What do Doctors call this Condition – Presenile dementia, primary degenerative dementia.

What is this Condition?

Alzheimer’s disease is a type of dementia – a condition marked by mental deterioration. An estimated 5% of people over age 65 have the severe form of this disease, and an additional 12% suffer from a mild-to-moderate form. A cure has not yet been found for the disorder.

What Causes it?

The cause of Alzheimer’s disease is unknown. However, several factors are thought to contribute to the condition. These include shortages of certain chemicals in the brain, known as neurotransmitters, which allow stimuli to travel from one nerve cell to another; environmental factors, such as dietary intake of manganese; slow-growing viruses in the brain or spinal cord; injuries; and genetic immunologic factors.

What are its Symptoms?

Onset of Alzheimer’s disease is slow and subtle. At first, the person experiences almost imperceptible changes, such as forgetfulness, inability to recall recent events, difficulty learning and remembering new information, inability to concentrate, and declining personal hygiene and appearance.

Gradually, tasks that require abstract thinking and judgment become more difficult. The person experiences progressive difficulty communicating with others and severe deterioration in memory, language ability, and coordination. The ability to write or speak may be lost. Personality changes and insomnia are common.

Eventually, the person becomes disoriented. His or her emotions may change suddenly. Physical and intellectual functions continue to deteriorate. The person becomes susceptible to infection and accidents. Usually, death results from infection.

How is it Diagnosed?

Early diagnosis of Alzheimer’s disease is difficult because the person’s signs and symptoms are obscure. To make a diagnosis, the doctor relies on information provided by a family member, supported by tests of mental status, neurologic examinations, and psychometric testing.

Currently, certain diagnostic tests are performed to rule out other disorders. The diagnosis cannot be confirmed until after death, when an exam of brain tissue shows the disorder’s effects.

How is it Treated?

Overall treatment is focused on supporting the person’s abilities and compensating for those that have been lost. The doctor may prescribe a variety of drugs to help a person with Alzheimer’s. Some of these drugs help to increase circulation in the brain – for example, Hydergine, Vasodilan, and Cyclospasmol. The doctor may prescribe other drugs (such as Ritalin) to enhance the person’s mood. If depression seems to exacerbate the person’s condition, the doctor may prescribe antidepressants. To treat memory deficits, the doctor may prescribe Cognex.

Sometimes, a person with Alzheimer’s will undergo hyperbaric (pressurized) oxygen treatment to increase the oxygen supply to the brain. The person is placed inside a special chamber where he or she breathes 100% oxygen.

Additional drugs are being tried to assess their ability to slow the disease process. These include choline salts, lecithin, Antilirium, enkephalins, and Narcan.

One of the most widely publicized diseases, AIDS is marked by progressive weakening of the immune system, which makes a person vulnerable to opportunistic infections and unusual cancers. The syndrome was first defined by the Centers for Disease Control and Prevention in 1981. Since then, the agency has revised its definition of AIDS, most recently in 1993.Homosexual and bisexual men who are sexually active witl1 many partners have the highest risk for contracting AIDS. Other high-risk groups include intravenous drug users and hemophiliacs, especially those who’ve been treated with Factor VIII (one of the blood clotting factors) concentrate. Most recently, heterosexual partners and children of persons with AIDS or of those in high-risk groups and persons receiving multiple blood transfusions have been added to the high-risk category. Drug therapy and prevention and treatment of common opportunistic infections can delay the natural progression of HI V infection and prolong survival.

To reduce the risk of contracting AIDS, public health advocates recommend following safe sex practices, such as condom use.

What Causes it?

AIDS is caused by a retrovirus called human immunodeficiency virus (HIV). The retrovirus strikes cells bearing a substance called the CD4 antigen. This antigen serves as a receptor for HIV and lets it enter the cell. HIV prefers to infect CD4+ cells, which are white blood cells that are sometimes called helper cells. But it may also infect other cells. including certain digestive tract cells, uterine cervical cells, and neuroglial cells, a type of nerve cell.

After HIV invades a cell, it reproduces. Recent research shows that in the first weeks after infection, HIV is extremely active. It eventually causes profound illness by hindering the immune system’s ability to fight disease.

The infection process takes three forms:

immunodeficiency – opportunistic infections and unusual cancers

autoimmunity – the body’s reaction against its own tissues

neurologic problems – AIDS dementia, a brain condition known as HIV encephalopathy, and peripheral nerve disorders.

Transmission modes

HIV is transmitted by intimate sexual contact, especially during rectal intercourse that injures the mucous membranes; by transfusion of contaminated blood or blood products (this risk has diminished thanks to routine testing of all blood products); by sharing of contaminated needles; and by transmission from an infected mother to her fetus (by cervical or blood contact at delivery and in breast milk). Mounting evidence suggests that HIV is not transmitted by casual household or social contact.

