Decades of studies have documented the link between eating a diet rich in vegetables and multiple health benefits, yet nearly eight out of 10 people worldwide fall short of the daily recommendation. Research presented at the International Symposium on Human Health Effects of Fruits and Vegetables suggests the best approach may be to focus on the factors that are often behind this vegetable gap: convenience and enjoyment.

Two studies presented at the symposium found that the addition of vegetable juice in people’s diets was a successful strategy to help them reach the vegetable guidelines (at least 4 servings per day). In fact, the addition of a portable drink, such as V8® 100% vegetable juice, was more successful than an approach that focused solely on nutrition education, or offering dietary counseling on ways to increase vegetable intake.

Researchers at the University of California-Davis conducted a 12-week study among adults ages 40-65 years. All of the people in the study who drank at least two cups of vegetable juice met daily vegetable recommendations, yet only seven percent of the non-juice drinkers met the goal. The participants in the study with borderline high blood pressure who drank one to two servings of V8 juice lowered their blood pressure significantly.

According to the research, the vegetable juice drinkers said they enjoyed the juice and felt like they were doing something good for themselves by drinking it.

“Enjoyment is so critical to developing eating habits you can stick with for the long-term,” said study co-author Carl Keen, PhD, Professor of Nutrition and Internal Medicine at the University of California-Davis. “Health and nutrition professionals must help people find simple ways for people to get their vegetables or they simply won’t do it, and that means they won’t reap the benefits of a vegetable-rich diet. Vegetable juice is something that people enjoy, plus it’s convenient and portable, which makes it simple to drink every day.”

Research conducted at the Baylor College of Medicine revealed that drinking vegetable juice helped overweight individuals with metabolic syndrome lose more weight compared to non-juice drinkers. In the study, participants who drank one to two servings of Low Sodium V8® 100% vegetable juice a day as part of a balanced diet increased their vegetable intake and lost an average of four pounds over the 12-week study period. Those who did not drink juice lost only one pound.

Metabolic syndrome is a cluster of risk factors for heart disease and diabetes that includes excess body fat in the midsection, high blood pressure, high blood sugar and elevated blood cholesterol.

“Heart disease and obesity are two major global health issues today, so if we can provide people with actionable, small steps in reducing risk factors, that’s a big win in promoting good health” said study co-author John Foreyt, PhD, Director of the Behavioral Medicine Research Center at Baylor College of Medicine. “We’re encouraged to see that something as easy as drinking vegetable juice can help people increase their vegetable intake and have significant health benefits.”

About the Studies:
Both studies were randomized controlled trials, each lasting 12 weeks. The University of California-Davis study involved 90 healthy adults, ages 40-65 years. The Baylor study enrolled 81 adults (83.5% of whom were minority) with metabolic syndrome risk factors. The studies were supported in part by Campbell Soup Company and by resources provided from University of California-Davis and Baylor College of Medicine.

Source:
Emily Jane Watt

Previous studies have shown that prenatal cigarette smoke exposure is associated with increased rates of behaviour problems, irritability, attention-deficit/hyperactivity disorder, the risk of violent offenses, conduct disorder, adolescent onset of drug dependence, and the risk for criminal arrest in offspring.

The new study adds another potential negative outcome to the list of reasons for mothers to stop smoking while pregnant.

Most of the effects of tobacco either during pregnancy or on postnatal outcomes are attributed to nicotine.

However, smoking is associated with reduced monoamine oxidase A (MAO-A) activity, enzymes that degrade brain neurotransmitters in smokers.

Prenatal smoke exposure-induced low MAO-A activity in foetal life may dysregulate brain neurotransmission, creating a potential vulnerability to develop behavioural disorders later in life.

This dysregulation can occur with or without interaction with nicotine”s effect on the developing brain.

French scientists compared blood biomarkers of MAO-A activity in smoking and non-smoking pregnant women and in the cord blood of their newborns.

They also assessed the newborns” comfort level during their first 48 hours of life and found that MAO-A activity is reduced both in pregnant smokers and in their newborns.

The newborns of smoking mothers also showed significantly more discomfort than those of non-smoking mothers, potentially related to MAO-A inhibition.

The study findings “may have implications for future research because it proposes a biological explanation for the previously demonstrated relationship between smoking during pregnancy and behavioural disorders in the offspring,” said co-author Dr. Ivan Berlin.

The study is being published in the October 15th issue of Biological Psychiatry.

Pulmonary edema (UK/Ireland: oedema) is fluid accumulation in the lungs. This fluid collects in air sacs in the lungs, making it difficult to breathe. It leads to impaired gas exchange and may cause respiratory failure.

According to Medilexicon’s medical dictionary, pulmonary edema is: “edema of lungs usually resulting from mitral stenosis or left ventricular failure.”

In most cases, heart problems cause pulmonary edema. But fluid can accumulate for other reasons, including pneumonia, exposure to certain toxins and medications, and exercising or living at high elevations.

Treatment depends on the cause, but it focuses on maximizing respiratory function and removing the source of the problem. It generally includes supplemental oxygen and medications.

When pulmonary edema develops suddenly, it is a medical emergency requiring immediate care. Pulmonary edema can sometimes be fatal. The outlook depends on the rapidity in receiving treatment along with treatment for the underlying problem.
What are the signs and symptoms of pulmonary edema?
A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, a headache may be a symptom, while a rash may be a sign.

Pulmonary edema symptoms may appear suddenly or develop gradually, depending on the cause.

Signs and symptoms that come on all of a sudden may include:

* A cough that produces foamy sputum that may be tinged with blood
* A feeling of suffocating or drowning
* Acute shortness of breath or difficulty breathing
* Anxiety, agitation or a sense of apprehension
* Chest pain, if pulmonary edema is caused by heart disease
* Excessive sweating
* Gasping for breath, wheezing , breathlessness
* Pale skin
* Rapid, irregular heartbeat, palpitations

Anyone experiencing these above-listed signs and symptoms should seek medical help as soon as possible. Pulmonary edema can result in death if the patient does not receive prompt treatment.

Signs and symptoms that develop more gradually are often due to heart failure.

They may include:

* Ankle edema or swelling of the legs.
* Difficulty in breathing with effort. This is more noticeable when lying flat as opposed to sitting up.
* Fatigue.
* Loss of appetite.
* Nocturia or frequent urination at night.
* Rapid weight gain. The weight gain is from accumulation of fluid in the body, especially in the legs. Pulmonary edema may develop as a result of congestive heart failure, a condition in which the heart pumps too little blood to meet the body’s needs.
* Unusual shortness of breath during physical activity.
* Waking-up at night with a breathless feeling that may be relieved by sitting up.

Signs and symptoms of pulmonary edema caused by high-altitude generally include:

* Cough
* Fluid retention
* Headache
* Insomnia
* Shortness of breath

Acute pulmonary edema comes on suddenly and is life-threatening. Get emergency assistance if any of the following acute signs and symptoms appears:

* A bubbly, wheezing or gasping sound when breathing
* A severe drop in blood pressure
* Breathing difficulty along with excessive sweating
* Pink, frothy sputum when coughing. It is a classic sign of pulmonary edema
* Skin has a blue or gray tone
* Trouble breathing or a feeling of suffocating (dyspnea)
* Sudden worsening of any of the symptoms associated with chronic pulmonary edema or high-altitude pulmonary edema

What are the causes of pulmonary edema?
The lungs hold numerous small, elastic air sacs called alveoli. With each breath, these air sacs take in oxygen and release carbon dioxide. Usually, the exchange of gases occurs without problems.

