Dengue Virus Type 2 Modulates Endothelial Barrier Function through CD73

Dengue Virus Type 2 Modulates Endothelial Barrier Function through CD73
Chinmay Patkar, Kris Giaya and Daniel H. Libraty

Dengue hemorrhagic fever is characterized by a unique vascular leakage syndrome. The mechanisms of endothelial barrier dysfunction in dengue hemorrhagic fever are not well understood. We examined the modulation of endothelial barrier function in dengue virus type 2 (DENV2) infections using primary human umbilical vein endothelial cells. We demonstrated that the increase in endothelial barrier function within 72 hours after DENV2 infection is mediated by type I interferon–dependent CD73 up-regulation. After 72 hours, DENV2 slowed the recovery of endothelial barrier function in response to tumor necrosis factor-α or vascular endothelial growth factor. This phenomenon was likely caused by type I interferon receptor signaling inhibition and lower CD73 levels in DENV2-infected endothelial cells. Our findings suggest that during DENV2 infection, endothelial barrier homeostasis is maintained by a balance between pro-inflammatory and pro-angiogenic cytokines, and type I interferon–dependent CD73 expression and activity.

PROBIOTICS, PREBIOTICS, AND SYNBIOTICS. WHAT ARE THEY AND WHEN SHOULD THEY BE IMPLEMENTED?

PROBIOTICS, PREBIOTICS, AND  SYNBIOTICS. WHAT ARE THEY AND WHEN SHOULD THEY BE IMPLEMENTED? 

Stanley L. Marks, BVSc, PhD, DACVIM (Internal Medicine, Oncology), DACVN University of California, 

Davis, School of Veterinary Medicine, Davis, CA, USA 

Professor of Small Animal Medicine 

The mammalian intestinal tract contains a complex, dynamic, and diverse population of non-pathogenic bacteria.  Researchers have estimated that the human body contains 10.000.000.000.000 cells, only 10% of which are not bacteria, and belong to the human body proper. 1. There has been a plethora of research focusing on the mechanisms by which pathogenic bacteria influence intestinal function and induce disease; however, recent attention has focused on the indigenous non-pathogenic microorganisms and the ways in which they may benefit the host.  Initial colonization of the sterile newborn intestine occurs with maternal vaginal and fecal bacterial flora.  The first colonizers have a high reduction potential and include species such as enterobacter, streptococcus, and staphylococcus. These bacteria metabolize oxygen, favouring the growth of anaerobic bacteria, including lactobacilli and bifdobacteria.  Colonization with these bacteria is significantly delayed in caesarean deliveries, 2. leading to delayed activation of the efferent limb of the mucosal immune response. 3.Additional beneficial effects of developing a normal bacterial flora is seen in germ free mice that have small intestines that weigh less than their healthy counterparts.  This effect occurs partly due to underdevelopment of lymphoid constituents, with a lack of plasma cells in the lamina propria and Peyer’s patches, and subsequent reduction in IgA production.  Exposure to bacteria results in a reversal of this phenomenon within 28 days of exposure.

What is The Role Of An Antibody

Antibodies have the ability to fight infections that can leave us feeling run down, sick and achy. Whether created by the body's natural defense systems or acquired through vaccines, antibodies have the ability to protect against a range of illnesses caused by bacteria and viruses.

Definition

Antibodies are proteins created by the body's immune system (the organs and cells that help to fight infection) that attack foreign viruses and bacteria that can cause infection and illness.

Production

Antibodies are produced when the immune system's B cells (lymphocytes that recognize foreign bacteria or viruses and send out defense mechanisms to destroy them) detect these antigens (the foreign bodies) and send out antibodies to fight off infection.

Action

Antibodies fight these foreign bodies by attaching themselves directly to them. Antibodies do not single-handedly destroy the foreign bodies, but help to signal other cells, such as phagocytes, to attack the bacteria or viruses.

Types

There are five groups of antibodies, each with their own specific role or area of the body to protect. They are known as IgA, IgD, IgE, IgM and IgG.

