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After Break Very Long Time...

2009-02-05T12:34:00.000-08:00

Hi...
I'm dr. Monte, after break very long time, finally I can surfing again at my blog... So wait for my new article of medicine.

Do You Have Any Health Information...?

2008-12-01T08:54:00.000-08:00

Do You Have Any Health Information...?

Hi, this article just for share. Do you have any health information? Just write down at list comment after this article. Thank you.

dr. Monte Selvanus

Information: CT Scan For Advance Services

2008-12-01T08:25:00.000-08:00

Information: CT Scan For Advance Services

From now on, PKU Muhammadiyah Gombong Hospital has one unit of CT Scan.

What is a CT scan?

A computerized axial tomography scan is an x-ray procedure that combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. Computerized axial tomography is more commonly known by its abbreviated names, CT scan or CAT scan. A CT scan is used to define normal and abnormal structures in the body and/or assist in procedures by helping to accurately guide the placement of instruments or treatments.

A large donut-shaped x-ray machine takes x-ray images at many different angles around the body. These images are processed by a computer to produce cross-sectional pictures of the body. In each of these pictures the body is seen as an x-ray "slice" of the body, which is recorded on a film. This recorded image is called a tomogram. "Computerized Axial Tomography" refers to the recorded tomogram "sections" at different levels of the body.

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Parent Smoking During Pregnancy Raises Kids' Heart Risks

2008-12-01T08:15:00.000-08:00

Parent Smoking During Pregnancy Raises Kids' Heart Risks

By Ed Edelson
HealthDay Reporter

THURSDAY, Nov. 20 (HealthDay News) -- Damage to the arteries of children of smokers can be detected in the early decades of their lives, a new Dutch study finds.

"Smoking in families is harmful for children, including their cardiovascular system, as was found in many other studies," said research leader Dr. Cuno S.P.M. Uiterwaal, an associate professor of clinical epidemiology at the University Medical Center in Utrecht. "This study adds that tobacco smoke exposure may have such effects already in very early life."

Uiterwaal and his colleagues reported the finding in the December issue of Arteriosclerosis, Thrombosis and Vascular Biology that they used ultrasound to measure the thickness of the walls of carotid arteries, the major blood vessels to the brain, in 732 young adults, average age 28. Records showed that 29% of the mothers and more than 60% of the fathers smoked during the pregnancies.

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Group: Soft Plastic Toys Are Health Risk

2008-12-01T07:50:00.000-08:00

Group: Soft Plastic Toys Are Health Risk

Consumer Group Concerned About Health Risks From Chemical Called Phthalates

By Todd Zwillich
WebMD Health News

Reviewed By Louise Chang, MD

Nov. 25, 2008 -- A consumer watchdog group is urging parents to avoid buying soft plastic toys this holiday season because of a risk that the toys may contain toxic chemicals.

Toys containing the chemicals, called phthalates, can no longer be manufactured or imported after February 2009, according to a product safety law that passed Congress over the summer.

But the group says the Consumer Product Safety Commission is allowing the toy industry to circumvent the law. The agency wrote a letter last week telling manufacturers they can still sell their existing stocks of phthalate-containing toys even after the ban takes effect in February.

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HEART FAILURE

2008-11-30T02:07:00.000-08:00

HEART FAILURE

Definition

Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs. Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

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

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

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Tuberculosis

2008-11-30T01:17:00.000-08:00

Tuberculosis

Infection and transmission

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.

Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater.

Someone in the world is newly infected with TB bacilli every second.
Overall, one-third of the world's population is currently infected with the TB bacillus.
5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.
Continue...

LORATADINE

2008-11-29T09:12:00.000-08:00

GENERIC NAME: LORATADINE

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Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

BRAND NAME: Claritin, Claritin RediTabs, Alavert, others

DRUG CLASS AND MECHANISM: Loratadine is a long-acting antihistamine that is used for the treatment of allergy. Histamine is a chemical that causes many signs and symptoms of allergy. Histamine is released from histamine-storing cells (mast cells) and attaches to other cells that have receptors for histamine on their surfaces. Histamine stimulates the cells to release chemicals that produce effects that we associate with allergy. Loratadine blocks one type of histamine receptor (the H1 receptor) and thus prevents activation of cells with H1 receptors by histamine. Unlike some antihistamines, loratadine does not enter the brain from the blood and, therefore, does not cause drowsiness when taken at recommended doses. The FDA approved loratadine in April 1993. Continue...

Diet Plans & Programs

2008-11-29T08:43:00.000-08:00

Diet Plans & Programs Comparing Popular Weight Loss Diets
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Author: Betty Kovacs, MS, RD
Medical Editors: Melissa Conrad Stöppler, MD and Ruchi Mathur, MD

Weight loss seems simple

A calorie is a calorie, the advice goes. Eat too many ... gain weight. Eat fewer ... lose weight. But many believe weight loss is more than a calorie equation, with so-called new-and-improved ways to lose weight being ever popular. Americans spend an estimated $42 billion annually on weight loss foods, products, and services. With that much money at stake, it's no surprise there are an overwhelming number of "fad" diets and other weight-loss products on the market.

Having so many diet options makes it difficult to know which ones to trust. For this reason, The Partnership for Healthy Weight Management has developed the "Voluntary Guidelines for Providers of Weight Loss Products or Services." The mission for these guidelines is to "promote sound guidance to the general public on strategies for achieving and maintaining a healthy weight." According to the guidelines, effective weight management involves:

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Nausea and Vomiting

2008-11-29T08:20:00.000-08:00

Nausea and Vomiting

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Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Introduction to nausea and vomiting

Nausea and vomiting are symptoms of an underlying disease and not a specific illness. Nausea is the sensation that the stomach wants to empty itself, while vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach.

Vomiting is a violent act in which the stomach has to overcome the pressures that are normally in place to keep food and secretions within the stomach. The stomach almost turns itself inside out - forcing itself into the lower portion of the esophagus (the tube that connects the mouth to the stomach) during a vomiting episode. Continue...

Depression

2008-11-27T08:24:00.000-08:00

Depression

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Medical Authors: Roxanne Dryden-Edwards, MD and Dennis Lee, MD

Medical Editor: William C. Shiel Jr., MD, FACP, FACR

What is a depressive disorder?

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression. Continue...

Albumin

2008-11-27T08:10:00.000-08:00

Albumin

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Dr. Monte Selvanus Luigi Kusuma

PKU Muhammadiyah Gombong Hospital

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USES: Albumin is the protein portion of the blood. It is important in maintaining blood volume. It is used in the treatment of shock, burns or low blood protein to temporarily correct or prevent a blood volume deficiency.

HOW TO USE: This medication is administered by injection into a vein. The dose and frequency of use of this medication will be determined by your condition and response to therapy. Follow your doctor's instructions closely and be sure to ask any questions you may have about this therapy.

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Hemoglobin

2008-11-27T07:29:00.000-08:00

Hemoglobin

Medical Author: Siamak Nabili, MD, MPH

Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

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What is hemoglobin?

Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.

Hemoglobin is made up of four protein molecules (globulin chains) that are connected together. The normal adult hemoglobin (Hbg) molecule contains 2 alpha-globulin chains and 2 beta-globulin chains. In fetuses and infants, there are only a few beta chains and the hemoglobin molecule is made up of 2 alpha chains and 2 gamma chains. As the infant grows, the gamma chains are gradually replaced by beta chains. Pay Per Click

Each globulin chain contains an important central structure called the heme molecule. Embedded within the heme molecule is iron that transports the oxygen and carbon dioxide in our blood. The iron contained in hemoglobin is also responsible for the red color of blood.

Hemoglobin also plays an important role in maintaining the shape of the red blood cells. Abnormal hemoglobin structure can, therefore, disrupt the shape of red blood cells and impede its function and its flow through blood vessels. Continue...

Weight Loss: The No-Diet Approach

2008-11-26T04:03:00.000-08:00

Weight Loss: The No-Diet Approach

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Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Introduction to weight loss

Whether you are trying to lose 5 pounds or more than 50, the same simple laws of physics determine whether or not you will lose weight and how fast your weight loss will occur. Remembering these simple guidelines and putting them into practice can lead to weight loss without the aid of any special diet plans, books, or medications.

Our weight is determined by the amount of energy that we take in as food and the amount of energy we expend in the activities of our day. Energy is measured in calories. If your weight remains constant, you are probably taking in the same amount of calories you burn each day. If you're slowly gaining weight over time, it is likely that your caloric intake is greater than the number of calories you burn through your daily activities. Pay Per Click

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Anorexia Nervosa

2008-11-25T16:50:00.000-08:00

Anorexia Nervosa

Dr. Monte Selvanus Luigi Kusuma

PKU Muhammadiyah Gombong Hospital

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Definition :
Anorexia nervosa is an eating disorder in which a person refuses to stay at even the minimum body weight considered normal for their age and height. Persons with this disorder may have an intense fear of weight gain and a distorted body image. Inadequate eating or excessive exercising results in severe weight loss.

Cause :

The exact cause of anorexia nervosa is not known, but social attitudes towards body appearance, as well as family factors, are believed to play a role. Continue...

Download Script Codes for Gadgets

2008-11-25T16:41:00.000-08:00

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Information -Do you have any Health Problem?

2008-11-25T14:58:00.001-08:00

Information

You can now, access my website at www.doktermonte.co.cc
Thank you.

If you have any health problem just write on comment of related article, on guest book, or on comment of article Do You Have Any Health Problem?

"At the first we make habits, at the last habits make us"

Asthma Bronchiale

2008-11-25T14:49:00.000-08:00

Asthma

Dr. Monte Selvanus Luigi Kusuma

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Definition

Asthma occurs when the airways in your lungs (bronchial tubes) become inflamed and constricted. The muscles of the bronchial walls tighten, and your airways produce extra mucus that blocks your airways. Signs and symptoms of asthma range from minor wheezing to life-threatening asthma attacks.

Asthma can't be cured, but its symptoms can be controlled. Management includes avoiding asthma triggers and tracking your symptoms. You may need to regularly take long-term control medications to prevent flare-ups and short-term "rescue" medications to control symptoms once they start. Asthma that isn't under control can cause missed school and work or reduced productivity due to symptoms. Because in most people asthma changes over time, you'll need to work closely with your doctor to track your signs and symptoms and adjust your treatment as needed. Continue...

Acute Renal Failure (ARF)

2008-11-25T14:40:00.001-08:00

Acute Renal (Kidney) Failure

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Definition :
Acute (sudden) kidney failure is the sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing electrolytes.

Cause :

There are many possible causes of kidney damage. They include:

Decreased blood flow, which may occur with extremely low blood pressure caused by trauma, surgery, serious illnesses, septic shock, hemorrhage, burns, or dehydration
Acute tubular necrosis (ATN)
Infections that directly injury the kidney such as acute pyelonephritis or septicemia
Urinary tract obstruction (obstructive uropathy)
Autoimmune kidney disease such as interstitial nephritis or acute nephritic syndrome
Disorders that cause clotting within the thin blood vessels of the kidney

Idiopathic thrombocytopenic thrombotic purpura (ITTP)
Transfusion reaction
Malignant hypertension
Scleroderma,
Hemolytic-uremic syndrome

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2008-11-25T14:16:00.000-08:00

Beta-carotene

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The name "carotene" was first coined in the early 19th Century by the scientist Wachenroder after he crystallized this compound from carrot roots. Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Alpha, beta, and gamma carotene are considered provitamins because they can be converted to active vitamin A.

The carotenes possess antioxidant properties. Vitamin A serves several biological functions including involvement in the synthesis of certain glycoproteins. Vitamin A deficiency leads to abnormal bone development, disorders of the reproductive system, xerophthalmia (a drying condition of the cornea of the eye), and ultimately death. Continue...

Menstrual Disorder

2008-11-24T08:49:00.000-08:00

Menstrual Disorder
doctor Monte Selvanus Luigi Kusuma
PKU Muhammadiyah Gombong Hospital
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You may download these related article. Download 1st Article, Download 2nd Article

Metrorrhagia: Uterine bleeding at irregular intervals, particularly between the expected menstrual periods. Metrorrhagia may be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids or, rarely, cancer of the uterus. Metrorrhagia may cause significant anemia

Menorrhagia: Excessive uterine bleeding occurring at the expected intervals of the menstrual periods. The bleeding from the uterus starts on schedule but is heavier than usual and may last longer than usual. Menorrhagia may be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids or, rarely, cancer of the uterus. Menorrhagia may cause significant anemia

Menometrorrhagia: Excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals. Menometrorrhagia can be a sign of a number of different disorders including hormone imbalance, endometriosis, benign fibroid tumors in the uterus, and, rarely, cancer. Women who have abnormal menstrual bleeding should always consult their physician to rule out these conditions. Anemia may result from the excessive uterine bleeding. Treatment depends on the cause. If there does not appear to be a dangerous cause, such as cancer, hormone supplementation or the therapeutic use of birth control pills to better control the menstrual cycle may be recommended.

Erectile Dysfunction

2008-11-24T06:28:00.001-08:00

Erectile Dysfunction
(Impotence, ED)

You may download this full article. Download here.

Medical Author: Dennis Lee, MD
Medical Editors: Jay W. Marks, MD, and Jacob Rajfer, MD

What is erectile dysfunction?

Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity. Erectile dysfunction is different from other conditions that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This article focuses on the evaluation and treatment of erectile dysfunction.

How common is erectile dysfunction?

Erectile dysfunction (ED, impotence) varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of erectile dysfunction make estimating its frequency difficult. Many men also are reluctant to discuss erectile dysfunction with their doctors, and thus the condition is under-diagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 30 million men in the Untied States.

While erectile dysfunction can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced erectile dysfunction at least some of the time. According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Population studies conducted in the Netherlands found that some degree of erectile dysfunction occurred in 20% of men between ages 50 to 54, and in 50% of men between ages 70 to 78. In 1999, the National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for erectile dysfunction.

