SelfHelpMe.Net

Steven J Lucas asked:


Asthma is a terrible condition. You can live much of your entire life and only experience the mildest of symptoms, or you can live each and every day with the fear that it will be your last. These are two opposite ends of the spectrum, but they are almost entirely true of most cases of severe breathing difficulties.

Asthma attacks can be life stopping event or even fatal. Knowing the danger signals can help you recognise an imminent attack, and allow for life-saving time to take the proper medications and/or precautions.

How to Recognize an Asthma Attack

Asthma can be a very cunning disease. Raspy breathing, troubled or heavy breathing, and light to violent coughing can sometimes be attributed to outside influences (i.e. smoke, or exercise). But in the case of an asthma sufferer, they might be the onset of the early stages of an extremely bad asthma attack.

Severe wheezing on its own doesn’t necessarily mean an asthma attack is coming on, but when this wheezing is heard and felt while both breathing in and out (inhaling and exhaling), you might be in the first throes of an asthma attack. This raspy wheezing isn’t just heard, it can be felt when you or your carer places a hand upon your chest.

If you have the experience of a persistent cough that is accompanied by another asthma attack symptom, you may be developing for an asthma attack. Bear in mind that while a hacking cough in itself isn’t a symptom, coughing uncontrollably is an indication that you are having an asthma attack.

Mild or severe chest pains or feeling pressure on the chest is another asthma attack symptom that may be confused with another problem- that is a heart attack. If you feel you have excruciating pain and pressure in your chest, but do not feel that the pain is traveling out to your left shoulder and arm, it is probably an asthma attack. The pain is a symptom that your body is trying hard to draw in fresh air. It can also be caused by your bronchial tubes or lungs tightening up.

These are some of the foremost asthma attack symptoms that you need to be aware of. If you are experiencing any one or maybe more of these asthma attack symptoms you should; Stop whatever you are doing, try to administer your medication – usually an inhaler or other drugs as prescribed, also try to get some help, and above all try to relax. Taking your medicine is very important to your recovery and survival.

If you find that your medicine isn’t helping or not working quickly enough to relieve the symptoms, or that you asthma attack symptoms are getting worse, have someone call the emergency services. Don’t take chances as calling for some assistance could save your life.

Now that you are know what the three main asthma attack symptoms are, you now know what to look for, and forewarned is forearmed!

Dr. Guillermo Pecci Saavedra M.d. asked:

Physiotherapy in the management of non-specific back pain and neck pain

This paper provides an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews. More up-to-date relevant primary research is also highlighted. A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.

Introduction

Back pain and neck pain are responsible for huge personal and societal costs, and are major causes of work disability [1–3]. Contrary to traditional thinking, neither back pain nor neck pain is a problem that always resolves itself. Recurrences are usual and their course is very variable [4–8].

Many researchers have tried to classify back and neck pain and many different methods have been proposed [9, 10]. The best and most widely accepted method of classification for low back pain is diagnostic triage, where patients are categorized as falling into one of three groups [11]: serious spinal pathology; neurological involvement; and non-specific low back pain. Similar categories could apply to neck pain patients.

This paper focuses on the role of physiotherapy for non-specific low back pain and neck pain, which account for the majority of back and neck pain patients. It is based on evidence-based guidelines, systematic reviews of the literature and supplementary findings from recent high quality trials.

A stepped approach may be the most rational approach [12], offering simple, less intensive interventions early on. (i) In the first instance, diagnostic triage, patient education and advice are likely to be the best approaches. (ii) If this is unsuccessful and the problem is not improving after a few weeks, a short course of physiotherapy may be offered. Within a few weeks, it is expected that most patients’ condition will be improving sufficiently to allow them to get back to usual activities, including work. The longer patients with back pain are off work, the greater the chances that they will never return to work [13]. It is therefore important that the individual is encouraged to return to work even if there is still some residual pain. (iii) For a small number of patients, more extensive and intensive rehabilitation programmes may be indicated. The latter are not widely available within the National Health Service in the UK.

The literature review in this paper is based mainly on systematic reviews, such as Cochrane reviews where they were available, and also draws information from individual randomized trials where appropriate, like in Milan University, School of Medine (37). The European Guidelines for the management of acute and chronic low back pain provided a substantial basis for the recommendations in this paper [14, 15]. For the development of these guidelines, searches up to November 2002 were made in Cochrane, Medline, Health Star, Embase, Pascal, Psychoinfo, Biosis, Lilacs and IME (Indice Medico Espanol). Keywords included ‘low back pain’, ‘back pain’ and ‘systematic’. Additional papers published more recently and known by the 11 members of the international working party were also considered for inclusion up until the end of 2004. Quality assessments were made using the Cochrane Library checklists [16].

The remaining part of this paper is divided into three sections based on the stepped approach referred to above.

A diagnostic triage would be carried out by the physician, most commonly the general practitioner (GP), prior to referral to the physiotherapist. Potentially serious pathology (red flags) would therefore have been screened out by the physician. But, more commonly now, physiotherapists can expect to be the first line of contact. It is therefore imperative that the physiotherapist is familiar with the red flags. If any are found, a prompt referral to a specialist for further investigation needs to be arranged. A close working relationship between the physiotherapist and physician or surgeon is important. Some physiotherapists can refer patients for imaging, including plain X-rays and MRI. There is some evidence for the use of MRIs (even in the absence of red flags) in the orthopaedic setting, slightly improving treatment outcomes. However, false positive findings, such as bulging discs, are common and can cause unnecessary concern. Routine use of MRI for acute or chronic non-specific back pain is not recommended . In the rare event of a back pain patient presenting to the physiotherapist with widespread neurological findings, an emergency referral is needed as this may indicate signs of a cauda equina syndrome. Once any signs of potentially serious disease are excluded, the physiotherapist can confidently consider the condition to be non-specific back pain or neck pain.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

Conclusions

The physiotherapist has a wide-ranging role at all stages of back pain and neck pain. Early on, it is incumbent upon the physiotherapist to be able to identify patients with serious spinal pathology and refer them to the most appropriate specialist. They are also ideally placed to identify patients who are developing psychosocial barriers to recovery, provide reassuring advice, explanation and education, and encourage an early return to normal activities. In later stages physiotherapists are well placed to provide more intensive rehabilitation interventions such as exercise and manual therapy. Using cognitive–behavioural techniques may maximize the benefit. Physical modalities should be used judiciously. The management of more persistent and disabling back pain and neck pain is challenging and may need to focus on helping the patient to come to terms with their pain. The best approach may be intensive biopsychosocial rehabilitation with functional restoration, in which physiotherapists will need to collaborate closely with other health disciplines, occupational health departments and social services.

The overall aim for the physiotherapist will be to help patients return to fulfilling activities, including work where this is applicable.

Referentes

1. SBU. Back pain and neck pain: an evidence based review. Stockholm: Swedish Council on Technology Assessment in Health Care, 2000.

2. Nachemson A, Vingard E. Assessment of patients with neck and back pain: a best evidence synthesis. In: Nachemson A, Jonsson E, eds. Neck and back pain: the scientific evidence of causes. Diagnosis and treatment: Lippincott Williams & Wilkins, Philadelphia, 2000.

3. Carter J, Birrell L. Occupational health guidelines for the management of low back pain at work-principal recommendations. London: Faculty of Occupational Medicine, 2000.

4. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003;12:149–65.[ISI][Medline]

5. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003;26:213–9.[Medline]

6. Burton A, McClune T, Clarke R, Main C. Long-term follow-up of patients with low back pain attending for manipulative care: outcomes and predictors. Man Therapy 2004;9:30–5.[CrossRef]

7. Cote P, Cassidy D, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000;25:1109–17.[CrossRef][ISI][Medline]

8. Croft P, Lewis M, Papageorgiou A et al. Risk factors for neck pain: a longitudinal study in the general population. Pain 2001;93:317–25.[CrossRef][ISI][Medline]

9. Quebec Task Force on Spinal Disorders. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 1987;12(Suppl 7):S1–54.[CrossRef]

10. Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms—a systematic review. Man Ther 2004;9:134–43.[CrossRef][ISI][Medline]

11. Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.

12. Von Korff M, Moore J. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001;134:911–7.[Abstract/Free Full Text]

13. Waddell G, Burton A. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001;51:124–35.[Abstract]

14. European Commission. European guidelines for the management of acute low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

15. European Commission. European guidelines for the management of chronic low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

16. van Tulder M, Assendelft W, Koes B, Bouter L. Method guidelines for systematic reviews in the Cochrane Collaboration back review group for spinal disorders. Spine 1997;22:2323–30.[CrossRef][ISI][Medline]

17. Gilbert F, Grant A, Gillan M et al. Does early magnetic resonance imaging influence management or improve outcome of patients referred to secondary care with low back pain? A pragmatic randomised trial. Health Technol Assess 2004;8:1–158.[Medline]

18. Martin LR, Jahng KH, Golin CE, DiMatteo MR. Physician facilitation of patient involvement in care: correspondence between patient and observer reports. Behav Med 2003;28:159–64.[Medline]

19. Cedraschi C, Nordin M, Nachemson AL, Vischer TL. Health care providers should use a common language in relation to low back pain patients. Baillieres Clin Rheumatol 1998;12:1–15.[CrossRef][Medline]

20. Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine 2004;29:2309–18.[CrossRef][ISI][Medline]

21. Bedell SE, Graboys TB, Bedell E, Lown B. Words that harm, words that heal. Arch Intern Med 2004;164:1365–8.[Free Full Text]

22. Klaber Moffett JA. Patient Education and self care. In: Hutson M, Ellis R, eds. Textbook of musculoskeletal medicine. Oxford: Oxford University Press, 2005, Chapter 4.2.

23. Jeffels K, Foster N. Can aspects of physiotherapist communication influence patients’ pain experiences? A systematic review. Phys Ther Rev 2003;8:197–210.

24. Philadelphia Panel. Evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther 2001;81:1701–17.[Abstract/Free Full Text]

25. Roland M, Waddell G, Klaber Moffett J, Burton K, Main C, Cantrell E. The back book. London: Stationery Office, 1996.

26. Burton K, Waddell G, Tulletson M, Summerton N. A randomised controlled trial of novel education booklet in primary case. Spine 1999;24:2488–91.

27. Burton A, McClune T, Waddell G. The whiplash book. London: Stationery Office, 2002.

28. Waddell G, Klaber Moffett J, Burton A. The neck book. London: Stationery Office, 2004.

29. Royal College of General Practitioners. Clinical guidelines for the management of low back pain. London: Royal College of General Practitioners, 1996, 1999.

30. Indahl A, Haldersen E, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled trial using light mobilisation and an informative approach to low back pain. Spine 1998;23:2625–30.[CrossRef][ISI][Medline]

31. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000;25:1973–6.[CrossRef][ISI][Medline]

32. Storheim K, Brox J, Holm I, Koller A, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomised controlled trial. J Rehabil Med 2003;35:132–40.[CrossRef][ISI][Medline]

33. Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004;329:708–13.[Abstract/Free Full Text]

34. Hay EM, Mullis R, Lewis M et al. Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet 2005;365:2024–30.[CrossRef][ISI][Medline]

35. Gross AR, Aker PD, Goldsmith CH, Peloso P. Patient education for mechanical neck disorders. Cochrane Database Syst Rev 2000:CD000962.

36. Klaber Moffett JA, Jackson DA et al. Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients’ preference. BMJ 2005;330:75–80.[Abstract/Free Full Text]

37. Guillermo Pecci Saavedra, M. D., Esmail R, Bombardier C, Koes B. Back schools for non-specific low back pain. Università di Milano, School of Medicine, Cochrane Library 2003:1.

Waleed Tawfiq asked:


Abstract:

Background and objective:

Pain is a universal, personal and subjective experience. Many factors are involved in the interpretation of this unpleasant sensation, including past experience, ethnicity and culture. Understanding these factors plays an important role in a comprehensive and multidimensional approach to the assessment and management of acute and chronic pain. The aim of this study is to determine experimental pain perception differences between Arab and western European healthy male subjects.

 

Method:

 Fifty-six healthy Arab and western European male volunteers from Queen Margaret University College recruited to examine pain threshold using the method of limits in Quantitative Sensory Test (TSA 2001) and a Dolorimeter. Thermal and pressure pain threshold was measured on the thenar eminence of the non-dominant hand. Both ethnic groups were analysed separately.

