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July 21, 2011 (Paris) -- If you're going to take your elderly parents in for a memory checkup, you may want to have their hearing tested first.
So suggest researchers who found that a substantial number of people may have false-positive results on cognitive tests designed to detect dementia due to undiagnosed hearing problems.
"A hearing test should be imperative prior to cognitive testing," says study researcher Michael Lerch, MD, of Diakonia Mark-Ruhr Hospital in Hagen, Germany.
Hearing problems can be overlooked, especially if they are mild, says William Thies, PhD, chief medical and scientific officer at the Alzheimer's Association.
"Just missing one word can distinctly affect performance on a cognitive test, particularly if it's done in a hurried fashion," he tells WebMD.
Thies' advice: If dementia is suspected, make sure cognitive testing is performed by a doctor with experience treating Alzheimer's disease patients.

Hearing Loss and Dementia

It's not uncommon for hearing loss and dementia to coexist, Lerch says. One in eight people over age 65 have dementia. And more than half of people over age 70 have hearing loss, he says.
The new study involved 1,600 patients in a geriatric practice. About 900 had scores suggestive of dementia on the Mini-Mental State Exam, a brief test of cognitive skills, including attention span and memory. Then, patients underwent hearing testing, with treatment if needed.
One-third of those with possible dementia were found to have a relevant hearing impairment and showed an improvement in cognitive testing results after treatment, Lerner reports.
The findings were presented here at the Alzheimer's Association International Conference 2011.
About 5.4 million Americans and 35 million people worldwide have Alzheimer's disease, the most common form of dementia.



Astigmatism is a common eye condition that's easily corrected by eyeglasses, contact lenses or surgery.
Astigmatism is characterized by an irregular curvature of the cornea. This is one type of refractive error. Astigmatism occurs in nearly everybody to some degree. For significant curvature, treatment is required.
A person's eye is naturally spherical in shape. Under normal circumstances, when light enters the eye, it refracts evenly, creating a clear view of the object. However, the eye of a person with astigmatism is shaped more like a football or the back of a spoon. For this person, when light enters the eye it is refracted more in one direction than the other, allowing only part of the object to be in focus at one time. Objects at any distance can appear blurry and wavy.

What Causes Astigmatism?

astigmatism
Astigmatism can be hereditary and is often present at birth. It can also result from pressure from the eyelids on the cornea, incorrect posture or an increased use of the eyes for close work.

What Are the Symptoms of Astigmatism?

People with undetected astigmatism often experience headaches, fatigue, eyestrain andblurred vision at all distances. While these symptoms may not necessarily be the result of astigmatism, you should schedule an eye exam if you are experiencing one or more symptoms.


Allergy facts

  • Allergy involves an exaggerated response of the immune system.
  • The immune system is the body's organized defense mechanism against foreign invaders, particularly infections.
  • Allergens are substances that are foreign to the body and can cause an allergic reaction.
  • IgE is the allergy antibody.
  • Allergies can develop at any age.
  • Your risk of developing allergies is related to your parents' allergy history.
Introduction

In this review you will learn how allergy relates to the immune system. You will begin understanding how and why certain people become allergic. The most common allergic diseases are discussed briefly in this article.

What does an allergy mean?

An allergy refers to an exaggerated reaction by our immune system in response to bodily contact with certain foreign substances. It is exaggerated because these foreign substances are usually seen by the body as harmless and no response occurs in non- allergic people. Allergic people's bodies recognize the foreign substance and one part of the immune system is turned on. Allergy-producing substances are called "allergens." Examples of allergens include pollens, dust mite, molds, danders, and foods. To understand the language of allergy it is important to remember that allergens are substances that are foreign to the body and can cause an allergic reaction in certain people.
When an allergen comes in contact with the body, it causes the immune system to develop an allergic reaction in persons who are allergic to it. When you inappropriately react to allergens that are normally harmless to other people, you are having an allergic reaction and can be referred to as allergic or atopic. Therefore, people who are prone to allergies are said to be allergic or "atopic."
Austrian pediatrician Clemens Pirquet (1874-1929) first used the term allergy. He referred to both immunity that was beneficial and to the harmful hypersensitivity as "allergy." The word allergy is derived from the Greek words "allos," meaning different or changed and "ergos," meaning work or action. Allergy roughly refers to an "altered reaction." The word allergy was first used in 1905 to describe the adverse reactions of children who were given repeated shots of horse serum to fight infection. The following year, the term allergy was proposed to explain this unexpected "changed reactivity."
Allergy Fact
  • It is estimated that 50 million North Americans are affected by allergic conditions.
  • The cost of allergies in the United States is more than $10 billion dollars yearly.
  • Allergic rhinitis (nasal allergies) affects about 35 million Americans, 6 million of whom are children.
  • Asthma affects 15 million Americans, 5 million of whom are children.
  • The number of cases of asthma has doubled over the last 20 years.

