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TUMOR RECURRENCE AND TAMOXIFEN RESISTANCE: WHAT CAUSES DRUG RESISTANCE?

Posted on July 28, 2011, under Cancer.

Cancer cells develop resistance to specific types of drugs in many ways. Perhaps one of the first steps is exposure of the cells to concentrations of drug that are not high enough to kill them. A patient may have been given a dose of chemotherapy that is too low, or a standard dose may have been administered to a patient who has faster metabolism or excretes drugs more rapidly than the average person. Thus, the cells are exposed to low concentrations of drug without being killed. The resulting cancer cells are now “educated” about how to deal with the drug, so that even if the next dose is higher, the cells have a better chance of fending off its toxic effects. That is why chemotherapy drugs must be given in doses that are high enough to kill the cancer cells but below the level that causes severe side effects.
Once cancer cells have been exposed to a specific drug in concentrations that have not killed it, the cells may develop a number of techniques to handle the drug and keep themselves from being killed. Perhaps the most common mechanism that breast cancer cells adopt is the ability to pump the drug outside the cell (55, 56). This action occurs even in normal cells, where it functions to protect the cells from toxins during everyday life (dietary or environmental toxins, for instance).
Cancer cells have other methods of becoming drug resistant. In the case of methotrexate they actually go through elaborate changes in their biochemistry after exposure to the drug. The cancer cells have the ability to increase the amount of protein that is the target for methotrexate—an enzyme called dihydrofolate reductase. With augmented production of the enzyme, the cells have found a way to protect themselves from the lethal effects of the chemotherapy agent.
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ALTERNATIVES TO HRT: ‘NATURAL’ PROGESTERONE AND OESTROGEN

Posted on July 17, 2011, under Women's Health.

You need to be aware that progesterone creams contain a powerful pharmaceutical hormone that is made in a laboratory. Because the US FDA (Food and Drug Administration) won’t allow the manufacturers of the creams to make medical claims, they are sold as cosmetics, not as hormone replacements. It is because these creams contain a pharmaceutical agent that the UK’s Medicines Control Agency will only let them be sold under prescription, and rightly so. My main concern is that women are being duped into thinking they are buying a natural herbal remedy containing wild yam. They are not: they are buying hormone replacement – just a different hormone (progesterone instead of the usual HRT combination of a form of oestrogen plus progestogen). And they may not be buying anything truly to do with wild yam, which has a very respectable reputation as a herbal treatment for menstrual and menopausal problems. Although for centuries, herbalists have indeed used wild yam in a tincture form, the effect of the herb in its pure state is very different from that of the synthesized progesterone. This wild yam is taken orally and has traditionally been used as an anti-spasmodic and anti-inflammatory herb. As is the case with so many effective herbs it is not known precisely how it acts on the body. Since the essence of herbal medicine is that all the ingredients help towards the overall therapeutic effect, diosgenin alone cannot be responsible for the wild yam’s beneficial qualities. Herbs work because they contain a host of substances – active substances, balancing substances and substances that cope with any side effects of the active substances. They are holistic and truly ‘natural’. But the ‘natural’ progesterone that is being hyped is no more ‘natural’ than a number of the plant-based oestrogen preparations that form the basis of some HRT products.
These oestrogens are ‘natural’ in the same sense that plant-based progesterone is classed as ‘natural’. The oestrogens too are synthesized in the laboratory from soya beans and yams. They still have side effects, however. We need to be clear that these hormones, oestrogen and progesterone, which are synthesized in a laboratory from plants, are not natural to us. They may be chemically identical to what our bodies produce but they are powerful drugs, hence the need to put them on prescription. Plant-based progesterone is termed ‘natural’ because it has the same molecular structure as the progesterone molecule found in humans. This idea of different substances being chemically identical can be very misleading. For example, coal, diamond and graphite (the ‘lead’ in your pencil) are all chemically identical and yet they have very different properties and functions. They have the same molecular structure, but you wouldn’t expect to produce much heat by putting diamonds on the fire.
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REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: TYPES I AND II DIABETES

Posted on July 3, 2011, under Cardio & Blood-Сholesterol.

