Ишемическая болезнь сердца-Ischemic heart disease

Tonsillitis refers to inflammation of the tonsils, and is part of the spectrum of upper respiratory tract infections in children.

Cause

Tonsillitis is caused most often by one of the common viruses, but sometimes it can be caused by a germ (bacterium). It is often impossible to distinguish between viral and bacterial infection. For this reason, many doctors will treat tonsillitis with a course of antibiotics, or even an injection.

Clinical features

The child will complain of a sore throat and sometimes of difficulty in swallowing. There may be a fever and the glands in the neck may be enlarged and tender. Very often he will have a headache, a runny nose and many of the symptoms of an upper respiratory tract infection as described above. The symptoms usually improve after a few days and disappear within a week.

Sometimes the doctor may order a throat swab to determine whether a virus or bacterium is causing the infection, and occasionally a blood test may be helpful. No other tests are generally useful or indicated.

Treatment

If the infection is a viral one, no specific treatment is necessary. However, it is often difficult clinically to distinguish between an infection caused by a virus and one due to a germ, so the doctor will often prescribe a course of antibiotics. This is given in the form of a mixture, tablets or capsules to be taken by mouth. Very occasionally, if the child is sick or has difficulty swallowing, the antibiotics are given by injection, but this is not usually necessary.

General treatment is similar to that suggested for a cold. Gargling with warm salt water may ease a sore throat, as will frequent warm drinks and lozenges. Specific food (e.g. ice cream and jelly) has no proven value, except that the child enjoys it.

When to see your doctor

See upper respiratory tract infection (colds).

Prevention

There is no effective way to prevent tonsillitis.

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A baby born before 37 weeks of pregnancy is called a pre-term infant.

Cause

The causes of most premature deliveries are unknown but certain conditions are associated with early labour. Malformations of the womb, an incompetent cervix, early breaking of the waters (premature rupture of membranes), multiple pregnancy (e.g. twins), and maternal diabetes or an acute illness in the mother, are all more likely to result in premature labour.

Clinical features

Premature babies are generally immature. They are smaller than full-term babies and usually require special care. Tiny babies may need intensive care. In general, premature babies are more prone to develop breathing problems, cardiovascular problems, anaemia, jaundice, feeding problems, low levels of calcium and glucose, hypothermia (low body temperature), and infection due to an immature immune system. With new sophisticated techniques available to highly skilled paediatric staff, most premature babies do very well nowadays, and do not suffer any long-term consequences. If your premature baby is at major risk of developing complications, he will usually be transferred to a hospital that has a neonatal intensive care nursery.

Nerve damage

If a nerve has been stretched during the baby’s passage through the birth canal, it may result in temporary weakness of certain muscles. This is more common in breech deliveries or if your pelvis is small and the baby is large. If the baby has been delivered by forceps, damage may have occurred to a nerve supplying one side of the face. The baby may not be able to move one side of the face very well. This usually improves without treatment after several weeks.

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«I can’t help feeling that I am doing something wrong when I have sex. Years of upbringing can’t be overcome. I’m still a Catholic boy at heart.»

ANSWER: There is no need to overcome those important years. The idea is to incorporate your feelings and memories and values from those years into your sexual life. If this seems almost impossible, I suggest you consult a clergyperson. Examination of belief and value systems is a key part of developing super marital sex for all couples, so your orientation gives you a head start here. The challenge will be in learning a new sexuality that is comfortable and nonoffensive to you both. I can assure you that in the years I have been doing therapy, I have never encountered a religious system that prohibits sensitive, caring intimacy between married people. The problem is usually not the religion, but the religiosity, the way it was taught and not what was taught. We must learn to look for the deeper messages in our value system, the messages about and not against sexual intimacy.

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We have discovered the ultimate reason for all diseases: poisoning of our body beyond its capacity to purify itself.

Nearly 100% of such poisoning comes from our diet. We basically poison ourselves, simply because we do not care about what we eat.

In view of the above, our diet requires a basic revision

The wisdom of many civilisations in the past was expressed in their diet. Two key items in the diet are common for all civilisations without exception, from ancient India to modern Georgia :

1. PURE AIR

2. PURE WATER (from the spring)

I have not heard anyone objecting to this. However, the word to which we should pay special attention is pure.

Unfortunately, the criteria for purity have become quite arbitrary nowadays. The prevailing doctrine is, that there is a threshold of pollution in the water, which is acceptable and safe for humans to consume. Medical Authorities generally accept and recommend the chemical treatment of water, leaving chlorine and other chemicals in it. Poisons are added

(fluoride), in the name of sterilisation and safety of supply, despite the fact that their toxicity is beyond doubt, and they accumulate in our body causing chronic diseases (arthritis). Municipal water also contains heavy metals from pipes, pumps etc., traces of herbicides, pesticides and other chemicals. It is very difficult to obtain information about the levels of such ingredients in our water from the relevant authorities. They would prefer that we do not know and believe that the water is OK.

