Mga Pahina

CONGENITAL HEART DISEASE: TETRALOGY OF FALLOT

Tetralogy of Fallot consists of 4 features: a large ventricular septal defect, right ventricular outflow tract and pulmonary valve obstruction, right ventricular hypertrophy, and over-riding of the aorta. Symptoms include cyanosis, dyspnea with feeding, poor growth, and tet spells (sudden, potentially lethal episodes of severe cyanosis). A harsh systolic murmur at the left upper sternal border with a single 2nd heart sound (S2) is common. Diagnosis is by echocardiography or cardiac catheterization. Definitive treatment is surgical repair.

Tetralogy of Fallot (see Fig. 6: Congenital Cardiovascular Anomalies: Tetralogy of Fallot.) accounts for 7 to 10% of congenital heart anomalies. Associated anomalies include right aortic arch (25%), abnormal coronary artery anatomy (5%), stenosis of the pulmonary artery branches, presence of aorticopulmonary collateral vessels, patent ductus arteriosus, complete atrioventricular septal defect, atrial septal defect, additional muscular ventricular septal defects (VSDs), and aortic valve regurgitation.


Fig. 6
Tetralogy of Fallot.
Tetralogy of Fallot.
Pulmonary blood flow is decreased, the RV is hypertrophied, and unoxygenated blood enters the AO.
Systolic pressures in the RV, LV, and AO are identical. Level of arterial desaturation is related to severity of the RV outflow tract obstruction. Atrial pressures are mean pressures.
AO = aorta; IVC = inferior vena cava; LA = left atrium; LV = left ventricle; PA = pulmonary artery; PV = pulmonary veins; RA = right atrium; RV =right ventricle; SVC = superior vena cava.

Pathophysiology

The VSD is typically large; thus, systolic pressures in the right and left ventricles (and in the aorta) are the same. Pathophysiology depends on the degree of right ventricular outflow obstruction. A mild obstruction may result in a left-to-right shunt through the VSD; a severe obstruction causes a right-to-left shunt, resulting in low systemic arterial saturation (cyanosis) that is unresponsive to supplemental O2.

In some children with tetralogy of Fallot, most often those several months up to 2 yr of age, sudden episodes of profound cyanosis and hypoxia (tet spell) may occur, which may be lethal. A spell may be triggered by any event that slightly decreases O2 saturation (eg, crying, defecating) or that suddenly decreases systemic vascular resistance (eg, playing, kicking legs when awakening) or by sudden onset of tachycardia or hypovolemia. The mechanism of a tet spell remains uncertain, but several factors are probably important in causing an increase in right to left shunting and a fall in arterial saturation. Factors include an increase in right ventricular outflow tract obstruction and a decrease in systemic resistance—a vicious circle caused by the initial fall in arterial Po2, which stimulates the respiratory center and causes hyperpnea and increased adrenergic tone. The increased circulating catecholamines then stimulate increased contractility, which increases outflow tract obstruction.

Symptoms and Signs

Neonates with severe right ventricular outflow obstruction (or atresia) have severe cyanosis and dyspnea with feeding with poor weight gain. But those with mild obstruction may not have cyanosis at rest.

Tet spells may be precipitated by activity and are characterized by paroxysms of hyperpnea (rapid and deep respirations), irritability and prolonged crying, increasing cyanosis, and decreasing intensity of the heart murmur. The spells occur most often in young infants; peak incidence is age 2 to 4 mo. A severe spell may lead to limpness, seizures, and occasionally death. During play, some toddlers may intermittently squat, a position that increases systemic vascular resistance and aortic pressure, which decreases right to left ventricular shunting and thus raises arterial O2 saturation.

Auscultation detects a harsh grade 3 to 5/6 systolic ejection murmur at the left mid and upper sternal border. The murmur in tetralogy is always due to the pulmonary stenosis; the VSD is silent because it is large and has no pressure gradient. The 2nd heart sound is often single because the pulmonary component is markedly reduced. A prominent right ventricular impulse and a systolic thrill may be present.

