Cholestasis Of Pregnancy

What Is Cholestasis Of Pregnancy? What Is Obstetric Cholestasis?

Cholestasis of pregnancy, also known as obstetric cholestasis or intrahepatic cholestasis of pregnancy, usually occurs during the last trimester of pregnancy, and triggers severe itching, especially on the hands and feet. On rare occasions symptoms may appear before the third trimester. The condition is rarely of concern for the mother's long-term health, but may cause severe complications for the fetus baby.

Cholestasis is when the excretion of bile (from the liver) is interrupted. Bile is a fluid that helps the body process fat.

There are two main types of cholestasis:

• Short and long term cholestasis (acute and chronic)
  
  
  • The one that comes on suddenly is known as acute cholestasis.
  • Long-term interruption in the excretion of bile is called chronic cholestasis.
• Cholestasis outside and inside the liver
  
  
  • Extrahepatic cholestasis occurs outside the liver.
  • Intrahepatic cholestasis occurs inside the liver.

The term "cholestasis" comes from the Greek word chole meaning "bile" and the Greek word stasis meaning still.

Pregnancy is a possible cause of intrahepatic cholestasis. Apart from giving the patient intense itching, it does not usually cause any serious problems for the mother. However, it can be potentially dangerous for the fetus (developing baby inside the mother).

According to Medilexicon's medical dictionary:

Intrahepatic cholestasis of pregnancy is "intrahepatic cholestasis with centrilobular bile staining without inflammatory cells or proliferation of mesenchymal cells; clinically characterized by pruritus and icterus; of unknown cause but associated with high estrogen levels.

What are the signs and symptoms of cholestasis of pregnancy?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

The following signs and symptoms may be present when the mother has cholestasis of pregnancy:

• Very intense itching, especially on the palms of the hands and soles of the feet.
• Dark urine.
• Light-colored feces (stools, bowel movements).
• Jaundice - whites of the eyes, skin and tongue may take on a yellowish/orangey tinge.

It is not uncommon for the itchiness to be the only symptom, which tends to become much worse during the night.

Pregnant mothers who have any of the signs or symptoms mentioned above should tell a health care professional as soon as possible.

What causes cholestasis of pregnancy?

Experts believe that pregnancy hormones trigger the condition; but they are not sure.

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What is bile? Bile is a yellow-green fluid that helps to digest fat. It is produced by the liver and stored in the gallbladder. From the gallbladder it passes through the common bile duct, into the duodenum.

Bile mainly consists of cholesterol, bile salts, and the pigment bilirubin.

Pregnancy hormones - these can affect the proper functioning of the gallbladder. On some occasions pregnancy can slow or even completely block the flow of bile. If the excess bile enters the bloodstream the condition is called cholestasis of pregnancy.

What are the risk factors for cholestasis of pregnancy?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

We do not really know how many women globally develop cholestasis of pregnancy. According to The Mayo Clinic, USA, estimates vary from 1% to 15%. In Chile and Scandinavia records indicate that the risk of cholestasis of pregnancy is higher during the winter months.

The following factors may increase a woman's risk of developing cholestasis of pregnancy:

• Having a close relative who had cholestasis of pregnancy.
• Having had cholestasis of pregnancy before (up to70% risk of recurrence during the subsequent pregnancies).
• Carrying multiple babies (twins, triplets, etc).
• Having a history of liver damage.
• Being pregnant as a result of in-vitro fertilization (IVF).

What are the possible complications of cholestasis of pregnancy?

The mother

• The pregnant mother may have some problems with absorbing fat-soluble vitamins (vitamins A, D, E and K), as well as intense itching. However, within a few days after giving birth the problems resolve with hardly ever any subsequent liver problems.
• The greatest complication for the mother is a very high risk of recurrence in subsequent pregnancies.

The baby

• The risk of being born prematurely is significantly greater if the mother has cholestasis of pregnancy. Experts are not sure why.
• There is also a risk of the baby inhaling meconium during childbirth, resulting in breathing difficulties.
• The risk of fetal death during late pregnancy is also higher if the mother has the condition.

Doctors often induce labor early if the mother has cholestasis of pregnancy because of the potential serious complications for the baby.

How is cholestasis of pregnancy diagnosed?

The doctor will ask the patient questions related to potential signs and symptoms, such as urine and stool color, itchiness, etc. The mother will also be asked about her personal and family medical histories. A physical exam will also be performed.

• Blood test - this may reveal how well the patient's liver is functioning. Blood levels of bile may also be measured.
• Ultrasound scan - the aim here is to check the mother's liver (not the baby) for any abnormalities.

What are the treatment options for cholestasis of pregnancy?

There are two aims when treating a mother with this conditions: 1. To relieve the symptoms, mainly of itching. 2. To prevent potential complications.

Relief of symptoms

• Ursodeoxycholic acid is a drug which helps relieve itching as well as increasing bile flow.
• Corticosteroids - these will be in the form of anti-itching creams or lotions.
• If the patient soaks the affected areas of skin in lukewarm water there may be some temporary relief.

Preventing potential complications

• Blood tests - the patient's liver function and blood levels of bile will be closely monitored.
• Ultrasound scans - these will occur more frequently to monitor the baby's health and development.
• Non-stress test - the aim here is to check how often the baby moves in a given period. The baby's heartbeat in relation to body movements is also measured.
• Induced labor - in most cases the health care professional will recommend inducing labor at about 38 weeks. If cholestasis is severe induction may occur earlier.

Cholesterol

What is Cholesterol? What Causes High Cholesterol?

Cholesterol is a fat (lipid) which is produced by the liver and is crucial for normal body functioning. Cholesterol exists in the outer layer of every cell in our body and has many functions. It is a waxy steroid and is transported in the blood plasma of all animals. It is the main sterol synthesized by animals - small amounts are also synthesized in plants and fungi.

The word "cholesterol" comes from the Greek word chole, meaning "bile", and the Greek word stereos, meaning "solid, stiff".

What are the functions of cholesterol?

• It builds and maintains cell membranes (outer layer), it prevents crystallization of hydrocarbons in the membrane
• It is essential for determining which molecules can pass into the cell and which cannot (cell membrane permeability)
• It is involved in the production of sex hormones (androgens and estrogens)
• It is essential for the production of hormones released by the adrenal glands (cortisol, corticosterone, aldosterone, and others)
• It aids in the production of bile
• It converts sunshine to vitamin D
• It is important for the metabolism of fat soluble vitamins, including vitamins A, D, E, and K
• It insulates nerve fibers

There are three main types of lipoproteins

Cholesterol is carried in the blood by molecules called lipoproteins. A lipoprotein is any complex or compound containing both lipid (fat) and protein. The three main types are:

• LDL (low density lipoprotein) - people often refer to it as bad cholesterol. LDL carries cholesterol from the liver to cells. If too much is carried, too much for the cells to use, there can be a harmful buildup of LDL. This lipoprotein can increase the risk of arterial disease if levels rise too high. Most human blood contains approximately 70% LDL - this may vary, depending on the person.
• HDL (high density lipoprotein) - people often refer to it as good cholesterol. Experts say HDL prevents arterial disease. HDL does the opposite of LDL - HDL takes the cholesterol away from the cells and back to the liver. In the liver it is either broken down or expelled from the body as waste.
• Triglycerides - these are the chemical forms in which most fat exists in the body, as well as in food. They are present in blood plasma. Triglycerides, in association with cholesterol, form the plasma lipids (blood fat). Triglycerides in plasma originate either from fats in our food, or are made in the body from other energy sources, such as carbohydrates. Calories we consume but are not used immediately by our tissues are converted into triglycerides and stored in fat cells. When your body needs energy and there is no food as an energy source, triglycerides will be released from fat cells and used as energy - hormones control this process.

