Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia.

The hiatus is an opening in the diaphragm — the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia(also called hiatus hernia) the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become “strangled,” or have its blood supply shut off.

Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

People with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. That’s why it’s so important to undergo testing and get properly diagnosed.

What Causes a Hiatal Hernia?

Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from pregnancy, obesity, coughing, or straining during bowel movements may also play a role.

Who Is at Risk for Hiatal Hernia?

Hiatal hernias occur more often in women, people who are overweight, and people older than 50.

How Is a Hiatal Hernia Diagnosed?

A hiatal hernia can be diagnosed with a specialized X-ray (using a barium swallow) that allows a doctor to see the esophagus or with endoscopy.

How Are Hiatal Hernias Treated?

Most people do not experience any symptoms of their hiatal hernia so no treatment is necessary. However, the paraesophageal hernia (when part of the stomach squeezes through the hiatus) can sometimes cause the stomach to be strangled, so surgery is sometimes recommended. Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated.Symptoms of GERD, such asheartburn, should be treated.

When Is Hiatal Hernia Surgery Necessary?

If the hiatal hernia is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.

Hiatal hernia surgery can often be performed as a laparoscopic, or “minimally invasive,” procedure. During this type of surgery, a few small (5 to 10 millimeter) incisions are made in the abdomen. The laparoscope that allows the surgeon to see inside the abdomen and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs to a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.

What Is Gout?

Gout is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid and crystallization of these compounds in joints can cause attacks of painful arthritis, kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history.

Symptoms of Gout

Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. The small joint at the base of the big toe is the most common site for an attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. In some people, the acute pain is so intense that even a bed sheet touching the toe causes severe pain. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most people with gout will experience repeated bouts over the years.

 

Risk Factors for Gout

Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

How Are Gout Attacks Prevented?

Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.

Treating Gout with Medications

Certain medications reduce the pain and inflammation of gout attacks, such as anti-inflammatory drugs (ibuprofen and others), colchicine, and corticosteroids. Other medications decrease the level of uric acid in the blood and prevent the deposit of uric acid in joints (gouty arthritis), the kidneys (stones), and in tissue (tophi), helping to prevent further attacks and complications. These drugs include allopurinol, febuxostat, lesinurad, and probenicid.

Schizophrenia most commonly strikes between the ages of 16 and 30, and males tend to show symptoms at a slightly younger age than females. In many cases, the disorder develops so slowly that the individual does not know that they have had it for many years. However, in other cases, it can strike suddenly and develop quickly.

Schizophrenia affects approximately 1 percentof all adults, globally. Experts say schizophrenia is probably many illnesses masquerading as one.

Some research suggests that schizophrenia may be the result of faulty neuronal development in the brain of the fetus, which later in life emerges as a full-blown illness.

Individuals with schizophrenia may hear voices that are not there. Some may be convinced that others are reading their minds, controlling how they think, or plotting against them. This can distress patients severely and persistently, making them withdrawn and, at times, frantic.

Symptoms of schizophrenia

A sizable proportion of people with schizophrenia have to rely on others because they are unable to hold a job or care for themselves. Many may also resist treatment, arguing that there is nothing wrong with them.

Some patients may present clear symptoms, but on other occasions, they may seem fine until they start explaining what they are truly thinking. The effects of schizophrenia reach far beyond the patient – families, friends, and society are affected too.

Symptoms and signs of schizophrenia will vary, depending on the individual.

The symptoms are classified into four categories:

• Positive symptoms – also known as psychotic symptoms. For example, delusions and hallucinations.
• Negative symptoms – these refer to elements that are taken away from the individual. For example, absence of facial expressions or lack of motivation.
• Cognitive symptoms – these affect the person’s thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
• Emotional symptoms – these are usually negative symptoms, such as blunted emotions.

Below is a list of the major symptoms:

• Delusions – the patient displays false beliefs, which can take many forms, such as delusions of persecution, or delusions of grandeur. They may feel others are attempting to control them remotely. Or, they may think they have extraordinary powers and abilities.
• Hallucinations – hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, however, people with schizophrenia may experience a wide range of hallucinations.
• Thought disorder – the person may jump from one subject to another for no logical reason. The speaker may be hard to follow or erratic.

Other symptoms may include:

• Lack of motivation (avolition) – the patient loses their drive. Everyday actions, such as washing and cooking, are neglected.
• Poor expression of emotions – responses to happy or sad occasions may be lacking, or inappropriate.
• Social withdrawal – when a patient with schizophrenia withdraws socially, it is often because they believe somebody is going to harm them.
• Unawareness of illness – as the hallucinations and delusions seem so real for patients, many of them may not believe they are ill. They may refuse to take medication for fear of side effects, or for fear that the medication may be poison, for example.
• Cognitive difficulties – the patient’s ability to concentrate, recall things, plan ahead, and to organize their life are affected. Communication becomes more difficult.

What are the causes schizophrenia?

fig: looks images in both sides of eye becomes more dark

Experts believe several factors are generally involved in contributing to the onset of schizophrenia.

Evidence suggests that genetic and environmental factors act together to bring about schizophrenia. The condition has an inherited element, but environmental triggers also significantly influence it.

Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:

Genetic inheritance

If there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent. However, that risk rises to 10 percent if a parent was diagnosed.

Chemical imbalance in the brain

Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. Other neurotransmitters, such as serotonin, may also be involved.

Family relationships

There is no evidence to prove or even indicate that family relationships might cause schizophrenia, however, some patients with the illness believe family tension triggers relapses.

Environmental factors

Although there is no definite proof, many suspect trauma before birth and viral infections may contribute to the development of the disease.

Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocused. This can trigger relationship problems, divorce, and unemployment.

These factors are often blamed for the onset of the disease, when really it was the other way round – the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.

Drug induced schizophrenia

Marijuana and LSD are known to cause schizophrenia relapses. Additionally, for people with a predisposition to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode.

Some researchers believe that certain prescription drugs, such as steroids and stimulants, can cause psychosis.

Treatments for schizophrenia

With proper treatment, patients can lead productive lives. Treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life.

Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of:

• medication
• psychological counseling
• self-help resources

Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in a hospital.

The most common schizophrenia medications are:

• Risperidone (Risperdal) - less sedating than other atypical antipsychotics. Weight gain and diabetes are possible side effects, but are less likely to happen, compared with Clozapine or Olanzapine.
• Olanzapine (Zyprexa) – may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
• Quetiapine (Seroquel) – risk of weight gain and diabetes, however, the risk is lower than Clozapine or Olanzapine.
• Ziprasidone (Geodon) – the risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia.
• Clozapine (Clozaril) – effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors in patients with schizophrenia. The risk of weight gain and diabetes is significant.
• Haloperidol – an antipsychotic used to treat schizophrenia. It has a long-lasting effect (weeks).

The primary schizophrenia treatment is medication. Sadly, compliance (following the medication regimen) is a major problem. People with schizophrenia often come off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them.

The patient must continue taking medication even when symptoms are gone. Otherwise they will come back.

The first time a person experiences schizophrenia symptoms, it can be very unpleasant. They may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a person living with schizophrenia receives the full support of their family, friends, and community services when onset appears for the first time.

What Is Polyarteritis Nodosa?

What Are the Symptoms of Polyarteritis Nodosa?

What Are the Causes of Polyarteritis Nodosa?

CAUSES OF HEARING LOSS IN ADULTS:

Hearing loss in adults has many causes such as, exposure to noise, disease or infection, ototoxic drugs, tumors, trauma and the aging process. Some examples of causes of hearing loss in adults are described below:

Presbycusis

Presbycusis is the most common cause of sensory hearing loss in the adult population. This loss is caused by some degenerative changes (in the auditory system) associated with the aging process. The hearing loss is progressive in nature with the high frequencies affected first. While the process begins after age 20-30, it is often at ages 55 to 65 that the high frequencies in the speech range begin to be affected.

Noise-Induced Hearing Loss

This is the second most common cause of acquired sensorineural hearing loss. Prolonged exposure to loud noise causes damage to the hair cells in the cochlea and results in this type of permanent hearing loss. The noise-induced hearing loss usually develops gradually and painlessly. Sometimes the hearing loss can occur as a result of an acoustic trauma, or a single exposure or very few exposures to very high levels of sound. When this happens, a complete breakdown of the Organ of Corti in the inner ear occurs. When the hair cells become damaged from prolonged exposure to loud noises such as music, machines, motors and other noise producing equipment or to a single but very loud noise exposure such as gunfire or an explosion, they are unable to be stimulated properly by an incoming sound signal. Once these hair cells have become damaged there is no way for them to be repaired.

Otitis Media

This is the condition often referred to as an ear infection. When otitis media occurs, fluid accumulates behind the eardrum in the middle ear space. This space is normally air filled in a healthy ear. The fluid arises because of the inability of the Eustachian tube to adequately function and keep the pressure equalized to atmospheric pressure in the middle ear space. The Eustachian tube dysfunction can be the result of allergies, infection in the upper respiratory tract.

Otosclerosis

This is a progressive ear disease involving the middle ear bony capsule, specifically affecting the movement of the stapes (one of the three small bones in the middle ear).

Meniere’s Disease

This is an inner ear disease and is characterized by progressive fluctuating sensorineural hearing loss, vertigo (dizziness) , and tinnitus (ringing in the ear).

Ototoxic Drugs

Drugs used to treat some diseases are damaging to the auditory system (ototoxic) and cause hearing loss. The more common drugs that are particularly toxic to the ear are certain antibiotics (such as Streptomycin, Kanamycin, Neomycin), Salicylates in large quantities (drugs containing aspirin), and quinine. Some drugs used in chemotherapy regimens are reported to be ototoxic. The damage caused by these drugs often depends on the dose administered and length of time used and is usually permanent.

Acoustic Neuroma

This is an example of a tumor that causes sensorineural hearing loss. Acoustic neuromas arise in the 8th cranial nerve (acoustic nerve). The first symptom could be a unilateral hearing loss, tinnitus in one ear, or vertigo.

Trauma

Trauma can cause a conductive, sensorineural or even a mixed hearing loss. Damage can occur to the as a result of trauma to the ear itself or to the side of the head. Examples include fractures of the temporal bone, puncture of the ear drum by foreign objects, , and sudden changes in air pressure.

Sudden Hearing Loss

This is an abrupt loss of hearing. Sudden hearing loss of known causes may be due to drugs, trauma, infection, or disease. There are, however, many instances when no cause can be found. There are two theories as to what happens in these cases: Vascular Occlusion which is the abrupt interference of blood supply to the cochlea and Viral Labrynthitis (viral infection of the inner ear), which produces damage to the inner ear structures.

SYMPTOMS OF HEARING LOSS:

Why is folic acid important?

Vitamin B9 includes both folate and folic acid and is important for several functions in the body.

Folic acid is vital for making red blood cells, as well as:

• the synthesis and repair of DNA and RNA
• aiding rapid cell division and growth
• enhancing brain health, although the evidence is mixed and more research is needed
• age-related hearing loss

It is particularly important for women who are pregnant to consume enough folic acid. This helps prevent the fetus from developing major congenital deformities of the brain or spine, including neural tube defects, such as spina bifida and anencephaly.

Women planning to get pregnant should take folic acid supplements for a full year before conception to reduce the risk of these developments.

Folic acid is thought to play a preventive role in a range of conditions.

Types of diseases which causes by deficiency of Folic acid as follows:

Autism

A recent study connected folic acid deficiency with autism. The investigators concluded: “Periconceptional folic acid [before conception and during early pregnancy] may reduce [autism spectrum disorder] risk in those with inefficient folate metabolism.”

Cleft lip and palate

A literature review carried out in 2014 concluded that folic acid supplementation might reduce the risk of a cleft palate.

Rheumatoid arthritis

Folic acid is often used to support a methotrexate prescription for rheumatoid arthritis.

Methotrexate is an effective medicine for this condition. However, it is also known to remove folate from the body. This can cause gastrointestinal symptoms for between 20 and 65 percent of people who use the drug.

However, folic acid supplements have been shown to reduce the gastrointestinal side effects of methotrexate by 79 percent. Speak to a doctor for recommendations on how much to take, and how often. 1 milligram (mg) per day is often prescribed.

Deficiency

Folic acid deficiency occurs when not enough folate or folic acid is present in the body.

Aside from anemia and congenital deformities, folic acid deficiency can result in other health problems, including:

• a higher risk of developing clinical depression
• possible problems with memory and brain function
• a higher risk of potentially developing allergic diseases
• a higher potential long-term risk of lower bone density

The Medical Journal of Australia advised in January 2011 that the prevalence of folate deficiency in the country had dropped considerably since introducing the compulsory fortification of wheat flour in breadmaking.

Deficiency anemia

Individuals can develop folic acid deficiency anemia if they do not consume enough folic acid.

As folate is important for producing and maintaining red blood cells, inadequate levels can mean that there are not enough red blood cells to supply the body with a healthy level of oxygen.

This condition can appear in people who require higher quantities of folate and are not taking supplements, such as women who are pregnant and lactating.

Folic acid deficiency anemia can occur in people with underlying conditions, such as sickle cell anemia. It can also affect people with conditions that affect folate absorption. Alcohol abuse or kidney disease can reduce the ability of the body to effectively absorb folate.

Some medications, such as those used for treating rheumatoid arthritis, cancer, and seizures, may increase the risk of folic acid deficiency anemia.

The signs and symptoms of folic acid deficiency disease include:

• fatigue
• feeling weak
• sores around the mouth
• memory and cognition difficulties
• irritable mood
• loss of appetite
• weight loss

People with folic acid deficiency anemia are given folic acid pills for daily use. Once folate levels return to normal, the body can produce enough blood cells to allow normal function.

Side effects

There are no serious side effects when taking folic acid. In rare cases, individuals report an upset stomach.

Even if a person takes more folate than needed, there is no cause for concern. Because folic acid is water-soluble, any excess will be naturally passed in urine.

Who should take it?

All women who are pregnant or planning to become pregnant should consume more folic acid, according to March of Dimes, a research organization focused on preventing deformity and death in newborn infants.

They also recommend that women take folic acid before getting pregnant as well as during the first 4 weeks following conception.

Every woman capable of getting pregnant should be taking daily folic acid supplements. Women over the age of 14 years should take 400 micrograms (mcg) per day, and this should increase to 600 mcg during a pregnancy.

Women should maintain a daily intake of 500 mcg.

Multiple Sclerosis – Literally, “many hardenings,” MS is a disease of unknown cause that manifests as multiple hard plaques of degeneration of the insulating layer of nerve fibers in the central nervous system. The loss of insulation allows “short circuiting” of nerve impulses. Depending upon where the degeneration occurs, patients may suffer paralysis, sensory disturbances or blindness.

Cerebrovascular accident (CVA) – the fancy name for a “stroke”. A blood vessel in the brain may burst causing internal bleeding. Or, a clot may arise in a brain blood vessel (a thrombus), or arise elsewhere (embolus) and travel to get stuck in a brain vessel which then deprives brain tissue of oxygen. Depending upon the area of the brain involved, the patient may suffer paralysis, loss of speech or loss of vision.

Transient Ischemic Attack (TIA) – “Ischemia” was introduced previously in the circulatory diseases module referring to the heart. It literally means “not quite enough blood”. A short period of insufficient blood supply to the brain can have the same signs and symptoms as a stroke such as weakness in an arm, a partial loss of vision, but the problem lasts less than 24 hours. People who get TIA’s are at increased risk of having a stroke in the future.

Epilepsy – a Greek word for “seizure.” Convulsions is another term used. Seizures may have many causes and not all seizures are epilepsy. High fevers in young children may trigger seizures which are short in duration, easily controlled and, typically, have no permanent aftereffects. Epilepsy is a specific condition which may occur at any age, seizures are more intense, longer lasting in duration, and recur with some frequency. The condition may be controlled with medication, or if unresponsive to drugs, may require surgery.

Aphasia – loss of speech. The speech centers are located on the left side of the brain in a majority of people. If someone suffers a “stroke” (cerebrovascular accident-CVA), or traumatic brain injury, and it involves the left side of the brain, they may suffer speech impediments that vary over a spectrum of problems from difficulty in finding the right word, speaking slowly and with difficulty, or complete loss of speech. Actually, there are two speech centers. Injury described above involves the motor speech area, the area of the brain that produces language by integrating thoughts of speech with the movements of the larynx, lips and tongue. There is a second speech area, the receptive or sensory area, that enables us to understand speech. Injury to the latter results in still fluent speech, but the individual does not understand what they are hearing.

 

Anencephaly occurs early in the development of an unborn baby. It results when the upper part of the neural tube fails to close. Why this happens is not known. Possible causes include environmental toxins and low intake of folic acid by the mother during pregnancy

Causes:

Anencephaly is one of the most common neural tube defects. Neural tube defects are birth defects that affect the tissue that grows into the spinal cord and brain.

Anencephaly occurs early in the development of an unborn baby. It results when the upper part of the neural tube fails to close. Why this happens is not known. Possible causes include environmental toxins and low intake of folic acid by the mother during pregnancy.

Anencephaly occurs in about 1 out of 10,000 births. The exact number is unknown, because many of these pregnancies result in miscarriage. Having one infant with this condition increases the risk of having another child with neural tube defects.