What is Depression?

What is depression?

The word 'depression' causes much confusion. It's often used to describe when someone is feeling 'low', 'miserable', 'in a mood' or having 'got out of bed on the wrong side'.
However, doctors use the word in two different ways. They can use it to describe the symptom of a 'low mood', or to refer to a specific illness, ie a 'depressive illness'. This factsheet relates to depression, the illness.
This confusion is made all the worse because it is often difficult to tell the difference between feeling gloomy and having a depressive illness.
Doctors make a diagnosis of depression after assessing the severity of the low mood, other associated symptoms and the duration of the problem.
Depression is very common. Almost anybody can develop the illness; it's certainly NOT a sign of weakness.
Depression is also treatable. You may need to see a doctor, but there are things you can do yourself or things you can do to help somebody suffering from the illness.
What you cannot do is 'pull yourself together' – no matter whether this is what you think you should be able to do or what other people tell you to do.
People who have experienced an episode of depression are at risk of developing another in the future. A small proportion may experience an episode of depression as part of a bipolar affective disorder(manic depression), which is characterised by episodes of both low and high moods.

Who gets depressed?

• Depression is very common.
• Between 5 and 10 per cent of the population are suffering from the illness to some extent at any one time.
• Over a lifetime you have a 20 per cent, or one in five, chance of having an episode of depression.
• Women are twice as likely to get depression as men.
• Bipolar affective disorder is less common than depressive illness with a life-time risk of around one to two per cent. Men and women are equally affected.

Getting depression is not a sign of weakness. There are no particular 'personality types' that are more at risk than others.
However, some risk factors have been identified. These include inherited (genetic) factors – such as having parents or grandparents, who have suffered from depression, and non-genetic factors – such as the death of a parent when you were young.

What causes depression?

• We do not fully understand the causes of depression.
• Genes or early life experiences may make some people vulnerable.
• Stressful life events, such as losing a job or a relationship ending, may trigger an episode of depression.
• Depression can be triggered by some physical illness, drug treatments and recretional drugs.

It's often impossible to identify a 'cause' in many people, and this can be distressing for people who want to understand the reasons why they are ill.
However depression, like any illness, can strike for no apparent reason.
It's clear that there are definite changes in the way the brain works when a person is depressed.

• Modern brain scans that can look at how 'hard' the brain is working have shown that some areas of the brain (such as at the front) are not working as well as normal.
• Depressed patients have higher than normal levels of stress hormones.
• Various chemical systems in the brain may not be working correctly, including one known as the serotonin or 5-HT system.
• Antidipresent may help to reverse these changes.

Symptoms of depression

Stress can lead to you to feeling 'down' and 'miserable'. What is different about a depressive illness is that these feelings last for weeks or months, rather than days.
In addition to feeling low most or all of the time, many other symptoms can occur in depressive illness (though not everybody has every one).

• Being unable to gain pleasure from activities that normally would be pleasurable.
• Losing interest in normal activities, hobbies and everyday life.
• Feeling tired all of the time and having no energy.
• Difficulty sleeping or waking early in the morning (though some feel that they can't get out of bed and 'face the world').
• Having a poor appetite, no interest in food and losing weight (though some people overeat and put on weight – 'comfort eating').
• Losing interest in sex.
• Finding it difficult to concentrate and think straight.
• Feeling restless, tense and anxious..
• Being irritable.
• Losing self-confidence.
• Avoiding other people.
• Finding it harder than usual to make decisions.
• Feeling useless and inadequate – 'a waste of space'.
• Feeling guilty about who you are and what you have done.
• Feeling hopeless – that nothing will make things better.
• Thinking about suicide – this is very common. If you feel this way, talk to somebody about it. If you think somebody else might be thinking this way, ask them about it – it will not make them more likely to commit suicide.

How is depression diagnosed?

Unfortunately, there's no brain scan or blood test that can be used to diagnose when a person has a depressive illness.
The diagnosis can only be made from the symptoms.
Generally speaking a diagnosis of depression will be made if a person has a persistently low mood that significantly influences their everyday life and has been present for two weeks or more, and there are also three or four or more other symptoms of depression.

Who treats people with depression?

• general practisners(GP), most commonly help treat people with depression.
• Patients may also be seen by counsellors, who are often attached to GP surgeries.
• If the diagnosis is unclear, or the person is particularly ill, the GP may refer the patient to a psychiatrict.
• Patients may be referred tocommunity psychiatric nurses (CPNs)  by their GP or psychiatrist.
• People suffering from depression may also be seen by CBT therapist and other psychotherapist.

Treatments for depression

Sometimes when we are going through a 'bad patch' in our life, it's enough to talk through our problems with a friend or relative.
However, this may not be enough and we may need to seek professional help.
The important thing to remember about depression is that it's treatable.
There are many different types of treatment. These include medication and talking therapies (psychotherapy).

Psychotherapy

• There are many different forms of psychotherapy.
• Simply talking to somebody or your doctor about your problems is a form of psychotherapy and can help greatly.
• It's far better to talk about your problems than 'bottling-up' your emotions.
• More formal psychotherapy includes counselling, cognitive behavioral therapy(CBT), interpersonal psychotherapy (IPT) and dynamic psychotherapy or psychoanalysis.

As a general, rule psychotherapies are as effective as medication for the treatment of mild depression. However, for more severe illnesses, medication is likely to be needed but may be supplemented with psychotherapy.
Exactly which type of therapy a doctor recommends depends on the particular problems a patient is suffering from, the views of the patient and local availability of psychotherapy. There's little evidence to suggest that one form of therapy is better than another.

Medication

• Antidepressant medication (for example fluoxetine) helps to correct the 'low' mood and other symptoms experienced during depression – they are NOT 'happy pills'.
• Antidepressants do not change your personality.
• Antidepressants are NOT addictive.

In the last few years, there has been an explosion of new antidepressant medications. The main advantage of these new drugs is that they have fewer side effects than older drugs and so are more pleasant to take.
Your doctor will choose which medication to prescribe for you based on the side-effects of the drugs and your particular symptoms. We do not fully understand how antidepressants work. However, they appear to act on chemicals in the brain to correct the abnormalities that cause the illness.
When taking medication, it's important to remember:

• to take your medication regularly
• you are unlikely to see any improvement in your symptoms for two to four weeks after starting the medication
• once you have started to respond, you should slowly improve over several weeks
• current World Health Organization guidelines recommend that patients continue to take their medication for six months after having recovered. This is to prevent a recurrence of the illness when the medication is stopped
• antidepressants are effective for both treating episodes of depression and also for preventing further episodes of illness. Some patients who have had severe or many episodes of illness are therefore recommended to take medication for a long time
• stopping to take medication once you feel well is a common cause of a return of the symptoms of depression. You should therefore only stop after discussion with your doctor
• generally coming off antidepressants is not a problem, though usually you should gradually reduce the dose of the medication over a few weeks rather than stopping abruptly. If you stop antidepressants abruptly you may notice anxiety, headache, stomach upset, sleep disturbance or other symptoms.

What happens if you do not respond to treatment?

Some people unfortunately do not get better with simple straightforward treatments.
It may be that they need to try a higher dose or different antidepressants. A combination of medication and psychotherapy could also be helpful.
It may be necessary for these people to be referred to a psychiatrist for more specialised help. The psychiatrist will want to talk about the problems the person is suffering and find out about background information, such as work and family, previous health or emotional problems and current medication.
The psychiatrist may then recommend different treatments. Rarely, it may be necessary for the person to be admitted to hospital if the depression is very severe. This is only necessary in about 1 in 100 patients with depression.

Electroconvulsive therapy (ECT)

Most people do not like the idea of electroconvulsive therapy (ECT). It's a treatment that is reserved only for patients who have severe depression, for which it's highly effective and can work faster than medication.
It involves having a brief anaesthetic, which sends the person to sleep for 5 to 10 minutes. While asleep, a muscle-relaxing drug is given and a small electric current is passed through the brain for a fraction of a second.
Once the person has woken, it takes half an hour or so to get over the effects of the anaesthetic.
ECT is only given under the close supervision of an anaesthetist, a psychiatrist and nursing staff.
Most commonly, ECT is administered twice a week and around 6 to 10 treatments are necessary to treat the depression, though an effect may be seen after the first one or two treatments.
There's no evidence that properly administered ECT damages the brain in any way.

