Sleeping pills help when stress, travel or other disruptions keep you awake. If you have chronic insomnia, a better approach may be to remove the cause by changing your lifestyle.

If you're regularly having trouble either falling or staying asleep (insomnia), make an appointment with your doctor. Treatment is available — but it depends on what's causing your insomnia. Sometimes, an underlying medical or sleep disorder can be found and treated, a much more effective approach than just treating the symptom of insomnia itself.

Behavior changes learned through cognitive behavioral therapy are generally the best treatment for persistent insomnia. However, there are times when prescription sleeping pills may be helpful. Although sleeping pills don't treat the underlying cause of your sleeping problems, they may help you get some much needed rest.

Today's prescription sleeping pills don't carry the same level of risks of dependence and overdoses as sleeping pills of the past. But risks remain — especially for people who have certain medical conditions, including liver or kidney disease. Always talk with your doctor before trying a new treatment for insomnia.

Here's information on some of the most common types of sleeping pills used today.

Types of prescription sleeping pills

Prescription sleeping pills are available to help you fall asleep easier, stay asleep longer — or both. Before prescribing a medication to help you sleep, your doctor will ask you a number of questions to get a clear picture of your sleep patterns. He or she may also order tests to rule out any underlying conditions that may be causing difficulty sleeping.

To reduce the risk of side effects and of becoming reliant on drugs to sleep, your doctor likely will prescribe medications for two to four weeks. If the first medication you take doesn't work after the full prescribed course, call your doctor. You may need to try more than one prescription sleeping pill before finding one that works for you.

Some prescription sleeping pills are available as generic drugs, which are typically less expensive than are brand-name drugs. Ask your doctor whether there is a generic version available of the medication he or she prescribes. Insurance companies may have restrictions on which sleeping pills are covered, and they may require that you try other approaches to your insomnia first.

Sleeping pills that help you fall asleep

The following prescription medications are used mainly to help you fall asleep.

Drugs that help you fall asleep
Drug	May not be safe if you:	Considerations
Eszopiclone (Lunesta)	Have a history of drug or alcohol abuse, depression, lung disease, or a condition that affects metabolism.	May be used for a longer period of time than zolpidem or zaleplon. High-fat meals may slow your absorption of the drug and make it less effective. Stopping the drug suddenly may cause symptoms of withdrawal, such as anxiety, unusual dreams, nausea and vomiting.
Ramelteon (Rozerem)	Are pregnant or breast-feeding. Have a history of kidney or respiratory problems, sleep apnea, or depression. Have a liver disease.	May interact with alcohol. High-fat meals may slow your absorption of the drug and make it less effective. A manufactured drug similar to melatonin. Not likely to be habit-forming.
Triazolam (Halcion)	Are pregnant or breast-feeding. Have a history of drug abuse, depression or respiratory conditions.	May interact with grapefruit juice, alcohol and many medications. Can be habit-forming. Seldom prescribed by sleep specialists. Drug must be stopped gradually.
Zaleplon (Sonata)	Have severe liver problems. Are pregnant or breast feeding. Have a history of depression, liver or kidney disease, or respiratory conditions.	May interact with other medications.  Can be habit-forming. High-fat meals may slow your absorption of the drug and make it less effective. Very short acting, so can be taken in the middle of the night following precautions from your doctor.
Zolpidem (Ambien, Edluar)	Have a history of depression, liver or kidney disease, or respiratory conditions.	May become less effective over time. Sleep behaviors, such as sleep-driving and sleep-eating may occur.

Sleeping pills that help you stay asleep

The following prescription medications are used to help you get to sleep and stay asleep.

Side effects of prescription sleeping pills

Side effects associated with prescription sleeping pills include:

• Dizziness
• Headache
• Gastrointestinal problems, such as diarrhea and nausea
• Prolonged drowsiness, more so with drugs that help you stay asleep
• Severe allergic reaction
• Sleep behaviors, such as sleep-driving and sleep-eating
• Daytime memory and performance problems

Medications to help you stay asleep may not be safe if you are pregnant, are breast-feeding or are an older adult. Sleeping pill use may increase the risk of nighttime falls and injury in older adults. If you're an older adult, your doctor may prescribe a lower dose of medication to reduce your risk of problems.

Sedating antidepressants

Sometimes prescription drugs used mainly to treat depression may ease insomnia when taken in lower doses. Although widely used, these are not approved by the Food and Drug Administration for insomnia only. Discuss alternatives with your doctor. When insomnia is secondary to depression or anxiety, antidepressants may improve both conditions at the same time.

Drugs that help you stay asleep
Drug	May not be safe if you:	Considerations
Estazolam	Are pregnant, breast-feeding, or are an older adult.	May interact with many other medications. Can be habit-forming.
Eszopiclone (Lunesta)	Have a history of drug or alcohol abuse, depression, lung disease, or a condition that affects metabolism.	High-fat meals may slow absorption of the drug and make it less effective. Stopping the drug abruptly may cause symptoms of withdrawal such as anxiety, unusual dreams, nausea and vomiting.
Temazepam (Restoril)	Have a history of severe depression, substance abuse, lung disease, or kidney or liver problems. Are pregnant or breast-feeding.	May interact with alcohol and many medications. Can be habit-forming.
Zolpidem (Ambien CR)	Have a history of depression, liver or kidney disease, or respiratory conditions. Are pregnant or breast-feeding.	This extended-release formula may be used for a longer period of time than regular zolpidem or zaleplon.
Doxepin (Silenor)	Have a history of glaucoma, trouble urinating (urinary retention) or heart disease.	May cause weight gain.

