Overview
Thalassemia (thal-uh-SEE-me-uh) is an inherited blood disorder characterized by less hemoglobin and fewer red blood cells in your body than normal. Hemoglobin is the substance in your red blood cells that allows them to carry oxygen. The low hemoglobin and fewer red blood cells of thalassemia may cause anemia, leaving you fatigued.

If you have mild thalassemia, you may not need treatment. But if you have a more severe form of the disorder, you may need regular blood transfusions. You can also take steps on your own to cope with fatigue, such as choosing a healthy diet and exercising regularly.

Symptoms
Thalassemia signs and symptoms may include:

Fatigue
Weakness
Pale or yellowish skin
Facial bone deformities
Slow growth
Abdominal swelling
Dark urine
Several types of thalassemia exist, including alpha-thalassemia, thalassemia intermedia and Cooley anemia. The signs and symptoms you experience depend on the type and severity of your condition. Some babies show signs and symptoms of thalassemia at birth, while others may develop them during the first two years of life. Some people who have only one affected hemoglobin gene don't experience any thalassemia symptoms.

When to see a doctor
Make an appointment with your child's doctor for an evaluation if he or she has any signs or symptoms that worry you.

Causes
Thalassemia is caused by mutations in the DNA of cells that make hemoglobin — the substance in your red blood cells that carries oxygen throughout your body. The mutations associated with thalassemia are passed from parents to children.

Thalassemia disrupts the normal production of hemoglobin and healthy red blood cells. This causes anemia. With anemia, your blood doesn't have enough red blood cells to carry oxygen to your tissues — leaving you fatigued.

Types of thalassemia
The type of thalassemia you have depends on the number of gene mutations you inherit from your parents and which part of the hemoglobin molecule is affected by the mutations. The more mutated genes, the more severe your thalassemia. Hemoglobin molecules are made of alpha and beta parts that can be affected by mutations.

Alpha-thalassemia
Four genes are involved in making the alpha hemoglobin chain. You get two from each of your parents. If you inherit:

1 mutated gene, you'll have no signs or symptoms of thalassemia. But you are a carrier of the disease and can pass it on to your children.
2 mutated genes, your thalassemia signs, and symptoms will be mild. This condition may be called alpha-thalassemia trait.
3 mutated genes, your signs, and symptoms will be moderate to severe.
4 mutated genes. This type is rare. Affected fetuses have severe anemia and usually are stillborn. Babies born with this condition often die shortly after birth or require lifelong transfusion therapy. In rare cases, a child born with this condition may be treated with transfusions and a stem cell transplant, which is also called a bone marrow transplant.
Thalassemia minor
Two genes are involved in making the beta hemoglobin chain. You get one from each of your parents. If you inherit:

1 mutated gene, you'll have mild signs and symptoms. This condition is called thalassemia minor or beta-thalassemia.
2 mutated genes, your signs, and symptoms will be moderate to severe. This condition is called thalassemia major, or Cooley anemia. Babies born with two defective beta hemoglobin genes usually are healthy at birth but develop signs and symptoms within the first two years of life. A milder form, called thalassemia intermedia, also may occur with two mutated genes.
Risk factors
Factors that increase your risk of thalassemia include:

Family history of thalassemia. Thalassemia is passed from parents to children through mutated hemoglobin genes. If you have a family history of thalassemia, you may have an increased risk of the condition.
Certain ancestry. Thalassemia occurs most often in African-Americans and in people of Mediterranean and Southeast Asian ancestry.
Complications
Possible complications of thalassemia include:

Iron overload. People with thalassemia can get too much iron in their bodies, either from the disease or from frequent blood transfusions. Too much iron can result in damage to your heart, liver and endocrine system. This system includes hormone-producing glands that regulate processes throughout your body.
Infection. People with thalassemia have an increased risk of infection. This is especially true if you've had your spleen removed.
In cases of severe thalassemia, the following complications can occur:

Bone deformities. Thalassemia can make your bone marrow expand, which causes your bones to widen. This can result in abnormal bone structure, especially in your face and skull. Bone marrow expansion also makes bones thin and brittle, increasing the chance of broken bones.
Enlarged spleen (splenomegaly). The spleen helps your body fight infection and filter unwanted material, such as old or damaged blood cells. Thalassemia is often accompanied by the destruction of a large number of red blood cells. This causes your spleen to enlarge and work harder than normal. Splenomegaly can make anemia worse, and it can reduce the life of transfused red blood cells. If your spleen grows too big, your doctor may suggest surgery to remove it (splenectomy).
Slowed growth rates. Anemia can cause a child's growth to slow. And thalassemia may cause a delay in puberty.
Heart problems. Heart problems — such as congestive heart failure and abnormal heart rhythms (arrhythmias) — may be associated with severe thalassemia.

Tennis elbow
Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.

Despite its name, athletes aren't the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. Pain can also spread into your forearm and wrist.

Rest and over-the-counter pain relievers often help relieve tennis elbow. If conservative treatments don't help or if symptoms are disabling, your doctor might suggest surgery.


Symptoms
The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to:

Shake hands or grip an object
Turn a doorknob
Hold a coffee cup
When to see a doctor
Talk to your doctor if self-care steps such as rest, ice and use of over-the-counter pain relievers don't ease your elbow pain and tenderness.

Causes
Tennis elbow is an overuse and muscle strain injury. The cause is repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in a series of tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow.

As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. However, many other common arm motions can cause tennis elbow, including:

Using plumbing tools
Painting
Driving screws
Cutting up cooking ingredients, particularly meat
Repetitive computer mouse use
Risk factors
Factors that may increase your risk of tennis elbow include:

Age. While tennis elbow affects people of all ages, it's most common in adults between the ages of 30 and 50.
Occupation. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers and cooks.
Certain sports. Participating in racket sports increases your risk of tennis elbow, especially if you employ poor stroke technique.

A tooth abscess is a pocket of pus that's caused by a bacterial infection. The abscess can occur at different regions of the tooth for different reasons. A periapical (per-e-AP-ih-kul) abscess occurs at the tip of the root, whereas a periodontal (per-e-o-DON-tul) abscess occurs in the gums at the side of a tooth root. The information here refers specifically to periapical abscesses.

A periapical tooth abscess usually occurs as a result of an untreated dental cavity, an injury or prior dental work.

Dentists will treat a tooth abscess by draining it and getting rid of the infection. They may be able to save your tooth with a root canal treatment, but in some cases the tooth may need to be pulled. Leaving a tooth abscess untreated can lead to serious, even life-threatening, complications.

Symptoms
Signs and symptoms of a tooth abscess include:

Severe, persistent, throbbing toothache that can radiate to the jawbone, neck or ear
Sensitivity to hot and cold temperatures
Sensitivity to the pressure of chewing or biting
Fever
Swelling in your face or cheek
Tender, swollen lymph nodes under your jaw or in your neck
Sudden rush of foul-smelling and foul-tasting, salty fluid in your mouth and pain relief, if the abscess ruptures
Difficulty breathing or swallowing
When to see a doctor
See your dentist promptly if you have any signs or symptoms of a tooth abscess.

If you have a fever and swelling in your face and you can't reach your dentist, go to an emergency room. Also go to the emergency room if you have trouble breathing or swallowing. These symptoms may indicate that the infection has spread deeper into your jaw and surrounding tissue or even to other areas of your body.

Causes
A periapical tooth abscess occurs when bacteria invade the dental pulp — the innermost part of the tooth that contains blood vessels, nerves and connective tissue.

Bacteria enter through either a dental cavity or a chip or crack in the tooth and spread all the way down to the root. The bacterial infection can cause swelling and inflammation at the tip of the root.

Risk factors
These factors may increase your risk of a tooth abscess:

Poor dental hygiene. Not taking proper care of your teeth and gums — such as not brushing your teeth twice a day and not flossing — can increase your risk of tooth decay, gum disease, tooth abscess, and other dental and mouth complications.
A diet high in sugar. Frequently eating and drinking foods rich in sugar, such as sweets and sodas, can contribute to dental cavities and turn into a tooth abscess.
Dry mouth. Having a dry mouth can increase your risk of tooth decay. Dry mouth is often due to the side effect of certain medications or aging issues.
Complications
A tooth abscess won't go away without treatment. If the abscess ruptures, the pain may decrease significantly — but you still need dental treatment. If the abscess doesn't drain, the infection may spread to your jaw and to other areas of your head and neck. You might even develop sepsis — a life-threatening infection that spreads throughout your body.

If you have a weakened immune system and you leave a tooth abscess untreated, your risk of a spreading infection increases even more.

Prevention
Avoiding tooth decay is essential to preventing a tooth abscess. Take good care of your teeth to avoid tooth decay:

Use fluoridated drinking water.
Brush your teeth at least twice a day with a fluoride toothpaste.
Use dental floss or an interdental cleaner to clean between your teeth on a daily basis.
Replace your toothbrush every three or four months, or whenever the bristles are frayed.
Eat healthy food, limiting sugary items and between-meal snacks.
Visit your dentist for regular checkups and professional cleanings.
Consider using an antiseptic or a fluoride mouth rinse to add an extra layer of protection against tooth decay

Tachycardia is a common type of heart rhythm disorder (arrhythmia) in which the heart beats faster than normal while at rest.

It's normal for your heart rate to rise during exercise or as a physiological response to stress, trauma or illness (sinus tachycardia). But in tachycardia (tak-ih-KAHR-dee-uh), the heart beats faster than normal in the upper or lower chambers of the heart or both while at rest.

Your heart rate is controlled by electrical signals sent across heart tissues. Tachycardia occurs when an abnormality in the heart produces rapid electrical signals that quicken the heart rate, which is normally about 60 to 100 beats a minute at rest.

In some cases, tachycardia may cause no symptoms or complications. But if left untreated, tachycardia can disrupt normal heart function and lead to serious complications, including:

Heart failure
Stroke
Sudden cardiac arrest or death
Treatments, such as drugs, medical procedures or surgery, may help control a rapid heartbeat or manage other conditions contributing to tachycardia.

Types of tachycardia
There are many different types of abnormal tachycardia. They're classified according to the origin and cause of the abnormally fast heartbeat. Common types of tachycardia include:

Atrial fibrillation. Atrial fibrillation is a rapid heart rate caused by chaotic, irregular electrical impulses in the upper chambers of the heart (atria). These signals result in rapid, uncoordinated, weak contractions of the atria.

Atrial fibrillation may be temporary, but some episodes won't end unless treated.

Atrial fibrillation is the most common type of tachycardia. Most people with atrial fibrillation have some structural abnormalities of the heart related to underlying conditions such as heart disease or high blood pressure. Other factors that may contribute to atrial fibrillation include a heart valve disorder, hyperthyroidism or heavy alcohol use.

Atrial flutter. In atrial flutter, the heart's atria beat very fast but at a regular rate. The fast rate results in weak contractions of the atria.

Atrial flutter is caused by irregular circuitry within the atria. Episodes of atrial flutter may resolve themselves or may require treatment.

People who experience atrial flutter also often experience atrial fibrillation at other times.

Supraventricular tachycardia (SVT). Supraventricular tachycardia is an abnormally fast heartbeat that originates somewhere above the ventricles. It's caused by abnormal circuitry in the heart that is usually present at birth and creates a loop of overlapping signals.
Ventricular tachycardia. Ventricular tachycardia is a rapid heart rate that originates with abnormal electrical signals in the lower chambers of the heart (ventricles). The rapid heart rate doesn't allow the ventricles to fill and contract efficiently to pump enough blood to the body.

Ventricular tachycardia episodes may be brief and last only a couple of seconds without causing harm. But episodes lasting more than a few seconds can become a life-threatening medical emergency.

Ventricular fibrillation. Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body. This can be fatal if the heart isn't restored to a normal rhythm within minutes with an electric shock to the heart (defibrillation).

Ventricular fibrillation may occur during or after a heart attack. Most people who experience ventricular fibrillation have an underlying heart disease or have experienced serious trauma, such as being struck by lightning.

Symptoms
When your heart is beating too fast, it may not pump blood effectively to the rest of your body. This can deprive your organs and tissues of oxygen and can cause the following tachycardia-related signs and symptoms:

Shortness of breath
Lightheadedness
Rapid pulse rate
Heart palpitations — a racing, uncomfortable or irregular heartbeat or a sensation of "flopping" in the chest
Chest pain
Fainting (syncope)
Some people with tachycardia have no symptoms, and the condition is only discovered during a physical examination or with a heart-monitoring test called an electrocardiogram.

When to see a doctor
A number of conditions can cause a rapid heart rate and tachycardia symptoms. It's important to get a prompt, accurate diagnosis and appropriate care. See your doctor if you or your child experiences any tachycardia symptoms.

If you faint, have difficulty breathing or have chest pain lasting more than a few minutes, get emergency care, or call 911 or your local emergency number. Seek emergency care for anyone experiencing these symptoms.

Causes
Tachycardia is caused by something that disrupts the normal electrical impulses that control the rate of your heart's pumping action. Many things can cause or contribute to problems with the heart's electrical system. These include:

Damage to heart tissues from heart disease
Abnormal electrical pathways in the heart present at birth (congenital heart conditions, including long QT syndrome)
Disease or congenital abnormality of the heart
Anemia
Exercise
Sudden stress, such as fright
High or low blood pressure
Smoking
Fever
Drinking too much alcohol
Drinking too many caffeinated beverages
Medication side effects
Abuse of recreational drugs, such as cocaine
Imbalance of electrolytes, mineral-related substances necessary for conducting electrical impulses
Overactive thyroid (hyperthyroidism)
In some cases, the exact cause of tachycardia can't be determined.

The heart's electrical system
To understand the causes of heart rate or rhythm problems such as tachycardia, it helps to understand how the heart's internal electrical system works.

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by a natural pacemaker called the sinus node, which is located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat.

From the sinus node, electrical impulses travel across the atria, causing the atrial muscles to contract and pump blood into the ventricles.

The electrical impulses then arrive at a cluster of cells called the atrioventricular (AV) node — usually the only pathway for signals to travel from the atria to the ventricles.

The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body.

When anything disrupts this complex system, it can cause the heart to beat too fast (tachycardia), too slow (bradycardia) or with an irregular rhythm.

Risk factors
Any condition that puts a strain on the heart or damages heart tissue can increase your risk of tachycardia. Lifestyle changes or medical treatment may decrease the risk associated with the following factors:

Heart disease
High blood pressure
Sleep apnea
Overactive or underactive thyroid
Smoking
Diabetes
Heavy alcohol use
Heavy caffeine use
Use of recreational drugs
Psychological stress or anxiety
Anemia
Other risk factors
Other factors that may increase the risk of tachycardia include:

Older age. Aging-related wear on the heart makes you more likely to develop tachycardia.
Family. If you have a family history of tachycardia or other heart rhythm disorders, you may have an increased risk of tachycardia.
Complications
Complications of tachycardia vary in severity depending on factors such as the type of tachycardia, the rate and duration of rapid heart rate, and the existence of other heart conditions. Possible complications include:

Blood clots that can cause a stroke or heart attack
Inability of the heart to pump enough blood (heart failure)
Frequent fainting spells or unconsciousness
Sudden death, usually only associated with ventricular tachycardia or ventricular fibrillation
Prevention
The most effective way to prevent tachycardia is to maintain a healthy heart and reduce your risk of developing heart disease. If you already have heart disease, monitor it and follow your treatment plan to lower your tachycardia risk.

Prevent heart disease
Treat or eliminate risk factors that may lead to heart disease. Take the following steps:

Exercise and eat a healthy diet. Live a heart-healthy lifestyle by exercising regularly and eating a healthy, low-fat diet that's rich in fruits, vegetables and whole grains.
Maintain a healthy weight. Being overweight increases your risk of developing heart disease.
Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take medications as prescribed to correct high blood pressure (hypertension) or high cholesterol.
Stop smoking. If you smoke and can't quit on your own, talk to your doctor about strategies or programs to help you break a smoking habit.
Drink in moderation. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. For some conditions it's recommended that you completely avoid alcohol. Ask your doctor for advice specific to your condition.
Don't use recreational drugs. Don't use stimulants, such as cocaine. Talk to your doctor about an appropriate program for you if you need help ending recreational drug use.
Use over-the-counter medications with caution. Some cold and cough medications contain stimulants that may trigger a rapid heartbeat. Ask your doctor which medications you need to avoid.
Limit caffeine. If you drink caffeinated beverages, do so in moderation (no more than one to two beverages daily).
Control stress. Avoid unnecessary stress and learn coping techniques to handle normal stress in a healthy way.
Go to scheduled checkups. Have regular physical exams and report any signs or symptoms to your doctor.
Monitor and treat existing heart disease
If you already have heart disease, you can take steps to lower your risk of developing tachycardia or another arrhythmia:

Follow the plan. Be sure you understand your treatment plan, and take all medications as prescribed.
Report changes immediately. If your symptoms change or get worse or you develop new symptoms, tell your doctor immediately.

Swine Influenza

What is Swine Influenza?

Swine influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that regularly cause outbreaks of influenza in pigs. Swine flu viruses can cause high levels of illness in swine herds, but usually, cause few deaths. Common signs in sick pigs include fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed. However, influenza-infected pigs also may not appear ill or be only mildly ill. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks of seasonal influenza in humans.

What is a variant influenza virus?

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant influenza virus.” For example, if a swine influenza A H3N2 virus is detected in a person, that virus will be called an “H3N2 variant” virus or “H3N2v” virus.

Can humans be infected with swine influenza viruses?

Yes. Swine flu viruses do not normally infect humans, however, sporadic human infections with influenza viruses that normally infect swine have occurred. When this happens, these viruses are called “variant viruses.” Most commonly, human infections with variant viruses have occurred in people exposed to infected pigs. In addition, there have been documented cases of multiple persons becoming sick after exposure to one or more sick pigs. Also, cases of limited person-to-person spread of variant viruses have occurred.

Why are human infections with variant viruses of concern?

Influenza viruses that infect pigs may be different from human influenza viruses. Thus, influenza vaccines made against human influenza viruses are generally not expected to protect people from influenza viruses that normally circulate in pigs. In addition, because pigs are susceptible to avian, human and swine influenza viruses, they potentially may be infected with influenza viruses from different species at the same time. If this happens, it is possible for the genes of these viruses to mix and create a new virus. This type of major change in the influenza A viruses is known as antigenic shift. If this new virus causes illness in people and can be transmitted easily from person-to-person, an influenza pandemic can occur.

What symptoms do people have when they are infected with variant viruses?

People who have been infected with variant viruses have had symptoms similar to the symptoms of regular human seasonal influenza. These include fever, lethargy, lack of appetite and coughing. Some people also have reported runny nose, sore throat, eye irritation, nausea, vomiting and diarrhea.

How are variant influenza viruses spread?

Influenza viruses can be directly transmitted from pigs to people and from people to pigs. These infections have most commonly been reported after close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Infected pig cough or sneeze and droplets with influenza virus in them can spread through the air. If these droplets land in your nose or mouth, or are inhaled, you can be infected. There also is some evidence that you might get infected by touching a surface with the virus on it and then touching your mouth or nose. A third way to possibly get infected is to inhale droplets or dust containing influenza virus. Scientists aren’t really sure which of these ways of spread is the most common. Human-to-human transmission of variant flu viruses also has occurred, though this method of spread has been limited. This kind of transmission is thought to occur in the same way that seasonal flu transmits in people, which is mainly through coughing or sneezing by people who are infected. People also may become infected by touching something with flu viruses on it and then touching their mouth or nose. It’s important to note that in most cases, variant flu viruses have not shown the ability to spread easily and sustainably from person to person

How can human infections with variant influenza viruses be diagnosed?

To diagnose variant influenza A virus infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some people, especially children, may shed virus longer. H1N1 pandemic, state health departments have the ability to test for novel (non-human) influenza viruses. However, if a variant influenza virus is suspected, it is sent for further testing.

What medications are available to treat variant flu infections in humans?

There are three different antiviral drugs that are recommended for the treatment of influenza: oseltamivir, peramivir and zanamivir.