What are its symptoms?

Some people with AIDS lack symptoms until they suddenly develop an opportunistic infection or the purple skin lesions of Kaposi’s sarcoma, one of the cancers associated with AIDS.

But more often, they have nonspecific signs and symptoms, such as fatigue, afternoon fevers, night sweats, weight loss, diarrhea, or cough. Soon after these appear, they typically develop several infections at the same time.

In children with AIDS, the time between exposure to HIV and appearance of symptoms seems to be shorter (an average of 8 months). Signs and symptoms resemble those of adults with AIDS, except for those related to sexually transmitted disease. Finally, in children, the most common manifestation and cause of death isn’t Pneumocystis carinii pneumonia, as in adults, but diffuse interstitial pneumonitis.

How is it diagnosed?

According to the Centers for Disease Control and Prevention, a diagnosis of AIDS is confirmed by the presence of an opportunistic infection with lab evidence of HIV infection and a CD4+ T-cell count of less than 200 cells per microliter.

How is it treated?

Currently, no cure exists for AIDS. However, the drug Retrovir (known as AZT) is used alone or along with other drugs, such as Hivid, to inhibit HIV reproduction. Videx may be used if a person can’t tolerate AZT or no longer responds to it.

Supportive measures aim to reduce the person’s risk of infection, treat existing infections and cancers, maintain adequate nutrition, and provide emotional support.

Additional drug treatment

Although drugs can eliminate many of the organisms that cause opportunistic infections, these infections tend to recur once drug treatment stops. The drug of choice for P. carinii pneumonia is oral or intravenous Bactrim or Septra. If this treatment fails or if toxicity occurs, the person may be given NebuPent or Pentam 300. However, this drug may cause liver problems, a rapid pulse, low blood pressure, low blood sugar, and rashes.

To treat Kaposi’s sarcoma, the person may receive chemotherapy drugs, such as Oncovin and VePesid. Unfortunately, aggressive treatment of this cancer makes infection more likely. An interferon alfa drug is also being used to treat Kaposi’s sarcoma. Radiation and laser therapy can relieve, but not cure, local Kaposi’s lesions.

To treat retinitis, the person may receive Foscavir or Cytovene.

Allergic rhinitis, commonly called hay fever, is similar to asthma except in one respect. In asthma, an airborne substance causes an allergic, or hypersensitive, reaction in your lungs and chest. In allergic rhinitis, the reaction occurs in your eyes, nose, and throat. Exposure to an airborne irritant known as the allergen triggers the release of histamine, a body chemical. The release of this substance causes inflammation and fluid production in the fragile lining of the nasal passage, the sinuses, and the eyelids and surface layer of the eyes.

Nobody knows why some people are allergic to otherwise harmless pollen grains or other airborne particles. Presumably, there is a difference in some people’s natural immune systems . Since allergic based diseases such as asthma, contact dermatitis and allergic rhinitis often run in families, the cause is probably partly genetic.

If you have allergic rhinitis, you react to specific allergens. For example, if you have hay fever, the most familiar variety of the disease, you may be sensitive to grass pollen, which is abundant in early summer, to tree pollen, which is in the air in spring, or to ragweed, which blooms in the fall.

In addition to pollen, almost any airborne substance derived from a living organism can cause allergic rhinitis, including bits of animal skin, hair, and feathers. You may also be allergic to house dust or, to be more precise, to the mites that infest the dust.

There are two types of allergic rhinitis, seasonal and perennial. Seasonal allergic rhinitis only bothers you part of the year because it is an allergy to a substance that is not in the air year round. Perennial allergic rhinitis occurs all year round because it is caused by exposure to airborne allergens that may be present at any time.

What are the Symptoms?

If you have allergic rhinitis, you sneeze frequently, your nose runs, and your eyes are red, itchy, and watery. If you rub your eyes, it makes them worse. Itchy skin, dry throat, and wheezing can also occur. If you have hay fever, the symptoms are most severe when there is a lot of pollen in the air. Symptoms tend to be especially severe for 15 to 30 minute periods. These brief periods of acute symptoms are called allergy attacks.

Because airborne allergens are generally too small to see, it is difficult to predict when, or even why, you may have an attack. For example, if you are allergic to cat hair, you may start to sneeze on entering an empty room, because invisible bits of hair from a recent feline occupant are still in the air.

Allergic rhinitis is very common. Although there is a widespread belief that allergic rhinitis is a childhood disorder that you out­grow in your late teens or early twenties, this is not necessarily so. You can develop the disorder at any age, and later recover. You are particularly susceptible, however, if you are under 40 and have another allergic condition such as asthma or dermatitis, or if other members of your family have similar disorders. Many people react to more than one allergen, and some people have both seasonal and perennial bouts of allergic rhinitis.

