Spina Bifida

• Spina bifida occulta;

• Dermal or epidermal fistulas;

• Meningocele;

• Myelomeningocele.

Spina Bifida

Spina bifida occulta is an elementary lesion, which can be only seen on X-ray. It is  a partial defect of the posterior vertebral arch. If the neurological signs and skin lesions which can be associated are absent, then any course of treatment is not imposed.

• Myelomeningocele with open medullary area – it has a round, red, bleeding central area, with a upper central hole through which cerebrospinal fluid leaks. Peripheral it is followed by a transition zone, which is covered with a thin skin and make the transition to the normal dermal area. Spine slides are missing and spinal canal has a posterior opening;
• Myelomeningocele cyst – is the most commonly encountered and is often situated in the lumbar median area. It is covered with thin skin and contain fluid. The coating membrane can crack easily and can lead to loss of cerebrospinal fluid and meningitis;
• Covered myelomeningocele – it is a rare and less severe variant, which is covered entirely  with normal skin.

Neurological manifestations of myelomeningocele

• Partial or complete motor disorders of the lower limbs, represent a common manifestation;
• Dislocation of the hip and crooked legs;
• Flaccid paralysis of the lower limb is more often present than spastic paralysis of the lower limb;
• Insensitive areas of the limbs and gluteal region and perineum;
• Partial or complete paralysis for anal and bladder sphincter;
• Hydrocephalus which can lead to different degrees of retardation.

Meningitis

Meningitis is an inflammation of the meninges which can be associated with modification of the cerebrospinal fluid which is contained between this membranes. Many diseases, like cancer or connective tissue diseases, like lupus erythematosus or sarcoidosis may be accompanied by an inflammatory reaction of the meninges. Meningitis is a very serious disease and requires urgent diagnosis and initiation of treatment.

Meningitis has a variable evolution, from spontaneous healing to even fatal. Meningitis is common in children, young adults aged between 15 and 24 years, older adults and persons with chronic diseases. The severity of meningitis depends on the cause of infection and the patient age and general health condition.

The most frequent cause of the meningitis remains infection and can be classified into two groups by the type of cerebrospinal fluid: purulent or clear. Viral meningitis is a mild form of the disease which can be cured in less than 10 days. A group of viruses known as the enteroviruses, causing stomach problems, are responsible for approximately 90% of recorded viral meningitis.

Meningitis

Causes

In most cases meningitis is a result of a viral infection, but can also be determined by a bacterial infection. Meningitis can occur due to allergies to medicines, some cancers and autoimmune diseases such as lupus.

Symptoms and signs

Initially, the meningitis symptoms are associated with influenza symptoms . The patient has fever with or without chills, malaise. Due to the cerebral edema, intracranial hypertension is present and manifested by intense headaches, vomiting and photophobia. In such cases, seeing a doctor is mandatory.

Meningeal syndrome: headaches, vomiting, unpleasant sensation to light. The appearance of  skin bleeding points is a characteristic to meningococcus infection. In the absence of treatment, the infection will spread to the brain (meningo-encephalitis) and can lead to coma, behavioral disorders, paralysis and convulsions. Germs may even pass into the bloodstream and disseminate into internal organs.

Symptoms of Meningeal

Treatment

Treatment of meningitis depends on the cause of infection, age, extension of infection and the presence of other medical conditions or complications of meningitis. In the case of viral meningitis, patients usually start to feel better after three days of illness and get better in about two weeks. In mild cases of viral meningitis only home treatment may be required which includes drinking fluids to prevent dehydration along with drugs that control pain and fever. Meningitis caused by bacteria must be treated in hospital with antibiotics as bacterial meningitis causes complications more often than viral meningitis. If bacterial meningitis is not treated promptly and appropriately, death can occur. The  patient is given antibiotics and the pressure in the brain must be lowered. Any fluid that accumulates between the membranes that surrounding the brain should be drained or surgically removed. Also, the patient is given oxygen in case of difficulty in breathing.

