Tennis Elbow Injury

Tennis Elbow Injury

Doctors first described tennis elbow (lateral epicondylitis) more than 100 years ago. Almost half of all tennis players will eventually get tennis elbow but less than 5 percent of all cases result from playing tennis. Golfer’s Elbow & Bursitis are 2 related conditions, which are sometimes mistaken for tennis elbow. How are these three conditions similar?
With tennis elbow the pain comes on gradually and is experienced as tenderness on or below the outside of the elbow. Gripping, lifting and carrying objects becomes painful. Golfers Elbow has similar causes and pain but the tenderness is felt on the inside of the elbow where the bone seems to jut out from the joint. Bursitis affects the back of the joint where the pain is and there is sometimes a visible lump. Bursitis is caused by either a fall or a blow directly to the tip of the elbow. Excessive leaning on the joint can also cause it.
Tennis elbow is a form of tendonitis. When the muscles and bones of the elbow joint are involved, then the condition is called epicondylitis. If the pain is felt directly on the back of your elbow joint, and not on the outside of your arm, you could have bursitis, which is caused by inflamed lubricating sacs in the joint. There should not be any swelling associated with tennis elbow. If there is swelling then it's probably not tennis elbow but another condition, such as arthritis, infection, gout or a tumor.
The Symptoms
Victims of tennis elbow will experience recurring pain on the outside of the upper forearm just below the bend of the elbow. Sometimes the pain radiates down the arm all the way to the wrist. Lifting with or bending the arm or even holding a light object like a cup will cause pain. Sufferers will have problems fully extending their forearm because of inflamed muscles, tendons and ligaments. The pain typically lasts for six to twelve weeks and there can be discomfort for anywhere from 3 weeks to several years.
The actual damage that tennis elbow causes is very small tears in a part of the tendon and in the muscle coverings. Once the original injury heals, these areas often tear again which leads to hemorrhaging and the forming of calcium deposits and development of some rough tissue around the injury and in surrounding tissues. Collagen can leak out from around the injured areas and cause inflammation. The pressure from this blocks the blood flow and pinches the radial nerve, which controls the muscles in the arm and hand.
Tendons do not heal as quickly as muscles do and some cases of tennis elbow can last for years. The inflammation usually goes down in 6 to 12 weeks.
Treatment
The best way to treat tennis elbow is to stop doing the things that irritate your arm. This is not a problem for the recreational tennis player, but creates a dilemma for a laborer, office worker or professional athlete. The most effective treatments for tennis elbow involve resting the arm until the pain disappears, massage to relieve muscle stress and tension, and strengthening exercises to prevent reinjury. If you have to go back to the activity that caused the problem, a 5 to 10 minute period of warm-up stretching and movement before starting that activity will help. It also helps to take breaks frequently.
Medicine offers different treatments for tennis elbow, from injections to surgery, but the pain will continue unless you stop stressing the joint. The tennis elbow will return if the joint is not given adequate rest. For mild and moderate cases aspirin or ibuprofen will help reduce the inflammation and the pain while you are resting the injury. Later you can get exercise and massage to accelerate the healing process.
For stubborn cases of tennis elbow your doctor may prescribe corticosteroid injections. These injections will reduce the inflammation, but they cannot be used long-term because of the risk of detrimental side effects. Topical ointments are another option for many sufferers, especially those who would rather not take medications.
If rest, medication, and a stretching routine fail to cure your tennis elbow, surgery may be advised. Less than 3 percent of patients require an operation. One surgical procedure cuts the tendon loose from the epicondyle, the round bump at the end of the bone. This eliminates the stress on the tendon but leaves the muscle useless. Another technique removing granulated tissue in the tendon and repairing the tears. After you have seemingly overcome a case of tennis elbow, continue to baby your arm. Always warm up your arm for 5 to 10 minutes before starting any activity that involves your elbow. If you develop severe pain after the activity anyway, pack your arm in ice and call your doctor.
Prevention
To prevent tennis elbow, try these techniques:
When lifting something, do it with your palm facing your body. Do some strengthening exercises with hand weights. Before beginning a possibly stressful activity stretch the relevant muscles by pulling the top part of your fingers gently but firmly back toward your body while keeping your arm fully extended and your palm facing outward.
To prevent a relapse, discontinue or change the action that is causing the strain on your elbow. Be sure to warm up for at least 10 minutes before performing any activity involving your arm and apply ice to it after. Take a break as often as you can.
It might help to strap a band around your forearm just below the elbow. The support should help you lift heavy objects. These bands can impede circulation and slow down the healing, so they should only be used after the symptoms of tennis elbow have disappeared.
If the pain lasts for more than a few days, chronic inflammation of the tendons can lead to permanent disability. If the elbow joint begins to swell, you may have another condition such as arthritis, gout, infection or even a tumor.

