Obesity (An Innocent Killer)

Obesity (An Innocent Killer)

Obesity is the most popular condition in both genders of all ages. Obesity is the excessive accumulation of fats in body. There are different classes of obesity like MILD (20-40% overweight), moderate (41-100% overweight), severe (more than 100% overweight). Severe obesity occurs only in 0.6 % of obese people. In United state the obesity is increasing 33% by last some decades. Overall 31% men & 35% women are obese.

How Obesity develop:

The level of fats in our body control by a system which works like a thermostat. This system has a point around which the level of fats is maintained in our body. When a person persistently intake high caloric content or over eating than this point shifted from its original value to a higher one. The body then recognizes this elevated point as normal and as a result body increase the storage and eventually obesity occurs.

Causes of Obesity:

Obesity is caused by taking high calories than the body requirement. Obesity also caused by various factors such as:

• Lifestyle factors that include food of high caloric contents, smoking, high alcohol intake (alcohol increases the metabolism of body) high biscuits intake etc.

• Socioeconomic factors may also influence the obesity; in US women of low socioeconomic status are at high risk of obesity rather than women of high socioeconomic status because these women have not enough time & resources for dieting & exercise.

• Developmental factors: An increase in size or number of fat cells providing  aid to store more fat in body.

• Physical factors: lack of physical activity (exercise, walking, cycling etc) is also a major risk factor.

• Drugs: Steroids, Antipsychotic drugs & some hormones can cause obesity.

• Psychological stress: promote the development of some eating behavior disorders such as OVER-NIGHT EATING SYNDROME (lack of appetite in morning but overeating at night leads to obesity, insomnia, agitation).

Symptoms & complications:

The fats mostly accumulate in chest area, hips & thigh areas, under chin area & lower abdomen areas. Difficulty in breathing & shortening of breath, low back pain, worsening of arthritis in hips, knees & ankles, more sweating, swelling of feet & ankles are common symptoms found in case of obesity.

Obese people have more chance to become ill. The accumulation of fat in chest & abdomen may associate with coronary artery (arteries which supply blood to heart) disease, hypertension or diabetes. It is unknown that why these complications are developing but loosing weight dramatically reduces the occurrence of all these symptoms.

Certain cancers (in women: breast cancer, ovarian cancer, uterine cancer in men: colon cancer, rectum cancer, prostate cancer) are more common in obese people rather than those who are not.

Treatment:

Consume less caloric food stuff and adopt healthy, physically active life style to maintain your body weight and exercise regularly because when you loose your weight by any method and stop this then obesity re-occur within 3 years so be careful about your healthy life.

Tumescent liposuction also use for weight reductions.

Some drugs (Phentermine, sibutramine, Orlistat) also used for weight reduction.

Hepatitis

Hepatitis

Hepatitis (plural Hepatitides) implies injury to liver characterized by presence of inflammatory cells in the liver tissue. Etymologically the word hepatitis is derived from ancient Greek Hepar or heat meaning liver and suffix –itis denoting   ‘inflammation’. The condition can be self-limiting (healing on its own), or can progress to scaring of liver. 

Acute hepatitis is when it lasts less than 6 months and chronic hepatitis is when it persists longer. A group of viruses known as the hepatitis viruses cause most liver damages worldwide. Hepatitis can also be due to toxins (notably alcohol), other infections or from autoimmune process. It may run a sub-clinical course when affected person may not feel ill. Patient becomes unwell and symptomatic when the disease impairs liver functions that include among other things, screening of harmful substances, regulation of blood composition and production of bile to help digestion

What we can do to reduce the risk of hepatitis?

Vaccines are only available for hepatitis A and B viruses and complete cure is not achieved even with best treatment in many cases. Therefore, more attention should be directed towards prevention. Following steps can reduce the spread of hepatitis.

