What is Pes Planus

Flatfoot (pes planus) is a condition in which the longitudinal arch in the foot, which runs lengthwise along the sole of the foot, has not developed normally and is lowered or flattened out. One foot or both feet may be affected.

What causes flatfoot?

Flatfoot may be an inherited condition or may be caused by an injury or condition such as rheumatoid arthritis, stroke, or diabetes.

Who is affected by flatfoot?

Children as well as adults may be flat-footed. Most children are flat-footed until they are between the ages of 3 and 5 when their longitudinal arch develops normally.

What are the symptoms?

People who have flat feet rarely have symptoms or problems. Some people may have pain because of:

• Changes in work environment.
• Minor injury.
• Sudden weight gain.
• Excessive standing, walking, jumping, or running.
• Poorly fitted footwear.

Children sometimes have foot discomfort and leg aches associated with flat-footedness.

How is it treated?

Treatment in adults generally consists of wearing spacious, comfortable shoes with good arch support. Your doctor may recommend padding for the heel (heel cup) or orthotic shoe devices, which are molded pieces of rubber, leather, metal, plastic, or other synthetic material that are inserted into a shoe. They balance the foot in a neutral position and cushion the foot from excessive pounding.

For children, treatment using corrective shoes or inserts is rarely needed, as the arch usually develops normally by age 5.

Surgery is rarely needed.

You may be able to relieve heel pain by stretching tight calf muscles. See a picture a calf stretch  exercise.

• Stand about 1 ft (30 cm) from a wall and place the palms of both hands against the wall at chest level.
• Step back with one foot, keeping that leg straight at the knee, and both feet flat on the floor. Your feet should point directly at the wall or slightly in toward the center of your body. Keep the knee of the leg nearest the wall centered over theankle.
• Bend your other (front) leg at the knee, and press the wall with both hands until you feel a gentle stretch on your back leg (calf muscle).
• Hold for a count of 10 (increasing the count to 30 or longer as you continue over several weeks). Switch legs and repeat. Do this 2 to 4 times a day.

Foot-strengthening exercises done with a towel and weights. See a picture of atowel curl  exercise.

• Place a towel on the floor, and sit down in a chair in front of it with both feet resting flat on the towel at one end.
• Grip the towel with the toes of one foot (keep your heel on the floor and use your other foot to anchor the towel). Curl your toes to pull the towel toward you.
• Repeat with the other foot. To increase strength, later use 3 lb (1.5 kg) to 5 lb (2.5 kg) weights (such as a large can of fruit or vegetables) on the other end of the towel.

Torticollis

Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.

Causes

Torticollis may be:

• Inherited -- due to changes in your genes
• Acquired -- develops as a result of damage to the nervous system, upper spine, or muscles

If the condition occurs without a known cause, it is called idiopathic torticollis.

Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the baby's head was in the wrong position while growing in the womb, or if the muscles or blood supply to the neck are injured.

Symptoms

• Limited range of motion of the head
• Headache
• Head tremor
• Neck pain
• Shoulder that is higher on one side of the body
• Stiffness of the neck muscles
• Swelling of the neck muscles (possibly present at birth)

Exams and Tests

Tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show:

• Head tilts toward the affected side while the chin points to the opposite side
• Shortening of the neck muscles
• The entire head pulls and turns to one side (in more severe cases)

Tests that may be done include:

• CT scan of the neck
• Electromyogram (EMG) to see which muscles are most affected
• MRI of the brain

Treatment

Treating torticollis that is present at birth involves stretching the shortened neck muscle. Passive stretching and positioning are used in infants and small children. These treatments are often successful, especially if they are started within 3 months of birth.

Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Torticollis that is caused by damage to the nervous system, spine, or muscles is treated by identifying the cause of the disorder.

• Applying heat, traction to the cervical spine, and massage may help relieve head and neck pain.
• Stretching exercises and neck braces may help with muscle spasms.
• Medications may be used, including the anticholinergic drug baclofen.
• Injecting botulinum toxin can temporarily relieve torticollis, but repeat injections are usually needed every 3 months.
• Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. In some cases, surgery involves destroying some of the nerves in the neck muscles, or brain stimulation.

