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INTRODUCTION-

Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities.

It’s also fairly common. The Centers for Disease Control and Prevention (CDC) estimates that 8.1 percent of American adults ages 20 and over had depression in any given 2-week period from 2013 to 2016.

Depression is a common illness worldwide, with more than 264 million people affected(1). Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Close to 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.

Although there are known, effective treatments for mental disorders, between 76% and 85% of people in low- and middle-income countries receive no treatment for their disorder(2). Barriers to effective care include a lack of resources, lack of trained health-care providers and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at the country level.

CAUSES-

There are several possible causes of depression. They can range from biological to circumstantial.

Common causes include:

• Family history. You’re at a higher risk for developing depression if you have a family history of depression or another mood disorder.
• Early childhood trauma. Some events affect the way your body reacts to fear and stressful situations.
• Brain structure. There’s a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms.
• Medical conditions. Certain conditions may put you at higher risk, such as chronic illness, insomnia, chronic pain, or attention-deficit hyperactivity disorder (ADHD).
• Drug use. A history of drug or alcohol misuse can affect your risk.

other risk factors for depression include:

• low self-esteem or being self-critical
• personal history of mental illness
• certain medications
• stressful events, such as loss of a loved one, economic problems, or a divorce

Many factors can influence feelings of depression.

Types and symptoms-

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate or severe.

A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period) with relapses, especially if they go untreated.

Recurrent depressive disorder: this disorder involves repeated depressive episodes. During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite, and may have feelings of guilt or low self-worth, poor concentration and even symptoms that cannot be explained by a medical diagnosis.

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities but will probably not cease to function completely. During a severe depressive episode, it is unlikely that the sufferer will be able to continue with social, work or domestic activities, except to a limited extent.

Bipolar affective disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.

Depression test-

There isn’t a single test to diagnose depression. But your healthcare provider can make a diagnosis based on your symptoms and a psychological evaluation.

In most cases, they’ll ask a series of questions about your:

• moods
• appetite
• sleep pattern
• activity level
• thoughts

Because depression can be linked to other health problems, your healthcare provider may also conduct a physical examination and order blood work. Sometimes thyroid problems or a vitamin D deficiency can trigger symptoms of depression.

Don’t ignore symptoms of depression. If your mood doesn’t improve or gets worse, seek medical help. Depression is a serious mental health illness with the potential for complications.

If left untreated, complications can include:

• weight gain or loss
• physical pain
• substance use problems
• panic attacks
• relationship problems
• social isolation
• thoughts of suicide
• self-harm

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Contributing factors and prevention-

Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.

Types of depression-

Depression can be broken into categories depending on the severity of symptoms. Some people experience mild and temporary episodes, while others experience severe and ongoing depressive episodes.

There are two main types: major depressive disorder and persistent depressive disorder.

Major depressive disorder

Major depressive disorder is the more severe form of depression. It’s characterized by persistent feelings of sadness, hopelessness, and worthlessness that don’t go away on their own.

In order to be diagnosed with clinical depression, you must experience 5 or more of the following symptoms over a 2-week period:

• feeling depressed most of the day
• loss of interest in most regular activities
• significant weight loss or gain
• sleeping a lot or not being able to sleep
• slowed thinking or movement
• fatigue or low energy most days
• feelings of worthlessness or guilt
• loss of concentration or indecisiveness
• recurring thoughts of death or suicide

There are different subtypes of major depressive disorder, which the American Psychiatric Association refers to as “specifiers.”

These include:

• atypical features
• anxious distress
• mixed features
• peripartum onset, during pregnancy or right after giving birth
• seasonal patterns
• melancholic features
• psychotic features
• catatonia

Persistent depressive disorder

Persistent depressive disorder (PDD) used to be called dysthymia. It’s a milder, but chronic, form of depression.

In order for the diagnosis to be made, symptoms must last for at least 2 years. PDD can affect your life more than major depression because it lasts for a longer period.

It’s common for people with PDD to:

• lose interest in normal daily activities
• feel hopeless
• lack productivity
• have low self-esteem

Depression can be treated successfully, but it’s important to stick to your treatment plan.

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Treatment for depression

Living with depression can be difficult, but treatment can help improve your quality of life. Talk to your healthcare provider about possible options.

You may successfully manage symptoms with one form of treatment, or you may find that a combination of treatments works best.

It’s common to combine medical treatments and lifestyle therapies, including the following:

Medications

Your healthcare provider may prescribe:

• antidepressants
• antianxiety
• antipsychotic medications

Each type of medication that’s used to treat depression has benefits and potential risks.

Psychotherapy

Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.

Light therapy

Exposure to doses of white light can help regulate your mood and improve symptoms of depression. Light therapy is commonly used in seasonal affective disorder, which is now called major depressive disorder with seasonal pattern.

Alternative therapies

Ask your healthcare provider about acupuncture or meditation. Some herbal supplements are also used to treat depression, like St. John’s wort, SAMe, and fish oil.

Talk with your healthcare provider before taking a supplement or combining a supplement with prescription medication because some supplements can react with certain medications. Some supplements may also worsen depression or reduce the effectiveness of medication.

Exercise

Aim for 30 minutes of physical activity 3 to 5 days a week. Exercise can increase your body’s production of endorphins, which are hormones that improve your mood.

Avoid alcohol and drugs

Drinking or misusing drugs may make you feel better for a little bit. But in the long run, these substances can make depression and anxiety symptoms worse.

Learn how to say no

Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.

Take care of yourself

You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.

Sometimes depression doesn’t respond to medication. Your healthcare provider may recommend other treatment options if your symptoms don’t improve.

These include electroconvulsive therapy (ECT), or repetitive transcranial magnetic stimulation (rTMS) to treat depression and improve your mood.

Physical Therapy Management

One of the biggest things a physical therapist can do for their patients is to be aware of the signs and symptoms of depression and some of the common disorders associated with depression. If the therapist is sensitive to the signs and symptoms of depression they can document it in the plan of care and then notify the physician so the patient can get the appropriate medical treatment, if necessary. Also, because patients with depression may be emotionally unstable, recognizing the signs and symptoms of depression can help you in approaching different situations and then redirecting the patient toward other activities, instructions or more positive topics of conversation.

Exercise has been shown to benefit patients with mild to moderate mood disorders, especially anxiety and depression. When performing aerobic exercise your body releases endorphins from the pituitary gland which are responsible for relieving pain and improving mood. These endorphins can also lower cortisol levels which have been shown to be elevated in patients with depression. Additionally, exercise increases the sensitivity of serotonin in the same way antidepressants work, allowing for more serotonin to remain in the nerve synapse. Exercise can be aerobic or resistive in nature, as both have been shown to be beneficial in a variety of patient types. Anyone with depression can participate in an exercise program no matter how old or young they are, as long as proper supervision is provided. Exercise is an excellent option for treatment when taking anti-depressants is not an option due to their side effects. Depression symptoms can be decreased significantly after just one session but the effects are temporary. An exercise program must be continued on a daily basis to see continued effects. As a person continues to exercise they may experiences changes in their body type which can help to improve self esteem and body image issues they may have been having. Some other benefits of regular physical exercise include:

• Reduces/prevents functional declines associated with ageing
• Maintains/improves cardiovascular function
• Aids in weight loss and weight control
• Improves function of hormonal, metabolic, neurologic, respiratory, and hemodynamic systems
• Alteration of carbohydrate/lipid metabolism results in favourable increase in high-density lipoproteins
• Strength training helps to maintain muscle mass and strength
• Reduces age-related bone loss; reduction in risk for osteoporosis
• Improves flexibility, postural stability, and balance; reduction in risk of falling and associated injuries
• Psychological benefits (preserves cognitive function, alleviates symptoms/behaviours of depression, improves self awareness, promotes sense of well-being)
• Reduces disease risk factors
• Improves functional capacity
• Improves immune function
• Reduces age-related insulin resistance
• Reduces incidence of some cancers
• Contributes to social integration
• Improves sleep pattern

Because of depression’s effect on the neuromusculoskeletal system, research has shown that treating a patient’s underlying depression can lead to better improvements in their pain. Physical therapists can implement other strategies into their practice to further improve the effects of therapy beyond the benefits of exercise.

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INTRODUCTION-

Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. A person is diagnosed with epilepsy if they have two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that were not caused by some known and reversible medical condition like alcohol withdrawal or extremely low blood sugar.

