Medical Articles, Medicine Information.

HIV: MEDICAL TREATMENTS-TRADITIONAL MEDICINE: PAYING FOR THE DRUGS

admin — Wed, 20 Jul 2011 08:28:35 +0000

The question of who pays for drugs is complicated and controversial. Drugs are expensive, often costing $5,000 to $15,000 per year in the later stages of HIV infection. The expense of the drugs means that the insurers have much at stake. All insurers, public or private, differ in whether they pay for drugs, how much they pay, and which drugs they pay for. Medicaid and the Veterans Administration both provide coverage for prescription drugs; Medicare does not. Only 15 percent to 30 percent of both the commercial insurance companies’ plans and Blue Cross/Blue Shield’s plans cover prescription drugs. The companies and plans that do cover drugs sometimes put limits on their coverage. They will pay only for FDA-approved drugs and sometimes only for FDA-approved drugs used for the medical conditions the FDA has approved them for. Nonprescription drugs and drugs used in alternative treatments are not covered by any insurer. Whether or not insurers will cover drugs for conditions for which the FDA has not approved the drug is still a matter of controversy. Insurers cover drugs that are in what is called “generally accepted medical practice”; they do not cover drugs that are considered experimental. The problem is that new drugs are being developed rapidly, and the FDA’s approval process can take a long time; as a result, the distinction between experimental drugs and drugs used in generally accepted medical practice is vague. Some insurers make that distinction by soliciting advice from physicians or physicians’ professional societies. Some insurers make the distinction strictly by following FDA guidelines, although the FDA has repeatedly stated that a drug can be used in generally accepted medical practice and still not be approved for that specific condition.*182\191\2*

LIVING WITH SPINAL CORD INJURY: SINGLE-FAMILY HOMES

admin — Mon, 11 Jul 2011 08:23:39 +0000

Most people returned to their family homes after rehabilitation. In most instances, these homes were single-family dwellings where modifications were made to allow the newly disabled person to move about with the greatest possible freedom. Some modifications are inexpensive and can be made by family or friends – a ramp over a couple of steps, for example. However, when undertaking a building project with accessibility in mind, some standards – such as door widths or ramps with “do-able” inclines – are very helpful. In response to the growing numbers of senior citizens in the United States, a trend has arisen among enlightened architects to emphasize accessibility. The two popular terms for the types of homes designed are visitable and universal. As described in En-able Magazine, a visitable home is one “that provides the essentials of barrier-free access such as zero-step or sloped entrances, doorways at least 32 inches wide, electrical outlets at reachable heights and reinforced bathroom walls for grab bars.”A universal home, on the other hand, “offers a wide range of accessibility and convenience features to accommodate a broad range of human ability and age groups.” Universal design goes beyond the barrier-free design concept. It eliminates the need for special features that can be stigmatizing, different-looking, and usually more expensive. Ron Mace (the “father of universal design”) notes, “The features of a Universal Design Home make it appealing and marketable to persons of all ages and abilities.” Sources of information on universal design are included in the Resources.If you are searching for an older house or even a newly constructed house, you’ll benefit from working with a realtor who is knowledgeable about what is required for accessibility. Check advertisements in the newspaper, call the real estate board to inquire about realtors with accessibility specialties, or get information from friends who have used realtors to find accessible homes.
*132/156/5*

DISEASES OF THE VEINS : THROMBOPHLEBITIS – HOW SERIOUS IS THROMBOPHLEBITIS?

admin — Fri, 01 Jul 2011 08:13:47 +0000

If the thrombophlebitis is in a superficial vein lying just under the skin, serious complications are rare. However, if the clotting is in a deep vein, the valves in the veins may be damaged, and this damage leads to future problems of swelling of the leg. If a portion of the thrombus is dislodged, it may travel to the lung and cause pulmonary embolism.If the thrombophlebitis is in a superficial vein, your doctor may recommend applying heat to the sore area, elevating the leg, and using an antiinflammatory drug. If your thrombophlebitis is in a deep vein, treatment will require hospitalization. Your leg will be elevated and an anticoagulant drug will be administered intravenously. Occasionally, if blood thinners have not been effective or cannot be given for some reason, it may be necessary to insert a “filter” into the inferior vena cava (the vein that carries blood back to the heart) to prevent the clot from traveling to your lungs. The filter can be inserted either with a catheter or a surgical procedure.*207\252\8*