Cirrhosis

2008-11-23T15:52:00.000-08:00

Cirrhosis

Dr. Monte Selvanus Luigi Kusuma

Workstation PKU Muhammadiyah Gombong Hospital

You may download this full article. Download here

Definition

Cirrhosis is a condition that causes irreversible scarring of the liver. As scar tissue replaces normal tissue, blood flow through your liver is affected. This makes it increasingly difficult for your liver to carry out essential functions, such as detoxifying harmful substances, purifying your blood and manufacturing vital nutrients.

Cirrhosis rarely causes signs and symptoms in its early stages. But as liver function deteriorates, you may experience fatigue, nausea, unintended weight loss, and swelling in your legs and abdomen. In time, jaundice — a yellowing of your skin and the whites of your eyes — and intense itching can develop. You may also experience bleeding from your digestive system that could be severe.

Excessive use of alcohol and chronic infection with the hepatitis C virus are the leading causes of cirrhosis. But other factors — including damaged bile ducts, immune system problems and prolonged exposure to certain environmental toxins — can cause liver scarring, too.

Although liver damage from cirrhosis is irreversible, the disease usually progresses slowly and symptoms are often controllable. Specific treatment for cirrhosis depends on the underlying cause, but anyone with cirrhosis must avoid alcohol and other substances that harm the liver. When damage is so severe that liver function is seriously impaired, a liver transplant may be the only option.

Symptoms

You may not have signs and symptoms of cirrhosis in the early stages of the disease. But as more scar tissue replaces healthy tissue and liver function declines, you may experience some of the following:

* Lack of appetite

* Weight loss

* Nausea

* Small, red spider veins under your skin or easy bruising

* Weakness

* Fatigue

* Yellowing of your skin and eyes and dark, cola-colored urine

* Bleeding from engorged veins in your esophagus or intestines

* Loss of interest in sex

* Fluid in your abdominal cavity (ascites)

* Itching on your hands and feet and eventually on your entire body

* Swelling of your legs and feet from retained fluid (edema)

* Mental confusion, such as forgetfulness or trouble concentrating (encephalopathy)

Causes

A healthy liver performs hundreds of vital functions, including processing most of the nutrients absorbed from your intestine, removing drugs, alcohol and other harmful substances from your bloodstream, and manufacturing bile — the greenish fluid stored in your gallbladder that helps digest fats. The liver also produces cholesterol, substances to help your blood clot and certain other proteins.

Because of the complexity of the liver and its exposure to so many potentially toxic substances, it would seem especially vulnerable to disease. But the liver has an amazing capacity for regeneration — it can heal itself by replacing or repairing injured cells. In cirrhosis, however, the healing process seems to go slightly awry. In response to chronic injury, certain liver cells increase dramatically in size and number forming excess scar tissue that interferes with the liver's ability to function. And although groups of cells may continue to regenerate, the pattern of regeneration isn't normal.

What damages the liver?

Many people associate cirrhosis with alcohol abuse, and in fact, chronic alcoholism is the primary cause of cirrhosis in the United States. Alcoholic cirrhosis usually occurs after a decade or more of heavy drinking, although the amount of alcohol that can injure the liver varies from person to person. The liver is particularly vulnerable because it breaks down alcohol into highly toxic chemicals. Some of these chemicals trigger inflammation that eventually destroys liver cells. In time, web-like scars and small knots of abnormal tissue replace healthy liver tissue. In the initial stages of cirrhosis, the liver swells, but it later shrinks as larger areas of scar tissue form.

Osteoporosis

2008-11-23T15:24:00.000-08:00

Osteoporosis

dr.Monte Selvanus Luigi Kusuma

Definition

Osteoporosis, which means "porous bones," causes bones to become weak and brittle — so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones.

A common result of osteoporosis is fractures — most of them in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis also affects many men. And aside from people who have osteoporosis, many more have low bone density.

It's never too late — or too early — to do something about osteoporosis. You can take steps to keep bones strong and healthy throughout life.

Symptoms

In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have been weakened by osteoporosis, you may have osteoporosis symptoms that include:

* Back pain, which can be severe if you have a fractured or collapsed vertebra

* Loss of height over time, with an accompanying stooped posture

* Fracture of the vertebrae, wrists, hips or other bones

Causes

The strength of your bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure.

The process of bone remodeling

Scientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. Bone is continuously changing — new bone is made and old bone is broken down — a process called remodeling, or bone turnover.

A full cycle of bone remodeling takes about two to three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone loss in women increases dramatically. Although many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause.

Your risk of developing osteoporosis depends on how much bone mass you attained between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. Not getting enough vitamin D and calcium in your diet may lead to a lower peak bone mass and accelerated bone loss later.

What keeps bones healthy

Three factors that you can influence are essential for keeping your bones healthy throughout your life:

* Regular exercise

* Adequate amounts of calcium

* Adequate amounts of vitamin D, which is essential for absorbing calcium

Infertility Treatment: 7 Tips to Manage Stress

2008-11-18T07:20:00.000-08:00

Infertility Treatment: 7 Tips to Manage Stress

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD

Infertility treatment can be physically uncomfortable, time-consuming, exhausting, and costly — all without a guarantee of success. The infertility experience for many can range from multiple diagnostic procedures through progressively more aggressive treatment options, all of which impose demands upon the emotional and physical self. It's no wonder that many women experience severe stress, depression, or anxiety during treatment for infertility.

It is possible although difficult to relieve some of the stress and pressure of infertility treatment. Some tried-and-true stress control suggestions from former infertility patients and counselors include the following:

Accept that you are experiencing a time of heightened stress and don’t try to downplay or deny its effects. You may find that you need to cut back on some or all of your nonessential obligations or activities for a while. Give yourself permission to say 'no' to nonessential commitments and demands on your time.

Don’t suffer alone. Confide in a trusted friend, loved one, or support group. Social support networks can tremendously reduce feelings of stress and emotional pain. Many infertility clinics also offer support groups and/or counseling services. If you’re trying to conceive as a couple, accept that your partner may also feel stress, depression, or anxiety and may not be able to provide all the emotional support you require right now.

Join RESOLVE, the National Infertility Association. You should be able to find a local chapter in your area. Individual chapters sponsor support groups, newsletters, and seminars and lectures on treatment options. Both health care providers and patients make up the membership of this valuable organizational resource.

Empower yourself with knowledge about the procedures and treatments you may need. After researching on the Web, write down a list of questions to take with you to your next appointment if you feel there are issues you'd like to clarify.

Decide in advance with whom you want to share your experience, and plan some strategies for avoiding inappropriate questions and unwanted advice from colleagues and acquaintances.

Discuss the possibility of treatment breaks with your doctor, if you feel that you need "time off" from the experience. Some people prefer to be treated every other month or every few menstrual cycles, while others are stressed by the waiting periods. Work with your doctor to find a treatment schedule that is comfortable for you.

Know that it's common for women in the midst of treatment to experience feelings of depression or sadness, and sometimes these feelings are strongest when participating in baby or child centered functions. Don't feel guilty if you want to pass up the baby shower or child's birthday party you're invited to. Taking care of yourself and your emotional needs is the top priority now.

1 in 4 Teen Girls Infected With an STD

2008-11-18T07:01:00.000-08:00

1 in 4 Teen Girls Infected With an STD

Researchers' 'Alarming' Find: 25% of Teen Girls, Half of African-American Teen Girls Have a Sexually Transmitted Disease

By Todd Zwillich
WebMD Health News

Reviewed By Louise Chang, MD

March 11, 2008 — One in four teenage girls in the United States is infected with a sexually transmitted disease, according to data released Tuesday by the CDC.

The figures, based on research conducted in 2003 and 2004, show that nearly one in five girls between 14 and 19 years old is infected with human papillomavirus (HPV), which can cause of cervical cancer and genital warts. About one in 25 girls carries chlamydia, a sexually transmitted bacterium.

"What we found is alarming," says Sara Forhan, MD, a CDC researcher who conducted the study among 838 girls nationwide.

"These numbers translate into 3.2 million young women aged 14 to 19 who are infected with an STD," Forhan says.

The study also showed that nearly half of adolescent African-American girls are infected with an STD. Researchers say poorer access to testing for sexually transmitted diseases contributed to the increased STD incidence in that group.

"This does not mean that African-Americans are taking greater risks individually," says John Douglas Jr., MD, director of the CDC's division of STD prevention.
Screening Falling Short

The CDC recommends regular chlamydia screening at least yearly for all sexually active women and for females 25 years old and younger. All pregnant women should also be screened because the infection can pass to the baby during delivery. But only about one-third of females get proper screening, Douglas says.

Experts recommend regular screening primarily because most women with chlamydia infections don't have noticeable symptoms. That means women can carry the infectious for years without knowing they have it, putting them at risk for pelvic inflammatory disease and infertility.

The CDC also recommends HPV vaccination for all women and girls between 11 and 26. The vaccine comes in three doses and covers four strains of the virus.

Still, Douglas says STD testing is rife with "missed opportunities." Another study unveiled by the CDC showed that only 40% of female patients who go to a doctor for emergency contraception, such as the "morning after pill," also receive advice and testing for STDs.

Both studies were presented at the National STD Prevention Conference in Chicago.

"An emergency contraception prescription is a missed opportunity because by definition that was unprotected sex," Elizabeth Alderman, MD, director of adolescent medicine at Children's Hospital at Montefiore in New York, tells WebMD.

Alderman says many clinics don't have easier-to-use urine-based testing for chlamydia.

Douglas says abstinence is "the surest way to prevent getting an STD." The agency also pushes monogamous sexual relationships and the consistent use of condoms, he says.

Alderman says the majority of sexually active teens in her practice use condoms. If you ask, "some of the time, all the time, or most of the time,' you'll usually get a "most of the time," she says.

SOURCES: Sara Forhan, MD, CDC. John Douglas Jr., MD, director, CDC division of STD prevention. Elizabeth Alderman, MD, Children's Hospital at Montefiore, New York, chairwoman, Executive Committee, Section of Adolescent Health, American Academy of Pediatrics.

HEMORRHOID

2008-11-17T05:22:00.000-08:00

HEMORRHOID

Medical Author: Jay W. Marks, MD

Medical Editor: Thomas P. Sokol, MD, FACS, FASCRS

You may download full article. Download.

What are hemorrhoids?

A precise definition of hemorrhoids does not exist, but they can be described as masses or clumps ("cushions") of tissue within the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers. The anal canal is the last four centimeters through which stool passes as it goes from the rectum to the outside world. The anus is the opening of the anal canal to the outside world.

Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.

Prevalence of hemorrhoids

Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.

Anatomy of hemorrhoids

The arteries supplying blood to the anal canal descend into the canal from the rectum above and form a rich network of arteries that communicate with each other around the anal canal. Because of this rich network of arteries, hemorrhoidal blood vessels have a ready supply of arterial blood. This explains why bleeding from hemorrhoids is bright red (arterial blood) rather than dark red (venous blood), and why bleeding from hemorrhoids occasionally can be severe. The blood vessels that supply the hemorrhoidal vessels pass through the supporting tissue of the hemorrhoidal cushions.

The anal veins drain blood away from the anal canal and the hemorrhoids. These veins drain in two directions. The first direction is upwards into the rectum, and the second is downwards beneath the skin surrounding the anus. The dentate line is a line within the anal canal that denotes the transition from anal skin (anoderm) to the lining of the rectum.

Formation of hemorrhoids

If the hemorrhoid originates at the top (rectal side) of the anal canal, it is referred to as an internal hemorrhoid. If it originates at the lower end of the anal canal near the anus, it is referred to as an external hemorrhoid. Technically, the differentiation between internal and external hemorrhoids is made on the basis of whether the hemorrhoid originates above or below the dentate line (internal and external, respectively).

As discussed previously, hemorrhoidal cushions in the upper anal canal are made up of blood vessels and their supporting tissues. There usually are three major hemorrhoidal cushions oriented right posterior, right anterior, and left lateral. During the formation of enlarged internal hemorrhoids, the vessels of the anal cushions swell and the supporting tissues increase in size. The bulging mass of tissue and blood vessels protrudes into the anal canal where it can cause problems. Unlike with internal hemorrhoids, it is not clear how external hemorrhoids form.

Download Area

2008-11-15T09:51:00.000-08:00

Make Money From Internet (Indonesian Version: Nyari Duit Lewat Internet)

Wealth is important, but Wealth without health is nothing. I have an article to make money from internet. This is a halal way, no trick, no hack. Download here.

Another article, download here

Dengue Hemorrhage Fever

2008-11-15T09:17:00.001-08:00

Dengue Hemorrhage Fever

dr. Monte Selvanus Luigi Kusuma

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Definition

Dengue Hemorrhage Fever is an infection disease, caused by virus from flavovirus.

Etiology
Etiology of this disease is a virus from flavovirus (Arbovirus group B). Dengue virus is a termolabil viral that can be stored in a frozen (-70^oC). It shapes likely the stem, sensitive to inactivation by Diethyl Ether and Na Dioxycolate, stable at temperatures 70^oC. 4 serotypes known dengue, they are D1, D2, D3, D4. Each type can cause symptoms and the most severe is type 3.

Vector
Dengue virus can be transmitted by:

1. Aedes aegypti mosquitoes

2. Aedes albopictus mosquitoes

OBESITY

2008-11-14T05:35:00.000-08:00

OBESITY
dr. Monte Selvanus Luigi Kusuma
Workstation PKU Muhammadiyah Gombong Hospital

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What is obesity?

The definition of obesity varies depending on what one reads, but in general, it is a chronic condition defined by an excess amount body fat. A certain amount of body fat is necessary for storing energy, heat insulation, shock absorption, and other functions. The normal amount of body fat (expressed as percentage of body fat) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese.

How common is obesity?

Obesity has reached epidemic proportions in the United States. One in three Americans is obese. Obesity is also increasing rapidly throughout the world, and the incidence of obesity has nearly doubled form 1991 to 1998.

Being Overweight Doesn't Mean You're Unhealthy!

