Pneumonia

What Happens When People Have Pneumonia?

Symptoms

People who have streptococcal pneumonia, the most common kind, often get a fever of 102 to 104 degrees F (39 to 40.5 degrees Centigrade) and chills that cause the body to shake. They cough, often bringing up large amounts of thick, greenish mucus, sometimes mixed with blood. They may breath more quickly, and they may have rales (pronounced "rahls"), a crackling sound that can be heard with a stethoscope. Their chests hurt, too; the stabbing pain seems to get worse the more they cough. Other symptoms include a bad headache, loss of appetite, tiredness, nausea, and vomiting.

People who are elderly or who have immune system problems often have milder symptoms in the beginning, even though their illness may be more dangerous. They might, for instance, have just a low-grade fever, tiredness, or confusion, and a sense of being ill.

People with atypical or mycoplasma pneumonia often get a dry cough, a sore throat, skin rashes, and muscle and joint pain. Because these are not the classic symptoms of pneumonia, people may think they just have a mild case of flu.

People with influenza pneumonia often have fever, a severe dry cough, rales, and severe fatigue.

Diagnosis

If a person has persistent fever and a cough, doctors will suspect pneumonia. They may be able to diagnose pneumonia by listening through a stethoscope to the person's breathing. In any case, a chest x-ray usually makes the diagnosis clear.

Treatment

If a specific type of bacteria has been identified as the cause of the pneumonia, the doctor can prescribe antibiotic drugs that target those bacteria. If the germ is not pinpointed but bacteria are suspected, the doctor may give antibiotics that are active against the most likely causes. If the cause is a virus or fungus, antibiotics will not help. Instead, some antiviral and antifungal drugs are available, although not all viruses have treatments.

When the pneumonia is severe, people often are hospitalized. They may be given oxygen or put on a ventilator (a breathing machine) to help them breathe while the medications and the immune system fight the infection.

How Is Pneumonia Prevented?

Yearly flu vaccinations can prevent pneumonia caused by certain influenza viruses, and a one-time vaccination can help protect people against pneumococcal pneumonia.

People who have the AIDS virus can reduce their chances of getting Pneumocystic carinii pneumonia by taking daily medication. Not smoking, or quitting the habit, and not drinking alcohol excessively also can reduce the risk of pneumonia.

To prevent pneumonia in the hospital, patients are encouraged to breathe deeply, and they are sometimes given plastic breath meters that measure how well they are doing. They also are encouraged to move around, if possible, rather than staying in bed. These practices prevent the lungs from filling with mucus and other fluids that some bacteria thrive in.

Can Cancer Be Prevented?

How Do People Know They Have Cancer?
Many symptoms of cancer such as weight loss, fever, fatigue, and various kinds of lumps could also be caused by other diseases. Some cancers may cause no symptoms until they have spread. Based on the most commonly occurring cancers, the American Cancer Society publishes a list of seven warning signs of cancer. These symptoms do not mean that a person has cancer, but if they occur, a person should see the doctor:

Change in bowel or bladder habits (for instance diarrhea that does not go away or pain on urination)
A sore anywhere on the skin that does not heal
Unusual bleeding or discharge from the nose, mouth, skin, nipple, or vagina
A thickening or lump in the breast or elsewhere
Indigestion or difficulty in swallowing
Obvious changes in a wart or mole
Nagging cough, particularly if these symptoms occur in a cigarette smoker.
Eating for Health
The American Cancer Society recommends the following general nutritional guidelines to help people stay healthy:

Choosing most foods from plant sources such as vegetables, fruits, and grains
Limiting intake of high-fat foods, especially from animal sources
Staying physically active
Maintaining a healthy weight
Limiting consumption of alcoholic beverages
How Is Cancer Diagnosed and Treated?
Diagnosis
Diagnosing cancer involves removing some tissue for evaluation. This procedure is called a biopsy (BY-op-see). Once the diagnosis is made, a treatment plan is put together. To do that, it is necessary to determine how widespread the disease is, and how serious. "Staging" the disease means assigning letters and numbers to it as a way of indicating whether it has spread and how far. There are several systems for staging, depending on the type of cancer. Generally speaking, the smaller the tumor, the more curable it is, although some cancer can be unpredictable. The outlook for some cancers, for example, leukemia and lymphoma, is judged according to other criteria. Cancer is classified by the part of the body in which it began and by how it looks under a microscope.

Chemotherapy uses anticancer drugs to treat cancer. Chemotherapy drugs are given through a vein or by mouth as pills. These drugs enter the bloodstream and reach places in the body that surgery and radiation cannot reach. Chemotherapy often is given for cancer that has spread.

Treatment
Treatment for cancer includes surgery, radiation, and chemotherapy (kee-mo-THER-a-pee), alone or together. Because different types of cancer vary in how fast they grow, where they spread, and how they respond to treatment, treatment is specifically tailored to the kind of cancer a person has.

Surgery is the oldest form of treatment for cancer, and it still offers the greatest chance of cure for many kinds of cancer. About 60 percent of patients with cancer will have some type of surgery.
Radiation therapy uses high-energy particles or waves to damage cancer cells that surgery cannot catch because they are too small.
Chemotherapy uses anticancer drugs to treat cancer. Chemotherapy drugs are given through a vein (also called an intravenous or IV line) or by mouth as pills. These drugs enter the bloodstream and reach places in the body that surgery and radiation cannot reach. Chemotherapy is often given for cancer that has spread.
Another kind of therapy interferes with the production of substances in the blood called hormones (HOR-mones) that stimulate certain kinds of cells (for example, cells in the breast) to grow.

Will There Ever Be a Cure for All Cancers?
Every day researchers learn a little more about how the cell works, and many of these discoveries are being applied to cancer research. Many current therapies have side effects because they kill healthy cells as well as cancer cells or affect the function of other parts of the body. So one area of research scientists are working on is therapies that will kill only cancer cells and that will leave healthy cells alone. Another area of research is investigating ways of helping the body's own defense system to fight cancer. Scientists are also exploring substances in food or drugs that will prevent cancer from developing in the first place.

Can Cancer Be Prevented?
There is no way to prevent cancers children get. But many cancers that occur in adults could be prevented by changes in a person's lifestyle. For example, cancers caused by cigarette smoking and drinking a lot of alcohol could be prevented completely. Limiting certain kinds of foods, such as red meats and animal fats, and eating lots of fruits and legumes (such as peas and lentils) may help reduce the risk of getting many cancers. Physical activity helps to avoid obesity and may have other protective effects against cancer. Most of the one million skin cancers that are diagnosed each year could be avoided by staying out of the sun.

Regular cancer checks, called screenings, for cancer of the breast, colon, rectum, cervix, prostate, testes, mouth, and skin are an effective way of detecting cancer early enough to be treated successfully. In addition, self-examination for breast and skin cancers also helps to detect tumors at earlier stages. The American Cancer Society estimates that if all Americans participated in regular cancer screenings, survival would be dramatically improved

Blindness

What Causes Blindness?

Many conditions may cause blindness. The most common cause of vision loss in infants and young children is amblyopia (am-ble-O-pe-a).

^*strabismus is a condition that causes the eyes to cross or not work together correctly, which may lead to permanent loss of vision in one eye.

^*glaucoma is a group of disorders that cause pressure to build in the eye, which may result in vision loss.

^*cataracts result from cloudiness of the lenses in the eyes that usually develops as a person ages. They often impair vision.

Amblyopia

Amblyopia is the loss of vision in one eye that results when the eyes are misaligned or not working together correctly in a condition known as strabismus (stra-BIZ-mus). About 3 to 5 percent of children have strabismus, which usually is present from birth or develops during infancy. In most cases, there is no known cause for the condition, which often makes a person look cross-eyed. With early diagnosis and treatment,

Anatomy of the eye. The optic nerve (also referred to as the second cranial nerve) sends messages from the eyes to the brain, making it possible to see.

the eye that is not pointing straight can be trained to develop normal vision. For some people, surgery is needed to align the eye correctly.

Cataracts

Some children are born with cataracts, which cloud the lens in the eye and prevent images from being seen clearly or at all. People also develop cataracts as they age, which makes it one of the most common causes of reduced vision. More than 400,000 new cases of cataracts develop each year in the United States. Surgery to remove cataracts is common for adults and for those few children with them. This restores vision in more than 90 percent of cases.

Diabetes

Diabetes may lead to vision loss if diabetic retinopathy develops. Diabetic retinopathy, one of the leading causes of blindness in adults, results in vision loss if blood vessels supplying the eye's retina^* are damaged by the disease. The blood vessels sometimes leak or break open to damage the retina. More vessels also may grow and start to cover the retina or grow into the fluid that fills the eyeball, further reducing vision.

Researchers estimate that as many as 10 million to 15 million people have diabetes in the United States and 700,000 are at risk of developing diabetic retinopathy. Almost all people with diabetes can show signs of damage to their retina after two or three decades of living with the disease, but not all of them lose their vision. There are no symptoms of diabetic retinopathy at first. As the damage increases, vision becomes blurred. Doctors can see the damage with a device that looks at the retina, which is why annual vision exams are so important for people with diabetes.

The best treatment for diabetic retinopathy is prevention, which means managing diabetes (and high blood pressure, if present) with proper nutrition, exercise, and medications. In some cases, laser treatment may be used to prevent worsening of diabetic retinopathy. People with diabetes also are at higher risk for cataracts and glaucoma.

