Symptoms, Causes and the Cost of Athetoid Cerebral Palsy

What is Athetoid Cerebral Palsy?

What is Athetoid?

Athetoid is a type of Cerebral Palsy that causes muscles to move uncontrollably. According to CerebralPalsySource.com, Athetoid Cerebral Palsy is recognizable by loose movements that affect the whole body such as scratching a nose or holding a small object. It is because of this erratic and uncontrollable movement that Athetoid can also be referred to as dyskenetic cerebral palsy. People with Athedoid CP can have difficulty doing everyday tasks like using scissors and writing to not having the ability to walk.

Causes and Signs of Athetoid

CerebralPalsySource.com says Athetoid is caused when the basal ganglia, or cerebellum, located near the middle of the brain, is damaged. This area of the brain’s task is to process signals that enable smooth, coordinated movements and body posture control. It is estimated that Athetoid affects 25 percent of patients with cerebral palsy. Athetoid can also affect the cervical spine. This can lead to the child being highly-disabled. Other possible complications include:

• Hip dislocations

• Joint deformities

• Ankle equines

• Foot drop

Patients of Athetoid CP often times have difficulty controlling the muscles in the face, resulting in grimacing or drooling. Abnormal speech and hearing difficulty is also often associated with this type of CP.

Costly Needs for Athetoid Children

Caring for Athetoid children can be very expensive. Care requires the use of a lot of special equipment and tools. According to a news report from the Seattle Times, medical care can add up to millions of dollars. Of this money, some is for the child’s future income, pain and suffering and specialized equipment that improves the child’s quality of learning and living. Unfortunately, medical insurance and Medicaid do not provide for all that an Athetoid child needs in life. Some of the costs associated with Athetoid cerebral palsy include:

• Wheelchair – a manual wheelchair with an adaptive seat can cost as much as $3,500. An electric wheelchair can run anywhere between $5,000 to $10,000.

• Prone Stander – used to help children stand and can cost between $1,000 and $1,500.

• Communication System – children who are diagnosed with Athetoid have extreme difficulties talking. An augmentative system can cost up to $4,000.

• Transportation – to transport the child, a special van is needed. This can cost caregivers approximately $25,000.

Most Important Discoveries in Vaccinology Part II

Polysaccharides, Bacterial polysaccharide

The way this will open the pre World War II, but the operation the immunological effect of the combination of bacterial polysaccharide with proteins has happened only recently. The 80’s saw the implementation of this technology coma Hib vaccine as a first conjugate being licensed for infants in 1990;

A reminder is not necessary for the spectacular success of the Hib vaccine, which promises eradicate the disease and perhaps also the body.
It seems that the spectacular success also attend the conjugate vaccine
pneumococcus.

Invasive disease with bacteremia caused by serotypes in the vaccine is likely to be prevented almost completely. The localized disease as meningitis and pericarditis should also disappear.

In addition, the test of the vaccine showed high efficacy against pneumonia with consolidation the X-rays, suggesting that pneumococcal pneumonia is more common in children suspected.

The application of the vaccine in the developing world could thus have major consequences on mortality, while the application in the world developed could reduce the problem of antibiotic resistant peneumococo. However, the effect of vaccination on the epidemiology of pneumococcal serotypes and substitution by non-vaccine serotypes will have to be observed carefully.

The meningococcal polysaccharide conjugated to proteins are still in early, but the results in conjunction with the Group C in the United Kingdom has suggested that a large proportion of meningococcal meningitis and fulminant disease can be prevented.

GENETIC ENGINEERING

No doubt historians genetic engineering as one of the discoveries of the twentieth century. For vaccinology, this discovery means that someone isolate the encoding for a protective antigen protein, one gene can be inserted into cells of bacteria, yeast or animal origin, which then produce the protein in large quantities. The most important result of this discovery so far is recombinant yeast that produces the surface antigen for hepatitis B, but the same technique has already produced in bacteria antigens for vaccines against the disease Lyme disease, pertussis and cholera.


VECTOR ATTENUATOR

In the 80s, the researchers determined that certain organisms attenuated naturally or artificially could carry the genetic information of pathogens and that during replication in an animal, they could transcribe, translate and present such information to the host’s immune system. Thus, the field of vetorologia born. Among the bacteria, the vectors are the most popular Bacillus Calmette-Guerim (BCG) and attenuated salmonella, while among the viruses, the attention has turned to the pox virus, adenovirus and alphavirus, although other agents such as herpes simplex virus, adeno associated with them, and even retroviruses, have their defenders.

The study of vectors has raised the concept of first rib. This is because although vector antigens themselves are rarely given an answer sufficient B cells, inoculation serial vector vaccine followed by protein 5 or plasmid DNA is induced, respectively, strong responses of T and B cell Replicas of alphavirus and poxvirus serve as illustration. Poxviruses include vaccinia mutants, such as MVA and NYVAC, as well as attenuated poxvirus animals naturally.

The recombinant preparations are recombination events that occur together in cells infected with viruses and cross-infected with the gene of interest. The Canarypox is an example of a virus that replicates only in human abortion. As regards the production of antibody, the ability of poxvirus vectors to prepare for the antibody response has been demonstrated by recombinant canarypox HIV envelope, while the ability of poxviruses to stimulate strong cellular immunity has been demonstrated by the canarypox-CMV.

The alphaviruses as vectors depend on the ability to insert foreign genes in the genome, which are reflected in pseudovirions produced during replication abortion. The genome of the alphavirus structural genes do not contain required for replication and structural genes.

If the structural genes are replaced by foreign genes, pseudo-replication can be induced by auxiliary builders containing the structural genes but incapable of making viral RNA. The structural proteins will accumulate together with foreign proteins.

TRANSGENIC PLANTS AND PLANT VIRUSES

The use of fruit or vegetables administered oral vaccine containing antigens could also be considered an example of vetoriação. However, the idea of distributing vaccines in the food chain is sufficiently different to give it its own place.

There are two ways to make vaccines in plants: the plants transgenic for the genes coding for proteins of vaccine virus or chimeric plants containing the same genes. Clinical trials have shown responses to a variety of antigens produced in plants, including labile toxin from Escherichia coli surface antigens of hepatitis V and glycoprotein vaccine.

Developments in the fields continue to be promising and have already started to change ideas about the immunology of the gastrointestinal tract. If it can be figured out how to stimulate immunity to the antigens of pathogens without breaking the tolerance against the antigens of food, plants or recombinant plant virus may become strategies of effective vaccines.

This will require considerable immune attack, but my great hope for the new century is that immunologists will make more contributions to vaccinology. We know little about the mechanisms of antigenic domain, processing, interference, preparation and many other aspects of immune stimulation that could be used.

DNA UNPROTECT

Unprotected DNA is a term of specialized language for foreign genetic information inserted into a bacterial plasmid that is expressed in the skin or injection into muscle of the host.

The antigen is produced in the muscle cell, but the antigen must be processed in bone marrow cells to achieve an immune response. In animals, magnificent responses have been generated after intramuscular injection of gen, but the results in humans have so far been somewhat disappointing when the DNA is used alone.

If a DNA vaccine will be licensed depends on the response to several questions:

1. Intradermal administration or transcutaneous DNA result in a good answer antibody in humans?

2. An adjuvant is found to reduce the amount of DNA needed to get the answer?

3. The combination of prime rib of DNA with other forms of vaccination will full immune response, ie, strong cellular responses and antibody when necessary?

The answers to these questions are likely to come early studies of vaccines against HIV and malaria. Even if the DNA ever achieve the status of a vaccine for a particular infection, already has had tremendous value as a tool for the identification of antigens
guards. The more pathogens are sequenced, their genes may be identified and tested for protection in animal models.

This will simplify the selection of protective antigens that could have escaped the attention otherwise. This strategy has already proved useful for the development of vaccines against experimental meningococcal group B and Chlamydia pneumoniae.

A Good Defense Without Being Offensive

I recently had to learn a lesson which I often suggest that my clients learn: how to set boundaries and convey the truth in such a way that the other person doesn’t feel attacked. In other words, how to respond when someone has irritated, frustrated, or infuriated you.

