Mga Pahina

Brittle bone disease (osteogenesis imperfecta)

What is osteogenesis imperfecta?

Osteogenesis imperfecta (OI) is the most common disease causing fractures in childhood. It also causes fractures in adults.
OI is a genetic disorder usually resulting from abnormalities of the genes, which control the production of a protein called collagen. This is the main protein in bone and essential for its strength.
The fragility of bone in OI is due to the collagen problems. It has nothing to do with the calcium part of bone, which is what shows up on X-rays.

How common are fractures?

Some OI children are born with fractures that have taken place in the womb. Others have their first fractures soon after birth or several years later.
Some people with OI have so few fractures in childhood that the correct diagnosis is not made.
Fractures are difficult to predict, especially in childhood. Some occur with normal handling. Some occur with so little trauma that the usual signs of a fracture may not be seen and the fracture is not identified till some weeks or months later, when an X-ray is done for another reason.
The bones do not always behave in a brittle way: fractures may not occur when they might be expected from an injury. The reason for these variations is unknown.
In both sexes and in almost all types of OI the fracture rate diminishes during the teenage years and remains low in adult life. The reason for this is not known.

What other clinical problems can occur?

Besides fractures, there may be problems in other parts of the body. Most of these are, like the fractures, the result of the defects of collagen.
  • The joints may be lax.
  • The whites of the eyes may be blue or grey.
  • The teeth may be discoloured and fragile.
  • There may be an increased liability to bruising (thought to be due to the defective collagen in small blood vessels).
  • Deafness may occur (see below).
  • Hernias are more common in people with OI.
  • Excessive sweating or intolerance of heat are common complaints. The cause of this is not known.
  • Growth may be impaired.

Is OI inherited?

OI in an individual is present from the time of conception.
In some people, mostly those with milder OI, the disorder passes from one generation to another. In others, including most of the patients with severe severe OI, it arises without any family history.
In many of these the cause is a 'new genetic mutation' – in other words the responsible change in the person's genes arises anew, and not because it has been passed on from a parent.
It's important to obtain advice from a specialist in gene problems (clinical geneticist), who may be able to identify the pattern of inheritance and advise on the risk to further children or the risk of passing on the condition.

How is OI diagnosed?

In most people the diagnosis is made from the pattern of fractures and the finding of any of the associated clinical features, such as blue or grey whites of the eyes.
However, it's important to recognise that none of these signs may be present and that the diagnosis may be very difficult.
In severely affected people, X-rays may show characteristic abnormalities – the result of previous fractures.
In many people with only mild or moderate OI, the X-rays may appear normal at the time of the first few fractures.
Later, in bones that have been the site of previous fractures, the bones may appear demineralised (less white on X-ray), and reduced radiation may be needed to obtain satisfactory films for the diagnosis of fractures.
In about half of people with mild OI, a useful sign is seen in X-rays of the skull where there may be additional small bones in the sutures known as wormian bones.
Bone density measurements are usually unhelpful for the diagnosis of OI. They frequently give normal results in bones that have not previously been fractured.
Two specialised tests are sometimes used for the diagnosis of OI.
One involves taking a small piece of skin, culturing the cells and chemically examining the collagen produced. The other uses a blood sample and searches for mutations of the genes coding for the collagen of bone.
Both tests are labour-intensive, and neither test is more than 85 per cent accurate in identifying cases of OI.

What treatment can be given?

The mainstay of treatment is competent orthopaedic care at the time of fractures, to ensure that each fracture heals in a good position.
Patients should be mobilised as early as possible to minimise the loss of bone due to immobilisation.
In some circumstances 'rodding' operations, in which fixed or telescopic metal rods are inserted into the shafts of bones, are very helpful – particularly in children with frequent fractures or appreciable deformity.
Help in the form of competent occupational therapy may be invaluable in ensuring that parents are given good advice in handling of a young child, in prescribing the most appropriate seating or wheelchairs, in advising on adaptations to the home and on practical ways of ensuring a good education.
There is no drug treatment for OI itself.
Various bisphosphonate drugs are widely used and have given encouraging results in some children with the more severe types of OI. There's no reliable evidence of their value in the milder types of OI or in adults.

