Stroke is a form of cardiovascular disease affecting the blood supply to the brain. Also referred to as cerebrovascular disease or apoplexy, strokes actually represent a group of diseases that affect about one out of five people in the United States.

In the US, approximately 40% of stroke deaths are in males, with 60% in females. According to the American Heart Association (AHA), in 2006, the stroke death rates per 100,00 population could be split into specific social groups at 41.7% for white males, 41.1% for white females, 67.7% for black males and 57.0% for black females.

Blood carries essential nutrients and oxygen to your brain. Without blood, your brain cells can be damaged or destroyed and they won’t be able to do their job.

Because your brain controls everything your body does, a stroke will affect the way your body functions. For example, if a stroke damages the part of your brain that controls your right leg, then you may have weakness or numbness in that leg. Your brain also controls how you think, learn, feel and communicate. A stroke is sudden and the effects on your body are immediate.

How does Stroke happen?

There are two main types of stroke. The most common type of stroke (about 85% of cases) is caused by a blockage. This is called an Ischaemic stroke and may be caused when –

• Cerebral Thrombosis – A blood clot forms in a main artery to the brain.
• Cerebral Embolism – A blockage, usually a blood clot from the heart, is carried in the bloodstream to one of the arteries supplying the brain.
• Lacunar Stroke – A blockage forms in the tiny blood vessels deep within the brain.

Ischemic strokes may also be caused by a sticky substance called plaque that can clog arteries.

Some strokes are caused by bleeding in or around the brain. This type of stroke is called a Haemorrhagic stroke. It may be caused when –

• A blood vessel bursts within the brain (an intracerebral haemorrhage), or
• A blood vessel on the surface of the brain bursts, causing bleeding into the area between the brain and the skull (called a subarachnoid haemorrhage).

Hemorrhagic strokes may also occur when someone is taking blood thinners, such as warfarin (Coumadin). Very high blood pressure may cause blood vessels to burst, leading to hemorrhagic stroke.

An ischemic stroke can develop bleeding and become a hemorrhagic stroke.

Other Causes

High blood pressure is the main risk factor for strokes. The other major risk factors are:

• Atrial fibrillation
• Diabetes
• Family history of stroke
• High cholesterol
• Increasing age, especially after age 55
• Race (black people are more likely to die of a stroke)
• Stroke risk is also higher in:
• People who have heart disease or poor blood flow in their legs caused by narrowed arteries
• People who have unhealthy lifestyle habits such as smoking, a high fat diet, and lack of exercise
• Women who take birth control pills (especially those who smoke and are older than 35)

A transient ischaemic attack (also called a TIA or mini-stroke) happens when there is a temporary blockage in the blood supply to the brain. A TIA doesn’t cause permanent damage to your brain and the symptoms usually pass within 24 hours.

It’s often hard to tell the difference between a stroke or TIA, so if you think someone is having a TIA you should still call 999. A TIA can be an important warning that there is a problem with the blood supply to your brain.

Risk Factors

Age – The older a person gets, the greater the risk of stroke.

Sex – Men are 30% more likely to have a stroke than women. But after menopause, a woman’s risk of stroke rises significantly.

Family history – Having a parent, grandparent, or sibling who has had a stroke, puts you at greater risk yourself.

Race – African-Americans have a greater risk of stroke than Caucasians. This is related to an increased risk of high blood pressure, obesity, and diabetes in African-Americans.

Heart attack – If you have had a heart attack in the past, you are more likely to have a stroke than someone who has not had a heart attack.

A history of migraine headaches – Recent studies indicate that people with migraines may be at higher risk for ischemic stroke.

A prior stroke – If you have had a stroke, you are at increased risk for another.

Sickle cell anemia – People with this condition are at risk for stroke at a younger age.

Berry aneurysms – Some people are born with small, sac-like areas within the wall of an artery in the brain. They occur most often at the junctures of vessels at the base of the brain. Berry aneurysms may rupture without warning, causing bleeding within the brain.

