Medial Collateral Ligament ( MCL)

What is the medial collateral ligament?
The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).
The medial collateral ligament spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents "opening-up" of the knee.

How is the medial collateral ligament injured?
Because the medial collateral ligament resists widening of the inside of the knee joint, the MCL is usually injured when the outside of the knee joint is struck. This action causes the outside of the knee to buckle, and the inside to widen. When the medial collateral ligament is stretched too far, it is susceptible to tearing and injury. This is the injury seen by the action of "clipping" in a football game.

An injury to the medial collateral ligament may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the anterior cruciate ligament (ACL), or the meniscus (cartilage), may be torn along with a medial collateral ligament injury.

What are the symptoms of a medial collateral ligament injury?
The most common symptom following a medial collateral ligament injury is pain directly over the ligament. Swelling over the torn ligament may appear, and bruising and generalized joint swelling are common 1 to 2 days after the injury. In more severe injuries, patients may complain that the knee is unstable, or feel as though their knee may 'give out' or buckle.

Medial Collateral Ligament Injuries
MCL Injury
By
Jonathan Cluett, M.D.

Image from ADAM Images

CDC Treatment Recommendations for Gonorrhea( STD - Tulo )

"Gonorrhea is the second most commonly reported infectious disease in the
US, with about 340,000 cases reported in 2005," John M. Douglas, Jr., MD,
Director of the Division of Sexually Transmitted Diseases Prevention
(DSTD), National Center for HIV/AIDS, Viral Hepatitis, STD [sexually
transmitted disease], and TB Prevention (NCHHSTP), said in a CDC
teleconference. "Like most STDs, gonorrhea is underdiagnosed and
underreported, and we estimate that about twice that number of people were
affected. We've made substantial progress in reducing the burden of
gonorrhea over the years as a result of efforts to prevent, detect and
effectively treat the disease."
Rising rates of gonorrhea resistance to fluoroquinolones were first noted
in Hawaii and California, leading the CDC to recommend in 2000 and in
2002, respectively, that fluoroquinolones not be used to treat gonorrhea
infections in these states. In 2004, rising rates of gonorrhea resistance
to fluoroquinolones in men who have sex with men led the CDC to recommend
against using fluoroquinolones in this group.
"Part of our success in controlling this disease has been our ability to
treat the changing organism itself," Dr. Douglas says. "Gonorrhea has
proven to be quite efficient at navigating around the drugs we use to
combat it, with resistance first to penicillin, then tetracycline, then,
most recently, to fluoroquinolones.... We want a recommended treatment to
cure 95% or more of all gonorrhea infections, [and] we have reached a
level of resistance that threatens our ability to control the disease
across populations."
Data from CDC's Gonococcal Isolate Surveillance Project (GISP) in 26 US
cities showed that in the first half of 2006, 6.7% of gonorrhea cases in
heterosexual men were fluoroquinolone-resistant Neisseria gonorrhoeae
(QRNG), an 11-fold increase from 0.6% in 2001, and well above 5%, the
recognized threshold for changing treatment recommendations.
"As a result of these increases in fluoroquinolone resistance throughout
the country, CDC is no longer recommending that fluoroquinolones be used
to treat gonorrhea anywhere in the U.S.," Dr. Douglas says. "These
recommendations are critical to preserve the progress we've made in
controlling gonorrhea, one of the nation's most common STDs."
The overall proportion of gonorrhea cases that were QRNG increased from
less than 1% in 2001 to 13.3% in the first half of 2006, with dramatic
increases from 2004 to 2006 in Philadelphia (1.2% - 26.6%) and Miami (2.1%
- 15.3%). QRNG also continued to rise among men who have sex with men,
from 1.6% in 2001 to 38% in the first half of 2006.
"We do not have the full data yet from the last half of 2006," Hillard S.
Weinstock, MD, MPH, Medical Epidemiologist, DSTD, NCHHSTP, said in the
teleconference. "However, given the trends we have observed over the last
several years, we expect that the percentage of fluoroquinolone-resistant
cases will go up in the second half of 2006."
Therefore, the CDC no longer recommends fluoroquinolone antibiotics
(ciprofloxacin, ofloxacin, and levofloxacin) for treatment of gonorrhea in
the United States. Because gonorrhea resistance to penicillin, sulfa
drugs, and tetracycline is already widespread, this limits available
options for gonorrhea treatment to drugs in the cephalosporin class. The
United Kingdom preceded the United States by about 3 to 4 years in its
recommendation to switch from fluoroquinolones to cephalosporins in
gonorrhea treatment.
"There is an urgent need for new, effective medicines to treat gonorrhea,"
Kevin Fenton, MD, Director of CDC's National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention, said in a news release. "We are running
out of options to treat this serious disease. Increased vigilance in
monitoring for resistance to all available drugs is essential."
Although significant resistance to cephalosporins has not been reported
thus far, CDC is collaborating with state and local health departments to
detect emerging cephalosporin resistance. Now that gonorrhea is largely
diagnosed by a convenient DNA test, many laboratories and providers no
longer have the capability of culturing N gonorrhoeae for drug resistance
testing. The CDC is urging health departments to maintain or develop this
capacity and to evaluate any gonorrhea treatment failures for possible
resistance.
"Importantly, with fluoroquinolones no longer recommended, only one class
of drugs remains recommended for treating gonorrhea: the antibiotics known
as cephalosporins," Dr. Douglas says. "Although the cephalosporins offer
several potential options for treating gonorrhea, the lack of additional
classes of antibiotics is a serious concern. There are currently no new
drugs for gonorrhea in the drug development pipeline."