What about older women with OI?

We know that after the menopause, women with OI lose bone like anybody else. This bone loss can be prevented with hormone replacement therapy (HRT).
Because people with OI already have bones that are prone to fractures, women with OI should consider taking HRT from approximately the time of the menopause.
Like any drug treatment, HRT has advantages and disadvantages.
On the positive side, HRT preserves the bones and relieves menopausal symptoms.
On the negative side, there's a small increase in the likelihood of breast cancer. But this risk is thought to be reduced by the use of low dose preparations.
For most people, monthly bleeds can be avoided by modern forms of HRT (continuous combined HRT).
For most people with OI the advantages of HRT outweigh the disadvantages – without it the likelihood of fractures increases quite quickly after the menopause.
Stopping smoking is vital. Smoking diminishes the bone by up to 5 per cent – a loss that people with OI can ill afford. Apart from this, there's evidence that smoking diminishes the effectiveness of HRT.
Some women cannot or should not take HRT. Other drugs may have a place depending on a detailed specialist review.

What about older men?

Men do not appear to have a 'menopause', and older men with OI do not have a rise in the fracture rate in later life.

How common is hearing loss in OI?

About 50 per cent of people with OI find that they have impaired hearing with an onset mainly in the teenage years or early adult life.
Not everyone is affected and, of those who have no hearing loss at the age of 50, relatively few become deaf thereafter.
Hearing loss in OI is most commonly due to problems in the small bones in the middle ear, which may be fractured or deformed so that sounds are not transmitted effectively to the inner ear.
There are a smaller number of people with OI whose hearing loss is caused by problems in the inner ear and some with mixed causes. It's important to investigate hearing loss properly to find out exactly what the cause is, because this influences treatment.
For most people with both types of hearing loss, hearing aids are the first line of treatment at any age.
The hearing loss that is caused by problems in the middle ear may, if severe or progressive, be helped by surgery.
The decision about whether or not surgery is appropriate needs discussion with an expert ENT (ear, nose and throat) surgeon, preferably someone with a special interest in OI.

What is temporary brittle bone disease?

A special type of OI has become recognised in the last 25 years. In this, fractures occur in the first year of life and largely in the first six months.
The identification of this disorder is still controversial, in part because the cause is not yet known.
The disorder is more common in infants born before term and in twins. In some cases there are minor features of collagen abnormality in parents or other relatives.

Where can I obtain fuller information about OI?

In the UK, the Brittle Bone Society has a website and can be contacted by mail, e-mail or telephone.
In the United States the corresponding society is the Osteogenesis Imperfecta Foundation.
Both societies issue factsheets on different aspects of OI and may be able to give advice on appropriate specialists, welfare provision and education.
There are similar societies in many European countries, in Canada, in Australia and in some Latin American countries.

Cold (common cold): symptoms and treatment

What is a cold?



NatMags - cold
Many symptoms of a cold can also be soothed by warm drinks.
A cold is a contagious viral disease that infects the soft lining (mucous membrane) of the nose.
There are more than 100 different viruses that can result in a cold. The characteristic symptom is a runny nose.
Usually, it's a mild condition, with recovery taking place within about a week. But sometimes the same symptoms can be more serious – like influenza.
It's most common during the cold winter months and affects children and adults of all ages. Most people will catch a cold two to four times a year.

How do we catch a cold?

A person's contagious from the day before the illness breaks out, until one to three days after they feel better. The infection is spread by airborne droplets, when the sufferer coughs or sneezes.
It can also be spread by hand, if someone has the virus on their hands and then puts them close to their eyes or nose. This is possibly the most common way of catching a cold.

What are the symptoms of a cold?


A sore throat.
There may be pain on swallowing.
Sneezing.
The nose begins to run, with a water-like secretion that gradually becomes thicker and more yellow.
As the mucous membrane of the nose swells, it may be hard to breathe through the nose.
An aching feeling in the ears.
Headache.
Coughing.
A feeling of being unwell.
A high temperature. Children are more likely to run a temperature than adults.