Being overweight or obese does not mean you are unhealthy or at a higher risk for diseases like high blood pressure, high cholesterol, or diabetesThe results of a study published in the Archives of Internal Medicine should not come as a shock to most people. Being overweight doesn't necessarily make you unhealthy, according to researchers in both the United States and Germany. Sports fans have known this forever; elite athletes can have an appearance ranging from tiny Olympic gymnasts to massive NFL linemen. Athletes at both extremes- and all those in between- are in shape and trained to perform at high levels.

The new research confirmed this. People who are overweight have a fifty-fifty chance of having high cholesterol, high blood pressure, or elevated blood sugar levels. Pretty good odds, but not as good as those for people who are within the normal weight range. They have a 75% chance of having normal results on blood tests for cholesterol and blood sugar. And for those who are obese, the chance of having normal results falls to one-third.

Body fat distribution associated with mortality risk

2008-11-13T07:59:00.001-08:00

Body fat distribution associated with mortality risk

Wednesday, Nov. 12, 2008; 5:26 PM

NEW YORK (Reuters Health) - New research indicates it is not just overall body fat but also how the fat is distributed that determines a person's risk of dying over a given period.

According to the report in The New England Journal of Medicine for November 13, both waist circumference and the waist-to-hip ratio were independent predictors of mortality in a study that began in 1992.

Most studies have used body mass index (BMI: the ratio of height to weight) to gauge the impact of body fat on mortality, so it was unclear if the distribution of body fat per se had an effect on the risk, Dr. Tobias Pischon, from the German Institute of Human Nutrition, Potsdam-Rehbruecke, and colleagues explain.

To investigate this topic, the research team analyzed BMI, waist circumference and waist-to-hip ratio data from 359,387 subjects from nine countries who were enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC). During an average follow-up of 9.7 years, 14,723 of the subjects died.

A J-shaped curve was noted between BMI and mortality. A BMI of 25.3 in men and 24.3 in women carried the lowest risks of death, the report indicates.

After accounting for BMI, waist circumference and waist-to-hip ratio also showed J-shaped curves with respect to mortality. In men, those with the highest waist circumference and waist-to-hip ratio conferred a relative mortality risk of 2.05 and 1.68, respectively, compared with men with the lowest percentage. In women, the corresponding relative risks were 1.78 and 1.51.

Nonetheless, BMI was still a significant predictor of death in models that accounted for the influence of waist circumference or waist-to-hip ratio.

"The results support the use of waist circumference or waist-to-hip ratio in addition to BMI in the assessment of the risk of death, particularly among persons with a low BMI," the authors conclude.

SOURCE: The New England Journal of Medicine for November 13, 2008.

Mayo Clinic medical information and tools for healthy living - MayoClinic.com

2008-11-13T07:53:00.001-08:00

Mayo Clinic medical information and tools for healthy living - MayoClinic.com

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Mayo Clinic medical information and tools for healthy living - MayoClinic.com

2008-11-13T07:45:00.001-08:00

Mayo Clinic medical information and tools for healthy living - MayoClinic.com

Blogged with Flock

Do You Have Any Helth Problems Today?

2008-11-13T07:36:00.001-08:00

Do You Have Any Helth Problems Today?

Drugs Information: Cefixime

2008-11-13T07:04:00.001-08:00

Cefixime

Cefixime is a cephalosporin antibiotic used to treat infections caused by bacteria such as pneumonia; bronchitis; gonorrhea; and ear, lung, throat, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.

Cefixime comes as a tablet and liquid to take by mouth. It is usually taken once a day or every 12 hours (twice a day) for 5-14 days. Gonorrhea may be treated in 1-10 days. Shake the liquid well before each use to mix the medication evenly. The tablets should be swallowed whole and taken with a full glass of water.

Side effects

Cefixime may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

* upset stomach

* diarrhea

* vomiting

* mild skin rash

* headache

If you experience any of the following symptoms, call your doctor immediately:

* severe skin rash

* itching

* hives

* difficulty breathing or swallowing

* wheezing

* vaginal infection

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Keep liquid medicine in the refrigerator, closed tightly, and throw away any unused medication after 14 days. Do not freeze, that may caused broken this drugs.

Hypertension

2008-11-11T14:37:00.000-08:00

Hypertension

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Definition

Hypertension is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them. Arteries are the blood vessels that carry oxygenated blood from the heart to the body's tissues.

Description

As blood flows through arteries it pushes against the inside of the artery walls. The more pressure the blood exerts on the artery walls, the higher the blood pressure will be. The size of small arteries also affects the blood pressure. When the muscular walls of arteries are relaxed, or dilated, the pressure of the blood flowing through them is lower than when the artery walls narrow, or constrict.

Blood pressure is highest when the heart beats to push blood out into the arteries. When the heart relaxes to fill with blood again, the pressure is at its lowest point. Blood pressure when the heart beats is called systolic pressure. Blood pressure when the heart is at rest is called diastolic pressure. When blood pressure is measured, the systolic pressure is stated first and the diastolic pressure second. Blood pressure is measured in millimeters of mercury (mm Hg). For example, if a person's systolic pressure is 120 and diastolic pressure is 80, it is written as 120/80 mm Hg. The American Heart Association has long considred blood pressure less than 140 over 90 normal for adults. However, the National Heart, Lung, and Blood Institute in Bethesda, Maryland released new clinical guidelines for blood pressure in 2003, lowering the standard normal readings. A normal reading was lowered to less than 120 over less than 80.

Hypertension is a major health problem, especially because it has no symptoms. Many people have hypertension without knowing it. In the United States, about 50 million people age six and older have high blood pressure. Hypertension is more common in men than women and in people over the age of 65 than in younger persons. More than half of all Americans over the age of 65 have hypertension. It also is more common in African-Americans than in white Americans.

Hypertension is serious because people with the condition have a higher risk for heart disease and other medical problems than people with normal blood pressure. Serious complications can be avoided by getting regular blood pressure checks and treating hypertension as soon as it is diagnosed.

If left untreated, hypertension can lead to the following medical conditions:

Arteriosclerosis is hardening of the arteries. The walls of arteries have a layer of muscle and elastic tissue that makes them flexible and able to dilate and constrict as blood flows through them. High blood pressure can make the artery walls thicken and harden. When artery walls thicken, the inside of the blood vessel narrows. Cholesterol and fats are more likely to build up on the walls of damaged arteries, making them even narrower. Blood clots also can get trapped in narrowed arteries, blocking the flow of blood.

Arteries narrowed by arteriosclerosis may not deliver enough blood to organs and other tissues. Reduced or blocked blood flow to the heart can cause a heart attack. If an artery to the brain is blocked, a stroke can result.

Hypertension makes the heart work harder to pump blood through the body. The extra workload can make the heart muscle thicken and stretch. When the heart becomes too enlarged it cannot pump enough blood. If the hypertension is not treated, the heart may fail.

The kidneys remove the body's wastes from the blood. If hypertension thickens the arteries to the kidneys, less waste can be filtered from the blood. As the condition worsens, the kidneys fail and wastes build up in the blood. Dialysis or a kidney transplant are needed when the kidneys fail. About 25% of people who receive kidney dialysis have kidney failure caused by hypertension.

Causes and symptoms

Many different actions or situations can normally raise blood pressure. Physical activity can temporarily raise blood pressure. Stressful situations can make blood pressure go up. When the stress goes away, blood pressure usually returns to normal. These temporary increases in blood pressure are not considered hypertension. A diagnosis of hypertension is made only when a person has multiple high blood pressure readings over a period of time.

The cause of hypertension is not known in 90 to 95 percent of the people who have it. Hypertension without a known cause is called primary or essential hypertension. When a person has hypertension caused by another medical condition, it is called secondary hypertension. Secondary hypertension can be caused by a number of different illnesses. Many people with kidney disorders have secondary hypertension. The kidneys regulate the balance of salt and water in the body. If the kidneys cannot rid the body of excess salt and water, blood pressure goes up. Kidney infections, a narrowing of the arteries that carry blood to the kidneys, called renal artery stenosis, and other kidney disorders can disturb the salt and water balance.

Cushing's syndrome and tumors of the pituitary and adrenal glands often increase levels of the adrenal gland hormones cortisol, adrenalin, and aldosterone, which can cause hypertension. Other conditions that can cause hypertension are blood vessel diseases, thyroid gland disorders, some prescribed drugs, alcoholism, and pregnancy.

Even though the cause of most hypertension is not known, some people have risk factors that give them a greater chance of getting hypertension. Many of these risk factors can be changed to lower the chance of developing hypertension or as part of a treatment program to lower blood pressure.

Risk factors for hypertension include:

Some risk factors for getting hypertension can be changed, while others cannot. Age, male sex, and race are risk factors that a person can't do anything about. Some people inherit a tendency to get hypertension. People with family members who have hypertension are more likely to develop it than those whose relatives are not hypertensive. People with these risk factors can avoid or eliminate the other risk factors to lower their chance of developing hypertension. A 2003 report found that the rise in incidence of high blood pressure among children is most likely due to an increase in the number of overweight and obese children and adolescents.

Diagnosis

Because hypertension doesn't cause symptoms, it is important to have blood pressure checked regularly. Blood pressure is measured with an instrument called a sphygmomanometer. A cloth-covered rubber cuff is wrapped around the upper arm and inflated. When the cuff is inflated, an artery in the arm is squeezed to momentarily stop the flow of blood. Then, the air is let out of the cuff while a stethoscope placed over the artery is used to detect the sound of the blood spurting back through the artery. This first sound is the systolic pressure, the pressure when the heart beats. The last sound heard as the rest of the air is released is the diastolic pressure, the pressure between heart beats. Both sounds are recorded on the mercury gauge on the sphygmomanometer.

The latest blood pressure guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories:

1. Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.

2. Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one-third of adults ages 35 to 64 and nearly half the adults age 65 or older develop high blood pressure.

3. Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.

4. Stage 2 hypertension. The most severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Normal blood pressure is defined by a range of values. Blood pressure lower than 120/80 mm Hg is considered normal. A number of factors such as pain, stress or anxiety can cause a temporary increase in blood pressure. For this reason, hypertension is not diagnosed on one high blood pressure reading. If a blood pressure reading is 120/80 or higher for the first time, the physician will have the person return for another blood pressure check. Diagnosis of hypertension usually is made based on two or more readings after the first visit.

Systolic hypertension of the elderly is common and is diagnosed when the diastolic pressure is normal or low, but the systolic is elevated, e.g.170/70 mm Hg. This condition usually co-exists with hardening of the arteries (atherosclerosis).

Blood pressure measurements are classified in stages, according to severity:

A typical physical examination to evaluate hypertension includes:

The medical and family history help the physician determine if the patient has any conditions or disorders that might contribute to or cause the hypertension. A family history of hypertension might suggest a genetic predisposition for hypertension.

The physical exam may include several blood pressure readings at different times and in different positions. The physician uses a stethoscope to listen to sounds made by the heart and blood flowing through the arteries. The pulse, reflexes, and height and weight are checked and recorded. Internal organs are palpated, or felt, to determine if they are enlarged.

Because hypertension can cause damage to the blood vessels in the eyes, the eyes may be checked with a instrument called an ophthalmoscope. The physician will look for thickening, narrowing, or hemorrhages in the blood vessels.

A chest x ray can detect an enlarged heart, other vascular (heart) abnormalities, or lung disease.

An electrocardiogram (ECG) measures the electrical activity of the heart. It can detect if the heart muscle is enlarged and if there is damage to the heart muscle from blocked arteries.

Urine and blood tests may be done to evaluate health and to detect the presence of disorders that might cause hypertension.

Class I–mild Diastolic pressure 90-104 mm Hg

Class II–moderate Diastolic pressure 105-119 mm Hg

Class III–severe Diastolic pressure > than 120 mm Hg

Hypertension types

A. Essential hypertension Idiopathic Hypertension (HTN)

The major form comprising 90% of all HTN

Malignant hypertension

A sustained Blood Pressure (BP) > 200/140 mm Hg, resulting in arteriolar necrosis, most marked in the brain, eg. cerebral hemorrhage, infarcts, and hypertensive encephalopathy, eyes, eg papilledema and hypertensive retinopathy and kidneys, eg acute renal failure and hypertensive nephropathy; if malignant HTN is uncorrected or therapy refractory, may suffer a hypertensive crisis in which prolonged high BP causes left ventricular hypertrophy and CHF

Paroxysmal hypertension

Transient or episodic waves of BP of any etiology, punctuated by periods of normotension, typical of pheochromocytoma

Portal hypertension

Portal vein pressure caused by a backflow of blood through splenic arteries, resulting in splenomegaly and collateral circulation, resulting in esophageal varices and/or hemorrhoids; PH may be intra- or extrahepatic, and is often due to cirrhosis, or rarely portal vein disease, venous thrombosis, tumors or abscesses

Pulmonary hypertension

A condition defined as a 'wedge' systolic/diastolic pressure > 30/20 mm Hg–Normal: 18-25/12-16 mm Hg, often secondary to blood stasis in peripheral circulation, divided into passive, hyperkinetic, vasoocclusive, vasoconstrictive and secondary forms.

B. Secondary hypertension

· Aging

· Cardiovascular Open heart surgery, coarctation of aorta, cardiac output–anemia, thyrotoxicosis, aortic valve insufficiency

· Cerebral Intracranial pressure

· Endocrine Mineralocorticoid excess, congenital adrenal hyperplasia, glucocorticoid excess, eg Cushing syndrome, hyperparathyroidism, acromegaly

· Gynecologic Pregnancy, oral contraceptives

· Neoplasia Renin-secreting tumors, pheochromocytoma

· Peripheral vascular resistance AV shunts, Paget's disease of bone, beri-beri

· Renal disease Vascular, parenchymal

Treatment

There is no cure for primary hypertension, but blood pressure can almost always be lowered with the correct treatment. The goal of treatment is to lower blood pressure to levels that will prevent heart disease and other complications of hypertension. In secondary hypertension, the disease that is responsible for the hypertension is treated in addition to the hypertension itself. Successful treatment of the underlying disorder may cure the secondary hypertension.