What are the Risks?

This disorder does not usually endanger your general health.

What should be done?

If you find that allergic rhinitis interferes with your daily routine, see your physician, who will probably first ask questions to find out how serious the problem is for you. The doctor may advise you against professional treatment, because the possible side effects and the inconvenience of some kinds of treatment may cause more problems than the condition itself. If you do not know what causes your allergic rhinitis, your physician may suggest skin tests to find out which allergens make you react. The physician scratches the skin on your forearm and puts drops of liquid that contain a common allergen on the same spot. If the skin under any of the drops turns red and itchy, you are allergic to the allergen in that drop.

What is the Treatment?

Self-help: If you get hay fever regularly, stay indoors as much as possible during the hay fever season, especially when the news media reports a high pollen count. You should avoid wearing contact lenses, because they can increase eye irritation. Resist the temptation to rub your eyes. If your allergic rhinitis is perennial rather than seasonal, try to find out what you are allergic to, and take steps to avoid it or minimize your exposure to it. Self-help recommendations for asthmatics also apply to those people who suffer from allergic rhinitis.

Whether your condition is seasonal or perennial, there are many drugs that ease the symptoms of allergic rhinitis. A large number of them are available without a prescription. The most commonly used drugs are antihistamines, which are generally effective for both preventing and stopping attacks. To be fully effective, antihistamines must be taken regularly, often for several days at a time. Some common side effects from antihistamines are drowsiness, and dryness in the nose and throat. These may be more trouble some than the allergic rhinitis itself. Since antihistamines often make you sleepy, you should never take them if you intend to drive a motor vehicle or to operate machinery within the next few hours.

For quick relief from a stuffy nose, you can use decongestant nose drops or nasal sprays,

which can ease symptoms within minutes. Do not use such medicines often or regularly, however. They eventually aggravate the very symptoms they are supposed to suppress.

Professional help: There are quite a few symptom suppressing drugs that are available only with a prescription. If you do not get relief from any of the self -help measures suggested above, your physician may prescribe a type of antihistamine that works better for you than the non-prescription types. Another possible treatment for you is the use of a steroid spray.

All of these drug treatments merely suppress symptoms. They do not alter the basic allergic reaction. The only possible cure for allergic rhinitis is a series of injections designed to desensitize your system to the allergen or allergens that bother you. This is possible only if you have a skin test and successfully identify the substance or substances that bother you. In the treatment, your physician gives you a series of injections containing increasingly strong concentrations of your particular allergen in an attempt to stop your reactions.

This treatment is not always successful, and it takes a long time to complete the series of injections. Before you decide to have desensitization treatment, you should consider the possibility that it may not work for you and discuss the risks and benefits with your physician.

Information about the Condition

polycythemia Vera

What do doctors call this condition?

Primary polycythemia

What is this condition?

Polycythemia vera is a chronic bone marrow disorder characterized by increased red blood cell mass, increased white cell production, thrombocytosis, and increased hemoglobin concentration, with normal or increased plasma volume. It usually occurs between ages 40 and 60, most commonly among males of Jewish ancestry. It rarely affects children or Blacks and doesn’t appear to run in families.

The prognosis depends on the person’s age at diagnosis, the treatment used, and complications. The mortality rate is high if the disease is untreated or is associated with leukemia or other types of cancer.

What causes this condition?

In polycythemia vera, uncontrolled and rapid cell reproduction and maturation cause proliferation of all bone marrow cells. The cause of the uncontrolled cellular activity is unknown. Increased red blood cell mass causes blood thickening, which slows blood flow to small blood vessels. These conditions combine with thrombocytosis to promote blockages in some blood vessels.

What are its symptoms?

In its early stages, polycythemia vera usually produces no symptoms . However, as changes in circulation develop, the person may complain of a vague feeling of fUllness in the head, headache, dizziness, and other symptoms, depending on the body system affected. Paradoxically, hemorrhage may occur as a complication of polycythemia vera.

How is it diagnosed?

Lab studies confirm polycythemia vera by showing increased red blood cell mass and other characteristic findings. Bone marrow biopsy (removal and analysis of tissue) reveals increased levels of all bone marrow components.

How is it treated?

Phlebotomy (blood removal therapy) can reduce the red blood cell mass promptly. The frequency of phlebotomy and the amount of blood removed each time depend on the persons condition. Typically, 350 to 500 milliliters of blood can be removed every other day. After repeated phlebotomies, the person develops iron deficiency, which stabilizes red blood cell production and reduces the need for phlebotomy.

For severe symptoms, therapy to depress the bone marrow may be used. In the past, radioactive phosphorus or cancer drugs could usually control the disease. But these agents may cause leukemia and should be reserved for older people and those with problems uncontrolled by phlebotomy. Currently, the preferred myelosuppressive agent is the drug Hydrea. People who’ve had previous problems with blood clot formation should be considered for myelosuppressive therapy

Iron Deficiency Anemia

What is this condition?

In iron deficiency anemia, a lack of iron in the body causes an array of symptoms, including fatigue, weakness, and abnormally pale skin. When the body’s iron stores are low, the red blood cell count falls, and with it the supply of hemoglobin, the iron-containing pigment in red cells that carries oxygen. The blood’s oxygen-carrying capacity is thereby diminished.

A common disease worldwide, iron deficiency anemia affects 10% to 30% of adults in the United States. It’s most prevalent in premenopausal women, infants (especially premature or low-birth-weight infants), children, and adolescents (especially girls).

What causes it?

Iron deficiency anemia may result from:

• too little iron in the diet, as in prolonged unsupplemented breast­or bottle-feeding of infants or during periods of stress, such as rapid growth in children and adolescents

• iron malabsorption, as in chronic diarrhea, surgical removal of the stomach, and malabsorption syndromes

• blood loss caused by heavy menstrual bleeding, injury, gastrointestinal ulcers, cancer, drug-induced gastrointestinal bleeding, or twisted, dilated veins

• pregnancy, which diverts the mother’s iron supply to the fetus for red blood cell formation

• abnormal presence in urine of free (extracellular) hemoglobin.

What are its symptoms?

Because iron deficiency progresses slowly, many people have no symptoms at first (except those of any underlying condition). Typically, they don’t go to the doctor until anemia is severe. In advanced stages, they may have trouble breathing on exertion, fatigue, weakness, listlessness, pallor, inability to concentrate, irritability, headache, and susceptibility to infection. Also, the heart may pump more blood than usual and the pulse rate may increase.

Chronic iron deficiency anemia causes spoon-shaped and brittle nails, cracks in the corners of the mouth, a smooth tongue, and difficulty swallowing.

How is it diagnosed?

Blood tests and bone marrow studies may confirm iron deficiency anemia. However, test results may be misleading because of complicating factors, such as infection, pneumonia, blood transfusion, or iron supplements. Bone marrow studies may also provide important information about the disorder. The doctor also must rule out other forms of anemia.

How is it treated?

The first goal of treatment is to determine the underlying cause of anemia. Then, iron replacement can begin. The preferred treatment is an oral iron preparation or a combination of iron and ascorbic acid (which enhances iron absorption). However, some people may need iron injections – for instance, those who need more iron than they can take orally.

What is this Condition?

This disorder is a complication of conditions that accelerate blood clotting. It causes blockages in the small blood vessels, depletes the body’s supply of clotting factors and platelets, and destroys fibrin critical component of blood clots). In effect, the disorder causes severe bleeding at multiple sites.

Disseminated intravascular coagulation is generally an acute condition, but it may be chronic in people with cancer. The prognosis depends on early detection and treatment, on the severity of hemorrhaging, and on whether the underlying disease or condition can be treated.

What causes Disseminated Intravascular Coagulation?

Disseminated intravascular coagulation may result from a variety of disorders, but the reason for this isn’t known.

What are its symptoms?

The most significant symptom is abnormal bleeding in a person who has never had a serious bleeding disorder. The principal signs of such bleeding include oozing from the skin, red or purple skin spots, and hematomas caused by bleeding into the skin. Bleeding from sites of surgical or invasive procedures and from the digestive tract are equally significant, as are bluish, cold hands and feet and kidney problems.

Other possible symptoms include nausea, vomiting, shortness breath, decreased urination, seizures, coma, shock, failure of major body systems, and severe muscle, back, and abdominal pain.

How is it diagnosed?

Abnormal bleeding in the absence of a known blood disorder suggests disseminated intravascular coagulation. Lab findings that measure blood clotting support the diagnosis. Assessing kidney function may also provide important information.

Final confirmation of the diagnosis may be difficult because many of these test results also occur in other disorders. Additional diagnostic tests determine the underlying disorder.

How is it treated?

Successful management of disseminated intravascular coagulation depends on a prompt diagnosis and adequate treatment of the underlying disorder. Treatment may be supportive (when the underlying disorder is self-limiting, for example) or highly specific. If the person isn’t actively bleeding, supportive care alone may reverse the disorder. However, in active bleeding the doctor may order intravenous heparin and transfusions of blood, fresh-frozen plasma, platelets, or packed red blood cells.