Monthly Archives: April 2017

Rubella

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild with half of people not realizing that they are sick. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is not as bright as that of measles and is sometimes itchy. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. In adults joint pain is common. Complications may include bleeding problems, testicular swelling, and inflammation of nerves. Infection during early pregnancy may result in a child born with congenital rubella syndrome (CRS) or miscarriage. Symptoms of CRS include problems with the eyes such as cataracts, ears such as deafness, heart, and brain. Problems are rare after the 20th week of pregnancy.

Rubella is usually spread through the air via coughs of people who are infected. People are infectious during the week before and after the appearance of the rash. Babies with CRS may spread the virus for more than a year. Only humans are infected. Insects do not spread the disease. Once recovered, people are immune to future infections. Testing is available that can verify immunity. Diagnosis is confirmed by finding the virus in the blood, throat, or urine. Testing the blood for antibodiesmay also be useful.

Rubella is preventable with the rubella vaccine with a single dose being more than 95% effective. Often it is given in combination with the measles vaccine and mumps vaccine, known as the MMR vaccine. With a population vaccination rate of less than 80%, however, more women might make it to childbearing age without developing immunity and issues could increase. Once infected there is no specific treatment.

Rubella is a common infection in many areas of the world. Each year about 100,000 cases of congenital rubella syndrome occur. Rates of disease have decreased in many areas as a result of vaccination. There are ongoing efforts to eliminate the disease globally. In April 2015 the World Health Organization declared the Americas free of rubella transmission. The name “rubella” is from Latin and means little red. It was first described as a separate disease by German physicians in 1814 resulting in the name “German measles.”

The disease is caused by rubella virus, a togavirus that is enveloped and has a single-stranded RNA genome. The virus is transmitted by the respiratory route and replicates in the nasopharynx and lymph nodes. The virus is found in the blood 5 to 7 days after infection and spreads throughout the body. The virus has teratogenic properties and is capable of crossing the placenta and infecting the fetus where it stops cells from developing or destroys them. During this incubation period, the patient is contagious typically for about one week before he/she develops a rash and for about one week thereafter.

Increased susceptibility to infection might be inherited as there is some indication that HLA-A1 or factors surrounding A1 on extended haplotypes are involved in virus infection or non-resolution of the disease.

Rubella virus specific IgM antibodies are present in people recently infected by rubella virus, but these antibodies can persist for over a year, and a positive test result needs to be interpreted with caution. The presence of these antibodies along with, or a short time after, the characteristic rash confirms the diagnosis.

Rubella infections are prevented by active immunisation programs using live, disabled virus vaccines. Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of adult disease. However their use in prepubertal females did not produce a significant fall in the overall incidence rate of CRS in the UK. Reductions were only achieved by immunisation of all children.[citation needed]

The vaccine is now usually given as part of the MMR vaccine. The WHO recommends the first dose be given at 12 to 18 months of age with a second dose at 36 months. Pregnant women are usually tested for immunity to rubella early on. Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus.[24]

The immunisation program has been quite successful. Cuba declared the disease eliminated in the 1990s, and in 2004 the Centers for Disease Control and Prevention announced that both the congenital and acquired forms of rubella had been eliminated from the United States.[25][26]

Screening for rubella susceptibility by history of vaccination or by serology is recommended in the United States for all women of childbearing age at their first preconception counseling visit to reduce incidence of congenital rubella syndrome (CRS). It is recommended that all susceptible non-pregnant women of childbearing age should be offered rubella vaccination. Due to concerns about possible teratogenicity, use of MMR vaccine is not recommended during pregnancy. Instead, susceptible pregnant women should be vaccinated as soon as possible in the postpartum period.

There is no specific treatment for rubella; however, management is a matter of responding to symptoms to diminish discomfort. Treatment of newborn babies is focused on management of the complications. Congenital heart defects and cataracts can be corrected by direct surgery.

Management for ocular congenital rubella syndrome (CRS) is similar to that for age-related macular degeneration, including counseling, regular monitoring, and the provision of low vision devices, if required.

Rubella infection of children and adults is usually mild, self-limiting and often asymptomatic. The prognosis in children born with CRS is poor. Rubella is a disease that occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine to rubella was introduced in 1969, widespread outbreaks usually occurred every 6–9 years in the United States and 3–5 years in Europe, mostly affecting children in the 5-9 year old age group. Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates.

Vaccination has interrupted the transmission of rubella in the Americas: no endemic case has been observed since February 2009. Since the virus can always be reintroduced from other continents, the population still need to remain vaccinated to keep the western hemisphere free of rubella. During the epidemic in the U.S. between 1962–1965, rubella virus infections during pregnancy were estimated to have caused 30,000 stillbirths and 20,000 children to be born impaired or disabled as a result of CRS. Universal immunisation producing a high level of herd immunity is important in the control of epidemics of rubella.

