Saturday, July 21, 2012

What Is Sinusitis? What Causes Sinusitis?

Sinusitis comes from the Latin sinuo meaning "bend, wind, curve", and the Greek itis meaning "pertaining to". In medical English, the suffix "itis" means an "inflammation". According to Medilexicon`s medical dictionary, sinusitis is the "Inflammation of the mucous membrane of any sinus, especially the paranasal".

What are the sinuses?

Behind the bones of your face there are some hollow spaces, filled with air, which lead to the nose cavity - they are what we know as the sinuses. Your sinuses have the same mucous membrane lining as your nose does. The membrane produces a slimy secretion (mucus), keeping the nasal passages moist. The mucus traps dirt particles and germs.

There are four main sets of sinuses, they are all paired.

  • In each cheekbone
    These are the largest sinuses, also the ones that most commonly are affected when a person has sinusitis.

  • Above your eyes, either side of your forehead

  • Behind the bridge of your nose, between your eyes
    Can also be broken down into anterior and posterior - front and back

  • Between the upper part of your nose an behind your eyes

What is sinusitis?

Sinusitis is an inflammation of the paranasal sinuses. Paranasal means adjacent to the naval cavities. The inflammation could be caused by an infection from a virus, bacteria or fungus. It may also be the result of an allergic or autoimmune reaction. An autoimmune reaction is when your immune system attacks the good parts of your body.

Doctors often refer to sinusitis as rhinosinusitis, because an inflammation of the sinuses nearly always occurs with inflammation of the nose (rhinitis).

Sinusitis can also be referred to the cavity is affects:

  • Maxillary sinusitis - the patient feels pain or pressure in the cheek (maxillary) area. This can be experienced as toothache or headache.

  • Frontal sinusitis - the patient feels pain and/or pressure behind or above the eyes (frontal sinus cavity). The pain will generally be experienced as headache.

  • Ethmoid sinusitis - the patient feels pain and/or pressure behind or between the eyes. Usually as in the form of a headache.

  • Sphenoid sinusitis - the patient usually feels pain or pressure in the top part (vertex) of the head.
Many experts believe that sinusitis is often linked to asthma and happens as part of a group of diseases which affect the respiratory tract - the one airway theory. As sinusitis may result in, or be part of a generalized inflammation of the airway, other symptoms such as a cough are generally associated with it.

How long does sinusitis last?

  • Acute sinusitis - lasts up to a maximum of 4 weeks.

    Acute sinusitis is often caused by the common cold. However, it could be caused by bacteria, allergies, or a fungal infection. Treatment depends on what caused it. In the majority of cases home remedies are suitable treatments. However, if the sinusitis is persistent it can lead to serious infections and complications.

    Typically, with acute sinusitis, the patient's sinuses become inflamed and swollen. This stops the drainage and causes a build up of mucus. Doctors may refer to this as acute rhinosinusitis.

    If you have acute sinusitis may find it hard to breathe through your nose. The area adjacent to your eyes and nose may feel swollen and puffed up. You could also have throbbing facial pain and a headache. Sometimes a patient with acute sinusitis may have a fever. Treatment may include an antibiotic.

  • Subacute sinusitis - lasts from 4 to 12 weeks

    This type of sinusitis represents a continuation of the natural progression of acute sinusitis that has not got better. Symptoms will be pretty much the same as with acute sinusitis, possibly less severe, but treatment may be different. Treatment may include an antibiotic.

  • Chronic sinusitis - Lasts at least 12 weeks, or keeps coming back.

    Chronic sinusitis is usually caused by an infection. However, it can also be caused by nasal polyps (growths in the sinuses), as well as a deviated septum.

    As with acute and subacute sinusitis the sinuses become inflamed and swollen, causing blockage and mucus build up. Doctors often refer to this as chronic rhinosinusitis. The patient may find it hard to breathe through his nose. He may experience throbbing facial pain and a headache.

    At onset it is very hard for a doctor to know which one a patient is likely to have as the symptoms are very similar.

What are the signs and symptoms of sinusitis?

Acute Sinusitis signs and symptoms

If the patient has two or more of these symptoms, and/or thick, green or yellow nasal discharge he may be diagnosed with acute sinusitis.
  • Facial pain and pressure
  • Blocked nose
  • Nasal discharge
  • Poor sense of smell
  • Congestion
  • Cough
  • These symptoms may also be present
  • A high temperature
  • Halitosis (bad breath)
  • Tiredness
  • Toothache
Subacute sinusitis may have symptoms of acute or chronic sinusitis. Chronic Sinusitis signs and symptoms

The following signs and symptoms may have been present for at least 8 weeks
  • Congested, puffy face
  • Blocked nose
  • Nasal cavity has pus
  • A high temperature (fever)
  • Nasal discharge
  • Discolored postnasal drainage
  • These symptoms may also be present
  • Headache
  • Halitosis (bad breath)
  • Tiredness
  • Toothache

What are the treatments for sinusitis?

In the majority of cases sinusitis will resolve itself without treatment. Many patients find that home treatments provide some relief. These treatments include some OTC (over-the-counter) medications.
  • Steam inhalation - you breath in steam from a bowl of hot water - not boiling. The water may have some drops of menthol oil. Although patients do feel they experience some relief, this treatment has not been scientifically proven. Standing or sitting in a very steamy shower may sometimes provide the same effect.

  • Nasal Irrigation - this is also known as sinus irrigation, sinus rinse, or sinus lavage. It is a home procedure that involves a salt water rinse to clear the nasal passages.

  • Warm compress - if you apply a warm compress gently to the affected areas of your face you may have some relief of symptoms.

  • Sleeping with your head raised - when you go to bed prop up some pillows so your head is higher than it usually is. This may reduce the amount of pressure around the sinuses and lower the discomfort and pain.

  • Painkillers - if you take a painkiller that you would normally have to treat a headache, your fever may improve.

  • Decongestant tablets - these may reduce swelling and allow the sinuses to drain.

  • Decongestant sprays - these may have the same effect as tablets. However, do not use them for more than a week. The risk of making the blockage worse rises if you use decongestant sprays for prolonged periods. Ask your doctor or pharmacist for advice.
If none of these home remedies work after about a week, you should see your doctor. Your doctor may decide the sinusitis has been caused by a bacterial infection and prescribe antibiotics.
  • Antibiotics - a review of clinical trials found that while antibiotics can provide small improvements in uncomplicated sinusitis cases, most patients recover without the drugs within two weeks. However, in patients with severe symptoms, like high fever, severe pain in cheeks and swelling of face, antibiotic treatment is justified. The most commonly prescribed antibiotics for sinusitis are:

    • Beta-Lactams - these include penicillins, such as Amoxicillin (Amoxil, Polymox, Trimox, Wymox (or any generic formulations). These antibiotics work by interfering with the bacterial cell walls. As drug resistance grows, many of these types of medications have lost some of their effectiveness. Make sure you are not allergic to penicillins if you are prescribed these. Cephalosporins are also beta-lactams, and may include first generation (Keflex), cefadroxil (Duricef, Ultracef), and cephradine (Velosef), second generation cefaclor (Ceclor), cefuroxime (Ceftin), cefprozil (Cefzil), and loracarbef (Lorabid), and third generation cefpodoxime (Vantin), cefdinir (Omnicef) cefditoren (Sprectracef), cefixime (Suprax), and ceftibuten (Cedex). Ceftriaxone (Rocephin). These are effective against a wide range of bacteria.

      If you are allergic to penicillin you may find cefpodoxime, cefdinir, and cefuroxime are effective for mild to moderate sinusitis.

    • Macrolides and Azalides - these antibiotics attack the bacteria genetically. They are sometimes used with patients with mild to moderate symptoms who are allergic to penicillin. Included are such drugs as erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), and roxithromycin (Rulid). These drugs are not effective against H. influenzae.

      These drugs also have anti-inflammatory properties, which might help patients with chronic sinusitis.

    • Trimethoprim-Sulfamethoxazole - these are also useful alternatives to patients who are allergic to penicillin. Certain streptococcal strains, however, have developed resistance to these types of drugs. Allergic reactions can be severe. They should not be given to patients who have had infections after dental work.

    • Fluoroquinolones (Quinolones) - these medications stop the bacteria from reproducing. Levofloxacin (Levaquin), sparfloxacin (Zagam), gatifloxacin (Tequin), and moxifloxacin (Avelox) are extremely effective against the common bacteria that cause sinusitis. They are commonly used to treat patients who have already taken antibiotics within six weeks. They are also commonly prescribed for patients who are allergic to beta-lactams.

    • Lincosamide - also stops the bacteria from reproducing. Effective against S. pneumonia but not H. influenza.

    • Tetracyclines - these drugs help stem the spread of bacteria, and include doxycycline, tetracycline, and minocycline. Patients may have side effects which include skin sensitivity to sunlight, sore throat sensation, and tooth discoloration.

    • Ketolides - effective against antibiotic-resistant bacterial strains.

Video: Sinusitis Pathology (Para-nasal Sinus Anatomy)

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What Are Symptoms? What Are Signs?

In medicine a symptom is generally subjective while a sign is objective. Any objective evidence of a disease, such as blood in the stool, a skin rash, is a sign - it can be recognized by the doctor, nurse, family members and the patient. However, stomachache, lower-back pain, fatigue, for example, can only be detected or sensed by the patient - others only know about it if the patient tells them.

There are varying approaches to defining the medical meanings of signs and symptoms. This article aims to reflect them, rather than judging which the right one is.

