Fish Bile ‘Treatment’ Lands Woman in Hospital- Folly of Fringe Theories in medicine


    It has become a common practice to advertise health products or therapies that claim to be panacea for all ailments enhance immunity, to increase power and health by creating an impression on minds on various platforms. Instead of producing scientific evidence, such products and therapies are sold under disguise of natural therapies or alternate medicines. Needless to say, the objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.

    Companies have created huge fortunes based on circulation of such pedagogic narratives and social knowledge. But in real sense, these are actually chemical and have biological actions and reactions. Chemical derived from natural sources can have side effects and contain impurities.  Global neutral trials to validate effects and side effects remain an urgent need of the hour for all health products.

   Suffering for the common public is immense. Doctors’  sincere warning had no effect rather they were called as medicine mafia.   Unfortunately  false beliefs  like local religious figures can cure cancer and kidney diseases  cause they could communicate with invisible spirits  and gain knowledge. Unsurprisingly the cranks  have been  wrong and innocent patients suffer.   Doctors objecting to  elevation of  crank theories were painted as  western medicine agents,  or nattering nabobs of negativity.

 Here is an example of the folly of following fringe  theories.

Fish bile ‘treatment’ lands woman in hospital

Fish bile ‘treatment’ lands woman in hospital

 A 52-year-old homemaker from Dum Dum had to undergo a few rounds of dialysis and was put under intense critical care for a renal failure, triggered by ‘fish bile poisoning’. The patient had ingested raw fish bile for four consecutive days as a treatment to cure her diabetes prior to being rushed to Manipal Hospitals Kolkata with acute abdominal pain. Doctors at the Salt Lake hospital found the patient had low blood pressure and was in a state of shock. Initial reports showed a significant derangement of liver and kidney functions. It led doctors to treat common causes of liver and kidney injuries or drug induced organ damage. When further tests didn’t match with these diagnoses, the team started looking for a possible cause. The patient then revealed she had ingested bile of Rohu fish for four days to control her diabetes. “Consuming fish bile causes acute kidney and liver injury with the need to go for long term dialysis. This patient had to be put under dialysis within 72 hours of admission,” said internal medicine and critical care consultant. She was discharged from hospital after a month.

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All about Monkeypox & its Relation to Smallpox


How monkeypox relates to smallpox

The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which has been eradicated. Smallpox was more easily transmitted and more often fatal as about 30% of patients died. The last case of naturally acquired smallpox occurred in 1977, and in 1980 smallpox was declared to have been eradicated worldwide after a global campaign of vaccination and containment. It has been 40 or more years since all countries ceased routine smallpox vaccination with vaccinia-based vaccines. As vaccination also protected against monkeypox in West and Central Africa, unvaccinated populations are now also more susceptible to monkeypox virus infection.

Whereas smallpox no longer occurs naturally, the global health sector remains vigilant in the event it could reappear through natural mechanisms, laboratory accident or deliberate release. To ensure global preparedness in the event of reemergence of smallpox, newer vaccines, diagnostics and antiviral agents are being developed. These may also now prove useful for prevention and control of monkeypox.

Key facts

  • Monkeypox is caused by monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.
  • Monkeypox is a viral zoonotic disease that occurs primarily in tropical rainforest areas of Central and West Africa and is occasionally exported to other regions.
  • Monkeypox typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications.
  • Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur. In recent times, the case fatality ratio has been around 3-6%.
  • Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus.
  • Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.
  • The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide in 1980. Monkeypox is less contagious than smallpox and causes less severe illness.
  • Vaccines used during the smallpox eradication programme also provided protection against monkeypox. Newer vaccines have been developed of which one has been approved for prevention of monkeypox
  • An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox.

WHO- Monkeypox

WHO- Monkeypox

Introduction

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms very similar to those seen in the past in smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health. Monkeypox primarily occurs in Central and West Africa, often in proximity to tropical rainforests and has been increasingly appearing in urban areas. Animal hosts include a range of rodents and non-human primates.

The pathogen

Monkeypox virus is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family. There are two distinct genetic clades of the monkeypox virus – the Central African (Congo Basin) clade and the West African clade. The Congo Basin clade has historically caused more severe disease and was thought to be more transmissible. The geographical division between the two clades has so far been in Cameroon – the only country where both virus clades have been found.

Natural host of monkeypox virus

Various animal species have been identified as susceptible to monkeypox virus.. This includes rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates and other species. Uncertainty remains on the natural history of monkeypox virus and further studies are needed to identify the exact reservoir(s) and how virus circulation is maintained in nature.

Outbreaks

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-year-old boy in a region where smallpox had been eliminated in 1968. Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, particularly in the Democratic Republic of the Congo and human cases have increasingly been reported from across Central and West Africa.

Since 1970, human cases of monkeypox have been reported in 11 African countries – Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. The true burden of monkeypox is not known. For example, in 1996–97, an outbreak was reported in the Democratic Republic of the Congo with a lower case fatality ratio and a higher attack rate than usual. A concurrent outbreak of chickenpox (caused by the varicella virus, which is not an orthopoxvirus) and monkeypox was found which could explain real or apparent changes in transmission dynamics in this case. Since 2017, Nigeria has experienced a large outbreak, with over 500 suspected cases and over 200 confirmed cases and a case fatality ratio of approximately 3%. Cases continue to be reported until today.

Monkeypox is a disease of global public health importance as it not only affects countries in West and Central Africa, but the rest of the world. In 2003, the first monkeypox outbreak outside of Africa was in the United States of America and was linked to contact with infected pet prairie dogs. These pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana. This outbreak led to over 70 cases of monkeypox in the U.S. Monkeypox has also been reported in travelers from Nigeria to Israel in September 2018, to the United Kingdom in September 2018, December 2019, May 2021 and May 2022, to Singapore in May 2019, and to the United States of America in July and November 2021. In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. Studies are currently underway to further understand the epidemiology, sources of infection, and transmission patterns.  

Transmission

Animal-to-human (zoonotic) transmission can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa, evidence of monkeypox virus infection has been found in many animals including rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys and others. The natural reservoir of monkeypox has not yet been identified, though rodents are the most likely. Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor. People living in or near forested areas may have indirect or low-level exposure to infected animals.

Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers, household members and other close contacts of active cases at greater risk. However, the longest documented chain of transmission in a community has risen in recent years from six to nine successive person-to-person infections. This may reflect declining immunity in all communities due to cessation of smallpox vaccination. Transmission can also occur via the placenta from mother to fetus (which can lead to congenital monkeypox) or during close contact during and after birth. While close physical contact is a well-known risk factor for transmission, it is unclear at this time if monkeypox can be transmitted specifically through sexual transmission routes. Studies are needed to better understand this risk.

Signs and symptoms

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.

The infection can be divided into two periods:

  • the invasion period (lasts between 0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches) and intense asthenia (lack of energy). Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox)
  • the skin eruption usually begins within 1-3 days of appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk. It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases). Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (20%), as well as the cornea. The rash evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. The number of lesions varies from a few to several thousand. In severe cases, lesions can coalesce until large sections of skin slough off.

Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications. Underlying immune deficiencies may lead to worse outcomes. Although vaccination against smallpox was protective in the past, today persons younger than 40 to 50 years of age (depending on the country) may be more susceptible to monkeypox due to cessation of smallpox vaccination campaigns globally after eradication of the disease.  Complications of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. The extent to which asymptomatic infection may occur is unknown.