What are normal cholesterol levels?

The amount of cholesterol in human blood can vary from 3.6 mmol/liter to 7.8 mmol/liter. The National Health Service (NHS), UK, says that any reading over 6 mmol/liter is high, and will significantly raise the risk of arterial disease. The UK Department of Health recommends a target cholesterol level of under 5 mmo/liter. Unfortunately, two-thirds of all UK adults have a total cholesterol level of at least five (average men 5.5, average women 5.6).

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Below is a list of cholesterol levels and how most doctors would categorize them in mg/dl (milligrams/deciliter) and 5mmol/liter (millimoles/liter).

• Desirable - Less than 200 mg/dL
• Bordeline high - 200 to 239 mg/dL
• High - 240 mg/dL and above
• Optimum level: less than 5mmol/liter
• Mildly high cholesterol level: between 5 to 6.4mmol/liter
• Moderately high cholesterol level: between 6.5 to 7.8mmol/liter
• Very high cholesterol level: above 7.8mmol/liter

• Dangers of high cholesterol levels

  High cholesterol levels can cause:

  • Atherosclerosis - narrowing of the arteries.
  • Higher coronary heart disease risk - an abnormality of the arteries that supply blood and oxygen to the heart.
  • Heart attack - occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. This causes your heart muscle to die.
  • Angina - chest pain or discomfort that occurs when your heart muscle does not get enough blood.
  • Other cardiovascular conditions - diseases of the heart and blood vessels.
  • Stroke and mini-stroke - occurs when a blood clot blocks an artery or vein, interrupting the flow to an area of the brain. Can also occur when a blood vessel breaks. Brain cells begin to die.
  If both blood cholesterol and triglyceride levels are high, the risk of developing coronary heart disease rises significantly.

  Symptoms of high cholesterol (hypercholesterolaemia)

  Symptoms of high cholesterol do not exist alone in a way a patient or doctor can identify by touch or sight. Symptoms of high cholesterol are revealed if you have the symptoms of atherosclerosis, a common consequence of having high cholesterol levels. These can include:
• Narrowed coronary arteries in the heart (angina)
• Leg pain when exercising - this is because the arteries that supply the legs have narrowed.
• Blood clots and ruptured blood vessels - these can cause a stroke or TIA (mini-stroke).
• Ruptured plaques - this can lead to coronary thrombosis (a clot forming in one of the arteries that delivers blood to the heart). If this causes significant damage to heart muscle it could cause heart failure.
• Xanthomas - thick yellow patches on the skin, especially around the eyes. They are, in fact, deposits of cholesterol. This is commonly seen among people who have inherited high cholesterol susceptibility (familial or inherited hypercholesterolaemia).

What causes high cholesterol?

Lifestyle causes

• Nutrition - although some foods contain cholesterol, such as eggs, kidneys, eggs and some seafoods, dietary cholesterol does not have much of an impact in human blood cholesterol levels. However, saturated fats do! Foods high in saturated fats include red meat, some pies, sausages, hard cheese, lard, pastry, cakes, most biscuits, and cream (there are many more).
• Sedentary lifestyle - people who do not exercise and spend most of their time sitting/lying down have significantly higher levels of LDL (bad cholesterol) and lower levels of HDL (good cholesterol).
• Bodyweight - people who are overweight/obese are much more likely to have higher LDL levels and lower HDL levels, compared to people who are of normal weight.
• Smoking - this can have quite a considerable effect on LDL levels.
• Alcohol - people who consume too much alcohol regularly, generally have much higher levels of LDL and much lower levels of HDL, compared to people who abstain or those who drink in moderation.

Treatable medical conditions

These medical conditions are known to cause LDL levels to rise. They are all conditions which can be controlled medically (with the help of your doctor, they do not need to be contributory factors):

• Diabetes
• High blood pressure (hypertension)
• High levels of triglycerides
• Kidney diseases
• Liver diseases
• Under-active thyroid gland

Risk factors which cannot be treated

These are known as fixed risk factors:

• Your genes 1 - people with close family members who have had either a coronary heart disease or a stroke, have a greater risk of high blood cholesterol levels. The link has been identified if your father/brother was under 55, and/or your mother/sister was under 65 when they had coronary heart disease or a stroke.
• Your genes 2 - if you have/had a brother, sister, or parent with hypercholesterolemia (high cholesterol) or hyperlipidemia (high blood lipids), your chances of having high cholesterol levels are greater.
• Your sex - men have a greater chance of having high blood cholesterol levels than women.
• Your age - as you get older your chances of developing atherosclerosis increase.
• Early menopause - women whose menopause occurs early are more susceptible to higher cholesterol levels, compared to other women.
• Certain ethnic groups - people from the Indian sub-continent (Pakistan, Bangladesh, India, Sri Lanka) are more susceptible to having higher cholesterol levels, compared to other people.

How is high cholesterol diagnosed?

Cholesterol levels may be measured by means of a simple blood test. It is important not to eat anything for at least 12 hours before the blood sample is taken. The blood sample can be obtained with a syringe, or just by pricking the patient's finger.

The blood sample will be tested for LDL and HDL levels, as well as blood triglyceride levels. The units are measure in mg/dl (milligrams/deciliter) or 5mmol/liter (millimoles/liter).

People who have risk factors should consider having their cholesterol levels checked.

What are the treatments for high cholesterol?

Lifestyle

Most people, especially those whose only risk factor has been lifestyle, can generally get their cholesterol and triglyceride levels back to normal by:

• Doing plenty of exercise (check with your doctor)
• Eating plenty of fruits, vegetables, whole grains, oats, good quality fats
• Avoiding foods with saturated fats
• Getting plenty of sleep (8 hours each night)
• Bringing your bodyweight back to normal
• Avoiding alcohol
• Stopping smoking

Many experts say that people who are at high risk of developing cardiovascular disease will not lower their risk just by altering their diet. Nevertheless, a healthy diet will have numerous health benefits.

Cholesterol-controlling medications

If your cholesterol levels are still high after doing everything mentioned above, your doctor may prescribe a cholesterol-lowering drug. They may include the following:

• Statins (HMG-CoA reductase inhibitors) - these block an enzyme in your liver that produces cholesterol. The aim here is to reduce your cholesterol levels to under 4 mmol/liter and under 2 mmol/liter for your LDL. Statins are useful for the treatment and prevention of atherosclerosis. Side effects can include constipation, headaches, abdominal pain, and diarrhea. Atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin are examples of statins.
• Aspirin - this should not be given to patients under 16 years of age.
• Drugs to lower triglyceride levels - these are fibric acid derivatives and include gemfibrozil, fenofibrate and clofibrate.
• Niacin - this is a B vitamin that exists in various foods. You can only get very high doses with a doctor's prescription. Niacin brings down both LDL and HDL levels. Side effects might include itching, headaches, hot flashes (UK: flushes), and tingling (mostly very mild if they do occur).
• Anti hypertensive drugs - if you have high blood pressure your doctor may prescribe Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin || receptor blockers (ARBs), Diuretics, Beta-blockers, Calcium channel blockers.

