Screening Tests for Down syndrome

Aim of screening test: to predict the chance the child has of having a particular disease

ULTRASOUND
-Checking the foetus
-10-14 weeks of pregnancy
-detects 60% of Down Syndrome pregnancies
-strong association between the size of a collection of fluid at the back of the foetal neck, called nuchal translucency, and the risk of Down syndrome.
-echogenic bowel, echogenic intracardiac focus (small bright spot seen in the baby’s heart on an ultrasound exam. This is thought to represent mineralization, or small deposits of calcium, in the muscle of the heart), and dilitation of the kidneys (pyelctasis).
-In early 2001, a study (Smith-Bindman, 2001) was published that looked at all of the previous studies on this topic. The authors concluded that "[these markers] could not discriminate well between unaffected foetuses and those with Down syndrome."
-A more specific marker that is currently under investigation is the measurement of the foetal nose; foetuses with Down syndrome appear to have smaller noses on ultrasound than foetuses without chromosomal abnormalities. However, there is still no standardized technique to measuring the nasal bone and it is considered strictly investigational at this time.

MATERNAL SERUM SCREENING
-blood sample from mother
-The triple screen (also called the multiple marker test) and the alpha fetoprotein plus. These tests measure the quantities of various substances in the mother's blood, and together with the woman's age, estimate the likelihood that her baby has Down syndrome.
available 14-20 weeks of pregnancy
-detects two-thirds (60-70%) of Down syndrome
-Triple screen: alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG)
-Sometimes a marker called inhibin A is added, making the "quadruple screen."
-Another marker called PAPP-A was found to be of use for earlier in pregnancy (1st trimester)
-Alpha-fetoprotein is made in the part of the womb called the yolk sac and in the foetal liver, and some amount of AFP gets into the mother's blood. In neural tube defects, the skin of the foetus is not intact and so large amounts of AFP is measured in the mother's blood. In Down syndrome, the AFP is lower in the mother's blood, because the yolk sac and foetus are smaller than usual.
-Estriol is a hormone produced by the placenta, using ingredients made by the foetal liver and adrenal gland. Estriol is decreased in the Down syndrome pregnancy.
-Human chorionic gonadotropin hormone is produced by the placenta, and is used to test for the presence of pregnancy. A specific smaller part of the hormone, called the beta subunit, is increased in Down syndrome pregnancies.
-Inhibin A is a protein secreted by the ovary, and is designed to inhibit the production of the hormone FSH by the pituitary gland. The level of inhibin A is increased in the blood of mothers of foetuses with Down syndrome.
-PAPP-A, which stands for pregnancy-associated plasma protein A, is produced by the covering of the newly fertilized egg. In the first trimester, low levels of this protein are seen in Down syndrome pregnancies.

SOURCES
http://www.dsav.asn.au/
http://www.ds-health.com/prenatal.htm
http://www.kidshealth.org/parent/medical/genetic/down_syndrome.html

DIAGNOSTIC TESTS FOR DOWN SYNDRONE (DS)

…include 3 different invasive techniques:

1. Amniocentesis
2. Chorionic Villus Sampling (CVS)
3. Percutaneous Umbilical Blood Sampling (PUBS) or Fetal Blood Sampling

1. AMNIOCENTESIS

1. BRIEF OUTLINE

This procedure involves the collecting of a small sample of amniotic fluid (about 15mLs) via a thin needle through the abdominal wall and into the uterus (under the guidance of an ultrasound scan) Usually carried out at weeks 14-18 of gestation.

2. AMNIOTIC FLUID

The amniotic fluid is found in the amniotic sac. The amniotic sac is a tough pair of membranes that holds the embryo. It holds fluids which allow the embryo to move and cushions it during development. It is in this fluid that fetal cells that the fetus sheds can also be found.

- The inner membrane (the amnion) contains the amniotic fluid & fetus

- The outer membrane (the chorion) contains the amnion and is part of the placenta

3. PROCEDURE

- Antiseptic fluid is used to clean the area of the abdomen.

- A very thin needle enters through the abdominal wall and into the uterus

- A sample is collected via syringe and the cells sent to a laboratory

- Cells are allowed to grow and multiply until there is enough to tests

4. RESULTS

Results from a full karyotyping usually takes 2-3 weeks, however, a rapid test (2 days) may be carried out on the chromosomes most commonly associated with disorders (21, 13, 18, X & Y)

A positive result should initiate the doctor to provide information to the parents about Down syndrome and counseling may be offered to aid parents make an informed decision as to keep or terminate the fetus.

However, a negative result does not mean the baby has a 0% chance of developing chromosomal abnormalities at birth.

5. RISKS

The risk of this procedure is less than 1% and if miscarriages were to be a result of this procedure, it would occur usually within a few weeks of this test.

