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Human Diseases Caused by Viruses

When a cell is infected with a virus several effects may be seen. Many viruses cause no harm or disease whatsoever. However, some viruses may attack certain cells and multiply within them.
Once mature the daughter viruses break the cell and spread elsewhere. This is called a lytic infection. Eventually, if host immunity operates effectively, the virus-infected cell may be killed by the host, leading to interruption of the virus cycle and cure of the infection. However, this is not true for all viral infections.
The viruses may persist in the cell without damaging it and make the cell a carrier. The patient may appear to be cured but the infection persists and can spread to others. In addition, the infection may reappear later after this period of lull or latency.

Spread of viruses

Viruses cannot exist on their own and for survival they need to spread to another host. This is because the original host may either die or eliminate the infection. Some important routes of viral transfer include:

Route	Examples
Skin contact	HPV (warts)
Respiratory	Cold virusues, influenza, measles, mumps, rubella
Faecal-oral	Polio, echo, Coxsackie, Hepatitis A, Rotavirus
Milk	HIV, HTLV-1, CMV
Transplacental	Rubella, CMV, HIV
Sexually	Herpes 1 and 2, HIV, HPV, Hepatitis B
Insect vector	Yellow fever, Dengue fever
Animla bite	Rabies
CMV - cytomegalovirus, HPV - Human Papilloma Virus, HTLV - Human T-Lymphotropic Virus

In addition, in order to spread the viruses also need to withstand the immune system. A special category of viruses is those that cause disease only when the immune system is deficient in some way; these are called opportunists, and  opportunistic infection is one of the main problems in patients with, for example, AIDS.

Where do viruses reside?

There are several viruses that have an animal or plant reservoir from where they affect humans. Some of the common reservoirs of viruses include;

Virus	Animal reservoir
Influenza	Birds, pigs, horses
Rabies	Bats, dogs, foxes
Lassa and Hanta viruses	Rodents
Ebola and marburg viruses	Monkeys
HIV-1 and -2	Chimpanzees, monkeys
Newcastle disease	Poultry
West Nile virus	Birds

Host defence to viral infections

The body's first line of defence against viruses is the innate immune system. This is made up of cells and other mechanisms that defend the host from infection. This provides a temporary protection against the viral onslaught.
Once within the adaptive immunity faces the virus and remembers it. This is a more permanent form of immunity that may last a life time against the particular strain of virus. Specific antibodies are produced against the virus. This is called humoral immunity.
Two types of antibodies are important. The first called IgM is highly effective at neutralizing viruses but is only produced by the cells of the immune system for a few weeks. The one that lasts a life time is the IgG antibodies.
The second line of defence is called cell-mediated immunity and involves immune cells known as T cells. T cell recognises a suspicious viral fragment there and the killer T cells destroy the virus.

Virus spread control

Viral diseases can be prevented from spreading by vaccinations and the most successful of these is the small pox vaccine that has completely eradicated the disease in 1980. It is hoped that several other viruses, such as polio and measles, will follow.

Epidemics and pandemics of viral infections

Spread or outbreak of a viral infection in a community is termed an epidemic. A pandemic occurs when there is a worldwide epidemic.
The 1918 flu pandemic, commonly referred to as the Spanish flu was such a pandemic. It was caused by an unusually severe and deadly influenza A virus. The victims were often healthy young adults in contrast from weakened and elderly who are usual victims. It killed around 100 million people or at least 5% of the world's population in 1918.
HIV is now considered a pandemic with an estimated 38.6 million people now living with the disease worldwide.

Viruses and cancer

Some viruses may incorporate their DNA (or DNA copied from viral RNA) into host DNA, with effects on the control of cell growth. This may sometimes lead to transformation, in other words a tumour.
However, integration does not always lead to transformation and is not mandatory for transformation. The association of viruses with tumours in animals was first suspected 90 years ago but only in the 1960s was a virus (EBV) shown convincingly to be associated with a human tumour (Burkitt’s lymphoma).
Now the role of oncogenes that are activated for causing cancer is being better understood to know why all viruses and all infections do not cause cancer in all individuals.

Treatment of viral infections

Several antiviral drugs that are used to treat viral infections have been developed over the past two decades. Many of these are focussed against HIV. These do not cure HIV infection but stop the virus from multiplying and prevent the progress of the disease. Another notable antiviral drug is Ribavarin against hepatitis C.
Viruses in general are notoriously difficult drug targets as they modify and adapt themselves rapidly to build up a resistance against the drug. Case in point is Oseltamivir (trade name - Tamiflu) used in influenza.

