Congestive heart failure

Congestive heart failure (CHF), congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood through the body. It is not to be confused with "cessation of heartbeat", which is known as asystole, or with cardiac arrest, which is the "cessation of normal cardiac function" with subsequent hemodynamic collapse leading to death.

Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.

The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

Causes:
Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can be present without knowing it:

Coronary artery disease and heart attack- Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart's pumping ability.

High blood pressure (hypertension)- Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
Faulty heart valves- The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.
Damage to the heart muscle (cardiomyopathy)- Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can't be found, it's referred to as idiopathic dilated cardiomyopathy.
Myocarditis- Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
Heart defects present at birth (congenital heart defects)- If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
Abnormal heart rhythms (heart arrhythmias)- Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
Other diseases- Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

Symptoms:

Heart failure typically develops slowly and is a chronic, long-term condition, although you may experience a sudden onset of symptoms, known as acute heart failure. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.

Some of the signs and symptoms for chronic and acute heart failure are:

Chronic heart failure- Fatigue and weakness, Rapid or irregular heartbeat, Shortness of breath (dyspnea) when you exert yourself or when you lie down, Reduced ability to exercise, Persistent cough or wheezing with white or pink blood-tinged phlegm, Swelling (edema) in your legs, ankles and feet, Swelling of your abdomen (ascites), Sudden weight gain from fluid retention, Lack of appetite and nausea, Difficulty concentrating or decreased alertness, etc.

Acute heart failure- Signs and symptoms similar to those of chronic heart failure but more severe, and start or worsen suddenly, Sudden fluid buildup, Rapid or irregular heartbeat with palpitations that may cause the heart to stop beating, Sudden, severe shortness of breath and coughing up pink, foamy mucus, Chest pain if caused by a heart attack, etc.

Diagnosis:
To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination.

Blood tests- Your doctor may take a sample of your blood to check your kidney and thyroid function and to look for indicators of other diseases that affect the heart. In addition, your doctor may check your blood for specific chemical markers of heart failure, such as a hormone called brain natriuretic peptide (BNP). Although first identified in the brain, BNP is secreted by the heart at high levels when it's injured or overworked.
Chest X-ray- X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
Electrocardiogram (ECG)- This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
Echocardiogram- An important test for diagnosing and monitoring heart failure is the echocardiogram. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can't fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping by measuring the percentage of blood pumped out of your heart's main pumping chamber (the left ventricle) with each heartbeat. This measurement is called the ejection fraction.
Ejection fraction- Your ejection fraction is measured during an echocardiogram. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 60 percent — meaning 60 percent of the blood that fills the ventricle is pumped out with each beat.
Other imaging tests- They may be used to measure ejection fraction, including cardiac catheterization, multiple gated acquisition (MUGA) scanning of the heart, magnetic resonance imaging (MRI) and computerized tomography (CT).

Treatment:
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one, two or more of these drugs. Several types of drugs have proved useful in the treatment of heart failure. They include:

Angiotensin-converting enzyme (ACE) inhibitors- These drugs help people with heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens or dilates blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).
Angiotensin II (A-II) receptor blockers (ARBs)- These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.
Digoxin (Lanoxin)- This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with the condition.
Beta blockers- This class of drug slows your heart rate and reduces blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines also reduce the risk of some abnormal heart rhythms.
Diuretics- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix).
Aldosterone antagonists- These drugs include spironolactone (Aldactone) and eplerenone (Inspra). They're primarily potassium-sparing diuretics, but they have additional properties that help the heart work better, may reverse scarring of the heart and may help people with severe heart failure live longer.

***A medication called BiDil is a single pill that combines hydralazine and isosorbide dinitrate — both of which dilate and relax the blood vessels. BiDil increases survival when added to standard therapy in black people with advanced heart failure.***

Surgery and medical devices:
Researchers continue to search for new and better ways to treat heart failure. Some treatments being studied and used in certain people include:

Implantable cardioverter-defibrillators (ICDs)- An ICD is a device implanted under the skin and attached to the heart with small wires. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, the ICD shocks it back into normal rhythm. Sometimes a biventricular pacemaker is combined with an ICD for people with severe heart failure.
Cardiac resynchronization therapy (CRT) or biventricular pacing- A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles), so that they pump in synchrony and in a more efficient, coordinated manner. As many as half the people with heart failure have abnormalities in their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart's limited energy and may cause heart failure to worsen. Sometimes a biventricular pacemaker is combined with an ICD for people at greatest risk of rhythm problems.
Heart pumps- These mechanical devices, called left ventricular assist devices (LVADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. LVADs are now being considered as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with end-stage heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.

Coeliac disease

Coeliac disease, also spelled Celiac disease, is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. It is a digestive condition triggered by consumption of the protein gluten, which is found in bread, pasta, cookies, pizza crust and many other foods containing wheat, barley or rye. Oats may contain gluten as well. When a person with celiac disease eats foods containing gluten, an immune reaction occurs in the small intestine, resulting in damage to the surface of the small intestine and an inability to absorb certain nutrients from food.

Eventually, decreased absorption of nutrients (malabsorption) can cause vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment, which can lead to other illnesses. The decreased nutrient absorption that occurs in celiac disease is especially serious in children, who need proper nutrition to develop and grow.

No treatment can cure celiac disease. However, you can effectively manage celiac disease through changing your diet.

Causes:
Normally, your small intestine is lined with tiny, hair-like projections called villi. Resembling the deep pile of a plush carpet on a microscopic scale, villi work to absorb vitamins, minerals and other nutrients from the food you eat. Celiac disease results in damage to the villi. Without villi, the inner surface of the small intestine becomes less like a plush carpet and more like a tile floor, and your body is unable to absorb nutrients necessary for health and growth. Instead, nutrients such as fat, protein, vitamins and minerals are eliminated with your stool.

The exact cause of celiac disease is unknown, but it's often inherited. If someone in your immediate family has it, chances are 5 percent to 15 percent that you may as well. It can occur at any age, although problems don't appear until gluten is introduced into the diet.

Many times, for unclear reasons, the disease emerges after some form of trauma: an infection, a physical injury, the stress of pregnancy, severe stress or surgery.

