Health tips

Fit for Hot Weather Summer weather is no excuse to “chill out” indefinitely in your air-conditioned family room. The guideline still applies: Get 60 minutes of moderate activity every day if you can. In the summer heat, try air-conditioned action, such as indoor mall walking or inside home improvement projects. Enjoy summer-time sports such as swimming, bicycling, tennis, canoeing, or in-line skating. Active outdoor leisure can include early-morning or late-afternoon walks, nature hikes, playing with your kids in the sprinkler. And remember outdoor chores, like gardening and car, bike, or dog washing. For safety’s sake in hot, steamy weather: • Dress for it.Wear a hat to shade your head and light-colored, light-weight, loose-fitting clothes. • Stay hydrated.Drink plenty of fluids. Even when you swim, you sweat. • Go easy. Wait until later in the day if the heat, humidity, and air quality are potentially dangerous. • Wear sunscreen. Fillet of sole with port Prep: 20 minutes Cook: 30…

Since the 1960s, researchers have bombarded us with information on everything we can do to keep our heart strong and our arteries clear—what to eat to lower our cholesterol, keep our arteries from clogging, and the rhythms of our heartbeat regular. But what about the brain? It, too, scientists now know, is greatly influenced by what we eat. In fact, few people realize that brain cells are even more sensitive than other body cells to nutrients and dietary chemicals which determine at any moment how your brain functions or malfunctions. Unquestionably, the brain is our most precious physical possession, the seat of our entire being—our intelligence, personality, our humanity, our mind, and soul. Nothing is more central to a successful and fulfilling life than an optimally functioning brain. Failure to achieve a brain’s full intellectual, creative, and emotional potential is a personal tragedy for millions of people, handicapping them from birth to death. Losing one’s mind, from psychiatric diseases, nutritional ignorance, and premature…

Basics Description Intimal tear in the aorta resulting in hematoma formation. Accumulating blood in false lumen of arterial wall leads to propagation of dissection (1): Stanford classification (most widely used): Type A: Involves ascending aorta and aortic arch regardless of site of intimal tear Type B: Involves descending aorta DeBakey classification (based on origin site): Type 1: Originates in ascending aorta, propagates at least as far as aortic arch Type 2: Involves only ascending aorta Type 3: Originates in descending aorta, may propagate proximately or distally Svensson: Class 1: Classic dissection with true and false lumen Class 2: Intramural hematoma or hemorrhage Class 3: Subtle dissection without hematoma Class 4: Atherosclerotic plaque rupture and ulceration Class 5: Iatrogenic Synonym: Dissecting aneurysm Epidemiology Predominant age varies with cause Type A dissection average age 60 Type B dissection patients generally older Patients with Marfan syndrome have mean age 36 Approximately 2/3 of…

Basics Description The Diagnostic and Statistical Manual of the American Psychological Association , Revised Fourth Edition (DSM-IV-R) recognizes generalized anxiety disorder (GAD) as a persistent, excessive, and difficult-to-control anxiety with significant symptoms of motor tension, autonomic hyperactivity, and/or disturbances of sleep or concentration lasting >6 months. System(s) affected: Nervous (resulting in increased sympathetic tone and increased catecholamine release) Epidemiology Prevalence 12-month prevalence rate: 3.1% Lifetime prevalence rate: 5.7% Onset can occur any time in life, from adolescence to adulthood. Predominant age: Median age of onset in US is 31 years. Predominant sex: Female > Male (2:1) Risk Factors Caucasian race Adverse life events, including medical illness, disability, and unemployment Family history Lack of social support Increase in stress Lesbian/bisexual women at increased risk above heterosexual women; no increased risk found for homosexual/bisexual men Depression Genetics GAD and major depression are strongly linked in heritability studies. A variant of the serotonin…

Basics Description Antithrombin is a protease that inhibits thrombin by forming an irreversible thrombin-antithrombin complex. Antithrombin can also inhibit factors Xa, IXa, and XIa. This process is catalyzed by the presence of heparin. Patients deficient in antithrombin have an increased incidence of venous thrombosis, including deep vein thrombosis (DVT) of the lower extremity. Arterial thrombosis is much less common in patients deficient in antithrombin: System(s) affected: Cardiovascular; Nervous; Pulmonary; Reproductive; Hemic/Lymphatic/Immunologic Synonym(s): Antithrombin III deficiency Epidemiology Predominant age: Mean age of 1st thrombosis is in 2nd decade. Predominant sex: Male = Female Incidence 4% of patients with thrombophilia Prevalence 0.16% of normal individuals Risk Factors Oral contraceptives, pregnancy, and the use of hormone replacement therapy (HRT) increase the risk of venous thrombosis in patients with antithrombin deficiency. Patients with antithrombin deficiency and another prothrombotic state, such as factor V Leiden or the prothrombin 20210 mutation, have increased rates of thrombosis….

