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PARASOMNIAS: SLEEPWALKING

December 23rd, 2010 Posted in Anti Depressants-Sleeping Aid | No Comments »

Perhaps the strangest of all sleep disorders is sleepwalking, more technically known as somnambulism. Many of us can recall incidents where we, or our relatives, were discovered wandering about the house, seemingly wide awake but behaving in bizarre, funny, or sometimes dangerous ways. Come morning, sleepwalkers are completely unaware of their nocturnal perambulations and frequently wince as others recount the tales of their outrageous activities.
Sleepwalking episodes are probably directly related to deep sleep. The most striking symptom of the condition, of course, is what researchers call intense autonomic activation—or, in layman’s terms, unconscious movement. Sleepwalking activity may last anywhere from five minutes to half an hour but usually less than ten minutes. Walkers wear blank expressions (and sometimes not much else). They seem indifferent to the environment, for example, ignoring freezing cold and traipsing barefoot in the snow. Physically awake but mentally asleep, they demonstrate only a minimal level of awareness and reactivity but do exhibit some skill in maneuvering around objects. They know they are walking down steps, for example, and can open doors or use tools appropriately. By and large, however, their activity is purposeless and clumsy; they are unable to play the piano, for instance, or to prepare a meal. Somnambulists’ eyes are open, but they don’t see. A sleepwalker may talk, more or less coherently.
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PHYSICAL ACTIVITY AS A THERAPY FOR PARKINSON’S DISEASE

December 16th, 2010 Posted in Parkinson's | No Comments »

Clinical Studies
Physical activity is probably the most important adjunctive therapy for Parkinson’s disease, and can be beneficial for patients in all stages of the disease. Three key benefits of physical activity in Parkinson’s disease patients are:
1. Significant improvement in preventing the impairment in mobility and functional activity that results as a consequence of the major symptoms of the disease (i.e., bradykinesia, tremor, postural instability, and rigidity). This functional improvement is noted in all stages of the disease, even though physical activity has no direct effect on the symptoms per se.
2. Positive effects on mobility and mood. A regular and focused physical activity that includes aerobic, stretching, and strengthening activities – primarily aimed at improving flexibility and strength, rather than adding bulk – is necessary.
3. Energy preservation for the most important activities of the day. Physical activity counteracts fatigue, a major symptom of the disease.

Mechanisms
Tillerson et al showed a remarkable attenuation of the loss in striatal dopaminergic neurons with increasing levels of physical activity. However, the precise biochemical mechanisms underlying this process are currently unknown.
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сенная лихорадка

November 17th, 2010 Posted in Allergies, General health | No Comments »

ВТОРИЧНАЯ ПРОФИЛАКТИКА СЕННОЙ ЛИХОРАДКИ У ДЕТЕЙ
Вторичная профилактика, то есть предупреждение приступов сенной лихорадки (поллиноза) у детей, сводится к следующему:
- Не рекомендуется напоминать ребенку о его болезни, обсуждать в его присутствии тяжесть приступов. Наоборот, следует всячески подчеркивать временный характер нарушений в его состоянии здоровья и вселять уверенность в полной возможности выздоровления.
- Важно приучить ребенка вовремя ложиться спать и вставать. Дети в возрасте 6-10 лет должны спать 11 – 12 ч, а в 13-14 лет – не менее 10 ч. Перед сном нужно хорошо проветрить комнату.
- Питание ребенка должно быть полноценным, богатым витаминами. Следует избегать употребления в пищу консервированных продуктов, острых блюд и приправ, пряностей, особенно с резким запахом.
- При появлении у ребенка кашля, хрипов следует вспомнить, какие продукты питания включались в рацион накануне, чтобы выяснить возможный пищевой аллерген, который в дальнейшем придется исключить из диеты. Очень кислые и очень соленые продукты способствуют проявлению аллергических реакций.
- Следует вести пищевой дневник, куда надо записывать все продукты, которые употребляет ребенок в течение каждого дня. Тогда легче будет определить, какой из них сыграл роль аллергена. Таким аллергеном может оказаться продукт, который был добавлен к обычной пище, не вызывающей аллергической реакции.
- Важно подумать, как организовать летний отдых. Лучшие результаты достигаются от пребывания на даче, у реки или в той климатической зоне, где нет цветущих растений, трав, деревьев и кустарников, к которым имеется повышенная чувствительность. В других же случаях ребенка можно отправить на дачу только в тот сезон года, когда нет цветения растений, вызывающих аллергические реакции.