 By Dr Ananya Mandal, MD

Bone Diseases

Your bones help you move, give you shape and support your body. They are living tissues that rebuild constantly throughout your life. During childhood and your teens, your body adds new bone faster than it removes old bone. After about age 20, you can lose bone faster than you make bone. To have strong bones when you are young, and to prevent bone loss when you are older, you need to get enough calcium, vitamin D and exercise.
There are many kinds of bone problems:

• Low bone density and osteoporosis, which make your bones weak and more likely to break
• Osteogenesis imperfecta makes your bones brittle
• Paget's disease of bone makes them weak
• Bone disease can make bones easy to break
• Bones can also develop cancer and infections
• Other bone diseases are caused by poor nutrition, genetic factors or problems with the rate of bone growth or rebuilding

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Bones and What They Do

From our head to our toes, bones provide support for our bodies and help form our shape. The skull protects the brain and forms the shape of our face. The spinal cord, a pathway for messages between the brain and the body, is protected by the backbone, or spinal column.
The ribs form a cage that shelters the heart, lungs, liver, and spleen, and the pelvis helps protect the bladder, intestines, and in women, the reproductive organs.
Although they're very light, bones are strong enough to support our entire weight.
The human skeleton has 206 bones, which begin to develop before birth. When the skeleton first forms, it is made of flexible cartilage, but within a few weeks it begins the process of ossification. Ossification is when the cartilage is replaced by hard deposits of calcium phosphate and stretchy collagen, the two main components of bone. It takes about 20 years for this process to be completed.
The bones of kids and young teens are smaller than those of adults and contain "growing zones" called growth plates. These plates consist of columns of multiplying cartilage cells that grow in length, and then change into hard, mineralized bone. These growth plates are easy to spot on an X-ray. Because girls mature at an earlier age than boys, their growth plates change into hard bone at an earlier age.

Growing Bones

Bone-building continues throughout life, as a body constantly renews and reshapes the bones' living tissue. Bone contains three types of cells: osteoblasts, which make new bone and help repair damage; osteocytes, mature bone cells which help continue new born formation; and osteoclasts, which break down bone and help to sculpt and shape it.
Osteoclasts are very active in kids and teens, working on bone as it is remodeled during growth. They also play an important role in the repair of fractures.
Bones are made up of calcium, phosphorus, sodium, and other minerals, as well as the protein collagen. Calcium is needed to make bones hard, which allows them to support body weight. Bones also store calcium and release some into the bloodstream when it's needed by other parts of the body. The amounts of certain vitamins and minerals that you eat, especially vitamin D and calcium, directly affects how much calcium is stored in the bones.
The soft bone marrow inside many of the bones is where most of the blood cells are made. The bone marrow contains stem cells, which produce the body's red blood cells and platelets, and some types of white blood cells. Red blood cells carry oxygen to the body's tissues, and platelets help with blood clotting when someone has a cut or wound. White blood cells help the body fight infection.
Bones are made up of two types of bone tissues:

1. Compact bone is the solid, hard, outside part of the bone. This type of bone makes up the most of the human skeleton. It looks like ivory and is extremely strong. Holes and channels run through it, carrying blood vessels and nerves from the periosteum, the bone's outer membrane covering.
2. Cancellous bone, which looks like a sponge, is inside the compact bone. It is made up of a mesh-like network of tiny pieces of bone called trabeculae. This is where red and white blood cells are formed in the marrow.

Bones are fastened to other bones by long, fibrous straps called ligaments. Cartilage, a flexible, rubbery substance in our joints, supports bones and protects them where they rub against each other.

Muscles and What They Do

Bones don't work alone — they need help from the muscles and joints. Muscles pull on the joints, allowing us to move. They also help your body perform other functions so you can grow and remain strong, such as chewing food and then moving it through the digestive system.
The human body has more than 650 muscles, which make up half of a person's body weight. They are connected to bones by tough, cord-like tissues called tendons, which allow the muscles to pull on bones. If you wiggle your fingers, you can see the tendons on the back of your hand move as they do their work.
Humans have three different kinds of muscle:

1. Skeletal muscle is attached to bone, mostly in the legs, arms, abdomen, chest, neck, and face. Skeletal muscles are called striated because they are made up of fibers that have horizontal stripes when viewed under a microscope. These muscles hold the skeleton together, give the body shape, and help it with everyday movements (known as voluntary muscles because you can control their movement). They can contract (shorten or tighten) quickly and powerfully, but they tire easily and have to rest between workouts.
2. Smooth, or involuntary, muscle is also made of fibers, but this type of muscle looks smooth, not striated. Generally, we can't consciously control our smooth muscles; rather, they're controlled by the nervous system automatically (which is why they're also called involuntary). Examples of smooth muscles are the walls of the stomach and intestines, which help break up food and move it through the digestive system. Smooth muscle is also found in the walls of blood vessels, where it squeezes the stream of blood flowing through the vessels to help maintain blood pressure. Smooth muscles take longer to contract than skeletal muscles do, but they can stay contracted for a long time because they don't tire easily.
3. Cardiac muscle is found in the heart. The walls of the heart's chambers are composed almost entirely of muscle fibers. Cardiac muscle is also an involuntary type of muscle. Its rhythmic, powerful contractions force blood out of the heart as it beats.

