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anisakiasis-Anxiety-Anorexy

Anisakiasis

Anisakiasis is a parasitic condition that is acquired when eating certain foods, such as fish or any raw or undercooked cephalopod containing a larva of the anisakiadae family.

Anisakis is a parasite between 20 and 30 millimeters long whose larvae are housed in multiple marine species and from which man becomes an accidental host. The types of fish that most frequently contain this parasite are hake and bonito but those that produce more cases of anisakiasis are others, such as anchovies, anchovies and sardines.


However, there are some species that do not usually contain the parasite and among them are the bivalves (mussels, oysters or cockles, for example), because when feeding by filtration this prevents the larvae from nesting in them.

Causes
Anisakis can affect the human being through two procedures. In the case of the first one is produced by immediate mediated hypersensitivity that implies that the parasite has several antigens capable of indirectly causing allergic conditions ranging from a simple urticaria to an anaphylactic shock.

In addition, there is a second type of mechanism involving the local effect of the parasite on the wall of the digestive tract, although the first type is usually the most common.

According to the Spanish Digestive Foundation, the incidence of anisakiasis in Spain depends both on the amount of fish consumed (being higher in the coastal areas) and on the specific culinary habits of each zone, since high temperatures usually destroy the parasite .

With regard to the latter, it is necessary to take into account that the larvae resist both temperatures of up to 50ºC and some forms of cooking, such as vinegar, salt or certain smoking techniques.

Therefore, it is easier to get anisakiasis when eating fish prepared with vinegar, salted, smoked, pickled, raw or undercooked fish. Likewise, the preserves are safer, since the food is cooked previously, except for anchovies or marinades.
As regards the symptoms of this condition, these are divided into symptomatic digestive and allergic symptoms.

The first ones consist of nausea, vomiting and abdominal pain that will vary depending on the location of the parasite. The most frequent is intense pain in the mouth of the stomach a few hours after ingestion and, in case the parasite reaches the intestine, it is possible that abdominal surgery may be necessary.

On the other hand, as far as the allergic condition is concerned, it can range from mild urticaria to anaphylaxis, which represents the most serious symptom of being able to cause shock and vital danger.

It is possible that the allergy is not produced by ingestion, as is the case of fishermen or fishmongers, who may suffer other conditions such as asthma, rhinoconjunctivitis or contact dermatitis.

All clinical manifestations of this pathology are produced by the presence of anisakis in the gastrointestinal tract, specifically in the stomach or in the distal portion of the small intestine.
From the legislative point of view, there are decrees and laws that require a visual inspection by suppliers of fresh fish and, in certain cases, restaurants are forced to freeze the food to avoid this type of problem.

With regard to preventive measures of an individual nature, these include:

Be sure to eat fish that has been frozen beforehand.

Avoid ingesting fish parts that are close to the fish's digestive system.

Cook it more than 60 degrees for at least 2 minutes as some forms of treatment, such as grilling, are often insufficient.

Freeze the fish for at least 72 hours before cooking.
Types
Currently, there is no classification of this pathology.

Diagnosis
To diagnose this condition, the specialist will carry out the following tests:

Serological: In these tests the presence of antibodies against certain antigens is detected, being one of the skin tests more known the Prick-Test that consists of reproducing in the skin an allergic reaction to determine to which substances one is allergic.

Radiological: To detect defects in barium (barium) transit or to detect if there is any thickening caused by edema of the mucosa that could produce a narrowing in the intestine.

Ultrasound: Through which a thickening of some intestinal segment can be detected.
Treatments
According to the Spanish Foundation of the Digestive System, in the majority of patients the symptoms refer without specific treatment of the condition, although they are usually prescribed, mainly, gastric protectors.

On the other hand, it may be necessary to remove the parasite if it is known where it is located in the body of the patient through an endoscopy and, in the case of an intestinal involvement involving inflammation, the specialist will prescribe corticosteroids to Avoid surgical interventions.

To treat allergic reactions, antihistamines may reduce the symptomatic picture, while anaphylactic reactions should be treated with adrenaline, being considered a serious and urgent presentation of the pathology.

Other data
Recently, according to the Gastroenterology Service of the Ramón y Cajal University Hospital, studies have been carried out in which it has been discovered that the parasite contains certain proteins called antigens that prove to be thermoresistant and therefore not destroyed with very high temperatures.

In these cases, the specialist should perform tests to detect the patient's sensitivity to these proteins, although these are tests that can only be carried out in research studies.

Therefore, specialists only prohibit the consumption of fish to those patients who have shown anisakiasis after having ingested this food previously frozen or properly cooked.
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Anorexy

Anorexia consists of an eating disorder that involves a loss of weight caused by the patient himself and leads to a state of starvation. Anorexia is characterized by fear of gaining weight, and by a distorted and delirious perception of the body itself that makes the patient look fat even when his weight is below recommended. Therefore, it initiates a progressive reduction of the weight by means of fasts and the reduction of the food intake.

It usually starts with the elimination of carbohydrates, since there is the false belief that they are fattening. It then rejects fats, proteins and even liquids, leading to cases of extreme dehydration. These other drastic measures can be added to other associated behaviors such as the use of diuretics, laxatives, purges, induced vomiting or excessive physical exercise. Affected people can lose 15 to 50 percent, in the most critical cases, of their body weight. This disease is often associated with severe psychological changes that lead to changes in behavior, emotional behavior and stigmatization of the body.

Causes
Its cause is unknown, but social factors seem important. Although there are many sociocultural factors that can trigger anorexia, it is likely that a part of the population has a greater physical predisposition to suffer from this disorder, regardless of the pressure exerted by the environment. Therefore there are general factors that are associated with a triggering factor or some biological vulnerability, which is what precipitates the development of the disease.

The own obesity of the sick.

Maternal obesity.

Death or illness of a loved one.

Separation of parents.

Away from home.

School failures.

Accidents.

Traumatic events.
This pathology is characterized by a significant loss of weight caused by the patient and by an erroneous perception of the body itself. Consequently, endocrine problems become evident in a relatively short space of time. The main symptoms that determine the onset of the disease are:

Refusal to maintain body weight above the minimum appropriate for the patient's age and size.

Fear of weight gain or obesity even when the weight is below the recommended level.

Distorted perception of body weight and proportions.

Absence of three consecutive menstrual cycles in women (amenorrhea).
Anorexics may experience a variety of symptoms: constipation, amenorrhea, abdominal pain, vomiting, and so on.

But it is the family that detects the symptoms that give the alarm:

Excessive concern about the caloric composition of food and the preparation of food.

Constant sensation of cold.

Progressive reduction of food.

Obsession with the image, the scale, the studies and the sport.

Use of traps to avoid food.

Hyperactivity.
These symptoms are compounded by other typical traits such as irritability, depression and emotional or personality disorders. Likewise, there is an alteration in the sensation of satiety and fullness before meals, nausea, swelling, or even absence of sensation. In this pathology there are also numerous cognitive disorders that focus on food, body weight and physical appearance:

Selective abstractions.

selective use of information.

Generalizations.

Superstitions.

The negative side of any situation is magnified.

Dichotomous thinking.

Self-referential ideas.

Arbitrary Inference.
As for the clinical consequences, the symptoms are as follows:

Cardiac pulsations are reduced.

Arrhythmias occur which can lead to cardiac arrest.

Low blood pressure.

Menstruation disappears in women (amenorrhea).

It decreases bone mass and, in very early cases, slows growth rate.

Decreased intestinal motility.

Anemia.
It appears a fine and long hair, called wooly, in the back, the forearms, the thighs, the neck and the cheeks.

Chronic constipation.

The decrease in energy expenditure produces a constant sensation of cold.

The skin is dehydrated, dried and cracked.

Yellowing of the palms of the hands and soles of the feet by the accumulation of carotenes in the sebaceous glands.

The nails are broken.

Hair loss.

Problems with teeth and peripheral edema. Bloating and abdominal pain.
Prevention
Since it is a disorder that usually begins in adolescence, observation by the family is crucial to detect in the minor habits that signal a warning. These are some risk factors:

Poor eating habits: Many teens eat alone while watching TV or communicating with their friends via whatsapp. The lack of fixed schedules and supervision by parents about what they eat increases the likelihood of developing an eating disorder.

Poor communication with parents: Knowing the concerns of children, their tastes and their circle of friends can help prevent this type of disorder or detect it at an early stage.
Types
In anorexia nervosa, two subtypes can be distinguished:

Restricting subtype: weight reduction is achieved through diets or intense physical exercise and the patient does not resort to overeating, bingeing or purging.

Bulimic subtype: The patient resorts to purges even if he has ingested a small amount of food.
Diagnosis
Anorexia nervosa is usually diagnosed based on intense weight loss and characteristic psychological symptoms. The typical anorexic is a teenager who has lost at least 15 percent of her body weight, fears obesity, has stopped menstruating, denies being sick and seems healthy.

Treatments
The overall goals of treatment are to correct malnutrition and psychic disorders of the patient. First is to try to achieve rapid weight gain and recovery of eating habits, as they may imply an increased risk of death. But a full recovery of body weight is not synonymous with healing. Anorexia is a psychiatric illness and should be treated as such. Treatment should be based on three aspects:

Early detection of the disease: knowledge of symptoms by primary care physicians and protocols that set the criteria that the physician should observe.

Coordination between health services involved: psychiatry, endocrinology and pediatrics.

Outpatient follow-up once the patient has been discharged, with regular visits. Hospitalizations are usually prolonged, which means a disconnection of the environment that may impair the normal development of the adolescent. Therefore, ambulatory treatments are advisable whenever possible.

The admission to a medical center is necessary when:

Malnutrition is very serious and there are alterations in vital signs.

When family relationships are unsustainable and it is better to isolate the patient.

When mental disorders are aggravated.
Outpatient treatment is effective when:

It is detected at an early stage.

There are no episodes of bulimia or vomiting and there is a family commitment of cooperation.
This way the treatment with the feedback begins, which can sometimes cause digestive discomfort, since the body is not accustomed to ingest food. Over time the biological situation is restored and menstruation returns. Then begins the psychological treatment, which attempts to restructure rational ideas, eliminate the wrong perception of the body, improve self-esteem, and develop social and communicative skills between the patient and his environment. The family must take an active part in the treatment because sometimes the triggering factor of the disease is in the breast and, in addition, the recovery is inevitably prolonged in the home.

Other data
About 95 percent of people with this disorder are women. It usually begins in adolescence, sometimes before and less frequently in adulthood. Anorexia nervosa primarily affects people of medium and high socioeconomic class. In Western society the number of people with this disorder seems to increase. Anorexia nervosa can be mild and transient or severe and long-lasting. Lethal rates as high as 10 to 20 percent have been reported. However, since mild cases can not be diagnosed, no one knows exactly how many people have anorexia nervosa or what percentage dies of it.

The age of onset of anorexia is in the first adolescence, around 12 years, although the most affected population is between 14 and 18 years. It is more frequent in the cla
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Anxiety

Anxiety is a natural adaptive mechanism that allows us to be alert to committed events. In reality, a certain degree of anxiety provides an adequate component of caution in especially dangerous situations. Moderate anxiety can help us stay focused and face the challenges ahead.

Sometimes, however, the anxiety response system is overflowed and malfunctions. More specifically, anxiety is disproportionate to the situation and even sometimes occurs in the absence of any ostensible danger. The subject feels paralyzed with a feeling of defenselessness and, in general, there is a deterioration of the psychosocial and physiological functioning. It is said that when anxiety occurs at inappropriate times or is so intense and lasting that it interferes with the normal activities of the person, then it is considered as a disorder.

Causes
Genetic causes: Anxiety can be inherited through genes. However, even someone who is not naturally anxious may experience this feeling of fear in the face of tension, as the Spanish Society of Psychiatry (SEP) states.

Circumstantial causes: traumatic events such as a traffic accident, an attack or a fire can cause anxiety; In these cases, the feeling of anxiety may disappear when the problem ends or you stay for months or years. It is what is known as posttraumatic stress disorder.

Drug use: Amphetamines, ecstasy or LSD are narcotic substances that can cause anxiety. For some people, too, caffeine or teina can produce it.

Significant life experiences: without becoming traumatic, vital changes in the present as a pregnancy, or even alterations in the workplace (a dismissal, an ascent, etc.) can produce anxiety.
Anxiety manifests itself emotionally and physically. It is important to recognize both types of manifestations and to see the doctor as soon as they are detected, since a person with anxiety who experiences these symptoms may consider them as signs of a serious illness and, consequently, worsen in the disease.

Mental symptoms: constant worry, tiredness, irritability and problems concentrating and falling asleep.

Physical symptoms: high pulsations, excessive sweating, muscle tension, tremors, dizziness, fainting, indigestion, diarrhea and deep breathing.
Prevention
Anxiety is a normal feeling of fear in threatening or difficult situations. According to the Spanish Society of Psychiatry, it is estimated that 1 in 10 people suffer some episode of anxiety at some point in their life. Anxiety itself is not bad as it alerts us and motivates us to cope with the dangers. It becomes a problem when the episodes of anxiety are frequent, intense and appear for no apparent reason, limiting the person in their day to day.

To prevent anxiety, it is important to adopt a healthy lifestyle and to avoid the use of drugs and substances that cause it (caffeine, teina and drugs such as ecstasy, amphetamines or LSD).

Practicing physical exercise on a regular basis, especially outdoors, also helps to clear the mind and avoid anxious feelings.

Similarly, relaxation techniques help to combat the onset of crisis. They can be learned in the hands of professionals or in a self-taught way, through books and audiovisual material of self-help.

Types
Generalized anxiety disorder:
It is a chronic tension even when nothing seems to provoke it. This excessive worry or nervousness is almost daily and is diagnosed as such when it has a minimum duration of six months.

Panic Disorder (or Anxiety Attack):
The patient experiences recurrent bouts of anguish that arise spontaneously. It is an acute and extreme anxiety in which it is frequent that the person who suffers it believes that it is going to die. These sudden attacks of intense fear do not have a direct cause. Occasionally, patients who suffer from this disorder develop anxiety to experience the next attack, whose occurrence they can not anticipate, is the so-called anticipatory anxiety.

Phobic disorder:
Disorder that has as essential feature the presence of an irrational and persistent fear of a specific object, activity or situation with the consequent avoidance of the dreaded object. For example, the fear of flying, the birds or the open spaces.

Obsessive-compulsive disorder:
These are non-voluntary thoughts or actions that the patient can not stop thinking or do not generate anxiety. In any case, the subject recognizes the absurdity of his thoughts or actions. For example: wash your hands every few minutes.

Post-traumatic stress disorder:
It occurs in those cases where there are unpleasant psychological consequences after the impact of an emotional trauma, a war, a violation, etc. It is characterized by persistent memories of the traumatic event, an emotional state with exalted vigilance and the general reduction of interest in everyday events.

Diagnosis
Diagnostic criteria:
To assess whether a particular patient is suffering from anxiety, it is advisable to rule out the existence of a systemic disease. To do this, the doctor must take into account the following aspects:

Physical symptoms it presents.
Previous medical and psychological history of the patient and his / her family.
Possibility of suffering a disease that generates anxiety disorder.
Influence of toxins such as caffeine, cannabis or cocaine and other synthetic drugs, triggers anxiety crisis and distress in people with predisposition.
Semi-structured interview:
The clinical interview is the instrument par excellence to be able to establish a diagnosis of anxiety disorders and reach a global understanding of the patient. It must collect the necessary information to guide the diagnosis and is usually structured in four phases:

1. Preliminary stage: the objective is to know the reason for the consultation.

2. Exploratory phase: the patient is asked about the following:

Symptoms, location, intensity, chronology and evolution.
Presence of organic pathologies.
Direct triggers, such as vital changes, duels, traumatic events, and so on.
Personal history: manic episodes, previous depressions, etcetera.
Exploration of the psychosocial sphere: beliefs and expectations, thought, affectivity and socio-familial environment, personality, ...
3. Resolving phase: the problems are summarized, the patient is informed of the nature of the problem and their involvement in the elaboration of a diagnostic-therapeutic plan is requested.

4. Final phase: the doctor offers the patient a series of recommendations that he should begin to implement until the next appointment.

Scales:
The risk of underdiagnosis of anxiety has resulted in a large number of structured scales attempting to be screening instruments to detect the disorder. These scales are not sufficient in themselves to establish a diagnosis, but allow for the identification of persons susceptible to mental pathology, who must be subjected to a deeper study. Some of the most used scales are the Goldberg Anxiety and Depression Scale and the Hamilton Anxiety Scale.

Treatments
Drugs are the treatment of choice for generalized anxiety. Anxiolytic drugs such as benzodiazepines are usually prescribed; However, because long-term use of benzodiazepines may create dependence, if discontinuation is decided, it should be reduced stepwise rather than abruptly. The relief provided by benzodiazepines usually compensates for some minor side effects.

Buspirone is another effective drug for many people with generalized anxiety. Its use does not seem to entail physical dependence. However, buspirone may take two weeks or longer to work, in contrast to benzodiazepines, which begin to work within a few minutes. Behavioral therapy is usually not generally beneficial because there are no clear situations that trigger anxiety. Relaxation and biofeedback techniques can help.

Generalized anxiety may be associated with underlying psychological conflicts. These conflicts are often related to insecurities and self-destructive attitudes that are self-destructive. For some people, psychotherapy can be effective in helping to understand and resolve internal psychological conflicts.

Other data
Frequency of disease:
Anxiety disorders are, as a whole, the most frequent psychiatric illness. Among them, phobic disorder stands out: around 7 per cent of women and 4.3 per cent of men suffer from specific phobias (to an animal, to an object, to the darkness, etc.), while the so-called social phobias The ability of a person to interact in a friendly way with others) are found in 13 percent of the population.

Generalized anxiety occurs in a percentage of 3 to 5 percent of adults (at some point during the year). Women are twice as likely to have it.

Panic disorder is less common and is diagnosed in less than 1 percent of the population. Women are two to three times more likely.

Obsessive-compulsive disorder affects about 2.3 percent of adults and occurs with about the same frequency in women as in men.

Post-traumatic stress affects at least 1 percent of the population at some time


Contact your doctor for more information. The information provided on (what the health) is of a general nature and for purely disclosure purposes can in no way replace the advice of a physician (or a legally qualified person) or, in specific cases, of other operators health.


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