To bolster international monitoring for the emergence of cephalosporin
resistance, CDC is also working with the World Health Organization (WHO)
and with government and industry partners to identify and evaluate new
drug regimens for gonorrhea treatment.
"While we have not seen any evidence of resistance to cephalosporins to
date, emergence of any resistance would be a serious public health
concern," Dr. Douglas said. "CDC will work with government and industry
partners to identify and evaluate promising alternative drug regimens for
treating gonorrhea. Ultimately, reducing the burden of gonorrhea will
require comprehensive and continued action on many fronts, as we work to
maintain and expand effective programs to prevent and control this disease
across the nation."
Most cases of gonorrhea in women are asymptomatic and untreated. However,
failure to treat gonorrhea aggressively and early may result in pelvic
inflammatory disease with associated infertility, chronic pelvic pain,
and/or ectopic pregnancy. In men, rare complications of untreated
gonorrhea may include epididymitis, rarely associated with infertility.
Even when asymptomatic, inflammation of the male genitourinary tract
associated with gonorrhea may increase susceptibility to HIV infection.
Rarely, untreated gonorrhea may be associated with serious sequelae such
as infectious arthritis, meningitis or endocarditis.
Updated recommended treatment regimens for gonorrhea infection are as
follows:
For uncomplicated gonococcal infections of the cervix, urethra, and
rectum, recommended treatments are 125 mg of ceftriaxone in a single
intramuscular (IM) dose or 400 mg of cefixime (not available in the United
States) in a single oral dose, plus treatment of Chlamydia if chlamydial
infection is not ruled out. Although 400-mg tablets of cefixime are not
available in the United States, and it is only available in a suspension
formulation, Dr. Douglas said that the CDC has approached the Food and
Drug Administration regarding this, and they are hopeful that oral tablets
will soon be an option in the United States.
"While we only have this single class of recommended antibiotics, the
cephalosporins, and the vigilance we've talked about today is a key public
health priority, we've been using this class of drugs for the treatment of
gonorrhea since the early 1980s, and fortunately, so far, there has not
been any documentation of emergence of resistance," Dr. Douglas says. "I
don't want to present an injectable antibiotic as an insurmountable
obstacle, because we used it for years with penicillin; it's more of a
bump in the road in terms of how providers will be caring for patients
with gonorrhea."
Alternative regimens for uncomplicated gonococcal infections of the
cervix, urethra, and rectum are 2 g of spectinomycin (not available in the
United States) in a single IM dose or cephalosporin single-dose regimens
(ceftizoxime, 500 mg IM; or cefoxitin, 2 g IM, administered with
probenecid, 1 g orally; or cefotaxime, 500 mg IM).
For uncomplicated gonococcal infections of the pharynx, recommended
regimens are 125 mg of ceftriaxone in a single IM dose, plus treatment of
Chlamydia if chlamydial infection is not ruled out. There are currently no
recommended alternatives for pharyngeal infection.
For disseminated gonococcal infection, pelvic inflammatory disease,
epididymitis, and treatment of gonorrheal infections in patients with
documented severe allergic reactions to penicillins or cephalosporins,
updated treatment regimens are available at
http://www.cdc.gov/std/treatment.
A limitation of findings from GISP, which is conducted in publicly funded
clinics and includes only male urethral isolates, is that they might not
be representative of the entire US population infected with gonorrhea.
"We've looking hard for resistance for the duration of the GISP project,
and we've never seen gonorrhea that we would consider to be resistant to
cephalosporins," Dr. Douglas said. "Based on global surveillance, we have
not documented any strains resistant to cephalosporins at all. That's
comforting, of course, but because of the genetic versatility of the
organism, it's not something we feel completely complacent about.
Although test of cure is not recommended routinely for uncomplicated
gonorrhea treated with recommended or alternative regimens, persons with
persistent symptoms of gonococcal infection or whose symptoms recur
shortly after treatment with a recommended or alternative regimen should
be reevaluated by culture for N gonorrhoeae. Positive isolates should be
tested for antimicrobial susceptibility, and clinicians and laboratories
should report treatment failures or resistant gonococcal isolates to the
CDC at the telephone number: 1-404-639-8373, through state and local
public health authorities.
"In [other] Gram-negative bacteria, very highly resistant strains even to
these third generation cephalosporin antibiotics have occurred," Dr.
Douglas concluded. "It's just very hard to know if that could happen [for
N gonorrheae], and when it could happen, but it's certainly not
implausible. Can it happen? Absolutely."
Morbid Mortal Wkly Rep. 2007;56:332-336.
http://www.cdc.gov/std/treatment
http://www.cdc.gov/std/gonorrhea/arg/
Clinical Context
In the United States, gonorrhea is the second most frequently reported
notifiable disease, with 339,593 cases documented in 2005. Although
fluoroquinolones (ciprofloxacin, ofloxacin, or levofloxacin) are highly
effective, readily available, and convenient as single-dose oral therapy
and have been used since 1993 for gonorrhea treatment, prevalence of
fluoroquinolone resistance in N gonorrhoeae has been increasing and is now
widespread.
Beginning in 2000, fluoroquinolones were no longer recommended for
treatment of gonorrhea acquired in Asia or the Pacific Islands (including
Hawaii); in 2002, this recommendation was extended to California; and in
2004, CDC recommended that fluoroquinolones not be used in the United
States to treat gonorrhea in men who have sex with men. This Morbidity and
Mortality Weekly Report article summarizes findings from the GISP and
updates CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006
regarding the treatment of N gonorrhoeae infections.


Disclaimer : Medicines and the cure for gonococal urethritis or Tulo may differ from person to person and it is always advisable to consult a physician whenever possible.

5 Steps to Lower Blood Pressure

Every day, millions of Americans quietly battle a silent killer. High blood pressure is an elevation in the force of blood pushing against the walls of the arteries. It affects one out of every three Americans, according to the American Heart Association (AHA). High blood pressure is considered a major risk factor for heart attack, heart failure and stroke. Untreated high blood pressure can cause the heart to eventually overwork itself to the point at which serious damage can occur. High blood pressure can also cause injury to other areas served by delicate arteries that are damaged by the increased pressure. These include the brain, the eyes (retinopathy) and/or the kidneys (nephropathy). In most cases, there is no cure for high blood pressure. Medication can control high blood pressure, but there are several lifestyle changes you can make to keep your blood pressure lower. What You Can Do There are several things you can do to lower your blood pressure. The top five are:
1)Eat a healthful diet.
Studies have shown that people on the American Heart Association's Dietary Approaches to Stop Hypertension diet, or "DASH" diet, for only eight weeks experienced a significant reduction in blood pressure. The DASH diet emphasizes fruits, vegetables, whole grains and low-fat dairy while limiting saturated fat and red meat.
Excessive sodium intake also has been linked to an increased risk of high blood pressure. Limiting salt intake to 2,000 milligrams per day may help keep blood pressure low. A diet of 1,500 milligrams or less salt is especially effective at controlling blood pressure, according to the National Institutes of Health. Sodium is found in many foods, so keep an eye on the ingredients list to help rein in your sodium intake. In addition, avoid adding table salt to foods.
2)Avoid smoking and excessive drinking.
The nicotine found in tobacco products constricts blood vessels, causing your hear to beat faster and raising blood pressure for a period of time. Smoking also damages blood vessel walls and hardens the arteries, which both increase the risk of high blood pressure.
Alcohol consumption has a significant impact on blood pressure in some people. Limit alcohol use to one drink per day for women and two drinks per day for men. One drink is defined as one 6-ounce glass of wine per day, one 12-ounce beer or one 1-ounce shot of distilled spirits.
3)Get regular exercise.
Exercising three to four times per week helps regulate high blood pressure, keeping in mind that the regularity of the exercise is more important than the intensity of the workout. Individuals should consult their physician before starting an exercise program.
To be effective, the exercise must be aerobic, meaning it must move large muscle groups and cause you to both breathe more deeply and to push your heart to work harder to pump blood. However, your activity level does not need to be especially intense. For example, studies have shown that tai chi (an ancient Chinese workout involving slow, relaxing movements) may lower blood pressure almost as well as moderately intense aerobics.
4)Lose weight.
Shedding pounds, especially in the abdominal area, can immediately lower blood pressure and help reduce the size of the heart. A loss of just 10 pounds can make a significant difference. In many people, a simple combination of weight loss and salt restriction eliminates the need for taking blood-pressure medication.
5)Try to relax.
Emotional factors may play important roles in the development of high blood pressure. Studies have linked numerous activities to reducing blood pressure. These include cognitive-behavioral therapy, transcendental meditation, active religious faith and participation in activities related to a faith community. Other research has linked owning a pet with lower overall blood pressure. Relaxation techniques typically work best when they are employed at least once a day.

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New Guidelines Issued for Food Allergies

New Guidelines Issued for Food Allergies News Author: Laurie Barclay, MD

In children of parents with asthma, the rate of observed food allergy may be 4 times higher than in the general population. IgE-mediated food reactions may occur as a result of gastrointestinal sensitization, respiratory tract sensitization, or sensitization through the epidermis. Immune responses include acute IgE-mediated, local inhalational, systemic, and cell-mediated reactions (eg, atopic dermatitis and celiac disease). Sensitivity to most food allergens, such as milk, wheat, and egg, tend to remit in late childhood. Sensitivity to peanut, tree nuts (walnuts, cashew, Brazil nut, pistachio), and seafood are likely to continue throughout life. Allergies to fruits and vegetables tend to develop later in life as a consequence of shared homologous proteins with airborne allergens (eg, pollen). Anaphylaxis after exposure to foods reflects reactions of respiratory, dermatologic, cardiovascular, and other organ systems. In children, anaphylaxis occurs most commonly after ingestion of peanuts, other legumes, tree nuts, fish, shellfish, milk, and eggs. Diagnosis requires a detailed history of exposures and targeted physical examination. Initial evaluation may include skin prick or puncture tests. Commercial food extracts with stable proteins (eg, peanut, milk, egg, tree nuts, fish, shellfish) are reliable to detect IgE antibodies in most patients. Extracts from foods with more labile proteins (eg, many fruits and vegetables) are less reliable for diagnosis. Intradermal skin tests are not recommended as they are dangerous. A positive skin test has a positive predictive value (PPV) of less than 50% (ie, not specific) but a negative skin test has a negative predictive value (NPV) of more than 95% (ie, highly sensitive) and can reliably rule out IgE-mediated food allergy. Double-blind, placebo-controlled food challenge is most likely to provide a high PPV in conjunction with a careful history. In vitro serum tests are useful in patients with a history of life-threatening reaction, with medical conditions, a nonreactive histamine control, and in pregnant women. If a patient has a history of anaphylactic reaction with a positive test for IgE specific antibodies, no further evaluation is usually required. Provocation-neutralization is considered disproved as a diagnostic method. Hair analysis, food-specific IgG, cytotoxic tests, and immune complex assays are considered experimental or unproven. Adverse reactions to food additives (such as tartrazine) are rare.
Monosodium glutamate is a rare cause of angioedema, urticaria, or bronchospasm in patients with asthma. Sulfites produce bronchospasm in 5% of the population with asthma. Food allergy prevention strategies include breast-feeding, maternal dietary restriction during breast-feeding, late introduction of solids and allergenic foods, and the use of hypoallergenic infant formulas although effectiveness of the strategies has not been established. Avoidance of allergens is the key management strategy. Because elimination diets may lead to malnutrition or other serious adverse effects (eg, personality change), every effort should be made to ensure that the dietary needs of the patient are met and that the patient and/or caregiver(s) are fully educated in dietary management measures to prevent inadvertent exposure to known or suspected allergens. Injectable epinephrine should be given to patients or caregivers of patients with a history of IgE-mediated systemic reactions. Delay in epinephrine administration is the most common cause of fatalities, with peanuts and tree nuts accounting for most fatal and near-fatal reactions.