Some of the common risks are:

- bleeding from puncture

- infection

- premature rupture of the amniotic sac

- injury to the baby

6. RECOMMENDATIONS/WHO SHOULD TAKE THE TEST

- Women over the age of 40 years (Victorian women aged 37 years and over are routinely offered this test).

- Women with a family history of chromosomal abnormalities, such as Down's syndrome.

- Women who have already had children with chromosomal abnormalities.

- Women known to be carriers of genetic diseases.

- Women with partners who have a family history of a genetic disorder or chromosomal abnormality.

- Women who return an abnormal 'serum screen' blood test or ultrasound examination result.

2. CHORIONIC VILLUS SAMPLING

1. BRIEF OUTLINE

Involves removing tiny pieces of tissue from the placenta either via a needle through the abdomen or via a catheter inserted through the vagina and into the cervix. It carried out earlier than Amniocentesis at 10-12^th week of pregnancy.

2. CHORIONIC VILLI

These are tiny finger-like growth found in the placenta and contain the same DNA as the baby’s cell.

3. PROCEDURE RISKS AND RECOMMENDATIONS

Procedure is similar to Amniocentesis; however the risks are a little higher (although still roughly about 1% of miscarriages). Results are obtained similarly through karyotypes or rapid sampling. Recommendations for taking this test are similar to the Amniocentesis Test.

3. PERCUTANEOUS UMBILICAL BLOOD SAMPLING

1. BRIEF OUTLINE

This test is usually carried out after 18 weeks and is done when CVS and Amniocentesis Tests fail to give clear results. It involves taking a blood sample from the umbilical cord of the baby for further testing similar the other tests. Risks and procedures are similar as is recommendations.

Also found something called preimplantation diagnosis for IVF babies. Couldn’t find much information on it though. Sorry!

RESOURCES:

http://www.pregnancy-info.net/fetal_blood_sampling.html

http://www.webmd.com/baby/Chorionic-Villus-Sampling-CVS

http://www.wcox.com.au/cvs.htm

http://www.kidshealth.org/parent/medical/genetic/down_syndrome.html

http://www.ucsfhealth.org/childrens/medical_services/preg/prenatal/conditions/down/diagnosis.html

http://www.wcox.com.au/amniocen.htm

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Amniocentesis?open

Clinical Features and Life Expectancy of Down Syndrome

Clinical Features of Down syndrome

• Dr Langdon Down described the characteristics of Down syndrome as a resemblance to those of the Mongolian race.
• The extra chromosome can cause problems in every cell of the body and thus features are distinguished in a wide range of areas.
• There are over 50 physical characteristics that can be found in people who have Down syndrome, No person with Down syndrome will have all the characteristics described.

Some common traits

• low muscle tone
• eyes may have an upward and outward slant
• small white patches on the edge of the iris of the eye
• ears tend to be small and low set
• jaw bone and mouth can appear to be small; the tongue can have less space and protrude
• legs and arms are often shorter in relation to the torso
• hands are often short and stubby; tip of the little finger may turn inwards
• may be a cleft between the first and second toes
• genitals may be small
• skin may have a spotted appearance
• hair is sometimes fine and straight
• teeth may be slightly smaller and do not appear in normal ‘order’
• delay in reaching milestones, eg. sitting, crawling, talking, toileting, etc

Life Expectancy

• As late as 1927 80% of children died before reaching 6 years of age and even in 1960, 60% of children still died before 5 years old.
• However, medical research has totally changed the quality of health of people with Down syndrome and today, the average life expectancy of a person with Down syndrome is 55+, with some people living into their 80's.

Screening Tests for Down syndrome…

There are screening tests that exist for neural tube defects and chromosome disorders (including Down syndrome) in a foetus. Screening tests can indicate to women that they are at an increased risk of having a child with a birth-defect, but the results aren’t definite, diagnosis tests are required to be certain.

Second trimester testing:
There is a blood test that is usually taken 15 – 18 weeks after the last menstrual period. This test measures the levels of three or four substances in the mother’s blood. The first is alpha-fetoprotein, which is produced by the liver of the foetus. Some is released into the amniotic fluid and passes into the mother’s bloodstream where its concentration rises gradually until late in pregnancy. These maternal serum alpha-fetoprotein (MSAFP) levels are noted. The levels of pregnancy hormones estriol and human chorionic gonadotropin (hCG) are also measured, and sometimes the levels of inhibin-A are also measured.

A woman’s individual risk of having a child with a birth defect is calculated, based on the levels of these substances as well as the woman’s age, weight, race, and whether she has diabetes requiring insulin treatment. Low levels of MSAFP and estriol along with high levels of hCG suggest an increased risk of Down syndrome.

