We have to treat smoking as a major public health issue. We have to reduce the extent to which young people start smoking, and one of the issues is the extent to which display of cigarettes and brands does draw young people into sm1956, oking in the first place.
Andrew Lansley (born 11 December 1956, is a British Conservative politician who served as Member of Parliament (MP) for South Cambridgeshire from 1997 to 2015.
“There is no cure for multiple sclerosis (MS), but much progress has been made in developing new drugs to treat it. Research is ongoing to develop new and better disease-modifying therapies (DMTs) for this disease of the central nervous system.”
*Speech problems-this including slurring (dysarthria) and loss of volume (dysphonia) occur in approximately 25-40% of people with MS, particularly later in the disease course and during periods of extreme fatigue. Stuttering is occasionally reported as well.
*Swallowing problems — referred to as dysphagia — result from damage to the nerves controlling the many small muscles in the mouth and throat.
*Tremor, or uncontrollable shaking, can occur in various parts of the body because of damaged areas along the complex nerve pathways that are responsible for coordination of movements.
*Seizures — which are the result of abnormal electrical discharges in an injured or scarred area of the brain — have been estimated to occur in 2-5% people with MS, compared to the estimated 3% of the general population.
*Breathing Problems-Respiration problems occur in people whose chest muscles have been severely weakened by damage to the nerves that control those muscles.
*Itching-Pruritis (itching) is one of the family of abnormal sensations — such as “pins and needles” and burning, stabbing or tearing pains — which may be experienced by people with MS.
*Headaches-Although headache is not a common symptom of MS, some reports suggest that people with MS have an increased incidence of certain types of headache.
While the primary symptoms described on this page (more and less common) are the direct result of damage to the myelin and nerve fibers in the central nervous system (CNS), the secondary symptoms are the complications that can arise as a result of these primary symptoms. For example:
While secondary symptoms can be treated, the optimal goal is to avoid them by treating the primary symptoms.
Tertiary symptoms are the “trickle down” effects of the disease on your life. These symptoms include social, vocational and psychological complications. For example, if you are no longer able to drive or walk, you may not be able to hold down your usual job. The stress and strain of dealing with MS often alters social networks and sometimes fractures relationships. Problems with bladder control, tremor or swallowing may cause people to withdraw from social interactions and become isolated.
Depression is very common in people with MS. Depression may be both a primary and a tertiary symptom as it can be caused by the disease process itself and/or triggered by the challenges discussed above.
Multiple sclerosis is a neurologic disease that affects women more often than men. Onset is most commonly in the 20s or 30s.
MS is an autoimmune disease in which there is initially focal inflammation and then permanent damage to nerves of the central nervous system. The damage is really removal of the insulating material surrounding nerves. The tissue that insulates nerves is called myelin, and the damage is referred to as demyelination.
As a nerve that controls sensation or movement of a part of the body loses some of its myelin covering, the nerve may become dysfunctional. This can manifest itself as loss of that nerves function which can be sensation, vision, movement or coordination of movement. Affected sensory nerves can also cause pain.
There have been tremendous advances in our ability to diagnose and assess MS with the development of magnetic resonance imaging. Unfortunately, our understanding of the cause of this disease remains limited, as does our ability to treat it. There is some limited success in stopping or decreasing the severity of an MS attack. We would also like to stimulate a regrowth of the damaged myelin over the nerve. Unfortunately, this is not possible at this time.
There are several types of MS. Some patients have disease that will have an acute exacerbation followed by a prolonged quiet period, which can last years or decades. This form of disease is referred to as relapsed remitting MS, or RRMS. Others have a disease that gets progressively worse over time. There are two types of progressive disease. In primary progressive MS, or PPMS, symptoms steadily worsen over time from the very beginning. Secondary progressive MS, known as SPMS, begins as relapsed remitting disease and becomes progressive over time.
For an acute exacerbation of multiple sclerosis that can result in neurologic symptoms and increased disability or impairments in vision, strength or coordination, the preferred initial treatment is usually a type of steroid called a glucocorticoid. Patients who do not have a good response to steroidal therapy are often treated with plasma exchange. Plasma exchange is an extreme therapy that removes antibodies to myelin from the blood.
Patients with RRMS are often treated with immune-modulating drugs such as interferon or glatiramer acetate. Glatiramer is an exciting drug. It is a series of small proteins that are similar to myelin protein. It is thought to prompt the immune system to avoid attacking myelin.
Available treatments of primary and secondary progressive MS are of limited efficacy and have significant side effects. An additional fact to consider is that most trials have not lasted longer than two or three years and give only hints about long-term results of treatment.
In brief, no clinical trial has shown convincing evidence of benefit in the treatment of primary progressive MS. All suggested treatments for PPMS are empiric. Several drugs that are more commonly used in the treatment of malignancy, cladribine and mitozantrone, appear to have some activity.