Glaucoma

Glaucoma is a disorder that causes fluid pressure to build up inside the eye, which may cause optic nerve^* damage. It may go undetected for many years before its effects on vision are noticed. It is one of the leading causes of blindness in the United States, with elderly people and people of African ancestry at increased risk.

Trachoma

Trachoma is a chronic infection of the eye by Chlamydia trachomatis bacteria. The bacteria infect the linings of the eyelid, causing them to become thick and rough. If the condition is untreated or if the infection returns, the eyelashes can turn inward and cause small scars on the eyes' surfaces. Eventually, blindness results. Trachoma is the leading cause of preventable blindness in the world.

Trachoma is spread through contact with the discharge from the eyes of infected persons. For example, if infected people rub their eyes and then shake another person's hands, the bacteria that cause trachoma can be spread. Also, using the handkerchief or towel of an infected person can spread the bacteria.

Today, about 10 percent of the world's population live in areas where trachoma is a problem, including Africa, Asia, Australia, Latin America, and some poorer areas of the United States.

Treatment can stop trachoma before it blinds people. Antibiotic ointments or oral antibiotics are used to treat the disease. The World Health Organization (WHO) has established a WHO Alliance for the Global Elimination of Trachoma. WHO hopes to achieve its goal by the year 2020 through prevention, antibiotics, and surgery to repair eyelids.

^*retina is the area at the inside rear of the eyeball that acts like film in a camera to capture the image a person sees.

^*optic nerve is the nerve that sends messages, or conducts impulses, from the eyes to the brain, making it possible to see. The optic nerve is also referred to as the second cranial nerve.

Macular degeneration

Macular degeneration is similar to diabetic retinopathy. Changes in the blood vessels supplying the central portion of the retina, known as the macula, cause the vessels to leak and to damage cells that are needed for the central part of the field of vision. Peripheral or side vision usually remains, but without treatment, the damaged field of vision may expand. Doctors sometimes recommend laser surgery to treat the leaking blood vessels when people are in the early stages of macular degeneration in order to prevent or slow progressive vision loss. Others compensate for vision loss by using magnifying devices.

Infections

Ocular (OK-yoo-lar) herpes may cause vision loss as a result of herpesvirus infections, usually the herpes simplex virus that causes cold sores or the herpes zoster virus that causes chickenpox and shingles. The U.S. National Eye Institute estimates that ocular herpes affects approximately 400,000 people in the United States.

Infection of the eyes by the Chlamydia trachomatis organism is a leading cause of blindness in developing nations. The eyes of newborn babies may become infected during childbirth if the mother has chlamydia.

Accidents

About 3 percent of cases of blindness occur from accidents or other injuries that damage the eyes.

How Do People with Vision Loss and Blindness Adapt?

Millions of people with severe vision loss, including more than 1 million people who are blind, can do many of the same things that people with normal vision do. People with partial sight can use powerful eyeglasses and magnifying devices to improve their ability to read and to see objects. People with blindness also can:

• listen to books, newspapers, and magazines on tape
• use computers that read text aloud and respond to spoken commands
• read Braille, a system that translates words into raised patterns of dots that are read by touching them
• use guide dogs to increase their mobility
• take many of the same classes, jobs, and roles as people with sight
• become parents and teachers

Dengue Fever

The Aëdes mosquito picks up the dengue virus by biting a person who has it and then transfers the virus to the next person it bites.

Who Gets Dengue?

Dengue (DENG-gee, English; DAIN-gay, Spanish) affects millions of people each year in tropical and subtropical regions. It is especially common in southeastern Asia and is also found in Latin America and the Caribbean, including Puerto Rico. Sometimes dengue may also appear in temperate climates in summer. Only very rarely does it occur in the United States.

Although dengue sometimes breaks out in epidemics, it is not spread directly from person to person. Instead, it is spread by the bite of a tropical mosquito whose scientific name is Aëdes (a-EE-dez). The Aedes mosquito picks up the dengue arbovirus^* by biting a person who has dengue (people are the main source of the virus), and when the mosquito bites someone else, it infects the next person with the virus. The virus then multiplies in the new person's body, causing the disease symptoms.

Does Dengue Cause Broken Bones?

Dengue does not cause broken bones, but the severe pain that often accompanies it may be the reason why it is called "breakbone fever." Its symptoms begin very abruptly, several days after infection. In addition to bone, joint, and muscle pain, there may be high fever, a rash, headache, and pain behind the eyes. The symptoms usually subside after five to seven days, return a few days later, and then go away entirely.

After recovery from dengue, people may feel weak and psychologically^* depressed. These feelings may last for days or weeks, but dengue is rarely fatal. In a small percentage of cases, people get a severe form of the disease, called dengue hemorrhagic^* fever, which causes internal bleeding. This sometimes turns into an even more dangerous condition called dengue shock syndrome. According to the World Health Organization, these severe forms of dengue kill approximately 24,000 children in tropical countries each year, although most people who get these diseases recover.

What Is the "Dengue Triad"?

In diagnosing dengue fever, doctors look for three main signs or symptoms called the "dengue triad": (1) fever, (2) rash, and (3) pain, including headache. Blood tests may be done to help in the diagnosis. In areas where dengue is uncommon, the physician may also ask if the patient has recently been in a tropical country.

How Do Doctors Treat Dengue?

There is no specific treatment for a typical case of dengue fever, which runs its course and clears up by itself. Doctors usually recommend bed rest and drinking plenty of fluids. They may also prescribe pain-relieving medications to ease symptoms.

How Is Dengue Prevented?

Prevention requires control or eradication of Aides mosquitoes, and protection against their bites. The Aedes mosquito also spreads other diseases, such as yellow fever, making public health improvements especially important. There is no available drug or vaccine that is effective against the dengue virus.

The U.S. and the World

• Dengue fever exists in more than 100 countries, but occurs mostly in tropical and subtropical areas of Asia, Africa, and Central and South America. Overall, as many as 2.5 billion people worldwide are at risk.
• Some cases have occurred in the United States, but most often in people who have traveled recently to other countries. The Aedes mosquito also can be found along the border between Texas and Mexico.
• The World Health Organization reports that approximately 500,000 people worldwide—almost 90 percent under age 15—are hospitalized every year with dengue fever. Millions more are infected but are not hospitalized.
• Approximately 24,000 people die from dengue each year, most of them children or young adults.

Get Rid of Athletes Foot

 

The human body is home to many different kinds of fungi. Most never cause a problem. Athlete's foot is caused by one group of fungi called dermatophytes (der-MA-to-fites), which are microorganisms^* that live on the skin, hair, and nails. Dermatophytes need a warm, moist environment to survive and to reproduce, like the feet of athletes, for example. But, in fact, anyone with wet or sweaty feet may be prone to getting athlete's foot. Athlete's foot is also called tinea pedis (TIN-e-a PED-is), or ringworm of the foot.

How Do People Get Athlete's Foot?

Athlete's foot is somewhat contagious^*, and the most common places where people catch it are also the dampest ones: public showers, pool areas, wet towels, and bath mats. People who wear the same shoes or sneakers all the time are more likely to develop athlete's foot, as are people who wear shoes or socks made from certain synthetic^* materials such as rubber, vinyl, or nylon. Anything that keeps the feet warm, wet, and sweaty gives the fungus an opportunity to grow and survive.

What Are the Signs and Symptoms of Athlete's Foot?

Athlete's foot is a condition with very specific symptoms, and these symptoms can be mild or intense, depending on the case and the person. A person with athlete's foot may feel burning and stinging on the soles of the feet and in between the toes. The skin can feel very itchy as well. The fungus causes the skin to become red, flaky, or soggy. Sometimes, the skin can become cracked.

How Do Doctors Diagnose and Treat Athlete's Foot?

Diagnosis

When examining a patient with athlete's foot, a doctor will usually have an easy time making a diagnosis, because the fungi that cause skin problems are usually easy to recognize. Just to be sure, the doctor may take a small scraping of skin to gather some of the fungus. The fungus can then be cultured, or grown, in a small dish in a laboratory. This gives the doctor an opportunity to identify the fungus, if present.

Treatment

Most cases of athlete's foot can be cured with antifungal creams or sprays, which are put directly on the skin to kill the fungus. Many of these creams and sprays are available without a prescription at drugstores. If athlete's foot persists, doctors may prescribe stronger antifungal creams than those available over the counter or possibly an antifungal medication to be taken orally. If a bacterial infection has developed along with the fungal infection, then the doctor may also prescribe an antibiotic to kill the bacteria.

^*microorganisms are living organisms that can only be seen using a microscope. Examples of microorganisms are fungi, bacteria, and viruses.

^*contagious means transmittable from one person to another.

^*synthetic means produced artificially or chemically rather than grown naturally.

How Do People Prevent Athlete's Foot?

People who tend to get athlete's foot can do some simple things to help prevent it. The most important step is to keep the feet as dry as possible, because the fungi that cause athlete's foot do not like dry places. Taking a few extra minutes to dry feet thoroughly after showering, bathing, and swimming can help a lot. Other methods of prevention include:

• Wearing sandals and avoiding bare feet around a pool area or a public shower
• Wearing shoes that are well ventilated, such as sneakers with small holes on their tops or sides to let air in and out
• Wearing shoes and sneakers made of leather rather than of synthetic materials such as vinyl and nylon
• Wearing cotton or wool socks rather than polyester socks
• If possible, not wearing the same pair of shoes or sneakers every day, as switching between pairs gives shoes a chance to dry out after being worn.