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CHRONIC CONFUSION: PARKINSON’S DISEASE

September 14th, 2010 Posted in General health | No Comments »
This is a condition that most people have heard of but very few know about. It was first described by James Parkinson in 1817 and his description of his first six cases has never been bettered.
He worked as a doctor in Shoreditch in the East End of London, and whilst out in the market one day he saw two men, both were running but the front one was upright and the one behind severely stooped and only kept from falling by the front man’s hand under his chin. He watched them run daily through the market area, and gradually got to know them. They were brothers, and as one became more bent over he could only stagger forwards, getting raster and faster, and would fall over without his brother’s help. Parkinson made a study of the stooped brother and over the years round five other cases that he wrote up for the medical journals, describing them as having the ‘shaking palsy’. His detailed assessment of the condition, later to be known as Parkinson’s disease, missed very few symptoms and signs. Parkinson did however state that he thought that in this condition the intellect was spared. This is now being questioned.
Parkinson’s disease is one of the most common neurological disorders of the elderly. It has many special features. One is the tremor of the fingers and hand. This usually starts on one side and is very rhythmical; the fingers are said to resemble someone who is ‘pill rolling’. There is difficulty in starting a movement so that getting out of a chair or bed can be very difficult. The muscles become more stiff and rigid so that movements are slow and the face becomes blank and staring as the facial muscles become affected. All movements become disordered and the person tends to fall easily because they cannot balance well, and as the disease progresses they tend to stoop forwards and hence fall forwards. To try and prevent overbalancing the person takes little fast steps and may find themselves at a trot like Parkinson’s first case.
The natural arm-swing goes, so the arms hang by the side and even the muscles in the gullet can be affected, making swallowing difficult. The skin can become very greasy with a tendency to spots, and the bladder can be affected, causing extreme urgency to pass urine and often incontinence. All these features may not occur at all in some people when the disease is very mild; for others the symptoms and signs described come on over years but can cause increasing severe disability – all aspects of daily life can be affected, even down to handwriting, so that letters and cheque signing become impossible and buttons and laces something to avoid.
It is not surprising that depression is very common in this condition. The expressionless face and slow, often whispered, speech can lead people to think that the person behind the mask is simple. As we shall see, chronic confusion can be a feature of the condition but for most sufferers their mind is alert, seemingly trapped in a body that won’t do what they want it to. The greasy skin and tendency to drool at the mouth adds to the distress and misery. Depression should always be looked for because it is, amenable to treatment and can make a lot of difference to the quality of life of the person with Parkinson’s disease.
Unfortunately, as the disease progresses, there is a tendency for the sufferer to become confused. At the end stages of the condition there appears to be an overlap with Alzheimer’s disease and the same changes are found in the brain. For many, this intellectual impairment occurs at the same time as the disease stops being sensitive to drug therapy and the two systems’ failures are often a terminal event. For some, however, the mental deterioration appears to occur earlier and this makes their management especially difficult. There is still debate as to whether these people are subjects with Parkinson’s disease who have also developed Alzheimer’s disease or whether their chronic confusion is another manifestation of the Parkinson’s disease.
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CONTROVERSIES IN REFRACTIVE EYE CARE

September 14th, 2010 Posted in General health | No Comments »
Next to the brain, the eye is the most complex organ in the human body. Like most any delicate and enormously intricate human body mechanism, unfortunately, the eye does not always function properly. Almost half a million people in the United States are legally blind and many others suffer from a wide range of visual disorders. They are especially subjected to refractive problems including myopia, hyperopia, presbyopia, and/or astigmatism.
Over the past decade, dramatic breakthroughs have been made in medical scientists* understanding of the eye. Vision experts are attaining more knowledge concerning the cause of eye difficulties, new scientific instruments to help detect eye trouble have been developed, and meaningful breakthroughs entailing surgical techniques to cure visual disorders have taken place. Yet, with all the breakthroughs in a diversity of eye care fields, controversy among people rendering professional health care services has arisen. Competition is keen. Sometimes the many contentions, particularly between optometrists and ophthalmologists or between optometrists and opticians or among opposing groups within the separate professions themselves are bitter and combative.
Disagreements among these eye care professionals, in particular those who treat refractive problems, are based upon the von Helmholtz theory. About 126 years ago Herman Ludwig Ferdinand von Helmholtz, M.D., the inventor of the ophthalmoscope, came up with the concept of accommodation on which orthodox ophthalmology and optometry are founded.  Dr. von Helmholtz claimed that accommodation is effected by the change in shape of the lens. In turn this change is governed by the action of the ciliary muscles, although he did not offer any reasonable explanation as to how the ciliary muscles operated. He also admitted that his theory was merely a probability because the image obtained on the lens was so variable and uncertain that to use his own words, it is “most usually so blurred that the form of the flame could not be definitely distinguished”.
Dr. von Helmholtz declared that nearsightedness and farsightedness, as well as most other errors of refraction, were fixed states. He stated unequivocally that these conditions could not be corrected. He believed that somewhere along the line either through birth or another reason these faults existed and there just was no cure for the situation. The only means of help, von Helmholtz said, was to wear artificial lenses so ground as to counteract the refractive error of the crystalline lens.
From the time of Dr. von Helmholtz’s statement to now, the entire medical profession and its various branches dealing with vision, such as ophthalmologists, opticians, and optometrists have accepted and followed the long standing principle. Millions of people around the world today wear lens corrections because of the von Helmholtz theory. Furthermore, the intraprofessional and interprofessional controversies arising from the theory’s interpretation for treatment have tended to alienate colleagues from each other.
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ALZHEIMER’S DISEASE: GETTING AN ACCURATE DIAGNOSIS