If there is an abnormal test result, the next step is usually an ultrasound examination, which uses sound waves to take a picture of the foetus. If the foetus is older than suspected or there are twins, this may be what is causing the abnormal test results. If the ultrasound doesn’t provide an explanation for the test results, further diagnostic testing (such as amniocentesis or chorionic villus sampling) is recommended.


First trimester testing:
There is testing that can be done earlier, within the 11th – 14th week of the pregnancy. An ultrasound imaging exam called a nuchal translucency test can be used to measure the width of the foetus’ neck, when abnormalities are present, more fluid than usual tends to collect in this tissue. Blood test’s on the mother’s blood are also undertaken, looking for unusual levels of pregnancy-associated plasma protein A and human chorionic gonadotropic (hCG).

When this two-step screening is done during the 11th week of pregnancy, researchers claim that it can identify 87% of babies with Down syndrome. This first trimester testing enables the follow up diagnostic testing to be done earlier in the pregnancy, so a mother will know earlier if the foetus has Down syndrome.

ARGUMENTS AGAINST GENE TESTING

…can be divided into 4 major separate categories:

1. Implications for the individual
2. Implications for the family
3. Implications for society
4. Implications for the medical industry and doctors

1. IMPLICATIONS ON THE INDIVIDUAL

- Testing only gives indication if the gene coding for the disease is present and does not necessarily mean the trait will definitely be expressed

- cause of unnecessary stress and fear; possibly result in a limited upbringing/life

- a stigma is attached to the person tested positive for a gene coding for the disease, affecting employment, health insurance and loans

- feeling of isolation from family or society

- the child was never given the choice if he/she wanted to know about the decision

- Preventative measures for the disease may possibly be very expensive or life changing and permanent.

2. IMPLICATIONS FOR THE FAMILY

- Do children or siblings with a genetic order deserve to know? What if they don’t want to know? How can we ensure that patients will respect the wishes of their family members who do not want to know?

- Potential for family breakdown

- In the case where someone is forced to know. For instance, the grandma is positive for the gene and has the disease. Her daughter doesn’t want to know if she has the gene. However, the grandchild does want to know and gets tested. If the results come back positive, the mother will automatically know she has the gene; thus she was forced into knowing

- Stress on the family that may all be unnecessary because the gene may never be expressed

- May result in increased abortion rates

- Effect on marriages and relationships, potentially higher divorce rate; may stress the couples who want to have children but are fearful of gene testing results: possibly resulting in marriage breakdowns.

3. IMPLICATIONS FOR SOCIETY

- Testing, no doubt will cost money. It will be very difficult to control and ensure equal access to everyone in society. The situation where only people with money will be able to have the gene tests may occur; hence segregating society.

- Costs of preventative treatment and counseling for a disease that may or may not develop could be very costly on families and individuals. Once again, access becomes an issue.

- Treatment may not be available.

- Employment as well as schooling, finance and health services will severely be affected if genetic testing becomes a more prevalent aspect of health in society – especially on equal opportunity and discrimination

- Potentially the branching of gene selection for superior traits (to a lesser extent, GATTACA) Access to this technology may further segregate society as not everyone agrees to genetic testing and gene manipulation.

- Catering to the individual needs vs the effects on society

4. IMPLICATIONS FOR THE MEDICAL INDUSTRY AND DOCTORS

- The balance between a patient’s confidentiality and a doctor’s duty of care to other patients. In the situation where a person is tested positive for a genetic disease that is inherited but refuses to let his siblings know about his condition, there is a potential for his/her siblings to also have the gene.

- By respecting confidentiality, this becomes an ethical dilemma where the idea of beneficence or doing no harm is question. Doing nothing, where early treatment and diagnosis is beneficial for the siblings could be considered unethical.

- However, telling the siblings will breach on a patients confidentiality and privacy

- This ultimately leads to a situation where the medical industry may lose a lot of respect and trust from patients and the public as a whole no matter what course of action they take

- Increased stress in doctors

- Potentially a trend in more accounts of depression in doctors, may lead to increased suicide rates in a professional that already has a very high rate.

- Also, running tests on the siblings without stating the reason is a dangerous method of medical practice. What if the siblings didn’t want to know? According to the tort of battery, this constitute an illegal consent and thus invalid. Could result in doctors being sued, as the patient was not informed of why the procedure was carried out.

- Increased law suits against doctors once again reflect badly on the medical industry.

