Leukoplakia is a condition characterized by white patches of tissue inside the mouth that are known to be premalignant. The major risk factors for leukoplakia are tobacco use, alcohol use, dietary factors, and the chewing of betel nuts. The highest rates of oral cancer are seen in India, Sri Lanka, Vietnam, New Guinea, the Philippines, Hong Kong, Taiwan, and parts of Brazil. In the United States there are about 32,000 cases of oral cancer.Patients who have been treated for and cured of their first cancer of the head and neck usually continue the same lifestyle, then develop and succumb to a second one.Certain nutrients, including retinoids, carotene, vitamin A, and vitamin E, have an important role in the prevention of oral cancer. These nutrients inhibit leukoplakia and other precancerous and cancerous lesions in animal studies and in human trials. In humans, the use of certain retinoids reversed leukoplakia, but it recurred once the retinoids were discontinued. Taking beta-carotene alone or in combination with vitamin A was found to decrease the incidence of damaged mucosal cells in populations at high risk for oral cancer.In India, patients with oral lesions were divided into three groups: the first group received 180 milligrams per week of beta-carotene alone; the second received beta-carotene plus vitamin A (100,000 IU per week); and the third group received a placebo. Six months after treatment, complete remissions were seen in 15 percent of group one, 27.5 percent of group two, and only 3 percent of group three. New appearances of leukoplakia were strongly inhibited. In another study, similar patients were given 200,000 IU of vitamin A per week for six months; 57 percent of them responded completely and also had a complete suppression of new leukoplakia.Of twenty-four patients with leukoplakia given 30 milligrams of beta-carotene daily, 71 percent responded completely after three to six months. The investigators of this study also showed that betacarotene enhanced the immune system by significantly increasing the number of killer cells as well as effecting smaller increases in other immune cells. Hence beta-carotene effectively inhibits the cancer process, is nontoxic, and is readily available.In another human study beta-carotene conclusively reversed leukoplakia. The results of this study suggest that beta-carotene may not protect the body from cancer until late, when a normal cell is about to be transformed into a cancer cell. This means that the initial actions triggered by a carcinogen may not be inhibited by beta-carotene as it is by other nutrients, but rather the carotene stops the transformation of the cell from a normal one to a malignant one.Very high doses of carotene taken by mouth appear to lower the blood concentration of vitamin E over a period of eight months, and other studies show similar findings. In these studies, the protective effect of beta-carotene was somewhat reduced, indicating that all of the antioxidants are needed to protect the cell.*43\360\2*

