Causes of Diarrhea

Diarrhea is the condition of having three or more loose or liquid bowel movements per day. Every day, the digestive system, particularly your small and large bowels (intestines), must process nearly nine quarts of fl uid! Of course, that does not all come from the water, coffee, tea, juice, or other beverages that you drink, which typically account for only about two quarts of this total. Your body actually produces the rest of this fl uid, in the form of saliva, digestive juices from the stomach and pancreas, bile from the gallbladder, and an additional one to two quarts of fluids produced in the intestines to aid in digestion.

Normally, your bowels can effi ciently handle both the fluids that you drink and those your body produces. Problems arise, however, when viruses, bacteria, certain foods, sweeteners, or disease irritate or alter the lining of the small or large bowel, preventing the absorption of this fluid.

Some common conditions that cause diarrhea: Too Much Fluid, Viral and Bacterial Gastroenteritis.

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Three Types of Alzheimer's Disease

There are three known basic types of Alzheimer’s disease (AD):

• Early- onset AD is a rare form of the disease that afflicts people younger than 65. Less than 10% of people with AD have this type. Memory loss, behavior changes, and premature aging characterize this type. Because they experience premature aging, people with Down syndrome are particularly at risk for a form of early onset Alzheimer's disease. Early-onset Alzheimer's appears to be linked with a genetic defect on chromosome 14, to which late-onset Alzheimer's is not linked.
• Late- onset AD, the most common form, accounts for about 90% of cases and usually occurs after age 65. Geneticists are working hard to make the connection between genes and AD. There are several suspect genes. Late-onset dementia is also called sporadic Alzheimer's disease. 
• Familial Alzheimer’s disease (FAD). This form is inherited. In affected families, at least two generations
  have had the condition. FAD is rare and  accounts for less than 1% of all cases of AD. People may display symptoms of FAD as early as age 40. The presence of a positive family history in the late onset cases is considered as a risk factor, but a clear autosomal dominant pattern of inheritance is rare.

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Alzheimer's Disease - A Brain of Clumps and Plaques

What is Alzheimer's disease? Alzheimer’s disease (AD) is a condition in which the brain slowly shrivels and dies. Nerve cells in the brain stop working, and brain signals that are essential for life do not function properly. Although some people believe that dementia and decline in the later years are inevitable, geriatricians—who study and treat diseases of older adults—strongly disagree. Alzheimer’s disease and other dementias are considered illnesses and are not part of normal aging.

People with AD gradually lose judgment, thinking, and reasoning ability, or cognition. Personality and behavior change. The person may become anxious, agitated, and delusional. The progressive loss of intellectual abilities is called dementia. As the disease progresses, the individual needs help in all phases of life, including bathing, eating, and using the restroom. Families and friends of people with AD are especially affected. Seeing their loved ones change from the person they once knew to a stranger is emotionally devastating. Most scientists now agree that AD is a genetic disease. They have located the genes that may cause some kinds of early- onset AD. Researchers throughout the world are working on connections between the environment and genetics in the many types of dementia.

There are three basic types of Alzheimer’s disease:

1. Early- onset AD is a rare form of the disease that afflicts people younger than 65. Less than 10% of people with AD have this type. Memory loss,behavior changes, and premature aging characterizethis type.
2. Late- onset AD, the most common form, accountsfor about 90% of cases and usually occurs afterage 65. Geneticists are working hard to make the connection between genes and AD. There are severalsuspect genes.
3. Familial Alzheimer’s disease (FAD). This form is inherited. In affected families, at least two generations
   have had the condition. FAD is rare andaccounts for less than 1% of all cases of AD. People may display symptoms of FAD as early as age 40.

Here are 10 warning signs of Alzheimer's (source: http://www.alz.org) :

1. Memory loss that disrupts daily life.
2. Challenges in planning or solving problems.
3. Difficulty completing familiar tasks at home, at work or at leisure.
4. Confusion with time or place.
5. Trouble understanding visual images and spatial relationships.
6. New problems with words in speaking or writing.
7. Misplacing things and losing the ability to retrace steps.
8. Decreased or poor judgment.
9. Withdrawal from work or social activities.
10. Changes in mood and personality.