In some cases cholesterol absorption inhibitors (ezetimibe) and bile-acid sequestrants may be prescribed. They have more side effects and require considerable patient education to achieve compliance (to make sure drugs are taken according to instruction).

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Avian Flu / Bird Flu

What Is Avian Flu? What Is Bird Flu?

Avian flu (commonly referred to as Bird flu) is used to describe the influenza viruses that infect birds - for example wild birds such as ducks and domestic birds such as chickens. In fact, birds appear to a natural reservoir of flu viruses - 15 subtypes influenza A virus are known to be circulating in bird populations.

Many forms of avian flu virus cause only mild symptoms in the birds, or no symptoms at all. However, some of the viruses produce a highly contagious and rapidly fatal disease, leading to severe epidemics.

These virulent viruses are known as 'highly pathogenic avian influenza' and it is these viruses that cause particular concern. One such avian flu virus is currently infecting chickens in Asian countries.

Why are scientists and governments so concerned about avian flu?

Until 1997 avian flu was believed to only infect birds, however in 1997 it was discovered that the virus can occasionally infect people who have been in close contact with live birds in markets or farms.

This rare ability of avian flu viruses to infect humans (known as 'species jumping') throws up a worrying possibility. It is possible that a highly pathogenic avian flu virus could merge with a human flu virus and create a new virus that could be easily passed between humans and was rapidly fatal.

If this happens, the result could be the next flu pandemic.

What is a flu pandemic?

When a new, highly infectious form of a flu virus is formed it can rapidly infect a large number of people. The result is a illness that rapidly spreads round the world and may cause widespread loss of life. An example is the Spanish flu pandemic of 1918-1919 which caused an estimated 40-50 million deaths worldwide.

How would an avian flu virus merge with a human flu virus to produce a new, highly infectious flu virus?

There are two circumstances in which an avian flu virus could merge with a human flu virus:

In humans - if a person who already has flu is comes into close contact with birds who have highly pathogenic avian flu, there is a tiny chance that the person could become infected with the avian flu virus.

If this happens, the person would now be carrying both the human flu virus and the avian flu virus. The two viruses could meet in the person's body and swap genes with each other.

If the new virus had the avian flu's genes that made it rapidly fatal and the human flu's genes to allow it to be passed from person to person, a flu pandemic could result.

In pigs - pigs are susceptible to both human and bird flu viruses. If a pig became infected with both viruses at the same time, it could act as a 'mixing vessel', allowing the two viruses to swap genes and produce a new virus.

Has such a new flu virus happened yet?

No. There is no evidence that the people who have been infected with avian flu have passed the disease on to other people. This suggests that a new, highly infectious, flu virus has not been produced yet.

However, every time an avian flu virus jumps from a bird to a person, the risk of a new flu virus being produced increases. For this reason, governments are keen to prevent the spread of avian flu among birds and this is why they are culling their poultry stocks.

How is the avian flu virus transmitted?

When a bird is infected with avian flu, it sheds the flu virus in its faeces, saliva and mucus.

Other birds become infected by eating or inhaling the virus. Very rarely, the virus can infect people who are in close contact with infected birds - for example by people inhaling dried faeces that have become trampled into dust.

People cannot catch avian flu from eating cooked chickens.

It is suggested that travellers to Asian countries affected by avian flu should avoid poultry markets and farms to minimise any risk of becoming infected.

What is being done to contain the spread of avian flu?

In the countries that have been affected by avian flu, governments have begun to cull affected poultry stocks.

By removing the potential for the virus to spread through the countries' chicken populations, it is hoped that the virus will be contained and removed from circulation.

What are the symptoms of avian flu in humans?

In humans, it has been found that avian flu causes similar symptoms to other types of flu:

• fever
• cough
• sore throat
• muscle aches
• conjunctivitis

in severe cases of avian flu, it can cause severe breathing problems and pneumonia, and can be fatal.

Are there any treatments available for avian flu?

Antiviral medications used to treat human flu viruses appear to be effective in treating avian flu.

How dangerous is avian flu?

Avian flu appears to have a high mortality rate among people who get it. There have been a number of small outbreaks of avian flu since 1997:

Hong Kong 1997 - during this outbreak, 18 people were infected and 6 people died.

Hong Kong 2003 - in a family that had visited southern China, there were two cases of the disease and one death.

Far East 2004 - up to 10 deaths have been linked to this latest outbreak of the disease in a number of Asian countries.

What is the current travel advice for visitors travelling to Asian countries affected by avian flu?

The UK Department of Health (DoH) advises:

'Although there is no restriction on travel to any of the areas where avian flu is being reported, travellers are advised to take sensible precautions such as avoiding bird markets, farm or contact with live poultry.'

The US Centers for Disease Control and Prevention (CDC) advises:

'At this time CDC and WHO [the World Health Organisation] have not issued any travel alerts or advisories for the region in response to the H5N1 [avian flu virus] outbreak. However, travellers to countries in Asia with documented H5N1 outbreaks are advised to avoid poultry farms, contact with animals in live food markets and any surfaces that appear to be contaminated with faeces from poultry or other animals.'

Vigorous Exercise 3 Times Weekly Reduces Men's Heart Attack Risk By 22%

Men who do vigorous exercise three times a week were found to have a significantly lower risk of having a heart attack, compared to those of the same age who did not, researchers from the Harvard School of Public Health wrote in the American College of Sports Medicine. The authors added that other important markers included hemoglobin A1c, apolipoprotein B and vitamin D.

Lead author, Andrea Chomistek, Sc.D. and team gathered data on activity levels and biomarkers from adult males from the Health Professional Follow-Up Study (HPFS). Included in the data were insulin sensitivity, cholesterol levels and markers of inflammation. The participants were asked to complete a questionnaire twice a year, in which they wrote about how long they spent each week on leisure-time physical activity.
Andrea Chomistek said:

"We studied vigorous exercise because of its stronger association with coronary heart disease. While we discovered that vigorous-intensity exercise decreases a man's risk of heart attack, we also were able to partially determine why. The benefits of exercise on a man's levels of HDL-C, or 'good' cholesterol, account for approximately 38 percent of that decrease. Other important markers included vitamin D, apolipoprotein B and hemoglobin A1c."

Blood samples were collected from 18,225 adult males, of which 454 had suffered a non-fatal heart attack or had died form coronary heart disease between 1994 and 2004, the period of the study. 412 of those with coronary heart disease were compared to 827 controls and matched for smoking status, age and date of blood donation.

Chomistek said:

"As expected, traditional cardiovascular disease risk factors were more common among cases than controls. Men who suffered a nonfatal heart attack or died from coronary heart disease had less 'good' cholesterol, more 'bad' cholesterol and were more likely to have high blood pressure, high cholesterol and diabetes."

