End Stage Renal Disease

End-stage kidney disease is the last stage of chronic kidney disease. This is when your kidneys can no longer support your body’s needs. The kidneys remove waste and excess water from the body.

Causes
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End-stage kidney disease (ESRD) is when the kidneys are no longer able to work at a level needed for day-to-day life.

The most common causes of ESRD in the U.S. are diabetes and high blood pressure. These conditions can affect your kidneys.

ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working over 10 - 20 years before end-stage disease results.

Symptoms
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Common symptoms may include:

General ill feeling and fatigue
Itching (pruritus) and dry skin
Headaches
Weight loss without trying
Loss of appetite
Nausea
Other symptoms may include:

Abnormally dark or light skin
Nail changes
Bone pain
Drowsiness and confusion
Problems concentrating or thinking
Numbness in the hands, feet, or other areas
Muscle twitching or cramps
Breath odor
Easy bruising, nosebleeds, or blood in the stool
Excessive thirst
Frequent hiccups
Problems with sexual function
Menstrual periods stop (amenorrhea)
Sleep problems
Swelling of the feet and hands (edema)
Vomiting, often in the morning
Exams and Tests
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Your health care provider will perform a physical exam and order blood tests. Most people with this condition have high blood pressure.

Patients with end-stage kidney disease will make much less urine, or urine production may stop.

End-stage kidney disease changes the results of many tests. Patients receiving dialysis will need these and other tests done often:

Potassium
Sodium
Albumin
Phosphorous
Calcium
Cholesterol
Magnesium
Complete blood count (CBC)
Electrolytes
This disease may also change the results of the following tests:

Erythropoietin
PTH
Bone density test
Treatment
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Dialysis does some of the job of the kidneys when they stop working well.

Dialysis can:

Remove extra salt, water, and waste products so they don't build up in your body
Keep safe levels of minerals and vitamins in your body
Help control blood pressure
Help produce red blood cells
Your health care provider will discuss dialysis with you before you need it. Dialysis removes waste from your blood when your kidneys can no longer do their job.

Usually, you will go on dialysis when you have only 10 - 15% of your kidney function left.
Even people who are waiting for a kidney transplant may need dialysis while waiting.
Two different methods are used to perform dialysis:

During hemodialysis, your blood passes through a tube into an artificial kidney, or filter.
During peritoneal dialysis, a special solution passes into your belly though a catheter tube. The solution remains in your abdomen for period of time and then is removed. This method can be done at home, at work, or while traveling.
A kidney transplant is surgery to place a healthy kidney into a person with kidney failure. Your doctor will refer you to a transplant center. There, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for kidney transplant.

You may need to follow a special diet for chronic kidney disease. These changes may include:

Eat a low-protein diet.
Get enough calories if you are losing weight.
Limit fluids.
Limit salt, potassium, phosphorous, and other electrolytes.
Other treatment depends on your symptoms but may include:

Extra calcium and vitamin D (always talk to your doctor before taking supplements)
Medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
Treatment for anemia, such as extra iron in the diet, iron pills or shots, shots of a medicine called erythropoietin, and blood transfusions.
Medicines to control your blood pressure
You should be up-to-date on important vaccinations, including:

Hepatitis A vaccine
Hepatitis B vaccine
Flu vaccine
Pneumonia vaccine (PPV)

Tinea Cruris(ringworm of the groin)

Tinea cruris, also known as crotch itch, crotch rot, Dhobie itch, eczema marginatum,gym itch,
jock itch, jock rot, scrot rot and ringworm of the groin is a dermatophyte fungal infection of the groin region in any sex, though more often seen in males.

Tinea cruris is similar to, but different from Candidal intertrigo, which is an infection of the skin by Candida albicans. It is more specifically located between intertriginous folds of adjacent skin, which can be present in the groin or scrotum, and be indistinguishable from fungal infections caused by tinia. However, candidal infections tend to both appear and disappear with treatment more quickly.It may also affect the scrotum.

Signs and symptoms

As the common name for this condition implies, it causes itching or a burning sensation in the groin area, thigh skin folds, or anus. It may involve the inner thighs and genital areas, as well as extending back to the perineum and perianal areas.

Affected areas may appear red, tan, or brown, with flaking, rippling, peeling, or cracking skin.

The acute infection begins with an area in the groin fold about a half-inch across, usually on both sides. The area may enlarge, and other sores may develop. The rash has sharply defined borders that may blister and ooze.

Causes

Macroconidia from the Epidermophyton floccosum
Opportunistic infections (infections that are caused by a diminished immune system) are frequent.
Fungus from an athlete's foot infection can spread to the groin through clothing.

Tight, restrictive clothing, such as jockstraps, traps heat and moisture, providing an ideal environment for the fungus.

The type of fungus involved is usually Trichophyton rubrum. Some other contributing fungi are Candida albicans, Trichophyton mentagrophytes and Epidermophyton floccosum.

Prevention
Medical professionals suggest keeping the groin area clean and dry by drying off thoroughly after bathing and putting on dry clothing right away after swimming or perspiring.

Other recommendations are:
not sharing clothing or towels with others, showering immediately after athletic activities, wearing loose cotton underwear, avoiding tight-fitting clothes, and using antifungal powders.

Treatment
Tinea cruris is best treated with topical antifungal medications of the allylamine or azole type.The evidence is best for terbinafine and naftifine but other agents may also work.

The benefits of the use of topical steroids in addition to an antifungal is unclear. There might be a greater cure rate but no guidelines currently recommend its addition.

10 risky jobs that can damage your lungs

1.Bartending and Waitressing
Secondhand smoke has been linked to lung cancer. It remains a threat to workers in cities where smoking hasn't been banned in public places. Casino workers also can find themselves in a cloud of smoke.
No one's going to wear a respirator while serving martinis or dealing a blackjack game. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings won't keep nonsmokers from being exposed.

2. Housekeeping and Cleaning
Some cleaning supplies, even so-called "green" or "natural" products, have harmful chemicals that have been linked with developing asthma.

"Cleaners are reactive chemicals, meaning that they react with dirt and also with your lung tissues," Von Essen says.

Some release volatile organic compounds, which can contribute to chronic respiratory problems and allergic reactions. Read labels and follow instructions.

Consider using "simple cleaning agents like vinegar and water or baking soda," Von Essen says. Open windows and doors to keep the area well ventilated, too.

Short of working to change policy, the best solution may be to find another job.

"Unfortunately, the individual worker has limited options," says Susanna Von Essen, MD. She's a University of Nebraska Medical Center professor of internal medicine in the division of pulmonary, critical care, sleep, and allergy.