Symptoms:
There are no typical signs and symptoms of celiac disease. Most people with the disease have general complaints, such as intermittent diarrhea, abdominal pain and bloating. Sometimes people with celiac disease may have no gastrointestinal symptoms at all. Celiac disease symptoms can also mimic those of other conditions, such as irritable bowel syndrome, gastric ulcers, Crohn's disease, parasite infections, anemia, skin disorders or a nervous condition.

Celiac disease may also present itself in less obvious ways, including irritability or depression, anemia, stomach upset, joint pain, muscle cramps, skin rash, mouth sores, dental and bone disorders (such as osteoporosis), and tingling in the legs and feet (neuropathy).

Some indications of malabsorption that may result from celiac disease include: Weight loss, Diarrhea, Abdominal cramps, gas and bloating, General weakness, Foul-smelling or grayish stools that may be fatty or oily, Stunted growth (in children), Osteoporosis, etc.

Diagnosis:
People with celiac disease carry higher than normal levels of certain antibodies (anti-gliadin, anti-endomysium and anti-tissue transglutaminase). Antibodies are specialized proteins that are part of your immune system and work to eliminate foreign substances in your body. In people with celiac disease, their immune systems may be recognizing gluten as a foreign substance and producing elevated levels of antibodies to get rid of it.

A blood test can detect high levels of these antibodies and is used to initially detect people who are most likely to have the disease and who may need further testing. To confirm the diagnosis, your doctor may need to microscopically examine a small portion of intestinal tissue to check for damage to the villi. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue.

A trial of a gluten-free diet also can confirm a diagnosis, but it's important that you not start such a diet before seeking a medical evaluation. Doing so may change the results of blood tests and biopsies so that they appear to be normal.

Treatment:
Celiac disease has no cure, but you can effectively manage the disease through changing your diet.

Once gluten is removed from your diet, inflammation in your small intestine will begin to subside, usually within several weeks. If your nutritional deficiencies are severe, you may need to take vitamin and mineral supplements recommended by your doctor or dietitian to help correct these deficiencies. Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people.

Improvements after starting a gluten-free diet may be especially dramatic in children. Not only do their physical symptoms improve, but also their behavior improves. In addition, their growth starts to pick up.

Your doctor may recommend that you meet with a dietitian who can instruct you on a gluten-free diet. There are still many basic foods allowed in a gluten-free diet. These include:

* Fresh meats, fish and poultry (not breaded or marinated).
* Most dairy products.
* Fruits.
* Vegetables.
* Rice.
* Potatoes.
* Gluten-free flours (rice, soy, corn, potato).

Most foods made from grains contain gluten. Avoid these foods unless they're labeled as gluten-free or made with corn, rice, soy or other gluten-free grain.

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, variably debilitating disorder of uncertain cause/causes. It is a complicated disorder characterized by extreme fatigue that doesn't improve with bed rest and may worsen with physical or mental activity. Chronic fatigue syndrome may occur after an infection, such as a cold or viral illness. The onset can be during or shortly after a time of great stress, or chronic fatigue syndrome come on gradually without a clear starting point or obvious cause. Women are diagnosed with chronic fatigue syndrome far more often than men are. However, it's unclear whether chronic fatigue syndrome affects women more frequently or if women report it more often than men do. Treatment for chronic fatigue syndrome focuses on a combination of approaches to relieve signs and symptoms.

Causes:
Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike definite infections, it has no clear cause. Several possible causes have been proposed, including:

* Depression.
* Iron deficiency anemia.
* Low blood sugar (hypoglycemia).
* History of allergies.
* Virus infection, such as Epstein-Barr virus or human herpesvirus 6.
* Dysfunction in the immune system.
* Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands.
* Mild, chronic low blood pressure (hypotension).

The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood as in other autoimmune diseases, such as rheumatoid arthritis and lupus. Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system.

Symptoms:
Chronic fatigue syndrome is a flu-like condition that can drain your energy and, sometimes, last for years. People previously healthy and full of energy may experience a variety of signs and symptoms.
Primary- Loss of memory or concentration, Sore throat, Painful and mildly enlarged lymph nodes in your neck or armpits, Unexplained muscle soreness, Pain that moves from one joint to another without swelling or redness, Headache of a new type, pattern or severity, Sleep disturbance, Extreme exhaustion lasting more than 24 hours after physical or mental exercise, etc.
Additional signs and symptoms-Abdominal pain, Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise, Bloating, Chest pain, Chronic cough, Diarrhea, Dizziness, balance problems or fainting, Dry mouth, Earache, Irregular heartbeat, Jaw pain, Morning stiffness, Nausea, Chills and night sweats, Psychological problems, such as depression, irritability, anxiety disorders and panic attacks, Shortness of breath, Tingling sensations, Visual disturbances, such as blurring, sensitivity to light, eye pain and dry eyes, Weight loss or gain, etc.

Diagnosis:
A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms.

In general, doctors find it difficult to diagnose chronic fatigue syndrome because it has some of the same signs and symptoms as many other diseases. There's no diagnostic or laboratory procedure to confirm the presence of chronic fatigue syndrome.

Doctors exclude certain conditions before considering a diagnosis of chronic fatigue syndrome. These include:

* Having an active, identifiable medical condition that often results in fatigue, such as low levels of thyroid hormones (hypothyroidism) or sleep apnea.
* Using medicines that may cause fatigue.
* Having a relapse of a previously treated illness that can result in fatigue, such as cancer.
* Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness, such as schizophrenia or an eating disorder.
* Abusing alcohol or another substance.
* Being severely obese, as defined by a body mass index (BMI) of 45 or greater.

Over time, be alert to any new cues that might indicate that the problem is caused by something other than chronic fatigue syndrome. When other diseases or conditions are excluded, your doctor may then determine if your illness meets the CFS-specific criteria.