Even though they had identified some biomarkers that could explain the link between physical activity and a lower chance of developing coronary heart disease, the authors stressed that further research on other mechanisms by which physical activity impacts on cardiovascular risk are needed.

Heart disease causes more premature adult male deaths in the USA than any other illness or condition, according to the CDC (Centers for Disease Control and Prevention). From 70% to 89% of all sudden cardiac events occur in males. Almost half of all men who suffer a heart attack before they are 65 years old do not live more than eight years.

In an Abstract in the journal, the authors wrote:

"Participating in 3 h•wk^-1 of vigorous-intensity activity is associated with a 22% lower risk of MI among men. This inverse association can be partially explained by the beneficial effects of physical activity on HDL-C, vitamin D, apolipoprotein B, and hemoglobin A1c. Although the inverse association attributable to these biomarkers is substantial, future research should explore benefits of exercise beyond these biomarkers of risk."

Hemoglobin A1C is monitored to assess the long-term control of diabetes mellitus.

Apolipoprotein B, also known as APOB or ApoB is the main apolipoprotein of LDL (low-density lipoproteins or "bad cholesterol").

HDL-C, also known as high-density lipoprotein is what is often termed the good cholesterol. Higher HDL-C levels are generally associated with a lower risk of coronary artery disease.

SIGMAR1 Gene Mutation

SIGMAR1 Gene Mutation Linked To Juvenile ALS Development, Researchers Identify

From the Kingdom of Saudi Arabia, investigators have identified a mutation on the SIGMAR1 gene linked with the development of juvenile amyotrophic lateral sclerosis (ALS). Sigma-1 receptors, which are involved in motor neuron function and disease development, are affected by the gene variant, according to a study published in the Annals of Neurology, a journal of the American Neurological Association and the Child Neurology Society.

ALS, (Lou Gehrig's disease), is a progressive neurodegenerative disorder attacking brain and spinal cord nerve cells (neurons) which are responsible for controlling voluntary muscle movement. The degeneration of upper and lower motor neurons slowly weakens the muscles they control, which will ultimately lead to paralysis and death from respiratory failure.

The study revealed that yearly 1 to 3 per 100,000 individuals are affected by ALS, of which 90% of cases have no family history of the disease (sporadic ALS) with the remaining 10% of cases showing more than one family member being affected by it (familial ALS). Characterized by age of onset below 25 years, juvenile ALS is a rare and sporadic disorder which makes it hard to establish incidence rates. Having being diagnosed at 21, physicist, Professor Stephen Hawking is one of the most well known juvenile ALS patients.

Earlier investigations discovered that mutation of the superoxide dismutase 1 (SOD1) gene accounts for 20% of familial and 5% of sporadic ALS cases, while ALS2 and SETX gene mutations have been reported in juvenile ALS cases.

Dr. Amr Al-Saif from the King Faisal Specialist Hospital and Research Center in Riyadh, KSA, who is leading the present investigation, performed genetic testing on four patients from an ALS family who were diagnosed with juvenile ALS to study mutations suspected in disease development.

Using direct sequencing to detect the genetic variants, together with gene mapping on the DNA of study participants, researchers identified a shared homozygosity region in the affected individuals, and gene sequencing of SIGMAR1 showed a mutation affecting the encoded protein, Sigma-1 receptor. Cells with the mutant protein were not as resistant to programmed cell death (apoptosis) induced by stress to the endoplasmic reticulum.

Dr. Al-Saif explains:

"Prior evidence has established that Sigma-1 receptors have neuroprotective properties and animal models with this gene inactivated have displayed motor deficiency.

Our findings emphasize the important role of Sigma-1 receptors in motor neuron function and disease. Further exploration is warranted to uncover potential therapeutic targets for ALS."

Holding Alcohol Retailers Liable Reduces Alcohol-Related Problems Says US Task Force

Holding retailers that sell alcohol liable for damage caused by customers under the influence of alcohol bought on their premises can reduce alcohol-related problems, including deaths on the road, injuries and homicides, says the Community Preventive Services Task Force, an independent body whose members, all volunteer experts working in public health and prevention, are appointed by the US Centers for Disease Control and Prevention (CDC).

In a report to be published in the September 2011 issue of the American Journal of Preventive Medicine, which details the findings of a systematic review of available studies, the Task Force concludes that "commercial host liability", also known as "dram shop liability" is an effective way to reduce alcohol-related harms. (A "dram" is an old word for a small unit of spirits).

More than 79,000 Americans die every year because of excessive alcohol use, which also contributes to many health and social problems, says the CDC.

44 states and the District of Columbia have had dram shop laws since January 2009. However, these vary from state to state, for instance in the evidence required for liability.

The Task Force says there is evidence that this type of law makes alcoholic drink sellers manage their beverage service more responsibly: keeping tighter control over what they serve to underage and drunken customers. The incentive is that they suffer penalties if their service can be traced to harms and damages done by those customers.

They find that jurisdictions that enforce the laws and hold alcohol retailers liable for damage caused by their intoxicated customers or underage minors have reduced the rate of alcohol-related problems, injuries and deaths.

They found six studies that showed in areas where dram shop liability had increased, there was a 6.4% reduction in motor vehicle deaths.

However, the Task Force said more studies were needed to find out if how effective stronger laws that prohibited establishments selling alcohol to intoxicated customers would be.

Today's News

Today's Health News Headlines

 

Saturday 13 August 2011 08:00 PDT

Holding Alcohol Retailers Liable Reduces Alcohol-Related Problems Says US Task Force

Written by Catharine Paddock PhD

Holding retailers that sell alcohol liable for damage caused by customers under the influence of alcohol bought on their premises can reduce alcohol-related problems, including deaths on the road, injuries and homicides...
[read article]

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SIGMAR1 Gene Mutation Linked To Juvenile ALS Development, Researchers Identify

Written by Grace Rattue

From the Kingdom of Saudi Arabia, investigators have identified a mutation on the SIGMAR1 gene linked with the development of juvenile amyotrophic lateral sclerosis (ALS). Sigma-1 receptors, which are involved in motor...
[read article]

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TB Jab May Help Fight Cancer, Researchers Discover

Written by Grace Rattue

Using the Baculillus Calmette-Guerin (BCG) - the germ commonly used to inoculate against tuberculosis (TB), researchers have found a potential new mechanism to stimulate the body's own ability to fight cancer...
[read article]

Reference Ranges and What They Mean

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Reference v. normal | Reference range defined | Age & sex | Other factors | Normal doesn't matter | Out of range | Few on this site | Common misconceptions | Sources

The "Normal" or Reference Range

"Your test was out of the normal range," your doctor says to you, handing you a sheet of paper with a set of test results, numbers on a page. Your heart starts to race in fear that you are really sick. But what does this statement mean, "Out of the normal range"? Is it cause for concern? The brief answer is that a result out of the normal or reference range is a signal that further investigation is needed.
The term "normal range" is not used very much today because it is considered to be misleading. If a patient's results are outside the range for that test, it does not automatically mean that the result is abnormal. Therefore, today "reference range" or "reference values" are considered the more appropriate terms, for reasons explained on the next page. The term reference values is increasing in use and is often used interchangeably with reference range. For simplicity, we use the term reference range in this article.
Tests results—all medical data—can only be understood once all the pieces are together. Take one of the simplest medical indicators of all—your heart rate. You can take your resting heart rate right now by putting your fingers on your pulse and counting for a minute. Most people know that the "average" heart rate is about 70 beats per minute. How do you know what a "normal" heart rate is? We know this on the basis of taking the pulse rate of millions of people over time.
You probably also know that if you are a regular runner or are otherwise in good physical condition, your pulse rate could be considerably lower—so a pulse rate of 55 could also be "normal." Say you walk up a hill—your heart rate is now 120 beats a minute. That would be high for a resting heart rate but "normal" for the rate during this kind of activity.
Your heart rate, like any medical observation, must be considered in context. Without the proper context, any observation or test result is meaningless. To understand what is normal for you, your doctor must know what is normal for most other people of your age and what you were doing at the time—or just before—the test or observation was conducted.
The interpretation of any clinical laboratory test must consider this important concept when comparing the patient's results to the test's "reference range."