UNRESTRICTED ENTRANCE – SIGNIFICANT STUDY

admin — Wed, 29 Jun 2011 08:28:17 +0000

One significant study found that the higher the level of prenatal PCB exposure, the heavier the girls were at age four- f teen and their puberty was statistically earlier. Boys with higher prenatal exposure to DDE also were fatter, but the age they entered puberty was not affected. Could childhood obesity be partially caused by prenatal exposure to endocrine disrupters?4Two new studies indicate that Monsanto’s herbicide, Roundup, is a hormone disrupter and is also associated with birth defects in humans.Farm families that applied pesticides to their crops in Minnesota were studied to see if their elevated exposure to pesticides caused birth defects in their children. The study found that two kinds of pesticide — fungicides and the herbicide Roundup — were linked to statistically significant increases in birth defects. Roundup was also linked to a three-fold increase in neuro-developmental (attention deficit) disorders.*10/165/1*

DMARDs: DEEPER TREATMENTS FOR RHEUMATOID ARTHRITIS

admin — Wed, 15 Jun 2011 08:15:54 +0000

The NSAIDs and pain killers can be used for all types of arthritis. However, there are other medications used for autoimmune forms of arthritis such as rheumatoid arthritis.The major class of these drugs is called disease-modifying anti-rheumatic drugs, or DMARDs. They have received this description because they seem to be able to slow down the progression of rheumatoid arthritis, rather than just treat symptoms.The DMARDs each function in its own way, but the end results is somewhat similar. For all DMARDs, weeks or months of treatment are required for benefits to develop.Each is at least partially effective in about two-thirds of patients, and when one fails to work, another may succeed. Good results include not only reduction of pain and inflammation, but also an improvement in the laboratory signs of rheumatoid arthritis. Sometimes, a drug in this family can even produce a full or partial remission that lasts after the drug is stopped.This collection of effects has led to an impression that DMARDs somehow reach deeper in rheumatoid arthritis and get closer to its root than other drugs. Unfortunately, all the drugs in this category (with the possible exception of the new drug Enbrel) reliably cause severe side effects. Because of this toxicity, doctors have traditionally taken a “pyramid” approach with rheumatoid arthritis patients. Physicians started with NSAIDs to help with the pain and inflammation and only progressed to successively stronger and more toxic medications when the basic treatments failed.Over the last few years, however, research has found that severe joint damage occurs very early in rheumatoid arthritis. In one study, x rays showed that more than 70% of patients had joint erosion and narrowing within 3 years of being diagnosed. Furthermore, more damage occurred in the first year after diagnosis than during the next 2 years. This evidence has caused many authorities to suggest early, aggressive treatment with disease-modifying drugs to prevent joint damage.This approach makes good sense. There are, however, two things wrong with the strategy. First, all the traditional DMARDs are quite toxic and frequently cause severe side effects. Second, there is no definitive evidence that this strategy really works. At present, the belief that DMARDs can actually prevent joint destruction in rheumatoid arthritis is just a hope.Fish oil supplements can relieve symptoms of rheumatoid arthritis, but there is no evidence that they can retard the progression of the disease. In general, natural options for rheumatoid arthritis are not as effective as are those for osteoarthritis. However, a number of exciting new conventional treatments have recently become available. *23/306/5*

UNRESTRICTED ENTRANCE – INTRODUCING INTO THE BODY

admin — Thu, 02 Jun 2011 07:51:08 +0000

When a compound like DES is introduced into the body and doesn’t bind with the blood proteins, it can be as much as 100 times more potent than natural estradiol in the fetus. In another example, bisphenol A, by not binding to SHBG, has higher activity levels in the fetus than when tested in the lab.”Fetal exposure to hormones can program the way a gene functions for the rest of a person’s life. Some genes are supposed to be turned on early in life, some later. If a fetus or developing child is exposed to a potent hormone disrupter during a specific window of vulnerability, the molecular path their cells take may be altered, possibly permanently. A girl may show signs of puberty at age five instead of during early teen years. A boy’s testicles may not descend. Intelligence may be affected. Sustained attention or response to stress may be altered. Individuals respond differently to these different signals.*9/165/1*