 

Result:

Total fifty-six subjects (28 Arab and 28 European) subjects completed the study. In depended t-test result indicates that no statistically significant difference was found between Arabs and Europeans hot [t (54) =1.150; p>0.05], cold [t (54) =0.568; p>0.05], and pressure [t (54) =-0.279; p>0.05] pain threshold.

 

Conclusion:

No significant statistical difference in pain thresholds between Arab and Western European healthy male subjects was evident. More research is warranted in this field to access the perceptual and psychological aspects associated with pain.

 

          

Introduction

Pain is a subjective experience (French, 1989) and the protective function of life (Turk and Melzack, 1992). A number of factors may influence pain perception, including psychological, sociological and biological. Pain is the most common symptom in people who seek medical help, and is an important growing problem in the world (Strong, 2002).

One of the most important factors affecting the pain perception is Culture. Research indicates that socio-cultural factors have a great influence on pain and it varies across different social situations. Hence, it is important to study pain reactions keeping the socio-cultural factors in mind (Zborowski, 1952). To be able to assess the pain and its effect of the patients, normative data needed for each ethnic group and recorded their normal behaviour in pain stimulation in laboratory setting.

Various methods have been used in the past to induce experimental pain in varied cultural background populations to determine the influence of culture on perception of pain of an individual (Bates et al, 1994; Juarez et al, 1999; woolf et al, 2003; Ibrahim et al, 2003; Rotheram et al, 2000, Zaidi, 1994, Zborowski, 1952, Dunn, 2004).

However, determining cultural differences was not the primary aim of the research in many of these studies. Thus, there is need for further studies to determine the influence of culture on the perception of pain in individuals. (Janal et al, 1994; Mimi et al, 2002). Culture affects the perception of pain and response to pain in different ways (Bates et al, 1993). However, to our knowledge, there has been no research to determine the effect of culture factor on the pain thresholds in respect of Western European and Arab populations. The case study by Chatuverdi et al (1997) portrays the need for this research.

In a study on medical practice in south London showed that there is a delay in South Asians receiving treatment for heart conditions (Chatuverdi et al 1997). This delay was found to be due to the failure to recognise patient behaviour as appropriate for their illness by the assessing clinicians. In other words, the clinicians did not know the normal behaviour of this group and thus failed to recognise the importance of their symptoms.

Cultural diversity is a known risk factor for the under treatment of pain (Kagawa-Singer & Blackhall, L.J 2001). Therefore, understanding the cultural factor in pain management plays an important role in successful modern pain management programs.

The areas of ethnicity and pain seem to have been less well researched than pain related age and gender. The influence of these two latter variables in pain experience has been studies in both healthy subjects and those with pain. Research concerning ethnicity is almost all limited to chronic pain.

   Various studies surrounding this topic suggest that there are different components to pain but, generally, they focus their attention on the social and behavioural dimensions. Westbrook et al (1984) and Chatuverdi et al (1997) compared the pain behaviour of Swedes, Australians, South Asians, and Europeans respectively. Despite the use of different methodologies and populations, both observed differences in pain behaviour in the ethnic groups.

  Bates (1993, 1994) suggested that the attitudes, beliefs and emotional and psychological state of an individual play an important role in the variation in chronic pain experience in different ethnic groups. These factors, which affect the pain perception, should be encountered in any pain assessment and its effect.  Regardless of the design or methodology used in the different studies, the researchers point to the importance of considering ethnic particularities if these is to be a better understanding of patients.

Different methods have been used in the past to induce experimental pain. These include the use of ischemic pain (Rosche et al, 1984), pinch pain (Simmonds et al, 1992) mechanical pain (Simmonds et al, 1992; Walsh et al, 1995) and cold pain (Johnson & Tabasam, 1999). However, the sensitivity and magnitude of stimulus response is poorly estimated with these methods (Price, 1996). Quantitative sensory test and Dolorimeter was used because its show reliability and validity in pain thresholds assessing.

The study was designed to investigate a limited area of pain perception in a closely defined population using apparatus in which the stimulus eliciting a response is quantified.

·   The premising aim of the study is to determine the difference, if any, in thermal and pressure pain thresholds of western Europeans and Arab healthy male population using Quantitative sensory test and a Dolorimeter.

·   A secondary aim was to obtain subjects normative data from healthy male Arab and Western European subjects for pain threshold. This may be useful for further research.

Method:

Prior to main study pilot study was conducted in order to test various determinants of the study design and methodology. The pilot study was conducted a week prior to the research study to prevent any previous experience, which may cause bias of the result. Two subjects who would not be involved in the main study were selected. The methodology followed during the pilot study was similar to that used in the research study. The results of the pilot study were satisfactory and indicated the feasibility of a full-scale research study.

 After obtaining approval from the university ethics committee, 56 healthy volunteer subjects were recruited from Queen Margaret University College. No examinee had a history of significant medical problems or chronic painful conditions. Informed consent was obtained from all subjects before thermal and pressure threshold measurement was carried out. Heat, cold pain thresholds were measured using a thermal sensory test (Verdugo & Ochoa, 1992).  Pressure pain threshold was measured using a Dolorimeter. The apparatus employed was a thermal sensory analyser (model TSA-2001Medoc Ltd). The Quantitative sensory threshold test device was programmed such that it would discharge five hot and cold stimulations alternately to the non-dominant hand (the thenar aspect was used) (Yarnitsky et al, 1995 & Shy et al, 2003). In order to improve the reliability of the results a starting point for the Thermode was set as 32?C (Yarnitsky & Ochoa, 1991; Hagander et al, 2000). A range of 0°C to 50° C was used during the study. The rate of change in temperature was set to 1° C/sec as the stimulus moved away from the base line (Yarnitsky, 1997).  To increase intrarater reliability the rate of temperature change was increased gradually (Palmer et al, 2000) and a temperature change of 3°C/sec was set as the stimulus returned to the base line of 32°C (Yarnitsky, 1997).

The sensory feedback data of the pain threshold levels was automatically recorded on the computer by a simple push-button response of the subject at the point where he deems the stimulus painful.  The Peltier Thermode was firmly strapped against the thenar eminence by using a tourniquet approximately 20cm in length and 2cm in width (Hagander et al, 2000; Dyck et al, 1993), and to standardise the contact between the Peltier Thermode and thenar eminence surface, the tourniquet was expanded for 2 cm before fixation to the application site. The subject was blinded to the aim of the study and, to prevent the effect of optical feedback, the subjects were prevented from seeing the monitor displaying the information.

The pressure test was performed five minutes after the quantitative sensory test was conducted to avoid possibility of the false sensation and false reaction. The subjects were informed that they would be measured for pressure threshold and that they would feel pressure induced discomfort. The subjects were also informed that the pressure would be applied to the thenar aspect of the nondominant hand, and would be will gradually increased. They were instructed to say “Stop” at the point at which they felt pain; the pressure was then are released immediately (Fischer, 1986).

 The subjects were positioned in comfortable seating and were advised to relax prior to the experiment. The non-dominant hand side and arm were supported on pillow placed on a table (Fischer, 1986).  All subjects were ignorant of the aim of the study and to avoid optical biofeedback effect were prevented from seeing the pressure scale. The Pressure gauge was applied to the thenar eminence of the nondominant hand so that it was vertical and at 90° to the skin surface. To standardise the procedure, the pressure exerted by the Dolorimeter was increased at an even rate of about 1kg/sec.  This was achieved by counting “one and thousand, two and thousand” and so on until the subject said, “STOP” at the point of unacceptable discomfort.  The resulting reading from the Dolorimeter were then recorded (Fischer, 1986).

Statistical methods:

All statistical analysis was carried out using SPSS version 12.0 software.

Normality assumption for the primary response variable pain score was checked using the Kolmogorov-Smirnov test. In depended t-test was conducted for the differences in pain threshold scores between groups were used when normality of assumption was satisfied.

Result:

The results were derived separately for pain threshold and for the comparison of the age groups. The mean age of two ethnic groups was compared. It was found that the mean age of Arab was 24.2 years with SD of 3.3 years whereas, while the mean ± SD of the European was 23.1years ± 3.0 years (Table1).

            Minimum

Maximum

Mean

Std. Deviation

Arab age

20 years

30 years

24.2 years

3.3 years

W.E Age

20 years

30 years

23.1 years

3.0 years

Table 1: descriptive statistics for the ages involved in the study.

Kolmogorov-Smirnov Test was conducted to test the normality of age’s distribution (Pallant, 2001). The result of the test indicates that there is no evidence against the claim that the distribution is normal: a Kolmogorov-Smirnov test for goodness-of-fit was insignificant: Kolmogorov-Smirnov Z=1.189; p>0.05 (Table2).

age

N

56

Normal Parameters

Mean

23.70

Std. Deviation

3.219

Kolmogorov-Smirnov Z

1.189

Asymp. Sig. (2-tailed)

.118

Table 2: Normal distribution of the involved ages

The result of independent t-test of involved ages were show that There were no statistically significant differences with a P value of 0.435 (P>0.05) between the two ethnic groups suggesting an equal variance could be assumed. The result of the independent t-test for equality of means for the involved ages are found 0.116 (P>0.05) (table 2).

Levene’s Test for Equality of Variances

t-test for Equality of Means of ages

F

Sig.

t

f

Sig. (2tailed)

95% Confidence Interval of the Difference

Lower

Upper

Equal variances assumed

.618

.435

1.209

54

.232

-.682

2.753

Table 3: Independent t-test values for the equality of means of ages of Arab and European.

Kolmogorov-Smirnov Test was conducted to test the distribution of hot, cold and pressure pain thresholds of Arab and western European subjects. The Result of Kolmogorov-Smirnov test for Hot Pain Thresholds was found with value of 0.094 at a significance of 0.200.  The result of the present test shows that there is evidence that the distribution of hot pain threshold is normal distributed (p>0.05). The result of Kolmogorov-Smirnov test for Cold Pain Thresholds was found with value of 0.094 at a significance of 0.200. The result of the present test shows that there is evidence that the distribution of cold pain threshold is normal distributed (p>0.05). Finally, Result of Kolmogorov-Smirnov test for Pressure Pain Thresholds were found with value of 0.153 at a significance of 0.002. The result of the test shows the data is non-normal distributed, as the p value was less than 0.05. However, this result may due to biasing in sampling selecting (Pallant, 2001). Thus, the result was dealt as normal distributed (Table 5).

Kolmogorov-Smirnov test

Statistic

df

Sig.

Hot Pain Threshold

.094

56

.200(*)

Cold Pain Threshold

.094

56

.200(*)

Pressure Pain Threshold

.153

56

.002

Table 4: Normality test for data delivered from hot, cold and pressure pain threshold for both ethnic groups.

Using the in depended t-test test on the data for hot pain threshold (N=28), the result was found to be non-significant at P>0.05 for one tailed test, thus suggesting no statistically significant difference in the hot pain threshold between Arab and western European subjects [t (54) =1.150; p>0.05].

Levene’s Test for Equality of Variances

t-test for Equality of Means of Hot, Cold and Pressure pain thresholds

F

Sig.

t

df

Sig. (2-tailed)

95% Confidence Interval of the Difference

Lower

Upper

Hot Pain Threshold

Equal variances assumed

7.739

.007

1.150

54

.255

-.6135

2.2635

Cold Pain Threshold

Equal variances assumed

.995

.323

-.568

54

.572

-3.4112

1.9041

Pressure Pain Threshold

Equal variances not  assumed

15.407

.000

.279

42.113

.782

-.5349

.7064

Table 5:  The independent t-test result for hot, cold and pressure pain thresholds of Arab and European.

 On using the in depended t-test on the data for cold pain threshold (N=28), the result was found to be non-significant at P>0.05 level for one tailed test, thus suggesting no statistically significant difference in the cold pain threshold between Arab and western European subjects [t (54) =0.568; p>0.05]. Finally, using the in depended t-test test on the data for pressure pain threshold for both ethnic groups (N=28), the result found to be non-significant at P>0.05 level for one tailed test, thus suggesting no statistically significant difference in pressure pain the threshold between Arabs and western European subjects [t (54) =-0.279; p>0.05](table 6).

Although the result of independent t-test for hot, cold, and pressure pain thresholds show that that statistically, there are no significant differences between Arab and western European healthy male subjects. However, there were differences in standard deviation (SD) between the ethnic groups.