Type l diabetes often occurs in younger people (it used to be called juvenile-onset diabetes) and affects about 1 million Americans. It is caused by decreased or no insulin production by the pancreas. The high blood levels of glucose (called hyperglycemia: hyper means “high,” give means “sweet,” emia means “in the blood”) must be regulated by insulin injections to compensate for the deficiency of insulin production.
Type II diabetes is much more common than type I diabetes. It is known to affect at least 7 million Americans. Another 5 to 7 million people probably have type II diabetes but are unaware of it. More than 75 percent of people who have type II diabetes are over- weight. Evidently, obesity is a “trigger,” causing diabetes to develop in genetically vulnerable people. For them, the problem is both a deficiency of insulin and an inability of their body’s cells to respond appropriately to the insulin that is there. Evidence is mounting that exercise lowers the risk of type II diabetes developing, even in people who are overweight or who have a family history of diabetes. The best treatment for type II diabetes is weight loss, but if this is not achievable, then oral medications, or insulin injections, may be required.
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KNEE FRACTURE: STRESS FRACTURES

Posted on June 21, 2011, under Healthy bones Osteoporosis Rheumatic.

“I played a lot of tennis over the weekend, and I woke up Monday morning and my knee was killing me. I limped around for a week or so, and then I felt a lot better.” When I hear this kind of complaint from a patient who otherwise checks out to be completely normal, I immediately consider the possibility that he may have had a stress fracture. A stress fracture is a microscopic crack in the bone’s surface. Although it is not a serious injury, it can be a very painful one.
Stress fractures can occur when bones are overworked. If you sliced a piece of bone and looked at it under a high-powered microscope, you would see that bone is a hotbed of activity. Bone cells are constantly engaged in a process called remodeling: new bone is being laid down by bone-building cells called osteoblasts while old bone is being absorbed by cells called osteoclasts. In fact, an adult skeleton turns over every 7 years, and a child’s skeleton turns over even more rapidly. Stress fractures can occur when normal force is applied to bone at a time when it is remodeling. Overworked and overstressed, the bone gives way, resulting in microscopic cracks. The only symptom of a stress fracture is pain and tenderness to the touch. Most people have had stress fractures at one time or another and may not have even have realized it. The pain may be here one day and gone the next, and all is forgotten. However, if the pain persists—and sometimes it does—it may warrant an examination by a physician, mostly to rule out other potential problems.
Diagnosis
Physical Examination. The only positive finding on a physical examination is localized tenderness at the site of the stress fracture. Occasionally, there might be associated swelling. The stress fracture is rarely, if ever, intraarticular (within the joint) but more characteristically on the tibia (shinbone).
An MRI or Bone Scan. Because it is so small, a stress fracture cannot be detected on plain X rays until the bone begins to heal, and the body lays down a callus, a layer of new bone over the crack. A normal X ray may not be able to pick up an early stress fracture, but a bone scan or an MRI will note the increased vascularity, which will have a characteristic pattern for stress fractures.
Treatment
Stress fractures normally heal by the themselves within 3 to 6 weeks. Ice and over-the-counter analgesics can help to relieve pain. Any activity that causes a great deal of discomfort during this healing period should be avoided, otherwise, you can pursue your usual activities.
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SURGICAL APPROACHES TO EPILEPSY: SURGERY FOR PARTIAL (FOCAL) SEIZURES – EVALUATION OF LANGUAGE

Posted on June 19, 2011, under Epilepsy.