The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. The word “epilepsy” does not indicate anything about the cause of the person’s seizures or their severity.

A mild seizure may be difficult to recognize. It can last a few seconds during which you lack awareness.

Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening.

There are several reasons you might have a seizure. These include:

• high fever
• head trauma
• very low blood sugar
• alcohol withdrawal

Having seizures and epilepsy can affect one’s safety, relationships, work, driving, and so much more. Public perception and treatment of people with epilepsy are often bigger problems than actual seizures.

Epilepsy is a fairly common neurological disorder that affects 65 million people around the world. In the United States, it affects about 3 million people.

Anyone can develop epilepsy, but it’s more common in young children and older adults. It occurs slightly more in males than in females.

CAUSES-

Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:

• Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it’s likely that there’s a genetic influence. Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
• Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.
• Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.

Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy. Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy. Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.

SYMPTOM-

Seizures are the main symptom of epilepsy. Symptoms differ from person to person and according to the type of seizure.

Focal (partial) seizures

A simple partial seizure doesn’t involve loss of consciousness. Symptoms include:

• alterations to sense of taste, smell, sight, hearing, or touch
• dizziness
• tingling and twitching of limbs

Complex partial seizures involve loss of awareness or consciousness. Other symptoms include:

• staring blankly
• unresponsiveness
• performing repetitive movements

Generalized seizures

Generalized seizures involve the whole brain. There are six types:

Absence seizures, which used to be called “petit mal seizures,” cause a blank stare. This type of seizure may also cause repetitive movements like lip smacking or blinking. There’s also usually a short loss of awareness.

Tonic seizures cause muscle stiffness.

Atonic seizures lead to loss of muscle control and can make you fall down suddenly.

Clonic seizures are characterized by repeated, jerky muscle movements of the face, neck, and arms.

Myoclonic seizures cause spontaneous quick twitching of the arms and legs.

Tonic-clonic seizures used to be called “grand mal seizures.” Symptoms include:

• stiffening of the body
• shaking
• loss of bladder or bowel control
• biting of the tongue
• loss of consciousness

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DIAGNOSIS-

If you suspect you’ve had a seizure, see your doctor as soon as possible. A seizure can be a symptom of a serious medical issue.

Your medical history and symptoms will help your doctor decide which tests will be helpful. You’ll probably have a neurological examination to test your motor abilities and mental functioning.

In order to diagnose epilepsy, other conditions that cause seizures should be ruled out. Your doctor will probably order a complete blood count and chemistry of the blood.

Blood tests may be used to look for:

• signs of infectious diseases
• liver and kidney function
• blood glucose levels

Electroencephalogram (EEG) is the most common test used in diagnosing epilepsy. First, electrodes are attached to your scalp with a paste. It’s a noninvasive, painless test. You may be asked to perform a specific task. In some cases, the test is performed during sleep. The electrodes will record the electrical activity of your brain. Whether you’re having a seizure or not, changes in normal brain wave patterns are common in epilepsy.

Imaging tests can reveal tumors and other abnormalities that can cause seizures. These tests might include:

• CT scan
• MRI
• positron emission tomography (PET)
• single-photon emission computerized tomography

Epilepsy is usually diagnosed if you have seizures for no apparent or reversible reason.

RISK FACTOR-

Certain factors may increase your risk of epilepsy:

• Age. The onset of epilepsy is most common in children and older adults, but the condition can occur at any age.
• Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
• Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
• Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly.

Dementia. Dementia can increase the risk of epilepsy in older adults. Brain infections. Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk. Seizures in childhood. High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won’t develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy.

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COMPLICATION-

Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.

• Falling. If you fall during a seizure, you can injure your head or break a bone.
• Drowning. If you have epilepsy, you’re 15 to 19 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.
• Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment. Many states have driver’s license restrictions related to a driver’s ability to control seizures and impose a minimum amount of time that a driver be seizure-free, ranging from months to years, before being allowed to drive.
• Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, talk to your doctor as you plan your pregnancy.

Most women with epilepsy can become pregnant and have healthy babies. You’ll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It’s very important that you work with your doctor to plan your pregnancy.

Emotional health issues. People with epilepsy are more likely to have psychological problems, especially depression, anxiety and suicidal thoughts and behaviors. Problems may be a result of difficulties dealing with the condition itself as well as medication side effects.

Other life-threatening complications of epilepsy are uncommon, but may happen, such as:

• Status epilepticus. This condition occurs if you’re in a state of continuous seizure activity lasting more than five minutes or if you have frequent recurrent seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
• Sudden unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows it may occur due to heart or respiratory conditions. People with frequent tonic-clonic seizures or people whose seizures aren’t controlled by medications may be at higher risk of SUDEP. Overall, about 1 percent of people with epilepsy die of SUDEP.

TREATMENT-

Most people can manage epilepsy. Your treatment plan will be based on severity of symptoms, your health, and how well you respond to therapy.

Some treatment options include:

• Anti-epileptic (anticonvulsant, antiseizure) drugs: These medications can reduce the number of seizures you have. In some people, they eliminate seizures. To be effective, the medication must be taken exactly as prescribed.
• Vagus nerve stimulator: This device is surgically placed under the skin on the chest and electrically stimulates the nerve that runs through your neck. This can help prevent seizures.
• Ketogenic diet: More than half of people who don’t respond to medication benefit from this high fat, low carbohydrate diet.
• Brain surgery: The area of the brain that causes seizure activity can be removed or altered.

Research into new treatments is ongoing. One treatment that may be available in the future is deep brain stimulation. It’s a procedure in which electrodes are implanted into your brain. Then a generator is implanted in your chest. The generator sends electrical impulses to the brain to help decrease seizures.

Another avenue of research involves a pacemaker-like device. It would check the pattern of brain activity and send an electrical charge or drug to stop a seizure.

Minimally invasive surgeries and radiosurgery are also being investigated.

Medications for epilepsy–

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

Many children with epilepsy who aren’t experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults can discontinue medications after two or more years without seizures. Your doctor will advise you about the appropriate time to stop taking medications.

Finding the right medication and dosage can be com

plex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won’t interact with them.

Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled.

Anti-seizure medications may have some side effects. Mild side effects include:

• Fatigue
• Dizziness
• Weight gain
• Loss of bone density
• Skin rashes
• Loss of coordination
• Speech problems
• Memory and thinking problems

More-severe but rare side effects include:

• Depression
• Suicidal thoughts and behaviors
• Severe rash
• Inflammation of certain organs, such as your liver

To achieve the best seizure control possible with medication, follow these steps:

• Take medications exactly as prescribed.
• Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.
• Never stop taking your medication without talking to your doctor.
• Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors.
• Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy.

At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don’t provide satisfactory results, your doctor may suggest surgery or other therapies. You’ll have regular follow-up appointments with your doctor to evaluate your condition and medications.

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PHYSIOTHERAPY

Apart from medications and surgery, these potential therapies offer an alternative for treating epilepsy

Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck. The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It’s not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent. Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing.

Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that’s high in fats and low in carbohydrates.

In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet — under close supervision of their doctors — and remain seizure-free.

Consult a doctor if you or your child is considering a ketogenic diet. It’s important to make sure that your child doesn’t become malnourished when following the diet.

Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised.

Following a ketogenic diet can be a challenge. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control.

Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain, typically your thalamus. The electrodes are connected to a generator implanted in your chest or your skull that sends electrical pulses to your brain and may reduce your seizures.

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INTRODUCTION-

Parkinsonism is a disease that occurs when a person has symptoms and brain dysfunction commonly associated with Parkinson’s disease but also has other symptoms related to an additional condition or cause.Parkinsonism is any condition that causes a combination of the movement abnormalities seen in Parkinson’s disease — such as tremor, slow movement, impaired speech or muscle stiffness — especially resulting from the loss of dopamine-containing nerve cells (neurons).

Parkinson’s disease (PD) is a neurodegenerative disorder characterized primarily by loss of dopamine neurons in the substantia nigra. Symptoms generally develop on one body side slowly over years but the progression may differ from one person to another due to the diversity of the disease. People with PD may experience tremor, mainly at rest (described as pill rolling tremor in hands), bradykinesia, limb rigidity, gait and balance problems. Prevalence is approximately 200 cases per 100,000 population, and the incidence is about 25 cases per 100,000 population, but these figures might show differences from one region of the world to another.

