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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

The importance of being fully informed about serious heart conditions like atrial fibrillation

New York surgeon Dr. Leo Keegan of 5th Ave. Millennium Surgery (http://www.5thavesurgery.com) speaks on the subject of liposuction.

Holoprosencephaly (HPE, once known as arhinencephaly) is a cephalic disorder in which the prosencephalon (the forebrain of the embryo) fails to develop into two hemispheres. Normally, the forebrain is formed and the face begins to develop in the fifth and sixth weeks of human pregnancy. The condition also occurs in other species, as with Cy, the Cyclops kitten.

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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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The impacts of infertility from the bedroom to the bank account – options to support the journey to parenthood.

How smoking is causing a hazy filter over your life. Kick cigarettes to the curb for good.

The incidence of digitalis toxicity has declined in recent years, due to decreased use of this drug along with improved technology for monitoring of drug levels and increased awareness of drug interactions. Nevertheless, cardiac glycoside toxicity continues to be a problem in the United States because of the wide use of digoxin (a preparation of digitalis) and its narrow therapeutic window. Digitalis is a plant-derived cardiac glycoside commonly used in the treatment of chronic heart failure (CHF), atrial fibrillation, and reentrant supraventricular tachycardia.[1, 2] Digoxin is the only available preparation of digitalis in the United States. (See Etiology and Epidemiology.) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley. Indigenous people in various parts of the world have used many plant extracts containing cardiac glycosides as arrow and ordeal poisons. The ancient Egyptians used squill (Urginea maritime) as a medicine. The Romans employed it as a diuretic, heart tonic, emetic, and rat poison. Digitalis, or foxglove, was mentioned in the year 1250 in the writings of Welsh physicians. Fuchsius described it botanically 300 years later and named it Digitalis purpurea. William Withering published his classic account of foxglove and some of its medical uses in 1785, remarking upon his experience with digitalis. He recognized many of the signs of digitalis toxicity, noting, "The foxglove, when given in very large and quickly repeated doses, occasions sickness, vomiting, purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urine, slow pulses, even as low as 35 in a minute, cold sweats, convulsions, syncope, death." (See Presentation and Workup.) During the early 20th century, as a result of the work of Cushny, Mackenzie, Lewis, and others, the drug was gradually recognized as specific for treatment of atrial fibrillation. Only subsequently was the value of digitalis for treatment of CHF established. Cardiac glycosides enhance cardiac contractility and slow conduction through the atrioventricular (AV) junction by increasing vagal tone.[3] (See Etiology.) Cardiac glycoside toxicity has been known to result from ingestion of some plants, including yellow oleander (Thevetia peruviana) and foxglove, and a similar toxidrome has been associated with the use of herbal dietary supplements that contain cardiac glycosides. Digoxin is among the top 50 prescribed drugs in the United States.[4] In 2011, the American Association of Poison Control Centers reported 1601 single exposures to cardiac glycoside drugs.[5] Cardiac glycosides account for 2.6% of toxic plant exposures in the United States.[6, 7] Most of these exposures are in children.[7] (See Epidemiology.) Digoxin-specific fragment antigen-binding (Fab) antibody fragments have contributed significantly to the improved morbidity and mortality of toxic patients since their approval in 1986 by the US Food and Drug Administration (FDA). (See Prognosis, Treatment, and Medication.)

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.

Insulin is a hormone made by the pancreas that allows your body to use (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use. Insulin helps keeps your blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia). The cells in your body need sugar for energy. However, sugar cannot go into most of your cells directly. After you eat food and your blood sugar level rises, cells in your pancreas (known as beta cells) are signaled to release insulin into your bloodstream. Insulin then attaches to and signals cells to absorb sugar from the bloodstream. Insulin is often described as a “key,” which unlocks the cell to allow sugar to enter the cell and be used for energy.

6 Weird Things That Happen To Us During Sleep

If a patient comes to you with a painful, throbbing, swollen, red face (a ''fat face'), perhaps with fever, trismus and lymphadenitis, he is probably suffering from an acute dental or oral infection, most probably an alveolar abscess. He may have: (1) An alveolar abscess begins as an infection in the bone around a non-vital infected tooth. He has severe pain, which becomes less as pus is released into more superficial tissues and his face starts to swell. After 36 hours of cellulitis he usually has a fluctuant abscess which needs draining. If drainage is delayed, the pus in his abscess discharges spontaneously through a sinus (26-8) in his gum or face, which may become chronic. First, control infection with antibiotics, and then drain the abscess, either by incising it where it is pointing, or by removing the infected tooth, which acts as a cork to prevent the pus escaping, or by doing both these things. If you remove a tooth before you have controlled the infection with antibiotics, and while his face is still severely swollen, you may spread the infection; your task will also be more difficult. (2) A periodontal abscess at the side of a tooth, caused by spread from an infected gum. (3) A pericoronal abscess caused by infection of the gum over the crown of an unerupted and impacted tooth, usually a lower third molar (''an infected wisdom tooth'). Often, an abscess does not form, and the gum round the tooth is merely inflamed.

Many women with hair loss suffer in silence, altering their hairstyle to hide thinning or patches. But the sooner you seek care, the better the chances of successfully treating it, says Mary Gail Mercurio, MD, associate professor of dermatology at the University of Rochester in Rochester, N.Y. It's not as uncommon as you may think: As many as 5% of women under 30 and 60% of those older than 70 are affected, she says. At the recent meeting of the American Academy of Dermatology in Miami Beach, Fla., Mercurio discussed common forms of hair loss in women and treatment options.

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If levels of both vitamins are extremely high, there is more than a 17-fold greater risk that a child will develop autism, the researchers said. Most of the women in the study said they took multivitamins — which would include folic acid and vitamin B12 — throughout their pregnancy.