What can you do to avoid catching a cold?


If possible, stay away from people with colds.
Avoid crowded places, where the risk of infection is greater.
Do not touch your nose or eyes after being in physical contact with somebody that has a cold.
Wash your hands thoroughly, especially after blowing your nose.
Keep rooms well aired.

How does the doctor make a diagnosis?

Consultations with a doctor are unnecessary, unless the cold is severe.

Outlook

Usually a common cold causes no serious trouble, and symptoms will clear up in one to two weeks.
Possible complications include inflammation of the eyes, sinusitis, inflammation of the middle ear, tonsillitis, and pneumonia.
The reason for these complications may be that a bacterium infects the irritated mucous membrane.

How do you treat a cold ?


There's no effective way of treating an ordinary cold to make it go away quicker. If the sufferer has no other diseases than the common cold, and it goes away in one to two weeks, there's no reason to see a doctor. Since a cold is caused by a virus, antibiotics are not appropriate.
Make sure you drink plenty of non-alcoholic fluids, ideally water – this is especially important for children. Many symptoms can also be soothed by warm drinks.
Sleep with the head on a high pillow.
There's no need to reduce daily activities. But you should expect to become tired more easily. Children with a cold should be allowed to get plenty of rest.
Avoid smoking. It irritates the mucous membrane of the nose further.
A blocked nose and chesty cough can be eased by using steam inhalations, which help to loosen mucus. Sit with your head over a bowl of hot water, place a towel over your head, close your eyes and breathe deeply to inhale the steam. This isn't recommended for children because of the risk of scalding.
Symptoms such as cough, sore throat, nasal congestion and headache can be relieved by a variety of over-the-counter medicines. Nasal decongestants may ease breathing. You can get advice from a pharmacist about which are most suitable for you and your symptoms.
Coughs and colds in children will usually go away on their own in a few days. Over-the-counter cough and cold remedies are no longer recommended for children under six years of age because there's no evidence that they work – and they can potentially cause side-effects, such as allergic reactions, effects on sleep or hallucinations. If your child seems uncomfortable or has a fever, you can give them paracetamol or ibuprofen to relieve pain and lower their temperature. If they have a cough, you can give them a simple soothing cough syrup containing glycerol, honey or lemon. For children over six years of age, other medicines are available from pharmacies – ask your pharmacist for advice. Any medicine should be administered carefully using the spoon or measuring device supplied to ensure the maximum dose is not exceeded.
For young babies who are having difficulty feeding due to a stuffy nose, saline nasal drops, available from pharmacies, can be helpful to thin and clear nasal secretions. Vapour rubs and inhalant decongestants, which can be applied to a child’s clothing, can also be used to provide relief from a stuffy nose. You should never apply these directly underneath or inside the child's nose.
You should avoid using more than one cough and cold medicine at the same time, particularly when treating children's symptoms. Different medicines may contain the same active ingredient(s), and using more than one may lead to you exceeding the maximum recommended dose(s). Ask your pharmacist for more advice.
Throw away paper tissues after use to prevent the spread of infection.

Back pains diagnosed: Tips to get rid of back pains in instant

Back pain

Photodisc
With no definitive treatment for back pain, many people turn to complementary therapies such as yoga.
It can happen walking up a hill, lifting a suitcase or even watching TV. There is a feeling of something going 'click' in the lower part of the spine. It may start as a little twinge, but it's likely to get worse over the next 24 hours.

What does it feel like?

At first there will be a lack of flexibility in the back, then some pain on walking or bending with gradual stiffness spreading throughout the body.
Back pain can progress so virtually every movement is painful. Lying down may give some relief, but turning over can be difficult.
Getting out of bed may involve rolling onto the floor and raising yourself to a crawling position before teasing your body to its feet.

How long does it last?

Back pain can last up to six weeks and in 90 per cent of cases is likely to come back again within a year.

Who gets back pain?

