other inflammation-related ailments like heart disease, arthritis and diabetes. By supplementing with all-natural krill oil, you can protect your heart and brain for decades to come

Source :Better Health Research

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Ailmemts & Remedies

Dehydration

Definition:
Water makes up around 75 per cent of the human body. It’s important for digestion, joint function, healthy skin and removal of waste products.
CLICK & SEE

Dehydration occurs when more fluid is lost from the body than is taken in. This causes an imbalance in important minerals, such as sodium and potassium, which are required for muscle and nerve function.

If there is a one per cent or greater loss in body weight because of fluid loss, dehydration occurs. This may be mild, moderate or severe, depending on the amount lost.

Infants and children are more susceptible to dehydration than adults because of their smaller body weights and higher turnover of water and electrolytes. The elderly and those with illnesses are also at higher risk.

Dehydration is classified as mild, moderate, or severe based on how much of the body’s fluid is lost or not replenished. When severe, dehydration is a life-threatening emergency.

Who are at Risk?
Anyone’s at risk of dehydration, but some people are more at risk than others.

•Babies and young children have relatively low body weights, making them more vulnerable to the effects of fluid loss.
•Older adults tend to eat less and may forget to eat and drink during the day. With increasing age, the body’s ability to conserve water decreases and a person’s sense of thirst becomes less acute. Illness and disability are also more common, which may make it harder to eat and drink enough.
•People with long-term medical conditions, such as kidney disease and alcoholism, are more at risk of dehydration.
•Short-term, acute health problems, such as viral infections, can result in dehydration because fever and increased sweating mean more fluid is lost from the body. Such illnesses may also make you feel less inclined to eat and drink.
•People living or working in hot climates or those who take part in sports or other strenuous physical activities are at greater risk of dehydration.

Symptoms:
The body’s initial responses to dehydration are thirst to increase water intake along with decreased urine output to try to conserve water. The urine will become concentrated and more yellow in color.

As the level of water loss increases, more symptoms can become apparent. The following are further signs and symptoms of dehydration:

•dry mouth,
•the eyes stop making tears,
•sweating may stop,
•muscle cramps,
•nausea and vomiting,
•heart palpitations, and
•lightheadedness (especially when standing).

The body tries to maintain cardiac output (the amount of blood that is pumped by the heart to the body); and if the amount of fluid in the intravascular space is decreased, the body tries to compensate for this decrease by increasing the heart rate and making blood vessels constrict to try to maintain blood pressure and blood flow to the vital organs of the body. This coping mechanism begins to fail as the level of dehydration increases.

With severe dehydration, confusion and weakness will occur as the brain and other body organs receive less blood. Finally, coma and organ failure, and death eventually will occur if the dehydration remains untreated.

Causes:
Around two-thirds of the water we need comes from drinks. Up to one-third comes from food (tomatoes, cucumber, fish and poultry are good sources). Some is also provided as a result of chemical reactions within the body.
CLICK & SEE

The average adult loses around 2.5 litres of water every day through the normal processes of breathing, sweating and waste removal. If we lose more fluid than usual this tips the balance towards dehydration.

Your body may lose too much fluids from:
•Vomiting or diarrhea
•Excessive urine output, such as with uncontrolled diabetes or diuretic use
•Excessive sweating (for example, from exercise)
•Fever

You might not drink enough fluids because of:
•Nausea
•Loss of appetite due to illness
•Sore throat or mouth sores

Dehydration in sick children is often a combination of both — refusing to eat or drink anything while also losing fluid from vomiting, diarrhea, or fever.

Lifestyle factors such as drinking too much alcohol, exercise, being in a hot environment or being too busy to drink liquid can also lead to dehydration.

Diagnosis:–
Dehydration is often a clinical diagnosis. Aside from diagnosing the reason for dehydration, the health care practitioner’s examination of the patient will assess the level of dehydration. Initial evaluations may include:

•Mental status tests to evaluate whether the patient is awake, alert, and oriented. Infants and children may appear listless and have whiny cries and decreased muscle tone.

