GUÍA DE CLASES

INGLÉS BÁSICO III

2017 – II

Lic. Geraldina Vallejos Torres

Lic. Vivian Morales Sanchez
Mgtr. Marita Quispe Cisneros
Lic. Erika Matsusita Manabe

LIMA – PERU

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Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita
Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita
 Session 2 & 3

OSTEOPOROSIS

Osteoporosis, which means "porous bones," causes bones to become weak and
brittle — so brittle that even mild stresses like bending over, lifting a vacuum
cleaner or coughing can cause a fracture. In most cases, bones weaken when you
have low levels of calcium, phosphorus and other minerals in your bones.
A common result of osteoporosis is fractures — most of them in the spine, hip or
wrist. Although it's often thought of as a women's disease, osteoporosis also affects
many men. And aside from people who have osteoporosis, many more have low
bone density.

In the early stages of bone loss, you usually have no pain or other symptoms. But
once bones have been weakened by osteoporosis, you may have osteoporosis
symptoms that include:
 Back pain, which can be severe if you have a fractured or collapsed vertebra
 Loss of height over time, with an accompanying stooped posture
 Fracture of the vertebrae, wrists, hips or other bones

The strength of your bones depends on their size and density; bone density
depends in part on the amount of calcium, phosphorus and other minerals bones
contain. When your bones contain fewer minerals than normal, they're less strong
and eventually lose their internal supporting structure.
Scientists have yet to learn all the reasons why this occurs, but the process
involves how bone is made. Bone is continuously changing — new bone is made
and old bone is broken down — a process called remodeling, or bone turnover.
A full cycle of bone remodeling takes about two to three months. When you're
young, your body makes new bone faster than it breaks down old bone, and your
bone mass increases. You reach your peak bone mass in your mid-30s. After that,
bone remodeling continues, but you lose slightly more than you gain. At
menopause, when estrogen levels drop, bone loss in women increases dramatically.
Although many factors contribute to bone loss, the leading cause in women is
decreased estrogen production during menopause.
Your risk of developing osteoporosis depends on how much bone mass you attained
between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The
higher your peak bone mass, the more bone you have "in the bank" and the less
likely you are to develop osteoporosis as you age. Not getting enough vitamin D
and calcium in your diet may lead to a lower peak bone mass and accelerated bone
loss later.

Three factors that you can influence are essential for keeping your bones healthy
throughout your life:
 Regular exercise
 Adequate amounts of calcium

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 Adequate amounts of vitamin D, which is essential for absorbing calcium
A number of factors can increase the likelihood that you'll develop osteoporosis,
including:

 Your sex. Fractures from osteoporosis are about twice as common in women as
they are in men. That's because women start out with lower bone mass and tend
to live longer. They also experience a sudden drop in estrogen at menopause that
accelerates bone loss. Slender, small-framed women are particularly at risk. Men
who have low levels of the male hormone testosterone also are at increased risk.
The risk of osteoporosis in men is greatest from age 75 on.
 Age. The older you get, the higher your risk of osteoporosis. Your bones become
weaker as you age.
 Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian
descent. Black and Hispanic men and women have a lower, but still significant,
risk.
 Family history. Osteoporosis runs in families. For that reason, having a parent
or sibling with osteoporosis puts you at greater risk, especially if you also have a
family history of fractures.
 Frame size. Men and women who are exceptionally thin or have small body
frames tend to have higher risk because they may have less bone mass to draw
from as they age.
 Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly
understood, but researchers do know that tobacco use contributes to weak
bones.
 Lifetime exposure to estrogen. The greater a woman's lifetime exposure to
estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if
you have a late menopause or you began menstruating at an earlier than
average age. But your risk of osteoporosis is increased if your lifetime exposure
to estrogen has been deficient, such as from infrequent menstrual periods or
menopause before age 45.
 Eating disorders. Women and men with anorexia nervosa or bulimia are at
higher risk of lower bone density in their lower backs and hips.
 Corticosteroid medications. Long-term use of corticosteroid medications, such
as prednisone, cortisone, etc., is damaging to bone. These medications are
common treatments for chronic conditions, such as asthma, rheumatoid arthritis
and psoriasis. If you need to take a steroid medication for long periods, your
doctor should monitor your bone density and recommend other drugs to help
prevent bone loss.
 Thyroid hormone. Too much thyroid hormone also can cause bone loss. This
can occur either because your thyroid is overactive (hyperthyroidism) or because
you take excess amounts of thyroid hormone medication to treat an underactive
thyroid (hypothyroidism).
 Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007
showed lower bone mineral density among both men and women currently using
SSRIs compared with study participants not taking these antidepressants. More

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 research is needed to fully understand the association between SSRI use and low
bone density.
 Other medications. Long-term use of the blood-thinning medication heparin,
the cancer treatment drug methotrexate, some anti-seizure medications,
diuretics and aluminum-containing antacids also can cause bone loss.
 Breast cancer. Postmenopausal women who have had breast cancer are at
increased risk of osteoporosis, especially if they were treated with chemotherapy
or aromatase inhibitors such as anastrozole and letrozole, which suppress
estrogen.
 Low calcium intake. A lifelong lack of calcium plays a major role in the
development of osteoporosis. Low calcium intake contributes to poor bone
density, early bone loss and an increased risk of fractures.
 Medical conditions and procedures that decrease calcium absorption.
Stomach surgery (gastrectomy) can affect your body's ability to absorb calcium.
So can conditions such as Crohn's disease, celiac disease, vitamin D deficiency,
anorexia nervosa and Cushing's disease — a rare disorder in which your adrenal
glands produce excessive corticosteroid hormones.
 Sedentary lifestyle. Bone health begins in childhood. Children who are
physically active and consume adequate amounts of calcium-containing foods
have the greatest bone density. Any weight-bearing exercise is beneficial, but
jumping and hopping seem particularly helpful for creating healthy bones.
Exercise throughout life is important, but you can increase your bone density at
any age.
 Excess soda consumption. The link between osteoporosis and caffeinated
sodas isn't clear, but caffeine may interfere with calcium absorption and its
diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda
may contribute to bone loss by changing the acid balance in your blood. If you do
drink caffeinated soda, be sure to get adequate calcium and vitamin D from other
sources in your diet or from supplements.
 Chronic alcoholism. For men, alcoholism is one of the leading risk factors for
osteoporosis. Excess consumption of alcohol reduces bone formation and
interferes with the body's ability to absorb calcium.
 Depression. People who experience serious depression have increased rates of
bone loss.