   Our Nonstop Muscles

   Even when we sit perfectly still, muscles throughout the body are constantly moving. Muscles enable the heart to beat, the chest to rise and fall during breathing, and blood vessels to help regulate the pressure and flow of blood through the body. When we smile and talk, muscles help us communicate, and when we exercise, they help us stay physically fit and healthy.
   The movements your muscles make are coordinated and controlled by the brain and nervous system. The involuntary muscles are controlled by structures deep within the brain and the upper part of the spinal cord called the brain stem. The voluntary muscles are regulated by the parts of the brain known as the cerebral motor cortex and the cerebellum.
   When you decide to move, the motor cortex sends an electrical signal through the spinal cord and peripheral nerves to the muscles, causing them to contract. The motor cortex on the right side of the brain controls the muscles on the left side of the body and vice versa.
   The cerebellum coordinates the muscle movements ordered by the motor cortex. Sensors in the muscles and joints send messages back through peripheral nerves to tell the cerebellum and other parts of the brain where and how the arm or leg is moving and what position it's in. This feedback results in smooth, coordinated motion. If you want to lift your arm, your brain sends a message to the muscles in your arm and you move it. When you run, the messages to the brain are more involved, because many muscles have to work in rhythm.
   Muscles move body parts by contracting and then relaxing. Muscles can pull bones, but they can't push them back to the original position. So they work in pairs of flexors and extensors. The flexor contracts to bend a limb at a joint. Then, when the movement is completed, the flexor relaxes and the extensor contracts to extend or straighten the limb at the same joint. For example, the biceps muscle, in the front of the upper arm, is a flexor, and the triceps, at the back of the upper arm, is an extensor. When you bend at your elbow, the biceps contracts. Then the biceps relaxes and the triceps contracts to straighten the elbow.
   

   Joints and What They Do

   Joints occur where two bones meet. They make the skeleton flexible — without them, movement would be impossible.
   Joints allow our bodies to move in many ways. Some joints open and close like a hinge (such as knees and elbows), whereas others allow for more complicated movement — a shoulder or hip joint, for example, allows for backward, forward, sideways, and rotating movement.
   Joints are classified by their range of movement. Immovable, or fibrous, joints don't move. The dome of the skull, for example, is made of bony plates, which must be immovable to protect the brain. Between the edges of these plates are links, or joints, of fibrous tissue. Fibrous joints also hold the teeth in the jawbone.
   Partially movable, or cartilaginous, joints move a little. They are linked by cartilage, as in the spine. Each of the vertebrae in the spine moves in relation to the one above and below it, and together these movements give the spine its flexibility.
   Freely movable, or synovial, joints move in many directions. The main joints of the body — found at the hip, shoulders, elbows, knees, wrists, and ankles — are freely movable. They are filled with synovial fluid, which acts as a lubricant to help the joints move easily.
   Three kinds of freely movable joints play a big part in voluntary movement:
   
4. Hinge joints allow movement in one direction, as seen in the knees and elbows.
5. Pivot joints allow a rotating or twisting motion, like that of the head moving from side to side.
6. Ball-and-socket joints allow the greatest freedom of movement. The hips and shoulders have this type of joint, in which the round end of a long bone fits into the hollow of another bone.

   Problems With Bones, Muscles, and Joints

   As strong as bones are, they can break. Muscles can weaken, and joints (as well as tendons, ligaments, and cartilage) can be damaged by injury or disease.
   Problems that can affect the bones, muscles, and joints include:
   
7. Arthritis. Arthritis is the inflammation of a joint, and people who have it experience swelling, warmth, pain, and often have trouble moving. Although we often think of arthritis as a condition that affects only older people, arthritis can also occur in children and teens. Health problems that involve arthritis in kids and teens include juvenile idiopathic arthritis (JIA, also known as juvenile rheumatoid arthritis, or JRA), lupus, Lyme disease, and septic arthritis (a bacterial infection of a joint).
8. Fracture. A fracture is when a bone breaks; it may crack, snap, or shatter. After a fracture, new bone cells fill the gap and repair the break. Applying a strong plaster cast, which keeps the bone in the correct position until it heals, is the usual treatment. If the fracture is complicated, metal pins and plates can be placed to better stabilize it while the bone heals.
9. Muscular dystrophy. Muscular dystrophy is an inherited group of diseases that affect the muscles, causing them to weaken and break down over time. The most common form in childhood is called Duchenne muscular dystrophy, and it most often affects boys.
10. Osgood-Schlatter disease (OSD). Osgood-Schlatter disease is an inflammation (pain and swelling) of the bone, cartilage, and/or tendon at the top of the shinbone, where the tendon from the kneecap attaches. OSD usually strikes active teens around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly.
11. Osteomyelitis. Osteomyelitis is a bone infection often caused by Staphylococcus aureus bacteria, though other types of bacteria can cause it, too. In kids and teens, osteomyelitis usually affects the long bones of the arms and legs. Osteomyelitis often develops after an injury or trauma.
12. Osteoporosis. In osteoporosis, bone tissue becomes brittle, thin, and spongy. Bones break easily, and the spine sometimes begins to crumble and collapse. Although the condition usually affects older people, kids and teens with eating disorders can get the condition, as can girls with female athlete triad syndrome — a combination of three conditions that some girls who exercise or play sports may be at risk for: disordered eating, amenorrhea (loss of a girl's period), and osteoporosis. Participation in sports where a thin appearance is valued can put a girl at risk for female athlete triad.
13. Repetitive stress injuries (RSIs). RSIs are a group of injuries that happen when too much stress is placed on a part of the body, resulting in inflammation (pain and swelling), muscle strain, or tissue damage. This stress generally occurs from repeating the same movements over and over again. Playing sports like tennis that involve repetitive motions can also lead to RSIs. Kids and teens who spend a lot of time playing musical instruments or video games are also at risk for RSIs. RSIs are becoming more common in kids and teens because they spend more time than ever using computers.
14. Scoliosis. Every person's spine curves a little bit; a certain amount of curvature is necessary for people to move and walk properly. But 3-5 people out of 1,000 have scoliosis, which causes the spine to curve too much. It can be hereditary, so someone who has scoliosis often has family members who have it.
15. Strains and sprains. Strains occur when muscles or tendons are overstretched. Sprains are an overstretching or a partial tearing of the ligaments. Strains usually happen when a person takes part in a strenuous activity when the muscles haven't properly warmed up or the muscle is not used to the activity (such as a new sport or playing a familiar sport after a long break).
    