•Vital signs may include postural readings (blood pressure and pulse rate are taken lying down and standing). With dehydration, the pulse rate may increase and the blood pressure may drop because the intravascular space is depleted of fluid. People taking beta blocker medications for high blood pressure, heart disease, or other indications, occasionally lose the ability to increase their heart rate as a compensation mechanism since these medications block the adrenaline receptors in the body.

•Temperature may be measured to assess fever.

•Skin may be checked to see if sweat is present and to assess the degree of elasticity (turgor). As dehydration progresses, the skin loses its water content and becomes less elastic.

•Infants may have additional evaluations performed, including checking for a soft spot on the skull (sunken fontanelle), assessing the suck mechanism, muscle tone, or loss of sweat in the armpits and groin. All are signs of potential significant dehydration.

•Pediatric patients are often weighed during routine child visits, thus a body weight measurement may be helpful in assessing how much water has been lost with the acute illness.

Laboratory testing:-
The purpose of blood tests is to assess potential electrolyte abnormalities (especially sodium levels) associated with the dehydration. Tests may or may not be done on the patient depending upon the underlying cause of dehydration, the severity of illness, and the health care practitioner’s assessment of their needs.

Urinalysis may be done to determine urine concentration – the more concentrated the urine, the more dehydrated the patient.

Treatment:-
As is often the case in medicine, prevention is the important first step in the treatment of dehydration. (Please see the home treatment and prevention sections.)

Fluid replacement is the treatment for dehydration. This may be attempted by replacing fluid by mouth, but if this fails, intravenous fluid (IV) may be required. Should oral rehydration be attempted, frequent small amounts of clear fluids should be used.

Clear fluids include:
•water,
•clear broths,
•popsicles,
•Jell-O, and
•other replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
Decisions about the use of intravenous fluids depend upon the health care practitioner’s assessment of the extent of dehydration and the ability for the patient to recover from the underlying cause.

The success of the rehydration therapy can be monitored by urine output. When the body is dry, the kidneys try to hold on to as much fluid as possible, urine output is decreased, and the urine itself is concentrated. As treatment occurs, the kidneys sense the increased amount of fluid, and urine output increases.

Medications may be used to treat underlying illnesses and to control fever, vomiting, or diarrhea.

Home Treatment:
Dehydration occurs over time. If it can be recognized in its earliest stages, and if its cause can be addressed, home treatment may be beneficial and adequate.

Steps a person can take at home to prevent severe dehydration include:–

•Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Clear fluids often recommended as the diet of choice for the first 24 hours, with gradual progression to a BRAT diet (bananas, rice, apples, toast) and then adding more foods as tolerated.
•Loperamide (Imodium) may be considered to control diarrhea.
•Acetaminophen or ibuprofen may be used to control fever.
•Fluid replacements may be attempted by small, frequent amounts of clear fluids (see clear fluids information in previous section). The amount of fluid required to maintain hydration depends upon the individual’s weight. The average adult needs between 2 and 3 liters of fluid per day.
If the person becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed.

Prevention:-
•Environment: Dehydration due to the weather is a preventable condition. If possible, activities should not be scheduled in the heat of the day. If they are, adequate fluids should be available, and cooler, shaded areas should be used if possible. Of course, people should be monitored to make certain they are safe. Those working in hot environments need to take care to rehydrate often.
•Exercise: People exercising in a hot environment need to drink adequate amounts of water.
•Age: The young and elderly are most at risk. During heat waves, attempts should be made to check on the elderly in their homes. During the Chicago heat wave of 1995, more than 600 people died in their homes from heat exposure.
•Heat related conditions: Know the signs and symptoms of heat cramps, heat rash, heat exhaustion, and heat stroke. Preventing dehydration is one step to avoid these conditions.

Carefully monitor someone who is ill, especially an infant, child, or older adult. If you believe that dehydration is developing, consult a doctor before the person becomes moderately or severely dehydrated. Begin fluid replacement as soon as vomiting and diarrhea start — DO NOT wait for signs of dehydration.