Immunity

One of the benefits of antibodies is the body's ability to subsequently remember what the antigens looked like and keep the antibodies used to fight off that bacterium or virus in the body's memory. So if that particular virus or bacterium (such as chicken pox or measles) were to strike again, the antibodies would already be ready to fight off the infection. Because of the body's ability to remember the antibodies, chicken pox and other illnesses are much less likely to strike twice in a person's life.

Definition of Dengue Shock Syndrome

Dengue shock syndrome: A syndrome due to the dengue virus that tends to affect children under 10, causing abdominal pain, hemorrhage (bleeding) and circulatory collapse (shock). Known also as dengue hemorrhagic fever (DHF), it starts abruptly with high continuous fever and headache plus respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Shock occurs after 2 to 6 days with sudden collapse, cool clammy extremities, weak thready pulse, and blueness around the mouth (circumoral cyanosis). There is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums and nosebleeds (epistaxis). Pneumonia and heart inflammation (myocarditis) may be present. The mortality is appreciable ranging from 6 to 30%. Most deaths occur in children. Infants under a year of age are especially at risk of death. It is also called Philippine or Southeast Asian hemorrhagic fever.

How is Varicocele Happened in Man?

nlm.nih.gov- A varicocele is a widening of the veins along the cord that holds up a man's testicles (spermatic cord).

Causes

A varicocele forms when valves inside the veins along the spermatic cord prevent blood from flowing properly. This causes the blood to back up, leading to swelling and widening of the veins. (This is essentially the same process that leads to varicose veins, which are common in the legs.)

Varicoceles usually develop slowly. They are more common in men ages 15 - 25 and are most often seen on the left side of the scrotum.

The sudden appearance of a varicocele in an older man may be caused by a kidney tumor, which can block blood flow to a vein. This is more common on the left side than the right.

Symptoms

Enlarged, twisted veins in the scrotum

Painless testicle lump, scrotal swelling, or bulge in the scrotum

There may not be symptoms.

Exams and Tests

The health care provider will examine the groin area, including the scrotum and testicles. The health care provider may feel a twisted growth along the spermatic cord. (It feels like a bag of worms.)

However, the growth may not be able to be seen or felt, especially when you are lying down.

The testicle on the side of the varicocele may be smaller than the one on the other side.

Treatment

A jock strap (scrotal support) or snug underwear may help relieve the pain or discomfort. If pain continues or other symptoms occur, you may need further treatment.

Surgery to correct a varicocele is called varicocelectomy. You will leave the hospital on the same day as your surgery. During this procedure, you will receive some type of numbing medication (anesthesia). The urologist will make a cut, usually in the lower abdomen, and tie off the abnormal veins. Blood will now flow around the area into normal veins. Keep an ice pack on the area for the first 24 hours after surgery to reduce swelling.

An alternative to surgery is varicocele embolization. This method is also done without an overnight hospital stay. It uses a much smaller cut than surgery, so you will heal faster. A small hollow tube called a catheter (tube) is placed into a vein in your groin or neck area.

Using x-rays as a guide, the health care provider moves the tube into the varicocele. A tiny coil passes through the tube into the varicocele. The coil blocks blood flow to the bad vein, and sends it to normal veins.

After the procedure, you will be told to place ice on the area and wear a scrotal support for a little while.

Outlook (Prognosis)

A varicocele is usually harmless and often does not need to be treated.

If you have surgery, your sperm count will likely increase but it will not improve your chances of getting a woman pregnant. In most cases, testicular wasting (atrophy) does not improve unless surgery is done early in adolescence.

Possible Complications

Infertility is a complication of varicocele.

Complications from treatment may include:

Atrophic testis

Blood clot formation

Infection

Injury to the scrotum or nearby blood vessel

When to Contact a Medical Professional

Call for an appointment with your health care provider if you discover a testicle lump or need to treat a diagnosed varicocele.

Alternative Names

Varicose veins - scrotum

References

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37:613-626. 

Barthold JS. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 132. 

