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Apoptosis
 Definition
“The term apoptosis can be defined as a natural biological process of programmed
cell death in which the cells destroy themselves for maintaining the smooth
functioning of the body.”

 What is Apoptosis?
 There are two forms of cell death

1. Programmed death of cells called Apoptosis.

2. An uncontrolled death of cells called Necrosis.

 Both apoptosis and necrosis occur under different circumstances and involve different steps.
 The term apoptosis is derived from the Greek word meaning dropping or falling off. It was first
introduced by Kerr, Wyllie, and Currie.
 Apoptosis is a biological process which occurs in all multicellular organisms including plants and
animals. It removes the cells from the organisms that should no longer be a part of the organism.
 This process plays a major role in the development of humans and in developing and maintaining a
healthy immune system.
 On an average, 50 – 80 billion cells die every day in a human adult due to apoptosis.
 During this biological process, infected cells, pre-cancerous cells and other cancer cells are eliminated
successfully and maintain the balance of cells in the human body.
 Therefore, it is an essential process that is responsible for the normal development of cells, cell cycle
maturation and maintaining the regular functions and activities of cells.
 Apoptosis occurs in all the vertebrates that have fingers and toes like digits. A slight mistake during
apoptosis results in fused toes or fingers. The loss of the tail of a tadpole when it develops into a frog is
yet another example of apoptosis.

 Apoptosis Pathways
The process of apoptosis undergoes two pathways:

 Extrinsic Pathway
 Intrinsic Pathway

 Extrinsic Pathway
 This pathway triggers apoptosis in response to external stimuli, like, ligand binding at death receptors
on the cell surface. These receptors are members of the Tumor Necrosis Factor gene family.
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 The receptor binding initiates caspase activation.

 Intrinsic Pathway
 This pathway triggers apoptosis in response to internal stimuli such as biochemical stress, DNA
damage and lack of growth factors. This pathway is modulated by two groups of molecules- Bax, and
Bcl-2.
 These groups of molecules determine whether a cell will survive or undergo apoptosis in response to
the stimuli.

 Significance of Apoptosis
 Apoptosis is significant for the following reasons:

1. It helps to maintain homeostasis in the multicellular organisms.

2. Proper size of the body is maintained by apoptosis.
3. Apoptosis maintains the constancy of cell number in an organism.
4. The unwanted cells are eliminated from the body by apoptosis.
5. The dangerous T-lymphocytes are eliminated by apoptosis.
6. Programmed cell death is crucial for cell development.

 Role Of Apoptosis
 Apoptosis plays an important role in the body of an organism. Following are a few such roles
performed by the process:

1. The separation of the fingers during the development of the foetus is due to apoptosis.
2. It results in the closure of the neural tube in the dorsal part.
3. Programmed cell death results in the removal of vestigial remnants such as pronephros.
4. During the determination of sex of the foetus, the Wolffian ducts are removed by cell death.
5. In the urachus, apoptosis allows the removal of redundant tissues between the bladder and
umbilicus.

 Relationship Between Apoptosis and Cancer

 Cancer is the uncontrolled division of cells that leads to the development of tumour. If the apoptotic
signalling works properly, these unwanted cells can be removed from the body. The main reason for
cancer is that they have the ability to prevent apoptosis and therefore multiply uncontrollably.

URINARY TRACT INFECTION (UTI)

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 A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary system
includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the
bladder and the urethra.
 Women are at greater risk of developing a UTI than are men. If an infection is limited to the bladder, it
can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys.
 Health care providers often treat urinary tract infections with antibiotics. You can also take steps to
lower the chance of getting a UTI in the first place.

 Symptoms

 UTIs don't always cause symptoms. When they do, they may include:

 A strong urge to urinate that doesn't go away

 A burning feeling when urinating
 Urinating often, and passing small amounts of urine
 Urine that looks cloudy
 Urine that appears red, bright pink or cola-colored — signs of blood in the urine
 Strong-smelling urine
 Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

 In older adults, UTIs may be overlooked or mistaken for other conditions.

 Types of urinary tract infections

 Each type of UTI may result in more-specific symptoms. The symptoms depend on which part of the
urinary tract is affected.

 Causes

 UTIs typically occur when bacteria enter the urinary tract through the urethra and begin to spread in the
bladder. The urinary system is designed to keep out bacteria. But the defenses sometimes fail. When
that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.
 The most common UTIs occur mainly in women and affect the bladder and urethra.
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 Infection of the bladder. This type of UTI is usually caused by Escherichia coli (E. coli). E. coli is a
type of bacteria commonly found in the gastrointestinal (GI) tract. But sometimes other bacteria are the
cause.

Having sex also may lead to a bladder infection, but you don't have to be sexually active to develop one. All
women are at risk of bladder infections because of their anatomy. In women, the urethra is close to the
anus. And the urethral opening is close to the bladder. This makes it easier for bacteria around the anus to
enter the urethra and to travel to the bladder.

 Infection of the urethra. This type of UTI can happen when GI bacteria spread from the anus to the
urethra. An infection of the urethra can also be caused by sexually transmitted infections. They include
herpes, gonorrhea, chlamydia and mycoplasma. This can happen because women's urethras are close
to the vagina.

 Risk factors

 UTIs are common in women. Many women experience more than one UTI during their lifetimes.
 Risk factors for UTIs that are specific to women include:

 Female anatomy. Women have a shorter urethra than men do. As a result, there's less distance for
bacteria to travel to reach the bladder.
 Sexual activity. Being sexually active tends to lead to more UTIs. Having a new sexual partner also
increases risk.
 Certain types of birth control. Using diaphragms for birth control may increase the risk of UTIs.
Using spermicidal agents also can increase risk.
 Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract.
The changes can increase the risk of UTIs.

Other risk factors for UTIs include:

 Urinary tract problems. Babies born with problems with their urinary tracts may have trouble
urinating. Urine can back up in the urethra, which can cause UTIs.
 Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder.
As a result, risk of UTIs is higher.
 A suppressed immune system. Diabetes and other diseases can impair the immune system — the
body's defense against germs. This can increase the risk of UTIs.
 Catheter use. People who can't urinate on their own often must use a tube, called a catheter, to
urinate. Using a catheter increases the risk of UTIs. Catheters may be used by people who are in the
hospital. They may also be used by people who have neurological problems that make it difficult to
control urination or who are paralyzed.
 A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical
instruments can both increase the risk of developing a UTI.

 Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left
untreated, UTIs can cause serious health problems.
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Complications of a UTI may include:

 Repeated infections, which means you have two or more UTIs within six months or three or more
within a year. Women are especially prone to having repeated infections.
 Permanent kidney damage from a kidney infection due to an untreated UTI.
 Delivering a low birth weight or premature infant when a UTI occurs during pregnancy.
 A narrowed urethra in men from having repeated infections of the urethra.
 Sepsis, a potentially life-threatening complication of an infection. This is a risk especially if the
infection travels up the urinary tract to the kidneys.
 Prevention

These steps may help lower the risk of UTIs:

 Drink plenty of liquids, especially water. Drinking water helps dilute the urine. That leads to
urinating more often — allowing bacteria to be flushed from the urinary tract before an infection can
begin.
 Try cranberry juice. Studies that look into whether cranberry juice prevents UTIs aren't final.
However, drinking cranberry juice is likely not harmful.
 Wipe from front to back. Do this after urinating and after a bowel movement. It helps prevent the
spread of bacteria from the anus to the vagina and urethra.
 Empty your bladder soon after having sex. Also drink a full glass of water to help flush bacteria.
 Avoid potentially irritating feminine products. Using them in the genital area can irritate the
urethra. These products include deodorant sprays, douches and powders.
 Change your birth control method. Diaphragms, unlubricated condoms or condoms treated with
spermicide can contribute to bacterial growth.

Inflammation
 When your body activates your immune system, it sends out inflammatory cells. These cells attack
bacteria or heal damaged tissue.
 If your body sends out inflammatory cells when you are not sick or injured, you may have chronic
inflammation.
 Inflammation is a symptom of many chronic diseases, such as arthritis or Alzheimer’s disease.

 What is inflammation?

 When your body encounters an offending agent (like viruses, bacteria or toxic chemicals) or suffers an
injury, it activates your immune system. Your immune system sends out its first responders:
inflammatory cells and cytokines (substances that stimulate more inflammatory cells).
 These cells begin an inflammatory response to trap bacteria and other offending agents or start healing
injured tissue. The result can be pain, swelling, bruising or redness. But inflammation also affects body
systems you can’t see.

 What is the difference between acute inflammation and chronic inflammation?

 There are two types of inflammation:

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 Acute inflammation: The response to sudden body damage, such as cutting your finger. To heal
the cut, your body sends inflammatory cells to the injury. These cells start the healing process.
 Chronic inflammation: Your body continues sending inflammatory cells even when there is no
outside danger. For example, in rheumatoid arthritis inflammatory cells and substances attack joint
tissues leading to an inflammation that comes and goes and can cause severe damage to joints
with pain and deformities.

 What are the symptoms of acute and chronic inflammation?

 Acute inflammation may cause:

 Flushed skin at the site of the injury.

 Pain or tenderness.
 Swelling.
 Heat.

 Chronic inflammation symptoms may be harder to spot than acute inflammation symptoms. Signs of
chronic inflammation can include:

 Abdominal pain.
 Chest pain.
 Fatigue. (example: systemic lupus)
 Fever. (example: tuberculosis)
 Joint pain or stiffness. (example: rheumatoid arthritis)
 Mouth sores. (example: HIV infection)
 Skin rash. (example: psoriasis)

 What conditions are associated with chronic inflammation?

 Chronic inflammation is involved in the disease process of many conditions, including:

 Alzheimer’s disease.
 Asthma.
 Cancer.
 Heart disease.
 Rheumatoid arthritis (RA) and ankylosing spondylitis (AS).
 Type 2 diabetes.

 POSSIBLE CAUSES

 What are the most common causes of inflammation?

 The most common reasons for chronic inflammation include:

 Autoimmune disorders, such as lupus, where your body attacks healthy tissue.
 Exposure to toxins, like pollution or industrial chemicals.
 Untreated acute inflammation, such as from an infection or injury.

 Some lifestyle factors also contribute to inflammation in the body. You may be more likely to develop
chronic inflammation if you:

 Drink alcohol in excess.

 Have a high body mass index (BMI) that falls within the ranges for obesity, unless that is a result of
being very muscular.
 Exercise at your maximum intensity too frequently, or you don’t exercise enough.
 Experience chronic stress.
 Smoke.
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High Blood Pressure (Hypertension)

 High blood pressure (hypertension) can be dangerous if it’s not treated. It can put you at risk for stroke,
heart failure, kidney failure and other medical problems.
 Changing what you eat, exercising more and taking your medicine can help you keep your blood
pressure where it should be.

 What is high blood pressure (hypertension)?

 Blood pressure is the measurement of the pressure or force of blood pushing against blood vessel
walls. When you have hypertension (high blood pressure), it means the pressure against the blood
vessel walls in your body is consistently too high.

 High blood pressure is often called the “silent killer” because you may not be aware that anything is
wrong, but the damage is still occurring within your body.

 Your blood pressure reading has two numbers. The top number is the systolic blood pressure, which
measures the pressure on the blood vessel walls when your heart beats or contracts.

 The bottom number is the diastolic blood pressure, which measures the pressure on your blood
vessels between beats when your heart is relaxing.

 For example, a blood pressure of 110/70 is within the normal range, but a blood pressure of 135/85 is
stage 1 (mild) hypertension, and so on (see table).

Category Blood Pressure

Normal Under 130/80 mmHg

Stage I Hypertension (mild) 130-139/OR diastolic between 80-89 mmHg
Stage 2 Hypertension (moderate) 140/90 mmHg or higher
Hypertensive Crisis (get emergency care) 180/120 mmHg or higher

 What are the types of high blood pressure?

