09 Nov 2011

Sample Essay: Genetic Disease: Elephantiasis

Elephantiasis is noted to have been researched to come from particular condition caused by parasitic worms. Often following the infection comes the thickening of the skin and the tissues found usually in the legs and private genitals. The inflammation of the body parts are considered to be caused by extensive infection that continues to affect the areas that have already been under attack by the parasitic worms. The parasitic worms usually come from being bitten by an infected mosquito. Most often than not, the parasites include round worms and nematodes. These worms often inhabit the lymphatic vessels that makes it impossible for the inability of the said body part to function well which makes it impossible to drain the extremities that have been affected by the infection. There are two particular types of elephantiasis:

(a) Lymphatic filariasis [which is characterized by the infection of the lymphatic area] and

(b) nonfilariar elephantiasis [which is noted to be common among members of the African society due to their regular contact with the volcano ash. As of now, the main target of this ailment is the African society and the Southeast Asian residents. These particular facts impose on the idea that both the genetic sources of the ailment and the incurring course of effect that the red soil has on African individuals who are in direct contact of the said substance.

Symptoms

Most often than not, elephantiasis affects the lower extremities of the body, other infections occur in the upper extremities but this is less likely to happen. It usually depends on what particular worm entered the body. The symptoms often start with skin rashes and abdominal pain due to the occurrence of worms deeply dwelling within the tissues. Usually, enlargement of the genital areas specifically mark the onset of elephantiasis. The occurrence of fever and chills and the mere feeling of being unwell due to the inner inflammation of the parts of the body that are infected. (Price, 1974)

Causes

The inflammation is adapted to have been explained by the occurrence of the infection and the actual fight that the immune system is putting up against the infection. However, due to the deep effect of the worm’s impact on the areas affected, the inflammation may affect other areas of the body therefore spreading the impact of the medical situation. The weakness of the immune system further creates a chance for the infection to move further. The death of the issues further makes it hard to work especially on the part of the function of of the lymphatic node. The blockage caused by the infection causes the release of the infectious substance to be released out of the system. With this occurrence, obstruction of the flow of blood supply also happens making the affected area slowly die of function.

On the other end, when it comes to the occurrence of the African elephantiasis, it is assumed that such matter is caused by the red soil coming from the volcano  which the African society usually gets in contact with as they walk barefoot along the said type of soil. The particles of the soil gets lodged in the lymphatic tissues therefor irritating the entire system. With this streptococcal infection could also be sourced out from.

Another cause of elephantiasis is the genetic disorder which is more known as the hereditary lymphedema. The symptoms of this particular ailment comes the same as that of the regular elephantiasis. The underdevelopment of the lymph vessels often create the blockage opening the doors to the occurrence of inflammation within the said vessels.

Prevention

As of now, only the course of identifying the development of research on elephantiasis is considered to be the source of an ideal form of prevention. Increasing knowledge about this ailment hence equipping the people with the idea on when to be checked for early diagnosis is exposed as the most effective source of prevention. Other than this, no vaccinations have been developed yet which means that it is only the occurrence of careful consideration upon one’s health that could protect one from incurring the ailment.

Ones the ailment has already been developed, it is strongly advised that constant cleaning and of the area infected be imposed so as to prevent the distribution of the infection to other parts of the body. Like other ailments, it is also considered that early diagnosis of the disease could be the course taken into consideration hence lessening the health dilemma that   shall affect the individual already suffering from the ailment. Preventing the infection from spreading is the primary course of defense that doctors suggest so as not to further deepen the effect of the said ailment on the individual.

Treatments and Therapies

During the onset of the ailment, it is best that early diagnosis be served. At the first stage of the infection, antibiotics could be prescribed by the doctors. The most common form of antibiotic suggested by doctors is doxycycline. This further kills the bactria that lives within the worms which means that the treatment affects the operational function of the foreign substances from the roots of the problem. This then slows down the growth of the worms likely weakening the capability of the worms to reproduce. Another possible prescription could include albendazole which is a combination of diethylcarbamazine and ivermectin. This medication is directed towards killing the spreading young worms that are expected to be released by the old worms which are likely the ones spreading in the affected area. These medications however cannot kill the full grown worms hence making it hard for completely stopping the disease from spreading.

