Lyme disease or Lyme borreliosis is a spirochettal disease, whose etiological agent, the bacteria Borrelia burgdoferi, is transmitted by ticks. The bacteria spreads hematogenously, thus determining the three stages of the disease.

The signs and symptoms in the first stage of Lyme disease consist in cutaneous manifestations. After the incubation period, which lasts up to 30 days, erythema migrans, the characteristic, expanding skin lesion appears at the site of the bite. The erythema migrans is at first a red macule but in time it slowly expands to an anular lesion with a bright red outer border and central clearing. In some cases the center of the lesion may become necrotic, vesiculous or erythematous. This type of lesion is not usually painful. The most common sites of erythema migrans are thigh, axilla and groin, but the lesion may virtually be located anywhere.

In the second stage of Lyme borreliosis the bacteria spreads hematogenously to many sites. The early signs and symptoms of the disease are usually changing and sometimes intermittent, except for fatigue which is constant. The most common symptoms in this stages are skin lesions, fever, severe headaches,chills, musculoskeletal pain, malaise, arthralgias.

Less common features of the disease are: hepatitis, lymphadenopathy, splenomegaly, iritis, nonproductive cough, dyspnea and sore throat.

In this stage it may appear symptoms suggesting meningeal irritation and after several weeks up to 15% untreated patients present neurological abnormalities such as meningitis, encephalitic signs, radiculoneuropathy, myelitis an cranial neuritis. A serious complication of neurological involvement happens in children, where due to the inflammation and the increased intracranial pressure the optic nerve may be affected, leading to blindness.

Another 8% of the untreated patiens develop cardiac symptoms, the most common cardiac abnormality being atrioventricular block, myopericarditis and chronic cardiomyopathy, pancarditis and cardiomegaly.
A very common feature of Lyme disease in this stage is articular and musculoskeletal pain. This typical feature consist in migratory pain in muscles, joints, bones, and tendons.In the third stage of the disease , several months after the infection more than 60% of the untreated patients develop arthritis. This feature usually presents as intermittent attacks of oligoarticular arthritis, especially in large joints (most commonly the knee).

A less common feature, chronic neurologic involvement may also manifest. The most common forms of neurological involvement are:encelopathy affecting mood, memory and sleep and axonal polyneuropathy (manifested as distal paresthesia or spinal radicular pain).In this stage of the disease the late skin manifestation is acrodermatitis chronica atrophicans. This lesion usually begins with reddish-violaceous discoloration; over the years it becomes sclerotic or atrophic.

The signs and symptoms of Addison's disease (also known as primary adrenal insufficiency) are produced by the reduced serum concentration of steroid hormones. The oset of the disease is insidious and in many cases the patients consider that the first symptoms are the result of stress.

The most common signs and symptoms of the disease are: fatigue, hyperpigmentation of skin and mucous membranes, anorexia, nausea, diarrhea, vomiting and muscle weakness.

The most specific symptom of this disorder is fatigue, which at the onset of the disease is sporadic but whose intensity and frequency increases as adrenal function is impaired. This symptom is determined mainly by deficient neuromuscular function which is determined by the following process: the lack of glucocorticoid hormones disturbs the glucidic, lipidic and proteic metabolism; due to the lack of cortisol, the amount of glucose produced from proteins decreases, thus diminishing the muscle and liver glycogen deposit and so, weakness occurs. It also may occur muscular or articular pain.




Hypoglicemia also determines the diminished resistance to infection and trauma in addison's disease patients and the myocardial weakness reduces cardiac output (leading to hypotension).

Although hyperpigmentation may be absent, it is a specific feature of the disease. It appears as a tanny aspect of the skin, even in areas not expose to the sun. The most affected areas are: skin creases, old scars, the areolae, and the mucous membranes. Other disorders that produce skin abnormalities and which may co-exist with Addison's disease are goitre (6%) and vintiligo (3%).

Many patients also complain of gastrointestinal abnormalities. The gastrointestinal symptoms vary from anorexia, nausea and weight loss to severe nausea, fulminating vomiting and diarrhea with marked dehydratation.

