Let us study different laws about suicide and assisted suicide for some countries.

Sweden’s crime code has no laws forbidding assisted suicide. Legal proceedings will accuse an assister with unlawful killing. In 1979 Berit Hedeby, the leader for right-to-die, was sentenced to jail for assisting a man to die. While the rules for neighbouring country Norway has special crime code for assisted suicide called as “accessory to murder”. If you prove the situation and give valid reasons for the assisted suicide the court might spare you with negligible punishment. The latest survey says assisted suicide is not a crime and the ratio has given the figures of 5:2.

Christian Sandsdalen, a retired physician in Norway was claimed to be responsible for putting a woman to death in year 2000. A woman who was seriously ill for 20years begged for assistance and wanted to get rid of this illness was helped by the physician by giving an excess dose of morphine. He had to pay his medical license for assisting the woman for her peace but he was spared from being sent to jail. He filled a case to the Supreme Court but it didn’t prove fruitful. He passed away at the age of 82 his memorial holds dignity with Norwegians. He holds great respect by people who believe in killing person painlessly.

Finland has no specific laws and code for assisted suicide. An assister will enlighten officials and powers about the assistance during suicide and will justify his deeds in helping and if he proves himself innocent he is safe. Assistance is mostly provided to friends and relatives. The laws for doctors in Finland for practicing killing painlessly to the patient who has incurable disease and assisted suicide are different. But specifically no case till now has been brought to notice.

Since 1751, Germany has no Specific Criminal code or penalty for assisted suicide and suicide. But it still believes euthanasia is an offence and should be restricted. Nazi and modern church believers believe excess practising of direct killing should be restricted. A German appeal court convicted a Swiss clergyman for bringing the drugs to the country but not for assisted suicide as no particular law mentioned assisted suicide as a crime. No punishment was given for the act.

Further, France also has no particular rules prohibiting assistance in suicide. But law under 223-6 Of the Penal Code proves a man guilty for failure in assisted suicide. Only few are found guilty and minor punishments are given. All the publications on suicide assistance are restricted.

Highlights of the report filed at Council of Europe are mentioned below:

a. Assisted suicide and euthanasia has no law to convict the person if it proves that    person has wished to end his life because of pain and illness.

b. No laws prove euthanasia as an offence and no doctors or physician are claimed to be guilty or inconsiderate of human importance and their life.

c. Members and associate of Government of council of Europe are asked to evaluate and analyze the reason about suicide. All necessary facts and data are collected and researched about end-of-life decisions. It helps in encouraging public discussions and evaluates different analysis given by the public adhering to the rules and laws framed by council of Europe. It also brings to the notice whether euthanasia is a crime or a help under the criminal code.

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We normally forget our dreams when we wake up. But if you can recollect your dream and try to evaluate and understand your dreams, it has a meaning. By evaluating your dreams you can acknowledge your mistakes and flaws and try to get moral sense of evaluating right and wrong. Thus it helps you and also develops functioning of your mind. Normally, human beings are habituated to use only one portion of their psychological function, but this helps other function to perform and work.

Your dreams are resemblance of your thoughts and acts. Your dream activates your mind and your ability to think and judge someone and perform accordingly in reality. Incase if your personality depicts your outgoing person and your sensitive nature, your dreams will revolve around your looks, your appearance, your food your actions and all materialistic things that makes you look good and gives you happiness and satisfy your psychological nature.

Evaluate your dreams and act on your thinking. Suppose, if you neglect your behavior about the person and your opinion of what you feel about them, you are encouraging non function of your psychological behavior. And you will develop intuition about that person. Intuition is an immediate apprehension by mind without reasoning and immediate insight and reaction about a person. Working with psychological function will also give you awareness at your work place, in a sense that who will are your actual customers and who are passer-by.  You can develop a conscience about the person who is right and wrong for you and can take steps accordingly.

If you don’t work on this psychological function, you are not working on decision making process and ability to guess and predict something. You are wasting your abilities.

This helps full functioning of psychological function. Dream interpretations help you
develop your sense. You tend to widen your thinking and imagination and conclude reality which otherwise was in gloom. Traditionally, we use only partial of our psychological function.

