Diseases Related to the Human Body Systems

The human body has several systems that function together to help everyday activities happen. Sometimes these individual systems can become impaired by an outside source causing the creation of a disease within the system. The four systems and their related diseases that will be discussed are: the nervous system- Parkinson’s disease and Cerebral Palsy, the circulatory system- Atherosclerosis and Arrhythmia, the respiratory system- Cystic Fibrosis and Pneumonia, and the excretory system- Bright disease and Uremia. All of these diseases have their own signs, symptoms, treatments, and prognosis; which will be discussed in further detail one system and disease at a time.

The Nervous System

The nervous system is an essential part of the body that helps humans not only thing but act as well. The system is made up of a collection of nerves and neurons to send signals to different parts of the body. The nervous system is made up of two different systems: the central nervous system and the peripheral nervous system. The brain, spinal cord, and nerves make up the central nervous system. Clusters of neurons (ganglia), sensory neurons, and nerves that connect to the central systems and to other nerves are all included in the peripheral nervous system. When relating to function the system shave two subdivisions: somatic and automatic. These are also known as voluntary and involuntary. Automatic relates to things that are done without thought, such as the beating of the heart and blood flow. Somatic relates to things that are controlled, such as movement, which is why this subdivision has the connection of the brain and spinal cord to muscles and sensory receptors.

Parkinson’s disease

Neurodegenerative disorders are diseases that cause the loss of brain cells and celling within the spinal cord. Over time, the loss of these cells causes dysfunction and disability. An example of this disorder is Parkinson’s disease. This disease affects an area of the brain called the substantia nigra. This area is part of the basal ganglia, which is where dopamine cells are produced. Parkinson’s disease affects the dopamine producing neurons in this specific area of the brain. The cause of this disease is unknown but thought to be associated with the exposure to chemicals.

There are several signs of the development of Parkinson’s disease but not all are present or noticeable. Listed below are a few of the common symptoms that are looked for when diagnosing Parkinson’s disease: 1) Micrographia is small and cramped handwriting. A change in letter sizes and crowded words is a sign Parkinson’s disease when the change is unrelated to aging. If there is a stiffness in the hand or fingers and poor vision, then the change is likely due to getting older. 2) The loss of smell is associated with the development of Parkinson’s disease. A trouble in smelling bananas, dill pickles, or licorices is what doctors look out for when diagnosing for this disease. 3) Constipation, difficulty passing bowel movements without staining, is an early sign of Parkinson’s disease. If there is a constant intake of fiber and no pain medications in the diet, then there should be no constant constipation.

Parkinson’s is known to be a very diverse disease causing the symptoms to vary from person to person. Generally, symptoms are developed slowly over the span of years. Common symptoms are tremor, bradykinesia, limb rigidity, and gait and balance problems. Tremor is the involuntary shaking of the hands, arms, legs, and other parts of the body. There are two types of tremor: pill-rolling and resting tremor. Pill-rolling is described as the motion of rolling a small round object between two fingers. Resting tremor is more of a sensation than actual movement. It is reported as felling the shaking movement inside the body, common places are the chest and legs. Bradykinesia is the slowing of movement. This can range from walking to writing. Limb rigidity refers to the stiffening of the arms and legs. It differs from the results of aging and arthritis. It is best described as the tightening of the limbs. Gait is the way someone walks. Someone who has developed Parkinson’s disease can have difficulty walking or difficulty continuing to walk when in the middle of doing so.

Parkinson’s has an unknown cause. There is no cure but there are various treatment pathways, some of which are medications and surgery. There is ongoing research to find biomarkers that will lead to an earlier diagnosis and a treatment plan that will be more effective from patient to patient to slow down the disease. The current course of treatments improves or lessen the symptoms being experiences but fail to slow the process or growing of the disease itself. Parkinson’s is not considered to be a fatal one but can have serious complications. Complications of Parkinson’s disease is the 14

^th

cause of death in the United States of America.

Cerebral Palsy

A developmental disorder called Cerebral palsy, also known as CP, is the leading cause of disabilities in young children. This disorder is a result of brain injury that can be acquired during birth or fetal development. This can be a hard disease to diagnose due to it affecting the coordination and independent movement of the child. The injury is not always diagnosed quickly due to the time it takes to notice the symptoms, even more so when the symptoms are mild. When relating to children, parents notice something is wrong when babies do not meet developmental milestones, such as: rolling over, crawling, walking

Some children are diagnosed as late as toddlers. When there is damage to the motor cortex of the brain, cerebral palsy is developed. The motor cortex is the part of the brain that has muscle control and coordination of the body.

Symptoms can vary from person to person based on the severity of the patient. Some of them take longer to develop. Some are seen as early as five months and other won’t be noticed until later during the toddler ages. The commonalities of them all are the struggle with fine motor skills and walking. If there are other conditions within a patient the complexity of the disease can increase. Some of the coexisting conditions are epilepsy, vison problems, and cognitive disability. This isn’t a disease with a well-defined list of symptoms. This leads to many unknown things and a difficult condition to understand.

Due to this disease being such a complicated and difficult one to understand not much to do to help. There is no cure for this disease, but there are treatment plans to help improve the quality of life for those who are diagnosed with cerebral palsy. Treatment plans can help prevent worsening conditions and secondary symptoms to develop. The overall idea is to provide the best possible life for a child that has been diagnosed.

The Circulatory System

The circulatory system in a network that uses several components in the body and controls several others. These organs and vessels involved are responsible for the flow of substances throughout the body. There substances include blood, nutrients, hormones, oxygen, and other gases. These substances are transported from cell to cell throughout the body to fit the individual needs of them separately. There is a process called homeostasis which enables the body to fight against disease or maintain the proper temperature and pH within the internal environment.

