A cold is a contagious viral disease which infects the soft lining (mucous membrane) of the nose. There are more than 100 different viruses which can result in a cold. The characteristic symptom is a runny nose

Usually, it is a mild condition, recovery taking place within about a week. However, sometimes the same symptoms occur with other illnesses like influenza.

It is most common during the cold winter months and affects children and adults of all ages. Most people will catch a cold two to four times a year.

What are the symptoms of a cold?

A sore throat.

There may be pain on swallowing.

Sneezing.

The nose begins to run with a water-like secretion which gradually becomes thicker and more yellow.

As the mucous membrane of the nose swells it may be hard to breathe through the nose.

An oppressive feeling in the ears.

Headache.

Coughing.

A feeling of being unwell.

A high temperature. Children are more likely to run a temperature than adults.

What can you do to avoid catching a cold?

If possible, stay away from people with colds.

Avoid crowded places where the risk of infection is greater.

Do not touch your nose or eyes after being in physical contact with somebody that has a cold.

Wash your hands thoroughly, especially after blowing your nose.

Keep rooms well aired.

A migraine is a throbbing, intense headache in one half of the head. It can affect people of all ages. The cause of migraine is not known.

During an attack, the blood vessels in the brain dilate and then draw together with stimulation of nerve endings near the affected blood vessels. These changes to the blood vessels are probably what cause the pain, but migraine is still a condition that is poorly understood.

• headaches that occur in bouts of between roughly 4 to 72 hours.

• the headaches usually affect one side of the head at a time, although both sides may be affected in separate attacks.

• the headaches are usually throbbing and worsened by normal physical activity

• nausea and/or vomiting

• preceding symptoms, called the ‘aura’ that most often are visual, such as zigzag lines or flashing lights across or at the edges of the fields of vision

• other symptoms can include sensitivity to light and sound, or non-visual aura such as a sensation of tingling in the body.

Only about 15 per cent of people experience visual aura before an attack. ‘Common migraine’ refers to the majority who have all the other symptoms but no aura. Rarely some people with migraine experience transient loss of power of a limb with severe attacks, or temporary difficulty with speech.

In addition to an interview, the doctor should also perform a physical examination. If there is any doubt about the diagnosis, the doctor will refer the patient to an expert on diseases of the brain (neurologist).

Asthma is a chronic disease in which sufferers have repeated attacks of difficulty in breathing and coughing. There seems to be an increase in the amount of asthma all over the world, especially in children. To understand what happens in asthmatic attacks it is helpful to visualise the basic structure of the airway tubes of the lung (bronchi).

The main airway (windpipe, trachea) of the body is about 2-3cm across. It divides into its main branches (bronchi), which lead to the right and left lung, which divide further, like the branches of a tree, to supply air to all parts of the lungs. The smallest tubes (bronchioles) are only millimetres wide and they are made up of ring-shaped muscles that are capable of contracting or relaxing. Anything that makes them contract will narrow the passages, which makes it more difficult for the air to pass through and also gives rise to the characteristic wheezy noise. Asthmatics tend to be sensitive to various types of irritants in the atmosphere which can trigger this contraction response from the bronchial muscles.

The bronchi also have an inner lining that becomes inflamed in asthma, which makes the lining swell and produce an excess amount of the mucus (phlegm) which it normally makes. All of these processes contribute to the airway narrowing and the treatment for asthma is aimed at reversing them as much as possible.

People of all ages get asthma but 50 per cent of sufferers are children, mostly boys, under 10. Among adults, women are more likely to develop asthma than men.

• Exertion.
• Cold.
• Smoke.
• Air pollution including exposure to certain chemicals. An example is isocynates which are used in some painting and plastics industries.
• Airway infection.
• Allergies, eg to pollens, house dust mites, domestic animals (especially cats), aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

What does asthma feel like?

• It is difficult to breathe and there is shortness of breath.
• Wheezing when breathing out.
• Coughing, especially at night and with a little mucus.

What are the warning signals of worsening attacks?

• Inhaled medicines appears less effective than usual.
• Symptoms of cough or wheeze on exertion.
• Night-time wakening with wheeze or cough.
• Fall in the peak flow meter reading (a peak flow meter is a simple device that measures the maximum speed at which a person can breathe out).

What are the danger signals of severe attacks requiring immediate medical attention?

• Bluish skin colour and gasping breath.
• Exhaustion so severe that speech is difficult or impossible.
• Confusion and restlessness.

The dictionary definition is: ‘A condition in which bowel emptying occurs infrequently or in which the stools are hard and small or where bowel movement causes difficulty or pain.’

But defining infrequent is difficult when some 90 per cent of people in Western countries have a bowel pattern that ranges from three bowel movements a day to three per week.

And it is possible to move your bowels every day and still be constipated if the stools are hard and difficult to pass. Equally, a daily bowel movement is by no means essential for, nor a sign of, good health.

Provided the bowels move regularly and without discomfort, it doesn't matter if your natural bowel frequency is once every two or three days.

• Tummy pain associated with bowel movements.
• A feeling of incomplete emptying of the bowel.
• A bloated feeling in the stomach region.
• Diarrhoea: constipation is one of the most common causes of diarrhoea, especially in the elderly in care. Diarrhoea caused by constipation is known as bypass diarrhoea.

What causes ulcerative colitis?

The exact cause of ulcerative colitis is unknown. Hereditary, infectious and immunological factors have been proposed as possible causes.

What are the symptoms of ulcerative colitis?

• The symptoms of ulcerative colitis can vary considerably.
• The disease is characterised by periods with diarrhoea, mixed with pus, blood, and mucus, which alternate with periods of few or no symptoms.
• When the colitis is active, the patient often has mild stomach pains, and sometimes a fever.
• The symptoms vary according to the extent of the disease. A quarter of patients only have the disease in the rectum, which means that the symptoms are fairly mild. In one third of patients, the disease also affects the lower part of the large intestine. In the remaining patients, ulcerative colitis affects all of the large intestine.

The blood pressure depends on how forcefully the heart pumps the blood around the body and how narrowed or relaxed your arteries are. Hypertension occurs when blood is forced through the arteries at an increased pressure.

Blood pressure is measured using two numbers. An example of this could be 'the blood pressure is 120 over 80', which is written as '120/80'. The first figure is the systolic blood pressure - the pressure in the arteries when the heart contracts and pushes the blood out into the body. The second figure is the diastolic blood pressure. This is the pressure in the arteries when the heart is filled with blood as it relaxes between two beats.

What is hypertension?

There is a natural tendency for blood pressure to rise with age due to the reduced elasticity of the arterial system. The definition of hypertension is thus dependent on the age of the patient.

For example, in a 60-year-old patient, hypertension occurs when the blood pressure is higher than 160/90 while the patient is at rest.

Some patients have lower thresholds for the diagnosis of hypertension, in particular diabetic patients, for whom any persisting pressure above 130/80 causes problems.

Even though hypertension itself rarely has any symptoms, it can cause many serious problems.

• headache, sleepiness, confusion or coma
• serious breathing difficulties
• nosebleeds.

What factors increase the risk of hypertension?

Anyone can suffer from hypertension but certain factors can seriously aggravate hypertension and increase the risk of complications:

• a tendency in the family to suffer hypertension
• obesity
• smoking
• diabetes Type 1 or Type 2
• kidney diseases
• high alcohol intake
• excessive salt intake
• lack of exercise
• certain medicines, such as steroids and certain kinds of diet pills.

Failure in a valve in the left side of the heart - the aortic or the mitral valve - results in left-sided heart failure. This leads to an accumulation of fluids in the lungs, or pulmonary oedema.

Valve diseases of the right side of the heart - the pulmonary and tricuspid valve - are rare but can occur as the result of some forms of congenital heart disease or long-term left-sided heart failure. Right-sided heart failure is characterised by fluid accumulation in the body, particularly in the legs, abdominal cavity and the liver.

Malformation of the heart valves can be divided into two categories: narrowed (stenosed) valves and leaking (regurgitant) valves - or a combination of both.

What causes heart valve disease?

Narrowed valves
These may be due to:
• congenital abnormality
• degeneration through atherosclerosis (aortic stenosis only)
• damage from rheumatic fever
• excessive calcification in old age (aortic stenosis only).

Leaking valves
These may be due to:

• bacterial infection or inflammation of a valve
• excessive floppiness of the leaflets (mitral valve prolapse)
• enlargement of the heart or aorta - the main blood vessel into which the left ventricle pumps.

What does a malformation of the heart valve feel like?
In mild cases there are no symptoms and generally no cause for worry, although antibiotic treatment to prevent the risk of a valve infection is recommended, for example to cover a dental procedure when there is a chance that there will be some bacteria introduced into the bloodstream temporarily.

Serious cases may not be evident for a long time either. There may be no symptoms, even though the heart is already under strain. In cases of stenosis of the aortic valve, it is important to be aware of the following possible symptoms, since this condition may result in sudden death:

• dizziness or a faint brought on by physical effort
• shortness of breath
• angina (chest pain) on exertion.

How does it feel to have arthritis?

Arthritis may be preceded or accompanied by a period of fatigue and a feeling of weakness. Pain in the joints almost always begins in the hands, especially in the knuckles, and often in both hands simultaneously, as in the case of one of the commonest types called rheumatoid arthritis.

• Because of the inflammatory reaction, the joints swell and become red, stiff and sore.
• The problem is worse in the morning than during the day.
• There can be periods of improvement which may be followed by a relapse.

Who is at special risk?

We do not know the cause of arthritis. In rheumatoid arthritis the theory that it is triggered by an infection has never been proved. It may be partly hereditary and it occurs three times as often in women as in men. All age groups can develop arthritis - even children - but usually rheumatoid arthritis appears between the ages of 30 and 35.

Schizophrenia is a major mental illness that causes changes in perception, thoughts and behaviour.

It is a complex condition that defies simple description, but a distinction can be made between two broad types: acute schizophrenia and chronic schizophrenia.

Acute schizophrenia
This is the form that probably most comes to mind when people think of schizophrenia.

Acute schizophrenia is when a previously healthy person, generally a young adult, shows increasingly odd behaviour over a fairly short period of time of perhaps a few weeks.

They may express paranoid ideas or respond to the hallucinations they experience. These hallucinations usually take the form of hearing voices that other people cannot hear.

Chronic schizophrenia

• a lack of drive
• underactivity
• social withdrawal.

Left to their own devices, schizophrenics may spend long periods of time doing nothing, or engage in repeated and purposeless activity. Sometimes they can neglect themselves quite markedly.
As with the acute state, hallucinations and delusions are common.
Sometimes in chronic schizophrenia the person appears to become used to these disordered thoughts.
For example, they might harbour the idea that someone is trying to get at them, but this does not cause any emotional reaction.

How does schizophrenia develop?

The cause of schizophrenia is unknown, but it may have a genetic component. There is no ‘gene for schizophrenia’ but a family history of the illness increases the risk of being affected:

• if a grandparent had the illness, the risk rises to 3 per cent.
• if one parent was affected, the risk is as high as 10 per cent.
• this rises to 40 per cent if both parents have schizophrenia.

Other predisposing factors in the development of schizophrenia include complications during pregnancy or childbirth and difficulties in childhood development.

Factors that may trigger an episode of schizophrenia include stressful life events, and the use of illegal drugs such as cannabis.

How common is obesity?

Obesity is found a little more among men than women. Stomach obesity is more frequent and occurs in 30 per cent of adult men and, to a lesser degree, in adult women. Obesity and stomach obesity are rapidly increasing, especially in young people. The occurrence of obesity has increased by five fold since the Second World War.

What are the serious obesity-related diseases?

Most importantly, being overweight and obese may cause several psychological problems like a feeling of inferiority, often caused by discrimination. Furthermore, many physical problems are related to obesity, like difficulties in breathing, personal hygiene, pain in the knees and back and skin problems. People suffering from obesity more frequently have high blood pressure and diseases related to hardening of the arteries, with blood clots in the heart and the brain. Other related problems include non-insulin dependent diabetes, gallstones, some types of cancer, difficulties in mobility and increased risk of mortality.

What causes obesity?

Obesity can be hereditary, hence some people are at increased risk. However, obesity only develops from overeating, irregular meals and lack of daily physical activity. Many people think that when a disease is hereditary, it is inevitable that you will suffer from the condition but this is not true. If the people in Europe had grown up in China with plenty of non-fat foods and hard daily work in the rice fields, only a few of them would be overweight or fat. It is lifestyle which determines how the genes develop. The fact that the existence of obesity has increased by five times since the Second World War, is hardly due to a change of our genes. On the contrary, our lifestyles have changed rapidly.

Besides genes, food and physical activity, it is possible that other so far unknown elements may play a part.

When is obesity dangerous?

With a BMI of more than 25, it is advisable to change lifestyles and lose weight, especially if it is stomach obesity (apple-shaped). The waist circumference may be used in order to determine if you are apple-shaped. Men with a waist circumference of more than 94cm (37in) and women with a waist of more than 80cm (31.5in) should not further increase their weight. An increased risk of obesity-related diseases is present with a waist circumference of more than 102cm (40in) for men and more than 88cm (34.6in) for women. Test if you are apple or pear shaped here. If your BMI is more than 30, it is required that you lose weight.

What are the symptoms of haemorrhoids?

Haemorrhoids may be present for many years but remain undetected until symptoms appear. They can cause anal bleeding and itching and also pain and discomfort. Normally, the bleeding is limited to small stains of fresh blood on the toilet paper, but more severe bleeding can sometimes be present when stools are passed.

A lump may also be felt in the anus and large haemorrhoids give a sensation that the bowel hasn't emptied completely. If you observe blood in your stools, and have the symptoms mentioned above, you should visit your doctor for a check-up. If haemorrhoids are present ,the doctor will then perform an examination to find out if there are any other possible causes of the bleeding that may be more serious. The doctor will feel the anal canal, and inspect the mucous membrane of the rectum and lower part of the large intestine using an examination tube called a proctoscope or sigmoidoscope.

Diabetes is a condition where the blood glucose (sugar) level is higher than normal. There are two major forms of diabetes:

Type 1 diabetes, or insulin-dependent diabetes. This type is often seen in young people.

Type 2 diabetes, or non insulin-dependent diabetes. This type tends to affect the elderly or overweight people.

Other types include:

gestational diabetes. This type is often associated with pregnancy and usually goes away after birth.

Around 1.4 million people have been diagnosed with diabetes in the UK today. It is estimated that a similar number have the condition without knowing it.

What causes diabetes?

The blood glucose level will rise if the body lacks the hormone insulin (Type 1 diabetes), or if the production of insulin is not sufficient and the effectiveness of available insulin is reduced (Type 2 diabetes). It is believed that the cause of Type 2 diabetes is related to factors associated with a Western lifestyle, since it is most common among overweight people and those who do not get enough exercise.

Gestational diabetes is associated with pregnancy, but will usually disappear upon delivery. Secondary diabetes is also much like Type 2 diabetes. It is quite variable, depending on the underlying cause.

Common symptoms of diabetes

When blood glucose levels rise, one or more classical symptoms will appear, mainly due to blood sugar being secreted into the urine. These symptoms are:

increased thirst

increased urination

fatigue

weight loss, although appetite often increases (especially in Type 1 diabetes)

itchiness, especially around the genitals

recurrent infections on the skin and mucous membranes.

Whereas Type 1 patients usually develop the above symptoms within days or weeks, Type 2 patients are often asymptomatic (do not show symptoms) and are diagnosed by chance through routine medical check-ups.

Both types of diabetes are hereditary, but only about 10 per cent of Type 1 patients have a family history of diabetes. For Type 2, this rises to 30 per cent.

If you are experiencing any of the above symptoms on a consistent basis, it is important to seek medical attention and be tested for diabetes.

How is the diagnosis made?

The diagnosis is made by examining glucose levels in blood samples using one or more of the following tests (World Health Organisation recommendations 1999):

random glucose test: a glucose level above 11.1mmol/l taken at a random time on two occasions is a diagnosis of diabetes.

fasting glucose test: a glucose level above 7.0mmol/l measured without anything to eat and on two different days is also a diagnosis of diabetes.

glucose tolerance test: a blood glucose test is taken two hours after a glucose drink is given to the patient. A level above 11.1mmol/l is a diagnosis of diabetes, while a level below 7.8 is normal. However, if the level falls between these values you may have a decreased tolerance for glucose (known as impaired glucose tolerance or IGT).

Some of the common traits in Type 2 diabetic patients are:

family history of diabetes

obesity

increased blood pressure

premature vascular problems such as heart attacks and stroke

abnormal triglycerides (lipid or neutral fats) in the blood.

How is diabetes treated?

Diabetes is treated in two ways:

a combination of proper diet and exercise

medication with tablets or insulin.

For Type 1 diabetic patients, and some Type 2 diabetics, insulin injections will increase the insulin level in the blood and bring down the blood sugar level.

There are different types of oral medication for treating Type 2 diabetes. Some increase the amount of insulin secreted by the pancreas, others increase the action of insulin in the body, while others delay the absorption of glucose.

The treatment of diabetes is based on individual needs. This is a process that starts the very first time you give yourself an insulin injection, or take a diabetes tablet, and which continues through eating an appropriate diet and starting an exercise programme.

To help you, consult your hospital healthcare team, which should also include a diabetes nurse specialist. Do not hesitate to ask them for help and guidance.

The most important aspect of treatment is the home blood glucose apparatus, which enables you to measure your own blood glucose levels and make any necessary adjustments to diet, level of exercise and insulin intake.

Controlling diabetes and its possible complications

Diabetes can be controlled through routine check-ups by your doctor or annual check-ups at the hospital on an outpatient basis, or both. The purpose of the controls is to check that treatment is progressing satisfactorily (routine check-ups) and also to determine if any late-stage complications have appeared or worsened (annual check-ups).

Routine check-ups every three to six months or when decided by your doctor

Blood sample to check the amount of HbA1c (long-term glucose) in the blood.

Evaluation of home glucose readings.

Discussion of diet.

Blood pressure.

Weight.

Various tests and examinations decided by the doctor.

Annual check-ups (every one to two years)

Blood sample to check the amount of HbA1c (long-term glucose) in the blood.

Blood sample to determine the amount of fats in the blood.

Blood sample to check the amount of creatinine (used to determine if the kidneys are functioning properly) and various salts in the blood (mainly sodium and potassium).

Blood pressure.

Urine sample to determine the presence of protein (albuminuria).

Foot examination, including a check of various pulse points on the foot.

Possible ECG (electrocardiogram).

Weight.

Measuring the waistline.

Discussion of exercise habits.

Smoking.