1.Allergies

If you have allergies, or more specifically, allergic rhinitis, you are more likely experiencing symptoms such as itching of the nose and eyes, sneezing, a blocked or runny nose, and red swollen eyes. Many allergy symptoms are similar to those of the common cold, and the two conditions can be easily confused. Unlike cold symptoms (which typically last four to five days and usually include a sore throat, cough, and fever), allergy symptoms will often last for weeks or months.

Allergy symptoms are caused by your body inappropriately producing antibodies in response to an irritant (called an allergen) such as dust, pollen, or animal dander. These antibodies trigger chemical reactions in the body which cause the blood vessels and glands around your nose and eyes to swell, producing the familiar symptoms of allergies. One of the chemicals produced is called histamine.

Allergies can occur all year round if the symptoms are caused by allergens like dust, animal dander, mould, or certain foods. Allergies can also be seasonal if you are allergic to grass or weed pollen (also known as hay fever). These allergy attacks flare up during pollen season and disappear when weeds have finished flowering .

Lifestyle Modifications to Prevent Allergies

If possible, eliminate as many allergens in your environment as possible and avoid situations that cause your allergies to act up. The best way to minimize your exposure to dust, moulds, and animal dander is to keep your home as clean as possible.

If you are allergic to dust:

If you are allergic to moulds:

If you are allergic to animal dander:

If you are allergic to pollen:

Asthma is a disease where the airways of the lungs become constricted by tightened muscles, mucus and inflamed tissue, causing laboured breathing. Asthma is a chronic condition typically induced by environmental factors in people who are predisposed to it. Uncontrolled asthma is a serious problem that can lead to death.

Risk Factors for Developing Asthma

You may be at risk of developing asthma if you have any of the following risk factors:

Symptoms

The classic symptoms of asthma are wheezing, coughing, and shortness of breath. Sometimes people also notice sweating or tightness in the chest. If you or your child have had an unexplained cough for more than four weeks, your doctor may test you for asthma if other symptoms are not found.

Emergency symptoms include extreme shortness of breath, bluish nails and lips, sweating, and severe coughing. Call your doctor or an ambulance immediately.

Factors That May Trigger Asthma:

Diagnosis

To check for asthma, you may be asked to undergo breathing tests or chest x-rays. Other diseases may have to be ruled out first. In some cases, allergy testing is done if triggers of asthma attacks cannot be identified.

Prevention

If you have young children, do not smoke because it increases the chance that your children will develop asthma.

Managing Your Asthma

Asthma can not be cured, but symptoms can be reduced or eliminated with proper treatment.

The Goals of Treatment Are:

Here are five important steps you can take to help manage your asthma

1. Educate Yourself

If you understand how and when to use your medications properly, what your triggers are and how to control them, chances are you will be able to reduce the severity and frequency of asthma attacks.

2. Adjust Your Lifestyle

Remove all known triggers. This is the first thing you need to do as part of your treatment for asthma.

Stop smoking. If you smoke, stop immediately and avoid second-hand smoke.

Modify your home environment. Your home can be a major source of asthma triggers because it is sealed for heating purposes, and often has wall-to-wall carpets, which can collect animal hairs and skin flakes. As well, many household products release gas and chemicals into the air.

Reduce exposure to animals:

Reduce exposure to cockroaches:

Reduce exposure to moulds:

Reduce exposure to pollens:

Reduce exposure to indoor pollutants:

Reduce stress. The role of stress reduction techniques in asthma is still being studied. You may find progressive relaxation techniques or meditation helpful.

Improve your diet. People with severe asthma have been shown to have low intake of Vitamins A and E. It is possible that increasing intake of these vitamins through food or supplements may improve asthma symptoms.

3. Understand Your Medication

The two main classes of medications for treating asthma are bronchodilators and anti-inflammatory medications.

Bronchodilators
Bronchodilators (sometimes called “relievers”) open up the air passages by relaxing the small muscles that constrict the airways. They are usually inhaled as needed up to three times a week to control asthma symptoms. If asthma symptoms continue, then anti-inflammatory medications are needed. Bronchodilators may occasionally be used before exposure to known asthma triggers, such as pets or smoke, to prevent symptoms.

Anti-inflammatory Medications
Anti-inflammatory medications (sometimes called “preventers”) reduce swelling and inflammation in the airways to prevent symptoms before they develop, and are the mainstay of asthma treatment. They are usually inhaled twice daily, but with serious asthma, doses that are more frequent or oral tablets are used instead. For general treatment of asthma, you and your doctor will decide on the amount of medication that you need to control symptoms. Many people under-use this effective medication and therefore may have poor control of their asthma.

If your asthma symptoms are getting worse on your current medication dosages, see your doctor or pharmacist. Worsening asthma is best treated quickly before it becomes more severe.

4. Use Your Medication Properly

One of the most common reasons for asthma attacks is improper use of inhaler devices. Let your doctor and pharmacist check your technique periodically to make sure it is still good. For small children and people who may have problems using inhalers, different kinds of delivery systems and aids (such as spacers) are available to make taking asthma medication easier.

Another important cause of asthma problems is not taking your medication in the right dose and frequency for your needs. Take a moment to discuss both of these important issues with your pharmacist.

Your doctor or pharmacist can explain how to adjust your medication to deal with specific situations such as acute attacks, oncoming colds or flu, and exercise-induced asthma. Some communities have asthma education clinics, which can be very helpful.

5. Monitor Your Asthma

You may find it helpful to use a “peak flow meter”, especially if you are having problems controlling your asthma. This is a simple tube-like device that measures the speed with which you can blow air out of your lungs. Recording your peak flow measurements along with the time and date can help determine the correct medication doses for you. Including the time of exposure to any suspected triggers along with your peak flow measurements can also be helpful.

Pregnancy and Asthma

Poorly controlled asthma puts both a mother and her baby at increased risk for health complications during pregnancy. Although most asthma drugs are safe to use during pregnancy, a good rule of thumb is to discuss any medication with your doctor before using it.

Children and Asthma

Asthma is one of the most common diseases of childhood. Parents of children with asthma must be educated about the condition and how to integrate their child's treatment plan into family, school, and social life.

Sometimes a 20-minute bedtime massage helps children's nighttime asthma. There is evidence that air pollution may worsen a child's asthma.

Some children have asthma that is only brought on by exercise. With proper preparation, education, and medications, exercise-induced asthma should not interfere with your child's activities or life.

Warning Signs of Uncontrolled Asthma and Emergency Treatments

If symptoms suddenly become severe, bronchodilators are used as “rescue medications.

What is Arthritis?

Arthritis is a condition of pain and stiffness in any joint in the body. Though many forms of arthritis exist, the two most common are osteoarthritis and rheumatoid arthritis.

What is Osteoarthritis?

Osteoarthritis is the gradual loss of the soft, smooth covering on the ends of the bone (called cartilage) where two bones come together at the joint. It is usually caused by wear and tear on the joints over time and is a common condition in older adults. Osteoarthritis can also be caused by an injury involving a joint.

Who is Affected by Osteoarthritis?

Osteoarthritis affects about three in 10 people between the ages of 54 and 64, and more than six in 10 people over the age of 65.

Risk Factors for Developing Osteoarthritis

A number of factors can increase a person's risk of getting osteoarthritis:

• Your diet is high in animal fat
• You rarely eat fruits and vegetables
• You have had ulcerative colitis or diseases that tend to cause polyps (small growths) in the colon
• You have had uterine, ovarian, or breast cancer
• You have a parent or sibling who has had colon cancer

• Bleeding from the anus
• A change in bowel habits such as black, sticky stools or "pencil thin" stools
• Unexplained anemia (low amount of red blood cells)
• Unexplained abdominal pain, gas pains, or bloating
• Unexplained fatigue, weakness, weight loss, or loss of appetite

Migraine

Definition    

Migraine headaches are a type of headache that some people get repeatedly over time. Migraines are different from other headaches because they occur with symptoms such as nausea, vomiting, or sensitivity to light.

Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. Most people, however, do not have such warning symptoms.

Causes, incidence, and risk factors    

A lot of people get migraines -- about 11 out of 100. The headaches tend to start between the ages of 10 and 46, may run in families, and occur in women more often than men.

Migraines are classified as either "with aura" or "without aura". An aura is a warning symptom. Most migraine patients do not have auras.

A migraine is caused by abnormal brain activity, which is triggered by stress, food, or some other factor. The exact chain of events is not known. However, it seems to involve various nerve pathways and chemicals in the brain. The changes affect blood flow in the brain and surrounding membranes.

Migraine attacks may be triggered by:

• Allergic reactions
• Bright lights, loud noises, and certain odors or perfumes
• Physical or emotional stress
• Changes in sleep patterns
• Smoking or exposure to smoke
• Skipping meals
• Alcohol or caffeine
• Menstrual cycle fluctuations, birth control pills
• Tension headaches
• Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
• Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods

Symptoms    

Migraine headaches, which can be dull or severe, usually:

• Feel throbbing, pounding, or pulsating
• Are worse on one side of the head
• Last 6 to 48 hours

Symptoms accompanying migraines include:

• Nausea and vomiting
• Sensitivity to light or sound
• Loss of appetite
• Fatigue
• Numbness, tingling, or weakness

Warning signs that a migraine is coming include seeing stars or zigzag lines, having tunnel vision, or temporary blind spot.

Symptoms that may linger even after the migraine has gone away include:

• Feeling mentally dull, like your thinking is not clear or sharp
• Increased need for sleep
• Neck pain

Signs and tests    

Migraine headache may be diagnosed by your doctor based on your symptoms, history of migraines in the family, and your response to treatment. Your doctor will take a detailed history to make sure that your headaches are not due to tension, sinus inflammation, or a more serious underlying brain disorder. During the physical exam, your doctor will probably not find anything wrong with you.

Sometimes an MRI or CT scan is obtained to rule out other causes of headache like sinus inflammation or a brain mass. In the case of a complicated migraine, an EEG may be needed to exclude seizures. Rarely, a lumbar puncture (spinal tap) might be performed.

Treatment    

When migraine symptoms begin:

• Rest in a quiet, darkened room.
• Drink fluids to avoid dehydration (especially if you have vomited).
• Try placing a cool cloth on your head.

Over-the-counter pain medications like acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. If these don't help, ask your doctor about prescription medications.

Your doctor will select from several different types of medications, including:

• Ergots like ergotamine, dihydroergotamine, or ergotamine with caffeine.
• Triptans like sumatriptan, rizatriptan, almotriptan, and zolmitriptan; these are available as a tablet, nasal spray, or self-administered injection.
• Isometheptene
• Stronger pain relievers like narcotics

Many of the prescription medications for migraines narrow your blood vessels. Therefore, these drugs should not be used if you have heart disease, unless specifically instructed by your doctor.

Prevention    

• Avoid smoking, caffeine, and alcohol.
• Exercise regularly.
• Get enough sleep each night.
• Learn to relax and reduce stress. Try progressive muscle relaxation (contracting and releasing muscles throughout your body), meditation, biofeedback, or joining a support group.

If you get at least three headaches per month, your doctor may prescribe medication for you to prevent recurrent migraines.

Such prescription drugs include:

• Beta-blockers, such as propranolol
• Anti-depressants, including tricyclics like amitriptyline or SSRIs like fluoxetine, paroxetine, or sertraline
• Anti-convulsants, like valproic acid or divalproex sodium
• Calcium channel blockers, such as verapamil

Psoriasis is a chronic (long-lasting) skin disease of scaling and inflammation. Although the disease occurs in all age groups, it primarily affects adults. It appears about equally in males and females. Psoriasis occurs when skin cells quickly rise from their origin below the surface of the skin and pile up on the surface before they have a chance to mature. Usually this movement (also called turnover) takes about a month, but in psoriasis it may occur in only a few days. In its typical form, psoriasis results in patches of thick, red (inflamed) skin covered with silvery scales. These patches, which are sometimes referred to as plaques, usually itch or feel sore. They most often occur on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet, but they can occur on skin anywhere on the body.

The disease may also affect the fingernails, the toenails, and the soft tissues of the genitals and inside the mouth. While it is not unusual for the skin around affected joints to crack, approximately 1 million people with psoriasis experience joint inflammation that produces symptoms of arthritis. This condition is called psoriatic arthritis.

Psoriasis is considered a skin disease, but really it is the result of a disordered immune system. The T-cells, a type of white blood cell, become over-stimulated. They then direct the skin to try and "heal" a non-existent injury. The skin reacts in the same way it does when it has a fungus infection; it grows very fast, trying to "grow" the infection off the skin. These areas become the reddened, inflamed patches with white scale on them.

Psoriasis flare-ups may be triggered by changes in climate, infections, stress, excess alcohol, a drug-related rash and dry skin. Medications may trigger a flare up weeks to months after starting them. These include non-steroidal anti-inflammatory drugs, blood pressure (beta-blockers), oral steroids such as prednisone, or depression (lithium).

How Is Psoriasis Diagnosed?

Occasionally, doctors may find it difficult to diagnose psoriasis, because it often looks like other skin diseases. It may be necessary to confirm a diagnosis by examining a small skin sample under a microscope. There are several forms of psoriasis. Some of these include:

•  Plaque psoriasis --Skin lesions are red at the base and covered by silvery scales.

•  Guttate psoriasis --Small, drop-shaped lesions appear on the trunk, limbs, and scalp. Guttate psoriasis is                                  most often triggered by upper respiratory infections (for example, a sore throat caused                                  by streptococcal bacteria).

•  Pustular psoriasis --Blisters of noninfectious pus appear on the skin.

•  Inverse psoriasis --Smooth, red patches occur in the folds of the skin near the genitals, under the breasts,                                  or in the armpits.

•  Erythrodermic psoriasis --Widespread reddening and scaling of the skin

•  Psoriatic arthritis --Joint inflammation that produces symptoms of arthritis in patients who have or will                                 develop psoriasis.

Treatment

Doctors generally treat psoriasis in steps based on the severity of the disease, size of the areas involved, type of psoriasis, and the patient's response to initial treatments. This is sometimes called the "1-2-3" approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 uses light treatments (phototherapy). Step 3 involves taking medicines by mouth or injection that treat the whole immune system (called systemic therapy).

Topical Treatment

•  Corticosteroids --These drugs reduce inflammation and the turnover of skin cells, and they suppress the                                 immune system. Available in different strengths, topical corticosteroids (cortisone) are                                 usually applied to the skin twice a day.

•  Calcipotriene --This drug is a synthetic form of vitamin D3 that can be applied to the skin. Applying                             calcipotriene ointment twice a day controls the speed of turnover of skin cells.

•  Retinoid --Topical retinoids are synthetic forms of vitamin A. If used alone, this preparation does not act as                      quickly as topical corticosteroids, but it does not cause thinning of the skin or other side effects                       associated with steroids

•  Coal tar --Preparations containing coal tar (gels and ointments) may be applied directly to the skin, added                    (as a liquid) to the bath, or used on the scalp as a shampoo. Coal tar is less effective than                     corticosteroids and many other treatments and, therefore, is sometimes combined with ultraviolet                      B (UVB) phototherapy for a better result.

•  Anthralin --Anthralin reduces the increase in skin cells and inflammation.

•  Salicylic acid --This peeling agent, which is available in many forms such as ointments, creams, gels, and                             shampoos, can be applied to reduce scaling of the skin or scalp.

•  Clobetasol propionate --This is a foam topical medication, which has been approved for the treatment of                                           scalp and body psoriasis. The foam penetrates the skin very well, is easy to use,                                           and is not as messy as many other topical medications.

•  Bath solutions --People with psoriasis may find that adding oil when bathing, then applying a moisturizer,                              soothes their skin. Also, individuals can remove scales and reduce itching by soaking for                              15 minutes in water containing a coal tar solution, oiled oatmeal, Epsom salts, or Dead                               Sea salts.

•  Moisturizers --When applied regularly over a long period, moisturizers have a soothing effect. Preparations                            that are thick and greasy usually work best because they seal water in the skin, reducing                            scaling and itching.

Light Therapy

Natural ultraviolet light from the sun and controlled delivery of artificial ultraviolet light are used in treating psoriasis.

•  Sunlight --Much of sunlight is composed of bands of different wavelengths of ultraviolet (UV) light. When absorbed into the skin, UV light suppresses the process leading to disease, causing activated T cells in the skin to die. This process reduces inflammation and slows the turnover of skin cells that causes scaling.

Ultraviolet B (UVB) phototherapy --UVB is light with a short wavelength that is absorbed in the skin's epidermis. An artificial source can be used to treat mild and moderate psoriasis.

•  Psoralen and ultraviolet A phototherapy (PUVA) --This treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light. UVA has a long wavelength that penetrates deeper into the skin than UVB. Psoralen makes the skin more sensitive to this light.

•  Light therapy combined with other therapies --Studies have shown that combining ultraviolet light treatment and a retinoid, like acitretin, adds to the effectiveness of UV light for psoriasis

Systemic Treatment

For more severe forms of psoriasis, doctors sometimes prescribe medicines that are taken internally by pill or injection. This is called systemic treatment. Recently, attention has been given to a group of drugs called biologics (for example, alefacept and etanercept), which are made from proteins produced by living cells instead of chemicals. They interfere with specific immune system processes.

•  Methotrexate -- methotrexate slows cell turnover by suppressing the immune system

•  Retinoids --A retinoid, such as acitretin (Soriatane), is a compound with vitamin A-like properties that may                       be prescribed for severe cases of psoriasis that do not respond to other therapies.

•  Cyclosporine --Taken orally, cyclosporine acts by suppressing the immune system to slow the rapid                             turnover of skin cells.

•  6-Thioguanine --This drug is nearly as effective as methotrexate and cyclosporine.

•  Hydroxyurea --Compared with methotrexate and cyclosporine, hydroxyurea is somewhat less effective. It                             is sometimes combined with PUVA or UVB treatments.

•  Alefacept --This is the first biologic drug approved specifically to treat moderate to severe plaque psoriasis.                       alefacept suppresses the immune system & the skin often improves, but there is also an                       increased risk of infection or other problems, possibly including cancer.

•  Etanercept --This drug is an approved treatment for psoriatic arthritis where the joints swell and become                         inflamed. it is a biologic response modifier, which after injection blocks interactions between                         certain cells in the immune system. Etanercept limits the action of a specific protein that is                         overproduced in the lubricating fluid of the joints and surrounding tissues, causing inflammation

•  Antibiotics --These medications are not indicated in routine treatment of psoriasis. However, antibiotics                         may be employed when an infection, such as that caused by the bacteria Streptococcus,                           triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.

Combination Therapy

There are many approaches for treating psoriasis. Combining various topical, light, and systemic treatments often permits lower doses of each and can result in increased effectiveness.

Psychological Support

Some individuals with moderate to severe psoriasis may benefit from counseling or participation in a support group to reduce self-consciousness about their appearance or relieve psychological distress resulting from fear of social rejection.

Menopause

Menopause is the medical term for the end of a woman's menstrual periods. It is a natural part of aging, and occurs when the ovaries stop making hormones called estrogens. This causes estrogen levels to drop, and leads to the end of monthly menstrual periods. This usually happens between the ages of 45 and 60, but it can happen earlier. Menopause can also occur when the ovaries are surgically removed or stop functioning for any other reason.

Every woman's period will stop at menopause. Some women may have other symptoms also which include:

The period of time leading up to menopause is often characterized by irregular periods. In fact, changes such as shorter or longer periods, heavier or lighter menstrual bleeding, and varying lengths of time between periods may be a sign that menopause is near.

Hot flashes are the classic sign of menopause, as well as the most common reason for seeking treatment. A hot flash produces a sudden sensation of warmth or even intense heat that spreads over various parts of the body, especially the chest, face, and head. Flushing and sweating usually occur as well, followed by a chill. Some women feel their heart beating very fast or hard and feel anxious.

Estrogen plays a key role in maintaining the function of a woman's vagina and surrounding tissues, uterus, urinary bladder, and urethra (the organ through which urine is passed from the bladder). After menopause, all of these organs may weaken or shrink. When these changes occur in the bladder and urethra, they can lead to the involuntary leakage of urine, infection, or painful urination.

A thinning of the tissue lining the vagina may lead to pain during intercourse. Vaginal dryness can also occur, as may itching or irritation.

Night sweats and sleeping problems – these may lead to feeling tired, stressed, or tense.

Thinning of bones – this may lead to loss of height and bone breaks (osteoporosis).

Mood changes – such as mood swings, depression, and irritability.

Urinary problems – such as leaking, burning or pain when urinating, or leaking when sneezing, coughing, or laughing.

Problems with concentration or memory.

Less interest in sex and changes in sexual response.

Weight gain or increase in body fat around your waist.

Hair thinning or loss.

Diagnosis

Menopause is usually diagnosed after the doctor reviews a woman's medical history and performs a physical examination. The doctor may also order blood tests to make sure the symptoms are related to menopause and to decide what therapy, if any, might be most appropriate.

Health Changes after Menopause

Osteoporosis

Osteoporosis is the medical term for thinning of the bones. Thin bones become weaker and break easily, with the bones of the spine, wrists, and hips most prone to fracture. Although bones naturally weaken with age in both men and women starting at about age 40, women lose bone more rapidly after menopause.

Using estrogen after menopause can slow the rate of bone thinning and may prevent bones from breaking.

Heart disease

The rate of heart disease rises considerably in women after menopause. Because many people think of heart disease as a "man's problem," it may be surprising to know that heart disease is the leading cause of death among women.

Risk factors for heart disease in women (as well as men) include:

The use of estrogen replacement therapy has been shown to dramatically reduce the risk for heart disease. Estrogen can lower high levels of "bad" cholesterol and helps maintain healthy veins. It may also help lower blood pressure and play a role in keeping blood sugar close to normal levels.

Treatment for the symptoms of menopause:

•  Hormone Replacement Therapy: This includes prescription drugs that contain types of hormones that your ovaries stop making around the time of menopause. Hormone therapy can contain estrogen alone or estrogen with progestin (for a woman who still has her uterus or womb). Estrogen therapy usually is taken by pill, skin patch, as a cream or gel, or with an intrauterine device (IUD) or vaginal ring. How estrogen is taken can depend on its purpose. For instance, a vaginal ring or cream can ease vaginal dryness, leakage of urine, or vaginal or urinary infections, but does not relieve hot flashes. If you want to prevent bone loss, you also should talk with your doctor about medicines other than hormone therapy that can help your bones.

Other ways to help symptoms:

•  Vaginal Dryness: Regular sexual intercourse can help to keep the vagina moist and toned. Use an over-the-counter vaginal lubricant. There are also prescription estrogen replacement creams that your doctor might give you. If you have spotting or bleeding while using estrogen creams, you should see your doctor.

What are the benefits and risks of hormone therapy?

Benefits: Hormone therapy can help with menopause by:

Risks: For some women, hormone therapy may increase their chance of getting:

For a woman with a uterus, taking estrogen alone, without progesterone, increases her chance of getting endometrial cancer (cancer of the lining of the uterus). Adding progesterone to the hormone therapy lowers this risk.

Hormone therapy also may cause these side effects:

Definition    

A cataract is a cloudy or opaque area in the lens of the eye.

Causes and risk factors    

The lens of an eye is normally clear. If the lens becomes cloudy, the condition is known as a cataract. Rarely, cataracts may be present at or shortly after birth. These are called congenital cataracts .

Adult cataracts are generally associated with aging. They develop slowly and painlessly with a gradual onset of difficulty with vision . Most people develop some clouding of the lens after the age of 60. About 50% of people aged 65-74 and about 70% of those 75 and older have visually significant cataracts.

Development of cataracts may be accelerated by

Congenital cataracts can also be caused by infections of the mother during pregnancy such as rubella , or associated with metabolic disorders such as galactosemia . Risk factors include inherited metabolic diseases, a family history of cataracts, and maternal viral infection.

Adult cataracts are classified as immature, mature, and hypermature. A lens that has some remaining clear areas is referred to as an immature cataract. A mature cataract is completely opaque. A hypermature cataract has a liquefied surface that leaks through the capsule and may cause inflammation of other structures in the eye.

Most people with cataracts have similar changes in both eyes, although one eye may be worse than the other. Many people with this condition have only minimal visual changes and are not aware of their cataracts.

In many cases, the cause of cataract is unknown.

Symptoms    

Signs and tests    

Other tests that may be done (rarely) include:

Treatment    

The only treatment for cataract is surgical removal. This is done when a person cannot see well enough with glasses to perform normal activities. For some people, changing glasses, getting stronger bifocals, or using a magnifying lens is helpful enough. Others choose to have cataract surgery .

If a cataract is not bothersome, then surgery is usually not necessary. Sometimes there is an additional eye problem that cannot be treated without first proceeding with cataract surgery.

Cataract surgery consists of removing the lens of the eye and replacing it with an artificial lens. A cataract surgeon will discuss the options with the patient, and together they will decide which type of removal and lens replacement is best.

Lens Replacement:

People who have cataract surgery are usually fitted with an artificial lens at the same time. The artificial lens is a synthetic disc called an intraocular lens. It is usually placed in the lens capsule inside the eye.

Other options include contact lenses and cataract glasses.

Prevention    

The primary prevention involves controlling associated diseases and avoiding exposure to factors known to promote cataract formation.

Wearing sunglasses when you are outside during the day can reduce the amount of UV light your eyes are exposed to. Some sunglasses do not filter out the harmful UV. An optician should be able to tell you which sunglasses filter out the most UV. For patients who smoke cigarettes, quitting will decrease the risk of cataracts.

A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. An ulcer occurs when the lining of these organs is corroded by the acidic digestive juices which are secreted by the stomach cells.

CAUSES

For many years, excess acid was believed to be the major cause of ulcer disease. Accordingly, treatment emphasis was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by bacteria called "Helicobacter pylori" (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs), including aspirin. Cigarette smoking is also an important cause of ulcer formation and ulcer treatment failure.

Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation. Similarly, there is no conclusive evidence to suggest that life stresses or personality types contribute to ulcer disease.

SYMPTOMS

Symptoms of ulcer disease are variable. Many ulcer patients experience minimal indigestion or no discomfort at all.

Hunger pain: Some report upper abdominal burning or hunger pain intermittently during the day, often when stomach is empty.

Night pain: Pain wakes the patient from sleep and may be relieved by food, a drink of milk or antacids.

Pain relief: Pain is relieved by food, milk or antacids and by belching and vomiting.

Episodic pain (‘Periodicity'): Pain is episodic and may last for several weeks at a time. Between episodes the patient feels perfectly well.

Other symptoms: Other symptoms that occur, especially during episodes of pain include water brash, heartburn, loss of appetite and vomiting.

DIAGNOSIS

The diagnosis of an ulcer is made by either a barium upper GI x-ray or an upper endoscopy (EGD-esophagogastroduodenoscopy).

In addition the patient may also need to be screened for H. Pylori infection. These include tests like Urea breath test, Rapid urease test, etc. If an endoscopy has been done for the patient, then a specimen can be taken for histology.

COMPLICATIONS

Patients with ulcers generally function quite comfortably. Some ulcers probably heal even without medications. Therefore, the major problems resulting from ulcers are related to ulcer complications. Complications include ulcer bleeding, ulcer perforation, gastric obstruction and in long standing gastric ulcers, cancer.

TREATMENT

The goal of ulcer treatment is to relieve pain and to prevent ulcer complications, such as bleeding, obstruction, and perforation. The first step in treatment involves the reduction of risk factors (NSAIDs and cigarettes). The next step is medications.

Antacids neutralize existing acid in the stomach. However, the neutralizing action of these agents is short-lived, and frequent dosages are required. Magnesium containing antacids can cause diarrhoea, while aluminum agents can cause constipation. Ulcers frequently return when antacids are discontinued.

H2 Blockers: Studies have shown that a protein in the stomach called histamine stimulates gastric acid secretion. Histamine antagonists (H2 blockers) are drugs designed to block the action of histamine on gastric cells, hence reducing acid output. Examples of H2 blockers are cimetidine, ranitidine, nizatidine and famotidine.

Proton pump inhibitor : These drugs inhibit the proton pump in the parietal cells lining the stomach which secrete acid and hence are able to reduce the secretion of acid. E.g. Omeprazole, Lansoprazole.

Sucralfate and misoprostol are agents that strengthen the gut lining against attacks by acid digestive juices. Sucralfate coats the ulcer surface and promotes healing. The most common side effect is constipation and the interference with the absorption of other medications. Misoprostol is a prostaglandin analogue commonly used to counteract the ulcer effects of NSAIDs.

Antibiotics: Patients with documented ulcer disease and H. pylori infection should be treated with antibiotic combinations. Treatment is based upon a proton pump inhibitor taken simultaneously with two antibiotics. Commonly used antibiotics are tetracycline, amoxicillin, metronidazole and clarithromycin. Eradication of H. pylori prevents the return of ulcers & may also decrease the risk of developing gastric cancer in the future.

There is no conclusive evidence that dietary restrictions and bland diets play a role in ulcer healing. No proven relationship exists between peptic ulcer disease and the intake of coffee and alcohol. However, since coffee stimulates gastric acid secretion, and alcohol can cause gastritis, moderation in alcohol and coffee consumption is often recommended.