Doctor's office Year 1 no.1 Maturity JAUNDICE It is the yellowing of the skin, eyes and urine.

Jaundice occurs by the release of bilirubin, a pigment that is originating from the decomposition of core heme of hemoglobin of red blood cells. The bilirubin passes through the liver and sec retes bile, which helps digestion. Jaundice in the newborn may be due to the rup ture of red blood cells of children due to an incompatibility with the mother's blood. In severe cases involving the Rh blood factor that needs to be replaced. In mild cases phototherapy in the nursery is sufficient. But the baby can have a severe jaundice because it has biliary atresia, ie, the liver produces bile, bu t as there is to be eliminated into the intestine, leaks into the blood, and usu ally it is necessary to perform surgery. In middle-aged, 40-50 years, the presen ce of jaundice, pain, may be linked to obstruction Bile (canal off of the gallbl adder, where it accumulates in bile). The obstruction usually occurs through the presence of calculi (stones). In the elderly, when the jaundice is more to the green and itching in the body, which appears suddenly, it must be flushed to inv estigate cancer of the pancreas or the gallbladder itself. Hepatitis (liver infl ammation), liver cirrhosis (by alcohol or drugs), contact with rats can cause a disease called leptospirosis (virus) are causes of jaundice. Symptoms Abdominal pain, especially at the time of the liver, right at the top of the abdomen near the ribs. Occurs in cases of cancer, biliary colic by calculation (choledocholit hiasis). White feces, because it lacks pigment and urine is very dark because th ey have excessive pigment. What to do? The great difficulty in some patients is to decide whether the jaundice is of clinical resolution or surgical. Laboratory tests may show whether the lesion is in the intimacy of the liver, the cell, ca used by viruses (hepatitis, leptospirosis etc..), Drugs, alcohol or cirrhosis, o r some external problem, and if you need to do other more invasive examinations such as ultrasound, cholangiography with application of contrast in vein to stud y the mapping of the bile ducts and gallbladder and laparoscopy with biopsy or n ot, when investigating the liver and bile duct through a direct examination with a device with special lenses, introduced in the abdomen . Cirrhosis is the seve nth leading cause of death in the U.S., causing over 25,000 deaths each year. In Brazil, notifies Number 1 Jaundice Anemia in the elderly Depression Diabetes Exercise for people with skin disorders at maturity ANEMIA IN THE ELDERLY an average of 12,800 deaths per year. The most serious complications of liver ci rrhosis are haemorrhage, infections, jaundice and encephalopathy (increases the pressure inside the brain, convulsions and hallucinations). Virtually all body s ystems are affected by cirrhosis that still exposes the patient to the risk of l iver cancer. Cirrhosis is irreversible, but the rate of progression can be quite slow in some patients. In patients with hepatitis B, for example, the five-year survival after diagnosis of cirrhosis is 71%. In alcoholics who abstain, the fi ve-year survival reaches 85%. Those who persist in drinking, on the other hand, is only 60%. The World Health Organization defines anemia in adults, the hemoglo bin concentration below 7.5 mmol / L (120g / L) for women and 8.1 mmol / L (130g / L) in humans. In an evaluation of 755 seniors with 85 or more years old who w ere followed for 10 years, of both sexes, the mortality rate increased in propor tion as decreased hemoglobin. The elderly who had referred to anemia at baseline had 2.2 times higher risk of death. Mortality from tumors and infectious diseas es was also higher in the anemic elderly. Anemia in the elderly means disease. B lood Blood is pumped by the heart throughout the body through arteries and veins . Red blood cells carry oxygen from lungs to tissues and remove carbon dioxide f rom the tissues causing it to be eliminated by the lungs. The white blood cells

actively participate in the defense of the organism. The hematology or blood tes t examines the blood cells, identifying a number of diseases, ranging from those characteristic of blood (such as anemia and leukemia, for example) to infection s and allergic diseases. Major hematologic diseases in old age are anemia, resul ting from various causes such as small hemorrhages or large, leukopenia (low whi te blood cells), leukemia (excess white blood cells), and tumors of blood cells, such as lymphoma and multiple myeloma.