What Are Pinworms (threadworms)? What Causes Pinworm Infection?

The pinworm, also known as threadworm, seatworm, and formally known as Enterobius vermicularis, is a very common intestinal parasite. Enterobiasis, or oaxyuriasis refers to the medical condition associated with pinworm infestation.

Pinworm is the most common type of roundworm found in the USA. They are parasites that use the human body to survive and reproduce. The pinworm's microscopic eggs hatch and grow into adults in the human body - adults measure from 0.2 to 0.4 inches (5 to 10 millimeters). The worms mature in the intestine and then move through the digestive system to lay eggs in the anal area. Adult worms, which are white and look like small pieces of thread, live for up to six weeks.

Pinworms do not always cause symptoms. Some patients may experience itchiness around their anus and females may experience itchiness in the vaginal area. The itchiness tends to be worse or more noticeable at night, and can sometimes wake up the patient.

According to Medilexicon's medical dictionary:

A Pinworm is "A member of the genus Enterobius or related genera of nematodes in the family Oxyuridae, abundant in a large variety of vertebrates, including such species as Oxyuris equi (the horse pinworm), Enterobius vermicularis (the human pinworm), Syphacia and Aspiculuris species (the mouse pinworm), Passalurus ambiguus (the rabbit pinworm), and Syphacia muris (the rat pinworm)."

What are the signs and symptoms of pinworm infection?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

If the patient has only a small number of adult worms the infection will be mild and there may be no symptoms at all. Symptoms tend only to be present with heavy or moderate infections.

A few weeks after ingesting pinworm eggs, the mature females make their way from the intestine to the anal area, where eggs are laid, usually at night. During the maturing and reproduction stages the patient may experience:

• Disturbed sleep
• Itching of the anal area, may sometimes be intense, especially at night when the female worms are laying eggs
• Itching of the vaginal area (females)
• Slight nausea
• Vague intermittent abdominal pain

Individuals with severe itching may experience:

• Loss of appetite
• Severe irritability
• Sleeping difficulties
• Weight loss

If somebody is found to have an infection, all other members of the household should be treated too, even if they have no symptoms.

What are the causes of pinworm infection?

The main reason for pinworm infection is poor hygiene. Eggs are transferred from the anus of an infected person to either their mouth (re-infecting themselves) or another surface. If somebody else touches that contaminated surface and then touches their mouth, they may have ingested the eggs and become infected.

The female pinworm lays eggs around the anus and vagina (of females). A pinworm can lay thousands of microscopic eggs.

The eggs can be transferred from the person's anus to:

• Bed sheets
• Carpets
• Hands
• Towels
• Underwear and clothes

The female pinworm releases an itchy mucus when laying her eggs, triggering an urge to scratch the affected area (anus/vagina). If the area is scratched the eggs will be transferred to the patient's hands. From the hands, the eggs may be transferred to anything that is touched, such as:

• Bathroom utensils (toothbrush, combs, etc)
• Directly to other people's hands (if the hands of an infected person touch the hands of another)
• Furniture
• Kitchen and bathroom worktop surfaces
• Kitchen utensils
• Toys

Swallowing the eggs - the eggs can survive for up to three weeks on surfaces. If they are touched they will be transferred onto the hands. If the hands then touch the person's mouth, there is a serious risk of ingesting (swallowing) the eggs and becoming infected.

Breathing in the eggs - the microscopic eggs may become airborne and be breathed in and then swallowed. This may happen if you shake a towel or bed sheets.

The eggs hatch in the intestines two weeks after being swallowed. Two weeks later the pinworm is able to reproduce.

Poor hygiene - small children are more likely to become infected because they tend to be less thorough about hand washing, compared to other people.

Children may also have long-lasting infections because they are swallowing fresh eggs continually - children are usually in close contact with each other and share items and hold hands while playing, making re-infection more likely.

Pinworms are more common in crowded conditions.

Pinworms that affect humans cannot infect animals or pets. However, some microscopic eggs may land on a pet's fur and then be transferred to human hands when stroking (petting). It is important to remember that the problem is not the pet, it is human hand washing and hygiene.

How is a pinworm infection diagnosed?

• Tape test - this is a cellophane tape test. The doctor places a piece of clear plastic tape against the skin around the patient's anus and then looks at the tape under a microscope. As the worm tends to lay her eggs at night, good samples are more likely early in the morning. Patients may themselves apply the tape before going to the toilet (before defecating, doing a poo) or bathing. The sample should then be taken to the doctor. Sometimes several tape samples are required.


• Moistened swab - a doctor or nurse may take a moistened swab from around the anal area.


• Sighting a worm - sometimes the worms may be seen in the anal area, underwear or in the toilet (in stools). In stools the worms look like small pieces of white cotton thread. Because of their size and color (white), pinworms are difficult to see. The male worm is rarely seen because it remains inside the intestine.
  
  It is best to search for pinworms at night, when the female comes out to lay her eggs. If you are checking children it is best to inspect about two to three hours after they have fallen asleep.

The pinworm eggs are not visible to the naked eye.

If you are pregnant, breastfeeding, or have a baby less than three months of age, and you suspect you may have pinworms, you should see your doctor straight away.

Treatment for pinworm infection

Pinworm infection can be easily treated. It is important to remember that treatment also focuses on preventing reinfection. All members of the family need to be treated. Treatment may consist of either a six-week strict hygiene method, or medication followed by strict hygiene for two weeks.

Some medications are available OTC (over the counter, no prescription required) at your local pharmacy. It is important to follow the manufacturer's instructions. If you are pregnant, breastfeeding, or have a baby less than three months old you should be treated by your doctor.

Hygiene method - according to the National Health Service (NHS), UK, strict hygiene measures can clear up pinworm infection and significantly reduce the risk of reinfection. The worm has a life span of about six weeks; hence the hygiene method needs to last that long. Everyone in the household has to adhere to strict hygiene.

• Wash all bed linen, bedclothes (pajamas) and cuddly toys. Normal washing temperature is fine, but it needs to be well rinsed.
• Vacuum the home thoroughly, especially the bedrooms. Vacuuming needs to be regular and thorough throughout the six-week period.
• Damp-dust surfaces in the kitchen and bathroom, washing the cloth often in hot water. Do this regularly throughout the period.
• Do not shake things that may have eggs on them, such as clothing, pajamas, bed lined or towels.
• Do not eat in the bedroom. There is a risk of swallowing eggs that have shaken off the bedclothes.
• Make sure everybody's fingernails are cut short.
• Refrain from nail biting and finger sucking. This may not be easy if there are small children in the house.
• Wash your hands thoroughly and frequently, and scrub under your fingernails. Before eating, after going to the toilet, and after changing diapers (nappies) make sure you wash your hands.
• At night wear close-fitting underwear. Change your underwear every morning.
• Some people say that cotton gloves may help prevent scratching during sleep.
• Have a bath or shower regularly, thoroughly cleaning your body, paying particular attention to your anal and vaginal (females) areas.
• Do not share towels or face flannels.
• Toothbrushes should be kept in a closed cupboard and rinsed well before use.

When the infestation has gone, good hand washing practice and hygiene will help prevent reinfection. Good hygiene can prevent another outbreak even if children pick up another pinworm infection from friends at school.

Medication - if medication is used, it should be given to everybody in the household. There is a 75% risk of transmission between family members (people in the same household); so the chances of being infected if somebody has been diagnosed are high, even if no symptoms are present.

• Mebendazole - this medication blocks the worm's ability to absorb glucose, effectively killing it within a few days. It can be taken in chewable form or as a liquid. A single 100mg dose is usually enough. For reinfection, a repeated dose may be prescribed. Mebendazole is suitable for patients aged over two years. Side effects may include diarrhea or abdominal pain, especially if the patient has a severe infection.
• Piperazine - this medication paralyzes the worm so that it is rapidly expelled out of the bowel. Sometimes the patient is also given senna (a slight laxative). The two medications usually come in a sachet of powder; the powder is drunk with water. This medication is also suitable for patients aged 3 months to two years; in such cases they will need two doses of either 2.5ml or 5ml each, two weeks apart. Patients with kidney problems or epilepsy should not take this medication.
  
  Both mebendazole and piperazine are said to be from 90% to 100% effective at killing the pinworms. However, they do not kill the eggs. Hygiene measures should be followed for at least two weeks after treatment.

If the infection continues after medical treatment, you should see your doctor, who will probably recommend a second course of medication.

Pregnancy and breastfeeding - the hygiene method is recommended for pregnant or breastfeeding mothers, rather than medication. Neither mebendazole nor piperazine should be taken during the first 13 weeks of pregnancy. During the 2nd and 3rd trimesters of pregnancy and during breastfeeding, medication may be used if necessary. This decision should be made by a qualified health care professional.

Small babies - babies aged less than three months should not take medication; the hygiene method should be used. Every time the baby's diapers (nappies) are changed his/her bottom should be washed thoroughly and gently.

What are the possible complications of pinworm infection?