Beta Lactam Antibiotics

Beta Lactam Antibiotics

INTRODUCTION Beta-lactam antibiotics are among the most commonly prescribed drugs, grouped together based upon a shared structural feature, the beta-lactam ring. Beta-lactam antibiotics include:
* Penicillins
* Cephalosporins
* Cephamycins
* Carbapenems
* Monobactams
* Beta-lactamase inhibitors
Since this category of antibiotics is so broad, it is important to subdivide these drugs into functional drug groups to facilitate understanding and prescribing practices. It is not necessary for clinicians to know every drug within each of these groups. The grouping of these agents can be based upon spectrum of activity, for choice of agents for an antibiotic formulary, for therapeutic use or for routine susceptibility testing. Within each functional group, differences between antibiotics in pharmacokinetics, safety, duration of the clinical experience with their use, and cost allow reasonable choices to be made in selecting an individual drug as representative of that group.
The mechanisms of action and resistance and major adverse reactions to these antibiotics will be reviewed here. The penicillins, cephalosporins, and novel beta-lactam drugs are discussed separately. (See related topics).
MECHANISM OF ACTION Beta lactam antibiotics inhibit the growth of sensitive bacteria by inactivating enzymes located in the bacterial cell membrane, which are involved in the third stage of cell wall synthesis. It is during this stage that linear strands of peptidoglycan are cross-linked into a fishnet-like polymer that surrounds the bacterial cell and confers osmotic stability in the hypertonic milieu of the infected patient. Beta-lactams inhibit not just a single enzyme involved in cell wall synthesis, but a family of related enzymes (four to eight in different bacteria), each involved in different aspects of cell wall synthesis. These enzymes can be detected by their covalent binding of radioactively-labeled penicillin (or other beta-lactams) and hence have been called penicillin binding proteins (PBPs).
Different PBPs appear to serve different functions for the bacterial cell. As an example, PBP2 in Escherichia coli is important in maintaining the rod-like shape of the bacillus, while PBP3 is involved in septation during cell division [1]. Different beta-lactam antibiotics may preferentially bind to and inhibit certain PBPs more than others. Thus, different agents may produce characteristic effects on bacterial morphology and have different efficacies in inhibiting bacterial growth or killing the organism.

