health journal

Electrolyte imbalances

2011-11-06T10:51:00.000-08:00

Electrolyte imbalances:

1. Hyperkalemia
2. Hypocalcemia
3. Hypoalbuminemia
4. Increase serum creatinine
5. Hyponatremia
6. Hypoproteinemia

Clinical measurements
Three simple clinical measurements that we can initiate without a physician order are daily weights, vital signs, and fluid intake and output.

1. Daily weights
Daily weight measurements can provide a relatively accurate assessment of patient fluid status. Each kilogram (2.2 lb) of weight gained or lost of equivalent to one liter of fluid gained or lost. To obtain accurate weight measurements the nursing responsibility is the nurse should balance the scale before use and weigh the client:
a. At the same time each day, (eq, before breakfast and after the first void)
b. Wearing the same or similar clothing
c. And on the same scale.
The type of scale (i.e. standing, bed, chair) documented.

2. Vital signs
Monitor vital signs regularly, because changes in the vital signs may indicate fluid, electrolyte, and acid base balances or compensating mechanisms for maintaining balance:
 Checked temperature regularly, because elevation in body temperatures may be a result of dehydration or a cause of fluid balance problems.
 Checked pulse rate regularly, because tachycardia is one of the first signs of hypovolemia, irregular pulse rates may occur with potassium imbalances.
 Checked respiration regularly, because changes in respiration rates and depth may cause respiratory acid base balances or act as a compensatory mechanism in metabolic acidosis.

3. Fluid intake and output chart
Intake
 Convert household measures such as a glass, cup, or soup bowl to metric units.
 Records intake each time.

Output
Wear gloves and measure the following fluids:
 Record the amount of urine from catheter and bilateral percutaneous nephrostomy at the end of the shift and records the 24 hours total on the clients graphic sheet.
 Compares the total 24 hours fluid output measurement with the total fluid intake measurement to determine whether the fluid out put is proportional to fluid intake.

Physical Examination
Skin turgor
Skin turgor is an indication of interstitial fluid volume and skin elasticity. Edema is associated with fluid volume excess or decrease oncotic pressure due to loss of albumin.
 Check for pitting edema.
 Check for decrease or increase skin turgor.

Neuromuscular irritability
Because imbalance of calcium, the nurse assess the client for increased or decreased neuromuscular irritability.
 Assess Chvostek’s sign, the nurse percusses ( taps) the facial nerve about 2 cm anterior to the earlobe. A positive response that is unilateral twitching of the facial muscles, including the eyelids and lips, indicate hypocalcemia.
 Assess Trousseau’s sign, places a blood pressure cuff on the area and inflates the cuff above the systolic for 2-3 mmhg, if develop carpal spasm or tetany indicate or possible hypocalcemia.

Stress out of communication

2008-12-25T02:54:00.000-08:00

Review dari artikel referensi, ada dua jenis gaya komunikasi dan efeknya
terhadap pasen, pertama perawat dan health care provider memakai gaya
komunikasi biomedikal atau tradisional dengan pendekatan close ended
komunikasi dan pertanyaan tertutup yang berfokus hanya merespon keluhan
pasen tanpa dan sedikit melibatkan partisipasi pasen, dan berkomunikasi
tatkala ada prosedur dan tindakan yang kadang tidak manusiaw., Yang
kedua memakai pendekatan gaya komunikasi biopsikososial yang melibatkan
pasen aktif dalam komunikasi, memutuskan sesuatu yang berhubungan dengan
perawatan pasen. Menurut hasil riset, gaya komunikasi kedua memiliki
beberapa nilai positif diantaranya meningkatkan kepuasan pasen dalam
pelayanan kesehatan, meningkatkan ketaatan dan kepatuhan pasen dalam
pengobatan dan meningkatkan kesembuhan sakit pasen. Pengalaman
dilapangan sebagian besar gaya komunikasi kita mengarah ke gaya pertama
disebabkan karena beberapa faktor; language barrier contohnya, bahasa
arab dan bahasa inggris menjadi kendala kita untuk menerangkan dan
menjelaskan lebih detail dengan bahasa kesehatan kepada pasen yang
berbeda bahasa ibu dan bahasa nasionalnya dengan kita. Selanjutnya, kita
tidak mau diambil pusing sama pasen, dengan banyaknya menerangkan dan
berkomunikasi membikin pasen banyak bertanya dan merintah yang kdang
bukan garapan atau job description kita, contoh gaya orang Mesir, tidak
cukup diterangkan satu kali, mereka akan bertanya berkali-kali dengan
pertanyaan yang sama, yang akhirnya waktu kita juga terbuang padahal
pekerjaan lain menanti, padahal kalau ditelaah salah satu yang
ditanyakan sama mereka adalah pertanyaan garapan profesi lain yang
karena kurangnya komunikasi kepada pasen akhirnya pasen kebingungan dan
bertanya kepada kita, misalnya pasen diadmit di rumah sakit hari ini
untuk jadwal operasi besok, tapi tidak mempunyai pengetahuan dan tidak
di kasih tahu tentang jenis operasi, anesthesia, siapa dokter yang mau
mengoperasi dia, resiko, lamanya tinggal setelah operasi, dll, sampai
informed consent yang harusnya kita sebagai witness akhirnya mengerjakan
tugas limpahan dari mereka karena kondisi, yang sebagian besar waktu
kita terfokus dan mengerjakan tugas limpahan, apakah kondisi ini dapat
diterima secara professional? sehingga secara otomatis kita terjebak
kepada komunikasi gaya pertama.
Wassalam

MENTAL ILLNESS COMMON IN RETURNING SOLDIERS

2007-03-19T10:54:00.000-07:00

NEW YORK: High rates of mental health disorders are being diagnosed among US military personnel soon after being released from duty in Iraq and Afghanistan, according to investigators in San Francisco. They estimate that out of 103,788 returning veterans, 25 percent had a mental health diagnosis, and more than half of these patients had two pr more distinct conditions.
     Those most at risk were the youngest soldiers and those with the most combat exposure, Dr. Karen H. Seal at the Veterans Administration Medical Center and Associates report in the Archives of Internal Medicine.
     Seal’s group based their findings on records of US veterans deployed in Iraq and Afghanistan who were seen at VA health care facilities between September 2005.
In addition to the high rate of mental health disorders, about one in three (31 percent) were affected by at least one psychosocial diagnosis.
The most frequent diagnosis was post traumatic stress disorder. Other diagnoses included anxiety disorder, depression, substance use disorder, or other behavioral or psychosocial problem.
     The researchers observed very little difference between men and women, racial and ethnic subgroups, and those on active duty and National Guard or Reserves.
     “the youngest group of active duty veterans (age,18 to 24 years) had significantly higher risk of receiving one or more mental health diagnoses and post traumatic stress disorder compared with active duty veterans 40 years or older.” Seal and her colleagues write. The research team maintains that enhanced prevention, detection, and treatment of mental health problems “should be targeted at the youngest…veterans, ”especially those who were on active duty. Reuters

QUICK WALK COULD HELP SMOKER QUIT

2007-03-16T22:44:00.000-07:00

London: As little as five minutes of exercise could help smokers quit, says new study. Research published in the international medical journal Addiction showed that moderate exercise, such as walking, significantly reduced the intensity of smoker’s nicotine withdrawal symptoms. “ If we found the same effects in a drug, it would immediately be sold as an aid to help people quit smoking, “Said Dr Adrian Taylor, this study’s lead author and Professor exercise and health psychology at the university of Exeter.

Taylor and colleagues received 12 papers looking at the connection between exercise and nicotine deprivation. They focused on exercises that could be done outside a gym, such as walking and isometrics, or the flexing and tensing of muscles. According to they research, just five minutes of exercise was often enough to help smokers overcome their immediate need for nicotine fix. After various types of moderate physical exercised reported reduced a desire.

Minor burns management

2007-02-03T23:30:00.000-08:00

Thanks to my friend for asking the article about burns and muscle injury in the previous post, at this moment i would like to present to you about burns management.According so many types of burns which is frequently complicated by presence of fire, an explosion, electricity, smoke, toxic fumes, or other hazards, and because burns can be very distressing, and both you and the casualty may be upset by the smell of singed hair and burned flesh, so i am going to specify to manage minor burns and scalds.

Assessing a Burn

Before treating a burn, it is important to consider the extent and the depth of the burn, its cause, and wether the airways is affected.
Once you are able to establish the cause of the burn, you can decide on the treatment. If the airway has been injured, the casualty may experience breathing difficulties, which will require urgent attention.

Minor Burns and Scalds

Small, superficial burns are often caused by domestic accidents. Most can be treated by a First Aider and will heal naturally. If you are in any doubt as to the severity of the injury, seek medical advice.

Treatment

your aims are:

> To stop the burning.
> To relieve pain and swelling.
> to minimise the risk of infection.

1. Flood the injured part with cold water for at least ten minutes to stop the burning and relieve the pain. If water is not available, any cold, harmless liquid, such as milk or canned drinks, will do.

2. Gently remove any jewellery, watches, belts, or constricting clothing from the injured area before it begins to swell.

3. In some country MEBO (moist exposure burn ointment) is available in the pharmacy, so we can apply gently before covering by steril gouze, or it can be exposed if minor burn only occur.

4. Cover the area with a sterile dressing, or any clean, non fluffy material, and bandage loosely in place. A plastic bag or some kitchen film makes a good temporary.

5. If you identify as Severe burns, immediately to gather relevant information for emergency services and arrange to removal to hospital.

Caution:

DO NOT break blisters or otherwise interfere with injured area.
DO NOT apply adhesive dressing or adhesive tape to the skin; the burn may be more extensive than it first appears.

BLISTERS:
Thin "bubbles", known as blisters, form on skin that has been damages by heat or friction. they are caused by tissue fluid (serum) leaking into the burned area below the skin's surface. During healing, new skin forms at the base of the blister; the serum is re-absorbed and the outer layer of dead skin will eventually peel off.

Good luck, so you can be a doctor at home or workplace to give first aid.

First aid; Effect of extreme cold

2007-01-12T10:07:00.000-08:00

The body reacts to cold by shutting down blood vessles in the skin to stop "core heat" escaping. When deprived of warm blood, extremities such as finger or toes may freeze in severe conditions, causing frostbite. If the body's core temperature becomes dangerously low, bodily functions slow down (hypothermia) and may cease altogether.

Frosbite
This condition usually occurs in freezing and often dry and windy conditions. Those who cannot move are particularly vulnerable. The tissues of the extremities freeze-in severe cases this can lead to permanent loss of sensation and, eventually, gangrene.
Frostbite is often accompanied by hypothermia, which should be treated accordingly.
Recognition
There may be:
> At first, "pins and needles".
> A hardening and stiffening of the skin.
> A colour change to the skin of the affected area: first white; then mottled and blue; and eventually black;on recovery,red,hot,painful, and blistered.

Treatment
your aims are:
> To warm the affected area slowly, to prevent further tissue damage.
> To obtain medical aid if necessary.

1. Very gently remove gloves, rings, and any other constructions, such as boots. Warm the affected part with your hands, in your lap, or in the casualty's armpit. Avoid rubbing because it can damage skin and tissues.

2. Move the casualty into warmth before you thaw the affected part; carry her if possible when the feet are affected.
3. Place the affected part in warm water. Dry carefully, and apply a light dressing of fluffed-up, dry gauze bandage.
4. Raise and support the limb to reduce swelling. An adult casualty may take two paracetamol tablets for intense pain. Take or send her to hospital, if necesarry.

Leptin: The Weight-Loss Hormone

2007-01-09T22:16:00.000-08:00

Despite day-to-day variations in food intake and physical activity, a healthy individual maintains a constant body weight and energy reserves of fat over long periods. Clearly, long-term negative feedback mechanisms are at work, but until recently scientists did not understand them. With the discovery of the hormone Leptin ( from the Greek word leptos, meaning thin), researchers have been able to piece together one long adypocytes, the cells in adipose tissue. Fat storage that occurs when food intake exceeds the body's demands stimulates adipocytes to release more leptin into the bloodstream. Centers in the hypotalamus respond to the increased leptin by decreasing food intake and increasing food intake and increasing energy expenditure, which result in weight loss. If this feedback mechanism is disrupted, obesity wil result. For example, mice with a genetic mutation that prevents them from making leptin are obese. Injecting the mice with leptin causes them to lose weight.
After discovering leptin and demonstrating that it could reverse obesity in genetically obese mice, researchers hoped that leptin cold be used to treat obesity in humans. It is now known that unlike genetically obese mice, the vast majority of obese humans are able to make leptib. Human obesity appears to be caused by an inability of the hypotalamus to respond to leptin, rather than our inability to make the hormone.

WHAT IS FIRST AID?

2007-01-08T21:31:00.000-08:00

First aid is the immediate assistance or treatment given to someone injured or suddenly taken ill before the arrival of an ambulance, doctor or other appropriately qualified person. The person offering this help to a casualty must act calmly and with confidence, and above all must be willing to offer assistance whenever the need arises.

Being a First Aider

Most people can, by following the guidance given, give useful and effective first aid. However, first aid is a skill based on knowledge, training, and experience. The term “first Aider” is usually applied to someone who has completed a theoretical and practical instruction course, and passed a professionally supervised examination.

AIMS OF FIRST AID
 >To preserve life
 >To limit worsening of the condition
 >To promote recovery

THE FIRST AIDER IS:
 >Highly trained
 >Examined and regularly re-examined
 >Up-to-date in knowledge and skill

BEING A FIRST AIDER

The first aider learned from a manual or course is not quite like reality. Most of us feel apprehensive when dealing with “the real thing”. By facing up to cope with the unexpected.

Doing your part
First aid is not an exact science, and is thus open to human error. Even with appropriate treatment, and however hard you try, a casualty may not respond as hoped. Some conditions inevitably lead to death, even with the best medical care. If you do your best, your conscience can be clear.

Assessing risks
The golden rule is, “ First do no harm”, while applying the principle of “calculated risk”. You should use the treatment that is most likely to be of benefit to a casualty, but do not use a doubtful treatment just for the sake of doing something.

The “Good Samaritan”
This principle supports those acting in an emergency (but not those who go beyond accepted boundaries). If you keep calm, and you follow the guidelines ,you need not fear any legal consequences.
PROTECTING THE CASUALTY
To avoid cross-infection when giving first aid, if possible you should:
 >Avoid direct contact with body fluids where possible
 >Wash your hands
 >Wear protective gloves.
If gloves are unavailable, life-saving treatment must still be given.

YOUR RESPONSIBILITIES AS A FIRST AIDER
 >To assess a situation quickly and safely, and summon appropriate help.
 >To protect casualties and others at the scene from possible danger.
 >To identify, as far as possible, the injury or nature of the illness affecting a casualty.
 >To give each e early and appropriate treatment, treating the most serious condition first.
 >To arrange for the casualty’s removal to hospital, into the care of a doctor, or to his or her home.
 >To remain with a casualty until appropriate care us available.
 >To report your observations to those taking over care of the casualty, and to give further assistance if required.
 >To prevent cross-infection between yourself and the casualty as much as possible.

GIVING CARE WITH CONFIDENCE

Every casualty needs to feel secure and in safe hands. You can create an air of confidence and assurance by:
 being in control, both of yourself and the problem;
 acting calmly and logically;
 being gentle, but firm, with your hands, and speaking to the casualty kindly, but purposefully.

Building up trust
Talk to the casualty throughout your examination and treatment.
 >Explain what you are going to do.
 >Try to answer questions honestly to allay fears as best you can. If you do not know the answer, say so.
 >Continue to reassure the casualty even when your treatment is complete-find out about the next-of-kin, or anyone else who should be contacted about the incident. Ask if you can help to make arrangements so that any responsibilities the casualty may have, such as collecting a child from school, can be taken care of.
 >Do not leave someone whom you believe to be dying. Continue to talk to the casualty, and hold his or her hand, never let the person feel alone.

Talking to relatives
The task of informing relatives of a death is usually the job of the police or the doctor on duty. However, it may well be that you have to tell relatives or friends that someone has been taken ill, or has been involved in an accident.
Always check that you are speaking to the right person first. Then explain, as simply and honestly as you can, what has happened, and, if appropriate, where the casualty has been taken. Do not be vague or exaggerate; you may cause undue alarm, it is better to admit ignorance than to give misleading information.