Osteopenia refers to mild bone loss that isn't severe enough to be called
osteoporosis, but that increases your risk of osteoporosis. Doctors can detect
osteopenia or early signs of osteoporosis using a variety of devices to measure
bone density.
The best screening test is dual energy X-ray absorptiometry (DEXA). This
procedure is quick, simple and gives accurate results. It measures the density of
bones in your spine, hip and wrist — the areas most likely to be affected by
osteoporosis — and it's used to accurately follow changes in these bones over time.
Other tests that can accurately measure bone density include:
 Ultrasound
 Quantitative computerized tomography (CT) scanning

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If you're a woman, the National Osteoporosis Foundation in USA recommends that
you have a bone density test if you aren't taking estrogen and any of the following
conditions apply to you:
 You're older than age 65, regardless of risk factors.
 You're postmenopausal and have at least one risk factor for osteoporosis,
including having fractured a bone.
 You have a vertebral abnormality.
 You use medications, such as prednisone, that can cause osteoporosis.
 You have type 1 diabetes, liver disease, kidney disease, thyroid disease or a
family history of osteoporosis.
 You experienced early menopause.
Doctors don't generally recommend osteoporosis screening for men because the
disease is less common in men than it is in women.
Fractures are the most frequent and serious complication of osteoporosis. They
often occur in your spine or hips — bones that directly support your weight. Hip
fractures usually result from a fall. Although most people do relatively well with
modern surgical treatment, hip fractures can result in disability and even death
from postoperative complications, especially in older adults. Wrist fractures from
falls also are common.
In some cases, spinal fractures can occur without any fall or injury simply because
the bones in your back (vertebrae) become so weakened that they begin to
compress. Compression fractures can cause severe pain and require a long
recovery. If you have many such fractures, you can lose several inches of height as
your posture becomes stooped.

Getting adequate calcium and vitamin D is an important factor in reducing your risk
of osteoporosis. If you already have osteoporosis, getting adequate calcium and
vitamin D, as well as taking other measures, can help prevent your bones from
becoming weaker. In some cases you may even be able to replace bone you've
lost.
The amount of calcium you need to stay healthy changes over your lifetime. Your
body's demand for calcium is greatest during childhood and adolescence, when
your skeleton is growing rapidly, and during pregnancy and breast-feeding.
Postmenopausal women and older men also need to consume more calcium. As you
age, your body becomes less efficient at absorbing calcium, and you're more likely
to take medications that interfere with calcium absorption.

Premenopausal women and postmenopausal women who use HT should consume at

least 1,000 milligrams (mg) of elemental calcium and a minimum of 800
international units (IU) of vitamin D every day. Postmenopausal women not using
HT, anyone at risk of steroid-induced osteoporosis, and all men and women older
than 65 should aim for 1,500 mg of elemental calcium and at least 800 IU of
vitamin D daily.

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 Getting enough vitamin D is just as important as getting adequate amounts of
calcium. Not only does vitamin D improve bone health by helping calcium
absorption, but it also may improve muscle strength.
These measures also may help you prevent bone loss:
 Exercise. Exercise can help you build strong bones and slow bone loss. Exercise
will benefit your bones no matter when you start, but you'll gain the most
benefits if you start exercising regularly when you're young and continue to
exercise throughout your life. Combine strength training exercises with weight-
bearing exercises. Strength training helps strengthen muscles and bones in your
arms and upper spine, and weight-bearing exercises — such as walking, jogging,
running, stair climbing, skipping rope, skiing and impact-producing sports —
mainly affect the bones in your legs, hips and lower spine.
 Add soy to your diet. The plant estrogens found in soy help maintain bone
density and may reduce the risk of fractures.
 Don't smoke. Smoking increases bone loss, perhaps by decreasing the amount
of estrogen a woman's body makes and by reducing the absorption of calcium in
your intestine.
 Consider hormone therapy. Hormone therapy can reduce a woman's risk of
osteoporosis during and after menopause. But because of the risk of side effects,
discuss the options with your doctor and decide what's best for you. Testosterone
replacement therapy works only for men with osteoporosis caused by low
testosterone levels. Taking it when you have normal testosterone levels won't
increase bone mass.
 Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may
decrease bone formation and reduce your body's ability to absorb calcium.
There's no clear link between moderate alcohol intake and osteoporosis.
 Limit caffeine. Moderate caffeine consumption — about two to three cups of
coffee a day — won't harm you as long as your diet contains adequate calcium.

Brittle Bone Disease (Osteogenesis Imperfecta)

Brittle bone disease is a disorder that results in fragile bones that break easily. It’s
typically present at birth, but it only develops in children who have a family history of
the disease.

The disease is often referred to as osteogenesis imperfecta (OI), which means

“imperfectly formed bone.”

Brittle bone disease can range from mild to severe. Most cases are mild, resulting in
few bone fractures. However, the severe forms of the disease can cause:

 hearing loss
 heart failure
 spinal cord problems

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  permanent deformities
Causes

Brittle bone disease is caused by a defect, or flaw, in the gene that produces type 1
collagen, a protein used to create bone. The defective gene is usually inherited. In
some cases, however, a genetic mutation, or change, can cause it.

What Are the Types of Brittle Bone Disease?

