Pulmonary Sarcoidosis Vs Tuberculosis

Introduction:

Sarcoidosis with a prevalence of 10/100,000, is a multisystem disease of unknown etiology characterized by non-caseating granulomas.i It involves virtually any organ, lungs, thoracic lymph nodes, skin liver, central nervous system, eyes, kidneys and heart, and is more common in Afro-Americans. There is no sex predilection but some manifestations of the disease are more common is females. � It begins in the third or fourth decade and tends to be rare in children and the elderly.? We are presenting a case of sarcoidosis of the lungs which should be considered in the differential diagnosis of tuberculosis, common in countries like Pakistan.



Discussion:

Considering the common disease first which is tuberculosis, long-standing history of low grade fever, weight loss and persistent cough not responding to anitibiotics along with raised ESR and positive PPD(13 mm) supports tuberculosis put PPD is not reliable in developing countries as a tool for diagnosis.



Diagnostic procedure performed was an endobronchial biopsy. � Histopathological examination showed multiple granulomas, composed of epitheloid histiocytes, with occasional Langerhan�s giant cell and no necrosis. According to one study endobronchial biopsy increased the yield of fibreoptic bronchoscopy by 20.6%.4 Fungal stain, AFB stains and cultures, were negative (Table II).



The patient had X-ray findings consistent with stage II disease. 1,5 Unilateral hilar adenopathy is an atypical manifestation of sarcoidosis in initial stage. 6 Her ACE level was raised about three folds, serum calcium was in upper normal range and ESR was persistently raised (Table I) supported by radiological findings, which favour sarcoidosis. PPD is negative in sarcoidosis are anergic to PPD tuberculin but distribution of memory T-cells in the blood and humoral immune response are normal and opportunistic infections are rare.�



Fifty percent of sarcoid cases have clinically silent involvement of organs, which is one of the hallmarks.� 20-40% of symptomatic patients have respiratory symtoms and 10-40% have eye pain, rashes arthralgia and other symptoms while 20-30% with constitutional symptoms like weight loss and fatigue.�



Sarcoidosis may present atypically as Lofgrens and HeerFordt�s syndrome.� Sarcoidosis in younger patients with spontaneous remission and less than two years duration of symptoms are classified as subacute while chronic form have more than two years duration with insidious onset and presents with constitutional symptoms, pulmonary fibrosis and nephrocalcinosis.�



In one study in which histopathological diagnosis required presence of non-caseating granuloma, bronchoscopic biopsy yielded diagnosis in 60% of patients with stage I disease, tranbronchial needle aspiration yielded diagnosis in 53% and two procedures in combination yielded 83% of diagnosis. 7,8 In stage II disease probability of obtaining a positive result with a single specimen was 46%, the yielded with more specimens followed a logarithmic curve and increased to 90% with four specimen, at which point the yield approached a plateau for additional specimen. 7,8 The suggests that four biopsy specimens are sufficient to make diagnosis. Biopsy of gastrocnemius muscle is another sensitive and specific tool for diagnosis. 9 If transbronchial biopsies are non-diagnostic, mediastinal lymph node biopsies are diagnostic in 8-90% of case. 10 Finally , the patient was kept on steroids (Deltacortil) 40mg/day in divided doses and He/She responded well with remarkable improvements. 11 His/Her ESR came down to 13mm, chest X-ray showed remarkable improvement as infiltrates and bilateral hilar adenopathy disappeared altogether.



We kept His/Her on the same dose of Deltacortil till 8 weeks, and then it was trapered off to 7.5mg/day without recurrence.



� Dr. D.S. Merchant Resident Medicine AKUH

Gold Medalist (Anatomy & Histology)

www.ehealthguide.info & www.blogsbasket.com & www.dubaistock.info

Earth's Answers - B Vitamins by Dr. Bryce Hunter

B-vitamins are necessary for everything from heart health to carbohydrate, protein, and fat metabolism Subclinical deficiencies in these B-vitamins are thought to be relatively common among the world's population and in particular among the elderly. B-vitamins are water-soluble which means that the body purges it through sweat, urine and natural waste.



For those who are moderate to highly active, a marginal deficiency in the B vitamins may affect the ability of the body to repair itself and to operate, at an efficient level, to fight disease.