The case fatality ratio of monkeypox has historically ranged from 0 to 11 % in the general population and has been higher among young children. In recent times, the case fatality ratio has been around 3-6%.

Diagnosis

The clinical differential diagnosis that must be considered includes other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish monkeypox from chickenpox or smallpox.

If monkeypox is suspected, health workers should collect an appropriate sample and have it transported safely to a laboratory with appropriate capability. Confirmation of monkeypox depends on the type and quality of the specimen and the type of laboratory test. Thus, specimens should be packaged and shipped in accordance with national and international requirements. Polymerase chain reaction (PCR) is the preferred laboratory test given its accuracy and sensitivity. For this, optimal diagnostic samples for monkeypox are from skin lesions – the roof or fluid from vesicles and pustules, and dry crusts. Where feasible, biopsy is an option. Lesion samples must be stored in a dry, sterile tube (no viral transport media) and kept cold. PCR blood tests are usually inconclusive because of the short duration of viremia relative to the timing of specimen collection after symptoms begin and should not be routinely collected from patients.

As orthopoxviruses are serologically cross-reactive, antigen and antibody detection methods do not provide monkeypox-specific confirmation. Serology and antigen detection methods are therefore not recommended for diagnosis or case investigation where resources are limited. Additionally, recent or remote vaccination with a vaccinia-based vaccine (e.g. anyone vaccinated before smallpox eradication, or more recently vaccinated due to higher risk such as orthopoxvirus laboratory personnel) might lead to false positive results.

In order to interpret test results, it is critical that patient information be provided with the specimens including: a) date of onset of fever, b) date of onset of rash, c) date of specimen collection, d) current status of the individual (stage of rash), and e) age.

Therapeutics

Clinical care for monkeypox should be fully optimized to alleviate symptoms, manage complications and prevent long-term sequelae. Patients should be offered fluids and food to maintain adequate nutritional status. Secondary bacterial infections should be treated as indicated.  An antiviral agent known as tecovirimat that was developed for smallpox was licensed by the European Medical Association (EMA) for monkeypox in 2022 based on data in animal and human studies. It is not yet widely available.

If used for patient care, tecovirimat should ideally be monitored in a clinical research context with prospective data collection.

Vaccination

Vaccination against smallpox was demonstrated through several observational studies to be about 85% effective in preventing monkeypox. Thus, prior smallpox vaccination may result in milder illness. Evidence of prior vaccination against smallpox can usually be found as a scar on the upper arm. At the present time, the original (first-generation) smallpox vaccines are no longer available to the general public. Some laboratory personnel or health workers may have received a more recent smallpox vaccine to protect them in the event of exposure to orthopoxviruses in the workplace. A still newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) was approved for the prevention of monkeypox in 2019. This is a two-dose vaccine for which availability remains limited. Smallpox and monkeypox vaccines are developed in formulations based on the vaccinia virus due to cross-protection afforded for the immune response to orthopoxviruses.

Prevention

Raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus is the main prevention strategy for monkeypox. Scientific studies are now underway to assess the feasibility and appropriateness of vaccination for the prevention and control of monkeypox. Some countries have, or are developing, policies to offer vaccine to persons who may be at risk such as laboratory personnel, rapid response teams and health workers.

 

Reducing the risk of human-to-human transmission

Surveillance and rapid identification of new cases is critical for outbreak containment. During human monkeypox outbreaks, close contact with infected persons is the most significant risk factor for monkeypox virus infection. Health workers and household members are at a greater risk of infection. Health workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions. If possible, persons previously vaccinated against smallpox should be selected to care for the patient.

Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories. Patient specimens must be safely prepared for transport with triple packaging in accordance with WHO guidance for transport of infectious substances.

The identification in May 2022 of clusters of monkeypox cases in several non-endemic countries with no direct travel links to an endemic area is atypical. Further investigations  are underway to determine the likely source of infection and limit further onward spread. As the source of this outbreak is being investigated, it is important to look at all possible modes of transmission in order to safeguard public health. Further information on this outbreak can be found here

 

Reducing the risk of zoonotic transmission

Over time, most human infections have resulted from a primary, animal-to-human transmission. Unprotected contact with wild animals, especially those that are sick or dead, including their meat, blood and other parts must be avoided. Additionally, all foods containing animal meat or parts must be thoroughly cooked before eating.

Preventing monkeypox through restrictions on animal trade

Some countries have put in place regulations restricting importation of rodents and non-human primates. Captive animals that are potentially infected with monkeypox should be isolated from other animals and placed into immediate quarantine. Any animals that might have come into contact with an infected animal should be quarantined, handled with standard precautions and observed for monkeypox symptoms for 30 days.

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Obesity & Overweight: Quality of Life, Causes, Diagnosis Treatment


Obesity is a complex disease involving an excessive amount of body fat. Obesity isn’t just a cosmetic concern. It’s a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

There are many reasons why some people have difficulty losing weight. Usually, obesity results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss procedures are additional options for treating obesity.

Symptoms

Body mass index (BMI) is often used to diagnose obesity. To calculate BMI, multiply weight in pounds by 703, divide by height in inches and then divide again by height in inches. Or divide weight in kilograms by height in meters squared.

BMIWeight status
Below 18.5Underweight
18.5-24.9Normal
25.0-29.9Overweight
30.0 and higherObesity

Asians with BMI of 23 or higher may have an increased risk of health problems.

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn’t directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don’t have excess body fat.

Many doctors also measure a person’s waist circumference to help guide treatment decisions. Weight-related health problems are more common in men with a waist circumference over 40 inches (102 centimeters) and in women with a waist measurement over 35 inches (89 centimeters).

Causes

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through normal daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people’s diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less physically demanding, so they don’t tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping and drive-through banks.

Risk factors

Obesity usually results from a combination of causes and contributing factors:

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise.

Obesity tends to run in families. That’s not just because of the genes they share. Family members also tend to share similar eating and activity habits.

Lifestyle choices

  • Unhealthy diet. A diet that’s high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
  • Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to significant weight gain.
  • Inactivity. If you have a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is a sedentary activity. The number of hours spent in front of a screen is highly associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.

Some medications can lead to weight gain if you don’t compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. Avoiding obesity is difficult if you don’t have safe areas to walk or exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have access to healthier foods. In addition, the people you spend time with may influence your weight — you’re more likely to develop obesity if you have friends or relatives with obesity.

Age

Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. Generally, lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don’t consciously control what you eat and become more physically active as you age, you’ll likely gain weight.

Other factors

  • Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
  • Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. In the long run, however, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your doctor can help you prevent weight gain after quitting smoking.
  • Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
  • Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food when experiencing stressful situations.
  • Microbiome. Your gut bacteria are affected by what you eat and may contribute to weight gain or difficulty losing weight.

Even if you have one or more of these risk factors, it doesn’t mean that you’re destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

Complications

People with obesity are more likely to develop a number of potentially serious health problems, including:

  • Heart disease and strokes. Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes.
  • Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.
  • Certain cancers. Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
  • Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
  • Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
  • Osteoarthritis. Obesity increases the stress placed on weight-bearing joints, in addition to promoting inflammation within the body. These factors may lead to complications such as osteoarthritis.
  • Severe COVID-19 symptoms. Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019 (COVID-19). People who have severe cases of COVID-19 may require treatment in intensive care units or even mechanical assistance to breathe.

