Medical World

Urinary tract infection

2011-03-10T21:48:00.004+06:00

Urinary tract infection is the most common bacterial infection managed in general medical practice and accounts for 1-3% of consultations. Up to 50% women have a UTI at some time. In male UTI is uncommon. Most common presentation of UTI is acute urethritis and cystitis.

Spectrum of presentation:

1) Asymptomatic bacteriuria
2) Acute pyelonephritis
3) Symptomatic acute urethritis & cystitis
4) Acute prostatitis
5) Septicaemia

Common causes:

1) E. coli
2) Klebsiella
3) Proteus
4) Pseudomonus
5) Streptococci
6) Staphylococci epidermidis
7) In Hospitals- E. coli , Klebsiella and streptococci

Risk factors:

1) incomplete bladder emptying :

a) bladder outflow obstruction
b) neurological problems-
multiple sclerosis
diabetic neuropathy
c) gynaecological abnormalities-
uterine prolapse
d) vesico ureteric reflux

2) foreign body-

a) urethral catheter
b) ureteric stent

3)loss of host defence-

a) diabetes mellitus
b) atrophic urethritis and vaganitis in post menopausal women

Differential diagnosis:

1) urethritis
2) vaginitis

Clinical feature :

1) abrupt onset of frequency of micturation and urgency
2) dysuria
3) supra pubic pain during and after voiding
4) stranguary
5) urine may appear cloudy and have an unpleasant odur
6) microscopic or visible heamaturia
7) fever, rigor, vomitting

Investigations :

1) Dipstick examination - nitrite, leucocyte esterase and glucose
2) urine R/E - for pus cell and epithelial cell ( > 5-6)
3) urine culture (midstream urine)
4) CBC
5) Blood culture
6) USG
7) Serum urea ,electrolytes, creatinine
8) Cystoscopy

Management:

1) fluid intake at least 2 litre per day
2) regular complete emptying of bladder
3) good personal hygiene
4) emptying of bladder before and after sexual intercourse
5) if vesico ureteric reflux is present practice double micturation
6) antibiotics according to the report of urine culture

ciprofloxacin - 500mg 12 hourly for 3 days
trimethoprim - 200 mg 12 hourly for 3 days
nitrofurontion - 50 mg 6 hourly for 3 days
coamoxiclav - 500/ 125mg 8 hourly for 3 days

Seriously ill patient I/V cefuroxime -750 mg 8 hourly for 3-14 days
In pregnancy - penicillin and cephalosporins

Edited by ImAn NoOr

Common surgical symptoms

2011-01-10T18:55:00.003+06:00

Pain

Pain anywhere should have the same features elicited. These can be summarized by the acronym SOCRATES.

Site. Where is the pain, is it localized, in a region. or generalized?
Onset. Gradual, rapid, or sudden? Intermittent or constant?
Character. Sharp, stabbing, dull, aching, tight, sore?
Radiation. Does it spread to other areas? (From loin to groin in ureteric pain, to shoulder tip in diaphragmatic irritation, to back in retroperitoneal pain, to jaw and neck in myocardial pain.)
Associated symptoms. Nausea, vomiting, dysuria, jaundice?
Timing. Does it occur at any particular time?
Exacerbating or relieving factors. Worse with deep breathing, moving, or coughing suggests irritation of somatic nerves either in the pleura or peritoneum; relief with hot water bottles suggests deep inflammatory or infiltrative pain.
Surgical history. Does the pain relate to surgical interventions?

Dyspepsia

(epigastric discomfort or pain, usually after eating).
What is the frequency?
Is it always precipitated by food or is it spontaneous in onset?
Is there relief from anything, especially milky drinks or food?
Is it positional?

Dysphagia

(pain or difficulty during swallowing).
Is the symptom new or longstanding?
Is it rapidly worsening or relatively constant?
Is it worse with solid food or fluids? (Worse with fluids suggests a motility problem rather than a stenosis.)
Can it be relieved by anything, e.g. warm drinks?
Can the patient point to a level of hold-up on the surface (usually related to the sternum)? This often accurately relates to the level of an obstructing lesion.
Is it associated with spluttering? (suggests tracheo-oesophageal fistula).

Acid reflux

(bitter or acidic tasting fluid in the pharynx or mouth).
How frequently?
What colour is it? (Green suggests bile, whereas white suggests only stomach contents).
When does it occur (lying only, on bending, spontaneously when standing)?
Is it associated with coughing?

Haematemesis

(the presence of blood in vomit).
What colour is the blood (dark red-brown coffee grounds is old or small-volume stomach bleeding; dark red may be venous from the oesophagus; bright red is arterial and often from major gastric or duodenal arterial bleeding).
What volume has occurred over what period?
Did the blood appear with the initial vomits or only after a period of prolonged vomiting (suggests a traumatic oesophageal cause).

Abdominal distension

Symmetrical distension suggests one of the cause (fluid ascites, flatus due to ileus or obstruction, fetus of pregnancy, fat, or a flipping big mass).
Asymmetrical distension suggests a localized mass.
What is the time course?
Does it vary?
It is changed by vomiting, passing stool/flatus?

Change in bowel habit

May be change in frequency, or looser or more constipated stools. Increased frequency and looser stools suggests a pathological cause.
Is it a persistent or transient?
Are there associated symptoms?
Is it variable?

Frequency and urgency of defecation

New urgency of defecation is almost always pathological.
What is the degree of urgency?
how long can the patient delay?
Is there associated discomfort?
What is passed?
Is the stool normal?

Bleeding per rectum

What colour is the blood?
Is it pink-red and only on the paper when wiping?
Does it splash in the pan? (Both suggest a case from the anal canal.)
Is it bright red on the surface of the stool? (Suggests a lower rectal cause.)
Is the blood darker, with clots or marbled into the stools? (Suggests a colonic cause.)
Is the blood fully mixed with the stool or altered? (Suggests a proximal colonic cause.)

Tenesmus

(desire to pass stools with either no result or incomplete satisfaction of defecation). Suggests rectal pathology.

Jaundice

(yellow discoloration due to hyperbilirubinaemia; ).
How quickly did the jaundice develop?
Is there associated pruritus?
Are there any symptoms of pain, fever, or malaise? (Suggests infection.)

Haemoptysis

(the presence of blood in expectorate).
What colour is the blood? (Light pink froth suggests pulmonary oedema.)
Are there clots or dark blood? (Infection or endobronchial lesion.)
How much blood? Moderate bleeds quickly threaten airways: get help quickly.

Dyspnoea

(difficulty in or increased awareness of breathing).
When does the dyspnoea occur?
quantify the amount of effort. Is it positional?

Orthopnoea is difficulty in breathing that occurs on lying flat: quantify it by asking how many pillows the patient needs at night to remain symptom-free.
Paroxysmal nocturnal dyspnoea is intermittent breathless at night. Both orthopnoea and paroxysmal nocturnal dyspnoea suggest cardiac failure.

Claudication

(the presence of pain in the muscles of the calf, thigh, or buttock precipitated by exercise and relieved by rest).
After what degree of exercise does the pain occur (both distance on the flat and gradients)?
How quickly is the pain relieved by rest?

Rest pain

(pain in a limb at rest without significant exercise)
How long has the pain been present?
Is it intermittent?
Does it occur mainly at night?
Is it relieved by dependency of the limb involved?

History taking and making notes

2011-01-08T23:11:00.005+06:00

Making medical notes

All medical and paramedical professionals have a duty to record their input and care of patients in the case-notes. These form a permanent legal and medical document. There are some basic rules.

Write in blue or black color.
Date, time, and sign all entries: always identify retrospective entries.
Be accurate.
Make it clear which diagnoses are provisional.
Abbreviations are lazy and open to misinterpretation; avoid them.
Clearly document information given to patients and relatives.
Avoid non-medical judgement of patients or relatives.

Basics

Always record name, age occupation, method of presentation.
Cover all the principal areas of medical history:
- presenting complaint and past history relevant to it;
- other past medical history, drug history, and systematic enquiry;
- previous operations/allergies/drugs;
- family history, social history, and environment.

Presenting complaint

This is a one- or two-word summary of the patient's main symptoms, e.g. abdominal pain, nausea and vomiting, swollen leg, PR bleeding.

In emergency admissions do not write a diagnosis here (e.g. ischaemic leg). The diagnosis of referral may well turn out to be wrong.
In elective admissions it is reasonable to write elective admission for varicose vein surgery.

History of presenting complaint

This is a detailed description of the main symptom and should include the relevant systems enquiry.
Try to put the important positives first, e.g. right-sided lower abdominal pain, sharp, worse with moving, and coughing, anorexia 24h.
Include the relevant negatives, e.g. no vomiting, no PR bleeding.
Be very clear about chronology of events.
In a complicated history, or with multiple symptoms use headings, e.g. Current episodes, Previous operations for this problem Results of investigations.
Summarize the results of investigations performed prior to admission systematically: bedside tests, blood tests, histology or cytology, X-rays, cross-sectional imaging, specialized tests.

Past medical history

Ask about thyroid problems, TB, hypertension, rheumatic fever, epilepsy, asthma, diabetes, and previous surgery, specifically.
List and date all previous operations.
Ask about previous problems with an anaesthetic.
Asking Have you ever had any medical problem, or been to hospital for anything? at the end often produces additional information.

Systematic enquiry

This is extremely important and often neglected. A genitourinary history is highly relevant in young females with pelvic pain. A good cardiovascular and respiratory systems enquiry will help avoid patients being cancelled because they have undiagnosed anaesthetic risks. Older patients may have pathology in other systems that may change management, e.g. the patient with prostatism should be warned about urinary retention.

Cardiovascular. Chest pain, effort dyspnoea, orthopnoea, nocturnal dyspnoea, palpitations, swollen ankles, strokes, transient ischaemic attacks, claudication.
Respiratory. Dyspnoea, cough, sputum, wheeze, haemoptysis.
Gastrointestinal. Anorexia, change in appetite, weight loss (quantify how much, over how long).
Genitourinary. Sexual activity, dyspareunia (pain on intercourse), abnormal discharge, last menstrual period.
Neurological. 3 Fs: fits; faints; funny turns.

Social history

At what time did they last eat or drink?
Ask who will look after the patient. Do they need help to mobilize?
Smoking and alcohol history.

Tips for case presentation

Practice. Every case is a possible presentation to someone!
Always set the scene properly. Start with name, age, occupation, and any key medical facts together with the main presenting complaint(s).
Be chronological. Start at the beginning of any relevant prodrome or associated symptoms; they are likely to be an important part of the presenting history.
Be concise with past medical history. Only expand on things that you really feel may be relevant either to the diagnosis or to management, e.g. risks of general anaesthesia.
For systematic examination techniques see the relevant following pages.
Always summarize the general appearance and vital signs first.
Describe the most significant systemic findings first but be systematic inspection, palpation, percussion, and auscultation.
Briefly summarize other systemic findings. Only expand on them if they may be directly relevant to the diagnosis or management.
Finally, summarize and synthesize don't repeat. Try to group symptoms and signs together into clinical patterns and recognized scenarios.
Finish with a proposed diagnosis or differential list and be prepared to discuss what diagnostic or further evaluation tests might be necessary.

Terminology in surgery

2011-01-07T14:29:00.003+06:00

How to describe an operation

The terminology used to describe all operations is a composite of basic Latin or Greek terms.

First describe the organ to be operated on

Examples:

lapar-, abdomen (laparus = flank);
nephro-, kidney;
pyelo-, renal pelvis;
cysto-, bladder;
chole-, bile/the biliary system;
col(on)-, large bowel;
hystero-, uterus;
thoraco-, chest;
rhino-, nose;
masto/mammo-, breast.

Second describe any other organs or things involved in the procedure

Examples:

docho-, duct;
angio-, vessel (blood- or bile-carrying);
litho-, stone.

Third describe what is to be done

Examples:

-otomy, to cut (open);
-ectomy, to remove;
-plasty, to change shape or size;
-pexy, to change position;
-raphy, to sew together;
-oscopy, to look into;
-ostomy, to create an opening in (stoma = mouth);
-paxy, to crush;
-graphy/gram, image (of).

Lastly add any terms to qualify how or where the procedure is done

Examples:

percutaneous, via the skin;
trans-, across;
antegrade, forward;
retrograde, backwards.

