Triple X syndrome

Triple X syndrome

Definition  :

Triple X syndrome is an abnormality of the chromosomes that affects about 1 in 1,000 females. Females normally have two X chromosomes, one from each parent. In triple X syndrome, a female has three X chromosomes — hence, the name.
Triple X syndrome usually results from an error in the formation of a mother's egg cell or a father's sperm cell. Sometimes, triple X syndrome occurs as a result of an error early in the embryo's development.

Many girls and women with triple X syndrome have no symptoms or only mild symptoms. In other cases, symptoms may be more pronounced — possibly including developmental delays.
Treatment for triple X syndrome depends on which symptoms, if any, your daughter exhibits and their severity.

Symptoms:

Triple X syndrome may not cause any signs or symptoms. If symptoms do appear, they may include:

• Tall stature
• Vertical skinfolds that may cover the inner corners of the eyes (epicanthal folds)
• Delayed development of speech and language skills
• Weak muscle tone (hypotonia)
• Curved pinky fingers (clinodactyly)
• Behavior and mental health problems
• Premature ovarian failure or ovary abnormalities
• Constipation or abdominal pains

When to see a doctor
See your daughter's doctor if you have any concerns about your daughter's developmental progress. Your doctor can help determine what may be the cause and suggest appropriate action.

Causes:


Most people have 46 chromosomes occurring in 22 pairs, plus two sex chromosomes, one maternal and one paternal. These chromosomes contain genes, which carry instructions that determine everything from your height to your eye color.
One of these chromosome pairs determines your sex. You receive one sex chromosome from your mother and another from your father. Your mother can give you only an X chromosome, but your father can pass on an X or a Y chromosome. If you receive an X chromosome from your father, the XX pair makes you genetically a female. If you receive a Y chromosome from your father, then your XY pair means you're genetically a male.

Females with triple X syndrome have a third X chromosome. Although this condition is genetic, it's typically not inherited. Instead, what usually happens is that either the mother's egg cell or the father's sperm cell has not formed correctly, resulting in an extra X chromosome. This random error in egg or sperm cell division is called nondisjunction.

When the cause is a malformed egg cell or sperm cell, as is usually the case, all the cells in the offspring's body have the extra chromosome. Occasionally, the extra chromosome doesn't appear until early in the development of the embryo. If this is the case, then the female is said to have a mosaic form of triple X syndrome.

In the mosaic form, only some of the body's cells have the third X chromosome. Because only some cells contain the extra X chromosome, females with the mosaic form of triple X syndrome may have less severe symptoms.
Triple X syndrome is also called trisomy X, triplo X syndrome and XXX syndrome. It's also referred to as 47,XXX syndrome because of the existence of a 47th chromosome, which is the extra X chromosome.

Complications:

Triple X syndrome can cause developmental delays or learning disabilities, and it's possible that learning disabilities or delayed development could eventually lead to a variety of other issues, including academic problems, stress and poor socialization skills that cause social isolation.
Other possible, though much rarer, complications that may occur include:

• Premature ovarian failure or ovary abnormalities. When the ovaries stop working before the expected age of menopause, there's a decline in the production of certain hormones and eggs are no longer released by the ovaries each month. This can cause infertility. Additionally, girls and women with triple X syndrome may have malformed ovaries.
• Seizures. Girls and women with triple X syndrome may develop a seizure disorder.
• Kidney abnormalities. Females born with triple X syndrome may also have abnormally developed kidneys or may have only one kidney. 

Treatments and drugs:

If your daughter has triple X syndrome, treatment is based on her symptoms, if any are present. For instance, if she has a learning disability from the triple X, she would require the same counseling as anyone else with that learning disability. This counseling usually involves teaching new techniques and strategies for learning, as well as providing motivation and help with using these tips in daily life.

If your daughter has been diagnosed with triple X syndrome, her doctor may recommend periodic screenings throughout childhood. This would help ensure that any developmental delays or learning disabilities that may occur receive prompt treatment.

Because girls with triple X syndrome may be more susceptible to stress, it's important to make sure your daughter has a supportive environment as well. Psychological counseling may help, both by teaching you and your family useful methods of demonstrating love and encouragement, and by discouraging behaviors that you might not realize are negative.