Quality of life

Obesity can diminish the overall quality of life. You may not be able to do physical activities that you used to enjoy. You may avoid public places. People with obesity may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

  • Depression
  • Disability
  • Shame and guilt
  • Social isolation
  • Lower work achievement

Diagnosis

To diagnose obesity, your doctor will typically perform a physical exam and recommend some tests.

These exams and tests generally include:

  • Taking your health history. Your doctor may review your weight history, weight-loss efforts, physical activity and exercise habits, eating patterns and appetite control, what other conditions you’ve had, medications, stress levels, and other issues about your health. Your doctor may also review your family’s health history to see if you may be predisposed to certain conditions.
  • A general physical exam. This includes measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
  • Calculating your BMI. Your doctor will check your body mass index (BMI). A BMI of 30 or higher is considered obesity. Numbers higher than 30 increase health risks even more. Your BMI should be checked at least once a year because it can help determine your overall health risks and what treatments may be appropriate.
  • Measuring your waist circumference. Fat stored around the waist, sometimes called visceral fat or abdominal fat, may further increase the risk of heart disease and diabetes. Women with a waist measurement (circumference) of more than 35 inches (89 centimeters) and men with a waist measurement of more than 40 inches (102 centimeters) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, waist circumference should be checked at least once a year.
  • Checking for other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure, high cholesterol, underactive thyroid, liver problems and diabetes.

Treatment

The goal of obesity treatment is to reach and stay at a healthy weight. This improves overall health and lowers the risk of developing complications related to obesity.

You may need to work with a team of health professionals — including a dietitian, behavioral counselor or an obesity specialist — to help you understand and make changes in your eating and activity habits.

The initial treatment goal is usually a modest weight loss — 5% to 10% of your total weight. That means that if you weigh 200 pounds (91 kilograms), you’d need to lose only about 10 to 20 pounds (4.5 to 9 kilograms) for your health to begin to improve. However, the more weight you lose, the greater the benefits.

All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your obesity severity, your overall health and your willingness to participate in your weight-loss plan.

Dietary changes

Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently.

There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:

  • Cutting calories. The key to weight loss is reducing how many calories you take in. The first step is to review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
  • Feeling full on less. Some foods — such as desserts, candies, fats and processed foods — contain a lot of calories for a small portion. In contrast, fruits and vegetables provide a larger portion size with fewer calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
  • Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole grains. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils.
  • Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans are effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended. Limiting these drinks or eliminating them altogether is a good place to start cutting calories.
  • Meal replacements. These plans suggest replacing one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that’s low in fat and calories. In the short term, this type of diet can help you lose weight. But these diets likely won’t teach you how to change your overall lifestyle. So you may have to stay on the diet if you want to keep your weight off.

Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don’t appear to be any better than other diets.

Similarly, you may lose weight on a crash diet, but you’re likely to regain it when you stop the diet. To lose weight — and keep it off — you must adopt healthy-eating habits that you can maintain over time.

Exercise and activity

Increased physical activity or exercise is an essential part of obesity treatment:

  • Exercise. People with obesity need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve.
  • Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Park farther from store entrances and take the stairs instead of the elevator. A pedometer can track how many steps you take over the course of a day. Many people try to reach 10,000 steps every day. Gradually increase the number of steps you take daily to reach that goal.

Behavior changes

A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity.

  • Counseling. Talking with a mental health professional can help address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Counseling can be one-on-one or in a group.
  • Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area.

Weight-loss medication

Weight-loss medications are meant to be used along with diet, exercise and behavior changes, not instead of them. Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects.

The most commonly used medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of obesity include:

  • Bupropion-naltrexone (Contrave)
  • Liraglutide (Saxenda)
  • Orlistat (Alli, Xenical)
  • Phentermine-topiramate (Qsymia)

Weight-loss medications may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.

Endoscopic procedures for weight loss

These types of procedures don’t require any incisions in the skin. After you are under anesthesia, flexible tubes and tools are inserted through the mouth and down the throat into the stomach. Common procedures include:

  • Endoscopic sleeve gastroplasty. This procedure involves placing stitches in the stomach to reduce the amount of food and liquid the stomach can hold at one time. Over time, eating and drinking less helps the typical person lose weight.
  • Intragastric balloon for weight loss. In this procedure, doctors place a small balloon into the stomach. The balloon is then filled with water to reduce the amount of space in the stomach, so you’ll feel full eating less food.

Weight-loss surgery

Also known as bariatric surgery, weight-loss surgery limits the amount of food you’re able to comfortably eat or decreases the absorption of food and calories. However, this can also result in nutritional and vitamin deficiencies.

Common weight-loss surgeries include:

  • Adjustable gastric banding. In this procedure, an inflatable band separates the stomach into two pouches. The surgeon pulls the band tight, like a belt, to create a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently.
  • Gastric bypass surgery. In gastric bypass (Roux-en-Y), the surgeon creates a small pouch at the top of the stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of the stomach.
  • Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It’s a less complicated surgery than gastric bypass.

Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.

Mayo Clinic

Other treatments

Other treatments for obesity include:

  • Hydrogels. Available by prescription, these edible capsules contain tiny particles that absorb water and enlarge in the stomach, to help you feel full. The capsules are taken before meals and are passed through the intestines as stool.
  • Vagal nerve blockade. This involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full.
  • Gastric aspirate. In this procedure, a tube is placed through the abdomen into the stomach. A portion of the stomach contents are drained out after each meal.

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Diarrhea-Cause-Diagnosis-Treatment-Complication-Dehydration


Overview

Diarrhea — loose, watery and possibly more-frequent bowel movements — is a common problem. It may be present alone or be associated with other symptoms, such as nausea, vomiting, abdominal pain or weight loss.

Luckily, diarrhea is usually short-lived, lasting no more than a few days. But when diarrhea lasts beyond a few days into weeks, it usually indicates that there’s another problem — such as irritable bowel syndrome (IBS) or a more serious disorder, including persistent infection, celiac disease or inflammatory bowel disease (IBD).

Symptoms

Signs and symptoms associated with diarrhea (loose, watery stools) may include:

  • Abdominal cramps or pain
  • Bloating
  • Nausea
  • Vomiting
  • Fever
  • Blood in the stool
  • Mucus in the stool
  • Urgent need to have a bowel movement

When to see a doctor

If you’re an adult, see your doctor if:

  • Your diarrhea persists beyond two days with no improvement
  • You become dehydrated
  • You have severe abdominal or rectal pain
  • You have bloody or black stools
  • You have a fever above 102 F (39 C)

In children, particularly young children, diarrhea can quickly lead to dehydration. Call your doctor if your child’s diarrhea doesn’t improve within 24 hours or if your child:

  • Becomes dehydrated
  • Has a fever above 102 F (39 C)
  • Has bloody or black stools

Causes

A number of diseases and conditions can cause diarrhea, including:

  • Viruses. Viruses that can cause diarrhea include Norwalk virus (also known as norovirus), enteric adenoviruses, astrovirus, cytomegalovirus and viral hepatitis. Rotavirus is a common cause of acute childhood diarrhea. The virus that causes coronavirus disease 2019 (COVID-19) has also been associated with gastrointestinal symptoms, including nausea, vomiting and diarrhea.
  • Bacteria and parasites. Exposure to pathogenic bacteria, such as E. coli or parasites through contaminated food or water, leads to diarrhea. When traveling in developing countries, diarrhea caused by bacteria and parasites is often called traveler’s diarrhea. Clostridioides difficile (also known as C. diff) is another type of bacterium that causes diarrhea, and it can occur after a course of antibiotics or during a hospitalization.
  • Medications. Many medications, such as antibiotics, can cause diarrhea. Antibiotics alleviate infections by killing bad bacteria, but they also kill good bacteria. This disturbs the natural balance of bacteria in your intestines, leading to diarrhea or a superimposed infection such as C. diff. Other drugs that cause diarrhea are anti-cancer drugs and antacids with magnesium.
  • Lactose intolerance. Lactose is a sugar found in milk and other dairy products. People who have difficulty digesting lactose have diarrhea after eating dairy products. Lactose intolerance can increase with age because levels of the enzyme that helps digest lactose drop as you get older.
  • Fructose. Fructose is a sugar found naturally in fruits and honey. It’s sometimes added as a sweetener to certain beverages. Fructose can lead to diarrhea in people who have trouble digesting it.
  • Artificial sweeteners. Sorbitol, erythritol and mannitol — artificial sweeteners are nonabsorbable sugars found in chewing gum and other sugar-free products — can cause diarrhea in some otherwise healthy people.
  • Surgery. Partial intestine or gallbladder removal surgeries can sometimes cause diarrhea.
  • Other digestive disorders. Chronic diarrhea has a number of other causes, such as IBS, Crohn’s disease, ulcerative colitis, celiac disease, microscopic colitis and small intestinal bacterial overgrowth (SIBO).

Complications

Diarrhea can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems.

If you have signs of serious dehydration, seek medical help.

Indications of dehydration in adults

These include:

  • Excessive thirst
  • Dry mouth or skin
  • Little or no urination
  • Weakness, dizziness or lightheadedness
  • Fatigue
  • Dark-colored urine

Indications of dehydration in infants and young children

These include: Not having a wet diaper in three

  • or more hours
  • Dry mouth and tongue
  • Fever above 102 F (39 C)
  • Crying without tears
  • Drowsiness, unresponsiveness or irritability
  • Sunken appearance to the abdomen, eyes or cheeks

Prevention

Preventing infectious diarrhea

Wash your hands to prevent the spread of infectious diarrhea. To ensure adequate hand-washing:

  • Wash frequently. Wash your hands before and after preparing food. Wash your hands after handling uncooked meat, using the toilet, changing diapers, sneezing, coughing and blowing your nose.
  • Lather with soap for at least 20 seconds. After putting soap on your hands, rub your hands together for at least 20 seconds. This is about as long as it takes to sing “Happy Birthday” twice through.
  • Use hand sanitizer when washing isn’t possible. Use an alcohol-based hand sanitizer when you can’t get to a sink. Apply the hand sanitizer as you would hand lotion, making sure to cover the fronts and backs of both hands. Use a product that contains at least 60% alcohol.

Vaccination

You can help protect your infant from rotavirus, the most common cause of viral diarrhea in children, with one of two approved vaccines. Ask your baby’s doctor about having your baby vaccinated.

Preventing traveler’s diarrhea

Diarrhea commonly affects people who travel to countries where there’s inadequate sanitation and contaminated food. To reduce your risk:

  • Watch what you eat. Eat hot, well-cooked foods. Avoid raw fruits and vegetables unless you can peel them yourself. Also avoid raw or undercooked meats and dairy foods.
  • Watch what you drink. Drink bottled water, soda, beer or wine served in its original container. Avoid tap water and ice cubes. Use bottled water even for brushing your teeth. Keep your mouth closed while you shower.

Beverages made with boiled water, such as coffee and tea, are probably safe. Remember that alcohol and caffeine can aggravate diarrhea and worsen dehydration.

  • Ask your doctor about antibiotics. If you’re traveling to a developing country for an extended time, ask your doctor about antibiotics before you go, especially if you have a weakened immune system.
  • Check for travel warnings. The Centers for Disease Control and Prevention maintains a travelers’ health website where disease warnings are posted for various countries. If you’re planning to travel outside of the United States, check there for warnings and tips for reducing your risk.

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About ‘Shigella’- Bacteria killed a girl after she ate Shawarma in Kerala


 

 Diarrhoea –loose motions  has many causes. Bacterial, protozoal or viruses all can cause diarrhoea. Infections like cholera caused by bactweria Vibrio cholera can be life threatening. Similarly Shigella, another bacteria can be fatal occasionally, if treatment is delayed.  Shigellosis is not a very common infection, and it can be treated easily, doctors say. But a delay in getting to a doctor can complicate the effects of the food poisoning. Young children and those with weakened immune systems are more vulnerable.

The Kerala health department on Tuesday (May 3) identified Shigella bacteria as the cause for the food poisoning incident in Kasaragod, which claimed the life of a 16-year-old girl and led to 30-odd others being admitted to hospital.

The presence of the bacteria was confirmed in the blood and faeces of people undergoing treatment after they consumed chicken shawarma from an eatery at Cheruvathur in Kasaragod last week. Police have arrested the owner and staff of the eatery.

While food poisoning is fairly common and can occur in a range of situations, how common is Shigella infection, what are its symptoms, and when should you consult a doctor?

First, what is Shigella?

Shigella is a bacterium that belongs to the Enterobacter family — a group of bacteria that reside in the intestine, not all of which cause disease in humans. It mainly affects the intestine and results in diarrhoea, sometimes bloody, stomach pain, and fever.

The infection spreads easily as it takes only “a small number of bacteria to make someone ill”, says the US Centres for Disease Control and Prevention (CDC). It is a food- and water-borne infection, and can happen when someone consumes contaminated food — like in the case from Kerala — unwashed fruit or vegetables.

The disease is easily spread by direct or indirect contact with the excrement of the patient. You can get the infection if you swim or take a bath in contaminated water.

How widespread is Shigella infection?

Shigella outbreaks appear to be exacerbated during pregnancy and in children under five years of age, and in those with weakened immune systems.

There are four types of Shigella bacteria that affect humans — Shigella sonnei, Shigella flexneri, Shigella boydii, and Shigella dysenteriae. The fourth type causes the most severe disease because of the toxin it produces.

But is it common for people to die of the infection?

It is not. Doctors say that the infection does not generally kill, unless the patient has a weak immune system or the pathogen is resistant to the antibiotics that are prescribed. It is a very treatable condition; if a patient reaches hospital on time they can effectively be treated using IV antibiotics.

He said that doctors usually send samples of patients with severe diarrhoea for culture to see what pathogen is causing the symptoms, in order to decide which antibiotics were likely to work the best. In the meanwhile, doctors prescribe antibiotics for the most common infections that cause diarrhoea, and they will generally work for Shigella as well.

The problem though, occurs when the antibiotics do not work because the bacteria are resistant to it.

The problem with Shigella is that it produces a lot of toxins that can affect all other organs. So, if the bacteria continue to proliferate in the body even after giving the antibiotics, it will continue to produce toxins, which can then affect the kidney, cause seizures, lead to multi-organ failure, and shock, and even turn fatal. This, however, does not happen in most cases, the mortality of the infection is less than 1%.