Diagnosis

  • Chest x-ray and ECG
  • Echocardiography

Diagnosis is suggested by history and clinical examination, supported by chest x-ray and ECG, and established by 2-dimensional echocardiography with color flow and Doppler studies. Chest x-ray shows a boot-shaped heart with a concave main pulmonary artery segment and diminished pulmonary vascular markings. A right aortic arch is present in 25%. ECG shows right ventricular hypertrophy and may also show right atrial hypertrophy. Cardiac catheterization is rarely needed, unless there is suspicion of a coronary anomaly that might affect the surgical approach (eg, anterior descending arising from the right coronary artery) that cannot be clarified with echocardiography.

Treatment

  • For symptomatic neonates, prostaglandin E1 infusion
  • For tet spells, positioning, calming, O2, and sometimes drugs
  • Surgical repair

Neonates with severe cyanosis may be palliated with an infusion of prostaglandin E1 (0.05 to 0.1 μg/kg/min IV) to open the ductus arteriosus.

Tet spells: Tet spells are treated by placing infants in a knee-chest position (older children usually squat spontaneously and do not develop tet spells), establishing a calm environment, and giving O2. If the spell persists, options (roughly in order of preference) include morphine 0.1 to 0.2 mg/kg IV or IM, IV fluids for volume expansion, NaHCO3 1 mEq/kg IV, and propranolol starting at 0.02 to 0.05 mg/kg, titrated up to 0.1 to 0.2 mg/kg IV if needed for effect. If these measures do not control the spell, systemic BP can be increased with ketamine 0.5 to 3 mg/kg IV or 2 to 3 mg/kg IM ( ketamine also has a beneficial sedating effect) or phenylephrine starting at 5 μg/kg and titrating up to 20μg/kg IV for effect. Ultimately, if the preceding steps do not relieve the spell or if the infant is rapidly deteriorating, intubation with muscle paralysis and general anesthesia may be necessary. Propranolol 0.25 to 1 mg/kg po q 6 h may prevent recurrences, but most experts feel that even one significant spell indicates the need for expeditious surgical repair.

Definitive management: Complete repair consists of patch closure of the VSD, widening of the right ventricular outflow tract with muscle resection and pulmonary valvuloplasty, and a limited patch across the pulmonic annulus or main pulmonary artery if necessary. Surgery is usually done electively at age 3 to 6 mo but can be done at any time if symptoms are present.

In neonates and very small infants with complex anatomy, initial palliation may be preferred to complete repair; the usual procedure is a modified Blalock-Taussig shunt, in which the subclavian artery is connected to the ipsilateral pulmonary artery with a synthetic graft.

Perioperative mortality rate for complete repair is < 5% for uncomplicated tetralogy of Fallot. For untreated patients, survival rates are 55% at 5 yr and 30% at 10 yr.

Endocarditis prophylaxis is recommended preoperatively but is required only for the first 6 mo after repair unless there is a residual defect adjacent to a surgical patch or prosthetic material.

TOP 10 BLADDER SIGNS AND HOW TO MAKE IT STOP

When your bladder isn't as reliable as you'd like, all sorts of day-to-day situations become unexpectedly stressful. Who wants to worry about embarrassing leaks every time you sit down to giggle over an episode of Modern Family? Here are the top ten bladder triggers, and ways to keep them in check.

1. Laughing or sneezing

Why leaks happen

The pelvic floor muscles that support the bladder and urethra are weakened. So when you laugh, the sphincter muscle at the juncture between the urethra and bladder can't hold as tightly as it should.



What to do

Schedule bathroom trips at regular, set intervals. Learning to follow a bathroom schedule is known as bladder training, and over time it can help your bladder relearn how not to release unexpectedly.

Get a referral to a physical therapist who specializes in pelvic floor strengthening. You can learn exercises to regain control over these muscles.

Practice double voiding. If incontinence seems to be related to your bladder not emptying completely, returning to the bathroom after waiting a few minutes can help eliminate residual urine.

Don't get caught out. If you haven't been to the bathroom in a while and someone launches into a joke, don't feel self-conscious about excusing yourself. It's OK to say, "Hold that thought" so you don't miss out on a good laugh.

2. Running, jumping, and exercise

Why leaks happen

"Exercise-induced urinary incontinence" is the term for stress incontinence that happens during physical exertion. When the pelvic floor muscles weaken, the muscles of the bladder and the urethra don't have the support they need to tighten fully and retain urine. Running, jumping, kicking, and any serious exertion can cause a release.