Beta Lactam Resistance

Beta Lactam Resistance

ß-lactams belong to a family of antibiotics which is characterized by a ß-lactam ring. Penicillins, cephalosporins, clavams (or oxapenams), cephamycins and carbapenems are members of this family. The integrity of the ß-lactam ring is necessary for the activity which results in the inactivation of a set of transpeptidases that catalyze the final cross-linking reactions of peptidoglycan synthesis.
Resistance to ß-lactams in clinical isolates is primarily due to the hydrolysis of the antibiotic by a ß-lactamase. Mutational events resulting in the modification of PBPs (penicillin binding proteins) or cellular permeability can also lead to ß-lactam resistance.
ß-lactamases constitute a heterogenous group of enzymes. Several classification schemes have been proposed according to their hydrolytic spectrum, susceptibility to inhibitors, genetic localisation (plasmidic or chromosomal), gene or amino-acid protein sequence. The functional classification scheme of ß-lactamases proposed by Bush, Jacoby and Medeiros (1995) defines four groups according to their substrate and inhibitor profiles. Group 1 are cephalosporinases that are not well inhibited by clavulanic acid; group 2 penicillinases, cephalosporinases, and broad-spectrum ß-lactamases that are generally inhibited by active site-directed ß-lactamase inhibitors; group 3 metallo-ß-lactamases that hydrolyze penicillins, cephalosporins, and carbapenems and that are poorly inhibited by almost all ß-lactam-containing molecules; group 4 penicillinases that are not well inhibited by clavulanic acid. Subgroups were also defined according to rates of hydrolysis of carbenicillin or cloxacillin (oxacillin) by group 2 penicillinases. The classification initially introduced by Ambler (1980) and based on the amino-acid sequence recognizes four molecular classes designated A to D. Classes A, C, and D gather evolutionarily distinct groups of serine enzymes, and class B the zinc-dependent ("EDTA-inhibited") enzymes.