June 1st, 2010 Posted in General health | No Comments »
Because no technological advance has enabled us to see into the brain to prove that Alzheimer’s disease (or multi-infarct dementia) is there, experts estimate that an alarming 20 to 30 percent of the time people are wrongly diagnosed as having dementia when they actually have a treatable disease. Doctors may leap to a diagnosis of dementia in an older patient because they are conditioned to think that old age equals senility and are not skilled enough (or willing) to do the fine-grained testing needed to judge whether a dementing illness really does exist. The diagnosis of Alzheimer’s disease is made by exclusion, after a full medical and psychological evaluation has been done and when every other explanation for mental changes has been ruled out. Proof can be obtained only by autopsy, when the brain is examined directly. A surprising number of reversible conditions can look like Alzheimer’s disease.
Depression. On the surface, depression seems to have nothing in common with dementia. How can an emotional disorder look like pathology of the intellect? The reason is that a cardinal symptom of depression is intellectual change – cloudy thinking, problems in focusing, trouble in remembering what is going on. Unfortunately, these intellectual changes often appear in depressed older people without the gloomy attitude that cues doctors to depression – making the two illnesses sometimes very difficult to distinguish.
Physical illnesses. Because being sick almost always clouds our thinking, practically any illness can potentially be mistaken for dementia – the flu, an earache, even a bad cold. However, these illnesses in particular can produce the chronic mental confusion that makes a false diagnosis a special risk: metabolic problems such as thyroid dysfunction, kidney failure, Addison’s disease, hypoglycemia; cancer of the lung, breast, or other tissues; neurological disorders such as brain tumors, Parkinsonism, meningitis; and kidney and bladder infections.
Memory problems mislabeled dementia may occur after surgery, following an accident, or even from lying in bed for a few weeks. A person who is profoundly deaf may appear demented. If you ask your ninety-year-old mother a question and she stares blankly at you, it is surprisingly hard to tell whether the problem is her ears or her mind. A heart attack can be misdiagnosed as dementia too. Among the elderly, about 13 percent of the time mental confusion is its main or only symptom.
Medications. Medicines can impair thinking in people of any age. But drug-induced mental confusion is much more likely in later life, because our body metabolizes medications less effectively and we are more likely to be taking several types of drugs regularly.
People who take L-dopa, steroids, gentamicin, digitalis, antihypertensive medications, or tranquilizers are at special risk of being misdiagnosed as demented, because high doses of these drugs in particular produce symptoms that can look very much like Alzheimer’s disease. A poignant 1985 study involving the tranquilizer Valium amply demonstrates this. When researchers gave normal older people ten milligrams of Valium – a dose that, while large, is within the range a doctor might prescribe – they had problems on a memory test that were very similar to those of a comparison group suffering from Alzheimer’s disease.
Delirium is the medical term for the mental confusion many drugs and diseases cause. A person who rapidly becomes very confused and disoriented – within a few hours or days – is usually suffering from delirium. The hallmark of dementia is slow progression. Although people with dementia do vary in how well they can think on different days, when someone becomes delirious the shifts are dramatic – a rational human being is there one hour, the next a madman appears. And the delirious person may really look mad – perhaps seeing things on the wall or babbling incoherently. If you witness this type of transformation, get medical help immediately. The person may have a life-threatening problem or one that can cause permanent brain damage if not treated right away.
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GENERAL HEALTH

ALZHEIMER’S DISEASE: WHAT IS YOUR RISK OF GETTING IT?