The majority of lay people tend to just use the word symptom, and will understand the term 'sign' if used by a doctor as having the same meaning as symptom.

Who notices it defines whether it is a sign or a symptom

Many say it is not necessarily the nature of the sign or symptom, but rather who observers it that defines it.

For example:
  • A rash - this could be a sign, symptom, or both.

    • If the patient notices the rash it is a symptom.
    • If the doctor, nurse or anyone else (but not the patient) notices the rash it is a sign.
    • If both the patient and doctor notice the rash it is both a sign and a symptom.

  • Light headache - this can only be a symptom.

      A light headache can only be a symptom because it is only ever detected by the patient.

  • High blood sugar - this can only be a sign

      High blood sugar can only be a sign because the patient cannot detect it; it can only be measured in a medical laboratory.

It is only a sign when it matters, and a symptom when it doesn't

Historically, patients and physicians used to participate more equally in identifying signs and symptoms during a medical consultation. Over the last 200 years as medicine advanced and diagnosis techniques developed, the identification of signs became more and more the doctor's domain. In fact, in order to listen to the lungs, heart and some other features the patient must keep quiet.

In 1808 the percussion technique was developed - the physician gently tapped the chest wall and listened carefully so that he could diagnose respiratory diseases. Then came the technique of auscultation (using a stethoscope to listen to the circulatory and respiratory body functions), the spirometer (to measure aspects of lung function), the ophthalmoscope (to examine the inside of the eye), the clinical use of X-rays, and the sphygmomanometer (for measuring blood pressure). During the 20th century hundreds of new devices and techniques were created to identify signs - most of them studied by doctors and health care professionals, not patients.

It was during this period in modern medical history that the term symptoms became known as something the patient notices. Many experts say that the meaning of signs has been distorted, and that a sign is anything that really matters, while a symptom remains as a mere observation which did not help in the diagnosis.

Lester S. King, a physician and author of several medical books, wrote:
    "The belief that a symptom is a subjective report of the patient, while a sign is something that the physician elicits, is a 20th-century product that contravenes the usage of two thousand years of medicine. In practice, now as always, the physician makes his judgments from the information that he gathers. The modern usage of signs and symptoms emphasizes merely the source of the information, which is not really too important.

    Far more important is the use that the information serves. If the data, however derived, lead to some inferences and go beyond themselves, those data are signs. If, however, the data remain as mere observations without interpretation, they are symptoms, regardless of their source. Symptoms become signs when they lead to an interpretation. The distinction between information and inference underlies all medical thinking and should be preserved."
As language constantly changes and evolves it is sometimes necessary to focus on how words and terms are currently being used, rather than how they used to be and therefore should be used. The word symptom(s) is currently used with a wider meaning than "a mere observation", even in medical articles published by scientists. Many years ago the word awful used to mean with awe (awesome).

Medical symptoms

There are three main types of symptoms.
  • Chronic symptoms - long lasting or recurrent symptoms. As may be the case with such diseases as diabetes, asthma, or cancer.

  • Relapsing symptoms - when a person is affected by symptoms again; symptoms which had occurred in the past, disappeared, and then come back. As may be the case with depression, multiple sclerosis, and also cancer.

  • Remitting symptoms - when symptoms improve, and sometimes go away completely.
Symptoms may also progressively get worse, or better. Diseases and conditions can also be described as:
  • Asymptomatic diseases/conditions - this means the disease is present but there are no symptoms. For example, during the early stages of breast cancer the patient may feel or sense no symptoms at all. Often, the first a person knows about an asymptomatic disease or condition is during a routine health check. High blood pressure (hypertension) is often asymptomatic.

    An asymptomatic infection is also called a subclinical infection. An infected individual may not develop symptoms during the incubation period - also known as the period of subclinical infection. This is often the case with sexually transmitted diseases such as AIDS and genital warts.

    The danger of asymptomatic infections is that the infected individual may not experience any symptoms but might transmit the infection to other people. It is also hard for health authorities to know accurately what the incidence of infection is. Examples of asymptomatic infections during which individuals may spread the infection include, whooping cough (pertussis), chlamydia, clostridium difficile, dengue virus, Epstein-Barr virus, Group A streptococcal infection, HIV-1, Legionnaires' disease), measles, gonorrhea, meningitis, tuberculosis (TB), salmonellosis (salmonella infection), noroviruses, poliomyelitis (polio), common cold, pneumonia, and syphilis.

    Another danger of asymptomatic (subclinical) infections is that they can cause complications which are unrelated to the infection itself. For example, untreated urinary tract infections may cause premature births.

    Many cancers are asymptomatic during their early stages. Prostate cancer, for example, is mainly asymptomatic until it has advanced to a certain point. This is unfortunate, because early treatment is crucial for effective cancer therapy. This is why regular testing for higher risk groups for some cancers is so important.

  • Symptomatic diseases/conditions - this means the disease is present and there are symptoms. Some diseases/conditions are always symptomatic, such as motion sickness - feeling nausea and being unwell when travelling by car, plane or boat.

  • Constitutional symptoms - also known as general symptoms. These are symptoms which are related to the effects a condition/disease has on the whole body - the systemic effects, e.g. fever, weight loss, or altered appetite. A constitutional symptom relates to the whole body.

  • Presenting symptom - also known as chief complaint or presenting complaint, is a term used by doctors which refers to the initial symptom(s) that brought the patient to see the doctor. A patient who is eventually diagnosed with prostate cancer may have first come to the doctor because he had to keep getting up during the night to urinate - the presenting symptom was frequent urination, or getting up at night to urinate.

  • Cardinal symptom - this is a term used by medical professionals referring to the symptom that ultimately leads to a diagnosis.

Medical signs

A medical sign is an objective feature indicating some medical fact or characteristic that is detected by a physician, nurse or medical/laboratory device during a physical examination of a patient.

Sometimes a sign may not be noticed by the patient, and have no meaning at all for the patient, but is meaningful for the physician. Signs can help the doctor in his/her diagnosis. Examples of signs include:
  • High blood pressure - this may indicate a cardiovascular problem, a reaction to medication, an allergy, as well as many other possible conditions or diseases.

  • Clubbing of the fingers - this may point to lung disease, as well as other diseases.
Lester S. King wrote that a sign must have a thing signified. He said a sign must convey information and can only be a sign if it has meaning. He added that "a sign ceases to be a sign when you cannot read it".

There are different types of signs
  • Prognostic signs - these are signs that point to the future. Rather than indicating the name of the disease they predict the outcome for the patient - what is likely going to happen to him/her. Hippocrates, a physician in ancient Greece, described the following facial signs as a predictor of impending death (re-written in modern lay terms):

      Pinched nose, sunken eyes, hollow temples, cold and retracted ears, the skin of the forehead tense and dry, the lips pendent (hanging), relaxed and cold, and a discolored (livid) complexion. (Known as the Hippocratic face. Latin: facies Hippocratica).

  • Anamnestic signs - these signs always point to the past. Some skin scars may point to severe acne in the patient's past. An anamnestic sign of polio during childhood may be observed as a limp during adulthood, or a distorted limb.

  • Diagnostic signs - these signs help the doctor recognize and identify what the patient has; the name of the condition or disease. For example, elevated levels of PSA (prostate-specific antigen) in a male patient's blood may be a sign of prostate cancer or a prostate problem.

  • Pathognominic signs - this is step further from a diagnostic sign - it means "a sure sign". A pathognominic sign is one that leaves the physician certain, sure, without a doubt, that a particular disease is present. For example, thickened lion-like facial skin (leonine facies) is a sure sign (pathognominic sign) of leprosy. A pseudomembrane on the tonsils, pharynx and nasal cavity is a pathognominic sign of diphtheria. A prostate biopsy is when a sample of the prostate is taken and observed under the microscope - if cancerous cells are detected there is no doubt the patient has prostate cancer.
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What Is Lyrica (pregabalin)? What Does Lyrica Treat?

Lyrica is Pfizer's trade name for a drug called pregabalin. Pregabalin is an anticonvulsant (anti-seizure) drug that is often used to treat neuropathic pain as well as partial seizures that are common in temporal lobe epilepsy. In Europe, pregabalin is also approved to treat generalized anxiety disorder.

What does Lyrica treat?

Lyrica or pregabalin has been approved in the U.S. to treat epilepsy, diabetic neuropathy pain, and post-herpetic neuralgia (pain after shingles). In addition, pregabalin has been approved in the U.S to treat fibromyalgia, a condition where there is pain in muscles and connective tissue as well as widespread pain and a heightened and painful response to touch. The European Union has also approved Lyrica to treat generalized anxiety disorder.

What are the side effects of Lyrica?

The most prevalent side effect of pregabalin is dizziness or drowsiness, which occurs in more than 10% of patients. Between one and ten percent of patients experience visual problems, lack of coordination in muscle movements, disorder of speech, tremor, lethargy, memory problems, euphoria, constipation, dry mouth, peripheral swelling, loss of sex drive, erectile dysfunction, and weight gain.

Less than 1 percent of patients taking pregabalin may experience depression, confusion, agitation, hallucinations, muscle twitching, change in sensitivity to touch, increased heart rate, excessive salivating, sweating, redness, rash, muscle cramps, muscle and joint pain, urinary problems, or kidney stones.

Less than 0.1% of patients may experience low neutrophil (type of white blood cell) levels, heart block, blood pressure changes, inflammation of the pancreas, difficulty swallowing, halt in urine production, or a breakdown in skeletal muscle tissue.