Most healthy adults who have recovered from meningitis do not require further treatment. However, adults who have medical conditions that make them more likely than others to develop long-term complications or to develop a new meningitis, should return to a routine medical examination after they have healed. Infants and children treated for meningitis should always be monitored after they healed and should be checked to prevent long-term complications such as hearing loss.

Nicotine Withdrawal

It is interesting to see that in the front of tobacco people are not the same, because some people do not ever start smoking, others start late and others can not stop. Another interesting fact is that  women, although starting to smoke later than men, developing a greater degree of dependence and more difficult to quit the habit. Therefore, it is important to know that behind of our will or motivation there is also a biological reason that influence the easily passing over short-term effects of quitting smoking.

Nicotine withdrawal

To explain this diffrent reaction from the same product, the researchers appeal to genetics research. They are three classes of genetic factors that may determine vulnerability:

• Genes involved in metabolism of tobacco substances. Some people carry a altered versions of a gene that encodes the cytochrome P450, which is a small protein that participate in the degradation of nicotine. Because of this mutation, nicotine is degraded more slowly, persists longer in the body and the people who carry this altered version of the gene  smoke less and quit more easily.
• Genes that encode nicotinic receptors . Alteration of this genes cause a moderate or a late smoking addiction.
• a multitude of genes that play a role depending on the response to environmental factors (stress, taste, smell, etc.) which can turn into genetic factors of tobacco dependence.

What is nicotine withdrawal?

Nicotine withdrawal  is defined as all symptoms that appear after interruption of nicotine intake after a long use. The symptoms can be explained by the fact that nicotine is a true drug which cause a disrupt in brain function, resulting a physical and psychological dependence.

Generally, smokers tend to exaggerate the disadvantages of smoking cessation and minimize the benefits (health improvement, physical performance, external appearance).

Withdrawal manifestations are multiple and depending on the person, because there are smokers who have not had any symptoms of nicotine withdrawal, as there are people who have severe forms of nicotine withdrawal. The symptoms are ephemeral, with have a peak at 48-72 hours and then decrease gradually in three or four weeks.

After quitting smoking, a person can experience different sensations:

a) Psychical:

• Acute need to smoke is the most frequent and most typical symptom of nicotine withdrawal. It is a result of the decreased blood concentrations of nicotine. It is manifested by episodes of short duration (1-3 minutes), apparently without a special reason, which can occur even several months after quitting smoking. The intensity of the symptom depends on the degree of nicotine addiction but also by factors such as psychic stress and pain tolerance, motivation, social context and others;
• Nervousness, irritability, anxiety. This symptoms appear because the substances that are inhaled by tobacco smoke affects the entire central nervous system, and nervousness caused by the lack of these substances can take several days. The absence of smoking can induce a state of nervousness and anxiety which may last even months, depending on the person’s resilience;
• Frustration, anger and depression. Often this symptoms appear in those who were not prepared enough of quitting smoking or the  personal reasons are not strong enough.

In addition, the absence of the nicotine can cause diverse types of  symptoms. Duration depends on the period of adjustment and acceptance of former smokers to the new conditions.

Smoking Kills

b) Biological:

• Dizziness and headache may appear because quitting smoking increases the blood oxygen concentration as a result of the disappearance of carbon monoxide in the blood.  In addition, because of the absence of nicotine, which is vasoconstrictor substance, will appear an increase in blood flow to the brain, which can sometimes cause headaches. Dizziness may occur once or twice a day, in the first week and usually takes a second or two;
• Sensation of hunger, it is a symptom that occurs in many former smokers who noticed that they tend to eat more than they ate before. The explanations are: a return to normal of the hunger and satiety center, a return to normal metabolism, replacing the gesture of smoking with eating. It will appear a improved food absorption, along with smoking cessation and weight gain may occur;
• Tremor. It may be noted that hands and fingers get a slight tremor which is likely to persist over several weeks;
• Sweat.This reaction it disappears after a while. Frequent hot baths may help in the disappearance of these effect;
• Bradycardia and decreased blood pressure;
• Cough appears because after quitting smoking, airway cilia begin to recover, they start to clear the bronchial tree and remove phlegm, causing an increase in cough that lasts several weeks. Also the additives added to cigarettes may produce mild bronchodilation, masking a possible underlying disease. In these cases, giving up cigarettes could unmask a disease  like chronic bronchitis, which requires the submission of the emergency physician;
• Sleep disorders. Some smokers complain that they find it difficult to sleep, because quitting smoking increases the amount of energy accumulated in the body;

