Human Immunodeficiency Virus

HIV is the first in fact human retrovirus so that’s a particular class of viruses that are known to exist in other species and HIV is the first example of one of those species, one of those viruses in humans. HIV was first identified in the early 80s when there was a series of cases of gay men turning up in hospitals in emergency rooms with a new illness that appeared to be related somehow to immunodeficiency. Their immune systems were failing and it really wasn’t clear why that was and it took some time to work out that this was a new viral infection that hadn’t been seen in humans before. It was first described in the early 80s in San Francisco and then it was realised that it was more widespread than that. The people who identified it worked in the Institute Pasteur. So Françoise Barré-Sinoussi and Luc Montagnier had a lab working on other retroviruses and they discovered that, they looked down a microscope essentially, an electron microscope, and they could see that there was a retrovirus in the cells from the patients who had this disease.

They won a Nobel Prize for that work, a lot of other people contributed in the US, for example, Robert Gallo. And that was and for that retrovirus, a test was developed and we could test who had the virus, it turned out that quite a large number of people had the virus and at that early point there was no treatment. So it turned out that it is spread through sexual transmission, it’s a sexually transmitted disease, it can also be spread through blood products and in the early days before screening people who were taking blood products as a medicine, for example, people with hemophilia, were infected with the virus. You could be infected through blood contact, for example. So intravenous drug users also are very susceptible to catching it because there a tendency to share needles, and so if one person was infected that would infect everybody who shared the needle. So in those early days, it was very frightening because it was a new virus and people were dying and nobody knew what to do about it. But luckily we knew quite a lot about retroviruses because retroviruses have been described in other species particularly mice, so it was reasonably quickly for the development of a new type of medicine to come up with ways to treat HIV and that treatment advanced to nowadays.

In 2016 you can really treat the virus with a cocktail of antiviral drugs that will stop it infecting new cells in your body theoretically. And that means that the virus becomes undetectable in the vast majority of cases and we think that you can probably live a normal lifespan if you take your antiretrovirals. That’s fine if you can afford the antiretrovirals so in West that is great, in a resource-poor setting like sub-Saharan Africa that’s more problematic where there is money available to buy antiretrovirals which can be quite expensive. But they are available and there are large programs to roll out antiretroviral treatment with a goal of making sure that everybody who has the disease has access to antiretrovirals.

HIV is the human retrovirus, it stands for Human Immunodeficiency Virus, there are several versions of it and the most common of it is called HIV-1. So AIDS is acquired immunodeficiency syndrome and that is a disease that’s caused by being infected with HIV. And as far as we can tell, we believe that pretty much everybody who becomes infected with the virus will eventually get a disease so it’s extremely rare for somebody to never get a disease and it’s very difficult to say whether somebody would never get it – they might die for some other reason, but the vast majority of people suffer from disease but until about 8 to 10 years after they’ve become infected. So there is a long period where they don’t really suffer significant symptoms, although there are symptoms.

When you first become infected with HIV, you get infection syndrome very similar to other viral infections, for example, influenza. So the virus replicates in your body to very high titers, very large amounts of virus in your body, and it makes you feel quite ill. You might have a rash and a temperature and you might spend a few days in bed and you feel like you’ve had some kind of viral infection. And then it goes away, and your immune system suppresses viral replication. And it can suppress it to very low levels so that you can’t actually detect the virus in your body after that first couple of weeks of infection.

So what happens after that it’s not entirely clear but what’s certainly true is that your immune system is fighting an ongoing battle with the virus and you don’t feel particular symptoms during that period so there is sense that you’ve got better, you’ve recovered from the virus but that isn’t the case in the case of HIV. It’s is still in you body replicating. And that means that eventually for reasons that we don’t fully understand your immune systems runs out of energy or runs out of steam and it starts to fail and the virus gets the upper hand and destroys your immune system and this long battle between the virus and immune system leads to a complete failure of your immune system and that’s why you get the disease and the disease of HIV is largely the disease of opportunistic infection.

So the illnesses that you would not normally suffer, for example, fungal infections, we’re constantly exposed to fungi that would like tike eat us up but they don’t because our immune system protects us from it. But without an immune system, those fungal infections start to cause very bad infections in your mouth and in your lungs and your airways. And when AIDS was first described those kinds of diseases haven’t been seen in humans before because we’re very good at fighting them using our immune system, so it was very difficult to treat them. Nowadays much more treatments have been developed for those diseases. But there is a long period between 8-10 years median when your body is fighting the virus and keeping it in check.