Although the likelihood is low, patients may become dependent on pregabalin and they may see withdrawal effects after using the drug for an extended period of time.

Does Lyrica interact with other drugs?

The manufacturer of Lyrica warns of potential dangerous interactions with the following drugs:
  • Opioids
  • Benzodiazepines
  • Barbiturates
  • Alcohol
  • Any drugs that depress the central nervous system
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What Are Crabs (Pubic Lice)? What Causes Crabs?

Pubic lice (Sing: pubic louse), also known as crab louse, crabs, or Fullers; Latin name Pthirus pubis are tiny parasitic blood-sucking wingless insects that infest the human genitals, causing itching and red spots. The only other animal known to be affected by this insect is the gorilla. Crabs may also affect other coarse hair on the body, including the eyelashes, eyebrows, beards, moustaches, as well as the hair on the back and abdomen. Pubic lice are about 2mm long and are gray-brown in color.

Pubic lice pass from person-to-person, in most cases as a result of sexual intercourse - close hugging and kissing are also possible routes. Parents can pass on the lice to their children via the sharing of towels, clothing, bedding or closets (wardrobes); however this is rare. Infested children are at risk of lice spreading to their eyelashes, resulting in possible infections.

Crabs affect sexually active adolescents and adults much more commonly than children. Pubic lice cannot survive for very long away from the warmth and humidity of a human body. Experts say that crabs are the most contagious STD (sexually transmitted disease). If an infected person has sexual intercourse with a non-infected person, the latter has a 90% risk of getting an infestation, according to The Mayo Clinic, USA.

According to the National Health Service (NHS), UK, there were 2,500 cases of pubic lice seen at sexual health clinics in the UK in 2006.

According to Medilexicon's medical dictionary:
    Pthirus is "a genus of lice (family Pediculidae) formerly grouped in the genus Pediculus. The main species is Pthirus pubis (formerly Pediculus pubis), the crab or pubic louse, a parasite that infests the pubes and neighboring hairy parts of the body."

What are the signs and symptoms of crabs (pubic lice infestation)?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Signs and symptoms may not become apparent until one to three weeks after a person comes into contact with the lice. Signs and symptoms may include:
  • Itching in the pubic region - this is not caused by biting from the insect, but from an allergic reaction to the louse saliva and feces (droppings, excrements, stools). The itching is usually worse at night.

  • Red spots and skin lesions - small red bumps or spots may appear. Scratching by the patient may also results in marks.

  • Blue spots on the skin - especially on the thighs or lower abdomen.

  • Other parts of the body - the lice may spread to the stomach, upper thighs, chest, moustache, and beard. In children they may spread to the eyelashes. Wherever the lice are located, symptoms of itching are common, as well as skin irritation.

  • Louse droppings - the presence of dark brown or black powder on the skin or in underwear could indicate the presence of crab droppings.

  • Blood in underwear - this is usually caused by scratching by the patient which breaks the skin.

  • Adult pubic lice and eggs - an adult pubic louse is smaller than a match head; it is approximately 2mm long. It has six legs and has a gray-brown color. Its back legs are very large, and look like the claws of a crab. The large back legs are used to cling onto the hair.
Eggs are very small, oval shaped, with a yellowish-white color. They stick firmly to the base of the hair.

Both the adult pubic lice and their eggs are visible to the naked eye - some people may need a magnifying glass. You may be able to detect them in coarse hair in the following parts of your body:
  • Along the edge of the scalp
  • In facial hair (beards, moustaches)
  • In the eyebrows
  • In the eyelashes
  • In the hair around the anus
  • In the hair of the armpits
  • In the pubic hair (genital area)
The detection of empty eggshells (nits) after treatment does not mean the infestation is necessarily still present.

When should you see your doctor?

In the majority of cases OTC (over-the-counter, no prescription required) medications will successfully treat the infestation. You should see you doctor if:
  • The OTC medication, usually in the form of a lotion, cream or shampoo, does not kill the lice.

  • You are pregnant. Pregnant women should not use anti-lice medications without checking with their doctor.

  • You have developed a skin infection due to skin lesions (from scratching).

  • The patient is a child.

What are the risk factors for crabs?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. Risk factors for crabs include:
  • Being sexually active, especially for adolescents.
  • Having several sex partners.
  • Having sexual relations with a person who has an infestation.
  • Sharing towels, bedding or clothing with an infested person.

What are the causes of crabs?

An infested person needs to be in close-body contact with another person for the infestation to be passed on. The lice cannot jump, fly or swim - they crawl from one hair to another.
  • Sex - the most common form of contact that results in an infestation is through sex, including sexual intercourse, anal sex and oral sex.

  • Non-sexual bodily contact - such as hugging or kissing may also result in an infestation (less common).

  • Sharing items - sharing towels, bedding, etc., with an infected person can raise the risk of pubic lice infestation in other people (much smaller risk).
Condoms are effective for protection against many sexually transmitted infections, but not from pubic lice infestation. It is not the penetration during the sexual act that raises the risk, but rather the close proximity of hair from one person to the hair of another person.

Pubic lice life-cycle

A pubic louse has a life expectancy of between 1 to 3 months. A female might lay up to 300 eggs during her life.

Eggs hatch within 6 to 10 days. Lice take 2 to 3 weeks to reach maturity (the age for reproduction).

A louse can survive for up to 24 hours away from the human body. They will never deliberately leave a human, unless it is to crawl onto another human, because they feed on human blood - without it they starve. The only other animal, apart from humans, known to be affected by pubic lice infestation is the gorilla.

Diagnosing pubic lice infestation

Both the doctor, as well as the patient can easily detect the presence of lice and eggs through a visual examination of the affected area - usually the pubic area. Some people may find that a magnifying glass is easier.

An infestation is confirmed if moving lice are spotted.

The presence of lice eggs (nits) does not necessarily mean there is an infestation. After successful treatment there may still be some remaining empty egg shells.

Sexually transmitted infections - doctors in the UK and many other countries will ask the patient whether the infestation was transferred through sexual contact or some other means. If they were the result of sexual contact the doctor will recommend that the patient be screened for other STIs (sexually transmitted infections) or STDs (sexually transmitted diseases) as a precaution. In this text, and virtually all medical texts, STI and STD have the same meaning.

What are the treatment options for crabs?

Pubic lice can be treated without needing to go to the doctor's. There are insecticidal creams, lotions and shampoos available at pharmacies which do not require a doctor's prescription. Ask your pharmacy for a suitable medication. If you are pregnant see your doctor first.

Most treatments are applied once, and then again seven days later.

Anybody with an infestation should also make sure that other people who came into close physical contact receive treatment; including all members of the household, not just sexual partners.

Some pubic lice may have developed resistance to some medications - i.e. the medication does not work because they have become immune to it. If this happens to you, either talk to a pharmacist or your doctor - they will recommend an alternative treatment after checking whether you have been applying the application properly.

Make sure you talk to your pharmacist or GP before using a treatment so that you know how to use it properly. Follow their instructions carefully. Sometimes the GP's or pharmacist's instructions may vary from what is written on the packet; do what the health care professional told you - if their instructions vary from what is written on the packet, do not be afraid to mention this fact to them.

The following groups of people should not be treated without first talking to your doctor or qualified pharmacist (do not be afraid to ask the person at the pharmacy whether they are fully qualified pharmacists):
  • Infants
  • Children under 18 years of age
  • A pregnant woman
OTC lotions and creams - these are usually the first line of defense. If they do not kill the lice a doctor may prescribe a stronger lotion (or shampoo).
  • Malathion (Ovide) aqueous lotion - this medication is suitable for anybody aged over six months. Malathion is flammable (can catch fire), so keep away from cigarettes, hair dryers and other heat sources. In many countries this is a prescription lotion.

  • Permethrin 5% dermal cream - this medication should not be used on patients aged less than 18 years. Pregnant women and breastfeeding mothers should not take it, unless her doctor says so.
Instructions for both malathion lotion or permethrin cream, in most cases, are:
  • Apply the lotion to the whole body, including the scalp, face, neck and ears (not just the affected areas).

  • Make sure the lotion is applied to the eyebrows.

  • Apply the lotion to your beard or moustache (if you have a beard and/or moustache).

  • Apply to pubic hair, hair between your legs, and hair around the anus.

  • Keep the lotion away from your eyes. If some does get in your eyes, rinse thoroughly with water.

  • One total application will generally require about 100ml of lotion or 30-60g of cream.

  • Malathion lotion - leave on for 12 hours or overnight.
  • Permethrin 5% cream - leave on for 24 hours.

  • Wash the medication off with warm water (gently and thoroughly).

  • Repeat the whole process seven days later.

  • Do not use medication more often than indicated. Do not repeat the application for more than three consecutive weeks.
Eyelash treatment - anybody with an eyelash infestation should treat the eyelashes and the body as well. Patients should not try to pull the nits out - there is a serious risk of eye injury. The medication for eyelashes is different from the treatments for other parts of the body - do not use them on your eyes. For eyelashes you should use:
  • An eye ointment - ideal for patients under 18 years of age and pregnant or nursing mothers. The medication has a white or yellow soft paraffin base and suffocates the parasite.

    • Apply twice a day to the eyelashes, making sure every part of each eyelash is covered.

    • Wash hands thoroughly before applying, and again afterwards.

    • Each time the ointment is applied, gently wipe away any ointment that is still there from the previous application (with a tissue). Then throw away the tissue.

    • Continue like this, twice a day for eight days. If lice are still present (ignore the eggs) continue until day 10.