Drugs for when you can't sleep and you're depressed
Drug	May not be safe if you:	Considerations
Amitriptyline	Are recovering from a heart attack or have a history of seizures, glaucoma, trouble urinating (urinary retention).	May interact with many other medications.
Doxepin	Have a history of glaucoma, trouble urinating (urinary retention) or heart disease.	May interact with many other medications.
Trazodone (Oleptro)	Have a history of high blood pressure.	May interact with many other medications.
Mirtazapine (Remeron)		May cause weight gain. May cause daytime sedation. May interact with many other medications.

Side effects of sedating antidepressants

Side effects associated with sedating antidepressants include:

• Dizziness
• Headache
• Prolonged drowsiness
• Dry mouth
• Nausea
• Irregular heartbeats
• Weight gain

Taking sleeping pills

If your best attempts to get a good night's sleep have failed, prescription sleeping pills may be an option. Here's some advice on how to use them safely.

• Get a medical evaluation. Before you take sleeping pills, see your doctor for a thorough exam. Often your doctor may be able to find specific causes for your insomnia. Your doctor also likely will recommend trying nondrug approaches, such as cognitive behavioral therapy. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check also are likely to help. In addition, if you're taking sleeping pills for more than a few weeks, be sure to schedule follow-up appointments with your doctor at least every six months.
• Never take a sleeping pill until you're going to bed. Sleeping pills can make you less aware of what you're doing, increasing the risk of dangerous situations. Wait to take your sleeping pill until you've completed all of your evening activities, about 15 to 30 minutes before you plan on sleeping.
• Plan to take your first sleeping pill when you can sleep in. Don't take a new sleeping pill the night before an important appointment or activity. Until you've taken the drug, you won't know how it affects you. So, make sure you take a sleeping pill for the first time on a night when you know you can sleep in the next day, such as on a Friday night if you work weekdays.
• Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint. And, alcohol can actually cause insomnia.
• Quit carefully. When you're ready to stop taking sleeping pills, follow your doctor's instructions or the directions on the label. Some medications must be stopped gradually. Also, be aware that you may have some short-term rebound insomnia for a few days after you stop taking sleeping pills.
• Watch for side effects. If you feel sleepy or dizzy during the day, talk to your doctor about changing your dose or weaning off your pills.

If you continue to have trouble sleeping, ask your doctor for additional help.

References

1. Clinical guideline for the evaluation and management of chronic insomnia in adults. Philadelphia, Pa.: University of Pennsylvania Health System. http://www.aasmnet.org/Resources/ClinicalGuidelines/040515.pdf. Accessed Sept. 28, 2011.
2. Sullivan SS. Insomnia pharmacology. Medical Clinics of North America. 2010;94:563.
3. Ahmed QA, et al. Effects of common medications used for sleep disorders. Critical Care Clinics. 2008;24:493.
4. Halcion (prescribing information). New York, N.Y.: Pfizer; 2007. http://labeling.pfizer.com/ShowLabeling.aspx?id=586. Accessed Sept. 28, 2011.
5. Lunesta (prescribing information). Marlborough, Mass.:Sunovion Pharmaceuticals, Inc.; 2010. http://www.lunesta.com/PostedApprovedLabelingText.pdf. Accessed Sept. 28, 2011.
6. Davidson JR. Insomnia treatment options for women. Obstetrics and Gynecology Clinics of North America. 2009;36:831.
7. Rozerem (prescribing information). Deerfield, Ill.: Takeda Pharmaceuticals America, Inc.; 2010. http://www.rozerem.com/en/. Accessed Sept. 28, 2011.
8. Tibbitts GM. Sleep disorders: Causes, effects and solutions. Primary Care: Clinics in Office Practice. 2008;35:817.
9. Sonata (prescribing information). Bristol, Tenn.: King Pharmaceuticals, Inc.; 2007. http://www.kingpharm.com/products/product_document.cfm?brand_name=Sonata&product_specific_name=CIV&document_type_code=PI. Accessed Sept. 28, 2011.
10. Ambien (prescribing information). Bridgewater, N.J.: Sanofi-Aventis; 2010. http://products.sanofi.us/ambien/ambien.pdf. Accessed Sept. 28, 2011.
11. Estazolam (prescribing information). Corona, Calif.: Watson Laboratories, Inc.; 2008. http://pi.watson.com/data_stream.asp?product_group=1232&p=pi&language=E. Accessed Sept. 28, 2011.
12. Restoril (prescribing information). Hazelwood, Mo.: Mallinckrodt Inc.; 2010. http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/018163s054lbl.pdf. Accessed Sept. 28, 2011.
13. Ambien CR (prescribing information). Bridgewater, N.J.: Sanofi-Aventis; 2010. http://products.sanofi.us/ambien_cr/ambienCR.html. Accessed Sept. 28, 2011.
14. Roth T, et al. Efficacy and safety of sleep-promoting agents. Sleep Medicine Clinics. 2008;3:175.
15. Antidepressants. The Merck Manuals. The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/media/professional/pdf/Table_200-2.pdf. Accessed Oct. 2, 2011.
16. Doghramji K. The evaluation and management of insomnia. Clinics in Chest Medicine. 2010;31:327.
17. Remeron (prescribing information). Kenilworth, N.J.: Schering Corporation; 2010. http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020415s023s024.pdf. Accessed Oct. 27, 2011.