The main aspect of this kind of communication is to make “I” statements. In my case, I received an unjust criticism. I wanted to respond, “You dirty, rotten so-and-so! Who do you think you are?” I wanted to recount every fault and point out every failure in this person’s history. I wanted to lash out. You know what that would have done. It wouldn’t be pretty. I thought better of it. Not knowing what to say, I didn’t say anything.

That was a mistake. Not saying anything just let the injustice stew in my gut. I turned it over and over, looking at it from every angle to see just how inaccurate the criticism was and feeling mighty justified about being indignant. I was giving up my own sense of peace and well-being, fighting a battle that had no end.

What to do? I mentioned it to a wise friend who suggested something I should have done in the first place, “Tell him how his words affected you. Say something like, ‘When you said this, I found it very difficult to do my job properly. Please be more supportive and constructive.'” That statement is true. It probably wouldn’t have caused a conflagration and, more importantly, I would have set my boundaries.

Making “I” statements is a good technique. Expressing the felt emotion is a remarkable tool for dialogue. But what if the person you must communicate with is too powerful or too unstable to be trusted or has moved out of your life completely? What if you don’t feel safe telling the person anything about how you feel? What then?

Even when it’s impossible or inadvisable to express your feelings to the appropriate person, it is still important to define how you feel to yourself. You can write a letter and never deliver it. You can say it to someone who has a sympathetic ear. But define it you must because keeping a list of grievances can fester and bubble up when you least want them. For me, when I examined the frustration I felt from this unjust criticism, I realized that my not addressing it immediately made my life difficult; I had constant rebuttals bouncing aimlessly around in my head.

When I asked myself what emotions I felt, what was under the frustration, I was surprised to identify feelings in my chest. We feel sadness and grief in our chests. I thought it would be anger but under it all was sadness. I am feeling sad about having never built an alliance of mutual support with this person. I was letting go of lost dreams and more than anything, that was the root of my frustration.

What can you do to communicate what you feel?

* Stop whatever you’re doing and take several deep breaths.

* Scan your body for sensations.

* Equate locations of sensations to the major emotions.

Belly, solar plexus = Fear

Center of body, heart = Love

Chest = Sadness, grief

Shoulders, jaw, back of neck = Anger

* Express your emotion in a non-judgmental way.

Remember the adage: “Good fences make good neighbors.” Create good boundaries and express your emotions when someone crosses one.

New Advances in Treating Congestive Heart Failure

Congestive heart failure is an insidious opponent, possessing a slow onset that results in a patient often not even noticing they are having symptoms. Over time the patient will suffer from worsening dyspnea and edema that will eventually drive them to seek treatment, where they will discover that for whatever reason their heart is no longer able to function properly.

Heart failure occurs when the cells of the heart tissue are either destroyed or made non-functional due to another cardiac event, often secondary to ischemic heart disease or coronary artery disease. As a result, the heart is no longer able to pump the blood throughout the body properly; instead the blood pools, resulting in fluids being retained rather than excreted properly and oxygen starved organs being unable to function. The death of these cells is critical because, like brain cells, once the cells of the heart die the body is unable to reproduce them and restore full function to the heart. Congestive heart failure carries with it a high mortality rate, with over fifty percent of its victims dying within five years of being diagnosed. Doctors and researchers are able to use modern advancements in medicine to make the patient more comfortable and, in many cases, to provide them with a more favorable prognosis.

Many patients do not even discover that they have suffered heart failure until they are brought into the Emergency Department of their local hospital complaining of chest pain and difficulty breathing. Doctors will stabilize them there, giving them supplemental oxygen and beginning a course of medicinal treatment that will carry them out of the hospital.

Modern science has provided physicians with a wide array of methods with which to combat the damage done by congestive heart failure. Once oxygen is returned to an acceptable level a physician will usually administer a diuretic to stimulate the renal system to pull fluid out of circulation, relieving the edema and taking a great of stress off of the lungs, heart and other organs. This will also usually be accompanied by supplemental potassium, as the renal system will remove potassium along with the excess fluid and hypokalemia carries with it its own hazards.

A great deal of attention in the field of medicine has been focused on the body’s production of angiotensin II as it aggravates congestive heart failure. Angiotensin II is a substance produced by the body which raises blood pressure and causes the blood vessels to constrict, thereby forcing the heart to work much harder to pump blood throughout the body. An ACE inhibitor will often be administered to prevent the body from making angiotensin II, and an angiotensin receptor blocker is available to those who do not respond as desired to the ACE inhibitor. Many patients with heart problems are given nitroglycerin for this reason.

Along with medicine, research into the field of congestive heart failure is ongoing. The speculated use of stem cells, particularly embryonic stem cells, has opened a whole field of debate for possible treatment of heart failure in the science community. Patients with congestive heart failure were given some of their own stem cells in the heart via injection, and all reacted favorably. Scientists are unsure as to whether this is because the stem cells aid the body in growing new vessels or simply act as a lighthouse for the body’s natural healing mechanisms, drawing other cells to the site of the damage. Whichever the case may be, stem cells present a fascinating opportunity to finally find a means by which to restore heart function to patients who have suffered heart failure.

Modern science is providing a whole new world of treatment options to patients with congestive heart failure, and researchers are making new discoveries all the time. It is the hope of all of those in the medical field that one day heart failure will be another disease medicine has the answer to.

Symptoms of Back Surgery Injury

Any type of bodily injury can be quite debilitating, but one of the worst types of injuries that can happen to you are back injuries. This is one of the worst types of injuries because your back helps to control so much of your movement in you body. When injuring your back depending on the severity of the injury you can face anything from a mild inconvenience with pain during movement to paralysis. There are many different types of treatments for back injuries depending on the type of injury and the location in the back most common is rest and heat or ice. However if pain persists especially disc pain such as a ruptured disc, bulging disc or a herniated disc back surgery may be inevitable.

There are many back surgeons and back specialists out there to help you seek the answer to your back ailments. Some people prefer to see a chiropractor however before making that decision on your own it is recommend to see a back specialist for advice first as sometimes seeing a chiropractor is not the right answer to help you heal. If you are in need of back surgery it is most common that there are nerves being pinched in your spinal column. Lower back surgery is more common than upper back surgery. The usually reason for back pain surgery is to remove a part of a disc, or replace the disc completely to relieve the pressure on the spine. While there are laser back surgery techniques most surgeons prefer to use other techniques as laser surgery is not as well proven to help control the pain as other surgical procedures have been.

Spinal stenosis is the condition in which the spinal column becomes narrow causing increased pressure on the spinal cord or nerves in the spine. There are two common types which are lumbar spinal stenosis which is when this problem occurs in the back, and cervical spinal stenosis which is when the problem occurs in the neck. Symptoms are numbness in the back, butt, legs, shoulders, or arms and weakness in the limbs. This first type of treatment for this is rest and trying to avoid repeat episodes of back pain. Medications, physical therapy, and certain lifestyle changes may help control the pain and limit the need for surgical assistance. However if none of these options seem to help spinal stenosis surgery is the next option. The surgery will be done on the site of the narrowing and will help to relieve the pressure of the obstruction.

Back surgeries can be one of the toughest surgeries to heal from as your back helps to support your weight when standing and controls so much of your movements. After back surgery expect to be hospitalized for several days or weeks after the surgery, and the pain may become much greater right after the surgery. It can take anywhere from about 6 weeks to over a year to completely heal after surgery. Physically therapy and rehabilitation will be required for a few weeks as you will need to learn how to sit, stand, and walk to keep your spine aligned properly. The best thing to do after your surgery is to take your time to heal. Do not rush yourself as this may damage your spine further and reverse the entire point of the surgery in the first place. Let your body heal. Listen to all doctor recommendations, and do not rush into anything.

The Acer D2D Erecovery 101

Disclaimer: First of all backup your system before launching you in any hazardous operation, some of the operations to come can cause data loss. Any modification and/or damage done on your laptop will be under your responsibility.