What to do

Don't be afraid to talk about it. It might come as a surprise to know that 30 to 40 percent of women have this problem -- it's not the rare little secret you think it is. Ask your doctor for help.

Sign up for pelvic floor therapy. A specialist will put you through a program of Kegel exercises designed to build up strength in the deep abdominal muscles that support the bladder.

Be vigilant about bathroom trips. Go just before a run or game, and don't be self-conscious about excusing yourself to use the bathroom again during a session.

Don't overhydrate. One eight-ounce glass of water before you exercise is plenty, experts say, but many women drink much more. Save the rest for during and after your training.

Wear a tampon. Inserting a tampon puts pressure on the urethra through the vaginal wall. There are also medical devices called pessaries that do much the same thing.

3. Sex

Why leaks happen

Sexual activity puts pressure on the abdomen, urethra, and bladder, which can trigger stress incontinence. Stimulation and arousal can bring on urge incontinence.

What to do

Limit fluid intake for an hour prior to sex.

Use the bathroom just before sex.

Perform pelvic floor exercises regularly to build up bladder control. Hint: They make sex better too!

Choose sex positions that make incontinence less likely. With the woman on top, it's easier to control your pelvic muscles and the stress caused by penetration; entry from behind puts less pressure on the bladder and urethra.

4. Alcohol

Why leaks happen

Not only is alcohol a bladder stimulant, it's also a diuretic, causing your body to flush out water through the kidneys. So it's a double whammy for those struggling with incontinence.

What to do

Choose water-based mixed drinks. A gin and tonic -- with plenty of tonic -- is much easier on the bladder than straight whisky.

Don't add insult to injury. Mixing one bladder irritant -- alcohol -- with another, such as coke or a citrus juice, is just going to make leakage more likely.

Cut back on the celebrating. You'll enjoy the evening more if you stay dry even if you have to give up that second drink.

Remember your water chaser. Following wine, beer, or a mixed drink with water flushes the irritating alcohol out more quickly.

5. Coffee and tea

Why leaks happen

Caffeine is a double whammy for those with incontinence because it's a diuretic and it stimulates the bladder. So it makes you have to go more often -- and it makes you have to go now.

What to do

Eliminate caffeine as much as possible. That means black tea and chocolate as well as coffee, experts say. If you can't start your day without a cup of joe, keep the refills down, and follow it with a glass of water to dilute the stimulating effects. Also, limit your coffee and tea drinking to mornings. If you're going to be running to the bathroom, you don't want it to be when you're trying to sleep.
6. Soda pop

Why leaks happen

Soda pop can contain carbonation, caffeine, and cocoa-based flavorings, all of which are among the most irritating bladder triggers. And many experts say diet cola's worse than coffee for those with incontinence; with the addition of artificial sweeteners, it contains four different bladder irritants.

What to do

Experiment. When you need an ice-cold refresher, try other options such as lemonade, herbal ice tea, or fizzy water with a splash of juice. When trying to break a cola addiction, gradually reduce your daily intake rather than quitting cold turkey.
7. Medications

Why leaks happen

Medications that relax muscles in other parts of the body often relax the muscles of the bladder and urethra as well. Meanwhile, some medications cause you to produce and expel more urine, while others make you sleepy and less alert. Some examples:

Alpha-blocking medications that lower blood pressure, such as Cardura (doxazosin), Minipress (prazosin), and Hytrin (terazosin), weaken the bladder's ability to hold tight.

Diuretics such as Bumex (bumetanide), Lasix (furosemide), Aldactone (spironolactone), and all the thiazides cause your body to flush liquids.

Antidepressants and other drugs with anticholinergic effects, such as Norpramin (desipramine), Cogentin (benztropine), Haldol (haloperidol), and Risperdal (risperidone), block a neurotransmitter and in the process can cause bladder spasms.

Sedatives and sleeping pills such as Ativan (lorazepam), Valium (diazepam), Dalmane (flurazepam), Lunesta (eszopiclone), and Ambien (zolpidem) relax muscles and make you sleep extremely deeply.