The chromosome change that causes triple X syndrome cannot be repaired, so the syndrome itself has no cure. However, given the treatable nature of most symptoms and how frequently no symptoms appear at all, it's quite possible to lead a full and normal life with this syndrome.

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Dry mouth

Dry mouth

Definition  :

Dry mouth is a condition in which your mouth is unusually dry. Dry mouth is a common problem that may seem little more than a nuisance. But a dry mouth can affect both your enjoyment of food and the health of your teeth. The medical term for dry mouth is xerostomia (zeer-o-STO-me-uh).

A result of reduced or no saliva, dry mouth can lead to problems because saliva helps prevent tooth decay by limiting bacterial growth and washing away food particles. Saliva also enhances your ability to taste and makes it easier to swallow. In addition, enzymes in saliva aid in digestion.
Although the treatment depends on the cause, dry mouth is often a side effect of medication. Dry mouth may improve with an adjusted dosage or a new prescription.

Symptoms:

If you're not producing enough saliva, you may notice the following signs and symptoms:

• Dryness in your mouth
• Saliva that seems thick and stringy
• Sores or split skin at the corners of your mouth
• Cracked lips
• Bad breath
• Difficulty speaking and swallowing
• Sore throat
• An altered sense of taste
• A fungal infection in your mouth
• Increased plaque, tooth decay and gum disease

In women, dry mouth may result in lipstick adhering to the teeth.
When to see a doctor
If you've noticed persistent dry mouth signs and symptoms, make an appointment with your family doctor or your dentist.

 Causes:

• Medications. Hundreds of medications, including some over-the-counter drugs, produce dry mouth as a side effect. Among the more likely types to cause problems are some of the drugs used to treat depression and anxiety, antihistamines, decongestants, high blood pressure medications, anti-diarrheals, muscle relaxants, drugs for urinary incontinence, and Parkinson's disease medications.
• Aging. Getting older isn't a risk factor for dry mouth on its own; however, older people are more likely to be taking medications that may cause dry mouth. Also, older people are more likely to have other health conditions that may cause dry mouth.
• Cancer therapy. Chemotherapy drugs can change the nature of saliva and the amount produced. Radiation treatments to your head and neck can damage salivary glands, causing a marked decrease in saliva production.
• Nerve damage. An injury or surgery that causes nerve damage to your head and neck area also can result in xerostomia.
• Other health conditions. Dry mouth can be a consequence of certain health conditions — or their treatments — including the autoimmune disease Sjogren's syndrome, diabetes, Parkinson's disease, HIV/AIDS, anxiety disorders and depression. Stroke and Alzheimer's disease may cause a perception of dry mouth, even though the salivary glands are functioning normally. Snoring and breathing with your mouth open also can contribute to the problem.
• Tobacco use. Smoking or chewing tobacco can increase dry mouth symptoms.

Treatments and drugs:

If your doctor believes medication to be the cause, he or she may adjust your dosage or switch you to another medication that doesn't cause a dry mouth. Your doctor may also consider prescribing pilocarpine (Salagen) or cevimeline (Evoxac) to stimulate saliva production.
In severe cases, to prevent cavities, your dentist might fit you for coverings for your teeth filled with fluoride to wear at night.

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Dry skin

Dry skin

Definition  :

Ordinarily, dry skin isn't serious, but it can be uncomfortable and unsightly, turning plump cells into shriveled ones and creating fine lines and wrinkles.
Serious dry skin conditions — an inherited group of disorders called ichthyosis — can sometimes be disfiguring, causing psychological distress. Fortunately, most dry skin results from environmental factors that can be wholly or partially controlled. These include exposure to hot or cold weather with low humidity levels and excessive bathing.
Chronic or severe dry skin problems may require a dermatologist's evaluation. But first you can do a lot on your own to improve your skin, including using moisturizers, bathing less and avoiding harsh, drying soaps.