What to do if you are depressed

• Talk to people about how you feel. Don't bottle things up. It is NOT a sign of weakness to get help for your problems, in the same way that it would not be to get medical help for a broken leg or a chest infection.
• Although you may not be able to do the things you normally would (such as work), try to keep active as much as you can. Lying in bed or sitting thinking about your problems can make them seem worse. Physical exercise can also help depression and keep your mind off your worries.
• Do not increase your alcohol intake to try and 'drown your sorrows' or help you sleep better. Alcohol will only make the depression worse and harder to treat.
• If you are having problems sleeping, try not to lie in bed thinking about your problems and anxieties. Do something to take your mind off your worries, such as reading or listening to the radio.
• Self-help books may be helpful. Check out the health section of any good bookshop.
• If you are feeling suicidal or desperate contact a voluntary sector organisation, such as the samaritans.
• Always remember that you are suffering from an illness. It is not you being weak, and you can NOT simply 'pull yourself together'. Your illness is treatable. You are also NOT ALONE. Depression is extremely common.

What to do if you know somebody who is depressed

Sometimes people are not aware that they are depressed. This can happen when the depression comes on slowly.
In addition many people suffering from depression blame themselves for not coping as they normally would, rather than thinking there might be some illness that has caused them to be this way. The illness can make a person think that it would be a sign of weakness to seek help for their difficulties. If you think that this has happened to somebody, you should try to talk to him or her about it.
Also try to remember the following.

• Listening can really help.
• Avoid saying, 'pull yourself together' or other remarks that make the person think that it is their fault that they are ill.
• If the person's problems do not sort themselves out in a week or so, suggest that the person seek professional help. Remind the person that this is not a sign of weakness or of being a failure.
• Don't nag the person or try to get them to do what they normally would. Remember they are suffering from an illness.
• Remind the person that they have an illness, it's not their fault and they'll get better no matter how hopeless they feel.
• Try to help them avoid resorting to alcohol, which does not help the situation. If the person talks of harming themself or committing suicide, take this seriously. Insist that they see a doctor.
• Remember that it does NOT increase the chances of a person committing suicide to talk to them about it.

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Detailed about Schizophrenia ?

What is schizophrenia?

Schizophrenia is a major mental illness that causes changes in perception, thoughts and behaviour.
It is a complex condition that defies simple description, but a distinction can be made between two broad types: acute schizophrenia and chronic schizophrenia.

Acute schizophrenia

This is the form that probably most comes to mind when people think of schizophrenia.
Acute schizophrenia is when a previously healthy person, generally a young adult, shows increasingly odd behaviour over a fairly short period of time of perhaps a few weeks.
It can take the form of hallucinations, irrational beliefs or disordered thoughts, ie illogical or incoherent thinking of any degree of severity.

'Positive' symptoms

The most common symptoms of acute schizophrenia are:

• lack of insight
• auditory hallucinations (hearing sounds, voices or music)
• delusions of persecution
• suspiciousness
• flat mood
• thoughts spoken aloud.

These symptoms are called the positive symptoms of schizophrenia.
Not all patients with acute schizophrenia experience all of these symptoms.

Mood disturbance often accompanies acute schizophrenia and can be of any type, such as depression and anxiety, irritability or euphoria.
Emotional responses are often inappropriate for their surroundings – for example, laughing at sad news or appearing unconcerned by important events.
Generally, a schizophrenic knows where they are in time and place, but the presence of disordered thoughts may make them feel confused.
Higher mental reasoning is usually impaired and they often lack insight into their condition. They find it difficult to plan things or organise themselves.

Spotting the signs

Usually a person suffering from schizophrenia will not know they are experiencing symptoms of the illness.
By definition, hallucinations and delusions are experienced as real by the person having them.
As a result, the person with schizophrenia may have different perceptions of the world compared with the rest of us.

Delusions

The following delusions are strongly suggestive of schizophrenia:

• the belief they are under the control of another influence
• that thoughts are being put into or taken out of their mind.

If a person has delusions of persecution, they may be suspicious of any questions about their mental state.

Often the person may feel persecuted or 'got at' in some way, which can cause fear and anxiety.
Other people may notice a change in the person's behaviour, or in the content of their speech.
Sufferers may become preoccupied with certain issues that seem bizarre to those around them.
They may express paranoid ideas or respond to the hallucinations they experience. These hallucinations usually take the form of hearing voices that other people cannot hear.

Chronic schizophrenia

This is the longer-term state and is characterised by:

• a lack of drive
• underactivity
• social withdrawal.

Left to their own devices, schizophrenics may spend long periods of time doing nothing, or engage in repeated and purposeless activity. Sometimes they can neglect themselves quite markedly.
As with the acute state, hallucinations and delusions are common.
Sometimes in chronic schizophrenia the person appears to become used to these disordered thoughts.
For example, they might harbour the idea that someone is trying to get at them, but this does not cause any emotional reaction.

'Negative' symptoms

The most common symptoms of chronic schizophrenia are:

• social withdrawal
• underactivity and slowness
• lack of conversation or interests
• odd ideas or behaviour
• neglect of appearance
• depression.

These symptoms are often called the negative symptoms of schizophrenia.
Not all people with chronic schizophrenia experience all of the symptoms.

How common is schizophrenia?

Worldwide schizophrenia is present in two to four people per 1000 of the population at any one time. One in 100 people will develop schizophrenia in their lifetime.

How does schizophrenia develop?

The cause of schizophrenia is unknown, but it may have a genetic component.
There is no 'gene for schizophrenia' but a family history of the illness increases the risk of being affected:

• if a grandparent had the illness, the risk rises to 3 per cent
• if one parent was affected, the risk is as high as 10 per cent
• this rises to 40 per cent if both parents have schizophrenia.

Other predisposing factors in the development of schizophrenia include complications during pregnancy or childbirth and difficulties in childhood development.
Factors that may trigger an episode of schizophrenia include stressful life events, and the use of illegal drugs, such as cannabis.

What can schizophrenics and their families do to help themselves?

If you think you are experiencing symptoms of schizophrenia, you should seek help from your doctor.
However, one of the features of the disease is sufferers do not understand they are unwell during acute episodes of illness. It is therefore important that family and friends are able to seek help on their behalf.
The first point of call should be the person's family doctor or mental health team worker.
Schizophrenics who are on long-term medication should continue to take this medication, because it has a protective effect against future relapses.

How does the doctor make a diagnosis?

The diagnosis is based on an assessment of the history given by the patient and by any other people who are able to give further information.

What is the course of the disease?

• About a quarter of the people diagnosed with schizophrenia will have one episode of illness, make a good recovery and have no further problems.
• A further 25 per cent will develop a long-term chronic illness with no periods of remission.
• The remaining 50 per cent of those diagnosed will have a long-term illness that comes and goes with periods of remission and relapse.

The long-term outcome may be worse in people:

• with poor social support
• with a strong family history of schizophrenia
• in whom the illness came on slowly
• in whom treatment was delayed.

Male sex and continuing use of illicit drugs are also associated with a poorer outcome.
The risk of relapse is significantly improved by continuing appropriate medication for at least six months after an acute episode.
Positive family intervention may also help to maintain periods without illness, as can help with social skills training and psychological therapy.
People with schizophrenia have higher rates of depression than the general population. There are also high rates of suicide among people with schizophrenia.

What medicines can treat schizophrenia?

Injections

Antipsychotic drugs can be given as an injection that lasts for days or weeks, called a depot injection.
It is often used to prevent a relapse after recovery from acute illness.
It also helps those who prefer it to remembering daily medication.

There are many different  avaantipsychotic medicinesilable, all of which aim to calm someone without making them excessively drowsy.
Modern treatments are called atypical antipsychotics and include:
These are said to have fewer side-effects than some of the older antipsychotics, and so are now the usual treatment for most patients.
Examples of the older treatments include:     amisulpride (eg Solian)olanzapine (eg Zyprexa)quetiapine (eg Seroquel)risperidone (eg Risperdal)clozapine (eg Clozaril)     chlorpromazine (eg Largactil)hyaloperidol (eg Haldol)trifluoperazine (eg Stelazine)
  
Although not a cure, studies show antipsychotic medicines improve the symptoms of schizophrenia and help prevent relapse.
They are effective against the positive symptoms of schizophrenia, eg hallucinations, but have little impact on the negative symptoms, such as lack of motivation and flat mood.
Antipsychotic medicines have important short-term and long-term side-effects.
Side-effects can include:

• sedation
• dry mouth
• constipation
• blurred vision
• light-headedness.

Antipsychotic medicines can also affect movement, for example in slowing gait or causing tremor or abnormal face and body movements.
If these side-effects occur, your doctor may change your dose or prescribe other medicines to help with the side-effects, or another antipsychotic medicine can be tried that may cause less problems.
A long-term movement problem known as tardive dyskinesia occurs in some patients who are on treatment for a prolonged period.
Because there is a high risk that schizophrenia symptoms will recur, treatment should continue for at least one to two years.
If taking medication is a problem then a GP or specialist can prescribe injectable antipsychotic treatment usually given monthly and many patients find this very useful.