 Primary (also called essential) high blood pressure. Causes of this most common type of high blood
pressure include aging and unhealthy habits like not getting enough exercise.
 Secondary high blood pressure. Causes of this type of high blood pressure include different medical
problems (for example kidney or hormonal problems) or sometimes a medication you’re taking.

 What can happen if high blood pressure is not treated?

 Untreated hypertension may lead to serious health problems including:

 Stroke.
 Heart attack.
 Peripheral vascular disease.
 Kidney disease/failure.
 Complications during pregnancy.
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 Eye damage.
 Vascular dementia.

 What are the risk factors for high blood pressure?

 You are more likely to have high blood pressure if you:

 Have family members who have high blood pressure, cardiovascular disease or diabetes.
 Are of African descent.
 Are older than 55.
 Are overweight.
 Don’t get enough exercise.
 Eat foods high in sodium (salt).
 Smoke or use tobacco products.
 Are a heavy drinker (more than two drinks a day in men and more than one drink a day in women).

 DIAGNOSIS AND TESTS

 How is high blood pressure diagnosed?

 Since high blood pressure doesn’t have symptoms, your healthcare provider will need to check your blood
pressure with a blood pressure cuff.
 Providers usually check your blood pressure at every annual checkup or appointment. If you have high
blood pressure readings at two appointments or more, your provider may tell you that you have high blood
pressure.

 What tests will be done to diagnose this condition?

Providers use a blood pressure cuff to measure your blood pressure.

 What diet helps manage high blood pressure?

 Eat foods that are lower in fat, salt and calories,

 Use flavorings, spices and herbs to make foods tasty without using salt.
 Avoid or cut down on foods high in fat or salt,
 Ask your provider if you should increase potassium in your diet.

 PREVENTION

 How can you reduce your risk of high blood pressure?

Fortunately, there are certain things you can do to help reduce your risk of developing high blood pressure.
These include the following:

 Eat right:
 Keep a healthy weight:
 Cut down on salt:
 Keep active:
 Drink alcohol in moderatio

Asthma
 Bronchial asthma (or asthma) is a lung disease. Your airways get narrow and swollen and are blocked
by excess mucus. Medications can treat these symptoms.

 What is asthma?
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 Asthma, also called bronchial asthma, is a disease that affects your lungs. It’s a chronic (ongoing)
condition, meaning it doesn’t go away and needs ongoing medical management.
 Asthma affects more than 25 million people in the U.S. currently. This total includes more than 5 million
children. Asthma can be life-threatening if you don’t get treatment.

 What is an asthma attack?

 When you breathe normally, muscles around your airways are relaxed, letting air move easily and
quietly. During an asthma attack, three things can happen:

 Bronchospasm: The muscles around the airways constrict (tighten). When they tighten, it makes
your airways narrow. Air cannot flow freely through constricted airways.
 Inflammation: The lining of your airways becomes swollen. Swollen airways don’t let as much air in
or out of your lungs.
 Mucus production: During the attack, your body creates more mucus. This thick mucus clogs
airways.

 When your airways get tighter, you make a sound called wheezing when you breathe, a noise your
airways make when you breathe out.
 You might also hear an asthma attack called an exacerbation or a flare-up. It’s the term for when your
asthma isn’t controlled.

 What types of asthma are there?

 Asthma is broken down into types based on the cause and the severity of symptoms. Healthcare
providers identify asthma as:

 Intermittent: This type of asthma comes and goes so you can feel normal in between asthma
flares.
 Persistent: Persistent asthma means you have symptoms much of the time. Symptoms can be
mild, moderate or severe. Healthcare providers base asthma severity on how often you have
symptoms. They also consider how well you can do things during an attack.

Asthma has multiple causes:

 Allergic: Some people’s allergies can cause an asthma attack. Allergens include things like molds,
pollens and pet dander.
 Non-allergic: Outside factors can cause asthma to flare up. Exercise, stress, illness and weather
may cause a flare.

Asthma can also be:

 Adult-onset: This type of asthma starts after the age of 18.

 Pediatric: Also called childhood asthma, this type of asthma often begins before the age of 5, and
can occur in infants and toddlers. Children may outgrow asthma. You should make sure that you
discuss it with your provider before you decide whether your child needs to have an inhaler
available in case they have an asthma attack. Your child’s healthcare provider can help you
understand the risks.

 In addition, there are these types of asthma:

 Exercise-induced asthma: This type is triggered by exercise and is also called exercise-induced
bronchospasm.
 Occupational asthma: This type of asthma happens primarily to people who work around irritating
substances.
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 Asthma-COPD overlap syndrome (ACOS): This type happens when you have both asthma
and chronic obstructive pulmonary disease (COPD). Both diseases make it difficult to breathe.

 SYMPTOMS AND CAUSES

 What causes asthma?

 Researchers don’t know why some people have asthma while others don’t. But certain factors present
a higher risk:

 Allergies: Having allergies can raise your risk of developing asthma.

 Environmental factors: People can develop asthma after exposure to things that irritate the
airways. These substances include allergens, toxins, fumes and second- or third-hand smoke.
These can be especially harmful to infants and young children whose immune systems haven’t
finished developing.
 Genetics: If your family has a history of asthma or allergic diseases, you have a higher risk of
developing the disease.
 Respiratory infections: Certain respiratory infections, such as respiratory syncytial virus (RSV),
can damage young children’s developing lungs.

 What are common asthma attack triggers?

 Air pollution: Many things outside can cause an asthma attack. Air pollution includes factory
emissions, car exhaust, wildfire smoke and more.
 Dust mites: You can’t see these bugs, but they are in our homes. If you have a dust mite allergy,
this can cause an asthma attack.
 Exercise: For some people, exercising can cause an attack.
 Mold: Damp places can spawn mold, which can cause problems if you have asthma. You don’t
even have to be allergic to mold to have an attack.
 Pests: Cockroaches, mice and other household pests can cause asthma attacks.
 Pets: Your pets can cause asthma attacks. If you’re allergic to pet dander (dried skin flakes),
breathing in the dander can irritate your airways.
 Tobacco smoke: If you or someone in your home smokes, you have a higher risk of developing
asthma. You should never smoke in enclosed places like the car or home, and the best solution is
to quit smoking. Your provider can help.
 Strong chemicals or smells. These things can trigger attacks in some people.
 Certain occupational exposures. You can be exposed to many things at your job, including
cleaning products, dust from flour or wood, or other chemicals. These can all be triggers if you have
asthma.

 What are the signs and symptoms of asthma?

 People with asthma usually have obvious symptoms. These signs and symptoms resemble many
respiratory infections:

 Chest tightness, pain or pressure.

 Coughing (especially at night).
 Shortness of breath.
 Wheezing.

 With asthma, you may not have all of these symptoms with every flare. You can have different
symptoms and signs at different times with chronic asthma. Also, symptoms can change between
asthma attacks.

How do healthcare providers diagnose asthma?

 Your healthcare provider will review your medical history, including information about your parents and
siblings. Your provider will also ask you about your symptoms.
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 Your provider will need to know any history of allergies, eczema (a bumpy rash caused by allergies)
and other lung diseases.
 Your provider may order spirometry. This test measures airflow through your lungs and is used to
diagnose and monitor your progress with treatment. Your healthcare provider may order a chest X-ray,
blood test or skin test.

Renal failure
 Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal
kidney function. There are two different types of renal failure--acute and chronic.

 Acute renal failure has an abrupt onset and is potentially reversible.

 Chronic renal failure progresses slowly over at least three months and can lead to permanent renal
failure.

 The causes, symptoms, treatments, and outcomes of acute and chronic are different.

Conditions that may lead to acute or chronic renal failure may include, but are not limited to, the following:

Acute renal failure Chronic renal failure

Myocardial infarction. A heart attack may Diabetic nephropathy. Diabetes can cause
occasionally lead to temporary kidney failure. permanent changes, leading to kidney damage.
Rhabdomyolysis. Kidney damage that can occur from Hypertension. Chronic high blood pressure
muscle breakdown. This condition can occur from severe (hypertension) can lead to permanent kidney
dehydration, infection, or other causes. damage.
Decreased blood flow to the kidneys for a period of Lupus (SLE). A chronic inflammatory/autoimmune
time. This may occur from blood loss or shock. disease that can injure the skin, joints, kidneys,
and nervous system.
An obstruction or blockage along the urinary tract. A prolonged urinary tract obstruction or blockage.
Hemolytic uremic syndrome. Usually caused by an E. coli Alport syndrome. An inherited disorder that
infection, kidney failure develops as a result of obstruction causes deafness, progressive kidney damage,
to the small functional structures and vessels inside the and eye defects.
kidney.
Ingestion of certain medications that may cause toxicity to Nephrotic syndrome. A condition that has several
the kidneys. different causes. Nephrotic syndrome is
characterized by protein in the urine, low protein in
the blood, high cholesterol levels, and tissue
swelling.
Glomerulonephritis. A type of kidney disease that involves Polycystic kidney disease. A genetic disorder
glomeruli. During glomerulonephritis, the glomeruli characterized by the growth of numerous cysts
become inflamed and impair the kidney's ability to filter filled with fluid in the kidneys.
urine. Glomerulonephritis may lead to chronic renal failure
in some individuals.
Any condition that may impair the flow of oxygen and Cystinosis. An inherited disorder in which the
blood to the kidneys such as cardiac arrest. amino acid cystine (a common protein-building
compound) accumulates within specific cellular
bodies of the kidney, known as lysosomes.
Interstitial nephritis or pyelonephritis. An
inflammation to the small internal structures in the
kidney.
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 What is end-stage renal disease (ESRD)?

 End-stage renal disease is when the kidneys permanently fail to work.

 What are the symptoms of renal failure?

 The symptoms for acute and chronic renal failure may be different. The following are the most common
symptoms of acute and chronic renal failure.

 However, each individual may experience symptoms differently. Symptoms may include:

 Acute

 (Symptoms of acute renal failure depend largely on the underlying cause.):

 Hemorrhage
 Fever
 Weakness
 Fatigue
 Rash
 Diarrhea or bloody diarrhea
 Poor appetite
 Severe vomiting
 Abdominal pain
 Back pain
 Muscle cramps
 No urine output or high urine output
 History of recent infection (a risk factor for acute renal failure)
 Pale skin
 Nosebleeds
 History of taking certain medications (a risk factor for acute renal failure)
 History of trauma (a risk factor for acute renal failure)
 Swelling of the tissues
 Inflammation of the eye
 Detectable abdominal mass
 Exposure to heavy metals or toxic solvents (a risk factor for acute renal failure)

 Chronic:

 Poor appetite
 Vomiting
 Bone pain
 Headache
 Insomnia
 Itching
 Dry skin
 Malaise
 Fatigue with light activity
 Muscle cramps
 High urine output or no urine output
 Recurrent urinary tract infections
 Urinary incontinence
 Pale skin
 Bad breath
 Hearing deficit
 Detectable abdominal mass
 Tissue swelling
 Irritability
 Poor muscle tone
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 Change in mental alertness
 Metallic taste in mouth

 The symptoms of acute and chronic renal failure may resemble other conditions or medical problems.
Always consult your doctor for a diagnosis.

 How is renal failure diagnosed?

 In addition to a physical examination and complete medical history, diagnostic procedures for renal
failure may include the following:

 Blood tests. Blood tests will determine blood cell counts, electrolyte levels, and kidney function
 Urine tests
 Renal ultrasound (also called sonography). A noninvasive test in which a transducer is passed over
the kidney producing sound waves which bounce off the kidney, transmitting a picture of the organ on a
video screen. The test is use to determine the size and shape of the kidney, and to detect a mass,
kidney stone, cyst, or other obstruction or abnormalities.
 Kidney biopsy. This procedure involves the removal of tissue samples (with a needle or during surgery)
from the body for examination under a microscope; to determine if cancer or other abnormal cells are
present.
 Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that
uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often
called slices) of the body. A CT scan shows detailed images of any part of the body, including the
bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Contrast CT usually
cannot be done when there is kidney failure.