Raymond’s case is instructive because he responded well to a very simple behavior therapy program. All that was necessary for marked improvement was for Raymond to systematically expose himself to his everyday obsessions while doing his level best to prevent compulsions.When Raymond first came to me, he was in the midst of a severe OCD crisis. He was unable to work. His days were filled with obsessions of poisonous spills, and he performed hours of checking rituals in order to prevent imagined catastrophes. Raymond thought that he had lost control of his mind, that his life was ruined. He fully expected to be hospitalized.Instead what happened was that Raymond worked hard at behavior therapy for six months, seeing me every one to two weeks for consultation. By the end of that time, his symptoms were more under control than they had been since he was a teenager. Antiobsessional medications were also quire helpful in Raymond’s treatment, especially in the beginning. Group therapy was very beneficial, too. But Raymond and I both believe that behavior therapy was the critical factor in his striking improvement.Raymond’s behavior therapy was divided into three stages. Our first four sessions together were educational. He learned the nature of OCD and how to clearly recognize his obsessions and compulsions. Sessions five through seven were concerned with assessment; here, we identified all of Raymond’s symptoms and ranked them by severity. Our last nine sessions formed the active behavioral therapy phase, during which exposure and response was accomplished.As is often the case, Raymond was greatly comforted right at the beginning of treatment when he learned that obsessions and compulsions are caused by a physical, chemical disorder. Like most OCD sufferers, he had never carefully considered the root of his symptoms but rather had blindly assumed what, somehow, he was to blame for them because of some mental weakness. Learning the truth about OCD began a revolution in the way he looked at himself. For twenty years, although he had been an excellent worker, citizen, and family man, he had thought himself mentally inadequate and half crazy. That he is neither of these things but instead the sufferer of a specific brain disorder continues to surprise him even now.Identifying obsessions and compulsions—the critical step in the early part of therapy upon which all further progress depends— presented no special problems for Raymond. His intrusive thoughts of vile and dangerous spills were classic, easily recognizable obsessions. Carefully looking for spills, feeling carpets, checking hallways, and conjuring up visions of vacuum cleaners while making “whooshing” sounds were obvious compulsions. With Raymond as with all OCDers, however, identifying obsessions and compulsions was easier when he was sitting in the office calmly discussing his symptoms than when he was in the heat of an OCD attack.In the assessment stage of therapy, the important work is to take a comprehensive inventory of obsessions and compulsions and then to rank them according to their severity. In order to accomplish this, I first asked Raymond to keep a daily diary of compulsions for three consecutive days. Here is a typical day of entries:Even though Raymond’s symptoms were significantly improved by the fifth visit, his daily diary shows that compulsions were still taking up almost three hours a day. Obsessions, Raymond told me, were on his mind virtually every minute, except at work, when perhaps a half an hour would go by when he was completely free of them. The diary demonstrated that his obsessions were of two types: “spill fantasies,” in which he vividly imagined a container full of a deadly liquid ready to tip over and cause a disaster; and “poison fantasies,” in which he conjured up the image of a poison or diseased substance either accidentally present or deliberately planted in the food or drink of family members.Using his daily diaries as a starting point, Raymond then constructed a list of all the various situations in which compulsions commonly arose and ranked these situations according to the degree of anxiety he experienced when the obsession struck. His anxiety ratings were purely subjective—estimates of his level of anxiety during certain situations relative to others. To rate the anxiety, he used an “anxiety thermometer,” on which “o” represented no anxiety at all and “100″ was the most anxious that it was possible for him to feel. We divided the OCD situations into those involving “spill” and those involving “poison” obsessions.*25/338/2*

Pathophysiological DOES—learned behavior in which the pattern of daytime sleepiness is reinforced by habit—is much less common than the bad sleep habits that may be associated with insomnia. For short intervals of time some people may take to their beds as a minor depressive response to an event, or to escape the pressures of living. They may thus come to depend on such escape on a regular basis, conditioning themselves to expect sleepiness to occur with a certain frequency. Such a pattern seldom extends over the long term, although in some cases it can develop into a persistent complaint of chronic weariness, excessive sleep, and daytime napping. Thorough clinical examination, including a visit to a sleep lab, will usually reveal no objective findings to suggest a cause for the hypersomnia. Supportive counseling to address the initial reason for sleepiness and to change the pattern of behavior is called for.*157\226\8*

A 26′year’old computer programmer, Anna has had asthma since child’ hood. She is fortunate that she is able to easily identify her triggers.I have had asthma since I was about five years old. I have been treated with the standard medication and, generally, my asthma is controlled. On average, 1 get a mild attack every two to three months. I am particularly susceptible to changes of temperature. One of my worst attacks happened when I left a very warm room and went outside into a cold winter’s night. Within seconds I was having a bad attack. Strong winds make me wheeze, particularly if the weather is cold. I always cover my nose and mouth with a scarf if I go out in cold weather.My other trigger is house dust. When my three-year-old bounces up and down on cushions I always start sneezing and then wheezing. If I am anywhere near raised dust, I react. We have no carpets in our house and very close pile rugs. We also keep our bedroom clutter free and I have all floor surfaces mopped twice a week.My doctor says all asthmatics are different, and he’s right. I can exercise as hard and long as I like and never wheeze, yet a friend of mine, who is a mild asthmatic, cannot even walk briskly without becoming puffed out. Asthma is a strange disease. I hate to say it, but I think my daughter is showing symptoms. I guess my husband will be the only one in our family without a Becotide next to his bed.*58\148\2*