As you know now the Acer laptops and those of other manufacturers are now delivered with a restoration system installed in a hidden partition (PQservice for Acer)on your hard disk. Normally this system launches out while pressing simultaneously keys ALT+F10, but sometimes that does not function.

What’s the problem?

There are many possible causes, but most common are:

A The function D2D was disabled in the bios.

Solution: Enable the function by pressing F2 during the boot to access the bios menu and change the setting, then reboot and press keys ALT+F10 during the starting of the laptop.

Note: For all the following solutions take into account the Max advice, I quote Max now, a contributor in my site «But I want to mention the way I sorted out the thing, because it’s very rarely mentioned on the web. All the methods to repair the D2D Alt+f10 issue are knowledgeable and smart but all of them forget to say a fundamental thing:

first of all you have to rebuild with a partition soft the D:Acerdata FAT32 empty partition that almost everybody deletes cause is usually empty. Simply doing it, everything turned fine and the recovery worked perfectly.»

Yes much of attempts to restore fail because of this condition.

B An other common problem the Acer Master Boot Record (MBR)is damaged, or replaced by the MBR of another system. You can reinstall the Acer MBR if the partition PQservice is present or if you can have access to the necessary files.

Solutions:

FIRST

On a functional FAT32 Windows system the partition table values are OC or OB for installable FAT32 system files and 12 or 1B for Hidden FAT32 partition, for a NTFS system the known partition table values are O7 for installable NTFS files system and 27 for Acer custom hidden NTFS partition:

1. Go in the bios and disable the D2D recovery option.

2. Download partedit32.

3. Identify the PQservice partition by its size (there is an information box at the bottom of the partedit window) it is the small sized partition approximately 4 to 9 Go.Once made change the type of your partition into 0C(FAT32) or 07(NTFS) and save. Reboot and now you should be able to navigate inside the PQservice partition.

Search for these two files:

mbrwrdos.exe

rtmbr.bin

(The name of these two files can be different sometimes)

When localized open a command prompt windows as an administrator and enter this command “mbrwrdos.exe install rtmbr.bin”, to install the Acer MBR. Close the command prompt, reboot again your laptop, reactivate the D2D recovery in the bios. Now ALT+F10 should work and run the Acer Erecovery when the laptop start.

SECOND

Somebody who tried to follow the first method but did not succeed to find the 2 files found another solution to restore the partition.

Use partedit32 to locate the partition pqservice(on aspire 5920g,its the larger 9 gb partition)

Change the partition type to 07(Installable NTFS),reboot.

After reboot,go to the windows computer management and mark the PQservice partition as active then reboot again.

Voila!! You can now proceed to the road to recovery

THIRD

On a nonfunctional Windows system.

Download the Ultimate Boot CD(UBCD) run it choose in the menu:

-Filesystem Tools

-Boot Managers

-For me GAG functioned well, but you can choose any of the other boot loader, you will recognize the PQservice by it type(hidden).

Just install any boot loader and use it to boot into the PQservice to start the Erecovery restoring process.

C The last problem: You replaced your hard disc( in this case PQservice is not present any more) or your partition was erased or damaged.

Solution: I hope that you burned the Acer restoration CD/DVD when it had been asked to you at the time of the first use, cause if you did not previously make a backup of your laptop by making a disc image, it will not be possible to use the Acer Erecovery.

Let us give the last words to Max:

«Problem Sorted Alan. And you’re right that an external drive for data backup it’s all important. Yes I have it and backed-up my data before starting messing up… »

Natural Pain Relief

DLPA – Natural Pain Killer

Everyday doctors are prescribing pain killers to their patients who are recovering from injuries, operations, migraine headaches, back problems and other conditions. Pharmaceutical companies are researching better formulas to relieve specific types of pains. Most likely, every household in America contains at least one over-the-counter pain killer like Aspirin, Tylenol, Ibuprofin, Motrin or Excedrin. Some pain killers have serious potential side effects and many patients have reactions that cause other problems. If you have tried the major pain medications and have not found relief for your chronic pain, you may respond well to one of the natural painkillers called, DL-Phenylalanine. (DO NOT confuse this amino acid with L-Phenylalanine which is an essential amino acid necessary for synthesizing neurotransmitters in the brain and promoting sexual arousal. L-phenylanine also helps to control appetite.) DLPA is a form of phenylalanine but is formulated using equal parts of D – or synthetic phenylalanine, and L, the natural form of that amino acid.

DLPA has the ability to activate and produce endorphins, the body's natural painkillers.
Although available at your local health food store, please check with your doctor because in certain cases it might be contraindicated; such as if you are pregnant, or have PKU, which stands for phenylketonuria. Infants are tested for PKU at the hospitals today.
DLPA may also elevate blood pressure so check with your physician before trying it if you have any circulatory distress.

DLPA has worked wonders for many people who suffer with migraine headaches, severe leg cramps, forms of neuralgia and even backaches. The double benefit is that DLPA is also a natural antidepressant. You know what it feels like to be in pain, and you may remember, if you are not in pain right now, how depressing pain can be. Severe pain monopolizes your every moment. But, DLPA can be helpful to both soothe pain and lift your spirits.

How much should you take? Well, of course we can not prescribe for you, but I can tell you that DLPA is generally available in 375 mg doses and may be taken up to six times daily up to a maximum intake of 1.5grams according to some labels and general info available. Again, check with your doctor before trying this natural pain killer.

Other natural pain killer techniques include: EFT (Emotional Freedom Therapy) consisting of specific tapping points, Acupressure, Acupuncture, Bio-Feedback, Sound & Light Therapy, Hypnotherapy, Chiropractic Adjustments and Massage.

To try a natural pain relief custom formula made specifically for you, or to learn more about, or experience, EFT, Acupressure, Hypnotherapy, Sound & Light and other possibilities please call for an appointment or contact me via the website below at Totally Well. ..847 / 836-8345

Giving you more options to wellness.

Janet Angel, PhD

DRUG USE AND PRINCIPLES OF CLINICAL CARE IN GERIATRIC PATIENTS

Geriatrics and Gerontology are often used to mean the same thing.  Geriatrics is the branch of medicine that deals with the illness and care of the aged, while Gerontology is the study of factors affecting the normal aging process and the effects of aging on persons of all ages.

Geriatric nursing focuses on the care of the sick elderly.  Gerontologic nursing includes not only the care of the sick elderly, but also health maintenance, illness prevention, and the promotion of quality of life to assist the person to grow to an ideal state of health and well being.

Simply stated, our role as health care providers is to assist our elderly patients to get better, to maintain at their current status – accepting declines – or to ease their dying.

Pharmacotherapy for the elderly can cure or palliate disease as well as enhance health-related quality of life (HRQOL). HRQOL considerations for the elderly include focusing on improvement in physical functioning, psychological functioning, social functioning, and overall health. Despite the benefits of pharmacotherapy, HRQOL can be compromised by drug-related problems. The avoidance of drug related adverse consequences in the elderly requires health care practitioners to become knowledgeable about a number of age-specific issues.

GERIATRIC PHARMACOLOGY

In general, everything diminishes with age. Both the pharmacodynamic as well as the pharmacokinetic character changes with time. With aging inherent variability in physiologic differences becomes accentuated. Pharmacodynamic responses are blunted, ability to eliminate drugs is diminished and sensitivity to the toxic effects of drugs is increased. The effects of diseases are often additive and accumulate with time. Disability and capacity for recuperation or compensation are decreased. As a result the incidence of adverse drug events is concentrated in the elderly.

The concern for drug use in the elderly stems from the disproportionate use of drugs in the elderly. Geriatric patients represent 12% of population but receive 30% of all prescriptions. Two thirds use 1 or more drugs daily. Average use is 5 – 12 drugs daily and < 5% use no drugs. One third use 1 or more psychotropic drugs each year.

PATHOPHYSIOLOGY OF AGING

In the elderly the physiologic underpinnings are altered. There is an altered, usually diminished, receptor sensitivity and responsiveness. The ability to mount a compensatory physiologic response is diminished. Normal homeostatic mechanisms are blunted and sometimes produce inappropriate responses.