Symptoms

The symptoms of stroke depend on which part of the brain is damaged. In some cases, a person may not know that a stroke has occurred.

Most of the time, symptoms develop suddenly and without warning. However, symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

• A headache may occur if the stroke is caused by bleeding in the brain. The headache:
• Starts suddenly and may be severe
• May be worse when you are lying flat
• Wakes you up from sleep
• Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include –

• Change in alertness (including sleepiness, unconsciousness, and coma)
• Changes in hearing
• Changes in taste
• Changes that affect touch and the ability to feel pain, pressure, or different temperatures
• Clumsiness
• Confusion or loss of memory
• Difficulty swallowing
• Difficulty writing or reading
• Dizziness or abnormal feeling of movement (vertigo)
• Eyesight problems, such as decreased vision, double vision, or total loss of vision
• Lack of control over the bladder or bowels
• Loss of balance
• Loss of coordination
• Muscle weakness in the face, arm, or leg (usually just on one side)
• Numbness or tingling on one side of the body
• Personality, mood, or emotional changes
• Trouble speaking or understanding others who are speaking
• Trouble walking

Treatment

People who are having stroke symptoms need to get to a hospital as quickly as possible.

If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.

To be effective, this treatment must be started within 3 to 4 1/2 hours of when the symptoms first started. The sooner this treatment is started, the better chances of a good outcome.

Other treatments given in the hospital will depend on the cause of the stroke. These may include:

Blood thinners such as heparin, warfarin (Coumadin), aspirin, or clopidogrel (Plavix)

Medicine to control risk factors, such as high blood pressure, diabetes, and high cholesterol.

Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital. If the person has severe swallowing problems, a feeding tube in the stomach (gastrostomy tube) will likely be needed.

Medications –

Aspirin – Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming.

Intravenous injection of tissue plasminogen activator (TPA) – Some people can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase. An injection of TPA is usually given through a vein in the arm. This potent clot-busting drug needs to be given within 4.5 hours after stroke symptoms begin if it’s given in the vein.

Statins – If the level of cholesterol in the blood is too high, patient will be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in the blood by blocking an enzyme (chemical) in the liver that produces cholesterol.

Antihypertensives – If the blood pressure is too high, patient may be offered medicines to lower it. Medicines that are commonly used include –

• thiazide diuretics
• angiotensin-converting enzyme (ACE) inhibitors
• calcium channel blockers
• beta-blockers
• alpha-blockers

Surgeries

• Carotid endarterectomy
• Angioplasty and stents
• Surgical clipping
• Coiling (endovascular embolization)
• Surgical AVM removal
• Intracranial bypass
• Stereotactic radiosurgery

Alternative treatment

Alpha-lipoic acid – Alpha-lipoic acid works together with other antioxidants, such as vitamins C and E. It is important for growth, helps to prevent cell damage, and helps the body rid itself of harmful substances. Because alpha-lipoic acid can pass easily into the brain, it has protective effects on brain and nerve tissue and shows promise as a treatment for stroke and other brain disorders involving free radical damage.

Calcium – In a population based study (one in which large groups of people are followed over time), women who take in more calcium, both through the diet and supplements, were less likely to have a stroke over a 14 year period.

Folic Acid, Vitamin B6, Vitamin B12, and Betaine – Many clinical studies indicate that patients with elevated levels of the amino acid homocysteine are as much as 2.5 times more likely to suffer from a stroke than those with normal levels. Homocysteine levels are strongly influenced by dietary factors, particularly vitamin B9 (folic acid), vitamin B6, vitamin B12, and betaine. These substances help break down homocysteine in the body.

Magnesium – Population based information suggests that people with low magnesium in their diet may be at greater risk for stroke.

Omega-3 Fatty Acids – Strong evidence from population-based studies suggests that omega-3 fatty acid intake (primarily from fish) helps protect against stroke caused by plaque buildup and blood clots in the arteries that lead to the brain.