CAUSES-

Parkinsonism can be caused by Parkinson’s disease itself as well as another underlying condition.

Other causes associated with Parkinsonism include:

• Corticobasal degeneration: This condition causes dementia as well as affected movements, usually on one side. A person may also be unable to make controlled muscle movements.
• Dementia with Lewy bodies: This condition causes changes in overall alertness as well as visual hallucinations. This condition is the second most common cause of dementia after Alzheimer’s disease, according to Johns Hopkins Medicine.
• Multiple system atrophy: This condition affects coordination and autonomic dysfunction, including bowel and bladder incontinence.
• Progressive supranuclear palsy: This condition causes dementia, frequent backward falls, and problems moving the eyes up and down in addition to Parkinson’s disease symptoms.

The conditions above are the four most common causes of Parkinsonism, according to University of Texas Southwestern Medical Center. The number of people with these conditions is about one-fourth of the amount of people who have Parkinson’s disease itself.

Another, less common condition called vascular Parkinsonism also exists. This condition causes multiple, small strokes that can affect a person’s balance, walking, and memory.

Parkinsonism is also sometimes the result of taking certain medications. Doctors call this condition drug-induced Parkinsonism. Examples of drugs that could cause it include aripiprazole (Abilify), haloperidol (Haldol), and metoclopramide (Reglan).

Ideally, if a person has drug-induced Parkinsonism, they can slowly reduce the dosages of these medicines. However, that may not always be possible, and a person should not stop taking a medication without their doctor’s approval.

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SYMPTOM-

A person with Parkinsonism usually starts developing symptoms at anywhere from age 50 to 80, according to the University of Texas Southwestern Medical Center.

Parkinson’s disease can cause varying and progressive symptoms throughout its course. Some of the most common symptoms associated with the disease include:

• difficulty showing facial expressions
• muscle stiffness
• slowed, affected movements
• speech changes
• tremor, especially of one hand

A person with Parkinsonism may have some, but not all, of the symptoms listed above. This is because they also have an additional disorder that affects the brain’s functioning.

For example, people with Parkinsonism often do not have the hand tremor that affects many people with Parkinson’s disease.

Other symptoms associated with Parkinsonism include:

• dementia
• issues with the autonomic nervous system, such as problems with controlled movements or spasms
• early problems with balance
• rapid onset and progression of symptoms

Each underlying cause of Parkinsonism, such as dementia with Lewy bodies, also has its own unique set of symptoms.

DIAGNOSIS-

No single test exists for doctors to diagnose Parkinsonism.

A doctor will start by taking a person’s health history and review their current symptoms. They will ask for a medication list to determine if any medicines could be causing the symptoms.

A doctor will likely also order blood testing to check for underlying potential causes, such as thyroid or liver problems. A doctor will also order imaging scans to examine the brain and body for other causes, such as a brain tumor.

Doctors can perform a test that tracks the movement of dopamine in the brain. This is known as the DaT-SPECT test.

The test uses radioactive markers designed to track dopamine in the brain. This allows a doctor to watch the release of dopamine in a person’s brain and identify the areas of the brain that do or do not receive it.

Because Parkinsonism does not respond to typical treatments and can have a variety of symptoms, doctors can have difficulty coming to a quick diagnosis. It may take time for doctors to rule out other conditions and begin to make treatment recommendations.

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TREATMENT-

One of the most commonly prescribed medications to treat Parkinson’s disease is levodopa. This medication is related to dopamine and can increase the amount of dopamine available in the brain.

However, people with Parkinsonism not only have problems producing dopamine, but they also have damaged or destroyed cells that cannot respond to dopamine. As a result, levodopa may not work as well to reduce their symptoms.

Doctors can find Parkinsonism challenging to treat because the symptoms of the condition do not always respond as well or at all to medications that boost dopamine.

As a result, treatments for Parkinsonism depend upon the “plus” disease that a person has. For example, if a person has corticobasal degeneration and related muscle spasms, a doctor may prescribe antidepressants and botulinum toxin A (BOTOX) injections.

Treatments for Parkinsonism usually aim to help reduce a person’s symptoms whenever possible to help them maintain independence. Doctors often recommend physical and occupational therapy because they can help a person keep their muscles strong and improve balance.

PHYSICAL THERAPY FOR PARKINSON

Exercise

Exercise has been proven to maintain health and well-being in Parkinson’s and now importantly it is shown to play a big role in addressing secondary prevention (focusing on strength, endurance, flexibility, functional practice and balance). Exercise for neuroprotection focuses on endurance and uses motor learning principles approaches, such as mental imagery and dual task training. Neuroprotection training, to be effective, should be introduced in the early stages, but helps at all stages. It involves complex, powerful and intensive exercises.

Exercise undertaken in a group setting has the added value of providing a social connection to those becoming increasingly isolated as the condition progresses, or for those who are newly diagnosed, so they can see the benefits of maintaining exercise and activity. A group environment also permits time for people to ask questions and discuss their symptoms and own management strategies with one another.

Movement Strategy Training

Basal ganglia disorders cause deficits in the generation of internal (automatic) behavior. Strategies (physical or attentional cues and combined strategies) can help overcome some of the resultant problems, hence have become an increasingly utilised method of intervention for people with Parkinson’s.

Music-based movement therapy is a promising intervention that needs some further research. It is interesting since it combines cognitive movement strategies, cueing techniques, balance exercises and physical activity. The focus is on enjoying moving and not on the mobility limitation which might appeal more to the patients than standard exercises.

We can see immediately the effects of external cueing and attention on improving step length, freezing and turning during walking tasks, and in activities of daily living. A Systematic Review and Meta-Analyses suggests better outcomes with short-term physiotherapy on the symptoms of freezing of gait in Parkison’s patient. However, further randomized control trial studies are still needed.Literature suggests that robot-assisted gait technology has better results in addressing the freezing of gait for Parkinson’s patients. However, more research is needed in this field.

Depending on the cognitive state of the individual, they may be able to learn how to self-instruct in the use of an internal cue or strategy. If less able, the cue or strategy has to come from an external source e.g. a visual strip on the ground, the rhythmic beat of a metronome.

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INTRODUCTION-

Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.

Insomnia is the most common of all sleep disorders, according to the American Psychiatric Association (APA). In fact, the APA states that about one-third of all adults report insomnia symptoms. But between 6 to 10 percent of all adults have symptoms severe enough for them to be diagnosed with insomnia disorder.

The condition can be short-term (acute) or can last a long time (chronic). It may also come and go.Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens at least 3 nights a week for 3 months.

TYPES OF INSOMNIA –

There are two types of insomnia: primary and secondary.

• Primary insomnia: This means your sleep problems aren’t linked to any other health condition or problem.
• Secondary insomnia: This means you have trouble sleeping because of a health condition (like asthma, depression,arthitis, heartburn)

CAUSES-

Causes of primary insomnia include:

• Stress related to big life events, like a job loss or change, the death of a loved one, divorce, or moving
• Things around you like noise, light, or temperature
• Changes to your sleep schedule like jet lag, a new shift at work, or bad habits you picked up when you had other sleep problems

Causes of secondary insomnia include:

• Mental health issues like depression and anxiety
• Medications for colds, allergies, depression, high blood pressure, and asthma
• Pain or discomfort at night
• Caffeine, tobacco, or alcohol use
• Hyperthyroidism and other endocrine problems
• Other sleep disorders, like sleep apnea or restless legs syndrome.

SYMPTOM-

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Symptoms

Insomnia symptoms may include:

• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early
• Not feeling well-rested after a night’s sleep
• Daytime tiredness or sleepiness
• Irritability, depression or anxiety
• Difficulty paying attention, focusing on tasks or remembering
• Increased errors or accidents
• Ongoing worries about sleep

Risk factors for insomnia

Insomnia can occur at any age and is more likely to affect women than men.

According to the National Heart, Lung, and Blood Institute (NHLBI)Trusted Source, people with certain risk factors are more likely to have insomnia. These risk factors include:

• high levels of stress
• emotional disorders, such as depression or distress related to a life event
• lower income
• traveling to different time zones
• sedentary lifestyle
• changes in work hours, or working night shifts

Certain medical conditions, such as obesity and cardiovascular disease, can also lead to insomnia. Menopause can lead to insomnia as well. Find out more about the causes of — and risk factors for — insomnia.

