Therapeutic Areas

Therapeutic Areas

PAIN
HEADACHE

Headaches can be basically separated into two categories, namely primary headaches and secondary headaches. Whilst migraine and tension-type headaches are in the primary category, headaches due to more serious problems, such as head and neck trauma or intracranial disorders are in the secondary category. Tension headaches are the most common type of primary headache. In tension-type headaches, the pain is usually mild or moderate, and is felt in the form of pressure (tension) on both sides of the head. Migraine, on the other hand, is the most common reason amongst all types of headaches for consulting a doctor. In migraine, the pain comes in the form of attacks, is typically unilateral and is throbbing in character. For headaches that start abruptly, are extremely severe and accompanied by a change in consciousness and drowsiness, the patient should access the emergency services.

TOOTHACHE

In the majority of cases, toothache is the result of problems within the tooth. It is felt in the tooth, the jaw or in certain parts of the face. It is usually severe and reduces the sufferer's quality of life. Toothache may have multiple causes. Tooth decay, gingival disorders and trauma are some of the possible causes. However, tooth decay due to inadequate oral care is the most common cause of toothache. When toothache starts, a dentist should be consulted as soon as possible.

LOW BACK PAIN

Back pain is a commonly occurring problem. One in four adults will complain of low back pain for at least one day within the preceding three months. Pain lasting less than 6 weeks is termed acute low back pain, whilst pain lasting longer than 3 months is termed chronic low back pain. Back pain may occur in situations such as sitting disorder, heavy lifting, osteoporosis or hereditary disorders. Pain in the lumbar region, limitation of movement and paraesthesia in the legs are all possible symptoms. Non-steroidal anti-inflammatory drugs and muscle relaxants may be used to treat the condition.

FIBROMYALGIA

Fibromyalgia is a disease seen in the musculoskeletal system, which is characterised by pain spreading all over the body. Whilst it may be seen at any age, it is most common in middle age. Women are more frequently affected by this disorder than men. Closely investigating the signs and symptoms of the disorder, the conditions which may lead to it and the diagnosis and treatment will lead to a better understanding of this condition.

Symptoms / signs of fibromyalgia

The symptoms of fibromyalgia differ from person to person. The following are the most frequently encountered symptoms:

  • Widespread pain: This is the main indication of fibromyalgia. Pain is felt throughout the whole body, but may be more intense in places like the back and neck. Pain may persist for a lengthy period and may improve or deteriorate over time. The pain may be felt as burning, sharp or piercing.
  • Excessive sensitivity: In fibromyalgia, sensitivity to pain increases. Patients may feel even the smallest touch as pain. Pain following light touch or mild bumps may go on for a long time.
  • Stiffness: Patients, after remaining in the same position for a lengthy period feel stiff and have difficulty starting to move. For example, after waking up in the morning, they may experience a problem in getting out of bed.
  • Muscular cramps: By contracting tightly and painfully, muscles may give rise to aches.
  • Fatigue: The level of fatigue varies from person to person. A wide range may be seen, from slight weakness to feeling so fatigued that the individual is unable to do anything.
  • Disruption of sleep quality: Even if patients do sleep for a sufficient length of time, they may not feel rested and relaxed. The reason for this is that the part of sleep termed deep sleep, when the body can renew itself, is shortened in fibromyalgia patients. This alteration in sleep quality may manifest itself as fatigue and an inability to concentrate.
  • Cognitive problems: In individuals with fibromyalgia, thinking, learning and other similar processes may be problematic. Patients may have a thought structure that can be described as hazy or blurry. Other signs may appear, such as difficulty learning new facts and recalling old events, inability to focus and slowed speech.
  • Feeling too hot or too cold: This comes about because the body is unable to regulate its temperature appropriately.
NEUROPATHIC PAIN

Neuropathic pain is a type of pain resulting from a lesion or dysfunction within the nervous system. Neuropathic pain is caused by uncontrolled electrical discharges originating from a particular area following neuronal trauma. Structural changes occurring over time in the sheath surrounding the neurone lead to permanent pain. Neuropathic pain is a finding in several different disorders.