But in certain conditions, the alveoli fill with fluid instead of air. This prevents the oxygen from being absorbed into the bloodstream.

Several factors can cause fluid to accumulate in the lungs. They are usually associated with the heart (cardiac pulmonary edema). The functions of heart and lungs are closely related.

The heart

It is composed of two upper and two lower chambers. The upper chambers are called the right and left atria. They receive incoming blood and pump it into the lower chambers. The lower chambers, through the ventricles, pump blood out of the heart. The heart valves keep blood flowing in the right direction.

The heart and the lungs

Usually, deoxygenated blood from all over your body enters the right atrium and flows into the right ventricle, where it is pumped through large blood vessels to the lungs. There, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then returns to the left atrium through the pulmonary veins, flows through the mitral valve into the left ventricle, and finally leaves the heart through another large artery, the aorta. The aortic valve at the base of the aorta keeps the blood from flowing backward into your heart. From the aorta, the blood travels to the rest of the body.

Cardiac pulmonary edema

Cardiac pulmonary edema is also known as congestive heart failure. It occurs when the overworked left ventricle is not capable of pumping out enough of the blood it receives from the lungs. As a result, pressure increases inside the left atrium and then in the pulmonary veins and capillaries. This causes fluid to be pushed through the capillary walls into the air sacs.

Congestive heart failure can also occur when the right ventricle is unable to overcome the amplified pressure in the pulmonary artery. This usually results from left heart failure, chronic lung disease or high blood pressure in the pulmonary artery (pulmonary hypertension).

Medical conditions that can cause weakness and failing of the left ventricle include:

* Coronary artery disease. Over time, the arteries that supply blood to the heart can become narrow from fatty deposits. A heart attack occurs when a blood clot forms in one of these narrowed arteries. There is blocking of the blood flow. This damages the section of the heart muscle supplied by that artery. The result is that the damaged heart muscle can no longer pump as well as it is supposed to.

The rest of the heart tries to compensate. However, it is unable function efficiently or it is weakened by the added workload. When the pumping action of the heart is damaged, blood backs up into the lungs. As a result, fluid is forced to pass through the capillary walls and into the air sacs.

* Cardiomyopathy. It is a condition where the heart muscle is damaged by causes other than blood flow problems. Frequently, cardiomyopathy has no known cause. Although it is sometimes genetically inherited. Less common causes include viral infections (myocarditis), alcohol abuse and the toxic effects of drugs such as heroin and some types of chemotherapy.

Cardiomyopathy weakens the left ventricle which is the heart’s main pump. The heart may not be able to respond to conditions that require it to work harder (surge in blood pressure, a faster heartbeat with exertion or excess salt consumption that causes water retention or infections..) When the left ventricle cannot carry on with the demands, fluid backs up into the lungs.

* Heart valve. In mitral valve disease or aortic valve disease, the valves that regulate blood flow in the left side of the heart either do not open wide enough or do not close completely. This allows blood to flow backward through the valve. This condition causes greater stress on the coronary arteries.

The increased pressure extends into the left atrium and then to the pulmonary veins, causing fluid to accumulate in the lungs. If the mitral valve leaks, some blood is backwashed toward the lung every time the heart pumps. If the leakage develops rapidly, sudden and severe pulmonary edema may develop.

* High blood pressure (hypertension) . Untreated or uncontrolled high blood pressure causes a thickening of the left ventricular muscle. It worsens coronary artery disease.

Noncardiac pulmonary edema

Pulmonary edema is not always caused by heart disease. This condition is known as noncardiac pulmonary edema because the heart is not the cause of the problem.

Some factors that can cause noncardiac pulmonary edema are:

* Lung infections. Such as pneumonia. The edema occurs only in the part of the lung that is irritated.

* Exposure to certain toxins. Inhaled toxins such as chlorine or ammonia.

* Kidney disease. When the kidneys cannot eliminate waste effectively, excess fluid can build up, causing pulmonary edema.

* Smoke inhalation. Smoke from a fire contains chemicals. They can damage the membrane between the air sacs and the capillaries, allowing fluid to enter the lungs.

* Adverse drug reaction. Many drugs, (illegal drugs, aspirin and chemotherapy drugs) are recognized to cause noncardiac pulmonary edema.

* Acute respiratory distress syndrome (ARDS) . This serious disorder occurs when the lungs suddenly fill with fluid and inflammatory white blood cells. Many conditions can cause ARDS, including severe injuries (trauma), systemic infection (sepsis), pneumonia and shock.

* High altitudes. High-altitude pulmonary edema (HAPE) typically occurs at elevations above 8,000 feet (about 2,400 meters). It can affect climbers, hikers or skiers who start exercising at higher altitudes without first becoming acclimated. Even people who have hiked or skied at high altitudes in the past are not immune.

The precise cause is not entirely clear. HAPE seems to develop as a result of increased pressure from constriction of the pulmonary capillaries. Without proper care, HAPE can be fatal.

Most people with pulmonary edema will be hospitalized for at least a few days, often longer.

After the condition has been stabilized, the patient might be referred to a specialist such as a cardiologist or a pulmonologist.

It is a good idea to prepare ahead of time for the first medical appointment and gather all the necessary information (list of symptoms, relevant personal information, copies of medical records, medications and vitamins, type of diet, preparing a list of questions to ask the doctor..).
Diagnosis of pulmonary edema
Pulmonary edema requires prompt treatment. Diagnosis is made on the basis of symptoms, physical exam and chest X-ray.

Several types of blood tests will be necessary:

A blood test from an artery on the wrist to check the amount of oxygen and carbon dioxide it contains. Blood will also be checked for levels of a substance called B-type natriuretic peptide (BNP). Increased levels of BNP may indicate that pulmonary edema is caused by heart problems. Other blood tests will usually be done, including tests of kidney function, blood count, and tests to exclude a heart attack as the cause of the pulmonary edema.

Once condition is stable, the patient’s medical history will be reviewed especially for cardiovascular or lung disease. Other tests might include:

* X-ray. A chest X-ray will probably be the first test to confirm the diagnosis of pulmonary edema.

* Electrocardiography (ECG) . This noninvasive test can reveal a wide range of information about the heart. During an ECG, patches are attached to the patient´s skin and receive electrical impulses from the heart. These are recorded in the form of waves on graph paper or a monitor. The wave patterns show the heart rate and rhythm, and if areas of the heart show diminished blood flow.

* Echocardiography or diagnostic cardiac ultrasound exam. It is a noninvasive test. It uses high-frequency sound waves that are reflected from the tissues of the heart. The sound waves are then sent to a machine that uses them to compose images of the heart on a monitor.

This test can help diagnose a number of heart problems, including valve problems, abnormal motions of the ventricular walls, fluid around the heart and congenital heart defects.