Outlook (Prognosis)

The condition may be easier to treat in infants and children. If torticollis becomes chronic, numbness and tingling may develop due to pressure on the nerve roots in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Possible Complications

Complications may include:

• Muscle swelling due to constant tension
• Nervous system symptoms due to pressure on nerve roots

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms do not improve with treatment, or if new symptoms develop.

Torticollis that occurs after an injury or with illness may be serious. Seek immediate medical help if this occurs.

Prevention

While there is no known way to prevent this condition, early treatment may prevent it from getting worse.

Poliomyelitis

What is polio?

Polio is a viral disease which may affect the spinal cord causing muscle weakness and paralysis. The polio virus enters the body through the mouth, usually from hands contaminated with the stool of an infected person. Polio is more common in infants and young children and occurs under conditions of poor hygiene. Paralysis is more common and more severe when infection occurs in older individuals.

Who gets polio?

The number of cases of polio decreased dramatically in the United States following the introduction of the polio vaccine in 1955 and the development of a national vaccination program. The last cases of naturally occurring polio in the United States were in 1979. Most of the world's population resides in areas considered free of wild poliovirus circulation. Travelers to countries where polio cases still occur should know they are immune or be fully immunized. In 2008, these areas include Africa, Southeast Asia, and the Eastern Mediterranean.

How is polio spread?

Polio is spread when the stool of an infected person is introduced into the mouth of another person through contaminated water or food (fecal-oral transmission). Oral-oral transmission by way of an infected person's saliva may account for some cases.

When and for how long is a person able to spread polio?

Patients are most infectious from seven to ten days before and after the onset of symptoms. However, patients are potentially contagious as long as the virus is present in the throat and feces. The virus persists in the throat for approximately one week after the onset of illness and is excreted in the feces for three to six weeks.

What are the symptoms of polio?

Up to 95 percent of people infected with polio have no symptoms. However, infected persons without symptoms can still spread the virus and cause others to develop polio. About four to five percent of infected people have minor symptoms such as fever, muscle weakness, headache, nausea and vomiting. One to two percent of infected persons develop severe muscle pain and stiffness in the neck and back. Less than one percent of polio cases result in paralysis.

How soon after infection do symptoms appear?

The incubation period is commonly six to 20 days with a range of three to 35 days.

What are the complications associated with polio?

Complications include paralysis, most commonly of the legs. Paralysis of the muscles of breathing and swallowing can be fatal.

What is the treatment for polio?

There is presently no cure for polio. Treatment involves supportive care.

Does past infection with polio make a person immune?

There are three types of polio virus. Lifelong immunity usually depends on which type of virus a person contracts. Second attacks are rare and result from infection with a polio virus of a different type than the first attack.

Is there a vaccine for polio?

There are two types of polio vaccine: trivalent oral polio vaccine (tOPV), given by mouth, and inactivated polio vaccine (IPV), given as an injection. As of January 2000, tOPV is no longer recommended for immunization in the United States. The recommended schedule for childhood immunization is for IPV to be given at two, four, and six to 18 months of age and between four to six years of age. Adults traveling to countries where polio cases are occurring should review their immunization status to make sure they are immune.

In New York State, polio vaccine is required for all children enrolled in pre-kindergarten programs and schools.

How can polio be prevented?

Maintaining high levels of polio immunization in the community is the single most effective preventive measure.

What is post-polio syndrome (PPS)?

PPS is a condition that affects polio survivors ten to 40 years after recovery from an initial infection. PPS is characterized by further weakening of muscles that were previously affected by the polio infection. Symptoms include fatigue, slowly progressive muscle weakness and deterioration. Joint pain and bone deformities are common. PPS is generally not life-threatening. There is no known cause or effective treatment for PPS.

The Moro reflex

The Moro reflex is an early infantile survival reflex and describes the behavior towards a threatening situation which occurs also in other mammals. The pediatrician Ernst Moro discovered and named the reflex after himself.