Is therapy helpful?

Research shows interventions with the families of schizophrenics can reduce relapse rates.
These family interventions usually last several weeks and consist of education about the illness and help with problem solving.
Research also suggests a type of psychological therapy known as cognitive behavioural therapy may help to reduce relapse rates. Further studies are required in this area.
There is limited evidence that giving people with schizophrenia help and training in social skills may help prevent relapses.

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Detailed about Tuberculosis?

What is tuberculosis?

Tuberculosis (TB) is a disease caused by an infection with the bacteria Mycobacterium tuberculosis complex.
During the 19th century, up to 25 per cent of deaths in Europe were caused by this disease. It used to be called the 'white death' as opposed to the Black Death caused by plague.
The death toll began to fall as living standards improved at the start of the 20th century, and from the 1940s, effective medicines were developed.
However, there are now more people in the world with TB than there were in 1950, and 3 million individuals will die this year from this disease – mainly in less developed countries.
It is estimated that any one time, up to a third of the world's population have been infected with TB.
The disease is more common in areas of the world where poverty, malnutrition, poor general health and social disruption are present.
In the UK, too, the number of TB cases is again rising.alcholic, hiv positive person, some recent immigrants and healthcare workers are at increased risk.
The disease is most commonly found in places such as hostels for the homeless, prisons, and centres for immigrants arriving from areas with high rates of hiv infection or inadequate health provision.

What parts of the body are affected by tuberculosis?

Lung TB: TB commonly presents as a disease of the lungs. However, the infection can spread via blood from the lungs to all organs in the body.
This means that you can develop tuberculosis in the pleura (the covering of the lungs), in the bones, the urinary tract and sexual organs, the intestines and even in the skin.
Lymph nodes in the lung root and on the throat can also get infected.
Tuberculous meningitis is sometimes seen in newly infected children. This form of the disease is a life-threatening condition.
Non-lung TB is an important cause of skin, bowel and gynaecological problems.

How do you catch tuberculosis?

Lung TB: the bacteria that cause the disease are inhaled in the form of microscopic droplets that come from a person with tuberculosis.
When coughing, speaking or sneezing, the small droplets are expelled into the air. They dry out quickly, but the bacteria itself can remain airborne for hours.
However, the tuberculosis bacteria are killed when exposed to ultraviolet light, including sunlight.
Non-Lung TB: infected milk or dairy products can cause the mycobacterium to set up infections in the gastro-intestinal tract and also affect the reproductive systems in men and women.

How does the disease develop inside the body?

Lung TB: after the tuberculosis bacteria have been inhaled they reach the lungs and, within approximately six weeks, a small infection appears that rarely gives any symptoms. This is called a primary infection.
After this, the bacteria can then spread through the blood. If you have a healthy immune system, in most cases the infection will remain dormant without doing any obvious harm.
Non-Lung TB: a similar process as above but the route of entry may be through the gut.
Months or even years later, however, the disease can become reactivated in different organs if the immune system is weakened. The lungs are the favourite place for the illness to strike.

What are the symptoms?

Typical signs of tuberculosis are:

• chronic or persistent cough and sputum production. If the disease is at an advanced stage the sputum will contain blood
• fatigue
• lack of appetite
• weight loss
• fever
• night sweats.

Tuberculosis can mimic many forms of disease and must always be considered if no firm diagnosis has been made.
Other non-tuberculous mycobacteria found in soil and water can cause disease in susceptible patients with a history of cystic fibrosis, chronic lung damage, alcoholism and immunosuppression (suppression of immune responses by a disease or drugs).
These atypical mycobacteria can be present as colonising organisms without necessarily causing disease.

When should I see a doctor?

If you have a persistent cough with sputum for more than three weeks or you see blood in your sputum or unexplained weight loss or unexplained night ,sweats, you should contact your doctor.

How does the doctor make the diagnosis?

Lung TB: the doctor cannot always hear enough to make a diagnosis by just using a stethoscope.
If your physician suspects there is something wrong and that it is not just a cold, you may be referred to an outpatient department for people with lung diseases or to an X-ray department.
The chest x ray examination is the most important test. If there are changes in the lungs, a sample of sputum will be sent for microscopic element and culture.
Culture of tuberculosis bacteria will take 4 to 12 weeks. For this reason, it takes some time before an accurate diagnosis is possible.
Quicker methods using DNA techniques are now available, and a skin reaction Mantoux test can sometimes be a great help.
In this test, tuberculin, which is a substance extracted from the tubercle bacteria, is injected into the skin.
If the skin shows a strong reaction after 72 hours, it means there is hypersensitivity to tuberculin protein acquired either by a previous BCG vaccination, or possibly due to an active infection.
Non-Lung TB: The diagnosis may only be made after surgical exploration.
In both lung and non-lung TB, we now have blood tests that can tell if you are on of the two-thirds in the world never infected (a negative test).
If the test is positive you either have active TB (which may be infective to others) or you have latent TB (which may become active if your immune system is made less effective by steroids, age or HIV).

Are there other diseases with similar symptoms?

Lung TB: bronchitis,  pneumonia, smoker's lung and lung cancercan all show practically the same symptoms as tuberculosis.
If tuberculosis is suspected, tests will need to be done to rule out the presence of these other diseases. Examination of sputum will usually include a check for cancer if the chest X-ray raises any suspicion of this type of diagnosis.
Non-Lung TB: can be confused with cancers, it can be a cause of a wide range of gastro-intestinal symptoms, infertility and unusual skin lesions.

Where can I get a vaccination against tuberculosis?

In the UK, BCG vaccination (with live but weakened tubercle bacteria) is no longer routinely given to all children of secondary school age.
The highest rates of the disease occur in particular risk groups and it now makes more sense to target BCG vaccination for people who are at greatest risk of the disease.
The vaccine is now recommended for:

• infants under one year of age living in areas where the incidence of TB is 40 cases per 100,000 people or higher (technically this applies to London, UK)
• infants under one year of age whose parents or grandparents were born in a country with an incidence of TB of 40 cases per 100,000 people or higher
• children with risk factors for TB who have not previously been vaccinated
• new immigrants from countries with a high incidence of TB who have not already been vaccinated
• contacts of people diagnosed with TB affecting the lungs
• health care workers, veterinary staff, staff working in prisons, residential homes, shelters for the homeless or hostels for refugees
• people intending to live, travel or work in countries with a high incidence of TB for more than a month.

Vaccination is thought to reduce the likelihood of subsequent pulmonary TB and effectively prevents varieties of blood-borne tuberculosis such as miliary TB or tuberculosis meningitis in infants, which can be difficult to diagnose in time and can cause devastating damage.

How is tuberculosis treated?

Today, treatment involves three or four different kinds of antibiotic  given in combination over six to nine months.
Multiple medicines are necessary to prevent the emergence of resistance, which would lead to treatment failure and the nightmare of multiple drug-resistant organisms.
Single medicines must never be added to a failing treatment regime. Therapy should be directed by a chest physician who will have specialist knowledge of the complications and side-effects of TB medicines.
Attention to the details of treatment are vital. The main cause of treatment failure is non-compliance with what is perceived as a demanding and prolonged programme of therapy.
Those patients who are microscopy or smear positive are infectious and, if possible, should avoid contact with other people for two weeks.
Patients do not require hospital admission in order to start treatment. Other patients with a lower bacterial load are smear negative but culture positive on testing. These patients are not as infectious but should still have therapy along conventional lines.
Chemoprophylaxis with a single medicine, isoniazid, may be given for 6 to 12 months with the aim of preventing future disease in individuals who show no evidence of disease, but have a strongly positive tuberculin skin test and no evidence of previous BCG vaccine to explain the positive skin test.
pregnent women with TB must be treated urgently as the disease may progress rapidly with high risk to both mother and baby.

Is it possible to become resistant to the medicine?

Yes, if medication is not taken every day or as prescribed by the doctor.
In some parts of the world there are problems with resistance to medication and even multi-drug resistance.
This is a very serious situation, which has been experienced on a large scale in parts of Africa, the Baltic States, many East European countries, certain American cities and in areas of the developing world.
XDR-TB, is an abbreviation for extensively drug-resistant tuberculosis (TB) (this form of TB is resistant to at least four of the core anti-TB drugs).
MDR-TB involves resistance to the two most powerful anti-TB drugs, isoniazid and rifampicin. MDR-TB and XDR-TB both take much longer to treat than ordinary TB, and require the use of anti-TB drugs, which are more expensive and have more side effects than the normal TB drugs.
If there are problems with patients not taking their medicines, it may be necessary to arrange supervision either in a hospital or at home with a nurse. This programme is known as DOTS (directly observed treatment, short-course) and is recommended by the World Health Organisation (WHO).