Always encourage the person to drink during an illness, and remember that a person’s fluid needs are greater when that person has fever, vomiting, or diarrhea. The easiest signs to monitor are urine output (there should be frequent wet diapers or trips to the bathroom), saliva in the mouth, and tears when crying.

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.bbc.co.uk/health/physical_health/conditions/dehydration1.shtml
http://www.medicinenet.com/dehydration/page4.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm

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Health Problems & Solutions

Some Health Quaries & Answers

Bundle Of Joy:-

Q: My grandmother wraps up children in a bed sheet all the time so that they cannot move. She says it makes them sleep better.

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A: She is following an ancient practice called “swaddling”. This involves wrapping the baby so that its hands and legs are inside the sheet. Newborn babies sleep better when they are swaddled as it makes them feel they are still in the womb. But this should be discontinued after 10-14 days as the baby needs to move its arms and legs freely to grow and develop normally.

By-pass surgery :-
Q: I am a 58-year-old woman. I underwent hysterectomy at 40. Of late, I’ve been developing a vague chest pain while climbing stairs. I consulted a cardiologist. He did an angiogram and said I had triple vessel block and advised immediate by-pass surgery. A second surgeon, however, said that since I had well-developed collaterals, there was no need for surgery now. He advised revaluation with a stress test every year.

A: I would go with the more conservative approach and not of the knife-happy surgical team. If your collaterals are well developed, you can probably continue indefinitely without a problem. You need to make sure the collaterals stay patent by walking an hour a day on level ground and maintaining your ideal body weight.

Vitamin deficiency :-
Q: I feel very tired all the time. My muscles pain and I cannot eat any spicy food. I went to a physician who prescribed a battery of tests. Finally, he said I had vitamin D deficiency, anaemia and vitamin B12 deficiency. I am only 37.

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A: Vitamin D deficiency is common in India and much of the time it goes unrecognised. It may occur because of our lifestyle (remaining indoors) or it may be a genetic problem. A lot of research is being carried out. The deficiency makes the bones weak and this is reflected as muscle pain.

The stomach contains some cells that are essential for the body to bind and absorb vitamin B12. If those cells are damaged or wasted away, you will not only develop intolerance to spicy food but also adequate amounts of vitamin B12 will not be absorbed. Vitamin B12 is essential for red blood cell formation. That is why you are anaemic.

Your doctor will be able to treat all of this with medical supplements. Once your body responds, your symptoms will disappear.

TV and chips :-
Q: My niece is 10 years old. She is 150 cm tall and weighs 50 kg. I think she is fat. She watches cartoons all day and eats potato chips. Please advise.

A: Being fat or thin is a perception which may be incorrect. You need to find her ideal body weight using the calculation 23 x 1.5 x 1.5 = 51.75 (height in metre squared multiplied by 23). As per the calculation, if you have measured her height correctly, she is not overweight. On the other hand she may have no muscle mass, poor posture and a general round appearance. She does, however, need to curtail her television viewing, stop snacking and become physically more active.

This often involves a change of lifestyle for the whole family. Children learn a great deal by watching their parents and other family members.

Anti-obesity pill :-
Q: I want some tablets to lose weight. All this advice about diet and exercise really depresses me. Exercise makes my body ache and diets make me hungry.

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A: Weight gain and loss are usually gradual processes. When we gain weight, we are probably unaware of it until our clothes become tight and people make unkind remarks. Very rarely do people weigh themselves regularly. For many, maintaining the ideal body weight involves a lifetime of concentrated effort.

Try to control your total calorie intake. Say no to second helpings and avoid fat-filled snacks. Jog, walk or run for an hour every day. That way your body will utilise the food you consume more efficiently.

There are no “weight control” tablets. There are appetite suppressants but they have been banned in India as well as abroad as they were found to cause dangerous, non-reversible, life threatening side effects.

Taking thyroid hormones to increase your basal metabolic rate or steroids to “bulk up” is equally dangerous. Some advertised commercially available weight loss supplements contain these.