* Transesophageal echocardiography (TEE) . A soft, flexible tube with a special transducer tip is inserted through the mouth and into the esophagus. It allows a closer and more accurate picture of the heart and central pulmonary arteries. The patient is given a sedative. It might cause a sore throat for a few days after the procedure. There’s a slight risk of perforation or bleeding from the esophagus.

* Pulmonary artery catheterization. If other tests fail to reveal the reason for pulmonary edema, this procedure measures the pressure in the lung capillaries. During this test, a small, balloon-tipped catheter is inserted through a vein in the leg or arm into a pulmonary artery.

* Cardiac catheterization. If the ECG or echocardiography fails to uncover the cause of the pulmonary edema, or if the patient has chest pain, heart catheterization with coronary angiogram may be suggested. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in the groin, neck or arm and threaded through the blood vessels to the heart. If dye is injected during the test, it is referred to as a coronary angiogram. During this procedure, corrective action such as opening a blocked artery can be taken, which may quickly improve the pumping action of the left ventricle. Cardiac catheterization can also be used to measure the pressure in the heart chambers, evaluate the heart valves, and look for causes of pulmonary edema.

What is the treatment for pulmonary edema?
Giving oxygen is the first step in the treatment for pulmonary edema. It should relieve some of the symptoms. Sometimes it may be necessary to assist breathing with a machine.

Depending on the patient´s condition and the reason for the pulmonary edema, treatment may include one or more of the following medications:

* Preload reducers. Nitroglycerin and diuretics (such as furosemide (Lasix)) are commonly used to treat pulmonary edema. These medications dilate the veins in the lungs and elsewhere in the body. This decreases fluid pressure going into the heart and lungs. Diuretics initially induce frequent urination. A catheter might be temporarily needed while in the hospital.

* Morphine (Astramorph, Roxanol) . This narcotic may be used to relieve shortness of breath and anxiety. However, there is debate on whether the risks of morphine outweigh the benefits.

* Afterload reducers. These drugs dilate the peripheral vessels and take a pressure load off the left ventricle. Some examples of afterload reducer medications include nitroprusside (Nitropress), enalapril (Vasotec) and captopril (Capoten).

* Blood pressure medications. If there is high blood pressure when developing pulmonary edema, these medications will help control it. On the other hand, if blood pressure is too low, drugs to raise it will be given.

Treating high-altitude pulmonary edema (HAPE)

If there are mild symptoms of HAPE when climbing or traveling at high altitudes, descending a few thousand feet (about 600 to 900 meters) should relieve symptoms. Also, oxygen is helpful. Because HAPE can be life-threatening, a helicopter rescue may be necessary for the most serious cases.

To help treat or prevent symptoms of HAPE, some climbers take the prescription medication acetazolamide (Diamox). This medication can occasionally have side effects (tingling or burning in the hands and feet, diarrhea, confusion, nausea, loss of appetite, and hearing problems).
Possible complications of pulmonary edema
If pulmonary edema is not treated, it can raise pressure in the pulmonary artery and eventually the right ventricle begins to fail. The increased pressure backs up into the right atrium and then into various parts of your body, where it can cause:

* Abdominal swelling
* Buildup of fluid in the membranes that surround the lungs (pleural effusion)
* Congestion and swelling of the liver
* Leg swelling (edema)

When not treated, acute pulmonary edema can be fatal.

In some cases it may be fatal even if treatment is received.
Recovery and preventing recurrence
The following suggestions may speed recovery from cardiac pulmonary edema and help prevent a recurrence:

* Check Weight daily. Keeping a record of daily weight (in the morning before breakfast). Seek medical advice if there is a gain of 2 to 3 pounds (about 4 to 7 kilograms) in a single day.

* Controlling high blood pressure. Checking blood pressure with a home cuff at least once a day.

* Diet. Typically, people with pulmonary edema will need to follow a low-salt diet.

* Medical advice. Follow medical advice about controlling any underlying health problems, including guidance on diet, weight and exercise.

* Plenty of sleep. If feeling tired, napping during the day is recommended. Lung function may take as long as three to six months before returning to normal.

In the case of noncardiac pulmonary edema and some forms of ARDS, any further damage to the lungs should be minimized. Avoid drugs, allergens or high altitudes.
Prevention of pulmonary edema
Some of these measures can help reduce the risk of pulmonary edema:

Preventing cardiovascular disease

Cardiovascular disease is the leading cause of pulmonary edema.

* Control blood pressure. High blood pressure (hypertension) can lead to serious conditions such as stroke, cardiovascular disease and kidney failure. Most adults should take just a few minutes to have their blood pressure checked at least once every two years.

A resting blood pressure reading below 120/80 millimeters of mercury (mm Hg) is considered normal. Blood pressure of consistently 140/90 mm Hg or higher, is an indication of high blood pressure. A reading in between these levels is in the prehypertensive category.

In many cases, blood pressure can be lowered or maintained at a healthy level by getting regular exercise, eating a diet rich in fresh fruits, vegetables and low-fat dairy products, and limiting salt and alcohol.

* Blood cholesterol. Elevated cholesterol levels can cause fatty deposits to form in the arteries. This alters blood flow and increases the risk of vascular disease. But lifestyle changes can often keep cholesterol levels low. This includes limiting fats (especially saturated fats) eating more fiber, fish, and fresh fruits and vegetables, exercising regularly, stopping smoking, and drinking in moderation.

* Smoking. Smoking increases the risk of a second heart attack or heart-related death and also increases risk of lung cancer and other lung problems such as emphysema. In addition, exposure to secondhand smoke is a contributing factor to coronary artery disease.

* A heart-healthy diet. A diet rich in omega-3 fatty acids (found in fish) helps improve blood cholesterol levels and prevent blood clots. It is also important to eat plenty of fruits and vegetables, which contain antioxidants, vitamins and minerals. Reduce fat intake, especially animal (saturated) and trans fats (hydrogenated oils).

* Low-salt diet. Limit the use of salt (sodium). In some people with severely damaged left ventricular function, excess salt (even in a single meal or a bag of chips) may be enough to trigger congestive heart failure.

* Exercise regularly. Exercise is vital for a healthy heart. Regular aerobic exercise (about 30 minutes a day), helps control blood pressure and cholesterol levels, and maintain a healthy weight.

* Control weight. Being even slightly overweight increases the risk of cardiovascular disease. On the other hand, losing small amounts of weight can lower blood pressure, cholesterol and reduce the risk of diabetes.

* Taking baby aspirin. Seek medical advice about the pros and cons of taking one baby aspirin (81 milligrams) a day.

* Manage stress. To reduce the risk of heart problems, try to decrease stress levels.

Preventing HAPE (high-altitude pulmonary edema)

If traveling or climbing at high altitudes, gradual adaptation is necessary. Most experts advise ascending no more than 1,000 or 2,000 feet (300 to 600 meters) a day, once you reach 8,000 feet (about 2,400 meters). In addition, it is important to drink plenty of water to stay hydrated. Being physically fit will not necessarily prevent HAPE. The medication acetazolamide (Diamox) can help prevent HAPE (taken 12 to 72 hours before travelling to a high altitude). It is advised to continue the medication for an extra few days if there are any signs of altitude sickness (especially headache or insomnia).