Guidelines advise that clinicians work with patients to agree on blood pressure goals and develop a treatment plan for the individual patient. Actual combinations of medications and lifestyle changes will vary from one person to the next. Treatment to lower blood pressure may include changes in diet, getting regular exercise, and taking antihypertensive medications. Patients falling into the pre-hypertension range who don't have damage to the heart or kidneys often are advised to make needed lifestyle changes only. A 2003 report of a clinical trial showed that adults with elevated blood pressures lowered them as mush as 38% by making lifestyle changes and participating in the DASH diet, which encourages eating more fruit and vegetables.

The major types of medication used to control high blood pressure include:

Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. Still, diuretics are often not prescribed. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic.

If you're age 80 or older, a special type of thiazide diuretic, indapamide (Lozol), may be particularly effective in lowering your blood pressure. In this age group, indapamide has been shown to reduce deaths from stroke, heart failure and other cardiovascular disease causes.

Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks — but they're effective when combined with a thiazide diuretic.
Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors don't work as well in blacks when prescribed alone, but they're effective when combined with a thiazide diuretic.
Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure and kidney failure.
Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.
Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a cascade of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. The drug is still being studied to figure out its ideal use and dosage for people with high blood pressure.

If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.

Lifestyle changes that may reduce blood pressure by about 5 to 10 mm Hg include:

Patients whose blood pressure falls into the Stage 1 hypertension range may be advised to take antihypertensive medication. Numerous drugs have been developed to treat hypertension. The choice of medication will depend on the stage of hypertension, side effects, other medical conditions the patient may have, and other medicines the patient is taking.

If treatment with a single medicine fails to lower blood pressure enough, a different medicine may be tried or another medicine may be added to the first. Patients with more severe hypertension may initially be given a combination of medicines to control their hypertension. Combining antihypertensive medicines with different types of action often controls blood pressure with smaller doses of each drug than would be needed for just one.

Antihypertensive medicines fall into several classes of drugs:

Diuretics help the kidneys eliminate excess salt and water from the body's tissues and the blood. This helps reduce the swelling caused by fluid buildup in the tissues. The reduction of fluid dilates the walls of arteries and lowers blood pressure. New guidelines released in 2003 suggest diuretics as the first drug of choice for most patients with high blood pressure and as part of any multi-drug combination.

Beta-blockers lower blood pressure by acting on the nervous system to slow the heart rate and reduce the force of the heart's contraction. They are used with caution in patients with heart failure, asthma, diabetes, or circulation problems in the hands and feet.

Calcium channel blockers block the entry of calcium into muscle cells in artery walls. Muscle cells need calcium to constrict, so reducing their calcium keeps them more relaxed and lowers blood pressure.

ACE inhibitors block the production of substances that constrict blood vessels. They also help reduce the build-up of water and salt in the tissues. They often are given to patients with heart failure, kidney disease, or diabetes. ACE inhibitors may be used together with diuretics.

Alpha-blockers act on the nervous system to dilate arteries and reduce the force of the heart's contractions.

Alpha-beta blockers combine the actions of alpha and beta blockers.

Vasodilators act directly on arteries to relax their walls so blood can move more easily through them. They lower blood pressure rapidly and are injected in hypertensive emergencies when patients have dangerously high blood pressure.

Peripheral acting adrenergic antagonists act on the nervous system to relax arteries and reduce the force of the heart's contractions. They usually are prescribed together with a diuretic. Peripheral acting adrenergic antagonists can cause slowed mental function and lethargy.

Centrally acting agonists also act on the nervous system to relax arteries and slow the heart rate. They are usually used with other antihypertensive medicines.

Prognosis

There is no cure for hypertension. However, it can be well controlled with the proper treatment. Therapy with a combination of lifestyle changes and antihypertensive medicines usually can keep blood pressure at levels that will not cause damage to the heart or other organs. The key to avoiding serious complications of hypertension is to detect and treat it before damage occurs. Because antihypertensive medicines control blood pressure, but do not cure it, patients must continue taking the medications to maintain reduced blood pressure levels and avoid complications.

Prevention

Prevention of hypertension centers on avoiding or eliminating known risk factors. Even persons at risk because of age, race, or sex or those who have an inherited risk can lower their chance of developing hypertension.

The risk of developing hypertension can be reduced by making the same changes recommended for treating hypertension:

Resources

Periodicals

McNamara, Damian. "Obesity Behind Rise in Incidence of Primary Hypertension." Family Practice News April 1, 2003: 45-51.

McNamara, Damian. "Trial Shows Efficacy of Lifestyle Changes for BP: More Intensive Than Typical Office Visit." Family Practice News July 1, 2003: 1-2.

"New BP Guidelines Establish Diagnosis of Pre-hypertension: Level Seeks to Identify At-risk Individuals Early." Case Management Advisor July 2003: S1.

"New Hypertension Guidelines: JNC-7." Clinical Cardiology Alert July 2003: 54-63.

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

National Heart, Lung and Blood Institute. PO Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

Texas Heart Institute. Heart Information Service. PO Box 20345, Houston, TX 77225-0345. http://www.tmc.edu/thi.

Key terms

Arteries — Blood vessels that carry blood to organs and other tissues of the body.

Arteriosclerosis — Hardening and thickening of artery walls.

Cushing's syndrome — A disorder in which too much of the adrenal hormone, cortisol, is produced; it may be caused by a pituitary or adrenal gland tumor.

Diastolic blood pressure — Blood pressure when the heart is resting between beats.

Hypertension — High blood pressure.

Renal artery stenosis — Disorder in which the arteries that supply blood to the kidneys constrict.

Sphygmomanometer — An instrument used to measure blood pressure.

Systolic blood pressure — Blood pressure when the heart contracts (beats).

Vasodilator — Any drug that relaxes blood vessel walls.

Ventricle — One of the two lower chambers of the heart.

Do You Have Any Helth Problems Today?

2008-11-11T06:49:00.001-08:00

Do You Have Any Helth Problems Today?

Nephrotic Syndrome

2008-11-11T06:41:00.000-08:00

Nephrotic Syndrome

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Definition

Nephrotic syndrome is a disorder caused by damage to the small blood vessels in your kidneys that filter waste and excess water from your blood. When healthy, these small blood vessels keep blood protein from seeping into your urine and out of your body. When damaged, they don't perform this function effectively, and protein can leak out of your blood and lead to swelling (edema).

Signs and Symptoms

Symptoms

* Swelling (edema), particularly around your eyes and in your ankles and feet

* Foam in the toilet water, which may be caused by excess protein in your urine

* Weight gain due to excess fluid retention

* Loss of appetite

* Vomiting

Signs

* High levels of protein in your urine (proteinuria)

* Low levels of the blood protein albumin (hypoalbuminemia)

* Elevated blood levels of cholesterol and triglycerides

* Swelling (edema)

Causes

Nephrotic syndrome is caused by damage to the tiny blood vessels (glomeruli) of your kidneys.

Healthy glomeruli keep blood protein (mainly albumin) — which is needed to maintain the right amount of fluid in your body — from seeping into your urine. When damaged, glomeruli often lose this ability.

Many possible causes

Many disorders can cause glomerular damage and lead to nephrotic syndrome. The following medical conditions account for most cases of nephrotic syndrome:

1. Minimal change disease. The most common cause of nephrotic syndrome in children, this disorder results in abnormal kidney function, but when the kidney tissue is examined under a light microscope, it appears normal or nearly normal. The cause of the abnormal function typically can't be determined.

2. Focal segmental glomerulosclerosis. Characterized by scattered scarring of some of the glomeruli, this condition may result from another disease, a genetic defect or occur for no known reason.

3. Membranous nephropathy. This kidney disorder is the result of thickening membranes within the glomeruli. The exact cause of the thickening isn't known, but it's sometimes associated with other medical conditions, such as hepatitis B, malaria, lupus and cancer.

4. Diabetic kidney disease. Diabetes can lead to kidney damage (diabetic nephropathy) that affects the glomeruli, particularly in people with diabetes that's poorly controlled or people who have high blood pressure.

5. Systemic lupus erythematosus. This chronic inflammatory disease can lead to serious kidney damage.

6. Amyloidosis. This disorder occurs when substances called amyloid proteins accumulate in your organs. Amyloid buildup often affects the kidneys, damaging their filtering system.

Tests and diagnosis

* Urine tests. A urinalysis will show large amounts of protein in your urine if you have nephrotic syndrome. Fats also may be present in your urine.

* Blood tests. If you have nephrotic syndrome, a blood test may show low levels of the protein albumin (hypoalbuminemia) specifically and decreased levels of blood protein overall. Loss of blood protein may cause an increase in blood cholesterol and blood triglycerides. Serum creatinine and blood urea also may be measured to assess your overall kidney function.

* Kidney biopsy. A kidney biopsy may be necessary to confirm a diagnosis of the renal cause of nephrotic syndrome. This procedure involves using a special biopsy needle to extract small pieces of kidney tissue under local anesthesia for microscopic examination to search for glomeruli damage. Sometimes special stains of the kidney tissue or special studies, such as electron microscopy, also are necessary for diagnosis. If so, tissue diagnosis may take longer.

TRANSIENT ISCHEMIC ATTACK

2008-11-09T14:52:00.000-08:00

TRANSIENT ISCHEMIC ATTACK

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A stroke occurs when blood flow to a part of the brain is interrupted or severely reduced. This deprives part of the brain of oxygen and nutrients, which can destroy brain cells and result in some degree of permanent disability. Stroke symptoms may include trouble walking and speaking, as well as paralysis or numbness on one side of the body. Prompt treatment is essential. The longer a stroke goes untreated, the greater the risk of permanent disability.

definition

Rushing through the grocery store, you suddenly lose some of the feeling in your right arm and leg. You grab some shelves to steady yourself. You try to talk to a fellow shopper, but your words sound garbled and listeners seem confused by your speech. Then, after a few minutes, your signs and symptoms disappear and you go on with your shopping.

You may have experienced a temporary or intermittent neurological event called a transient ischemic attack (TIA). Ignoring this episode could have serious consequences for your health.

Even though a transient ischemic attack doesn't last very long and leaves no permanent effects, it's far from an insignificant event. About one in three people who have a transient ischemic attack eventually have a stroke, with about half occurring during the year after the transient ischemic attack.

A transient ischemic attack can serve as both a warning and an opportunity — a warning of an impending stroke and an opportunity to take steps to prevent it.

Symptoms

Transient ischemic attacks usually last for a few minutes. Most signs and symptoms disappear within an hour, and, by definition, all effects disappear within 24 hours. The signs and symptoms of TIA resemble those found early in a stroke and may include:

Sudden weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body
Slurred or garbled speech or difficulty understanding others
Sudden blindness in one or both eyes or double vision
Dizziness, loss of balance or loss of coordination

You may have more than one TIA, and the recurrent signs and symptoms may be similar or different depending on which area of the brain is involved. If signs and symptoms last longer than 24 hours, it's considered a stroke.

Causes

The cause of a transient ischemic attack is a temporary decrease in blood supply to part of your brain. Most attacks last just a few minutes.

A transient ischemic attack has the same origins as that of an ischemic stroke. In ischemic strokes, which are the most common type of stroke, a clot blocks the blood supply to part of your brain. But in contrast to a stroke, which involves a more prolonged lack of blood supply and causes some permanent damage to your brain tissue, a TIA doesn't leave lasting effects to your brain.

The underlying cause of a TIA often is a buildup of cholesterol-containing fatty deposits called plaques (atherosclerosis) in an artery or one of its branches that supply oxygen and nutrients to your brain. Plaques can decrease the blood flow through an artery or lead to the development of a clot. Other causes include a blood clot moving to your brain from another part of your body, most commonly from your heart.

Risk factors

You can't change the following risk factors for transient ischemic attack and stroke. But knowing you're at risk can motivate you to change your lifestyle to reduce other risks.

Family history. Your risk may be greater if one of your family members has had a TIA or a stroke.
Age. Your risk increases as you get older.
Sex. Men generally have a higher incidence of TIA and stroke than women do, but when it comes to deaths from stroke, the gender difference reverses. More than half of total deaths from stroke occur in women.
Race. Blacks are at greater risk of dying of a stroke than are people of other races. The reason is partly because of their higher prevalence of high blood pressure and diabetes.

You can control the following risk factors:

High blood pressure. Having high blood pressure — 140/90 millimeters of mercury or higher — increases your risk of TIA or stroke. Poor diet, lack of exercise and being overweight contribute to this risk factor.
Cardiovascular disease. Conditions including a previous heart attack, heart valve abnormalities, a patent foramen ovale, acute heart valve disease and atrial fibrillation — an irregular and, often, rapid heartbeat — increase your risk. Your heart doesn't pump blood as efficiently with these conditions, or it beats irregularly, allowing blood clots to form in the chambers of your heart that can break off and travel to the brain.
Cigarette smoking. Smoking contributes to development of cholesterol-containing fatty deposits in your arteries (atherosclerosis). Nicotine increases your heart rate and blood pressure. The carbon monoxide in cigarette smoke replaces some of the oxygen in your blood, decreasing the amount of oxygen delivered to your tissues, including your brain. Smoking also increases the risk of blood clots.
Diabetes. Diabetes increases the severity of atherosclerosis — narrowing of the arteries due to accumulation of fatty deposits — and the speed with which it develops.
Undesirable levels of blood cholesterol. High blood levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — and triglycerides, or low levels of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — increase your risk of narrowed or blocked arteries.
Elevated homocysteine level. Homocysteine — an amino acid and a building block of proteins — naturally occurs in your blood. Elevated levels of homocysteine can cause arteries to thicken and scar, making it more likely that cholesterol will clog arteries. B complex vitamins — B-6, B-12 and folic acid — have been shown to reduce blood levels of homocysteine. However, it isn't known whether taking supplements will reduce the likelihood of a stroke.
Blood disorders. Some blood disorders, such as sickle cell anemia, increase the risk of stroke because blood abnormalities can cause blood cells to be stickier and more likely to cling to artery walls, blocking them.
Sleep apnea. People with this sleep disorder seem to have a higher risk of stroke, which may be because people with sleep apnea also seem to have an increased risk of high blood pressure, a known risk factor for stroke.
Migraine. Some studies have found that people who have chronic headaches have an increased risk of stroke. However, since not all studies have found this association, additional research is needed to confirm this finding.
Sedentary lifestyle. People with limited physical activity are at increased risk of stroke. A brisk walk or some other exercise, if done on a regular basis, may lessen your risk of stroke.
Obesity. Your risk of stroke increases if you're overweight. Obesity can also increase your blood pressure and your risk of diabetes.
Carotid artery disease. Your doctor may hear a noise (bruit) over the arteries in the front part of your neck (carotid arteries) and then may recommend some studies of these arteries. If your doctor detects moderate to severe narrowing, your risk of stroke may be elevated, even though you haven't had signs or symptoms. You may need additional treatment to prevent a stroke from occurring.
Peripheral artery disease. In peripheral artery disease, fatty deposits build up on the artery walls in the legs and arms, narrowing the arteries. Anyone with peripheral artery disease has an increased risk of carotid artery disease, which increases stroke risk.
Heavy drinking. While moderate drinking — up to two drinks daily for men and one drink daily for women — is associated with a reduced risk of stroke, drinking more than this appears to increase stroke

Do You Have Any Helth Problems Today?