Pregnancy puff :-
Q: I have wheezing. I think it’s asthma. I am now pregnant and my doctor switched me from tablets to inhalers. Are they safe for the baby?

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A: Inhalers deliver the medicine direct to your lungs which will help you stop the wheezing. Tablets, on the other hand, enter the bloodstream and go all over the body, including the lungs. Many also cross the placenta and reach the baby. Your doctor is right — inhalers are better.

All answers are given by Dr Gita Mathai , a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Source : The Telegraph ( Kolkata, India)

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Deafness and Hearing Problems

Definition:
Deafness is a condition wherein the ability to detect certain frequencies of sound is completely or partially impaired. When applied to humans, the term hearing impaired is rejected by the Deaf Culture movement, where the terms deaf and hard-of-hearing are preferred.

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Hearing sensitivity is indicated by the quietest sound that an animal can detect, called the hearing threshold. In the case of humans and some animals, this threshold can be accurately measured by a behavioral audiogram. A record is made of the quietest sound that consistently prompts a response from the listener. The test is carried out for sounds of different frequencies. There are also electro-physiological tests that can be performed without requiring a behavioral response.

Normal hearing thresholds within any given species are not the same for all frequencies. If different frequencies of sound are played at the same amplitude, some will be perceived as loud, and others quiet or even completely inaudible. Generally, if the gain or amplitude is increased, a sound is more likely to be perceived. Ordinarily, when animals use sound to communicate, hearing in that type of animal is most sensitive for the frequencies produced by calls, or in the case of humans, speech. All levels of the auditory system contribute to this sensitivity toward certain frequencies, from the outer ear’s physical characteristics to the nerves and tracts that convey the nerve impulses of the auditory portion of the brain.

A hearing loss exists when an animal has diminished sensitivity to the sounds normally heard by its species. In humans, the term hearing impairment is usually reserved for people who have relative insensitivity to sound in the speech frequencies. The severity of a hearing loss is categorized according to the increase in volume that must be made above the usual level before the listener can detect it. In profound deafness, even the loudest sounds that can be produced by an audiometer (an instrument used to measure hearing) may not be detected.

Another aspect to hearing involves the perceived clarity of a sound rather than its amplitude. In humans, that aspect is usually measured by tests of speech perception. These tests measure one’s ability to understand speech, not to merely detect sound. There are very rare types of hearing impairments which affect speech understanding alone.

Causes:
The following are some of the major causes of hearing loss:-

*Age:-
Presbycusis, the progressive loss of ability to hear high frequencies with increasing age, begins in early adulthood, but does not usually interfere with ability to understand conversation until much later. Although genetically variable it is a normal concomitant of aging and is distinct from hearing losses caused by noise exposure, toxins or disease agents.

*Long-term exposure to environmental noise:-
Populations of people living near airports or freeways are exposed to levels of noise typically in the 65 to 75 dB(A) range. If lifestyles include significant outdoor or open window conditions, these exposures over time can degrade hearing. The U.S. EPA and various states have set noise standards to protect people from these adverse health risks. The EPA has identified the level of 70 dB(A) for 24 hour exposure as the level necessary to protect the public from hearing loss and other disruptive effects from noise, such as sleep disturbance, stress-related problems, learning detriment, etc. (EPA, 1974).

Noise-induced hearing loss (NIHL) typically is centered at 3000, 4000, or 6000 Hz. As noise damage progresses, damage starts affecting lower and higher frequencies. On an audiogram, the resulting configuration has a distinctive notch, sometimes referred to as a “noise notch.” As aging and other effects contribute to higher frequency loss (6–8 kHz on an audiogram), this notch may be obscured and entirely disappear.

