Dyslexia

Dyslexia facts

Dyslexia is difficulty in learning to read.
Dyslexia can be related to hereditary factors or other factors that affect brain development.
The precise cause of dyslexia is not fully understood.
Diagnosis of dyslexia involves reviewing the child's processing of information from seeing, hearing, and participating in activities.
Treatment of dyslexia ideally involves planning between the parent(s) and the teachers.

What is dyslexia?

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Dyslexia has been around for a long time and has been defined in different ways. For example, in 1968, the World Federation of Neurologists defined dyslexia as "a disorder in children who, despite conventional classroom experience, fail to attain the language skills of reading, writing, and spelling commensurate with their intellectual abilities." The International Dyslexia Association offers the following definition of dyslexia:

"Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge."

Dyslexia is the most common learning disability in children and persists throughout life. The severity of dyslexia can vary from mild to severe. The sooner dyslexia is treated, the more favorable the outcome. However, it is never too late for people with dyslexia to learn to improve their language skills.

Dyslexia can go undetected in the early grades of schooling. Children can become frustrated by the difficulty in learning to read. It is important to note that other problems can disguise dyslexia such as a child may:

Show signs of depression and low self-esteem
Have behavior problems at home, as well as at school that often manifest
Become unmotivated and develop a dislike for school, and their success may be jeopardized if the problem remains untreated

What causes dyslexia?

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Children with dyslexia have difficulty in learning to read despite traditional instruction, at least average intelligence, and adequate motivation and opportunity to learn. It is thought to be caused by impairment in the brain's ability to process phonemes (the smallest units of speech that make words different from each other). It does not result from vision or hearing problems. It is not due to mental retardation, brain damage, or a lack of intelligence.

The causes of dyslexia vary with the type. In primary dyslexia, much research focuses on the hereditary factors. Researchers have recently identified specific genes identified as possibly contributing to the signs and symptoms of dyslexia. This research is very important because this may permit the identification of those children at risk for developing dyslexia and allow for earlier educational interventions and better outcomes.


What are the different types of dyslexia?

Primary dyslexia: This is the most common type of dyslexia, and is a dysfunction of, rather than damage to, the left side of the brain (cerebral cortex) and does not change with age. There is variability in the severity of the disability for Individuals with this type of dyslexia, and most who receive an appropriate educational intervention will be academically successful throughout their lives. Unfortunately there are others who continue to struggle significantly with reading, writing and spelling throughout their adult lives. Primary dyslexia is passed in family lines through genes (hereditary) or through new genetic mutations and it is found more often in boys than in girls.
Secondary or developmental dyslexia: This type of dyslexia is caused by problems with brain development during the early stages of fetal development. Developmental dyslexia diminishes as the child matures. It is also more common in boys.
Trauma dyslexia: This type of dyslexia usually occurs after some form of brain trauma or injury to the area of the brain that controls reading and writing. It is rarely seen in today's school-age population.
Other types of learning disability include:

The term visual dyslexia is sometimes used to refer to visual processing disorder, a condition in which the brain does not properly interpret visual signals.
The term auditory dyslexia has been used to refer to auditory processing disorder. Similar to visual processing disorder, there are problems with the brain's processing of sounds and speech.
Dysgraphia refers to the child's difficulty holding and controlling a pencil so that the correct markings can be made on the paper

What are the signs and symptoms of dyslexia?

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Classroom teachers may not be able to determine if a child has dyslexia. They may detect early signs that suggest further assessment by a psychologist or other healthcare professional in order to actually diagnose the disorder.

Signs and symptoms of dyslexia

Delayed early language development
Problems recognizing the differences between similar sounds or segmenting words.
Slow learning of new vocabulary words
Difficulty copying from the board or a book.
Difficulty with learning reading, writing, and spelling skills
A child may not be able to remember content, even if it involves a favorite video or storybook.
Problems with spatial relationships can extend beyond the classroom and be observed on the playground. The child may appear to be uncoordinated and have difficulty with organized sports or games.
Difficulty with left and right is common, and often dominance for either hand has not been established.
Auditory problems in dyslexia encompass a variety of functions.

Commonly, a child may have difficulty remembering or understanding what he hears.
Recalling sequences of things or more than one command at a time can be difficult.
Parts of words or parts of whole sentences may be missed, and words can come out sounding funny.
The wrong word or a similar word may be used instead.
Children struggling with this problem may know what they want to say but have trouble finding the actual words to express their thoughts.
Many subtle signs can be observed in children with dyslexia.

Children may become withdrawn and appear to be depressed.
They may begin to act out, drawing attention away from their learning difficulty.
Problems with self-esteem can arise, and peer and sibling interactions can become strained.
These children may lose their interest in school-related activities and appear to be unmotivated or lazy.
The emotional symptoms and signs are just as important as the academic and require equal attention.


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Dyslexia
Medical Author: David Perlstein, MD, MBA, FAAP  Medical Editor: Melissa Conrad Stöppler, MD
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Dyslexia facts
What is dyslexia?
What causes dyslexia?
What are the different types of dyslexia?
What are the signs and symptoms of dyslexia?
What should parents or caregivers do if they suspect a child has the signs and symptoms of dyslexia?
What tests diagnose dyslexia?
What type of treatment is available for dyslexia?
What is the prognosis for a person with dyslexia?
More information about dyslexia


What should parents or caregivers do if they suspect a child has the signs and symptoms of dyslexia?

It is important to consult your pediatrician if you are concerned about your child's development. Additionally, meeting with your child's teachers is an important step toward getting more answers.

Ideally, every school has a team that meets on a regular basis to discuss problems a specific child might be having. These teams are made up of the principal, classroom teacher, and one or a combination of the following depending on the staffing of the school such as

school psychologist,
nurse,
speech therapist,
reading specialist, and
other pertinent professionals.
A parent should always be included as a part of this team. The teams are commonly referred to as

Child Study Teams,
Student Study Teams, or
Student Support Teams.
Any parent or teacher who suspects a learning problem may request a meeting with this team to discuss the child's problem. The parent may request this even if the teacher feels the child is doing well. Sometimes a decision to test the child will be made. The parent or teacher may request testing, but it cannot be done without the parents' written permission.

If the child attends a private school which lacks the appropriate professionals to evaluate a suspected learning problem, he should be referred to the public-school system for evaluation. If testing is not satisfactorily conducted in the public-school system for private or public school students, the parent will need to locate the appropriate health professionals for assessment. A list of resources is provided at the conclusion of this article.

Because testing can sometimes be stressful for children, especially if they are unhappy about their school performance, alternative strategies are usually tried before testing is done. Once the assessment plan has been discussed with the parent(s) and they have granted permission, the school team completes the testing and holds a meeting with the parent(s) to discuss the test results.

The assessment plan for each child depends on the specific problems the child is having. Each plan should include testing in five areas:

cognition (intelligence),
 academic performance,
communication,
sensory/motor, and
health and developmental.
The testing will be done by the various members of the school team or the professionals consulted by the parent. Typically, the school or clinical psychologist determines whether or not the child has dyslexia. Since there are different forms of dyslexia, such as learning disability in reading, written language, or math, the psychologist diagnoses the specific type. Another form known as expressive language delay can be diagnosed by a speech therapist.


What tests diagnose dyslexia?