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General order to do first to stroke patients

Initial measures applied to all stroke patients are necessary to stabilize and assess the patient, and prepare for definitive therapy. All current and, probably, future stroke therapies for both ischemic and hemorrhagic stroke are best implemented as fast as possible, so these things need to be done quickly.

• O2 via nasal cannula (routine oxygen delivery in ischemia might improve outcome).
• Intubation may be necessary if the patient shows arterial oxygendesaturation or cannot “protect” their airway from aspiratingsecretions. However, intubation means that the ability to monitorthe neurological exam is lost. The best approach in such patientsis to prepare to intubate immediately, but before doing so, take a moment to be sure the patient does not spontaneously improve or stabilize with good nursing care (suctioning, head position, etc.).
• Consider putting the head of the bed flat. This can significantly help cerebral perfusion. 
• Consider normal saline bolus 250–500 mL if blood pressure is low.
• If the blood pressure is high, antihypertensive treatment.
• Determining the exact time of onset is critical for establishing eligibility for acute therapies, especially TPA. It is very important to be a detective. You will usually be told a time by the  paramedics or ED triage nurse, but be sure to recheck the information you receive from them. If possible, try to speak personally with first-hand witnesses, nursing home staff, etc.
• In most cases, the onset is not observed – the patient is found with the deficit. In that case, or in patients who awaken with symptoms, the onset time is the time the patient was last seen normal. However, if the patient awoke with symptoms, be sure to ask if the patient was up in the middle of the night for any reason (often to go to the bathroom) – as sometimes this puts the patient in the time window for treatment.
• Examine the patient and do the NIH Stroke Scale. The initial stroke severity is the most important predictor of outcome
• Do a non-contrast head CT. This will immediately rule out hemorrhage as blood is bright on a CT.
• The result will determine the first major branching point in therapeutic decision-making.
• Obtaining the CT is often the major impediment in preparing for thrombolytic therapy, so efforts should be made to shorten “door to CT” time, which should be below 30 minutes.
• In some select centers, emergent MRI can be done very quickly and substitute for CT, but this is the exception.
• If the CT shows no blood, try to get the artery open TPA is the only FDA-approved treatment for ischemic stroke, and you should immediately begin to determine if the patient is eligible for this therapy, and prepare for its administration.

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Stroke 'Mimic' or Real Stroke?

Distinguishing stroke 'mimic' from real stroke has not been well studied.  It's not unusual for patients to show up in the emergency room, worried they are experiencing a stroke. But other medical conditions, such as tumors, systemic infections and hematomas, can actually "mimic" a stroke.

All of the following may present similarly to a stroke. In all cases, the distinction can be made by an emergent MRI scan, which will showabnormal diffusion-weighted signal in most stroke cases, but not inmimics.