Seasonal Allergy Symptoms

Seasonal Allergy Symptoms

Seasonal allergies cause itchy skin, a runny nose, watery and bloodshot eyes, and sneezing,
Symptoms and their seasonal appearance usually suggest the diagnosis, and skin tests can help identify the allergy trigger. Antihistamines, decongestants, and corticosteroid nasal sprays help relieve symptoms.
Seasonal allergies (commonly called hay fever) are common. They occur only during certain times of the year particularly the spring, summer, or fall depending on what a person is allergic to. Symptoms involve primarily the membrane lining the nose, causing allergic rhinitis, or the membrane lining the eyelids and covering the whites of the eyes (conjunctiva), causing allergic conjunctivitis (see Conjunctival and Scleral Disorders: Allergic Conjunctivitis).
The term hay fever is somewhat misleading because symptoms do not occur only in the summer when hay is traditionally gathered and never include fever. Hay fever is usually a reaction to pollens and grasses. The pollens that cause hay fever vary by season:
Spring: Usually trees (such as oak, elm, maple, alder, birch, juniper, and olive)
Summer: Grasses (such as Bermuda, timothy, sweet vernal, orchard, and Johnson grass) and weeds (such as Russian thistle and English plantain)
Fall: Ragweed
Also, different parts of the country have very different pollen seasons. In the western United States, mountain cedar (a juniper) is one of the main sources of tree pollen from December to March. In the arid Southwest, grasses pollinate for much longer, and in the fall, pollen from weeds, such as sagebrush and Russian thistle, can cause hay fever. People may react to one or more pollens, so their pollen allergy season may be from early spring to late fall. Seasonal allergy is also caused by mold spores, which can be airborne for long periods of time during the spring, summer, and fall.
Allergic conjunctivitis may result when airborne substances, such as pollens, contact the eyes directly.
Symptoms
Hay fever can make the nose, roof of the mouth, back of the throat, and eyes itch. Itching may start gradually or abruptly. The nose runs, producing a clear watery discharge, and may become stuffed up. In children, the stuffy nose may lead to an ear infection. The lining of the nose may become swollen and bluish red.
The sinuses may also become stuffed up, causing headaches. Sneezing is common.
The eyes may water, sometimes profusely, and itch. The whites of the eyes may become red, and the eyelids may become red and swollen. Wearing contact lenses can irritate the eyes further.
Other symptoms include coughing, wheezing, and irritability. A few people become depressed, lose their appetite, and have problems sleeping.
The severity of symptoms varies with the seasons.
Many people who have allergic rhinitis also have asthma (which results in wheezing), possibly caused by the same allergens that contribute to allergic rhinitis and conjunctivitis.
Diagnosis
The diagnosis is based on symptoms plus the circumstances in which they occur—that is, whether they occur only during certain seasons. This information can also help doctors identify the allergen.
The nasal discharge may be examined to see whether it contains eosinophils (a type of white blood cell produced in large numbers during an allergic reaction). Skin tests can help confirm the diagnosis and the identity of the allergen (see Allergic Reactions: Diagnosis).
Treatment
Nasal Symptoms: Antihistamines are usually used first (see Allergic Reactions: Antihistamines). Sometimes a decongestant, such as pseudoephedrine Some Trade Names
AFRINOLSUDAFED
, is taken by mouth with the antihistamine to help relieve a stuffy nose. Many antihistamine-decongestant combinations are available as a single tablet. However, people with high blood pressure should not take a decongestant unless a doctor recommends it and monitors its use. Nonprescription decongestant nose drops or sprays should not be used for more than a few days at a time because using them continually for a week or more may worsen or prolong nasal congestion. This reaction is called a rebound effect, which may eventually result in chronic congestion. Antihistamines may also have other side effects, particularly anticholinergic effects. They include sleepiness, dry mouth, blurred vision, constipation, difficulty with urination, confusion, and light-headedness.
A corticosteroid nasal spray is also effective. This spray may be prescribed instead of or in addition to antihistamines. Most of these sprays have few side effects, although they can cause nosebleeds and a sore nose.
Other drugs are sometimes useful. Cromolyn Some Trade Names
CROLOMINTAL
is available by prescription as a nasal spray and may help relieve a runny nose. To be effective, it must be used regularly. Azelastine Some Trade Names
OPTIVAR
(an antihistamine) and ipratropium Some Trade Names
ATROVENT
, both available by prescription as nasal sprays, may be effective. But these drugs can have anticholinergic effects similar to those of antihistamines taken by mouth, especially drowsiness.
Montelukast Some Trade Names
SINGULAIR
, a leukotriene modifier, reduces inflammation and helps relieve a runny nose. But how it is best used has not been established. Omalizumab Some Trade Names
XOLAIR
may be used when other treatments are ineffective. This drug binds to immunoglobulin E (IgE), an antibody produced in large amounts during an allergic reaction. Both montelukast Some Trade Names
SINGULAIR
and omalizumab Some Trade Names
XOLAIR
are available by prescription.
Regularly flushing out the sinuses with a warm water and salt (saline) solution may help loosen and wash out mucus and hydrates the nasal lining. This technique is called sinus irrigation.
When these treatments are ineffective, a corticosteroid may be taken by mouth or by injection for a short time (usually for fewer than 10 days). If taken by mouth or injection for a long time, corticosteroids can have serious side effects.
Eye Symptoms: Bathing the eyes with plain eyewashes (such as artificial tears) can help reduce irritation. Any substance that may be causing the allergic reaction should be avoided. Contact lenses should not be worn during episodes of conjunctivitis.
Eye drops containing antihistamines and a drug that causes blood vessels to narrow (a vasoconstrictor) are often effective. These eye drops are available without a prescription. However, they may be less effective and have more side effects that prescription eye drops (see Conjunctival and Scleral Disorders: Diagnosis and Treatment). Eye drops containing cromolyn Some Trade Names
CROLOMINTAL
, available by prescription, are used to prevent rather than relieve allergic conjunctivitis. They can be used when exposure to the allergen is anticipated. If symptoms are very severe, eye drops containing corticosteroids, available by prescription, may be used. During treatment with corticosteroid eye drops, the eyes should be checked regularly for increased pressure and infection by an ophthalmologist.