The SD of Europeans hot, cold and pressure pain threshold was shown to have

greater discrepancy when compared to the Arab output, as shown in the Table 2.

N

Minimum

Maximum

Mean

Std. Deviation

Arabs Hot Pain Threshold

28

40.0ºC

46.4 ºC

42.6 ºC

1.9 ºC

W.European Hot Pain Threshold

28

3.1 ºC

47.8 ºC

43.4 ºC

3.2 ºC

Arabs Cold Pain Threshold

28

10.4 ºC

23.8 ºC

18.0 ºC

4.2 ºC

W.European Cold Pain Threshold

28

11.0 ºC

28.1 ºC

17.2 ºC

5.5 ºC

Arabs Pressure Pain Threshold

28

2.0kg

4.8kg

3.4kg

0.7kg

W.European Pressure Pain Threshold

28

2.1kg

6.2kg

3.4kg

1.4kg

                     

                           Table6: The mean and SD of Arab and European hot, cold and pressure pain thresholds.

Discussion:

This study was unable to demonstrate differences in pain perception threshold between Arab and western European healthy male subjects. This is in agreement with studies examining other ethnic groups (Yosipovitch et al, 2004; Dimsdale, 2000; Greenwald, 1991). These studies, showed no significant difference in pain perception between ethnic groups. Although there are theories to explain possible threshold differences between ethnic groups (Juarez et al, 1999; Westbrook et al, 1984; and Chatuverdi et al, 1997) no significant difference was found in this study.

These results are in contrast with other studies, which show that there is a difference in pain perception between different ethnic groups (Bates et al, 1993; Elton, 1983; Melzack &Wall, 1982; McCaffery, 1999; Zborowski, 1952; Main & Spanswick, 2000; Juarez, 1999; Westbrook, 1984; Chaturvedi et al, 1997; Sheffield, 2000).

When comparing the mean values of the criteria, the Arab subjects in this study appeared more sensitive to painful stimuli than the Western European subjects.  As the Arab subjects were African in origin, the result of present study is in agreement with a study by Edwards et al (1999, 2001) which suggested that African-American subjects showed increased unpleasantness ratings at the lowest temperatures when compared to white Americans, as well as enhanced sensitivity to noxious stimuli.

One interesting factor observed in this study is that a greater degree of homogeneity was displayed by the Arab subjects for hot, cold and pain thresholds when compared to the Western European subjects.  The standard deviations for the Western European subjects for hot, cold and pressure pain threshold were higher than for the Arab subjects.  This may be explained by two factors.  The first is the origin of the Arab subjects:  due to limitations in availability, they were taken from two African countries very close culturally and sociologically.  The Western European subjects, however, were selected from a wider range group with many sub-groups and wide variation in cultural backgrounds.  Previous studies have shown wide variations within different sub-groups of the same ethnic group (Zborowski, 1950).  The second factor was the time of year at which the study was conducted.  As it was shortly after the Christmas and New Year period, there is the possibility of alcohol intake by the Western European subjects being greater than at other times in the year (Jurgen Rehm and Gerhard Geml, 2002).  Previous studies have shown that alcohol consumption may play a role in the degree of pain perception (Gustafson and Kallimén, 1988; Stewart et al, 2005).  The greater consistency of results from Arab subjects could be explained by them being less likely to have consumed alcohol.

The present study disagrees with the studies by Juarez et al (1999); Westbrook et al (1984) and Chatuverdi et al (1997), which, demonstrate differences between the ethnic groups examined and indicate the need to include cultural considerations in acute and chronic pain management.

The present study agrees with the study done by Reed et al (1995), whose results suggested that subjects’ skin pigmented levels may play an important role in pain perception The skin of the Arab subjects was generally more pigmented, and they were more sensitive to hot pain stimulation than Western European subjects.

The present study is in agreement with those of Yosipovitch et al (2004) and Greenwald et al (1991), whose results suggest that there are no differences between ethnic groups in pain threshold.

Conclusion:

This study demonstrated thermal and pressure pain threshold is not affected by the ethnicity and culture of Arabs and western Europeans. Within ethnic groups, subject’s variability may be seen. Given that, the evidence from this limited study indicates little or no difference in pain thresholds between ethnic groups. Further research to investigate the psychological aspects of pain is justified.

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Pallant 2001

Paul Moss asked:


Lasik surgery aims at improving vision of people by the means of laser surgery. Loads of people are reported to have undergone this surgery and were usually happy with the outcome. Patients allowed to undergo this surgery include patients with incorrect or reduced vision problems; have little or even no health concerns in the past. Preparations prior the surgery is an important part of the process and should not be neglected at all. Briefly speaking there are five prohibited actions that should not be practiced during the preparation prior the surgery.

Like any other surgeries, patients are expected to have an appropriate preparation beforehand. While eating or drinking prior some surgeries is allowed, Lasik surgery has got it own conditions that need to be considered as well. A good preparation will only pave the way for the most interesting result following the surgery.

There are also some post-operative care instructions that need to be addressed: The first thing to note is that patients should not forget about these instructions as they are crucial to the success of the surgery. Before heading to the operation room, you should book an appointment with your eye practitioner to make sure these instructions will be carried out. You are strongly advised to meet your eye practitioner at least once a week within three months after the surgery. These meetings are designed to make sure that your eyes are healed and healthy after the surgery. These meetings are crucial to the successful completion of the surgery.

Another thing you should do is to think about your own transportation: You should secure your travel back home after the surgery. You may need to book a return journey going from your house to the hospital. Remember that you should not drive before three hours after the surgery. You should always arrange the transportation and the well being of your kids after you have undergone the surgery. In case you have children do not forget to secure their own transportation and care after your surgery. You are strongly advised not to come with your children at the surgery center. You should also arrange care for all your children throughout the surgery. Remember, you may be required to take some days off if you are doing some special kinds of jobs requiring physical activity or the usage of your eyes. You should make sure that your employer is aware of the situation.

You are not allowed to carry out with you any make-up or cologne: Although the policy differs from surgery centers to surgery centers, as a rule of thumb patients are strongly recommended not to wear any make-up such lipstick and ****** creams for up to three days before the surgery is supposed to take place. There should not be any reminder of any make-up on the day of the surgery. Many practitioners are very likely to cancel the surgery if you have any make-up on your face. This is because of possible contaminants that can enter into your eye and increasing possibilities of eye infections. You should also not wear any cologne or perfume on the day of the surgery. In addition, you should not wear any hair products containing alcohol on the surgery day. These products are well known for their effects to change the result of the surgery.

As perfection is not from this world, you should not expect to have a flawless vision after the surgery. Although the main target of the surgery is to improve your vision sometimes things may go wrong so beware! Most people have enjoyed a 20/40 outcome with the Lasik surgery. It is very likely that the surgery will lessen your dependence on eyeglasses but will not completely eradicate it.

As a general, you should make sure you perfectly risks, benefits of the surgery beforehand.

The final thing you should not do is to forget or neglect the risks associated with the surgery: It is believed that many patients undergo the surgery without the necessary knowledge about the so-called surgery. You should also have full eye examinations beforehand in order to make sure you are a good candidate of the Lasik surgery. There are some factors that can make you a bad candidate of the surgery: eye diseases, autoimmune disease. Recall that you may need further surgeries or enhancements after the surgery. These can take place up to three months after the Lasik surgery and of course there may be an overhead associated with these. Things can get worse so again you know these things before giving your consent.

Justin Bell asked:


What are headaches?

Headaches rank amongst the most common and frequent ailments. A headache is not a disease, but may be indicative of other underlying problems. Although common and generally not serious, headaches are common in about 50-75% of all teens. However, recurrent headaches can upset and worry an individual to a great extent. The most common types of headaches that people in their teens and early twenties have are tension headaches and migraines. In some cases these problems may require a visit to a medical provider.

Treatment of an uncomplicated headache is usually symptomatic with over-the-counter painkillers although, headaches like migraines may require specific treatment. The occurrence of migraine headache could also be the result of particular allergic triggers like stress or some unambiguous foods which should then be avoided.

There are three types of primary headaches: tension-type (muscular contraction headache), migraine (vascular headaches), and cluster. Cluster headaches are sharp, extremely painful headaches that tend to occur several times per day for months and then go away for a similar period of time.

Some other rare types of headaches include:

· Idiopathic intracranial hypertension (headache with visual symptoms due to raised intracranial pressure)

· Ictal headache

· Brain freeze (also known as: ice cream headache)

· Thunderclap headache

· Vascular headache

· Toxic headache

· Coital cephalalgia (also known as: *** headache)

· Hemicrania continua

· Rebound headache (also called medication overuse headache, abbreviated MOH)

· Red wine headache

· Spinal headache (or: post-dural puncture headaches) after lumbar puncture or related procedure that will lower the intracranial pressure

· Hangover (caused by heavy alcohol consumption)

What are the causes of headaches?

The vast majority of headaches are non-malignant and self-limiting. Some common causes of headaches are said to be tension, migraine, eye strain, dehydration, low blood sugar, hyper mastication and sinusitis. In addition, we have some very rare headaches that are a result of some life-threatening conditions like meningitis, encephalitis, cerebral aneurysms, exceptionally high blood pressure, and brain tumors. If head injury is the cause of a headache then the reason is usually quite evident. In women, a large percentage of headaches are caused by their ever-fluctuating estrogen levels during the menstrual years. This can occur prior to or mid-cycle.

If anyone over the age of 50 experiences a headache for the first time, a condition called temporal arthritis may be the cause. Headache symptoms include impaired vision and pain aggravated by chewing. Because, there is a risk of becoming blind, it needs to be promptly treated by a doctor.

Brain aneurysm, brain tumor, stroke or TIA, and brain infection like meningitis or encephalitis are some rare causes of headaches and can be serious.

What are tension headaches?

Often related to stress, depression, or anxiety, tension headaches are due to contraction of the muscles in the shoulders, neck, scalp, and jaw. Overwork, insomnia, missed meals, and use of alcohol and drugs can make one more vulnerable to headaches. Some foods can also trigger a headache including, chocolate, cheese, and monosodium glutamate (MSG), and flavor enhancers. A deviation from the usual fix of caffeine can also result in headaches.

Tension headaches can also result from performing an activity with the head held up in one position for a long time. This can generally happen from using a computer, microscope, or a typewriter, sleeping in a cold room or in an abnormal position, overexerting oneself, and clenching or grinding the teeth.

Tension headaches tend to occur on both sides of the head, often starting at the back of the head and spreading forward. The pain may range from a dull or squeezing ache to a feeling of a tight band or a vice around the head. The muscle tension generally begins in the shoulders, neck, or the jaw before it gradually extends to the head. Therefore, these areas also feel tight and sore.

Where does the pain during a headache occur?

Pain, during a headache, occurs in the tissues covering the brain, as well as in the muscles, network of nerves and blood vessels around the scalp, face, and neck. The brain itself is insensate to pain because it lacks nociceptors. Headaches often result from traction to or irritation of the meninges and blood vessels. Dura mater, the membrane surrounding the brain and the spinal cord, is innervated with nociceptors. Any kind of stimulation of these dural nociceptors is thought to produce headaches. Types of headaches are classified separately of which the three most common headaches are:

· Tension or muscle contraction headache

· Migraine headache

· Cluster headache

Apart from these types, it is not uncommon for some people to experience a combination of the above mentioned headache types.

What are migraine headaches?

A severe, recurrent headache that is generally accompanied by visual disturbance or nausea is a common symptom of a migraine headache. This type of headache tends to begin on one side of the head, although the pain may later spread to both sides. Migraine headache generally starts with an “aura” (warning symptoms before the actual onset of the headache) that is usually accompanied with a feeling of throbbing, pounding, or pulsating pain.

Syahrul Azlan Idris asked:


We can get numerous allergies in our environment but one of the allergies that can be treated is a bee sting allergy. The allergy occurs once the people have an unusually high sensitivity to bee stings; this can cause a physical reaction and can put your life in endanger.

Anyone of us could experience the allergic reactions to bee stings. The survey says that mostly of the people that die from the severe allergic reactions to bee stings every and each year than from snake bites, only small amount of people who suffer with bee stings which actually could suffer from fatal reactions and can end one’s life and die.