How to bear easy the effects of nicotine withdrawal:

• Think positive. List every day the reasons why you quit smoking and rewarded with small gifts for your progress;
• Keep the money saved on quitting smoking in a bowl or jar to see how their level is growing every day. Use the money to celebrate the fact that you managed to quit smoking;
• Try to find preoccupation in the early days of quitting smoking. Avoid exposing yourself in situations or places in which you are predispose to smoking;
• Search the support of relatives and friends;
• Constantly remember yourself that in a few weeks you will be freed from tobacco addiction;

Reactive Arthritis

Reactive arthritis is defined as a arthritis that occurs at 1-4 weeks after an enteral or urogenital infection, especially in individuals with HLA  B27 . Reactive arthritis has two particular aspects:

• Because it differs from infectious arthritis, in reactive arthritis was not obtained culture of viable bacteria from the joint.

• There are some reactive arthritis which can not be classified as seronegative arthropathies and are not associated with HLA B27: arthritis from rheumatic fever (reactive arthritis as a consequence of reactive arthritis)

There are now considered as reactive arthritis only arthritis which can be classified as seronegative arthropathies. The onset of this disease is around 20-40 years of age with an incidence of approximately 30-40/100.000, no features related to race and sex.

Reactive Arthritis

Causes

In the occurrence of the reactive arthritis are involved two factors: genetic factors and infectious factors.

The genetic factor is HLA B27. Another gene that is involved in the development of reactive arthritis is TAP (transporter antigen peptide). The infectious factor it is represented by the germs which have same characteristics: the ability to synthesize lipopolisaccharide, adhere easily to the cell membrane and the ability to invade the cell of intestinal and urogenital mucosa. Among enetric bacteria are included: Shigella flexuri, Salmonella, Campylobacter, Yersinia. Urogenital bacteria involved in the development of reactive arthritis are: Clamydia trachomatis and Ureaplasma urealyticum.

Symptoms

The factor that triggers reactive arthritis is enteral infection which is expressed by diarrhea or urogenital infection such as urethritis, prostatitis, epididymitis, vaginitis and cervicitis which are expessed by mucopurulent discharge and dysuria. After about 1-4 weeks from the systemic manifestation, can occur articular and extra-articular manifestations.

Systemic manifestations consist of malaise, fatigue, weight loss, anorexia, fever up to 39 degrees.

The articular manifestations are:

• Peripheral arthritis which can be monoarticular or olifoarticular and affects large joints of the lower limb (knee and ankle), it has a acute and migration character and can be accompanied by signs of inflammation. Peripheral arthritis may also have chronic character, but is slowly and affects the small joints of the upper limbs;
• Axial arthritis: sacroileitis which is expressed by buttock pain and is accompanied by spondylitis;
• Entezitis which is represented by inflammation of the ahilian tendon,   chest pain as a result of  the inflammation of the insertion of intercostal muscles insertion and pain in the iliac crest;
• Dactylitis: swelling of the finger joints

• Hypertrophy of the quadriceps muscle.

Reactive Arthritis

Extra-articular manifestations are represented by cutaneous manifestations like keratoderma blenorrhagicum which is manifested by clear vesicles on erythematous background, located on the palms and plants. Another manifestation is represented by painful ulcers of the digestive tract (located especially in the mouth).  In reactive arthritis can appear sterile urethritis, which has a immune mechanism.

Other extra-articular manifestations can be localized to the nails (discoloration, hyperkeratosis and onycholisis, lesions the are similar to those that appears in psoriasis) and to the eyes (conjunctivitis and anterior uveitis).

Cardiac manifestations occur in less then 10%, being  the consequence of aortic root inflammation, causing aortic insufficiency and atrio-ventricular conduction disturbancens.

Can also be seen renal manifestations such as mesangial glomerulonephritis with Ig A deposis an renal amyloidosis.

Neurological manifestations associated with reactive arthritis may be peripheral neuropathy, transverse myelitis and encephalitis.

Vaccinations

Diagnosis

Laboratory tests may show inflammatory syndrome: ESR more than 6o mm/h, positive C-reactive protein, leukocytosis, anemia due to chronic inflammation and thrombocytosis.

Synovial fluid analysis may reveal predominant exudate with leukocytes, polymorphonuclear,  glucose that is reduced, increased complement and negative cultures.

Immunology highlights negative rheumatoid factor, positive antinuclear antibodies. HLA B27 is negative in 60-80% of cases.

X-ray examination of the joints in the acute phase reveals non-specific juxtaarticular osteoporosis and soft tissue swelling. In the chronic phase, the x-ray examination reveals periostitis, marginal erosions and ankylosis.

Positive diagnosis is based on clinical examination, patient history which has a very important role and the laboratory tests.

Transverse Myelitis

Transverse myelitis is a neurological disorder caused by inflammation of the spinal cord. The term of myelitis  refers  to an inflammation of the spinal cord, while the term of transverse refers to the location of the inflammatory process. The condition can be found both to children and adults.

Causes

Determining the exact cause of transverse myelitis installation is unknown. It was observed that the transverse myelitis can occur as a result of a viral infection that can be caused by herpes simplex virus, Epstein-Barr virus, influenza virus, enterovirus, measles, rubella, chicken pox or HIV infection. Also it can be cause by bacterial infection with Mycoplasma pneumoniae or with Treponema pallidum (etiologic agent of syphilis). Transverse myelitis can be determined by an autoimmune process or a recent vaccination.

Transverse Myelitis

Transverse myelitis may occur in some disease, such as:

• Multiple sclerosis;
• Systemic lupus erythematosus;
• Sjogren’s syndrome;
• Sarcoidosis;
• Spinal arterio-venous malformation;
• Spinal artery thrombosis.

Inflammation of the spinal cord will cause damage or destruction of the myelin (   the layer that surrounds the axons of neurons), which will affect the relationship between spinal cord and whole body.

Symptoms

The symptoms that appear are rapidly worsen in a few hours or a few weeks. In most patients, symptoms develop within 24 hours. The firs symptom is pain of the back, which may radiate to the upper or lower limbs. Pain may be accompanied  by moderate fever, burning sensation when the patient urinate, loss of appetite or headaches.

Gradually, can appear signs of spinal suffering, which can be represented by:

• paresthesia: numbness or abnormal sensation;
• paraplegia: paralysis of the arms or legs;
• tetraplegia: paralysis of all 4 members.

Other symptoms may appear such as:

• Sensitive disorder that is manifested by anesthesia;
• Sphincter disorders  like loss of urine, constipation or sensation of incomplete evacuation of the colon;
• Vasomotor and trophic disorders which are represent by vasoparalisy that causes cyanosis and edema which determines pressure sores, whose superinfection can cause spesis;
• Respiratory infection.

Transverse Myelitis

Diagnosis

Diagnosis is established on patient history, neurological examination and laboratory investigations which will determine with certainty if is transverse myelitis. Among para-clinical investigations required to establish the diagnosis include:

• Cerebrospinal fluid examination;
• MRI;
• Myelography;
• Blood tests.

Treatment

There is no specific treatment for transverse myelitis. Treatment can be used just for the improvement of the symptoms. A patient with transverse myelitis may receive:

• Corticosteroids like dexamethasone or methylprednisolone;
• Group B vitamins.

Fever should be treated only at very high, because it appears to disfavor the viral infection.

In cases with significant respiratory disorders that endanger the patient’s life, it will require placing the patient in the ICU. After the transition period of acute inflammation, massage and passive mobilization of paralyzed segments are necessary.