Louder sounds cause damage in a shorter period of time. Estimation of a “safe” duration of exposure is possible using an exchange rate of 3 dB. As 3 dB represents a doubling of intensity of sound, duration of exposure must be cut in half to maintain the same energy dose. For example, the “safe” daily exposure amount at 85 dB A, known as an exposure action value, is 8 hours, while the “safe” exposure at 91 dB(A) is only 2 hours (National Institute for Occupational Safety and Health, 1998). Note that for some people, sound may be damaging at even lower levels than 85 dB A. Exposures to other ototoxins (such as pesticides, some medications including chemotherapy, solvents, etc.) can lead to greater susceptibility to noise damage, as well as causing their own damage. This is called a synergistic interaction.

Some American health and safety agencies (such as OSHA-Occupational Safety and Health Administration and MSHA-Mine Safety and Health Administration), use an exchange rate of 5 dB. While this exchange rate is simpler to use, it drastically underestimates the damage caused by very loud noise. For example, at 115 dB, a 3 dB exchange rate would limit exposure to about half a minute; the 5 dB exchange rate allows 15 minutes.

While OSHA, MSHA, and FRA provide guidelines to limit noise exposure on the job, there is essentially no regulation or enforcement of sound output for recreational sources and environments, such as sports arenas, musical venues, bars, etc. This lack of regulation resulted from the defunding of ONAC, the EPA’s Office of Noise Abatement and Control, in the early 1980s. ONAC was established in 1972 by the Noise Control Act and charged with working to assess and reduce environmental noise. Although the Office still exists, it has not been assigned new funding.

Many people are unaware of the presence of environmental sound at damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise levels include car stereos, children’s toys, transportation, crowds, lawn and maintenance equipment, power tools, gun use, and even hair dryers. Noise damage is cumulative; all sources of damage must be considered to assess risk. If one is exposed to loud sound (including music) at high levels or for extended durations (85 dB A or greater), then hearing impairment will occur. Sound levels increase with proximity; as the source is brought closer to the ear, the sound level increases.

*Genetic:-
Hearing loss can be inherited. Both dominant genes and recessive genes exist which can cause mild to profound impairment. If a family has a dominant gene for deafness it will persist across generations because it will manifest itself in the offspring even if it is inherited from only one parent. If a family had genetic hearing impairment caused by a recessive gene it will not always be apparent as it will have to be passed onto offspring from both parents. Dominant and recessive hearing impairment can be syndromic or nonsyndromic. Recent gene mapping has identified dozens of nonsyndromic dominant (DFNA#) and recessive (DFNB#) forms of deafness.

#The first gene mapped for non-syndromic deafness, DFNA1, involves a splice site mutation in the formin related homolog diaphanous 1 (DIAPH1). A single base change in a large Costa Rican family was identified as causative in a rare form of low frequency onset progressive hearing loss with autosomal dominant inheritance exhibiting variable age of onset and complete penetrance by age 30.

#The most common type of congenital hearing impairment in developed countries is DFNB1, also known as Connexin 26 deafness or GJB2-related deafness.

#The most common dominant syndromic forms of hearing impairment include Stickler syndrome and Waardenburg syndrome.

#The most common recessive syndromic forms of hearing impairment are Pendred syndrome, Large vestibular aqueduct syndrome and Usher syndrome.

#The congenital defect microtia can cause full or partial deafness depending upon the severity of the deformity and whether or not certain parts of the inner or middle ear are affected.

#Mutations in PTPRQ Are a Cause of Autosomal-Recessive Nonsyndromic Hearing Impairment

*Disease or illness:-
#Measles may result in auditory nerve damage

#Meningitis may damage the auditory nerve or the cochlea

#Autoimmune disease has only recently been recognized as a potential cause for cochlear damage.
#Although probably rare, it is possible for autoimmune processes to target the cochlea specifically, without symptoms affecting other organs. Wegener’s granulomatosis is one of the autoimmune conditions that may precipitate hearing loss.

#Mumps (Epidemic parotitis) may result in profound sensorineural hearing loss (90 dB or more), unilateral (one ear) or bilateral (both ears).

#Presbycusis is a progressive hearing impairment accompanying age, typically affecting sensitivity to higher frequencies (above about 2 kHz).

