How to Dignosis of Lung Cancer

Dignosis of Lung Cancer
 Physical exam-The doctor will check the patient for general health condition, pay attention to the breathing, and ensures for the fluid in the lungs. The doctor will look for enlarged liver and swollen lymph nodes.
    Chest x-ray-The x-ray of the chest will show abnormal fluid or tumors.
    CT scan-To have a closer look at the tissues within the chest, the doctor often takes help of a CT scan. The x-ray machine is attached to a computer to perform the job. For a spiral CT scan, the CT scanner spins around the patient’s body as they lie on a table. The table goes by the center of the scanner. The picture will appear with the tumor, abnormal fluid, or inflamed lymph nodes.

Lung Cancer

To find out the presence of the cancer cells in the lungs a pathologist will check the sample of tissues or cells under a microscope. There are several ways to collect the samples and they are as follows:

    Sputum cytology-The lab confirms samples of sputum for cancer cells. Sputum is a thick fluid which is coughed up from the lungs.
    Thoracentesis-The doctor will use a long needle to draw fluid from the chest. The fluid is also called pleural fluid. In the lab, the fluid is checked for cancer cells.
    Bronchoscopy-A bronchoscope is a thin, illuminated tube that a doctor will pass through the nose or mouth into the lung. This will allow the doctor to look inside the lungs and the air passages that lead to them. The doctor will take a sample of cells with a needle, brush, or other utensil. For this, the doctor will wash the area with water to assemble cells in the water.
    Fine-needle aspiration-The tissue or fluid from the lung or lymph node is removed by the doctor with a thin needle. Sometimes the doctor will use a CT scan or other imaging techniques to direct the needle to lung tumor or lymph node.
    Thoracotomy-In this procedure the surgeon will open the chest with a long incision and lymph nodes and samples of other tissues may be extracted.
    Mediastinoscopy-The surgeon will make an incision at the top of the breastbone using a thin, lighted tube to look inside the chest. The surgeon will remove a sample of tissue and lymph nodes for laboratory observation.

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Unknown diagnosis, lung cancer

Acute Bronchitis Symptoms Diagnosis Treatment in Children

 Acute bronchitis in children is observed in those with chronic sinusitis, allergies, or those with engorged tonsils and adenoids. Usually, pneumonia is a complication that follows unchecked bronchitis
Causes of acute bronchitis in children

Acute bronchitis is mostly caused due to infectious from bacteria or viruses. Sometimes acute bronchitis may be caused by some external physical or chemical agents such as dust, allergens, strong fumes, especially from chemical cleaning compounds, or tobacco smoke. The most common cause of bronchitis in children is a virus, although it can be due to bacteria. Acute bronchitis is usually a mild condition of the disease and gets cured within a few days.

Symptoms of acute bronchitis in children

Although, every child may experience the symptoms of acute bronchitis in children and the signs include

•     Before a cough starts, one may experience a running nose
•     Malaise – an overall body discomfort
•     Frequent chills
•     Mild fever
•     Back and muscle ache
•     Constant wheezing
•     Sore throat

In the initial stages of the disease, a child may experience a dry and non-productive cough which later develops to an abundant mucus-filled cough. Some young children may experience some vomiting or gagging with the cough. The symptoms of acute bronchitis in children usually last for 7 to 14 days, however they may also persist for 3 to 4 weeks.

The symptoms of acute bronchitis are similar to some other conditions or medical problems. A proper diagnosis is very important to treat the disease effectively.

Diagnosis of acute bronchitis in children

Acute bronchitis is generally diagnosed on the basis of the history and physical examination of the child. Some tests may be asked to be performed to rule out the possibilities of other diseases.

The medical practitioner will listen to the child’s breathing with a stethoscope. Abnormal sounds (rales) in the lungs or other abnormal breathing sounds may be heard during this.

Some test may be asked to be performed such as

    X-ray of the chest
This is done to eliminate any other possibilities of the irritation and discomfort in the chest.

    Lung function tests

Mostly, this test is done to examine the extent of the disease and its effects.

    Pulse oximetry

This test helps to determine the amount of oxygen in the child’s blood. This quick and painless test uses a device that is placed onto the tip of the child’s finger.

    Arterial blood test

Arterial blood gas is a more accurate measurement of oxygen and carbon dioxide (CO 2) levels, but it includes a needle stick and is more painful.

    Sputum samples

These are taken to check for signs of inflammation or the bacterial infection.

Treatment for acute bronchitis in children

Acute bronchitis in children is observed in those with chronic sinusitis, allergies, or those with engorged tonsils and adenoids. Usually, pneumonia is a complication that follows unchecked bronchitis

The treatment of bronchitis in children varies depending on the cause of the illness. Medication that suppresses the cough or release and clear secretions may be helpful.

    Cough suppressants

If the child has severe and uncontrollable coughing spells, then a good prescription is with strong cough suppressants. In most of the cases only these stronger cough suppressants stop a ferocious cycle of coughing which leads to more irritation of the bronchial tubes, which in turn causes more coughing in the child.

    Inhalers

Bronchodilator inhalers are helpful in opening the airways and in decreasing wheezing in a child suffering from bronchitis. The cool mist humidifier or vaporizer will help to decrease the bronchial irritation.

    Antibiotics

Antibiotics play a limited role in the treatment for bronchitis but in a bacterial bronchitis antibiotics become a necessity and even for chronic bronchitis they play a vital role. Children with other bacterial infections or any lung problems may need to be prescribed antibiotics as well. However, a viral bronchitis cannot be treatment by antibiotics. In such cases, treatment can be given for curing the symptoms only to reduce the discomfort.

Increased intake of fluids is necessary as coughing and fever leads to dehydration of the child’s body.

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Unknown Acute Bronchitis, diagnosis, Symptoms, Treatment

Viral bronchitis Symptoms Diagnosis Treatment

Viral bronchitis is Caused by many kind of viruses common virus including caused by viral bronchitis as influenza virus characterstic is both virus and bacterial

Symptoms of viral bronchitis

Every person may experience the symptoms of viral bronchitis but the most common signs include

•     Before a cough starts, one may experience a running nose
•     A transparent or white mucus
•     Malaise – an overall body discomfort
•     Frequent chills
•     Fever, up to 101 degrees F
•     Back and muscle ache
•     Constant wheezing
•     Sore throat
•     Hyper reactivity of the airways

Viral bronchitis diagnosis

A doctor generally makes a diagnosis of bronchitis based on the symptoms and eliminating the signs of pneumonia. The doctor may hear the sounds of the lungs during the physical examination.

Some test may be asked to be performed such as

•     X-ray of the chest
•     Lung function tests
•     Pulse oximetry
•     Arterial blood test
•     Sputum samples

Viral bronchitis treatment

The treatment of bronchitis varies depending on the cause of the illness. Medication that suppresses the cough or releases and clears secretions may be helpful.

    Cough suppressants

If the person has severe and uncontrollable coughing spells, then a good prescription is with strong cough suppressants. In most of the cases only these stronger cough suppressants stop a ferocious cycle of coughing which leads to more irritation of the bronchial tubes, which in turn causes more coughing in the person.

    Inhalers

Bronchodilator inhalers are helpful in opening the airways and to decrease wheezing in a person suffering from bronchitis. The cool mist humidifier or vaporizer will help to decrease the bronchial irritation.

Antibiotics are not effective for the viral infections thus are not prescribed. Some of the medications included in the treatment of viral bronchitis are:

•     Aspirin, acetaminophen, or ibuprofen
•     Amoxicillin
•     Ttetracycline
•     Doxycycline
•     Trimethoprim-sulfamethoxazole

Rarely used but highly effective medicines include

•     Cephalosporins
•     Azithromycin
•     Clarithromycin
•     Fluoroquinolones

Viral bronchitis natural treatment

The following natural treatments may be useful in easing some of the viral bronchitis symptoms.

    American and Siberian ginseng

These are especially excellent for the lungs. They clear bronchial tubes and reduce the inflammation. These are not recommended for people having high blood pressure or any other heart disease.

    Bromelain

Bromelain, mixture of proteolytic (protein-digesting) enzymes mostly found in pineapples (Ananas comosus). If consumed in tea form, it helps liquefy and decrease bronchial secretions. It also stops the progression of viral bronchitis and sinusitis.

Typical dosage should be 250 to 500 mg of bromelain 2 to 3 times in a day.

    Lobelia

Lobelia, lobelia inflata, popular as Indian tobacco, has a long history of use as an herbal medicine for respiratory conditions such as bronchitis, asthma, pneumonia, and cough. Lobelia reduces the bronchial congestion and prevents wheezing.

Typical dosage should be of 500 to 1000 mg in capsule form 3 times per day. Lobelia is to be used for about 2 to 3 weeks and more than that.

Viral bronchitis leads to dehydration and thus there should be an increased intake of fluids such as water, juices, and vegetables soups etc to keep the body hydrated and accelerates the recovery process. Bronchitis recovery basically depends on the immune system of the person and thus it is very important to improve the immunity.

Note: It is recommended to discuss with an authorized medical practitioner before following viral bronchitis treatment.

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Unknown diagnosis, Symptoms, Treatment, Viral bronchitis

Eosinophils Causes Symptoms Diagnosis and Treatment

Blood of the person suffering from eosinophilia shows excess eosinophils when tested. Eosinophils are white blood cells that are produced by the bone marrow and circulate in the blood stream. They are present in gut lining and help the body to fight against the various infections caused by the parasitic organisms.

Eosinophils constitute 5-7% of the total white blood cells. Higher count indicates significant health hazards and progressing eosinophilia.

Causes of eosinophilia

Many factors can influence eosinophilia, which ranges from a simple hay fever to a life threatening tumour. Parasitic infections caused by schistosomiasis, hookworm are the most common causes for eosinophilia. Other factors include, drug reactions and certain types of allergic conditions. It can also be due to the rare case of:

•     Certain types of antibodies deficiencies
•     Lung diseases
•     Certain malignant tumours
•     Certain type of skin diseases
•     inflammation of blood vessels

In children the disorder is difficult to detect and diagnose due to a wide range of probable causes.

Symptoms of Eosinophilia

Depending on the underlying cause, symptoms may vary from one person to another. Some common symptoms are,

•     Breathlessness and wheezing caused due to asthma
•     Fever, abdominal pain, diarrhea and rashes caused due to parasitic infections
•     Abscesses, pneumonia, mouth sores
•     Enlargement of lymph nodes, tingling and numbness due to nerve damage, night sweats and weight loss

All these are some of the common indicators of eosinophilia. These symptoms are however observed in very rare cases.

Diagnosis of eosinophilia

A simple blood test is sufficient to diagnose the disorder. A biopsy of the relevant tissue may be performed to diagnose the condition if the problem exists in a particular tissue. Alternatively a lumber puncture may be performed to examine the fluid from spine.

Lab studies are performed based on the following lines:

•     A complete blood count is performed to identify whether the problem exists
•     If the condition is caused due to a worm infection then a spinal fluid examination is carried out.
•     Imaging studies such as computed technology (CT) scan can be carried out to examine lungs, pelvis, abdomen etc. depending on the cause of the disorder.

Treatment for eosinophilia

After diagnosis of the disorder, treatment proceeds on the lines to identify cause of the eosinophilia. Physician may perform simple blood or skin test. Physicians essentially require the following information to decide the course of treatment:

    History of the diet and details of medication in order to find any possible allergic reactions
    Information related to travel history of the patient to identify if infection has occurred due to travelling or due to any infection endemic area.
    A complete detail of the history of symptoms

As a part of treatment physician may also carry out examination of brain, lymph nodes, skin, eyes, heart, spleen, liver, intestine and bones in detail.

Initially treatments are mostly oral and proceed primarily on the line of reducing symptoms.

Systemic therapy is used to treat allergic condition. Route of administration for this therapy is oral, intravenous or intramuscular. Alternative to this, a corticosteroid therapy may be carried out. This generally includes steroids like prednisolone. Many treatments aim to reduce the symptoms of eosinophilia significantly so that a person can lead a normal life.

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Unknown Causes, diagnosis, Eosinophils, Symptoms, Treatment

Viral Meningitis Diagnosis Treatment Prevention and Drug therapy

Meningitis is an inflammation of the meninges, the protective membranes that surround the brain and spinal cord.
Signs and Symptoms Viral Meningitis

The symptoms of viral meningitis differ from an infant to an adult.

In newborns, signs and symptoms include:

•     Irritability
•     High-pitched cry
•     Poor feeding
•     Vomiting
•     Fever
•     Seizures
•     Stiffness in neck (a rare problem)

In young children and adults, signs and symptoms include:

•     High fever
•     Severe headache
•     Vomiting or nausea
•     Stiff neck
•     Sensitivity to light
•     Drowsiness
•     Skin rash
•     Confusion
•     Seizures
•     Clouding or loss of consciousness

Diagnosis of viral meningitis

Viral meningitis can be diagnosed by some of the laboratory practices which include a test of spinal fluid obtained with a lumbar puncher (spinal tap). This test is performed by injecting a needle on the back of the patient and the fluid is taken and observed. This test is basically used to distinguish between the infections i.e. viral, bacterial or fungal. There are certain blood tests that need to be performed in order to determine viral meningitis.

Treatment of viral meningitis

There is no such specific treatment for viral meningitis, but there are some of the medications that can be used so as to reduce the effect of viral meningitis to a great extent. Treatment includes rest, hydration, anti-inflammatory medications, and antipyretics. There are different treatment options, which include:

    Prevention- Prevention can be done with proper vaccination against H. influenzae and mumps. Vaccination is given to children, since they have a weaker immune system. It is given to control epidemics in dormitories. Since viral meningitis is contagious, so it is important to wash your hand frequently, so as to reduce the risk of viral meningitis. It is also important to clean the contaminated surfaces with soap and water, in order to stop the spreading of viral meningitis.
    Drug therapy- The dose of the drug differs from one person to another. The treatment of viral meningitis aims at reducing the symptoms of fever and ache.  There are certain antibiotics that are given to the patient which includes ampicillin, cephalosporins, and trimethoprim-sulfamethoxazole. Corticosteroids are also prescribed by the doctor to reduce inflammation or irritation. If seizures occur, then diazepam or phenytoins are prescribed.
    Nutrition and supplements- There are several nutrients that can strengthen the immune system. It is recommended to take multivitamin daily which contains vitamins A, C, E, D, the B-complex vitamins. Omega-3 fatty acids are also prescribed to reduce inflammation and improve immunity. Coenzyme Q10 is prescribed to take at night (at bedtime), as an antioxidant and increase the immune system activity. Alpha-lipoic acid and Resveratrol should be taken twice a day, for antioxidant effects.

One thing should be kept in mind that any disease should not be ignored; rather if needed, take medical assistance. Viral meningitis is not a severe form of meningitis, but if left untreated can lead to a life threatening condition.

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Unknown diagnosis, prevention, Treatment, Viral Meningitis

Dehydration Symptoms Causes Diagnosis and Treatment Self-Care

Loss of Removal of fluid in the body this condition arises when the fluid intake fails to replace fluid loss.

Symptoms of dehydration
There are some of the mild symptoms of dehydration, which include:

•     Chills
•     Nausea
•     Vomiting
•     Swollen tongue
•     Severe headache
•     Wrinkled skin
•     Fatigue or weakness
•     Excessive sweating
•     Dizziness
•     Dry mouth
•     Increase in thirst
•     Low blood pressure
•     Decreased in urine output
•     Color of urine changes to deep yellow

There are some severe dehydration symptoms which include:

•     Seizure
•     Confusion
•     Muscle cramps
•     Unconsciousness
•     Increased heart rate
•     Inability to urinate
•     Difficulty in breathing
•     Decreased or painful urination
•     Increased body temperature

Causes of dehydration

There are certain causes of dehydration which are as follows:

•     High fever
•     Vomiting
•     Diarrhea
•     Exposure to heat
•     Excessive  exercise
•     An impaired ability to drink
•     No access to safe drinking water
•     Diseases such as diabetes
•     Increased urination due to infection
•     The inability to seek appropriate water and food
•     Significant injuries of skin, such as burns or mouth sores, or some serious skin diseases or infections

Diagnosis of dehydration

Dehydration can be either diagnosed by the patient’s past medical history or some physical examination. Usually physical examination includes heart rate, checking of blood pressure. Blood tests are required to determine the intensity of dehydration. It is also performed so that therapy for electrolyte replacement can be planned. Blood tests check the level of the electrolyte. Urine test is also performed to evaluate the severity of the loss of fluid. There are other laboratory tests that may be performed to determine its cause.

Dehydration Symptoms and Treatment Self-Care for dehydration

•     Increase in the intake of fruit juice
•     Avoid your skin from exposure to heat
•     Try to wear cotton and loose clothes in summer
•     Drink electrolyte-containing drinks, if dehydration occurs
•     Use a straw to sip, since if you have a jaw surgery or mouth sores
•     Use air-conditioners to keep the temperature of the room cool
•     Drink water at regular intervals of time, as it would keep the accurate level of water in the body
•     Avoid exposure to excessive cold as it will cause shivering, which will increase body temperature, and you might feel the opposite effect of it.

Diet for dehydration
There are certain dietary plans that should be considered for reducing the effect of dehydration, such as
    Increase in the intake of fruit juice and vegetable such as watermelons, strawberries, raisins, tomatoes and cucumbers
    Consume salad, as it will reduce the effect of dehydration
    Drink milk, coconut water, barley water, unsweetened fruit juices such as pomegranate juice, papaya juice etc.
    Avoid the use of alcohol or caffeine or other beverages
    Sucking on popsicles helps to reduce the problem of dehydration, especially in children

Dehydration symptoms and treatment are inter-related to each other and therefore it is important to have a regular check on that, especially in small children and elderly people. One thing should be kept in mind that, this condition should not be ignored at all, since it can lead to serious complication such as kidney failure, heat strokes, or other type of serious illness.

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Unknown Dehydration, diagnosis, Symptoms, Treatment

Polymyositis Pathophysiology Causes Diagnosis and Treatment

Polymyositis is one of a group of diseases termed idiopathic inflammatory myopathies. It is a rare condition with an incidence that is estimated to be from fewer than one to eight cases per million (Ruddy et al., 2001)

Pathophysiology

Polymyositis is classified as autoimmune because autoantibodies are present. However, these antibodies do not cause damage to muscle cells, indicating only an indirect role in tissue damage. The pathogenesis is multifactorial, and a genetic predisposition is likely. Drug-induced disease is rare. Some evidence suggests a viral link.

Signs and symptoms
Symptoms
 involve pain, with stained weakness and/or loss of muscle accumulation in the proximal musculature, especially in the shoulder and pelvic girdle. The hip extensors are often sternly influenced, guiding to particular intricacy in ascending stairs and getting up from a seated position. Coagulating of the skin on the fingers and hands (sclerodactyly) is a common characteristic; however, this is non-specific and appears in other autoimmune connective tissue ailments.

Dysphagia (trouble in swallowing) and/or other features of esophageal dysmotility take place in as many as 1/3 of patients. Low grade fever and peripheral adenopathy may be there. Foot drop in one or both feet may be a symptom of progressed polymyositis and inclusion body myositis. Polymyositis is also related with interstitial lung issues.

Polymyositis is connected to enlarge in the incidence of certain cancers especially non-Hodgkin lymphoma, bladder and lung cancers, but the overall involvement is weaker than in the associated condition dermatomyositis. The latter is connected to a significant increase in the risk of a range of malignancies including pancreatic, lung, and ovarian cancer.

Polymyositis tends to become marked in adulthood, representing with bilateral proximal muscle weakness repeatedly distinguished in the upper legs because of early fatigue while walking. Every so often the weakness display itself as an incapability to rise from a seated position without help or incapacity to raise the person’s arm above their head. The weakness is usually advanced, attended by lymphocytic inflammation.

Polymyositis, similar to dermatomyositis, appears in females with larger frequency in comparison with males. The skin participation of dermatomyositis is missing in polymyositis.

Causes of polymyositis-The origin of polymyositis is unidentified and may be multifactorial, maybe correlated to autoimmune features, genetics, and viruses. In exceptional cases, the reason is known to be infectious, related with the pathogens that cause Lyme disease, toxoplasmosis, and other infectious causes. Polymyositis generally is believed non-fatal in the absence of ILD.

It is assumed that an early injury leads to release of muscle auto antigen, which is consequently taken up by macrophages and offered to CD+4 TH cells. Triggered TH cells synthesize IFN-γ that excites added macrophages and inflammatory mediator discharge like IL-1 and TNF-α.

Another significant event in the pathogenesis of polymyositis is the augmented expression of MHC proteins by m/s cells. Auto-Ag is offered in relationship with MHC-I molecules and is accepted by CD8 cytotoxic T cells that consequently commence m/s devastation.

Diagnosis of polymyositis-diagnosis of polymyositis is multiple, including increase of creatine kinase, history and physical inspection, electromyograph (EMG) modification, and a helpful muscle biopsy. Sporadic inclusion body myositis (sIBM): This is often mistaken for polymyositis and dermatomyositis that does not react to treatment is probable IBM.

As IBM progresses on over months to years, polymyositis arrives on over weeks to months. It shows that sIBM and polymyositis communicate familiar features, particularly the preliminary sequence of immune system commencement, however, polymyositis does not show the following muscle deterioration and protein irregularities as observed in IBM. Polymyositis tends to react well to treatments, IBM does not. IBM and polymyositis actually involve different disorder mechanisms that are observed in dermatomyositis.

Laboratory findings may show presence of Anti Jo antibodies in over 65% patients. Raised serum creatine kinase is feature, but not particular to polymyositis.

Treatment for polymyositis-Characteristically, high-dose steroids are the treatment of option. Typically, muscle strength will perk up within four to six weeks. Indifferent patients may be evaluated other immunosuppressive medicines. IVIG has also revealed to be a helpful treatment. Specialized exercise therapy may enhancement treatment to improve quality of life.

It is advisable to consult a doctor if any of the above polymyositis symptoms occurs for early diagnosis and subsequent treatment.

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Unknown Causes, diagnosis, Pathophysiology, Treatment

Sepsis Symptoms Causes Diagnosing and Treating

Sepsis is related to medical condition and severe kind of illness due to bacteria and many microorganisms these Pathogens is caused several infection in bloodstream.

Symptoms of sepsis

•     disinterest or difficulty in feeding, or vomiting

•     fever (above 100.4° Fahrenheit [38° Celsius] rectally) or sometimes low, unstable temperatures

•     irritability or increased crankiness

•     lethargy (not interacting and listless)

•     decreased tone (floppiness)

•     changes in heart rate — either faster than normal (early sepsis) or significantly slower than usual (late sepsis, usually associated with shock)

•     breathing very quickly or difficulty breathing

•     periods where the baby seems to stop breathing for more than 10 seconds (apnea)

•     change in skin color — becoming pale or blue

•     jaundice (when the skin and eyes look yellow)

•     rash

•     decreased amount of urine

Causes of Sepsis

There are various causes for sepsis as the bacterial infection can originate from any of the organ. Some of them are described as under:

    Liver: This is one of the largest glandular organs in the human body. Its main function is filtration of toxins and breaking down fats. While filtration, many times some harmful chemicals are left and this gives rise to many problems. The blood count is affected by this.
    Kidney: This is also very important organ and the main function is the separation of harmful chemicals from blood. Many times, due to various factors the wastes are left in the body. This makes the blood impure. The impure blood can have improper blood count so a person becomes anemic.
    Gall Bladder: This pear shaped organ, stores and accumulates bile juices in the body. Gall Bladder is connected to the liver, which uses bile juices for the proper digestion of food. Bile juices help in breaking down the fats. Any problem in the bile secretion will affect the liver, which in turn affect other body fluids and blood. The irregularity in the blood cells raises the problem of anemia.
    Lungs: This is one of the main organs of our body and any problem in this affects the whole body as it directly affects the amount of oxygen in the body. The decrease in oxygen affects the count of red blood cells.

Diagnosing and Treating Sepsis

Blood tests (including white blood cell counts) and blood cultures may be taken to determine whether bacteria are present in the blood. Other blood tests may be done to see how well certain organs, such as the liver and kidneys, are functioning.
Urine is usually collected by inserting a sterile catheter into the baby's bladder through the urethra for a few seconds to remove urine; this will be examined under a microscope and cultured to check for the presence of bacteria.
A lumbar puncture (spinal tap) may be performed, depending on the baby's age and overall appearance. A sample of cerebrospinal fluid will be tested and cultured to determine if the baby could have meningitis.
X-rays, especially of the chest (to make sure there isn't pneumonia), are sometimes taken.
If the baby has any kind of medical tubes running into the body (such as IV tubes, catheters, or shunts), the fluids inside those tubes may be tested for signs of infection
Typically, doctors start infants with sepsis on antibiotics right away — even before the diagnosis is confirmed. If needed, they may start them on IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.

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Unknown Causes, diagnosis, Sepsis, Symptoms, Treatment