The elderly accumulate diseases. Even “healthy” elderly have diminished capacities. Aging is a continuum and the aged are stratified by degree of age. As age progresses so do the exceptional considerations.

ALTERED PHARMACOKINETICS

  • ABSORPTION –

Age related changes are small. Decreased motility and changes in surface area are less significant than disease-specific changes. Effects of age on absorption for delayed and sustained release formulations have not been well-documented. A diminished first-pass effect results in an increased bioavailability.

  • DISTRIBUTION-

As a consequence of the age-related changes in body composition, polar drugs that are mainly water-soluble tend to have smaller volumes of distribution (V) resulting in higher serum levels in older people. Gentamicin, digoxin, ethanol, theophylline, and cimetidine fall into this category.  Loading doses of digoxin need to be reduced to accommodate these changes. On the other hand, nonpolar compounds tend to be lipid-soluble and so their V increases with age. The main effect of the increased V is a prolongation of half-life. Increased V and t1/2 have been observed for drugs such as diazepam, thiopentone, lignocaine, and chlormethiazole.

  • METABOLISM-
    In general, oxidative capacity is somewhat diminished with age. Phase II reactions are better preserved than Phase I. Disease and environmental factors have a greater impact on hepatic drug metabolism than age per se. High extraction drugs may have decreased clearance.
  • ELIMINATION  –

Decrease in Clearance and increase in half- life for renally cleared drugs.
The age-related change in renal clearance is the most consistent and predictable change in pharmacokinetics. The dose of most drugs that are renally cleared should be adjusted for renal function. The adjustment method most frequently used is the Cockroft-Gault equation to estimate renal clearance.

CLCr (ml/min) =

(140 – age)  (lean weight in kg)

72 (serum creatinine in mg/dL)

ALTERED PHARMACODYNAMICS

There is some evidence in the elderly of altered drug response or “sensitivity.” Four possible mechanisms have been suggested: (1) changes in receptor numbers, (2) changes in receptor affinity, (3) postreceptor alterations, and 4) age-related impairment of homeostatic mechanisms. For example, muscarinic, parathyroid hormone, β-adrenergic, α1-adrenergic, and μ-opioid receptors exhibit reduced density with increasing age. Also, the elderly are more sensitive to the central nervous system effects of benzodiazepines. The elderly also exhibit a greater analgesic responsiveness to opioids when compared with their younger counterparts, even when pharmacokinetic parameters are similar in the two groups. In addition, the elderly demonstrate an enhanced responsiveness to anticoagulants such as warfarin and heparin, as well as thrombolytic therapy. In contrast, the elderly exhibit decreased responsiveness to certain drugs (e.g., β-agonists/antagonists). Also, reflex tachycardia, seen commonly with vasodilator therapy, is often blunted in the elderly. For some drugs (e.g., calcium channel blockers), both enhanced responsiveness (as demonstrated by greater reduction in blood pressure) and decreased responsiveness (as demonstrated by reduced atrioventricular nodal blockade) can occur simultaneously in elders.

Physiologic Changes with Aging

Organ System Manifestation

Body composition

↓ Total body water

↓ Lean body mass

↑ Body fat

↔ or ↓ Serum albumin

↔ or ↑ α1-Acid glycoprotein (↑ by several disease states)

Cardiovascular

↓ Myocardial sensitivity to beta-adrenergic stimulation

↓ Baroreceptor activity

↓ Cardiac output

↑ Total peripheral resistance

Central nervous system

↓ Weight and volume of the brain

Alterations in several aspects of cognition

Endocrine

Thyroid gland atrophies with age

Increase in incidence of diabetes mellitus, thyroid disease

Menopause

Gastrointestinal

↑ Gastric pH

↓ Gastrointestinal blood flow

Delayed gastric emptying

Slowed intestinal transit

Genitourinary

Atrophy of the vagina due to decreased estrogen

Prostatic hypertrophy due to androgenic hormonal changes

Age-related changes may predispose to incontinence

Immune

↓ Cell-mediated immunity

Liver

↓ Liver size

↓ Liver blood flow

Oral

Altered dentition

↓ Ability to taste sweetness, sourness, and bitterness

Pulmonary

↓ Respiratory muscle strength

↓ Chest wall compliance

↓ Total alveolar surface

↓ Vital capacity

↓ Maximal breathing capacity

Renal

↓ Glomerular filtration rate

↓ Renal blood flow

↑ Filtration fraction

↓ Tubular secretory function

↓ Renal mass

Sensory

↓ Accommodation of the lens of the eye, causing farsightedness

Presbycusis (loss of auditory acuity)

↓ Conduction velocity

Skeletal

Loss of skeletal bone mass (osteopenia)

Skin/hair

Skin dryness, wrinkling,

changes in pigmentation, epithelial thinning,

loss of dermal thickness

↓ Number of hair follicles

↓ Number of melanocytes in the hair bulbs

COMMON CLINICAL DISORDERS IN GERIATRICS

Dementia

Dementia is progressive deterioration in intellectual function and other cognitive skills, leading to a decline in the ability to perform activities of daily living. Diagnosis is by history and physical examination. Potentially reversible causes of cognitive impairment (e.g., drugs, delirium, depression) should be excluded. Treatment is with general measures and usually a cholinesterase inhibitors(donepezil, rivastigmine, galantamine), memantine, or both.

Parkinsonism

It is a relatively common disease of the elderly. Levodopa preparations should be used with caution and bromocriptine and other ergot derivatives should be avoided.

Hypertension

Hypertension is defined as systolic BP >= 140 mm Hg or diastolic BP >= 90 mm Hg. Isolated systolic hypertension, a common form of hypertension in the elderly, is defined as systolic BP >= 140 mm Hg and diastolic BP < 90 mm Hg. For most elderly patients, hypertension does not have a reversible cause and is asymptomatic. Evaluation should include detection of other cardiovascular risk factors and end-organ damage and a search for secondary causes when appropriate. Treatment is with lifestyle modifications and drugs, often starting with a thiazide-type diuretic.

Cardiac failure

Heart failure is common among persons >= 65 years. Its prevalence increases exponentially after age 70. Heart failure is now the most common diagnosis among hospitalized elderly patients. Treatment should be aimed at reducing symptoms, improving quality of life, and preventing acute exacerbations and hospitalization. Diuretics, ACE inhibitors, nitrates and digoxin are important for elderly.

Myocardial infarction

Clinically recognized or unrecognized MI occurs in 35% of elderly persons; 60% of hospitalizations due to acute MI occur in persons >= 65yrs. Unless contraindicated, aspirin (or if contraindicated, ticlopidine or clopidogrel) should be given. The role of glycoprotein IIb/IIIa inhibitors (e.g., tirofiban, abciximab) in the treatment of elderly patients with acute MI is under study.

Urinary incontinence

Eight to 34% of community-dwelling elderly persons suffer from urinary incontinence; rates are higher in women than in men, and urinary incontinence affects > 50% of elderly patients in hospitals and in nursing homes. The commonly used drugs for detrusor instability are oxybutynin and tolterodine.

Constipation

Constipation is more common in elderly persons–who report more straining and sensation of anal blockage–than in middle-aged persons. It can be treated in most elderly persons with dietary and behavioral changes and judicious use of laxatives and enemas.

Osteoporosis

Fractures resulting from minimal trauma result in significant morbidity and mortality in the elderly. These fragility fractures are related to underlying osteoporosis. Treatment of osteoporosis with bisphosphonate therapy has been shown to be effective in reducing fracture incidence and was largely underutilized in our study.

Arthritis

Osteoarthritis, gout, pseudogout, rheumatoid arthritis and septic arthritis are the important joint diseases in elderly.