#Adenoids that do not disappear by adolescence may continue to grow and may obstruct the Eustachian tube, causing conductive hearing impairment and nasal infections that can spread to the middle ear.

#AIDS and ARC patients frequently experience auditory system anomalies.

#HIV (and subsequent opportunistic infections) may directly affect the cochlea and central auditory system.

#Chlamydia may cause hearing loss in newborns to whom the disease has been passed at birth.

#Fetal alcohol syndrome is reported to cause hearing loss in up to 64% of infants born to alcoholic mothers, from the ototoxic effect on the developing fetus plus malnutrition during pregnancy from the excess alcohol intake.

#Premature birth results in sensorineural hearing loss approximately 5% of the time.

#Syphilis is commonly transmitted from pregnant women to their fetuses, and about a third of the infected children will eventually become deaf.

#Otosclerosis is a hardening of the stapes (or stirrup) in the middle ear and causes conductive hearing loss.

#Superior canal dehiscence, a gap in the bone cover above the inner ear, can lead to low-frequency conductive hearing loss, autophony and vertigo.

*Medications:–
Some medications cause irreversible damage to the ear, and are limited in their use for this reason. The most important group is the aminoglycosides (main member gentamicin) and platinum based chemotherapeutics such as cisplatin.

Various other medications may reversibly affect hearing. This includes some diuretics, aspirin and NSAIDs, and macrolide antibiotics.

The 1995 Miss America Heather Whitestone lost her hearing after receiving strong antibiotics for haemophilus influenzae.[citation needed] Extremely heavy hydrocodone (Vicodin or Lorcet) abuse is known to cause hearing impairment. Commentators have speculated that radio talk show host Rush Limbaugh’s hearing loss was at least in part caused by his admitted addiction to narcotic pain killers, in particular Vicodin and OxyContin.

*Exposure to ototoxic chemicals:-
In addition to medications, hearing loss can also result from specific drugs; metals, such as lead; solvents, such as toluene (found in crude oil, gasoline[6] and automobile exhaust, for example); and asphyxiants. Combined with noise, these ototoxic chemicals have an additive effect on a person’s hearing loss.Hearing loss due to chemicals starts in the high frequency range and is irreversible. It damages the cochlea with lesions and degrades central portions of the auditory system. For some ototoxic chemical exposures, particularly styrene, the risk of hearing loss can be higher than being exposed to noise alone. Controlling noise and using hearing protectors are insufficient for preventing hearing loss from these chemicals. However, taking antioxidants helps prevent ototoxic hearing loss, at least to a degree. The following list provides an accurate catalogue of ototoxic chemicals:-

#Drugs
antimalarial, antibiotics, anti-inflammatory (non-steroidal), antineoplastic, diuretics

#Solvents
toluene, styrene, xylene, n-hexane, ethyl benzene, white spirits/Stoddard, carbon disulfide, fuels, perchloroethylene, trichloroethylene, p-xylene

#Asphyxiants
carbon monoxide, hydrogen cyanide

#Metals
lead, mercury, organotins (trimethyltin)

#Pesticides/Herbicides
paraquat, organophosphates

#Physical trauma
There can be damage either to the ear itself or to the brain centers that process the aural information conveyed by the ears.

#People who sustain head injury are especially vulnerable to hearing loss or tinnitus, either temporary or permanent.

#Exposure to very loud noise (90 dB or more, such as jet engines at close range) can cause progressive hearing loss. Exposure to a single event of extremely loud noise (such as explosions) can also cause temporary or permanent hearing loss. A typical source of acoustic trauma is an excessively loud music concert. I King Jordan lost his hearing after suffering a skull fracture as a result of a motorcycle accident at age 21

Diagnosis:
The diagnosis starts with verifying the medical and the family histories of the person. Ear examination is done to assess the hearing and the balancing ability of the person.

 The following tests may be required to confirm the diagnosis and to find the cause:

Audiogram: The person sits in a sound proof room and wears a headphone attached to a machine. Different sounds of varying intensity or loudness are sent through the headphone and the person is asked to tell whether he hears the sound or not. Each ear is tested separately. An audiogram helps to assess any hearing loss.