3. Health Care
Doctors, nurses, and other people who work in hospitals, medical offices, or nursing homes are at increased risk for lung diseases such as tuberculosis, influenza, and severe acute respiratory syndrome (SARS).

So, health care workers should keep up with immunizations (including the flu vaccine) that the CDC recommends for them.

Health care workers may also develop asthma if latex is used in gloves or other supplies. Latex-free synthetic gloves are an alternative.

4. Hair Styling
Certain hair-coloring agents can lead to occupational asthma. Some salon hair-straightening products contain formaldehyde, a known carcinogen. It's also a strong eye, nose, throat, and lung irritant.

Good ventilation is important. Because wearing a respirator might cause appointments to cancel, know what's in the products you're working with. If they're not safe, find a safer product.

5. Manufacturing
Some factory workers risk getting asthma or making their existing asthma worse. Asthma not caused by work but made worse by it affects as many as 25% of adults with asthma, Harber says.
Factory workers can be exposed to everything from inhaled metals in foundries to silica or fine sand, which can lead to silicosis, a disease that scars the lung, or increased risk of lung cancer.

A lung disorder called "popcorn lung," or bronchiolitis obliterans, has been seen in plant workers exposed to some of the flavoring chemicals used to make microwave popcorn. Again, respirators and proper ventilation are key for those workers. (No risk of "popcorn lung" has been seen in people who eat that popcorn.)

6. Construction
Workers who demolish old buildings or do remodeling can be exposed to asbestos used as insulation around pipes or in floor tiles.

Even minimal exposure to its microscopic fibers has been linked to a variety of problems. One is mesothelioma, a form of cancer, Von Essen says.

Exposure also seems to raise the risk of small-cell lung cancer and can lead to asbestosis, or scarring of the lung. Removal should be left to trained and licensed crews.

"Know where the asbestos is," Von Essen says. "Follow all the rules and don't take chances."
7. Farming
Working with crops and animals can lead to several disorders. Hypersensitivity pneumonitis is a rare but serious problem caused by repeated exposures to mold-contaminated grain or hay. The lung's air sacs become inflamed and may develop scar tissue.

Grain in metal bins can get moldy. Breathing dust from this grain can lead to fevers, chills, and a flu-like illness called "organic dust toxic syndrome." Farmers also are more likely to report a cough and chest tightness.

"We think about 30% of farmers who grow crops in this way have had that at some point," Von Essen says. Workers in hog and chicken barns sometimes get an asthma-like syndrome

"Dust and ammonia levels together seem to be risk factors," she says. Keep grain from getting damp, ensure adequate ventilation, and wear a respirator.

8. Auto Body Spray Painting
People who work in auto body shops are often exposed to chemicals known as isocyanates. They're a significant cause of occupational asthma.

"It's frequently a career-ending disease where they need to leave their profession," Harber says.

Using quality respirators that are appropriate for your task can lessen the risk. It also helps to enclose the area being sprayed and to have a ventilated exhaust system. Better yet, replace hazardous materials with safer ones.
9. Firefighting
People who battle blazes are exposed not only to the fire, but also to other materials, including burning plastics and chemicals. Firefighters can significantly lower their risk of lung disease and other problems by using a "self-contained breathing apparatus" (SCBA). These devices should also be used during "mop up" or the clean-up period.

"Many of the chemicals are still in the air," Harber says. Ventilation also is critical.

10. Coal Mining
Underground miners are at risk for everything from bronchitis to pneumoconiosis, or "black lung." It's a chronic condition caused by inhaling coal dust that becomes embedded in the lungs, causing them to harden and make breathing very hard.

Dehydration

Dehydration is a condition that occurs when the loss of body fluids, mostly water, exceeds the amount that is taken in. 

With dehydration, more water is moving out of our cells and bodies than what we take in through drinking. 

 We lose water every day in the form of water vapor in the breath we exhale and in our excreted sweat, urine, and stool. Along with the water, small amounts of salts are also lost. When we lose too much water, our bodies may become out of balance or dehydrated. Severe dehydration can lead to death. 

Causes of dehydration 

Many conditions may cause rapid and continued fluid losses and lead to dehydration: Fever, heat exposure, and too much exercise Vomiting, diarrhea, and increased urination due to infection Diseases such as diabetes 

The inability to seek appropriate water and food (as in the case of a disabled person) 

An impaired ability to drink (for instance, someone in a coma or on a respirator) No access to safe drinking water Significant injuries to skin, such as burns or mouth sores, or severe skin diseases or infections (water is lost through the damaged skin)  Symptoms of Dehydration in Adults

 The signs and symptoms of dehydration range from minor to severe and include: Increased thirst Dry mouth and swollen tongue 

Weakness 

Dizziness 

Palpitations (feeling that the heart is jumping or pounding) 

Confusion 

Sluggishness 

Fainting 

 Inability to sweat 

Decreased urine output 

Urine color may indicate dehydration.

 If urine is concentrated and deeply yellow or amber, you may be dehydrated. 

 When to Seek Medical Care 

Call your doctor if the dehydrated person experiences any of the following: 

Increased or constant vomiting for more than a day 

Fever over 101°F Diarrhea for more than 2 days 

Weight loss 

Decreased urine production 

Confusion 

Weakness

 Take the person to the hospital's emergency department if these situations occur: 

 Fever higher than 103°F Confusion Sluggishness (lethargy) 

Headache 

Seizures 

Difficulty breathing

 Chest or abdominal pains 

Fainting 

No urine in the last 12 hour.

 

Exams and Tests 

The doctor may perform a variety of simple tests at the examination or send blood or urine samples to the laboratory. Through tests and examination, the doctor will try to identify the underlying cause or causes that led to the dehydration. 

 Vital signs Fever, 

increased heart rate, 

decreased blood pressure, 

and faster breathing are signs of potential dehydration and other illnesses. 

Taking the pulse and blood pressure while the person is lying down and then after standing up for 1 minute can help determine the degree of dehydration. 

Normally, when you have been lying down and then stand up, there is a small drop in blood pressure for a few seconds. 

The heart rate speeds up, and blood pressure goes back to normal. However, when there is not enough fluid in the blood because of dehydration and the heart rate speeds up, not enough blood is getting to the brain. 

The brain senses this condition, and the heart beats faster. 

If you are dehydrated, you feel dizzy and faint after standing up. 

Urinalysis

 The color and clarity of urine, the urine specific gravity (the mass of urine is compared with that of equal amounts of distilled water), and the presence of ketones (carbon compounds that signify dehydration) in the urine may all help to indicate the degree of dehydration. 

Increased glucose in the urine may lead to a diagnosis of diabetes or indicate loss of diabetic control and a cause for the dehydration. 