Atherosclerosis

A substance, that can be sticky, made of fat, cholesterol, calcium, and other things found in the blood stream is called plaque. When this plaque builds up inside the arteries it is a disease called Atherosclerosis. With this disease, the plaque hardens over time and causes the arteries to become narrower. This causes a limited amount of oxygen-rich blood to be distributed throughout the body. This disease should not be taken lightly as it can lead to other serious disease, such as coronary artery disease, carotid artery disease, and peripheral arterial disease. Coronary artery disease can cause a heart attack due to the blocking of the arteries that supply blood to the heart. Carotid artery disease can cause a stroke due to the blocking of blood flow to the brain. Peripheral arterial disease can cause numbness, pain, and infection in the limbs due to the blocking of the arteries that supply blood to these body parts. Symptoms for atherosclerosis are not usually seen or noticed until the arteries are very narrow or completely blocked. In most cases, patients don’t know they have the disease until a medical emergency has happened.

Test such as physical exams, diagnostic test, and imaging are required to be done in order to be diagnosed with the disease. There isn’t a cure necessarily, but there are ways to help manage the disease. These can go from simple changes to heavy ones. The heavy one would be getting an angioplasty, which is done to open the arties. This can also be done on the coronary and carotid arteries. The simple changes are the ones that relate to life style changes. Things that can help are healthy eating, regular exercise, not smoking, and managing the stress level of the patient.

Arrhythmia

Arrhythmia is also known as an irregular heartbeat. It affects the rate in the rhythm of your heartbeat. This can vary from the heart rate being too fast or too slow causing an irregular heart pattern. Tachycardia is the name used when the heart is beating at a rate considered faster than what is known to be normal. Bradycardia is what it is called when the heart is seen to be beating at a rate slower than what is considered to be normal. An irregular and faster hear beat is the mast common arrhythmia and it is called atrial fibrillation. There are several factors that can cause a change in the heart’s rhythm. These things can be having a heart attack, excessive smoking, congenital heart defects and even stress. Sometimes even medications and other substances can cause arrhythmias.

Symptoms can be seen through the use of test that a doctor can perform on a patient. The more obvious one is the speed of the heartbeat, ranging from fast and slow. In some cases, the heart can skip a beat causes the blood flow to the lungs and body to be thrown off and lessened. Being lightheaded or dizzy and be an effect from the lack of blood flow and oxygen to the brain. Chest pain is a direct result from an irregular heart. Shortness of breath can be causes by the lack of blood and oxygen going to the lungs. The last common system is sweating to cool the body due to the lack of oxygen throughout the body, causing it hard to breath and a rise in body temperature.

A series of test must be run in order to diagnose arrhythmia. There are treatments to help maintain a normal heart rhythm. Sometimes heart medication can help and in other cases an implantable cardioverter-defibrillator, also known as an ICD or a pacemaker. This just regulates the heartbeat by sending a signal to tell it to beat on command. In extreme cases surgery may be necessary.

The Respiratory System

The respiratory system is responsible for the gas exchanging of taking in oxygen and releasing carbon dioxide out of the body. The primary organs are the lungs, which does the exchange of gasses as breathing takes place. The lungs and red blood cells work together by getting oxygen where it is needed in the body and carbon dioxide back to the lungs to be exhaled. Oxygen is one of the primary resources the human body needs to survive.

Cystic Fibrosis

Cystic fibrosis is a genetic disease that leads to constant lung infections and causes restricted breathing overtime. The trouble is from the buildup of thick and sticky mucus. This is from the dysfunctionality of the CFTR protein. When the protein messes up in the body it can’t move chloride within salt to the surface of the cell. Chloride is supposed to attract water, but without it at the cell surface it causes mucus to form on various organs. When the lungs have mucus, it can clog the pores and create a way for germs to get stuck on the lung. Sometimes bacteria can get stuck to the lungs and cause inflammation. Infection, and even respiratory failure. Due to how easy it is for germs to get stuck; it is important for patients with cystic fibrosis to avoid contamination as much as possible. The mucus can all so buildup on the pancreas, preventing digestive enzymes to be released, and on the liver, which can cause liver disease by blocking the bile duct.

Symptoms in patients with cystic fibrosis can vary but the many that are seen are as followed: salty skin, heavy cough (sometimes with phlegm), consistently having lung infections (such as pneumonia), shortness of breath, malnutrition, frequent bowel movements. There are several ways to test for this disease. Some of which are a newborn screening, a sweat test, and a genetic test since it is a genetic disease that is passes down from parents. Just like the symptoms, the treatments vary from patient to patient. Usually, people with CF do through more than one treatment at a time. Some of the include clearing the airway to loosen mucus, enzyme supplements to promote absorption of vital nutrients, and medications that are inhales that thin the mucus and open airways. Cystic fibrosis is a non-curable disease but has a lot of research being done to help further the knowledge to better treatment plants. Due to the varying disease, it is possible for a CF patient to have an almost normal and happy life.

Pneumonia

Pneumonia is an infection in the lungs that cause inflammation in the alveoli (the lungs’ air sacs). Alveoli can fill with fluids or pus, which may cause several symptoms such as a cough, fever, chills, and difficulty breathing. The cough can have mucus that varies from green to bloody. There may even be sharp chest main that progressively gets worse as the patient breaths. There are multiple facts that are considered on how the body will react to having pneumonia. Some of the things are age, health, and the organism causing the infection.

The symptoms of pneumonia often resemble those of the flu and a strong cold. It is because of this that it can be hard to diagnose at times. In order to diagnose the disease a medical history will be charted, a physical exam will be performed, and multiple test will be run. Some of the test are blood test, chest x-rat, and sputum test (sample of mucus). When looking at treatments, the main goal is to cure the infection and prevent further complication. When a bacterium is causing the infection and antibiotic is given. If it is viral pneumonia an antiviral medication is used to treat it.

The Excretory System

The primary responsibility of the excretory system is to expel the waste within the body. The waste is seen to be unnecessary materials from the body and its organisms. The organs that are involved in this process are the lungs, kidneys, lives, and sweat glands. The excretory system also works with the digestive system to discharge the waste from the body.