Stroke

Stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. They result in part of the brain not functioning properly. Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning, or loss of vision to one side. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours it is known as a transient ischemic attack (TIA) or mini-stroke. A hemorrhagic stroke may also be associated with a severe headache. The symptoms of a stroke can be permanent. Long-term complications may include pneumonia or loss of bladder control.

The main risk factor for stroke is high blood pressure. Other risk factors include tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, previous TIA, and atrial fibrillation. An ischemic stroke is typically caused by blockage of a blood vessel, though there are also less common causes. A hemorrhagic stroke is caused by either bleeding directly into the brain or into the space between the brain’s membranes. Bleeding may occur due to a ruptured brain aneurysm. Diagnosis is typically with medical imaging such as a CT scan or magnetic resonance imaging (MRI) scan along with a physical exam. Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and rule out other possible causes. Low blood sugar may cause similar symptoms.

Prevention includes decreasing risk factors, as well as possibly aspirin, statins, surgery to open up the arteries to the brain in those with problematic narrowing, and warfarin in those with atrial fibrillation. A stroke or TIA often requires emergency care. An ischemic stroke, if detected within three to four and half hours, may be treatable with a medication that can break down the clot. Aspirin should be used. Some hemorrhagic strokes benefit from surgery. Treatment to try to recover lost function is called stroke rehabilitation and ideally takes place in a stroke unit; however, these are not available in much of the world.

Strokes can be classified into two major categories: ischemic and hemorrhagic. Ischemic strokes are caused by interruption of the blood supply to the brain, while hemorrhagic strokes result from the rupture of a blood vessel or an abnormal vascular structure. About 87% of strokes are ischemic, the rest being hemorrhagic. Bleeding can develop inside areas of ischemia, a condition known as “hemorrhagic transformation.” It is unknown how many hemorrhagic strokes actually start as ischemic strokes.

Subtypes

If the area of the brain affected contains one of the three prominent central nervous system pathways—the spinothalamic tract, corticospinal tract, and dorsal column (medial lemniscus), symptoms may include:

  • hemiplegia and muscle weakness of the face
  • numbness
  • reduction in sensory or vibratory sensation
  • initial flaccidity (reduced muscle tone), replaced by spasticity (increased muscle tone), excessive reflexes, and obligatory synergies.

In most cases, the symptoms affect only one side of the body (unilateral). Depending on the part of the brain affected, the defect in the brain is usually on the opposite side of the body. However, since these pathways also travel in the spinal cord and any lesion there can also produce these symptoms, the presence of any one of these symptoms does not necessarily indicate a stroke.In addition to the above CNS pathways, the brainstem gives rise to most of the twelve cranial nerves. A brainstem stroke affecting the brainstem and brain, therefore, can produce symptoms relating to deficits in these cranial nerves:

  • altered smell, taste, hearing, or vision (total or partial)
  • drooping of eyelid (ptosis) and weakness of ocular muscles
  • decreased reflexes: gag, swallow, pupil reactivity to light
  • decreased sensation and muscle weakness of the face
  • balance problems and nystagmus
  • altered breathing and heart rate
  • weakness in sternocleidomastoid muscle with inability to turn head to one side
  • weakness in tongue (inability to stick out the tongue or move it from side to side)

Aerobic exercise

Aerobic exercise  is physical exercise of low to high intensity that depends primarily on the aerobic energy-generating process. Aerobic literally means “relating to, involving, or requiring free oxygen”, and refers to the use of oxygen to adequately meet energy demands during exercise via aerobic metabolism. Generally, light-to-moderate intensity activities that are sufficiently supported by aerobic metabolism can be performed for extended periods of time.

When practiced in this way, examples of cardiovascular/aerobic exercise are medium to long distance running/jogging, swimming, cycling, and walking, according to the first extensive research on aerobic exercise, conducted in the 1960s on over 5,000 U.S. Air Force personnel by Dr. Kenneth H. Cooper.

Kenneth Cooper was the first person to introduce the concept of aerobic exercise. In the 1960s, Cooper started research into preventive medicine. He became intrigued by the belief that exercise can preserve one’s health. In 1970 he created his own institute (the Cooper Institute) for non-profit research and education devoted to preventive medicine. He sparked millions into becoming active and is now known as the “father of aerobics”.

Benefits:

Among the recognized benefits of doing regular aerobic exercise are:

  • Strengthening the muscles involved in respiration, to facilitate the flow of air in and out of the lungs
  • Strengthening and enlarging the heart muscle, to improve its pumping efficiency and reduce the resting heart rate, known as aerobic conditioning
  • Improving circulation efficiency and reducing blood pressure
  • Increasing the total number of red blood cells in the body, facilitating transport of oxygen
  • Improved mental health, including reducing stress and lowering the incidence of depression, as well as increased cognitive capacity.
  • Reducing the risk for diabetes. One meta-analysis has shown, from multiple conducted studies, that aerobic exercise does help lower Hb A1Clevels for type 2 diabetics.