What to do

Check side effects. If you think a medication is affecting your bladder, check the listed side effects to see if urinary problems or incontinence is among them. Even if it's not in the notes, that doesn't mean your experience is invalid. Keep track of how the drug is affecting you from day to day, then talk to your doctor about whether it's possible to switch to an alternative medication.
8. Urinary tract infections (UTIs)

Why leaks happen

When a urinary tract infection irritates the lining of your bladder, the result can be strong, sudden urges to urinate. And you may not even know you have a UTI; some are symptomless, at least at first. There may also be other symptoms, such as itching or burning, discharge, or a fishy or foul-smelling odor.

What to do

Get tested for any suspected case of a UTI.

If you seem to be getting frequent bouts of UTIs or an infection won't clear up, ask your doctor about interstitial cystitis, a chronic condition that can lead to incontinence.

9. Super-tight jeans, leggings

Why leaks happen

There's a reason your doctor tells you to wear loose-fitting clothing to prevent vaginal and urinary tract infections. Airflow prevents moisture from becoming trapped and providing a breeding ground for bacteria. Wearing tight jeans, "jeggings," or thick stretchy leggings for long periods of time can lead to UTIs and bladder infections, which in turn can cause incontinence.

What to do

Give your body a break. If you want to wear tight jeans for a hot date, do so, but slip into your comfies as soon as you get home.

Save exercise leggings for class; shower and change before heading home.

Choose cotton over nylon, and watch that lycra content. The more lycra in the fabric, the more elasticized it is.

Go one size larger.

10. Constipation

Why leaks happen

The lower colon and rectum are located near the bladder and share many of the same nerves. When you have hard, compacted stool in your rectum, these nerves become overactive, with the result that you have sudden and frequent urges to go.

What to do

Bulk up your diet with fiber. Fiber prevents constipation and has the additional benefit of making the urinary tract muscles function more effectively.

Take laxatives temporarily to clear your colon and rectum.

Drink plenty of water at regular intervals.

Eat more fruits and veggies. The water content in fruits and vegetables helps prevent constipation.

10 WAYS TO LIVE NORMALLY WITH A LEAKY BLADDER

Do you plan your day to make sure bathroom stops will be available at short notice and scope out buildings so you always know where the nearest bathroom is? Do you tell yourself to wait an hour for that glass of iced tea so you won't have to dash for the ladies'? If so, it's likely you have a condition called overactive bladder, or OAB. And if you're between 40 and 55, you may be one of the many women for whom OAB is a menopause- and age-related problem.

10 Ways to Live Normally With a Leaky Bladder

One comfort: You're in good company. Studies show overactive bladder affects at least -- and probably more than -- 17 percent of women in the U.S. Why more? Because this problem is vastly underreported, due to the embarrassment factor. (It's not the easiest thing to talk to your doctor about.) But help is available. In the meantime, here's what you should know about the connection between OAB and menopause -- along with available treatments.


What's the connection between menopause and OAB?

During perimenopause, the period leading up to menopause, and menopause itself, the level of estrogen -- which helps to keep the tissues of your bladder and urethra healthy -- begins to drop significantly. If you've begun to notice dryness and sensitivity during sex, it's likely you're at risk for bladder problems as well. The reason: Just as the tissues of the vaginal wall begin to thin and dry out, so does the tissue that lines the bladder. When that happens, your bladder becomes more sensitive to irritants and more susceptible to "hair-trigger" releases.

What's more, lack of estrogen can cause the pelvic muscles, which are responsible for maintaining bladder control, to weaken, eventually resulting in incontinence.

What kinds of bladder control problems can happen with menopause?

Overactive bladder problems take several forms:

Urgency: When you have to go, you have to go now.

Frequency: You have to go all the time, defined as a problem if you need to go more than eight times in a 24-hour period. And yes, this problem is a doozy for sleep disruption.

Urge incontinence: The need to go now comes on suddenly, and if life conspires to keep you from a bathroom, you're likely to have an accident.

How is overactive bladder diagnosed?

To diagnose a bladder control problem, your doctor will perform a physical exam, including a pelvic exam, and order lab tests to look for signs of a urinary tract infection or other problems. The doctor will likely ask you to keep a "voiding diary" in which you write down when you go, note any associated symptoms, and describe accidents or other problems. Keeping a diary can also help you reconstruct the circumstances prior to an accident (what you ate and drank beforehand, for example) or any overwhelming urges you can recall.