Some patients also have neurological disturbances such as postural dizziness, syncope, the enhancement of hearing and olfaction and reduced sensory modality of taste. They may also have personality changes, mood swings increased irritability and restlessness which may lead to an incorrect diagnosis of neurosis. In 12% of cases it has been observed a decreased tolerance to cold.

Due to the loss of adrenal androgens, axilary and pubic hair may be decreased in women. Amenorrhea may also occur as a result of metabolical disturbances.


Addisonian crisis (adrenal crisis) is a very severe complication of Addison's disease. It represents a rapid intensification of the disease and it is usually triggered by sepsis or by surgical stress. The adrenal crisis signs and symptoms are: severe abdominal pain, profound astenia, severe lower back and leg pain, low temperature or fever (in case the crisis has been triggered by infection), fulminating vomiting and diarrhea (leading to severe dehydratation), confusion or psychosis, convulsions, hypotension, rapid heart rate and loss of consciousness. This is a life-threatening state and immediate treatment is imperative. In all cases the precipitating or the triggering cause must be sought. Delay in diagnosis and treatment can result in poor outcomes.

The signs and symptoms of liver disease can be determined either by the liver disease itself or by the complications of the disease; for example, the portal hypertension syndrome- a complication of cirrhosis may determine acute GI bleeding.  The most common signs and symptoms of liver disease are: jaundice, right upper quadrant pain, abdominal distension, fatigue, intestinal bleeding, and itching. Fever may occur in viral (most common) or alcoholic hepatitis. Jaundice (the yellow pigmentation of sclerae, mucous membranes and skin) is the most common feature of liver disease, and many hepatologists consider it to be a very reliable marker of severity. Many patient observe the darkening of the urine before the noticing the pigmentation of sclerae. Jaundice is accompanied in many cases by steatorrhea (fatty stools) and the lightening of the colour of the stool, due to cholestasis.

Another common symptom of liver disease is fatigue. The patients describe it variously as lack of stamina, increased need for sleep, malaise, lethargy, weakness and poor energy. This symptom usually occurs after exercise or physical activity. Its severity is reduced in the morning or after adequate rest. The fatigue is intermittent in liver disease and it varies in severity from hour to hour.

Right upper quadrant pain is caused by the extension of liver's capsule (which is very rich in nerve endings) and it is another common feature of liver disease. Right upper quadrant pain is usually accompanied by hepatomegaly. Due to the variability in size and shape of the liver hepatomegaly is not a very reliable feature of liver disease. Hepatomegaly is a typical finding in alcoholic hepatitis, cirrhosis, amiloidosis, venoocclusive disease and liver cancer.

Abdominal distension and shifting dullness suggests ascites (fluid in the peritoneal cavity). Ascites in hepatic disease is determined usually by portal hypertension (90% cases), but also by chronic hepatitis, severe alcoholic hepatitis and  Budd-Chiari syndrome.

In acute liver disease itching may occur. Itching appears early in obstructive jaundice and later in acute hepatitis. It may also occur in chronic cholestatic liver diseases such as primary biliary cirrhosis and sclerosing cholangitis.

The physical examination also shows palmar erythema and spider angiomata in both acute and chronic disease, but they are not very reliable signs since they can occur in normal individuals, especially during pregnancy. Spider angiomata are visible, superficila, tortuous arteries which occur only on the face, arms, and upper torso.

In advanced liver disease the signs are more proeminent including edema, muscle wasting, bruising and weight loss. Other signs of advanced liver disease are:umbilical hernia caused by ascites, hydrothorax and caput medusa- proeminent collateral veins radiating from the umbilicus. Severe cirrhosis and portal hypertension may lead to hepatopulmonary syndrome which consists in liver disease,  pulmonary arteriovenous shunting and hypoxemia.

Skin changes may also occur in liver disease. Hyperpigmentation is typical in chronic conditions such as primary cirrhosis and sclerosing cholangitis. Mucocutaneous vasculitis is a common feature of cryoglobulinemia in  chronic hepatitis C but it can also appear  in chronic hepatitis B.