What causes allergies?

To help answer this question, let's look at a common household example. A few months after the new cat arrives in the house, dad begins to have itchy eyes and episodes of sneezing. One of the three children develops coughing and wheezing, especially when the cat comes into her bedroom. The mom and the other two children experience no reaction whatsoever to the presence of the cat. How can we explain this?
The immune system is the body's organized defense mechanism against foreign invaders, particularly infections. Its job is to recognize and react to these foreign substances, which are called antigens. Antigens are substances that are capable of causing the production of antibodies. Antigens may or may not lead to an allergic reaction. Allergens are certain antigens that cause an allergic reaction and the production of IgE.
The aim of the immune system is to mobilize its forces at the site of invasion and destroy the enemy. One of the ways it does this is to create protective proteins called antibodies that are specifically targeted against particular foreign substances. These antibodies, or immunoglobulins(IgG, IgM, IgA, IgD), are protective and help destroy a foreign particle by attaching to its surface, thereby making it easier for other immune cells to destroy it. The allergic person however, develops a specific type of antibody called immunoglobulin E, or IgE, in response to certain normally harmless foreign substances, such as cat dander. To summarize, immunoglobulins are a group of protein molecules that act as antibodies. There are five different types; IgA, IgM, IgG, IgD, and IgE. IgE is the allergy antibody.
(In 1967, the husband and wife team of Kimishige and Teriko Ishizaka detected a previously unrecognized type of immunoglobulin in allergic people. They called it gamma E globulin or IgE.)
In the pet cat example, the dad and the youngest daughter developed IgE antibodies in large amounts that were targeted against the cat allergen, the cat dander. The dad and daughter are now sensitized or prone to develop allergic reactions on subsequent and repeated exposures to cat allergen. Typically, there is a period of "sensitization" ranging from months to years prior to an allergic reaction. Although it might occasionally appear that an allergic reaction has occurred on the first exposure to the allergen, there must have been a prior contact in order for the immune system to be poised to react in this way.
IgE is an antibody that all of us have in small amounts. Allergic persons, however, produce IgE in large quantities. Normally, this antibody is important in protecting us from parasites, but not from cat dander or other allergens. During the sensitization period, cat dander IgE is being overproduced and coats certain potentially explosive cells that contain chemicals. These cells are capable of causing an allergic reaction on subsequent exposures to the dander. This is because the reaction of the cat dander with the dander IgE irritates the cells and leads to the release of various chemicals, including histamine. These chemicals, in turn, cause inflammation and the typical allergic symptoms. This is how the immune system becomes exaggerated and primed to cause an allergic reaction when stimulated by an allergen.
On exposure to cat dander, the mom and the other two children produce other classes of antibodies, none of which cause allergic reactions. In these non-allergic members of the family, the dander particles are eliminated uneventfully by the immune system and the cat has no effect on them.
Figure 1
The Immune System
-
Foreign Substance

 alt="-"
(cat dander, pollen, virus, bacteria)
**
Normal Immune Response
IgM, IgG, IgA, IgD and various immune cells respond to attack.
Exaggerated Immune Response
IgE is overproduced in response to cat dander, pollens, and other harmless allergens.
*
*
Foreign substance is eliminated.
Subsequent exposure results in an allergic reaction.
*

Non-Allergic Individual
Allergic Individual




Who is at risk and why?

Allergies can develop at any age, possibly even in the womb. They commonly occur in children but may give rise to symptoms for the first time in adulthood. Asthma may persist in adults while nasal allergies tend to decline in old age.
Why, you may ask, are some people "sensitive" to certain allergens while most are not? Why do allergic persons produce more IgE than those who are non-allergic? The major distinguishing factor appears to be heredity. For some time, it has been known that allergic conditions tend to cluster in families. Your own risk of developing allergies is related to your parents' allergy history. If neither parent is allergic, the chance that you will have allergies is about 15%. If one parent is allergic, your risk increases to 30% and if both are allergic, your risk is greater than 60%.
Although you may inherit the tendency to develop allergies, you may never actually have symptoms. You also do not necessarily inherit the same allergies or the same diseases as your parents. It is unclear what determines which substances will trigger a reaction in an allergic person. Additionally, which diseases might develop or how severe the symptoms might be is unknown.
Another major piece of the allergy puzzle is the environment. It is clear that you must have a genetic tendency and be exposed to an allergen in order to develop an allergy. Additionally, the more intense and repetitive the exposure to an allergen and the earlier in life it occurs, the more likely it is that an allergy will develop.
There are other important influences that may conspire to cause allergic conditions. Some of these include smoking, pollution, infection, and hormones.

