Vitamin D "New Information"

As the sun begins to break through over Chicago, its warming rays are resuming a critical role that has lain dormant most of the winter, coaxing our skin to make vitamin D.

Emerging research indicates that vitamin D is more important to our health than previously thought, leading an increasing number of scientists to challenge whether the fear of sun exposure has made us cover up too much.

Doctors are finding an increase in vitamin D deficiencies, even as researchers discover remarkable results from the vitamin that affects nearly every tissue in the body.

Told their pain and muscle weakness would only get worse, and that they would likely remain in wheelchairs the rest of their lives, five patients in Buffalo decided to take a chance on large doses of vitamin D.

In 4 to 6 weeks they were up and about, saying goodbye to their wheelchairs and back to normal activities, pain free.

When women took vitamin D in multivitamin supplements over a long period of time, their risk of developing multiple sclerosis was reduced by 40 percent.

And a disturbing number of children who don't have enough vitamin D in their bodies are showing up with rickets, a crippling bone disorder thought to have been eradicated more than 70 years ago.

Dr. Craig Langman, a kidney and mineral metabolism expert at Children's Memorial Hospital and Northwestern University Medical School, sees a new case of rickets every week, triple the rate of five years ago.

"We're finding more and more kids are presenting with evidence of vitamin D malnutrition," said Langman, who noted that includes fractures and bone pain.

Vitamin D is a critical hormone that scientists are discovering helps regulate the health of more than 30 different tissues, from the brain to the prostate. It plays a role in regulating cell growth, the immune system and blood pressure, and in the production of insulin, brain chemicals and bone.

"We thought that vitamin D was a very narrow-acting substance," said Dr. Hector DeLuca of the University of Wisconsin, where vitamin D was first identified in the early 1900s, leading to the fortification of milk and some other foods that eliminated endemic rickets.

"The big surprise is that it's got a lot of important biological effects that probably contribute to our health and we're just now beginning to uncover them," said DeLuca. "Are we getting enough vitamin D? No we're not, especially in the winter."

Vitamin D is one of the body's many control systems. It acts like an emergency brake that helps stop cells from perilously misbehaving, as immune cells can do when they cause such autoimmune diseases as MS and as breast and prostate cells do when they turn cancerous.

Variable protection

This protection declines as vitamin D levels drop. University of Chicago microbiologist Yan Chun Li discovered just how that happens with high blood pressure. Vitamin D helps normalize blood pressure by keeping a pressure-increasing switch called renin in check.

Vitamin D's importance for health goes back more than 750 million years to the earliest life forms that left the ocean for the Earth's surface. All vertebrates today depend on sun exposure for vitamin D production.

The lack of vitamin D is known to cause rickets, osteoporosis and osteomalacia (soft bones). New research indicates that vitamin D malnutrition may also be linked to many chronic diseases such as cancer (breast, ovarian, colon and prostate), chronic pain, weakness, chronic fatigue, autoimmune diseases like multiple sclerosis and Type 1 diabetes, high blood pressure, mental illnesses--depression, seasonal affective disorder and possibly schizophrenia--heart disease, rheumatoid arthritis, psoriasis, tuberculosis and inflammatory bowel disease.

"A lot of people with aches and pains and marginal weakness could be helped by vitamin D supplements," said Dr. Paresh Dandona of the State University of New York at Buffalo who reported the first five cases of vitamin D deficient myopathy three years ago in the Archives of Internal Medicine.

Undiagnosed pain is the chief complaint of more than one-third of patients.

Studying 150 children and adults with undiagnosed pain, Dr. Greg Plotnikoff of the University of Minnesota discovered that 93 percent were severely or profoundly vitamin D deficient. All were put on prescription doses of the vitamin.

"One patient with chest pain had multiple balloon angioplasties and his pain never went away," Plotnikoff said. "He also had surgery for his low back pain but he didn't get any better.

"I measured his vitamin D level and it was basically zero," he said. "His chest and low back pain were not due to cardiac or spinal disease but to low vitamin D. We put him on prescription strength vitamin D and he got much better. We had spent over $200,000 on him in the hospital for these other procedures without doing a $20 blood test."

A study in the British medical journal Lancet found that infants receiving 2,000 IU of vitamin D daily were protected from developing Type 1 diabetes. Various forms of vitamin D have become a major treatment for psoriasis and preliminary evidence suggests it reduces blood pressure, reduces hip fracture risks in older people and improves symptoms of rheumatoid arthritis and multiple sclerosis.

Research help

"Our study supports a possible role for vitamin D in the prevention of MS," said epidemiologist Kassandra Munger of the Harvard School of Public Health. "Further studies are needed to confirm the findings, but taking a multiple vitamin as part of a healthy diet can't hurt."

Researchers are finding that the current recommended daily allowances of vitamin D--ranging from 200 international units for infants, children and adults up to age 50 years; 400 IU for men and women from 50 to 70; and 600 IU for people older than 70--are probably far lower than the minimum amount necessary for optimum health.

Scientists are quick to warn that although people may need more vitamin D, mostly in the form of supplements in higher latitudes where sunlight is weak during winter months, they should consult a physician before consuming large doses. Taking too much vitamin D can elevate levels of calcium in the blood, a potentially serious condition that can lead to nausea, vomiting, or even death. It is especially easy for children to overdose on vitamin D supplements.

Dr. Michael F. Holick of Boston University Medical Center, one of the world's foremost vitamin D experts, recommends 1,000 IU daily for everyone through a combination of safe exposure to sunlight and supplements.

Summertime sun exposure on the face, arms and hands around noon for only 5 to 15 minutes for people with light skin 2 to 3 times a week provides sufficient vitamin D, he said.

Blacks have the highest risk for vitamin D deficiency because dark skin needs 5 to 10 times more sunlight than white to produce the same amount of the vitamin. One study found that 42 percent of African-American women in the U.S. were vitamin D deficient.