Trigger of the Moro reflex is a sudden stimulus which frightens children. Babies open their mouth, breathe in fiercely, move their arms and straddle their fingers. Afterwards they breathe out move their arms back to body and clench their fists.

This course of movement proceeds rapidly and enables suckling for instance the first breath when they are threatened to choke.

History shows that the Moro reflex grants sucklings a secure hold of their mother’s fur when danger occurs. You can notice this reflex while observing primates.

The persistent Moro reflex

The startle response normally replaces Moro reflex during neuronal development in the second to fourth month. Persistence of Moro reflex is perceived when a baby is older than 4 or 5 months. These children are often jumpy and sleep very anxiously. They often wake up at night because of that reflex.

Moro reflex in adulthood is actually observable too. Persistence of Moro reflex is especially unpleasant in childhood and leaves the growing person concerned with many questions. This results in distortion of perception and at long last in anxiety, disorder of coordination, balance problems, photosensitivity and eyestrain. You can ascribe recurring infections in the ENT Ear-nose-throat area to persistent Moro reflex.

What can you do?

Wrap your baby tightly in a soft blanket or in the special NONOMO® swaddle if it suffers from persistent Moro reflex. By this, you can avoid uncontrolled startle response while baby is sleeping at night.

Many babies don’t startle too when they are close to their parents and in motion e.g. when they are carried or in the NONOMO® hammock.

Being limited in the space of movement reminds many babies of their time in womb and the granted security. So many babies calm down when they are wrapped in a swaddle.

Arm Injuries

Minor arm injuries are common. Symptoms often develop from everyday wear and tear, overuse, or an injury. Arm injuries are often caused by:

• Sports or hobbies.
• Work-related tasks.
• Work or projects around the home.

Your child may injure his or her arm during sports or play or from accidental falls. Chances of having an injury are higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Forearms, wrists, hands, and fingers are injured most often. An injury to the end of a long bone near a joint may harm the growth plate and needs to be checked by a doctor.

Older adults have a greater chance for injuries and broken bones because they lose muscle mass and bone strength (osteoporosis) as they age. Older adults also have more problems with vision and balance, which increases their chances of having an accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Acute injuries

Acute injuries come on suddenly and may be caused by a direct blow, a penetrating injury, or a fall or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries usually require prompt medical evaluation and may include:

• Bruises (contusions), which occur when small blood vessels under the skin tear or rupture, often from a twist, bump, or fall. Blood leaks into tissues under the skin and causes a black-and-blue color that often turns purple, red, yellow, and green as the bruise heals.
• Injuries to the tough, ropelike fibers (ligaments) that connect bone to bone and help stabilize joints (sprains).
• Injuries to the tough, ropelike fibers that connect muscle to bone (tendons).
• Pulled muscles (strains).
• Muscle ruptures, such as a biceps or triceps rupture.
• Broken bones (fractures). A break may occur when a bone is twisted, struck directly, or used to brace against a fall. See a picture of a fractured arm.
• Pulling or pushing bones out of their normal relationship to the other bones that make up a joint (dislocations).

Overuse injuries

Overuse injuries occur when stress is placed on a joint or other tissue, often by "overdoing" an activity or repeating the same activity. Overuse injuries include:

• Pain and swelling of the sac of fluid that cushions and lubricates the joint area between one bone and another bone, a tendon, or the skin (bursitis).
• Pain and swelling of the tough, ropelike fibers that connect muscles to bones (tendinitis).
• Pain and swelling from tiny tears (microtears) in the connective tissue in or around the tendon (tendinosis). Other symptoms of this type of tendon injury include loss of strength or movement in the arm.
• Hairline cracks in bones of the arm (stress fractures).
• Pressure on nerves in the arm, such as carpal tunnel syndrome.

Treatment

Treatment for an arm injury may include first aid measures (such as using a brace, splint, or cast), "setting" a broken bone or returning a dislocated joint to its normal position, physical therapy, medicines, and in some cases surgery. Treatment depends on:

• The location, type, and severity of the injury.
• When the injury occurred.
• Your age, health condition, and activities (such as work, sports, or hobbies).