Diabetes
 If you have diabetes, your body isn’t able to properly process and use glucose from the food you eat.
 There are different types of diabetes, each with different causes, but they all share the common
problem of having too much glucose in your bloodstream.
 Treatments include medications and/or insulins. Some types of diabetes can be prevented by adopting
a healthy lifestyle.

 What is diabetes?

 Diabetes happens when your body isn't able to take up sugar (glucose) into its cells and use it for
energy. This results in a build up of extra sugar in your bloodstream.
 Mismanagement of diabetes can lead to serious consequences, causing damage to a wide range of
your body's organs and tissues — including your heart, kidneys, eyes and nerves.

 Why is my blood glucose level high? How does this happen?

 The process of digestion includes breaking down the food you eat into various different nutrient
sources. When you eat carbohydrates (for example, bread, rice, pasta), your body breaks this down
into sugar (glucose).
 When glucose is in your bloodstream, it needs help – a "key" – to get into its final destination where it's
used, which is inside your body's cells (cells make up your body's tissues and organs). This help or
"key" is insulin.
 Insulin is a hormone made by your pancreas, an organ located behind your stomach. Your pancreas
releases insulin into your bloodstream.
 Insulin acts as the “key” that unlocks the cell wall “door,” which allows glucose to enter your body’s
cells. Glucose provides the “fuel” or energy tissues and organs need to properly function.
 If you have diabetes:
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 Your pancreas doesn’t make any insulin or enough insulin.

Or

 Your pancreas makes insulin but your body’s cells don’t respond to it and can’t use it as it normally
should.

 If glucose can’t get into your body’s cells, it stays in your bloodstream and your blood glucose level
rises.

 What are the different types of diabetes?

 The types of diabetes are:

 Type 1 diabetes: This type is an autoimmune disease, meaning your body attacks itself. In this
case, the insulin-producing cells in your pancreas are destroyed. Up to 10% of people who have
diabetes have Type 1. It’s usually diagnosed in children and young adults (but can develop at any
age). It was once better known as “juvenile” diabetes. People with Type 1 diabetes need to take
insulin every day. This is why it is also called insulin-dependent diabetes.
 Type 2 diabetes: With this type, your body either doesn’t make enough insulin or your body’s cells
don’t respond normally to the insulin. This is the most common type of diabetes. Up to 95% of
people with diabetes have Type 2. It usually occurs in middle-aged and older people. Other
common names for Type 2 include adult-onset diabetes and insulin-resistant diabetes. Your parents
or grandparents may have called it “having a touch of sugar.”
 Prediabetes: This type is the stage before Type 2 diabetes. Your blood glucose levels are higher
than normal but not high enough to be officially diagnosed with Type 2 diabetes.
 Gestational diabetes: This type develops in some women during their pregnancy. Gestational
diabetes usually goes away after pregnancy. However, if you have gestational diabetes you're at
higher risk of developing Type 2 diabetes later on in life.

 Less common types of diabetes include:

 Monogenic diabetes syndromes: These are rare inherited forms of diabetes accounting for up to
4% of all cases. Examples are neonatal diabetes and maturity-onset diabetes of the young.
 Cystic fibrosis-related diabetes: This is a form of diabetes specific to people with this disease.
 Drug or chemical-induced diabetes: Examples of this type happen after organ transplant,
following HIV/AIDS treatment or are associated with glucocorticoid steroid use.

 Diabetes insipidus is a distinct rare condition that causes your kidneys to produce a large amount of
urine.

 Who gets diabetes? What are the risk factors?

 Risk factors for Type 1 diabetes include:

 Having a family history (parent or sibling) of Type 1 diabetes.

 Injury to the pancreas (such as by infection, tumor, surgery or accident).
 Presence of autoantibodies (antibodies that mistakenly attack your own body’s tissues or organs).
 Physical stress (such as surgery or illness).
 Exposure to illnesses caused by viruses.

 Risk factors for prediabetes and Type 2 diabetes include:

 Family history (parent or sibling) of prediabetes or Type 2 diabetes.

 Being Black, Hispanic, Native American, Asian-American race or Pacific Islander.
 Having overweight/obesity.
 Having high blood pressure.
 Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level.
 15
 Being physically inactive.
 Being age 45 or older.
 Having gestational diabetes or giving birth to a baby weighing more than 9 pounds.
 Having polycystic ovary syndrome.
 Having a history of heart disease or stroke.
 Being a smoker.

 Risk factors for gestational diabetes include:

 Family history (parent or sibling) of prediabetes or Type 2 diabetes.

 Being African-American, Hispanic, Native American or Asian-American.
 Having overweight/obesity before your pregnancy.
 Being over 25 years of age.

 SYMPTOMS AND CAUSES

 What causes diabetes?

 The cause of diabetes, regardless of the type, is having too much glucose circulating in your
bloodstream. However, the reason why your blood glucose levels are high differs depending on the
type of diabetes.

 Causes of Type 1 diabetes: This is an immune system disease. Your body attacks and destroys
insulin-producing cells in your pancreas. Without insulin to allow glucose to enter your cells, glucose
builds up in your bloodstream. Genes may also play a role in some patients. Also, a virus may
trigger the immune system attack.
 Cause of Type 2 diabetes and prediabetes: Your body’s cells don't allow insulin to work as it
should to let glucose into its cells. Your body's cells have become resistant to insulin. Your pancreas
can’t keep up and make enough insulin to overcome this resistance. Glucose levels rise in your
bloodstream.
 Gestational diabetes: Hormones produced by the placenta during your pregnancy make your
body’s cells more resistant to insulin. Your pancreas can’t make enough insulin to overcome this
resistance. Too much glucose remains in your bloodstream.

 What are the symptoms of diabetes?

 Symptoms of diabetes include:

 Increased thirst.
 Weak, tired feeling.
 Blurred vision.
 Numbness or tingling in the hands or feet.
 Slow-healing sores or cuts.
 Unplanned weight loss.
 Frequent urination.
 Frequent unexplained infections.
 Dry mouth.

Other symptoms

 In women: Dry and itchy skin, and frequent yeast infections or urinary tract infections.
 In men: Decreased sex drive, erectile dysfunction, decreased muscle strength.

 Type 1 diabetes symptoms: Symptoms can develop quickly – over a few weeks or months.
Symptoms begin when you’re young – as a child, teen or young adult. Additional symptoms include
nausea, vomiting or stomach pains and yeast infections or urinary tract infections.
 16
 Type 2 diabetes and prediabetes symptoms: You may not have any symptoms at all or may not
notice them since they develop slowly over several years. Symptoms usually begin to develop when
you’re an adult, but prediabetes and Type 2 diabetes is on the rise in all age groups.

 Gestational diabetes: You typically will not notice symptoms. Your obstetrician will test you for
gestational diabetes between 24 and 28 weeks of your pregnancy.

 What are the complications of diabetes?

 If your blood glucose level remains high over a long period of time, your body’s tissues and organs can
be seriously damaged. Some complications can be life-threatening over time.

Complications include:

 Cardiovascular issues including coronary artery disease, chest pain, heart attack, stroke, high blood
pressure, high cholesterol, atherosclerosis (narrowing of the arteries).
 Nerve damage (neuropathy) that causes numbing and tingling that starts at toes or fingers then
spreads.
 Kidney damage (nephropathy) that can lead to kidney failure or the need for dialysis or transplant.
 Eye damage (retinopathy) that can lead to blindness; cataracts, glaucoma.
 Foot damage including nerve damage, poor blood flow and poor healing of cuts and sores.
 Skin infections.
 Erectile dysfunction.
 Hearing loss.
 Depression.
 Dementia.
 Dental problems.

 Complications of gestational diabetes:

 In the mother: Preeclampsia (high blood pressure, excess protein in urine, leg/feet swelling), risk of
gestational diabetes during future pregnancies and risk of diabetes later in life.

 In the newborn: Higher-than-normal birth weight, low blood sugar (hypoglycemia), higher risk of
developing Type 2 diabetes over time and death shortly after birth.

Alzheimer's disease

 What is Alzheimer's disease?

 Alzheimer’s disease is a brain disorder that cannot be stopped or reversed. The disease severely
affects memory, thinking, learning and organizing skills and eventually affects a person’s ability to carry
out simple daily activities. Alzheimer’s disease is not a normal part of the aging process.
 Alzheimer’s is a disease whose symptoms worsen over time. In fact, scientists believe the disease
process may go on for 10 years or longer before the first symptoms of Alzheimer’s disease appear.
 When memory problems do begin to be noticeable, they are often identified as mild cognitive
impairment (MCI).
 At this stage, intellectual function is affected but the ability to function and live independently remain
intact as the brain compensates for disease-related changes.
 17
 In some people, MCI can hold steady at this stage. However, people with MCI are at high risk for
progressing to dementia. Alzheimer’s disease is the most common form of dementia.
 (Dementia can also be due to a variety of reasons such as Parkinson’s disease, dementia with Lewy
bodies, vascular dementia, frontotemporal dementia and more.) With dementia, in contrast to MCI,
daily function is affected.
 As dementia due to Alzheimer’s disease progresses to late stages, affected individuals cannot carry on
a conversation, recognize family and friends, or care for themselves.

 Pathophysiology of Alzheimer Disease

 The two pathologic hallmarks of Alzheimer disease are

 Extracellular beta-amyloid deposits (in senile plaques)

 Intracellular neurofibrillary tangles (paired helical filaments)

 The beta-amyloid deposition and neurofibrillary tangles lead to loss of synapses and neurons, which
results in gross atrophy of the affected areas of the brain, typically starting at the mesial temporal
lobe.
 The mechanism by which beta-amyloid peptide and neurofibrillary tangles cause such damage is
incompletely understood. There are several theories.
 The amyloid hypothesis posits that progressive accumulation of beta-amyloid in the brain triggers a
complex cascade of events ending in neuronal cell death, loss of neuronal synapses, and
progressive neurotransmitter deficits; all of these effects contribute to the clinical symptoms of
dementia.
 A sustained immune response and inflammation have been observed in the brain of patients with
Alzheimer disease. Some experts have proposed that inflammation is the third core pathologic
feature of Alzheimer disease (1).
 Prion mechanisms have been identified in Alzheimer disease. In prion diseases, a normal cell-
surface brain protein called prion protein becomes misfolded into a pathogenic form termed a prion.
 The prion then causes other prion proteins to misfold similarly, resulting in a marked increase in the
abnormal proteins, which leads to brain damage.
 In Alzheimer disease, it is thought that the beta-amyloid in cerebral amyloid deposits and tau in
neurofibrillary tangles have prion-like, self-replicating properties.

 SYMPTOMS AND CAUSES

 What causes Alzheimer’s disease?

 Alzheimer’s disease is caused by the abnormal build-up of proteins in the brain. The build-up of these
proteins — called amyloid protein and tau protein — leads to cell death.
 The human brain contains over 100 billion nerve cells as well as other cells.
 The nerve cells work together to fulfill all the communications needed to perform such functions as
thinking, learning, remembering, and planning.
 Scientists believe that amyloid protein builds up in the brain cells, forming larger masses called
plaques. Twisted fibers of another protein called tau form into tangles. These plaques and tangles
block the communication between nerve cells, which prevents them from carrying out their processes.
 The slow and ongoing death of the nerve cells, starting in one area of the brain (usually in the area of
the brain that controls memory) then spreading to other areas, results in the symptoms seen in patients
with Alzheimer’s disease.

 What are the symptoms of Alzheimer’s disease?