Excessive protein in the urine may signal kidney problems. Signs of infections or other diseases, such as liver disease, may be found by urine testing. 

Blood chemistries The amount of salts (sodium and potassium) and sugar, as well as indicators of kidney function (BUN and creatinine), may be important to evaluate the degree of dehydration and possible causes. 

A complete blood count (CBC) may be ordered if the doctor thinks an underlying infection is causing the dehydration. 

Other blood tests, such as liver function tests, may be indicated to find causes of the symptoms. 

 

Treatment - Self-Care at Home

 Try to get people who are dehydrated (even those who have been vomiting) to take in fluids in the following ways: 

 Sipping small amounts of water

 Drinking carbohydrate/electrolyte-containing drinks.

 Good choices are sports drinks such as Gatorade or prepared replacement solutions (Pedialyte is one example) 

Sucking on popsicles made from juices and sports drinks Sucking on ice chips Sipping through a straw (works well for someone who has had jaw surgery or mouth sores) Try to cool the person, if there has been heat exposure or if the person has an elevated temperature, in the following ways: 

 Remove any excess clothing and loosen other clothing. 

Air-conditioned areas are best for helping return body temperatures to normal and break the heat exposure cycle.

 If air conditioning is not available, increase cooling by evaporation by placing the person near fans or in the shade, if outside. 

Place a wet towel around the person. If available, use a spray bottle or misters to spray lukewarm water on exposed skin surfaces to help with cooling by evaporation. Avoid exposing skin to excessive cold, such as ice packs or ice water. 

This can cause the blood vessels in the skin to constrict and will decrease rather than increase heat loss. 

Exposure to excessive cold can also cause shivering, which will increase body temperature --the opposite effect you're trying to achieve. 

 Medical Treatment in the emergency department focuses first on restoring blood volume and then body fluids, while determining the cause of the dehydration. If your core body temperature is greater than 104 °F, doctors will cool the entire body.

 They may promote cooling by evaporation with mists and fans or cooling blankets and baths. 

 Fluid replacement If there is no nausea and vomiting, fluid replacement is begun. You are asked to drink electrolyte/carbohydrate-containing fluids along with water. 

If there are signs of significant dehydration (elevated resting heart rate, low blood pressure), fluids are generally given through an IV, a tube placed into a vein. 

Disposition If your condition improves, you may be sent home, preferably in the care of friends or family who can help monitor your condition.

 If you remain dehydrated, confused, feverish, have persistently abnormal vital signs, or signs of infection, you may need to stay in the hospital for additional treatment.

 

Medications 

If fever is a cause of dehydration, the use of acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil) may be used. This can be given by mouth if you are not vomiting or as a rectal suppository if you cannot take anything by mouth. 

 Next Steps Call or return to your doctor or the hospital as instructed. Follow-up Take prescribed medications as directed. Continue to keep yourself well hydrated with plenty of water or sports drinks. 

Watch for signs of dehydration in yourself and others.

 Prevention 

The foremost treatment for dehydration is prevention. Anticipate the need for increased fluid intake. Plan ahead and take extra water to all outdoor events and work where increased sweating, activity, and heat stress will increase fluid losses. 

Encourage athletes and outdoor workers to replace fluids at a rate that equals the loss. Avoid exercise and exposure during high heat index days. 

Listen to weather forecasts for high heat stress days, and plan events that must occur outside during times when temperatures are cooler. 

Ensure that older people and infants and children have adequate drinking water or fluids available and assist them as necessary. Make sure that any incapacitated or impaired person is encouraged to drink and provided with adequate fluids. 

Avoid alcohol consumption, especially when it is very warm, because alcohol increases water loss and impairs your ability to sense early signs associated with dehydration. 

Wear light-colored and loose-fitting clothing if you must be outdoors when it is hot outside. Carry a personal fan or mister to cool yourself. Break up your exposure to hot temperatures. Find air-conditioned or shady areas and allow yourself to cool between exposures.

 Taking someone into a cooled area for even a couple of hours each day will help prevent the cumulative effects of high heat exposure.

Pneumonia

Pneumonia (nu-MO-ne-ah) is an infection in one or both of the lungs. Many germs—such as bacteria, viruses, and fungi—can cause pneumonia.

The infection inflames your lungs' air sacs, which are called alveoli (al-VEE-uhl-eye). The air sacs may fill up with fluid or pus, causing symptoms such as a cough with phlegm (a slimy substance), fever, chills, and trouble breathing.

Overview

Pneumonia and its symptoms can vary from mild to severe. Many factors affect how serious pneumonia is, such as the type of germ causing the infection and your age and overall health.

Pneumonia tends to be more serious for:

Infants and young children.
Older adults (people 65 years or older).
People who have other health problems, such as heart failure, diabetes, or COPD (chronic obstructive pulmonary disease).
People who have weak immune systems as a result of diseases or other factors. Examples of these diseases and factors include HIV/AIDS, chemotherapy (a treatment for cancer), and an organ transplant or blood and marrow stem cell transplant.
Outlook

Pneumonia is common in the United States. Treatment for pneumonia depends on its cause, how severe your symptoms are, and your age and overall health. Many people can be treated at home, often with oral antibiotics.

Children usually start to feel better in 1 to 2 days. For adults, it usually takes 2 to 3 days. Anyone who has worsening symptoms should see a doctor.

People who have severe symptoms or underlying health problems may need treatment in a hospital. It may take 3 weeks or more before they can go back to their normal routines.

Fatigue (tiredness) from pneumonia can last for a month or more.

Types of Pneumonia

Pneumonia is named for the way in which a person gets the infection or for the germ that causes it.

Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) occurs outside of hospitals and other health care settings. Most people get CAP by breathing in germs (especially while sleeping) that live in the mouth, nose, or throat.

CAP is the most common type of pneumonia. Most cases occur during the winter. About 4 million people get this form of pneumonia each year. About 1 out of every 5 people who has CAP needs to be treated in a hospital.

Hospital-Acquired Pneumonia

Some people catch pneumonia during a hospital stay for another illness. This is called hospital-acquired pneumonia (HAP). You're at higher risk of getting HAP if you're on a ventilator (a machine that helps you breathe).

HAP tends to be more serious than CAP because you're already sick. Also, hospitals tend to have more germs that are resistant to antibiotics (medicines used to treat pneumonia).

Health Care-Associated Pneumonia

Patients also may get pneumonia in other health care settings, such as nursing homes, dialysis centers, and outpatient clinics. This type of pneumonia is called health care-associated pneumonia.

Other Common Types of Pneumonia

Aspiration Pneumonia

This type of pneumonia can occur if you inhale food, drink, vomit, or saliva from your mouth into your lungs. This may happen if something disturbs your normal gag reflex, such as a brain injury, swallowing problem, or excessive use of alcohol or drugs.

