System Optimizer and Restorer: Easy-to-use software

Every user of a computer is concerned about the safety of his/her precious data. The restoration of crashed system and safe retrieval of data is always cumbersome, time consuming and costly affair, and needs expertise. Everybody needs a simple solution to prevent system crash or to restore the system to a healthy state. In my opinion Digeus System Optimizer is the smartest way to solve computer problems and protection & restoration of your valuable data. Digeus System Optimizer 8.2 is easy-to-use software that could help you eliminate system crash and restore your system to a healthy state. It eliminates system crashes and slowdowns. It automatically identifies and repairs the common Window problems. It is very easy to down load, install and use the same with free support from Digeus Inc.

The suite of Digeus System Optimizer 8.2 is composed of following tools:

1. Digeus Data Encryptor


2. Digeus Disk Space Analyzer


3. Digeus Drivers and Programs


4. Digeus Duplicate Files Finder


5. Digeus Icon Manager


6. Digeus IE Manager


7. Digeus Junk Files Cleaner


8. Digeus Memory Cleaner


9. Digeus Multimedia Settings Tweaker


10. Digeus Optimization Wizard


11. Digeus Privacy Protection


12. Digeus Process Manager


13. Digeus Registry Cleaner


14. Digeus Registry Defragmenter
    
15. Digeus Repair System Settings


16. Digeus Service Manager


17. Digeus File Shredder


18. Digeus Smart Uninstaller


19. Digeus Startup Manager


20. Digeus System Customization


21. Digeus System Info


22. Digeus System Security Tweaker


23. Digeus System Speed Optimizer


24. Digeus Unnecessary Files Cleaner

One can download and install System Optimizer 8.2:

http://www.digeus.com/
downloads/systemoptimizer/
files/8/sysoptimizer_8_2.exe

Learn more what is included in System Optimizer 8.2:

http://digeus.com/products/
systemoptimizer/system-
optimizer.html

Methyl Alcohol Poisoning: Management Tips

Successful management of methyl alcohol poisoning requires prompt recognition. The most important therapeutic action is to correct the metabolic acidosis quickly. Methyl alcohol or methanol is an industrial solvent and widely used as paint thinner, paint remover, nail-polish remover and as a denaturant in ethyl alcohol. The poisoning due to methyl alcohol occurs due to consumption of rectified spirit or methylated spirit or illicit distilled ethyl alcohol. Methanol is completely absorbed within 3-4 hours of ingestion. After absorption the methanol is metabolized in the liver by the action of alcohol dehydrogenase to form formaldehyde and formic acid. Some of the ingested methanol is eliminated unchanged by the kidneys and lungs.

Ingestion of more than 30 ml of methanol/methyl alcohol is lethal, but the extent of toxicity may be influenced by concomitant ingestion of ethyl alcohol and other unknown host factors. A blood level of methanol of 20mg/dl is toxic. Severity of toxicity correlates with the level of methanol in blood. The variability in the development of methanol toxicity may be due to various liver diseases and availability and synthesis of alcohol dehydrogenase.

Symptoms of methanol poisoning after illicit alcohol consumption:

A person suspected of having consumed pure methanol or rectified spirit, industrial solvent/thinner, nail-polish remover or illicit distilled alcohol may complain of abdominal discomfort and pain, breathlessness, cardiac arrhythmia and blurred vision. If medical help is delayed the patient may go blind with delayed onset of coma.

Tips to manage methanol poisoning:

If the patient is not unconscious, try to know the type of alcoholic drink he/she has consumed. The patient should be shifted to emergency wing of a nearby hospital immediately. If the patient has consumed pure methanol, he/she should be encouraged to take around 4 oz of brandy or whisky to retard the metabolism as the enzyme alcohol dehydrogenase has more affinity for ethyl alcohol than the methyl alcohol. An assay of methanol blood levels can help to confirm the diagnosis, however, a patient having consumed a doubtful solvent and having metabolic acidosis and burred vision, should be considered a case of methanol poisoning and treated accordingly. Liver function tests along with blood pH and urine analysis should be done. The patient should be put on hemodialysis or promptly referred to a hospital where facilities for hemodialysis are available. Any arrhythmia, heart failure, convulsions or shock need urgent medical attention. If more than 4 hours have elapsed since ingestion and patient do not have arrhythmia and blurred vision, gastric lavage should be performed with sodium bicarbonate solution until the return fluid is clear of methanol. Patient should be kept under observation till considerable metabolic recovery.