TIn addition you can make food one of your strongest allies in keeping heart disease at bay. This is the latest from the research front.Anti-oxidants are substances in foods that are thought to prevent chronic diseases (heart disease being one of them) by “mopping up” stray oxygen molecules called free radicals which cause cellular and other damage in our bodies. In the case of heart disease, such damage could alter free-circulating cholesterol into a form that sticks to arteries and clogs them. There are several antioxidants; hedge your bets by trying to incorporate as many of them as you ean in your heart-healthy diet:Flavonoids. Recent studies have suggested that foods rich in flavonoids — natural chemical compounds found in fruits, vegetables, wine and tea — reduce the risk of fatal heart- disease. Flavonoids, in their anti-oxidant role, are thought to clean up toxic particles that can damage cells in the coronary arteries and other parts of the body. In one study reported in The Lancet, older men who consumed foods and beverages with the most flavonoids — primarily tea, onions and apples — were less than half as likely to die of heart disease as were men who consumed the least.Carotenoids. Another group of anti-oxidants is the carotenoids, the “pigments” that give some fruits and vegetables their deep rich hues of orange, yellow and red as in mangoes, papayas, carrots, oranges, tomatoes and yellow corn. They are also found in green leafy vegetables like spinach and turnip greens, though here chlorophyll hides the carotenoid colours. Scientists have discovered more than 50 different edible carotenoids in the plant kingdom; of these, beta-carotene has received the most press. However, more recently, it’s lycopene — the carotenoid in tomatoes — that has become the health establishment’s darling. Earlier research had chiefly linked it to a reduced risk of various deadly cancers. Now a study of 139 middle-aged European men at the University of North Carolina has found that those who consumed the most lycopene in their foods cut their risk of heart disease by half, compared to those who consumed the least. 662 of the men had suffered previous heart attacks. In contrast to several other studies that asked subjects how much of lycopene -rich foods they ate, this one determined the actual amount of this carotenoid by measuring its presence in the body. The team simultaneously measured levels of other anti-oxidants like alpha-carotene, beta-carotene and lutein in the men’s bodies; but lycopene alone was associated with a reduced risk for heart disease.Tomatoes are the richest source of lycopene; but the body does not absorb it well unless the tomatoes are cooked. Other sources include water-melon, red grapefruit and, in smaller quantities, shellfish like lobster and crab.Vitamin E. Several studies indicate that vitamin E may have special chemical properties that make it heart-protective. Lab research shows that LDL cholesterol (the artery-clogging kind) may be able to cling to artery walls only after it has been oxidized (that is, chemically altered by certain destructive molecules in the body — the so-called “free radicals”.) And Vitamin E, which travels through the bloodstream by latching on to LDL molecules, appears to be in an ideal position to inhibit such oxidation.Indeed, various lab and human trials have shown that Vitamin E intake:Results in fewer oxidized LDL molecules in the blood.Slows down the clogging of coronary arteries with cholesterol deposits. (Also, reduces the incidence of re-clogging in arteries that have been opened up with angioplasty.)Helps to prevent the formation of blood clots (which can trigger a heart attack by plugging a partially-clogged artery).Reduces the risk of developing coronary disease.Reduces the risk of dying from coronary disease.Medical opinion is that, while the evidence is strong, it may be too soon to prescribe Vitamin E as a heart-protective supplement. Still, you may wish to boost your own intake. Doing so through diet alone may prove difficult since the best Vitamin E sources are the concentrated plant fats, such as vegetable and seed oils. If you don’t need to worry about your weight you could try boosting your dietary intake by substituting these plant fats for animal fats like butter, cream or ghee. Other good sources include wheatgerm, sunflower seeds, peanuts, sweet potatoes and avocados.But the strongest evidence of the heart-protective benefits of Vitamin E has been found with higher levels than can he achieved in a healthy diet. All the same, if you do supplement, stick to modest doses of 100 to 400 IU daily. Extremely high doses increase the risk of life-threatening haemorrhagic strokes.Also, if you regularly take medications that inhibit clotting (such as warfarin and, possibly, aspirin), talk to your doctor before starting to take Vitamin E.Fill up on fibre. Studies have shown that subjects put on a high-fibre diet lowered their cholesterol more than the controls (put on only a low-fat, low-cholesterol diet) did. But the most dramatic effects were seen in. those who (i) had a high level of blood cholesterol to start with; (ii) customarily ate a low-fibre high-fat diet; and (iii) were put on very large amounts of fibre (say, 100 grams of oat bran every day.) Other studies (including the pioneering Harvard research that caused oat-bran sales to crash) have found little effect in subjects who already had normal cholesterol.A major, long-term study of 40,000 men who were followed for six years found that the risk of a heart attack was 36 per cent lower among the men who consumed the most fibre compared to those who consumed the least. Though fibre from grains, fruits and vegetables was associated with a reduced heart-attack risk, the link was strongest in the case of fibre from grains.Overall, the consensus is that if you’re at high risk for one of the diseases that fibre can affect (and heart disease is one of them), then higher amounts, as part of a calorie-controlled, doctor-supervised diet, may reduce your risks. (That means higher than the normal daily recommendation of 20 to 30 grams).But there are two types of fibre, and the one that has an impact on heart disease is soluble fibre, found in oat bran, in pectin-rich fruits like apples, and in psyllium (a seed that forms the active ingredient in some brands of “natural laxatives”).How does soluble fibre act in the body to lower heart disease risks? In different ways, it appears. Some fibres bind with bile acids and carry them out of the intestines so that they can’t be used to form cholesterol. The soluble pectin fibre in fruits and the beta glucan in oat bran appear to sponge up harmful fatty acids. In a few cases, an oily substance in the fibre seems to interfere with cholesterol synthesis.*55\332\2*