The characteristics of neuropathic pain are varied and often more than one characteristic may be present. Patients describe neuropathic pain as burning, freezing, like crawling insects, stinging, pounding, stabbing, stinging or like an electric shock. It occurs in 1-2% of the general population. The most common cause of neuropathic pain is diabetes. Neuropathic pain may be divided into two types, i.e. central and peripheral.

The finding of decreased tactile sensation, reduced ability to perceive pain, decreased responsiveness to a stimulus, pins and needles, excessive pain, pain due to a stimulus that is normally painless, abnormal painful reactions to a stimulus or uncomfortable, abnormal sensations should make clinicians consider possible neuropathic pain.

Neuropathic pain has social and emotional effects on our lives. Chronic pain causes sleep disorder, disruption to social life, depression and tension. The sensation of pain, the intensity of pain and the degree of pain perception may vary from person to person.

To supply the most appropriate treatment in neuropathic pain, the underlying cause needs to be investigated. Neuropathic pain treatment aims to reduce the patient's symptoms. The underlying reason for the neuropathic pain significantly affects how progression can be prevented and treatment selected. For example, in a diabetic patient, a high blood sugar interferes with neuronal nutrition and may cause neuropathic pain.

Neuropathic pain treatment is multifaceted, with various drugs and interventional treatment alternatives in treatment-resistant cases. Epilepsy medication, anti-depressants, specific muscle relaxants, morphine derivatives and local anaesthetic agents can be used for treatment.

In cases of treatment resistance or where we are unable to use pharmacotherapy for various reasons, interventional methods, such as nerve blocks, can be used.

UPPER RESPIRATORY TRACT INFECTIONS
TONSILLITIS / TONSILLOPHARYNGITIS

Acute tonsillopharyngitis or tonsillitis, which is a more common clinical picture in childhood, is inflammation of the pharynx and tonsillar tissue and is one of the most common reasons for consulting a doctor. Bacteria are a factor in between 5 and 10% of adults, whilst this rate rises to between 30 and 40% in adults. The condition is commonly seen in children aged 5 to 15 years. It is more commonly seen during the winter months. Patients most often complain of a sore throat and fever when they consult a physician. Treatment is planned according to the cause of the infection.

SINUSITIS

Sinusitis is inflammation of the mucosal lining of the paranasal sinuses. The frequency of sinusitis rises in the winter months. Upper respiratory tract infections, which are more frequent at that time, are amongst the most common reasons for sinusitis. Sinusitis is a disorder which has negative physical and psychological effects and affects patients' quality of life. For this reason it definitely requires treatment.

OTITIS MEDIA

Otitis media (OM) is infection and inflammation of the middle ear and the aerated spaces within the temporal bone, as well as the mucosal lining of the eustachian tubes. It more commonly affects children than adults. Both bacterial and viral pathogens are responsible. Some of the symptoms that may be seen are otalgia and a rise in body temperature. Treatment is planned according to the age of the patient and the characteristics of the infection.

LOWER RESPIRATORY TRACT INFECTIONS
BRONCHITIS

Bronchitis is inflammation of the airways known as the bronchi. There are several causes of bronchitis, including viral and bacterial infections, as well as smoking, asthma and various allergies. Bronchitis manifests in transitions from season to season and is especially prevalent in the winter months. It may be classified into acute and chronic forms. Acute bronchitis has a stronger connection to viral infection. Coughing, wheeze and shortness of breath may be observed. In many patients recovery is expected within a few weeks. In the pathogenesis of chronic bronchitis, smoking is a key factor. A history of cough and production of sputum, together with shortness of breath is frequently noted. At the beginning, shortness of breath increases with exertion, but as chronic bronchitis advances, it may also be noted at rest. To diagnose chronic bronchitis, there must be a history of cough and sputum production for two consecutive years and it must have persisted for at least three months each year.

PNEUMONIA

Pneumonia is inflammation of the lung parenchyma. It is referred to as "winter fever". The cause of this condition is mostly bacterial or viral infections, but more rarely it may be due to fungal pathogens in immunocompromised patients. The pathogen which is most often responsible is Streptococcus pneumoniae. It may be a grave illness in children and the elderly. Patients in high-risk groups may be protected in the winter months by receiving a pneumococcal vaccination. The most obvious symptoms are a high fever, cough, shortness of breath, shivering, debility and chest pain. Treatment is tailored according to the cause of the infection.