Cushing' s syndrome is determined by the excess cortisol in blood and therefore, its signs and symptoms are the direct result of the action of  glucocorticoid hormones.

Cushing's syndome most common causes are: adrenal hyperplasia, adrenal macronodular hyperplasia, Carney's syndrome, adrenal neoplasia, prolonged use of glucocorticoids and prolonged use of ACTH. The ectopic ACTH syndrome is determined by tumors (nonpituitary) that secrete ACTH and determine adrenal hyperplasia. The symptoms of cushing's syndrome determined by the ectopic ACTH syndrome are subtle or even absent but the laboratory tests show many important changes in the biochemical values.

Cushing's syndrome most common symptoms are: truncal obesity, fatigue, hirsutism, hypertension, amenorrhea, edema, osteoporosis and purplish abdominal striae. The laboratory analysis of urine shows glucosuria.

The action of glucocorticoid hormones on the tissue metabolism determines muscle weakness and fatigability. decreased bone mineralization is very frequent among children and in adults osteoporosis, which is an important clinical issue since it can lead to fractures of the bones and to the colaps of vertebral bodies.

The increased gluconeogenesis (the body's production of glucose) and the increased resistance to insulin may reduce the glucose tolerance and therefore diabetus mellitus may occur (approximately in 20% cases).

Another common sign of Cushing's syndrome is the rapid weight gain, in which adipous tissue deposits in specific sites (lipodystrophy): the face ("moon face" aspect), the back of the head and the interscapular area ("the buffalo hump") and the mesenteric area, thus producing the "truncal obesity". The cause of this lipodystrophy is unknown , but it may be determined by by the elevated insulin levels and the insulin resistance.  The patient presents polydipsia (excessive thirst) excessive sweating and polyuria (large quantity of urine). The face is frequently plethoric (red face) even though the red cell count is normal. The massive weight gain causes the skin to stretch and therefore it can easily bruise or hemorrage, causing the purple striae( a frequent feature of Cushing's)

A common cardio-vascular manifestation of Cushing's syndrome is hypertension determined by the fact that epinephrine's vasoconstrictive effect is enhanced by cortisol. The hypertension and the hyperglicemia may also lead to different heart disease, increasing the mortality among the Cushing's syndrome patients. Cushing's syndrome may also have psychological manifestations such as profound emotional changes, irritability, depression, confusion, anxiety, emotional lability or even psychosis.

In women, cushing's syndrome may determine oligomenorhhea (reduced frequency and length of menstruation) hirsutism (male hair growth pattern in a woman) or dry, brittle hair and nails. Male patients may complain of reduced libido, impotence and infertility.Due to the fact that cortisol reduces the immune and the inflammatory response the wound healing is impaired and many patients may contact opportunistic infections.Other (less frequent symptoms of Cushing's syndrome are:acne, episternal fatty tumors and aching, sore joints (especially shoulders or lower back).

The symptoms of thyroid disease are grouped in two syndroms: hypothyroidism and hyperthyroidism, depending on the serum concentration on thyroid hormones.

Hypothyroidism is a complex syndrome determined by the reduced serum levels of thyroid hormones, and it may have many causes such as iodine deficiency (the most common cause), autoimune disorders (such as Hashimoto thyroiditis), sarcoidosis, scleroderma Riedel's thyroiditis, or some medical procedures such as thyroidectomy or irradiation for cancer.

The symptoms of hypothyroidism are various and depend on the concentration of thyroid hormones and the patient's age. Therefore, in infants and children the neurological signs and symptoms are: learning disabilities, inactivity, cretinism (the type of mental retardation caused by this disorder) with severe consequences. Other signs and symptoms include short stature, opened fontanelles even after the age of 2 years, hypotonia, edema and delayed bone age.

In adults , hypothyroidism it usually has an insidious onset and many patients come to the doctor mainly because of the goiter and the edema. The skin is dry, cold,the epiderm is thin, the nails growth is reduced and the hair is brittle and dry and hairloss occurs in many cases. Weight gain is very common, although the patient has a poor apetite, and is caused by fluid retention in the subcutaneous tissue. The cardiovascular symptoms are bradycardia, hypertension, cardiomyopathy and pericardial effusion. The libido is reduced and the fertility decreases and women present menstrual irregularities.

Myxedema coma is a severe complication of hypothyroidism and consists in hypoglicemia, hyponatremia, hypothermia, extreme weakness, and cerebellar ataxia, and it has a high mortality rate.The elevated concentration of circulating thyroid hormones determines the syndrome known as hyperthyroidism or thyrotoxicosis, caused in most cases by Grave's disease, which occurs in 2% of women and 0.15% of men.

The signs and symptoms of thyrotoxicosis are: unexplained weight loss, increased sweating, polidipsia, increased apetite, diarheea, due to increased metabolic rate.  The neurological signs and symptoms are:hyperreflexia, proximal myopathy without fasciculation and a specific form of hypokalemic periodic paralysis. The most common cardiac manifestations are tachycardia and atrial fibrilation.

The result of the sympathetic overactivity, the lid retraction causes a specific staring appearance, proptosis, periorbital edema, ophthalmoplegia. Patients with thyroid eye disease may report episodic blurring of vision or diplopia, periorbital edema, scleral injection, watering of the eyes, or irritation with a foreign body sensation.

The most severe (and in many cases life threatening) complication of hyperthyroidism is th "thyroid storm" or the thyrotoxic crisis. The patient presents all the symptoms of the exacerbated hyperthyroidism and, in addition, jaundice, fever, delirium, seizures, coma, cardiac failure and arrhythmia. The mortality rate is 30% even with treatment.Clinical features of hyperthyroidism can mimic symptoms of other disorders such as panic attacks,weight loss associated with malignancy, mania and pheochromocytoma, but the differential diagnosis can be made after th laboratory evaluation of the T3 and T4 levels. These tests have diagnostic value in hypothyroidism as well.

Not many people knows that the cardiovascular disease(CVD) is a woman’s disease.Although CVD is one of the most preventable disease,The American Heart Association discovered that CVD makes more victims annually than cancer itself,even breast cancer.Women’s symptoms of CVD such as dizziness or overwhelming fatigue are often confused with stress symptoms and women don’t pay them much attention.The most met women’s symptoms for heart disease are:unusual fatigue,trouble sleeping,shortness of breath,indigestion,anxiety.nausea,irregular heartbeat,a burning sensation on the chest or abdomen,pain on one or both arms,cold sweat,weakness and pain or pressure in the back chest.



Recognizing these symptoms and treating them on time improves the chance of survival.Women suffering from CVD have higher death rate and complications risks than men.Women are adviced to do frequently heart exams and ask their doctor of any problem they seem to have with their hearts.Women should pay attention to their blood pressure,cholesterol level and lifestyle.

A study shows that CVD kills one woman per minute and most of the women who died had no pre CVD symptoms.The same study shows that anually die more women from CVD than men.

The American Heart Association categorized the women in 3 categories,based on certain symptoms or way of being:
a.high risk.Here are included those women who have a history in heart disease and have 20% chance to have a heart attack in the next 10 years.
b.intermediate risk.Here are included women who have calcium in coronary arteries,metabolic syndrome or multiple heart risk factors.These women have 10-20% chance to heave a heart attack in the next 10 years.
c.lower risk.Here are included those women who have less than 10% chances of having a heart attack in the next 10 years and have no symptoms like high or intermediate risk women.

Medicine gives some piece of advice to prevent a heart attack,or to prevent death.Doctor suggest that women should not smoke.Women should maintain a healthy weight.Woman who recently suffered of a heart disease should go to a rehabilitation program.Women should eat healthy.Their diet should be consisted in vegetables,fruits,grains,low-fat products.High risk women should take fatty acids supplements.Cholesterol and blood pressure should be kept at normal levels.The medication used for cholesterol and blood pressure can vary,depending on a woman’s level of risk.Some doctors recommend the aspirine therapy.

This therapy is recommended on women over the age of 65 years old to prevent heart attack.This therapy is not recommended to healthy under 65 years old women.It can cause gastric problems.Women who experienced a heart attack should use beta blockers.High risk women should use ACE inhibitors.Angiotensin receptor should be used on women who had a heart failure.

Learning these symptoms and recognizing them by the women can prevent death occurring among women.

Cholera is an acute disease.The body’s intestine is infected with the Vibrio Cholerae bacterium.The infections comes sometimes without symptoms and it’s not very severe,but other times it can have complications.Cholera was discovered in the US 200 years ago,but it was partially exctinct by the time,with the development of new sewage and water purification.

Cholera is not a major treat.It can be easily prevented and treated,but if not treated,this disease can be deadly.

Here are some symptoms of the disease cholera:watery diarrhea,severe vomiting and major leg cramps,sometimes fever and loss of electrolytes which lead to:profound dehydration,circulatory collapse and anuria.Cholera incubation time is usually 24 to 72 hours since the body was infected with this disease.

People can take cholera from different locations.Either is in the food we ea eat,in the water we drink,or things we touch,cholera must be treated qucikly,otherwise the infected person might die from dehydration caused by vomiting and diarrhea within hours.People,who wish to travel in areas infested with cholera,must get a piece of advice before leaving there.The US Center of Disease Control has a telephone line for the public and travellers learn how to prevent cholera and other diseases.

To prevent cholera,when travelling in areas which can be infested with the cholera bacterium,certain recommendations must be respected:
1.water must be drank only boiled or treated with clorine and iodine.
2.food must be eaten only hot,because the heat destroys bacteria.
3.fish dishes must be avoided,especially ceviche.
4.salads must be avoided,the vegetables must be cooked.
5.different bevereages and food from street vendors must be avoided.
6.persons who travel to areas were the risk of infection with the cholera disease should not bring back with them perishable food or seafood.

At this time it has been developed a vaccine for cholera,called Wyeth-Ayerst,but is not highly recommended,because of the low immunity it provides.

In time,two other vaccines were made:Ducoral and Mutacol.It seems that this vaccine offers a little bit more protection against the cholera disease.

Even if this disease can provoke death,cholera is a simple disease that can be treated immediatly.The patient’s lost fluids by vomitting or diarrhea must be immediatly replaced.The patient can be treated orally.He must drink large amounts of a mixture made out of salts,sugars and water.If the case of cholera is severe,the fluid replacement is made intravenous.Rehydration must be combined with antibiotics,because medication destroys the bacteria inside the body.The best antibiotic used against cholera bacterium is the tetracycline.But there are other antibiotics which are good against cholera,antibiotics such as:cotrimoxazole,erythromycin,doxycycline,cloramphenicol and furazolidone.

If cholera is treated immediatly,it’s death rate is 1%,which means that a person from one hundred die because of the cholera disease.If not treated,the death rate is higher:50 to 50% of the untreated patients die from cholera.

Lyme disease come from the bite of an infected tick with the Borrelia burgdorferi bacteria.It’s probably the most common disease spread by ticks in the US.It was first discovered in a small town in the USA,called Lyme in 1975.

Mostly of the lyme disease reports were from the US,especially from the east coastal states,north coastal states and northern California,Connecticut,Rhode Island,New York,New Jersey,Delaware,Pennsylvania,Maryland and Wisconsin.

The black-legged tick spreades lyme in northeastern US and The Great Lakes Region.Black-legged ticks live in woods and places with grass,yards for example.In the Pacific there is the western-black legged tick who spreads lyme disease.

These ticks become infected because they’re eating from infected animals such as mice,chipmunks.

This tick ussualy lives 2 years and feeds only 3 times:once as a larvae,once as a nymph and once as an adult.

By their opinion,doctors suggest that lyme disease has three stages:early lyme disease,early disseminated lyme disease and late lyme disease.

Early lyme disease is the first stage of this illnes.This stage developes many symptomes such as:fatigue,chills,fever,headache,muscle and joint pain,swollen lymph nodes,tiredness and erythema migrants.

Erythema migrans is one of the first symptoms of lyme disease and it’s consisted of a circular skin rash that grows regularly.This skin rash can appear from 1 day to 1 month since the bite of the infected tick,but it usually appears in 7 days since the bite and has a 2 inches diameter.After it enlarges,the rash appears as a large „bulls-eye”.The rash is usually worm but it’s not painfully.Erythema migrans doesn’t appear on every patient who suffers from lyme disease.The patient recognises the disease when is on it’s second or third stage.

To prevent lyme disease people should protect themselves from tick bites,they shoyld remove imediatly any attached tick on their skin and get early treatment.Antibiotic treatment is adviced because untreated lyme disease can leave severe health problems on the future.Antibiotic treatment should last from 3 to 4 weeks.The problem is that a prevent method wasn’t discovered yet.It’s being worked at a vaccine,but all the doctors suggest that the best method to prevent the infection with lyme disease is to avoid exposure to ticks.People should not stay in places with wild mice,dead or alive,avoid woods with thick ground cover.There are suggestions regarding clothing.

Doctors suggest that people when are working in the garden to wear long clothes to protect their skin and to prevent an infected tick to come in contact with the skin.Insecticid is a good way to prevent ticks coming near a person or inhabited areas.After getting inside the house people should always check theirselves for tick.Ticks usually stay behind the knees,between the fingers and toes,under the arms,in the ears,behind the ears and on the neck.

Parkinson disease is also known as Pallidotomy.It’s a disease of the nervous system and it’s based on trembling of the arms and legs.Parkinson is caused by the loss of the brain cells of the substantia nigraBecause of the loss of these cells,less dopamine is produced and because of that,the striatum(the area that co-ordinates movement) doesn’t work properly.A study shows that one person in every 500 is infected a year with Parkinson disease.People could get this disease by exposing theirselves on certain risks such as:
1.pesticide and herbicide exposures.
2.rural living.
3.previous head injury.
4.impairment of smelling capacity.
5.obssesive personality.
6.severe emotional trauma.
7.severe emotional stress.

This disease is difficult to be recognised in it’s early stages.Because it has no regular symptoms,the doctors find it difficult to diagnose Parkinson disease in it’s early stage.Early treatment may help so that the disease won’t spread that quickly.

These are some early symptoms of parkinson disease :
a.difficulty of moving and slowness.These are probably the first symptoms of Parkinson disease.
b.a tremor when the body is relaxed,usually on resting.Tremors often come when the person is awake.
c.a response to the drug levedopa,the first treatment in Parkinson disease.
d.bradykinesia-movement initiated slow.The person finds it hard to move from a resting position.The person often tends to stop suddenly.
e.poor balance and unstable walking.An affected person with Parkinson disease walks very hard and very slow.
Other symptoms may include:expressionless face,reduced manual dexterity,handwritting difficulties,drooling,sleep problems,urination at night,depretion and anxiety,constipation and difficulty in turning in bed at night,weakness of face and throat muscles.The person with Parkinson disease finds it hard to talk or to swallow,and because of the disease the person may choke or drool.

Early symptoms of Parkinson disease also include stiff fingers or shoulder or stiff muscles.Stiff muscles is a very common Parkinson symptome.Also there are symptoms like:decreased dexterity and coordination,cramps in the muscles and joints,oily skin and increased dandruff,digestive problems,increased sweating,low blood pressure,freezing.,sleeping problems,mood problems and postural instability.
Symptoms usually affect on side of the body for the first or two years.The tremor can also affect the chin,lips and tongue.Tremors are reduced by complete relaxation or sleep.
In Parkinson the protein level is low.

A person which suffers from Parkinson disease cand become passive,dependent,confused.A sick person will not talk as much as it used to do.Parkinson disease can bring depressions on people as an effect of the disease.
Because the symptoms are not obvious all the time,people are recommended to take maybe an annual exam for Parkinson disease,exam which is called DATScan.Recent medicine won’t prevent or cure the disease but it can make life easier of a person who has this horrible disease.