Speech is usually located on the left side of the brain, in the posterior temporal lobe (see Chapter 6). However, in 10 to 15 percent of left-handed people speech is on the right side. It is vital to know where it is before proceeding with surgery.
The Wada test, named after the neurosurgeon Dr. Juhn Wada, is designed to localize speech and memory. A catheter is threaded from the groin of the awake patient up to the internal carotid artery, the main artery supplying one side of the brain. After a small injection of a dye, which can be seen on x-ray, a small amount of barbiturate is injected and that side of the brain is briefly “put to sleep.”
As the test begins, the patient is asked to hold his arms up in the air and to count. If the injection is done on the left side of the brain, the right arm becomes weak as the left side of the brain goes “to sleep.” If speech is on that same side, the child will simultaneously, but briefly, lose the ability to speak or count. Memory is also tested by showing objects and pictures. When the medication wears off, the patient will be asked to recall the objects he has seen. If lost, speech and memory quickly return when the drug wears off. In this crude fashion the laterality (side) of speech is determined. The same procedure may also be carried out on the other side of the brain, because occasionally speech is located on both sides.
If injecting the right side produces no alteration in speech or memory, then it can be assumed that it is safe to operate on that side. If speech is on the left and the surgery is to be done near that area, then far more careful evaluation of speech, language, and the epileptic focus must precede a decision about surgery.
Detailed neuropsychological testing may be performed prior to surgery to assess the person’s intellectual function and personality. This may help in understanding if certain parts of the brain previously have been damaged.
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DIABETES AND EXERCISE THERAPY: EXERCISE AND TYPES-1,2 DIABETES EXERCISE AND TYPE-1 DIABETES

Posted on June 8, 2011, under Diabetes.

Special Instructions:
General guide lines for type-1 diabetes patients.
1. Metabolic control before exercise.
avoid exercise if FBS>250 + ketosis.
avoid exercise if FBS>300 without ketosis.
Ingested added carbohydrate if glucose levels are <100 mg/dl.
2. Blood glucose monitoring before and after exercise.
Identifying when changes in insulin or food intake are necessary.
Learn the blood sugar responses to different exercise conditions.
3. Food Intake
Consume added carbohydrate as needed to avoid hypoglycaemia (low sugar reactions).
Carbohydrate food should be readily available during and after exercise.
Extra food for extra exercise.
EXERCISE AND TYPE-2 DIABETICS (NON -INSULIN
DEPENDENT OR INSULIN REQUIRING DIABETICS)
In type 2 diabetes insulin resistance syndrome is one of the important risk factor for premature CAD, concomitant hypertension, hyperinsulinaemia, central obesity, hypertriglyceridaemia, Low HDLC, high LDL, elevated FFA.
Important: In many of these, risk factors are linked with improvement (decrease) in plasma insulin levels and it is likely that many of the beneficial effects of exercise on cardiovascular risk are related to improvement in insulin sensitivity.
HYPERLIPIDEMIA
VLDL   …. Regular exercise effective in reducing levels of Triglyceride (TG) richVLDL.
LDL     …. However, effects on LDL by regular exercise have not been
consistently documented. HDL    …. Most studies fail to document increase in HDL cholesterol with
type 2 diabetes.
HYPERTENSION
Effects of exercise on reducing blood pressure levels have been demonstrated most consistently in hyperinsulinemic subjects.
OBESITY
Data suggesting that exercise may enhance weight loss when used along with appropriate caloric controlled meal plan.
FIBRINOLYSIS
Many patients with type 2 diabetes have impaired fibrinolytic activity associated with elevated levels of plasminogen activator inhibitor-1 (PAI-1). There is no clear cut consensus whether physical training results in improved fibrinolytic activity in these patients.
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SEXUALITY AND CANCER

Posted on May 29, 2011, under Cancer.