Animal Fat Consumption Before Conception Linked To Gestational Diabetes Risk

medicalnewstoday.com- Women who consumed a diet high in animal fat and cholesterol before pregnancy were at higher risk for gestational diabetes than women whose diets were lower in animal fat and cholesterol, according to researchers at the National Institutes of Health and Harvard University.

Gestational diabetes is a form of diabetes seen during pregnancy. Gestational diabetes increases the risk for certain pregnancy complications and health problems in the newborn.

Women whose diets were high in total fat or other kinds of fats - but not in animal fat or cholesterol - did not have an increased risk.

Moreover, the increased risk for gestational diabetes seen with animal fat and cholesterol appeared to be independent of other, dietary and non-dietary, risk factors for gestational diabetes. For example, exercise is known to reduce the risk of gestational diabetes. Among women who exercised, however, those who consumed higher amounts of animal fat and cholesterol had a higher risk than those whose diets were lower in these types of fat.

"Our findings indicate that women who reduce the proportion of animal fat and cholesterol in their diets before pregnancy may lower their risk for gestational diabetes during pregnancy," said senior author Cuilin Zhang, M.D., M.P.H., Ph.D., of the Epidemiology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of three NIH institutes supporting the study.

The researchers concluded that changing the source of 5 percent of dietary calories from animal fat to plant-derived sources could decrease a woman's risk for gestational diabetes by 7 percent.

The U.S. Department of Agriculture website, ChooseMyPlate.gov*, contains information on healthy eating for children and adults, as well as health and nutrition information for pregnant and breast feeding women.

First author Katherine Bowers, Ph.D., conducted the research with NICHD colleagues Dr. Zhang and Edwina Yeung, Ph.D., and with Deirdre K. Tobias and Frank B. Hu, M.D., M.P.H., Ph.D., of Harvard University, in Boston.

Their findings appear online in the American Journal of Clinical Nutrition.

The research was also funded by the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.

The researchers utilized information from more than 13,000 women participating in the Nurses' Health Study II. The women were 22 to 45 years old when they enrolled in the study. Every two years they responded to questions on their general health, pregnancy status, and lifestyle habits, such as consuming alcohol or smoking. In addition, every four years they completed a comprehensive survey about the kinds of food and drink they consumed.

About 6 percent of the participants reported having been diagnosed with gestational diabetes. The researchers calculated the amount of animal fat in participants' diets as a percentage of total calories and divided participants into five groups, or quintiles, based on those percentages. Then the researchers compared the risk for developing gestational diabetes for each group. Women in the highest quintile of intake had almost double the risk for gestational diabetes compared to women in the lowest quintile.

They also observed that women in the highest quintile for cholesterol consumption were 45 percent more likely to develop gestational diabetes than were women in the lowest quintile.

"This is the largest study to date of the effects of a pre-pregnancy diet on gestational diabetes," Dr. Bowers said. "Additional research may lead to increased understanding of how a mother's diet before and during pregnancy influences her metabolism during pregnancy, which may have important implications for the baby's health at birth and later in life."

There are Three Types of Diabetes?

medicalnewstoday.com- Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

There are three types of diabetes: 

1) Type 1 Diabetes

The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years.

Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1.

Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.

Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and Prevention). (Link to article) 

2) Type 2 Diabetes

The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).

Approximately 90% of all cases of diabetes worldwide are of this type.

Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form.

Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems.

The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active. Those with a close relative who had/had type 2 diabetes, people of Middle Eastern, African, or South Asian descent also have a higher risk of developing the disease.

Men whose testosterone levels are low have been found to have a higher risk of developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance. (Link to article) 

Measuring the glucose level in blood

3) Gestational Diabetes

This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose.

Diagnosis of gestational diabetes is made during pregnancy.

The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.

Scientists from the National Institutes of Health and Harvard University found that women whose diets before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats.

How to Dengue Fever happened

vectorbase.org

Medicinenet.com-Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes.

Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the dengue triad) of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever.

Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and in Paraguay in South America, and Costa Rica in Central America.

