Coronary Heart Disease

Coronary artery and its branches provide the myocardium whit needed oxygen and nutrients,specially glucose,otherwise the heart muscle will suffer of ischemia(local anemia),and the risk of developing ischemia heart disease.

Causesof Myocardial ischemia:
-diminished blood flow in coronary artery
-diminished flow of oxygenated blood to myocardium
-increased oxygen requirement of myocardium

Risk factors:
Coronary atherosclerosis is the main cause of coronary heart disease and others.
classification of risk factors:
-unmodified factors:personal factors of age,gender,genetic and inheritance(family history).
-modified factors:potential factors that can be changed whit treatment.

Major factors:
-hyperlipidamia(serum cholesterol level)
-cigarette smoking
-hypertention
-diabetesor impaired glucose tolerance
Contributing factors:
-physical inactivity,lack of exercise
-heavy consumption of alcohol
-obesity
-personality type,mental stress and worry
-oral contraception
-socioeconomic circumstances

Characteristics:
In case of asymptomatic type the obstruction of blood flow in the coronaries is light at the beginning of disease and gives no symptoms.
In case of angina pectoris the obstraction and impaired blood flow are progressing,causing hypoxia of glucose,myocardium.
Types of angina:
-Classical angina:anginal pain appears on physical exertion and may be provoked by excitement,psychological upset and unger,exposure to cold or after heavy meals.
The attack is transient,for few minutes and disappears on rest.
-Nonclassical angina:this type arises under certain circumstances other then exertion,for exemple nocturnal angina due to coronary spasm during sleep,angina at rest,without any obvious provoking factors.
Acute myocardial infarction may arise from complete obstruction of involved vessels.

Prevention of coronary heart disease is based on prevention and control of determined risk factors:
1.Diet control:
-no excess of calories,fat and common salt
-dietary carbohydrates must be largely of the complex form: from grain and their products
-no excess of rafined sugar
-consumption of vegetable oil,rather then animal fat and margarine
-restriction of solid fats.
Marine fat oils(omega 3 tryglycerides)contain large amount of two highly unsaturated fatty acids and have potenital role in prevention of coronary heart coronary.

Red Sea Tourists and Life Medical Assistance

Is time for vacation and as an exotic place with oriental look and charm,Red Sea attracts during the whole year the interest of a large number of tourists from all over the world.A special place for diving,boat trips,swimming and other activities,an envirounment favourable to so many ways to spend free time,can bring risk of accidents.
Life Medical Assistance is next to you in vacation!In case of injuries or a minor suffering,L.M.A has special prices for Red Sea tourists and offers a big discount for insurance companies too.
Life Medical Assistance provides 24/7 emergency system,availability for any type of treatment,brilliant technology,laboratory service,surgery and hospitalization.
Our services are safety and affortable!

Cancer of Female Genitalia

Cancer and other malignant tumours may involve the female genital system.This form includes around 6% of total female malignancy.The frequency is:
-the cervix comes first:more than half of cases
-the ovary,vagina,endometrium,vulva and myometrium.

CERVIX CANCER:
Cervical cancer is the commonest cancer of female genital system.Peak is found around the age of 50 years.
The causes cannot be given.
Cervical cancer control:the case to be early finding and management.
-females must be aware of any vaginal discharge,or abnormal uterine bleeding,to seek medical consultation at time
-periodic health appraisal of at risk females over 40 years:clinical examinatio for visible cervical lesions(swelling,ulceration),taking cervical smear,to be examinated for positive cytology,so as to screen suspected cases.Diagnosis can be confirmed by biopsy.

ENDOMETRIAL CANCER:
Cancer of endometrium is a common cancer of female genital tract that comes next to cancer cervix.
A good percent of cases may occur before menopause and the majority after 50 years,with peak incidence in women aged 60-70 years.

Risk factors:
-hormonal-administration of hormones or hormonal disorders.
-giving synthetic estrogens(uncontrolled administration,before or around menopause to relieve menopausal symptoms)
-hormonal disorders as estrogenic disturbance,disturbance of hypothalamic,polycystic ovaries with prelonged anovulation.
-metabolic disorders,including impaired glucose tolerance and diabetes
-obesity(specially when is combinated with diabetes)
-nulliparity(radiation to induce menopause,did not prove to be a risk factor)

Females must be aware of gynecologic disorders(menstrual disorders including abnormal bleeding,and postmenopausal bleeding) and seek medical care,becouse are women that apparently have normal health condition and a medical examination is necessary to detect malignant disease early enough in the microscopic asymptomatic phase.

Breast Cancer

Breast cancer affects females and rarely males.
The causes of breast cancer in females are not definitely known,but certain risk factors,precancerous conditions and host variable are known to inluence susceptibility to incidence of breast cancer.
Risk Factors:
1.Hormonal disturbance:endogenous and exogenous.Increased estrogen,progesterone or prolactin.
2.Contaceptive pill:proper use is safe(not precancerous,ot risky).Under certain circumstances,however,oral contraception may be potentially risky for development of breast cancer:
-continued,not interrupted,oral contraception for long time,years undefined,may be more than four.
-practice of oral contraception over 35 years of age,may be also risky.
3.Parity:
-multiparas are exposed to more incidence of breast cancer,that usually appears in 40-60 years,specially when regular breast feeding in not fallowed
-practice of breast feeding:mothers not or irregularly practising breast feeding are exposed to milk retention,with more risk of breast cancer
-nulliparous women
-delayed childbearing:women having their first full-term pregnancy at older age,specially after 35,may show somewhat higher incidence of breast cancer.
4.Menstruatio Pattern:
-early menarche(under 12) and late natural menopause(after 50) are associated with little increased incidence
-late menarche at early menopause are associated with lower incidence.
5.Morbidity:
-cancer of one breast increases susceptibility to involvement of the other breast
-cases of cancer body uters show more incidence of breast cancer and cases of breast cancer show increased endometrial cancer.
6.Family history of breast cancer:families having cases of breast cancer show higher incidence of disease.the more intimate the degree of relation,more is the risk.
Prevention:
Primary prevention cannot be precisely given,since cause is not known.Prevention is based on:
-avoiding exposure to risk factors
-early detection and management of precancerous conditions.
Hormonal preparation has to be used only on medical prescription,and under supervision.
For those who use oral pill:
-select the proper pill and dosage
-don't have a continued use,not more than 4 years
-the women over 35 have to not use the pill and use an other method.For womens that use oral contraception,change to some other method after 4 years and then you can come back to pill after some time if is recomandated.

Role of Antioxidants

The antioxidants are vitamin A,C,E and selenium.They are valuable for diminished morbility in general,lowered incidence of cancer and cotributing to increased life expectancy.
They have synergistic effect.When dietary supply may be deficient,supplemention by suitable preparation can be given.
Beta-carotene-Vitamin A:are needed to maintain stability of biological membranes(protect the cells against oxidats).
Vitamin E:many tocopherols have vitamin E value and the alpha is particularly important.Vitamin E contributes to maintaining stability of the protective biological membranes.Vitamin E also protects polyunsaturated fatty acids against oxidation.
Vitamin C:ascorbic acid is a powerful reducing agent,prevents atherosclerosis and cancer.
Selenium:cofactor of the enzyme glutathione peroxidase that protects membranes from the oxidative damage of oxidants.the enzyme destroys peroxides derived from unsaturated fatty acids.deficiency may affect the liver and skeletal muscles.
Adequate Diet:
Must be considered:
-energy:just needed calories
-low fat,specially that saturated,or restricted fat
-low cholesterol cotent of diet
-adequate complex content of diet
-adequate fiber content,no excess
-limited salt intake,no excess
-limited sugar
-sufficient vegetable,fruits and whole grain cereals.