Examples of terms

Choledochoduodenostomy an opening between the bile duct and the duodenum.
Rhinoplasty nose reshaping.
Pyelolithopaxy destruction of pelvicalyceal stones.
Bilateral mastopexy breast lifts.
Percutaneous arteriogram arterial tree imaging by direct puncture injection.
Loop ileostomy external opening in the small bowel with two sides.
Flexible cystourethroscopy internal bladder and urethral inspection.

QUESTION NO-6

2010-12-06T11:08:00.002+06:00

Your patient is a 70-year-old man who under went bowel surgery for colon cancer 3days ago,He now has a fever and abdominal pain.You concerned that he may have peritonitis.which one of the following pairs of organisms is MOST likely to be the cause?

A) Bacteroides fragilis & Klebsiella pneumoniae
B) Bordetella pertussis & Salmonella enteritidis
C) Actinomyces israelii & Campylobacter jejuni
D) Clostridium botulinum & Shigella dysenteriae

Whats your diagnosis?
Write your answer in comment. Answer will be given 3days later.

QUESTION NO-5

2010-11-25T16:36:00.002+06:00

Whats your diagnosis?
Write your answer in comment. Answer will be given 3days later.

QUESTION NO-4

2010-11-19T18:01:00.004+06:00

Whats your diagnosis?
Write your answer in comment. Answer will be given 3days later.

QUESTION NO-3

2010-11-16T17:40:00.001+06:00

Whats your diagnosis?
Write your answer in comment. Answer will be given 3days later.

QUESTION NO-2

2010-11-13T19:00:00.002+06:00

Whats your diagnosis?
Write your answer in comment. Answer will be given 3days later.

Acute respiratory distress syndrome (ARDS)

2010-11-09T23:41:00.004+06:00

What is ARDS?

Acute respiratory distress syndrome (ARDS) is breathing failure that can occur in critically ill persons with underlying illnesses. It is not a specific disease. Instead, it is a life-threatening condition that occurs when there is severe fluid buildup in both lungs. The fluid buildup prevents the lungs from working properly—that is, allowing the transfer of oxygen from air into the body and carbon dioxide out of the body into the air.

In ARDS, the tiny blood vessels (capillaries) in the lungs or the air sacs (alveoli (al-VEE-uhl-eye)) are damaged because of an infection, injury, blood loss, or inhalation injury. Fluid leaks from the blood vessels into air sacs of the lungs. While some air sacs fill with fluid, others collapse. When the air sacs collapse or fill up with fluid, the lungs can no longer fill properly with air and the lungs become stiff. Without air entering the lungs properly, the amount of oxygen in the blood drops. When this happens, the person with ARDS must be given extra oxygen and may need the help of a breathing machine.

Breathing failure can occur very quickly after the condition begins. It may take only 1 or 2 days for fluid to build up. The process that causes ARDS may continue for weeks. If scarring occurs, this will make it harder for the lungs to take in oxygen and get rid of carbon dioxide.

In the past, only about 4 out of 10 people who developed ARDS survived. But today, with good care in a hospital's intensive or critical care unit, many people (about 7 out of 10) with ARDS survive. Although many people who survive ARDS make a full recovery, some survivors have lasting damage to their lungs.

How the Lungs Work

To understand acute respiratory distress syndrome (ARDS), it is helpful to understand how your lungs work.

Normal Lung Function

A slice of normal lung looks like a pink sponge—filled with tiny bubbles or holes. Around each bubble is a fine network of tiny blood vessels. These bubbles, which are surrounded by blood vessels, give the lungs a large surface to exchange oxygen (into the blood where it is carried throughout the body) and carbon dioxide (out of the blood)

. This process is called gas exchange. Healthy lungs do this very well.

Here's how normal breathing works:

You breathe in air through your nose and mouth. The air travels down through your windpipe (trachea) through large and small tubes in your lungs called bronchial (BRON-kee-ul) tubes. The larger tubes are bronchi (BRONK-eye), and the smaller tubes are bronchioles (BRON-kee-oles). Sometimes, we use the word "airways" to refer to the various tubes or passages that air uses to travel from the nose and mouth into the lungs. The airways in your lungs look something like an upsid e-down tree with many branches.

At the ends of the small bronchial tubes, there are groups of tiny bubbles called air sacs or alveoli. The bubbles have very thin walls, and small blood vessels called capillaries are next to them. Oxygen passes from the air sacs into the blood in these small blood vessels. At the same time, carbon dioxide passes from the blood into the a ir sacs.

Effects of ARDS

In ARDS, the tiny blood vessels leak too much fluid into the lungs. This results from toxins (poisons) that the body produces in response to the underlying illness or injury. The lungs become like a wet sponge, heavy and stiffer than normal. They n

o longer provide the effective surface for gas exchange, and the level of oxygen in the blood falls. If ARDS is severe and goes on for some time, scar tissue called fibrosis may form in the lungs. The scarring also makes it harder for gas exchange to occur.

People who develop ARDS need extra oxygen and may need a breathing machine to breathe for them while their lungs try to heal. If they survive, ARDS patients

may have a full recovery. Recovery can take weeks or months. Some ARDS survivors take a year or longer to recover, and some never completely recover from having ARDS.

Other Names for ARDS

Adult respiratory distress syndrome

Stiff lung

Shock lung

Wet lung

There is a similar condition in infants called Infant Respi

ratory Distress Syndrome (also called IRDS, RDS, and hyaline membrane disease). It mainly affects premature infants whose lungs are not well developed when they are born.

What Causes ARDS?

The causes of acute respiratory distress syndrome (ARDS) are not well understood. It can occur in many situations and in persons with or without a lung disease.

There are two ways that lung injury leading to AR

DS can occur: through a direct injury to the lungs, or indirectly when a person is very sick or has a serious bodily injury. However, most sick or badly injured persons do not develop ARDS.

Direct Lung Injury

A direct injury to the lungs may result from breathing in h

armful substances or an infection in the lungs. Some direct lung injuries that can lead to ARDS include:

Severe pneumonia (infection in the lungs)

Breathing in vomited stomach contents

Breathing in harmful fumes or smoke

A severe blow to the chest or other accident that bruises the lungs

Indirect Lung Injury

Most cases of ARDS happen in people who are very ill or who have been in a major accident. This is sometimes called an indirect lung injury. Less is known about how indirect injuries lead to ARDS than about how direct injuries to the lungs cause ARDS. Indirect lung injury leading to ARDS sometimes occurs in cases of:

Severe and widespread bacterial infection in the body (se psis)

Severe injury with shock

Severe bleeding requiring blood transfusions

Drug overdose

Inflamed pancreas

It is not clear why some very sick or seriously injured people develop ARDS, and others do not. Researchers are trying to find out why ARDS develops and how to prevent it.

Who is At Risk for ARDS?

Acute respiratory distress syndrome (ARDS) usually affects people who are being treated for another serious illness or those who have had major injuries. It affects about 150,000 people each year in the United States. ARDS can occur in people with or without a previous lung disease. People who have a serious accident with a large blood loss are more likely to develop ARDS. However, only a small portion of people who have problems that can lead to ARDS actually develop it.

In most cases, a person who develops ARDS is already in the hospital being treated for other medical problems. Some illnesses or injuries that can lead to ARDS include:

Serious, widespread infection in the body (sepsis)

Severe injury (trauma) and shock from a car crash, fire, or other cause

Severe bleeding that requires blood transfusions

Severe pneumonia (infection of the lungs)

Breathing in vomited stomach contents

Breathing in smoke or harmful gases and fumes

Injury to the chest from trauma (such as a car accident) that causes bruising of the lungs
Nearly Drowning

Some drug overdoses

What Are the Signs and Symptoms of ARDS?

The major signs and symptoms of acute respiratory distress syndrome (ARDS) are:

Shortness of breathing
Fast, labored breathing

A bluish skin color (due to a low level of oxygen in the blood)

A lower amount of oxygen in the blood

Doctors and other health care providers watch for these signs and symptoms in patients who have conditions that might lead to ARDS. People who develop ARDS may be too sick to complain about having trouble breathing or other related symptoms. If a patient shows signs of developing ARDS, doctors will do tests to confirm that ARDS is the problem.

ARDS is often associated with the failure of other organs and body systems, including the liver, kidneys, and the immune system. Multiple organ failure often leads to death.

How is ARDS Diagnosed?

Doctors diagnose acute respiratory distress syndrome (ARDS) when:

A person suffering from severe infection or injury develops breathing problems.

A chest x ray shows fluid in the air sacs of both lungs.

Blood tests show a low level of oxygen in the blood.

Other conditions that could cause breathing problems have been ruled out.

ARDS can be confused with other illnesses that have similar symptoms. The most important is congestive heart failure. In congestive heart failure, fluid backs up into the lungs because the heart is weak and cannot pump well. However, there is no injury to the lungs in congestive heart failure. Since a chest x ray is abnormal for both ARDS and congestive heart failure, it is sometimes very difficult to tell them apart.

How is ARDS Treated?

Patients with acute respiratory distress syndrome (ARDS) are usually treated in the intensive or critical care unit of a hospital. The main concern in treating ARDS is getting enough oxygen into the blood until the lungs heal enough to work on their own again. The following are important ways that ARDS patients are treated.

Extra Oxygen

The main treatment is giving a higher concentration of oxygen than that found in normal air—that is, enough to raise blood levels of oxygen to safe levels. This can sometimes be done with a face mask. A face mask can deliver oxygen at a concentration of 40-60 percent. As the ARDS progresses over hours or days, the patient may need a higher level of oxygen than a face mask can give.

If the patient becomes tired from breathing so hard, it may become necessary to connect the patient to a breathing machine (ventilator). This can be done by placing a tube through the mouth or nose into the windpipe (trachea) in a procedure called endotracheal intubation (or just intubation) and connecting the tube to the ventilator. Sometimes the connecting tube is inserted through a surgical opening in the neck (this procedure is called a tracheotomy). The breathing machine can be set to help or completely control breathing. It will deliver the minimum amount of air every minute. If the extra oxygen and help with breathing are not enough, the breathing machine can be set to Positive End Expiratory Pressure (PEEP) to maintain the surface for gas exchange.

PEEP keeps some air in the lungs at the end of each breath. It helps keep the air sacs open instead of collapsing. The setting on the breathing machine can be adjusted to fit the needs of the patient. Other settings on the breathing machine control the number of breaths per minute (rate control) and the amount of air the ventilator uses to inflate the lungs in each breath (tidal volume).

Medicines

Many different kinds of medicines are used to treat ARDS patients. Some kinds of medicines often used include:

Antibiotics to fight infection

Pain relievers

Drugs to relieve anxiety and keep the patient calm and from "fighting" the breathing machine

Drugs to raise blood pressure or stimulate the heart

Muscle relaxers to prevent movement and reduce the body's demand for oxygen

Other Treatment

With breathing tubes in place, ARDS patients cannot eat or drink as usual. They must be fed through a feeding tube placed through the nose and into the stomach. If this does not work, feeding is done through a vein. Sometimes a special bed or mattress, such as an airbed, is used to help prevent complications such as pneumonia or bedsores. If complications occur, the patient may require treatment for them.

Results

With treatment:

Some patients recover quickly and can breathe on their own within a week or so. They have the best chance of a full recovery.

Patients whose underlying illness is more severe may die within the first week of treatment.

Those who survive the first week but cannot breathe on their own may face many weeks on the breathing machine. They may have complications and a slow recovery if they survive.

Recovering from ARDS

Some people who survive acute respiratory distress syndrome (ARDS) heal quickly and recover completely in a relatively short time. Some are able to have the breathing tube and breathing machine removed in a week or so. Survivors often recover much of their lung function in the first 3-6 months after leaving the hospital, and they continue to recover for up to a year or more.

Others recover more slowly, however. Some ARDS survivors never recover completely, and they have continuing problems with their lungs. Every case is different. People who are younger and healthier when they develop ARDS are more likely to recover quickly than those who are older or who have more health problems.

ARDS patients who survive the first week but cannot breathe on their own may have to be on a breathing machine for several weeks or longer. These patients often develop complications, such as infections or air leaks (see the next section on Complications of ARDS). While some of these patients will die, others will get better and be able to breathe on their own again. Their recovery is usually slow, and they may have continuing problems.