Treatment:
There's no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a combination of treatments, which may include:

Moderating daily activity- Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal should be to maintain a moderate level of daily activity and gently increase your stamina over time.
Cognitive behavior therapy- This treatment, often used in combination with graduated exercise, also has been found to improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health professional to identify negative beliefs and behaviors that might be delaying your recovery and replace them with healthy, positive ones.
Treatment of depression- If you're depressed, medications, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), may help. Antidepressants may also help improve sleep and relieve pain. Tricyclic antidepressants include amitriptyline (Limbitrol, a multi-ingredient drug that contains amitriptyline), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin).
Treatment of existing pain- Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), may be helpful to reduce pain and fever.
Treatment of allergy-like symptoms- Antihistamines, such as fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.
Treatment of low blood pressure (hypotension)- The drugs fludrocortisone (Florinef), atenolol (Tenormin) and midodrine (ProAmatine, Orvaten) may be useful for certain people with chronic fatigue syndrome.
Treatment for problems of the nervous system- Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.

Chromoblastomycosis

Chromoblastomycosis is a long-term fungal infection of the skin and subcutaneous tissue (a chronic subcutaneous mycosis). The infection occurs most commonly in tropical or subtropical climates, often in rural areas. It can be caused by many different type of fungi which become implanted under the skin, often by thorns or splinters. Chromoblastomycosis spreads very slowly; it is rarely fatal and usually has a good prognosis, but it can be very difficult to cure. There are several treatment options, including medication and surgery.

Forms of the disease:

* cicatricial
* nodular
* plaque
* tumorous
* verrucous

Histopathology:
The skin lesions show a hyperkeratous pseudoepitheliomatous hyperplasia and keratolytic microabscesses in the epidermis. Dematiaceous hyphae and sclerotic bodies are found in the stratum corneum, with essentially only sclerotic bodies found in the areas of dermal inflammation. The sclerotic bodies are round, thick-walled, muriform, chestnut brown, and 5-12 µm in diameter. Brain abscesses are typically multilocular and well demarcated with thick walls. Irregular dematiaceous hyphae are seen in these abscesses.

Diagnosis:
The most informative test is to scrape the lesion and add potassium hydroxide (KOH), then examine under a microscope. (KOH scrapings are commonly used to examine fungal infections.) The pathognomonic finding is observing Medlar bodies, sclerotic cells. Scrapings from the lesion can also be cultured to identify the organism involved. Blood tests and imaging studies are not commonly used.

Treatment:
Chromoblastomycosis is very difficult to cure. There are two primary treatments of choice. Itraconazole, an antifungal azole, is given orally, with or without flucytosine (5-FC). Alternatively, cryosurgery with liquid nitrogen has also been shown to be effective. Other treatment options are the antifungal drug terbinafine, an experimental drug posaconazole (noxafil), and heat therapy. Antibiotics may be used to treat bacterial superinfections.

Chicken Pox

Chickenpox is one of the five classical childhood exanthems or rashes, once a cause of significant morbidity and mortality, but now chiefly of historical importance—it was formerly one of the childhood infectious diseases caught by and survived by almost every child.

Chicken pox is a highly contagious viral infection caused by the varicella virus. The word chickenpox comes from the Old English word "gican" meaning "to itch" or from the Old French word "chiche-pois" for chickpea, a description of the size of the lesion.

Chickenpox has a 10-21 day incubation period and is highly contagious through physical contact two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox.

Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and those with a suppressed immune system being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the fetus.

Causes:

Chickenpox is a disease of childhood - 90% of cases occur in children aged 14 years and younger. Before widespread vaccination, the incidence of chicken pox in the United States approached the annual birth rate, averaging between 3.1 and 3.8 million cases per year. Chicken pox can occur at any time, but occurs most often in March, April, and May in temperate climates.
Chicken pox is acquired by direct contact with infected blister fluid or by inhalation of respiratory droplets. When a person with chicken pox coughs or sneezes, they expel tiny droplets that carry the varicella virus. A person who has never been exposed to chicken pox inhales these droplets and the virus enters the lungs, and then is carried through the bloodstream to the skin where it causes a rash. While the virus is in the bloodstream (before the rash begins) it causes typical viral symptoms like fever, fatigue, joint pains, headache, and swollen glands. These symptoms usually resolve by the time the rash develops.

Symptoms:
Symptoms of chicken pox include that:

* children sometimes have a prodrome of fever, malaise, headache, lack of appetite, and mild abdominal pain for 1 to 2 days.
* the rash typically appears first on a child's trunk, scalp, and face and consists of small, very itchy, flat red spots, which then turn into raised fluid filled vesicles, often described as looking like a 'dewdrop' that become umbilicated and cloudy and eventually crust over.
* the fever only lasts about 2 to 4 days.
* new 'crops' of the rash on the child's trunk and then arms and legs continue for about 4 days
* all of the lesions are crusted over about 6 to 7 days after the illness begins.
* the crusts then fall off in another 7 days, although it sometimes takes up to 20 days, usually without scarring.

Facts:
* The average child with chicken pox gets about 300 lesions.
* It is very typical or characteristic for children with chicken pox to have lesions in different stages at the same time, including the first flat red spots, the fluid filled vesicles, and the crusted vesicles.
* The fever with chicken pox usually ranges from 100 to 102 degrees Fahrenheit, but may be as high as 106 degrees in some cases.
* Children with chicken pox are contagious for 1 or 2 days before they develop a rash and until all of their vesicles have crusted.
* Chicken pox crusts that are scratched off or infected may lead to scars.
* Children who have chicken pox after having the chicken pox vaccine often have an atypical case, with much milder symptoms and fewer lesions.

Diagnosis:
Chicken pox is typically diagnosed clinically based on the history of viral symptoms and the characteristic appearance of the rash. However, sometimes chicken pox can be confused with herpes simplex, impetigo, insect bites, or scabies. Sometimes a viral culture can be performed to confirm the diagnosis, but it takes from 1 to 14 days to get the results.

Treatment:
Because chicken pox is usually a benign self-limited disease, treatment is typically aimed at treating symptoms and making the patient more comfortable. In some cases, the antiviral medication acyclovir may be used to treat chicken pox.

Patients with chicken pox typically have viral-type, prodromal symptoms such as headache, fever, fatigue, and muscle aches. These symptoms can be treated with acetaminophen (Tylenol) with doses determined by the weight of the patient.