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Long denigrated as vestigial or useless, the appendix now appears to have a reason to be – as a "safe house" for the beneficial bacteria living in the human gut.

---

William Robert Parker Jr., PhD  

   Drawing upon a series of observations and experiments, Duke University Medical Center investigators postulate that the beneficial bacteria in the appendix that aid digestion can ride out a bout of diarrhea that completely evacuates the intestines and emerge afterwards to repopulate the gut. 

"While there is no smoking gun, the abundance of circumstantial evidence makes a strong case for the role of the appendix as a place where the good bacteria can live safe and undisturbed until they are needed," said William Parker, Ph.D., assistant professor of experimental surgery, who conducted the analysis in collaboration with R. Randal Bollinger, M.D., Ph.D., Duke professor emeritus in general surgery.

The appendix is a slender two- to four-inch pouch located near the juncture of the large and small intestines. While its exact function in humans has been debated by physicians, it is known that there is immune system tissue in the appendix.

The gut is populated with different microbes that help the digestive system break down the foods we eat. In return, the gut provides nourishment and safety to the bacteria. Parker now believes that the immune system cells found in the appendix are there to protect, rather than harm, the good bacteria.

apppendix

For the past ten years, Parker has been studying the interplay of these bacteria in the bowels, and in the process has documented the existence in the bowel of what is known as a biofilm. This thin and delicate layer is an amalgamation of microbes, mucous and immune system molecules living together atop of the lining the intestines.

"Our studies have indicated that the immune system protects and nourishes the colonies of microbes living in the biofilm," Parkers explained. "By protecting these good microbes, the harmful microbes have no place to locate. We have also shown that biofilms are most pronounced in the appendix and their prevalence decreases moving away from it."

This new function of the appendix might be envisioned if conditions in the absence of modern health care and sanitation are considered, Parker said.

"Diseases causing severe diarrhea are endemic in countries without modern health and sanitation practices, which often results in the entire contents of the bowels, including the biofilms, being flushed from the body," Parker said. He added that the appendix's location and position is such that it is expected to be relatively difficult for anything to enter it as the contents of the bowels are emptied.

"Once the bowel contents have left the body, the good bacteria hidden away in the appendix can emerge and repopulate the lining of the intestine before more harmful bacteria can take up residence," Parker continued. "In industrialized societies with modern medical care and sanitation practices, the maintenance of a reserve of beneficial bacteria may not be necessary. This is consistent with the observation that removing the appendix in modern societies has no discernable negative effects."

Several decades ago, scientists suggested that people in industrialized societies might have such a high rate of appendicitis because of the so-called "hygiene hypothesis," Parker said. This hypothesis posits that people in "hygienic" societies have higher rates of allergy and perhaps autoimmune disease because they -- and hence their immune systems -- have not been as challenged during everyday life by the host of parasites or other disease-causing organisms commonly found in the environment. So when these immune systems are challenged, they can over-react.

"This over-reactive immune system may lead to the inflammation associated with appendicitis and could lead to the obstruction of the intestines that causes acute appendicitis," Parker said. "Thus, our modern health care and sanitation practices may account not only for the lack of a need for an appendix in our society, but also for much of the problems caused by the appendix in our society."

Parker conducted a deductive study because direct examination the appendix's function would be difficult. Other than humans, the only mammals known to have appendices are rabbits, opossums and wombats, and their appendices are markedly different than the human appendix.

Parker's overall research into the existence and function of biofilms is supported by the National Institutes of Health. Other Duke members of the team were Andrew Barbas, Errol Bush, and Shu Lin.

This theory appears online in the Journal of Theoretical Biology

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Agar kehamilan terjadi, setiap bagian proses reproduksi manusia yang kompleks – dari pelepasan indung telur dari telur yang matang menuju fertilisasi (pemuahan) hingga terjadinya implantasi (menempel pada dinding rahim) harus terjadi dengan benar. Pada wanita, sejumlah faktor bisa mengganggu proses ini pada setiap tahap. Infertilitas wanita disebabkan oleh salah satu atau lebih dari faktor-faktor ini.
Gangguan ovulasi
Gangguan ovulasi menjadi penyebab infertilias dalam 25 persen pasangan. Ini bisa disebabkan oleh kerusakan dalam regulasi hormon reproduktif oleh kelenjar hipotalamus dan hipofisis , atau karena masalah dalam indung telur sendiri. Anda mengalami gangguan ovulasi jika anda berovulasi tidak sering atau tidak sama sekali.