Leg Fracture

A leg fracture is a break in any of the 3 long bones of your leg. The femur is the largest bone and goes from your hip to your knee. The fibula and tibia are the 2 bones in your lower leg that go from your knee to your ankle.

What causes a leg fracture?

A leg fracture is often caused by an injury. Car and sports accidents are common causes of leg fractures. Stress fractures can occur from repetitive use or overuse. They are tiny cracks that form in long bones, such as your tibia. Osteoporosis (brittle bones) can increase your risk for a leg fracture if you fall.

What are the different types of leg fractures?

• Nondisplaced: The bone cracks or breaks but stays in place.
• Displaced: The bone breaks into 2 pieces.
• Open fracture: The broken bone breaks through your skin.

What are the signs and symptoms of a leg fracture?

• Pain that worsens when you move your leg
• Decreased ability or inability to move your leg
• Leg pain that worsens when you stand on your injured leg
• Deformity (your leg is shaped differently than normal).
• Swelling, bruising, or blistering in the area of your leg injury
• Pain when you touch the injured area
• Weakness or loss of feeling in your leg

What is Quadriplegia

Quadriplegia is a type of paralysis and loss of sensation that affects a person’s upper and lower body. It usually starts at or around the shoulders and extends downward, including both arms and legs. An individual who is quadriplegic may lack sensation in the affected areas and lose the ability to control the affected body parts. For example, an affected individual is typically unable to feel and lift her arms and legs.

Brain or spinal cord injuries are generally the cause of quadriplegia. An injury to the spinal cord that results in quadriplegia is referred to as a lesion. Such injuries may occur in vehicle accidents or falls. Some people develop quadriplegia because of a sporting accident. The condition also can result from a disease, such as polio.

A person is said to have a complete spinal cord injury if he is totally paralyzed below a lesion. If he has some function or feeling below the lesion, the individual is said to have an incomplete spinal cord injury. For example, an individual may be able to feel body parts below a lesion but not move them. The condition can work in an opposite manner as well, allowing patients to have control of their body parts but no sensation.

Besides the loss of function and feeling in the arms and legs, an individual with quadriplegia may have to deal with the loss of bladder and bowel control and impaired digestion. Breathing may be affected too, particularly in patients with lesions that affect a high part of the spinal cord. Quadriplegics often struggle with pressure sores, infections, and fractures. Many battle depression as well.

Many quadriplegics have injuries that leave them without sensation and function for the duration of their lives. Some do, however, recover a small amount of function. Many patients require machines to help them breathe, while others are able to breathe on their own. Some are able to handle daily living tasks independently, while others are completely dependent on others for their care.


Interestingly, the idea that all quadriplegics are confined to a wheelchair is a misconception; some retain the ability to walk. The function and sensation a person has depends on the severity of his injury. An individual may be more severely affected on one side of the body or even in a certain area of the body. For example, an individual may lose function of his fingers but not his arms. Likewise, he may lose sensation in one leg, yet retain some sensation in the other.

Medial epicondylitis

Tennis elbow is an overload or overuse condition in which the muscles of the forearm are affected – in particular the muscles that flex the wrist – the ‘forehand’ muscles in tennis or the muscles of the dominant arm in golf.

Although the condition is termed ‘golf elbow’ since it is common in golfplayers, only a small proportion of patients actually get the condition from playing golf.

The forehand muscles are attached to the medial epicondyle of the humerus. Hence the other term for it is medial epicondylitis – since the ‘common flexor attachment’ is involved due to the repetitive strain.

Statistics on Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

Golfer’s elbow is less common than tennis elbow. It is common in sportsmen and middle aged people, though it occurs in younger and older persons as well.

Risk Factors for Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

• Golf – with golf there is repetitive use of the muscles causing flexion of the wrist.
• Tennis – similarly, in tennis, repetitive use of the ‘forehand’ muscles causing flexion of the wrists can lead to this condition, especially with putting more top-spin on the ball.
• Other sports and occupational activities may be a cause – involving a lot of flexion of the wrist – gripping, grasping etc
• A direct blow to the elbow may also cause it.
  