Frequent baths are sometimes helpful to relieve itching. Adding finely-ground (colloidal) oatmeal such as Aveeno can help improve itching. Oatmeal baths can be prepared at home also by grinding or blending dry oatmeal into a fine powder and adding about 2 cups to the bath water. One-half to one cup of baking soda may also be added to bath water to reduce itching.

Over-the-counter and prescription antihistamines may be used to control severe itching. Diphenhydramine (Benadryl) is available over-the-counter and hydroxyzine (Atarax) is available by prescription. Both of these antihistamines cause drowsiness and may be helpful at night to help the patient sleep. The newer antihistamines such as loratadine (Claritin), certrizine (Zyrtec), and fexofenadine (Allegra) can be used to control itching but do not cause drowsiness.

Cataract

A Cataract is a condition that develops in the lens of the eye. Cataracts are made from a protein that has altered from its natural state (denaturation), distorting and eventually prohibiting required light from entering into the retina, the part of the eye that receives light. Often cataracts cause no problems for many years but as the cataracts matures the cloudiness increases on the lens, the light reaching the retina decreases and significant sight loss and perhaps blindness can result.

Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated. Moreover, with time the cataract cortex liquefies to form a milky white fluid in a Morgagnian Cataract, and can cause severe inflammation if the lens capsule ruptures and leaks. Untreated, the cataract can cause phacomorphic glaucoma.

Classification:

The following is a classification of the various types of cataracts. This is not comprehensive and other unusual types may be noted.

Classified by etiology:
* Age-related cataracts
1) Immature Senile Cataract (IMSC) - partially opaque lens, disc view hazy
2) Mature Senile Cataract (MSC) - Completely opaque lens, no disc view
3) Hypermature Senile Cataract (HMSC)-Liquefied cortical matter: Morgagnian Cataract

* Congenital cataracts
1) Sutural cataract
2) Lamellar cataract
3) Zonular cataract
4) Total cataract

* Secondary cataracts
1) Drug-induced cataract (e.g. Corticosteroids)

* Traumatic cataracts
1) Blunt trauma (capsule usually intact)
2) Penetrating trauma (capsular rupture & leakage of lens material occurs)

Classified by location of opacity within lens structure:
* Anterior cortical cataracts
* Anterior polar cataracts
* Anterior subcapsular cataracts
* Nuclear cataracts
1) Grey
2) Yellow
3) Amber
4) Brown/Black

* Posterior cortical cataracts
* Posterior polar cataracts
* Posterior subcapsular cataracts (PSC)

Causes:
Cataracts develop from a variety of reasons, including long-term ultraviolet exposure, exposure to radiation, secondary effects of diseases such as diabetes, hypertension and advanced age; they are usually a result of denaturation of lens proteins. Genetic factors are often a cause of congenital cataracts and positive family history may also play a role in predisposing someone to cataracts at an earlier age, a phenomenon of "anticipation" in pre-senile cataracts. Cataracts may also be produced by eye injury or physical trauma. A study among Icelandair pilots showed commercial airline pilots as three times more likely to develop cataracts than people with non-flying jobs. This is thought to be caused by excessive exposure to radiation coming from outer space. Cataracts are also unusually common in persons exposed to infrared radiation, such as glassblowers who suffer from "exfoliation syndrome". Exposure to microwave radiation can cause cataracts.

Cataracts may be partial or complete, stationary or progressive, hard or soft.

Some drugs can induce cataract development, such as Corticosteroids and anti-hyperlipidemics like Ezetimibe.

Symptoms:

The most common symptom of cataracts is the noticeable blurring and worsening of vision. Other symptoms include the dimming and fading of colors, decreased night vision, problems with bright lights and sunshine, and in many cases, regular visits to the ophthalmologist for changes in glasses and contact lens prescriptions as vision worsens. Some patients report double vision in the affected eye although this symptom seems to decrease or disappear entirely as the cataracts grows.

If an individual's eyesight grows progressively worse, it is best to schedule a visit to an eye specialist as soon as possible. They will be able to assist with a diagnosis of the problem and available treatments if required.

Diagnosis:

In many cases, the diagnosis of a cataract is fairly simple. However, in the prenatal population, although diagnosis is possible it is a bit more difficult. Ultrasounds have proven an effective method to detect cataracts in unborn children. It is imperative that they be detected early if present as cataracts in babies can result in blindness for life if not treated properly and quickly soon after birth.
The most common way for an age-related cataracts to be diagnosed is during a routine eye exam.
During an eye exam, performed by an ophthalmologist or optometrist, there are several tests which may be administered to check for the presence of a cataracts.

* A visual acuity test will measure how well the individual can see while standing at various lengths from the cue card.
* A slip lamp exam uses a specialized microscope to increase the magnification of the eye. The specialist can then examine the eye in detail and up close.
* A tonometry test is a standard test which measures the fluid pressure inside the eye. The major finding in this test, if an increased pressure is detected, is the possibility of glaucoma.
* A dilated eye exam dilates the pupil. In this manner, the specialist is better able to view the lens to check for the present of a cataracts.

Treatment:
Natural-
* Limit consumption of lactose-containing foods (milk products). In animal studies, galactose, a component of lactose, has been shown to promote cataracts formation.
* A riboflavin deficiency has been implicated in cataracts development. Therefore, a supplemental dosage of riboflavin, 10-50 mg/day, may help treat or at least slow the progression of cataracts formation.
* Quercetin is recommended in a dosage of 500-1000 mg/day. WARNING: Quercetin may increase the possibility of birth defects in pregnant women and is not recommended during pregnancy.
* A supplemental dosage of 15-50 mg/day of zinc along with 2-3 mg/day of copper may help with cataracts.
* Taking Vitamin C, 1000 mg, two times a day may help to decrease damage caused by free radicals, in turn helping to treat cataracts.
* Supplementing the diet with Vitamin E at 400-800 IU/day plus selenium at 200-300 mcg/day has effectively cured cataracts in dogs.
* 200-600 mg/day of N-Acetylcysteine (NAC) along with zinc and copper may treat cataracts by working to destroy free radicals.