Osteoporosis

Osteoporosis is the commonest metabolic disease of bone and is characterised by:
-segnificantly reduced bone density(low bone mass,diminised amount of bone)
-increased bone fragility,with the risk of collapse of vertebral bodies and fractures of vertebre and bones.
Mass and bone density increase with age to attain optimal level between age of 30.The growth and development of bone are influenced by:genetic factors,adequate nutrition and growth steroids,significantly increased during puberty.
The bone is continually exposed to two process,bone formation and resorption,the first must gain the upper hand,as to prevent loss of bone.
As about the causes of osteoporosis some of them can be only occasionally and multiple causes are related the inability to reach the peak of optimal bone density before the age of 30 years and loss of bone substance,when resorption goes at higher rate than formation.
Predisposing and Risk factors:
I.Personal factors:
-Age:bone mass begins to decline around the age of 40 years and progress with age.At risk age factores is 50-75 years for type I,and over 70 for type II osteoporosis.
-Sex:women are signifcantly more ate risk that men due to:lower bone mass in women and much increased postmenopausal loss of bone.
-Slender body built(low body weight is a risk factor)
-Delaued puberty in males and menarche in females(sice increased growth steroids during puberty are a determinant of peak bone density).

II.Faulty Lifestyle:
-Diet(inadequate bone-forming and maintainig nutrients,excess protein cosumption for long time)
-Sedentary life:lack of physical activity and exercise(the exercises preserve bone mass)
-Smoking:increases loss of bone and may affect estrogen
-Alcohol consumption.

III.Morbidity:
-Endocrine disease:hyperparathyroidism,hypogonadism,diabetes.
-Rheumatoid arthritis
-Malignancy
-Others;chronic liver disease,chronic renal failure,anorexia nervosa.

Types of Osteoporosis:
Type I(including the menopausal)
Type II-of the elderly

Type I Osteoporosis;
Both men and women are involved,due to estrogen and androgen deficiency.
Mainly women are affected,commonly the postmenopausal middle-aged.Gives painful vertebral fractures.At risk age of fractures: 50-75 years.
Osteoporosis of Menopause:
Menopause osteoporosis is due to estrogen deficiency.In men causes of hypogonadism are at risk of osteoporosis type I.

Type II Osteoporosis;
It is osteoporosis of the elderly,due to changes of bone mass with age.Both men and women over 70 years are at risk,though may be more in women.
Causes:aging in associated with deficiency of calcium and vitamin D that are needed for maintenance of boe and prevention of bone loss.
Cases are exposed to fractures commonly of:hip(fracture neck femur) and vertebre(collapse of vertebral bodies)

Prevention of Osteoporosis:
Prevention is based on increasing bone density and preventing loss of bone.
1.Healthful lifestyle:adequate nutritio,physical activity and exercise and no smoking and alcohol.Balanced diet with special consideration of bone(calcium,vitamin D).
Supplementatio may be given when necessary on medical advice for calcium(oral),vitamin D(oral),fluoride(oral).
2.Hormonal Prophylaxis:
-estrogen:for postmenopausal women,specially during first 10 years
-antrogens for men
Don't take drugs without medical advice.

Food Additives and Food Cancer

Food additives are the substances added to different processed foods for some purposes.More then 3000 additives are widely used in food technology processes at present.
Food additives are used for:
-to make food more attractive to consumers,through providing appealing features:colour and flavour that gives smell and taste
-to preserve food(chemical preservatives are added)
-to keep food fresh,by adding sodium nitrate and vitamin C to uncooked fruits,to prevent becoming brownish
-to help processing and improve texture and consistency of food
to improve nutritive value(fortification of certain foods,like baby powder milk,margarine,common salt for iodine,refined flour.

Uncontrolled use of additives may be unsafe whit potential risk of toxicity to body organs,specially the liver and kidney and carcinogenicity,specially on regular long term consumption.

Marketing of processed food must be submitted to quality and safety assurance regulation and must have as objecties:
-prevention of all forms of adulteration
-regulation of additives for safety:allowing only additives that proved safe,on laboratory and experimental animal testing,specifying maximal allowable concentration,giving name and concentration of additives on food lebel,regular inspectation for quality,validity(manufacture and expiry date),used additives and presentation.

Studies are ongoing for correlation of food and cancer.They suggest that according to circumstances both protective value of diet(anticarcinogens containing and protective factors as antioxidants) and the role risk(may contain carcinogens).
To decrease the risk of cancer we have to take in consider:
-just the needed calories,and caloric restriction if is necessary
-get energy from complex carbohydrates mainly whit reduce fat and sugar
-regular checking of dietry control of weight
-the alcohol must be avoided,and salted and smoked foods.
Saccharin is an artificial nonsucrose sweetener that gives no calories.
Saccharin is used sweetener for many diet products on the market,as soft drinks,syrops and sweets to be labelled "Diet" and personal used at home,to sweeten drinks as tea and sweets.
Saccharin has been implicated as potential carcinogen,based on experimental studies on rats.
Carcinogenic role in man,however,has not been established.There was no difference in the incidence of cancer in a study group of saccharin users and a control group of nonusers.
A balanced diet must provide vegetable and fruits(the main source of vitamins and essential elements,provide antionxidants that protect the body cells against the effects of free radicals and oxidants) and suitable fiber,from vegetable and fruits and high fibre grain.It is valuable for gastrointestinal mobility and contributes to prevention of cancer colon.

Nutritive value of some foods

Foods with high nutritive value:

1.MILK-
is a basic highly valuable food,specially for vulnerable groups,the ederly and the sick.
The milk contains:
-high biological value protein:caseinogen,lactalbumen
-calcium and phosphoris,milk is the richest source of available(absorbable) calcium
-fat,lactose
-riboflavin and vitamin A and little niacin,thiamine and vitamin C
-is poor in iron and vitamin D,while the little vitamin C is destroyed by oxidation,on pasteurization or boiling
Milk Products:
a)Shimmed Milk(milk from which fat is removed)-has similar nutritive value of milk(specially high bilogical value protein,calcium and B2),exept for fat and vitamin A.
b)Yoghurt-curdled milk,prepared by adding culture of Lactobacillus(or part of yoghurt).It provides the same nutrients of milk.
c)Cream:includes milk fat,with vitamin A and good part of protein and lactose.
d)Butter:milk fat,rich in vitamin A.
e)Cheese:a big variety made by special processes

2.MEAT:
Meat is the muscle of farm animals(cattle),poutry(chicken,ducks,turkeys,pigeons) and fish.
Nutritive value of cattle and poultry:
-high biological value protein:18% of lean muscles
-varied fat,outside muscle
-phosphorus,little iron,poor in calcium
-niacin,B2 and some B1.
Nutritive value of fish muscles:
-high biological value protein(about 10%)
-elements:phosphorus(rich source),iodine in sea fish and calcium in canned fish with bones
-little B vitamins
-fat:varies,only 1% in lean fish,and good content in fat fish,providing vitamins A and D
Shellfish-the nutritive value is nearly similar to fish,whit more protein and little fat.They are usually eaten raw,hence the risk of foodborne infection and the need for shellfish sanitation.

3.EGGS:
Eggs of different pountry are consumed.They are vary in size,but they have nearly similar nutritive value.
The egg commonly weighs 30-60 gm and is made of egg white(58%) and egg youlk(30%) and shell(12%)
Nutritive value of egg:
-egg white made of egg albumen
-egg youlk contains high biological value protein,fat,phosphorus(but little calcium),iron,vitamin A and B vitamins
Total protein contant of the egg is 12% of the weight.

4.VEGETABLES:
Green leafy vegetables are either cooked or consumed raw(having better nutritive value),after thorough washing under running water,to eliminate pathologens,specially ascaris egg,amoeba cysts and fasciola cysts.
Nutritive value of vegetable:
-vitamins:A precursor(carotenes),C,E and K
-elements:iron,calcium and iodine in areas of iodine-rich soil.
Dark leafy of vegetable have more provitamin A and iron content.Cellulose of vegetables in undigested,but valuable to prevent constipation.

5.FRUITS:
-sugars:fructose,glucose,sucrose
-vitamin C,specially citrus fruits and juava
-little carotenes and B vitamins.

6.CEREALS:wheat,corn,rye,rice and others,consumed as whole grains or flour.
Nutritive value of whole grains:
-provide energy and protein
-calcium and iron
-B vitamins-in good amounts
The flour produced by miling of garin and exist high or low extraction flour.
-High extraction flour:more brain is included whit more protein,B vitamins,iron,calcium and fibre.The flour and bread are less white(appears brownish) but of better nutrive value than the white(low-extraction).
-Low-extraction flour:less contents of the grain pass into flour,while more brain is remouved,the flour and the bread appear white.
Brain is made of the outer layers of grain including te germ.
Low-extraction flour and bread are less nutritive value than the high-extraction.