    Sprains, on the other hand, are usually the result of an injury, such as twisting an ankle or knee. A common sprain injury is a torn Achilles tendon, which connects the calf muscles to the heel. This tendon can snap, but it usually can be repaired by surgery. Both strains and sprains are common in kids and teens because they're active and still growing.
16. Tendonitis. This common sports injury that usually happens after overexercising a muscle. The tendon and tendon sheath become inflamed, which can be painful. Resting the muscles and taking anti-inflammatory medication can bring relief.

    Diagnosis/Symptoms

    • ALP (Alkaline Phosphatase) Test (American Association for Clinical Chemistry)

    How is it used?

    The alkaline phosphatase test (ALP) is used to help detect liver disease or bone disorders.
    

    • In conditions affecting the liver, damaged liver cells release increased amounts of ALP into the blood. This test is often used to detect blocked bile ducts because ALP is especially high in the edges of cells that join to form bile ducts. If one or more of them are obstructed, for example by a tumor, then blood levels of ALP will often be high.
    • Any condition that affects bone growth or causes increased activity of bone cells can affect ALP levels in the blood. An ALP test may be used, for example, to detect cancers that have spread to the bones or to help diagnose Paget's disease, a condition that causes malformed bones. This test may also sometimes be used to monitor treatment of Paget's disease or other bone conditions, such as vitamin D deficiency.

    If ALP results are increased but it is not clear whether this is due to liver or bone disease, tests for ALP isoenzyme may be done to determine the cause. A GGT test and/or a test for 5'-nucleotidase may also be done to differentiate between liver and bone disease. GGT and 5'-nucleotidase levels are increased in liver disease but not in bone disorders.
    

    When is it ordered?

    An ALP test may be ordered as part of routine laboratory testing, often with a group of other tests called a liver panel. It is also usually ordered along with several other tests when a person has symptoms of a liver or bone disorder.
    Signs and symptoms of liver involvement may include:
    

    • Weakness, fatigue
    • Loss of appetite
    • Nausea, vomiting
    • Abdominal swelling and/or pain
    • Jaundice
    • Dark urine, light-colored stool
    • Itching (pruritus)

    Some examples of the signs and symptoms suggesting a bone disorder include:
    

    • Bone and/or joint pain
    • Increased frequency of fractures
    • Deformed bones

      Calcium

      How is it used?

      A blood calcium test is ordered to screen for, diagnose, and monitor a range of conditions relating to the bones, heart, nerves, kidneys, and teeth. The test may also be ordered if a person has symptoms of a parathyroid disorder, malabsorption, or an overactive thyroid.
      A total calcium level is often measured as part of a routine health screening. It is included in the comprehensive metabolic panel (CMP) and the basic metabolic panel (BMP), groups of tests that are performed together to diagnose or monitor a variety of conditions.
      When an abnormal total calcium result is obtained, it is viewed as an indicator of an underlying problem. To help diagnose the underlying problem, additional tests are often done to measure ionized calcium, urine calcium, phosphorous, magnesium, vitamin D, parathyroid hormone (PTH) and PTH-related peptide (PTHrP). PTH and vitamin D are responsible for maintaining calcium concentrations in the blood within a narrow range of values.
      If the calcium is abnormal, measuring calcium and PTH together can help determine whether the parathyroid glands are functioning normally. Measuring urine calcium can help determine whether the kidneys are excreting the proper amount of calcium, and testing for vitamin D, phosphorus, and/or magnesium can help determine whether other deficiencies or excesses exist. Frequently, the balance among these different substances (and the changes in them) is just as important as the concentrations.
      Calcium can be used as a diagnostic test if a person has symptoms that suggest:
      

      • Kidney stones
      • Bone disease
      • Neurologic disorders

      The total calcium test is the test most frequently ordered to evaluate calcium status. In most cases, it is a good reflection of the amount of free calcium present in the blood since the balance between free and bound is usually stable and predictable. However, in some people, the balance between bound and free calcium is disturbed and total calcium is not a good reflection of calcium status. In these circumstances, the measurement of ionized calcium may be necessary. Some conditions where ionized calcium should be the test of choice include: critically ill patients, those who are receiving blood transfusions or intravenous fluids, patients undergoing major surgery, and people with blood protein abnormalities like low albumin.
      Large fluctuations in ionized calcium can cause the heart to slow down or to beat too rapidly, can cause muscles to go into spasm (tetany), and can cause confusion or even coma. In those who are critically ill, it can be extremely important to monitor the ionized calcium level in order to be able to treat and prevent serious complications.

What is Ulcerative Colitis?

What is Ulcerative Colitis?

Ulcerative colitis is a disease in which there is chronic inflammation of the inner lining of the colon. The inflammation can cause the lining tissue to break down, forming ulcerations that can bleed. Inflammation can involve the entire colon or only parts of it. Almost always, ulcerative colitis requires treatment.