Surgery-
The most effective and common treatment is to surgically remove the cloudy lens. There are two types of surgery that can be used to remove cataracts: extra-capsular (extracapsular cataract extraction, or ECCE) and intra-capsular (intracapsular cataract extraction, or ICCE).

Extra-capsular (ECCE) surgery consists of removing the lens but leaving the majority of the lens capsule intact. High frequency sound waves (phacoemulsification) are sometimes used to break up the lens before extraction.

Intra-capsular (ICCE) surgery involves removing the entire lens of the eye, including the lens capsule, but it is rarely performed in modern practice. In either extra-capsular surgery or intra-capsular surgery, the cataractous lens is removed and replaced with a plastic lens (an intraocular lens implant) which stays in the eye permanently.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) or Median Neuropathy at the Wrist is a medical condition in which the median nerve is compressed at the wrist, leading to pain, paresthesias, and muscle weakness in the forearm and hand. A form of compressive neuropathy, CTS is more common in women than it is in men and, though it can occur at any age, has a peak incidence around age 42. The lifetime risk for CTS is around 10% of the adult population.

Most cases of CTS are idiopathic (without known cause). Repetitive activities are often blamed for the development of CTS along with several other possible causes. However, the correlation is often unclear.

It is a multi‐faceted problem and can therefore be challenging to treat. Still, there are a multitude of possible treatments: treating any possible underlying disease or condition, immobilizing braces, physiotherapy, massage therapy, medication, prioritizing hand activities, ergonomics, et cetera. Ultimately, carpal tunnel release surgery may be required in which outcomes are generally good.

The condition was first noted in medical literature in the early 1900s.

Causes:

The cause of carpal tunnel syndrome is pressure on the median nerve. The median nerve is a mixed nerve, meaning it has a sensory function and also provides nerve signals to move your muscles (motor function). The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger.

Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Causes might include anything from bone spurs to the most common cause, which is swelling or thickening of the lining and lubricating layer (synovium) of the tendons in your carpal tunnel.

The exact cause of the swelling usually isn't known, but a variety of conditions and factors can play a role:

* Other health conditions. Some examples include rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders and menopause — fluid retention due to pregnancy, or deposits of amyloid, an abnormal protein produced by cells in your bone marrow.
* Repetitive use or injury. Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, also can increase pressure within the carpal tunnel. Injury to your wrist can cause swelling that exerts pressure on the median nerve.
* Physical characteristics. It may be that your carpal tunnel is more narrow than average. Other less common causes include a generalized nerve problem or pressure on the median nerve at more than one location.

Symptoms:

Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm. Other common carpal tunnel syndrome symptoms include:

* Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This sensation often occurs while driving a vehicle or holding a phone or a newspaper or upon awakening. Many people "shake out" their hands to relieve their symptoms.
* Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on palm side of your forearm.
* A sense of weakness in your hands and a tendency to drop objects.
* A constant loss of feeling in some fingers. This can occur if the condition is advanced.

Diagnosis:

If you have signs and symptoms of carpal tunnel syndrome, your doctor may recommend the following diagnostic tests:

* Electromyogram- Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. This test can help determine if muscle damage has occurred.
* Nerve conduction study- In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.

Treatment:

Most people with carpal tunnel syndrome experience effective treatment with nonsurgical methods, including:

* Wrist splinting- A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely to help you if you've had only mild to moderate symptoms for less than a year.
* Nonsteroidal anti-inflammatory drugs- NSAIDs may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition. If no inflammatory condition is involved, NSAIDs are unlikely to help relieve your symptoms.
* Corticosteroids- Your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone, to relieve your pain. Corticosteroids decrease inflammation, thus relieving pressure on the median nerve. Oral corticosteroids aren't as effective as corticosteroid injections for treating carpal tunnel syndrome.

Candidiasis

Candidiasis, commonly called yeast infection or thrush, is a fungal infection (mycosis) of any of the Candida species, of which Candida albicans is the most common. Candidiasis thereby encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases. Candida infections of the latter category are also referred to as candidemia and are usually confined to severely immunocompromised persons, such as cancer, transplant, and AIDS patients, whereas superficial infections of skin and mucosal membranes by Candida causing local inflammation and discomfort is common in many human populations. While clearly attributable to the presence of the opportunistic pathogens of the genus Candida, candidiasis describes a number of different disease syndromes that often differ in their causes and outcomes.

Causes:

Candida yeasts are usually present in most people, but uncontrolled multiplication resulting in disease symptoms is kept in check by other naturally occurring microorganisms, e.g., bacteria co-existing with the yeasts in the same locations, and by the human immune system.
A weakened or undeveloped immune system or metabolic illnesses, such as diabetes may predispose individuals to Candidiasis. Diseases or conditions linked to candidiasis include HIV/AIDS, mononucleosis, cancer treatments, steroids, stress and nutrient deficiency, among many others. Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida species. In extreme cases, these superficial infections of the skin or mucous membranes may enter into the bloodstream and cause systemic Candida infections.
Pregnancy, the use of oral contraceptives, engaging in vaginal sex immediately and without cleansing after anal sex and using lubricants containing glycerin have been found to be causally related to yeast infections.
Diet has been found to be the cause in some animals. Hormone Replacement Therapy and infertility treatments may also be predisposing factors.

Symptoms:

Symptoms include severe itching, burning, and soreness, irritation of the vagina and/or vulva, and a whitish or whitish-gray discharge, often with a curd-like appearance.
In men, symptoms include red patchy sores near the head of the penis or on the foreskin, severe itching and/or a burning sensation. Candidiasis of the penis can also have a white discharge, although uncommon. However, having no symptoms at all is common and usually, a more severe form of the symptoms may emerge later.

Diagnosis:

Medical professionals use two primary methods to diagnose yeast infections: microscopic examination, and culturing.

For the microscope method, a scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% potassium hydroxide (KOH) solution is then also placed on the slide. The KOH dissolves the skin cells but leaves the Candida untouched, so that when the slide is viewed under a microscope, the hyphae and pseudo spores of Candida are visible. Their presence in large numbers strongly suggests a yeast infection.