 Symptoms of Alzheimer’s disease vary from person to person and worsen over time. Symptoms of the
disease include:

 Memory loss. This is usually one of the first symptoms of Alzheimer’s disease.
 Putting objects in odd places
 Confusion about events, time and place
 Repeating questions
 18
 Trouble managing money and paying bills
 Trouble performing/taking longer to perform familiar tasks
 Getting lost/wandering
 Not being able to sleep
 Changes in personality and behavior including agitation, anxiety and aggression
 Having groundless suspicions about family, friends and caregivers
 Poor judgment or reasoning
 Trouble recognizing family and friends
 Difficulty learning and remembering new information/recent events
 Difficulty performing multistep tasks, such as dressing or cooking
 Having hallucinations, delusions or paranoia
 Difficulty speaking/finding the right words
 Difficulty reading, writing and working with numbers
 Difficulty walking
 Difficulty swallowing

 Risk factors for the development of Alzheimer’s disease include:

 Age. Increasing age is the primary risk factor for developing Alzheimer’s disease.
 Genetics (runs in families). There is a certain gene, apolipoprotein E (APOE) that is associated with
late-onset Alzheimer’s disease. Other genes have been associated with early-onset Alzheimer’s
disease.
 High blood pressure
 High cholesterol
 Diabetes
 Smoking
 Obesity

 Researchers believe the presence of the last five risk factors mentioned above might reduce the
clearance of amyloid protein from the brain, which then increases the risk of developing Alzheimer’s
disease. In particular, the presence of a number of these risk factors at the same time and while the
person is in his or her 50s is associated with a higher risk of Alzheimer’s disease.

 There may be some ways to reduce the risk of mental decline. In general, living a healthy lifestyle
protects the body from strokes and heart attacks and is believed to also protect the brain from cognitive
decline.

 Scientists can’t absolutely prove the cause and effect of the following factors, but studies have shown a
“positive association.”

 Stay mentally active. Play board games, read, do crossword puzzles, play a musical instrument,
audit courses at a local community college, do other hobbies that require “brain power.”
 Get physically active. Exercise increases blood flow and oxygen to the brain, which may directly
affect brain cell health. Wear protective head gear if engaging in activities that increase the risk of a
head injury.
 Stay socially active. Regularly talk with friends and family, join in on group activities (such as
worship services, exercise classes, choir, book clubs)
 Follow the Mediterranean or DASH diet or another healthy diet that includes antioxidants. Consume
beverages that contain alcohol in moderation — no more than one drink per day for women and no
more than two per day for men.
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ANEMIA
 What is anemia?

 Anemia happens when you don’t have enough red blood cells or your red blood cells don’t work as
they should. Your red blood cells carry oxygen throughout your body.

 Oxygen powers your cells and gives you energy. Without healthy red blood cells that do their job, your
body doesn’t get the energy it needs to function.

 While some types of anemia are short-term and mild, others can last for a lifetime. Left untreated,
anemia may be life-threatening.

 The most common types of anaemia are:

 Iron deficiency anaemia

 Thalassaemia
 Aplastic anaemia
 Haemolytic anaemia
 Sickle cell anaemia
 Pernicious anaemia
 Fanconi anaemia

1.Iron Deficiency Anaemia

 Overview

 The most common form of anaemia is iron deficiency anaemia which is usually due to chronic blood
loss caused by excessive menstruation.

 Increased demands for iron, such as foetal growth in pregnancy, and children undergoing rapid growth
spurts in infancy and adolescence, can also cause iron deficiency anaemia.

 This condition is treated with iron supplementation as well as the treatment of the underlying cause of
the iron deficiency.

 Causes

 Iron deficiency occurs when the rate of loss or use of iron is more than its rate of absorption and use.
The reasons for this are

 Chronic blood loss: Most commonly due to excessive menstruation or bleeding into or from the gut as a
result of a peptic ulcer, gastritis, haemorrhoids or in children, worm infestation.
 Increased use of iron: In pregnancy, due to the growth of the foetus or children undergoing rapid
growth spurts in infancy and adolescence.
 Decreased absorption of iron
 after a partial or total removal of the stomach;
 lack of stomach acid;
 chronic diarrhoea; or
 malabsorption.
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 Signs and symptoms

 The most common symptoms of chronic anaemia include tiredness, weakness, shortness of breath
and sometimes, a fast heartbeat. The tongue may also become smooth, shiny and inflamed - this is
called glossitis.

 Angular stomatitis (erosion, tenderness and swelling at the corners of the mouth) may also occur.

 In some instances, the patient also suffers from pica, a craving for strange foods such as starch, ice
and clay.

 The symptoms of the underlying cause of the iron deficiency may be present such as heavy menstrual
bleeding or abdominal pain due to peptic ulceration.

 Treatment

 Treatment for iron-deficiency anaemia will depend on the cause and severity of the condition.
Treatments may include dietary changes and supplements, medicines, and surgery. Severe iron-
deficiency anaemia may require treatment in hospital, blood transfusions, iron rejections, or
intravenous iron therapy.

 Risk

 Infants and young children, women, and adults who have internal bleeding are at highest risk for iron-
deficiency anaemia.

2.Thalassaemia

 Overview

 Thalassaemias are inherited blood disorders which cause the body to make fewer healthy red blood
cells and less haemoglobin (an iron-rich protein in red blood cells).

 The two major types of thalassaemia are alpha- and beta thalassaemia. The most severe form of alpha
thalassaemia is known as alpha thalassaemia major or hydrops fetalis, while the severe form of beta
thalassaemia is known as thalassaemia major or Cooley's anaemia.

 Thalassaemias affect both males and females and occur most often in people of Italian, Greek, Middle
Eastern, Asian, and African descent. Severe forms are usually diagnosed in early childhood and are
lifelong conditions.

 Causes

 Haemoglobin in red blood cells has two kinds of protein chains: alpha globin and beta globin. If your
body doesn't make enough of these protein chains, red blood cells don't form properly and can't carry
enough oxygen.

 Genes control how the body makes haemoglobin protein chains. When these genes are missing or
altered, thalassaemias occur.

 Thalassaemias are inherited disorders – they are passed on from parents to their children through
genes.

 People who get abnormal haemoglobin genes from one parent but normal genes from the other are
carriers. Carriers often have no signs of illness other than mild anaemia. However, they can pass the
abnormal genes on to their children.
 21
 Signs and symptoms

 Symptoms of thalassaemias are caused by a lack of oxygen in the blood stream. This occurs because
the body doesn't make enough healthy red blood cells and haemoglobin. The severity of symptoms
depends on the severity of the disorder:

 People who have alpha or beta thalassaemia can have mild anaemia, which can make you feel
tired.
 People with beta thalassaemia intermedia have mild to moderate anaemia. They may also have
other health problems including: slowed growth and delayed puberty; bone problems; and an
enlarged spleen.
 People with haemoglobin H disease or beta thalassaemia major have severe thalassaemia.
Symptoms occur within the first two years of life and include severe anaemia and other serious
health problems
 Pale and listless appearance
 Poor appetite
 Dark urine
 Slowed growth and delayed puberty
 Jaundice
 Enlarged spleen, liver and heart
 Bone problems

 Treatment

 Treatment for thalassaemias depends on the type and severity of the disorder. People who are carriers
or who have alpha or beta thalassaemia need little or no treatment.

 Three standard treatments are used to treat moderate and severe forms of thalassaemia, these include
blood transfusions, iron chelation therapy, and folic acid supplements.

 Risk

Family history and ancestry are the two risk factors for thalassaemias.

3.Megaloblastic anemia

 Megaloblastic anemia is a form of macrocytic anemia. Macrocytic anemia is a blood disorder that
causes your bone marrow to make abnormally large red blood cells.

 It’s also a type of vitamin deficiency anemia. This condition happens when you don’t get enough
vitamin B12 and/or vitamin B9 (folate).

 Healthcare providers treat megaloblastic anemia with vitamin B12 and vitamin B9 supplements.

 How does megaloblastic anemia affect my body?

 Your body needs a certain amount of healthy red blood cells to carry oxygen from your lungs to your
tissues and back again. Like all blood cells, red blood cells start as stem cells in your bone marrow.

 Vitamin B12 and vitamin B9 help form red blood cells. Without enough vitamin B12 or vitamin B9, your
body produces abnormal cells called megaloblasts.

 Megaloblasts don’t divide and reproduce like healthy cells, which means there are fewer red blood cells
in your bone marrow.

 The abnormal cells are unusually large, so large they often can’t get out of your bone marrow to move
into your bloodstream. And even if they do make their way into your bloodstream, the abnormal cells
 22
die earlier than healthy red blood cells. Combined, these factors reduce the number of red blood cells,
causing anemia.

 What causes megaloblastic anemia?

 Megaloblastic anemia happens when you don’t have enough vitamin B12 or vitamin B9 to make sure
your bone marrow develops enough healthy red blood cells to carry oxygen throughout your body.

 What causes vitamin B12 deficiency?

 Some people develop vitamin B12 deficiency because their diet doesn’t include enough vitamin B12-
rich foods like meat, fish, eggs and dairy products. Some people develop vitamin B12 deficiency
because they have conditions or have had medical treatments that affect their ability to absorb vitamin
B12. Those conditions include

 Pernicious anemia: This autoimmune disorder keeps your body from absorbing vitamin B12.
 Gastrectomy: This surgery removes part of your stomach, which may affect vitamin B12
absorption.
 Zollinger-Ellison syndrome: This rare condition keeps your body from absorbing vitamin B12.
 Blind loop syndrome: Blind loop syndrome happens when food you’ve digested stops moving
through your intestines, causing bacteria overgrowth that uses up vitamin B12.
 Fish tapeworm infestation: You can get a tapeworm infection or infestation by eating infected fish
that was undercooked. Tapeworms feed on vitamin B12.
 Pancreatic insufficiency: This condition affects your pancreas’ ability to make enough digestive
enzymes to break down food, which means you may not get all the nutrients you need, including
enough vitamin B12 or vitamin B9.

 What causes vitamin B9 (folate) deficiency?

 People may develop vitamin B9 (folate) deficiency if their daily diet doesn’t include green vegetables,
fruits, meat and liver or foods that are enriched with folic acid. Other causes may include:

 Digestive system diseases:

 Excessive alcohol use:
 Overcooking your fruits and vegetables:Hemolytic anemia: A blood disorder that occurs when
your red blood cells are broken down and your bone marrow can’t replace red blood cells fast
enough.
 Certain medications: Some antiseizure drugs and ulcerative colitis drugs interfere with the proper
absorption of folate.
 Dialysis:

 What are the signs and symptoms of megaloblastic anemia?

 Megaloblastic anemia symptoms are similar to symptoms of other types of anemia:

 Fatigue:
 Weakness:
 Pallor: Your skin is more pale than usual.
 Shortness of breath (dyspnea): Feeling light-headed or woozy: Feeling as if you may faint.

 Vitamin B12 deficiency sometimes affects your nerves, causing symptoms like tingling sensations, loss
of sensation or muscle weakness.

 Foods with vitamin B12

 Animal food products: Red meat, fish, poultry, eggs, milk and other dairy products all contain vitamin
B12.
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 Fortified foods: Fortified foods are foods that have certain vitamins and nutrients added to them that
they don’t naturally have. Fortified foods include certain breakfast cereals, nutritional yeast, plant milk
and certain bread. Be sure to check the food label (nutritional facts) to confirm the food is fortified with
vitamin B12.

 Foods with vitamin B9

 Vegetables: Dark green leafy vegetables, peas, beans and legumes.

 Fruits: Citrus fruits.
 Animal food products: Liver, seafood, meat and poultry.
 Eggs and dairy.
 Fortified foods: Certain breads, flour, pasta, rice and cereal contain folic acid. Be sure to check the food
label (nutritional facts) to confirm the food is fortified with vitamin B9.

Gout
 Gout is a painful form of arthritis. When your body has extra uric acid, sharp crystals may form in the
big toe or other joints, causing episodes of swelling and pain called gout attacks.
 Gout is treatable with medications and changes in diet and lifestyle.

