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HEROPHILIUSS ELIXIR

Study Guide

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Module Director Hafi Wadgama

This guide was exclusively written for HSS-Fusion 2015 by our very own Managing

Director- Mr. Hafi Qadir Wadgama. He was assisted in writing this work by the

STEM coordinator-Sualeh Asif and HSS alumni- Areeba Abid Ali.

The guide was edited and compiled by The Executive Council members- Sualeh

Asif and Muhammad Zain Viqar (President and Vice-President

respectively).)

Our Advice

The reviews here in are not at all exhaustive. They are written to facilitate

students and thus are not meant to be rote-learnt. 3 participants from each

delegation are expected to go through the guide understanding the diseases-

their symptoms and effects to be able to diagnose patients and produce

relevant treatments. The module director specially recommends you to go

through the history taking section, since it is the most important part of the

event.

WE WILL REWARD THE BEST DIAGNOTITIAN FROM YOU!

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PSYCHIATRIC DISORDERS

INTRODUCTION

destroys memory and thinking skills, and eventually the ability to carry out the

simplest tasks. Alzheimer's is the most common form of dementia, a general term

for memory loss and other intellectual abilities serious enough to interfere with

CAUSES

It is not known exactly what causes this process to begin, although people with

Alzheimer's disease have been found to have abnormal amounts of protein, fibers

and a chemical called acetylcholine in the brain.

These reduce the effectiveness of healthy neurons (nerve cells that carry

messages to and from the brain), gradually destroying them.

SYMPTOMS

- the early, the middle

and the late symptoms

In the early stages, the main symptom of Alzheimer's disease is memory lapses.

For example, someone with early Alzheimer's disease may:

forget about recent conversations or events

forget the names of places and objects

repeat themselves regularly, such as asking the same question several

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times

show poor judgment or find it harder to make decisions

become unwilling to try out new things or adapt to change

There may also be some early signs of mood changes, such as increasing anxiety

or agitation, or periods of confusion.

As Alzheimer's disease develops, memory problems will get worse and someone

with the condition may find it increasingly difficult to remember the names of

people they know and may struggle to recognize their family and friends.

Other symptoms may also develop, such as:

increasing confusion and disorientation for example not knowing where

they are and walking off and getting lost

obsessive, repetitive or impulsive behavior

delusions (believing things that are untrue)

problems with speech or language (aphasia)

disturbed sleep

changes in mood, such as frequent mood swings, depression and feeling

increasingly anxious, frustrated or agitated

difficulty performing spatial tasks, such as judging distances

problems with eyesight, such as poor vision or hallucinations(seeing

things that are not there)

By this stage, someone with Alzheimer's disease will usually need support to help

them with their everyday living. For example, they may need help eating, washing,

getting dressed and using the toilet.

In the later stages of Alzheimer's disease, the symptoms become increasingly

severe and distressing for the person with the condition, as well as their careers,

friends and family.

Hallucinations and delusions will often become worse and the person with the

condition may start to become violent, demanding and suspicious of those around

them.

A number of other symptoms may also develop as Alzheimer's disease progresses,

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such as:

difficulty eating and swallowing (Dysphagia)

difficulty changing position or moving around without assistance

considerable weight loss (although some people eat too much and put

on weight)

unintentional passing of urine (urinary incontinence) or stools (bowel

incontinence)

gradual loss of speech

significant problems with short and long-term memory

During the severe stage of Alzheimer's disease, people often start to neglect their

personal hygiene. It is at this stage that most people with the condition will need

to have full-time care because they will be able to do very little on their own.

TREATMENT

There is currently no cure for Alzheimer's disease, although medication is available

that can temporarily reduce some symptoms or slow down the progression of the

condition in some people.

Cholinesterase inhibitors are drugs that work by boosting levels of a cell-to-cell

communication chemical depleted in the brain by Alzheimer's disease. Most

people can expect to keep their current symptoms at bay for a time.

Less than half of those taking these drugs can expect to have any improvement.

Memantine (Namenda). This drug works in another brain cell communication

network and slows the progression of symptoms with moderate to severe

Alzheimer's disease. It's sometimes used in combination with a cholinesterase

inhibitor.

PROGNOSIS

disease is varies from person to person. Some might lose the ability to

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perform daily activities early on in the disease, whereas others will be

able to perform quite well until the late stage of the disease.

The disease tends to get worse gradually. It usually starts with mild

memory loss. It progresses to severe mental and functional problems

and eventual death.

- early,

middle and late will last.

The average amount of time a person lives after developing symptoms

of Alzheimer's disease is 8 to 10 years.

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BIPOLAR DISORDER

INTRODUCTION

Bipolar disorder is a mental illness that brings severe high and low moods and

changes in sleep, energy, thinking, and behavior.

People who have bipolar disorder can have periods in which they feel overly

happy and energized and other periods of feeling very sad, hopeless, and sluggish.

In between those periods, they usually feel normal. You can think of the highs and

the lows as two "poles" or phases of mood, which is why it's called "bipolar"

disorder. Mood shifts may occur only a few times a year or as often as several

times a week.

CAUSES

The cause of bipolar disorder is not entirely known. The current thinking is that

this is a predominantly biological disorder that occurs in a specific part of the brain

and is due to a malfunction of the neurotransmitters (chemical messengers in the

brain). As a biological disorder, it may lie dormant and be activated spontaneously

or it may be triggered by stressors in life.

Although, no one is quite sure about the exact causes of bipolar disorder,

researchers have found these important clues:

MRI study found that the brain's prefrontal cortex in adults with bipolar

disorder tends to be smaller and function less well compared to adults who

don't have bipolar disorder. (The prefrontal cortex is a brain structure

involved in "executive" functions such as solving problems and making

decisions.)

About half the people with bipolar disorder have a family member with a

mood disorder, such as depression.

A person who has one parent with bipolar disorder has a 15 to 25 percent

chance of having the condition.

A person who has a non-identical twin with the illness has a 25 percent

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chance of illness, the same risk as if both parents have bipolar disorder.

A person who has an identical twin (having exactly the same genetic

material) with bipolar disorder has an even greater risk of developing the

illness about an eightfold greater risk than a non-identical twin.

SYMPTOMS

As bipolar disorder has two opposite phases- hypomania and depression, the

symptoms vary for both phases

1) Symptoms of hypomania are the following:

Euphoria or irritability

Increased energy and activity

Excessive talk; racing thoughts

Inflated self-esteem

Unusual energy; less need for sleep

Impulsiveness, a reckless pursuit of gratification (shopping

sprees, impetuous travel, more and sometimes promiscuous sex,

high-risk business investments, fast driving)

2) Symptoms of depression are the following:

Depressed mood and low self-esteem

Low energy levels and apathy

Sadness, loneliness, helplessness, guilt

Slow speech, fatigue, and poor coordination

Insomnia (inability to sleep) or oversleeping

Suicidal thoughts and feelings

Poor concentration

Lack of interest or pleasure in usual activities

DIAGNOSIS

When doctors suspect someone has bipolar disorder, they typically do a number

of tests and exams. These can help rule out other problems, pinpoint a diagnosis

and also check for any related complications. These may include:

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Physical exam. A physical exam and lab tests may be done to help identify

any medical problems that could be causing your symptoms.

Psychological evaluation. Your doctor or mental health provider will talk the

one suspected about his thoughts, feelings and behavior patterns. He may

also have fill out a psychological self-assessment or questionnaire.

With his permission, his family members or close friends may be asked to provide

information about his symptoms and possible episodes of mania or depression.

Mood charting. To identify exactly what's going on, the doctor may have

the suspect keep a daily record of his moods, sleep patterns or other

factors that could help with diagnosis and finding the right treatment.

Signs and symptoms. The doctor or mental health professional typically will

compare the symptoms with the criteria for bipolar and related disorders in

order to determine a diagnosis.

TREATMENT

Treatment for bipolar disorder aims to reduce the number and severity of the

episodes of depression and mania that characterize the condition. In doing so, a

person can live as normal a life as possible.

Medications may include:

Mood stabilizers: When one has bipolar disorder, he will typically need

mood-stabilizing medication to control manic or hypomanic episodes.

Examples of mood stabilizers include lithium and valproic acid

Antipsychotics: If symptoms of depression or mania persist in spite of

treatment with other medications, adding an antipsychotic medication such

as olanzapine, risperidone may help. The doctor may prescribe some of

these medications alone or along with a mood stabilizer.

Antidepressants: The doctor may add an antidepressant to help manage

depression. Because an antidepressant can sometimes trigger a manic

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episode, it's usually prescribed along with a mood stabilizer or

antipsychotic.

Anti-anxiety medications: Benzodiazepines may help with anxiety and

improve sleep. Benzodiazepines are generally used for relieving anxiety

only on a short-term basis.

Most people with bipolar disorder can receive most of their treatment without

having to stay in hospital.

However, hospital treatment may be needed in case the symptoms are severe.

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AUTISM SPECTRUM DISORDER

INTRODUCTION

Autism is a brain disorder that often makes it hard to communicate with and relate

to others. With autism, the different areas of the brain fail to work together. The

main features of ASD typically start to develop in childhood, although the impact

of thes

such as a change of school.

CAUSES

There is no known single cause for autism spectrum disorder, but it is generally

accepted that it is caused by abnormalities in brain structure or function. Brain

scans show differences in the shape and structure of the brain in children with

autism compared to in neurotypical children. However, the exact cause of autism

is not yet known.

SYMPTOMS

Features of ASD that can develop in older children and teenagers are explained

below.

Spoken Language

preferring to avoid using spoken language

speech that sounds very monotonous or flat

speaking in pre-learned phrases, rather than putting together individual

words to form new sentences

seeming -way conversation

Responding to others

metaphors or figures of speech

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reacting unusually negatively when asked to do something by someone else

Interacting with others

intolerant of people entering their own personal space

little interest in interacting with other people, including children of a similar

age, or having few close friends despite attempts to form friendships

not understanding how people normally interact socially, such as greeting

people or wishing them farewell

being unable to adapt the tone and content of their speech to different

social situations, for example speaking very formally at a party and then

speaking to total strangers in a familiar way

not enjoying situations and activities that most children their age like

rarely using gestures or facial expressions when communicating

avoiding eye contact

Behavior

having repetitive movements such as flapping their fingers, rocking back

and forth or flicking their fingers

playing in a repetitive and unimaginative way, often preferring to play with

objects rather than people

developing a highly specific interest in a particular subject or activity

preferring to have a familiar routine, and getting extremely upset if there

are changes to their normal routine

Having a strong like or dislike of certain foods, based on the texture or color of the

food as much as taste.

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DIAGNOSIS/TESTS

specially trained physicians and psychologists administer the symptoms of autism

In most cases, parents notice the symptoms of autism spectrum disorder (ASD)

when their child is around two or three years old.

In some instances, mild cases may not be detected until adulthood.

There are no individual tests to confirm a diagnosis of ASD, a diagnosis is instead

based on the range of features the child is showing.

The type of assessment carried out often depends on things such as access to

additional information (for example nursery or school records) Moreover existing

information about the child's development, health and behavior may be sought.

Focused observation may also help to diagnose autism. Focused observation looks

at language, behavior, the pattern of your child's thinking (known as their

cognitive ability) and how they interact with others.

TREATMENT

There is no cure for ASDs. Therapies and behavioral interventions are designed to

remedy specific symptoms and can bring about substantial improvement. The

ideal treatment plan coordinates therapies and interventions that meet the

specific needs of individual children. Most health care professionals agree that

the earlier the intervention, the better.

Educational/behavioral interventions: Therapists use highly structured and

intensive skill-oriented training sessions to help children develop social and

language skills, such as Applied Behavioral Analysis. Family counseling for the

parents and siblings of children with an ASD often helps families cope with the

particular challenges of living with a child with an ASD.

Medications: Doctors may prescribe medications for treatment of specific autism-

related symptoms, such as anxiety, depression, or obsessive-compulsive disorder.

Antipsychotic medications are used to treat severe behavioral problems. Seizures

can be treated with one or more anticonvulsant drugs. Medication used to treat

people with attention deficit disorder can be used effectively to help decrease

impulsivity and hyperactivity.

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Other therapies: There are a number of controversial therapies or interventions

available, but few, if any, are supported by scientific studies. Parents should use

caution before adopting any unproven treatments. Although dietary

interventions have been helpful in some children, parents should be careful that

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ATTENTION DEFICIT HYPERACTIVITY DISORDER

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a chronic condition that affects

millions of children and often persists into adulthood. ADHD includes a group of

behavioral symptoms that include inattentiveness, hyperactivity and

impulsiveness. These symptoms can cause problems at home, school, work, or in

relationships.

CAUSES

ADHD runs in families. If a parent has ADHD, a child has more than a 50% chance of

having it. If an older sibling has it, a child has more than a 30% chance.

Children born with a low birth weight, born premature, or whose mothers had

difficult pregnancies have a higher risk of having ADHD. The same is true for

children with head injuries to the frontal lobe of the brain, the area that controls

impulses and emotions. However, only a small percentage of children with ADHD

a have suffered a traumatic brain injury. Studies show that pregnant women who

smoke or drink alcohol may have a higher risk of having a child with ADHD.

Exposure to lead or pesticides may also have a role - preschoolers who are

exposed to high levels of lead, which can sometimes be found in plumbing

fixtures or paint in old buildings, have a higher risk of developing ADHD.

SYMPTOMS

1) Inattention:

You might not notice it until a child goes to school. In adults, it may be easier to

notice at work or in social situations.

The person might procrastinate, not complete tasks like homework or chores, or

frequently move from one uncompleted activity to another.

They might also:

Be disorganized

Lack focus

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Have a hard time paying attention to details and a tendency to make

careless mistakes. Their work might be messy and seem careless.

Have trouble staying on topic while talking, not listening to others, and not

following social rules

Be forgetful about daily activities (for example, missing appointments,

forgetting to bring lunch)

Be easily distracted by things like trivial noises or events that are usually

ignored by others.

2) Hyperactivity

It may vary with age. You might be able to notice it in preschoolers. ADHD

symptoms nearly always show up before middle school.

Kids with hyperactivity may:

Fidget and squirm when seated.

Get up frequently to walk or run around.

Run or climb a lot when it's not appropriate. (In teens this may seem like

restlessness.)

Have trouble playing quietly or doing quiet hobbies

Always be "on the go"

Talking excessively

Toddlers and preschoolers with ADHD tend to be constantly in motion,

jumping on furniture and having trouble participating in group activities

that call for them to sit still.

School-age children have similar habits, but one may notice those less

often. They are unable to stay seated, squirm a lot, fidget, or talk a lot.

Hyperactivity can show up as feelings of restlessness in teens and adults. They

may also have a hard time doing quiet activities where you sit still.

3) Impulsivity

Symptoms of this include:

Impatience

Having a hard time waiting to talk or react

There is no single test that can be used to diagnose attention deficit hyperactivity

disorder in children and adults. ADHD is diagnosed after a person has shown some

or all of the symptoms of ADHD on a regular basis for more than six months. In

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addition, symptoms must be present in more than one setting. Depending on the

number and type of symptoms, the diagnosis may be done.

TREATEMENT

There is no cure for attention deficit hyperactivity disorder (ADHD), but treatment

can help relieve the symptoms and make the condition much less of a problem in

day-to-day life.

ADHD can be treated using medication or therapy, but a combination of both is

often the best way to treat it.

Treatment will usually be arranged by a specialist, such as a pediatrician or

psychiatrist.

Medication

There are four types of medication licensed for the treatment of ADHD:

1. Methylphenidate

2. Dexamphetamine

3. Iisdexamfetamine

4. Atomoxetine

These medications are not a permanent cure for ADHD, but they can help

someone with the condition concentrate better, be less impulsive, feel calmer,

and learn and practice new skills.

Some medications need to be taken every day, but some can be taken just on

school days. Treatment breaks are occasionally recommended, to assess whether

the medication is still needed.

If you or your child is prescribed one of these medications, you will probably be

given small doses at first, which may then be gradually increased. You or your

child will need to see your GP for regular check-ups, to ensure the treatment is

working effectively and to check for signs of any side effects or problems.

Your specialist will discuss how long you should take your treatment but, in many

cases, treatment is continued for as long as it is helping.

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Some of the therapies that may be used to treat ADHD are outlined below.

PSYCHOEDUCATION means you or your child will be encouraged to discuss ADHD

and how it affects you. It can help children, teenagers and adults make sense of

being diagnosed with ADHD, and can help you to cope and live with the condition.

BEHAVIOUR THERAPY provides support for careers of children with ADHD, and

may involve teachers as well as parents. Behavior therapy usually involves

behavior management, which uses a system of rewards to encourage your child to

try to control their ADHD.

If your child has ADHD, you can identify types of behavior you want to encourage,

such as sitting at the table to eat. Your child is then given some sort of small

reward for good behavior, and removal of a privilege for poor behavior. For

teachers, behavior management involves learning how to plan and structure

activities, and to praise and encourage children for even very small amounts of

progress.

These programmes are usually arranged in groups and can last several weeks.

SOCIAL SKILLS TRAINING involves your child taking part in role play situations, and

aims to teach them how to behave in social situations by learning how their

behavior affects others.

COGNITIVE BEHAVIOURAL THERAPY (CBT) is a talking therapy that can help you

manage your problems by changing the way you think and behave. A CBT

therapist would try and change how your child feels about a situation, which

would in turn potentially change their behavior.

Diet: People with ADHD should eat a healthy, balanced diet. Do not cut out foods

without medical advice.

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NARCISSISTIC PERSONALITY DISORDER

INTRODUCTION

Narcissistic personality disorder is a mental disorder in which people have an

inflated sense of their own importance, a deep need for admiration and a lack of

empathy for others. People with this disorder often believe they are of primary

importance in ev

ultra-confidence lies a fragile self-esteem that's vulnerable to the slightest

-

absorbed, often called a narcissist, and having narcissistic personality disorder,

which is a mental illness.

CAUSES

The exact cause is not known, but there are several theories. Parents who put

their children on a pedestal and shower them with endless praise can plant a seed

of

supportive and inflating an ego. Moreover narcissistic personality disorder may

also be linked to genetics or psychobiology the connection between the brain

and behavior and thinking

SYMPTOMS

In order for a person to be diagnosed with narcissistic personality disorder (NPD)

they must meet five or more of the following symptoms:

Has a grandiose sense of self-importance (e.g., exaggerates achievements

and talents, expects to be recognized as superior without commensurate

achievements)

Is preoccupied with fantasies of unlimited success, power, brilliance,

beauty, or ideal love

by, or should associate with, other special or high-status people (or

institutions)

Requires excessive admiration

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Has a very strong sense of entitlement, e.g., unreasonable expectations of

especially favorable treatment or automatic compliance with his or her

expectations

Is exploitative of others, e.g., takes advantage of others to achieve his or

her own ends

Lacks empathy, e.g., is unwilling to recognize or identify with the feelings

and needs of others

Is often envious of others or believes that others are envious of him or her

Regularly shows arrogant, haughty behaviors or attitudes

DIAGNOSIS

Narcissistic personality disorder is typically diagnosed by a trained mental health

professional, such as a psychologist or psychiatrist. Family physicians and general

practitioners are generally not trained or well-equipped to make this type of

psychological diagnosis. There are no laboratory, blood or genetic tests that are

used to diagnose personality disorder.

t.

People with personality disorders, in general, do not often seek out treatment

life.

TREATEMENT

Clinical treatment is rare because most narcissists avoid therapy. However,

narcissists can learn to be more caring about others, and narcissism can be

reduced when these individuals are included in social groups.

Psychotherapy may be useful in getting the individual with narcissistic personality

disorder to relate to others in a less maladaptive manner.

There are no medications specifically used to treat narcissistic personality

disorder. However, if you have symptoms of depression, anxiety or other

conditions, medications such as antidepressants or anti-anxiety drugs may be

helpful.

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GASTROINTESTINAL DISORDERS

CROHN'S DISEASE

INTRODUCTION

Crohn's disease is a long-term condition that causes inflammation of the lining of

the digestive system. It is one of the types of IBD (Inflammatory Bowel Disease)

and is an autoimmune disease.

Inflammation can affect any part of the digestive system, from the mouth to the

back passage, but most commonly occurs in the last section of the small intestine

(ileum) or the large intestine (colon).

CAUSES

The exact cause of Crohn's disease remains unknown. Previously, diet and stress

were suspected, but now doctors know that these factors may aggravate but

don't cause Crohn's disease. A number of factors, such as heredity and a

malfunctioning immune system, likely play a role in its development.

Immune system. It's possible that a virus or bacterium may trigger Crohn's

disease. When the immune system tries to fight off the invading

microorganism, an abnormal immune response causes the immune system to

attack the cells in the digestive tract, too.

Heredity. Crohn's is more common in people who have family members with

the disease, so genes may play a role in making people more susceptible. In

fact about 20% of people with Crohn's disease may have a close relative with

either Crohn's or ulcerative colitis. However, most people with Crohn's disease

don't have a family history of the disease.

Moreover smoking also has an impact on Crohns disease- the symptoms of

smokers with Crohns disease are more severe than those of nonsmokers.

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SYMPTOMS

People with Crohn's disease can experience periods of severe symptoms followed

by periods of remission that can last for weeks or years. The symptoms of Crohn's

disease depend on where the disease occurs in the bowel and its severity. In

general, symptoms can include:

Chronic diarrhea, often bloody and containing mucus or pus

Weight loss

Fever

Abdominal pain and tenderness

Feeling of a mass or fullness in the abdomen

Rectal bleeding

experience loss of appetite and may

lose weight as a result. A feeling of low energy and fatigue is also common.

Among younger children, Crohn's may delay growth and development.

DIAGNOSIS

There isn't any one test that can tell you whether or not one has Crohn's disease.

And Crohn's disease has many possible symptoms that are the same as symptoms

for other health problems.

Through history taking the doctor will be able the following information:

Diarrhea, which may be bloody

Family history of Crohn's disease

Fever

Pain and tenderness in the abdomen

These would indicate the need for further tests for example Barium X-rays, CT

scans, colonoscopy, etc.

After the exams and lab tests the doctor will discuss the findings with the patient.

If the doctor believes that the patient is suffering from Crohn's disease, he will

work with the patient to develop a treatment program.

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TREATMENT

There's currently no cure for Crohn's disease, so the aim of treatment is to stop

the inflammatory process, relieve symptoms (induce and maintain remission) and

avoid surgery wherever possible.

The first treatment offered to reduce symptoms is usually steroid medication

(corticosteroids). If this doesn't help, medication to suppress the immune system

(immunosuppressant) and medication to reduce inflammation may be used.

In some cases, surgery may be needed to remove the inflamed section of

intestine.

Once the symptoms are under control (in remission), further medication may be

needed to help maintain this.

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CANCERS

BRAIN CANCER

INTRODUCTION

Brain tumors are abnormal growths of cells in the brain. Although such growths

are popularly called brain tumors, not all brain tumors are cancer. Cancer is a term

reserved for malignant tumors.

Malignant tumors can grow and spread aggressively, overpowering healthy cells

by taking their space, blood, and nutrients. They can also spread to distant parts

of the body. Like all cells of the body, tumor cells need blood and nutrients to

survive.

Tumors that do not invade nearby tissue or spread to distant areas are called

benign. In general, a benign tumor is less serious than a malignant tumor. But a

benign tumor can still cause many problems in the brain by pressing on nearby

tissue.

PRIMARY BRAIN CANCERS

The brain is made up of many different types of cells.

Some brain cancers occur when one type of cell transforms from its normal

characteristics. Once transformed, the cells grow and multiply in abnormal ways.

As these abnormal cells grow, they become a mass, or tumor.

The brain tumors that result are called primary brain tumors because they

originate in the brain. The most common primary brain tumors are gliomas,

meningiomas, pituitary adenomas, vestibular schwannomas, and primitive

neuroectodermal tumors (medulloblastomas).

Most of these are named after the part of the brain or the type of brain cell from

which they arise.

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CAUSES

As with tumors elsewhere in the body, the exact cause of most brain cancer is

unknown. Genetic factors, various environmental toxins, radiation to the head,

HIV infection, and cigarette smoking have all been linked to cancers of the brain.

In most cases, no clear cause can be shown.

SYMPTOMS

Not all brain tumors cause symptoms, and some (such as tumors of the pituitary

gland) are often not found until after death. The symptoms of brain cancer are

numerous and not specific to brain tumors, meaning they can be caused by many

other illnesses as well. The only way to know for sure what is causing the

symptoms is to undergo diagnostic testing. Symptoms can be caused by:

A tumor pressing on or encroaching on other parts of the brain and keeping

them from functioning normally.

Swelling in the brain caused by the tumor or surrounding inflammation.

The symptoms of primary and metastatic brain cancers are similar. The following

symptoms are most common:

Headache

Weakness

Clumsiness

Difficulty walking

Seizures

Other nonspecific symptoms and signs include the following:

Altered mental status -- changes in concentration, memory, attention, or

alertness

Nausea, vomiting

Abnormalities in vision

Difficulty with speech

Gradual changes in intellectual or emotional capacity

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In many people, the onset of these symptoms is very gradual and may be missed

by both the person with the brain tumor and the family. Occasionally, however,

these symptoms appear more rapidly. In some instances, the person acts as if he

or she is having a stroke.

DIAGNOSIS/TESTS

Findings of a medical interview and physical exam suggests to health care

providers that one has problem with the brain or brain stem.

In most cases, a CT scan of the brain is done. This test is like an X-ray, but shows

more detail in three dimensions. Usually, a harmless dye is injected into the

bloodstream to highlight abnormalities on the scan. More often, the MRI scan is

being used instead of a CT scan for suspected brain tumors. This is because MRI

has a higher sensitivity for detecting the presence of, or changes within, a tumor.

Currently, however, most institutions still use the CT scan as the first diagnostic

test.

People with brain cancer often have other medical problems; therefore, routine

lab tests may be performed. These include analysis of blood, electrolytes, liver

function tests, and a blood coagulation profile.

If the mental status has been the major change in a person, blood or urine tests

may be done to detect drug use.

If scans indicate the presence of a brain tumor, the patient is referred to a cancer

specialist, called an oncologist.

The next step in diagnosis is confirmation that cancer exists, usually by taking and

testing a sample of the tumor. This is called a biopsy:

The most widely used technique for obtaining a biopsy is surgery. The skull is

opened, usually with the intention of removing the whole tumor, if possible. A

biopsy is then taken from the tumor.

If the surgeon is unable to remove the entire tumor, a small piece of the tumor is

removed.

In some cases, it is possible to collect a biopsy without opening the skull. The

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exact location of the tumor in the brain is determined by using a CT or MRI scan

while the head is held still in a frame. A small hole is then made in the skull and a

needle guided through the hole to the tumor. The needle collects the biopsy and

is removed. This technique is called stereotaxis, or stereotactic biopsy.

The biopsy is examined under a microscope by a pathologist (a doctor who

specializes in diagnosing diseases by looking at cells and tissues).

TREATMENT/PROGNOSIS

Treatment of brain cancer is usually complex. Most treatment plans involve

several consulting doctors.

The team of doctors includes neurosurgeons (specialists in the brain and

nervous system), oncologists, radiation oncologists (doctors who practice

radiation therapy), and, of course, the primary health care provider. The

team may also include a dietitian, a social worker, a physical therapist, and,

possibly, other specialists.

The treatment protocols vary widely according to the location of the tumor,

its size and type, your age, and any additional medical problems that you

may have.

The most widely used treatments are surgery, radiation therapy, and

chemotherapy. In most cases, more than one of these is used,

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COLON CANCER

INTRODUCTION

Colon cancer is cancer of the large intestine (colon) which is the lower part of your

digestive system. Rectal cancer is cancer of the last several inches of the colon.

Together, they're often referred to as colorectal cancer.

CAUSES

In most cases, it's not clear what causes colon cancer. Doctors know that colon

cancer occurs when healthy cells in the colon become altered.

Healthy cells grow and divide in an orderly way to keep your body functioning

normally. But when a cell is damaged and becomes cancerous, cells continue to

divide even when new cells aren't needed. These cancer cells can invade and

destroy normal tissue nearby. Cancerous cells can also travel to other parts of the

body.

Colon cancer most often begins as clumps of precancerous cells (polyps) on the

inside lining of the colon. Removing polyps before they become cancerous can

prevent colon cancer.

Inherited gene mutations that increase the risk of colon cancer can be passed

through families, but these inherited genes are linked to only a small percentage

of colon cancers. They can increase an individual's risk of cancer significantly.

SYMPTOMS

In its early stage, colorectal cancer usually produces no symptoms. Even when

symptoms appear, they'll likely vary, depending on the cancer's size and location

in your large intestine. Signs and symptoms of colon cancer include:

A change in your bowel habits, including diarrhea or constipation or a

change in the consistency of your stool

Rectal bleeding or blood in your stool

Persistent abdominal discomfort, such as cramps, gas or pain

A feeling that your bowel doesn't empty completely

Weakness or fatigue

Unexplained weight loss

HSS-Fusion 2015 29

DIAGNOSIS

The following tests and procedures may be used:

Physical Exam and History: An exam of the body to check general signs of

health, including checking for signs of disease, such as lumps or anything

illnesses and treatments will also be taken.

Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a

lubricated, gloved finger into the rectum to feel for lumps or anything else

that seems unusual.

Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid

that contains barium (a silver-white metallic compound) is put into the

rectum. The barium coats the lower gastrointestinal tract and x-rays are

taken. This procedure is also called a lower GI series.

Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower)

colon for polyps (small areas of bulging tissue), other abnormal areas, or

cancer. A sigmoidoscope is inserted through the rectum into the sigmoid

colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens

for viewing.

Colonoscopy: A procedure to look inside the rectum and colon for polyps,

abnormal areas, or cancer. A colonoscope is inserted through the rectum

into the colon. A colonoscope is a thin, tube-like instrument with a light and

a lens for viewing. It may also have a tool to remove polyps or tissue

samples, which are checked under a microscope for signs of cancer.

Virtual Colonoscopy: A procedure that uses a series of x-rays called

computed tomography to make a series of pictures of the colon. A

computer puts the pictures together to create detailed images that may

show polyps and anything else that seems unusual on the inside surface of

the colon. This test is also called colonography or CT colonography.

Biopsy: The removal of cells or tissues so they can be viewed under a

microscope by a pathologist to check for signs of cancer.

HSS-Fusion 2015 30

TREATEMENT

Treatment depends partly on the stage of the cancer. In general, treatments may

include:

Surgery (most often a colectomy) to remove cancer cells

Chemotherapy to kill cancer cells

Radiation therapy to destroy cancerous tissue

SURGERY

Stage 0 colon cancer may be treated by removing the cancer cells, often during a

colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to

remove the part of the colon that is cancerous.

There is some debate as to whether patients with stage II colon cancer should

receive chemotherapy after surgery. This should be discussed with the oncologist.

CHEMOTHERAPHY

Almost all patients with stage III colon cancer should receive chemotherapy after

surgery for approximately 6 - 8 months. The chemotherapy drug 5-fluorouracil has

been shown to increase the chance of a cure in certain patients.

Chemotherapy is also used to improve symptoms and prolong survival in patients

with stage IV colon cancer.

One may receive just one type, or a combination of drugs as a part of treatment

too.

RADIATION

Although radiation therapy is occasionally used in patients with colon cancer, it is

usually used in combination with chemotherapy for patients with stage III rectal

cancer.

For patients with stage IV disease that has spread to the liver, various treatments

directed specifically at the liver can be used. This may include:

Burning the cancer (ablation)

Delivering chemotherapy or radiation directly into the liver

Freezing the cancer (cryotherapy)

Surgery

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LEUKEMIA

INTRODUCTION

Leukemia is cancer of the blood cells. Most blood cells form in the bone marrow.

In leukemia, cancerous blood cells form and crowd out the healthy blood cells in

the bone marrow.

The type of leukemia depends on the type of blood cell that has become

cancerous. For example, acute lymphoblastic leukemia is a cancer of the

lymphoblasts (white blood cells that

fight infection). White blood cells are

the most common type of blood cell to

become cancer. But red blood cells

(cells that carry oxygen from the lungs

to the rest of the body) and platelets

(cells that clot the blood) may also

become cancer.

Leukemia occurs most often in adults

older than 55 years, and it is the most

common cancer in children younger

than 15 years.

Leukemia is either acute or chronic. Acute leukemia is a fast-growing cancer that

usually gets worse quickly. Chronic leukemia is a slower-growing cancer that gets

worse slowly over time. The treatment and prognosis for leukemia depend on the

type of blood cell affected and whether the leukemia is acute or chronic.

Chemotherapy is often used to treat leukemia.

CAUSES

There is no single known cause for any of the different types of leukemia.

Leukemia, like other cancers, results from mutations in the DNA. Certain

mutations can trigger leukemia by activating oncogenes or deactivating tumor

suppressor genes, and thereby disrupting the regulation of cell death,

differentiation or division. These mutations may occur spontaneously or as a result

of exposure to radiation or carcinogenic substances.

Exposure to radiation is known to increase the risk of developing AML, CML, or

HSS-Fusion 2015 32

ALL. Increases in leukemia were observed in people surviving atomic bombs.

Radiation therapy for cancer can also increase the risk of leukemia. Exposure to

benzene, used commonly in the chemical industry, increases the risk of leukemia.

Cigarette smoking is known to increase the risk of developing AML.

Down syndrome, Li-Fraumeni syndrome, and other medical conditions can

increase the risk of developing leukemia.

Viruses have also been linked to some forms of leukemia. For example, human T-

lymphotropic virus (HTLV-1) causes adult T-cell leukemia.

Some people have a genetic predisposition towards developing leukemia. This

predisposition is demonstrated by family histories and twin studies. The affected

people may have a single gene or multiple genes in common. In some cases,

families tend to develop the same kinds of leukemia as other members; in other

families, affected people may develop different forms of leukemia or related

blood cancers.

SYMPTOMS

Symptoms of acute leukemia depend on how much the cancer has grown. They

may include:

bruising, or very heavy menstrual bleeding.

The chronic forms of leukemia often cause no symptoms until much later in the

disease. And when symptoms appear, they usually appear gradually. If leukemia

cells have infiltrated the brain, symptoms such as headaches, seizures, confusion,

loss of muscle control, and vomiting can occur.

HSS-Fusion 2015 33

DIAGNOSIS

If your doctor suspects leukemia, he or she may:

Ask about your medical history.

Check for enlarged lymph nodes camera.gif in your neck, underarm, or

groin.

Check for an enlarged liver or spleen camera.gif.

Do a complete blood count (CBC) and a blood chemistry. These tests let

your doctor look into symptoms such as fatigue, weakness, fever, bruising,

or weight loss.

Do a bone marrow aspiration and biopsy. This is the key to diagnosing most

leukemias and helps determine the type.

If your blood work points to possible leukemia, your doctor will want to find out

what kind you might have. Your treatment plan will depend on the specific kind of

leukemia that you have. The doctor may also order for several other X-Rays and

CT-Scans to check if the cancer has metastasized.

TREATMENT

There are a number of different medical approaches to the treatment of leukemia.

Treatment will typically depend upon the type of leukemia, the patient's age and

health status, as well as whether or not the leukemia cells have spread to the

cerebrospinal fluid. The genetic changes or specific characteristics of the leukemia

cells as determined in the laboratory can also determine the type of treatment

that may be most appropriate.

Treatments for leukemia include:

chemotherapy (major treatment modality for leukemia)

radiation therapy

biological therapy

targeted therapy

Stem cell transplant.

Combinations of these treatments may be used. Surgical removal of the spleen

can be a part of treatment if the spleen is enlarged.

Acute leukemia needs to be treated when it is diagnosed, with the goal of

inducing a remission (absence of leukemia cells in the body). After remission is

achieved, therapy may be given to prevent a relapse of the leukemia. This is called

HSS-Fusion 2015 34

consolidation or maintenance therapy. Acute leukemias can often be cured with

treatment.

Chronic leukemias are unlikely to be cured with treatment, but treatments are

often able to control the cancer and manage symptoms. Some people with

chronic leukemia may be candidates for stem cell transplantation, which does

offer a chance for cure.

Supportive treatments Because many of the treatments for leukemia deplete normal blood cells,

increasing the risk for bleeding and infection, supportive treatments may be

needed to help prevent these complications of treatment. Supportive treatments

may also be needed to help minimize and manage unpleasant side effects of

medical or radiation therapy.

Types of supportive and preventive treatments that can be used for patients

undergoing treatment for leukemia include the following:

Vaccines against the flu or pneumonia

Blood or platelet transfusions

Anti-nausea medications

Antibiotics or antiviral medications to treat or prevent infections

White blood cell growth factors to stimulate white blood cell production

Red cell growth factors to stimulate red blood cell production (darbepoetin

alfa [Aranesp] or epoetin alfa [Procrit])

Intravenous injections of immunoglobulin to help fight infection

HSS-Fusion 2015 35

LUNG CANCER

INTRODUCTION

Lung cancer is a type of cancer that begins in the lungs. Lung cancer is the

uncontrolled growth of abnormal cells that start off in one or both lungs; usually

in the cells that line the air passages. The abnormal cells do not develop into

healthy lung tissue, they divide rapidly and form tumors. As tumors become larger

with oxygen.

This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death in men and women, is responsible for 1.3 million deaths worldwide annually, as of 2004. The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important, because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation.

CAUSES

Most cases of lung cancer are caused by smoking, although people who have

never smoked can also develop the condition.

1) Smoking Smoking cigarettes is the single biggest risk factor for lung cancer. It is responsible

for about 90% of all cases.

Tobacco smoke contains more than 60 different toxic substances, which can lead

to the development of cancer. These substances are known to be carcinogenic

(cancer-producing).

If you smoke more than 25 cigarettes a day, you are 25 times more likely to get

lung cancer than a non-smoker.

Smoking is measured in pack-years. (No. of packets smoked in a day X No. of

years) So the higher the pack years the greater the risk of Cancer.

While smoking cigarettes is the biggest risk factor, using other types of tobacco

products can also increase your risk of developing lung cancer and other types of

HSS-Fusion 2015 36

cancer, such as Oesophageal Cancer and Mouth Cancer.

These products include:

cigars

pipe tobacco

snuff (a powdered form of tobacco)

chewing tobacco

Smoking cannabis has also been linked to an increased risk of lung cancer. Most

cannabis smokers mix their cannabis with tobacco. While they tend to smoke less

than tobacco smokers, they usually inhale more deeply and hold the smoke in

their lungs for longer.

2) Passive smoking

smoking) can increase your risk of developing lung cancer.

For example, research has found that non-smoking women who share their house

with a smoking partner are 25% more likely to develop lung cancer than non-

smoking women who live with a non-smoking partner.

3) Radon Radon is a naturally occurring radioactive gas that comes from tiny amounts of

uranium present in all rocks and soils. It can sometimes build up in buildings. If

radon is breathed in, it can damage your lungs, particularly if you are a smoker.

4) Occupational exposure and pollution Exposure to certain chemicals and substances that are used in several occupations

and industries has been linked to a slightly higher risk of developing lung cancer.

These chemicals and substances include arsenic, asbestos, beryllium, cadmium,

coal and coke fumes, silica and nickel.

Research also suggests that being exposed to large amounts of diesel fumes for

many years may increase your risk of developing lung cancer by up to 50%. One

study has shown that your risk of developing lung cancer increases by about a

third if you live in an area with high levels of nitrogen oxide gases (mostly

produced by cars and other vehicles).

5) Asbestos fibers

Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue

following exposure to asbestos. The workplace is a common source of exposure

to asbestos fibers, as asbestos was widely used in the past for both thermal and

acoustic insulation materials. Today, asbestos use is limited or banned in many

countries including the Unites States. Both lung cancer and mesothelioma (a type

http://www.nhs.uk/conditions/Cancer-of-the-oesophagus/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Cancer-of-the-mouth/Pages/Introduction.aspx

HSS-Fusion 2015 37

of cancer of the pleura or of the lining of the abdominal cavity called the

peritoneum) are associated with exposure to asbestos. Cigarette smoking

drastically increases the chance of developing an asbestos-related lung cancer in

exposed workers. Asbestos workers who do not smoke have a fivefold greater

risk of developing lung cancer than non-smokers, and those asbestos workers

who smoke have a risk that is 50 to 90 times greater than non-smokers.

SYMPTOMS

There are usually no signs or symptoms in the early stages of lung cancer.

However, symptoms develop as the condition progresses.

The main symptoms of lung cancer are listed below:

Persistent or intense coughing

Pain in the chest shoulder, or back from coughing Syndrome)

Changes in color of the mucus that is coughed up from the lower airways

(sputum)

Difficulty breathing and swallowing

Hoarseness of the voice

Chronic bronchitis or pneumonia

If the lung cancer spreads, or metastasizes, additional symptoms can present

themselves in the newly affected area. Swollen or enlarged lymph nodes are

common and likely to be present early. If cancer spreads to the brain, patients

may experience vertigo, headaches, or seizures.

In addition, the liver may become enlarged and cause jaundice and bones can

become painful, brittle, and broken. It is also possible for the cancer to infect the

adrenal glands resulting in hormone level changes.

Lung cancers frequently are accompanied by paraneoplastic symptoms that result

from production of hormone-like substances by the tumor cells. These

paraneoplastic syndromes occur most commonly with SCLC but may be seen with

any tumor type. A common paraneoplastic syndrome associated with SCLC is the

production of a hormone called adrenocorticotrophic hormone (ACTH) by the

cancer cells, leading to over secretion of the hormone cortisol by the adrenal

with NSCLC is the production of a substance similar to parathyroid hormone,

resulting in elevated levels of calcium in the bloodstream.

As lung cancer cells spread and use more of the body's energy, it is possible to

HSS-Fusion 2015 38

present symptoms that may also be associated with many other ailments.

These include:

Fever

Fatigue

Unexplained weight loss

Pain in joints or bones

Problems with brain function and memory

Swelling in the neck or face

General weakness

Bleeding and blood clots

DIAGNOSIS

Physicians use information revealed by symptoms as well as several other

procedures in order to diagnose lung cancer. Common imaging techniques include

chest X-rays, bronchoscopy (a thin tube with a camera on one end), CT scans, MRI

scans, and PET scans.

Physicians will also conduct a physical examination, a chest examination, and an

analysis of blood in the sputum. All of these procedures are designed to detect

where the tumor is located and what additional organs may be affected by it.

Although the above diagnostic techniques provided important information,

extracting cancer cells and looking at them under a microscope is the only

absolute way to diagnose lung cancer. This procedure is called a biopsy. If the

biopsy confirms lung cancer, a pathologist will determine whether it is non-small

cell lung cancer or small cell lung cancer.

After a diagnosis is made, an oncologist will determine the stage of the cancer by

finding out how far the cancer has spread. The stage determines which choices

will be available for treatment and informs prognosis.

For non-small cell lung cancer, TNM descriptions lead to a simpler categorization

of stages. These stages are labeled from I to IV, where lower numbers indicate

earlier stages where the cancer has spread less.

More specifically:

Stage I is when the tumor is found only in one lung and in no lymph nodes.

Stage II is when the cancer has spread to the lymph nodes surrounding the

infected lung.

Stage III-a is when the cancer has spread to lymph nodes around the

trachea, chest wall, and diaphragm, on the same side as the infected lung.

HSS-Fusion 2015 39

Stage III-b is when the cancer has spread to lymph nodes on the other lung

or in the neck.

Stage IV is when the cancer has spread throughout the rest of the body and

other parts of the lungs.

Small cell lung cancer has two stages: limited or extensive. In the limited stage,

the tumor exists in one lung and in nearby lymph nodes. In the extensive stage,

the tumor has infected the other lung as well as other organs in the body.

TREATMENT

Lung cancer treatments depend on the type of cancer, the stage of the cancer

(how much it has spread), age, health status, and additional personal

characteristics. As there is usually no single treatment for cancer, patients often

receive a combination of therapies and palliative care.

The main lung cancer treatments are surgery, chemotherapy, and/or radiation.

However, there also have been recent developments in the fields of

immunotherapy, hormone therapy, and gene therapy.

1) Surgery Surgery is the oldest known treatment for cancer. If a cancer is in stage I or II and

has not metastasized, it is possible to completely cure a patient by surgically

removing the tumor and the nearby lymph nodes. After the disease has spread,

however, it is nearly impossible to remove all of the cancer cells.

Lung cancer surgery is performed by a specially trained thoracic surgeon.

Surgery carries side effects - most notably pain and infection. Lung cancer surgery

is an invasive procedure that can cause harm to the surrounding body parts.

Doctors will usually provide several options for alleviating any pain from surgery.

Antibiotics are commonly used to prevent infections that may occur at the site of

the wound or elsewhere inside the body.

2) RADIATION Radiation treatment, also known as radiotherapy, destroys or shrinks lung cancer

tumors by focusing high-energy rays on the cancer cells. This causes damage to

the molecules that make up the cancer cells and leads them to commit suicide.

Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such

as radium or high-energy x-rays that are created in a special machine. Radiation

can be used as the main treatment for lung cancer, to kill remaining cells after

surgery, or to kill cancer cells that have metastasized.

Common side effects of radiation therapy may include fatigue, nausea, loss of

appetite, hair loss, and skin affectations that cause skin to become dry, irritated,

HSS-Fusion 2015 40

and sensitive.

3) Chemotherapy Chemotherapy utilizes strong chemicals that interfere with the cell division

process - damaging proteins or DNA - so that cancer cells will commit suicide.

These treatments target any rapidly dividing cells (not just cancer cells), but

normal cells usually can recover from any chemical-induced damage while cancer

cells cannot. Chemotherapy is considered systemic because its medicines travel

throughout the entire body, killing the original tumor cells as well as cancer cells

that have spread throughout the body.

A medical oncologist will usually prescribe chemotherapy drugs for lung cancer to

be taken intravenously, but there are also drugs available in tablet, capsule, and

liquid form. Chemotherapy treatment occurs in cycles so the body has time to heal

between doses, and dosages are determined by the type of lung cancer, the type

of drug, and how the person responds to treatment. Medicines may be

administered daily, weekly, or monthly, and can continue for months or even

years.

Chemotherapy carries several common side effects, but they depend on the type

of chemotherapy and the health of the patient. These include nausea and

vomiting, appetite loss, diarrhea, hair loss, fatigue from anemia, infections,

bleeding, and mouth sores. Many of these side effects are only temporarily felt

during treatment, and several drugs exist to help patients cope with the

symptoms.

Complications:

Lung cancer can cause complications, such as:

Shortness of breath. People with lung cancer can experience shortness of

breath if cancer grows to block the major airways. Lung cancer can also cause

fluid to accumulate around the lungs, making it harder for the affected lung to

expand fully when you inhale.

Coughing up blood. Lung cancer can cause bleeding in the airway, which can

cause you to cough up blood (hemoptysis). Sometimes bleeding can become

severe. Treatments are available to control bleeding.

Pain. Advanced lung cancer that spreads to the lining of a lung or to another

area of the body, such as a bone, can cause pain. Tell your doctor if you

experience pain. Pain may initially be mild and intermittent, but can become

constant. Medications, radiation therapy and other treatments may help make

you more comfortable.

HSS-Fusion 2015 41

Fluid in the chest (pleural effusion). Lung cancer can cause fluid to accumulate

in the space that surrounds the affected lung in the chest cavity (pleural space).

Pleural effusion can result from cancer spreading outside the lungs or in reaction

to lung cancer inside the lungs. Fluid accumulating in the chest can cause

shortness of breath. Treatments are available to drain the fluid from your chest

and reduce the risk that pleural effusion will occur again.

body (metastasis). Lung cancer often

spreads (metastasizes) to other parts of the body most commonly the brain,

bones, liver and adrenal glands. Cancer that spreads can cause pain, nausea,

headaches, or other signs and symptoms depending on what organ is affected. In

some cases, treatments are available for isolated metastasis, but in most cases,

the goal of treatment for metastasis is only to relieve signs and symptoms.

Death. Unfortunately, survival rates for people diagnosed with lung cancer are

very low. In most cases, the disease is fatal. People diagnosed at the earliest

stages have the greatest chances for a cure. Your doctor can discuss your chances

for survival with you.

HSS-Fusion 2015 42

DIABETES MELLITUS

INTRODUCTION

Diabetes Mellitus is a widespread

The Blood from the Intestines enters the Liver via the Hepatic Portal Artery

containing a high concentration of Glucose. The Liver and the Pancreas then

ch helps maintain a

constant glucose concentration in the blood by converting excess glucose into

Glycogen (then stored in the Liver for later use). However, any disfunctioning of

these organs may result in a lack of Insulin produced to convert the glucose giving

a rise to the glucose concentration in the blood. This may further lead to the

egestion of the excess glucose in the bloodstream by the Kidneys as urine,

resulting in a deficiency of Glucose in the body, a condition known as "Diabetes

Mellitus".

CAUSES

There are two main types of diabetes which can be classified as Type 1 diabetes

and Type 2 diabetes.

In type 1 diabetes, the body's immune system malfunctions and attacks the tissues

making them unable to produce sufficient insulin. With the lack of insulin

produced, a rise in the blood glucose level may be experienced.

Type 1 diabetes is an auto-immune condition. Your immune system (the body's

natural defense against infection and illness) mistakes the cells in your pancreas as

harmful and attacks them, destroying them completely or damaging them enough

to stop them producing insulin.

It's not known exactly what triggers the immune system to do this, but some

researchers have suggested that it may be due to a viral infection.

Type 1 diabetes is often inherited by the gene (runs in families), so the auto-

immune reaction may also be genetic

Type 2 diabetes is where the body doesn't produce enough insulin, or the body's

cells don't react to insulin. This is known as insulin resistance. At first, the pancreas

makes extra insulin to make up for it. But, over time it isn't able to keep up and

HSS-Fusion 2015 43

can't make enough insulin to keep your blood glucose at normal levels. Type 2

diabetes is the most common form of diabetes

TREATMENT

In Type 1 Diabetes insufficient insulin is produced, therefore those with this type

have to inject insulin in their bodies for the rest of their lives.

As for the Type 2 Diabetes, there is seldom a need to inject insulin on daily basis.

However, the body requires other things in order to bring it under control.

A combination of exercises aerobic exercises, such as walking or dancing on

most days, combined with resistance training, such as weightlifting or yoga twice

a week will help to control blood sugar level.

There is no specific diet prescribed for diabetes, however the meal should be

made up of foods that are rich in fibre but low in fat for example vegetables, fruits

and whole grain.

PROGNOSIS

Diabetes is a leading cause of death in all industrialized nations.

Type 1 diabetes

About 15% of people with type 1 diabetes die before age 40 year

In Type 1, prognosis can be improved with good blood sugar control. Maintaining

tight blood sugar control has been proven to prevent, slow the progression of,

and even improve established complications of type 1 diabetes.

Type 2 diabetes

Excellent glycemic control, tight blood pressure control, and keeping the "bad"

cholesterol (LDL) level at the recommended level of

HSS-Fusion 2015 44

APPENDICITIS

INTRODUCTION

Appendicitis is a painful swelling of the appendix, a finger-like pouch connected to

the large intestine.

Appendicitis typically starts with a pain in the middle of your abdomen (tummy)

that may come and go. Within hours the pain travels to the lower right-hand side,

where the appendix usually lies, and becomes constant and severe.

CAUSES

Appendicitis occurs when the appendix becomes blocked, often by stool, a

foreign body, or cancer. Blockage may also occur from infection, since the

appendix swells in response to any infection in the body.

SYMPTOMS

Dull pain near the navel or the upper abdomen that becomes sharp as it

moves to the lower right abdomen. This is usually the first sign.

Loss of appetite

Nausea and/or vomiting soon after abdominal pain begins

Abdominal swelling

Fever of 99-102 degrees Fahrenheit

Inability to pass gas

DIAGNOSIS/TESTS

Tests and procedures used to diagnose appendicitis include:

Physical exam to assess the pain. The doctor may apply gentle pressure

on the painful area. When the pressure is suddenly released,

appendicitis pain will often feel worse, signaling that the adjacent

peritoneum is inflamed.

Blood test to see if the body is fighting the infection

Urine test to rule out a urinary tract infection

Rectal exam

Imaging tests

HSS-Fusion 2015 45

CT scans and/or ultrasound

TREATMENT

Surgery to remove the appendix, which is called an appendectomy, is the standard

treatment for appendicitis.

Generally, if appendicitis is suspected, doctors tend to err on the side of safety

and quickly remove the appendix to avoid its rupture. If the appendix has formed

an abscess, you may have two procedures: one to drain the abscess of pus and

fluid, and a later one to remove the appendix. However, there is some research

showing that treatment of acute appendicitis with antibiotics may eliminate the

need for surgery.

HSS-Fusion 2015 46

NAEGLERIA FOWLERI - PRIMARY AMEBIC MENINGOENCEPHALITIS (PAM)

INTRODUCTION

Naegleria fowleri (commonly referred to as the "brain-eating amoeba" or "brain-

eating ameba"), is a free-living microscopic ameba, (single-celled living organism).

It can cause a rare and devastating infection of the brain called primary amebic

meningoencephalitis (PAM) The amoeba is commonly found in warm freshwater

(for example, lakes, rivers, and hot springs) and soil.

CAUSES

Naegleria Fowleri is acquired by people when infected water is forcibly aspirated

into the nose. This infected water can be bodies of warm freshwater, such as lakes

and rivers, inadequately chlorinated swimming pool water or heated tap water

(greater than 47 degree). When such infected water enters the nose (This can

occur through recreational swimming, diving, or during sports like water skiing).

The amoeba then migrates through the olfactory nerves and enters the brain

where it destroys the brain tissue causing brain swelling and death. However one

cannot be infected by naegleria by drinking contaminated water. Moreover,

naegleria is not found in salt water like the ocean.

SYMPTOMS

Naegleria infection causes a disease called primary amebic meningoencephalitis.

This disease causes brain inflammation and destruction of brain tissue.

Generally beginning within two to 15 days of exposure to the amoeba, signs and

symptoms of naegleria infection may include:

A change in the sense of smell or taste

Fever

Sudden headache

Stiff neck

Sensitivity to light

HSS-Fusion 2015 47

Nausea and vomiting

Confusion

Loss of balance

Sleepiness

Seizures

Hallucinations

These signs and symptoms can progress rapidly. They typically lead to

death within a week.

DIAGNOSIS

Because of the rarity of the infection and difficulty in initial detection, about 75% of

diagnoses of PAM are made after the death of the patient.

PAM and Naegleria fowleri infection can be diagnosed in the laboratory by

detecting:

Naegleria Fowleri organisms in cerebrospinal fluid (CSF), biopsy, or tissue

specimens, or

Naegleria Fowleri nucleic acid in CSF, biopsy, or tissue specimens, or

Naegleria Fowleri antigen in CSF, biopsy, or tissue specimens.

TREATMENT

Miltefosine is a drug, which when tested in the lab against Naegleria Fowleri killed

it. However, when the drug is transferred in the human infection scenario, a lot of

factors come into play. The drug was effective against Kali Hardig (though many

other treatments were used on her) one of the three survivors of Naegleria in the

United States. It was also used once three years ago in a boy who had contracted

the parasite, but the boy didn't survive.

PROGNOSIS

The fatality rate is over 97%. Only 3 people out of 133 known infected individuals in

the United States from 1962 to 2014 have survived

HSS-Fusion 2015 48

HISTORY TAKING

of clinical diagnosis and the foundation for the doctor patient relationship. The

history will help you to formulate a differential diagnosis and focus your physical

examination.

As important, it will also help you in getting to know patients, winning their

confidence and understanding the social context of their illness. The consultation

an expert on the

experience of illness and the unique context in which it has occurred, and the

clinician, an expert on the diagnosis and management of illness.

The aims of history taking are threefold:

ible for symptoms

interpretation of symptoms, beliefs and attributions and any limitations of daily

activities consequent upon their illness.

Diagnostic information

The key to reaching an accurate diagnosis is obtaining a detailed description of the

which may initially be wide ranging but can be brought into sharper focus by

obtaining as much detail as possible about the symptomatology.

Approach to the patient. You will feel intimidated in your first attempts at history

taking. Most patients, however, are keen to put the apprehensive student at ease.

Aim to develop a professional but friendly manner. View the consultation as a

meeting of two experts and you will quickly gain an effective rapport with the

patient. Try to be caring and compassionate but remember that you are not

directly r

with the elderly and the deaf. Seek first to understand and not judge the patient

Introduce yourself with a friendly greeting, giving your name and status.

HSS-Fusion 2015 49

request permission to interview and examine the patient. Some patients rapidly

tire of being questioned or examined, and others may be depressed because they

are ill or apprehensive in a strange environment. If there are difficulties in

establishing a rapport, try to determine the reason; if in doubt, consult the

medical or nursing staff.

Factors in establishing rapport

ourself in a warm, friendly manner.

-verbally.

METHODS OF HISTORY TAKING

Eliciting accurate, detailed and unbiased information from a patient is a skilled

questions. Adopt a personal, conversational style rather than an interrogative

medical jargon. Avoid interrupting

patients, particularly as they begin to tell you the story of the presenting features

of the illness.

Given the opportunity, most patients will provide relevant information about their

illness and often need to talk abou

to talk without interruption and being a good listener will greatly help you to

establish a good relationship quickly. Try to limit your intervention at this stage to

encouraging the flow of information with simple verbal and nonverbal cues but, if

necessary, steer the talkative individual from less relevant facts. Clarify any details

about which you remain uncertain such as the precise meaning of ambiguous

terms, e.g. indigestion. When asking specific questions relating to symptoms,

avoid leading questions which might compromise the quality of information

obtained. If asking about the aggravating and relieving factors of pain, ask as

follows:

hether anything made the pain better or worse?

HSS-Fusion 2015 50

(NB: Try to avoid suggesting a particular answer to the patient, such as by asking

that you have all

the necessary information, it is important to summarize the story, as you

understand it, so that the patient can check its accuracy and alter or add to it if

required. Some patients may be unable to give a history because they are too ill,

confused, demented or unconscious.)

It is then vital to obtain further information from relatives, friends and the

Give the patient your undivided attention

Keep your note-taking to a minimum when the patient is talking

Use language which the patient can understand

Let patients tell their own story in their own way

Steer patients towards the relevant

Use open questions initially and specific (closed) questions later

Summarize (reflect back) the story for the patient to check

Utilize all available sources of information

There is no single, correct way to take a history; with time you will develop your

own style; however, one effective and commonly used sequence comprises:

1. Introduction

2. Presenting complaint

3. History of current illness

4. Systemic enquiry

5. Past medical history

6. Drugs and allergies

7. Family history

8. Social and personal history

9.

As described earlier, you should begin by inviting patients to provide an account

of recent events in their own words. Learn to listen without interruption and

encourage the patient to continue the story right up to the time of interview.

HSS-Fusion 2015 51

tate of health?

Interrogation

When the patient has completed the story, clarify the description by specific

questioning to obtain a detailed chronological account of the development of the

illness from the first symptom to the time of the interview. Do not be misled by

accepting the pa

treatment have been undertaken so far and what the patient has been told about

the illness. Obtain a detailed description of every symptom reported by the

patient.

HSS-Fusion 2015 52

HISTORY TAKING: SYSTEMIC ENQUIRY

Fatigue Dysuria

Anorexia Frequency/nocturia

Weight change

Change in color/smell of urine

Itch Prostatic symptoms

Rashes Urethral/vaginal discharge

Low mood Incontinence

Fevers/night sweats

Menstrual difficulties

Heat/cold intolerance

Postmenstrual bleeding

Change in appearance Sexual difficulties

Cardiorespiratory Central nervous system

Chest pain Headaches

Breathlessness Fits/faints/funny turns

Orthopnoea Weakness

Paroxysmal nocturnal dyspnoea Sensory symptoms

Palpitation Changes in taste/smell

Cough Hearing disturbance

Sputum Visual disturbance

Wheeze Speech disturbance

Haemoptysis Dizziness

Gastrointestinal Locomotor

Swallowing difficulty Pain

Nausea and vomiting Stiffness

Haematemesis Immobility

Heartburn Swelling

Indigestion Loss of joint function

Abdominal pain

Change in bowel habit

Change in colour/consistency of motions

General Genitourinary

HSS-Fusion 2015 53

forgotten about previous health problems or believe them to be irrelevant or too

embarrassing. Ask about the outcome of any previous medical or radiological

examinations including those tests performed for employment or insurance

HSS-Fusion 2015 54

tuberculosis. Ask about any travel or residence abroad, especially if infection is

suspected and the cause is not immediately obvious, e.g. falciparum malaria.

-the-

remedies. Adverse drug effects are a common cause of ill health and may explain

any worsening of existing symptoms, particularly if drug therapy has changed

recently.

Checklist 1 Have you had any similar episodes in the past?

What investigations have you had in the past? X-rays? Scans?

What were the results of your previous tests?

Have you had any other medical problems or conditions?

Have you had any serious illness in the past?

Have you been in hospital before?

Have you had any operations?

Have you ever had a blood transfusion?

What injuries or accidents have you had in the past?

When and where have you travelled abroad?

Have you ever had any of the following conditions: asthma/chronic

obstructive pulmonary disease (COPD)/angina/heart attack/stroke

/diabetes/epilepsy/rheumatic fever/blood clot in the leg or lung/tuberculosis

(TB)/jaundice/high blood pressure/high blood cholesterol?

Checklist 2 What medications do you actually take?

-the-

Do you take low-dose aspirin? Vitamin pills?

Do you take the oral contraceptive pill? HRT (hormone replacement

therapy)?

Have your medications changed at all recently?

How often do you forget to take your tablets?

Have any medicines ever upset you? If so, how?

What exactly happens when you take that medication?

Are you allergic to anything? Hay fever? Asthma? Eczema?

In addition to providing information on any predisposition to disease, the family

When relevant, draw a family tree to map the inheritance pattern of particular

diseases Use symbols in a pedigree chart beginning with the affected person first

found to have the trait (propositus if male, proposita if female); include all the

HSS-Fusion 2015 55

relevant information regarding siblings and all maternal and paternal relatives.

Has any family member suffered from a similar problem?

Do you know of any illnesses that run in your family?

Has any member of your family died before the age of 60?

Abortion or stillbirth

Affected male

Affected female Propositus

-being are affected by occupational, social and

diagnosis but also for management. How patients think, live and behave influence

es, events and

difficulties serve both to inform you and reaffirm your interest in the patient as an

individual. Get to know your patients and their concerns; seek to understand the

impact of illness on their personal, working and family lives. Ask about their

employment, housing, personal and sexual relationships (or lack of them), leisure

interests, physical exercise and the use of drugs including tobacco, alcohol and

other recreational drugs, e.g. cannabis. Quantify cigarette consumption in pack

years (20/day/year), and alcohol consumption as average number of units per

week.

Checklist 3 What jobs have you done since starting work?

What did these jobs involve?

How do you spend your time when you are not at work?

Where do you live? What is your house like?

Are you able to do all the activities that you need to be able to do?

Who lives with you at home? Partner? Single?

Have you had children? Any worries or illness with them?

How many sexual partners have you had? Male? Female?

Have you ever smoked? Ever been a heavy drinker?

1 Alcohol unit (8 g) 1 small glass wine 1 single spirit.

CAGE Questionnaire

HSS-Fusion 2015 56

-

(Scores of two or more positive answers indicate a significant alcohol problem.)

The commonest cause of patient dissatisfaction from consultations is a failure of

communication. Consultations are significantly more likely to be ranked by

doctor asks about the personal aspects of

personal and social history is overlooked, unfounded assumptions may be made

leading to either unnecessary

anxiety or unrealistic optimism.

This guide may not be used, or

copied without the permission of

the HSS Fusion 2015 Medical Unit.