Let me tell you a story about a friend of mine; let's call her Jill. Jill was new patient in my office, but was certainly not new to the world of health care. In fact, she had previously been to a number of doctors with the hope that she could find some answers to her health concerns. Her main symptoms were; no energy, upset stomach, and bouts of depression and anxiety. She said that she had always had problems concentrating. One of her children also had symptoms common to ADD. At this point, you would probably suspect some lab tests of some sort, but they had already been done and yielded no conclusive answers.



After having her fill out a food log of the foods she daily consumed, it became very apparent that she was suffering from a B-vitamin deficiency. These B-vitamin deficiencies had apparently gone on for many years. She decided to free herself of the drugs that were merely covering up the symptoms and instead rid herself of the deficiency that had existed for most of her life. The results were astonishing!



Without B-vitamins, your everyday health will become a challenge. I recommend that you so stay away from as much processed food as possible. Work to improve your diet using a well balanced variety of natural foods. Finally with some simple daily natural supplements, and regular exercise you can regain and maintain your health. So best of luck and for more free information and a free health screening go to Earth's Answers.



Credentials:

Host of the acclaimed radio show "The Heath Revolution"

Logan College of Chiropractic, St. Louis, MO

BS: Human Biology, Logan College of Chiropractic, St. Louis, MO

BS: Heath and Human Performance, Brigham Young University

Postgraduate Training (selected) Digestive Heath Specialist, The Loomis Institute of Enzyme Nutrition: Integrating N8utrition into the Practice, The Nutrition Clinic Certified: International College of Applied Kinesiology, Activator Methods, CPR for the for the Heath Professional

Member: American Chiropractic Association Utah Chiropractic Association

Disasters Change Lives Forever

In the year 2005, natural disasters killed over 25,000 people and caused $57.7 billion in damage worldwide. Besides the obvious, direct impact of natural disasters (such as a tornado destroying a house), there are usually many indirect effects. Although these effects may be less obvious, they are often times more costly and can add years on to the recovery time from a disaster. As people who live in communities that have been devastated by a natural hazard will often say, �there is no such thing as a complete recovery, disasters change people�s lives forever�.



Disaster Mitigation is the first link in the chain of disaster survival. Mitigation is the process of reducing the severity of the impact of natural hazards through planning. Each hazard requires a specific type of mitigation. In some cases, we can use engineering solutions. Earthquake-resistant construction and devices to hold objects in place such as earthquake straps could at least reduce the impact of a natural hazard. In other cases, the only form of mitigation that is guaranteed to be successful is to limit or not allow human activities where the hazard occurs, such as floodplains, volcanoes and high fire risk areas.



But unfortunately, in some cases such as Hurricane Katrina and the Asian Tsunami, the fact that there was little or no planning or mitigation took its toll on human life. These types of disasters have a profound impact on us all. Prediction of natural disasters has improved greatly but more work needs to be done. Protection against manmade disasters must continue in a logical, controlled and decisive manner.



The second link in the chain of disaster survival is personal preparation. Making plans for evacuation, having the correct survival supplies such as water and food that has a five-year shelf life, a flashlight that doesn�t need batteries and a radio to stay connected to the outside world, is essential to us all. It is suggested that each person have at least 72 hours of supplies. Statistically, the citizens of the United States are not prepared. Less then 40% of the population has a plan and even less have supplies. The list of items is overwhelming to some people and just knowing where to start can be a conundrum.



Disasters do come in all forms and change our lives. We have seen it first hand in recent years. Mitigation, preparation and prediction will decrease loss of life and property.



Every one of us must participate in disaster preparation. Some people say �expect the unexpected� but in reality we must anticipate the expected and prepare.



For more information about emergency disaster preparedness or to see a comprehensive list of survival kits to help you get prepared in the event of disaster, visit: www.survivalkitsonline.com

Should Medical Students Consider Disability Insurance?

Last year the Association of American Medical Colleges (AAMC) said that schools should require disability insurance for all medical students and provide access to policies. Medical students are particularly vulnerable to the financial hardships that may result from a disability. Disability insurance protects students from possible fiscal disaster and is also a prudent investment. Purchasing a policy while still in medical school presents tremendous advantages that can save students money after graduation, while protecting their financial future and providing the peace of mind necessary to focus on the demands of a career in medicine.