• Sekresi abnormal FSH dan LH. Kedua hormon tersebut bertanggung jawab untuk merangsang ovulasi setiap bulan — hormon yang merangsang folikel (FSH) dan hormon LH (memecahkan telur dan menebalkan endometrium)— diproduksi oleh kelenjar hipofisis dalam pola spesifik selama siklus menstruasi. Tekanan fisik atau emosi yang berlebihan, berat badan yang amat tinggi atau amat rendah, atau penambahan atau kehilangan berat badan yang banyak – contohnya, 10 persen dari berat badan anda – bisa mengganggu pola ini dan mempengaruhi ovulasi. Tanda utama masalah ini adalah periode yang tidak teratur atau tidak terjadinya menstruasi. Yang lebih jarang, penyakit hipofisis spesifik, biasanya disertai dengan defisiensi hormon tiroid, hormon pertumbuhan atau adanya produksi prolaktin berlebih, mungkin menjadi penyebabnya.
• Sindrom ovarium polikistik (PCOS). Dalam PCOS, perubahan kompleks terjadi dalam hipotalamus, hipofisis dan indung telur, berakibat overproduksi hormon pria (androgen), yang mempengaruhi ovulasi. PCOS bisa juga disertai dengan resistensi insulin dan obesitas.
• Gangguan fase luteal. Gangguan fase luteal terjadi ketika indung telur anda tidak cukup memproduksi cukup hormon progesteron setelah ovulasi. Progesteron adalah vital dalam mempersiapkan lapisan endometrium sebagai “bantalan”telur yang dibuahi.
• Kegagalan ovarium prematur. Gangguan ini biasanya disebabkan oleh respon autoimun, di mana tubuh anda secara salah menyerang jaringan ovarium. Ini berakibat hilangnya telur dalam indung telur, dan juga dalam produksi estrogen yang berkurang.

Kerusakan tuba fallopi (infertilitas tuba)
Ketika tuba fallopi menjadi rusak atau tersumbat, mereka mencegah sperma dari mencapai telur atau menutup bagian telur yang dibuahi ke dalam rahim. Penyebab kerusakan atau penyumbatan tuba fallopi bisa termasuk:

• Peradangan tuba fallopi (salpingitis) disebabkan oleh infeksi klamidia atau gonorea
• Kehamilan ektopik sebelumnya, di mana telur yang dibuahi menjadi ditanamkan dan mulai berkembang dalam tuba fallopi daripada dalam rahim (uterus)
• Pembedahan sebelumnya dalam perut (abdomen) atau panggul

Endometriosis
Endometriosis terjadi ketika jaringan yang umumnya berkembang dalam rahim (endometrium) tertanam dan berkembang dalam lokasi lain. Perkembangan jaringan ekstra – dan pembedahan untuk menghilangkannya – bisa menyebabkan jaringan parut yang mengganggu fertilitas. Lesi endometriosis mungkin juga menghasilkan zat-zat yang mengganggu pembuahan.
Penyempitan atau penyumbatan serviks
Juga disebut stenosis serviks, ini bisa disebabkan oleh cacat bawaan atau kerusakan terhadap serviks. Hasilnya adalah bahwa serviks tidak bisa menghasilkan jenis lendir terbaik untuk mobilitas dan fertilisasi sperma. Selain itu, lubang serviks mungkin, mencegah sperma mencapai telur.
Masalah rahim
Polip atau tumor jinak (fibroid atau mioma) dalam rahim, umumnya pada wanita berumur 30-an, bisa merusak fertilitas dengan menyumbat tuba fallopi atau dengan mengganggu implantasi. Tapi, banyak wanita yang memiliki fibroid bisa menjadi hamil. Jaringan parut dalam rahim bisa juga mengganggu implantasi, dan beberapa wanita lahir dengan abnormalitas rahim, seperti rahim bicornuate (berbentuk hati) bisa menghambat terjadinya kehamilan.
Infertilitas yang tidak dijelaskan
Dalam beberapa kasus, penyebab infertilitas tidak pernah ditemukan. Ini mungkin bahwa kombinasi faktor kecil dalam kedua pasangan berkenaan dengan masalah fertilitas yang tidak dijelaskan. Berita baik ini adalah bahwa pasangan dengan infertilitas yang tidak dijelaskan memiliki tingkat kehamilan spontan tertinggi dari semua pasangan tidak subur.
sumber:
dr. prima

yukk,,,kita diskusi di facebook fanspage blog saya di sini Medical & Public Info

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Obat Anti Depresi

Berikut ini adalah macam-macam obat antidepresant beserta golongan, efek samping dan bahayanya bagi tubuh kita.

Golongan penghambat pelepasan selektif Serotonin
Citalopram, Fluoxetine, Paroxetine, Sertraline, Fluvoxamine Golongan obat depresi ini lebih sedikit efek sampingnya dibanding yang lain. Efek samping dari obat ini adalah mulut kering, mual, kecemasan, insomnia, masalah seksual dan sakit kepala.

Selama dua minggu pertama pengobatan, anda mungkin bertambah sakit dan lebih cemas. Beberapa obat dapat menimbukan pencernaan buruk, tapi anda dapat menghentikannya dengan meminum obat sembari makan. Yang lebih serius dapat mempengaruhi fungsi seksual anda.

Golongan Trisiklik
Amitriptyline, Imipramine, Nortriptyline, Clomitramine
Obat depresi golongan ini biasanya menyebabkan mulut kering, tremor ringan, detak jantung cepat, konstipasi, mengantuk, dan bertambah berat badan.
Khususnya pada penderita yang lebih tua, dapat menyebabkan kebingungan, menjadi lambat atau terhenti sewaktu berkemih, pingsan bila tekanan darah rendah, dan koma. Jika anda mempunyai masalah detak jantung, ada baiknya anda tidak minum semua golongan antidepresan.
Pada pria dapat mengalami kesulitan untuk dan mempertahankan ereksi, atau gagal ejakulasi. Golongan ini sangat berbahaya bila overdosis.

