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M.Torabi Nami MD, PhDc Department of Neuroscience Institute for Cognitive Science Studies (ICSS), Tehran 15948 Iran Torabi_m@iricss.org Abstract Sleepiness, tiredness and fatigue are complaints which must be thoroughly analyzed to eliminate blur and ambiguity. Physiological sleepiness (“sleep pressure”) increases while being awake and additionally underlies the circadian rhythm with a lower threshold to fall asleep during night time. Excessive daytime sleepiness (EDS) is considered normal only after sleep deprivation. Clinically, EDS manifests by frequents daytime napping and/or reduced alertness with automatic behavior or - in its extreme form - in recurrent attacks of sudden, uncontrollable compulsion to sleep also in inappropriate situations (= “sleep attacks”). EDS is “objectively” addressed by measuring the mean sleep latency to four to five nap opportunities throughout the day using the multiple sleep latency test (MSLT) or the maintenance of wakefulness test (MWT). EDS denotes both, a ready entrance into sleep as well as difficulty in staying awake during daytime or accordingly in inappropriate situations. These two partially independent aspects of EDS are separately assessed by the “passive” MSLT and the “active” MWT respectively. For that reason the MSLT and MWT only weakly correlate with each other when tested over a broad range of patients with EDS. It is important to keep in mind, that these tests are importantly influenced by a great variety of factors such as mood, anxiety, and motivation. “Vigilance” comprises wakefulness, alertness and attention and therefore is more than just the reciprocal to sleepiness. Cognitive performance tasks such as Steer Clear Reaction Time Test (SCRTT) or driving simulators require the complete integrity of vigilance to achieve normal results. Hypersomnia is usually broadly defined as the combination of abnormally prolonged night-time sleep (regularly >10 h) with EDS during ≥1 months. On the other hand, the term hypersomnia has also been used in a narrower scene for the isolated abnormality of a prolonged night-time sleep need (>10 h). “Tiredness”, also in colloquial language often used for sleepiness, in a broader sense also describes the feeling of lack of energy, motivation and initiative. These patients seek rest rather than sleep. They often cannot fall asleep when given the opportunity in spite of feeling tired, and hence, in an MSLT, do not show an abnormally short sleep latency. Furthermore, tiredness (and fatigue) as opposed to sleepiness has a mental (“central”) and physiological (bodily or “peripheral”) component, which the patients can readily distinguish. Patients with insomnia, mild sleep apnea syndrome, or depression rather suffer from mental tiredness than sleepiness during the day. The simple subjective self-assessment using the Epworth Sleepiness Scale (ESS) quite reliably differentiates between sleepiness and mental tiredness (without sleepiness), which makes it a widely used test. The term “fatigue” is also heterogeneously used. In physiology the “fatigue” implied a “time on task performance decrement” to describe decreasing muscle force during a sustained physical effort. In clinical medicine one distinguishes physical (“peripheral”) from mental (“central”) fatigue and the term usually denotes a chronic and more abnormal situation than tiredness. In a broad sense “fatigue” implies a deficiency in coping satisfactorily with mental and physical work load. The chronic fatigue syndrome entails both mental as well as a physical fatigue (so called “leaden paralysis” of limbs). Depressive states are often associated with insomnia and fatigue, but there are also cases with hypersomnia rather than insomnia ( non organic hypersomnia , “atypical depression” or “hypersom
Acne, or acne vulgaris, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. Check out the video for detailed research study on Acne vulgaris and provide us feedbacks. Please subscribe for regular updates...............
Hipertension Arterial Pdf, Hipertension Esencial, Hipertension Pulmonar Tratamiento
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Lo Que Todos Necesitan Saber Sobre La Presión Arterial Alta
Si le han dicho que tiene presión arterial alta, usted puede decir, "Pero me siento muy bien!" Esto se debe a que la hipertensión o la presión arterial alta no tiene síntomas visibles. Es por eso que se la describe a menudo como el "asesino silencioso". No hay achaques o limitaciones físicas sólo porque tiene la presión arterial alta. Entonces, por qué siquiera preocuparse?