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is purely concerned with relief of the symptoms (symptomatic).

The acute phase of the illness with fever and myalgias lasts about one to two weeks.

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).

The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.

There is currently no vaccine available for dengue fever.

New Swine Flu Found in Minnesota

Current Situation 

Friday September 7, 2012  -- New Swine Flu Found in Minnesota

The Minnesota Department of Health reported human infections of an influenza A H1N2 variant (“H1N2v”) virus with the pandemic M gene from the 2009 H1N1 virus. These cases were reportedly associated with prolonged contact with pigs at a fair. H1N2 viruses normally circulate in pigs. This virus is different from the H3N2v virus.

The three people infected with the H1N2v virus exhibited pigs or spent prolonged time with pigs at the Minnesota State Fair. Two of the three people had underlying health conditions that placed them at high risk of serious flu complications.

The CDC has confirmed the Minnesota samples as H1N2v viruses. This is the first time this virus has included the M gene from the 2009 H1N1 pandemic virus when isolated from a person. CDC officials also reported genetic analysis shows that the hemagglutinin (H) of this virus is similar to human seasonal influenza viruses that circulated in people as recently as 2007, thus it is likely there is protective immunity against this particular virus in the human population.

AIDS and Treatment

ucsfhealth.org - AIDS and Treatment. At this time, there is no cure for AIDS, but medications are effective in fighting HIV and its complications. Treatments are designed to reduce HIV in your body, keep your immune system as healthy as possible and decrease the complications you may develop.

You and your doctor will work together to develop a treatment plan that best meets your needs. Three main factors will be considered when designing your treatment plan:

Your willingness and readiness to begin therapy

The stage of your disease

Other health problems

The U.S. Food and Drug Administration (FDA) has approved a number of drugs for treating HIV and AIDS. It's important that you take your medications exactly as prescribed. This is a crucial part of your treatment success. Our program offers pharmacy services to help you maintain your drug regimen and to answer any questions you may have.

Most medications have side effects, which your doctor will discuss with you. Individuals respond differently to medications and side effects may vary. Our doctors, nurses and pharmacists can help you manage these side effects.

AIDS Medications

Although there is no cure for acquired immunodeficiency syndrome (AIDS), medications have been highly effective in fighting HIV and its complications. Drug treatments help reduce the HIV virus in your body, keep your immune system as healthy as possible and decrease the complications you may develop.

Some of the drugs approved by the FDA for treating HIV and AIDS are listed below.

Nucleoside Reverse Transcriptase Inhibitors (NRTI)

These drugs interrupt the virus from duplicating, which may slow the spread of HIV in the body. They include:

Abacavir (Ziagen, ABC)

Didanosine (Videx, dideoxyinosine, ddI)

Emtricitabine (Emtriva, FTC)

Lamivudine (Epivir, 3TC)

Stavudine (Zerit, d4T)

Tenofovir (Viread, TDF)

Zalcitabine (Hivid, ddC)

Zidovudine (Retrovir, ZDV or AZT)

Combinations of NRTIs make it possible to take lower doses and maintain effectivenss. These drugs include Combivir (Zidovudine and Lamivudine), Trizivir (Zidovudine, Lamivudine and Abacavir), Epzicom (Abacavir and Lamivudine) and Truvada (Tenofovir and Lamivudine). We expect more combination drugs to be available in the future.

Side Effects of NRTIs

Side effects from taking NRTIs vary, depending on the individual. We recommend that you consult with your doctor regarding any side effects you experience. Common side effects include:

Abacavir (Ziagen, ABC) — Side effects may include fever, rash, fatigue, vomiting, diarrhea, abdominal pain, malaise or fatigue, loss of appetite and respiratory symptoms.

Dideoxyinosine (Videx, ddI) — Side effects may include nausea, vomiting and bloating. More serious side effects include pancreatitis and peripheral neuropathy. Peripheral neuropathy is a common neurological disorder resulting from damage to the peripheral nerves. Symptoms of peripheral neuropathy include a sharp, burning pain sensation in the hands or legs.