DRUG RELATED PROBLEMS IN THE ELDERLY

Although medications used by the elderly can lead to improvement in HRQOL, negative outcomes owing to drug-related problems are considerable. Three important and potentially preventable negative outcomes owing to drug-related problems that can

occur in the elderly are adverse drug withdrawal events (ADWEs), which are clinically significant sets of symptoms or signs caused by the removal of a drug; therapeutic failure (inadequate or inappropriate drug therapy and not related to the natural progression of disease); and adverse drug reactions (ADRs), defined as a reaction that is noxious and unintended and which occurs at dosages normally used in humans for prophylaxis, diagnosis, or therapy.

A number of factors are believed to increase the risk of drug related problems in the elderly, including suboptimal prescribing (e.g., overuse of medications or polypharmacy, inappropriate use, and underuse), medication errors (both dispensing and administration problems), and patient medication nonadherence (both intentional and unintentional).

Overuse

Polypharmacy can be defined as either the concomitant use of multiple drugs or the administration of more medications than are indicated clinically. Multiple medication use has been strongly associated with ADRs. Polypharmacy is also problematic for elderly

patients because it may increase the risk of geriatric syndromes (e.g., falls, cognitive impairment), diminished functional status, and health care costs.

Inappropriate prescribing

Inappropriate prescribing can be defined as prescribing of medications outside the bounds of accepted medical standards.

Underuse

An important and increasingly recognized problem in elders is underuse, defined as the omission of drug therapy that is indicated forthe treatment or prevention of a disease or condition. Underuse may have an important relationship with negative health outcomes in the elderly, including functional disability, death, and health services use.

Medication Nonadherence

Medication nonadherence is a common problem in the elderly. Nonadherence is associated with increased health services use and adverse drug reactions.

Approach to medication prescribing

At the point of initial prescribing, it is important to avoid using medications that are potentially inappropriate in the elderly. When starting a new medication, the lowest

possible dose should be used and titrated slowly. A rule of thumb to help prevent potentially harmful iatrogenic illness is to initiate a medication at one-third to one-half of the manufacturer’s recommended dosage. Whenever possible, once-a-day dosing is preferred since complex dosing makes it difficult for patients to adhere to medications. Each medication should be matched  with its diagnosis, and those without a clear indication should be eliminated. A medication should not be added to combat the side effects of another one. When multiple medications are used for one diagnosis, maximizing doses should be considered  the number of medications.  A time-limited prescription should be written  and a team approach, involving the family, caregiver and pharmacist should be followed.

GERIATRIC CARE

Generally, elderly have a different perception of life and death. They tend to be more anxious about disabilities, as it may lead to loss of independence and a precursor of death. They do not want to be a burden to themselves or to the family or society. The central theme of geriatric care is “Care rather than Cure”. Geriatric care aims at achieving:

  • Maximum functional capacity
  • Independence and comfort
  • Minimum caregiver stress

Best forms of health care

  • Listening to their statements
  • Respecting them at all times
  • Providing regular medical examination
  • Screening for common diseases
  • Implementing preventive measures
  • Executing health promotional activities

Geriatric care principles

  • To improve the quality of life is more important than prolonging life
  • To honor the patient’s wishes while investigating and treating
  • To improve the general condition and nutritional status
  • To identify co morbid conditions and correct them before surgery
  • To explain the procedure, possible risks and complications of the proposed surgery
  • To get detailed informed consent in writing for all procedures
  • To initiate the treatment early
  • To consider alternative modalities of treatment instead of high-risk surgery
  • To modify the treatment regimen considering the ageing physiology
  • To take up proactive measures so as to prevent any iatrogenic complications
  • To assess the capabilities of the patient and the family or caregivers as it is essential to make a good and safe management plan
  • To provide continued, comprehensive, interdisciplinary team care.

Differences between general and geriatric principles

General Principles

Geriatric Principles

Aim: to cure the disease

Aim: to cure if possible /take care always

Investigation & diagnosis is important

Investigations as per the wishes and

convenience of elders

Curative / extensive surgery

Curative/ palliative surgery

Preserve life at any cost

Preserve functional capacity

Geriatric Assessment

A comprehensive multidimensional geriatric assessment is the first step in treating the geriatric patients. It is important to examine physiological, mental and emotional functions as well as socioeconomic and environmental factors. A systematic evaluation of the patient’s ability to perform the tasks associated with independent living should be done and recorded for problem detection and treatment.

History taking in elders

  • Spend time in getting a good history from the patient, the family members and/ or the care giver in a comfortable surroundings. If needed, ask leading questions to get the proper history.
  • Elicit past history (go through the previous medical records), treatment history, personal history and family history.
  • Record patient’s attitude and treatment preferences, availability of family and financial support.
  • Enquire thoroughly complete medication history, poly pharmacy, over the counter drugs and alternative medicines. Consult referring physician for more details, if required.
  • Sometimes the history may not be forthcoming and the physian has to rely on the history given by the caregivers, physical examination and investigations.

Physical examination

Provide a comfortable environment for the elderly and carry out complete clinical examination under good lighting. Sometimes it is necessary to postpone the examination according to the patient’s wishes. Examine the following and record the findings.

  • General examination for the presence of anemia, cyanosis, jaundice, lymphadenopathy, edema, nutritional disorder, decubitus, colour of skin, hydration, oral cavity (for hygiene, dryness, glossitis, presence of teeth or dentures) etc.,
  • Systemic examination for CNS, CVS, RS, and abdomen
  • Local examination for mass lesion, ulceration and malignancy. Detailed inspection, palpation, percussion and auscultation should be done.

Diagnosis

  • All efforts should be taken to arrive at the clinical diagnosis and confirmed by investigations
    • Multiple pathological problems with multiple symptoms are common in elders and no single diagnosis is possible for all symptoms
    • Sometimes it may not be possible to arrive at a diagnosis due to patients ill health and unwillingness or it may not be necessary if the patient is terminally ill. In such cases the general measures are taken to keep the geriatric patient comfortable and free from pain.

Treatment

  • Always aim for complete cure of the disease
  • The geriatric patient has many modalities of treatment and surgical option is one

among them.

  • Alternatives to high-risk surgery and non-operative treatments should also be ex-

-plained, if and when the surgery is contemplated.

  • Consider the general condition and co- morbidities, diagnosis, natural course of

the disease, complications and prognosis.

  • Sometimes cure may not be possible due to various reasons, in such situations palliative and supportive measures should be undertaken
    • To relieve symptoms like dyspnoea, dysphagia and pain
    • To ameliorate the ill effects of foul smelling discharge, fungating ulceration
    • To provide enteric route for nutrition
    • Always provide general supportive measures and care

STRATEGIES OF HEALTHY PRESCRIBING IN OLDER PATIENTS

The vision is that older people should  participate to their fullest ability in decisions about their health and wellbeing and in family  and community life. They are supported in this by co-ordinated and responsive health and disability support programmes.

The following eight objectives identify areas where change is essential if the vision is to be achieved.

1. Older people and their families are able to make well-informed choices about options for healthy living, health care and/or disability support needs.

2. Policy and service planning will support quality health and disability support programmes integrated around the needs of older people.

3. Funding and service delivery will promote timely access to quality integrated health and disability support services for older people, family and carers.

4. The health and disability support needs of older will be met by appropriate, integrated health care and disability support services.

5. Population-based health initiatives and programmes will promote health and wellbeing in older age.

6. Older people will have timely access to primary and community health services that proactively improve and maintain their health and functioning.

7. Admission to general hospital services will be integrated with any community-based care and support that an older person requires.

8. Older people with high and complex health and disability support needs will have access to flexible, timely and co-ordinated services and living options that take account of family and carer needs.

ROLE OF PHARMACIST IN GERIATRIC CARE

Pharmacists are committed to optimizing pharmaceutical therapies for each patient to improve outcomes and reduce costs. They are making significant contributions to the profession through specialized pharmaceutical care. Pharmacists, aided by a comprehensive system employing information technology and clinical “best practices ” work with physicians to identify patients at risk for a given disease state and ensure that optimal drug therapy is received and unnecessary healthcare expenditures are eliminated. Medications are probably the single most important healthcare technology in preventing illness, disability and health in the geriatric population. New products provide pharmacists with valuable tools for promoting quality of life but also confer upon them the more difficult task as well as the greater responsibility of balancing clinical effects to provide the highest possible quality of life for their patients.