  • An insecticide shampoo or cream rinse - for example, permethrin 1%.

    • Apply the cream to where the eyelashes start (the base), using a cotton bud.
    • Do not open your eyes during the application.
    • Leave it there for 5 to 10 minutes.
    • Wash off the cream with water.
    • If any gets into your eyes wash them straight away with water.
In the majority of cases the first treatment will be successful and all the lice will be killed off. However, the eggs may still be there, with the risk of hatching. If you re-apply the medication after seven days it makes sure that any hatched lice will be killed off before they are mature enough to reproduce.

One week after your second treatment check for lice again. If you are not sure how to check, go to your GP (general practitioner, primary care physician) or a GUM (genitor-urinary medicine) clinic.

Nits (eggs or empty egg-shells) may linger for a while even after successful treatment. Their presence does not mean the infestation is still there. However, if you find moving lice or eggs that are not empty (they can hatch), you should see your GP.

You doctor will make sure the patient fully understands how to apply the medication. In some cases the GP may ask the patient to repeat the treatment. If treatment fails a second time the doctor will recommend an alternative medication. This may mean switching from malathion to permethrin, or vice-versa. Other possible medications include phenothrin or carbaryl.

Preventing crabs

Protecting others - if you have an infestation, refrain from sexual activity until your treatment is completed successfully.

Sexual partners - the fewer sexual partners you have, the lower the risk will be of becoming infected with STIs generally, including pubic lice.

Regular check-ups - regular check-ups can reduce the risk for all STIs.

Condoms - although condoms will not protect you from pubic lice, they will help protect you from other STIs.

Sharing items - if you have an infestation, do not share your bedding, clothing, towels and closet with other members of your household.

Other members of the household - if one person has an infestation, treat everyone in that household for pubic lice as a precaution.

Possible complications

If complications to occur they tend to be minor and usually as a result of leaving the infestation untreated.

Skin - intense itching can lead to scratching, which can cause excoriation (skin flakes off) and/or infection.

Eyes - if the eyelashes have been affected there is a risk of:
  • Blepharitis - swelling of the eyelids. The patient will have a foreign body or burning sensation, there may be excessive tearing (liquid tears), itching, photophobia (sensitivity to light), red and swollen eyelids, the whites of the eyes becomes reddened, blurred vision, or crusting of the eyelashes first thing in the morning.

  • Conjunctivitis - there is a thin layer of cells (membrane) between the inner surface of the eyelids and the whites of the eyes, called the conjunctiva. Conjunctivitis is when the conjunctiva becomes inflamed. Another name for conjunctivitis is pink eye. Inflammation causes tiny blood vessels (capillaries) in the conjunctiva to become more prominent, giving the eye a red or pink look.

  • Corneal epithelial keratitis - the cornea becomes inflamed.
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What Is Yeast Infection Or Candidiasis? What Is Vaginal Thrush?

Vaginal thrush (thrush) is a yeast infection caused by a type of fungus of the candida species, usually Candida albicans. It can affect all women, but is more common among women who are pregnant, those who have weakened immune systems, and women aged 30 to 50. Thrush is generally recurring - it comes back. The fungus, candida albicans, exists naturally in the vagina. As long as it does not multiply too much a woman will not notice it is there. However, if can sometimes multiply to such an extent that it causes swelling of the vagina and vulva.

The vulva refers to the external genital organs of the female. In laypeople's speech the vagina is used to refer to female genitals in general. However, strictly speaking, the vagina refers to the internal structure, while the vulva refers to the whole exterior. In this article, the two terms are used with their proper meanings.

Candidal balanitis (inflammation of the head of the penis) can develop in the male partners of women with thrush; however, it is very rare. Male genital yeast infection is much less common than female genital yeast infection.

Thrush is not considered to be a sexually transmitted infection.

What are the symptoms of vaginal thrush?

  • Itching of the vulva
  • Soreness and irritation in the vulva
  • Vaginal discharge
  • Superficial dyspareunia (pain, discomfort during sexual intercourse)
  • Dysuria (discomfort, pain during urination)
Women can also experience inflammation of the vagina/vulva (vulvovaginal inflammation). The signs of vulvovaginal inflammation are:
  • The vagina and/or vulva become red (erythema)
  • The skin of the vagina cracks
  • Swelling (if the swelling becomes severe there can be inflammation)
  • Sores in the surrounding area (rare)
If a woman has sores in the surrounding areas, this could also be an indication of other fungi, or herpes simplex.

A vaginal discharge is also common. The discharge might be watery, white, or with pus (purulent).

What are the causes of thrush? Who is more susceptible to thrush?

In most cases, thrush is caused by the Candida albicans fungus. This fungus is generally present in the mouth and vagina.
  • Pregnancy - changes in a pregnant woman's hormone levels may make her more susceptible to develop thrush.

  • Diabetes - if a woman's diabetes is poorly controlled, she is at a significantly higher risk of developing thrush.

  • Antibiotics - when women take antibiotics their chances of developing thrush increase substantially. According to the NHS (National Health Services, UK), approximately 30% of women who take systemic or intravaginal antibiotics develop thrush.

  • Weakened immune system - women with a weakened immune system, such as with HIV/AIDS, recipients of chemotherapy, and lupus are more likely to develop thrush, compared to other women.

  • Contraceptives - some studies indicate that oral contraceptives raise the risk of thrush. However, other studies indicate there is no increased risk.

  • Oral sex - women who have oral sex are at greater risk of developing thrush (the woman being the recipient of oral sex).
There is evidence that tight fitting clothing may raise the risk of developing thrush. However, this is not the case with sanitary towels.

Diagnosis of thrush

A doctor will diagnose thrush by checking for the signs and symptoms. However, if the thrush is recurring, even after treatment, it is advisable to have a vaginal secretion test to make sure it really is a fungus causing the problem, and not another condition, such as bacterial vaginosis, or trichomoniasis.

What is the treatment for thrush?

A 1 to 3 day course of antifungal medicine will usually be enough to clear up the infection. If the symptoms are severe the treatment will last longer.

Medications can be taken orally (by mouth) or intravaginally. Medications administered intravaginally for thrush are called intravaginal pessaries.

Oral medications can have some side-effects, including nausea, upset stomach, constipation, diarrhea, vomiting, and/or bloating.

Intravaginal pessaries include clotrimazole, econazole, or miconazole. They are much less likely to cause side effects, however, they can be awkward to use and cause mild irritation when inserted. Some women say they cause stinging initially. They can also damage latex condoms and diaphragms (types of contraceptives).

If the patient is aged 12-16 she is generally given an oral antifungal, such as fluconazole, or itraconazole.

If a woman has sores in her vulva there are topical creams that can be applied, such as clotrimazole or econazole.

If the thrush does not clear up after treatment the patient should tell her doctor.

Pregnant and breastfeeding women must take intravaginal pessaries and not oral antifungal medications, as they can be passed on to the baby. Examples of intravaginal pessaries prescribed for pregnant and breastfeeding mothers are clotrimazole, econazole, or miconazole. A full course usually lasts for seven days or more.

Pregnant women must be careful when inserting a pessary with an applicator, as this may injure the cervix. In most cases, application by hand is recommended.

Some medications are available without the need for a doctor's prescription. Flucanozole is an OTC (over-the-counter) medication in most countries, and is available usually as a single dose tablet.

Women who have developed thrush for the first time are advised to see their doctors, rather than going to the pharmacy to self-treat. It is important that thrush is diagnosed initially. Also, over-the-counter medications should not be used long-term without checking with a doctor first - this would be discussed during a woman's initial doctor's visit and/or subsequent ones.

Things you can do to ease the symptoms of thrush:

  • Avoid using perfumed soaps, vaginal deodorants, shower gels, or douches to wash your vaginal area. Use just water.
  • Avoid using latex condoms.
  • Avoid using spermicidal creams.
  • Avoid using lubricants.
  • Avoid wearing synthetic clothes, and tight-fitting clothes. Cotton underwear is best.

The following women should go back to see their doctor if symptoms return:

  • Pregnant women.

  • Those with lower abdominal pain (stomach pain) .

  • Women whose symptoms have changed.

  • Women who have not seen a doctor for over a year and have had two recurrences in a 12-month period.

  • A woman who has had an STI (sexually transmitted disease) previously (or her partner) .

  • A woman whose antifungal medications were ineffective.

  • A woman who has had a bad reaction to antifungal medication.

Maintenance therapy for thrush

Maintenance therapy is a term used for managing recurring thrush. Studies indicate that oral fluconazole, taken weekly is effective in preventing recurrence. Other studies have also found that oral itraconzole, or intravaginal clotrimazole, taken monthly, are also effective.
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What Is a Peptic Ulcer? What Causes Peptic Ulcers?

A peptic ulcer is a hole in the lining of the stomach, duodenum, or esophagus. An ulcer is a sore or erosion that forms when the lining of the digestive system is corroded by acidic digestive juices. It is estimated that between 5% and 10% of adults globally are affected by peptic ulcers at least once in their lifetimes.

When a peptic ulcer affects the stomach it is called a gastric ulcer, one in the duodenum is called a duodenal ulcer, while an esophageal ulcer is an ulcer in the esophagus. When the lining of these organs is corroded by acidic digestive juices secreted by stomach cells peptic ulcers can form.

Peptic ulcer disease affects millions of Americans each year at an annual cost for the country estimated to run in the billions of dollars.

According to Medilexicon's medical dictionary, a peptic ulcer is "an ulcer of the alimentary mucosa, usually in the stomach or duodenum, exposed to acid gastric secretion."