Complications rarely develop as a result of pinworm infection; when they do, they may include:

• Urinary tract infection - this is more common in females with a heavy pinworm infestation. The worm may also migrate to the bladder, causing cystitis.
• Peritoneal cavity infection - in females the worm may migrate from the anal area into the vagina and to the uterus, fallopian tubes and around the pelvic organs, causing vaginitis or endometritis.
• Weight loss - if the infection is severe the parasite may leech essential nutrients, resulting in weight loss.
• Skin infection - the itching may lead to intense scratching which may break the skin, raising the risk of infection.

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What Is Hydrocephalus (Water On The Brain)? What Causes Hydrocephalus?

Hydrocephalus, also called Water on the Brain is a condition in which there is an abnormal build up of CSF (cerebrospinal fluid) in the cavities (ventricles) of the brain. The buildup is often caused by an obstruction which prevents proper fluid drainage. The fluid buildup can raise intracranial pressure inside the skull which compresses surrounding brain tissue, possibly causing progressive enlargement of the head, convulsions, and brain damage. Hydrocephalus can be fatal if left untreated.

The damage to the brain can cause headaches, vomiting, blurred vision, cognitive problems, and walking difficulties.

The term water on the brain is incorrect, because the brain is surrounded by CSF (cerebrospinal fluid), and not water. CSF has three vital functions:

• It protects the nervous system (brain and spinal cord) from damage
• It removes waste from the brain
• It nourishes the brain with essential hormones

The brain produces about 1 pint of CSF each day. The old CSF is absorbed into blood vessels. If the process of replenishment and release of old CSF is disturbed, CSF levels can accumulate, causing hydrocephalus.

There are three types of hydrocephalus:

• Congenital hydrocephalus - this is present at birth. According to the National Health Service (UK), approximately 1 in every 1,000 babies are born with congenital hydrocephalus, while The Mayo Clinic, USA, says 1 in every 500 US babies are born with it. It may be caused by an infection in the mother during pregnancy, such as rubella or mumps, or a birth defect, such as spina bifida. It is one of the most common developmental disabilities, more common than Down syndrome or deafness.
• Acquired hydrocephalus - this develops after birth, usually after a stroke, brain tumor or as a result of a serious head injury.
• Normal pressure hydrocephalus - only affects people aged 50 years or more. It may develop after stroke or injury. In most cases doctors do not know why it occurred. 2 in every 100,000 people are affected by normal pressure hydrocephalus in England each year.

According to the National Institutes of Health (NIH), USA, approximately 700,000 American children and adults live with hydrocephalus. Hydrocephalus is also the leading cause of brain surgery for children in the USA. The NIH adds that over the past 25 years death rates linked to hydrocephalus have dropped from 54% to 5%, while the occurrence of intellectual disability has dropped from 62% to 30%.

The NIH says there are more than 180 different possible causes of hydrocephalus; a common cause being brain hemorrhage linked to premature birth.

A prenatal ultrasound examination can sometimes detect hydrocephalus in the developing baby.

According to Medilexicon's medical dictionary:

Hydrocephalus is " A condition marked by an excessive accumulation of cerebrospinal fluid resulting in dilation of the cerebral ventricles and raised intracranial pressure; may also result in enlargement of the cranium and atrophy of the brain."

The outlook for a patient with hydrocephalus depends mainly on how quickly the condition is diagnosed and treated, and whether there are any underlying disorders.

Treatment for hydrocephalus often involves using a shunt - a thin tube that is implanted in the brain to drain away excess cerebrospinal fluid (CSF).

What are the signs and symptoms of hydrocephalus?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom, while dilated pupils may be a sign.

Signs and symptoms of congenital hydrocephalus (present at birth):

• Breathing difficulties.
• Muscles in the baby's arms and legs may be stiff and prone to contractions.
• Some of the developmental stages may be delayed, such as sitting up or cradling.
• Tense fontanelle - an outward curving of an infant's soft spot (fontanelle). The soft part of the top of the baby's head bulges outwards.
• The baby may be irritable and/or drowsy
• The baby may be unwilling to bend or move his/her neck or head.
• The baby may feed poorly.
• The baby's head seems larger than it should be.
• The baby's scalp is thin and shiny. There may be visible veins on the scalp.
• The pupils of the baby's eyes may be right close to the bottom of the eyelid; sometimes known as the setting sun.
• There may be a high-pitched cry.
• There may be seizures.
• There may be vomiting.

Signs and symptoms of acquired hydrocephalus (develops after birth):

• Bowel incontinence (rare)
• Confusion and/or disorientation
• Drowsiness
• Headaches
• Irritability, which may be progressive
• Lack of appetite
• Lethargy
• Nausea
• Personality changes
• Problems with eyesight, such as blurred or double vision
• Seizures (fits)
• Urinary incontinence
• Vomiting
• Walking difficulties (more common in adults)

Signs and symptoms of normal pressure hydrocephalus (affects people aged 50+) - signs and symptoms may take many months or years to develop.

• Changes in gait - the patient may feel as if they are frozen on the spot when taking their first step to start walking. The individual may appear to shuffle rather than walk.
• Normal thinking process slows down - the patient may respond to questions more slowly than normal, there may be delayed reactions to situations. The individual's ability to process information slows down.
• Urinary incontinence - this usually comes after changes in gait.

What are the risk factors for hydrocephalus?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. The following are possible risk factors for hydrocephalus:

• Being born prematurely - infants born prematurely have a higher risk of intraventricular hemorrhage (bleeding within the ventricles of the brain), which may result in hydrocephalus.
• Problems during pregnancy - an infection in the uterus during pregnancy may increase the risk of hydrocephalus in the developing baby.
• Problems with fetal development, such as incomplete closure of the spinal column. Some congenital defects may not be detectable at birth - but the baby may be at increased risk of developing hydrocephalus when he/she is older (still during childhood).
• Lesion and tumors of the spinal cord or brain.
• Infections of the nervous system.
• Bleeding in the brain.
• Having a severe head injury
.

What are the causes of hydrocephalus?

Hydrocephalus occurs when too much fluid builds up in the brain; specifically, excess CSF (cerebrospinal fluid) accumulates in the cavities (ventricles) of the brain.

How does CSF (cerebrospinal fluid) circulate through the brain?

The brain is like gelatin and floats in CSF. CSF flows through the brain through chambers; these chambers are known as ventricles, and they lie deep inside the brain. The fluid-filled ventricles protect the brain; like a cushion. Most of the CSF is made in the choroid plexus, a part of the brain.

Surplus CSF is removed from the brain through the dural venous sinuses; a series of channels. The dural venous sinuses run down the arachnoid villi, a layer of tissue which is like a one-way valve. The arachnoid villi allow excess CSF to leave the brain and filter into the bloodstream, while at the same time preventing blood from getting into the brain and causing damage.

It is important that the production, flow and absorption of CSF occur in such a way that normal pressure is maintained inside the skull - it is a delicate balance.

Hydrocephalus may occur if:

• Too much CSF is produced in the choroid plexus.
• One of the ventricles in the brain is blocked or narrowed, stopping or restricting the flow of CSF, which means it cannot leave the brain.
• CSF cannot filter into the bloodstream because there is something wrong with the arachnoid villi.

Causes of congenital hydrocephalus (present at birth):

The baby is born with a blockage in the cerebral aqueduct, a long passage in the midbrain that connects two large ventricles. This is the most common cause.

The choroid plexus produces too much CSF.

Health conditions in the developing baby can cause problems in how the brain develops. According to the National Health Service (NHS), UK, 70% of children with severe spina bifida develop hydrocephalus.

Infections during pregnancy - if the pregnant mother develops some infections, there is a risk that the normal development of the baby's brain may be affected. Examples include:

• CMV (Cytomegalovirus) - a virus which infects over 50% of American adults by the time they are 40 years old. Also known as the virus that is most commonly transmitted to a child before birth. This virus is responsible for glandular fever.
• German measles (rubella) - an infectious disease caused by the rubella virus. The virus passes from person-to-person via droplets in the air expelled when infected people cough or sneeze - the virus may also be present in the urine, feces and on the skin. The hallmark symptoms of rubella are an elevated body temperature and a pink rash.
• Mumps - an acute (short-term) viral infection in which the salivary glands, particularly the parotid glands (the largest of the three major salivary glands) swell.
• Syphilis - an STD (sexually transmitted disease) caused by a bacterium Treponema pallidum.
• Toxoplasmosis - in infection caused by a single-celled parasite - Toxoplasma gondii.

Causes of acquired hydrocephalus (develops after birth) - usually caused by an injury or illness that results in blockage between the ventricles. The following may be causes:

• Brain hemorrhage - bleeding inside the brain.
• Brain lesions - areas of injury or disease within the brain. There are many possible causes, including injury, infection, exposure to certain chemicals, or problems with the immune system.
• Brain tumors - benign (non-cancerous) or malignant (cancerous) growths in the brain. A primary brain tumor originates in the brain, while a secondary brain tumor comes from a cancer that has spread to brain tissue from another part of the body.
• Meningitis - inflammation of the membranes of the brain or spinal cord (inflammation of the meninges).
• Stroke - a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in impairment in speech, movement, and memory.