EMERGENCIES: MUMPS

admin — Thu, 12 May 2011 16:08:50 +0000

Prevention is the best medicineMumps is a viral disease that usually causes painful swelling of the salivary glands. The virus is spread through coughing or sneezing or direct contact with saliva-contaminated materials. Infected persons can transmit the disease six or seven days before symptoms develop and up to nine days after. Once a person has had mumps or been vaccinated, they are usually immune for life.Note the symptomsAlmost one-third of those infected do not develop symptoms. Others will start noticing symptoms 14 to 21 days after being exposed. Symptoms may include chills, headache, loss of appetite, malaise or a low- to moderate-grade fever.The salivary glands between the ear and the angle of the jaw (the parotids) typically swell and become tender, as does the face. The combination creates the chipmunk-cheek look. The first sign of swelling may be pain while chewing or swallowing, especially when consuming anything acidic, like pickles or lemon juice.A fever of 103° F to 104° F is common in adults but not typical in young children. Symptoms usually last two weeks or less.PreventionMumps live virus vaccine is the answer to preventing mumps. This vaccine is safe and highly effective, and is usually combined with vaccines for measles and rubella in the MMR vaccine.All babies should be immunized between 12 and 15 months, and a second dose given between 4 and 6 years of age. If the second dose has not been given as scheduled, give by 11 to 12 years old, or at any childhood visit. Babies up to 1 year old are usually immune because they carry antibodies from their mother. The vaccine shouldn’t be given to pregnant women or those with weakened immune systems.To speed recuperation and avoid spreading the infection:Stay home until the swelling goes down or your doctor recommends returning to work or school.Bed rest is helpful until the fever subsides, but shouldn’t be forced on a child who is happy playing quietly.Drink plenty of fluids but avoid acidic ones like orange juice.Take pain relievers for headache and general discomfort.NEVER give aspirin to children/teenagers. It can cause Reye’s syndrome, a rare but often fatal condition. Acetaminophen (Tylenol) is a safe alternative.Final notesComplications of mumps, though rare in an otherwise healthy individual, are more common in adults than in children. These complications include an inflammation of the testes (orchitis) in males past puberty; an inflammation of the ovaries (oophoritis) in females past puberty; an inflammation of the membranes of the brain or spinal cord (meningitis); and an inflammation of the pancreas (pancreatitis).*25\303\2*

INFECTIOUS ARTHRITIS AND LABORATORY STUDIES

admin — Sun, 08 May 2011 15:34:39 +0000

The most valuable study in the evaluation of acute monoarthritis is synovial fluid analysis. Examination of the fluid can distinguish between non-inflammatory, inflammatory, and infectious effusions. Fluid should be sent for total leukocyte count with differential, Gram stain, and culture (both aerobic and anaerobic) as well as crystal analysis with polarized light microscopy. It should be noted, however, that the presence of either uric acid or calcium pyrophosphate crystals does not necessarily exclude the possibility of infection. Protein and glucose are not useful clinical indicators of infection. While both elevated protein and decreased glucose levels are common in infectious arthritis, these measurements are not specific.In septic arthritis, the synovial fluid is purulent in about 80% to 90% of cases. The leukocyte count is usually greater than 50,000 cells/mm3 with predominant (greater than 75%) polymorphonuclear cells. Fluid taken from patients with rheumatoid arthritis or crystalline disease can also contain a significant amount of neutrophils in the absence of infection. Meanwhile, in infected patients with cancer or a history of intravenous drug use or steroid use, the total leukocyte count may not exceed 50,000 cells/mm3.Additional studies that may be helpful, include rheumatoid factor and antinuclear antibody measurements. Erythrocyte sedimentation rate and C-reactive protein are usually elevated and can be useful in following the progression of treatment. A complete blood cell count is not often useful in adults, who typically have little to no rise in peripheral blood leukocyte count. If gonococcal infection is suspected, pharyngeal, rectal, and urethral or cervical cultures should be obtained. For patients with chronic monoarthritis, in whom there is a persistent effusion or an underlying immunocompromised state, synovial tissue should be sent for mycobacterial and fungal cultures. Peripheral blood cultures are positive in about one third of patients, particularly in those with polyarticular involvement or infection at extra-articular sites.*136/348/5*