In more serious cases, standard therapies could include chemo therapy which are designed to attack the adult worms hence serving as a symptomatic treatment that could repair the damage that the infection has already caused in the decay of the different parts of the body. Revitalizing the immune system through killing the foreign elements in the system could further increase the capability of the body to fight the effects of the impending infection from the worms. Along with the therapy comes the implication of applying medication that supports the process.

During the current years of further researching on the development of therapies that could provide more effective support for the need of the suffering patients to recover from the matter, it has been realized that a particular consideration on massage therapy could alleviate certain developmental progression of the infection. Strengthening the muscles of the infected area apparently also improves the process of protection that the lymphatic vessels establish against the impending effects of the worms in the system (Desta, et al, 2003).

Conclusive Implications of Research

The manner by which elephantiasis develops is specifically dependent on how one considers good hygiene. Prevention as always is better than cure and the same thing applies with the case of elephantiasis. Avoiding genetically passing on the medical case starts from the need of parents to be specifically concerned about how they deal with their hygiene. No matter what sort of elephantiasis is being avoided, it is important to consider proper hygiene and if in case the ailment’s symptoms have already been identified, early diagnosis and treatment could help in reducing the course of dilemma that the ailment puts the sufferer in.

References:

Desta K, Ashine M, Davey G (2003). “Prevalence of podoconiosis (endemic non-filarial elephantiasis) in Wolaitta, Southern Ethiopia”.Trop Doct 2: 217–220.

Price EW (1974). “The relationship between endemic elephantiasis of the lower legs and the local soils and climate. A study in Wollamo District, Southern Ethiopia“.Trop Geogr Med 32:26–230.

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03 Mar 2011

Sample Essay: Holisitc Paper

FP is 86 years of age and is a Caucasian female of Lutheran faith and Swedish heritage. She presently lives at Cerenity Senior Care in White Bear Lake, MN. She was born and brought up in Scandia, MN and lived with a big family comprising of her parents, five elder brothers and five sisters on a 60 acre cow farm. Both her parents also spent their lives in Scandia and were of Swedish heritage.

FP was brought up in a lower class family and suffered considerable difficulties in her childhood. However, she was immensely interested in educating herself and was able to complete High School as well as one year of Business College. Her most important role in life was to perform the responsibility of a mother although she always had the desire to become a psychologist. She was unable to pursue her interest in psychology because money was not provided to her on account of being a farmer’s daughter. However, FP did get the opportunity to study astrology and palm reading. This was something that she was able to teach herself although she did not earn a single penny from such specialization. She pursued these studies more out of a sense of achievement and accomplishment. When she was asked if she had ever made attempts to start a business of her own, she replied that “if you were not known in this trade you would not be taken seriously.” She further added that “Plus I was a farmer’s daughter that married a Yugoslavian and nobody took me for anything.”

It is unfortunate that FP is now a widow. She was married in 1945 and lost her husband in 1996. Her husband died after he suffered from severe complications from Malaria. FP is proud of her husband and always speaks very high of him. He fought in World War II and when he returned he was suffering from a number of diseases and other problems. She mentioned that “He spent weeks, months and years at the VA in Minneapolis and that is where he died”.

Her family was against her decision to marry a Yugoslavian but FP was firm and asserted that she fell in love with him primarily because of his good height. She was proud of his 6’2 height and she admired him because he resembled Clark Gable very much. With her husband she had three children; all boys. Actually FP was desperately in need of a female child but had to stop having additional children because they could not afford more children.

FP made efforts to find a suitable job and was eventually able to find a position as a receptionist with 3M after all her children grew up and left home. FP was very happy and would often speak happily that she now felt smarter in comparison to average people but she also regretted that “there wasn’t a lot of opportunities for a farmer’s daughter”.

Presently FP has a very weak economic support system because all her family members have passed away or left her. FP does have three sons but she feels sad in mentioning that “they are delinquent and are in and out of prison”.  FP was questioned as to who takes care of her expenses and finances to which she replied, “who knows, I have no money”. While sitting in FP’s room I saw a very nice 52” Plasma TV and when I asked her about how she was able to purchase such an expensive gadget, she replied, “My delinquent son, he probably stole it.”  However, from what I have known about FP and her sons, I believe that her three sons may have been delinquent for some time but they appear to have improved now. But FP continues to stick to her opinion on the basis of the past instead of reconsidering the improvements that may have occurred in her sons with the passage of time.