Four different genes are responsible for collagen production. Some or all of these
genes can be affected in people with OI. Defective genes can produce eight types of
brittle bone disease, labeled as type 1 OI through type 8 OI. The first four types are the
most common. The last four are extremely rare, and most are subtypes of type 4 OI.
Here are the four main types of OI:

Type 1 OI is the mildest and most common form of brittle bone disease. In this type of
brittle bone disease, your body produces quality collagen but not enough of it. This
results in mildly fragile bones. Children with type 1 OI typically have bone fractures due
to mild traumas. Such bone fractures are much less common in adults. The teeth may
also be affected, resulting in dental cracks and cavities.

Type 2 OI is the most severe form of brittle bone disease, and it can be life-
threatening. In type 2 OI, your body either doesn’t produce enough collagen or
produces collagen that’s poor quality. Type 2 OI can cause bone deformities. If your
child is born with type 2 OI, they may have a narrowed chest, broken or misshapen
ribs, or underdeveloped lungs. Babies with type 2 OI can die in the womb or shortly
after birth.

Type 3 OI is also a severe form of brittle bone disease. It causes bones to break easily.
In type 3 OI, your child’s body produces enough collagen but it’s poor quality. Your
child’s bones can even begin to break before birth. Bone deformities are common and
may get worse as your child gets older.

Type 4 OI is the most variable form of brittle bone disease because its symptoms range
from mild to severe. As with type 3 OI, your body produces enough collagen but the
quality is poor. Children with type 4 OI are typically born with bowed legs, although
the bowing tends to lessen with age.

What Are the Symptoms of Brittle Bone Disease?

Symptoms

The symptoms of brittle bone disease differ according to the type of the disease.
Everyone with brittle bone disease has fragile bones, but the severity varies from
person to person. Brittle bone disease has one or more of the following symptoms:

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

  bone deformities  kyphosis, or an abnormal
 multiple broken bones outward curve of the upper
 loose joints spine
 weak teeth  scoliosis, or an abnormal lateral
 blue sclera, or a bluish color in curve of the spine
the white of the eye  early hearing loss
 bowed legs and arms  respiratory problems
 heart defects

Diagnosis

Your doctor can diagnose brittle bone disease by taking X-rays. X-rays allow your
doctor to see current and past broken bones. They also make it easier to view defects
in the bones. Lab tests may be used to analyze the structure of your child’s collagen. In
some cases, your doctor may want to do a skin punch biopsy. During this biopsy, the
doctor will use a sharp, hollow tube to remove a small sample of your tissue. Genetic
testing can be done to trace the source of any defective genes.

Treatment

There’s no cure for brittle bone disease. However, there are supportive therapies that
help reduce your child’s risk of broken bones and increase their quality of life.
Treatments for brittle bone disease include:

 physical and occupational therapy to increase your child’s mobility and muscle
strength
 bisphosphonate medications to strengthen your child’s bones
 medicine to reduce any pain
 low-impact exercise to help build bone
 surgery to place rods in your child’s bones
 reconstructive surgery to correct bone deformities
 mental health counseling to help treat issues with body image

Electronic references

 Kivi R., Ronald M. (2015), Brittle Bone Disease, Healthline Media. Retrieved on
June 8th. 2016 Available on: http://www.healthline.com/health/osteogenesis-
imperfecta#Overview1
 Meng H., Meng A. (n.d), Skeletal System, Interactive Science Worksheets.
Retrieved on June 8th. 2016 Available on:
http://www.vtaide.com/png/skeletal-mcq.htm

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

Posterior view

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Frontal view

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 Session 4

GALLSTONES

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your
gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your
liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people
develop just one gallstone, while others develop many gallstones at the same time.

People who experience symptoms from their gallstones usually require gallbladder removal
surgery. Gallstones that don't cause any signs and symptoms typically don't need treatment. If
a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as:

 Sudden and rapidly intensifying pain in the upper right portion of your abdomen
 Sudden and rapidly intensifying pain in the center of your abdomen, just below your
breastbone
 Back pain between your shoulder blades
 Pain in your right shoulder
 Yellowing of your skin and the whites of your eyes

I's not clear what causes gallstones to form. Doctors think gallstones may result when:

 Your bile contains too much cholesterol. Normally, your bile contains enough
chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes
more cholesterol than your bile can dissolve, the excess cholesterol may form into
crystals and eventually into stones.
 Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when
your body breaks down red blood cells. Certain conditions cause your liver to make too
much bilirubin, including liver cirrhosis, biliary tract infections and certain blood
disorders. The excess bilirubin contributes to gallstone formation.
 Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely
or often enough, bile may become very concentrated and this contributes to the
formation of gallstones.

Types of gallstones that can form in the gallbladder include:

 Cholesterol gallstones. It is the most common type of gallstone often appears yellow in
color. These gallstones are composed mainly of undissolved cholesterol, but may
contain other components.
 Pigment gallstones. These dark brown or black stones form when your bile contains
too much bilirubin.

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Complications of gallstones may include:

 Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the
gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can
cause severe pain and fever.
 Blockage of the common bile duct. Gallstones can block the tubes (ducts) through
which bile flows from your gallbladder or liver to your small intestine. Jaundice and
bile duct infection can result.
 Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the
pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow
through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct,
which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes
intense, constant abdominal pain and usually requires hospitalization.
 Gallbladder cancer. People with a history of gallstones have an increased risk of
gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of
cancer is elevated, the likelihood of gallbladder cancer is still very small.

Small Bowel Obstruction

What is Small Bowel Obstruction?

From the moment you swallow food until you release the remains of your meal in a bowel
movement, the entire digestive tract performs an amazing feat of moving the food through the
organs by way of a special set of muscles that contract and expand. In fact, the sound you hear
when your stomach growls is a result of the contractions that are going on as you digest food.
Small bowel obstruction is a potentially dangerous condition. There are a number of conditions
in which the contractions of the bowel muscles make the process of moving the food very
slow. These can be annoying and impact the quality of life.
There are two types of small bowel obstruction:

 Functional — there is no physical blockage, however, the bowels are not moving food
through the digestive tract
 Mechanical — there is a blockage preventing the movement of food.
Functional causes may include:

 Muscle or nerve damage that may be the result of abdominal surgery, or disorders
such as Parkinson's disease
 Infections
 Certain medications that paralyze the contractions. Strong narcotics have this effect.
There are also serious conditions which may require immediate intervention:

 Hernias — probably the most common condition in children and adults, in which a
small part of the intestine protrudes through another part of the body. Adhesions may
also be a cause. Scar tissue can form that blocks the intestinal canal.
 Inflammatory Bowel Disease — a condition in which the walls of the intestine become
inflamed
 Tumors in the intestine that impede the flow
 A volvulus, or a twisting of the intestine
 Intussusception, a condition in which a segment of the intestine collapses into itself

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Symptoms of Small Bowel Obstruction

 intermittent pain due to peristalsis

 distension of the stomach depending on where the obstruction is located
 vomiting
 constipation
 fever and a racing heart

Why you need to see a physician if you suspect you have a small bowel obstruction?

If a part of the intestine becomes twisted, blood flow to that portion may be reduced, and the
blocked part may die. This is a very serious condition. Another serious condition can occur in
which the intestine ruptures, leaking contents into the bowel cavity. This causes an infection
known as peritonitis.
Your doctor may ask you these questions about your condition:

 How long have you been experiencing this problem

 Have you had this condition before? Did it clear up?
 Did the pain arise quickly?
 Is the pain constant?
 Have you ever had surgery in the abdominal area?

Diagnosis of Small Bowel Obstruction

 Usually all that is required to diagnose an obstruction of the small bowel is an x-ray of
the abdomen.
 Luminal contrast studies
 computed tomography (CT scan)
 ultrasonography (US)
Once the diagnosis of bowel obstruction is entertained, location, severity and etiology are to
be determined. Most importantly is the differentiation between simple and complicated
obstruction.

Treatment of Small Bowel Obstruction

 Antiemetics are medications that keep you from throwing up

 Analgesics are mild pain relievers
 Antibiotics will attack any infection you may have
 Bowel decompression is a procedure in which a tube is guided into the impacted area
in an attempt to reduce the pressure and address adhesions.
 Surgery
Reference:

 Medical University of South Carolina, Small Bowel Obstruction, retrieved on June 8th.
2016 Available on: http://www.ddc.musc.edu/public/diseases/small-intestine/small-
bowel-obstruction.html
 Meng H. &A. (n.d), Skeletal System, Interactive Science Worksheets. Retrieved on June
8th. 2016 available on http://www.vtaide.com/png/digest-mcq.htm

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

 Session 5

ASTHMA

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This
can make breathing difficult and trigger coughing, wheezing and shortness of breath. For
some people, asthma is a minor nuisance. For others, it can be a major problem that interferes
with daily activities and may lead to a life-threatening asthma attack.

Asthma can't be cured, but its symptoms can be controlled. Because asthma often changes
over time, it's important that you work with your doctor to track your signs and symptoms and
adjust treatment as needed.

If you have asthma, the inside walls of the airways in your lungs can become inflamed and
swollen. In addition, membranes in your airway linings may secrete excess mucus. The result is
an asthma attack. During an asthma attack, your narrowed airways make it harder to breathe
and you may cough and wheeze. Asthma symptoms range from minor to severe and vary from
person to person.

Asthma signs and symptoms include:

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

  Shortness of breath
 Chest tightness or pain
 Trouble sleeping caused by shortness of breath, coughing or wheezing
 A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in
children)
 Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold
or the flu

For some people, asthma symptoms flare up in certain situations:

 Exercise-induced asthma, which may be worse when the air is cold and dry
 Occupational asthma, triggered by workplace irritants such as chemical fumes, gases
or dust
 Allergy-induced asthma, triggered by particular allergens, such as pet dander,
cockroaches or pollen

It isn't clear why some people get asthma and others don't, but it's probably due to a
combination of environmental and genetic (inherited) factors.

Asthma triggers

Exposure to various substances that trigger allergies (allergens) and irritants can trigger signs
and symptoms of asthma. Asthma triggers are different from person to person and can
include:

 Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
 Respiratory infections, such as the common cold
 Physical activity (exercise-induced asthma)
 Cold air
 Air pollutants and irritants, such as smoke
 Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB,
others) and naproxen (Aleve)
 Strong emotions and stress
 Sulfites and preservatives added to some types of foods and beverages, including
shrimp, dried fruit, processed potatoes, beer and wine
 Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up
into your throat
 Menstrual cycle in some women

You may also be given lung (pulmonary) function tests to determine how much air moves in
and out as you breathe. These tests may include:

 Spirometry. This test estimates the narrowing of your bronchial tubes by checking how
much air you can exhale after a deep breath and how fast you can breathe out.
 Peak flow. A peak flow meter is a simple device that measures how hard you can
breathe out. Lower than usual peak flow readings are a sign your lungs may not be
working as well and that your asthma may be getting worse. Your doctor will give you
instructions on how to track and deal with low peak flow readings.

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Lung function tests often are done before and after taking a bronchodilator (brong-koh-DIE-
lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a
bronchodilator, it's likely you have asthma.

Other tests to diagnose asthma include:

 Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled,

will cause mild constriction of your airways. If you react to the methacholine, you likely
have asthma. This test may be used even if your initial lung function test is normal.
 Nitric oxide test. This test, though not widely available, measures the amount of the
gas, nitric oxide, that you have in your breath. When your airways are inflamed — a
sign of asthma — you may have higher than normal nitric oxide levels.
 Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan
of your lungs and nose cavities (sinuses) can identify any structural abnormalities or
diseases (such as infection) that can cause or aggravate breathing problems.
 Allergy testing. This can be performed by skin test or blood test. Allergy tests can
identify allergy to pets, dust, mold and pollen. If important allergy triggers are
identified, this can lead to a recommendation for allergen immunotherapy.
 Provocative testing for exercise and cold-induced asthma. In these tests, your doctor
measures your airway obstruction before and after you perform vigorous physical
activity or take several breaths of cold air.

