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Alok's Questions & Answers

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Traement of Cushing syndrome ?

Asked by Silvia in Personal Health at 1:53 PM on January 03, 2009

Alok's Answer

Treatment depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects.

Pituitary Adenomas

Several therapies are available to treat the ACTH-secreting pituitary adenomas of Cushing's disease. The most widely used treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and very fine instruments, the surgeon approaches the pituitary gland through a nostril or an opening made below the upper lip. Because this is an extremely delicate procedure, patients are often referred to centers specializing in this type of surgery. The success, or cure, rate of this procedure is over 80 percent when performed by a surgeon with extensive experience. If surgery fails, or only produces a temporary cure, surgery can be repeated, often with good results. After curative pituitary surgery, the production of ACTH drops two levels below normal. This is a natural, but temporary, drop in ACTH production, and patients are given a synthetic form of cortisol (such as hydrocortisone or prednisone). Most patients can stop this replacement therapy in less than a year.

For patients in whom transsphenoidal surgery has failed or who are not suitable candidates for surgery, radiotherapy is another possible treatment. Radiation to the pituitary gland is given over a 6-week period, with improvement occurring in 40 to 50 percent of adults and up to 80 percent of children. It may take several months or years before patients feel better from radiation treatment alone. However, the combination of radiation and the drug mitotane (Lysodren®) can help speed recovery. Mitotane suppresses cortisol production and lowers plasma and urine hormone levels. Treatment with mitotane alone can be successful in 30 to 40 percent of patients. Other drugs used alone or in combination to control the production of excess cortisol are aminoglutethimide, metyrapone, trilostane and ketoconazole. Each has its own side effects that doctors consider when prescribing therapy for individual patients.

Ectopic ACTH Syndrome

To cure the overproduction of cortisol caused by ectopic ACTH syndrome, it is necessary to eliminate all of the cancerous tissue that is secreting ACTH. The choice of cancer treatment--surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of these treatments--depends on the type of cancer and how far it has spread. Since ACTH-secreting tumors (for example, small cell lung cancer) may be very small or widespread at the time of diagnosis, cortisol-inhibiting drugs, like mitotane, are an important part of treatment. In some cases, if pituitary surgery is not successful, surgical removal of the adrenal glands (bilateral adrenalectomy) may take the place of drug therapy.

Adrenal Tumors

Surgery is the mainstay of treatment for benign as well as cancerous tumors of the adrenal glands. In Primary Pigmented Micronodular Adrenal Disease and the familial Carney's complex, surgical removal of the adrenal glands is required.

Answered at 2:14 PM on January 03, 2009

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Diagnosis of Cushing syndrome ?

Asked by Silvia in Personal Health at 1:52 PM on January 03, 2009

Alok's Answer

Diagnosis is based on a review of a person’s medical history, a physical examination, and laboratory tests. X rays of the adrenal or pituitary glands can be useful in locating tumors.

Tests to Diagnose Cushing’s Syndrome

No single lab test is perfect and usually several are needed. The three most common tests used to diagnose Cushing’s syndrome are the 24-hour urinary free cortisol test, measurement of midnight plasma cortisol or late-night salivary cortisol, and the low-dose dexamethasone suppression test. Another test, the dexamethasone-corticotropin-re leasing hormone test, may be needed to distinguish Cushing’s syndrome from other causes of excess cortisol.

* 24-hour urinary free cortisol level. In this test, a person’s urine is collected several times over a 24-hour period and tested for cortisol. Levels higher than 50 to 100 micrograms a day for an adult suggest Cushing’s syndrome. The normal upper limit varies in different laboratories, depending on which measurement technique is used.
* Midnight plasma cortisol and late-night salivary cortisol measurements. The midnight plasma cortisol test measures cortisol concentrations in the blood. Cortisol production is normally suppressed at night, but in Cushing’s syndrome, this suppression doesn’t occur. If the cortisol level is more than 50 nanomoles per liter (nmol/L), Cushing’s syndrome is suspected. The test generally requires a 48-hour hospital stay to avoid falsely elevated cortisol levels due to stress.

However, a late-night or bedtime saliva sample can be obtained at home, then tested to determine the cortisol level. Diagnostic ranges vary, depending on the measurement technique used.
* Low-dose dexamethasone suppression test (LDDST). In the LDDST, a person is given a low dose of dexamethasone, a synthetic glucocorticoid, by mouth every 6 hours for 2 days. Urine is collected before dexamethasone is administered and several times on each day of the test. A modified LDDST uses a onetime overnight dose.