Aspiration pneumonia can cause pus to form in a cavity in the lung. When this happens, it's called a lung abscess (AB-ses).

Atypical Pneumonia

Several types of bacteria—Legionella pneumophila, mycoplasma pneumonia, and Chlamydophila pneumoniae—cause atypical pneumonia, a type of CAP. Atypical pneumonia is passed from person to person.

What Causes Pneumonia?

Many germs can cause pneumonia. Examples include different kinds of bacteria, viruses, and, less often, fungi.

Most of the time, the body filters germs out of the air that we breathe to protect the lungs from infection. Your immune system, the shape of your nose and throat, your ability to cough, and fine, hair-like structures called cilia (SIL-e-ah) help stop the germs from reaching your lungs. (For more information, go to the Diseases and Conditions Index How the Lungs Work article.)

Sometimes, though, germs manage to enter the lungs and cause infections. This is more likely to occur if:

Your immune system is weak
A germ is very strong
Your body fails to filter germs out of the air that you breathe
For example, if you can't cough because you've had a stroke or are sedated, germs may remain in your airways. ("Sedated" means you're given medicine to make you sleepy.)

When germs reach your lungs, your immune system goes into action. It sends many kinds of cells to attack the germs. These cells cause the alveoli (air sacs) to become red and inflamed and to fill up with fluid and pus. This causes the symptoms of pneumonia.

Germs That Can Cause Pneumonia

Bacteria

Bacteria are the most common cause of pneumonia in adults. Some people, especially the elderly and those who are disabled, may get bacterial pneumonia after having the flu or even a common cold.

Many types of bacteria can cause pneumonia. Bacterial pneumonia can occur on its own or develop after you've had a cold or the flu. This type of pneumonia often affects one lobe, or area, of a lung. When this happens, the condition is called lobar pneumonia.

The most common cause of pneumonia in the United States is the bacterium Streptococcus (strep-to-KOK-us) pneumoniae, or pneumococcus (nu-mo-KOK-us).

Viruses

Respiratory viruses cause up to one-third of the pneumonia cases in the United States each year. These viruses are the most common cause of pneumonia in children younger than 5 years old.

Most cases of viral pneumonia are mild. They get better in about 1 to 3 weeks without treatment. Some cases are more serious and may require treatment in a hospital.

If you have viral pneumonia, you run the risk of getting bacterial pneumonia as well.

The flu virus is the most common cause of viral pneumonia in adults. Other viruses that cause pneumonia include respiratory syncytial virus, rhinovirus, herpes simplex virus, severe acute respiratory syndrome (SARS), and more.

Fungi

Three types of fungi in the soil in some parts of the United States can cause pneumonia. These fungi are:

Coccidioidomycosis (kok-sid-e-OY-do-mi-KO-sis). This fungus is found in Southern California and the desert Southwest.
Histoplasmosis (HIS-to-plaz-MO-sis). This fungus is found in the Ohio and Mississippi River Valleys.
Cryptococcus (krip-to-KOK-us). This fungus is found throughout the United States in bird droppings and soil contaminated with bird droppings.
Most people exposed to these fungi don't get sick, but some do and require treatment.

Serious fungal infections are most common in people who have weak immune systems due to the long-term use of medicines to suppress their immune systems or having HIV/AIDS.

Pneumocystis jiroveci (nu-mo-SIS-tis ye-RO-VECH-e), formerly Pneumocystis carinii, sometimes is considered a fungal pneumonia. However, it's not treated with the usual antifungal medicines. This type of infection is most common in people who:

Have HIV/AIDS or cancer
Have had an organ transplant and/or blood and marrow stem cell transplant
Take medicines that affect their immune systems
Other kinds of fungal infections also can lead to pneumonia.
What Are the Signs and Symptoms of Pneumonia?

The signs and symptoms of pneumonia vary from mild to severe. Many factors affect how serious pneumonia is, including the type of germ causing the infection and your age and overall health. (For more information, go to "Who Is at Risk for Pneumonia?")

See your doctor promptly if you:

Have a high fever
Have shaking chills
Have a cough with phlegm (a slimy substance), which doesn't improve or worsens
Develop shortness of breath with normal daily activities
Have chest pain when you breathe or cough
Feel suddenly worse after a cold or the flu
People who have pneumonia may have other symptoms, including nausea (feeling sick to the stomach), vomiting, and diarrhea.

Symptoms may vary in certain populations. Newborns and infants may not show any signs of the infection. Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy.

Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. If they already have a lung disease, it may get worse. Older adults who have pneumonia sometimes have sudden changes in mental awareness.

Complications of Pneumonia

Often, people who have pneumonia can be successfully treated and not have complications. But some people, especially those in high-risk groups, may have complications such as:

Bacteremia (bak-ter-E-me-ah). This serious complication occurs if the infection moves into your bloodstream. From there, it can quickly spread to other organs, including your brain.
Lung abscesses. An abscess occurs if pus forms in a cavity in the lung. An abscess usually is treated with antibiotics. Sometimes surgery or drainage with a needle is needed to remove the pus.
Pleural effusion. Pneumonia may cause fluid to build up in the pleural space. This is a very thin space between two layers of tissue that line the lungs and the chest cavity. Pneumonia can cause the fluid to become infected—a condition called empyema (em-pi-E-ma). If this happens, you may need to have the fluid drained through a chest tube or removed with surgery.
How Is Pneumonia Diagnosed?

Pneumonia can be hard to diagnose because it may seem like a cold or the flu. You may not realize it's more serious until it lasts longer than these other conditions.

Your doctor will diagnose pneumonia based on your medical history, a physical exam, and test results.

Medical History

Your doctor will ask about your signs and symptoms and how and when they began. To find out what type of germ is causing the pneumonia, he or she also may ask about:

Any recent traveling you've done
Your hobbies
Your exposure to animals
Your exposure to sick people at home, school, or work
Your past and current medical conditions, and whether any have gotten worse recently
Any medicines you take
Whether you smoke
Whether you've had flu or pneumonia vaccinations
Physical Exam

Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale. Your doctor also may hear wheezing.

Your doctor may find it hard to hear sounds of breathing in some areas of your chest.

Diagnostic Tests

If your doctor thinks you have pneumonia, he or she may recommend one or more of the following tests.

Chest X Ray

A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels.

A chest x ray is the best test for diagnosing pneumonia. However, this test won't tell your doctor what kind of germ is causing the pneumonia.

Blood Tests

Blood tests involve taking a sample of blood from a vein in your body. A complete blood count (CBC) measures many parts of your blood, including the number of white blood cells in the blood sample. The number of white blood cells can show whether you have a bacterial infection.