DIAGNOSIS-

Depending on your situation, the diagnosis of insomnia and the search for its cause may include:

• Physical exam. If the cause of insomnia is unknown, your doctor may do a physical exam to look for signs of medical problems that may be related to insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that may be associated with poor sleep.
• Sleep habits review. In addition to asking you sleep-related questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks.
• Sleep study. If the cause of your insomnia isn’t clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

TREATMENT-

Meditation

Meditation is a natural, easy, drug-free method for treating insomnia. According to the National Sleep Foundation, meditation can help improve the quality of your sleep, as well as make it easier to fall asleep and stay asleep.

MANY CONDITIONS CONTRIBUTE TO INSOMNIA THESE ARE:-

anxiety

depression

digestive problems

pain

Many apps and videos are available to help you meditate.

Melatonin

The hormone melatonin is naturally produced by the body during the sleep cycle. People often take melatonin supplements in hopes of improving their sleep.

Studies are inconclusiveTrusted Source regarding whether melatonin can actually help treat insomnia in adults. There’s some evidence that supplements may slightly decrease the time it takes you to fall asleep but more research is needed.

Melatonin is generally thought to be safe for a short period of time, but its long-term safety has yet to be confirmed.

It’s always best to work with your doctor when deciding to take melatonin.

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MEDICATION-

sedative-a drug that subues excitement and calms the without inducing sleep, though drowsiness maybe produced.

hypnotic- a drug that induces and/ or maintains sleep, simila to normal arousable sleep .

PHYSICAL THERAPY

To integrate sleep health in prevention, health promotion, and wellness interventions, therapists should:

1. Assess overall sleep health and screen for risk of sleep disorders.
2. Refer for additional assessment if individual is identified as at increased risk for a sleep disorder.
3. Provide sleep hygiene education.
4. Provide an appropriate exercise program.
5. Consider positioning to promote sleep quality.
6. Address bed mobility issues.

Getting a full night sleep is critical to a healthy lifestyle. Sometimes we all have difficulty sleeping to due to a number of factors: stressful lives, chronic pain, our busy schedules. Many of our physical therapy patients come to us with physical pain or limitations that can also impact their quality of life…including their ability to rest.

Conducting an assessment or a screening to determine a patient’s sleep deficits provides an overview of their sleep profile and habits before going to sleep and after waking. Known as sleep hygiene, it is characterized by the National Sleep Foundation as “...a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.” Conducted by a physical therapist, assessment is part of understanding how physical conditions, body positioning and limitations to mobility can affect sleep. Additional factors may include a discussion on ergonomics: the type of bed and mattress used, number of pillows, body positioning for sleeping, etc.

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INTRODUCION-

Gout is a common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big toe joint). There are times when symptoms get worse, known as flares, and times when there are no symptoms, known as remission. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis.

There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies.

Gout is a general term for a variety of conditions caused by a buildup of uric acid. This buildup usually affects your feet.

If you have gout, you’ll probably feel swelling and pain in the joints of your foot, particularly your big toe. Sudden and intense pain, or gout attacks, can make it feel like your foot is on fire.

SYMPTOM-

Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remission—weeks, months, or years—without symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.

Some people have too much uric acid in their blood, but no symptoms. This is called asymptomatic gout.

Acute gout symptoms come on quickly from the buildup of uric acid crystals in your joint and last for 3 to 10 days. You’ll have intense pain and swelling, and your joint may feel warm. Between gout attacks you won’t have any symptoms.

If you don’t treat gout, it can become chronic. Hard lumps called tophi can eventually develop in your joints and the skin and soft tissue surrounding them. These deposits can permanently damage your joints.

Prompt treatment is important to prevent gout from turning chronic.

Symptoms in the affected joint(s) may include:

• Pain, usually intense.
• Swelling.
• Redness.
• Heat.

The buildup of uric acid in your blood from the breakdown of purines causes gout.

Certain conditions, such as blood and metabolism disorders or dehydration, make your body produce too much uric acid.

A kidney or thyroid problem, or an inherited disorder, can make it harder for your body to remove excess uric acid.

You’re more likely to get gout if you:

• are a middle-aged man or postmenopausal woman
• have parents, siblings, or other family members with gout
• eat too much purine-rich food, such as red meats, organ meats, and certain fish
• drink alcohol
• take medications such as diuretics and cyclosporine
• have a condition like high blood pressure, kidney disease, thyroid disease, diabetes, or sleep apnea

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ETIOLOGY-

Gout is caused by a condition known as hyperuricemia, where there is too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat. When there is too much uric acid in the body, uric acid crystals (monosodium urate) can build up in joints, fluids, and tissues within the body. Hyperuricemia does not always cause gout, and hyperuricemia without gout symptoms does not need to be treated.

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.

Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Risk factors

You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

• Diet. Eating a diet rich in meat and seafood and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
• Obesity. If you’re overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
• Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
• Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
• Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
• Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
• Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.

Complications

People with gout can develop more-severe conditions, such as:

• Recurrent gout. Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
• Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
• Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Prevention

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

• Drink plenty of fluids. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high-fructose corn syrup.
• Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
• Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
• Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
• Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

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TREATMENT-

Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to

• Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
• Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food (like red meat or organ meat), may help prevent future attacks. Changing or stopping medications associated with hyperuricemia (like diuretics) may also help.
• Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.

In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.

Gout foods to avoid

Certain foods are naturally high in purines, which your body breaks down into uric acid. Most people don’t have a problem with high-purine foods, but if your body has trouble releasing excess uric acid, you may want to avoid foods and drinks like these:

• red meats
• organ meats
• certain seafood
• alcohol

Sugar-sweetened beverages and foods containing the sugar fructose can also be problematic, even though they don’t contain purines.

Certain foods help reduce uric acid levels in the body.

Gout home remedies

Some gout-relief methods don’t come in a bottle from your pharmacy. Evidence from studies suggests that these natural remedies may help lower uric acid levels and prevent gout attacks:

• tart cherries
• magnesium
• ginger
• apple cider vinegar
• celery
• nettle tea
• dandelion
• milk thistle seeds

Gout surgery

Gout can typically be treated without surgery. But after many years, this condition can damage the joints, tear the tendons, and cause infections in the skin over the joints.

Hard deposits, called tophi, can build up on your joints and in other places, like your ear. These lumps may be painful and swollen, and they can permanently damage your joints.

Three surgical procedures treat tophi:

• tophi removal surgery
• joint fusion surgery
• joint replacement surgery

Which one of these surgeries your doctor recommends depends on the extent of the damage, where the tophi are located, and your personal preferences.

PHYSIOTHERAPY MANAGEMENT –

Physical therapy management of gout falls under preferred practice pattern 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation.  

The physical therapist should be aware that any patient with a history of gout, hyperuricemia, and/or a septic joint presentation should be refered for medical evaluation prior to treatment.

During acute exacerbations the physical therapist should focus on reinforcement of management program and splinting, orthotics, or other assistive devices to protect the affected joint(s).

A 2002 study in the Journal of Rheumatology found that the use of cryrotherapy to alleviate the pain associated with acute bouts of gout may be effective.

During intercritical phases physical therapists may offer assistance with maintinance of ROM, strength, and function.  The physical therapist can also assist the patient in the creation of a suitable exercise routine and keeping thier weight under control.

There is a Randomized Clinical Trial which suggests that Electroacupuncture in combination with blood letting puncture and cupping has relatively good results as a treatment for Gout. The treatment is effective mostly because the blood uric acid decreased significantly after the treatment was given to the patients.

There is another study about Electroacupuncture combined with local blocking therapy on acute gouty arthritis that shows an improvement in health status of the patients. This treatment is positive and it also decreases blood uric acid levels.

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Introduction-

The human immunodeficiency virus (HIV) is an enveloped retrovirus that contains 2 copies of a single-stranded RNA genome. It causes the acquired immunodeficiency syndrome (AIDS) that is the last stage of HIV disease.

1. Four to 10 weeks after the HIV enters the body, the patient may complain of symptoms of primary infection.
2. After the primary infection, a long chronic HIV infection occurs, which can last for decades.

AIDS is mainly characterized by opportunistic infections and tumors ( as a result of immunodeficiency) which are usually fatal without treatment.

