IRRITABLE BOWEL SYNDROME (IBS) : SIGNS AND SYMPTOMS

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a “syndrome,” meaning a group of symptoms. The most common symptoms of IBS are abdominal pain or discomfort often reported as cramping, bloating, gas, diarrhea, and/or constipation. IBS affects the colon, or large bowel, which is the part of the digestive tract that stores stool.

IBS is not a disease. It’s a functional disorder, meaning that the bowel doesn’t work, or function, correctly.

Doctors are not sure what causes IBS. The nerves and muscles in the bowel appear to be extra sensitive in people with IBS. Muscles may contract too much when you eat. These contractions can cause cramping and diarrhea during or shortly after a meal. Or the nerves may react when the bowel stretches, causing cramping or pain.

IBS can be painful. But it does not damage the colon or other parts of the digestive system. IBS does not lead to other health problems.

The main symptoms of IBS are

• abdominal pain or discomfort in the abdomen, often relieved by or associated with a bowel movement
• chronic diarrhea, constipation, or a combination of both

Other symptoms are

• whitish mucus in the stool
• a swollen or bloated abdomen
• the feeling that you have not finished a bowel movement

Women with IBS often have more symptoms during their menstrual periods.

he doctor may suspect that you have IBS because of your symptoms. Specific symptoms, called the Rome criteria, can be used to more accurately make this diagnosis. Medical tests may also be done to make sure you don’t have any other health problems that cause the same symptoms.

Medical Tests for IBS

• In addition to a physical exam and blood tests, the following tests might be done to diagnose IBS:
• Lower gastrointestinal (GI) series. This test uses x rays to diagnose problems in the large intestine. It is also called a barium enema x ray. Before you have the x ray, the doctor will put barium into your large intestine through the anus—the opening where stool leaves the body. Barium is a thick liquid that makes your intestines show up better on the x ray.
• Colonoscopy. For this test the doctor inserts a long, thin tube, called a colonoscope, into your anus and up into your colon. The tube has a light and tiny lens on the end. The doctor can view the inside of your colon on a big television screen. In some cases, a shorter tube, called a flexible sigmoidoscope, is used to look at just the lower portion of the colon.

IBS has no cure, but you can do things to relieve symptoms. Treatment may involve

• diet changes
• medicine
• stress relief

You may have to try a few things to see what works best for you. Your doctor can help you find the right treatment plan.

Diet Changes

Some foods and drinks make IBS worse.

Foods and drinks that may cause or worsen symptoms include

• fatty foods, like french fries
• milk products, like cheese or ice cream
• chocolate
• alcohol
• caffeinated drinks, like coffee and some sodas
• carbonated drinks, like soda

These foods may make IBS worse.

To find out which foods are a problem, keep a diary that tracks

• what you eat during the day
• what symptoms you have
• when symptoms occur
• what foods always make you feel sick

Take your notes to the doctor to see if certain foods trigger your symptoms or make them worse. If so, you should avoid eating these foods or eat less of them.

Some foods make IBS better.

Fiber may reduce the constipation associated with IBS because it makes stool soft and easier to pass. However, some people with IBS who have more sensitive nerves may feel a bit more abdominal discomfort after adding more fiber to their diet. Fiber is found in foods such as breads, cereals, beans, fruits, and vegetables.

Examples of foods with fiber include

Fruits	Vegetables	Breads, cereals, and beans
apples peaches	broccoli (raw) cabbage carrots (raw) peas	kidney beans lima beans whole-grain bread whole-grain cereal

Add foods with fiber to your diet a little at a time to let your body get used to them. Too much fiber at once can cause gas, which can trigger symptoms in a person with IBS.

Your doctor may ask you to add more fiber to your diet by taking a fiber pill or drinking water mixed with a special high-fiber powder.

Eat small meals.

Large meals can cause cramping and diarrhea in people with IBS. If this happens to you, try eating four or five small meals a day instead of less-frequent big meals.

Medicine

The doctor may give you medicine to help with symptoms.

• Laxatives treat constipation. Many kinds of laxatives are available. Your doctor can help you find the laxative that is right for you.
• Antispasmodics control spasms in the colon and help ease abdominal pain.
• Antidepressants, even in lower doses than are used for treating depression, can help people with IBS. They can help reduce the abdominal discomfort or pain associated with IBS and, depending on the type chosen, may help the diarrhea or constipation.

Another drug is sometimes prescribed for the treatment of IBS. Alosetron hydrochloride (Lotronex) is for women with severe IBS whose main symptom is diarrhea. Because it can cause serious side effects, Lotronex is only used if other medicines do not work.

You need to follow your doctor’s instructions when you use the medicine. Otherwise, you may need to keep taking it in order to have a bowel movement. Talk with your doctor about potential side effects and what to do if you experience them.

Does stress cause IBS?

Emotional stress does not cause IBS. But people with IBS may have their bowels react more to stress. So, if you already have IBS, stress can make your symptoms worse.

Stress Relief

Learning to reduce stress can help with IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.

Meditation, exercise, hypnosis, and counseling may help. You may need to try different activities to see what works best for you.