Golongan penghambat pelepasan Serotonin dan Norepineprin
Venlafaxine, Duloxetine
Efek samping mirip dengan golongan penghambat pelepasan selektif Serotonin, tetapi Venlafaxine tidak direkomendasikan pada penderita gangguan detak jantung, tekanan darah tinggi atau masalah pada kadar garam pada darah mereka.
Obat ini dapat membantu jika golongan lain tidak dapat membantu tetapi hanya boleh digunakan atas resep dokter kejiwaan yang berpengalaman saja.

Golongan penghambat pelepasan Norepineprin dan Dopamin
Bupropion, belum tersedia di Indonesia

Golongan kombinasi penghambat pelepasan dan reseptor blocker
Trazodone dan Nefazodone belum tersedia di Indonesia, tetapi Maprotiline dan Mirtazpine sudah tersedia.

Golongan penghambat Monoamin oksidase Moclobemide
Golongan ini sudah jarang diresepkan sekarang ini. Golongan ini dapat menyebabkan tekanan darah tinggi yang berbahaya jika anda makan makanan yang mengandung Tyramine. Jika anda setuju untuk minum obat golongan obat ini dokter anda akan memberikan daftar makanan yang harus dihindari.

Golongan Tetrasiklik
Amoxapine, Maprotiline

Lainnya ;Tianeptine, mempunyai struktur mirip trisiklik dan bekerja dengan meningkatkan pengambilan serotonin secara selektif.

download artikel diatas:

klik obat anti depresi

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I want to say something about cytomegalovirus, more commonly known as CMV.  It’s a common virus, part of the herpes family.  Once it is in your body it is there for life.

In healthy adults and children, the virus has no harmful effects. If you have it you probably don’t know anything about it and never will. So should you be concerned?  Maybe and maybe not, but you should most certainly be aware.

The Center for Disease Control (CDC) says the virus affects about one in every 150 children born in the USA.  Of those, one in five will have permanent health problems.

How so, if the virus has no effect on healthy children?  Because what the CDC doesn’t mention is that when the virus infects a woman during pregnancy, her child runs a risk of severe disability.

A simple blood test could establish whether a pregnant woman is infected with CMV, yet the procedure is not standard and most women are unaware of any danger and have not heard of the virus.

Dr Tom Bass, neonatologist at the Children’s Hospital of the King’s Daughters, Norfolk, VA sees between six and eight cases each year.  He says: “part of the impetus for not having universal screening is that the treatment is very poor. You’re not going to reverse the devastating brain effects even if you clear the virus.”

Polly Lynne Matthews is regional president of a virtual support group, trying to get the message to mothers about the potential dangers of CMV infection via social media such as Facebook.

Her son, Liam was born deaf and with cerebral palsy after she contracted the virus during pregnancy.   She says: “When health professionals say it’s rare, I want to scream it from the rooftops.”  She adds: “If someone had only told me.  They take enough blood – just ask for one more test.  People are suffering because they don’t know about it.”

by: Virgo Mulana Al-banjari & Tom Bass

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Definition : A Serious Disorder Of The Heart Due To Relationship Between A Male and A Female Which Can Sometime Cause Death Of 1 Or Both Depending On The Resistance Associated.
Types:
- 1 Way
- 2 Ways

Age And Risk Factors : Usualy Occurs After Puberty But Recent Studies Revealed That It Can Happen In Any Age Group Even In Children.
Sites Affected: Brain And Heart
Etiology:
- Time Pass
- Desired To Be Loved
- Money And Beauty
Symptoms:
- Tension
- Sleeplessness
- Daydream
- Tachycardia
- Insomnia
- Phone Addict
- No Concentration
Investigation:
- Diary
- Album
- Books
- Mobile (Most Confirmatory)
Prevention And Treatment:
- It is a non preventable Condition Especially In The First Attacks
- Marriage Is The Best Solution For This Condition

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Preservation of Viscera

1.  Stomach and its contents

2.  30 cm small Interline and contents

3.  Liver > 500 gms                             

4.  One kidney/Half of each                            

5.  Blood 100 cc (in NaF), (Minimum 10 ml)*

• Blood Best Specimen.
• Peripheral blood concentration ( femoral ) have been shown to be more reliable for toxicological analysis than the conventional heart blood.
•  

6.  Urine > 100 cc–(in Thymol)* [Toulene* is the best preservative for urine examination]

     •    The best preservative for preservation of viscera is rectified spirit.

     •    Most commonly used preservative is saturated sodium chloride.

     •    Rectified spirit is not used in:

          –   Alcohol

          –   Phenol

          –   Phosphorous 

[ Alcohol also cannot be used in case of  phosphorus poisoning, because  alcohol prevents the luminosity of phosphorus in dark ]

          –   Paraldehyde.

     •    Formaldehyde is used for preservation of Museum specimens and not for preservation of viscera for toxicological analysis.

     •    Formalin is 40% formaldehyde.

     •    NaF should be added to urine, blood, vitreous humor for Alcohol estimation and to samples of

          –   Cocaine (C)                  

          –   Carbon monooxide (C)   ® 3C’s

          –   Cyanide (C)         

Special Preservations :

Liver is the most important tissue because it concentrates many substances.