As a result, aerobic exercise can reduce the risk of death due to cardiovascular problems. In addition, high-impact aerobic activities (such as jogging or using a skipping rope) can stimulate bone growth, as well as reduce the risk of osteoporosis for both men and women.

In addition to the health benefits of aerobic exercise, there are numerous performance benefits:

  • Increased storage of energy molecules such as fats and carbohydrates within the muscles, allowing for increased endurance
  • Neovascularization of the muscle sarcomeres to increase blood flow through the muscles
  • Increasing speed at which aerobic metabolism is activated within muscles, allowing a greater portion of energy for intense exercise to be generated aerobically
  • Improving the ability of muscles to use fats during exercise, preserving intramuscular glycogen
  • Enhancing the speed at which muscles recover from high intensity exercise
  • Neurobiological effects: improvements in brain structural connections and increased gray matter density, new neuron growth, improved cognitive function (cognitive control and various forms of memory), and improvement or maintenance of mental health

Some drawbacks of aerobic exercise include:

  • Overuse injuries because of repetitive, high-impact exercise such as distance running.
  • Is not an effective approach to building muscle.
  • Only effective for fat loss when used consistently.

Both the health benefits and the performance benefits, or “training effect”, require a minimum duration and frequency of exercise. Most authorities suggest at least twenty minutes performed at least three times per week.

Cooper himself defines aerobic exercise as the ability to utilise the maximum amount of oxygen during exhaustive work. Cooper describes some of the major health benefits of aerobic exercise, such as gaining more efficient lungs by maximising breathing capacity, thereby increasing ability to ventilate more air in a shorter period of time. As breathing capacity increases, one is able to extract oxygen more quickly into the blood stream, increasing elimination of carbon dioxide. With aerobic exercise the heart becomes more efficient at functioning, and blood volume, hemoglobin and red blood cells increase, enhancing the ability of the body to transport oxygen from the lungs into the blood and muscles. Metabolism will change and enable consumption of more calories without putting on weight. Aerobic exercise can delay osteoporosis as there is an increase in muscle mass, a loss of fat and an increase in bone density. With these variables increasing, there is a decrease in likelihood of diabetes as muscles use sugars better than fat. One of the major benefits of aerobic exercise is that body weight may decrease slowly; it will only decrease at a rapid pace if there is a calorie restriction, therefore reducing obesity rates.

Diabetes Mellitus

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:

  • Type 1 DM results from the pancreas’s failure to produce enough insulin. This form was previously referred to as “insulin-dependent diabetes mellitus” (IDDM) or “juvenile diabetes”. The cause is unknown.
  • Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as “non insulin-dependent diabetes mellitus” (NIDDM) or “adult-onset diabetes”. The most common cause is excessive body weight and not enough exercise.
  • Gestational diabetes is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.

Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco. Control of blood pressure and maintaining proper foot care are important for people with the disease. Type 1 DM must be managed with insulin injections. Type 2 DM may be treated with medications with or without insulin. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM. Gestational diabetes usually resolves after the birth of the baby.

Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious issues such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases. Moderate hypoglycemia may easily be mistaken for drunkenness; rapid breathing and sweating, cold, pale skin are characteristic of hypoglycemia but not definitive. Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.

People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis, a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness.

A rare but equally severe possibility is hyperosmolar hyperglycemic state, which is more common in type 2 DM and is mainly the result of dehydration.

Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and “other specific types”. The “other specific types” are a collection of a few dozen individual causes. Diabetes is a more variable disease than once thought and people may have combinations of forms. The term “diabetes”, without qualification, usually refers to diabetes mellitus.

Type 1

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the pancreatic islets, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which a T cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin.[33] It causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed “juvenile diabetes” because a majority of these diabetes cases were in children.

Type 2

Type 2 DM is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 DM is the most common type of diabetes mellitus.

Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 DM in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. However, after pregnancy approximately 5–10% of women with gestational diabetes are found to have diabetes mellitus, most commonly type 2. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.

Maturity onset diabetes of the young

Maturity onset diabetes of the young (MODY) is an autosomal dominant inherited form of diabetes, due to one of several single-gene mutations causing defects in insulin production. It is significantly less common than the three main types. The name of this disease refers to early hypotheses as to its nature. Being due to a defective gene, this disease varies in age at presentation and in severity according to the specific gene defect; thus there are at least 13 subtypes of MODY. People with MODY often can control it without using insulin.

Benefits of Coffee for Health

Coffee is actually very healthy.

