July 22nd, 2011
Symptoms that affect the whole body, or constitution, are called constitutional symptoms. Constitutional symptoms include fever, night sweats, weight loss, fatigue, lethargy, and malaise. All these symptoms are relatively common both in the general population and in people with HIV infection. People with HIV infection tend to have constitutional symptoms when the CD4 count is low, unless the people are also depressed or have some unrelated medical problem like influenza. Some of these symptoms—fatigue, lethargy, malaise—are subjective and difficult to measure. Others—fever, severe weight loss (wasting)—are more objective. Fever-Physicians always want to know when a person with HIV infection has a fever: fever is an objective indication of a problem that is not just a day-to-day variation in health status. Fever, especially prolonged fever in people with low CD4 counts, is usually the result of infections. In people with HIV infection, the infections that are most likely are tuberculosis, sinusitis, Mycobacterium avium-intracellulare infection, cytomegalovirus infection, fungal infection, Pneumocystis pneumonia, and lymphoma. Most people with fever are aware of it. They cannot tolerate the usual range of heat and cold that most people consider normal room temperature; they have chills and sweats. In people with HIV infection, fevers often begin gradually, occurring off and on for extended periods of weeks or months. The fever is often accompanied by sweating at night, called night sweats, that may be severe enough to require changes in pajamas and sheets. It is important to measure the fever. The body temperature that is normal differs for different people and at different times of the day. The average temperature is 97 degrees F at 3:00 A.M. and 99.3 degrees F at 5:00 P.M. In general, temperatures are about two degrees higher (on the Fahrenheit scale) in the late afternoon than they are in the morning. A fever usually exaggerates this daily variation, and the highest temperatures usually come after 6:00 P.M. For this reason, people with HIV infection who think they have a fever should take their temperatures several times during the day, when they feel feverish, and in the late afternoon. Although there is no general agreement on the precise definition of fever, most physicians consider 99.6 degrees F or 100 degrees F to be a fever. (Temperature is measured on two scales: the Fahrenheit, or F scale, commonly used in the United States, and the centigrade, or C scale, used in the rest of the world and in some hospitals in the United States. A temperature of 98.6 degrees F corresponds to 37 degrees C.) Fever is basically treated by treating whatever is causing it. Treating fever itself is a little controversial. Fever actually has advantages: the immune system works better at higher temperatures, and fever is an important indicator of the course of the disease and of the effectiveness of treatment. But fever is also unpleasant for the person who has it and increases the metabolic rate, burning more calories and making good nutrition more difficult. Otherwise, there is little evidence that fever is harmful. When the decision is made to reduce fever, the usual drugs are aspirin or acetaminophen. The fever decreases or disappears when people take one of these drugs, but returns when the effect of the drug wears off. For people with persistent fever, these fluctuations in temperature can be more unpleasant than a steady, if high, temperature. For this reason, people with persistent fevers are often advised to take these drugs regularly, every four to six hours, without waiting for the fever to recur.*136\191\2*
Categories: HIV |
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July 12th, 2011
Female fertility is not affected by spinal cord injury: for a woman of childbearing age, the ability to become pregnant persists unless she has some unrelated fertility problem. Menstruation may stop immediately after the injury, but usually resumes within six months. Keep in mind, however, that even during this early time, ovulation continues and you can become pregnant. The length and duration of your menstrual cycle may change after injury, and bleeding may be lighter or heavier.If you don’t want to become pregnant, some form of birth control is just as necessary after spinal cord injury as before. If you do become pregnant, there are special considerations for ensuring the health of you and your child, as discussed shortly.Male fertility after spinal cord injury is a more complex matter. For most men with spinal cord injury, fertility problems result from inability to ejaculate, from retrograde ejaculation (ejection of semen into the bladder rather than out of the penis), or from lowered sperm counts or decreased motility of sperm.Several techniques are available for obtaining sperm from men with spinal cord injury, for use in artificial insemination of a partner or for in vitro fertilization (fertilization, in the laboratory, of an egg that has been removed from the woman’s body and will be re-implanted as an embryo).In vibratory stimulation, a vibrator is applied to the penis to produce reflex ejaculation. This technique must be used with medical supervision owing to the risk of autonomic dysreflexia. The technique usually works only for men with lesions above T12, because thoracic and sacral pathways are necessary for the reflex.Another technique for obtaining sperm is electro-ejaculation, electrical stimulation of the prostate gland and seminal vesicles that produces muscle contraction and ejaculation. A specially trained clinician places the device in the man’s rectum and stimulates the genitals electrically through the intervening tissue, producing ejaculation. The procedure can be scheduled when the man’s partner is ovulating, and artificial insemination can be done immediately after. Or the sperm sample can be used for in vitro fertilization.A new technique for in vitro fertilization is intracytoplasmic sperm injection. This technique improves the chances of fertilization by selecting only the healthiest sperm cells in a given sample and then directly injecting the sperm into the egg cell using microscopic equipment.Depending on your individual situation, you may be able to father a child without medical intervention or with one of the techniques described above. An urologist who specializes in fertility can provide a thorough assessment of your individual situation and help you explore your options. The American Society of Reproductive Medicine can supply you with a list of medical centers that provide infertility treatments of all types.
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Categories: Healthy bones Osteoporosis Rheumatic |
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July 1st, 2011
For 80 percent of children with epilepsy, seizures can be controlled. For those children and their families, epilepsy is not and should not be a substantial handicap. For zo percent, the uncontrolled seizures themselves may constitute a significant impairment; and for some children with mental retardation or cerebral palsy, epilepsy may be a substantial secondary disability. These children and their parents carry a significant burden, a greater degree of guilt, anger, frustration, sorrow, and just plain hard work. These parents need to understand these disabilities so they may help their children as much as circumstances allow.Damage to the brain causes these problems. Damage in the motor areas of the brain causes cerebral palsy. When damage or dysfunction occurs throughout a considerable area of the brain it may lead to mental retardation. Epilepsy also exists because the brain is not functioning properly. Mental retardation and cerebral palsy, while sometimes accompanied by epilepsy, never cause epilepsy. Epilepsy never causes cerebral palsy and seldom causes mental retardation.Parents with a severely disabled child must also gradually come to a realistic acceptance of their child’s disability. Mechanisms for coping are the same as for the parent of the less disabled child, but the goal is often far more difficult to achieve. In addition to working through your own adjustment, you must also help your child get the service he will need. You must be an advocate. Both you and your child will have special needs. Finding the help is sometimes difficult; for some people, accepting the help is even more difficult.*193\208\8*
Categories: Epilepsy |
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