Herpes Vagina Symptoms – How Women Can Manage Genital Herpes Outbreaks

When it comes to herpes vagina sores and/or blisters are the most common symptom in women. These sores, or lesions, are a sure-fire way to detect that you have become infected with genital herpes. If you find yourself suffering from these sores, it is highly important to visit your doctor for a proper diagnosis. Try to keep in mind that there is no need to fear herpes. A visit to the doctor will shed light on the many ways genital herpes can be managed.

As far as symptoms vaginal herpes can manifest itself in other ways besides these painful sores and blisters. If you find yourself suffering from unusual headaches, fever, tingling or itching in the vaginal or buttocks area, you may have contracted the herpes simplex virus. Staying aware of your body as well as your sexual activities, will allow you to get treatment as soon as possible once symptoms arise.

Vagina herpes does not have to hinder you from living life to the fullest. The virus can be managed quite effectively. Among the numerous prescription medications out there, genital herpes can be controlled with natural treatments, such as topical creams, that make outbreaks much more bearable, without the side effects. Other ways to ease the discomfort of outbreaks is by wearing loose, cotton clothing and keeping the infected area clean and dry.

Did you know that when it comes to herpes vagina infections are contracted in more ways than just vaginal intercourse? If your partner is a carrier of oral herpes and performs oral sex on you, then you can become infected with herpes. Another way is by anal sex. Masturbation is yet another way to contract the virus. Knowing your partner’s history could help keep you safe and virus free.

In dealing with symptoms vaginal herpes outbreaks can first be spotted within two weeks of sexual activity. This initial outbreak can last for several weeks. In the beginning, red bumps appear. These bumps then turn into blisters, which will eventually burst, starting the healing process. When these blisters begin to crust over, you know that you’re in the end stages of the outbreak.

As stated earlier, when it comes to herpes vagina sores are not the only symptoms you may suffer from during an outbreak. If you feel swelling in the vaginal area, feel pain when urinating, or have unusual vaginal discharge, you may be some of the few that have minimal discomfort during an outbreak. These particular types of outbreaks are much easier to deal with. Many times, extremely mild outbreaks need no steady treatment.

There is no reason to let vagina herpes inhibit you. With the vast array of treatments available, you can live life to the fullest. It is more than possible to have a long and rewarding life just by staying aware, staying educated and staying in control.

Heart Disease, Herbs And Spices

The principal pathology underlying the occurrence of cardiovascular disease is atherosclerosis, or hardening of the arteries. Initially this process causes blood vessel narrowing but the subsequent rupture of an atheromatous deposit into the lumen of a coronary or cerebral artery usually results in a heart attack or thrombotic stroke respectively.

Although the precise mechanisms associated with plaque development have not been fully elucidated some of these processes, and their associated risk factors, are well understood. Central to the atherosclerotic process are two principal factors:

1) The oxidation and deposition of lipids in the endothelial lining of blood vessels

2) An insidious inflammatory process that leads to calcification of the atheromatous deposits and the eventual rupture of these plaques into the lumens of blood vessels.

Specific factors known to accelerate atherosclerosis are generally well-known and include smoking, a diet rich in saturated fats, obesity, lack of exercise and a minimal intake of appropriate phytonutrients. Unfortunately the last factor has not really received the attention that it deserves as we are often (quite rightly) too busy eliminating the adverse factors from our diet to focus on the foods that can help to negate many of the environmental risk factors to which we are exposed.

Apart from food-derived substances such as omega-3 fatty acids, other unsaturated fats and dietary fibre there are a number of compounds found in plant foods that are potent inhibitors of atherosclerosis. There are also several categories of phytonutrients that inhibit platelet aggregation – the abnormal clotting process that aggravates thrombus formation in heart attacks and thrombotic strokes.

Culinary herbs and spices probably contain the widest, most effective cardiovascular-protective compounds of all food categories – their specific actions are summarized here:

Blood pressure control: Garlic, fenugreek

Lower LDL (bad) cholesterol: Caper, coriander, cinnamon, fenugreek, garlic, ginger

Raise HDL (good) cholesterol): Fenugreek

Lower homocysteine levels: Mustard, wasabi, horseradish

Anti-inflammatory: Bay leaf, garlic, ginger, oregano, rosemary, thyme, turmeric

Inhibit platelet aggregation: Clove, ginger, onion, oregano, rosemary, thyme

One can see that the above list includes at least 10 different culinary herbs and spices – some of which have more than one action. That is why it is important to eat as many of them as possible. Many people make the mistake of assuming that, by eating large quantities of a single spice (garlic, quite rightly, is well-known as a heart-friendly spice), they will protect themselves against cardiovascular disease. While this is true up to a point it is far more important to eat a range of spices as their actions often complement one another through the synergistic relationships that often exist between these valuable foods.

To benefit from the cardio-protective effects of herbs and spices we should eat as many of those mentioned in this article as possible. In addition it would be wise for us to include a range of other herbs and spice in our recipes.

Safety note: Although spices are very safe, if you are planning to substantially increase your intake of these foods and are on medications such as coumadin (warfarin) and others, it is important to check with your health care provider before doing so.

Diabetes Misinformation Part 1

Are you confused about your diabetes? Do you really have to avoid sugar if you have diabetes? Do artificial sweeteners cause cancer? Are you "fine" if you have "borderline diabetes"? To get answers to these questions and many more please read on.

Misconception # 1

If you have diabetes, you must give up your favorite food.

False.

Decades ago, this may have been the advice people with diabetes were given, especially if there was sugar in those foods. With newer medicines, blood glucose monitoring and new research, there is no reason to avoid sugar or give up your favorite foods. Remember – foods with carbohydrates are the greatest concern because they raise blood sugar levels.

Misconception # 2

Once you start using insulin, you can not stop.

True and False.

This is true if you have type 1 diabetes because your body does not make insulin. In order to live, you must take insulin. If you have type 2 diabetes, it may be possible to reduce your need for insulin with weight loss, regular physical activity and food choices.

Misconception # 3

Artificial sweeteners can cause cancer.

False.

Artificial sweeteners have been proven safe over and over again around the world. In all of these studies, there were no cases of cancer or serious illness linked to the use of artificial sweeteners. Artificial sweeteners open up a world of eating options to those who choose to avoid sugar, allowing them to have their favorite foods without affecting their blood glucose levels.

Misconception # 4

Exercise only helps if you sweat and bring your heart rate up.

False.

All movement is important. Even brief periods of physical activity can help improve your health. Here are a few activities suggested by the American Heart Association:

  • Walk your dog.
  • Stand up while talking on the phone.
  • Use the stairs instead of the elevator.
  • Park father away from the mall and walk to the stores.
  • Do your own yard work.
  • Do your own house work.
  • Reach to get things from top shelves.
  • Do deep knee bends to reach lower shelves.

Misconception # 5

Your blood glucose meter tells you all about your overall blood glucose levels.

False.

A blood glucose meter does not show your overall blood glucose levels. It provides a snapshot of your blood glucose level at that moment in time. The true measure of your overall blood glucose is your A1C level. This tells you your average glucose level for the past two to three months.

Malnutrition and Obesity

Obesity is caused by several different factors such as overeating, diseases as well as malnutrition. It may come as a surprise to you that someone who is obese is malnourished, but it is very possible.

The reason behind that is that when your body does not have enough nutrients it craves for food. Usually this is junk food as that will give your body the quickest fix. However, this does not provide your body with proper nutrients, and thus you crave for more, and the cycle continues.

What Causes Malnutrition

Malnutrition occurs when your body does not get enough nutrients so that it can function properly. This could be due to reasons such as poverty, or not choosing a proper diet. It could also be the result of a sickness or disease where the body rejects the food or is unable to absorb the nutrients.

There is little that you can do if you are living in poverty and just cannot afford to buy food, or if you are sick, then you may need to take care of your condition first. However, there is a lot that you can do to choosing a proper diet in order to prevent malnutrition.