It is loaded with antioxidants and beneficial nutrients that can improve your health.

The studies show that coffee drinkers have a much lower risk of several serious diseases.

1. Coffee Can Improve Energy Levels and Make You Smarter

Coffee can help people feel less tired and increase energy levels. This is because it contains a stimulant called caffeine, which is actually the most commonly consumed psychoactive substance in the world . After you drink coffee, the caffeine is absorbed into the bloodstream.

Bottom Line: Caffeine blocks an inhibitory neurotransmitter in the brain, which leads to a stimulant effect. This improves energy levels, mood and various aspects of brain function.

2. Coffee Can Help You Burn Fat

There’s a good reason for that… caffeine is one of the very few natural substances that have actually been proven to aid fat burning. However, it is possible that these effects will diminish in long-term coffee drinkers.

Bottom Line: Several studies show that caffeine can increase fat burning in the body and boost the metabolic rate.

3. The Caffeine Can Drastically Improve Physical Performance

Caffeine stimulates the nervous system, causing it to send signals to the fat cells to break down body fat. But caffeine also increases Epinephrine (Adrenaline) levels in the blood. Because of this, it makes sense to have a strong cup of coffee about a half an hour before you head to the gym.

Bottom Line: Caffeine can increase adrenaline levels and release fatty acids from the fat tissues. It also leads to significant improvements in physical performance.

4. There Are Essential Nutrients in Coffee

Coffee is more than just black water. Many of the nutrients in the coffee beans do make it into the final drink.

A single cup of coffee contains:

  • Riboflavin (Vitamin B2): 11% of the RDA.
  • Pantothenic Acid (Vitamin B5): 6% of the RDA.
  • Manganese and Potassium: 3% of the RDA.
  • Magnesium and Niacin (B3): 2% of the RDA.

Although this may not seem like a big deal, most people are drinking more than one cup per day. If you drink 3-4, then these amounts quickly add up.

Bottom Line: Coffee contains several important nutrients, including Riboflavin, Pantothenic Acid, Manganese, Potassium, Magnesium and Niacin.

5. Coffee May Lower Your Risk of Type II Diabetes

Type 2 diabetes is a gigantic health problem, currently afflicting about 300 million people worldwide.

It is characterized by elevated blood sugars in the context of insulin resistance or an inability to secrete insulin.

For some reason, coffee drinkers have a significantly reduced risk of developing type 2 diabetes.

Bottom Line: Several observational studies show that coffee drinkers have a much lower risk of getting type II diabetes, a serious disease that currently afflicts about 300 million people worldwide.

6. Coffee May Protect You From Alzheimer’s Disease and Dementia

Alzheimer’s disease is the most common neurodegenerative disease and the leading cause of dementia worldwide. This disease usually affects people over 65 years of age. Unfortunately, there is no known cure for Alzheimer’s. However, there are several things you can do to prevent the disease from showing up in the first place. This includes the usual suspects like eating healthy and exercising, but drinking coffee may be incredibly effective as well.

Bottom Line: Coffee drinkers have a much lower risk of getting Alzheimer’s disease, which is a leading cause of dementia worldwide.

7. Caffeine May Lower The Risk of Parkinson’s

Parkinson’s disease is the second most common neurodegenerative disease, right after Alzheimer’s. It is caused by death of dopamine-generating neurons in the brain. Same as with Alzheimer’s, there is no known cure, which makes it that much more important to focus on prevention.

Bottom Line: Coffee drinkers have up to a 60% lower risk of getting Parkinson’s disease, the second most common neurodegenerative disorder.

8. Coffee Appears to Have Protective Effects on The Liver

The liver is an amazing organ that carries out hundreds of important functions in the body. Several common diseases primarily affect the liver, including hepatitis, fatty liver disease and others. Many of these diseases can lead to a condition called cirrhosis, in which the liver has been largely replaced by scar tissue.

Bottom Line: Coffee drinkers have a much lower risk of developing cirrhosis, which can be caused by several diseases that affect the liver.

9. Coffee Can Fight Depression and Make You Happier

Depression is a serious mental disorder that causes a significantly reduced quality of life. It is incredibly common and about 4.1% of people in the U.S. currently meet the criteria for clinical depression.

Bottom Line: Coffee appears to lower the risk of developing depression and may dramatically reduce the risk of suicide.

10. Coffee Drinkers Have a Lower Risk of Some Types of Cancer

Cancer is one of the world’s leading causes of death and is characterized by uncontrolled growth of cells in the body. Coffee appears to be protective against two types of cancer… liver cancer and colorectal cancer. Liver cancer is the third leading cause of cancer death in the world, while colorectal cancer ranks fourth.

Bottom Line: Liver and colorectal cancer are the 3rd and 4th leading causes of cancer death worldwide. Coffee drinkers have a lower risk of both.