Electrocochleography: This test measures electrical activity in the cochlea and in the nerves that take sensations from the ear to the brain. This is done by passing a thin needle into the ear that records the activity and sends it to an attached computer. In people who have SHL, the activity will be abnormal because of damage.

Caloric Testing: It is done to assess the functioning of the vestibular part of the inner ear, which maintains the body balance. The person is asked to sit in a chair. Cold and hot water is poured into the ear alternately and the associated involuntary eye movements are checked.

Computed Tomography Scan or Magnetic Resonance Imaging: Multiple images of the affected ear are taken and then they are assembled by a computer to generate a clear image of the internal body parts. These tests help to assess any damage in the inner ear. Also, any nerve tumor, such as Acoustic Neuroma, can be diagnosed.

Blood Tests such as fluorescent treponemal antibody absorption may be required to check for Syphili. Antinuclear antibodies may be checked to detect any autoimmune disorders.

Treatment:
The treatment of hearing loss depends on its cause. For example:

•ear wax can be removed,
•ear infection can be treated with medications,
•medications that are toxic to the ear can be avoided and;
•occasionally surgical procedures are necessary.

Gene therapy:-
A 2005 study achieved successful regrowth of cochlea cells in guinea pigs.[13] It is important to note, however, that the regrowth of cochlear hair cells does not imply the restoration of hearing sensitivity as the sensory cells may or may not make connections with neurons that carry the signals from hair cells to the brain. A 2008 study has shown that gene therapy targeting Atoh1 can cause hair cell growth and attract neuronal processes in embryonic mice. It is hoped that a similar treatment will one day ameliorate hearing loss in humans.

Assistive techniques and devices for hearing impairment:-
Many hearing impaired individuals use assistive devices in their daily lives:

#Individuals can communicate by telephone using Telecommunications Device for the Deaf (TDD). These devices look like typewriters or word processors and transmit typed text over regular telephone lines.Other names in common use are textphone and minicom.

#There are several new Telecommunications Relay Service technologies including IP Relay and captioned telephone technologies.

#Mobile textphone devices came onto the market as of 2004, allowing simultaneous two way text communication.

#Videophones and similar video technologies can be used for distance communication using sign language. Video conferencing technologies permit signed conversations as well as permitting a sign language-English interpreter to voice and sign conversations between a hearing impaired person and that person’s hearing party, negating the use of a TTY device or computer keyboard.

#Video Relay Service and Video Remote Interpreting services also use a third-party telecommunication service to allow a deaf or hard-of-hearing person to communicate quickly and conveniently with a hearing person, through a sign language interpreter.

#In the U.S., the UK, the Netherlands and many other western countries there are Telecommunications Relay Services so that a hearing impaired person can communicate over the phone with a hearing person via a human translator. Wireless, internet and mobile phone/SMS text messaging are beginning to take over the role of the TDD.

#Phone captioning is a service in which a hearing person’s speech is captioned by a third party, enabling a hearing impaired person to conduct a conversation with a hearing person over the phone.

#Hearing dogs are a specific type of assistance dog specifically selected and trained to assist the deaf and hearing impaired by alerting their handler to important sounds, such as doorbells, smoke alarms, ringing telephones, or alarm clocks.

#Other assistive devices include those that use flashing lights to signal events such as a ringing telephone, a doorbell, or a fire alarm.

#The advent of the Internet’s World Wide Web and closed captioning has given the hearing impaired unprecedented access to information. Electronic mail and online chat have reduced the need for deaf and hard-of-hearing people to use a third-party Telecommunications Relay Service in order to communicate with the hearing and other hearing impaired people;

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.bbc.co.uk/health/physical_health/conditions/deafness1.shtml
http://en.wikipedia.org/wiki/Hearing_impairment
http://www.medicinenet.com/deafness/article.htm

http://www.assiutknol.com/hearing-loss-and-deafness

http://healthscribes.com/disease/Hearing+Loss,+Sudden

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