• Vaccines every new born child against HBV as per EPI schedule of the government of Pakistan
• Avoid the use of contaminated water ,unwashed and unpeeled fruits and vegetable etc, as they can be a source  of HAV and HEV
• Keep all utensils covered and clean to avoid contaminated by files.
• Adopt good personal hygienic measure e.g. washing of hands thoroughly before eating and after toilet use.
• All the workers of food industry must be monitored on regular basis for the carrier states of Hepatitis A and E.
• Blood and blood products must always be adequately screened before transfusion.
• Strongly discourage the sharing of needles, syringes and shaving accessories.
• Practice safe sex and spread awareness in public about the dangers of unprotected sex.
• Women who are infected with hepatitis B or C must undertake adequate contraceptive measures.
• Early recognition and treatment may prevent long-term complications of hepatitis and reduce morbidity due to this disease.
• Public awareness programs must be put in place to educate general public about clinical features, mode of spread, prevention and treatment of different types of hepatitis.

Types:

Most cases of acute hepatitis are due to viral infections:

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis B with D
• Hepatitis E
• Hepatitis F (discredited)
• Hepatitis G

Hepatitis A

Hepatitis A or infectious jaundice is caused by a picornavirus. The oro-fecal route, transmitted to human through methods such as contaminated food, transmits it. The patient’s immune system makes antibodies against hepatitis A that confer immunity against future infection .people with hepatitis A are advised to rest, stay hydrated and avoid alcohol. A vaccine is available that will prevent infection from Hepatitis A for life. Hepatitis A can be spread through personal contact; consumption of raw seafood or drinking contaminated water. This occurs primarily in third world countries, infected people excrete the Hepatitis A virus with their stool two weeks before and one week after the appearance of jaundice. This time between the infection and the start of the illness can run from 15 to 45 days, and approximately 15% of suffers may experience relapsing symptoms from 6 months to a year following initial diagnosis.

Hepatitis B

Hepatitis B is caused by a hepadnavirus (A DNA virus, aka Dane particle), which can cause both acute and chronic Hepatitis. Identified method of transmission include blood (Blood transfusion, now rare), tattoos (amateur and professionally done), sexually (through sexual inter course and through contact with blood are bodily fluids), or utero from mother to her unborn child (as the virus can cross the placenta). Blood contact and occur by sharing syringes intravenous drug abuse, shaving accessories such as razor blades, or touching bounds of infected persons. In the United States, 95 % of patients clear their infection and develop anti bodies against Hepatitis B virus. 5% of patients do not clear the infection and develop chronic infection: Only these people are at risk of long terms complication of Hepatitis B which include fulminant hepatic failure, cirrhosis and hepatocellular carcinoma, among others.

Hepatitis C

Hepatitis C (originally “non-A non-B Hepatitis”) is caused by a flavivirus. It can be transmitted through contact with blood as well as through sexual contact. Hepatitis C may lead to a chronic form of Hepatitis, although in January 2007, Researchers at the University Washington announced a breakthrough, which they predict, will lead to a vaccine within five years. {2} Patient with Hepatitis C prone to severe Hepatitis if they contract either Hepatitis A or B, so all Hepatitis C patients should immunized against Hepatitis A & Hepatitis B if they are not already immune. The genotype of the virus determines the rate of response to treatment. Genotype 1 is more resistant to interferon therapy than other HCV genotype.  The cellular receptors for the virus are CD81 and SR-B1 with claudin-1 as a co-receptor required for a later-step in entry.

Hepatitis E

Hepatitis E produces symptoms similar to Hepatitis A, although which can take a fulminant course in some patients, particularly pregnant woman: it is more prevalent in the Indian sub-continent.

Hepatitis G

Another type of Hepatitis, Hepatitis G, has been identified, and is probably spread by blood and sexual contact. There is, however, doubt about whether it causes Hepatitis, or is just associated in Hepatitis, as it does not appear to be primarily replicated in the liver.

Drug induced hepatitis.