Heart–Strychnine, Digitalis.

Spleen–It is the best organ for Cyanide poisoning. ( ? Supposedly best specimen for DNA )

Brain–Alkaloids, organophosphates, volatile organic poisons.

Bile–Narcotic drugs, cocaine, methadone, Gluta­thione, Barbiturates, Tranquilizers.Opiates and acetaminophen

Vitreous–Alcohol, Chloroform. [ Vitreous Humour is preserved by keeping at 4ºC for 48 hours, normally preservative is of no value..though could be preserved with sodium fluoride (10 mg/ml). ]

Lung–Gaseous poison, HCN, Alcohol, Chloroform.

Bone–Arsenic, Antimony, Thallium, Radium.

Skin–C/o hypodermic injections (10 cm radius about site with muscle and fat), snake bite.

Hair, Nails, Uterus, spinal card–When indicated.

CSF–(in 10 mg NaF/ml of fluid) in Alcohol intoxi­cation.

Body Fat—Endrin , DDT(Organo Chlorines).

Muscle–When internal organs badly putrified.Skeletal Muscle of Buttock best specimen for Toxicology in Embalming

•    Viscera is stored at 4°C.

•    Histopathology specimen is preserved in 10% neutral formalin/95% Alcohol.

•    Virology specimen 80% Glycerol in Buffer saline.

REFERENS

Sumit Seth ,. Review of Forensic Medicine 4 th edition

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Medical student syndrome "MSS" also named medical student disorder, medical student disease and hypochondriasis of medical students is a condition frequently reported in medical students nowadays.

MSS is a constellation of psychiatric symptoms that affect the mood and behaviour of a medical student, especially during the first year of studying medicine.

While Medical students are learning medicine they read lists of symptoms for different diseases daily. Although they are completely healthy, they feel that they are suffering from the symptoms of specific diseases and they have it. 

For example: If a medical student is reading about swine flu he may feel its symptoms and do unnecessary laboratory tests to confirm his wrong diagnosis.

Now the disease included millions of non medical students who can easily search in the internet about any disease and believe in having its symptoms.

If you suffered from this syndrome before share with us your experience through writing your comment here.

by: 

1. my Facebook

2. medical and public info (Fb fansfage)

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Aetiology : Unkown
Age of Onset : Teenage. Recent studies
have shown that it may affect people upto 25 years of age.
Risk Factors : The age itself is the major risk factor. Others include
(a) Co-education
(b) Cell Phones
(c) Movies
(d) Internet Of these the part played by the cell phones is note worthy.
Pathology
Multi Organ System Failure

Clinical Features
Symptoms
A) The most common presenting feature is
throbbing pain in the heart often described by the patient as sweet pain.
B) Loss of appetite.
C) Sleeplessness.
D) Day dreaming
E) Disinterest in any type of work. There is a danger of patient being transformed into a
poet.
Signs
A) Very much dilated pupil (In search of his sweet
heart).
B) Blushing of cheeks (mainly seen in girls).
C) On Auscultation:
The First Heart Sound is heard as LOVE instead of LUB.
D) Smiling to self.
Pathogenesis and Clinical Course
The Disease is Gradual in onset. The patient presents with vague symptoms like loss of appetite,
sleeplessness, etc., As time progress mutli organ system involvement occurs with
varied symptoms. The symptoms are aggravated at the sight of patients sweet
heart. The sight of patients love causes the contraction of the radial fibres of
the iris muscle leading to the dilation of the pupil. The eyes remain wide open
and cease to blink. The Zygomaticus major muscle automatically contarcts and the
patient smiles (Smile at Sight Phenomenon). As the patient approaches his sweet
heart, action potentials are generated at an irregular rate in the heart and the
normal rhythm of the heart is lost. Microscopic examination of the cardiac
muscle reveals the presence of abnormal pacemaker tissue at certain areas called
the ROMANTIC SPOTS that are responsible for the lost rhythm of the Heart. The
patient feels agitated, and a throbbing pain develops in the heart. The
characteristc feature of the pain that patient wants to feel it more and more.
In advanced stages, the brain is affected. If not treated properly, the patient
may go bad.
Treatment
Marriage Therapy holds promise of 100% cure rates. If is effective only after 22 years of age. If performed early,
it may lead to adverse reactions.

hehehehehehehe........... ^_^

by:
1. virgo the shinigami (my facebook)