Superoxide aka The Master Oxygen RadicalIt is the first one formed. It’s pretty destructive all on its own, but it also converts easily to hydrogen peroxide and produces the even more dead hydroxyl radical.Hydroxyl RadicalThis is the most dangerous of all the free radicals. It consists of equal parts hydrogen and oxygen. And even though it lasts only a micro-fraction of a second before it self-destructs, it will attack just about any other molecule it comes into contact with in a frantic attempt for chemical stability.Singlet OxygenThis is a free radical formed mainly in our skin as a response to ultraviolet light.Hydrogen PeroxideThis is a molecule that can swim right through cell walls, damaging the delicate insides and scrambling up the messages that keep us healthy. It can also form the deadly hydroxyl radical.Lipid Peroxy RadicalThis is the free radical formed when oxygen attacks the fatty acids in cell membranes. Once the attack begins, the cell membrane is damaged and cell guts begin to ooze out.*54\323\8*

After effects of shock, physical or mental. When a man is fighting with another man he may get injured. The injury may be simple or it may be serious, but there is no element of shock in it. His injuries can be attended to by appropriate medicines which repair the injury. But if a scooterist is waiting on the red light signal on a crossing and a fast vehicle coming from behind strikes him or a tree falls on him when passing on a road, he is said to have been accidentiy injured. Accident has an element of unforeseenness, which may be termed as shock. So when a person is injured in an accident, he has to be treated for the shock as well as for the physical injuries. You are driving your car on a main road when a boy running from a side-lane comes before your car which is screeched to a halt inches before over-running the boy. The boy is saved, and you have no physical injury and yet you sit frozen on the seat, your heart thumping violently—the mental shock. It is to remove the aftereffects of shock that ‘Star of Bethlehm’ suits.*44\308\8*