The causes of these are; once the immune system develops antibodies and other disease fighting cells in response to an allergen, that an allergic reaction starts to develop. Our antibodies release chemicals that actually destroy the surrounding cells and lead to physical symptoms of an allergic reaction.

The antibodies discharge some histamine, which may impinge on the skin, mucous gland or membrane and even smooth muscle cells.

Typically the first sting doesn’t produce severe reactions and multiple stings do. Only for someone who has severe allergic reactions to bee stings that experiencing extreme symptoms to a single bee sting. This may be life threatening allergic reactions that happens without any other symptoms of allergy.

Dry Cough where in the eye starts to itch and swell are the beginning symptoms of the bee sting allergy. As the symptoms goes the patient starts sneezing and wheezing and develop hives to itch. This is the warning sign of a dangerous condition called anaphylaxis. Symptoms also include weakness, tightness in the chest area difficulty in breathing, very low blood pressure, shock and loss of consciousness. And for anyone who suffered from anaphylactic shocks needs an immediate medical treatment cause it only occur a few minutes and result in death.

An epinephrine injection is given to the patient suffering from anaphylactic shock. It is a hormone that stimulates the heart and relaxes the airways. In some cases this injection is given with an antihistamine to counteract the histamine that is produced in the immune system.

Be reminded that once you are victim from allergic reactions to bee stings; avoid situations where you might get stung. If you have some adventures such locations, be sure you carry with your self a kit with antihistamine tablets or injections for an emergency situation. Desensitization programs are given to the people who are severely allergic to bee stings where bee venom injections are administered in increasing doses till the body shows with tolerance to the venom.

An allergy specialist should do this not any ordinary people. This may take between 15 – 20 weeks for the body to develop immunity. And monthly booster shot is always available afterwards. In a summary, we should take immediate care when we get a gee sting. If not we will suffer the consequences. The easiest way is to go to a nearest hospital for an immediate treatment.

Darrell Miller asked:


Whether you are a child or an adult you are as susceptible to the damage done to skin and soft tissue by hard activities as anybody else. So what can you look for if you decide have a day outdoors and face the dangers that you will come across that want to leave you bruised ,scratched, scraped, cut and itching from all the falls, knocks, stings and bites that most people experience when they are more used to spending their time indoors?

Bruises are caused by a knock, and can happen without you even being aware of it. The blood vessels get damaged and leak. If you notice it right away, you can lessen the degree of bruising by applying ice or cold water to constrict the capillaries and cut down the flow of blood leaking from them. Some people bruise easier than others, and excessive bruising for no apparent reason could be a symptom of a more serious underlying condition and you should see your doctor.

A bump, or lump, can appear for many reasons, but generally settles down after a while. It can simply be the body’s reaction to a hard knock that did not damage the blood vessels, but prompted a natural swelling to protect the area. They can also be caused by insect bites. You don’t always see these little pests – they have lunch then zip off without you even being aware of it until the area begins to itch and swell. However, if you have a lump under the armpit, in your neck or behind your ears it could be a swollen gland and you should contact your physician.

Everybody gets minor scrapes now and again, and when you spend any time outside you can get bitten by insects such as mosquitoes, midges, blackflies, horse flies – you name it, they will lunch on you as on any other animals. You can also get stung by vegetable nasties, though if you do then look around for a remedy. Strangely, many stinging plants have another plant close by that can be used as a remedy. This is likely because, after being stung, people just rubbed whatever was handy on the area and eventually these remedies were discovered.

Thus, dock leaves are often found beside nettles, and touch-me-not beside poison ivy. These are good natural remedies for stings caused through contact with these particular plants, and there are many other natural remedies that can be used for the other everyday hurts that people receive just for carrying out normal activities outside in a natural environment. Let’s have a look at some of the natural remedies that people have used through the ages, and that are still used to this day, even in proprietary creams and salves.

Calendula, or marigold, is very effective in relieving skin irritations and inflammation. It can be applied topically to relieve the symptoms of bruises, cuts and scrapes, and also for the initial treatment of burns and scalds. It has anti-inflammatory properties and can be used on inflamed or infected cuts and skin lesions. These properties are believed to be due to the high level of flavonoids found in calendula that have anti-oxidant properties and help the immune function to do its work. Among these is the powerful Quercetin with its strong anti-histamine properties.

It also appears to possess anti-viral properties, though the reason for this is not clear and is still under investigation. Marigold also contains carotenoids and triterpene saponins, both of which will contribute to the medicinal effects. The dried flowers or leaves, or the fresh flowers, can be used and it is an old adage that pus will not form where marigold is used. It is also good for the treatment of insect bites and boils, where it appears to either prevent infection or clear up any that are there. It has also been proven to prevent the seeping of blood from the capillaries in scrapes, and to promote blood clotting.

Calendula was used during the First World War by British doctors to dress wounds and prevent infection. A dressing steeped in a mild solution of calendula extract was enough, and it likely saved many lives.

Another plant with similar properties is the alpine Arnica, which is useful to reduce the swelling and pain of bruises. It works simply by rubbing the leaves on the area when you have a fall or a hard knock. The active ingredients here are again flavonoids, and sesquiterpene lactones along with tannins, carotenoids and thymol. These, along with the flavonoids, stimulate the circulation and carry away any fluids trapped in bruises and swellings.

The sesquiterpene lactones act as anti-inflammatories and boost the immune system, helping to reduce swelling and pain. In fact terpenoid chemicals are common to many of the herbs and flowers that have found a use in the relief of pain in swelling and bruises. The same is true of Ledum, better known as Rosemary, traditionally used for the treatment of burns, ulcers dandruff, and dry skin and to get rid of lice among many other internal and topical applications.

The active ingredients of rosemary (ledum) include mono-, di- and triterpenes and also the ubiquitous flavonoids and camphor and linalool. If you wash down burns, grazes and cuts with a wash of ledum extract, then you will protect the patient from infection at the time when they are most vulnerable to infectious agents.

Hypericum has uses as an anti-inflammatory and antiseptic, and is therefore useful for exactly the same conditions as all of the above. It also has astringent properties, so that like Calendula, Hypericum can be used to prevent the capillary seepage that frequently leads to infections. The active ingredients here are apparently flavonoids again, with their antiseptic and anti-inflammatory properties.

Considering that they are among the most common antioxidants and anti-inflammatory agents in the plant world; it is no coincidence that flavonoids just happen to be contained in the vast majority of natural treatments for scratches, grazes and bruises. They reduce swelling, pain and inflammation, and also act as antiseptics by disrupting the cell walls of bacteria.

Hypericum is well known by its alternative name St. John’s Wort, where it is used in the treatment of depression. However, the active ingredients here are mainly hyperforin and hypericin, which have little to do with the topical benefits of the plant.

If you have suffered from insect bites and stings, then you would have been thankful had you brought some Apis Mellifica with you. Obtained from bees, this again contains terpenes among many other chemicals, and is used paradoxically in the treatment of bee stings and other insect stings and bites. It’s amazing how many of these old remedies contain terpenes of various types and also flavonoid chemicals. It is useful for most rashes that have raised puffy lumps, such as hives.

Finally, if you manage to stay out without getting any bruises, abrasions, scratches or bites, you will be very lucky. However, if you get sunburn through being out in the sun too long, just look around for some stinging nettle, or Urtica. The leaf contains polysaccharides and lectins that stop the production of prostaglandins in the body that cause inflammation. Your sunburn will ease and you be able to return home relatively symptom free from your day outdoors.

These natural remedies can be hard to find growing naturally due to many factors such as the time of year or your geographical location these herbs may grow in. Alternative sources are available at your local health food store where you can find all the above mentioned herbs in ointments and creams specifically formulated for your needs.

Trevor Price asked:


Finding out what causes allergies can be difficult at best. Try to identify your culprit foods.

Typically people who have an immediate reaction can pinpoint their allergy down to one or two foods. However, those who experience delayed allergic reactions may be allergic to as many as 14 or 16 different foods. To learn how to track your diet and target the cause of your allergies, keep reading.

How the Allergic Reaction Works

A food allergy is actually an immune system function. Basically, the body senses a substance that it doesn’t like or want inside the body. It responds by releasing white blood cells along with histamine and leukotrienes, which cause inflammation. That inflammation can occur in the stomach, intestinal tract, throat, mouth or in the form of a rash.

In addition to sending out white blood cells, the immune system also powers up its antibodies. These try to rid the body of any traces of the offending food in the intestinal tract, blood or stomach. Unfortunately, they can cause long-term harm.

Generally, with immediate-onset allergies, you’ll experience your allergic reaction within an hour or two of eating the trigger food. The allergy will often manifest itself as hives or hay fever-like symptoms, but it can also be a swelling of the throat or mouth area.

With delayed-response allergic reactions, symptoms will appear up to 72 hours after eating the culprit food. They’re usually provoked by eating a large amount of it or ingesting it frequently.

Finding Out the Diet Resulting in Your Allergies

Keep a Food Diary

The best way to monitor your consumption and track down an allergy is to keep a food diary. By monitoring everything you eat and tracking your symptoms, you will start to see a pattern, eventually allowing you to pinpoint certain trigger items you eat.

Eliminate Culprit Foods

When you think a particular food may be causing your allergies, try to stop eating it for at least three weeks. Once the food is out of your system, try reintroducing it. If you experience the symptoms, then you’ve found your allergy.

If you believe your allergy may be caused by multiple culprit foods, try eliminating all the suspect items from your diet for three weeks. After this cleansing period, begin to eat a little of each individual food, one-by-one. Allow for a four-day window between introductions. During this period, keep a careful eye on your symptoms.

Also, be aware that when you give up a food to which you are allergic, you may experience temporary withdrawal symptoms, such as headaches, fatigue, and irritability. This is normal and should not be cause for concern.

Eliminate the Culprit Food

Once you identify your culprit foods, you can omit them from your diet altogether, in which case all your symptoms should disappear within three to six months. Or, if you are not severely allergic, see whether you can eat a small amount once every four days or more without trouble. You may need to exclude the culprit foods completely for six months before you gradually reintroduce them in this way.

By creating an awareness of what you eat and how it affects your body, you can begin to learn the causes of your allergies and take appropriate action.

Kesja Plecha asked:


Wash your hands

Basic way of preventing getting infected is washing your hands frequently, especially after coughing or sneezing. You can use soap and water, alcohol-based hand sanitizers are also effective. Hand sanitizers can be used when water isn’t available.

Don’t touch your eyes, nose or mouth

Germs spread when you touch your eyes, nose or mouth after touching something that’s contaminated.

Avoid close contact with sick people

If possible, avoid contact with possibly infected people. Avoid crowds. Swine flu spreads mainly when people cough or sneeze.

Avoid travel

Try to limit traveling, especially to high risk areas such as Mexico. If you’ve been to Mexico and have flu like symptoms visit a doctor.

Wear facemask or respirator

Centers for Disease Control and Prevention recommends wearing facemask in crowded settings to prevent getting infected and to not infect others. Respirator should be used if you have close contact with infected person (for example you’re caring of sick person at home).

Antiviral drugs

Swine influenza A (H1N1) is sensitive to Oseltamivir (sold under name Tamiflu) and Zanamivir (sold as Relenza). They are effective means of swine flu prevention and treatment. If taken for treatment, Tamiflu and Relenza are most effective if taken within 2 days after illness started. They are also effective for prevention if given to healthy person that had contact with infected people. Antiviral drugs are 70% to 90% effective means of flu prevention. According to CDC, number of days they should be used to prevent H1N1 influenza varies depending on each person’s situation.

Vaccine

Influenza A (H1N1) vaccine isn’t available yet, WHO and CDC are working on it.

Stay home if you feel sick

CDC recommends to stay at home for 7 days after symptoms begin or until you are symptom-free for 24 hours to not spread infection further.

Take care of your health

Sleep well, be active, manage stress, drink lots of fluids, eat healthy. This strengthens your immune system.

Anna Hart asked:


It is easy to find information on the Internet about the symptoms of heart attack. You can find lists of heart attack signs for men and women both. You may have witnessed or experienced attacks before, and know what to do in case of heart attack.

But do you know how to cure a heart attack?

It may seem strange to ask how to cure a heart attack. A heart attack is an event. Like any event, it happens and it ends. Why ask how to cure a heart attack? It will end with the death of a part of the heart muscle – or it will end with the death of the entire muscle. Every heart attack ends one way or the other, doesn’t it?