Next »

Deciphering Your Lab Report

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If you’ve had laboratory tests performed, you may have been given a copy of the report by the laboratory or your health care provider. If not, you may wish to request one from your physician. Once you get your report, however, it may not be easy for you to read or understand, leaving you with more questions than answers. This article points out some of the different sections that may be found on a typical lab report and explains some of the information that may be found in those sections.
Different laboratories generate reports that can vary greatly in appearance and in the order and kind of information included. Here is one example of what a lab report may look like.
(Note: Pathology reports, such as for a biopsy, will look different than this representative lab report. For some examples of what a pathology report may look like, see The Doctor’s Doctor: A Typical Pathology Report or download the following PDF from the College of American Pathologists web site.)
Despite the differences in format and presentation, all laboratory reports must contain certain elements as mandated by federal legislation known as the Clinical Laboratory Improvement Amendments (CLIA). (CLIA '88 REGULATIONS, Section 493.1291; for more on regulation of laboratories, see Lab Oversight: A Building Block of Trust.) Your lab report may look very different than the sample report, but it will contain each of the elements required by CLIA. It may also contain additional items not specifically required but which the lab chooses to include to aid in the timely reporting, delivery, and interpretation of your results.
Some items included on lab reports deal with administrative or clerical information:

• Patient name and identification number or a unique patient identifier and identification number. These are required for proper patient identification and to ensure that the test results included in the report are correctly linked to the patient on whom the tests were run.
• Name and address of the laboratory location where the test was performed. Tests may be run in a physician office laboratory, a laboratory located in a clinic or hospital, and/or samples may be sent to a reference laboratory for analysis.
• Date report printed. This is the date this copy of the report was printed. Often, the time that the report was printed will also be included. The date of printing may be different than the date the results were generated (see below), especially on cumulative reports. This report is an example of a cumulative report which is a report that includes results of several different tests run on different days.
• Test report date. This is the day the results were generated and reported to the ordering physician or to the responsible person. Tests may be run on a particular patient’s samples on different dates. Since a patient may have multiple results of the same test from different days, it’s important that the report includes this information for correct interpretation of results.
• Name of doctor or legally authorized person ordering the test(s). This information enables the lab to forward your results to the person who requested the test(s). Sometimes a report will also include the name of other doctors requesting a copy of your report. For example, a specialist may order tests and request that a copy of the results be sent to your primary physician.

Other elements found on reports deal with the specimen that was collected and with the test itself:

• Specimen source, when appropriate. Some tests can be performed on more than one type of sample. For example, protein can be measured in blood, urine or cerebrospinal fluid, and the results from these different types of specimens can indicate very different things.
• Date and time of specimen collection. Some test results may be affected by the day and time of sample collection. This information may help your doctor interpret the results. For example, blood levels of drugs are affected by the time a dose of the drug was last taken, so results of the test and its interpretation can be affected by when the sample was collected.
• Laboratory accession number. Number(s) assigned to the sample(s) when it arrives at the laboratory. Some labs will have a single accession number for all your tests and other labs may have multiple accession numbers that help the lab identify the samples.
• Name of the test performed. Test names are often abbreviated on lab reports. You may want to look for abbreviated test names in the pull down menu on the home page of this site or type the acronym into the search box to find information on specific tests.
• Test result. Some results are written as numbers when a substance is measured in a sample as with a cholesterol level (quantitative). Other reports may simply give a positive or negative result as in pregnancy tests (qualitative). Still others may include text, such as the name of bacteria for the result of a sample taken from an infected site.
• Abnormal test results. Lab reports will often draw attention to results that are abnormal or outside the reference range (see “Reference intervals” below) by setting them apart or highlighting them in some way. For example, “H” next to a result may mean that it is higher than the reference range. “L” may mean “low” and “WNL” usually means “within normal limits.”
• Critical results. Those results that are dangerously abnormal must be reported immediately to the responsible person, such as the ordering physician. The laboratory will often draw attention to such results with an asterisk (*) or something similar and will usually note on the report the date and time the responsible person was notified.
• Units of measurement (for quantitative results). The units of measurement that labs use to report your results can vary from lab to lab. It is similar to the way, for example, your doctor chooses to record your weight during an examination. He may decide to note your weight in pounds or in kilograms. In this same way, labs may choose to use different units of measurement for your test results. Regardless of the units that the lab uses, your results will be interpreted in relation to the reference ranges supplied by the laboratory.
• Reference intervals (or reference ranges). These are the ranges in which “normal” values are expected to fall. The ranges that appear on your report are established and supplied by the laboratory that performed your test. They are made available to the doctor who requested the test(s) and to other health care providers to aid in the interpretation of the results. For more on this, see the article on Reference Ranges and What They Mean.
• Interpretation of results. In certain circumstances, the lab may note on the report what certain test results may indicate.
• Condition of specimen. Any pertinent information regarding the condition of specimens that do not meet the laboratory's criteria for acceptability will be noted. This type of information may include a variety of situations in which the specimen was not the best possible sample needed for testing. For example, if the specimen was not collected or stored in optimal conditions or if it was visually apparent that a blood sample was hemolyzed or lipemic, it will be noted on the report. In some cases, the condition of the specimen may preclude analysis (the test is not run and results are not generated) or may generate additional comments directing the use of caution in interpreting results.
• Deviations from test preparation procedures. Some tests have specific procedures to follow before a sample is collected or a test is performed. If such procedures are not followed for some reason, it may be noted on the report. For example, if a patient forgets to fast before having a glucose test performed, the report may reflect this fact.
• Medications, health supplements, etc. taken by the patient. Some tests results are affected by medications, vitamins and other health supplements, so laboratories may obtain this information from the test request form and transcribe it onto the lab report.

Raynaud's Disease

What Is Raynaud's Disease? What Causes Raynaud's Phenomenon?

Raynaud's disease, also known as Raynaud's phenomenon and sometimes simply Raynaud's, is a condition that causes some areas of the body to feel numb and cool in response to cold temperatures or emotional stress, caused by a problem with the blood supply to the skin. Raynaud's disease is a vasospastic disorder - spasms in the blood vessels lead to vasoconstriction (narrowing).