Potassium – Although low levels of potassium in the blood may be associated with stroke, taking potassium supplements does not seem to reduce the risk of having a stroke.

Vitamin C – Having low levels of vitamin C contributes to the development of atherosclerosis and other damage to blood vessels and the consequences, such as stroke. Vitamin C supplements may also improve cognitive function if you have suffered from multiple strokes.

Vitamin E – Eating plenty of foods rich in vitamin E, along with other antioxidants like vitamin C, selenium, and carotenoids, reduces your risk for stroke. In addition, low levels of vitamin E in the blood may be associated with risk of dementia (memory impairment) following stroke.

Coenzyme Q10 – works as an antioxidant and may reduce damage following a stroke. CO Q10 may interfere with some blood-thinning medicines, such as warfarin (Coumadin) and others.

Selenium – low levels can worsen atherosclerosis and its consequences. However, it is not known if taking selenium supplements will help.

Bilberry – A close relative of the cranberry, bilberry fruits contain flavonoid compounds called anthocyanidins. Flavonoids are plant pigments that have excellent antioxidant properties.

Garlic – Clinical studies suggest that fresh garlic and garlic supplements may prevent blood clots and destroy plaque. Blood clots and plaque block blood flow and contribute to the development of heart attack and stroke. Garlic may also be beneficial for reducing risk factors for heart disease and stroke like high blood pressure, high cholesterol, and diabetes.

Ginkgo – Gingko may reduce the likelihood of dementia following multiple strokes (often called multi-infarct dementia). The protection from ginkgo may be related to the prevention of platelet adhesion which can help prevent blood clot formation. Most health care providers choose to use medications for this effect rather than herbs.

Ginseng – Asian ginseng may decrease endothelial cell dysfunction. Endothelial cells line the inside of blood vessels. When these cells are disturbed, referred to as dysfunction, it may lead to a heart attack or stroke.

Acupuncture – Many studies have been conducted on the effects of acupuncture during stroke rehabilitation. These studies show that acupuncture reduces hospital stays and improves recovery speed. Acupuncture has been shown to help stroke patients regain motor and cognitive skills and to improve their ability to manage daily functioning.

Chiropractors do not treat stroke, and high velocity manipulation of the upper spine is considered inappropriate in individuals who are taking blood-thinning medications or other medications used to reduce the risk of stroke.

Reference –

https://www.nice.org.uk/guidance/cg68/chapter/Introduction#drugs

http://www.nhs.uk/Conditions/Stroke/Pages/treatment.aspx

http://www.stroke.org.nz/preventing-stroke-translations

http://www.stroke.org.nz/preventing-stroke-translations

http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/@sta/documents/downloadable/ucm_452860.pdf

https://www.nlm.nih.gov/medlineplus/stroke.html

https://www.stroke.org.uk/

http://www.stroke.org/understand-stroke/what-stroke

http://www.emedicinehealth.com/stroke/article_em.htm

http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483935/k.736A/Stroke__What_is_Stroke.htm

Migraines are a type of recurring severe headache that can cause you to have time off work and need to rest in bed. They are often accompanied by feeling sick, vomiting or an increased sensitivity to light.

It’s estimated that about 36 million Americans suffer from migraine, but only 1 of every 3 people talk with a doctor about their headaches. Of those, only half get the right diagnosis.

Women are roughly three times more likely to get migraines than men. About four in every 20 women get migraines, while only about one in every 20 men do. You can get migraines for the first time at any age, but they commonly start during the teenage years.

In general, a migraine is a very bad headache that tends to come back. It may occur as often as several times a week or only once every few years. It can last anywhere from a few hours to 3 days. The pain usually begins in the morning, on one side of the head. (In fact, the word migraine is derived from a Greek word that means “half-head.”) Less frequently, the entire head is swallowed up by pain.

The amount of pain can vary. Some migraines can be fairly mild, while others seem almost unbearable. Obviously, the worse the pain, the more trouble you have carrying out daily activities, whether it’s going to work or simply getting out of bed. Of course, different people have different abilities to put up with pain. For some people, even a mild migraine can force them to lie down; others are able to work through a more severe migraine.