Choosing a Proper Diet

The foods you should eat are fruits, vegetables, herbs, nuts and seeds. And you should eat these foods raw as much as possible, as cooking destroys many essential nutrients.

They say ‘an apple a day, keeps the doctor away’, but you need much more than just an apple a day. Your body was designed to live off of raw and living foods. Studies have shown that plants can provide you with more usable proteins and other nutrients than any other foods such as meat, dairy and eggs. But most people do not even eat as many fresh fruits and vegetables as recommended by the FDA. As a result the majority of people are malnourished.

Hunger

Your body sends a signal that it is hungry when it needs more nutrients, not when it has eliminated all the foods from the last meal. This means that you can still have food in your stomach from your last meal when it sends the signal. Some of the so-called healthiest foods such as animal proteins can leave you in this state where you just keep craving for more and more before your previous meal has been digested.

Raw and living foods will not leave you in this state, as they are digested quickly and eliminated from the body in less than 24 hours. Therefore in order to prevent yourself from overeating you should stick to a raw food diet as much as possible so that your body will not cause you to overeat on junk foods.

Heart Disease: America's leading Cause of Death – An "Equal Opportunity" Illness by Lawrence Broxmeyer MD

Inflammation plays a crucial role in the pathogenesis of arteriosclerosis, especially in acute coronary syndromes such as happen with a heart attack. And it was the very inability of ‘established’ risk factors such as high blood cholesterol (hypercholesterolemia), high blood pressure (hypertension) and smoking to fully explain the incidence of cardiovascular disease that has resulted in historically repeated calls to search out an infectious cause and the specific microbe behind it. Today, half of US heart victims have acceptable cholesterol levels, including HDL and LDL fractions, and 25% or more have none of the “risk factors” associated with heart disease, including smoking, high blood pressure or obesity, most of which are not inconsistent with being caused by infection to begin with. [1,2] Cholesterol itself was on the rise in Japanese blood during the very decade (1980-1989) when its incidence in coronary heart disease was on its way down. [22] So Nieto stressed the need to continue to look for an infectious disease behind heart disease. [3}

Which Disease?

Ever since a 1988 report of raised antibodies against Chlamydia pneumoniae in patients with heart disease, it was hoped that this microbe might be behind heart disease and atherosclerosis [28] Hurting this was the low incidence of atherosclerosis in the tropics despite Chlamydia’s high frequency there. [29]. Also Loehe, Bittman and other groups concluded that although Chlamydia, on occasion, might be present, it was not a causative factor in heart disease [30], because there was no correlation between the severity or extent of atherosclerosis and the involvement of chlamydial infection. Recently the Chlamydial hypothesis has been subject to a flurry of antibiotic trials, with mixed results, leaving some investigators to conclude that possibly Chlamydia doesn’t even play a role in atherosclerosis. [42] Certainly this was born out in two sizeable trials, one of which [47] had 1,187 participant. In neither trial [48] could any of the commonly thought of bacterial causes of heart problems – Chlamydia pneumonia and Helobacter pylori be correlated with cardiovascular disease. Nor could a virus. Also, in those trials which did show benefit antibiotics used (Azithromycin, Clarithromycin) are first line agents against certain forms of tuberculosis (fowl tuberculosis or Mycobacterium avium). Contrary to common belief, TB infections occur as a mixed infection with “atypical” TB in up to 11% of cases, even in HIV free individuals. [41] Today the antibiotic Rapamycin is used to coat coronary stents. [45] Rapamycin enhances the killing of mycobacteria like tuberculosis by human white blood cells called macrophages. [46]

Historical Associations

The association between active pulmonary tuberculosis and Acute Myocardial Infarction or heart attack has been reported and stubbornly ignored for around four and a half decades. Certainly, TB shares a more striking connection to heart disease than its nearest competitor, Chlamydia pneumonia. CDC maps for cardiovascular disease case rates bear a striking resemblance to comparable state and regional tuberculosis maps. [4,5]

Long before there was such a thing as a ‘heart specialist’ The National Tuberculosis Association created an offshoot called the American Heart Association (AHA). In one of its first bulletins, the American Heart Association came up with a long list of similarities between tuberculosis and heart disease. [17] And Ellis’s 1977 New England Journal of Medicine article [6], confirmed that the mortality rate for TB and heart disease were curiously about the same: 200 to 300 persons per 100,000.

By 1965, Rutgers investigators Livingston and Alexander-Jackson, working with sterile, post-catastrophic coronary artery and muscle specimens, established low-grade tubercular infection, staining ‘acid-fast’ (stains which did not decolorize when acid-alcohol was added) occuring in all ischemic heart specimens. [11] In that same year Russian investigators began generating their own proof that tuberculosis was causative in both atherosclerotic heart disease [18,19,20,21] and acute myocardial infarction (a heart attack) itself. [13,14,15].

Measuring Heart Trouble With Cardiac Enzymes In The Blood

Cases were soon on record of individuals with no cardiac risk factors, presenting with acute onset chest pain, ST elevation on their electrocardiogram (EKG), and elevated cardiac enzymes – all indicative of a heart attack with no other involvement than pulmonary tuberculosis [37]. As with its predecessor creatine kinase (CK-MB), today’s new enzymatic gold standard for detecting a heart attack, the troponins, are elevated in disseminated tuberculosis, an example of which can be found in TB’s role in acute pericarditis. [43]. Acute pericarditis, often not detected either until death was historically linked most commonly to Mycobacterium tuberculosis. In 1951, Christian [44] suggested that viral infection was more responsible for “idiopathic” (of unknown cause) or “benign” pericarditis. Such a viral cause, however, was never substantiated in many cases. Also, when it was found that the fatty substance (phospolipid) phosphatidylinositol  was not only housed itself inside TB’s cell wall, but was a potent coagulant and thrombin former as well – it further raised the question as to whether M. tuberculosis, by its very nature, lays down the conditions for the vessel clogging atherosclerosis behind heart disease and myocardial infarctions or heart attacks. [31]

Livingston and Alexander-Jackson [11] were far from the first ones to document lab evidence that TB can cause heart disease. Hektoen [7], Osler [8], and Schwartz [11], all documented lab and animal evidence to this effect. MacCallum [9] claimed that of all the infectious causes of heart disease, one one, tuberculosis, caused arteriosclerosis. At autopsy MacCallum cited 101 cases of advance tuberculous arteriosclerosis. In separate studies, Kossowsky [13], Tarakanova [14] and Ferrari-Sacco [15] all directly linked heart attacks with pulmonary tuberculosis.

Further evidence

There can no longer be any doubt that tubercular protein HSP-65 is involved in atherosclerosis. Xu [12] used it to cause experimental atherosclerosis in laboratory animals with normal cholesterol. George and Shoenfeld found it not only in atherosclerosis but fatty streak formation in cardiovascular blood vessels. [32] Mukherjee and De Benedictis showed also that the higher the antibodies against such tubercular protein in the body, the higher the possibility of “restenosis” or future closure of heart vessels. Also Afek proved that the higher the amount of tuberculoprotein (HSP-65) administered, the larger the area of vessel clogging atherosclerosis, even despite a low-fat diet. [34] Xu saw similar changes in New Zealand White Rabbits. [35] Xu’s rabbits had normal serum cholesterol, but when injected with tubercular protein, their arteries soon developed the classic features of arteriosclerosis in humans – both with regards to inflammatory cell accumulation and smooth cell proliferation. [IBID]. The only finding missing from Xu’s animals were “foam cells” – fat laden tissue white blood cells called macrophages in which tuberculosis lives and thrives. Xu remedied this by subjecting his animals to a cholesterol rich diet in addition to tubercular protein. this combination produced classic human heart disease, with foam cells. Xu continued to find sustained antibodies to HSP-65 in human subjects with the severe atherosclerosis predictive of mortality. [49] By 2004 Mandal and Xu even confirmed a positive association between high levels of antibodies to HSP-65, which are cytotoxic, and the vexing atrial fibrillation that often accompanies cardiac surgery. [50]

Present day heart disease “markers” have been suggest as indicators of possible heart disease, even in the 25 million US patients who have none of its “risk factors”. These include blood test for C-Reactive Protein (CRP), interleukin-6 and homocysteine [39] – all of which are similarly elevated in tuberculosis. [32,33,34,40,36].