So if you have abdominal discomfort or an upset stomach, at which point should you start worrying?

There is no need to rush to a doctor or a hospital every time you have loose motions.  However, if you have loose motions accompanied with high fever, blood in the stool, or constant vomiting such that you cannot keep any fluids down, you must get yourself to a doctor.

     A person who has severe diarrhoea — which means 20 or more bowel movements in a day — must see a doctor within a day; a patient with mild diarrhoea may wait for three to four days before going to a doctor.

This is true of any diarrhoea, whether it is because of Shigella or any other reason. It is possible that the student from Kerala who died after eating the shawarma did not get medical treatment in time, he said.

What precautions should you take?

The measures to prevent a Shigella infection are the same as that of any other food- and water-borne infection. Wash your hands thoroughly before and after a meal. Wash your hands properly after a bowel movement. Ensure the water that you drink is clean and the fruits and vegetables are fresh.

“Products such as milk, chicken, and fish can get infected easily and must be kept at a proper temperature. They must also be properly cooked.

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‘Warning’ Label, Not Health Star Rating on Junk Food: Experts to FSSAI


A triple burden of malnutrition – under-nutrition, micro-nutrient malnutrition, as well as overweight and obesity – is rising in India. Paradoxically, these forms of poor nutrition often have the same nutritional root cause. More nourishing freshly cooked home-foods or more natural foods are being replaced by cheaper pre-processed packaged alternatives with high levels of salt, sugar and fat that fill the stomach, but do not nourish and in fact promote ill health and disease.

India is the diabetic capital of the world, with the highest concentration of diabetics in any single country. Hypertension closely follows, leading to an overall non-communicable disease (NCD) burden reaching epidemic proportions. A major pathway leading here is the rise of overweight and obesity, as a consequence of poor diets combining with sedentary lifestyles.

      Health star ratings are designed by the powerful food industry to mislead the consumer. If the government is serious about the epidemic of obesity and non-communicable diseases, the consumer needs to be cautioned about junk foods through warning’ labels, public health experts gathered at the National Conclave on Sustainable Food Systems’, organized by the Centre for Science and Environment (CSE) in Nimli, Rajasthan, said.

      The government should issue a warning’ label on packaged junk foods instead of health star ratings as they are misleading and doing more harm to customers than good, health experts said on Wednesday. Health star rating is a labelling system that grades packaged foods on the scale of one to five stars.

    By pushing these, the Food Safety and Standards Authority of India (FSSAI) will give license to glorify junk foods, which is the opposite of what should be done, Director General, CSE, said while leading the expert deliberation on the Need for front-of-pack warning labels on ultra-processed junk foods’. Health star ratings are designed by the powerful food industry to mislead the consumer.

 Front-of-pack labelling on packaged foods was first recommended by  the FSSAI-led committee formed in 2013. CSE was part of this committee. FSSAI then came up with a draft regulation in 2018, which had strict thresholds limits to know unhealthy levels based on those developed by the WHO for countries like India in the South-East Asia Region.Due to industry pressure, FSSAI came up with another draft in 2019.

  what does junk food deserve stars or warnings times of india

The food industry was still not pleased and this draft was repealed.

From January-June 2021, stakeholder consultations were held on the labelling design to be adopted, thresholds to made applicable and nutrients to be displayed.

CSE has documented all delays and dilutions until June 2021, the organisation alleged in a statement.

The latest consultation took place in February during which it was made clear that FSSAI plans to go ahead with the Health Star Rating’.

The sole objective of the stakeholder consultations, which were heavily dominated by the packaged food industry, was to come up with a labelling system, which is industry-friendly, said Khurana, who was part of these consultations, adding that all this while, FSSAI has been insensitive to the information needs of the consumer.

He alleged that the statutory body also ignored the global best practices and evidence around it. Instead, in an orchestrated way, through the scientific panel and commissioned studies, it is now getting ready to adopt a labelling system which is considered least effective and rejected across the world, he said.

Health star ratings are depicted based on an algorithm at the back-end, which is not known to consumers, CSE said, adding that it is only adopted voluntarily in few countries such as Australia and New Zealand and only some food products carry it.

It has been rejected in several other countries as it can mislead the consumer and be easily manipulated by the industry, the CSE said.The proven best practice in front-of-pack labelling is nutrient specific warning’ labels, experts said.They have been simple and effective in discouraging junk food consumption. Several Latin American countries, Canada and Israel have already adopted warning labels.Many other countries are considering them.

Among them, the best known are symbol-based warning labels such as that of Israel. These will be most suitable for India, as it would transcend the literature and language barriers, the CSE said.We have submitted our concerns to FSSAI. It can’t allow a system that will effectively nudge the consumer to make unhealthy choices. It will mislead the consumer because of its design, algorithm and inclusion of positive nutrients in the calculation. It can’t allow relaxed limits and voluntary adoption, Narain said.

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Myocardial ischemia-Complications-Prevention-Treatment 


Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart’s arteries (coronary arteries).

Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle’s ability to pump blood. A sudden, severe blockage of one of the heart’s artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms.

Treatment for myocardial ischemia involves improving blood flow to the heart muscle. Treatment may include medications, a procedure to open blocked arteries (angioplasty) or bypass surgery.

Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia.

Symptoms

Some people who have myocardial ischemia don’t have any signs or symptoms (silent ischemia).

When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include:

  • Neck or jaw pain
  • Shoulder or arm pain
  • A fast heartbeat
  • Shortness of breath when you are physically active
  • Nausea and vomiting
  • Sweating
  • Fatigue

When to see a doctor

Get emergency help if you have severe chest pain or chest pain that doesn’t go away.

Causes

Myocardial ischemia occurs when the blood flow through one or more of your coronary arteries is decreased. The low blood flow decreases the amount of oxygen your heart muscle receives. Myocardial ischemia can develop slowly as arteries become blocked over time. Or it can occur quickly when an artery becomes blocked suddenly. Conditions that can cause myocardial ischemia include:

Coronary artery disease (atherosclerosis). Plaques made up mostly of cholesterol build up on your artery walls and restrict blood flow. Atherosclerosis is the most common cause of myocardial ischemia.

Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary artery from elsewhere in the body.

Coronary artery spasm. This temporary tightening of the muscles in the artery wall can briefly decrease or even prevent blood flow to part of the heart muscle. Coronary artery spasm is an uncommon cause of myocardial ischemia. Chest pain associated with myocardial ischemia can be triggered by: Physical exertionEmotional stressCold temperaturesCocaine useEating a heavy or large mealSexual intercourse Risk factors Factors that can increase your risk of developing myocardial ischemia include: Tobacco. Smoking and long-term exposure to secondhand smoke can damage the inside walls of arteries. The damage can allow deposits of cholesterol and other substances to collect and slow blood flow in the coronary arteries. Smoking causes the coronary arteries to spasm and may also increase the risk of blood clots.

Diabetes. Type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.

High blood pressure. Over time, high blood pressure can accelerate atherosclerosis, resulting in damage to the coronary arteries.

High blood cholesterol level. Cholesterol is a major part of the deposits that can narrow your coronary arteries. A high level of “bad” (low-density lipoprotein, or LDL) cholesterol in your blood may be due to an inherited condition or a diet high in saturated fats and cholesterol.

