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Symptoms: The symptoms usually begin between 10days - 6 weeks after being bitten by and infected mosquito.However in some cases,symptoms may not develop for months or years,especially if preventive drugs were being taken at the time of the infection.If not treated,Malaria due to the Plasmodium parasites - P.vivax,P.ovale & P.malariae - causes recurrent attacks of symptoms each time the parasites multiply inside red blood cells and destroy them.Each attack usually lasts for 4-8 hours and may occur at intervals of 2-3days,depending on the species of parasite.Symptoms may include 1. high fever 2. shivering and chills 3. heavy sweating 4. confusion 5. fatigue 6. headaches 7. muscle pain 8. dark brown urine 9. between each attack,extreme fatigue due to anaemia may be the only symptom 10. Falciparum malaria - caused by Plasmodium falciparum - causes continuous fever that may be mistaken for influenza.It is more severe than other types and attacks may lead to loss of consciousness,cerebral malaria and kidney failure and may be fatal within 48 hours of symptoms appearing if left untreated Treatment: Your doctor may suspect Malaria if you have an unexpalined fever within a year of a trip to a region where the infection occurs.Diagnosis is confirmed by identifying the malarial parasite in a blood smear under a microscope.If you are diagnosed with Malaria,you should be given antimalarial drugs as early as possible to avoid complications.Treatment depends on the type of Malaria,how resistant the parasite is to drugs and the severity of the symptoms.If you have Falciparum malaria,you may be treated in hospital with oral or intravenous antimalarial drugs.Treatment may also involve blood transfusions to replace destroyed red blood cells or kidney dialysis if kidney function is impaired.Other types of malaria are usually treated on an outpatient basis with oral antimalarial drugs.If treated early,the prognosis is usually good - most people make a full recovery.Malaria caused by P.vivx and P.ovale may recur after treatment Prevention: If you plan to visit an area where malaria occurs,your doctor will be able to give you up-to-date advice about antimalarial drugs for that area.You may need to start taking the drugs several days before you leave and continue taking them during and after your visit.To protect yourself against mosquito bites your should keep your body well covered when out with long sleeve shirts and pants.Sleep under a mosquito net that is impregnated with insect repellent.Use insect repellent on clothes and exposed skin * see www.malaria.org.za - info & tips on Malaria in S.A* Malignant Melanoma: Of all the types of Skin Cance - ,Malignant Melanoma is the most deadly. Melanoma has become more common with our obsession with getting and keeping a TAN.a Melanoma may begin as a new growth on normal skin or may develop from an existing mole.Left untreated,the cancer can spread rapidly to other parts of the body and may be fatal.As with most other SKin Cancers, exposure to the sun and the use of sunbeds are risk factors.Fair-skinned people are most at risk.Malignant Melanoma is most common between the ages of 40 & 60.Worldwide the number of cases of Malignant Melanoma - particularly in young adults, has increased dramatically over the past 10 years.This rise is probably due to the growing popularity of outdoor activities & the emphasis on a TANNED skin. Causes: It is though to result from damage to melanocytes (skin cells that produce the pigment melanin) by sunlight.The cancer occurs more frequently in people with fair skin than in those with darker skin.People who continually expose themselves to intense sunlight or who live in sunny climates - are at greater risk of developing the cancer.Severe sunburn in childhood - has been shown to double the chance of developing Malignant Melanoma in later life.Reducing exposure to the sun can help decrease the risk of developing any type of skin cancer Symptoms: Malignant Melanomas can develop on any part of the body - but appear most commonly on sun-exposed areas.Some Melanomas spread across the skin in irregular flat patches,others as fast-growing lumps.In older people -they may occur on the face as freckle-like spots, known as Lentigo Maligna - that grow slowly over many years.If they are not removed,all of these types of Melanoma will grow down into the underlying layers of skin Prognosis: If caught early,most cases of skin cancer can be treated succdessfully through surgery - although some can prove fatal.Skin cancers have increased in fair-skinned people worldwide over the last 10 years.A person's risk of developing skin cancer, is increased by several factors - including 1. Having fair-skin 2. Having a skin that has a tendency towards freckling 3. Having many moles 4. Having a family hisory of Malignant Melanoma 5. Having had one or more attacks of severe sunburn during childhood 6. Being aged over 30 years 7. Having many years of exposure to strong sunlight *also see SKin Cancers*
Procedure: 1. You will be asked to strip to the waist and remove any deodorant or talc from your breast.The reason for this is that it may show up as micorcalcifications 2. You will then be asked to stand in front of the machine and the radiologist will compress your breast(S) between two plates 3. The procedure is not without a degree of discomfort, particularly if the plates are cold 4. The sensation lasts no more than 10-15 seconds- so it's easily bearable 5. Two views of each breast will usually be taken 6. The radiologist compresses each breast in turn between two plates so that a good image is obtainded 7. ULTRASOUND SCANS: May be used to investigate breast lumps found in women aged 35 and below 8. After the screening, the films are developed and examined by a radiologist who specializes in interpreting mammograms 9. The results may be quick or take a few hours to come through and most women will be told that they are fine and just need regular screening 10. A small number will be asked to come back for further tests.This can be worrying - but the chances of getting an all-clear are still high 11. EXTRA TESTING: Although Mammograms are good for detecting small lumps, they cannot determine a lump's precise character, so extra tests may be needed to pin that down 12. MICROCALCIFICATIONS: Are tiny deposits of calcium that can show up as very fine specks on a Mammogram.They may be quite normal and many women have them,but because they have been occasionally linked with cancer, the radiologist will always mention their presence.They are only worrying if they suddenly appear in a cluster in one breast 13. If it's your first Mammogram, your doctor may wait a year before doing another one to see if there is any change 14. If the pattern of Microcalcifications is very abnormal,a biopsy will be carried out at once.If your Mammogram shows any kind of lump, futher tests will be necessary 15. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC): If the lump is large enough to feel easily with your fingers, a fine needle can be inserted to draw off some of the cells.This is called FNAC - Fine Needle Aspiration Cytology - and send away to the laboratory for microscopical examination.If the lump is fluid-filled, it is a cyst and nearly always perfectly harmless.A sample of the fine-needle aspiration will also be send to the lab for examination.It is very important that the doctor re-examen the breast after the cyst has been drained in order to feel for any possible lumps that might be situated under the cyst.If the lump is solid, some cells that have been drawn off will be smeared on a slide,stained and examined in the lab.If the lump is not easy to feel, you will probably have an Ultrasound Scan, to determine whether ti is a solid lump or a cyst 16. CORE NEEDLE BIOPSY: Either way it will be investigated with FNAC or cutting-needle biopsy.When a lump cannot be felt,FNAC and Core Needle Biopsy are done with guidance of Ultrasound so that the tumor can be precisely located 17. OPEN BIOPSY: Open Biopsy is a kind of biopsy - and an alternatige to a Core Needle Biopsy.As the name implies, the skin is cut open to reveal the lump, which is then removed with a margin of healthy breast tissue.In practical terms, open biopsy nearly always means revoving the whole lump- Lumpectomy.It is always carried out in hospital under a genreal anaesthetic.Not every woman over age 30, with an obvious breast lump should have it removed.The aim is to diagnose the lump - those that are benign are in the main left alone and not excised.Biopsy or lump is sent to the Pathology Laboratory where it is very finely sliced,stained to show up the cells and examined under a microscope, a test known as Histology 18. MALIGNANCY: If the tissue is found to be cancerous, a very precise diagnosis of the type of cancer can be made.The tumor is also graded - giving information on how malignant it is.Spread of the cancer to lymph nodes in the armpit and further a field in the body is checked by a series of simple tests, generally performed during the initial assessment, so that the tumor can be staged 1,2,3 or 4
Causes: Breast pain can be divided into two types: Cyclical - assosiated with menstrual period and Non-Cyclical.The most common kind of breast pain is associated with the menstrual cycle, and is nearly always related to the sensitivity of breast tissue to hormones and this can differ witin a breast and between your two breasts.Hormones are not the whole story,however,because in the majority of women the pain is more severe in one breast than in the other.Most women experience some degree of breast pain when their breasts become sensitive just prior to menstration.Some women, however, may experience soreness and tenderness starting with ovulation in the middle of the cycle, and continuing for about two weeks until menstruation takes place.Others find that this premenstrual soreness becomes even worse after the birth of their first child.There are 2 types of Non-Cyclical Breast Pain, which comes from the breast, but is unrelated to the menstrual cycle and pain that is felt in the region of the breast, but is actually coming from somewhere else.This latter kind nearly always involves the muscles, bones or joints and for this reason it is called Muscoloskeletal Pain.Two-thirds of Non-Cyclical Mastalgia is pain of Muscouloskeletal origin.Rarely what appears to be breast pain - is due to underlying lung or gallbladder disease. True Non-Cyclical Breast Pain - Some benign breast conditions may be associated with true breast pain.Burning or stabbing pains centred around or under the Nipple may be due to dilatation of the ducts (duct ectasia) and tend to run an intermittent, though harmless course.They may also be due to periductal mastitis, a condition that affects your women, the majority of whom are smokers.A tender spot with occasional stabbing pain or an ache is common.Its cause is unknown, but it is no reason for anxiety Treatament: The pain can be relieved by an injection of local anaesthetic mixed with prednisone to help to reduce any inflammation. A Cyst occasionally underlies a tender spot, removal of fluid from the cyst can ease the pain.Pain originating in the chest wall or spine may be felt in the breast area.The most usual cause is a from of arthritis called Costochondritis - which affects the ends of the ribs where they join the breastbone - the condition is called Tietze's Syndrome.If the pain is worse when you take a deep breath, or presson your breastbone and ribs, it's likely to be Costochondritis.Taking a painkiller, such as paracetamol,or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, is often effective
Causes & Solutions: The centres in the brain that control a sense of wellbeing,a positive state of mind and a feeling of control and tranquility are affected by the absence of estrogen.Taking estrogen supplements as hormone replacement therapy (HRT) can cause dramatic return to normality.For some women,the emotional troubles they experience around the menopause may mainly be due to the fact that their sleep is being interrupted by night sweats.People who are tired are often irritable and anxious.If you are experiencing this problem,try self-help tips for promoting sleep.A major depression,although rare,can descend upon you during your menopausal years,and this is distinct from other emotional symptoms that you may experience,such as tearfulness and anxiety There are possible predictors of depression during the menopause: a past of recent history of stressful events such as divorce or bereavement.A surgical-induced menopause.Having negative expectations of menopause.Severe hot flushes or night sweats.A family history of depressive illness.Empty nest syndrome Depression can be a debilitating illness that can last for weeks,months or even years if left untreated.It affects your body,your mood,your thoughts and severely interferes with normal life.As a woman,you are most likely to experience depression than a man is. Consult your doctor if you have experienced x4 of the symptoms for at least 2weeks.Any extreme eating patterns,such as bingeing or loss of apetite.Unusual sleeping patterns,such as sleeping all the time or insomnia.Being exceptionally lethargic or restless. An inability to enjoy a once pleasurable activity,including a loss of sex drive.Debilitating fatique or loss of energy.Feelings of worthlessness and self-reproach.Difficulty concentrating,remebbering and making decisions.Thoughts of death or suicide,or suicide attempts - seek help straight away Complementary Therapies: Herbs that my have a calming effect are passion flower andf valerian root taken as a tea or a tincture.Passion flower helps with insomnia and elevates the levels of serotonin in the blood,which creates a feeling of well-bieng.A herbal bath can also be therapeutic Self-help: Severe mood swings and irritablility can distance you from your partner and occasionaly can jeopardize a relationship.However,if you share your feelings you may find your partner is very supportive.Several studies show that partners are keen to understand menopausal symptoms and would prefer to have insight into potential problems before the onset of menopause.Women who go to self-help groups may be better able to deal with depression.think about joining such a group or starting one yourself. 20-30 min of strenuous exercise results in the release of endorphins,which are brain opioids similar to morphine.This can lift mood and produce an 'exercise high' that lasts up to eight hours.Exercise can also reduce hot flushes and night sweats,which is helpful if these are the root cause of your depression.Yoga,relaxation techniques and meditation all promote tranquillity and combat anxiety and tension
Causes: Menorrhagia is common and may affect the women approaching the menopause, the lining of the womb becomes extremely thick and there is a heavier blood loss as the lining is shed.Or women who have been fitted with an IUD which increases blood loss. Or women with fibroids, because they increase the surface of the womb and its lining.Heavy periods are due to the absence of progesterone, the hormone that's responsible for controlling menstrual blood loss.It usually means that ovulation if failing.As a result the uterine lining builds up until finally it breaks down naturally, resulting in a heavy, uncontrolled bleed Treatment: Bleeding of this type that occurs around the time of the menopause can often be successfully treated using certain types of hormone replacement therapy (HRT).It is important that a Hysterectomy should be seen as a last resort and if your doctor advises it, get a second opinion. Drugs are the first option in the treatment of menorrhagia and not a hysterectormy.A woman may be prescribed a clotting drug such as Tranexamic acid, which will help her uterus to stop bleeding.Hormones such as progestogen and the combined contraceptive pill may control bleeding.Another form of hormone treatment has just become available that will be a boon to women with heavy bleeding.It is progestogen IUD, known as the IUS.This alters hormone levels less drastically than the combined pill, so there are few side effects.It seem ideal for women who have had their chldren because it cures the heavy bleeding and it is a virtually 100% effective contraceptive.It remains during the menopause and is part of your HRT treatment. Second Options - Hysteroscopic Transcervical Resection (TCRE) - The cavity of the womb is viewed suing a small telescope that is inserted via the vagina and cervix.At the same time, the lining of the womb can be removed using an electrical loop.This way periodsare minimized of even stopped completely and no abdominal surgery is involved.There aer many advantage to TCRE.It's an alternative to long-term drug therapy.The major surgery of a hysterectomy is avoided and Hospital stay and recovery are much shorter than for hysterectomy.There is no surgical incision and therfore no scar Uterine Balloon Therapy - Thje latest treatment for menorrhagia is still a new procedure that is performed under local anaesthesia.It aims to destroy the linng of the uterus with heat and so make periods lighter.It is not available everywhere.A flexible balloon attached to a thin catheter is inserted into the vagina throug the servix and placed in the uterus.The baloon is inflated with a sterile fluid and heated to 87o/C for about 8min.After treament you have a period over the next 7-10days Self - help Methods - Claims are made for certain foods and supplements but there is no proof of their usefulness.Bioflavonoids, which are found in citrus fruits, are said to alleviate heavy bleeding.Regular strenuous exercise and keeping weight down may also be helpful.Avoiding alcohol, the use of aspirin.Avoid hot showers or baths during menstruation, because this can also increase bleeding because heat dilates the uterine blood vessels and increases flow.Your blood should be checked regularly for signs of Anaemia and if your haemoglobin is low you should eat more iron-rich foods such as nuts,liver,red meats, egg yolk, green leafy vegetables and dried fruits
*also see Malignant Melanoma & Skin Cancers*
Symptoms: In the initial stage of the disease, 1.there is weakness and wasting - developing over a few months and usually affecting muscles of the hands,arms or legs 2.Other early symptoms include twitching movements in the muscles 3.stiffness and muscle cramps 4.difficulty performing twisting movements,such as unscrewing bottle tops and turnign keys.As the disease progresses,other symptoms may include -5. dragging one foot or a 6.tendency to stumble when walking 7.Difficulty climbing stairs or 8.getting up from low chairs 9.Less commonly,slurred speech,hoarseness and 9.difficulty swallowing if the muscles of the mouth and throat are involved 10.Mood swings,anxiety and depression 11.Recurrent chest infections and possilby pneumonia,if the muscles involved in breathing and swallowing are affected and small particles of food enter the lungs 12.The head falling forward because the muscles in the neck are too weak to support it 13.Eventually diffuculty in breathing due to weakness of the muscles that control respiration Treatments: At present no treatment can significantly slow down the progression of motor nearon disease,although a new drug called Riluzole may have a small effect.Treatment for symptoms may include antidepressants to relieve depression and antibiotics to treat chest infections.A gastrostomy may be done to treat difficult swallowing.This is a surgically created opeing through which a permanent feeding tube is inserted directly into the stomach or the small intestines.Usually a team of specialists will be availble to provide support and care for an afected person and members of his/her family.Counselling may be offered to both and the affected person may be given physiotherapy to help keep joints and muscles supple
Symptoms: Mouth ulcers present as grey-white pits with a red border and may occur singly or in clusters anywhere in the mouth.Often excruciating for the first few days and particularly when you are chewing spicy,hot or acidic food.They are slightly more common is girls and women and sometimes run in families,suggesting that a genetic factor may be involved.These sores in the lining of the mouth is known as mouth ulcers or Aphthous ulcers and they can be extremely painful Causes: The cause of mouth ulcers are unknown,but they tend to occur in people who are run down, ill and are stress related.They can appear before menstruation in women.Injuries to the lining of the mouth caused by ill-fitting dentures,a roughened tooth or by careless tooth-brusing can also result in mouth ulcers.Rarely recurrent mouth ulcers may be linked to Anaemia,a deficiency of either Vit B12 or folic acid,an intestinal disorder such as Crohn's disease or coeliac disease or Behchet syndrome - a rare autoimmine disorder.Ulcers may also occur as a result of specific infections such as Herpes simplex infections.Very rarely and ulcer that enlarges slowly and does not heal may be mouth cancer Types of ulcers: - Aphthous Ulcers are usually small very painful, creamy-white and appear on the tongue, the gums or the lining of the mouth.A Traumatic Ulcer is larger and usually starts as a sore patch on the side of the inside of the cheeks,possibly after injury by biting or rubbing,White curd-like blisters could indicate - a Thrush infections and White painful blisters on the roof of the mouth, the gums or on the inside of the cheeks, can be the result of a primary infecton with the Cold Sore Virus Treatment: Mouth ulcers usually heal without treatment.Rinsing your mouth with a weak salt water solution can help heal the ulcers quicker.Over-the-counter preparations containing a corticosteroid to reduce the inflammation combined with a local anaesthetic are available in lozenge,gel and paste form,which sticks to most surfaces.If you have an ulcer that does not heal within three weeks,you should consult a doctor *also see under Herpes & Cold Sores*
Symptoms: The symptoms of Duchenne muscular dystrophy usually appear around the time a child would begin to walk.Late walking is common,often an affected child does not begin to walk until about 18 months and then will fall more frequently than other children.The more obvious symptoms may not appear until the child reaches age 3-5 and may include waddling gait,difficulty climbing stairs,difficulty getting up from the floor,characteristicalys using the hands to 'walk up' the tights,large calf muscles and wasted muscles at the tops of the legs and arms,mild learning disabilities - escpecially in the Becker type.The symptoms are progressive and a child may be unable to walk by the age of 12.The symptoms of Becker muscular dystrophy are similar but usually do not appear until about age 11 or later.The disease progresses more slowly,many of those affected are still able to walk until their late 20s or later Treatment: If your doctor suspects Muscular Dystrophy he may arrange for a blood test to look for evidence of muscle damage.Electromyography,which records electrical activity in muscle may be performed. A small piece of tissue may be removed under general anaesthesia for microscopic examination.Tests may be done to find out if the heart is affected,including recording electrical activity in the hearat (ECG) and ultrasound scanning.The treatment for muscular dystrophy is aimed at keeping a child mobile and active for as long as possible.A team of professionals such as a physical therapist,doctor and social worker can provide support for the whole family.Physical therapy is important to keep limits supple and supportive splints to keep limbs.Duchenne muscular dystrophy is usually fatal before the age of 20,the outlook in the Becker type is better,with affected people often surviving into their 40's
Symptoms: The symptoms usually develop suddenly and include:Severe heavy crushing pain - just like Angina,but worse in the centre of the chest spreading into the neck,teeth and into the arms - especially the left arm,sometimes centering on the elbow.Pale clammy skin & shortness of breath.Nausea and sometimes Vomiting,Anxiety,sometimes accompanied by a Fear of dying or Restlessness Warning: An episode of Angina that does not respond to your usual treatment or that lasts longer than 15min may be a heart attack and requires immediate emergency hospital treatment.About 1 in 5 people expericne no chest pain in a heart attack.However there may be other symptoms, such as breathlessness,faintness,sweating and pale skin.This pattern of symptoms is known as 'silent heart attacks' or 'silent infarction' Treatment & Diagnosis:An ECG - Electrocardiogram will show evidence of a heart attack.To confirm the diagnosis,blood samples may be taken to measure the levels of particular enzymes that leak into the blood from damaged heart muscle.The immediate aims of treatment are to relieve pain and restore blood supply to the heart muscle in order to minimize the amount of damage and prevent further complications.These aims are best achieved by immediate admission to an (ICU) Intensive Care Unit.You will be given an injection of a powerful painkiller, such as morphine,to relieve pain.To help minimize damage to your heart within the first 6hours of the attack, you may also be given a drug to dissolve the blood clot that is blocking the Coronary Artery.Alternatively, you may have immediate Coronary Angiplasty, to open the artery.If the blood flow to the damaged heart muscle can be restored within 6hours, there is a greater likelihood of full recovery.Once you have recovered from the attack,the condition of your Coronary Arteries and heart muscle is assessed.Tests such as exercise ECG and echocardiography are used to help decide on further treatment.If the pumping action of the heart is impaired, you may be prescribed and ACE inhibitor and / or a diuretic drug.If tests reveal that you have a persistent irregular heartbeat, you may need to have a Pacemaker implanted in your chest.Certian drugs taken long term can reduce the risk of another heart attack, and you may be prescribed a Beta-Blocker drug and / or aspirin for this reason.You may also be adviced to eat a low-fat diet and to take lipid-lowering drugs to lower your blood cholesterol level.These drugs are beneficial after a heart attack even if your cholesterol level is not elevated.If a Coronary Artery is blocked you may need Bypass Surgery Precaution: It is important to avoid becoming disabled by the fear of having another heart attack.Many hospitals offer ongoing cardiac rehabillitation programmes after discharge from the hospital.If you have not had a previous heart attack, if you are treated quickly and if there are no complications,your outlook is good.After two weeks the risk of another heart attack is considerably reduced.The prognosis is better if your STOP SMOKING,reduce ALCOHOL INTAKE, and follow a HEALTHY DIET and try to keep your weight within the ideal range,learn to relax with relaxation exercises and try to avoid stressful situaltions.You should be able to drive your car within 4 weeks, and resume having sexual intercourse aboaut 4 weeks after a heart attack.iogether with your doctor agree on a programme of increasing exeercise until you are able to engage in moderate exercise such as swimming regularly
info sources: South African Family Medical Adviser Family Health Guide & The Baby & Child Health Care Handbook - Dr.Miriam Stoppard
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