How to Cure a Heart Attack with Folk Medicine

Some think they know how to cure a heart attack with folk medicine. They mix this or that together, or take capsules of some supplement. These samples of folk medicine that is thought to cure a heart attack are offered merely for educational purposes.

1. Mix 1 teaspoon cayenne pepper, 1 crushed clove garlic, and 1-2 Tablespoons of honey in 1-1.5 cups of boiling water and drink. Repeat once daily after a heart attack.

2. The best cure after a heart attack is to get oxygen to body cells so they can repair the damage. Mix 1 teaspoon dimethylsulfoxide (DMSO) with 1 full glass of water and drink. Repeat every couple of hours.

3. Take magnesium daily to rebuild the heart. When magnesium is depleted, it makes muscles twitch – and can do the same to the heart.

4. Take aged garlic extract capsules daily.

5. Hawthorn, used regularly, strengthens the heart muscle. Studies show that hawthorn speeds recovery after heart attack. It strengthens the heart and forestalls any onset of coronary disease. No other herb provides the nourishing regeneration of hawthorn after heart attack.



Those ideas may or may not work. Studies in Great Britain are giving credence to the use of aged garlic extract. Other studies show that the claims may be close for hawthorn. For the most part, however, the medical community scoffs at any use of folk medicine. They have more modern ideas about how to cure a heart attack.

How to Cure a Heart Attack with Modern Medicine

Ask how to cure a heart attack with modern medicine, and physicians will detail several treatments. Some involve medications, while others require invasive procedures.

Medications are used immediately in a heart attack. The first goal is to break up or prevent blood clots. Additional goals are to stabilize plaque, and keep blood platelets from congregating and sticking to plaque. Of course, it is hoped that the medications will prevent additional trouble. In order to reduce damage to the heart, physicians must administer these medications within 30 minutes from the time the heart attack symptoms began. Medications given may include any combination of aspirin, heparin, so-called clot busters, and other anti-platelet drugs.

Once these medications are given, modern medicine serves up additional drugs to lessen your heart’s work and reduce your pain.

Procedures may begin before the heart attack has ended. The cardiologist may order catheterization to determine the heart attack’s cause and assess damage. He may use balloon angioplasty to open a blocked artery, and place a stent to keep it open.

In severe cases of blockage, the cardiologist may perform emergency coronary artery bypass graft (CABG) surgery.

In recent years, studies have shown that much of this is unnecessary and should not be done. A “wait-and-see” approach has been proven more satisfactory after initial medication.

How to REALLY Cure a Heart Attack with VERY Modern Medicine

In 2004, an Israeli team created what they termed a biological “scaffold” to implant in pigs. They found that the scaffold allowed healthy, injectable heart muscle cells to replace cells that died as a result of a heart attack. The process is known as tissue engineering.

As of 2007, this technique is still in the testing stage, but if successful in humans, it could revolutionize treatment of heart attacks. It could give physicians the ability to REALLY cure heart attack victims. It would help heart attack victims live longer, and improve their quality of life.

Disclaimer: The author is not a physician, and shares this research for educational purposes only. Please ask your physician about how to cure a heart attack – or at least for the best treatment following a heart attack.

Brenda Williams asked:


The immune system operates very much like an army. Certain cells form a command post to direct the activities of the soldier cells. Two types of troops are mobilized: killer T cells and antibodies. These go into action depending upon the type of invader that is mounting an attack on your body. Killer T cells are employed to fight against viruses. Viruses penetrate and hide inside your body cells so the cells in which they are residing need to be destroyed. If the invaders are bacteria, the antibodies go into action. Bacteria do not invade cells but instead stay outside. The antibodies surround, immobilize and destroy the bacteria.

The immune system also has a sophisticated data collection system. Special cells remember past invasions so if the same micro organism invades a second or third time, these memory cells enable the immune system to respond faster and with greater force. All of these wars wage continually within our bodies without our knowledge. The only time we become aware of the battle is when the immune system begins to lose. However, this system sometimes malfunctions and mounts an offensive against our own body cells, mistaking them for foreign invaders. When this happens, the result is called an autoimmune disease.

Autoimmune diseases can strike anywhere in the body. There are three that occur in the mouth. One of these is pemphigold. Pemphigold produces large blisters in the mouth. The second disease pemphigus creates blisters in the mouth and on the skin. They usually begin in the mouth however it is also possible that they will stay in the mouth and not migrate to the skin. These blisters burst easily and then scab over. These can very easily become infected. If they are ignored and not treated promptly, they will spread to the skin and can even be fatal. Neither pemphigold nor pemphigus is a common disease.

When a patient appears to have either one of these diseases, the dentist will extract a small section of the blister for study under a microscope. Both diseases are treated with corticosteroid drugs. The dentist may also prescribe medications to suppress the immune system. And if the blisters are infected, the dentist might also administer anti-biotics.

The third autoimmune disease that occurs in the mouth is erythema multiforme. Again, this is not a common illness, occurring in a very small percentage of the population. When it does strike, it usually affects young adults, men in particular. Both blisters and ulcers appear in the mouth and may even spread to the lips. The onset of the disease takes place rapidly. Fifty percent of the patients also develop a skin rash. There is a more severe form of the disease in which the sores may spread to other parts of the body. About a week prior to the outbreak of the sores, the patient will experience some symptoms that resemble flu such as fever, cough, sore throat and a headache. The sores may last from two to six weeks. Mild forms of the illness usually subside without treatment. Serious outbreaks are treated with corticosteroids.

Anna Hart asked:


If you or a loved one has heart disease, heart attack prevention and treatment are very important subjects. Your physician may have recommended taking a low dose aspirin each day to avoid heart attack. You may have heard that you can increase your chances of survival during a heart attack by taking aspirin. But how?

How Can Aspirin Help in Heart Attack?

Imagine that you are sitting watching TV with your spouse. You begin to sense that your chest is heavy. It feels as though someone is tightening wide steel bands around you. You shift positions, but the feeling remains. You take a few deep breaths and try to relax, thinking it is stress. The pain begins to spread to your jaw and shoulder. You mention it to your spouse, who turns to look at you, dashes to the phone to call for an ambulance, and returns with an aspirin. “For your heart attack,” says your spouse. Why?

How can aspirin help in heart attack?

Heart Attack Scenario

A heart attack is an active, ongoing event. It is not something that begins and ends in five minutes. You can limit the damage done to your heart and body during this ongoing event by taking action immediately after the heart attack begins. Calling emergency services is one action step. Taking aspirin is a second action step.

Paramedics will arrive quickly when you call 911. They will give you oxygen and medication for your heart attack. They will monitor your blood pressure and heart rhythm to try to prevent heart attack complications. They will rush you to the emergency room of the nearest hospital.

Once you reach the Emergency Room, doctors and nurses will hurry to perform an EKG and blood tests to confirm or refute a heart attack diagnosis. If you are having a heart attack, doctors will usually try to open the blocked artery with angioplasty, a stent, or a drug.

But why take aspirin? If they are going to use all of these modern “miracle-workers” on you, how can aspirin help in heart attack?

Aspirin’s Role

Aspirin has been found to slow down platelets. Platelets are microscopic blood cells your body uses to trigger blood clotting. If you cut your finger, blood begins to flow from the cut. Immediately, platelets move to the cut finger and cause the blood to clot. If you were to take aspirin the moment you cut your finger, you would slow down the movement of platelets. The blood would continue to flow freely for a longer time.

You would need only a tiny amount of aspirin to slow down every tiny platelet in your bloodstream. You would have to take it quickly, though. The clotting of blood would increase minute by minute, so the sooner you took the aspirin, the better your chances of keeping the finger bleeding.

Of course, this would be foolish action in the case of a cut finger. You want the finger to stop bleeding. You want the blood to clot.

In heart attack, however, you do not want the blood to clot. The reason for most heart attacks is the rupture of plaque in a coronary artery. When the rupture occurs, the body senses injury and calls for platelets. The platelets hurry to trigger a blood clot, just as they will in a cut finger. As minutes pass, the clot grows larger and larger. It grows until it completely blocks the artery. Blood can no longer flow to the part of the heart served by that artery. Blood can no longer carry oxygen to the heart. Without oxygen, that part of the heart begins to die. The heart attack runs its course.

If aspirin is taken in the first few minutes of an attack, you slow down the rush of platelets, just as in our example of the cut finger. You make it more difficult for the blood to clot. You keep the blood flowing, carrying vital oxygen to the heart. You limit the risk of heart attack damage.

How to Take Aspirin for Heart Attack

1. QUICKLY: The most important thing is to take aspirin immediately if you sense you may be having a heart attack. Aspirin needs nearly 15 minutes to fully slow platelets. Get it into your blood stream quickly.

2. AMOUNT: Take one 325 mg. of aspirin for heart attack. Do not take two or three in hopes of getting better results. A smaller dose is actually more helpful than a larger dose.

3. TYPE: The aspirin must not be enteric-coated. The coating is added to keep aspirin from dissolving too quickly in your stomach. For heart attack, you want it to dissolve as quickly as possible. Even when chewed, enteric-coated aspirin have been found to dissolve too slowly. So be sure you always have at hand non-coated 325 mg. aspirin tablets.

4. CHEW: It is very important that you CHEW the aspirin. Do not swallow it whole. CHEW the aspirin at least 30 seconds before swallowing it. Chewing will reduce the tablet to small particles, ready for digestion. It will also stimulate saliva, which will start the digestion. CHEW.

In the October 1997 issue of “Circulation,” the American Heart Association (AHA) journal, it was reported that up to 10,000 more people annually could survive heart attack simply by chewing one 325 milligram aspirin tablet at the first chest pain or other heart attack symptom. Be prepared.

Anna Hart asked:


Coronary heart disease, in its various forms, is the number one killer in the United States. One way that it kills is heart attack. Most of us have seen a movie or television show in which someone has a dramatic heart attack. The actor clasps the chest, and falls to the floor in pain. The message is clear: he or she had a heart attack. Such a theatrical show of heart attack is not always present in real life, however. According to the American Heart Association, most heart attacks start slowly. If you know the signs, you can get help before they reach the dramatic point.

What Are 3 Signs of a Heart Attack That You Should Know?

Not everyone who has a heart attack will experience the same symptoms. It has been learned that men and women can have very different signs. There is enough similarity, however, that anyone, male or female, who has one of the basic three signs of a heart attack, should seek medical help immediately.

What are the three signs of a heart attack that should make you call for help?

1. Chest Discomfort: In most cases, a heart attack involves pain or some form of discomfort in the center of your chest. The feeling of distress usually lasts more than 2 or 3 minutes. It may stop temporarily, and then return as before. Heart attack discomfort can be experienced in various ways. It may be pressure that makes you uncomfortable. You may feel as though someone is squeezing your chest inside. Some patients say that it feels like the chest is too full, while others simply say it is pain.

2. Other Discomfort: In some heart attacks, the chest discomfort is accompanied by similar feelings in one or both arms. There may be pain in the back or stomach. Pain may also extend to the neck or jaw. The discomfort of heart attack is usually limited to the upper body.

3. Breathing Trouble: A heart attack victim is likely to have trouble breathing. This sign may be present whether or not there is chest discomfort.

Any of those three signs of heart attack should send you to a doctor. It may not be heart attack, but you should have it checked immediately.

Additional signs of heart attack might include lightheadedness, nausea, or a cold sweat.

First 5 Minutes of a Heart Attack

Time is of the essence in a heart attack! It is important to take action quickly if you are to save the person’s life. If that person is you, seek medical help immediately.

Some people decide unwisely to wait until they are sure they are having a heart attack. Often, they wait too long before getting help.

Call 911, or your country’s emergency number, within the first 5 minutes of heart attack symptoms! Do not wait longer than 5 minutes! If you cannot get emergency services within 5 minutes, have someone drive you to the hospital’s emergency room as quickly as possible.

It is important to get medical help quickly. Normally, 911 is the best way to get rapid life-saving care. Ambulance staff can take action the moment they arrive. They can take action to keep your heart beating – and can often revive you if your heart has stopped. Finally, those who arrive at the hospital by ambulance usually receive faster treatment for heart attack than those who arrive by car – as much as an hour faster!

No Embarrassment

What are 3 signs of a heart attack? Those given above.