HIV is a virus that damages the immune system. The immune system helps the body fight off infections. Untreated HIV infects and kills CD4 cells, which are a type of immune cell called T cells. Over time, as HIV kills more CD4 cells, the body is more likely to get various types of infections and cancers. HIV is transmitted through bodily fluids that include:

• blood
• semen
• vaginal and rectal fluids
• breast milk

• HIV continues to be a major global public health issue, having claimed more than 32 million lives so far.
• With increasing access to effective HIV prevention, diagnosis, treatment and care (including for opportunistic infections) HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
• There were approximately 37.9 million people living with HIV at the end of 2018.
• Concerted international efforts to respond to HIV had lead to an increased coverage of services. In 2018, 62% of adults and 54% of children living with HIV in low- and middle-income countries were receiving lifelong antiretroviral therapy (ART).
• Between 2000 and 2018, new HIV infections fell by 37% and HIV-related deaths fell by 45%, with 13.6 million lives saved due to ART. This achievement was the result of great efforts by national HIV programmes supported by civil society and international development partners.

AIDS-

AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV. But just because a person has HIV doesn’t mean they’ll develop AIDS. HIV kills CD4 cells. Healthy adults generally have a CD4 count of 500 to 1,500 per cubic millimeter. A person with HIV whose CD4 count falls below 200 per cubic millimeter will be diagnosed with AIDS. A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer that’s rare in people who don’t have HIV. An opportunistic infection, such as pneumonia, is one that takes advantage of a unique situation, such as HIV. Untreated, HIV can progress to AIDS within a decade. There’s no cure for AIDS, and without treatment, life expectancy after diagnosis is about three yearsTrusted Source. This may be shorter if the person develops a severe opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing. If AIDS does develop, it means that the immune system is severely compromised. It’s weakened to the point where it can no longer fight off most diseases and infections. That makes the person vulnerable to a wide range of illnesses, including:

• pneumonia
• tuberculosis
• oral thrush, a fungal infection in the mouth or throat
• cytomegalovirus (CMV), a type of herpes virus
• cryptococcal meningitis, a fungal infection in the brain
• toxoplasmosis, a brain infection caused by a parasite
• cryptosporidiosis, an infection caused by an intestinal parasite
• cancer, including Kaposi’s sarcoma (KS) and lymphoma

The shortened life expectancy linked with untreated AIDS isn’t a direct result of the syndrome itself. Rather, it’s a result of the diseases and complications that arise from having an immune system weakened by AIDS.

etiology-

The cause of this infectious disease is the human immunodeficiency virus (HIV) which can be classified into HIV-1 and HIV-2.

• HIV-1 is more globally expanded and virulent. It originated in Central Africa.
• HIV-2 is much less virulent and comes from West Africa.
• Both viruses are related antigenically to immunodeficiency viruses found primarily in primates.

HIV is a variation of a virus that infects African chimpanzees. Scientists suspect the simian immunodeficiency virus (SIV) jumped from chimps to humans when people consumed infected chimpanzee meat. Once inside the human population, the virus mutated into what we now know as HIV. This likely occurred as long ago as the 1920s. HIV spread from person to person throughout Africa over the course of several decades. Eventually, the virus migrated to other parts of the world. Scientists first discovered HIV in a human blood sample in 1959. It’s thought that HIV has existed in the United States since the 1970s, but it didn’t start to hit public consciousness until the 1980s.

Signs and symptoms–

The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months after being infected, many are unaware of their status until the later stages. In the first few weeks after initial infection people may experience no symptoms or an influenza-like illness including fever, headache, rash or sore throat.

As the infection progressively weakens the immune system, they can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without treatment, they could also develop severe illnesses such as tuberculosis (TB), cryptococcal meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi’s sarcoma.

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DIGNOSIS –

Several different tests can be used to diagnose HIV. Healthcare providers determine which test is best for each person.

Antibody/antigen tests

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 18–45 daysTrusted Source after someone initially contracts HIV. These tests check the blood for antibodies and antigens. An antibody is a type of protein the body makes to fight an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

Antibody tests

These tests check the blood solely for antibodies. Between 23 and 90 daysTrusted Source after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva. These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a healthcare provider’s office or clinic. Other antibody tests can be done at home:

• OraQuick HIV Test. An oral swab provides results in as little as 20 minutes.
• Home Access HIV-1 Test System. After the person pricks their finger, they send a blood sample to a licensed laboratory. They can remain anonymous and call for results the next business day.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in three months. If they have a positive result, they should follow up with their healthcare provider to confirm.

Nucleic acid test (NAT)

This expensive test isn’t used for general screening. It’s for people who have early symptoms of HIV or have a known risk factor. This test doesn’t look for antibodies; it looks for the virus itself. It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test. Today, it’s easier than ever to get tested for HIV.

WHO-

HIV can be diagnosed through rapid diagnostic tests that provide same-day results. This greatly facilitates early diagnosis and linkage with treatment and care. People can also use HIV self-tests to test themselves. However, no single test can provide a full HIV diagnosis; confirmatory testing is required, conducted by a qualified and  trained health or community worker at a community centre or clinic. HIV infection can be detected with great accuracy using WHO prequalified tests within a nationally approved testing strategy.

Most widely-used HIV diagnostic tests detect antibodies produced by the person as part of their immune response to fight HIV. In most cases, people develop antibodies to HIV within 28 days of infection. During this time, people experience the so-called “window” period –  when HIV antibodies haven’t been produced in high enough levels to be detected by standard tests and when they may have had no signs of HIV infection, but also when they may transmit HIV to others. After infection, an individual may transmit HIV transmission to a sexual or drug-sharing partner or for pregnant women to their infant during pregnancy or the breastfeeding period.

Following a positive diagnosis, people should be retested before they are enrolled in treatment and care to rule out any potential testing or reporting error. Notably, once a person diagnosed with HIV and has started treatment they should not be retested.

While testing for adolescents and adults has been made simple and efficient, this is not the case for babies born to HIV-positive mothers. For  children less than 18 months of age, serological testing is not sufficient to identify HIV infection – virological testing must be provided as early as birth or at 6 weeks of age). New technologies are now becoming available to perform this test at the point of care and enable same-day results, which will accelerate appropriate linkage with treatment and care.

SYMPTOM-

After the first month or so, HIV enters the clinical latency stage. This stage can last from a few years to a few decades. Some people don’t have any symptoms during this time, while others may have minimal or nonspecific symptoms. A nonspecific symptom is a symptom that doesn’t pertain to one specific disease or condition. These nonspecific symptoms may include:

• headaches and other aches and pains
• swollen lymph nodes
• recurrent fevers
• night sweats
• fatigue
• nausea
• vomiting
• diarrhea
• weight loss
• skin rashes
• recurrent oral or vaginal yeast infections
• pneumonia
• shingles

As with the early stage, HIV is still infectious during this time even without symptoms and can be transmitted to another person. However, a person won’t know they have HIV unless they get tested. If someone has these symptoms and thinks they may have been exposed to HIV, it’s important that they get tested. HIV symptoms at this stage may come and go, or they may progress rapidly. This progression can be slowed substantially with treatment. With the consistent use of this antiretroviral therapy, chronic HIV can last for decades and will likely not develop into AIDS, if treatment was started early enough.

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DIFFERENTIAL DIAGNOSIS –

Many individuals with HIV/AIDS may remain asymptomatic for years, with a mean time of 10 years between exposure and development. Virtually, all the findings in the initial onset of AIDS may be found/mimic other diseases such as:

• Fever
• Headaches
• Night sweats
• Fatigue
• HTN
• Back pain
• Pulmonary complications ex. cough and SOA
• GI complaints (change in bowel habits and function)
• Cutaneous complaints (dry skin, new rashes, nail bed changes)
• Poor wound healing
• Thrush
• Easy Bruising
• Weight loss
• Herpes Simplex virus
• Cytomegalovirus
• Lymphoma

 All of these signs/symptoms may be associated with other diseases, a combination of complaints is more suggestive of HIV infection than any one symptom alone.

TREATMENT –

HIV can be suppressed by  treatment regimens composed by a combination of 3 or more ARV drugs. Current ART does not cure HIV infection but  highly  suppresses viral replication within a person’s body and allows an individual’s immune system  recovery to strengthen and regain the capacity to fight off infections.