Warning Sign: Abdominal Pain

Warning Sign: Abdominal Pain

The main symptoms caused by ulcerative colitis are abdominal pain and diarrhea, usually bloody. Symptoms vary in severity from mild to severe. The photograph shows the typical pattern of ulcerative colitis with ulcerations covered by white pus.

Other Warning Signs

Other Warning Signs

Associated with the colonic inflammation in ulcerative colitis are complications that are not a direct result of the inflammation in the colon. Some of these complications are generalized symptoms and signs of inflammation such as fever, fatigue, and anemia. Others are the result of inflammation occurring outside of the colon such as arthritis and skin sores.

Warning Sign: Weight Loss

Warning Sign: Weight Loss

The chronic inflammation and symptoms of ulcerative colitis, if not controlled, have general effects on nutrition; poor appetite, loss of weight, and poor growth in children are common.

Who is Affected by Ulcerative Colitis?

Who is Affected by Ulcerative Colitis?

Ulcerative colitis is a disease that occurs in developed nations, and is more common in cities than in the countryside. Approximately 700,000 people in the U.S. suffer from ulcerative colitis. Individuals with ulcerative colitis usually develop the disease between ages 15 and 25 although the disease may begin at any age. There seems to be a genetic component since ulcerative colitis is more common among relatives of individuals with ulcerative colitis. Caucasians and individuals of eastern European Jewish descent are more likely to develop ulcerative colitis.

Ulcerative Colitis or Crohn’s Disease?

Ulcerative Colitis or Crohn’s Disease?

Ulcerative colitis is considered to be related to Crohn's disease, another chronic inflammatory disease of the intestines (both are referred to as inflammatory bowel disease); however, Crohn's disease, unlike ulcerative colitis, is not limited to the colon. In fact, Crohn's disease usually involves the small intestine or small intestine and colon although occasionally it too is limited to the colon. Another chronic gastrointestinal disorder, irritable bowel syndrome, shares with ulcerative colitis abdominal pain and diarrhea as its main symptoms; however, the cause of irritable bowel syndrome is believed to be dysfunction of the nerves and muscles of the intestines since there is no identifiable inflammation.

What Causes Ulcerative Colitis?

What Causes Ulcerative Colitis?

The cause of ulcerative colitis is unknown, but it is believed to be somehow related to abnormal immunologic reactions of the body to the bacteria normally found in the colon. There is no evidence that diet is the cause of ulcerative colitis.

Diagnosing Ulcerative Colitis

Diagnosing Ulcerative Colitis

The best way of diagnosing ulcerative colitis is with colonoscopy, a procedure in which a camera on the end of a long flexible tube is passed through the anus and into the colon and then traverses the entire colon. Although ulcerative colitis also can be diagnosed by barium enema, a procedure that requires X-rays of a barium-filled colon, colonoscopy is more sensitive, that is, it identifies lower levels of inflammation than can be identified by barium enema. Colonoscopy also allows biopsies to be taken of the colonic lining to confirm the diagnosis.

Urgent Care for Ulcerative Colitis

Urgent Care for Ulcerative Colitis

During a flare of ulcerative colitis, treatment is important to avoid complications. The most common complication is bleeding that can lead to anemia. With a severe flare, the colon may stop working and dilate (enlarge). If not successfully treated, the colon may rupture and become a medical emergency. If treatment is not successful, surgery may be necessary. Usually, the entire colon is removed.

The Course of Ulcerative Colitis

The Course of Ulcerative Colitis

The course of ulcerative colitis is variable. Untreated, it usually fluctuates in severity from mild to severe in the same individual, most often over years. Occasionally, the disease "burns out," becoming inactive although residual scarring usually is visible with colonoscopy.

Other Complications

Other Complications

Ulcerative colitis is associated with important complications in parts of the body unconnected with the colon. Inflammation may involve the spine and large joints (arthritis). Serious skin ulcerations may occur. A serious liver disease, sclerosing cholangitis, occurs in a small number of people with ulcerative colitis. All of these complications involve inflammation and the immune system just like in the colon. Some of these complications improve with successful treatment of the colitis, others do not.

Ulcerative Colitis and Colon Cancer

Ulcerative Colitis and Colon Cancer

Individuals with ulcerative colitis are at increased risk for colon cancer. The risk of colon cancer increases as the duration of disease, and the extent of the disease in the colon increase. To prevent colon cancer, screening colonoscopy with biopsies are recommended on a regular basis (usually annually) in order to detect precancerous cells so that the colon can be removed surgically before cancer develops. Screening usually is begun approximately eight years after the onset of the disease, the time at which the incidence of colon cancer begins to increase.

Biologic Therapies

Biologic Therapies

The most recent innovation in the treatment of ulcerative colitis is what is referred to as biologic therapy. Biologic therapy is therapy with antibodies that are directed against molecules that the immune system produces and that cause the inflammation. The biologic therapy with the most experience is directed against a protein produced by the immune system called tumor necrosis factor. The antibodies must be given intravenously every few weeks.

Medications for Ulcerative Colitis

Medications for Ulcerative Colitis

Treatment of ulcerative colitis aims to reduce the inflammation in the colon. The inflammation-reducing drugs with the most extensive experience are the aminosalicylates, drugs that are related to aspirin. If aminosalicylates are ineffective, corticosteroids (for example, prednisone) are used. A third type of drug that is used is immunomodulators, drugs that reduce the immune response and thereby the inflammation. It may take several weeks to months for the drugs to become maximally effective.