On January 23, 2007 FP was admitted to Cerenity Senior Care after she was transferred from Maplewood Center in Maplewood, MN. Her doctors had referred her to Cerenity Senior Care because she was not cared for properly at Maplewood Care Center and she had repeatedly said that it was as good as trash. At the ripe age of 86 years FP had admitted that she was unable to care for herself any more and that she felt good about the help rendered to her by staff at Cerenity Senior Care. FP’s present health status is quite complicated. Her long age has made her legally blind because she no longer has the ability to make out shapes when she tries to see things. Her images of people get blurred when they approach closer to her. She has also admitted that she is unable to see anything with her left eye. To make matters worse, FP is now suffering from type 2 diabetes, because of which she has become entirely dependent on nursing staff to be administered insulin three to four times a day. FP’s old age has caused her to develop further complications by way of hypertension and depression for which she is receiving treatment. It is not known when she contracted this ailment but she is being given treatment with medications. It is evident that FP had been suffering from all these complications much before she was transferred to Cerenity Center and it was only because she was not happy with the treatment and care that she sought a transfer.

22 Jan 2010

Sample Essay: Mental Illness Treatment

Introduction

This essays subject matter is mental illness and the treatment of mental illness. We will argue that medication is a relic of the 19th century and that psychological treatments that do not deny the mythic and irrational are more conducive as they better represent the whole of the psyche which is rational and irrational. Medication denies the irrational side of the psyche. And it is the repression of the irrational side of the psyche that has brought about much neurosis in the first place.

Part 1

Before the material scientific revolution of the 19th century, religion was too literal. Science was correct to bring attention to that but incorrect to castigate the irrational and meaningful as of no value. Myth, fairy tale, and the esoteric in general equates to natural psychotherapy.

Hence there is a science of the irrational. But the modern western world denied this in order to place value solely on the physical. This is clear in sciences focus on the five senses… see, smell, hear, taste, touch. Yet is contradicted by gravity which is only proven by its effects. (Stein in Fordham, 1994, p6)

In the introduction (above) I said that the consequences of repressing the irrational side of the psyche is neurosis. It is also psychosis in extreme cases. The neuroses (and occasional psychosis) substitute for irrationalism. Addictions come onto the field of play in place of the natural irrational. One may take up shopping. Such a person won’t call it a religion (or if they do they misunderstand religion). Let’s stick with this example for now. Excessive clothes shopping maybe vain but it is not very irrational. Hence it never fulfils in the same way that ancient myths, traditional religion, myth and fairy tale did/does. Meanwhile other addictions are all the more obvious in their failure to fulfill. Drink and drugs comes to mind here. They too are in-a-sense rational. Their physical nature equates to predictability that they would become crutches for the modern westerner believing in scientific materialism which rates the physical as oh-so-real and the psychic as utter nonsense. Sport (as in supporting a team) is another substitute but is far too rational and at the extremes of excessive competition becomes a blatant power-trip.

There is however one modern western myth that qualifies as a psychotherapeutic irrational myth. And that is the UFO phenomenon. The UFO phenomenon has legs. It has staying power precisely because it is irrational. It is not a substitute religion like drink, drugs, shopping or supporting a sports team. On the contrary it is a religion itself. The psychology of this is healthy. Ufology completes the psyche precisely because it isn’t repressing the irrational. It allows the irrational in and therefore the whole of the psyche is experienced. Quite simply the esoteric is psychotherapeutic. Yet the modern mental health industry, influenced by the physical 19th century scientific revolution… prefers the banal, statistical and methodological, mind-numbing, dust covered text-books. Hence psychiatry (to a large extent) values psychiatric medication. And what does this do? It further denies and further represses irrationalism in favor of rationalism. Yet it is this western denial of the mythic irrational that causes so much neurosis in the first place. So there is an irony here. The Jungian psychologist Maureen Roberts is spot on when she says “I suggest that the underlying or root issue is this: the human psyche, as an immensely complex fact of Nature, will not be tamed, modified, or bought off with medications, attempts at behavioral modification, neatly rational theories, or well-meaning advice. It has its own agenda, and that includes its innate yearning for the mythic, the sacred, the symbolic, the meaningful, the irrational, the universal.” (Roberts). Roberts goes on to say that if these needs are not met the psyche collapses to differing degrees and that our culture shuns these collapses. (Roberts). Rather than color these collapses as “symbolic death, imaginal irrationality and mythic descent [which are] facets of the psyche […they are instead…] feared, repressed, ignored, or treated patronizingly as pathological, or abnormal.” (ibid)