After leaving the hospital, ARDS survivors need to visit a doctor during recovery to check how well their lungs are doing. Doctors use lung function tests to check the lungs. Spirometry (speh-ROM-uh-tree) is the most commonly used lung function test. It involves taking a deep breath and blowing hard into a plastic tube. The doctor will also do an oxygen saturation (oximetry (ok-SIM-eh-tree)) test or a blood test to check the amount of oxygen in the blood.

After going home from the hospital, the ARDS survivor may need only a little or a lot of help. While recovering from ARDS at home, a person may:

Need to use oxygen at home or when going out of the home, at least for a while

Need to have physical, occupational, or other therapy

Have shortness of breath, cough, or phlegm (mucus)

Have hoarseness from the breathing tube in the hospital

Feel tired and not have much energy

Have muscle weakness

Complications of ARDS

Anyone who stays in the hospital for a long time can get complications. Common complications in ARDS patients are infections with hospital-acquired bacteria and leaks of air out of the lungs into other body spaces.

Bacterial infections. The lungs or other parts of the body may become infected. These infections are usually treated with antibiotics after a test to see what kind of bacteria is causing the infection.

Air leaks. Leaks of air through holes in the lungs are caused by pressure from the breathing machine that is needed to be sure the patient gets enough air, and from the very stiff lungs. Air from the injured lungs may enter the space between the lungs and the lining around the lungs (the pleura) and cause a pneumothorax (noo-mo-THOR-aks) (collapsed lung). Treatment involves using a chest tube and suction to remove the air and help the lungs reinflate. Air may also enter the space between the membranes that line the abdomen (pneumoperitoneum) or the soft tissue under the skin (subcutaneous emphysema). These are not usually treated.

Each complication is treated as it arises. Careful hand washing by hospital staff and visitors helps reduce infections, and new breathing machine methods help reduce air leaks.

Acne (Pimples)

2010-11-07T11:52:00.004+06:00

What is acne? What are the different types of acne?

Acne (acne vulgaris, common acne) is not just a problem forteenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). On the positive side, those few individuals who have acne into their 40s may well grow out of it. Acne can appear on the skin as any of the following:

congested pores ("comedones"),
whiteheads,
blackheads,
pimples ("zits"),
pustules, or
cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.These blemishes occur wherever there are many oil (sebaceous) glands, mainly on the face, chest, and back.

What causes acne?

No one factor causes acne. Acne happens when oil (sebaceous) glands come to life around puberty, stimulated by male hormones from the adrenal glands of both boys and girls. Sebum (oil) is a natural substance which lubricates and protects the skin, and under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria (which live on everyone's skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed.Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt, and do not reflect poor hygiene.Here are some factors that don't usually cause acne, at least by themselves:

Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.

Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and dairy products in aggravating acne, these findings are far from established.

Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.

Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.

Hormones: Some women break out cyclically, but most women (and men) don't. Some oral contraceptive pills may help relieve acne, but unless a woman has abnormal menstrual periods and excessive hair growth, it's unlikely that hormones play much of a role in causing acne. Pregnancy has a variable effect on acne; some women report that they clear up completely, and others get worse, while many others see no overall change.

Cosmetics: Most cosmetic and skin-care products are not pore-clogging ("comedogenic"). Of the many available brands, those which are listed as "water-based" or "oil-free" are generally a better choice.In occasional patients, the following may be contributing factors:

Pressure: In some patients, pressure from helmets, chinstraps, collars, suspenders, and the like can aggravate acne.

Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium, which is used to treat bipolar disorder. Most cases of acne, however, are not drug-related.

Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.

What other skin conditions can mimic acne?

Rosacea: This condition is characterized by pimples in the middle third of the face, along with redness, flushing, and superficial blood vessels. It generally affects people in their 30s and 40s and older. There is sometimes no "bright line" separating acne from rosacea; however, there are no blackheads or whiteheads in rosacea.
Pseudofolliculitis: This is sometimes called "razor bumps" or "razor rash." When cut close to the skin, curly neck hairs bend under the skin and produce pimples. This is a mechanical problem, not a bacterial one, and treatment involves shaving less (growing a beard, laser hair removal.) Pseudofolliculitis can, of course, occur in patients who have acne too.

Folliculitis: Pimples can occur on other parts of the body, such as the abdomen, buttocks, or legs. These represent not acne but inflamed follicles. If these don't go away on their own, doctors can prescribe oral or external antibiotics, generally not the same ones used for acne.

Gram-negative folliculitis: Some patients who have been treated with oral antibiotics for long periods develop pustules filled with bacteria resistant to the antibiotics which have previously been used. Bacterial culture tests can identify these germs, leading the doctor to prescribe different antibiotics or other forms of treatment.

When should you start acne treatment?

Since everyone gets acne at some time, the right time to treat it is when it bothers you. This can be when severe acne flares suddenly, mild acne that just won't go away, or even when a single pimple decides to show up the week before your prom or wedding. The decision is yours.

What can you do about acne on your own?

Think back to the three basic causes of acne and you can understand why the focus of both home treatment and prescription therapy is to (1) unclog pores, (2) kill bacteria, and (3) minimize oil. But first a word about...

Lifestyle: Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink eight glasses of water a day. You can, however, still control your acne even if your routine is frantic and unpredictable. Probably the most useful lifestyle changes you can make are to apply hot compresses to pustules and cysts, to get facials (see below), and never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean you are, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately it usually isn't in the permanent sense. It's just a mark that takes months to fade if left entirely alone.

Open the pores

Cleansing and skin care: Despite what you read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.

Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation.
Exfoliating cleansers and masques: A variety of mild scrubs, exfoliants, and masques can be used. These products contain either fine granules or salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.
Retinol: Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.

Kill the bacteria

Antibacterial cleansers: The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.
Topical (external) applications: These products come in the form of gels, creams, and lotions, which are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol. Some brands promoted on the Internet and cable TV (such as ProActiv) are more costly but not really any better than ones you can buy in the drugstore.

Benzoyl peroxide causes red and scaly allergic skin in a small number of people, which goes away as soon as you stop using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide leave unsightly blotching on colored clothes, shirts, towels, and carpets.

Reduce the oil

You cannot stop your oil glands from producing oil (unless you mess with your hormones or metabolism in ways you shouldn't). Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they come back to life later. What you can do is to get rid of oil on the surface of the skin and reduce the embarrassing shine.

Use a gentle astringent/toner to wipe away oil.

(There are many brands available in pharmacies, as well as from manufacturers of cosmetic lines.)
Products containing glycolic acid or one of the other alpha hydroxy acids are also mildly helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).
Masques containing sulfur and other ingredients draw out facial oil.
Antibacterial pads containing benzoyl peroxide have the additional benefit of helping you wipe away oil.

What are other things you can do for acne?

Cosmetics: Don't be afraid to hide blemishes with flesh-tinted coverups or even foundation, as long at it is water-based or oil-free (which makes them noncomedogenic). There are many quality products available.

Facials: While not absolutely essential, steaming and "deep-cleaning" pores is useful, both alone and in addition to medical treatment, especially for people with "whiteheads" or "blackheads." Having these pores unclogged by a professional also reduces the temptation to do it yourself.

Pore strips: Pharmacies now carry, under a variety of brand names, strips which you put on your nose, forehead, chin, etc., to "pull out" oil from your pores. These are, in effect, a do-it-yourself facial. They are inexpensive, safe, and work reasonably well if used properly.

Toothpaste? One popular home remedy is to put toothpaste on zits. There is no medical basis for this. Ditto for vinegar.

What is a good basic skin regimen?

These are all good basic skin regimens that may help with the acne battle:

Cleanse twice daily with a 5% benzoyl peroxide wash. An alternative for those who are allergic to benzoyl peroxide is 2% salicylic acid.

Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol.

At night, apply a spot cream containing sulfur to the affected areas.

Use a light skin moisturizer and oil-free makeup.

What can the doctor do for acne?

If you haven't been able to control your acne adequately, you may want to consult a primary-care physician or dermatologist. Here are some of the things they can assist with:

Topical (externally applied) antibiotics and antibacterials: These include erythromycin, clindamycin (Benzaclin, Duac), sulfacetamide (Klaron), and azelaic acid (Azelex).

Retinoids: Retin-A (tretinoin) has been around for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. With proper sun protection, however, they can be used even during sunny periods. In December 2008 the U.S. FDA approved the combination medication known as combination preparation, known as Epiduo gel, which contains the retinoid adapalene along with the antibacterial cleanser benzoyl peroxide. This once-daily prescription treatment was approved for use in patients 12 years of age and older.

Oral antibiotics: Most doctors start treatment with tetracycline or one of the related "cyclines," such as doxycycline and minocycline. Other oral antibiotics that are useful for treating acne are cefadroxil, amoxicillin, and the sulfa drugs.

Problems with these drugs can include allergic reactions (especially sulfa),

Despite many people's concerns about using oral antibiotics for several months or longer, such use does not "weaken the immune system" and make them more susceptible to infections or unable to use other antibiotics when necessary.

Recently published reports that long-term antibiotic use may increase the risk of breast cancer will require further study, but at present they are not substantiated. In general, doctors prescribe oral antibiotic therapy for acne only when necessary and for as short a time as possible.

Oral contraceptives: Oral contraceptives, which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been to shown to have modest effectiveness in treating acne. Those FDA-approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary physicians or gynecologists when recommending these medications.

Spironolocatone: This drug blocks androgen (hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it.

Cortisone injections: To make large pimples and cysts flatten out fast, doctors inject them with a form of cortisone.

Isotretinoin: (Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem.) Isotretinoin is an excellent treatment for severe, resistant acne and has been used on millions of patients since it was introduced in Europe in 1971 and in the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, which has been unresponsive to conventional therapies like those listed above. Those with milder forms of acne often relapse shortly after finishing a course of isotretinoin, making this drug less useful in such cases. This means that isotretinoin is not a good choice for people whose acne is not that bad but who are frustrated and want "something that will knock acne out once and for all."

Used properly, isotretinoin is safe and produces few side effects beyond dry lips and occasional muscle aches. This drug is prescribed for five to six months. Fasting blood tests are monitored monthly to check liver function and the level of triglycerides, relatives of cholesterol which often rise a bit during treatment, but rarely to the point where treatment has to be modified or stopped.
Even though isotretinoin does not remain the body after therapy is stopped, improvement is often long-lasting. It is safe to take two or three courses of the drug if unresponsive acne makes a comeback. It is, however, best to wait at least several months and to try other methods before using isotretinoin again.
Isotretinoin has a high risk of inducing birth defects if taken by pregnant women. Women of childbearing age who take isotretinoin need two negative pregnancy tests (blood or urine) before starting the drug, monthly tests while they take it, and another after they are done. Those who are sexually active must use two forms of contraception, one of which is usually the oral contraceptive pill. Isotretinoin leaves the body completely when treatment is done; women must be sure to avoid pregnancy for one month after therapy is stopped. There is, however, no risk to childbearing after that time.
Another concern, much discussed in the popular press, is the risk of depression and suicide in patients taking isotretinoin. Government oversight has resulted in a highly publicized and very burdensome national registration system for those taking the drug. This has reinforced concerns in many patients and their families have that isotretinoin is dangerous. In fact, large-scale studies so far have shown no increased risk for depression and suicide in those taking isotretinoin compared with the general population. Although it is important for those taking this drug to report mood changes (or any other symptoms) to their doctors, even patients who are being treated for depression are not barred from taking isotretinoin, whose striking success often improves the mood and outlook of patients with acne scars.

Laser treatments: Recent years have brought reports of success in treating acne using lasers and similar devices, alone or in conjunction with photosensitizing dyes. It appears that these treatments are safe and can be effective, but it is not clear that their success is lasting. At this point, laser treatment of acne is best thought of as an adjunct to conventional therapy, rather than as a substitute.
Chemical peels: Whether the superficial peels (like glycolic acid) performed by estheticians or deeper ones performed in the doctor's office, chemical peels are of modest, supportive benefit only, and in general, they do not substitute for regular therapy.
Treatment of acne scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed acne scars and laser resurfacing to smooth out shallow acne scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and they may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne scars.