  Progression of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

  
  
• The pain may develop gradually or occasionally it may be sudden.
• At the moment the small tear occurs the patient may feel nothing, though several days later an ache develops.
• The pain is worse with activities such as turning on taps, turning door handles, shaking hands.
• The pain often subsides with time if the person abstains from the activity.
  

  How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Diagnosed?

  No investigations are needed for the diagnosis of golfer’s elbow – the diagnosis is clinical.

  Prognosis of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

  This is not a serious condition, though it can be reasonably disabling in the sense that it limits certain activities, and the person’s work. It usually lasts for months – as long as 24 months, though this depends on treatment and whether the exacerbating activity is stopped.

  How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Treated?

  The mainstay of therapy is:
  
  
• Abstaining from exacerbating activities;
• Anti-inflammatory medications (e.g. Non-steroidal anti-inflammatories, Cox-2 inhibitors – though prolonged use may lead to gastritis);
• Gradual stretching and strengthening exercises – such as:
  - Wringing exercises – e.g. rolling up a hand towel, then ‘wringing’ the towel, by first flexing the wrist for 10 seconds, and then extending the wrist for 10 seconds.
  - Weights: sitting with the arms rested, a weight is grasped with the palm facing upwards, and raised by flexing the wrist then extending – gradually increasing the weight.
• Injection of a corticosteroid and local anesthetic (1ml each) may be tried into the lateral epicondyle – up to 2 injections 2-4 weeks apart may be tried.
• After resolution of the condition – the person can gradually return back to the offending activity, though with caution. A non-stretch band or a brace placed 3cm below the elbow may help.

Lateral Epicondylitis

Tennis elbow or lateral epicondylitis is a common injury causing pain on the outside of the elbow.

Despite it's name, this condition is not commonly seen in tennis players but more in work related elbow injuries particularly where repetitive stress is involved. Tennis elbow symptoms can be similar to those of other elbow injuries so it is important to get a correct diagnosis early on.

Symptoms of tennis elbow typically consist of pain about 1 to 2 cm down from the bony part on the outside of the elbow called the lateral epicondyle. The patient will have weakness in the wrist and difficulty doing simple tasks such as opening a door handle or shaking hands with someone. Pain is reproduced when pressing just below the lateral epicondyle on the outside of the elbow as well as when trying to straighten or extend the hand and fingers against resistance. See tennis elbow diagnosis for more information on how tennis elbow is diagnosed.

Entrapment of the radial nerve is another injury with symptoms similar to tennis elbow. Tennis elbow symptoms can also be caused by neck injury

Tennis elbow or Lateral epicondylitis as it is sometimes technically known is inflammation of the lateral epicondyle or bony bit on the outside of the elbow where the muscles attach. However, actual inflammation of the tendon is rare and the cause of the lateral elbow pain could be degeneration of the tendon.

It occurs most commonly in the tendon of the Extensor carpi radialis brevis muscle where there is an increase in pain receptors in the area making the region extremely tender.

The most common cause of tennis elbow is overuse or repetitive strain caused by repeated extension or bending back of the wrist against resistance. Gripping heavy objects like a manual screw driver, weight training or handling bricks will also cause tennis elbow. This is seen much more often than in tennis players.

However, if tennis is thought to be the cause then the following should be considered. A poor backhand technique in tennis. If the wrist is bent when striking a back hand the huge forces are transferred through the tendons to the elbow rather than through the entire arm. A racket grip that is too small. This will make the muscles work harder increasing the forces through the tendon. Strings that are too tight. More shock and energy will be transmitted through the forearm from the ball. Playing with wet, heavy balls.

Two types of onset are commonly seen. Sudden onset of tennis elbow occurs in a single instance of exertion such as a late back hand where the extensors of the wrist become strained. This is thought to correspond to micro-tearing of the tendon. Late Onset: This normally takes place within 24-72 hours after an intensive term of unaccustomed wrist extension. Examples may be a tennis player using a new racket or even a person who's spent a weekend doing DIY..