Chronic diseases associated with vitamin D deficiency are 25 to 50 percent more frequent in northern climates than among people living closer to the sunny equator, where humans first evolved. As people migrated away from the equator, it is thought, skin evolved lighter shades to absorb more sunlight for vitamin D production.

Limited menu

Vitamin D is not available in most foods (oily fish, egg yolks, liver and cod liver oil have some), but it is abundantly made when sunlight strikes the skin, which normally produces about 90 percent of the body's store of the vitamin.

People living in northern latitudes don't get enough sun from December through February to make vitamin D. A person living in Chicago, Boston, Detroit or New York can stand naked outside all day in the winter and not make any vitamin D, said Holick, author of "The UV Advantage."

Even in summer the skin's vitamin D-making ability gets dampened from the increasing use of sunscreen, leading a growing number of health experts to challenge the advice given over the last two decades to avoid the sun at all costs in order to reduce skin cancer risk.

"The amount of vitamin D in our diet is totally inadequate," Holick said. "We are in an era of sunphobia--that is not being exposed to any direct sunlight--that's being promoted widely by the dermatology community and it's probably hurting people's health more than it's helping them."

"That message needs to be modified and moderated to a more sensible approach so that people can get a little bit of safe sun," he said.

The evidence is overwhelming that excessive sun exposure causes skin cancer. More than 1 million cases of squamous and basal cell cancers, which are highly treatable, are expected this year, according to the American Cancer Society. Solar exposure is also blamed for the anticipated 55,100 cases of melanoma in 2004 and 7,910 deaths. Melonama, a potentially deadly skin cancer, usually occurs years after severe sunburns in childhood.

Conflicting research

On the other hand, increasing but less conclusive evidence suggests that adequate vitamin D levels from healthy sun exposure may reduce the risk of many other cancers.

A recent study of more than 430,000 death certificates showed that people who had more exposure to sunlight had a 26 percent lower risk of death from colon and breast cancer, said D. Michal Freedman, an epidemiologist at the National Cancer Institute.

Testifying in October at a "Vitamin D and Health in the 21st Century" conference called by the National Institutes of Health's Office of Dietary Supplements, William B. Grant, a retired NASA senior scientist and solar radiation expert, said his studies determined that lack of vitamin D accounts for 45,000 cancer deaths annually and 165,000 new cancer cases.

The conference was prompted by growing concerns of widespread vitamin D inadequacy and how to strike a balance between supplements, dietary fortification, tanning booths and sun exposure, said NIH nutritionist Mary Frances Picciano.

"If you go to the literature where people are talking about sunlight and cancer risk, nobody mentions that you need sun for vitamin D," she said. "By the same token if you go to the vitamin D literature where people are talking about skin irradiation to get vitamin D, nobody talks about cancer.

"One of the first things that might be necessary is to get the skin cancer people together with vitamin D requirement people," Picciano said. "There are questions that need to be addressed before meaningful public health policy can go forward.

How Your Diet Affects Your Health

Eating for convenience rather than for health is the norm these days. When you're on the go, stopping at a fast food drive-through is the easy way to get a quick bite. Health is affected by a poor diet, just as your car is affected by poor quality gasoline or the wrong kind of gasoline. A fad diet, a diet low in fiber, or high in fats can be detrimental to your body's organs. Though dietary supplements are important, popping vitamin pills is not the way to become healthy. The real key to good health is awareness of the foods we eat and the food groups. Real food provides vitamins in a "live," or chelated, form. Chelated vitamins are easier for the body to digest and assimilate.

Food Allergies and Intolerances

Food allergies and intolerances can wreak havoc on the system. For example, people with gluten intolerance, or Celiac disease, suffer extreme gastro-intestinal disturbances. Gluten is found in wheat, barley and rye. A skin rash can also be an indicator of food allergies. Common allergens are peanuts, eggs, and fish. Reactions that manifest as a skin rash include hives, a reddish color and swelling. Suspected food allergies should be brought to the attention of a physician.

The Risks of Poor Nutrition

While extremely low fat diets are appealing for their effect on weight loss, to function properly, the body requires thirty percent of its calories from fat. Fad diets are notorious for causing health problems. A fad diet that causes rapid weight loss in a week's time may increase the risk for development of gallstones or kidney stones. Low carbohydrate diets can also predispose one to gallstones. Other conditions such as dehydration can also result.

Conditions such as malnutrition, cardiovascular disease, obesity, diabetes, arthritis, cancer, vitamin deficiency, and bowel disorders are caused by poor nutrition. Many disease processes are exacerbated by lack of sufficient fluids or the wrong kinds of fluids, such as soda or alcohol instead of water. A simple awareness of how your diet incorporates items from food groups, such as protein, carbohydrates, and fat, is the first step in improving the diet.

Tips for Eating on the Go

1. Consider the nutrition facts at the restaurant. If they are not apparent, ask for them.

2. Consider the amount of fat and fiber in the item you wish to order. If it has little or no
fiber, is high in fat or salt, don't eat it.

3. Eat whole fruit and vegetables. Choose a different one in each color every day:
red, green, yellow or orange. A whole fruit or vegetable is just as fast or faster than

eating a burger and fries, and is rich in fiber and nutrients.

Specific Benefits:

Adaptogenic Properties-Eleuthero (Siberian Ginseng)

Weight Control-Green Tea

Toxic Metal Removal-Apple Pectin

Great Source of Minerals and Vitamins-Spirulina, Hawthorn/Crateagus, Bilberry, Gingko, Green Tea, Grape Seed Extract, Schisandra, Astragalus, Eleuthero Coccus (Siberian Ginseng), Licorice, Ginger, Cordyceps, Kale, Parsley, Cabbage, Broccoli.

Relieves Symptoms of Fibromyalgia and Arthritis-Chlorella, Bromelain, Grape Seed Extract.