Childhood Asthma

A wheezing child has over 80% chances of having asthma. Though wheezing has been considered as a hallmark feature of asthma but it may be associated with other disorders. Recurrent wheezing in infants and children should be considered a diagnostic feature of asthma, but all asthma does not wheeze. Pulmonary function tests (PFT) should be performed to confirm a diagnosis of asthma. Non-wheezing asthma is called 'occult asthma'. Spasmodic, persistent or recurrent cough may also be a feature of asthma. In the absence of wheezing a diagnosis of asthma may be missed in children. All cases of suspected asthma should be subjected to PFT. The response to asthma therapy can also be assessed with PFT. General pulmonary fitness in-between attacks should be monitored at home or at doctor's clinic by Peak Expiratory Flow Rate (PEFR) meter. Various precipitating and aggravating factors may differ with age in children and the trend may continue during adult life.

Because of various misconceptions, asthma is highly undertreated disorder in children. Symptoms of asthma may vary with age and asthmatic children always have different clinical patterns. Type and duration of pharmacotherapy appropriate for one pattern may be inappropriate for the other, so it is important both for the physician and the parents of children to understand these patterns.

Childhood Asthma: Pattern-I

Allergic, viral or exercise induced asthma are included in pattern-I. Here the chest congestion with wheezing and breathlessness (bronchospasm) occurs in minutes or hours and rarely lasts for more than a few days. Around 50% percent of all cases of childhood asthma have pattern-I asthma. There may be 1 to 5 episodes per year. The lung functions are near normal and these cases respond well to bronchodilators along with anti-allergic treatment and rarely need steroids.

Childhood Asthma: Pattern-II

Aetiology and features of this type also resemble pattern-I but number of attacks may be 5 to 6 per year. Longer duration of treatment with bronchodilators and sometimes steroids may be required.

Childhood Asthma: Pattern-III

Undertreated children may develop this pattern where overt symptoms of asthma may be variable with impairment of PFT. These children require steroids along with bronchodilators and the course of treatment may be longer.

Childhood Asthma: Pattern-IV

Children with this pattern experience breathlessness without considerable wheezing. Variable but persistent airway obstruction and impaired PFT have been documented in children affected by pattern-IV asthma. These patients need long term treatment with bronchodilators and steroids.

Childhood Asthma: Pattern-V

Children having no symptoms of asthma during the day but having asthmatic attack at midnight or early in the morning should be labeled as the cases of pattern-V asthma. These patients may need aerosol therapy with steroids or beta agonists at night to control the cough and wheezing. Concurrent exposure to various aggravating factors may induce severe effects. Aggravation of symptoms by exercise or a specific allergen should be recognized and reported to the treating physician.

Understanding Obesity

Basically the term obesity means excess of body weight due to increase in adipose tissue-mass. It is important to understand the cause of obesity for its effective management. Weight measures in excess of 'ideal body weight' with reference to normal range ideal for age, sex, height and body built. To define obesity we should measure the adiposity by measuring the skinfold thickness at triceps (normal: 23mm in males and 27mm in females) or at inter scapular region (normal: 35mm in males and 42mm in females). In most of the cases the obesity is due to overeating while in minority it could be associated with the metabolic and endocrine disorders. Beyond certain degree, obesity may increase the state of morbidity and cause associated diseases like diabetes mellitus, hypertension, coronary artery disease (CAD), gall stones, osteoarthritis etc.

Understanding patient's eating habits, likes & dislikes, temperaments, lifestyle, work schedules and adaptability to environment are important to decide a course of treatment. Compliance of doctor's advice is important for effective treatment of obesity. Dietary measurements, exercise and slimming pills are always helpful in controlling the obesity. Treatment of associated metabolic or endocrine disorders should be pursued effectively.

Dietary management:

A variety of dietary schedules ranging from zero calorie to isocaloric high protein diets are available for the treatment of obesity. Diet should be adjusted in such a way that weight loss is not in excess of one kg/week. For the success of diet regime it is important to keep a balance between 'forbidden' and 'permitted' items. Too much recommendation of low carbohydrate diet sometimes leads to a notion that non-carbohydrate diets are absolutely harmless. Rapid weight loss through zero calorie diet or fasting may sometimes be non productive as the weight lost due to loss of water would be regained quickly. The 'ad lib' items should be salads and leafy vegetables.

Exercise:

Exercise is known to increase calorie expenditure and thus leads to loss of adiposity. Exercise also increases our metabolic rate and thus supports the weight loss. In practice, however, exercise alone cannot be sufficient way to try to reduce weight. Exercise along with dietary control is good for both the general fitness and weight loss.

