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Jumat, 17 Juli 2020

Osteoporosis

Osteoporosis


Osteoporosis is a disease that weakens bones to the point where they break easily—most often, bones in the hip, backbone (spine), and wrist. Osteoporosis is called a “silent disease” because you may not notice any changes until a bone breaks. All the while, though, your bones had been losing strength for many years.
Bone is living tissue. To keep bones strong, your body breaks down old bone and replaces it with new bone tissue. Sometime around age 30, bone mass stops increasing, and the goal for bone health is to keep as much bone as possible for as long as you can. As people enter their 40s and 50s, more bone may be broken down than is replaced.
A close look at the inside of bone shows something like a honeycomb. When you have osteoporosis, the spaces in this honeycomb grow larger, and the bone that forms the honeycomb gets smaller. The outer shell of your bones also gets thinner. All of this makes your bones weaker.

Who Has Osteoporosis? Risk Factors and Causes

Although osteoporosis can strike at any age, it is most common among older people, especially older women. Men also have this disease. White and Asian women are most likely to have osteoporosis. Other women at great risk include those who:
  • Have a family history of broken bones or osteoporosis
  • Have broken a bone after age 50
  • Had surgery to remove their ovaries before their periods stopped
  • Had early menopause
  • Have not gotten enough calcium and/or vitamin D throughout their lives
  • Had extended bed rest or were physically inactive
  • Smoke (smokers may absorb less calcium from their diets)
  • Take certain medications, including medicines for arthritis and asthma and some cancer drugs
  • Used certain medicines for a long time
  • Have a small body frame
The risk of osteoporosis grows as you get older. At the time of menopause, women may lose bone quickly for several years. After that, the loss slows down but continues. In men, the loss of bone mass is slower. But, by age 65 or 70, men and women are losing bone at the same rate.

What Is Osteopenia?

Whether your doctor calls it osteopenia or low bone mass, consider it a warning. Bone loss has started, but you can still take action to keep your bones strong and maybe prevent osteoporosis later in life. That way you will be less likely to break a wrist, hip, or vertebrae (bone in your spine) when you are older.

Can My Bones Be Tested?

For some people, the first sign of osteoporosis is to realize they are getting shorter or to break a bone easily. Don’t wait until that happens to see if you have osteoporosis. You can have a bone density test to find out how strong your bones are.
The U.S. Preventive Services Task Force recommends that women aged 65 and older be screened (tested) for osteoporosis, as well as women under age 65 who are at increased risk for an osteoporosis-related fracture.
A bone mineral density test compares your bone density to the bones of an average healthy young adult. The test result, known as a T-score, tells you how strong your bones are, whether you have osteoporosis or osteopenia, and your risk for having a fracture.

How Can I Keep My Bones Strong? Preventing Osteoporosis

There are things you should do at any age to prevent weakened bones. Eating foods that are rich in calcium and vitamin D is important. So is regular weight-bearing exercise, such as weight training, walking, hiking, jogging, climbing stairs, tennis, and dancing.
If you have osteoporosis, avoid activities that involve twisting your spine or bending forward from the waist, such as conventional sit-ups, toe touches, or swinging a golf club. 
Those are the best ways to keep your bones strong and healthy. Learn more about keeping your bones strong to prevent falls.

What Can I Do for My Osteoporosis?

Treating osteoporosis means stopping the bone loss and rebuilding bone to prevent breaks. Healthy lifestyle choices such as proper diet, exercise, and medications can help prevent further bone loss and reduce the risk of fractures.
But, lifestyle changes may not be enough if you have lost a lot of bone density. There are also several medicines to think about. Some will slow your bone loss, and others can help rebuild bone. Talk with your doctor to see if medicines might work to treat your osteoporosis.
In addition, you'll want to learn how to fall-proof your home and change your lifestyle to avoid fracturing fragile bones.

Can I Avoid Falling?

When your bones are weak, a simple fall can cause a broken bone. This can mean a trip to the hospital and maybe surgery. It might also mean being laid up for a long time, especially in the case of a hip fracture. So, it is important to prevent falls. Learn how to prevent falls.