7.PULSES:
Pulses include dried beans,peas,lentile and others,which are the seeds of legumes.They provide:
-protein about 20%
-B vitamins(exept B2 and B12)
-starch
-germinated pulses are also rich in vitamin C
Soyabeans provide high biological value protein(about 40%),fat(up to 20%) and little B vitamins.
Peanuts "monkey nuts" have the similar nutritive value as pulses,whit higher fat content about $0%.
Nuts,walnuts,almonds,pistachio and others have high protein and fat content.
Honey contains sugars,mostrly fructose and glucose(75%),traces of some nutrients and water(20%).

OBESITY-Prevention and Management

The prevention of the morbidity and mortality as risk of obesity(the disease that increased newadays as result of modern society) has to be done by:
-a good nutrition education of the public for adequate balanced diet that satisfies just the body needs,and education for a proper dietary habits for no excess energy(fats and carbohydrates)
-encourage the public for suitable physical activity and open air exercise
-doing social and mental health promotion,within the family,at school and work
-promote a control diet where appetite can be satisfied by:frequent small meals,leaving the table before full stomach,consumption of vegetables,that gives filling effect without adding weight.
-and by medical indication and supervision use appetite-suppressing drugs.

Management of Obesity:

The obesity management includes:diet control,physical activity,social welfare,medication and health appraisal.
1.Diet control:
-Restricted diet(according to degree of obesity) that may start with 1000 calories a day,and can be reduced to 500 calories in severe cases.
-Limiting carbohydrate content of diet,specially sugar
-Low-fat diet
-Attempting change of faulty eating habits,and provide a good consumption of vegetables.
2.Activity:convenient physical activity and exercise for a suitable period,daily.
3.Social welfare:social and mental health promotion ,specially of the elderly and lonely cases,for psychologic relief and adjustment and management of problem cases.
4.Medication:
-appetite suppressions according to medical prescription and supervision(for selected cases)
-supplementation of restricted diet
5.Surgical therapy:bypass surgery(reducing the size of the stomach).

OBESITY -cause of mortality

Obesity is the excess adipose tissue in different parts of the body,due to excess storage of fat in this tissues.
Increased body fat is usually a slow process over many years.
In case of simple obesity the cause is related to continued ingestion of excess calories and sedentary lifestyle.
How obesity develops is not preciserly known.
Other causes of obesity are nondietary factors(in minority cases) like:genetic and hormonal defects,metabolic disorders of fat and disorders of hypothalamus.

SIMPLE OBESITY
Predisposing Factors:Dietary,personal,social and psychologic factors.
1.Dietary factors:
Obese people eat more than they need,due to faulty feeding pattern and food and eating habits.As:taking much sweets and snacks,nibbling inbetween meals,consumin soft drinks regularly,special in hot weather and this provides sugar,appetizing presentation of fat this encourages overeating.
2.Personal and Social factors:
-sedentary lifestyle
-food is the basic way of celebrating different social,occasisns
-those living lonely,specially the elderly(either they have anorexia or they overeat)
-home environment:those preferring indoor life,with least activity and sitting to the TV for many hours
3.Psychological disturbance and emotional disorders-in case of subjects of anxiety,depression and other disorders
Are at risk:
-overfed infants and young children,specially the bottle-feed
-middle age women when are exposed to predisposing factors in traditional communities
-psycologically disturbed subjects
-those who are deeply interested in food.
Simple obesity may appear at any age and both sexes are exposed to it,can be genetic and developed usually by sharing similar food habits and lifestyle and can be influenced by the quality and quantity of consumed food too.

THE EXCESS BODY WEIGHT IS ASSOCIATED WITH HIGHER MORBIDITY AND MORTALITY!

Morbidity:
1.Cardiovascular diseases:
-hyperlipidemia and hypercolesterolemia associated with artherosclerosis
-hypertension
-celebrovascular disease and risk of sroke
-varicosity and thromboembolic disease.
2.Metabolic and Endocrine disorders:
-diabetes.It was faound that incidence of diabetes in children of diabetic parents is significantly higher(may be doubled),when the parents are obese too.
-menstrual irregularities,fertility disorders and other endocrine problems.
3.Gastrointestinal diseases:
-digestive disorders and constipation
-cholecystitis and tendency to cholelithiasis
-more susceptibility to develop hernias.
4.Musculoskeletal diseases:
-degenetarive jiont disease and osteorthritis(specially of knees)
-back pain
-flatfood
5.Psychologic disturbances:more found in obese adolescents and young adults,specially females.
6.Malignancy:studies showed more incidence of cancer among subjects of severe obesity,specially of:colon,rectum,biliary tract,prostate in male,breast.endometrium and overy in females.
7.Other complications:
-impaired pulmonary function
-frequent skin disorders
-increased surgical risk
-increased obstetric risk

Mortality:
The obese are exposed to significantly higher mortality,from associated health hazards,specially:cardiovascular disease,cerebrovascular disease and stroke,complicated diabetes,malignancy.
Mortality is proportional to degree of obesity and may be up to tenfold in very severe obesity.
Heavy smoking increases morbidity and mortality risk of obesity.

Dental Caries(Tooth decay)

Dental caries is a worldwide health problem.
Tooth decay is a multifactorial health problem,where many factors determine resistance of teeth to caries,including nutrition.The nutrition of the individual during period of teeth formation influence their future reaction to caries.Inadeguate nutrition is partly responsible for less rezistance of teeth to caries.

Predisposing factors:
-Nutritional:deficiency of calcium,phosphorus and vitamin D,that cause defective calcification of teeth and fluorine deficiency with unsatisfactory low floride content of potable water.
-ingestion of soft carbohydrate foods(cakes,pastries,sweets and candies).
-neglecting oral hygiene(mouth cleaninless),the essential predisposing factor where oral organisms have the chance to act on soft food remnats causing fermentation of sugar and liberation of lactic acid that decalcifies the enamel.

Prevention:
Adequate nutrition,specially:during pregnancy,for benefit of the foetus and children during period of teeth eruption.
Take care of the oral hygiene by a regular toothbrushing after food and mouthwashig specially when toothbrushing is not practically available after food.
Education of the public and training of children for the proper way and times of toothbrushing and mouth cleaning can prevent the dental decay.

Premature delivery

"Preterm infant" is the infant borne after the 28th week of pregnancy(when the foetus become viable),and before the 37th week from date of the last menstrual period.
Cause of premature labour before complation of normal intrauterine period is unknown.Certain factors may be associated with premature labour and delivery of preterm baby.The risk factors are related to mother and foetus.
Type of factors:

1.Maternal risk:
-Personal and social factors:
-age:mother below 16 and over 35 years are more exposed to premature labour.
-low socio-economic level:with poor living conditions and malnutrition,high-fertility pattern.
-overactivity,fatique and stress.
-Obstetric risk:
-short pregnancy spacing
-uterine abdominalities,uterine stretch.
-Maternal Morbidility:malnutrition,psychological disorders,chronic disease(heart disease,hypertention,infections) and trauma.

2.Foetal risk:
-At risk pregnancy:multiple pregnancy,congenital malformations.
-Complicated pregnancy

Characteristics of preterm delivery of the foetus:
-low body weight,usually but not necessarilly
-soft,red,wrinkled skin(with heavy lanugo hair)
-poor suckling and digestion
-undescended testicles,and other features of immaturity.

Other causes of premature delivery:
-increased risk of birth injuries and sequeles,when labour is usually difficult.
-blood disorders
-kernicterus:excessive destrruction of red blood cells may be associated with deposition of bilirubin in the basal ganglia of brain.The infant shows convulsions,and te case is fatal.
-retrorental fibroplasia:due to hyperoxygenation,when the infant is exposed to high oxygen concentration over long time in premature units.
-respiratory distress syndrome:due to deficiency of pulmonary surfactant that is required for expansion of alveoli.
-impaired mental development,and neurological disorders.