Etymologies of peptic and ulcer

The English word "peptic" comes from the Latin word pepticus which comes from the Greek word peptikus which comes from the Greek word peptein, meaning "to digest".
The English word "ulcer" comes from the Latin word ulcus (genitive: ulceris), meaning "a sore, a wound, an ulcer".

Meanings of peptic and ulcer

The English word peptic means relating to digestion or promoting digestion.
The English word ulcer means an area of tissue erosion.
The term peptic ulcer literally means tissue erosion in the digestive system.

What are the signs and symptoms of peptic ulcers?

A symptom is something the patient feels and reports, such as a stomachache, while a sign is something other people, including the doctor detect, such as a rash.

The first symptom of peptic ulcer is usually stomach pain - caused by the ulcer and intensified by stomach acid coming in contact with it. However, it is not uncommon for people to have a peptic ulcer and no symptoms at all. Even though stomachache is the first symptom, most stomachaches are not serious and do not mean the individual is ill.

The most common signs or symptoms of peptic ulcers are:
  • Indigestion-like pain. The pain can.. felt anywhere from the belly button to the breast bone
      ..last from a couple of minutes to a number of hours more severe when the stomach is empty worse during the night (during sleeping hours) temporarily relieved after eating certain foods
      ..go away and return for a few days or weeks

  • Difficulty getting food down (swallowing it)

  • Food that is eaten regurgitates (comes back up)

  • Retching after eating

  • Feeling unwell after eating

  • Weight loss

  • Loss of appetite
Ulcers can cause severe signs and symptoms, such as (much less common):
  • Vomiting blood
  • Black and tarry stools, or stools with dark blood
  • Nausea and vomiting
  • These symptoms should be treated as medical emergencies
When you should see a doctor:

A peptic ulcer should be treated with your doctor's help. OTC (over-the-counter) medications may temporarily provide some pain relief, but will not provide comprehensive treatment. If you have the signs and symptoms described above you should see your doctor.

What are the causes of peptic ulcers?

Peptic ulcers are usually caused by either Helicobacter pylori (H pylori) bacteria or non-steroidal anti-inflammatory drugs (NSAIDs). H Pylori bacteria are responsible for about four-fifths of all gastric ulcers and 95% of duodenal ulcers, while NSAIDs are known to cause about 20% of gastric ulcers and 5% of duodenal ulcers.
  • H pylori

    Over 25% of people in Western Europe and North America carry H pylori. Experts are not certain why the bacteria do not cause ulcers in all people who carry H pylori. The bacterium spreads through food and water. As it is present in human saliva it can spread through mouth-to-mouth contact, such as kissing. It lives in the mucus that coats the lining of the stomach and duodenum and produces urease, an enzyme that neutralizes stomach acid by making it less acidic. To compensate for this the stomach makes more acid, which irritates the stomach lining.

    H pylori also weakens the defense system of the stomach and causes inflammation. Patients with peptic ulcers caused by H pylori need treatment to get rid of the bacterium from the stomach to prevent recurrences.

  • NSAIDs (non-steroidal anti-inflammatory drugs)

    These are medications for headaches, period pains, and other minor pains. Examples include aspirin and ibuprofen. Many NSAIDs are OTC medications, while others, such as diclofenac, naproxen and meloxicam can only be acquired with a doctor's prescription.

    Non-steroidal anti-inflammatory drugs lower the stomach's ability to make a protective layer of mucus, making it more susceptible to damage by stomach acids. NSAIDs can also affect the flow of blood to the stomach, undermining the body's ability to repair cells.

  • Genetics - a significant number of individuals with peptic ulcers have close relatives with the same problem, suggesting that genetic factors may also be involved.

  • Smoking - people who regularly smoke tobacco are more likely to develop peptic ulcers compared to non-smokers.

  • Alcohol consumption - regular heavy drinkers of alcohol have a higher risk of developing peptic ulcers.

  • Mental stress - mental stress has not been linked to the development of new peptic ulcers. However, people with ulcers who experience sustained mental stress tend to have worse symptoms.

How are peptic ulcers diagnosed?

A patient's description of symptoms will usually make the doctor suspect a peptic ulcer. Some tests will be ordered so that diagnosis can be confirmed, such as:
  • Blood test - a blood test can determine whether H pylori bacteria are present. However, a blood test cannot determine whether the patient had past exposure or is currently infected. Also, if the individual has been taking antibiotics or proton pump inhibitors a blood test can give a false-negative result.

  • Breath test - a radioactive carbon atom is used to detect H pylori. The patient drinks a glass of clear liquid containing radioactive carbon as part of a substance (urea) that the H pylori will break down. An hour later the patient blows into a bag which is subsequently sealed. If the patient is infected with H pylori the breath sample will contain radioactive carbon in carbon dioxide. The breath test is also useful in checking to see how effective treatment has been in eliminating H pylori.

  • Stool antigen test - this test determines whether H pylori is present in the feces (stools). This test is also useful in determining how effective treatment has been in getting rid of the bacteria.

  • Upper gastrointestinal X-ray (upper GI X-ray) - the test outlines the esophagus, stomach and duodenum. The patient swallows a liquid which contains barium. The barium coats the digestive tract and shows up on the X-ray, making the ulcer easier to see. Upper GI X-rays are only useful in detecting some ulcers.

  • Endoscopy - a long-narrow tube with a camera attached to the end is threaded down the patient's throat and esophagus into the stomach and duodenum. The doctor can see the upper digestive tract on a monitor and identify an ulcer if one is present. Endoscopies are also performed if the patient has other signs or symptoms, such as weight loss, vomiting (especially if blood is present), black stools, anemia, and swallowing difficulties.

    If an ulcer is detected the doctor may take a biopsy - a small sample of tissue is taken near the ulcer. The sample is examined under a microscope to rule out cancer. A biopsy can also be used to test for the presence of H pylori.

    Sometimes another endoscopy is performed a few months later to determine whether the ulcer is healing.

What are the treatment options for peptic ulcers?

The type of treatment is usually determined by what caused the peptic ulcer - H Pylori or NSAIDs. Treatment will focus on either lowering stomach acid levels so that the ulcer can heal, or eradicating the H pylori infection.
  • PPIs (proton pump inhibitors)

    These tablets reduce the amount of acid the stomach produces and are prescribed for patients who tested negative for H pylori infection. Treatment usually lasts from one to two months - if the ulcer is severe treatment may last longer.

    Patients who have to undergo an endoscopy will have to stop taking PPIs for at least 14 days beforehand. PPIs make it harder to see the inside of the abdomen.

    If side effects do occur they are usually mild and go away when treatment stops. They may include:

    • Nausea
    • Skin rashes
    • Stomach pain
    • Dizziness
    • Headaches
    • Constipation
    • Diarrhea

  • H pylori infection treatment

    Patients infected with H pylori will usually have to take a PPI (proton pump inhibitor) and two different antibiotics - twice a day for seven days. It is crucial that the patient adheres to dosage instructions. This treatment is effective in about 90% of patients, whose ulcer will start to disappear within a matter of days.

    When treatment is over the individual will have to be tested again to make sure the H pylori have gone, especially if such symptoms as indigestion persist. If the infection is still present he/she will undergo another course of antibiotics; this time with different antibiotics.

    A person who has a gastric ulcer caused by H pylori infection has a slightly higher risk of developing stomach cancer. Hence, confirming that treatment has been successful is important.

  • NSAIDs (non-steroidal anti-inflammatory drugs)

    People whose peptic ulcer was caused by taking NSAIDs will have to stop taking them, if possible. The doctor will prescribe another painkiller, such as acetaminophen (Tylenol, paracetamol).

    Individuals with another condition that causes severe pain may have to stop taking NSAIDs for as long as possible until their ulcer has healed.

    In some cases it may not be possible to stop taking NSAIDs. The doctor may minimize the dosage and review the patient's need for them later on. The doctor may also prescribe a medication to be taken long term, alongside the NSAID - this might be either a PPI or an H2-receptor antagonist.

  • Alginates

    Alginates help relieve indigestion caused by acid reflux and is often found in antacids. Alginates form a foam barrier on the surface of the stomach contents, keeping the stomach acid in the stomach. Antacids which contain alginates help medications stay in the stomach for longer.

  • H2-receptor antagonists

    These medications reduce the amount of acid in the stomach. They are swallowed as tablets. Patients taking erythromycin or warfarin will not be able to take cimetidine (a type of H2-receptor antagonist).

    Individuals who are to undergo an endoscopy will have to stop taking H2-receptor antagonists for at least 14 before the procedure.

    If side effects do occur, they may include:

    • Headaches
    • Skin rashes
    • Fatigue
    • Diarrhea
    • Dizziness

  • Follow-up treatment

    Even after the ulcer has healed and treatment has been completed the patient may still have indigestion. In such case the doctor may advise some eating and lifestyle changes. If symptoms persist the doctor may prescribe a low-dose PPI or H2-receptor antagonist.

What are the possible complications of peptic ulcers?

The risk of complications is much greater if the ulcer is left untreated, or if treatment was not completed. Examples include:
  • Internal bleeding - slow blood loss can lead to anemia, while severe blood loss requires hospitalization and blood transfusions.

  • Infection - a peptic ulcer can bore a hole through the wall of the stomach or small intestine, significantly increasing the risk of infection in the abdominal cavity - peritonitis. Peritonitis can be very painful and causes chills and fever, nausea, vomiting and a hard feeling in the abdomen. Individuals with peritonitis should seek medical attention as soon as symptoms are felt.