Helps Reduce Risk of Cancer and Demonstrates Antitumor Activity-Spriulina, Bilberry, Apple Pectin, Celandine/Chelidonium, Silymarin/Milk Thistle, Green Tea, Grape Seed Extract, Licorice, Ginger Cordyceps, Maitake, Carrot, Kale, Spinach, Cabbage, Broccoli, Beet Root.

Helps Support the Immune System and Antiviral, Antibacterial, and Antifungal Activity-Spriulina, Apple Pectin, Bromelain, Celandine/Chelidonium,, Schisandra, Astragalus, Poria, Reishi.

Help Reduce Risk of Heart Disease and Improve Cardiac Function-Hawthorne/Crataegus, Green Tea, Grape Seed Extract, Astragalus, Cordyceps, Broccoli.

Helps Lower Cholesterol-Spirulina, Apple Pectin, Cordyceps.

Support of Eyes & Helps Prevent Macular Degeneration-Zuccini, Spinach, Collard Greens.

Rich Source of Vitamin A-Carrot, Spinach.

Reduce Risk of Cataracts-Kale, Spinach.

Childhood HIV Disease

The World Health Organization¹ estimates that approximately 2.3 million children are living with the human immunodeficiency virus (HIV) as of 2006. In 2006 alone, 530,000 children were newly infected, an improvement from the 640,000 newly infected in 2004. Not only are the children themselves ravaged by disease, but their primary caregivers have also often succumbed to acquired immune deficiency syndrome (AIDS). This is most prevalent in sub-Saharan Africa, where 18 million children are predicted to be orphaned by AIDS by the end of 2010. Worldwide, the United Nations Children's Fund (UNICEF) predicts the number of children orphaned and made vulnerable by HIV/AIDS is expected to reach 25 million by the end of the decade.

Although 2 strains of HIV have currently been identified, most patients who have AIDS are positive for HIV type 1 (HIV-1) or are positive for both HIV-1 and HIV type 2 (HIV-2). HIV-2 infection is most commonly observed in West Africa.

Vertical transmission of HIV from mother to child is the main route by which childhood HIV infection is acquired; the risk of perinatal acquisition is 25%. Perinatal transmission of infection by the mother accounts for 80% of pediatric HIV disease cases in the United States. Perinatal transmission can occur in utero, during the peripartum period, and from breastfeeding. Other routes of transmission, such as transfusion of blood and blood components, are rare in the United States but still exist in developing countries. Sexual abuse of children and high-risk behaviors in adolescents also contribute to youth HIV infection.

A variety of signs and symptoms manifesting in a child in whom HIV infection was not previously suspected should alert the clinician to the possibility of the disease. The presentations include recurrent bacterial infections, unrelenting fever, unrelenting diarrhea, unrelenting thrush, recurrent pneumonia, chronic parotitis, generalized lymphadenopathy, delay in development with failure to thrive, and significant pruritic dermatoses. Mucocutaneous eruptions may be the first sign of HIV infection and may vary in presentation, depending on the child's immune status.

Pathophysiology

HIV is a retrovirus that exhibits a variety of structural and nonstructural proteins that determine the interaction of the virus with the host's immune system and cellular components. The HIV virus attaches to the host cell by the association of a surface glycoprotein to the CD4 molecule; therefore, it primarily infects CD4⁺ lymphocytes and macrophages.

Once the virus core enters the cell cytoplasm of the host, viral reverse transcriptase copies viral RNA to the DNA of the host. The viral DNA is then transported into the nucleus and incorporated into the DNA of that cell. If activated, viral expression can result in new viral RNA and proteins. New viral core proteins, enzymes, and viral RNA molecules can induce budding, with additional cell infection. The reduction in cell-mediated immunity and secondary B-cell dysfunction result in the immunocompromised state and in the proliferation of opportunistic infections and malignancies. An elevated level of activation-induced cell death resulting from apoptosis of T cells occurs in patients who are HIV positive.

The CD95/Fas receptor/ligand system is necessary for the apoptosis of T cells, and abnormalities in this system are linked with increased T-cell death in patients who are HIV positive. As the immune status deteriorates, an increase in CD95⁺ T cells is found; conversely, a low CD95⁺ T cell count is found in asymptomatic patients who are HIV positive.

Frequency

United States

According to the Centers for Disease Control and Prevention (CDC), the cumulative estimated number of diagnoses of AIDS in children younger than 13 years through 2005 in the United States is 9089. This represents a drop from the 9419 cases reported in 2003. In the United States, the number of new cases of pediatric AIDS is decreasing, mostly because of public health initiatives regarding universal HIV testing for pregnant women and use of zidovudine in infected pregnant women and their newborn infants. In 2005 in the United States, 3764 children younger than 13 years were living with HIV infection, and an estimated 7 children younger than 13 years died from AIDS-related causes that year. These numbers are in stark contrast to what is occurring internationally.

International

Globally, children outside the United States are not faring as well. Everyday, 1400 children become HIV positive and 1000 children die of HIV-related causes. An estimated 2.3 million children worldwide younger than 15 years are living with HIV/AIDS. In sub-Saharan Africa alone, 1.9 million children are living with HIV/AIDS and more than 60% of all new HIV infections occur in women, infants, or young children. As of 2007, 90% of the newly infected children are infants who acquire HIV from their infected mothers. Alarmingly, 90% of babies who acquire the disease from infected mothers are found in sub-Saharan Africa. The prevalence of HIV infection among undernourished children has been estimated to be as high as 25%.

The prevalence of HIV infection in Asia and Europe varies considerably because of varied cultural practices and lack of a national reporting system in many areas. The commercial sex worker industry in countries such as Thailand and in the CaribbeanIslands is responsible for increased HIV transmission to young girls and, vertically, to infants.

Mortality/Morbidity

In 2004, more than half a million children younger than 15 years died from HIV/AIDS. In 2006, this number decreased to 380,000. In 2002, HIV/AIDS was the seventh leading cause of mortality in children in developing countries. The disease progresses rapidly in approximately 10-20% of children who are infected, and they die of AIDS by age 4 years, whereas 80-90% survive to a mean age of 9-10 years. In affected regions of sub-Saharan Africa, the infant mortality rate has increased by 75% due, in part, to the orphaned status of most children. In contrast to much of the developed world, the mortality rates for children younger than 5 years are higher today than those observed in 1990 in many African countries, mostly because of the devastating effects of HIV/AIDS. A 2006 South African study² estimates that HIV/AIDS is the single largest cause of infant and childhood deaths in rural South Africa. HIV/AIDS is now responsible for 332,000 child deaths in sub-Saharan Africa, almost 8% of all child deaths in the region.

Race

In the United States, children from minority communities have been most affected by AIDS. More than 50% of affected children are black, and slightly less than 25% are Hispanic. Of the new childhood HIV cases in 2003, 68% occurred in African Americans. The number of pediatric AIDS cases reported in black non-Hispanic children is 3.4 times higher than in white non-Hispanic children and is 2.6 times higher than that of Hispanic children.

Sex

Young people (aged 15-44 y) account for one of the fastest growing infected groups and account for almost half of all infections. Among young people, young women are more likely to become infected. In sub-Saharan Africa, more than two thirds of all youth infected are young girls. Variations in frequencies in the sexes in other regions of the world depend on the predominance of commercial sex workers and the proportion of a transient and mobile workforce more likely to be separated from family.

Age

Because vertical transmission from mother to child is the main route by which pediatric HIV infection is acquired, most children who are HIV positive should be identified in infancy. Vertical transmission can occur in utero, during delivery, and from breastfeeding. Although current treatment strategies can prevent vertical transmission, the drugs are simply not available in many places, especially in Africa.

Because passive transfer of maternal antibodies to the infant occurs, the standard enzyme-linked immunosorbent assay (ELISA) and Western blot tests cannot be used with diagnostic certainty until age 2 years; however, HIV RNA assays and the HIV DNA polymerase chain reaction (PCR) test can be used for early detection. HIV infection can be diagnosed in most infants by age 1 month and in all infants by age 6 months. The use of at least 2 virologic assays is recommended to confirm positive results, with a final exclusion of HIV infection verified by ELISA or Western blot after age 18 months in infants born to mothers who are HIV positive.

Clinical

History

• A variety of cutaneous conditions may occur in children with HIV.
• Ideally, the diagnosis of HIV in a child is made through perinatal testing. The CDC has issued guidelines for recommended testing and counseling for all pregnant women; however, many women, especially in developing countries and in poorer areas of the developed world, do not have access to or do not avail themselves of the resources available. Thus, for example, the diagnosis of HIV infection may follow an investigation of a prolonged or unusual presentation of an infection or a malignancy.
• Children infected as a result of sexual abuse or drug use may not present with known HIV infection.

Physical

Numerous mucocutaneous disorders have been reported in children infected with HIV. As the CD4⁺ count decreases, an increase in the number and severity of skin manifestations can be expected. Some studies suggest that children infected with HIV become symptomatic from the neonatal period up to age 8 years and that 57% of this group have associated disease within the first year. Dermatologic manifestations occur more frequently in children with advanced HIV disease; many tend to improve after antiretroviral therapy is initiated.

• A high percentage of oral disease has been seen in children infected with HIV, and oral manifestations are often early indicators of infection. The most common oral disease and mucocutaneous presentation of HIV infection is candidiasis caused by Candida albicans. Both the pseudomembranous variant and the atrophic oral variant are most common.
• Pseudomembranous candidiasis manifests as creamy white–to–yellow oral plaques, commonly referred to as thrush. Atrophic candidiasis manifests as distinct areas of erythema with the loss of tongue papillae if the tongue is affected. Hyperplastic candidiasis (with both erythematous and white mucosal coloration symmetrically distributed) and angular cheilitis are 2 additional clinical variants of candidiasis.
• Difficulty in swallowing, inadequate oral intake, or dysphagia may be the initial symptoms of oral or esophageal candidiasis³ and may contribute to the already-compromised nutritional status of the child.
• An inflammatory, destructive, and necrotic process characterizes candidal periodontal disease in the gingival mucosa and the underlying connective tissue.
• The usual symptoms in children with candidal esophagitis are odynophagia, dysphagia, and retrosternal pain.
• Although C albicans is the most commonly identified Candida species, Candida dubliniensis has recently garnered notice as a cause of oral infection that is seen, for the most part, only in patients who are HIV positive.⁴ Other Candida species implicated in HIV-related candidiasis are Candida glabrata and Candida tropicalis.
• Candidiasis may manifest as an unresponsive or recurrent diaper rash or as a chronic paronychia and onychomycosis. In Candida -associated diaper dermatitis, the area covered by the diaper is usually inflamed and erythematous, with satellite lesions extending beyond the central area of involvement. Other intertriginous areas have also been reported, including neck folds and axillary regions.
• Candidal involvement of the proximal nailfolds causes severe paronychia and nail dystrophy. Candidal onychomycosis results in yellow-brown thickened nail plates.
• Linear gingival erythema and median rhomboid glossitis have also been found, especially in children with a low CD4⁺ cell count.
• Children infected with HIV also have a higher rate of dental caries in the primary teeth but a diminished prevalence in the permanent teeth, a finding attributed to the greater number of primary teeth and the delayed eruption of the permanent teeth in these patients. HIV-infected children should be screened and considered at high risk for dental caries, usually secondary to chronic medication use.^5,6