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then rubbed across a culture medium. The medium is incubated for several days, during which time colonies of yeast and/or bacteria develop. The characteristics of the colonies provide a presumptive diagnosis of the organism causing symptoms.

Treatment:
In clinical settings, candidiasis is commonly treated with antimycotics—the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole. For example, a one-time dose of fluconazole (as Diflucan 150-mg tablet taken orally) has been reported as being 90% effective in treating a vaginal yeast infection. This dose is only effective for vaginal yeast infections, and other types of yeast infections may require different treatments. In severe infections (generally in hospitalized patients), amphotericin B, caspofungin, or voriconazole may be used. Local treatment may include vaginal suppositories or medicated douches. Gentian violet can be used for breastfeeding thrush, but pediatrician William Sears recommends using it sparingly, since in large quantities it can cause mouth and throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals.

Cancer

Cancer (malignant neoplasm) is a class of diseases in which a group of cells display the traits of uncontrolled growth (growth and division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not.

Cancer may affect people at all ages, even fetuses, but risk for the more common varieties tends to increase with age. Cancer causes about 13% of all deaths. According to the American Cancer Society, 7.6 million people died from cancer in the world during 2007. Apart from humans, forms of cancer may affect other animals and plants.

Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or infectious agents. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Complex interactions between carcinogens and the host genome may explain why only some develop cancer after exposure to a known carcinogen. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly being recognized as important.

Genetic abnormalities found in cancer typically affect two general classes of genes. Cancer-promoting oncogenes are often activated in cancer cells, giving those cells new properties, such as hyperactive growth and division, protection against programmed cell death, loss of respect for normal tissue boundaries, and the ability to become established in diverse tissue environments. Tumor suppressor genes are often inactivated in cancer cells, resulting in the loss of normal functions in those cells, such as accurate DNA replication, control over the cell cycle, orientation and adhesion within tissues, and interaction with protective cells of the immune system.

Cancer is usually classified according to the tissue from which the cancerous cells originate, as well as the normal cell type they most resemble. These are location and histology, respectively. A definitive diagnosis usually requires the histologic examination of a tissue biopsy specimen by a pathologist, although the initial indication of malignancy can be symptoms or radiographic imaging abnormalities. Most cancers can be treated and some cured, depending on the specific type, location, and stage. Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming more specific for different varieties of cancer. There has been significant progress in the development of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimize damage to normal cells. The prognosis of cancer patients is most influenced by the type of cancer, as well as the stage, or extent of the disease. In addition, histologic grading and the presence of specific molecular markers can also be useful in establishing prognosis, as well as in determining individual treatments.

Classification:
Male
prostate cancer (33%), lung cancer (13%), colorectal cancer (10%), bladder cancer (7%), cutaneous melanoma (5%), leukemia (4%), pancreatic cancer (5%).

Female
breast cancer (32%), lung cancer (27%), colorectal cancer (11%), endometrial cancer (6%), ovarian cancer (6%), non-Hodgkin lymphoma (4%), pancreatic cancer (6%).

Children

Leukemia is the most common infant malignancy (30%), followed by the central nervous system cancers and neuroblastoma. The remainder consists of Wilms' tumor, lymphomas, rhabdomyosarcoma, retinoblastoma, osteosarcoma and Ewing's sarcoma. Teratoma is the most common tumor in this age group, but most teratomas are surgically removed while still benign, hence not necessarily cancer.

Female and male infants have essentially the same overall cancer incidence rates, but white infants have substantially higher cancer rates than black infants for most cancer types. Relative survival for infants is very good for neuroblastoma, Wilms' tumor and retinoblastoma, and fairly good (80%) for leukemia, but not for most other types of cancer.

Symptoms:
Roughly, cancer symptoms can be divided into three groups:

* Local symptoms: unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and/or ulceration. Compression of surrounding tissues may cause symptoms such as jaundice (yellowing the eyes and skin).
* Symptoms of metastasis (spreading): enlarged lymph nodes, cough and hemoptysis, hepatomegaly (enlarged liver), bone pain, fracture of affected bones and neurological symptoms. Although advanced cancer may cause pain, it is often not the first symptom.
* Systemic symptoms: weight loss, poor appetite, fatigue and cachexia (wasting), excessive sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e. specific conditions that are due to an active cancer, such as thrombosis or hormonal changes.

Diagnosis:
A cancer may be suspected for a variety of reasons, but the definitive diagnosis of most malignancies must be confirmed by histological examination of the cancerous cells by a pathologist. Tissue can be obtained from a biopsy or surgery. Many biopsies (such as those of the skin, breast or liver) can be done in a doctor's office. Biopsies of other organs are performed under anesthesia and require surgery in an operating room.

The tissue diagnosis given by the pathologist indicates the type of cell that is proliferating, its histological grade and other features of the tumor. Together, this information is useful to evaluate the prognosis of this patient and to choose the best treatment. Cytogenetics and immunohistochemistry are other types of testing that the pathologist may perform on the tissue specimen. These tests may provide information about future behavior of the cancer (prognosis) and best treatment.

Treatment:

Cancer can be treated by surgery, chemotherapy, radiation therapy, immunotherapy, monoclonal antibody therapy or other methods. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient. A number of experimental cancer treatments are also under development.

Complete removal of the cancer without damage to the rest of the body is the goal of treatment. Sometimes this can be accomplished by surgery, but the propensity of cancers to invade adjacent tissue or to spread to distant sites by microscopic metastasis often limits its effectiveness. The effectiveness of chemotherapy is often limited by toxicity to other tissues in the body. Radiation can also cause damage to normal tissue.

Because "cancer" refers to a class of diseases, it is unlikely that there will ever be a single "cure for cancer" any more than there will be a single treatment for all infectious diseases.

For More Information visit http://www.cancer.gov/

Bursitis

Bursitis is the inflammation of one or more bursae, or small sacs of synovial fluid, in the body. Bursae rest at the points where internal functionaries, like muscles and tendons, slide across bone. Healthy bursae create a smooth and almost frictionless gliding surface. With hundreds of them throughout the body they provide this surface for all motion, making movement normally painless. When bursitis takes hold, however, movement that relies on the inflamed bursa becomes rough and painful. Movement of tendons and muscles over the inflamed bursa causes it to become more inflamed, perpetuating the problem.