Causes of normal pressure hydrocephalus (affects people aged at least 50 years) - in most cases doctors don't know what caused it (idiopathic normal pressure hydrocephalus). Sometimes it may develop after a stroke, infection or injury to the brain.

There are two theories:

• There is something wrong with the arachnoid villi and CSF (cerebrospinal fluid) is not reabsorbed into the bloodstream properly. Consequently the brain starts to produce less new CSF, resulting in a gradual rise in intracranial pressure over a longer period compared to other forms of hydrocephalus. The gradual rise in pressure may cause progressive brain damage.
• An underlying condition, such as heart disease, a high blood cholesterol level, or diabetes is affecting normal blood flow, which may lead to a softening of brain tissue. The softened brain tissue may result in increasing pressure.

Diagnosing hydrocephalus

Babies and young children (congenital hydrocephalus):

• A routine prenatal ultrasound scan may detect hydrocephalus during pregnancy in the developing fetus.
• After birth, the head of the baby is measured regularly. Any abnormalities in head size will probably lead to further diagnostic tests. If a baby's head is seen to be too big, or is growing more rapidly than it should, the doctor may order an ultrasound scan of the head. If the ultrasound scan shows any abnormality, further tests will be ordered, such as an MRI (magnetic resonance imaging) scan or a CT (computerized tomography) scan, which give more detailed images of the brain.

Acquired hydrocephalus (occurs after birth) - if the child or adult develops the signs and symptoms of hydrocephalus the doctor may:

• Examine the patient's medical history carefully.
• Carry out a physical and neurological examination.
• Order an imaging scan, such as a CT or MRI scan. If imaging tests reveal hydrocephalus or any other faults, the doctor will refer the patient to a brain surgeon for further evaluation and treatment.

Normal pressure hydrocephalus (occurs in patients aged 50 years and over) - diagnosing this type of hydrocephalus is more tricky because symptoms are more subtle and do not appear suddenly. Also, normal pressure hydrocephalus shares symptoms with some other common conditions, such as Alzheimer's disease.

Making a correct diagnosis is important, because treatment for normal pressure hydrocephalus does relieve symptoms, unlike Alzheimer's.

Doctors in the UK have devised the following checklist for diagnosing normal pressure hydrocephalus. The checklist looks at:

• The patient's gait (how he/she walks)
• The patient's mental ability
• Any signs of urinary incontinence
• The results of the imaging scans show moderately higher levels of cerebrospinal fluid than normal

A combination of these four characteristics will most likely lead to a diagnosis of normal pressure hydrocephalus.

What are the treatment options for hydrocephalus?

Treatment for congenital and acquired hydrocephalus - both types of hydrocephalus require urgent treatment to alleviate intracranial pressure (pressure on the brain), otherwise there is a serious risk of damage to the brainstem. Our automatic functions, such as breathing and our heartbeat are regulated by the brainstem.

• A shunt, the surgical insertion of a drainage system - this is a catheter (a thin tube with a valve) that is placed in the brain to drain away excess fluid into another part of the body, such as the abdomen or a chamber in the heart. One end is placed in one of the brain's ventricles; it is tunneled under the skin to another part of the body which is better able to absorb the fluid. Usually, this is all that is needed and no further treatment is required. Sometimes shunt repair surgery may be needed if it gets blocked or infected.
  
  Patients with hydrocephalus will usually need to have a shunt system in place for the rest of their lives. If the shunt is placed in a child, additional surgeries may be needed to insert longer tubing as he/she grows.
• Ventriculostomy - the surgeon makes a hole in the bottom of a ventricle so that the excess fluid flows towards the base of the brain. Normal absorption occurs at the base of the brain. This procedure is sometimes performed when the flow of fluids between ventricles is obstructed.

Treatment for normal pressure hydrocephalus - shunts may also be used. However, shunts may not be suitable for some patients. The surgeon needs to carefully assess the potential risks involved in surgery against the possible benefits.

• Lumbar puncture - some of the cerebrospinal fluid is removed from the base of the spine. If this improves the patient's gait or mental abilities, fitting a shunt will probably help him/her.
• Lumbar infusion test - a needle is inserted through the skin of the lower back into the spine. Measurements are then taken of cerebrospinal fluid pressure (CSF) as fluid is injected into the spine. The surgeon will then be able to determine the pressure of the CSF. Patients usually benefit from having a shunt fitted if their CSF pressure is over a certain limit.

What are the complications of hydrocephalus?

Hydrocephalus severity depends on several factors, including at what age it developed and how it progressed. If the condition is advanced when the baby is born, it is more likely there will be brain damage and physical disabilities. If cases are not so severe and treatment is proper and prompt, the outlook is much better.

Problems with the shunt - shunt blockage occurs in 20% of cases during the first year; after that the risk drops to 5%. Approximately 3% to 12% of shunts may have an infection; experts say the risk is linked to the patient's age and general state of health.

A patient with a malfunctioning shunt will have hydrocephalus symptoms and should be treated immediately.

Babies with congenital hydrocephalus may experience some kind of permanent brain damage, which may result in long-term complications. Examples include:

• A limited attention span
• Autism
• Learning difficulties
• Physical coordination problems
• Problems with memory
• Speech problems
• Vision problems

Prevention of hydrocephalus

Pregnancy - regular prenatal care can significantly reduce the risk of having a premature baby, which reduces the risk of the baby developing hydrocephalus.

Infectious diseases - make sure you have had all your vaccinations and attended all the screenings that are recommended for you.

Meningitis vaccine - meningitis used to be a common cause of hydrocephalus. Ask your doctor whether you should be vaccinated. Vaccination is recommended for individuals who are travelling to parts of the world where meningitis is common, people with terminal complement deficiency (an immune system disorder), patients who either had their spleen removed or have a damaged spleen, and military personnel.

Preventing head injuries

• Car seat belts:
  
  
  • Wear a seatbelt every time you drive your car or ride as a passenger.
  • Make sure children are buckled up using either a safety seat, booster seat, or a seat belt that is suitable for the child's size and age. When children outgrow their safety seats - usually when they weight about 40 pounds (18 kilos) - they should start using a booster seat.
  • Children should continue using the booster seat until the lap/shoulder belts fit properly; usually when they are about 4ft 9inches (1meter 45 centimeters) tall.
• Drinking and driving - never drive when you are under the influence of alcohol.
• Helmets or specific protective headgears should always be worn when:
  
  
  • Batting in baseball/softball or cricket (and running bases in baseball)
  • Engaged in contact sports, such as karate, boxing, or American football
  • Riding a horse
  • Riding on a motorbike, snowmobile, scooter, or all-terrain vehicle (both riders and passengers)
  • Skiing
  • Snowboarding
  • Using a skateboard
  • When roller-skating or in-line skating
• Living areas for seniors (UK: elderly people):
  
  
  • Grab bars should be installed next to the bathtub, shower and/or toilet
  • Seniors should keep physically active to make sure lower body strength and balance is adequate (thus lowering the risk of falls)
  • Make sure lighting in the house is bright enough
  • On bathtub and shower floors use nonslip mats
  • Remove throw rugs and other objects which may be cause tripping
  • Stairways should ideally have handrails on both sides
• Living areas for children:
  
  
  • Install window guards
  • Place safety gates at the bottom and top of stairs if the children are young
• Children's play areas - the ground surface of a child's playground should be made of hardwood mulch, sand or some specific shock-absorbing material.
• Firearms - Firearms should be stored, unloaded, in a locked safe or cabinet. Bullets should not be stored in the same location.

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What Is Heel Pain? What Causes Heel Pain?

Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone. Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).

There are 26 bones in the human foot, of which the heel (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.

In the majority of cases heel pain has a mechanical cause. It may also be caused by arthritis, infection, an autoimmune problem, trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).

What are the signs and symptoms of heel pain?

Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed).

In most cases the pain is under the foot, towards the front of the heel.

Post-static dyskinesia (pain after rest) - symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day.

After a bit of activity symptoms often improve a bit. However, they may worsen again towards the end of the day.

What are the causes of heel pain?

Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.

The most common causes of heel pain are:

• Plantar fasciitis (plantar fasciosis) - inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot. When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too.
• Heel bursitis - inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse.
• Heel bumps (pump bumps) - common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature.
• Tarsal tunnel syndrome - a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot.
• Chronic inflammation of the heel pad - caused either by the heel pad becoming too thin, or heavy footsteps.
• Stress fracture - this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports, or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis.
• Severs disease (calcaneal apophysitis) - the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected.
• Achilles tendonosis (degenerative tendinopathy) - also referred to as tendonitis, tendinosis, and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly - the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens, and becomes painful.

Heel pain may also be caused by:

• Achilles tendon rupture - the tendon of the heel cord behind the ankle is torn
• Bone bruise
• Bone cyst - a solitary fluid-filled cyst (cavity) in a bone
• Gout - levels of uric acid in the blood rise until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens.
• Neuroma (Morton's neuroma) - a swollen nerve in the ball of the foot, commonly between the base of the second and third toes.
• Osteomyelitis - osteomyelitis means infection of the bone or bone marrow; inflammation of the bone due to infection. Osteomyelitis sometimes occurs as a complication of injury or surgery. In some cases the infection may get into bone tissue from the bloodstream. Patients with osteomyelitis typically experience deep pain and muscle spasms in the inflammation area, as well as fever.
• Peripheral neuropathy - neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders, and exposure to toxins. One of the most common causes of neuropathy is diabetes.
• Problems with your gait - wrong posture when walking/running.
• Rheumatoid arthritis - rheumatoid arthritis, sometimes referred to as rheumatoid disease, is a chronic (long lasting), progressive and disabling auto-immune disease condition that causes inflammation and pain in the joints, the tissue around the joints, and other organs in the human body. Rheumatoid arthritis usually affects the joints in the hands and feet first, but any joint may become affected. Patients with rheumatoid arthritis commonly have stiff joints and feel generally unwell and tired.

When to call a doctor about heel pain

See your doctor as soon as possible if you experience:

• Severe pain accompanied by swelling near your heel
• There is numbness or tingling in the heel, as well as pain and fever
• There is pain in your heel as well as fever
• You are unable to walk normally
• You cannot bend your foot downwards
• You cannot stand with the backs of the feet raised (you cannot rise onto your toes)

You should arrange to see a doctor if:

• The heel pain has persisted for more than one week
• There is still heel pain when you are not standing or walking

Diagnosing heel pain

A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis.

Sometimes further diagnostic tests are needed, such as blood tests and imaging scans.

What are the treatment options for heel pain?

Treatment for plantar fasciitis - the vast majority of patients recover with conservative treatments (designed to avoid radical medical therapeutic measures or operative procedures) within months.

• Non-steroidal anti-inflammatory drugs (NSAIDs) - medications with analgesic (pain reducing), antipyretic (fever reducing) effects. In higher doses they also have anti-inflammatory effects - they reduce inflammation (swelling). Non-steroidal distinguishes NSAIDs from other drugs which contain steroids, which are also anti-inflammatory. NSAIDs are non-narcotic (they do not induce stupor). For patients with plantar fasciitis they may help with pain and inflammation.
• Corticosteroids - a corticosteroid solution is applied over the affected area on the skin; an electric current is used to help absorption. Alternatively, the doctor may decide to inject the medication. However, multiple injections may result in a weakened plantar fascia, significantly increasing the risk of rupture and shrinkage of the fat pad covering the heel bone. Some doctors may use ultrasound to help them make sure they have injected in the right place. Corticosteroids are usually recommended when NSAIDs have not helped.
• Physical therapy (UK: physiotherapy) - a qualified/specialized physical therapist (UK: physiotherapist) can teach the patient exercises which stretch the plantar fascia and Achilles tendon, as well as strengthening the lower leg muscles, resulting in better stabilization of the ankle and heel. The patient may also be taught how to apply athletic taping, which gives the bottom of the foot better support.
• Night splints - the splint is fitted to the calf and foot; the patient keeps it on during sleep. Overnight the plantar fascia and Achilles tendon are held in a lengthened position; this stretches them.
• Orthotics - insoles and orthotics (assistive devices) can be useful to correct foot faults, as well as cushioning and cradling the arch during the healing process.
• Extracorporeal shock wave therapy - sound waves are aimed at the affected area to encourage and stimulate healing. This type of therapy is only recommended for chronic (long-term) cases which have not responded to conservative therapy.
• Surgery - the plantar fascia is detached from the heel bone. This procedure is only recommended if nothing else works. There is a risk that the arch of the foot is subsequently weakened.

Treatment for heel bursitis - effective treatment depends on the doctor being able to distinguish heel bursitis as a separate condition to plantar fasciitis. The patient may have to use a cushioning insole or heel cup to limit the movements which are causing the bursitis. This treatment, along with plenty of rest is usually effective. In severe cases the patient may require a steroid injection.

Treatment for heel bumps - the inflammation behind the heel may be relieved with ice, compression and a change of footwear. There may also be temporary help with Achilles pads, tortoise and heel grip pads. Sometimes the doctor may administer cortisone injections for pain. In severe cases the bumps may have to be removed surgically.

Home care - in cases that are not severe, home care is probably enough to get rid of heel pain.

• Rest - avoid running or standing for long periods, or walking on hard surfaces. Avoid activities which may stress the heels.
• Ice - place an ice-pack on the affected area for about 15 minutes. Do not place bare ice directly onto skin.
• Footwear - proper-fitting shoes that provide good support are crucial. Athletes should be particularly fussy about the shoes they use when practicing or competing - sports shoes need to be replaced at specific intervals (ask your trainer).
• Foot supports - wedges and heel cups can help relieve symptoms.

Preventing heel pain

Prevention of heel pain involves reducing the stress on that part of the body. Tips include:

• Barefeet - when on hard ground make sure you are wearing shoes.
• Bodyweight - if you are overweight there is more stress on the heels when you walk or run. Try to lose weight.
• Footwear - footwear that has material which can absorb some of the stress placed on the heel may help protect it. Examples include heel pads. Make sure your shoes fit properly and do not have worn down heels or soles. If you notice a link between a particular pair of shoes and heel pain, stop wearing them.
• Rest - if you are especially susceptible to heel pain, try to spend more time resting and less time on your feet. It is best to discuss this point with a specialized health care professional.
• Sports - warm up properly before engaging in activities which may place lots of stress on the heels. Make sure you have proper sports shoes for your task.

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What Is Fainting (Syncope)? What Causes Fainting?

The medical term for fainting is syncope. Fainting is a sudden loss of consciousness, usually temporary and typically caused by a lack of oxygen in the brain. The brain oxygen deprivation has many possible causes, including hypotension (low blood pressure).

The following words or phrasal expressions also mean to faint: to pass out, to black out, to fall unconscious, to fall in a faint. The verbs to come to and to come round mean to recover consciousness.

Sometimes syncope may be just that - a fainting episode with no medical importance. On some occasions, however, it may be caused by a serious illness, condition or disorder. Every case of fainting should be treated as a medical emergency until the cause is known and signs and symptoms have been treated. Anybody who has recurring fainting episodes should contact their doctor.

If oxygen levels are below 16% at atmospheric pressure most people faint due to hypoxia. If oxygen levels fall below 11% individuals may die by suffocation. The amount of oxygen in the air depends on its partial pressure - inhaling pressurized gas while scuba diving which is below 16% oxygen does not cause hypoxia (because the air is pressurized).

Syncope due to hypoxia may also be caused by malfunctioning lungs, problems with blood circulation, or carbon monoxide poisoning. Some people faint at the sight of blood, or when receiving an injection or seeing somebody having one.

In Victorian England (19th Century) fainting in women was a commonplace stereotype, as well as modern portrayals of that period. Some believe that the respiratory effects of tight corsets worn at the time may have been a contributory factor. However, during Victorian times aristocratic women were encouraged to display a feminine frailty by fainting at dramatic moments.

Children sometimes play a game (fainting game) in which they deliberately restrict blood flow to the brain in order to trigger syncope - this is dangerous and may cause brain damage, and even death.

According to Medilexicon's medical dictionary:

Syncope is "Loss of consciousness and postural tone caused by diminished cerebral blood flow."

What is the difference between near-syncope and syncope?

• Pre- or near-syncope (a pre- or near-syncoptic episode) - this is when the person can remember events during the loss of consciousness, such as dizziness, blurred vision, muscle weakness, as well as the fall before hitting their head and losing consciousness.
• Syncope (a syncoptic episode) - this is when the individual may remember the feelings of dizziness and loss of vision, but not the fall.

What are the signs and symptoms of fainting (syncope)?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

The hallmark sign is evident to anyone around - the patient passes out, faints, suddenly loses consciousness.

The following signs and symptoms may precede a fainting episode:

• A feeling of heaviness in the legs
• Blurred vision
• Confusion
• Feeling warm or hot
• Lightheadedness, dizziness, a floating feeling
• Nausea
• Sweating
• Vomiting
• Yawning

When a person faints, the following signs may be evident:

• The individual may be falling over
• The patient may be slumping
• The person may be unusually pale
• There may be a drop in blood pressure
• There may be a weak pulse

What are the causes of fainting (syncope)?

Syncope is a mechanism used by the brain to help us survive. If brain blood and oxygen levels drop considerably the brain immediately shuts down all other non-vital parts of the body so that resources can focus primarily on vital organs.

When the brain detects lower levels of oxygen the body will start breathing faster (hyperventilating) to bring levels back up again. The heart rate (pulse) will also rise in order to get more oxygen into the brain. This rise in the heart rate results in hypotension (drop in blood pressure) in other parts of the body, because the brain is flooded with blood (at the expense of other parts of the body). Hyperventilation combined with hypotension may result in short-term loss of consciousness, muscle weakening, and syncope (fainting).

There are different types of fainting, which describe the underlying cause for loss of blood/oxygen supply to the brain:

• Neurocardiogenic syncope (also known as reflex syncope, vasovagal episode, vasovagal response, vasovagal attack, vasovagal syncope) - occurs when something causes a short-term malfunction of the autonomous (autonomic) nervous system (ANS). The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils, micturition (urination), and sexual arousal. Whereas most of its actions are involuntary, some, such as breathing, work in tandem with the conscious mind.
  
  The patient experiences hypotension (drop in blood pressure) and a slower heartbeat (pulse rate), causing the brain's blood/oxygen supply to be temporarily interrupted. Possible triggers include:
  
  
  • Suddenly seeing something that is unpleasant or shocking, such as blood
  • Being suddenly exposed to a horrible/frightening experience, such as a huge gorilla running into a room straight up to you and screaming in your face.
  • Becoming suddenly emotionally upset, such as when hearing about the death of a loved one.
  • An extremely embarrassing situation or event.
  • Standing still for long periods. Sometimes soldiers standing guard, or people in church may faint.
  • Being in a hot and stuffy place for a long time
• Occupational syncope - this is also a type of neurocardiogenic syncope, but the link is physical rather than emotional, mental or abstract. Examples of the many possible triggers are included:
  
  
  • Coughing
  • Defecating (passing stools, feces)
  • Lifting a heavy weight, and some other demanding physical activities
  • Sneezing
  • Urinating
• Orthostatic hypotension - this is when a person stands up rapidly from a seated or lying down position and faints; gravity pulls blood down to the legs, resulting in lower blood pressure elsewhere. The body's nervous system reacts by raising the heart beat and narrowing blood vessels, stabilizing blood pressure. However, sometimes something undermines this stabilization process, resulting in poor blood/oxygen supply to the brain, and the individual faints.
  
  Orthostatic hypotension may be caused by:
  
  
  • Severe dehydration - if body fluid levels drop, so will blood pressure. If this continues for long enough the nervous system finds it harder to stabilize blood pressure, resulting in less blood/oxygen reaching the brain, raising the risk of fainting.
  • Untreated diabetes - the patient urinates much more frequently and becomes dehydrated. If blood glucose levels go to high there may be damage to some nerves, especially those that regulate blood pressure.
  • Some medications - some diuretics, beta-blockers and anti-hypertensive drugs may cause orthostatic hypotension in some patients.
  • Alcohol - some people may pass out if they consume too much alcohol in one sitting. One moment they are chatting away (perhaps with slurred speech), when suddenly they slouch over, resting their head on a table, as if asleep.
  • Some neurological conditions - such as Parkinson's disease, may have problems with their nervous systems, which lead to orthostatic hypotension.
  • Carotid sinus syndrome - temporary unconsciousness resulting from pressure on the pressure sensors (carotid sinus) in the carotid artery (the main arteries that supply blood to the brain). Some patients may have an over-sensitive (hypersensitive) carotid sinus in which blood pressure drops when any physical stimulation of the carotid sinus occurs, resulting in fainting. This may occur when the individual turns his head to one side, wears a tight collar or tie, or presses over the carotid sinus while shaving. The condition is more common among males aged over 50 years.
  • Cardiac syncope - an underlying heart problem causes a drop in blood/oxygen supply to the brain. Possible conditions include:
    
    
    - Arrhythmias - when the heart beats abnormally
    - Stenosis - a blockage of the heart valves
    - Hypertension - high blood pressure
    - A heart attack - a heart muscle dies because it does not get enough blood (oxygen)

Diagnosing syncope (fainting)

It is not easy to differentiate a simple fainting episode from something more serious, such as a stroke. If the patient experiences numbness in the face, paralysis, weakness, numbness in an arm, and/or slurred speech you should seek emergency medical help.

People should see their doctor if:

• Before losing consciousness there were chest pains, arrhythmia (irregular heart beat) or a pounding heartbeat (palpitations).
• Fainting resulted in an injury
• The fainting was preceded by fecal incontinence
• The fainting was preceded by urinary incontinence
• There is a history of heart disease
• They are pregnant
• They experience recurring episodes of syncope
• They have diabetes
• They were unconscious for more than a few minutes

When you see your doctor, have the following information ready:

• Details of any medications you are currently taking
• Whether this was an isolated case of fainting. If not, details of previous episodes
• Your family history - e.g. are there any close relative with heart disease
• Your medical history

What occurred just before you fainted?

• What symptoms you felt
• What you were doing
• Where you were

What the doctor will do - the doctor, often a GP (general practitioner, primary care physician) will listen to the patient's heart to rule out any possible underlying heart conditions. If signs indicating a heart problem are detected, the GP may refer the patient to a specialist (cardiologist).

• ECG (electrocardiogram) - the doctor may order an ECG to check for the electrical activity of the heart. Electrodes are attached to the patient's skin to measure electrical impulses given off by the heart. The impulses are recorded as waves and displayed on a screen (or printed). An irregularity of heart action is generally obvious right away.
• Carotid sinus - the doctor may massage the carotid sinus to determine whether this triggers symptoms of lightheadedness or dizziness.
• Blood tests - these may be ordered to check for anemia, diabetes or an infection.
• Tilt-table test - this test monitors the patient's blood pressure, heart rhythm and heart rate while he/she is moved from a lying down to an upright position. A healthy patient's reflexes cause the heart rate and blood pressure to change when moved to an upright position - this is to make sure the brain gets an adequate supply of blood. If the reflexes are inadequate, they could explain the fainting spell(s).
• Holter monitor test - the patient wears a portable device which records all his/her heartbeats. It is worn under the clothing and records information about the electrical activity of the heart while the individual goes about his/her normal activities for one or two days. It has a button which can be pressed if specific symptoms are felt - then the doctor can see what heart rhythms were present at that moment.

If none of these tests reveal anything the doctor will probably conclude that the patient had neurocardiogenic syncope, and leave it at that (no treatment).

What to do if somebody feels faint?

You feel faint:

• Don't stay standing up. Find somewhere to either sit or lie down.
• If you manage to sit down place your head between your knees.
• When you do get up, do so slowly.

If you see somebody fainting:

• Place the patient on his/her back, facing up.
• If the individual is breathing, raise their legs about 12 inches (30 cms) above heart level to restore blood flow to the brain.
• Try to loosen all belts, ties, collars and restrictive clothing.
• When the person comes round do not let them get up too quickly.
• If they remain unconscious for more than about a minute, put the patient into the recovery position and get emergency medical help.
• Check the patient's airway for any obstruction. Check for vomiting.
• Check for breathing, coughing or movement (signs of circulation). If you cannot detect any, start CPR (cardiopulmonary resuscitation). Continue administering CPR until either help arrives or the patient starts breathing on his/her own.
• If the individual was injured and is bleeding after the fall, apply direct pressure to control the bleeding.

Treating syncope (fainting)

If the fainting is found to be caused by an underlying health condition, that will need to be treated, which should help prevent syncoptic episodes.

• Treating neurocardiogenic syncope - in the majority of cases no further treatment is needed. Avoid the triggers, such as long periods standing still, dehydration, and being in hot and stuffy places. This may help prevent future episodes.
• Injections and blood - if the sight or thought of injections or blood make a person feel faint, they should tell the doctor or nurse beforehand. The health care professional can then make sure the patient is in a safe position (lying down) before any procedure begins.
• Beta-blockers - this medication is primarily used for the treatment of high blood pressure (hypertension). However, it may help patients whose neurocardiogenic syncope interferes with their quality of life. The side effects of beta-blockers may include fatigue, cold extremities (hands and feet), slow heartbeat (pulse rate), nausea, and diarrhea. Although rare, the following side effects are also possible - erectile dysfunction (impotence, problems either getting or sustaining an erection), nightmares, and sleep disturbances.

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What Is Sexual Addiction (Compulsive Sexual Behavior)? What Causes Sexual Addiction?

Sexual addiction, also called sexual dependency, hypersexuality, nymphomania (females), satyriasis (males) compulsive sexual behavior and sexual compulsivity, refers to the phenomenon in which people cannot manage their sexual behavior. The individual is obsessed with sexual thoughts - thoughts which interfere with their ability to work properly, have relationships, and go about their daily activities. Many say that sexual addiction is a form of obsessive compulsive behavior.

The individual with sexual addiction has an obsession with sex, or an abnormally intense sex drive. Their lives are dominated with sex and the thought of sex; so much so that other activities and interactions become seriously affected.

It is not uncommon for the person with sexual addiction to rationalize and justify their behavior and thought patterns. People with a sex addiction may deny there is a problem.

Experts say there is a strong link between sexual addiction and risk-taking. Even though the risk of danger is clear, the individual with sex addiction may take risks regardless of the potential consequences, even if this means potential health problems (sexually transmitted diseases), physical risks or emotional consequences.

The sex addict may initially be involved in a healthy and enjoyable sexual situation which eventually develops into an obsession. Fantasies and sometimes actual acts may be well outside the radar of most people's idea of what is sexually acceptable behavior.

According to Medilexicon's medical dictionary:

Nymphomania is An insatiable impulse to engage in sexual behavior in a female; the counterpart of satyriasis in a male.

There is effective treatment available for individuals with sexual addiction.

The World Health Organization in the International Classification of Diseases (ICD) includes "excessive sexual drive" as a diagnosis of sexual addiction.

What are the signs and symptoms of sexual addiction?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Even though there is no current official diagnosis for sex addiction, doctors and researchers have tried to define the disorder using criteria based on literature on chemical dependency. Some sex addiction behaviors may include:

• Compulsive self-stimulation (masturbation)
• Multiple affairs, this includes extra marital affairs
• Multiple one-night stands
• Multiple sexual partners
• Persistent use of pornography
• Practicing unsafe sex
• Cybersex
• Using prostitutes
• Prostitution
• Exhibitionism
• Dating through personal ads, but in an obsessive way
• Watching others in a sexual way (voyeurism)
• Sexual harassment
• Molestation
• Rape
• Detachment - the sexual activity does not satisfy the individual sexually or emotionally. Bonding with the sexual partner is lacking.
• Feelings of guilt and shame
• Feeling of lack of control over the sexual addiction, even though he/she is aware of the financial, health, or social consequences. The individual may have a recurrent failure pattern to resist impulses to engage in extreme acts of lewd sex.
Individuals find themselves often engaging in sexual behaviors for much longer than they had intended, and to a much greater extent.
• There have been several attempts to stop, reduce or control behaviors.
• The person spends a great deal of time obtaining sex, being sexual, or recovering from a sexual experience.
• The person may give up social, work-related or recreational activities because of their sexual addiction.
• Sexual rage disorder - the individual may become distressed, anxious, restless and even violent if unable to engage in their addiction.

What are the causes of sexual addiction?

Nobody is sure why some people become addicted to sex while others don't. As antidepressant medication and some other psychotropic drugs have been found to be effective in the treatment of sex addiction in a significant number of cases, experts believe sex addiction may be linked to a biochemical abnormality or some chemical changes in the brain.

There may be a common pathway within our brain's survival and reward systems which dictate our behavior with food, drugs (abusing them) and sexual interests. The pathway may reach parts of our brain which influence our judgment, rational thought and higher thinking.

Researchers found that lesions of the medial prefrontal cortex (mPFC) - a part of the brain - result in compulsive sexual behavior.

Some studies have found that people with sex addiction frequently come from dysfunctional families. A person with sexual addiction is more likely to have been abused than other people. A significant number of recovering sex addicts have reported some type of addiction among family members.

What are the complications of compulsive sexual behavior?

If left untreated, compulsive sexual behavior can leave the individual with intense feelings of guilt. His/her self confidence and feeling of self-worth may be low. Some patients may develop severe anxiety, and even depression.

Other complications may include family relationship problems and even family break-ups, financial problems, becoming infected with sexually transmitted infections, and unplanned pregnancies. If the individual becomes involved in stalking, exhibitionism and/or prostitution (client or prostitute) there may be problems with the law.

How is sexual addiction diagnosed?

People who suffer from sexual addiction/compulsivity may have several similar symptoms to those present in individuals with other addictions. Health care professionals and most members of the public used to, until recently, ignore sexual addiction as a serious and debilitating condition. As destroyed careers, extreme emotional pain, deep shame and serious health risks linked to compulsive sexual behavior are known about more widely, more people and doctors understand this disorder better today.

A common characteristic of sexual addiction, as in many other addictions, is the combination of denial and demonstration of loss of control - the patient denies he/she has a problem, but it is clear they are not in control. Psychiatrists commonly use the DSM (Diagnostic and Statistical Manual of Mental Disorders), created by the American Psychiatric Association, to help with the diagnosis of sexual addiction.

Some experts have noted that "Addictive sexual disorders that do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence." (Irons and Schneider). Others define sexual addiction as "a condition in which some form of sexual behaviour is employed in a pattern that is characterized at least by two key features: recurrent failure to control the behavior and continuation of the behavior despite harmful consequences" (Lowinson and team).

Patrick Carnes, Executive Director of the Gentle Path program at Pine Grove Behavioral Center in Hattiesburg, Mississippi, and a leading expert on sexual addiction in the USA, believes that most experts agree with the WHO's (World Health Organization's) definition of addiction.

Patrick Carnes proposed the following as diagnostic criteria for sexual addiction: (Source: Wikipedia)

• Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd sex.
• Frequently engaging in those behaviors to a greater extent or over a longer period of time than intended.
• Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors.
• Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience.
• Preoccupation with the behavior or preparatory activities.
• Frequently engaging in violent sexual behavior when expected to fulfill occupational, academic, domestic, or social obligations.
• Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
• Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk.
• Giving up or limiting social, occupational, or recreational activities because of the behavior.
• Resorting to distress, anxiety, restlessness, or violence if unable to engage in the behavior at times relating to SRD (Sexual Rage Disorder).

Dr. Aviel Goodman, director of the Minnesota Institute of Psychiatry in St. Paul, USA, proposed a maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by at least three of the following, occurring at any time in the same 12-month period: (Source: Wikipedia)

• tolerance, as defined by either of the following:
  
  
  • a need for markedly increased amount or intensity of the behavior to achieve the desired effect
  • markedly diminished effect with continued involvement in the behavior at the same level or intensity
• withdrawal, as manifested by either of the following:
  
  
  • characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior
  • the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms
• the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended
• there is a persistent desire or unsuccessful efforts to cut down or control the behavior
• a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects
• important social, occupational, or recreational activities are given up or reduced because of the behavior
• the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior

What is the treatment for sex addiction?

There is much more help available today compared to a few years ago. Organizations include such self-help groups as Sex Addicts Anonymous, Sexaholics Anonymous, Sexual Compulsives Anonymous and Sex and Love Addicts Anonymous.

Sex Addicts Anonymous (SAA) - this has a 12-step program for sex addicts. The group was founded in 1977 by some males who sought a greater sense of anonymity in other 12-Step sex addiction programs. SAA says it is a safe place for heterosexuals, homosexuals and bisexuals who wish to treat their addictive sexual behaviors.

A growing number of SAA groups initially give an enquirer a questionnaire which is used to determine whether a prospective member is likely to be a sex addict.

An SAA member creates his/her own definition of sexual sobriety - a personalized list of compulsive sexual behaviors from which he/she will abstain. SAA encourages members to respect each other's definition of sobriety.

As well as regular meetings, SAA also has boundary meetings attended by doctors, professional caregivers, psychotherapists and clergy who need to attend meetings separate from clients, patients, and parishioners.

Sexaholics anonymous - on its website it says it is a fellowship of people who share their experience, strength and hope so that their common problem may be solved, as well as helping others to recover. The organization has no dues or fees, and survives through contributions.

Sexaholics anonymous "is not allied with any sect, denomination, politics, organization, or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. Our primary purpose is to stay sexually sober and help others to achieve sexual sobriety." Their recovery program is based on the principles of Alcoholics Anonymous and received permission from that organization to use its 12-Steps and 12-Traditions in 1979.

Sexual Compulsives Anonymous (SCA) - "SCA is a 12-Step fellowship, inclusive of all sexual orientations, open to anyone with a desire to recover from sexual compulsion. We are not group therapy, but a spiritual program that provides a safe environment for working on problems of sexual addiction and sexual sobriety. There are no requirements for admission to our meetings: anyone having difficulties with sexual compulsion is welcome." It also says there are no fees or dues and that its survival is thanks to voluntary donations. It is not allied with any sect, denomination, politics, organization, or institution.

Sources: America Psychiatric Association, Wikipedia, the Mayo Clinic, National Institutes of Health, National Health Service (NHS).

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What Is Mephedrone? What Are The Effects Of Mephedrone?

Mephedrone, also called 4-methylmethcathinone (4-MMC), or 4-methylephedrone is a synthetic stimulant. A stimulant is a psychoactive drug which induces temporary improvements in mental and/or physical function. Mephedrone is an entactogen drug - a class of psychoactive drugs that produce distinctive emotional and social effects, similar to those of Ecstasy (MDMA).

Mephedrone is an amphetamine and cathinone class drug. An amphetamine is a drug with a stimulant effect on the (CNS) central nervous system that can be physically and psychologically addictive when used too much. Cathinone is a naturally occurring stimulant present in the Khat plant. Its structure and effects are similar to those of ephedrine and amphetamine.

Mephedrone is a synthetic (artificial) substance based on the (cathinone) compounds that exist in the Khat plant of East Africa. Users may swallow, snort or inject mephedrone. It can come in the form of tablets, capsules or white powder. Snorting is the most common way of taking the drug, and injection the rarest.

In 2009 mephedrone became the 4^th most popular street drug in the United Kingdom, after marijuana, cocaine and ecstasy.

Mephedrone is informally known as meph, MCAT, bubbles and drone. The UK tabloid press sometimes refers to it as meow, miaow, meow-meow, or miaow-mioaw.

What are the intended effects of mephedrone (why do people take it)?

Users of mephedrone say it raises:

• alertness
• restlessness
• euphoria
• excitement
• the urge to talk
• openness
• sex drive
• gives a feeling of stimulation

Some say it makes them feel more confident, talkative and alert.

The effects of mephedrone, like cocaine, seem to last about an hour before wearing off.

Most users say mephedrone's effects are a combination of ecstasy and cocaine.

What is the difference between mephedrone and methadone?

Although they may have similar sounding scientific names, mephedrone and methadone are entirely different substances.

• Methadone is a pharmaceutical medication. It is used as a very powerful painkiller (synthetic opiate) to treat heroin addicts. It is a legal substitute for heroin in treatment programs. It is typically administered to patients in the form of a green liquid at drug treatment clinics.
• Mephedrone is a recreational drug taken by users who want an amphetamine or ecstasy like effect. A recreational drug is one people use occasionally for enjoyment, without medical justification for its psychoactive effects - many users believe its occasional use is not habit-forming.

What are the most common side effects of mephedrone?

According to a survey by Mixmag, a dancing and clubbing magazine:

• 67% of users experienced hyperhidrosis (excessive sweating)
• 51% of users experienced headaches
• 43% of users experienced heart palpitations
• 27% of users experienced nausea
• 15% of users had blue or cold fingers

Non-survey (anecdotal) reports indicate mephedrone may have the following effects on some users:

• Severe panic attacks
• Hallucinations
• Paranoia

Some say these last three side effects may be the result of sleep deprivation after overusing mephedrone for a couple of days - it is a stimulant and will make it more difficult to sleep if the user has a "marathon session". However, some anecdotal reports exist of these symptoms without sleep deprivation.

How safe or dangerous is mephedrone?

Unlike many other recreational drugs, such as amphetamines and ecstasy, mephedrone was not first developed as a medicine. Mephedrone was developed in backstreet sweat-shops laboratories; it has had no human testing. Put simply - we do not know what the medium-term, long-term and many of the short-term effects might be.

Les King, who used to be a leading researcher into mephedrone for the UK government, told the British Broadcasting Corporation (BBC) that it is closely related to ecstasy and amphetamine, but appears to be less potent. However, as users seem to be taking much larger doses to get the same effect, it cannot be seen as less harmful. King added "So all we can say is, it is probably as harmful as ecstasy and amphetamines and wait until we have some better scientific evidence to support that."

Is mephedrone addictive?

Experts say it is too early to tell. The drug has not been around enough time. A significant number of users re-dose after the effects start to wear off - after about an hour. Some anecdotal reports comment on a number of users consuming more than they had intended to and finding it hard to stop.

There is not enough proof to determine whether it is addictive.

A short history of mephedrone

The Psychonaut Web Mapping Project, a 2-year European Union funded project (January 2008 - December 2009) with the aim of developing a web scanning system to identify and categorize novel recreational drugs/psychoactive compounds, and new trends in drug use based on information available on the Internet, first identified mephedrone in 2008. They suggest it first became available in 2007.

In May 2007, French police sent a tablet they assumed to be ecstasy to be analyzed. This is thought to be the first seizure of the drug.

A legal high company called Neorganics, Israel, used the drug in early products, such as Neodoves pills. However, the range was discontinued in January 2008 after the Israeli government made mephedrone illegal.

Reports indicate it has probably been sold as ecstasy in Cairns, Australia, as well as some parts of Europe and the USA. It is most commonly sold and used in the United Kingdom, where it sells for between £10 and £15 per gram ($15 to $22). According to an article in The Daily Telegraph, a respected UK newspaper, dealers in Britain pay £2,500 ($3,700) to ship 1 kilogram from China, from which they can make a profit of £7,500 ($11,250). A March 2010 report informed that the wholesale price of mephedrone in the UK was £4,000 ($6,000) per kilogram.

According to Mixmag magazine, the chemical formula of mephedrone is C11H15NO, which is similar to Cocaine (C17H21NO4).

UK official response to the recent mephedrone surge

The British Home Secretary, Alan Johnson, said on March 29^th that within weeks mephedrone and other synthetic legal highs will be banned. This was in response to a recommendation by the Advisory Council on the Misuse of Drugs that they be classified as Class B drugs. Class B drugs (in the UK) include cannabis and amphetamine sulphate and carry a maximum prison sentence of 5 years for possession and 14 years for supply.

There has been pressure to ban mephedrone after media reports of four deaths in the UK.

Alan Johnson added that the importation of mephedrone and chemical compounds linked to its manufacture have been banned with immediate effect. "As a result of the council's swift advice, I am introducing legislation to ban not just mephedrone and other cathinones but also to enshrine in law a generic definition so that, as with synthetic cannabinoids, we can be in the forefront of dealing with this whole family of drugs. This will stop unscrupulous manufacturers and others peddling different but similarly harmful drugs."

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How To Relieve and Prevent "Winter Itch"

All winter flakes are not made of snow. Cold weather wreaks havoc on our skin, sometimes making it dry and flaky. Skin dries out if it's deprived of water and this dryness often causes itchiness, resulting in a condition commonly referred to as "winter itch."

"Most of us experience dry and itchy skin from time to time, but you should seek medical attention if discomfort becomes severe," says Dr. Diane Berson, a dermatologist at the Iris Cantor Women's Health Center of NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "The best thing you can do to relieve the itch is to moisturize your skin because, unfortunately, you can't do anything about the weather."

"Remember, dry skin is due to lack of water, not oil. Apply moisturizers immediately after bathing or showering to trap water in the skin," notes Dr. Berson.

She suggests the following tips to turn your skin from alligator into suede:

• Moisturize daily. Cream moisturizers are best for normal to dry skin. People with sensitive skin should choose a moisturizer without perfume or lanolin.
• Cleanse your skin, but don't overdo it. It is enough to wash your face, hands, feet, and between the folds of your skin once a day. The trunk, arms, and legs can be rinsed daily, but it is not necessary to use soap or cleanser on these areas everyday. Too much cleansing removes the skin's natural moisturizers.
• Limit the use of hot water and soap. If you have "winter itch," take short lukewarm showers or baths with a non-irritating, non-detergent-based cleanser. Immediately afterward, apply a "water-in-oil" type moisturizer. Gently pat skin dry.
• Humidify. Humidifiers can be beneficial. However, be sure to clean the unit according to the manufacturer's instructions to reduce mold and fungi.
• Protect yourself from the wind. Cover your face and use a petroleum-based balm for your lips.
• Avoid extreme cold. Cold temperatures can cause skin disorders or frostbite in some people. See a doctor immediately if you develop color changes in your hands or feet accompanied by pain or ulceration. If you develop extreme pain followed by loss of sensation in a finger or toe, you may have frostbite.
• Protect your skin from the sun. Winter sun can be as dangerous for the skin as summer sun. It can lead to premature aging of the skin and skin cancer. When outdoors for prolonged periods, use a sunscreen with a sun-protection factor of 15 or greater.
• Exercise. For skin with a healthy glow, 20 to 30 minutes of aerobic exercise three times a week is recommended.
• See your dermatologist. If you have persistent dry skin, scaling, itching, skin growths that concern you, or other rashes, see your dermatologist -- not only in winter but throughout the year.

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New Form Of Ketamine Treats Depression "Like Magic"

"It's like a magic drug", said the lead researcher of a team from Yale University in the US whose latest study suggests that ketamine, a drug normally used as an anasthetic, could be reformulated as an anti-depressant that takes effect in hours rather than the usual weeks and months of most available medications.

You can read how the researchers discovered this effect in a study they performed on rats which was published online on 20 August in the journal Science.

Senior author Dr Ronald Duman, professor of psychiatry and pharmacology at Yale, told the media that just one dose of the drug can work rapidly and lasts for seven to ten days.

This is the same ketamine that is used as a recreational drug, called "Special K", or "K".

He and his team found that the drug not only improved the rats' depression-like behaviors, it also restored connections between neurons or brain cells that had been damaged by chronic stress. They called this "synaptogenesis".

They hope their findings will help to speed up the development of a safe and easy to administer version of ketamine, which has already proved to be effective in severely depressed patients, they said.

About ten years ago, scientists at Connecticut Mental Health Center found that in lower doses, ketamine, normally used as a general anasthetic for children, appeared to relieve patients with depression.

Since then, other studies have shown that over two thirds of patients who don't respond to all other types of anti-depressants improved hours after receiving ketamine, said Duman.

The problem with using ketamine more widely to treat depression has been the fact it has to be given intravenously under medical supervision, and it can also cause short-term psychotic symptoms.

So Duman and colleagues decided to investigate the effect of ketamine on the brain to see if it might reveal suitable targets for other safer and easier to adminster drugs.

" ... the mechanisms underlying this action of ketamine [a glutamate N-methyl-D-aspartic acid (NMDA) receptor antagonist] have not been identified," they wrote.

They found that ketamine acts on a pathway that controls the formation of new synaptic links between neurons, encouraging synaptogenesis; they wrote that they observed:

" ... increased synaptic signaling proteins and increased number and function of new spine synapses in the prefrontal cortex of rats."

Moreover, they found that a critical point on the pathway, involving the enzyme mTOR, controls production of proteins needed to form the new synapses.

The researchers concluded that:

"Our results demonstrate that these effects of ketamine are opposite to the synaptic deficits that result from exposure to stress and could contribute to the fast antidepressant actions of ketamine."

Duman and colleagues told the press that they can already see ways to sustain the rapid effect of ketamin by intervening at other points downstream of this critical one. These could be additional targets for new drugs.

This discovery not only brings new hope to the 40 per cent or so of patients with depression who don't respond to medication, but to many others who only experience relief after months and sometimes years of treatment.

The researchers also noted that ketamine has already shown to be effective as a rapid way to treat people with suicidal thoughts, many such patients usually only respond weeks later with traditional drugs.

The National Institute of Mental Health, the Connecticut Mental Health Center and Yale University School of Medicine paid for the study.

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What Is Scarlet Fever? What Causes Scarlet Fever?

Scarlet fever, also known as scarlatina, is a disease caused by a toxin (erythrogenic exotoxin) released by Streptococcus pyogenes or group A beta-hemolytic streptococcus - the disease occurs in a small percentage of patients with strep infections, such as strep throat or impetigo. Although scarlatina may be used interchangeably with scarlet fever, scarlatina is more commonly used to refer to the less acute form of scarlet fever.

The bacterial illness, scarlet fever, causes a distinctive pink-red rash, which occurs when the bacteria release toxins.

Scarlet fever is extremely contagious - people can catch it by breathing in the bacteria in airborne droplets that come from an infected individual's sneezes or coughs. Infection may also occur as a result of touching the skin of an infected person, or touching surfaces or objects that the infected person has touched.

Scarlet fever is rare these days, mainly because antibiotics are used to treat strep infections.

Scarlet fever is much more common among children aged 5 to 15 years than other people. It used to be considered a serious childhood illness. However, modern antibiotics have made it a much less threatening disease. If left untreated scarlet fever can sometimes lead to serious conditions that affect human organs, including the heart and kidneys.

According to Medilexicon's medical dictionary:

Scarlet fever or Scarlatina is "An acute exanthematous disease, caused by infection with streptococcal organisms producing an erythrogenic toxin, marked by fever and other constitutional disturbances, and a generalized eruption of closely aggregated bright red points or small macules followed by desquamation in large scales, shreds, or sheets; mucous membrane of the mouth and fauces is usually also involved."

What are the signs and symptoms of scarlet fever?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Signs and symptoms generally appear about one to four days after initial infection. The first symptoms are usually:

• A very sore and red throat (sometimes with white or yellowish patches).


• A fever of 101 F (38.3 C) or higher, frequently with chills. 12 to 48 hours later the rash will appear.


• Rash - red blotches appear on the skin; they then turn into a fine pink-red rash that looks like sunburn. The skin feels rough, like sandpaper, when touched.
  
  The rash spreads to the ears, neck, elbows, inner thighs and groin, chest and some other parts of the body. Although the rash does not usually appear on the face, the patient's cheeks will become flushed and the area around his/her mouth appear pale.
  
  If a glass is pressed on the skin the rash will turn white (blanche).
  
  After about six days the rash usually fades. In milder cases, such as scarlatina, the rash may be the only symptom.

Scarlet fever may also have the following signs and symptoms:

• Difficulty swallowing
• General malaise
• Headache
• Itching
• Loss of appetite
• Nausea
• Pastia's lines - broken blood vessels in the folds of the body, for example the armpits, groin, elbows, knees and neck.
• Stomachache
• Swollen neck glands (lymph nodes) that are tender to the touch
• Tongue - a white coating forms on the tongue. This eventually peels away leaving a strawberry tongue; the tongue is red and swollen.
• Vomiting

If the patients has other symptoms, such as severe muscle aches, vomiting or diarrhea the doctor will have to rule out other possible causes, such as toxic shock syndrome.

The skin of the hands and feet will usually peel for up to six weeks after the rash has gone.

What are the risk factors for scarlet fever?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

• Children - aged from 5 to 15 years have a higher risk of developing scarlet fever compared to other people.
• Close contact - the strep bacteria can spread more easily among people in close contact. If somebody in the household carries the bacteria, infection may spread more readily among household members (and colleagues at school).

What causes scarlet fever?

Scarlet fever is caused by a bacterium called Streptococcus pyogenes, or group A beta-hemolytic streptococcus. This is the same bacterium that causes strep throat. When the bacteria release toxins scarlet fever symptoms occur, including the rash, Pastia's lines, red tongue and flushed face.

Scarlet fever transmits from human-to-human by fluids from the mouth and nose. When an infected individual coughs or sneezes the bacteria become airborne in droplets of water and can be inhaled. The bacteria may land on surfaces, such as drinking glasses, work surfaces and doorknobs and infect people who touch them with their hands and then touch their own nose or mouth. The bacteria may also be inhaled.

If you touch the skin of an individual with a streptococcal skin infection there is a risk of becoming infected.

People who share towels, baths, clothes or bed linen with an infected person risk becoming infected themselves.

A person with scarlet fever who is not treated may be contagious for several weeks, even after symptoms have gone. It is also possible for somebody to carry the infection and be contagious, even though they never had any symptoms - only people who are susceptible to the toxins released by streptococcal bacteria develop symptoms. These factors make it harder for individuals to know whether they have been exposed.

Although much less common, people may become infected by touching or consuming contaminated food, especially milk.

Other types strains of Streptococcus pyogenes linked to either skin infections, such as impetigo, or uterine infections that may occur during childbirth may also cause scarlet fever - however, this is much rarer.

Diagnosing scarlet fever

The characteristic rash and symptoms usually make it fairly easy for a doctor to diagnosis scarlet fever. The doctor may take a throat swab in order to determine which bacteria caused the infection. Sometimes a blood test is also ordered.

Rapid DNA test - a throat swab is taken. Results are returned within a day at the most.

In the United Kingdom and many other countries scarlet fever is a notifiable disease. This means that any confirmed cases must be reported to local health authorities.

What are the treatment options for scarlet fever?

According to the National Health Service (NHS), UK, the majority of mild cases of scarlet fever resolve themselves within a week without treatment. The NHS advises people to get treatment anyway, as this will accelerate recovery and reduce the risk of complications. Patients generally recover about four to five days after treatment begins.

Antibiotics - a 10-day course of antibiotics is the most common treatment for scarlet fever. In the UK, and many other countries this involves taking oral penicillin. Patients who are allergic to penicillin may take erythromycin instead. Patients are advised to stay at home during the course of the antibiotic treatment.

The fever will usually go away within 12 to 24 hours of taking the first antibiotic medication.

According to the Mayo Clinic, USA, a child with scarlet fever may be prescribed one of the following antibiotics:

• Penicillin, in pill form or by injection
• Amoxicillin (Amoxil, Trimox)
• Azithromycin (Zithromax)
• Clarithromycin (clarithromycin extended-release tablets). External link" target="_blank">Biaxin)
• Clindamycin (clindamycin phosphate). External link" target="_blank">Cleocin)
• A cephalosporin such as cephalexin (Keflex)

It is important to complete the full course of antibiotics, even if symptoms go away before it is finished. Otherwise, the infection may not be completely eradicated, raising the risk of subsequent post-strep disorders.

If the patient does not start feeling better within 24 to 48 hours after starting the antibiotic treatment, call the doctor.

Within 24 hours of starting the antibiotics the patient will no longer be contagious.

Other treatments - it is important to drink plenty of liquids, especially if there is no appetite. The room should be kept cool.

Tylenol (paracetamol) may help relieve aches and pains, as well as bringing the fever down.

Calamine lotion may help with itchy skin.

What are the possible complications of scarlet fever?

In the majority of cases there are no complications. If any occur, they may include:

• Ear infection, including otitis media
• Pneumonia
• Throat abscess - a pus-filled sac in the throat
• Sinusitis
• Inflammation of the kidney(s) - poststreptococcal glomerulonephritis, resulting from certain byproducts of strep bacteria. In some cases there may be long-term kidney disease.
• Rheumatic fever
• Some skin infections

The following complications are possible, but very rare:

• Acute kidney (renal) failure
• Meningitis - inflammation of the membranes and fluid that surround the brain and spinal cord.
• Necrotizing fasciitis - commonly known as flesh-eating disease
• Toxic shock syndrome
• Endocarditis - infection of the heart's inner lining
• Infection of the bone and bone marrow (osteomyelitis)
• PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) - according to the Mayo Clinic, USA, some research has indicated that strep bacterial infection may trigger an autoimmune response that exacerbates symptoms of certain childhood disorders, such as OCD (obsessive-compulsive disorder), Tourette syndrome and ADHD (attention deficit hyperactivity disorder). The increase in symptoms does not usually last for more than a few weeks or months.

Scarlet fever prevention

The best prevention strategies for scarlet fever, as with all highly infectious diseases, are:

• Isolation - keep the patient away from other people. Keep the child away from school.
• Handkerchiefs or tissues that the patient has used should be washed or disposed of immediately. If you have touched any of these wash your hands thoroughly with warm water and soap.
• Handwashing - the patient, usually a child, should be taught to wash his/her hands thoroughly and frequently.
• Dining utensils - do not share drinking glasses or eating utensils with the patient.
• Coughing and sneezing - the patient should be taught to cover his/her mouth and nose when coughing and sneezing. This should be done into a tissue or handkerchief. If one is not available it is better to cough/sneeze into the inside of the elbow - coughing into one's hands raises the risk of contaminating things when they are touched.

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