Spring Allergy

Spring Allergy

Spring allergy season hit the East Coast hard last year. With the amount of pollen floating in the air four times greater than what observers consider to be high, East Coast allergy sufferers were left wondering what hit them.
People who normally wouldn't even notice the change of season experienced watery eyes and sneezing. Allergy sufferers all too familiar with the perils of high pollen counts were forced indoors, giving up visits to the park or a pick-up game of basketball because the sneezing, stuffiness and general misery of allergy symptoms were overwhelming.
Whether pollen counts will be high again this year or settle back into what is considered to be a normal range remains to be seen. Seasonally, and daily, weather conditions impact pollen counts, making it difficult to predict pollen counts more than a few days in advance.
On windy days, or for days after high winds, pollen counts are high because the pollen has been spread throughout the air," said Gillian Shepherd, MD, FAAAAI, chair of the Education Sub-Committee of the American Academy of Allergy, Asthma and Immunology. "After it rains, counts drop as the rain washes the pollen away."
Pollen is measured in grains per cubic meter. For trees, 1,500 grains per cubic meter is considered very high. Last spring, areas of the East Coast measured 6,000 grains per cubic meter.
Though high pollen counts can affect numerous types of allergies, from eye allergies (conjunctivitis) to skin reactions (dermatitis), the most common spring allergy is allergic rhinitis.
Frequently called hay fever, seasonal allergic rhinitis affects 35 million people in the United States. It is triggered by "allergens," substances that initiate an allergic response, such as pollens or molds.
When people who have allergic rhinitis inhale these allergens, they combine with an allergic antibody called immunolgolbulin E (IgE). Normally present at very low levels in the body, IgE is found in larger quantities in people who have allergies.
When the allergen and the IgE combine in the lining of the nose or eyes, the result is the release of chemicals, including histamine. These chemicals cause the allergic symptoms of sneezing, itching, watery eyes, nasal congestion or headaches as the body tries to fight off the foreign allergen, Shepherd said.
Seasonal allergies have a large impact on not just quality of life, but the economy. Missed work days because of allergies cost U.S. companies more than $250 million a year.
Allergies, particularly in the spring have a huge impact across the country. Fortunately, medical treatment is usually very effective, shahg says.

Food Allergy Treatment

Food Allergy Treatment

Food allergy is treated by avoiding the foods that trigger the reaction. Once you and your healthcare provider have identified the food(s) to which you are sensitive, you must remove them from your diet. To do this, you must read the detailed ingredient lists on each food you consider eating.
Many allergy-producing foods such as peanuts, eggs, and milk, appear in foods one normally would not associate them with. Peanuts, for example, may be used as a protein source, and eggs are used in some salad dressings.
Because of a new law in the United States, FDA now requires ingredients in a packaged food to appear on its label. You can avoid most of the things to which you are sensitive if you read food labels carefully and avoid restaurant-prepared foods that might have ingredients to which you are allergic.
If you are highly allergic, even the tiniest amounts of a food allergen (for example, a small portion of a peanut kernel) can prompt an allergic reaction.