You have more than 150 bursae in your body. These small, fluid-filled sacs lubricate and cushion pressure points between your bones and the tendons and muscles near your joints. They help your joints move with ease. Bursitis occurs when a bursa becomes inflamed. When inflammation occurs, movement or pressure is painful.

Bursitis often affects the joints in your shoulders, elbows or hips. But you can also have bursitis by your knee, heel and the base of your big toe. Bursitis pain usually goes away within a few weeks or so with proper treatment, but recurrent flare-ups of bursitis are common.

Causes:

Bursitis is commonly caused by repetition of movement or excessive pressure. Elbows and knees are the most commonly affected because they are rested upon more than many parts of the body with bursae and they also get the most repetitive use. Inflammation of bursae can also be caused by other inflammatory conditions such as rheumatoid arthritis. Scoliosis can also be a cause of bursitis of the shoulders although this is rare. Shoulder bursitis is more commonly due to overuse of the shoulder joint and muscles.

The other main cause of bursitis is traumatic injury, which can cause swelling of the bursae. The swelling itself causes irritation because the sac will no longer fit in the small area between the bone and the functionary. When the bone begins to increase pressure on the bursa, bursitis ensues.

Symptoms:

If you have bursitis, you may notice:

* A dull ache or stiffness in the area around your elbow, hip, knee, shoulder, big toe or other joints.
* A worsening of pain with movement or pressure.
* An area that feels swollen or warm to the touch.
* Occasional skin redness in the area of the inflamed bursa.

Bursitis of the hip doesn't cause any visible swelling or skin redness because the bursae are located beneath some of your body's bulkiest muscles. In this type of bursitis, pain is primarily over the greater trochanter, a portion of your thighbone (femur) that juts out just below where the bone joins the hip.

Diagnosis:

Your doctor may have you undergo a physical examination and ask you about your recent activities. By feeling the painful joint and surrounding area, your doctor may be able to identify a specific area of tenderness.

If it appears that something else may be causing the discomfort, your physician may request an X-ray of the affected area. If bursitis is the cause, X-ray images can't positively establish the diagnosis, but they can help to exclude other causes of your discomfort.

Although you usually can trace bursitis to events of overuse or pressure, there may be no obvious cause. In the latter case, your doctor may want to perform additional screening to rule out other causes of joint inflammation and pain. This may include blood tests or an analysis of fluid from the inflamed bursa.

Treatment:

Bursitis treatment is usually simple and includes:

* Resting and immobilizing the affected area.
* Applying ice to reduce swelling.
* Taking Non Steroidal Anti-Inflammatory Drugs (NSAIDs) to relieve pain and to reduce the inflammation.

With simple self-care and home treatment, bursitis usually disappears within a couple of weeks.
Sometimes, your doctor may recommend physical therapy or exercises to strengthen the muscles in the area. Additionally, your doctor may inject a corticosteroid drug into the bursa to relieve inflammation. This treatment generally brings immediate relief and, in many cases, one injection is all you'll need.

If your bursitis is caused by an infection, you'll need to take antibiotics. Sometimes the bursa must be surgically drained, but only rarely is surgical removal of the affected bursa necessary.

Bulimia

Bulimia nervosa, mostly known as Bulimia is an eating disorder in which the subject engages in recurrent binge eating followed by feelings of guilt, depression, and self-condemnation. The sufferer will then engage in compensatory behaviors to make up for the excessive eating, which are referred to as "purging". Purging can take the form of vomiting, fasting, the use of laxatives, enemas, diuretics or other medications, or overexercising.

Causes:

Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives. They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories.) After a length of time, the sufferer of bulimia will find that they no longer have control over their binging and purging. The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia.

There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, dance, cheerleading, acting and figure skating. Bulimia is more prevalent among Caucasians. In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduced cravings for fat and sugar.

Types:

There are two sub-types of bulimia nervosa: purging and non-purging.

Purging type is the more common type of bulimia, and involves any of self-induced vomiting, laxatives, diuretics, enemas, or Ipecac, to rapidly extricate the contents from their body.

Non-purging type occurs in only approximately 6%-8% of bulimia cases, as it is a less effective means of ridding the body of such a large number of calories. It involves doing excessive exercise or fasting after a binge, to counteract the large amount of calories previously ingested. This often occurs in purging-type bulimics, but is a secondary form of weight control.

Symptoms:

Some of the most common symptoms of bulimia are:
Eating uncontrollably, Purging, Strict dieting, Fasting, Vigorous exercise, Vomiting or abusing laxatives or diuretics in an attempt to lose weight, Vomiting blood, Using the bathroom frequently after meals, Preoccupation with body weight, Depression or mood swings, Feeling out of control, Swollen glands in neck and face, Heartburn, Bloating, Indigestion, Constipation, Irregular periods, Dental problems, Sore throat, Weakness, Exhaustion, Bloodshot eyes etc.

Diagnosis:

The criteria for diagnosing a patient with bulimia are:

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
* Eating, in a fixed period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
* A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
2. Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting, or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Treatment:
Standard bulimia nervosa treatments include medications (prescription drugs), various psychotherapies, nutrition therapy, other non-drug therapies and supportive or adjunct interventions such as yoga, art, massage, and movement therapy. Some novel treatments are currently under research, such as implantation of a device called a vagus nerve stimulator implanted at the base of the neck. This stimulator is currently in use to treat some forms of depression, and it is under research for treating obesity.
The most commonly used treatments—psychotherapy and medication—are delivered at various levels of inpatient and outpatient care, and in various settings depending on the severity of the illness and the treatment plan that has been developed for a particular patient.

Many types of prescription drugs have been used in treatment of bulimia nervosa, however, only one prescription drug (fluoxetine) actually has a labeled indication for bulimia nervosa.

Most prescription drug therapy used for treatment of the disorder is aimed at alleviating major depression, anxiety, or obsessive-compulsive disorder (OCD), which often co-exist with bulimia nervosa. Some prescription drug therapies are intended to make individuals feel full to try to prevent binge eating.