Since 2016, WHO recommended that all people living with HIV be provided with lifelong ART, including children, adolescents and adults, and pregnant and breastfeeding women, regardless of clinical status or CD4 cell count. By the end of 2019, 185 countries had already adopted this recommendation, covering 99% of all people living with HIV globally.

• WHO updated its HIV treatment guidelines in 2018 and 2019 to reflect the latest scientific advances.  

The current  HIV treatment guidelines include new ARV options with better tolerability, higher efficacy, and lower rates of treatment discontinuation when compared with previous recommended medicines. In 2019, WHO recommends the use of dolutegravir-based or low-dose efavirenz for first-line therapy. DTG should also be used in 2^nd line therapy , if not used in 1^st line and darunavir/ritonavir is recommended as the anchor drug in third- line  or a alternative option second-line therapy.

By mid-2020, transition to dolutegravir has been implemented  in 100  low- and middle-income countries and is expected to improve the durability of the treatment and the quality of care for people living with HIV. Despite improvements, limited options remain for infants and young children. For this reason, WHO and partners are coordinating efforts to enable a faster and more effective development and introduction of age-appropriate paediatric formulations of  new ARV drugs.

In addition, 1 in each 3 people living with HIV present to care with advanced disease, usually with  severe clinical  symptoms, low CD4 cell counts, and at high risk of develop serious illness and death. To reduce this risk, WHO recommends that these individuals receive a “package of care” that includes screening tests and drug prophylaxis for  the most common serious infections that can cause severe morbidity and death, such as TB and cryptococcal meningitis, in addition to rapid ART initiation.

Globally, 25.4 million people living with HIV were receiving ART in 2019. This equates to a global ART coverage rate of 67%. However, more efforts are needed to scale up treatment, particularly for children and adolescents. Only 53% of children were receiving ART at the end of 2019.

Expanding access to treatment is at the heart of a set of targets for 2020, which aim to bring the world back on track to end the AIDS epidemic by 2030.

PHYSIOTHERAPY APPROACH –

Physical Therapists play an important role in treating conditions that limit the patient’s movement and function.

• Goals will be set to improve the quality of life and keep the patient active in both his/her life and in the community.
• Patients with HIV develop many of the functional limitations that any other patient may have, such as sports-related injuries or arthritis. In addition to managing impairments, these patients may have problems with the disease process, infections, and/or side effects of the medication.
• A physical therapist will develop a plan of care to help the patient improve his/her ability to do daily activities, improve heart health, improve balance, reduce pain, and maintain healthy body weight.
• In addition, this plan of care, a proper home exercise program will be prescribed to achieve goals set by the patient or physical therapist. A qualitative study by deBoer et al. suggests that collaborating physiotherapists on the interprofessional health care team would help in addressing the unique requirements of patients living with HIV.

In addition to improving the above mentioned positive benefits, the therapist must also address the following issues:

• Quality of life issues
• Work environment
• Community management skills (how to access transportation, socialisation opportunities, shopping, banking, ability to access and negotiate health care and insurance systems)
• Integumentary care

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The term sexually transmitted disease (STD) is used to refer to a condition passed from one person to another through sexual contact. You can contract an STD by having unprotected vaginal, anal, or oral sex with someone who has the STD.

An STD may also be called a sexually transmitted infection (STI) or venereal disease (VD).

That doesn’t mean sex is the only way STDs are transmitted. Depending on the specific STD, infections may also be transmitted through sharing needles and breastfeeding.

Some STIs are benign, but others can lead to severe complications if a person does not seek treatment.

HIV has other routes of transmission. For example, this STI can spread through the use of unsterilized drug needles, as well as through sexual contact.

Anyone can contract an STI, regardless of their sexual orientation and hygiene standards. Many STIs can transmit through nonpenetrative sexual activity.

This article looks at some common STIs, when to seek help, and how to prevent them.

Scope of the problem

STIs have a profound impact on sexual and reproductive health worldwide.

More than 1 million STIs are acquired every day. In 2016, WHO estimated 376 million new infections with 1 of 4 STIs: chlamydia (127 million), gonorrhoea (87 million), syphilis (6.3 million) and trichomoniasis (156 million). More than 500 million people are living with genital HSV (herpes) infection and an estimated 300 million women have an HPV infection, the primary cause of cervical cancer. An estimated 240 million people are living with chronic hepatitis B globally. Both HPV and hepatitis B infections are preventable with vaccination.

STIs can have serious consequences beyond the immediate impact of the infection itself.

• STIs like herpes and syphilis can increase the risk of HIV acquisition three-fold or more.
• Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-birth-weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis, and congenital deformities. Approximately 1 million pregnant women were estimated to have active syphilis in 2016, resulting in over 350 000 adverse birth outcomes of which 200 000 occurred as stillbirth or neonatal death (5).
• HPV infection causes 570 000 cases of cervical cancer and over 300 000 cervical cancer deaths each year (6).
• STIs such as gonorrhoea and chlamydia are major causes of pelvic inflammatory disease (PID) and infertility in women.

Symptoms of STDs in men

It’s possible to contract an STD without developing symptoms. But some STDs cause obvious symptoms. In men, common symptoms include:

• pain or discomfort during sex or urination
• sores, bumps, or rashes on or around the penis, testicles, anus, buttocks, thighs, or mouth
• unusual discharge or bleeding from the penis
• painful or swollen testicles

Specific symptoms can vary, depending on the STD.

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Symptoms of STDs in women

In many cases, STDs don’t cause noticeable symptoms. When they do, common STD symptoms in women include:

• pain or discomfort during sex or urination
• sores, bumps, or rashes on or around the vagina, anus, buttocks, thighs, or mouth
• unusual discharge or bleeding from the vagina
• itchiness in or around the vagina

The specific symptoms can vary from one STD to another.

WHO response

WHO develops global norms and standards for STI treatment and prevention, strengthens systems for surveillance and monitoring, including those for AMR in gonorrhoea, and leads the setting of the global research agenda on STIs.

Our work is currently guided by the “Global health sector strategy on sexually transmitted infections, 2016 -2021 (8), adopted by the World Health Assembly in 2016 and the 2015 United Nations Global Strategy for Women’s, Children’s and Adolescents’ Health (9), which highlight the need for a comprehensive, integrated package of essential interventions, including information and services for the prevention of HIV and other sexually transmitted infections. The Sixty-ninth World Health Assembly adopted 3 global health sector strategies for the period 2016-2021 on HIV, viral hepatitis and STIs.

WHO works with countries to:

• Scale-up effective STI services including:
  • STI case management and counseling
  • syphilis testing and treatment, in particular for pregnant women
  • hepatitis B and HPV vaccination
  • STI screening of populations at increased risk of STIs
• Promote strategies to enhance STI-prevention impact including:
  • integrate STI services into existing health systems
  • promote sexual health
  • measure the burden of STIs
  • monitor and respond to STI antimicrobial resistance.
• Support the development of new technologies for STI prevention such as:
  • point-of care diagnostic tests for STIs
  • additional drugs for gonorrhoea
  • STI vaccines and other biomedical interventions.

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Fatty liver is also known as hepatic steatosis. It happens when fat builds up in the liver. Having small amounts of fat in your liver is normal, but too much can become a health problem.

Your liver is the second largest organ in your body. It helps process nutrients from food and drinks and filters harmful substances from your blood.

Too much fat in your liver can cause liver inflammation, which can damage your liver and create scarring. In severe cases, this scarring can lead to liver failure.

When fatty liver develops in someone who drinks a lot of alcohol, it’s known as alcoholic fatty liver disease (AFLD).

In someone who doesn’t drink a lot of alcohol, it’s known as non-alcoholic fatty liver disease (NAFLD). According to researchers in the World Journal of Gastroenterology, NAFLD affects up to 25 to 30 percent of people in the United States and Europe.

Fatty liver disease is becoming increasingly common in many parts of the world, affecting about 25% of people globally .

It is linked to obesity, type 2 diabetes and other disorders characterized by insulin resistance.

What’s more, if fatty liver isn’t addressed, it may progress to more serious liver disease and other health problems.

Unfortunately, it is difficult to predict whether fatty liver will progress to NASH, which greatly increases the risk of cirrhosis (severe scarring that impairs liver function) and liver cancer

NAFLD is also linked to an increased risk of other diseases, including heart disease, diabetes and kidney disease.

symptom-

There are several signs and symptoms of fatty liver, although not all of these may be present.