Bright Disease

Bright disease is now known as glomerulonephritis. This is the inflammation of the glomeruli. The glomeruli are in the kidneys and are the foundations of small blood vessels. The vessels help filter the blood and remove unnecessary fluids. If the glomeruli are damages, it can cause the kidneys to stop working properly and eventually lead to kidney failure. There are two types of glomerulonephritis: acute and chronic. The symptoms of acute are blood in the urine, urinating less often, high blood pressure, fluid in the lungs, and swelling in the face. For chronic the symptoms are blood or protein in the urine, high blood pressure, swelling in the ankles, constant nosebleeds, and pain in the abdomen.

To diagnose bright disease a urinalysis test must be done first. The blood and protein within in the urine are key markers for having the disease. These tests look for osmolarity, red blood cells, concentration of urine, and total protein. Blood test can also be done and may show anemia (low red blood cells count), high creatinine levels, abnormal albumin levels and blood urea nitrogen. The main treatment that is seen is the control of the blood pressure. This is a main cause which is why it is necessary to control. If the disease is advances and is leading to kidney failure, then dialysis will need to be performed. Dialysis is the use of a machine to filter the blood but is not a permanent fix. A kidney transplant will be needed.

Uremia

Uremia can be life threatening if left untreated. It happens when the kidneys are damaged. Usually the damage done to the kidneys at this point cannot be reversed. This disease means that the kidneys can’t filters the waste any longer. Instead of sending toxins and waste out through urine, the kidneys send it to the bloodstream. The toxins are better known as creatinine and urea. Uremia is the last stage for chronic kidney disease and a symptom of renal failure. Uremia can come with other symptoms such as fatigue, leg cramps, head pain, nausea, and difficulty concentrating.

One of the only treatments at this point in kidney damage is dialysis. Dialysis is the use of a machine to filter the blood to remove waste products, toxins, and unnecessary substances from the bloodstream. Once the patient reaches end stage renal failure a kidney transplant is necessary. This is when a healthy kidney is placed in place of the failing one in the patient. In order to ensure the body takes the kidney the patient will be placed on antirejection medicine to prevent the body from rejecting the new organ.

Conclusion

There are several systems that relate to each other but with the invasion of a virus or bacteria, it can cause the body to perform functions that are less than ideal. No matter how small the disease is to the body, it affects multiple organs and organ systems.  For example, Parkinson’s disease is a nervous system disease, but it can also affect the skeletal system by causing involuntary movement. Uremia is involved in the excretory system and affects the circulatory system by infecting the bloodstream. Even through a disease is more targeted to one system, it plays a role throughout the whole body.

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Chapter One: Introduction

Overweight and obesity have turn out to be the most serious health problem in children, adolescents and adults. “O

verweight in children and adolescents was defined as ≥ 85



^th



percentile according to BMI-for-age growth sex-specific charts, whereas obesity ≥ 95



^th



percentile of the BMI-for-age growth, sex-specific charts

“(Ogden et al., 2010). In the United States and Canada, 30% of adolescents were obese or overweight while the percentage doubled in adult (Anis et al., 2010). Obesity in adolescents’ population tripled in the last 30 years at both countries (Ogden et al., 2002). Several chronic conditions such as cardiovascular disease, diabetes, and cancers were observed in obese adults (Panel, 1998). Adipose tissue is composed of subcutaneous and visceral adipocytes (Chowdhury et al., 1994). Visceral fat accounts for 20% of total body fat in men compared to only 6% in premenstrual women (Krotkiewski et al., 1983). The etiology of visceral tissue disposition in humans is still indistinct (Samaras et al., 1999, Batra and Siegmund, 2012).

In the last decade, blood pressure increased among children and adolescents (Muntner et al., 2004). Furthermore, children with high BMI are more probable to have elevated blood pressure and lipid profile (Freedman et al., 2007). Additionally, premature mortality is attributed to elevated blood pressure by increasing the incidence of cardiovascular disease (Stamler et al., 1993, Vasan et al., 2001).On the other hand, treatment of childhood obesity initiates reduction in blood pressure among adults which leads to cardiovascular disease prevention(Freedman et al., 1999). In 2008, Khader and colleagues estimated that 28.1% of north Jordanian adult men were obese. Whereas, in 2009 the obesity rate, as regards to studies conducted on children in north Jordan, was 18.8% of the targeted population(Khader et al., 2008, Khader et al., 2009). Comparing those studies, there is domination of obesity among adults rather than adolescents which leads to a prediction of escalating the obesity problem by age in north Jordan. This study aims to estimate abdominal and total fat among Jordanian adolescents and its relation to blood pressure. Many studies have shown that blood pressure is associated with being overweight in children and adolescents of Western countries (Genovesi et al., 2005, Ebbeling et al., 2002). Therefore, the aim of this study aims to estimate abdominal and total fat among Jordanian adolescents and its relation to blood pressure.

Chapter Two: Literature Review.

High body mass index is usually associated with elevated blood pressure (Cercato et al., 2004). Relation of trunk, waist circumferences and visceral fat with blood pressure were considered predictor indicators in children and adolescents for cardiovascular mortality (Welborn and Dhaliwal, 2007). The prevalence of hypertension among adolescents population has not been acknowledged as in adults. Adolescents with elevated blood pressure (BP) can develop several chronic diseases and body organ damage also they will increase risk of cardiovascular disease in adulthood. Therefore, prevention of obesity will help to limit the disease burden due to hypertension (Lande et al., 2006, Must et al., 1992).

In several studies conducted in Western countries, prevalence of high blood pressure among children ranged from 7 to 19% (Sorof et al., 2004, Paradis et al., 2004). However, few studies have been conducted in adolescence at developing countries (Mehdad et al., 2013, Abdulle et al., 2014, Abolfotouh et al., 2011).