Although blood cholesterol seems an imperfect criterion by itself for determining coronary heart disease, its intimate interaction with TB is unique. Tuberculosis is the only microorganism to depend on cholesterol for its destructive pathogenesis, and it relies upon cholesterol to enter the body’s white blood cell macrophages. [23] The tuberculous bacilli alone is able to produce [24], esterify [25], take up, modify, accumulate [26], and promote the deposition of, and release [27] of cholesterol. The statins, among the most popular drugs in America (Lipitor), inhibit Coenzyme-A compounds, and as such lower serum cholesterol levels. But they do more. Specifically, when macrophages were depleted of cholesterol by these agents, it hinders tuberculosis’s entrance into the body’s macrophages that TB likes to house in, thrive in, and depends upon. [23]

Nieto concludes that the introduction of antibiotic therapies in the 1940’s and 1950’s could have contributed to the decline of heart disease and heart attacks, and so, by 2000, the CDC found that 14% of the cardiologists in Alaska and West Virginia treated heart patients with antibiotics for angina, heat attacks, angioplasty or after by-pass surgery.

Conclusion

In Tuberculosis in Disguise, Rab and Rahman report cases of congestive heart failure and ischemic heart disease (IHD) with chest pain, raised erythrocyte sedimentation rate, leukocytosis (elevated white cell count) and inverted T-waves across the chest leads in an Electrocardiogram – otherwise indistinguishable from a heart attack, which turned out to be miliary (systemic) tuberculosis. [38]

Though more than 120 years have passed since its discovery Mycobacterium tuberculosis is still the leading cause of infectious death globally due to a single infectious agent. At least a staggering 1.7 million around the globe die of tuberculosis each year, while another 1.9 million are infected and at risk for active tubercular disease. [16] The World Health Organization [WHO] estimates that 1/3 of the planet has contracted TB. It would take such a disease of such magnitude to adequately explain the scope of cardiovascular disease, which affects, according to the CDC (Centers for Disease Control) about 61 million people, or almost one-fourth of the population of the US alone. Almost 6 million US hospitalizations each year are due to cardiovascular disease, which has become an equal opportunity disease that is now both the leading cause of death among women as well as the general US population.

There is at least as much, and probably much more evidence that Mycobacteria, particularly Mycobacterium tuberculosis causes cardiovascular disease than there is regarding Chlamydia Pneumoniae. Yet oddly, to this point Chlamydia has been pursued in therapeutic antibiotic trial after trial…………with not one such trial directed towards tuberculosis.

References

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2. Thom DH, Grayston JT. Association of prior infection with Chlamydia    pneumoniae and angiographically demonstrated coronary artery disease. JAMA 1992;268:68–72.

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7. Hektoen L. The vascular changes of tuberculous meningitis. J Exper Med 1986:112.

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13. Kossowsky WA, Rafii S. Letter: acute myocardial infarction in miliary tuberculosis. Ann Intern Med 1975;82(6):813–4.

14. Tarakanova KN, Terent’eva GM. Myocardial infarct in patients with pulmonary tuberculosis. Probl Tuberk 1972;50(4):90–1.

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17. AHA Similarity of tuberculosis and heart disease. Bull Am Heart Assoc 1927;2(5):22.

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19. Kamyshnikova VS, Kolb VG. Biochemical factors involved in atherogenesis in pulmonary tuberculosis. Probl Tuberk 1984;11:48–52.

20. Kazykhanov NS. Lung tuberculosis in patients with atherosclerosis. Sov Med 1965;28(8):37–44.

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22. Okayama A. Ueshima changes in total serum cholesterol and other risk factors for cardiovascular disease in Japan, 1980–1989. Int J Epidemiol 1993;22:1038–47.

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Cold Sore Remedies – You Can Use at Home

The world today is pestered with different types and kinds of diseases or illnesses. One of the most common health conditions is cold sores. If you have cold sores, there are remedies that you can easily find at home.

Home remedies are not only less costly but oftentimes very effective. Like numbing creams and antiviral pills, home remedies can work just as effectively. There is a great advantage in using home remedies because you can treat the cold sores as soon as it appears. You don’t have to trouble yourself in going to your doctor’s clinic to get prescription medicines and then after that, you would still have to go to the nearest drugstore and purchase the creams. Immediately address your cold sores problem with little effort.

The best thing about home remedies is because they are all natural. First and foremost, you have to monitor your everyday diet. Most of today’s modern diet consists of ready-to-eat foods, food items rich in fats and oils, and junk foods. If you eat these kinds of foods, your body will not get all the needed nutrients and vitamins it needs. So you must start eating healthy food choices from now on. You can ask help from a dietician to help you out in choosing the right types of food to eat.

You would also need to take vitamin supplements and other food supplements to fill in some of the nutrients and vitamins lacking in your diet. There are also certain powder and juices that you can use to treat cold sores. An ice cube is also quite helpful to relieve cold sore symptoms. Not all home remedies work quite well; all you have to do is to choose the right and the best home cold sore remedy that you can use.

The best home remedy is using ice cubes. Once you develop cold sores, you need to apply ice cubes on it immediately. This will slow down metabolism around the cold sore’s local area. Growth will then be slowed down because the virus can’t spread or move easily. Try to apply ice cubes on your cold sores every 10 minutes and keep on doing it for the rest of the day.

In order to reduce pain and the size of cold sores, you can use tea bags, extracts of lemon balm, and aloe. You can purchase these things from a local store at a very cheap price. It would even be best if you can plant some of the herbs in your backyard especially if you have enough planting space. This way, if cold sore occurs, all you have to do is to pick the herbs in your yard.

Avoid drinking too much coffee. Coffee can greatly contribute in the formation of the sores so try to avoid it as much as possible. Instead of drinking coffee, why not try drinking tea instead? Tea are much healthier than coffee.

If you use the herbs and have a healthy eating habit, you can surely fight cold sores. The sores will also tend to heal quicker than usual. So if you want your cold sore treatments to be cheap, easy, and quick, choose the home remedies over the commercial cold sore products.

Yeast Infection – The Warning Signs

It is often difficult to figure out when something is wrong enough to seek some kind of treatment. It is no different with yeast infections. A little redness here, a little itch there. When are you experiencing something just a little out of the ordinary, and when are you up against the actual signs of yeast infection?

Itchiness is probably the most common of the signs of yeast infection. Usually though, there are others. When women have vaginal yeast infections, they may feel pain during urination. They may experience painful sex. They will probably notice swelling of the vagina and the area surrounding it, and may feel burning and redness besides. There is a vaginal discharge that is one of the signs of yeast infection if women. It is thick and white. Some have said that it has the appearance of cottage cheese.

If a woman is having these signs of yeast infection, she should call her doctor. Symptoms of some STD's are similar. Chlamydia and gonorrhea both fall into this category. If she has yeast infections often, then and only then she should talk to her doctor about using over-the-counter medications.

A doctor can recognize signs of yeast infection that the woman herself can not. He or she will look for swelling and discharge. A sample will also be taken to check under a microscope in a lab test that will determine once and for all if it is a yeast infection.

The signs of yeast infection in men are pretty straightforward. They will simply have a bit of redness, itching, and a sense of burning at the tip of their penis. They should also go to a doctor to rule out other causes.

In children, the signs of yeast infection are more difficult to ascertain. What may appear to be a simple diaper rash may well turn out to be a yeast infection. It can be distinguished from the usual diaper rash by looking at the rash itself. Are there many red, maybe pus-filled bumps? Is there a scaling pattern? It may be yeast infection. The rash may also be located in an unusual place, like the pubic area, the groin area, and the lower abdomen. Most important of all, if a diaper rash does not clear up in a few days, a child should be taken to see a doctor.

The signs of yeast infection seem to be easy to spot. However, they can be confused with symptoms of other diseases. When in doubt, call in the experts.