Vitamins

Vitamins are dietary substances required by the body in very small amounts for normal biochemical function. There are two major groups: water-soluble vitamins (the B vitamins and vitamin C ), and the fat-soluble vitamins A, D, E and K. Intensive research into their sources, their function and our requirements for them has been going on over the last sixty years or so and we now know a great deal about them.

Vitamin A. The term vitamin A covers several fat-soluble compounds including retinal, which is the most important component, and two lesser components, retinal and retinoic acid. Vitamin A is only found in animal produce but various vitamin-A-type compounds, the most important of which is beta-carotene, are found in vegetables, and these are water-soluble.

All of them are fat-soluble, are sensitive to light and are easily oxidized.

Though the deficiency signs of vitamin A were recognized in ancient Egyptian times, it was only in the century that its chemical nature was elucidated. Two researchers recognized a substance described as “fat-soluble A” as being a growth-promoting factor in animals. Later it was shown that vitamin A activity was present in plants in the yellow pigments known as carotenes.

What it does.

The most important and well-known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye (xerophthalmia) and corneal changes; also, the normal function of the retina, the part of the eye involved with vision, and particularly the function of the light-sensitive areas of the eye, are dependent upon there being sufficient vitamin A. Vitamin A is involved in a number of other bodily functions. It is important in maintaining the stability of cell membranes and this may be clinically important. Furthermore, beta-carotene is the most effective receptor of free radical oxygen and this may be relevant in situations involving cancer, inflammatory disease and atherosclerosis, in which free radical mechanisms are thought to play a part.

A connection between vitamin A and zinc metabolism has been described by several researchers. It appears that in severe zinc deficiency the formation of the protein which carries vitamin A, retinolbinding protein, is described. Zinc is an important constituent of many enzymes, including one found in the retina that is involved in vitamin A metabolism. Night blindness which does not improve with vitamin A supplements has been described in zinc deficient individuals, particularly in alcoholics with liver disease who are often vitamin A and zinc deficient.

In diseases such as alcoholic cirrhosis, pancreatic disease and cystic fibrosis, zinc and vitamin A and other deficiencies also often occur together.

Food sources:

The major dietory sources are from animal produce, which provides vitamin A-retinol – usually combined with a fatty acid. As vitamin A is stored in animal and fish livers, these provide the most concentrated sources. Others include kidneys, eggs, milk and butter. Margarine is, by law, fortified with vitamin A. Good vegetable sources include any green, yellow or orange-pigmented produce; the darker the colour, the higher the content of beta-carotine. Carrots, spinach, cabbage and orange and yellow fruits are the best sources.

Deficiency symptoms and signs.

Vitamin A deficiency, one of the commonest and most serious world-wide nutritional deficiencies, occurs in people who have malabsorption states. In particular, anyone with fatty stools caused by pancreatic disease, biliary obstruction, or small bowel disease, is at risk.

The earliest symptoms of vitamin A deficiency include night blindness (difficulty in seeing well in dim light ) and dryness of the eyes.

Skin signs of vitamin A deficiency include follicular hyperkeratosis, a condition in which the whole hair follicle and its adjacent skin is raised by a plug of horny keratin. Dryness of the skin can be a feature of vitamin A deficiency but this may be due to an associate essential fatty acid deficiency or a deficiency of other micronutrients such as vitamin B complex.

Vitamin C and zinc are involved in fatty acid metabolism. Deficiency can occur without skin signs.

In general vitamin A deficiency is associated with poor growth and development, and impaired resistance to infection.

HEMOCHROMATOSIS ?

S. Foster’s health began to collapse in 1990, during her second pregnancy.

“It was like somebody hit me over the head with a sledge hammer.” She had no energy. Her joints ached. She walked like a drunk woman. Some days she was so tired she couldn’t move from the couch. She would sit in her husband’s lap and cry and tell him, “Just put me in a home when I can’t go any more.”

Foster visited a dozen doctors and investigated every explanation she could think of: Mercury poisoning? Copper poisoning? Multiple sclerosis? No one could tell her what was wrong with her. It wasn’t until 1995 that she got an answer: hemochromatosis.

Hemochromatosis is an inherited blood disorder that causes the body to store excess iron. A normal person’s body absorbs the iron that it needs and lets the rest pass through. But people with hemachromatosis have no shut-off mechanism. Their bodies absorb and absorb, storing the extra iron in the joints, liver, heart and pancreas. This can cause arthritis, cirrhosis of the liver, diabetes, heart problems – and eventually, death.

Hemochromatosis is the most common genetic disorder in the US. More than a million Americans have hemochromatosis, and another 10% carry one gene for the disorder.

“It’s much more common than people realize,” said Dr. R.Brodkin, a Winston-Salem hematologist.

The good news is that treatment is simple. Patients can control iron levels simply by giving blood. How often patients need to give depends on how much iron they have absorbed.

Foster gave 36 pints of blood in 39 weeks. “After giving the blood, almost immediately, I felt a little bit lighter,” she said.

But losing that much blood took its toll. At times, she felt more exhausted than she had before. But a few months after she finished the intense bloodletting, her health returned.

“I feel much better. I still have joint pain. That will be lifelong.” But, she said, “I feel like a suit of armor has been lifted off my body.”

She now gives a pint of blood three or four times a year.

Foster, 38, is a nurse at High Point Regional Hospital. But in all of her years of nursing she never heard the word hemochromatosis until her mother, who suffers from liver disease, visited a new doctor who tested her blood and told her that she had the disorder. After Foster read about it, she was sure that she had it too. Blood tests and a liver biopsy confirmed her suspicions. More tests revealed that an aunt, an uncle and both of her sisters have hemochromatosis as well. She believes that her father, who died a number of years ago of a massive heart attack, also had it.

Throughout her experience, Foster has been frustrated by many doctors’ lack of knowledge or interest in hemochromatosis. “The ignorance is just rampant in the medical community.”

Dr.G.Block agrees. He is a graduate of Bowman Gray School of Medicine and the medical director of the Hemochromatosis Center at the University of Pittsburgh Medical Center Health System.

Studies have shown that it takes patients with full-blown hemochromatosis an average of 3 ½ to 5 years and seven to 11 doctors to get a diagnosis, he said. And until about a year ago, professors devoted maybe five minutes of medical school time to hemochromatosis and told students that the disorder was extremely rare.

A new genetic test is raising the disorder’s profile.

Before the development of the test, doctors couldn’t identify hemochromatosis until it had already caused a lot of damage. And determining whether hemochromatosis or something else was causing the problem required a liver biopsy, a relatively painful and involved procedure. Now the genetic test provides a quicker, easier answer.

The test isn’t perfect. It identifies only 85% of people with hemochromatosis, Block said. The other 15% of people with the disorder got it through some other gene problem doctors can’t identify yet.

One reason that doctors didn’t catch the disorder earlier, Brodkin and Block said, is because most insurance companies don’t cover the routine iron-level screenings that would indicate a problem.

The tests aren’t that expensive, usually between $60 to $120. And studies show that the average undiagnosed hemochromatosis patient racks up $20,000 a year in medical bills, according to David Snyder. Snyder is the executive director and vice president of the American Hemochromatosis Society.

The society is educational and advocacy group that is pushing blood banks to accept hemochromatosis patients’ blood. Right now patients must go to a doctor and pay to have blood drawn.

“There’s nothing wrong with the blood,” Brodkin said. “It would be very safe for this blood to be used for transfusions, but the Red Cross won’t accept it.” It is also pushing for genetic testing for all newborns.

He said that currently, only about 3% of all people with hemochromatosis know that they have the disorder.

People who are carriers need to know that, too, he said. Carriers can have somewhat elevated iron levels, Brodkin said. And being a carrier can worsen certain existing problems, such as liver disease or heart trouble. Also, if two carriers marry, they have a 25% chance of passing the disease on to their children.

The need-to-know is what has Foster out talking to anyone who asks about hemochromatosis.

“One of the reasons I do this is because I know there’s another Shiryl out there, who thinks she’s lost her mind, who thinks she’s just a whiner.”

ANEMIA

Anemia, one of the more common disorders, occurs when the number of healthy red blood cells decreases in the body. The disc-shaped red blood cells contain hemoglobin, a unique molecule that carries oxygen to the body’s tissues.

Anemia occurs for different reasons. These include: 1. increased destruction (break down) of red blood cells (RBCs); 2. increased blood loss from the body; 3. inadequate production of red blood cells by the bone marrow.

In some cases anemia results from an inherited disorder, whereas in other cases the condition is caused by something in a person’s environment, such as a nutritional problem, infection, or exposure to a drug or toxin.

Signs and symptoms of the disease:

The most common sign of iron deficiency and other types of nutritional anemia is mild paleness of the skin, along with decreased pinkness of the lips, the lining of the eyelids, and the nail beds. A friend or relative who sees your child only occasionally may be more likely to notice this than you because the changes usually happen so gradually.

Other common signs of anemia may include: irritability, fatigue, dizziness, lightheadedness, and a rapid heartbeat.

Depending on the condition causing the anemia, other signs and symptoms may occur, such as jaundice (yellow-tinged skin), dark tea-colored urine, easy bruising or bleeding, and enlargement of the spleen or liver.

In infants and preschool children, iron-deficiency anemia can result in development delays and behavioral disturbances, such as decreased motor activity and problems with social interaction and attention to tasks. Recent research studies indicate that behavioral problems may persist into and beyond school age if the iron deficiency is not properly treated.

Diagnosing anemia: In many cases doctors don’t discover anemia until they run blood tests as part of a routine physical examination. A complete blood (CBC) may indicate that there are fewer red blood cells than normal.

Caring for a child with anemia: the type, cause and severity of the child’s anemia will determine what kind of care she needs. In general, though if your child has significant anemia, she may tire more easily than other children and therefore need to limit her activity. Make sure that her teachers and other caregivers are aware of her condition. If iron deficiency is the cause, follow her doctor’s directions about dietary changes and iron supplementation.

If the spleen is enlarged, your child may be prohibited from playing contact sports because of the risk of rupture and hemorrhage.

Treatment for anemia depends on the cause of the condition. It’s important not to assume that any symptoms your child may be having are due to iron deficiency. Be sure to have her checked by a doctor, and don’t attempt to treat her yourself before doing so.

If a certain medication appears to be the cause, your child’s doctor may discontinue it or replace it with something else – unless the benefit of the drug outweighs this side effect. If an infection is the cause, the anemia will usually get better when the infection passes on its own or it is cured by treatment.

Treatment for more severe or chronic forms of anemia may include (depending on the cause): 1. transfusions of normal red blood cells taken from a donor; 2. removal of the spleen or treatment with medications to prevent blood cells from being removed from the circulation or destroyed too rapidly; 3. medications to fight infection or stimulate the bone marrow to make more blood cells.

Whether anemia can be prevented depends on the cause of the condition. Presently there is no way to prevent anemia that is caused by genetic defects affecting the production of red blood cell or hemoglobin.

However there are steps you can take to help prevent iron deficiency – the most common form of anemia. Before following any of these suggestions, be sure to talk them over with your child’s doctor.

C. Тексты для чтения без словаря и передачи содержания на русском языке.

SLEEP

The growing organism must have efficient sleep. The newborn baby whose mechanism is largely vegetative sleeps from 20 to 22 hours out of 24. From this time on the amount of sleep required gradually decreases. At 6 months the average length of sleep is from 16 to 18 hours and at 1 year from 14 to 16. From the second to the six year 12 hours at night and a daily nap or rest meet the needs.

The decrease in sleeping hours should always be made at the expense of the day sleep. At 6 months the baby usually sleeps 2 hours in the forenoon and 2 in the afternoon. The afternoon period should be over by 3 p.m. One of these periods is gradually shortened until the second year but one nap a day is taken, and this should be continued until the sixth year. Even if children of 5 or 6 no longer sleep they should be made to rest in bed alone in the room, without toys and books.

The infant and the child should sleep alone. The bed clothing must vary with the season and the weight should never be too heavy or too light. Sleeping without pillows is best and if the child is trained this way pillows are not liked or needed. Sleeping out of doors when it is not too cold is advisable if it is available; otherwise the windows should be always open. Some children require more sleep than others. Every child must have, however, a certain minimum. The bed hour should be quieting. Rough play and intense excitement at this time are apt to delay the on-coming of sleep. When the child wakes from the nap or night rest it is important to teach habits of rapid dressing, and to prevent dallying and playing until dressing is complete and the morning toilet is finished.

PAIN IN THE HEAD

Pain is nature’s way of telling us that the body has a problem that needs attention. In most instances we know that there is no serious cause for concern, but this does not mean that we have to put up with the associated discomfort and subsequent disruption to our daily routines. The information contained in this article has therefore been designed to prove simple advice on the most effective ways to treat the variety of aches and pains that are commonly encountered.

All of us suffer from the occasional headache and fortunately in the majority of cases they tend to be an irritation rather than a serious problem. The four most common types of headache are described below with some tips for appropriate treatment:

Tension Headaches are usually a direct result of stress, including anxiety and tiredness, and are caused by a tightening of muscles in the shoulders, neck and head. The pain is frequently described as a heavy weight pressing down on the head. It follows that if we are able to identify and avoid stressful situations we may be able to prevent these headaches occurring. If not, anything helping to relax the muscles, for example a soak in a warm bath or a massage, should help relieve the problem.

Migraines are associated with severe pain and are sometimes confused with bad headaches. However they usually affect one side of the head and sometimes an attack is preceded by an “aura” – a period of strange sensations affecting sight, hearing and sometimes the voice. Symptoms include nausea and vomiting and sufferers tend to need to lie down in the dark. Some people are able to identify certain “triggers” responsible for their migraine attacks. Often it will be a certain food, like cheese, chocolate or red wine. It is thought that the actual pain is due to alternate contraction and expansion of blood vessels in the brain, caused by the action of chemicals in the blood. If you are prone to migraines, it is advisable to consult your doctor who may be able to prescribe a medicine to help prevent attacks developing beyond the early stages.

Sinus Headaches are usually easy to recognize but can be extremely painful. They occur when our sinuses are congested, for example, during a bad cold, and are often accompanied by a feeling of pressure on either side of the nose or below the eyes. Using a decongestant spray or vaporiser to unblock the sinuses is helpful in the relief of this type of headache.

Hangovers are famous for their association with the headache. Excessive alcohol can cause low blood sugar levels and dehydration, both of which contribute to the problem. In addition some alcoholic drinks, particularly highly coloured ones like red wine, contain substances called ‘congeners’ which also cause headaches. Naturally the best way to avoid hangovers is to drink only in moderation. If not try and stick to the clearer drinks like vodka and white wine, and drink a pint or two of water before bed.

STRAINS AND SPRAINS

There can be any one of a number of causes for muscle strain or injury. It may be an one-off accident caused by sudden twisting or turning on the sport field. It may be over-use, for example after a long walk if you are not used to taking regular exercise.

Strains and sprains should be treated using the RICE principle:

R – rest the injured area to aid healing and prevent further damage.

I – ice or freeze spray to cool inflammation and reduce swelling (heat treatments should never be used until 2 or 3 days after the injury has been sustained).

C – compress by bandaging. This provides support for the injured area.

E - elevate the damaged limb to lessen swelling and bruising.

Analgesics containing ibuprofen or aspirin are ideal for such problems as they treat the inflammation as well as the pain. These are also appropriate for the more general aches and pains common after over exertion. But as always, prevention is better than cure, so always take the time to warm up properly any sports activity and ensure you are wearing clothing, especially shoes, that won’t restrict movement and lead to damage.

Sportsmen and women, the elderly young children are particularly susceptible to more serious muscular or soft tissue injuries. In general a doctor’s advice should be sought when swelling has not subsided after 72 hours, the injury cannot bear any weight, or there is extensive or persistent bruising.

WATCH YOUR BACK

Back problems vary in severity. For some people a bad back means the odd twinge while for others it can be completely disabling and agonisingly painful.

There are many causes of back pain, including things like pregnancy, kidney infections and obesity. The majority of problems however, result from damage to the mechanical structure of the back which is put under constant stress as we go about our daily activities.

The following points provide simple self-help measures to help protect your back from everyday stresses: - Posture – always keep the back straight when seated or standing; A well-sprung bed will support the spine during sleep. A firm board under the mattress provides additional support; Work surfaces should be adjusted to a height which does not require bending; If overweight, losing a few pounds will ease the strain on the back; When carrying heavy objects, keep them close to the body and the spine straight. Bend the knees not the back when picking things up and putting them down. When carrying heavy shopping, distribute the load evenly between both hands – better still use a rucksack; The elderly should try and take regular, gentle exercise to maintain flexibility and strength of muscles and ligaments.

Pain resulting from back injuries can be treated in a similar way to muscular strains, as outlined above. Anti-inflammatory analgesics are now available in a gel form at your UniChem Pharmacy. These can be applied directly to the area causing discomfort for immediate relief. However if pain should persist beyond three days it is advisable to see your doctor who may recommend further treatment. Always ask your doctor to suggest a reputable osteopath, chiropractor or physiotherapist, if you want to try alternative approaches.

CROUP

Spasmodic croup without fever. Croup is the word commonly used for various kinds of laryngitis in children. There is usually a hoarse, ringing, barking cough (croupy cough) and some tightness in the breathing.

The commonest and mildest type, spasmodic croup without fever, comes on suddenly during the evening. The child may have been perfectly healthy during the day or have had the mildest kind of cold without cough. Suddenly he wakes up with a violent fit of croupy coughing, is quite hoarse and is having difficulty breathing. He struggles and heaves to get his breath in. It’s quite a scary picture when you see it the first time, but it’s not so serious as it looks. You should call the doctor promptly for any kind of croup.

The emergency treatment of croup, until the doctor can be reached, is moist air. Use a cold mist humidifier if you have one, or other ways to humidify. Carry the child into the bathroom and turn on the hot water in the bathtub or shower – to make steam, not to put the child into. If there is a shower, that will work best of all.

When the child breathes the moist air, the croup usually begins to improve rapidly. Meanwhile, the air in the room where he will go back to be should be moistened. An adult should stay awake as long as there are any symptoms of croup, sleep in the same room with the child for 3 nights, and wake herself 2 or 3 hours after the croup is over to make sure that the child is breathing comfortably.

Spasmodic croup without fever sometimes comes back the next night or two. To avoid this, have the child sleep in a room in which the air has been moistened for 3 nights. This form of croup is apparently caused by the combination of a cold infection, a child with a sensitive larynx, and dry air.

Severe croup with fever (laryngobronchitis). This is a more severe form of croup which is usually accompanied by a real chest cold. The croupy cough and the tight breathing may come on gradually or suddenly at any time of the day or night. Steaming only partly relieves it. If your child has hoarseness with fever or tightness of breathing with fever, he must be put under the close, continuous supervision of a doctor without delay. If you cannot reach your doctor right away, find another doctor. If a doctor cannot reach you, you should take the child to a hospital.

Diphtheria of the larynx is still another cause of croup. There is a gradually increasing hoarseness, cough, difficulty in breathing and moderate fever. There is practically no danger of this form of croup developing if a child has received diphtheria inoculations.

However with any form of croup, a child should be seen promptly by a doctor. The urgency is greatest when hoarseness and tight breathing are persistent.

(B.Spock. Baby and Child Care.)

COMMON INFECTIONS

Children with HIV infection have an increased frequency of minor bacterial infections such as otitis media, sinusitis, impetigo, cellulites, urinary tract infection, and pneumonia. More serious infections reported include meningitis, osteomyelitis, septic arthritis, deep tissue abscesses, and bacteremia. Although the majority of children have hypergammaglobulimia, some present with hypogammaglobulinemia and these children are particularly susceptible to infection. In children, the development of two or more serious bacterial infections within a 2-year period of time is an AIDS-defining condition. The causative organisms are usually common childhood pathogens, particularly Streptococcus pneumoniae, Haemophilus influenzae type b, and Salmonella species. In children in terminal stages of illnesses and with frequent hospitalizations, Staphylococcus aureus and Gramnegative pathogens, including Pseudomonas spp., take on increased importance.

This increased susceptibility to infection occurs as a result of B cell dysfunction induced by the virus, which leads to a decreased or absent antibody response to specific antigens. This dysfunction affects children to a greater extent than adults, probably because children are infected at a time when the immune response is immature and they do not have preexisting memory cells. The ability to produce antibody to a vaccine antigen can be used as a method to determine the response to other antigens in vivo and as an assessment of B cell function.

Children with HIV infection and recurrent infection may given from intravenous gamma globulin (IVIG) given monthly or bimonthly. A multicenter, doubleblind, placebo-controlled study comparing intravenous gamma globulin with an albumin placebo given to children with HIV infection showed that there was an increased time to development of a serious infection in those children with a CD4+ lymphocyte count greater than 200 mm³.

Tuberculosis continues to be public health problem in the USA. Since 1985, the number of cases have increased over the expected rate, and this is thought to be due to the increased number of cases among patients with HIV. Fourteen children with HIV infection with concomitant infection with tuberculosis have been reported. Of nine children reported from Miami, Florida, eight had pulmonary tuberculosis and four had extrapulmonary disease. Cough, fever, and anorexia were the most common symptoms at presentation. Only one child had a positive skin test reaction to purified protein derivative, and four had no known exposure to tuberculosis. In children with HIV infection, a tuberculin skin test reaction of 5 mm or greater is considered positive. In the severely immunodeficient child, the skin test for tuberculosis may not be reliable, and a control skin test using diphtheria toxoid or Candida antigen should be applied as a control to detect anergy. The diagnosis of pulmonary tuberculosis in the HIV-infected child should be suspected in the presence of perihilar or paratracheal nodes with a chronic lung infiltrate and in those children with pneumonia who are unresponsive to the usual antibiotic therapy. Diagnosis should be confirmed by culture of gastric aspirates in the young infant and child and sputum in older children. Initial therapy should include at least three drugs and these should be continued for at least a 1-year period. Short-course therapy or other abbreviated treatment schedules should not be used for therapy in this population. If multiple drug-resistant tuberculosis organisms are prevalent in the community, the four-drug therapy should be instituted pending results of culture and sensitivity. This epidemic has necessitated a reevaluation of the use of bacillus Calmette-Guerin (BCG) vaccine for those parts of the USA with a high incidence of tuberculosis and/or with a high incidence of drug-resistant strains of Mycobacterium tuberculosis.

D. Ориентирование в тексте.

QUITTING SMOKING

Many people who are addicted to tobacco believe that smoking has no effect on the heart, but the evidence is loaded against them. The nicotine in tobacco smoke increases your heart rate and raises your blood pressure, while the carbon monoxide cuts down the amount of oxygen that can be carried by your blood. The heart must work harder but has less oxygen supplied to it. If you smoke, the best way to reduce your risk of heart disease is to quit.

Everybody knows that smoking can cause cancer, but not everyone realizes how bad it is for the heart. Overall, cigarette smokers have a death rate from coronary heart disease that is 70% higher that that of nonsmokers. The more heavily you smoke 40 or more cigarettes a day, you are between two and three times more likely to die of heart disease than a nonsmoker.

Smoking also increases the likelihood of cerebrovascular disease (disorders of blood vessels in the brain) and thus increases the risk of stroke. It is also directly related to diseases of the arteries in the legs. Smokers make up at least 95 % of patients suffering from these diseases – which can result in gangrene and amputation of the leg.

Stop now.

A strong motivation to quit smoking is the most important factor in being successful. Some people find it easiest to go “cold turkey”, quitting all smoking at once. Many people benefit from behavior modification programs.

If you give up smoking, your risk of heart disease declines rapidly. For example, if you consume less than one pack of cigarettes a day and give up now, after about 3 years of not smoking your risk of heart disease is almost identical to that of a lifelong nonsmoker. As the years without tobacco pass, the risk diminishes for other diseases as well. Every day spent without smoking is an investment in your future health.

WHY DO YOU SMOKE?

Find the answer to the given questions:

1.Do you smoke out of sheer habit or whenever you are unoccupied?

2.Do you smoke because you need something to do with your hands or mouth?

3.Do you smoke only when you are with other smokers?

4.Do you smoke because you are truly addicted to nicotine?

5.Do you reach for your cigarettes as a way of relieving tension?

6.Do you smoke to help with tasks requiring mental concentration?

To help you stop smoking it is useful to think about your reasons for smoking and to decide what type of smoker you are. Answer these questions after careful consideration. Be honest in your assessment of your smoking habits. And remember – your desire to quit smoking is the most important and effective means of becoming an ex-smoker.

If so, you probably begin to feel restless and crave another cigarette a few minutes after finishing the previous one. You will do best with the “cold turkey” approach. Nicotine chewing gum, available by prescription, helps relieve withdrawal symptoms.

You must break your habit pattern. Delay your first cigarette by an hour each day, smoke less of each cigarette, don’t carry cigarettes, and sit in the “no-smoking” areas in restaurants and on airplanes. Also, try using your other hand to hold the cigarette.

If so, you probably have a problem with mental discipline. Physical exercise increases mental alertness and stamina and relieves depression, which will help you concentrate without cigarettes. In addition, it is difficult to smoke and exercise at the same time.

Many smokers reach for a cigarette to alleviate boredom. You may need a hobby that keeps your hands occupied and is mentally stimulating in a nonstressful way. To keep your mouth occupied, try chewing on coffee stirrers, toothpicks, or gum.

You may need to avoid socializing for a while with friends who smoke. This may seem to be a drastic measure, but consider it a short-term sacrifice that will add to the quality of your life. Once you have built up your resistance to the temptation to smoke, you can join them again.

In the long term, smoking can add to personal stress by impairing your health and thus your ability to cope with stress effectively. Learn some other ways of dealing with stressful situations. Smoking doesn’t solve any problems.

ASK YOUR DOCTOR QUITTING SMOKING

1.Q I’ve smoked for more than 30 years. Is stopping really going to help my heart now?

A It’s never too late. Studies show that ex-smokers are much less likely to have a heart attack than people who smoke. The risks associated with smoking decrease quickly in the first year of giving up.

2.Q My mother smoked 20 cigarettes a day all her life, and she died in her sleep when she was 92. Might I not be like her?

A There are always exceptions. In any case, your mother probably would have felt a lot healthier had she not smoked.

3.Q Is there any danger of becoming addicted to the nicotine chewing gum my doctor prescribed?

A Yes, but it’s not as bad for you as smoking because you are not inhaling carbon particles and carbon monoxide from the cigarettes.

Q I’d like to quit smoking, but I worry about gaining weight. Isn’t obesity just as bad for the heart?

A People do tend to put on weight when they quit smoking, but being overweight is not as bad for your heart as smoking. The average person gains only 5 to 10 pounds and some people don’t gain any weight.

Q A friend of mine underwent hypnosis to help him stop smoking. Does hypnosis work?

A Some smokers find it helpful, but it works only if you are motivated to quit.

NOTE: Тексты Quitting Smoking, Why do you smoke?, Ask your doctor quitting smoke могут быть использованы для ролевой игры “Round table talk: Quitting Smoking”.

DON’T PUSH YOUR KIDS TOO HARD

Dr.B.Spock on bringing up today’s children.

Find the answers to the questions:

Are children raised in single-parent homes more stressed than other kids?

How do working mothers affect kids?

Do parents harm kids by pushing them to achieve?

Dr. Spock, why are today’s children under stress?

Is watching television harmful to kids?

Are there specific things to avoid?

What kind of parents will today’s children make?

Do the new stresses on kids make them better equipped to deal with adult stresses?

Is it harder to be a parent today?

Partly because we’ve given up so many of the comforts and sources of security of the past, such as the extended family and the small, tightly knit community and the comfort and guidance that people used to get from religion.

It is stressful to children to have to cope with groups, with strangers, with people outside the family. That has emotional effects, and, if the deprivation of security is at all marked, it will have intellectual effects, too.

We know now that if there’s good day care it can substitute pretty well for parental care. But, though we’re the richest country the world has ever known, we have nowhere near the amount of subsidized day care we need. We’re harming our children emotionally and intellectually to the degree that they’re in substandard day care.

It’s not that a single parent can’t raise a child well but that it’s harder to raise a child in most cases with one parent than it is with two parents. The parents can comfort and consult and back up each other.

Our emphasis on fierce competition and getting ahead minimizes the importance of cooperation, helpfulness, kindness, lovingness. These latter qualities are the thing that we need much more than competitiveness. I’m bothered, for instance, at the way we coach young children in athletics and, even more ludicrous, the interest we focus on superkids. It hasn’t gone very far, but there are parents who, when they hear that other children are learning to read at the age of 2, think, “My God, we should be providing reading instruction, too,” without ever asking the most significant question: “Does it make the child a better reader or is there any other advantage to learning to read at 2 rather than waiting until age 6?” It imposes strains on children.

Absolutely no violence on television. Don’t give war toys. These are poisonous to children. This whole Rambo spirit is a distressing thing, especially in the most violent country in the world.

A lot of what they see brutalizes sexuality. In simpler societies, you don’t see people smashing each other in the face or killing each other. The average American child on reaching the age of 18 has watched 18,000 murders on TV. Yet we know that every time a child or an adult watches brutality, it desensitizes and brutalizes them to a slight degree. We have by far the highest crime rates in the world in such areas as murders within the family, rape, wife abuse, child abuse. And yet we’re turning out more children this way, with this horrible profusion of violence that children watch on TV. It’s a terrible thing.

No, human beings do make some adjustment to stresses, but that doesn’t mean that they’re doing better by being brought up with stresses. It’s going to make them more tense, more harsh, more intensely competitive and more greedy. I don’t think people can live by that. It is a spiritual malnutrition, just like a lack of vitamins or a lack of calories.

If they’re brought up with tension and harshness, then they’ll do the same with their children. Everybody acquires his attitude and behavior toward his children by how he was treated in his own childhood. What was done to you in childhood, you are given permission to do. To put it more positively, good parental standards are what make for a better society and poor parental standards are what make for a deteriorating society.

Yes. When I started pediatric practice in ’33, parents worried about polio and pneumonia. Now they have to worry about drugs and teenage pregnancy and nuclear annihilation.

NOTE: Text “Don’t push your kids too hard” may be used for the role game “Round table talk: On bringing up today’s children”.

LIVING OUT LOUD

Timothy Stevens has lived most of his life in a silent world. Until six months ago, he had never heard his mother’s voice, never listened to music and never heard the sound of birds singing or the laughter of his playmates.

#0- His mother, Sandra, knew that something was wrong with her baby son, because he did not have the same reactions as other babies. “If I didn’t look into Tim’s eyes, he didn’t seem to know I was there,” she says. When he was eight months old, Sandra took Timothy to the hospital and explained why she was worried. The doctors carried out hearing tests and decided that Timothy must be a little backward. #1-

Sandra insisted that the hospital should send Timothy to a specialist for more tests. Unfortunately, it was a long time before a specialist would see him. Finally, when he was almost two years old, Timothy and his mother went to a children’s hospital in Manchester where the staff had plenty of experience in dealing with deaf children.

#2- At last, someone believed her when she told them that her son was deaf. “Doctors often think that others worry too much about their children and that they always think the worst,” she smiles. “I knew I was right about Tim, but it took almost two years before the doctors would agree with me.” However, even Sandra had not imagined that Timothy’s condition could be as serious as it was.

#3- Doctors told Sandra that there was no chance that his hearing would ever improve. Sandra was shocked to learn that the only hope for Timothy was to have a bionic implant.

#4- The electrodes would send electric signals to his brain, which would allow him to hear them as sounds. The implant would not allow Timothy to hear perfectly, but it would be the only way for him to ever have a chance of overcoming his deafness. After checking that there was no serious risk involved, Sandra put Timothy’s name on the waiting list for the operation. Because he was so young, the doctors decided that Timothy should be given the implant as soon as possible.

#5- “I have to admit, I was very worried,” says Sandra, “but only hours after he came out of theatre, he was playing with the other children on the ward and I knew he was going to be fine! I couldn’t wait to find out whether or not the operation had been successful.” The moment of truth came on Timothy’s third birthday, when the doctors switched on the implant for the very first time. Timothy played with toys in the doctor’s surgery while a speech therapist played different sounds and checked his reactions. When Sandra said, “Hello Timothy,” and he looked into her eyes, she cried tears of happiness.

Timothy is now enjoying a life full of sound. #6- He is also attending the local nursery school where he likes nothing more than to make as much noise as possible as he plays with his friends.

Timothy celebrated his fourth birthday last week.

#7- “He is driving me mad with the noise he makes,” laughs Sandra, “and that’s something I never imagined I would complain about! For me, though, the greatest gift of all is to hear my son talking and to know that he can hear me when I speak to him.”

Find the right comment to each part of the text:

A – He has already learnt several words and phrases which allow him to communicate with his mother.

B - His presents included a variety of musical instruments which he loves to play with.

C - Sandra was relieved to find people who would listen to her.

D - A full examination showed that Timothy was completely deaf.

E - However, Sandra knew that the problem was more serious than that.

F - Timothy is only able to communicate by using sign language.

G - Three months before his third birthday, he went into hospital to have the operation that would change his life.

H - Timothy was born deaf.

I - This would mean having an operation to put a special receiver in Timothy’s head, with electrodes connected to the nerves in his ears.

E. Лексические тесты.

SLEEPING (1)

Every baby is different and has very 1..... needs. Your 2..... baby may need more than twenty hours of sleep a day or she may only 3..... twelve. You’ll find that your baby’s sleep 4..... is as individual as her fingerprint. We give you some information and practical hints to help you 5..... a sound sleep routine with your child.

After nine months of secure, warm comfort, your baby emerges into a strange world of daylight and darkness. For the first few months she’ll 6..... to make any distinction between the two and will 7..... and 8..... whenever it seems right to do so!

At the outset sleep is closely related to 9..... and most babies wake when they are 10..... . You’ll soon begin to recognize her own timetable and rhythms, which will 11..... when she wakes and for how long she remains 12..... at any one time.

As she grows 13..... she will need 14..... sleep as she becomes more and more interested in her surroundings. So by the time she’s about four months old, she 15..... to be wide awake for two or three periods each day. By establishing a pattern for her and by associating night with sleep you will help your baby to settle into a routine pattern of 16..... sleeping.

____________________________

1. be unable; 2. awake; 3. older; 4. require; 5. less; 6. night-time; 7. individual; 8. hungry; 9. newborn; 10. establish; 11. pattern; 12. newborn; 13. feeding; 14. determine; 15. sleep; 16. wake.

SLEEPING (2)

Your child may wake at night for a variety of 1..... . She may be hungry or thirsty, too 2..... or uncomfortably hot. She may just want a reassuring cuddle or she may be telling you that she is 3..... . She may wake 4..... because she’s poorly or teething. Most of these simply need practical 5..... or are situations that will resolve themselves in time.

Some children seem 6..... for no apparent reason. She may have had a vivid dream or have heard an 7..... noise outside. If she 8....., go to her and pacify her, but try not to bring her out of her room. Check that her room is cosy and quiet and 9..... that the curtains are thick enough to keep out the light. You may 10..... to keep a night light on.

Look at what has happened during the day. Is she getting 11..... enough or is she getting 12..... tired during the day? Can you 13..... anything which may be upsetting or frightening her? Try to avoid wild rough and tumbles just before bed too.

You could 14..... reading to her, rocking her to sleep, singing or playing gentle music. While it may be temping 15..... her into bed with you this habit can be very hard to break so it’s usually 16..... to leave her in her cot and let her settle there.

____________________________

1. at night; 2. unusual; 3. need; 4. better; 5. identify; 6. to take; 7. reasons; 8. action; 9. to wake; 10. cold; 11. tired; 12. wet; 13. make sure; 14. cries; 15. try; 16. too.

BLOOD

Blood is a fluid which 1..... though the arteries, capillaries and veins exchanging fluids and gases with the bodily 2..... . The latter receive the products 3..... from the food and oxygen taken up by the blood in its passage through the lungs, while the blood 4..... from the tissues carbonic acid gas and various waste products.

Composition. The blood 5..... of corpuscles in addition to the fluid is well-known. They are of the three 6..... : red corpuscles (erythrocytes), white corpuscles (leucocytes) and blood platelets (thrombocytes). In the fluid are dissolved the various salts and 7..... . We know the red corpuscles acting as the 8..... of oxygen, which acts as a medium of interchange between the 9..... of the air in the lungs, and the tissues requiring it. There are over 5000000 red corpuscles in every cubic millimeter of 10..... .

The white corpuscles are of 11..... different kinds, they have many functions to perform, of which the chief are repair of 12..... , the absorption of foreign bodies, and the 13..... of bacteria; their 14..... bodies being in large numbers form the matter or pus of abscesses.

Blood groups. People are 15..... , in respect of certain reaction of the blood, into four groups. Their being divided into these groups 16..... upon the capacity of the serum of one person’s blood to 17..... the red blood corpuscles of another’s. The reaction depends on antigens in the red corpuscles and 18..... in the serum. There are two of each, the antigens being known as A and B. Anyone’s blood 19..... may have (I) no antigens, (II) antigen A, (III) antigen B. (IV) antigens A and B: these are the four groups. The practical 20..... is that, in blood transfusion, the person giving and the person 21..... the blood should belong to the same blood group, or a 22..... reaction will take place from the agglutination.

____________________________

1. proteins; 2. several; 3. kinds; 4. dead; 5. receiving; 6. corpuscles; 7. circulates; 8. consisting; 9. removes; 10. dangerous; 11. destruction; 12. problem; 13. absorbed; 14. wounds; 15. divided; 16. blood; 17. antibodies; 18. agglutinate; 19. depends; 20. tissues; 21.carriers; 22. oxygen.

HYGIENE

Many infections such as gastroenteritis 1..... E coli, hepatitis A, typhoid and cholera are water-borne and can 2..... a holiday into a nightmare. Travellers 3..... be advised to give careful attention to personal 4..... , sterilization of drinking 5..... and to the hygiene with which food has been prepared. Breast feeding 6..... a safe, uncontaminated supply of food and water for 7..... and can usually be continued even if the mother 8..... an infection. For 9..... babies, supplies of a ready-to-feed pre-packed formula are ideal. Scrupulous 10..... must always be paid to sterilization of bottle feeds and equipment. Water should be 11..... , as should milk if not pre-packed. Sterilizing water with chlorine tablets is an 12..... method.

Hand 13..... before and after using toilet or changing nappies, sanitary wear or stoma bags is a sensible 14..... . If water is not 15..... , a supply of disposable moist antiseptic cloths is 16..... . Make sure that disposable items are safely wrapped before disposal.

____________________________

1. babies; 2. available; 3. hygiene; 4. turn; 5. useful; 6. due to; 7. boiled; 8. precaution; 9. water; 10. provides; 11. attention; 12. contracts; 13. alternative; 14. washing; 15. bottle-fed; 16. should.

F. САМОСТОЯТЕЛЬНОЕ ЧТЕНИЕ.

A brief overview of AIDS

Although we know that AIDS is caused by Human Immunodeficiency Virus (HIV), it was originally observed by its effects on the immune system. An important clue was that AIDS patients often had a lung infection or pneumonia caused by a member of the fungi family of organisms called Pneumocystis carinii. This infection is very rare in healthy individuals but patients with cancers of the immune system itself (lymphomas) are susceptible to this disease. Lymphomas are usually treated by chemotherapy, which is intended to destroy the cancer cells. However, chemotherapy, which is intended to destroy many healthy immune cells along with the cancerous lymphoma cells. Thus, this type of pneumonia predominantly occurs in patients with a damaged immune system. Examination of the immune system in AIDS patients confirmed that the cells of their immune systems were damaged. It had been known for some time that other various virus infections could damage as seen with AIDS was unprecedented. Although it was suspected early on that AIDS resulted from infection by a virus, it was not until 1984 that this virus was finally isolated by both French and American researchers. That virus is now known as HIV.

In addition to pneumonia, AIDS is associated with numerous other infections. These secondary infections are caused by various bacteria, protozoa, other fungi and other viruses. Usually, it is these infections (known as opportunistic infections) that cause death in AIDS patients. In addition to secondary infections AIDS patients frequently develop cancers, including lymphomas and an otherwise rare cancer called Kaposi’s sarcoma. HIV infection also can result in damage to brain cells. This leads to loss of mental function, referred to as AIDS dementia. A more complete description of the clinical features of AIDS is presented further. Most of these opportunistic infections and some other effects of HIV infection can be explained by damage to the immune system by HIV infection.

HIV has a very insidious nature in causing a disease. The early stages of infection are often unapparent, without any visible symptoms. The infected person may feel healthy and appear to be completely normal during this time, known as the incubation period, but such a person is able to transmit the infection. The HIV incubation period is of variable duration, and can be quite long (more than 5 years). Therefore, it is not possible to distinguish infected from uninfected people solely by the time since possible exposure to the virus. In contrast, for most common virus infections, such as colds or influenza, an incubation period of several days will be closely followed by an apparent disease. This adds greatly to the difficulty in studying and controlling AIDS because many people who have the virus have not developed the disease yet.

THE AIDS EPIDEMIC. Despite the many different clinical symptoms associated with AIDS, medical investigations have already learned a great deal about how AIDS is spread in our population. For example, it is now clear that HIV transmission requires close contact and that infection occurs by one of only three routes; blood, birth, or sex. Casual contact does not lead to disease transmission. AIDS epidemiology will be further discussed..

Between 1981 (the beginning of AIDS epidemic) and the early part of 1988 about 57,000 cases of AIDS have been reported to the National Center for Disease Control (CDC) in Atlanta, Georgia. Of these cases, about 32,000 (56%) have died.

Promiscuous homosexual males were the major afflicted group and represent about 63% of these reported cases. Another 18% of the cases were intravenous drug users, and 7% were both male homosexuals transmissions, or by blood transfusion during the period when American blood supply was not monitored for HIV antibodies (1981-1985).

The AIDS epidemic is not restricted to the USA. It can be found in all continents and hence is considered a pandemic. There may be as many as ten million people in sub-Saharan Africa who are infected with HIV. In Africa, HIV transmission appears to result from heterosexual contact and other modes as well. Given the relatively poor medical support available in much of Africa, the number of infected people is expected to increase significantly. As there is no current cure for AIDS these numbers are alarming. They indicate the clear potential of AIDS to spread unchecked, in spite of recent advances in modern medicine, epidemiology, virology, and recombinant DNA technology. This reminds us of previous eras when major infectious diseases devastated human populations. How can we control this epidemic? An overview of the relationship between epidemics and human populations may shed some light on this.

THE EPIDEMIOLOGY OF AIDS IN THE U.S.

Today AIDS has become a major cause of morbidity and mortality in the U.S. Indeed, it has become the leading cause of death in the country among people with hemophilia and users of illegal intravenous (IV) drugs. Moreover, nation-wide morbidity and mortality rates will increase in the next few years as some of the one to 1.5 million Americans who are already infected with the human immunodeficiency virus (HIV) develop AIDS. Most of those drug abusers, and a significant proportion of them will be blacks and Hispanics. Yet, given the fact that the virus is transmitted through sexual contact, through the traces of blood in needles and other drug paraphernalia and from mother to newborn infant, one can envision many possible chains of infection, which leave no segment of the U.S. population completely unaffected by the threat of AIDS.

The discovery of the epidemic, the enumeration of the varied manifestations of HIV infection and the analysis of the circumstances that made it possible for such an infection to spread have been missions assigned to epidemiology: the study of the occurrence and distribution of disease as well as its control in a given population. Epidemiologists monitor mortality and morbidity rates associated with HIV infection and AIDS; they also make predictions of likely changes in HIV infection rates in the course of time.

Most important, by carrying out studies to define the ways HIV is transmitted from person to person, epidemiologists can identify the population groups that are at greatest risk of acquiring AIDS and thereby develop strategies for the prevention and control of the disease – strategies that are independent of the development of an effective vaccine or therapy. Indeed, determining the risk factors for AIDS enabled the U.S. Public Health Service and other groups to issue recommendations for the prevention of AIDS as early as 1983, a full year before HIV was firmly identified and two years before laboratory tests to detect the presence of the virus became widely available.

To carry out all these tasks epidemiologists depend on surveillance: the gathering of high-quality, consistent and interpretable data on a disease or an infection. Surveillance data are routinely compiled from reports filed with state and local health departments that are then forwarded to the U.S. Centers for Disease Control (CDC).

Because the disease appeared to be transmitted through the exchange of blood or by sexual contact, most investigators were convinced by late 1982 that the cause of AIDS was an infectious agent (most likely a virus) and not the result of exposure to toxic substances or other environmental or genetic factors. The infection hypothesis was finally confirmed when HIV was isolated by Luc Montagnier and his colleagues at the Pasteur Institute in Paris and by Robert C. Gallo and his colleagues at the National Cancer Institute.

Soon after the discovery of the AIDS agent a laboratory test was developed to detect antibodies to HIV in the blood. A positive result in a test of a person’s blood sample was a reliable sign that the person was infected with the virus. Such a serological test made it possible to detect HIV infection in people who showed no clinical symptoms, and to confirm clinical diagnoses of AIDS and other HIV-related conditions. It also made it possible to measure directly the prevalence of HIV infection (the number of infected people in a given time) and its incidence (the number of new infections occurring within a defined period in a specific population). Most important, perhaps, was the fact that the national supply of donated blood could now be screened, so that additional cases of AIDS due to blood transfusions and contaminated blood products could be avoided.

RISK OF HIV INFECTION

The possibility that one can become infected with HIV if contaminated blood penetrates the skin or mucous membranes also represents a small but definite occupational risk for health-care workers. In a national collaborative study done by the CDC, four of 870 health-care workers who had accidentally punctured their skin with needles contaminated with the blood of HIV-infected people developed HIV infection, but none of the 104 workers whose mucous membranes or skin had been exposed to blood became infected. In another study of health-care workers at the National Institute of Health, no HIV infections occurred among 103 workers with needle-stick injuries, nor were there any HIV infections among 691 workers who had a total of more than 2000 reported skin and mucous-membrane exposures to blood or body fluids of AIDS patients. The studies are consistent with other data indicating that the occupational risk of acquiring HIV infection in health-care settings is low and is most often associated with percutaneous inoculation of blood from an infected patient.

HIV is also transmitted from an infected mother to her newborn child, but the extent of transmission that takes place respectively during pregnancy, at birth or soon afterward is as yet unknown. Detection of HIV in fetal tissues supports the hypothesis that infection occurs in utero, and case reports of women who became infected with HIV immediately after giving birth, and subsequently infected their infants, suggest that the virus may be transmitted through breast-feeding.

Studies of such perinatal transmission are greatly complicated by the lack of a reliable diagnostic test to determine HIV infection in newborns. As is the case with other infections, infants born to HIV-infected mothers have maternally derived HIV antibodies circulating in their blood – regardless of whether or not they have been infected. The maternal HIV antibodies may persist for as long as 12 months and cannot be distinguished from antibodies that may be present in an infant infected with HIV. Other tests are under development for identifying HIV infection in these newborns. Currently all infants born to infected mothers must be followed closely for at least 12 months to see whether there is any clinical or laboratory evidence of HIV infection or AIDS.

To evaluate the risk of HIV transmission through other casual contacts, several prospective studies (which are carried out over several years) have been done of the families of infected adults and children. In spite of tens of thousands of days of household contact with infected individuals, not one of more than 400 family members has been infected with HIV – except for sexual partners of the infected person and children born to infected mothers. In these studies the documented risk of household transmission was zero, and therefore the actual risk must be extremely low, even in crowded households. The risk of transmission in other social settings, such as schools and offices, is presumably even lower than in household settings.

Epidemiological studies in the U.S. and other countries throughout the world show no patterns of HIV infection consistent with transmission by insect vectors. If HIV were transmitted by insect vectors, additional cases of infection would be seen in people who share environments with infected individuals. Such evidence is lacking, in spite of extensive surveillance efforts.

Although HIV can survive for from several hours to several days in insects artificially fed blood with high concentrations of the virus, there is no evidence that HIV actually grows in insects. Such a biological event is important in most viral diseases transmitted by insects.

To be sure, the existence of other unrecognized modes of HIV transmission can never be entirely excluded, but if they do exist, they appear to be extremely rare.

HIV INFECTION: THE CLINICAL PICTURE

As physicians we are often asked to describe the typical course of AIDS: the severe immune deficiency that enables normally benign organisms to flourish destructively in patients. Our answer is that people are asking the wrong question. Now that AIDS is known to be caused by a virus – the human immunodeficiency virus, or HIV – the focus should be on the full course of the viral infection, not solely on AIDS. HIV causes a predictable, progressive derangement of immune function, and AIDS is just one, late manifestation of that process.

An emphasis on HIV is important because it facilitates both treatment and prevention. Prompt diagnosis of HIV infection enables the patient to receive optimal medical care from the earliest moments of the disease. Such care can often prevent complications from developing or getting unnecessarily out of hand. For instance, the lethal opportunistic infection “Pneumocystis carinii” pneumonia (PCP), which has been a hallmark of AIDS, can now actually be prevented with medication given early in the course of HIV disease. (Opportunistic infections are ones that occur because the immune system has broken down.) In addition, the medicine Retrovir (also known as AZT), which has been shown to prolong life in patients with late-stage disease, holds promise as a therapy for patients in earlier stages of infection. Early diagnosis also eliminates the unwitting transmission of HIV and gives people the opportunity to consider changing their behavior before they pass the virus to others.

Although the continuing emphasis on AIDS alone is seriously misguided, it is somewhat understandable. When AIDS was first identified in 1981, it was a mysterious syndrome: a cluster of rare diseases that had suddenly become alarmingly common in homosexual men. In order to identify similar cases of AIDS, and thereby help to uncover the cause and means of transmission, the U.S.Center for Disease Control (CDC) adopted a strict epidemiological-surveillance definition. People were said to have AIDS if they contracted Kaposi’s sarcoma (a rare cancer) or if they developed any of a few rare opportunistic infections, most notably PCP.

Because we and our colleagues at the Walter Reed Army Medical Center believe HIV-infected patients must be treated on the basis of the fullest possible understanding of their disease, we developed a classification system that provides a framework for managing patients and understanding the progression of the disease. The system groups patients according to their stage of infection.

The Walter Reed classification system begins with stage zero: exposure to the virus through any of the known transmission routes. Noting exposure facilitates early diagnosis: people who are known to have been exposed to HIV can be evaluated for evidence of infection, such as the presence of antibodies to HIV in the blood. Even before infection is detected they can be told that they may be infected with HIV and so should take steps to avoid spreading the possible infection to others; HIV usually causes no symptoms at first can take root from six weeks to a year before it is detected by the standard (antibody) HIV test.

Once the presence of HIV has been documented by any reliable test, patients are said to be in Walter Reed stage 1, provided they do not meet the criteria for a higher stage.

Although most people have no symptoms when HIV infection is first diagnosed, some patients develop a disorder resembling mononucleosis. Its symptoms include fatigue, fever and swollen glands, which may or may not be accompanied by a rash. In addition self-limited disorders of the central nervous system have been noted. These range from headaches to encephalitis (inflammation of brain tissue). The cause of these symptoms is not entirely clear. In any event, they disappear, usually within a few weeks.

For the majority of patients the first sign that something is amiss in the immune system is the development of chronically swollen lymph nodes. With the appearance of this chronic lymphadenopathy a patient moves into stage 2.

Stage 2 typically lasts for from three to five years, and patients still feel well even when it ends. The beginning of stage 3 is defined by a persistent drop in the T4-cell count to less than 400, which is a harbinger of a decline in immune functioning. Patients remain in this stage, however, until direct evidence of an impairment in cell-mediated immunity is discovered – usually about 18 months later – at which point they enter stage 4. That evidence is the failure to respond to three out four skin tests that measure what is called delayed hypersensitivity: the individual’s ability to mount a cellular immune response against specific proteins injected under the skin.

Progression to stage 5 is usually determined on the basis of the development of anergy (a total absence of delayed hypersensitivity). Some time later the first overt symptom of a breakdown in cell-mediated immunity arises: the development of thrush, a fungal infection of the mucous membranes of the tongue or the oral cavity. Thrush is identified by the presence of white spots and ulcers covering the infected area.

In addition to thrush, stage 5 patients often develop unusually severe or persistent viral or fungal infections of the skin and mucous membranes. One example is chronic infection with the Herpes simplex virus, which often produces painful and persistent sores in the skin surrounding the anus, the genital area or the mouth.

Many people develop chronic or disseminated opportunistic infections at sites beyond the skin and mucous membranes within a year or two after entering stage 5. The emergence of these infections reflects an extremely severe decline in immune function and constitutes progression to stage 6, or what is also called opportunistic-infection-defined AIDS. Most patients enter stage 6 with a T4-cell count of 100 or less and most, unfortunately, die within two years.

Any pathogen that can be eradicated only with the help of vigorous cell-mediated immunity can cause serious disease.

In addition to PCP (Pneumocystis carini pneumonia), other disorders associated with AIDS include the parasitic infectious toxoplasmosis (which typically attacks the intestinal tract, causing chronic diarrhea).

Stage 6 opportunistic diseases also include the fungal infectious cryptococeosis (which frequently causes meningitis but may also damage the liver, bone, skin and other tissues), and histoplasmosis (which can cause self-limited pneumonia in individuals with an intact immune system but causes a disseminated infection of the liver, bone marrow and other tissues in HIV-infected patients and is a frequent cause of chronic fevers).

A common viral infection is cytomegalovirus, a cause of pneumonia, encephalitis, blindness and inflammation of the gastrointestinal tract. As is the case with histoplasmosis and tuberculosis, the cytomegalovirus infection seen in HIV patients is usually a reactivation of a childhood infection that was well controlled until HIV seriously hobbled the patient’s immune system. Such bacteria as “Legionella” and “Salmonella” can also be a severe problem for someone in stage 6.

Standard or experimental therapies exist for all these disorders. Among the most exciting developments in recent years is the discovery of several medications that control or even prevent PCP. Pentamidine, Septra/Bactrium and Dapsone are all effective in clearing up the infection; the first two – and a drug called Fansidar – serve as preventives as well.

Also exciting are new treatments for cytomegalovirus. Just two years ago investigators had little hope of discovering an effective therapy for the virus. Today there are two treatments, including a medicine (ganciclovir) that can halt the progression of cytomegalovirus- induced blindness. Research workers are making progress against other HIV-related diseases as well. A drug called acyclovir is under study for the prevention of Herpes simplex infection, and new treatments have been developed for cryptococcal meningitis, disseminated histoplasmosis and mycobacterial diseases.

STRANGE TRIP BACK TO THE FUTURE

Officially, the AIDS epidemic began in the U.S. in 1981. Recently, however, researchers jolted the medical community with evidence that the disease may have made its first appearance in the U.S. almost 15 years earlier. In a front-page article in the Chicago “Tribune”, they related the extraordinary saga of Robert R., a 16-year-old black Missourian who, they believe, died of AIDS in 1969. The case may represent the earliest documented instance of AIDS in North America. Predating that of Gaetan Dugas, a Canadian flight attendant. Dugas, who contracted AIDS before 1980 and died in 1984, was publicly identified as “Patient Zero” only quite recently. Tissue samples from Robert R. may eventually reveal what caused the virus to spread.

Two researchers, microbiologist Memory Elwin-Lewis of Washington University in St. Louis and Marlys Witte, a professor of surgery at the University of Arizona in Tucson, told of a black teenager who showed up at St. Louis City Hospital in 1968 with chronic genital swelling. The youngster, then 15, admitted that he was sexually active; laboratory tests disclosed that he has a severe case of chlamydia, a common but curable venereal disease. Doctors prescribed several antibioyics and put him on a low-salt diet. Nothing worked. His muscles wasted away, and his lungs filled with fluid.Robert R. died on May 15, 1969. An autopsy revealed the distinctive purplish lesions of AIDS-related Kaposi’s sarcoma.

Hoping at the time that medical advances might someday solve the mystery of his affliction, Elwin-Lewis and Witte, then both at Washington University, froze samples of Robert R.’s blood, brain, and other organs. In June 1987, four years after the AIDS virus was first isolated, Witte sent some of the frozen samples to Tulane University, where they were definitely analyzed by Virologist Robert Garry. “There’s no question that the tissue was positive for AIDS”, Garry states. In fact, Robert R.’s blood reacted to all nine markers used in the highly sensitive Western blot test for AIDS antibodies. Why didn’t the researchers have the samples tested earlier? “We waited until the chance of documenting the infection was more likely.” Witte explains.

Robert R.’s case is even more intriguing because he never visited New York City, San Francisco and Los Angeles, the current AIDS epicenters. In fact, he told his doctors, he never left the Midwest. That is not surprising, says Dr. James Curran, director of the AIDS program at the Center for Disease Control. “It’s just not logical that AIDS entered the country only once,” he says. I think that there were several entry points but that most of them occurred in the late 1970s.”

Other presumptive cases are emerging from the past. In New York City in 1959, for example, a 49-year-old Haitian-born shipping clerk fell victim to what today would be a telltale disorder:

“Pneumocystis carinii” pneumonia. “It was so unusual at the time”, recalls Dr. Gordon Hennigar, who performed the postmortem and now is chairman of pathology at the Medical University of South Carolina. “AIDS is such a strong possibility that I’ve often thought about getting the samples and testing them.”

Indeed, the history of AIDS in the U.S. may have a much longer prologue than was once suspected. “What we’re saying is that AIDS has been around for a long time but just wasn’t recognized”, Elwin-Lewis explains. It is possible, Tulane’s Garry speculated, that the AIDS virus mutated and became more lethal in the 1970s. To test that hypothesis, he plans to spend much of the next year or so attempting to reconstruct viral genes from Robert R.’s tissue. “We know that the virus was not epidemic in 1969, so we might be able to identify the changes between then and now that enabled it to spread, Garry says. If scientists can figure out how the AIDS virus might have changed, the puzzling case from the past might shed light on the future of the epidemic.

A STARTLING CLAIM about the AIDS Virus

Twenty years ago, Peter Duesberg had a reputation as one of the world’s most respected virologists. In 1969, when he was just 33, he demonstrated that the flu virus has a segmented genome, which explains its unique ability to change. One year later he isolated the first cancer gene. When reading his academic biography, one encounters the word “first” quite a number of times. But Duesberg’s primary subject was retroviruses; he is arguably the scientist who discovered their structure. He received Investigator Grants from the National Institute of Health for seven years in a row. In 1986, he became a member of the National Academy of Sciences and was considered a probable candidate for the Noble Prize. Next year, his career crashed. In 1987, Duesberg published an article in which he claimed that the HIV retrovirus doesn’t – and cannot possibly – cause AIDS.

Colleagues branded his views not only wrong but dangerous. Scientific magazines stopped publishing his articles and most harmfully, the financing of his research was cancelled. The scientific community all but set up a boycott of the reckless scientist. If Duesberg had admitted his mistake, everything would have been back to normal. But he always had a reputation as an uncompromising scientist. 18 years later, Duesberg still argues that HIV is a harmless passenger virus, while AIDS is caused by completely different factors. He explained his views in the following interview for ‘The Moscow News’.

Q. Can you explain your point of view that HIV does not cause AIDS?

The distinctions of an infectious epidemic are:

Random spread in a population; 2) Exponential increase over weeks or months followed by exponential decline over same period due to anti-microbial/viral immunity or death of susceptible individuals; 3) Latent periods from contact/infection to disease of days to weeks corresponding to generation time of virus/microbe; 4) Virus/microbe is very active and abundant during course of disease; 5) Virus- or micro-specific disease.

By contrast,

AIDS in the US and Europe is more than 80% male, of which 1/3 are intravenous drug users and 2/3 are male homosexuals using psychoactive/aphrodisiac and anti-HIV drugs – unlike any microbial epidemic in history. 2) The AIDS epidemic in the US and Europe has increased slowly during the decade from the early 1980-s to the early 1990-s and has since declined slowly – unlike any new microbial epidemic in history. But very much like chemical epidemics such as lung cancer from smoking or tuberculosis from cocaine. 3) Since the ‘AIDS virus’ replicates in 24 hours, just like other human virus – the latent period for HIV-caused AIDS should be the same as that of other viruses, like flu or measles, namely days to weeks. But it is 5-10 years – just about equal to the ‘latent periods’ for lung cancer from smoking or liver cirrhosis from drinking. 4) HIV is undetectable in AIDS patients. See Gallo (US) and Weiss (UK) scandals of misappropriating Montagnier’s virus, because they could not find it in hundreds of AIDS patients! Only anti-bodies against HIV are detectable in patients – classical certificate of vaccination! 5) There is no HIV-specific disease. More than 26 AIDS-defining diseases are simply old diseases under new names, e.g. tuberculosis, dementia, diarrhea, weight loss, yeast infection, pneumocystis, etc.

Q. How did you come to your conclusions about HIV/AIDS?

HIV is claimed to cause AIDS by killing T-cells. But, at the same time mass production of HIV in immortal T-cell lines was patented in 1984 as source of HIV proteins for ‘AIDS tests’ by Gallo/NIH, Weiss/Burroughs, Wellcome (UK), and Montagnier (Pasteur). These infected cell lines are still producing HIV 21 years later! Thus HIV does not kill cells, just like all other retroviruses.

2) HIV is latent and neutralized by antibody, when it is said to cause fatal AIDS. I have studied virus for 25 years, and I don’t know one example of a fatal disease caused by a virus that is neutralized by antibodies and only detectable indirectly via antibodies.

Once I realized that HIV-AIDS hypothesis was paradoxical, because viruses are not pathogenic if they are latent and neutralized by antibodies, and retroviruses don’t kill cells (the reason why they are considered cancer viruses), it was clear that something was wrong with the HIV-AIDS hypothesis. But, there are no paradoxes in nature, only flawed hypotheses.

Q. Why do most of modern scientists think that HIV causes AIDS?

This is a non-scientific, perhaps political question and I have no ‘scientific’ answer. But based on my anthropological experiences, to ‘think’ that HIV causes AIDS is politically correct, socially attractive, and very fundable if you are a ‘modern scientist’ in need of a grant and a publication, and is beneficial for a merit increase, and for an award and for a company. None of these benefits are available to ‘non-conformists’ – even ‘in the freest of all countries’(US). On the contrary, non-conformists are excommunicated at all social and scientific levels available in ‘free’ countries.

Q. If HIV doesn’t cause AIDS, what does?

Based on the American/English AIDS establishment from before 1984, when HIV was discovered, AIDS was a ‘lifestyle’ disease (a euphemism for addiction to recreational drug). So logic led me more and more to the chemical-AIDS hypothesis, which proved to be a consistent theory to this date. Once I became suspicious, all I had to do was to look up the literature on the pathogenic effects of long term drug use, to see the chemical AIDS theory. More recently I had to include into the chemical AIDS hypothesis the DNA chain-terminators like AZT and protease inhibitors, prescribed to HIV-antibody-positives as anti-HIV drugs, for a complete case for chemical AIDS and against viral AIDS.

Q. Why is AZT dangerous? As far as I know, it’s used to cure cancer?

All chemotherapy is ‘dangerous’, ideally less dangerous than cancer – but certainly always less dangerous than a latent retrovirus that cannot kill cells. The principle of chemotherapy is to kill growing cancer cells chemically. However, since no chemical can distinguish between normal and cancer ells, billions of normal cells are killed together with cancer cells. The strategy is to kill the cancer before you kill the cancer before you kill the patient! This is the best we can do against cancer now. But it would be a disaster if we were to use this inevitably toxic treatment against a virus that in all likelihood does not cause AIDS.

Q. CDC says that there is a very strong statistical correlation between HIV and AIDS. Can you comment on that?

Even a 100% correlation is no proof. According to Koch’s postulates, the correlation must be 100% with the microbe – NOT antibody against it; the virus/microbe must be isolated from potential competitor microbes; and the pure virus must cause the disease.

Over 150 chimpanzees have been infected over the last 22 years, but not one has developed AIDS. And from over 40 million HIV-positives, the World Health Organization has not registered more than 2 million AIDS patients in 20 years. This is less than the normal mortality of 20 million people in 20 years. However, there are plenty of noncorrelations. In one study published in 1993 I listed 4,621 HIV-free AIDS cases described in the literature by the HIV-AIDS establishment at that time.

Q. But CDC claims that Koch’s postulates have been fulfilled by HIV. What do they mean, and how can you comment on that?

They mean that infection with HIV is sufficient to cause AIDS. However, according to the peer-reviewed literature, not one American doctor has ever contracted AIDS from more than 929000 American AIDS patients in 21 years, although several got infected by HIV. Likewise, no American scientist ever developed AIDS from studying and mass producing HIV. And according to the World Health Organization, 40 million people on this planet are HIV-positive, but have no AIDS! So HIV can not be sufficient to cause AIDS.

Q. Can you comment? Your opponents argue that Koch’s postulates don’t have to be fulfilled by HIV because they were invented before the discovery of retroviruses.

Algebra was invented before computers were made. Does this mean that computers don’t have to follow the laws of algebra?

Q. What level of financing does your research require?

My research budgets prior to AIDS run between 4,250,000 and 4,500,000 per year in current $ equivalents. Now I am studying the role of aneuploidy in cancer with support from private foundations for about $100,000 per year.

Q. How long could it take for the scientific establishment to understand their mistake about HIV (if they are wrong)?

It took the highly established and affluent catholic church 400 years to ‘understand’ Galileo. Since the NIH/CDC bio-establishment is the church of the 20/21 century and just as affluent as Rome it may take up to 400 years too – at least as long as everything that confirms the HIV/AIDS hypothesis gets funded and polished in the professional and public press and all alternative interpretations are censored in the ‘freest of all countries.’

Q. Your opponents insist that your statements are irresponsible and thousands of people can die if they believe you. Doesn’t it bother you?

For a scientist, scientific truth is the only ‘responsibility’ that matters. The rest is for politicians and philosophers. Fortunately, I am not scientifically responsible for prescribing DNA chain-terminators – developed exclusively to kill human cells for cancer chemotherapy over 40 years ago – to 450,000 HIV-positives in the name of a hypothesis that has not been proved in 21 years.

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