Your doctor also may recommend a blood culture to find out whether the infection has spread to your bloodstream. This test is used to detect germs in the bloodstream. A blood culture may show which germ caused the infection. If so, your doctor can decide how to treat the infection.

Other Tests

Your doctor may recommend other tests if you're in the hospital, have serious symptoms, are older, or have other health problems.

Sputum test. Your doctor may look at a sample of sputum (spit) collected from you after a deep cough. This may help your doctor find out what germ is causing your pneumonia. Then, he or she can plan treatment.

Chest computed tomography (CT) scan. A chest CT scan is a painless test that creates precise pictures of the structures in your chest, such as your lungs. A chest CT scan is a type of x ray, but its pictures show more detail than those of a standard chest x ray.

Pleural fluid culture. For this test, a fluid sample is taken from the pleural space (a thin space between two layers of tissue that line the lungs and chest cavity). Doctors use a procedure called thoracentesis (THOR-ah-sen-TE-sis) to collect the fluid sample. The fluid is studied for germs that may cause pneumonia.

Pulse oximetry. For this test, a small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood. Pneumonia can keep your lungs from moving enough oxygen into your bloodstream.

If you're very sick, your doctor may need to measure the level of oxygen in your blood using a blood sample. The sample is taken from an artery, usually in your wrist. This test is called an arterial blood gas test.

Bronchoscopy. Bronchoscopy (bron-KOS-ko-pee) is a procedure used to look inside the lungs' airways. If you're in the hospital and treatment with antibiotics isn't working well, your doctor may use this procedure.

Your doctor passes a thin, flexible tube through your nose or mouth, down your throat, and into the airways. The tube has a light and small camera that allow your doctor to see your windpipe and airways and take pictures.

How Is Pneumonia Treated?

Treatment for pneumonia depends on the type of pneumonia you have and how severe it is. Most people who have community-acquired pneumonia—the most common type of pneumonia—are treated at home.

The goals of treatment are to cure the infection and prevent complications.

General Treatment

If you have pneumonia, follow your treatment plan, take all medicines as prescribed, and get ongoing medical care. Ask your doctor when you should schedule followup care. Your doctor may want you to have a chest x ray to make sure the pneumonia is gone.

Although you may start feeling better after a few days or weeks, fatigue (tiredness) can persist for up to a month or more. People who are treated in the hospital may need at least 3 weeks before they can go back to their normal routines.

Bacterial Pneumonia

Bacterial pneumonia is treated with medicines called antibiotics. You should take antibiotics as your doctor prescribes. You may start to feel better before you finish the medicine, but you should continue taking it as prescribed. If you stop too soon, the pneumonia may come back.

Most people begin to improve after 1 to 3 days of antibiotic treatment. This means that they should feel better and have fewer symptoms, such as cough and fever.

Viral Pneumonia

Antibiotics don't work when the cause of pneumonia is a virus. If you have viral pneumonia, your doctor may prescribe an antiviral medicine to treat it.

Viral pneumonia usually improves in 1 to 3 weeks.

Treating Severe Symptoms

You may need to be treated in a hospital if:

Your symptoms are severe
You're at risk for complications because of other health problems
If the level of oxygen in your bloodstream is low, you may receive oxygen therapy. If you have bacterial pneumonia, your doctor may give you antibiotics through an intravenous (IV) line inserted into a vein.
How Can Pneumonia Be Prevented?

Pneumonia can be very serious and even life threatening. When possible, take steps to prevent the infection, especially if you're in a high-risk group.

Vaccines

Vaccines are available to prevent pneumococcal pneumonia and the flu. Vaccines can't prevent all cases of infection. However, compared to people who don't get vaccinated, those who do and still get pneumonia tend to have:

Milder cases of the infection
Pneumonia that doesn't last as long
Fewer serious complications
Pneumococcal Pneumonia Vaccine

A vaccine is available to prevent pneumococcal pneumonia. In most adults, one shot is good for at least 5 years of protection. This vaccine often is recommended for:

People who are 65 years old or older.
People who have chronic (ongoing) diseases, serious long-term health problems, or weak immune systems. For example, this may include people who have cancer, HIV/AIDS, asthma, or damaged or removed spleens.
People who smoke.
Children who are younger than 5 years old.
Children who are 5–18 years of age with certain medical conditions, such as heart or lung diseases or cancer. For more information, talk with your child's doctor.
For more information about the pneumococcal pneumonia vaccine, go to the Centers for Disease Control and Prevention's (CDC's) Vaccines and Preventable Diseases: Pneumococcal Vaccination Web page.

Influenza Vaccine

The vaccine that helps prevent the flu is good for 1 year. It's usually given in October or November, before peak flu season.

Because many people get pneumonia after having the flu, this vaccine also helps prevent pneumonia.

For more information about the influenza vaccine, go to the CDC's Vaccines and Preventable Diseases: Seasonal Influenza (Flu) Vaccination Web page.

Hib Vaccine

Haemophilus influenzae type b (Hib) is a type of bacteria that can cause pneumonia and meningitis (men-in-JI-tis). (Meningitis is an infection of the covering of the brain and spinal cord.) The Hib vaccine is given to children to help prevent these infections.

The vaccine is recommended for all children in the United States who are younger than 5 years old. The vaccine often is given to infants starting at 2 months of age.

For more information about the Hib vaccine, go to the CDC's Vaccines and Preventable Diseases: Hib Vaccination Web page.

Other Ways To Help Prevent Pneumonia

You also can take the following steps to help prevent pneumonia:

Wash your hands with soap and water or alcohol-based rubs to kill germs.
Don't smoke. Smoking damages your lungs' ability to filter out and defend against germs. For information about how to quit smoking, go to the Health Topics Smoking and Your Heart article. Although this resource focuses on heart health, it includes general information about how to quit smoking.
Keep your immune system strong. Get plenty of rest and physical activity and follow a healthy diet.
If you have pneumonia, limit contact with family and friends. Cover your nose and mouth while coughing or sneezing, and get rid of used tissues right away. These actions help keep the infection from spreading.

LUMBAR SPODYLOSIS

Lumbar spondylosis, as shown in the image below, describes bony overgrowths (osteophytes), predominantly those at the anterior, lateral, and, less commonly, posterior aspects of the superior and inferior margins of vertebral centra (bodies). This dynamic process increases with, and is perhaps an inevitable concomitant, of age.

Spondylosis deformans is responsible for the misconception that osteoarthritis was common in dinosaurs.[1] Osteoarthritis was rare, but spondylosis actually was common.

Lumbar spondylosis usually produces no symptoms. When back or sciatic pains are symptoms, lumbar spondylosis is usually an unrelated finding.