Written by Stephanie Brunner B.A.

Munchausen syndrome (UK: Munchausen’s syndrome) is the recurrent faking of catastrophic illnesses. It is a psychological disorder in which the individual keeps coming back for treatment for an acute and often serious illness which does not exist or has been deliberately induced – patients recurrently pretend they are seriously ill and ask for treatment.

Munchausen syndrome should be spelled with a double “H”, as in Munchhausen. However, the misspelling with just one “H” has become so common that it is probably no longer considered as a spelling mistake, and most likely many people, including a significant number of health care professionals may even see the correct spelling as a typo.

A patient with Munchausen syndrome will typically give a credible and remarkable history, which is completely made up. An individual with Munchausen syndrome may go from hospital-to-hospital, pretending to have medical or surgical diseases and giving invented information about their medical history and social background. Some patients may have managed to con medical personnel into giving them unnecessary surgical procedures, resulting in a gridiron abdomen – a mass of scars on the abdomen as a result of these surgeries. In some cases, patients may ingest substances or inject themselves in order to induce illness.

Munchausen syndrome is one of the mental conditions called factitious disorders that are either invented or self-inflicted. Factitious disorders can be either physical or psychological. Munchausen syndrome is the most severe and long-lasting (chronic) form of factitious disorder.

Richard Asher, an English doctor, coined the phrase Munchausen syndrome in 1951 in an article in the medical journal The Lancet, after the German cavalry office Baron Karl Friedrich Hieronymous von Munchhausen (1720-1797), known for his fanciful, incredible tales about his exploits and past.

The syndrome itself was discovered by Henry Miege in 1893. Famous French neurologist, Jean Charcot, referred to Miege’s writings later on. Karl Menninger, an American psychiatrist, discussed the descriptions and writings made by Miege and Charcot 40 years later in a paper entitled “Polysurgery and Polysurgical Addiction”.

According to Medilexicon’s medical dictionary, Munchausen syndrome is :
“Repeated fabrication of clinically convincing simulations of disease for the purpose of gaining medical attention; a term referring to patients who wander from hospital to hospital feigning acute medical or surgical illness and giving false and fanciful information about their medical and social background for no apparent reason other than to gain attention.”

Munchausen syndrome is a rare condition. Experts say it is very hard to know exactly how common it is because patients use false names, visit different hospitals and health care professionals, and can become very adept at avoiding detection. The condition appears to be more common among males than females. Most diagnosed Munchausen syndrome patients tend to be middle-aged or young adults.
What are the signs and symptoms of Munchausen syndrome?
A symptom is something the patient feels and reports, while a sign is something other people, including the health care provider can detect. For example, a headache may be a symptom while a rash might be a sign.

Munchausen syndrome signs and symptoms are all associated with the faking or deliberately inducing illness or causing injury in order to satisfy deep emotional needs. The patient will be incredibly resourceful in his/her attempts not to be found out; this makes it extremely difficult for the health care provider to detect signs of a serious mental disorder.

If a person fakes an illness or injury to win a lawsuit or get some days off work he/she does not have Munchausen syndrome. There is no link between hypochondria and Munchausen syndrome. People with hypochondria really believe they are ill, while a person with Munchausen syndrome desperately wants medical attention, and will either fake signs and symptoms or induce illness or injury in order to get that attention.

Signs and symptoms of Munchausen syndrome include:

* Fanciful stories about several medical problems – often there is little documentary evidence. A common ruse is to say that they have been out of the country for a long time.

* Often being hospitalized.

* Symptoms which are inconsistent, tenuous or vague. They may not match the results of tests.

* Symptoms which unexpectedly get worse (for no logical reason).

* A desire to undergo lots of tests.

* The patient has surprisingly good medical knowledge.

* Desire and keenness to undergo surgical procedures, even risky ones.

* Seeking treatment from many different doctors.

* Seeking treatment from many different hospitals.

* Unwillingness to allow the health care provider to talk to friends or family.

* Frequently asking for painkillers and other drugs.

* Having very few or no visitors when in hospital.

* If confronted with their behavior, they may become defensive, aggressive or leave the hospital or health care provider and never return.

How does the patient feign illness?

It can be very difficult for doctors, nurses, other health care providers, friends and relatives to know whether the signs and symptoms are made up or deliberately induced. The patient may invent signs and symptoms or cause illness or injury by:

* Reporting a fictitious medical history – health care providers, friends, and relatives may be told an untrue medical history, such as claiming to have had cancer or some other major disease.

* Feigning symptoms – pretending to have pain, seizures, or even fainting. Often symptoms are selected carefully and tend to be those that are difficult to disprove, such as having very bad headaches.

* Hurting themselves – this may include injecting themselves with bacteria, feces, or some other substance. They may burn their skin or cut it. They may take medicines to provoke symptoms of diseases – such drugs as blood thinners, chemotherapy medicines and diabetes drugs may be used.

* Stop the healing process – cuts and wounds may be opened up to prevent healing.

* Tampering with tests – this may include heating up thermometers when their temperature is taken, tampering with laboratory tests, contaminating urine and blood samples.

What are the risk factors for Munchausen syndrome?
A risk factor is something which increases the risk of developing a condition or illness. For example, somebody who practiced boxing professionally for many years has a higher risk of developing brain damage than other people. Therefore, we say that boxing, especially long term professional boxing is a risk factor for brain damage.

Experts are not sure what causes Munchausen syndrome. However, the following factors may increase an individual’s chances of developing the disease:

* A close relative with a serious condition or disease.
* A poor sense of identity.
* A serious childhood illness during which the patient was nursed and cared for.
* Childhood trauma, including physical, sexual or emotional abuse.
* Inadequate coping skills.
* Losing a loved one earlier on in life; could be due to death, illness or abandonment.
* Low self-esteem.
* Personality disorders.
* Wanting to and failing to become a health care professional.
* Working in health care.

Experts warn that some of the data mentioned above are often received from the patient, who has a tendency to invent and dramatize his/her medical and personal history. In other words, these are known risk factors, but be aware that the patient has a tendency to lie and dramatize.
What are the causes of Munchausen syndrome?
Experts say that there is extremely little evidence on the possible causes of the condition because patients refuse to cooperate with most kinds of psychiatric treatment or psychological profiling.

Most experts agree that Munchausen syndrome is a kind of personality disorder. A personality disorder is one in which the patient has a distorted pattern of thoughts and beliefs about themselves and other people. This pattern makes them behave in ways others consider as abnormal or disturbed.

Some psychiatrists and a significant number of psychologists say that those with Munchausen syndrome have an antisocial personality disorder which makes them enjoy manipulating and duping health care professionals. They see doctors as figures of authority and derive a sense of power and control when they deceive them.