Coping with children
Young children are extremely perceptive and will quickly detect any uncertainly on your part. Gain an injured or sick child’s confidence by talking first to someone he or she trust-a parent accepts you and believes you will help, this confidence will be conveyed to the child.
Always explain simply to a child what is happening and what you intend to do;
Do not talk over his or her head. You should not separate a child from his or her mother, father or other trusted person.

LOOING AFTER YOURSELF
It is important not to jeopardize your personal safety. Do not attempt heroic rescues in hazardous circumstances.

Coping with unpleasantness
The practice of first aid can be messy, smelly, and distasteful, and you may feel that you will not be able to cope with this. Such fears are common but usually groundless. First-aid training will bolster your self-reliance and confidence and will help you to control your emotions in a difficult situation.

Taking stock after an emergency
Assisting at an emergency is a stressful event, and you may suffer a delayed reaction some time afterwards. You may feel satisfaction r even elation, but it is common to be upset, particularly if the casualty was a stranger and you might not know the outcome of your efforts.

PROTECTING YOUR SELF AGAINST INFECTION

You may worry about picking up infections from casualties. Often, simply measures such as washing your hands and wearing gloves will protect both you and the casualty from cross-infection.
However, there is a risk that blood-borne viruses, such as hepatitis B or C and HIV (which can lead to AIDS-Acquired Immune Deficiency Syndrome), may be spread by blood-to-blood contact.
These viruses can be transmitted only if an infected person’s blood makes contact with a break in the skin, such as a cut or abrasion containing blood or blood products, of another person. No evidence exists of hepatitis or HIV being passed on during mouth-to-mouth resuscitation.
To prevent cross-infection, you should:
 always carry protective gloves;
 cover your own sores or skin wounds with a waterproof plaster;
 wear a plastic apron when dealing with large quantities of a casualty’s body fluids and wear plastic glasses to protect your eyes against splashes;
 take care not to prick yourself with any needle found on or near the casualty, or to cut yourself on glass;
 if your eyes, nose or mouth or any wound on your skin is splashed by the casualty’s blood, wash thoroughly with soap and water as soon as possible, and consult a doctor;
 use a mask or face shield for mouth to mouth ventilation if the casualty’s mouth or nose is bleeding;
 dispose of blood and waste safely after treating the casualty

Seeking immunization
First Aiders should seek medical advice on hepatitis B immunization from their own doctors. If, after giving first aid, you are concerned that you have been in contact with infection of any sort, seek further medical advice.

Thick and Thin Skin: Getting a Grip on Their Differences

2007-01-08T10:56:00.000-08:00

The skin is the largest organ in the body, weighing about 4 kg. Though it appears uniform in structure and function. Its thickness in fact varies, from less than 1 mm covering the eyelids to more than 5 mm on the upper back. Many of the functional differences between skin regions reflect the thickness of the epidermis and not the skin's overall thickness. Based on epidermal thickness, skin can be categoraized as thick (about 1 mm deep) or thin (about 0.1 mm deep).
Areas of the body exposed to significant wear and tear (the palms, fingertios, and bottoms of the feet and toes) are covered with thick skin. It is composed of a thick stratum corneum and an extra layer not found in thin skin, the stratum lucidum, both of which make thick skin resistant to abration. Thick skin is also characterized by epidermal ridges (e.g, fingerprints) and numerous sweat glands, but lacks hair and sebaceous (oil) glands. These adaptations make the thick skin covering the hand and feet effective for grasping or gripping. Thick skin's dermis also contains many sencory receptors, giving the hands and feet a superior sense of touch.
Thin skin covers area of the body not exposed to much wear adn tear. It has a very thin stratum lucidium. Though thin skin lacks epidermal ridges and has fewer sensory receptors than thick skin, it has several specializations that thick skin does not. Thin skin is covered with hair, which may help prevent hear loss from the body. In fact, hair is most densely distributed in skin that covers regions of great heat loss--the head, axille (armpits), and groin. Thin skin also contains numerous sebaceous glands, making it supple and free of cracks that may let infectious organisms enter.

Surgical Management of Stones

2007-01-02T10:10:00.000-08:00

Normally, urine contains chemicals that prevent crystals from forming. But what happens when you start to have pain in your back or side or you are having problems with urination? Could you be one of the thousands of people with kidney stones? The information below should give you a head start about this potentially serious health hazard.

What happens under normal conditions?

The kidney performs many functions, the most important of which is the filtering of blood to remove toxins. Blood flows into the filtering component of the kidney called the glomerulus. The filtered portion of the blood then progresses through channels within the kidney, called tubules, which perform "fine tuning" of the filtering process. The final product of the filtered blood is urine, which gathers briefly in the renal pelvis and then is transported down the ureter, the muscular tube that carries urine to the bladder.

What are kidney stones?

Normally, urine contains many dissolved substances. At times, some materials may become concentrated in the urine and form solid crystals. These crystals can lead to the development of stones when materials continue to build up around them, much as a pearl is formed in an oyster.

The incidence of urolithiasis, or stone disease, is about 12 percent by age 70 for males and 5 percent for females in the United States. The debilitating effects of urolithiasis are quite substantial, with patients incurring billions of dollars in treatment costs each year. Stones occur more commonly in men than women, at a ratio of 3-to-1. In general, the peak incidence of stones occurs when a person is in their 30s.

The majority of stones contain calcium, with most being comprised of a material called calcium oxalate. Other types of stones include substances such as calcium phosphate, uric acid, cystine and struvite.

What are some risk factors for kidney stones?

A number of risk factors play major roles in stone formation. The first is loss of body fluids (dehydration). When one does not consume enough fluids during the day, the urine often becomes quite concentrated and darker. This increases the chance that crystals can form from materials within the urine, because there is less fluid available to dissolve them.

Diet can also affect the probability of stone formation. A high-protein diet can cause the acid content in the body to increase. This decreases the amount of urinary citrate, a "good" chemical that helps prevent stones. As a result, stones are more likely to form. A high-salt diet is another risk factor, as an increased amount of sodium passing into the urine can also pull calcium along with it. The net result is an increased calcium level in the urine, which increases the probability for stones. Intake of oxalate-rich foods such as leafy green vegetables, tea or chocolate may also worsen the situation.

Finally, a family history of stones, especially in a first-degree relative (parent or sibling), dramatically increases the probability of having stones.

What are the symptoms of kidney stones?

Once stones form in the urinary tract, they often grow with time and may change location within the kidney. Some stones may be washed out of the kidney by urine flow and end up trapped within the ureter. Stones usually begin causing symptoms when they block the outflow of the urine leading to the bladder.

Symptoms of an obstructing stone can vary. Most often, patients will complain of pain centered in their sides (flank), which may also radiate toward the front of the abdomen or to the groin area. At times, the pain may become so severe that the patient becomes unable to find a comfortable position. Blood in the urine (hematuria) may also appear when a stone is present. In some patients, especially those with diabetes, a fever may develop from infected urine that becomes trapped behind a stone. This is a medical emergency, as a bacterial infection that is not drained can cause a critical illness.

How are kidney stones diagnosed?

When a urinary stone is suspected, an immediate evaluation is required. Blood is obtained to check on overall kidney function as well as to exclude signs of infection throughout the body. Urine is sent for a urinalysis and culture. A simple X-ray of the abdomen is sometimes enough to pinpoint a calcification in the area of the kidneys or ureters, thus identifying a likely obstructing stone. If the X-ray film does not provide enough information to make a diagnosis, then an intravenous pyelogram (IVP) may be performed. A kidney blocked by a stone will not be able to excrete the dye from the IVP test as quickly and may appear enlarged. A final diagnostic exam that can be done is an abdominal/pelvic CT scan, which is very sensitive and can detect almost all types of urinary stones.

The abovementioned tests give your urologist information about the size, location and number of stones that are causing the symptoms. This allows the urologist to determine appropriate treatments.

How are kidney stones treated?

Stone size, the number of stones and their location are perhaps the most important factors in deciding the appropriate treatment for a patient with kidney stones. The composition of a stone, if known, can also affect the choice of treatments. Options for surgical treatment of stones include:

Shock Wave Lithotripsy (SWL): This is a completely non-invasive form of treatment in which an energy source generates a shock wave that is directed at a urinary stone within the kidney or ureter. Shock waves are transmitted to the patient either through a water bath, which the patient is placed in, or using a water-filled cushion that is placed against the skin. Ultrasound or fluoroscopy is used to locate the stone and focus the shock waves. The repeated force caused by the shock waves fragments the stone into small pieces.

SWL is most often performed under heavy sedation, although general anesthesia is sometimes used. Once the treatment is completed, the small stone particles then pass down the ureter and are eventually urinated away. In certain cases, a stent may need to be placed up the ureter just prior to SWL to assist in stone fragment passage.

Certain types of stone (cystine, calcium oxalate monohydrate) are resistant to SWL and usually require another treatment. In addition, larger stones (generally greater than 2.5 centimeters) may break into large pieces that can still block the kidney. Stones located in the lower portion of the kidney also have a decreased chance of passage.

Ureteroscopy (URS): This treatment involves the use of a very small, fiber-optic instrument called a ureteroscope, which allows access to stones in the ureter or kidney. The ureteroscope allows your urologist to directly visualize the stone by progressing up the ureter via the bladder. No incisions are necessary but general anesthesia is used.

Once the stone is seen through the ureteroscope, a small, basket-like device can be used to grasp smaller stones and remove them. If a stone is too large to remove, a laser, spark-generating probe or air-driven (pneumatic) probe can be passed through a channel built into the ureteroscope and the stone can be fragmented.

A straightforward case is complete once the stone has been shattered appropriately. However, if extensive manipulation was required to reach and/or treat the stone, your urologist may choose to place a stent within the ureter to allow the post-operative swelling to subside.

Percutaneous nephrolithotomy (PNL): PNL is the treatment of choice for large stones located within the kidney that will not be effectively treated with either SWL or URS. General anesthesia is required to perform a PNL. The main advantage of this approach compared to traditional open surgery is that only a small incision (about one centimeter) is required in the flank. The urologist then places a guide wire through the incision. The wire is inserted into the kidney under fluoroscopic guidance and directed down the ureter. A passage is then created around the wire using dilators to provide access into the kidney.

An instrument called a nephroscope is then passed into the kidney to visualize the stone. Fragmentation can then be done using an ultrasonic probe or a laser. Because the tract allows passage of larger instruments, your urologist can suction out or grasp the stone fragments as they are produced. This results in a higher clearance of stone fragments than with SWL or URS.

Once the procedure is complete, a tube is left in the flank to drain the kidney for several days.

Open surgery: A large incision is required in order to expose the kidney or portion of ureter that is involved with the stone. The portion of kidney overlying the stone or the ureteral wall is then surgically cut and the stone removed.

At present, open surgery is used only for very complicated cases of stone disease.

What can be expected after treatment for kidney stones?

Recovery times vary depending upon treatment, with the less invasive procedures allowing shorter recovery periods and quicker return to activity.

Shock Wave Lithotripsy (SWL): Patients generally go home the same day as the procedure and are able to resume a normal activity level in two to three days. Fluid intake is encouraged, as larger quantities of urine can help stone fragments to pass. Because the fragments need to pass spontaneously down the ureter, some flank pain can be anticipated. It is possible that the stone may not have shattered well enough to pass all of the fragments. If so, a repeat SWL treatment or other option may be required. If a stent was placed prior to SWL, this will need to be removed in your urologist's office within a few weeks. Stents are usually well tolerated by patients but can occasionally cause some bladder irritation and frequent urination.

Ureteroscopy (URS): Patients normally go home the same day and can resume normal activity in two to three days. As with SWL, if your urologist places a stent, it will need to be removed in approximately one week.

Percutaneous nephrolithotomy (PNL): After PNL, patients usually spend two to three days in the hospital. Your urologist may choose to have additional X-rays done while you are still in the hospital to determine if any stone fragments are still present. If some remain, your urologist may want to look back into the kidney with a nephroscope to remove them. This secondary procedure usually can be done with sedation and through the existing tract into the kidney. Once the stones have been removed, the stent coming out of the flank is removed and the patient can be discharged. Normal activity can be resumed after approximately one to two weeks.

Open surgery: Because these procedures are the most invasive and painful, patients often spend up to five to seven days in the hospital. Full recovery may take up to six weeks.

Postoperatively, your urologist will encourage a high fluid intake, to keep the daily volume of urine produced greater than two liters a day. In addition, you may need to undergo additional blood and urine tests to determine specific risk factors for stone formation and help minimize the chance for future stones. Although stone recurrence rates differ with each individual, a good estimate to keep in mind is a 50 percent chance of redeveloping a stone within a five-year period.

Frequently Asked Questions:

What are the risks or potential complications of the various treatments?

Each treatment has its own inherent risks. Some risks that can be associated with all surgical procedures are the possibility of bleeding and infection. It is extremely rare for patients undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) to have any problems with blood loss or infection. The probability is higher with more invasive treatments such as percutaneous nephrolithotomy (PNL) or open surgery. In most cases, patients do not require transfusion unless the procedure is unusually difficult.

With SWL, except in emergencies, patients must avoid aspirin, non-steroidal anti-inflammatory drugs such as ibuprofen or other blood thinners, as these can cause significant bleeding around the kidney. It is important that these medications be stopped at least one week prior to treatment if possible. SWL is generally a very safe treatment. Long-term follow up of patients has shown a slight increase in blood pressure, but no lasting adverse effect on kidney function has been noted.

In URS, there is a small possibility that the ureteral wall could be damaged or torn during the procedure. If this occurs, placement of a stent for two to three weeks is usually sufficient to allow the damaged area to heal. A complete tear of the ureter is very rare and requires open surgery to repair.

When PNL is performed, there is a small chance of air or fluids forming around a lung if the access channel is made toward the upper portion of the kidney. These entities are treated with a chest tube, which allows drainage of the fluid from around the lung. Other rare complications include injury to the bowel and injury to blood vessels within the kidney.

Will I have significant pain after the procedure?

Some discomfort is inevitable after surgical intervention for stones. The degree of discomfort is directly related to the invasiveness of the procedure. If needed, your urologist will prescribe medication to help control the pain during the recovery period.

What are signs of a problem postoperatively?

It is not uncommon for a patient to have a low-grade fever for the first 48 hours after surgery. However, if the fever continues or rises above 101.5° F (38.5° C) it could be a sign of active infection and should be reported to your urologist. Flank discomfort is also common after surgical interventions. However, if the pain becomes increasingly worse or unbearable, despite medication, your urologist should be notified.

How many times will I need to be treated?

The answer to this question depends on the size of stone and the treatment used. The chances for re-treatment are highest after SWL if the stone is large, extremely hard or in the lower portion of the kidney. PNL and open surgery tend to produce the highest stone-free rates.

New experimental vaccine blocks tranmission of malaria in mice

2006-12-21T02:19:00.000-08:00

Chicago: US researchers said yesterday that they had developed an experimental vaccine that would neutralize the malaria parasite that carries the most deadly form of the disease inside its mosquito host.
The vaccine targets the mnicroscopic parasite, Plasmodium falciparum, inside the gut of the mosquito, blocking the organism's development, thereby preventing further transmission of the disease.
Scientists at the National Institutes of Health, (NIH) took a protein which is only present in the parasite during its time in the mosquito gut and souped it up by combining it with other proteins.
When it was administered to mice, the souped-up protein created long-lived antibodies, according to the study published in the proceedings of the National Academy of Sciences USA.

Previous studies have shown that antibodies againts the protein, Pfs 25, in the blood meal of mosquitoes can hinder parasite development.
malaria affects up to 500 million people and kills more than one million children each year, mostly in africa, but a vaccine against the disease still eludes scientists despite decades' of research.
The most severe form of the disease is caused by the Plasmodium falciparum parasite, which, once in a human's bloodstream, travels to the liver where it multiplies. New forms of the parasite are then released into the blood where they invade red blood cells, ultimately destroying them.

ileal conduit

2006-12-16T08:32:00.000-08:00

A surgical procedure in which the normal flow of urine is diverted through a segment of the small bowel to a collection bag outside of the abdomen. Also called a urostomy. Ileal conduits may be performed when the bladder has been removed

An ileal conduit urinary diversion is a surgically-created urinary diversion used to create a way for the body to store and eliminate urine for patients who have had their urinary bladders removed as a result of bladder cancer or pelvic exenteration.

To create an ileal conduit, the ureters are surgically unattached from the bladder and made to drain into a detached section of ileum (a part of the small intestine). The end of the ileum is then brought out through an opening (a stoma) in the abdominal wall. The urine is collected through a bag that attaches on the outside of the body over the stoma. The bag must be periodically emptied of urine.