Those people who are particularly prone to athlete's foot may find they can keep the fungi away by using antifungal powders on their feet every day.

What Is Asthma?

Several changes happen inside the airways in the lungs of people who have asthma. First, there is inflammation, or swelling, of the lining of the airways. Second, the swollen tissues make a thick, slippery substance called mucus (MYOO-kus). Third, the muscles around the airways may squeeze tight, causing the airways to narrow. These three processes—inflammation, mucus production, and muscle constriction—combine to reduce the size (the diameter) of the airways. That makes it harder to breathe, like trying to blow air through a narrow straw.

During an asthma attack, these changes get worse. The airways swell on the inside while they are being squeezed on the outside. At the same time, thick mucus plugs the smaller airways. The person may start to make whistling or hissing sounds with each breath. The person's chest may also feel tight. In addition, the person may cough to try to clear the lungs.

What Triggers Asthma?

People with asthma have what are sometimes called "sensitized" airways. Everyday things that cause little or no trouble for most people can sometimes cause people with asthma to have a flare or attack.  The first are allergens (AL-er-jens), or substances that trigger an allergy. Examples of allergens that may trigger asthma are pollens, molds, animal dander (small scales from fur or feathers), dust mites, cockroaches, and certain foods and medicines. Most of these allergy-causing substances enter the body through the air people breathe, but some are swallowed.

The second kind of asthma trigger has nothing to do with an allergy but causes the same kind of reaction in the airways. Asthma can be triggered or made worse by irritating substances in the air, such as tobacco smoke, wood smoke, fresh paint, cleaning products, perfumes, workplace chemicals, and air pollution. Some other triggers include cold air, sudden changes in air temperature, exercise, heartburn, and infections of the airways, such as a cold or the flu. Exactly which of these might trigger a reaction varies from person to person.

Who Gets Asthma?

Asthma is one of the most common health problems in the United States. The number of people with the condition has grown rapidly in recent years. The reason for this increase is not yet known. About a third of these people are children under age eighteen. Asthma is more common in African American children than in white children, although the reason for this is not clear. It may have to do with environmental conditions.

What Are the Symptoms?

Following are the most common symptoms of asthma. A person may have all, some, or just one of these symptoms:

• Shortness of breath
• Coughing, particularly if it lasts longer than a week
• Wheezing (whistling or hissing sounds made primarily when breathing out)
• A feeling of tightness or discomfort in the chest

The degree to which asthma interferes with a person's daily life varies significantly. Some people have ongoing problems. They may have attacks anywhere from a couple of times a week to almost constantly. Their ability to take part in physical activities may be limited until, with treatment, they are able to get their asthma under control. Those with milder problems are usually able to do whatever they want to do, so long as they reduce their environmental triggers, take their medicine as directed, and follow any other advice from their doctors.

Childhood asthma

Babies often wheeze when they have a cold or other infection of the airways, blockage of the airways, or other problems. This symptom may go away on its own with no ill effects. However, if the problem is severe, lasts a long time, or comes back, treatment may be needed. In older children, normal breathing should be quiet. Wheezing may be a sign of asthma, but it can also signal an infection, lung disease, heartburn, heart disease, a blood vessel blocking the airways, or even a piece of food or other object (such as part of a toy) lodged in the airway. In addition to noisy breathing, asthma in children can cause rapid breathing and frequent coughing spells. Parents may also notice that the child tires quickly during active play.

Nighttime asthma

Asthma tends to get worse at night. Nocturnal (or nighttime) asthma occurs while a person is sleeping. For some people, nocturnal asthma is one of many symptoms; other people seem to have coughing or wheezing only at night.

FOUR CENTURIES
OF MEDICAL RESEARCH

The word "asthma" comes from the Greek word for "panting," which is a symptom that occurs in several different pulmonary (lung) disorders.

Asthma was first depicted as a disease rather than a symptom by the English chemist Thomas Willis (1621-1675).

In 1698, Sir John Floyer first gave the first formal account of an asthma attack or "fit." However, an accurate diagnosis of asthma was not possible until the early nineteenth century when the celebrated French physician René Laënnec (1781—1826) invented the stethoscope.

During the early nineteenth century, asthma was treated in a variety of ways including whiffs of chloroform and even the smoking of ordinary tobacco.

Exercise-related asthma

Up to four out of five people with asthma have trouble with noisy breathing during or after exercise. This is known as exercise-induced asthma. Other symptoms include coughing, a rapid heartbeat, and a feeling of tightness in the chest five to ten minutes after exercise. Cold or dry air, high pollen counts, air pollution, a stuffed-up nose, and an infection of the airways are all things that tend to make the problem worse. Types of exercise that may lead to wheezing include running, using a treadmill, and playing basketball—in short, exercises that are aerobic (designed to increase oxygen consumption).

Job-related asthma

Occupational asthma is caused by breathing in fumes, gases, or dust while on the job. Asthma can start for the first time in a worker who was previously healthy, or it can get worse in a worker who already had the condition. Symptoms include wheezing, chest tightness, and coughing. Other symptoms that may go along with the asthma include a runny or stuffed-up nose and red, sore, itchy eyes. The asthma may last for a long time, even after the worker is no longer around the substance that caused it.

Severe attacks

Status asthmaticus (STA-tus az-MAT-i-kus) is a severe asthma attack that does not get better when the person takes his or her medicine as usual. This kind of attack is an emergency that must be treated right away in a hospital or doctor's office, where other medicines may be used.

How Is Asthma Diagnosed?

The doctor will do a physical checkup and ask questions about symptoms and when they occur. In addition, the doctor may do various tests to help identify asthma and its causes. These are some of the tests that may be done:

Allergy tests

Allergy tests help identify which things a person is allergic to. Skin tests are most c, ommon. Tiny amounts of possible allergens are put on the skin, and the skin is checked to see which substances, if any, cause a reaction. In another type of allergy test, a blood sample is checked for certain antibodies, which are substances made in the blood to fight foreign or harmful things. People with allergies may have high levels of immunoglobulin E (IgE) antibodies. However, the blood test is generally not considered as sensitive as the skin test, and it cannot check for as many allergens.

Chest x-ray.

An x-ray is an invisible wave that goes through most solid matter and produces an image on film. In this case, a special picture is made to show how the lungs look.

Lung-function tests.

These tests show how well the lungs are working. In one test, the person blows into a device called a spirometer (spi-ROM-i-ter), which measures the amount of air going in and out of the lungs. Another test uses a peak flow meter to measure how fast the person can breathe air out of the lungs. A peak flow meter is a simple, hand-held device that can be used at home. Many people with asthma use peak flow meters regularly to check for early warning signs of an upcoming asthma attack. This gives them time to take certain medicines that can often stop the attack.

Why Is Treatment Needed?

Asthma that is not under control can cause many problems. People miss school or work, must go to the hospital, and can even die (rarely) because of asthma. With a doctor's help, though, it is possible to control asthma. People with well-controlled asthma have few, if any, symptoms during the day and can sleep well at night. They can also take part in their usual activities, including sports and exercise. However, the asthma does not go away just because the symptoms do. A person needs to keep taking care of the condition as part of life: avoiding triggers, not smoking, and living in a healthful, clean environment. This is true even if the asthma is mild.

How Is Asthma Treated?

Besides avoiding exposure to asthma triggers, the chief way that asthma is treated is with various medicines. One key to good control is taking the right medicine at the right time. There are two main kinds of asthma medicines: those that help with long-term control of the disease, and those that give short-term relief when a person is having an asthma attack.

Long-term control medicines

Long-term control medicines are taken every day to help prevent symptoms before they start. It may take several weeks for these medicines to produce their best results, though. The most effective ones work by reducing swelling in the airways. Many are inhaled, or breathed into the lungs. Not everyone needs such medicines. However, they may be very helpful for people who have daytime asthma symptoms three or more times a week or nighttime symptoms three or more times a month. These are some medicines for long-term control of asthma:

• Inhaled corticosteroids (kor-ti-ko-STER-oids). These strong drugs prevent and reduce swelling in the airways. They also make the airways less sensitive to triggers. However, they work only if they are used regularly. These drugs are taken every day by people with long-lasting asthma. They are not the same as the unsafe steroids some athletes use to build muscles.
• Other inhaled drugs. These medications also help prevent and reduce swelling in the airways and make the airways less sensitive. However, it can take four to six weeks of regular use before they start to work. These drugs are taken every day by people with long-term asthma, but they can also be used before exercise or contact with a trigger.
• Oral corticosteroids. These drugs are taken by mouth in pill or liquid form. Unlike inhaled corticosteroids, they sometimes cause serious side effects when used for a long time. However, they can often be used safely for a short time to treat severe asthma attacks and to quickly bring asthma under control. They are sometimes taken every day or every other day by people with the most severe asthma.
• Long-acting bronchodilators (brong-ko-DY-lay-tors). These drugs relax the muscles around the airways, making it easier to breathe. They can prevent or reduce narrowing of the airways. However, they keep working only if they are used regularly. These drugs are inhaled or taken by mouth in a pill. Some are especially useful for preventing nighttime or exercise-related asthma.
• Antileukotrienes (an-ti-loo-ko-TRY-eens). This is a new class of asthma drugs. These drugs prevent and reduce swelling in the airways and make the airways less sensitive to triggers. They also prevent squeezing of the muscles around the airways. These drugs are taken regularly by mouth in a pill. So far, they have been used mainly for mild asthma in patients of age twelve and older.
• Allergy vaccines. In some cases, a person's asthma symptoms can be prevented or lessened by giving a course of special allergy injections over months or years. These shots contain small amounts of the allergens that are triggering the person's asthma. The course of injections causes the person to become less sensitive to the allergen when exposed to it.

