HIV / AIDS

What are HIV and AIDS?
Over the last fifteen years a new disease spread by a family of viruses, HIV, has spread globally. HIV stands for Human lmmuno-deficiency Virus. HIV has been given this name because its long-term effect is to attack the immune system of the body, making it weak and deficient. We live virtually in a sea of microorganisms and at every moment an enormous number of them are entering our body. It is the immune system that normally fights off these microorganisms and keeps us healthy. Any compromise with the working of the immune system has profound effect on our body.

After about 5 to 10 years of contracting the HIV infection, the virus has weakened the immune system of the patients so much that they develop a number of different illnesses such as tuberculosis, pneumonia, persistent diarrhea, fever and skin infections. This condition is called AIDS Acquired Immune Deficiency Syndrome.

Why do you need to know about it?
At the moment it is estimated that 13 million people in the world may have HIV. Every day there are thousands of new cases of HIV infections in the world and these occur in every country. People who have HIV may have no symptoms for many years, and infected people may not even be aware that they have the virus. They look and feel well, but can infect other people during this time.

The most difficult aspect of HIV/AIDS is that though there are medicines, which can help them, cope with these illnesses, there is no vaccine, and no cure for the HIV, so almost all the infected people become more and more ill and eventually die. It is important that we all know and understand about this infection, so we can protect ourselves and our families.

We have responsibility not only towards ourselves but also towards our children who are growing up in a very different world from that of our childhood. They will have many new opportunities, but also may sometimes be faced with new relationships, standards of behavior and new risks. It is up to us to explain the truth of the situation to them in an honest and informed way, so they may have the knowledge to take the necessary steps to protect their health.

We have to understand that presently prevention is the only cure of HIV/AIDS and that can come about only if we are adequately informed about it. Following are some frequently asked questions about HIV/AIDS:

How does HIV affect the body? Is it the same as AIDS?
When HIV gets into a persons blood it attaches itself to a special type of white blood cells called as helper T-Lymphocytes. These Helper T- cells are crucial in defending the body against many infections. during all this the persons have no symptoms at all. They look and feel well. They may not know they now have the virus, but could pass it on to someone else through having sex, or by sharing needles or syringes.


Being HIV Positive is not the same as having AIDS. The HIV actually goes inside the white blood cells and lies their quietly. After about 5 to 10 years the HIV virus tricks the cell to start making the viral proteins, this results in the formation of a huge number of viral particles inside the white cells and eventually the cells burst releasing thousands of new viruses in the blood. The released viruses infecting new white cells This cycle goes on and on, and eventually the immune system of the body is overwhelmed and is no longer capable of fighting the infections.

Eventually the infected person may lose weight and become ill with diseases like persistent severe diarrhea, fever, or pneumonia, or skin cancer. He or she has now developed AIDS. People with AIDS can be helped with medicines for the different infections. At the moment though, in spite of much research, there is no cure for HIV or for AIDS and so, sadly, it is almost certain that people diagnosed with AIDS will die.

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Introduction to sexually transmitted diseases

What are sexually transmitted diseases?
Sexually transmitted diseases (STDs) are diseases that can spread from one person to another by sexual contact. STDs can cause pain, and some can cause infertility and even death if not treated. Some common curable STDs are gonorrhea, trichomoniasis, chlamydial infection, syphilis and HIV/AIDS.
Each year there are more than 333 million new cases of curable STDs, one million new cases of HIV infection, and millions of other viral STDs such as herpes and hepatitis B.

How can sexually transmitted diseases be contracted?
By definition STD’s are diseases contracted during sexual contact but the important thing to keep in mind is that as far sexual contacts, as far as STDs are concerned includes, more than just sexual intercourse (vaginal and anal). Kissing, oral-genital contact, and the use of sexual "toys," such as vibrators too can cause STDs.

What can be done to prevent STDs?
People can avoid STDs by changing their sexual behavior. They can follow any of the ABCs:

a. Abstain from sex -This is the only guaranteed protection.

b. Be mutually faithful -Always have sex with the same person. This person must not have sex with any other person and must not have a STD.