Most medical students do not generate income while in school, but instead accumulate debt at staggering rates. In 2005, medical school graduates who took out loans started their residencies with an average debt of $100,000, a figure that does not include undergraduate debt. Only the expected future income from a career in medicine makes such exorbitant debt palatable; however, a student that suffers a disability may never realize that income. According to the 1994 Statistical Abstract of the United States, in the course of a year, 1 in 10 people between the ages of 25 and 64 will suffer a disability. When comparing that ratio to the odds of being victim of a house fire (1 in 122); injured in an automobile accident (1 in 160); or even of death (1 in 117), the value and protection offered by disability insurance is clear.



A student who suffers a disability and is unable to complete their education will be saddled with student loan debt and may not be able to work in any field depending on the disability and its severity. Repayment of student loans combined with medical expenses and lack of income due to disability can destroy a financial future. Even a student that is able to continue medical school could face the burden of simultaneously repaying loans and paying tuition.



Aside from the obvious advantages disability insurance offers by minimizing the risk riding behind a medical student�s debt, there are other long-term advantages to purchasing a policy as a student instead of as a physician. A student purchasing a policy will likely get a lower rate than a physician. According to doctordisability.com, three factors determine disability insurance rates: age at the time of purchase, occupation, and health status. These factors tend to favor a student. Not only are students younger, but generally the health status of younger people is better than that of older people. Obtaining insurance at a younger age may also protect the policyholder from the difficulties of securing a policy later in life when other health issues may affect insurability.



A disability insurance policy also adapts to meet the changing needs of the insured. A Future Increase Option (FIO) Rider allows the policyholder optional future increases in coverage without providing evidence of medical insurability. The ability to increase coverage regardless of current health status is attractive to any policyholder, but the FIO Rider is also ideal for a student who wants to increase coverage upon graduation and the expectation of significant income. A policy purchased by a student before they take their first class in medical school can be flexible enough to last a career.



The protection, flexibility, and benefits the insured has by purchasing a disability insurance policy as a student are reflected by the stance that medical schools take. Dartmouth Medical School and the University of North Carolina School of Medicine mandate that all students have disability insurance. While in some states it is illegal to require students to have a disability insurance policy, most medical schools at least recommend that all their students have it. In 2006, the University of Washington School of Medicine was ranked by U.S. News and World Report as one of only three schools in the top 10 for both research and primary care. Their office of student affairs and services says it is �advisable� to have disability insurance in light of the cost of education and risks associated with practicing medicine. The school offers its students a plan, but in general, group plans come with limitations and restrictions.



The Liaison Committee on Medical Education (LCME) is the sole accrediting authority for medical education programs leading to the M.D. degree in the United States. Accreditation standard MS-28 states, �all students must have access to disability insurance.� Simply allowing access to disability insurance�a minimal requirement placed on accredited medical schools�or even recommending it, is not enough to save students from the risks of not protecting their future income. In light of the monetary investment that students make to medical schools, it should be the responsibility of each school to promote and educate its students about the benefits, value, and importance of disability insurance.



Andy Puls is the author of Resident Economics and a freelance writer for Doctor Disability Insurance

HGH Supplements - Facts and Fiction

Now things start to get fun. It is time to separate fact from fiction and look at some of the products out on the market today. Is it possible to increase HGH levels by taking dietary supplements? Let's find out...



Every web site claims they have a simple supplement that will cause my HGH levels to skyrocket. Do these supplements work?



For the most part - no! I hate to be the one to break the news to you, but most companies in the HGH market are out to make a quick buck with exaggerated claims. Here are some claims you will see on the web and our feeling on their accuracy...



Claim: HGH will give you a 8.8% increase in muscle mass and a 14.4% loss of fat - without dieting or exercise!



This is the old bait and switch. Technically, they are not lying when they quote Dr. Rudman's number. With HGH Injections, Dr. Rudman did see a 8.8% increase in muscle mass and a 14.4% loss of fat. The problem is, they are not selling HGH Injections! These companies do not provide any evidence that their pill, powder or spray will have the same results as HGH Injections. So, they bait you with all the positives of HGH injections and then switch you to their untested supplement.



Claim: Our spray/pill/powder contains real HGH!