Polymyositis

2010-11-06T20:03:00.008+06:00

Polymyositis (pol-e-mi-o-SI-tis) is an uncommon connective tissue disease. It's a type of inflammatory myopathy, which is characterized by muscle inflammation and weakness. The most noticeable characteristic of polymyositis is weakness of the skeletal muscles, which control movement.

Polymyositis can occur at any age, but it mostly affects adults sometime between their 30s and 50s. It's more common in blacks than in whites, and women are affected more often than men are. Polymyositis signs and symptoms usually develop gradually, over weeks or months.

Periods of remission in polymyositis, during which symptoms improve spontaneously, rarely occur. However, treatment can improve your muscle strength and function.

symptoms

Signs and symptoms of polymyositis usually appear gradually, so it may be difficult to pinpoint when they first started. They may also fluctuate from week to week or month to month.

Progressive muscle weakness is the most common polymyositis symptom. It typically affects the muscles closest to the trunk, such as those in your hips, thighs, shoulders, upper arms and neck. The weakness is symmetrical, affecting both the left and right sides of your body, and tends to gradually worsen.

Although the muscle weakness starts subtly, after it progresses over the course of the disease it can make it difficult for you to climb stairs, rise from a seated position, lift objects or reach overhead.

Other polymyositis signs and symptoms include:

Difficulty swallowing (dysphagia)
Difficulty speaking
Mild joint or muscle tenderness
Fatigue
Shortness of breath

Causes
Polymyositis is in a group of diseases or disorders of the muscles called inflammatory myopathies. The cause of most inflammatory myopathies is unknown.

Infections caused by bacteria, parasites or viruses can cause inflammatory myopathies, but in most cases of polymyositis, doctors aren't able to identify a preceding infection. Some doctors think certain people may have a genetic susceptibility to the disease.

Inflammatory myopathies share many characteristics with autoimmune disorders, in which your immune system attacks normal body components. Normally, your immune system works to protect your healthy cells from attacks by foreign substances, such as bacteria and viruses. If you have polymyositis, an unknown cause may act as a trigger for your immune system to begin producing autoimmune antibodies (autoantibodies) that attack your body's own tissues.

Many people with polymyositis show a detectable level of autoantibodies in their blood.

complications

Possible complications of polymyositis include:

Difficulty swallowing. If the muscles in your esophagus are affected, you may have problems swallowing (dysphagia), which in turn may cause weight loss and malnutrition.
Aspiration and pneumonia. Difficulty swallowing may also lead to entrance of food or liquids, including saliva, into your lungs (aspiration), which can lead to pneumonia.
Breathing problems. If your chest muscles are affected by the disease, you may experience breathing problems, such as shortness of breath or in severe cases, respiratory failure.
Calcium deposits. Late in the disease, particularly if you've had the disease for a long time, deposits of calcium can occur in your muscles, skin and connective tissues (calcinosis).

Associated conditions

Although these are not complications, polymyositis is often associated with other conditions that may cause further complications of their own, or in combination with polymyositis symptoms. Associated conditions include:

Raynaud's phenomenon. This is a condition in which your fingers, toes, cheeks, nose and ears turn pale when exposed to cold temperatures.
Other connective tissue diseases. Other conditions, such as lupus, rheumatoid arthritis, scleroderma and Sjogren's syndrome, can occur in combination with polymyositis.
Cardiovascular disease. Polymyositis may cause the muscle of your heart to become inflamed (myocarditis). In a small number of people who have polymyositis, congestive heart failure and heart arrhythmias may develop.
Lung disease. A condition called interstitial lung disease may occur with polymyositis. Interstitial lung disease refers to a group of disorders that cause scarring (fibrosis) of lung tissue, making lungs stiff and inelastic. Signs and symptoms include a dry cough and shortness of breath.

Concerns during pregnancy
Pregnancy may worsen signs and symptoms in women whose disease is active. Active polymyositis can also increase the risk of premature birth or stillbirth. If the disease is in remission, the risk isn't as great.

Tests & Diagnosis

Diagnosis of polymyositis isn't always easy and can be a lengthy process. Even though the attempt to diagnose your condition may be frustrating, remember that an accurate diagnosis is necessary to receive appropriate treatment.

In addition to a thorough physical exam, your doctor will likely use other tests to confirm a diagnosis of polymyositis.

Imaging tests

Magnetic resonance imaging (MRI). A scanner creates cross-sectional images of your muscles from data generated by a powerful magnetic field and radio waves.

As MRI has become more sensitive, doctors have been using it more to diagnose inflammatory myopathies. MRI can detect active inflammation in your muscles, fibrosis and calcification. Its high sensitivity can detect subtle muscle inflammation and swelling early in the disease. A benefit of MRI is that it can look at large amounts of muscle to look for patterns or patches of muscle weakness, instead of taking a small sample from a single muscle, for example.

Muscle tests

Electromyography. A doctor with specialized training inserts a thin needle electrode through the skin into the muscle to be tested. Electrical activity is measured as you relax or tighten the muscle, and changes in the pattern of electrical activity can confirm a muscle disease. The doctor can determine the distribution of the disease by testing different muscles.
Muscle biopsy. A small piece of muscle tissue is removed surgically for laboratory analysis. A muscle biopsy may reveal abnormalities in your muscles, such as inflammation, damage or infection. The tissue sample can also be examined for the presence of abnormal proteins and checked for enzyme deficiencies. In polymyositis, a muscle biopsy typically shows inflammation, dead muscle cells (necrosis), and degeneration and regeneration of muscle fibers.

Blood tests

Blood analysis. A blood test will let your doctor know if you have elevated levels of muscle enzymes, such as creatine kinase (CK) and aldolase. Increased CK and aldolase levels can indicate muscle damage. A blood test can also detect specific autoantibodies associated with different symptoms of polymyositis, which can help in determining the best medication and treatment.

Treatments and drugs

Although there's no cure for polymyositis, treatment can improve your muscle strength and function. The earlier treatment is started in the course of polymyositis, the more effective it is, leading to fewer complications.

Drugs

Corticosteroids. These medications suppress your immune system, limiting the production of antibodies and reducing muscle inflammation, as well as improving muscle strength and function. Corticosteroids, especially prednisone, are usually the first choice in treating inflammatory myopathies such as polymyositis.

Your doctor may start with a very high dose, and then decrease it as your signs and symptoms improve. Improvement generally takes about two to four weeks, but therapy is often needed for years.

Prolonged use of corticosteroids can have serious and wide-ranging side effects, so your doctor may recommend supplements to combat them, such as calcium and vitamin D, and may prescribe bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel) or zoledronic acid (Reclast). Bisphosphonates in pill form may not be recommended if you have difficulty swallowing.
Corticosteroid-sparing agents. Your doctor may recommend other medications, either to decrease side effects or if your condition doesn't respond to corticosteroids. These medications include azathioprine (Imuran) or methotrexate (Rheumatrex). Your doctor may prescribe these alone or in combination with corticosteroids.

When in combination, these additional immunosuppressants can be used to lessen the dose and potential side effects of the corticosteroid. Immunosuppressants, such as cyclophosphamide (Cytoxan) and cyclosporine (Neoral, Sandimmune), may improve signs and symptoms of polymyositis and interstitial lung disease.

Antibody therapy

Intravenous immunoglobulin (IVIg). Immunoglobulin contains healthy antibodies from blood donors. High doses can block the damaging antibodies that attack muscle in polymyositis.

Immunosuppressive therapies
In addition to corticosteroids and immunosuppressive drugs, other treatments to suppress your immune system include:

Tacrolimus (Prograf). This transplant-rejection drug may work to inhibit the immune system. Tacrolimus is often used topically to treat dermatomyositis and other skin problems. When taken orally, it may be helpful in treating people who have polymyositis complicated by interstitial lung disease.

Investigational treatment

Biological therapies. Rituximab (Rituxan) has been studied in small numbers of people with polymyositis and dermatomyositis and shown to improve muscle strength, lung involvement and skin rash. Tumor necrosis factor (TNF) inhibitors such as etanercept (Enbrel) and infliximab (Remicade) have not been shown to be effective in trials with small numbers of people with polymyositis or dermatomyositis. Rituximab is not approved by the Food and Drug Administration for the treatment of polymyositis, so your insurance company will likely require preapproval if you wish to be reimbursed.

Other treatment

Physical therapy. A physical therapist can show you exercises to maintain and improve your strength and flexibility and advise an appropriate level of activity.
Dietetic assessment. Later in polymyositis, chewing and swallowing can become more difficult. A registered dietitian can teach you how to prepare easy-to-eat foods.
Speech therapy. If your swallowing muscles are weakened by polymyositis, speech therapy can help you learn how to compensate for those changes.

Lifestyle and home remedies

Get active. Maintaining an exercise routine can help you maintain and build your muscle strength. Just be sure that you get a detailed plan and recommendations from your doctor or physical therapist before starting an exercise program.
Rest when you're tired. Don't wait until you're exhausted. This will only set you back further as your body tries to recuperate. Learning to pace yourself can help you maintain a consistent level of energy, accomplish just as much and feel better emotionally.

QUESTION NO- 1

2010-10-28T23:35:00.003+06:00

Your patient is a 3 year old girl with fever and pain in her right ear. On physical examination, the ear drum is found to be perforated and a bloody exudate is seen. A gram stain of the exudate reveals gram-positive diplococci.
Of the following, which one is the MOST likely cause?

a) streptococcus pyogenes
b) staphylococcus aureus
c) corynebacterium diptheriae
d) streptococcus pneumoniae

Write your answer in comment. Answer will be given 3days later.

Helicobacter Pylori

2010-10-09T21:39:00.003+06:00

What is Helicobacter pylori?

Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation of the inner lining of the stomach (gastritis) in humans. This bacterium also is the most common cause of ulcers worldwide. H. pylori infection is most likely acquired by ingesting contaminated food and water and through person to person contact. In the United States, 30% of the adult population is infected. (50% of infected persons are infected by the age of 60.) The infection is more common in crowded living conditions with poor sanitation. In countries with poor sanitation, 90% of the adult population can be infected. Infected individuals usually carry the infection indefinitely unless they are treated with medications to eradicate the bacterium. One out of every six patients with H. pylori infection will develop ulcers of the duodenum or stomach. H. pylori also is associated with stomach cancer and a rare type of lymphocytic tumor of the stomach called MALT lymphoma.

How is H. pylori infection diagnosed?

Accurate and simple tests for the detection of H. pylori infection are available. They include blood antibody tests, urea breath tests, stool antigen tests, and endoscopic biopsies.

Blood tests for the presence of antibodies to H. pylori can be performed easily and rapidly. However, blood antibodies can persist for years after complete eradication of H. pylori with antibiotics. Therefore, blood antibody tests may be good for diagnosing infection, but they are not good for determining if antibiotics have successfully eradicated the bacterium.

The urea breath test (UBT) is a safe, easy, and accurate test for the presence of H. pylori in the stomach. The breath test relies on the ability of H. pylori to break down the naturally occurring chemical, urea, into carbon dioxide which is absorbed from the stomach and eliminated from the body in the breath. Ten to 20 minutes after swallowing a capsule containing a minute amount of radioactive urea, a breath sample is collected and analyzed for radioactive carbon dioxide. The presence of radioactive carbon dioxide in the breath (a positive test) means that there is active infection. The test becomes negative (there is no radioactive carbon dioxide in the breath) shortly after eradication of the bacterium from the stomach with antibiotics. Despite the fact that individuals having the breath test are exposed to a minute amount of radioactivity, the breath test has been modified so that it also may be performed with urea that is not radioactive.

Endoscopy is an accurate test for diagnosing H. pylori as well as the inflammation and ulcers that it causes. For endoscopy, the doctor inserts a flexible viewing tube (endoscope) through the mouth, down the esophagus, and into the stomach and duodenum. During endoscopy, small tissue samples (biopsies) from the stomach lining can be removed. A biopsy specimen is placed on a special slide containing urea (e.g., CLO test slides). If the urea is broken down by H. pylori in the biopsy, there is a change in color around the biopsy on the slide. This means that there is an infection with H. pylori in the stomach.

The most recently-developed test for H. pylori is a test in which the presence of the bacterium can be diagnosed with a sample of stool. The test uses an antibody to H. pylori to determine if H. pylori is present in the stool. If it is, it means that H. pylori is infecting the stomach. Like the urea breath test, in addition to diagnosing infection with H. pylori, the stool test can be used to determine if eradication has been effective shortly after treatment.