Risks of breast cancer

Yay i got into the blog!
Here's my research - i fixed that statistic to do with age, it makes more sense now, oops

What Are the Risk Factors for Breast Cancer?
American Cancer Society (www.cancer.org)

Risk factors that can’t be changed:
Gender: Breast cancer is about 100 times more common in women than men
Age: As age increases risk increases: About 17% of invasive breast cancer diagnoses are among women in their 40s, while about 78% of women with invasive breast cancer are age 50 or older when they are diagnosed
Genetics: Around 5-10% cases are hereditary
Family History: Risk increases if:
-You have 2 or more relatives with breast or ovarian cancer, or both.
-Breast cancer occurs before age 50 in a relative (mother, sister, grandmother or aunt) on either side of the family. The risk is higher if your mother or sister has a history of breast cancer.
-You have 1 or more relatives with two cancers (breast and ovarian, or 2 different breast cancers).
-You have a male relative (or relatives) with breast cancer.
-You have a family history of breast or ovarian cancer and Ashkenazi Jewish heritage.
-Your family history includes a history of diseases associated with hereditary breast cancer such as Li-Fraumeni or Cowden Syndrome.
-Having 1 first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk. Having 2, first-degree relatives increases her risk 5-fold. Although the exact risk is not known, women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, about 20% to 30% of women with breast cancer have a family member with this disease.

Personal History: If you have already had breast cancer there is a 3-4 fold risk of developing a new cancer
Race: White women are at greatest risk of developing cancer, whilst African women are at greatest risk of dying from it. Asian, Hispanic and Native American women have a lower risk of developing/dying from breast cancer.
Abnormal Breast Biopsy: Breast lesions are divided into 3 groups:
-Non-proliferative lesions (those not associated with any overgrowth of breast tissue – no added risk or to small extent
-Proliferative lesions without atypia (those with excessive growth of cells in the ducts or lobules of the breast tissue) – 1 ½ - 2 times normal risk
-Proliferative lesions with atypia (those with excessive growth of cells in the ducts or lobules of the breast tissue and the cells no longer appear normal) – 4-5 times normal risk
Radiation: Radiation therapy in chest area can increase risk (up to 12 times), younger patients have higher risk - especially if breast is still developing. If chemotherapy was also used and this stopped ovarian hormone production the risk may be lowered
Menstrual Periods: Starting menstruation before 12 yrs, or menopause after 55 can increase risk
Diethylstilbestrol (DES): A drug used from the 1940s-1960s to decrease risk of miscarriage. Women who used the drug have been shown to have slightly increased risk of breast cancer

Lifestyle related factors:

Not Having Children: Women who do not have a child before the age of 30 have increased risk.
Breast-feeding & pregnancy: Women who have multiple pregnancies or become pregnant at an early age have decreased risk of breast cancer. In some studies breastfeeding has been shown to decrease the risk of breast cancer but other studies have shown no correlation between the two.
Oral Contraceptive Use: It is uncertain which ones but women using oral contraceptives were found to have an increased risk
Hormone Replacement Therapy: If postmenopausal hormone therapy (PHT) is used for several years or more there is an increased risk of developing, and dying of breast cancer. Particularly with the use of estrogen and progesterone combined.
Alcohol: Alcohol increases the risk: compared with non drinkers, women who consume 2-5 drinks daily have 1 ½ times the risk of developing breast cancer, those who have 1 drink daily have a slight increase also.
Obesity and High fat diets: Obesity, especially for women after menopause, has been found to increase the risk of breast cancer. This is because fat tissue adds to the estrogen produced by your ovaries; the more estrogen, the higher the risk.
Physical Activity: Physical activity can reduce the risk of breast cancer, one study has shown that 1.25-2.5 hrs/week of brisk walking decreased a woman’s risk by 18%.

This is a summary of the information from the American Cancer Society, there were also some other factors, eg antiperspirant deodorant, that are unproven or controversial. For a more detailed read go to http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp


-Amy

Addition

Just a last minute addition.
Rates of breast cancer among black men were higher than among white and Asian-Pacific Island men, in contrast to women among whom rates in whites exceeded those among other ethnic groups.
Breast cancer rates among non-Hispanic men were 50% greater than among Hispanic men.
Cancer was 10% more likely to be diagnosed in the left breast than the right breast among men

Breast cancer in men.

Not sure if this is relevant, not as good as Ronit with all the numbers.

Breast cancer accounts for about 0.22% (two tenths of a percent) of cancer deaths among men. The number of breast cancer cases relative to the population has been increasing in the last 20 years mainly due to increased use of mammography.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_male_breast_cancer_28.asp?sitearea=

Male breast cancer is rare. Less than 1% of all breast carcinomas occur in men. The mean age at diagnosis is between 60 and 70 years, though men of all ages can be affected with the disease.
Predisposing risk factors appear to include radiation exposure, estrogen administration, and diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter’s syndrome. Definite familial tendencies are evident with an increased incidence seen in men who have a number of female relatives with breast cancer. An increased risk of male breast cancer has been reported in families in which the BRCA2 mutation.
The pathology is similar to that of female breast cancer.
http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/healthprofessional

Hey Ronit, dunno if you are reading this, but could you help me search for the numbers? All I'm getting are reports about the risk factors and the treatments, etc. Sorry to bother you.