Points to Remember

• IBS means your bowel doesn’t work the right way.
• IBS can cause cramping, bloating, gas, diarrhea, and constipation.
• IBS doesn’t damage the bowel or lead to other health problems.
• The doctor will diagnose IBS based on your symptoms. You may need to have medical tests to rule out other health problems.
• Stress doesn’t cause IBS, but it can make your symptoms worse.
• Fatty foods, milk products, chocolate, alcohol, and caffeinated and carbonated drinks can trigger symptoms.
• Eating foods with fiber and eating small meals throughout the day may reduce symptoms.
• Treatment for IBS may include medicine, stress relief, and changes in eating habits.

VITAMIN B6

Vitamin B6, a part of the vitamin B complex group, is a water-soluble vitamin metabolized in the liver. Although there are several recognized forms, PLP (pyridoxal phosphate) is the active form and cofactor in many aspects of amino acid metabolism, and is necessary for the enzymatic reaction that governs the release of glucose and glycogen.


The seven forms of vitamin B6 are as follows:

1. Pyridoxine (PN): most commonly given as vitamin B6 supplement
2. Pyridoxine 5'-phosphate (PNP)
3. Pyridoxal (PL)
4. Pyridoxal 5'-phosphate (PLP): the metabolically active form (sold as 'P-5-P' vitamin supplement)
5. Pyridoxamine (PM)
6. Pyridoxamine 5'-phosphate (PMP)
7. 4-Pyridoxic acid (PA): the catabolite which is excreted in the urine

All forms of vitamin B except PA can be inter-converted.

Vitamin B6: Functions in the Human Body

Pyridoxal phosphate, the metabolically active form of vitamin B6 is involved in macronutrient metabolism, histamine synthesis, neurotransmitter synthesis, hemoglobin synthesis, and gene expression. Pyridoxal phosphate serves as a coenzyme and facilitates decarboxylation, transamination, racemization, elimination, replacement and beta-group inter-conversion reactions. Vitamin B6 is involved in over 100 chemical processes in the body per minute. These processes include the production of amino acids, creating neurotransmitters such as serotonin, metabolizing energy, and balancing a range of hormones. Like other B-vitamins, B6 also strengthens the immune system.

Vitamin B6: Recommended Daily Intake

The recommended RDI for vitamin B6 is displayed below.

• Infants up to 6 months old: 100mcg
• 6 - 12 months old: 300mcg
• 1 - 3 years old: 500mcg
• 4 - 8 years old: 600mcg
• Males 9 - 13 years old: 1mg
• Males 14+: 1.3mg
• Females 9 - 13 years old: 1mg
• Females 14 - 50 years old: 1.2mg
• Females 50+: 1.5mg
• Pregnant females all ages: 1.9mg
• Lactating females all ages: 2mg

Deficiency of B6 alone is rare and usually associated with a deficiency in other B-vitamins. Alcoholics and the elderly are most at risk, and availability to the body may be impaired by certain drugs such as anticonvulsants and corticosteroids. Clinical B6 deficiency syndrome is a seborrhoeic dermatitis outbreak and neurological symptoms of somnolence, confusion, and neuropathy will also occur. Less severe cases of deficiency will experience metabolic lesions and impaired glucose intolerance.

Vitamin B6: Risk of Overdose


Adverse effects of vitamin B consumption have only ever been observed in supplements and not food intake, yet although Vitamin B6 is a water soluble vitamin, excess RDI over a sustained period will result in neurological problems. Pain and numbness, and in some cases problems walking are typical symptoms of excessive consumption of pyridoxine at a level of 1,000mg per day. The Tolerable Upper Limit (TL) has been set at 100mg/pd by the US FDA (2000).

Source: Wl

TOP 10 INCURABLE DISEASE

Modern medicine has done much to erradicate and cure disease, but it has failed in some areas. Of those areas, at least one disease that cannot be cured is suffered by many people in the world every year – the common cold. This is a list of the top ten incurable diseases. As always, click the images for a larger view. NOTE: There are no graphic images in this post.

10. Ebola

Ebola is a virus of the family Filoviridae that is responsible for a severe and often fatal viral hemorrhagic fever; outbreaks in primates such as gorillas and chimpanzees as well as humans have been recorded. The disease is characterized by extreme fever, rash, and profuse hemorrhaging. In humans, fatality rates range from 50 to 90 percent.

The virus takes its name from the Ebola River in the northern Congo basin of central Africa, where it first emerged in 1976. Outbreaks that year in Zaire (now Congo [Kinshasa]) and The Sudan resulted in hundreds of deaths, as did another outbreak in Zaire in 1995. Ebola is closely related to the Marburg virus, which was discovered in 1967, and the two are the only members of the Filoviridae that cause epidemic human disease. A third related agent, called Ebola Reston, caused an epidemic in laboratory monkeys in Reston, Virginia, but apparently is not fatal to humans.

9. Polio

Polio is known in full as poliomyelitis – also called infantile paralysis. It is an acute viral infectious disease of the nervous system that usually begins with general symptoms such as fever, headache, nausea, fatigue, and muscle pains and spasms and is sometimes followed by a more serious and permanent paralysis of muscles in one or more limbs, the throat, or the chest. More than half of all cases of polio occur in children under the age of five. The paralysis so commonly associated with the disease actually affects fewer than 1 percent of persons infected by the poliovirus.