Do Men Have Osteoporosis?

Osteoporosis is not just a woman’s disease. Not as many men have it as women do, maybe because most men start with more bone density. As they age, men lose bone density more slowly than women. But, men need to be aware of osteoporosis.
Experts don’t know as much about this disease in men as they do in women. However, many of the things that put men at risk are the same as those for women, including family history, not enough calcium or vitamin D, and too little exercise. Low levels of testosterone, too much alcohol, taking certain drugs, and smoking are other risk factors.
Older men who break a bone easily or are at risk for osteoporosis should talk with their doctors about testing and treatment.
For more information about osteoporosis, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

10 Common Causes of Hair Loss in Women


Losing some hair every day is completely natural. But when you’re losing a lot of hair, it can be difficult to figure out what’s causing that hair loss—especially in women.

Most of the time minor hair loss is just a sign that your body's growing new, healthy ones to replace the old. In fact, losing up to 100 hairs per day is totally normal. If you’re not sure what’s normal for you, it’s a good idea to simply pay attention to what you typically see in your brush or shower drain. And "if all of a sudden you're noticing a lot more, or your ponytail is thinner or you're seeing more scalp," then you may be losing more hair than you should, Francesca Fusco, M.D., dermatologist at Wexler Dermatology in NYC and assistant clinical professor of dermatology at Mount Sinai, tells SELF.

Figuring out why you’re suddenly losing more hair than usual can be tricky because there are many different causes of hair loss in women. Some, like hereditary hair loss (androgenetic alopecia), aren’t really in your control—you get the hand you're dealt. But others, like traction alopecia or temporary hair shedding (a very common condition called telogen effluvium), can be managed or even reversed if caught early. Making things even more complicated, some causes of hair loss in women result in sudden shedding while others may become progressively more noticeable over time.

If you've noticed your hair is falling out more than usual, looks thinner, or seems to be growing more slowly, here are some of the most common reasons for hair loss in women.

1. Genetics

When we think of hereditary hair loss, we usually go straight to male pattern baldness. But people of all genders are susceptible to hereditary hair loss. In women the hair loss is usually concentrated at the crown of the head (especially noticeable at the hair part), while it’s more likely to affect men along the hairline, the American Academy of Dermatology (AAD) notes.

Although you can’t prevent this type of hair loss entirely, there are treatments available—such as over-the-counter minoxidil or finasteride—that can slow it down and make hair stay fuller longer. So the sooner you start treatment, the better.

2. Childbirth

Normally, your hair goes through three major life stages. First, there’s a growth phase; second, there’s a transitional phase when the growing stops but the hair doesn’t fall out; and then there’s a resting phase. Finally, after the resting phase, your hair falls out.

But during pregnancy, most people notice their hair going into rapid growth mode. "That’s when everything is in a grow, grow, grow phase, because there are surges of hormones [estrogen] that make hair grow," Fusco says. Not only is the growth stage kicked into high gear, but also it lasts longer than normal, meaning that normal shedding doesn't occur.

Once estrogen levels go back to normal after delivery, hair resumes its normal growth cycles and starts to shed all that thick, luscious hair that accumulated over the last 10 months. Some women experience very mild shedding, but others experience intense shedding for a few months.

This type of hair loss (technically, hair shedding) is called telogen effluvium, and it can occur months after a stressful or major life event like childbirth, Bethanee Schlosser, M.D., assistant professor of dermatology and director of the Women's Skin Health Program for Northwestern Medicine, tells SELF. "Shedding peaks about four months after the incident" that caused it, she explains.

Postpartum hair loss is, luckily, temporary. So you don’t really have to do anything to treat it, the AAD says. But there are ways to make your hair look and feel fuller while you wait. For instance, look for volumizing shampoos and conditioners that are formulated for fine hair and avoid products that weigh down the hair.

3. Changes in birth control

Going off hormonal birth control or changing to a different type of hormonal contraception can also cause hormone-induced shedding. "Whether you're just starting it, discontinuing it, or changing brands, your body can react by causing the hair to go into an increased shedding mode," Dr. Fusco says.