Surgery for Ulcerative Colitis

Surgery for Ulcerative Colitis

Despite drug therapies, approximately one-third of people with ulcerative colitis will need surgery to treat the inflammation, prevent or treat cancer, or to treat a complication such as rupture of the colon. Surgery in which the entire colon is removed cures the person of their ulcerative colitis. In the past they were left with ileostomies, external bags into which the small intestine emptied. Surgical techniques have been developed, however, that now allow the colon to be removed without the need for an ileostomy.

Whipworm Therapy

Whipworm Therapy

An interesting observation is that infection with the pig whipworm may be effective treatment for ulcerative colitis. Scientists believe that the worms that inhabit the colon alter the immune response and thereby reduce the inflammation. In one study, 43% of patients with ulcerative colitis improved after ingesting pig whipworm eggs for 12 weeks. The impetus for investigating treatment with the whipworm came from the observation that ulcerative colitis was not common in developing countries where intestinal parasitic diseases are common.

Living With UC: Reducing Flares

Living With UC: Reducing Flares

There are few non-drug, controllable factors that can reduce the symptoms of ulcerative colitis. Stress reduction is important although it probably makes the symptoms seem less severe without actually reducing them. Of course, it is of utmost importance for patients to take their medications regularly and not miss doses. Although smoking can reduce the inflammation of ulcerative colitis, smoking cannot be recommended as treatment because of its many other detrimental effects.

Ulcerative Colitis in Children

Ulcerative Colitis in Children

Children with ulcerative colitis that is not controlled often grow more slowly than normal, and may end up shorter than they would have. This occurs because when there is active inflammation, appetite is reduced and an insufficient amount of food is eaten. It may be necessary to recommend high calorie diets or even augment the diet with supplements. Children with psycho-social problems because of their disease may need a therapist to help them develop strategies to cope with the disease.

Living With UC: Supplements

Living With UC: Supplements

The bleeding caused by ulcerative colitis may lead to iron deficiency anemia due to the loss of the body's store of iron in the red blood cells that are lost into the colon. Iron supplementation may be necessary. Medications used to treat ulcerative colitis may reduce the absorption of nutrients such as folic acid and calcium. Supplements of vitamins and minerals may be necessary.

Living With UC: Diet Changes

Living With UC: Diet Changes

Although it has not been found that diet has an effect on ulcerative colitis, it generally is recommended that patients eliminate any foods that they find are making their symptoms worse. For example, milk in people with UC who are intolerant to the sugar in milk, lactose, may be causing gastrointestinal symptoms such as abdominal bloating, flatulence, and diarrhea, symptoms that may overlap with those of ulcerative colitis. Despite not being the cause of the ulcerative colitis, eliminating milk may improve gastrointestinal symptoms in these people. It is important to be sure that the diet is nutritionally adequate, and this may require the assistance of a dietician.

Living With UC: Staying Hydrated

Living With UC: Staying Hydrated

Chronic diarrhea can lead to dehydration, particularly if individuals feel ill and are not eating or drinking enough fluids. It is important to maintain an adequate fluid intake. The simplest way to judge whether intake is adequate is to look at the volume and color of urine each the day. A small amount or a dark color of the urine suggests that the intake of water is not adequate. A suggested amount of liquid to drink each day is half an ounce per pound of weight.

Living With UC: Probiotics

Living With UC: Probiotics

Probiotics consist of bacteria that confer a health benefit on the person who ingests them. In general, they are bacteria that are normally found in the human intestine. Probiotics have beneficial effects in several medical conditions. Studies have shown that probiotics help people with ulcerative colitis maintain their remissions. Probiotics are found in yogurts and some other foods, but the probiotics that have been studied and found to be effective are sold separately as supplements and are not food products. The effects of probiotics vary greatly and depend on the exact bacteria that are present. Therefore, it is likely that many probiotics that are sold have no beneficial effect, and, therefore, the one that is used for treatment needs to be chosen carefully on the basis of scientific studies.

Living With UC: Relationships

Living With UC: Relationships

Ulcerative colitis can have a major effect on relationships, particularly intimate ones. Issues of feeling ill or needing to visit the restroom frequently can be socially limiting. Both of these issues can be controlled by adequate treatment of the ulcerative colitis. Medications, for example, corticosteroids can cause changes in mood such as depression or euphoria. Libido also can be reduced. It is important to be open about these issues with intimate partners and with physicians. It may be of value to see a specialist - psychologist or psychiatrist - to help deal with the issues.

What are Bacteria?

What are Bacteria?

Bacteria are microscopic, single-cell organisms that live almost everywhere. Bacteria live in every climate and location on earth. Some are airborne while others live in water or soil. Bacteria live on and inside plants, animals, and people. The word "bacteria" has a negative connotation, but bacteria actually perform many vital functions for organisms and in the environment. For example, plants need bacteria in the soil in order to grow.
The vast majority of bacteria are harmless to people and some strains are even beneficial. In the human gastrointestinal tract, good bacteria aid in digestion and produce vitamins. They also help with immunity, making the body less hospitable to bad bacteria and other harmful pathogens. When considering all the strains of bacteria that exist, relatively few are capable of making people sick.