A survey by the Department of Health found that 40 per cent of UK adults had back pain in the previous year, with 15 per cent in continuous pain. A conservative estimate is that 11 million working days are lost each year as a result of back pain.
It strikes men and women equally. Young people tend to have short episodes of back pain that resolve quickly. With older people, the pain is more likely to be long term (chronic).
Some people are more at risk because of their jobs. Back pain is more common in manual jobs and unskilled workers. You are at higher risk if you drive more than 25,000 miles a year.
People who work on the telephone for more than two hours a day without a headset and supermarket cashiers are also likely to be hit by back pain.

How is back pain diagnosed?

Dr Jeremy Sager, GP, says: 'First, it's important to make sure that your problem is back pain and not something more serious.'
  • The pain should be in the lower back, be related to movement and be present all the time.
  • It shouldn't involve the legs.
  • It should have begun suddenly and not have come on over time.
  • You should feel well, apart from the back pain.
  • There should be no sudden loss of weight.

What else could it be?

  • Back pain can be confused with sciatica, which is caused by the degeneration of an intervertebral disc. In sciatica leg pains accompany the back pain.
  • Kidney problems and pelvic and abdominal diseases can also cause back pain.
  • Although very rare, tumours can occur in the spine or lungs and cause back pain.
Always visit your GP so they can diagnose your symptoms.

What causes back pain?

Dr Loic Burn, a GP and author of books on back pain, says: 'There is no known single cause for back pain, which makes it difficult to name a specific treatment or method of prevention.
'Heavy lifting, for instance, can be a cause of back pain, but it is in a minority of cases. Basically we don't know what causes back pain.'

How is back pain treated?

Doctors used to advise complete bed rest for backache. Now this advice has changed: evidence shows the more active you can remain, the quicker your recovery.
Dr Burn says: 'The best medical advice is to take painkillers at once at the full dosage.'
Dr Sager agrees: 'You should take paracetamol or ibuprofen at the maximum dose. There is no use in pussyfooting about, you have to really attack the pain.
'Being as active as you can and taking painkillers cannot do you any harm and you will be back to living a normal life more quickly.'
Evidence also shows that manipulation techniques work for back pain, particularly if given in the first two weeks of pain.
Dr Burn says it doesn't matter who does the manipulation, as long as they have been trained. This means the person is a registered chiropractor, osteopath, physiotherapist or doctor.
'There are also medical treatments that involve epidural or spinal injections, but they don't always work.
'Spine-fusing surgery [where vertebrae are joined] is a last resort and only given to one in 10,000 patients. It is a very radical step considering we don't understand the causes of back pain and the results aren't always wonderful.'

What about alternative therapies?

Dr Burn is happy for his patients to try complementary therapies such as the Alexander Technique, yoga, shiatsu, acupuncture and massage. There is limited evidence that these therapies work, but some people find they help.
'Since we don't know the cause of back pain, we have to be open-minded on methods of treatment and look at every case on its merits.'
While it's fine to try different therapies, Dr Burn says 'if it doesn't work, move on to other things. The best approach is to stay active and be proactive in looking for something that stops the pain.'
A cure for back pain may be years away, but the fact to remember, he says, is the more active you are, the more likely you are to beat that pain in your back.

What is arthritis?

What is arthritis?

Arthritis simply means a painful condition of the joints.
There are different types of the disease – many inflammatory, for example rheumatoid arthritis (RA), and others more degenerative in nature, for example osteoarthritis (OA).

How does it feel to have arthritis?

NetDoctor/Justesen
Rheumatoid arthritis (RA) often starts with pain in the joints of the hands, especially in the knuckles and wrists , and often both hands simultaneously.
Arthritis may be preceded or accompanied by a period of fatigue and a feeling of stiffness. This appears more in rheumatoid arthritis than in osteoarthritis.
Pain in the joints in rheumatoid arthritis almost always begins in the hands, especially in the knuckles, and often in both hands simultaneously, as one of the commonest types of inflammatory arthritis.
  • Because of the inflammatory reaction, the joints swell and become red, stiff and sore.
  • The problem is worse in the morning than during the day.
  • There can be periods of improvement, which may be followed by a relapse.
Arthritis can affect all joints in the body, and it's impossible to predict which or how many joints will be attacked.