Anti-obesity drugs:

There are a variety of drugs for combating the food-obesity axis. There are drugs for decreasing appetite, digestion, absorption and inhibiting lipogenesis. There drugs for increasing heat production or thermogenesis. The drug treatment of obesity is not very promising, as the majority of drugs at effective therapeutic level have been found toxic.

Itching and Associated Diseases

Itching or pruritus is defined as the skin sensation that prompts the patient to scratch a particular area of the skin. Irritative stimulation of skin is caused due to activation of free nerve endings situated at the dermo-epidermal junction. Itching is a physiologic or pathologic symptom caused due to internal or external factors. Itch receptors present in the free nerve endings at the dermo-epidermal junction are stimulated by histamine and other anaphylactic substances and evoke motor response of scratching. If not controlled, scratching may lead to skin injury and infection. There is a scratching itch cycle and one feels relieved after the itching cycle. Itching or pruritus is the most common disease of the skin caused by innumerable causes. If the cause of itching/pruritus remains undiagnosed even after two weeks then it is labeled as pruritus of undetermined origin (PUO). The cause of itching/pruritus could be local or systemic. It can be associated with the following systemic diseases.

Renal disease and pruritus:

Chronic renal failure (CRF) is a well-recognized cause of generalized and persistent pruritus. Uremia during CRF and cellular changes in the skin could be the possible cause of itching/pruritus. It is not directly related to renal function parameters, as patients with acute renal failure (ARF) do not complain of itching.

Liver disease and pruritus:

Patients with liver disease may also present with mild transient or severe or persistent sensation of itching. Intra-hepatic or extra-hepatic cholestasis in these patients leads to pruritus or itching. Primary billiary cirrhosis, cholangitis, viral infections, drugs and pregnancy can cause intra-hepatic cholestasis and lead pruritus.

Pregnancy and pruritus:

Pregnant women with mild abnormalities of liver function in the form of cholestasis may develop itching in the third trimester of pregnancy. Three out of 100 pregnant women may have pruritus.

Endocrine diseases and pruritus:

Pruritus confined to genital or peri-anal areas is most common in diabetics. Patients with diabetes mellitus sometimes may present with pruritus as the main presenting feature for medical consultation. Patients suffering from hypothyroidism and hyperthyroidism may also have generalized itching or pruritus.

Pruritus in occult malignancies:

Intense itching of nostrils has been observed in patients with tumors of brain. Adenocarcinomas and squamous cell carcinomas of various organs may also lead to generalized itching/pruritus. Around 30% patients with Hodgkin's disease have been found to be affected by itching disorder; some patients may show these symptoms as presenting features.

Computer Related Health Disorders

Computer users may experience occasional discomfort in their hands, arms, shoulders, neck as well as other parts of body. If some one experiences symptoms such as recurring or persistent discomfort, pain, throbbing, aching, stiffness, burning sensation, tingling or numbness; should not ignore these warning signs. One should consult a qualified medical professional even if symptoms occur occasionally. Above cited symptoms can be associated with painful and sometimes permanently disabling injuries involving nerves, muscles or tendons. These computer associated musculoskeletal disorders (MSDs) include carpal tunnel syndrome, tendonitis, and tenosynovitis. Severity of symptoms depend on many factors like general physical & medical conditions of the computer user, daily duration of computer use, type and make of computer key board & mouse, type of monitor (CRT, TFT or LCD) and posture during computer operation. For guidelines to reduce the risk of developing an MSD, please refer to "Healthy Computing Guide". You can access the "Healthy Computing Guide" at www.microsoft.com/hardware/hcg/default.html .

Celiac Disease: Gluten-free diet is the treatment

The term allergy means hyper-action of our body's immune system to allergens (mostly proteins or compounds tagged to proteins). Like our skin and respiratory tract, our digestive tract (intestines) can also be hypersensitive to some constituents of food. Celiac disease is a disorder of the digestive system which is caused by intolerance/allergy to a protein called gluten. People with celiac disease can not tolerate gluten. The disease is partially genetic and inherited. Parents, siblings and children of people with celiac disease may also have/be having this disease. Celiac disease damages the inner lining of the small intestine and interferes with the absorption of nutrients from food. The cause of celiac disease is the immunological allergic reaction to gluten present in food that causes inflammation and damages the inner border (microvilli) of small intestine. Figure-1 below shows the ultrastructural changes at the inner lining of small intestine in a patient affected by Celiac disease. A visual comparison with Figure-2 (Normal inner surface of small intestine) would make you understand the pathological change.

Figure-1: Electron micrograph of biopsy from the small intestine of a patient affected by celiac disease showing eroded microvilli.

