Thursday, January 24, 2008
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Labels: HAGIA SOFIA
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New knowledge and sophisticated diagnostic techniques are helping doctors recognize early signs of autism, Alzheimer's disease and heart problems in women. Harvard experts report on the advances that are giving patients hope.
Detecting Autism
Early diagnosis of autism is critical because educational programs that build upon a child's strengths and improve social skills may help sculpt the developing brain, minimizing the impact of the illness later in life. But spotting the disorder is hard since there is no test for it, although scientists are slowly uncovering gene abnormalities that make children vulnerable to autism. Last week The New England Journal of Medicine reported that a specific location on chromosome 16 was the site of mutations responsible for some cases of autism.
For now, diagnosis depends on observing a child's behavior. It's a complex process, since no two cases are alike and signs range from mild to severe. Indeed, even though signs of autism may be apparent before their first birthday, most children aren't diagnosed until the age of 3. That makes parents, who are so intimately familiar with their child's behavior, perhaps the most effective diagnostic "tools." The American Academy of Pediatrics recently issued screening guidelines recommending that pediatricians engage parents in evaluating infants for autism. Even babies developing typically, the guidelines say, should be screened at set intervals, such as during the 9-, 18- and 24-month visits.
Healthy infants as young as 6 or 8 months do communicate and respond nonverbally to social cues. Most look up or turn at the sound of their name. By 12 months they typically babble and point at objects. By 16 months they say single words; by 24 months, two-word phrases. In contrast, children with autism seldom make meaningful eye contact or respond to familiar voices. They may never speak. Their play is often repetitive and characterized by limited imagination (neatly arranging crayons instead of coloring with them). Others may simply flap their hands in excitement or disappointment.
On their own, none of these signs means that a child has autism or another developmental disorder. Nevertheless, if your child has any of these signs, he or she merits evaluation. Although no treatments are curative, they can help children learn the skills they need to cope in a normal environment, achieve greater independence and have brighter futures.
--Kerim Munir, SC.D., M.B., Psychiatrist at Children's Hospital Boston and Harvard Medical School, And Suzanne Coulter Rose, Editor at Harvard Health Publications
The Alzheimer ' s Mystery
Alzheimer's disease, which begins years, even decades, before it causes symptoms, is a quietly ticking time bomb. But until recently doctors had no diagnostic test that could "hear" the ticking. Unfortunately, it didn't matter much that Alzheimer's couldn't be spotted early—at a stage called mild cognitive impairment, or MCI—since there were no treatments. Today, however, there are new diagnostic tests that can detect Alzheimer's at an early stage, and several disease-modifying drugs are in advanced clinical trials.
The brain shrinkage caused by Alzheimer's can now be measured with volumetric magnetic resonance imaging (MRI). This technique takes a series of MRI brain scans and then uses sophisticated mathematical models to analyze the results. Most important, volumetric MRI enables researchers to identify subtle shrinkage in brain areas first affected by Alzheimer's, such as the hippocampus, which is involved in memory.
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What happens when a husband's libido lags? Two new books offer advice on a surprisingly common problem. Lack of adventurousness on the part of their wives was one of the chief reasons men gave for losing interest in sex
Beth Leary is one of those lucky people who are still happy after nearly 20 years of marriage. Leary (not her real name) and her husband are the best of friends. Both are middle-aged college-educated professionals with demanding jobs. But they call each other frequently during the day to chat, go to church together, and spend their limited free time either going out to restaurants or staying at home reading and enjoying each other's company. Many women would envy the setup. Except for one thing: Leary and her husband rarely have sex. By her estimate, they make love about every other month. And it's always at her urging. "In terms of sex, this isn't what I signed up for," she says. "But I don't think we're that unusual."
Leary may be on to something. Research shows that about 20 percent or more of the married among us are DINS: Dual Income No Sex couples. While conventional wisdom holds that it's usually women who aren't up for sex (no pun intended), marriage experts say that's not necessarily true. Many men who are physically capable of having sex don't fit the stereotypical image of macho sex machines who want to do "it" anytime, anyplace.
Whether due to a demanding job, anger, boredom, insecurity or a host of other problems, an increasing number of otherwise healthy married men like Leary's husband are telling their wives, "Not tonight, honey, I have a headache." Though there are no good statistics about just how many men are the culprits behind the so-called sexless marriage, loosely defined as having sex 10 or fewer times a year, some intrepid relationship experts are trying to get a handle on why some husbands prefer a good night's sleep to a roll in the hay.
For their new book, "He's Just Not Up for It Anymore: Why Men Stop Having Sex, and What You Can Do About It" (HarperCollins), Dr. Bob Berkowitz, who has a Ph.D. in clinical sexology, and his wife, Susan Yager-Berkowitz, surveyed more than 4,000 people in long-term heterosexual relationships in which the absence of sex was due to the man forgoing sexual intimacy. Though there has been a significant amount of scientific literature about treating erectile dysfunction, for example, there is "surprisingly little data" on men who are physically able to have intercourse but whose libidos are stuck in neutral, says Berkowitz. "When people think of a sexless marriage, they automatically assume it's the woman who doesn't want sex. We wanted to find out the reasons why men may choose not to have sex."
Though they admit the survey doesn't meet the rigorous requirements of an epidemiological tome, the data is nonetheless compelling. A mere 14 percent of men said they were "too tired" for sex, while more than 60 percent said their wives were simply not sexually adventurous or didn't seem to enjoy sex. When wives were asked why they thought their husbands were uninterested in sex, nearly 70 percent said they had no clue. "What this tells us is that people simply aren't talking," says Berkowitz. "And without that communication, no one can resolve any issues, especially sexual issues."