€Anemia is a decrease in the number of r ed blood cells or blood cell count is normal, but its substance (hemoglobin) is low. It is a consequence of severe malnutrition. The main cause of anemia is iro n deficiency (anemia), the basic substance in the formation of hemoglobin. It ca n also occur in vitamin B12, copper and zinc. The discrete and continuous loss o f blood in the feces (due to an intestinal tumor silent, or hemorrhoids, for exa mple) can lead to anemia with few clinical symptoms due to its slow installation , the same can occur in vaginal blood loss continued (myoma for example). Diets low in iron and in plants, used for a long time, can lead to anemia. Diets varie d little, very common in many types of treatments such as in diabetes, for examp le, are causes of anemia in the elderly. Situations where there is poor absorpti on of food (stomach diseases, for example) can also lead to anemia, vitamin B12 deficiency. A deficiency of vitamin C can also be a cause of anemia in the elder ly and is favored by alcoholism. Kidney disease and thyroid disorders can lead t o anemia. Various medications can cause anemia highlighting, for example, antibi otics (chloramphenicol and various penicillins), chemotherapy, anticonvulsants ( drugs against epilepsy (carbamazepine), drugs used to treat thyroid cancer, diab etes and allergy. Several anti-inflammatory drugs and tranquilizers may also lea d to anemia. Anemia is manifested in different manners and may lead to demonstra tions Rheumatologists in New Zealand studied 293 healthy women in the postmenopausal p eriod (when no longer menstruating, a year ago), and found that women who had wh ite hair before the age of 40, showed a decrease in bone mass ( which meant they had osteopenia (mild bone loss) or osteoporosis (more severe degree of bone los s). Read the full article at first. editing Doctor's office 2 EXERCISE FOR PEOPLE WITH HEALTH DISORDERS The elderly can not get to exercise without first making a consultation with the doctor if you have health problems like hypertension, diabetes, cardiac, pulmon ary or orthopedic. See a doctor for guidance. And always watch after exercise if you are too breathless or sweating excessively. These are signs that may be mak ing more effort than your body can handle. Choose a time of day that is not too hot. Excessive heat can cause dehydration and thereby increasing the stress on t he heart too. Wear appropriate clothing, fresh and elastic, and a tennis that ca n cushion the impact of a hike, not to overload the joints. Do not exercise on a n empty stomach, because the energy for physical activities are what you eat, bu t if he ate or drank too much, did not exercise. Drink water in small portions, 20 to 20 minutes during exercise. Exercise at least twice a week for at least 15 -30 minutes. Strength of hands Rheumatologists Boston University conducted a stu dy with 453 people who underwent a radiograph of the hand between 1967-1969 and had no signs of arthrosis. At the same time they measured the strength of appreh ension (the force to tighten a dynamometer device that measures the force in num bers) and found that this force was high. In 1992-1993 (ie 24 years later) these same people have again radiography of hands and it was observed that there are 2.8 times more of osteoarthritis in the fingers and the thumb, in men and 2.7 ti mes most of osteoarthritis in the fingers of women, because, knowing the strengt h that they have more people use their hands and spend more joints. Continued - Anemia in the Elderly

cardiac, vascular and lung. Fatigue and lack of provision are the most frequent symptoms. There are also weight loss and pallor. Can occur in obese people who h ave poorly diversified diet. The complete blood test, blood iron and occult bloo d in the stool are also part of the study of anemia. Sometimes it is necessary t o examine the bone marrow, local trainer of blood cells. The correct treatment o f anemia should be based on a diagnosis. In certain situations should be the rep lacement of iron or folic acid and other vitamin B12. There are situations where there is need for blood transfusion. 3 DEPRESSION AFTER 60 YEARS About 10% of patients seeking a general practitioner have depression as the main frame, though often the patient will not be this customer and to resist accepti ng the diagnosis.€It was a self-administered questionnaire in 2732 patients ove r 60 years in medical practices. It was found that 17.8% of women and 9.4% of me n aged over 60 years, met criteria for depression. A total of 10.6% of women and 5.7% of men met the criteria of so-called major depression, it is more pronounc ed. Depression was strongly correlated with female sex, presence of family histo ry of mental illness and lack of social contacts. Therefore, these factors shoul d increase the degree of suspicion for the diagnosis of depression for family me mbers who live with people with those characteristics. Frequency of Depression D epression is a major psychological illness that affects the elderly. It is usual ly confused by their symptoms with a number of other diseases. Depression causes sadness, deep sadness, feelings of guilt and a tendency to suicide. The solitud e, inactivity, loss of loved ones are among the main causes of depression in old age. Depression is a psychological state that lasts for weeks or even years if untreated. It is a disease that is hereditary. Clinical Manifestations addition of melancholy and sadness can also manifest itself through agitation, irritabili ty or aggression. Insomnia is a major symptom of depression, which is accompanie d by anxiety and muscle tension, muscle aches may occur that usually fall back o r neck. Frequently occurring headaches. The depressed person may have hand tremo rs, palpitations and sweating, which can be confused with other medical conditio ns. The feeling of fatigue and tiredness may be due to depression. The mood may be a symptom of depression. The depressed person may have weight problems, can s ometimes gain weight and sometimes weight loss. Depression brings, in general, p sychosocial problems, making people isolated from society. Low self-esteem and i nsecurity are major symptoms that exacerbate these problems. Depression may be b ehind diseases such as gastric ulcers, colitis, myocardial infarction, hypertens ion, allergies and bronchitis. Depression in Women and Men In 10% of women, depr ession comes in the years before the period of menopause, so around 50 years. Wi dows, separated or divorced, and smokers are more prone to depression. Women who had menstruation very young who have never been pregnant and suffering from pre menstrual syndrome are also candidates for depression. Major depressive symptoms observed were loss of appetite, insomnia, difficulty in concentration, sadness, hopelessness, and fatigue. Only 40% of women sought treatment. In men, depressi on has far fewer risk factors and stresses in life, being more marked after 60 y ears. The decreased production of hormones by the ovaries (estrogen) seems to be an important cause of disease. Causes a depression may arise from the use of dr ugs, especially long-term use of tranquilizers and sleeping pills. Besides tranq uilizers, various cardiac medications, The book prevents osteoporosis is being sold on the internet. Much cheaper and e asier than buy in any bookstore. Visit the iEditora and discover how to purchase this and other titles. w w w. i and d i t o r a. c o m. b r 4 antirheumatic, antiallergic, and anti-inflammatory can also cause depression. Am

ong these drugs stand out steroids, beta-blockers and vasodilators brain. Some d iseases are accompanied by depression, especially hypothyroidism. Depression oft en produces a decrease in immunity, reducing the physical resistance to disease, especially infectious diseases and cancer. In the Third Age losses, retirement, inactivity promote the very depressed state. Severe depression in the elderly m ay have a confusional state similar to what occurs with dementia. Depression can arise in the development of many diseases, even after surgical treatment. It is a serious complication of the person who suffers stroke or have Parkinson's dis ease. The diagnosis is clinical, with no specific tests to identify the disease. Treatment Treatment involves medication, psychotherapy, physiotherapy and occup ational therapy. The medicinal use of antidepressant medication in many situatio ns, it is useful, but always under strict medical criteria. Some substances anti depressant (tricyclic, tetracyclic and MAO inhibitors) can cause side effects su ch as air pressure changes terial and heart problems.€Recently been developed substances that act on serot onin metabolism and noradarenalina, which are hormones that exist within the ner ve cells and actively participate in the emotional process. Are drugs that selec tively inhibit serotonin reuptake (fluoxetine, paroxetine, sertraline and citalo pran) or serotonin and norepinephrine (venlafaxine), fenilpiperazÍnicos (trazod one and nefazodone), noradrenergic and specific serotonergic (mirtazapine). Thes e substances aremam last generation antidepressants, which produce fewer side effects and can be administered once daily. A product called St. John's wort (Hypericum perfuratum ) of plant origin has mild antidepressant action and has been used widely. The f enialalanina and L-tyrosine, producing substances that brain hormones, have also been used. The psychological approach is essential. Occupational therapy produc es good results in many situations, especially in the Third Age. The holding of regular physical activity is very effective for the disease. The understanding, affection, love is essential and must always be present. Plant against depression British and American doctors have found clues about a plant called St. John's wo rt (Hypericum perfuratum), which operates in mild or moderate depression, 23% to 55% of the time compared to placebo, but it has 6% to 18% of times weaker resul ts compared to tricyclics. Doctors warn that the alternative treatments, homeopa thy, Bach flower remedies, teas, acupuncture, music therapy, etc., should be adj uvant treatment, auxiliaries, and never during a basic treatment, because depres sed patients, especially the elderly, often commit suicide. Today the existing m edication brings a fast relief and can be used for a short time and then can be used alternative methods, which certainly are inferior to anti-depressants. 5 DIAGNOSIS OF DIABETES A committee of experts from the American Diabetes Association recommended a lowe r level of blood sugar in the blood to diagnose diabetes, which now rises to 126 milligrams per deciliter (mg / dL) instead of 140 mg / dL. The rate of 126 shou ld be reduced to the nearest 100 mg, because it is associated with an increased risk of complications of the eyes, nerves and kidneys. When the diagnosis was ba sed on a blood glucose value of 140 mg / dL or greater, these complications ofte n developed before the diagnosis of diabetes. Experts believe that early diagnos is and treatment can prevent or delay the costly and burdensome complications of diabetes. Currently, about 5 to 6 million U.S. adults have diabetes but do not know it. People at high risk for diabetes are adults with 45 years of age or old er should get tested every common interval of three years and / or be subject to the conditions below: - Being more than 20% above ideal body weight, or have a body mass index (BMI) greater than or equal to 27. BMI is the ratio of the weigh t in kilograms to height in meters squared (kg/m2). - Have the father, mother, b

rother or sister with diabetes. - People of color are more likely to have diabet es - have given birth to a baby weighing more than 4 (pounds) or having diabetes during pregnancy. -Have blood pressure to or above 140/90 millimeters of mercur y (mm Hg). - Have abnormal levels of blood cholesterol, such as high density lip oprotein (HDL) cholesterol below 35 mg / dL or triglycerides greater than 250 mg / dL. - A value of fasting plasma glucose 126 mg / dL or higher. Taste and smel l in the elderly has been identified that older people have loss of taste and sm ell of food due to various diseases, ingestion of drugs and surgery and, thus, f ood becomes less pleasant. The decrease in the variety of foods cause a deficien cy of nutritional factors, weight loss and changes in the immune system. The los s of sweet taste may complicate control of diabetes in the elderly and the salty taste hypertension control. The authors recommended that make gustatory and olf actory stimuli giving more spicy foods. Adding coffee and chocolate in the diet can mask the bitter taste of some foods. In E. United States 33.5 million people , among a population of 250 million, were over 65 years in 1995.No year 2030 one in five people will be over 65 years of age. His bookshop w w w. i and d i t r a. c o m. b r Soon launching of the book: What you should know about arthritis 6 Know or not know ...? That is the question The answers are contained in the text and will be presented in the next issue. I f you have any questions,€send an email to medgraf@uol.com.br. The Code of Medi cal Ethics is forbidden to consult on specific clinical cases, by e-mail. Consul t your doctor. Consider these texts as general information. JAUNDICE 1) The jaundice appears that organ? 2) What color is the stool of patients with jaundice? 3) What are the exams to be held for the diagnosis? 4) Name two diseas es that cause jaundice? 5) The jaundice of the newborn is equal to the adult pat ient? 3) What is the most important mineral in the anemia? 4) What is the most sensibl e diet to combat anemia? 5) What vitamins should be taken? 5) What part of the day you should exercise? DIABETES 1) the new criteria for diagnosis of diabetes was more frequent? 2) Which are th e organs that were affected with the old criteria? 3) Name two risk factors for people who need to be careful not to have diabetes? 4) What percentage of people who have diabetes and not know? 5) The level of cholesterol worsens the chances of diabetes appear? has no pleasure? Explain. EXERCISE FOR PEOPLE WITH DISORDERS 1) Before starting to exercise you should do that take? 2) What are the diseases that may worsen with exercise? 3) Lots of power in the hands can result in what ? 4) It's good exercise fasting? ANEMIA IN THE ELDERLY 1) What are the characteristic clinical symptoms of anemia of the elderly? 2) Wh at tests should be asked to diagnose? EUTHANASIA AND ASSISTED DEATH EJEmanuel and employees of the bioethics committee of the National Institutes of Health, Bethesda, did a poll with 3 299 oncologists, members of the American So

ciety of Clinical Oncology of which 22.5% supported the assisted death of termin ally ill patients with cancer pain and 6.5% were in favor of euthanasia. The stu dy revealed that two types of oncologists are reluctant to accept these two meth ods are the ones who wear little morphine as a medicine to calm the intractable pain and are more willing to talk with their patients. About 3.7% of oncologists have already made in their medical practice of euthanasia and 10.8% have helped the patient to commit suicide. The authors cite the fact that physicians who be lieve they can not give the best care to their terminally ill patients have a gr eater willingness to accept euthanasia and assisted death, than the oncologists who work in centers equipped more. Euthanasia and Assisted Suicide in Homosexual In Holland euthanasia was officially legalized in November 2000 but had long si nce a tolerance for this type of solution between doctors and pacientes.Em 1996, 38% of recorded deaths are the result of information provided by doctors from i ncurable diseases, and 2.1% of that total are cases of euthanasia. PJ Bindels an d colleagues at the Public Health Service of Amsterdam, decided to investigate h ow many there were cases of euthanasia among 131 male homosexuals with AIDS diag nosis and found that 29 (22%) patients died by euthanasia and 17 (13%) used othe r ways of ending life. The big difference between those who decided euthanasia w as the age, since 72% had 40 or more years compared with 38% of those who died n aturally. By laboratory tests of patients who killed themselves could provide if they do not have more than a month old. 7 SKIN IN THE MATURITY OF LIFE The skin of the body of an adult measuring 2 square meters, the largest organ in the body which represents 15% of body weight. The texture of the skin depends o n the inheritance of body region, age, race, sex and nutritional status of the i ndividual. People who spend 65 years of age have no discernible change in the sk in. Depending on the region of the body and the time that the skin was exposed t o the sun these changes are very marked, but in general there is a diffuse degen eration; the top, which is called the epidermis, is thin. The fat that sits on t he bottom, a layer called the dermis, loses water and the very fat gets thinner. The hair falls and the sebaceous glands almost disappear. The nails are changed . There is loss of elasticity, there are wrinkles, spots, moles and other change s. The high incidence of precancerous lesions and cancer (basal cell carcinoma, squamous cell and melanoma), the elderly, is attributed to prolonged sun exposur e and repeated Several environmental and genetic factors, chronic exposure to ultra violet is t he most important influence factor for two reasons: firstly, the ultraviolet irr adiation causes a mutation (change in reproduction) within the skin cell. This g enetic alteration starts a disorderly cell growth and tumor formation. Second, u ltraviolet irradiation has profound effects on the immune system of the skin,€i nducing a similar state of immunosuppression (no defense), which prevents the bo dy from defenders of the initial tumor. and ultraviolet radiation from the sun, from an early age. To decrease the incid ence of ultraviolet rays of the sun, assigned that premalignant transformation, it is recommended to use sunscreen, clothing, hats, shirts, all hours of the day . It is forbidden the exposure during the hours around noon when the sun's rays are strongest. Melanoma vaccine against two types of vaccines have been shown to combat melanom a, skin cancer is highly malignant, causing the rapid spread of metastases leadi ng to death within five years. The first one was developed for 10 or 15 years ag o, in E. United States, but later proved to be ineffective. The second vaccine w as developed in Germany causing tumor regression in 31% of patients, and in two cases, the reduction was complete, which persisted after a year of remission. Th e surgery is difficult because this nodule, which is seen in the figure, is in m

any places of the skin. The worst affected by skin cancer are mostly people with white skin, blond, they burn easily and never tan or tan with difficulty. About 90% of lesions located on skin areas that are exposed to the sun. Skin cancer is increasing its impact, dramatically, in virtually the entire world, due to loss of Earth's ozone layer , letting the sun's rays more intense. In the U.S., where epidemiological studie s are carried out regularly, about 1.2 million new cases were diagnosed in 1999 and probably 10,000 patients lose their lives. Thus, skin cancer is one of the m ost serious public health problems, setting up a silent epidemic. Doctor's office 8 Doctor is a realization of Medgraf. To contact: medgraf@uol.com.br