Common Biological Effects of Alcohol

Alcohol Poisoning

How does it occur?
Section of the Brain which is affected by alcohol: 1st is the CEREBRUM followed by the CEREBELLUM and finally the MEDULLA.

CEREBRUM controls :- recognition, vision, reasoning, emotion
CEREBELLUM controls :- co-ordination, reflexes, balance
MEDULLA controls :- Basic Survival Functions such as breathing & heart rate.

Lethal dose of alcohol: Blood alcohol content of 0.4%

However the lethal dose varies. It depends on the gender and on the person itself (e.g. non-drinker vs virgin drinker, hydartion level of person and etc.)

* The human body is only able to oxidise about an ounce of alcohol an hour. This oxidation rate also depends on how fast you drink and what is in your stomach prior to drinking. It may take about 30-90 minutes to reach the highest level of intoxication. Therefore, it is very dangerous to leave an unconscious drunk to 'sleep it off'.

Symptoms of alcohol poisoning
- Vomitting
- Seizures
- Slow & irregular breathing (fewer than 8 breaths/min)
- Hypothermia, bluish skin colour, paleness
- Mental confusion, stupor, coma or person can't be roused

If left untreated
- Victim chokes on vomit
- Breathing slows, becomes irregular, or stops
- Heart beats irregularly or stops
- Hypothermia
- Hypoglycemia (low blood sugar, body's inability to produce glucose from pyruvate)
- Dehydration from vomitting which may lead to seizures, brain damage or death

Treatment of Alcohol Poisoning
Treatment involves supportive care while your body rids itself of the alcohol
- Careful monitoring (Recovery position, clear vomit from mouth)
- Airway protection
- Oxygen therapy
- Administration of fluids intraveneously to prevent dehydration

Sources:
Alcohol Poisoning "http://www.unm.edu/~shc1/htalcoholpoison.html"
Alcohol Poisoning "http://www.mayoclinic.com/health/alcohol-poisoning/DS000861/DSECTION=7"
Facts about Alcohol Poisoning "http://www.collegedrinkingpreventation.gov/OtherAlcoholInformation/factsAboutAlcoholPoisoning.aspx"

Chemical Breakdown of Alcohol

- NAD+ is reduced to NADH when alcohol is converted into acetaldehyde
- Increased concentration of NADH affects conversion of lactate into pyruvate because it is dependent on a higher concentration of NAD+ than NADH
- Therefore, lactate is produced instead of pyruvate
- Since there is a lower concentration of pyruvate, less glucose is produced through Gluconeogenesis

Leads to:-
Hypoglycemia (low blood glucose) : Mild form - Sweating & Dizziness
Severe form - Coma & Death
Lactic Acidosis (occurs when increased synthesis of lactate which results in a drop of pH lvl in blood)
: Coma & Death

- NAD+ is reduced to NADH when alcohol is converted into acetaldehyde
- NADH produced supplies it's electrons to the ETC which in turn produces ATP
- It therefore replaces NADH produced when fatty acid is converted into Acetyl CoA
- Leads to build-up of fatty acids
- NADH produced also disrupts the Citric Acid Cycle which leads to a build-up of Acetyl CoA.
- Acetyl CoA is converted back to fatty acids which ultimately converts back to Triacylglycerols which accumulate in the liver.

Leads to:-
Fatty Liver : Build-up of Triacylglycerols in liver (Fatty Liver)
Fat droplets accumulate which increases the size of the liver & damages the liver's organelles
(esp. mitochondria)
Hyperlipemia : Build-up in fat in liver leads to increased secretion of fat into blood
Known risk factor for heart disease
High Blood Cholesterol : Fats secreted in blood contains cholesterol
Known risk factor for heart disease
Alcoholic Hepatitis : Inflammation of liver cells lead to loss of liver function
Detected through presence of liver enzymes & compounds in blood
Cirrhosis (Severe form of fibrosis) : Growth of fibrous scar tissue leading to loss of liver functon

ALCOHOL IN AUSTRALIA

Alcohol is the most widely used psychoactive (mood-changing) recreational drug in Australia.

Each year, around 3000 people die from excessive alcohol consumption and approximately 65 000 are hospitalised.

The cost annually to the Australian community due to alcohol related social problems is estimated to be $7.6 billion.