Lamivudine (Epivir, 3TC) — Side effects may include cough, diarrhea, dizziness, headache, loss of appetite, mild stomach cramps or pain and trouble sleeping. More serious side effects include burning, tingling, or pain in the hands, arms, feet, or legs; chills; ear, nose, or throat problems; fever; muscle aches; nausea; pale skin; severe stomach pain; skin rash; unusual tiredness or weakness; vomiting; and yellow eyes or skin.

Stavudine (Zerit, d4T) — Side effects may include peripheral neuropathy. Symptoms of peripheral neuropathy include a sharp, burning pain sensation in the hands or legs. In rare cases, Stavudine also may cause pancreatitis.

Tenofovir (Viread, TDF) — Side effects may include weakness and lack of energy, headache, diarrhea, nausea, vomiting and intestinal gas. More serious side effects include liver or kidney failure and pancreas disease.

Zalcitabine (Hivid, ddC) — Side effects may include oral ulcers and peripheral neuropathy. Symptoms of peripheral neuropathy include a sharp, burning pain sensation in the hands or legs.

Zidovudine (Retrovir, ZDV or AZT) — Side effects may include diarrhea, nausea, vomiting, headache, insomnia, weakness and fatigue, bone marrow suppression, anemia and neutropenia. Neutropenia refers to an abnormally low number of neutrophils in the blood. Neutrophils, a type of white blood cell, help fight bacterial infections. Neutropenia isn't a disease but a sign of an underlying problem. In mild cases, it may cause no symptoms. Severe neutropenia increases the risk of infection of the lungs, kidneys, blood and skin.

Protease Inhibitors (PI)

These FDA-approved drugs interrupt virus replication at a later step in the virus life cycle. Protease inhibitors include:

Amprenavir (Agenerase, APV)

Atazanavir (Reyataz, ATV)

Fosamprenavir (Lexiva, FOS)

Indinavir (Crixivan, IDV)

Lopinavir (Kaletra, LPV/r)

Ritonavir (Norvir, RIT)

Saquinavir (Fortovase, Invirase, SQV)

Side Effects of PIs

Side effects from protease inhibitors vary, depending on the individual. We recommend that you consult with your doctor to discuss any side effects you may experience. The following is a list protease inhibitors and their possible side effects:

Amprenavir (Agenerase, APV) — Side effects include nausea, diarrhea, vomiting, rash, numbness around the mouth and abdominal pain. About 1 percent of people have serious skin reactions, including Stevens-Johnson syndrome.

Atazanavir (Reyataz, ATV) — Side effects include headache, rash, stomach pain, vomiting, depression, increased cough, trouble sleeping, tiredness, back pain, joint pain, as well as numbness, tingling or burning of the hands or feet. More serious side effects include yellowing of the eyes or skin, change in heart rhythm, diabetes and high blood sugar, diarrhea, infection, nausea and blood in the urine.

Fosamprenavir (Lexiva, FOS) — Side effects may include rash, nausea and diarrhea.

Indinavir (Crixivan, IDV) — Side effects include change in sense of taste, diarrhea, nausea, vomiting, dizziness or drowsiness, general feeling of weakness, headache, stomach pain and trouble sleeping. More serious side effects include kidney stones, changes in body fat, increased bleeding in patients with hemophilia, high sugar and fat levels in the blood, and onset or worsening of diabetes.

Lopinavir (Kaletra, LPV/r) — Side effects include abdominal pain, abnormal stools or bowl movements, diarrhea, feeling weak or tired, headache and nausea. In addition, patients taking Lopinavir should be monitored for possible liver problems. People taking the drug who have liver disease, such as hepatitis B or hepatitis C, may experience a worsening of their liver condition. A small number of patients have experienced severe liver problems.

Nelfinavir (Viracept, NFV) — Side effects include diarrhea, weakness, headache, nausea and abdominal pain.