2008-11-09T07:59:00.000-08:00

How are today? Please write your health problem here. If it doesn't properly work, please send me email at dokter.monte@gmail.com. thx

Article For Download

2008-11-09T06:59:00.000-08:00

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Chest Pain
Alprazolam
Acne Vulgaris
Cortisol
Antihistamin

Do You Have Any Helth Problems Today?

2008-11-08T06:50:00.001-08:00

Do You Have Any Helth Problems Today?

Knowing of Drug: Captopril

2008-11-07T05:03:00.000-08:00

Captopril

Definition

Captopril is an angiotensin-converting enzyme inhibitor (ACE inhibitor) used for the treatment of hypertension and some types of congestive heart failure. Captopril was the first ACE inhibitor developed and was considered a breakthrough both because of its novel mechanism of action and also because of the revolutionary development process. Captopril is commonly marketed by Bristol-Myers Squibb under the trade name Capoten

Clinical Use

Captopril's main uses are based on its vasodilatation and inhibition of some renal function activities. These benefits are most clearly seen in the following conditions:

1) Hypertension

2) Cardiac conditions such as post myocardial infarction and congestive heart failure

3) Preservation of kidney function in diabetic nephropathy

Additionally, it has shown mood-elevating properties in some patients. This is consistent with the observation that animal screening models indicate putative antidepressant activity for this compound, although there has been one negative study. Formal clinical trials in depressed patients have not been reported.

History

Captopril was developed in 1975 by three researchers at the U.S. drug company Squibb (now Bristol-Myers Squibb): Miguel Ondetti, Bernard Rubin and David Cushman. Squibb filed for U.S. patent protection on the drug in February 1976 and U.S. Patent 4,046,889 was granted in September 1977.

The development of captopril was amongst the earliest successes of the revolutionary concept of structure-based drug design. The renin-angiontensin-aldosterone system had been extensively studied in the mid-20th century and it had been decided that this system presented several opportune targets in the development of novel treatments for hypertension. The first two targets that were attempted were renin and ACE. Captopril was the culmination of efforts by Squibb's laboratories to develop an ACE inhibitor.

Ondetti, Cushman and colleagues built on work that had been done in the 1960s by a team of researchers led by John Vane at the Royal College of Surgeons of England. The first breakthrough was made by Kevin K.F.Ng in 1967 when he found that the conversion of angiotensin I to angiotensin II took place in the pulmonary circulation instead of in the plasma. In contrast, Sergio Ferreira found that bradykinin disappeared in its passage through the pulmonary circulation. The conversion of angiotensin I to angiotensin II and the inactivation of bradykinin was thought to be mediated by the same enzyme.

In 1970, using Bradykin Potentiatin Factor (BPF) provided by Sergio Ferreira, Ng and Vane found that the conversion of angiotensin I to angiotensin II was inhibited during its passage through the pulmonary circulation. BPF was later found to be a peptide in the pit viper (Bothrops jararaca) venom which was a “collected-product inhibitor” of the converting enzyme. Captopril was developed from this peptide after it was found via QSAR-based modification that the terminal sulfhydryl moiety of the peptide provided a high potency of ACE inhibition.

Captopril gained FDA approval in June 1981. The drug went generic in the U.S. in February 1996 as a result of the end of market exclusivity for Bristol-Myers Squibb.

Limitations of captopril

The adverse drug reaction (ADR) profile of captopril is similar to other ACE inhibitors, with cough being the most common ADR (Rossi, 2006). However, captopril is also commonly associated with rash and taste disturbances (metallic or loss of taste), which are attributed to the unique sulfhydryl moiety (Atkinson & Robertson, 1979).

Captopril also has a relatively poor pharmacokinetic profile. The short half-life necessitates 2–3 times daily dosing, which may reduce patient compliance.

Subsequent ACE inhibitors

The adverse effect and pharmacokinetic limitations of captopril stimulated the development enalapril and subsequent ACE inhibitors. These were specifically designed to lack the sulfhydryl moiety believed to be responsible for rash and taste disturbance (Patchett et al., 1980). Most subsequent ACE inhibitors are given as prodrugs, to improve oral bioavailability. All have a longer half-life and are given once or twice daily, which may improve patient compliance.

Cough is the most common long-term adverse drug reaction associated with captopril therapy, as it is with all the ACE inhibitors. Hypotension is also a possible adverse effect, if the dose is too high. Hyperkalemia is possible, due to ACE inhibition reducing aldosterone production. Captopril can also be the cause of glomerulonephritis.

References

1. Atkinson AB, Robertson JIS. Captopril in the treatment of hypertension and cardiac failure. Lancet 1979;2(8147):836–9. PMID 90928

2. Patchett AA, Harris E, Tristam EQ, et al. A new class of angiotensin-converting enzyme inhibitors. Nature 1980;288(5788):280–3. PMID 6253826

3. Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006.

4. Smith CG, Vane JR. The discovery of captopril. FASEB J 2003;17:788-9. Fulltext. PMID 12724335.

5. Ferreira SH and Vane JR: The disappearance of bradykinin and eledoisin in the circulation and vascular beds of the cat. Br. J. Pharm. Chemother.,1967,30, 417-424.

Knowing of Chest Pain

2008-11-06T07:36:00.000-08:00

Knowing of Chest Pain

Angina

Angina is chest pain or discomfort you get when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw or back.

Angina is a symptom of coronary artery disease (CAD), the most common heart disease. CAD happens when a sticky substance called plaque builds up in the arteries that supply blood to the heart, reducing blood flow.

There are three types of angina: stable, unstable and variant. Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. It is does not go away with rest or medicine. It is a sign that you could have a heart attack soon.

Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include

Chest discomfort - pressure, squeezing, or pain
Shortness of breath
Discomfort in the upper body - arms, shoulder, neck, back
Nausea, vomiting, dizziness, lightheadedness, sweating

Arrhythmia

Has your heart ever skipped a beat? Sometimes it really does if you have an arrhythmia. An arrhythmia is any disorder of your heart rate or rhythm. It means that your heart beats too quickly, too slowly or with an irregular pattern. When the heart beats faster than normal, it is called tachycardia. When the heart beats too slowly, it is called bradycardia.

Many factors can affect your heart's rhythm, such as having had a heart attack, blood chemistry imbalances or abnormal hormone levels. Some substances or medicines may also cause arrhythmias.

Symptoms of arrhythmias include

* Fast or slow heart beat

* Skipping beats

* Lightheadedness, dizziness

* Chest pain

* Shortness of breath

* Paleness

* Sweating

Thalassemia

2008-11-05T14:58:00.000-08:00

Thalassemia

Definition

Thalassemia describes a group of inherited disorders characterized by reduced or absent amounts of hemoglobin, the oxygen-carrying protein inside the red blood cells. There are two basic groups of thalassemia disorders: alpha thalassemia and beta thalassemia. These conditions cause varying degrees of anemia, which can range from insignificant to life threatening.

Description

All types of thalassemias are considered quantitative diseases of hemoglobin, because the quantity of hemoglobin produced is reduced or absent. Usual adult hemoglobin is made up of three components: alpha globin, beta globin, and heme. Thalassemias are classified according to the globin that is affected, hence the names alpha and beta thalassemia. Although both classes of thalassemia affect the same protein, the alpha and beta thalassemias are distinct diseases that affect the body in different ways.

Beta thalassemia

Beta thalassemia may be the most best-known type of thalassemia and is also called Cooley's anemia. It is caused by a change in the gene for the beta globin component of hemoglobin. Beta thalassemia causes variable anemia that can range from moderate to severe, depending in part on the exact genetic change underlying the disease. Beta thalassemia can be classified based on clinical symptoms. Beta thalassemia major usually causes severe anemia that can occur within months after birth. If left untreated, severe anemia can result in insufficient growth and development, as well as other common physical complications that can lead to a dramatically decreased life-expectancy. Fortunately, in developed countries beta thalassemia is usually identified by screening in the newborn period, before symptoms have developed. Children who are identified early can be started on ongoing blood transfusion therapy as needed. Although transfusion therapy prevents many of the complications of severe anemia, the body is unable to eliminate the excess iron contained in the transfused blood. Over time, the excess iron deposits in tissues and organs, resulting in damage and organ failure. Another medication must be administered to help the body eliminate the excess iron and prevent iron-over-load complications. Beta thalassemia intermedia describes the disease in individuals who have moderate anemia that only requires blood transfusions intermittently, if at all.

Alpha thalassemia

Alpha thalassemia is the result of changes in the genes for the alpha globin component of hemoglobin. There are two main types of alpha thalassemia disease: hemoglobin H disease and alpha thalassemia major. The two diseases are quite different from beta thalassemia as well as from one another. Individuals with hemoglobin H disease can experience events of hemolytic anemia—anemia caused by the rapid breakdown of the red blood cells. These events are thought to be triggered by various environmental causes, such as infection and/or exposure to certain chemicals. Hemoglobin H disease is in most cases milder than beta thalassemia. It does not generally require transfusion therapy. Alpha thalassemia major is a very serious disease that results in severe anemia that begins even before birth. Most affected babies do not survive to be born or die shortly after birth.

The thalassemias are among the most common genetic diseases worldwide. Both alpha and beta thalassemia have been described in individuals of almost every ancestry, but the conditions are more common among certain ethnic groups. Unaffected carriers of all types of thalassemia traits do not experience health problems. In fact, the thalassemia trait is protective against malaria, a disease caused by blood-borne parasites transmitted through mosquito bites. According to a widely accepted theory, most genetic changes—mutations—that cause thalassemia occurred multiple generations ago. Coincidentally, these mutations increased the likelihood that carriers would survive malaria infection. Survivors passed the mutation onto their offspring, and the trait became established throughout areas where malaria is common. As populations migrated, so did the thalassemia traits.

Beta thalassemia trait is seen most commonly in people with the following ancestry: Mediterranean (including North African, and particularly Italian and Greek), Middle Eastern, Indian, African, Chinese, and Southeast Asian (including Vietnamese, Laotian, Thai, Singaporean, Filipino, Cambodian, Malaysian, Burmese, and Indonesian). Alpha-thalassemia trait is seen with increased frequency in the same ethnic groups. However, there are different types of alpha thalassemia traits within these populations. The frequency of hemoglobin H disease and alpha thalassemia major depends on the type of alpha thalassemia trait. The populations in which alpha thalassemia diseases are most common include Southeast Asians and Chinese (particularly Southern Chinese).

It is difficult to obtain accurate prevalence figures for various types of thalassemia within different populations. This difficulty arises due to testing limitations in determining exact genetic diagnoses, as well as the fact that many studies have focused on small, biased hospital populations.

Two studies reflect prevalence figures that can be helpful counseling families and determining who to screen for beta thalassemia. Between the years of 1990 and 1996, the State of California screened more than 3.1 million infants born in the state for beta thalassemia. Approximately 1 in 114,000 infants had beta thalassemia major, with prevalence rates being highest among Asian Indians (about one in 4,000), Southeast Asians (about one in 10,000), and Middle Easterners (about one in 7,000). Another type of beta thalassemia disease, E/beta thalassemia, was represented in approximately one in 110,000 births, all of which occurred in families of Southeast Asian ancestry. Among Southeast Asians, the prevalence of E/beta thalassemia was approximately one in 2,600 births. This is in keeping with the observation that hemoglobin E trait carrier rates are relatively high within the Southeast Asian population: 16% in a study of 768 immigrants to California, and up to 25% in some specific Southeast Asian populations such as Cambodians. While these California studies address some of the limitations of earlier population studies, the pattern observed in California is expected to be different in other areas of the United States and the world. For example, Italians are underrepresented in this population when compared to the population of the East Coast of the United States.

Determining prevalence figures for alpha thalassemia is even more difficult due to increased limitations in diagnostic testing. All types of alpha thalassemia disease are most common among people of Southeast Asian and Chinese descent, for reasons that become clearer with an understanding of the underlying genetics of alpha thalassemia. One study of 500 pregnant women in Northern Thailand estimated a frequency of one in 500 pregnancies affected by alpha thalassemia major, for example. Prevalence of alpha thalassemia disease is significantly lower in the United States primarily because of immigration patterns; although at least one state, California, has observed growing hemoglobin H disease incidence rates that are high enough to justify universal newborn screening for the condition.