In 2004, the drinking statuses of the population over 13 years old were as follows:
Daily: 8.9%
Weekly: 41.2%
Less than weekly: 33.5%
Ex-drinker (has consumed at least a full drink but not in the last 12 months):7.1%
Never a full serve of alcohol: 9.3%

In 2004, one in ten Australian drank at levels which are considered to be risky or high risk for alcohol related harm in the future.

The peak age for risky and high risk alcohol consumption is the 20-29 age group and males drink at a slightly higher risk rate.

In the 14-19 age group, females are more likely to indulge in risky drinking than males of the same age.

The estimated pure alcohol intake per person aged 15 and over is 10 litres. The amount of wine consumed per year is around 20L.

Actual statistics on medical students/doctors and alcohol abuse is incredibly hard to find. Doctors are more likely to abuse alcohol and other substances as well as avoid exercise than other groups in society. There are several organisations devoted entirely to doctors’ health such as VDHP (Victorian Doctors Health Program) who have treated 220 doctors in the last 3 years, but only around 30 alcohol related.

In other topics: 15 and 25 per cent of medical students met the criteria for a psychiatric diagnosis.
Female doctors are six times more likely to commit suicide than other women, and all doctors have a heightened risk of suicide and emotional ill health, as do spouses. Their children also have a significantly higher rate of psychiatric breakdown.

Hangover

A hangover is characterized by the constellation of unpleasant physical and mental symptoms that occur after a bout of heavy alcohol drinking.

Symptoms of Hangover
Class of Symptoms Type
Constitutional Fatigue, weakness, and thirst
Pain Headache (alcohol intoxication results in vasodilatation,
which may induce headaches.) and muscle aches
Gastrointestinal Nausea, vomiting, and stomach pain
Sleep and biological rhythms Decreased sleep, decreased REM,1
and increased slow-wave sleep
Sensory Vertigo and sensitivity to light and sound
Cognitive Decreased attention and concentration
Mood Depression, anxiety, and irritability
Sympathetic hyperactivity Tremor, sweating, and increased pulse
and systolic blood pressure

The particular set of symptoms experienced and their intensity may vary from person to person and from occasion to occasion. In addition, hangover characteristics may depend on the type of alcoholic beverage consumed and the amount a person drinks.


Symptoms usually peak about the time BAC is zero and may continue for up to 24 hours thereafter. Overlap exists between hangover and the symptoms of mild alcohol withdrawal(AW), leading to the assertion that hangover is a manifestation of mild withdrawal. Hangovers, however, may occur after a single bout of drinking, whereas withdrawal occurs usually after multiple, repeated bouts. Other differences between hangover and AW include a shorter period of impairment (i.e., hours for hangover versus several days for withdrawal) and a lack of hallucinations and seizures in hangover.

Possible Contributing Factors to Hangover

Direct effects of alcohol
• Dehydration-
Sweating, vomiting, and diarrhea also commonly occur during a hangover, and these conditions can result in additional fluid loss and electrolyte imbalances. Symptoms of mild to moderate dehydration include thirst, weakness, dryness of mucous membranes, dizziness, and lightheadedness.

• Electrolyte imbalance

• Gastrointestinal disturbances-
Alcohol causes inflammation of stomach lining, delayed stomach emptying, increase in production of stomach acid, pancreatic and intestinal secretions which causes the upper abdominal pain, nausea and vomitting.

• Low blood sugar-
Because glucose is the primary energy source of the brain, hypoglycemia can contribute to hangover symptoms such as fatigue, weakness, and mood disturbances. However, it
has not been documented whether it contributes to hangover symptomatically.

• Sleep and biological rhythm disturbances-
Results from alcohol’s effects on sleep. Alcohol induced
sleep may be of shorter duration and poorer quality, decreasing the time spent in the dreaming
state (i.e., rapid eye movement [REM] sleep) and increasing the time spent in deep (i.e., slow-wave) sleep. This leads on to fatigue.

Alcohol withdrawal-
Sympathetic nervous system hyperactivity accounts for the tremors, sweating, and tachycardia.

Alcohol metabolism (i.e., acetaldehyde toxicity)-
Acetaldehyde binds to proteins and other biologically important compounds. At higher concentrations, it causes toxic effects, such as a rapid pulse, sweating, skin flushing, nausea, and vomiting.

Nonalcohol effects
• Compounds other than alcohol in beverages, especially methanol
Products of methanol metabolism (i.e., formaldehyde and formic acid) are extremely toxic and in high concentrations may cause blindness and death. Distilled spirits that are more frequently associated with the development of a hangover contain the highest concentrations of methanol.
Methanol persisted for several hours after ethanol was metabolized, which corresponded to the time course of hangover symptoms as ethanol competitively inhibited methanol metabolism and administration of ethanol fends off hangover effects.
Recent research finds that red wine can increase plasma serotonin and plasma histamine levels which can cause headaches.