Ritonavir (Norvir, RIT) — Ritonavir often is used in combination with other protease inhibitors — an approach called "Ritonavir boosting." Studies have shown that small amounts of Ritonavir, taken in combination with other PIs, can boost or increase the strength and effectiveness of some drugs and may overcome drug and food interactions. In some cases, "Ritonavir boosting" reduces the number of pills necessary or how often they're taken. The disadvantage is that Ritonavir interacts with many drugs, both prescription and over the counter. It is important that you speak with your doctor about all your medications before taking Ritonavir. 

Side effects include general weakness, burning or prickling sensation in the hands and feet, stomach pain, diarrhea, constipation, indigestion, flatulence, nausea, vomiting, loss of appetite, change in sense of taste, headache, dizziness, drowsiness, insomnia, fever, throat irritation, abnormal thinking, rash, sore throat and sweating. More serious effects include pancreas disease, changes in body fat, increased bleeding in patients with hemophilia, high sugar and fat levels in the blood, and onset or worsening of diabetes.

Saquinavir (Fortovase, Invirase, SQV) — Side effects are related to the stomach and intestinal system, including diarrhea, nausea, stomach-intestinal pain, heartburn, rectal gas, vomiting, altered taste sensation, headache, fatigue, depression, sleep disturbance including insomnia, anxiety, sex drive disorder, muscle aches, rash, hepatitis and abnormal fat redistribution.

Other AIDS Medications

Fusion Inhibitors

Fusion inhibitors are a new class of drugs that act against HIV by preventing the virus from fusing with the inside of a cell, preventing it from replicating. The group of drugs includes Enfuvirtide, also known as Fuzeon or T-20.

Highly Active Antiretroviral Therapy (HAART)

In 1996, highly active antiretroviral therapy (HAART) was introduced for people with HIV and AIDS. HAART — often referred to as the anti-HIV "cocktail" — is a combination of three or more drugs, such as protease inhibitors and other anti-retroviral medications. The treatment is highly effective in slowing the rate at which the HIV virus replicates itself, which may slow the spread of HIV in the body. The goal of HAART is to reduce the amount of virus in your body, or the viral load, to a level that can no longer be detected with blood tests.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) block the infection of new cells by HIV. These drugs may be prescribed in combination with other anti-retroviral drugs. NNRTs include:

Delvaridine (Rescriptor, DLV)

Efravirenz (Sustiva, EFV)

Nevirapine (Viramune, NVP)

Reviewed by health care specialists at UCSF Medical Center

What is Parkinson's Disease?

informasitips.com

Health.nytimes.com-Parkinson's disease. Do you remember Moh. Ali,  a boxer who get parkinson's  disease. parkinson's disease most often develops after age 50. It is one of the most common nervous system disorders of the elderly. Sometimes Parkinson's disease occurs in younger adults. It affects both men and women. In some cases, Parkinson's disease runs in families. When a young person is affected, it is usually because of a form of the disease that runs in families. Nerve cells use a brain chemical called dopamine to help control muscle movement. Parkinson's disease occurs when the nerve cells in the brain that make dopamine are slowly destroyed. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why these brain cells waste away is unknown. Parkinson's is rare in children. It may occur because the nerves are not as sensitive to dopamine. The term "parkinsonism" refers to any condition that involves the types of movement changes seen in Parkinson's disease. Parkinsonism may be caused by other disorders (called secondary parkinsonism) or certain medications.

Symptoms may be mild at first. For instance, you may have a mild tremor or a slight feeling that one leg or foot is stiff and dragging. Symptoms may affect one or both sides of the body, and can include:
Symptoms include:
Slow blinking
Constipation
Difficulty swallowing
Drooling
Problems with balance and walking
No expression in the face (like you are wearing a mask)
Muscle aches and pains
Movement problems, which include:
Difficulty starting movement, such as starting to walk or getting out of a chair
Difficulty continuing to move
Slowed movements
Loss of small or fine hand movements; writing may become small and difficult to read; eating becomes difficults
Rigid or stiff muscles, often beginning in the legs
Shaking, called tremors
Usually occurs in the limbs at rest, or when the arm or leg is held out
Goes away when you move
Eventually may be seen in the head, lips, tongue, and feet
May be worse when tired, excited, or stressed
Finger-thumb rubbing (pill-rolling tremor) may be present
Slowed, quieter speech and monotone voice
Stooped position
Low blood pressure when getting up, sweating, drooling, lack of body temperature control. These problems are due to something called autonomic dysfunction.
Other symptoms may include:
Anxiety, stress, and tension
Confusion
Dementia
Depression
Fainting
Hallucinations
Memory loss