Why treat H. pylori?

Chronic infection with H. pylori weakens the natural defenses of the lining of the stomach against the ulcerating action of acid. Medications that neutralize stomach acid (antacids), and medications that decrease the secretion of acid in the stomach (H2-blockers and proton pump inhibitors or PPIs) have been used effectively for many years to treat ulcers. H2-blockers, include ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet), and nizatidine (Axid). PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). Antacids, H2-blockers and PPIs, however, do not eradicate H. pylori from the stomach, and ulcers frequently return promptly after these medications are discontinued. Hence, antacids, H2-blockers or PPIs have to be taken daily for many years to prevent the return of the ulcers and the complications of ulcers such as bleeding, perforation, and obstruction of the stomach. Eradication of H. pylori prevents the return of ulcers and ulcer complications even after the medications are stopped. Eradication of H. pylori also is important in the treatment of the rare condition known as MALT lymphoma of the stomach. Treatment of H. pylori to prevent stomach cancer is controversial and discussed later.

How is H. pylori treated?

H. pylori is difficult to eradicate from the stomach because it is capable of developing resistance to commonly used antibiotics. Therefore, two or more antibiotics usually are given together with a PPI and/or bismuth containing compounds to eradicate the bacterium. (Bismuth and PPIs have anti-H. pylori effects.) Examples of combinations of medications that are effective are:

a PPI, amoxicillin (Amoxil) and clarithromycin (Biaxin)
a PPI, metronidazole (Flagyl), tetracycline and bismuth subsalicylate

These combinations of medications can be expected to cure 70%-90% of infections. However, studies have shown that resistance of H. pylori (failure of antibiotics to eradicate the bacteria) to clarithromycin is common among patients who have prior exposure to clarithromycin or other chemically similar macrolide antibiotics (such as erythromycin). Similarly, H. pylori resistance to metronidazole is common among patients who have had prior exposure to metronidazole. In these patients, doctors have to find other combinations of antibiotics to treat the H. pylori. Antibiotic resistance is another reason why antibiotics should be used carefully and judiciously for the right reasons, and indiscriminate use of antibiotics for improper reasons should be discouraged.

Some doctors may want to confirm eradication of H. pylori after treatment with a urea breath test or a stool antigen test, particularly if there have been serious complications of the infection such as perforation or bleeding in the stomach or duodenum. Endoscopic biopsies to determine eradication of the bacteria are not necessary, and blood tests are not good for determining eradication since it takes many months for the antibodies to H. pylori to decrease. The best tests for determining eradication are the breath and stool tests discussed previously. Patients who fail to eradicate H. pylori with treatment are retreated, often with a different combination of medications.

Hay Fever (Allergic Rhinitis)

2010-09-20T09:59:00.007+06:00

What is hay fever? What are the symptoms and signs?

Hay fever is a misnomer. Hay is not a usual cause of this problem, and it does not cause fever. Early descriptions of sneezing, nasal congestion, and eye irritation while harvesting field hay promoted this popular term. Allergic rhinitis is the correct term used to describe this allergic reaction, and many different substances cause the allergic symptoms noted in hay fever. Rhinitis means "irritation of the nose" and is a derivative of rhino, meaning nose. Allergic rhinitis which occurs during a specific season is called "seasonal allergic rhinitis." When it occurs throughout the year, it is called "perennial allergic rhinitis." Rhinosinusitis is the medical term that refers to inflammation of the nasal lining as well as the lining tissues of the sinuses. This term is sometime used because the two conditions frequently occur together.

Symptoms of allergic rhinitis, or hay fever, frequently include nasal congestion, a clear runny nose, sneezing, nose and eye itching, and excess tear production in the eyes. Postnasal dripping of clear mucus frequently causes a cough. Loss of the sense of smell is common, and loss of taste sense occurs occasionally. Nose bleeding may occur if the condition is severe. Eye itching, redness, and excess tears in the eyes frequently accompany the nasal symptoms. The eye symptoms are referred to as "allergic conjunctivitis" (inflammation of the whites of the eyes). These allergic symptoms often interfere with one's quality of life and overall health.

Allergic rhinitis can lead to other diseases such as sinusitis and asthma. Many people with allergies have difficulty with social and physical activities. For example, concentration is often difficult while experiencing allergic rhinitis.

Why does an allergic reaction occur?

An allergic reaction occurs when the immune system attacks a usually harmless substance called an allergen that gains access to the body. To more simply describe this complex immune process, we will make an analogy to a war within the body. The immune system calls upon a protective substance called immunoglobulin E (IgE) antibodies ("E" for "erythema" or redness) to fight these invading allergic substances or allergens. Even though everyone has some IgE, an allergic person has an unusually large army of these IgE defenders -- in fact, too many for his/her own good. This army of IgE antibodies attacks and engages the invading army of allergic substances of allergens.

As is often the case in war, innocent bystanders are affected in battle. These innocent bystanders are special cells called mast cells. These cells are frequently injured during the warring of the IgE antibodies and the allergic substances. When a mast cell is injured, it releases a variety of chemicals into the tissues and blood, one of which is known as histamine. These chemicals frequently cause allergic reactions. These chemicals are very irritating and cause itching, swelling, and fluid leaking from cells. Through various mechanisms, these allergic chemicals can cause muscle spasm and can lead to lung and throat tightening as is found in asthma and loss of voice.

What causes allergic rhinitis?

Any substance can cause an allergy if exposed to a person in the right way. But for all practical purposes and with few exceptions, allergic rhinitis is caused by proteins. Commonly, allergic rhinitis is a result of an allergic person coming in contact several times with protein from plants. Many trees, grasses, and weeds produce extremely small, light, dry protein particles called pollen. This pollen is spread by the wind and is inhaled. These pollen particles are usually the male sex cells of the plant and are smaller than the tip of a pin or less than 40 microns in diameter.

Even though pollen is usually invisible in the air, pollen is a potent stimulator of allergy. Pollen lodges in the nasal lining tissues (mucus membranes) and other parts of the respiratory tract where it initiates the allergic response. Up to 30% of Americans at times suffer from allergic rhinitis. A person is programmed to be allergic by his/her genetic makeup and is destined to be allergic from birth. Approximately one in four people with allergic rhinitis also has asthma.

When and where does allergic rhinitis occur?

Since allergic rhinitis is frequently caused by pollen, symptoms occur when pollen is in the air. Trees primarily pollinate in the spring, while grasses pollinate in the spring and summer. Weeds usually pollinate in the late summer and fall. Of all allergy sufferers in the United States, 75% are allergic to ragweed, 50% are allergic to grasses ,and 10% are allergic to trees. Of course, many people are allergic to other substances such as mold spores, animal protein, and mites, to name a few. Food is an uncommon cause of allergic rhinitis. If you wish to know the pollen count in your area, this information can often be found in the newspaper in the weather section or you can access the National Allergy Bureau's pollen count information at their web site (http://www.aaaai.org/nab/index.cfm).

How is allergic rhinitis diagnosed, and how are allergies identified?

If a person is experiencing the typical symptoms of hay fever, a consultation with an allergy specialist can help identify the offending substances. Since the ideal way to manage an allergy is to avoid the substances that cause allergic reaction, it is therefore very important to first identify these substances (allergens). Many allergens can be suspected from information obtained in a patient's particular history. For example, if symptoms usually worsen with exposure to cats, then cat dander protein is a probable allergen causing the symptoms. If cutting grass is associated with the onset of symptoms, then grass allergy is probable. A patient's history of reactions is very important in determining his/her unique allergies.

Because the identification of allergens is important and often difficult to pinpoint, skin testing is often needed to identify exactly the specific substance causing the allergy. Skin testing is now done with minimal discomfort and is performed as follows:

A small amount of the suspected allergy substance is placed on the skin.

The skin is then gently scratched through the small drop with a special sterile needle. This is known as the prick-puncture method and is typically used for initial evaluations. A second method, known as the intradermal method, involves injection of a small amount of the test substance into the skin. Intradermal testing is more sensitive but also tends to lead to more false-positive results.

If the skin reddens and, more importantly, swells, then an individual is said to be "sensitized" to the particular allergen. If typical symptoms occur when a sensitized individual is exposed to the suspected substance, then allergy to that substance is probable.

The skin testing described is tolerated by the youngest of patients and should be the standard of testing.

Skin testing is not indicated for people who are at risk of a severe (anaphylactic) allergic reaction, who have certain skin conditions, or who are taking certain medications.

A number of blood tests are also available to aid in the diagnosis of allergy. These blood tests may be useful in people who cannot be skin tested due to skin diseases, who are taking medications that interfere with skin testing, or who are at a high risk of having an anaphylactic reaction to skin testing. These blood tests typically use various techniques to look for IgE antibodies in the blood and by inference suggest allergy in the tissues. If the allergy testing agrees with the history of symptoms upon exposure to the substance, then a diagnosis of allergic rhinitis is likely.

How are allergies treated?

Avoidance of identified allergens is the most helpful factor in controlling allergy symptoms. Attempts to control the environment and avoidance measures often significantly aid in resolving symptoms. However, allergy avoidance is often not easy. A thorough discussion with your physician is needed, and control measures may be required daily.

If avoidance is not possible or does not relieve symptoms, additional treatment is needed. Many patients respond to medications that combat the effects of histamine, known as antihistamines. Antihistamines do not stop the formation of histamine, nor do they stop the conflict between the IgE and antigen. Therefore, antihistamines do not stop the allergic reaction but rather protect tissues from the effects of the allergic response.

The first-generation antihistamines, such as diphenhydramine (Benadryl), chlorpheniramine (Chlortrimaton), dimenhydrinate (Dramamine), brompheniramine (Dimetapp and others), clemastine fumarate (Tavist, Allerhist), and dexbrompheniramine (Drixoral) frequently cause mouth dryness and sleepiness as side effects. Newer, so-called "non-sedating" or second-generation antihistamines are also available. These include loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), fexofenidine (Allegra), and azelastine (Astelin Nasal Spray). In general, this group of antihistamines is slightly more expensive, has a slower onset of action, is longer acting, and induces less sleepiness. Discuss with your physician other antihistamine side effects that very occasionally occur (for example, urine retention in males, fast heart rate, and others).

Decongestants help control allergy symptoms but not their causes. Decongestants shrink the swollen membranes in the nose and make it easier to breathe. Decongestants can be taken orally or by nasal spray. Decongestant nasal sprays should not be used for more than five days without a doctor's advice, and if so, usually only when accompanied by a nasal steroid. Decongestant nasal sprays often cause a so-called "rebound effect" if taken for too long. A rebound effect is the worsening of symptoms when a drug is discontinued. This is a result of a tissue dependence on the medication.

Some people with allergies need specialized prescription medications such as corticosteroids, cromolyn, and ipratropium (Atropine-like) nasal sprays. These nasal sprays do not cause the rebound effect noticed with decongestant nasal sprays. Cortisone nasal sprays are very effective in reducing the inflammation which causes swelling, sneezing, and a runny nose. Cortisone can also stop the allergy "war" by halting the formation of the many allergy chemicals described above. Many cortisone nasal sprays are on the market through prescription only. Fluticasone (Flonase) is one example, but many preparations are available.

Cromolyn is also an antiinflammatory medication. Although cromolyn is not as potent as cortisone, it has a very safe profile. Cromolyn must be used well in advance of anticipated allergy symptoms to be useful. Ipratropium nasal spray is available for drying a wet runny nose. It will not prevent allergic reactions. This is an atropine derivative and although usually very safe, a person sensitive to atropine should be cautious when taking this drug.

Montelukast (Singulair) is an inhibitor of leukotriene action, another chemical involved in the allergic reaction. This medication is used for therapy of asthma and has also been approved for treatment of allergic rhinitis. It has been shown to be most effective in those for whom significant congestion is a primary complaint. It may also be used in some cases together with second-generation antihistamines.