Who is at special risk?

We do not know the cause of arthritis. In rheumatoid arthritis, the theory that it's triggered by an infection has never been proved. It may be partly hereditary, and it occurs three times as often in women as in men.
All age groups can develop arthritis – even children – but usually rheumatoid arthritis appears between the ages of 30 and 35.

How is arthritis treated?

The disease is unpredictable and the treatment difficult. But there are several medical remedies that can both ease the pain and slow down the spread of the disease and the damage it causes.
  • The medicine must be adjusted from time to time, which means it's important to visit your doctor regularly.
  • The treatment of arthritis takes great experience, since it never develops in the same way from one person to the next. It often needs to be treated by a specialist (rheumatologist).
  • Surgery can be offered if permanent deformation of the joints develops, despite medication and physiotherapy treatment.

Future prospects

Some doctors may recommend a diet, but there's no evidence that dietary changes alone can ease or stop the development of arthritis.
Simple painkillers can help. When used with caution, non-steroidal anti-inflammatory drugs (NSAIDs) can provide relief from pain, as well as stiffness. These are prescribed more often in rheumatoid arthritis than in osteoarthritis.
Overweight patients should aim to reduce weight with appropriate diet and exercise.
It's important for patients with arthritis to obtain help to keep the muscles and joints active and to be supported in leading a normal life.
Physiotherapists, who are trained to maintain a patient's physical ability and relieve pain, and occupational therapists, who assess physical ability and provide help and advice including aids, play a large part in making life bearable for arthritis sufferers.
During recent years, there has been great progress in the treatment of arthritis – particularly with the use of artificial joints. Some people still have to live with the discomfort of the disease because not all joints can be replaced surgically.
Research has suggested that the natural treatment glucosamine sulphate, taken at a daily dose of 1500mg, is effective in relieving arthritis symptoms – particularly of the knee joints in patients with osteoarthritis rather than rheumatoid arthritis.
Rheumatoid arthritis patients benefit from disease modifying drugs, such assulphasalazine and methotrexate, or even the latest biologic treatments in those who fail with routine drugs (anti-TNF drugs and others (rituximab).
Based on a text by Dr Erik Fangel Poulsen, specialist  and Dr Per Grinsted, GP

How long do drugs/medicine stay in your body?

Drugs are synthetic products which can be used as medicines or narcotics. Drugs are of different types and are differentiated on the basis of their effect on human beings. For e.g., certain drugs and medications are classified as depressants, while some others are stimulants. Prescription drugs are taken for medicinal purposes to overcome depression or physical or psychological disorders. However, certain drugs, mostly, narcotics, are consumed illegally and are termed as drugs of abuse. Do you wish to know how long do drugs stay in your system after taking them? Let us find out.

How Long do Drugs Stay in Your System?

The duration any drug stays in the body varies and it can last for hours to days to even more than a couple of weeks. With the use of modern methods of drug testing, it is even possible to detect whether a person had a drug 2-3 months backs. Drug tests include urine test, blood test and hair test which also help in the diagnosis of the type of drug a person has taken. However, while determining an exact answer on how long do drugs stay in your system, one needs to take several other things into consideration like the amount of drug the person has taken, whether the drug was taken orally or injected in the body, the person's age, gender, etc. Secondly, a person's rate of metabolism (or metabolic rate) also plays an important role in determining the duration the drug stays in the body. If a person has a slower metabolic rate, it takes a longer time for the drugs to get out from the body.

The frequency at which a certain drug is taken (drug abuse) and the drug tolerance capacity of the person also determine the duration of the drug in the body. The following is a chart showing how long do drugs stay in your system in case of prescription drugs as well as drugs of abuse.

How Long do Prescription Drugs Stay in Your System?

Most commonly used drugs like codeine, used to relive cough and pain, can also stay in the body for more than one day. Take a look at the chart to find out the duration prescription drugs stay in the body.