What treatments are available for menopause-related overactive bladder?

There are treatments for overactive bladder that help you control urges, treatments that strengthen muscles or improve muscle control, and treatments aimed to reduce irritation. Your primary care physician or a specialist can work with you to analyze the type of bladder problems you're having and devise the best treatment plan. Doctors are likely to suggest lifestyle changes, muscle-strengthening exercises, and bladder retraining before they start considering medications -- which might have side effects -- or surgery. What follows are the most common treatment strategies for bladder problems associated with menopause, in the approximate order a doctor might suggest them.

Treatments for menopause-related OAB

Dietary changes

Many women are surprised to learn how dramatically what they eat and drink can affect bladder function. With that in mind, try eliminating these foods and beverages -- all known to irritate the bladder, triggering urges -- one at a time:

coffee and black tea

citrus fruits and juices

chocolate

regular and diet sodas

alcohol

spicy foods

tomatoes and tomato-based foods and sauces

artificial sweeteners

vinegar and vinegar-based salad dressings

To protect your bladder from irritation and urges:

Drink eight glasses of water, spaced throughout the day.

Drink milk, almond milk, or soy milk to see if this soothes the bladder.

Take a probiotic supplement, which helps control yeast growth and promotes a healthy bladder.

Strengthening bladder muscles with Kegel exercises

With menopause and age, the pelvic floor muscles known as Kegels that control the bladder's ability to hold in urine can weaken. Strengthening these muscles is one of the best ways to control leakage. To do Kegel exercises, squeeze and hold the pelvic muscles and then relax them. You can locate these muscles by stopping the flow of urine midstream. Although it's possible to strengthen Kegels on your own, it's most effective to work with a nurse or physical therapist (PT) who specializes in pelvic floor strengthening.

Bladder retraining for OAB

Your bladder muscles have been conditioned over time to influence the sudden need to urinate -- probably in ways you're not even aware of. Bladder retraining is a therapeutic approach to relearning the ability to resist or inhibit the feeling of urgency. Working with a physical therapy nurse, you retrain your bladder by timing visits to the bathroom according to a strict schedule, gradually extending the intervals between bathroom visits. In addition, the therapist will teach you ways to distract yourself between bathroom visits. A bladder retraining program usually takes at least six to eight weeks to produce results.

Estrogen therapy

If your bladder symptoms first appeared during perimenopause or if you're experiencing other menopause-related symptoms, working with your ob/gyn to control these symptoms with hormone therapy may be the best solution. Many women find that vaginal estrogen, applied as a ring or cream, is extremely effective in treating overactive bladder. This is different from systemic hormone therapy, which uses oral hormones distributed throughout the body, and has fewer risks.

Weight loss

Weight gain -- often associated with menopause -- puts pressure on the bladder, urethra, and pelvic floor muscles. Many women have found that when they lose weight, their overactive bladder problems are gone along with the extra pounds. If you're overweight, try using your frustration with overactive bladder problems as a motivator to embark on a diet and exercise regime.

Other medications

A number of medications can help with OAB, but they're not usually the first treatments of choice, since they can have side effects. Known as anticholinergic agents, they block the action of acetylcholine, a neurotransmitter that stimulates the bladder to contract. By reducing contractions, they control sudden urges to go. Common brand names include Ditropan, Detrol, Oxytrol, Enablex, Sanctura, and Vesicare. The problem with anticholinergics is that they can block other bodily functions as well, causing side effects such as dry eyes, dry mouth, and constipation. Some women also report memory and cognitive problems from these medications.

Biofeedback

Many experts now recommend using biofeedback to aid in the process of retraining the bladder and strengthening pelvic floor muscles. Biofeedback uses electrodes to measure your heart rate, skin temperature, and breathing. It's designed to help you become more aware of your bladder and the muscles you use when you urinate, so you can develop more control.

