Treatment for Sundowning

Sundowning is a phenomenon unique to Alzheimer’s disease where the mortal becomes more confused and agitated in the late salutation and primeval evening. Several theories have been proposed most why sundowning occurs, much as increased fault cod to darkness and shadows, fatigue, and a reduced ability to tolerate stressful situations. The best way to approach sundowning is to make late afternoons and evenings as simple and relaxing as possible. Reduce distractions or unscheduled activities, and keep rooms well-lit until bedtime.

Confusion –

Alzheimers ofttimes causes confusion. Your idolized digit haw embellish confused most person, place, and time. In another words, he haw still know who he is, but he haw not recognize others; he might also be unable to identify where he is or name the current time, date, or year.

People with Alzheimer’s disease also embellish confused most the determine of objects, much as keys or pencils. As frustrating as this crapper be for caregivers, the best way to move is to stay calm and wage simple, clear, positive answers when your idolized digit asks for help. For instance, if he seems confused most the determine of a fork, simply say, \”Here’s your subfigure for eating your food.\” It crapper also hold to demostrate how the item is used. Never nagger your relative for becoming confused most things she used to know.

Sundowning is a behavioral phenomenon associated with dementia, Alzheimer’s Disease, and whatever another neurological conditions. When patients sundown, their behavior changes radically right around dusk. These behavior changes crapper be rattling stressful for caregivers, and sundowning in generalized crapper complicate tending for a patient with dementia or a similar condition. Classically, patients start to exhibit this behavior in the region stages of their disease.

The causes of sundowning are not substantially understood. Researchers have suggested that it haw be related to a flutter of the patient’s internal clock, and it could also be related to hormones, restlessness, obtuse reddened in the gloaming hours, or even caregiver stress and fatigue. Sundowning incidents are marked by occurrences same visual hallucinations, confusion, paranoia, aggressiveness, and another behavioral changes which are rattling discover of character for the patient.

One of the biggest risks for a patient who experiences sundowning incidents is that he or she haw embellish upset and agitated enough to wander away. The confused patient will have trouble communicating with grouping who haw want to wage help, and is at risk of injury. Sundowning crapper also put a great deal of lineage on caregivers, as it crapper be emotionally upsetting for kinsfolk members and grueling for caregivers outside the kinsfolk as well.

Patients who undergo sundowning are sometimes said to have sundown or sundowner’s syndrome. Several methods crapper be used to address late-day confusion, including keeping days active so that elderly grouping are more tired at night, making dietary adjustments, keeping reddened levels high in the evening, and using medications to control behavioral changes. Medications are usually advisable after another management techniques have been tried.

In patients with Alzheimer’s, the appearance of sundowner’s syndrome is a drive of concern for doctors because it crapper inform that the patient’s disease will be aggressive and rapid. The emergence of sundown syndrome is also a sign that a patient is in the region stages of disease, and that he or she is going to undergo a decline in noetic function and quality of life in the near future. Caregivers should be aware that sundowning is rattling common, and that it is essential to get respite tending to secure that caregivers are not strained by providing constant care. Some elderly advocacy organizations wage respite tending for free to needy families caring for their relatives, and it is also doable to lease caregivers to hold families providing tending at home.

The term “sundowning” refers to a state of fault at the end of the punctuation and into the night. Sundowning isn’t a disease, but a symptom that ofttimes occurs in grouping with dementia, much as Alzheimer’s disease. The drive isn’t known. But factors that haw aggravate late-day fault include:

* Fatigue
* Low lighting
* Increased shadows

Some tips for reducing this type of disorientation in your idolized digit with dementia:

* Plan for activities and danger to reddened during the punctuation to encourage nighttime sleepiness.
* Limit caffeine and sugar to farewell hours.
* Serve dinner primeval and offer a reddened snack before bedtime.
* Keep a night reddened on to turn turmoil that occurs when surroundings are Stygian or unfamiliar.
* In a strange or unfamiliar setting much as a hospital, bring familiar items much as photographs or a radio from home.

When sundowning occurs in a tending facility, it haw be related to the flurry of activity during staff shift changes. Staff arriving and leaving haw cue whatever grouping with Alzheimer’s to want to go home or to check on their children — or another behaviors that were appropriate in the late salutation in their past. It haw hold to occupy their instance during that period.

Dementia and sundowning

People with dementia haw embellish more confused, restless and insecure late in the salutation or primeval evening. It crapper be worse after a move or change in the person’s routines. This behaviour is ofttimes called ‘sundowning’.

The mortal haw embellish more demanding, restless, upset, suspicious or disoriented. They haw even see, hear or believe things that aren’t real, especially at night. Attention span and concentration embellish even more limited. Some grouping haw embellish more impulsive, responding to their own ideas of reality that haw locate them at risk. There are whatever practical things carers crapper do to control sundowning.

No digit is sure what causes sundowning, although it seems to result from brain disease. People with dementia tire more easily, even with rattling few demands on their thinking ability. They mostly embellish more restless and difficult to control when tired.

Sundowning haw relate to demand of sensory stimulation after dark. At night, there are fewer cues in the environment, with the obtuse lights and absence of noises from turn daytime activity. A sundowning, restless mortal haw also be hungry, uncomfortable, in pain or need to use a toilet – all of which they crapper only express through restlessness.

As the dementia progresses and the mortal understands less most what is event around them, they embellish more frantic in trying to restore their sense of information or security. Many carers feature that the mortal becomes more anxious most ‘going home’ or ‘finding mother’ late in the day, which haw inform a need for security and protection. They haw be trying to find an surround that is familiar to them, particularly a locate that was familiar to them at an earlier instance in their life.

Where to begin
Arrange for a thorough medical examination and discuss the person’s medications with the doctor. Sometimes dynamical the dosage or timing crapper hold relieve the symptoms.

Things you crapper try
Strategies for managing sundowning include:

* Keep the mortal active in the farewell and encourage a rest after lunch. If fatigue is making the sundowning worse, an primeval salutation rest might help.
* Don’t physically restrain the person. Let them pace where they are safe. A walk outdoors crapper hold turn restlessness.
* Some grouping are comforted by soft toy animals, pets, hearing familiar tunes or an opportunity to do a favourite pastime.
* Consider the effect of bright lights and noise from television and radios on the person. Are these adding to the fault and restlessness?
* Try not to hold baths or showers for the late salutation if these are upsetting activities. The exception haw be the mortal who is calmed by a hot bath before bed.
* Night-lights or a radio playing softly haw hold the mortal sleep.
* Some grouping find warm milk, a back rub or music calming.
* Some haw need medication. This will need to be discussed with the doctor.
* Make sure you get plenty of rest yourself.

Support for families and carers
Dealing with dementia-related behaviours punctuation in and punctuation discover is not easy. It is essential that you seek hold for yourself from an understanding kinsfolk member, a friend, a professional or a hold group. Remember that you are not alone. Alzheimer’s state offers support, information, activity and counselling through the National Dementia Helpline.

The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory assist established to hold carers and tending workers of grouping with dementia who undergo dementia-related behaviours. Telephone advice, assessment, intervention, activity and specialised hold are available 24 hours a day.

Where to get help

* Your doctor
* Your topical community health service
* Your topical council
* National Dementia Behaviour Management Advisory Service Tel. 1800 699 799 – for telephone advice, assessment, intervention, activity and specialised hold (24 hours)
* National Dementia Helpline Tel. 1800 100 500
* Commonwealth Carer Respite Centre Tel. 1800 059 059
* Carer Resource Centres Tel. 1800 242 636
* Aged Care Assessment Services – occurrence your regional Department of Human Services office
* Aged Care Information Line Tel. 1800 500 853

Things to remember

* A mortal with dementia haw embellish more confused, restless and insecure late in the salutation or primeval evening. This is called ‘sundowning’.
* Understanding the drive crapper hold carers decide which strategies haw be helpful to control sundowning.
* Arrange for a thorough medical examination and discuss the person’s medications with the doctor – sometimes dynamical the dosage or timing crapper hold relieve the symptoms.


Very little data subsist to hold the effectiveness of the following treatment measures.  However, as caregivers we same to feel that we are doing something so here are whatever suggestions that have been made by professionals.

Structured Activity
Some have suggested that planned activities that interest the elderly mortal might decrease the incidence of agitation.

Redirection, Reassurance, Distraction
Speaking in gentle, loving tones and not being direct confrontational haw hold to prevent or lessen turmoil in an elderly person.  It might, then, be doable to involve the mortal in a newborn activity. Meeting Physical Needs Be sure base fleshly needs same toileting and relief of pain or hunger have been met .

Antipsychotic Medicines
Antipsychotic drug has had the greatest success with sundowners syndrome; however, these medicines crapper also drive sedation. A equilibrise has to be found between the anti-psychotic and sedating affect for this treatment to be genuinely affective for the elderly person.

Clearly, a lot more research needs to be done.  But as a caregiver knowing that this syndrome exists is important.  Seeing a usually clear and cognizant idolized digit suddenly exhibit odd behaviors towards the end of the punctuation crapper be rattling disconcerting to feature the least. Talking to your doctor or geriatric manager should be your first step when this happens, but knowing that much a syndrome exists crapper also give you hopes that the mortal you know will return in the morning.

Behavioural disturbance is ofttimes treated with antipsychotic drug much as haloperidol, risperidone, or olanzapine. However, these have significant lateral effects.


What is Swine Flu?

swine fluSwine Flu as the name suggests is supposed to bother swines and not humans in the first place. It isn’t really as big a devil as it is conceived to be. It just so happened that people working closely or in contact with pigs (mostly in Mexico) picked up the disease and it started spreading soon after.

Now it really isn’t that simple. The virus has mutated enough to be able to inoculate humans and can now be considered a different strain altogether. Swine flu affects the respiratory system and is caused by the H1N1 virus or Type A influenza virus.

Not all are vulnerable. People with minor chest/respiratory infections are more susceptible to H1N1 infections. Medications prescribed are usually the usual flu medicines, though Tamiflu is being recommended now. Therapeutical challenges are presented because the virus is a state of mutation and keeps evolving.

It’s always better to avoid getting inoculated rather than trying to fight it. A healthy immune system along with appropriate prevention measures like face masks, avoidance of contact with the disease, proper disposal of items used by the diseased can help you keep the disease at bay.

There’s no point in trying to infect the world with your infection. If you’ve got the symptoms make sure you get in touch with your doctor immediately and prevent the spread of the disease to others.

Know More About Treatment of Swine Flu


Benefits of Green Tea

green tea1.Does green tea clean?

Green tea is rich in catechins and polyphenols. There are published clinical trials supporting the cleaning action of green tea on teeth. Green tea is also helpful in reducing inflammation of the gingiva.

In most of the trials it was seen that the oral application of the catechins and polyphenols had a positive impact on gingival and periodontal structures.

2. Does green tea help acne?

Green tea is one of the most popular beverages all over the world. There have been several scientific findings endorsing the positive impact of green tea in reducing acne, though they are not conclusive yet.

It is believed that the catechins and flavonols which are integral parts of green tea are very powerful antioxidants which protect the skin from damages due to oxidation and free radicals. The free radicals contain free oxygen ions which attract ions from skin, rendering it vulnerable to infections and acne. The antioxidants in green tea take place of the skin tissues and satisfy the oxygen ions thereby protecting the skin tissues.

3.What is genmaicha green tea?

Genmaicha means “brown rice”. This variety of tea is prepared by combining toasted rice with “sencha tea”.

This is very popular in Japan and is also called “pop-corn” tea. Sometimes this tea is served with “Macha” which is a powdered green tea. It has a slightly grassy and nutty flavor. The sencha leaves have a bitter kind of flavor which blends well with toasted rice.

4.What is the effect of green tea on hypertension?

Research suggests that as little as half a cup of green tea brings down the chances of hypertension by 50%.

The powerful antioxidants present in green tea help clear the arteries and thereby let the blood flow freely through them. Hence, chances of hypertension are reduced considerably. Keeping all parameters same like smoking, alcohol consumption etc. it been seen that people who consumed green tea are less vulnerable to hypertension than the non tea drinkers.

5. What are the effects of green tea on skin?

Research suggests that green tea extracts can be used to manufacture medicines for skin and wound treatments.

Free radicals are carcinogenic and polyphenols in green tea help eliminate those free radicals. They guard the healthy cells against cancer. EGCG present in green tea rejuvenates the dying skin cells, thereby rendering long lasting glow and lustier to the skin. Some creams and lotions are available in the market which uses EGCG in them.

6. What are the effects of green tea on pregnancy?

Three to four cups of green tea per day is sensible during pregnancy. Green tea is health promoting and is safe to be taken while pregnancy.

The powerful antioxidants in green tea help increase immunity and promote bone growth. Some researchers however suggest that green tea brings down folic acid levels. A dip in folic acid levels can cause serious neural tube defects in the zygote. There is however no conclusive evidence on this.

7. What is herb and fruit green tea?

The green tea market is flooded with green teas infused with herbal and fruit juices. The tea has a real good taste and has immense health benefits.

It should be prepared in cold water that has been brought to temperatures of 205° F. Then the water should be poured on the tea bags and stee4ped for around 5 minutes.

Antibiotic Resistance—where do antibiotic resistance genes come from and what do they do there?

microbeEvery year the clinicians write more than 160 million prescriptions in the United States alone, with subjects consuming 235 million doses of antibiotics annually of which only 50% – 80% is actually necessary.

Drug – resistant infections are more likely to cause longer hospitalizations to the affected, more severe side effects and incur more expenses.

A feverishly important question, doing its rounds in an era of growing microbial resistance is “how microbes manage to defeat antibiotics?” The answers are, as diverse as the problem itself. “Molecular biology is telling us . . . . what the resistant mechanisms are , although we don’t know all the details , “ says Julian Davies from University of British Columbia .

The common prevalent explanation is that bacteria in order to gain resistance to antibiotics, bacteria rely on mutations. Drug manufacturers in their endeavor to modify an existing antibiotic, impenetrable to resistant strains cause the bacteria to mutate and regain mastery over the new antibiotic, which already had a gene to defeat the older version. The following are the three commonly believed ways in which bacteria acquire genes for resistance:

1 . Spontaneous mutation: the bacterial DNA changes spontaneously, as in starburst. e.g :- Drug resistant tuberculosis .

2 . Transformation: A form of microbial sex wherein one bacterium takes DNA from another. e.g :- Gonorrhea (defined) resistant to Penicillin .

3 . Plasmid mediated resistance: A small circle of DNA called plasmid flits between different bacterial types carrying multiple resistances. e.g :- The case of Shigella diarrhea claiming lives of 12 , 500 Guatemalans in 1968 . The microbe harbored a plasmid resistant to four antibiotics.

The resistance of bacteria to antibiotics is not only attributed to “mutation”. Sharing of resistant genes also has a role to play. Plasmids — existing outside the main chromosomes as if they were mini chromosomes are also shared. In bacterial phylogeny (defined) this type of sharing is able to leap broad divisions.

There are genes called gene cassettes that can be integrated in the chromosomes (defined). Integrons which are genes code for integraces which can integrate the cassettes into chromosomes or other genetic material, where they start working making the integrons function like a carrier. Bacteria are able to pick up several cassettes and hence obtain resistance to several antibiotics. “Bacteria also integrate resistance to disinfectants or pollutants in these clusters, says Abigail Salyers of the university of Illinois.

The Microbial Mind :-

“The issue of resistance is converging from the human infectious disease and agricultural angles,” says plant pathologist Jo Handelsman, “whether the microbe is trying to protect itself against antibiotics, fungicides, insecticides, herbicides, even antiviral agents.” Handelsman, from the University of Wisconsin – Madison, points to more similarities. “At the molecular level, there are only a few mechanisms of resistance: change the target molecule, inactivate or decompose the drug or pesticide, sequester (defined) the drug or pesticide, or keep it out of the cell” to begin with. “We find resistance genes in the streptomycetes (bacteria that produce many antibiotics) that have exactly the same biochemical function as the resistance genes” in samples from hospital patients. The similarity (not identical) between the gene sequences suggests that the genes jumped between species, although Davies admits “we can’t yet prove it”. Salyers , involved in the studying of gene jumping suggests that bacteria are tricky when it comes to moving resistant genes.

They can induce other bacteria to initiate genetic swap meets. When one bacterium receives DNA resistance plasmid released by another bacterium, the former releases it’s own plasmid, this is termed as retrotransfer . “This transfer capability gives bacteria the ability to sample DNA from other bacteria,” Salyers says. This is a new form of symbiosis (defined) . “Just about any bacterium can get genes from just about any other bacterium.” Salyers says.


Very distantly related bacteria with resistance genes have been found to have 90 – 95 % similar DNA sequences. This might not qualify for proof but strongly suggests the common origin of genes.

Case Study:-

1) Theory : Resistance in Pseudomonas aeruginosa is attributed to Mex efflux pumps.

Method : A combined phenotypic and genotypic approach for the differential diagnosis of r esistance mediated by the transporters MexAB-OprM , MexCD-OprJ , MexEF-OprN , MexXY-OprM was developed. Reference strains harbouring only one specific transporter were used to validate the methodology and its applicability was evaluated towards seven clinical isolates as their resistance mechanisms could not be assigned by the prevalent techniques . MIC measurements with antibiotics [carbenicillin (MexAB-OprM); erythromycin (MexCD-OprJ); norfloxacin and imipenem (MexEF-OprN); gentamicin ( MexXY-OprM)] was used for Phenotypic detection, with and without Phe – Arg – ß – naphthylamide . Semi – quantitative reverse transcription PCR (RT – PCR) for mexC and mexE determined genotypic detection , and by quantitative competitive RT – PCR and real – time PCR for mexA and mexX (correlation between both methods : > 88 % ; overexpression levels – 4.8 – 8.1).

Results: In control strains for all pumps convergence between phenotypic and genotypic methods was observed. Convergence was obtained in 6 of 7 strains for MexXY- OprM and MexEF-OprM , and in 5 of 7 for MexAB-OprM and MexCD-OprJ for clinical isolates.

Conclusions: The data suggests a combination of phenotypic and genotypic approaches in the diagnosis of efflux – mediated resistance in P. aeruginosa.

(Journal of Antimicrobial Chemotherapy 2007 59(3):378-386; doi:10.1093/jac/dkl504)

2) Cross-resistance to fluoroquinolones in multiple-antibiotic-resistant (Mar) Escherichia coli selected by tetracycline or chloramphenicol: decreased drug accumulation associated with membrane changes in addition to OmpF reduction.

S P Cohen, L M McMurry, D C Hooper, J S Wolfson and S B Levy

Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts 02111.

Mar mutants(chromosomal multiple-antibiotic-resistant) of Escherichia coli, cultured on agar having low tetracycline or chloramphenicol contents, were 6- to 18- times less permeable to the fluoroquinolones than E. coli K-12 or E. coli C parental strains. The emergence frequency of these mutants was at least 1,000 times higher than that of those selected by the fluoroquinolone norfloxacin directly. When Mar mutants(not wild-type) , were coated on norfloxacin, mutants resistant to high levels of norfloxacin (2 micrograms/ml) appeared at a comparatively higher (approximately 10(-7] frequency. In addition to decreased amounts of OmpF, Mar mutants had also changes in outer membrane protein and were four- to eight times less susceptible to fluoroquinolones than was an ompF::Tn5 mutant lacking only OmpF. Conglomeration of [3H]norfloxacin was more than three times lower in the Mar mutants than in wild-type and two times lower than in the OmpF-deficient derivative. These differences were not attributed to a change in the endogenous active efflux system for norfloxacin in E. coli. Norfloxacin-induced inhibition of DNA synthesis was three times lower in intact cells of a Mar mutant than in susceptible cells, but this difference was not there in toluene-permeabilized cells.

Insertion of Tn5 into marA (min 34.05 on the chromosome) led to a return of the wild-type patterns of norfloxacin accumulation, fluoroquinolone and other antimicrobial agent susceptibilities, and outer membrane protein profile, including partial restoration of OmpF.

Conclusion : These findings strongly suggest that marA-dependent fluoroquinolone resistance is linked to decreased cell permeability . Once mutated to marA, cells can achieve high levels of quinolone resistance at a relatively high frequency. (Antimicrob Agents Chemother. 1989 August; 33(8): 1318-1325)

Way Forward :-

The synthesis of large numbers of antibiotics over the past three decades has caused today’s crisis . Bugs have learnt to defy their killers as a result of chromosomal change . The most rational thing to do would be to use antibiotics more judiciously and let the pace of the modern scenario slow down while a medical miracle steps in to defy the notorious bugs .

Benign Prostate Hyperplasia

prostate_glandBPH – Causes, Epidemiology and Medication

Epidemiology of BPH:

The study of the distribution and the determinants of diseases in manlike beings is titled Epidemiology. hyperplasia or Benign Prostatic Hyperplasia is a term used to indicate the rousing or “hyperplasia” of the endocrine gland. There being no globally accepted medicine definition of BPH, the prevalence and incidence rates of this disease are commonly viewed in context of the definitions chosen by the physician reporting the data. Prevalence of hyperplasia is commonly not compared based on clinical criteria, because clinical definitions have been found to vary greatly. So physicians commonly choose autopsy or histological evidence to compare the prevalence of the disease.

Pathogenesis of BPH:

The development of hyperplasia in men is commonly attributed to testicular hormones and aging. Though the role of androgens as the anorectic factor for hyperplasia is debated, they definitely have at least some role as a anorectic agent. It has been seen that men castrated before puberty do not develop hyperplasia as compared to those in the same age assemble and belonging to the same strata of society. It has also been seen that men having diseases that inhibit the production of androgens are less likely to have BPH.

The principal prostatic ketosteroid responsible for hyperplasia is dihydrotestosterone or DHT. DHT is actually a figuring of testosterone – the male sex hormone. It has been seen that though the concentrations of DHT and testosterone in blood (plasma) modification with age, they rest in connatural concentration in the endocrine with aging. There are different theories as to the exact cause of BPH. Though none of them have been evidenced to be conclusive singularly, yet the theory of DHT is probably the most referred to by physicians. The other most common theories are:

· The theory of interaction between stroma and epithelium

· The theory of reduction of the cellular death rate

· The theory of estrogenic synergy

· The theory of genetic and familial factors.

Role of DHT in BPH:

Though the levels of Testosterone and Dihidrotestosterone in serum decline with age, the concentration of DHT remains unchanged in the prostate. The reason for this is probably the fact

that DHT has a very high affinity for ketosteroid receptors. For a better understanding of ketosteroid receptors, we can consider the receptors to be something like magnets and the DHT molecules like iron filings. When Testosterone gets converted into DHT cod to the participation of a endocrine specific enzyme titled 5α-reductase, the DHT molecules rush off and get settled on the ketosteroid receptors and then complex cellular reactions are initiated. Since this phenomenon is independent of the old process, ketosteroid dependent cell ontogeny is maintained finished out the old process. Careful examination has shown that hyperplasic tissues (inflamed areas of the prostate) commonly have higher concentrations of ketosteroid receptors as compared to connatural areas. These are supposed to be the major culprits for feat BPH.

Role of Stromal – Epithelial Interactions in BPH:

The endocrine gland is histologically divided into two parts – Stroma and Epithelium. Experiments suggest that both the compartments communicate with each other and the ontogeny of the endocrine is highly dependent on the behave or regulatory signaling between them.

DHT is believed to behave either in autocrine (secretes a chemical signal and binds to the same cell) fashion by protection with the stromal cells or by protection with neighboring epithelial cells in paracrine (opposite of autocrine) fashion. In both these instances DHT binds with ketosteroid receptors and triggers the transcription (synthesis of RNA or ribo nucleic acid) of ontogeny factors, which in turn cause prostatic tissue growth.

Medical treatment for BPH:

It has been seen that 5α-reductase inhibitor assemble of drugs like Finasteride, Dutasteride etc. are efficient in arresting hyperplasia progression. These drugs inhibit the formation of 5α-reductase enzyme and thereby hinder the transmutation of Testosterone into DHT. Though clinicians have reportable of other anorectic agents of BPH, the fact that arresting DHT formation arrests hyperplasia progression proves that DHT is one of the vital anorectic agents of BPH.