DrugsMinimum Duration in the BodyMaximum Duration in the Body
Amphetamines1 day2 days
Anabolic steroids1 week3 weeks
Barbiturates2 days3 days
Benzodiazepines2 days8 days
Codeine1 day2 days
Dilaudid2 days90 days
Ketamine2 days4 days
Phenobarbital2 weeks3 weeks
Suboxone2 days5 days
Oxycodone1 day2 days
Valium2 days7 days

How Long do Recreational Drugs Stay in Your System?

The duration of addictive drugs in the body also differs. The following is the chart depicting how long do these drugs stay in the body.


DrugsMinimum Duration in the BodyMaximum Duration in the Body
Alcohol8 hours12 hours
Cocaine1 day2 days
Fentanyl1 day90 days
Heroin1 day2 days
GHB1 day2 days
LSD2 hours5 days
Marijuana2 days30 days
MDMA1 day5 days
Methadone1 day7 days
Methamphetamine2 days4 days
Methaqualone9 days15 days
Nicotine1 day2 days
Opiates1 day2 days
PCP1 day30 days
Quaalude1 hour90 hours

As there are severe and even fatal effects of drugs on the body, people are advised not to abuse drugs. It should also be noted that drugs are more addictive as compared to alcohol or cigarette. However, all the three are equally harmful. If a friend, or a partner is found to suffer from drug abuse, he should be encouraged to go to drug rehabilitation where recovery is possible.

Now that you know how long do drugs stay in your system, you might as well be careful before taking any drugs (illegally, without prescription). Drug abuse is a sure way to end life as it is addictive and life threatening. So it is wise to stay away from it. Take care!

Vitamin B3: NIACIN


Vitamin B3, most commonly known as niacin, but also known as nicotinic acid and vitamin PP, is an essential human nutrient. Vitamin B3 is a water soluble, solid vitamin that comes in other forms such as amide and nicotinamide, both of which contain the same biochemical activity. The terms are often used interchangeably. However, it should be noted that nicotinamide does not have the same pharmacological effects as niacin. Nicotinamide does not reduce cholesterol or cause flushing and may be toxic at doses higher than 3g/day.

Vitamin B3: Functions in the Human Body

Vitamin B3 (niacin) is involved in DNA repair and the production of steroid hormones in the adrenal gland. Vitamin B3 is important for maintaining healthy skin and normal nerve and brain functions. It also plays an important part in memory improvement, digestion and the absorption of proteins, fats, and carbohydrates. Niacin is capable of reversing atherosclerosis by reducing total cholesterol, triglycerides, very-low-densitylipoprotein (VLDL), and low-density lipoprotein (LDL), and increasing high-density lipoprotein (HDL). By increasing high-density lipoprotein, niacin can reduce the risk of heart attack.

Vitamin B3: Recommended Daily Intake

The recommended daily intake (RDI) for vitamin B3 is as follows:
  • 16 mg/day for men
  • 14 mg/day for women
  • 18 mg/day for pregnant or breast-feeding women
  • 2–12 mg/day for children
  • The Tolerable Upper Limit (UL) for adult men and women is 35 mg/day
Vitamin B3 deficiency is rare in developed countries and usually occurs where poverty and malnutrition is prevalent. Chronic alcoholism is also known to cause deficiency. Severe deficiency causes pellagra, a disease causing symptoms of dermatitis, diarrhea, dementia, lesions on the lower neck, thickening of the skin, hyperpigmentation, digestive problems, amnesia, delirium, inflammation of the mouth, and potentially death. More common psychiatric symptoms of niacin deficiency are anxiety, fatigue, irritability, poor concentration, apathy, depression, and restlessness.

Vitamin B3: Risk of Overdose

At high doses niacin can have life-threatening results. Research has shown that doses higher that 1.5-6g per day may lead to dermatological conditions such as flushing and itching, skin rashes, and dry skin. Niacin administered at doses for lowering cholesterol has cause birth defect in laboratory animals and, as such, may cause birth complications in pregnant women. Other health problems related with niacin overdose are gastrointestinal problems such as nausea, indigestion, and liver toxicity.


Source: WL

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