If you get infected with HIV the modern thinking is that you should be treated with drugs as soon as possible. In the past, we thought seeing as you’re not suffering over symptoms there is no need to take the drugs until you start to suffer the symptoms and we can measure the amount of CD4 cells, the target of the virus, and we can monitor how your immune system is doing. In the past, we kind of only started treating people when they reach a certain point where their immune system is breaking down. Nowadays we’re thinking that treating early is probably better because it protects your immune system from the damage that it’s going to take even though you don’t suffer particularly severe symptoms. So the goal of therapy that you take now is to simply stop the virus replicating. But that doesn’t constitute a cure unfortunately and we really don’t understand why that is. So if you take the drugs you can suppress the virus replication until can’t see it: it could be completely undetectable in your body. And yet if you stop taking the medicine within a short period of time, a few months perhaps sometimes years the virus will come back. So we know the drugs don’t get rid of it and we know that your immune system can’t get rid of it but we don’t really understand why.

There is really two possibilities for that, I think and it’s currently a lot of research trying to work out which of these two possibilities is true, possibly both. Possibility number one is that the virus is in your body somewhere in the organs perhaps in the gut in the lymphoid tissue and it’s replicating there just at low levels. Another possibility is that it really does stop replicating and the drugs get rid of all of the cells that are making virus and the only cells that are left in your body are cells that got the virus in them but that aren’t actively making virus and so can’t get rid of those guys until they start making virus. So if you stop taking the medicine sooner or later those cells will start making a virus and the whole process will start again. So we don’t really understand whether we need to make the drugs better to kill the virus, the last little bit of virus or whether we need a new strategy to wake up the cells that are quiet and not making the virus, so we can kill them as well. And that essentially constitutes the cure research agenda that is currently trying to work out the best way to actually cure people.

There are two broad areas of HIV research. So particularly in the US, I think now there is a very strong effort to focus everybody’s research onto the cure. There is a sense that we shouldn’t be fooling around, we should just focus on curing the patients that are infected and that is really the only way to eradicate the disease. There is also, of course, a big effort to make a vaccine, but we just don’t understand how to make a vaccine and we just don’t understand enough about vaccines as to understand why can’t we make an HIV vaccine. The things that have been tried are the classical ways to make a vaccine and they simply don’t work for HIV.

There are lots of possible reasons for that but we don’t really understand why. And I don’t think that anyone really believes that there is going to be a vaccine anytime soon, hence I think the shift towards the notion of perhaps we can start to think of new ways to cure people, perhaps with new therapeutic strategies. So that’s one big area focused on research.

The second broad area of HIV research, I think, is using HIV as a tool. HIV is a fairly small virus, it only has nine genes, so it makes nine proteins. Some of those proteins are quite complex and they’re broken up into other proteins, but it’s a simple virus. A Herpes virus, for example, would have more than 200 genes, whereas HIV only has nine. So that makes it a very tractable genetic tool.

We can use the virus to study cell biology and that’s been a very powerful way to understand what’s going on inside the cells of our body, how do they work, how do they divide, how does the stuff move around, how are they organised and HIV is a fantastic tool for doing that. For example, we’ve learned a great deal about RNA export from the nucleus, how is the RNA export from the nucleus regulated, how is splicing regulated. HIV has to manipulate these processes and studying how it does that told us a great deal about that. We’ve understood a great deal about transcriptional control, the virus carries its own transcriptional activator, a protein called Tat and how that works is quite different from other transcriptional activators and studying it told us a great deal about how transcription works. So it’s a fantastic tool to use for various scientific questions, so we in my own laboratory use HIV really as a tool to study the innate immunity.

A question that we’re asked is: Does studying HIV and how it works help you cure it as a disease or cure other diseases? And the answer is yes, I think. So it’s very important to understand that when HIV first showed up in the early 80s, the only way that we could develop treatments was because we understood retrovirus biology from understanding mouse retroviruses. All of the treatments for HIV are based on a sound of understanding of how it works. And as we increase our understanding, I think that helps us to develop more treatments. It’s a question as to whether we need more treatments, the treatments we have at the clinic at the moment are pretty effective. Drug resistance is something of a problem. If you treat a person with a single drug then the virus can mutate and change and not be sensitive to that drug anymore. But that’s much less of a problem if you treat with several drugs. So typically people treat with three drugs. Nonetheless, drug resistance is arising. It is becoming more prevalent and it is possible that will end up in a situation similar to antimicrobial resistance, that the drugs we have in the clinic are less effective against viruses like HIV. And so in this case, knowing how HIV works, knowing how to develop new drugs is a good thing. It’s also possible that by understanding really well how HIV works, we might understand weak spots that are general to viruses, so some people are suggesting that it might be possible to develop more broad specificity antivirals.