If you have food allergies, you must be prepared to treat unintentional exposure. Even people who know a lot about what they are sensitive to occasionally make a mistake. To protect yourself if you have had allergic reactions to a food, you should take the following precautions:
* Wear a medical alert bracelet or necklace stating that you have a food allergy and are subject to severe reactions
* Carry an auto-injector device containing epinephrine (adrenaline), such as an epipen or twinject, that you can get by prescription and give to yourself if you think you are getting a food allergic reaction
* Seek medical help immediately, even if you have already given yourself epinephrine, by either calling the rescue squad or by getting transported to an emergency room
Anaphylactic allergic reactions can be fatal even when they start off with mild symptoms such as a tingling in the mouth and throat or gastrointestinal discomfort.
Exercise Induced Food Allergy
At least one situation may require more than simply eating food with allergens to start a reaction: exercise-induced food allergy. People who have this reaction only experience it after eating a specific food before exercising. Some people get this reaction from many foods, and others get it only after eating a specific food. As exercise increases and body temperature rises, itching and light-headedness start allergic reactions such as hives may appear and even anaphylaxis may develop.
The management of exercised-induced food allergy is simple—avoid eating for a few hours before exercising.
Childcare concerns
Schools and daycare centers must have plans in place to address any food allergy emergency. Parents and caregivers should take special care with children and learn how to do the following:
* Protect children from foods to which they are allergic
* Manage children if they eat a food to which they are allergic
* Give children epinephrine
Simply washing your hands with soap and water will remove peanut allergens. Also, most household cleaners will remove them from surfaces such as food preparation areas at home, as well as at daycare facilities and schools. These easy-to-do measures will help prevent peanut allergy reactions in children and adults.
There are several medicines you can take to relieve food allergy symptoms that are not part of an anaphylactic reaction:
* Antihistamines to relieve GI symptoms, hives, or sneezing and a runny nose
* Bronchodilators to relieve asthma symptoms
It is not easy to determine if a reaction to food is anaphylactic. It is important to develop a plan with a healthcare provider as to what reactions you should treat with epinephrine first, rather than antihistamines or bronchodilators.
Controversial and Unproven Treatments
One controversial treatment, which sometimes may be used with provocative challenge, includes putting a diluted solution of a particular food under your tongue about a half-hour before you eat the food suspected of causing an allergic reaction. This is an attempt to “neutralize” the subsequent exposure to the food you believe is harmful. The results of carefully conducted clinical research show this procedure does not prevent an allergic reaction.
Allergy shots
Another unproven treatment involves getting allergy shots (immunotherapy) containing small quantities of the food extracts to which you are allergic. These shots are given regularly for a long period of time with the aim of “desensitizing” you to the food allergen. Researchers have not yet proven that allergy shots reliably relieve food allergies.

Obesity And Pregnancy

Obesity And Pregnancy

A significant research done by a team from the French Institute for Public Health Surveillance has discovered that obesity could be one of the major contributing causes in critical swine flu cases.The latest research has been done by analyzing the deaths from swine flu pandemic across the globe.The research team took into account the characteristics of 574 deaths linked to the pandemic H1N1 influenza till the middle of July.
Underlying disease mostly present in swine flu deaths
As per the research findings, it was established that an underlying disease was present in at least half of all fatal cases. Not only this, the research team also discovered major differences in demographic patterns among those affected by the pandemic.
When an underlying disease was found to be the cause if a person died of swine flu, it was seen that in more than one in four cases the person suffered from a metabolic condition- diabetes and/or obesity.
Although the mortality patterns were more or less the same as those seen in seasonal flu, but two risk factors emerged out of all of them, i.e., pregnancy and obesity.
The team studied deaths of women, and found that 16 women, who represented 10 percent of all female deaths, were pregnant or had freshly delivered when they died. Half of the women had some other health-related problems.
Younger people more susceptible
Also, there has been a general view that the pandemic has mostly claimed the lives of people in the younger age group and this was found to be true.
Compared to younger age groups, the elderly seem to be protected from infection to some extent, perhaps due to previous exposure to strains akin to influenza A (H1N1) v virus,” the team was quoted as saying.
The research team found that the average age of those who have died was 37. People in the age group of 20 to 49 years comprised of more than half of all deaths. Overall, 12 percent of deaths were discovered in people above 60 years of age.
Obesity as a risk-factor in swine flu deaths could add another dimension to the research currently being done by epidemiologists on swine flu.
But the team has said that elaborate studies need to be done before it is thoroughly established that there is a connection between obesity, acute influenza and mortality.
Pandemic likely to get worse
As per a new update issued by the Health Protection Agency (HPA), “In the last seven days, cases reported globally have increased by eight percent and the number of deaths by 21 percent.
But the good news by HPA is that flu cases have gone down in England now. However, as the autumn is arriving, there is a fear that the infection will gain momentum again.
The French team warned, “The pandemic is far from over, and deaths will unfortunately continue to occur. As in previous pandemics, available data show that age groups are not equally affected.