Past teleologically misleading names for this phenomenon are degenerative joint disease (it is not a joint), osteoarthritis (same critique), spondylitis (totally different disease), and hypertrophic arthritis (not an arthritis).

Causes/risk factors
umbar spondylosis appears to be a nonspecific aging phenomenon. Most studies suggest no relationship to lifestyle, height, weight, body mass, physical activity, cigarette and alcohol consumption, or reproductive history. Adiposity is seen as a risk factor in British populations, but not Japanese populations. The effects of heavy physical activity are controversial, as is a purported relationship to disk degeneration.
Lumbar spondylosis occurs as a result of new bone formation in areas where the anular ligament is stressed.

PRESENTATION
Lumbar spondylosis usually produces no symptoms. When back or sciatic pains are symptoms, lumbar spondylosis is usually an unrelated finding. Lumbar spondylosis is usually not found unless a complication ensues.

Other problems to consider include the following:

Spondyloarthropathy
Spinal stenosis
Diffuse idiopathic skeletal hyperostosis
Fibromyalgia
Postural disturbance
Aortic aneurysm
Psychogenic rheumatism
Ischial bursitis
Trochanteric bursitis
Hip arthritis
Spondylolisthesis
Osteoporosis[6]
Compression fracture
Neoplasia
Hemangioma
Infectious spondylitis
Endocarditis
Disk disease.

Treatments

How is spondylosis treated?

Spondylosis is not curable, but in many cases the symptoms may decrease or stabilize on their own. Treatment is aimed at relieving pain to help you participate in as many of your normal activities as possible, and occasionally surgical treatment may be required to prevent permanent nerve or spinal cord damage.

You may be prescribed a round of physical therapy or a short course of a painkiller or muscle relaxant. Surgery is only required if conservative treatments fail or if you have worsening signs of nerve compression.

Traditional short-course pain medications for spondylosis

The most common short-course pain medications for spondylosis include:

Celecoxib (Celebrex)
Diclofenac (Voltaren)
Hydrocodone (Vicodin, Lortab)
Ibuprofen (Advil, Motrin)
Indomethacin (Indocin, Indocin SR)
Naproxen (Aleve, Naprosyn)
Oxycodone (Percocet, Roxicet)
Muscle relaxants

Your medical practitioner may prescribe a muscle relaxant instead of a traditional pain relieving medication. These include:

Carisoprodol (Soma, Vanadom)
Cyclobenzaprine (Fexmid, Flexeril)
Methocarbamol (Robaxin)
Nerve pain medications

Some medications focus specifically on nerve pain and include:

Duloxetine (Cymbalta)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Other drugs for chronic pain

In addition to NSAIDs and muscle relaxants, several other specific drugs have been found particularly effective for chronic pain and include:

Carbamazepine (Carbatrol, Equetro, Tegretol)
Phenytoin (Dilantin, Phenytek, Di-Phen)
Nonsurgical pain interventions

In cases of uncontrolled pain, steroid and anesthetic delivery procedures can help relieve chronic pain without requiring surgery. These procedures include:

Corticosteroid injection, usually cortisone (Celestone, Kenalog)
Neck brace or lumbar orthopedic device
Physical therapy
Traction (in severe cases)
Surgical interventions

In cases of uncontrolled pain, loss of movement, loss of sensation, or loss of bladder or bowel control, surgery to take pressure off spinal nerves or the spinal cord may be immediately necessary.

What you can do to improve your spondylosis

In addition to following your treatment regimen as prescribed by your medical practitioner, you may also be able to reduce your pain and increase mobility by:

Applying ice or heat
Attending physical therapy as recommended
Practicing exercises as advised by your medical practitioner
Taking all of your medications as prescribed
Wearing a cervical collar (in some cases)
Complementary treatments

Some complementary treatments may help some people to better deal with spondylosis. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

Acupuncture
Biofeedback
Massage therapy
Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
Yoga
What are the potential complications of spondylosis?

Complications of untreated or poorly controlled spondylosis can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of spondylosis include:

Adverse effects of treatment
Chronic, debilitating pain
Diminished overall quality of life
Fecal incontinence
Inability to participate in work or recreational activities
Permanent disability (rare)
Progression of symptoms
Urinary incontinence.

What is breast cancer?

Breast cancer is a kind of cancer that develops from breast cells. Breast cancer usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. A breast cancer that started off in the lobules is known as lobular carcinoma, while one that developed from the ducts is called ductal carcinoma.

The vast majority of breast cancer cases occur in females. This article focuses on breast cancer in women.

Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16% of all female cancers and 22.9% of invasive cancers in women. 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer.

Invasive breast cancer - the cancer cells break out from inside the lobules or ducts and invade nearby tissue. With this type of cancer, the abnormal cells can reach the lymph nodes, and eventually make their way to other organs (metastasis), such as the bones, liver or lungs. The abnormal (cancer) cells can travel through the bloodstream or the lymphatic system to other parts of the body; either early on in the disease, or later.

Non-invasive breast  - this is when the cancer cancer is still inside its place of origin and has not broken out. Lobular carcinoma in situ is when the cancer is still inside the lobules, while ductal carcinoma in situ is when they are still inside the milk ducts. "In situ" means "in its original place". Sometimes, this type of breast cancer is called "pre-cancerous"; this means that although the abnormal cells have not spread outside their place of origin, they can eventually develop into invasive breast cancer.

Signs and symptoms of breast cancer.

A symptom is only felt by the patient, and is described to the doctor or nurse, such as a headache or pain. A sign is something the patient and others can detect, for example, a rash or swelling.

The first symptoms of breast cancer are usually an area of thickened tissue in the woman's breast, or a lump. The majority of lumps are not cancerous; however, women should get them checked by a health care professional.

Some of the possible early signs of breast cancer
According to the National Health Service, UK, women who detect any of the following signs or symptoms should tell their doctor:

A lump in a breast

A pain in the armpits or breast that does not seem to be related to the woman's menstrual period
Pitting or redness of the skin of the breast; like the skin of an orange
A rash around (or on) one of the nipples
A swelling (lump) in one of the armpits
An area of thickened tissue in a breast
One of the nipples has a discharge; sometimes it may contain blood
The nipple changes in appearance; it may become sunken or inverted
The size or the shape of the breast changes
The nipple-skin or breast-skin may have started to peel, scale or flake.

Causes of breast cancer

Experts are not sure what causes breast cancer. It is hard to say why one person develops the disease while another does not. We know that some risk factors can impact on a woman's likelihood of developing breast cancer.

Getting older - the older a woman gets, the higher is her risk of developing breast cancer; age is a risk factor. Over 80% of all female breast cancers occur among women aged 50+ years (after the menopause).