Causes

Genetics

Humans normally make several types of the oxygen-carrying protein hemoglobin. An individual's stage in development determines whether he or she makes primarily embryonic, fetal, or adult hemoglobins. All types of hemoglobin are made of three components: heme, alpha (or alpha-like) globin, and beta (or beta-like) globin. All types of thalassemia are caused by changes in either the alpha- or beta-globin gene. These changes cause little or no globin to be produced. The thalassemias are, therefore, considered quantitative hemoglobin diseases. All types of thalassemias are recessively inherited, meaning that a genetic change must be inherited from both the mother and the father. The severity of the disease is influenced by the exact thalassemia mutations inherited, as well as other genetic and environmental factors. There are rare exceptions, notably with beta thalassemia, where globin gene mutations exhibit a dominant pattern of inheritance in which only one gene needs to be altered in order to see disease expression. Scientists continue to study the causes. For instance, a new mutation for alpha-thalassemia was discovered for the first time among Iranian patients in 2004.

BETA-THALASSEMIA. Most individuals have two normal copies of the beta globin gene, which is located on chromosome 11 and makes the beta globin component of normal adult hemoglobin, hemoglobin A. There are approximately 100 genetic mutations that have been described that cause beta thalassemia, designated as either beta0 or beta + mutations. No beta globin is produced with a beta0 mutation, and only a small fraction of the normal amount of beta globin is produced with a beta + mutation.

When an individual has one normal beta globin gene and one with a beta thalassemia mutation, he or she is said to carry the beta thalassemia trait. Beta thalassemia trait, like other hemoglobin traits, is protective against malaria infection. Trait status is generally thought not to cause health problems, although some women with beta thalassemia trait may have an increased tendency toward anemia during pregnancy.

When two members of a couple carry the beta thalassemia trait, there is a 25% chance that each of their children will inherit beta thalassemia disease by inheriting two beta thalassemia mutations, one from each parent. The clinical severity of the beta thalassemia disease—whether an individual has beta thalassemia intermedia or beta thalassemia major—will depend largely on whether the mutations inherited are beta0 thalassemia or beta + thalassemia mutations. Two beta0 mutations generally lead to beta thalassemia major, and two beta+ thalassemia mutations generally lead to beta thalassemia intermedia. Inheritance of one beta0 and one beta + thalassemia mutation tends to be less predictable.

Although relatively uncommon, there are other thalassemia-like mutations that can affect the beta globin gene. Hemoglobin E is the result of a substitution of a single nucleotide. This change results in a structurally altered hemoglobin that is produced in decreased amounts. Therefore, hemoglobin E is unique in that it is both a quantitative (i.e. thalassemia-like) and qualitative trait. When co-inherited with a beta thalassemia trait, it causes a disease that is almost indistinguishable from beta thalassemia disease. Large deletions around and including the beta globin gene can lead to delta/beta thalassemia or hereditary persistence of fetal hemoglobin (HPFH). Interestingly, delta/beta thalassemia trait behaves very similarly to beta thalassemia trait in its clinical manifestations. However, HPFH trait does not tend to cause hemoglobin disease when co-inherited with a second thalassemia or other beta globin mutation.

ALPHA-THALASSEMIA. Most individuals have four normal copies of the alpha globin gene, two copies on each chromosome 16. These genes make the alpha globin component of normal adult hemoglobin, which is called hemoglobin A. Alpha globin is also a component of fetal hemoglobin and the other major adult hemoglobin called hemoglobin A2. Mutations of the alpha globin genes are usually deletions of the gene, resulting in absent production of alpha globin. Since there are four genes (instead of the usual two) to consider when looking at alpha globin gene inheritance, there are several alpha globin types that are possible.

Absence of one alpha globin gene leads to a condition known as silent alpha thalassemia trait. This condition causes no health problems and can be detected only by special genetic testing. Alpha thalassemia trait occurs when two alpha globin genes are missing. This can occur in two ways. The genes may be deleted from the same chromosome, causing the 'cis' type of alpha thalassemia trait. Alternately, they may be deleted from different chromosomes, causing the 'trans' type of alpha thalassemia trait. In both instances, there are no associated health problems, although the trait status may be detected by more routine blood screening.

Hemoglobin H disease results from the deletion of three alpha globin genes, such that there is only one functioning gene. Typically, this can occur when one parent carries the silent alpha thalassemia trait, and the other parent carries the 'cis' type of the alpha thalassemia trait. In this situation, there is a 25% chance for hemoglobin H disease in each of such a couple's children.

Hemoglobin H disease-like symptoms can also be a part of a unique condition called alpha thalassemia mental retardation syndrome. Alpha thalassemia mental retardation syndrome can be caused by a deletion of a significant amount of chromosome 16, affecting the alpha globin genes. This is usually not inherited, but rather occurs sporadically in the affected individual. Affected individuals have mild hemoglobin H disease, mild-to-moderate mental retardation, and characteristic facial features. This syndrome can also occur as a sex-linked form in which a mutation is inherited in a particular gene on the X-chromosome. This gene influences alpha globin production, as well as various other developmental processes. Individuals affected with this form of the syndrome tend to have more severe mental retardation, delayed development, nearly absent speech, characteristic facial features, and genital-urinary abnormalities. The remaining discussion will focus only on aspects of hemoglobin H disease.

Alpha thalassemia major results from the deletion of all four alpha globin genes, such that there are no functioning alpha globin genes. This can occur when both parents carry the 'cis' type of the alpha thalassemia trait. In this situation, there is a 25% chance for alpha thalassemia major in each of such a couple's children.

Symptoms

Beta thalassemia

Beta thalassemia major is characterized by severe anemia that can begin months after birth. In the United States and other developed countries beta thalassemia is identified and treated early and effectively. Therefore, the following discussion of symptoms applies primarily to affected individuals in the past and unfortunately in some underdeveloped countries now. If untreated, beta thalassemia major can lead to severe lethargy, paleness, and delays in growth and development. The body attempts to compensate by producing more blood, which is made inside the bones in the marrow. However, this is ineffective without the needed genetic instructions to make enough functioning hemoglobin. Instead, obvious bone expansion and changes occur that cause characteristic facial and other changes in appearance, as well as increased risk of fractures. Severe anemia taxes other organs in the body—such as the heart, spleen, and liver—which must work harder than usual. This can lead to heart failure, as well as enlargement and other problems of the liver and spleen. When untreated, beta thalassemia major generally results in childhood death, usually due to heart failure. In 2004, the first known heart attack associated with beta thalassemia major was reported. Fortunately, in developed countries diagnosis is usually made early, often before symptoms have begun. This allows for treatment with blood transfusion therapy, which can prevent most of the complications of the severe anemia caused by beta thalassemia major. Individuals with beta thalassemia intermedia have a more moderate anemia that may only require treatment with transfusion intermittently, such as when infections occur and stress the body. As a person with beta thalassemia intermedia gets older, however, the need for blood transfusions may increase to the point that they are required on a regular basis. When this occurs their disease becomes more similar to beta thalassemia major. Other genetic and environmental factors can influence the course of the disease as well. For example, co-inheritance of one or two alpha thalassemia mutations can tend to ameliorate some of the symptoms of beta thalassemia disease, which result in part from an imbalance in the amount of alpha- and beta-globin present in the red blood cells.

Hemoglobin h disease

Absence of three alpha globin genes causes an imbalance of alpha and beta globin proteins in the red blood cells. The excess beta globin proteins tend to come together to form hemoglobin H, which is unable to release oxygen to the tissues. In addition, hemoglobin H tends to precipitate out in the cells, causing damage to the red blood cell membrane. When affected individuals are exposed to certain drugs and chemicals known to make the membrane more fragile, the cells are thought to become vulnerable to breakdown in large numbers, a complication called hemolytic anemia. Fever and infection are also considered to be triggers of hemolytic anemia in hemoglobin H disease. This can result in fatigue, paleness, and a yellow discoloration of the skin and whites of eyes called jaundice. Usually, the anemia is mild enough not to require treatment. Severe anemia events may require blood transfusion, however, and are usually accompanied by such other symptoms as dark feces or urine and abdominal or back pain. These events are uncommon in hemoglobin H disease, although they occur more frequently in a more serious type of hemoglobin H disease called hemoglobin H/Constant Spring disease. Individuals effected with this type of hemoglobin H disease are also more likely to have enlargement of and other problems with the spleen.

Alpha thalassemia major

Because alpha globin is a necessary component of all major hemoglobins and some minor hemoglobins, absence of all functioning alpha globin genes leads to serious medical consequences that begin even before birth. Affected fetuses develop severe anemia as early as the first trimester of pregnancy. The placenta, heart, liver, spleen, and adrenal glands may all become enlarged. Fluid can begin collecting throughout the body as early as the start of the second trimester, causing damage to developing tissues and organs. Growth retardation is also common. Affected fetuses usually miscarry or die shortly after birth. In addition, women carrying affected fetuses are at increased risk of developing complications of pregnancy and delivery. Up to 80% of such women develop toxemia, a disturbance of metabolism that can potentially lead to convulsions and coma. Other maternal complications include premature delivery and increased rates of delivery by cesarean section, as well as hemorrhage after delivery.

Diagnosis

Thalassemia may be suspected if an individual shows signs that are suggestive of the disease. In all cases, however, laboratory diagnosis is essential to confirm the exact diagnosis and to allow for the provision of accurate genetic counseling about recurrence risks and testing options for parents and affected individuals. Screening is likewise recommended to determine trait status for individuals of high-risk ethnic groups.

The following tests are used to screen for thalassemia disease and/or trait:

A complete blood count will identify low levels of hemoglobin, small red blood cells, and other red blood cell abnormalities that are characteristic of a thalassemia diagnosis. Since thalassemia trait can sometimes be difficult to distinguish from iron deficiency, tests to evaluate iron levels are important. A hemoglobin electrophoresis is a test that can help identify the types and quantities of hemoglobin made by an individual. This test uses an electric field applied across a slab of gel-like material. Hemoglobins migrate through this gel at various rates and to specific locations, depending on their size, shape, and electrical charge. Isoelectric focusing and high-performance liquid chromatography (HPLC) use similar principles to separate hemoglobins and can be used instead of or in various combinations with hemoglobin electrophoresis to determine the types and quantities of hemoglobin present. Hemoglobin electrophoresis results are usually within the normal range for all types of alpha thalassemia. However, hemoglobin A2 levels and sometimes hemoglobin F levels are elevated when beta thalassemia disease or trait is present. Hemoglobin electrophoresis can also detect structurally abnormal hemoglobins that may be co-inherited with a thalassemia trait to cause thalassemia disease (i.e., hemoglobin E) or other types of hemoglobin disease (i.e., sickle hemoglobin). Sometimes DNA testing is needed in addition to the above screening tests. This can be performed to help confirm the diagnosis and establish the exact genetic type of thalassemia.

Diagnosis of thalassemia can occur under various circumstances and at various ages. Several states offer thalassemia screening as part of the usual battery of blood tests done for newborns. This allows for early identification and treatment. Thalassemia can be identified before birth through the use of prenatal diagnosis. Chorionic villus sampling (CVS) can be offered as early as 10 weeks of pregnancy and involves removing a sample of the placenta made by the baby and testing the cells. CVS carries a risk of causing a miscarriage that is between 0.5%-1%. Amniocentesis is generally offered between 15 and 22 weeks of pregnancy, but can sometimes be offered earlier. Two to three tablespoons of the fluid surrounding the baby is removed. This fluid contains fetal cells that can be tested. The risk of miscarriage associated with amniocentesis ranges from 0.33-0.5%. Pregnant woman and couples may choose prenatal testing in order to prepare for the birth of a baby that may have thalassemia. Alternately, knowing the diagnosis during pregnancy allows for the option of pregnancy termination. Preimplantation genetic diagnosis (PGD) is a relatively new technique that involves in-vitro fertilization followed by genetic testing of one cell from each developing embryo. Only the embryos unaffected by sickle cell disease are transferred back into the uterus. PGD is currently available on a research basis only and is relatively expensive.

Treatment

Beta thalassemia

Individuals with beta thalassemia major receive regular blood transfusions, usually on a monthly basis. This helps prevent severe anemia and allows for more normal growth and development. Transfusion therapy does have limitations, however. Individuals can develop reactions to certain proteins in the blood—called a transfusion reaction. This can make locating appropriately matched donor blood more difficult. Although blood supplies in the United States are very safe, particularly relative to the past and to other areas of the world, there remains an increased risk of exposure to such blood-borne infections as hepatitis. Additionally, the body is not able to get rid of the excess iron that accompanies each transfusion. An additional medication called desferoxamine is administered, usually five nights per week over a period of several hours, using an automatic pump that can be used during sleep or taken anywhere the person goes. This medication is able to bind to the excess iron, which can then be eliminated through urine. If desferoxamine is not used regularly or is unavailable, iron overload can develop and cause tissue damage and organ damage and failure. The heart, liver, and endocrine organs are particularly vulnerable. Desferoxamine itself may rarely produce allergic or toxic side effects, including hearing damage. Signs of desferoxamine toxicity are screened for and generally develop in individuals who overuse the medication when body iron levels are sufficiently low. Overall, however, transfusion and desferoxamine therapy have increased the life expectancy of individuals with the most severe types of beta thalassemia major to the 4th or 5th decade. This can be expected to improve with time and increased developments in treatment, as well as for those with more mild forms of the disease.

New treatments offer additional options for some individuals with beta thalassemia major. There are various medications that target the production of red blood cells (i.e. erythropoeitin) or fetal hemoglobin (i.e. hydroxyurea and butyrate). Their effectiveness in ameliorating the severity of beta thalassemia is currently being investigated. Another promising new treatment is bone marrow transplantation, in which the bone marrow of an affected individual is replaced with the bone marrow of an unaffected donor. If successful, this treatment can provide a cure. However, there is an approximately 10-15% chance the procedure could be unsuccessful (i.e. the thalassemia returns); result in complications (i.e. graft-versus-host disease); or result in death. The risk for specific individuals depends on current health status, age, and other factors. Because of the risks involved and the fact that beta thalassemia is a treatable condition, transplant physicians require a brother or sister donor who has an identically matched tissue type, called HLA type. HLA type refers to the unique set of proteins present on each individual's cells, which allows the immune system to recognize "self" from "foreign." HLA type is genetically determined, so there is a 25% chance for two siblings to be a match.