Between 5 and 10 percent of infected persons display only the general symptoms outlined above, and more than 90 percent show no signs of illness at all. For those infected by the poliovirus, there is no cure, and in the mid-20th century hundreds of thousands of children were struck by the disease every year. Since the 1960s, thanks to widespread use of polio vaccines, polio has been eliminated from most of the world, and it is now endemic only in several countries of Africa and South Asia. Approximately 1,000–2,000 children are still paralyzed by polio each year, most of them in India.

8. Lupus Erythematosus

Also often referred to simply as lupus, this is an autoimmune disorder that causes chronic inflammation in various parts of the body. Three main types of lupus are recognized—discoid, systemic, and drug-induced.

Discoid lupus affects only the skin and does not usually involve internal organs. The term discoid refers to a rash of distinct reddened patches covered with grayish brown scales that may appear on the face, neck, and scalp. In about 10 percent of people with discoid lupus, the disease will evolve into the more severe systemic form of the disorder.

Systemic lupus erythematosus is the most common form of the disease. It may affect virtually any organ or structure of the body, especially the skin, kidneys, joints, heart, gastrointestinal tract, brain, and serous membranes (membranous linings of organs, joints, and cavities of the body.) While systemic lupus can affect any area of the body, most people experience symptoms in only a few organs. The skin rash, if present, resembles that of discoid lupus. In general, no two people will have identical symptoms. The course of the disease is also variable and is marked by periods when the disease is active and by other periods when symptoms are not evident (remission).

7. Influenza

Influenza, also known as the flu, or grippe, is an acute viral infection of the upper or lower respiratory tract that is marked by fever, chills, and a generalized feeling of weakness and pain in the muscles, together with varying degrees of soreness in the head and abdomen.

Influenza is caused by any of several strains of orthomyxoviruses, categorized as types A, B, and C. The three major types generally produce similar symptoms but are completely unrelated antigenically, so that infection with one type confers no immunity against the others. The A viruses cause the great influenza epidemics, and the B viruses cause smaller localized outbreaks; the C viruses are not important causes of disease in humans. Between pandemics, the viruses undergo constant, rapid evolution (a process called antigenic drift) in response to the pressures of human population immunity. Periodically, they undergo major evolutionary change by acquiring a new genome segment from another influenza virus (antigenic shift), effectively becoming a new subtype to which none, or very few, of the population is immune.

6. Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob disease is a rare fatal degenerative disease of the central nervous system. Creutzfeldt-Jakob disease occurs throughout the world at an incidence of one person in a million; however, among certain populations, such as Libyan Jews, rates are somewhat higher. The disease commonly occurs in adults between the ages of 40 and 70, although some young adults have been stricken with the disease. Both men and women are affected equally. The onset of the disease is usually characterized by vague psychiatric or behavioral changes, which are followed within weeks or months by a progressive dementia that is often accompanied by abnormal vision and involuntary movements. There is no known cure for the disease, which is usually fatal within a year of the onset of symptoms.

The disease was first described in the 1920s by the German neurologists Hans Gerhard Creutzfeldt and Alfons Maria Jakob. Creutzfeldt-Jakob disease is similar to other neurodegenerative diseases such as kuru, a human disorder, and scrapie, which occurs in sheep and goats. All three diseases are types of transmissible spongiform encephalopathies, so called because of the characteristic spongelike pattern of neuronal destruction that leaves brain tissue filled with holes.

5. Diabetes

Diabetes is a disorder of carbohydrate metabolism characterized by impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar (glucose) in the blood.

There are two major forms of the disease. Type I diabetes, formerly referred to as insulin-dependent diabetes mellitus (IDDM) and juvenile-onset diabetes, usually arises in childhood. It is an autoimmune disorder in which the diabetic person’s immune system produces antibodies that destroy the insulin-producing beta cells. Because the body is no longer able to produce insulin, daily injections of the hormone are required.

Type II diabetes, formerly called non-insulin-dependent diabetes mellitus (NIDDM) and adult-onset diabetes, usually occurs after 40 years of age and becomes more common with increasing age. It arises from either sluggish pancreatic secretion of insulin or reduced responsiveness in target cells of the body to secreted insulin. It is linked to genetics and obesity, notably upper-body obesity. People with type II diabetes can control blood glucose levels through diet and exercise and, if necessary, by taking insulin injections or oral medications.

4. HIV/AIDS

AIDS is the byname of acquired immunodeficiency syndrome – a transmissible disease of the immune system caused by the human immunodeficiency virus (HIV). HIV slowly attacks and destroys the immune system, the body’s defense against infection, leaving an individual vulnerable to a variety of other infections and certain malignancies that eventually cause death. AIDS is the final stage of HIV infection, during which time fatal infections and cancers frequently arise.

HIV/AIDS spread to epidemic proportions in the 1980s, particularly in Africa, where the disease may have originated. Spread was likely facilitated by several factors, including increasing urbanization and long-distance travel in Africa, international travel, changing sexual mores, and intravenous drug use. According to the United Nations 2004 report on AIDS, some 38 million people are living with HIV, approximately 5 million people become infected annually, and about 3 million people die each year from AIDS. Some 20 million people have died of the disease since 1981.