• Seizures. If a seizure has a focal onset in the brain, the patient may be left with weakness, numbness, speech, or vision problems for a period of time (usually less than 24 hours) after the seizure. Patients with seizures at onset are usually excluded from clinical trials of new stroke therapies.
• Migraine. Patients may have unilateral weakness or numbness, visual changes, or speech disturbances associated with a migraine headache (“complicated” or “complex” migraine). The best rule of thumb is not to make the diagnosis of complicated migraine or migrainous stroke unless the patient has a history of previous complicated migraine events similar to the deficit displayed in the emergency department.
• Syncope. This is usually due to hypotension or a cardiac arrhythmia. Stroke rarely presents with syncope alone. Patients with vertebrobasilar insufficiency may have syncope, but there are usually other brainstem or cerebellar findings if syncope is part of the stroke presentation.
• Hypoglycemia. Patients with low blood sugar may have symptoms that exactly mimic a stroke. The important thing is to check the blood sugar and, if low, correct it. If the symptoms do not resolve with correction of the hypoglycemia, the symptoms are probably from a stroke.
• Metabolic encephalopathy. Patients may have confusion, slurred speech, or rarely aphasia with this condition. They usually do not have other prominent focal findings.
• Central nervous system tumor. The location of the tumor would determine the type of signs and symptoms seen. A tumor, unlike a stroke, usually does not present with sudden focal findings, unless accompanied by a seizure.
• Herpes simplex encephalitis (HSE). This infection tends predominantly to affect the temporal lobes, so patients may have signs of aphasia, hemiparesis or visual-field cuts. Onset can be rapid and in its early stages may mimic a stroke, but fever, CSF pleocytosis, seizures and decreased level of consciousness are more prominent with HSE.
• Subdural hematoma. Depending on the location, this may cause contralateral weakness or numbness that may mimic a stroke. A CT scan can make this diagnosis, but the subdural hematoma, if small, may be subtle.
• Bell’s palsy (peripheral seventh nerve palsy). The important point here is that the forehead and eye closure are weak on the same side. One can have a stroke involving the pons and produce a peripheral seventh nerve palsy, but usually there are other signs and symptoms such as weakness, a gaze palsy, or ipsilateral sixth nerve palsy.
• Benign paroxysmal positional vertigo (BPPV). This may cause vertigo, nausea, vomiting, and a sense of imbalance, usually with turning of the head in one direction. This characteristic syndrome is due to labyrinthine dysfunction and not stroke. However, as with syncope, the presence of any brainstem or
  cerebellar signs should alert one to the possibility of a stroke.
• Conversion disorder. Patients may develop neurological signs or symptoms of weakness, numbness, or trouble talking that are manifestations of stress or a psychiatric illness.

Stroke is a clinical diagnosis, supported in some cases, but not all, by an appropriate abnormality on brain imaging. Despite its limitations, the clinical assessment directs immediate management of the patient with suspected stroke. For patients to receive time-critical treatments (such as thrombolysis, medical or surgical treatment of intracerebral hematoma, reversal of anticoagulation), they must be brought to hospital rapidly, assessed quickly and accurately, and promptly sent for the appropriate investigation.

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What Is a Stroke?

The term “stroke” usually refers either to a cerebral infarction or to non-traumatic cerebral hemorrhage. Depending on the population you are seeing (ethnicity, age, comorbidities) the ratio of infarcts to hemorrhages is about 4:1. A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a “brain attack.”

There are two major types of stroke: ischemic stroke and hemorrhagic stroke.
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:

• A clot may form in an artery that is already very narrow. This is called a thrombotic stroke.
• A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.

Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.

There is currently no 100% sensitive and specific test for cerebral infarction in the emergency department, so that the diagnosis is usually made on the basis of a characteristic history, exam, presence of comorbidities, and the absence of seizures or other stroke mimics. CT scanning is usually negative in the first three hours, or shows only subtle signs that have low inter-observer reliability. If available, MR imaging, or detection of an occluded artery by transcranial Doppler or arteriography (by CT, MRI or intra-arterial catheterization), can be confirmatory. Parenchymal or subarachnoid hemorrhage, on the other hand, can be reliably detected by emergent CT scanning.

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Efficacy and benefits of soursop fruit

Soursop, a native fruit from the West Indies, Central America, down to Brazil and it is a common fruit in tropical Asia nowadays.  Soursop is a fruit that has the most delectable flavor. Soursop is not only a delicious and healthy fruit but it is use medicinally to treat illness such as:

• Hemorrhoid.
  Take the ripe soursop fruit. Squeeze to take water as much as 1 cup, and drink 2 times a day, morning and afternoon.
• Bladder pain.
  Half-ripe soursop fruit, sugar and salt to taste. All material is cooked compote made​​. Eaten plain, and performed regularly every day for 1 week in a row.
• Infant Diarrhoea.
  Take the ripe soursop fruit. Soursop fruit is squeezed and filtered to take water, drenched diarrhea in infants as much as 2-3 tablespoons.
• Urinary tract infections
  Half-ripe soursop and sugar to taste. Soursop peeled and boiled with sugar with 2 cups of water, filtered and drunk.
• Back Pain.
  20 soursop leaves, boiled with 5 cups water to boiling until tinggal3 glasses, drink 1 a day 3 / 4 cup.
• Ulcer
  Soursop leaves are still young enough, stick it in a place exposed to ulcers.    

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