Fat accumulation especially in abdominal region:

More than one third of obese children remained obese at adulthood (Serdula et al., 1993). A study showed that 77% of obese adults was related to overweight in childhood (Freedman et al., 2001). Another longitudinal study pointed that only1.6% of adolescents’ in the transition to young adulthood shifted from obese to non-obese, while 9.4% remained obese (Gordon-Larsen et al., 2004). Presence of abdominal fat was observed among non-obese children (Goran et al., 1995) and adolescents (Fox et al., 1993, De Ridder et al., 1992).

In the topic of obesity, especially the android type of obesity , an observation of high mortality rate was recorded among the Danish population in a study with 27178 men and 29875 women. Mortality rate was 10% higher among 136 men than 130 women who were having increased waist circumferences. A similar observation was detected among smokers, overweight or obese participants (Bigaard et al., 2005). A study was in Morocco on 167 adolescents aged from 11- 17 years (123 girls and 44 boys) were, 42% overweight and/ or obese in addition to 58% were at normal weight. Significant relation between BMI and each of fat mass percent body fat in both genders. Waist circumferences could be predictor tool for fatness among adolescents (Neovius et al., 2004, Wang et al., 2007). In Kuwait, a study on adolescents 4,219 participants aged from 11 to 19, Boys who had waist circumference ≥ 90th percentile account 8- 30.3%, mean of waist circumference was higher in boys than it was in Kuwaiti girls. Also, increase in percentage of boys who had ≥ 90th percentile observed in boys unlike girls (Jackson et al., 2010). Peeters and colleagues (2003) detected a remarkable decrease in life expectancy by 7.1 and 5.7 years in nonsmoking males and females respectively at 40 years old. While, a lower life expectancy of 13.3-13.7 years identified in obese smoking females and males respectively (Peeters et al., 2003). Relation between smoking among adolescents and excessive fat in abdominal region young adults (men and women) has been investigated (Saarni et al., 2009). Intra-abdominal fat increases cardiovascular risks such as hypertension and dyslipidemia. Cardiovascular disease risks rise when accompanied with smoking which leads to modifications in the physiological functions of adipokines, endothelial, insulin and proatherogenic status (Ritchie and Connell, 2007). Other studies confirmed the association between abdominal obesity and smoking. Both abdominal fat and smoking were attributed to the same risk factors, which were unhealthy dietary behavior (Wingard et al., 1982, Keski-Rahkonen et al., 2003), low education (Pierce, 1989, Green et al., 2007) and low physical inactivity (Aarnio et al., 2002, Escobedo et al., 1993), the etiology of this causal link remained unclear. The reason could be related to the change in glucocorticoid metabolism and psychosocial stress that has been caused mainly by smoking (Cohen et al., 2006, Lahiri et al., 2007, Rohleder and Kirschbaum, 2006) may be in charge with abdominal fat (Björntorp and Rosmond, 2000, Björntorp, 2001).

Visceral tissue were more sensitive to lipolytic stimuli than other fatty tissue make fatty acid from triglycerides turnover increased in blood stream by portal vein, this led to, increasing hepatic fatty acid release make liver exposing to fatty acid also increased hepatic gluconeogenesis and secretion of LDLs moreover to inhibit hepatic role of insulin riddance to develop hyperinsulinemia and insulin resistance (Björntorp, 1992).

Studies showed that ischemic heart disease, independent lipid level changes (Després et al., 1996) and metabolic abnormalities were associated to patients with fasting hyperinsulinemia (Haffner et al., 1992). A hypothesis studied by Randle suggested a reduction in insulin resistance and glucose uptake because of reduce the need for glucose oxidation when fat oxidation increased (Randle et al., 1963).

Dietary effects on visceral fat, a study on white non-obese men, explains visceral and subcutaneous fat and dietary effect. Fat intake explained only 1.4% of the variance in subcutaneous fat and no variance in visceral fat. On the other hand, 2% of the variance appear in total adiposity, which make dietary factors have a minor role in total adiposity and with no effect on visceral fat (Larson et al., 1996). In Bogalusa Heart Study, children and adolescents aged from 6-18 years demonstrate that high fat in truncal region associated with elevated LDL and VLDL cholesterol concentrations (Freedman, 1995). Total and visceral fat were inversely affected by dietary fibers intake; that effect was significantly observed among adolescent boys without a significant effect on girls in sample aged 14-18 years old in total participants of 559. Moreover, it linked between dietary fiber intake and inflammation markers include adiponectin and C-reactive protein (Parikh et al., 2012).

Aerobic exercise among adolescents for 8 weeks had significant effect on decreasing total fat 700 g by (0.6 %); the majority of the lost fat was observed in abdominal region, but, no significant changes were noticed in subcutaneous fat to alteration in body compositions (Watts et al., 2004).

Risk for elevated blood pressure and it’s relation to total and abdominal fat:

Hypertension raised atherosclerotic cardiovascular disease outcomes by 2 to 3 folds. Moreover, Hypertension is the most influential accompaniment with cardiovascular disease that leads to death in a prospective longitudinal analysis (Kannel, 1996).

In Bogalusa Heart Study, prevalence of adult patients with hypertension who were diagnosed clinically, they were significantly higher in those who had elevated blood pressure at childhood (Bao et al., 1995). In young boys, an increase in blood pressure from pubescence to 18 years was observed (Cornoni-Huntley et al., 1979). Relation between blood pressure and fat distribution had a marked variance upon sexual difference among adolescents. Boys had an elevated blood pressure associated to adiposity that was enhanced by visceral and peripheral fat, unlike girls where blood pressure was affected by peripheral adiposity but no significant effect by visceral adiposity (Pausova et al., 2012). Low averages at cognitive test scores were observed among 5077 children and adolescents from 6 to 16 years when systolic blood pressure were ≥90th percentile and diastolic ≥ 90th percentile (Lande et al., 2003). In adolescents, 9-17years old, cardiovascular risk factors associated with fat accumulation areas, which was analyzed by Dual-energy X-ray absorptiometry (DEXA) (Daniels et al., 1999). Android type of obesity and cardiovascular disease risk factors as blood pressure produced a powerful relation among African-American and Caucasian children (He et al., 2002). Abdominal fat distribution that was measured by DEXA and skinfold- thikness among 920 healthy children and adolescents (American, Asian, and Caucasian aged from 5 to 18 years) was predictor for blood pressure in boys but not in girls (He et al., 2002). Systolic and diastolic blood pressure relation to total fat and fat distribution by using DEXA on 127 adolescents aged from 9-17 years, systolic blood pressure have significant relation to total body fat and fat distribution but diastolic blood pressure was significant with total body fat but was not with fat distribution (Daniels et al., 1999).