 What is gout?

 Doctors place gout under the umbrella term “arthritis” — a broad range of joint diseases and joint pain.
Some forms of arthritis inflame joints, while others don’t.
 Gout is a common form of inflammatory arthritis. It’s due to a crystal called uric acid.
 Gout causes pain and swelling in one or more joints. It typically affects the big toe. But it’s also found in
other joints, including the knee, ankle, foot, hand, wrist and elbow.

 Who is affected by gout?

 Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs
after menopause in women. Men can be three times more likely than women to get it because they
have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
 People are more likely to get gout if they have:

 Overweight/obesity.
 Congestive heart failure.
 Diabetes.
 Family history of gout.
 Hypertension (high blood pressure).
 Kidney disease.

 You are also more likely to develop gout if you:

 Consume a diet high in animal proteins.

 Consume a significant amount of alcohol.
 Are on water pills (diuretics).

 SYMPTOMS AND CAUSES

What causes gout?

 The human body makes uric acid during the breakdown of chemicals called purines found in certain
food and drinks. This normal byproduct goes through the kidneys and exits the body when you pee.
 Sometimes the body produces too much uric acid. Or the kidneys can’t do a good job handling it. When
the body has high levels of uric acid, or hyperuricemia, uric acid crystals can concentrate in the joints.
The sharp, needle-like crystals cause gout. However, many people with higher uric acid levels never
get gout.
 24
 What are the symptoms of gout?

 An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite
suddenly, often overnight. During a gout attack, symptoms in the affected joint(s) may include:

 Intense pain.
 Redness.
 Stiffness.
 Swelling.
 Tenderness, even to light touch, such as from a bedsheet.
 Warmth, or a feeling like the joint is “on fire.”

 PREVENTION

 Can I prevent gout?

 You can make certain lifestyle changes to help prevent gout:

 Drink plenty of water to help your kidneys function better and avoid dehydration.
 Exercise regularly. Having overweight/obesity increases uric acid in your body and puts more stress
on your joints.

 Do your best to limit the purines in your body, since these chemicals can trigger uric acid buildup.
Foods and drinks containing high purine levels include:

 Alcohol.
 Red meat and organ meats (liver, for example).
 Shellfish.
 Gravy.
 Drinks and foods high in fructose (fruit sugar).
 Protein from animal sources. All protein from animal flesh can potentially lead to elevated uric acid
levels.

 Certain medications can lead to elevated uric acid levels. These medications include:

 Diuretics, also known as “water pills.”

 Immunosuppressants, or drugs used to slow the immune system (common in organ transplants, for
example).

Cancer
 Cancer is a large group of diseases with one thing in common: They all happen when normal cells
become cancerous cells that multiply and spread.

 Early detection and innovative treatments are curing cancer and helping people with cancer live longer.

 At the same time, medical researchers are identifying independent risk factors linked to developing
cancer to help prevent people from developing cancer.

 What is the difference between a normal cell and a cancerous cell?

 Normally, cells follow instructions provided by genes. Genes set down rules for cells to follow, such as
when to start and stop growing. Cancerous cells ignore the rules that normal cells follow:
 25
 Normal cells divide and multiply in a controlled manner. Cancerous cells multiply uncontrollably.
 Normal cells are programmed to die (apoptosis). Cancerous cells ignore those directions.
 Normal cells for solid organs stay put. All cancerous cells are able to move around.
 Normal cells don’t grow as fast as cancerous cells.

 How does cancer start in your body?

 Cancer starts when a gene or several genes mutate and create cancerous cells. These cells create
cancer clusters, or tumors. Cancerous cells may break away from tumors, using your lymphatic
system or bloodstream to travel to other areas of your body. (Healthcare providers call this metastasis.)

 For example, a tumor in your breast may spread to your lungs, making it hard for you to breathe. In
some types of blood cancer, abnormal cells in your bone marrow make abnormal blood cells that
multiply uncontrollably. Eventually, the abnormal cells crowd out normal blood cells.

 The most common cancers in the United States are:

 Breast cancer:
 Lung cancer:
 Prostate cancer:
 Colorectal cancer:
 Blood cancers:

 What are cancer symptoms?

 Cancer is a complicated disease. You can have cancer for years without developing symptoms.

 Other times, cancer may cause noticeable symptoms that get worse very quickly.

 Many cancer symptoms resemble other, less serious illnesses. Having certain symptoms doesn’t mean
you have cancer.

 In general, you should talk to a healthcare provider anytime there’s a change in your body that lasts for
more than two weeks.

 First symptoms of cancer

 Some common early cancer symptoms include:

 Unexplained weight loss.

 Chronic tiredness.
 Persistent pain.
 Fever that occurs mostly at night.
 Skin changes, particularly moles that change shape and size or new moles.

 Left untreated, cancer may cause additional symptoms, including:

 Bruising or bleeding more easily.

 Lumps or bumps under your skin that don’t go away.
 Difficulty breathing.
 Difficulty swallowing.

 What causes cancer?

 26
 Cancer is a genetic disorder. It happens when genes that manage cell activity mutate and create
abnormal cells that divide and multiply, eventually disrupting how your body works.

 Medical researchers estimate 5% to 12% of all cancers are caused by inherited genetic mutations that
you can’t control.

 More frequently, cancer happens as an acquired genetic mutation. Acquired genetic mutations happen
over the course of your life.

 Medical researchers have identified several risk factors that increase your chance of developing
cancer.

 Cancer risk factors you can control

 Smoking: Smoking cigarettes and cigars and using e-cigarettes increases your chance of
developing lung, pancreatic, esophageal and oral cancer.
 Diet: Eating high-fat or high-sugar foods can increase your risk for many types of cancer. You’re
also more vulnerable to disease if you don’t get enough exercise.
 Environment: Exposure to toxins in your environment — such as asbestos, pesticides and radon
— can eventually lead to cancer.
 Radiation exposure: Ultraviolet (UV) radiation from the sun significantly increases your risk of
developing skin cancer. Over-exposure to radiation treatment can also be a risk factor.
 Hormone therapy: Women and people AFAB taking hormone replacement therapy may have an
increased risk for breast cancer and endometrial cancer.

 How can I reduce my risk of developing cancer?

 You can reduce your risk by changing some of your lifestyle choices:

 If you smoke or use tobacco, try to stop. Ask a healthcare provider about smoking cessation
programs that can help you quit tobacco.
 Follow a diet plan that’s healthy for you. If you want help managing your weight, ask a healthcare
provider about nutritional guidance and weight management programs.
 Add exercise to your daily routine. Exercise may boost your immune system so it provides more
protection against cancer.
 Avoid toxins, including asbestos, radon and pesticides.
 Protect yourself against sun damage.
 Have regular cancer screenings.

 What are the four stages of cancer?

 Most cancers have four stages. The specific stage is determined by a few different factors, including
the tumor’s size and location:

 Stage I: The cancer is localized to a small area and hasn’t spread to lymph nodes or other tissues.
 Stage II: The cancer has grown, but it hasn’t spread.
 Stage III: The cancer has grown larger and has possibly spread to lymph nodes or other tissues.
 Stage IV: The cancer has spread to other organs or areas of your body. This stage is also referred
to as metastatic or advanced cancer.

 Though stages one through four are the most common, there’s also a Stage 0. This earliest phase
describes cancer that’s still localized to the area in which it started.
 Cancers that are still in Stage 0 are usually easily treatable and are considered pre-cancerous by most
healthcare providers.

 MANAGEMENT AND TREATMENT

 How do healthcare providers treat cancer?

 27
Healthcare providers may use several different treatments, sometimes combining treatments based on your
situation. Common cancer treatments include:

 Chemotherapy: Chemotherapy is one of the most common cancer treatments. It uses powerful
drugs to destroy cancer cells. You may receive chemotherapy in pill form or intravenously (through
a needle into a vein). In some cases, providers may be able to direct chemotherapy to the specific
area affected.
 Radiation therapy: This treatment kills cancer cells with high dosages of radiation. Your healthcare
provider may combine radiation therapy and chemotherapy.
 Surgery: Cancerous tumors that haven’t spread may be removed with surgery. Your healthcare
provider may recommend therapy. This treatment combines surgery with chemotherapy or radiation
to shrink a tumor before surgery or to kill cancer cells that may remain after surgery.
 Hormone therapy: Sometimes, providers prescribe hormones that block other cancer-causing
hormones. For example, men and people assigned male at birth who have prostate cancer might
receive hormones to keep testosterone (which contributes to prostate cancer) lower than usual.
 Biological response modifier therapy: This treatment stimulates your immune system and helps it
perform more effectively. It does this by changing your body’s natural processes.
 Immunotherapy for cancer: Immunotherapy is a cancer treatment that engages your immune
system to fight the disease. The treatment may be called biological therapy.
 Targeted therapy for cancer: Targeted therapy is a cancer treatment that targets the genetic
changes or mutations that turn healthy cells into cancer cells.
 Bone marrow transplant: Also called stem cell transplantation, this treatment replaces damaged
stem cells with healthy ones. Autologous transplantation uses your supply of healthy stem cells.
Allogeneic transplantation uses stem cells donated by another person.

 Classification by site of origin

 By primary site of origin, cancers may be of specific types like breast cancer, lung cancer, prostate
cancer, liver cancer renal cell carcinoma (kidney cancer), oral cancer, brain cancer etc.

 Classification by tissue types

 The international standard for the classification and nomenclature of histologies is the International
Classification of Diseases for Oncology, Third Edition (ICD-O-3). This classification is based on the
ICD-O-3.
 Based on tissue types cancers may be classified into six major categories:

1. Carcinoma

 This type of cancer originates from the epithelial layer of cells that form the lining of external parts of
the body or the internal linings of organs within the body.
 Carcinomas, malignancies of epithelial tissue, account for 80 to 90 percent of all cancer cases since
epithelial tissues are most abundantly found in the body from being present in the skin to the covering
and lining of organs and internal passageways, such as the gastrointestinal tract.
 Carcinomas usually affect organs or glands capable of secretion including breast, lungs, bladder, colon
and prostate.
 Carcinomas are of two types – adenocarcinoma and squamous cell carcinoma. Adenocarcinoma
develops in an organ or gland and squamous cell carcinoma originates in squamous epithelium.
Adenocarcinomas may affect mucus membranes and are first seen as a thickened plaque-like white
mucosa. These are rapidly spreading cancers.

2. Sarcoma
 28
 These cancers originate in connective and supportive tissues including muscles, bones, cartilage and
fat. Bone cancer is one of the sarcomas termed osteosarcoma. It affects the young most commonly.
Sarcomas appear like the tissue in which they grow.
 Other examples include chondrosarcoma (of the cartilage), leiomyosarcoma (smooth muscles),
rhabdomyosarcoma (skeletal muscles), Mesothelial sarcoma or mesothelioma (membranous lining of
body cavities), Fibrosarcoma (fibrous tissue), Angiosarcoma or hemangioendothelioma (blood
vessels), Liposarcoma (adipose or fatty tissue), Glioma or astrocytoma (neurogenic connective tissue
found in the brain), Myxosarcoma (primitive embryonic connective tissue) and Mesenchymous or
mixed mesodermal tumor (mixed connective tissue types).

3. Myeloma

 These originate in the plasma cells of bone marrow. Plasma cells are capable of producing various
antibodies in response to infections. Myeloma is a type of blood cancer.

4. Leukemia

 This a group of cancers that are grouped within blood cancers. These cancers affect the bone marrow
which is the site for blood cell production. When cancerous, the bone marrow begins to produce
excessive immature white blood cells that fail to perform their usual actions and the patient is often
prone to infection.