This is another form of telogen effluvium, which means that it’s usually temporary. You can rely on volumizing products and styling tricks while you wait for your hair to regain its fullness.

4. Nutritional deficiencies

Creating and maintaining healthy hair relies on getting solid nutrition. In particular, deficiencies in iron, zinc, vitamin B3 (niacin), and protein have all been linked to various types of hair loss.

Treating a nutritional deficiency usually starts with a chat with your doctor and a blood test to accurately diagnose your issue. Then your doctor may treat your deficiency with prescription supplements or may refer you to an R.D. for further guidance.

5. Medications

Some "medications can cause chronic shedding," Dr. Schlosser says. In particular, those used to manage high blood pressure, cancer, arthritis, and depression are known to cause hair loss issues, according to the Mayo Clinic.

If you think your medication may be causing hair loss, check in with your doctor. In many cases, this type of hair loss is temporary. But if your hair loss becomes chronic, your doctor may be able to prescribe a different medication that doesn’t cause this side effect.

6. Intense emotional or physical stress

When you're experiencing something stressful or traumatic—not your average day-to-day stress, but something big and life-altering like a divorce, a death in the family, a significant job change, or a big move—you may experience a temporary halt in hair growth as your body puts its resources toward getting you through said big event.

"Hairs don’t all grow at the same rate," Dr. Schlosser explains. "Some are growing, some are resting, and some are actively being shed. When you have these conditions, your body halts hair growth, and then things get restarted and all these hairs that have been halted start to get pushed out at the same time." The same thing can happen with physical stress and trauma, like having a big operation, being hospitalized, or even losing a significant amount of weight very quickly.

Usually this type of hair shedding is temporary. But if it bothers you, check in with a dermatologist to learn more about styling changes and products you can use to make your hair look and feel fuller.

7. Autoimmune diseases

"An autoimmune condition makes the body recognize its own hair follicles as foreign and it attacks them and makes the hair fall out," Dr. Fusco explains.

This could be a condition like alopecia areata, in which the immune system attacks the hair follicles. Sometimes people with alopecia areata do see their hair grow back (although it may fall out again). But if not, dermatologists can help by prescribing various treatments, like corticosteroid injection to stimulate hair growth, the AAD says.

Conditions that primarily affect another part of the body—like thyroid disease, rheumatoid arthritis, or sickle-cell anemia—can also cause hair loss as one of many symptoms. Additionally, Dr. Schlosser notes that lupus can cause some scarring of the hair follicle, resulting in permanent hair loss.

These conditions can be serious and require an accurate diagnosis from an experienced health care provider. So if you think your hair loss may be connected to an underlying issue like an autoimmune condition, it’s important to talk to your doctor.

8. Wearing too-tight hairstyles too often

This can cause traction alopecia, Dr. Schlosser says. "Classically, this happens when people wear tight braids chronically, but I’ve seen it with tight ponytails too," she explains. It can cause progressive thinning of the hairline, and if you do it for long enough, the hair loss may actually become permanent. It's considered a scarring process, which can damage the hair follicle beyond repair.

To help prevent and treat hair loss due to traction alopecia, Dr. Schlosser advises never wearing one hairstyle for too long, and trying not to pull too tightly if you can help it.

9. Heat-styling your hair regularly

Fusco says that women will come to her and tell her they have hair loss, when really they have something called trichorrhexis nodosa. This is a condition in which damaged, weak points in the hair shaft cause hair to break off easily. The cause? Thermal damage to the hair from things like using hot tools and overbleaching. In this case, the hair loss “is not necessarily from the root but it's from somewhere along the shaft," she explains.

Treatment for trichorrhexis nodosa usually involves finding and avoiding the source of the damage, which could be hot tools, harsh chemicals, or aggressive brushing. Instead, opt for gentle brushing techniques and gentle, soothing hair products.

10. Overprocessing your hair

Getting frequent perms, chemical straightening procedures, or relaxing procedures—basically anything that uses harsh chemicals on your scalp and hair—can damage the hair follicle and cause permanent hair loss. "After repeated insults, the hair follicles just won't grow back," Dr. Schlosser says. This can cause hair to appear thinner, and may be especially noticeable on the scalp.