Figure-2: Electron micrograph showing normal microvilli at the inner surface of small intestine.

Sources of Gluten

Wheat, barley and rye are the main source of gluten. The gliaden component of gluten causes celiac disease. Some adhesives, medicines and vitamin products, which we use daily, may contain gluten.

Diagnostic symptoms of celiac disease

Some of the typical symptoms of celiac disease are failure to gain weight, diarrhoea, irritability, vomiting, abdominal pain and foul stools, early in infant life. The most common period of presentation and detection of celiac disease is between six months and two years of age. Some children may present with excessive appetite, abdominal distension, wasted muscle, finger clubbing and edema.

Preventive treatment of celiac disease

A gluten-free diet is the only treatment of celiac disease. A person aware of having intolerance to gluten should avoid eating foods containing wheat, barley and rye products. Modern drugs may provide symptomatic relief but ultimate treatment is preventive therapy in celiac disease.

Important Tips

1. Parents of the children with celiac disease have great responsibility to make the children comply with the doctor's instructions for gluten-free diet.


2. Recognizing and avoiding new food products containing wheat, barley or rye is a great challenge and people with celiac disease should be very careful since non-compliance of gluten-free diet may cause relapse.


3. People having celiac disease should take food items prepared from rice and corn only along with fruits, juices and milk products.


4. Reading the contents of grocery items is important before eating because many corn and rice products come from the manufacturers of wheat products.


5. Gluten-free but balanced diet is must for normal growth of the children affected by celiac disease.


6. Medicines coated/laced with gluten products should be avoided.

Management of Knee Pain

There are around 150 joints in our body and the Knee joint is most afflicted by disease or injury. The knee joint bears the brunt of our body weight and pain in this joint affects our mobility. Knee injury, immunological disorders, rheumatoid arthritis and gouty arthritis in addition to age related bone disorders may complicate the problem. Early management of pain and care of knee joints could be helpful to prevent any deformity and disability. Knee pain may be at front, back or at inner or outer side of knee joint. Our body weight exerts pressure on our knee joints during we walk, run or climb stairs. Pressure force on knee joint is almost 5 to 6 times more when we climb stairs as compared to when we walk on leveled ground or road. The size of our hips also affects pressure on our knee joints. Individuals with broader hips are at more risk to develop knee pain. Both the young and old people can be inflicted by knee pain but site of pain may vary person to person.

Tips to manage knee pain:

• Consult your family doctor or bone & joint expert for an early diagnosis.
• At home, early treatment involves wrapping with crepe bandage and elevation of knees to prevent swelling.
• Obesity is the major factor for the knee problem, so body weight control should be your first priority.
• Avoid climbing stairs and do non-impact exercise like walking or stationary cycling.
• Use sports shoes as these would help to reduce impact shock while walking.
• Warm oil or pain relieving liniment, spray or gel can be applied to knee joint and injured muscles.
• Try to keep your knees straight while sitting in a chair.
• Join rehabilitation exercise program to strengthen the muscles involved in injury and to regain power & coordination of the knee joint movement.
• Keep in touch with your physician for proper medication to avoid osteoarthritis.

Urinary Bladder Cancer and People at Risk

Blood in urine, termed as hematuria in medical terminology, is the first warning sign of urinary bladder cancer. However, other causes need to be evaluated and one should not panic on seeing blood in urine. Benign tumors, stones in kidney or urinary bladder and infection can also cause hematuria. Generally early stages of the bladder cancer cause bleeding but pain may be absent or there could be mild pain. Enlarged prostate in males may also show such symptoms. Blood in urine may be present one day and absent on the other day or for a week also. Change in bladder habits, such as burning during urination and extra urgency of passing urine can also be symptoms of bladder cancer.

Smokers are at great risk of having urinary bladder cancer. Cancer causing chemicals carcinogens) from tobacco smoke are absorbed from the lung into the blood circulation, filtered through kidneys and concentrated in urine. Toxic effect of these chemicals damage the internal lining of the bladder and increase the chances of development of cancer. Beta-naphthylamine , aromatic amines and benzidine used in dye industry can cause bladder cancer in industrial workers associated with textile & dying industry. Industrial workers associated with industries making rubber, leather goods and paints are also at high risk. Workers of printing companies are also at risk due to exposure to aromatic amines in printing inks. Painters and hairdressers are equally at risk of developing urinary bladder cancer. The risk of developing urinary bladder cancer increases with advancing age. It has been observed that urinary bladder cancer is more prevalent in men than women probably due to variation in exposure to carcinogenic chemicals and smoking habits.