It is also possible, say psychologists, that an individual with Munchausen syndrome is attempting to form relationships, trying to become more socially acceptable. A significant number of patients live solitary lifestyles and have no or very little contact with their family. Adopting the role of patient provides comfort, and being nurtured by doctors and other health care providers provides human contact and emotional warmth.
How is Munchausen syndrome diagnosed?
Many people with Munchausen syndrome are extremely good at manipulating and exploiting a health care provider’s concern for the patient – they can be expert liars. They may have real symptoms and life-threatening conditions, even though these were self-inflicted. This can make effective and prompt diagnosis difficult.

When Munchausen’s syndrome is suspected the doctor will review the patient’s medical records and search for possible inconsistencies between what is documented and what the patient has told them. They will also try to get in touch with family or friends to find out whether claims about their medical history are true.

The medical team can also check blood and urine samples for traces of substances which would suggest they were deliberately ingested or injected and could explain their symptoms.

The patient’s hospital room may be searched for injected materials or hidden medications or substances. However, this procedure has ethical considerations of its own.

Even if they suspect the patient may be faking it, they also have to try to determine whether it is Munchausen syndrome or an attempt to get strong painkillers or to make money (fake illness for a lawsuit).

The following factors will contribute towards making a diagnosis of Munchausen syndrome:

* There is compelling evidence that the patient is faking symptoms.

* There is compelling evidence that the patient has induced symptoms deliberately.

* There is compelling evidence that the patient’s main aim is to be seen as sick.

* The patient’s behavior cannot be put down to anything else, such as an attempt at financial gain or getting early retirement.

If you suspect a member of your family may have Munchausen syndrome and express this to the doctor, the physician will probably adopt an approach that reduces the likelihood of humiliation, which may result in the patient becoming defensive, aggressive and seeking medical help elsewhere. The doctor may reassure the patient that not having a clear explanation for medical signs and symptoms is stressful in itself, and suggest that the problem may be caused, or at least exacerbated by stress. Whatever approach the doctor takes, it will most likely gently steer the patient towards care with a mental health provider.
What are the treatment options for Munchausen syndrome?
Treating a patient with Munchausen syndrome can be extremely challenging. Most of them will deny ever having had such a problem, and will most likely be uncooperative, making it hard to get them to adhere to treatment plans.

In view of this, most good health care providers will adopt a gentle, non-confrontational approach. The patient may be told that they may have multi-faceted health requirements which include treatment with a psychiatrist or psychologist. Unfortunately, even the most “white-gloves” approach may not work, and the patient leaves and moves on to another hospital or doctor, or even another town.

Treatment may be possible, and sometimes effective, if the patient accepts he/she has a problem and cooperates with treatment.

A combination of psychoanalysis and CBT (cognitive behavioral therapy) is most likely to have the best results.

* Psychoanalysis – Sigmund Freud (1856-1939), Austria, developed psychoanalysis – a method of psychotherapy. His understanding of the mind was mainly based on interpretive methods, introspection and clinical observations. He focused on resolving unconscious conflict, mental distress and psychopathology. The main principle of Freud’s theory was that the unconscious is responsible for most thought and behavior in everybody and the disorders of the mentally ill. Freud had a considerable influence in psychiatrist Carl Jung (Switzerland).

* CBT (cognitive behavioral therapy) – this helps people identify their unrealistic behavioral patterns and deal with the way we think about things and how they affect us emotionally. The aim of the therapist is to replace beliefs with more realistic and balanced ones. The therapy is based on present thinking, behavior and communication, rather than on past experiences and is oriented toward problem-solving. Put simply, CBT is aimed at helping people in the way they think (cognitive) and the way they act (behavior).

There is no standard treatment for Munchausen syndrome. If medications are prescribed, they will be for the treatment of other mental disorders that are also present, such as anxiety or depression.

Researchers observing the effects of various diets on the brains of genetically engineered mice bred for studying Alzheimer’s disease found quite unexpectedly that mice fed a high protein, low carbohydrate diet, developed brains that were five per cent lighter than those of mice fed other diets.

The study was the work of lead author, Sam Gandy, a professor at The Mount Sinai School of Medicine in New York City and a neurologist at the James J Peters Veterans Affairs Medical Center in the Bronx NY, and colleagues from research centers in the US, Canada, Australia and the UK. The study is published this week in BioMed Central’s open access journal Molecular Neurodegeneration.

Many other studies have already suggested that low calorie, low fat diets rich in vegetables, fruits, and fish may delay or slow down Alzheimer’s disease, so Gandy and colleagues decided to take this a step further and compare the effects of several different diets on mice that were genetically engineered to have some of the disease characteristics of Alzheimer’s.

Alzheimer’s is a brain-wasting disease where the cerebral cortex shrinks, and microscopic beta-amyloid plaques form around neurons or brain cells and neurofibrillary tangles form inside them.

Beta amyloid is a protein fragment snipped from an amyloid precursor protein (APP), whose role in the brain is not fully understood. What we do know is that in a healthy brain, beta amyloid fragments are broken down and eliminated, but in Alzheimer’s disease, they build up and form hard, insoluble plaques.

For the study, Gandy and colleagues tested four different diets on mice that were genetically engineered to express a mutant form of APP.

For 14 weeks (from the age of 4 weeks until 18 weeks) they fed the male and female mice on one of four diets: (1) a regular (reference) diet; (2) a high fat/low carbohydrate diet (60 per cent fat, 30 per cent protein, 10 per cent carbs, by calorie value); (3) a high protein/low carbohydrate diet (60 per cent protein, 30 per cent fat, 10 per cent carbohydrate by calorie value); or (4) a high carbohydrate/low fat diet (60 per cent carbohydrate, 30 per cent protein, 10 per cent fat, by calorie value).

After this, the researchers did post mortems on the brains of the 18-week old mice and measured their weight, plaque build up and structural differences in those regions known to be involved in the memory defects of Alzheimer’s disease (eg the hippocampus).

To their surprise, they found that the brains of the mice that had been fed the high protein/low carbohydrate diet were five per cent lighter than those of mice on the other diets, and regions of the hippocampus were less developed.

However, until they test for this effect in non-genetically engineered mice, it remains unclear whether the loss of brain mass is linked to the type of plaque found in Alzheimer’s disease.

Meanwhile, since previous studies have already indicated that diet may play a role in the progress of Alzheimer’s, the researchers tentatively put forward the theory that perhaps a diet high in protein makes neurons more vulnerable to the type of plaque that is characteristic of Alzheimer’s.

To support this theory they pointed out that the mice that were fed on a high fat diet had higher levels of plaque proteins in their brains but this did not raise the amount of plaque.

Gandy told the media that:

“Given the previously reported association of high protein diet with aging-related neurotoxicity, one wonders whether particular diets, if ingested at particular ages, might increase susceptibility to incidence or progression of AD [Alzheimer's Disease].”

The only way to verify this would be to do prospective randomized double blind diet trials, he said, explaining that while this would be difficult, it would be worth it if “there is a real chance that the ravages of AD might be slowed or avoided through healthy eating”. “Such trials will be required if scientists are ever to make specific recommendations about dietary risks for AD,” he added.

Walter and Eliza Hall Institute research into the development of a ‘whole organism’ vaccine against malaria has received a US$100,000 Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation.

The grant will support a global health research project titled ‘Development of a genetically attenuated live malaria vaccine’, that will be undertaken by Dr Krystal Evans, a post-doctoral fellow in Dr Louis Schofield’s laboratory in the institute’s Infection and Immunity Division.