In fact, you may not even realize you have fatty liver.

• Fatigue and weakness
• Slight pain or fullness in the right or center abdominal area
• Elevated levels of liver enzymes, including AST and ALT
• Elevated insulin levels
• Elevated triglyceride levels

If fatty liver progresses to NASH, the following symptoms may develop:

• Loss of appetite
• Nausea and vomiting

• Moderate to severe abdominal pain
• Yellowing of eyes and skin

It’s important to see your doctor regularly for standard exams and blood tests that can diagnose fatty liver at the early, reversible stage.

In many cases, fatty liver causes no noticeable symptoms. But you may feel tired or experience discomfort or pain in the upper right side of your abdomen.

Some people with fatty liver disease develop complications, including liver scarring. Liver scarring is known as liver fibrosis. If you develop severe liver fibrosis, it’s known as cirrhosis.

Cirrhosis may cause symptoms such as:

• loss of appetite
• weight loss
• weakness
• fatigue
• nosebleeds

causes

there are many factor contribute to developing fatty liver:

• Obesity: Obesity involves low-grade inflammation that may promote liver fat storage. It’s estimated that 30–90% of obese adults have NAFLD, and it’s increasing in children due to the childhood obesity epidemic .
• Excess belly fat: Normal-weight people may develop fatty liver if they are “viscerally obese,” meaning they carry too much fat around the waist.
• Insulin resistance: Insulin resistance and high insulin levels have been shown to increase liver fat storage in people with type 2 diabetes and metabolic syndrome.
• high intake of refined carbs: Frequent intake of refined carbs promotes liver fat storage, especially when high amounts are consumed by overweight or insulin-resistant individuals.
• Sugary beverage consumption: Sugar-sweetened beverages like soda and energy drinks are high in fructose, which has been shown to drive liver fat accumulation in children and adults .
• Impaired gut health: Recent research suggests that having an imbalance in gut bacteria, problems with gut barrier function (“leaky gut”) or other gut health issues may contribute to NAFLD development.

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Less common causes include:

• pregnancy
• rapid weight loss
• some types of infections, such as hepatitis C
• side effects from some types of medications, such as methotrexate (Trexall), tamoxifen (Nolvadex), amiodorone (Pacerone), and valproic acid (Depakote)
• exposure to certain toxins

Certain genes may also raise your risk of developing fatty liver.

Diagnosing of fatty liver

To diagnose fatty liver, your doctor will take your medical history, conduct a physical exam, and order one or more tests.

Medical history

If your doctor suspects that you might have fatty liver, they will likely ask you questions about:

• your family medical history, including any history of liver disease
• your alcohol consumption and other lifestyle habits
• any medical conditions that you might have
• any medications that you might take
• recent changes in your health

If you’ve been experiencing fatigue, loss of appetite, or other unexplained symptoms, let your doctor know.

Physical exam

To check for liver inflammation, your doctor may palpate or press on your abdomen. If your liver is enlarged, they might be able to feel it.

However, it’s possible for your liver to be inflamed without being enlarged. Your doctor might not be able to tell if your liver is inflamed by touch.

Blood tests-

In many cases, fatty liver disease is diagnosed after blood tests show elevated liver enzymes. For example, your doctor may order the alanine aminotransferase test (ALT) and aspartate aminotransferase test (AST) to check your liver enzymes.

These tests might be recommended if you’ve developed signs or symptoms of liver disease, or they might be ordered as part of routine blood work.

Elevated liver enzymes are a sign of liver inflammation. Fatty liver disease is one potential cause of liver inflammation, but it’s not the only one.

If you test positive for elevated liver enzymes, your doctor will likely order additional tests to identify the cause of the inflammation.

If you test positive for elevated liver enzymes, your doctor will likely order additional tests to identify the cause of the inflammation.

Imaging studies

Your doctor may use one or more of the following imaging tests to check for excess fat or other problems with your liver:

• ultrasound exam
• CT scan
• MRI scan

They might also order a test known as vibration-controlled transient elastography (VCTE, FibroScan). This test uses low-frequency sound waves to measure liver stiffness. It can help check for scarring.

Liver biopsy

A liver biopsy is considered the best way to determine the severity of liver disease.

During a liver biopsy, a doctor will insert a needle into your liver and remove a piece of tissue for examination. They will give you a local anesthetic to lessen the pain.

This test can help determine if you have fatty liver disease, as well as liver scarring.

Treatment for fatty liver

Currently, no medications have been approved to treat fatty liver disease. More research is needed to develop and test medications to treat this condition.

In many cases, lifestyle changes can help reverse fatty liver disease. For example, your doctor might advise you to:

• limit or avoid alcohol
• take steps to lose weight
• make changes to your diet

If you’ve developed complications, your doctor might recommend additional treatments. To treat cirrhosis, for example, they might prescribe:

• lifestyle changes
• medications
• surgery

Cirrhosis can lead to liver failure. If you develop liver failure, you might need a liver transplant.

Home remedies

Lifestyle changes are the first-line treatment for fatty liver disease. Depending on your current condition and lifestyle habits, it might help to:

• lose weight
• reduce your alcohol intake
• eat a nutrient-rich diet that’s low in excess calories, saturated fat, and trans fats
• get at least 30 minutes of exercise most days of the week

According to the Mayo Clinic, some evidence suggests that vitamin E supplements might help prevent or treat liver damage caused by fatty liver disease. However, more research is needed. There are some health risks associated with consuming too much vitamin E.

Always talk to your doctor before you try a new supplement or natural remedy. Some supplements or natural remedies might put stress on your liver or interact with medications you’re taking.

What are some lifestyle changes that can help with fatty liver disease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

• Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
• Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
• Get regular exercise, which can help you lose weight and reduce fat in the liver
• Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

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hyperthyroidism is a condition of the thyroid. The thyroid is a small, butterfly-shaped gland located at the front of your neck. It produces tetraiodothyronine (T4) and triiodothyronine (T3), which are two primary hormones that control how your cells use energy. Your thyroid gland regulates your metabolism through the release of these hormones.

Hyperthyroidism occurs when the thyroid makes too much T4, T3, or both. Diagnosis of overactive thyroid and treatment of the underlying cause can relieve symptoms and prevent complications.

causes-

A variety of conditions can cause hyperthyroidism. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Graves’ disease occurs more often in women than in men. It tends to run in families, which suggests a genetic link. You should tell your doctor if your relatives have had the condition.

Other causes of hyperthyroidism include:

• excess iodine, a key ingredient in T4 and T3
• thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland
• tumors of the ovaries or testes
• benign tumors of the thyroid or pituitary gland
• large amounts of tetraiodothyronine taken through dietary supplements or medication

symptoms-

High amounts of T4, T3, or both can cause an excessively high metabolic rate. This is called a hypermetabolic state. When in a hypermetabolic state, you may experience a rapid heart rate, elevated blood pressure, and hand tremors. You may also sweat a lot and develop a low tolerance for heat. Hyperthyroidism can cause more frequent bowel movements, weight loss, and, in women, irregular menstrual cycles.

Visibly, the thyroid gland itself can swell into a goiter, which can be either symmetrical or one-sided. Your eyes may also appear quite prominent, which is a sign of exophthalmos, a condition that’s related to Graves’ disease.

Other symptoms of hyperthyroidism include:

• increased appetite
• nervousness
• restlessness
• inability to concentrate
• weakness
• irregular heartbeat
• difficulty sleeping
• fine, brittle hair
• itching
• hair loss
• nausea and vomiting
• breast development in men

The following symptoms require immediate medical attention:

• dizziness
• shortness of breath
• loss of consciousness
• fast, irregular heart rate

Hyperthyroidism can also cause atrial fibrillation, a dangerous arrhythmia that can lead to strokes, as well as congestive heart failure.

How do doctors diagnose hyperthyroidism?

Your doctor will take a medical history and do a physical exam, but also will need to do some tests to confirm a diagnosis of hyperthyroidism. Many symptoms of hyperthyroidism are the same as those of other diseases, so doctors usually can’t diagnose hyperthyroidism based on symptoms alone.

Because hypothyroidism can cause fertility problems, women who have trouble getting pregnant often get tested for thyroid problems.