Indications for radical cystectomy are outlined below.
Flat in-situ transitional cell carcinoma (TCC) of bladder usually where BCG therapy has failed (T1b).
Multiple papillary tumours of bladder uncontrolled by endoscopic means (Ta, T1).
Invasive TCC of bladder (T2, T3).
Bladder TCC invading the prostate (T4a).
Squamous carcinoma of the bladder.
Sarcoma of the bladder.

This is a major procedure and the patient must be assessed for fitness, independent of age.

Admission

The patient is brought into the ward two days prior to surgery and started on a low residue diet. The stoma nurse, or similar counsellor, is booked to discuss the practical aspects of the stoma and show the patient the fitting of the appliance. The patient is shown how to change this and, after discussion, the site for the stoma is chosen below the belt line, paying particular attention to skin folds and avoiding previous scars. This site is marked with an indelible skin pencil.

On the day prior to surgery, the patient is patch tested for iodine. The patient is only permitted clear fluids to drink. Low molecular weight Heparin is given subcutaneously on the day before surgery and until the patient is mobilised and compression (TED) stockings applied.

Picolax sachets are given at 10am and again at 2pm. If there is no result, a Microlax enema can then be given (or a high phosphate enema, if the patient has not opened their bowels for several days). If the patient is frail, urea and electrolytes may be checked on the morning of surgery to identify hypokalaemia. An IV infusion may be requested overnight prior to surgery.

Where high dependency unit facilities are available, epidural analgesia is beneficial and may be mandatory if the patient has pulmonary disease. The pain team discuss analgesics. The physiotherapist instructs the patient on breathing and leg exercises. Where the patient is unfit, it is also prudent to ensure that there is an intensive therapy unit (ITU) bed available.

PROCEDURE

Antibiotics (Augmentin and Metronidazole) are given intravenously soon after anaesthetic induction. The patient is catheterised with a 16 French Foley catheter and the bladder drained. The patient is prepared using an iodine skin preparation, draped exposing the abdomen from xiphisternum to pelvis. The cross marking at the prepared site for the conduit is then transfixed with a silk or Vicryl suture, so that the mark of the site for the conduit does not become obliterated during the operation. In females, the vagina is packed with an iodine soaked swab.

Approach

The abdomen is opened. Nowadays, the patient will have previously had an abdominal and a pelvic CT scan, but it is sensible just to check that no large lesion has been missed in the liver (smaller lesions are, paradoxically, usually identified). At this stage, it is also easy to free the greater omentum. Two dry packs are used to retract the abdominal contents and a ring retractor is then placed in position.

The first approach is to open the retroperitoneal space and expose each obturator fossa in turn. Any lymph nodes are excised and sent in separate jars to the pathology laboratory.

The lymph nodes are dissected, taking all tissue medial to the genitofemoral nerve off the iliopsoas muscle and the external iliac vessels, including the fat pad at the inguinal ligament. The lymph node (Cloquet’s node) at the femoral canal, is also removed. The obturator nodes are removed and they lie between the external and internal iliac vessels The obdurator nerve is exposed, running across the picture at the end of the forceps

At this stage, it is useful to expose the ureters and place sloops around each. The bladder can then be mobilised gradually. At this stage it is possible to decide whether the bladder can be removed. If the scans are accurate, it is rare that this decision has to be reversed. Once this decision is made, the ureters can be divided at leisure. I place 2.0 Vicryl sutures around each distal end of the ureter and leave long tails. This is to allow the ureters to dilate, stops urine washing into the peritoneal cavity and the long tails allow easy identification at a later stage.

The vasa deferentes (or the round ligaments in females) are divided bilaterally (to avoid small bowel strangulation). The pedicles of the bladder can be divided, using a mixture of sharp and blunt dissection and automatic clips. The superior and inferior vesical arteries carry most of the blood supply. The pelvic fascia may be opened on either side of the bladder and Santorinis’ venous plexus divided, as one would with a radical prostatectomy. This can allow much easier mobilisation of the bladder and prostate. The parietal peritoneum over the bladder should be removed to allow the small bowel ultimately to fall into the pelvic cavity. Failure to do this can lead to a pyopelvis.

The bladder is removed and any obvious bleeding points diathermied or tied. A dry pack is then placed in the pelvis and attention is then turned to fashioning the ileal conduit. The appendix is identified and, because continent diversion is not being used, there is still a strong argument for removing the appendix, since appendicitis in patients with an ileal conduit can be very difficult to diagnose.

Ileal Conduit

The terminal ileum is then identified and a portion of ileum is isolated, avoiding the terminal 25cm of terminal ileum, which is where bowel salts are reabsorbed.

Identification of the terminal ileum

The distance can be measured. The small bowel is trans-illuminated using a satellite lamp at right angles to the bowel
Trans-illumination of mesentery aids identification of vessels

The small bowel is divided between non crushing Doyens clamps. At this stage, I find it very helpful to identify the terminal end of the conduit, by marking it with a long Vicryl suture. It is remarkably easy to get these ends reversed during a longer procedure and identification at this stage avoids difficulties later on.

The small bowel is re-anastomosed using controlled release 3.0 Nurolon (Polyamide 6 braided non absorbable, Ethicon) sutures and the window of the mesentery is repaired using interrupted absorbable sutures (2/0 Vicryl). In most cases, the small bowel sits better in an inferior position, below the anastomosis. A Backhaus towel clip can be used to approximate the Doyens clamps while the anastomosis is performed.

The distal ends of the ureters can then be identified using the long tags suture and tunnels are made so that the created gap in the posterior layer of the peritoneum acts as a window, through which the ureters are drawn The left ureter is drawn through the sigmoid mesocolon. Once again the long tags of Vicryl may be used to assist this.
Figure 5a (left) and 5b (right)

The two ureters are drawn through the window in the posterior layer of peritoneum using the long tags of sutures

The conduit is irrigated with a normal saline solution, ensuring that any remaining debris is removed.

Both ureters are joined together as the posterior layer of the Wallace I anastomosis The long tags of suture are used to secure the ureters during this and then the redundant distal ureter is excised at leisure, care being taken to ensure that the entire area remains well vascularised. If the ureters are short, a Wallace II anatomosis can be fashioned

The ends of the ureters are then spatulated and the terminal ends of Vicryl sutures can be held together until the anastomosis is partially fashioned. At this stage, size 6 Fr infant feeding tubes are passed into each ureter and drawn through the conduit

The conduit is sutured to the right side of the anastomosis and a stent is depicted in the right ureter, running through the conduit. Note the marker suture on the distal end of the conduit; this can be used to guide the conduit to the anterior abdominal wall at a later stage

The cap on the infant feeding tube is taken off the left one (shorter tube, shorter number of letters) and I found that a 3.0 Vicryl suture placed through the ureter, but not through its maximum circumference anchors the tube. The suture must of course be absorbable. Alternatively, a No. 8F single J stent may be used and does not need suturing. I use the method described by Wallace, and usually a Wallace 1.(3)

The anastomosis is then completed. At this stage, the integrity of the anastomosis is tested using 50mls of saline, injected gently with a bladder tip syringe into the distal end of the conduit. Any small leaks are sutured.

Fashioning of the stoma

The silk or Vicryl stitch on the skin, at the site of the stoma is lifted. This allows an easy excision of a circular area of skin

The suture is pulled anteriorly to allow excision of circular area of skin

A tract is then fashioned through the muscle layers (preferably through rectus abdominis to avoid parastomal hernias), into the abdomen and the distal end of the conduit is drawn through the skin. Care must be taken that there is no obstruction at this point

The stents have already been drawn through the abdominal wall and the distal end of conduit is eased through the abdominal wall using non-crushing clamps and the long suture

It is imperative that there is no tension on this anastomosis. If there is any tension or marked ischaemia, then a new conduit must be fashioned. The ends of the conduit are turned back on themselves, with four sutures 4.0 Dexon (Davis and Geck) at each corner, securing the distal end to the lower proximal area, thus everting the stoma

The anastomosis can then be dropped back into the retroperitoneum, but at this stage, the omentum is drawn down and wrapped around this area, to allow for revascularisation. Any redundant omentum is also placed near the small bowel anastomosis. At this point the attention is then turned to the pelvis again. Any residual bleeders can be dealt with at leisure.

SPECIFIC COMPLICATIONS

Apart from any general complications, occurring with any major surgery, specific complications are associated with the procedure and are listed in Table 2.

Urinary leakage
Lymphatic leakage
Ileus

Late (after 6 weeks)
Recurrent UTI
Parastomal hernia
Ureteric strictures - probably ischaemic
Stomal infarction - ischaemic
Stomal retraction
Stomal stricture
Acidosis
Bilateral hydronephrosis
Renal stone

World AIDS Day

2006-12-08T09:05:00.000-08:00

25 million people have died of AIDS since 1981

According to UNAIDS, each day 1,500 children around the world become infected with HIV, most of them newborns. Fewer than one in five poeple worldwide, at risk of becomeing infected with HIV has access to basic prevention services. Around the world, only one in eight people who want to be tested are able to do so.
Increasing available prevention strategies in 125 low and middle-income countries would have avert an estimated 28 million new infections between now and 2015 more than half of those that are projected to occur during this period-and would save $24 billion in related treatment costs.
To mark World AIDS Day in Dec1, we look at key events in the history of the disease and some of the famous names that have been affected by it.

Origins

Scientists believe the simian immunodefeciency virus spread from monkeys to human between the 1920s and 1940s, perhaps through African hunters` contact with infected animals.

1959
A man in with is now Kinshasa. Congo dies after exhibiting symptoms resembling sickle-cell anemia. Doctors save samples of his blood, and researchers later determine that he had the first known case of AIDS.

1969
A 15-years-old St louis boy suspected of prostitution dies of mysterious causes; tests of his blood later prove he was HIV-positive.

1978
Multiple cases of what will be known as AIDS appear in the US and elsewhere among gaymen.

1981
> Centers for Disease Control reports on June 5 that five homosexual men in Los Angeles were treated for a rare type of pneumonia and two died.
> On July 4, CDC reports 26 cases of Kaposi's sarcoma, a rare form of cancer, among gay men.
> The disease is first called "gay cancer", then gay related immune deficiency (GRID). In october, CDC declares the disease an epidemic.

1982
CDC renames the disease AIDS, acquiredd immune deficiency syndrome.

1983
> Scientists at France's Pasteur Institute discover what is later named human immunodeficiency virus, or HIV, the virus that causes AIDS.
> Researchers confirm that the virus can be spread by heterosexual contact.

1985
> Ryan White, a 13-year-old Indiana boy who contacted AIDS from a blood transfusion, is barred from attending school and becomes a poster child for the stigma associated with disease.
> Movie star Rock Hudson dies of AIDS, makinng the disease a household word.

1986
President Reagen says research is a top priority to combat this "major epidemic public health threat."

1987
AZT, the first drug approved to fight HIV, goes on the market at a cost of $10,000 for a one-year supply

1988
Dec 1 is named World AIDS Day.

1989
Responding to two years of protests, Burroughs wellcome lowers the price of AZT by 20 per cent.

1990
>Ronald Reagan apologises for his neglect of the epidemic during his presidency.
>President Bush signs the Americans with Disabilities Act, banning discrimination againts people with disabilities, including those with HIV.
>American fashion designer Halston and 18-year-old Ryan White die of AIDS.

1991
> los Angeles Lakers star Earvin "Magic " Johnson announces that he is HIV-positive, having become infected by heterosexual activity.
> Freddie Mercury, lead singer of Queen, dies a day after announcing that he has AIDS.

1992
> The FDA begins an accelerated approval process for AIDS drugs.
> Actor Robert Reed, who played the father on "The Brady bunch," dies of AIDS.

1993
> "Angels in America," a play about AIDS, win the Ashe die of AIDS.

1994
> HIV becomes the leading cause of death for American men between 25 and 44 years old.
> The first "AIDS czar," Kristine Gebbie, resigns after months of criticsm that she is ineffective at coordinating AIDS policy.
> Activist Elizabeth Glaser and author Randy Shilts die of AIDS.

1995
> AIDS patient Jeff Getty receives a controversial bone marroe transplant from a baboon.
> Olimpic diver Greg Lougains announces that he has AIDS, raising questions about whether other divers were exposed to infection when he hit his head on a diving board and bled intio pool at the 1988 Olimpics.
> Rapper Eric "Eazy-E" Wright, a cofounder of the NWA rap group, dies of AIDS.

1996
> Heavyweight boxer Tommy Morrison, a former WBO world champion, is found to be HIV positive after a mandatory test by boxing authorities, forcing him to retire.
> "Rent" a play featuring characters with AIDS, wins the Tony Awards for best musical.
> Time magazine names AIDS researcher David Ho its man of the year.

1997
US AIDS deaths fall 40 per cent from the previous year, primarily due to a combination of drugs called an AIDS cocktail

1998
African Americans account for 49 per cent of all US AIDS deaths.
UN directive discourages women with HIV from breast-feeding.

1999
CDC's HIV Prevention Conference notes that new AIDS cases and AIDS deaths have levelled off but warns against complacency.

2000
South African President Thabo Mbeki, whose country has the most AIDS cases, causes an uproar by asserting that AIDS is not caused by HIV but is a byproduct of peverty.

2001
> The UN adopts a global blueprint for action against AIDS including increased funding, education and distribution of drugs.

2002
> FDA approves an HIV testing device, OraQuick, that produces resu;ts in 20 minutes.
> South Africa's version of"Sesame Street" introduces an HIV-positive Muppet, Kami.

2003
> President Bush launches an initiative to spend $15 billion over five years to combat AIDS in Africa and Th Caribbean.

2004
> FDA approves a new version of the OraQuick HIV test that uses saliva instead of blood

2005
> Scientists reportmthat more than 40 million people worldwide are living with HIV.
> Nelson Mandela discloses that his 54-year-old son, Makgatho Mandela, has died of AIDS.

2006
june 5 marks the 25th anniversary of the first CDC report about AIDS.
UNAIDS estimates hat 25 million people worldwide have died of AIDS since 1981.

CAUTION

AIDS is the most killing disease in the world. Who are the next targets? Save your live, and other right now.

Obesity

2006-08-23T23:43:00.000-07:00

Obesity

By; Sandi Effendi
urology staff nurse mubarak al kabeer hospital, kuwait

Obesity is an overabundance of body fat resulting in body weight of 20% or more than the average weight for the person’s age, height, sex, and body frame. Increasingly, obesity is being diagnosed using the Body Mass Index (to account for body build) and/or Body Surface Area and Basal Metabolic Rates (to account for metabolic activity for the person). A BMI greater than 30 is considered obese. About 18% of American are obese (up from 12% in 1991) and 63& of men and 55% of women are over weight.

Pathophysiology and etiology
1. Increasing evidence reveals that heredity plays a part in the development of obesity. Identical twins raised apart are more likely to have similar amounts of body fat than fraternal twin raised separately.
2. Environment plays a role.
a. Some evidence shows that children reared by obese parents have an increased tendency toward obesity.
b. In addition, social class may be associated with more weight-conscious behavior.
3. A variety of psychological factors may contribute to weight gain, including depression and anxiety.
4. Physiologic factors
a. Endocrine abnormalities (rare causes of obesity)-Cushing’s syndrome, hypothyroidism, hypogonadism, or hypothalamis lesions.
b. Age-advancing age may be associated with obesity often because of changes in activity level or in women, because of hormonal changes; early childhood and the start of puberty may also be associated with obesity.
(i) Overeating after puberty may increase the total number of fat cells.
(ii) Despite dieting, these extra ft cells can never be eliminated; they only decrease in size.