Genetics - women who have a close relative who has/had breast or ovarian cancer are more likely to develop breast cancer. If two close family members develop the disease, it does not necessarily mean they shared the genes that make them more vulnerable, because breast cancer is a relatively common cancer.

The majority of breast cancers are not hereditary.

Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of developing breast and/or ovarian cancer. These genes can be inherited. TP53, another gene, is also linked to greater breast cancer risk.

A history of breast cancer - women who have had breast cancer, even non-invasive cancer, are more likely to develop the disease again, compared to women who have no history of the disease.

Having had certain types of breast lumps - women who have had some types of benign (non-cancerous) breast lumps are more likely to develop cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.

Dense breast tissue - women with more dense breast tissue have a greater chance of developing breast cancer.

Estrogen exposure - women who started having periods earlier or entered menopause later than usual have a higher risk of developing breast cancer. This is because their bodies have been exposed to estrogen for longer. Estrogen exposure begins when periods start, and drops dramatically during the menopause.

Obesity - post-menopausal obese and overweight women may have a higher risk of developing breast cancer. Experts say that there are higher levels of estrogen in obese menopausal women, which may be the cause of the higher risk.

Height - taller-than-average women have a slightly greater likelihood of developing breast cancer than shorter-than-average women. Experts are not sure why.

Alcohol consumption - the more alcohol a woman regularly drinks, the higher her risk of developing breast cancer is. The Mayo Clinic says that if a woman wants to drink, she should not exceed one alcoholic beverage per day.

Radiation exposure - undergoing X-rays and CT scans may raise a woman's risk of developing breast cancer slightly. Scientists at the Memorial Sloan-Kettering Cancer Center found that women who had been treated with radiation to the chest for a childhood cancer have a higher risk of developing breast cancer.

HRT (hormone replacement therapy) - both forms, combined and estrogen-only HRT therapies may increase a woman's risk of developing breast cancer slightly. Combined HRT causes a higher risk.

Certain jobs - French researchers found that women who worked at night prior to a first pregnancy had a higher risk of eventually developing breast cancer.

Canadian researchers found that certain jobs, especially those that bring the human body into contact with possible carcinogens and endocrine disruptors are linked to a higher risk of developing breast cancer. Examples include bar/gambling, automotive plastics manufacturing, metal-working, food canning and agriculture. They reported their findings in the November 2012 issue of Environmental Health.

Cosmetic implants may undermine breast cancer survival - women who have cosmetic breast implants and develop breast cancer may have a higher risk of dying prematurely form the disease compared to other females, researchers from Canada reported in the BMJ (British Medical Journal) (May 2013 issue).

The team looked at twelve peer-reviewed articles on observational studies which had been carried out in Europe, the USA and Canada.
Diagnosing breast cancer Women are usually diagnosed with breast cancer after a routine breast cancer screening, or after detecting certain signs and symptoms and seeing their doctor about them.

If a woman detects any of the breast cancer signs and symptoms described above, she should speak to her doctor immediately. The doctor, often a primary care physician (general practitioner, GP) initially, will carry out a physical exam, and then refer the patient to a specialist if he/she thinks further assessment is needed.

Below are examples of diagnostic tests and procedures for breast cancer:
Breast exam - the physician will check both the patient's breasts, looking out for lumps and other possible abnormalities, such as inverted nipples, nipple discharge, or change in breast shape. The patient will be asked to sit/stand with her arms in different positions, such as above her head and by her sides.

X-ray (mammogram) - commonly used for breast cancer screening. If anything unusual is found, the doctor may order a diagnostic mammogram.

What are the treatment options for breast cancer? A multidisciplinary team will be involved in a breast cancer patient's treatment. The team may consists of an oncologist, radiologist, specialist cancer surgeon, specialist nurse, pathologist, radiologist, radiographer, and reconstructive surgeon. Sometimes the team may also include an occupational therapist, psychologist, dietitian, and physical therapist.

The team will take into account several factors when deciding on the best treatment for the patient, including:
The type of breast cancer

The stage and grade of the breast cancer - how large the tumor is, whether or not it has spread, and if so how far

Whether or not the cancer cells are sensitive to hormones

The patient's overall health

The age of the patient (has she been through the menopause?)

The patient's own preferences.
The main breast cancer treatment options may include:
Radiation therapy (radiotherapy)
Surgery
Biological therapy (targeted drug therapy)
Hormone therapy
Chemotherapy.
Surgery
Lumpectomy - surgically removing the tumor and a small margin of healthy tissue around it. In breast cancer, this is often called breast-sparing surgery. This type of surgery may be recommended if the tumor is small and the surgeon believes it will be easy to separate from the tissue around it. British researchers reported that about one fifth of breast cancer patients who choose breast-conserving surgery instead of mastectomy eventually need a reoperation.

Mastectomy - surgically removing the breast. Simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy means also removing muscle of the chest wall and the lymph nodes in the armpit.

Many undergo pointless mastectomies due to fear - a study carried out at the Dana-Faber Cancer Institute and published in Annals of Internal Medicine found that many young women choose to have their healthy breast removed after being diagnosed with cancer in one breast. Unfortunately, doing so does not improve survival rates, the authors explained.

Sentinel node biopsy - one lymph node is surgically removed. If the breast cancer has reached a lymph node it can spread further through the lymphatic system into other parts of the body.

Axillary lymph node dissection - if the sentinel node was found to have cancer cells, the surgeon may recommend removing several nymph nodes in the armpit.

Breast reconstruction surgery - a series of surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. This procedure may be carried out at the same time as a mastectomy. The surgeon may use a breast implant, or tissue from another part of the patient's body.
Radiation therapy (radiotherapy)

Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Usually, radiotherapy is used after surgery, as well as chemotherapy to kill off any cancer cells that may still be around. Typically, radiation therapy occurs about one month after surgery or chemotherapy. Each session lasts a few minutes; the patient may require three to five sessions per week for three to six weeks.

The type of breast cancer the woman has will decide what type of radiation therapy she may have to undergo. In some cases, radiotherapy is not needed.

Radiation therapy types include:
Breast radiation therapy - after a lumpectomy, radiation is administered to the remaining breast tissue

Chest wall radiation therapy - this is applied after a mastectomy

Breast boost - a high-dose of radiation therapy is applied to where the tumor was surgically removed. The appearance of the breast may be altered, especially if the patient's breasts are large.

Lymph nodes radiation therapy - the radiation is aimed at the axilla (armpit) and surrounding area to destroy cancer cells that have reached the lymph nodes

Breast brachytherapy

Preventing breast cancer Some lifestyle changes can help significantly reduce a woman's risk of developing breast cancer.
Alcohol consumption - women who drink in moderation, or do not drink alcohol at all, are less likely to develop breast cancer compared to those who drink large amounts regularly. Moderation means no more than one alcoholic drink per day.

