Do you struggle to get to sleep no matter how tired you are? Or do you wake up in the middle of the night and lie awake for hours, anxiously watching the clock? Insomnia is a common problem that takes a toll on your energy, mood, health, and ability to function during the day. Chronic insomnia can even contribute to serious health problems. Simple changes to your lifestyle and daily habits can put a stop to sleepless nights.


Insomnia is the inability to get the amount of sleep you need to wake up feeling rested and refreshed. Because different people need different amounts of sleep, insomnia is defined by the quality of your sleep and how you feel after sleeping—not the number of hours you sleep or how quickly you doze off. Even if you’re spending eight hours a night in bed, if you feel drowsy and fatigued during the day, you may be experiencing insomnia.

Although insomnia is the most common sleep complaint, it is not a single sleep disorder. It’s more accurate to think of insomnia as a symptom of another problem, which differs from person to person. It could be something as simple as drinking too much caffeine during the day or a more complex issue like an underlying medical condition or feeling overloaded with responsibilities.

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Typhoid fever — also known simply as typhoid — is a common worldwide bacterial disease transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica subsp. enterica, serovar Typhi.

The disease has received various names, such as gastric fever, enteric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever and pythogenic fever. The name typhoid means "resembling typhus" and comes from the neuropsychiatric symptoms common to typhoid and typhus. Despite this similarity of their names, typhoid fever and typhus are distinct diseases and are caused by different species of bacteria.


Signs and symptoms

Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. Over the course of these stages, the patient becomes exhausted and emaciated.

•In the first week, the temperature rises slowly, and fever fluctuations are seen with relative bradycardia (Faget sign), malaise, headache, and cough. A bloody nose (epistaxis) is seen in a quarter of cases, and abdominal pain is also possible. A decrease in the number of circulating white blood cells (leukopenia) occurs with eosinopenia and relative lymphocytosis; blood cultures are positive for Salmonella typhi or S. paratyphi. The Widal test is negative in the first week.[citation needed]
•In the second week of the infection, the patient lies prostrate with high fever in plateau around 40 °C (104 °F) and bradycardia (sphygmothermic dissociation or Faget sign), classically with a dicrotic pulse wave. Delirium is frequent, often calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around a third of patients. Rhonchi are heard in lung bases.
The abdomen is distended and painful in the right lower quadrant, where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green, comparable to pea soup, with a characteristic smell. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender, and liver transaminases are elevated. The Widal test is strongly positive, with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage.(The major symptom of this fever is that the fever usually rises in the afternoon up to the first and second week.)•In the third week of typhoid fever, a number of complications can occur: ◦Intestinal haemorrhage due to bleeding in congested Peyer's patches; this can be very serious, but is usually not fatal.
◦Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
◦Encephalitis
◦Neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil", with picking at bedclothes or imaginary objects.
◦Metastatic abscesses, cholecystitis, endocarditis, and osteitis
◦The fever is still very high and oscillates very little over 24 hours. Dehydration ensues, and the patient is delirious (typhoid state). One-third of affected individuals develop a macular rash on the trunk.
◦Platelet count goes down slowly and risk of bleeding rises.

•By the end of third week, the fever starts subsiding (defervescence). This carries on into the fourth and final week.
Treatment[edit]

The rediscovery of oral rehydration therapy in the 1960s provided a simple way to prevent many of the deaths of diarrheal diseases in general.

Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as ciprofloxacin. Otherwise, a third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice. Cefixime is a suitable oral alternative.

Typhoid fever, when properly treated, is not fatal in most cases. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, amoxicillin, and ciprofloxacin, have been commonly used to treat typhoid fever in microbiology. Treatment of the disease with antibiotics reduces the case-fatality rate to about 1%.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in 10% to 30% of untreated cases. In some communities, however, case-fatality rates may reach as high as 47%

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Sickle-cell disease (SCD), or sickle-cell anaemia (SCA) or sometimes drepanocytosis, is a hereditary blood disorder, characterized by an abnormality in the oxygen-carrying haemoglobin molecule in red blood cells. This leads to a propensity for the cells to assume an abnormal, rigid, sickle-like shape under certain circumstances. Sickle-cell disease is associated with a number of acute and chronic health problems, such as severe infections, attacks of severe pain ("sickle-cell crisis", and stroke, and there is an increased risk of death. Sickle-cell disease occurs when a person inherits two abnormal copies of the haemoglobin gene, one from each parent. Several subtypes exist, depending on the exact mutation in each haemoglobin gene. A person with a single abnormal copy does not experience symptoms and is said to have sickle-cell trait.

