Protozoan Diseases of the Cardiovascular and Lymphatic Systems

Trypanosoma cruzi causes Chagas’ disease. The reservoir includes many wild animals. The vector is reduviid, the “kissing bug.”

Xenodiagnosis allows for the identification of trypanosomes in the intestinal tract of the reduviid bug, which confirms the diagnosis. 

                                                                       Trypanosoma cruzi 

                                      

Toxoplasmosis

Toxoplasmosis is caused by the sporozoan Toxoplasma gondii.

T. gondii undergoes sexual reproduction in the intestinal tract of domestic cats (the reservoir), and oocysts are eliminated in cat feces.

In the host cell, sporozoites reproduce to form either tissue invading tachyzoites or bradyzoites.

Humans contract the infection by ingesting tachyzoites or tissue cysts in undercooked meat from an infected animal or contact with cat feces (transmission is gastrointestinal).

Congenital infections can occur. Signs and symptoms include severe brain damage or vision problems.

Toxoplasmosis can be identified by serological tests, but interpretation of the results is uncertain. 

                         

Malaria

The signs and symptoms of malaria are chills, fever, vomiting, and headache, which occur at intervals of 2-3 days.

Malaria is transmitted by Anopheles mosquitoes. The causative agent is any one of four species of Plasmodium.

Sporozoites reproduced in the liver and release merozoites into the blood stream, where they infect red blood cells and produce more merozoites.

Laboratory diagnosis is based on microscopic observation of merozoites in red blood cells.

New drugs are being developed as the protozoa develop resistance to drugs such as chloroquine.

Malaria in the United States

                         

Malaria

Leishmaniasis

Leishmania spp., which are transmitted by sandflies, cause leishmaniasis.

Leishmania donovani - visceral leishmaniasis: the protozoa reproduce in the liver, spleen and kidneys.

Leishmania tropica - cutaneous leishmaniasis (Oriental sore): affects skin

Leishmania braziliensis - mucocutaneous leishmaniasis: affects mucous membranes as well as skin

Antimony compounds are used for treatment.

Cutaneous Leishmaniasis

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Babesiosis

Babesiosis is caused by the protozoan Babesia microti and transmitted to humans by ticks.

Helminthic Diseases of the Cardiovascular and Lymphatic Systems

Schistosomiasis

Species of the blood fluke Schistosoma cause schistosomiasis.

Eggs eliminated with feces hatch into larvae that infect the intermediate host, a snail. Free-swimming cercariae are released from the snail and penetrate the skin of a human.

The adult flukes live in the veins of the liver or urinary bladder in humans.

Granulomas are from the host’s defense against eggs that remain in the body.

Observation of eggs or flukes in feces, skin tests, or indirect serological tests may be used for diagnosis.

Chemotherapy (praziquantel or oxamniquine) is used to treat the disease; sanitation and snail eradication are used to prevent it.

Schistosomiasis

Schistosome Granuloma

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Swimmer’s Itch

Swimmer’s itch is a cutaneous allergic reaction to cercariae that penetrate the skin. The definitive hosts for this fluke are wildfowl.

                                                                                       

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ATP: The Perfect Energy Currency for the Cell

Abstract The major energy currency molecule of the cell, ATP, is evaluated in the context of creationism. This complex molecule is critical for all life from the simplest to the most complex. It is only one of millions of enormously intricate nanomachines that needs to have been designed in order for life to exist on earth. This motor is an excellent example of irreducible complexity because it is necessary in its entirety in order for even the simplest form of life to survive.

Introduction In order to function, every machine requires specific parts such as screws, springs, cams, gears, and pulleys. Likewise, all biological machines must have many well-engineered parts to work. Examples include units called organs such as the liver, kidney, and heart. These complex life units are made from still smaller parts called cells which in turn are constructed from yet smaller machines known asorganelles. Cell organelles include mitochondria, Golgi complexes, microtubules, and centrioles. Even below this level are other parts so small that they are formally classified as macromolecules (large molecules). Fig. 1. Views of ATP and related structures. A critically important macromolecule—arguably “second in importance only to DNA”—is ATP. ATP is a complexnanomachine that serves as the primary energy currency of the cell (Trefil, 1992, p.93). A nanomachine is a complex precision microscopic-sized machine that fits the standard definition of a machine. ATP is the “most widely distributed high-energy compound within the human body” (Ritter, 1996, p. 301). This ubiquitous molecule is “used to build complex molecules, contract muscles, generate electricity in nerves, and light fireflies. All fuel sources of Nature, all foodstuffs of living things, produce ATP, which in turn powers virtually every activity of the cell and organism. Imagine the metabolic confusion if this were not so: Each of the diverse foodstuffs would generate different energy currencies and each of the great variety of cellular functions would have to trade in its unique currency” (Kornberg, 1989, p. 62). ATP is an abbreviation for adenosine triphosphate, a complex molecule that contains the nucleoside adenosine and a tail consisting of three phosphates. (See Figure 1 for a simple structural formula and a space filled model of ATP.) As far as known, all organisms from the simplest bacteria to humans use ATP as their primary energy currency. The energy level it carries is just the right amount for most biological reactions. Nutrients contain energy in low-energy covalent bonds which are not very useful to do most of kinds of work in the cells. These low energy bonds must be translated to high energy bonds, and this is a role of ATP. A steady supply of ATP is so critical that a poison which attacks any of the proteins used in ATP production kills the organism in minutes. Certain cyanide compounds, for example, are poisonous because they bind to the copper atom in cytochrome oxidase. This binding blocks the electron transport system in the mitochondria where ATP manufacture occurs (Goodsell, 1996, p.74).

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The Aufbau Principle

The electron configuration of an atom gives the distribution  of electrons among atomic orbitals in the atom.  Two general methods are used to show electron configurations.  The subshell notation uses numbers to designate the principal shells and the letters s, p, d, and f to identify the subshells.  A superscript following the letter indicates the number of electrons in the designated subshell.  The ground state electron configuration for nitrogen would be   1s²2s²2p³.  A drawback to this method of showing the electron configuration is that it does not tell us how the three 2p electrons are distributed among the three 2p orbitals.  We can show this by using an orbital diagram in which boxes are used to indicate orbitals within subshells and arrows to represent electrons in these orbitals.  The direction of the arrows represent the directions of the electron spins.  The orbital diagram for nitrogen is

1s	2s		2p

The way we arrive at electron configurations such as the one for nitrogen above is to use a set of rules collectively called the aufbau principle. 

• Electrons occupy orbitals of the lowest energy available
• No two electrons in the same atom may have all four quantum numbers alike
• When entering orbitals of the same energy, electrons initially occupy them singly ant with the same spin
• Electrons fill orbitals in order of the quantum number sum (n + l). For equal (n + l) sums, fill levels in order of increasing n.

A mnemonic diagram for the aufbau principle known as the diagonal rule is shown here

The aufbau principle is really a thought process in which we think about building up an atom from the one that preceeds it in atomic number, by adding a proton and neutrons to the nucleus and one electron to the appropriate atomic orbital.  

There are some exceptions to the to the aufbau principle.  The first is chromium (Z = 24), the aufbau principle predicts the an electron configuration of  [Ar]3d⁴4s² but experimentally we find it to be  [Ar]3d⁵4s¹.  The next exception found is that of copper (Z = 29), the predicted electron configuration is  [Ar]3d⁹4s² but experimentally we find it to be  [Ar]3d¹⁰4s¹.  The reason for these and other exceptions are not completely understood, but it seems that a half-filled 3d subshell in the case of chromium or a completely-filled  3d subshell in the case of copper lend a special stabilty to the observed electron configurations.  There is no need to dwell on these exceptions, the point to remember is that the aufbau principle predicts the correct electron configuration most of the time and that the energy of the predicted electron configuration is very close to the ground state energy.

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Artificial respiration

Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration. Assistance takes many forms, but generally entails providing air for a person who is not breathing or is not making sufficient respiratory effort on their own(although it must be used on a patient with a beating heart or as part of cardiopulmonary resuscitation to achieve the internal respiration).

Pulmonary anton ventilation (and hence external parts of respiration) is achieved through manual insufflation of the lungs either by the rescuer blowing into the patient's lungs, or by using a mechanical device to do so. This method of insufflation has been proved more effective than methods which involve mechanical manipulation of the patient's chest or arms, such as the Silvester method. It is also known as Expired Air Resuscitation (EAR), Expired Air Ventilation (EAV), mouth-to-mouth resuscitation, rescue breathing or colloquially the kiss of life.

Artificial respiration is a part of most protocols for performing cardiopulmonary resuscitation(CPR) making it an essential skill for first aid. In some situations, artificial respiration is also performed separately, for instance in near-drowning and opiate overdoses. The performance of artificial respiration in its own is now limited in most protocols to health professionals, whereas lay first aiders are advised to undertake full CPR in any case where the patient is not breathing sufficiently.

Mechanical ventilation involves the use of a mechanical ventilator to move air in and out of the lungs when an individual is unable to breathe on his or her own, for example during surgery withgeneral anesthesia or when an individual is in a coma.

Insufflations

Insufflation, also known as 'rescue breaths' or 'ventilations', is the act of mechanically forcing air into a patient's respiratory system. This can be achieved via a number of methods, which will depend on the situation and equipment available. All methods require good airway management to perform, which ensures that the method is effective. These methods include:

• Mouth to mouth - This involves the rescuer making a seal between their mouth and the patient's mouth and 'blowing', to pass air into the patient's body
• Mouth to nose - In some instances, the rescuer may need or wish to form a seal with the patient's nose. Typical reasons for this include maxillofacial injuries, performing the procedure in water or the remains of vomit in the mouth
• Mouth to mouth and nose - Used on infants (usually up to around 1 year old), as this forms the most effective seal
• Mouth to mask – Most organisations recommend the use of some sort of barrier between rescuer and patient to reduce cross infection risk. One popular type is the 'pocket mask'. This may be able to provide higher tidal volumes than a Bag Valve Mask.
• Bag valve mask (BVM) - This is a simple device manually operated by the rescuer, which involves squeezing a bag to expel air into the patient.
• Mechanical resuscitator - An electric unit designed to breathe for the patient.

Adjuncts to insufflation

A CPR pocket mask, with carrying case

Most training organisations recommend that in any of the methods involving mouth to patient, that a protective barrier is used, to minimise the possibility of cross infection (in either direction).

Barriers available include pocket masks and keyring-sized face shields. These barriers are an example of Personal Protective Equipment to guard the face against splashing, spraying or splattering of blood or other potentially infectious materials.

These barriers should provide a one-way filter valve which lets the air from the rescuer deliver to the patient while any substances from the patient (e.g. vomit, blood) cannot reach the rescuer. Many adjuncts are single use, though if they are multi use, after use of the adjunct, the mask must be cleaned and autoclaved and the filter replaced.

The CPR mask is the preferred method of ventilating a patient when only one rescuer is available. Many feature 18mm inlets to support supplemental oxygen, which increases the oxygen being delivered from the approximate 17% available in the expired air of the rescuer to around 40-50%.

Tracheal intubation is often used for short term mechanical ventilation. A tube is inserted through the nose (nasotracheal intubation) or mouth (orotracheal intubation) and advanced into the trachea. In most cases tubes with inflatable cuffs are used for protection against leakage and aspiration. Intubation with a cuffed tube is thought to provide the best protection against aspiration. Tracheal tubes inevitably cause pain and coughing. Therefore, unless a patient is unconscious or anesthetized for other reasons, sedative drugs are usually given to provide tolerance of the tube. Other disadvantages of tracheal intubation include damage to the mucosal lining of the nasopharynx or oropharynx and subglottic stenosis.

In an emergency a Cricothyrotomy can be used by health care professionals, where an airway is inserted through a surgical opening in the cricothyroid membrane. This is similar to atracheostomy but a cricothyrotomy is reserved for emergency access. This is usually only used when there is a complete blockage of the pharynx or there is massive maxillofacial injury, preventing other adjunts being used .

Efficiency of mouth to patient insufflation

Normal atmospheric air contains approximately 21% oxygen when created in. After gaseous exchange has taken place in the lungs, with waste products (notably carbon dioxide) moved from the bloodstream to the lungs, the air being exhaled by humans normally contains around 17% oxygen. This means that the human body utilises only around 19% of the oxygen inhaled, leaving over 80% of the oxygen available in the exhalatory breath.

This means that there is more than enough residual oxygen to be used in the lungs of the patient, which then crosses the cell membrane to form oxyhemoglobin.

Oxygen 

The efficiency of artificial respiration can be greatly increased by the simultaneous use of oxygen therapy. The amount of oxygen available to the patient in mouth to mouth is around 16%. If this is done through a pocket mask with an oxygen flow, this increases to 40% oxygen. If a Bag Valve Mask or mechanical respirator is used with an oxygen supply, this rises to 99% oxygen. The greater the oxygen concentration, the more efficient the gaseous exchange will be in the lungs.

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Bone grafting

Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly.

Bone generally has the ability to regenerate completely but requires a very small fracture space or some sort of scaffold to do so. Bone grafts may be autologous (bone harvested from the patient’s own body, often from the iliac crest), allograft (cadaveric bone usually obtained from a bone bank), or synthetic (often made ofhydroxyapatite or other naturally occurring and biocompatible substances) with similar mechanical properties to bone. Most bone grafts are expected to be reabsorbed and replaced as the natural bone heals over a few months’ time.

The principles involved in successful bone grafts include osteoconduction (guiding the reparative growth of the natural bone), osteoinduction (encouraging undifferentiated cells to become active osteoblasts), and osteogenesis (living bone cells in the graft material contribute to bone remodeling). Osteogenesis only occurs with autografts.

Biological mechanism

Properties of various types of bone graft sources.

	Osteoconductive	Osteoinductive	Osteogenic
Alloplast	+	–	–
Xenograft	+	–	–
Allograft	+	+/–	–
Autograft	+	+	+

Bone grafting is possible because bone tissue, unlike most other tissues, has the ability to regenerate completely if provided the space into which to grow. As native bone grows, it will generally replace the graft material completely, resulting in a fully integrated region of new bone. The biologic mechanisms that provide a rationale for bone grafting are osteoconduction, osteoinduction and osteogenesis

Osteoconduction

Osteoconduction occurs when the bone graft material serves as a scaffold for new bone growth that is perpetuated by the native bone. Osteoblasts from the margin of the defect that is being grafted utilize the bone graft material as a framework upon which to spread and generate new bone. In the very least, a bone graft material should be osteoconductive.

Osteoinduction

Osteoinduction involves the stimulation of osteoprogenitor cells to differentiate into osteoblasts that then begin new bone formation. The most widely studied type of osteoinductive cell mediators are bone morphogenetic proteins (BMPs). A bone graft material that is osteoconductive and osteoinductive will not only serve as a scaffold for currently existing osteoblasts but will also trigger the formation of new osteoblasts, theoretically promoting faster integration of the graft.

Osteopromotion

Osteopromotion involves the enhancement of osteoinduction without the possession of osteoinductive properties. For example,enamel matrix derivative has been shown to enhance the osteoinductive effect of demineralized freeze dried bone allograft(DFDBA), but will not stimulate de novo bone growth alone.

Osteogenesis

Osteogenesis occurs when vital osteoblasts originating from the bone graft material contribute to new bone growth along with bone growth generated via the other two mechanisms

Types and Tissue Sources

Autograft

Autologous (or autogenous) bone grafting involves utilizing bone obtained from the same individual receiving the graft. Bone can be harvested from non-essential bones, such as from the iliac crest, or more commonly in oral and maxillofacial surgery, from the mandibular symphysis (chin area) or anterior mandibular ramus (the coronoid process); this is particularly true for block grafts, in which a small block of bone is placed whole in the area being grafted. When a block graft will be performed, autogenous bone is the most preferred because there is less risk of the graft rejection because the graft originated from the patient's own body. As indicated in the chart above, such a graft would be osteoinductive and osteogenic, as well as osteoconductive. A negative aspect of autologous grafts is that an additional surgical site is required, in effect adding another potential location for post-operative pain and complications.

Autologous bone is typically harvested from intra-oral sources as the chin or extra-oral sources as the iliac crest, the fibula, the ribs, the mandible and even parts of the skull.

All bone requires a blood supply in the transplanted site. Depending on where the transplant site is and the size of the graft, an additional blood supply may be required. For these types of grafts, extraction of the part of the periosteum and accompanying blood vesels along with donor bone is required. This kind of graft is known as a vital bone graft.

An autograft may also be performed without a solid bony structure, for example using bone reamed from the anterior superior iliac spine. In this case there is an osteoinductive and osteogenic action, however there is no osteoconductive action, as there is no solid bony structure.

Allografts

Allograft bone, like autogenous bone, is derived from humans; the difference is that allograft is harvested from an individual other than the one receiving the graft. Allograft bone is taken from cadavers that have donated their bone so that it can be used for living people who are in need of it; it is typically sourced from a bone bank.

There are three types of bone allograft available:

1. Fresh or fresh-frozen bone
2. Freeze-dried bone allograft (FDBA)
3. Demineralized freeze-dried bone allograft (DFDBA)

Synthetic variants

Artificial bone can be created from ceramics such as calcium phosphates (e.g. hydroxyapatite and tricalcium phosphate), Bioglass and calcium sulphate; all of which are biologically active to different degrees depending on solubility in the physiological environment. These materials can be doped with growth factors, ions such as strontium or mixed with bone marrow aspirate to increase biological activity. Some authors believe this method is inferior to autogenous bone grafting however infection and rejection of the graft is much less of a risk, the mechanical properties such as Young's modulus are comparable to bone. The presence of elements such as strontium can result in higher bone mineral density and enhanced osteoblast proliferation in vivo

Xenografts

Xenograft bone substitute has its origin from a species other than human, such as bovine. Xenografts are usually only distributed as a calcified matrix. In January 2010 Italian scientists announced a breakthrough in the use of wood as a bone substitute, though this technique is not expected to be used for humans until at the earliest 2015.

Alloplastic grafts

Alloplastic grafts may be made from hydroxylapatite, a naturally occurring mineral that is also the main mineral component of bone. They may be made from bioactive glass. Hydroxylapetite is a Synthetic Bone Graft, which is the most used now among other synthetic due to its osteoconduction, hardness and acceptability by bone. Some synthetic bone grafts are made of calcium carbonate, which start to decrease in usage because it is completely resorbable in short time which make the bone easy to break again. Finally used is the tricalcium phosphate which now used in combination with hydroxylapatite thus give both effect osteoconduction and resorbability.

Growth Factors

Growth Factor enhanced grafts are produced using recombinant DNA technology. They consist of either Human Growth Factors or Morphogens (Bone Morphogenic Proteins in conjunction with a carrier medium, such as collagen).

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Low HDL Cholesterol (Hypoalphalipoproteinemia)

Low levels of high-density lipoprotein cholesterol (HDL), or hypoalphalipoproteinemia (HA), includes a variety of conditions, ranging from mild to severe, in which concentrations of alpha lipoproteins or high-density lipoprotein (HDL) are reduced. The etiology of HDL deficiencies ranges from secondary causes, such as smoking, to specific genetic mutations, such as Tangier disease and fish-eye disease.

HA has no clear-cut definition. An arbitrary cutoff is the 10th percentile of HDL cholesterol levels. A more practical definition derives from the theoretical cardioprotective role of HDL. The US National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) redefined the HDL cholesterol level that constitutes a formal coronary heart disease (CHD) risk factor. The level was raised from 35 mg/dL to 40 mg/dL for men and women. A prospective analysis by Mora et al investigated the link between cholesterol and cardiovascular events in women and found baseline HDL-C level was consistently and inversely associated with incident coronary and CVD events across a range of LDL-C values.

For the metabolic syndrome in which multiple mild abnormalities in lipids, waist size (abdominal circumference), blood pressure, and blood sugar increase the risk of CHD, the designated HDL cholesterol levels that contribute to the syndrome are sex-specific. For men, a high-risk HDL cholesterol level is still less than 40 mg/dL, but for women, the high-risk HDL cholesterol level is less than 50 mg/dL.

A low HDL cholesterol level is thought to accelerate the development ofatherosclerosis because of impaired reverse cholesterol transport and possibly because of the absence of other protective effects of HDL, such as decreased oxidation of other lipoproteins.

The common, mild forms of HA have no characteristic physical findings, but patients may have premature coronary heart or peripheral vascular disease, as well as a family history of low HDL cholesterol levels and premature CHD.

Therapy to raise the concentration of HDL cholesterol includes weight loss, smoking cessation, aerobic exercise, and pharmacologic management with niacin and fibrates.

This review addresses the pathogenesis and presenting features of, and the diagnostic tests, therapeutic interventions, and follow-up strategies for, low HDL cholesterol levels.

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ILOVEYOU ( virus)

ILOVEYOU, sometimes referred to as Love Letter, was a computer worm that attacked tens of millions of Windows personal computers on and after 5 May 2000 local time in the Philippines when it started spreading as an email message with the subject line "ILOVEYOU" and the attachment "LOVE-LETTER-FOR-YOU.txt.". The first file extension 'VBS' was most often hidden by default on Windows computers of the time, leading unwitting users to think it was a normal text file. Opening the attachment activated the Visual Basic script. The worm did damage on the local machine, overwriting image files, and sent a copy of itself to the first 50 addresses in theWindows Address Book used by Microsoft Outlook.

Four things led to the success of ILOVEYOU.

• It relied on the scripting engine system setting being enabled. The engine had not been known to have ever been used previously and Microsoft received scathing criticism for leaving such a powerful (and dangerous) tool enabled by default with no one aware of its existence.
• It took advantage of a Microsoft algorithm for hiding file extensions. Windows had begun hiding extensions by default; the algorithm parsed file names from right to left, stopping at the first 'period' ('dot'). The attachment (which had two file extensions) could thus display the inner file extension 'TXT' as the real extension; text files are considered to be innocuous as they are normally incapable of running executable code.
• It utilised social engineering to entice users to open the attachment (out of actual desire to connect or simple curiosity) to ensure continued propagation.
• It exploited systemic weaknesses in the design of Microsoft Outlook and Microsoft Windows which led to unused features easily running malicious code capable of achieving complete access to the operating system, secondary storage, and system and user data simply by unwitting users clicking on an icon.

Spread

Messages generated in the Philippines began to spread westwards through corporate email systems. Because the worm used mailing lists as its source of targets, the messages often appeared to come from acquaintances and were therefore often regarded as considered "safe" by their victims, providing further incentive to open them. Only a few users at each site had to access the attachment in order to generate millions more messages that crippled mail systems and overwrote millions of files on computers in each successive network

Impact

The worm is believed to have originated near manila in the Philippines on 5 May 2000 local time and to thereafter have spread westward across the world, moving first to Hong Kong, then to Europe, and finally the US as people reported to their offices that Friday morning. The outbreak was later estimated to have caused US $5.5 billion in damages worldwide.Already ten days later 50 million infections had been reported. Most of the damage cited was the time and effort spent getting rid of the infection and recovering damaged files from backup. In order to protect themselves, The Pentagon, CIA, the British Parliament, and most large corporations were forced to completely shut down their mail systems.

Architecture of the Worm

The ILOVEYOU script (the attachment) was written in Microsoft Visual Basic Scripting (VBS) which ran in Microsoft Outlook and was enabled by default. The script added Windows Registrydata for automatic startup on system boot.

The worm then searched connected drives and replaced files with extensions JPG, JPEG, VBS, VBE, JS, JSE, CSS, WSH, SCT, DOC, HTA, MP2, and MP3 with copies of itself, whilst appending the additional file extension VBS.

The worm propagated itself by sending out copies of the payload to the first 50 entries in theMicrosoft Outlook address book (Windows Address Book). It also downloaded the Barok trojan renamed for the occasion as "WIN-BUGSFIX.EXE"

Developments

On 5 May 2000 two young Filipino computer programmers named Reomel Ramores and Onel de Guzman became the target of a criminal investigation by the Philippines' National Bureau of Investigation (NBI) agents. The NBI received a complaint from Sky Internet, a local Internet service provider (ISP). The ISP claimed that they have received numerous calls from European computer users, complaining that malware in the form of an "ILOVEYOU" worm was sent to their computers through the said ISP.

After several days of surveillance and investigation spearheaded by Darwin Bawasanta, systems development manager of Sky Internet, the NBI was able to trace a frequently appearing telephone number which turned out to be that of Ramores' apartment in Manila. His residence was searched by the NBI and Ramores was consequently arrested and placed on inquest investigation before the Department of Justice (DOJ). Onel de Guzman was likewise arrested in absentia. At that point, the NBI were at a loss as to what felony or crime to charge them with. There were some agents who suggested they might be charged with violation of Republic Act 8484 or the Access Device Regulation Act, a law designed mainly to penalisecredit card fraud, the reason supposedly being that both used, if not stole, pre-paid Internet cards which enabled them to use several ISPs. Another school of thought within the NBI suggested Ramores and de Guzman could be charged with malicious mischief, a felony involving damage to property under the Philippines Revised Penal Code enacted in 1932. But the drawback with a charge of malicious mischief is that one of its elements, aside from damage to property, was intent to damage, and de Guzman and Igi Gando claimed during custodial investigation that de Guzman may have merely unwittingly released the worm.

To show intent, the NBI investigated AMA Computer College where de Guzman dropped out at the very end of his final year. They found that de Guzman was not only quite familiar with computer viruses but had in fact proposed to use one. For his undergraduate thesis, de Guzman proposed the implementation of a trojan to steal Internet login passwords. De Guzman proposed that users would finally be able to afford an Internet connection. The proposal was rejected by the College of Computer Studies board, prompting de Guzman to cancel his studies the day before graduation.

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Rapid Weight Loss Side Effects

Weight loss is alright, but is losing weight too quickly going to harm your body? The answer is yes. To put it simply, the fast loss of weight will go unchecked by the body and it won't be able to control what it's losing and what it needs to gain. You just might end up putting your health at risk.


Some people unfortunately fall to the fad that they can lose weight fast. While this may be possible theoretically, it is not the best thing to do. The problem is that people who try to go for rapid weight loss end up causing damage to their bodies because they may be tempted to excessively use diet pills, without being aware of the dangers of diet pills. Even those who go off food completely are not aware how much harm they may end up causing their bodies in the long run.


Problems With Losing Weight Too Fast

1. While most side effects may be temporary, one of the most severe problems arising out of rapid weight loss is Gallstones. If you suddenly stop eating, there may be a shift in the balance of bile salts and cholesterol. This may turn out to be a lethal concoction for the body. The cholesterol will then form lumps, called gallstones. Gallstones lodge themselves in the bile ducts and can be extremely painful. In some situations, it may also result in inflammation in the liver, pancreas and bladder. Sudden reduction in eating also reduces contractions in the gallbladder which aids the process of gallstone creation.
2. Another problem is the loss of muscle mass. If the body does not get the necessary food to fuel its daily activities, it's going to turn to other sources for energy. And ironically, research suggests that it will not use up the fat reserve as the body is programmed to use fat reserves as the last resort. So, before eating up the fat reserve, your body will first consume the muscle mass.
3. Loss of muscle tissue will lead to loss of water content in the body. The muscle mass comes from protein, which has a significant amount of water. Muscles also store most of the water, so loss of muscle from the body will lead to loss of muscle mass.
4. One problem that will really get you in a tizzy is hair loss. Hair needs protein for its growth. In fact, hair itself is made of a protein known as keratin. Hence if you decide to go off food, your protein consumption will reduce and there will be no protein available for hair growth, as the body will try to optimize whatever protein it gets. So hair basically pulls out the short straw and is left as the last in the hierarchy functions that protein needs to perform.
5. Other side effects include shivering. This is temporary and occurs if you have resorted to weight loss surgery. Surgery dramatically cuts out all the fat from the body. Fat insulates the body and stops the loss of body heat. Once all the fat is lost, the body heat will be lost quickly, leading to shivering.
6. The most unsightly side effect is hanging skin. When you lose weight, the skin, stretched due the fat, takes some time to tighten itself around the body. In some cases, especially ones related to obese people, there have been instances where people have lost weight too quickly, but their skin still hangs lose because it wasn't given enough time to adapt and wrap itself around the body tightly enough again.
7. Some people consume weight loss pills without being aware of the dark side of excessive intake. Consuming diet pills may lead to various medical complications such as increasing your heart rate and causing palpitations.

While losing weight may be important from the point of view of fitness, you have to remember to do it step by step. Losing weight too fast can bring on the above problems

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Causes of Dark Spots

Dark spots on the skin, also called hyperpigmentation, are a common skin problem especially beginning in middle age. There are a variety of conditions and agents that can cause dark spots to develop.

Skin Diseases that Cause Dark Spots

One of the most under-recognized causes of dark spots is post-inflammatory hyperpigmentation. This is a dark spot that occurs after some type of trauma to the skin - especially infections like acne. This and other skin diseases are listed here:
                                   
    

• Melasma
• Riehl's melanosis
• Poikiloderma of Civatte
• Erythromelanosis follicularis
• Linea Fusca
• Post inflammatory hyperpigmentation 

Medications that Cause Dark Spots

Certain medications sensitize the skin to the sun and other medications can cause dark spots without sun exposure. The most common offending medications are listed here:

• Estrogens
• Tetracyclines
• Amiodarone
• Phenytoin
• Phenothiazines
• Sulfonamides  

UV Light Causes Specific Types of Dark Spots   

UV light is a major cause of not only dark spots, but also other types of skin damage. The various types of dark spots caused by UV light are listed here:

• Melasma
• Solar lentigines - freckles
• Ephelide  

Other Causes of Dark Spots
These are other conditions or diseases that can cause dark spots:

• Pregnancy
• Liver disease
• Addison's disease
• Hemachromatosis
• Pituitary tumors 

Preventing and Treating Dark Spots on Your Skin

Many women are dreaming to have beautiful and healthy skin and currently there are many beauty clinics that offer various treatments. People have two major contrasting skin colors, black and white. Skin as the outer layer of our body has many problems and most of people with brighter skin often complain about their reddish or purplish marks. In dermatology, those kinds of spots are called as macules. Macules are a condition where your skin turns red like freckles.

Macules can also happen to dark skin, except those same reddish spots will look a good deal darker, deep brown or completely black or dozens of shades in between, it is particularly true after they heal. Americans of African ancestry usually have more concern about these dark macules caused by acne rather than the acne itself. These dark spots are called PIP (postinflammatory pigmentation or postinflammatory hyperpigmentation).

How Dark Spots Are Formed?

Here is a short explanation of how PIP is formed. It is limited to the skin area in which inflammation has developed previously. It is a kind of "footprints" or telltale signs of where the "first battle" took place. PIP can be caused by a cut, rash, burn, or the aftermath of a healed acne lesion.

These "footprints" can disappear eventually, but they usually outlast the original inflamed acne lesions, however sometimes it takes a few months or even several years to fade away completely.

PIP is divided into two types, which appear when skin inflammation happens:

1. Epidermal Hypermelanosis

The highly-active melanocytes respond by transferring their melanin pigments (in small granules) to the nearby keratinocytes, which are one of the epidermal cells. The stimulation increases and melanin granules transfer causes epidermal hypermelanosis. As the result, the skin gets darker although the pigmentation isn’t too intense. In this condition, PIP responds quite well to many topical bleaching cream products, which help to make it disappears faster. This is because most of melanin pigments are in the top layer of the skin (epidermis) which allows better treatment.

2. Dermal Melanosis

This type of PIP is quite difficult to treat and may never completely disappear. Unless the pigment is very deep, PIP will improve over time. It really needs a good deal of extra patience. The dermal melanosis happens when inflammation attacks the basal cell layer, which causes the release of melanin pigments and subsequently they are "dropped" deeper into the dermis, as the result, those pigments are trapped by scavenger white cells (macrophages).

It takes some time for dark spots to fade. PIP treatment is often a prolonged and difficult process that may require between six and twelve months to achieve good depigmentation results.

Prevention

Because these dark spots could take time to disappear or often longer than expected, it’s important to perform actions to avoid their emergence. It can be stopped with early treatment. You need to be aware of things that can possibly give you greater risk of having PIP, such as:

a. Squeezing, picking or rubbing your acne

b. Using OTC toners, alcohol-based products and also prescribed acne products that may irritate and dry your skin and cause PIP

c. Excessive washing using harsh soaps

d. Scrubbing with buff puffs

e. Cosmetic products that might worsen your skin and acne problems

f. Shaving your beard may wreak havoc with your facial skin condition, as it increases the possibility of PIP development

Treatment

The same medications that are used to treat acne for Caucasian skin can also used to treat people with different skin color. One way to treat acne and the dark spot is by OTC Medication.

Benzoyl Peroxide and Salicylic Acid

Benzoyl peroxide and salicylic acid are parts of Over-the-counter (OTC) medications. They might be an excellent approach if your acne is mild and your body or skin is able to tolerate these products. But they can be quite irritating for some people due to the presence of benzoyl peroxide. If your skin is able to tolerate it and you see improvement with your acne, then stick with it. However, benzoyl peroxide and salicylic acid can be irritating and produce whitish scales on dark skin. These scales are often referred to as to look "ashy." The appearance of the scales is difficult for some people to tolerate. (Light skin or white skin gets ashy appearance too).

If benzoyl peroxide or salicylic acid is causing ‘ashy’ appearance and scales, apply a light non-oily moisturizer like Olay Active Hydrating Beauty Fluid or Cetaphil Moisturizing Cream. If you have dark spots, you can use a moisturizer that contains a sunscreen such as Purpose Moisturizer SPF 15. Alternatively, you may use a heavier, greasier moisturizer. If you have a sensitive skin, try to use the lower strength (like 2.5 percent water-based benzoyl peroxide).

Repeat treatment every two days, then increase to once a day, as you’re able to tolerate the product. Similarly, if your skin gets too ashy or is irritated from salicylic acid products that have a mild peeling activity, try using lower than the 1 percent concentration and try applying the medications on an alternate-day basis.

Over-the-Counter Bleaches

For PIP spots, look for over-the-counter preparations that contain 1 to 2 percent hydroquinone, a chemical that’s traditionally been the main component for the treatment of PIP. Esoterica, Porcelana, Black Opal and Ambi are companies that manufactured over-the-counter hydroquinone-containing creams and gels. These products are applied as thin layer on the affected areas once or twice a day. There are over-the-counter products that contain 10 percent of hydroquinone or higher that are available in many other countries, particularly within Africa and Asia, and some of them have found their way (illegally) into "health" stores in the United States — mostly in ethnic neighborhoods within big cities. These high concentrations actually bring the risk of a darkening reaction known as ochronosis.

Home Remedies

Unfortunately, typical kitchens have plenty of ingredients that can be used to treat dark spots. Before deciding to seek expensive treatment, you should know that there are safer and cheaper ways to eliminate dark spots.

Citrus Fruits

Limes, lemons and oranges are packed with Vitamin C, a good natural bleaching agent. Among citrus fruits, lemon is considered to be the best remedy to eliminate dark spots. You can directly apply on the affected spot, using a dab of cotton or clean fingers. The citric acid will also help to bleach dark spots.

Honey and Milk

Both are excellent remedies to treat facial dark spots. It is a good idea to choose sour milk as the lactic acid exhibits gentle peeling effects, which can lighten dark spots without irritating your skin. On the other hand, honey has a number of renewing properties.

Other Concoction

Parsley juice can be mixed with red currant, orange and lemon juices, which can be applied along with moisturizing cream. This mixture may also work well with brown spots and freckles.

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