Basics Description Antiphospholipid antibody syndrome (APS) is an autoimmune thrombotic syndrome characterized by the presence of antiphospholipid antibodies (APAs) in association with either recurrent venous or arterial thromboembolic events or repeated fetal loss. The antiphospholipid antibodies are directed against phospholipid-binding plasma proteins and cause an increased risk of clot formation. Types: Primary (50%): Occurs in patients without clinical evidence of another autoimmune disease Secondary: Occurs in association with another disease, most commonly systemic lupus erythematosus (SLE) Catastrophic APS (<1%): Differs from primary and secondary types in the caliber of vessels affected. Venous or arterial thrombosis of large vessels is less common, and patients present with acute thrombotic microangiopathy, the kidneys being the most commonly affected organ. DIC, which does not occur in primary or secondary forms, is seen in up to 25% of patients with the catastrophic type Has a high mortality, approaching 50% even with treatment Synonym(s): Hughes syndrome…

Basics Description Anthrax is a highly infectious disease of animals, especially ruminants (hooved animals such as cows, goats, and sheep) that is caused by the bacteria Bacillus anthracis. Cutaneous (95% of US cases), inhalational, and GI forms can be transmitted to humans by contact with the animals or their products (typically hair or hides). Synonym(s) for cutaneous anthrax: Charbon; Malignant pustule; Siberian ulcer; Malignant edema; Splenic fever; Milzbrand Synonym(s) for inhalational anthrax: Ragpicker disease; Woolsorter disease Epidemiology Total of 235 anthrax cases (224 cutaneous and 11 inhalational) occurred in the US between 1955 and 1994, resulting in 20 fatalities. Cutaneous: 95% of cases in the US; cases of cutaneous anthrax without occupational risk should raise concern for bioterrorism. ∼5–20% of untreated cases result in death; case fatality rate is <1% with antibiotic therapy. GI: Very rare in the US (no documented case in the 20th century). Inhalational anthrax is very…

Basics Description Refusal to maintain normal body weight, with associated fear of weight gain, body-image disturbance, and amenorrhea Restricting and binge eating/purging subtypes System(s) affected: Cardiovascular; Endocrine; Metabolic; GI; Nervous; Reproductive Epidemiology Predominant age: 13–20 years Predominant sex: Female > Male (20:1) Global distribution Incidence 8–19 women, 2 men per 100,000 population per year Prevalence 0.9% in women 0.3% in men (higher in gay and bisexual men) Risk Factors Female gender Body dissatisfaction Perfectionism, obsessionality, rigidity Negative self-evaluation Academic and other achievement pressure Severe life stressors Participation in sports or artistic activities that emphasize leanness or involve subjective scoring: Ballet, running, wrestling, figure skating, gymnastics, cheerleading, weight lifting Type I diabetes mellitus Family history of substance abuse, affective disorders, or eating disorder Genetics Underlying genetic vulnerability likely but not well understood 1st-degree female relative with eating disorder increases risk 6- to 10-fold. General Prevention Prevention programs can reduce risk factors…

Basics Description Inflammatory tract with 1 opening in the anal canal and another in perianal skin. Fistulas occur spontaneously or secondary to perirectal abscess. Most fistulas originate in the anal crypts at the anorectal junction: Goodsall rule: If external opening is anterior to an imaginary line drawn horizontally through anal canal, fistula usually runs directly into anal canal. Positive predictive value is ∼70%. If external opening is posterior to line, fistula usually curves to posterior midline of anal canal. PPV is ∼40%. In children, tract is usually straight. Classification (1)[C]: Intersphincteric: Fistula is confined to the intersphincteric plane (most common). Trans-sphincteric: Fistula connects intersphincteric plane with ischiorectal fossa by perforating the external sphincter. Suprasphincteric: Fistula connects intersphincteric plane with ischiorectal fossa but loops over external sphincter. Extrasphincteric: Fistula connects rectum to perineal skin but passes external to sphincter. System(s) affected: Gastrointestinal; Skin/Exocrine Synonym(s): Fistula-in-ano; Anal fistula Geriatric Considerations Constipation is…

Basics Description Localized induration and fluctuance due to inflammation of the soft tissue near the rectum or anus 80% are perianal; the remainder are intrasphincteric or supralevator. System(s) affected: Gastrointestinal; Skin/Exocrine Geriatric Considerations A high pelvirectal abscess may cause minimal symptoms, such as lower abdominal pain and fever. Pediatric Considerations Common in 1st year of life Epidemiology Predominant age: All ages (most common in infants) (1)[C] Predominant sex: Male > Female (4:1) Incidence Common Risk Factors Inciting trauma: Injections for internal hemorrhoids Enema tip abrasions Puncture wounds from eggshells or fish bones Foreign objects Prolapsed hemorrhoid Inflammatory bowel disease Chronic granulomatous disease (especially Crohn disease) Immunodeficiency disorders Hematologic malignancies (5–8% of these patients will have abscess at some time) Diabetes Chronic medical immunosuppression General Prevention Avoid constipation. Avoid rectal thermometers, enemas, or suppositories whenever possible in immunocompromised patients. Etiology Bacterial invasion of the anal glands found in the intersphincteric space,…