Evidence approved that truncal fat was associated to high cardiovascular risks such as hypertension compared with peripheral fat (Kannel et al., 1991, Sardinha et al., 2000). Adolescents with left ventricular hypertrophy were associated with high rate of essential hypertension; those who developed severe hypertrophy and abnormal left ventricular geometry were in high degree of the risk to cardiovascular disease and increase in morbidity rate (Daniels, 1999).

Abdominal fat could be estimated by using waist circumferences as a better indicator for abdominal fat rather than waist to hip ratio among children and adolescent because waist to hip ratio reflected changes in fat amount less than bones and muscular changes when children and adolescent were growing (

Kissebah and Krakower, 1994

). Waist circumference had relevance to blood pressure adolescents of both sexes and showed, by a study applied on multivariate models instead of visceral fat, no association between blood pressure and visceral fat, which made waist circumference an inappropriate tool to evaluate visceral fat in adolescents (Pausova et al., 2012). Adults, who deposited fat viscerally, rather than elsewhere in the body, were at a higher risk for hypertension (Hayashi et al., 2003, Fox et al., 2007). This relationship was shown to be stronger in men than in women (Fox et al., 2007).

Insulin absence, resistance and hyperinsulinemia were associated to obesity chiefly in abdominal region. insulin was responsible to elevated blood pressure due to obesity. One of the mechanisms to protect body from gaining weight, hypothesized by Landsberg, was activating the sympathetic nervous system when consuming high calories which lead to increasing thermogenesis (LANDSBERG, 1986). Mikhail and Tuck. 2000 observed an alteration in artery structure include thickness and artery flexibility in hemodynamic effects of insulin. Abdominal obesity related to increased plasma renin activity is the possible key to blood pressure elevation (Licata et al., 1994). Strong evidence showed that management of hypertension was related to obesity by block renin-angiotensin system (RAS), which was active in obese subjects (Sharma, 2004). In mice, adipocyte differentiation and growth effect by adipocyte-derived angiotensinogen which secreted into the bloodstream, redounding blood pool of angiotensinogen (Massiéra et al., 2001).

It was recently found that mice have greater angiotensinogen gene expression in visceral fat at variance with other fat tissue when it was on high fat diet to induce obesity (Rahmouni et al., 2004). Patients who accumulated fat, especially visceral fat, were associated with elevated plasma aldosterone (Goodfriend and Calhoun, 2004). Elevated blood pressure could be induced by aldosterone by effect on mineralocorticoid receptors situated on tissue as in brain, kidney and vasculature to make Aldosterone have a significant relation on obesity-hypertension (Rahmouni et al., 2005). Aldosterone relation to obesity-hypertension, explained by De Paula, showed blocking mineralocorticoid receptors with the specific antagonist eplerenone. A remarkable blood pressure increase was inhibited without development of weight on dogs even on the high fat fed ones (de Paula et al., 2004).

Vasculature health preservation depended on endothelium status when nitric oxide was released which was characterized by antiatherogenic properties (Vita and Keaney, 2002). Exercise was one of interventions that could be applied to improve nitric oxide dilator function (Maiorana et al., 2000, Maiorana et al., 2001), considering cardio-protective factors. Normalizing in vascular function and alteration in body compositions by increasing muscular strength were results for exercise training to minimize cardiovascular disease in future. Detection and treatment of endothelial dysfunction for 19 obese subjects aged 14.3 ± 1.5 in early stages were known as primary strategy role to prevent to prevent adolescents who were susceptible from developing cardiovascular disease in adulthood (Watts et al., 2004).

Machine Learning (ML) aims at providing computational methods for accumulating, changing and updating knowledge in intelligent systems, and in particular learning mechanisms that will help us to induce knowledge

from examples or data. Machine learning methods are useful in cases where algorithmic solutions are not available, there is lack of formal models, or the knowledge about the application domain is poorly defined.

The fact that various scientific communities are involved in ML research led this scientific field to incorporate ideas from different areas, such as computational learning theory, artificial neural networks, statistics, stochastic modeling, genetic algorithms and pattern recognition. Therefore, ML includes a broad class of methods that can be roughly classified in symbolic and subsymbolic (numeric) according to the nature of the manipulation which takes place whilst learning.

2.Technical discussion

Machine Learning provides methods, techniques, and tools that can help solving diagnostic and prognostic problems in a variety of medical domains. ML is being used for the analysis of the importance of clinical parameters and of their combinations for prognosis, e.g. prediction of disease progression, for the extraction of medical knowledge for outcomes research, for therapy planning and support, and for overall patient management. ML is also being used for data analysis, such as detection of regularities in the data by appropriately dealing with imperfect data, interpretation of continuous data used in the Intensive Care Unit, and for intelligent alarming resulting in effective and efficient monitoring. It is argued that the successful implementation of ML methods can help the integration of computer-based systems in the healthcare environment providing opportunities to facilitate and enhance the work of medical experts and ultimately to improve the efficiency and quality of medical care. Below, we summarize some major ML application areas in medicine. Medical diagnostic reasoning is a very important application area of computer-based systems (Kralj and Kuka, 1998; Strausberg and Person, 1999; Zupan et al., 1998). In this framework, expert systems and modelbased schemes provide mechanisms for the generation of hypotheses from patient data. For example, rules are extracted from the knowledge of experts in the expert systems. Unfortunately, in many cases, experts may not know, or may not be able to formulate, what knowledge they actually use in solving their problems. Symbolic learning techniques (e.g. inductive learning by examples) are used to add learning, and knowledge management capabilities to expert systems (Bourlas et al., 1996). Given a set of clinical cases that act as examples, learning in intelligent systems can be achieved using ML methods that are able to produce a systematic description of those clinical features that uniquely characterize the clinical conditions. This knowledge can be expressed in the form of simple rules, or often as a decision tree. A classic example of this type of system is KARDIO, which was developed to interpret ECGs (Bratko et al., 1989).