3. Asthma

Asthma is a chronic disorder of the lungs in which inflamed airways are prone to constrict, causing episodes of breathlessness, wheezing, coughing, and chest tightness that range in severity from mild to life-threatening. Inflamed airways become hypersensitive to a variety of stimuli, including dust mites, animal dander, pollen, air pollution, cigarette smoke, medications, weather conditions, and exercise. Stress can exacerbate symptoms.

Asthmatic episodes may begin suddenly or may take days to develop. Although an initial episode can occur at any age, about half of all cases occur in persons younger than 10 years of age, with boys being affected more often than girls. Among adults, however, the incidence of asthma is approximately equal in men and women. When asthma develops in childhood, it is often associated with an inherited susceptibility to allergens, substances such as pollen, dust mites, or animal dander that may induce an allergic reaction. In adults, asthma also may develop in response to allergens, but viral infections, aspirin, and exercise may cause the disease as well. Adults who develop asthma may have nasal polyps or sinusitis.

2. Cancer

Cancer refers to a group of more than 100 distinct diseases characterized by the uncontrolled growth of abnormal cells in the body. Cancer affects one in every three persons born in developed countries and is a major cause of sickness and death throughout the world. Though it has been known since antiquity, significant improvements in cancer treatment have been made since the middle of the 20th century, mainly through a combination of timely and accurate diagnosis, selective surgery, radiation therapy, and chemotherapeutic drugs. Such advances actually have brought about a decrease in cancer deaths (at least in developed countries), and grounds for further optimism are seen in laboratory investigations into elucidating the causes and mechanisms of the disease.

Owing to continuing advances in cell biology, genetics, and biotechnology, researchers now have a fundamental understanding of what goes wrong in a cancer cell and in an individual who develops cancer—and these conceptual gains are steadily being converted into further progress in prevention, diagnosis, and treatment of this disease.

1. The Common Cold

The common cold is an acute viral infection that starts in the upper respiratory tract, sometimes spreads to the lower structures, and may cause secondary infections in the eyes or middle ears. More than 100 agents cause the common cold, including parainfluenza, influenza, respiratory syncytial viruses, and reoviruses. Rhinoviruses, however, are the most frequent cause.

The popular term common cold reflects the feeling of chilliness on exposure to a cold environment that is part of the onset of symptoms. The feeling was originally believed to have a cause-and-effect relationship with the disease, but this is now known to be incorrect. The cold is caught from exposure to infected people, not from a cold environment, chilled wet feet, or drafts. People can carry the virus and communicate it without experiencing any of the symptoms themselves. Incubation is short — usually one to four days. The viruses start spreading from an infected person before the symptoms appear, and the spread reaches its peak during the symptomatic phase.

Notable Exclusions: Cystic Fibrosis, Multiple sclerosis

CRYPTOCHIDISM: SIGNS AND SYMPTOMS

Cryptorchidism means "concealed testicle." It occurs when one or both testicles get stuck at some point in fetal descent.

Ectopic maldescent means one or both testicles have strayed from the normal path of descent. The usual place for a missing testicle is the groin.

Both these conditions are often called undescended testicles.

Description of Cryptorchidism (Undescended testicles)



The testes start to develop 40 days after conception. They grow inside the fetal abdomen. Near the end of the eighth month, they travel down the inguinal canal and through the abdomen wall. They reach their low-hanging position in the scrotum a few days before birth. A post-birth check ensures that they have safely descended.
Cryptorchidism is a congenital disorder when one or both of a newborn's testicles fail to descend into the scrotum. Although this condition may occur on both sides, it more commonly affects the right testis.

Because the testicles normally descend into the scrotum during the eighth month of gestation, undescended testicles most commonly affect newborns. In about 80 percent of affected infants, testicles descend spontaneously during the first year; in the rest, the testicles may or may not descend later.

Of full-term babies, 3.4 percent are born with undescended testicles. Of these, 50 percent descend in the first month of life.

Of premature babies, 30 percent have undescended testicles. Of these, 80 percent are safely down by the first month.

In most cases, the natural history of an undescended testis is spontaneous descent, usually occurring within the first year of life and, in most cases, within the first three months of life. If no descent is observed in the first 1 to 3 months, urologic consultation is indicated. If the bilateral condition persists untreated into adolescence, it may result in sterility, make the testicles more vulnerable to injury, and significantly increase the risk of testicular cancer and infertility.

Cryptorchidism on both sides can rarely be a sign of an inter-sex disorder. In particular, babies with absent testes on both sides and hypospadius (opening of the penis is located not at the tip but lower down on or toward the shaft) may rarely be genetic females. In any case where there is a double abnormality, expert consultation should be obtained before a baby is assigned a gender.

Retractile testicles is a related condition where the testes can be at times found within the scrotum and at times not. In more than half of all cases, this resolves without intervention. However, nearly 40% of boys with this condition will need intervention. They should be followed closely. A urologist can decide with the pediatrician when and if a procedure is needed.

Treatment of Cryptorchidism (Undescended testicles)
Treatment for cryptorchidsm includes both medical (hormonal) and surgical approach separately or in combination with one another. Procedures are usually completed between 6 and 24 for months of age for the best outcomes.