Dr Evans’ project is one of 76 grants announced today by the Gates Foundation in the third funding round of Grand Challenges Explorations, a five-year $100 million initiative that provides financial support to scientists worldwide as they explore bold and largely unproven ways to improve health in developing countries.

Each year more than 400 million people contract malaria, and more than one million people, mostly children, die from the disease.

Dr Evans, in collaboration with Dr Schofield and Professor Alan Cowman, will use the funding to develop a live, genetically-modified, vaccine against Plasmodium falciparum, the parasite that causes the form of malaria mostly deadly to humans.

“Malaria presents an enormous health burden but also has a major impact on social and economic development in countries where the disease is endemic,” Dr Evans said. “New therapies are urgently needed. The parasite is becoming increasingly resistant to available drugs and although the past 10 years have seen more than 40 clinical trials of malaria subunit vaccines, they have consistently failed to provide strong and lasting immunity.”

Rather than developing a ‘subunit’ vaccine that uses only part of the parasite, Dr Evans plans to develop a live vaccine that will use the whole parasite. “This approach to vaccine development – using a weakened form of the whole organism that causes a particular disease – has proven successful in eradicating smallpox and controlling diseases such as flu and polio,” she said.

“We believe our laboratory’s recent advances in the genetic modification of parasites, together with its advances in stem cell technology and delivery, give us a good chance of success.”

Dr Tachi Yamada, president of the Gates Foundation’s Global Health Program said the winners of the grants showed the bold thinking needed to tackle some of the world’s greatest health challenges. “I’m excited about their ideas and look forward to seeing some of these exploratory projects turn into life-saving breakthroughs.”

This is the third Grand Challenges Explorations grant awarded to the Walter and Eliza Hall Institute since the program began. Prior grants were awarded to Dr Irene Caminschi and Dr Louis Schofield for other anti-malaria vaccine approaches. Promising research projects are eligible for further support of up to US$1 million.

Source:
Penny Fannin
Walter and Eliza Hall Institute

Experts at The University of Nottingham say our stress levels at work peak when we reach about 50 to 55 years of age and decrease as we head towards retirement.

In the first comprehensive report into age related stress and health at work to be carried out in Britain researchers from the Institute of Work, Health and Organisations also found that the effects of stress in our working lives can stay with us well into retirement.

The research, led by Amanda Griffiths, Professor of Occupational Health Psychology, reviewed hundreds of publications from the last 20 years. Professor Griffiths, said: “Work related stress is thought to be responsible for more lost working days than any other cause and it is becoming clear that it is also one factor affecting older workers’ willingness and ability to remain in the labour force. Therefore, protecting tomorrow’s older workers, as well as today’s, will pay dividends, as older workers will form a major part of tomorrow’s workforce.”

Many of us are likely to be working much longer than we expected. Until now the majority of reviews of research into work-related stress – its causes and its effects – have been based on large groups of workers and very rarely distinguished by age. This report, for TAEN – The Age and Employment Network, Age Concern and Help the Aged, aimed to address that gap.

This new research suggests that the reason studies show smaller number of workers report high stress levels once in their 50s might be because they have left stressful posts in favour of something less demanding; they already have retired voluntarily or because of ill health; or increasing seniority can give staff more control over their working life which makes it less stressful. The report says this makes older staff the healthy ‘survivors’ of the workplace.

Chris Ball, TAEN Chief Executive, said: “This report fills an important gap in our understanding of how stressful work can impact upon people towards the end of their working lives and into retirement. Demographic change and ageing populations have made extending working life a priority both in the UK and elsewhere. Clearly, we have to consider the kind of work people do and every aspect of the working environment with a view to removing stressors where we possibly can. TAEN and our sister charity, Age Concern and Help the Aged, sincerely hope this report will influence thinking and practice, so the casual acceptance of work-created mental ill health, permeating into older age, becomes a thing of the past.”

The report suggests that stress could be eased by giving older staff more control over their job; better recognition for the contribution they make; increased flexible working; and improvements in social support.

Professor Griffiths said: “As we get older people’s priorities may also change; they often have caring responsibilities, or wish to spend time with grandchildren and develop other interests. Their work and career may not be their primary drivers. Making work attractive and flexible – to allow older people to balance work and their other interests more easily may be one very important step forward”. She suggests that such investments in the quality of people’s ‘third age’ – their life after retirement – should be made during working life, not just afterwards.

Embryos that are most likely to result in a pregnancy are crucial to the success of in vitro fertilization (IVF) but are difficult to identify. Researchers at Yale School of Medicine, led by Emre Seli, M.D., are developing a fast, non-invasive test to help assess embryo viability for IVF.

Seli, associate professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale, presented new embryo selection findings at the American Society for Reproductive Medicine (ASRM) meeting held in Atlanta, Georgia.

Women undergoing infertility treatment with IVF are hormonally stimulated to produce multiple eggs, which are then fertilized in the lab. In most cases, multiple embryos are generated and cultured. Selecting embryos for implantation is currently highly subjective.

“It’s a guessing game that can end in IVF failure or multiple pregnancies,” said Seli. “Our goal is to find a way to pinpoint the embryos with the best chance of success, so that we can transfer fewer embryos and cut down on the possibility of multiple pregnancies without reducing the pregnancy rate.”

To detect the difference between a viable and non-viable embryo, Seli and his team have studied the metabolomic profile of spent embryo cultures. A metabolomic profile is the unique chemical fingerprint that results from the metabolic activity of embryos in culture. The team previously found that metabolomic profiling could give an instant snapshot of the physiology of a cell. This non-invasive approach may provide a useful adjunct to the current embryo grading systems based on the structure of the embryo and the rate at which the embryo divides.

Building on this groundbreaking finding, Seli and his team have found that a viability score generated by non-invasive assessment of embryo culture media using metabolomics affected pregnancy outcomes in women treated in four different centers in Europe and Australia. This study – performed in collaboration with Molecular Biometrics, Inc. and co-authored by Denny Sakkas, Lucy Botros, Marc Henson and Kevin Judge – was presented at the ASRM meeting.

“These findings have important implications for the more than 125,000 IVF cycles performed yearly in the United States,” said Seli. “The high multiple pregnancy rates associated with IVF have significant public health consequences, such as decreased survival and increased risk of lifelong disability associated with severe prematurity.”

Seli also received the 2009 Ira and Ester Rosenwaks New Investigator Award on October 18. This prestigious award is given annually by ASRM and recognizes outstanding contributions to research in reproductive sciences by an investigator within the first 10 years of his/her career. The award recognizes Seli’s work in infertility research, identifying novel genes and characterizing key aspects of the regulation of gene expression during early development.

Fever is a common medical sign that describes an increase in internal body temperature to levels above normal. Generally, a fever is an indication of something unusual in the body. It is the body’s response to a disease. In adults, a fever usually is not dangerous unless it reaches 103 F (39.4 C) or higher. In young children and infants, a slightly elevated temperature may be a sign of a serious infection.