Bacteria vs. Virus

Bacteria vs. Virus

Bacteria and viruses are different types of pathogens, organisms that can cause disease. Bacteria are larger than viruses and are capable of reproducing on their own. Viruses are much smaller than bacteria and cannot reproduce on their own. Instead, viruses reproduce by infecting a host and using the host's DNA repair and replication systems to make copies of itself.
The symptoms of a bacterial or viral infection depend on the area of the body that is affected. Sometimes the symptoms of the two can be very similar. For example, runny nose, cough, headache, and fatigue can occur with the common cold (virus) and with a sinus infection (bacteria). A doctor may use the presence of other symptoms (such as fever or body aches), the length of the illness, and certain lab tests to determine if an illness is due to a virus, bacteria, or some other pathogen or disease process.

What Is a Bacterial Infection?

What Is a Bacterial Infection?

A bacterial infection is a proliferation of a harmful strain of bacteria on or inside the body. Bacteria can infect any area of the body. Pneumonia, meningitis, and food poisoning are just a few illnesses that may be caused by harmful bacteria. Bacteria come in three basic shapes: rod-shaped (bacilli), spherical (cocci), or helical (spirilla). Bacteria may also be classified as gram-positive or gram-negative. Gram-positive bacteria have a thick cell wall while gram-negative bacteria do not. Gram staining, bacterial culture with antibiotic sensitivity determination, and other tests are used to identify bacterial strains and help determine the appropriate course of treatment.

Foodborne Bacterial Infections

Foodborne Bacterial Infections

Bacterial infections are one cause of foodborne illness. Vomiting, diarrhea, fever, chills, and abdominal pain are common symptoms of food poisoning. Raw meat, fish, eggs, poultry, and unpasteurized dairy may harbor harmful bacteria that can cause illness. Unsanitary food preparation and handling can also encourage bacterial growth. Bacteria that cause food poisoning include:

• Campylobacter jejuni (C. jejuni) is a diarrheal illness often accompanied by cramps and fever.
• Clostridium botulinum (C. botulinum) is a potentially life-threatening bacterium that produces powerful neurotoxins.
• Escherichia coli (E. coli) O157:H7 is a diarrheal (often bloody) illness that may be accompanied by nausea, vomiting, fever, and abdominal cramps.
• Listeria monocytogenes (L. monocytogenes) causes fever, muscle aches, and diarrhea. Pregnant women, elderly individuals, infants, and those with weakened immune systems are most at risk for acquiring this infection.
• Salmonella causes fever, diarrhea, and abdominal cramps. Symptoms typically last between 4 and 7 days.
• Vibrio causes diarrhea when ingested, but it can also cause severe skin infections when it comes in contact with an open wound.

Bacterial Skin Infections

Bacterial Skin Infections

Bacterial skin infections are usually caused by gram-positive strains of Staphylococcus and Streptococcus or other organisms. Common bacterial skin infections include:

• Cellulitis causes a painful, red infection that is usually warm to the touch. Cellulitis occurs most often on the legs, but it can appear anywhere on the body.
• Folliculitis is an infection of the hair follicles that causes red, swollen bumps that look like pimples. Improperly treated pools or hot tubs can harbor bacteria that cause folliculitis.
• Impetigo causes oozing sores, usually in preschool-aged children. The bullous form of impetigo causes large blisters while the non-bullous form has a yellow, crusted appearance.
• Boils are deep skin infections that start in hair follicles. Boils are firm, red, tender bumps that progress until pus accumulates underneath the skin.

Bacterial skin infections are treated with oral or topical antibiotics depending on the strain causing the infection.

Other Bacterial Infections

Other Bacterial Infections

Harmful bacteria can affect almost any area of the body. Other types of bacterial infections include:

• Bacterial meningitis is a severe infection of the meninges, the lining of the brain.
• Otitis media is the official name for an infection or inflammation of the middle ear. Both bacteria and viruses can cause ear infections, which commonly occur in babies and small children.
• Urinary tract infection (UTI) is a bacterial infection of the bladder, urethra, kidneys, or ureters.
• Respiratory tract infections include sore throat, bronchitis, sinusitis, and pneumonia. Bacteria or viruses may be responsible for respiratory tract infections. Tuberculosis is a type of bacterial lower respiratory tract infection.

Antibiotics

Antibiotics

Antibiotics are medications that fight bacterial infections. They work by disrupting the processes necessary for bacterial cell growth and proliferation. It's important to take antibiotics exactly as prescribed. Failure to do so could make a bacterial infection worse. Antibiotics don't treat viruses, but they're sometimes prescribed in viral illnesses to help prevent a "secondary bacterial infection." Secondary infections occur when someone is in a weakened or compromised state due to an existing illness.

Sexually Transmitted Bacterial Infections

Sexually Transmitted Bacterial Infections

Many sexually transmitted diseases (STDs) are caused by harmful bacteria. Sometimes, these infections aren't associated with any symptoms but can still cause serious damage to the reproductive system. Common STDs caused by bacterial infections include:

• Chlamydia is an infection in men and women caused by an organism called Chlamydia trachomatis. Chlamydia increases the risk of pelvic inflammatory disease (PID) in women.
• Gonorrhea, also known as "clap" and "the drip," is caused by Neisseria gonorrhoeae. Men and women can be infected. Gonorrhea also increases the risk of pelvic inflammatory disease (PID) in women.
• Syphilis can affect men and women and is caused by the bacteria Treponema pallidum. Untreated, syphilis is potentially very dangerous and can even be fatal.