You can prevent further damage by avoiding those harsh procedures and using products designed to help hydrate and heal your hair and scalp. But if you want your hair to grow back, you’ll likely need to enlist the guidance of a board-certified dermatologist.

There are things you can do to prevent hair loss.

If you notice your hair is thinning and it bothers you, there are some easy ways to make it appear fuller and simultaneously help prevent more hair loss or breakage. For instance, as SELF explained previously, it’s important to:

Wash as often as you need to—but no more. Both under- and overwashing can affect the volume and feel of your hair. Not washing enough causes a buildup of product and oil that can weight your hair down. But washing too frequently can strip the hair of its natural oils, making it more dry and prone to breakage. Experts recommend sticking to washing about two or three times per week and adjusting as needed for your particular situation.

Always use conditioner after shampooing. Conditioner makes your hair shinier and helps reduce static electricity, both of which helps thinning hair look fuller and glossier. But remember: A little goes a long way, and too much will weigh hair down.

Try leave-on products. Leave-in conditioners and detanglers help keep your hair moisturized throughout the day and protect against the effects of heat styling that otherwise can cause thinning and breakage.

Use hair masks for deep conditioning. If your hair tends to be dry and brittle, an occasional deep-conditioning mask may be just what it needs to regain some life and strength. These can also help hair look shinier.

Style your hair gently—and without heat, if possible. Because heat can cause damage to the hair that leads to shedding and breakage, it’s important to limit or avoid heat styling entirely. And when putting your hair up, choose styles that don’t put too much pressure on your hair or scalp. Styles like tight braids, dreads, and ponytails can be particularly damaging when worn repeatedly or for extended periods of time.

Treatment for hair loss is out there.

Most cases of increased shedding will gradually resolve on their own without treatment, Dr. Schlosser says. But if your hair doesn't return to its normal fullness after within nine months, see a doctor for an evaluation to find out whether something else is going on. And if you have other worrying symptoms, like itching, pain, burning, flaking, or redness, you should seek help sooner.

See your primary care provider or go directly to a dermatologist who specializes in treating hair loss. They can determine what type it is and what the right treatment approach is for you.

Kamis, 16 Juli 2020

Heart attack: Symptoms, and How to Overcome Them




heart attacks are:

A heart attack happens when something blocks the blood flow to your heart so it can’t get the oxygen it needs.

More than a million Americans have heart attacks each year. Heart attacks are also called myocardial infarctions (MI). "Myo" means muscle, "cardial" refers to the heart, and "infarction" means death of tissue because of a lack of blood supply. This tissue death can cause lasting damage to your heart muscle..

Heart Attack Symptoms

Symptoms of a heart attack include:
  • Discomfort, pressure, heaviness, tightness, squeezing, or pain in your chest or arm or below your breastbone
  • Discomfort that goes into your back, jaw, throat, or arm
  • Fullness, indigestion, or a choking feeling (it may feel like heartburn)
  • Sweatingupset stomach, vomiting, or dizziness
  • Severe weakness, anxietyfatigue, or shortness of breath
  • Fast or uneven heartbeat
Symptoms can be different from person to person or from one heart attack to another. Women are more likely to have symptoms like an upset stomach, shortness of breath, or back or jaw pain.

With some heart attacks, you won’t notice any symptoms (a "silent" myocardial infarction). This is more common in people who have diabetes.