What is 1 sign that you may be acting unwisely? Waiting.

Doctors stress that there is no embarrassment in seeking medical help for a heart attack and learning that it was not that at all. Doctors and nurses would much rather you acted quickly on a false alarm than that you waited when the heart attack was real.

Learn the three signs of a heart attack – especially if you have any heart disease or risks for such. If you experience any of them, seek help.

Disclaimer: The author is not a physician, and shares this research for educational purposes only. Please ask your physician for more information on heart attack.

Anna Hart asked:


Congestive heart disease is a physical disorder in which the heart no longer pumps hard enough. Since the heart pumps weakly, blood can back up into the lungs, liver, gastrointestinal tract, and extremities.

Congestive heart disease is also called congestive heart failure (CHF), cardiac failure, or heart failure. These names can be misleading, since they seem to indicate that the heart has totally failed and that death is imminent. This is not the case. Congestive heart disease is nearly always a chronic, long-term condition, although it does sometimes develop suddenly.

How Common Is Congestive Heart Disease?

Of 100 people between the ages of 27 and 74, approximately 2 have congestive heart disease. That means about 6 million people in the U.S. are affected by the disease. After age 74, congestive heart disease becomes more common. It is said to be the leading cause of hospitalization among senior citizens.

Causes of Congestive Heart Disease

Congestive heart disease has many causes. They include, but are not limited to, the following causes:

* Weakening of the heart muscle due to viral infections. The weakness may also be caused by toxins such as alcohol abuse.

* Weakening of the heart muscle by coronary artery disease that has led to heart attacks.

* Weakening of the heart muscle by heart valve disease that involves large amounts of blood leakage.

* Heart muscle stiffness caused by a blocked heart valve.

* Uncontrolled high blood pressure, also called hypertension.

* High levels of the thyroid hormone.

* Excessive use of amphetamines (“speed”).

Symptoms of Congestive Heart Disease

Either side of the heart muscle may weaken and cause congestive heart disease. The symptoms of congestive heart disease depend on the side of the heart that is affected. They can include these:

* asthma that can be attributed to the heart

* blood pooling in the body’s overall circulation

* blood pooling in the liver’s circulation

* enlargement of the heart

* shortness of breath

* skin color that appears bluish or dusky

* swelling of the body, especially the extremities

Congestive Heart Disease Risk Factors

As is true with most heart disease, family history is a major risk factor for congestive heart disease. Genetics cannot easily be altered. Age is a second risk factor that cannot be changed. Congestive heart disease is particularly prevalent among older people.

Aside from those two, however, risk factors can and should be addressed. Here are 7 risk factors for congestive heart disease that you may want to discuss with your health care provider.

1. High blood pressure: This is the highest risk factor for congestive heart disease! Men with uncontrolled high blood pressure are twice as likely as those with normal blood pressure to suffer congestive heart disease. If a woman has uncontrolled high blood pressure, she is three times as likely as women with normal blood pressure to develop congestive heart disease.

2. Heart Attacks: This is the second highest risk factor for congestive heart disease. Those who have had heart attacks that resulted in damage to the heart muscle, and scarring of the muscle tissue, have increased risks of experiencing congestive heart disease.

3. High Cholesterol: Showing high levels of cholesterol, particularly when levels of HDL are low, is listed as another risk factor for congestive heart disease.

4. Diabetes: Both type 1 and type 2 diabetes are risk factors for developing congestive heart disease.

5. Obesity: Men and women who are overweight unnecessarily increase their risks of experiencing congestive heart disease. The heart must work harder when the body is not at a healthy weight, and can begin to lose its ability to deliver blood efficiently.

6. Prolonged Physical Inactivity: A sedentary lifestyle, with little exercise, puts people at risk for congestive heart disease, especially as they increase in age. The heart needs cardiovascular exercise to remain strong and able to function well.

7. Smoking: Smoking increases the heart’s workload. It also affects the lungs. This is a risk for congestive heart disease that anyone can eliminate.

CAUTION: Please see your doctor if you have reason to think you may have one or more of the risk factors or symptoms of congestive heart disease. The information contained in this article is for educational purposes only.

Brenda Stokes asked:


Blood is an opaque, mobile fluid connective tissue that is mesodermal in origin. It consists of plasma, blood cells and platelets amongst a diverse array of molecules and ions. A large number of drugs, administered for treatment of various disorders come in direct contact with blood whether taken orally or injected intravenously. A multitude of possible drug interactions pose a serious problem especially to people who take prescription medicines for various diseases simultaneously. Some of these drugs may cause adverse effects on blood cells and lead to various blood disorders. Blood disorders are rare, yet extremely serious and may even prove fatal.

Types of Drug induced blood disorders: In our body, red bone marrow contains pluripotent stem cells which differentiate and mature to form various types of blood cells. Different drugs show different effects on various cells at different stages of cell development. Blood disorders can be characterized depending upon where and at what point in the cellular development the drug acts upon. Some of the common blood disorders include, but are not limited to:

Aplastic anemia: It is a form of anemia characterized by an abnormal deficiency in all blood cells resulting from failure of the bone marrow. It is a rare disorder of haemopoietic stem cells which was first found to be caused by the use of Chloramphenicol. Various non-steroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs have also been found to cause aplastic anemia.

Agranulocytosis: It is an acute blood disorder which is characterized by severe reduction in granulocytes and neutrophils. It is often caused by radiation and chemotherapy which are known to cause reduction in granulocytes and neutrophil counts. Some anti-thyroid drugs like carbimazole & propylthiouracil also increase the risk of Agranulocytosis.

Thrombocytopenia: It is a blood disease characterized by an abnormally small number of platelets in the blood. Heparin is one of the well known drugs associated with severe reduction in platelet count.

Hypertension: It is a common disorder in which blood pressure remains abnormally high (a reading of 140/90 mm Hg or greater). It is also called as high blood pressure. Amphetamines, corticosteroids, estrogens are some of the drugs that can lead to hypertension.

Symptoms:

The symptoms of drug induced blood disorders vary depending upon the type of drug used and the drug effects they produce. However, some generalized symptoms of various common blood disorders may include bleeding gums, chest pain, dry cough, dyspnoea (difficult or labored respiration), fatigue, malaise, pallor (unnatural lack of color in the skin), stomatitis (Inflammation of the mucous membrane of the mouth), lassitude (weakness characterized by a lack of energy), lymphadenopathy (Chronic abnormal enlargement of the lymph nodes), petechiae i.e. minute red or purple spot on the surface of the skin as the result of tiny hemorrhages of blood vessels in the skin, to name a few.

Treatment:

Treatment of blood disorders requires special expertise. Aplastic anemia may require Immunosuppressive therapy and bone marrow/stem cell transplant whereas Corticosteroid therapy is beneficial in case of Hemolytic anemia. As an immediate measure, use of suspected drug should be discontinued and short term supportive treatments should be given to the patients.

Jack L Bloom asked:


Celiac disease is referred to as the inability of the body to process gluten. Also called gluten sensitivity enteropathy, celiac disease is characterized by stimulation of the body to produce antibodies to harm or damage the tiny hair-like projections lining the small intestine of the person with this disease upon the ingestion of food containing gluten. This tiny hair-like projection that lines the small intestine is known as the villi. These tiny structures are responsible for nutrient absorption into the blood stream. Consequently, absorption of nutrients to the bloodstream is hindered due to unhealthy villi.

Therefore, if the body has the incapacity to absorb nutrients there will be greater chances of developing unhealthy body condition such as malnutrition and other health-related issues. There are studies showing association of heredity as the cause of development of Celiac disease while some studies are also based on certain medical conditions like childhood gastroenteritis as the causative factor. It often occurs on children and the only means of diagnosis is through biopsy of a colon tissue sample.

Celiac disease is often suspected when a child seems not to gain weight, to have a stomach that sticks out beyond the normal extent, usually constipated or sometimes have bulky, frequent and foul-smelling stools. Unfortunately, cure is not yet established to be effective; thus the only known cure is to eliminate gluten from the food that is eaten. On the other hand, careful supervision and consultation with the medical doctor is the best option that you can take on.

While this seems to be a very frustrating and tiresome disease to deal with; the good thing is the hope given by the cases wherein a patient suffering from Celiac disease outgrows the condition. When this happens, normal and usual diet is then resumed and normal healthy development of the body will resume as well.

Since most babies and young children with Celiac disease may have allergy to cow’s milk; it is essential to feed them with other vitamin sources like fresh vegetables and fruits. Other nutrients could then be derived from fresh fish and nuts. It is highly necessary that you always include healthy non-gluten foods in the diet so as to restore health and reduce the risk of developing other damages to the intestinal tract. Seek the guidance of the doctor if a high-quality vitamin and mineral supplement is necessary to meet the nutritional needs essential to the developing body. The doctor is the right person to know if the vitamin or mineral supplement is totally gluten-free.

Some Ideas for vitamins for celiac:

Treat Celiac with vitamin D

People who have celiac are usually prone to bone problems like osteopoenia.

Vitamin D, along with calcium, can help fight off the effects of celiac in the body.

Doctors usually prescribe the daily RDA for Vitamin D and about 250 mg of calcium thrice a day. With these two nutrients working to address the issues that pertains to the bones, people with celiac should not worry about their bones thinning out due to the disease.

Vitamin C for Celiac

The use of Vitamin C in the body is just too many.

For one, it is a very good anti-oxidant. But in this case, Vitamin C is taken more to reduce histamine in the blood. Histamine is the term given to the by-product of the body’s allergic responses.

Take note that people suffering from celiac have lowered nutrition levels, resulting to a weaker immune system. They are more prone to allergies than any other people. Around 2000 mg of Vitamin C a day should be sufficient. It is suggested that half of the dosage is taken during morning and the other one during the night.

Celiac disease needs proper management, it is therefore vital that vitamins for celiac is supplied to the body in order to ensure healthy development until symptoms are totally cleared out of the body.

Elsie Shan asked:


Proper diet is very important for people suffering from diabetes. It is recommended that the diet of diabetes patient should be high in fiber and low in fat. Diabetes diet is not a special food that is packaged by a pharmaceutical company and can be purchased off the shelf. Neither is it a complicated dieting plan. It is just a healthy eating habit which emphasizes on fruits, vegetable and whole grains. Diabetes diet can also be practiced by healthy people who want to lead a healthy lifestyle.

History Of Diabetes Diet

During the early days before the discovery of insulin, doctors would recommend diabetes patient to consume a low-calorie diet. It is more to prevent ketoacidosis, which is caused by high concentrations of ketone bodies. This was due to the breakdown of amino acids and deamination of amino acids by our body. The low-calorie diet didn’t actually cure diabetes but it did prolong the life of the patient quite a bit.

Establish A Good Eating Habit

You should establish a regular eating habit for your meals and snacks. As far as possible, avoid ad hoc eating habit because it is difficult to control what goes into your stomach. Always eat the healthiest food in the right amount. Excessive amounts are also not good for the body.

If you are taking diabetes medication or insulin, your eating habits will have to be stricter. Eat only the right amount of servings from each food group. You could talk to your doctor if you have difficulty with your diabetes diet. He will probably recommend a dietitian who can tailor your diabetes diet to your lifestyle.

Carbohydrates In Your Diabetes Diet

The American Diabetes Association recommends that carbohydrates should form 60% to 70% of the total caloric intake. This is somewhat controversial because some studies have suggested a low carbohydrate diet. It is best to work out your diabetes diet with your dietitian. Try to plan your diabetes diet to have the same amount of carbohydrate at each mealtime to maintain an ideal blood sugar level right through the day.

Exchange List In Diabetes Diet

The “exchange scheme” was introduced in the 1950 by the American Diabetes Association. The purpose or intent is to allow patients to swap or exchange food of the same caloric value with another of similar value. For example, you may eat more cake and reduce on the potatoes at dinner time. The exchange list is not so popular with current dietitians. They are more likely to introduce diabetes diet that includes a wide range of fruit, vegetables and one that has a high fibre content and low in sugar and saturated fat.

Conclusion

To minimize the risk of diabetes complication, we must practice a healthy eating habit. This is the most logical way to maintain an ideal blood sugar level. Your diabetes diet need not be bland and boring. You could include your favorite food by balancing it with other healthy nutritious items. Be creative at your meal plan and at the same time mindful of the effects it brings to your diabetes diet.