This statement is at best a tremendous exaggeration and at worst a complete lie. There are a couple of reasons why companies who claim to have a significant amount of HGH in their products are not being truthful. First, HGH is a prescription drug. If you put significant amounts of HGH in a dietary supplement it is no longer a supplement - it is a drug. As a drug it must meet FDA approval and only sold with prescription. So, the phrase HGH dietary supplement is an oxymoron. If a product has a significant amount of HGH, it is a drug.



If you remember from our HGH definitions page, HGH is a delicate and complex 191 amino acid hormone. This brings up the second problem with the above claim - you can not take HGH orally. So, even if a company wanted to break the law and sell HGH as a pill/spray or powder - it would not work because the HGH would break down before it ever reaches the bloodstream.



Finally, you have a financial problem with the above claim. Give Eli Lilly a call and see how much 200 micrograms (the amount a 40 year old secretes each day) of recombinant GH cost. You will quickly find out that the math just doesn't work. How can they sell a 1 month supply for $100 when the raw material would cost over $1,000 a month?



There is a case when the above claim can be true - but very exaggerated. The FDA has determined that if there is less than 2001 nanograms (ng) of the HGH drug present in a supplement - it is NOT considered a drug. The theory is that in such small trace amounts, the drug has no impact so it is not classified as a drug. Let's look at what a nanogram is...



1,000 nanograms (ng) = 1 microgram (�g)

1,000,000 micrograms = 1 gram



So, even a product that had the highest legal amount of HGH would only have 2 micrograms. Dr. Rudman gave his patients 49,500 microgram - three times a week! What this means is that technically and legally you could make the claim that your product contains real HGH. The problem is, that claim is pure marketing hype. It is not a significant source of HGH.



We defined homeopathic medicine back on the definitions page. As you recall, the homeopathic approach works by using miniscule amounts of a substance. So, some homeopathic HGH remedies could contain up to 2000 ng of real HGH. In honest homeopathic products the goal is not to replace your HGH with the HGH in the bottle (this would be impossible). The theory is that even the smallest amount of HGH can stimulate your own body to produce more HGH. This stimulation theory may be valid and we will discuss it more on our HGH enhancer article.



Claim: Our product is FDA approved!



There are no FDA Approved Dietary Supplements. The simple truth is that the FDA does not approve or disapprove of Dietary Supplements. The Dietary Supplements Health and Education Act (DSHEA) of 1994 says that Dietary Supplements do not need FDA approval. This is why there are so many supplements on the market - there is no approval process. The best advice is buyer beware.



Are there any supplements worth taking?



Luckily, yes. I know this article has been pretty depressing so far, but if you search through all the misinformation out there, sometimes you find the needle in the haystack. Research indicates that the best way to elevate HGH levels is to stimulate the body to produce more HGH. Rather than introduce more HGH into the body, you can stimulate your own pituitary gland to produce more HGH. Remember that studies have shown that an old pituitary gland has the same capacity to produce HGH as a young pituitary gland. If we can find a way to stimulate our pituitary gland we will have the best of all worlds. You are not introducing a foreign GH, so you eliminate the side effects. Also, our body is very good at self regulating - it will not produce an excessive amount of HGH which could be harmful. In effect, you body knows best what the correct dosage of HGH is to release for your body.



The Article is Published here: http://www.advice-hgh.com/supplements.html



Advice HGH - Detailed research on human growth hormone (HGH) and IGF-1 supplements. Information and clinical studies on Growth Hormone products. Sound HGH advice without all the hype.

Sytropin HGH - Official Sytropin HGH website.

About the Author:

Sudha is an internet marketer and enjoys writing on various subjects. Reach him at Ani SEO Firm.

Holiday to Florida with Orlando Holiday Rental

It cannot get any simpler than this. A holiday to Florida is incomplete without Orlando, period. It is amazing to know how much entertainment a city can offer! Orlando is the undisputed gateway to the entertainment capital of USA, and also probably, the world. Orlando attracts hoards of tourists all year long, especially during holidays. One may chose to navigate Orlando's world-renown theme parks, or otherwise have a great time visiting the Kennedy Space Center.



If you are planning to visit Disney World or other attractions in Orlando, planning the trip with a little research on the internet can save you some money. Rather than choosing the first package that comes your way, it is highly recommended to get some more information about holiday rentals other kinds of lodgings available.