The disease mostly affects the fingers, toes, tip of the nose and the ears. The problem is in the blood vessels that supply the skin. Smaller arteries narrow and limit blood circulation to affected areas. Areas of the body subsequently become cold and very pale. Patients typically feel pins and needles, numbness, and even burning. The sensation can be unpleasant and painful.

According to Medilexicon's medical dictionary:

Raynaud's phenomenon is an idiopathic paroxysmal bilateral cyanosis of the digits due to arterial and arteriolar contraction; caused by cold or emotion.

The disease is named for Maurice Raynaud (1834 - 1881), a French physician who first described it in 1862.

The condition is either:

• Primary Raynaud's. This is the most common form, there is no apparent cause (idiopathic). It is possible for the primary form to move to the secondary form.
• Secondary Rayndaud's. It is associated with an underlying disease, such as rheumatoid arthritis. In extreme cases this form can progress to necrosis or gangrene of the fingertips.

Doctors may measure hand-temperature to distinguish between primary and secondary forms of the condition.

The National Health Service (NHS), UK, says that there could be as many as 10 million British people affected by Raynaud's disease. The NHS adds that a significant number of individuals never see their doctor about it because they think it is just part of their makeup, not knowing it is a disease with a name and treatment.

Raynaud's disease will usually affect people during or after middle age, although it can develop in all age groups. The majority of sufferers are women. As cold temperatures is one of the possible triggers, the condition becomes more common the further you move from the equator.

Most people have mild symptoms and do not find their daily tasks or general quality of life is affected. Even if symptoms are more severe, treatment (with medications) is usually effective.

What are the signs and symptoms of Raynaud´s disease?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Generally, primary Reynaud's disease symptoms are mild, while the secondary form's may be more severe. In the primary form both hands are affected simultaneously, usually all fingers at the same time. In the secondary form the development and appearance of symptoms is more patchy, with perhaps a couple of fingers on one side being affected.

The affected areas will become very pale (pallor), and then take on a bluish color (cyanosis) due to hypoxia (lack of oxygen to that area). They will feel very cold and numb. If all fingers are affected, trying to rummage in your pockets for specific coins becomes much more difficult. This can sometimes be distressing.

When the episode subsides and bloodflow returns to the affected area the skin may turn red (rubor). During the recovery period there may be tingling and swelling.

Meanings in medicine:

• Pallor - whiteness.
• Cyanosis - a bluish color of skin (or mucous membranes) due to lack of oxygen in the blood.
• Rubor - redness

Not all sufferers go through the three color process - pallor, cyanosis, rubor - especially those with mild symptoms.

Symptoms may not only affect the fingers, but also the toes, lips, ears and nose.

An episode may range from a few minutes to a number of hours.

Breastfeeding - Raynaud's-type symptoms may occur during breastfeeding; the nipples will turn white and become extremely painful.

What are the risk factors?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

• Gender. The phenomenon is more common in women than men; the Framingham Study found that 5% of men and 8% of women suffer from it.
• Age. Although any age group can be affected, middle-aged and elderly individuals have a higher risk, compared to young people.
• Geography. A significantly higher percentage of adults in, for example, Alaska suffer from the phenomenon compared to individuals in Florida.
• Genes. A significant number of individuals with Raynaud's disease have a parent or sibling who also has it.
• Underlying diseases - people with some other underlying diseases have a much higher risk of developing the phenomenon, such as people:
  
  
  • with connective tissue disorders, including scleroderma, systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, dermatomyositis, polymyositis, mixed connective tissue disease, cold agglutinin disease, and Ehlers-Danlos Syndrome.
  • with eating disorders, such as anorexia nervosa.
  • with obstructive disorders, such as atherosclerosis, Buerger's disease, Takayasu's arteritis, subclavian aneurysms, and thoracic outlet syndrome.
  • on certain medications, such as beta-blockers, cytotoxic drugs - particularly chemotherapeutics and most especially bleomycin, ciclosporin, ergotamine, sulfasalazine, and anthrax vaccines whose primary ingredient is the Anthrax Protective Antigen.
  • some other conditions, such as hypothyroidism, cryoglobulinemia, malignancy, reflex sympathetic dystrophy, carpal tunnel syndrome, and Magnesium Deficiency Erythromelalgia

What causes Raynaud's disease?

When the body is exposed to the cold, heat is lost through the extremities (fingers and toes) as capillaries (small blood vessels) under the skin constrict - become narrower, resulting in less blood getting to tissue in that area. For people with Raynaud's disease, the narrowing is more severe, and the consequent blood supply is much less than other people. If the blood supply is very low, that part of the body experiences an abnormal drop in temperature - hence the sensation of cold fingers.

For some people it needs to get really cold for symptoms to appear, while for others even a slight drop in temperature can trigger symptoms.

Stress, specifically emotional stress, which includes anxiety or anger can also trigger symptoms.

In secondary Raynaud's, where there is an underlying condition/disease, we know that the cause is that condition. In primary Raynaud's, nobody really knows why the blood vessels narrow so much.

Some occupations - there may be a link between repetitive movements and Raynaud's type symptoms, as may happen with a typist whose fingertips receive little blows for prolonged periods. Certain occupations may make individuals more susceptible, especially those where vibrating equipment is used, such as hammer drills, chainsaws or hedge trimmers (vibration white finger). Some people who work in the plastics industry develop Raynaud's type symptoms.

Smoking - smoking causes the blood vessels to narrow, increasing the risk of developing Raynaud's disese.

What are the complications of Raynaud´s disease?

A combination of thickening blood vessel walls and narrowing can lead to permanent reduction of blood flow to susceptible areas. If blood flow is seriously impaired there is a risk of finger or toe deformity, and even gangrene.

Some people with Raynaud's syndrome go on to develop scleroderma, where scar tissue (fibrosis) forms in the skin and sometimes other organs of the body.

How is Raynaud´s disease diagnosed?

Most doctors, after a careful examination, will be able to determine whether the patient has the primary or secondary form of Raynaud's. Possible secondary causes need to be identified or excluded. The following diagnostic tests may be ordered:

• Digital artery pressure - the pressure of the arteries of the fingers are measured before and after they are cooled. A drop of 15mmHg or more allows for a positive diagnosis.
• Blood test - to determine blood count (may reveal anemia or renal failure). Urea and electrolyte levels may also be tested to rule out a kidney problem (renal impairment).
• Thyroid function test - to rule out hypothyroidism (underactive thyroid gland)
• An auto-antibody screen - to test for rheumatoid factor, Erythrocyte sedimentation rate, or C-reactive protein. These may reveal either an inflammatory process or some illnesses.
• Nail fold vasculature capillaroscopy - a fold of hard skin overlapping the base and sides of a finger/toe nail is examined under a microscope and the tiny blood vessels are observed. This test can help determine whether the patient has the primary or secondary form of the disease.

What is the treatment for Raynaud´s disease?

Treatment options depend on the type (secondary or primary), and the severity of symptoms. Treatment for primary Raynaud's concentrates primarily on avoiding triggers.

If symptoms are mild, most patients find that simply avoiding the triggers, such as staying warm, learning to relax (to avoid stress, anxiety and anger), and avoiding vibrating machines is all they need to do. Smokers should seriously consider giving up.