Studying viral infections in general is very important because there is a possibility that as we understand more about how viruses replicate and particularly about how cells typically protect themselves from infection and how viruses get over those protective strategies, we can start to understand that there are certain things that many different viruses have to do in order to infect human cells. And if we start to drug those processes, there is every chance that you can start to develop antivirals with much broader specificity. So you might be able to develop drugs that hit multiple viruses with a single drug. I think that is something that’s only really now becoming a realistic prospect, but it’s something that we feel very enthusiastic about.

Reference : Greg Towers
Professor of Molecular Virology, University College London; Head of Research Group, UCL Division of Infection and Immunity

Abdominal Pain

Many times a person will suffer from stomach and back pain at the same time. There are many conditions that may cause these feelings. Some of these problems may be serious and life threatening. Most of the causes are not serious and can be readily diagnosed and treated. Abdominal pain comes from organs within the abdomen or organs adjacent to the abdomen. Abdominal pain can occur in any age group or population. 

Causes :

The diagnosis of the cause of abdominal pain is challenging because the characteristics of the pain may be atypical, tests are not always abnormal, diseases causing pain may mimic each other, and the characteristics of the pain may change over time.

Occasionally, pain may be felt in the abdomen even though it is arising from organs that are close to, but not within, the abdominal cavity. For example, conditions of the lower lungs, the kidneys, and the uterus or ovaries can cause abdominal pain. On the other hand, it also is possible for pain from organs within the abdomen to be felt outside of the abdomen. For example, the pain of pancreatic inflammation may be felt in the back. These latter types of pain are called "referred" pain because the pain does not originate in the location that it is felt. Rather, the cause of the pain is located away from where it is felt (i.e., it is referred to a different area).

Some most common are :

1. Indigestion

2. Constipation

3. Gas

4. Gallstones

5. Appendicitis

6. Kidney stones

7. Stomach virus

8. Menstrual cramps

9. Food poisoning

10. Food allergies

11. Lactose intolerance

12. Ulcers

13. Pelvic inflammatory disease

14. Hernia

15. Endometriosis

16. Crohn's disease

17. Urinary tract infection

18. Gastroesophageal reflux disease (GERD)

Treatment :

Treatment plans for abdominal pain are individualized depending on the underlying cause, the presence of coexisting diseases, the age and medical history of the patient, and other factors. Treatment generally involves a multifaceted plan that addresses.

Rest - First is rest. Lie down and rest until you feel better. A warm washcloth or heating pad on the stomach for 20 minutes may help speed recovery.

Diet - Peppermint or ginger teas can help ease nausea or stomach ache. Increase your daily intake of fiber to promote a healthy gastrointestinal system. Also be sure to drink enough fluids.

Relaxation - Use relaxation exercises for mild pains. Lie down in a quiet place; take deep, slow breaths; and think about something pleasant. Listen to audiotapes that teach relaxation to learn relaxed breathing, progressive muscle relaxation and autogenic relaxation techniques.

Meniere

                     

Meniere's disease occurs in the inner ear and causes dizziness, temporary hearing loss, and/or ringing and pressure in the ears. Attacks happen suddenly and can be as brief as 20 minutes or as long as several hours. Symptoms include a continuous, low-pitched noise or feeling of pressure in the ear.

In 1861 Prosper Menière, a French medical practitioner, identified the syndrome affecting people who suffered extreme dizziness, ringing in the ears and temporary total loss of balance accompanied by nausea or a combination of all symptoms.  The disease that bears his name is thought to be a condition in which there is an excess of endolymph, an inner ear fluid creating a condition called ‘hydrops’.
Anybody can get Meniere's, male or female, young children to old age pensioners.

Tinnitus
An abnormal ringing noise inside the ear. Distorted hearing and pressure in the ear often occurs in conjunction with the vertigo.

Vertigo
A form of dizziness where your surroundings appear to spin due to involuntary eye movements. In Meniere’s Disease, the ‘attacks’ usually occur in clusters and can occur without warning, often accompanied by vomiting.