High blood triglyceride level. Triglycerides, another type of blood fat, also may contribute to atherosclerosis.

Obesity. Obesity is associated with diabetes, high blood pressure and high blood cholesterol levels.

Waist circumference. A waist measurement of more than 35 inches (89 centimeters) for women and 40 inches (102 cm) in men increases the risk of high blood pressure, diabetes, and heart disease.

Lack of physical activity. Not getting enough exercise contributes to obesity and is linked to higher cholesterol and triglyceride levels. People who get regular aerobic exercise have better heart health, which is associated with a lower risk of myocardial ischemia and heart attack. Exercise also reduces blood pressure.

Complications

Myocardial ischemia can lead to serious complications, including:

Heart attack. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle. The damage can be serious and sometimes fatal.

Irregular heart rhythm (arrhythmia). An abnormal heart rhythm can weaken your heart and may be life-threatening.

Heart failure. Over time, repeated episodes of ischemia may lead to heart failure. Prevention The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow.

Diagnosis

Your doctor will start by asking questions about your medical history and with a physical exam. After that, your doctor might recommend:

Electrocardiogram (ECG). Electrodes attached to your skin record the electrical activity of your heart. Certain changes in your heart’s electrical activity may be a sign of heart damage.

Stress test. Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump harder and faster than usual, so a stress test can detect heart problems that might not be noticeable otherwise.

Echocardiogram. Sound waves directed at your heart from a wand-like device held to your chest produce video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn’t pumping normally.

Stress echocardiogram. A stress echocardiogram is similar to a regular echocardiogram, except the test is done after you exercise in the doctor’s office on a treadmill or stationary bike.

Nuclear stress test. Small amounts of radioactive material are injected into your bloodstream. While you exercise, your doctor can watch as it flows through your heart and lungs — allowing blood-flow problems to be identified.

Coronary angiography. A dye is injected into the blood vessels of your heart. Then a series of X-ray images (angiograms) are taken, showing the dye’s path. This test gives your doctor a detailed look at the inside of your blood vessels.

Cardiac CT scan. This test can determine if you have a buildup of calcium in your coronary arteries — a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (coronary CT angiogram).

Treatment

The goal of myocardial ischemia treatment is to improve blood flow to the heart muscle. Depending on the severity of your condition, your doctor may recommend medications, surgery or both. Medications Medications to treat myocardial ischemia include:

Aspirin. A daily aspirin or other blood thinner can reduce your risk of blood clots, which might help prevent blockage of your coronary arteries. Ask your doctor before starting to take aspirin because it might not be appropriate if you have a bleeding disorder or if you’re already taking another blood thinner.

Nitrates. These medications widen arteries, improving blood flow to and from your heart. Better blood flow means your heart doesn’t have to work as hard.

Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure so blood can flow to your heart more easily.

Calcium channel blockers. These medications relax and widen blood vessels, increasing blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.

Cholesterol-lowering medications. These medications decrease the primary material that deposits on the coronary arteries.

Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels and lower blood pressure. Your doctor might recommend an ACE inhibitor if you have high blood pressure or diabetes in addition to myocardial ischemia. ACE inhibitors may also be used if you have heart failure or if your heart doesn’t pump blood effectively.

Ranolazine (Ranexa). This medication helps relax your coronary arteries to ease angina. Ranolazine may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitrates.

Procedures to improve blood flow

Sometimes, more-aggressive treatment is needed to improve blood flow. Procedures that may help include:

Angioplasty and stenting. A long, thin tube (catheter) is inserted into the narrowed part of your artery. A wire with a tiny balloon is threaded into the narrowed area and inflated to widen the artery. A small wire mesh coil (stent) is usually inserted to keep the artery open.

Coronary artery bypass surgery. A surgeon uses a vessel from another part of your body to create a graft that allows blood to flow around the blocked or narrowed coronary artery. This type of open-heart surgery is usually used only for people who have several narrowed coronary arteries.

Enhanced external counterpulsation. This noninvasive outpatient treatment might be recommended if other treatments haven’t worked. Cuffs that have been wrapped around your legs are gently inflated with air then deflated. The resulting pressure on your blood vessels can improve blood flow to the heart. Lifestyle and home remedies

Lifestyle changes are an important part of treatment. To follow a heart-healthy lifestyle:

Quit smoking. Talk to your doctor about smoking cessation strategies. Also try to avoid secondhand smoke.

Manage underlying health conditions. Treat diseases or conditions that can increase your risk of myocardial ischemia, such as diabetes, high blood pressure and high blood cholesterol.

Eat a healthy diet. Limit saturated fat and eat lots of whole grains, fruits and vegetables. Know your cholesterol numbers and ask your doctor if you’ve reduced them to the recommended level.

Exercise. Talk to your doctor about starting a safe exercise plan to improve blood flow to your heart.

Maintain a healthy weight. If you’re overweight, talk to your doctor about weight-loss options.

Decrease stress. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. It’s important to have regular medical checkups. Some of the main risk factors for myocardial ischemia — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.  

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Hyperlipidemia- Bad cholesterol (LDL) and plaque in an artery


Hyperlipidemia

Hyperlipidemia (high cholesterol) means your blood has too many lipids (fats) in it. These can add up and lead to blockages in your blood vessels. This is why high cholesterol can put you at risk for a stroke or heart attack. But you can make lifestyle changes like eating healthier and exercising to lower your cholesterol. Medicine can help, too.

  Hyperlipidemia, or high cholesterol, can let plaque collect inside your blood vessels and put you at risk of a heart attack or stroke. The good news is that you have the power to reduce your risk of heart attack and stroke. Exercising more and eating healthier are just two of the ways you can improve your cholesterol numbers. Taking medicine your provider orders makes a difference, too.

OVERVIEW

Bad cholesterol (LDL) and plaque in an artery

What is hyperlipidemia?

Hyperlipidemia, also known as dyslipidemia or high cholesterol, means you have too many lipids (fats) in your blood. Your liver creates cholesterol to help you digest food and make things like hormones. But you also eat cholesterol in foods from the meat and dairy aisles. Since your liver can make as much cholesterol as you need, the cholesterol in foods you eat is extra.

Too much cholesterol (200 to 239 mg/dL is borderline high and 240 mg/dL is high) is not healthy because it can create roadblocks in your artery highways where blood travels around to your body. This damages your organs. Bad cholesterol (LDL) is the most dangerous type because it causes hardened cholesterol deposits (plaque) to collect inside of your blood vessels. This makes it harder for your blood to get through, which puts you at risk for a stroke or heart attack.

Think of cholesterol, a kind of fat, as traveling in lipoprotein cars through your blood.

  • Low-density lipoprotein (LDL) is known as bad cholesterol because it can clog your arteries like a large truck that broke down and is blocking a traffic lane. (Borderline high number: 130 to 159 mg/dL. High: 160 to 189 mg/dL.) 
  • Very low density lipoprotein (VLDL) is also called bad because it carries triglycerides that add to artery plaque. This is another type of traffic blocker.
  • High-density lipoprotein (HDL) is known as good cholesterol because it brings cholesterol to your liver, which gets rid of it. This is like the tow truck that removes the broken down vehicles from the traffic lanes so vehicles can move. In this case, it’s clearing the way for your blood to get through your blood vessels. For your HDL, you don’t want to have a number lower than 40 mg/dL.