Clinical Manifestation
1. Body weight greater than 20% of acceptable weight for eight or BMI > 30.
2. Increased weight is correlated with increased incidence of:
a. Cardiovascular disease
b. Diabetes mellitus

Diagnostic evaluation
Conservative Measures
1. Diet therapy-has been controversial, but a well-balanced diet containing all the major food groups is still advised.
a. One thousand calories per day must be eliminated from a diet to lose 1 kg (2.2 lb) of body weight per week.
b. A 1,200-calorie diet for women and a 1,500-calorie diet for men with variations depending on patient size and activity level are basic to diet management. Fats should compose no more than 30 % of all calories, proteins approximately 15 to 20% and carbohydrates should constitute the remaining portion
c. A balance of food groups is essential to maintain vitamin and nutrient balance. Nutrient supplements may be necessary (iron, B6,Zinc, and folate)
d. Food preparation, should include seasoning with herbs, onion, garlic, and pepper, and foods should be baked, broiled, steamed, or sauteed using minimal polyunsaturated oil.
e. Food attractively arranged on smaller plates, using whole rather than processed foods and eaten slowly, will assist the overall process
f. Eliminating entire food groups from the diet, such as carbohydrates (in many popular protein and fat-based diets), will eventually result in craving of those foods eliminated, disruption of normal metabolic processes, and quick weight gain when the food is added to the diet.
2. Exercise—a daily exercise program may include walking or other aerobic activities for approximately 180 minutes per week, or 1 hour at least three times a week, however daily exercise is optimal.
3. Behavior modification is a cornerstone of any successful diet.
a. Identify and eliminate situations or cues leading to overeating or high-calorie foods with use of a food diary.
b. Provide positive reinforcement of proper dietary habits.
c. Should a lapse in diet habits occur, focus on a prompt and positive return to appropriate dietary habits
d. Stress reduction techniques, such as visual imagery or progressive relaxation; peer support may be helpful

Pharmacotherapy
1. Anorexia medications, such as amphetamines and norepinehrine-releasing agents or reuptake inhibitors, reduce appetite and stimulate weight loss initially.
2. However, tolerance develops within 2 to 4 weeks and weight is rapidly regained when the drugs are discontinued
3. Numerous long-term studies have failed to show long term success with these agents
4. Phentermine (Ionamin, Fastin) is one of the most widely prescribed agents; however, it causes stimulating effects and should not be used in uncontrolled hypertension, advanced heart disease, history of drug abuse, and with MAO inhibitors.
5. Sibutramine (Meridia) is a mixed neurotransmitter reuptake inhibitor that acts on the central nervous system to reduce appetite.
a. The long-term risks of the medication are not known, but it must be used cautiously with hypertension, coronary artery disease, heart failure, arrhythmia, renal and hepatic impairment, narrow angle glaucoma, and seizure disorders.
b. Multiple drug interactions include monamine oxidase inhibitors, other serotonic drugs (selective serotonin reuptake inhibitors (SSRIs) antidepressants, sumatriptahn and other migraine agents), lithium, dextromethorphan, and possible erythromycin and ketoconazole.
c. Side effects include dry mouth, constipation, dizziness, nervousness, insomnia. Has not been shown to be addictive.
6. Recently, scientists have found success in weight loss with the use of orlistat (xenical), agastrointestinal lipase inhibitor, which blocks the breakdown of fat in the GI system. About 30% of dietary fat is eliminated.
a. Side effects include oily or fatty stools, flatulence, and GI distress.
b. Long term safety of the drug has not been determined, but addition of fat-soluble vitamin supplement (vitamin A,D,E,K and beta carotene) taken prevent a theoretical vitamin deficiency.
c. Should not be used in cases of cholestasis or malabsorption.
d. These medications are only adjunct to diet and exercise therapy.

Surgical Interventions
Numerous surgical procedures have been used. However, gastroplasty is the current procedure of choice. These therapies are generally reserved for morbidity obese patients who cannot lose weight through the above therapies.
1. Gastroplasty-most common procedure is vertical banding involving creation of a 30 ml pouch along the lesser gastric curvature with a small outlet created with the use of a ring of plastic at the distal end to prevent dilation
2. Gastric bypass-a Roux-en-Y gastroenterostomy is constructed by first creating a 50 –ml pouch in the proximal stomach by stapling horizontally and completely separating the smaller proximal stomach pouch from the larger distal stomach pouch. To this proximal pouch, the distal jejunum is attached, thus bypassing the distal stomach pouch. The transected proximal portion of the jejunum is anastomosed to the distal jejunum.

Complications
1. Obesity is a risk factor for diabetes, gallbladder disease, osteoarthritis of weight-gearing joints, high blood pressure, and coronary artery disease.
2. Vitamin and mineral deficiencies because of surgical intervention and/or severely restricted diet
a. A moderate, well-balanced weight reduction diet will generally not cause deficiencies, although a multiple vitamin/ mineral supplement may be used
b. A low-calorie diet (fewer than 800 to 1,000 calories/day) will require careful monitoring and vitamin/ mineral supplements.

Nursing Assessment
1. Obtaining a complete nutritional assessment (may be in collaboration with a nutritionist)
2. Assess behavioral/ emotional components of eating, coping mechanism, and past successes/ failures with dieting.

Nursing diagnosis
 Altered Nutrition: More Than body Requirements related to high-calorie, high-fat diet, and limited exercise
 Fluid volume Deficit related to gastroplasty or gastric bypass surgery
 Self esteem Disturbance related to weight

Nursing Interventions
Modifying Nutritional Intake
1. Assist patient in assessing current dietary habits and identifying poor dietary habits
2. Assist patient in developing appropriate diet plan based on likes and dislikes, activity level, and lifestyle
3. Suggest behavior modification strategies, such as shortening lunch break, preventing access to quick snacks, eating only at mealtimes at the table
4. Provide emotional support to patient during weight reduction efforts positive reinforcement and creative problem solving
5. Provide patient with alternative coping mechanisms, including stress reduction techniques, such as progressive relaxation and guided imagery
6. Assess patient’s ability to tolerate exercise through measurement of vital signs before, during, and after exercise and ask about symptoms of shortness of breath and chest pain

Outcome Based Evaluation
 Five pound weight loss during first month
 No abdominal distention, nausea, vomiting, or wound infection
 verbalizes feeling good about self secondary to change in diet exercise habits

Source reference

The Lippincott seventh edition

Eczema

2006-08-23T13:05:00.000-07:00

Eczema
(infantile and childhood eczema)
by; Sandi Effendi
urology staff nurse in mubarak al kabeer hospital kuwait

Atopic dermatitis the most common cause of eczema in childhood, is a characteristic inflammatory response of the skin. The major problem features include pruritus, a typical
Morphology and distribution, a chronic or chronically relapsing nature, and personal or family history of atopy (asthma, hay fever, and atopic dermatitis). There is tendency toward dry skin and lower threshold of itching.
Atopic dermatitis affects 10 % to 15% of the childhood population. It usually starts after 2 months of age. By age 5, 90% of the patients who will develop atopic dermatitis have already manifested the disease. It may stop after an indefinite period of time, or it may progress from infancy to adulthood with little or no relief. It is rare of adults to develop atopic dermatitis without a history of eczema in childhood.

Pathophysiology and Etiology
1. Atopic dermatitis involves immunologic abnormalities, such as elevated immunoglobulin E levels and increased rates of sensitization to common contact allergens and to intradermal skin tests. Although the exact cause is unknown, there is a constitutional predispotition to develop pruritus. In general, the skin of patients with atopic dermatitis is different from that of healthy patients in the following respects:
a. Increased tendency toward dryness
b. Lowered threshold for pruritis from minor irritants, such as soap, perspiration, cold weather, and heat
c. Tendency toward lichenification (leathery thickening of skin ) and production of a rash when the skin is rubbed or scratched
2. The etiology is unknown but has familial tendencies. Almost 75 % of patients with this form of eczema will develop hay fever or asthma themselves.

Clinical manifestations
Age and Distribution of the lesions
Atopic dermatitis is divided into three phases based on the age of the patient and the distribution of the lesions. There are referred to as the infant, childhood, and adult phases.
1. Infant (2 months to 2 years):
a. The onset is between 2 and 6 months of age. Half of affected infants have spontaneous resolution by age 2 or 3
b. Characterized by intense itching, erythema, papules, vesicles, oozing, and crusting
c. The rash usually begins on the cheeks, forehead, or scalp and then extends to the trunk or extremities in scattered, often symmetric patches. The perioral, perinasal, and diaper areas are usually spared
2. Childhood (4 to 10 years):
a. Affected persons in this age group are less likely to have exudates and crusted lesions. Eruption are characteristically more dry and popular and often occur as circumscribed scaly patches. There is a greater tendency toward chronicity and lichenification
b. The typical areas of involvement are the face, including the perioral and perinasal areas, neck, antecubital and popliteal fossae, wrists, and ankles.
3. Adult (puberty to old age):
a. Predominant areas of involvement include the flexor folds, face, neck, upper arms, back, dorsa of the hands and feet, fingers, and toes.
b. The eruption appears as thick, dry lesions, confluent papules, and large lichenified plaques. Weeping, crusting, and exudation can occur, but they are usually the result of superimposed external irritation or infection.

Clinical Appearance
Atopic dermatitis is also divided into three stages based on the clinical appearance of the lesions. The acute, subacute, and chronic stages can occur in infants, children, and adults,
1. Acute moderate to intense eryhema, vesicles, a wet surface, and severe itching.
2. Subacute:
a. Erythema and scaling are present in various patterns with indistinct borders. The redness may be faint or intense. The surface is dry. There are varying degrees of pruritus.
b. The subacute stage may be an initial stage or may follow an acute inflammation or exacerbation of a chronic stage. Irritation, allergy, or infection can convert a subacute process into an acute one.
3. Chronic the inflamed area thickens and the surface skin markings become more prominent. Thick plaques with deep parallel skin markings are called lichenified. Lichenification is the hallmark of chronic eczema. The surface of the skin is dry and the border of the lesion well defined. There is moderate to intense itching.

Diagnostic Evaluation
Atopic dermatitis is usually a clinical diagnosis based on the evaluation of the aggregate of signs, symptoms, stigmata, course, and associated familial findings. The major features include pruritus, a characteristic morphology and typical distribution for the age of the patient, a chronic or chronically relapsing nature, and a personal or family history of atopical disease. When the diagnosis is in doubt, a skin biopsy may be performed.

Treatment
Acute
1. Open wet dressing for 1 to 3 days
2. Avoidance of any known allergen
3. Topical corticosteroids
a. Topical corticosteroids are ranked into seven groups according to potency. Group 1 contains the most potent topical steroids and group 7 the least potent ones. The concentration listed on the medication does not correlate with its potency or safety, but is merely a statement of its specific chemical formulation.
b. Very potent (Group 1) topical corticosteroids are avoided in children younger than 12 years of age because of greater skin absorption.
4. Oral medication to relieve itching- hydroxyzine hydrochloride (ataraz), diphenhydramine hydrochloride (Benadryl), or protmethazine hydrochloride (Phenergan). Diphenhydramine and promethazine cause more sedation than hydroxyzine hydrochloride. Mild sedation may be desirable.
5. Management of secondary infection, if present, with oral antibiotics
6. Initiation of a hypoallergenic diet to eliminate any responsible food for infants and young children with severe, recalcitrant atopic dermatitis
Subacute and Chronic
1. Prevention of dry skin:
a. Diminish the frequency and duration of bathing
b. Use mild soap and hydrophilic lotion
c. Lubricate the skin with emollients
d. Add tar preparations to the bath water
e. Maintain environmental humidity above 40% in winter months
2. Same measures as acute stage with exception of wet dressings

Nursing Assessment
1. Take a nursing history focusing on clinical manifestations:
a. Onset and duration of rash
b. Location, course, and distribution of lesions
c. Change in morphology of lesions
d. Local and systemic symptoms
e. Exposure to possible allergens
f. Previous episodes of rashes
g. Personal history of allergies, asthma, or hay fever
h. Family history of eczema, allergies, or hay fever
i. Medications, treatments tried, and their effect
2. Perform a physical assessment.
a. Examine the entire skin in an orderly fashion with specific attention to the type of lesion (ie, macule, papule, vesicle, etc), its appearance (shape, border, color, texture, and surface), and its distribution (areas of the body involved)
b. Note any associated symptoms, such as scratching, fever, or drainage.
3. Document findings:
a. Describe skin finding using dermatologic terminology
b. Draw pictures to facilitate communication.

Nursing Diagnoses
 Impaired skin Integrity or high risk for impairment, related to skin pathology and scratching
 Sensory/ Perceptual Alterations (Tactile), related to skin pathology
 Risk for infection related to increased bacterial colonization of skin and possible break in defensive barrier

Nursing Interventions
The nurse may perform the following interventions or teach the patient or family to do the following:
Improving skin integrity
1. Reduce inflammation during the acute stage with the topical application of open wet dressings.
a. Use a soft, lightweight cloth, such as a handkerchief, a thin diaper, or strips of bed sheeting. Do not use gauze (adheres to skin), washcloths, or towels (too heavy)
b. Open wet dressings should be clean. In certain situations, they should be sterile to prevent contamination.
c. Solutions should be lukewarm or at body temperature to soothe the skin and prevent chilling.
d. Compresses should be moderately wet, not dripping, and removed after 20 minutes, unless otherwise directed. They should be reapplied three to four times a day.
e. After the compress, a topical corticosteroid may be applied to further reduce itching and inflammation.
f. Observe the skin for changes in response to therapy
2. Prevent dry skin during the subacute and chronic stages.
a. Decrease the frequency and duration of bathing, long, hot tub are not be avoided.
b. Avoid hot water and harsh soaps. Patients should bathe in lukewarm water using mild soap (dove, Neutrogena); avoid bubble baths ;rinse well and pat skin dry with towel.
c. If bath water stings, add 1 cup of table salt.
d. Apply unscented emollients (eg, Eucerin, Keri, Lubriderm) within 3 minutes of bathing, when the skin is slightly moist. Creams and ointment are more effective than lotions because they are better at preventing evaporation of water from the skin. Bathing will dry and damage skin unless an emollient is applied immediately after existing bath.
e. Some patients may benefit from soaking in a tar bath for 15 to 20 minutes daily, preferably in the evening. Add to bath skin and clothing and may cause sunlight sensitivity.
f. For patient with extremely dry skin, cleanse with a hydrophilic lotion (eg. Cetaphil). Apply without water until light foam occurs. Remove by wiping with soft cotton cloth or cleansing tissue.
g. Keep environmental humidity above 40 % in winter months. Use a humidifier.
h. Observe the skin for changes in response to therapy.

Controlling Pruritus
1. Apply topical corticosteroids.
a. Apply a thin layer of topical corticosteroids to the affected skin two to four times a day as directed. Use only for the duration prescribed.
b. Observe for possible side effects from long-term use of topical corticosteroids (ie, striae, cutaneous atrophy, telangiectasia, acne, and growth retardation).
c. Note any scratching and intervene as necessary
2. Administer oral antipruritic medications
a. Give medications exactly as prescribed
b. Note the degree of sedation and presence of scratching.
3. Teach the care taker or family of infants and small children a hypoallergenic diet when indicated.
a. Write any known allergens on care plan and chart. Inform the dietitian of the child’s food allergies
b. Avoid substances that have a high potential for sensitization, such as cow’s milk, eggs, tomatoes, citrus fruits, chocolate, wheat products, spiced food, fish, nuts, and peanut butter.
c. A minimal diet is prescribed. The trial diet may be composed of milk substitute, rice cereal, two fruits, two vegetables, beef, a multivitamin, and no eggs.
d. A new food is added to the diet every 3 to 5 days, during which time the response to the food is observed.
e. An allergic response occurring during this 3 to 5 day period indicates sensitivity to that food. The food is then eliminated from the diet. If no response is apparent, the food is added to the child’s diet.
f. Another food substance is then added, and child is observed for the following 3 to 5 days period. This method is followed until the food allergen is determined.

Preventing infection
1. Assess and/or treat secondary infection:
a. Observe the skin for sign of bacterial infection (discharge, oozing, crusts). Report positive findings
b. Administer antibiotic as prescribed.
c. Loosen exudates and crusts with water or wet dressings, unless otherwise specified.
d. Note changes in the skin in response to therapy

Selected references
Boiko,S (200), Making rash decisions in the diaper area. Pediatric annals
Habif, T.P. (1996), Clinical dermatology: A color guide to diagnosis and therapy
Hall, J.C. (2000) Sauer’s manual of skin diseases. Philadelphia: Lippincott Williams and Wilkins.

Hydronephrosis

2006-08-22T23:24:00.000-07:00

By:
Sandi Effendi
staff nurse in urology ward, mubarak al kabeer hospital kuwait

Hydronephrosis is dilation of the renal pelvis and calyces of one or both kidneys due to an obstruction.