June 1st, 2010 Posted in General health | No Comments »
Finding a genetic marker for Alzheimer’s disease brings us a step closer to developing a test to tell what a person’s chances are of getting this terrible disease. However, because scientists are just beginning to unravel the genetic determinants of the illness, this test may be years away. Statistics must suffice to answer that anxious question, ”How likely am I to get Alzheimer’s disease?”
If you have a strong family history – if several close family members developed the disease unusually early, before sixty or so – you do run a real risk. Otherwise the statistics are very comforting. Your chance of developing Alzheimer’s disease (or any other form of dementia) is small, at least until advanced old age. Alzheimer’s disease (and other old-age dementias) is illness of very late life – extremely rare before age sixty, uncommon but rising gradually in prevalence over the next two decades. Real vulnerability begins in the mid-eighties, when a significant minority of people does have serious memory problems. However, even among people hardy enough in body to live to one hundred, many survive sound in mind.
Interpret these statistics cautiously; the proportion of people with memory problems at each age varies greatly depending on the study we pick. The reason is not necessarily that older people in Japan are less (or more) prone to senility than residents of New York State but that the criteria for judging problems differ from survey to survey. And even some people diagnosed as having severe memory problems do not have dementia. They may have a treatable condition or even no intellectual deficit at all.
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GENERAL HEALTH

TRANSITIONS/CHANGES IN A CHILD’S LIFE: MOVING HOUSE AND GOING AWAY ON HOLIDAY

May 21st, 2009 Posted in General health | No Comments »

Moving house

This results in an upheaval for the whole family, especially the child. Parents need to prepare the child for the move, emphasising its positive aspects. Reassure the child that he will be able to maintain contact with all his old friends (provided this is possible, of course). For some time after the move, depending on the age of the child, he may feel a little insecure in his new surroundings. He may have separation anxiety about his parents or may want a night light kept on. It is important for parents to provide reassurance and support at this time.

This is stressful for a child at any age. He will have to get used to a new school environment and teacher, as well as leaving old friends and making new ones. Parents need to support the child during this time, and keep emphasising the positive aspects of the move.

Going away on holiday

Some children will find going on holiday stressful because of the change in routine. There will be a different environment, a different room, a different bed. Younger children may be insecure for a while. They should be encouraged to take a well-loved cuddly doll or bear, or a selection of favourite toys or books.

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OTHER WAYS OF REDUCING YOUR PAIN – INTRODUCTION

May 18th, 2009 Posted in Cancer | No Comments »

I believe that the effective use of painkillers is absolutely central to good pain control and that is why I have discussed this first. However, there are other ways of reducing your pain which you may also want to use. Choose the combination of painkillers and other approaches that gives you the greatest benefit for the least cost. For example, you can experiment to find the positions for sitting and lying that are most comfortable for you. You can try to avoid activities that aggravate your pain and to get plenty of rest. Heat on the painful spot can be very soothing— try using a good old hot water bottle! A gentle massage might help. Other possibilities that may appeal to you are meditation and acupuncture.

Whatever means you use to control it, your pain will be more of a problem at some times than at others. It will probably seem much worse when you are bored, lonely, depressed, anxious, frightened, physically tired or lying awake at night (the worst)! On the other hand, your pain is likely to seem less of a problem when you are in comfortable surroundings, have pleasant company, are keeping your mind occupied, sleeping well at night and at peace with yourself and your situation.

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VITILIGO; SEBORRHOEIC WARTS – GENERAL INFORMATION

May 18th, 2009 Posted in General health | No Comments »

Vitiligo is a condition where the skin loses its pigment and the patchy white areas may stand out markedly, especially when the person has an olive skin or gets a tan in summer.

It affects a little fewer than one in 200 people and does seem to run in families. It causes no serious problems but many sufferers are concerned by the appearance and because the skin which has lost its pigment may be easily burned.

Sometimes there is spontaneous repigmentation and the process may be assisted by the taking of drugs called psoralens and exposing the skin to ultra-violet light.

Treatment with UV light and psoralens is time-

consuming but those who are distressed by their condition may be willing to pay the price.

Those big, black, raised warts which appear in middle-age are unsightly and may frighten the owner into thinking they are malignant melanomas, a particularly dangerous form of skin cancer.

These are usually seborrhoeic warts. They are raised, with a bumpy surface and feel greasy to touch. They vary in color from grey through brown to black.

They may occur anywhere on the body but the front and particularly the back of the trunk are the favored sites.

Seborrhoeic warts rarely appear before the forties, may be single or dozens may be present. Treatment is only indicated for cosmetic reasons as they do not become cancerous.

They may be treated by the application of intense cold from liquid nitrogen or by heat from an electric cautery.

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