The massive test, financed by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), began back in 1983, at twenty-nine medical centers in the United States and Canada. A total of 1,441 people with Type I diabetes took part. Their average age at the start of the test was twenty-seven; the group was approximately half men and half women. Some of the test subjects had no signs of complications, but in others there were indications that eye disorders, kidney problems, nerve damage, or other complications were beginning to develop. Each person was assigned randomly to one of two groups.The first group (the controls) received the diabetes treatment that had been the standard for many years. The IDDM patients typically injected insulin once or twice a day, tested their blood sugar once a day, followed a planned program of diet (including three meals plus three snacks each day) and exercise, and were checked by medical professionals every two or three months.Patients in the second group (the experimentals) followed a much more aggressive approach to diabetes control. They monitored their blood sugar levels four to seven times a day and fine-tuned their insulin dosages either with three to five injections a day or by using an insulin pump that supplied a continuous flow of insulin into the body. They paid close attention to diet and exercise. The patients were helped by teams of nurses, dietitians, and doctors who called them on the phone at least once a week to check on how things were going and provide any needed advice. The experimental patients also visited a diabetes clinic each month.The study was intended to go on until 1994, but the results were so striking that the test was stopped a year early so that all people with diabetes could benefit from its findings. “The discovery of insulin was an absolute miracle; this study is in the ball park of comparison,” commented NIDDK director, Dr. Phillip Gordon.Comparisons of the two treatment groups indicated that the “tight-control” program decreased the development of eye problems by 76 percent, cut the rate of severe kidney problems by 35 to 56 percent, and decreased crippling nerve disorders by 60 percent.There were a few drawbacks. People on the tight-control regimen had about triple the risk of fainting as a result of an insulin reaction, compared to those on the conventional diabetes treatment. And the cost of treatment (typically about $1,500 to $2,000 a year on the conventional regimen) is doubled. But this short-term cost increase is far less than the long-term costs of treating the serious complications that the tight-control treatment can delay or prevent. And most people would say that the increased risk of a hypoglycemic reaction is well worth the benefit of a longer, healthier life.Does the tight-control regimen add to the burdens of coping with diabetes? Not really, says New Jersey diabetes specialist Dr. Richard Agrin. The aggressive approach has been used for years at the Diabetes Treatment Center at Somerset Medical Center, where he is the medical director. “Our experience is that patients have better control of their disease, and as a result, they also are happier and less anxious,” he says. “Aggressive treatment allows them to tailor their treatment to their life-styles instead of adjusting their life-styles to their need for insulin.”*29\268\2*

The seizure is now over, but the child is not awake and will not yet respond. This post-seizure period is the post-ictal state when the brain can be thought of as “exhausted” from all its activity. In reality, the brain is quite active, but its major activity is to inhibit (stop) the cells from firing. This inhibition has brought the seizures under control.The post-ictal period often lasts a few minutes, longer if the tonic-clonic period has been long. If left alone, the person may sleep but can be aroused and may feel tired and confused. Muscles may be sore, and the tongue may have been bitten. The best course of action for an observer at this time is to be supportive and reassuring. Allow the person to rest until he is alert and able to go his own way.A seizure occasionally may be just the tonic (stiffening) phase described under tonic-clonic seizures. The tonic phase lasts for only a short while, usually less than a minute, and may be followed by a postictal sleep. A patient may on rare occasions experience a clonic seizure with the rhythmic movements previously described, but without the preceding tonic phase. Management during and after the clonic seizure is identical to that after a tonic-clonic seizure.There is no important distinction among these last three types of seizures—tonic, clonic, and tonic-clonic—formerly called grand mal seizures. Their causes are variable, their outlooks are the same, and their management with medication is identical.*60\208\8*

A red eye is the most common presenting complaint seen by primary care physicians. The clinical term red eye is applied to a variety of distinct infectious or inflammatory ocular disorders that involve one or more tissue layers of the eye. In some cases, a red eye signals a vision-threatening condition that requires urgent referral to an ophthalmologist. The majority of cases, however, is benign and can be treated by primary care physicians. Conjunctivitis is the most common cause of the red eye in the community setting. The conjunctiva is a thin mucous membrane with both bulbar and palpebral portions. The palpebral portion of the conjunctiva covers the inside surface of the eyelids, while the bulbar portion covers the surface of the globe up to the limbus (the junction of the sclera and cornea). Underneath the conjunctiva lie the episclera, sclera, and uveal tissue layers. The conjunctiva is generally transparent, but when it is inflamed, as in conjunctivitis, it appears pink or red at a distance. The superficial blood vessels within the conjunctiva become engorged (termed injection), and edema of the conjunctiva may become apparent.*27/348/5*