True to its fame, Orlando spoils a tourist by its plethora of options as far as staying is concerned. Holiday rentals, holiday homes, hotels, resorts, rental apartments- you name it and Orlando has it. Depending on your spending capacity and holiday interest, you get to chose among a plethora of holiday rentals, hotels and resorts. A good selection of Orlando villas you can find at http://disney-vacationrentals.com



Holiday rental means renting out fully furnished villa or house on a temporary basis to tourists. Holiday rental at Florida is also known as holiday homes, rental apartments, holiday rentals or rental apartment. Unlike hotels or resorts which charge per person, holiday rentals or holiday rentals have a set price for an entire holiday with a cap on the maximum number of persons allowed.



Starting from inexpensive single family style homes to a luxurious villa with a private mini golf course and a swimming pool, holiday rentals at Orlando cover the entire spectrum. Most of the holiday rentals at Orlando have separate bedrooms, fully functional kitchens, bathrooms, and more often than not, a balcony. Many of the Orlando holiday rentals come with added facilities which make them as comfortable as a hotel. This makes these holiday homes of Orlando ideal for price sensitive guests as renting a holiday apartment often works out far less expensive than a resort or a hotel.



Most of the holiday apartments do not allow pets and Pet friendly rental apartments generally are costlier than normal holiday homes.



Orlando is a great place to spend your holiday with your family. And make no mistake. Orlando has as much to offer to adults as it has for children. Explore the Walt Disney World, or indulge yourself in shopping or visit the Orange County Regional History Center; Orlando never runs out of options. And to top it all, after a day of entertainment, adventure and fun, when you stay at an Orlando holiday rental you get the feeling of being back at home.



Orlando holiday Rental or Disney holiday villa at Orlando can be directly rented or leased from their owners or holiday rental agencies. Most of the rental appartments are directly listed by the owners.

A Common Mistake of Many Writers

A common mistake of many beginning or aspiring writers is using too many words. While it may seem advantageous to paint a picture for your readers; using wordy descriptions isn�t the way to do it. Writers should strive to get their point across in as few words as possible.



Ernest Hemingway said:



�My aim is to put down what I see and what I feel in the best and simplest way I can tell it.�



Ernest Hemingway�s reference to telling things the �simplest way� should not be confused with talking down to your reader. Simply put, we should tell our readers in a way they will easily relate to and understand. How can we do this? The best way is through showing our readers, not telling them.



For example, let�s say our character really wants a bagel and coffee from her favorite bakery before heading to work, but they are really busy and the line is long. In our example, let�s assume our goal is to get this information across to our reader, along with our character�s irritation and final decision to stay despite being late for work.



The following paragraph is an example of �telling� our reader what we want them to know:



Leslie walked into the bakery. She was already late for work. There was a long line. This made Leslie irritated and she almost left. She wanted a bagel and a coffee so bad though, that she decided to stay, even if it made her late for work. �Why can�t they just hurry up?� she thought.



This next paragraph is an example of �showing� our reader this same information:



Rushing through the bakery door, Leslie nearly slammed in to the last person in line it was so long. Biting her nails and tapping her foot rapidly, Leslie debated leaving. Mmmm. The smell of poppy seed bagels and fresh brewed coffee sealed her fate; she would be late to work again today.



As you can see, the 2nd example is more effective, as well as attention grabbing. Showing our reader provokes feeling, paints a picture and places our reader in the setting with our character. Showing fosters our reader�s imagination. If we tell our reader what to think and how to perceive each situation; what is left for our reader to imagine? Without imagination, our reader can�t place himself in the situations with our characters; and this makes for a very boring read.



Spend some time practicing showing, not telling. Pull out some of your old writings and rewrite them with a goal of showing your reader in any of the places you�ve told your reader what to think or feel. This could make such a big difference; you just might end up with a few �like new� articles to submit for publication! And, wouldn�t that be great?



Deanna Bounds Ross is a successful freelance writer, writing coach, internet business owner, and business consultant with over 15 years experience in business management and public relations in a corporate setting and 20+ years writing, coaching and teaching experience. Deanna is the founder and administrator of Creative Multiplicity, a resource site for writers, as well as an online education center for writers and entrepreneurs.

www.creativemultiplicity.com