ENDOCRINOLOGY
DIABETES MELLITUS

Diabetes mellitus, which is known by the public as "sugar diabetes", is a chronic illness in which there is an elevation in the level of glucose (sugar) circulating in the blood as a result of insulin hormone deficiency or a reduction in its effect. The term diabetes means "sieving" or "filtering" and was first used by the physician Arateus, working in the Cappadocian lands of Anatolia. "Mellitus" means "as sweet as honey". The increase in blood glucose results in glucose filtered by the kidneys being excreted into the urine. The patients' urine is therefore sweet-tasting, hence the use of this term.

The methods used to treat diabetes depend on the type of diabetes, but the cornerstone of treatment consists of lifestyle adjustments such as healthy nutrition, regular physical activity, quitting smoking and limiting the consumption of alcohol. The other elements of treatment are the group of medications taken by mouth which we call oral antidiabetics and insulin and insulin analogues administered by injection (i.e. by needle).

CHEST DISEASES
ASTHMA

Asthma is a disease involving exacerbations (attacks) in which there is shortness of breath, wheezing and coughing. The principal characteristic of asthma is restricted airflow due to narrowing of the airways. On average its frequency is 15%. Medication used to treat asthma may be divided into two categories. The first group contains drugs used to provide symptomatic relief to patients during an asthma flare-up. The second group contains drugs used longterm to treat the illness and bring it under control.

WOMAN'S HEALTH AND DISEASES
VAGINAL INFECTIONS

When the natural balance between microorganisms in the vaginal flora is disturbed, one or several microorganisms may multiply and dominate the flora, causing an infection. In vaginal infections, the volume, colour and smell of vaginal secretions change.

Fungal infections are the most common cause of vaginitis. Some 75% of women experience a fungal infection at least once during their lifetime. One of the fungal microorganisms in the vaginal flora is a species known as Candida albicans. When these fungi overgrow uncontrollably they cause vaginal infections and symptoms. The most frequently seen patient complaint in the genital region is powerful itching and burning. The diagnosis is made on the basis of observing fungi in a sample of discharge. The infection causes a white-coloured, cheese-like discharge that resembles curdled milk. Treatment involves antifungal cream, tablets or vaginal ovules.

CARDIAC AND CIRCULATORY DISORDERS
HYPERTENSION (HIGH BLOOD PRESSURE)

The heart pumps blood to the tissues where it is needed through the arteries. The force exerted by blood within the arteries on the vessel walls is termed the blood pressure (vascular tension). Blood pressure which is sufficiently high to cause cellular damage is termed hypertension, i.e. high blood pressure.

In treating hypertension, especially at the diagnostic stage, if an underlying disorder causing hypertension is diagnosed, this disorder should be treated. If there is no underlying disorder and the blood pressure is high, adjustments to lifestyle should be recommended to patients first. Adjustments to lifestyle include eating healthily, restricting the consumption of salt, regular physical activity, quitting smoking, restricting consumption of alcohol and weight loss if the patient is overweight. If the blood pressure remains high despite adhering to these recommendations, drug treatment is initiated. Hypertensive patients should have check-ups at specific intervals.

ATHEROSCLEROSIS (HARDENING OF THE ARTERIES

Atherosclerosis is a disease of the blood vessels in which atheromatous plaques are formed. Plaques of atheroma are produced by lipid-containing bodies, i.e. it is a disease determined by a lipid in the blood known as cholesterol. This is a systemic disorder referred to by the general public as hardening of the arteries. It may affect any of the arteries within the body. However, the most affected vessels are the arteries supplying the heart, namely the coronary arteries. Next most commonly affected are the carotid arteries in the neck, then the arteries supplying the brain and the lower leg. The condition usually continues silently for many years. Approximately 15 to 20 years after the condition begins to take hold, the first symptoms and signs begin to appear. Depending on which site is involved, there may be many different presenting complaints. The most frequent type of atherosclerosis we encounter is where the cardiac vessels are involved. The condition usually reveals itself by chest pain. The term given to this pain in the chest is angina pectoris. There are two forms - unstable and stable angina. Patients generally experience a burning pain in the middle of the chest after mild exertion, chest tightness and other types of pain. When they cease exerting themselves, the pain is said to go away. This is the first sign of arterial occlusion. Some patients state that the chest pain is present even when they are at rest. This finding is evidence of very severe vascular occlusion. To prevent atherosclerosis, the balance of weight gain needs to be managed, a programme of healthy nutrition needs to be established, and it is important that doing some sport is at the centre of patients' lives. It is recommended that patients avoid smoking altogether and minimise their consumption of alcohol.

HYPERLIPIDAEMIA

The term used by the public, "high cholesterol", refers to hyperlipidaemia, in which various lipids are in excess of their normal level. The most fundamental type of lipid found in the blood is cholesterol. Since cholesterol is found in all cells within the body and is a basic building block for hormones, it is an essential material for a healthy life. However, if cholesterol is above a certain level, it presents a threat to life. High cholesterol increases the risk of occlusive vascular disease, in other words, atherosclerosis, in all the arteries that supply the body, especially the coronary arteries. There is no single cause of hyperlipidaemia. Many factors in combination contribute to this process. Genetic factors, the slowing down of metabolism as patients age, a diet rich in fatty foods, obesity, a sedentary lifestyle, lack of exercise, smoking, excessive alcohol consumption and endocrine disorders such as diabetes or thyroid disease count amongst the causes. The principal aim in the treatment of hyperlipidaemia is to achieve lifestyle change. For this, a healthy diet and regular exercise are recommended. The second stage of treatment involves medication.

EAR, NOSE AND THROAT DISORDERS
ALLERGIC RHINITIS

Allergic rhinitis is an inflammatory disorder of the nasal mucosa which develops following exposure to an allergen to which the individual has a hypersensitivity. Its average frequency is up to 20%. Amongst the symptoms which may occur are nasal congestion, nasal and ocular pruritus and sneezing. Treatment involves taking preventive measures and the use of medication.

GASTROINTESTINAL DISORDERS
GASTRO-OESOPHAGEAL REFLUX DISEASE

The word "reflux" signifies reverse flow. Gastro-oesophageal reflux, then, is gastric acidic fluid which escapes backwards into the oesophagus to produce the characteristic clinical picture. It is noted in approximately 20% of adults in general. The most frequent symptoms are a burning sensation in the chest and what we call reflux, in other words, bitter gastric juice coming up into the mouth. However, the condition may also cause atypical symptoms such as a dry cough and dysphonia. Obesity increases the gastric pressure and thus makes it easier for symptoms of reflux to appear. Caffeinated and carbonated drinks and greasy food can increase the symptoms of reflux. Treatment with medications that suppress gastric acidity may be beneficial. Although treatment resistant cases do not occur very frequently, when they do, surgical intervention may be required.

PEPTIC ULCERS

Peptic ulcer refers to ulcers which develop in the stomach and duodenum. The most common reason for this to occur is an infection with a bacterium called Helicobacter pylori. However, it may also result from the use of pain killers or medications based on cortisone. Stomach pain, nausea, vomiting and bleeding are amongst the symptoms. Gastric ulcers are more commonly painful after eating, whereas duodenal ulcers cause pain when the patient is feeling hungry. If Helicobacter pylori is demonstrated to be present, this infection should first be treated and afterwards symptoms related to gastric acidity may be treated beneficially with drugs which suppress acid production.

NSAID-RELATED GASTROPATHIES

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are non-steroidal medications which reduce pain and inflammation. Through their side effect of reducing prostaglandins, which protect the gastric mucosa, they may result in a mild clinical presentation of inflammation or gastritis, or a more severe presentation, with gastric haemorrhage. These gastric symptoms particularly affect elderly patients (i.e. those aged over 65 years), those with a previous history of gastric ulceration, those taking painkillers at a high dose or multiple drugs at the same time, or those taking a class of drugs known as anticoagulants, which prevent the blood from clotting, when they take NSAIDs. In the risk groups mentioned, using gastroprotective medications alongside NSAIDs may lower the risk.