Cortisol and other glucocorticoids signal the pituitary to release less ACTH, so the normal response after taking dexamethasone is a drop in blood and urine cortisol levels. If cortisol levels do not drop, Cushing’s syndrome is suspected.

The LDDST may not show a drop in cortisol levels in people with depression, alcoholism, high estrogen levels, acute illness, or stress, falsely indicating Cushing’s syndrome. On the other hand, drugs such as phenytoin and phenobarbital may cause cortisol levels to drop, falsely indicating that Cushing’s is not present in people who actually have the syndrome. For this reason, physicians usually advise their patients to stop taking these drugs at least 1 week before the test.
* Dexamethasone-corticotropin-re leasing hormone (CRH) test. Some people have high cortisol levels but do not develop the progressive effects of Cushing’s syndrome, such as muscle weakness, fractures, and thinning of the skin. These people may have pseudo-Cushing’s syndrome, a condition sometimes found in people who have depression or anxiety disorders, drink excess alcohol, have poorly controlled diabetes, or are severely obese. Pseudo-Cushing’s does not have the same long-term effects on health as Cushing’s syndrome and does not require treatment directed at the endocrine glands.

The dexamethasone-CRH test rapidly distinguishes pseudo-Cushing’s from mild cases of Cushing’s. This test combines the LDDST and a CRH stimulation test. In the CRH stimulation test, an injection of CRH causes the pituitary to secrete ACTH. Pretreatment with dexamethasone prevents CRH from causing an increase in cortisol in people with pseudo-Cushing’s. Elevations of cortisol during this test suggest Cushing’s syndrome.

Answered at 2:12 PM on January 03, 2009

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What is a garter belt used for?

Asked by Neha Bist in Beauty & Fashion at 1:56 PM on December 05, 2008

Alok's Answer

Garters are articles of clothing: narrow bands of fabric fastened about the leg, used to keep stockings up. Normally just a few inches in width, they are usually made of leather or heavy cloth, and adorned with small bells and/or ribbons. In the 18th to 20th centuries, they were tied just below the knee, where the leg was slenderest, to keep the stocking from slipping. The advent of elastic has made them unnecessary from this functional standpoint, although they are still often worn for fashion.

Answered at 2:11 PM on December 05, 2008

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what is the autorun file?

Asked by pranay gore in Computers & Technology at 12:11 PM on October 20, 2008

Alok's Answer

Autorun.inf is a file written to the root of a data CD. If the user's PC autorun has not been disabled, then the commands in autorun.inf will be executed when the CD is inserted.

Recommend all software authors include autorun.inf on their CDs, especially if the target market consists of relatively unsophisticated users. We have found that if applications launch when the CD is inserted, customer support calls and e-mails will be greatly reduced. We get many complaints of "defective CDs", just because some authors don't include autorun.inf.

autorun.inf can be written with any text editor. Here is the content of a typical file:

[autorun]
OPEN=setup .exe

In this case, the file setup.exe in the CD root will automatically start when the CD is inserted by the user.

Visit:http://www.swif tcd.com/faq/autorun.html

Answered at 12:18 PM on October 20, 2008

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I am 25 weeks pregnant, i need to travel by train from Rajasthan to bangalore. what precautions need to be taken?

Asked by Sona S in Personal Health at 12:42 PM on November 12, 2008

Alok's Answer

Travelling by train does not hold any special health risks and as long as your pregnancy is normal. However, if you do have pregnancy related complications like high blood pressure , diabetes, placental problems or a previous premature delivery, then it is advisable to check with your doctor before travelling. If you have been suffering from morning sickness in your first trimester then you may find it easier to travel in the second trimester when the rocking motion of the train is no longer likely to make you nauseous.

It is important, though, to keep in mind some general precautions while travelling. Pack only as much as you can carry or choose a suitcase with wheels (strolley) which doesn't have to be lifted. Reconfirm the departure time for the train before you leave home. Reach the station well in advance of the departure time, so you don't have to rush through a crowd to find your compartment. This will also help you find adequate space for your luggage to be stowed away under your seat where it will be more accessible. If you need to cross a foot-over bridge to get to the platform, engage a porter to carry your luggage.

How can I make my journey more comfortable?

For short journeys, try to find a seat facing the direction of travel if that makes you feel more comfortable. For longer or overnight journeys, ask for a lower berth at the time of reservation or if that's not possible, request the concerned railway official on board to arrange for someone to swap berths with you.

There are Shatabdi and InterCity trains available on most routes – these trains have centrally air conditioned chair car coaches with reclining seats which make travel more comfortable. If possible try to book an aisle seat. Trains make it easier to walk around than other modes of transport so try to get up every hour and stretch your legs. If you're sitting or standing, extend your leg, heel first, and gently flex your foot to stretch your calf muscles. When you're sitting, rotate your ankles and wiggle your toes.

While visiting the toilet, be careful about maintaining your balance. Watch out for stray shoes, spilt water and food, and pieces of luggage. It is best to use an Indian toilet to maintain hygiene and always wash your hands well after a visit to the toilet.
Carry enough bottled water so that you don't need to get off the train to buy water; the vendors who sell water on the train may carry only local brands. Carry snacks like dry fruits, fresh fruit such as oranges, apples, khakras or roasted namkeens and protein biscuits to keep you going. For longer journeys where you need a meal or two, you can pack food such as idlis, theplas, parathas/chapattis and pickle, lemon rice and potatoes, and steamed rice which will not spoil.

Do not buy food from the station vendors – it may have been prepared or stored unhygienically; also food prepared in the morning and kept unrefrigerated through the day tends to spoil easily. Drink a lot of water and avoid drinking too many cups of tea and coffee which may be dehydrating. Check expiry dates of packaged juices and snacks before consuming them. Sucking on a mint or boiled sweet or chewing saunf (fennel seeds) may help with any queasiness during the journey.

Wear comfortable and sturdy footwear like sneakers or flats which make it easier to maintain your balance in a moving train. Loose cotton clothing is best while travelling though you may need to carry a light shawl if the air-conditioning gets too cold for comfort. Overnight journeys in the air conditioned classes usually come equipped with blankets and pillows, but if you are not comfortable using them you can carry your own bedding instead.
Other precautions:

• Carry a chain and lock to secure your luggage so that you don't have to worry about it at night and while visiting the restroom

• Do not get down at stations unless you are sure there is going to be

Answered at 12:49 PM on November 12, 2008

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What is Active Directory?

Asked by mano in Computers & Technology at 2:54 PM on November 08, 2008

Alok's Answer

Active Directory (AD) is a technology created by Microsoft that provides a variety of network services, including:

* LDAP-like Directory services
* Kerberos based authentication
* DNS based naming and other network information

Using the same database, for use primarily in Windows environments, Active Directory also allows administrators to assign policies, deploy software, and apply critical updates to an organization. Active Directory stores information and settings in a central database. Active Directory networks can vary from a small installation with a few hundred objects, to a large installation with millions of objects.

Active Directory was previewed in 1996, released first with Windows 2000 Server edition, and revised to extend functionality and improve administration in Windows Server 2003. Additional improvements were made in both Windows Server 2003 R2 and Windows Server 2008.

Active Directory was called NTDS (NT Directory Service) in older Microsoft documents. This name can still be seen in some AD binaries.

There is a common misconception that Active Directory provides software distribution. Software distribution is run by a separate service that uses additional proprietary schema attributes that work in conjunction with the LDAP protocol. Active Directory does not automate software distribution, but provides a mechanism by which other services can provide software distribution.

Visit:http:// en.wikipedia.org/wiki/Active_D irectory

Answered at 3:02 PM on November 08, 2008

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how can get rid of dark pigmentation, is there any home remeady/cream/ available to get rid off

Asked by r r in Beauty & Fashion at 1:20 PM on October 06, 2008

Alok's Answer

Here are some simple home remedies that you can do to lighten the skin tone and get a lighter complexion. However, they must be done regularly and best results are obtained if they are inculcated as a part of daily routine.

Mix 1 tsp of milk powder, 1 tsp of honey, 1 tsp of lemon juice, and ½ tsp of almond oil. Apply on face and wash off after 10-15 minutes. This pack helps bring shine to the skin and also removes tan.

Mix oatmeal with curd and tomato juice and apply on the face. Keep it on for 20 minutes and then wash it off with cold water. It helps remove the tan and lightens the skin.

Place sliced raw potato on the face. It helps reduce blemishes and other marks.

Applying turmeric powder along with lime juice removes the tan. Lime juice is a natural bleach.

Dried orange peels mixed with curd also help reduce blemishes and scars. Wash off this mixture with cold water after 15 minutes.

Soak 4 almonds overnight. Grind into a fine paste using milk. Apply on face and neck and leave it overnight. Wash with cold water in the morning. Do this daily for 15 days, followed by twice a week.

Answered at 1:25 PM on October 06, 2008

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WHAT IS THE BEST AYURVEDIC CURE OF GUMS PROBLEMS

Asked by ARSHI KHAN in Personal Health at 12:40 PM on September 07, 2008

Alok's Answer

Ayurveda explains some simple and wonderful practices and remedies, which help to maintain strong and healthy teeth & Gums.

1. Brushing the teeth twice a day is most necessary to maintain proper hygiene. Ayurveda advises use of various herbs to clean the teeth. Special formulas of tooth powders are prescribed for general use. Although you might feel a bit uncomfortable to rub those herbal tooth powders on your teeth, you will see remarkable results within a few weeks. And if you really live in natural surroundings and love to live naturally, fresh small stick-like branches of trees like the neem or local trees (bitter taste is good) can be used for brushing or cleansing the teeth. Chew the stick at one end to make it brush-like. Rub your teeth with the brush.
2. Many people are in the habit of drinking tea or coffee early in the morning. Some people even drink tea without properly brushing and cleaning their teeth. This is a very prominent cause of dental problems, as this not only increases pitta dosha, it also causes acidity and constipation. So never drink your early morning tea or coffee without properly brushing and cleaning your teeth. It would be best to eat some solid food before drinking tea or coffee.
3. Drinking a glass of water (250ml.) mixed with a tablespoon of honey is very beneficial for the teeth. You can even replace your morning tea with this drink. It acts both in prevention of and in curing dental problems.
4. After each meal fresh water gargles must be done at least 4-5 times. It is very important to clean the teeth each time after eating something. It may not be practical to brush your teeth each time, but just cleaning with fresh water or warm water is sufficient. Fill the mouth with water, circulate this water 2-3 times around the teeth, and then spit it out. In case some food particles are sticking to the teeth, use the index finger of your right hand to clean them.
5. Take a cup of water (warm water in winter) and mix a pinch of common salt in it. Gargle with water 3-4 times. Also fill your mouth with this water and circulate it around the teeth. This is good for the teeth, gums, and throat. It should be done everyday before going to bed.
6. Take one gram of finely powdered rock salt (common salt if rock salt is not available) and mix half to one teaspoonful of mustard oil in it to make a paste. Apply this paste on the gums and massage gently. Do not rub very hard and if there is a little bleeding from the gums while massaging, do not worry. Rinse the mouth with warm water. This is a very good treatment for pyorrhea, swollen gums, toothache, and bleeding gums. It strengthens the gums and kills the germs. This massage can be done at any time of the day.
7. Fine turmeric powder can be used in place of salt (same quantity) in the above recipe. This should be used before going to bed. It is very beneficial for toothache, dental caries, and pain in teeth while eating chilled or hot food items, and also for bleeding gums.
8. Drinking half a glass of water mixed with two teaspoonsful of fresh lemon juice may be taken twice a day. It is good for strengthening both gums and teeth.
9. Chewing a clove after meals acts as a mouth freshener and also maintains strong teeth and gums. Keep the clove in the mouth and chew slowly.
10. Do not mix very hot and chilled items together, like eating an ice cream immediately after a cup of hot coffee or vice-versa.
11. Avoid excessive sweets and foods containing sugar and rinse the mouth immediately after eating such items.
12. In case of pain in the gums avoid hot, spicy, sour and fried foods.
So just try to follow these simple practices and remedies, and continue enjoying delicious food.

Answered at 4:25 PM on September 08, 2008

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I am want to know about the medical insurance which will fulfill my requirements. Me 31years old working wife - 28 years old Baby - 8 months.

Asked by Anil Kumar in Personal Health at 3:53 PM on September 18, 2008

Alok's Answer

ICICI Lombard Family Footer Plan
A single policy that secures the hospitalization expenses of your entire family.

For More information visit: http://www.icicilombard.com/ap p/ilom-en/Personalproducts/Hea lth.aspx

Answered at 4:26 PM on September 18, 2008

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