5. Lymphoma

 These are cancers of the lymphatic system. Unlike the leukemias, which affect the blood and are called
“liquid cancers”, lymphomas are “solid cancers”. These may affect lymph nodes at specific sites like
stomach, brain, intestines etc. These lymphomas are referred to as extranodal lymphomas.
 Lymphomas may be of two types – Hodgkin’s lymphoma and Non-Hodgkin’s lymphomas. In Hodgkin
lymphoma there is characteristic presence of Reed-Sternberg cells in the tissue samples which are not
present in Non-Hodgkin lymphoma.

6. Mixed types

 These have two or more components of the cancer. Some of the examples include mixed mesodermal
tumor, carcinosarcoma, adenosquamous carcinoma and teratocarcinoma. Blastomas are another type
that involves embryonic tissues.

 Classification by grade

 Cancers can also be classified according to grade. The abnormality of the cells with respect to
surrounding normal tissues determines the grade of the cancer. Increasing abnormality increases the
grade, from 1–4.
 Cells that are well differentiated closely resemble normal specialized cells and belong to low grade
tumors. Cells that are undifferentiated are highly abnormal with respect to surrounding tissues.
 These are high grade tumors.

 Grade 1 – well differentiated cells with slight abnormality

 Grade 2 – cells are moderately differentiated and slightly more abnormal
 29
 Grade 3 – cells are poorly differentiated and very abnormal
 Grade 4 – cells are immature and primitive and undifferentiated

 Classification by stage

 Cancers are also classified individually according to their stage. There are several types of staging
methods. The most commonly used method uses classification in terms of tumor size (T), the degree of
regional spread or node involvement (N), and distant metastasis (M). This is called the TNM staging.
 For example, T0 signifies no evidence of tumor, T 1 to 4 signifies increasing tumor size and
involvement and Tis signifies carcinoma in situ or limited to surface cells.
 Similarly N0 signifies no nodal involvement and N 1 to 4 signifies increasing degrees of lymph node
involvement. Nx signifies that node involvement cannot be assessed.
 Metastasis is further classified into two – M0 signifies no evidence of distant spread while M1 signifies
evidence of distant spread.
 Stages may be divided according to the TNM staging classification. Stage 0 indicates cancer being in
situ or limited to surface cells while stage I indicates cancer being limited to the tissue of origin.
 Stage II indicates limited local spread, Stage II indicates extensive local and regional spread while
stage IV is advanced cancer with distant spread and metastasis.

Tuberculosis
 Tuberculosis is an infectious disease that can cause infection in your lungs or other tissues. It
commonly affects your lungs, but it can also affect other organs like your spine, brain or kidneys. The
word “tuberculosis” comes from a Latin word for "nodule" or something that sticks out.

 Tuberculosis is also known as TB. Not everyone who becomes infected with TB gets sick, but if you do
get sick you need to be treated.

 If you’re infected with the bacterium, but don’t have symptoms, you have inactive tuberculosis or latent
tuberculosis infection (also called latent TB). It may seem like TB has gone away, but it’s dormant
(sleeping) inside your body.

 If you’re infected, develop symptoms and are contagious, you have active tuberculosis or tuberculosis
disease (TB disease).

 The three stages of TB are:

 Primary infection.
 Latent TB infection.
 Active TB disease.

 What causes tuberculosis?

 TB is caused by the bacterium Mycobacterium tuberculosis. The germs are spread through the air and
usually infect the lungs, but can also infect other parts of the body. Although TB is infectious, it doesn’t
spread easily. You usually have to spend a lot of time in contact with someone who is contagious in
order to catch it.
 30
 How is tuberculosis spread?

 TB can be spread when a person with active TB disease releases germs into the air through coughing,
sneezing, talking, singing or even laughing. Only people with active pulmonary infection are
contagious. Most people who breathe in TB bacteria are able to fight the bacteria and stop it from
growing. The bacterium becomes inactive in these individuals, causing a latent TB infection.
 As many as 13 million people in the U.S. have latent TB. Although the bacteria are inactive, they still
remain alive in the body and can become active later. Some people can have a latent TB infection for a
lifetime, without it ever becoming active and developing into TB disease.
 However, TB can become active if your immune system becomes weakened and cannot stop the
bacteria from growing. This is when the latent TB infection becomes active TB. Many researchers are
working on treatments to stop this from happening.

 What are the signs and symptoms of tuberculosis?

 People with inactive TB do not exhibit symptoms. However, they may have a positive skin reaction test
or blood test.
 Those with active TB can show any of the following symptoms:

 Bad cough (lasting longer than two weeks).

 Pain in your chest.
 Coughing up blood or sputum (mucus).
 Fatigue or weakness.
 Loss of appetite.
 Weight loss.
 Chills.
 Fever.
 Night sweats.

 DIAGNOSIS AND TESTS

 What kinds of tests are used to diagnose tuberculosis?

 There are two kinds of screening tests for TB: the Mantoux tuberculin skin test (TST) and the blood
test, called the interferon gamma release assay (IGRA).
 For the TST, a healthcare provider will inject a small amount of a substance called purified protein
derivative (PPD) under the skin of your forearm. After two to three days, you must go back to the
healthcare provider, who will look at the injection site.
 For the IGRA, a healthcare provider will draw blood and send the sample to the lab.
 Further tests to determine if an infection is active or if your lungs are infected include:

 Lab tests on sputum and lung fluid.

 Chest X-ray.
 Computed tomography (CT) scans.
 31

Atherosclerosis
 Atherosclerosis is a disease that happens when plaque builds up on the inside walls of your arteries.
Arteries are blood vessels that deliver blood and oxygen from the heart to the rest of the body.

 Plaque is a sticky substance made of fat, cholesterol, calcium and other substances. As plaque builds
up, your arteries become hard and narrow.

 What are the stages of atherosclerosis?

 There are several stages of atherosclerosis (described below). Each stage involves changes in your
artery wall. These changes are so tiny that you can’t see most of them without a microscope. But they
add up to cause serious damage to your artery.

 The stages of atherosclerosis happen over many years. And they often go undetected.

 Atherosclerosis involves gradual plaque buildup inside your artery. Eventually, the plaque can rupture
and trigger a blood clot.

Stage 1: Endothelial damage and immune response

 Atherosclerosis begins when damage occurs to the inner layer of your artery wall. This layer is called
the intima. The surface of your intima is lined with endothelial cells. This thin lining, called the
endothelium, is the barrier between your blood and your artery wall.

 Many things can harm your endothelium. The most common culprits include:

 High levels of LDL (“bad”) cholesterol circulating in your blood.

 Toxins, like those from cigarette smoke.
 High blood pressure that persists for a long time.

 Once your endothelium is damaged, several things happen:

 32
1. Cholesterol from your blood starts gathering at the site of injury.
2. These cholesterols become oxidized (a chemical process) and trigger an immune response.
3. This immune response causes many white blood cells to travel to the area. These white blood cells
are called monocytes. They gather and lead to inflammation within your artery.

Stage 2: Fatty streak

 A “fatty streak” is the first visible sign of atherosclerosis. It’s a yellow streak or patch formed from dead
cells at the site of endothelial damage.

 Here’s how it forms:

1. The monocytes that moved to your artery turn into cells called macrophages. Macrophages
surround and consume invaders to get rid of them. In this case, your macrophages consume the
cholesterol.
2. As your macrophages fill up with cholesterol, they take on a foamy appearance. So, they’re then
called “foam cells.”
3. After the foam cells consume cholesterol, they die.
4. As the foam cells die, your body sends more and more white blood cells to the area. Those cells
continue consuming cholesterol, get foamy and die. As this process continues, it damages your
endothelium more.

 All the dead foam cells form a bulge underneath your endothelium. This “fatty streak” is the beginning
of plaque formation.

 Stage 3: Plaque growth

 More dead foam cells and other debris continue building up at the site of the fatty streak. The fatty
streak slowly gets bigger and forms into a larger piece of plaque.

 Your artery’s smooth muscle cells form a layer on top of this plaque. This is called a fibrous cap. The
fibrous cap covers the plaque. It prevents bits of plaque from breaking off into your bloodstream.
Meanwhile, the plaque keeps growing. It gains calcium, which makes it harder.

 For a while, your blood still has enough room to pass through. That’s because your artery wall expands
outward to make space for the plaque. But it can only expand outward so far. As the plaque gets too
big, the opening of your artery becomes narrower and narrower. There’s less room for your blood to
flow through.

 The plaque may stay stable for a long time. But eventually, it can rupture.

Stage 4: Plaque rupture

 In this final stage, the plaque ruptures and causes major problems in your body. At this point, the
plaque has been in your artery for a long time — perhaps many years. It has grown in size and taken
up more space in your artery. But the fibrous cap has kept the plaque from breaking open until this
point.

 When the fibrous cap breaks open, the plaque inside comes into contact with your blood. This can
trigger a blood clot to form. This blood clot (known as a “thrombus”) blocks your blood flow and leads to
a heart attack or stroke.

 Researchers are still learning how these ruptures happen and who’s at risk. A thin fibrous cap may be
more likely to rupture than a thicker one. The size of the plaque itself may not matter as much. In some
cases, smaller plaque bulges lead to a heart attack.

 Causes:
 33
 Atherosclerosis is a slowly worsening disease that may begin as early as childhood. The exact cause is
unknown. It may start with damage or injury to the inner layer of an artery. The damage may be caused
by:

 High blood pressure

 High cholesterol
 High triglycerides, a type of fat (lipid) in the blood
 Smoking or chewing tobacco
 Diabetes
 Insulin resistance
 Obesity
 Inflammation from an unknown cause or from diseases such as arthritis, lupus, psoriasis or
inflammatory bowel disease

 Once the inner wall of an artery is damaged, blood cells and other substances may gather at the injury
site and build up in the inner lining of the artery.
 Some early warning signs include:

 Chest pain (angina) while exercising. This pain stops when you rest.
 Leg cramps when walking (intermittent claudication).
 Transient ischemic attack (TIA). This is a “mini stroke” that has the same symptoms as a stroke. But
it goes away within a day and doesn’t damage your brain. If you have a TIA, you’re at risk of having
a stroke within days or weeks.

 If you have a blood clot or sudden blockage, you may have a heart attack or stroke.

 Symptoms of a heart attack include:

 Chest pain. It may be mild discomfort or severe, crushing pain.

 Pain in one or both arms or shoulders.
 Discomfort in your neck or jaw.
 Nausea or vomiting.
 Heart palpitations.
 Anxiety or a feeling of “impending doom.”
 Sweating.
 Dizziness or fainting.

The blood clot or blockage can also lead to a stroke.

 Symptoms of a stroke include:

 Sudden numbness or weakness in your face, arms or legs, especially on one side of your body.
 Sudden trouble speaking or understanding others.
 Slurred or confused speech.
 Trouble seeing in one or both eyes.
 Severe dizziness or loss of balance.
 Trouble walking.
 Sudden and severe headache.

 How is atherosclerosis diagnosed?

 To determine whether you have atherosclerosis, your healthcare provider will start with:

 Family medical history.

 Personal medical history.
 34
 Physical exam, listening with a stethoscope for weak or absent pulse or an abnormal sound in your
arteries called bruit.
 Blood tests, which can measure the amount of fat, cholesterol, sugar and protein in your blood.

 What tests diagnose atherosclerosis?

 Your healthcare provider may order additional tests to diagnose atherosclerosis and plan the best
treatment for you. These tests include:

 Angiography. This test uses special X-rays to locate and measure blockages. Your healthcare
provider will inject a contrast dye into your arteries to help the blockages show up on the X-rays.
Your healthcare provider will insert a catheter (thin tube) into one of your arteries, usually in your
groin or arm.
 Ankle/brachial index. This test compares the blood pressure in your ankle to the pressure in your
arm to measure blood flow in your limbs.
 Chest X-ray. A chest X-ray takes pictures inside of your chest.
 CT scan. This scan takes pictures inside of your body and can show any hardening and narrowing
of your large arteries.
 Echocardiogram (echo). An echo takes pictures of your heart’s valves and chambers and
measures how well your heart is pumping.
 Electrocardiogram (EKG). An EKG measures your heart’s electrical activity, rate and rhythm.
 Exercise stress test. This test measures your heart function while you’re physically active.
 Carotid ultrasound. This test takes ultrasound pictures of the arteries in your neck (carotid
arteries). It can detect hardening or narrowing of these arteries as blood flows to your brain.
 Abdominal ultrasound. This ultrasound takes pictures of your abdominal aorta. It checks for
ballooning (abdominal aortic aneurysm) or plaque buildup in your aorta.