This approach can be extended to handle cases where there is no previous experience in the interpretation and understanding of medical data. For example, in the work of Hau and Coiera (Hau and Coiera, 1997) an intelligent system, which takes real-time patient data obtained during cardiac bypass surgery and then creates models of normal and abnormal cardiac physiology, for detection of changes in a patient’s condition is described. Additionally, in a research setting, these models can serve as initial hypotheses that can drive further experimentation.

2.1 Methodology

In this section we propose a new algorithm called REMED (Rule Extraction for MEdical Diagnostic). The REMED algorithm includes three main steps: 1) attributes selection, 2) selection of initial partitions, and finally 3) rule construction.

2.1.1 Attributes Selection

For the first step we consider that in medical practice the collection of datasets is often expensive and time consuming. Then, it is desirable to have a classifier that is able to reliably diagnose with a small amount of data about the patients. In the first part of REMED we use simple logistic regression to quantify the risk of suffering the disease with respect to the increase or decrement of an 574attribute. We always use high confidence levels (>99%) to select attributes that are really significant and to guarantee the construction of more precise rules. Other important aspect to mention is that depending on the kind of association established (positive or negative) through the odds ratio metric, we build the syntax with which each attribute’s partition will appear in the rules system. This part of the algorithm is shown in the top of figure 1.

2.1.2 Partitions Selection

The second part of REMED comes from the fact that if an attribute x has been statistically significant in the prediction of a disease, then its mean x (mean of the values of the attribute) is a good candidate as initial partition of the attribute. We sort the examples by the attribute’s value and from the initial partition of each attribute, we search the next positive example (class = 1) in the direction of the established association. Then, we calculate a new partition through the average between the value of the found example and the value of its predecessor or successor. This displacement is carried out only once for each attribute. This can be seen in the middle part of figure 1.

2.1.3 Rules Construction

In the last part of the algorithm, we build a simple rule system of the following way: if (ei,1 ≥ p1) and (ei,j ≤ pj ) and … and (ei,m ≥ pm) then class = 1 else class = 0 where ei,j denotes the value of attribute j for example i, pj denotes the partition for attribute j and the relation ≥ or ≤ depends on the association attribute-disease.

With this rule system we make a first classification. We then try to improve the accuracy of our system by increasing or decreasing the value of each partition as much as possible. For this we apply the bisection method and calculate possible new partitions starting with the current partition of each attribute and the maximum or minimum value of the examples for this attribute. We build a temporal rule system changing the current partition by each new partition and classify the examples again. We only consider a new partition if it diminishes the number of false positives (FP) but does not diminish the number of true positives (TP). This step is repeated for each attribute until we overcome the established convergence level for the bisection method or the current rule system is not able to decrease the number of FP (healthy persons diagnosed incorrectly). This part of the algorithm is exemplified at the bottom of figure 1.

We can appreciate that the goal of REMED is to maximize the minority class accuracy at each step, first selecting the attributes that are strongly associated with the positive class. Then stopping the search of the partition that better discriminates both classes in the first positive example, and finally trying to improve the accuracy of the rule system but without diminishing the number of TP (sick persons diagnosed correctly).

3. Machine learning in complementary medicine

3.1 Kirlian effect – a scientific tool for studying subtle energies

The history of the so called Kirlian effect, also known as the Gas Discharge Visualization (GDV) technique (a wider term that includes also some other techniques is bioelectrography), goes back to 1777 when G.C. Lihtenberg in Germany recorded electrographs of sliding discharge in dust created by static electricity and electric sparks. Later various researches contributed to the development of the technique (Korotkov, 1998b): Nikola Tesla in the USA, J.J. Narkiewich-Jodko in Russia, Pratt and Schlemmer in Prague until the Russian technician Semyon D. Kirlian together with his wife Valentina noticed that through the interaction of electric currents and photograph plates, imprints of living organisms developed on film. In 1970 hundreds of enthusiasts started to reproduce Kirlian photos an the research was until 1995 limited to using a photo-paper technique. In 1995 a new approach, based on CCD Video techniques, and computer processing of data was developed by Korotkov (1998a;b) and his team in St. Petersburg, Russia. Their instrument Crown-TV can be routinely used which opens practical possibilities to study the effects of GDV.

The basic idea of GDV is to create an electromagnetic field using a high voltage and high frequency generator. After a thershold voltage is exceeded the ionization of gas around the studied object takes place and as a side effect the quanta of light { photons are emitted. So the discharge can be fixed optically by a photo, photo sensor or TV-camera. Various parameters in°uence the ionization process (Korotkov, 1998b): gas properties (gas type, pressure, gas content), voltage parameters (amplitude, frequency, impulse waveform), electrode parameters (configuration, distance, dust and moisture, macro and micro defects, electromagnetic field configuration) and studied object parameters (common impedance, physical fields, skin galvanic response, etc.). So the Kirlian effect is the result of mechanical, chemical, and electromagnetic processes, and field interactions. Gas discharge acts as means of enhancing and visualization of super-weak processes.

Due to the large number of parameters that in°uence the Kirlian effect it is very di±cult or impossible to control them all, so in the development of discharge there is always an element of vagueness or stochastic. This is one of the reasons why the technique has not yet been widely accepted in practice as results did not have a high reproducibility. All explanations of the Kirlian effect apprehended °uorescence as the emanation of a biological object. Due to the low reproducibility, in academic circles there was a widely spread opinion that all observed phenomena are nothing else but °uctuation of the crown discharge without any connection to the studied object. With modern technology, the reproducibility became su±cent to enable serious scientific studies.