Urinary bladder cancer can be treated through intravesical therapy and/or chemotherapy after surgical cystectomy. Cytological study of urinary deposit can be helpful in establishing a diagnosis of urinary bladder cancer. Pathological diagnosis of transurethral biopsy of urinary bladder is also sometimes required to establish the diagnosis. Superficial bladder cancer (early stage) can be treated through transurethral resection(TUR) using a rigid cystoscope called resectoscope, by an expert urologist. When the bladder cancer has deep roots or it is of invasive type, radical cystectomy may be required to remove all parts of the urinary bladder and further reconstructive surgery is performed to construct artificial bladder from a short piece of intestine. Just trust your urologist.

Chemistry of Life: A convergence of organic and Inorganic matter

The chemistry of life is very complex subject. Our body is made-up of very complicated chemical compounds built up from about one dozen elements. Several dozen chemicals produced from about a dozen basic elements make the living matter in unicellular as well as multi-cellular plants and animals. The most common elements, which are constituents of various organic and inorganic compounds in our body are: Hydrogen (H), Oxygen (O), Carbon (C), Nitrogen (N), Calcium (Ca), Phosphorus (P), Iron (Fe), Iodine (I), Magnesium (Mg), Sulphur (S), Sodium (Na), Potassium (K) and Chlorine (Cl). Sodium is the main constituent of the living matter in all body fluids in animals and human beings. Potassium is present in the cells in animals and humans but present in abundant in plants. Hydrogen and Oxygen are the constituents of water (H₂O). Water is the vehicle of life force as life is not possible without water. Hydrogen, Oxygen and Carbon are the constituents of carbohydrates. Proteins are composed of Hydrogen, Carbon, Oxygen, Nitrogen, Phosphorus and Sulphur, however all proteins do not contain Sulphur. Though we have been successful in analyzing the chemical constituents of living matter but life can not be created by just mixing of these chemicals. These chemicals act as a fuel for the propagation and preservation of life. Water and Oxygen have a vital role in creation of bioenergy and its transportation to various cells and tissues of the body. Exocrine and endocrine glands of our body play a vital role in the production and regulation of various bio-compounds required for normal health. Kidneys play excretory and regulatory function for maintaining a state of homoeostasis.

Screen Capture Software 3.6.242197

Whenever we write ezine articles for our blog, we need to capture and crop images from different sources. This tool would be very convenient for you as it is a multitasking tool. To try SnapIt Screen Capture Software for Free, just visit link cited at the end of the article. Brief information about the wonderful features and uses of this product has been exhibited below:

Snapshot-Screen Capture:

Capture anything you see on your PC screen! Don't waste time cropping your captures. Take a "snapshot" of anything exactly what you need, with just a click. Irreplaceable tool for Bloggers, Designers, Office Workers, Business People, Analysts, Technical Writers who have to describe interfaces, menus, buttons, etc.

Unique Features:

- Supports hotkeys, auto-saving, clipboard
- Automatically copies screenshots to the clipboard
- Tracks capture history, auto-saves captured images
- Saves files in BMP, GIF, JPEG, PNG and TIFF formats
- Auto-names captured images

Here is the Link: <a href="http://www.digeus.com/
products/snapit/snapit_screen_
capture_3_5.html">Screen Capture</a>

Windows 7 TuneUp suite for better PC maintenance and security

Windows 7 TuneUp suite is your all-purpose tool for better PC maintenance and security. Plus, it protects your computer from system crashes, repairs and maintains your PC health, removes unneeded Internet clutter, regains valuable disk space, cleans your registry and tweak windows to perform better.

Main Features:
* Support Windows XP/Vista/7
* Eliminates system crashes, freezes and slowdowns
* Automatically identifies and repairs common Windows problems
* Eliminate BSOD (Blue Screen of Death)
* Speeds up boot up time
* Repairs defects by building a fresh registry
* Compacts registry by removing gaps and unused space
* Removes fragmentation with a linear and sequential registry
* Improves system performance due to faster registry load/read
* Finds and deletes duplicate files of any type
* Saves space on your hard drive
* Extends internal system uninstaller with features to find and delete left traces (e,g registry keys, folders etc.)
* Improves your Windows PC's overall performance and stability
* Question based services and drivers tune up
* Automatically tweaks system services and drivers for better performance
* Recovers CPU & Memory usage taken by unneeded services and drivers
* Full control of the programs that are loaded during Windows startup
* Add/remove/edit startup items
* Task scheduler configurator
* Cleans Browser History
* Cleans history index.dat file content in Internet Explorer.