Transplant physicians and researchers are also investigating ways to improve the safety and effectiveness of bone marrow transplantation. Using newborn sibling umbilical cord blood—the blood from the placenta that is otherwise discarded after birth but contains cells that can go on to make bone marrow—seems to provide a safer and perhaps more effective source of donor cells. Donors and recipients may not have to be perfect HLA matches for a successful transplant using cord blood cells. Trials are also underway to determine the effectiveness of "partial transplants," in which a safer transplant procedure is used to replace only a percentage of the affected individual's bone marrow. Other possible treatments on the horizon may include gene therapy techniques aimed at increasing the amount of normal hemoglobin the body is able to make.

Hemoglobin h disease

Hemoglobin H disease is a relatively mild form of thalassemia that may go unrecognized. It is not generally considered a condition that will reduce one's life expectancy. Education is an important part of managing the health of an individual with hemoglobin H disease. It is important to be able to recognize the signs of severe anemia that require medical attention. It is also important to be aware of the medications, chemicals, and other exposures to avoid due to the theoretical risk they pose of causing a severe anemia event. When severe anemia occurs, it is treated with blood transfusion therapy. For individuals with hemoglobin H disease, this is rarely required. For those with the hemoglobin H/Constant Spring form of the disease, the need for transfusions may be intermittent or ongoing, perhaps on a monthly basis and requiring desferoxamine treatment. Individuals with this more severe form of the disease may also have an increased chance of requiring removal of an enlarged and/or overactive spleen.

Key terms

Anemia — A blood condition in which the level of hemoglobin or the number of red blood cells falls below normal values. Common symptoms include paleness, fatigue, and shortness of breath.

Bilirubin — A yellow pigment that is the end result of hemoglobin breakdown. This pigment is metabolized in the liver and excreted from the body through the bile. Bloodstream levels are normally low; however, extensive red cell destruction leads to excessive bilirubin formation and jaundice.

Bone marrow — A spongy tissue located in the hollow centers of certain bones, such as the skull and hip bones. Bone marrow is the site of blood cell generation.

Bone marrow transplantation — A medical procedure used to treat some diseases that arise from defective blood cell formation in the bone marrow. Healthy bone marrow is extracted from a donor to replace the marrow in an ailing individual. Proteins on the surface of bone marrow cells must be identical or very closely matched between a donor and the recipient.

Desferoxamine — The primary drug used in iron chelation therapy. It aids in counteracting the life-threatening buildup of iron in the body associated with long-term blood transfusions.

Globin — One of the component protein molecules found in hemoglobin. Normal adult hemoglobin has a pair each of alpha-globin and beta-globin molecules.

Heme — The iron-containing molecule in hemoglobin that serves as the site for oxygen binding.

Hemoglobin — Protein-iron compound in the blood that carries oxygen to the cells and carries carbon dioxide away from the cells.

Hemoglobin A — Normal adult hemoglobin that contains a heme molecule, two alpha-globin molecules, and two beta-globin molecules.

Hemoglobin electrophoresis — A laboratory test that separates molecules based on their size, shape, or electrical charge.

Hepatomegaly — An abnormally large liver.

HLA type — Refers to the unique set of proteins called human leukocyte antigens. These proteins are present on each individual's cell and allow the immune system to recognize 'self' from 'foreign'. HLA type is particularly important in organ and tissue transplantation.

Hydroxyurea — A drug that has been shown to induce production of fetal hemoglobin. Fetal hemoglobin has a pair of gamma-globin molecules in place of the typical beta-globins of adult hemoglobin. Higher-than-normal levels of fetal hemoglobin can ameliorate some of the symptoms of thalassemia.

Iron overload — A side effect of frequent blood transfusions in which the body accumulates abnormally high levels of iron. Iron deposits can form in organs, particularly the heart, and cause life-threatening damage.

Jaundice — Yellowing of the skin or eyes due to excess of bilirubin in the blood.

Mutation — A permanent change in the genetic material that may alter a trait or characteristic of an individual, or manifest as disease, and can be transmitted to offspring.

Placenta — The organ responsible for oxygen and nutrition exchange between a pregnant mother and her developing baby.

Red blood cell — Hemoglobin-containing blood cells that transport oxygen from the lungs to tissues. In the tissues, the red blood cells exchange their oxygen for carbon dioxide, which is brought back to the lungs to be exhaled.

Screening — Process through which carriers of a trait may be identified within a population.

Splenomegaly — Enlargement of the spleen.

Alpha thalassemia major

Because alpha thalassemia major is most often a condition that is fatal in the prenatal or newborn period, treatment has previously been focused on identifying affected pregnancies in order to provide appropriate management to reduce potential maternal complications. Pregnancy termination provides one form of management. Increased prenatal surveillance and early treatment of maternal complications is an approach that is appropriate for mothers who wish to continue their pregnancy with the knowledge that the baby will most likely not survive. In recent years, there have been a handful of infants with this condition who have survived long-term. Most of these infants received experimental treatment including transfusions before birth, early delivery, and even bone marrow transplantation before birth, although the latter procedure has not yet been successful. For those infants that survive to delivery, there seems to be an increased risk of developmental problems and physical effects, particularly heart and genital malformations. Otherwise, their medical outlook is similar to a child with beta thalassemia major, with the important exception that ongoing, life-long blood transfusions begin right at birth.

Prognosis

As discussed above, the prognosis for individuals with the most serious types of thalassemia has improved drastically in the last several years following recent medical advances in transfusion, chemo-, and transplantation therapy. Advances continue and promise to improve the life expectancy and quality of life further for affected individuals.

Resources

Periodicals

"First Known Heart Attack Associated With Beta-thalassemia Major Reported." Heart Disease Weekly February 22, 2004: 10.

"Novel Alpha-thalassemia Mutations Identified." Hematology Week January 26, 2004: 19.

Organizations

Children's Blood Foundation. 333 East 38th St., Room 830, New York, NY 10016-2745. (212) 297-4336. cfg@nyh.med.cornell.edu.

Cooley's Anemia Foundation, Inc. 129-09 26th Ave. #203, Flushing, NY 11354. (800) 522-7222 or (718) 321-2873. http://www.thalassemia.org.

March of Dimes Birth Defects Foundation. 1275 Mamaroneck Ave., White Plains, NY 10605. (888) 663-4637. resourcecenter@modimes.org. http://www.modimes.org.

National Heart, Lung, and Blood Institute. PO Box 30105, Bethseda, MD 20824-0105. (301) 592-8573. nhlbiinfo@rover.nhlbi.nih.gov. http://www.nhlbi.nih.gov.

National Organization for Rare Disorders (NORD). PO Box 8923, New Fairfield, CT 06812-8923. (203) 746-6518 or (800) 999-6673. Fax: (203) 746-6481. http://www.rarediseases.org.

Other

Bojanowski J. "Alpha Thalassemia Major: The Possibility of Long-Term Survival." Pamphlet from the Northern California Comprehensive Thalassemia Center. (1999).

Children's Hospital Oakland, Northern California Comprehensive Thalassemia Center website. http://www.thalassemia.com.

Cooley's Anemia Foundation, Inc. website. http://www.thalassemia.org/gohome.html.

Joint Center for Sickle Cell and Thalassemic Disorders website. http://cancer.mgh.harvard.edu/medOnc/sickle.htm.

http://medical-dictionary.thefreedictionary.com/Thalasemia

How are you today?

2008-11-05T14:20:00.000-08:00

November 6, 2008
How are today? Please write your health problem here. If it doesn't properly work, please send me email at dokter.monte@gmail.com. thx

Acne Vulgaris

2008-11-05T07:53:00.001-08:00

Acne vulgaris

Definition

Acne is a skin condition characterized by whiteheads, blackheads, and inflamed red pimples or "zits."

Causes

Acne occurs when tiny holes on the surface of the skin, called pores, become clogged. Each pore is an opening to a canal called a follicle, which contains a hair and an oil gland. Normally, the oil glands help keep the skin lubricated and help remove old skin cells. When glands produce too much oil, the pores can become blocked, accumulating dirt, debris, and bacteria. The blockage is called a plug or comedone.

The top of the plug may be white (whitehead) or dark (blackhead). If it ruptures, the material inside, including oil and bacteria, can spread to the surrounding area and cause an inflammatory reaction. If the inflammation is deep in your skin, the pimples may enlarge to form firm, painful cysts.

Acne commonly appears on the face and shoulders, but may also occur on the trunk, arms, legs, and buttocks.

Acne is most common in teenagers, but it can happen at any age, even as an infant. Three out of four teenagers have acne to some extent, probably caused by hormonal changes that stimulate oil production. However, people in their 30s and 40s may also have acne.

Acne tends to run in families and can be triggered by:

* Hormonal changes related to menstrual periods, pregnancy, birth control pills, or stress

* Greasy or oily cosmetic and hair products

* Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)

* High levels of humidity and sweating

Despite the popular belief that chocolate, nuts, and other foods cause acne, this does not seem to be true.

Symptoms

* Blackheads

* Crusting of skin eruptions

* Cysts

* Inflammation around the skin eruptions

* Pustules

* Redness around the skin eruptions

* Scarring of the skin

* Whiteheads

Treatment

Take the following self-care steps to lessen the effects of acne:

* Clean your skin gently with a mild, non-drying soap (such as Dove, Neutrogena, or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising. However, avoid excessive or repeated skin washing.

* Shampoo your hair daily, especially if it's oily. Comb or pull your hair back to keep the hair out of your face. Avoid tight headbands.

* Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to scarring and skin infections.

* Avoid touching your face with your hands or fingers.

* Avoid greasy cosmetics or creams. Look for water-based or "non-comedogenic" formulas. Take make-up off at night.

If these steps do not clear up the blemishes to an acceptable level, try over-the-counter acne medications. These creams and lotions are applied directly to the skin. They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid. They work by killing bacteria, drying up the oil, and causing your skin to peel.

If the pimples are still a problem, a dermatologist can prescribe stronger medications and discuss other options with you.

Prescription medicines include:

* Oral antibiotics (taken by mouth) such as minocycline, doxycycline, and tetracycline

* Topical antibiotics (applied to the skin) such as clindamycin or erythromycin

* Retinoic acid cream or gel (Retin-A) and isotretinoin pills (Accutane) -- pregnant women and sexually active adolescent females should NOT take Accutane, as it causes severe birth defects; Women taking Accutane should use two forms of birth control before starting the drug

* Prescription formulas of benzoyl peroxide, sulfur, resorcinol, salicylic acid

Birth control pills can sometimes help clear up acne. (In some cases, though, they may make it worse.)

Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion, or removal or drainage of cysts.

A small amount of sun exposure may improve acne. However, excessive exposure to sunlight or ultraviolet rays is not recommended because it increases the risk of skin cancer.

Outlook (Prognosis)

Acne usually subsides after adolescence, but may last into middle age. The condition generally responds well to treatment after a few weeks, but may flare up from time to time. Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become significantly depressed if acne is not treated.

Possible Complications

Possible complications include:

* Changes in skin color

* Cysts

* Damage to self-esteem, confidence, personality, and social life

* Permanent facial scars

* Side effects of Accutane (including very dry skin and mucous membranes, high triglyceride levels, liver damage, and birth defects in an unborn baby; call your doctor right away if you become pregnant while taking this drug)

* Side effects of other medications

adapted from:

http://www.nlm.nih.gov/medlineplus/ency/article/000873.htm

Do You Have Any Health Problems?

2008-11-04T15:44:00.000-08:00

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MIGRAINE

2008-11-04T07:53:00.000-08:00

MIGRAINE

Everyone should have the problem with headache, especially migraine. Migraine is specific headache, with a half headache and rush for a moment.

What are migraine triggers?

A migraine trigger is any factor that causes a headache in individuals who are prone to develop headaches. Only a small proportion of migraine sufferers, however, clearly can identify triggers. Examples of triggers include stress, sleep disturbances, fasting, hormones, bright or flickering lights, odors, cigarette smoke, alcohol, aged cheeses, chocolate, monosodium glutamate, nitrites, aspartame, and caffeine. For some women, the decline in the blood level of estrogen during the onset of menstruation is a trigger for migraine headaches. The interval between exposure to a trigger and the onset of headache varies from hours to two days. Exposure to a trigger does not always lead to a headache. Conversely, avoidance of triggers cannot completely prevent headaches. Different migraine sufferers respond to different triggers, and any one trigger will not induce a headache in every person who has migraine headaches.

We can mention the triggers of migraine:

1. Sleep, disturbances such as sleep deprivation, too much sleep, poor quality of sleep, and frequent awakening at night are associated with both migraine and tension headaches, whereas improved sleep habits have been shown to reduce the frequency of migraine headaches.

2. Fasting

3. Bright lights

4. Caffeine, in low doses can increase alertness and energy, but caffeine in high doses can cause insomnia, irritability, anxiety, and headaches. The over-use of caffeine-containing analgesics causes rebound headaches. Furthermore, individuals who consume high levels of caffeine regularly are more prone to develop withdrawal headaches when caffeine is stopped abruptly.

5. Chocolate, wine, tyramine, MSG, nitrites, aspartame

6. Female hormones

What should migraine sufferers do?
Individuals with mild and infrequent migraine headaches that do not cause disability may require only analgesics. Individuals who experience several moderate or severe migraine headaches per month or whose headaches do not respond readily to medications should avoid triggers and consider modifications of their life-style. Life-style modifications for migraine sufferers include:

· Go to sleep and waking up at the same time each day.

· Exercise regularly (daily if possible). Make a commitment to exercise even when traveling or during busy periods at work. Exercise can improve the quality of sleep and reduce the frequency and severity of migraine headaches. Build up your exercise level gradually. Over-exertion, especially for someone who is out of shape, can lead to migraine headaches.