A large number of drugs can cause Hepatitis. The anti-diabetic drug Troglitazon was withdrawn in 2000 for causing Hepatitis. Other drugs associated with Hepatitis:

• Allopurinol.
• Amitriptyline (antidepressant).
• Amiodarone (anti-arrhythmic).
• Azathioprine.
• Halothane (anesthetic gas).
• Hormonal contraceptives.
• Ibuprofen and indomethacin (NSAIDs).
• Ketoconazole (antifungal).
• Methylbopa (antihypertensive).
• Minocycline (tetracycline antibiotic).
• Nifedipine (antihypertensive).
• Nitrofurantioin (antibiotic).
• Phenytoin and valproic acid (antiepileptics).
• Zidovudine (antiretroviral i.e. against AIDS).
• Some herbs and nutritional supplements.
• Isoniazid (INH), rifampicin, and pyrazinamide

Treatment

Drug therapies

The standard of care for hepatitis C treatment is weekly injunctions of a drug called pegylated interferon Alfa combined with twice-daily oral doses of ribvirin (rebetol) – a broad- spectrum antiviral agent. Two pegylated interferon medications are available, pig interferon alfa-2b (Pig-intron) and pig interferon Alfa 2a (pegasys).

The goal HCV treatment is to clear the virus from your blood stream. Combined pegylated interferon and ribavirin clear HCV infection in up to half of the people 1—the most common genotype found in the U.S—and in up to 80% of those with genotype 2 and 3.

If you have genotype 1 HCV, your doctor may recommend a course of relatively high dose medications for 48 weeks. If you have genotype 2 or 3, a 24 week course of medication at the lower dose may be adequate.

If one course of combined Pegylated interferon and Ribavirin does not clear HCV from your bloodstream, your doctor may recommend a second course of combination therapy. If your viral load declined during the first round of medication, a second round may clear the virus completely. Even if there was no change in your viral load during the first course of treatment, a second course may help reduce the damage HCV does to your liver.

Guidelines from NIH: indication of Inteferon therapy

• A positive test result indicating hepatitis A diagnosis of HCV does not necessarily mean you need treatment. The national institute of Health recommends treatment for HCV if you have
• C virus circulating in bloodstream
• A biopsy that indicate significant liver damage
• Elevated levels of liver enzyme called alanine amminotransferase (ALT) in blood

Side effect of medication

Side effects from interferon include serve flu like symptoms, irritability, depression, concentration and memory problem and insomnia. Ribavirin can cause a low red blood cell count (anemia), gout and birth defect. Both drugs can cause skin irritation and extreme fatigue. A small number of people taking combined pegylated interferon and ribavirin may experience psychosis or suicidal behavior.

Side effect from combine pegylated interferon and ribivirin are generally most serve during the first week of treatment, and may be improved with pain relief medications and antidepressant. However, some people taking interferon need their dosage reduce because of severe side effect, and others must stop treatment altogether.

Contra-indication of interferon therapy

• Uncontrolled major depression
• Untreated thyroid diseases
• Very low blood cell count
• Autoimmune disease
• Compulsive alcohol abuse
• Compulsive drug abuse

Valley Fever (Coccidioidomycosis)

Valley Fever (Coccidioidomycosis)

The disease can progress to chronic or progressive lung disease and may even become disseminated to the skin, brain (meninges), skeleton, and other body areas. The disease can also infect many animal types (for example, dogs, cattle, otters, and monkeys).

What Is Valley Fever (Coccidioidomycosis)?

Valley fever, also known as coccidioidomycosis,  California disease,  Desert rheumatism and  San Joaquin valley fever is a fungal disease that is endemic in certain parts of Arizona, New Mexico, Texas, Utah, Nevada and northwestern Mexico. It is caused by Coccidioides immitis or C. posadasii. Infected individuals experience fever, chest pain, coughing and some other symptoms.

The disease can progress to chronic or progressive lung disease and may even become disseminated to the skin, brain (meninges), skeleton, and other body areas. The disease can also infect many animal types (for example, dogs, cattle, otters, and monkeys).

Coccidioidomycosis was first noted in the 1890s in Argentina; tissue biopsies of people with the disease showed pathogens that resembled coccidia (protozoa). During 1896-1900, investigators learned the disease was caused by a fungus, not protozoa, so the term “mycosis” was eventually added to “coccidia.”

What causes valley fever (coccidioidomycosis)?

Valley fever, coccidioidomycosis for technical, is an infection caused by Coccidioides immitis or Coccidioides posadasii fungi.  These organisms are found in the semiarid areas of:

•       Texas

•       Mexico

•       Nevada

•       Arizona

•       California

•       New Mexico

•       South America

•       Central America

These locations are known for mild winters and arid summers.