It’s important to know that providers consider other factors in addition to your cholesterol numbers when they make treatment decisions.

Is hyperlipidemia the same as high cholesterol?

Yes, hyperlipidemia is another name for high cholesterol, and so is hypercholesterolemia.

What is dyslipidemia vs. hyperlipidemia?

They are mostly interchangeable terms for abnormalities in cholesterol. Your cholesterol can be “dysfunctional” (cholesterol particles that are very inflammatory or an abnormal balance between bad and good cholesterol levels) without being high. Both a high level of cholesterol and increased inflammation in “normal” cholesterol levels put you at increased risk for heart disease.

What are the risk factors for hyperlipidemia? 

Several things can put you at a higher risk of hyperlipidemia, including:

  • Having a family history of high cholesterol.
  • Having hypothyroidism.
  • Having obesity.
  • Not eating a nutritious diet.
  • Drinking too much alcohol.
  • Having diabetes.
  • Smoking.

How common is hyperlipidemia?

Hyperlipidemia is very common. Ninety-three million American adults (age 20 and older) have a total cholesterol count above the recommended limit of 200 mg/dL.

How serious is hyperlipidemia?

Hyperlipidemia can be very serious if it’s not controlled. As long as high cholesterol is untreated, you’re letting plaque accumulate inside your blood vessels. This can lead to a heart attack or stroke because your blood has a hard time getting through your blood vessels. This deprives your brain and heart of the nutrients and oxygen they need to function. Cardiovascular disease is the leading cause of death in Americans.

How does hyperlipidemia affect my body?

Hyperlipidemia (high cholesterol) that’s not treated can allow plaque to collect inside your body’s blood vessels (atherosclerosis). This can bring on hyperlipidemia complications that include:

  • Heart attack.
  • Stroke.
  • Coronary heart disease.
  • Carotid artery disease.
  • Sudden cardiac arrest.
  • Peripheral artery disease.
  • Microvascular disease.

SYMPTOMS AND CAUSES

What are the symptoms of hyperlipidemia?

Most people don’t have symptoms when their cholesterol is high. People who have a genetic problem with cholesterol clearance that causes very high cholesterol levels may get xanthomas (waxy, fatty plaques on the skin) or corneal arcus (cholesterol rings around the iris of the eye). 

What causes hyperlipidemia?

Various hyperlipidemia causes include:

  • Smoking.
  • Drinking a lot of alcohol.
  • Eating foods that have a lot of saturated fats or trans fats. 
  • Sitting too much instead of being active.
  • Being stressed.
  • Inheriting genes that make your cholesterol levels unhealthy.
  • Being overweight.

Medications that are helpful for some problems can make your cholesterol levels fluctuate, such as:

  • Beta blockers.
  • Diuretics.
  • Hormonal birth control.
  • Steroids.
  • Antiretrovirals for HIV.

Medical problems can also affect how much cholesterol you have. These include:

  • Multiple myeloma.
  • Polycystic ovary syndrome (PCOS).
  • Hypothyroidism.
  • Primary biliary cirrhosis.
  • Chronic kidney disease.
  • Diabetes.
  • Lupus.
  • Sleep apnea.
  • HIV.

DIAGNOSIS AND TESTS

How is hyperlipidemia diagnosed?

Your provider will want:

  • A physical exam.
  • Your medical history.
  • Your family’s medical history.
  • To calculate your 10 year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score.

A blood test called a lipid panel will tell you these numbers:

Type of cholesterolBest number to have
Total cholesterolLess than 200 mg/dL
Bad (LDL) cholesterolLess than 100 mg/dL
Good (HDL) cholesterolAt least 60 mg/dL
TriglyceridesLess than 150 mg/dL

What tests will be done to diagnose hyperlipidemia?

Your provider may also do these tests:

  • High sensitivity C-reactive protein (hs-CRP).
  • Lipoprotein (a).
  • Apolipoprotein B.
  • Coronary calcium scan.

MANAGEMENT AND TREATMENT

How is hyperlipidemia treated?

Changing their lifestyles may be all some people need to do to improve their cholesterol numbers. For other people, that’s not enough and they need medication.

Things you can do include:

  • Exercising.
  • Quitting smoking.
  • Sleeping at least seven hours each night.
  • Keeping your stress level under control.
  • Eating healthier foods.
  • Limiting how much alcohol you drink.
  • Losing a few pounds to reach a healthy weight.

What medications are used for hyperlipidemia?

People who need medicine to treat their high cholesterol usually take statins. Your provider may order a different type of medicine if:

  • You can’t take a statin.
  • You need another medicine in addition to a statin.
  • You have familial hypercholesterolemia, a genetic problem that makes your bad (LDL) cholesterol number extremely high.

Are there side effects of hyperlipidemia treatment?

Any medication can have side effects, but the benefits of statins far outweigh the risks of minor side effects. Let your provider know if you aren’t doing well on your medicine so they can develop a plan to manage your symptoms.

How soon will the hyperlipidemia treatment start working?

Your provider will order another blood test about two or three months after you start taking hyperlipidemia medication. The test results will show if your cholesterol levels have improved, which means the medicine and/or lifestyle changes are working.

PREVENTION

How can I reduce my risk of hyperlipidemia?

Even children can get their blood checked for high cholesterol, especially if someone in the child’s family had a heart attack, stroke or high cholesterol. Children and young adults can get checked every five years.

Once you reach middle age, you should have your cholesterol checked every year or two. Your healthcare provider can help you decide how often you should have a hyperlipidemia screening.

How can I prevent hyperlipidemia?

Changes you make in your life can keep you from getting hyperlipidemia. Things you can do include:

  • Stop smoking.
  • Stay active instead of sitting too much.
  • Keep your stress level down.
  • Get the right amount of sleep.
  • Eat healthy foods.
  • Cut back on eating fatty meats.
  • Don’t buy snacks that have “trans fat” on the label.
  • Stay at a healthy weight.

OUTLOOK / PROGNOSIS

What can I expect if I have hyperlipidemia?

If you have hyperlipidemia, you’ll need to keep using healthy lifestyle habits for years to come. You’ll also need to keep follow-up appointments with your provider and continue to take your medicine.

How long will you have hyperlipidemia?

Hyperlipidemia is a condition you’ll need to manage for the rest of your life.

What is the outlook for hyperlipidemia? 

Although high cholesterol puts you at risk for heart attacks and stroke, you can protect yourself by living a healthier lifestyle and taking medicine if needed.

LIVING WITH

How do I take care of myself with hyperlipidemia? 

Be sure to follow your provider’s instructions for making your lifestyle healthier.

Here are things you can do yourself:

  • Exercise.
  • Stop smoking.
  • Sleep at least seven hours each night.
  • Control your stress level.
  • Eat healthier foods.
  • Limit how much alcohol you drink.
  • Stay at a healthy weight.

Other things you can do:

  • If your provider ordered medicine for you, be sure to keep taking it as the label tells you to do. 
  • Keep your follow-up appointments.

When should I see my healthcare provider?

You should see your provider if you have:

  • High blood sugar.
  • High blood pressure.
  • High cholesterol.

What questions should I ask my doctor?