SKIN IN ADOLESCENCE: RO-ACCUTANE AS ORAL THERAPY FOR ACNE

admin — Sat, 23 Apr 2011 15:05:05 +0000

The biggest breakthrough in the treatment of acne has been the introduction of Ro-Accutane, which is a vitamin A derivative taken in tablet form. It was discovered by accident that this drug penetrates into the sebaceous glands and decreases sebum production. Vitamin A itself in the doses required is far too toxic and is ineffective for acne.Ro-Accutane is the most effective treatment for acne but is used mainly in more severe cases. It often cures acne completely. Ro-Accutane can only be prescribed by dermatologists and normally needs to be used for several months. The advantage of Ro-Accutane is that the acne continues improving and remains clear for three to four years or longer after treatment.The main side effect of Ro-Accutane is that if it is taken during pregnancy it can cause major birth defects in the baby. If Ro-Accutane is prescribed for women they must be counseled about this risk and it is generally advised that women do not become pregnant for one month after taking it. After this period it is safe to get pregnant with no increased risk of birth defects. Ro-Accutane does not decrease fertility in women or men.Other side effects of Ro-Accutane include dry lips, nose, eyes and skin. It also produces temporary sun sensitivity so increased sun protection is necessary while on the medication. Occasionally, people may experience headaches, tiredness and muscle aching.Although Ro-Accutane does have a large number of side effects, it is such an effective treatment that it has much to commend it. Many teenagers with acne who have been socially withdrawn and lacking in self-confidence experience a complete personality transformation after taking Ro-Accutane. They become more confident and outgoing – the psychological effects of Ro-Accutane are truly amazing.
*24/150/5*

FERTILITY MANAGEMENT

admin — Sun, 17 Apr 2011 14:45:50 +0000

Conception refers to the fertilization of an ovum by a sperm. The sperm enters the ovum. Its tail breaks off, and a protective chemical barrier secreted by the ovum surrounds the sperm and prevents other sperm from entering. The following conditions are necessary for conception:1. A viable egg2. A viable sperm3. Possible access to the egg by the spermThe term contraception refers to methods of preventing conception. Sometimes the term birth control is used interchangeably with contraception, but it implies that a couple or individual is using methods to limit the number of children who are birthed. Thus, birth control is more equivalent to family planning. All of these methods offer control over when and whether pregnancies occur. However, since people first associated sexual activity with pregnancy, society has searched for a simple, infallible, and risk-free method of preventing pregnancy. We have not yet found one.To evaluate the effectiveness of a particular contraceptive method, you must be familiar with two concepts: perfect failure rate and typical use failure rate. Perfect failure rate refers to the number of pregnancies that are likely to occur in a year (per 100 uses of the method during sexual intercourse) if the method is used absolutely perfectly, that is, without any error. More practical is the typical use failure rate. This refers to the number of pregnancies that are likely to occur with typical use, that is, with the normal number of errors, memory lapses, and incorrect or incomplete use. This information is much more practical for people in helping them make informed decisions about contraceptive methods. The contraception equation is complicated further by the fact that many contraceptive methods are also used as protection against sexually transmitted infections (STIs). This is an important factor to consider in choosing a contraceptive. Present methods of contraception fall into several categories. Barrier methods use a physical or chemical block to prevent the egg and sperm from joining. Hormonal methods introduce synthetic hormones into the woman’s system that prevent ovulation, thicken cervical mucus, or prevent a fertilized egg from implanting. Surgical methods can be used to permanently prevent pregnancy. Other methods of contraception may involve temporary or permanent abstinence or awareness and planning in accordance with fertility patterns. *7/277/5*