Contrary, if you fully and completely utilize your conscience you can know the repercussions of many actions and reactions. You try to avoid and stay away from negative anti-conscience. Thus you can be confident about fruitful and profitable outcome of reality.

Thus you expand your power of thinking, and you develop “third eye” ability. It means you be judgmental not in your dreams but also in real life. You thoroughly study the matter and solve it accordingly; this will give you rewards in your real life.

Interpreting your dreams can help you to be a better person. So don’t neglect your dreams, it has a special significance to say.

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Day 1:

1. Savour taste of all your favourite fruits, just no bananas.
2. Sip cranberry juice, tea and black coffee and water with no sweeteners.
3. Gobble down on as many soup bowls as you can.

Day 2:

On day two stay away from fruits. You can consume vegetables cooked or uncooked, your choice but no peas and beans and corns. For a feast you are allowed to eat a big size baked potato for dinner, you can add butter for taste.

Day 3:

Its combination of the above two days, sip on soup and also you can feed yourself with fruits and vegetables except baked potato.

Day 4:

It’s about milk and bananas on day four. You are allowed to eat up to eight bananas and no restriction on glasses of skimmed milk. You can also have soup for the day. It will decrease your craving for sweets.

Day 5:

All you beef dieters, you can nosh-up with beef today. You are allowed to have 300-500gms of beef with tomato juice or puree. A soup bowl is compulsory at least once. You can have baked or grilled chicken without skin or even fish if you prefer it as an alternative of beef. Drink minimum of 6 to 8 glasses of water, it will clear your body and even flush out uric acid.

Day 6:

It’s a vegetable and beef day. You can have 2 to 3 thick slice of meat especially beef with vegetables and salads. No potato for the day and at least a bowl of soup is mandatory.

Day 7:

It’s a feast day as you are allowed to include brown rice in your food along with natural fruit juice no sugar and vegetables. A portion of soup is recommended for the day. Stay away from bread, carbonated drinks like cokes and colas not even diet coke and strict no to alcohol.

Wishing you all the best for your diet and get set go to lose weight quickly and be ready to face world more positively.

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Fig1 Beijing Olympics 2008

Half of the runners who run 80 miles per week have amenorrhea. Disordered eating occurs in more than 60% gymnasts. It is result of psychological pressure to maintain body figure and certain body weight. The calorie restriction is common in light weight rovers to maintain low body weight in spite of hard training. Athletes like ballet and gymnasts during late teens are more prone to menstrual irregularities than those in twenties.

Fig.2. Incidence of Amenorrhea

Abnormalities of menstrual functions occur as endurance training is increased, and these increase with increase in intensity of exercise. The luteal phase is decreased; there is less production of progesterone and more anovulatory cycles. The psychological profiling is similar to anorexia nervosa patients. The release of gonadotrophin releasing hormone (GnRH) is slowed down leading to hypothalamus induced suppression of ovaries¹ (hypogonadotrophic hypogonadism) resulting in very low estrogen production. The picture is similar to that in pre-puberty stage.

Fig.3 Hypothalamus-pituitary-ovarian axis

Different factors are responsible for release of hormones including cartisol, insulin-like growth-factor binding protein-1 (IGFBP-1) and leptin. Opioids have inhibitory action on GnRH release. Rise in serum cartisol level in amenorrhic athletes is found as compared to their counterparts without amenorrhea. This occurs due to stress mechanism that causes release of corticotrophin-releasing hormone (CRH). This increases sensitivity of GnRH for opioid inhibition and endorphin release thus causing amenorrhea. There is decrease in bone density due to raised cortisol level.⁴ An other proposed mechanism for amenorrhea is decreased calorie intake by athletes causing energy imbalance in them. Low energy intake but high energy output due to exercise results in weight loss. The athletes usually have body mass index less than 18 and body fat less than 17 percent. They have low BMR, low level of insulin and insulin like growth factor-1 (IGF-1) and try-iodothyronine. It is not still clear how these changes affect GnRH release. The level of IGFDP-1 is found elevated in atheletes with amenorrhea and serum leptin levels are decreased in these athletes but their role in GnRH pulse generator regulation is not clear yet².

The bone density is decreased in athletes with amenorrhea. But the areas of bones involved in high stress activities like femoral necks in runners, spine in rowers, and spinal and femoral neck areas in gymnasts have high bone density. If episodes of amenorrhea are short then bone density is reversible with restoration of normal menstruation. If amenorrhea remains for a longer time the bone density becomes similar to post-menopausal women leading to risk of early osteoporosis. These athletes are prone to stress fractures which are incomplete and usually heal with rest and treatment².

The investigations include identifying the cause of amenorrhea, measuring serum tri-iodo-thyronine and bone mineral density. Assessment of energy and calcium intake is also done. Treatment of female athlete triad syndrome include decreasing amount of exercise, increasing energy intake, psychological intervention, estrogen replacement therapy and supplementing diet with calcium, and vitamin D².

References

1- Otis, C. L., & Goldingay, R. (2000). The athletic woman’s survival guide. Champaign, Illinoi

2- Warrell A D(2005), (Edt). Oxford Textbook of Medicine (Fourth Edition). Oxford University Press, Oxford.

Figures

1- Beijing Olympics China 2008. Picture retrieved from http://www.upi.com

2- Data taken from Wolman RL, Harries MG (1989). Clinical Sports Medicine.

3- Hypothalamus-pituitary-ovarian axis (picture, ch6fb43) retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/picrender.

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Incidence

Prostatic cancer is commonly found in United States (black population), UK and Northern Europe. In United Kingdom it is the third most common male cancer and second most common cause of cancer related death in males; and fifty males out of every one hundred thousand males suffer with it. It is less common in Asian countries like China and Japan. It is uncommon before 60 years of age and the mean age of prostate cancer is 70 years.

Symptoms

The main symptoms are due to outflow obstruction. Patient has weak and interrupted urinary stream.  There is hesitancy, terminal dribbling, feeling of incomplete emptying and straining to void. Patient also has symptoms of urinary tract infection including increased frequency, urgency, urge incontinence and increased frequency and urge to pass urine during night (nocturia).

The patients also have general symptoms of malignancy including loss of appetite, weight loss, anemia, weakness and cachexia and inability to perform.  There are symptoms due to local spread and metastasis. These may include pain due to obstruction of ureters, backache, cough and neurological symptoms when nerve roots are involved.

Investigations

A plain radiograph is taken to investigate pain in lower back that may be the first symptom. The metastasis from the primary carcinoma of prostate to the lumber vertebrae causes degenerative changes resulting in backache.

Endoscopic resection of patient’s prostatic tissue is done to provide relief from outflow obstruction. Tissue sample is taken for histology.

Transrectal ultrasound scan with needle biopsy of prostate is done to diagnosis cancer.

Radioisotope bone scan is done to see distant metastasis.

Blood investigations like blood complete examination is done to confirm anemia. Specific investigation like high serum level of Prostatic Specific Antigen (PSA more than 100 ng/ml) shows distant metastasis and its serum level is used to monitor response to treatment.

Management

When tumor is limited to prostate, it can be cured with surgery (radical prostatectomy) or radical radiotherapy of prostate. This treatment should be considered when patient has ten years or more live expectancy. A small tumor found and dissected out by endoscopic resection does not alter life expectancy even if removed. Prostatic cancer is sensitive to hormonal treatment.  Localized, with local spread or distant spread, the cancer can be treated by surgically removing testicles, or using medication to suppress androgens. The use of androgen suppressing drug is more common than surgery. The drugs act at receptor sites of tumor cells and block them for hormone dihydrtestosteron thus do not allow growth of tumor. A large number of patients respond to drug treatment for 1-2 yeas then cancer again shows up.

Chemotherapy with 5-fluorouracil, cyclophosphamide or nitrogen mustard is done to treat bone pain. For more widespread pains hemi body radiotherapy is used as palliative treatment. The pain is relieved with strong analgesia.

Prognosis

When carcinoma is found at its focal stage and removed the life expectancy is similar to general public. When tumor is localized to prostate, half of the patients have 10 years life expectancy. If metastasis is present then only 10% of patients have 10 year survival.

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Depending upon the setting pneumonia can be community acquired, hospital acquired or acquired by patients with impaired immune functions. The community acquired pneumonia causes one million hospital admissions per year in UK.

Spread and risk factors

Microorganisms causing community-acquired pneumonia spread by droplet infection (coughing, sneezing, nasal secretions). The patients are previously well, but have risk factors like cigarette smoking, alcohol consumption, corticosteroid therapy, old age, recent influenza infection, lung disease and contact with sick birds or farm animals.

Symptoms

The patient has short, painful dry cough, fever, malaise and chest pain. The chest pain may be referred to shoulder or abdomen. Latter cough becomes productive with rust colored sputum or blood stained sputum. There is high temperature with rigors. Children may present with vomiting and febrile convulsions. There may be headache and confusion.

Microorganism causing community-acquired pneumonia

From most common organisms to least common organisms in order of sequence these include Streptococcus pneumoniae, Chlamydia pneumoniae, Mycoplasma  pneumoniae, Legionella Pneumoniae, Haemophilus influenza, Staphylococcus aureus, Chlamydia psittaci, Coxiella burnetii and Klebsiella pneumoniae.

Investigations

Radiological examination shows homogenous opacity affecting lobe or segment of lung and it appears within eighteen hours of start of symptoms. Complications of pneumonia like pus cavities in the lung, empyema and enlargement of lymph nodes in the middle part of lungs can also be diagnosed with radiograph. Follow up radiological examination, after patient has received treatment, is necessary to assess resolution of pneumonia.

Other investigations are sputum microscopy and culture, blood examination and culture and serological tests.  In case patient does not improve with treatment and sputum sample cannot be obtained, aspiration of secretions from trachea, bronchi and lower lung is needed to detect microorganism and establish diagnosis. Agglutination tests for pneumococcal antigen in blood, sputum, urine and finding C-reactive proteins are useful tests to diagnose pneumococcal pneumonia. Arterial blood gas analysis is performed for all patients admitted in the hospital.

Blood tests include complete examination of blood cells including total white cell count and differential count. The neutrophils increase in pneumococcal pneumonia. White cell count is normal if pneumonia is caused by atypical agent. When number of white cells is less than normal count, it shows viral or severe bacterial pneumonia.

Management

Oxygen, assisted ventilation and intravenous fluids

High concentration of oxygen is administered to all patients to treat hypoxemia except those with hypercapnia. Assisted ventilation is provided at initial stage of treatment. Intravenous fluids are often needed to rehydrate patient.

Antibiotics

Sputum, blood and urine samples are taken and antibiotic treatment is started according to clinical diagnosis. The antibiotic is changed if needed after detection of microorganism in the laboratory.The antibiotic treatment is continued for 10-14 days.

Analgesics

The analgesics like Paracetamol usually cannot relieve chest pain (pleural pain). So it is treated with medicines having strong analgesic effect. These include injections of morphine and pethidine. But these should be used with caution in patients with poor respiratory function due to their depressive action on respiration.

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Symptoms

Severe prolonged chest pain with feeling of tightness, constriction, or heaviness is the cardinal symptom. It may be the most severe pain patient has experienced in life time. The pain can also be felt at other sites like, shoulder, neck and back. Other symptoms are breathlessness, syncope, nausea, vomiting and fear of death due to severe anxiety. Elderly and diabetic patients may have only one symptom and that is breathlessness.

Investigations

Electrocardiography (ECG) shows ST elevation or depression, T wave inversion, Q wave and decreased size of R wave.

Blood tests detect presence of increased amount of enzymes and proteins that are normally found in cardiac cells. These include raised blood level of creatine kinase (CK) and  CK-MB. Other blood tests show rise in ESR, leukocytosis and raised C-reactive protein.

Chest X-ray may show fluid around heart, lung and enlargement of heart.

Echocardiography can detect abnormalities of heart structure and fluid around it.

Management

When myocardial infarction is suspected immediate medical intervention is required. An ambulance service with coronary care equipment fitted inside is needed for patient. The urgent treatment of patient includes oxygen, morphine or diamorphine injection with antiemetic to relieve pain, continuous ECG monitoring and maintenance of intravenous line. Aspirin 75-300 per day is given to prevent clot formation in the blood. Thrombolytic treatment includes i.v injection of streptokinase 1.5 million units diluted in saline. Ateplase is non antigenic and more effective than streptokinase. Other thrombolytic agents are Reteplase and Tenecteplase. Anticoagulants like heparin and warfarin can be used with aspirin. Beta blockers can be used for pain and arrhythmias. Nitrates are useful for recurrent and persistent pain due to ischemia.

When patient has survived the acute attack of MI, the secondary measure of prevention is used for further treatment. These include removing risk factors of ischemia to heart by stopping smoking, modifying diet to lose weight and lower blood cholesterol and regular exercise. The drugs used are aspirin for its anti platelet effects, beta blockers for arrhythmias and ACE inhibitors for heart failure. Patient can gradually increase physical activities after 2^nd day and returns to work in 4-6 weeks. Patient and his/her family need emotional support and counseling. A personal rehabilitation program with graded exercises is helpful to return to normal life.

Prognosis

Twenty five percent patients die within few minutes of onset of MI. Forty percent patients die within first month of onset of symptoms due to complication of disease. Patients who receive hospital care have more chances of survival. Those who survive acute attack, 75% live for 5year, 50% for 10 year and 25% for 20 year.

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Below are few listed herbal weight loss alternatives that you can look into before deciding the products:

Herbal weight loss products

Market these days are flooded with ample option for herbal weight loss products. Just a simple click on World Wide Web and you will have list and ways of herbal weight loss products.

Don’t blindly follow the herbal products available on the internet. It’s better to investigate and evaluate the herbal products available yourself for your betterment.

Some herbal weight loss products are made through use of some chemicals and components which could be dangerous to your health, so it’s better to look in for the composition of the weight loss products before buying them.

Senna:

Senna, an herbal laxative mostly found in teas acts as a stimulus to lower and greater part of large intestine. The drawback of the Senna is that it leads to dehydration and a person can get addicted to the herb. Sometimes more usage of Senna makes people habituated and is not able to do bowel movements. To be on safer side if weight loss products comprises of senna drink lots and lots of water and abide by the directions.

Chromium Picolinate:

Chromium is a supplement which maintains a check in blood sugar level and found in herbal weight loss products. The compound when taken in more amounts can lead to dehydration and can also harm chromosomes. So it’s better to put an eye on the dose.

St. John’s wort:

This ingredient leads to increase of chemical production in the brain. If this supplement not used appropriately, the usage can lead to eye and skin diseases, gastrointestinal sufferings, exhaustion and burning. Mostly all herbal weight loss products deprive from using this herb. But it is still advisable to read the percentage of herb present in the product.

It’s advisable to research about the components and compounds found in the herbal weight loss products before consuming them. It says that, most of the herbal pills are safe and natural. One should deeply study and spend time researching the product and its effect on our body rather than solely depending on doctor or any advises.

Organic food

Organic food has become very popular from Kelowna BC. People feeding themselves with organic food say it helps their bodies and natural amenities also.

Organically raised vegetables and eggs are said to be healthier than processed food products. Organically made food keeps a person away from doctors and hospitals. There is no side effect in organic food that harms your body and also it is the ideal option for weight reduction as it is not made chemically.

Green Tea

Research has proved that consumption of green tea and extracts from green tea burns more calories. Caffeine in green tea burns fat more up to 40% and thus reduces fat.

It is also found that people who consume green tea are found to shed 2 to 3 times more weight than who do not. All those who want to shed those extra kilos this is a best alternative.

Green tea is good option for curing obesity and it also lowers cholesterol level. Alternate to caffeine, green tea is healthier option. It’s advisable to sip a cup of natural tea as it boost up the energy level nullifying the effects of caffeine.

Immortality Herb

Gymnostemna Pentaphyllum also known as immortality herb is used in herbal weight loss products the usage helps in:

It helps in maintaining the flow of blood. Blockage in artery is reduced. It keeps a check on blood pressure.  It helps in burning fat easily.

Apple Cider Vinegar

Apple cider vinegar is main component of many herbal weight loss products.  Advantage of apple cider vinegar is:

• It helps in weight reduction.
• It keeps an eye on cholesterol level.
• It also aids in blood pressure.
• It aids in curing rheumatoid arthritis.

You can have many more herbs in herbal weight loss products but these are the best effective option for weight loss.

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Diabetes mellitus is mainly caused because of non-function of a hormone that converts glucose and other food items to produce energy. Diabetes is caused as the sugar level in the body rises high and the hormone regulating sugar is not functioning properly, due to which there is rise in glucose level. Sugar in the body has to be maintained at certain level. Insulin and glucagon serves the purpose of maintaining a thin line of sugar level. The purpose of glucagon is to produce energy through release of glucose from cells into blood.

Three types of diabetes found commonly:

1. Diabetes Type I

1. Diabetes Type II
2. Gestational diabetes

Type I and type II diabetes is dangerous as it hampers your stress free life. In type I and type II diabetes, the hormone making glucose has stopped producing energy so body has to use fat and protein for the production of energy needed. Mainly because of this reason weight loss and symptoms like polyuria, polydipsia and polyphegia are found in a diabetic patient. The ideal blood sugar in human body has to between 70mg/dl-110mg/dl when fasting. There are two forms of diabetes, it is hypoglycemia if blood sugar is less than 70mg/dl and said to be hyperglycemia if blood sugar is more than 110 mg/dl.

Diabetes has many other repercussions leading to death. It is a main cause for blindness among adults, ESRD (renal diseases), and death of body tissues mainly caused by circulation and surgical cuts. Hereditary, sedentary life style, obesity and stress in life could be one of the causes for diabetes. When there is a striking increase in sugar level it could damage kidney and can lead to damage nerve system and a diabetic person has to face many other cardiovascular problems. Diabetic patient has more chance to get attack by coronary heart diseases and stroke attacks. Gestational diabetes is too risky for expecting mothers and their embryo.

Jotted down are few ways to remove and control diabetes type2

If you are affected by Type II diabetes, it is like a lifetime member of your body. There’s no remedy to type II diabetes. You along with your doctor’s advice can take steps to maintain sugar level and   lessen your chances of risks and complication involved with Type II diabetes. There should be regular change in medication plan to maintain type II diabetes monthly or yearly. Healthy diet along with exercise maintains the blood sugar but medication is important in long run. Amendments in medicines should be done on regular interval to keep sugar level maintained. Over a period of time if medicines fail to be fruitful, insulin has to be taken for precautions.

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Symptoms

More often the disease starts slowly but sometimes it may have acute onset. There is pain, stiffness in the morning and swelling of small joints of hands and feet, and loss of function in hands. Both hands and feet are affected symmetrically. In hands middle joints of fingers become swollen and look like spindles. Finger tips are turned toward palm. The fingers at the bases are stretched opposite to the palm and joints at bases of fingers are dislocated so fingers look like ‘swan neck ‘. Moreover the fingers are pushed towards inner side of arm. Patient cannot grip anything due to decreased power and pain.

In feet there is swelling of joints at the bases of phalanges and phalanges turn toward sole from their tips making ‘claw foot’. Patient feels pain like ’walking on pebbles’. Other symptoms are pain in the neck, wrist, elbow and knee joints. As the disease advances deformities in the joints of hands and feet also increase with more loss of function. Patients also have fever, weight loss, malaise, weakness and feeling of hard rounded bony material under the skin of forearm.

The disease commonly involves heart, lungs, kidney, nerves and small blood vessels causing structural damage and producing associated signs and symptoms.

Investigations

Full blood count, ESR, Rheumatoid factor, joint X-ray

Management

1. Patient Support: It includes provision of information about disease, its treatment and support available regarding disability caused by disease. The patent is provided with disable parking permit and financial support. He/ she is helped in joining disability groups.
2. Physiotherapy:  Exercises help in maintaining mobility of joints and give strength to muscles. Splints and other appliances also help by increasing body mobility.
3. Drug Treatment: Drugs used for rheumatoid arthritis include non-steroidal anti-inflammatory drugs (NSAIDs), steroids and disease modifying anti-rheumatoid drugs (DMARDs). NSAIDs include aspirin, ibuprofen, mefenamic acid, diclofenac and others. Sustained release preparations are also available. These decrease inflammation and pain. Steroids are used when only NSAIDs do not relieve pain and inflammation. Injections for joints and oral forms of steroids are available. DMARDs are used when disease is resistant to other treatments. These include methotrexate, gold, penicillamine and sulphasalazine. These have serious side effects.

Prognosis

Most of the patients have chronic course of disease with remissions and relapses. After 10 years 25 per cent will have complete remission, 35 will have severe disease and 40% moderate form of disease.

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