Physical exercise - exercising five days a week has been shown to reduce a woman's risk of developing breast cancer. Researchers from the University of North Carolina Gillings School of Global Public Health in Chapel Hill reported that physical activity can lower breast cancer risk, whether it be either mild or intense, or before/after menopause. However, considerable weight gain may negate these benefits.

Diet - some experts say that women who follow a healthy, well-balanced diet may reduce their risk of developing breast cancer.

Fish oils help reduce breast cancer risk - a study published in BMJ (June 2013 issue) found that women who regularly consumed fish and marine n-3 polyunsaturated fatty acids had a 14% lower risk of developing breast cancer, compared to other women. The authors, from Zhejiang University, China, explained that a "regular consumer" should be eating at least 1 or 2 portions of oily fish per week (tuna, salmon, sardines, etc).

Postmenopausal hormone therapy - limiting hormone therapy may help reduce the risk of developing breast cancer. It is important for the patient to discuss the pros and cons thoroughly with her doctor.

Bodyweight - women who have a healthy bodyweight have a considerably lower chance of developing breast cancer compared to obese and overweight females.

Women at high risk of breast cancer - the doctor may recommend estrogen-blocking drugs, including tamoxifen and raloxifene. Tamoxifen may raise the risk of uterine cancer. Preventive surgery is a possible option for women at very high risk.

Breast cancer screening - patients should discuss with their doctor when to start breast cancer screening exams and tests.

Breastfeeding - women who breastfeed run a lower risk of developing breast cancer compared to other women.

A team of researchers from the University of Granada in Spain reported in the Journal of Clinical Nursing that breastfeeding for at least six months reduces the risk of early breast cancer. This only applies to non-smoking women, the team added. They found that mothers who breastfed for six months or more, if they developed breast cancer, did so on average ten years later than other women.

What is gout?

Gout is a common form of inflammatory arthritis - a condition affecting the joints and musculoskeletal system. It is the most common form of inflammatory arthritis in men, and although it is more likely to affect men, women become more susceptible to it after the menopause.

Gout commonly affects the base of the big toe. When affecting this area, the condition can also be referred to as podagra.
The condition is characterized by sudden and severe pains, redness and tenderness in the joints, most commonly in the base of the big toe. When affecting the big toe, gout can also be referred to as podagra.

These symptoms occur when uric acid, a bodily waste produce, is deposited in the form of needle-like crystals in tissues and fluids within the body. Chalky deposits of uric acid known as tophi can also form as lumps under the skin surrounding the joints. Uric acid crystals can also collect in the kidneys, sometimes resulting in kidney stones.

At its most disabling, gout can cause permanent damage to joints and the kidneys.

CAUSES
Gout is caused initially by an excess of uric acid in the blood (hyperuricemia). Uric acid is produced in the body through the breakdown of purines - specific chemical compounds that are found in certain foods such as meat, poultry and seafood.

Normally, uric acid dissolves in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced or not enough is excreted then it can build up and form the needle-like crystals that cause inflammation and pain in the joints and surrounding tissue.

There are a number of factors that can increase the likelihood of hyperuricemia, and therefore gout:

Age and gender: men produce more uric acid than women, though women's levels of uric acid approach those of men after the menopause
Genetics: a family history of gout increases the likelihood of the condition developing
Lifestyle choices: alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body
Lead exposure: chronic lead exposure has been linked in some cases to gout
Medications: certain medications can increase the levels of uric acid in the body, such as diuretics and drugs containing salicylate
Weight: being overweight increases the risk as there is more tissue in the body for turnover or breakdown, leading to the production of excess uric acid
Other health problems: if the kidneys are unable to eliminate waste products adequately (renal insufficiency) then uric acid levels can remain high. Other conditions that can contribute are high blood pressure (hypertension), diabetes and hypothyroidism.

Signs and Symptoms

Gout usually becomes symptomatic suddenly without warning, often in the middle of the night. The main symptoms are intense joint pain that subsides to discomfort, inflammation and redness. Gout frequently affects the large joint of the big toe, but can also commonly affect the ankles, knees, elbows, wrists and fingers.

There are four stages through which gout progresses. Each is characterized by its symptoms (or lack of)..    

Asymptomatic hyperuricemia
It is possible for a person to have hyperuricemia without any outward symptoms. At this stage, treatment is not required, though urate crystals are being deposited in tissue and causing slight damage.

Acute gout
This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain. This sudden attack is referred to as a "flare" and will normally subside within 3-10 days. Flares can sometimes be triggered by stressful events, alcohol and drugs.

Interval or inter critical gout
This stage is the period in between attacks of acute gout. Subsequent flares may not occur for months or years, though if not treated over time they can last longer and occur more frequently. During this time, further urate crystals are being deposited in tissue.

Chronic tophaceous gout
This final stage is the most debilitating form of the disease. Permanent damage may have been dealt to joints and the kidneys. The patient can suffer from chronic arthritis and develop tophi - big lumps of urate crystals - in cooler areas of the body such as the joints of the fingers.

It takes a long time without treatment to reach the stage of chronic tophaceous gout, around 10 years. It is very unlikely that a patient receiving proper treatment would progress to this stage.

Treatment and prevention

The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares and reduce the risk of gout complications such as kidney stones and the development of tophi.

Commonly used medications are nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are commonly administered orally.

It is recommended that you drink between 2 and 4 liters of water a day to reduce the risk of gout.
Medications can also be used to either reduce the production of uric acid (xanthine oxidase inhibitors such as allopurinol) or improve the kidney's ability to remove uric acid from the body (probenecid).

There are many lifestyle and dietary guidelines that can be followed to protect against future flares or prevent gout from occurring in the first instance:

Maintain a high fluid intake (2-4 liters a day)
Avoid alcohol
Maintain a healthy body weight
Eat a balanced diet
Limit fish, meat and poultry intake.
If attempting to lose weight, avoid low-carbohydrate diets. If carbohydrate intake is insufficient, the body is unable to burn its own fat properly, releasing substances called ketones into the bloodstream. This results in a condition called ketosis that can increase the level of uric acid in the blood.

It is most important to avoid foods that are high in purines, to ensure that the levels of uric acid in the blood do not get too high. Here is a list of high-purine foods to be wary of:

Anchovies
Asparagus
Beef kidneys
Brains
Dried beans and peas
Game meats
Gravy
Herring
Liver
Mackerel
Mushrooms
Sardines
Scallops
Sweetbreads.