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Osteoarthritis is a degenerative joint disease that is caused by the chronic breakdown and eventual loss of cartilage within the joints. As the cartilage wears away, the bones that meet at the joint begin to rub against each other. This can cause extreme pain and can severely reduce movement and flexibility of the joint. Growths of bone, called bone spurs, can also form around the edges of the joint and cause pain. Joint swelling can also occur if the synovial membrane lining the joint becomes irritated, producing excess fluid that collects inside the joint. What Causes Osteoarthritis? More than half of the population age 65 or older have osteoarthritis in at least one joint. Osteoarthritis usually results from injury to a joint or from wear and tear over time. Heredity, lack of use, and being overweight also contribute to the development of osteoarthritis. Treating Osteoarthritis Treatment can include weight loss, physiotherapy, and medication. If the condition becomes severe and mobility is greatly reduced, hip replacement surgery may be necessary.
Male 19 y. age victim of penetrating brain injury. All the criteria for the encephalic death diagnosis were present. The presence of this complex spinal reflex doesn't exclude the brain death diagnosis and must be known and understood by the professionals involved in this very important diagnosis
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
http://www.thenyac.com/ Like Restylane and Juvederm, Belotero Balance is an FDA approved component for the correction of moderate-to-severe facial wrinkles, superficial lines, folds and upper lip. A doctor can use both Juvederm and Restylane on deeper areas and Belotero on top to correct wrinkles, lines and folds. In addition acne scars can benefit from fillers like Belotero