Two types of migraines

While there are many variations, there are two main types of migraines –

Migraine without aura (previously called common migraine) – Almost 80 percent of migraine sufferers have this type of migraine.

Migraine with aura (previously called classic migraine) – This type of migraine announces itself about a half-hour before the onset of head pain with an aura.

Aura is a term used to describe the visual or sensory symptoms that some people get when their migraine is starting. The following are less common types of migraine –

• Retinal migraines are headaches associated with visual changes in one eye only.
• Abdominal migraines are associated with stomach pains, and happen more often in children.
• Menstrual migraines can happen in women two days before their period starts or finishes.
• Status migrainosus are migraines that can last for a few weeks.

Migraine is a medical condition that can have a big effect on your life and others caring for you. It can affect your daily life and can mean taking time off work or school.

Causes

There are many theories that discuss the causes of migraine. The cortical spreading depression (CSD) theory suggests that migraine is a disease of the brain such as angina is a disease of the heart. Disruption of normal brain functioning is believed to be the underlying cause of the migraine pain and aura. Another theory is the vascular theory which suggests that migraines result from the widening of blood vessels surrounding the brain. The chemical serotonin is also thought to play an important role in migraine development. While the precise cause of migraines remains unknown, a number of potential migraine triggers (habits or conditions associated with the onset of a migraine) have been identified.

Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include –

• Allergies and allergic reactions
• Bright lights, loud noises, flickering lights, smoky rooms, temperature changes, strong smells and certain odors or perfumes
• Physical or emotional stress, tension, anxiety, depression, excitement
• Physical triggers such as tiredness, jet lag, exercise
• Changes in sleep patterns or irregular sleep
• Smoking or exposure to smoke
• Skipping meals or fasting causing low blood sugar
• Dehydration
• Alcohol
• Hormonal triggers such as menstrual cycle fluctuations, birth control pills, menopause
• Tension headaches
• Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs and salami)
• Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products and fermented or pickled foods
• Medication such as sleeping tablets, the contraceptive pill, hormone replacement therapy.
• A higher percentage of obese people have episodic (occasional) migraines compared to individuals with a healthy body weight.
• Sudden weather changes, including a drop in barometric pressure or changes in temperature, humidity, or wind
• Loud noises
• Perfumes or fumes
• Secondhand smoke
• Exposure to glare or flickering lights

Symptoms

Migraine symptoms may begin one to two days before the headache itself. This is known as the migraine’s prodrome stage. Symptoms include –

• Food cravings
• Depression
• Fatigue or low energy
• Frequent yawning
• Hyperactivity
• Irritability
• Neck stiffness

Some people may also experience an aura after the prodrome stage. An aura causes visual, motor, and/or speech disturbances, such as –

• Difficulty speaking clearly
• Feeling a prickling or tingling sensation in the arms and legs
• Flashes of light
• Seeing shapes, light flashes or bright spots
• Transient vision loss

The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine occurs. Attack phase symptoms can last anywhere from four hours to three days. Symptoms of a migraine can vary from person to person. Some symptoms may include –

• Feeling dizzy or faint
• Increased sensitivity to light and sound
• Nausea
• Pain on one side of the head
• Pulsing and/or throbbing pain
• Vomiting

Risk Factors

Family history – You are much more likely to have migraines if one or both of your parents had migraines.

Sex – Women are more likely than men to have migraines.

Age – Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.

Treatment 

Medications

Analgesia – Over-the-counter medications such as naproxen, ibuprofen, acetaminophen (paracetamol), and other analgesics like Excedrin (aspirin with caffeine) are often the first abortive therapies to eliminate the headache or substantially reduce pain.

Anti-emetics – Metoclopramide may also be used to control symptoms such as nausea and vomiting.

Serotonin agonists – Sumatriptan may also be prescribed for severe migraines or for migraines that are not responding to the over-the-counter medications. Antidepressants such as tricyclics – are prescribed to reduce migraine symptoms although they are not approved in all countries for this purpose.