How can treatment be controlled?

An undetected infectious TB victim will, on average, infect another 10 cases in a year, each of whom could transmit the disease in turn.
According to the WHO and the international tuberculosis union IUATLD, all countries should have a national tuberculosis programme and authorities should also be notified about patients who have been diagnosed with TB.
The treatment itself is prescribed under the supervision of chest clinics where they make sure that the patient has correctly taken a curative course of treatment.
Negative culture from sputum in 6 to 12 months from the moment of the diagnosis indicates a cure.
The clinics make sure that the environment in which the patient lives is also carefully examined. All family members will be required to undergo chest X-rays. Sometimes, the patient's workplace will also be examined.

What are the world's highest-risk regions?

Infection is possible anywhere, but tuberculosis is especially prevalent in sub-Saharan Africa and in Southeast Asia.
The disease is more common in Eastern Europe than Western Europe, and Scandinavia has the lowest number of cases in the world.

Is HIV/AIDS associated with tuberculosis?

Yes. In certain African countries and many parts of Southeast Asia, HIV is becoming more and more endemic.
Where tuberculosis is also endemic among the population, a weakened immune system will increase the risk of getting tuberculosis.
This is an extremely worrying situation and the WHO and the IUATLD are doing all they can to prevent the disease from spreading.

Can tuberculosis be prevented?

TB is reduced with better housing and less over-crowding.
The most important step is to find, isolate and treat all disease carriers until they are no longer an infective risk to others.
It is always advisable not to get too close to people who are coughing; equally, people with a cough should be aware of those around them and try not to cough or spit near them.

Good advice

If you travel in countries where tuberculosis is a problem, get travel health advice about BCG vaccination and avoid socialising with people who have a persistent cough.
Make sure that you eat well and enjoy plenty of sunlight and exercise.
Seek medical attention:

• if you develop a cough that persists for more than three weeks
• if you see blood in your sputum
• if you have unexplained weight loss or unexplained night sweats.

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Detailed about Asthma Disease and it's treatment ?

What is asthma?

Asthma is a chronic disease in which sufferers have repeated attacks of difficulty in breathing.
In recent decades there has been an increase in the number of people affected by asthma all over the world, especially in children.
However, since the 1990s the percentage of the population who are affected seems to have levelled out in the UK at least.
To understand what happens in an asthmatic attack, it's helpful to visualise the basic structure of the airway tubes of the lung.
The main airway (windpipe, trachea) of the body is about 2 to 3cm across. It divides into its main branches (bronchi), which lead to the right and left lung. Each bronchus divides further, like the branches of a tree, to supply air to all parts of the lungs.
The smallest tubes (bronchioles) are only millimetres wide and they are made up of ring-shaped muscles that are capable of contracting or relaxing.
Anything that makes them contract will narrow the passages, which makes it more difficult for the air to pass through (so making it harder to breathe) and also gives rise to the characteristic wheezy noise that a person makes when they have an asthma attack.
Asthmatics tend to be sensitive to various types of irritants in the atmosphere that can trigger this contraction response from the bronchial muscles.
The bronchioles also have an inner lining that becomes inflamed in asthma. This inflammation makes the lining swell (further narrowing the airway) and produce an excess amount of the mucus (phlegm) it normally makes, clogging up the tubes.
All of these processes contribute to the airway narrowing and the treatment for asthma is aimed at reversing them as much as possible. The airway inflammation and narrowing may be an on-going chronic problem which is intermittently made worse during acute asthma attacks.
People of all ages get asthma but 20 per cent of sufferers are children. Asthma is slightly more common among boys than girls. But after puberty the pattern reverses and among adults, women are more likely to develop asthma than men.
About 5.4 million people in the UK are currently receiving treatment for asthma (about 1.1 million children and 4.3 million adults), with it costing the NHS £1,000 million per year (stats from asthma UK).

How do you get asthma?

In most cases a person who develops asthma has been born with an inherited predisposition to the disease.
There may be a family history of asthma, and a great deal of research is being carried out to look for the genes that allow asthma to develop (some of these genes have been identified).
However environmental factors are important too, and asthma may not reveal itself until that person is exposed to a particular asthma trigger in their environment.
Some other links have been established.
A mother who smokes, a low birth weight, and exposure to traffic fumes have all been associated with asthma.
It's also thought that the modern obsession with a very clean environment in early life (avoiding exposure to infections and particularly parasites) may mean than a child's immune system is not 'primed' properly and an increased sensitivity to asthma triggers results.
Modern housing may also play a part, as less draughty, better heated homes result in higher levels of house dust mites or cooking gases.
Asthma can be dividied into two types.

1. In allergic or extrinsic asthma, an attack is triggered by agents which cause an allergic reaction, for example when pollen, dust mites or animal fur are breathed in. Some kinds of food can also trigger an attacks. These agents are known as allergens – they consist of foreign proteins which activate the immune system. A reaction to animal fur is actually a reaction to a protein in the animals saliva which been coated onto the fur as the animal grooms itself.
2. Asthma may also be triggered by non-allergic factors. This is known as intrinsic or non-allergic asthma and factors which cause an attack include anxiety, stress, exercise and cold air, as well as smoke, chemical fumes, and other irritants including viral infections. Certain medicines, eg aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), may  also cause an asthma attack. Although these factors cause inflammation of the airways, they do not activate the immune system.

Most people with asthma are susceptible to either of these types.
Until we can prevent asthma, the aim is to try to avoid these triggers where possible, and then effectively manage symptoms during an attack.

What might trigger an acute asthma attack?

• Exertion and exercise.
• Cold air.
• Smoke.
• Emotional stress.
• Air pollution including exposure to certain chemicals. An example is isocynates, which are used in some painting and plastics industries.
• Airway infection, eg viral infections such as colds.
• Chemical irritants including chemicals in medicines such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
• Allergies, eg to pollens, house dust mites, some foods, and the fur or dander from domestic animals (especially cats and horses). In these allergies, the immune system is reacting to a foreign protein or 'allergen'.

What does asthma feel like?

• It is difficult to breathe, with a feeling of tightness in the chest, and there is shortness of breath.
• Wheezing (a fine whistling sound) when breathing out.
• coughing, especially at night and there may be increased production of mucus or phelgm.

Symptoms vary from person to person and from attack to attack. In some they are mild and occasional while others have continuous or severe breathing problems.

What are the warning signals of worsening attacks?

• Symptoms become more severe.
• Inhaled medicines appears less effective than usual, and you may realise you are taking more of your reliever inhaler.
• Symptoms of cough or wheeze on exertion.
• Night-time wakening with wheeze or cough.
• Fall in the peak flow meter reading (a peak flow meter is a simple device that measures the maximum speed at which a person can breathe out).

When it appears that your asthma is becoming less well controlled, you should consult your doctor for advice on what to do.

What are the danger signals of severe attacks requiring immediate medical attention?

• Severe shortness of breath, so that you can't complete a sentence.
• Having to sit hunched forwards to breathe.
• Bluish skin colour (especially noticeable around the lips or fingernails) and gasping breath.
• Exhaustion so severe that speech is difficult or impossible.
• Fast breathing but with a silent chest (ie the wheeze disappears – a sign that very little air is even moving in and out of the lungs).
• Confusion and restlessness.
• Drowsiness.

What can you do to help yourself?

• Avoid the substances you know that you are allergic to, or that you know tend to trigger an attack for you if possible. It can be difficult to know which specific factors may give you trouble, but general irritants like tobacco smoke should be avoided.
• It is important to take your prescribed preventive medicines, even if you feel well.
• If you get a serious attack, contact your doctor or the emergency services.
• Discuss ur treatment with ur docter or practice nurse. You should know what to do if, for example, you get a bit worse during a cold. This will usually involve a temporary increase in the dosage of your treatment.
• Be familiar with the use peak flow meter, which can help you judge your asthma during spells when it is worse.
• Make sure you use your inhaler correctly. If you are unsure your practice nurse, doctor or pharmacist will be able to help and advise you.
• Make sure you have an adequate supply of your treatments, and don’t risk running out if symptoms get worse.

How does the doctor make the diagnosis?