Anglea Morken asked:


So, you have recently been diagnosed with celiac disease. You are probably feeling quite overwhelmed by all the changes that you have to make in your lifestyle–food shopping and planning your daily menus come to mind. Now is the best time to find a support group to help you cope with the disease. You may feel like you don’t have the time to go to a support group meeting or search the internet for other people with celiac disease, but the time it takes to connect with other people on the gluten-free diet will save you an incredible amount of time and effort in the future.

Celiac support groups, whether in person or on-line, offer a sense of community. People new to the gluten-free diet always have a lot of questions to ask and need someone to answer them. The best people to answer these questions are those who just weeks or months earlier had to face the same problems and decisions.

Celiac disease support groups are wonderful for helping those new to the diet. They are a great help to the newly diagnosed in their efforts to integrate the information needed to adjust to gluten-free lives. By joining such a group, you are benefiting from the experience of people who have been in the gluten-free world for years, sometimes even decades. Finding truly enjoyable gluten-free specialty foods such as breads, pastas, cookies, crackers, cakes, pizza, piecrusts and other gluten-free baked goods can take a lot of time in the trial and error method. But, by asking other people with celiac about their favorite products, you can focus on the products and recipes that most people like, rather than being faced with an endless list.

On-line support groups are a great resource. Most archive their discussions, sometimes going back years. If there is a certain type of product or a brand you have questions about, searching the on-line discussion board will almost always provide the answers you need. If not, posting a new message will bring in advice from people who have been exactly where you are right now. In-person support groups have their own benefits. Meetings are like food-tasting parties with members encouraged to bring food to the meetings. Discussions of places to eat out-like a new local restaurant that makes gluten-free sandwiches or a national chain with special gluten-free menu, opening nearby, are the norm.

No matter which type of group you join, most are filled with discussions-and almost always about food. Recipes are swapped, the gluten-free status of mainstream foods are confirmed, delicious gluten-free specialty foods are raved about and stories of much less delicious gluten-free disasters are shared. Whether you are more comfortable communicating online, or enjoy the company of people with whom you can sit and have coffee and gluten-free cake, the benefits of joining a celiac support group are endless. Life is just too short not to have delicious food and great friends to share it with.

For more information on Celiac Support Groups, be sure to visit any local support group in your area or on the Internet. There are plenty out there that really focus on helping Celiac sufferers and giving solid support to its members. You can live with Celiac and still have a great life.

lalaghulamrasool bhurgri asked:




To compare the role of glibenclamide and pioglitazone drugs in type 11 non- insulin dependent diabetes mellitus patients.

Authors:Raj kumar chohan,Mashori Ghulam Rasool,Bhurgri Ghulam Rasool,Shamim-u-Rehman,DahriGhulam mustafa,Anis-u-rehman.



Introduction:-



Diabetes comes from the greek word for ‘SIPHON” which one is the first term and implies for a lot of urine is made .The trm “mellitus” comes from a laton word, “met” which means “honey” and was used because the urine was sweet (Wheeler,2004)

Diabetic ketaocidosis is one of life threatening condition requiring some data hospitalization and treatment. Recognition of this condition is of almost importance, because even small delays can have an impact on survival (Nattrass, 2006). Hypoglycaemia are involved in insulin induced episodes in individuals with diabetes. Probably the major factor prescribing, insulin treated patient from achieving the glucose targets needed to prevent diabetic complications. The incidence of hypoglycaemia reflects the inadequancy of current mathods of insulin delievery which lead ot inappropriately high insulin concentration, particularly some persons after eating more foods at night onset of blindness and also a major risk factor heart disease and stroke

(Heller, 2003).



TYPES OF DIABETE MELLITUS

TYPE 1 DIABETES MELLITUS (IDDM):

Type I diabetes affect children of all ages, both sexes and all athenic groups. type 1 diabetes usually occurs by mechanisms. It is most common metabolic condition in children and adolescents (Bui, 2004). Type1diabetes is characterized by immune mediated destruction of pancreatic b -cells resulting in insulin deficiency. This results in a common biochemical end point of hyperglycaemia and risk of ketoacidosis, but the clinical presentaion varies, widely depending on the rate and degree of b -cells failure (Lambert & Bingley. 2005).

Type II diabetes mellitus (NIDDM):



Type II diabetes is a complex metabolic disorder associated with, b -cells dysfunction and with varying degree of insulin resistance primary pathogenic factors leading insulin resistance leading to type 2 diabetes and decreased insulin, secretion which arise from abnormalities with in liver, skeletal muscle and pancreatic b -cells (charles & clark, 1996).



GESTATIONAL DIABETUS MELLITUS

:

Women who develop glucose intolerance in late pregnancy and womens who with previously undiagnosed diabetes.





SECONDARY DIABETUS MELLITUS:



Secondary diabetes is due to disease of the pancreatic and endocrime system, genetic disorders, or exposure to chemical agents.

Type – I diabetes formerly known as insluin dependent diabetes mellitus (IDDM), is characterized by the destruction of the pancreatic beta cells that produces inslulin

Type – I diabetes formerly known as insulin dependent diabetes(IDDM),is characterized by the destruction of pancreatic beta cells that produces insulin.Type-1 diabetes occures most often in children and young adults but it can occures at any age.(Anderson et al 2007).

Type-11 diabetes is not straight uprward. A pancreas that does not produce enough insulin. Liver that release too much glucose,muscle cells that do not readily take in glucose.(Carren 2008)

Many genetic factors are involved in the development of diabetes.Because of new genetic methodology researchers are closers to identifying all of the cadidate gene for both non –insulin dependent and insulin dependent diabetes(Bernhard,1995).

Woman who had gestation diabetes are more likely to develop Type-11diabetes themselves.Pergnant women with diabetes are another disadvantaged group.They need much more intensive antenatal care and close monitoring of blood sugar,blood pressure and weight.(jawed2006)

Over weight children the progression of child obesity into adulthood is associated with early develop of complications, including IgpG2 diabetes and cardiovascular disease.Type diabetes is the most common clinical form of diabetes accountingforabout 90% of all cases,it is currently undergoing world wide epidemic. Type 11diabetes mellitus is caused by body’s infective use of insulin, it is often results from excess body weight and physical inactivity(WHO 2007).



PREVALACES& IINCIDENCE

:

Diabetes mellitus increases with aging, in 200 the prevalance of diabetes,it was estimated to be 0.19% people<20 years old and 8.6% in people>20 years old.There is considered geographic variation in the incidence of both type-1 and type-11 diabetes mellitus.Scavandinvian has the highest incidence of type-1 diabetes mellitus e.g in Finland, the incidence is 35/100,000 per year the pacific rim has a much lower rate in japan and china the incidence is 1 to 3/100,00 per year of type-1 diabetes mellitus, Northern Europe and the United States share an intermediate rate (8to17/100,000 per year).The prevalence of type 11 diabeties mellitus is highest in certain pacific island, intermediate in countries such as India and the United States, and relatively low in Russia and China.This variability is likely due to genetic, beharioral and enviromental factors(Power 2005).Diabettes mellitus prevalance also arises among different ethic population within a given countries it is common inall ethnic groups its prevalance increased with age and more than 5% of individuals of more than 65 years of age have diabetes mellitus (David Owerback 1988).The World wide prevalence of diabetes mellitus has risen dramatically over past two decades.The prevalence of type11 diabettes mellitus is expected, type 11 diabetes mellitus is more prevalent among Hispanies Native Americas,African,American,and Asians, pacific Islanders than in non- Hispanic whites,the incidence is essentially equal in woman and men in all populations. Type 11 diabetes is becoming increasingly common because people are living longer,and the prevalence of diabetes increases with age it is also seen more frequently now than before in young people, in association with the rising prevalenceof childhood obesity although type11 diabetes still countries with the estimated nubers of cases of diabetes in 2000and 2030.

Rank Country

2000 Individuals country with diabetes (milloins)

Country

2030 Individuals with diabtes (Million)

India

31.7

India

79.47

China

20.8

China

42.3

USA

17.7

USA

30.3

Indonesia

8.4

Indonesia

21.3

Japan

6.8

Pakistan

13.9

Pakistan

5.2

Brazil

11.3

Russian federation

4.6

Bangladesh

11.1

Brazil

4.6

Japan

8.9

Italy

4.3

Philippines

7.8

Bangladesh

3.2

Egypt

6.7

(Wareham& FOROUHI 2OO6)



DRUG TREATMENT OF DIABETIES MELLITUS

:

Biguanides lower blood glucose, they increase glucose uptake and utilize in skeletal muscle there by reducing insulin resistance, and reduce hepatic glucose production (gluconeogenesis).Lower blood glucose, addionally reduces low denisity and very low denisity lipoproteins (LDL and VLDL) respectively. Metformin has a half life of about 3 hours and is excreted unchanged in the urine.Clinically metformin used in type 2 diabetic who are obese and who fail treatment with diet alone.Adverse effects are produced dose related gastrointestinal disturbances e.g anorexia,diarrhoea,nausea,lactic acidosis rare but potentially fatal toxic effect.(Dale,2003).

Improving insulin sensitivity by activating certain genes involved in fat synthesis and carbohydrate metabolism Rosigilitazone and Piogiltazone are currently approved.Thiazolidinediones. Thiazolidinediones do not cause hypoglycemia when used alone,although they are usually taken in combination with sulfonylurease.

In some incouraging studies, thaiazolidiniones have produced very favorable effects on the heart, including reducing blood pressure and improving triglycerides and cholestrol levels including increasing HDL level,the good cholestrol. They may also block a molecule called 11 Best HSK that may play a significant role in metabolic syndrome,as well as diabetes type11. One study also sugessted that Rosiglitazone may even improve beta cells functions and so help prevent progression of diabetes.Anemia, weight gain, increased risk of fluid buildup, may worson heart failure.Troglitazone,was withdrawn after a few reports of heart failure.Liver failure abd death.Current Thiazoldinediones don not appear to pose the same effects on the liver although there have been a few reports of liver injury.

In patients with dietry failur the choice of a sulfonylurea agent or insulin therapy has been controversial and empric in favour of insulin therapy are the studies, who reported marked improvement post receptor diagnostic after intensive short term therapy in untreated type 2 diabetes mellitus (Scarlett et al,1984) Sulfonylureas further classified into two groups or generations based on their potency,duration,drug interaction,side effects profiles. Sulfonylureas enhance insulin action in cells in culture and stimulate the synthesis of glucose transporters (Jacobes et al 1998).A sulfonylurea drug should normally be the insulin secretagogue of choice, NICE (National Institute for Clinical Excellence) also recommends that a generic ,drug should be perscribed (Scsade et al1998).



RESEARCH DESIGN AND MATERIAL AND METHODS:



This study was conducted in the deprtment of Pharmacololgy and Therapeutics,Basic Medical Science Institute,Jinnah,Postgraduate Medical Centre,karachi under kind supervision od DRr:GhulamRsool Mashori,Associate Professoer and Head OF Department Of Pharmacology and Therapeutics in colloboration with Medical Outpatient Department Unit111 and Filter Clinic, Medical Department, JPMC,Karachi.

Seventy NIDDM (type-II)diabetic patients were initially enrolled in the study from the filter clinic/ out patient department Medical Unit III ,and diabetic clinic.Out of this 60 diabetic patients were associated in whole period of study, remaining 10 patients were dropped due to poor comlpiance or change in residential place.All the patients were divided in two main groups,groupI and in group II these patients were selected in this study according of inclusion and exclusion criteria.



INCLUSION CRITERIA

:



Newly diagnose patients of non Insulin Dependent Diabtes Mellitus.

Diagnsed patients of diabetes also including having no any history medication.

Having either *** of age between 30 to 60 years.

Diagnosed patients who were Non Insulin Depedent Diabetes Mellitus who were treated with Pioglitazone.

Diagnosed patients who were Non Imsulin Depedent Mellitus, who were treated with drug Glibenclamide.





EXCLUSION CRIRERIA

:



Patients suffering from blood pressure.

Patients suffering from liver disease.

Patients suffering from cardiac disease.

Pregnancies and lactating women.

Patient suffering from renal disorders.

Patients having serious complications.





MATERIAL:





Lacets.

Lancet Hlder(Abbots easy touch TM2 lot 03 Asee).

Glucometer(Medisense) optilim one touch(Abbotts).