 Prevention

 The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These
lifestyle changes can help keep the arteries healthy:

 Quitting smoking
 Eating healthy foods
 Exercising regularly
 Maintaining a healthy weight
 Checking and maintaining a healthy blood pressure
 Checking and maintaining healthy cholesterol and blood sugar levels

Parkinson’s disease
 Parkinson’s disease is a condition where a part of your brain deteriorates, causing more severe
symptoms over time.

 While this condition is best known for how it affects muscle control, balance and movement, it can also
cause a wide range of other effects on your senses, thinking ability, mental health and more.

 Who does it affect?

 The risk of developing Parkinson’s disease naturally increases with age, and the average age at which
it starts is 60 years old. It’s slightly more common in men or people designated male at birth (DMAB)
than in women or people designated female at birth (DFAB).
 35
 While Parkinson’s disease is usually age-related, it can happen in adults as young as 20 (though this is
extremely rare, and often people have a parent, full sibling or child with the same condition).

 How does this condition affect my body?

 Parkinson’s disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area
deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that
Parkinson’s disease causes a major shift in your brain chemistry.

 Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how
your brain cells (neurons) communicate with each other. When you have Parkinson’s disease, you
don’t have enough dopamine, one of the most important neurotransmitters.

 When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements
using cells that require dopamine. That’s why lack of dopamine causes the slowed movements and
tremors symptoms of Parkinson's disease.

 As Parkinson's disease progresses, the symptoms expand and intensify. Later stages of the disease
often affect how your brain functions, causing dementia-like symptoms and depression.

 Stages of Parkinson’s disease

 Parkinson’s disease can take years or even decades to cause severe effects.

 In 1967, two experts, Margaret Hoehn and Melvin Yahr, created the staging system for Parkinson’s
disease. That staging system is no longer in widespread use because staging this condition is less
helpful than determining how it affects each person’s life individually and then treating them
accordingly.

 Today, the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is
healthcare providers' main tool to classify this disease. The MDS-UPDRS examines four different areas
of how Parkinson’s disease affects you:

 Part 1: Non-motor aspects of experiences of daily living. This section deals with non-motor
(non-movement) symptoms like dementia, depression, anxiety and other mental ability- and mental
health-related issues. It also asks questions about pain, constipation, incontinence, fatigue, etc.
 Part 2: Motor aspects of experiences of daily living. This section covers the effects on
movement-related tasks and abilities. It includes your ability to speak, eat, chew and swallow, dress
and bathe yourself if you have tremors and more.
 Part 3: Motor examination. A healthcare provider uses this section to determine the movement-
related effects of Parkinson's disease. The criteria measure effects based on how you speak, facial
expressions, stiffness and rigidity, walking gait and speed, balance, movement speed, tremors, etc.
 Part 4: Motor complications. This section involves a provider determining how much of an impact
the symptoms of Parkinson’s disease are affecting your life. That includes both the amount of time
you have certain symptoms each day, and whether or not those symptoms affect how you spend
your time.

 What are the symptoms?

 The best-known symptoms of Parkinson's disease involve loss of muscle control. However, experts
now know that muscle control-related issues aren't the only possible symptoms of Parkinson's disease.

 Motor-related symptoms

 Motor symptoms — which means movement-related symptoms — of Parkinson’s disease include the
following:
 36
 Slowed movements (bradykinesia). A Parkinson’s disease diagnosis requires that you have this
symptom. People who have this describe it as muscle weakness, but it happens because of muscle
control problems, and there’s no actual loss of strength.
 A tremor** while muscles are at rest**. This is a rhythmic shaking of muscles even when you’re not
using them and happens in about 80% of Parkinson's disease cases. Resting tremors are different
from essential tremors, which don’t usually happen when muscles are at rest.
 Rigidity or stiffness. Lead-pipe rigidity and cogwheel stiffness are common symptoms of
Parkinson's disease. Lead-pipe rigidity is a constant, unchanging stiffness when moving a body
part. Cogwheel stiffness happens when you combine tremor and lead-pipe rigidity. It gets its name
because of the jerky, stop-and-go appearance of the movements (think of it as the second hand on
a mechanical clock).
 Unstable posture or walking gait**. **The slowed movements and stiffness of Parkinson’s disease
cause a hunched over or stooped stance. This usually appears as the disease gets worse. It’s
visible when a person walks because they’ll use shorter, shuffling strides and move their arms less.
Turning while walking may take several steps.

 Additional motor symptoms can include:

 Blinking less often than usual. This is also a symptom of reduced control of facial muscles.
 Cramped or small handwriting. Known as micrographia, this happens because of muscle control
problems.
 Drooling. Another symptom that happens because of loss of facial muscle control.
 Mask-like facial expression. Known as hypomimia, this means facial expressions change very
little or not at all.
 Trouble swallowing (dysphagia). This happens with reduced throat muscle control. It increases
the risk of problems like pneumonia or choking.
 Unusually soft speaking voice (hypophonia). This happens because of reduced muscle control
in the throat and chest.

 Non-motor symptoms

 Several symptoms are possible that aren't connected to movement and muscle control. In years past,
experts believed non-motor symptoms were risk factors for this disease when seen before motor
symptoms.

 However, there’s a growing amount of evidence that these symptoms can appear in the earliest stages
of the disease.

 That means these symptoms might be warning signs that start years or even decades before motor
symptoms.

Non-motor symptoms (with the potential early warning symptoms in bold) include:

 Autonomic nervous system symptoms. These include orthostatic hypotension (low blood
pressure when standing up), constipation and gastrointestinal problems, urinary
incontinence and sexual dysfunctions.
 Depression.
 Loss of sense of smell (anosmia).
 Sleep problems such as periodic limb movement disorder (PLMD), rapid eye movement (REM)
behavior disorder and restless legs syndrome.
 Trouble thinking and focusing (Parkinson’s-related dementia).
 37

 What tests will be done to diagnose this condition?

 When healthcare providers suspect Parkinson’s disease or need to rule out other conditions, various
imaging and diagnostic tests are possible. These include:

 Blood tests (these can help rule out other forms of parkinsonism).
 Computerized tomography (CT) scan.
 Genetic testing.
 Magnetic resonance imaging (MRI).
 Positron emission tomography (PET) scan.

Parkinsonism
 Parkinsonism is an umbrella term that refers to conditions with similar, movement-related effects. These
conditions involve slowed movements, and other symptoms are possible depending on the condition. These
conditions are usually lifelong, and most (but not all) involve deterioration of your brain. However, most are
also treatable.

 Parkinsonism is a term for a group of neurological conditions that cause difficulty with movement. Some of
the defining symptoms of parkinsonism include:

 slowness of movement
 tremors
 rigid muscles
 trouble walking
 impaired posture

 Parkinson’s disease is the most common type of parkinsonism. It makes up about 80 percentTrusted
Source of parkinsonism cases.
 Other types of parkinsonism are collectively known as atypical parkinsonian disorders or Parkinson-plus
syndromes. There are many types of parkinsonism that closely mimic symptoms of Parkinson’s, and
diagnosis can be difficult.
 In this article, we look at the different types of parkinsonism and break down the symptoms and treatment of
each.

 How parkinsonism differs from Parkinson’s disease

 38
 Parkinson’s disease is one of many types of parkinsonism. It’s caused by a loss of cells in the part of your
brain that produces the neurotransmitter dopamine.
 Parkinson’s disease and the different types of parkinsonism progress in different ways. Some may progress
more rapidly than Parkinson’s disease. Others, like secondary parkinsonism, may be reversible.
 The conditions also respond differently to treatments. For instance, someone who has a type of
parkinsonism may not respond to the drug levodopa, which is commonly used for Parkinson’s disease.
 It can be hard to tell the difference between types of parkinsonism. Here’s a look at some of the identified
categories of parkinsonism with their typical symptoms and treatments.

 What is parkinsonism?

 Parkinsonism is an umbrella term that refers to brain conditions that cause slowed movements, rigidity
(stiffness) and tremors. These conditions can happen for many reasons, including genetic mutations,
reactions to medications and infections.

 Who does it affect?

 Parkinsonism overall is usually an age-related disease. It’s slightly more common in people assigned male
at birth than in those assigned female at birth. The most common forms of parkinsonism are more likely to
happen after age 60.

 But some forms can happen at a much earlier age. The average age when juvenile parkinsonism starts is
17. That form of parkinsonism is also four times more common in assigned males than assigned females.

 How does this condition affect my body?

 The effects of parkinsonism depend on why it happens. Most parkinsonian conditions affect parts of your
brain responsible for movement. That means you move more slowly. You also may have muscle tremors,
causing you to shake.

 What are the symptoms of parkinsonism?

The key symptoms of parkinsonism are:

 Slowed movements (bradykinesia)*.

 Tremors.
 Stiffness or rigidity.

*This symptom always happens with parkinsonism.

Other possible symptoms include:

 Unstable posture or walking gait.

 Flexed, hunched or stooped posture.
 Freezing (being unable to move when trying to walk).

 Condition-specific parkinsonian symptoms

 Certain symptoms are more likely with a few conditions involving parkinsonism. Those conditions and the
symptoms include:

 Parkinson’s disease: In addition to motor (movement-related) symptoms, this condition tends to

involve several non-motor symptoms also. Many of these affect the unconscious processes of your
body. Examples of this include constipation, loss of sense of smell and sleep problems.
 Vascular parkinsonism: This condition tends to cause early balance and walking problems. It can
also cause trouble speaking (dysarthria) and swallowing (dysphagia). People with this also tend to
have an unusual reflex when the bottom of their foot is touched a certain way (known as Babinski’s
sign, this causes their toes to extend and fan out rather than curl).
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 Drug-induced parkinsonism: People with this tend to have parkinsonism-type symptoms equally
on both sides of their body. With Parkinson’s disease, the effects usually are worse on one side.
 Toxin-induced parkinsonism: People with this have more severe "cogwheel rigidity," which is a
jerky pattern to their movements (similar to the second hand of a clock). Their muscles also are
tense, causing slowed movements and trouble walking backward.
 Juvenile parkinsonism: Experts usually suspect this type of parkinsonism once they rule out other
causes because it is rare for this condition to happen to those under age 45.

 Possible causes of parkinsonism

For many types of parkinsonism, the exact cause isn’t known. Genetic and environmental factors are both
believed to play a role.

Parkinson’s disease has been linked to exposure to pesticides and herbicides, as well as living close to
industrial plants. Some genes are also associated with an elevated risk of developing Parkinson’s.

Conditions that cause brain damage, like traumatic injuries, tumors, and exposure to certain toxins, are also
potentially contributing factors to the development of parkinsonism.

 What tests will be done to diagnose this condition?

When healthcare providers suspect a condition that falls under parkinsonism, various imaging and
diagnostic tests are possible. These include:

 Blood tests (these can help look for other forms of parkinsonism).
 Computerized tomography (CT) scan.
 Genetic testing.
 Magnetic resonance imaging (MRI).
 Positron emission tomography (PET) scan

DIFFERENCE BETWEEN ASTHMA AND COPD

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Rheumatoid Arthritis
 Rheumatoid arthritis is a type of arthritis where your immune system attacks the tissue lining the joints
on both sides of your body. It may affect other parts of your body too.
 The exact cause is unknown. Treatment options include lifestyle changes, physical therapy,
occupational therapy, nutritional therapy, medication and surgery.