Heart Attack Causes

Your heart muscle needs a constant supply of oxygen-rich blood. Your coronary arteries give your heart this critical blood supply. If you have coronary artery disease, those arteries become narrow, and blood can’t flow as well as it should. When your blood supply is blocked, you have a heart attack.
Fat, calcium, proteins, and inflammatory cells build up in your arteries to form plaques. These plaque deposits are hard on the outside and soft and mushy on the inside.
When the plaque is hard, the outer shell cracks. This is called a rupture. Platelets (disc-shaped things in your blood that help it clot) come to the area, and blood clots form around the plaque. If a blood clot blocks your artery, your heart muscle becomes starved for oxygen. The muscle cells soon die, causing permanent damage.
Rarely, a spasm in your coronary artery can also cause a heart attack. During this coronary spasm, your arteries restrict or spasm on and off, cutting off the blood supply to your heart muscle (ischemia). It can happen while you’re at rest and even if you don’t have serious coronary artery disease.
Each coronary artery sends blood to a different part of your heart muscle. How much the muscle is damaged depends on the size of the area that the blocked artery supplies and the amount of time between the attack and treatment.
Your heart muscle starts to heal soon after a heart attack. This takes about 8 weeks. Just like a skin wound, a scar forms in the damaged area. But the new scar tissue doesn’t move the way it should. So your heart can’t pump as much after a heart attack. How much that ability to pump is affected depends on the size and location of the scar.

What Do I Do if I Have a Heart Attack?

After a heart attack, you need quick treatment to open the blocked artery and lessen the damage. At the first signs of a heart attack, call 911. The best time to treat a heart attack is within 1 or 2 hours after symptoms begin. Waiting longer means more damage to your heart and a lower chance of survival.

Heart Attack Diagnosis

Emergency medical workers will ask you about your symptoms and do some tests.
Tests to diagnose a heart attack
Your doctor may order tests including:
  • EKG. An EKG (also known as an electrocardiogram or ECG) can tell how much your heart muscle has been damaged and where. It can also monitor your heart rate and rhythm.
  • Blood tests. Different levels of cardiac enzymes in your blood can indicate heart muscle damage. These enzymes are usually inside the cells of your heart. When those cells are injured, their contents -- including the enzymes -- spill into your bloodstream. By measuring the levels of these enzymes, your doctor can find out the size of the heart attack and when it started. Tests can also measure troponin levels. Troponins are proteins inside heart cells that are released when the cells are damaged by the lack of blood supply to your heart.
  • Echocardiography. This imaging test can be used during and after a heart attack to learn how your heart is pumping and what areas aren’t pumping the way they should. The "echo" can also tell whether any parts of your heart (valves, septum, etc.) have been injured in the heart attack.
  • Cardiac catheterization. You might need cardiac catheterization, also called cardiac cath, during the first hours of a heart attack if medications aren’t helping the ischemia or symptoms. The cardiac cath can give an image of the blocked artery and help your doctor decide on a treatment.

Heart Attack Treatment

Treatment begins right away, sometimes in the ambulance or emergency room.
What drugs are used to treat a heart attack?
Drug therapy aims to break up or prevent blood clots, stop platelets from collecting and sticking to the plaque, stabilize the plaque, and prevent more ischemia.
Take these medications as soon as possible (within 1 or 2 hours from the start of your heart attack, if possible) to limit heart damage.
Drugs used during a heart attack may include:
  • Aspirin to stop blood clotting that may make the heart attack worse
  • Other antiplatelet drugs, such as clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta) to stop clotting
  • Thrombolytic therapy ("clot busters") to dissolve blood clots in your heart's arteries
  • Any combination of these
Other drugs given during or after a heart attack help your heart work better, widen your blood vessels, lower your pain, and help you avoid life-threatening heart rhythms.
Are there other treatments for a heart attack?
  • Cardiac catheterization. In addition to making a picture of your arteries, cardiac cath can be used for procedures (such as angiography or stent) to open narrowed or blocked arteries.
  • Bypass surgery. You might have bypass surgery in the days after a heart attack to restore the blood supply to your heart.
Treatments don’t cure coronary artery disease. You can still have another heart attack. But you can take steps to make it less likely.