Upper limb muscles

The muscles of the superior limb arise from three different developmental primordia – the caudal branchial arches, the hypaxial body wall, and the limb bud. The first two groups, the branchial arches and body wall muscles, form attachments with the pectoral girdle and help stabilize and move the proximal end of the limb. The muscles of the limb proper (brachial, antebrachial, and hand muscles) and some of the shoulder joint muscles, which migrate secondarily back onto the trunk wall, are all derived from the embryonic limb bud. This is a highly varied group of muscles with a wide range of functions. The muscles range from large muscles that play major roles in supporting and stabilizing the limb, yet produce very small ranges of movement, to other muscles that produce the greatest range of movements in the entire body. Because of its diverse embryonic origins, the muscles of this group receive their nerve supply from different sources. Some of the muscles are supplied by cranial nerves (branchial arch muscles), another is innervated by body wall ventral rami (levator scapulae), and the remainder are supplied by the ventral rami that form the large brachial plexus that courses through the entire upper limb.

Risk Factors for Alzheimer's Disease

While the specific cause or the cure for Alzheimer's disease is not known, the disease appears to develop when the combined effects of certain risk factors reach a threshold level. Many of these risk factors are known but there are likely others that are yet to be identified. When the threshold level is reached, the brain's ability to repair and maintain itself is overwhelmed, and the disease process begins. 

Risk factors increase the chances of getting Alzheimer's disease. Age and genetics are two risk factors that can not be changed. However, it may be possible to reduce many of the other known risks for the disease through lifestyle choices. 

Age 
Advancing age is the most significant risk factor for Alzheimer's disease. Most people who develop Alzheimer's disease are over the age of 65. However the disease process is thought to begin years before cognitive and memory impairments are apparent. It is important to remember that most people do not get Alzheimer's disease as they age. It is not a normal part of aging. Whatever other risk factors are present, Alzheimer's disease never sets in until some minimum adult age is reached. 

Genes 
The familial form of the disease (FAD), passed on directly from generation to generation, accounts for only about 7% of the total incidence of Alzheimer’s disease. While the common form of the disease (sporadic Alzheimer's disease) also has some genetic links much is still unknown. The majority of cases have no single identifiable cause. The role of genetics continues to be studied. 

Other Risk Factors Include:

• Unhealthy eating habits
• Diabetes
• High blood pressure
• High cholesterol levels
• Strokes
• Obesity
• Stress
• Chronic inflammatory conditions
• History of clinical depression
• MCI (mild cognitive impairment)
• Low levels of physical activity
• Low socio-economic status
• Inadequate exercising of the brain
• Low levels of formal education
• Brain injury
• Smoking

Diagnosing Alzheimer’s disease

Since there is no single definitive medical test for identifying Alzheimer’s disease, arriving at the correct diagnosis can take time and patience. Diagnosing Alzheimer's requires a detailed evaluation, including:

A thorough history of symptoms from the patient and spouse or family, including past and present functioning. Determining classic patterns can help your doctor eliminate other causes of Alzheimer’s symptoms, and also distinguish Alzheimer’s from other forms of dementia.

A physical and neurological exam, including cognitive tests to assess such things as orientation (ability to recall details about self, place, and time), attention span, speed of information processing, working memory, and mood and personality.

Other tests, such as brain imaging and blood tests, to rule out other medical causes.

To diagnose Alzheimer's disease from your symptoms, a doctor will look for:

Significant memory problems in immediate recall, short-term, or long-term memory.

Significant thinking deficits in at least one of four areas: expressing or comprehending language; identifying familiar objects through the senses; poor coordination, gait, or muscle function; and the executive functions of planning, ordering, and making judgments.

Decline severe enough to interfere with relationships and/or work performance.

Symptoms that appear gradually and become steadily worse over time.

Other causes to be ruled out to ensure memory and cognitive symptoms are not the result of another medical condition or disease, such as mild cognitive impairment.

Alzheimer's Disease

Alzheimer's disease is a progressive, degenerative disease of the brain, which causes thinking and memory to become seriously impaired. It is the most common form of dementia. 

The disease was first identified by Dr. Alois Alzheimer in 1906. He described the two hallmarks of the disease: 

• Plaque: Numerous tiny dense deposits scattered throughout the brain which become toxic to brain cells at excessive levels.
• Tangles: Twisted fibers that interfere with vital processes eventually "choking" off the living cells.

When brain cells degenerate and die, the brain markedly shrinks in some regions. 

The Effects of Alzheimer's Disease

Alzheimer's disease eventually affects all aspects of a person's life: how he or she thinks, feels and acts. Since individuals are affected differently, it is difficult to predict the symptoms each person will have, the order in which they will appear, or the speed of the disease's progression. 

In general the following will gradually be affected by the disease: 

Mental Abilities
A person's ability to understand, think, remember and communicate will be affected. The ability to make decisions will be reduced. Simple tasks that have been performed for years will become more difficult or be forgotten. Confusion and memory loss, initially for recent events and eventually for long-term events, will occur. The ability to find the right words and follow a conversation will be affected. 

Emotions and Moods 
A person may appear uninterested and apathetic, and may quickly lose interest in the hobbies they previously enjoyed. The ability to control mood and emotion may be lost. Some individuals are less expressive and are more withdrawn. However, it is now becoming clear that a person even in the later stages of the disease may continue to feel joy, anger, fear, love, and sadness. 

Behaviour 
Changes will develop in the way the person reacts to his or her environment. These actions may seem out of character for the person. Some common reactions include repeating the same action or words, hiding possessions, physical outbursts and restlessness. 

Physical abilities 
The disease can affect a person’s physical co-ordination and mobility, leading to a gradual physical decline. This will affect the person's ability to independently perform day-to-day tasks such as eating, bathing and getting dressed. 

Tuberculosis

Tuberculosis (TB) is an infectious disease that usually infects the lungs, but can attack almost any part of the body. Tuberculosis is spread from person to person through the air. When a person with TB in their lungs or throat coughs, laughs, sneezes, sings, or even talks, the germs that cause TB may spread through the air. If another person breathes in these germs, there is a chance that they will become infected with tuberculosis. 

It is not easy to become infected with tuberculosis. Usually a person has to be close to someone with TB disease for a long period of time. TB is usually spread between family members, close friends, and people who work or live together. TB is spread most easily in closed spaces over a long period of time.

If it is not treated, TB can be fatal. But TB can almost always be treated and cured if you take medicine as directed by your healthcare provider. Once you begin treatment, within weeks you will no longer be contagious. That means you can't spread the disease to others. If you take your medicine just as your healthcare provider tells you, all the TB germs should be killed.

What are the Symptoms of TB?

A person with TB infection will have no symptoms. A person with active TB disease may have any, all or none of the following symptoms:

• A persistent cough
• Constant fatigue
• Weight loss
• Loss of appetite
• Fever
• Coughing up blood
• Night sweats

These symptoms can also occur with other diseases so it is important to see a healthcare provider and to let them find out if you have TB. A person with TB disease may feel perfectly healthy or may only have a cough from time to time. If you think you have been exposed to TB, get a TB test.

How is TB Detected?

TB can be detected through a skin test or a TB blood test.

The skin test is done by injecting a small amount of fluid called tuberculin into the skin in the arm. You will be told to return within 48 to 72 hours to have a healthcare worker check the arm to see if a bump has developed. The healthcare worker will measure the bump and tell you if your reaction to the test is positive or negative. If it's positive, it usually means you have been infected with the TB germ.

The TB blood test measures how your immune system reacts to the germs that cause TB.

If you have a positive test for TB infection, it only means that you have been infected with TB germs. It does not tell whether you have developed TB disease. You will be given other tests, such as a chest x-ray and a check of your sputum (coughed up mucus), to see whether you have TB disease.