If antihistamines and nasal sprays are not effective or not tolerated by the patient, other modalities of therapy are available. Allergy desensitization or immunotherapy may be needed. Allergy immunotherapy stimulates the immune system with gradually increasing doses of the substances to which a person is allergic. Since the patient is being exposed to the allergy-inducing substance, an allergic reaction can occur, and this treatment should be supervised by an allergy specialist. Although the exact way allergy desensitization works is not completely known, allergy injections appear to modify or stop the allergy "war" by reducing the strength of the IgE and its effect on the mast cells. This form of treatment is very effective for allergies to pollen, mites, cats, and especially stinging insects (for example, bees). Allergy immunotherapy usually requires a series of injections and takes three months to one year to become effective. The required length of treatment may vary, but three years is a typical course. Frequent office visits are necessary.

The success rate of an allergy desensitization program in significantly reducing symptoms can be up to about 80%. The duration of the effect of allergy immunotherapy should last many years, if not a lifetime. Although rare (one in 2-5 million injections given), serious allergy reactions can occur while receiving allergy injections. One cannot predict who will have a severe reaction. Even after years of receiving allergy shots, a patient can experience a reaction.

Hay Fever At A Glance

Hay fever (Allergic rhinitis) is common.
Allergy symptoms mimic chronic colds.
Allergic rhinitis can lead to other diseases.
The best way to treat an allergy condition is to identify the allergic substance and avoid it.
Effective treatment is available in many forms.

ELISA Tests

2010-09-16T19:45:00.005+06:00

What is ELISA?

ELISA is an abbreviation for "enzyme-linked immunosorbent assay."

What is an ELISA test?

An ELISA test uses components of the immune system and chemicals to detect immune responses in the body (for example, to infectious microbes). The ELISA test involves an enzyme (a protein that catalyzes a biochemical reaction). It also involves an antibody or antigen (immunologic molecules).

What is the use of an ELISA test?

ELISA tests are widely utilized to detect substances that have antigenic properties, primarily proteins (as opposed to small molecules and ions such as glucose and potassium). The substances detected by ELISA tests include hormones, bacterial antigens and antibodies.

How does an ELISA test work?

There are variations of the ELISA test, but the most basic type consists of an antibody attached to a solid surface. This antibody has affinity for (will latch on to) the substance of interest, for example, human chorionic gonadotropin (HCG), the commonly measured protein which indicates pregnancy. A mixture of purified HCG linked (coupled) to an enzyme and the test sample (blood, urine, etc) are added to the test system. If no HCG is present in the test sample, then only HCG with linked enzyme will bind. The more HCG which is present in the test sample, the less enzyme linked HCG will bind. The substance the enzyme acts on is then added, and the amount of product measured in some way, such as a change in color of the solution.

What are the advantages of ELISA?

ELISA tests are generally relatively accurate tests. They are considered highly sensitive and specific and compare favorably with other methods used to detect substances in the body, such as radioimmune assay (RIA) tests. They have the added advantages of not needing radioisotopes (radioactive substances) or a costly radiation counter (a radiation-counting apparatus).

Hydrocephalus

2010-09-13T11:49:00.004+06:00

What is hydrocephalus?

The term hydrocephalus is derived from the Greek words "hydro" meaning water and "cephalus" meaning head. As the name implies, it is a condition in which the primary characteristic is excessive accumulation of fluid in the brain. Although hydrocephalus was once known as "water on the brain," the "water" is actually cerebrospinal fluid (CSF) — a clear fluid that surrounds the brain and spinal cord. The excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles. This widening creates potentially harmful pressure on the tissues of the brain.

The ventricular system is made up of four ventricles connected by narrow passages.. Normally, CSF flows through the ventricles, exits into cisterns (closed spaces that serve as reservoirs) at the base of the brain, bathes the surfaces of the brain and spinal cord, and then reabsorbs into the bloodstream.

CSF has three important life-sustaining functions: 1) to keep the brain tissue buoyant, acting as a cushion or "shock absorber"; 2) to act as the vehicle for delivering nutrients to the brain and removing waste; and 3) to flow between the cranium and spine and compensate for changes in intracranial blood volume (the amount of blood within the brain).

What are the different types of hydrocephalus?

Hydrocephalus may be congenital or acquired. Congenital hydrocephalus is present at birth and may be caused by either events or influences that occur during fetal development, or genetic abnormalities. Acquired hydrocephalus develops at the time of birth or at some point afterward. This type of hydrocephalus can affect individuals of all ages and may be caused by injury or disease.Hydrocephalus may also be communicating or non-communicating. Communicating hydrocephalus occurs when the flow of CSF is blocked after it exits the ventricles. This form is called communicating because the CSF can still flow between the ventricles, which remain open. Non-communicating hydrocephalus - also called "obstructive" hydrocephalus - occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles. One of the most common causes of hydrocephalus is "aqueductal stenosis." In this case, hydrocephalus results from a narrowing of the aqueduct of Sylvius, a small passage between the third and fourth ventricles in the middle of the brain.

There are two other forms of hydrocephalus which do not fit exactly into the categories mentioned above and primarily affect adults: hydrocephalus ex-vacuo and normal pressure hydrocephalus.

Hydrocephalus ex-vacuo occurs when stroke or traumatic injury cause damage to the brain. In these cases, brain tissue may actually shrink. Normal pressure hydrocephalus can happen to people at any age, but it is most common among the elderly. It may result from a subarachnoid hemorrhage, head trauma, infection, tumor, or complications of surgery. However, many people develop normal pressure hydrocephalus even when none of these factors are present for reasons that are unknown.

Who gets this hydrocephalus?

The number of people who develop hydrocephalus or who are currently living with it is difficult to establish since there is no national registry or database of people with the condition. However, experts estimate that hydrocephalus affects approximately 1 in every 500 children.

What causes hydrocephalus?

The causes of hydrocephalus are still not well understood. Hydrocephalus may result from inherited genetic abnormalities (such as the genetic defect that causes aqueductal stenosis) or developmental disorders (such as those associated with neural tube defects including spina bifida and encephalocele). Other possible causes include complications of premature birth such as intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage, which block the exit of CSF from the ventricles to the cisterns or eliminate the passageway for CSF into the cisterns.

What are the symptoms of hydrocephalus?

Symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to the condition. For example, an infant's ability to compensate for increased CSF pressure and enlargement of the ventricles differs from an adult's. The infant skull can expand to accommodate the buildup of CSF because the sutures (the fibrous joints that connect the bones of the skull) have not yet closed.

In infancy, the most obvious indication of hydrocephalus is often a rapid increase in head circumference or an unusually large head size. Other symptoms may include vomiting, sleepiness, irritability, downward deviation of the eyes (also called "sunsetting"), and seizures.

Older children and adults may experience different symptoms because their skulls cannot expand to accommodate the buildup of CSF. Symptoms may include headache followed by vomiting, nausea, papilledema (swelling of the optic disk which is part of the optic nerve), blurred or double vision, sunsetting of the eyes, problems with balance, poor coordination, gait disturbance, urinary incontinence, slowing or loss of developmental progress, lethargy, drowsiness, irritability, or other changes in personality or cognition including memory loss.

Symptoms of normal pressure hydrocephalus include, problems with walking, impaired bladder control leading to urinary frequency and/or incontinence, and progressive mental impairment and dementia. An individual with this type of hydrocephalus may have a general slowing of movements or may complain that his or her feet feel "stuck." Because some of these symptoms may also be experienced in other disorders such as Alzheimer's disease, Parkinson's disease, and Creutzfeldt-Jakob disease, normal pressure hydrocephalus is often incorrectly diagnosed and never properly treated. Doctors may use a variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar catheter, intracranial pressure monitoring, and neuropsychological tests, to help them accurately diagnose normal pressure hydrocephalus and rule out any other conditions.

How is hydrocephalus diagnosed?

Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring techniques. A physician selects the appropriate diagnostic tool based on an individual's age, clinical presentation, and the presence of known or suspected abnormalities of the brain or spinal cord. top

What is the current treatment for hydrocephalus?

Hydrocephalus is most often treated by surgically inserting a shunt system. This system diverts the flow of CSF from the CNS to another area of the body where it can be absorbed as part of the normal circulatory process.

A shunt is a flexible but sturdy plastic tube. A shunt system consists of the shunt, a catheter, and a valve. One end of the catheter is placed within a ventricle inside the brain or in the CSF outside the spinal cord. The other end of the catheter is commonly placed within the abdominal cavity, but may also be placed at other sites in the body such as a chamber of the heart or areas around the lung where the CSF can drain and be absorbed. A valve located along the catheter maintains one-way flow and regulates the rate of CSF flow.

A limited number of individuals can be treated with an alternative procedure called third ventriculostomy. In this procedure, a neuroendoscope — a small camera that uses fiber optic technology to visualize small and difficult to reach surgical areas — allows a doctor to view the ventricular surface. Once the scope is guided into position, a small tool makes a tiny hole in the floor of the third ventricle, which allows the CSF to bypass the obstruction and flow toward the site of resorption around the surface of the brain.

What are the possible complications of a shunt system?

Shunt systems are not perfect devices. Complications may include mechanical failure, infections, obstructions, and the need to lengthen or replace the catheter. Generally, shunt systems require monitoring and regular medical follow up. When complications occur, the shunt system usually requires some type of revision.

Some complications can lead to other problems such as overdraining or underdraining. Overdraining occurs when the shunt allows CSF to drain from the ventricles more quickly than it is produced. Overdraining can cause the ventricles to collapse, tearing blood vessels and causing headache, hemorrhage (subdural hematoma), or slit-like ventricles (slit ventricle syndrome). Underdraining occurs when CSF is not removed quickly enough and the symptoms of hydrocephalus recur.

What is the prognosis for hydrocephalus?

The prognosis for individuals diagnosed with hydrocephalus is difficult to predict, although there is some correlation between the specific cause of the hydrocephalus and the outcome. Prognosis is further complicated by the presence of associated disorders, the timeliness of diagnosis, and the success of treatment. The degree to which relief of CSF pressure following shunt surgery can minimize or reverse damage to the brain is not well understood.

Affected individuals and their families should be aware that hydrocephalus poses risks to both cognitive and physical development. However, many children diagnosed with the disorder benefit from rehabilitation therapies and educational interventions and go on to lead normal lives with few limitations. Treatment by an interdisciplinary team of medical professionals, rehabilitation specialists, and educational experts is critical to a positive outcome. Left untreated, progressive hydrocephalus may be fatal.

The symptoms of normal pressure hydrocephalus usually get worse over time if the condition is not treated, although some people may experience temporary improvements. While the success of treatment with shunts varies from person to person, some people recover almost completely after treatment and have a good quality of life. Early diagnosis and treatment improves the chance of a good recovery.

Leukoplakia

2010-09-12T16:09:00.003+06:00

Introduction

Leukoplakia is a white or gray patch that develops on the tongue or the inside of the cheek. It is the mouth's reaction to chronic irritation of the mucous membranes of the mouth. Leukoplakia patches can also develop on the female genital area; however, the cause of this is unknown.

The growth can occur at any time in your life, but it is most common in the elderly.

"Hairy" leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in people who are infected with HIV, have AIDS, or AIDS-related complex. It consists of fuzzy, hence the name "hairy," white patches on the tongue and less frequently elsewhere in the mouth. It may resemble thrush, an infection caused by the fungus Candida which, in adults, usually occurs if your immune system is not working properly, and may be one of the first signs of infection with the HIV virus.

What Causes Leukoplakia?

Irritation from rough teeth, fillings, or crowns, or ill-fitting dentures that rub against your cheek or gum
Chronic smoking, pipe smoking, or other tobacco use
Sun exposure to the lips
Oral cancer, although rare
HIV or AIDS

What Are the Symptoms?

The presence of white or gray colored patches on your tongue, gums, roof of your mouth, or the inside of the cheeks of your mouth may be a sign of leukoplakia. The patch may have developed slowly over weeks to months and be thick, slightly raised, and may eventually take on a hardened and rough texture. It usually is painless, but may be sensitive to touch, heat, spicy foods, or other irritation.

How Is Leukoplakia Diagnosed?

Your dentist may suspect leukoplakia upon examination; however, a biopsy will likely be taken to rule out other causes, such as oral cancer. During the biopsy, a small piece of tissue from the lesion will be removed to be examined in a lab. A numbing agent will be used so that you will not feel any pain.

How Is Leukoplakia Treated?