La hipertensión afecta a uno de cada tres adultos estadounidenses, y muchas de estas personas ni siquiera saben que la tienen. Además, aquellos con presión arterial alta tienen también un mayor riesgo de tener el colesterol alto.
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Hipertension Arterial Pdf, Hipertension Esencial, Hipertension Pulmonar Tratamiento,
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A new natural painkiller based on a body-own molecule, available as supplement. An educational video on its mechanism of action: palmitoylethanolamide (PEA) is a new compound ready 4 use in the clinic to calm glia and mast cells in all states of chronic pain. Thus it focusses on 2 new targets in the treatment of pain: these extra-neuronal targets in chronic pain can be modulated by PEA.
This video: Pericarditis is swelling and irritation of the pericardium, the thin sac-like membrane surrounding your heart. Pericarditis often causes chest pain and sometimes other symptoms. The sharp chest pain associated with pericarditis occurs when the irritated layers of the pericardium rub against each other. Pericarditis usually begins suddenly but doesn't last long (acute). When symptoms develop more gradually or persist, pericarditis is considered chronic. Most cases are mild and usually improve on their own. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help to reduce the risk of long-term complications from pericarditis.
Less than a decade ago, corneal transplantation took a big leap forward with the introduction of Descemet’s stripping endothelial keratoplasty (DSEK), which removes only Descemet’s membrane and the diseased endothelium and replaces them with a thin, tripartite donor graft of posterior corneal stroma, Descemet’s membrane, and healthy endothelium. Then came DSAEK, in which the donor graft is prepared with an automated microkeratome, allowing for easier donor preparation and reproducible results by surgeons and eye bank technicians.1 DSAEK has proved to have many advantages over penetrating keratoplasty (PK) and its endothelial predecessors (see “A Brief History of Endothelial Keratoplasty”). Now DSAEK is being compared with a newer technique, Descemet’s membrane endothelial keratoplasty (DMEK), which has emerged as a promising alternative—grafting only Descemet’s membrane and endothelium, allowing for a pure anatomical replacement of only what was removed and the possibility of even better vision with quicker healing.1 Although indications for these procedures are similar, each has unique benefits and drawbacks. Five cornea surgeons offer their perspectives on the procedures and their thoughts on whether it may be time to move to the newer surgery.
The most common symptoms noticed by people with haemochromatosis (inherited iron overload disorder) are • Fatigue, weakness and lethargy • Joint pains leading to osteoarthritis * Other symptoms include: • Abdominal pain • Diabetes • Liver disorders; enlarged liver, cirrhosis • Sexual disorders; loss of sex drive in both male and female, impotence in men, absent or scanty menstrual periods and early menopause in women • Decrease in body hair • Discolouration or bronzing of the skin • Cardiomyopathy; disease of the heart muscle • Neurological/psychiatric disorders; impaired memory, mood swings, severe irritability, depression. These symptoms, if present, take time to develop. No two people are alike and symptoms will vary from person to person. Some people never develop any symptoms at all. All of the symptoms of haemochromatosis can also be caused by other medical conditions or even just the stresses of modern life. They develop slowly and people often do not notice what is happening for a long time. This can make haemochromatosis difficult to diagnose. Symptoms are caused by high levels of iron stored in the body. One indicator of the level of iron stored is serum ferritin. If iron stores are high the serum ferritin level will be high, but serum ferritin levels can also be raised by other factors. The normal range is 20 – 300 micrograms per litre (µg/L) for men and 10 – 200 µg/L for women. There is strong medical evidence of a potential for significant organ damage when iron stores cause serum ferritin levels above 1,000 µg/L. However some people seem to experience symptoms with levels between 300 and 1,000 µg/L. Higher levels are more likely to be associated with more severe symptoms. If haemochromatosis is diagnosed and treated before serious iron overload and significant damage occurs, most symptoms will decrease or disappear. However there is evidence that treatment may not alleviate arthritis symptoms.