 What is rheumatoid arthritis?

 Rheumatoid arthritis (RA) is an autoimmune disease that is chronic (ongoing). It occurs in the joints on
both sides of your body, which makes it different from other types of arthritis. You may have symptoms
of pain and inflammation in your:

 Fingers.
 Hands.
 Wrists
 Knees
 Ankles.
 Feet.
 Toes.

 Uncontrolled inflammation damages cartilage, which normally acts as a “shock absorber” in your joints.
In time, this can deform your joints.

 Eventually, your bone itself erodes. This can lead to the fusion of your joint (an effort of your body to
protect itself from constant irritation).

 Specific cells in your immune system (your body’s infection-fighting system) aid this process.

 These substances are produced in your joints but also circulate and cause symptoms throughout your
body.

 In addition to affecting your joints, rheumatoid arthritis sometimes affects other parts of your body,
including your:

 Skin.
 Eyes.
 Mouth.
 Lungs.
 Heart.

 What are the symptoms of rheumatoid arthritis?

 Rheumatoid arthritis affects everyone differently. In some people, joint symptoms develop over several
years.

 In other people, rheumatoid arthritis symptoms progress rapidly. Many people have time with
symptoms (flares) and then time with no symptoms (remission).

 Symptoms of rheumatoid arthritis include:

 Pain, swelling, stiffness and tenderness in more than one joint.

 Stiffness, especially in the morning or after sitting for long periods.
 Pain and stiffness in the same joints on both sides of your body.
 Fatigue (extreme tiredness).
 Weakness.
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 Fever.

 What causes rheumatoid arthritis?

 The exact cause of rheumatoid arthritis is unknown. Researchers think it’s caused by a combination of
genetics, hormones and environmental factors.

 Normally, your immune system protects your body from disease. With rheumatoid arthritis, something
triggers your immune system to attack your joints.

 An infection, smoking or physical or emotional stress may be triggering.

 What are the risk factors for developing rheumatoid arthritis?

 There are several risk factors for developing rheumatoid arthritis.

 These include:

 Family history: You’re more likely to develop RA if you have a close relative who also has it.
 Sex: Women and people designated female at birth are two to three times more likely to develop
rheumatoid arthritis.
 Smoking: Smoking increases a person’s risk of rheumatoid arthritis and makes the disease worse.
 Obesity: Your chances of developing RA are higher if you have obesity.

 DIAGNOSIS AND TESTS

 How is rheumatoid arthritis diagnosed?

 Your healthcare provider may refer you to a physician who specializes in arthritis (rheumatologist).
Rheumatologists diagnose people with rheumatoid arthritis based on a combination of several factors.
 They’ll do a physical exam and ask you about your medical history and symptoms. Your rheumatologist
will order blood tests and imaging tests.
 The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid
arthritis. These may include:

 Erythrocyte sedimentation rate (ESR) or “sed rate” confirms inflammation in your joints.
 C-reactive protein (CRP).
 About 80% of people with RA test positive for rheumatoid factor (RF).
 About 60% to 70% of people living with rheumatoid arthritis have antibodies to cyclic citrullinated
peptides (CCP) (proteins).

 Your rheumatologist may order imaging tests to look for signs that your joints are wearing away.
Rheumatoid arthritis can cause the ends of the bones within your joints to wear down. The imaging
tests may include:

 X-rays.
 Ultrasounds.
 Magnetic resonance imaging (MRI) scans.

 In some cases, your provider may watch how you do over time before making a definitive diagnosis of
rheumatoid arthritis.
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Heart Failure (Congestive Heart Failure)

 Heart failure is a long-term condition in which your heart can’t pump blood well enough to meet your
body’s needs all the time.
 Treatment includes exercise and medicine at first and possible surgical procedures when heart failure
gets worse.
 Your outlook depends on a range of factors, including how well you take care of yourself.

 What is heart failure?

 Heart failure, or congestive heart failure, is a long-term condition that gets worse over time.

 Although the name sounds like your heart has stopped working, heart failure means your heart isn’t
able to pump blood as well as it should.

 When your heart has less pumping power, that can damage your organs and fluid can collect in your
lungs.

 What is congestive heart failure?

 This is a state in which your heart hasn’t been able to handle the blood volume. This causes an
accumulation in other parts of your body, most commonly in your lungs and lower extremities
(feet/legs).

 What are the complications of heart failure?

 Some of the complications from heart failure include:

 Irregular heartbeat.
 Sudden cardiac arrest.
 Heart valve problems.
 A collection of fluid in your lungs.
 Pulmonary hypertension.
 Kidney damage.
 Liver damage.
 Malnutrition

 What are the heart failure stages?

 Heart failure is a chronic condition that gets worse with time. There are four heart failure stages (Stage
A, B, C and D). The stages range from "high risk of developing heart failure" to "advanced heart
failure."

 Stage A
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 Stage A is considered pre-heart failure. It means you’re at high risk of developing heart failure because
you have a family history of heart failure or you have one or more of these medical conditions:

 Hypertension.
 Diabetes.
 Coronary artery disease.
 Metabolic syndrome.
 History of alcohol abuse.
 History of rheumatic fever.
 Family history of cardiomyopathy.
 History of taking drugs that can damage your heart muscle, such as some cancer drugs.

 Stage B

 Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of
systolic left ventricular dysfunction but you’ve never had symptoms of heart failure. Most people with
 Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or
less. (See "Diagnosis" section for more about ejection fraction.) This category includes people who
have heart failure and reduced EF (HF-rEF) due to any cause.

 Stage C

 People with Stage C heart failure have a heart failure diagnosis and currently have or previously had
signs and symptoms of the condition.

 There are many possible symptoms of heart failure. The most common are:

 Shortness of breath.
 Feeling tired (fatigue).
 Less able to exercise.
 Weak legs.
 Waking up to urinate.
 Swollen feet, ankles, lower legs and abdomen (edema).

 Stage D and reduced EF

 People who have Stage D HF-rEF have advanced symptoms that don’t get better with treatment. This
is the final stage of heart failure.

 SYMPTOMS AND CAUSES

 What are the symptoms of heart failure?

 Symptoms of heart failure include:

 Shortness of breath.
 Feeling tired (fatigue) and having leg weakness when you’re active.
 Swelling in your ankles, legs and abdomen.
 Weight gain.
 Need to urinate while resting at night.
 Rapid or irregular heartbeats (palpitations).
 A dry, hacking cough.
 A full (bloated) or hard stomach, loss of appetite or upset stomach (nausea).

 There may be times that your symptoms are mild or you may not have any symptoms at all. This
doesn't mean you no longer have heart failure. Symptoms of heart failure can range from mild to
severe and may come and go.
 45
 Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different
signs or symptoms. It’s important to let your doctor know if you have new symptoms or if your
symptoms get worse.

 What causes heart failure (congestive heart failure)?

 Although the risk of heart failure doesn’t change as you get older, you’re more likely to have heart
failure when you’re older.
 Many medical conditions that damage the heart muscle can cause heart failure. Common conditions
include:

 Coronary artery disease.

 Heart attack.
 Cardiomyopathy.
 Heart issues present at birth (congenital heart disease).
 Diabetes.
 High blood pressure (hypertension). This is a common cause in people assigned female at birth.
 Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
 Kidney disease.
 Having obesity.
 Tobacco and recreational drug use.
 Medications. Some drugs used to fight cancer (chemotherapy) can lead to heart failure.

 Heart Failure Diagnosis

 In order to determine if you have heart failure, your healthcare provider needs to know about your
symptoms and medical history. They will ask you about things such as:

 Other health conditions you have, such as diabetes, kidney disease, chest pain (angina), high blood
pressure, high cholesterol, coronary artery disease, or other heart problems.
 If you have a family history of heart disease or sudden death.
 If you smoke or use tobacco.
 How much alcohol you drink.
 If you’ve had chemotherapy and/or radiation.
 The medications you take.

 You’ll also have a physical exam. Your provider will look for signs of congestive heart failure and
diseases that may have caused your heart muscle to become weak or stiff.

 What types of tests are used to diagnose heart failure?

 You’ll have tests to see how bad your heart failure is and what caused it. Common tests include:

 Blood tests.
 NT-pro B-type Natriuretic Peptide (BNP) blood test.
 Cardiac Catheterization.
 Chest X-ray.
 Echocardiogram (echo).
 Magnetic resonance imaging (MRI).
 Electrocardiogram (EKG or ECG).
 Multigated Acquisition Scan (MUGA scan).
 Stress test.

 How can I prevent heart failure?

 Although you can’t control some risk factors like age, family history or race, you can change your
lifestyle to give yourself the best chance of preventing heart failure. Things you can do include:
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 Staying at a healthy weight.
 Eating foods that are good for your heart.
 Exercising regularly.
 Managing your stress.
 Stopping the use of tobacco products.
 Not drinking alcohol.
 Not using recreational drugs.
 Taking care of other medical conditions you have that can increase your risk.

Sickle cell anemia

 Sickle cell anemia, or sickle cell disease (SCD), is a genetic disease of the red blood cells (RBCs).
 Normally, RBCs are shaped like discs, which gives them the flexibility to travel through even the
smallest blood vessels.
 However, with this disease, the RBCs have an abnormal crescent shape resembling a sickle. This
makes them sticky and rigid and prone to getting trapped in small vessels, which blocks blood from
reaching different parts of the body. T
 his can cause pain and tissue damage.
 SCD is an autosomal recessive condition. You need two copies of the gene to have the disease. If you
have only one copy of the gene, you are said to have sickle cell trait.

 What are the symptoms of sickle cell anemia?

 Symptoms of sickle cell anemia usually show up at a young age. They may appear in babies as early
as 4 months old, but generally occur around the 6-month mark.
 47

 While there are multiple types of SCD, they all have similar symptoms, which vary in severity. These
include:

 excessive fatigue or irritability, from anemia

 fussiness, in babies
 bedwetting, from associated kidney problems
 jaundice, which is yellowing of the eyes and skin
 swelling and pain in hands and feet
 frequent infections
 pain in the chest, back, arms, or legs

 What are the types of sickle cell disease?

 Hemoglobin is the protein in red blood cells that carries oxygen. It normally has two alpha chains and
two beta chains. The four main types of sickle cell anemia are caused by different mutations in these
genes.

 Hemoglobin SS disease

 Hemoglobin SS disease is the most common type of sickle cell disease. It occurs when you inherit
copies of the hemoglobin S gene from both parents.
 This forms hemoglobin known as Hb SS. As the most severe form of SCD, individuals with this form
also experience the worst symptoms at a higher rate.

 Hemoglobin SC disease

 Hemoglobin SC disease is the second most common type of sickle cell disease. It occurs when you
inherit the Hb C gene from one parent and the Hb S gene from the other. Individuals with Hb SC have
similar symptoms to individuals with Hb SS. However, the anemia is less severe.

 Hemoglobin SB+ (beta) thalassemia

 Hemoglobin SB+ (beta) thalassemia affects beta globin gene production. The size of the red blood cell
is reduced because less beta protein is made. If inherited with the Hb S gene, you will have
hemoglobin S beta thalassemia. Symptoms are not as severe.

 Hemoglobin SB 0 (Beta-zero) thalassemia

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 Sickle beta-zero thalassemia is the fourth type of sickle cell disease. It also involves the beta globin
gene. It has similar symptoms to Hb SS anemia.
 However, sometimes the symptoms of beta zero thalassemia are more severe. It is associated with a
poorer prognosis.

 Hemoglobin SD, hemoglobin SE, and hemoglobin SO

 These types of sickle cell disease are more rare and usually don’t have severe symptoms.

 Sickle cell trait

 People who only inherit a mutated gene (hemoglobin S) from one parent are said to have sickle cell
trait. They may have no symptoms or reduced symptoms.