Short-term relief medicines

Short-term relief medicines are taken only when needed to relax and open the airways quickly. They can be used to relieve symptoms or to prevent them if a person's peak flow meter readings begin to drop, signaling an upcoming asthma attack. However, the effects last for only a few hours. They cannot keep the symptoms from coming back the way long-term control medicines can. These drugs are inhaled and are taken at the first sign of trouble or before contact with a trigger.

Medicines that provide short-term relief of asthma are called shortacting bronchodilators. These drugs relax the muscles around the airways, making it easier to breathe. They begin to work within five minutes, and their effects last for four to six hours. Such drugs are taken right after symptoms start or just before exercise.

How Are Inhaled Medicines Taken?

Many asthma medicines are made to be breathed into the lungs. Such inhaled drugs go straight to the place where they are needed. The most popular device for taking inhaled medicines is a metered dose inhaler, which gets the drug to the lungs in exact amounts. The inhaler is a small, hand-held canister with a button that the person pushes to make the medicine spray out. Often a tube, called a spacer, is attached to the canister to make it easier to use.

Breathtaking Facts

• More than 17 million people in the United States have asthma. Of these, almost 5 million are children.
• About one in every ten children has asthma-like symptoms.
• About three out of four children with asthma continue to have symptoms as adults.
• Asthma results in about 3 million lost days of work each year among American adults.
• According to the Centers for Disease Control and Prevention (CDC), between 1980 and 1994, the number of Americans who reported having asthma rose 75 percent

Animal Bites

 

Are Animal Bites Dangerous?

Animal bites can range from mild to serious. When the skin is not broken, bites usually are not dangerous. When skin, muscles, or tendons are torn, bones are crushed, a deep hole is made (a puncture), or the wound becomes infected by germs in the saliva, then animal bites can be very serious. In these cases, a doctor should examine the wound.

^*mammals are warm-blooded animals with backbones, who usually have fur or hair. Female mammals secrete milk from mammary glands to feed their young. Humans are mammals.

Rabies

Rabies is a viral disease that affects the nervous system. A rabid animal, whose saliva contains the rabies virus, can infect another animal or a person by biting them. Any mammal^* can get rabies, but it is extremely rare among pets or domestic animals in the United States because they are vaccinated against it. Nine out often cases of rabies occur

Dog bites usually occur on the hands, face, or legs. This bite is on the leg of an adult. Most dogs do not bite unless they are provoked or teased or protecting their puppies. Children should be taught always to ask permission before petting a dog and never to pet unknown dogs. Dog bites should be examined by a doctor. Infections are rare, but if they do occur, they usually cause redness, swelling, and tenderness around the wound site.

© 1995 Dr. P.Marazzi/Science Photo Library, Custom Medical Stock Photo.

in wild animals, particularly skunks, raccoons, bats, foxes, groundhogs, and rodents. Rarely is rabies transmitted to people, but people who have been bitten by rabid animals need to get immediate treatment before the infection begins, or they may die. Deaths are rare, however: between 1990 and 1995, only 18 people died of rabies in the United States.

Who Bites and Why?

Household pets, such as dogs and cats, cause the majority of animal bites in the United States, and most bites are from animals known to the person bitten.

Dogs

Dog bites usually occur on the hands, face, or legs. About a million people a year seek medical care for dog bites in the United States, and millions more bites are unreported. Sixty percent of those bitten are children, so dog bites are a major health problem of children. Dog bites rarely become infected, and rabies in dogs is rare. On average, 12 people, mostly young children, die each year from dog bites.

Most dogs do not bite unless provoked or teased, so most dog bites can be prevented by following simple guidelines that include:

• Asking permission from a dog's owner before petting the dog
• Not petting unknown dogs
• Not teasing dogs or pulling their ears or tails
• Not bothering dogs when they are eating or sleeping
• Not bothering a dog who is protecting puppies
• Not running away from a growling dog, but instead backing away very slowly or waiting calmly for the dog to leave.

Cats

Cat bites and scratches also are very common, and they are more likely than dog bites to become infected. Cat bites most often involve the hands, followed by the legs, face, and torso. Rabies is rare in cats, but it is more common in cats than in dogs. One infection caused by cat bites or cat scratches is called Cat Scratch Disease. It causes enlargement of the lymph nodes^* but usually goes away by itself after about three weeks.

Humans

Human bites are dangerous because the human mouth contains bacteria that can cause serious infection. The most common human bite wound is a "fight bite," one that occurs when one person punches another person and cuts his knuckles on his opponent's teeth. Children sometimes bite other children or adults, and these wounds result from skin being caught between the teeth. The situation can be made worse when people are embarrassed about the bite and do not see a doctor right away, because delay in treatment can allow an infection to develop.

^*lymph node is a round mass of tissue that contains immune cells that fight harmful microorganisms. Lymph nodes may become enlarged during infections.

Other Animals

Mice, rats, guinea pigs, and hamsters sometimes bite, as do exotic pets such as ferrets, snakes, and birds. Horses, mules, sheep, pigs, and goats also can bite. Wild animals like skunks, raccoons, and bats bite thousands of people each year, and these bites can be very dangerous because the animals might have rabies.

Wild or wounded animals should never be approached. If a wild animal that usually avoids people instead starts to approach or to seem friendly, it may be sick. An adult should be notified about a sick animal right away. They should call police or park rangers or animal control officers who have been trained to handle sick and injured animals.

How Are Animal Bites Treated?

All bites should be cleaned as soon as possible. If the skin is broken but not torn or bleeding, the wound should be washed with soap and water and treated with antibiotic cream to prevent infection. If the bite is a puncture wound or is bleeding, pressure should be applied to stop the bleeding. In all cases, the wound should be examined by a doctor, who may recommend antibiotics, as well as a tetanus shot if the person has not had one in the last 10 years.

A person with a bite wound should watch for signs of infection, such as redness, swelling, and tenderness around the wound site. If any of these symptoms appear, they should see a doctor immediately.

Alcoholism

 

What Is Alcoholism?

Among adults in many social circles, a drink or two of an alcoholic beverage is a common part of many social events in everyday life. People have a glass of wine with dinner or toast the bride and groom with champagne at weddings. Fans at sporting events and people at picnics have a beer. There is even some research that suggests that moderate drinking by adults can lower the risk of heart disease and stroke.

"Moderate" drinking is no more than two drinks a day for adult men and no more than one drink a day for adult women and people who are age 65 or older. But millions of Americans drink too much, leading to problems with their health and affecting their families, friends, schoolwork, and jobs: About 14 million people in the United States either abuse alcohol or have the disease alcoholism, according to the U.S. National Institute of Alcohol Abuse and Alcoholism. Other surveys put the number as high as 20 million people. It is a widespread problem, with some experts estimating that more than half of all Americans say they have a close relative with an alcohol problem.

Alcoholism is a disease that can affect anyone, from young people like Roberta to the elderly. The numbers are increasing, especially for boys and girls who are younger than the legal drinking age. More boys and men are affected than girls and women.

People with alcoholism are addicted to alcohol, so they feel a physical and mental urge to drink. As time passes, the person's urge to drink becomes an uncontrollable craving, like a starving person's hunger for food. This craving for alcohol leads people to behave recklessly, and as a result they wind up failing in school, missing work deadlines, or driving drunk. Yet even when their drinking begins to result in bad grades, family fights at home, legal problems, or job loss, people with alcoholism continue to drink unless they seek help.

People who are addicted to alcohol start to need alcohol more often and in greater amounts in order to get the same physical and emotional feelings they used to get when they drank less. Their drinking continues even as their health problems and personal problems increase. If they stop drinking, they may shake, sweat, and feel anxious or sick to their stomach. These are symptoms of withdrawal, their body's adjustment to being denied alcohol.

Not everyone who drinks excessively meets the medical definition of alcoholism. When drinking leads to problems but not all the symptoms are physically dependent on alcohol, the disorder is called alcohol abuse. Alcoholism can almost never be overcome unless the person stops drinking completely. People who drink too much, but who do not have alcoholism (are not dependent on alcohol), sometimes can cut their drinking to moderate amounts. But often they, too, need to stop drinking completely. Fortunately, programs can help people stay sober and help families cope.

Genes

Scientists know that alcohol is processed differently in the bodies of people with alcoholism, but no direct link between a gene^* or set of genes and how alcohol is processed has been proven. It may be that inheriting certain genes results in personality or emotional characteristics that increase the chances that children would abuse alcohol.

Friends and family

The attitudes of family and friends toward drinking alcohol may affect whether people develop alcoholism. Those who abuse alcohol often have family or friends who make it easier or more acceptable to drink excessively.