Good Bacteria and Probiotics

Good Bacteria and Probiotics

Beneficial bacteria live in the human gastrointestinal (GI) tract and play an important role in digestion and immunity. Everyone knows it's smart to eat yogurt after completing a course of antibiotics to repopulate the GI tract with helpful bacteria that were wiped out from the antibiotics.
Some studies have shown probiotics can shorten the duration of infectious diarrhea. They may also reduce the risk of developing diarrheal illness due to antibiotic use. Probiotics seem to reduce gas, bloating, and abdominal pain associated with irritable bowel syndrome (IBS). Ongoing research seeks to determine the types and dosages of bacteria that are most beneficial to human health.

Antibiotic Resistance

Antibiotic Resistance

Overuse and misuse of antibiotics has led to a rise in antibiotic resistance. Antibiotic resistance occurs when bacteria are no longer sensitive to a medication that should eliminate an infection. Antibiotic-resistant bacterial infections are potentially very dangerous and increase the risk of death. About 2 million people in the U.S. suffer from antibiotic resistant infections each year and 23,000 die due to the condition. The CDC estimates 14,000 deaths alone are due to Clostridium difficile (C. difficile) infections that occur because of antibiotic suppression of other bacteria allow C.difficile to proliferate. Most deaths due to antibiotic resistant infections occur in hospitalized patients and those who are in nursing homes.

Warning Sign: Uneven Pulse

Warning Sign: Uneven Pulse

Atrial fibrillation causes an irregular heart rate. If you check your pulse, you will often feel a "fluttering." When atrial fibrillation is new in onset or poorly controlled by medications you will often feel your heart racing. This rapid, abnormal heart rate can be dangerous if not treated and controlled quickly.

What Is Atrial Fibrillation?

What Is Atrial Fibrillation?

Atrial fibrillation (AFib) is a heart rhythm abnormality caused by a problem with the heart's electrical system. Normally, the heart's electricity flows from the top chambers (atria) to the bottom chambers (ventricles), causing the normal contraction. In atrial fibrillation the electrical flow is chaotic causing the heartbeat to become irregular.

Warning Sign: Dizziness

Warning Sign: Dizziness

If your heart goes into atrial fibrillation you may experience dangerous and frightening symptoms. AFib may cause symptoms such as:

• Dizziness
• Feeling of palpitations
• Shortness of breath
• Chest pain
• Fatigue or exercise intolerance

AFib vs. Normal Heart Rhythm

AFib vs. Normal Heart Rhythm

When the heart beats with a normal rhythm, electricity flows from the top of the heart to the bottom of the heart, causing the heart muscle to contract and moving the blood through the body. In AFib, the electricity flows chaotically and the bottom chambers of the heart contract irregularly.

When To Call 911

When To Call 911

If you think you are experiencing atrial fibrillation and have chest pain, feel faint, feel a very rapid heart rate (greater than 100 beats per minute), or have any signs or symptoms of a stroke, call 9-1-1 immediately.

AFib and Stroke

AFib and Stroke

Atrial fibrillation is a risk factor for stroke. About 15 percent of all people who have strokes have AFib. Because of the irregular and chaotic flow of blood through the heart, small blood clots can form in the heart chambers when you have atrial fibrillation. These clots can travel through the bloodstream to the brain, causing a stroke. This is why people with chronic AFib are usually on blood-thinning medications.

Risk Factors You Can't Control

Risk Factors You Can't Control

Having a family history of atrial fibrillation is a strong risk factor for you developing it as well. Your risk of getting AFib also increases with age, and white males have a higher incidence of atrial fibrillation.

What Causes Atrial Fibrillation?

What Causes Atrial Fibrillation?

Atrial fibrillation is a common problem. Risk factors for AFib include:

• Poorly controlled high blood pressure (hypertension)
• Heart valve problems
• Coronary artery disease
• Alcohol abuse
• Obesity
• Sleep apnea
• Thyroid disorders

Heart Surgery Can Be a Trigger

Heart Surgery Can Be a Trigger

One of the risks of having open-heart surgery or coronary artery bypass graft surgery (CABG) is atrial fibrillation. Your doctor will work to control or correct this as it can lead to other complications.

Lone AFib

Atrial fibrillation that happens in younger people (less than 60 years old), without an obvious cause is called lone AFib. Lone AFib can be triggered by exercise, eating, sleeping, and alcohol. Sometimes it comes and goes on its own and may not need immediate treatment. Consult your doctor.

Risk Factors You Can Control

Risk Factors You Can Control

There are some risk factors for atrial fibrillation that are in your control. Maintain a healthy lifestyle and watch your weight. Stop smoking and limit alcohol use. Do not use illegal drugs and be very careful if you use certain prescription drugs such as albuterol or other stimulants. Talk to your doctor if you are prescribed these medications and have concerns.

Diagnosing AFib: EKG

Diagnosing AFib: EKG

Your doctor will diagnose atrial fibrillation on an electrocardiogram (EKG). This heart tracing shows a distinct pattern in the electricity of the heart that your doctor can diagnose. If your AFib comes and goes you may need to wear a continuous heart monitor (Holter monitor) to diagnose the abnormal rhythm.