Treatment, if needed, involves removing the source of irritation. For example, if leukoplakia is caused by a rough tooth or an irregular surface on a denture or filling the tooth will be smoothed and dental appliances repaired. If leukoplakia is caused by smoking, you will be asked to minimize or stop smoking or using other tobacco products.

Leukoplakia is usually harmless, and lesions usually clear in a few weeks or months after the source of irritation is removed. If eliminating the source of irritation is ineffective in reducing leukoplakia, the lesion may need to be surgically removed. The lesion can be removed either by your general dentist or by an oral surgeon in their office under local anesthesia.

Hairy leukoplakia requires treatment with an antiviral medication.

Leukemia

2010-09-11T00:08:00.010+06:00

What is leukemia?
Leukemia is cancer that starts in the tissue that forms blood. To understand cancer, it helps to know how normal blood cells form.
Normal Blood Cells
Most blood cells develop from cells in the bone marrow called stem cells. Bone marrow is the soft material in the center of most bones.
Stem cells mature into different kinds of blood cells. Each kind has a special job:

White blood cells help fight infection. There are several types of white blood cells.

Red blood cells carry oxygen to tissues throughout the body.

Platelets help form blood clots that control bleeding.
White blood cells, red blood cells, and platelets are made from stem cells as the body needs them. When cells grow old or get damaged, they die, and new cells take their place.
The picture below shows how stem cells can mature into different types of white blood cells. First, a stem cell matures into either a myeloid stem cell or a lymphoid stem cell:

A myeloid stem cell matures into a myeloid blast. The blast can form a red blood cell, platelets, or one of several types of white blood cells.
A lymphoid stem cell matures into a lymphoid blast. The blast can form one of several types of white blood cells, such as B cells or T cells.

The white blood cells that form from myeloid blasts are different from the white blood cells that form from lymphoid blasts.

Leukemia Cells
In a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells.
Unlike normal blood cells, leukemia cells don't die when they should. They may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for normal blood cells to do their work.

Types of Leukemia

The types of leukemia can be grouped based on how quickly the disease develops and gets worse. Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly):

Chronic leukemia: Early in the disease, the leukemia cells can still do some of the work of normal white blood cells. People may not have any symptoms at first. Doctors often find chronic leukemia during a routine checkup - before there are any symptoms.
Slowly, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, people get symptoms, such as swollen lymph nodes or infections. When symptoms do appear, they are usually mild at first and get worse gradually.
Acute leukemia: The leukemia cells can't do any of the work of normal white blood cells. The number of leukemia cells increases rapidly. Acute leukemia usually worsens quickly.

The types of leukemia also can be grouped based on the type of white blood cell that is affected. Leukemia can start in lymphoid cells or myeloid cells. See the picture of these cells. Leukemia that affects lymphoid cells is called lymphoid, lymphocytic, or l
ymphoblastic leukemia. Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia.
There are four common types of leukemia:

Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It accounts for more than 15,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.

Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It accounts for nearly 5,000 new cases of leukemia each year. It mainly affects adults.

Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows quickly. It accounts for more than 5,000 new cases of leukemia each year. ALL is the most common type of leukemia in young children. It also affects adults.

Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly. It accounts for more than 13,000 new cases of leukemia each year. It oc curs in both adults and children.

Hairy cell leukemia is a rare type of chronic leukemia.

Risk Factors

When you're told that you have cancer, it's natural to wonder what may have caused the disease. No one knows the exact causes of leukemia. Doctors seldom know why one person gets leukemia and another doesn't. However, research shows that certain risk factors increase the chance that a person will get this disease.
The risk factors may be different for the different types of leukemia:

Radiation: People exposed to very high levels of radiation are much more likely than others to get acute myeloid leukemia, chronic myeloid leukemia, or acute lymphocytic leukemia.

Atomic bomb explosions: Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II). People, especially children, who survive atomic bomb expl osions are at increased risk of leukemia.
Radiation therapy: Another source of exposure to high levels of radiation is medical treatment for cancer and other conditions. Radiation therapy can increase the risk of leukemia.
Diagnostic x-rays: Dental x-rays and other diagnostic x-rays (such as CT scans) expose people to much lower levels of radiation. It's not known yet whether this low level of radiation to children or adults is linked to leukemia. Researchers are studying whether having many x-rays may increase the risk of leukemia. They are also studying whether CT scans during childhood are linked with increased risk of developing leukemia.

Smoking: Smoking cigarettes increases the risk of acute myeloid leukemia.
Benzene: Exposure to benzene in the workplace can cause acute myeloid leukemia. It may also cause chronic myeloid leukemia or acute lymphocytic leukemia. Benzene is used widely in the chemical industry. It's also found in cigarette smoke and gasoline.
Chemotherapy: Cancer patients treated with certain types of cancer-fighting drugs sometimes later get acute myeloid leukemia or acute lymphocytic leukemia. For example, being treated with drugs known as alkylating agents or topoisomerase inhibitors is linked with a small chance of later developing acute leukemia.
Down syndrome and certain other inherited diseases: Down syndrome and certain other inherited diseases increase the risk of developing acute leukemia.
My elodysplastic syndrome and certain other blood disorders: People with certain blood disorders are at increased risk of acute myeloid leukemia.
Human T-cell leukemia virus type I (HTLV-I): People with HTLV-I infection are at increased risk of a rare type of leukemia known as adult T-cell leukemia. Although the HTLV-I virus may cause this rare disease, adult T-cell leukemia and other types of leukemia are not contagious.
Fa mily history of leukemia: It's rare for more than one person in a family to have leukemia. When it does happen, it's most likely to involve chronic lymphocytic leukemia. However, only a few people with chronic lymphocytic leukemia have a father, mother, brother, sister, or child who also has the disease.

Having one or more risk factors does not mean that a person will get leukemia. Most people who have risk factors never develop the disease.

Symptoms

Like all blood cells, leukemia cells travel through the body. The symptoms of leukemia depend on the number of le
ukemia cells and where these cells collect in the body.
People with chronic leukemia may not have symptoms. The doctor may find the disease during a routine blood test.
People with acute leukemia usually go to their doctor because they feel sick. If the brain is affected, they may have headaches, vomiting, confusion, loss of muscle control, or seizures. Leukemia also can affect other parts of the body such as the digestive tract, kidneys, lungs, heart, or testes.
Common symptoms of chronic or acute leukemia may include:

Swollen lymph nodes that usually don't hurt (especially lymph nodes in the neck or armpit)
Fevers or night sweats
Frequent infections
Feeling weak or tired
Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
Swelling or discomfort in the abdomen (from a swollen spleen or liver)
Weight loss for no known reason
Pain in the bones or joints

Most often, these symptoms are not due to cancer. An infection or other health problems may also cause these symptoms. Only a doctor can tell for sure.

Anyone with these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.

Diagnosis

Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what's causing the problems. Your doctor may ask about your personal and family medical history.
You may have one or more of the following tests:

Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver.
Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.
Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells.

There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:

Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Other Tests
The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests:

Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

Treatment

People with leukemia have many treatment options. The options are watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. If your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination of these treatments is used.
The choice of treatment depends mainly on the following:

The type of leukemia (acute or chronic)
Your age
Whether leukemia cells were found in your cerebrospinal fluid

It also may depend on certain features of the leukemia cells. Your doctor also considers your symptoms and general health.
People with acute leukemia need to be treated right away. The goal of treatment is to destroy signs of leukemia in the body and make symptoms go away. This is called a remission. After people go into remission, more therapy may be given to prevent a relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with acute leukemia can be cured.
If you have chronic leukemia without symptoms, you may not need cancer treatment right away. Your doctor will watch your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.
When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. People may receive maintenance therapy to help keep the cancer in remission, but chronic leukemia can seldom be cured with chemotherapy. However, stem cell transplants offer some people with chronic leukemia the chance for cure.
Your doctor can describe your treatment choices, the expected results, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia. Your health care team may also include an oncology nurse and a registered dietitian.
Whenever possible, people should be treated at a medical center that has doctors experienced in treating leukemia. If this isn't possible, your doctor may discuss the treatment plan with a specialist at such a center.
Before treatment starts, ask your health care team to explain possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Watchful Waiting
People with chronic lymphocytic leukemia who do not have symptoms may be able to put off having cancer treatment. By delaying treatment, they can avoid the side effects of treatment until they have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you'll have regular checkups (such as every 3 months). You can start treatment if symptoms occur.
Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. It may reduce the chance to control leukemia before it gets worse.
You may decide against watchful waiting if you don't want to live with an untreated leukemia. Some people choose to treat the cancer right away.
If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. A different approach is nearly always available.

Chemotherapy
Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy leukemia cells.
Depending on the type of leukemia, you may receive a single drug or a combination of two or more drugs.
You may receive chemotherapy in several different ways:

By mouth: Some drugs are pills that you can swallow.
Into a vein (IV): The drug is given through a needle or tube inserted into a vein.
Through a catheter (a thin, flexible tube): The tube is placed in a large vein, often in the upper chest. A tube that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.
Into the cerebrospinal fluid: If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. Intrathecal chemotherapy is given in two ways:

Into the spinal fluid: The doctor injects the drugs into the spinal fluid.
Under the scalp: Children and some adult patients receive chemotherapy through a special catheter called an Ommaya reservoir. The doctor places the catheter under the scalp. The doctor injects the drugs into the catheter. This method avoids the pain of injections into the spinal fluid.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.
You may have your treatment in a clinic, at the doctor's office, or at home. Some people may need to stay in the hospital for treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing leukemia cells, but the drug can also harm normal cells that divide rapidly:

Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. You'll get blood tests to check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of drug. There also are medicines that can help your body make new blood cells. Or, you may need a blood transfusion.
Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Ask your health care team about medicines and other ways to help you cope with these problems.
Sperm or egg cells: Some types of chemotherapy can cause infertility.

Children: Most children treated for leukemia appear to have normal fertility when they grow up. However, depending on the drugs and doses used and the age of the patient, some boys and girls may be infertile as adults.
Adult men: Chemotherapy may damage sperm cells. Men may stop making sperm. Because these changes to sperm may be permanent, some men have their sperm frozen and stored before treatment (sperm banking).
Adult women: Chemotherapy may damage the ovaries. Women may have irregular menstrual periods or periods may stop altogether. Women may have symptoms of menopause, such as hot flashes and vaginal dryness. Women who may want to get pregnant in the future should ask their health care team about ways to preserve their eggs before treatment starts.

Targeted Therapy
People with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive drugs called targeted therapy. Imatinib (Gleevec) tablets were the first targeted therapy approved for chronic myeloid leukemia. Other targeted therapy drugs are now used too.
Targeted therapies use drugs that block the growth of leukemia cells. For example, a targeted therapy may block the action of an abnormal protein that stimulates the growth of leukemia cells.
Side effects include swelling, bloating, and sudden weight gain. Targeted therapy can also cause anemia, nausea, vomiting, diarrhea, muscle cramps, or a rash. Your health care team will monitor you for signs of problems.
Biological Therapy
Some people with leukemia receive drugs called biological therapy. Biological therapy for leukemia is treatment that improves the body's natural defenses against the disease.
One type of biological therapy is a substance called a monoclonal antibody. It's given by IV infusion. This substance binds to the leukemia cells. One kind of monoclonal antibody carries a toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.
For some people with chronic myeloid leukemia, the biological therapy is a drug called interferon. It is injected under the skin or into a muscle. It can slow the growth of leukemia cells.
You may have your treatment in a clinic, at the doctor's office, or in the hospital. Other drugs may be given at the same time to prevent side effects.
The side effects of biological therapy differ with the types of substances used, and from person to person. Biological therapies commonly cause a rash or swelling where the drug is injected. They also may cause a headache, muscle aches, a fever, or weakness. Your health care team may check your blood for signs of anemia and other problems.
Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. People receive radiation therapy at a hospital or clinic.
Some people receive radiation from a large machine that is aimed at the spleen, the brain, or other parts of the body where leukemia cells have collected. This type of therapy takes place 5 days a week for several weeks. Others may receive radiation that is directed to the whole body. The radiation treatments are given once or twice a day for a few days, usually before a stem cell transplant.
The side effects of radiation therapy depend mainly on the dose of radiation and the part of the body that is treated. For example, radiation to your abdomen can cause nausea, vomiting, and diarrhea. In addition, your skin in the area being treated may become red, dry, and tender. You also may lose your hair in the treated area.
You are likely to be very tired during radiation therapy, especially after several weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Although the side effects of radiation therapy can be distressing, they can usually be treated or controlled. You can talk with your doctor about ways to ease these problems.
It may also help to know that, in most cases, the side effects are not permanent. However, you may want to discuss with your doctor the possible long-term effects of radiation treatment.