Further on Roberts claims that “a third of all schizophrenics on medication end up committing suicide”. (ibid). Hence she argues that psychotherapy exists but that it is shunned by much of psychiatry. She says that psychotherapists should have knowledge of areas such as mysticism, fairy tales, the UFO phenomena, Shamanism (and so forth) (ibid)

Conclusion

The American psychologist James Hillman is someone who is in agreement with what has been argued in this essay. He describes the psychiatric culture as suffering itself… “When we read professional psychology, hear its language, the voice with which it drones, the bulk of its textbooks, the serious pretensions and bearded proclamations of new ‘findings’ that could hardly be more banal […we observe…] a psychology without soul, beauty, or pleasure to train you to help the suffering. Psychology has no self-help manual for its own affliction.” (Hillman)

What is required is the same as what Carl Jung was saying in the first half of the 20th century (and right up to his death in 1961). We need to respect the psyche as real in its own right to the extent that it is worthy of study and not repression. At the start of his text Psychology and Religion he wrote: “Psychological existence is subjective in so far as an idea occurs in only one individual. But it is objective in so far as it is established by a society – by a consensus gentium. This point of view is the same as that of natural science. Psychology deals with ideas and other mental contents as zoology for instance deals with different species of animals. An elephant is true because it exists. The elephant, moreover is neither a conclusion nor a statement not a subjective judgment of a creator. It is a phenomenon.” (Jung, 1960, p3). And Jung saw the archetypal in mental illness. This is a large subject area and it would require a different essay to discuss it properly. All we can say here is that we have touched the surface of the problem and that not until we value the whole psyche can we say that we are scientific in our approach to the psyche. Psychiatry, with its emphasis on physical medications, is analogous to a doctor (when dealing with the physical body) treating the outer body when the problem is inside.

Bibliography

Fordham, M, (1994) Analytical Psychology: A Modern Science (Karnac Books)

Hillman, J, (1997) The Soul’s Code: In Search of Character and Calling (Grand Central Publishing)

Jung, C, (1960) Psychology and Religion (The Terry Lectures Series) (Yale University Press)

Roberts, M. B, (Website) On the Need to Radically Re-Vision the Mental Health System

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15 Oct 2009

Sample Essay: Medical Benefits Package (Standard Benefits)

Medical benefits package provides the following health care services to all enrolled veterans. It provides Preventive Care Services like Immunizations and Physical Examinations Health Care with assessments based on Screening Tests.

Other relevant provisions like Health Education Programs, Diagnosis and treatment Services, Emergency, outpatient care in VA facilities include Medical Surgery like reconstructive/plastic surgery as a result of disease and trauma are also offered.

Bereavement Counseling, Substance abuse, Hospital (Inpatient) Diagnostic and Treatment Emergency inpatient care in VA facilities Medical Surgical Mental Health,
Medications and Supplies Prescription, must be authorized by a VA provider and be available under VA’s national formulary system.

Generally, only veterans with special eligibility, such as veterans receiving Aid and poor Households would benefits, otherwise if not approved by a VA health care facility one is expected to pay a Fee Basing on eligibility to receive medications at VA expense.

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03 Jul 2009

Sample Essay: New Developments on AIDS

DEVELOPMENTS IN HIV TREATMENT

Human immunodeficiency virus (HIV) is a deadly disease. HIV is a virus that causes acquired immunodeficiency syndrome (AIDS). Aids is a disease in which the immune system of a human being begins to slow down and eventually fail which leads to life threatening infections. AIDS has taken more lives then any other disease known to the mankind. It is estimated that a 0.6% population of this world is infected with HIV (AIDS), most of which are from Sub-Saharan Africa. [Joint UN program on HIV/AIDS: (2006)]. There are four major reasons behind the transfer of HIV in to human beings. These factors are; Unprotected Intercourse, Contaminated needles, transmission to a child by mother by birth, and through Breast milk. According to (UNAIDS) and (WHO) AIDS has killed more than 25 million people since it was recognized first in year 1981.