Sacral nerve stimulation surgery

Electrically stimulating the nerves that control the bladder can greatly reduce or prevent incontinence. Sacral nerve stimulation uses a small neurotransmitter that's implanted under the skin and sends mild electrical impulses to a nerve located in the lower back (the sacral nerve) to influence the bladder and the pelvic floor muscles. The surgery doesn't have a permanent effect on nerves; it only works as long as the neurotransmitter is operational. This means it's a symptom treatment rather than a cure, but it also means it can be discontinued at any time.

THE EFFECTS OF RADIATION ON THE HUMAN BODY

Effects of Radiation on the Human Body

Radiation effects on the body

(1) Hair

The losing of hair quickly and in clumps occurs with radiation exposure at 200 rems or higher.

(2) Brain

Since brain cells do not reproduce, they won't be damaged directly unless the exposure is 5,000 rems or greater. Like the heart, radiation kills nerve cells and small blood vessels, and can cause seizures and immediate death.

(3) Thyroid

The certain body parts are more specifically affected by exposure to different types of radiation sources. The thyroid gland is susceptible to radioactive iodine. In sufficient amounts, radioactive iodine can destroy all or part of the thyroid. By taking potassium iodide, one can reduce the effects of exposure.

(4) Blood System

When a person is exposed to around 100 rems, the blood's lymphocyte cell count will be reduced, leaving the victim more susceptible to infection. This is often refered to as mild radiation sickness. Early symptoms of radiation sickness mimic those of flu and may go unnoticed unless a blood count is done.According to data from Hiroshima and Nagaski, show that symptoms may persist for up to 10 years and may also have an increased long-term risk for leukemia and lymphoma.

(5) Heart

Intense exposure to radioactive material at 1,000 to 5,000 rems would do immediate damage to small blood vessels and probably cause heart failure and death directly.

(6) Gastrointestinal Tract

Radiation damage to the intestinal tract lining will cause nausea, bloody vomiting and diarrhea. This is occurs when the victim's exposure is 200 rems or more. The radiation will begin to destroy the cells in the body that divide rapidly. These including blood, GI tract, reproductive and hair cells, and harms their DNA and RNA of surviving cells.

(7) Reproductive Tract

Because reproductive tract cells divide rapidly, these areas of the body can be damaged at rem levels as low as 200. Long-term, some radiation sickness victims will become sterile.

LUPUS: SYMPTOMS AND CURE

Lupus is an autoimmune condition wherein the immune system harms the healthy tissue and cells in the body. Individuals with lupus display varied symptoms based on the particulars of each case. These symptoms may be mild in some cases while severe in others. Some common and painful lupus symptoms include swollen and painful joints along with fatigue and unexplained fever.

A red skin rash called malar or butterfly rash is often one of the commonly observed lupus symptoms and it can be seen to appear across a patient’s cheeks and the nose. The rash may also be seen on the upper arms, face and the ears, chest, hands and the shoulders as well. People suffering from lupus are quite sensitive to sunlight and skin rashes tend to get worse on exposure to sunlight. So people with lupus often have to wear sun screen agents and avoid exposure to ultraviolet light.



Some other lupus symptoms include chest pain particularly on deep breathing, loss of hair, unexplained fever, photosensitivity, swollen legs and eyes, mouth and nose ulcers, fatigue and swollen glands. The symptoms of this condition may appear for some time and then disappear. Other symptoms include paleness or purple color in toes and fingers because of stress and cold.

Some people suffering from lupus may experience certain lupus symptoms such as dizziness, headaches, confusion, seizures and depression. Many people experience new and different symptoms and these symptoms may appear after the initial diagnosis and in some cases different symptoms may be observed at different points of time. In some cases only one part or system of body may be affected and this may include the joints or the skin. In some other cases individuals may experience varied symptoms in different parts.

The extent to which a person may be affected with lupus symptoms varies from case to case. Some patients may experience severe symptoms such as kidney inflammation and this can be determined from a swelling in the ankles. Some people may develop inflammation in the chest cavity lining. This can cause chest pain particularly when the patient tries to breathe. In some patients the condition can even affect the central nervous system and this can cause dizziness, headaches, vision problems, stroke, seizures and other changes in the behavior.

Vasculitis or inflammation of blood vessels may also be observed in some cases and some people may experience inflammation of the heart. Women suffering from lupus and who are pregnant are at a great risk of suffering from premature birth or experiencing a miscarriage. Those patients who have a history of possible kidney disease are at a greater risk of preeclampsia.