There is no known cure for Parkinson's disease. The goal of treatment is to control symptoms. Medications control symptoms, mostly by increasing the levels of dopamine in the brain. At certain points during the day, the helpful effects of the medication often wears off, and symptoms can return. If this happens to you, your health care provider may need to change the:
Type of medication
Dose
Amount of time between doses
How the medicine is taken
Work closely with your doctors and therapists to find a treatment program that works best for you. Never change or stop taking any medications without talking with your doctor.
Many medications can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and delirium. Monitoring and follow-up by the health care provider is important.
Eventually, symptoms such as stooped posture, frozen movements, and speech difficulties may not respond very well to drug treatment.
Medications used to treat movement-related symptoms of Parkinson's disease include:
Levodopa (L-dopa), Sinemet, levodopa and carbidopa (Atamet)
Pramipexole (Mirapex), ropinirole (Requip), bromocriptine (Parlodel)
Selegiline (Eldepryl, Deprenyl), rasagiline (Azilect)
Amantadine or anticholinergic medications to reduce early or mild tremors
Entacapone
Other medications may include:
Memantine, rivastigmine, galantamine for cognitive difficulties
Antidepressants for mood disorders
Gabapentin, duloxetine for pain
Fludrocortisone, midodrine, botox, sidenafil for autonomic dysfunction
Armodafinil, clonazepam, zolpidem for sleep disorders
Lifestyle changes may be helpful for Parkinson's disease:
Good general nutrition and health. Changes in what you eat or drink are needed if there are swallowing problems
Exercising, but adjusting the activity level to meet changing energy levels
Regular rest periods and avoiding stress
Physical therapy, speech therapy, and occupational therapy
Railings or banisters placed in commonly used areas of the house. Other changes may be needed around the home to prevent falls and make the bathroom safe.
Assistive devices, such as special eating utensils, wheelchairs, bed lifts, shower chairs, walkers, and wall bars
Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)
Surgery may be an option for some patients with Parkinson's disease. These surgeries do not cure Parkinson's, but may help ease symptoms.
Deep brain stimulation involves placing electrical stimulators in specific areas of the brain that control movement.
Another type of surgery destroys brain issues that cause Parkinson's symptoms.
Stem cell transplant and other clinical trials are currently ongoing in the USA.

High Blood Pressure is One of A Silent Killer

medicinenet.com One in every four adults some 50 million people in the USA alone have high blood pressure. But many people are unaware that they have the condition.

Untreated hypertension increases the risk of heart disease and stroke. These are the first and third commonest causes of death in the USA. Hypertension can also damage the kidneys and increase the risk of blindness and dementia. That is why hypertension is referred to as a "silent killer."

Everyone is at risk from high blood pressure. However, the elderly tend to have a different hypertension profile compared with younger people, according to the National Heart, Lung, and Blood Institute (NHLBI), which is part of the National Institutes of Health (NIH).

It is important to raise our collective consciousness of a particular type of high blood pressure known as isolated systolic hypertension (ISH).

Systolic pressure is the first number in a blood pressure reading and is an indicator of blood pressure when the heart contracts. The second number, the diastolic pressure, reflects pressure when the heart relaxes between beats.

In the past, many doctors diagnosed high blood pressure based on diastolic pressure, the smaller number. However, new research suggests that systolic pressure is a much better indicator of hypertension, particularly in the elderly.