In contrast, there is definite modest benefit in some treatments for secondary progressive MS. These treatments include various regimens of steroid therapy and the use of some drugs that modulate the immune system. Many of these drugs are more commonly used in treatment of cancer and rheumatoid arthritis such as cyclophosphamide, methotrexate and interferon.
MS should be treated by a neurologist with experience in managing it.
“Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).”
Multiple Sclerosis Foundation
“Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.”
MAYO CLINIC
The kidneys are responsible for handling urine, so it makes sense that urine will start to change if the kidneys are failing. Some examples of urination changes include: • Urine comes out bubbly or foamy • Urine may have traces of blood • You may have the overwhelming urge to urinate during the night, waking up • Urination occurs more often and appears pale • Urination occurs less often and appears dark • You may have difficulty attempting to urinate
The kidneys are responsible for producing a specific hormone called erythropoietin (EPO). This hormone is responsible for instructing the body to produce red blood cells, which are meant to carry oxygen throughout the body. If the kidneys start to fail, they will make less EPO, which means fewer hormones are directing the body to produce the necessary amount of red blood cells. At the end of this cycle, you’re left feeling very tired and weakened throughout the day. Experiencing fatigue even when you seem to get enough sleep at night is one symptom that the kidneys are not producing enough hormones for your body.
Because of the way the kidneys interact with the body and handle the process of urination, they also are largely responsible for removing the extra fluid within your body. Kidneys that are starting to fail won’t get rid of that fluid as well as they should be. As a result, it stays inside the body — and while it’s in the body, it has to go somewhere; the fluid starts filling in pocketed areas. You may experience swelling in one or both ankles, the legs, the face, hands, as well as feet. While the swelling can be mild, it can also swell to difficult stages; for instance, it might be hard to wear a regular shoe. This is edema.
Healthy kidneys also take on the role of the body’s garbage men; that is, they’re responsible for getting rid of waste in the body. In the event of kidney problems or failure, waste won’t exit the body as efficiently as before, causing a buildup of excess waste in the bloodstream. This is known as uremia, and it can cause feelings of nausea or make you need to vomit. It should go without saying that your body doesn’t like being filled with waste, and it attempts to purge the waste by way of vomiting.
When kidneys begin to fail and cause uremia, or a buildup of waste in the body, the body may react by producing the taste of metal in your mouth or causing bad breath. Overall, you might taste a rather poor flavor in your mouth that causes you not to taste food in the same way as you did before. In particular, this may make you less interested in eating meats. In addition, you might start to notice some weight loss as a result of not eating. This could be due to the taste issue or you may simply not feel hungry enough to eat much.
Developing uremia as a result of kidney disease doesn’t stop with metallic taste or the need to vomit. The waste buildup in the bloodstream manifests further by causing patches of rashes on the skin and causing itchiness. In some cases, patches of skin can break out in what appears to be acne as well. These itchy rashes can be difficult to relieve; in more progressed instances, the itch can feel like it goes right down to the bone, making it difficult to feel relief by way of scratching.
As explained in a previous slide, the kidneys produce the hormone EPO to signal the body’s production of red blood cells. Failing this, there are fewer blood cells, which is anemia. Anemia comes with its own set of symptoms, the most prominent but overlooked being chills. If you feel cold, even inside of a warm room, you could be experiencing anemia.
One of the more characteristic symptoms of chronic kidney disease include feeling discomfort in the back or in the legs. In some cases, the feelings of discomfort could be painful. It is also possible to experience pain as far as the upper back. Problems that can cause pain include: • Kidney stones and infections, which cause severe spasms of pain • Bladder infections, which can produce a burning sensation during urination • Polcystic kidney disease, which produces painful cysts on the kidneys and liver.
If you have been experiencing shortness of breath lately, it could be connected to the kidneys in two different ways. The first possible connection is a result of the extra fluid buildup; sometimes, this extra fluid builds up in the lungs, making it more difficult to breathe. Otherwise, the shortness of breath can be a result of anemia; in this case, there are an insufficient number of red blood cells available to carry oxygen throughout the body. This leaves the brain and body starved and short of breath. If you experience shortness of breath, sit down for a moment and calmly attempt deep breaths. The experience is naturally frightening, but panicking can only lead to more difficulty breathing.
Anemia as a result of kidney disease has one more grasp on the body: It can make you dizzy and cause you to have trouble concentrating on things. When this happens, your brain is becoming starved of the oxygen it needs to be at full power. When your brain isn’t getting enough oxygen, it manifests beyond dizziness and concentration problems; you can also experience memory problems and other issues with cognitive functions. This symptom often goes hand in hand with fatigue due to the taxing effects on the brain.
“Kidney donors don’t have to be close relatives of recipients, but they do need to have the right blood type. And kidneys from living donors tend to last many years longer than kidneys from deceased donors.”
Virginia Postrel (born January 14, 1960 is an American political and a cultural writer). …