  • Do I need to make lifestyle changes, take medication or both?
  • If I do what you tell me to do, how quickly can my numbers improve?
  • How often do I need to check in with you? 

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High blood pressure (hypertension), symptoms, causes, risk factors, complications, diagnosis


What is High blood pressure (hypertension)

High blood pressure (hypertension) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. A blood pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.

  • Top number (systolic pressure). The first, or upper, number measures the pressure in your arteries when your heart beats.
  • Bottom number (diastolic pressure). The second, or lower, number measures the pressure in your arteries between beats.

You can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Symptoms

Symptoms

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.

Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.

Your doctor will likely recommend more-frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.

If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.

Causes

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Obstructive sleep apnea
  • Kidney disease
  • Adrenal gland tumors
  • Thyroid problems
  • Certain defects you’re born with (congenital) in blood vessels
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines

Risk factors

High blood pressure has many risk factors, including:

  • Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood flow through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don’t get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.

If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

  • Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels as well as your organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

  • Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
  • Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
  • Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
  • Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
  • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
  • Metabolic syndrome. This syndrome is a group of disorders of your body’s metabolism, including increased waist size, high triglycerides, decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol), high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
  • Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
  • Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia. 

Diagnosis

Blood pressure measurement

Your doctor will ask questions about your medical history and do a physical examination. The doctor, nurse or other medical assistant will place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.

Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff.

Blood pressure measurements fall into several categories:

  • Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg.
  • Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.
  • Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
  • Stage 2 hypertension. More-severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
  • Hypertensive crisis. A blood pressure measurement higher than 180/120 mm Hg is an emergency situation that requires urgent medical care. If you get this result when you take your blood pressure at home, wait five minutes and retest. If your blood pressure is still this high, contact your doctor immediately. If you also have chest pain, vision problems, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack, call local emergency medical number.

Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more important. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a common type of high blood pressure among people older than 65.

Because blood pressure normally varies during the day and may increase during a doctor visit (white coat hypertension), your doctor will likely take several blood pressure readings at three or more separate appointments before diagnosing you with high blood pressure.

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What is Cerebral palsy? Symptoms, Causes, Prevention


Microsoft Corp. said Zain Nadella, son of Chief Executive Officer Satya and his wife Anu, died Monday morning. He was 26 years old and had been born with cerebral palsy. The software maker told its executive staff in an email that Zain had passed away. The message asked executives to hold the family in their thoughts and prayers while giving them space to grieve privately.

Zain Nadella, son of C E O Satya died, suffering from cerebral palsy.

 What is Cerebral palsy?

Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It’s caused by damage that occurs to the immature, developing brain, most often before birth.

Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with exaggerated reflexes, floppiness or spasticity of the limbs and trunk, unusual posture, involuntary movements, unsteady walking, or some combination of these.

People with cerebral palsy can have problems swallowing and commonly have eye muscle imbalance, in which the eyes don’t focus on the same object. They also might have reduced range of motion at various joints of their bodies due to muscle stiffness.

The cause of cerebral palsy and its effect on function vary greatly. Some people with cerebral palsy can walk; others need assistance. Some people have intellectual disabilities, but others do not. Epilepsy, blindness or deafness also might be present. Cerebral palsy is a lifelong disorder. There is no cure, but treatments can help improve function.

Symptoms

Symptoms

Signs and symptoms of cerebral palsy can vary greatly from person to person. Cerebral palsy can affect the whole body, or it might be limited primarily to one or two limbs, or one side of the body. Generally, signs and symptoms include problems with movement and coordination, speech and eating, development, and other problems.

Movement and coordination

  • Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
  • Variations in muscle tone, such as being either too stiff or too floppy
  • Stiff muscles with normal reflexes (rigidity)
  • Lack of balance and muscle coordination (ataxia)
  • Tremors or jerky involuntary movements
  • Slow, writhing movements
  • Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
  • Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
  • Difficulty with fine motor skills, such as buttoning clothes or picking up utensils

Speech and eating

  • Delays in speech development
  • Difficulty speaking
  • Difficulty with sucking, chewing or eating
  • Excessive drooling or problems with swallowing

Development

  • Delays in reaching motor skills milestones, such as sitting up or crawling
  • Learning difficulties
  • Intellectual disabilities
  • Delayed growth, resulting in smaller size than would be expected

Other problems

Damage to the brain can contribute to other neurological problems, such as:

  • Seizures (epilepsy)
  • Difficulty hearing
  • Problems with vision and abnormal eye movements
  • Abnormal touch or pain sensations
  • Bladder and bowel problems, including constipation and urinary incontinence
  • Mental health conditions, such as emotional disorders and behavioral problems

The brain disorder causing cerebral palsy doesn’t change with time, so the symptoms usually don’t worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.

When to see a doctor

It’s important to get a prompt diagnosis for a movement disorder or delays in your child’s development. See your child’s doctor if you have concerns about episodes of loss of awareness of surroundings or of unusual bodily movements or muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues.

Causes

Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn’t known. Many factors can lead to problems with brain development. Some include:

  • Gene mutations that result in genetic disorders or differences in brain development
  • Maternal infections that affect the developing fetus
  • Fetal stroke, a disruption of blood supply to the developing brain
  • Bleeding into the brain in the womb or as a newborn
  • Infant infections that cause inflammation in or around the brain
  • Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
  • Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought

Risk factors

A number of factors are associated with an increased risk of cerebral palsy.

Maternal health

Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby’s developing brain.

  • Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth defects if a mother has her first active infection during pregnancy.
  • German measles (rubella). This viral infection can be prevented with a vaccine.
  • Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
  • Syphilis. This is a sexually transmitted bacterial infection.
  • Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
  • Zika virus infection. This infection is spread through mosquito bites and can affect fetal brain development.
  • Intrauterine infections. This includes infections of the placenta or fetal membranes.
  • Exposure to toxins. One example is exposure to methyl mercury.
  • Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid problems, preeclampsia or seizures.

Infant illness

Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:

  • Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
  • Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
  • Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of “used” blood cells aren’t filtered from the bloodstream.
  • Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.

Factors of pregnancy and birth

While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:

  • Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
  • Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors’ risk of cerebral palsy increases.
  • Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
  • Delivery complications. Problems during labor and delivery may increase the risk of cerebral palsy.

Complications

Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or in adulthood, including:

  • Contracture. Contracture is muscle tissue shortening due to severe muscle tightening that can be the result of spasticity. Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation. These can include hip dislocation, curvature of the spine (scoliosis) and other orthopedic deformities.
  • Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
  • Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavioral problems can also occur.
  • Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing disorders. Problems with swallowing can result in respiratory problems, such as aspiration pneumonia.
  • Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
  • Osteoporosis. Fractures due to low bone density can result from several factors such as lack of mobility, inadequate nutrition and anti-epileptic drug use.
  • Other complications. These can include sleep disorders, chronic pain, skin breakdown, intestinal problems and issues with oral health.

Prevention

Most cases of cerebral palsy can’t be prevented, but you can reduce risks. If you’re pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:

  • Make sure you’re vaccinated. Getting vaccinated against diseases such as rubella, preferably before getting pregnant, might prevent an infection that could cause fetal brain damage.
  • Take care of yourself. The healthier you are heading into a pregnancy, the less likely you’ll be to develop an infection that results in cerebral palsy.
  • Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
  • Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.

Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.

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