Hearing Loss
Fluctuating hearing loss with a feeling of pressure or fullness in the ear is thought to be due to inner ear fl uid build up. Hearing returns to normal levels following a vertigo attack, but as the disease progresses, measurable and permanent hearing loss occurs as delicate hair cells are destroyed. Hearing aids are then required.

Balance Problems
The last stage is often referred to as ‘burnt out’. Hearing loss may be severe. Tinnitus is less of a problem, attacks of vertigo are less frequent and eventually cease. Vomiting, nausea and dizziness are mild. When the ear has lost 50% of its balance function, a persistent feeling of of unsteadiness or floating may replace attacks of vertigo. Imbalance is more noticeable in the dark. Some people may experience ‘drop attacks’ (Tumarkin’s Crises) when without warning, balance is suddenly lost and they drop to the ground.

Causes

Meniere’s Disease is associated with an abnormality of a part of the inner ear called the labyrinth. This includes the cochlea (which converts vibrations caused by sound waves into signals to the brain) and the semicircular canals (which control balance and a sense of bodily motion). Meniere’s disease may result when the balance of fluids contained in the labyrinth is interrupted by a blockage or rupture; researchers are still unsure of this condition’s exact causes.
•    A feeling of pressure or “fullness” in the affected ear
•    Hearing loss (which is usually temporary but can become permanent over time)
•    Vertigo (a sense of dizziness and imbalance)
•    Tinnitus (a ringing, buzzing, or other sound with no external cause)
•    These symptoms usually last for two to four hours at a time, although this can vary.
•    In the hydropic ear, excess fluid, in some way, disturbs the tiny balance and hearing mechanisms and produces the symptoms. The extra pressure in the delicate balance and hearing canals distorts or blocks sound and balance information to the hearing and balance nerve and to the brain. This may be the cause of roaring or tinnitus, hearing loss and incorrect balance information, rather like an ‘error message’ to the brain. Sufferers can often experience vertigo, 'brain fog' and visual disturbances.

Treatment

The treatment for Meniere’s disease differs from patient to patient. At CEI, Otologists strive to diagnose the cause of the disorder and then to treat the symptoms of the disorder. This includes first the symptoms of vertigo or balance disorder followed by hearing loss and tinnitus.

In many patients, dietary modifications in the form of low salt diets plus diuretic therapy to lower inner ear fluid pressure can reduce symptoms. In others, second line therapy in the form of the Menniette Device, Intratympanic Gentamycin, or Endolymphatic Shunt Surgery are needed to control symptoms. If other methods fail, surgery to eliminate the ability of the balance nerve to send signals to the brain is needed. Hearing loss associated with Meniere’s Disease can be ameliorated through the use of hearing aids, BAHA implantation, or in the case of individuals with bilateral Meniere’s Disease, cochlear implants.

The progression of Meniere’s disease is unpredictable. Symptoms may become more severe, remain the same, or disappear completely. Overall, over 95% of patients with Meniere’s disease will achieve vertigo control when treated by a CEI Otologist. Treatment is very individualized and begins with a thorough work up and evaluation followed by a treatment plan.

Coronary Artery Disease

The heart is a muscular organ that pumps blood to the body at an average of 72 times per minute. Oxygen and nutrients serve as a fuel supply to the pump and are carried to heart in the form of blood that flows through the coronary arteries. Thus, the coronary arteries serve as fuel pipe lines to the heart muscle.

Coronary Heart Disease (CHD), Coronary Artery Disease (CAD) is the most common form of heart disease.

The coronary arteries (Strong, elastic blood vessels that carry blood away from the heart to the rest of the body) are blood vessels that carry blood and oxygen to the heart muscle. They are located along the surface of the heart. When these arteries become clogged with fatty deposits called plaque (buildup of fatty deposits such as lipids, cholesterol, calcium and other materials on the inner walls of blood vessels). The buildup of plaque contributes to atherosclerosis, coronary artery disease, and stroke), it is called coronary artery disease (CAD). Plaque forms in the arteries over many years in a process called atherosclerosis. Clogged arteries can keep the heart from getting enough blood and oxygen and can cause chest pain (angina). If a blood clot forms, it can suddenly cut off blood flow in the artery and cause a heart attack.

Coronary artery disease may also be referred to as coronary heart disease (CHD), ischemic heart disease, or atherosclerotic heart disease.

Atherosclerosis is the main cause not only of coronary artery disease but of the whole group of diseases called cardiovascular diseases—diseases of the heart and blood vessels. Clogged arteries in the legs or arms lead to peripheral artery disease (PAD), and clogged arteries in the brain can result in stroke.

 Causes

The cause of CAD is a narrowing of the coronary arteries that supply oxygen and nutrients to the heart muscle. Most of the time, narrowing of coronary arteries is the result of atherosclerosis, which is the thickening and hardening of the inside walls of arteries. Some hardening of the arteries occurs normally as you grow older.

Symptom

·        tightness or a squeezing sensation across the chest

·        burning or pressure beneath the breast bone

·        pain or ache radiating to the shoulders, jaw, arms, throat, neck, or upper abdomen

·        fatigue

·        nausea or vomiting

·        sweating

·        weakness

·        shortness of breath

·        lightheadedness

Men will often feel:

·        constant pain in the middle of the chest that may radiate to the neck, jaw, left shoulder, or arm

·        tightness or squeezing in the chest

·        a sensation of "heaviness" or heavy indigestion

·        sweating, nausea, and vomiting

·        shortness of breath

·        anxiety, fear, or denial

In women, the main symptoms can be similar to men but may also include:

·        shoulder, neck, or back pain

·        feeling a sharp pain on breathing in cold air

·        unusual fatigue or weakness

Risk Factors

here are many risk factors associated with coronary heart disease and stroke. The major risk factors, tobacco use, alcohol use, high blood pressure (hypertension), high cholesterol, obesity, physical inactivity, unhealthy diets, have a high prevalence across the world.

Modifiable risk factors:

Hypertension

Abnormal blood lipid levels

Tobacco

Physical inactivity

Type 2 diabetes

Saturated fat

Treatment

There are three approaches for treating Coronary Artery Disease:

1.     Medication

2.     Interventional Cardiology

3.     Cardiovascular Surgery

Meningitis

Meningitis is an inflammation of the membranes covering the brain and spinal cord, called the meninges. It is caused when germs infect the cerebrospinal fluid (CSF), which circulates around the brain and spinal cord. The infection can be caused by three kinds of germs; bacteria, viruses and fungi.

Viral meningitis is the most common and less severe type.  Almost all patients recover without any permanent damage, although full recovery may take many weeks or months. Bacteria however, cause severe infections which can lead to permanent damage or death. Fungi also cause severe infections but are much less frequent than bacterial meningitis.

Causes

Septicaemia is caused when bacteria enter and then multiply rapidly in the bloodstream, this manifestation of the infection may be seen alone or in addition to meningitis.

·        Viral meningitis is usually a mild disease, but it can make people very unwell. Many thousands of cases occur each year, mostly affecting babies and children. Although most people will make a full recovery, some are left with serious and debilitating after-effects.

·        Bacterial meningitis can be life-threatening and needs urgent medical attention. Most people who suffer from bacterial meningitis recover, but many can be left with a variety of after-effects and one in 10 will die.

·        The main bacteria that cause meningitis in the UK are Meningococcal, Pneumococcal, TB and Hib
Neonatal meningitis occurs in babies under one month old. Other causes of meningitis are all serious and need medical attention.

·        Eschericia coli (E. Coli), seen mainly in newborn babies;

·        Streptococcus agalactiae B, (Group B Strep or GBS) seen mainly in newborn babies;

·        Listeria monocytogenes, seen mainly in newborn babies or persons with impaired immunity;

·        Mycobacteria tuberculosis (Tuberculosis or TB), seen in countries where tuberculosis is prevalent

·        The meningococcus can be subdivided into distinct groups called serogroups, of which serogroups A, B, C, Y and W135 are responsible for over 95% of cases meningitis and septicaemia. Although 6 distinct groups, called types, of Haemophilus influenzae have been identified, type b causes almost all human illness. There are almost 90 distinct groups , called serotypes, of the pneumococcus. In children less than five years of age, up to 13 of these serotypes cause most serious illnesses. In older children and adults a much larger number of pneumococcal serotypes cause disease – 23 cause around 85% of serious illnesses.

·        Meningitis germs share the same method of transmission from person to person. The first step occurs when the bacteria land on the mucosa of the back of the nose and throat. The bacteria colonise the surface of the mucosa, usually without causing any symptoms. This is called the carrier state, because the bacteria may persist in the nose and throat for weeks or months. The meningitis bacteria do not survive very long outside of the body. Infection spreads from person to person by direct contact with secretions from the nose and throat which contain the bacteria. Spread from a carrier to another person requires close, direct physical contact, combined with activities such as kissing, coughing, and sneezing which result in production of large numbers of droplets which can be contaminated with bacteria.

Treatment

Bacterial meningitis requires immediate treatment with antibiotic medications. Viral meningitis is self-limiting and usually improves on its own as the illness runs its course.

Antiviral medications may be prescribed for meningitis caused by viruses. Antibiotics are prescribed for bacterial infections. Anticonvulsants may be used to prevent or treat seizures. Corticosteroids are used to reduce brain swelling and inflammation. Sedatives may be needed for irritability or restlessness. Individuals with bacterial meningitis are usually hospitalized and treated with antibiotics intravenously.

standard meningitis treatment involves delivering the antibiotics intravenously, through a vein, in the hospital. Oral antibiotics are less reliable for meningitis because their infection-fighting ability can be hampered by vomiting, poor absorption in the gastrointestinal tract, and other uncertainties.

Commonly used meningitis treatments include a class of antibiotics called cephalosporins, especially cefotaxime and ceftriaxone. Various penicillin-type antibiotics, aminoglycoside drugs such as gentamicin, and others, are also used.

Some forms of bacterial meningitis are particularly dangerous as well as very contagious, so family members and friends who’ve had contact with the patient may need to take prophylactic antibiotics to prevent getting the disease. Ciprofloxacin is most commonly used for preventive meningitis treatment.

Homeopathic Treatment for Meningitis

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions.

Heart Burn

Acid rising from the stomach and irritating the lower esophageal sphincter (LES), the valve that separates the esophagus from the stomach, results in the feeling of what is commonly called heartburn. Occasionally it may feel like food is coming back up, and may get an acid or bitter taste in the back of the mouth. Heartburn is often worse after eating, or when lying down, straining or bending over.

Heartburn is very common, up to 1 in 5 experience heartburn at least once a week.  More chronic and ongoing heartburn is something known as GERD, or gastroesophageal reflux disease. This more serious level of the burning and discomfort can lead to long term complications. One must realize that the heartburn is NOT about heart issues.

Sometimes this chest pain is confused with heart pain. If anyone is unsure about the cause of any pain in chest, be sure to have a thorough exam by a physician.

Causes

Almost everyone has heartburn sometimes. As mentioned above, there are several interrelating factors and cofactors that can contribute to the weakening of the LES or to extra acid secretion in the stomach. Those include:

1. Genetic tendency.

2. Lifestyle patterns: including smoking (that contributes to weakening of the LES) and stress evoked either by inadequate sleep, emotional pressure or work overload. Excessive stress can trigger digestive problems, weaken the immune systems and encourage Candida overgrowth, thus contributing to acid reflux disease.

3. Dietary patterns: the daily consumption of foods that trigger acid secretion (i. e. peppermint, tomatoes, citric fruits, chocolate etc.), foods that contribute to the weakening of the LES (fatty foods, spicy foods, chocolate) and hard to digest foods can exacerbate acid reflux.   

4. Hiatal Hernia: This is a physical condition where part of the stomach protrudes through the diaphragm. It can generally be reduced without surgery, though even when present it is not necessarily the sole cause of heartburn.

5. Low Acid Production: Ironically, low stomach acid levels can result in heartburn. This is much more common than increased acid. This problem can be assessed clinically and is readily treatable.

6. Pregnancy & Obesity: These are related in that both put pressure on the stomach, decreasing its volume and forcing food back from whence it came.

7. Smoking: Smoking also causes the lower esophageal sphincter to relax, leading to heartburn.

8. Many medications can bring on heartburn or make it worse.

Drugs that can cause heartburn include:

·        Anticholinergics (e.g., for sea sickness).

·        Beta-blockers for high blood pressure or heart disease.

·        Calcium channel blockers for high blood pressure.

·        Dopamine-like drugs for Parkinson's disease.

·        Progestin for abnormal menstrual bleeding or birth control.

·        Sedatives for anxiety, or if you can't sleep (insomnia).

·        Theophylline (for asthma or other lung diseases).

·        Tricyclic antidepressants.

 Treatment

Although heartburn symptoms vary from patient to patient, there are general treatment guidelines, based on frequency of heartburn, to direct individuals to the most appropriate and effective medication options.

Medications are common in acid reflux treatment. The simplest of medications for acid reflux treatment are the antacids, which can be bought over the counter. Antacids are usually the first drugs recommended for acid reflux treatment. The antacids neutralize stomach acid so the reflux contains no acid to burn the esophagus. The main drawback of antacids in acid reflux treatment is that they empty quickly from the stomach and then the acid returns. A foaming agent is another acid reflux treatment.

Histamine antagonists, known as H2 Blockers help to stop acid production. This acid reflux treatment prevents histamine from stimulating acid producing cells. The receptor they block is known as the histamine type two receptor. The H2 antagonists should be taken thirty minutes before meals to be an effective acid reflux treatment. The H2 blockers relieve the symptoms of acid reflux, but do not heal the inflammation of the esophagus that often accompanies acid reflux.

Another acid reflux treatment medication are the Proton Pump Inhibitors. It is more effective than the H2 Blockers. The Proton Pump Inhibitors both block the secretion of acid into the stomach, and protect the esophagus from acid so the inflammation heals.

 Self Care

•    Eat small regularly spaced meals rather than fewer heavy meals. Foods with high fat and protein contents (including dairy produce) stimulate acid production and delay gastric emptying.

•     Avoid irritant food triggers: e.g. highly spiced or chilli-containing foods, acidic fruit juices, caffeine containing drinks, tomatoes, and foods with high osmolarity such as chocolate.

•    Avoid exercise or tasks involving lifting or bending soon after eating.

•     Avoid eating close to bedtime.  A gap of at least 3 hours between the last meal of the day and retiring is recommended.

•    Raising the head of the bed on blocks can help to reduce positional reflux and heartburn at night.

Homeopathy for Heartburn

In treating heartburn, a skillful homeopath will assess the patient's emotional characteristics, constitutional attributes, and the precise nature of the symptoms in order to choose an effective remedy that will alleviate the severity and frequency of the problem. The homeopathic remedy also readuces the future recurrence of the symptoms and can support the patient to eliminate the use of medications.

Among the numerous possible homeopathic remedies that can help with heartburn are the following: Nux vomica, Arsenicum album, Carbo vegetabilis, Lycopodium, Bryonia, Natrum carbonicum, and Pulsatilla.

Sinusitis

Sinusitis (also called "Rhino sinusitis") is an inflammation of the sinus membranes that can be infectious (caused by a virus or bacteria) or non-infectious (often caused by allergies).

Sinus infection, or sinusitis, is an inflammation of one or more of sinuses and nasal passages. A sinus infection can cause a headache or pressure in the eyes, nose, cheek area, or on one side of the head. A person with a sinus infection may also have a cough, a fever, bad breath, and nasal congestion with thick nasal secretions. Sinusitis is categorized as acute (sudden onset) or chronic (long term, the most common type).

If sinusitis lasts anything from a few days up to a month it's called acute sinusitis. If  sinusitis is an ongoing problem lasting three months or more have chronic sinusitis. The medical terms acute and chronic refer to how long the condition lasts for, rather than how severe it is.

Acute sinusitis is common and can affect people of any age.

Sinusitis occurs most often in the maxillary sinus area. Symptoms include facial pain, which is sometimes aggravated when stooping. There may also be purulent nasal discharge or altered facial sensations. Headache can be associated with sinusitis. Complications are rare.

Sinusitis in the ethmoid sinus area may lead to complications of the eye such as edema or cellulites of the eyelid and orbital cellulitis. Sinusitis in the ethmoid sinuses may lead to meningitis.

Sphenoid sinusitis is somewhat rare; however, the relationship of the sphenoid sinus to other organs may lead to severe complications such as pituitary insufficiency; or meningitis.

 

Causes

Sinusitis can be caused by three things:

·        Viruses.

·        Bacteria.

·        Fungi.

The same viruses that cause the common cold cause most cases of sinusitis.

When the lining of the sinus cavities gets inflamed from a viral infection like a cold, it swells. This is viral sinusitis. The swelling can block the normal drainage of fluid from the sinuses into the nose and throat. If the fluid cannot drain and builds up over time, bacteria or fungi (plural of fungus) may start to grow in it. These bacterial or fungal infections can cause more swelling and pain. They are more likely to last longer, get worse with time, and become chronic.

Nasal allergies or other problems that block the nasal passages and allow fluid to build up in the sinuses can also lead to sinusitis.

There are several types of para nasal sinuses:

·        Maxillary sinuses: These are the largest and are located underneath the eyes.

·        Frontal sinuses: These are in the frontal bone above the eyes.

·        Ethmoid sinuses: These are located in the ethmoid bone between the nose and eyes.

·        Sphenoid sinuses: These are in the sphenoid bone near the front of the skull.