  • Scar tissue - scar tissue caused by peptic ulcers can obstruct the passage of food through the digestive tract, making the patient feel full more easily. Scarring may also cause vomiting and weight loss.

  • Pyloric stenosis - chronic inflammation in the lining of the stomach or duodenum caused by a peptic ulcer can result in a narrowing of the pylorus (small passage that links the stomach and the duodenum). Pyloric stenosis is the narrowing of the pylorus. Food will not pass through to the intestines, causing vomiting and weight loss.

  • Recurrence of peptic ulcers - People with the highest risk of developing peptic ulcers are those who have had them before. Somebody who had a peptic ulcer caused by H pylori infection runs a 5% risk of having another one during their lifetime; even after their original ulcer was successfully treated and healed.

    Somebody who had a peptic ulcer caused by H pylori infection and still has the bacteria runs a 60% risk of having another gastric ulcer during their lifetime and a 80% risk of having another duodenal ulcer.
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What Is Osteoporosis? What Causes Osteoporosis?

The bones of people with osteoporosis become thin and weak. The word "osteo" comes from the Greek osteon meaning "bone", while "porosis" comes from the Greek poros meaning "hole, passage". According to Medilexicon's medical dictionary, osteoporosis is a "reduction in the quantity of bone or atrophy of skeletal tissue; an age-related disorder characterized by decreased bone mass and loss of normal skeletal microarchitecture, leading to increased susceptibility to fractures."

About 3 million people have osteoporosis in the UK, causing approximately 230,000 fractures each year, according to the National Health Service (NHS). Osteoporosis is a public health threat for an estimated 44 million people in the USA, 55% of people aged 50 or over, says the National Osteoporosis Foundation (NOF). The NOF says that 10 million people currently have osteoporosis, while 34 million are thought to have low bone mass; which places them at significantly increased risk for the condition.

As people are living longer and leading more sedentary lives, the incidence of osteoporosis is expected to continue rising. This study reports that policy makers and funding agencies do not always consider this development sufficiently in their planning.

If osteoporosis is not prevented, or if it is left untreated, it can progress without causing any pain until a bone breaks - most likely the hip bone, a bone in the spine, or the wrist. A hip fracture invariably requires hospitalization and major surgery. Hip fractures generally lead to serious walking disability and sometimes death if left untreated. Fractures of the spine or vertebrae can sometimes result in loss of height, severe back pain, and deformity.

German scientists have elucidated a molecular mechanism which regulates the equilibrium between bone formation and bone resorption. They were able to show that two different forms of a gene switch - a short isoform and a long isoform - determine this process

What are the symptoms of osteoporosis?

Osteoporosis develops very slowly over a period of many years. The condition may creep up on the patient without any obvious symptoms initially - it can take several months, and even several years to become noticeable. Early signs of osteoporosis may include:
  • Joint pains
  • Difficulty standing
  • Difficulty sitting up straight. The stooping position often seen among elderly people is a visible sign of possible osteoporosis.
As the person's bone density or bone mass continues to go down fractures of the hip, wrist or bones in the spine become more common. Even a cough or a sneeze may fracture a rib or cause partial collapse of one of the spinal bones.

Elderly people suffer greatly if they fracture a bone, because the bone cannot repair itself properly. Bones that do not effectively repair themselves are more likely to trigger arthritis, eventually leaving the patient seriously disabled. A large percentage of elderly patients who break a bone are not able to live independently afterwards.

Although osteoporosis is not painful in itself, the condition causes bones to break more easily, and broken bones are very painful. The most common cause of chronic pain linked to osteoporosis is a spinal fracture.

What are the risk factors for osteoporosis? What diseases or conditions may be linked to osteoporosis?

A risk factor is something that increases a person's chances of developing a disease or condition. A number of factors can raise the probability of developing osteoporosis. They include:
  • The patient's sex - women are twice as likely to develop osteoporosis as men. Experts say there are two reasons for this: 1. Women start life with a lower bone life than men. 2. Women live longer than men. 3. The menopause causes a sudden drop in estrogen in women which speeds up bone loss.

  • Age - a person's bone mass lowers each year as he/she gets old. The falling bone mass continues until the person dies.

  • Vertigo - Korean scientists found a link between people who suffer from vertigo and osteoporosis.

  • HIV - people with HIV/AIDS have a significantly higher risk of developing osteoporosis, as this study found.

  • Gastric cancer - many surviving gastric cancer patients might suffer from osteoporosis and be at risk of developing multiple fractures in their later life.

  • Ethnicity - people who are Caucasian, or of South Asian descent are more likely to develop osteoporosis than people of African or North/South American Indian descent. However, the risk is still significant for everybody.

  • Family history - people who have a close relative - parent or sibling) who has/had osteoporosis are much more likely to develop it themselves. This is especially the case if the close relative had fractures. A study found that a gene called DARC negatively regulates bone density in mice.

  • People with small frames - people who have small body frames, as well as people who are very thin tend to have a higher risk of developing osteoporosis when they get older. This is because their bone mass is lower than other people's when they start to age and bone density begins to fall.

  • Smoking - people who smoke run a much higher risk of developing osteoporosis. Experts are not completely sure why.

  • Estrogen exposure - women who have a late menopause, when estrogen levels drop significantly, have a lower risk of developing osteoporosis compared to women whose menopause arrives early or at an average age. Conversely, women whose menopause arrived early are at a higher risk.

  • Anorexia and/or bulimia - people of both sexes who have, or have had eating disorders have a higher risk of developing osteoporosis. International Osteoporosis Foundation warns of bone damage from anorexia.

  • Cardiovascular disease and possibly Alzheimer's disease link - a research project at Rice University has brought scientists to the brink of comprehending a long-standing medical mystery that may link cardiovascular disease, osteoporosis and perhaps even Alzheimer's disease.

  • Some medications:

    • Corticosteroids - long term use of corticosteroids damages bones. Such drugs include prednisone, cortisone, prednisolone and dexamethasone. Patients with asthma, rheumatoid arthritis, and psoriasis may have been prescribed these medications. Doctors often monitor such patient's bone density and recommend other drugs to prevent bone loss.

    • Selective serotonin reuptake inhibitors (SSRIs) - these are types of antidepressants. They have been found to lower bone density. It is not completely clear yet whether they do cause osteoporosis; but the fact that they have an impact on bone density means patients on SSRIs may need to be aware.

    • Blood thinning medications - long term use may lower bone density.

    • Methotrexate - a drug used for cancer treatment.

    Some drugs used for epilepsy, diuretics, as well as some aluminum-containing antacids also cause bone loss.

  • Thyroid hormone - if there is too much thyroid hormone in the person's body his/her bone mass may be affected. This could be caused by an overactive thyroid (hyperthyroidism) or overconsumption of medications for the treatment of hypothyroidism (underactive thyroid).

  • Breast cancer - women who have had breast cancer may have a higher risk of developing osteoporosis after the menopause. This is especially the case if they were treated with chemotherapy or aromatase inhibitors (anastrozole and letrozole) which suppress estrogen. Tamoxifen, on the other hand, reduces fracture risk and is not an osteoporosis risk factor.

  • Long-term low calcium consumption - people who have consumed too little calcium during their lives are at a significantly higher risk of developing osteoporosis.

  • Some medical conditions and surgical procedures - especially those which may undermine or lower calcium absorption. They include:

    • Gastrectomy (stomach surgery)
    • Crohn's disease
    • Celiac disease
    • Vitamin D deficiency
    • Cushing's disease

  • Long-term physical inactivity - people who have lead a generally sedentary lifestyle with little exercise are much more prone to developing osteoporosis one day, compared to people who had physically active childhoods, and adulthoods.

  • Too much caffeine consumption - the association between high caffeine consumption and bone loss is highly suspected, but not completely proven. As caffeine is a diuretic it may increase mineral (calcium) loss. Many experts say that the phosphoric acid in sodas (fizzy drinks) may contribute to bone loss. People who drink lots of coffee and sodas should make sure they are consuming enough calcium and vitamin D. This study found that regular female cola drinkers have a higher risk of developing osteoporosis than women who don't drink cola.

  • Alcoholism - this is the main cause of osteoporosis among males. Consuming too much alcohol regularly undermines bone formation and messes with our body's ability to absorb alcohol.

  • Depression - people with depression tend to lose bone mass faster than other people.

How is osteoporosis diagnosed?

In most cases, the patient does not know he/she has osteoporosis until later on, when a bone is fractured. X-rays cannot measure bone density reliably - but they are good at identifying spinal fractures.
  • DEXA scan - this scan measures bone density. DEXA stands for Dual Energy X-ray Absorptiometry. The DEXA scan measures bone densities and compares them to a normal range. The patient is then given a 'T' score. This score describes the person's bone density compared to the average. T scores are set out in the following way:

    • 0 or minus 1 - normal range bone density
    • Minus 1 to minus 2.5 is a lower bone density. The patient has osteopenia (not osteoporosis)
    • Below minus 2.5 - the patient has osteoporosis.
    The DEXA scan is fast, simple and accurate. It measures bone density in the most likely areas to be affected by osteoporosis - the spine, hip and wrist. It also follows changes in these bones over time.

  • Dental X-rays - Researchers in the school of dentistry at the University of Manchester have created a unique way of identifying osteoporosis sufferers from ordinary dental X-rays.

  • Ultrasound - an ultrasound scan can also provide a doctor with a reliable indication of bone density.

  • CT (computerized tomography) - this can also provide a doctor with a reliable indication of bone density.

  • Measuring calcium intake in men - a study revealed that measuring a man's daily calcium intake is an effective way of identifying prostate cancer patients with a higher than average risk of osteoporosis.

Who should have a test?

The National Osteoporosis Foundation says women should have a bone density test if they aren't taking estrogen and:
  • Are aged 65 or over
  • Are postmenopausal and have one or more risk factors for osteoporosis
  • Have an abnormality in their spine
  • Are taking medications which may raise the risk of osteoporosis
  • Have Type 1 diabetes
  • Have a liver disease
  • Have a kidney disease
  • Have a thyroid disease
  • Have a family history of osteoporosis
  • Have experienced early menopause
Doctors do not usually advise men to have routine osteoporosis tests because it is far less common among men.

Treatment for osteoporosis

  • HRT (Hormone replacement therapy) - for women going through the menopause HRT helps prevent bone density loss, thus reducing the risk of fractures during treatment. In many cases, though, HRT is not recommended as the first osteoporosis treatment, because it can raise her risk of having a stroke, heart disease and breast cancer. It is important that the patient discuss this option with a doctor.

  • Testosterone treatment - when a man has osteoporosis because of low testosterone production, testosterone treatment may be recommended. However, as with breast cancer, testosterone may accelerate the growth of prostate cancer as well as increasing the risk of prostate cancer recurrence.

  • Bisphosphonates - these help prevent bone density loss and are non-hormonal drugs. The breakdown rate of bone by osteoclasts is slowed down while the production of new bone is speeded up. If biphosphonates are unsuitable strontium ranelate might be a good alternative. Taking just one pill per month may help slow down bone loss, this study revealed. Side effects may include abdominal pain, nausea, inflamed esophagus, esophageal ulcers (especially for patients who have had acid reflux) - side effects may be severe. A study revealed that short term use of oral bisphosphonates may leave the jaw vulnerable to devastating necrosis (death of bone tissue).

  • Calcitonin - this inhibits the cells that break down bone. Calcitonin is a hormone made by the thyroid gland.

  • Calcium and vitamin D supplements - these may help older patients lower their risk of hip fractures. Sunlight is the best source of vitamin D. If patients do not have access to sunlight, as may be the case during the winter in some countries, the doctor may recommend a supplement. A Canadian study found that less than half (43%) of patients in Europe with osteoporosis are claiming to take both calcium and vitamin D supplementation with their osteoporosis treatment.

  • SERMs (Selective estrogen receptor modulators) - these drugs help prevent bone density loss. They mimic the beneficial effects of estrogen on bone density in postmenopausal women - however, without the risk of triggering cancers. Raloxifene is an example of this type of drug. Patients who have a history of blood clots should not take this medication. A common side effect is hot flashes. This drug is only approved for women with osteoporosis, not men.

  • Stem cell therapy - scientists report that stem cells could halt osteoporosis, promote bone growth - and new pathways that controls bone remodeling.

Complications of osteoporosis

  • Fractures in the spinal column can cause loss of height because the spine cannot bear the person's body weight, leading to the characteristic hunched posture. These fractures may occur without any fall or blow to the bones.

  • Minor falls can cause fractures to the wrist, neck, forearm, and hip bones.

  • Weakened bones can cause disability and loss of mobility.

  • Hip replacements are frequently required after a fracture, making it extremely difficult for the person to walk without help.

  • Death can result from postoperative complications, especially if the osteoporosis patient is elderly.

  • Many patients with osteoporosis have to be looked after in nursing homes as a result of loss of mobility.


  • Calcium - Make sure your calcium intake is adequate. The National Osteoporosis Foundation (NOF) says adults under 50 years of age need 1,000 mg of calcium per day, while people over 50 need 1,200 mg of calcium each day.

  • Vitamin D - Make sure your vitamin D intake is adequate. Remember that sunlight is a brilliant source of vitamin D. You need vitamin D for your body to be able to absorb calcium. The NOF says people under 50 require 400-800 IU of vitamin D daily, while those over 50 require 800-1,000 IU of vitamin D daily. Two types of vitamin D supplements are available - vitamin D3 and vitamin D2. Some research suggests that vitamin D3 is better, while others indicate that it does not matter.

  • Exercise - Make sure you are physically active. The best exercises to prevent osteoporosis are those in which you have to carry the weight of your body, such as walking, dancing, jogging, stair-climbing, racquet sports and hiking. This study reveals that cycling does not help prevent osteoporosis - in fact, the opposite may be the case.

  • Soy - Eat soy and soy products. They contain plant estrogens which help maintain bone density.

  • Smoking - Quit smoking.

  • HRT - Consider hormone therapy (HRT). However, bear in mind the risk of cancers for some people. Talk about this with your doctor.

  • Alcohol - Control your consumption of alcohol. Excessive alcohol consumption is closely linked to loss of bone mass.

  • Caffeine - Do not consume too much caffeine. Remember that many sodas (fizzy drinks) also contain caffeine.
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What Is Chronic Pancreatitis? What Causes Chronic Pancreatitis?

Chronic pancreatitis is long-term progressive inflammatory disease of the pancreas that leads to permanent deterioration of the structure and function of the pancreas. It is estimated that in Western Europe and North American chronic pancreatitis is diagnosed in 3 to 9 people in every 100,000 each year.

The most common cause is long-term alcohol abuse - it is thought to account for approximately 70% of all cases. The gradual rise in the incidence of chronic pancreatitis in several countries around the globe has been attributed to increasing alcohol consumption and earlier diagnosis.

Chronic pancreatitis results in over 122,000 outpatient visits and 56,000 hospitalizations annually in the USA. Significantly more men than women are affected.

Chronic pancreatitis usually begins in adults aged 40 to 50.

What is the pancreas?

The pancreas is a gland organ that is located in the abdomen, behind the stomach and below the ribcage. It is part of the digestive system and produces important enzymes and hormones that help break down foods. It has an endocrine function because it releases juices directly into the bloodstream, and it has an exocrine function because it releases juices into ducts.

Enzymes, or digestive juices, produced by the pancreas are secreted into the small intestine to further break down food after it has left the stomach. The gland also produces the hormone insulin and secretes it into the bloodstream in order to regulate the body's glucose or sugar level.

What are the symptoms of chronic pancreatitis?

  • Pain - the patient may feel pain in the upper abdomen. The pain may sometimes be severe and can travel along the back. It is usually more intense after eating. Some pain relief may be gained by leaning forward or curling into a ball.

  • Nausea and vomiting - more commonly experienced during episodes of pain.

  • Constant pain - As the disease progresses the episodes of pain become more frequent and severe. Some patients eventually suffer constant abdominal pain.
As chronic pancreatitis progresses, and the pancreas' ability to produce digestive juices deteriorates, the following symptoms will appear:
  • Smelly and greasy feces (stools)
  • Bloating
  • Abdominal cramps
  • Flatulence (breaking wind, farting)
Eventually the pancreas may not be able to produce insulin, leading to diabetes type 1, with the following symptoms:
  • Thirst
  • Frequent urination
  • Intense hunger
  • Weight loss
  • Tiredness (fatigue)
  • Blurred vision

What are the causes of chronic pancreatitis?

Chronic pancreatitis is usually the follow-on of repeated episodes of acute pancreatitis which lead to permanent damage of the pancreas.

Acute pancreatitis is caused when trypsin becomes activated within the pancreas. Trypsin is an enzyme produced in the pancreas and released into the intestines where it breaks down proteins as part of the digestive system. Trypsin is inactive until it has reached the intestines. If trypsin becomes activated inside the pancreas it will start to digest the pancreas itself, leading to irritation and inflammation of the pancreas - acute pancreatitis. Alcohol can cause a process which triggers the activation of trypsin inside the pancreas, as can gallstones.
  • Alcohol misuse causes 70% of chronic pancreatitis cases

    People who misuse alcohol and develop acute pancreatitis tend to have repeated episodes, and eventually develop chronic pancreatitis (long-term) - that is why 70% of all chronic pancreatitis cases are caused by alcohol misuse. The repeated bouts of acute pancreatitis eventually take their toll on the pancreas, causing permanent damage, which then becomes chronic pancreatitis - also known as alcoholic chronic pancreatitis.

    According to the National Health Service, UK, long-term alcoholic misuse that typically causes chronic pancreatitis consists of about 10 to 15 years of 10 units of alcohol per day or more. A typical 750ml bottle of 12% wine contains 9 units of alcohol. Approximately 5% to 10% of people with long-term alcohol misuse develop chronic pancreatitis.

    Experts believe that patients with alcoholic chronic pancreatitis have specific genetic mutations which make them more susceptible to the effects of alcohol.

  • Idiopathic chronic pancreatitis makes up the bulk of the remaining 30% of cases

    When a disease is idiopathic it means there is no known cause or reason to explain why or how it developed. Idiopathic chronic pancreatitis accounts for most of the remaining cases. Most cases of idiopathic chronic pancreatitis start to develop in people aged 10 to 20 years, and those over 50.

    Nobody is certain why other age groups are rarely affected. The SPINK-1 and The CFTR genes, types of mutated genes, exist in about 50% of patients with idiopathic chronic pancreatitis. Experts believe these genetic mutations may undermine the functions of the pancreas.

    Other much rarer causes include autoimmune chronic pancreatitis in which the person's own immune system attacks the pancreas, heredity pancreatitis where patients have a genetic condition and are born with a faulty pancreas, and cystic fibrosis, another genetic condition which damages certain organs.

How is chronic pancreatitis diagnosed?

There are no reliable tests to diagnose chronic pancreatitis. A doctor will suspect the disease because of the patient's symptoms, history of repeated acute pancreatitis flare-ups, or alcohol abuse.

Blood tests may be useful in checking the blood glucose levels, which may be elevated.

Blood tests for elevated levels of amylase and lipase are not reliable at this stage. Amylase and lipase blood levels rise during the first couple of days of pancreatitis, and then settle back to normal after five to seven days. A patient with chronic pancreatitis would have had the disease for much longer.

Doctors need to have a good look at the pancreas in order to diagnose the disease properly. This will most likely involve:
  • An ultrasound scan - high frequency sound waves create an image on a monitor of the pancreas and its surroundings.

  • A CT (computed tomography) scan - X-rays are used to take many pictures of the same area from several angles, which are then placed together to produce a 3-D image. The scan will reveal changes of chronic pancreatitis.

  • MRCP (magnetic resonance cholangiopancreatography) scan - this scan will show the bile and pancreatic ducts more clearly than a CT scan.

  • An ERCP (endoscopic retrograde cholangio-pancreatography) scan - an endoscope (thin, flexible tube with a camera at the end) is inserted into the digestive system. The doctor uses ultrasound to guide the endoscope through.
Patients with chronic pancreatitis have an elevated risk of developing pancreatic cancer. If symptoms worsen, especially the narrowing of the pancreatic duct, doctors may suspect cancer. If so, they will order a CT scan, MRI scan, or endoscopic study.

What are the treatment options for chronic pancreatitis?

Lifestyle changes

Patients with chronic pancreatitis will need to undergo some lifestyle changes. These will include:
  • Stop drinking - giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.

  • Stop smoking - smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.

  • Diet - the pancreas is involved in digestion; pancreatitis damages the functions of the pancreas. This means that patients with the disease will have difficulty digesting many foods. Rather than three large meals a day, patients will be advised to change to six small meals. It is also better to avoid fatty meals, i.e. to follow a low-fat diet.

    A diet plan will either be drawn up by the doctor, or the patient may be referred to a qualified dietitian.

    Depending on the extent of pancreatic damage, patients may also have to take artificial versions of some enzymes to aid digestion. These will ease bloating, make the feces less greasy and foul-smelling, and help the abdominal cramps.
Pain - treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain. Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until the patient responds.

Insulin - the pancreas may stop producing insulin if the damage is extensive. The patient will have developed diabetes type 1. Regular insulin treatment will become part of the treatment for the rest of the patient's life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets because most likely the digestive system will not be able to break them down.


Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head (top section) of the pancreas. The inflammation aggravates the nerve endings.

Endoscopic surgery - a narrow, hollow, flexible tube (endoscope) goes into the digestive system guided by ultrasound. A devise with a tiny deflated balloon at the end is threaded through the endoscope. When it reaches the duct the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.

Pancreas resection - the head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation which was irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:
  • The Beger procedure - this involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.

  • The Frey procedure - this is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection - the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.

  • Pylorus-sparing pancreaticoduodenectomy (PPPD) - the gall bladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed and the ducts are blocked as well. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk infection and internal bleeding.
Total pancreatectomy - this involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain. However, the patient will be totally dependent on treatment for some of the vital functions of the pancreas, such as the release of insulin.

Autologous pancreatic islet cell transplantation (APICT) - during the total pancreatectomy procedure a suspension of isolated islet cells is created from the surgically removed pancreas and injected into the portal vein of the liver. The islets cells will function as a free graft in the liver - they will exist in the liver where they produce insulin.

What are the complications of chronic pancreatitis?

Stress, anxiety, depression

The disease may have an effect on the patient's psychological and emotional well being. Constant or recurring pain, which is often severe, may cause distress, anxiety, irritability, stress and depression. It is important for patients to tell their doctors if they are emotionally or psychologically affected. If there is a support group in your area, being able to talk to people who share the same condition may help you feel less isolated and more able to cope.


This is a collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen, caused by leakage of digestive fluids escaping from a faulty pancreatic duct. Pseudocysts don't usually cause any problems. However, sometimes they can become infected, cause blockage to part of the intestine, or rupture and cause internal bleeding. If this happens the cyst will have to be surgically drained.

Pancreatic cancer

Even though pancreatic cancer is more common among patients with chronic pancreatitis, the risk is only 1 in 500.

Prevention of chronic pancreatitis

Patients with acute pancreatitis significantly reduce their risk of developing chronic pancreatitis if they give up drinking alcohol. This is especially the case for patients who drink heavily and regularly.
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What Is Dehydration? What Causes Dehydration?

Dehydration (from the Greek hydor (water)) and the Latin prefix de- (indicating deprivation, removal, and separation) occurs when more water and fluids are exiting the body than are entering the body. With about 75% of the body made up of water found inside cells, within blood vessels, and between cells, survival requires a rather sophisticated water management system. Luckily, our bodies have such a system, and our thirst mechanism tells us when we need to increase fluid intake. Although water is lost constantly throughout the day as we breathe, sweat, urinate, and defecate, we can replenish the water in our body by drinking fluids. The body can also shift water around to areas where it is more needed if dehydration begins to occur.

Most occurrences of dehydration can be easily reversed by increasing fluid intake, but severe cases of dehydration require immediate medical attention.

A study explains that even small levels of dehydration can create headaches, lethargy, or just overall lack of alertness. Dehydration can also cause constipation.

What causes dehydration?

The immediate causes of dehydration include not enough water, too much water loss, or some combination of the two. Sometimes it is not possible to consume enough fluids because we are too busy, lack the facilities or strength to drink, or are in an area without potable water (while hiking or camping, for example). Additional causes of dehydration include:
  • Diarrhea - the most common cause of dehydration and related deaths. The large intestine absorbs water from food matter, and diarrhea prevents this function, leading to dehydration.

  • Vomiting - leads to a loss of fluids and makes it difficult to replace water by drinking it.

  • Sweating - the body's cooling mechanism releases a significant amount of water. Hot and humid weather and vigorous physical activity can further increase fluid loss from sweating.

  • Diabetes - high blood sugar levels cause increased urination and fluid loss.

  • Frequent urination - usually caused by uncontrolled diabetes, but also can be due to alcohol and medications such as diuretics, antihistamines, blood pressure medications, and anti-psychotics.

  • Burns - water seeps into damaged skin and the body loses fluids.

Who is at risk of dehydration?

Although dehydration can happen to anyone, some people are at a greater risk. Those highest at risk include:
  • People in higher altitudes

  • Athletes, especially those in endurance events such as marathons, triathlons, and cycling tournaments. Dehydration can undermine performance in sports.

  • People with chronic illnesses such as diabetes, kidney disease, cystic fibrosis, alcoholism, and adrenal gland disorders

  • Older adults, infants, and children. Dehydration in elderly people can be explained by brain malfunction, a study revealed. An article explains how drinking more water improved the health of elderly people.

What are the symptoms of dehydration?

The first symptoms of dehydration include thirst, darker urine, and decreased urine production. In fact, urine color is one of the best indicators of a person's hydration level - clear urine means you are well hydrated and darker urine means you are dehydrated. As the condition progresses to moderate dehydration, symptoms include:
  • Dry mouth

  • Lethargy

  • Few or no tears when crying

  • Weakness in muscles

  • Headache

  • Dizziness
Severe dehydration may be characterized by extreme versions of symptoms mentioned above as well as:
  • Lack of sweating

  • Sunken eyes

  • Shriveled and dry skin

  • Sunken fontanels (soft spots) in babies

  • Low blood pressure

  • Increased heart beat

  • Fever

  • Delirium

  • Unconsciousness

How is dehydration diagnosed?

A physician will use both physical and mental exams to diagnose dehydration. A patient presenting symptoms such as disorientation, low blood pressure, rapid heart beat, fever, lack of sweat, and inelastic skin will usually be considered dehydrated.

Blood tests are often employed to test kidney function and to check sodium, potassium, and other electrolyte levels. Electrolytes are chemical ions that regulate hydration in the body and are crucial for nerve and muscle function. A urinalysis will provide very useful information for a dehydration diagnosis. In a dehydrated person, urine will be darker in color and more concentrated - containing a certain level of a compound called ketones.

To diagnose dehydration in infants, doctors usually check for a sunken soft spot on the skull. They may also look for a loss of sweat and certain muscle tone characteristics.

How is dehydration treated?

Dehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water, clear broths, frozen water or ice pops, or sports drinks (such as Gatorade). Some dehydration patients, however, will require intravenous fluids in order to rehydrate. People who are dehydrated should avoid drinks containing caffeine such as coffee, tea, and sodas. A study indicated that dehydrated children should be given fluids by mouth. Underlying conditions that are causing dehydration should also be treated with the appropriate medication. This may include anti-diarrhea medicines, anti-emetics (stop vomiting), and anti-fever medicines.

How can dehydration be prevented?

Prevention is really the most important treatment for dehydration. Consuming plenty of fluids and foods that have high water content (such as fruits and vegetables) should be enough for most people to prevent dehydration. People should be cautious about doing activities during extreme heat or the hottest part of the day, and all person who are exercising should make replenishing fluids a priority. Since the elderly and very young are often most at risk being dehydrated, special attention should be given to them to make sure they are receiving enough fluids.

Videos: Signs of dehydration - How to prevent it

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