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Introduction
Tuberculosis (TB) results from infection by the bacterium, Mycobacterium tuberculosis. According to the WHO in 2009 around 1.7 million people are thought to have died from TB, with the majority of these deaths occurring in Africa (1). TB is a particular problem in this area due to the high incidence of HIV infection, which acts to suppress the immune system, allowing M. tuberculosis to overcome the body’s defences. In 2008 the number of new cases of TB was still rising each year in regions of Africa, the Eastern Mediterranean and South East Asia (1). With TB being responsible for such a large number of deaths the demand for an effective vaccine against it is great. This article aims to investigate the implications that a novel vaccine against TB might have for reducing the number of deaths caused by M. tuberculosis.
Mycobacterium tuberculosis
One of the difficulties facing eradication of M. tuberculosis is its ability to form latent infections in humans. It achieves this by being able to survive uptake into phagosomes by the host’s phagocytes, which would normally destroy bacteria. The M. tuberculosis bacterium limits the maturation of these phagosomes and prevents them from fusing with lysosomes that would degrade the bacterium (2). Since the bacteria aren’t cleared from the body by the immune system, they persist, with the ability to cause active TB if the host’s immune system becomes suppressed.
M. tuberculosis secretes a variety of proteins during the course of an infection, and it is these proteins that modern vaccines against TB have targeted. For example, ESAT-6 and Ag85b proteins are secreted during the early stages of infection by M. tuberculosis in order to help protect it from the host’s immune responses (3). The Rv2660c protein is thought to play a part in establishing latency due to the fact that is expressed at similar levels in both the early and later stages of M. tuberculosis infection in mice as opposed to only during the start of infection like most other proteins it expresses (3).
Existing Vaccines against Tuberculosis
Currently the only vaccine used for human immunisation against tuberculosis is the BCG vaccine (3). The BCG vaccine is developed from an attenuated strain of Mycobacterium bovis. An attenuated vaccine contains live bacteria that have lost their ability to cause infection in humans. Although there is widespread use of the BCG vaccine, it has several shortcomings which need to be addressed in order to try to reduce the impact of TB, particularly in less economically developed areas where TB is endemic. The BCG vaccine is mostly considered to be effective against TB in children with its impact on adult TB being less marked (4). This is partly due to the decreased effectiveness of the vaccine when there has been previous exposure to mycobacteria (4) and partly because of the poor performance of the BCG vaccine against latent infections (3). On top of this, many studies have indicated that BCG loses its effectiveness with time, giving protection for as little as 10-20 years (5). Since adult infections with TB are the primary cause of new mycobacterial infections in a population, and since they account for the majority of cases of TB (4), these inefficiencies of the BCG vaccine need to be addressed.
Several new vaccines that are hoped to be more effective against TB are now in clinical trials. Such vaccines include subunit vaccines that contain a fusion of antigen proteins associated with M. tuberculosis, for example the H1 vaccine which fuses ESAT-6 and Ag85b antigens (6) and the Mtb72f vaccine (7).
A Novel Vaccine against Tuberculosis
Recent experiments conducted by Aagaard et al. have established a vaccine that could have the potential to reduce the incidence of TB in humans, particularly in those with latent M. tuberculosis infections (3). The H56 vaccine contains a fusion of the antigens found in the H1 vaccine that are associated with early M. tuberculosis infection with a third protein, Rv2660c, which is associated with latent infection by the bacteria.
Experiments by the team have so far shown that the H56 vaccine is able to outperform the currently used BCG vaccine. In tests where mice were injected with one of the vaccines before exposure to M. tuberculosis, it was shown that H56 could lower bacterial counts in the lungs of the mice after six weeks, with the effect of H56 vaccination being greater than BCG vaccination after 12 weeks of infection. Further experiments suggested that H56 is also able to protect mice even if M. tuberculosis exposure has already taken place. Additionally, the team also vaccinated mice with H56 three months after receiving a BCG vaccine to establish whether it would be able to boost the effects of the BCG vaccine. The results showed that with H56 boosting, there were lower bacterial counts in the mice after six weeks of infection than when only BCG vaccination was used. Further experiments also established that after 24 weeks of infection, H56 boosting produced lower counts than when H1 was used to boost BCG vaccination.
Implications of the H56 Vaccine
A vaccine that aims to replace the BCG vaccine must be effective enough to last for a longer portion of a person’s life if it is to improve on the BCG vaccine and be worthwhile developing. The development of a significantly more powerful vaccine is, however, difficult. One of the strengths of the H56 vaccine lies in its ability to boost the BCG vaccine besides simply replacing it. Booster vaccines could be used to restore BCG effectiveness once it begins to diminish in adult life, thereby allowing continued protection against M. tuberculosis. In addition, the apparent ability of H56 to combat latent infections further improves on the BCG vaccine.
As with all vaccines, results in animal studies do not always translate to similar effects in humans. For example, animal trials with the BCG vaccine do not show the exposure-dependent variability in effectiveness seen in humans (4). These discrepancies are likely to arise when previous exposure to other mycobacteria establishes some sort of immunity (4). The attenuated bacteria in the vaccine might not have enough different antigens for a new response to be initiated. Alternatively, the immune responses developed against mycobacteria might prevent the attenuated bacteria in the BCG vaccine from replicating so they do not form a large enough population in the host to bring about a new immune response which the vaccine relies on. Many booster vaccines would face these same problems as it would be highly likely that by the time the booster was administrated, the patient would have been exposed to environmental mycobacteria. Since H56 contains antigens, the vaccine does not depend on replication to generate enough antigen for a response. However it still might not be effective enough to stimulate a new immune response over existing immunity to mycobacteria.
Finally, in individuals that fully recover from TB one would expect immunity against further infection from M. tuberculosis; however this has not been found to be the case (8), implying that it might not be possible for a vaccine to grant full protection either. Nevertheless a method for improving on the immunity that can be established by the BCG vaccine would still be valuable for attempting to reduce the prevalence of TB.
Implications of a New Vaccine in Endemic Countries
Since the majority of deaths due to TB occur in endemic areas such as Africa, a new vaccine that can help reduce these cases will have the greatest benefit for combating TB. Mathematical models used by Ziv et al. (9) predict that using either a high-efficacy vaccine (defined as 50-90% effective) that protects the individual prior to exposure from developing TB or one that limits the progression of the disease after exposure has already occurred could reduce the number of cases of TB by up to a third. Although this will by no means eradicate the presence of M. tuberculosis in endemic areas, it will significantly reduce the number of deaths due to TB as well as limit the development of antibiotic resistant mycobacteria. M. tuberculosis strains are being discovered with resistance to the antibiotics commonly used to treat TB. Many strains show resistance to single antibiotics while some are resistant to multiple drugs used against TB (1). While these strains are still treatable, albeit through more costly second-line drugs that cause more severe side effects, if further resistance develops against these reserve drugs it will become increasingly difficult to control M. tuberculosis infections. A vaccine that lowered the number of TB infections would reduce the reliance on antibiotic drugs for treatment, which in itself would lessen the selection pressure for M. tuberculosis to develop resistance.
Ziv et al. suggest that a new vaccination programme might reduce the number of cases of TB by more than a third if a vaccine can be developed both to tackle existing latent or active infections of M. tuberculosis and prevent infection in individuals that have not yet been exposed to the bacterium(9). Such a vaccine would be more effective because it would tackle the spread of infection from those who are already infected as well as those that might develop TB rapidly on infection with M. tuberculosis. Studies of the H56 vaccine suggest that it may be able to act in such a way.
Conclusion
The H56 vaccine could have the potential to be used in a variety of situations to limit TB. The studies so far imply that it could have the flexibility to be used as a booster in conjunction with previous administration of the BCG vaccine, as a means to preventing the progression of a latent M. tuberculosis infection into TB as well as replacing the BCG vaccine to immunise individuals pre-exposure. If the vaccine can deliver all of these possibilities in humans it should have a strong effect in reducing the incidence of TB, particularly in areas where it is endemic. At the same time, however, these areas are also less economically developed and therefore the cost of implementing a new vaccination programme in these locations might not be feasible.