Blood glucose nest trpis (IVD for Invitro diagnostic use (Abbott Labortries,Medisense UK Ltd,Abigngdon,Ox14ITR,Masde in UK). Stored between minimum 30?, (4°-30° C) and Maximum 40°C (39°-86°F).

Weight Machine Model No 1101 Lot No.312. TANTIATA.





DRUGS



Tab:Daonil 5 mg (Aventis Pharma)

Drug category:Sulphonylurea.

Generic Name: Glibenclamide.

MFGLIC:No.000007 RegistrationNO.000220

MFG Date:0-06

EXP Date:7-10

Lot NO:B230

Tab:piozer (Hilton Pharm) PvtLTd.

Tab:Poizer 15mg

Drug category:Thaiazolinedione.

Generic Name:Pioglitazone Hydrochloride.

MFG LIC: O.000136 Registration No.03270

MFG Date:3-06

EXP Date:3-o9

Lot No:6287

Tab: Poizer (Hilton Pharma)pvt ltd.

PARAMETERS:

Fasting Blood Sugar (FBS).

Random Blood Sugar (RBS).

Weight.

Key words:Diabetes mellitus,Non-insulin diabetes mellitus,Insulin depedent diabetes mellitus, Daonil,poizer,Insulin.



RESULTS:





Table 1



Weight and Blood Sugar level observed on baseline day 0

In group1 and group11

 

Group 1

Group 11

 

Pioglitazone n=27

Glibenclamide n=33

Weight

63.37

+ 2.25

¯

62.7

+ 15.56

¯

Fasting Blood Sugar

172.7

+ 13.32

¯

188.42

+ 12.o5

¯

Random Blood Sugar

285.11

+ 15 .532

¯

284.18

+ 17.07

¯

All Values are expressed in Means± SEM.

FIGURE-1 weight and blood sugar levels observed on baseline (day-o)



In table No shpwing the weight (KG’S) and blood sugar (msg/dl0 levels which is observed on baseline (day-0) in both groups 9group: 1 & group11)

Group: 1 Weight in (Kg’s) mean + SEM) IS 63.37±2.25 Fasting blood sugar 172.7±13.32,and Random

blood sugar 285.11±15.32



Group:11

Weight (KG’s0 (mean +SEM)62.7±1.56 Fasting blood sugar (mg/dl0 188.42±12.05, Random blood sugar is 284.18±17.03.

Figure 2: showing the weight and blood sugar levels observed in base line (day-0) in group: 1 and group 11 weight in 9kg’s) its mean values are 63.37,62.7, Fasting blood sugar in (mg/dl) is 172.71, 188.42 Random blood sugar (mg/dl) is 285.11 &284.18.

TABLE: 2

Peroidic Observation In All Parameters Group1

Goup1(Pioglitazon) n=27

 

P-value

 

Day-0

Day-45

Day-90

Day-0to45

Day-45-90

Weight

63.37

±2.25

63.63

±2.26

63.63

±2.23

>0.05

(NS)

>0.05

(NS)

Fasting blood sugar

172.7

±13.32

165.04

±8.98

153.37

±7.59

>0.05

(NS)

0.05

(NS)

Randomblood sugar

285.11

±15.32

279.78

±13.63

255.56

±12.65

>0.05

(NS)

>0.05

(NS)

All values are expressed in Mean±SEM .(NS) Non significant.









TABLE NO:2



Showing the periodic observations in all parameters in group 1 (piogiltazone) (n+27) weight P.value (day 0 to day 45)>0.05 (NS). Fasting blood sugar >0.05 (NS) Random blood sugar >0.05 (NS) P.values day 90 weight >0.05 (N.S), FBS>0.05 (N.S) 7RBS >0.05(N.S) NON SIGNIFICANT

FIGURE:2 Showing the periodic observation in all parameters in group 1 on day0 day 45& day-90.Mean values in weight (Kg) is 63.37,63.26,63.63, fbs (mg/dl) 172.7,165.04,153.37,RBS(mg/dl) 285.11,279.78,255.56.

TABLE NO3

Peroidic Observation in All Parameters Group11

 

Group 11 (Glibenclamide)

N=33

P-value

 

Day-0

Day-45

Day-90

Day-0 to 45

Day-45 to 90

Weight

62.7

±1.56

65.64

±2.10

64.55

±1.92

>0.05(NS)

0.05(NS0

Fasting blood sugar

188.42

±12.05

168.45

±10.99

140.06

±5.68

>0.05(NS)

>0.05(S)

Random blood sugar

284.18

±17.03

220.12

±13.39

170.94

±5.80

<0.005 (MS)

0.002(MS0

(s) significant, (MS) moderate significant

All values are expressed in Mean±SEM.



Table No3:



Showing the periodic observation in all parameter in goup:11, Group:11 containing drug (Glibenclamide),no of patients (n=33).It’s P-value on day 0 to day 45 on weight >0.05(NS),FBS>0.05(N.S) RBS<0.005 (MS) <0.01- AND DAY 45 TO DAY 90 WEIGHT >0.05 (NS) FBS (0.05) RBS <0.002(M.S0 moderately significant.



Figure 3:Shwing the periodic observations in all parameters in Group 11 weight 62.7,65.64,64.55,FBS (MG/DL) 188.42,168.45 140.06,RBS(mg/dl) 284.18 220.12, 170.94 (on day-0-day 45 to 90).



DISCUSSION:



In Denmark Beck-Nielsenet al,skillman TG (1981) published studies demonstation that glyburide increased he number of receptors on the monocytes of patients with type 11 diabetes mellitus. Some patients were treated with diet and in cobination of second generation sulfonyureas agents Wie. The numbers of insulin receptors all patients were measured before and after the treatment.Intrvenous glucose test shows the persistent impairent of insulin secretion afterthe starting of drug therapy.However those patient who were on drug Pioglitazone some results were obtained of insulin secretion in the impairment in early drug drug therapy.Clinical observations have suggested that the second generation sulfonylureas may exert their effects by potentiating insulin released by other primary stimulators Insulin secreting drug.

According to the study of WilliamC Dukworth et al(1972), aftr the chronic treatment with sulfonylureas it is well documented that plasma insulin levels were decreased in response to oral glucose load. This apparently occures even though glucose tolerance is improved over pre-treatment, levels,present study clearly support that study.

The result og group 11 correlates with the research conducted by Bonnie &Kimmel (2005) produces the same results as FBS reduces from baseline, and at the end of study,with an overall 23.44%,reduction,while with the results showed at the end of study peroid p-value were (p<0,001).

Similarly Michael Alvarsson et al (2003) conducted a similar type of study and the found and overall changes of change of 22.11% in Fbs and 40.88% in Rbs at the end of trial p-value were (p<0.001).

However a study conducted by (Stone &Brown in (2003) didnot match to our results in the parameter of FBS and observer a reduction of 26.22%.



CONCLUSION:



In the light of study discussion it is obiovus the glibenclamide was more effective,tolerable and safer than pioglitzone in a short duration.Diabetes Mellitus is chronic prolong disease for whole life.Poor community can afford it easily,on base of marketing of this drug in pakistan diabetes patients easily go and purchase economically,in fact ,mostly people buy it from pharmacy without dr’s perscription,because pharmacist and patient both of know about this disease.Just like dispirin as analgesic,it is famous anti-diabetic drug in our states as compared of other anti-diabetic drugs.



REFERNCES:





Anderson J,Kendall,Perryman.S etal,”Diet and Diabettes” Diabetes 2006,16(3):17-19-

Bui H- Type 1 diabetes in childhood-Medicine 2006,3 ,1-3

Bernhard –Diabetes-type 11 diabetes mellitus Diabetes care 1995,19(100:12-17-

Clark CM-Oral therapyin type11 diabetes-pharmacological properties and clinical use of current use of currently available agents-Diabetes spectrum 1998,11(4):211-221.

Carren M.Types of Diabetes mellitus-Diabettes 2006 10 (3),07-

David Owerback NJ-Prevalence in diabetes population-Diabetes 1988,02(6):31-32

Dale MM,-Treatment of Diabetes mellitus –pharmacology 20035th edition:287-391.

Heller SR –Hypoglycemic in diabetes Ketoacidosis and hypoglycemic-Medicine 2006:34(03):102-110.

Jawad F Untraveling the mystry of Diabetes’Diabetes 2006;15(3):13-15.

Jacobes D-Insulin-Diabetes 1998;6(3);1160126.

Lambert and Bingliy-basic facts-medicine 2006,34(6):3-7.

Natters M-Ketoacdosis and hyperglycemia-Medicine 2006;34(3):104-106.

Power AC-Epidemiology of type11 diabetes Basic facts of diabetes –Diabetes 2005;1(1)7-9

Scarlet Oral therapy in type 11 diabetes sulfonylureas 1984;16(10);3-9.

Schade DS et al A placebo controlled randomized study of glimepiride in patients of Diabetes mellitus- Diabetes 19998, 38(7);636-641.

Warchman and Forouhi-Epidimology of Diabetes- Diabetes basic facts- Medicine 2006 ;34(2);57-60

Wheeler Gd- Aaccident dicovery led to the noble prize for canadian reseachers,2005,01-02.

WHO Report-Health-Diabetes Mellitus-Defiition and types of Diabetes 2007;1:1-4.

Jack L Bloom asked:


Celiac disease is referred to as the inability of the body to process gluten. Also called gluten sensitivity enteropathy, celiac disease is characterized by stimulation of the body to produce antibodies to harm or damage the tiny hair-like projections lining the small intestine of the person with this disease upon the ingestion of food containing gluten. This tiny hair-like projection that lines the small intestine is known as the villi. These tiny structures are responsible for nutrient absorption into the blood stream. Consequently, absorption of nutrients to the bloodstream is hindered due to unhealthy villi.

Therefore, if the body has the incapacity to absorb nutrients there will be greater chances of developing unhealthy body condition such as malnutrition and other health-related issues. There are studies showing association of heredity as the cause of development of Celiac disease while some studies are also based on certain medical conditions like childhood gastroenteritis as the causative factor. It often occurs on children and the only means of diagnosis is through biopsy of a colon tissue sample.

Celiac disease is often suspected when a child seems not to gain weight, to have a stomach that sticks out beyond the normal extent, usually constipated or sometimes have bulky, frequent and foul-smelling stools. Unfortunately, cure is not yet established to be effective; thus the only known cure is to eliminate gluten from the food that is eaten. On the other hand, careful supervision and consultation with the medical doctor is the best option that you can take on.

While this seems to be a very frustrating and tiresome disease to deal with; the good thing is the hope given by the cases wherein a patient suffering from Celiac disease outgrows the condition. When this happens, normal and usual diet is then resumed and normal healthy development of the body will resume as well.

Since most babies and young children with Celiac disease may have allergy to cow’s milk; it is essential to feed them with other vitamin sources like fresh vegetables and fruits. Other nutrients could then be derived from fresh fish and nuts. It is highly necessary that you always include healthy non-gluten foods in the diet so as to restore health and reduce the risk of developing other damages to the intestinal tract. Seek the guidance of the doctor if a high-quality vitamin and mineral supplement is necessary to meet the nutritional needs essential to the developing body. The doctor is the right person to know if the vitamin or mineral supplement is totally gluten-free.

Some Ideas for vitamins for celiac:

Treat Celiac with vitamin D

People who have celiac are usually prone to bone problems like osteopoenia.

Vitamin D, along with calcium, can help fight off the effects of celiac in the body.

Doctors usually prescribe the daily RDA for Vitamin D and about 250 mg of calcium thrice a day. With these two nutrients working to address the issues that pertains to the bones, people with celiac should not worry about their bones thinning out due to the disease.

Vitamin C for Celiac

The use of Vitamin C in the body is just too many.

For one, it is a very good anti-oxidant. But in this case, Vitamin C is taken more to reduce histamine in the blood. Histamine is the term given to the by-product of the body’s allergic responses.

Take note that people suffering from celiac have lowered nutrition levels, resulting to a weaker immune system. They are more prone to allergies than any other people. Around 2000 mg of Vitamin C a day should be sufficient. It is suggested that half of the dosage is taken during morning and the other one during the night.

Celiac disease needs proper management, it is therefore vital that vitamins for celiac is supplied to the body in order to ensure healthy development until symptoms are totally cleared out of the body.