What are common allergic conditions, and what are allergy symptoms and signs?

The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Although the various allergic diseases may appear different, they all result from an exaggerated immune response to foreign substances in sensitive people. The following brief descriptions will serve as an overview of common allergic disorders.




Claudication is pain and/or cramping in the lower leg due to inadequate blood flow to the muscles. The pain usually causes the person to limp. The word "claudication" comes from the Latin "claudicare" meaning to limp. Claudication typically is felt while walking, and subsides with rest. It is commonly referred to as "intermittent" claudication because it comes and goes with exertion and rest. (In severe claudication, the pain is also felt at rest.)

What causes claudication?

Several medical problems can cause claudication, but the most common is peripheral artery disease. Peripheral artery disease (PAD) is caused by atherosclerosis, which is a hardening of the arteries from accumulation of cholesterol plaques form on the inner lining of the arteries. This is especially common at branching points of the arteries in the legs. Blockage of the arteries from these plaques cause low blood flow to the muscles in the legs. When walking or exercising the muscles in the legs require more blood flow to increase oxygen to the cells. Atherosclerotic plaques cause decreased blood flow and decreased oxygen. The muscles of the legs can ache and burn as a result of inadequate oxygen. This is felt as cramping in the legs.

What are the symptoms of claudication?

Pain and cramping in the legs is the main symptom of claudication. Pain can be sharp or dull, aching or throbbing, or burning. The severity of the peripheral artery disease, the location of the plaque, and the activity of the muscles determine the severity of symptoms and location of pain. Calf pain is the most common location for leg cramps. This is because the atherosclerotic plaques often begin in the arteries farthest from the heart. If the blockage or plaque formation is farther up the leg, the pain from claudication may be in the thigh. If the blockage is in the aorta (the main artery from the heart to the legs) then symptoms may include pain in the buttocks, groin, or erectile dysfunction.

Why does claudication come and go?

The usually intermittent nature of the pain of claudication is due to a temporary inadequate supply of oxygen to the muscles of the leg. The poor oxygen supply is a result of narrowing of the arteries that supply the leg with blood. This limits the supply of oxygen to the leg muscles and is especially noticeable when the oxygen requirement of these muscles rises with exercise or walking. Claudication that comes and goes is often referred to as intermittent claudication.

What can cause the artery narrowing that leads to claudication?

Intermittent claudication can be due to temporary artery narrowing due to spasm of the artery (vasospasm), permanent artery narrowing due to atherosclerosis, or from the complete blockage of an artery of the leg.

Who typically is affected by claudication?

Intermittent claudication is more common in men than in women. The condition affects 1%-2% of the population under 60 years of age, increasing in incidence with age, to affect over 18% of persons over 70 years of age, according to the American Academy of Family Physicians.

What are the risk factors for claudication and peripheral vascular disease?

Risk factors for peripheral artery disease and claudication include:
  • Smoking
  • Diabetes
  • High blood pressure
  • High cholesterol
  • African American descent
  • Heart disease

How is claudication diagnosed?

A physician will take a history and the diagnosis will be based on the patient's symptoms.
Testing for claudication may include:
  • Ultrasound is most commonly used to determine location and severity of the narrowing in the blood vessels.
  • Ankle-arm index measures the blood pressure at the ankle compared with the blood pressure in the arm. An abnormal result is an indication of peripheral artery disease.
  • Segmental blood pressure measures blood pressure in different parts of the leg (calf, low thigh, high thigh) to detect a blockage that is causing decreased blood flow.
  • Computed tomography (CT) and magnetic resonance angiography(MRA) are other noninvasive tests that can help a doctor map the blood flow in the affected areas. These tests may be considered if the patient's doctor thinks that a procedure (revascularization) to treat peripheral artery disease may be helpful.

What is the treatment for claudication?