Some other lupus symptoms may include dry eyes, depression, anxiety, memory loss and easy bruising. Skin rashes, fatigue, aching joints, slight fever and anemia are most commonly seen in lupus patients. Following the treatment plan is important to ensure that the problems associated with lupus are managed properly. A healthy diet plan and moderate exercise along with minimizing of stress can help in reducing the symptoms and problems of this condition.

APPLES and ITS HEALTH BENEFITS

THE HEALTH BENEFITS OF APPLES

An Apple a day, keeps the doctors away. We've probably heard this phrase for a long time and a lot time by now. But what really are the health benefits of apples.
Health Benefits of Apples
First up, what really is an apple.

Apple is the pomaceous fruit of the apple tree, species Malus domestica. It is one of the most popular, healthy and widely cultivated tree fruits. It is one of the most recognizable fruit and is well loved.


Apples or eating it can help in lowering cholesterol, aiding digestion and detoxifying the body. 

Apples are abundant in Quercetin, a flavonoid, which helps prevent the growth of prostate cancer cells.

Apples are said to help in slowing down ageing-related problems, avoiding wrinkles and promoting hair growth.

Apples have been found to have a positive result on those suffering from risk of stroke, Type II diabetes and asthma.

Apples, because of the presence of flavonoids, inhibit the growth of carcinogenic substances in the bladder and thus, diminish the risk of bladder cancer, especially in smokers.

Eating apples has been long associated with improvement of the lung function.

Researches have suggested that apples may protect post-menopausal women from osteoporosis and may also increase bone density.

The antioxidants and flavonoids present in apples help in the reducing the risk of respiratory diseases like chronic obstructive pulmonary disease (COPD).

The fiber and phytonutrients present in apples help in the reduction of blood cholesterol and also improve bowel function. In fact, apple juice has been found to restrain the oxidation of the harmful cholesterol (LDL or low-density lipoprotein).

The phytonutrients present in the skin of apples have been found to inhibit the growth of colon cancer cells.

The presence of dietary fiber in apples helps in better digestion and also promotes weight loss.

Researches have also suggested that foods like apples, which contain flavonoids, might reduce the risk of lung cancer.

Apples are low in calories; 100 g of fresh fruit slices provide only 50 calories. They are however contain no saturated fats or cholesterol; but rich in dietary fiber which helps prevent absorption of dietary LDL cholesterol in the gut. The dietary fibers also help protect the mucous membrane of the colon from exposure to toxic substances by binding to cancer causing chemicals in the colon.

Apple fruit contains good quantities of vitamin-C and beta carotene. Vitamin C is a powerful natural antioxidant. Consumption of foods rich in vitamin C helps body develop resistance against infectious agents and scavenge harmful, pro-inflammatory free radicals from the body.

Apples are rich in antioxidant phyto-nutrients flavonoids and polyphenols. The total measured anti-oxidant strength (ORAC value) of 100 g apple fruit is 5900 TE. The important flavonoids in apples are quercetin, epicatechin, and procyanidin B2. Apples are also good in tartaric acid that gives tart flavor to them. These compounds help body protect from deleterious effects of free radicals.

In addition, apple fruit is a good source of B-complex vitamins such as riboflavin, thiamin and pyridoxine (vitamin B-6). Together these vitamins help as co-factors for enzymes in metabolism as well as in various synthetic functions inside the body.

Apple also contains small amount of minerals like potassium, phosphorus and calcium. Potassium in an important component of cell and body fluids helps controlling heart rate and blood pressure; thus counters the bad influences of sodium.



If symptoms persists consult you doctors!

LUPUS: SIGNS AND SYMPTOMS

Lupus is a chronic autoimmune disease in which the body's antibodies attack one's own tissues. Lupus attacks tissues such as the skin, muscles, tendons and ligaments as well as the kidneys, heart, lungs and brain.
Description of Lupus
Lupus frequently strikes women of childbearing years, however, it can affect both sexes from youth to the elderly and range in severity from mild to disabling.
In lupus, the regulation of the immune system goes awry and the body produces autoantibodies (antibodies that attack the patient's own tissues). This reaction results in inflammation that causes redness, pain and swelling in the affected parts of the body.
Lupus usually appears in one of two forms - systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE).