Medical Treatment:
Increasing the level of the male sex hormone testosterone can increase the likelihood that undescended testicles will move into the scrotum. This is done by either giving injections of human chorionic gonadotropin (hCG) or gonadotropin releasing analog (not approved in the United States). Both cause the testes to produce testosterone. The approach is most likely to work if the testes are already low and are not blocked or actually just retractile. Retractile testicles are sometimes in the scrotum or sometimes in the inguinal canal. This approach results in descent of 5-25% with about 25% of those for whom the treatment work relapsing.

Surgical Treatment:
The first step is to confirm the location of the testes (often can be felt in the inguinal canal). If a boy has non-palpable testicles, he may need exploratory surgery to determine if testes are present. In some cases, testes are completely absents (about 1/10 boys with undescended testicles). Consequently, diagnostic laparoscopy is often used first in these boys confirm the presence of testes before a full inguinal incision is made for the full orchiopexy. Once the location of the testes in confirmed, surgeons will perform the full procedure.

Orchiopexy is a surgical procedure that secures the proper position of a testicle in the scrotum. When successful, orchiopexy decreases the risk of sterility, testicular cancer, and testicular injury from abnormal positioning. If a testicle is missing or must be removed, a prosthesis is inserted to achieve a normal appearance and to foster the person's positive body image. Orchiopexy for correction of an undescended testicle is usually performed in children ages 1 to 6.

Orchiopexy is performed when other treatments such a hormonal therapy fail. It is performed under general anesthesia. If there is testicular torsion (twisting), the surgeon makes an incision in the scrotal skin and attempts to untwist and stabilize the spermatic cord. To treat an undescended testicle, the surgeon makes an incision in the groin or lower abdomen to expose the testicle and a small incision to open the scrotum. He or she then frees the testicle, lowers it into the scrotal sac, and secures it with stitches. If both testicles are undescended this procedure is repeated for the other testicle.

In two-stage orchiopexy, an alternative procedure, the surgeon brings the testicle down into the scrotal sac and stitches it to the thigh; then, 2 to 3 months later, she embeds it in the scrotal sac. If the spermatic cord is too short to accommodate repositioning the testicle, the surgeon may sever the spermatic cord before replacing the testicle in the scrotal sac. After completing the procedure, the surgeon closes the incision and applies a dressing. Complications of the procedure are uncommon but include hemorrhage, infection, and painful urination.

POST-TRAUMATIC STRESS DISORDER (PTSD): CAUSES AND DIAGNOSTIC

Post-traumatic Stress Disorder is a severe reaction to an extremely traumatic event. The person can actually experience the event (i.e. be in a plane crash) or be a witness to the event (i.e. rescue worker at a plane crash).

Over time and with psychological help, some people learn to cope with the aftermath of the event. However, for others, symptoms such as flashbacks and depression can become worse, lasting a long period of time, and seriously disrupting the person's life.


Sometimes symptoms do not begin until many months or even years after the traumatic event took place. If post-traumatic stress disorder has been present for 3 months or longer, it is considered chronic.

PTSD is an anxiety disorder which can affect both children and adults. About 7% of the population will develop PTSD in their lifetime; 5 million adults in the U.S. have PTSD during any given year.

Diagnostic Criteria for Post-traumatic Stress Disorder (PTSD)

The person has been exposed to a traumatic event in which both of the following were present:

• the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
• the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

The traumatic event is persistently reexperienced in one (or more) of the following ways:

• recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
• recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
• acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
• intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
• physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

• efforts to avoid thoughts, feelings, or conversations associated with the trauma
• efforts to avoid activities, places, or people that arouse recollections of the trauma
• inability to recall an important aspect of the trauma
• markedly diminished interest or participation in significant activities
• feeling of detachment or estrangement from others
• restricted range of affect (e.g., unable to have loving feelings)
• sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

• difficulty falling or staying asleep
• irritability or outbursts of anger
• difficulty concentrating
• hypervigilance
• exaggerated startle response

Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Causes of Post-traumatic Stress Disorder (PTSD)

Living through or seeing something that's upsetting and dangerous, psychological trauma, can cause PTSD. This can include:

• Being a victim of or seeing violence (kidnapping, torture, sexual abuse)
• The death or serious illness of a loved one
• War or combat
• Car accidents and plane crashes
• Hurricanes, tornadoes, and fires
• Violent crimes, like a robbery or shooting.

Studies indicate the amount of dissociation that directly follows a trauma predicts PTSD. Individuals who are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD.
There also seems to be a genetic component to post-traumatic stress disorder. PTSD runs in families. And, as with many psychological disorders, a person's temperament, brain chemistry and other environmental factors likely play a role in the development of PTSD. In addition, having an existing psychiatric disorder, a family history of depression, or a poor support system following a traumatic event are all risk factors for PTSD.

MOST EFFECTIVE ANTI-DEPRESSAT MEDICATION

Antidepressants are medicines used to help people who have depression. With the help of these depression medications, most people can achieve significant recovery from depression.

Antidepressant drugs are not happy pills, and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits, and should only ever be taken under a doctor's supervision. They are, however, one depression treatment option. Taking medications for depression is not a sign of personal weakness - and there is good evidence that they do help.

Whether antidepressant medication is the best treatment option depends on how severe the person's depression is, their history of illness, their age (psychological treatments are usually the first choice for children and adolescents), and their personal preferences. Most people do best with a combination of medications for depression and therapy.

For adults with severe depression, says psychiatrist, Petros Markou, M.D., there is strong evidence that antidepressants are more effective than any other treatment. If depression is mild or moderate, psychotherapy alone may be sufficient, though even in this case, short-term antidepressant drug treatment or herbal therapy can help people get to the point where they can engage in therapy and get some exercise (which is also thought to help improve mood).

How Antidepressants Work
Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters (such as serotonin and norepinephrine). Neurotransmitters are needed for normal brain function and are involved in the control of mood and in other responses and functions, such as eating, sleep, pain, and thinking.

Antidepressants help people with depression by making these natural chemicals more available to the brain. By restoring the brain's chemical balance, antidepressants help relieve the symptoms of depression.

Specifically, antidepressant drugs help reduce the extreme sadness, hopelessness, and lack of interest in life that are typical in people with depression. These drugs also may be used to treat other conditions, such as obsessive compulsive disorder, premenstrual syndrome, chronic pain, and eating disorders.

Typically, antidepressants are taken for 4 to 6 months. In some cases, however, patients and their doctors may decide that antidepressants are needed for a longer time.

Types of Antidepressants
There are many different kinds of antidepressants, including:
•Selective serotonin reuptake inhibitors (SSRIs)
•Tricyclic antidepressants (tricyclics)
•Others

Like most medicines, antidepressant drugs can cause side effects. Not all people get these side effects. Any side effects you have will depend on the medicine your doctor has chosen for you. Your doctor should talk to you about your medicine.

SSRI Antidepressants
SSRIs are a group of antidepressants that includes drugs such as escitalopram (brand name: Lexapro) citalopram (brand name: Celexa), fluoxetine (brand name: Prozac), paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft). Selective serotonin reuptake inhibitors act only on the neurotransmitter serotonin, while tricyclic antidepressants and MAO inhibitors act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body.

Selective serotonin reuptake inhibitors have fewer side effects than tricyclic antidepressants and MAO inhibitors, perhaps because selective serotonin reuptake inhibitors act only on one body chemical, serotonin. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, headache and sexual problems. People taking fluoxetine might also have a feeling of being unable to sit still. People taking paroxetine might feel tired. People taking sertraline might have runny stools and diarrhea.

Tricyclic Antidepressants
The tricyclics have been used to treat depression for a long time. They act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. They include amitriptyline (brand name: Elavil), desipramine (brand name: Norpramin), imipramine (brand name: Tofranil) and nortriptyline (brand names: Aventyl, Pamelor). Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.

Other Antidepressants
Other antidepressants exist that have different ways of working than the SSRIs and tricylics. Commonly used ones are venlafaxine, nefazadone, bupropion, mirtazapine and trazodone. Less commonly used are the monoamine oxidase inhibitors (MAOIs).

Some of the most common side effects in people taking venlafaxine (brand name: Effexor) include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased blood pressure, increased heart rate and increased cholesterol levels can also occur.

Nefazodone (brand name: Serzone) can give people headaches, blurred vision, dizziness, nausea, constipation, dry mouth and tiredness.

Bupropion (brand name: Wellbutrin) can cause agitation, insomnia, headache and nausea. Mirtazapine (brand name: Remeron) can cause sedation, increased appetite, weight gain, dizziness, dry mouth and constipation. Some of the most common side effects of trazodone (brand name: Desyrel) are sedation, dry mouth and nausea. MAOI antidepressants like phenelzine (brand name: Nardil) and tranylcypromine (brand name: Parnate) commonly cause weakness, dizziness, headaches and tremor.

Important Warning When Taking Antidepressants
The U.S. Food and Drug Administration (FDA) ordered makers of all antidepressant medications to include a "black box warning" (the most serious warning) on their products' labeling to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in children, adolescents and young adults (ages 18 to 24) during initial treatment (generally the first one to two months).

IMPORTANT SAFETY INFORMATION – Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Antidepressants increased the risk of suicidality (suicidal thinking and behavior) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of antidepressants in children, adolescents or young adults must balance the risk to clinical need. Patients of all ages started on antidepressant therapy should be closely monitored and observed for clinical worsening, suicidality or unusual changes in behavior, especially at the beginning of therapy or at the time of dose changes. This risk may persist until significant remission occurs. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Lexapro is not approved for use in pediatric patients.

Interactions of Antidepressants

Antidepressants Can Affect Other Medications You May Be Taking
Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant. When taken together, some medicines can cause serious problems.

Taking an MAOI antidepressant at the same time as any other antidepressants or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking a MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.

Another risk of antidepressants is serotonin syndrome, a drug reaction resulting from the over-stimulation of serotonin receptors. This can occur when an antidepressant is taken either with another antidepressant, with certain recreational and other drugs (see below), or more rarely, even when one antidepressant is taken alone. Symptoms include hyperactivity, mental confusion, agitation, shivering, sweating, fever, lack of coordination, seizure, and diarrhoea.

To minimise the risk of serotonin syndrome, there must be a 'washout' period of at least two weeks when switching from one antidepressant drug to another.

Drugs that may induce serotonin syndrome when taken with antidepressants (not a complete list)
•ecstasy
•cocaine
•lithium
•St John's wort (Hypericum) - herbal antidepressant
•diethylproprion - an amphetamine
•dextromethorphan - found in many cough suppressants
•Buspar (buspirone) - for anxiety
•Selgene, Eldepryl (selegiline) - for Parkinson's Disease
•anti-epileptics - Tegretol, Carbium, Teril (carbamazepine)
•analgesics - pethidine, Fortral (pentazocine), Tramal (tramadol), fentanyl
•anti-migraine drugs - Naramig (naratriptan), Imigran (sumatriptan), Zomig (zolmitriptan)
•appetite suppressants - phentermine and fenfluramine
•tryptophan - an amino acid
Which Antidepressant Drug Is Best For Me?
Because the neurotransmitters involved in the control of moods are also involved in other processes, such as sleep, eating, and pain, drugs that affect these neurotransmitters can be used for more than just treating depression. Headache, eating disorders, bed-wetting, and other problems are now being treated with antidepressants.

All antidepressant drugs are effective, but certain types work best for certain kinds of depression. For example, people who are depressed and agitated do best when they take an antidepressant drug that also calms them down. People who are depressed and withdrawn may benefit more from an antidepressant drug that has a stimulating effect.

Antidepressants Are Not A Magic Bullet
While antidepressant drugs help people feel better, they cannot solve problems in people's lives. Some mental health professionals worry that people who could benefit from psychotherapy rely instead on antidepressant drugs for a "quick fix." Others point out that the drugs work gradually and do not produce instant happiness. The best approach is often a combination of counseling and medicine, but the correct treatment for a specific patient depends on many factors. The decision of how to treat depression or other conditions that may respond to antidepressant drugs should be made carefully and will be different for different people.

THE IMPORTANCE OF POSTURE

We have become a sedentary society. From dawn to dusk we are busy sitting at a desk, sitting in front of the television, sitting while driving or sitting in front of the computer working. As a result, our body is only hunching unconsciously the whole time that we are conscious and awake. Having a good posture is seldom taken into account until back pain strikes. Its importance can’t be stressed enough as apart from instilling confidence in us; it has a direct impact on our mental and physical well-being as well. A poor posture reflects negatively on our self-confidence and intelligence. Not only does it strain the back, neck and vertebrae muscles, it also makes the body expend more energy to perform the simplest of activities such as breathing. If you look at models and celebrities, you will see that they exude supreme confidence and poise. This is because they never slouch and maintain good posture in whatever they do, be it sitting or standing. If you want to know more, explore the information below elaborating on the importance of good posture.

Information On Importance Of Posture

If you hunch for long hours, the blood flow to the back of the head will get restricted. This can cause tension headaches that can be a source of great botheration. Hence, it is important to keep your head vertical to your shoulders and your body straight.

Bad posture can cause energy levels to plummet. This happens because restricted airflow and muscular stress accelerates fatigue. Maintaining correct posture enables proper blood circulation.

Sitting incorrectly for hours together disturbs the smooth process of digestion. When we hunch or slump, the digestive organs get squeezed. Proper posture when adopted allows the smooth functioning of the digestive system. This is because no organ is turned or twisted as the process continues.

Your body becomes sturdier when you take care to have a good posture while doing different activities. This helps decrease the risk of injury as your body is able to withstand it better through balance. A badly postured body can find it difficult to balance itself even under normal circumstances.

It is widely believed in the scientific fraternity that extended hunching and strained neck muscles contribute to higher blood pressure. This kind of strain can trigger the brain cells to raise blood pressure as the body sits in the same position for a very long time without any physical movements to relax it.

Lungs cannot work at their optimum best when you are slouching. This is because slouching prevents the physical intake of a full breath and in turn aggravates your stress levels. On the other hand, retaining an erect back facilitates the inflow of air and facilitates relaxation.

The correct alignment of the spine is important for a proper posture. Sometimes, misalignment of the rib cage can occur if a vertebra gets out of alignment and it can be very painful for the person. Worse, it leads to further strain on the lungs and heart.

Poor posturing of the body forces the muscles to work harder to keep us upright and an undue physical stress on our musculoskeletal structure is created. This can disrupt the release and concentration of stress hormones in the body causing imbalances in the endocrine system. Hormones are vital to the overall health of the body and imbalances in them only trigger more complications. Good posture goes a long way in keeping hormonal issues at bay.

Incorrect body posture fills you with languor and dullness. It may sound incredible, but research has proved that rectifying your posture boosts your confidence levels. Good posture can literally alter your body’s chemistry and energy in an amazingly positive way.

So, now you know the importance of posture. The effects of posture encompass the respiratory, digestive, circulatory systems, as well as the musculoskeletal system.

KAWASAKI DISEASE

What is Kawasaki's disease?

Kawasaki's disease is an uncommon illness in children that is characterized by high fever of at least five days' duration together with at least four of the following five findings:

1. Inflammation with reddening of the whites of the eyes (conjunctivitis) without pus
2. Redness or swelling of the hands or feet, or generalized skin peeling
3. Rash
4. Lymph node swelling in the neck
5. Cracking inflamed lips or throat, or red "strawberry" tongue

The above criteria are used to make a diagnosis of Kawasaki's disease. The terminology "incomplete Kawasaki's disease" is sometimes used for patients with only some features of classical Kawasaki's disease.

What is mucocutaneous lymph node syndrome?

Mucocutaneous lymph node syndrome is the original name for Kawasaki's disease. The original name was quite descriptive because the disease is characterized by the typical changes in the mucous membranes that line the lips and mouth and by the enlarged and tender lymph nodes.

What are the usual symptoms and signs of Kawasaki's disease?

The usual symptoms and signs of Kawasaki's disease include

• fever,
• reddening of the eyes,
• cracked and inflamed lips and mucous membranes of the mouth with an inflamed "strawberry" tongue,
• ulcerative gum disease (gingivitis),
• swollen lymph nodes in the neck (cervical lymphadenopathy),
• and a rash that is raised and bright red.

The rash appears in a glove-and-sock fashion over the skin of the hands and feet. The rash becomes hard, swollen (edematous), and then peels off.

What are the less common findings?

Most of the common symptoms described above will resolve without complications, even if untreated. Less common findings include inflammation of the lining of the heart (pericarditis), joints (arthritis), or covering of the brain and spinal cord (meningitis), and the other heart complications listed below in the section on serious complications. The outlook (prognosis) for an individual affected is primarily determined by the seriousness of any heart complications.

What is the difference between Kawasaki's disease and Kawasaki's syndrome?

They are the same. Kawasaki's disease is also referred to as Kawasaki's syndrome. It was first described in the late 1960s in Japan by the pediatrician Tomisaku Kawasaki.

What causes Kawasaki's disease?

The cause is not known. Microorganisms and toxins have been suspected, but none has been identified to date. Kawasaki's disease is not felt to be a contagious illness. Genetic factors and the immune system seem to play roles in the disease, which is characterized by immune activation.

Who develops Kawasaki's disease?

Kawasaki disease typically affects children under 5 years of age. Only rarely does it affect children over 8 years of age, in which case it is sometimes referred to as atypical Kawasaki's disease.

How can Kawasaki's disease cause serious complications?

Children with Kawasaki's disease can develop inflammation of the arteries of various parts of the body. This inflammation of the arteries is called vasculitis. Arteries that can be affected include the arteries that supply blood to the heart muscle (the coronary arteries). Vasculitis can cause weakening of the blood vessels and lead to areas of vessel widening (aneurysms). Coronary aneurysms have been reported in up to 25% of those with Kawasaki's disease.

Because of the potential for heart injury and coronary aneurysms, special tests are performed to examine the heart. Children are typically evaluated with an electrocardiogram (EKG) and an ultrasound test of the heart (echocardiogram). Other arteries that can become inflamed include the arteries of the lungs, neck, and abdomen. These effects can lead to breathing problems, headaches, and pain in the belly, respectively.

What is the treatment for Kawasaki's disease?

Kawasaki's disease is treated with high doses of aspirin (salicylic acid) to reduce inflammation and to mildly thin the blood to prevent blood clot formation. Also used in treatment is gamma globulin administered through the vein (intravenous immunoglobulin or IVIG), together with fluids. This treatment has been shown to decrease the chance of developing aneurysms in the coronary arteries. Sometimes cortisone medications are given. Persisting joint pains are treated with anti-inflammatory drugs, such as ibuprofen (Advil) or naproxen (Aleve).

Plasma exchange (plasmapheresis) has been reported as effective in patients who were not responding to aspirin and gammaglobulin. Plasmapheresis is a procedure whereby the patient's plasma is removed from the blood and replaced with protein-containing fluids. By taking out portions of the patient's plasma, the procedure also removes antibodies and proteins that are felt to be part of the immune reaction that is causing the inflammation of the disease. Kawasaki's disease that is not responding to the traditional aspirin and gammaglobulin treatments can be deadly. Medications that block the effects of TNF (tumor necrosis factor), one of the messenger molecules in the inflammatory response, are being studied for use in these situations. Examples of TNF-blocking drugs are infliximab (Remicade) and etanercept (Enbrel). Further research is needed to design treatment programs for those who are failing conventional treatments. Pentoxifylline (Trental) is also being studied as a possible treatment for Kawasaki's disease.

What is the outlook (prognosis) for children with Kawasaki disease?

Kawasaki's disease generally resolves on its own after four to eight weeks.

However, the outcome is not so favorable in every case. Rarely, Kawasaki's disease can cause death from blood clots forming in abnormal areas of widening (aneurysms) of the heart arteries (coronary arteries). Those children with larger aneurysms have a worse prognosis because of this risk.

Researchers are searching for methods of detecting which children are at risk for the development of aneurysms of the coronary arteries. Further research is under way to investigate a variety of criteria for atypical variants of Kawasaki's disease that do not have classical presentations.

Kawasaki Disease At A Glance

• Kawasaki's disease is a syndrome of unknown cause that mainly strikes young children.
• Signs of the disease include fever and redness of the eyes, hands, feet, mouth, and tongue.
• The disease can be treated with high doses of aspirin (salicylic acid) and gammaglobulin.
• Kawasaki's disease usually resolves on its own within a month or two.
• Some children with Kawasaki's disease suffer damage to the coronary arteries.