Prevention of Prematurity:

Have a early prenatal care to prevent premature labour.
Is necessary:
-adequate nutrition:balanced diet with restricted fat and common salt.
-diagnosis and management of maternal predisposing conditions,and complete rest in bed if is necessary.
-drug therapy(at the doctor indication)
air unit:unit must be air-tight and conditioned,desinfection of air,by ultraviolet lamps.
-the personnel,the mother and the visitors have to be free of infection(and is recomandated in first days of life of the baby a limited contact with the baby or handling,or visiter to not be allowed at all)
The water and articles used to prepair formulas and feed the baby must be sterile(water must be boild).

Vomiting on Babies-Causes

Vomiting is defened as forceful expulsion of gastric contents trough the mouth.
Causes of vomiting:
1.Neonatal vomiting:
-Medical causes:
-Milk:over feeding and irregular feeding,increased intracranial tension for exemple intracranial hemorrhage.
-Systematic infections:urinary tract infections,meningitis and septicemia.
-Systematic and metabolic disorders:galaclosemia,congenital adrenal hyperplasia,drugs.
-Blood stained:hemorrhagic disease of newborn,swallowed maternal blood.
-Surgical:
-Non bile stained:with the first feed there is vomiting(frothy mucoid),coughinh and cyanosis and congenital hypertrophic pyloric stenosis(milk).
-Bile stained:intestinal obstruction and when the X-ray abdomen shows multiple fluid level.

2.Infancy and Chialdhood:
-Medical:overfeeding and irregular feeding,increased intracranian tension for eemple brain tumour
-Systematic infection:abdominal(appendicitis,hepatitis),meningitis- encephalitis,chest complications(acute bronchitis,pneumonia)
-Systematic and metabolic disease:diabetic ketosis,chronic renal failure,aminoacidophaty,hypervitaminosis,drugs.
-Surgical:intestinal obstruction.

CANCER-Definition and Causes

The cancer comprises a group of malignant disease,characterised by abnormal irregular growth of the cells of involved parts.
Recent statistical data showed significantly increased morbidity and mortality of cancer,specially of some sites of the body.This increasement can be explained by more exposure to risk factors of uncontrolled modernization for exemple pollution of the environment with carcinogens and increasingly used food additives:used for coloration,taste and odour or for preservation of food.The changes of lifestyle and extensive industrialization represents a risk of cancer too.

Causes of Cancer:
Defined causes of cancer are not fully known yet.Epidemiologic and experimental studies,however,have revealed many factors with etiologic causal role or risk role.They are classified into environmental and genetic factors.
1.Genetic factors;
-abnormal gene in retinoblastoma
-genetic disorders as Down's Syndrome,late appearance of malignancy as leukaemia.
2.Environment factors:
-physical factors:exposure to radiation(in medicine,industry,atomic explosions,exposer to ultraviolets rays of sun) is the basic causal agent.
-chemical factor:many chemicals are carcinogenic.the exposure can be personal,by environment and occupational.The persoanl exposure is related to the lifestyle,diet,smoking cigarettes,drinking alcohol,the environment exposure through pollution(air,food,water,food) and occupational exposure usually industrial.
3.Biological factors:
-some infection agents;herpes virus of genital tract,virus B and C of hepatitis.
-bacteria flora of intestine:metabolic activity may change some chemicals in food into carcinogens that predisposed to cancer colon.

Host factors of Cancer are;
1.Age-in general malignant disease affects older ages,usually over 40 years.Younger age however,even early in childhood,may be affected according to inherentance,living circumstances and exposure to risk factors.
2.Sex-primary cancer of nosexual sites shows higer male mortality,in general cancer of respiratory tract.cancer of thyroid and biliary passages show higher female mortality.

The risk of smoking

Tabacco smoking is a faulty social habit.
It is rapidly spreading in developing countries.
Tabacco smoking is responsible for higher incidence of morbidity and mortality!
Factors that influence the effects of smoking:
-form of smoking:cigarettes are the most risky,while cigar and piper are much less.
-quality of tabacco:low grade tabacco contains more nicotine and tar.
-age of starting:the earlier,the more the risk of smoking is.
-period of continued smoking and number of smoked cigarettes a day.
-smoking process:lenght of cigarettes,how much of it is smoked,number of taken puffs and extent of smoke inhalation.
The effects of smoking are caused by:
-tabacco contents:nicotine,tar,other hurmful substances that may be carcinogenic.
-products of burning tabacco,specially carbon monoxide.

The effects of cigarettes smoking:
1.Malignancy:cancer lung,cancer larynx,mouth,pharynx,esophagus,bladder and others.
2.Cardiovascular disease:smoking is a risk factor of cardiovascular disease,peripheral vascular disease and thromboagitis obliterans(Berger's disease).
3.Respiratory diseases:cancer lung and other parts,chronical bronchitis,asthma.
4.Peptic ulcer
5.Unfavourable outcome of pregnancy:increased risk of aborsion and congenital hazard.
6.Others:gingivitis,heartburn,digestive,disorders.

The passive smoking:
The inhalation of tabacco smoke by nonsmokers make a risk for nonsmokers,this chategory being exposed to the effects of smoking too.
This effects depends on:
-extent of smoking:number of smokers,and heaviness of smoking.
-duration,frequency and circumstances of exposure.
For this reasons is necessary to exist special places for smokers.
The smoking can be controled by antismoking programs.The basic lines are education programs,enforced restrictions and management of smokers.
The education program has to give full knoledge of the problem and helth risks of smoking and has to address to the public in general,students and providers of medical care and social service.High-risk groups as cardiovascular cases of oral pill,diabetics,workers in asbestos industry and the obese.
Enforced restrictions has to be done by legislation,so the cigarettes packets on the market must give the nicotine and tar content of tabacco in milligram by cigarette.They have to warn that "SMOKING IS DENGEROUS TO HEALTH" and this is the responsability of smoker.
One other method to dicrease the smoke of the cigarettes is the restriction of the availabbility and sales of cigarettes to the young and restricting smoking in public places,offices and means of transport.
On stoping smoking,the risk of hazards declines progressively to retorn to nonsmoking level within 10 years.

CONTRACEPTIVE : Methods of Birth Control

Birth control methods can be classified in:

1.Methods of Mass Application-commonly used by wives(or women)according to medical prescription and under supervision.This methods are:oral contraceptive pill and intrauterine device.
2.Local Methods:diaphragm,cervical cap and local contraceptive chemicals(foams,jellies,creams).They can be used by nonacceptors of pill or intrauterine device,and is not so reliable,specially when is not properly used.
3.Natural Methods(Physiological Methods):
-Breast-feeding associated with "lactation amenorrhea".To be effective for contraception,breast-feeding must be regular,troughout the 24 hours.This method is impractical and not reliable.
-Rhythm method:based on using the safe period,calculated according to menstrual period

THE SAFE PERIOD CALCULATOR:the duration of the menstrual cycle last from first day of the last menstrual bleeding to the first day of the present menstrual bleeding.Ovulation approximately occurs in the middle of the cycle,or you can calculate the ovulation as the period of the menstruation minus 14 days.A week before and a week after the approximate day of ovulation is considered to be Fertile Period.The day apart from this is called the Safe Periods,where the fertilization does not take place.

-Coitus interruptus(male methode):is the technique in which the man withdraws his penis from a woman prior to ejaculation during intercorse,the semen being ejaculated away from the vagina.
4.Sterilization:the surgical method that can only by occasionally used,in the cases when the wife or husband accepts it.
5.Male Methods of Contraception:
-Condom:is a barrier device most commonly used during sexual intercorse to avoid a pregnancy and the spread of a sexual disease.It is put on man's erect penis and physically blocks ejaculated semen from entering the body of the sexual partner.It's safe and reliable when is properly used.It is not generally accepted,specially of those people which belive that it interferes with enjoyment of sex,but the use is absolutlly necesary in case you change sexual partners.
-Sterilization
-Coitus interruptus(we discussed it up)
-male contraceptive pill(is under preparation)
Any female can make benefit of the service of family planing when is indicated.
A doctor will explain you the role of family planing and motivate the reason to practise birth control when is necessary.
In case of postpartum birth control(the practice of birth control after termination of pregnancy),whether by delivery of liveborn or unfavourable outcome.Objective is proper spacing before the next pregnancy,and avoiding early pregnancy,and its potential risk to the mother,the baby and outcome pregnancy.
As method of postpartum contraception is recommendeded the intrauterin device not the use of the pill to avoid the interference of the pill with milk flow and lactation.It is inserted in a suitable time after delivery,meanwhile a method of temporary contraception can be used.
The oral contraceptive pill can be used after abortion or stillbirth and when breast feeding is not practised.