CENTRAL NERVOUS SYSTEM - PSYCHIATRIC DISORDERS
DEPRESSION

Depression is a condition which manifests itself via emotional, behavioural and bodily (biological) symptoms. For example, in depressive disorder, bodily functions may be impaired, resulting in sleep disturbance, changes in appetite, weight loss or gain, sexual interest and potency. There is a reduction in the desire and ability to meet family, occupational or social expectations and to fulfil social roles, there may be thoughts of suicide or attempts at suicide, and the perceptions of reality may become distorted. Depressive illness is observed in 8-10% of the population. The lifetime risk of developing the disorder and having an episode of depression at least once in their life is one in ten for males and one in four or five for females. Currently depression is, on a global scale, the disorder causing the greatest level of disability. It should be treated without unnecessary delay. Untreated depression lays the ground for substance and alcohol misuse disorders or other mental health problems. Prolonged and poorly treated depression lays the ground for physical illnesses and worsens the progression of illnesses such as diabetes or cardiac disease and therefore increases the risk of dying.

OBSESSIVE-COMPULSIVE DISORDER

Obsession refers to constantly recurring (obsessive) thoughts in a person despite the person's perception of reality being undisturbed and their ability to perceive reality remaining intact. Obsessive-compulsive disorder (OCD) is a psychological disorder which forces an individual to exhibit behaviours where irrational thoughts and fears (obsessions) are repeated. You may be unable to realise that your obsessions are irrational and you may try to ignore or give up these obsessions. However, this only makes your obsessions and anxieties grow. Whilst trying to ignore disturbing thoughts or to escape from these thoughts, new thoughts and difficulties take the place of the previous ones and thus a perpetual cycle is generated from which you cannot exit.

Obsessions are generally of the following type:
Being dirty or a fear of dirtiness, lining up possessions or putting them in a symmetrical order, aggressive or frightening thoughts of harming oneself or other people and unwanted thoughts concerning sexual or religious topics.

Some of the signs and symptoms of an obsession are as follows:
There may be symptoms such as fear of contamination when touching things that other people have touched, doubts about whether the door is locked or unlocked, whether the iron is plugged in or unplugged and stress when things are not placed in the correct way.
In addition, thoughts of harming oneself or someone else, creating a commotion involving obscene thoughts and inappropriate behaviours, and imagining unpleasant sexual images may also be signs of this disorder.
Treatment for Obsessive-compulsive Disorder
Treatment of OCD may not aim for complete remission, but by reducing the symptoms to a minimum level, you may be able to prevent the disorder taking over your daily life. Some individuals may need to remain under treatment for their whole lives. There are two fundamental types of treatment for OCD - psychotherapy and drug treatment.

PANIC ATTACKS

This disorder involves a state of discomfort in which there is a constant state of anxiety between panic attacks about a further attack happening.
The belief that panic attacks may lead to death from a heart attack, losing control and going mad or suffering a stroke or other negative consequences may cause a persistent low mood.
Panic disorder is a mental health disorder in which some behavioural changes made to prevent attacks and the bad consequences arising from them, such as not attending school or sports, not doing household tasks, keeping away from particular food and drinks, or carrying about medication, water, alcohol or specific foods, may be observed.

SOCIAL PHOBIA

“Just close your eyes for a second and imagine walking into a room and seeing some of your friends and colleagues there, when suddenly you look down and realise you are not wearing any clothes.” This scenario describes very well how people with social phobia feel when they encounter a social situation. "You feel deeply ashamed, you want to escape from the room, you feel like you are about to die, you don't want to see anyone again". Social phobia is an anxiety disorder in which there is a definite and persistent fear of being judged by others when in a social environment and feeling ashamed and looked down upon. People are afraid of situations that require them to interact with others or to perform an action in the presence of others and try to avoid them as much as possible. They think that others will judge them as anxious, weak, crazy, or stupid. They may be afraid of public speaking out of fear that others will notice their hands or voice shaking, or they may be extremely anxious when talking to others because they are afraid of appearing unable to speak properly. They may avoid eating, drinking, or writing in front of others because they fear embarrassment when other people see their hands shaking.

How is social phobia treated?
Both drug treatments and psychotherapy (a treatment based on talking) are appropriate for social phobia. Depending on the condition of the individual patient, psychotherapy alone or drug treatment alone may be suitable, but usually treatment is more successful when both treatments are employed together. Medications which particularly target the serotonin system are selected for treatment. The patient should be informed that slight nausea, headache, insomnia, gastrointestinal discomfort or similar transient side effects may occur, but that the body can adapt to these effects over time. These medications do not produce dependency and there are no permanent harmful side effects. It is necessary to wait two to three weeks for the effect of the medication to become apparent. At least ten weeks should be allowed to pass before deciding on whether the drug is effective or not. On average the treatment period is between 9 and 12 months.
The most frequently used treatment in social phobia is cognitive behavioural therapy. Cognitive therapy consists of stages, such as recognising anxious feelings and the bodily reaction that occurs in response to this anxiety, understanding what thoughts in different situations lead to anxiety, and developing coping strategies to deal with these. In behavioural therapy there are different methods which can be adapted for each patient, such as acting as a role model, confronting the symptoms, role plays to allow a better appreciation of the symptoms, relaxation training, and social skills education. Family and group therapy are also suitable treatments for social phobia.

PANIC ATTACKS

The fundamental characteristic of panic attacks are sudden, repeated episodes which strike terror and deep fear into the individual. The majority of patients described these attacks as a "crisis". They are in fact panic attacks.
Panic attacks begin abruptly, gradually become more severe and reach their maximum intensity within ten minutes. They mostly continue for between 10 and 30 minutes (on rare occasions up to one hour), following which they spontaneously resolve.

What are the signs of a panic attack?

  • Chest pain or chest tightness
  • Palpitations, forceful or rapid heartbeats
  • Sweating
  • Shortness of breath or feeling like choking
  • Suffocation
  • Vertigo, dizziness, feeling like you are about to fall or faint
  • Numbness or tingling
  • Feeling cold, shivering or hot flush
  • Nausea or gastric pain
  • Tremors or shaking
  • A feeling that the individual, the surroundings have changed in some way, are strange or different
  • Loss of control or a fear of going mad
  • Fear of dying
    In a panic attack proper there are four or more of these symptoms present. If less than four symptoms appear, it is termed a limited symptoms panic attack.
PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

Premenstrual syndrome is a condition in which physical symptoms such as swollen breasts, headache, weakness and weight gain appear in the late luteal phase of the menstrual cycle in women, alongside mental symptoms such as depressive mood, irritability and tension. This situation usually resolves when menstruation begins. Although these symptoms are seen in 80% of women, they are of sufficient severity to be clinically significant in approximately 5%. If these symptoms produce clinical or social effects, the syndrome may be classified as a psychiatric disorder, namely premenstrual dysphoric disorder or late luteal phase disorder.
Cognitive behavioral interventions and problem-solving methods to combat premenstrual dysphoric disorder are helpful in letting patients relax. Cognitive interventions focus on the role of thoughts and comments in their emotional reactions, and the therapeutic process focuses on making the thoughts in response more realistic, appropriate and functional. There is an increasing role for agents used in the treatment of depression as drug therapy.

SCHIZOPHRENIA

Schizophrenia is a mental disorder which generally begins in youth and in which important impairments of cognition, feeling and behaviour occur. Patients withdraw from interpersonal relationships and reality and live in their own world. It is a disorder where the person is alienated from the usual ways of perceiving the world and thinking about it and lives free, feeling as if (s)he is pulled into a world of his /her own and withdraws into a world of introspection. Its lifetime prevalence in the general population is between 0.5 and 1%. Although the frequency of schizophrenia is generally the same in both men and women, in males it usually begins at a younger age. Despite typically having its onset between the ages of 15 and 25 years, it is also possible for it to begin in middle age. The fundamental factors that impair the quality of life in schizophrenia are the negative symptoms of schizophrenia, depression, thoughts of suicide, personality traits, disability, cognitive and psychosocial deficits, lengthy and frequent periods of hospitalisation, insufficient social support, difficulty coping, economic hardship and the side effects of antipsychotic medication. The tendency in society to stigmatise patients with schizophrenia and their relatives negatively affects their quality of life.

BIPOLAR DISORDER- MANIC AND DEPRESSIVE EPISODES

Bipolar disorder is an illness which used to be known as manic depression, manic attacks or manic depressive disorder. It is a disorder in which the patient experiences depressive episodes in addition to hypomanic or manic episodes. The individual's emotional state may change from mania (exuberance or joyfulness) to depression (excessive dejection), i.e. it alternates between two poles. In a manic episode, the individual feels elated or excessively irritable, whilst in a depressive episode, he or she feels extremely sad and downcast. The person's emotional state may be normal between episodes. The fluctuations in mood may last for hours, days, weeks or months. Bipolar depression is a mood disorder which affects between 1 and 2% of the population. Although it can affect anyone at any age, the first episode is typically in childhood, adolescence or early adulthood.

AUTISM (AUTISTIC SPECTRUM DISORDER)

Autistic spectrum disorder (ASD) is a complex neurodevelopmental disorder that may be congenital or may appear in the first years of life. Autism is thought to be caused by certain central nervous system problems which cause structural or functional abnormality. In this text, the term autism may be occasionally used instead of autistic spectrum disorder for the sake of ease.
It is currently unknown what causes ASD and how, but there is evidence showing that it has a genetic basis. However, which gene or genes are responsible is not yet known. There are also views that environmental factors may cause autism. A large number of studies are being carried out concerning the effects of both genetics and the environment.
There is no association of autism with the way the child is raised nor the socioeconomic situation of the family. Accordingly, autistic spectrum disorder may occur in every kind of population, in different geographical locations, ethnicities and families.
The importance of early diagnosis. An evaluation for potential autism should be undertaken if any of the following features are seen*:
*"He" refers to either a boy or a girl
The child avoids eye contact with others
The child does not respond when his or her name is called
He acts as if not hearing the person speaking
The child does not indicate what he wants by pointing
He does not know how to play with toys
He shows no interest in the toys other children are playing with
He repeats over and over certain words and says them in inappropriate situations
He is behind his peers in speech development
He rocks, flails around or makes other strange movements

He is hyperactive, he always does whatever he likes
He keeps staring at something
He performs unusual actions like turning some things round or lining items up
He overreacts to alterations in his daily routine
Around 50% of children who are identified with autism at an early stage and who receive intensive educational interventions may get their symptoms brought under control, are able to develop properly, demonstrate a great improvement and, by the time they reach adolescence, may be no different from other children of the same age.

CENTRAL NERVOUS SYSTEM - NEUROLOGICAL DISORDERS
EPILEPSY

Seizures used to be called ‘fits’ or ‘attacks’. Epilepsy and seizures occur for a brief period, when brain cells have a burst of abnormal electrical activity. Seizures happen when there is a sudden interruption in the way the brain normally works. In between seizures the brain functions normally. Epilepsy is a disease affecting approximately 1% of the global population. It is observed with equal frequency in both males and females. Epileptic seizures may occur at any age, but they commonly begin in childhood or in older adulthood. Epileptic seizures can occur suddenly and focal onset seizures start in one area and can spread across the brain. The type of seizure differs depending on the part of the brain in which it began. Most fits may last between 30 seconds and 2 minutes. People are diagnosed with epilepsy when they have had two or more seizures.

ALZHEIMER-TYPE DEMENTIA

Alzheimer-type dementia is a progressive neurodegenerative disorder characterised by insidious onset of memory loss, accompanied by deterioration in functioning and with behavioural problems. More than two out of three of all patients with dementia is noted to be of Alzheimer-type. Its onset manifests more with advancing age and, above the age of 65 years, its prevalence doubles every five years. Being female, having a low educational attainment, and certain genetic characteristics make Alzheimer disease more likely. Symptoms appear as memory problems, difficulty in thinking and understanding reasoning, indecisiveness, word-finding difficulties, ability to perform arithmetical operations, alterations in personality and behaviour, disappearances and difficulty in completing tasks that could previously be performed without difficulty. Alzheimer disease can be recognised as a process and with stages that occur in three dimensions. In the early, mild stage, forgetfulness, fatigue, inability to recall words, inability to learn new things and disruption to social behaviour and ability to make decisions is seen. In the middle stage, signs of problems which prevent the activities of daily living from being carried out appear, such as disappearances, loss of motor skills and behavioural problems. In the advanced stage, complete dependence on the care giver is seen and there is loss of bladder and bowel control. Patients have speech problems, cannot obey simple commands, live in a fantasy world, and lose awareness. These symptoms predominate. The course of this illness has a negative effect both on the patients and their caregivers.

MULTIPLE SCLEROSIS

Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system characterised by demyelination and axonal damage. The disease frequently appears in young adults. The prevalence is between 2 and 200 in 100,000 and depends on the geographical characteristics. MS is a chronic disease. Since MS affects the brain and spinal cord, it may cause multiple different signs. Symptoms linked to MS may appear in the course of an exacerbation, some of which may recover and some of which may persist for a long time. These symptoms vary in terms of severity and duration. A person suffering from MS may generally experience one or more symptoms but not every symptom is seen in everyone. There are silent periods observed in the disorder in which symptoms and signs are absent (i.e. remission periods). A group of patients continues with attacks and a portion goes on with symptoms recovering from the beginning or at a later stage. In MS patients, weakness in the extremities, sensory symptoms, ataxia, bladder problems, fatigue, diplopia, blurred vision and similar visual symptoms, dysarthria and cognitive symptoms causing dysfunction in memory, concentration and attention are frequently observed.

HEPATOLOGY
CHRONIC HEPATITIS B

Chronic hepatitis B is a disorder which can cause severe hepatic disease and persist for the infected person's entire life. The hepatitis B virus (HBV) is a DNA virus that can cause a range of conditions, from acute hepatitis (including hepatic insufficiency linked to fulminant hepatitis), to cirrhosis and hepatocellular carcinoma (liver cancer). The natural course of the disease is complex and it may begin as an acute infection that then turns into a chronic condition over time. Acute hepatitis may last from a few weeks to a few months and eventually an individual may recover. HBV may be transmitted perinatally, percutaneously, by sexual contact, by open wounds or cuts and by close personal contact. On a global scale, 2 billion people are estimated to be infected (i.e. 1 in 3 people) by HBV, 250 million people have a chronic HBV infection and 700,000 people die annually due to hepatitis B and its complications. To protect against hepatitis B infection at the time of birth, vaccination programmes should be set up, existing patients should be identified and precautions taken to protect at-risk groups from the disease.

HAEMATOLOGY
THALASSAEMIA

Thalassemia is the most common preventable hereditary blood disease in the world and in Turkey. It is also referred to as Mediterranean anaemia because it is commonly seen in countries bordering the Mediterranean. Depending on the presence of healthy or mutated genes in the mother and father, various types of thalassaemia are seen in individuals. People with carrier status (thalassaemia minor) are completely healthy and have no problems other than mild anaemia. In the mild disease (thalassaemia intermedia) phenotype symptoms do occur, but they begin later and are milder than in the major type. In thalassaemia major (severe phenotype) symptoms of anaemia generally appear from the age of three months onwards and it is a severe type of illness which calls for continuous transfusions. These children are incapable of synthesising haemoglobin for themselves. The initial findings in the disease are debility, pallor, anorexia, restlessness, hepatosplenomegaly, retardation of growth and abnormalities of the bones, especially in the face and the skull. Thalassaemia is a preventable disorder. Every new patient with thalassaemia is born to a carrier mother or father. This is the reason why a screening and prevention programme has been established in Turkey.

CHRONIC IRON OVERLOAD

Iron overload (haemochromatosis) is a disorder in which more iron is accumulated in the body than is required. Excess iron is toxic for the body. Iron may accumulate in several organs, but especially in the liver and the heart. Excessive accumulation of iron in the liver can cause hepatomegaly, hepatic insufficiency, liver cancer and cirrhosis. Cirrhosis is a severe disease which prevents the liver from functioning. An excessive build-up of iron in the heart may cause irregular heartbeats (known as an arrhythmia) and cardiac insufficiency. Excessive build-up of iron in the pancreas may lead to diabetes. There are two kinds of haemochromatosis - primary and secondary. In the majority of patients with primary haemochromatosis, it is transmitted genetically from the parents. The iron overload in secondary haemochromatosis, however, is usually the result of other diseases, such as thalassaemia or certain conditions which require blood transfusions to occur for a prolonged period. The treatment aims in the disease are to lower the amount of iron to a normal level, to prevent or delay the organ damage resulting from iron accumulation, to treat the complications of the illness and to help the iron to stay at normal levels in the body. Blood may be taken from the patient with a therapeutic aim (i.e. phlebotomy). Iron chelation treatment is used with the aim of removing excess iron from your body. Since the discovery of chelation therapy, the life expectancy has been extended in key haematological disorders which result in iron overload, such as in thalassaemia.

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