• Use of other drugs, especially nicotine
Although certain drugs can themselves produce hangover symptoms and affect alcohol intoxication, the effects of the various alcohol and other drug combinations on alcohol hangover are unknown

• Personality type
Negative life events and feelings of guilt about drinking also are associated with experiencing more hangovers (Harburg et al. 1993).

• Family history for alcoholism
History of alcoholism in a person’s family is associated with a decreased sensitivity to the intoxicating effects of alcohol and a greater risk for developing alcoholism (Schuckit and Smith 1996). Newlin and Pretorius (1990) suggested that a positive family history for alcoholism may be associated with a tendency for increased hangover symptoms as well.


Treatments for Hangover
Many treatments to prevent hangover, shorten its duration, and reduce the severity of its symptoms.
Conservative management offers the best course of treatment. Hangover symptoms will usually abate over 8 to 24 hours.
Attentiveness to the quantity and quality of alcohol consumed can have a significant effect. Hangover symptoms are less likely to occur if a person drinks only small, nonintoxicating amounts. Even among people who drink to intoxication, those who consume lower amounts of alcohol appear less likely to develop a hangover than those who drink higher amounts. Hangovers have not been associated with drinking beverages with a low alcohol content or with drinking nonalcoholic beverages.
The type of alcohol consumed also may have a significant effect on reducing hangover (Chapman 1970; Pawan 1973). Alcoholic beverages that contain few congeners are associated with a lower
incidence of hangover than are beverages that contain a number of congeners.
Consumption of fruits, fruit juices, or other fructose-containing foods is reported to decrease hangover intensity (Seppala et al. 1976).
Bland foods containing complex carbohydrates, such as toast or crackers, can counter low blood sugar levels in people subject to hypoglyemia and can possibly relieve nausea.
Adequate sleep may ease the fatigue associated with sleep deprivation, and drinking nonalcoholic beverages during and after alcohol consumption may reduce alcohol-induced dehydration.
Antacids may alleviate nausea and gastritis. Aspirin and other nonsteroidal anti-inflammatory medications (e.g., ibuprofen or naproxen) may reduce the headache and muscle aches but should be used cautiously, particularly if upper abdominal pain or nausea is present.
Caffeine (often taken as coffee) is commonly used to counteract the fatigue and malaise associated with the hangover condition.
Readministration of alcohol reportedly cures a hangover, but people experiencing a hangover should avoid further alcohol use. Additional drinking will only enhance the existing toxicity of the alcohol consumed during the previous bout and may increase the likelihood of even further drinking.


Alcohol Hangover: Mechanis and Mediators, Robert Swift, M.D., Ph.D.; and Dena Davidson, Ph.D.
Alcohol Health and Research World, Vol. 22, No. 1, 1998

EPIDEMIOLOGY
Diarrheal illness second major cause of death world wide (most in children)
Infection most common in winter
Rotaviruses (most common): transmission fecal-oral route.
Endemic in developing countries: poor sanitation, contaminated water supplies.
TREATMENT
Maintenance adequate fluid/electrolyte intake
Only very serious infections warrant therapeutic intervention (body combats virus itself)
CAUSES/PREVENTION
Contaminated food/ drinking water (bottled water, proper handling, cooking and food storage)
Strict hand-washing protocols at hospitals/daycare
Rotavirus vaccine (being modified to have less side effects)

SYMPTOMS/CLINICAL FEATURES
Vomiting (if no diarrhea usually characteristic of toxin-mediated food poisoning)
Diarrhea (watery in rotavirus)
Bloody diarrhea: colitis (colon inflammation)
Systemic upset (e.g with fever)
Fluid loss: DEHYDRATION, hypovolemic shock, electrolyte imbalance
Abdominal pain/cramps




Never trust daycare food…

The original document i made was in colour and had pictures and boxes...sorry this one isnt as fun