Symptoms :

Dry skin is often just a temporary problem — one you experience only in winter, for example — but it may be a lifelong concern. And although skin is often driest on your arms and lower legs, this pattern can vary considerably from person to person. What's more, signs and symptoms of dry skin depend on your age, your health status, your locale, the amount of time you spend outdoors and the cause of the problem.
If you have dry skin, you're likely to experience one or more of the following:

• A feeling of skin tightness, especially after showering, bathing or swimming
• Skin that appears shrunken or dehydrated
• Skin that feels and looks rough rather than smooth
• Itching (pruritus) that sometimes may be intense
• Slight to severe flaking, scaling or peeling
• Fine lines or cracks
• Redness
• Deep fissures that may bleed

When to see a doctor
Most cases of dry skin respond well to lifestyle and home remedies. See your doctor if:

• Your skin doesn't improve in spite of your best efforts
• Dry skin is accompanied by redness
• Dryness and itching interfere with sleeping
• You have open sores or infections from scratching
• You have large areas of scaling or peeling skin

Causes:

Though most cases of dry skin (xerosis) are caused by environmental exposures, certain diseases also can significantly alter the function and appearance of your skin. Potential causes of dry skin include:

• Weather. In general, your skin is driest in winter, when temperatures and humidity levels plummet. Winter conditions also tend to make many existing skin conditions worse. But the reverse may be true if you live in desert regions, where temperatures can soar, but humidity levels remain low.
• Central heating and air conditioning. Central air and heating, wood-burning stoves, space heaters, and fireplaces all reduce humidity and dry your skin.
• Hot baths and showers. Frequent showering or bathing, especially if you like the water hot and your baths long, breaks down the lipid barriers in your skin. So does frequent swimming, particularly in heavily chlorinated pools.
• Harsh soaps and detergents. Many popular soaps and detergents strip lipids and water from your skin. Deodorant and antibacterial soaps are usually the most damaging, as are many shampoos that dry out your scalp.
• Sun exposure. Like all types of heat, the sun dries your skin. Yet damage from ultraviolet (UV) radiation penetrates far beyond the top layer of skin (epidermis). The most significant damage occurs deep in the dermis, where collagen and elastin fibers break down much more quickly than they should, leading to deep wrinkles and loose, sagging skin (solar elastosis). Sun-damaged skin may have the appearance of dry skin.
• Atopic dermatitis. This is one of the more common types of eczema, and those affected have more sensitive and drier skin. Many persons with mild eczema confuse this skin condition with excessive dryness. Areas commonly affected include the face, sides of the neck, and fold areas around the elbows, wrists, knees and ankles.
• Psoriasis. This skin condition is marked by a rapid buildup of rough, dry, dead skin cells that form thick scales.
• Thyroid disorders. Hypothyroidism, a condition that occurs when your thyroid produces too little thyroid hormones, reduces the activity of your sweat and oil glands, leading to rough, dry skin.

Complications:

In some people who have a tendency toward eczema, dry skin that's not cared for can lead to:

• Atopic dermatitis (eczema). If you're prone to develop this condition, excessive dryness can lead to activation of the disease, causing redness, cracking and inflammation.
• Folliculitis. This is an inflammation of your hair follicles.
• Cellulitis. This is a potentially serious bacterial infection of the skin's underlying tissues; these bacteria may enter the lymphatic system and blood vessels.

These complications are most likely to occur when your skin's normal protective mechanisms are severely compromised. For example, severely dry skin can cause deep cracks or fissures, which can open up and bleed, providing an avenue for invading bacteria.

Treatments and drugs:

In most cases, dry skin problems respond well to home and lifestyle measures, such as using moisturizers and avoiding long, hot showers and baths. If you have very dry and scaly skin, your doctor may recommend you use an over-the-counter (nonprescription) cream that contains lactic acid or lactic acid and urea.
If you have a more serious skin disease, such as atopic dermatitis, ichthyosis or psoriasis, your doctor may prescribe prescription creams and ointments or other treatments in addition to home care.
Sometimes dry skin leads to dermatitis, which causes red, itchy skin. In these cases, treatment may include hydrocortisone-containing lotions. If your skin cracks open, your doctor may prescribe wet dressings with mildly astringent properties to contract your skin and reduce secretions and prevent infection.

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Shingles

Shingles

Definition  :

Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso.

Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.
While it isn't a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications.

Symptoms:

The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:

• Pain, burning, numbness or tingling
• A red rash that begins a few days after the pain
• Fluid-filled blisters that break open and crust over
• Itching

Some people also experience:

• Fever and chills
• General achiness
• Headache
• Fatigue

Pain is usually the first symptom of shingles. For some, it can be intense. Depending on the location of the pain, it can sometimes be mistaken for a symptom of problems affecting the heart, lungs or kidneys. Some people experience shingles pain without ever developing the rash.
Most commonly, the shingles rash develops as a stripe of blisters that wraps around either the left or right side of your torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face.
When to see a doctor
Contact your doctor promptly if you suspect shingles, but especially in the following situations:

• The pain and rash occur near an eye. If left untreated, this infection can lead to permanent eye damage.
• You're 65 or older, which increases your risk of complications.
• You or someone in your family has a weakened immune system (due to cancer, medications or chronic illness).
• The rash is widespread and painful.

Causes:

Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. Anyone who's had chickenpox may develop shingles. After you recover from chickenpox, the virus can enter your nervous system and lie dormant for years. Eventually, it may reactivate and travel along nerve pathways to your skin — producing shingles.

The reason for the encore is unclear. But it may be due to lowered immunity to infections as you grow older. Shingles is more common in older adults and in people who have weak immune systems.
Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted infection.

Are you contagious?
A person with shingles can pass the varicella-zoster virus to anyone who isn't immune to chickenpox. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles.
Chickenpox can be dangerous for some groups of people. Until your shingles blisters scab over, you are contagious and should avoid physical contact with:

• Anyone who has a weak immune system
• Newborns
• Pregnant women

Complications:
 Complications from shingles can include:

• Postherpetic neuralgia. For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain.
• Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss.
• Neurological problems. Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance problems.
• Skin infections. If shingles blisters aren't properly treated, bacterial skin infections may develop.

Treatments and drugs:


There's no cure for shingles, but prompt treatment with prescription antiviral drugs can speed healing and reduce your risk of complications. These medications include:

• Acyclovir (Zovirax)
• Valacyclovir (Valtrex)
• Famciclovir (Famvir)

Shingles can cause severe pain, so your doctor may prescribe:

• Anticonvulsants, such as gabapentin (Neurontin)
• Tricyclic antidepressants, such as amitriptyline
• Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin patch
• Medications that contain narcotics, such as codeine

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Metabolic syndrome

Metabolic syndrome

 Definition:

Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist or abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.
Having just one of these conditions doesn't mean you have metabolic syndrome. However, any of these conditions increase your risk of serious disease. If more than one of these conditions occur in combination, your risk is even greater.
If you have metabolic syndrome or any of the components of metabolic syndrome, aggressive lifestyle changes can delay or even prevent the development of serious health problems.

Symptoms:

Having metabolic syndrome means you have three or more disorders related to your metabolism at the same time, including:

• Obesity, with your body fat concentrated around your waist (having an "apple shape"). For a metabolic syndrome diagnosis, obesity is defined by having a waist circumference of 40 inches (102 centimeters or cm) or more for men and 35 inches (89 cm) or more for women, although waist circumference cutoff points can vary by race.
• Increased blood pressure, meaning a systolic (top number) blood pressure measurement of 130 millimeters of mercury (mm Hg) or more or a diastolic (bottom number) blood pressure measurement of 85 mm Hg or more.
• High blood sugar level, with a fasting blood glucose test result of 100 milligrams/deciliter (mg/dL), or 5.6 millimoles per liter (mmol/L), or more.
• High cholesterol, with a level of the blood fat called triglycerides of 150 mg/dL, (1.7 millimoles/liter or mmol/L) or more and a level of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — of less than 40 mg/dL (1.04 mmol/L) for men or 50 mg/dL (1.3 mmol/L) for women.

Having one component of metabolic syndrome means you're more likely to have others. And the more components you have, the greater are the risks to your health.
When to see a doctor
If you know you have at least one component of metabolic syndrome — such as high blood pressure, high cholesterol or an apple-shaped body — you may have the others and not know it. It's worth checking with your doctor. Ask whether you need testing for other components of the syndrome and what you can do to avoid serious diseases.

Complications:

Having metabolic syndrome can increase your risk of developing these conditions:

• Diabetes. If you don't make lifestyle changes to control your insulin resistance, your glucose levels will continue to increase. You may develop diabetes as a result of metabolic syndrome.
• Cardiovascular disease. High cholesterol and high blood pressure can contribute to the buildup of plaques in your arteries. These plaques can cause your arteries to narrow and harden, which can lead to a heart attack or stroke.

Treatments and drugs: 

 Tackling one of the risk factors of metabolic syndrome is tough — taking on all of them might seem overwhelming. But aggressive lifestyle changes and, in some cases, medication can improve all of the metabolic syndrome components. Getting more physical activity, losing weight and quitting smoking help reduce blood pressure and improve cholesterol and blood sugar levels. These changes are key to reducing your risk.

• Exercise. Doctors recommend getting 30 to 60 minutes of moderate-intensity exercise, such as brisk walking, every day.
• Lose weight. Losing as little as 5 to 10 percent of your body weight can reduce insulin levels and blood pressure and decrease your risk of diabetes.
• Eat healthy. The Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean Diet, like many healthy-eating plans, limit unhealthy fats and emphasize fruits, vegetables, fish and whole grains. Both of these dietary approaches have been found to offer important health benefits — in addition to weight loss — for people who have components of metabolic syndrome. Ask your doctor for guidance before starting a new eating plan.
• Stop smoking. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome. Talk to your doctor if you need help kicking the cigarette habit.

Work with your doctor to monitor your weight and your blood glucose, cholesterol and blood pressure levels to ensure that lifestyle modifications are working. If you're not able to reach your goals with lifestyle changes, your doctor may also prescribe medications to lower blood pressure, control cholesterol or help you lose weight. Taking a daily aspirin — after discussing it with your doctor — may help reduce your risk of heart attack and stroke.

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Yips

Yips

Definition:

Yips are involuntary wrist spasms that occur most commonly when golfers are trying to putt. However, the yips can also affect people who play other sports — such as cricket, darts and baseball.
It was once thought that the yips were always associated with performance anxiety. However, it now appears that some people have yips that are caused by a focal dystonia, which is a neurological dysfunction affecting specific muscles.
Some people have found relief from the yips by changing the way they perform the affected task. For example, a right-handed golfer might try putting left-handed.

Symptoms:

The involuntary movement associated with the yips may:

• Occur at the beginning or middle of your stroke
• Come and go
• Worsen during high-pressure situtations

Causes:

The yips may result from neurological factors, psychological factors or a combination of both.
Neurological factors
In some people, the yips are a type of focal dystonia, a condition that causes involuntary muscle contractions during a specific task. It's most likely related to overuse of a certain set of muscles, similar to writer's cramp. Anxiety worsens the effect.
Psychological factors
In a pressure situation, some athletes become so anxious and self-focused — over-thinking to the point of distraction — that their ability to execute a skill, like putting, is impaired. Choking is an extreme form of performance anxiety that may compromise a golfer's game.
A combination of factors
For some people who have a mild degree of focal dystonia, stress, anxiety or high-pressure situations can worsen the condition.

Treatments and drugs:

Because the yips may be related to overuse of specific muscles, a change of technique or equipment may help. Possible strategies include:

• Change your grip. This technique works for many golfers, because it changes the muscles you use to make your putting stroke. However, if you have the type of yips related to performance anxiety, changing your grip likely won't make much difference.
• Use a different putter. A longer putter allows you to use more of your arms and shoulders and less of your hands and wrists while putting. Other putters are designed with a special grip to help stabilize the hands and wrists.
• Mental skills training. Techniques such as relaxation, visualization or positive thinking can help reduce anxiety, increase concentration and ease fear of the yips.

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Yellow fever

Yellow fever

Definition:

Yellow fever is a viral infection spread by a particular species of mosquito. It's most common in areas of Africa and South America, affecting travelers to and residents of those areas.

In mild cases, yellow fever causes fever, headache, nausea and vomiting. But yellow fever can become more serious, causing heart, liver and kidney problems along with bleeding (hemorrhaging). Up to 50 percent of people with the more severe form of yellow fever die of the disease.

There's no specific treatment for yellow fever. But getting a yellow fever vaccine before traveling to an area in which the virus is known to exist can protect you from the disease.

Symptoms:

During the first three to six days after you've contracted yellow fever — the incubation period — you won't experience any signs or symptoms. After this, the virus enters an acute phase and then, in some cases, a toxic phase that can be life-threatening.
Acute phase
Once the yellow fever virus enters the acute phase, you may experience signs and symptoms including:

• Fever
• Headache
• Muscle aches, particularly in your back and knees
• Nausea, vomiting or both
• Loss of appetite
• Dizziness
• Red eyes, face or tongue

These signs and symptoms usually improve and are gone within several days.
Toxic phase
Although signs and symptoms may disappear for a day or two following the acute phase, some people with acute yellow fever then enter a toxic phase. During the toxic phase, acute signs and symptoms return and more-severe and life-threatening ones also appear. These can include:

• Yellowing of your skin and the whites of your eyes (jaundice)
• Abdominal pain and vomiting, sometimes of blood
• Decreased urination
• Bleeding from your nose, mouth and eyes
• Heart dysfunction (arrhythmia)
• Liver and kidney failure
• Brain dysfunction, including delirium, seizures and coma

The toxic phase of yellow fever can be fatal.
When to see a doctor
Make an appointment to see your doctor four to six weeks before traveling to an area in which yellow fever is known to occur. If you don't have that much time to prepare, call your doctor anyway. Your doctor will help you determine whether you need vaccinations and can provide general guidance on protecting your health while abroad.
Seek emergency medical care if you've recently traveled to a region where yellow fever is known to occur and you develop severe signs or symptoms of the disease. If you develop mild symptoms, call your doctor.

Causes:

Yellow fever is caused by a virus that is spread by the Aedes aegypti mosquito. These mosquitoes thrive in and near human habitations where they breed in even the cleanest water. Most cases of yellow fever occur in sub-Saharan Africa and tropical South America.
Humans and monkeys are most commonly infected with the yellow fever virus. Mosquitoes transmit the virus back and forth between monkeys, humans or both. When a mosquito bites a human or monkey infected with yellow fever, the virus enters the mosquito's bloodstream and circulates before settling in the salivary glands. When the infected mosquito bites another monkey or human, the virus then enters the host's bloodstream, where it may cause illness.

Complications:

Yellow fever results in death for 20 to 50 percent of those who develop severe disease. Death usually occurs within two weeks from the start of infection. Complications during the toxic phase of a yellow fever infection include kidney and liver failure, jaundice, delirium and coma.
People who survive the infection recover gradually over a period of several weeks to months, usually without significant organ damage. During this time a person may experience fatigue and jaundice. Other complications include secondary bacterial infections, such as pneumonia or blood infections.

Treatments and drugs:
 
No antiviral medications have proved helpful in treating yellow fever. As a result, treatment consists primarily of supportive care in a hospital. This includes providing fluids and oxygen, maintaining adequate blood pressure, replacing blood loss, providing dialysis for kidney failure, and treating any other infections that develop. Some people receive transfusions of plasma to replace blood proteins that improve clotting.
If you have yellow fever, you may also be kept away from mosquitoes, to avoid transmitting the disease to others.

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Yeast infection (vaginal)

Yeast infection (vaginal)

Definition:

A vaginal yeast infection is a type of vaginitis — inflammation of the vagina — characterized by vaginal irritation, intense itchiness and vaginal discharge. A vaginal yeast infection affects your vagina and the tissues at the opening to your vagina (vulva).

Vaginal yeast infection — also called vaginal candidiasis — is very common. As many as 3 out of 4 women experience a yeast infection at some point in their lifetimes. Many women experience two or more yeast infections.
A vaginal yeast infection isn't considered a sexually transmitted infection, although the fungus that causes the condition can be spread through oral-genital contact. Simple treatment is usually effective, unless you have recurrent yeast infections — four or more in a single year. In that case, you may need a longer course of therapy and a maintenance plan.

Symptoms:

Yeast infection symptoms can range from mild to moderate and include:

• Itching and irritation in the vagina and at the entrance to the vagina (vulva)
• A burning sensation, especially during intercourse or while urinating
• Redness and swelling of the vulva
• Vaginal pain and soreness
• Thick, white, odor-free vaginal discharge with a cottage cheese appearance

Complicated yeast infection
You might have a complicated yeast infection if:

• You have severe signs and symptoms, such as extensive redness, swelling and itching that leads to the development of tears or cracks (fissures) or sores
• You have recurrent yeast infections — four or more in a single year
• Your infection is caused by a type of candida other than Candida albicans
• You're pregnant
• You have uncontrolled diabetes
• You have lowered immunity due to use of certain medications or a condition such as HIV infection

When to see a doctor
Make an appointment with your doctor if:

• This is the first time you've experienced yeast infection symptoms
• You're not sure whether you have a yeast infection
• Your symptoms don't go away after self-treating with over-the-counter antifungal vaginal creams or suppositories
• You develop other symptoms

Causes:

A vaginal yeast infection is caused by the fungus candida. Candida is a microorganism that's normally present in your vagina, along with bacteria. Your vagina naturally contains a balanced mix of yeast and bacteria. Lactobacillus bacteria produce acid, which discourages overgrowth of yeast in the vagina. But disruption of the healthy balance can result in an overgrowth of yeast. Too much yeast in your vagina can lead to vaginal itching, burning, and other classic signs and symptoms of a yeast infection.
Overgrowth of yeast can result from:

• Antibiotic use, which leads to a decrease in the amount of lactobacillus bacteria in your vagina and a change in your vaginal pH that allows yeast to overgrow
• Pregnancy
• Uncontrolled diabetes
• Impaired immune system
• Anything that changes the type and amount of bacteria normally present in the vagina, such as douching or irritation from inadequate vaginal lubrication

Most often, yeast infection results from a type of candida fungus known as Candida albicans. Sometimes, however, a different type of candida fungus might be the cause of symptoms. Candida albicans responds well to typical treatments for yeast infections. Other types of candida, however, sometimes respond poorly to conventional therapies and may require more aggressive treatment.
A yeast infection can be sexually transmitted, especially through oral-genital sexual contact. However, yeast infection isn't considered a sexually transmitted infection because it happens in women who aren't sexually active and the candida fungus is naturally present in the vagina.

Treatments and drugs:


Yeast infection treatment depends on whether you have an uncomplicated or a complicated infection.
Uncomplicated yeast infection
For mild to moderate symptoms and infrequent episodes of yeast infection, your doctor might recommend:

• Short-course vaginal therapy. A one-time application or one-to-three-day regimen of an antifungal cream, ointment, tablet or suppository effectively clears a yeast infection in most cases. The medication of choice is from a class of drugs called the azoles; these include butoconazole (Gynazole-1), clotrimazole (Gyne-Lotrimin), miconazole (Monistat 3) and terconazole (Terazol 3). These medications are available by prescription or over-the-counter. The oil-based nature of these agents in cream and suppository form could potentially weaken latex condoms and diaphragms. Side effects might include slight burning or irritation during application.
• Single-dose oral medication. Your doctor might prescribe a one-time single dose of the antifungal medication fluconazole (Diflucan) to be taken by mouth.

Make a follow-up appointment with your doctor if you've finished your treatment and your symptoms haven't gone away or if your symptoms return within two months of being treated.
Complicated yeast infection
Treatment for a complicated yeast infection might include:

• Long-course vaginal therapy. Vaginal treatment for complicated yeast infections includes an azole medication in the form of a vaginal cream, ointment, tablet or suppository. The duration of treatment is usually seven to 14 days.
• Multidose oral medication. Instead of vaginal therapy, your doctor might prescribe two or three doses of fluconazole to be taken by mouth. However, this therapy isn't recommended for pregnant women.
• Maintenance plan. For recurrent yeast infections, your doctor might recommend a medication routine to keep yeast overgrowth in check and prevent future infections. Maintenance therapy starts after the initial treatment clears the yeast infection and may include fluconazole tablets taken by mouth once a week for six months. Some doctors prescribe clotrimazole as a vaginal tablet (suppository) used once a week instead of an oral medication.

Usually, your sex partner doesn't also need to be treated for a yeast infection. If you have recurrent yeast infections, your doctor might recommend treating your partner if your partner has signs or symptoms of a genital yeast infection — for instance, jock itch in a male partner — or using condoms during intercourse.

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Zollinger-Ellison syndrome

Zollinger-Ellison syndrome

Definition:

Zollinger-Ellison syndrome is a complex condition in which one or more tumors form in your pancreas or the upper part of your small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid. The excess acid, in turn, leads to peptic ulcers.
Zollinger-Ellison syndrome (ZES) is rare. The disease may occur at any time in life, but people are usually diagnosed between ages 30 and 50. Medications to reduce stomach acid and heal the ulcers is the usual treatment for Zollinger-Ellison syndrome.

Symptoms:

Signs and symptoms of Zollinger-Ellison syndrome may include:

• Abdominal pain
• Diarrhea
• Burning, aching, gnawing or discomfort in your upper abdomen
• Acid reflux and heartburn
• Nausea and vomiting
• Weakness
• Bleeding in your digestive tract
• Unintended weight loss
• Decreased appetite
• Anemia

When to see a doctor
See your doctor if you have a persistent, burning, aching or gnawing pain in your upper abdomen, especially if you've also been experiencing nausea, vomiting and diarrhea.
Tell your doctor if you've used over-the-counter acid-reducing medications such as omeprazole (Prilosec), cimetidine (Tagamet), famotidine (Pepcid) or ranitidine (Zantac) for long periods of time. These medications may mask your symptoms, which could delay your diagnosis. If you have Zollinger-Ellison syndrome, early detection and treatment are important.

Causes:

The exact cause of Zollinger-Ellison syndrome remains unknown. But the sequence of events that occurs in Zollinger-Ellison syndrome is clear. The syndrome begins when a tumor (gastrinoma) or tumors form in your pancreas, duodenum or the lymph nodes adjacent to your pancreas.
Your pancreas sits behind and below your stomach.

It produces enzymes that are essential to digesting food. The pancreas also produces several hormones, including gastrin, a hormone that controls stomach acid production. Digestive juices from the pancreas, liver and gallbladder mix in the duodenum, the part of the small intestine next to your stomach. This is where digestion reaches its peak.

The tumors that occur with Zollinger-Ellison syndrome are made up of cells that secrete large amounts of gastrin, which in turn causes the stomach to produce far too much acid. The excessive acid then leads to peptic ulcers and sometimes to diarrhea.
Besides causing excess acid production, the tumors may be cancerous (malignant). The tumors themselves grow slowly, but the cancer can spread elsewhere — most commonly to nearby lymph nodes or your liver.

Association with MEN I
Zollinger-Ellison syndrome may be caused by an inherited condition called multiple endocrine neoplasia, type I (MEN I). People with MEN I have multiple tumors in the endocrine system in addition to pancreatic tumors. They also have tumors in the parathyroid glands and may have tumors in their pituitary glands. About 25 percent of people who have gastrinomas have them as part of MEN I.

Treatments and drugs:

In treating Zollinger-Ellison syndrome, doctors treat the tumors as well as the ulcers. If your doctor can remove the tumors, then ulcer treatment may no longer be needed.
Treatment of tumors
An operation to remove the tumors that occur in Zollinger-Ellison requires a skilled surgeon because the tumors are often small and difficult to locate. If you have just one tumor, your doctor may be able to remove it surgically, but surgery may not be an option if you have multiple tumors or tumors that have spread to your liver. On the other hand, even if you have multiple tumors, your doctor still may recommend removing a single large tumor.
In some cases, doctors advise other treatments to control tumor growth, including:

• Removing as much of a liver tumor as possible (debulking)
• Attempting to destroy the tumor by cutting off the blood supply (embolization) or by using heat to destroy cancer cells (radiofrequency ablation)
• Injecting drugs into the tumor to relieve cancer symptoms
• Using chemotherapy to try to slow tumor growth
• A liver transplant

More radical surgical approaches, such as severing the nerves that promote acid secretion or removing the entire stomach, aren't generally done today because medications are usually successful in controlling acid production and ulcers.
Treatment of excess acid
Excess acid production can almost always be controlled. Medications known as proton pump inhibitors are the first line of treatment. These are the most effective medications for decreasing acid production in Zollinger-Ellison syndrome. Proton pump inhibitors are powerful drugs that reduce acid by blocking the action of the tiny "pumps" within acid-secreting cells. Commonly prescribed medications include lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium). Long-term use of prescription proton pump inhibitors, especially in people age 50 and older, has been associated with an increased risk of fractures of the hip, wrist and spine, according to the Food and Drug Administration. This risk is small and should be weighed against the acid-blocking benefits of these medications.
Your doctor may also suggest one of several operations to treat peptic ulcers, such as surgery to:

• Stop an ulcer from bleeding
• Relieve an obstruction caused by an ulcer
• Close up the hole (perforation) that an ulcer has made in the wall of your stomach or duodenum

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