You can become infected by inhaling coccidioides fungal spores.   These Valley Fever causers get into the air after contaminated soil is disturbed, such as during:

•       dust storms

•       earthquakes

•       construction

•       agricultural activities

What are the symptoms of valley fever (coccidioidomycosis)?

About 60% of all infected people (without immunosuppression) have no symptoms and do not seek medical care.Symptoms are not experienced in over half of those infected.  Those that do have coccidioidomycosis symptoms complain of stuff like:

•       rash

•       fever

•       chills

•       cough

•       wheezing

•       headache

•       chest pain

•       weight loss

•       night sweats

•       muscle aches

•       bloody sputum

•       loss of appetite

•       light sensitivity

•       profuse sweating

•       muscle, joint stiffness

How is valley fever (coccidioidomycosis) treated?

The drug of choice is usually amphotericin B, but oral azoles (fluconazole [Diflucan], itraconazole [Sporanox], ketoconazole [Nizoral]) and a triazole (posaconazole) can be used. A new drug called voriconazole may also be used.

Surgical treatment is sometimes needed. Pulmonary cavities, persistent pulmonary infection, empyema (pus collection), and shunt placement are some of the surgical interventions used to treat this disease.

REFRENCES

1-Charles Davis, MD, PhD  Article on VALLEY FEVER

Fibromylagia

Fibromylagia

Fibromyalgia is a long-term (chronic) condition that can cause widespread muscle pain. There aren’t usually any outward signs of fibromyalgia, but the pain and tiredness associated with it are very real. In the past, other terms were used for fibromyalgia. These include muscular rheumatism or fibrositis and generally mean conditions that cause a lot of pain in muscles and soft tissues but don’t damage to bones and joints.

What is fibromyalgia?

Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain.

Fibromyalgia is a long-term (chronic) condition that can cause widespread muscle pain. There aren’t usually any outward signs of fibromyalgia, but the pain and tiredness associated with it are very real. In the past, other terms were used for fibromyalgia. These include muscular rheumatism or fibrositis and generally mean conditions that cause a lot of pain in muscles and soft tissues but don’t damage to bones and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, fatigue, anxiety, depression, and disturbances in bowel function. Fibromyalgia was formerly known as fibrositis.

Fibromyalgia also does not cause damage to internal body organs. In this sense, fibromyalgia is different from many other rheumatic conditions (such as rheumatoidarthritis, systemic lupus, and polymyositis)

What Causes Fibromyalgia?

Fibromyalgia can be triggered (or made worse) by a number of different factors, such as:  Overexertion, Stress, Lack of exercise, Anxiety, Depression, Lack of sleep or sleep disturbances, Trauma, Extremes of temperature and/ or humidity, Infectious illness or Physically Unfit Muscle. Immune system problems – Certain immunologic abnormalities are common among people with fibromyalgia. Some suggest that fibromyalgia is the result of toxins accumulating in the muscles from lactic acid build-up.

Disturbance in brain chemistry – Many people who develop fibromyalgia have a history of clinical depression, Sleep Disturbances or Insomnia. Many researchers have noticed that fibromyalgia sufferers have a low level of serotonin. They suggest that the central cause of the pain of fibromyalgia is due to this low level of serotonin.

Food allergy (dairy products, wheat, fermented foods, and nightshades-potatoes, eggplant-are most common).

Who does fibromyalgia affect?

Fibromyalgia affects predominantly women (over 80% of those affected are women) between the ages of 35 and 55. Rarely, fibromyalgia can also affect men, children, and the elderly. It can occur independently or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. The prevalence of fibromyalgia varies in different countries. In Sweden and Britain, 1% of the population is affected by fibromyalgia. In the United States, approximately 2% of the population has fibromyalgia.

What are symptoms of fibromyalgia?