Diastolic pressure increases up to age 55 and then tends to decline, according to the NHLBI. On the other hand, systolic pressure continues to increase with age and is an important determinant of elevated blood pressure in middle-aged and older adults. While any pressure above 140/90 is considered elevated, about 65% of people with hypertension who are over age 60 have ISH.

High blood pressure interacts with other major risk factors such as diabetes and high levels of cholesterol to amplify the risk of heart attack and stroke. Changes in lifestyle can therefore help us achieve blood pressure goals. Other recommendations are as follows here:

Don't ignore your systolic pressure.

If you're middle-aged or older, the systolic is a better blood pressure indicator than diastolic of your risk of heart disease and stroke.

Blood pressure at all ages should be kept below 140/90.

Treatment for hypertension must begin early to prevent organ damage -- whatever be your age.

In persons with diabetes, blood pressure should be kept below 130/85, and in those with kidney failure and heart failure, at the lowest level possible.

What is Endometriosis?

Wikipedia.com

Wikipedia.com. Endometriosis is a gynecological medical condition in which cells from the lining of the uterus (endometrium) appear and flourish outside the uterine cavity, most commonly on the peritoneum which lines the abdominal cavity. The uterine cavity is lined with endometrial cells, which are under the influence of female hormones. Endometrial-like cells in areas outside the uterus (endometriosis) are influenced by hormonal changes and respond in a way that is similar to the cells found inside the uterus. Symptoms often worsen with the menstrual cycle.

Endometriosis is typically seen during the reproductive years; it has been estimated that endometriosis occurs in roughly 6–10% of women. Symptoms may depend on the site of active endometriosis. Its main but not universal symptom is pelvic pain in various manifestations. Endometriosis is a common finding in women with infertility.

Diagnostic
A health history and a physical examination can in many patients lead the physician to suspect endometriosis. Laparoscopy, a surgical procedure where a camera is used to look inside the abdominal cavity, is the gold standard in diagnosis. However, in the United States most insurance plans will not cover surgical diagnosis unless the patient has already attempted to become pregnant and failed.
Use of imaging tests may identify endometriotic cysts or larger endometriotic areas. It also may identify free fluid often within the Recto-uterine pouch. The two most common imaging tests are ultrasound and magnetic resonance imaging (MRI). Normal results on these tests do not eliminate the possibility of endometriosis. Areas of endometriosis are often too small to be seen by these tests.
Endoscopic image of endometriotic lesions in the Pouch of Douglas and on the right sacrouterine ligament.
The only way to diagnose endometriosis is by laparoscopy or other types of surgery with lesion biopsy.[citation needed] The diagnosis is based on the characteristic appearance of the disease, and should be corroborated by a biopsy. Surgery for diagnoses also allows for surgical treatment of endometriosis at the same time.
Although doctors can often feel the endometrial growths during a pelvic exam, and these symptoms may be signs of endometriosis, diagnosis cannot be confirmed without performing a laparoscopic procedure. To the eye, lesions can appear dark blue, powder-burn black, red, white, yellow, brown or non-pigmented. Lesions vary in size. Some within the pelvis walls may not be visible, as normal-appearing peritoneum of infertile women reveals endometriosis on biopsy in 6–13% of cases. Early endometriosis typically occurs on the surfaces of organs in the pelvic and intra-abdominal areas. Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules. Larger lesions may be seen within the ovaries as ovarian endometriomas or "chocolate cysts", "chocolate" because they contain a thick brownish fluid, mostly old blood.
Often the symptoms of ovarian cancer are identical to those of endometriosis.
If surgery is not performed, then a diagnosis of exclusion process is used. This means that all of the other plausible causes of pelvic pain are ruled out. For example, internal hernias are difficult to identify in women, and misdiagnosis with endometriosis is very common. One cause of misdiagnosis is that when the woman lies down flat on an examination table, all of the medical signs of the hernia disappear, but the woman typically has tenderness and other symptoms associated with endometriosis in a pelvic exam. The hernia can typically only be detected when symptoms are present, so diagnosis requires positioning the woman's body in a way that provokes symptoms.