Avoiding caffeine, stimulants and substances that cause the blood vessels to constrict (vasoconstrictors) may help alleviate symptoms.

If the fingers become extremely white, run tepid to slightly warm water over them and massage them gently. If no warm water is available, place your fingers under your arms, crotch, or even in your mouth. Keep the affected digits warm until their normal color is restored.

Medications

• Nifedipine - this medication, a dihydropyridine calcium channel blocker, rapidly lowers blood pressure and opens up the capillaries (tiny blood vessels); this helps speed up the return of proper bloodflow to affected areas. Patients should not drink grapefruit juice while on this medication.
• Angiotensin blocking vasodilators - angiotensin is a protein that makes our blood vessels narrow (constrict) and drives up blood pressure. A vasodilator is anything which opens up (widens) blood vessels. An angiotensin blocking vasodilator is a medication that blocks angiotensin and widens the blood vessels.
• Iloprost - if symptoms are severe and other therapies were not effective, this medication may be administered by intravenous infusion (through a drip). Iloprost widens the blood vessels, helping proper blood flow reach the affected areas.

Counseling - if the patient has the primary form of Raynaud's and emotional stress is identified as one of the triggers, counseling may help control stress, anger, frustration and anxiety. In some cases the patient may be prescribed an antidepressant.

Surgery - in extreme cases that have not responded to other therapies, some nerves in the affected area may be cut. This procedure is known as sympathectomy.

 

A Rectocele

What Is A Rectocele? What Causes A Rectocele?

 

A rectocele, also called a proctocele, results from a tear in the normally tough, fibrous, sheet-like divider between the rectum and vagina (rectovaginal septum), causing a bulge to protrude as a hernia into the vagina when there is a bowel movement. It is mainly caused by childbirth or a hysterectomy. It is more likely to occur as a result of childbirth if the baby weighs over nine pounds, or the birth was fast.

If the rectocele is small the patient may not notice it, there may be no signs or symptoms at all. In larger cases there may be a perceptible protrusion of tissue through the vaginal opening. The woman may experience some discomfort - pain is rare.

According to Medilexicon's medical dictionary a rectocele is:

"Prolapse or herniation of the rectum."

In the majority of cases the patient can treat the rectocele with self-care and other non-surgical methods. Surgery may be required in severe cases.

Males may also develop a rectocele (extremely rare).

What are the signs and symptoms of a rectocele?

A symptom is something the patient senses and describes, while a sign is something other people,

such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

In mild cases the woman may sense pressure within the vagina, she may feel that her bowels have not been completely emptied after going to the toilet.

In moderate cases an attempt to evacuate can push the stool into the rectocele rather that out through the anus, there may be pain and discomfort during evacuation. There is a higher chance of having constipation. Some women may experience pain during sexual intercourse.

Some women say it feels as if "something is falling out/down" within the pelvis.

In severe cases there may be vaginal bleeding, occasional fecal incontinence, and sometimes the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus.

Many females have rectoceles, but only a few may feel any symptoms.

What can cause a rectocele?

Roctoceles can have several causes, the most common being childbirth, especially when the baby is big (over nine pounds). Rapid births are also common causes. Experts say that using forceps during delivery is more likely to cause vaginal injury than directly cause the tear that leads to a rectocele.
The more vaginal births a woman has had, the higher her risk. However, females who have never given birth can also develop a rectocele.

The following may also cause rectoceles:

• A drop in estrogen levels when a woman gets older (menopause) can make pelvic tissues less elastic, increasing the risk of developing a rectocele
• A hysterectomy
• Chronic constipation
• Lots of long-term coughing, as in chronic bronchitis
• Pelvic surgery
• Sexual abuse during childhood (often an overlooked cause)
• Obesity or overweight

The underlying cause is the weakening of the pelvic support structures and weakening of the rectovaginal septum.

Females who only have cesarean births have a significantly lower chance of developing rectoceles compared to those who give birth naturally.

How is a rectocele diagnosed?

Doctors can usually diagnose a rectocele after examining the vagina and rectum. However, determining how big it is can sometimes be difficult. The patient may have to answer a questionnaire which helps the physician assess the degree of prolapse and whether it is having any impact on the her quality of life.

Imaging tests are not usually needed for an accurate diagnosis. However, the doctor may detect something during the physical examination that requires identification. In such cases an MRI (magnetic resonance imaging) scan or an X-ray may be ordered. Imaging tests can also show how big the rectocele is and how well the patient is emptying her rectum. A defecagram (defecrography) is a type of X-ray study that helps the doctor determine the size of the rectoceles and how well the patient is evacuating.

What are the treatment options for a rectocele?

In mild cases no medical treatment, apart from some pelvic exercises (Kegel exercises), is required. The patient should consume plenty of fluids and eat fiber to avoid constipation. It is important that she avoids prolonged straining when going to the toilet.

A woman with a rectoceles should avoid any type of heavy lifting and/or prolonged coughing.

If the patient is overweight or obese the doctor will advise her to try to lose weight.

The doctor may prescribe stool softeners. Hormone replacement therapy (HRT) may be recommended for post-menopausal women.

A vaginal pessary (plastic/rubber ring inserted into the vagina) helps support the protruding tissues.

Surgery, if necessary, is directed at repairs to the rectovaginal septum, which involves a simple incision (placation) of the vaginal skin.

Prevention

Don't smoke. Smoking increases the risk of having a chronic cough.

Do your Kegel exercises regularly, especially after you have given birth.

Try to maintain a healthy body weight.

If you have a chronic cough, get it treated.

Avoid constipation and prolonged straining when going to the toilet.

 

Repetitive Strain Injury (RSI)

What Is Repetitive Strain Injury (RSI)? What Causes Repetitive Strain Injury?

Repetitive strain injury or RSI, also known as repetitive stress injury, repetitive motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder (CTD), occupational overuse syndrome, overuse syndrome, and regional musculoskeletal disorder is a range of painful or uncomfortable conditions of the muscles, tendons, nerves and other soft tissues. RSI is usually caused by repetitive use of a certain part of the body, often somewhere in the upper limbs (arms).

Repetitive strain injury is typically related to an occupation (job), but may also be linked to some kinds of leisure activity. As opposed to a sudden or 'normal' injury, RSI signs and symptoms may continue for much longer.

Experts say that repetitive strain injury is an injury of the musculoskeletal and nervous systems that may be the result of repetitive tasks, forceful exertions, vibrations, pressing against hard surfaces (mechanical compression), or sustained or awkward positions. Conditions such as RSI tend to be linked to both physical and psychosocial stressors (mental stress).

A US study found that acute and sudden computer-related injuries, a separate category to injuries that take a while to emerge like repetitive strain injury, are rising rapidly in the US, and that young children are most affected.

Many health care professionals refer to RSI as ULD (upper limb disorder) because it frequently involves the forearm, elbow, wrist or hands. RSI often affects the neck as well.

The following are examples of repetitive strain injuries:

• Bursitis - happens when the bursa is inflamed. The bursa acts as a cushion between bones, tendons, joints and muscles - bursae are fluid-filled sacs (the plural of bursa is bursae). People with bursitis will feel pain at the site of inflammation.
  