Pathophysiology
Obstruction to the normal flow of urine causes the urine to back up, resulting in increased pressure in the kidney. If the obstruction is in the urethra or the bladder, the back pressure affects both kidneys, but if the obstruction is in one of the ureters because of a stone or kink, only one kidney is damaged.
Partial or intermittent obstruction may be caused by a renal stone that has formed in the renal pelvis but has moved into the ureter and blocked it. The obstruction may be due to a tumor pressing on the ureter or to bands of scar tissue resulting from an abscess or inflammation near the ureter as it leaves the renal pelvis or to an unusual position of the kidney, favoring a ureter obstruction at the elderly men, the most common cause is ureteral obstruction at the bladder outlet by an enlarged prostate gland. Hydronephrosis can also occur in pregnancy because of the enlarged uterus.
Whatever the cause, as the urine accumulates in the renal pelvis, it distends the pelvis and its calyces. In time, atrophy of the kidney results. As one kidney undergoes gradual destruction, the other kidney gradually enlarges (compensatory hypertrophy). Ultimately, renal function is impaired.

Clinical manifestations
The patient may not have symptoms if the onset is gradual. Acute obstruction may produce aching in the flank and back. If infection is present, dysuria, chills, fever, tenderness, and pyuria may occur. Hematuria and pyuria may be present. If both kidneys are affected, signs and symptoms of chronic renal failure may develop.

Medical management
The goal of management are to identify and correct the cause of the obstruction, to treat infection, and to restore and conserve renal function. To relieve the obstruction, the urine may have to be diverted by nephrostomy or another type of diversion. The infection is treated with antibiotic agents because residual urine in the calyces leads to infection and pyelonephritis. The patient is prepared for surgical removal of obstructive leasions (calculus, tumor, obstruction of the ureter). If one kidney is severely damaged and its function is destroyed, nephrectomy (removal of the kidney) mat be performed.

MIGRAINE

2006-08-18T00:28:00.000-07:00

Migraine is a neurologic disease, of which the most common symptom is an intense and disabling headache. Migraine is the most common type of vascular headache. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and at times disturbed vision. The word "Migraine" comes from the Greek construction "hemikranion" (ημικρανίον, pain affecting one side of the head)
Signs & Symptoms

Migraine with aura is a neurological disease characterized by flare-ups generally referred to as "Migraine attacks." "Aura" refers to the non-headache features of Migraine that often happen before, or in the place of, the actual headache.

It is possible to have a Migraine attack marked by other symptoms and no headache at all, which is called acephalgic Migraine. The aura symptoms associated with these Migraines are very similar to the symptoms of Chronic Fatigue Syndrome, and thus it is possible that the two may be related, or even the same.

Many Migraine sufferers have headache without aura. Such headaches are commonly misdiagnosed as sinusitis or chronic sinus infections. The error can be revealed by a CT scan of the sinuses, which will show inflammation in the sinuses if a sinus infection is present. Migraine had been thought to be caused by vasodilation in the head and neck; however, newer research suggests that vascular dilation associated with Migraine is a symptom of Migraine, not the cause of Migraine symptoms.

Blood vessel diameter is under neurochemical control; in other words, blood vessels dilate during a Migraine episode because the nervous system tells them to. The cause of the pain itself is from activation of the trigeminal nerve. This theory is still being examined though. The trigger of the Migraine may be overactivity of nerve cells in certain areas of the brain (for example, the raphe nucleus). Often a Migraine episode is associated with strong emotional expression or psychic tension, but those may be Migraine symptoms rather than Migraine triggers.

The pain from a Migraine is typically one-sided, though it may encompass the whole head, or move from side-to-side as the Migraine progresses. Additionally, the pain from a Migraine is usually described as throbbing and moderate to severe in intensity. Migraines are frequently accompanied by nausea/vomiting and either photophobia (excessive sensitivity to light) or phonophobia (excessive sensitivity to sound), causing the sufferer to seek a dark, quiet room for recovery. If the predominant feature is vomiting or nausea cyclic vomiting syndrome should be considered as a possible cause.

In Migraine with aura, formerly called classical Migraine, the headache phase is preceded or accompanied by a group of specific symptoms called aura, most commonly experienced as a visual disturbance prior to the attack. Aura usually lasts less than 60 minutes, and in those who suffer Migraine with aura there is generally little time between the onset of aura and the onset of the attack. Migraine without aura, formerly called common Migraine, in contrast to Migraine with aura, lacks any manifestations associated with headache. Some experience aura without Migraine, a condition formerly called amigrainous Migraine or optical Migraine, now usually called acephalgic Migraine. Although sometimes comparable in severity, the symptoms of Migraine differ from those of cluster headache.

Visual aura can include castellated scotoma or fortification spectra, multicolored zig-zag patterns which can cover a large part of the visual field of one eye (sometimes both). Other types of visual aura involve distortions in perception of color, such as color bleeding or the appearance of halos, or as a white spot in the visual field, similar to when a camera flash temporarily "blinds" your vision.

While the most common type of aura is visual, it can manifest as any specific neurological symptom complex. Some experience tingling sensations called paresthesias or disturbances of other regions of the brain (such as language ability or smell) instead of a visual aura, either as an occasional alternate or as their normal aura. Some experience unusual odors that are not actually present, fatigue, nausea, balance problems, and vertigo.

Aura need not be related to the five senses: many Migraineurs experience a prodrome, a vague feeling that things are just not right. While the types and severity of aura can be extremely diverse, a given sufferer will generally experience similar manifestations of aura with each Migraine attack. Many people experience difficulty in speaking and/or forming cohesive syntax.

Migraine can accompany, in many cases, another type of headache called tension headache. Studies have demonstrated that, in patients who get both Migraines and tension headaches, their tension headaches will respond to their usual Migraine treatment. This is in contrast to patients who get only tension headaches.

Because chronic tension headaches are sometimes caused by the same triggers as Migraine and can often be remedied using the same treatments used for Migraine, and because Migraine itself presents with different symptoms for different people, there are some who believe that chronic tension headaches are just another symptom of Migraine.

Migraines can be associated with seizures. Stroke symptoms are seen in some patients and are known as complicated Migraine; these symptoms should not be permanent.

Migraine often runs in families and starts in adolescence, although evidence indicates that it starts also in childhood (including infants) or even in utero. In children, Migraine has some distinct features: headache is more often bilateral or difficult to localize, the patient is unable to describe the symptoms with significant accuracy; in infants, Migraine attacks may be manifested by periods of somnolence or irritability.

Because their symptoms vary, an intense headache may be misdiagnosed as a Migraine by a layperson. Indeed, many other headaches, some of them caused by very serious diseases (like a brain tumour, hydrocephalus, brain vascular disorders) may have a great resemblance to the clinical picture of Migraine and can lead to misdiagnosis. Where possible, see a doctor to determine if the headaches are a symptom of something else.

Hemiplegic Migraine may have periods of one-sided paralysis. This is one of the few types with a known etimology, a defect in atomic-size pores in the cell membranes of nerves that admit calcium into the cell. It may be associated with loss of conscioiusness and is often misdiagnosed as epilepsy. It can often be effectively prevented with medicines called calcium channel blockers.

A less frequently seen type of Migraine is the Basilar Type Migraine, which, until recently had also been referred to as a Basilary Artery Migraine. These Migraines have many of the same symptoms as Migraine with aura or Migraine without aura, but affect a different part of the brain, and are oftentimes accompanied by difficulty walking, speaking, or use of other motor skills. Other symptoms of Basilar Type Migraine may include depersonalization, auditory and visual hallucinations, and a distorted time sense.

Pathophysiology

Research scientists are unclear about the precise cause of Migraine headaches. There seems to be general agreement, however, that a key element is blood flow changes in the brain. People who get Migraine headaches appear to have blood vessels that overreact to various triggers.

Scientists have devised one theory of Migraine which explains these blood flow changes and also certain biochemical changes that may be involved in the headache process. According to this theory, the nervous system responds to a trigger such as stress by causing a spasm of the nerve-rich arteries at the base of the brain. The spasm closes down or constricts several arteries supplying blood to the brain, including the scalp artery and the carotid or neck arteries.

As these arteries constrict, the flow of blood to the brain is reduced. At the same time, blood-clotting particles called platelets clump together-a process which is believed to release a chemical called serotonin. Serotonin acts as a powerful constrictor of arteries, further reducing the blood supply to the brain.

Reduced blood flow decreases the brain's supply of oxygen. Symptoms (neurological symptoms) signaling a headache, such as distorted vision or speech, may then result, similar to symptoms of stroke.

Reacting to the reduced oxygen supply, certain arteries within the brain open wider to meet the brain's energy needs. This widening or dilation spreads, finally affecting the neck and scalp arteries. The dilation of these arteries triggers the release of pain-producing substances called prostaglandins from various tissues and blood cells. Chemicals which cause inflammation and swelling, and substances which increase sensitivity to pain, are also released. The circulation of these chemicals and the dilation of the scalp arteries stimulate the pain-sensitive nociceptors. The result, according to this theory: a throbbing pain in the head.

More recent imaging techniques seem to show that Migraine is primarily a disorder of the brain (neurological), not of the blood vessels (vascular). A spreading depolarization (electrical changes) may begin 24 hours before the attack, with onset of the headache occurring at about the time of maximum brain coverage. The effects of Migraine may persist for some days after the main headache has ended. Many sufferers report a sore feeling in the area where the Migraine was, and some report impaired thinking for a few days after the headache has passed.

In 2005, research was published indicating that in some people with a patent foramen ovale (PFO), a hole between the upper chambers of the heart, Migraine might result and that the Migraine ended if the hole were blocked. That procedure is hazardous enough that it may not be wise to treat solely to prevent Migraine, but if there is evidence of small strokes on magnetic resonance imaging, the procedure could be worthwhile. Early speculation as to the cause of the relationship has centered on the idea that the lungs detoxify blood as it passes through. The PFO allows blood to go directly from the right side of the heart to the left without passing through the lungs.

Migraine triggers

Migraine is irregularly episodic, so there needs to be some explanation for why a particular Migraine episode occurs at a particular time and not at another time.

The trigger theory supposes that exposure to various environmental factors precipitates, or triggers, individual Migraine episodes. Many people report that one or more dietary, physical, hormonal, emotional, or environmental factors precipitate their Migraines. The most-often reported triggers include stress, alcohol, foods, too much or too little sleep, and weather. Sometimes the Migraine occurs with no apparent "cause".

Migraine patients have long been advised to try to identify personal headache triggers by looking for associations between their headaches and various suspected trigger factors. Patients are urged to keep a “headache diary” in which to note what they eat and when they get a headache, to look for correlations, and to try to avoid headache by avoiding factors they identify as triggers. Typically this advice is accompanied by a list of trigger factors.

Authors who in 2005 reviewed the medical literature found that the available information about dietary trigger factors relies mostly on the subjective assessments of patients. Some suspected dietary trigger factors appear to genuinely promote or precipitate Migraine episodes, but many other suspected dietary triggers have never been demonstrated to trigger Migraines. The review authors found that alcohol, caffeine withdrawal, and missing meals are the most important dietary Migraine precipitants. The authors say dehydration deserves more attention, and that some patients are sensitive to red wine. The authors found little or no demonstrated evidence that notorious suspected triggers chocolate, cheese, or that histamine, tyramine, nitrates, or nitrites normally present in foods trigger headaches. The artificial sweetener aspartame (NutraSweet) has not been shown to trigger headache, but in a large and definitive study monosodium glutamate (MSG) in large doses (2.5 grams) was associated with adverse symptoms including headache more often than was placebo. The review authors also note that general dietary restriction has not been demonstrated to be an effective Migraine therapy.

Treatment

Conventional treatment focuses on three areas: trigger avoidance, symptomatic control, and preventive drugs. Patients who experience Migraines often find that the recommended treatments are not 100% effective at preventing Migraines.

Trigger avoidance

Patients can attempt to identify and avoid factors that promote or precipitate Migraine episodes. Moderation in alcohol and caffeine intake, consistency in sleep habits, and regular meals may be helpful. Beyond an often pronounced placebo effect, general dietary restriction has not been demonstrated to be an effective approach to treating Migraine.

Symptomatic control to abort attacks

Migraine sufferers usually develop their own coping mechanisms for intractable pain. A cold or hot shower directed at the head, a wet washcloth, less often a warm bath, or resting in a dark and silent room may be as helpful as medication for many patients, but both should be used when needed.

For patients who have been diagnosed with recurring Migraines, doctors recommend taking painkillers to treat the attack as soon as possible. Many patients avoid taking their medications when an attack is beginning, hoping that "it will go away". However in many cases once an attack is underway, it can become intensely painful, last for a long time (sometimes even for several days), and become somewhat resistant to medical treatment. In contrast, treating the attack at the onset can often abort it before it becomes serious, and can reduce the frequency of subsequent attacks in the near-term.

The first line of treatment is over-the-counter abortive medication. Doctors start patients off with simple analgesics, such as paracetamol (acetaminophen), aspirin and caffeine. They may provide some relief, although they are not effective for most sufferers. Some patients find relief from taking Benadryl or other anti-nausea agents.

Narcotic pain killers (for example, codeine, morphine or other opiates) provide variable relief, but their side effects, the possibility of causing rebound headaches or analgesic overuse headache, and the risk of addiction contraindicates their general use.

If over-the-counter medications do not work, the next step for many doctors is to prescribe fioricet or fiorinal, which is a combination of butalbital (a barbiturate), acetaminophen (in fioricet) or acetylsalicylic acid (in fiorinal), and caffeine. While the risk of addiction is low, butalbital can be habit-forming if used daily, and it can also lead to rebound headaches.

Anti-emetics by suppository or injection may be needed in cases where vomiting dominates the symptoms. The earlier these drugs are taken in the attack, the better their effect.

Until the introduction of sumatriptan (Imitrex®/Imigran®) around 1985, ergot derivatives (see ergoline) were the primary oral drugs available to abort a Migraine once it is underway. However, ergotamine tablets (usually with caffeine), though sometimes effective, have fallen out of favour. Absorption is erratic unless taken by suppository or injection. Dihydroergotamine (DHE), which must be injected or inhaled, can also be effective. These drugs can be used either as a preventive or abortive therapy.

Sumatriptan and related selective serotonin receptor agonists are now the therapy of choice for severe Migraine attacks that cannot be controlled by other means. They are highly effective, reducing the symptoms or aborting the attack within 30 to 90 minutes in 70-80% of patients. Some patients have a recurrent Migraine later in the day, and only one such recurrence in a day can be treated with a second dose of a triptan. They have few side effects if used in correct dosage and frequency. Some members of this family of drugs are:
Sumatriptan (Imitrex®, Imigran®)
Zolmitriptan (Zomig®)
Naratriptan (Amerge®, Naramig®)
Rizatriptan (Maxalt®)
Eletriptan (Relpax®)
Frovatriptan (Frova®)
Almotriptan (Almogran®)

Evidence is accumulating that these drugs are effective because they act on serotonin receptors in nerve endings as well as the blood vessels. This leads to a decrease in the release of several peptides, including CGRP and Substance P.

These drugs are available only by prescription (US and UK). Many Migraine sufferers do not use them only because they have not sought treatment from a physician.

Regarding comparative effectiveness of these drugs used to abort Migraine atacks, a 2004 placebo-controlled trial (Cephalalgia. 2004 Nov;24(11):947-54) reveals that acetylsalicylic acid, sumatriptan and ibuprofen are equally effective.

Triptan therapy has been shown to result in a reduction in lost productivity. Sumatriptan has been shown to result in an average of 0.5 fewer missed workdays during the first three months of therapy and 0.7 fewer missed workdays within the first six months, as well as a reduction in the number of days spent working while symptomatic. The average reduction in lost productivity has been estimated at $1,249, at a cost of $25 per day of disability avoided. The annual net savings in reduced health care costs and lost productivity, over the increased cost of triptan therapy, has been estimated at between $114 and $540 per patient; thus the use of these pharmaceuticals represents a cost savings as well as an improvement in the patients’ quality of life.

Preventive drugs

Patients who have more than two headache days per week are usually recommended to use preventatives and avoid overuse of acute pain medications.

Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. It is used only if attacks occur more often than every two weeks. Supervision by a neurologist is advisable. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next.

The most effective prescription medications include several classes of medications including beta blockers such as propranolol and atenolol, antidepressants such as amitriptyline, and anticonvulsants such as valproic acid and topiramate.

This article is from Wikipedia. All text is available under the terms of the GNU Free Documentation License
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NHS helpline cuts 'a recipe for disaster'

2006-08-13T11:46:00.000-07:00

Health unions have warned that budget cuts at NHS Direct could put lives at risk and prompt them to take industrial action.