Do not consume such water. Do not use it for tea, soup on even in cooking. Use water obtained from natural springs. Alternatively, filter the municipal water yourself. Do not use chemical filters. They may initially work, but eventually they may leave even more chemicals in the water you drink. The best are multi-stage paper and active carbon filters, with the final stage that uses a reverse osmosis ceramic membrane. The process of reverse osmosis imitates the function of a natural spring: water runs over a stone (ceramic element) and minute quantities filter slowly through. For home installation, the rate is quite slow: about half a litre per hour. There are systems available, which store about 10 litres of filtered water under light pressure, ready for the immediate use.

Note, that most of the beverages, including fruit juices from concentrates, contain municipal tap water. It would be much better if you squeezed the juice yourself from fresh fruits, or bought the frozen concentrate and diluted it yourself with spring or filtered water.

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Most are related to the gastro-intestinal tract, but the cause may be apart from this. It may occur from other areas of the abdomen such as the gallbladder or the pancreas or the liver or it may be due to a rise in blood pressure.

It could even be due to the presence of circulating toxins, poisons or drugs in the system. The commonest cause of indigestion originates in the stomach. This is a gastritis or inflammation of this organ.

This may be due to infection either from contaminated food or passed on from another person. It may arise from irritation from too much food, too rich a food, or from such things as pickles or spices. It may be caused by the irritation of too much alcohol, tea or coffee or cigarette smoke.

It may be due to the irritation of the stomach from aspirin or the anti-inflammatory drugs used in rheumatism and arthritis. Or the gastritis may occur as the result of stress or nervous tension.

An ulcer may form in the stomach or the duodenum, which is the first part of the small bowel, and the symptoms of this may be exactly the same as with the gastritis.

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These drugs are bacteriostatic — that is, they do not kill the germ but inhibit its growth, and the body’s own defence mechanism can then overcome the infection.

They still have some advantages in that they readily cross from the blood into the fluid inside the brain and spinal cord, which many newer antibiotics don’t. They are thus useful in treating bacterial meningitis, an infection of the covering membranes of the brain.

Insoluble forms, which are not absorbed, are used to sterilise the bowel.

Some people become sensitised to the sulphonamides and can develop an allergic rash or other allergic symptoms.

A recently developed antibiotic combines a sul-phonamide with an antibiotic of the tetracycline group, trimethoprim.

These complement each other’s action to a considerable degree and make the drug bacteriocidal in some circumstances — that is, it kills the germ rather than inhibiting its growth.

This antibiotic is marketed in Australia as Septrin and Bactrim.

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Other studies examined lymphocyte activity among sufferers of endometriosis. In one such study, it was postulated that if an immune system misfunction were entirely the cause, women with endometriosis would show a higher incidence of infectious diseases and cancer. Increased illness, however, seems net to be a factor among the women who participated in this study. Newer experiments have focused on the effect of the cellular antigen CA-125, a cell that acts like a foreign substance in the body. How this antigen is produced by the body is unknown.

Two particular studies, one conducted by Dr. Donald Pittaway and colleagues at the Bowman Grey School of Medicine in Winston-Salem, North Carolina, and the other by Dr. Phillip Patron and colleagues at Minnesota’s Mayo Clinic, have both turned up evidence to show that women with advanced endometriosis had elevated levels of CA-125. as did women who had acute pelvic inflammatory disease (PID) and unexplained infertility. However, patients with less advanced stages of the disease, and women who did not have endometriosis, tended to have similar and lower CA-125 levels. Still, these investigators believe, this antigen bears further study because of marked elevated levels of kin women with endometriosis. They are also looking for a possible test for detecting endometriosis by analyzing CA-125 levels, and antigenic proteins like it, in blood samples.

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The four major types of skin infection are bacterial viral fungal and parasitic. These groups will be considered in turn and examples of the most common forms of infection described Bacteria live permanently on the skin surface, and are known as the permanent bacterial flora. In addition, transient organisms are constantly arriving at the skin surface but are usually prevented from multiplying by the normal defence mechanisms. Under certain circumstances either the permanent or transient organisms may become established, multiply excessively, and then cause disease or infection. The factors governing the host resistance or defence mechanism are several. Firstly there are the factors inherent in the skin itself, for example the amount of moisture or other secretions present, and whether there is a point of entry or an abrasion on the surface. Secondly there is the degree of interaction between the permanent flora and the invading organism. Finally, there is the factor of the various cellular and circulatory interactions provoked by the invasion. These may be influenced by the body’s general health or level of immunity.

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Starches, because of their more compound nature, have been thought to be more slowly digested and therefore to offer great benefits in the treatment of disease such as diabetes and for fat loss. However, recently it has been shown that digestion and metabolism are not that simple. The speed with which carbohydrates are broken down and absorbed is not simply determined by whether they are ‘simple’ or ‘complex’ and another measure has been developed to classify this.