Systemic lupus erythematosus(SLE) is the most common form of lupus. "Systemic" means it can affect several parts of the body. A subtype of SLE is drug-induced lupus. Some medications uncommonly used for high blood pressure, heart disease and tuberculosis can cause this condition.
Discoid lupus erythematosus(DLE) involves inflammation of the skin only.

Causes and Risk Factors of Lupus
Although the causes of lupus are not completely understood, the disease is believed to result from an interplay of genetic, environmental (such as ultraviolet light, stress, infections, certain drugs and chemicals) and hormonal factors.
Symptoms of Lupus
The symptoms of lupus may include:
skin rash
pain and swelling in joints
muscle aches
fatigue
weight loss
hair loss
loss of appetite
lesions over the bridge of the nose and cheeks, and sometimes on the scalp. Lesions dry into scales that fall off the body, leaving scars (DLE only)
Raynaud's syndrome (a condition in which a sudden, severe reduction in blood flow causes fingers to turn waxy, white and blue and painfully cold)
Diagnosis of Lupus
A thorough medical history, a physical exam, laboratory testing and presence of several defining symptoms (listed below) will determine a positive diagnosis of lupus. According to the Lupus Foundation of America, there is no single laboratory test that can definitively determine whether a person has lupus. The following tests will aid in diagnosis of lupus by examining the status of the patient's immune system:
1. The anti-nuclear antibody test determines if the person has autoantibodies that react with components in cell nuclei. Almost all lupus patients will have a positive reaction to this test.
2. The anti-DNA antibody test determines if the patient has antibodies to DNA.
3. The anti-Sm antibody test looks for antibodies to a protein. While many lupus patients do not have anti-Sm antibodies, they are rarely found in people without lupus.
4. Tests for the presence of immune complexes (the combination of antibodies and the substances with which they react) in the blood are valuable, both for diagnosing and monitoring the disease.
5. An analysis of the serum complement level, which tends to fall when the disease is active, is also useful for both diagnosis and monitoring. The serum complement is a group of proteins involved in the inflammation that can occur in immune reactions.
The interpretation of the results of these tests is made even more difficult by the unpredictability of the disease. A test may be positive one time and negative the next, depending on whether the disease is active or in remission. Kidney and skin biopsies can also help with diagnosis. A kidney biopsy may show deposits of antibodies and immune complexes, and a sample of skin tissue may reveal deposits of antibodies and complement proteins.
According to the American College of Rheumatology, the presence of four or more of the following 11 symptoms and signs usually indicates a positive diagnosis of lupus:
Butterfly rash: a reddish eruption across the nose and cheekbones
Discoid lesions: reddish, raised, disk-shaped patches on the body
Photosensitivity of the skin: a red rash that results from sun exposure
Oral ulcers: sores in the mouth or nose that are usually painless but can be blister-like
Arthritis: inflammation characterized by tenderness and swelling in two or more peripheral joints
Chest/heart problems: breathing difficulty or chest pain, caused by inflammation of the lining of the chest cavity or heart, respectively
Neurological disorders: sudden onset of seizures or psychosis
Kidney disorders: kidney failure
Blood cell disturbances: hemolytic anemia (a deficiency in red blood cells, resulting from their abnormal destruction) or leukopenia (an excessively low white blood cell count)
Immunologic disruption: a dysfunctional immune system's attack on healthy cell tissue
Antinuclear antibodies (ANA): antibodies that battle cell nuclei
Treatment of Lupus
Because the symptoms of lupus vary not only in type but also severity, the treatment may also need to vary. It may take time to find the right combination of treatments for each individual. Treatments may include:
rest
exercise
physical therapy for muscle weakness
avoiding sun exposure
using medications such as:
anti-inflammatory drugs such as aspirin for symptomatic relief
corticosteroid drugs such as prednisolone for inflammation
antimalarial drugs such as chloroquine phosphate or hydroxychloroquine for rashes, arthritis and malaise
immunosuppressive and cytotoxic drugs such as Immuran (azathioprine) and Cytoxan (cycyclophosphamide) are prescribed with vital organs are involved and/or corticosteroids aren't effective

Medical Guidebook