A diagnosis of asthma is made on the basis of a patient's history of symptoms combined with simple tests of how the lungs are functioning (this may include a peak flow test, which uses a simple device to measure how fast you can breathe air out of your lungs).
Sometimes treatments such as reliever inhalers are tried, simply to see if they help symptoms (and therefore help establish the diagnosis). But it's not always easy to come to a diagnosis of asthma if the symptoms are mild and intermittent.
For those people whose asthma is associated with eczema and hay fever indicating an allergic aspect to their symptoms, it can be helpful to take blood samples and skin tests to look for hypersensitivity towards specific substances.

Can I safely exercise?

Be active. If you get attacks during intense activity it may be a good idea to take 'reliever' medicine before you begin to exercise.
These medicines, properly known as bronchodilter, have a relaxing effect on the muscle surrounding the bronchioles.
swimming is probably the best form of exercise for asthma patients but the most important thing is to stay active.

What are the prospects for asthma suffers?

• Although asthma cannot be cured it can usually be well treated so that the symptoms give little trouble.
• Half of the children who get asthma 'grow out of it'.
• It is vital to stop smoking to avoid developing long-term lung damage (chronic bronchitis 'smoker's lung'), which will reduce the lung function drastically.
• Severe attacks of asthma can be fatal but only if they are treated inadequately or not soon enough.

Medicine

Medicines for asthma are generally thought of in two main groups.

• Relievers (bronchodilater): these are quick-acting medicines that relax the muscles of the airways. This opens the airways and makes it easier to breathe. They are used to relieve symptoms.

• Preventers (anti-inflamentries): these act over a longer time and work by reducing the inflammation within the airways. They should be used regularly for maximum benefit. When the dosage and type of preventive medicine is correct, there will be little need for reliever medicines.

A number of other types of drugs may also be used, for example to reduce secretions.

Relievers

There are many different drugs used as asthma relievers, and they fall into three groups.

Beta-2 agonists

Beta-2 agonists act on molecule-sized receptors on the muscle of the bronchioles.
The medicine fits the receptor like a key fits a lock and causes the muscle to relax. Examples of those which act for a short time (three or four hours following a single dose
These start to work very quickly after inhalation and are used when required to relieve shortness of breath. They can also be used to open the airways before exercise.Longer-acting beta-2 agonists include salmeterol (eg Serevent) and formoterol (eg Foradil, Oxis).Their action lasts over 12 hours, making them suitable for twice-daily dosage to keep the airways open throughout the day.Formoterol works rapidly to open the airways like the short-acting beta-2 agonists.Some combination inhalers contain both a long-acting beta-2 agonist to open the airways and a steroid drug to reduce inflammation (ie preventer drugs). These include Seretide (which contains salmeterol and fluticasone) and Symbicort (formoterol and budesonide).Beta-2 agonists are inhaled from a variety of delivery devices, the most familiar being the pressurised metered-dose inhaler (MDI).Other devices include breath-actuated inhalers such as autohalers and dry powder inhalers such as turbohalers.

Anticholinergics

One of the ways in which the size of the airways is naturally controlled is through nerves that connect to the muscles. The nerve impulses cause the muscles to contract, thus narrowing the airway.Anticholinergic medicines block these nerve impulses, allowing the airways to open.The size of this effect is fairly small, so it is most noticeable if the airways have already been narrowed by other conditions, such as chronic bronchitis. An example of an anticholinergic drug is ipratropium bromide (eg Atrovent).It has a maximum effect 30 to 60 minutes after inhalation, which lasts for three to six hours.A longer lasting anticholinergic called tiotropium bromide need only be taken once a day and may sometimes be used in severe or chronic asthma but is slow in onset and so not for acute attacks.TheophyllinesTheophylline (eg Slo-phyllin) and aminophylline (eg Phyllocontin continus) are given by mouth and are less commonly used in Britain because they are more likely to produce side-effects than inhaled treatment.They are still in very wide use throughout the rest of the world.All three types of reliever can be combined if necessary.

Preventer.

Corticosteroids

Corticosteroids (or 'steroids') such as beclometasone (eg Beclazone), budesonide (eg Pulmicort) and fluticasone (eg Flixotide) have made an enormous difference to the management of asthma.  They work to reduce the amount of inflammation within the airways,

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Tips to prvent hair loss and detailed about it?

Hair Loss 

What is male hair loss (male pattern baldness/androgenic alopecia)?

Male hair loss is the most common type of hair loss.
It's caused by increased sensitivity to male sex hormones (androgens) in certain parts of the scalp, and is passed on from generation to generation.
In the past, baldness was often seen as something unfortunate or undesirable.
However, this attitude has changed over the years and nowadays a clean-shaven head is usually considered both fashionable and attractive.

What causes male hair loss?

Some men have areas on the scalp that are very sensitive to the male sex hormones that circulate in men's blood.
The hormones make the hair follicles – from which hair grows – shrink. Eventually, they become so small that they cannot replace lost hairs. The follicles are still alive, but are no longer able to perform their task.
The condition usually starts in men aged 20 to 30 and follows a typical pattern.
First, a receding hairline develops, and gradually the hair on top of the head also begins to thin.
Eventually, the two balding areas meet to form a typical U-shape around the back and sides of the head. The hair that remains is often finer and does not grow as quickly as it used to.

Can male hair loss be prevented?

Male hair loss is genetically determined (passed on from parents). Although a doctor can offer medical treatment to improve the condition, this may have side-effects.

What can be done at home?

You need to decide how you feel about hair loss. Male hair loss affects a large part of the male population and people react very differently to it.
It is important to try to accept hair loss for what it is – something natural.
Rather than trying to camouflage bald spots with remaining hair or a wig, it is probably a better idea to leave your hair as it is, or shave it off completely.
If, however, you decide to try to regain your hair, possible medical treatments are discussed below.

How is male hair loss treated?

Baldness is generally regarded as natural, and not a disease.
So if a person decides they wish to try to get their hair back, they will probably have to pay for the lengthy, expensive procedure themselves.

Treatment with medication

• Minoxidil lotion (Regaine regular strength or Regaine extra strength) is applied twice daily to the scalp. Minoxidil was originally invented as a treatment for high blood pressure; the hair growth is a side effect that, in this case, has proved useful. It is not available on NHS prescription, but can be purchased over-the-counter. About 60 per cent of patients benefit from it to varying degrees and its effects start to wear off as soon as it is stopped.
• Finasteride (propecia) is a medicine taken in tablet form that partially blocks the effects of the male hormones (an 'anti-androgen'). It is used in a higher dose to reduce the size of the prostate gland in men with benign prostatic hypertrophy. Propecia has been shown to halt further hair loss and promote re-growth of scalp hair in approximately 80 per cent of patients after three to six months. Treatment must be continued to sustain the improvement in hair growth. It is only available on private prescription and a months supply costs around £45.

Plastic surgery

Plastic surgery may be the only reliable way to replace lost hair, and techniques for restoring hair growth are constantly improving. These include:

• a transplant, where the surgeon moves non-sensitive hairs from the back of the head to the top. This is best for men whose hair loss is limited to the front of the scalp. Factors that determine whether a person is a suitable candidate include age, hair colour, the nature of hair loss, and whether the hair type is straight or curly/
• scalp reduction, a technique that is most suitable for men with a small, well-defined bald spot on the top of the head/
• flap-surgery, which involves making the part of the scalp that still contains hair larger. This is a possibility in cases of hair loss over a small area.

Hair loss in women

Women can also suffer hair loss, especially those with many relatives who are also prone to losing their hair.
The female pattern sets in at a later age than in men and is usually limited to the top of the head. Total baldness is rarely seen in women.

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Detailed about Ebola virus?

Ebola Virus

'I think it's important to say that survivors are heroes and we need to commend them and welcome them into our communities because we need them.
'With the increasing number of orphans that we have – and from the Ebola situation we have approximately 350 of them – we are aware that we need to find suitable families and homes for these children.
'The survivors are well-positioned to actually support these children, if not themselves looking after children, then helping them back into communities.'

What is Ebola virus?

In 2016 the Ebola virus will celebrate the 40th year of its discovery. It was first reported in 1976 in humans in both Zaire (now the Democratic Republic of the Congo – DRC) and Sudan.
This virus has five known subtypes, four of which can cause severe illness in man:

1. Bundibugyo ebolavirus (BDBV)
2. Zaire ebolavirus (EBOV)
3. Reston ebolavirus (RESTV)
4. Sudan ebolavirus (SUDV)
5. Taï Forest ebolavirus (TAFV).

Reston ebolavirus mainly affects monkeys. Although it can infect man, it does not cause any significant illness.
Ebola virus is one of three members of the Filoviridae family (filovirus). Marburg virus is one of the other two.