The Glycaemic Index (GI) is a method of classifying the glycaemic (i.e. blood sugar) response to carbohydrate-rich foods. Put another way, it is a measure of how quickly carbohydrate reaches the bloodstream. Foods can be tested and ranked according to a measure of their GI. The GI is calculated by measuring the area under the curve (of glycaemia) versus time, after consuming a food containing 50g of available carbohydrate by comparison with 50g of reference food (either glucose or white bread). Blood glucose testing is carried out every 15-30 minutes for 2-3 hours.

The lower the GI of a food, the flatter the curve of blood glucose response, meaning the slower this is digested and converted to blood sugar.

It does not necessarily follow that all sweet sugary foods will be quickly absorbed and therefore have a high GI. It is much more complex and depends on a number of characteristics of the food consumed, e.g.:

Type of sugar—Glucose (GI = 100) has a higher GI than fructose (GI = 20). Temperate fruits (e.g. apples, pears, oranges) have a higher fructose content and therefore lower GI than tropical fruits (e.g. watermelon, rockmelon, mangoes).

Nature of the starch—The ratio of two types of starches (amylose: amylopectin) can affect the GI of foods. Amylopectin is more easily digested than amylose. Therefore, foods such as legumes, with a high amylose: amylopectin ratio have a lower GI than rice which has a higher amylopectin content.

Processing and particle size—Food particle size is a determinant of GI. This is shown with bread processing. Whole meal bread has a finer texture than rye bread and thus a higher GI.

Cooking methods—Cooking affects the degree of gelatinisation of fruits and thus GI. Stewed fruits have a higher GI than fresh fruits.

Starch-nutrient interactions—Carbohydrate forms molecular complexes with fats and proteins. This happens, for example, in a baked cake where GI will be reduced.

Fat—Large amounts can reduce GI (e.g. in ice cream) and hence high-fat foods may have a desirable GI but still be undesirable in terms of energy content.

Fibre—This depends on type of fibre. Insoluble fibre appears to have no immediate effects. However, soluble fibre (e.g. guar gum) can decrease the rate of absorption of glucose and hence decrease GI. Fibre supplements will not have the same effect because the fibre is not packaged into the food. Resistant starch will also lower the GI of a food.

Taking these properties into account we can see why, in Table 9.3, wholemeal bread has a higher GI than rye bread and a pineapple has a higher GI than an apple. GI is not a simple function of the sugar content of foods and detailed tables showing the GIs of a wide variety of foods are now available.

There are day-to-day variations in GI due to physiological effects, and the GI of component foods can predict the likely effect of a meal. Sydney University studies have shown that low-GI foods may be beneficial for fat loss as they decrease hunger ratings. Due to the slower absorption of low-GI foods, they may result in less rapid fluctuations in blood glucose and appetite changes for some individuals.

Australian researchers are leading the world in GI research. For more information on this evolving topic, please refer to The GI Factor by Sydney University’s Professor Jennie Brand Miller.

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It is usual for the partner to have a sperm test before the woman undergoes any testing.

The reason for this is that a sperm test is a simple procedure and certainly the most convenient of all fertility tests.

A sperm analysis is carried out to see if sperm are present, how many there are, how many are moving (motility) and how many are normal (morphology). The analysis also establishes if there is an infection in the reproductive tract and whether there are any sperm antibodies present. The testing of these factors will give a guide to your partner’s potential for fertility.

The sperm sample must be taken to the testing laboratory within an hour of collection as a delay may harm the specimen. Most infertility experts advise that intercourse should be delayed for at least three days before the sample is taken as a shorter period may affect the volume and sperm numbers.

A recent illness can affect the quality of the sperm, so if your partner has had a cold or flu recently it may be advisable to repeat the sample if the results are not favourable. Your doctor will advise if this is necessary.

Some medications may also affect the quality of sperm so, again, advise your doctor if your partner is on any medication.

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CT scans (computerised tomography) and ordinary X-rays are of no value in the diagnosis and monitoring of endometriosis. Ultrasound can have a role in some situations.

Ultrasound involves the use of high frequency sound waves to create an image or picture of the body on a screen or film. Over the last decade it has been used increasingly in the diagnosis and management of a number of gynaecological and obstetrical conditions, including the detection of ovarian cysts and determining the age and size of a foetus in early pregnancy.

Ultrasound has a limited role in the diagnosis and monitoring of endometriosis. At present, the machines used are not sensitive enough to detect small implants and adhesions. They can only detect cysts greater than two centimetres in diameter and determine their size and location. Ultrasound cannot determine the nature of a cyst nor can it distinguish it from other types of cysts or conditions.

Ultrasound should not be used as a substitute for laparoscopy to diagnose endometriosis. Its use is limited to confirming the existence of a cyst felt during a pelvic examination and determining its size and location prior to surgery. In some circumstances ultrasound may be used to help monitor the change in the size of a cyst after a laparoscopic diagnosis has been made.

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