There are two main ways to treat claudication: medication and a surgical treatment, called revascularization.
Medication therapies are often used initially as they are non-invasive. The two most commonly used medications include:
  • Cilostazol (Pletal) reduces the pain of intermittent claudication by widening (dilating) the arteries, thereby improving the flow of blood and oxygen to the legs.
  • Pentoxifylline (Trental) decreases the "stickiness" (viscosity) of blood and thereby improves its flow through arteries. This increases the flow of blood and oxygen to muscles.
A surgical procedure called a revascularization is used in patients who do not respond to medications. There are two types of revascularization procedures: endovascular (inside the blood vessel) and surgically grafting or bypassing the artery.
  • Endovascular procedures include
    • Angioplasty: A balloon is placed in the blocked area and inflated to widen the diameter of the artery and increase blood flow
    • Stenting: Wire mesh used to hold a blood vessel open after angioplasty and prevents scar tissue from narrowing the blood vessel
  • Surgical grafting or bypassing an artery involves an open surgery with an incision and sewing in a graft using either the patient's vein or a synthetic tube to increase blood flow around the blocked area.
  • Can claudication be prevented?

    Some of the risk factors for claudication are behaviors that can be modified such as:
    • quit smoking,
    • managing diabetes and high blood pressure, and
    • maintaining a healthy diet to keep cholesterol levels normal.
    Medications that help thin the blood can be used to help prevent symptoms of claudication, but they do not treat the underlying cause. Medications include:
    • aspirin,
    • clopidogrel (Plavix),
    • ticlopidine (Ticlid), and
    • dipyridamole (Permole, Persantine, Aggrenox).
    Exercise is recommend for patients with claudication symptoms. Frequent exercise, especially walking, greatly reduces symptoms and increases symptom-free walking distance and is one of the most effective preventive measures.

    What is the prognosis and treatment for patients with intermittent claudication?

    The prognosis of claudication is generally favorable with treatment. Without treatment, 26% of patients worsen over time. Over 5 years, 4% to 8% will progress to require a revascularization procedure.
    The underlying cause of claudication, peripheral vascular disease, does put patients at risk for other atherosclerotic diseases. A finding of claudication or peripheral artery disease should be considered a warning sign of other potential atherosclerotic blockages in the body.


-- It may be possible to predict who will survive or die as the result of a first heart attack, researchers have found.
They analyzed data from more than 18,000 people in two of the largest U.S. cardiovascular studies and pinpointed certain traits that could predict the risk that a heart attack would be fatal. Those traits included having high blood pressure, being black and having a very high body mass index (BMI) -- a measurement based on height and weight.
"For some people, the first heart attack is more likely to be their last," lead author Dr. Elsayed Z. Soliman, director of the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist Medical Center, said in a center news release. "For these people especially, it is important that we find ways to prevent that first heart attack from ever happening because their chances of living through it are not as good."
Among the researchers' findings:
  • Blacks are at higher risk than non-blacks of sudden cardiac death, in which the heart suddenly stops beating, but are at less risk of coronaryheart disease.
  • High blood pressure and increased heart rate were stronger predictors of sudden cardiac death than coronary heart disease.
  • Extreme high or low BMI was predictive of increased risk of sudden cardiac death, but not of coronary heart disease.
  • Certain markers that can be identified by doctors evaluating patients' electrocardiograms (ECGs) are associated with increased risk of sudden cardiac death.
The study was released online July 20 in advance of publication in an upcoming print issue of the journal Heart.
If the findings are validated and confirmed in future research, doctors will be able to identify patients who are at greater risk of dying if they suffer a heart attack and prescribe ways to reduce their risk, Soliman said.



  • Insomnia is difficulty in falling or staying asleep, the absence ofrestful sleep, or poor quality of sleep. Insomnia is a symptom and not a disease. The most common causes of insomnia are:
    • medications,
    • psychological conditions (for example, depression,anxiety),
    • environmental changes (travel, jet lag, or altitude changes), and
    • stressful events or a stressful lifestyle.
    Insomnia can also be caused by poor sleeping habits such as excessive daytime naps orcaffeine consumption and poor sleep hygiene.
    The National Center for Sleep Disorders Research at the National Institutes of Health estimates 30%-40% of adults report some symptoms of insomnia each year, and about 10%-15% report they have chronic insomnia.
    Insomnia may be classified by how long the symptoms are present.
    • Transient insomnia usually is due to situational changes such as travel, extreme climate changes, and stressful events. It lasts for less than a week or until the stressful event is resolved.
    • Short-term insomnia usually is due to ongoing stressful lifestyle or events, medication side effects or medical conditions and lasts for one to three weeks.
    • Chronic insomnia (long-term insomnia) often results from depression, digestive problems, sleep disorders, or substance abuse and continues for more than three weeks.
    Transient insomnia may progress to short-term insomnia and without adequate treatment, and short-term insomnia may become chronic insomnia.
    Among the medications and substances that can contribute to insomnia are:
  • caffine and coffee,
  • tobacco,
  • alcohol,
  • decongestants (for example, pseudoephedrine),
  • diuretics (for example, furosemide [Lasix], hydrochlorothiazide[Dyazide]) especially if taken in the evening or at bedtime,
  • antidepressants (for example, bupropion [Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban], fluoxetine [Prozac]),
  • appetite suppressants (for example, sibutramine [Meridia], phentermine[Fastin]), and
  • amphetamines.
Insomnia also may be the result of withdrawal from:
  • benzodiazepines (for example, diazepam [Valium], chlordiazepoxide[Librium], lorazepam [Ativan]),
  • alcohol,
  • antihistamines,
  • amphetamines,
  • cocaine,
  • marijuana, and
  • other addicting drugs.
Insomnia can also result from poor sleep-related habits (poor sleep hygiene).