While it may seem that the uninterested male is too quick to put the blame on his partner, that doesn't translate into the real scenarios that happen (or don't) in the bedrooms across America. The Berkowitzes found that when it comes to the "sexually unadventurous" wife, for example, some men simply don't understand that sex changes over the course of a relationship, going from passionate during the dating, honeymoon, and early years of marriage to a "calm, Sunday kind of love," says Yager-Berkowitz. On the other hand, one of the requests men had in the name of adventure was to leave the lights on—which may not seem all that wild a move.
Labels: Sexuality and Libido
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A drug-resistant strain of staph is infecting some gay men, but experts say a lot of the media coverage got it wrong.
The headlines this week about a new "gay" infection were dramatic. FLESH-EATING BUG SPREADS AMONG GAYS, said one Australian newspaper, referring to a study about an antibiotic-resistant bacterial infection affecting homosexual men in San Francisco and other American cities. EPIDEMIC FEARED--GAYS MAY SPREAD DEADLY STAPH INFECTION TO GENERAL POPULATION, shouted a press release from the Concerned Women for America, a conservative public-policy group.
But is there a new HIV-like public health epidemic on the horizon? Not likely, says Dr. Henry (Chip) Chambers, coauthor of the study, which was published this week in the online edition of the Annals of Internal Medicine. "This is definitely not the new AIDS," says Chambers, a professor of medicine at the University of California, San Francisco (UCSF). "HIV is a life-threatening disease that is incurable and necessitates lifelong treatment," adds Bill Stackhouse, director of the Institute for Gay Men's Health at the Gay Men's Health Crisis in New York.
That's not to say that drug-resistant staph infections aren't a serious health problem. As these so-called superbugs become more resistant to common first-line drugs, doctors have been forced to turn to alternative antibiotics, explains Chambers. Once restricted to hospitals, these virulent forms of staph have increasingly afflicted day-care centers, schools, gyms and other public areas in the last decade. These community forms of MRSA (methicillin-resistant Staphylococcus aureus) typically cause boils or abscesses to develop on the skin, and in serious cases, they can produce necrotizing fasciitis, which destroys tissue (hence the "flesh-eating" label). Infections that aren't controlled by medication or are left untreated can also damage the heart and infect the blood
In the UCSF study, researchers found that men in a clinic for HIV-positive patients who had a history of having sex with men were 13 times more likely than other HIV-positive patients to get a particular form of community-associated staph infection called MRSA USA300. But this does not mean that there is a new "gay" form of MRSA, the study's authors say. USA300 has been around since 2002 and has appeared in at least 38 American states among heterosexual and homosexual patients. What is new is the rapid rate the bacteria spread among this particular population of gay men, studied between 2004-2006. Why these men are more vulnerable than the heterosexuals studied is still a question. Researchers stopped short of labeling USA300 a sexually transmitted disease, but they did note that the infections in the men they studied were commonly found on parts of the body where skin-to-skin contact occurs during sexual activity.
Gay men's health advocates point out that MRSA can be spread through any kind of skin-to-skin contact, either sexual or nonsexual, without regard for sexual orientation. And they have been very critical of the media for its focus on the sexual aspects of the story. "It's very unfortunate," says GMHC's Stackhouse. "It's very stigmatizing, it's alarmist, it's homophobic and it's just unnecessary."
Stackhouse believes that no one benefits if USA300 gets labeled as a "gay disease." When that happens, he says, "people who aren't gay don't see themselves at risk, and there is a risk out there," he adds. "This kind of stigma presents a challenge. 'I'm not gay, so I'm not at risk,' whether it's about HIV, whether it's about MRSA. That's the big downside to this kind of reporting."
Labels: microbial diseases
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Friday, January 18, 2008
BASIC HEMATOLOGYHEMATOLOGY
>>> Hematology encompasses the study of blood cells and coagulation. Included in its corners are analyses of the concentration, structure and function of cells in blood; their precursors in the bone marrow; chemical constituents of plasma or serum intimately linked with blood cell structure & function; and function of platelets and proteins involved in blood coagulation. Increasingly, molecular biological techniques enable the detection of genetic mutations underlying the altered structure and function of cells and proteins that result in hematologic disease.
BLOOD
Blood is d far most frequent body fluid used for analytical purposes.
--The 3 general procedures for obtaining blood:
1. ARTERIAL PUNCTURE
It is use to measure oxygen and carbon dioxide tension, and to measure pH. These blood gas measurements are critical in assessment of oxygenation problems encountered in illness such as pneumonia, pneumonitis, and pulmonary embolism.
2. SKIN PUNCTURE
Skin puncture is the method of choice in pediatric patients, especially infants. The larger amount of blood required for repeated venipuncture may cause ANEMIA, especially in premature infants.
Can be used as a substitute for VENIPUNCTURE, because Venipuncture of deep veins in pediatric patients MAY ALSO RARELY CAUSE: CARDIAC ARREST, HEMMORHAGE, THROMBOSIS, VENOUS CONSTRICTION FOLLOWED BY GANGRENE OF AN EXTREMITY(Gangrene: The death of body tissue due to the loss of blood supply to that tissue, sometimes permitting bacteria to invade it and accelerate its decay. ), Damage to organs or tissues accidentally punctured and INFECTION.
REMINDER: Punctures from CoLd, cyanotic skin result in FALSELY HIGH figures for hemoglobin and cell counts, but ThEse Can Be avoided bY massage before The PuNCtURe until The Skin is PinK and warm.
3. VENOUS PUNCTURE
--- The relative ease of obtaining venous blood makes this a primary source of specimen for clinical laboratory analyses. The Venipuncture is in most instances a relatively simple procedure.
--Hematomas are usually evidence of poor technique or judgement.
Labels: Learning Medical Technology
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