What causes Ebola?

How long this virus has existed is unknown, but we do know that it is carried by animals, such as fruit bats and other mammals.
Outbreaks in humans are thought to be caused by animal-to-human transmission after people consume or come into contact with animals harbouring the virus.
Interestingly, the virus is known to survive several weeks in semen, but we do not know if that is a definite mode of transmission.
Controlling this virus in a country with good public health, trust in medical services, non-traditional practices and rule of law was thought to be relatively straightforward.
However, recent events in the USA and Spain have now shown that this is not the case and that there may be significant risk during and after the removal of complicated personal protective equipment (PPE).
On the other hand, both Nigeria and Senegal contained the virus and prevented onward transmission in their countries.
The spread within Africa could be down to a lack of early political involvement, public health dysfunction and lack of trust (understandably) in poorly functioning health systems, in some cases with workers or burial teams reportedly not getting paid on time.

Which other viruses are like Ebola?

There are other haemorrhagic (bleeding) viruses. These include Marburg, Lassa, Crimean-Congo, Argentine, Bolivian, Brazilian and more than 10 others.
The Marburg and Ebola viruses are the most alike, both being string-like (filamentous) and relatively large.

How does Ebola spread?

Healthcare workers can become infected with Ebola through contact with blood or mucus, hence the need for basic precautions, such as gloves, masks, goggles, boots and, where available, bio-suits.
Infection can occur after removal of PPE if instructions are not followed to the letter.
Relatives become infected with the virus through caring for patients and becoming directly exposed to blood or mucus.
In many traditional African funeral practices, it is customary to wash and clean the dead body, which increases the risk for infection.
Non-medically trained nuns also spread the infection by using unsterilised needles on patients.

Where does Ebola occur and how many people are affected?

The virus has a predilection for Africa.
Outbreaks have occurred in the Democratic Republic of the Congo, Sudan, Guinea, Liberia, Sierra Leone, Nigeria, Central African Republic, Ethiopia, Gabon, Ivory Coast, Kenya, Uganda, Zimbabwe and Madagascar.
Governments have now decided on airport screening of passengers from affected areas.

What are the symptoms of the disease?

The symptoms of Ebola virus disease usually start five to seven days after becoming infected, but this can vary to between two to 21 days after becoming infected.
The symptoms are non-specific and include headache, joint and muscle pains, sore throat and muscle weakness. This is then followed by diarrhoea, vomiting, fever, rash and stomach cramps.
Internal bleeding quickly follows, accompanied by bleeding from the ears, eyes nose or mouth.
Ebola virus disease is fatal in 50 to 90 per cent of cases.

What can you do yourself?

We know that Ebola spreads by contact with infected blood or mucus. To date we do not know if the virus can be air-borne, but fortunately we think it is not.
To avoid Ebola, do not travel to an outbreak area when it can be avoided.
Use basic hygiene precautions at all times, such as hand washing with soap and water after contact with cases or suspected cases.
Health care workers and relatives need to take specific precautions as above.
If you are infected, you need to be isolated from other non-medical people.
If you have had exposure as a health care worker, a self-quarantine of 21 days with daily temperature measurements now seems to be a sensible precaution and in some areas, such as New York, it will be imposed.

How is the disease diagnosed?

Laboratories with high levels of bio-security can test for the virus or the antibody reaction to it.
The test will not be positive before symptoms occur, which is usually on day three of the infection.

How is Ebola treated?

There are no medicines that are effective against this virus, so doctors are advised to treat the symptoms.
Patients may require admission to an intensive care unit.
Patients with Ebola need their fluid levels managed by medical staff.
Experimental treatments, such as ZMapp, do exist. However, it is only available on a named patient, government ethics committee-backed basis.
Some experts think we should use the serum antibodies of those who survive Ebola to treat others.
There is no current vaccine against Ebola. But three companies including Glaxo Smith Kline (GSK) are fast-tracking the vaccine production process with the hope that something may be available in the first quarter of 2015.

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Fully described HIV and AIDS ?

HIV and AIDS

What is HIV?

HIV means 'human immunodeficiency virus'. This is the virus that causes AIDS.
HIV first emerged as a threat to humanity in the early 1980s. It spread so fast that initially there were fears that it might wipe us all out. Happily, there now seems no danger of that.
However, in 2012 the worldwide situation is this.

• About 34 million people have HIV.
• Around half of these are women.
• Over two million children have the virus.
• Each year, about 2.7 million people catch HIV.

In some countries, particularly those located in Sub-Saharan Africa, the HIV rates are very high. For instance, in the Republic of South Africa it's estimated that about 11 per cent of the population is HIV-positive.
Therefore, you should bear in mind that having sex with a new partner in certain areas of the globe could be very dangerous.
Please note that there are now known to be two types of HIV – called HIV-1 and HIV-2. The latter one is more common is some parts of the world, notably West Africa.

What are the common myths about HIV?

Many people believe the following stories that have become commonplace during the 30 years since HIV first emerged.

1. 'You can tell if someone is HIV-positive by looking at them'. This is nonsense. The great majority of people with HIV look perfectly normal.
2. 'You can't get HIV from straight sex'. This isn't true. Worldwide, vaginal intercourse is now the most common way of acquiring the virus.
3. 'Only gay men get HIV'. This is also untrue. Very large numbers of heterosexual men and women get it.

How does HIV infect people?

There are four main ways in which it can enter the body.

1. During sex. Rectal intercourse is a very 'efficient' way of transmitting the virus from one person to another. But nowadays, the majority of infections worldwide are caused by vaginal intercourse with an infected person.
2. Through sharing injection needles. Intravenous drug users are at particular risk, if they use needles that have already been used by someone else and which therefore may be contaminated with the virus.
3. From infected blood products. In some parts of the world blood intended for transfusion is still not tested for HIV. However, this is NOT the case in the UK.
4. Though infection of a baby by its mother.

A tiny number of cases occur for other reasons, for instance as a result of organ donation or sperm donation from a person who is HIV-positive, though these occurrences are very unlikely in the UK.

How does HIV attack the human body?

HIV cannot live on its own in the environment. So, in order to survive, the virus has to attack other living cells and use their metabolism to make copies of itself.
Unfortunately, HIV attacks some of the human cells that are vital to a healthy immune system, including the white blood cells known as T-helper cells or CD4 cells.
At the start of HIV infection – the primary infection – there are two possible outcomes. You can either have a short, flu-like illness that occurs one to six weeks after infection, or you can have a so-called 'dumb' infection, with no symptoms at all.
However, even if you don't have any symptoms – you can still infect other people.
Six to 12 weeks after the infection, the white blood cells have produced so many antibodies against HIV that they can be measured by a blood test. If you have HIV antibodies in your blood, you are now HIV-positive (HIV+).
An infected person will probably feel well for a long time. But the infection is still active inside the body and the virus, which can infect and destroy new blood cells, is constantly being produced.
The number of T-helper cells in the blood will slowly be reduced and when, after a number of years, the immune system has been weakened, the infected person will start showing symptoms of AIDS.

What is AIDS?

AIDS means 'acquired immune deficiency syndrome'.
It's a condition that sets in when the HIV virus has killed so many T-helper cells that the immune system is no longer able to recognise and react to attacks from everyday infections.
HIV may also attack the nervous system, possibly causing dementia. And it may affect the skin, on which small tumours develop. This condition is known as Kaposi’s sarcoma.
A number of different symptoms can occur in people who have AIDS:

• fatigue
• inexplicable weight loss
• repeated bronchial and skin infections that do not react to normal treatment
• fever
• swollen lymph nodes
• diarhhoea
• night sweats
• outbreaks of previous infections that have remained dormant (herpes and other conditions)
• so-called 'opportunistic infections' – serious infections by micro-organisms of the type normally prevented by the immune system. These in turn could lead to a number of related illnesses, such as cancer or dementia.

In the end, the disease can become so serious that the infected patient dies.

How common is AIDS?

In Britain during 2011, only 350 people were identified as new cases of AIDS.
But a total of well over 25,000 people have now been diagnosed with AIDS in the UK. Sadly, more than 19,000 of these have died.
Worldwide, about two million men and women die from AIDS each year.
In Britain, 375 people died from this disease in 2011.
On a positive note, modern treatments for HIV have greatly prolonged the lives of many people who have the virus.

How do you get infected?

These are the major risk factors.

• Unprotected sex – that is, sex without a condom. However, condoms cannot give you complete protection. Occasionally, they break. Rectal sex carries a higher risk than any other type of sexual activity.
• Blood-to-blood infection, when using a contaminated needle (which has been used by someone else) or through transfusions of contaminated blood. Today, all blood that's donated in the UK is tested for HIV, so this route of infection is now almost unknown in Britain.
• Mother infecting her child. The child can be infected during the pregnancy, during labour or after the delivery, through the brast milk.