The row centres on government plans to save £15m at the flagship health information service which was set up by the government in 1997.

Managers at the service are set to axe hundreds of jobs and close 12 call centres across England, with other centres expanded and some staff moving from those being shut down.

But the Royal College of Nursing and Unison said the changes were threatening the quality of the services being provided and had left staff morale "at rock bottom".

The unions said the changes would reduce the number of qualified nursing staff from its current 66 per cent of frontline staff down to 50 per cent.

And closing 12 centres, with a further 19 'under review', would leave some regions with gaps in locally based services, they said.

Unison general secretary Dave Prentis said: "This cost-cutting exercise at NHS Direct could put lives at risk and staff are so angry at the prospect, unions are gearing up for industrial action.

"These proposals sacrifice quality for cost and the people who will suffer are the public in need of expert advice and reassurance.

"Hundreds of redundancies of staff and closure of call centres around England is not the way to make the service better. It is a recipe for disaster."

Dr Beverly Malone, general secretary of the RCN, added: "This is a nurse-led success story, admired across the world, yet we could see it dismantled with little thought or planning.

"NHS Direct staff morale is at rock bottom and they feel understandably angry and let down by their employer.

"NHS Direct was created by this government to lead NHS reforms, but it is now being asked to make cost-driven changes.

"This is another example of inconsistency in the reform agenda with little thought for the consequences, where patients and staff will suffer."

Commenting on the threat of industrial action, shadow health secretary Andrew Lansley said the problems were "another example of the government's crumbling health reforms".

"Many staff were employed at NHS Direct with a legitimate expectation that their skills would be used; now they face redundancy. It is a tragic waste of potential," he said.

"Clearly we should redeploy staff who have acquired excellent skills for handling telephone advice into local out-of-hours and unscheduled care services."

NHS Direct said in a statement that the plans were "not about dismantling our service, but improving it".

"We are currently consulting with our staff on a series of proposals which are designed to make us more effective and efficient," it added.

"They will help us maintain our excellent reputation for clinical safety and improve public access to health by signposting people to the right NHS service more quickly.

"We realise that change is unsettling and are working to minimise the impact on our staff. We are listening very carefully to their views on how best to make these changes to improve our service."

Nurses can help patients quit smoking

2006-08-13T11:38:00.000-07:00

Several U.S. studies find that a few well-chosen words from a nurse can play a part in convincing smokers to quit.

The research was published in a special summer issue of the journal Nursing Research.

"These reports are evidence that nurses are widely recognized as central to global efforts to reduce the detrimental health effects of tobacco use," said Dr. Molly C. Dougherty, nursing research editor and professor of nursing at the University of North Carolina at Chapel Hill.

One study found that patients given information by nurses on how and why to quit smoking were 50 percent more likely to stop. Another found that nurses can be especially effective because they are the health-care professionals usually seen by the medically underserved.

About 45 million people still smoke in the United States, and researchers say cigarettes are the biggest single cause of preventable death.

Moms need to weigh their impact

2006-08-12T09:37:00.000-07:00

Extreme attention to diet can make youngsters too body-conscious

Friday, August 11, 2006 Posted: 2252 GMT (0652 HKT)

ALBANY, New York (AP) -- Mom's dieting habits can have a bad influence on the children.

Research indicates youngsters learn attitudes about dieting through observation. For some youngsters, that might mean an unhealthy fixation on body image, experts warn.

"It's like trying on Mom's high heels. They're trying on their diets, too," said Carolyn Costin, spokeswoman for the National Eating Disorder Association.

As obesity rates climb among children, health officials are warning parents about the dangers of junk food and lack of exercise. Yet few speak about parents who meticulously count every calorie that crosses their lips.

That type of obsession can be just as destructive and eventually teaches kids to weigh their self-worth on the scale, said Christine Gerbstadt, spokeswoman for the American Dietetic Association.

While fathers also play a crucial a role in shaping children's attitudes about food, research has focused primarily on women and their daughters, since females are more likely to diet and worry about body image.

One study published this year by researchers at Harvard Medical School found that frequent dieting by mothers was associated with frequent dieting by their adolescent daughters. The study also found that girls with mothers who had weight concerns were more likely to develop anxieties about their own bodies.

A study in the Journal of the American Dietetic Association found that 5-year-old girls whose mothers dieted were twice as likely to be aware of dieting and weight-loss strategies as girls whose mothers didn't diet.

"If their mothers diet, it's a marker of how important weight is in the household," said Alison Field, lead author of the Harvard study and an assistant professor of pediatrics.

Even small cues -- such as making self-deprecating remarks about bulging thighs or squealing in delight over a few lost pounds -- can send the message that thinness is to be prized above all else, Field said.

"Parents, especially moms, need to understand kids watch and hear things at an early age and are like little sponges," Costin said.

Walking the line between encouraging healthy habits and not making an issue of weight can be tough, especially with parents already bearing the blame for rising obesity rates among children.

The best strategy is to lead by example, Costin said: If a fad diet isn't right for the child, what makes it right for the parent?

One Albany, New York, mom, Donna Choiniere, does just that. She threw dieting out the window long ago and has made fitness a part of family life. The 52-year-old runs marathons, and her 15-year-old daughter, Katelyn, is on the track team.

She tries not to keep heavy-duty junk food in the house, but does not make a big deal about it, and is OK with things like pretzels and popcorn.

WHO: Sun Exposure Kills 60,000 Worldwide Each Year

2006-08-05T10:00:00.000-07:00

published by sandi

Around 60,000 people worldwide die each year from skin cancer caused by too much sun exposure, according to a new estimate by the World Health Organization (WHO). The agency released a report Thursday detailing 9 diseases and conditions caused by ultraviolet (UV) radiation, and estimating their impact on global health.

Melanoma is the deadliest disease caused by the sun, and the primary cause of UV-related disease in the Americas, Europe, Australia, New Zealand, Brunei, Japan and Singapore. The WHO says 50%-90% of all melanomas are caused by too much sun exposure.

Excess UV exposure also causes most cases of non-melanoma skin cancers, the agency said. It estimates that 50%-90% of basal cell carcinomas and 50%-70% of squamous cell carcinomas are due to too much sun. The sun also causes a rare type of eye cancer called squamous cell carcinoma of the cornea or conjunctiva.

Using data from the year 2000, the agency calculated that these deadly skin cancers killed between 41,000 and 71,000 people, with the most likely figure being around 60,000.
Slip, Slop, Slap

The report serves as an important reminder to take precautions in the sun, said Martin A. Weinstock, MD, a professor of dermatology at Brown Medical School and chair of the American Cancer Society's Skin Cancer Advisory Group.

ACS recommends limiting sun exposure between the hours of 10 AM and 4 PM, when the sun's rays are most intense. If you are outside, ACS recommends seeking shade, using sunscreen with SPF 15 or higher, and covering up with hats, sunglasses, and long-sleeved clothing when possible. It is also important to avoid tanning beds and sunlamps, and check your skin regularly for any new moles or unusual spots. The WHO report offers similar advice.

"The recommendations in the WHO report reinforce those of the ACS, which advocates 'Slip!, Slop!, Slap!'; that is Slip on a shirt, Slop on the sunscreen, and Slap on a hat," Weinstock said.

Following those recommendations not only could help prevent skin cancer, but also other conditions. The WHO report lists solar keratoses (a type of skin spot that can lead to cancer), sunburn, cataracts, cold sores, and pterygium (an eye condition) as other diseases directly caused by too much sun.
Some Sun Exposure Beneficial

The report also notes that some sun exposure is beneficial to human health because it helps the body produce vitamin D. This nutrient is essential for strong bones and may even play a role in preventing other diseases.

People with dark skin who live in areas without much UV light and others who do not get a lot of sun exposure, such as prisoners and people who cover their bodies with clothing for religious or cultural reasons, should consult their doctors about taking a vitamin D supplement, the agency says. However, it says the overexposure to the sun is a bigger health threat than underexposure.

The American Cancer Society recently joined other health organizations in calling for greater research into vitamin D to determine how much is needed for good health and disease prevention.

Multiple Intelligences

2006-07-29T07:00:00.000-07:00

By Sandi Effendi

In 1983 American psychologist Howard Gardner proposed a theory that sought to broaden the traditional definition of intelligence. He felt that the concept of intelligence, as it had been defined by mental tests, did not capture all of the ways humans can excel. Gardner argued that we do not have one underlying general intelligence, but instead have multiple intelligences, each part of an independent system in the brain.

In formulating his theory, Gardner placed less emphasis on explaining the results of mental tests than on accounting for the range of human abilities that exist across cultures. He drew on diverse sources of evidence to determine the number of intelligences in his theory. For example, he examined studies of brain-damaged people who had lost one ability, such as spatial thinking, but retained another, such as language. The fact that two abilities could operate independently of one another suggested the existence of separate intelligences. Gardner also proposed that evidence for multiple intelligences came from prodigies and savants. Prodigies are individuals who show an exceptional talent in a specific area at a young age, but who are normal in other respects. Savants are people who score low on IQ tests—and who may have only limited language or social skills—but demonstrate some remarkable ability, such as extraordinary memory or drawing ability. To Gardner, the presence of certain high-level abilities in the absence of other abilities also suggested the existence of multiple intelligences.

Gardner initially identified seven intelligences and proposed a person who exemplified each one. Linguistic intelligence involves aptitude with speech and language and is exemplified by poet T. S. Eliot. Logical-mathematical intelligence involves the ability to reason abstractly and solve mathematical and logical problems. Physicist Albert Einstein is a good example of this intelligence. Spatial intelligence is used to perceive visual and spatial information and to conceptualize the world in tasks like navigation and in art. Painter Pablo Picasso represents a person of high spatial intelligence. Musical intelligence, the ability to perform and appreciate music, is represented by composer Igor Stravinsky. Bodily-kinesthetic intelligence is the ability to use one’s body or portions of it in various activities, such as dancing, athletics, acting, surgery, and magic. Martha Graham, the famous dancer and choreographer, is a good example of bodily-kinesthetic intelligence. Interpersonal intelligence involves understanding others and acting on that understanding and is exemplified by psychiatrist Sigmund Freud. Intrapersonal intelligence is the ability to understand one’s self and is typified by the leader Mohandas Gandhi. In the late 1990s Gardner added an eighth intelligence to his theory: naturalist intelligence, the ability to recognize and classify plants, animals, and minerals. Naturalist Charles Darwin is an example of this intelligence. According to Gardner, each person has a unique profile of these intelligences, with strengths in some areas and weaknesses in others.

Gardner’s theory found rapid acceptance among educators because it suggests a wider goal than traditional education has adopted. The theory implies that traditional school training may neglect a large portion of human abilities, and that students considered slow by conventional academic measures might excel in other respects. A number of schools have formed with curriculums designed to assess and develop students’ abilities in all of the intelligences Gardner identified.

Critics of the multiple intelligences theory have several objections. First, they argue that Gardner based his ideas more on reasoning and intuition than on empirical studies. They note that there are no tests available to identify or measure the specific intelligences and that the theory largely ignores decades of research that show a tendency for different abilities to correlate—evidence of a general intelligence factor. In addition, critics argue that some of the intelligences Gardner identified, such as musical intelligence and bodily-kinesthetic intelligence, should be regarded simply as talents because they are not usually required to adapt to life demands.

Microsoft® Encarta® Reference Library 2003. © 1993-2002 Microsoft Corporation. All rights reserved.

ACUTE CHILDHOOD LEUKEMIA

2006-07-24T22:08:00.000-07:00

By Sandy Effendi,
a staff nurse mubarak al kabeer hospital

A progressive, malignant disease of the blood-forming tissues that is characterized by the uncontrolled proliferation of immature leukocytes and their precursors, particularly in the bone marrow, spleen, and lymph nodes. It is the most frequent cancer in the children, with a peak onset occurring between 2 and 5 years of age.

> OBSERVATIONS: Acute leukemia is classified according to cell type: acute lymphoid leukemia (ALL) includes lymphatic, lymphocytic. Lymphoblastic, and lymphoblastoid types; acute nonlymphoid leukemia (ANLL) includes granulocytic, myelocytic, monocytic, myelogeneous, monoblastic, and monomyeloblastic types (the myelocytic and monocytic series are abbreviated AML). ALL is predominantly a disease of childhood, whereas AML occurs in all age groups. The traditional classification of leukemia into chronic and acute types is based on duration or expected course of illness and the relative maturity of the leukemic cells. Although this classification is still used, particularly to chronic, forms of disease, it is no longer valid as a prognostic indication. The exact cause of the disease is unknown, although various factors are implicated, including genetic defects, immune deficiency, viruses, and carcinogenic environmental factors, primarily ionizing radiation. In acute leukemia, large immature leukocytes accumulate rapidly and infiltrate other tissues of the body, especially the reticuloendothelial system, causing decreased production of erythrocytes and platelets. Neutropenia, anemia, and increased susceptibility to infection and hemorrhage, and weakening of the bones with tendency to fracture also occur. Initial symptoms of the disease include fever, pallor, fatigue, anorexia, secondary infections (usually of the mouth, throat, or lungs), bone and join pain, subdermal or submucosal hemorrhage, and enlargement of the spleen, liver, and lymph nodes. Onset may be abrupt or follow a gradual, progressive course. Involvement of the central nervous system may lead to leukemic meningitis. Characteristically, a peripheral blood smear reveals many immature leukocytes. The diagnosis is confirmed by bone marrow aspiration or biopsy and examination, which show a highly elevated number of lymphoblast with almost complete absence of erythrocytes, granulocytes and megakaryocytes. The prognosis is poor and untreated cases, and death occurs usually within 6 months after the onset of symptoms. Survival rates have dramatically increased in recent years with the use of antileukemic agents in combination regimens. Remission of 5 years or longer occurs in 50 % to 70% of children with ALL, with 20% to 30% achieving complete remission. For children with AML, the prognosis is poorer, and remission rate is far less.

> INTERVENTION: Treatment of acute leukemia consists of three-stage process involving the use of chemotherapeutic agents and irradiation. In the first, or remission induction, phase complete destruction of all leukemic cells is achieved within a 4-to 6 week period using a combination drug-therapy regimen. The main drugs used in ALL are the corticosteroids, usually three daily oral doses of prednisone; vincristine, administered intravenously once a week; and 1-asparaginase, given intramuscularly three times a week for a total of nine doses. Allopurinol, a xanthine-oxidase inhibitor, is usually administered to inhibit uric acid production. Other drugs used in various combination regimens in sequential cycles include methotrexate, 6-mercaptopurine, cyclophospamide, cytosine arabiniside, hydroxyurea, daunorubicin, and doxorubicin. In children with AML the primary drugs of induction remission are 6-thioguanine, daunomycin, cytosine arabinoside, 5-azacytidine, vincristine, and prednisone. The child is usually hospitalized for part or all of the treatment because of the many side effects of the drugs and the high risk of complications, especially infection and hemorrhage. If severe hemorrhaging occurs and does not respond to local treatment, platelet transfusions may be necessary, and in cases of severe anemia, especially during induction therapy. Whole blood or packed red cells may be needed to raise hemoglobin levels. The second stage of treatment involves prophylactic maintenance to prevent leukemic infiltration of the central venous system. Because chemotherapy drugs do not cross the blood-brain barrier, therapy usually consists of daily high-dose of cranial irradiation for about two weeks after induction remission and weekly or twice-weekly doses of intrathecal methotrexate, for a total of five or six injections, although in some cases only the drug is given, In small children the irradiation is limited to the cranium to prevent retardation of linear growth, but older children may receive craniospinal radiation. Therapy of maintain remission usually begins after the child is discharge from the hospital and consists of various regimens of drugs in combination. A common schedule includes daily oral doses of 6-mercaptopurine and weekly doses of oral methotrexate, intermittent short-term therapy with prednisone an vincristine, and periodic doses of intrathecal methotrexate for prophylaxis against spread to the central nervous system. Complete blood counts are done weekly or monthly, and bone marrow examinations are performed every 3 to 4 months to detect myelosuppression and drug toxicity. Maintenance therapy is discontinued after a period of 2 to 3 years if initial remission is maintained. Continuous treatment beyond 3 years is not advised, as the adverse affects of the medications increase with prolonged use. Relapse occurs, the child begin treatment cycle again, usually with predisone, vincristine, and a combination of other drugs not previously tried. With each relapse the prognosis becomes poorer. Other treatments for prolonging remission include immunotherapy using periodic inoculation with BCG vaccine or bone marrow transplant, which has been successful in including long-term remissions in about 10% to 20% of the cases, especially those with AML or severe, terminal ALL.

> NURSING CONSIDERATIONS: Nursing care for the child with acute leukemia involves intensive physical and emotional support during all phases of the disease, its diagnosis, and treatment. Foremost is the preparation of the child and parents for the various diagnostic and therapeutic procedures, including venipuncture, bone-marrow aspiration or biopsy, lumbar puncture, and x-ray treatment. Specific medical and nursing management depends on the particular regimen of drug therapy, although most of the chemotherapeutic agents used in treatment cause myelosuppression that may lead to secondary complications of infection, hemorrhage, and anemia. Overwhelming infection is a major problem and one of the most frequent causes of death. Severe neutropenia indicate increased risk of infection. It may occur during immunosuppressive therapy or after prolonged antibiotic therapy. The most common infectious organisms are viruses, especially varicella, herpes zoster, herpes simplex, measles, mumps, rubella, and poliomyelitis, both gram positive and gram-negative bacteria, including Staphylococcus aureus, S. epidermidis, group-A beta-hemolytic Streptococcus, Pseudomonas aeruginosa, Escerichia coli, Proteus, and klebsiella, and various parasites and fungi, especially pneumocytis carinii and candida albicans. To prevent infection, the nurse isolates the child as much as possible, screens visitors for active infection, institutes strict aseptic procedures, monitors temperature closely, evaluates possible sites of infection (such as needle punctures), encourage adequate nutrition, helps the child to avoid exertion or fatigue, and, at discharge, teaches the child and parents the necessity for voiding all known sources of infection. Primarily the common childhood communicable disease. Preventive measures to control infection also help decrease the tendency toward hemorrhage. Special attention is given to skin care, oral hygiene, cleanliness of the perineal area, and restriction of activities that could result in accidental injury. A major nursing consideration is the management of the many side effects resulting from drug toxicity and irradiation, including weakness and numbing of the extremities and severe jaw pain. Although corticosteroid treatment usually increase the appetite and produces a euphoric sense of well-being in the child, it also cause moon face, which is reversed with cessation of the steroid therapy. During maintenance therapy, the nurse continues to provide emotional support and guidance, specifically teaching parents which side effects are normal reactions to drugs and which indicate toxicity and require medical attention. In terminal stages of the disease, relief of discomfort and pain become primary focus. Effective measures include careful physical handling of the child, frequent position changes, avoidance of pressure on painful areas, and control of annoying environmental factors, such as excessive light and noise. Nonsalicylate analgesics are used as needed, depending on the severity of pain.

Source Mosby’s Dictionary 3rd edition

Exercise can reduce cancer treatment side effects

2006-07-21T03:56:00.001-07:00

NEW YORK (Reuters Health) - Exercising can help cancer patients feel better mentally and physically, a new analysis of data from published research shows.

But it remains unclear what type of exercise is most effective or how much a person needs to work out in order to benefit, lead author Dr. Vicki S. Conn of Missouri University-Columbia's Sinclair School of Nursing and her colleagues note.

The benefits of exercise for healthy people are well known, but the growing body of research on whether exercise can help patients undergoing cancer treatment has produced mixed results, the researchers report in the July issue of Supportive Care in Cancer.

To investigate, Conn and her team combined the findings of 30 previous studies that investigated the effects of exercise on cancer patients. Thirteen of the studies were conducted with breast cancer patients, while 21 looked at supervised exercise rather than at-home workouts.

Exercise had the strongest effect on boosting patients' physical function, such as improving their ability to climb stairs or walk a certain distance. It improved patients' body composition, increasing the percentage of lean muscle mass to total weight.

Exercise reduced some symptoms, such as nausea and vomiting and pain, and modest improvements were seen in fatigue, mood and quality of life.

Given the relatively small benefits for exercise identified by their analysis, Conn and her colleagues suggest combining exercise with other inventions designed to improve cancer patients' physical and mental health.

"Overall, the data support the potential efficacy of exercise interventions among cancer patients," Conn and her colleagues write. "Controlled experiments testing variations in intervention components and delivery are urgently needed to move forward our understanding of effective strategies to improve health and well being outcomes in this population."

SOURCE: Supportive Care in Cancer, July 2006.

Australia's demand for nurses grows

2006-07-21T03:56:00.000-07:00

SYDNEY, July 19 (UPI) -- An aging population and an increasing number of people living at home with chronic illnesses are increasing demands for nurses in Australia.

With that nation's healthcare system becoming more reliant on community nursing to care for people with chronic and complex health problems, researchers at the University of Western Sydney reviewed how patients perceive community nurses and the work they do.

UWS School of Nursing Senior Lecturer Dr Jane Cioffi says the study focused on care provided clients of community health nursing services in Greater Western Sydney during a 12-month period.

"Community nurses make a major contribution to Australia's health services, but because the work they do is 'behind closed doors', it's usually only people who receive the service who understand the real value of it," Cioffi said. "Our research has shown that the standard of care people are receiving is good ... but there's a need to look ahead to see how we can plan for the increasing demand for services in the future (since) clients are being discharged from hospitals earlier these days."

The researchers found community nurses provided 147,126 visits during the 12-month period to Greater Western Sydney clients.

Passive smoke increases risk of heart disease, lung cancer

2006-07-16T12:39:00.000-07:00

Sandi Effendi, staff nurse in mubarak al kabeer hospital

Kuwait city, July 16, a new comprehensive scientific report issued by the surgeon general in the united state, concluded that there is no risk- free level of exposure to passive or second-hand smoke. The study found that non smokers exposed to passive smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent.
The conclusions of the report one of a major public health concern, due to the fact that a large percentage of all the non-smoking residents in GCC countries are regularly exposed to passive smoke. In the region, non smokers are exposed to passive smoke to a much greater extend than in the most other countries across the world due to the fact that shopping centers, restaurants, and other public facilities, in the region have yet to implement a smoke free policy that has been establish in numerous countries world-wide.
Rany Victor, spokesperson for nicotinell in the region started the report further enhances and adds credibility to all the other studies on passive smoking and the dangers of smoke. Let this be a warning to all the smokers that put the health of others at risk. Its seen by the case of the ten year-old in Dubai who had lung cancer damage equivalent to a person who smokes 50 cigarettes a day, smoking can harm not only smokers but also non-smokers
The report also clearly started that the only real way to guard no- smokers from the 4,000 dangerous chemicals and toxin found in the passive smoke was to eliminate smoking in all public places
Banning smoking in public areas is one step that some high profile people in the UAE have been pushing for, including Dr Ayesha Al-Mutawa Director of the Central Health unit under the Ministry of Health, and Dr Laila Mohammad Al Marzouki of the Department of Health, and Medical Services, Nicotinell are also running campaigns to warn people of the danger of both smoking as well as the dangers that non smokers face and to assist people in giving up their smoking habit
The report went on to emphasize that passive smoke exposure is a leading cause of heart disease and lung cancer in non-smoking adults as well as being a known cause of sudden infant death syndrome, breathing complications, ear, nose and throat infections, and asthma attacks in children and infants

Women smokers' lung cancer risk twice that of men's, study finds

2006-07-12T12:33:00.000-07:00

Tuesday, July 11, 2006

CHICAGO, Illinois (Reuters) -- Cigarette-smoking women run twice the risk of lung cancer as men who smoke but are far less likely to die from the disease than males, according to a study published on Tuesday.

Why women are more susceptible to the cancer-causing agents in cigarette smoke is not clear, the report said, but the findings indicate that women who smoke should be screened sooner and targeted with anti-smoking messages earlier.

The conclusions, from researchers at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City, were based on 7,498 women and 9,427 men, at least 40 years of age and with a history of cigarette smoking, who were checked for lung cancer between 1993 and 2005.

When the study started none had lung cancer. Later 156 women and 113 men developed the disease.

"Given the same exposure, women are less likely to die from lung cancer than men, but they also have double the risk of getting the disease," said Claudia Henschke, the physician who led the study. "We're not really sure why that might be."

Overall, women were 52 percent less likely to die of the disease, said the report published in this week's Journal of the American Medical Association.

Henschke said public health officials need to warn teen-age girls especially that they face a higher risk of lung cancer.

Circumcision may stop millions of HIV deaths: study

2006-07-11T00:48:00.000-07:00

By Maggie Fox, Health and Science Correspondent
Mon Jul 10, 8:10 PM ET

WASHINGTON (Reuters) - Circumcising men routinely across Africa could prevent millions of deaths from
AIDS,
World Health Organization researchers and colleagues reported on Monday.

They analyzed data from trials that showed men who had been circumcised had a significantly lower risk of infection with the AIDS virus, and calculated that if all men were circumcised over the next 10 years, some two million new infections and around 300,000 deaths could be avoided.

Researchers believe circumcision helps cut infection risk because the foreskin is covered in cells the virus seems able to easily infect. The virus may also survive better in a warm, wet environment like that found beneath a foreskin.

So if men were circumcised, fewer would become infected and thus could not infect their female partners.

The human immunodeficiency virus or
HIV, which causes AIDS, now infects close to 40 million people and has killed another 25 million. It mostly affects sub-Saharan Africa and the main mode of transmission is sex between a man and a woman.

Several studies have suggested that men who are circumcised have a lower rate of HIV infection. This has been especially noticeable in some parts of Africa, where some groups are routinely circumcised while neighboring groups are not.

Last year, Dr. Bertran Auvert of the French National Research Agency INSERM and colleagues at WHO found that circumcised men in South Africa were 65 percent less likely to become infected with the deadly and incurable virus.

His team then did an analysis to see what would happen if all African men were circumcised.

"In West Africa, male circumcision is common and the prevalence of HIV is low, while in southern Africa the reverse is true," they wrote in the current report, published in the Public Library of Science Medicine.

"This analysis shows that male circumcision could avert nearly six million new infections and save three million lives in sub-Saharan Africa over the next twenty years," they wrote.

Overall, they project that universal male circumcision would reduce the rate of infections by about 37 percent.

"Male circumcision alone cannot bring the HIV/AIDS epidemic in Africa under control. Even circumcised men can become infected, though their risk of doing so is much lower," the journal cautioned in a commentary.

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Obesity, smoking increase impotence risk

2006-07-08T02:39:00.000-07:00

Friday, July 7, 2006

NEW YORK (Reuters) -- Many of the same things that are good for a man's heart may also be good for his sex life, new research confirms.

according to a study that followed more than 22,000 U.S. men for 14 years.

The findings, published in the Journal of Urology, help solidify evidence tying lifestyle choices to ED risk. They may also give men added incentive to make some changes for the better, said study co-author Dr. Eric B. Rimm of the Harvard University School of Public Health in Boston.

Among the men Rimm and his colleagues followed, those who were obese at the study's start were 90 percent more likely to develop ED than normal-weight men were. Similarly, smokers had a 50 percent greater risk than non-smokers.

On the other hand, regular exercise appeared to protect against erectile problems. Men who reported the highest exercise levels at the study's start were 30 percent less likely than their inactive peers to develop ED over the next 14 years.

At one time, Rimm noted in an interview, erectile problems were thought to be largely psychological. But it has become clear that heart disease and ED share many of the same risk factors, he said.

Anything that impairs blood vessel function and blood flow could affect erectile function, and it's known that certain medical conditions that raise the risk of heart disease -- such as high blood pressure and diabetes - can also lead to ED.

Similarly, the lifestyle choices that affect cardiovascular health, for example smoking and exercise habits, influence ED risk.

This knowledge may nudge more men to make lifestyle changes, Rimm said, since heart disease can seem a distant risk, but erectile problems may be more immediate. In addition, he said, with obesity rates climbing among young people, the ED risk associated with obesity may increasingly become apparent at relatively young ages.

mental health:TV, video games promoting violence

2006-07-07T14:44:00.000-07:00

Negative use of multimedia cause for concern

TV, video games promoting violence

By Dalal Nasser Al-Otaibi

Television and video games have the power to change our behavior and turn us into more violent people. The spread of games like “Battle Filed”, “Splinter Cell”, “Half Life” and last but not least” Grand Those Auto”, influence violent behavior. Those games have a lot of bloody scenes, especially “Grand Theft Auto” In “”Grand Theft Auto” you are criminal who completes a mission, like assassinating gang members.
The game also has a lot of killing, scenes like killing people with a chain-saw and machine-guns. The more you kill in the game, the better is your reputation. The game influences a person into thinking that if he commits a crime he will become popular and strong person, and more aggression will be brought into his life. Males are influenced by aggression more than females because they want to be strong and act like they are. “ Studies have shown that television’s effect on aggression is stronger among boys than girls”) Eshhcolz and Bufkin 656). These kinds of productions are filling the heads of people with negative ideas and influencing one’s behavior. Newsday had an articles on a real story where a man absorbed violence from the movie Robocop and Robocop II. The man who committed the crimes said that he committed his first of six crimes after seeing Robocop. “Referring to a character in Robocop II, Nathaniel White told WNBC:”I saw him cut somebody’s throat then take the knife and slit down the chest to the stomach and leave the body in a certain position. With the first person I killed I did exactly what I saw in the movie.” (Newsday, August 6, 1992)
Television and video games are shown influence violent behavior and it has been proven by the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana and Department of Radiology, Indiana University School of Medicine, Indianapolis. ”Violent television and video games have shown short-term increases in aggressive behavior in children, adolescents, and adults and co-relational studies suggest a long-term association between media violence exposure and aggressive behavior in the natural environment.”(Kronenberge and Williams 202).
For people who are already aggressive in nature, it will be a disaster. Researchers have said that aggressive people are the ones attracted to violent material and tend to watch it often to stimulate themselves. People who are aggressive in nature and also normal people may get violent thoughts from watching violent multimedia. ”Evidence indicates that media violence does elicit thoughts and emotional responses related to aggression.” (Felson, B. Richard 1996). The material shown in the multimedia is reshaping the values and is with no doubt escalating the undesirable behavior. The media increasingly shows material that is permissive, has problematic ideas, and images that include violence and drugs.
Televisions and video games are available to every single person, including children. Children can view this material and imitate the violence ;a child can commit a crime by watching a violent movie, or playing a violent video game. “Children imitate the violence they see on television, the process of imitation is emphasized by the social learning theory – a well-established approach in social psychology”(Felson, B. Richard 1996). Incidents have occurred where little children have taken violent ideas from a movie, which is why the situation is dangerous and it is evident, that multimedia does have a violent effect on the behavior of people. “After watching a genie on TV slap someone on both sides of the head, two children in England copied the stunt and suffered perforated eardrums. Other children, in different parts of the country, were also injured in what became known as (the slapping craze)”(The Guardian. March 12,1992).
Children are even more affected by what they see and absorb and it becomes a part of them. “Several studies in the field of psychology have found a relationship between children’s media consumption (particularly television and film) and aggression (Comstock and film) 1991, Hogben, 1998 This relationship is strongest when (1) children are exposed to the media at a young age (2) media exposure is high, (3) media content is violent (Hogben1998), and (4) (when the children are boys”) Eschholz and Bufkin 656. (Sickminded people will commit more crimes and normal people will be pulled towards the world of violence. “It could increase the frequency of violence if people who are motivated to harm someone choose a violent method they have observed on television.” (Felson, B. Richard 1996) Violence Is an addiction and seeing violence on television and video games just makes matters worse. People are getting used to seeing violence on television and video games which make it become normal as time passed by. The famous Nazi twins were influenced by racist and aggressive video games. The twins played those games and recited the aggressive racist songs. The Nazi twins were also a victim of the media violence and their behavior was shaped by the video games. The hate they hold inside towards African-Americans and Jews was formed as they played a certain video game; the negative ideas were forced into their minds without them realizing it at a young age. A child might carry a weapon to school and try applying something he seen in movie the night before. An adult might try doing the same because of a game he played last night. The multimedia has a direct effect on our behaviors and we should stop the negative use of multimedia to sell violent material, because the minds to sell violent material, because the minds of hundreds of young ones are being corrupted day by day. Stop buying violent material and people will stop producing the material. Parents should see what video game his child buys; violence can become, a dangerous addiction. Violence can grow each day because of the negative ideas in some movies and some video games.
In conclusion every one of us should take in consideration that even though we do not realize that television, video games, and the media in general can affect us this strongly we should be careful. Violence is becoming easy for the eye to see and it will be normal when that happens. Movies containing aggression are not to be watched because they will eventually lead to more aggression and violence in the world today.

Alternative Medicine: Drinking plenty of liquid helps check bladder infection

2006-07-03T09:45:00.000-07:00

Corn silk effective against UTIs

By Mia Ponzo

Many people suffer from recurring UTIs (urinary tract infections). This can be a particular problem in the hot weather that we are having now, when you don’t manage to get enough liquids into your body and become more dehydrated then you should be. While making sure that you get plenty of liquids helps, some people suffer anyway, no matter how much liquid they drink. Wintertime can also be a problem, since people drink less and less liquids at that time.
Our kidney and bladder need plenty of liquids, preferably plain, fresh water, flushed through them all the time in order to keep all the bacteria that pass through these organs in check. If the intake of liquid falls too low, bacteria are give a chance to grow and multiply, which they do so fast that a UTI is the result. People who are suffering from certain diseases are particularly likely to gets UTIs. Those who have diabetes, etc are more likely to get UTIs. Elderly people are more prone to getting UTIs as well. Also, women are more susceptible than men to bladder infection, due to short distance that the bacteria have to travel from the outside to get into bladder. Pregnant women and those going through the menopause are more likely to get UTIs. While most UTIs are not normally life threatening or seriously dangerous, they are most certainly extremely uncomfortable and can sometimes be excruciating, and left out of control can lead to more severe problems.
You know that you have a UTI if you suffering from the following symptoms:
Feeling of fullness while urine output is minimal, stinging or pain on urination, feeling of constant need to urinate, discomfort in the lower abdomen, pain in the back or sides of the back, bloody urine, fever, chills, nausea, vomiting, discharge (from the urethra(the opening of the bladder) or surrounding areas, particularly for women), referred pain in the thighs, etc, cloudy urine, bad smelling urine, confusion (in more serious cases, or with the elderly)
A simple test will be able to tell you right away if you are suffering from UTI, in fact the one that is used in the government hospitals here now is instant. You will know your results within seconds of dripping the stick into urine. If that type of test is not available in your area, a more traditional urine test will be done with the results in several hours, up to a day or two.
So, what do you do if you are suffering? Naturally, prevention is the best medicine, so do your best to make sure that you eat well and get plenty of liquids in order to keep UTIs away in the first place, but if you end up with one anyway, don’t worry, they are seem to be prone of things you can do. If you seem to be prone to get UTIs then keep out of the bathtub! Make sure that you shower instead, in order to prevent the entry of more bacteria through the urethra. Make sure that you wash very well with water after going to bath room. This is particularly important for those women on their monthly cycles. Wearing cotton underwear instead of synthetics has been shown to help prevent UTIs as well.
Conventional doctors usually treat UTIs with antibiotics, which kill the bacteria. But, the problem with that solution is that the antibiotic kills other good bacteria as well as the bad guys, which causes other problems. The good news is that there are plenty of natural alternatives to treating the UTI with chemicals. Nature has given us many options when it comes to this.
The easiest solution is to drink plenty of water. Flushing out the bacteria is the easiest method of preventing and solving the UTIs. Also make sure your urinate often enough, because leaving the urine to build up bacteria in the bladder is another way the bacteria has a chance to grow. But, if you still end up with something more serious even after taking these precautions, there are several herbs that are great for getting rid of UTIs.
Probably the most potent that I have ever found, is one of the easiest to get and use. Corn silk is one of the best herbs for UTI. Just take it out of the husk while it is fresh and steep (preferably don’t boil) it covered in a big pot of water. The resulting light tea can be drunk hot or cold, and doesn’t have much of a taste at all. If you suffer from frequent UTIs you can dry your corn silk for future use, and some people like to keep it in the freezer.
Cranberry juice (which has always been the old standby) is still a great choice but try to make sure that your juice is pure and not mixed with lots of sugar or other juices. Blueberries and blueberry juice are also good for this problem, but they are not widely available in Kuwait and are very expensive. You can find some lovely frozen blueberries in most freezer sections in most supermarkets.
There are other herbs that are great for dealing with urinary problems. Some of them are : parsey, ginger, juniper berries, dandelion leaf, marshmallow, golden seal, uva ursi, buchu leaf, dong quai, birsh leaf, Echinscea, stinging nettle leaf, horsetail, and more. While most of this are not available in Kuwait, you can certainly find them easily and widely available in any herbs shop in the USA or the UK, so do make and effort.
UTIs are not the way you want to start (or end) your day, but help is certainly on the way. It’s right there in your kitchen or at your local grocery store. So, you don’t have to suffer in silence any more, and you can often get rid of the problem yourself, without having to take chemical medications. So, what are you waiting for?

Mumps

2006-06-30T13:03:00.000-07:00

Overview

Mumps is a viral infection that primarily affects the parotid glands — one of three pairs of salivary glands, located below and in front of your ears. If you or your child contracts mumps, it can cause swelling in one or both parotid glands.

Your odds of contracting mumps aren't very high. Mumps was common until the mumps vaccine was licensed in 1967. Before the vaccine, up to 200,000 cases of mumps occurred each year in the United States. Since then, the number of cases has dropped dramatically.

Outbreaks of mumps still occur in the United States, and mumps is still common in many parts of the world, so getting a vaccination to prevent mumps is important.
Signs and symptoms

About one in five people infected with the mumps virus have no signs or symptoms. When signs and symptoms do develop, they usually appear about two to three weeks after exposure to the virus and may include:
Swollen, painful salivary glands on one or both sides of the face
Pain with chewing or swallowing
Fever
Weakness and fatigue

The primary — and best known — sign of mumps is swollen salivary glands that cause the cheeks to puff out. In fact, the term "mumps" is an old expression for lumps or bumps within the cheeks.

You have three pairs of salivary glands that secrete saliva. Each gland, including the parotid in the cheek, has its own tube (duct) leading from the gland to the mouth.

Mumps is characterized by swollen, painful salivary glands in the face, causing the cheeks to puff out.
Causes

The cause of mumps is the mumps virus, which spreads easily from person to person through infected saliva. If you're not immune, you can contract mumps by breathing in saliva droplets of an infected person who has just sneezed or coughed. You can also contract mumps from sharing utensils or cups with someone who has mumps. Mumps is about as contagious as the flu.
When to seek medical advice

If you suspect that you or your child has mumps, see your doctor. Mumps has become an uncommon illness, so it's possible that your signs and symptoms are caused by another more common condition. Swollen glands and a fever could be an indication of inflamed tonsils (tonsillitis) or a blocked salivary gland. Other, rarer viruses can infect the parotid glands, causing a mumps-like illness.
More On This Topic
Tonsillitis
Screening and diagnosis

If your doctor suspects that you or your child has mumps, a virus culture or a blood test may be needed. The blood test can detect mumps antibodies, which indicate whether you've had a recent or past infection.
Complications

Complications of mumps are potentially serious, but rare. These include:
Orchitis. This inflammatory condition causes swelling of one or both testicles. Orchitis is painful, but it rarely leads to sterility — the inability to father a child.
Pancreatitis. This is swelling of the pancreas. Signs and symptoms of pancreatitis include pain in the upper abdomen, nausea and vomiting.
Encephalitis. A viral infection, such as mumps, can lead to inflammation of the brain (encephalitis). Encephalitis can lead to neurologic problems and become life-threatening. Although it's serious, encephalitis is a rare complication of mumps.
Meningitis. Meningitis is infection and inflammation of the membranes and fluid surrounding your brain and spinal cord. It can occur if the mumps virus spreads through your bloodstream to infect your central nervous system. Like encephalitis, meningitis is a rare complication of mumps.
Inflammation of the ovaries. Pain in the lower abdomen in women may be a symptom of this problem. Fertility doesn't seem to be affected.
Hearing loss. In rare cases, mumps can cause hearing loss, usually permanent, in one or both ears.

If you or your child develops a complication from mumps, contact your doctor.
More On This Topic
Orchitis
Pancreatitis
Treatment

Because the cause of mumps is a virus, antibiotics are not an effective treatment.

Like most viral illnesses, mumps infection must simply run its course. Fortunately, most children and adults recover from an uncomplicated case of mumps within two weeks.
Prevention

In general, you're considered immune to mumps if you've previously had the infection or if you've been immunized against mumps.

The mumps vaccine is usually given as a combined measles-mumps-rubella (MMR) inoculation, which contains the safest and most effective form of each vaccine. Doctors recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 4 and 6 years of age — before entering school.

Do you need the MMR vaccine?
You don't need a vaccine if you:
Had two doses of the MMR vaccine after 12 months of age or one dose of the MMR vaccine plus a second dose of measles vaccine
Have blood tests that demonstrate you're immune to measles, mumps and rubella
Are a man who was born before 1957
Are a woman who was born before 1957 and you don't plan to have any more children, you already had the rubella vaccine or you have a positive rubella test

You should get a vaccine if you don't fit the criteria listed above and you:
Are a nonpregnant woman of childbearing age
Attend college, trade school or postsecondary school
Work in a hospital, medical facility, child care center or school
Plan to travel overseas or take a cruise

The vaccine is "not" recommended for:
Pregnant women or women who plan to get pregnant within the next four weeks
People who have had a life-threatening allergic reaction to gelatin or the antibiotic neomycin

If you have cancer, a blood disorder or another disease that affects your immune system, talk to your doctor before getting an MMR vaccine.

Side effects of the vaccine
You can't get mumps from the MMR vaccine, and most people experience no side effects from the vaccine. About 25 percent of people feel some achiness in their joints, 10 percent develop a fever between five and 12 days after the vaccination, and about 5 percent of people develop a mild rash. Less than one out of a million doses causes a serious allergic reaction.

In recent years, some news reports have raised concerns about a connection between the MMR vaccine and autism. However, extensive reports from the American Academy of Pediatrics, the Institute of Medicine, and the Centers for Disease Control and Prevention conclude that there's no scientifically proven link between the MMR vaccine and autism. In addition, there's no scientific benefit in separating these vaccines. These organizations note that autism is often identified in toddlers between the ages of 18 and 30 months, which happens to be about the time children are given their first MMR vaccine. But this coincidence in timing shouldn't be mistaken for a cause-and-effect relationship.
More On This Topic
Immunization: Why vaccines are so important to safeguarding health
Immunization schedule for children
Childhood immunizations: First line of defense against illnesses
Self-care

If you or your child has mumps, time and rest are the best treatments. There's little your doctor can do to speed recovery. But you can take some steps to ease pain and discomfort and keep others from becoming infected:
Rest in bed until the fever goes away.
Isolate yourself or your child to prevent spreading the disease to others.
Take acetaminophen (Tylenol, others) or a nonsteroidal anti-inflammatory drug such as ibuprofen (Advil, Motrin, others) to ease symptoms. Adults may also use aspirin. Don't give aspirin to children because of the risk of Reye's syndrome, a rare but potentially fatal disease.
Use a cold compress to ease the pain of swollen glands.
Wear an athletic supporter to ease the pain of tender testicles.
Avoid foods that require lots of chewing. Instead, try broth-based soups or soft foods, such as mashed potatoes or cooked oatmeal, for nourishment.
Avoid sour foods, such as citrus fruits or juices, that stimulate saliva production.
Drink plenty of fluids.
Plan low-key activities.

If your child has mumps, the most important thing you can do as a parent is to watch for complications. In boys, watch especially for high fever, with pain and swelling of the testicles. In girls, abdominal pain may mean involvement of the ovaries. Abdominal pain in boys or girls may be a sign of pancreatitis. If your child's fever is very high, contact your doctor for advice.

The nurse is in: Nurse practitioners filling void in primary care

2006-06-26T11:11:00.000-07:00

KENNETT SQUARE, Pennsylvania (AP) -- Marguerite Harris and her staff of eight provide prenatal care and child immunizations, write prescriptions, and diagnose and treat ailments from diabetes to the sniffles.

Though it may sound like a typical doctor's office, no one on staff at Project Salud is a doctor. The medical center is run by nurse practitioners -- registered nurses with specialized training and advanced degrees -- whose numbers in the United States have risen from 30,000 in 1990 to 115,000 today.

Increasingly, U.S. patients are being treated by nurse practitioners. Nurse-managed primary care centers such as Project Salud have increased to about 250 nationwide today, from a small handful 15 years ago.

"We've come a long way since the early days, the knockdown drag-outs with doctors who thought we were overstepping our roles," said Harris, a nurse practitioner at the Philadelphia-area medical center since 1974.

The change is attributed to factors that include a drop in the number of doctors choosing primary care as their specialty, a falloff expected to continue.

According to the American College of Physicians, U.S. medical school surveys showed that from 1998 to 2005, the percentage of third-year residents intending to pursue careers in general internal medicine dropped from 54 percent to 20 percent. Many new doctors, saddled with high student loans, are choosing more lucrative specialties.

The supply of general practice physicians is falling just as the American baby boomer population is aging and in greater need of medical care, and nurse-run medical centers are helping to bridge the gap.

Nurse practitioners first appeared about 40 years ago in pediatrics, and quickly expanded into obstetrics and gynecology, family medicine, and adult primary care.

They can perform many of the duties of primary care doctors such as performing physical exams, diagnosing and treating common health problems, prescribing medications, ordering and interpreting X-rays, and providing family planning services.

However, some physicians' groups are concerned about the trend.

The American Medical Association is against giving full autonomy to nurse practitioners, stating as its official policy position that a physician should be supervising nurse practitioners at all times and in all settings. An AMA spokeswoman said the association would not provide additional comment on its position.

"There is an element within the physician community that gets a little antsy. ... They think it's going to take away revenue and business from them," said Dr. Jan Towers, director of health policy for the American Academy of Nurse Practitioners. "Really, there's more than enough for everybody."

A 2000 study in the Journal of the American Medical Association concluded that patients who receive primary care from nurse practitioners fare just as well as those treated by doctors and report similar levels of satisfaction with their care.

Nurse practitioners also have steadily been gaining greater acceptance by insurers and in most states. In about half of America's states, nurse practitioners -- who frequently have lower fees for office visits than doctors -- are now recognized by insurance carriers as primary care physicians.

"One of the statistics that stands out is that we (nurse practitioners) see our patients twice as often as similar practices of physicians," said Tine Hansen-Turton, executive director of the National Nursing Centers Consortium, a Philadelphia-based industry group. "Doing primary care well is the foundation for saving health care dollars -- working on improving health early instead of, for example, paying for coronary surgery and bypasses later."

Copyright 2006 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

Cancer test delays force woman into surgery

2006-06-24T22:39:00.000-07:00

London: Some women with a family history of breast cancer are opting to have surgey rather than wait uo to two years for test result which would confirm whether they are at risk, a charity said yesterday.
A report by Breakthrough Breast Cancer said waiting times for test results have risen for three yeasr to reach an average six months, well above the goverment's two month target. Women wiht relatives who had breast cancer can take genetic tests to check whether they are at a higher risk of developing the diseas and could receive early treatment. "Some feel forced to have their breasts removed without knowing their results, simply because they are too worried to wait any longer," the charity said. Break-through's Chief Executive Jeremy Hughes said laboratories where the tests are checked are struggling to cope with the workload. A baclog of tests in london won't be cleared until the end of 2007."It is unacceptable that women are forced to put their lives on hold as they wait so long to get these vital test results,"he said.
About 4,500 women who fear they have a heightened risk of breast cancer have the egenetic tests each year. Hughes had no figures for the number who choose to have breast removal surgey rather than wait for the results. Reuters

essentials in buying trainers

2006-06-24T22:14:00.001-07:00

You might think the concept of different trainers of diffenrent sports is amarketing ploy by shoe manufacturers to get you to spend more. But the experts say not. Research from the Medical College of Wisconcin shows that the wrong shoes may contribute to development of stress fractures. "It's important to choose the appropriate shoe for your chosen activity, as the demands of each vary," says consultant podiatric surgeon Ron McCulloch, from the London Podiatry Clinic (Londonpodiatry.com)
For example, tennis involves lots of lateral movement and change of direction, while running is pure forward motion. 'You would be looking for a nice stable upper and lateral support in the tennis shoe, while cushioning and stability would be more important in the running shoe," explains Mike Buss, on the road coordinator for adidas.
If every sport has its perfect shoe, wjere do cross-trainers fit in?"Jack of all trades, and master of none.If you re doing anything more than the most basic non impact exercise and gymwork, you need more support and cushioning.