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Dyslexia is a difficult disorder to diagnose. There are many factors the psychologist or other health professional reviews to diagnose the disability. The testing determines the child's functional reading level and compares it to reading potential, which is evaluated by an intelligence test. All aspects of the reading process are examined to pinpoint where the breakdown is occurring. The testing further assesses how a child takes in and processes information and what the child does with the information. The tests determine whether a child learns better by

hearing information (auditory),
looking at information (visual), or
doing something (kinesthetic).
They also assess whether a child performs better when allowed to give information (output), by saying something (oral), or by doing something with their hands (tactile-kinesthetic). The tests also evaluate how all of these sensory systems (modalities) work in conjunction with each other.

The tests administered are standardized and are considered highly reliable.

The child should not feel as if there is something wrong because testing is occurring.
Many of the tests use a game-type or puzzle format which can help make the child feel more comfortable.
Children should get a good night's sleep prior to the testing and have a good breakfast.
If the testing is done in a school setting, the teacher can prepare the child by talking about the person who will come and do special work with the child.
With young children, the psychologist may visit the child's classroom before the testing so that the child is familiar with him.
Whether or not the testing is done at school, the parent may want to talk to their child about a new person coming to work with them. However, parents should not try to coach the child concerning the testing. It is recommended that parents not be present during the testing.
A standard battery of tests can include, but is not limited to, the following:

Wechsler Intelligence Scale for Children-Third Edition (WISC-III)
Kaufman Assessment Battery for Children (KABC)
Stanford-Binet Intelligence Scale
Woodcock-Johnson Psycho-Educational Battery
Peabody Individual Achievement Tests-Revised (PIAT)
Wechsler Individual Achievement Tests (WIAT)
Kaufman Tests of Educational Achievement (KTEA)
Bender Gestalt Test of Visual Motor Perception
Beery Developmental Test of Visual-Motor Integration
Motor-Free Visual Perception Test
Visual Aural Digit Span Test (VADS)
Test of Auditory Perception (TAPS)
Test of Visual Perception (TVPS)
Peabody Picture Vocabulary Test-Revised
Expressive One-Word Picture Vocabulary Test
Test for Auditory Comprehension of Language

What type of treatment is available for dyslexia?

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Before any treatment is started, an evaluation must be done to determine the child's specific area of disability. While there are many theories about successful treatment for dyslexia, there is no actual cure for it. The school will develop a plan with the parent to meet the child's needs. The plan may be implemented in a special education setting or in the regular classroom. An appropriate treatment plan will focus on strengthening the child's weaknesses while utilizing the strengths. A direct approach may include a systematic study of phonics. Techniques designed to help all the senses work together efficiently can also be used. Computers are powerful tools for these children and should be utilized as much as possible. The child should be taught compensation and coping skills. Attention should be given to optimum learning conditions and alternative avenues for student performance.

In addition to what the school has to offer, there are alternative treatment options available outside the school setting. Although alternative treatments are commonly recommended, there is limited research supporting the effectiveness of these treatments. In addition, many of these treatments are very costly, and it may be easy for frustrated parents to be misled by something that is expensive and sounds attractive.

Perhaps the most important aspect of any treatment plan is attitude. Children will be influenced by the attitudes of the adults around them. Dyslexia should not become an excuse for a child to avoid written work. Because the academic demands on a child with dyslexia may be great and the child may tire easily, work increments should be broken down into appropriate chunks. Frequent breaks should be built into class and homework time. Reinforcement should be given for efforts as well as achievements. Alternatives to traditional written assignments should be explored and utilized. Teachers are learning to deliver information to students in a variety of ways that are not only more interesting but helpful to students who may learn best by different techniques. Interactive technology is providing interesting ways for students to get feedback on what they have learned, in contrast to traditional paper-pencil tasks.


What is the prognosis for a person with dyslexia?

The prognosis for children with dyslexia is variable and dependent on the cause. In the case of primary dyslexia, the earlier the diagnosis is made and intervention started, the better the outcome. It is also important to focus on the child's self-esteem, since dealing with dyslexia can be extremely frustrating. Lastly it is important to recognize that many well-known and successful individuals have suffered from dyslexia, including Albert Einstein and Steven Spielberg, just to name a couple

Posted by Mudassar Satti in

Dyslexia

Dengue Fever

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes.
Symptoms include severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion, and rash. The presence of fever, rash, and headache (the "dengue triad") is characteristic of dengue fever.
Dengue is prevalent throughout the tropics and subtropics.
Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms (symptomatic treatment).
The acute phase of the illness with fever and muscle pain lasts about one to two weeks.
Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).
The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.
The first vaccine for dengue fever became available in December 2015 and is approved for use in dengue-endemic areas in Mexico, the Philippines, and Brazil


Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen lymph nodes (lymphadenopathy), and rash. The presence of fever, itchy rash, and headache (the "dengue triad") is characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.

Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused by one of five serotypes the dengue virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular viral serotype to which the patient was exposed.

Dengue goes by other names, including "breakbone fever" or "dandy fever." Victims of dengue often have contortions due to the intense joint, muscle, and bone pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait.

Dengue hemorrhagic fever is a more severe form of the viral illness. Symptoms include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red spots or purple splotches or blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.

Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Cases have also been imported via tourists returning from areas with widespread dengue, including Tahiti, Singapore, the South Pacific, including the Philippines, Southeast Asia, the West Indies, India, and the Middle East (similar in distribution to the areas of the world that harbor malaria and yellow fever). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia.

New Delhi, India, is reporting an outbreak of dengue fever, with 1,872 testing positive for the illness as of September 2015.
In American Samoa, there have been 370 cases of dengue reported from May 2015 to September 2, 2015; 133 people have been hospitalized.
In 2015, two non-native species of mosquito were found in California, including the Aedes aegypti mosquito, which can transmit dengue. No cases of dengue have been reported yet.
Thailand reported the worst dengue outbreak in 20 years, with 126 deaths and 135,344 people infected with the virus, in October 2013.
In 2011, Bolivia, Brazil, Columbia, Costa Rica, El Salvador, Honduras, Mexico, Peru, Puerto Rico, and Venezuela reported a large number of dengue cases. Paraguay reported a dengue fever outbreak in 2011, the worst since 2007. Hospitals were overcrowded, and patients had elective surgeries canceled due to the outbreak

The U.S. Centers for Disease Control and Prevention (CDC) reports that from 1946 to 1980, no cases of dengue acquired in the continental United States were reported. Since 1980, a few locally acquired U.S. cases have been confirmed along the Texas-Mexico border, temporally associated with large outbreaks in neighboring Mexican cities.

A 2009 outbreak of dengue fever in the Florida town of Key West involved three patients who did not travel outside of the U.S. contracted the virus. Subsequent testing of the population of Key West has shown that up to 5% of the people living in the area have antibodies to dengue. In total, 28 people were diagnosed with dengue fever in this outbreak. In 2015, 210 people were diagnosed with dengue in Hawaii. This is the largest outbreak in Hawaii since 2001, when 122 people were diagnosed with dengue.

Dengue fever is common in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean. Thailand, Vietnam, Singapore, and Malaysia have all reported an increase in cases.

According to the CDC, there are an estimated 400 million cases of dengue fever with several hundred thousand cases of dengue hemorrhagic fever requiring hospitalization each year. Nearly 40% of the world's population lives in an area endemic with dengue. The World Health Organization (WHO) estimates 22,000 deaths occur yearly, mostly among children.


The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can cause the disease.