Ordinary social interaction with HIV-positive people is not contagious.

Who is at risk?

It's common for HIV-campaigners to say that 'we are all at risk'.
Technically, this is so. But in reality, there are many factors that affect your level of risk.
For instance, if you live in a part of the world where HIV is still rare and only have sex with your spouse – you're not likely to get it.
In the UK, people who are at 'above-average' levels of risk include the following.

• Heterosexual men and women who do not practise safe sex, especially if their partners originate from areas of the world where HIV is widespread – Africa (south of the Sahara Desert), parts of Asia and some of the Caribbean Islands.
• Homosexual and bisexual men, who go in for anal sex with many different partners and who do not practise safe sex.
• Women who have unprotected sex with many different partners, especially if these include bisexual men or intravenous drug users.
• 'Straight' men who have unprotected sex with many different partners.
• Prostitutes who don't practise safe sex. Also at risk are their customers and these customers' other sexual partners.
• drug addict who share needles.
• Hospital workers whose work involves real risk of pricking or cutting themselves with infected instruments or needles.
• Babies of an HIV-infected mother.
• People who have had many blood transfusions overseas or who were treated with blood products before 1985.

How do you avoid infection?

• use a condom. This is not a guaranteed method of avoiding infection, but using a condom reduces the risk considerably. It must be worn all the way through sex.
• Avoid using recreational drugs that are injected with a syringe. Do not share syringes or needles with others.
• Avoid blood transfusions in certain countries, where they may not test the blood for HIV.

I might be infected – what should I do?

If you have been exposed to infection, you should contact a doctor as soon as possible for advice, testing and treatment.
In the UK, the best place to go is a genitourinary medicine (GUM) clinic because they're used to dealing with possible HIV cases. Also, their technical facilities are very good indeed.
Traditional HIV tests don't become positive until about three months after exposure to infection. But newer tests are now coming in, and these can provide an earlier diagnosis (see below).
If you know or suspect that your partner is HIV-positive or if you have been exposed to infection by accident – for instance through pricking yourself with a contaminated needle – treatment will be started to prevent an actual HIV infection. To be effective, it must commence within 72 hours of exposure.
The treatment may have some unpleasant side-effects, so before going ahead the real risk of infection should be estimated.
This should be decided by you, your doctor and your local HIV consultant.

How do I get tested?

If you're going to have an HIV test: you should talk to a doctor or counsellor first, in order to discuss the possible implications of the result.
Under the NHS, an HIV test at a GUM clinic is free of charge and anonymous. You can also have a free HIV test arranged by your GP, but this will appear on your medical records for the rest of your life.
Some people go for private HIV tests at one of the many commercial clinics that advertise their services in London and other large cities. Currently, the routine test will cost you about £110. The clinic shouldn't tell anyone else the result unless you authorise them to.
You might also encounter circumstances where HIV testing is obligatory. For instance, when people want to take out a large insurance policy, it is quite common for the company to ask for a preliminary HIV test.
Also, you're required to have a test if you want to do any of the following:

• become a blood donor
• donate some of your organs for transplantation
• use your sperm for artificial insemination
• adopt a child
• contribute an egg for transplantation.

What are the tests for HIV?

There are now various different tests for infection. Be guided by the GUM clinic or HIV consultant.

HIV antibody test

This is the basic, traditional test for HIV, and it's sometimes referred to as the INSTI test because you can get the result almost instantly.
It depends on the fact that when a man or woman gets infected with HIV, the body slowly reacts by producing protective proteins, called 'antibodies'.
These usually develop within three months of infection, so there's no point in doing the INSTI test before then.
It's possible to test for the antibodies in blood and saliva. If the result is negative, it's probably a good idea to have a re-test in a few months.

P24 (antigen) test

An antigen is the part of a virus that provokes the development of antibodies. In the case of HIV, the most important antigen is called 'P24'.
This antigen can often be detected in the early weeks after HIV infection.

Earlier diagnosis: the HIV DUO test

This is a newer test, which detects antibodies to both HIV-1 and HIV-2, as well as the P24 antigen. It becomes positive about 28 days after infection.
At private clinics, it currently costs about £110. Results should be available the same day.

Very early diagnosis: the HIV-1 Proviral (PCR) test

Also known as the RNA PCR test, this detects the genetic material in the HIV virus, and it can identify the virus within only about 14 days of infection.
Results take a few days to come back. If done privately, it is expensive – currently it's about £250.
A major drawback of this test is that it only detects HIV-1 infection, and not HIV-2.
So if you have recently had a sexual contact in West Africa, this would not be the ideal test for you.

Home tests

In 2012, a number of commercial companies are offering home tests for HIV. But this practice is illegal in some countries.
It's far better to have your test done by a specialist doctor, who can explain its implications to you.
Nevertheless, in July 2012 the American Food & Drug Administration approved a self-administered over-the-counter test called OraQuick.
You do the OraQuick test by taking a swab of your saliva and putting it into a tube containing a reactant.
If you think that the result is positive, you should then go and get more reliable testing from a clinic.

Treatment: what does it involve and what medication is used?

If you do have HIV, you should have expert treatment from a specialist. Please don't be persuaded by alternative 'cures'.
Rather alarmingly, statistics suggest that quite a lot of people who are HIV-positive and who need treatment are not actually receiving it.
In the first years of the HIV epidemic, back in the early 1980s, there was no specific treatment. And many people died very quickly of AIDS.
But in the late 1980s, it was discovered that treatment with virus-fighting drugs called anti-retrovirals could slow the onset of the disease. The first and most well-known of these drugs was zidovudine(azt). Unfortunately, it had many side-effects, and very often the HIV virus became resistant to it.
Happily, in the 1990s, other drugs from the same group as AZT (called 'reverse transcriptase inhibitors') became available. Shortly after that, several other classes of anti-virals were discovered, notably the protease inhibitors.
These days, people who have HIV, and whose CD4 cell count has dropped to dangerous levels, are treated with a combination of different groups of drugs – mainly as tablets or capsules.
These combinations reduce the chance of resistance occurring, and greatly increase the prospects of long life.
This combined treatment is generally known by the name HAART, which stands for highly active antiretroviral therapy.
All of the drugs which are used in HAART can have side-effects. But they do give you a really worthwhile lease of life.
As a result of HAART, there has been a very sharp decline in AIDS deaths in the UK.
New and more efficient treatments to fight HIV and reduce the content of virus in the blood are being developed all the time.
In additiion to anti-virus treatment, you will almost certainly need the following at times:

• Specific treatment of infections occurring as a result of HIV; please note that these can include tuberculosis.
• vaccination against illnesses such as flu, pneumonia and infectious hepatitis.
• Therapy for the symptoms connected with HIV infection and AIDS, for instance treatment of nausea and loss of appetite.

What can I do for myself?

If you do not have anyone to talk to about the situation, you might like to visit your GP, a counsellor with relevant experience or a psychotherapist. You should discuss your worries and the depression, which often follows the discovery that you are HIV-positive.
Your partner, if you have one, may well need counselling too.

• You should be treated for all infections and illnesses that result from the HIV virus. If these are serious, you will have to go to hospital.
• You should contact AIDS and HIV sorroport gp because these organisations can be helpful.
• Make sure you eat a varied and healthy diet.
• Avoid smoking and exessive drinking.
• Get adequate exercise.

Possible deterioration

Eventually, serious illnesses may develop as a result of HIV infection.
Commonly, these include infections that are normally prevented by the immune system.
These inlude:

• tubuculosis
• pneumonia caused by the germ Pneumocystis carinii
• toxoplasmosis infection in the brain
• reactivation of the germ cytomegalovirus
• infections involving the fungus candida albicans and also other fungal diseases
• cancer, especially skin cancer, and cancer in the lymph nodes
• meningitis and encephalopathy, a brain disease that may cause dementia.

Death may occur as a result of these illnesses. But at the present time, large numbers of HIV-positive patients are managing to avoid those complications and to remain perfectly well.

Future prospects

AIDS is not yet curable.
However, many of the illnesses resulting from the condition can be treated.
Generally, between 5 and 20 years pass from the time of infection until AIDS actually develops.
Previously, those infected only lived for a couple of years after developing AIDS.
Fortunately, with the new types of treatment available, the survival rate has greatly improved. There are patients alive today who caught the infection over 30 years ago.

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Tips to get firmer skin?

