THE THINKER : LETS TALK ABOUT DIZZY

Dizziness is a common symptom thats not usually a sign of anything serious, but should be checked out by a doctor. The term dizziness means different things to different people: some use it to describe feeling lightheaded or off balance, while others use it to describe a feeling that their surroundings are spinning. Because the symptom is quite vague and can be caused by a wide range of factors, it may not always be easy to identify the underlying cause of dizziness. This page explains what you should do if you feel dizzy for no apparent reason, and outlines the most common causes. Seeing your GP If you are feeling lightheaded or off balance and are worried, see your GP, especially if you also have other symptoms such as fainting episodes or headaches. Your GP will first want to establish exactly what you mean by dizziness, and check that you are not actually describing vertigo, a severe type of dizziness where you feel that your surroundings are spinning or moving. Theyll want to know:

whether the dizziness started for no apparent reason, or if it followed an illness

whether you have repeated episodes of dizziness and, if so, when you tend to experience these

how long the dizziness lasts

Dizziness can sometimes be caused by an ear condition. A simple way for your GP to distinguish between ear-related dizziness and dizziness due to other causes is to ask if it occurs only when you are upright, or even when you're lying down:

If the dizziness only happens when you're upright, the cause is probably not related to the ear.

If the dizziness sometimes happens when you're lying down, the cause is usually an ear condition.

Its a good idea to keep a diary of your dizziness, recording when and where you experience the problem, and bring this with you to your GP appointment. If you are taking prescription medicine, your GP will probably review this to check your dizziness is not one of the side effects and, if necessary, try you on a different medication instead. You may be referred to a specialist for further tests and investigations. Common causes of dizziness The most common causes of dizziness are outlined below.

A viral illness that affects the ear - this can cause a severe form of dizziness called vertigo

Migraine (dizziness may come on before, after or even without the headache)

Stress or anxiety, especially if you tend to hyperventilate (over-breathe) A low blood sugar level, which is usually seen in people with diabetes

A sudden fall in blood pressure when you suddenly sit or stand up, which goes away after lying down this is know as postural hypotension and is more common in older people

Dehydration or heat exhaustion - dehydration could be due to not drinking enough during exercise, or illness that causes vomiting, diarrhoea or fever

Decreased blood flow in the back of the brain, called vertebrobasilar insufficiency the blood vessels leading to the brain from the heart may be blocked (known as atherosclerosis)

You can click on the above links for more information on these conditions. Less common causes of dizziness These include:

any severe illness or disease that affects the whole body recreational drugs or excess alcohol (either binge drinking, or long-term alcohol misuse)

certain types of prescription medicine, such as antidepressants or blood pressure medication

a heart rhythm problem, such as atrial fibrillation (a fast, irregular heartbeat) carbon monoxide poisoning

HIV/AIDS Overview HIV (human immunodeficiency virus) infection has now spread to every country in the world. Statistics show that approximately 40 million people are currently living with HIV infection, and an estimated 25 million have died from this disease. The scourge of HIV has been particularly devastating in sub-Saharan Africa and South Africa, but infection rates in other countries remain high. In the United States, approximately 1 million people are currently infected. Here are a few key points about the disease:

Globally, 85% of HIV transmission is through heterosexual intercourse. In the United States, approximately one-third of new diagnoses appear to be related to heterosexual transmission. Male-to-male sexual contact still accounts for more than half of new diagnoses in the U.S. Intravenous drug use contributes to the remaining cases. Because the diagnosis may occur years after infection, it is likely that a higher proportion of recent infections are due to heterosexual transmission.

Infections in women are increasing. Worldwide, 42% of people with HIV are women. In the United States, approximately 25% of new diagnoses are in women, and the proportion is rising.

There is good news on one front. New HIV infections in U.S. children have fallen dramatically. This is largely a result of testing and treating infected mothers, as well as establishing uniform testing guidelines for blood products.

In order to understand HIV and acquired immunodeficiency syndrome (AIDS), it is important to understand the meanings behind these terms:

HIV stands for the human immunodeficiency virus. It is one of a group of viruses known as retroviruses. After getting into the body, the virus kills or damages cells of the body's immune system. The body tries to keep up by making new cells or trying to contain the virus, but eventually the HIV wins out and progressively destroys the body's ability to fight infections and certain cancers.

The virus structure has been studied extensively, and this has helped scientists develop new treatments for HIV/AIDS. Although all HIV viruses are similar, small variations or

mutations in the genetic material of the virus create drug-resistant viruses. Larger variations in the viral genes are found in different viral subtypes. Currently, HIV-1 is the predominant subtype that causes HIV/AIDS.

AIDS stands for the acquired immunodeficiency syndrome. It is caused by HIV and occurs when the virus has destroyed so much of the body's defenses that immune-cell counts fall to critical levels or certain life-threatening infections or cancers develop.

AIDS is the sixth leading cause of death among people aged 25 - 44 in the United States. This is an improvement since it was the number one killer in 1995. At the end of 2010, an estimated 91,500 people in the UK were living with HIV. Of these, around 1 in 4 (22,000 in total) did not know they were infected. The World Health Organization (WHO) estimates that around 34 million people in the world are living with HIV. The virus is particularly widespread in sub-Saharan African countries, such as South Africa, Zimbabwe and Mozambique. Cause of AIDS AIDS is caused by HIV infection. The virus attacks the immune system leaving the individual susceptible to life-threatening infections and cancers. Common bacteria, yeast, parasites, and viruses that usually do not cause serious disease in people with healthy immune systems can turn deadly for AIDS patients. How is HIV transmitted HIV is found in all the body fluids including saliva, nervous system tissue and spinal fluid, blood, semen, pre-seminal fluid, which is the liquid that comes out before ejaculation, vaginal secretions, tears and breast milk. Only blood, semen, and breast milk have been shown to transmit infection to others. The virus is transmitted by sexual contact including unprotected oral, vaginal, and anal sex and via transfusion of contaminated blood that contains HIV.

Another mode of transmission is sharing needles or injections with HIV infected individuals. A pregnant woman can transmit the virus to her unborn baby through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk. HIV infection does not spread by casual contact, mosquitoes, touching or hugging. Who is at risk? Those at highest risk include injection drug users who share needles, babies born to mothers with HIV (especially if the mother had not received anti- HIV therapy during pregnancy), those engaging in unprotected vaginal or anal sex with HIV positive individuals, and those who received blood transfusions or clotting products between 1977 and 1985 (before screening for HIV became standard practice). Symptoms of HIV/AIDS HIV infection may cause no symptoms for a decade or longer. At this stage carriers may transmit the infection to others unknowingly. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops. Acute HIV infection takes a few weeks to months to become a non-symptomatic HIV infection. Then it becomes early symptomatic HIV infection and later it progresses to AIDS. How is the progress of the disease marked? With advancing HIV infection the blood shows higher viral load and CD4 T-cell count drops below 200 cells/mm3. CD4 cells are a type of T cell. T cells are cells of the immune system. They are also called "helper cells." There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from significantly damaging their immune system.

Opportunistic infections These are infections that normally do not affect an individual with a healthy immune system but AIDS patients are susceptible to these infections. These include viral infections like:

herpes simplex virus herpes zoster infection cancers like Kaposi sarcoma, non-Hodgkins lymphoma fungal infections like candidiasis bacterial infections like tuberculosis

Other infections include Bacillary angiomatosis, Candida esophagitis, Pneumocystic jiroveci pneumonia, AIDS dementia, Cryptosporidium diarrhea, cryptococcal meningigits and Toxoplasma encephalitis. Treatment of AIDS There is no cure for AIDS once it develops. There are agents available that can help keep symptoms at bay and improve the quality and length of life for those who have already developed symptoms. Drugs against HIV include antiretroviral therapy. These prevent the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. Preventing the virus from replicating can improve T-cell counts or CD4 cell counts and help the immune system recover from the HIV infection. Medicines are also prescribed to prevent opportunistic infections if the CD4 counts are low. Outcome of HIV AIDS is almost always fatal without treatment. HAART however has dramatically increased the amount of time people with HIV remain alive.

Prevention of HIV Safe sex measures with use of condoms, shunning use of illicit drugs or shared needles or syringes, avoidance of contact with blood and fluids by wearing protective clothing, masks, and goggles etc. helps prevent transmission. HIV-positive women who wish to become pregnant may need therapy while they are pregnant to prevent transmission to their babies. The Public Health Service recommends that HIV-infected women in the United States avoid breastfeeding to prevent transmitting HIV to their infants through breast milk.