There has been improvement in the treatment method of HIV/AIDS over the years. People who suffered from AIDS before were able to survive for a shorter time, as compared to the people who are infected with this disease today. More improvement is being made everyday for curing this deadly disease. HIV affects the cells in the human immune system, making them weaker and vulnerable to a lot of diseases. HIV attacks the cells such as T cells, or more specifically CD4 cells. When the quantity of these cells reduces to a certain level, human develop acquired immunodeficiency syndrome (AIDS) and die, however 1 out of every 10 individuals do live their life for quite a few years, without any visible symptoms of AIDS. Treatment with anti-retroviral, where available, increases the life expectancy of people infected with HIV. HIV can be classified into two types namely HIV-1 and HIV-2. Research over the years has proven that HIV-1 is the major reason for most deaths as it is easily transmitted into human beings. HIV-1 is considered to be originated from Cameroon and transferred to human beings from chimpanzees. HIV-2 is a form of virus which is largely confined to Western African nations, HIV-2 may have originated from the Sooty Mangabey, an Old World monkey of Guinea-Bissau, Gabon, and Cameroon. There are many anti-viruses that help prevent the effects of HIV for a certain period of time. One of the major reasons obstacles for the design of HIV-1 vaccine is the diversity of viral. A single antigen cell is not sufficient enough to raise the functionality of T cells and B cells. [Frontiers In Bioscience: A Journal And Virtual Library [Front Biosci] 2008; Vol. 13, pp. 609-20. Date of Electronic Publication]. SJCRH multi-vectored, multi-envelope vaccine has now been shown to elicit HIV-1-specific B- and T-cell functions with a diversity and durability that may be required to prevent HIV-1 infections in humans. An HIV enters macrophages and CD4+ T cells by the adsorption of glycoproteins on its surface to receptors on the target cell followed by fusion of the viral envelope with the cell membrane and the release of the HIV cap Sid into the cell. [HIV-1 vaccine development: tackling virus diversity with a multi-envelope cocktail]. There is however, constant work done by the most talented people in this world, to find a solution to somehow, over come the disease properly. There is no vaccine and medicine in this world which can cure the disease completely. The only method of prevention is to avoid exposure from the virus itself. There are some methods which have reduced the effect of virus to a certain extent, but still unsuccessful in eliminating it. One of such treatments is post-exposure prophylaxis. This anti-viral treatment which is believed to reduce the risk of infection is effective when done within short period of infection. HAART (Highly active anti-retroviral therapy is also very useful in prevention of HIV virus to a certain extent. HAART is a combination of three different kinds of anti-retroviral agents, which are more useful in reviving the T cells and the B cells as well. [An anti-apoptotic protein, Hax-1, inhibits the HIV-1 rev function by altering its sub-cellular localization]

We know that HIV/AIDS has no cure at the current moment, there fore the best strategy against this disease to remain safe, and try to prevent this disease as much as possible. This disease is very harmful to a human body and there are no chances or survival, not until today. There is constant research going on in current world about this disease and a lot of developments have been done for the treatment of this disease. HAART allows the stabilization of the patient’s symptoms and viremia, but it neither cures the patient, nor alleviates the symptoms, and high levels of HIV-1, often HAART resistant, return once treatment is stopped. It is quite evident that prevention is the only cure of this disease at the moment; therefore we should always care in our daily life relationships and adopt prevention as much as possible.