Common signs and symptoms of fibromyalgia include:

• •       Widespread Pain
• •       Morning Stiffness
• •       Fatigue
• •       Vision Problems
• •       Nausea
• •       Sleep Disorders
• •       Urinary and Pelvic Problems
• •       Weight Gain
• •       Dizziness
• •       Chronic Headaches
• •       Cold Symptoms
• •       Temperomandibular Joint Dysfunction Syndrome
• •       Multiple Chemical Sensitivity Syndromes
• •       “Fibrofog”: Cognitive or Memory Impairment
• •       Skin Complaints
• •       Chest Symptoms
• •       Anxiety
• •       Depression
• •       Dysmenorrhea
• •       Aggravating Factors
• •       Myofascial Pain Syndrome
• •       Muscle Twitches and Weakness
  
• •       Weather Changes
• •       The Menstrual Cycle
• •       Troubles Breathing

The universal symptom of fibromyalgia is pain. As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, these patients seem to have an increased sensitivity to many different sensory stimuli and an unusually low pain threshold. Minor sensory stimuli that ordinarily would not cause pain in individuals can cause disabling, sometimes severe pain in patients with fibromyalgia. The body pain of fibromyalgia can be aggravated by noise, weather change, and emotional stress.

How is fibromyalgia diagnosed?

No medical test or x-ray can provide a definitive diagnosis of fibromyalgia.

Doctors typically use the American College of Rheumatology’s 1990 criteria for classifying fibromyalgia. According to these criteria, a person is considered to have fibromyalgia if he or she has widespread pain for at least 3 months in combination with tenderness in at least 11 of 18 specific tender point sites.

Pain is considered widespread when it occurs in both the left side of the body and the right side, and both above and below the waist. Cervical spine, anterior chest, thoracic spine or low back pain must also be present.

The “tender points” are precise areas of the body which, when pressed, generate pain. The 18 tender point sites include:

1.   The area where the neck muscles attach to the base of the skull, left and right sides ( Occiput).

2.   Midway between neck and shoulder, left and right sides ( Trapezius).

3.   Muscles over left and right upper inner shoulder blade, left and right sides ( Supraspinatus).

4.   2 centimeters below side bone at elbow of left and right arms ( Lateral epicondyle).

5.   Left and right upper outer buttocks ( Gluteal).

6.   Left and right hip bones ( Greater trochanter).

7.   Just above left and right knees on inside.

8.   Lower neck in front, left and right sides (Low cervical).

9.   Edge of upper breastbone, left and right sides (Second rib).

To be considered painful, pressure on the tender point must generate actual pain, not just tenderness.

Some physicians also conduct blood work looking at levels of serotonin, substance P, adenosine triphosphate (ATP), free cortisol, glucose, growth hormone, and other factors.

What is the treatment for fibromyalgia?

Other treatment options

As well as medication, there are some other treatment options that can be used to help cope with the pain of fibromyalgia. These include:

•       Swimming, sitting or exercising in a heated pool or warm water

•       An individually tailored exercise programmed cognitive behavioral therapy (CBT) – a talking therapy that changes the way you think about things so you can deal with problems more positively

•       Psychotherapy- a talking therapy that helps you understand and deal with your thoughts and feelings

•       Relaxation techniques physiotherapy – when techniques such as massage are used to improve any physical problems, such as muscle stiffness or weakness

•       Psychological support – any kind of counseling or support group that helps you deal with the issues caused by fibromyalgia

Fibromyalgia medications

Traditionally, the most effective medications in the treatment of fibromyalgia have been the tricyclic antidepressants, medications traditionally used in treating depression. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep, restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called serotonin. Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).

Studies have shown that adding fluoxetine (Prozac), or related medications, to low-dose amitriptyline further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can cause tiredness and fatigue, while Prozac can make patients more cheerful and awake. Even more recently, study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in relieving symptoms. Prozac has also been shown to be effective when used alone for some patients with fibromyalgia.

In 2007, pregabalin (Lyrica) became the first medication approved specifically for treating fibromyalgia. Lyrica may be work by blocking nerve pain in patients with fibromyalgia. Lyrica has advantages of flexible dosing that can be adjusted according to persisting symptoms.

More recently, drugs that simultaneously increase the amount of two brain nerve transmitters, serotonin and norepinephrine, have been approved to treat fibromyalgia in adults. These drugs include duloxetine (Cymbalta) and milnacipran (Savella). Research studies have shown significant effectiveness in decreasing pain and improving function in patients with fibromyalgia with these drugs. Cymbalta has been effective in treating depression and relieving pain in people with depression and is also used to treat anxiety.