The virus is not contagious and cannot be spread directly from person to person. It is mosquito-borne, so there must be a person-to-mosquito-to-another-person pathway. The full life cycle of the virus involves the mosquito as the vector (transmitter) and the human as the source of infection.

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear in stages. Dengue starts with chills, headache, pain upon moving the eyes, appetite loss, feeling unwell (malaise), and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relatively low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The lymph nodes in the neck and groin are often swollen.

High fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic itchy rash (small red spots, called petechiae) appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen

The diagnosis of dengue fever is usually made when a patient exhibits the typical clinical symptoms of headache, high fever, eye pain, severe muscle aches, and petechial rash and has a history of being in an area where dengue fever is endemic. Dengue fever can be difficult to diagnose because its symptoms overlap with those of many other viral illnesses, such as West Nile virus and chikungunya fever.

In 2011, the U.S. Food and Drug Administration (FDA) approved a blood test called the DENV Detect IgM Capture ELISA to diagnose people with dengue fever. The FDA notes that the test may also give a positive result when a person has a closely related virus, such West Nile disease

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is concerned with relief of the symptoms and signs. Rest and fluid intake for hydration is important. Pain relievers such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) should only be taken under a doctor's supervision because of the possibility of worsening bleeding complications. Acetaminophen (Tylenol) and codeine may be given for severe headache and for joint and muscle pain (myalgia).

What is the prognosis for typical dengue fever?
Typical dengue is fatal in less than 1% of cases. The acute phase of the illness with fever and muscle pain (myalgia) lasts about one to two weeks. Convalescence is accompanied by a feeling of weakness (asthenia), and full recovery often takes several weeks

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. This complication of dengue fever causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.

DHF starts abruptly with continuous high fever and headache. There are respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis).

In DHF, there is bleeding with easy bruising, red or purple blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.

Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (having a bluish coloration to the skin and mucus membranes) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.

The mortality (death) rate with DHF is significant. With proper treatment, the World Health Organization estimates a 2.5% mortality rate. However, without proper treatment, the mortality rate rises to 20%. Most deaths occur in children. Infants under 1 year of age are especially at risk of dying from DHF.

The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer able to transmit the virus to a biting mosquito.

The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective.

To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. There are no specific risk factors for contracting dengue fever, except living in or traveling to an area where the mosquitoes and virus are endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors for two hours after sunrise and before sunset will help, as the Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.

The first vaccine for dengue fever, Dengvaxia, became available in December 2015 and is approved for use in Mexico, the Philippines, and Brazil. It is only approved for use in people 9-45 years of age who live in dengue-endemic areas. In clinical trials, Dengvaxia reduced the chances of developing dengue by about 60%.

Five other vaccines for dengue are undergoing clinical trials, but none have yet been approved for use.

Posted by Mudassar Satti in

Dengue Fever

Fillings

Introduction

To treat a cavity your dentist will remove the decayed portion of the tooth and then "fill" the area on the tooth where the decayed material once lived.

Fillings are also used to repair cracked or broken teeth and teeth that have been worn down from misuse (such as from nail-biting or tooth grinding ).


What Steps Are Involved in Filling a Tooth?

First, the dentist will numb the area around the tooth with a local anesthetic. Next, a drill, air abrasion instrument or laser will be used to remove the decayed area. The choice of instrument depends on the individual dentist's comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay.

Next, your dentist will probe or test the area during the decay removal process to determine if all the decay has been removed. Once the decay has been removed, your dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it.

Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that "cures" or hardens each layer is applied. When the multilayering process is completed, your dentist will shape the composite material to the desired result, trim off any excess material and polish the final restoration

What Types of Filling Materials are Available?


Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic and glass materials called composite resin fillings. The location and extent of the decay, cost of filling material, patients' insurance coverage and your dentist's recommendation assist in determining the type of filling that will best address your needs.

Cast gold

Advantages:

Durability - lasts at least 10 to 15 years, usually longer; doesn't corrode
Strength - can withstand chewing forces

Aesthetics - some patients find gold more pleasing to the eye than silver, amalgam fillings
Disadvantages:

Expense - more than other materials; up to 10 times higher than cost of amalgam filings
Additional office visits - requires at least two office visits to place
Galvanic shock - a gold filling placed immediately next to a silver, amalgam filling can cause a sharp pain (galvanic shock) to occur. The interaction between the metals and saliva causes an electric current to occur - it's a rare occurrence, however
Aesthetics - most patients don't find any "colored" fillings to be an "eye-pleasing" advantage
Silver-fillings (Amalgams)

Advantages:

Durability - lasts at least 10 to 15 years and usually outlasts composite fillings
Strength - can withstand chewing forces
Expense - is less expensive than composite fillings
Disadvantages:

Poor aesthetics - fillings don't match the color of your natural teeth
Destruction of more tooth structure - healthy parts of the tooth must often be removed to make a space large enough to hold the amalgam filling
Discoloration - amalgam fillings can create a grayish hue to the surrounding tooth structure
Cracks and fractures - although all teeth expand and contract in the presence of hot and cold liquids, which ultimately can cause the tooth to crack or fracture, amalgam material - in comparison with other filling materials-may experience a wider degree of expansion and contraction and lead to a higher incidence of cracks and fractures
Allergic reactions - a small percentage of people, approximately 1%, are allergic to the mercury present in amalgam restorations
Tooth-colored composite fillings

Advantages:

Aesthetics - the shade/color of the composites can be closely matched to the color of existing teeth; is particularly well suited for use in front teeth or visible parts of teeth
Bonding to tooth structure - composite fillings actually chemically bond to tooth structure, providing further support to the tooth
Versatility in uses - in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken or worn teeth
Tooth-sparing preparation - sometimes less tooth structure needs to be removed compared with amalgams when removing decay and preparing for the filling
Disadvantages:

Lack of durability - composite fillings wear out sooner than amalgams (lasting at least 5 years compared with at least 10 to 15 for amalgams); in addition, they may not last as long as amalgams under the pressure of chewing and particularly if used as the filling material for large cavities
Increased chair time - because of the process to apply the composite material, these fillings can take up to 20 minutes longer than amalgams to place
Additional visits - if composites are used for inlays or onlays, more than one office visit may be required
Chipping - depending on location, composite materials can chip off the tooth
Expense - composite fillings can cost up to twice the cost of amalgams
In addition to tooth-colored, composite resin fillings, two other tooth-colored fillings exist--ceramics and glass ionomer.

Other

Ceramics, which are made most often of porcelain, are more resistant to staining than composite resin material but are also more abrasive. This material generally lasts more than 15 years and can cost as much as gold.
Glass ionomer is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children (drilling is still required). Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts 5 years or less with costs comparable to composite resin.


Does Dental Insurance Cover the Cost of Composites?

Most dental insurance plans cover the cost of the composites up to the price of the silver filling, then the patient must pay the difference.


What Are Indirect Fillings?

Indirect fillings are similar to composite or tooth-colored fillings except that they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown .

During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental laboratory that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while your restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.


There are two types of indirect fillings - inlays and onlays.

Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.
Inlays and onlays are more durable and last much longer than traditional fillings - up to 30 years. They can be made of tooth-colored composite resin, porcelain or gold. Inlays and onlays weaken the tooth structure, but do so to a much lower extent than traditional fillings.

Another type of inlay and onlay - direct inlays and onlays - follow the same processes and procedures as the indirect, the difference is that direct inlays and onlays are made in the dental office and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns

What's a Temporary Filling and Why Would I Need One?

Temporary fillings are used under the following circumstances:

For fillings that require more than one appointment - for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
Following a root canal
To allow a tooth's nerve to "settle down" if the pulp became irritated
If emergency dental treatment is needed (such as to address a toothache)
Temporary fillings are just that; they are not meant to last. They usually fall out, fracture, or wear out within 1 month. Be sure to contact your dentist to have your temporary filling replaced with a permanent one. If you don't, your tooth could become infected or you could have other complications.

Are Amalgam-Type Fillings Safe?

Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgams. Because amalgams contain the toxic substance mercury, some people think that amalgams are responsible for causing a number of diseases, including autism, Alzheimer's disease, and multiple sclerosis.

The American Dental Association (ADA), the FDA, and numerous public health agencies say amalgams are safe, and that any link between mercury-based fillings and disease is unfounded. The causes of autism, Alzheimer's disease, and multiple sclerosis remain unknown. Additionally, there is no solid, scientific evidence to back up the claim that if a person has amalgam fillings removed, he or she will be cured of these or any other diseases.

As recently as March of 2002, the FDA reconfirmed the safety of amalgams. Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth. The National Institutes of Health has several large-scale studies currently under way to ultimately answer many of the questions raised about silver-colored amalgams. Results of these studies are expected to be released in 2006.

In addition, there has been concern over the release of a small amount of mercury vapor from these fillings, but according to the ADA, there is no scientific evidence that this small amount results in adverse health effects

How Should I Care for My Teeth With Fillings?

To maintain your fillings, you should follow good oral hygiene practices - visiting your dentist regularly for cleanings, brushing with a fluoride-containing toothpaste, and flossing at least once daily. If your dentist suspects that a filling might be cracked or is "leaking" (when the sides of the filling don't fit tightly against the tooth, this allows debris and saliva to seep down between the filling and the tooth, which can lead to decay), he or she will take X-rays to assess the situation. If your tooth is extremely sensitive, if you feel a sharp edge, if you notice a crack in the filling, or if a piece of the filling is missing, call your dentist for an appointment.

Posted by Mudassar Satti in

Fillings

Cholera

*Brain tumor facts Medically Edited by: Charles P. Davis, MD, PhD

Primary brain tumors can be either malignant (contain cancer cells) or benign (do not contain cancer cells). A primary brain tumor is a tumor which begins in the brain. If a cancerous tumor which starts elsewhere in the body sends cells which end up growing in the brain, such tumors are then called secondary or metastatic brain tumors. This discussion is focused on primary brain tumors.
Brain tumors can occur at any age.
The exact cause of brain tumors is not clear.
The symptoms of brain tumors depend on their size, type, and location.
The most common symptoms of brain tumors include headaches; numbness or tingling in the arms or legs; seizures, memory problems; mood and personality changes; balance and walking problems; nausea and vomiting; changes in speech, vision, or hearing.
Physicians group brain tumors by grade (the way the cells look under a microscope). The higher the grade number, the more abnormal the cells appear and the more aggressively the tumor usually behaves.


Primary brain tumors emerge from the various cells that make up the brain and central nervous system and are named for the kind of cell in which they first form. The most common types of adult brain tumors are gliomas and astrocytic tumors. These tumors form from astrocytes and other types of glial cells, which are cells that help keep nerves healthy.

The second most common type of adult brain tumors are meningeal tumors. These form in the meninges, the thin layer of tissue that covers the brain and spinal cord.
What's the Difference Between Benign and Malignant Brain Tumors?
Benign brain tumors are noncancerous. Malignant primary brain tumors are cancers that originate in the brain, typically grow faster than benign tumors, and aggressively invade surrounding tissue. Although brain cancer rarely spreads to other organs, it will spread to other parts of the brain and central nervous system.
Types of primary brain tumors
There are many types of primary brain tumors. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin. For example, most primary brain tumors begin in glial cells. This type of tumor is called a glioma.

Among adults, the most common types are:

Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. It can be any grade. In adults, an astrocytoma most often arises in the cerebrum.
Grade I or II astrocytoma: It may be called a low-grade glioma.
Grade III astrocytoma: It's sometimes called a high-grade or an anaplastic astrocytoma.
Grade IV astrocytoma: It may be called a glioblastoma or malignant astrocytic glioma.
Meningioma: The tumor arises in the meninges. It can be grade I, II, or III. It's usually benign (grade I) and grows slowly.
Oligodendroglioma: The tumor arises from cells that make the fatty substance that covers and protects nerves. It usually occurs in the cerebrum. It's most common in middle-aged adults. It can be grade II or III.
Among children, the most common types are:

Medulloblastoma: The tumor usually arises in the cerebellum. It's sometimes called a primitive neuroectodermal tumor. It is grade IV.
Grade I or II astrocytoma: In children, this lowgrade tumor occurs anywhere in the brain. The most common astrocytoma among children is juvenile pilocytic astrocytoma. It's grade I.
Ependymoma: The tumor arises from cells that line the ventricles or the central canal of the spinal cord. It's most commonly found in children and young adults. It can be grade I, II, or III.
Brain stem glioma: The tumor occurs in the lowest part of the brain. It can be a low-grade or high-grade tumor. The most common type is diffuse intrinsic pontine glioma

Brain Tumor: Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 08/2015
ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with a brain tumor may experience the following symptoms or signs. Sometimes, people with a brain tumor do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a brain tumor.

Symptoms of a brain tumor can be general or specific. A general symptom is caused by the pressure of the tumor on the brain or spinal cord. Specific symptoms are caused when a specific part of the brain is not working well because of the tumor. For many people with a brain tumor, they were diagnosed when they went to the doctor after experiencing a problem, such as a headache or other changes.

General symptoms include:

Headaches, which may be severe and worsen with activity or in the early morning

Seizures. Motor seizures, also called convulsions, are sudden involuntary movements of a person’s muscles. People may experience different types of seizures, including myclonic and tonic-clonic (grand mal). Certain drugs can help prevent or control them. The differences between these types of seizures are listed below:

Myclonic

Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly lead to dehydration.
Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that resembles rice water and may lead to signs of dehydration (for example, vomiting, wrinkled skin, low blood pressure, dry mouth, rapid heart rate).
Cholera is most frequently transmitted by water sources contaminated with the causative bacterium Vibrio cholerae, although contaminated foods, especially raw shellfish, may also transmit the cholera-causing bacteria.
Cholera is presumptively diagnosed by patient history and examination of stool for rice-water appearance and presence of V. cholerae-like organisms microscopically; definitive diagnosis is done by isolation and identification of V. cholerae from stool samples.
The main treatment for cholera is fluid and electrolyte replacement, both oral and IV. Antibiotics usually are used in severe infections in which dehydration has occurred.
The prognosis of cholera ranges from excellent to poor. Rapid treatment with fluid and electrolytes result in better outcomes while people with other health problems beside cholera or those who are not rapidly replenished with fluid treatments tend to have a poorer prognosis.
It's possible to prevent cholera with appropriate measures such as safe drinking water and non-contaminated foods; some protection can be obtained from oral vaccines while avoiding areas where cholera commonly occurs or has had a recent outbreak

What is cholera?

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Cholera is an acute infectious disease caused by a bacterium, Vibrio cholerae (V. cholerae), which usually results in a painless, watery diarrhea in humans. Some affected individuals have copious amounts of diarrhea and develop dehydration so severe it can lead to death. Most people who get the disease ingest the organisms through food or water sources contaminated with V. cholerae. Although symptoms may be mild, some previously healthy people will develop a copious diarrhea within about one to five days after ingesting the bacteria. Severe disease requires prompt medical care. Hydration (usually by IV for the very ill) of the patient, and antibiotics in some individuals, is the key to surviving the severe form of the disease.

The World Health Organization (WHO) has maps of current and past areas with cholera outbreaks (see WHO reference). It is estimated that about 1.4 million to 4.3 million people are infected worldwide each year, with approximately 28,000-142,000 deaths per year. Only about one in 10 people infected with cholera develop the typical signs and symptoms. Outbreaks of cholera in 2015 include South Sudan, United Republic of Tanzania, Kenya, and most recently, 121 people diagnosed with

cholera in Iraq, their first outbreak since 2012.

The term cholera has a long history (see history section below) and has been assigned to several other diseases. For example, fowl or chicken cholera is a disease that can rapidly kill chickens and other avian species rapidly with a major symptom of diarrhea. However, the disease-causing agent in fowl is Pasteurella multocida, a gram-negative bacterium. Similarly, pig cholera (also termed hog or swine cholera) can cause rapid death (in about 15 days) in pigs with symptoms of fever, skin lesions, and seizures. This disease is caused by a pestivirus termed CSFV (classical swine fever virus). Neither one of these animal diseases are related to human cholera, but the terminology can be confusing.


What are cholera symptoms and signs?

The symptoms and signs of cholera are a watery diarrhea that often contains flecks of whitish material (mucus and some gastrointestinal lining [epithelial] cells) that are about the size of pieces of rice. The diarrhea is termed "rice-water stool" (See figure 1) and smells "fishy." The volume of diarrhea can be enormous; high levels of diarrheal fluid such as 250 cc per kg or about 10 to 18 liters over 24 hours for a 154-pound adult can occur. People may go on to develop one or more of the following symptoms and signs:

Watery diarrhea (sometimes in large volumes)
Rice-water stools (see figure 1)
Fishy odor to stools
Vomiting
Rapid heart rate
Loss of skin elasticity (washer woman hands sign; see figure 2)
Dry mucous membranes (dry mouth)
Low blood pressure
Thirst
Muscle cramps (leg cramps, for example)
Restlessness or irritability (especially in children)
Unusual sleepiness or tiredness
Other symptoms that may occur, especially with more severe disease, include the following:

Abdominal pain (cramps)
Rectal pain
Fever
Severe vomiting
Dehydration
Low or no urine output
Weight loss
Seizures
Shock
Death
Those infected require immediate hydration to prevent these symptoms from continuing because these signs and symptoms indicate that the person is becoming or is dehydrated and may go on to develop severe cholera. People with severe cholera (about 5%-10% of previously healthy people; higher if a population is compromised by poor nutrition or has a high percentage of very young or elderly people) can develop severe dehydration, leading to acute renal failure, severe electrolyte imbalances (especially potassium and sodium), and coma. If untreated, this severe dehydration can rapidly lead to shock and death. Severe dehydration can often occur four to eight hours after the first liquid stool, ending with death in about 18 hours to a few days in undertreated or untreated people. In epidemic outbreaks in underdeveloped countries where little or no treatment is available, the mortality (death) rate can be as high as 50%-60%

What causes cholera, and how is cholera transmitted?

Cholera is caused by the bacterium V. cholerae. This bacterium is Gram stain-negative, comma-shaped, and has a flagellum (a long, tapering, projecting part) for motility and pili (hairlike structures) used to attach to tissue. Although there are many V. cholerae serotypes that can produce cholera symptoms, the O groups O1 and O139, which also produce a toxin, cause the most severe symptoms of cholera. O groups consist of different lipopolysaccharides-protein structures on the surface of bacteria that are distinguished by immunological techniques.

The toxin produced by these V. cholerae serotypes is an enterotoxin composed of two subunits, A and B; the genetic information for the synthesis of these subunits is encoded on plasmids (genetic elements separate from the bacterial chromosome). In addition, another plasmid type encodes for a pilus (a hollow hairlike structure that supports bacterial attachment to human cells and facilitate the movement of toxin from V. cholerae into human cells). The enterotoxin causes human cells to extract water and electrolytes from the body (mainly the upper gastrointestinal tract) and pump it into the intestinal lumen where the fluid and electrolytes are excreted as diarrheal fluid. The enterotoxin is similar to toxin formed by bacteria that cause diphtheria in that both bacterial types secret the toxins into their surrounding environment where the

toxin then enters the human cells. The bacteria are usually transmitted by drinking contaminated water, but the bacteria can also be ingested in contaminated food, especially seafood such as raw oysters.

What is the history of cholera?

Cholera has likely been affecting humans for many centuries. Reports of cholera-like disease have been found in India as early as 1000 AD. Cholera is a term derived from Greek khole (illness from bile) and later in the 14th century to colere (French) and choler (English). In the 17th century, cholera was a term used to describe a severe gastrointestinal disorder involving diarrhea and vomiting. There were many outbreaks of cholera, and by the 16th century, some were being noted in historical writings. England had several in the 19th century, the most notable being in 1854, when Dr. John Snow did a classic study in London that showed a main source of the disease (resulting in about 500 deaths in 10 days) came from at least one of the major water sources for London residents termed the "Broad Street pump." The pump handle was removed, and the cholera deaths slowed and stopped. The pump is still present as a landmark in London. Although Dr. Snow did not discover the cause of cholera, he did show how the disease could be spread and how to stop a local outbreak. This was the beginning of modern epidemiologic studies. The last reference shows the map Dr. Snow used to identify the pump site.

V. cholerae was first isolated as the cause of cholera by Filippo Pacini in 1854, but his discovery was not widely known until Robert Koch (who also discovered the cause of tuberculosis), working independently 30 years later, publicized the

Library of Medicine houses original documents about multiple cholera outbreaks in the U.S. from the 1820s to the 1900s, with the last large outbreak in 1910-1911. Since the 1800s, there have been seven cholera pandemics (worldwide outbreaks).

Cholera riots occurred in Russia and England (1831) and in Germany (1893) when the people rebelled against strict government isolation (quarantines) and burial rules. In 2008, cholera riots broke out in Zimbabwe as police tried to disperse people who tried to withdraw funds from banks and were protesting because of the collapse of the health system that began with a cholera outbreak. Similar but less violent public protests have occurred when yellow fever, typhoid fever, and tuberculosis quarantines have been enforced by health authorities.

Multiple outbreaks worldwide continue into the 21st century with outbreaks in India, Iran, Vietnam, and several African countries occurring over the last 10 years (some recent outbreaks occurred in Haiti and Nigeria in 2010-2011). Why is cholera history repeating itself? The answer can be traced back to Dr. Snow's studies that show a source (water or occasionally food) contaminated with V. cholerae can easily and rapidly transmit the cholera-causing bacteria to many people. Until safe water and food is available to all humans, it is likely that cholera outbreaks will continue to happen.

What are risk factors for cholera, and where do cholera outbreaks occur?

Everyone who drinks or eats food that has not been treated to eliminate V. cholerae (liquids need to be chemically treated, boiled, or pasteurized, and foods need to be cleaned and cooked), especially in areas of the world where cholera is present, is at risk for cholera.

Outbreaks occur when there are disasters or other reasons for a loss of sanitary human waste disposal and the lack of safe fluids and foods for people to ingest. Haiti, a country that had not seen a cholera outbreak in over 50 years, had such circumstances develop in 2010 after a massive earthquake destroyed sanitary facilities and water and food treatment facilities for many Haitians. V. cholerae bacteria eventually contaminated primary water sources, resulting in over 530,000 people diagnosed with cholera that resulted in over 7,000 deaths. This cholera outbreak spread to Haiti's neighbor, the Dominican Republic. The Vibrio cholerae strain was closely related to a strain found in Nepal and leads some individuals to blame Nepalese troops that helped with the earthquake disaster as the source of the Haiti cholera outbreak.

In third-world countries, hunger can lead people to inadvertently eat contaminated food and/or drink contaminated water, thus raising the risk for cholera to infect malnourished populations.

There is some evidence that V. cholerae can survive in saltwater and have been isolated from shellfish; eating raw oysters is considered a risk factor for cholera, especially in underdeveloped countries and occasionally even in developed countries. A few people are diagnosed with cholera every year in the U.S. Most of the individuals diagnosed are travelers who were exposed to cholera outside the country, but occasionally, isolated cases are traced to contaminated seafood, usually from states that border the Gulf of Mexico.

Some individuals are at higher risk to become infected than others. People who are malnourished or immune-compromised are more likely to get the disease. Children ages 2-4 seem more susceptible than older children, according to some investigators. In addition, researchers have noted that patients with blood type O are twice as likely to develop cholera as others. The reason for this blood type susceptibility is not completely understood. People with achlorhydria (reduced acid secretion in the stomach) and people taking medicines to reduce stomach acid (H2 blockers and others) are also more likely to develop cholera because stomach acid kills many types of bacteria, including V. cholerae.

Is cholera contagious?

It takes about 100 million V. cholerae bacteria to infect a healthy adult. Because of this high number, significant contamination of food or water is required to transmit the disease, and direct person-to-person transmission is thought to be uncommon except in outbreaks. In outbreaks, cholera-causing bacteria become highly contagious indirectly and directly by the fecal-oral route because of widespread fecal contamination of food, water, and items like bedding and clothing.


What is the incubation period for cholera?

The incubation period (time period from exposure to the bacteria to the development of symptoms) may vary from a few hours (about six to 12 hours) to five days, with the average incubation period being about two to three days. About six to 12 hours is considered a very rapid incubation period and may suggest that rapid/immediate intervention is required for recovery.


What is the contagious period for cholera?

The contagious period for cholera begins as soon as organisms are excreted in the feces. This can occur as early as about six to 12 hours after exposure to the bacteria and can last for about seven to 14 days. Some individuals who are asymptomatic (infected but not having symptoms) will also excrete contagious organisms for about seven to 14 days.


How do health-care professionals diagnose cholera?

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Preliminary diagnosis is usually done by a caregiver who takes a history from the patient and observes the characteristic rice-water diarrhea, especially if a local outbreak of cholera has identified. The diarrhea fluid is often teeming with motile, comma-shaped bacteria (presumptively V. cholerae) that can be seen with a microscope. The definitive diagnosis is made by isolation of the bacteria from diarrhea fluid. All state health department laboratories in the U.S. are able to perform tests for Vibrio cholerae. Readers may see terms like serotypes Inaba, Ogawa, and Hikojima to describe V. cholerae; they simply indicate which O antigens (O antigens designated A, B, or C) are found on these strains of V. cholerae. PCR tests have also been developed to detect the genetic material of cholera, but currently they are not as widely used as the immunologic tests based on type-specific antiserum.

Definitive diagnosis helps to distinguish cholera from other diseases caused by other bacterial, protozoal, or viral pathogens that cause dysentery (gastrointestinal inflammation with diarrhea).


What is the treatment for cholera?

The CDC (and almost every medical agency) recommends rehydration with ORS (oral rehydration salts) fluids as the primary treatment for cholera. ORS fluids are available in prepackaged containers, commercially available worldwide, and contain glucose and electrolytes. The CDC follows the guidelines developed by the WHO (World Health Organization) as follows:

Reassess the patient every one to two hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200 mL/kg or more may be needed during the first 24 hours of treatment.
After six hours (infants) or three hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink.
In general, antibiotics are reserved for more severe cholera infections; they function to reduce fluid rehydration volumes and may speed recovery. Although good microbiological principles dictate it is best to treat a patient with antibiotics that are known to be effective against the infecting bacteria, this may take too long a time to accomplish during an initial outbreak (but it still should be attempted); meanwhile, severe infections have been effectively treated with tetracycline (Sumycin), doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others), furazolidone (Furoxone), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), or ciprofloxacin (Cipro, Cipro XR, ProQuin XR) in conjunction with the following antibiotics in conjunction with IV hydration and electrolytes:

Tetracycline (Sumycin)
Doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others)
Furazolidone (Furoxone)
Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)
Azithromycin (Zithromax)
Sulfamethoxazole/trimethoprim (Bactrim, Septra)
Ampicillin
Ciprofloxacin (Cipro, Cipro XR, ProQuin XR)
Norfloxacin (Noroxin)
Many antibiotics are listed; however, because of widespread antibiotic resistance, including multi-resistant Vibrio strains, antibiotic susceptibility testing is advised so the appropriate antibiotic is chosen. In addition, quinolones (for example, ciprofloxacin, norfloxacin) should not be used in children if other antibiotics can be effective because of possible musculoskeletal adverse effects.


What physicians usually treat cholera?

Because most individuals have either mild or no symptoms, these people are either not treated or treated by their primary-care physician. However, in some children and in individuals who have more severe disease, besides the primary-care physician or pediatrician, an infectious-disease specialist, a critical-care specialist, a gastroenterologist, and/or an internist may be needed to help the team manage and treat the patient.

In addition, specialists in travel medicine and/or epidemiology can help individuals avoid cholera and/or can give advice about prevention, treatment, and prognosis to those individuals traveling to or living in endemic areas

What is the prognosis of cholera?

The prognosis (outcome) of cholera can range from excellent to poor, depending on the severity of the dehydration and how quickly the patient is given and responds to treatments. Death (mortality) rates in untreated cholera can be as high as 50%-60% during large outbreaks but can be reduced to about 1% if treatment protocols (see above treatment section) are rapidly put into action. In general, the less severe the symptoms and the less time people have dehydration symptoms, the better the prognosis; in many people, if dehydration is quickly reversed, the prognosis is often excellent.


Is it possible to prevent cholera? Are cholera vaccines available?

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Yes, cholera can be prevented by several methods. Developed countries have an almost zero incidence of cholera because they have widespread water-treatment plants, food-preparation facilities that usually practice sanitary protocols, and most people have access to toilets and hand-washing facilities. Although these countries may have occasional lapses or gaps in these methods, they have prevented many disease outbreaks, including cholera.

Individuals can prevent or reduce the chance they may get cholera by thorough hand washing, avoiding areas and people with cholera, drinking treated water or similar safe fluids, and eating cleaned and well-cooked food. In addition, there are vaccines available that can help prevent cholera, although they are not available in the U.S., and their effectiveness ranges from 50%-90%, depending on the studies reported. The vaccines are oral preparations, because injected vaccines have not proved to be very effective. Two vaccines (Shanchol and Dukoral) are composed of killed V. cholerae bacteria and don't contain the enterotoxin B subunit. Unfortunately, both offer protection for only about two years, although one report suggests that Shanchol is about 65% effective over five years. Both vaccines are usually given in two doses, about one to six weeks apart. Unfortunately, the vaccines have limited availability; their recommended use is for people going to areas of known outbreaks with the likely possibility the person may be exposed to cholera. Some researchers suggest this limited oral vaccine availability should be changed and cite data that oral vaccine may help limit outbreaks, even after they have begun.

Research is ongoing; a research study in Haiti will try to determine if a two-dose vaccine in people will suffice to protect a difficult to treat (rural poor) population from cholera and thus save many lives. There are over 30 universities researching this disease (cholera's epidemiology, pathology, immunology, vaccine production, and other problems) currently worldwide.

In 2015, about 2 million doses of oral cholera vaccine were shipped to various outbreak areas, and currently available information suggests that there was a significant reduction in transmission of cholera; the study will be concluded in 2018

Posted by Mudassar Satti in

Cholera

Brain Tumor

*Brain tumor facts Medically Edited by: Charles P. Davis, MD, PhD

Primary brain tumors can be either malignant (contain cancer cells) or benign (do not contain cancer cells). A primary brain tumor is a tumor which begins in the brain. If a cancerous tumor which starts elsewhere in the body sends cells which end up growing in the brain, such tumors are then called secondary or metastatic brain tumors. This discussion is focused on primary brain tumors.
Brain tumors can occur at any age.
The exact cause of brain tumors is not clear.
The symptoms of brain tumors depend on their size, type, and location.
The most common symptoms of brain tumors include headaches; numbness or tingling in the arms or legs; seizures, memory problems; mood and personality changes; balance and walking problems; nausea and vomiting; changes in speech, vision, or hearing.
Physicians group brain tumors by grade (the way the cells look under a microscope). The higher the grade number, the more abnormal the cells appear and the more aggressively the tumor usually behaves.


Primary brain tumors emerge from the various cells that make up the brain and central nervous system and are named for the kind of cell in which they first form. The most common types of adult brain tumors are gliomas and astrocytic tumors. These tumors form from astrocytes and other types of glial cells, which are cells that help keep nerves healthy.

The second most common type of adult brain tumors are meningeal tumors. These form in the meninges, the thin layer of tissue that covers the brain and spinal cord.
What's the Difference Between Benign and Malignant Brain Tumors?
Benign brain tumors are noncancerous. Malignant primary brain tumors are cancers that originate in the brain, typically grow faster than benign tumors, and aggressively invade surrounding tissue. Although brain cancer rarely spreads to other organs, it will spread to other parts of the brain and central nervous system.
Types of primary brain tumors
There are many types of primary brain tumors. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin. For example, most primary brain tumors begin in glial cells. This type of tumor is called a glioma.

Among adults, the most common types are:

Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. It can be any grade. In adults, an astrocytoma most often arises in the cerebrum.
Grade I or II astrocytoma: It may be called a low-grade glioma.
Grade III astrocytoma: It's sometimes called a high-grade or an anaplastic astrocytoma.
Grade IV astrocytoma: It may be called a glioblastoma or malignant astrocytic glioma.
Meningioma: The tumor arises in the meninges. It can be grade I, II, or III. It's usually benign (grade I) and grows slowly.
Oligodendroglioma: The tumor arises from cells that make the fatty substance that covers and protects nerves. It usually occurs in the cerebrum. It's most common in middle-aged adults. It can be grade II or III.
Among children, the most common types are:

Medulloblastoma: The tumor usually arises in the cerebellum. It's sometimes called a primitive neuroectodermal tumor. It is grade IV.
Grade I or II astrocytoma: In children, this lowgrade tumor occurs anywhere in the brain. The most common astrocytoma among children is juvenile pilocytic astrocytoma. It's grade I.
Ependymoma: The tumor arises from cells that line the ventricles or the central canal of the spinal cord. It's most commonly found in children and young adults. It can be grade I, II, or III.
Brain stem glioma: The tumor occurs in the lowest part of the brain. It can be a low-grade or high-grade tumor. The most common type is diffuse intrinsic pontine glioma

Brain Tumor: Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 08/2015
ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with a brain tumor may experience the following symptoms or signs. Sometimes, people with a brain tumor do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a brain tumor.

Symptoms of a brain tumor can be general or specific. A general symptom is caused by the pressure of the tumor on the brain or spinal cord. Specific symptoms are caused when a specific part of the brain is not working well because of the tumor. For many people with a brain tumor, they were diagnosed when they went to the doctor after experiencing a problem, such as a headache or other changes.

General symptoms include:

Headaches, which may be severe and worsen with activity or in the early morning

Seizures. Motor seizures, also called convulsions, are sudden involuntary movements of a person’s muscles. People may experience different types of seizures, including myclonic and tonic-clonic (grand mal). Certain drugs can help prevent or control them. The differences between these types of seizures are listed below:

Myclonic

Single or multiple muscle twitches, jerks, spasms

Tonic-Clonic (Grand Mal)

Loss of consciousness and body tone, followed by twitching and relaxing muscles that are called contractions

Loss of control of body functions

May be a short 30-second period of no breathing and a person may turn a shade of blue

After this type of seizure a person may be sleepy and experience a headache, confusion, weakness, numbness, and sore muscles.

Sensory

Change in sensation, vision, smell, and/or hearing without losing consciousness

Complex partial

May cause a loss of awareness or a partial or total loss of consciousness

May be associated with repetitive, unintentional movements, such as twitching

Personality or memory changes

Nausea or vomiting

Fatigue

Symptoms that may be specific to the location of the tumor include:

Pressure or headache near the tumor

Loss of balance and difficulty with fine motor skills is linked with a tumor in the cerebellum.

Changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis is associated with a tumor in the frontal lobe of the cerebrum.

Partial or complete loss of vision is caused by a tumor in the occipital lobe or temporal lobe of the cerebrum.

Changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words can develop from a tumor in the frontal and temporal lobe of the cerebrum.

Altered perception of touch or pressure, arm or leg weakness on one side of the body, or confusion with left and right sides of the body are linked to a tumor in the frontal or parietal lobe of the cerebrum.

Inability to look upward can be caused by a pineal gland tumor.

Lactation, which is the secretion of breast milk and altered menstrual periods in women, and growth in hands and feet in adults are associated with a pituitary tumor.

Difficulty swallowing, facial weakness or numbness, or double vision is a symptom of a tumor in the brain stem.

Vision changes, including loss of part of the vision or double vision can be from a tumor in the temporal lobe, occipital lobe, or brain stem.

Brain tumors are classified as grade I, grade II, or grade III, or grade IV

The most common type of primary brain tumors among adults are astrocytoma, meningioma, and oligodendroglioma.

The most common type of primary brain tumors in children are medulloblastoma, grade I or II astrocytoma, (or glioma) ependymoma, and brain stem glioma.

Studies have found risk factors for brain tumors to include ionizing radiation from high dose X-rays (for example, radiation therapy where the machine is aimed at the head), and family history.

Brain tumors are diagnosed by the doctor based on the results of a medical history and physical examination and results of a variety of specialized tests of the brain and nervous system.

Treatment of a brain tumor depends on the type, location, and size of the tumor, as well as the age and health of the patient.

Options for brain tumor treatment include surgery, radiation therapy, and chemotherapy (or a combination of treatments)

What Is a Tumor?

A tumor is a mass of tissue that's formed by an accumulation of abnormal cells. Normally, the cells in your body age, die, and are replaced by new cells. With cancer and other tumors, something disrupts this cycle. Tumor cells grow, even though the body does not need them, and unlike normal old cells, they don't die. As this process goes on, the tumor continues to grow as more and more cells are added to the mass.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If a brain tumor is diagnosed, relieving symptoms remains an important part of your care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Learn more about managing symptoms of a brain tumor in the Treatment Options section.

The next section in this guide is Diagnosis and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.These are the most common symptoms of brain tumors:

Headaches (usually worse in the morning)

Nausea and vomiting

Changes in speech, vision, or hearing

Problems balancing or walking

Changes in mood, personality, or ability to concentrate

Problems with memory

Muscle jerking or twitching (seizures or convulsions)

Numbness or tingling in the arms or legs

Most often, these symptoms are not due to a brain tumor. Another health problem could cause them. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated

What are the risk factors for brain tumors?

When you're told that you have a brain tumor, it's natural to wonder what may have caused your disease. But no one knows the exact causes of brain tumors. Doctors seldom know why one person develops a brain tumor and another doesn't.

Researchers are studying whether people with certain risk factors are more likely than others to develop a brain tumor. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for brain tumors:

Ionizing radiation: Ionizing radiation from high dose x-rays (such as radiation therapy from a large machine aimed at the head) and other sources can cause cell damage that leads to a tumor. People exposed to ionizing radiation may have an increased risk of a brain tumor, such as meningioma or glioma.

Family history: It is rare for brain tumors to run in a family. Only a very small number of families have several members with brain tumors.

Researchers are studying whether using cell phones, having had a head injury, or having been exposed to certain chemicals at work or to magnetic fields are important risk factors. Studies have not shown consistent links between these possible risk factors and brain tumors, but additional research is needed.

Posted by Mudassar Satti in

Brain Tumor

Heart Attack

What Is a Heart Attack?

A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can’t get oxygen. If blood flow isn’t restored quickly, the section of heart muscle begins to die.

Heart attack treatment works best when it’s given right after symptoms occur. If you think you or someone else is having a heart attack, even if you’re not sure, call 9–1–1 right away.

Overview

Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Someone who has had a cardiac arrest will be unconscious and won’t be breathing normally. If you see someone having a cardiac arrest, you can increase the person's chances of survival by phoning 999 and giving them immediate CPR.
Why do heart attacks happen?
Most heart attacks are caused by coronary heart disease. Coronary heart disease (CHD) is when your coronary arteries (the arteries that supply your heart muscle with oxygen-rich blood) become narrowed by a gradual build-up of fatty material within their walls.

If a piece of this fatty material (atheroma) breaks off it may cause a blood clot (blockage) to form. If it blocks your coronary artery and cuts off the supply of oxygen-rich blood to your heart muscle, this is a heart attack.

You might also hear a heart attack called acute coronary syndrome, myocardial infarction (MI) or coronary thrombosis.

Other rarer causes of a heart attack include spontaneous coronary artery dissection (SCAD) where one or more of the coronary arteries tear.
It is important to stress that not everyone experiences severe chest pain; the pain can often be mild and mistaken for indigestion.
It is the combination of symptoms that is important in determining whether a person is having a heart attack, and not the severity of chest pain.
Coronary heart disease (CHD) is the leading cause of heart attacks. CHD is a condition in which coronary arteries (the major blood vessels that supply blood to the heart) get clogged up with deposits of cholesterol. These deposits are called plaques.
Before a heart attack, one of the plaques ruptures (bursts), causing a blood clot to develop at the site of the rupture. The clot may then block the supply of blood running through the coronary artery, triggering a heart attack.
Your risk of developing CHD is increased by:
smoking
a high-fat diet
diabetes
high cholesterol
high blood pressure
being overweight or obese
Recovery
The time it takes to recover from a heart attack will depend on the amount of damage to the heart muscle. Some people are well enough to return to work after two weeks. Other people may take several months to recover. The recovery process aims to:
reduce your risk of another heart attack through a combination of lifestyle changes, such as eating a healthy diet, and medications, such as statins (which help lower blood cholesterol levels)
gradually restore your physical fitness so you can resume normal activities (known as cardiac rehabilitation)
Most people can return to work after having a heart attack, but how quickly will depend on your health, the state of your heart and the type of work you do

Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.

Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias.

Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away.

Don't Wait--Get Help Quickly

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it's given right after symptoms occur.

Many people aren't sure what's wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are:

Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.
Other possible symptoms of a heart attack include:

Breaking out in a cold sweat
Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
Nausea (feeling sick to the stomach) and vomiting
Light-headedness or sudden dizziness
Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)
Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies, or other common symptoms such as chest discomfort. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one.
What is the difference between a heart attack and a cardiac arrest?
A cardiac arrest happens when your heart stops pumping blood around your body. Although a heart attack can result in a cardiac arrest, they are two different things.


There are five main steps you can take to reduce your risk of having a heart attack (or having another heart attack):
smokers should quit smoking
lose weight if you are overweight or obese
take regular exercise – adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week, unless advised otherwise by the doctor in charge of your care
eat a low-fat, high-fibre diet, including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)
moderate your alcohol consumption – read more about the alcohol units


Who is affected
Heart attacks are one of the most common reasons why a person requires emergency medical treatment.
Men are more likely to have a heart attack than women. The British Heart Foundation estimates that around 50,000 men and 32,000 women have a heart attack each year in England.
Most heart attacks occur in people aged over 45.
Complications
Complications of heart attacks can be serious and possibly life-threatening. These include:
arrhythmia – this is an abnormal heartbeat, where the heart begins beating faster and faster, then stops beating (cardiac arrest)
cardiogenic shock – where the heart's muscles are severely damaged and can no longer contract properly to supply enough blood to maintain many body functions
heart rupture – where the heart’s muscles, walls or valves split apart (rupture)
These complications can occur quickly after a heart attack and are a leading cause of death.
Many people will die suddenly from a complication of a heart attack before reaching hospital.
Outlook
The outlook for people who have had a heart attack can be highly variable, depending on:
their age – the older you are, the more likely you are to experience serious complications
the severity of the heart attack – specifically, how much of the heart's muscle has been damaged during the attack
how long it took before a person received treatment – the longer the delay, the worse the outlook tends to be
In general, around one third of people who have a heart attack die as a result. These deaths often occur before a person reaches hospital or, alternatively, within the first 28 days after the heart attack.
If a person survives for 28 days after having a heart attack, their outlook improves dramatically and most people will go on to live for many years.
Symptoms of a heart attack
Heart attack symptoms vary from one person to another. The most common signs are:

chest pain: tightness, heaviness or pain in your chest
pain in arms, neck, jaw, back or stomach: for some people, the pain or tightness is severe, while other people just feel uncomfortable
sweating
feeling light-headed
become short of breath
feeling nauseous or vomit
Treating heart attacks
A heart attack is a medical emergency. Dial 999 and ask for an ambulance if you think you or someone you know is having a heart attack.
If the casualty is not allergic to aspirin and it’s easily available, give them a tablet (ideally 300mg) to slowly chew and then swallow while waiting for the ambulance to arrive.
The aspirin will help to thin the blood and reduce the risk of a heart attack.
Treatment for a heart attack will depend on how serious it is. Two main treatments are:
using medication to dissolve blood clots
surgery to help restore blood to the heart
Read more about treating heart attacks.
Reducing your risk of a heart attack

Posted by Mudassar Satti in

Heart Attack