Prevention and long-term control are key in stopping asthma attacks before they start.
Treatment usually involves learning to recognize your triggers, taking steps to avoid them and
tracking your breathing to make sure your daily asthma medications are keeping symptoms
under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such
as albuterol.

Medications

The right medications for you depend on a number of things, including your age, your
symptoms, your asthma triggers and what seems to work best to keep your asthma under
control.

Preventive, long-term control medications reduce the inflammation in your airways that leads
to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are
limiting breathing. In some cases, allergy medications are necessary.

Long-term asthma control medications, generally taken daily, are the cornerstone of asthma
treatment. These medications keep asthma under control on a day-to-day basis and make it
less likely you'll have an asthma attack. Types of long-term control medications include:

 Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flovent

HFA), budesonide (Pulmicort Flexhaler), flunisolide (Aerobid), ciclesonide (Alvesco),
beclomethasone (Qvar) and mometasone (Asmanex).

You may need to use these medications for several days to weeks before they reach their
maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a
relatively low risk of side effects and are generally safe for long-term use.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

  Long-acting beta agonists. These inhaled medications, which include salmeterol
(Serevent) and formoterol (Foradil, Perforomist), open the airways. Some research
shows that they may increase the risk of a severe asthma attack, so take them only
in combination with an inhaled corticosteroid. And because these drugs can mask
asthma deterioration, don't use them for an acute asthma attack.
 Combination inhalers. These medications — such as fluticasone-salmeterol (Advair
Diskus), budesonide-formoterol (Symbicort) and mometasone-formoterol (Dulera)
— contain a long-acting beta agonist along with a corticosteroid. Because these
combination inhalers contain long-acting beta agonists, they may increase your risk
of having a severe asthma attack.

Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief
during an asthma attack — or before exercise if your doctor recommends it. Types of quick-
relief medications include:

 Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within

minutes to rapidly ease symptoms during an asthma attack. They include albuterol
(ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex) and pirbuterol (Maxair).
Short-acting beta agonists can be taken using a portable, hand-held inhaler or a
nebulizer — a machine that converts asthma medications to a fine mist — so that they
can be inhaled through a face mask or a mouthpiece.
 Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to
immediately relax your airways, making it easier to breathe. Ipratropium is mostly
used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma
attacks.
 Oral and intravenous corticosteroids. These medications — which include prednisone
and methylprednisolone — relieve airway inflammation caused by severe asthma.
They can cause serious side effects when used long term, so they're used only on a
short-term basis to treat severe asthma symptoms.

If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if
your long-term control medications are working properly, you shouldn't need to use your
quick-relief inhaler very often.
Keep a record of how many puffs you use each week. If you need to use your quick-relief
inhaler more often than your doctor recommends, see your doctor. You probably need to
adjust your long-term control medication.
Allergy medications may help if your asthma is triggered or worsened by allergies. These
include:

 Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your
immune system reaction to specific allergens. You generally receive shots once a week
for a few months, then once a month for a period of three to five years.
 Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is
specifically for people who have allergies and severe asthma. It acts by altering the
immune system.
 Allergy medications. oral and nasal spray antihistamines and decongestants as well as
corticosteroid and cromolyn nasal sprays.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

 Session 6

URINARY TRACT INFECTION (UTI)

The "urinary tract" consists of the various organs of the body that produce, store, and get rid
of urine. These include the kidneys, the ureters, the bladder, and the urethra.

Our kidneys are chemical filters for our blood. About one-quarter of the blood pumped by the
heart goes through the kidneys. The kidneys filter this blood, and the "filtrate" is processed to
separate out waste products and excess amounts of minerals, sugar, and other chemicals.
Since it sees so much of the body's blood flow, the kidneys also contain pressure-sensitive
tissue which helps the body control blood pressure, and some of the minerals and water are
saved or discarded partly to keep your blood pressure in the proper range.

The waste products and "extras" make up the urine, which flows through "ureters" (one per
kidney) into the bladder, where it is held until you are ready to get rid of it. When you urinate,
muscles in the bladder wall help push urine out of the bladder, through the urethra, and out.
(In men, the urethra passes through the penis; in women, the urethra opens just in front of the
vagina). When you aren't urinating (which is most of the time) a muscle called the "sphincter"
squeezes the urethra shut to keep urine in; the sphincter relaxes when you urinate so that
urine can flow out easily.

Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter the
opening of the urethra and multiply in the urinary tract. The urinary tract includes the kidneys,
the tubes that carry urine from the kidneys to the bladder (ureters), bladder, and the tube that
carries urine from the bladder (urethra).
Urinary tract infections are also known as uncomplicated cystitis and the problem mainly
affects women. About one in five women will experience a urinary tract infection.

Infections can be caused by bacteria which get into the bladder via the urethra (small tube
leading from the bladder). Sexual intercourse may be a trigger to this happening. This is more
likely if sex has been vigorous or if lubrication is not good.In older, post-menopausal women,
factors favoring urine infection relate more to changes involving the effects of less estrogen on
the tissues around the bladder and vagina.It is believed women's genitals are more sensitive to
infections because the urethra, vagina and anus are placed close together, making it easier for
bacteria to infect the urethra. The urethra is also much shorter in women than in men.

Sometimes underlying problems such as kidney stones or kidney abnormalities may lead to
urine infections. Sometimes further tests are done to check for this, particularly if infections
are recurring often.

Pregnant women, people with diabetes and weak immune systems are also more at risk of
infection.

Pain while urinating and a frequent urge to urinate are the main symptoms of a urinary tract
infection. There may be a burning or scalding sensation when going to the toilet, passing only a
small amount of urine, or not be able to go at all. You may feel the need to go again after
having just been to the toilet. The urine may look cloudy. There may also be blood in the urine
and an ache above the pelvic bone.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

The main complication of a bladder infection is that it can spread to the kidneys. A fever, rigors
(shaking and shivering), and pain on the loin area (back of the abdomen), may mean the
infection has reached the kidneys.

Children with an infection may have a change in their toileting, experience incontinence, loose
bowel movements, and have a fever. Children need a different approach to investigating
urinary infection, as underlying abnormalities need to be excluded. Men with an infection
often have a kidney stone, or an enlarged prostate gland. Men are usually investigated after a
urinary infection to make sure there is no underlying problem.

Laboratory tests of urine can confirm an infection. Inflammatory cells (white cells) are present
in the urine and a culture of the urine usually shows which bacteria are present and which
antibiotic they are sensitive to. A follow up test may be required in some cases.

In general, the farther the organ in the urinary tract from the place where the bacteria enter,
the less likely the organ is to be infected.

 Urethritis. This can be due to other things besides the organisms usually involved in
UTI's; in particular, many sexually-transmitted diseases (STD's) appear initially as urethritis.
However, stool-related bacteria (the most common bacteria on the skin near the meatus) will
also often cause urethritis.
 Cystitis. This is the most common form of UTI; it can be aggravated if the bladder does
not empty completely when you urinate. (Some people have valves at the bladder end of the
urethra as well as at the bladder ends of the ureters. You aren't supposed to have urethral
valves except for the sphincter; these "extra" valves usually prevent complete bladder
emptying and make cystitis more likely).
 Ureteritis. This can occur if the bacteria entered the urinary tract from above, or if the
ureter-to-bladder valves don't work properly and allow urine to "reflux" from the bladder into
the ureters.
 Pyelonephritis. This can happen with infection from above, or if reflux into the ureters
is so bad that infected urine refluxes all the way to the kidney.

The condition can be prevented in some cases by following this advice:

 Dab instead of wiping the genitals after urinating

 Do not use feminine hygiene products
 Avoid tight fitting garments like pantyhose. Wear cotton underwear.
 Wash your genitals with just water or mild soap
 Avoid products that may irritate the urethra (e.g., bubble bath, scented feminine
products).
 Cleanse the genital area before sexual intercourse.
 Change soiled diapers in infants and toddlers promptly.
 Drink plenty of water to remove bacteria from the urinary tract.
 Do not routinely resist the urge to urinate.
 Take showers instead of baths.
 Urinate after sexual intercourse. and drink water after having sex
 Women and girls should wipe from front to back after voiding to prevent contaminating
the urethra with bacteria from the anal area.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

 Urinary Tract Infection in Children
By Geoffrey A. Weinberg, MD

A urinary tract infection is a bacterial infection of the urinary bladder (cystitis) or the kidneys
(pyelonephritis).

 Urinary tract infections are caused by a bacterial infection.

 Newborns and infants may have no symptoms other than a fever, whereas older
children have pain or burning during urination, pain in the bladder region, and a need to
urinate frequently.
 The diagnosis is based on an examination of the urine.
 Proper hygiene may help prevent UTIs.
 Antibiotics are given to eliminate the infection.

Urinary tract infections (UTIs) are common in childhood. Nearly all UTIs are caused by bacteria
that enter the urethral opening and move upward to the urinary bladder and sometimes the
kidneys. Rarely, in severe infections, bacteria may enter the bloodstream from the kidneys and
cause infection of the bloodstream (sepsis) or of other organs.

During infancy, boys are more likely to develop UTIs. After infancy, girls are much more likely
to develop them. UTIs are more common among girls because their short urethras make it
easier for bacteria to move up the urinary tract. Uncircumcised infant boys (because bacteria
tend to accumulate under the foreskin) and young children with severe constipation also are
more prone to UTIs.

UTIs in older school-aged children and adolescents differ little from UTIs in adults. Younger
infants and children who have UTIs, however, more commonly have various structural
abnormalities of their urinary system that make them more susceptible to urinary infection.
These abnormalities include vesicoureteral reflux (an abnormality of the ureters—the tubes
connecting the kidneys to the bladder—that allows urine to pass backward from the bladder
up to the kidney) and a number of conditions that block the flow of urine. As many as 50% of
newborns and infants with a UTI and 20 to 30% of school-aged children with a UTI have such
abnormalities.

Up to 50% of infants and preschool children with a UTI—particularly those with fever—have
both bladder and kidney infections. If the kidney is infected and reflux is severe, 5 to 20% of
children go on to have some scarring of the kidneys. If there is little or no reflux, very few
children have scarring of the kidneys. Scarring is a concern because it may lead to high blood
pressure and impaired kidney function in adulthood.

Symptoms and Diagnosis

Newborns and infants with a UTI may have no symptoms other than a fever. Sometimes they
do not eat well, are sluggish (lethargic), vomit, or have diarrhea. Older children with bladder
infections usually have pain or burning during urination, a need to urinate frequently and
urgently, and pain in the bladder region. They may have difficulty urinating or holding urine
(incontinence). Urine may smell foul. Children with kidney infections typically have pain in the
side or back over the affected kidney, fever, chills, and a general feeling of illness (malaise).

A doctor diagnoses a UTI by examining the urine. Toilet-trained children may provide a urine
sample by urinating into a cup after thoroughly cleaning the urethral opening. Doctors obtain
urine from younger children and infants by inserting a thin, flexible, sterile tube (catheter)

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

through the urethral opening into the bladder. In infants, the doctor sometimes withdraws
urine from the bladder with a needle inserted through the skin just above the pubic bone.
Urine collected in plastic bags taped to the child's genital region is not helpful because it is
often contaminated with bacteria and other material from the skin.

To detect white blood cells and bacteria in the urine, which occur in UTI, the laboratory
examines the urine under a microscope and performs several chemical tests. The laboratory
also performs a culture of the urine to grow and identify any bacteria present. The culture is
the most significant of these tests.

In general, boys of all ages and girls younger than 2 years who develop even a single UTI need
further tests to look for structural abnormalities of the urinary system. Older girls who have
had recurring infections also need these tests. The tests include ultrasonography, which
identifies kidney abnormalities and obstruction, and voiding cystourethrography, which further
identifies abnormalities of the kidneys, ureters, and bladder and can identify when the flow of
urine is partially reversed (reflux). For voiding cystourethrography, a catheter is passed
through the urethra into the bladder, a dye is instilled through the catheter, and x-rays are
taken before and after the child urinates. Another test, radionuclide cystourethrography, is
similar to voiding cystourethrography, except that a radioactive agent is placed in the bladder
and images are taken using a nuclear scanner. This procedure exposes the child's ovaries or
testes to less radiation than voiding cystourethrography. However, radionuclide
cystourethrography is much more useful for monitoring the healing of reflux than for
diagnosing it, because the structures are not outlined as well as in voiding cystourethrography.
Another type of nuclear scanning may be used to confirm the diagnosis of pyelonephritis and
identify scarring of the kidneys.

Prevention and Treatment

Prevention of UTIs is difficult, but proper hygiene may help. Girls should be taught to wipe
themselves from front to back (as opposed to back to front) after a bowel movement to
minimize the chance of bacteria entering the urethral opening. Avoiding frequent bubble
baths, which may irritate the skin around the urethral opening of both boys and girls, may help
lessen the risk of UTIs. Circumcision of boys lowers their risk of UTIs during infancy by about 10
times, although it is not clear whether this advantage by itself is a sufficient reason for
circumcision. Regular urination and regular bowel movements may lessen the risk of UTIs.

UTIs are treated with antibiotics. Children who appear very ill or whose initial test results
suggest a UTI are given antibiotics before culture results are available. Otherwise, doctors wait
for culture results to confirm the diagnosis. Children who are very ill and all newborns receive
antibiotics by injection into either a muscle (intramuscularly) or a vein (intravenously). Other
children are given antibiotics by mouth. Treatment typically lasts 7 to 14 days. Children who
require tests to diagnose structural abnormalities often continue antibiotic treatment at a
lower dose until tests are complete.

Some children with structural abnormalities of the urinary tract require surgery to correct the
problem. Others need to take antibiotics daily to prevent infection. Certain mild abnormalities
resolve without treatment.

Weinberg, Geoffrey A., MD. Urinary Tract Infection in Children. Merck Manual (Consumer version).
Available on: http://www.merckmanuals.com/home/children-s-health-issues/miscellaneous-bacterial-
infections-in-infants-and-children/urinary-tract-infection-in-children-uti.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

 Session 7

Stroke

A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced,
depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die. It is a
medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and
potential complications.

The good news is that strokes can be treated and prevented, and many fewer Americans die of
stroke now than even 15 years ago.

Note when your signs and symptoms begin, because the length of time they have been
present may guide your treatment decisions:

 Trouble with walking. You may stumble or experience sudden dizziness, loss of balance
or loss of coordination.
 Trouble with speaking and understanding. You may experience confusion. You may
slur your words or have difficulty understanding speech.
 Paralysis or numbness of the face, arm or leg. especially on one side of your body. Try
to raise both your arms over your head at the same time. If one arm begins to fall, you
may be having a stroke. Similarly, one side of your mouth may droop when you try to
smile.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

  Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened
vision in one or both eyes, or you may see double.
 A sudden, severe headache, which may be accompanied by vomiting, dizziness or
altered consciousness, may indicate you're having a stroke.

When to see a doctor

 Seek immediate medical attention if you notice any signs or symptoms of a stroke,
even if they seem to fluctuate or disappear.
 Think "FAST" and do the following:
 Face. Ask the person to smile. Does one side of the face droop?
 Arms. Ask the person to raise both arms. Does one arm drift downward?
 Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or
strange?

The longer a stroke goes untreated, the greater the potential for brain damage and disability.
To maximize the effectiveness of evaluation and treatment, you'll need to be treated at a
hospital within three hours after your first symptoms appeared.

A stroke can sometimes cause temporary or permanent disabilities, depending on how long
the brain lacks blood flow and which part was affected. Complications may include:

 You may become paralyzed on one side of your body, or lose control of certain
muscles, such as those on one side of your face or one arm. Physical therapy may help
you return to activities hampered by paralysis, such as walking, eating and dressing.
 A stroke may cause you to have less control over the way the muscles in your mouth
and throat move, making it difficult for you to talk clearly, swallow or eat. You also
may have difficulty with language (aphasia), including speaking or understanding
speech, reading, or writing. Therapy with a speech and language pathologist may help.
 Many people who have had strokes experience some memory loss. Others may have
difficulty thinking, making judgments, reasoning and understanding concepts.
 People who have had strokes may have more difficulty controlling their emotions, or
they may develop depression.
 People who have had strokes may have pain, numbness or other strange sensations in
parts of their bodies affected by stroke. For example, if a stroke causes you to lose
feeling in your left arm, you may develop an uncomfortable tingling sensation in that
arm.
 People also may be sensitive to temperature changes, especially extreme cold (central
stroke pain or central pain syndrome). This complication generally develops several
weeks after a stroke, and it may improve over time. But because the pain is caused by
a problem in your brain, instead of a physical injury, there are few treatments.
 Changes in behavior and self-care ability. People who have had strokes may become
more withdrawn and less social or more impulsive.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

 Under Pressure: High Blood Pressure Risks in Post-Menopausal Women
By Patricia Nicholson

High blood pressure, or hypertension, is one of the biggest risk factors for cardiovascular disease.
While it affects both women and men, there are differences in when and why women and men
develop hypertension.
Dr. Paula Harvey, director of the cardiac research program at Women’s College Hospital and a
scientist at Women’s College Research Institute in Toronto, explored those sex differences and
some of the mechanisms behind them at a presentation she gave at Women’s College Hospital on
Feb. 3, 2010.
‘Hypertension is probably the most important cardiovascular risk factor in post-menopausal
women,’ Dr. Harvey said. ‘Cardiovascular disease remains the leading cause of illness and death in
women. And that’s the leading cause over all the next six leading causes of death and morbidity
combined. So it’s a major problem.’
In younger people, blood pressure tends to be higher in men than in women. Starting around age
30, men’s blood pressure tends to gradually increase at a regular pace until about age 55. In that
same age range, women’s blood pressure increases more slowly until they reach peri-menopause.
That slow increase in blood pressure begins to speed up around the menopausal transition, and
women’s blood pressure rises at a steeper rate as they get older. So while hypertension is more
common in young men than young women, high blood pressure rates in women begin to catch up
to men in middle age. ‘And when you get into the older age group, women not only catch up, they
overtake men,’ Dr. Harvey said. ‘So women have more high blood pressure than men once you
get over 60 years of age.’
The many roles of estrogen
One mechanism for these sex differences in blood pressure patterns may be estrogen. In the
complex interactions of the human body, estrogen plays many roles. Dr. Harvey explained how
some of them may help protect premenopausal women from hypertension:
 Estrogen increases levels of nitric oxide, which is a very powerful dilator of blood vessels, and
dilated blood vessels are conducive to healthy blood pressure.
 Estrogen not only helps keep blood vessels dilated by increasing nitric oxide levels, it also
helps reduce levels of endothelin, a substance that constricts blood vessels and is closely
linked to heart disease and high blood pressure.
 By increasing elastin and collagen, estrogen helps blood vessels maintain healthy, flexible
walls.
 Estrogen’s antioxidant properties also reduce the type of free radicals called reactive oxygen
species. These free radicals are implicated in cell damage and inflammatory responses,
including those associated with cardiovascular disease.
 It may help reduce sodium sensitivity, making women less sensitive to the hypertensive
effects of salt.
 Estrogen helps to suppress the renin-angiotensin system (RAS) that controls enzymes and
hormones that affect vasoconstriction (constriction of blood vessels) and sodium retention.
 Estrogen helps to suppress the RAS’s production of angiotensin 2, a substance that triggers
the sympathetic nervous system, which in turn is responsible for the fight-or-flight response
that constricts blood vessels, increases heart rate and raises blood pressure.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

‘Although angiotensin II was very protective back in the day, when we needed to be able to run
away from tigers and lions and survive trauma, it’s not a great situation in our present lifestyle,’ Dr.
Harvey said.
Given the many protective effects of estrogen, it’s not surprising that researchers suspect that
estrogen deficiency following menopause is one of the contributing factors to the increase in
hypertension that often occurs in post-menopausal women.
‘What we’re doing is reversing all those benefits of estrogen we see in the premenopausal period,’
Dr. Harvey said. Nitric oxide decreases, endothelin increases, blood vessel walls begin to stiffen and
oxidative stress increases.
Lifestyle and hypertension
Loss of estrogen isn’t the whole story in post-menopausal hypertension. Some of the biggest risk
factors are modifiable.
Studies have linked hypertension risk to body mass index (BMI) and waist-to-hip ratio – the ratio of
how much fat you carry around your waist to how much fat you carry around your hips. Either – or
both – of these factors can affect blood pressure. ‘As you increase your body mass index, your risk
of hypertension increases,’ Dr. Harvey said. ‘As you increase the amount of fat around your waist,
affecting your waist-to-hip ratio, your risk of hypertension increases. Combine the two, and you’re
really in big trouble.’ The double whammy of elevated BMI and belly fat adds up to a seven-fold
increase in risk of hypertension, compared to women with a normal BMI and waist-to-hip ratio.
Obesity is also big contributor. Women are more likely to be overweight than men, and this trend
increases with age, Dr. Harvey said. ‘Obesity is bad,’ she said. ‘In physiological terms, it leads to all
sorts of things like activation of the sympathetic nervous system, sodium retention, and it does
contribute to hypertension.’ Obesity in women peaks around ages 55 to 59. Its prevalence is
highest in aboriginal women, and in low-income groups.
Protective factors
Conversely, a healthy diet and an active lifestyle – two factors that help control BMI, obesity and
waist fat – can be protective against high blood pressure.
Some specific nutrients associated with reducing risk of hypertension include calcium and
magnesium. Diet elements that increase risk include alcohol, salt and cola drinks, Dr. Harvey said.
Exercise is one of the most important factors in reducing risk of high blood pressure. However, Dr.
Harvey noted that 60 per cent of Canadian women are inactive, and only 17 per cent are classified
as active. ‘Not surprisingly, this correlates with body mass index: the more active you are, the lower
your BMI,’ she said. Among the cardiovascular benefits of exercise is an increase in the production
of nitric oxide – the substance that dilates blood vessels and helps them stay healthy.
Dr. Harvey cited a 1997 study in which post-menopausal women with high blood pressure did a 12-
week treadmill exercise program. At the end of program, their blood pressure was significantly
reduced. Their systolic pressure dropped by an average of 10 mmHg during the study period. ‘This
is easily as good as adding a medication to somebody’s blood pressure treatment,’ Dr. Harvey said
of the results. ‘We know that exercise improves your cardiovascular risk profile in a number of
ways: augments the health of blood vessels, reduces blood pressure and pulse pressure,’ Dr. Harvey
said. Exercise also reduces risk of cardiovascular illness and death, and actually reduces risk of
death from all causes, she added. Cardiovascular disease is already the number 1 cause of illness
and death for women, and hypertension is a major risk factor that is most prevalent in post-
menopausal women. Demographics will soon make these figures even more worrying.
‘It’s estimated that by 2050, there will be 1 billion women over the age of 65 in the world,’ Dr.
Harvey said. ‘That’s a big cardiovascular burden.’

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

Nicholson, Patricia. Under Pressure: High Blood Pressure Risks in Post-Menopausal Women. Women’s
College Hospital – Toronto, Canada. Avilable on: http://www.womenshealthmatters.ca/feature-
articles/feature-articles/under-pressure-high-blood-pressure-risks-in-post-menopausal-women

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita