Although a certain amount of stress is a normal part of human existence, excessive amounts can undoubtedly act as a provocative factor. In many patients it therefore seems logical to try to lessen this, if possible. The first step, which often helps greatly, is to remove any worries regarding the nature of migraine with an explanation as well as reassurance that there is nothing more seriously wrong. Only very rarely are worries about the nature of the illness sufficiently intractable to need referral to a psychiatrist.Although life-style cannot always be changed, the worsening of any stress disease indicates the need for its re-examination. Obvious examples include the person in business or one of the professions who never takes time off to relax; here the important point to emphasize is that one headache a month equals one day lost from work a month, so that it is a good investment to take some time off. The type ‘A’ person may find periods of relaxation which take the form of just staring at the ceiling punitive; in this sort of case, physical exercise may be indicated, starting gently in those unaccustomed to it.Although it is impractical to suggest that the hard-working businessman gives up his job, it is possible to help him cope with the pressures involved in his work. By preventing the physiological (e.g. hormonal) changes caused by stress, the cycle of chemical changes involved in migraine can be arrested. One useful method of achieving this is relaxation therapy where many of the changes induced are the reverse of those seen in the tension headache/migraine syndrome. During relaxation certain physiological changes occur, e.g. muscle tone is decreased, and respiration and the heart rate slow; all of these are manifestations of a decrease in the tone of sympathetic muscles. Historically, there have been numerous types of relaxation therapy: the Japanese communal bath, which is not used for cleansing purposes, the Finnish sauna, the American ‘whirlpool’, and massage are all attempts in this direction. There is some evidence that teaching a tense person to relax is of benefit in reducing the incidence of headaches but it is difficult to separate this improvement from the placebo response, so that the claims to success of relaxation therapy are difficult to interpret.Often those persons who most need relaxation find the greatest difficulty in obtaining it. One way recommended for assessing a person’s state of tension is to imitate his posture, e.g. sitting on the edge of the chair leaning forward with shoulders hunched and fists clenched. If the patient holds this posture for a few minutes, there will be a feeling of discomfort. If, on breathing out rapidly there is a smooth exhalation, relaxation is possible but interrupted breathing with an involuntary holding of the breath implies that the patient may be resistant to relaxation therapy.Relaxation therapy aims at providing a variety of positive steps to ensure that the last remains of tension have been removed. Relaxation is much easier in a warm quiet room. Many hospitals and therapists have their own techniques for relaxation.
*44/152/5*
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TREATING MIGRAINE WITHOUT DRUGS: AVOIDANCE OF STRESS
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WHAT ARE EROTIC KISSINGS?
Comments OffKissing is the expression of sexual desire and an effective stimulant too. Erotic kissing is similar to coitus, builds up gradually and requires sensitivity and timing. To start kissing involves mostly lip contact then tongue care and gentle nibbling of the lower Upstarts. In due course of time tongue moves freely in the mouth of the partner who may suck on it. Both partners may bite each others lips. Kissing need not to be restricted to the sexual partners lips. Any part of the body may be similarly stimulated, hair, nape of the neck, breasts and genitals. Kissing not only serves as a measure of foreplay but may continue till orgasm. Kissing each other after reaching orgasm is a gentle expression of greatfulness to co-operation.Are all kisses erotic?No it is not the kiss but the way of kissing which expresses your feelings. To a child out of affection you may kiss on forehead but kissing on lips expresses your inner feelings to your wife. Hugging along with kissing on soft cheeks denotes your desires.*106\301\2*
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Drugs become accepted by physicians and the FDA on the basis of scientific proof of their effectiveness and safety. Scientific proof is obtained through a series of tests called a clinical trial. A clinical trial involves the combined efforts of the pharmaceutical company that makes the drug; the independent investigators who test the drug; and the FDA, which licenses the drug. Testing drugs through clinical trials has been standard for over four decades and has provided the foundation for most of the recommended treatments in traditional medicine. While a drug is being tested in a clinical trial, it is considered experimental. If the drug proves effective and is not too toxic, it is then licensed and available to the public. For people with HIV infection, participating in clinical trials has both advantages and disadvantages. Clinical trials are experiments with human lives, and special safeguards are necessary to guard both the people and the scientific procedure. These safeguards, plus the options and aspects of participation in a clinical trial, are spelled out to the participant in painstaking detail. Some trials can be seen as especially risky: they involve taking a drug with no established benefit in place of a standard drug with established merit. With other trials—for instance, the comparison of two drugs, both of which are known to work, to find out which works better—the risk is lower. The motivation to participate is an individual decision. For further discussion, see below, “Advantages of Participating in a Clinical Trial” and “Disadvantages of Participating in a Clinical Trial.” Anyone worried about the safety of a clinical trial can be reassured that the trials are conducted under the strict supervision of the FDA and a local board charged with reviewing the trial. Both the FDA and the local board periodically review the results of the trial. If the drug being tested proves significantly better or worse than the drugs in standard use, the trial is promptly discontinued. Moreover, a standing rule in all clinical trials is that participants may withdraw from the trial at any time.*183\191\2*
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TREATMENT OF SECONDARY PERITONITIS
Comments OffPatients with evidence of secondary peritonitis should be referred immediately for surgical evaluation. Prompt surgery is the mainstay of treatment for patients with secondary peritonitis to control the source of contamination and to remove necrotic tissue, blood, or intestinal contents from the peritoneal cavity. Medical management consists of antimicrobial therapy and physiologic support of the patient. The mortality rate of secondary peritonitis approaches 100% if treatment does not include surgical intervention.The choice of antimicrobial agents is generally made empirically, based on the likely pathogens. Although no clinical trials have demonstrated the superiority of one antimicrobial regimen over the other/it is known that both anaerobes and gram-negative aerobes should be covered. Combination antimicrobial therapy has traditionally been used, although single broad-spectrum agents, including beta-lactam/beta-lactamase inhibitor combinations and the carbapenems, are alternatives. Recommendations for empiric therapy depend on the severity of illness and whether the infection was acquired in a community or hospital setting. The duration of antimicrobial therapy after surgery is usually 5 to 7 days, depending on the severity of the infection, clinical response, and normalization of the white blood cell count.The role of enterococci in secondary peritonitis is not clearly defined, as most cases of secondary peritonitis are cured with regimens that do not have activity against enterococcus. However, regimens that include specific enterococcal coverage are recommended if these organisms grow in a pure culture from an intra-abdominal source of infection or from the blood.*93/348/5*
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WOMEN AS VICTIMS OF DOMESTIC VIOLENCE
Comments OffWhile young men are more apt to become victims of violent acts perpetrated by strangers, women are much more likely to become victims of violent acts perpetrated by spouses, lovers, ex-spouses, and ex-lovers. In 1999, more than 6 million women were victims of assault. In fact, 6 of every 10 women in the United States will be assaulted at some time in their lives by someone they know. Every year, approximately 12 percent of married women are the victims of physical aggression perpetrated by their husbands, according to a national survey. These acts of aggression are committed in anger and often include pushing, slapping, and shoving.Some women experience much more severe acts of aggression. Each year about 4 percent of married women are the victims of violence that takes the form of beating and/or threats of or actual harm caused by use of a knife or a gun. In fact, acts of aggression by a husband or boyfriend are one of the most common causes of death for young women, and roughly 2,200 women in the United States are killed each year by their partners or ex-partners. Over a recent 10-year period, according to the National Crime Survey, on average, more than 2 million assaults on women occurred each year. More than two thirds of these assaults were committed by someone the woman knew.The following U.S. statistics indicate the seriousness of this long-hidden problem:- The most vulnerable female victims are African American and Hispanic, live in large cities, are young and unmarried, and are far from their families.- Every 15 seconds, someone batters a woman.- Only 1 in every 250 such assaults is reported to the police.- More than a third of women victims of domestic violence are severely abused on a regular basis.- About five women are killed every day in domestic violence incidents.- Three of every four women murdered are killed by their husbands.- Domestic violence is the single greatest cause of injury to women, surpassing rape, mugging, and auto accidents combined.- About 25 to 45 percent of all women who are battered sustain such attacks during pregnancy.- One quarter of suicide attempts by women occur as a result of domestic violence.How many times have you heard of a woman who is repeatedly beaten by her partner or spouse and asked, “Why doesn’t she just leave him?” There are many reasons why some women find it difficult, if not impossible, to break their ties with their abusers. Many women, particularly those with small children, often are financially dependent on their partners. Others fear retaliation against themselves or their children. Some women hope that the situation will change with time (it rarely does), and others stay because their cultural or religious beliefs forbid divorce. Finally, some women still love the abusive partner and are concerned about what will happen to him if they leave.Psychologist Lenore Walker developed a theory known as the “cycle of violence” to explain how women can get caught in a downward spiral without knowing what is happening to them. The cycle has three phases:1. Tension building. In this phase, minor battering occurs, and the woman may become more nurturant, more pleasing, and more intent on anticipating the spouse’s needs in order to forestall another violent scene. She assumes guilt for doing something to provoke him and tries hard to avoid doing it again.- Acute battering. At this stage, pleasing her man doesn’t help and she can no longer control or predict the abuse. Usually, the spouse is trying to “teach her a lesson,” and when he feels he has inflicted enough pain, he’ll stop. When the acute attack is over, he may respond with shock and denial about his own behavior. Both batterer and victim may soft-pedal the seriousness of the attacks.- Remorse/reconciliation. During this “honeymoon” period, the batterer may be kind, loving, and apologetic, swearing he will never act violently toward the woman again. He may “behave” for several weeks or months, and the woman may come to question whether she overrated the seriousness of past abuse.- Then the kind of tension that precipitated abusive incidents in the past resurfaces, the man loses control again and he once more beats the woman.Unless some form of intervention breaks this downward cycle of abuse, contrition, further abuse, denial, and contrition, it will repeat itself again and again – perhaps ending only in the woman’s, or rarely, the man’s death.It is very hard for most women who get caught in this cycle of violence (which may include forced sexual relations and psychological and economic abuse as well as beatings) to summon up the courage and resolution to extricate themselves. Most need effective outside intervention.*2/277/5*
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WHO GETS OCD: MARTIN LUTHER AND IGNATIUS OF LOYOLA
Comments OffLastly, we may consider two great historical figures who, even though they were bitter enemies, had much in common. Both marked turning points in 1521: Luther was condemned by the Catholic Church as a heretic; and Ignatius of Loyola experienced religious conversion. Both men started great movements: Luther, the Reformation; and Ignatius, the Jesuits. Both men, too, suffered obsessions.Martin Luther underwent severe mental turmoil with obsessions and depression. In Young Man Luther, the psychiatrist Erik Erikson notes that during his first years in the monastery, Luther’s mental state was so disrupted that “it seems entirely probable that young Luther’s life at times approached what today we might call a borderline psychotic state.” Ignatius endured similar, if not quite so severe, afflictions. W. W. Meisner, M.D., writes in his biography Ignatius of Loyola that Ignatius’s early life was “filled with inner torment” due to “intense, destructive obsessions.”Luther and Ignatius both endured tormenting obsessional doubts and, to a lesser degree, other types of obsessions as well. Religious doubts, a form of scruples, were indeed a common problem in past centuries; they qualify as obsessions when they are persistent, tormenting, and recognized as inappropriate. Luther writes in his Commentary on Galatians:
When I was a monk I thought that I was utterly cast away. If at any time I felt fleshly lust, wrath, hatred, or envy against any brother, I assayed many ways to quiet my conscience, but it would not be; for the lust did always return, so that I could not rest, but was continually vexed with these thoughts: This or that sin thou hast committed: thou art infected with envy, with impatiency, and such other sins.
Because of these excruciating scruples, Luther could not feel certain that he had confessed all his sins. He would confess for hours and hours, splitting his transgressions smaller and smaller. He would go back to childhood and endlessly enumerate possibly sinful acts. After finishing he would ask for special appointments to correct previous statements. His preceptors, confused by his possessiveness, threatened to punish him for obstruction of confession. As quoted in The Way of Interior Peace, one of them told Luther: “You have no real sins with which to reproach yourself. . . give up your nonsensical and ludicrous notions.”Ignatius suffered similar battles with confessional scruples. He writes in his autobiography St. Ignatius’ Own Story:
Even though I had confessed . . . my scruples returned, each time becoming mote minute, so that I became quite upset, and although I knew that these scruples were doing me much harm, and that it would be good to be rid of them, I could not shake them off. … I continued with my seven hours of prayer on my knees, rising faithfully every midnight, and performing all the other exercises. But nothing provided me with a cute for my scruples.
Luther and Ignatius also suffered violent and blasphemous obsessions. Luther once declared at the dinner table that the sight of a knife conjured up “painful pictures” before him. He writes: “For more than a week I have been thrown back and forth in death andHell; my whole body feels beaten, my limbs are still trembling. I almost lost Christ completely, driven about on the waves and storms of despair and blasphemy against God.” Ignatius notes: “While these thoughts were tormenting me, I was frequently seized with the temptation to throw myself into an excavation close to my room. But, knowing that it was a sin, I cried again: ‘Lord, I will do nothing to offend you,’ and I frequently repeated these words.”Who knows how many other great historical figures suffered obsessions? Charles Darwin, arguably the single most influential scientist who ever lived, suffered frequent attacks of heart palpitations, shortness of breath, fainting, a buzzing noise in his head, stomach pains, and eczema. Most of his recent biographers agree that he had panic disorder. Darwin’s letters and diaries suggest he may have also been plagued by obsessions. Darwin mentions having “much involuntary fear” and sudden “insane feelings of anger.” He reports: “I awake in the night and feel so much afraid, though my reason laughs and tells me there is nothing to fear. … By habit the mind fixes on the same object.” In the 1977 medical biography of Darwin, To Be an Invalid, Ralph Cope, Jr., M.D., concludes that Darwin was “tortured by obsessional thoughts.”*19/338/2* -
Salmonella typhi and Salmonella paratyphi most commonly cause typhoid, or enteric fever, in which an acute febrile illness is preceded by ingestion of the organism and a short course of diarrhea, which resolves before the onset of fever. Non-typhoidal Salmonella, however, is the most common cause of food-borne diarrhea, transmitted via contaminated meats, poultry, eggs, and dairy products. Food handlers can be reservoirs. Rarely, outbreaks are water-borne or from Pet reptiles, which are frequently carriers. Patients with non-typhoidal illness often present with nausea, vomiting, and diarrhea 6 to 48 hours after ingestion of contaminated food. Abdominal pain and fever are common, but bloody stools occur less frequently. Stool examination reveals leukocytes, and routine cultures will be positive in 58% of cases.Most cases of gastroenteritis resolve without treatment in 3 to 7 days.Symptoms of colitis may persist for several weeks. Treatment can prolong the fecal excretion of organisms and should be avoided in mild cases. Antibiotics should be given to patients with severe symptoms, at extremes of age, with immunosuppression, with cardiovascular disease, or with a prosthesis, as the organism has a propensity to infect vascular aneurysms and prosthetic joints. Carriage of non-typhoidal salmonella can persist for 4 to 5 weeks after resolution of diarrhea. Fluoroquinolones, ampicillin, and trimethoprim-sulfamethoxazole are acceptable agents to treat Salmonella infection. Length of treatment is usually 1 week, but if the patient is bacteremic or focally infected, longer courses are necessary.*67/348/5*
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DIAGNOSING CHILDREN WITH EPILEPSY
Comments OffThere are special difficulties in diagnosing the child with epilepsy. Children, and especially adolescents, do behave strangely at times. At school, children with absence seizures may be accused of day-dreaming or lack of concentration, considered disobedient or inattentive. In adolescents especially, the irrational and sometimes truculent behaviour associated with partial complex seizures is often mistaken for a disorder of behaviour.But equally, there are serious consequences for the child if he or she is mistakenly diagnosed as having epilepsy when what they are actually suffering from is some other episode of disturbed behaviour. Breath-holding attacks and night terrors in young children, temper tantrums, fainting in school assembly and migraine are all sometimes confused with epilepsy.One of the most difficult things about epilepsy is its unpredictability and uncertainty. Even when your child has been diagnosed as having epilepsy, it may take some weeks before the pattern of their fits has been worked out, and the best medication for them has been found. You will want to know what the long-term prospects are for your child, and whether he or she will outgrow their epilepsy, and these are predictions that your doctor may be reluctant to make straight away. If there is a strong family history of epilepsy, the chances are good that your child will improve after adolescence or even that they will outgrow their epilepsy by the time they are 16.*66\193\2*
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VACATIONS – ADVICES (PART 2)
Comments Off• Drink lots of water during your vacation.• Check out the local dishes, especially if your vacation is in a foreign country. If they are fried, dipped in batter, sugary, or salty —avoid them. If they are fresh, natural, light, and still tasty— enjoy. If you try a national dish that turns out to be covered in sauce, gravy, or cream, pick out the chunks without sopping up the sauce. Avoid raw foods and tap water in foreign countries. Fresh fruits that can be peeled or husked are okay.• Lay off the bread products, no matter how good.• Stop at grocery stores and outdoor markets for fresh foods, rather than at roadside restaurants or greasy spoons. A rotisserie chicken, some carefully chosen cheese (Laughing Cow makes a reduced-calorie cheese that is only 35 calories per three-quarter-ounce triangle), and fresh fruit will make a much better meal than one eaten at a fast-food restaurant. It’s no harder to get off the freeway to stop at a supermarket than it is to get to a restaurant. Most major cities in America (and around the world for that matter) have markets that are tourist attractions—pay them a visit and enjoy.More and more, there are vacation spots that advertise low-calorie fare, exercise programs, and overall health benefits. There is a Club Med vacation where a doctor will check you out and tell you exactly what to eat. There are sports-oriented vacations: tennis camps, rafting trips, climbing trips, trekking, and so forth. You can get away from it all, have a great time, and come home thin.*144/243/1*
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SKIN DISORDERS IN ADULTS: LIFTING AND RIDGED NAILS
Comments OffLifting NailsLike flaky, weak nails, this condition occurs almost exclusively in women. Here the end of the nail plate lifts off its bed, leading to a secondary infection with Candida. Accidentally banging the nail on a hard object will cause the nail to either break or lift off its bed, especially if the nails are long and hard. Again, repeated wetting and drying of the nails can cause them to separate from the nail beds.Lifting of the nails can be prevented by keeping your nails moderately short, wearing cotton gloves inside rubber or vinyl gloves for all wet work and making sure your nails are properly dried (by using a hair dryer) when they get wet.Once the nails have lifted, secondary infection usually occurs, which requires treatment with anti-fungal lotions such as Canestan or Dakarin. Oral antibiotics are of no use.
Ridged NailsAs people get older, their nails become more ridged, in a similar way to wrinkles appearing on the skin. There is no specific treatment for this condition.
*54/150/5*