Back pain during pregnancy is a common complaint — and it's no wonder. You're gaining weight, your center of gravity changes, and your hormones are relaxing the ligaments in the joints of your pelvis. Often, however, you can prevent or ease back pain during pregnancy. Consider seven ways to give pregnancy back pain the boot. 1. Practice good posture As your baby grows, your center of gravity shifts forward. To avoid falling forward, you might compensate by leaning back — which can strain the muscles in your lower back and contribute to back pain during pregnancy. Keep these principles of good posture in mind: Stand up straight and tall. Hold your chest high. Keep your shoulders back and relaxed. Don't lock your knees. When you stand, use a comfortably wide stance for the best support. If you must stand for long periods of time, rest one foot on a low step stool — and take time for frequent breaks. Good posture also means sitting with care. Choose a chair that supports your back, or place a small pillow behind your lower back. 2. Get the right gear Wear low-heeled — not flat — shoes with good arch support. Avoid high heels, which can further shift your balance forward and cause you to fall. You might also consider wearing a maternity support belt. Although research on the effectiveness of maternity support belts is limited, some women find the additional support helpful. 3. Lift properly When lifting a small object, squat down and lift with your legs. Don't bend at the waist or lift with your back. It's also important to know your limits. Ask for help if you need it. 4. Sleep on your side Sleep on your side, not your back. Keep one or both knees bent. Consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.
Electrical injuries can present with a variety of problems, including cardiac or respiratory arrest, coma, blunt trauma, and severe burns of several types. It is important to establish the type of exposure (high or low voltage), duration of contact, and concurrent trauma. Low-voltage AC injury without loss of consciousness and/or arrest These injuries are exposures of less than 1000V and usually occur in the home or office setting. Typically, children with electrical injuries present after biting or chewing on an electrical cord and suffer oral burns. Adults working on home appliances or electrical circuits can also experience these electrical injuries. Low-voltage AC may result in significant injury if there is prolonged, tetanic muscle contraction. Low-voltage AC injury with loss of consciousness and/or arrest In respiratory arrest or ventricular fibrillation that is not witnessed, an electrical exposure may be difficult to diagnose. All unwitnessed arrests should include this possibility in the differential diagnosis. Query EMS personnel, family, and coworkers about this possibility. Inquire if a scream was heard before the patient’s collapse; this may be due to involuntary contraction of chest wall muscles from electrical current. High-voltage AC injury without loss of consciousness and/or arrest Usually high-voltage injuries do not cause loss of consciousness but instead cause devastating thermal burns. In occupational exposures, details of voltage can be obtained from the local power company. High-voltage AC injury with loss of consciousness and/or arrest This is an unusual presentation of high-voltage AC injuries, which do not often cause loss of consciousness. History may need to come from bystanders or EMS personnel. Direct current (DC) injury These injuries typically cause a single muscle contraction that throws the victim away from the source. They are rarely associated with loss of consciousness unless there is severe head trauma, and victims can often provide their own history. Conducted electrical devices Conducted electrical weapons (CEWs) such as tasers are weapons used by law enforcement that deliver high-voltage current that is neither true AC or DC but is most like a series of low-amplitude DC shocks.[16] They can deliver 50,000 V in a 5-second pulse, with an average current of 2.1 mA.[17] Though they have been temporally associated with deaths in the law enforcement setting, conducted electrical devices (CEDs) in healthy volunteers have been shown to be safe without evidence of delayed arrhythmia or cardiac damage as measured by troponin I.[18, 17] One study of their use in 1201 law enforcement incidents showed mostly superficial puncture wounds from the device probes, and significant injuries only from trauma subsequent to shock, not from the device itself. Of 2 deaths in custody, neither was related to CEW exposure.[19]