HIV-1 vaccine development: tackling virus diversity with a multi-envelope cocktail.
Hurwitz JL; Zhan X; Brown SA; Bonsignori M; Stambas J; Lockey TD; Sealy R; Surman S; Freiden P; Jones B; Martin L; Blanchard J; Slobod KS | Frontiers In Bioscience: A Journal And Virtual Library | 2008 | 13: | 609 | ISSN: 1093-4715

An anti-apoptotic protein, Hax-1, inhibits the HIV-1 rev function by altering its sub-cellular localization .Modem S; Reddy TR | Journal Of Cellular Physiology | 2008-01 | 214:1 | 14 | ISSN: 0021-9541

01 Jul 2009

Sample Essay: Cardiovascular Case Study

History and Patho-physiology: The focus of my case study is a 69 year old American, Victor Hartman who retired from IBM after a 30-year career in engineering; he wasn’t quite ready to settle into the typical, more relaxing retirement routine. Just one week after saying his goodbyes, he embarked on a fascinating journey to Hong Kong where he worked as a consultant for a Chinese firm for three years. Victor became healthier and got very fit in his new lifestyle where he walked a lot and was having active physical lifestyle. He says “Hong Kong is somewhat mountainous, and I did a lot of walking,” said Victor. “I could walk up hills that were over 60 stories high.””I went out to eat every day,” said Victor. “Even the fast food there is so much healthier than our fast food. You just don’t see overweight Chinese.” Victor returned to Rochester, Minn., in 1996 to begin the next phase of his retirement. Although home was comfortable and familiar, it did not automatically support a healthy lifestyle the way that Hong Kong had. Back in the United States, Victor no longer needed to walk to get where he wanted to go, and richer foods were convenient and plentiful. Not too surprisingly, Victor began to put on weight. “Then, one day, something happened,” said Victor. “All I did was run out to the mailbox, and when I was coming back, I blacked out.” After the blackout, Victor went to his doctor and learned he had coronary artery disease as well as high cholesterol. His doctor recommended further testing and treatment. He was diagnosed Victor with metabolic syndrome.

Diagnosis: “Metabolic syndrome” describes several conditions occurring together, such as increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels. Having just one of these conditions increases risk for heart disease, stroke and diabetes, but in combination, the risk is even greater.”Metabolic syndrome is a lifestyle syndrome,” said Dr. Thomas. “The most effective treatment is when we can help patients identify and improve habits that improve their overall health. The good news is patients with this syndrome have an opportunity to take control, make changes and help prevent the development of more serious diseases.” Although metabolic syndrome has been known for years (in the past, it was usually referred to as insulin resistance syndrome or syndrome X) today it is becoming more prevalent.

Treatment: He joined the newly launched Cardiometabolic Program in early 2006 — one of the few in the nation. “It is a six-week program,” said Dr. Thomas. “People learn how to make changes in their behavior regarding nutrition and exercise, and in the process they reduce weight and learn how to manage the disorder.” The Cardiometabolic Program brings together a team of experts — from preventive cardiologists and registered dietitians, to exercise physiologists, and even behavioral medicine and sleep medicine specialists — to teach the skills necessary to make good choices and maintain long-term, healthy nutrition and exercise habits. (Chobanian 2560-2572)

The lifestyle changes were critical in his recovery plan; he needed to adopt a more active routine for maintaining his cardiac muscles. He was advised to take a 45 min. walk in his routine with dietary control and lifestyle changes. With the dietary and lifestyle changes, as well as changes in medications, Victor lost 30 pounds in five months, and lowered his cholesterol significantly. He believes the weight loss may have already helped prevent a more serious condition. He incorporated healthier portions in his meal like more fruit, less dairy and red meat portions.

Disease Factors and Symptoms: Cardiovascular disease is a wide-encompassing category that includes all conditions that affect the heart and the blood vessels. Cardiovascular disease is the number one cause of death in the United States. There are several diseases that have a role in the development of cardiovascular disease. Many risk factors are associated with cardiovascular disease; most can be managed, but some cannot. The aging process and hereditary predisposition are risk factors that cannot be altered. Until age 50, men are at greater risk than women of developing heart disease, though once a woman enters menopause, her risk triples.

