First, you’ll have what’s called a cardiac catheterization. Medication will be given to relax you, then the doctor will numb where the catheter will go with anesthesia.

Next, a thin plastic tube called a sheath is inserted into an artery — sometimes in your groin, sometimes in your arm. A long, narrow, hollow tube called a catheter is passed through the sheath and guided up a bloodvessel to the arteries surrounding the heart.

A small amount of contrast liquid is put into your blood vessel through the catheter. It’s photographed with an X-ray as it moves through your heart’s chambers, valves, and major vessels. From those pictures, doctors can tell if your coronary arteries are narrowed and, in some cases, whether the heart valves are working correctly.

If the doctor decides to perform angioplasty, he will move the catheter into the artery that’s blocked. He’ll then do one of the procedures described below.

The whole thing lasts from 1 to 3 hours, but the preparation and recovery can add much more time. You may stay in the hospital overnight for observation.

What Types of Procedures Are Used in Angioplasty?

There are several your doctor will choose from. They include:

Balloon: A catheter with a small balloon tip is guided to the narrowing in your artery. Once in place, the balloon is inflated to push the plaque and stretch the artery open to boost blood flow to the heart.

Stent: This is a small tube that acts as a scaffold to support the inside your coronary artery. A balloon catheter, placed over a guide wire, puts the stent into your narrowed coronary artery. Once in place, the balloon is inflated, and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed while the stent stays in place. Over several weeks, your artery heals around the stent.

These are often placed during angioplasty to help keep the coronary artery open. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time.

Some stents contain medicine and are designed to reduce the risk of the artery getting blocked again (your doctor may call that restenosis). The doctor will decide if this is the right stent for your blockage.

Rotablation: A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of the narrowing in your coronary artery. The tip spins at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed away in your bloodstream. This process is repeated as needed to improve blood flow.

This is rarely used because balloon angioplasty and stenting have much better results. They’re also easier for the cardiologist to perform.

Atherectomy: The catheter used here has a hollow cylinder on the tip with an open window on one side and a balloon on the other. When the catheter is put into the narrowed artery, the balloon is inflated, pushing the window against the plaque. A blade in the cylinder rotates and shaves off any plaque that protrudes into the window. The shavings are caught in the catheter chamber and removed. This process is repeated as needed to allow for better blood flow.

Like rotablation, this procedure isn’t used much.

Cutting balloon: This catheter has a special balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then the balloon presses the plaque against the artery wall.

Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest.

This condition is also known as systemic exertion intolerance disease (SEID) or myalgic encephalomyelitis (ME). Sometimes it’s abbreviated as ME/CFS.

The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress. Some experts believe chronic fatigue syndrome might be triggered by a combination of factors.

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. You may need a variety of medical tests to rule out other health problems that have similar symptoms. Treatment for chronic fatigue syndrome focuses on symptom relief.

Symptoms

Signs and symptoms may include:

• Fatigue
• Loss of memory or concentration
• Sore throat
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle or joint pain
• Headaches
• Unrefreshing sleep
• Extreme exhaustion lasting more than 24 hours after physical or mental exercise

When to see a doctor

Fatigue can be a symptom of many illnesses, such as infections or psychological disorders. In general, see your doctor if you have persistent or excessive fatigue.

Causes:

People who have chronic fatigue syndrome appear to be hypersensitive to even normal amounts of exercise and activity.

Why this occurs in some people and not others is still unknown. Some people may be born with a predisposition for the disorder, which is then triggered by a combination of factors. Potential triggers include:

• Viral infections. Because some people develop chronic fatigue syndrome after having a viral infection, researchers question whether some viruses might trigger the disorder. Suspicious viruses include Epstein-Barr virus, human herpes virus 6 and mouse leukemia viruses. No conclusive link has yet been found.
• Immune system problems. The immune systems of people who have chronic fatigue syndrome appear to be impaired slightly, but it’s unclear if this impairment is enough to actually cause the disorder
• Hormonal imbalances. People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands. But the significance of these abnormalities is still unknown.

Diagnosis:

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. Because the symptoms of chronic fatigue syndrome can mimic so many other health problems, you may need patience while waiting for a diagnosis.

Your doctor must rule out a number of other illnesses before diagnosing chronic fatigue syndrome. These may include:

• Sleep disorders. Chronic fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnea, restless legs syndrome or insomnia.
• Medical problems. Fatigue is a common symptom in several medical conditions, such as anemia, diabetes and underactive thyroid (hypothyroidism). Lab tests can check your blood for evidence of some of the top suspects.
• Heart and lung impairments. Problems with your heart or lungs can make you feel more fatigued. An exercise stress test can assess your heart and lung function.
• Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression, anxiety, bipolar disorder and schizophrenia. A counselor can help determine if one of these problems is causing your fatigue.

Treatment:

There is no cure for chronic fatigue syndrome. Treatment focuses on symptom relief.

Medications

Many people who have chronic fatigue syndrome are also depressed. Treating your depression can make it easier for you to cope with the problems associated with chronic fatigue syndrome. Low doses of some antidepressants also can help improve sleep and relieve pain.

Therapy

The most effective treatment for chronic fatigue syndrome appears to be a two-pronged approach that combines cognitive training with a gentle exercise program.

• Cognitive training. Talking with a counselor can help you figure out options to work around some of the limitations that chronic fatigue syndrome imposes on you. Feeling more in control of your life can improve your outlook dramatically.
• Graded exercise. A physical therapist can help determine what exercises are best for you. Inactive people often begin with range-of-motion and stretching exercises for just a few minutes a day. Gradually increasing the intensity of your exercise over time may help reduce your hypersensitivity to exercise, just like allergy shots gradually reduce a person’s hypersensitivity to a particular allergen.

Risk factors

Factors that may increase your risk of chronic fatigue syndrome include:

• Age. Chronic fatigue syndrome can occur at any age, but it most commonly affects people in their 40s and 50s.
• Sex. Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
• Stress. Difficulty managing stress may contribute to the development of chronic fatigue syndrome.

Complications:

Possible complications of chronic fatigue syndrome include:

• Depression
• Social isolation
• Lifestyle restrictions
• Increased work absences

High blood cholesterol is best known for its effects on your heart in the form of heart disease, heart attack and stroke. It can, however, cause leg pain as well when the arteries in your legs suffer from restricted blood flow; this condition is known as peripheral artery disease. Although your doctor may prescribe cholesterol-lowering medications, these may also contribute to the pain and discomfort you feel.

Peripheral Artery Disease

Peripheral artery disease–PAD–can result from atherosclerosis, or hardening of the arteries. Plaque, a substance made of fat, cholesterol and various elements in your blood, is the cause of this condition. As plaque builds in the walls of your arteries, they begin to narrow, restricting blood flow to various areas of your body. The most common complications are heart attack and stroke; PAD is another. Affecting your arms, legs and pelvis, PAD can lead to numbness, pain and infection in these areas, according to the National Heart Lung and Blood Institute.

Autism spectrum disorder (ASD), also known as just autism, is an umbrella term for a group of complex brain development disorders.

Unlike cerebral palsy, which mostly affects a child’s motor functioning, autism affects the normal development of the brain in areas such as social interaction, problem-solving and communication.

Causes and Risk Factors

Autism is a complex disorder that can be caused by an array of factors. ASDs have no single known cause, but there are at least three aspects that researchers agree contribute to the development of autism, including:

• Genetics
• Environmental factors
• Maternal illness during pregnancy

Genetics

There are several biological differences in children with ASDs compared to children who do not have autism. Some of these genes can affect brain development and the ways in which brain cells communicate. Some genetic problems appear to be inherited, while others can occur spontaneously.

Due to the relationship between genetics and autism, parents who have one child with autism have an increased risk that their next child will also have an ASD. Additionally, if you have two children with autism, the chances that your third child will have autism increase to about 35%.

Environmental Factors

Environmental factors have recently been recognized as a potential cause of autism. Researchers are currently investigating the connection between things such as viral infections and air pollutants and the subsequent development of autism.

Maternal Conditions

There are various maternal conditions or illnesses that have been tied to autism in children. These include diabetes, hypertension and obesity during pregnancy. Additionally, a mother’s use of drugs or alcohol while pregnant has been linked as a potential cause of autism in children.

Risk Factors For Developing Autism

Autism can affect individuals of every gender, race and socioeconomic status. However, there are certain aspects that can increase the likelihood that a child will develop an ASD.

Some risk factors that increase the chances of developing an ASD are:

• Family history – Families who have one child or more with an ASD have an increased risk of having a second or third child with the disorder.
• A child’s sex – Males are four times more likely to develop an ASD than females.
• The parent’s age – Children born to older parents have a higher chance of developing an ASD.
• A premature birth – Babies born before 26 weeks have an increased risk of developing an ASD.

Types of Autism Spectrum Disorders

Individuals with an ASD have different ways of learning, paying attention and reacting to sensations and situations. The comprehension and learning capabilities of individuals with an ASD can vary from being extremely gifted in one field to severely challenged in others.

The five general types of ASDs are:

• Autistic Disorder
• Asperger’s Syndrome
• Pervasive developmental disorder
• Rett syndrome
• Childhood disintegrative disorder

Autistic Disorder

Autistic disorder is a brain development disorder that is often present during early childhood. This type of ASD is characterized by difficulty communicating and forming relationships with others, as well as trouble grasping language and abstract concepts.

Signs of autistic disorder include:

• Failure to respond to his or her name, or not hearing people speaking to them
• Has poor eye contact and lacks facial expression
• Resists cuddling or holding and seems to prefer playing alone
• Delayed speech and language development
• Speaks with an abnormal tone or rhythm – may use a “singsong voice” or robot-like speech
• Performs repetitive movements, such as rocking, spinning or hand-flapping
• Being fascinated by details of an object, such as the wheels of a toy car, but doesn’t understand the “big picture” of the subject

Asperger’s Syndrome

Also referred to as Asperger’s disorder, Asperger’s syndrome is a developmental disorder that involves a delay in the development of many basic skills. While Asperger’s syndrome is similar to autistic disorder, there are a few distinct differences.

Children with Asperger’s syndrome are typically higher functioning than those with autism, and they usually have normal intelligence and language development.

Signs of Asperger’s syndrome include:

• Slow development of social skills
• Eccentric or repetitive behaviors, such as hand wringing or finger twisting
• Unusual preoccupations or rituals
• Limited range of interest
• Poor coordination
• Exceptional skills or talents, such as in music, art or math

Pervasive Development Disorder

Individuals who meet some, but not all, of the criteria for autistic disorder and Asperger’s syndrome may be diagnosed with Pervasive Development Disorder, or PDD. Children with PDD usually have fewer and milder symptoms of autistic behavior and development. The symptoms of PDD mostly cause challenges in regards to social interaction and communication.

Signs of Pervasive Development Disorder include:

• Difficulty with verbal communication and understanding spoken language
• Challenges exhibiting nonverbal gestures, such as hand motions and facial expressions
• Difficulty with social interaction, relating to others and their surroundings
• Repetitive body movements or patterns of behavior, such as spinning or head banging
• Temper tantrums
• Aggressive behavior
• Trouble sleeping or staying asleep
• Difficulty adjusting to changes in routine or familiar surroundings

Rett Syndrome

Rett syndrome is a rare neurological disorder that occurs almost exclusively in girls, however it is possible in boys as well. This condition can lead to severe impairments that affect nearly every aspect of a child’s life. Rett syndrome can hinder a child’s ability to speak, walk, eat and even breathe easily on their own. A distinct symptom associated with this syndrome is constant, repetitive hand movements.

Signs of Rett syndrome include:

• A slowing of head growth between 6 and 18 months of age
• Loss of muscle tone
• Habitually wringing or rubbing hands together
• Deteriorating language skills
• Development of extreme social anxiety or withdrawing from others
• A jerky, stiff-legged walk
• Uncoordinated breathing
• Seizures

Childhood Disintegrative Disorder (CDD)

Childhood disintegrative disorder, or Heller’s syndrome, is a rare condition characterized by a gradual decrease in development. Children with PDD usually show signs of a typical development up until the age of 3 or 4. Then, over usually a few months, children lose language, motor, social and other skills that they have already acquired. For example, a child who previously spoke in phrases of a few words will gradually or abruptly lose the ability to communicate altogether.

Signs of Childhood Disintegrative Disorder include:

• Delay or regression of spoken language
• Impairment in nonverbal behaviors
• Inability to start or maintain conversations
• Lack of bowel or bladder control
• Loss of motor skills
• Problems forming relationships with other children or family members

Conversely, goiter is often caused by — and a symptom of — hyperthyroidism in the United States, where iodized salt provides plenty of iodine.

Goiter can affect anyone at any age, especially in areas of the world where foods rich in iodine are in short supply. However, goiters are more common after the age of 40 and in women, who are more likely to have thyroid disorders. Other risk factors include family medical history, certain medication usage, pregnancy, and radiation exposure.

There might not be any symptoms if the goiter isn’t severe. The goiter may cause one or more of the following symptoms if it grows large enough, depending on the size:

• swelling or tightness in your neck
• difficulties breathing or swallowing
• coughing or wheezing
• hoarseness of voice

Symptoms

The degree of swelling and the severity of symptoms produced by the goiter depends on the individual.

Most goiters produce no symptoms. When symptoms do occur, the following are most common:

• throat symptoms of tightness, cough, and hoarseness
• trouble swallowing
• in severe cases, difficulty breathing, possibly with a high-pitch sound

Other symptoms may be present because of the underlying cause of the goiter, but they are not because of the goiter itself. For example, an overactive thyroid can cause symptoms such as:

• nervousness
• palpitations
• hyperactivity
• increased sweating
• heat hypersensitivity
• fatigue
• increased appetite
• hair loss
• weight loss

In cases where goiter is a result of hypothyroidism, the underactive thyroid can cause symptoms such as:

• cold intolerance
• constipation
• forgetfulness
• personality changes
• hair loss
• weight gain

Aside from the swelling itself, many people with goiter present no symptoms or signs at all.

Causes

Goiter can be caused by a number of different conditions:

Iodine deficiency:

Iodine deficiency is the major cause of goiter worldwide, but this is rarely a cause in more economically developed countries where iodine is routinely added to salt.

As iodine is less commonly found in plants, vegan diets may lack sufficient iodine. This is less of a problem for vegans who live in countries such as the United States that add iodine to salt.

Dietary iodine is found in:

• seafood
• plant food grown in iodine-rich soil
• cow’s milk

In some parts of the world, the prevalence of goiters can be as high as 80 percent, such as in the remote mountainous regions of southeast Asia, Latin America, and central Africa. In these places, daily intake of iodine can fall below 25 micrograms (mcg) per day, and children are often born with hypothyroidism.

The thyroid gland needs iodine to manufacture thyroid hormones, which regulate the metabolism.

Other causes

Less common causes of goiter include the following:

• Smoking: Thiocyanate in tobacco smoke interferes with iodine absorption.
• Hormonal changes: Pregnancy, puberty, and menopause can affect thyroid function.
• Thyroiditis: Inflammation caused by infection, for example, can lead to goiter.
• Lithium: This psychiatric drug can interfere with thyroid function.
• Overconsumption of iodine: Too much iodine can cause a goiter.
• Radiation therapy: This can trigger a swollen thyroid, particularly when administered to the neck.

Goiter diagnosis and treatment

Your doctor will feel your neck area and have you swallow during a routine physical exam. Blood tests will reveal the levels of thyroid hormone, TSH, and antibodies in your bloodstream. This will diagnose thyroid disorders that are often a cause of goiter. An ultrasound of the thyroid can check for swelling or nodules.

Goiter is usually treated only when it becomes severe enough to cause symptoms. You can take small doses of iodine if goiter is the result of iodine deficiency. Radioactive iodine can shrink the thyroid gland. Surgery will remove all or part of the gland. The treatments usually overlap because goiter is often a symptom of hyperthyroidism.

Goiters are often associated with highly treatable thyroid disorders, such as Graves’ disease. Although goiters aren’t usually a cause for concern, they can cause serious complications if they’re left untreated. These complications can include difficulty breathing and swallowing.

• A urinary tract infection (UTI) is an infection that occurs when bacteria enters into any part of the urinary tract, including the kidneys, ureters, bladder, or urethra.
• Risk factors for urinary tract infections include being female, menopause, wiping from back to front after a bowel movement, sexual intercourse, some types of birth control, douches, diabetes, urinary catheters, kidney stones, genitourinary surgery, or structural abnormalities of the urinary tract.
• UTI symptoms and signs include
  • pain or burning when urinating,
  • frequent urination,
  • sudden urge to urinate,
  • frequent urge to urinate without much urine passing, and
  • urine that is milky/cloudy/bloody/foul smelling.
• See a health-care provider for diagnosis because some types of UTIs can be serious to life-threatening conditions.
• UTIs are usually treated with antibiotics.
• Most cases of UTIs go away with treatment, but in some cases, people may have recurrent urinary tract infections.
• Serious UTIs may lead to scarring of the urinary tract or pyelonephritis (kidney infection).

What Is the Definition of a Urinary Tract Infection (UTI)?

 A urinary tract infection is an infection that can occur in any area of the urinary tract, including the ureters, bladder, kidneys, or urethra. Bladder infections (cystitis) and urethra infections (urethritis) are most common.

Picture of the urinary tract

Urinary tract infections can be categorized as either simple or complicated.

• Simple UTIs occur in healthy people with normal urinary tracts. This is the type of UTI that occurs most frequently in women.
• Complicated UTIs occur in individuals with abnormal urinary tracts or when underlying medical conditions make treatment failure more likely. Men and children are more likely to have this type of UTI.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling and complex illness.

People with ME/CFS are often not able to do their usual activities. At times, ME/CFS may confine them to bed. People with ME/CFS have overwhelming fatigue that is not improved by rest. ME/CFS may get worse after any activity, whether it’s physical or mental. This symptom is known as post-exertional malaise (PEM). Other symptoms can include problems with sleep, thinking and concentrating, pain, and dizziness. People with ME/CFS may not look ill. However,

• People with ME/CFS are not able to function the same way they did before they became ill.
• ME/CFS changes people’s ability to do daily tasks, like taking a shower or preparing a meal.
• ME/CFS often makes it hard to keep a job, go to school, and take part in family and social life.
• ME/CFS can last for years and sometimes leads to serious disability.
• At least one in four ME/CFS patients is bed- or house-bound for long periods during their illness.

Anyone can get ME/CFS. While most common in people between 40 and 60 years old, the illness affects children, adolescents, and adults of all ages. Among adults, women are affected more often than men. Whites are diagnosed more than other races and ethnicities. But many people with ME/CFS have not been diagnosed, especially among minorities.

Scientists have not yet identified what causes myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). It is possible that ME/CFS has more than one cause, meaning that patients with ME/CFS could have illness resulting from different causes (see below). In addition, it is possible that two or more triggers might work together to cause the illness.

Some of the areas that are being studied as possible causes of ME/CFS are:

Primary Symptoms:

Also called “core” symptoms, these occur in most patients with ME/CFS. The three primary symptoms required for diagnosis are:

• Greatly lowered ability to do activities that were usual before the illness. This drop in activity level occurs along with fatigue and must last six months or longer. People with ME/CFS have fatigue that is very different from just being tired. The fatigue of ME/CFS:
  • Can be severe.
  • Is not a result of unusually difficult activity.
  • Is not relieved by sleep or rest.
  • Was not a problem before becoming ill (not life-long).
• Worsening of ME/CFS symptoms after physical or mental activity that would not have caused a problem before illness. This is known as post-exertional malaise (PEM). People with ME/CFS often describe this experience as a “crash,” “relapse,” or “collapse.” It may take days, weeks, or longer to recover from a crash. Sometimes patients may be house-bound or even completely bed-bound during crashes. People with ME/CFS may not be able to predict what will cause a crash or how long it will last. As examples:

• Attending a child’s school event may leave someone house-bound for a couple of days and not able to do needed tasks, like laundry.
• Shopping at the grocery store may cause a physical crash that requires a nap in the car before driving home or a call for a ride home.
• Taking a shower may leave someone with severe ME/CFS bed-bound and unable to do anything for days.

• Sleep problems. People with ME/CFS may not feel better or less tired, even after a full night of sleep. Some people with ME/CFS may have problems falling asleep or staying asleep.

In addition to these core symptoms, one of the following two symptoms is required for diagnosis:

• Problems with thinking and memory. Most people with ME/CFS have trouble thinking quickly, remembering things, and paying attention to details. Patients often say they have “brain fog” to describe this problem because they feel “stuck in a fog” and not able to think clearly.
• Worsening of symptoms while standing or sitting upright. This is called orthostatic intolerance. People with ME/CFS may be lightheaded, dizzy, weak, or faint while standing or sitting up. They may have vision changes like blurring or seeing spots.

Other Common Symptoms:

Many but not all people with ME/CFS have other symptoms.

Pain is very common in people with ME/CFS. The type of pain, where it occurs, and how bad it is varies a lot. The pain people with ME/CFS feel is not caused by an injury. The most common types of pain in ME/CFS are:

• Muscle pain and aches
• Joint pain without swelling or redness
• Headaches, either new or worsening

Some people with ME/CFS may also have:

• Tender lymph nodes in the neck or armpits
• A sore throat that happens often
• Digestive issues, like irritable bowel syndrome
• Chills and night sweats
• Allergies and sensitivities to foods, odors, chemicals, or noise

Treatments:

There is no cure or approved treatment for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). However, some symptoms can be treated or managed. Treating these symptoms might provide relief for some patients with ME/CFS but not others. Other strategies, like learning new ways to manage activity, can also be helpful.

1.Depression, Stress, and Anxiety