Your doctor may use several blood tests to confirm a diagnosis of hyperthyroidism and find its cause. Imaging tests, such as a thyroid scan, can also help diagnose and find the cause of hyperthyroidism.

Your first step in diagnosis is to get a complete medical history and physical exam. This can reveal these common signs of hyperthyroidism:

• weight loss
• rapid pulse
• elevated blood pressure
• protruding eyes
• enlarged thyroid gland

Other tests may be performed to further evaluate your diagnosis. These include:

Cholesterol test

Your doctor may need to check your cholesterol levels. Low cholesterol can be a sign of an elevated metabolic rate, in which your body is burning through cholesterol quickly.

T4, free T4, T3

These tests measure how much thyroid hormone (T4 and T3) is in your blood.

Thyroid stimulating hormone level test

Thyroid stimulating hormone (TSH) is a pituitary gland hormone that stimulates the thyroid gland to produce hormones. When thyroid hormone levels are normal or high, your TSH should be lower. An abnormally low TSH can be the first sign of hyperthyroidism.

Triglyceride test

Your triglyceride level may also be tested. Similar to low cholesterol, low triglycerides can be a sign of an elevated metabolic rate.

Thyroid scan and uptake

This allows your doctor to see if your thyroid is overactive. In particular, it can reveal whether the entire thyroid or just a single area of the gland is causing the overactivity.

Ultrasound

Ultrasounds can measure the size of the entire thyroid gland, as well as any masses within it. Doctors can also use ultrasounds to determine if a mass is solid or cystic.

CT or MRI scans

A CT or MRI can show if a pituitary tumor is present that’s causing the condition.

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What are my hyperthyroidism treatment options?

You may receive medicines, radioiodine therapy, or thyroid surgery to treat your hyperthyroidism. The aim of treatment is to bring thyroid hormone levels back to normal to prevent long-term health problems and to relieve uncomfortable symptoms. No single treatment works for everyone.

Treatment depends on the cause of your hyperthyroidism and how severe it is. When recommending a treatment, your doctor will consider your age, possible allergies to or side effects of the medicines, other conditions such as pregnancy or heart disease, and whether you have access to an experienced thyroid surgeon.

Medicines

Beta blockers. Beta blockers do not stop thyroid hormone production, but can reduce symptoms until other treatments take effect. Beta blockers act quickly to relieve many of the symptoms of hyperthyroidism, such as tremors, rapid heartbeat, and nervousness. Most people feel better within hours of taking beta blockers.

Antithyroid medicines. Antithyroid therapy is the simplest way to treat hyperthyroidism. Antithyroid medicines cause the thyroid to make less thyroid hormone. These medicines usually don’t provide a permanent cure. Health care providers most often use the antithyroid medicine methimazole. Health care providers more often treat pregnant women with propylthiouracil during the first 3 months of pregnancy, however, because methimazole can harm the fetus, although this happens rarely.

Once treatment with antithyroid medicine begins, your thyroid hormone levels may not move into the normal range for several weeks or months. The total average treatment time is about 1 to 2 years, but treatment can continue for many years. Antithyroid medicines are not used to treat hyperthyroidism caused by thyroiditis.

Antithyroid medicines can cause side effects in some people, including

• allergic reactions such as rashes and itching
• a decrease in the number of white blood cells in your body, which can lower resistance to infection
• liver failure, in rare cases

Call your doctor right away if you have any of the following symptoms:

• fatigue
• weakness
• dull pain in your abdomen
• loss of appetite
• skin rash or itching
• easy bruising
• yellowing of your skin or whites of your eyes, called jaundice
• constant sore throat
• fever

Doctors usually treat pregnant and breastfeeding women with antithyroid medicine, since this treatment may be safer for the baby than other treatments.

Radioiodine therapy

Radioactive iodine is a common and effective treatment for hyperthyroidism. In radioiodine therapy, you take radioactive iodine-131 by mouth as a capsule or liquid. The radioactive iodine slowly destroys the cells of the thyroid gland that produce thyroid hormone. Radioactive iodine does not affect other body tissues.

You may need more than one radioiodine treatment to bring your thyroid hormone levels into the normal range. In the meantime, treatment with beta blockers can control your symptoms.

Almost everyone who has radioactive iodine treatment later develops hypothyroidism because the thyroid hormone-producing cells have been destroyed. However, hypothyroidism is easier to treat and causes fewer long-term health problems than hyperthyroidism. People with hypothyroidism can completely control the condition with daily thyroid hormone medicine.

Doctors don’t use radioiodine therapy in pregnant women or in women who are breastfeeding. Radioactive iodine can harm the fetus’ thyroid and can be passed from mother to child in breast milk.

Thyroid surgery

The least-used treatment for hyperthyroidism is surgery to remove part or most of the thyroid gland. Sometimes doctors use surgery to treat people with large goiters or pregnant women who cannot take antithyroid medicines.

Before surgery, your doctor may prescribe antithyroid medicines to bring your thyroid hormone levels into the normal range. This treatment prevents a condition called thyroid storm—a sudden, severe worsening of symptoms—that can occur when people with hyperthyroidism have general anesthesia.

When part of your thyroid is removed, your thyroid hormone levels may return to normal. You may still develop hypothyroidism after surgery and need to take thyroid hormone medicine. If your whole thyroid is removed, you will need to take thyroid hormone medicine for life. After surgery, your doctor will continue to check your thyroid hormone levels.

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Physical Therapy Management

Preferred Practice Patterns:

• Impaired muscle performance
• Impaired joint mobility, motor function, muscle performance, and ROM associated with connective tissue dysfunction
• Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation
• Impaired aerobic capacity/endurance associated with deconditioning 

When Is a Medical Referral Required?

• Anytime a therapist discovers unusual swelling or enlargement (with or without pain), tenderness, hoarseness, or dysphagia they should refer out.
• If your patient experiences fever, rash, arthralgia, or other side effects of antithyroid drugs, notify their physician because it may be possible to use another form of treatment.

What Should I Monitor During Treatment Session?

• Vital Signs: This is especially important if the patient is an older adult, has CAD or previous hx of heart disease, or presents with signs of dyspnea, fatigue, tachycardia, and/or arrhythmia.
• Watch for signs of hypoparathyroidism such as muscular twitching, tetany, numbness, and tingling around mouth, fingertips, or toes if patient is post thyroidectomy. Hypoparathryoidism may result 1-7 days after thyroidectomy if there are complications during the surgery resulting in unintentional removal of part of the parathyroid glands.

Safety Precautions for Therapist

• When working with patients who have been given RAI, be aware their saliva is radioactive for 24 hours following their treatment. When working with these patients it is important to take the necessary precautions if the patient is coughing or expectorating.

Hyperthyroidism and Exercise

• Some patients with Graves’ disease suffer from heat intolerance, making exercising in a hot pool a contraindication to therapy. This patient would still be able to participate in aquatic therapy in a warm pool; given the patient’s body temperature is being monitored. Typically heat intolerance is associated with thyroid storm, and will normally not occur in clients attending therapy in outpatient settings.
• Hyperthyroidism is associated with exercise intolerance and reduced exercise capacity.
• Many patients with hyperthyroidism suffer from cardiopulmonary complications often leading to atrial fibriliation, CHF, and increased risk of a MI.
• 70% of people with hyperthyroidism develop proximal muscle weakness as a result of treatment, most often affecting the pelvis and thigh muscles
• Chronic periarthritis and calcific tendinitis are also associated with hyperthyroidism. They both tend to occur in the shoulder, causing limitations in a person’s ROM, which may progress and lead to adhesive capsulitis. Therapeutic interventions using ultrasound, joint mobilizations, stretching, and strengthening may be performed once the thyroid gland is regulated. Research suggest a 6 week treatment period using pulsed US for 15 minutes at 2.5 W/cm2 at a frequency of .89 MHz is associated with short term improvement in pain levels and quality of life in adults with calcific tendonitis.
• Graves’ disease is associated with a low bone mineral density (BMD) and has also been shown to be a risk factor for hip fractures

Differential Diagnosis

• Hyperparathyroidism
• Myasthenia gravis
• Psychological disorders (anxiety, panic attacks, or mood disorders)
• Thyroid Cancer
• Atrial Fibrilation
• Congestive Heart Failure.

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