Ergots – Another class of abortive treatments is called ergots, which are usually effective if administered at the first sign of a migraine.

Alternative Treatment

5-hydroxytryptophan – Body makes the amino acid 5-HTP and converts it into serotonin, an important brain chemical. Researchers think abnormal serotonin function in blood vessels may be related to migraines, and some of the drugs used to treat migraines work by affecting serotonin.

Magnesium – People with migraines often have lower levels of magnesium than people who do not have migraines, and several studies suggest that magnesium may reduce the frequency of migraine attacks in people with low levels of magnesium.

Vitamin B2 – A few studies indicate that riboflavin may reduce the frequency and duration of migraines. In one study, people who took riboflavin had more than a 50% decrease in the number of attacks.

Coenzyme Q10 – CoQ10 can interact with several medications including blood thinners such as warfarin (Coumadin), some cancer medications, and medications for high blood pressure.

Melatonin – Melatonin can interact with a number of medications, so ask your doctor before taking it.

Butterbur – A few studies suggest that butterbur may help reduce both the frequency and duration of migraine attacks when taken on a regular basis for up to 4 months. More research is needed to see whether butterbur is really effective at preventing migraines.

Feverfew – Feverfew has been used traditionally to treat headaches, and several well-designed studies have found that it may help prevent and treat migraines.

Acupuncture has been studied as a treatment for migraine headache for more than 20 years. While not all studies have shown it helps, researchers agree that acupuncture appears safe, and may work for some people.

Chiropractic – In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation worked as well as Elavil in reducing migraines and had fewer side effects. Combining the 2 therapies didn’t work any better.

Reflexology is a technique that places pressure on specific “reflex points” on the hands and feet that are believed to correspond to areas throughout the body. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication.

Reference –

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine

http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/treatment/con-20026358

http://www.medicinenet.com/migraine/article.htm

http://www.migraine.org.uk/get-involved/events

https://www.acponline.org/patients_families/pdfs/health/migraine.pdf

http://familydoctor.org/familydoctor/en/diseases-conditions/migraines.html

http://www.migraines.org/myth/mythreal.htm

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine

The metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood pressure. When a patient presents with these risk factors together, the chances for future cardiovascular problems are greater than any one factor presenting alone.

The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase the chance of developing a disease.

Metabolic syndrome is a serious health condition that affects about 34 percent of adults and places them at higher risk of cardiovascular disease, diabetes, stroke and diseases related to fatty buildups in artery walls. The underlying causes of metabolic syndrome include overweight and obesity, physical inactivity and genetic factors.

The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome. According to a national health survey, more than one in five Americans has metabolic syndrome. The number of people with metabolic syndrome increases with age, affecting more than 40 percent of people in their 60s and 70s.

Causes

Metabolic syndrome has several causes that act together. A person can control some of the causes, such as overweight and obesity, an inactive lifestyle, and insulin resistance.

People can’t control other factors that may play a role in causing metabolic syndrome, such as growing older. The risk for metabolic syndrome increases with age.

People also can’t control genetics (ethnicity and family history), which may play a role in causing the condition. For example, genetics can increase the risk for insulin resistance, which can lead to metabolic syndrome.

People who have metabolic syndrome often have two other conditions: excessive blood clotting and constant, low-grade inflammation throughout the body. Researchers don’t know whether these conditions cause metabolic syndrome or worsen it.

Researchers continue to study conditions that may play a role in metabolic syndrome, such as –

• A fatty liver (excess triglycerides and other fats in the liver)
• Polycystic ovarian syndrome (a tendency to develop cysts on the ovaries)
• Gallstones
• Breathing problems during sleep (such as sleep apnea)

Risk Factors

The following factors increase the chances of having metabolic syndrome –

• Age – The risk of metabolic syndrome increases with age, affecting 40 percent of people over the age of 60.
• Race – Hispanics and Asians seem to be at greater risk of metabolic syndrome than are people of other races.
• Obesity – Carrying too much weight increases the risk of metabolic syndrome
• Diabetes – People are more likely to have metabolic syndrome if they had diabetes during pregnancy (gestational diabetes) or if they have a family history of type 2 diabetes.
• Other diseases – The risk of metabolic syndrome is higher if people have ever had cardiovascular disease, nonalcoholic fatty liver disease or polycystic ovary syndrome.

Symptoms

Clinical manifestations of metabolic syndrome include the following –

• Hypertension
• Hyperglycemia
• Hypertriglyceridemia
• Reduced high-density lipoprotein cholesterol (HDL-C)
• Abdominal obesity
• Chest pains or shortness of breath: Suggesting the rise of cardiovascular and other complications
• Acanthosis nigricans, hirsutism, peripheral neuropathy, and retinopathy: In patients with insulin resistance and hyperglycemia or with diabetes mellitus
• Xanthomas or xanthelasmas: In patients with severe dyslipidemia

Complications

• Arteriosclerosis – This happens when cholesterol hardens and begins to build up in the walls of arteries, causing blockages that can lead to high blood pressure, heart attack, and stroke.
• Poor kidney function – The kidneys become less able to filter toxins out of the blood, which can also increase the risk of high blood pressure, heart attack, or stroke.
• Insulin resistance – This occurs when the body’s cells don’t respond to insulin (the hormone that helps to regulate sugar in the blood) normally, and that can lead to high blood sugar levels and diabetes.
• Polycystic ovarian syndrome – Thought to be related to insulin resistance, this disorder involves the release of extra male hormones by the ovaries, which can lead to abnormal menstrual bleeding, excessive hair growth, acne, and fertility problems. It is also associated with an increased risk for obesity, hypertension, and — in the long-term — diabetes, heart disease, and cancer.
• Acanthosis nigricans – A skin disorder that causes thick, dark, velvet-like patches of skin around the neck, armpits, groin, between the fingers and toes, or on the elbows and knees.

Treatment

Lose weight – Moderate weight loss, in the range of 5 percent to 10 percent of body weight, can help restore your body’s ability to recognize insulin and greatly reduce the chance that the syndrome will evolve into a more serious illness. This can be done via diet, exercise, or even with help from certain weight-loss medications if recommended by your doctor.

Exercise – Increased activity alone can improve your insulin levels. Aerobic exercise such as a brisk 30-minute daily walk can result in a weight loss, improved blood pressure, improved cholesterol levels and a reduced risk of developing diabetes. Most health care providers recommend 150 minutes of aerobic exercise each week. Exercise may reduce the risk for heart disease even without accompanying weight loss.

Consider dietary changes – Maintain a diet that keeps carbohydrates to no more than 50 percent of total calories. Eat foods defined as complex carbohydrates, such as whole grain bread (instead of white), brown rice (instead of white), and sugars that are unrefined (instead of refined; for example cookies, crackers).

Alternative Treatment

Reference –

http://umm.edu/health/medical/ency/articles/metabolic-syndrome

http://www.liebertpub.com/overview/metabolic-syndromebrand-related-disorders/115/

https://my.clevelandclinic.org/health/diseases_conditions/hic_Metabolic_Syndrome

http://patient.info/doctor/metabolic-syndrome

http://www.emedicinehealth.com/metabolic_syndrome/article_em.htm

http://www.liebertpub.com/editorialboard/metabolic-syndromebrand-related-disorders/115/

http://www.heart.org/HEARTORG/Conditions/More/MetabolicSyndrome/Metabolic-Syndrome_UCM_002080_SubHomePage.jsp

http://www.nhlbi.nih.gov/health/health-topics/topics/ms

https://www.pritikin.com/your-health/health-benefits/reverse-metabolic-syndrome/1381-metabolic-syndrome-cleaning-up-a-mess.html

http://familydoctor.org/familydoctor/en/diseases-conditions/metabolic-syndrome.html