• Carpal tunnel syndrome (CTS) - caused by the compression of the median nerve through the carpal tunnel in the wrist area. When constricted, blood cannot flow freely through the hand to the fingers causing individuals with CTS to experience numbness and pain in the hand.
  
• Diffuse RSI - conditions are where the patient complains of pain and yet, on examination by a health care professional, nothing physical can be found to be wrong.
  
• Dupuytren's contracture - a condition that affects the hands and fingers. It is an uncommon hand deformity in which the connective tissue under the skin of the palm contract and toughen over time. It causes one or more of the fingers on one or both hands to bend into the palm of the hand.
  
• Epicondylitis - often occurs as a result of strenuous overuse of the muscles and tendons where the bone and tendon join. Tennis elbow and golfer's elbow are examples.
• Ganglion - fluid-filled swellings that tend to form on top of joints or tendons in the wrists, hands, and feet. They have the appearance of firm or spongy sacs of liquid and their insides consist of a sticky, clear, thick, jelly-like fluid.
  
• Rotator cuff syndrome - inflammation of tendons and muscles in the shoulder.
  
• Tendinitis - also known as tendonitis, is the inflammation of a tendon.
  
• Tenosynovitis - the sheath around the tendon becomes inflamed, specifically the inner lining of the tendon sheath.
  
• Trigger finger - a condition in which one of your fingers or your thumb catches in a bent position. The tendon sheaths of the fingers or thumb become inflamed - the tendon is also inflamed.

RSI is frequently caused by such activities as golf or tennis - activities which require repetitive movements. Signs and symptoms generally persist if left untreated. Experts say that the number of people experiencing RSI as a result of computer use has been increasing for many years. RSI that is caused by typing on a computer keyboard is often referred to as writer's cramp.

Experts often refer to two main types of RSI:

• Type 1 RSI - usually caused by repetitive tasks, but not always; some people who do not perform repetitive tasks may have Type 1 RSI. The muscles and tendons swell. Examples of Type 1 RSI include:
  
  
  • Carpal tunnel syndrome
  • Tendinitis (tendonitis)
  • Tenosynovitis
• Type 2 RSI - there is a feeling of pain but no obvious inflammation or swelling in the area where symptoms are felt. The National Health Service (NHS), UK, refers to Type 2 RSI "when a person's symptoms do not fit into one of the (above listed) conditions". Also called non-specific pain syndrome.

What are the signs and symptoms of repetitive strain injury (RSI)?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Signs and symptoms vary, depending on which part of the body is affected, and what caused the problem in the first place. Initially, symptoms may only occur when the individual is doing the repetitive task - they will slowly go away when the person rests. Eventually, though, symptoms may be present all the time (and worsen during the repetitive task) if left untreated.

The most common RSI signs and symptoms include:

• Tenderness in the affected muscle or joint
• Pain in the affected muscle or joint
• A throbbing (pulsating) sensation in the affected area
• Pins and needles (tingling) in the affected area, especially the hand or arm
• Loss of sensation in the hand
• Loss of strength in the hand

Some patients with persistent symptoms may have sleeping problems - the condition is often irreversible at this stage. Early treatment is much more likely to prevent any irreversible damage.

What are the causes of repetitive strain injury (RSI)?

Experts say the causes of RSI are a bit of a mystery. Sometimes there is no swelling in the muscles or tendons, but the patient feels pain and discomfort. We know that often repetitive movements of a part of the body are linked to symptoms - movements, such as typing, using a computer mouse, poor posture while doing a movement, using excessive force, doing the repetitive movements without sufficient breaks, etc. But the precise reason for RSI is not clear. Neither do we know why some people develop RSI and others don't, when doing the same tasks for similar periods.

Some studies indicate that some psycho-social workplace factors, such as stress may be significant contributory factors to RSI. Perhaps stress affects our muscles (makes them tense), which in turn makes us more sensitive to pain.

The following are seen as causes of RSI:

• The overuse of muscles in our hands, wrists, arms, shoulders, neck and back are linked to RSI symptoms.
• The area is affected by repeated actions, which are usually performed on a daily basis over a long period.
• The repetitive actions are done in a cold place.
• The individual has to use vibrating equipment.
• Forceful movements are involved.
• Workstations are poorly organized.
• Equipment is badly designed.
• The individual commonly adopts an awkward posture.
• There are not enough rest breaks.

How is repetitive strain injury (RSI) diagnosed?

There is no objective way to diagnose RSI - there are no tests to confirm a diagnosis. Signs and symptoms could be caused by a wide range of factors.

A health care professional will usually diagnose RSI if the signs and symptoms can be linked to a specific repetitive task, and the symptoms lessen when the task is stopped.

If the patient develops a definable condition, such as frozen shoulder, carpal tunnel syndrome or tendinitis, it may or may not be linked to repetitive tasks.

What are the treatment options for repetitive strain injury (RSI)?

The National Health Service (NHS), UK, advises people to see their doctor as soon as they experience symptoms. Early treatment is more likely to result in effective outcomes.

A GP (general practitioner, primary care physician) will probably ask the patient to stop doing the repetitive movements which may be causing the symptoms. If this is not possible, as may be the case with work-related activities, the individual needs to tell his/her employer.

The aim of treatment is to help ease the pain, and to enable the patient to gain strength and mobility in the affected area.

Pain relief - a course of anti-inflammatory painkillers, such as ibuprofen or aspirin may help. Children under 16 years of age should not take aspirin. The following may also help:

• Use of heat (applying heat to the affected area)
• Cold packs
• Elastic supports
• Firm splints

Steroid injections - these may be administered if there is a well defined inflammation in the affected area.

Sleep - if the patient is having sleeping problems the doctor may prescribe a short course of sleeping tablets. Good sleep may help relax the patient and alter his/her perception and susceptibility to pain.

Physical therapy (UK: physiotherapy), exercise and relaxation techniques - a physical therapist (UK: physiotherapist) may help the patient adopt proper posture, as well as teaching him/her to strengthen muscles. Electrotherapy may also be used - small electrical impulses are placed at specific points of the body to help reduce pain. The following may also provide benefits:

• Walking
• Swimming
• A Danish study found that five exercises reduced neck pain for women office workers.
• Yoga
• Tai chi
• Mediation and relaxation techniques
• Some say the "Alexander Technique" helps

Scientists at the University of British Columbia, Canada, found that "physical activity is associated with a lower risk of work-related repetitive strain injury".

Occupational Therapy - by analyzing the following factors with the help of an occupational therapist, there may be ways of adopting measures to reduce symptoms:

• Working with a computer - is your equipment positioned properly. Are your seat, keyboard and mouse positioned in the best way to minimize strain on your hands, fingers, arms, back and neck. Adaptive technology, such as special keyboards, mouse replacements, pen tablets interfaces, and speech recognition software may help.
  
• Posture - are you sitting correctly?
  
• Breaks - when doing repetitive tasks are you getting enough breaks? There is software that reminds computer users it is time to have a break.
  
• Work environment - is there anything your employer might do to improve your working environment?
  
• Stress - is there anything you can do to alleviate (treat) your level of stress?

Many patients experience reduced symptoms, or total elimination of symptoms if prevention and treatment measures are carried out. Others, however, continue to suffer regardless. Unfortunately, there are cases of people having to leave/change their jobs.