· Do not skip meals, and avoiding prolonged fasting.

· Limit stress through regular exercise and relaxation techniques.

· Limit caffeine consumption to less than two caffeine-containing beverages a day.

· Avoid bright or flashing lights and wearing sunglasses if sunlight is a trigger.

· Identify and avoid foods that trigger headaches by keeping a headache and food diary. Review the diary with your doctor. It is impractical to adopt a diet that avoids all known migraine triggers, however, it is reasonable to avoid foods that consistently trigger migraine headaches.

What are prophylactic medications for migraine headaches?

Prophylactic medications are medications taken daily to reduce the frequency and duration of migraine headaches. They are not taken once a headache has begun. There are several classes of prophylactic medications: beta blockers, calcium-channel blockers, tricyclic antidepressants, antiserotonin agents and anticonvulsants. Medications with the longest history of use are propanolol, a beta blocker, and amitriptyline, an antidepressant. When choosing a prophylactic medication for a patient the doctor must take into account the drug side effects, drug-drug interactions, and co-existing conditions such as diabetes, heart disease, and high blood pressure

What is the treatment for moderate to severe migraine headaches?
Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. The abortive medications for moderate or severe migraine headaches are different than analgesics. Instead of relieving pain, they abort headaches by counteracting the cause of the headache, dilation of the temporal arteries. In fact, they cause narrowing of the arteries. Examples of migraine-specific abortive medications are the triptans and ergot preparations.

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2008-11-03T16:13:00.001-08:00

Hello, do you have any health problems today? Please write, your problems here at the bottom of this article. Thanks. dr. Monte

Tips For Today

2008-11-03T16:07:00.003-08:00

Good Morning...

How are you today?

Do you know, that every early morning our body produce a lot of hormone called by cortisone?

Cortisone is one of several end products of a process called steroidogenesis. This process starts with the synthesis of cholesterol which then proceeds through a series of modifications in the adrenal gland (suprarenal) to become any one of many steroid hormones. One end product of this pathway is cortisol.

Cortisol, a glucocorticoid, and adrenaline are the main hormones released by the body as a reaction to stress. They elevate blood pressure and prepare the body for a fight or flight response.

Why, cortisone (and the derivate product, especially cortisol) is producted much more in the morning? Because, naturally we have to work in the morning. And what happen if we don't use them, for example, we just sleep all morning. Our body still produce them and we respond to aware, but we don't have any activity. So these hormone are useless to us. The side effect of cortisone is likely two side sharpen sword. If we use them wisely, they will protect us, but if don't they will wound us. That's why, people whose awaken till noon, not being healthy, they feel so badly, rush in their body etc.

So, we have conclude that's better for us to wake up early and doing some activity for example aerobic, jogging, etc.

Nephropathy Diabeticum

2008-11-03T09:31:00.000-08:00

Nephropathy Diabeticum

Definition:

Diabetic nephropathy is a complication of diabetes. If you have this condition, your kidney loses its ability to function properly. The condition is characterized by high protein levels in the urine.

Diabetic nephropathy is the most common cause of chronic kidney failure and end-stage kidney disease in the United States. People with both type 1 and type 2 diabetes are at risk. The risk is higher if blood-glucose levels are poorly controlled. However, once nephropathy develops, the greatest rate of progression is seen in patients with poor control of their blood pressure.

Diabetic nephropathy is generally accompanied by other diabetes complications including hypertension, retinopathy, and vascular (blood vessel) changes, although these may not be obvious during the early stages of nephropathy. Nephropathy may be present for many years before high protein in the urine or chronic kidney failure develop.

Prevention:

Blood glucose levels should be controlled as closely as possible in people with diabetes. Controlling blood pressure, cholesterol, and weight is just as important.

Symptoms:

Throughout its early course, diabetic nephropathy has no symptoms. Symptoms develop in late stages and may be a result of excretion of high amounts of protein in the urine or due to renal failure:

swelling -- usually around the eyes in the mornings; later, general body swelling may result
foamy appearance or excessive frothing of the urine
unintentional weight gain (from fluid accumulation)
swelling of the legs
poor appetite
nausea and vomiting
general ill feeling
fatigue
headache
frequent hiccups
generalized itching

Signs And Tests:

The first laboratory abnormality is a positive microalbuminuria test. This means you are very likely to develop diabetic nephropathy. Most often, the diagnosis is suspected when a routine urinalysis of a person with diabetes shows too much protein in the urine (proteinuria). The urinalysis may also show glucose in the urine, especially if blood glucose is poorly controlled.

There may or may not be signs of other diabetic complications. High blood pressure may be present or develop rapidly and may be difficult to control. Serum creatinine and BUN may increase as kidney damage progresses.

Treatment:

The goals of treatment are to slow the progression of kidney damage and control related complications. The main treatment, once proteinuria is established, is angiotensin converting enzyme (ACE) inhibitors. This class of drugs reduces urine protein levels and slows the progression of diabetic nephropathy. Many studies have shown that related drugs, angiotensin receptor blockers (ARBs), have a similar benefit. In fact, a combination may be best.

Blood-glucose levels should be closely monitored and controlled. This may slow the progression of the disorder, especially in the very early ("microalbuminuria") stages.

Medications to manage diabetes include hypoglycemic pills and insulin injections. Your blood glucose must be monitored and the dose of insulin adjusted as needed. As kidney failure progresses, less insulin is excreted, so smaller doses may be needed to control glucose levels.

The diet may be modified (see diet for diabetics) to help control blood-sugar levels.

High blood pressure should be aggressively treated with antihypertensive medications. Uncontrolled high blood pressure will worsen kidney, eye, and blood vessel damage in the body. Controlling your high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy. It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity.

Contrast dyes that contain iodine are excreted through the kidney. They may worsen an already reduced glomerular filtration rate, and should be avoided if possible. If they must be used, fluids should be adequate to allow their rapid excretion.

Commonly used non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or Cox-2 inhibitors like Celebrax or Vioxx, may injure the weakened kidney. A physician must always be consulted before using any drugs, but especially these.

Urinary tract and other infections are common and can be treated with appropriate antibiotics.

Dialysis may be necessary once end-stage renal disease develops. At this stage, a

kidney transplant must be considered. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant.

Prognosis:

Diabetic nephropathy continues to get gradually worse. Complications of chronic kidney failure are more likely to occur earlier, and progress more rapidly, when it is caused by diabetes than other causes. Even after initiation of dialysis or after transplantation, people with diabetes tend to do worse than those without diabetes.

Complications:

• hypoglycemia (from decreased excretion of insulin)

• rapidly progressing chronic kidney failure

• end-stage kidney disease

• hyperkalemia

• severe hypertension

• complications of dialysis

• complications of kidney transplant

• coexistence of other diabetes complications

• peritonitis (if peritoneal dialysis used)

• increased infections

Antihistamines, Decongestants, and "Cold" Remedies

2008-11-03T08:48:00.000-08:00

Antihistamines, Decongestants, and "Cold" Remedies

Why Do We Suffer from Nasal and Sinus Discomfort?

The body's nasal and sinus membranes have similar responses to viruses, allergic insults, and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.

Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.

Today Treatment including:

Nasal Saline Sprays: Non-medicated Nasal Sprays

Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming "addicted" to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: contact your otolaryngologist for details.

Nasal Decongestant Sprays: Medicated Nasal Sprays

Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or "getting hooked on nasal sprays." The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant Medications

Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure, and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head, and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate. (Patients with high blood pressure or heart problems should consult a physician before use.) In addition, other medications may interact with oral decongestants causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as "non-drowsy" due to a side effect of stimulation of the nervous system.

Decongestant-combination Products

Some medications are combined to reduce the number of pills. Tylenol® Sinus or Advil Cold and Sinus® exemplify products that join a pain reliever (acetaminophen or ibuprophen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug including side effects.

Antihistamine Medications

Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl®), or clemastine (Tavist®) may be used for relieving allergic symptoms of itching, sneezing, and nasal congestion. They relieve the drainage associated with the allergic inflammation but not obstruction or congestion. Antihistamines have a potential for sedation causing grogginess and dryness after use. Newer nonsedating antihistamines are available.

Antihistamine-decongestant Combination Products

Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them "non-drowsy." The combined allergy product then relieves congestion and a runny nose

Early Treatment For Kid Common Cold

2008-11-03T08:36:00.000-08:00

Early Treatment For Kid Common Cold

In children with early colds, begin acetaminophen or ibuprofen in an appropriate dose on a regular schedule (every 4 hours) during the waking hours.

Other symptomatic treatments may be used if they appear to be helpful. These include:

Topical and systemic decongestants (neo-synephrine, pseudoephedrine); decongestants may cause excitability.
Antihistamine (especially at bedtime). Antihistamine may cause drowsiness.
Mucoevacuants (guafenesin)

Children should never be given aspirin because of the danger of it causing brain damage. (Reyes syndrome)

Antibiotics do not shorten a cold, reduce the severity of the illness, or prevent secondary bacterial complications.

Consider consulting your doctor

If the child develops a "second fever" later in the course of the cold.
If the nasal symptoms and cough are no better or worsen after 10-14 days.

If the child complains of ear pain (or the young child pulls at the ear).

Colsulting On Line Today (October 3, 2008)

2008-11-03T08:26:00.001-08:00

Do you want to consult? Please write your problems at comment bottom of this article. Thanks

DRUG INFORMATION: ALPRAZOLAM

2008-11-03T08:21:00.001-08:00

DRUG INFORMATION: ALPRAZOLAM

Definition

Alprazolam is a triazolobenzodiazepine, that is, a benzodiazepine with a triazolo-ring attached to its structure. Benzodiazepines produce a variety of effects by modulating the GABAA subtype of the GABA receptor, the most prolific inhibitory receptor within the brain. The GABAA receptor is made up from 5 subunits out of a possible 19, and GABAA receptors made up of different combinations of subunits have different properties, different locations within the brain and importantly, different activities in regards to benzodiazepines.

There is some evidence for antidepressant treatment of clinical depression in outpatient settings, evidence for inpatients is lacking; other benzodiazepines are not known to have antidepressant activity.

The main medical uses for alprazolam include:

· Alprazolam is FDA-approved for the short term treatment (up to 8 weeks) of panic disorder, with or without agoraphobia. Alprazolam is very effective in preventing moderate to severe anxiety, essential tremor, panic attacks and other types of convulsive behaviors. Physicians who elect to prescribe alprazolam for longer than 8 weeks should be aware that continued efficacy has not been systematically demonstrated beyond 8 weeks use as tolerance to alprazolam's effects may occur after 8 weeks and necessitate discontinuation or physician-directed dose escalation. However, long-term maintenance therapy on alprazolam is not unheard-of in the medical community, and, if a genuine therapeutic need exists, benefits must be weighed against risks.

· Alprazolam is recommended for the short-term treatment (2-4 weeks) of severe acute anxiety. Alprazolam should only very rarely be used for longer periods of time -- the body becomes rapidly tolerant to the drug's effects, which may translate to decreased efficacy. Decreased efficacy can lead to dose escalation, and the use of high doses puts the patient at higher risk for withdrawal if the drug is discontinued suddenly.

· However, in 1992 Romach and colleagues reported that dose escalation was not a characteristic of long-term alprazolam users, and the majority of patients indicated that alprazolam continued to be effective. A 2003 study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation. In a 1-year follow-up study of patients with panic disorder continuing treatment with clonazepam, 90% maintained a positive response without developing significant tolerance. In a 2.5-year follow-up study of alprazolam therapy, little evidence of tolerance emerged.

Alprazolam is available in English speaking countries under the following brand names. Alprax, Alprox, Alzam, Anxirid, Apo-Alpraz, Azor, Calmax, Gerax, Kalma, Niravam, Novo-Alprazol, Nu-Alpraz, Xanax, Xanor, Zopax

Side effects

Side effects of alprazolam may occur in patients and are more likely the higher the dosage taken. If signs of an allergic reaction occur such as hives, difficulty breathing, swelling of face, lips, tongue or throat occur medical attention should be sought immediately. Medical attention should also be sought immediately if signs of jaundice appear such as yellowing of the skin or eyes. Other side effects which may occur are as follows

· euphoria

· drowsiness

· decreased inhibitions, no fear of danger (increased risk taking behavior)

· depressed mood with thoughts of suicide or self harm or elevated mood and confidence

· hallucinations, agitation and hostility

· feeling dizziness, light headed or fainting

· urinating less than usual or not at all

· headache, fatigue, joint pain and unusual weakness (flu like symptoms)

· speech problems,

· Short term (anterograde amnesia) and concentration problems

· changes in appetite (including changes in weight)

· blurred vision, unsteadiness and clumsiness (impaired coordination and balance)

· constipation, diarrhea, nausea and vomiting

· decreased or increased sex drive

· dry mouth or. more likely, increased salivation

· sweating

· pounding in the chest or rapid heartbeat

· skin inflammation

The Effect of Sleep For Our Heart

2008-11-03T07:43:00.000-08:00

The Effect of Sleep For Our Heart

We are human being, sleep about 8-10 hours per day. What's the effect of sleep for our daily life. Here this some clue from doctor.

“Sleep — through a variety of mechanisms — affects our cardiovascular health,” said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital, who was not involved in the research. The findings show that “sleep not only impacts how we feel, but it may also affect whether we develop heart disease or not.”

Sleep can affect the heart through changes in blood pressure, inflammation, blood clotting, blood sugar, cholesterol and blood vessels, Mosca said. She suggested that anxiety from changes in routine may also be a factor, in addition to loss of sleep.

Dr. Ronald Chervin, director of the University of Michigan’s Sleep Disorders Center, said this is a “sleep-deprived society,” and he advises taking advantage of Sunday’s time change and getting an extra hour of sleep.

In the spring, he suggests gradually adjusting to the one-hour loss by going to bed and getting up 15 minutes earlier for a few days before the time change.

“We spend a third of our lives sleeping and people forget how much effect it has on overall health,” he said.

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