Many people with cardiovascular disease have elevated or high cholesterol levels. Low HDL cholesterol (known as the “good” cholesterol) and high LDL cholesterol (known as the “bad” cholesterol) are more specifically linked to cardiovascular disease than is total cholesterol. A blood test, administered by most healthcare professionals, is used to determine cholesterol levels. Atherosclerosis (hardening of the arteries) of the vessels that supply the heart with blood is the most common cause of heart attacks. Atherosclerosis and high cholesterol usually occur together, though cholesterol levels can change quickly and atherosclerosis generally takes decades to develop. The link between high triglyceride levels and heart disease is not as well established as the link between high cholesterol and heart disease. According to some studies, a high triglyceride level is an independent risk factor for heart disease in some people. High homocysteine levels have been identified as an independent risk factor for heart disease. Homocysteine can be measured by a blood test that must be ordered by a healthcare professional. Hypertension (high blood pressure) is a major risk factor for cardiovascular disease, and the risk increases as blood pressure rises.6 Glucose intolerance and diabetes constitute separate risk factors for heart disease. Smoking increases the risk of heart disease caused by hypertension. Abdominal fat, or a “beer belly,” versus fat that accumulates on the hips, is associated with increased risk of cardiovascular disease and heart attack. Overweight individuals are more likely to have additional risk factors related to heart disease, specifically hypertension, high blood sugar levels, high cholesterol, high triglycerides, and diabetes. (Randomised 1383-1389)

People with cardiovascular disease may not have any symptoms, or they may experience difficulty in breathing during exertion or when lying down, fatigue, lightheadedness, dizziness, fainting, depression, memory problems, confusion, frequent waking during sleep, chest pain, an awareness of the heartbeat, sensations of fluttering or pounding in the chest, swelling around the ankles, or a large abdomen.

Dietary Changes: Preliminary evidence has linked high salt consumption with increased cardiovascular disease incidence and death among overweight, but not normal weight, people. Among overweight people, an increase in salt consumption of 2.3 grams per day was associated with a 32% increase in stroke incidence, an 89% increase in stroke mortality, a 44% increase in heart disease mortality, a 61% increase in cardiovascular disease mortality, and a 39% increase in death from all causes. Intervention trials are required to confirm these preliminary observations.

Moderate alcohol consumption appears protective against heart disease. However, regular, light alcohol consumption in men with established coronary heart disease is not associated with either benefit or deleterious effect.

A high intake of carotenoids from dietary sources has been shown to be protective against heart disease in several population-based studies. A diet high in fruits and vegetables, fiber, and possibly fish appears protective against heart disease, while a high intake of saturated fat (found in meat and dairy fat) and trans fatty acids (in margarine and processed foods containing hydrogenated vegetable oils) may contribute to heart disease. In a preliminary study, the total number of deaths from cardiovascular disease was significantly lower among men with high fruit consumption than among those with low fruit consumption. A large study of male healthcare professionals found that those men eating mostly a “prudent” diet (high in fruits, vegetables, legumes, whole grains, fish, and poultry) had a 30% lower risk of heart attacks compared with men who ate the fewest foods in the “prudent” category. By contrast, men who ate the highest percentage of their foods from the “typical American diet” category (high in red meat, processed meat, refined grains, sweets, and desserts) had a 64% increased risk of heart attack, compared with men who ate the fewest foods in that category. The various risks in this study were derived after controlling for all other beneficial or harmful influencing factors. A parallel study of female healthcare professionals showed a 15% reduction in cardiovascular risk for those women eating a diet high in fruits and vegetables-compared with those eating a diet low in fruits and vegetables. (Chobanian 2560-2572)

Age is the most significant risk factor for cardiovascular disease. The decreasing overall age-adjusted mortality reflects important advances in prevention and treatment of these common conditions. Through risk-factor assessment, early disease detection, and preventive strategies, the average age of AMI and heart failure patients has shifted about ten to fifteen years forward. Further, one-year AMI mortality (after reaching the hospital alive) has declined from 40 percent to 4-8 percent over the past twenty years. Similarly, one-year mortality of patients hospitalized for heart failure was halved from 50 percent to about 25 percent over that same period of time. The reduction in stroke mortality is less impressive, but there has been a marked drop in the incidence of stroke through drug treatment of hypertension and anticoagulation use for atrial fibrillation.

Medications: Statins. By blocking an enzyme in the formation of low-density lipoproteins (LDL), this class of drugs reduces levels of LDL in the blood and diminishes the accumulation of lipids in arteries. Statins may exert a beneficial effect by decreasing inflammation and oxidative stress, both of which contribute to AMI. Accordingly, these agents reduce acute infarction, recurrent minor infarction, heart failure, stroke, and even atherosclerotic disease of the leg and other arteries. First, large groups of patients with elevated LDL levels, with and without overt cardiovascular disease, were shown to benefit from the drug. Next, patients with atherosclerotic disease but with previously considered normal levels of LDL were shown to benefit by a reduction in recurrent cardiac events. This has led to a lowering and reclassification of “normal” and “ideal” values for LDL. Thus, more and more adults now have an “indication” for the long-term use of this medication class. ( Downs 1615-1622.)

Antihypertensive agents. Similar to the high cholesterol epidemic, large segments of the population have hypertension, a risk factor for AMI, stroke, heart and kidney failure, and likely sudden death. Safe agents that modify specific “drugable targets,” and thereby lower blood pressure, have emerged. Over time, newer agents have evolved that reduce morbidity and mortality similar to older antihypertensive, but with reduced or different side effects. Antihypertensive drugs include blockers of enzymes, receptors, or hormones and vascular channels such as angiotensin-converting enzyme (ACE) inhibitors, blockers of the adrenergic nervous system (beta and alpha adrenergic blockers), calcium-channel blockers, and angiotensin-receptor blockers (ARBs). When compared for relative efficacy in a recent clinical trial sponsored by the National Institutes of Health (NIH), these various agents were effective, but none more so than very inexpensive diuretic agents, which are now strongly recommended for routine initial use in hypertension. Unfortunately, most patients with hypertension require multiple antihypertensive drugs for optimal blood pressure control. As with the reduction in LDL targets over time, the “normal” and “ideal” values for blood pressure have been progressively lowered as data support the finding that such blood pressure reduction lowers the incidence of heart attack, stroke, heart and kidney failure, and sudden death. At least 30 percent of adults do not know that they have hypertension; of those who do, only 60 percent have blood pressures in these ideal zones. Therapeutic treatment of hypertension is one area where specific drugs are proving more or less efficacious in certain ethnic or demographic groups. This may explain why not all members of the population benefit similarly from the use of specific agents in a particular drug class. This observation has spawned the advent of ethnic and gene-specific therapy (pharmacogenetics). ( Downs 1615-1622.)

Thrombolytic agents. A major breakthrough that proved life-saving in the management of AMI was the advent of thrombolytic drugs and the use of aspirin. Thrombolytics dissolve clots in arteries, while aspirin prevents platelets from forming new clots. Several European studies initially identified an inexpensive, nonselective thrombolytic agent, streptokinase, as effective and generally safe for clot dissolution. A more directed drug, tissue-plasminogen activator (t-PA), which activates a specific protein target in the blood-clotting cascade, was tested in hopes that targeting a specific target would improve efficacy and safety over streptokinase. Such proved to be the case, but only by a relatively modest amount. ( Downs 1615-1622.)

Testing: Imaging techniques that have proved invaluable to assess cardiac functioning and structure noninvasively are echocardiography and studies using nuclear tracers. Echocardiography uses ultrasonic waves, which are delivered to the heart by a probe placed over the chest; the reverberations are recorded as images. The resultant information allows not only real-time pictures of the beating heart and valvular function but also information on blood flow and intracardiac pressures. Although neither echocardiography nor nuclear imaging is capable of visualizing the coronary arteries, nuclear testing allows relative estimations of the blood flow to the heart muscle, particularly segments served by specific coronary arteries. Stress testing has become valuable to screen for significant anatomic coronary artery disease. This allows the clinician to “sort out” chest pain or other symptoms such as shortness of breath and to assess the success or failure of bypass surgery or angioplasty/stent placement.

Work Cited

Chobanian , A.V. . “”The Seventh Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,” .” Journal of the American Medical Association no. 19 (2003):(Chobanian 2560-2572)

“Randomised Trial of Cholesterol Lowering in 4,444 Patients with Coronary Heart Disease: The Scandinavian Simvastatin Survival Study (4S),” Lancet 344, no. 8934 (1994): 1383-1389.

Downs , J.R.. “”Primary Prevention of Acute Coronary Events with Lovastatin in Men and Women with Average Cholesterol Levels: Results of AFCAPS/TexCAPS,” .” Journal of the American Medical Association 279 no. 20 (1998): 1615-1622

( Downs 1615-1622.)http://content.healthaffairs.org/cgi/ijlink?linkType=ABST&journalCode=jama&resid=279/20/1615

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