Here is the link:

<a href="http://www.windsty.com/
products/windows_7_
tuneupsuite/windows-7-tuneup.
html">Windows 7 Repair</a>

Acute Rheumatic Fever in Children: Diagnostic Criteria

Acute rheumatic fever (ARF) is a common diagnostic problem in developing countries. The incidence of ARF (acute rheumatic fever) in developed countries is well under control. Joint pain can be common problem in children but may rarely be symptom of serious joint disease. The physician must be able to determine whether the pain is a result of some lifestyle disorder or of some serious problem within the joints. Juvenile rheumatoid arthritis or rheumatic fever may also be a cause of joint pains and should always be ruled out. Complex and variable presentation of this devastating disorder sometimes confuse the physicians to reach at a diagnosis clinically.

Signs & symptoms and clinical history:

The spectrum of diagnoses that need to be considered can be narrowed down on the basis of clinical history. Age, sex and the acute or insidious mode of onset and development of joint pains act as pointers of the clinical history's role in diagnosis of the rheumatic fever or juvenile rheumatoid arthritis. The diagnostic workup of a child demands a history of preceding or concurrent illness presenting with sore throat or viral symptoms, or a history of recent immunization for rubella or other viral infections. The location, pattern and duration of joint pain are other important points to be taken into consideration.

Diagnostic criteria:

The diagnosis of rheumatic fever is very complicated as the disease may affect a number of organs and tissues. The fact is that no single laboratory test or clinical manifestation is enough to be diagnostic. A composite understanding of clinical manifestations and laboratory investigations is essential to reach at a diagnosis of ARF. If supported by the evidence of preceding Group-A Streptococcal infection, the presence of two major manifestations or one major and two minor manifestations is must to make a diagnosis of rheumatic fever.

1) Major manifestations: As proposed by the American Heart Association, the major manifestations of acute rheumatic fever are clinical evidences of this disease. The major manifestations are: carditis polyarthritis, chorea, erythema marginatum and
subcutaneous nodules. The arthritis/polyarthritis is the most common major manifestation found in the majority (around 75%) of patients during the acute stage of the disease and the remainder being found in relatively small proportion (around 25%) of patients. The arthritis is painful with the joints being swollen, red and warm to touch. Ankles, knees, elbows and wrists are usually involved. Rheumatic carditis is the most serious manifestation of acute rheumatic fever and may affect around 5% of patients with ARF. Chorea means rapid, purposeless involuntary movements of various body parts, generally bilateral and accompanied by muscle weakness. Around 15% of the patients with rheumatic fever may show the signs of chorea. The rash of rheumatic fever is called Erythema marginatum and is nonpruritic, nonindurated and pink rash. Lesions may vary in size and occur mainly on the trunk, buttocks and proximal extremities and occurs in around 5% of patients with rheumatic fever. Subcutaneous nodules are firm, painless nodules and may appear over some joints in about 1% of patients with rheumatic fever.

2) Minor manifestations and laboratory investigations: The minor manifestations of rheumatic fever are: history of previous rheumatic fever or rheumatic heart disease, arthralgia, fever, elevated acute phase proteins and prolonged P-R intervals on Electrocardiogram (ECG). The minor manifestations tend to be less specific than the major manifestations discussed above. The laboratory studies such as detection of elevated levels of acute phase reactants are also nonspecific. Differential count of white blood cells may show granulocytosis in patients having acute streptococcal infection. Fever is always present at the onset of an attack of rheumatic fever. The temperature is usually around 102^o F (39^o C) at the onset and may persist at around 100^o F (37.8^o C) for several weeks. Arthralgia means the presence of joint pain in one or more joints without inflammation, tenderness or limitation of range of motion of a joint. If polyarthritis has already been counted as major manifestation, arthralgia should be ignored. Elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and fibrinogen are generally observed in untreated patients with rheumatic fever. These are nonspecific indicators of inflammation and neither ESR nor CRP is specific for rheumatic fever. Prolongation of P-R interval on ECG usually indicates an abnormal delay in conduction through the atrioventricular (AV) node. P-R interval prolongation on ECG is observed in around 35% of patients with rheumatic fever but may also be present in other inflammatory diseases (Myocarditis and digitalis or quinidine toxicity may also cause prolonged P-R intervals on ECG). A throat swab culture should always be done to isolate Group-A Streptococcal infection at the time of diagnosis of acute rheumatic fever. It is better if antistreptolysin-O (ASO) titers are measured in these patients. Elevated levels of antistreptolysin-O (ASO) titers are observed in approximately 80% of patients
affected by rheumatic fever. An ASO titer of over 300 units in a school-age child is an evidence of recent Group-A Streptococcal infection.

Differential diagnosis:

Non-rheumatic conditions that present with musculo-skeletal pain in children can usually be diagnosed on the basis of physical examination and history without any laboratory investigation. Such conditions could be trauma, hypermobility syndrome, overuse syndrome, benign recurrent limb pains and psychogenic rheumatism. Rheumatic fever, juvenile rheumatoid arthritis, infectious and neoplastic bone disease as causative agents of joint pains need to be evaluated in the light of major and minor manifestations discussed above.

Coronary Heart Disease and Dietary Interventions

Dyslipidemia is the main biochemical feature of coronary heart disease (CHD). Dyslipidemia refers to the elevated level of total cholesterol (TC) as well as triglycerides (TG) or a decreased level of high density lipoprotein (HDL). Dyslipidemia may result from alteration in the production of lipid components or due to abnormal catabolism or clearance as a result of environmental or genetic factors. Single or multiple gene mutations affecting the triglycerides/low density lipoprotein cholesterol are the cause of primary dyslipidemia. Sedentary life style or excessive dietary intake of saturated fat, cholesterol and trans fats can cause secondary dyslipidemia. Secondary dyslipidemia may also be caused due to certain health ailments, such as: diabetes mellitus (DM), obesity, chronic kidney disease, hypothyroidism, primary biliary cirrhosis and cholestatic liver disease. Overuse of alcohol and some drugs can also cause secondary dyslipidemia. Early identification and treatment of children with primary dyslipidemia or hyperlipidemia is important to prevent coronary heart disease. Screening is recommended for children above the age of two having positive family history of premature coronary heart disease, early heart disease. Positive family history of CHD refers to the history of angina pectoris, peripheral vascular disease, myocardial infarction, cerebrocardiac disease, coronary atherosclerosis or sudden death before the age of 55 years in parents, grand parents or first degree uncle or aunt.

Fasting cholesterol and low density lipoprotein (LDL) levels should be determined in the sera of children suspected to have dyslipidemia. Total cholesterol level <170 mg/dl and LDL <110 mg/dl are considered normal, whereas total cholesterol level >200 mg/dl and LDL >130 mg/dl are considered elevated in children. Levels between upper and lower limits could be called borderline values. Physical activity in the form of exercise and brisk walking should be encouraged to maintain weight control and endurance in insulin resistance in diabetics to prevent the risk of developing cardiovascular disease.

Dietary interventions play a vital role in the management of dyslipidemia. A diet low in saturated fat and cholesterol, high in complex carbohydrates should be encouraged for the normal growth and maintenance of desirable weight. Dietary fibre intake should be increased as it helps in reducing the blood cholesterol levels. 'Whole wheat flour bread', corn fakes and barley sattu should be preferred in addition to leafy vegetables. Regular intake of diet containing phytosterols/stanols, omega-3 fatty acid and Soya protein have been found to be effective to reduce the serum LDL cholesterol as well lowering the total cholesterol. Pharmacological treatment is recommended for managing the dyslipidemia in children at 10 years of age and adolescents with LDL>190mg/dl.

Rickets: A preventable bone disease

Rickets is a well known bone disease seen among infants and children. It causes skeletal deformities and softening of bones. An identical disorder seen amongst adults is known as osteomalacia. Rickets is a vitamin deficiency disease caused by lack of vitamin-D. Dietary intake of vitamin-D and natural conversion of pro-vitamin-D to vitamin-D through ultraviolet radiation of sunlight is must for the prevention of rickets. Inadequate exposure to sunlight may be the main biological factor responsible for the development of rickets, but inadequate intake of vitamin-D and calcium remains the number one cause of rickets. So, the main factors responsible for causing rickets are malnutrition, vegetarianism and inadequate exposure to sunlight. Rickets is very common amongst the malnourished children. Egg yolk, butter and some species of fish are the best known natural sources of vitamin-D. Lactating mothers should always take adequate diet rich in vitamin-D to prevent rickets in their infants. Growing children need food supplements fortified with vitamin-D in addition to normal diet and adequate exposure to sunlight for healthy bones and prevention of rickets.

Geriatrics: Old age and its management

The definition of old age varies in indifferent zones of the worldwith respect to the cutoff age or the age of onset of old age. Arbitrarily the attainment of the age of 65 years is said to be the knocking point of old age, but the health status of all old people is always influenced by physical and emotional stress. As a general criterion , all people above the age of 75 fall in the category of old. Generally doing all the duties of personal cleanliness and comfort, unassisted is a challenge for some old people. Since 1950 Geriatric medicine has been recognized as a specialty of medicine which focuses on the healthcare of aged citizens. Geriatricians are better trained in the care of elderly patients than the general physicians. The old generally suffer from incapacitating illness. Very few hospitals have special wards for old and the specialty of geriatrics. Many people suffer a decline in their metabolic and immune functions when they get old. The health authorities of all the countries should have comprehensive policy for the care of old people. Our cultural traditions include the respect for parents and the old. The fifth commandment directs, "to honour thy father and mother". The specialized agencies of the U.N. (including I.L.O., F.A.O., U.N.E.S.C.O. and W.H.O.) and many non-governmental organizations (NGOs) have been doing their best for the general care and medicinal needs of the elderly. NGOs should focus their attention on the vital sectors like personal hygiene, food, optimal clothing, exercise and entertainment in an effort to provide quality life to the inmates of old age homes. The elderly people need our special attention as we do in case of children. There is a need for integration of the specialty of geriatrics with other medical and paramedical services in order to provide appropriate medical expertise to elderly patients.

Type-2 Diabetes and the role of incretins

The incretins are the hormones, which are released into the blood circulation in response to nutrients we eat. These peptide hormones are generally released within minutes of eating or enteral nutrition. In humans, the major incretins are: (i) Glucagon like peptide-1 (GLP-1) and (ii) Glucose-dependent insulinotropic polypeptide (GIP). GLP-1 is secreted by L-cells in the ileum and colon, while GIP is secreted by K-cells in the duodenum of our alimentary canal. GLP-1 and GIP stimulate insulin secretion by the pancreas and also affect the gut and the brain. Their combine effect make significant contribution in glucose homoeostasis, particularly in scaling down the peak of postprandial glucose level. It has been proved through experimental studies that the GLP-1 has the major incretin effect; that is around 80% of the combine effect of GLP-1 and GIP. These incretins probably act via glycoprotein-coupled receptors.

Non-insulin dependent diabetes mellitus (NIDDM) or type-2 diabetes mellitus (Type-2 DM) is characterized by pancreatic beta-cell dysfunction and variable degree of insulin response. Complex interaction of genetics and environmental factors are responsible for metabolic disorders leading to diabetes. Taming of hyperglycemia through medicines, dietary control and regular exercise is possible. Increasing prevalence of obesity and reduced physical activity is directly related to the increasing prevalence of type-2 DM, worldwide. Oral antidiabetic agents, diet and or exercise and insulin are currently used for the treatment of patients with diabetes. Existing antihyperglycemic agents are often associated with an increased risk of adverse effects (such as weight gain and hypoglycemia) and most often become less effective due to histological/cellular variations (progressive beta cell failure) in the pancreas of the patient.

Incretins provide insulinotropic stimulus and thus lower the blood glucose level by increasing insulin secretion. However, the incretin response to a meal lasts approximately around 3 hours as the incretin molecules have very short half-life (<5 minutes) and are metabolized quickly. An enzyme known as dipeptidyl peptidase-4 (DPP4), produced by endothelial cells, disintegrate the incretin molecules within 2-3 minutes of their secretion. Poor incretin response has been observed in patients with type-2 diabetes during the glucose tolerance test as indicated by reduced level of GLP-1 as compared to normal individuals. The functional response (insulinotropic response) of GLP-1 was found to be intact in patients with type-2 diabetes and that gave new direction to the treatment regimen of diabetes. At present the incretin system has been under active study to find out the effective compounds for the treatment of type-2 diabetes. Pharmaceutical compounds like: (1) GLP-1 'analogues' or GLP-1 receptor agonists which are resistant to breakdown by DPP4 and (2) Incretin enhancers which inhibit the action of DPP4 on GLP-1 molecules, have been under active study for use in new formulations.

Exenatide is already in clinical use after its approval by US-FDA. Exenatide is a biosynthetic form of GLP-1 analogue-exendin-4. Exendin-4 is a naturally occurring GLP-1 found in the saliva of a lizard known as Gila monster. It was approved by US-FDA in 2005 for use in combination with metformin or sulfonylureas or both together. Exenatide is administered twice daily before meals by subcutaneous injections from a pre-filled pen. Incretin enhancers improve the control of glucose level in blood by inhibiting DPP4 action on incretin hormones especially GLP-1 molecules. Incretin enhancer Sitagliptin was approved by US-FDA in 2006 and Vildagliptin was approved by US-FDA in 2007, and both have been used as monotherapy or in combination with antidiabetic drugs like metformin or thiazolidinedione for glycemic control in patients affected by type-2 diabetes.

Important Note: Antihyperglycemic treatment should always be taken in consultation with a physician or specialized diabetologist.