Buerger's disease

Buerger's disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. It is strongly associated with use of tobacco products, primarily from smoking, but also from smokeless tobacco.

Buerger's disease is characterized by a combination of inflammation and clots in the blood vessels, which impairs blood flow. This eventually damages or destroys tissues and may lead to infection and gangrene. Buerger's disease usually begins in the hands and feet and may progress to affect larger areas of the limbs.

Buerger's disease is rare in the United States, but is more common in the Middle East and Far East. Buerger's disease most commonly affects men between ages 20 and 40, though it's becoming more common in women.

Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb may ultimately be necessary.

Causes:
Buerger's disease is caused by inflammation in the arteries and veins of the arms and legs. Inflammatory cells — and eventually blood clots — form in the vessels and block blood flow in and out of your hands and feet. Reduced blood flow means that the tissue in your hands and feet doesn't get adequate oxygen and nutrients needed to sustain it. This leads to the signs and symptoms of Buerger's disease, beginning with pain and weakness in your fingers and toes and advancing to other parts of your arms and legs. It isn't clear what triggers the inflammation and clots.

Symptoms:
Signs and symptoms of Buerger's disease include:

* Pain and weakness in your legs and feet or your arms and hands.
* Swelling in your feet and hands.
* Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon).
* Open sores on your fingers and toes.

Diagnosis:
No tests can definitely determine whether you have Buerger's disease. Instead, doctors order tests to narrow the diagnosis and rule out other more common conditions. These tests may include:

Blood tests-Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood clotting disorders and diabetes, along with other diseases and conditions.

The Allen's test-
Your doctor may conduct a simple test called the Allen's test to check blood flow through the arteries carrying blood to your hands. In the Allen's test, you make a tight fist, which forces the blood out of your hand. Your doctor alternately compresses the arteries at each side of your wrist to slow the flow of blood back into your hand. Next, you open your hand and your doctor releases the compression. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger's disease.

Arteriogram-An arteriogram, also called an angiogram, helps doctors see the condition of your arteries. Doctors inject dye into an artery and then take X-rays or other types of images. Images show any blockages in the artery. Your doctor may order arteriograms be performed on both of your arms and your legs — even if you don't have signs and symptoms of Buerger's disease in all of your limbs. Buerger's disease typically affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.

Treatment:
Quit using tobacco in any form-If you're diagnosed with Buerger's disease, you must stop using tobacco in order to stop progression of the disease. The inflammation stops when you quit using tobacco. Most people who quit tobacco won't have to face amputation of their fingers or toes in the future. Those who continue to use tobacco may worsen their Buerger's disease and need to have their affected fingers or toes removed.

It's hard to quit smoking. If you're like the majority of people who smoke, you've probably tried to quit in the past, but haven't been successful. Talk to your doctor about strategies to help you quit. Medications are available to ease your cravings. However, you won't be able to use nicotine replacement products, such as patches or gum, since the nicotine in these products also affects Buerger's disease.

Because it's imperative that you stop all tobacco use, your doctor may recommend more aggressive approaches to quitting. For instance, your doctor may periodically test your urine to make sure you aren't using tobacco. Another option is a residential smoking cessation program. In these programs, you stay at a treatment facility, sometimes a hospital, for a set number of days or weeks. During that time you participate in daily counseling sessions and other activities to help you deal with the cravings for cigarettes and to help you learn to live tobacco-free.

Other treatments-No treatments can cure Buerger's disease. Instead, your doctor may try various treatment approaches to reduce any signs and symptoms you have. Options include:

* Medications to improve blood flow or to dissolve blood clots.
* Surgery to cut the nerves in the affected area (surgical sympathectomy) to control pain.
* Amputation, if infection or gangrene occurs.

Brucellosis

Brucellosis, also called undulant fever, undulating fever, or Malta fever, is a zoonosis (infectious disease transmitted from animals to humans) caused by bacteria of the genus Brucella. It is primarily a disease of domestic animals (goats, pigs, cattle, dogs, etc) and humans and has a worldwide distribution, mostly now in developing countries.

Causes:
The disease is transmitted either through contaminated or untreated milk (and its derivates) or through direct contact with infected animals, which may include dogs, pigs, camels and ruminants, primarily sheep, goats, cattle, bison. This also includes contact with their carcasses.
Brucellae, along with leptospira have the unique property of being able to penetrate through intact human skin, so infection by mere hand contact with infectious material is likely to occur.

Symptoms:
Brucellosis induces inconstant fevers, sweating, weakness, anemia, headaches, depression and muscular and bodily pain.

The symptoms are like those associated with many other febrile diseases, but with emphasis on muscular pain and sweating. The duration of the disease can vary from a few weeks to many months or even years. In first stage of the disease, septicaemia occurs and leads to the classic triad of undulant fevers, sweating (often with characteristic smell, likened to wet hay) and migratory arthralgia and myalgia.

Diagnosis:
Diagnosis of brucellosis relies on:

1. Demonstration of the agent: blood cultures in tryptose broth, bone marrow cultures. The growth of brucellae is extremely slow (they can take until 2 months to grow) and the culture poses a risk to laboratory personnel due to high infectivity of brucellae.
2. Demonstration of antibodies against the agent either with the classic Huddleson, Wright and/or Bengal Rose reactions, either with ELISA or the 2-mercaptoethanol assay for IgM antibodies associated with chronic disease
3. Histologic evidence of granulomatous hepatitis (hepatic biopsy)
4. Radiologic alterations in infected vertebrae : the Pedro Pons sign (preferential erosion of antero-superior corner of lumbar vertebrae) and marked osteophytosis are suspicious of brucellic spondylitis.

Treatment:
Antibiotics like tetracyclins, rifampicin and the aminoglycosides streptomycin and gentamicin are effective against Brucella bacteria. However, the use of more than one antibiotic is needed for several weeks, due to the fact that the bacteria incubates within cells.

The gold standard treatment for adults is daily intramuscular injections of streptomycin 1 g for 14 days and oral doxycycline 100 mg twice daily for 45 days. Gentamicin 5 mg/kg by intramuscular injection once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain. Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks.