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Breast Cancer and Work

2008-08-07T03:22:00.001-07:00

Breast Cancer and Work

Knowing Your Rights, Telling Colleagues, Taking Accommodations

From Betsy Lee-Frye, for About.com

(LifeWire) - A cancer diagnosis can be terrifying on so many levels, not the least of which is how the disease and treatment will affect an individual's ability to work. Not only is income a necessity, but often, so is the health insurance provided by the employer. Before divulging the diagnosis, take the time to research the company's policies, including medical leave and flex time. It may also make sense to find an office mentor who has already navigated the maze of accommodations and disability pay.

Telling the Boss and Colleagues

Typically, sharing life news with those at work isn't difficult, but when talking about a breast cancer diagnosis, the words can get caught in your mouth.

First, don't rush it. There is no reason to talk to the boss or colleagues so soon after receiving the news. Wait until it feels as comfortable as possible.

There is no right or wrong way to divulge a cancer diagnosis. Some people might feel more comfortable talking to their boss or supervisor first, avoiding the miscommunication that can stem from the office gossip mill. Consider setting up a meeting or a lunch, so you can be sure to have his full attention. Also, remember that discussions between a boss and employee are protected. A supervisor has a legal obligation to keep the information private. However, co-workers do not have the same obligation.

Talking to colleagues about a cancer diagnosis isn't a necessity; however, co-workers can be an unexpected source of support. According to a survey of human resources managers conducted by the International Foundation of Employee Benefit Plans, a nonprofit organization based in Brookfield, Wisconsin, colleagues often organized volunteer support for those with breast cancer. Twenty-seven percent of the office managers surveyed said co-workers had provided personal assistance to the woman with breast cancer, 19% organized a fundraising campaign and 15% donated vacation days.

Be prepared for questions. Colleagues might inquire about treatment plans and side effects. Don't feel obligated to share information you'd rather keep private. A supervisor or boss might want to know what accommodations might be necessary. The American Cancer Society suggests having a plan in mind before talking to your boss. But for those who aren't sure yet, don't be afraid to simply say, "I'm don't know yet. Can I get back to you?"

Asking for Accommodations

Employers are required by federal law to provide "reasonable accommodations" for anyone with a disability. According to the Americans with Disabilities Act (ADA), cancer qualifies as a disability when the disease or its effects of treatment hinder an individual's "major life activities." See the following section for more about the qualifications of cancer as a disability.

These accommodations can vary greatly, depending on a person's need. According to the U.S. Equal Employment Opportunity Commission (EEOC), examples of accommodations include:

    * Time off for physician appointments and to recover from treatment
    * Short breaks during the workday to rest and recover
    * An altered work schedule
    * Temporarily assigning some job tasks to another employee
    * Changes to the workplace environment, such as temperature changes or workstation changes to insure comfort
    * A work-from-home arrangement

According to the EEOC, the word reasonable is key. Employees with breast cancer can't make requests of their employer that would cause them "undue hardship." The term "undue hardship" is different for every company. But according to a 2006 survey conducted by the University of Iowa's Law, Health, Policy and Disability Center, nearly 75% of employers reported that accommodations for individuals with any disability, not just cancer, cost them less than $500 per year.

The International Foundation of Employee Benefit Plans' survey, which focused on women working with breast cancer, found that employers were typically more than willing to provide accommodations. With regard to scheduling, the survey reported that about 85% allowed an employee with breast cancer to reduce her hours, 79% permitted a flexible schedule, 47% made telecommuting an option for the employee and 62% agreed to short breaks during the day for resting and recovering.

Employers said they also made arrangements to alter the employee's workload, including assigning different work (58%), altering deadlines or other previously agreed upon schedules (60%) and job sharing (28%).

Legal Rights: Disability and FMLA

Under the ADA, cancer qualifies on a case-by-case basis. The act protects individuals from losing their jobs due to disability and sets guidelines for employers regarding required accommodations. The U.S. EEOC, which enforces the ADA, offers the following example of a woman with breast cancer who would qualify for job protection under the act.

"Following a lumpectomy and radiation for aggressive breast cancer, a computer sales representative experienced extreme nausea and constant fatigue for six months. She continued to work during her treatment, although she frequently had to come in later in the morning, work later in the evening to make up the time, and take breaks when she experienced nausea and vomiting. She was too exhausted when she came home to cook, shop or do household chores and had to rely almost exclusively on her husband and children to do these tasks. This individual's cancer is a disability because it substantially limits her ability to care for herself."

If you feel your rights have been violated or you've been dismissed from a job due to your diagnosis, you need to file a charge "within 180 days of the alleged discriminatory action," according to the EEOC. The EEOC can be reached at (800) 669-4000.

Many companies offer disability pay for seriously ill or injured employees, but often these plans require an employee contribution. Talk to a human resources representative about disability pay and how to collect if your employer offers a plan.

The Family Medical Leave Act (FMLA) of 1993 also protects the jobs of people with a cancer diagnosis. However, not everyone qualifies for FMLA protection. An employee must have worked for the employer for at least 12 months prior to the FMLA request and have worked more than 1,250 hours in that calendar year. In addition, employers who have fewer than 50 employees do not have to follow FMLA regulations.

If protected by the FMLA, you can to take up to 12 weeks of unpaid leave from work. The act allows employees with serious medical illness, such as breast cancer, to use their leave "intermittently." This means an employee could take off 1 day each week or take 2 weeks off to recover from surgery, while saving the remaining weeks to use during radiation or chemotherapy treatments.

Hemoptysis

2008-01-17T17:48:00.000-08:00

Overview

Hemoptysis (which is pronounced he-MOP-tis-is) is coughing up blood from the respiratory tract. Blood can come from the nose, mouth, throat, the airway passages leading to the lungs, or the lungs. The word "hemoptysis" comes from the Greek "haima," meaning "blood," and "ptysis," which means "a spitting".

Blood-tinged mucus in a healthy nonsmoker usually indicates a mild infection. Indeed, the most common cause for coughing up blood is the least serious—a ruptured small blood vessel caused by coughing and/or a bronchial infection.

In patients with a history of smoking and those who are otherwise at risk for lung disease, however, hemoptysis is often a sign of serious illness. Serious conditions that can cause hemoptysis include bronchiectasis (chronic dilation and infection of the bronchioles and bronchi), pulmonary embolus (a clogged artery in the lungs that can lead to tissue death), pneumonia (a lung infection), and tuberculosis.

Hemoptysis can also result from inhaling a foreign body (e.g., particle of food) that ruptures a blood vessel. Whatever the suspected cause, hemoptysis should always be reported to a physician.

Hemoptysis refers specifically to blood that comes from the respiratory tract. Blood also may come from the nose, the back of the throat, or part of the gastrointestinal tract. When blood originates outside of the respiratory tract, the condition is known as "pseudohemoptysis." Vomiting up blood, medically known as hematemesis, is one type of pseudohemoptysis. Differentiating between hemoptysis and hematemesis is an integral part of diagnosis. Since they involve different parts of the body, treatments and prognose (prospect of recovery) are not the same.

Classifying hemoptysis as mild or massive (some practitioners classify it as trivial, moderate, or massive) is difficult because the amount of blood is often hard to accurately quantify. Life-threatening, "massive" hemoptysis, which requires immediate medical attention, is differentiated from less severe cases.

Massive hemoptysis
Hemoptysis is considered massive, or major, when there is so much blood that it interrupts breathing (generally more than about 200-240 mL, or about 1 cup, in 24 hours). Massive hemoptysis is a medical emergency: the mortality rate for patients with massive hemoptysis can be as high as 75%. Most patients who die from hemoptysis suffer from asphyxiation (lack of oxygen) due to too much blood in the airways.

Mild hemoptysis
If there is a small amount of blood or sputum streaked with blood, the spitting is considered mild hemoptysis. In 60% to 70% of mild hemoptysis cases, the underlying disorder is benign and disappears on its own without causing serious problems or permanent damage.

Even mild hemoptysis can result in critical breathing problems,
depending on the underlying cause for the bleeding. Additionally,
hemoptysis tends to occur intermittently and recur sporadically, and
there is no way to predict if patients with mild hemoptysis are at risk
for massive hemoptysis. Diagnosis is important to prevent a more
serious condition.

Mesothelioma Facts & FAQs What is mesothelioma?

2007-12-10T22:12:00.000-08:00

Mesothelioma Facts & FAQs

What is mesothelioma?
Mesothelioma is a cancer of the cells that make up the lining around the outside of the lungs and inside of the ribs (pleura), or around the abdominal organs (peritoneum).

What does asbestos have to do with mesothelioma?
The only known cause of mesothelioma in the U.S. is previous exposure to asbestos fibers. Asbestos manufacturers knew about the hazards of asbestos seventy years ago - but they kept this knowledge to themselves. The first warnings to workers exposed to asbestos were given in the mid-1960s, and they were terribly inadequate. Even today, workers are not always told they are working around asbestos and are at risk for asbestos disease.

What can someone with mesothelioma do?

Seek out the best and most up-to-date information.

Seek out the best medical care.

Early screening for mesothelioma diagnosis.

Stay in close contact with your doctor.

Consider whether or not you want to bring a lawsuit because of this asbestos-related injury.

Remember that resources are available to you through community and medical support groups, asbestos victims’ organizations, your place of worship, as well as your family and friends.

Pleural Mesothelioma

Pleural mesothelioma is of two kinds: (1) diffuse and malignant (cancerous), and (2) localized and benign (non-cancerous.)

Benign mesotheliomas can often be removed surgically, are generally not life-threatening, and are not usually related to asbestos exposure. Malignant mesotheliomas, however, are very serious. Fortunately, they are rare - about two thousand people are diagnosed with mesothelioma in the U.S. each year.

The remainder of this section is about diffuse malignant pleural mesothelioma.

Pleural mesothelioma is a cancer of the cells that make up the pleura or lining around the outside of the lungs and inside of the ribs. Its only known cause in the U.S. is previous exposure to asbestos fibers, including chrysotile, amosite or crocidolite. This exposure is likely to have happened twenty or more years before the disease becomes evident, since it takes many years for the disease to "incubate." It is the most common type of mesothelioma, accounting for about 75% of all cases.

Mesothelioma is sometimes diagnosed by coincidence, before there are any symptoms. For instance, tumors have been discovered through routine chest x-rays. However, when symptoms occur, they may include shortness of breath, weakness, weight loss, loss of appetite, chest pains, lower back pains, persistent coughing, difficulty in swallowing, alone or in combination. An initial medical examination often shows a pleural effusion, which means an accumulation of fluid in the pleural space - the area between the lungs and the chest wall.

The first step in detecting pleural mesothelioma is, typically, a chest x-ray or CT scan. This is often followed by a bronchoscopy, using a viewing scope to look inside the lungs.

The actual diagnosis usually requires obtaining a piece of tissue through a biopsy. This could be a needle biopsy, an open biopsy, or through a tube with a camera (thoracoscopy or chest scope.) If an abnormality is seen through the camera then a tissue sample can be taken at the same time, using the same tube. This is a hospital procedure that requires anesthesia, but is not usually painful. The tissue sample is tested by a pathologist.

Fluid build-up from the pleural effusion can generally be seen on a chest x-ray and heard during a physical examination, but a firm diagnosis of mesothelioma can only be made through a biopsy and pathological testing. This is important because there are also benign pleural effusions and other tumors that have a similar appearance to mesothelioma. Diagnosing mesothelioma can be quite difficult; it requires special lab stains, and much experience in understanding them.

The spread of the tumor over the pleura causes pleural thickening. This can reduce the flexibility of the pleura and encase the lungs in an increasingly restrictive girdle. With the lungs restricted, they get smaller and less functional, and breathing becomes more difficult. At first a person with mesothelioma may be breathless only when he or she exercises, but as lung function drops, he or she can become short of breath even while resting.

The tumor spreads by direct invasion of surrounding tissue. As it spreads inward it can compress the lungs. As the tumor spreads outward it can invade the chest wall and ribs, and this can be extremely painful.

Current medical science does not know exactly how and why, at a cellular level, asbestos fibers cause mesothelial cells to become abnormal (malignant or cancerous.) Thus it is not known whether only one fiber causes the tumor or whether it takes many fibers. It seems that asbestos fibers in the pleura can start a tumor as

Peritoneal Mesothelioma

Many of the organs in the abdomen are enveloped by a thin membrane of mesothelial cells, known as the peritoneum.

Peritoneal mesothelioma is a tumor of this membrane. Its only known cause in the U.S. is previous exposure to asbestos, but it can be many years after exposure before the disease appears. Peritoneal mesotheliomas account for about one-fifth of all mesotheliomas.

Like pleural mesothelioma, peritoneal mesothelioma can be either benign or malignant. This discussion is only about malignant peritoneal mesothelioma.

Mesothelioma is sometimes diagnosed by coincidence, before any symptoms have appeared. For example, the tumor is sometimes seen on a routine abdominal x-ray for a check-up or before surgery.

When the symptoms of peritoneal mesothelioma appear, they typically include abdominal pains, weakness, weight loss, loss of appetite, nausea, and abdominal swelling. Fluid often accumulates in the peritoneal space, a condition known as ascites. Over time the wasting symptoms can become more and more severe.

The growing tumor can exert increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. If the tumor presses upward, it can impair breathing capacity. If the tumor pushes against areas with many nerve fibers, and the bowel distends, the amount of pain can increase.

X-rays and CT scans are, typically, the first step towards detecting peritoneal mesothelioma. The actual diagnosis is typically achieved by obtaining a piece of tissue. The medical procedure of looking at the peritoneum is known as a peritoneoscopy. It is a hospital procedure and requires anesthesia. If an abnormality is seen, the doctor will attempt to obtain a tissue sample - this is known as a biopsy. The tissue sample will be examined by a pathologist who makes a diagnosis using microscopic analysis of specialized stains.

There are at least two explanations for how asbestos fibers can get into the peritoneum. The first is that fibers caught by the mucus of the trachea and bronchi end up being swallowed. Some of them lodge in the intestinal tract and from there they can move through the intestinal wall into the peritoneum. The second explanation is that fibers that lodge in the lungs can move into the lymphatic system and be transported to the peritoneum.

Medical science does not know exactly how or why, at a cellular level, a carcinogen like asbestos causes a cell to become malignant (cancerous.) Thus it is not known whether only one fiber can cause a tumor to develop or whether it takes many fibers, or what the exact conditions and predispositions are for this change to happen.

At this time there are treatments, but no known cure, for peritoneal mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, its extent, the cell type, and whether or not the tumor responds to treatment.

However, the options for relief and treatment of people with peritoneal mesothelioma have improved, especially for those whose cancer is diagnosed early and treated vigorously. Many people receive a combination of therapies, sometimes known as multimodal therapy.

Specific types of treatment include:

Chemotherapy and other drug-based therapies

Radiation therapy

and Surgery.

There are also clinical trials and various experimental treatments like gene therapy and immunotherapy, and antiangiogenesis drugs.

Further Resources

For more information about peritoneal mesothelioma and treatments, please explore this web site or visit:

National Cancer Institute

University of Pennsylvania/OncoLink

American Cancer Society

Medicine Online

Other Mesotheliomas

While the great majority of mesotheliomas are in either the pleura or the peritoneum, malignant mesotheliomas sometimes occur in other parts of the body, including the testicles (a variety of peritoneal mesothelioma) and the heart (a variety of pleural mesothelioma.) These are also caused by exposure to asbestos fibers. Benign mesotheliomas occur less frequently than malignant mesotheliomas. They are generally thought to be unrelated to asbestos exposure. Two thirds of benign mesotheliomas occur in females. (Kittle: Mesothelioma Diagnosis and Management, Year Book Medical Publishers, 1987).

Unfortunately, cystic benign mesotheliomas have a high incidence of local recurrence. (Katsube: Cystic Mesothelioma of the Peritoneum; Cancer 1982, 50:1615; Moore: Benign Cystic Mesothelioma; Cancer 1980, 45:2395) A July 1998 article by G.S. Letterie in the journal "Gynecology and Obstetrics" describes therapy with anti-estrogen tamoxifen as a non-surgical option for cases of symptomatic recurrent cystic mesotheliomas.

Diagnosis for Malignant Mesothelioma Cancer: Screening

The National Cancer Institute’s definition of screening for cancer is the examination or testing of people for early signs of certain type of cancer even though they have no symptons - this is the best way to achieve a diagnosis as early as possible. Early detection and diagnosis is particularly important for people with historical exposure to asbestos due to the latency period (up to 30 years) before which symptoms of malignant mesothelioma cancer may become apparent.

Early Signs of Mesothelioma Aid Diagnosis:

Recognizing early symptoms of malignant mesothelioma may aid in diagnosis. Symptoms include difficulty in breathing (dyspnea) and/or chest pains, fever, nausea or anemia; other signals are hoarseness, difficulty swallowing (dysphagia), or coughing up blood (hemoptysis). For many suffering from pleural mesothelioma, there may be pain in the chest or lower back. Those people with peritoneal mesothelioma may experience an expanding waist size or abdominal pain resulting from the growth of cancer cells in the abdomen.

Since many of these symptoms are also caused by less serious illnesses, it can be difficult to recognize asbestos-related diseases in the early stages. Due to this difficulty of early diagnosis of asbestos cancer and mesothelioma, the best way to determine your health risk is to consult a doctor for an initial examination, which may include a pulmonary function test (PFT) and x-rays.

Screening Methods to Identify Asbestos-Related Disease:

After a preliminary physical examination, the doctor may need to look inside your chest cavity with a thorascope for accurate diagnosis. During this thoracoscopy procedure, a cut will be made in your chest and a small piece of tissue (biopsy) may removed for examination. While you may feel some pressure, there is usually no pain.

Another special tool that may be used is the peritoneoscope, which allows for examination inside your abdomen. This instrument is inserted into an opening made in the abdomen, and a biopsy specimen may also be taken.

If the presence of fluid is indicated by either of these procedures, the doctor may drain it by inserting a needle into the affected area. Removal of chest fluid is called thoracentesis; removal of abdominal fluid is call paracentesis.

Other screening methods for diagnosis of asbestos-related disease include various imaging tests. In addition to X-rays, methods include magnetic resonance imaging (MRI) or positron emission tomography (PET). A more recent and promising screening method is the computed tomography (CT) scan.

Computed Tomagraphy / CT Scan:

Computed tomagraphy, or spiral CT scan, is a special radiographic technique that produces a clear cross-sectional image that allows a radiologist to see distinct aspects of the lung or pleura that are not readily apparent from the standard X-ray image. Recent studies (CHEST 2002;122:15-20 and MAYO CLIN PROC 2002;77:329-333) support the use of annual chest computed tomography (CT scans) exams as a valuable screening tool for people with a high risk of developing lung cancer, including mesothelioma cancer. There does appear to be conflicting assessment as to the cost-effectiveness of CT screening. A2003 study by Johns Hopkins raises this concern about the cost-effectiveness of CT scans and states, "There is a downside to this, including high costs and possible harm to individuals who may unnecessarily get invasive procedures if the scan detects a benign lung nodule." A more recent study in Chest, 2003:124:614-621 comes to a different conclusion: "A baseline low-dose CT scan for lung cancer screening is potentially highly cost-effective and compares favorably to the cost-effectiveness ratios of other screening programs."

Further Resources

"A Systematic Review and Lessons Learned From Early Lung Cancer Detection Trials Using Low-Dose Computed Tomography of the Chest, " by Gerold Bepler, MD, PhD, et al; Cancer Control 10(4):306-314, 2003

National Cancer Institute Cancer: Screening for Lung Cancer

"There’s no such thing as a free asbestos screening," Worksafe! Newsletter (October 1998, p.6)

Do you want more information about mesothelioma?
please visit this site: www.mesothelioma-facts.com

Mesothelioma

2007-12-10T07:43:00.000-08:00

Mesothelioma
Classification & external resourcesICD-10C45ICD-9163ICD-O:9050-9055OMIM156240DiseasesDB8074MedlinePlus000115eMedicinemed/1457
Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos.In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body’s internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).
Most people who develop mesothelioma have worked on jobs where theyinhaled asbestos particles, or have been exposed to asbestos dust andfibre in other ways, such as by washing the clothes of a family memberwho worked with asbestos, or by home renovation using asbestos cementproducts. Unlike lung cancer, there is no association betweenmesothelioma and smoking.

Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years afterexposure to asbestos. Shortness of breath, cough, and pain in the chestdue to an accumulation of fluid in the pleural space are often symptomsof pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites(a buildup of fluid in the abdominal cavity). Other symptoms ofperitoneal mesothelioma may include bowel obstruction, blood clottingabnormalities, anemia, and fever.If the cancer has spread beyond the mesothelium to other parts of thebody, symptoms may include pain, trouble swallowing, or swelling of theneck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:chest wall painpleural effusion, or fluid surrounding the lungshortness of breathfatigue or anemiawheezing, hoarseness, or coughblood in the sputum (fluid) coughed up
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:abdominal painascites, or an abnormal buildup of fluid in the abdomena mass in the abdomenproblems with bowel functionweight loss
In severe cases of the disease, the following signs and symptoms may be present:blood clots in the veins, which may cause thrombophlebitisdisseminated intravascular coagulation, a disorder causing severe bleeding in many body organsjaundice, or yellowing of the eyes and skinlow blood sugar levelpleural effusionpulmonary emboli, or blood clots in the arteries of the lungssevere ascites
A mesothelioma does not usually spread to the bone, brain, oradrenal glands. Pleural tumors are usually found only on one side ofthe lungs.

Diagnosis
Diagnosing mesothelioma is often difficult, because the symptoms aresimilar to those of a number of other conditions. Diagnosis begins witha review of the patient’s medical history. A history of exposure toasbestos may increase clinical suspicion for mesothelioma. A physicalexamination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis.While absence of malignant cells on cytology does not completelyexclude mesothelioma, it makes it much more unlikely, especially if analternative diagnosis can be made (e.g. tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist.A biopsy may be done in different ways, depending on where the abnormalarea is located. If the cancer is in the chest, the doctor may performa thoracoscopy.In this procedure, the doctor makes a small cut through the chest walland puts a thin, lighted tube called a thoracoscope into the chestbetween two ribs. Thoracoscopy allows the doctor to look inside thechest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy.To obtain tissue for examination, the doctor makes a small opening inthe abdomen and inserts a special instrument into the abdominal cavity.If these procedures do not yield enough tissue, more extensivediagnostic surgery may be necessary.

Screening
There is no universally agreed protocol for screening people whohave been exposed to asbestos. However some research indicates that theserum osteopontinlevel might be useful in screening asbestos-exposed people formesothelioma. The level of soluble mesothelin-related protein iselevated in the serum of about 75% of patients at diagnosis and it hasbeen suggested that it may be useful for screening.

Staging
Mesothelioma is described as localized if the cancer is found onlyon the membrane surface where it originated. It is classified asadvanced if it has spread beyond the original membrane surface to otherparts of the body, such as the lymph nodes, lungs, chest wall, orabdominal organs.

Pathophysiology
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleuralcavities. Deposition of asbestos fibres in the parenchyma of the lungmay result in the penetration of the visceral pleura from where thefibre can then be carried to the pleural surface, thus leading to thedevelopment of malignant mesothelial plaques. The processes leading tothe development of peritoneal mesothelioma remain unresolved, althoughit has been proposed that asbestos fibres from the lung are transportedto the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.
Pleural contamination with asbestos or other mineral fibres has beenshown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).However, there is now evidence that smaller particles may be more dangerous than the larger fibers.They remain suspended in the air where they can be inhaled, and maypenetrate more easily and deeper into the lungs. "We probably will findout a lot more about the health aspects of asbestos from [the WorldTrade Center attack], unfortunately," said Dr. Alan Fein, chief ofpulmonary and critical-care medicine at North Shore-Long Island JewishHealth System. Dr. Fein has treated several patients for "World TradeCenter syndrome" or respiratory ailments from brief exposures of only aday or two near the collapsed buildings.
Mesothelioma development in rats has been demonstrated followingintra-pleural inoculation of phosphorylated chrysotile fibres. It hasbeen suggested that in humans, transport of fibres to the pleura iscritical to the pathogenesis of mesothelioma. This is supported by theobserved recruitment of significant numbers of macrophages and other cells of the immune systemto localised lesions of accumulated asbestos fibres in the pleural andperitoneal cavities of rats. These lesions continued to attract andaccumulate macrophages as the disease progressed, and cellular changeswithin the lesion culminated in a morphologically malignant tumour.
Experimental evidence suggests that asbestos acts as a completecarcinogen with the development of mesothelioma occurring in sequentialstages of initiation and promotion. The molecular mechanisms underlyingthe malignant transformation of normal mesothelial cells by asbestosfibres remain unclear despite the demonstration of its oncogeniccapabilities. However, complete in vitro transformation of normal humanmesothelial cells to malignant phenotype following exposure to asbestosfibres has not yet been achieved. In general, asbestos fibres arethought to act through direct physical interactions with the cells ofthe mesothelium in conjunction with indirect effects followinginteraction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatinfibres or becoming entangled within the chromosome. This contactbetween the asbestos fibre and the chromosomes or structural proteinsof the spindle apparatus can induce complex abnormalities. The mostcommon abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:Neurofibromatosis type 2 at 22q12P16INK4AP14ARF
Asbestos has also been shown to mediate the entry of foreign DNAinto target cells. Incorporation of this foreign DNA may lead tomutations and oncogenesis by several possible mechanisms:Inactivation of tumor suppressor genesActivation of oncogenesActivation of proto-oncogenes due to incorporation of foreign DNA containing a promoter regionActivation of DNA repair enzymes, which may be prone to errorActivation of telomerasePrevention of apoptosis
Asbestos fibres have been shown to alter the function and secretoryproperties of macrophages, ultimately creating conditions which favourthe development of mesothelioma. Following asbestos phagocytosis,macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenicand membrane-active agents thought to promote asbestos carcinogenicity.These oxidants can participate in the oncogenic process by directly andindirectly interacting with DNA, modifying membrane-associated cellularevents, including oncogene activation and perturbation of cellularantioxidant defences.
Asbestos also may possess immunosuppressiveproperties. For example, chrysotile fibres have been shown to depressthe in vitro proliferation of phytohemagglutinin-stimulated peripheralblood lymphocytes, suppress natural killer cell lysis and significantlyreduce lymphokine-activated killer cellviability and recovery. Furthermore, genetic alterations inasbestos-activated macrophages may result in the release of potentmesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-ß(TGF-ß) which in turn, may induce the chronic stimulation andproliferation of mesothelial cells after injury by asbestos fibres.

Epidemiology
Although reported incidence rates have increased in the past 20years, mesothelioma is still a relatively rare cancer. The incidence isapproximately one per 1,000,000. For comparison, populations with highlevels of smoking can have a lung cancerincidence of over 1,000 per 1,000,000. Incidence of malignantmesothelioma currently ranges from about 7 to 40 per 1,000,000 inindustrialized Western nations, depending on the amount of asbestosexposure of the populations during the past several decades.[5]It has been estimated that incidence may have peaked at 15 per1,000,000 in the United States in 2004. Incidence is expected tocontinue increasing in other parts of the world. Mesothelioma occursmore often in men than in women and risk increases with age, but thisdisease can appear in either men or women at any age. Approximately onefifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States [4].Between 1973 and 1984, there has been a threefold increase in thediagnosis of pleural mesothelioma in Caucasian males. From 1980 to thelate 1990s, the death rate from mesothelioma in the USA increased from2,000 per year to 3,000, with men four times more likely to acquire itthan women. These rates may not be accurate, since it is possible thatmany cases of mesothelioma are misdiagnosed as adenocarcinoma of thelung, which is difficult to differentiate from mesothelioma.

Risk factors
Working with asbestosis the major risk factor for mesothelioma. A history of asbestosexposure exists in almost all cases. However, mesothelioma has beenreported in some individuals without any known exposure to asbestos. Inrare cases, mesothelioma has also been associated with irradiation,intrapleural thorium dioxide (Thorotrast), and inhalation of otherfibrous silicates, such as erionite.
Asbestos is the name of a group of minerals that occur naturally asmasses of strong, flexible fibers that can be separated into thinthreads and woven. Asbestos has been widely used in many industrialproducts, including cement, brake linings, roof shingles, flooringproducts, textiles, and insulation. If tiny asbestos particles float inthe air, especially during the manufacturing process, they may beinhaled or swallowed, and can cause serious health problems. Inaddition to mesothelioma, exposure to asbestos increases the risk oflung cancer, asbestosis (a noncancerous, chronic lung ailment), andother cancers, such as those of the larynx and kidney.
The combination of smoking and asbestos exposure significantly increases a person’s risk of developing cancer of the airways (lung cancer,bronchial carcinoma). The Kent brand of cigarettes used asbestos in itsfilters for the first few years of production in the 1950s and somecases of mesothelioma have resulted. Smoking modern cigarettes does notappear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.

Exposure

Asbestos was known in antiquity, but it wasn’t mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s,millions of American workers have been exposed to asbestos dust.Initially, the risks associated with asbestos exposure were notpublicly known. However, an increased risk of developing mesotheliomawas later found among shipyard workers, people who work in asbestosmines and mills, producers of asbestos products, workers in the heatingand construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration(OSHA) sets limits for acceptable levels of asbestos exposure in theworkplace, and created guidelines for engineering controls andrespirators, protective clothing, exposure monitoring, hygienefacilities and practices, warning signs, labeling, recordkeeping, andmedical exams. By contrast, the British Government’s Health and Safety Executive(HSE) states formally that any threshold for mesothelioma must be at avery low level and it is widely agreed that if any such threshold doesexist at all, then it cannot currently be quantified. For practicalpurposes, therefore, HSE does not assume that any such thresholdexists. People who work with asbestos wear personal protectiveequipment to lower their risk of exposure.

Occupational
Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s.Several epidemiological studies have associated exposure to asbestoswith the development of lesions such as asbestos bodies in the sputum,pleural plaques, diffuse pleural thickening, asbestosis, carcinoma ofthe lung and larynx, gastrointestinal tumours, and diffuse mesotheliomaof the pleura and peritoneum.
The documented presence of asbestos fibres in water supplies andfood products has fostered concerns about the possible impact oflong-term and, as yet, unknown exposure of the general population tothese fibres. Although many authorities consider brief or transientexposure to asbestos fibres as inconsequential and an unlikely riskfactor, some epidemiologists claim that there is no risk threshold.Cases of mesothelioma have been found in people whose only exposure wasbreathing the air through ventilation systems. Other cases had veryminimal (3 months or less) direct exposure.
Commercial asbestos mining at Wittenoom, Western Australia, occurredbetween 1945 and 1966. A cohort study of miners employed at the minereported that while no deaths occurred within the first 10 years aftercrocidolite exposure, 85 deaths attributable to mesothelioma hadoccurred by 1985. By 1994, 539 reported deaths due to mesothelioma hadbeen reported in Western Australia.

Paraoccupational Secondary Exposure
Family members and others living with asbestos workers have anincreased risk of developing mesothelioma, and possibly other asbestosrelated diseases. This risk may be the result of exposure to asbestosdust brought home on the clothing and hair of asbestos workers. Toreduce the chance of exposing family members to asbestos fibres,asbestos workers are usually required to shower and change theirclothing before leaving the workplace.
Asbestos in buildings
Many building materials used in both public and domestic premisesprior to the banning of asbestos may contain asbestos. Those performingrenovation works or diy activities may expose themselves to asbestosdust. In the UK use of Chrysotile asbestos was banned at the end of1999. Brown and blue asbestos was banned in the UK around 1985.Buildings built or renovated prior to these dates may contain asbestosmaterials.
Environmental Exposure
Incidence of mesothelioma had been found to be higher in populations living near Naturally Occurring Asbestos (NOA).

Treatment
Treatment of MM using conventional therapies has not proved successful and patients have a mediansurvival time of 6 - 12 months after presentation. The clinicalbehaviour of the malignancy is affected by several factors includingthe continuous mesothelial surface of the pleural cavity which favourslocal metastasis via exfoliated cells, invasion to underlying tissueand other organs within the pleural cavity, and the extremely longlatency period between asbestos exposure and development of the disease.

Surgery
Surgery, either by itself or used in combination with pre- andpost-operative adjuvant therapies has proved disappointing. Apleurectomy/decortication is the most common surgery, in which thelining of the chest is removed. Less common is an extrapleuralpneumonectomy (EPP), in which the lung, lining of the inside of thechest, the hemi-diaphragm and the pericardium are removed. It is not possible to remove the entire mesothelium without killing the patient.

Radiation

Wikibooks has a book on the topic ofRadiation Oncology/Lung/Mesothelioma
For patients with localized disease, and who can tolerate a radicalsurgery, radiation is often given post-operatively as a consolidativetreatment. The entire hemi-thorax is treated with radiation therapy,often given simultaneously with chemotherapy. This approach of usingsurgery followed by radiation with chemotherapy has been pioneered bythe thoracic oncology team at Brigham & Women’s Hospital in Boston.[7]Delivering radiation and chemotherapy after a radical surgery has ledto extended life expectancy in selected patient populations with somepatients surviving more than 5 years. As part of a curative approach tomesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapyalone, palliative treatment regimens are sometimes used to relievesymptoms arising from tumor growth, such as obstruction of a majorblood vessel. Radiation therapy when given alone with curative intenthas never been shown to improve survival from mesothelioma. Thenecessary radiation dose to treat mesothelioma that has not beensurgically removed would be very toxic.

Chemotherapy
In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.

Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin(BCG) in an attempt to boost the immune response, was found to be of nobenefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2(IL-2), but patients undergoing this particular therapy experiencedmajor side effects. Indeed, this trial was suspended in view of theunacceptably high levels of IL-2 toxicity and the severity of sideeffects such as fever and cachexia. Nonetheless, other trials involvinginterferon alpha have proved more encouraging with 20% of patientsexperiencing a greater than 50% reduction in tumor mass combined withminimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitonealchemotherapy was developed by Paul Sugarbaker at the Washington CancerInstitute.[7]The surgeon removes as much of the tumor as possible followed by thedirect administration of a chemotherapy agent, heated to between 40 and48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes andthen drained.
This technique permits the administration of high concentrations ofselected drugs into the abdominal and pelvic surfaces. Heating thechemotherapy treatment increases the penetration of the drugs intotissues. Also, heating itself damages the malignant cells more than thenormal cells.
[edit] Prevention & Expectations
What can be done to prevent the disease? Since the 1970s, theEnvironmental Protection Agency and the Occupational Safety and HealthAdministration have regulated the asbestos industry in the U.S. In thepast, asbestos was used as a fire retardant and an insulator. Otherproducts are now used in its place. The controversy involving exposureto different forms of asbestos continues.
There are two major types of asbestos: chrysotile and amphibole.It is thought that exposure to the amphibole form is more likely tocause mesothelioma. However, chrysotile has been used more frequently,hence many mesotheliomas are caused by chrysotile.
Removal is taking place in schools and other public buildingsthroughout the U.S. The hope is that these measures will greatly reducethe occurrence of this cancer.
What are the long-term effects of the disease? A mesotheliomais a highly aggressive tumor that is generally deadly. Currenttreatment of malignant mesothelioma is designed to make the person withcancer comfortable. Although long-term survival cannot usually beexpected, the case of famed paleontologist Stephen Jay Gould is a noted exception.
What are the risks to others? Mesothelioma is not contagiousand cannot be passed from one person to another. The exposure to theasbestos that caused the cancer occurred many years to several decadesbefore the disease appeared. People who live with asbestos workers havea higher risk of getting this cancer.
What happens once treatment is over? Although mesothelioma isvery unpleasant it’s still important for person after treatment is overto keep up all follow-up appointments and that’s vital because furthertesting is always needed to check whether cancer is coming back or toexamine possible side effects that could be rather unpleasant andwhat’s even worse permanent.

Notable people with mesothelioma
Mesothelioma, though rare, has had a number of notable patients. Australian anti-racism activist Bob Bellear died in 2005. British science fiction writer Michael G. Coney, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. Mickie Most, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.
Bernie Banton was an Australian workers’ rights activist, who fought a long battle for compensation from James Hardieafter he contracted mesothelioma after working for that company. Heclaimed James Hardie knew of the dangers of asbestos before he beganwork with the substance making insulation for power stations.Mesothelioma eventually took his life along with his brothers andhundreds of James Hardie workers. James Hardie made an undisclosedsettlement with Mr Banton only when his mesothelioma had reached itsfinal stages and he was expected to have no more than 48hrs to live.Australian Prime Minister-elect Kevin Rudd mentioned Mr Banton’sextended struggle in his acceptance speech after winning the 2007Australian Federal Election.
Steve McQueenwas diagnosed with peritoneal mesothelioma on December 22, 1979. He wasnot offered surgery or chemotherapy because doctors felt the cancer wastoo advanced. McQueen sought alternative treatments from clinics inMexico. He died of a heart attack on November 7, 1980, in Juárez,Mexico, following cancer surgery. He may have been exposed to asbestoswhile serving with the US Marines as a young adult—asbestos was thencommonly used to insulate ships’ piping—or because of its use as aninsulating material in car racing suits. (It is also reported that he worked in a shipyard during World War II, where he might have been exposed to asbestos.[citation needed]
United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevonwas diagnosed with inoperable mesothelioma in the fall of 2002.Refusing treatments he believed might incapacitate him, Zevon focusedhis energies on recording his final album The Wind including the song Keep me in your heart which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.
Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote the "The Median Isn’t the Message"[9] for Discovermagazine, in which he argued that statistics such as median survivalare just useful abstractions, not destiny. Gould lived for anothertwenty years eventually succumbing to metastatic adenocarcinoma of thelung, not mesothelioma.
Author Paul Krauswas diagnosed with mesothelioma in June 1997 following an umbilicalhernia operation. His prognosis was "a few months." He continues tosurvive using a variety of integrative and complimentary modalities andhas written a book about his experience.

Legal issues

Main article: asbestos and the law
The first lawsuits against asbestos manufacturers were in 1929.Since then, many lawsuits have been filed against asbestosmanufacturers and employers, for neglecting to implement safetymeasures after the links between asbestos, asbestosis, and mesotheliomabecame known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.[citation needed]The amounts and method of allocating compensation have been the sourceof many court cases, and government attempts at resolution of existingand future cases.

History
The first lawsuit against asbestos manufacturers was brought in1929. The parties settled that lawsuit, and as part of the agreement,the attorneys agreed not to pursue further cases. It was not until 1960that an article published by Wagner et al first officially establishedmesothelioma as a disease arising from exposure to crocidolite asbestos.[10]The article referred to over 30 case studies of people who had sufferedfrom mesothelioma in South Africa. Some exposures were transient andsome were mine workers. In 1962 McNulty reported the first diagnosedcase of malignant mesothelioma in an Australian asbestos worker. The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.
In the town of Wittenoom, asbestos-containing mine waste was used tocover schoolyards and playgrounds. In 1965 an article in the BritishJournal of Industrial Medicine established that people who lived in theneighbourhoods of asbestos factories and mines, but did not work inthem, had contracted mesothelioma.
Despite proof that the dust associated with asbestos mining andmilling causes asbestos related disease, mining began at Wittenoom in1943 and continued until 1966. In 1974 the first public warnings of thedangers of blue asbestos were published in a cover story called "Isthis Killer in Your Home?" in Australia’s Bulletin magazine. In 1978 the Western AustralianGovernment decided to phase out the town of Wittenoom, following thepublication of a Health Dept. booklet, "The Health Hazard atWittenoom", containing the results of air sampling and an appraisal ofworldwide medical information.
By 1979 the first writs for negligence related to Wittenoom wereissued against CSR and its subsidiary ABA, and the Asbestos DiseasesSociety was formed to represent the Wittenoom victims.

Wikipedia

Here Indonesian Pages about Mesothelioma

Becarefull Headeaches Kids!

2007-12-01T23:23:00.000-08:00

Headeache Kids ???

Whether they’re pounding and throbbing or dull and aching, headaches are no picnic for kids. A lot of the time, they’re caused by something simple - such as staying up too late, playing in the sun too long, or taking a bump to the head. But sometimes, headaches last longer or are accompanied by other symptoms.

Headaches can have a wide range of causes and many levels of severity. It’s important to understand how to recognize when a headache is just a passing pain, and when it’s something more and your child needs medical treatment.

What’s a Headache?
Most headaches happen outside the skull, in the nerves, blood vessels, and muscles that cover the head and neck. The muscles or blood vessels can swell, tighten, or go through other changes that stimulate or put pressure on the surrounding nerves. These nerves send a rush of pain messages to the brain, which brings on a headache.

What Causes Headaches?
In general, kids get the same types of headaches as adults. And headaches often are hereditary, so if you or your partner get them, your child may get them too.

Some of the many potential headache triggers include:

certain medications (headaches are a potential side effect of some)

too little sleep or sudden changes in sleep patterns

skipping meals

becoming dehydrated

being under a lot of stress

having a minor head injury

using the computer or watching TV for a long time

menstruation

experiencing changes in hormone levels

taking a long trip in a car or bus

listening to really loud music

smoking

smelling strong odors such as perfume, smoke, fumes, or a new car or carpet

drinking or eating too much caffeine (in soda, coffee, tea, and chocolate)

consuming certain foods (such as alcohol, cheese, pizza, chocolate, ice cream, fatty or fried food, lunchmeats, hot dogs, yogurt, aspartame, or anything with the seasoning MSG)

In some cases, headaches are caused by certain infections, such as:

ear infections

Lyme disease

sinus infections

strep throat

urinary tract infections

But most headaches aren’t signs that something more is wrong. Only 10% of headaches are caused by other medical conditions, such as infections or other serious illnesses.

What Are the Common Types of Headaches?
Two of the more common kinds of headaches that kids get are tension headaches and migraines.

Tension Headaches
Fairly common in kids, tension headaches (also called muscle-contraction headaches) are caused by tension in the muscles of the neck and head, which can be brought on by a variety of emotional and physical stressors. The pain is often described as:

constant pressure around the front, top, and sides of the head, almost like someone stretched a rubber band around it
constricting

dull

aching

A major distinction between tension headaches and migraines is that tension headaches typically are not accompanied by nausea or vomiting, and they’re usually not made worse by physical activity - symptoms that do often occur with migraines.

Migraines
About 5% of school-age kids and up to 10% of teens get migraine headaches, recurrent headaches with additional symptoms. Often triggered by things like stress, sleep deprivation, and certain foods and beverages, migraine headaches can cause the following symptoms:

pounding, throbbing pain on one or both sides of the head

dizziness

stomachaches

nausea and/or vomiting

seeing spots or halos

sensitivity to light, noise, and/or smells

Most migraines last anywhere from 30 minutes to 6 hours. Some can last as long as a couple of days. Some people:

Just don’t feel right. Light, smell, or sound may bother them or make them feel worse. Sometimes, if they try to continue with their usual routine after the migraine starts, they may become nauseated and vomit. Often the pain begins only on one side of the head. Trying to perform physical activities may make the pain worse.
Get auras, a kind of warning that a migraine is on the way (usually about 10 to 30 minutes before the start of a migraine). The auras may only be seen in one eye. The most common auras include: blurred vision, seeing spots, jagged lines, or flashing lights, or smelling a certain odor.
Experience a migraine premonition hours to days prior to the actual headache. This is slightly different from auras and may cause cravings for different foods, thirst, irritability, or feelings of intense energy.
Have muscle weakness, lose their sense of coordination, stumble, or even have trouble talking either just before or while they have a headache.
Unfortunately, parents of an infant or toddler probably won’t be able to tell if their little one is having migraines because little kids are often unable to explain or detail what hurts. Young kids with headaches may be cranky, or have symptoms of clumsiness or look pale.

There are also migraine variants that are thought to happen only to kids and are precursors to the more common migraines of adulthood. These include paroxysmal vertigo and cyclic vomiting.

Paroxysmal vertigo is described as a sensation of spinning or whirling that comes on suddenly and disappears in a matter of minutes. Kids who experience this may momentarily appear frightened and unsteady, or unable to walk. The vertigo typically goes away by the time a child is 5 years old.

Cyclic vomiting also occurs in young kids and involves repeated episodes of vomiting. The episodes can last for hours or days and are not associated with headache or any other symptoms. Cyclic vomiting usually goes away by the time kids grow into teens.

When Should I Call My Child’s Doctor?
When your child has a splitting headache, it’s easy to worry. Rest assured, though, that only very rarely are headaches a symptom of something serious. However, you should see your child’s doctor if your child has unexplained or recurring headaches over a short period of time or on a regular basis.

Call your the doctor if your child’s headaches:

occur once a month or more

don’t go away easily

are particularly painful

Another factor to consider is whether or not there are other symptoms along with the headaches. If your child is perfectly well between the headaches, this is less cause for concern. If not, then there’s more cause for concern - symptoms associated with the headaches themselves can help your child’s doctor identify what might be causing the headaches.

Other than nausea, which is common with migraine or tension headaches, you should call child’s doctor if your child also has any of the following symptoms:

decreased level of alertness

vomiting

headache when your child wakes up, or one that actually wakes up your child

headache following a head injury or loss of consciousness

headache accompanied by seizures

visual changes

tingling sensations

weakness

skin rash

difficulty walking or standing

neck pain or stiffness

fever or other signs of infection

unable to go to school or participate in everyday routines and activities

How Are Headaches Diagnosed?

Your child’s doctor will probably want to do a physical examination and get your child’s medical history to help figure out what might be causing the headaches.

The doctor may ask both you and your child about:

how severe and frequent your child’s headaches are

whether your child’s headaches have a pattern or change over time

your child’s concerns and symptoms

your child’s past health

your family’s health

any medications your child is taking

any allergies your child may have

any stresses your child might be experiencing

your child’s diet, habits, sleeping patterns, and what seems to help or worsen the headaches

To help pin down the problem, doctors often ask parents - and older children and teens - to keep a headache diary, listing each headache, when they happen, how long they last, and a few notes about what might have brought them on.

A good review of your child’s general health is also important. For example, an examination of the back of the eye, called a funduscopic exam, can give your child’s doctor a sense of any increase in pressure inside your child’s brain. This exam is done in the office using an ophthalmoscope, which is a special light that allows the doctor to see the back of the eye.

The doctor also checks to make sure the neck is not stiff, as it would be with meningitis, and that the cranial nerves that work the muscles of the face are working normally. A doctor may also take blood tests or imaging tests, such as a CAT scan or MRI of the brain, to rule out medical problems that might be causing your child’s headaches, especially if they’re diagnosed as migraines.

What Can I Do to Help My Child?
Treatment for your child’s headache will depend on what your child’s doctor determines is the likely cause. But most everyday headaches can be cared for at home with little medical intervention.

Here are some things you can do to help ease your child’s pain. Tell him or her to:

Lie down in a cool, dark, quiet room.

Put a cool, moist cloth across the forehead or eyes.

Relax.

Breathe easily and deeply.

Kids with migraines may just want to sleep and may feel better when they wake up. A big part of treating migraines is helping your child to avoid the triggers that may have caused them. That’s where a headache diary can be especially helpful.

You also can give your child an over-the-counter pain reliever such as acetaminophen or ibuprofen. Read the label, though, to make sure that you give your child the right dosage and at the right intervals. And if you have a baby or toddler under 2, call your child’s doctor before giving your little one any pain reliever. He or she will be able to tell you whether you should give it and, if so, how much (based on your child’s weight and age).

And never give aspirin to children younger than 12. Children and teens under age 19 also should avoid taking aspirin during an illness caused by a virus, such as chickenpox or an upper respiratory infection, as this can cause Reye syndrome, a potentially life-threatening condition.

If your child has chronic migraine headaches, the doctor may prescribe a medication to be taken daily as a preventive measure. In deciding whether to put your child on medication, the doctor will consider the frequency of the migraines as well as the potential benefit of the medication versus its possible side effects.

Discuss the medications your child has been taking with your child’s doctor, who will develop a treatment plan that may include approaches to pain relief that don’t involve medicine, such as relaxation, stress reduction techniques, and cutting down on other possible triggers like caffeine.

Keeping track of your child’s headaches and their symptoms and following the doctor’s recommendations are the keys to finding relief for your child’s painful headaches.

Reviewed by: Barbara P. Homeier, MD and Cecilia DiPentima, MD
www.kidshealth.org

Fever Children, High Temperatur

2007-11-26T09:37:00.000-08:00

Every parent has probably experienced this scenario: You wake up in the middle of the night to find your child standing by your bed, flushed, hot, and sweaty. Your little one's forehead feels warm. You immediately suspect that your child has a fever, but you're unsure of what to do next. Should you get out the thermometer? Should you call the doctor?

Even if your child does have a fever, it's likely that it's not serious. Although it can be frightening when your child's temperature rises, fever itself causes no harm and can actually be a good thing - it's often the body's way of fighting off infections. And not all fevers need to be treated. High fever, however, can make your child uncomfortable and can aggravate problems such as dehydration.

But there are steps you can take to correctly take your child's temperature and make your child comfortable when it's a little higher than usual. In this article, we'll talk about fevers, how to measure and treat them, and when to call your child's doctor.

What Is Fever?
Fever occurs when the body's internal "thermostat" raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be (usually around 98.6 degrees Fahrenheit, or about 37 degrees Celsius) and will send messages to your body to keep it that way.

Most people's body temperatures even change a little bit during the course of the day: It's usually a little lower in the morning and a little higher in the evening and can fluctuate as kids run around, play, and exercise.

Sometimes, though, the hypothalamus will "reset" the body to a higher temperature in response to an infection, illness, or some other cause. So, why does the hypothalamus tell the body to change to a new temperature? Researchers believe turning up the heat is the body's way of fighting the germs that cause infections and making the body a less comfortable place for them.

What Causes Fever?
It's important to remember that by itself fever is not an illness - it's usually a symptom of an underlying problem. Fever has several potential causes:

Infection: Most fevers are caused by infection or other illness. Fever helps the body fight infections by stimulating natural defense mechanisms.

Overdressing: Infants, especially newborns, may get fevers if they're overbundled or in a hot environment because they can't regulate their body temperature.

Immunizations: Babies and children sometimes get a low-grade fever after getting vaccinated.

Although teething may cause a slight rise in body temperature, it's probably not the cause if your baby's or toddler's temperature is higher than 100 degrees Fahrenheit (37.8 degrees Celsius).

How Do I Know if My Child's Fever Is a Sign of Something Serious?
In the past, doctors advised treating a fever on the basis of temperature alone. But now, they recommend taking both the temperature and the child's overall condition into account.

Children whose temperatures are lower than 102 degrees Fahrenheit (38.9 degrees Celsius) usually don't require medication, unless they're uncomfortable. There's one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, call your baby's doctor or go to the emergency department. Even a slight fever can be a sign of a potentially serious infection in very young infants.

For older children, take behavior and activity level into account. By watching how your child behaves, you can get a pretty good idea as to whether he or she has a minor illness or needs to be seen by a doctor.

The illness is probably not serious if your child:

is still interested in playing
is eating and drinking well
is alert and smiling at you
has a normal skin color
looks well when his or her temperature comes down
And don't worry too much about a child with a fever who doesn't want to eat. This is very common with infections that cause fever.

How Do I Know if My Child Has a Fever?
A gentle kiss on the forehead or a hand placed lightly on your child's skin is often enough to tell that your child has a fever. However, this method of taking a temperature (called tactile temperature) is dependent on the person doing the feeling and doesn't give an accurate measure of a child's temperature.

By using a reliable thermometer, you can tell if your child has a fever if his or her temperature is at or higher than one of the following levels:

100.4 degrees Fahrenheit (38 degrees Celsius) measured rectally (in the bottom)
99.5 degrees Fahrenheit (37.5 degrees Celsius) measured orally (in the mouth)
99 degrees Fahrenheit (37.2 degrees Celsius) measured in an axillary position (under the arm)
But how high a fever is doesn't tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102 to 104 degrees Fahrenheit, or 38.9 to 40 degrees Celsius, range), but doesn't usually indicate a serious problem. And serious infections may cause no fever or even an abnormally low body temperature, especially in young infants.

Because fevers may rise and fall, a child with fever may experience chills, which occur when the body tries to generate additional heat when the body's temperature begins to rise. The child may sweat as the body releases extra heat when the temperature starts to drop.

Sometimes children with a fever may also breathe faster than usual and may have a higher heart rate. You should call your child's doctor if your child is having difficulty breathing, is breathing a lot faster than normal, or continues to breathe fast after the fever comes down.

What Kind of Thermometer Should I Use?
Whichever type of thermometer you choose, be sure you know how to use it correctly to get an accurate reading. Keep and follow the manufacturer's recommendations for any thermometer.

Digital thermometers usually provide the quickest, most accurate readings. They come in many sizes and shapes, are available at most supermarkets and pharmacies, and are available in a range of prices. Although you should read the manufacturer's instructions to determine what method or methods the thermometer is designed for, many digital thermometers can be used for the following temperature-taking methods:

oral (in the mouth)
rectal (in the bottom)
axillary (under the arm)
Digital thermometers usually have a plastic, flexible probe with a temperature sensor at the tip and an easy-to-read digital display on the opposite end.

Electronic ear thermometers measure the tympanic temperature - the temperature inside the ear canal. Although they're quick, accurate, and easy to use in older children, electronic ear thermometers aren't as accurate for very young children as digital thermometers and are more expensive. The American Academy of Pediatrics (AAP) advises against using electronic ear thermometers for infants younger than 3 months.

Plastic strip thermometers (small plastic strips that you press against your child's forehead) may be able to tell you whether your child has a fever, but they aren't reliable for taking an exact measurement, especially in infants and children. If you need to know your child's exact temperature, plastic strip thermometers are not the way to go.

Forehead thermometers may be a reasonable alternative to ear thermometers, if your infant is younger than a year old. But they are not as accurate as oral or rectal digital thermometers.

Pacifier thermometers may seem convenient, but again, they're unreliable and shouldn't be used in infants younger than 3 months. They also require the child to keep the pacifier in the mouth for several minutes without moving, which is a nearly impossible task for most babies and toddlers.

Glass mercury thermometers were once commonly used, but the AAP now advises against using them because of concerns about possible exposure to mercury, which is an environmental toxin. (If you still have a mercury thermometer, do not simply throw it in the trash where the mercury can leak out. Talk to your child's doctor or your local health department about how and where to dispose of your mercury thermometer.)

As any parent knows, taking a squirming child's temperature can be challenging. But it's one of the most important tools doctors have to figure out if your child has an illness or infection. The method you choose to take your child's temperature will depend on his or her age and how cooperative your child is.

If your child is younger than 3 months, you'll get the most reliable reading by using a digital thermometer to take a rectal temperature. Electronic ear thermometers aren't recommended for infants younger than 3 months because their ear canals are usually too small.

If your child is between 3 months to 4 years old, you can use a digital thermometer to take a rectal temperature or an electronic ear thermometer to take the temperature inside the ear canal. You could also use a digital thermometer to take an axillary temperature, although this is a less accurate method.

If your child is 4 years or older, you can usually use a digital thermometer to take an oral temperature if your child will cooperate. However, children who have frequent coughs or are breathing through their mouths because of stuffy noses might not be able to keep their mouths closed long enough for an accurate oral reading. In these cases, you can use the tympanic method (with an electronic ear thermometer) or axillary method (with a digital thermometer).

How Do I Use a Digital Thermometer?
A digital thermometer offers the quickest, most accurate way to take your child's temperature and can be used in the mouth, armpit, or rectum. Before you use this device, read the directions thoroughly. You need to know how the thermometer signals that the reading is complete (usually, it's a beep or a series of beeps or the temperature flashes in the digital window on the front side of the thermometer). Then, turn on the thermometer and make sure the screen is clear of any old readings. If your thermometer uses disposable plastic sleeves or covers, put one on according to the manufacturer's instructions. Remember to discard the sleeve after each use and to clean the thermometer according to the manufacturer's instructions before putting it back in its case.

To take a rectal temperature: Before becoming parents, most people cringe at the thought of taking a rectal temperature. But don't worry - it's a simple process:

Lubricate the tip of the thermometer with a water-soluble lubricating jelly (talk with your pharmacist or child's doctor).
Place your child face down across your lap while supporting the head, or lay the child down on a firm, flat surface, such as a changing table.
Place one hand firmly on your child's lower back to hold him or her still.
With your other hand, insert the lubricated thermometer through the anal opening, about half an inch to 1 inch (about 1.25 to 2.5 centimeters) into the rectum. Stop if you feel any resistance.
Steady the thermometer between your second and third fingers as you cup your hand against your baby's bottom. Soothe your child and speak quietly as you hold the thermometer in place.
Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. If you'd like to keep a record, write down the temperature, noting the time of day.
To take an oral temperature: This process is easy in an older, cooperative child.

Wait 20 to 30 minutes after your child finishes eating or drinking to take an oral temperature, and make sure there's no gum or candy in your child's mouth.
Place the tip of the thermometer under the tongue and ask your child to close his or her lips around it. Remind your child not to bite down or talk and ask him or her to relax and breathe normally through the nose.
Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Read and write down the number on the screen, noting the time of day that you took the reading.
To take an axillary temperature: This is a convenient way to take your child's temperature. Although not as accurate as a rectal or oral temperature in a cooperative child, some parents may prefer to take an axillary temperature, especially if your child can't hold a thermometer in his or her mouth.

Remove your child's shirt and undershirt, and place the thermometer under your child's armpit (it must be touching skin only, not clothing).
Fold your child's arm across his or her chest to hold the thermometer in place.
Wait until you hear the appropriate number of beeps or other signal that the temperature is ready to be read. Read and write down the number on the screen, noting the time of day that you took the reading.
Whatever method you choose, here are some additional tips to keep in mind:

Never take your child's temperature right after a bath or if he or she has been bundled tightly for a while - this can affect the temperature reading.
Never leave a child unattended while taking a temperature.
How Can I Make My Child Feel Better?
Again, not all fevers need to be treated. And, in most cases, a fever should be treated only if it's causing your child discomfort. Here are some things you can do to alleviate the symptoms that often accompany a fever:

If your child is fussy or appears uncomfortable, you can give acetaminophen or ibuprofen based on the package recommendations for age or weight. If you don't know the recommended dose or your child is younger than 2 years, call your child's doctor to find out how much you should give. Remember that fever medication will usually temporarily bring a temperature down, but it will not return it to normal - and it won't treat the underlying reason for the fever. (Never give aspirin to a child under 12 due to its association with Reye syndrome, a rare but potentially fatal disease.)

Give your child a sponge bath to make him or her more comfortable and help bring the fever down. Use only lukewarm water; cool water may cause shivering, which actually raises body temperature. Never use rubbing alcohol (it can cause poisoning when absorbed through the skin) or ice packs/cold baths (they can cause chills that may raise body temperature).
Dress your child in lightweight clothing and cover him or her with a light sheet or blanket. Overdressing and overbundling can prevent body heat from escaping and can cause a temperature to rise.

Make sure your child's room is a comfortable temperature - not too hot or too cold.
Offer your child plenty of fluids to avoid dehydration - a fever will cause a child to lose fluids more rapidly. Water, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks containing caffeine, including colas and tea, because they can cause your child to pee more.
If your baby or child also has vomiting and/or diarrhea, ask your child's doctor if you should give him or her an electrolyte (rehydration) solution made especially for children. You can find these solutions at pharmacies and supermarkets. Don't offer sports drinks - they're not designed for younger children, and the added sugars may make diarrhea worse. Also, limit your child's intake of fruits and apple juice.

In general, let your child eat what he or she wants (in reasonable amounts) but don't force eating if your child doesn't feel like it.
Make sure your child gets plenty of rest. Staying in bed all day isn't necessary, but a sick child should take it easy.
It's best to keep your child home from school or child care if he or she has a fever. Most doctors feel that it's safe to return when temperature has been normal for 24 hours.
When Should I Call My Child's Doctor?
The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether the child has other symptoms with the fever.

Call your child's doctor if you have an:

- infant younger than 3 months with a temperature of 100.4 degrees Fahrenheit (38 degrees Celsius)
- older child with a temperature of higher than 104 degrees Fahrenheit (40 degrees Celsius)
If an older child has a fever of less than 104 degrees, call the doctor if the child also:

refuses fluids or seems too ill to drink adequately
has persistent diarrhea or repeated vomiting
has any signs of dehydration
has a specific complaint (i.e., sore throat or earache)
still has a fever after 24 hours in a child younger than 2 years or 72 hours in a child 2 years or older
has recurrent fevers, even if they only last a few hours each night
Seek emergency care if your child shows any of the following signs along with a fever:

inconsolable crying for several hours
extreme irritability
lethargy and difficulty waking
rash or purple spots that look like bruises on the skin (that were not there before the child got sick)
blue lips, tongue, and nails
infant's soft spot on the head seems to be bulging outward
stiff neck
severe headache
limpness and refusal to move
difficulty breathing that doesn't get better when the nose is cleared
leaning forward and drooling
seizure
Also, check with your child's doctor for his or her specific guidelines on when to call about a fever.

Fever: A Common Part of Childhood
All kids get fevers, and in the majority of cases, children are completely back to normal within a few days. For older infants and children (but not necessarily for infants younger than 3 months), the way your child is acting is far more important than the reading on your thermometer. Everyone gets cranky when they have a fever. This is normal and should be expected.

But if you're ever in doubt about what to do or what a fever might mean, or if your child is acting ill in a way that concerns you even if there's no fever, always call your child's doctor for advice.

Reviewed by: Mary L. Gavin, MD

Some Aging Brains Stay Sharp: How?

2007-11-26T08:21:00.000-08:00

Oct. 12, 2007 — When aging hampers memory, some people's brains compensate to stay sharp. Now scientists want to know how those brains make do — in hopes of developing treatments to help everyone else keep up.

This is not Alzheimer's disease, but the wear-and-tear of so-called normal aging. New research is making clear that memory and other brain functions decline to varying degrees even in otherwise healthy people as they age, as anyone who habitually loses car keys probably suspected.

The question is how to gird our brains against time's ravages, a question becoming critical as the population grays. If you're 65 today, odds are you'll live to 83. But improving health care means people in their 50s today may live another 40 years.

"I don't think we've recognized, as scientists or a society, (that) this is the front-and-center public health issue we face as a nation," Dr. Denise Park, director of the University of Illinois' Center for Healthy Minds, told fellow brain specialists assembled by the government last week.

"We need to understand how to defer normal cognitive aging ... the way we've invested in fighting heart disease and cancer."

There are intriguing clues, gleaned from discoveries that some seniors' brains literally work around aging's damage, forging new pathways when old ones disintegrate.

"It's not just fanciful or pie-in-the-sky" to try harnessing that ability, said Dr. Richard Hodes, director of the National Institute on Aging, which organized last week's meeting to seek advice on the most promising research.

High on the list: Simple physical exercise. It seems to do the brain as much good as the body.

Other options aren't as well-studied, but range from brain-training games to medications that may keep brain networks better connected. In fact, an old blood-pressure pill named guanfacine improves memory in old rats and monkeys by doing just that — but it hasn't yet been tested in older people with memory problems.

What's normal aging and what signals impending Alzheimer's? That is a big question for elders worried about periodic memory lapses. Science can't yet tell for sure, but there seem to be distinct differences.

Consider: A healthy brain is a bushy one. Branch-like tentacles extend from the ends of the brain's cells, enabling them to communicate with each other. The more you learn, the more those connections form.

Discovery News

Did u know HIV Aids???

2007-10-30T22:10:00.000-07:00

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the human immunodeficiency virus (HIV) in humans,^[1] and similar viruses in other species (SIV, FIV, etc.). The late stage of the condition leaves individuals susceptible to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to decelerate the virus' progression, there is currently no known cure. HIV, et al., are transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.^[2]^[3] This transmission can come in the form of anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, or breastfeeding, or other exposure to one of the above bodily fluids.

Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century;^[4] it is now a pandemic, with an estimated 38.6 million people now living with the disease worldwide.^[5] As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimate that AIDS has killed more than 25 million people since it was first recognized on June 5, 1981, making it one of the most destructive epidemics in recorded history. In 2005 alone, AIDS claimed an estimated 2.4–3.3 million lives, of which more than 570,000 were children.^[5] A third of these deaths are occurring in sub-Saharan Africa, retarding economic growth and destroying human capital. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but routine access to antiretroviral medication is not available in all countries.^[6] HIV/AIDS stigma is more severe than that associated with other life-threatening conditions and extends beyond the disease itself to providers and even volunteers involved with the care of people living with HIV.

Injection by HIV

For more details on this topic, see HIV.

Scanning electron micrograph of HIV-1 budding from cultured lymphocyte.

AIDS is the most severe acceleration of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as CD4⁺ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4⁺ T cells. CD4⁺ T cells are required for the proper functioning of the immune system. When HIV kills CD4⁺ T cells so that there are fewer than 200 CD4⁺ T cells per microliter (µL) of blood, cellular immunity is lost, leading to the condition known as AIDS. Acute HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified on the basis of the amount of CD4⁺ T cells in the blood and the presence of certain infections.

In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months.^[7] However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function.^[8]^[9] Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression.^[7]^[10]^[11] The infected person's genetic inheritance plays an important role and some people are resistant to certain strains of HIV. An example of this is people with the CCR5-Δ32 mutation are resistant to infection with certain strains of HIV.^[12] HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.^[13]^[14]^[15] The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time.

Diagnosis

Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control (CDC) Classification System is used.

WHO disease staging system for HIV infection and disease

Main article: WHO Disease Staging System for HIV Infection and Disease

In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.^[16] An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.

Stage I: HIV infection is asymptomatic and not categorized as AIDS
Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections
Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.

CDC classification system for HIV infection

Main article: CDC Classification System for HIV Infection

In the beginning, the Centers for Disease Control and Prevention (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.^[17]^[18] They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.^[19] In the general press, the term GRID, which stood for Gay-Related Immune Deficiency, had been coined.^[20] However, after determining that AIDS was not isolated to the homosexual community,^[19] the term GRID became misleading and AIDS was introduced at a meeting in July 1982.^[21] By September 1982 the CDC started using the name AIDS, and properly defined the illness.^[22] In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4⁺ T cell count below 200 per µL of blood or 14% of all lymphocytes.^[23] The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4⁺ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.

HIV test

Main article: HIV test

Many people are unaware that they are infected with HIV.^[24] Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities.^[24] Therefore, donor blood and blood products used in medicine and medical research are screened for HIV. Typical HIV tests, including the HIV enzyme immunoassay and the Western blot assay, detect HIV antibodies in serum, plasma, oral fluid, dried blood spot or urine of patients. However, the window period (the time between initial infection and the development of detectable antibodies against the infection) can vary. This is why it can take 3–6 months to seroconvert and test positive. Commercially available tests to detect other HIV antigens, HIV-RNA, and HIV-DNA in order to detect HIV infection prior to the development of detectable antibodies are available. For the diagnosis of HIV infection these assays are not specifically approved, but are nonetheless routinely used in developed countries.

Symptoms and complications

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS.^[25] HIV affects nearly every organ system. People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas.

Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.^[26]^[27] After the diagnosis of AIDS is made, the current average survival time with antiretroviral therapy (as of 2005) is estimated to be more than 5 years,^[28] but because new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year.^[7] Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system.^[29]

The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function^[8]^[9]^[12] health care and co-infections,^[7]^[29] as well as factors relating to the viral strain.^[14]^[30]^[31] The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.

Major pulmonary illnesses

X-ray of Pneumocystis jirovecii caused pneumonia. There is increased white (opacity) in the lower lungs on both sides, characteristic of Pneumocystis pneumonia

Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii. Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 per µL.^[32]
Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multidrug resistance is a potentially serious problem. Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.^[33] Alternatively, symptoms may relate more to the site of extrapulmonary involvement.

Major gastro-intestinal illnesses

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.^[34]
Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria, Campylobacter, or Escherichia coli) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and cytomegalovirus (CMV) colitis. In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.^[35]

Major neurological illnesses

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain causing toxoplasma encephalitis but it can infect and cause disease in the eyes and lungs.^[36]
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.^[37]
AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia which secrete neurotoxins of both host and viral origin.^[38] Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4⁺ T cell levels and high plasma viral loads. Prevalence is 10–20% in Western countries^[39] but only 1–2% of HIV infections in India.^[40]^[41] This difference is possibly due to the HIV subtype in India.
Cryptococcal meningitis is an infection of the meninx (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.

Major HIV-associated malignancies

Kaposi's sarcoma

Patients with HIV infection have substantially increased incidence of several malignant cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV), and human papillomavirus (HPV).^[42]^[43] The following confer a diagnosis of AIDS when they occur in an HIV-infected person.

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.
High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas.
Cervical cancer in HIV-infected women is considered AIDS-defining. It is caused by human papillomavirus (HPV).

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, such as Hodgkin's disease and anal and rectal carcinomas. However, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.^[44]

Other opportunistic infections

AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness. Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.^[45]

Symptom resurgence

The press reports specific symptom resurgence among AIDS patients undergoing treatment.

Kaposi's sarcoma in AIDS patients

San Francisco doctors reported a Kaposi's sarcoma cluster among gay men. All 15 patients undergoing treatment are long-term HIV survivors whose HIV infections are firmly controlled with antiviral drugs. None appears to be in any danger. The new cases are not aggressive, invasive or lethal as was typical with uncontrolled HIV during the 1980s. The lesions are unsightly, difficult to treat and raise questions about the immune response of aging HIV survivors.

Transmission and prevention

The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.

Sexual contact

The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. Heterosexual intercourse is the primary mode of HIV infection worldwide.^[55] Sexual transmission occurs with the contact between sexual secretions of one partner with the rectal, genital or oral mucous membranes of another. Unprotected receptive sexual acts are riskier than unprotected insertive sexual acts, with the risk for transmitting HIV from an infected partner to an uninfected partner through unprotected anal intercourse greater than the risk for transmission through vaginal intercourse or oral sex. Oral sex is not without its risks as HIV is transmissible through both insertive and receptive oral sex.^[56] The risk of HIV transmission from exposure to saliva is considerably smaller than the risk from exposure to semen; contrary to popular belief, one would have to swallow gallons of saliva from a carrier to run a significant risk of becoming infected.^[57]

Approximately 30% of women in ten countries representing "diverse cultural, geographical and urban/rural settings" report that their first sexual experience was forced or coerced, making sexual violence a key driver of the HIV/AIDS pandemic.^[58] Sexual assault greatly increases the risk of HIV transmission as protection is rarely employed and physical trauma to the vaginal cavity frequently occurs which facilitates the transmission of HIV.^[59]

Sexually transmitted infections (STI) increase the risk of HIV transmission and infection because they cause the disruption of the normal epithelial barrier by genital ulceration and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America have suggested that there is approximately a four times greater risk of becoming infected with HIV in the presence of a genital ulcer such as those caused by syphilis and/or chancroid. There is also a significant though lesser increased risk in the presence of STIs such as gonorrhea, Chlamydial infection and trichomoniasis which cause local accumulations of lymphocytes and macrophages.^[60]

Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions. Each 10-fold increment of blood plasma HIV RNA is associated with an 81% increased rate of HIV transmission.^[60]^[61] Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases.^[62]^[63] People who are infected with HIV can still be infected by other, more virulent strains.

During a sexual act, only male or female condoms can reduce the chances of infection with HIV and other STDs and the chances of becoming pregnant. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion.^[64] The effective use of condoms and screening of blood transfusion in North America, Western and Central Europe is credited with contributing to the low rates of AIDS in these regions. Promoting condom use, however, has often proved controversial and difficult. Many religious groups, most noticeably the Roman Catholic Church, have opposed the use of condoms on religious grounds, and have sometimes seen condom promotion as an affront to the promotion of marriage, monogamy and sexual morality. Defenders of the Catholic Church's role in AIDS and general STD prevention state that, while they may be against the use of contraception, they are strong advocates of abstinence outside marriage.^[65] This attitude is also found among some health care providers and policy makers in sub-Saharan African nations, where HIV and AIDS prevalence is extremely high.^[66] They also believe that the distribution and promotion of condoms is tantamount to promoting sex amongst the youth and sending the wrong message to uninfected individuals. However, no evidence has been produced that promotion of condom use increases sexual promiscuity,^[67] and abstinence-only programs have been unsuccessful in the United States both in changing sexual behavior and in reducing HIV transmission.^[68] Evaluations of several abstinence-only programs in the US showed a negative impact on the willingness of youths to use contraceptives, due to the emphasis on contraceptives' failure rates.^[69] The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making the condoms porous. If necessary, manufacturers recommend using water-based lubricants. Oil-based lubricants can however be used with polyurethane condoms.^[70] Latex condoms degrade over time, making them porous, which is why condoms have expiration dates. In Europe and the United States, condoms have to conform to European (EC 600) or American (D3492) standards to be considered protective against HIV transmission.

The female condom is an alternative to the male condom and is made from polyurethane, which allows it to be used in the presence of oil-based lubricants. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom contains an inner ring, which keeps the condom in place inside the vagina — inserting the female condom requires squeezing this ring. However, at present availability of female condoms is very low and the price remains prohibitive for many women. Preliminary studies suggest that, where female condoms are available, overall protected sexual acts increase relative to unprotected sexual acts, making them an important HIV prevention strategy.^[71]

With consistent and correct use of condoms, there is a very low risk of HIV infection. Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year.^[72]

The United States government and health organizations both endorse the ABC Approach to lower the risk of acquiring AIDS during sex:

Abstinence or delay of sexual activity, especially for youth,

Being faithful, especially for those in committed relationships,

Condom use, for those who engage in risky behavior.

This approach has been very successful in Uganda, where HIV prevalence has decreased from 15% to 5%. However, more has been done than just this. As Edward Green, a Harvard medical anthropologist, put it, "Uganda has pioneered approaches towards reducing stigma, bringing discussion of sexual behavior out into the open, involving HIV-infected people in public education, persuading individuals and couples to be tested and counseled, improving the status of women, involving religious organizations, enlisting traditional healers, and much more." However, criticism of the ABC approach is widespread because a faithful partner of an unfaithful partner is at risk of contracting HIV and that discrimination against women and girls is so great that they are without voice in almost every area of their lives.^[73] Other programs and initiatives promote condom use more heavily. Condom use is an integral part of the CNN Approach. This is:

Condom use, for those who engage in risky behavior,

Needles, use clean ones,

Negotiating skills; negotiating safer sex with a partner and empowering women to make smart choices.

In December 2006, the last of three large, randomized trials confirmed that male circumcision lowers the risk of HIV infection among heterosexual African men by around 50%. It is expected that this intervention will be actively promoted in many of the countries worst affected by HIV, although doing so will involve confronting a number of practical, cultural and attitudinal issues. Some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects.^[74] Furthermore, South African medical experts are concerned that the repeated use of unsterilized blades in the ritual circumcision of adolescent boys may be spreading HIV.^[75]

Exposure to infected body fluids

This transmission route is particularly relevant to intravenous drug users, hemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with not only HIV, but also hepatitis B and hepatitis C. Needle sharing is the cause of one third of all new HIV-infections and 50% of hepatitis C infections in North America, China, and Eastern Europe. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150 (see table above). Post-exposure prophylaxis with anti-HIV drugs can further reduce that small risk.^[76] Health care workers (nurses, laboratory workers, doctors etc) are also concerned, although more rarely. This route can affect people who give and receive tattoos and piercings. Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections.^[77] Because of this, the United Nations General Assembly, supported by universal medical opinion on the matter, has urged the nations of the world to implement universal precautions to prevent HIV transmission in health care settings.^[78] Drug abuse has an additional effect of an increased tendency to engage in unprotected sexual intercourse ^[79].

The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and "between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products".^[80]

Medical workers who follow universal precautions or body-substance isolation, such as wearing latex gloves when giving injections and washing the hands frequently, can help prevent infection by HIV.

All AIDS-prevention organizations advise drug-users not to share needles and other material required to prepare and take drugs (including syringes, cotton balls, the spoons, water for diluting the drug, straws, crack pipes, etc). It is important that people use new or properly sterilized needles for each injection. Information on cleaning needles using bleach is available from health care and addiction professionals and from needle exchanges. In some developed countries, clean needles are available free in some cities, at needle exchanges or safe injection sites. Additionally, many nations have decriminalized needle possession and made it possible to buy injection equipment from pharmacists without a prescription.

Mother-to-child transmission (MTCT)

The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between the mother to the child during pregnancy, labor and delivery is 25%. However, when the mother has access to antiretroviral therapy and gives birth by caesarean section, the rate of transmission is just 1%.^[49] A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Breastfeeding increases the risk of transmission by 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breast-feeding.

Studies have shown that antiretroviral drugs, caesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child.^[81] Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible.^[5] In 2005, around 700,000 children under 15 contracted HIV, mainly through MTCT, with 630,000 of these infections occurring in Africa.^[82] Of the estimated 2.3 million 1.7–3.5 million children currently living with HIV, 2 million (almost 90%) live in sub-Saharan Africa.^[5]

Prevention strategies are well known in developed countries, however, recent epidemiological and behavioral studies in Europe and North America have suggested that a substantial minority of young people continue to engage in high-risk practices and that despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV.^[83] However, transmission of HIV between intravenous drug users has clearly decreased, and HIV transmission by blood transfusion has become quite rare in developed countries.

Treatment

There is currently no vaccine or cure for HIV or AIDS. The only known methods of prevention are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment directly after a highly significant exposure, called post-exposure prophylaxis (PEP).^[76] PEP has a very demanding four week schedule of dosage. It also has very unpleasant side effects including diarrhea, malaise, nausea and fatigue.^[84]

Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART.^[85] This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available.^[6] Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of anti-retroviral agents. Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NARTIs or NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI). Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults.^[86] In developed countries where HAART is available, doctors assess the viral load, rapidity in CD4 decline, and patient readiness while deciding when to recommend initiating treatment.^[87]

HAART allows the stabilization of the patient’s symptoms and viremia, but it neither cures the patient of HIV, nor alleviates the symptoms, and high levels of HIV-1, often HAART resistant, return once treatment is stopped.^[88]^[89] Moreover, it would take more than the lifetime of an individual to be cleared of HIV infection using HAART.^[90] Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life, which has led to the plummeting of HIV-associated morbidity and mortality.^[91]^[92]^[93] In the absence of HAART, progression from HIV infection to AIDS occurs at a median of between nine to ten years and the median survival time after developing AIDS is only 9.2 months.^[7] HAART is thought to increase survival time by between 4 and 12 years.^[94]^[95] This average reflects the fact that for some patients — and in many clinical cohorts this may be more than fifty percent of patients — HAART achieves far less than optimal results. This is due to a variety of reasons such as medication intolerance/side effects, prior ineffective antiretroviral therapy and infection with a drug-resistant strain of HIV. However, non-adherence and non-persistence with antiretroviral therapy is the major reason most individuals fail to get any benefit from and develop resistance to HAART.^[96] The reasons for non-adherence and non-persistence with HAART are varied and overlapping. Major psychosocial issues, such as poor access to medical care, inadequate social supports, psychiatric disease and drug abuse contribute to non-adherence. The complexity of these HAART regimens, whether due to pill number, dosing frequency, meal restrictions or other issues along with side effects that create intentional non-adherence also has a weighty impact.^[97]^[98]^[99] The side effects include lipodystrophy, dyslipidaemia, insulin resistance, an increase in cardiovascular risks and birth defects.^[100]^[101]

Daily multivitamin and mineral supplements have been found to reduce HIV disease progression among men and women. This could become an important low-cost intervention provided during early HIV disease to prolong the time before antiretroviral therapy is required.^[102] Some individual nutrients have also been tried.^[103]^[104] Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS.^[105] It has been postulated that only a vaccine can halt the pandemic because a vaccine would possibly cost less, thus being affordable for developing countries, and would not require daily treatments.^[105] However, after over 20 years of research, HIV-1 remains a difficult target for a vaccine.^[105]

Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance. A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. Vaccination against hepatitis A and B is advised for patients who are not infected with these viruses and are at risk of becoming infected.^[106] Patients with substantial immunosuppression are also advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis as well.^[84]

Various forms of alternative medicine have been tried to treat symptoms or alter the course of the disease.^[107] In the first decade of the epidemic when no useful conventional treatment was available, a large number of people with AIDS experimented with alternative therapies. The definition of "alternative therapies" in AIDS has changed since that time. Then, the phrase often referred to community-driven treatments, untested by government or pharmaceutical company research, that some hoped would directly suppress the virus or stimulate immunity against it. Examples of alternative medicine that people hoped would improve their symptoms or their quality of life include massage, stress management, herbal and flower remedies such as boxwood,^[108]^[109] and acupuncture;^[107] when used with conventional treatment, many now refer to these as "complementary" approaches. Despite the widespread use of complementary and alternative medicine by people living with HIV/AIDS, the effectiveness of these therapies has not been established.

Epidemiology

UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed an estimated 2.8 million (between 2.4 and 3.3 million) lives in 2005 of which more than half a million (570,000) were children.^[5]

Globally, between 33.4 and 46 million people currently live with HIV.^[5] In 2005, between 3.4 and 6.2 million people were newly infected and between 2.4 and 3.3 million people with AIDS died, an increase from 2003 and the highest number since 1981.^[5]

Sub-Saharan Africa remains by far the worst affected region, with an estimated 21.6 to 27.4 million people currently living with HIV. Two million [1.5–3.0 million] of them are children younger than 15 years of age. More than 64% of all people living with HIV are in sub-Saharan Africa, as are more than three quarters (76%) of all women living with HIV. In 2005, there were 12.0 million [10.6–13.6 million] AIDS orphans living in sub-Saharan Africa 2005.^[5] South & South East Asia are second worst affected with 15%. AIDS accounts for the deaths of 500,000 children in this region. Two-thirds of HIV/AIDS infections in Asia occur in India, with an estimated 5.7 million infections (estimated 3.4 – 9.4 million) (0.9% of population), surpassing South Africa's estimated 5.5 million (4.9–6.1 million) (11.9% of population) infections, making it the country with the highest number of HIV infections in the world.^[111] In the 35 African nations with the highest prevalence, average life expectancy is 48.3 years— 6.5 years less than it would be without the disease.^[112]

The latest evaluation report of the World Bank's Operations Evaluation Department assesses the effectiveness of the World Bank's country-level HIV/AIDS assistance, defined as policy dialogue, analytic work, and lending, with the explicit objective of reducing the scope or impact of the AIDS epidemic.^[113] This is the first comprehensive evaluation of the World Bank's HIV/AIDS support to countries, from the beginning of the epidemic through mid-2004. Because the Bank's assistance is for implementation of government programs by government, it provides important insights on how national AIDS programs can be made more effective.

The development of HAART as effective therapy for HIV infection and AIDS has substantially reduced the death rate from this disease in those areas where it is widely available. This has created the misperception that the disease has gone away. In fact, as the life expectancy of persons with AIDS has increased in countries where HAART is widely used, the number of persons living with AIDS has increased substantially. In the United States, the number of persons with AIDS increased from about 35,000 in 1988 to over 220,000 in 1996.

In Africa, the number of MTCT and the prevalence of AIDS is beginning to reverse decades of steady progress in child survival. Countries such as Uganda are attempting to curb the MTCT epidemic by offering VCT (voluntary counseling and testing), PMTCT (prevention of mother-to-child transmission) and ANC (ante-natal care) services, which include the distribution of antiretroviral therapy.

Economic Impact

HIV and AIDS retard economic growth by destroying human capital. UNAIDS has predicted outcomes for sub-Saharan Africa to the year 2025. These range from a plateau and eventual decline in deaths beginning around 2012 to a catastrophic continual growth in the death rate with potentially 90 million cases of infection.^[5]

Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people in these countries are falling victim to AIDS. They will not only be unable to work, but will also require significant medical care. The forecast is that this will likely cause a collapse of economies and societies in the region. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.

The increased mortality in this region will result in a smaller skilled population and labor force.^[114] This smaller labor force will be predominantly young people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers’ time off to look after sick family members or for sick leave will also lower productivity. Increased mortality will also weaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents.^[114] By killing off mainly young adults, AIDS seriously weakens the taxable population, reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This results in a slower growth of the tax base, an effect that will be reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.

On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household. The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending. A study in Côte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.

UNAIDS, WHO and the United Nations Development Programme have documented a correlation between the decreasing life expectancies and the lowering of gross national product in many African countries with prevalence rates of 10% or more. Indeed, since 1992 predictions that AIDS would slow economic growth in these countries have been published. The degree of impact depended on assumptions about the extent to which illness would be funded by savings and who would be infected.^[115] Conclusions reached from models of the growth trajectories of 30 sub-Saharan economies over the period 1990–2025 were that the economic growth rates of these countries would be between 0.56 and 1.47% lower. The impact on gross domestic product (GDP) per capita was less conclusive. However, in 2000, the rate of growth of Africa's per capita GDP was in fact reduced by 0.7% per year from 1990–1997 with a further 0.3% per year lower in countries also affected by malaria.^[116] The forecast now is that the growth of GDP for these countries will undergo a further reduction of between 0.5 and 2.6% per annum.^[114] However, these estimates may be an underestimate, as they do not look at the effects on output per capita.^[117]

Many governments in sub-Saharan Africa denied that there was a problem for years, and are only now starting to work towards solutions. Underfunding is a problem in all areas of HIV prevention when compared to even conservative estimates of the problems.

The launching of the world's first official HIV/AIDS Toolkit in Zimbabwe on October 3, 2006 is a product of collaborative work between the International Federation of Red Cross and Red Crescent Societies, World Health Organization and the Southern Africa HIV/AIDS Information Dissemination Service. It is for the strengthening of people living with HIV/AIDS and nurses by minimal external support. The package, which is in form of eight modules focusing on basic facts about HIV and AIDS, was pre-tested in Zimbabwe in March 2006 to determine its adaptability. It disposes, among other things, categorized guidelines on clinical management, education and counseling of AIDS victims at community level.^[118]

The Copenhagen Consensus is a project that seeks to establish priorities for advancing global welfare using methodologies based on the theory of welfare economics. The participants are all economists, with the focus of the project being a rational prioritization based on economic analysis. The project is based on the contention that, in spite of the billions of dollars spent on global challenges by the United Nations, the governments of wealthy nations, foundations, charities, and non-governmental organizations, the money spent on problems such as malnutrition and climate change is not sufficient to meet many internationally-agreed targets. The highest priority was assigned to implementing new measures to prevent the spread of HIV and AIDS. The economists estimated that an investment of $27 billion could avert nearly 30 million new infections by 2010.

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Source: Wikipedia

Detailed Guide: Breast Cancer

2007-10-30T21:55:00.000-07:00

What Is Breast Cancer?

Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may invade surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too. The remainder of this document refers only to breast cancer in women. For information on breast cancer in men, see the American Cancer Society's document, Breast Cancer in Men.

Normal Breast Structure

In order to understand breast cancer, it is helpful to have some basic knowledge about the normal structure of the breasts.

The female breast is made up mainly of lobules (milk-producing glands), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).

Most breast cancers begin in the cells that line the ducts (ductal cancers); some begin in the cells that line the lobules (lobular cancers), and the rest in other tissues.

The Lymph (Lymphatic) System

The lymph system is important to understand because it is one of the ways in which breast cancers can spread. This system has several parts.

Lymph nodes are small, bean-shaped collections of immune system cells that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune system cells (cells that are important in fighting infections). Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and those either above or below the collarbone (supraclavicular or infraclavicular nodes).

Knowing if the cancer cells have spread to lymph nodes is important because if it has, there is a higher chance that the cells could have also gotten into the bloodstream and spread (metastasized) to other sites in the body. The more lymph nodes that are involved with the breast cancer, the more likely it is that the cancer may be found in other organs as well. This is important to know because it could affect your treatment plan. But not all women with lymph node involvement develop metastases, and it is not unusual for a woman to have negative lymph nodes and later develop metastases.

Benign Breast Lumps

Most breast lumps are not cancerous; that is, they are benign. Still, some need to be sampled and viewed under a microscope to prove they are not cancer.

Fibrocystic Changes

Most lumps turn out to be fibrocystic changes. The term "fibrocystic" refers to fibrosis and cysts. Fibrosis is the formation of fibrous (or scar-like) tissue, and cysts are fluid-filled sacs. Fibrocystic changes can cause breast swelling and pain. This often happens just before a period is about to begin. Your breasts may feel lumpy and, sometimes, you may notice a clear or slightly cloudy nipple discharge.

Other Benign Breast Lumps

Benign breast tumors such as fibroadenomas or intraductal papillomas are abnormal growths, but they are not cancer and cannot spread outside of the breast to other organs. They are not life threatening. Still, some benign breast conditions are important because women with these conditions have a higher risk of developing breast cancer.

For more information see the section, "What Are the Risk Factors for Breast Cancer?" and the American Cancer Society document, Noncancerous Breast Conditions.

Breast Cancer General Terms

It is important to understand some of the key words used to describe breast cancer.

Carcinoma

This is a term used to describe a cancer that begins in the lining layer (epithelial cells) of organs such as the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).

Adenocarcinoma

An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes and secretes a substance). The ducts and lobules of the breast are glandular tissue (they make breast milk), so cancers starting in these areas are sometimes called adenocarcinomas.

Carcinoma In Situ

This term is used for the early stage of cancer, when it is confined to the layer of cells where it began. Specifically in breast cancer, in situ means that the cancer cells remain confined to ducts (ductal carcinoma in situ) or lobules (lobular carcinoma in situ). They have not invaded into deeper tissues in the breast or spread to other organs in the body, and are sometimes referred to as non-invasive breast cancers.

Invasive (Infiltrating) Carcinoma

An invasive cancer is one that has already invaded beyond the layer of cells where it started (as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas -- either invasive ductal carcinoma or invasive lobular carcinoma.

Sarcoma

Sarcomas are cancers that start from connective tissues such as fat tissue or blood vessels. Sarcomas of the breast are rare.

Types of Breast Cancers

There are several types of breast cancer, although some of them are quite rare. It is not unusual for a single breast tumor to be a combination of these types and to have a mixture of invasive and in situ cancer.

Ductal Carcinoma In Situ (DCIS)

Ductal carcinoma in situ (also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.

About 1 out of 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.

When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from tissue samples) will look for an area of dead or dying cancer cells, called tumor necrosis, within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive. The term comedocarcinoma is often used to describe DCIS with necrosis.

Lobular Carcinoma In Situ (LCIS)

Although not a true cancer, LCIS (also called lobular neoplasia) is sometimes classified as a type of non-invasive breast cancer, and this is why it is included here. It begins in the milk-producing glands but does not grow through the wall of the lobules.

Most breast cancer specialists think that LCIS itself does not become an invasive cancer very often, but women with this condition do have a higher risk of developing an invasive breast cancer in the same breast or in the opposite breast. For this reason, women with LCIS should pay close attention to having regular mammograms.

Invasive (or Infiltrating) Ductal Carcinoma (IDC)

This is the most common type of breast cancer. It starts in a milk passage (duct) of the breast, has broken through the wall of the duct, and invaded the fatty tissue of the breast. At this point, it may have the ability to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 out of 10 invasive breast cancers are infiltrating ductal carcinomas.

Invasive (or Infiltrating) Lobular Carcinoma (ILC)

Invasive lobular carcinoma starts in the milk-producing glands (lobules). Like IDC, it can spread (metastasize) to other parts of the body. About 1 out of 10 invasive breast cancers are ILCs. Invasive lobular carcinoma may be harder to detect by a mammogram than invasive ductal carcinoma.

Less Common Types of Breast Cancer

Inflammatory breast cancer: This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm and gives the skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The affected breast may become larger or firmer, tender, or itchy. Inflammatory breast cancer is often mistaken for infection (mastitis) in its early stages. Because there is no defined lump, it may not appear on a mammogram, which may make it even harder to catch it early. It typically has a higher chance of spreading and a worse outlook than typical invasive ductal or lobular cancer.

Mixed tumors: Mixed tumors are those that contain a variety of cell types, such as invasive ductal cancer combined with invasive lobular breast cancer. In this situation, the tumor is treated as if it were an invasive ductal cancer.

Medullary cancer: This special type of infiltrating breast cancer has a rather well-defined, distinct boundary between tumor tissue and normal tissue. It also has some other special features, including the large size of the cancer cells and the presence of immune system cells at the edges of the tumor. Medullary carcinoma accounts for about 3% to 5% of breast cancers. The outlook (prognosis) for this kind of breast cancer is generally better than for the more common types of invasive breast cancer. These are often hard to distinguish from invasive ductal carcinoma. Most cancer specialists think that true medullary cancer is very rare, and that cancers that are called medullary cancer should be treated as the usual invasive ductal breast cancer.

Metaplastic carcinoma: Metaplastic carcinoma (also known as carcinoma with metaplasia) is a very rare variant of invasive ductal cancer. These tumors include cells that are normally not found in the breast, such as cells that look like skin cells (squamous cells) or cells that make bone. These tumors are treated like invasive ductal cancer.

Mucinous carcinoma: Also known as colloid carcinoma, this rare type of invasive breast cancer is formed by mucus-producing cancer cells. The prognosis for mucinous carcinoma is usually better than for the more common types of invasive breast cancer.

Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare, accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may notice burning or itching.

Paget disease is almost always associated with either ductal carcinoma in situ (DCIS) or, more often, with infiltrating ductal carcinoma. If no lump can be felt in the breast tissue and the biopsy shows DCIS but no invasive cancer, the prognosis is excellent.

Tubular carcinoma: Tubular carcinomas are another special type of invasive ductal breast carcinoma. It was named tubular because of the way the cells look under the microscope. Tubular carcinomas account for about 2% of all breast cancers and tend to have a better prognosis than infiltrating ductal or lobular carcinomas.

Papillary carcinoma: The cells of these cancers tend to be arranged in small, finger-like projections when viewed under the microscope. These cancers are most often considered to be a subtype of ductal carcinoma in situ (DCIS), and are treated as such. In rare cases they are invasive, in which case they are treated like invasive ductal carcinoma, although the outlook is likely to be better. These cancers make up no more than 1% or 2% of all breast cancers, and they tend to be diagnosed in older women.

Adenoid cystic carcinoma (adenocystic carcinoma): These cancers are so named because they have both glandular (adenoid) and cylinder-like (cystic) features when viewed under the microscope. They make up less than 1% of breast cancers. They rarely spread to the lymph nodes or distant areas, and they tend to have a very good prognosis.

Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are usually benign but on rare occasions may be malignant.

Benign phyllodes tumors are treated by removing the mass along with a margin of normal breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider margin of normal tissue, or by mastectomy. While surgery is often all that is needed, these cancers may not respond as well to the other treatments used for invasive ductal or lobular breast cancer.

Angiosarcoma: This is a form of cancer that starts from cells that line blood vessels. It rarely occurs in the breasts. When it does, it is usually seen as a complication of radiation to the breast. It tends to develop about 5 to 10 years after radiation treatment. However, this is an extremely rare complication of breast radiation therapy. Angiosarcoma can also occur in the arm of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see the section, "How Is Breast Cancer Treated?") These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas (see the American Cancer Society document Soft Tissue Sarcomas).

Source