References: 

1. World Health Organisation. WHO Tuberculosis fact sheet [Internet]. World Health Organisation 2010 Nov [cited 2011 Feb 15]; Available from: http://www.who.int/mediacentre/factsheets/fs104/en/index.html
2. Finlay BB, Falkow S. Common themes in microbial pathogenicity revisited. Microbiol Mol Biol Rev 1997 Jun [cited 2011 Feb 15];61(2):136-169. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC232605/?tool=pubmed
3. Aagaard C, Hoang T, Dietrich J, Cardona P-J, Izzo A, Dolganov G, Schoolnik GK, Cassidy JP, Billeskov R, Andersen P. A multistage tuberculosis vaccine that confers efficient protection before and after exposure. Nat Med 2011 Feb [cited 2011 Feb 15];17(2):189-194. Available from: http://www.nature.com/nm/journal/v17/n2/full/nm.2285.html
4. Andersen P, Doherty TM. The success and failure of BCG – implications for a novel tuberculosis vaccine. Nat Rev Micro 2005 Aug [cited 2011 Feb 15];3(8):656-662. Available from: http://www.nature.com/nrmicro/journal/v3/n8/full/nrmicro1211.html
5. Comstock GW, Woolpert SF, Livesay VT. Tuberculosis studies in Muscogee County, Georgia. Twenty-year evaluation of a community trial of BCG vaccination. Public Health Rep 1976 Jun [cited 2011 Feb 15];91(3):276-280. Available from: http://www.ncbi.nlm.nih.gov/pubmed/818671?dopt=Abstract&holding=npg
6. Doherty TM, Olsen AW, Weischenfeldt J, Huygen K, DʼSouza S, Kondratieva TK, Yeremeev VV, Apt AS, Raupach B, Grode L, Kaufmann S, Andersen P. Comparative Analysis of Different Vaccine Constructs Expressing Defined Antigens from Mycobacterium tuberculosis. Journal of Infectious Diseases 2004 Dec [cited 2011 Feb 15 ];190(12):2146 -2153. Available from: http://jid.oxfordjournals.org/content/190/12/2146
7. Skeiky YAW, Alderson MR, Ovendale PJ, Guderian JA, Brandt L, Dillon DC, Campos-Neto A, Lobet Y, Dalemans W, Orme IM, Reed SG. Differential immune responses and protective efficacy induced by components of a tuberculosis polyprotein vaccine, Mtb72F, delivered as naked DNA or recombinant protein. J. Immunol 2004 Jun [cited 2011 Feb 15 ];172(12):7618-7628. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15187142?dopt=Abstract&holding=npg
8. Van Rie A, Warren R, Richardson M, Victor TC Gie RP, Enarson DA, Beyers N, van Helden PD. Exogenous Reinfection as a Cause of Recurrent Tuberculosis after Curative Treatment. New Engl J Med 1999 Oct [Cited 2011 Feb 15];341:1174-1179. Available from: http://www.nejm.org/doi/full/10.1056/NEJM199910143411602
9. Ziv E, Daley CL, Blower S. Potential Public Health Impact of New Tuberculosis Vaccines. Emerg Infect Dis 2004 Sep [Cited 2011 Oct 8];10(9):1529-1535. Available from: http://wwwnc.cdc.gov/eid/article/10/9/03-0921_article.htm#suggestedcitation

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