Besides studying non-living objects, such as water and various liquids (Korotkov, 1998b), minerals, the most widely studied are living organisms: plants (leafs, seeds, etc. (Korotkov and Kouznetsov, 1997; Korotkov, 1998b)), animals (Krashenuk et al., 1998), and of course humans. For humans, most widely recorded are coronas of fingers (Kraweck, 1994; Korotkov, 1998b), and GDV records of blood excerpts (Voeikov, 1998). Principal among these are studies of the psycho-physiological state and energy of a human, diagnosis (Gurvits and Korotkov, 1998), reactions to some medicines, reactions to various substances, food (Kraweck, 1994), dental treatment (Lee, 1998), alternative healing treatment, such as acupuncture, ‘bioenergy’, homeopathy, various relaxation and massage techniques (Korotkov, 1998b), GEM therapy, applied kineziology and °ower essence treatment (Hein, 1999), leech therapy, etc., and even studying the GDV images after death (Korotkov, 1998a). There are many studies

currently going on all over the world and there is no doubt that the human subtle energy field, as vizualized using the GDV technique, is highly correlated to the human’s psycho-physiological state, and can be used for diagnostics, prognostics, theraphy selection, and controling the effects of the therapy.

4.Limitation

M. Schurr, from the Section for Minimal Invasive Surgery of the Eberhard-Karls-University of Tuebingen, gave an invited talk on endoscopic techniques and the role of ML methods in this context. He referred to current limitations of endoscopic techniques, which are related to the restrictions of access to the human body, associated to endoscopy. In this regard, the technical limitations include: restrictions of manual capabilities to manipulate human organs through a small access, limitations in visualizing tissues and restrictions in getting diagnostic information about tissues. To alleviate these problems, international technology developments focus on the creation of new manipulation techniques involving robotics and intelligent sensor devices for more precise endoscopic interventions. It is acknowledged that this new generation of sensor devices contributes to the development and spread of intelligent systems in medicine by providing ML methods with data for further processing. Current applications include suturing in cardiac surgery, and other clinical fields. It was mentioned that particular focus is put by several research groups on the development of new endoscopic visualizing and diagnostic tools. In this context, the potentials of new imaging principles, such as fluorescence imaging or laser scanning microscopy, and machine learning methods are very high. The clinical idea behind these developments is early detection of malignant lesions in stages were local endoscopic therapy is possible. Technical developments in this field are very promising, however, clinical results are still pending and ongoing research will have to clarify the real potential of these technologies for clinical use.

Moustakis and Charissis’ work (Moustakis and Charissis, 1999) surveyed the role of ML in medical decision making and provided an extensive literature review on various ML applications in medicine that could be useful to practitioners interested in applying ML methods to improve the efficiency and quality of medical decision making systems. In this work the point of getting away from the accuracy measures as sole evaluation criteria of learning algorithms was stressed. The issue of comprehensibility, i.e. how well the medical expert can understand and thus use the results from a system that applies ML methods, is very important and should be carefully considered in the evaluation.

5.Improvement & Conclusion

The workshop gave the opportunity to researchers working in the ML field to get an overview of current work of ML in medical applications and/or gain understanding and experience in this area. Furthermore, young researchers had the opportunity to present their ideas, and received feedback from other workers in the area. The participants acknowledged that the diffusion of ML methods in medical applications can be very effective in improving the efficiency and the quality of medical care, but it still presents problems that are related to both theory and applications.

From a theoretic point of view, it is important to enhance our understanding of ML algorithms as well as to provide mathematical justifications for their properties, in order to answer fundamental questions and acquire useful insight in the performance and behavior of ML methods.

On the other hand, some major issues which concern the process of learning knowledge in practice are the visualization of the learned knowledge, the need for algorithms that will extract understandable rules from neural networks, as well as algorithms for identifying noise and outliers in the data. The participants also mentioned some other problems that arise in ML applications and should be addressed, like the control of over fitting and the scaling properties of the ML methods so that they can apply to problems with large datasets, and high-dimensional input (feature) and output (classes-categories) spaces.

A recurring theme in the recommendations made by the participants was the need for comprehensibility of the learning outcome, relevance of rules, criteria for selecting the ML applications in the medical context, the integration with the patient records and the description of the appropriate level and role of intelligent systems in healthcare. These issues are very complex, as technical, organizational and social issues become intertwined. Previous research and experience suggests that the successful implementation of information systems (e.g., (Anderson, 1997; Pouloudi, 1999)), and decision support systems in particular (e.g., (Lane et al., 1996;

Ridderikhoff and van Herk, 1999)), in the area of healthcare relies on the successful integration of the technology with the organizational and social context within which it is applied. Medical information is vital for the diagnosis and treatment of patients and therefore the ethical issues presented during its life cycle are critical. Understanding these issues becomes imperative as such technologies become pervasive. Some of these issues are system-centered, i.e., related to the inherent problems of the ML research. However, it is humans, not systems, who can act as moral agents. This means that it is humans that can identify and deal with ethical issues. Therefore, it is important to study the emerging challenges and ethical issues from a human-centered perspective by considering the motivations and ethical dilemmas of researchers, developers and medical users of ML methods in medical applications.

Pulmonary Arterial hypertension is a type of blood pressure that creates consequences for arteries of lungs that are medically known as pulmonary arterioles. In this condition, capillaries are narrowed and devastated. This way it is harder for blood to flow with ease to the lungs, as it raises the pressure of lung arteries. The presence of this pressure makes it heart muscles to be weak and in some cases fail.