Hypertension (high blood pressure)

No fixed figures can be given for normal level of blood pressure,this dependes of age and activity of the individuals and environment(urban or rural life).
However hypertension can be based on the fallowing levels in mm Hg:
- recommended maximum level 140/90(specially in pregnancy)
-bordline level inbetween 140/90 and 160/95.
The two reading most be taken separately.
Hypertension is clasified in two types:
1.Primary hypertension
2.Secundary hypertension

1.PRIMARY HYPERTENSION:
No particular cause can be accused.
Risk factors:
-genetic factor:reported familial and racial tendency to hypertension suggest genetic contribution.
-foetal factors:impaired foetal health due to undernutrition and other adverse conditions.
-obesity:associated with increased systolic and diastolic pressure.
-common salt:sodium chloride content of diet play a role(hight potassium diet can protect against adverse effect of hight sodium intake).
-alcohol:elevate pressure.
-stress,worry,anxiety and psychological disorders cause only temporary,not persisting elevation of blood pressure in normotensives.
-others:hormonal,disorders and insulin resistance.
2.SECUNDARY HYPERTENSION:
Some pathological conditions are associated with hypertension:
-renal hypertension:over 80%of secundary hypertension.Renal disease may cause secundary hypertension through:sodium and water retantion,elevation of plasma renin.
-endocrine hypertention
-cardiovascular causes
-drugs:estrogen,steroids,vasopressin and others.
-collagen disease.

Hypertension in Pregnancy:
Though heart output increase in pregnancy,yet there is relatively more decline in peripheral vessel ressistance,and so blood pressure of healthy pregnants is usually lower than normal level.
The hypertension is detected on regular health of the pregnant:
-in the first half of the pregnancy:it and is usually perexisting(preconceptional)
-in the second half of pregnancy:induced hypertension that usually resolves after delivery.
Primary hypertension appears usually at 25-55 years,uncommon below 20,and secondary hypertension may appear at any age.Females are usually more affected,specially over 40 years,and they are less exposed to the risk of complications..
More then one family member may show essential hypertension,likely related to hereditary factor.
Busy,noisy,sophisticated urban life may show somewhat higher blood pressure.Cigarette smoking,alcohol intake and uncontrol dietary fat,calories,common salt and sugar are risk factors.
Uncontrolled hypertension is usually asymptomic,may be for years.
Uncomplicated cases may sometimes complain of headache,transient dizzines,and maybe palpitations.
Uncontrolled hypertension may cause serious sequeles and complications:cardiovascular,renal,ophthalmic and others
Early diagnosis and proper management are the main control measures.

Stomach Cancer

The causes of stomach cancer(carcinoma) are unknown,but certain dietary and environmental factors play a role in developing this disease.
Risk factors:
-Alcohol consumption
-Spicy foods
-Ingestion of nitrates,changed by bacterial action into nitrosamines that proved to be carcinogenic.
But exist precancerous conditions as:
-Malignant gastric ulcer
-Atrophic gastritis of pernicious anaemia
-Crhronic gasttritis
-Partial gastrectomy for pepticulcer
-Achlorhydria
-Helicabacter pylori(secretes cytotoxin that attacts the stomach mucosa,predisposing to chronic gastritis,gastric ulcer,and the risk of gastric carcinoma).
Symptoms:at the begining is mild,then increasingly severe upper gastrointestinal manifestetion,with anaemia,and loss of weight.
Diagnosis:
The symptoms are not diagnosis specially in the early stage of sisease.Persisting symptoms in a case over 40 years are suggestive,to be investigated(gastroscopy,radiodiagnosis,cytologic examination and occult blood in stools).
The rate of developing a stomach cancer is declining according to the dietary and environmental factor of different countries.
The possibility of having stomach cancer increase whit age,specially over 40 years,is significantly higher in men,is more common in blood group A and the incidence is relatively higher in Japan and China.
The prevention is based preventing known risk factors and precancerous conditions.
So,fallow proper dietary habits,avoid alcohol and too spicy food,control of food additives preservatives,early diagnosis and management of stomach disease,specially gastritis and ulcer.

Birth Injuries-Prevention

Birth injuries are the first potential risk to which the infant is exposed during labour.The severe cases may be fatal,usually neonatal.
Nonfatal injuries may recover,or cause varied forms and degrees of disability.
The birth injuries can be prevent by:
MATERNAL CARE:preconceptional,early prenatal,natal,and interpregnancy care for safety of labour and favourable outcome of pregnancy.
1.Preconceptional Care:to fulfil requirements of health promotion and prevention and control of morbidity.
2.Early Prenatal Care:
-satisfying requirement of maternal and foetal health,including adequate nutrition.
-early screening and management of high risk pregnancy,so as to avoid or minimize the risk of difficult labour.
-lowering the incidence of preterm and low birth weight(would otherwise be exposed to higher risk of birth injuries)
3.Natal Care for safe delivery.
4.Interpregnancy Care:family planning service for optimal pregnancy service for optimal pregnancy spacing(3 years),specially unfavourable outcome,for the benefit of next pregnancy.

The Detoxication

The detoxification is essentially the metabolism of the foreign organic compound,like substances which are not ordinarily utilized by the organism.It is sometimes applied to the changes undergone by ordinary metabolism,for exemple steroid hormones.It usually resolts in the formation of less toxic more soluble substances which are easily excreted by the kidneys.
Sometimes detoxification is used to refer to many of the reactions involved in the metabolism of xenobiotics.However,it is not always an appropriate term because in some cases the reaction to which some xenobiotics are subject actually increases their bilogical activity and toxicity.
In man detoxification occurs almost exclusively in the liver,but the kidneys also participate in animals.The reactions involved in detoxification processes includes:oxidation,reduction,hydrolysis and conjungation.

Detoxification by Oxidation:
Oxidation is a common mechanism of detoxification and it occurs in case of:
-intoxication with alcohols:methyl,ethyl and benzyl.
-intoxication with aromatic compounds:benzene,aniline,indole and skatole.
Detoxification by Reduction:
It is ussed on intoxication with nitro compounds,for exemple nitrobenzene and picnic acid.
Detoxification by Hydrolysis:
Hydrolysis is ussed in case of intoxication with some drugs.
Detoxification by Conjunction:
Conjunction is the commonest mecanism of detoxication.Toxic substances may be conjugated with:glucuronic acid,succinyl,glutanine,sulfates,cysteine,methyl groups,glycine,thiosulfates.

Hypoglycemia

HYPOGLYCEMIA -persistent decrease of blood glucose level below 45mg/dl.
Symptoms of hypoglycemia are due to two types of causes:
-Sympathetic overactivity(develop rapidly):due to discharge of adrenaline and include hunger,increased sweating,tachycardia and tremours.
-nervous system dysfunction(develop slowly):since practically glucose is te only fuel to brain and include headache,dizziness,confusion,convulsions,coma and even death.

Types of Hypoglycemia:
1.Fasting hypoglycemia-occurs during few to may hours of fasting.It is met with in:
-acute liver disease:acute extensive liver damage and afteranesthesia in patients with liver cirrhosis;
-hyperinsulinum
-Addison's disease:usully the fasting blood glucose is low normal or subnormal,but during starvation it progressively drops due to decreased gluconeogenesis.
-hypothyroidism:mild hypoglycemia may occurs in hypothyroidism during prolonged fasting.
-alcoholism
2.Postprandial hypoglycemia:It develops only after meals and are met with in:
-rapid gastric evacuation
-hereditary fructose intolerance

The essential Vitamins

The vitamins and minerals are components essential for the human body and are necesary for the normal growth,metabolism and immune system and are fundamentally involved vital metabolic processes,where they usually serve as oxidizing and reducing agents and as essential factors in various enzyme systems.
For a good function of the human body are required:
1.VITAMIN A,is essential for the maintenance of the integrity of ephitelial tissue,normal growth of healthy epithelial of skin and mucous membranes.Vitamin A is known as "anti-infection vitamin",but once the infection occurs,the vitamin A has no effect against it.Vitamin A is a component of visual purple of the retina,that is needed for vision in low-intensity light.
Diety sources of vitamin A:
-animal foods:liver,egg yolk,whole milk and cheese,fatty fish.
-plant food:plants don't provide vitamin A but the vitamin procursor(provitamin) carotenes converts in the body into vitamin A.Carotenes are found in pigments of most vegetable and fruits(green,yallow,red,orange).
2.VITAMIN D:is essential for bone metabolism,it regulates the intestinal absorbtion of both Calcium and Phosphates,which are important for bone and teeth formation and maintenance.Vitamin D2 and D3 are steroids having antirachitic effects.D3(the natural form)is produced by irradiation of the skin,on exposure to ultraviolet rays of the sun and vitamin D2 is not found in nature,but prepared by ultraviolet irradiation of ergosterol.
Dietary sources of vitamin D:
-oil-rich salt water fish(sardines and salmon),liver,egg yolk
3.VITAMIN E:it is the most essential antioxidizing agent.Accordingly ,it is essentioal for the maintenance of the cellular functions,minimizing the hurmful effect of pulluatants ,smoking,etc.
Sources of vitamin E:
-wheat-germ oil,egg yolk and liver
4.VITAMINS B(B1,B2,B6,B12):this group of vitamins act either alone or as structural components in catalytic systems of carbohydrates ,proteins and aminoacids metabolism,also in synthesis of DNA ,maturation of red blood cells,nerve cell function and oxidation-reduction biological reaction.
Dietary sources:plants and animals food,except B12 which is provided by animal food only.
-animal food:egg yolk,meat,organ meat.
-plant food:whole grain cereals,nuts,green vegetables.
5.VITAMIN C:is responsible for regineration of epithelial tissues,cartilage osteroid tissues,capilaries and blood vessels and lymphoid tissues and enhances the intestinal absorbtion of iron.
Sources:fruits and vegetables-citrus fruits,cauliflower,cabbage,tomatos,beans.

Persistent diarrhea on babies

It called persistent diarrhea that diarrhea of persumed infection caused that start acutely but unusully persist for more then 14 days.3 to 20% of acute diarrhea become persistent.
Causes:
-sugar intolerance(lactose intolerance).The infection cause the destruction of brush of intestinal vili and this lead to deficiency of disaccharidases(lactase deficiency),this leading to malabsorption of lactose and osmotic diarrhea.Fermentation of sugars by intestinal flora cause formation of organic acids which can also induce diarrhea.The treatment is the administration of lactose-free formula.
-cow milk protein allergy.Intestinal allergy cause damage of intestinal cells of continuos diarrhea.In this case the stool contains mucous and blood and as treatment is has to be administarted soya protein based formula.
-overgrowth of bacteria in upper intestine.The acute diarrhea cause colonic bacteria(fecal bacterias:anerobes and E-coli) can ascend and invade the upper small intestine which is sterile under normal condition and lead to mucosal demage by direct bacterial invasion or toxins production and this cause persist diarrhea.
Why diarrhea persist?
The continuation of diarrhea and the presence of offending agents(milk protein and bacteria) will lead to continuos intestinal mucosal injury and atrophy in prologed cases causing impaired digestion and absorption,this leading to the persistence of diarrhea and vicious cicle.
Characteristics:
Diarrhea with or without dehydration.
Complications:malnutrition,intercurrent infection.
Treatment:
-Prevention and treatment of water and electrolyte disturbance
-Proper nutrition management should continue for long time after stoppage of diarrhea,to give time for regeneration of intestinal mucosa.So remove the offending agent from diet,administrate vitamins,especially vitamin A in the recovery period.

Complications of diabetes

The diabetes is a disturbance of carbohydrate metabolism characterised by hyperglicemia and glycosuria with secondary distorbance of protein and fat metabolism.Exist 2 types:
Insulin dependent diabetes-this was termed as "juvenile onset diabetes" and the factors responsable for this type of diabetes may be genetic,immunological and virus infection.
Non-insulin dependent diabetes-this was previously termed "maturity onset diabetes".Here is no insulin defienciecy,but the condition may be due to anti-insulins or due to abnormal quantity or quality of peripheral insulin receptions.Two factors may be responsable:genetic predisposition and obesity(the lifestyle).
For more information about particularities view the posting archive(Diabetes).
Complications of diabetes:
1.Skin complications:
-pruritus
-infection:multiple furuncles
-fungus infections:for exemple in ano-genital region and toe
-necrobiosis diabeticorum(skin condition,yallow tendency)
-carotinaemia:yallow coloration for exemple over the palm due to excessive intake of vegetables
-insulin lipodystrophy(skin condition characterized by the loss subcutaneous fat at the insulin injection places)
2.Cardiovascular complications:
-microangiopathy(hight blood glucose level cause blood vessels to take more glucose and like that the walls of the vessels become abnormal ticker and weaker)
-atherosclerosis(artery wall is thick and buil-up of fatty materials as colesterol
-ischemia(an absolute or relative shortage of the blood supply to an organ),gangrene(cell death)
3.Neurological complications:
-cerebral coma
-cerebral atherosclerosis
4.Spinal cord:
-diabetic lateral sclerosis
-transverse myelitis(disorder caused by an inflamamatory process of the grey and white matter of the spinal cord)
-post spinal artery occlusion
5.Radicular:
-produce pain,wasting,sensory loss
6.Neuropathy:
-sensory deep and superficial
-impotence,urinary incontinance
-postural hypotension
-increase sweating and later anhydrosis
7.Urinary complictions:
-infections
-kidney stones
-Kimmelstiel-wilson syndrome(kidney disease in chronical diabetes)
8.Ocular complications:
-infections
-diabetic retinophaty in juvenile and long standing cases
-diabetic cataract
-nervous complications of the eye
9.Respiratory complications:
-pulmonar infections for exemple tuberculosis
-dyspnea,air hunger and acetone odor during ketosis
10.Gastro-intestinal complications:
-beefy tongue
-gingivitis and dental caries
-dyspepsia(known as upset stomach or indigestion)
-nausea,vomiting and abdominal pain during ketosis
-diarrhea
-fatty livergall stone
11.Genital complications:
-in males impotence
-in females:menorragia,sterility,pruritus vulvae and skin infections,abortion,premature labour,delivery of big babies.

Hyperprolactinaemia

Hyperprolactinaemia is the presence of abnormally hight levels of prolactin in the blood.Prolactine is a peptide hoemone produced by the anterior pituitary gland primarily associated with lactation and plays a vital role on breast developement during pregnancy.
Hyperprolactinaemia may cause prodaction and spontaneous flow of breast milk and disruption on the normal menstrual period in woman and hypogonadism,infertility and erectile dysfunction on men.
causes:
1.Physiological;
-sleep
-pregnancy,suckling and nipple stimulation
-coitus
-stress
2.Phatological:
-prolactinomasacromegaly(benign tumour to the gland that produce the prolactin hormon) and hypotalamo-hypophyseal tumour
-primary myxedema(dermal edema)
-renal failure
-opiates(narcotic opioid found in opium plant)
3.Drugs
-oestrogens
-metocopramide and cimetidine
-methyl dopa and reserpine
opiates
Characteristics:
-Galactorrhea:spontaneous flow of milk brom the breast unassociated with childbirth or nursering.
-Oligomenorrhea or amenorrea:the absence of the menstrual period in a woman in reproductive age.
-Decreased libido,deacreased potency and subfertility
-Delayed puberty in the peripubertal patient
The medical investigation has to view the prolactin level,realize a visual field,X-ray skull,C.T and MRI for pituitary tumours.
Treatment:
Bromocriptine wil decrease prolactinaemia and the pituitary tumour removed surgical or by irradiation.

Drug eruption

The drug erupsion represents the adverse reaction to drugs which may occur within minutes to 24 hours.
In this case one of the fallowing symptoms can occur:
1.Fixed drug eruption:the same eruption occur at the same site every time the same drug is administrated usually located on lips,dorsum of hands and penis.The common drugs that can cause this eruption are:asprine,analgesics and sulphonamides.
2.Skin diseases:urticaria,erythema multiform or erythema nodosum.
3.Contact dermatitis(rash)
4.Hair fall
5.Pigmentation
6.Depigmentation
7.Ulceration(discontinuity of the skin)
8.Photosensitization(sensitivity of the skin to a light source)
Treatment:
Stop the administration of the drug and after the doctor examination the eruption can be treated with oral antihistaminices and/or steroids.

Hemorrhage

The hemorrhage is defined as escape of blood outside the cardivascular system.
Causes:
-physological:menstruation
-traumatic:accidents,surgery
-erosion of vessels in case of:malignant tumors,tuberculosis,peptic ulcer
-venous congestion
-hypertension
-inflammation bilharzial cystitis
blood disease as hemophilia,purpura and leukemia
-vitamin C or K deficiency
Types:
1.External hemorages:
-from skin
-from respiratory tract:bleeding from the nose,coughing blood
-from alimentary tract:vomiting blood,passage of dark digested blood in stools,red blood passing with the stools
-from urinary tract
-from female genitals:excessive or prolonged menses,irregular uterine bleeding.
2.Internal hemorrhage
3.Intestitial hemorrhage.This is hemorrhage in the intestitial tissue spaces.According to the size of hemorrhagic zone it may be termed petechial(small spots of hemorrhage),ecchymosis or hematoma(large blood swelling).

Cirrhosis

Cirrhosis is a chronic diffuse irreversible liver disease characterized by:
-progressive necrosis of liver cells in all lobus,associated with distruction of the reticulum framework of liver
-repair by both regeneration(in the form of nodules) and fibrosis
-restoration of the normal liver function does not occur since the regeneration nodules have no regular relation to portal tracts,no or eccentric veins and irregular sinusoids.
Types of cirrhosis:
1.Nutritional and Alcoholic Cirrhosis.chronic alcoholism or prolonged severe malnutrition lead to steatosis fallowed by gradual progressive liver cells loss and cirrhosis.
2.Post hepatic Cirhosis.It fallows chronic active hepatitis.It is a mixed micro and macronodular cirrhosis.
3.Post necrotic Cirrhosis.It is a rare type fallowing diffuse liver necrosis(do to viral or toxic hepatitis caused by drugs or isoniazid or chemicals as carbon tetrachloride0.It is a macronodular cirrhosis.
4.Primary biliary cirrhosis.This is an autoimmune disease that mostly affects middle age females.In 95% of cases serum M antibodies are detected.
5.Secondary biliary Cirrhosis.
6.Cirrhosis caused by congenital metabolic disorders
7.Cirrhosis related to circulatory disorders
8.Indian Chialdhood Cirrhosis.
9.Cryptogenic cirrhosis
10.Other causes(rare):congenital syphilis,ulcerative colitis...

Hepatitis- Transmission

1.Hepatitis A Virus(HAV).This virus is mainly transmitted by contaminated food.It causes acute hepatitis which is self limited.It may rarely lead to fulminating hepatitis,but it does not cause chronical hepatitis or carrier states.The virus is shed in stools but not in semen,saliva or urine.

2.Hepatitis B Virus(HBV).This virus is transmitted by blood components as plasma.It can also be transmitted by infected needles as in case of intravenous drug addicts or by contaminated surgical instruments,dental instruments and shaving razors.Hemodyalisis(in uremic patients) and organ transplantation are other possible means of transmission.The virus is shed in orapharngeal secretion,in semen,in menstrual blood,in urine andin stools,therefore it can be transmitted by kissing and by sexual contact.Transplancental transmission is also possible.Illness may be acute hepatitis,fulminating hepatitis,carier state or chronic hepatitis.

3.Hepatitis C Virus(HCV).This virus was formerly termed "hepatitis non A non B virus".The virus is transmitted in the similar way to hepatitis B virus.It may cause acute hepatitis,fulminating hepatitis,carier state.

4.Hepatitis D Virus(HDV).This delta virus cannot infect person unless is already infected with hepatitis B virus.

5.Hepatitis E Virus(HEV).This virus is transmitted in the similar way to hepatitis A virus.It is transmitted by the fecals-oral route(contaminated food or drink).It cause acute hepatitis.The importance of hepatitis E virus is that can cause fulminating hepatitis in pregnant woman.

In case of hepatitis infection the liver is enlarged and yallowish green(bile stained) and the symptoms are:nausea,vomiting,abdominal pain fallowed by jaundice.

Herpes

The Herpes Simplex
There are 2 types of herpes simplex virus:
-type I responsable for oral and labial rashes and for encephalitis.
-type II responsable for genital and neonatal infection.
The virus attacks the inferior frontal and temporal lobes and can be treate it with antiviral agent as Acyclovir.

Herpes Zoster
It is caused by Varicella Zoster virus which is identical to the virus of chicken pox.Herpes Zoster infection is a reactivation of latent zoster virus originally acquired in a childhood attack of chicken pox.
Reactivation is facilitated by an immune system weakened by:
-steroids
-malignancy
-Hodjkin's disease
-AIDS
The virus invades the dorsal root ganglia of the spinal cord and/0r the cranial nerve sensory ganglia.
The clinical stage depends on the ganglion involved.
1.Dorsal root ganglion involvement:vascular rash,associated hurning painful sensation along the course of the affected nerve(dermatome distribution),motor weakness may occur due to spread of infection to the spinal cord.
2.Gasserian ganglion involvment
3.Genicular ganglion involvment
Complications:
Post herpatic neurologia:pain persists for months or years after cure of the vesicles and is sometimes refractory to treatment.
Treatment:
-boric acid plus zinc oxide locally to the vesicles
-analgesics and antiphyretics
-antiviral agent
-injection of novocaine or phenol in the trigeminal ganglion or resection of the posterior root in the intractable pain.
All after the medical examination and prescription.

Premature Ejaculation

The premature ejaculation is the automatically ejaculation(early)of the man without satisfaction of his female partner.
Causes:
-heavy masturbation
-over stimulation of sympathetic due to stress life,anxiety and fears
-pelvic congestion,chronic prostatis,urethritis
-diabetic neuropathy and disseminated sclerossis.
Investigation of premature ejaculation:
-examine prostate and smearing
-complete urine exam
-study of blood sugar level
Treatment:
-reverse the conditioned reflex of premature ejaculation and learn how to control the ejaculation using stop-start technique(muscle contraction)
-avoid any reason of stress,worry,eliminate any anxious thoughts,relax.

Acne vulgaris

Acne vulgaris is a chronic inflammation of the piloswbaceous follicles.Appearce usually during puberty and clears round age of 25 years.Is situated on face,chest,back ana upper arm.Can have the fallowing forms:
-comedo:a hormy plug which fill the pilosebaceous follicle.The retained sebum will appear as a black head(open comedo) or withe head(close comedo0 when is non inflamed pore blacked with sebum.
-papule:a solid spot.
-pustule:a small accumulation of pus in epidermis
-cyst:a closed sac that may contain air,fluids,or semi-solid material.A collection of pus represents an abcess,not a cyst.Once formed,a cyst can go away on its own or have to be remouved through surgery.
-scar:a wound in the repairing proces of the skin.
Theories about the causes:
1.Endocrinal:
-acne fallow testosterone
-acne in females is usually exacerbated near menses
-progesteron therapy increase acne
-estrogen makes them disappear
2.Genetic
3.Bacterian infection
4.Others:hypo or hypervitaminosis A,diets that contains chocolates,nuts,cheese and psychological facts.

Treatment:
a)Topical:
-benzyl peroxide:is comedolytic if it used regularly and on long term basis.It has an antibacterian activity.
-sulpher in proportion of 2% in calamin lotion:it may unblock the obstructed hair follicle orifice.
-retinoic acid cream:it is a vitamin A derivated.
-topical antibiotics(Aknemycin).
-azelaic acid(Skinoren)
b)Systematic
-antibiotics.they should be fat soluble.tetracycline or erythromycin 1gm/day for 2-4 weeks.
c)comedo extraction
d)dermabrassion
e)intralesional corticosteroid:in cystic acne.