  • Bone fracture, broken bone, bone crack all mean he same thing. The bone has been damaged such that. None of these terms indicate the severity of the bone damage.
  • Bones are the body's storage place for calcium. Under hormone control, calcium content of bone is constantly increasing or decreasing.
  • Bones break when they cannot withstand a force or trauma applied to them. Sometimes the bones are so weak that force may be just gravity, like compression fractures of the back in the elderly.
  • Fracture descriptions help explain how the breakage appears. For examples, whether or not the fragments are aligned (displaced fracture) and whether or not there is skin overlying the injury is damaged (compound fracture).
  • Fractures may be complicated by damage to nearby blood vessels, nerves and muscles and joints.
  • Children's fractures may be more difficult to diagnose because their bones lack enough calcium to be seen on X-ray and because growth plates in the bones may disguise or hide the fracture.
  • Diagnosis of a fracture includes a history and physical examination. X-rays are often taken. Occasionally, CT or MRI is used to find an occult or hidden fracture or provide more information regarding the damage to the bone and adjacent tissues.
  • Fractures of the skull, spine and ribs have their own unique diagnosis and treatment issues.

Introduction to fracture

Bones form the skeleton of the body and allow the body to be supported against gravity and to move and function in the world. Bones also protect some body parts, and bone marrow is the production center for blood products.
Bone is not a stagnant organ. It is the body's reservoir of calcium and is always undergoing change under the influence of hormones. Parathyroid hormone increases blood calcium levels by leeching calcium from bone, while calcitonin has the opposite effect, allowing bone to accept calcium from the blood.

What causes a fracture?

When outside forces are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not better or worse than another. The integrity of the bone has been damaged and the bone structure fails and a fracture occurs.
Broken bones hurt for a variety of reasons including:
  • The nerve endings that surround bones contain pain fiber. These fibers may become irritated when the bone is broken or bruised.
  • Broken bones bleed, and the blood and associated swelling (edema) causes pain.
  • Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms may cause further pain.
Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, fractures don't always occur in isolation, and there may be associated injuries that need to be addressed.
Fractures can occur because of direct blows, twisting injuries, or falls. The type of forces or trauma applied to the bone may determine what type of injury that occurs. Some fractures occur without any obvious trauma due toosteoporosis, the loss of calcium in bone (for example a compression fracture of the vertebrae of the back). 
Descriptions of fractures can be confusing. They are based on:
  • Where in the bone the break has occurred
  • How the bone fragments are aligned
  • Whether any complications exist
  • Whether the skin is intact
The first step in describing a fracture is to decide if it is open or closed. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn, or abraded (scraped), but if the skin's integrity is damaged, the potential for an infection to get into the bone exists. Since the fracture site in the bone communicates with the outside world, these injuries often need to be cleaned out aggressively and many times require anesthesia in the operating room to do the job effectively. Compound fracture was the previous term used to describe an open fracture.
Next, there needs to be a description of the fracture line. Does the fracture line go across the bone (transverse), at an angle (oblique) or does itspiral? Is the fracture in two pieces or is it comminuted, in multiple pieces?
A greenstick fracture describes the situation when the bone partially breaks. This often occurs in infants and children where the bone hasn't completely calcified and has the potential to bend instead of breaking completely through. It is similar to trying to break off a young branch or shoot from a tree (a green stick). Other fracture terms include torus or buckle fracture, again when only part of a bone breaks, but this may occur in adults as well.
Bone Fractures Illustration - Fracture of Bone
Finally, the fracture's alignment is described as to whether the fracture fragments are displaced or in their normal anatomic position. If the bones fragments aren't in the right place, they need to be reduced or placed back into their normal alignment.

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