Tips for Heart Attack Prevention

The goal after your heart attack is to keep your heart healthy and lower your risk of having another heart attack. Take your medications as directed, make healthy lifestyle changes, and see your doctor for regular heart checkups.
Why do I need to take drugs after a heart attack?
You might take certain drugs after a heart attack to:
  • Prevent blood clots
  • Help your heart work better
  • Prevent plaques by lowering cholesterol
You might take medications that treat an uneven heartbeat, lower your blood pressure, control chest pain, and treat heart failure.
Know the names of your medications, what they’re used for, and when you need to take them. Go over your medications with your doctor or nurse. Keep a list of all your medications, and take it to each of your doctor visits. If you have questions about them, ask your doctor or pharmacist.
What lifestyle changes are needed after a heart attack?
To keep heart disease from getting worse and to head off another heart attack, follow your doctor's advice. You might need to change your lifestyle, including:
  • Stop smoking
  • Lower your cholesterol
  • Control your diabetes and blood pressure
  • Follow an exercise plan
  • Keep a healthy body weight
  • Control stress
When will I see my doctor again after I leave the hospital?
Make a doctor's appointment for 4 to 6 weeks after you leave the hospital following a heart attack. Your doctor will want to check your recovery. You might need an exercise stress test on a regular basis. These tests can help your doctor find or slow blockages in your coronary arteries and plan your treatment.
Call your doctor if you have symptoms such as chest pain that happens more often, gets stronger, lasts longer, or spreads to other areas; shortness of breath, especially while you’re resting; dizziness; or uneven heartbeats.

10 of the best hospitals in the world



Methodology
according to global market research and consumer data company Statista, formed a panel of medical professional experts, doctors and administrators from four continents to rank.

Hospitals on the list are "ahead of adapting to ... new challenges while providing leading patient care," the research reports. According to research, this guide is intended to help consumers find where they can get the best hospital treatment "close to home and around the world."

List
Here are 10 of the best hospitals in the world, according to global research:
  1. The Mayo Clinic (Rochester, Minnesota). Mayo Clinic serves more than 1.3 million people each year in 19 hospitals across five states. But, according to Newsweek, what "sets it apart," is the clinic's "educational arm" and research center, which "provid[e] vital innovation for the entire medical community."

  2. Cleveland Clinic (Cleveland). Cleveland Clinic is one of the largest medical providers in the world, with hospitals in the United States, Canada, and the United Emirates. The medical center's heart and surgery program has been ranked as the best in America each year since 1995, and it was the first major medical center to combine clinical services around one organ system or disease.

  3. Singapore General Hospital (Singapore). Singapore General sees more than one million people annually. The tertiary referral hospital has on-campus specialist centers, leads clinical research, and offers undergraduate and postgraduate training for students and professionals.

  4. Johns Hopkins Hospital (Baltimore). Johns Hopkins Hospital serves over three million patients each year through its 40 patient care locations, four health and surgery centers, and six hospitals. It also houses the second-highest rated medical school in the United States, which has "the most advanced clinical research in the world," 

  5. Charité (Berlin). The research-based university hospital is "on the cutting-edge of biomedical innovation" and employs over half of Germany's Nobel laureates in medicine and physiology,  

  6. Massachusetts General Hospital (Boston). Massachusetts General, the teaching hospital for Harvard Medical School, has the largest hospital-based research program in the United States, with over 1,200 clinical trials being conducted at any given time, in topics ranging from the opioid epidemic to the impact of socioeconomic status on health.

  7. Toronto General Hospital (TGH) (Toronto). TGH, the teaching hospital for University of Toronto, is the largest research organization in Canada and the largest transplant center in North America. The hospital also performed the first triple organ transplant.

  8. University of Tokyo Hospital (Tokyo). The hospital, which focuses on patients' well-being, in 2017 treated more than 1 million patients and completed 35 clinical trials. The hospital in 2012 also established Japan's "trailblazing" Department of Disaster Medical Management, 

  9. Lausanne University Hospital (Lausanne, Switzerland). Lausanne University Hospital, Switzerland's teaching hospital for French-speaking citizens, was chosen by WHO to lead Ebola vaccine trials in 2014.

  10. Sheba Medical Center at Tel HaShomer (Tel Aviv).Also known as Tel HaShomer Hospital, the medical center's international collaborations have led to innovative medical practices and advances in biotechnology, according to Newsweek. More than 25% of all medical clinical research in Israel takes place at the hospital.