Cough

The Cough it is the most common symptom of chest disease and represents a defensive mechanism aiming at expulsion of secretions or inhaled particles from the respiratory tract.

I The reflex cough-due to stimulation of the sensory nerves of the respiratory mucosa.
Respiratory causes:
-pharyngeal diseases:pharyngitis,post-nasal discharge,tonsillitis,tumours.Features: painful,persist and may be accompanied by nausea and vomiting.
-laryngeal diseases:laryngitis,foreign body,tumours.Features:painful,paroxysmal,harsh and may be accompanied by stridor and hoarseness of voice
-tracheal diseases:tracheitis.Features:painful,dry.
-bronchial diseases:bronchitis,bronchial asthma,bronchial tumours,bronchiectasis.features:dry or productive plus specific features to each disease.
-pleural diseases:pleurisy,pleural effusion.Features:dry cough plus specific features to each disease.
Extra-respiratory causes:
-cardiovascular diseases:pulmonary congestion,left sided heart failure(dry or productive cough),pulmonary embolism
-mediastinal causes:causes of mediastinal syndrome(brassy cough)
-abdominal diseases:subpharenic abscess
-aural causes:otitis medianor externa
-meningeal causes:meningitis.

II Central cough- due to stimulation of the cough center.
-brain tumours,ecephalitis.

III Hysterical cough
-appearce usully in young neurotic females and is presentas dry and barking cough in front of the audiance.

Hazard of cough
1.Thoracic:
-rupture of a pleural bleb
-rupture of branchial varices
-rupture of an aneurysm
-stress fracture of a rib
2.Extrathoracic:
-increased intra-abdominal pressure:hernia,rectal prolapse,stress incontinence of urine
-increased intra-ocular pressure:retinal and subconjunctival hemorrages,retinal detachement
-increased intra-cranial pressure:subarachnoid hemorrage.

Hepatitis Virus

5 types at least of hepatitis viruses can cause the desease,other virusis as infectious mononucleosis,yallow fever,herpes simplex and cytomegalo-virus can cause acute hepatitis.

Presentation:

Hepatitis A Virus(HAV):
-Infections:foecal-oral and rarely parenteral
-Sporadic or in epidemics
-People at risk are those living in or traveling to areas with bad sanitation
-Mainly in chieldren and young adults
-Incubation period:2-8 weeks
-Acute stage;usully mild
-No cronicity and not related to hepatrocellular carcinoma
-Prophylaxis:Vaccination or immunoglobulinis.

Hepatitis B Virus(HBV):
-Infection:parenteral,sexual and from mother to baby
-Cases are sporadic
-People at risk are haemophiliacs and haemolytic:anemia patients,drug abusers,homosexuals and prostitutes,doctors and nurses,babies born to HBsAg positiv mother and people living in the Middle east,Africa or South East Asia.
-Occurs at any age
-Incubation period:4-24 weeks
-Acute stage:Usully severe
-May lead to chronic complication and hepatocellular carcinoma
-Prophylaxis:specific immunoglobulinis and vaccination.

Hepatitis C Virus(HCV):
-Infection:post transfusion and parenteral
-sporadic
-Age usually above 16 yeras old
-Incubation period:4-24 weeks
-Acute stage:usually mild or unnoticed
-Most of the cases become chronic
-It is frequent association with hepatocellular carcinoma
-Prophylaxis:supervision of blood donation.

Hepatitis D Virus(HDV):
-This is an incoplete virus depending on HBsAg for its survival,so it only causes hepatitis in HBsAg positive persons
-It spreads by blood transfusion and parenterally
-Incubation period:4-24 weeks
-There are 2 forms of infection:
-co-infection,where the host is infected with HDV and HBV together
-super-infection,where there is super-infection of a stable patient
-It may lead to chronicity
-It may decrease the incidence of HCC HBsAg positive patients
-Prophylaxis:vaccination against HBV

Hepatitis E Virus(HEV):
-Infection:foecal-oral
-Sporadic or epidemic
-usully in children and young adults
-Incubation period:2-8 weeks
-Acute stage:usually mild,exept in pregnant women.
-It causes no chronic complication and it is notrelated to cancer liver
-Prophylaxy:impoved hygiene and immunoglobulinis.

Mental retardation

Mental retardation is known as the impairement of intelligence from early life and inadequate mental development throughout the growth period.It is manifested by impaired learning ability and poor social adjustment.
The intelligence quotient(IQ) is calculated as mental age raported at chronological age multiplied with 100.
Causes that generates mental diseases:

I Prenatal:
a)Genetically determinated causes:
-chromosomal abnormalities:Down syndrome,Cri du chat,fragile X syndrome(sex chromosome).
-neurometabolic disorders:tyrosenemia(aminoacids),isovaleric acedemia(organic acids),carbohydrate(galactosemia)
-neurodegenerative brain disorders
-neurocutaneous disorders:tuberous sclerosis
b)Fetal brain insult
-intrauterine infection:cytomegalovirus,rubella,toxoplasmosis
-drugs:alcohol,phenytoin
-placental insufficiency
-malformations

II Natal:
-hypoxic ischemic injury
-intracranian hemorrhage

III Post natal causes:
-intracranial hemorrhage
-CNS infection
-kernicterus
-metabolic disorders
-poisoning
-psychological:infantil autism

Congenital hypothyroidism and phenylketonuria should not cause mental retardation as they should be diagnosed by routine screening test and treated before causing mental retarsation.
1.Down syndrome-individuals with Down syndrome can have some or all of this characteristics:abnormal small chin,oblique eye fissures with epicnathic skin folds on the inner corner of the eye,poor muscle tone,a flat naal bridge,a single palmar fold,,small oral cavity,short neck,white spots on the iris,congenital heart defects,excessive space between the large toe and second toe.
Down syndrom is a chromosomal abnormality characterized by the presence of an extra copy of genetic material on the 21 chromosome.
2.Cri du chat-is a rare genetic disorder due to a missing part of chromosome 5.The name means cry of the cat and the characteristics are similar to that of a meowing kitten,due to problems with the larynx and nervous system.Others symptoms include:feeding problems,low birth weght,poor growth,severe cognitive(speech0,hyperactivity,aggression,repetitive movements,excesive drooling,constipation.
3.Tyrosinemia-is an error of metabolism,usully inborn,in which the body cannot effectively break down the amino acid.Symptoms include liver and kidney disturbances and mental retardation.
4.Insovaleric acedemia-is a rare autosomal recessive metabolic disorder.A characteristic future is a distinctive odor of sweaty feet.The symptoms become apparentwithin a few days after birth and include poor feeding,vomiting,seizures,lack of energy that can progress to coma.
5.Galactosemia-affects an individual's ability to metabolize the suger galactose properly.
6.Tuberous sclerosis-is a rare multi-system genetic disease that cause benign tumours to grow in the brain and on other vital organs such as kidney,heart,eyes,lungs and skin.

Constipation

Normal humans show variations in the frequency of defection which varies from 3 times a day to once every 2-3 days.Change in bowl habits manifested by prolongation of the normal interval between defecation is defined as constipation.
Constipation causes slight anorexia mild abdominal disconfort and distention.These symptoms are not due to absorption of "toxic substances" becouse they are promptly relieved by evacuating the rectum.
Causes of constipation:
a)the most commun cause of constipation is inhibition of the natural defecation reflex initiated later on,is never as effective as that ar naturally for which reason peopleising who often inhibit their natural reflex are likely to become severelyconstipated.These people are advised not to inhibit the desire for defecation and to try to act regularly following breakfast to benefit from the gastrocolic reflex.
b)decrease in the colonic contractile activity which may resolt from:
-the diet is laking bulk,the amount of material in the colon is small and the colon is inactive.Including dietary fiber in diet in the form of fresh fruits and vegetables will stimulate the contractile activity of the colon by providing a larger volum of indigetable material.
-anxiety may be reflected by decrease in colonic activity leading to constipation and flatulance.
-lack of exercise and general weakness.