Because gynecological cancer relates specifically to the reproductive system and body parts that create our ‘sexual’ identity, the impact on sexuality and fertility can have significant consequences on a woman’s sense of self and intimate future.
An intimate relationship is one of life’s great joys. This can be expressed in a variety of ways, most commonly in sexual activity. Equally joyful is an intimate relationship with ourselves that reassures us, as women, that we are feminine and valued as sexual beings despite changes to our body. Just because we may have had radical treatment to save our life, treatment that changes our physical and gynecological self, does not mean we are ‘sexless’.
Immediately after a cancer diagnosis the primary focus for many women is on the physical issues around restoring good health. Sexual activity and other expressions of intimacy are often foregone, ignored or delayed as women come to terms with the impact of the medical (physical) treatment that has to be undergone to survive. It is only after one has come to terms with the physical coping that the realization of the impact on fertility, sexuality, body image, intimacy emotions and spirituality becomes apparent. The way in which this initial ‘physical’ phase is managed has an enormous impact on the way a woman will not only resume her life, but also in the way she sees her self as sexually relevant and ‘female’.
Whilst issues are relevant for all women independent of sexual preference, identity or relationship status we have included specific information for lesbians as research shows that these women have particular issues when dealing with gynecological cancer.
Many women at the time of diagnosis still see themselves as sexually desirable, despite body shape or age. Others have been celibate for some time either by choice or due to factors such as widowhood, and therefore body image and sex are not that relevant in the greater scheme of their life activities.
The range of women we interviewed covered the broad spectrum of relationships of all ages and stages in the life cycle – single, divorced, newly married, long-term married, lesbian, new mother experiences. The quality of their sexual activity and levels of intimacy was determined by the quality of the relationship prior to the diagnosis. Those in stable, caring relationships with good communication between them restored the intimate aspects of life far quicker than those whose relationships were in jeopardy before diagnosis.
Fertility issues were significant for all pre-menopausal women despite the status of their relationship. Young single women were concerned about the possibility of forming a long-term relationship. Many women, regardless of age, found it difficult to accept the surgical scars and saw them as a barrier initially to resuming or forming intimate relationships. The good news is that all these reactions are entirely normal in the process of recovery. The better news is that most of these feelings and reactions only last for a short time.
Do you know that the quicker intimacy can be resumed after a cancer diagnosis, the quicker your self-esteem and body image issues can be resolved?
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ALCOHOLICS ANONYMOUS

Posted on May 17, 2011, under Anti Depressants-Sleeping Aid.

Volumes have been written about the phenomenon of AA. It has been investigated, explained, challenged, and defended by laypeople, newspapers, writers, magazines, psychologists, psychiatrists, physicians, sociologists, anthropologists, and clergy. Each has brought a set of underlying assumptions and a particular vocabulary and professional or lay framework to the task. The variety of material on the subject reminds one of trying to force mercury into a certain-sized, perfectly round ball.
In this brief discussion, we certainly have a few underlying assumptions. One is that “experience is the best teacher.” This text will be relatively unhelpful compared to attending AA meetings over a period of time, watching and talking with people in the process of recovery actively using the program of AA. Another assumption is that AA works for a wide variety of people caught up in the disease and for this reason deserves a counselor’s attention. Alcoholics Anonymous has been described as “the single most effective treatment for alcoholism.” The exact whys and hows of its workings are not of paramount importance, but some understanding of it is necessary to genuinely recommend it. Presenting AA with such statements as “AA worked for me; it’s the only way,” or, conversely, “I’ve done all I can for you, you might as well try AA,” might not be the most helpful approach.
History
Alcoholics Anonymous had its beginnings in 1935 in Akron, Ohio, with the meeting of two alcoholics. One, Bill W, had had a spiritual experience that had been the major precipitating event in beginning his abstinence. On a trip to Akron after about a year of sobriety, he was overtaken by a strong desire to drink. He hit upon the idea of seeking out another suffering alcoholic as an alternative. He made contact with some people who led him to Dr. Bob, and the whole thing began with their first meeting. The fascinating story of this history is told in AA Comes of Age. The idea of alcoholics helping each other spread slowly in geometric fashion until 1939. At that point, a group of about a hundred sober members realized they had something to offer the thus far “hopeless alcoholics.” They wrote and published the book Alcoholics Anonymous, generally known as the Big Book. It was based on a retrospective view of what they had done that had kept them sober. The past tense is used almost entirely in the Big Book. It was compiled by a group of people who over time, working together, had found something that worked. Their task was to present this in a useful framework to others who might try it for themselves. This story is also covered in AA Comes of Age. In1941, AA became widely known after publication of an article in a national magazine. The geometric growth rapidly advanced, and in 1983 there were an estimated 1 million active members world wide.
Goals
Alcoholics Anonymous stresses abstinence and contends that nothing can really happen for a drinker until “the cork is in the bottle.” Many other helping professionals tend to agree. A drugged person-—and an alcoholic is drugged—simply cannot comprehend, or use successfully, many other forms of treatment. First, the drug has to go.
The goals of each individual within AA vary widely; simple abstinence to a whole new way of life are the ends of the continuum. Individuals’ personal goals may also change over time. That any one organization can accommodate such diversity is in itself something of a miracle.
In AA, the words sober and dry denote quite different states. A dry person is simply not drinking at the moment. Sobriety means a more basic, all-pervasive change in the person. Sobriety does not come as quickly as dryness and requires a desire for, and work toward, a contented, productive life without reliance on mood-altering drugs. The Twelve Steps provide a framework for achieving this latter state.
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HIV: SKIN PROBLEMS-BLISTERING RASH: HERPES SIMPLEX INFECTION

Posted on May 9, 2011, under HIV.