Pathophysiology of PAH is not clearly identified as it is related to the vascular resistance and vascular pressure. It includes the reasons that are behind this specific disorder. Major consequences and rare effects are showed. Pathophysiology is referred as the disorder happening in the body as it is related to the characteristics of the specified disease. In the case of Pulmonary Hypertension, the pathophysiology of this specific disease is not identified because of the reasons of vascular resistance and pressure that is related to Pulmonary Hypertension. In some cases, the increased amount of pulmonary vascular resistance happens because of the obliteration of these vascular walls or pathologic vasoconstriction. This vasoconstriction is most of the times related to thromboxane and endotheline. With an increased pressure it is also responsible for the increase in the parts of pressures related to pulmonary and injuries that happen due to the presence of coagulation.  With these responsibilities, the nature of Pathophysiology changes and consequences such as platelet dysfunction, plasminogen, and fibrinopeptide happens (Maron Et al 2016).

PAH have various effects on the cardiopulmonary status of the patient. The issue of PAH is connected to the heart as it affects the activity of heart and increases the heart rate with time. These changes are clearly noticeable in the electrocardiogram reports of patient.

Apart from an increased amount in pulmonary vascular resistance, the increase in pulmonary venous pressure is also happens. This mechanism is responsible for various dangerous medical conditions. These conditions are resulting harm in the left side of heart with the high rate of pressure in the left ventricle of heart (Maron Et al 2016). Apart from these major consequences, the other rare effects are included as the thickening of alveolar capillary walls and present edema.

There are current cases of this disease and 15-20% of these cases are related to the cases of Pathophysiology. This leads to the impression that people are mostly affected by this disease because of genetic disorders as medically it is found in various researches that this is actually caused because of hereditary factors.

There are a wide range of signs and symptoms for PAH, by identifying these symptoms on time it becomes easier for the medical authorities to control the drawbacks behind this disease, as it is not possible to completely cure it.

The included symptoms of Pulmonary Arterial hypertension are noticeable in the initial months of the development of this disease. Major included symptoms are short of breath, fatigue, dizziness, chest pain, swelling of body parts, bluish color of lips and skin, and increasing rate of pulse. With these symptoms there are some risk factors involved in the occurrence of this disease. Some of these risk factors include; risky for young adults, gain of weight at any stage of life, usage of continuous illegal drugs, intake of appetite fulfillment medications, and involved family history of hypertension (McLaughlin al 2015).

Involved complications after the occurrence of this disease are; the right side of heart is enlarged from its original size as it has to put hard pressure for the purpose of pumping of the heart, so that blood is flowed easily from the blocked part of arteries.  In this process, the thickening of a wall is only for a temporary period of time. Development of blood clots is also considered as a dangerous factor of this disease. Development of blood clots in the parts where they are not needed. Number unnecessary clots are developed in the places where they are not needed. These clots travel to the arteries of lungs where they are not needed. However, it is possible to remove these clots if consulted on time. If any patient has already narrowed arteries then it is quite dangerous for patients of Hypertension (McLaughlin Et al 2015). Irregular heartbeats that are normally known as arrhythmia as they are created in the chambers of heart are an unsafe complication as arrhythmia is able to lead the patient towards dizziness and fainting occurrences. Hemoptysis has also seen when a patient is going through Pulmonary Arterial hypertension as it is easily noticed by the professionals that that patients in complicated conditions are suffering from bleeding into their lungs and later they are coughing out the blood. Bleeding out is considered as a seriously fatal condition. With these conditions and symptoms Arterial hypertension is divided into five different groups. Namely; Normal Pulmonary Arterial Hypertension, PAH caused by left sided heart disease, PAH caused by lung disease, PAH caused by chronic blood clots, and PAH caused by unknown reasons.

Traditional practice to treat the disease process includes three totally different steps; application of these steps depends on the patient history. The applicable steps include; prescribed medications, surgeries for serious medical cases, and home remedies to control the drawbacks.

It is traditionally not possible to cure PAH, as according to doctors it is quite impossible to completely cure this disease, but according to medical staff it is quite possible to improve this condition to slow down the process of this disease. The involved treatment is still considered as the most complex treatment. Medications involved are; Vasodilators, Endothelin receptor, Sildenafil and tadalafil, Calcium Channel blockers, soluble guanylate cyclase, Anticoagulants, Digoxin, Diuretics, and Oxygen therapy.

Apart from medications, treatment through surgery is also conducted, these included surgeries for PAH are; Atrial Septostomy and Transplantation. Other treatment that are used to diagnosis PAH is ventilation and perfusion (VQ) scan, during this procedure the patient is given contrast liquid in the IV  helping the blood flow in the lungs showing up clear in the monitor. Meanwhile, the ventilation part the patient will breathe in a medical gas it will determine how well the lungs take in the oxygen.

The classifications of pulmonary hypertension are divided into four groups. Class I identifies the diagnosis at a minor stage with no available symptoms. Class II has no serious symptoms; however the patient has minor symptoms such as fatigue, breathing issues, and regular chest pain. Class III shows major symptoms that are not coming in between the physical activeness of an individual. Class IV shows that patient has symptoms that are present but not actively affecting the patient, however, they are able to become active and harm the patient physically (Maron Et al 2016).

After medical treatment, the recommended home remedies that could at least lessen the major symptoms connected to PAH. These home treatments include; resting for the ease of relieving pain, staying physically active by exercising, starting an alternative plan for quitting the habit of smoking, avoiding too much travel, and continuously joining follow up programs for the controlling this issue.

Normally, family genes have a vital role in having this disease and other reasons behind having this disease are; congestive failure of heart, presence of blood clots in lungs, aids, and usage of illegal drugs, heart defect by birth, lung diseases, and sleep apnea that is a sleeping disorder.

Role of both current and traditional practices for PAH is similar as both forms of practice have the responsibility of controlling this issue. These practices include pathophysiology, screening, clinical presentation, conventional therapies, and investigational therapies. Hazards of these practices include; nausea, vomiting, inflammation of lungs (in rare patients), alveoli damage, and inflammation. The benefit include controlling breathlessness, stable the stamina, and overcomes depression.

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