Stress

The stress of meeting deadlines for school assignments or coping with personal problems is a normal part of life, but some people use alcohol in an attempt to escape stressful situations. People coping with such conditions as depression and post-traumatic stress disorder also sometimes drink excessively. It is important to remember that it is not a weakness that keeps people drinking when they are under the powerful grip of alcoholism. Rather, alcoholism is a disease, much the same as other physical and mental conditions, and its treatment requires support from professionals, family, and friends.

The U.S. and the World

The World Health Organization reports that misuse of alcohol is "a major burden to nearly all countries in the world," resulting in disability, domestic violence, child abuse, and death. WHO says there are about 750,000 alcoholrelated deaths annually and that "alcohol-related diseases and injuries account for between three to four per cent of the annual global burden of disease and injury."

• Alcoholics Anonymous has almost 2 million members worldwide in almost 100,000 groups. There are more than 30,000 Al-Anon and Alateen groups meeting in 112 countries.
• Almost 82 percent of Americans 12 and older say they have used alcohol sometime in their lives, according to a 1997 survey. About 40 percent between ages 12 and 17 said they had tried alcohol at some point and 20.5 percent of this age group said they used it in the last month.
• Total per capita alcohol consumption in the U.S. has dropped since its alltime peak of 2.76 gallons per person (14 and older) in 1980 and 1981. By 1996, it was 2.19 gallons per capita.
• The top American state for per capita alcohol consumption in 1996 was New Hampshire (4.16 gallons per person 14 and older). The lowest state was Utah (1.29).

^*genes are chemicals in the body that help determine a person's characteristics, such as hair or eye color or the risk of getting diseases like alcoholism. They are inherited from a person's parents and are contained in the chromosomes found in the cells of the body.

Alcoholism often develops over many years, but it can develop quickly, especially in teenagers. Alcohol is the most widely used and abused drug among young people. Although the legal drinking age in the United States is 21, more than 50 percent of high school seniors and about 25 percent of eighth graders report having used alcohol.

Roberta liked to say that drinking beer was not like using illegal drugs like marijuana and cocaine. But the fact is, the dependency and unfortunate consequences that can result from people drinking alcohol are similar to those that result from taking drugs that are less socially acceptable.

Alcoholism is often considered a hidden disease. People who abuse alcohol become skilled at hiding their drinking. Families sometimes help, because they feel embarrassed by their loved one's actions. Also, as the disease progresses, the alcoholic's tolerance for drinking increases. This means they may appear sober even after many drinks or even with an elevated blood alcohol level^*.

There are many signs that indicate people are developing alcoholism. These signs include:

• Drinking despite bad consequences to health or problems at home, at school, or at work.
• Displaying behavior that, if they were sober, would embarrass drinkers or their families.
• Denying there is a problem even when it becomes obvious to others.
• Becoming annoyed af those who criticize their drinking.
• Drinking alone rather than with others, especially to avoid people or situations that had been important in the past.
• Having mood swings or anger when drinking.
• Having blackouts in which they forget what happened when they were drunk.
• Feeling nauseated, anxious, sweaty, and shaky when they stop drinking.

^*blood alcohol level is the amount of alcohol in a person's blood, It can be measured with a device that tests for a small amount of alcohol in the breath. In the United States, most states now consider people impaired if their blood alcohol level is 0.07 to 0.10 or higher.

^*binge drinking is having five or more drinks in a row within a few hours.

The amount or frequency of a person's drinking is not a factor in determining whether that person has alcoholism. Some people drink excessively every day, whereas others drink in binges^* every month or so. Some people drink amounts that would not be a problem for other people, but that are a problem for them. The important thing is whether the amount people drink causes the physical and emotional symptoms of alcoholism and harms their personal lives.

How Do Doctors Diagnose Alcoholism?

There are several ways for doctors to determine if a person has the disease of alcoholism. Doctors or other health professionals can use standard screening tests to see if patients have alcohol problems. These tests can include such questions as "Have you ever awakened the morning after drinking the night before and found that you could not remember part of the evening before?" and "Do you ever try to limit your drinking to certain times of the day or to certain places?"

Doctors also can look for physical signs, like liver problems, although these usually indicate that the person has had alcoholism for a long time. The liver is the organ that processes alcohol in the body. Too much alcohol damages the liver over time, causing it to become, fat. In some cases, alcoholics develop cirrhosis (si-RO-sis) of the liver (scarring) or hepatitis (inflammation of the liver). Chronic alcohol use also can damage the pancreas.

Alcohol abuse also can cause sleep disorders and malnutrition. It also appears to increase the risk for some forms of cancer and heart disease. People who drink too much are more likely to be injured in car accidents and to become victims of homicides or rapes. Men who drink too much are at risk for impotence^*, and women who drink when they are pregnant endanger their unborn babies.

How Do People Recover from Alcoholism?

Treatment for alcoholism can succeed if the person stops drinking now and forever. Doctors do not say the disease is "cured," because patients always are at risk of developing the disease again if they drink. Patients cannot simply cut down on their drinking. They must stop.

Blood Alcohol Levels

When people drink alcohol, it passes through their stomachs and intestines and is absorbed into the bloodstream, just like any other food or beverage.

The alcohol gets into the body's cells, especially those in the part of the brain that control behavior. Like a tranquilizer, the alcohol dulls the central nervous system, resulting at first in a relaxed feeling.

The liver eventually converts most of the alcohol into waste products like carbon dioxide and water. But the liver can handle only about one drink per hour. More than that amount begins to make a person drunk, resulting in poor judgment, emotional changes, and problems with walking, movement, and talking. Drinking too much alcohol will kill a person.

The effect of alcohol is complex. A full stomach can slow the absorption of alcohol into the bloodstream. Many men and people who weigh more than average usually do not feel the effects of alcohol as quickly as women and people whose weight is average or less. Alcohol also makes the effects of medications more extreme, especially cold medicines that cause drowsiness. If a person is in poor health, sleepy, ortired, alcohol's effects will increase in that person.

In the United States, most states now consider people impaired if their blood alcohol level is 0.07 to 0.10 or higher. A 100-pound person can approach or exceed that level after drinking only two drinks in one hour. Someone who weighs 140 to 160 pounds could be legally drunk after three to four drinks in two to three hours. And even at lower levels, judgment and driving skills are likely to be impaired.

^*impotence (IM-po-tens) is failure of a man to achieve or to maintain an erection.

Alcoholics often deny they have a problem, which makes it difficult to get them to seek professional help. Family members, friends, school

Alcoholism affects many different parts of the body.

counselors, employers, and health professionals usually must take the lead by discussing the alcohol abuse and its consequences.

Experts say it must become clear to the person with alcoholism that there will be no more "rescue missions" if the drinking continues. The person with alcoholism needs to know that if the drinking causes divorce, job loss, or poor performance in school, no one will be there to help, unless the person seeks treatment. It can be a good idea for family members to seek the aid of someone trained in dealing with alcoholism.

If the disease is in its earlier stages, support groups like Alcoholics Anonymous are a first step to recowery. Family members often seek help at Alanon or similar support groups for the emotional troubles they face.

Advanced alcoholism often is treated with a week-long stay in a residential treatment center or hospital detoxification^* unit. Doctors help patients cope with the withdrawal symptoms, which in advanced cases can include delirium tremens^*. Doctors may prescribe medications that help reduce the craving for alcohol or that cause people to feel sick if they try to resume drinking alcohol.

The recovery from alcoholism's physical and emotional effects can be a long process. Self-help groups like Alcoholics Anonymous, individual counseling with a therapist, and visits with health professionals often are needed.

^*detoxification (de-tox-i-fi-KAY-shun) is the process of breaking dependence on an addictive substance.

^*delirium tremens are also called "the DTs" or Alcohol Withdrawal Delirium. The DTs may occur two to three days after a person with long-term alcoholism stops drinking. Symptoms include rapid heartbeat, sweating, abnormally high blood pressure, an irregular tremor, delusions, hallucinations, and agitated or wild behavior. The delirium and other withdrawal symptoms usually subside in three or four days.

With treatment, many people with alcoholism recover to resume the parts of their lives that were disrupted when they drank. But sometimes they go back to drinking for a period and once again have problems with their health and personal life. People who are recovering from alcoholism often say they must take life "one day at a time," because they must maintain constant watchfulness so that they do not resume their drinking.

What Causes Albinism?

Albinism is an inherited condition in which a person lacks the usual amount of the pigment melanin, which is the substance that gives color to skin, hair, and eyes.

What Is Albinism?

Albinism (AL-bi-niz-im) is a disorder that occurs when a person inherits various genes^* that are defective in their ability to make the pigment melanin (MEL-a-nin). Melanin is the main substance that determines a person's skin, hair, and eye color. In the United States, albinism affects approximately 1 in 17,000 people.

^*genes are chemicals in the body that help determine a person's characteristics, such as hair or eye color. They are inherited from a person's parents and are contained in the chromosomes found in the cells of the body.

The outward signs of albinism vary depending on the amount of pigment a person has, and many people with albinism have skin much lighter than that of their family members. People with albinism also may have white or pale yellow hair, and light-colored eyes. Sometimes the eyes look pink because they contain no pigment to mask the red of the blood vessels in the retina^*.

Albinism always affects vision to some degree. The genes that cause albinism also cause abnormal development of the nerve connections between the eyes and the brain. The retina and the iris (the colored portion of the eye) are also affected by albinism.

What Causes Albinism?

Albinism is an inherited condition that can be caused by a number of different genes.

• Type 1 albinism: This form of albinism is characterized by almost no pigmentation and is caused by a defect in a gene for an enzyme^* that makes pigment.
• Type 2 albinism: People with Type 2 albinism usually have some pigmentation; this type is caused by a defect in a gene called the "P gene.
• Hermansky-Pudlak syndrome (HPS): A different defective gene causes Hermansky-Pudlak syndrome, which is a form of albinism characterized by easy bruising and bleeding and a susceptibility to lung and bowel disease. Skin, hair, and eye color vary from person to person with HPS.
• Ocular (eye) albinism: This form of albinism affects mainly the eyes; hair and skin may not look unusual.

^*retina is the back inner surface of the eyeball that plays a key role in vision. This surface contains millions of light-sensitive cells that change light into nerve signals that the brain can interpret.

^*enzymes (EN-zymz) are natural substances that speed up specific chemical reactions in the body.

Most people with albinism are born to parents without the condition, but both parents must carry a copy of the defective gene and both must pass on that copy to their child. Albinism is a recessive trait,

Many people with albinism have skin and eyes much lighter than that of their family members. People with albinism often have vision problems and must take care to protect their skin from sunburn.

meaning that if a person inherits even one good copy of the gene, he or she will not have the condition. Each time parents who both carry the trait have a child, there is a 25 percent chance that the child will have albinism regardless of whether it is a boy or a girl. Ocular albinism is the exception; most cases are caused by a sex-linked genetic defect. This means that the defective gene is carried by the X chromosome^*, which is one of two chromosomes that determine a person's sex. Sex-linked diseases occur most often in males.

Living with Albinism

Vision problems and protecting the skin are the biggest health problems for people with albinism. The lack of pigment makes eyes and skin very sensitive to sunlight and the skin prone to burning. Vision problems vary from person to person. Some people simply need glasses to correct their vision, but others need surgery. Some people can see well enough to drive a car, whereas others are legally blind. All people with albinism need consistent and continuing eye care.

People with albinism also face social and emotional hurdles as they learn to live with being different. Emotional support from family and friends is essential to building self-esteem in a child with albinism.

^*chromosomes (KRO-mo-somz) are threadlike structures inside cells on which the genes are located.

Albinism and the Eyes

Vision is always affected by albinism. Vision problems that can affect people with albinism include:

sensitivity to bright light

crossed eyes or "lazy" eyes

back-and-forth movement of the eyes

farsightedness

nearsightedness

blurry vision

What Does HIV Do in the Body?

AIDS is the most severe form of disease caused by HIV (human immunodeficiency virus), a virus that damages the immune system, leaving a person open to many life-threatening infections.

How Did the AIDS Epidemic Begin?

In the early 1980s, doctors in New York and California began noticing a very unusual disease in a small number of young men. The men, who were mostly homosexual, were developing unusual infections and cancers, and some of them were dying. The infections were similar to those seen in children who are born with very weak immune systems. But these men had been healthy as children and should have had normal immune systems.

Government scientists searched for other cases of the disease, and found more and more of them. The disease also seemed to strike people who had received blood transfusions, and drug addicts who had shared needles with each other. Reports of the disease began to come in from other countries, including African and Caribbean countries, where it seemed to spread mainly by sexual contact between men and women. Some babies were born with it, too.

AIDS

Less than 20 years later, that mysterious disease had become one of the worst epidemics ever to strike humanity. AIDS (acquired immune deficiency syndrome) had killed almost 14 million people worldwide, including more than 3 million children, by the end of 1998. In the United States, AIDS had killed more than 400,000 people, including almost 5,000 children younger than age 15.

HIV

Even greater numbers of people are infected with the virus that causes AIDS, but have not yet developed the disease. In the United States, almost a million people are thought to be infected with HIV, the human immunodeficiency virus, and most do not know they are carrying the virus that causes AIDS. Within 10 years of becoming infected, about half of them will have developed AIDS. Worldwide, more than 33 million people are living with HIV infection, mostly in developing countries in Africa and Asia.

People at risk

Like other sexually transmitted diseases, HIV infection is a particular risk among teenagers and young adults. In the United States, more than 110,000 people in their twenties have been diagnosed with AIDS, and it is likely that most of them became infected with HIV when they were teenagers. It is estimated that up to one quarter of all HIV infections in the United States—and half of all HIV infections worldwide—occur in teenagers and people in their early twenties.

Many billions of dollars have been spent to understand HIV/AIDS, to prevent it, and to treat it. Although there is still no cure and no proven vaccine, there has been progress. Because of new drugs, the number of deaths from AIDS fell sharply in the United States starting in 1996. Many Americans infected with HIV are living longer and better lives: they are going to school, working, raising their families, and enjoying life. There is hope that in the United States, HIV will soon be similar to other chronic^* diseases, like diabetes or asthma: a serious disease, but one that is manageable with good medical care.

.How Does HIV Spread?

HIV infection can spread only when an infected person's body fluid (blood, semen, vaginal fluid, breast milk, or any body fluid containing blood) enters the bloodstream or contacts the mucous membrane^* of another person.

Sexual intercourse, either homosexual (between men) or heterosexual (between men and women), is responsible for most cases of HIV infection. The virus also commonly spreads among people who share contaminated needles when they inject drugs. Infected mothers may pass it on to their babies during pregnancy, childbirth, or breast-feeding.

If blood is infected, transfusions can spread HIV. But in the United States, blood transfusions have been tested for HIV since 1985, and the risk of infection from a transfusion is extremely low.

Oral sex also can spread the virus, and at least one case has been reported in which the virus is thought to have spread through wet kissing (French kissing).

^*mucous membrane is the kind of tissue that lines body openings, such as the mouth, vagina, and rectum, as well as the respiratory, intestinal, and genital tracts.

HIV does not spread through air, water, food, or objects like doorknobs or toilet seats. It is not spread by mosquitoes or by other insects. A person cannot "catch HIV" by playing with, going to school with, shaking hands with, hugging, or even living with an infected person. Fortunately, HIV is much less contagious than many other infections, including chickenpox, flu, or hepatitis B.

How Can HIV Infection Be Prevented?

Prevention of HIV infection is easy—and hard. People can completely protect themselves by never sharing needles, whether for drug use or such practices as tattooing or body piercing, and by avoiding all sexual contact. As people grow up and become sexually active, however, things become more difficult.

Safer sex

The safest sexual relationship is between two uninfected people who have sex only with each other, sometimes called a monogamous (mo-NA-ga-mus), mutually faithful relationship. But there is no sure way to tell if a person is infected or not. People with HIV may seem completely healthy and often do not know they are infected. In the first few months after infection, they may even test negative on HIV tests.

So if people are sexually active, how can they reduce their chances of infection? One important step is not to have sexual contact with anyone who may be at risk of HIV infection. Who is at risk? Anyone who ever shared needles or engaged in promiscuous sex (had many sexual partners), as well as anyone who ever had a sexual partner who shared needles or engaged in promiscuous sex. Of course, often people are not truthful about past behavior. To judge whether a potential sexual partner is being honest, or is at risk, it may help to know the person well, over a long period of time. Unfortunately, however, that, too, is no guarantee.

Other safety measures

Other steps to reduce the chances of infection include:

• using latex condoms correctly and consistently during sexual activity
• not engaging in anal sex or other sexual practices likely to cause breaks in the skin
• not having sexual relations with multiple sexual partners
• avoiding drugs and alcohol, since their use might prevent people from making good decisions about protecting themselves and others from HIV
• getting prompt treatment for any sore or blister in the genital area, since these can act as an open door for HIV to enter the body.

. What Does HIV Do in the Body?

Once HIV gets into the body, it attacks and enters white blood cells called CD4 helper lymphocytes (LIM-fo-sites). These cells are very important for the proper functioning of the immune system. When the virus begins to destroy CD4 cells more rapidly than the body can replace them, the immune system becomes so weak that severe infections and cancers can develop. The virus also can directly attack some organs, including the brain, the kidneys, and the heart.

The retrovirus HIV invades a body cell called a CD4 helper lymphocyte. Once inside the lymphocyte, HIV combines its genetic material with the CD4 cell's genetic material. After that, whenever the CD4 cell reproduces itself, it also reproduces HIV. HIV can destroy CD4 lymphocytes and spread throughout the body during active AIDS infections.

HIV is a special kind of virus called a retrovirus (see sidebar) and includes two species, or types. HIV-1, which is far more common and more severe, has caused the current epidemic. Different subtypes of it occur in different parts of the world. HIV-2, which is seen in some parts of West Africa, causes a milder version of AIDS.

One reason it has been impossible so far to find an HIV cure or vaccine is that the virus can mutate and change its genetic features with amazing speed. That means HIV can quickly grow resistant to a medicine, making the drug no longer effective. It also means that any drug or vaccine must be able to work against a wide range of different strains of HIV.

What Are the Symptoms?

HIV Infection

Between two and four weeks after people get infected, most people develop a flu-like illness with fever, sore throat, muscle aches, and (often) a rash that looks a little like measles. After two weeks, this illness usually disappears. Others, however, get infected with no initial symptoms of illness. A person can transmit HIV to others without having had any symptoms.

Over the next few years, a person may suffer fevers, swollen glands, fatigue, weight loss, and diarrhea. These symptoms generally occur long before the serious complications that come with AIDS. Some people may have minor infections such as thrush (a yeast infection of the mouth) or shingles (a skin infection caused by the virus that causes chickenpox). Others do not have any symptoms until they develop AIDS itself.

Children, especially those who were infected before they were born, generally develop symptoms more quickly than adults. Often they are sick from birth or may fail to grow and develop at a normal rate.

How Is HIV/AIDS Diagnosed?

Doctors may suspect HIV infection from the symptoms, especially if a person has one of the rare infections mentioned above. But HIV infection can only be diagnosed by blood tests.

Testing for HIV

Doctors recommend testing for all people who think they may have been exposed. Testing is also recommended for all pregnant women and for newborns whose mothers either tested positive for HIV or were not tested during pregnancy. Such testing should lead to treatment that cuts the baby's risk of getting HIV from the mother. Treating an infected woman with the drug AZT (zidovudine) during pregnancy and delivery, and treating her newborn with the same drug after birth, reduces the baby's risk of getting HIV from about 25 percent to about 6 percent.

The most common HIV test detects antibodies, which are substances the body makes to fight the virus. This test may not show infection until several months after it has occurred. For that reason, a person who was recently infected may test negative. So people who think they may have been exposed to the virus should be tested immediately and again six months later.

WHERE DID HIV COME FROM?

Since the identification of AIDS in 1981, and the discovery of HIV (the human immunodeficiency virus that causes AIDS) in 1983, scientists have tried to discover the origin of the virus. They came to suspect that it had developed in Africa from a monkey virus known as SIV (simian immunodeficiency virus) and that it might have spread to humans from chimpanzees.

But it was not until 1999 that an international team of researchers found what could be the missing link: a virus that seems to be a genetic blend of HIV and SIV. It was found in one subspecies of chimpanzee, Pan troglodytes troglodytes, but it seems to cause them no illness. Researchers suspect that humans first became infected with SIV about 50 years ago when they were exposed to the chimps' blood while hunting the animals for food. Once in humans, it appears, the virus changed into the deadlier HIV we know today.

Researchers were elated at the discovery of the microbe they called SIVcpz (cpz stands for chimpanzee). Because it does not make infected chimps sick, studying what it does in their bodies may help scientists learn how to prevent HIV from making people sick. And it may help them prevent the spread of other viruses to humans in the future.

But the scientists got a harsh surprise. The type of chimp involved, they learned, soon may be extinct in the wild. Logging is driving the animals out of their rainforest homes in West and Central Africa, and they are being butchered as game meat. Now scientists are trying to save the chimps, as well as study them.

"We cannot afford to lose these animals," said Dr. Beatrice Hahn of the University of Alabama, one of the lead researchers involved. "Chimpanzees may represent both cause and solution to the AIDS problem."

What Is a Retrovirus?

One reason HIV is so dangerous is that it is a special kind of virus—a retrovirus. This means that it reproduces itself in a backward or "retro" manner. To understand what that means, it helps to know some basic information about viruses.

Viruses are tiny microbes—much smaller than bacteria—that are made largely of nucleic acid, the substance that makes up genes. They work by invading a cell and using the cell's energy and machinery to make copies of themselves.

The virus's nucleic acid may be either DNA (deoxyribonucleic acid) or RNA (ribonucleic acid). DNA viruses make direct copies of their DNA, and most RNA viruses make copies of their RNA. This copying process is called transcription. Retroviruses contain RNA but copy it into DNA in a process called reverse transcription. Then the viral DNA—called a provirus—is inserted directly into the genetic core of the cell. That means that wheneverthe cell reproduces itself, by making copies of its own DNA, it also makes copies of the retrovirus's DNA.

In the case of HIV, the virus invades CD4 helper lymphocytes, which are white blood cells important to the immune system.

In addition, for the first year or so of life, a baby born to an infected mother may test positive for HIV even if the baby is not infected.

Testing for CD4 lymphocytes

Once a person is known to be infected, a different blood test is done periodically to see how well the person's immune system is working. The test measures the level of CD4 lymphocytes, the type of white blood cell targeted by HIV. If the number of these cells falls below a certain level—or if the person has certain severe infections like those described earlier—then the person is said to have AIDS.

How Is HIV/AIDS Treated?

Drugs to fight the virus directly are generally prescribed as soon after infection as possible. These drugs block protease and reverse transcriptase, which are important enzymes^* that the virus makes in order to reproduce itself. The drugs are used in combinations of three to five medications, which is a form of treatment called HAART (highly active antiretroviral therapy).

The most powerful of these drugs are also the newest, so no one knows how effective they may be in the long run. But it is clear that they postpone the development of AIDS and often make other symptoms less frequent and less severe. Unfortunately, HIV may become resistant to one or more of the drugs. In addition, all the anti-HIV drugs have side effects that make them difficult for many patients to take. It is not yet known whether these drugs reduce the chance that an infected person will pass HIV to someone else.

Besides the antiviral drugs that attack HIV directly, other medications can help prevent or treat some of the serious infections that come with AIDS.

Histoplasmosis and HIV

In some areas of the United States, especially southern and southwestern areas, almost 80 percent of the population tests positive for the fungal infection histoplasmosis (his-to-plaz-MO-sis).

In the past, only people with severe cases of histoplasmosis required treatment, but HIV and AIDS have caused an increase in those numbers.

People with HIV, AIDS, and other immune system diseases should avoid activities that increase their chance of exposure to histoplasmosis. Such activities include cleaning chicken coops, disturbing soil beneath bird-roosting sites, and exploring caves. Once infected, people with histoplasmosis and HIV require ongoing treatment.

Bob drives a cab. When he gets busy at work, it is hard for him to remember to take the pills at just the right time and to be sure he has water with him. Plus, the nelfinavir gives him diarrhea. He has also noticed that he is beginning to develop a large pot belly. His doctor warned him that the nelfinavir might cause this.

Some days he feels encouraged thinking how the drugs are helping him. Other days he gets so depressed about all the pills and the side effects that he feels like giving up. But for now, he has decided to do what the doctor said and try never to miss a single dose. He just hopes he can keep hanging on and that better medicines come out soon.

Living with HIV/AIDS

In the early days of the epidemic, parents picketed outside schools to keep HIV-infected children out, and workers feared sitting next to someone with AIDS. Today, most Americans realize that HIV cannot be caught just by being around someone who has it. But people infected with HIV still can face stigma and discrimination. For many people, telling family and friends they are infected also means revealing something they have been keeping secret about themselves—that they are gay, or that they have used illegal drugs, or that they have had sex with many people. This can be very difficult, especially for young people who are gay and may fear rejection by their families. Often, however, people with HIV find that family and friends are very supportive.

To help stay healthy with HIV, good health habits become even more important. These include:

• for everyone: eating ample amounts of nutritious food, exercising, and getting adequate rest
• for drug addicts: stopping drug use
• for smokers: quitting smoking
• for people who have no symptoms: getting regular checkups, preferably by doctors who have a lot of experience treating HIV/AIDS
• for people who are taking medications: taking them properly and consistently, because taking these medicines on and off can cause a person's virus to become resistant to them.

Many people with HIV live normal lives for many years. Even those who struggle with bouts of illness often carry on with great fortitude and continue to enjoy their lives, just like people with any other chronic, life-threatening illness

Addison's Disease

What Is Addison's Disease?

Addison's disease develops because the adrenal glands do not produce enough of certain important hormones. The adrenal glands are thin triangular groups of cells about the size of an adult thumb. One adrenal gland is located above each of the two kidneys. Among other things, the glands release hormones known as cortisol and aldosterone. But the adrenal glands in people with Addison's disease are not functioning properly, which leaves the people without enough of the hormones they need to keep the body working normally.

Cortisol and aldosterone

Cortisol is needed to help the body respond to stresses such as diseases and infections. It also helps the body use sugars, proteins, carbohydrates, and other substances in food for energy. Aldosterone helps signal the kidneys to regulate the amount of salt and water retained in the body. This is important because without the proper amount of salt and water, blood pressure can drop.

Autoimmunity

Usually in Addison's disease, the adrenal glands do not work properly because the body's own immune system turns against the body and destroys part of the adrenal glands. The immune system releases antibodies to fight foreign substances in the body, like viruses. In Addison's disease, the antibodies and cells of the immune system destroy the outer part of the adrenal glands and cause them to release inadequate amounts of cortisol and aldosterone. No one is sure why this happens.

Other causes

The disease also can result from conditions that affect the functioning of the pituitary gland. People with tuberculosis may develop Addison's Disease if the infection involves and destroys the adrenal glands.

^*hormones are chemicals that are released by glands throughout the body to help regulate the body's function.

 

The adrenal glands are located above each of the two kidneys. When people have Addison's disease, the adrenal glands do not produce enough of the hormones cortisol and aldosterone.

Thomas Addison

The nineteenth century British physician Thomas Addison (1793-1860) was the first to relate the symptoms of Addison's Disease to problems with the adrenal glands. At that time, it was more common, because tuberculosis was widespread. Fortunately, Addison's disease is rare today. It strikes only about 1 of every 100,000 persons.

What Are Those Puzzling Feelings?

The first signs of Addison's disease can be puzzling to patients and their doctors. The lack of hormones in the body begin to leave the person feeling tired and their muscles seem weak. Patients also can feel dizzy, because of their low blood pressure. Appetite drops, and they start to lose weight from not eating as much. Because salt levels are out of balance in the body, people with Addison's might also hunger for salty foods, like potato chips.

Sometimes, people get sick to their stomachs and vomit, and they can develop dark areas on the skin, as if they are tanning. They also can seem unreasonably upset at things or become depressed.

Addison's usually develops slowly over many years. The symptoms might be noticed, but ignored as simply the result of working too hard or not exercising enough. About 25 percent of people with Addison's disease do not seek medical help until an accident or other illness triggers a sudden worsening of their symptoms. Without medical help, the sudden worsening can be fatal.

How Do Doctors Diagnose and Treat
Addison's Disease?

Doctors have various tests to check for the proper levels of the hormones involved in Addison's disease. They also can use an x-ray or other diagnostic tests to get an image of the adrenal glands to see if they look damaged.

 

People with Addison's need to take prescription hormones to do the work of the missing cortisol and aldosterone. Most of the time, this allows people with Addison's to avoid the disease's symptoms.

They still might experience a return of severe symptoms, if they get ill with another condition. For this reason, doctors recommend that people with Addison's wear a medical identification bracelet that explains their condition. This is in case they become sick suddenly and are unable to communicate with those trying to help them.

With treatment, however, people with Addison's disease can live as long and typical a life as people without the disease do.

Cure your acne in 3 days

Acne is the name for pimples or comedones^*: blackheads, whiteheads, and sometimes deeper lumps that occur on the skin, especially on the face, neck, chest, back, shoulders, and upper arms and legs. Almost all teenagers have at least a little acne, and some adults have the problem as well. Although acne is not a serious health threat, it can affect how people look, which in turn can affect how they feel about themselves. When the acne is severe, it can leave permanent scars on the skin.

Acne occurs when hair follicles (FOL-li-culs) become plugged. A follicle is a tiny shaft in the skin through which a hair grows. The follicles are connected to sebaceous (se-BAY-shus) glands, which are small structures in the skin that make an oily substance called sebum (SEE-bum). This oil helps keep the skin and hair healthy. To reach the surface of the skin, the oil drains from the glands into the follicles, then leaves the follicles through tiny openings in the top. As it leaves the follicles, the oil carries away dead skin cells shed by the follicle linings.

What Kinds of Acne Are There?

Sometimes the cells inside the follicles shed too fast and stick together, forming a white, cheesy plug at the surface of the skin. If the opening to the surface stays partly open, the top of the plug may darken, causing a blackhead. If the opening to the surface closes, the follicle may fill up and its wall may start to bulge, causing a whitehead. The mixture of oil and cells inside the follicle also aids the growth of bacteria. If the follicle wall bursts, the oil, cells, and bacteria spill into the skin. The result is redness, swelling, and pus, in other words, a pimple. Ordinary acne is made up of blackheads, whiteheads, and pimples.

At times, large, pus-filled lumps called cysts (pronounced SISTS) form deeper in the skin. This is a more severe form of acne. The lumps may be painful, and if they are not treated by a doctor, they may lead to permanent scars.

Who Gets Acne?

Nearly all teenagers have at least an occasional pimple. The problem usually starts between the ages of 10 and 13, and it typically lasts for 5 to 10 years. Acne usually goes away on its own by the early twenties. However, it can last into the twenties, thirties, and beyond. A few people get acne for the first time as adults. Acne strikes boys and girls about equally. However, boys are more likely than girls to have more severe, longer-lasting forms of the problem.

^*comedo (KOM-e-do) is an acne pimple. A blackhead is an open comedo. A whitehead is a closed comedo. Cosmetics that are labeled "non-comedogenic" (non-kom-e-do-JEN-ik) are less likely to cause pimples.

^*hormones are chemicals that are produced by different glands in the body. Hormones are like the body's ambassadors: they are created in one place but are sent through the body to have specific regulatory effects in different places.

During the teen years, both boys and girls go through changes in their hormones^*. One group of hormones, called androgens (AN-drojens), seem to play a role in acne. Among other things, androgens make the sebaceous glands work harder. The more oil the glands make, the greater the chance that the follicles will become clogged. Teenage boys

Healthy skin (left) has pores, hair follicles, and sebaceous glands that make an oily substance called "sebum." Sebum helps keep skin and hair healthy by carrying away dead skin cells that have been shed by the follicle linings. If the cells shed too fast and stick together, they may form a plug at the surface of the skin. If the opening to the surface stays partly open, the top of the plug may darken, causing a blackhead (center). If the opening to the surface closes, the follicle may fill up and its wall may start to bulge, causing a whitehead (right). If the follicle wall bursts, the oil, cells, and bacteria spill into the skin. The result is redness, swelling, and pus.

make ten times as much androgen as teenage girls, so it is not surprising that boys are more likely to get more severe cases of acne.

What Else Causes Acne?

Certain oily kinds of makeup and face cream can clog the openings of the skin and cause mild acne. That may mean that people who try to cover their pimples with makeup actually make the problem worse by causing new pimples. Oil-free products are labeled "non-comedogenic" (non-kom-ee-do-JEN-ik), meaning they should not cause blackheads or whiteheads, or "non-acnegenic" (non-ak-nee-JEN-ik), meaning they should not cause acne.

Several other things can cause acne or make it worse. These include certain medicines. People who work in fast food restaurants or garages may find that their acne is made worse by the constant contact with grease, motor oil, or chemical irritants. Many girls also find that their pimples get worse around the time of their periods.

What Does Acne Look Like?

Acne is typically found where the sebaceous glands are most numerous: on the face, neck, chest, back, and shoulders. Blackheads are spots with a dark top, whereas whiteheads are spots with a white center. Pimples look like small, red bumps. Some of them have a white center with a ring of redness around it. When pimples occur with no blackheads or whiteheads, they may be a sign of another skin disease or a skin reaction to medication. Cysts are large, red bumps that are often painful. They may leave deep pits and scars after healing.

It is usually easy for a doctor to recognize acne by sight. It is smart to see a doctor whenever:

• acne interferes with a person's life
• acne spots are large, red, and painful
• acne causes dark patches to appear on a dark-skinned person
• acne scars remain when the acne spots heal
• treatment with nonprescription medication does not work

How Is Acne Treated?

Acne treatments work by stopping new pimples from forming. They do this by cutting back on the amount of oil the sebaceous glands make, the number of bacteria that are present in the skin, or the rate at which dead skin cells are shed. It is important to give an acne treatment enough time to do its job. It may take weeks for the skin to clear up, even if a treatment is working.

Over-the-counter medications

Milder cases of acne are often helped by lotions, creams, pads, and gels sold without a prescription. Many will dry out the skin if used too frequently, however, and it is important to follow label instructions carefully.

Prescription medications

A doctor may prescribe stronger medicines than those sold over the counter. When put on the skin in creams or lotions, such medicines may cause dryness and peeling. The doctor can offer advice on how to deal with these side effects.

Other treatments

The doctor may open pimples or remove blackheads and whiteheads in the office. A skilled doctor is the best one to do this. People who try to do it themselves may wind up making the acne worse and increasing the risk of scarring.

Retin-A and Accutane

Two drugs used to clear up severe cases of acne are Retin-A and Accutane. Both of these drugs are derivatives of vitamin A.

Retin-A (tretinoin) comes in a cream, gel, or liquid and is applied to the skin daily. Exactly how it works is unknown but it is thought to loosen and expel existing acne plugs in the skin glands and prevent new lesions from forming. Results are seen in about 2 or 3 weeks but treatment should be continued for at least 6 weeks. The most common side effect is skin irritation.

Accutane (isotretinoin) is taken orally. Accutane must be taken daily for 4 or 5 months, and results last for about one year. Accutane has some serious side effects such as chapped lips, dry, itchy skin, nosebleeds, irritation of the eyelids, joint and muscle pain, temporary hair loss, and rash. It is particularly important that Accutane not be taken by women who are pregnantorwho may become pregnant during treatment as the drug can severely damage the developing fetus.

What Doesn't Cause Acne?

Acne is not caused by being dirty. Even the black in a blackhead is dried oil and dead skin cells, not dirt. Washing too often may actually irritate the skin and make the acne worse. In general, the following guidelines may help to prevent acne or to reduce its symptoms:

• not popping, squeezing, or picking at acne pimples, as this can just lead to more redness, swelling, and scars.

  

  Dermatologists may prescribe lotions or creams to treat acne.

  Choosing oil-free makeup and face creams labeled "non-comedogenic" or "non-acnegenic."

• Avoiding things that can irritate the skin, such as grease, oil, and rubbing from clothes and sports equipment.
• Washing the face gently twice a day with a mild soap, then patting it dry.
• Shampooing hair regularly.
• For men who shave, shaving as lightly as possible to avoid nicking any pimples.

Acne also is not caused by the foods a person eats. Studies have shown that a strict diet alone will not clear up the skin. On the other hand, some people are still convinced that certain foods such as chocolate or french fries make their acne worse. It certainly could not hurt to cut back on junk food. A healthier diet is always a plus, whether or not it has an effect on acne.