According to Medilexicon’s medical dictionary, fever is: “A complex physiologic response to disease mediated by pyrogenic cytokines and characterized by a rise in core temperature, generation of acute phase reactants, and activation of immune systems.”

The degree of fever is not necessarily related to the seriousness of the underlying condition. There are numerous over-the-counter medications to lower a fever. However, it seems sometimes it is better left untreated. Fever could play an important role in helping the body fight off a number of infections. Fever is considered as one of the body’s immune mechanisms to attempt a neutralization of a perceived threat inside the body (bacterial or viral).
What are the signs and symptoms of fever?
A symptom is something the patient reports and feels, while a sign is something other people, including a doctor may detect. For example, a headache may be a symptom while a rash may be a sign.

The average temperature of the human body is 98.6 F (37 C).

Depending on the cause of the fever, symptoms may include:

* Dehydration
* General weakness
* Headache
* Inability to concentrate
* Loss of appetite
* Muscle aches
* Sweating
* Trembling, shivering

High fevers between 103 F (39.4 C) and 106 F (41.1 C) may cause:

* Confusion
* Convulsions
* Hallucinations
* Irritability

Fever-induced seizures in children
In some cases, children younger than age 5 can experience fever-induced seizures or febrile seizures. When a child’s temperature rises or falls rapidly febrile seizures can occur. The signs include convulsions and a brief loss of consciousness.

Although alarming, these seizures usually do not cause any lasting effects and are often triggered by a fever from a common childhood illness.

Infants

An unexplained fever is greater cause for concern in infants and in children than in adults. It is recommended to seek medical advice when a baby has a fever of 101 F (38.3 C) or higher or when:

* The baby is younger than 3 months of age.

* Infant refuses to eat or drink.

* Has a fever and unexplained irritability. Unusual crying during a diaper change or when moved.

* Has a fever and seems lethargic and unresponsive. In infants and children younger than age 2, these may be signs of meningitis (an infection and inflammation of the membranes and fluid surrounding the brain and spinal cord).

* When a newborn and has a lower than normal temperature. Less than 97 F (36.1 C). Very young babies may not be able to regulate their body temperature when they are ill. They may become cold rather than hot.

Children

Children usually tolerate fevers well. Parents should not only check temperature measurement but also how the child behaves. There is probably no cause for alarm if the child has a fever but is responsive, drinking fluids, playing, making eye contact and responding to stimuli such as facial expressions and voice. Seek medical advice if the child:

* Has a fever after being left in a hot car. Seek medical care immediately.

* Has a fever that persists longer than one day in children younger than age 2. Fever lasting longer than three days in children ages 2 and older.

* Is lethargic or irritable, vomits repeatedly, has a severe headache or stomachache, or has any other symptoms causing major discomfort.

Ask for medical guidance if there are special circumstances (a child with immune system problems or with a pre-existing illness).

Sometimes, older children with severe neurological impairments, with a life-threatening bacterial infection in the blood (sepsis) or with suppressed immune systems can have a lower than normal temperature.

Adults

Seek medical advice if:

* Temperature is higher than 103 F (39.4 C)
* There is fever for more than three days

In addition, seek immediate medical attention if a fever appears together with any of these signs or symptoms:

* Abdominal pain or pain when urinating
* Difficulty breathing or chest pain
* Extreme lethargy or irritability
* Mental confusion
* Persistent vomiting
* Severe headache
* Severe throat swelling
* Stiff neck and pain when bending head forward
* Unusual sensitivity to bright light
* Unusual skin rash, especially if the rash rapidly worsens
* Any other unexplained signs or symptoms

What are the causes of fever?
There are many variations in normal body temperature, and this needs to be considered when measuring fever. Normal body temperature varies throughout the day according to circadian rhythm. It is lower in the morning and higher in the late afternoon and evening. Normal temperature can range from about 97 F (36.1 C) to 99 F (37.2 C). However, 98.6 F (37 C) is generally considered normal. Temperature is increased after eating, and psychological factors also influence body temperature. Other factors, such as menstrual cycle or heavy exercise, can have an effect.

The mechanism of body temperature:

* Body temperature is set by the hypothalamus which is an area at the base of the brain that acts as a thermostat for the whole system.

* Temperature is the balance of the heat produced by the body tissues (particularly the liver and muscles), and the heat the body loses.

* During illness, normal temperature may be set a little higher as the body directs blood away from the skin to decrease heat loss.

* When a fever starts, the body tries to elevate its temperature. There is a feeling of chilliness and possible shivering. This is to generate heat until the blood around the hypothalamus reaches the new set point.

* When temperature begins to return to normal, there may be profuse sweat to get rid of the excess heat.

* For the very old, the very young or alcoholic, the body’s ability to produce a fever may be diminished.

Usually, a fever indicates the body is responding to a viral or bacterial infection. Other possible causes include:

* Certain inflammatory conditions such as rheumatoid arthritis (inflammation of the lining of the joints)

* Extreme sunburn

* Heat exhaustion

* In some rare cases, a malignant tumor or some forms of kidney cancer

* Some immunizations, such as the diphtheria, tetanus and acellular pertussis (DTaP) or pneumococcal vaccines (in infants and children)

* Some medications, such as antibiotics and drugs used to treat high blood pressure or seizures

Sometimes it is impossible to identify the cause of a fever. If a temperature of 101 F (38.3 C) or higher lasts for more than three weeks and it is medically impossible to find the cause after extensive evaluation, the diagnosis may be fever of unknown origin.
How is fever diagnosed?
Put simply, diagnosing a fever is simple – if the patient’s body temperature is higher than normal when they are sedentary (not running around, just sitting or lying down), they have a fever. Depending on other signs and symptoms, a physical examination, and possibly some other tests, the physical will determine whether the cause is an infection or something else.

To confirm a diagnosis, other tests may be required, such as blood tests.

In the case of a low-grade fever that persists for three weeks or more, but with no other symptoms, a variety of tests may be recommended to help find the cause. These may include blood tests and X-rays.
What is the treatment for fever?
Treatment depends on the cause of the fever. Antibiotics will be prescribed for bacterial infections, such as pneumonia or strep throat.

Antibiotics do not treat viral infections, such as stomach infection and mononucleosis. There are a few antiviral drugs used to treat some specific viral infections. However, the most effctive treatment for most viruses is often rest and plenty of fluids.

Over-the-counter medications

Over-the-counter medications may be recommended, such as acetaminophen (Tylenol, parecetamol) or ibuprofen (Advil, Motrin) to lower a high fever. Adults also may use aspirin. However, do not give aspirin to children under 16 years of age, because it may trigger a rare, but potentially fatal, disorder known as Reye’s syndrome.

Is it wise to lower a fever?

In the case of a low-grade fever, it is not advisable to try to lower the temperature. This may extend the illness or mask symptoms and make it more difficult to determine the cause.

A number of experts judge that aggressively treating a fever interferes with the body’s immune response. The viruses that cause colds and other respiratory infections thrive at normal body temperature. By producing a low-grade fever, the body may be helping eliminate a virus.
What are the complications of fever?
A fast rise or fall in temperature may cause a fever-induced seizure (febrile seizure) in a small number of children aged from 6 months to 5 years. Although alarming, the vast majority of febrile seizures cause no long-lasting effects.