Blisters are small, fluid-filled bubbles that often break, becoming open sores filled with clear fluid or pus. Blisters can occur in groups in one specific area of the skin, or they can be distributed all over the skin.
Like red rashes, blistering rashes can be caused by adverse reactions to drugs. The most common causes of blistering rash in people with HIV infection, however, are two related viruses, herpes simplex and herpes zoster.
Herpes simplex infection-Infection by the herpes simplex virus is extremely common in healthy people. There are actually two different types of herpes simplex viruses: Type I and Type II. Type I most frequently causes the infection of the mouth called cold sores. Type II causes sores on the genitals and the anal region and is regarded as a sexually transmitted disease. Herpes simplex hides in nerve cells and periodically becomes active, causing recurrent blistering rashes. In people with weakened immune systems, herpes simplex can also affect skin on other parts of the body, and can even affect the internal organs.
Blood tests show that 15 percent to 50 percent of otherwise healthy people have one or both types of herpes simplex. Most of these people have either no problems or rare outbreaks; some have attacks more frequently, but these are brief, not severe, and restricted to the lips or genitals. By contrast, people with advanced HIV infection can have herpes simplex infections that cover a larger area of the skin, can be more painful, and can last longer.
Treatment with an antiviral drug called acyclovir (commercial name, Zovirax) usually controls symptoms. Acyclovir is available as pills and as ointment to be applied directly to the sores; when infection is severe, acyclovir can be taken intravenously. Treatment does not eliminate the virus. As a result, the infection can recur; recurrence can often be prevented or at least reduced in frequency by taking acyclovir pills.
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SKIN DISORDERS: DIFFERENT TREATMENT OF PSORIASIS

Posted on April 28, 2011, under Skin Care.

Topical cortisone creams
Topical cortisone creams are probably the most popular form of treatment. They are safe, cosmetically acceptable and do not stain clothing. They are generally helpful but by themselves do not usually clear the lesions. They are most useful when used in combination with other treatments.
Tar creams
Tar creams have been used for centuries and there is no doubt that they are useful in psoriasis although they rarely completely clear the lesions. They are more helpful when used in conjunction with ultraviolet light and their effectiveness varies, depending on where the tar comes from. The main problem with tar creams is that they are messy, smelly and often stain clothing. They are very useful, however, when used on the scalp as tar-based shampoos.
Dithranol cream
Dithranol cream has been used since the 1930s. It is extremely effective in psoriasis and can completely clear the lesions. The main problem with Dithranol is that it stains skin, hair, clothing and bed linen. If a cream containing triethanolamine is used after Dithranol cream, however, staining can be significantly reduced. Dithranol can burn the skin, especially in the first few days of use. Nonetheless, it is very safe and effective and so is still frequently used.
Sunlight
Sunlight has been used in treating psoriasis since at least Egyptian times. It is not certain how this treatment works, although recent studies suggest that it affects the immune system.
The main problem with this treatment is that sunlight is not available all year round and certain parts of the anatomy cannot be modestly exposed to it. Moreover, excessive exposure to sunlight carries with it the risk of skin cancer. Sunlight is, however, a very popular form of treatment where it is readily available. The Dead Sea region in Israel is renowned for its psoriasis treatment centers, and it seems the sunlight is more important than the Dead Sea minerals in treating the condition.
Artificial sunlight
Artificial ultraviolet В light is effective in treating psoriasis, but requires careful monitoring and preferably should be performed in a doctor’s surgery, so that burning will not occur. The main risk of this treatment is the possibility of developing skin cancer in the long term. For this reason it is not a good idea to use sunlamps at home – it is easy to ‘overdose’, causing significant burns and even cancer.
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