• Oral hairy leukoplakia, which is associated with Epstein-Barr virus, is usually rare in children, but it has been reported in children as the second most common oral presentation after candidiasis in some Asian countries. Results from a 2006 study⁷ suggest that oral hairy leukoplakia may be more common than previously believed; 16.7% of patients demonstrated subclinical, cytological disease, and only 1.7% of children had clinically visible disease.
• Herpes simplex, parotid enlargement, and recurrent aphthous ulcers are also common oral manifestations.
• Dermatophytosis manifesting as an aggressive tinea capitis, corporis, versicolor, or onychomycosis may be challenging to treat. As in adults, Trichophyton rubrum infection in the form of proximal, white, subungual onychomycosis is categorized as a typical nail manifestation of HIV disease.
• Deep fungal infections are not commonly seen in children who are HIV positive.
• Cryptococcosis, sporotrichosis, and histoplasmosis have been reported as either localized or disseminated variants.
• Molluscumlike Cryptococcus papules have been identified in some patients.
• Herpetic infection with herpes simplex virus (HSV) may take the form of herpes labialis; gingivostomatitis; esophagitis; or as chronic erosive, vesicular, and vegetating skin lesions.
• The involved areas of the lips, mouth, tongue, and esophagus are ulcerated, which may result in difficulty with oral nutritional intake.
• Skin lesions usually manifest as chronic erosions, which may have grouped vesicles. The fingers are a frequent site of infection. Pyoderma gangrenosum and ecthyma gangrenosum may be in the differential diagnosis of cutaneous herpetic infections.
• Recurrent or persistent varicella-zoster infection is strongly linked with the CD4⁺ count. Scarring can occur from a severe outbreak, in which lesions may be hyperkeratotic and/or hemorrhagic and involve more than 1 dermatome. Because herpes zoster is usually not seen in children who are immunocompetent, an evaluation for HIV infection should be undertaken in a child with this diagnosis. Children should be evaluated for evidence of dissemination because disastrous sequelae, such as encephalitis, intracranial thrombosis, fulminant hepatitis, disseminated intravascular coagulation, pneumonitis, and retinal necrosis, have been reported in patients with dissemination.
• Human papillomavirus infection, which may mimic the tinea versicolor–like rash in epidermodysplasia verruciformis, is noted. Large areas of flat warts most commonly occur on the forehead, the temples, the neck, and the upper body. Unusually large treatment-resistant condylomata are reported in children who are HIV positive.
• Widespread molluscum contagiosum can occur in pediatric AIDS patients. Molluscum contagiosum may manifest as a diffuse eruption of umbilicated papules involving areas (eg, face) usually not affected in patients who are immunocompetent. Molluscum lesions tend to be more persistent in patients with HIV infection. Some lesions are large and may be confused with Cryptococcus neoformans lesions. Molluscum tends to improve with antiretroviral therapy.
• Recurrent bacterial infections are seen in children who are HIV positive because of the abnormal B-cell response and consequent defective humoral immunity. A variety of bacterial infections occurs, the most common of which is caused by Staphylococcus aureus. As the CD4⁺ count decreases, invasive bacterial infections, including sepsis and pneumonia, occur.
• Sepsis, otitis media, impetigo, cellulitis, and furunculosis have been reported. Although the infections may initially manifest in a manner similar to that in a child who is not immunocompromised, widespread and persistent infection should prompt consideration of HIV status. Acral lesions should be sought if sepsis is a concern because a pustule on the sole may be the first sign of sepsis.
• Atypical presentations, such as plaquelike staphylococcal folliculitis, are also reported.
• Rare conditions, such as ecthyma gangrenosum as a result of infection by Pseudomonas aeruginosa, are also noted. In this disorder, hemorrhagic necrotic bullae that eventually form a black eschar manifest primarily on the extremities and the gluteal and perineal regions.
• Bacillary angiomatosis caused by Bartonella henselae and Bartonella quintana is rare in children but has been reported.⁸ Bacillary angiomatosis is considered by some to be an AIDS-defining opportunistic infection, typically seen with a CD4⁺ count less than 200 cells/m L. Clinically and histologically, the lesions often resemble pyogenic granulomas and Kaposi sarcoma. They often begin as pinpoint papules, which enlarge to become red nodules and usually involve the face or the upper torso. In addition to the cutaneous findings, these patients may have lymphadenopathy, abdominal symptoms, anemia, and an elevated alkaline phosphatase level.
• Mycobacterial infections caused by Mycobacterium tuberculosis and Mycobacterium avium are increasing in incidence in children who are HIV positive.
• Children who are HIV positive and have tuberculosis are usually extremely sick. Usually, pulmonary disease is present, but extrapulmonary findings can also occur.
• Acute pustular eruptions, widespread keratotic papules with hyperkeratotic palms and soles, tuberculous lymphadenitis, purple necrotic lesions, and ulcerations have been reported in patients who are HIV positive and have mycobacterial infections.
• Mycobacterium haemophilum often causes disseminated infection in patients with AIDS. Diffuse swelling and induration of the periarticular soft tissue and nodular formation are reported in patients infected with M haemophilum.
• Pneumocystis carinii pneumonia is the primary AIDS-defining illness and occurs in 7-20% of patients who have not been administered prophylaxis and are younger than 1 year. Most commonly, P carinii pneumonia manifests with cough, dyspnea, tachypnea, and fever. The incidence of P carinii pneumonia is declining in areas where AIDS medications are available, but it continues to shorten life expectancy in areas in which access to antiretrovirals is limited.
• Scabies in children infected with HIV may progress from a widespread pruritic papular eruption to a crusted variant as the CD4⁺ count decreases. This crusted (Norwegian) variant is characterized by an extremely high mite count and thus is very contagious. Secondary bacterial infection may complicate crusted scabies.
• In regions of the world where measles vaccination is not routinely administered and where HIV is endemic, the potential for serious measles infection exists.⁹ Measles typically manifests with an erythematous macular eruption of the trunk with caudal spread. Koplik spots (small blue-white dots surrounded by erythematous rings on the buccal mucosa) are the most common oral manifestation seen. In children who are immunocompromised, measles may manifest without skin involvement but with more severe complications.
• Death from pneumonitis and encephalitis has been reported in African children with both HIV infection and measles.
• Noma (cancrum oris) is a necrotic disease of tissues of the mouth.¹⁰ This disease quickly spreads to surrounding bone and soft tissue and is often associated with immunodeficient states, such as AIDS. Noma predominately occurs in young children from sub-Saharan Africa and is often associated with measles.
• Seborrheic dermatitis may be a manifestation of HIV in children who present outside of the usual neonatal and adolescent timeframes or who present with generalized disease. An association between Pityrosporum orbiculare growth in the presence of waning CD4⁺ cells and Langerhans cells has been postulated.
• The eczematous periorofacial eruption of acrodermatitis enteropathica caused by nutritional deficiency of zinc, secondary to diarrhea-induced malabsorption, has been reported. Other vitamin deficiencies can also be expected because of poor oral intake or diarrhea.
• Metabolic abnormalities have been reported in association with pediatric HIV disease. Lipodystrophy associated with insulin resistance and dyslipidemia occurs in children who are HIV positive (similar to adults who are HIV positive) and may be attributed to highly active antiretroviral therapy, although individual variations may make certain children more susceptible.¹¹ See also Lipodystrophy, HIV. Variations in presentation include peripheral lipoatrophy, truncal lipohypertrophy, and combined versions of these presentations. A more severe presentation occurs at puberty. Thyroid abnormalities with hypothyroidism have also occurred in children infected perinatally.¹²
• A variety of skin conditions, including exaggerated eczema, psoriasis, drug eruptions (including morbilliform eruptions and Stevens-Johnson syndrome), intense reactions to arthropod bites,¹³ alopecia, and trichomegaly, have been reported in children who are HIV positive. Children with HIV infection are at risk for child abuse because of family stressors; therefore, unusual skin lesions should be evaluated for potential signs of exogenous injury.
• A higher incidence of neoplasia is noted in children with HIV infection than in noninfected children.
• B-cell lymphoproliferative diseases, including non-Hodgkin lymphoma, Burkitt lymphoma, and smooth muscle tumors, have been identified.
• The prevalence of HIV-associated malignancies has been reported to be as high as 2%. A 2005 evaluation of 2969 pediatric patients with AIDS in the United States from 1993-2003 revealed that the incidence of malignancy is 1.56 cases per 1000 person-years, a number lower than European counterparts but significantly higher than noninfected children.
• Kaposi sarcoma is unusual in children; however, an African study has shown the childhood incidence of Kaposi sarcoma has risen more than 40-fold in the years after AIDS. Previously thought to only occur in males, it has been reported in both males and females born to mothers who are infected with HIV in high-risk groups for Kaposi sarcoma or in children infected postnatally by blood products. The most common sites of AIDS-related Kaposi sarcoma in children are the orofacial and the inguinal or genital regions

High Blood Pressure in Pregnancy

What Is High Blood Pressure?
Blood pressure is the amount of force exerted by the blood against the walls of the arteries. A person's blood pressure is considered high when the readings are greater than 140 mm Hg systolic (the top number in the blood pressure reading) or 90 mm Hg diastolic (the bottom number). In general, high blood pressure, or hypertension, contributes to the development of coronary heart disease, stroke, heart failure and kidney disease.

What Are the Effects of High Blood Pressure in Pregnancy?
Although many pregnant women with high blood pressure have healthy babies without serious problems, high blood pressure can be dangerous for both the mother and the fetus. Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure. However, some women develop high blood pressure while they are pregnant (often called gestational hypertension).

The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother develops preeclampsia--or "toxemia of pregnancy"--which can threaten the lives of both the mother and the fetus.

What Is Preeclampsia?
Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia--the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth.

There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The only way to "cure" preeclampsia is to deliver the baby.

How Common Are High Blood Pressure and Preeclampsia in Pregnancy?
High blood pressure problems occur in 6 percent to 8 percent of all pregnancies in the U.S., about 70 percent of which are first-time pregnancies. In 1998, more than 146,320 cases of preeclampsia alone were diagnosed.

Although the proportion of pregnancies with gestational hypertension and eclampsia has remained about the same in the U.S. over the past decade, the rate of preeclampsia has increased by nearly one-third. This increase is due in part to a rise in the numbers of older mothers and of multiple births, where preeclampsia occurs more frequently. For example, in 1998 birth rates among women ages 30 to 44 and the number of births to women ages 45 and older were at the highest levels in 3 decades, according to the National Center for Health Statistics. Furthermore, between 1980 and 1998, rates of twin births increased about 50 percent overall and 1,000 percent among women ages 45 to 49; rates of triplet and other higher-order multiple births jumped more than 400 percent overall, and 1,000 percent among women in their 40s.

Who Is More Likely to Develop Preeclampsia?

• Women with chronic hypertension (high blood pressure before becoming pregnant).
  
• Women who developed high blood pressure or preeclampsia during a previous pregnancy, especially if these conditions occurred early in the pregnancy.
  
• Women who are obese prior to pregnancy.
  
• Pregnant women under the age of 20 or over the age of 40.
  
• Women who are pregnant with more than one baby.
  
• Women with diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma.
  

How Is Preeclampsia Detected?
Unfortunately, there is no single test to predict or diagnose preeclampsia. Key signs are increased blood pressure and protein in the urine (proteinuria). Other symptoms that seem to occur with preeclampsia include persistent headaches, blurred vision or sensitivity to light, and abdominal pain.

All of these sensations can be caused by other disorders; they can also occur in healthy pregnancies. Regular visits with your doctor help him or her to track your blood pressure and level of protein in your urine, to order and analyze blood tests that detect signs of preeclampsia, and to monitor fetal development more closely.

How Can Women with High Blood Pressure Prevent Problems During Pregnancy?
If you are thinking about having a baby and you have high blood pressure, talk first to your doctor or nurse. Taking steps to control your blood pressure before and during pregnancy--and getting regular prenatal care--go a long way toward ensuring your well-being and your baby's health.

Before becoming pregnant:

• Be sure your blood pressure is under control. Lifestyle changes such as limiting your salt intake, participating in regular physical activity, and losing weight if you are overweight can be helpful.
• Discuss with your doctor how hypertension might affect you and your baby during pregnancy, and what you can do to prevent or lessen problems.
• If you take medicines for your blood pressure, ask your doctor whether you should change the amount you take or stop taking them during pregnancy. Experts currently recommend avoiding angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II (AII) receptor antagonists during pregnancy; other blood pressure medications may be OK for you to use. Do not, however, stop or change your medicines unless your doctor tells you to do so.

While you are pregnant:

• Obtain regular prenatal medical care.
• Avoid alcohol and tobacco.
• Talk to your doctor about any over-the-counter medications you are taking or are thinking about taking.

Does Hypertension or Preeclampsia During Pregnancy Cause Long-Term Heart and Blood Vessel Problems?
The effects of high blood pressure during pregnancy vary depending on the disorder and other factors. According to the National High Blood Pressure Education Program (NHBPEP), preeclampsia does not in general increase a woman's risk for developing chronic hypertension or other heart-related problems. The NHBPEP also reports that in women with normal blood pressure who develop preeclampsia after the 20th week of their first pregnancy, short-term complications--including increased blood pressure--usually go away within about 6 weeks after delivery.

Some women, however, may be more likely to develop high blood pressure or other heart disease later in life. More research is needed to determine the long-term health effects of hypertensive disorders in pregnancy and to develop better methods for identifying, diagnosing, and treating women at risk for these conditions.

Even though high blood pressure and related disorders during pregnancy can be serious, most women with high blood pressure and those who develop preeclampsia have successful pregnancies. Obtaining early and regular prenatal care is the most important thing you can do for you and your baby.

The Benefits of Yoga

Yoga benefits the body, mind and spirit. In recent years, yoga has worked its way into the mainstream health and fitness programs because people have begun to understand the benefits that those who practice it gain. When practiced regularly it can make a measured difference in a person’s physical, mental and spiritual health.

The physical benefits of yoga are outstanding. It’s been shown that yoga can:

• Increase muscle, joint and tendon flexibility

• Tone and strengthen muscles

• Increase cardiovascular efficiency

• Decrease blood pressure

• Increase respiratory functions

• Improve eye-hand coordination

• Improve posture

• Improve balance

• Increase energy levels

• Lower weight

• Increase endurance

• Eliminate toxins from the body

• Heal damaged muscles

• Limit the effects of diabetes, digestive orders, arthritis, asthma and heart conditions and decrease dependence on drugs for these problems

• Manage pain

• Reduce anxiety

• Increased stamina

• Slow the aging process

• Improve the immune system

One of the most impressive physical benefits of yoga that many people report having is an increased awareness of their bodies and when their bodies aren’t performing as they should. They can actually sense when a health problem is beginning. This allows them to start treating the problem before it goes any further, preempting many serious illnesses.

Yoga not only contributes to physical health; with regular practice it also can improve mental health. Practitioners of yoga have reported the benefits for centuries, and recently the scientific community has begun to research and confirm what has always been believed. The psychological benefits of yoga can include:

• Mental clarity

• Stress reduction

• Emotional groundedness

• Increased body awareness

• A relaxed mind

• Improved ability to pay attention, concentrate and retain information

• A countering effect to the feelings of depression or helplessness

• Increased brain activity including an improved communication between the left side of the brain and the right side of the brain

• Positive changes in mood

• Positive change sin vitality and energy

• An increased sex drive and a healthier view of sex

• Pride in taking care of the body

• Kinesthetic awareness

• A decrease in hostility and anger

• Increased social skills

• A feeling of being refreshed immediately after yoga – as if just waking from a good nap

On the spiritual level, many who practice yoga also report benefits. Some of the spiritual benefits believed to come from yoga are:

· A greater awareness of nature and a person’s connection to nature

· A feeling of being at one with the universe

· An awareness of how the yoga practitioner’s life affects the lives around him

· A sense of peace

· Enjoyment of oneself

· Enjoyment of life

· Awaking of the energy within oneself

· A connection with the soul

· An awareness of the Life Force

It’s easy to see how the three areas that benefit from the practice of yoga – body, mind and spirit – can intertwine. When the three areas are working together in harmony, the benefits of yoga increase. Because of the effects that yoga has, there is much that a person can accomplish that he may not be able to if not for yoga.

For instance, many people report that practicing yoga has helped them with smoking cessation. When the body is less stressed, when there is an increased awareness of the body, when there is an emotional groundedness and when there is sense of peace, it is easier to resist the pull of a cigarette or many other addictive habits. The practice of yoga can change much in person’s life.

Medical Weight Loss Tips

Medical weight loss is defined as a weight management program that is developed and monitored by a medical professional, either a family doctor or specialist physician. In medical weight loss, the therapeutic program is approached as a doctor would for any disease and the management is based on individual factors. Obesity is classified as a disease and is one of the leading causes of heart disease in developed nations. Obesity is curable and in many cases it does not require lifelong medical attention.

Watermelon Health Benefits

Nothing tastes as good as a slice of watermelon on a hot summer day. The sweet and watery flesh of the watermelon can quench your thirst, as a considerable part of this fruit consists of water. But apart from its thirst quenching quality, watermelon is very rich in nutrients and offers numerous health benefits as well. The nutritional value and health benefits of watermelon is not limited to its juicy flesh, but even the seeds and the rind are very rich in vitamins and minerals. Roasted watermelon seeds are used as snacks, whereas the rind is pickled or stir fried by some people. Scroll down to know more about watermelon health properties.

Watermelon Nutritional Value

As mentioned earlier, watermelon contains a good amount of water, which makes it very low in calories. This fruit is rich in vitamin A and vitamin C. Small amounts of vitamin B1, vitamin B2, vitamin B6, folate, niacin, etc. are also found in watermelon. It is very rich in potassium and also contains minerals like iron, calcium, magnesium, and phosphorous in traces. Watermelon is also free of fats and cholesterol. Apart from the vitamins and minerals, there are many components in this fruit which are also responsible for the health benefits of watermelon. It is rich in antioxidants called carotenoids, like lycopene, phytofluene, phytoene, beta-carotene, lutein, and neurosporene. Watermelon seeds contain a good quantity of protein and oil. Around 35% of watermelon seed is protein and 50% is oil, along with 5% of dietary fiber. These seeds also contain minerals like magnesium, calcium, potassium, iron, phosphorous, zinc, etc. This was, in short, a little about the nutritional facts about watermelon. The following is some information about watermelon health effects, or the benefits of watermelon on human health.

Watermelon Health Benefits

The health benefits of watermelon are mainly based on its nutritional value and presence of other components, like carotenoids. These nutrients offer various health benefits, which include preventing and fighting various diseases. Let us take a look at some of the important watermelon health facts.

Prevents Heart Attack and Stroke
Watermelon are rich in antioxidants like vitamin C, vitamin A (mainly in the form of beta carotene) and carotenoid lycopene. Antioxidants neutralize the free radicals in the body. Free radicals are the primary causes of heart attacks and strokes. Vitamin C and beta carotene fight free radicals and reduce the risk of diseases, like, heart attack, stroke, etc. Antioxidants also reduce cholesterol, which apart from causing heart related problems, can worsen other diseases too. Read more on heart attacks.

Reduces the Risk of Cancer
Watermelon is rich is antioxidants, called carotenoids, especially lycopene. Studies show that lycopene is beneficial in preventing some forms of cancer, like, breast cancer, prostrate cancer, endometrial cancer, lung cancer and colorectal cancers. Lycopene is an antioxidant, which can protect the genetic material of white blood cells and also prevents oxygen damage in cells and other structures, which has been found to be linked to the occurrence of cancer in humans.

Boosts Energy Production
We all know that B vitamins are essential for energy production in the body. Watermelon, being rich in B vitamins, can provide you with important B vitamins like Vitamin B1, vitamin B2 and vitamin B6. Apart from that it prevents dehydration, due to the high water content. Read more on vitamin B.
Apart from the above said watermelon health benefits, this fruit is beneficial in preventing macular degeneration, which is one of the main causes for the loss of vision in elderly persons. Watermelon contains a good amount of an amino acid called citrulline, which is used by the human body to produce another amino acid called arginine. It has been found that arginine can prevent erectile dysfunction, lower blood pressure, and improve insulin sensitivity in type 2 diabetic patients. Above all, it can help you to lose weight. As it is high in water content and low in fat and calories, this fruit can fill your stomach, but is non fattening. These watermelon health benefits make it a perfect fruit for human consumption. Use fresh watermelon to reap the health benefits offered by this fruit. Prefer watermelons kept at room temperature to those kept in the refrigerator, as the former has more nutrients than the latter.

Accurately Identifies Skin Cancer

High-frequency ultrasound with elastography can help differentiate between cancerous and benign skin conditions, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

"High-frequency ultrasound with elastography has the potential to improve the efficiency of skin cancer diagnosis," said lead author Eliot L. Siegel, M.D., vice chairman of the Department of Radiology at the University of Maryland School of Medicine (UMSM) in Baltimore. "It successfully delineated the extent of lesions and was able to provide measurable differentiation among a variety of benign and malignant lesions."

There are more than one million cases of skin cancer diagnosed in the U.S. every year, according to the American Cancer Society. Melanoma, the most serious type of skin cancer, will account for about 68,720 cases of skin cancer and 11,590 deaths in 2009, despite the fact that with early detection it is highly curable.

Suspicious skin lesions are typically diagnosed by dermatologists and biopsied based on their surface appearance and characteristics. Unfortunately, even to experienced dermatologists, benign and malignant lesions often appear similar visually and on physical examination, and some malignant lesions may have a benign appearance, especially in their early stages. It is not uncommon for patients to have one or more lesions that appear concerning.

"Dermatologists tend to biopsy any lesions that seem visually suspicious for disease," said coauthor Bahar Dasgeb, M.D., from the Department of Dermatology at Wayne State University in Detroit and Pinkus Dermatopathology Lab in Monroe, Michigan. "Consequently, many benign lesions are needlessly biopsied in order to avoid the risk of missing a potentially deadly melanoma."

Elastography was found to distinguish between benign and malignant lesions not by their visible appearance but by measuring their elasticity or stiffness. Since malignancies are stiffer than benign growths, elastography, when added to high-frequency ultrasound imaging of the skin, has potential to improve the accuracy of traditional clinical diagnosis of skin cancers and, in some cases, eliminate unnecessary biopsies of benign skin lesions. The procedure is noninvasive, convenient and inexpensive.

For the study, researchers used an ultra high-frequency ultrasound system to image 40 patients with a variety of malignant and nonmalignant, or benign, skin lesions. Malignant tumors included squamous cell carcinoma, basal cell carcinoma and melanoma. Benign lesions included dermatofibroma, a noncancerous growth containing scar tissue, and lipoma, a noncancerous tumor composed of fatty tissue.

The researchers calculated the ratio of elasticity between normal skin and the adjacent skin lesion, and used laboratory analysis to confirm their diagnoses. Cystic lesions, which are not malignant, demonstrated high levels of elasticity, while malignant lesions were significantly less elastic. The elasticity ratio of normal skin to the various skin lesions ranged from 0.04 to 0.3 for cystic skin lesions to above 10.0 for malignant lesions.

In addition, high-frequency ultrasound with elastography allows for accurate characterization of the extent and depth of the lesion below the surface, which can aid physicians in treatment.

"The visualized portion of a skin lesion can be just the tip of the iceberg, and most dermatologists operate 'blindly' beyond what they can see on the surface," Dr. Siegel said. "High-frequency ultrasound provides almost microscopic resolution and enables us to get size, shape and extent of the lesion prior to biopsy."