Transverse Myelitis

Prognosis

The prognosis of patients with transverse myelitis is darkened by pressure sores and disorders of the sphincter, because the superinfection of this lesions leads to reinfection of the spinal cord. Maild forms may remit by themselves. Unfortunately, many patients are cured but will remain important sequelae, while in other cases healing is not possible.

Hyperuricemia

Hyperuricemia  is defined by values of uric acid over 7 mg/dl in men or over 6 mg/dl in women. Hyperuricemia appears in many cases, of which the most common in gout, a condition characterized by recurrent episodes of painful inflammation of joints due to uric acid crystals deposit. Uric acid can be increased in other circumstances like cardiovascular diseases, obesity, kidney failure, alcohol, food excess (especially meat and organs), diabetes mellitus, metabolic syndrome, diuretic therapy. For this reason the interpretation of the increased amount of  uric acid should be done by a doctor, knowing the persons individual characteristics: diseases, treatment, diet.

Hiperuricemia

Treatment

Treatment of metabolic disorders, including hyperuricemia, always starts from an assessment that goes beyond the finding of analysis outside normal limits. The finding of hyperuricemia can be not followed by any specific measure, if it predicts that the uric acid will return to normal values (unbalanced diabetes), or require a long term treatment (gout). Of course, if there are clinical manifestations (joints, kidneys), the doctor will recommend specif measures for each problem.

In all cases, if is necessary to set a long-term treatment to lower the uric acid, this treatment refers to two measures: diet and medication.

Hyperuricemia diet

In hyperuricemia and gout, diet consists in several types of measures. A specific measure is to reduce purines consumption, which are present in large proportion in organs, meat extracts, yeast, seafood and some fish (sardines, herring, mackerel, anchovy). Plants with high content of purine are spinach, peas, beans. Mushrooms have high content of purine too.

Among alcoholic beverages, moderate wine consumption appears to be protective, while beer and spirits must be avoided.

Equally important, hyperuricemia is associated with insulin resistance and cardiovascular diseases, for which all measures aimed at weight loss and at measures against atherosclerosis  are listed in hyperuricemia. Reducing fat can directly contribute to a better elimination of uric acid. At the same time is recommended a good hydration and consumption of food with beneficial proprieties: low-fat dairy products, foods rich in vitamin C. Also, if there is a recommendation for medication (allopurinol), treatment should be followed and reviewed regularly (depending not only on uric acid, but others parameters like creatinine, age, weight).

Norwalk Virus Infection

Noroviruses are a group of viruses (Norwalk) that causes an infection of the stomach and intestines, also called viral gastroenteritis or stomach flu, although the disease is not caused by influenza virus. Norwalk virus or norovirus, often appears in epidemics in cruse ships  (when they are affected more then 2% of total passengers). Manifestations of the virus infection can be unpleasant, symptoms including stomach cramps, nausea, vomiting, diarrhea and sometimes fever and chills or headache and muscles pain. This infections were most frequently in communities, nurseries, schools, cruise ships, camps, hostels, restaurants and other places where groups can gather.

Norwalk Virus

Ways of transmission

The virus is present in the feces and vomit of infected people. The means by which a person can become infected are:

• Direct contact with another infected person with symptoms;
• Consumption of food or drinks contaminated with the virus. Food can be contagious trough the handling of the persons who are infected with norovirus, especially if you do not keep a proper hygiene ( hands should be washed before they rich the food);
• Achieving contaminated surfaces or objects contaminated with norovirus and placing fingers in mouth;

Norovirus is highly contagious and can spread rapidly. Like the common cold, norovirus has different strains, which makes it difficult for a person’s body to develop lasting immunity. Therefore, norovirus infection can recur several times during a person’s life. In addition, some people are more likely to become infected and develop more sever illness due to genetic susceptibility factors.

Risk factors

Anyone can become ill with norovirus because the disease is highly contagious. Most people  will recover without any complication. Symptoms of Norwalk  virus infection may be more serious in infants, young children, the elderly and those with weakened immune system.

norwalk

Symptoms

Norwalk virus symptoms usually starts after 24-48 hours after exposure to the virus, but can occur even 12 hours after ingestion. Infected people are contagious from the moment the first symptom manifests until at least 3 days after recovery ( the period of contagion may be extended  up to two weeks). Therefore it is very important to follow simple hygiene rules even after the recovery period.

In the first three days symptoms of norwalk virus infection are:

• Nausea;
• Vomiting;
• Watery diarrhea.

Other symptoms include fever, headache, stomachache, abdominal cramps. Generally, the disease dose not become  worse and hospitalization is not necessary. Typically, recovery takes 2-3 days without long effects of health. Dehydration is the most common complication, especially among children and elderly. If diarrhea contains blood, accompanied by high fever or symptoms lasting more the 72 hours, could be involved another virus than norovirus.

Infection control measure

Prevention of outbreaks of infection in communities, depends on maintaining a good hygiene level at the staff who handle food. Those who have symptoms of nausea, vomiting or diarrhea, should be removed from the workplace and return 48 hours after these symptoms disappear

Healthcare professionals caring for patients suffering with norovirus, must wear gown and glows. Special attention will be given to washing hands with soap.  Handling patient trough the hospital should be minimized.

Diagnosis

Doctor will diagnose the disease based on symptoms, which will improve after 2-3 days of onset. However, in certain circumstances may be necessary fecal analyze.

Treatment

Currently, there is no vaccine available to prevent Norwalk virus. And because the disease is triggered by virus, antibiotics are ineffective. Serious cases are rare and associated with dehydration or electrolyte imbalance. Maintaining an adequate intake of fluids to fill the needs of your organism, lost from vomiting or diarrhea is very important.

Synovial Fold Syndrome Of The Knee

This syndrome occurs when the folds (lanes of residual synovial tissue) are irritated by overuse or trauma. Synovial fold is a residual tissue which is found in the initial stages of fetal development. As the fetus develops, the tissue combine to form one large synovial cavity. If the process is incomplete, envelopes remain as four folds or bands of synovial tissue in the knee. Trauma, overuse or inflammatory diseases are associated with the development of this syndrome.

Knee Synovial Fold

Symptoms and diagnosis

Patients experience pain and joint swelling (arthritis of the knee), a punched noise at the joint movement, weakness and the sensation of a locked knee. This syndrome is often misdiagnosed because the symptoms are related to other joint diseases. The diagnosis usually depends on excluding other conditions that cause similar symptoms.

Treatment

The goal of treatment is to reduce the synovial inflammation and the thickening of the fold. The doctor usually recommend anti-inflammatory treatment like ibuprofen. It is indicated to reduce the activity of the joint, compresses with ice, the use of elastic buttocks and performing muscle strengthening exercises. If this treatment dose not improve symptoms in three months, the doctor may recommend arthroscopy or surgery to remove the fold. Treatment like joint injections with cortisone, it is beneficial to half of patients. The doctor may use arthroscopy to confirm the diagnosis and treat this disease.

Ortorexia Or Healthy Food Addiction

Ortorexia is a different eating disorder characterized by addiction to healthy eating. Eating healthy is one of the sides to shape healthy lifestyle, on which more and more people are concentrated. However, for some people healthy eating can become an obsession, so people who are overly concerned with the quality of food may suffer from an eating disorder called nervous ortorexia. People who suffer from ortorexia are obsessed with eating organic food, the idea of eating healthy constantly influence their life. For example they can create their own system of nutritional values to be reported at while they eat. In most cases, the patients choose a restricted diet, after which they will be underweight.

Ortorexia

Unlike patients with anorexia nervosa (eating disorder that a person wants to lose weight without ceasing), patients with ortorexia are trying to find a variant of optimal and healthy nutrition  plan trough their diet.

Ortorexia nervosa is characterized by limiting food consumption only at pure, organic and healthy products. Usually, large sums of money are spent to purchase healthy food and often they plan their menus a day in advance. As the disorder progresses the allowed food list is getting smaller and this is why eating in the city becomes a major problem.
Patients with ortorexia feel isolated, may suffer from depression or obsessive-compulsive disorder and their diet may prevent them from participating in many social activities. Another feature is their perfectionism and the healthy eating rules that are internalized and processed in personal values. Although ortorexia nervosa is not recognized as a disease, specialists in nutritional disorders can provide the best treatment solutions. Antidepressants or anxiolytics may be prescribed.

Healthy Food Addiction

Ortorexia nervosa symptoms include obsession with healthy eating, cachexia and even death by starvation. Usually, patients have specific views for each type of food, so canned food is considered dangerous, processed food is synthetic, while organic food is considered healthy.
People who suffer from this disease show a strong and uncontrollable desire for eating when they are nervous, excited, happy or guilty.
Ortorexia has a higher prevalence in men and especially those with a low education level. Ortorexia includes the following signs and symptoms:

• Waste of time (more than 3 hours per day) for planning the healthy food menu for the next day;
• Felling of guilt, fear or disgust when there is a deviation from the diet;
• Experiencing pleasure of eating when  food in the menu is pure (bio);
• Sacrificing relationships and preferred activities to eating healthy;
• Obtaining self-esteem and sens of control when they respect their food plan;
• Disregard for those who do not eat the same;
• Social isolation in order not to deviate from the right nutrition plan;

ortorexia

In ortorexia nervosa, healthy eating turns into fanaticism. Quality of life, in general, is replaced with the so-called quality of food consumption. Although the person with ortorexia nervosa can loose too much weight, the main objective is compliance with diet, not weight loss.

Caffeine Abuse

Caffeine may be beneficial for health in some situations and harmful in others, so it is important that each person should know whether or not to reduce the consumption of coffee. Caffeine stimulates the central nervous system, improves the level of attention and concentration, alleviate fatigue and improves physical performance. For most of the healthy adults, moderate dose of caffeine (200-300 mg or 3-4 cups of coffee per day) is not contraindicated. However in some cases the amount of caffeine can be minimized or even giving up completely.

Caffeine Abuse

Too much caffeine can have unpleasant  effects, if used every day more then 500-600 mg may cause

• Insomnia
• Nervousness
• Agitation
• Irritability
• Gastrointestinal disorders
• Quick emotion
• Muscle tremors

When does a low caffeine consume causes nervousness?

Some people are more sensitive to caffeine then others. This sensitivity is manifested even after consumption of a small amount of caffeine (only one cup of coffee or tea), which may cause unwanted effects such us sleep disturbance, restlessness, irritability.  Response to caffeine is particularly influenced by how much caffeine a person consumes. Those who do not drink coffee regularly, tend to be more sensitive to its harmful effects. Other factors may include body mass, age, administration of drugs, various health problem (such as anxiety disorders).  Research suggests that men should be more sensitive to the effects of caffeine than women.

When a person can not get enough sleep

Most adults need seven to eight hours of sleep every night, but caffeine may interfere with this much needed sleep. Chronic fatigue, whether it is the result of following trip, stressful situation or working conditions, lead to sleep deprivation. Cumulative  lack of sleep disrupt the performance needed for daily activities, quality of attention, etc.

Using caffeine to compensate the lack of sleep can create an undesirable cycle. For example, it takes three coffee for a person to remain awake during the day. However, caffeine can prevent a person to sleep or shortens the period in which a person needs to rest at night.

When a person uses certain drugs and herbal supplements

Certain medications as well as herbal supplements can interact with caffeine. Here are some examples:

• Some antibiotics like ciprofloxacin and norfloxacin can interfere with the absorption (decay) of caffeine. Thus, it can increase the length of time caffeine stays in the body and amplify its unwanted effects
• Theophylline a bronchodilator that contributes to dilatation of the airways by relaxing  the surrounding muscle. If it used with food or drinks containing caffeine, theophylline concentration in the blood will increase. This may cause side effects such as nausea, vomiting and heart palpitations
• Echinacea this herbal supplement that is used to prevent colds or other infections may increase the blood concentration of caffeine and may enhance the unpleasant effects of caffeine.