Important: You cannot usually tell whether a person has a STD. Just by looking at him or her. People with STDs, including HIV, usually do not look sick.

c. Consistently use condoms -Use them every time and use them correctly. To prevent STDs, people at risk should use condoms even when they use another family planning method. If a woman’s sex partner is not willing to use to use condoms, she should try to use spermicide. It is important to note that spermicides do not stop HIV/AIDS. The diaphragm and cervical cap may also help prevent some STDs.


Are all STD’s treatable?
Most STDs are treatable. However, even the once easily cured gonorrhea has become resistant to many of the older traditional antibiotics. Other STDs, such as herpes, AIDS, and genital warts, all of which are caused by viruses, have no cure. Some of these infections are very uncomfortable, while others can be deadly.

Getting Treated
Many STDs can be treated and cured, especially in their early stages. Some, such as HIV and herpes, cannot be cured, but sometimes their effects can be stopped for a time.
Prevention is better than cure. Especially since, sometimes scarring or infertility can follow.
A person who thinks he or she may have STD should:

1. Get diagnosed and treated immediately.
   
   
2. Take all of the medicine according to instructions, even if the symptoms go away. The medicines can cause some side effects, such as vomiting, diarrhea, or rash. If any of these side effects occurs and is severe, the person must return to the clinic that provided the medicine. All of the medicine must be taken for a lasting cure.
   
   
3. Avoid sex with anyone until three days after the treatment is finished and all symptoms are gone.
   
   
4. Tell his or her sex partner or partners so that they get treated too. Unless all sex partners are treated at the same time, they may infect each other again and again. It is especially important for a man to tell a woman. This is because many women do not have symptoms until the STD has reached a more serious stage.

If friends have symptoms, urge them to seek care. Urge them use condoms and/or spermicide and to see a health care provider for a check up. There really is no such thing as "safe" sex. The only truly safe sex is abstinence. Sex in the context of a monogamous relationship wherein neither party is infected with a STD is also considered "safe". Most people think that kissing is a safe activity. Unfortunately, syphilis, herpes, and other diseases can be contracted through this relatively simple and apparently harmless act. All other forms of sexual contact carry some risk. Condoms are commonly thought to protect against STDs. Condoms are useful in preventing certain diseases, such as herpes and gonorrhea. However, they do not fully protect against other diseases such as genital warts, syphilis and AIDS.

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Infertility

Infertility is defined as the failure to become pregnant after one year of unprotected intercourse. There are two types of infertility; Primary infertility, which is infertility without any previous pregnancy; and secondary infertility, when there has been a previous pregnancy.

What are the causes of infertility?
A basic infertility evaluation is carried out to find out the cause of infertility.

Common causes of infertility are:

1. Ovulation problems
2. Tubal causes
3. Sperm causes
4. Unexplained infertility
5. Age-related factors

Some less common causes are:

1. Uterine problems
2. Endometriosis
3. Previous tubal ligation
4. Previous vasectomy
5. Various drugs
6. Cervical factors

When to see your doctor?
Though there is no specific time frame as to when to consult your doctor but you can see your doctor if the pregnancy does not take place even after one year of unprotected intercourse.

You might want to wait a little longer if you are in your twenties but if both of the partners are in mid or late thirties then the advice will be to seek professional help.

Age of the female is an important factor for if she has crossed 35 or is near to it then it is advisable to seek help at the earliest.

Is it correct that the female partner is responsible for infertility?
No, male factors account for up to 40 percent of infertility problems.

How would the doctor go about it?
The first diagnostic step is the evaluation of the infertile couple and to determine which partner is infertile.

Normally the steps of a basic infertility evaluation would include:

1. History:
   Taking a thorough medical history including any other medical conditions you might be having, any history of drug intake, and any other obstetric or gynaecological problems that you may have.
   
   
2. Physical examination
   A thorough physical examination.
   
   
3. Blood tests
   Depending on the individual couple’s situation, various blood tests on either the female or the male may be needed. They can include testing for the levels of various sex hormones.
   
   
4. Taking a sample of semen and doing a semen analysis
   
   
5. Finding out if the woman is ovulating or not (i.e. producing egg in every menstrual cycle)
   
   
6. Hysterosalpingogram
   This test is done in order to assess the anatomy of the cavity of the uterus and the fallopian tubes.
   
   
7. Laparoscopy
   May be required after basic tests have been done. The surgeon looks inside the abdomen through an endoscope to look for any deformities of the tubes or for endometriosis.
   
   

What if they still can’t find the problem?
There are known cases of ‘unexplained infertility’ i.e. cases in which standard testing has not found a cause for infertility

Treatment for unexplained Infertility
This can include a combination of the following modalities

1. Ovarian stimulation
   -by drugs such as ‘clomiphene citrate’
   -using hormonal injections plus intercourse
   
   
2. Assisted reproductive technologies as treatment for unexplained infertility
   In vitro fertilization (IVF)
   
   
3. Gamete intra-fallopian transfer (GIFT)
   In GIFT a mixture of sperm and eggs are introduced into the end of the fallopian tube at laproscopy.

What is the success rate of these advanced procedures?
Although pregnancy rates vary from center to center on the specific technique used but generally a 30% success rate can be expected.

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Breast Cancer

Breast cancer is the one of the commonest malignancies afflicting women. In some parts it is the most common malignancy. It is currently estimated that one in 14 of all female children born will develop breast cancer in their lifetime.

Breast cancer causes:
Despite extensive investigation into the cause of breast cancer there is still no known cause. However, a combination of environmental factors and genetic mutations are thought to be responsible for this cancer. In familial breast cancers, a molecular change in the genes BRCA1 and BRCA2 play a major role in the onset of the disease.

Breast Cancer Types
Breast cancer is mainly of two types:

• Ductal carcinoma- occurs in milk ducts
• Lobular carcinoma- occurs in the milk secreting breast lobules

Categorically breast cancer can also be divided into following types:

• In-situ breast cancer- cancer cells remains confined within their place of origin and do not attack surrounding breast tissue.
• Invasive or metastatic breast cancer- cancer cells break free of their place of origin, and spread to different parts of the body.

Like all cancer types, breast cancer also progresses through different stages. Breast cancer stages are based on the size of the breast lump or tumor, whether the cancer is in-situ type or malignant, and whether the cancer has spread beyond the breast tissue.

Breast Cancer Symptoms
Following abnormalities in the breast anatomy are suggestive breast cancer symptoms:

• Unusual swelling of all or one specific part of the breast
• Continuous skin irritation or dimpling
• Persisting pain in breast
• Persisting nipple pain or inversion of nipple
• Inflammation or thickening of the nipple or breast skin
• An unusual discharge from the nipple other than breast milk
• Lump in the underarm area

What are the risk factors for breast cancer?
The exact cause of breast cancer is not known and most likely involves many factors:

Geographical: It is much more common in the western world.

Gender: Women are a hundred times more likely to have breast cancer as compared to men.

Age: Breast cancer risk increases with age. 16% of women aged between 40-60 years have breast-related problems, and complain of breast lumps. In most of the cases, these breast lumps may carry a potential breast cancer risk.

Genetic: A family history of breast cancer will increase the risk of developing breast cancer in a woman by three to five times. Recently, a breast cancer gene (BR CA 1) has been identified. If a woman has this gene present in her chromosomes, there is an 85% chance of developing either breast or ovarian cancer, or both in her lifetime.

Hormonal: It appears to be more common in women who did not bear children. It is also less common in women who have their first child at early age.

Women who started their menstrual periods before age 12, those who delayed menopause until after age 55, and those who had their first pregnancy after age 30 have a mildly increased risk of developing breast cancer (less than two times the normal risk).

Fitness levels and life style related factors such as smoking are also some of the most commonly known breast cancer risk factors that can be checked.

Breast Cancer Prevention:
Cancer prevention though a very ambiguous concept due to their molecular cause of origin, can be achieved through small but effective changes made to lifestyle:

• Restricted alcohol consumption
• Maintaining a healthy body weight
• Inclusion of limited fat in diet
• Regular exercise
• Avoiding unnecessary consumption of antibiotics
• Reverting to organic food free of pesticides

Besides, long-tern hormone therapy may also undermine breast cancer. But screening is by far the best breast cancer prevention method.

What factors have a protective effect?
Pregnancy and breast feeding have a protective effect in preventing breast cancer.

How is breast cancer diagnosed?

Screening:
The prognosis of breast cancer is closely related to the stage of disease at the time of diagnosis, therefore screening for breast cancer is extremely important. Numerous studies have confirmed that populations which get screened for breast cancer yield patients having much smaller tumors with much better prognosis. Currently, mammography and breast examination serve as the foundation in screening for breast cancer. Mammography is an x-ray examination of the breast. It has the ability to detect a cancer in the breast when it is quite small, long before it may be felt by breast examination. Eighty-five to 90% of all breast cancers are detectable by mammography. Approximately 10 to 15 percent of breast cancers are not visible on mammography, but can be felt on physical examination of the breast.

The importance of Breast Self Examination cannot be overstressed. A percentage of breast cancers is not seen on mammography and it is extremely important for a woman to perform Breast Self Examinations.

Currently, it is recommended that a woman should have a baseline mammogram between the ages of 35 and 40 years. Between 40 and 50 years of age mammograms are recommended every other year. After age 50 years, yearly mammograms are recommended at womens health care centers.

Other diagnostic tests and procedures:
Ultrasound: An ultrasound is a test that uses sound waves to visualize structures inside the body. It is often used to distinguish between cysts and solid tumors in the breast. Fluid within cysts can be aspirated (withdrawn with a needle and syringe) for analysis in the laboratory.

Biopsy: It is a procedure which involves removal of a piece of tissue to analyze under the microscope. Biopsy still remains the only confirmatory test for breast cancer. If an area of the breast is suspicious for a cancer, a biopsy is usually performed to confirm or deny the diagnosis.

Breast Cancer Treatment:
In recent years, there has been an overwhelming explosion of life-saving treatment advances against breast cancer. So, once breast cancer is detected, one should go for the following treatment options:

• Surgery
• Radiation
• Surgery followed by Radiation
• Chemotherapy
• Combined Therapy
• Adjuvant and Neoadjuvant Therapy for Breast Cancer
• Hormonal Therapy - Aromatase Inhibitors
• Targeted Therapies
• Complimentary and Holistic Medicines
• Angiogenesis Inhibitors Therapy

Breast Cancer Awareness:
A pink ribbon is universally accepted as the emblem of breast cancer awareness campaign. It denotes the struggle of the breast cancer patients. It was in 1996, when the pink and the blue ribbon was first designed to create awareness of the fact that "Men Get Breast Cancer Too!”

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Breast Feeding

Breast feeding practice is followed everywhere in India, except among higher socio- economic groups, who tend to look for alternatives to breast-feeding. Ignorance of the advantages of breast-feeding and the proper method often leads to discontinuation in most cases.

Basic Facts:

1. The ability of the breasts to produce milk diminishes soon after childbirth, without the stimulation of breast-feeding.
2. The immunity factors in breast milk can help the body fight off infections.
3. Breast milk contains vitamins, minerals and enzymes, which aid the baby’s digestion.
4. Breast and formula feeding can be used together.

Advantages of breast-feeding.

1. It is the simplest way to feed the baby.
2. It increases the period of lactation amenonhoes after childbirth.
3. Breast milk also contains infection-fighting anti-bodies from the mother.
4. Breast feeding in the initial 4- months of the baby’s life reduces the chances of infection and increases the immunity of the baby.
5. The amino acids in breast milk, the building blocks of proteins, are well balanced for the baby. These proteins best aid the baby’s intestinal tract.
6. The emotional bonding between the baby and mother is strengthened & gives a feeling of satisfaction and achievement to the mother.
7. It is much cheaper than artificial feeding.

The baby should be put to the breast as soon as possible after birth. The initial yellowish and thick fluid (colostrum) is rich in proteins and protective antibodies. The practice of giving ghutti should be discouraged, because the nourishment of the baby is delayed, increasing chances of infection and delaying the stimulation for milk production.

Some important points:

1. The mother should sit in a comfortable position, hold the baby in her arms and offer the baby her whole breast & not just the nipple.
   
   
2. The baby should be fed from a different breast each time so that both breasts produce the maximum amount of milk.
   
   
3. The baby should be fed, whenever she is hungry. Before offering the second breast to the baby, it should be ensured that the baby sucks the fat rich hind milk from the first breast.
   
   
4. A daily bath is sufficient to keep the breasts clean.
   
   
5. Frequent cleaning with soap removes the natural oils from the breasts, predisposing the nipples to develop fissures.
   
   
6. Burping the baby after every feed by holding her against the shoulder is advisable.
   
   
7. A mother who is feeding her baby should eat healthy foods to keep up her strength & feed the baby letter.
   
   
8. At times the breasts may feel hot, heavy and hard, due to accumulation of milk.
   
   
9. The mother should be encouraged to let the baby continue to suck for as long as possible.
   
   
10. If still enough milk is not removed, the milk should be squeezed out in a clear (preferably) boiled cup using the thumb and the finger.
    
    
11. A warm compress on the breast or a warm bath is also helpful.
    
    
12. It the baby is fed frequently both during the day and night this condition (engoryememt of breast) is uncommon.
    
    
13. If nipples are cracked and painful, the mother is advised to leave a drop of hind milk on, the nipple after feeding as this helps in healing. Malai can also be can applied.

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Premenstrual Syndrome

DEFINITION
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. It is characterized by premenstrual discomfort in the lower abdomen and back, and in the breasts. All these features precede the period by a week or ten days. Fortunately, a woman obtains relief when her menstrual period begins. Another feature of PMS is a symptom-free time for several days every month, in the first half of the menstrual cycle.

Features: these include physical features like acne, backache, bloating, sore breasts, and headache. Emotional symptoms might include changes in sexual desire, difficulty concentrating, irritability.

Women may gain upto a kg. of weight or more in the latter part of the menstrual cycle due to water retention in the body. Emotional stress often contributes to the symptoms.

The only saving grace in this problem is that few women experience all these symptoms! Most have a few that recur each month.

The symptoms of certain medical conditions can resemble PMS. These conditions include allergies, depression, diabetes, dysmenorrhea (painful periods), endometriosis, fibrocystic breast disease, and thyroid problems.

CAUSES
There's still some disagreement about what causes PMS, but it definitely seems to be linked to hormones. A relative lack of the hormone progesterone is suspected along with increase in a water retaining substance called anti diuretic hormone.

TREATMENT
The assessment of the emotional and work related stress is very important. Many women find that a balanced diet and healthy snacks are helpful, as are avoiding caffeine and reducing salt intake. Simple reassurance often does wonders, but often it is necessary to treat the symptoms with various drugs
Diuretics ("water pills") can reduce bloating
Analgesics like ibuprofen, aspirin ease headache or cramps
Combined oral contraceptives also called the birth control pill may be useful for some women.
Evening primrose oil (gamma linolenic acid) is also used widely these days.

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Pregnancy

Symptoms of Pregnancy
For a woman having a regular monthly cycle, the earliest and most reliable sign of pregnancy is a missed period, or sometimes women who are pregnant have a very light period, losing only a little blood. However, symptoms of pregnancy are very obvious, and keep changing with the pregnancy calendar. Some of the most important pregnancy symptoms are:

• Feeling sick, not necessarily in the morning, but at any time.
• The breasts may become larger and tender. Veins may become prominent and nipples may darken and stand out.
• Increased frequency in passing urine.
• Tendency for constipation.
• Tiredness.
• An increased vaginal discharge without any associated complaint.
• A metallic taste in the mouth.
• Dislike for certain things like tea or coffee or fatty foods.
• Increased liking for certain things like spicy foods.

Pregnancy test can be carried out on urine samples, as early as from the first day of a missed period-that is, about fourteen days after the conception.

A positive pregnancy test result is almost definitive of pregnancy. If the test is negative, it is less reliable. It can be repeated after a week, or a doctor can be consulted.

What you should eat?
Pregnancy puts additional nutritional demands on your body. You require to eat judiciously to meet the demands of the body. Make sure that you eat a mixture of different foods each day in order to get all the various nutrients that you and your baby need during pregnancy.

Your diet should have plenty of fruit and vegetables which provide vitamins, minerals and fibre. Eat them lightly cooked or raw. Let starchy foods like bread, potatoes, rice and breakfast cereals with vegetables form the main part of any meal.

Eat some good sources of nutrients like fish, eggs, cheese, beans, and lentils every day during pregnancy. Dairy products like milk, cheese and yogurt are important for women health as they contain calcium and other nutrients needed for your baby's development.

Unusual appetite or excessive food cravings is considered an early sign of pregnancy. But try to avoid sugar and sugary foods like sweets, biscuits and cakes and sugary drinks like cola during the time of pregnancy. Cut down on fat and fatty foods as well.

Mineral and vitamin supplements
A large number of pregnant women suffer from varying degrees of anemia so additional iron supplementation is provided by pills. Also tablets of Folic acid (a vitamin necessary to prevent certain spinal disorders in the growing baby) along with Calcium are generally prescribed by the women's health care providers.

Pregnancy and weight
Weight gain is another one of the most common pregnancy symptoms. Most women gain between 10 -12.5kgs (22 - 28lbs). Weight gain varies a great deal and depends on your weight before pregnancy. Unnatural weight gain, more or less than the average, could be an indicator of a problem and not necessarily one of those obvious signs of pregnancy. So, you must walk up to the nearest women's health clinic and get your weight gain monitored on a regular basis. Also if you weigh more than 100kg or below 50kg, your health care provider may have special advise for you.

Smoking during pregnancy
Try to stop smoking the moment you notice in you the early signs of pregnancy. When you smoke, carbon monoxide and nicotine passes into your lungs and blood stream. This means that: a) your baby gets less oxygen and cannot grow as well as it should, and b) the nicotine makes your baby's heart beat faster. Constantly breathing in other people's smoke may also have a harmful effect during your pregnancy.

Babies of mothers who smoke are, on an average, 200g (about 8 oz) lighter than other babies. These babies may have problems during and after labour and are more prone to infection; it will be better for your baby later too if you stop smoking. Babies born of smoking pregnant women are more likely to suffer from illnesses such as asthma; and there is an increased risk of cot death.

Alcohol
It has now been shown that even small amounts of alcohol can be harmful to your baby. Alcohol has adverse effects on women health as well as on the baby's development, and can produce a lot of anomalies generally termed as 'Fetal Alcohol Syndrome'. So, to be safe, avoid alcohol totally during your pregnancy.

Pills medicines and other drugs
You should be very careful while taking any kind of medication as soon as the signs of pregnancy start showing up. Majority of drugs have adverse effects on the growing fetus, especially in the earlier part of the pregnancy, and the first three months are crucial. You should better go to the nearest women's health center and ask the doctor about any medications you want to take. Make sure your doctor or dentist knows you're pregnant before prescribing anything or giving you any treatment.

At the same time it is important to remember that if you are on treatment for some chronic conditions like epilepsy or diabetes you should consult your doctor and continue your medications because control of such conditions is vitally important for you as well as the pregnancy. This should be done as soon as the pregnancy signs are detected.

Suggested Reading -
Pregnancy and your Feet - "Oh, my aching, swollen feet!" Most pregnant women, already handling so many changes in their bodies, find themselves echoing this complaint amongst other pregnancy symptoms.

Ultrasound Images of Pregnancy - Every would be parent is curious to see how the baby is growing inside the mother. Here are some very good Ultrasound images of a growing fetus.

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Women's Health

The woman's body is wonderfully complex and delicate. However, multiple roles as the mother, daughter, wife, homemaker, wage earner can be physically and mentally quite taxing. As a woman, you might share some common health risks with men, such as heart disease, but because of your special reproductive role, you are also at risk of some distinctly female disorders.

With regards to women health care there are many tips that will help ensure you to take proper care of yourself and leave yourself as healthy and happy as possible. One of the best things that you can do is, start to put yourself first, leaving all the priorities at back. And for proper health and wellness you need to look good to feel good.

It only takes a little more than 10 minutes of physical activity a day to start seeing and feeling the improvements, and to live longer. Any additional activity on top of that is just going to help boost your overall health and maximize your life span.

Drinking a cup of tea a day is one of the best ways of maximizing your life span and to maintain good health. Green tea as well as black tea contain great amounts of caffeines which are responsible for the risk of cancer as well as many forms of heart diseases.

Strong legs are important for women's well-being
Most women in their 70's and 80's tend to decline in their health rapidly because of hip fracture mostly caused when they fall down. Once that happens, the immobilization prevents them from getting their much needed exercise to ensure a healthy lifestyle. This problem can easily be prevented by doing some simple thigh and leg exercises on a daily basis.

This section deals with answers to some common problems like, menstrual disorders, pregnancy, breast feeding etc. Information on Sexually Transmitted Diseases, FAQs for women, and Contraceptives too have been included in this section. 

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