The complications of sickle-cell disease can be prevented to a large extent with vaccination, preventative antibiotics, blood transfusion, and the drug hydroxyurea/hydroxycarbamide. A small proportion requires a transplant of bone marrow cells.

Almost 300,000 children are born with a form of sickle-cell disease every year, mostly in sub-Sarahan Africa, but also in other countries such as the West Indies and South Asia, and in people of African origin elsewhere in the world. The condition was first described in the medical literature by the American physician James B. Herrick in 1910, and in the 1940s and 1950s contributions by Nobel prize-winner Linus Pauling made it the first disease where the exact genetic and molecular defect was elucidated

Sickle-cell anaemia can lead to various complications, including:

•Increased risk of severe bacterial infections due to loss of functioning spleen tissue (and comparable to the risk of infections after having the spleen removed surgically). These infections are typically caused by encapsulated organisms such as Streptococcus pneumoniae and Haemophilus influenzae. Daily penicillin prophylaxis is the most commonly used treatment during childhood, with some haematologists continuing treatment indefinitely. Patients benefit today from routine vaccination for S. pneumoniae.[18]
•Stroke, which can result from a progressive narrowing of blood vessels, prevents oxygen from reaching the brain. Cerebral infarction occurs in children and cerebral haemorrhage in adults.
•Silent stroke causes no immediate symptoms, but is associated with damage to the brain. Silent stroke is probably five times as common as symptomatic stroke. About 10–15% of children with SCD suffer strokes, with silent strokes predominating in the younger patients.[19][20]
•Cholelithiasis (gallstones) and cholecystitis may result from excessive bilirubin production and precipitation due to prolonged haemolysis.
•Avascular necrosis (aseptic bone necrosis) of the hip and other major joints may occur as a result of ischaemia.[21]
•Decreased immune reactions due to hyposplenism (malfunctioning of the spleen)[22]
•Priapism and infarction of the penis[23]
•Osteomyelitis (bacterial bone infection), the most common cause of osteomyelitis in SCD is Salmonella (especially the atypical serotypes Salmonella typhimurium, Salmonella enteritidis

Management

Folic acid and penicillin

Children born with sickle-cell disease will undergo close observation by the pediatrician and will require management by a haematologist to assure they remain healthy. These patients will take a 1 mg dose of folic acid daily for life. From birth to five years of age, they will also have to take penicillin daily due to the immature immune system that makes them more prone to early childhood illnesses.

Malaria chemoprophylaxis

The protective effect of sickle-cell trait does not apply to people with sickle cell disease; in fact, they are more vulnerable to malaria, since the most common cause of painful crises in malarial countries is infection with malaria. It has therefore been recommended that people with sickle-cell disease living in malarial countries should receive anti-malarial chemoprophylaxis for life.[40]

Vaso-occlusive crises

Most people with sickle-cell disease have intensely painful episodes called vaso-occlusive crises. The frequency, severity, and duration of these crises, however, vary tremendously. Painful crises are treated symptomatically with analgesics; pain management requires opioid administration at regular intervals until the crisis has settled. For milder crises, a subgroup of patients manage on NSAIDs (such as diclofenac or naproxen). For more severe crises, most patients require inpatient management for intravenous opioids; patient-controlled analgesia (PCA) devices are commonly used in this setting. Diphenhydramine is also an effective agent that is frequently prescribed by doctors in order to help control any itching associated with the use of opioids.

Acute chest crisis

Management is similar to vaso-occlusive crisis, with the addition of antibiotics (usually a quinolone or macrolide, since cell wall-deficient ["atypical"] bacteria are thought to contribute to the syndrome),[41] oxygen supplementation for hypoxia, and close observation. Should the pulmonary infiltrate worsen or the oxygen requirements increase, simple blood transfusion or exchange transfusion is indicated. The latter involves the exchange of a significant portion of the patients red cell mass for normal red cells, which decreases the percent of haemoglobin S in the patient's blood.

Hydroxyurea

The first approved drug for the causative treatment of sickle-cell anaemia, hydroxyurea, was shown to decrease the number and severity of attacks in a study in 1995 (Charache et al.)[42] and shown to possibly increase survival time in a study in 2003 (Steinberg et al.).[43] This is achieved, in part, by reactivating fetal haemoglobin production in place of the haemoglobin S that causes sickle-cell anaemia. Hydroxyurea had previously been used as a chemotherapy agent, and there is some concern that long-term use may be harmful, but this risk has been shown to be either absent or very small and it is likely that the benefits outweigh the risks.[44]

Transfusion therapy

Blood transfusions are often used in the management of sickle-cell disease in acute cases and to prevent complications by decreasing the number of red blood cells (RBC) that can sickle by adding normal red blood cells.[45] In children prophylactic chronic red blood cell (RBC) transfusion therapy has been shown to be efficacious to a certain extent in reducing the risk of first stroke or silent stroke when transcranial Doppler (TCD) ultrasonography shows abnormal increased cerebral blood flow velocities. In those who have sustained a prior stroke event it also reduces the risk of recurrent stroke and additional silent strokes.[46][47]

Bone marrow transplants

Bone marrow transplants have proven to be effective in children. Bone marrow transplants are the only known cure for SCD.[48] However, bone marrow transplants are difficult to obtain because of the specific HLA typing necessary. Ideally, a twin family member (syngeneic) or close relative (allogeneic) would donate the bone marrow necessary for transplantation

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Rheumatism or rheumatic disorder is a non-specific term for medical problems affecting the joints and connective tissue

rheumatic disorders currently recognized include
•Ankylosing spondylitis
•Back pain
•Bursitis/Tendinitis, Shoulder pain, wrist, biceps, leg, knee (patellar), ankle, hip, and Achilles
•Capsulitis
•Neck pain
•Osteoarthritis
eumatism or rheumatic disorder is a non-specific term for medical problems affecting the joints and connective tissue.

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Human immunodeficiency virus infection / acquired immunodeficiency syndrome (HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV).[1] The term HIV/AIDS represents the entire range of disease caused by the HIV virus from early infection to late stage symptoms. During the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a prolonged period without symptoms. As the illness progresses, it interferes more and more with the immune system, making the person much more likely to get infections, including opportunistic infections and tumors that do not usually affect people who have working immune systems.

HIV is transmitted primarily via unprotected sexual intercourse (including anal and MouthAction), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, delivery, or breastfeeding.[2] Some bodily fluids, such as saliva and tears, do not transmit HIV.[3] Prevention of HIV infection, primarily through safe sex and needle-exchange programs, is a key strategy to control the spread of the disease. There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of death and complications from the disease, these medications are expensive and have side effects. Without treatment, the average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype.[4]

Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century.[5] AIDS was first recognized by the United States Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade.[6] Since its discovery, AIDS has caused an estimated 36 million deaths worldwide (as of 2012).[7] As of 2012, approximately 35.3 million people are living with HIV globally.[7] HIV/AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading.[8]

HIV/AIDS has had a great impact on society, both as an illness and as a source of discrimination. The disease also has significant economic impacts. There are many misconceptions about HIV/AIDS such as the belief that it can be transmitted by casual non-sexual contact. The disease has also become subject to many controversies involving religion. It has attracted international medical and political attention as well as large-scale funding since it was identified in the 1980s
Acute infection
Main symptoms of acute HIV infectionThe initial period following the contraction of HIV is called acute HIV, primary HIV or acute retroviral syndrome.[10][12] Many individuals develop an influenza-like illness or a mononucleosis-like illness 2–4 weeks post exposure while others have no significant symptoms.[13][14] Symptoms occur in 40–90% of cases and most commonly include fever, large tender lymph nodes, throat inflammation, a rash, headache, and/or sores of the mouth and genitals.[12][14] The rash, which occurs in 20–50% of cases, presents itself on the trunk and is maculopapular, classically.[15] Some people also develop opportunistic infections at this stage.[12] Gastrointestinal symptoms such as nausea, vomiting or diarrhea may occur, as may neurological symptoms of peripheral neuropathy or Guillain-Barre syndrome.[14] The duration of the symptoms varies, but is usually one or two weeks.[14]

Due to their nonspecific character, these symptoms are not often recognized as signs of HIV infection. Even cases that do get seen by a family doctor or a hospital are often misdiagnosed as one of the many common infectious diseases with overlapping symptoms. Thus, it is recommended that HIV be considered in people presenting an unexplained fever who may have risk factors for the infection.[14]

Clinical latencyThe initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV.[11] Without treatment, this second stage of the natural history of HIV infection can last from about three years[16] to over 20 years[17] (on average, about eight years).[18] While typically there are few or no symptoms at first, near the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains.[11] Between 50 and 70% of people also develop persistent generalized lymphadenopathy, characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months.[10]

Although most HIV-1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) retain high levels of CD4+ T cells (T helper cells) without antiretroviral therapy for more than 5 years.[14][19] These individuals are classified as HIV controllers or long-term nonprogressors (LTNP).[19] Another group is those who also maintain a low or undetectable viral load without anti-retroviral treatment who are known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 infected persons.[20]
Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4+ T cell count below 200 cells per µL or the occurrence of specific diseases in association with an HIV infection.[14] In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years.[14] The most common initial conditions that alert to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%) and esophageal candidiasis.[14] Other common signs include recurring respiratory tract infections.[14]

Opportunistic infections may be caused by bacteria, viruses, fungi and parasites that are normally controlled by the immune system.[21] Which infections occur partly depends on what organisms are common in the person's environment.[14] These infections may affect nearly every organ system.[22]

People with AIDS have an increased risk of developing various viral induced cancers including Kaposi's sarcoma, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer.[15] Kaposi's sarcoma is the most common cancer occurring in 10 to 20% of people with HIV.[23] The second most common cancer is lymphoma which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3 to 4%.[23] Both these cancers are associated with human herpesvirus 8.[23] Cervical cancer occurs more frequently in those with AIDS due to its association with human papillomavirus (HPV).[23]

Additionally, people with AIDS frequently have systemic symptoms such as prolonged fevers, sweats (particularly at night), swollen lymph nodes, chills, weakness, and weight loss.[24] Diarrhea is another common symptom present in about 90% of people with AIDS.[25] They can also be affected by diverse psychiatric and neurological symptoms independent of opportunistic infections and canc

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Sleep paralysis is a phenomenon in which people, either when falling asleep or wakening, temporarily experience an inability to move. It is a transition state between wakefulness and rest characterized by complete muscle atonia (muscle weakness). It can occur at sleep onset or upon awakening, and it is often associated with terrifying visions, such as an intruder in the room, to which one is unable to react due to paralysis. It is believed to be a result of disrupted REM sleep, which is normally characterized by complete muscle atonia that prevents individuals from acting out their dreams. Sleep paralysis has been linked to disorders such as narcolepsy, migraines, anxiety disorders, and obstructive sleep apnea; however, it can also occur in isolation. When linked to another disorder, sleep paralysis commonly occurs in association with the neurological sleep disorder narcolepsy.The two major classifications of sleep paralysis are isolated sleep paralysis (ISP) and recurrent isolated sleep paralysis (RISP). Of these two types, ISP is much more common than RISP. ISP episodes are infrequent and of short duration, approximately one minute. Sleep paralysis might even only occur once in an individual's lifetime.As the name suggests, recurrent isolated sleep paralysis is a chronic condition. The individual suffers from frequent episodes throughout their lifetime.[2] One of the major differences between ISP and RISP is duration. RISP episodes can last for up to an hour or longer, and have a much higher occurrence of perceived out of body experiences—while ISP episodes are generally short (usually no longer than one minute) and are typically associated with the intruder and incubus hallucinations. RISP episodes can, however, persist for up to half an hour.[2] With RISP the individual can also suffer back to back episodes of sleep paralysis in the same night while this is unlikely in individuals who suffer from

It can be difficult to differentiate between cataplexy brought on by narcolepsy and true sleep paralysis, because the two phenomena are physically indistinguishable.[2] The best way to differentiate between the two is to note when the attacks occur most often. Narcolepsy attacks are more common when the individual is falling asleep; ISP and RISP attacks are more common on awakenin