Consumption of beer, wine, and distilled spirits in select countries, 2003

(in litres per capita of drinking-age population)
country beer wine spirits total**
LPA**
Luxembourg 101.6* 66.1* 1.6* 12.6*
Hungary 72.2* 37.4* 3.5* 11.4*
Czech Republic 157.0* *16.8* 3.8* 11.0*
Ireland 141.2* 15.2* 2.0* 10.8*
Germany 117.5* 23.6* 2.0* 10.2*
Spain 78.3* 30.6* 2.4* 10.0*
Portugal 58.7* 42.0* 1.4* 9.6*
United Kingdom 101.5* 20.1* 1.8* 9.6*
Denmark 96.2* 32.6* 1.1* 9.5*
Austria 110.6* 29.8* 1.4* 9.3*
France 35.5* 48.5* 2.4* 9.3*
Cyprus 60.0* 17.8* 3.9* 9.0*
Switzerland 58.1* 40.9* 1.6* 9.0*
Belgium 96.2* 23.0* 1.4* 8.8*
Russia 32.8* 8.6* 6.2* 8.7*
Slovakia 88.4* 13.0* 3.5* 8.5*
Latvia 36.6* 3.6* 6.1* 8.1*
Romania 67.0* 23.0* 2.0* 8.1*
Finland 80.2* 26.3* 2.1* 7.9*
Netherlands 78.7* 19.6* 1.5* 7.9*
Greece 40.4* 33.8* 1.6* 7.7*
Australia 91.5* 20.4* 1.2* 7.2*
Canada 67.8* 11.0* 2.2* 7.0*
Italy 30.1* 47.5* 0.4* 6.9*
New Zealand 72.8* 19.1* 1.6* 6.8*
United States 81.6* 9.5* 1.9* 6.8*
Poland 79.0* 11.9* 1.3* 6.7*
Estonia 75.0* 3.4* 1.3* 6.5*
Japan 27.3* 2.9* 3.6* 6.5*
Argentina 35.7* 34.6* 0.3* 6.2*
Uruguay 16.7* 33.3* 1.1* 5.9*
Iceland 55.8* 12.0* 1.2* 5.4*
Chile 25.0* 18.0* 1.8* 5.2*
Bulgaria 7.9* 21.3* 2.1* 5.0*
Malta 39.7* 22.3* 0.7* 4.9*
Sweden 54.2* 16.6* 0.9* 4.9*
South Africa 56.0* 8.6* 0.8* 4.6*
Venezuela 82.1* 0.5* 4.6*
Norway 50.5* 12.4* 0.8* 4.4*
Thailand 24.3* 3.1* 4.3*
Brazil 49.7* 1.9* 1.5* 4.2*
China 19.4* 0.2* 3.0* 4.0*
Colombia 40.1* 0.4* 1.8* 3.9*
Taiwan 27.5* 0.5* 0.7* 3.3*
Mexico 46.9* 0.2* 0.7* 3.1*
* Consumption data estimated from production data.
** Total litres of pure alcohol per drinking-age person. The alcohol content of beverages varies among countries.
Source: World Advertising Research Center, World Drink Trends 2005.

-countries leading in total alcohol consumption per drinking-age person in 2003 were Luxembourg, Hungary, the Czech Republic, Ireland, and Germany.

-differences in drinking levels for types of alcohol

-leading beer-drinking countries were the Czech Republic, Ireland, Germany, Austria, and Luxembourg.

-Russia (as expected...all that vodka helped them win the title!)
Latvia, Cyprus, the Czech Republic, and Japan were among the leading consumers of distilled spirits.

-Ireland and Russia had the highest rates of heavy alcohol consumption among women, while Russia, Hungary, and Austria had very high rates among men.

-Portugal and Spain had high rates of per capita consumption, but, since they also had high rates of abstinence, the per capita number of very heavy drinkers was higher than it was for countries such as France with few abstainers.

-AS FOR US AUSSIES....WELL WE ARNT AT THE TOP BUT WE CERTAINLY LIKE A FEW DRINKS....

Signs and Symptoms of Dehydration

Initial dehydration symptoms:
• Dry mouth/tongue
• Thirst
• Tiredness/lethargy
• Flushed face
• Headache
• Muscle cramps
• Dizziness
• Restlessness
• Irritability
• Confusion
• Dry and warm skin
• Less frequent urination
• Weakness
• Thick saliva

Severe dehydration symptoms:
• Fainting
• Severe cramping
• Low blood pressure
• Rapid deep breathing
• Increased heart rate
• Lack of elasticity of skin
• Extreme thirst
• Dark yellow urine
• Sunken eyes

Extreme effects:
• Convulsions
• Heart failure
• Death

Other symptoms in children:
• No tears when crying
• Listlessness
• No wet nappies for more than 3hrs
• Sunken abdomen, eyes, cheeks or fontanelle (infants)
• Skin doesn’t flatten when pinched


Sources:
Manawatu Standard. Palmerston North, New Zealand: Mar 4 2006. pg25
BusinessWorld. Manila: May 21, 2003. pg 1
The Atlanta Constitution. Atlanta, Ga. Jul18, 2000. pg C4
New York Times. New York, N.Y: Jul 11, 2000. pg F8

How the body responds to dehydration

-thirst
-loss of appetite
-dry skin
-onset of fatigue
-tiredness
-headache
-lack of tears when crying
-eyes sunken
-poor skin elasticity
-decrease blood pressure because low plasma volume
-respiration rate increases to compensate for decreased plasma volume and blood pressure
-decrease sweating
-decreased sweating causes body temperature to increase