Febrile seizures usually involve loss of consciousness and shaking of limbs on both sides of the body. Infrequently, a child may become rigid and convulse only part of his or her body.

What to do in case of a febrile seizure?

Lay the child on his or her side or stomach on the floor or ground. Remove any sharp objects that are near the child, loosen tight clothing and hold the child to prevent injury. Do not place anything in the child’s mouth or try to stop the seizure. Although most seizures stop on their own, call for emergency medical assistance if a seizure lasts longer than 10 minutes.

After the seizure, take the child to the doctor as soon as possible to determine the cause of the fever.

Remedies

A number of things can be of assistance during a fever:

* Drinking plenty of fluids. Drinking water, juices or broth. Fever can cause fluid loss and dehydration. The use an oral rehydration solution (such as Pedialyte) is recommended for a child under age 1.

* Resting. It is essential for recovery. Activity can raise body temperature.

* Staying cool. Dressing in light and comfortable clothing, keeping the room temperature cool.

* Taking acetaminophen or ibuprofen. Use according to the instructions or doctor’s recommendations. High doses or long-term use of acetaminophen may cause liver or kidney damage, and acute overdoses can be fatal.

* Soaking in lukewarm water. Particularly in case of high temperatures, a lukewarm five- to 10-minute soak or bath can be cooling. Do not use alcohol. And if the bath causes shivering, stop the bath. Shivering raises the body’s internal temperature (shaking muscles generate heat).

Taking a temperature
Fever is present if:

* Temperature in the anus (rectum/rectal) is at or over 100.0 °F (37.8 °C)
* Temperature in the mouth (oral) is at or over 99.5 °F (37.5 °C)
* Temperature under the arm (axillary) is at or over 99.0 °F (37.2 °C)
* Temperature in the ear is at or over 99.0 ºF (37.2 ºC)

To check temperature, there are several types of thermometers, including electronic thermometers and ear thermometers. Digital thermometers and those that quickly take temperature from the ear canal are particularly useful for young children and older adults. As glass mercury thermometers may have potential health implications for humans and the environment, they have been discontinued and are no longer recommended. Although not the most accurate way to take a temperature, oral thermometer can be used for an armpit reading:

* Place the thermometer in the armpit with arms crossed over the chest.

* Wait four to five minutes. The axillary temperature is slightly lower than an oral temperature.

* The actual number on the thermometer should be reported to the doctor. Specify where on the body the temperature taken.

Use a rectal thermometer for infants:

* Place a dab of petroleum jelly on the bulb.

* Lay baby on his or her tummy.

* Carefully insert the bulb one-half inch to one inch into the baby’s rectum.

* Hold the bulb and baby still for three minutes.

* Do not let go of the thermometer while it is inside the baby. If the baby moves, the thermometer could go deeper and cause an injury.

How to prevent fever?
It is possible to prevent fever by reducing exposure to infectious diseases. The most simple and effective way is frequent hand washing for adults and children.

Washing hands often, especially before eating and after using the toilet, after spending time in a crowd or around someone who’s sick, and after petting animals. Show children how to wash their hands properly, lathering both the front and back of each hand with soap, and rinsing carefully under running water. When there is no access to soap and water, carrying moist towelettes or hand sanitizer. When possible, trying not to touch nose, mouth or eyes which are the main way viral infections are transmitted.

In addition, adults and children should remember to turn away from others and to cover their mouths when coughing and their noses when sneezing.

Written by Stephanie Brunner B.A.

A study published Online First by The Lancet Oncology reports that lenalidomide plus low-dose dexamethasone is linked to better short-term overall survival. In addition, it is associated with lower toxicity than lenalidomide plus high-dose dexamethasone in patients with newly diagnosed myeloma. Therefore it is a possible treatment option for these patients. Currently, high-dose dexamethasone is a basis of therapy for multiple myeloma. The article is the work of Professor S Vincent Rajkumar, Mayo Clinic, Rochester, MN, USA, and colleagues on behalf of the Eastern Cooperative Oncology Group (ECOG), USA.

All of the patients involved in this randomised controlled trial had untreated, symptomatic myeloma. They were assigned to receive lenalidomide 25 mg on days 1 to 21 plus dexamethasone 40 mg on days 1 to 4, 9 to12, and 17 to 20 of a 28-day cycle (high dose), or lenalidomide given on the same schedule with dexamethasone 40 mg on days 1, 8, 15, and 22 of a 28-day cycle (low dose). After completing four cycles, patients could suspend therapy to follow stem-cell transplantation or continue treatment until disease progression. The primary endpoint was response rate after four cycles. It was evaluated according to the European Group for Blood and Bone Marrow Transplant criteria.

Results indicated that that 79 percent of 214 patients receiving high-dose therapy and 68 percent of 205 patients on low-dose therapy had complete or partial response within four cycles. But, at the second interim analysis after one year, overall survival was 96 percent in the low-dose dexamethasone group compared with 87 percent in the high-dose group. As a consequence, the trial was halted and patients on high dose therapy were crossed over to low-dose therapy. A total of 117 (52 percent) patients on the high-dose regimen had grade 3 or worse toxic effects in the first four months. This compared with 76 (35 percent) patients of the 220 on the low-dose regimen for whom toxicity data were available. In addition, 12 of 222 (5 percent) patients on high dose and one (<1 percent) of 220 on low-dose dexamethasone, died in the first four months. The three most common grade 3 or higher toxicities were:

• Deep-vein thrombosis: 57 (26 percent) of 223 versus 27 (12 percent) of 220.
• Infections including pneumonia: 35 (16 percent) of 223 versus 20 (9 percent) of 220.
• Fatigue: 33 (15 percent) of 223 versus 20 (9 percent) of 220.

The researchers explain: “High-dose dexamethasone in a community-setting seems more toxic than low-dose dexamethasone, with more early deaths in the first 4 months, increased risk of thromboembolic complications, and higher overall risk of serious adverse events, particularly in patients older than 65 years.”

They write in closing: “This trial…shows that low-dose dexamethasone in conjunction with lenalidomide is an active regimen for newly diagnosed myeloma with acceptable toxicity and low early mortality.”

They continue by saying: “The results of this trial show that the use of high-dose dexamethasone is not needed for the most part in the context of new active agents for myeloma, and as a result almost all current phase 3 trials have adopted low-dose dexamethasone as the standard in combination regimens.”

In an associated comment, Professor Antonio Palumbo and Dr Francesca Gay, Divisione di Ematologia dell’Universita di Torino, Turin , Italy remark: “The high efficacy and good tolerability of lenalidomide plus low-dose dexamethasone as initial therapy for myeloma has thus been established.”

They write in conclusion: “Further randomised phase 3 studies, comparing this regimen with current standards of care such as melphalan-prednisone-thalidomide or melphalan-prednisone-bortezomib, are still needed to verify whether lenalidomide plus low-dose dexamethasone can become a new standard of care for patients with myeloma, and whether the optimal therapeutic strategy should be long-term treatment with lenalidomide and steroids or short-term treatment followed by consolidation with autologous transplantation.”