Tips to get fair skin?         by NAV JIVAN Hospital Mehnagar.

Why do we age?

After our twentieth birthday, we produce around one per cent less collagen a year. That causes skin to become thinner and more fragile.
Our sweat and oil glands don't function as well, we produce less elastin and there's less GAG formation too – glycosaminoglycans or GAGs keep the skin hydrated.
Those are the natural causes of ageing. But some external factors play a role too; sun damagr , smoking and exposure to pollution all lead to sun spots and an exaggerated loss of collagen, elastin, and GAGs – so your skin ends up looking uneven, patchy, thin and lined.
Too much sugar in your diet doesn't help either. When you eat sugar a natural process called glycation happens, where the sugar in your bloodstream attaches to proteins to form new molecules called AGEs.
The skin proteins most susceptible to glycation are collagen and elastin, which make your skin look plump and springy, so that excess glucose makes those fibres stiff and inflexible, leading to fine lines and wrinkles.

Fight back!

Boost collagen

Research shows that the antioxidant powerhouse vitamin C is 20 times more beneficial applied to the skin, rather than eaten through your diet. And vitamin C helps boost collagen to keep skin looking plump, minimises lines and fades pigmentation.
It also boosts the skin's immune system, helping to combat free radical damage from pollution and UV rays.

Lock in moisture

Hyaluronic acid helps your skin to draw in moisture, making it look plump, wrinkle-free and youthful.
Glycerine, lactic acid and urea all have the ability to hold and attract water in the skin too.
Look for lanolin in your skincare products; it's softening, smoothing and prevents moisture loss. Itis the main ingredient in cult moisturising products, such as carmex . It's also in sodocrem, which makes an excellent mask when polished off with a facecloth.

Even out patchy skin

Retinol helps stimulate cell regeneration and fades the appearance of age spots and scarring.
When battling pigmentation, it's best to make a beeline for brightening products, which even out your complexion.
Make sure you choose ones that contain UVA and UVB protection too, so you don't do any further damage.
Ingredients like kojic acid block the production of too much melanin and glycolic acid speeds up the elimination of the over-pigmented skin cells.
If you've got the budget for it, sessions of IPL (intense pulsed light) disperse pigmentation. Hydroquinone bleaching cream will fade dark patches.

Limit future damage

Research has found that daily use of sunscreen can stop skin ageing for up to four-and-a-half years so always use sunscreen with a minimum SPF of 30 – all year round.
Make sure it's 'broad spectrum' so that it protects against both UVA and UVB rays. UVA rays are present all year round and are responsible for premature ageing.
Mineral sunscreens, which contain zinc oxide and titanium oxide, are particularly effective because they act as a physical barrier to the sun and work immediately. It takes twenty minutes for most sunscreens nto be absorbed so apply yours thirty minutes before heading out and use a teaspoon-full for your face.

Perfect your technique

Smearing your beauty products on willy-nilly won't banish lines because the nutrients won't be properly absorbed.
Facial massage boosts circulation, flushes out toxins and delivers nutrients where they're needed, resulting in firmer, skin.
Apply products by making circles with your knuckles along the cheekbones, jaw and forehead for a minute, then lightly drum your fingertips over your face for another minute.

Eat your skin line-free

Good fats, found in avocados, oily fish and nuts help skin cell regeneration and lock in moisture.
Antioxidant-rich berries boost circulation and help your body to produce collagen.
Broccoli helps clear toxins that can lead to fine lines.
Wholegrains, like oats and wholemeal bread, are rich in B vitamins, which encourage the growth of skin cells.
Foods rich in beta carotene, like carrots and sweet potato help your body create active vitamin A, otherwise known as retinol, which promotes cell turnover.

Don't forget your neck

The skin on your neck is more delicate, thinner and constantly exposed to the elements, so it often gives your age away.
Avoid harsh products that contain sharp particles and instead go for a very mild exfoliator.
Your neck has fewer oil glands so it gets dry easily – combat that by using a rich and greasy cream specifically designed for your neck and give it as much attention as your face.
Cleanse and tone your neck every morning and evening and massage your cream in using upwards motions.
Don't forget to use a high SPF suncreen, whatever the weather. And for a more extreme answer, try Botox.
A Nefertiti Lift takes 15-minutes and involves up to 40 tiny injections of Botox into the neck and lower jaw.

Exercise wrinkles away

As you exercise, oxygenated blood rushes around your body. This improves the delivery of nutrients and oxygen to cells and flushes away toxins.
Increased blood flow brings toxins to the surface of your skin, so you can easily cleanse them post-workout, leaving your skin clean and glowing. It also helps boost collagen levels.
Not only that, a sweaty workout reduces levels of the stress hormone cortisol, which leads to collagen loss through glycation                                                                      

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Why do i need Vitamin C ?

What is vitamin C?

Vitamin C is also known as ascorbic acid. It has antioxidant properties.

Why do I need vitamin C?

Vitamin C is involved in the following processes in the body:

• protecting cells from oxidative damage caused by free radicals
• helping the body to synthesise collagen which is required in the structure and function of connective tissues, such as skin and bones
• maintaining the normal structure and function of blood vessels and neurological function
• increasing the absorption of iron from plant sources in the intestines.

How much vitamin C do I need?

The recommended daily allowance (RDA) of vitamin C in the UK for adults is 40mg a day. Vitamin C is a water-soluble vitamin, so is not stored in the body.

What happens if I don't have enough vitamin C?

Severe vitamin C deficiency leads to scurvy. Symptoms include:

• fatigue
• weakness
• red dots on the skin
• aching joints and muscles
• bleeding gums
• poor wound healing
• bone and tissue damage

Symptoms of scurvy only appear four to six months after an individual becomes deficient in vitamin C.
Scurvy can be quickly treated by taking vitamin C supplements and eating foods rich in vitamin C.

Where is vitamin C found?

Vitamin C can be found in the following food sources:

• citrus fruit
• berries
• blackcurrants
• green vegetables, eg broccoli and Brussels sprouts
• green, leafy vegetables such as broccoli, spinach and Brussels sprouts
• red and green peppers
• tomato
• new potatoes

What are the effects of cooking on vitamin C?

Exposure to water, air, light and heat leads to some loss in vitamin C.
When cooking, it is important to use fresh food, steam rather than boil and avoid overly long cooking times to preserve vitamins.

Do I need to take vitamin C supplement?

The Department of Health advises that you should be able to get all the vitamin C you need from a healthy balanced diet.
If you do decide to take a vitamin C supplement, take no more than 1000mg a day.
It is advised that infants and young children take vitamins A, C and D supplements up to the age of 5 years.

What are the side effects and safety precautions of taking a vitamin C supplement?

Vitamin B supplements are considered as likely safe for most people when taken orally or topically at the correct dosage.
Vitamin C may cause the following side-effects in some people:

• stomach pain
• nausea and/or vomiting
• headache
• heartburn

Dosages above the recommended safety limit in the UK (1000mg) are deemed possibly unsafe and may cause side-effects such as severe diorrhea and kidney stone.
Pregnant or breastfeeding women are advised that a healthy balanced diet containing fruit and vegetables such as broccoli, citrus fruit, tomatoes, bell peppers and blackcurrants should provide all the vitamin C they need.
Individuals undergoing angioplasty should avoid taking vitamin C supplements unless advised otherwise by a healthcare professional.
If you have cancer, check with your oncologist before using high concentrations of vitamin C, as research suggests that cancerous cells may collect high concentrations of vitamin C.
People with blood-iron conditions such as thalassaemia and haemochromatosis should avoid large doses of vitamin C as it increases iron absorption.
People with kidney stones or a history of kidney stones should also avoid large amounts of vitamin C as it can increase the risk of kidney stones.
People with a metabolic deficiency known as glucose-6-phosphate dehydrogenase deficiency (G6PDD) should avoid excessive vitamin C as it can destroy red blood cells in people with this condition.
People with sickle cell disease should avoid large amounts of vitamin C as it may worsen their condition.

What happens if I take too much vitamin C?

High doses (over 1000mg per day) of vitamin C may lead to stomach pain, flatulence and diarrhoea.
These symptoms are reversed when supplementation is stopped.

Do vitamin C supplements have any drug interactions?

Vitamin C has moderate interactions with the following:

• aluminium
• oestrogen
• fluphenazine (Prolixin)
• chemotherapy medications
• protease inhibitors (HIV/AIDS medication)
• statins
• vitamin b3
• warfarin

Vitamin C has minor interaction with these medications:

• aspirin
• choline magnesium trisalicylate
• nicardipine
• paracetemal                                   by NAV JIVAN Hospital Mehnagar azamgarh up
  

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