Treatment

The majority of episodes of sinusitis are successfully treated without the use of antibiotics by simply treating the thick mucus and nasal swelling. Even if bacterial infection is involved, sinusitis often goes away without antibiotics. Inappropriate use of antibiotics can lead to bacterial resistance and side effects; thus these medications must be used carefully and thoughtfully. Many people can control their sinusitis with nasal washing and steroid nasal spray.

more about nasal wash in the managing section. Decongestants, antihistamines, and steroids help many people. Some people with chronic sinusitis may benefit from surgery.

Antibiotics : In some cases of sinusitis, but certainly not all, the underlying cause will be a bacterial infection. Such an infection can be difficult to treat because the bacteria thrive in the warm, moist, dark sinus cavities. These infections usually respond to antibiotic treatment, but need to continue treatment for one to three weeks or longer.

Steroid nasal spray : A prescription steroid nasal spray can decrease nasal inflammation and mucus production. This will relieve symptoms of nasal congestion and improve sinus drainage. A steroid nasal spray does not provide immediate relief of symptoms and may require several weeks of routine use to be effective. If have chronic sinusitis, may benefit from continued daily use of this medication. If have occasional sinusitis episodes, may only require periodic use. The combination of nasal wash and nasal steroid sprays can be highly effective for many patients with nasal and sinus problems.

Decongestants : These medicines, available as tablet, syrup, or nasal spray, help unblock the openings of the sinuses and temporarily reduce symptoms of nasal congestion. Common over the counter decongestants include Pseudoephedrine. Topical nasal decongestants (sprays) can be highly effective in the immediate shrinking of swollen nasal tissue. However these sprays must be used for no more than three consecutive days because more prolonged use can cause rebound nasal congestion with increased symptoms.

Antihistamines : Antihistamines are medicines designed to counter the actions of histamine, the main chemical produced in the body in allergic reactions. Antihistamines in tablet or syrup form may help reduce the allergic symptoms of sneezing and itchy eyes and nose, and may reduce mucus production.

Common over-the-counter antihistamines include:

·        Loratadine

·        Chlorpheniramine

·        Diphenhydramine

·        Desloratadine

·        Fexofenadine

·        Cetirizine

     Topical antihistamine sprays :

·        Azelastine

·        Olopatadine.

     Systemic Steroids : Systemic corticosteroids are sometimes required to treat severe nasal and sinus inflammation. They may also shrink nasal polyps. Steroids are powerful medicines that are very good at reducing inflammation and mucus production in the airways. Corticosteroids are not the same as anabolic steroids, used illegally by some athletes for bodybuilding, and do not affect the liver or cause sterility. Corticosteroids are similar to cortisol, a hormone produced by the adrenal glands in the body.

Fess :The majority of patients with sinusitis do not require surgery. However, in some patients with chronic sinusitis, the symptoms continue despite prolonged medical treatment. Surgery should only be considered when medicines have failed to improve the patient's symptoms and quality of life. The most common indications for surgery include chronic bacterial infection, nasal obstruction or blockage, and nasal polyps.

Functional Endoscopic Sinus Surgery (FESS) has become the standard technique for sinus surgery.

Steam inhalation in Sinusitis

Increased mucociliary activity has been observed with saline irrigation and steam inhalation which seems to achieve faster recovery. In patients of chronic sinusitis disease, the mucociliary activity is known to be impaired.

It is found that steam inhalation improved mucociliary activity significantly in chronic sinus patients.

Nasal inhalation of steam has been proposed as treatment of viral colds on the assumption that increased intranasal temperature will inhibit replication of rhinovirus. The steam inactivates the flu virus. Most people at home use the old fashioned way of head over a bowl of steaming hot water.
Eucalyptus oil or menthol or aromatic herbal leaves (tulsi) in steam inhalation is recommended for relieving nasal congestion and sinus congestion, usually from colds and flu. It can be done two to four times a day to relieve symptoms.

Yoga-Pranayam

The breathing exercises of yoga, especially the pranayam (Breath exercise) of Yoga opens the ducts which aids in free breath movements and cures the sinus ailment. These breath exercises free the nose and the tract of the congestion and ill effects of contamination in the environment.

Yoga rejuvenates the mind and the body. The inhalation and exhalation as a part of yoga practice creates sound vibrations which clears the nasal tract and aids in better breathing. The air movement in the nasal passage achieves free movements, this aids the lungs to function more effectively. It helps to deal with the virus that block the nasal tract and reduces the inflammation in the tract too. It helps to reduce the nasal discharge and helps to clot the mucous in the nasal cavity so that a person is cured from a runny nose.