Stem Cell Transplant
Some people with leukemia receive a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. After you receive high-dose chemotherapy, radiation therapy, or both, you receive healthy stem cells through a large vein. (It's like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.
Stem cell transplants take place in the hospital. Stem cells may come from you or from someone who donates their stem cells to you:

From you: An autologous stem cell transplant uses your own stem cells. Before you get the high-dose chemotherapy or radiation therapy, your stem cells are removed. The cells may be treated to kill any leukemia cells present. Your stem cells are frozen and stored. After you receive high-dose chemotherapy or radiation therapy, the stored stem cells are thawed and returned to you.
From a family member or other donor: An allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the stem cells come from a donor who isn't related. Doctors use blood tests to learn how closely a donor's cells match your cells.
From your identical twin: If you have an identical twin, a syngeneic stem cell transplant uses stem cells from your healthy twin.

Stem cells come from a few sources. The stem cells usually come from the blood (peripheral stem cell transplant). Or they can come from the bone marrow (bone marrow transplant). Another source of stem cells is umbilical cord blood. Cord blood is taken from a newborn baby and stored in a freezer. When a person gets cord blood, it's called an umbilical cord blood transplant.
After a stem cell transplant, you may stay in the hospital for several weeks or months. You'll be at risk for infections and bleeding because of the large doses of chemotherapy or radiation you received. In time, the transplanted stem cells will begin to produce healthy blood cells.
Another problem is that graft-versus-host disease (GVHD) may occur in people who receive donated stem cells. In GVHD, the donated white blood cells in the stem cell graft react against the patient's normal tissues. Most often, the liver, skin, or digestive tract is affected. GVHD can be mild or very severe. It can occur any time after the transplant, even years later. Steroids or other drugs may help.

Leukemia At A Glance

Leukemia is a cancer of the blood cells.
While the exact cause(s) of leukemia is not known, risk factors have been identified.
Leukemias are grouped by how quickly the disease develops (acute or chronic) as well as by the type of blood cell that is affected.
People with leukemia are at significantly increased risk for developing infections, anemia, and bleeding.
Diagnosis of leukemia is supported by findings of the medical history and examination, and examining blood under a microscope. Leukemia cells can also be detected and further classified with a bone marrow aspiration and/or biopsy.
Treatment of leukemia depends on the type of leukemia, certain features of the leukemia cells, the extent of the disease, and prior history of treatment, as well as the age and health of the patient.
Most patients with leukemia are treated with chemotherapy. Some patients also may have radiation therapy and/or bone marrow transplantation

Mycobacteria Protocols

2010-09-10T22:03:00.002+06:00

Mycobacteria Protocols
by: Tanya Parish, Amanda Claire Brown

Book Details
* Hardcover: 456 pages
* Publisher: Humana Press; 2nd edition (October 20, 2008)
* Language: English
* ISBN-10: 1588298892

Book Description

Due to the rising threat of tuberculosis and other mycobacterial infections, methods to study the biology of the mycobacteria and to improve diagnostic, therapeutic and preventative reagents are still very much in need. Mycobacteria Protocols, Second Edition updates and refines the methods of the well-received first edition while adding newly developed methods culled from the most cutting-edge research in the field. Ranging from the basics of sub-cellular fractionation to advanced methods using specialized growth conditions and whole genome, transcriptome and proteome analysis, the chapters conform to the Methods in Molecular Biology™ series format, providing step-by-step laboratory protocols, lists of necessary materials and reagents, and tips on troubleshooting and avoiding known pitfalls.
Comprehensive and up-to-date, Mycobacteria Protocols, Second Edition is the perfect resource to promote and stimulate further research into these intriguing, important and most fractious of bacteria.

DOWNLOAD

Dandruff (Seborrhea)

2010-09-09T13:32:00.003+06:00

What is dandruff (seborrhea)?

It is a common form of skin eczema that occurs in parts of the body with high oil (sebum) production. Body areas that are commonly affected include the scalp, ears, face, chest, and folds of skin, such as the underarms or the skin below breasts or overhanging abdominal folds. The cause of seborrhea is unknown, although a yeast that often lives on the skin, Malassezia furfur, may play a role.

One common manifestation of seborrhea that affects the scalp is dandruff. Scalp seborrhea can also present as thick, flaky, localized patches of scale. On the face, seborrhea produces reddish-brown, dry-looking, or thick, greasy scales on the eyebrows, sides of the nose, and behind the ears. Reddish, scaly patches may also appear in the folds of skin mentioned above. Although skin affected by seborrhea may feel "dry," moisturizing only makes them redder.

Scalp seborrhea and dandruff do not cause permanent hair loss. Often, scalp seborrhea doesn't even itch significantly. Seborrhea can appear during infancy, starting shortly after birth and lasting several months. It may affect the scalp ("cradle cap") or produce scaly patches on the body. Adults of all ages may develop seborrhea, too, especially on the scalp and face.

What treatments are available for dandruff?

Treatment of seborrhea (dandruff) is directed at fighting the skin inflammation. This is done either directly, by using cortisone-based creams and lotions (which reduce inflammation), or by reducing the yeast that builds up on scaly areas and adds to the problem. Note, though, that seborrhea is not a yeast infection.

What doesn't help dandruff?

Moisturizing: Moisturizing lotions don't do much more than smooth out scales and make patches look redder.
Switching brands of shampoo: Shampoo doesn't cause dandruff. However, medicated shampoos (see below) can help.
Changing hair-care routines: There is no "right" shampoo or conditioner, nor is there a "correct" number of times to shampoo per week; seborrhea and dandruff are not caused by excessive shampooing "drying out the scalp." Hair dyes and conditioners do not cause or aggravate dandruff.
Switching antiperspirants: When underarms are red from seborrhea, almost anything will make them redder, including antiperspirants, even though they are only aggravating the seborrhea and not causing it.

What over-the-counter products can help dandruff?

1. Shampoos: Here are some ingredients in medicated shampoos that you can look for to help control dandruff of the scalp. All are available over the counter.

tar (T/Gel)
salicylic acid
zinc pyrithione (like Head & Shoulders)
selenium sulfide (Selsun Blue)
ketoconazole (Nizoral)

You can use any of these either all of the time or just once or twice a week, depending on how severe your symptoms are. If the problem quiets down or disappears, stop and use nonmedicated shampoos. If one kind of shampoo works for a while and "runs out of gas," switch to another. For resistant cases, you can even alternate two different types.

2. Creams: Two additional types of medication that help seborrhea are cortisone creams and antifungal creams.

Cortisone creams reduce inflammation. You can buy them over the counter in either 0.5% or 1% concentrations. They are safe to use on the face and will often help in just a couple of days when applied twice daily. These products also are available as scalp lotions that are applied once a day, preferably on damp hair after shampooing. You can use scalp cortisone creams together with medicated shampoos.

Anti fungal creams are often effective, apparently because they reduce the number of yeast organisms living on the skin. Over-the-counter creams include 1% clotrimazole cream and miconazole cream 2%. Antifungal creams also are applied once or twice a day.

As with shampoos, creams should be applied until the seborrhea subsides. When the seborrhea comes back (and it will, sooner or later), the creams should be used again.

If over-the-counter products don't work, what can the doctor prescribe for dandruff?

Your physician or dermatologist can recommend prescription-strength shampoos or antifungal and cortisone creams that are stronger than those available over the counter, yet are not too strong to use on the face. There also are cortisone-based liquids, gels, and foams that you can apply to the scalp that won't leave your hair limp and matted. Nonsteroid cream like tacrolimus (Protopic) or pimecrolimus (Elidel) can also help.

As with all seborrhea (dandruff) treatments, prescription-strength shampoos and cortisone creams calm down your skin or scalp sensitivity, but they can't stop the seborrhea (dandruff) from coming back. Most people, however, only have to treat their condition from time to time when it becomes itchy or noticeable.

A word on eyelashes

Dandruff (seborrhea) of the eyelashes can be both annoying and hard to treat. Eye doctors like to recommend scrubbing the lashes with baby shampoo on a cotton swab. This method may be worth a try, but it often fails. Cortisone-based lotions should be used close to the eye only under medical supervision since continuous exposure of the eye to cortisone can lead to serious eye problems.

Dandruff (Seborrhea) At A Glance

Dandruff is a form of skin eczema called seborrhea.
Treatment of seborrhea (dandruff) is directed at fighting the skin inflammation.
Yeast is a fungus that sometimes builds up on scaly areas of seborrhea.
The physician may recommend prescription-strength shampoos or antifungal and cortisone creams for seborrhea.

Medical Search Engines

2010-09-09T13:13:00.003+06:00

Below we provide some link of important medical search engine where you can find all medical information.

www.omnimedicalsearch.com

www.healthline.com

www.pogofrog.com

www.medscape.com

www.searchmedica.co.uk

www.webmd.com

www.medic8.com

www.freeality.com

www.slideworld.org

www.mednets.com

Anthrax

2010-09-05T16:27:00.004+06:00

What is anthrax?

Anthrax is a life-threatening infectious disease that normally affects animals, especially ruminants (such as goats, cattle, sheep, and horses). Anthrax can be transmitted to humans by contact with infected animals or their products. In recent years, anthrax has received a great deal of attention as it has become clear that the infection can also be spread by a bio terrorist attack or by biological warfare. Anthrax does not spread from person to person.

What causes anthrax?

The agent of anthrax is a bacterium called Bacillus anthracis. While other investigators discovered the anthrax bacillus, it was a German physician and scientist, Dr. Robert Koch, who proved that the anthrax bacterium was the cause of a disease that affected farm animals in his community. Under the microscope, the bacteria look like large rods. However, in the soil, where they live, anthrax organisms exist in a dormant form called spores. These spores are very hardy and difficult to destroy. The spores have been known to survive in the soil for as long as 48 years.

How is anthrax contracted?

Anthrax can infect humans in three ways. The most common is infection through the skin, which causes an ugly sore that usually goes away without treatment. Humans and animals can ingest anthrax from carcasses of dead animals that have been contaminated with anthrax. Ingestion of anthrax can cause serious, sometimes fatal disease. The most deadly form is inhalation anthrax. If the spores of anthrax are inhaled, they migrate to lymph glands in the chest where they proliferate, spread, and produce toxins that often cause death.

How common is anthrax?

Anthrax is now rare in humans in the United States and developed countries. It still occurs today, largely in countries lacking public-health regulations that prevent exposure to infected goats, cattle, sheep, and horses and their products. In the last few years, there have been rare cases of anthrax in people exposed to imported animal hides used to make drums. Drum players, drum makers, and their family members have been infected in this way. The major concern for those of us in western countries (who don't play drums) is the use of anthrax as an agent of biological warfare.

How long is the incubation period with anthrax?

The incubation period (the period between contact with anthrax and the start of symptoms) may be relatively short, from one to five days. Like other infectious diseases, the incubation period for anthrax is quite variable and it may be weeks before an infected individual feels sick.

What kinds of diseases does anthrax cause?

There are three forms of disease caused by anthrax: cutaneous (skin) anthrax, inhalation anthrax, and gastrointestinal (bowel) anthrax.

CUTANEOUS ANTHRAX

The cutaneous (skin) form of anthrax starts as a red-brown raised spot that enlarges with considerable redness around it, blistering, and hardening. The center of the spot then shows an ulcer crater with blood-tinged drainage and the formation of a black crust called an eschar. There are swollen glands (lymph nodes) in the area. Symptoms include muscle aches and pain, headache, fever, nausea, and vomiting. The illness usually resolves in about six weeks, but deaths may occur if patients do not receive appropriate antibiotics.

INHALATION ANTHRAX

The first symptoms are subtle, gradual and, flu-like (influenza). In a few days, however, the illness worsens and there may be severe respiratory distress. Shock, coma and death follow. Inhalation anthrax does not cause a true pneumonia. In fact, the spores get picked in the lungs up by scavenger cells called macrophages. Most of the spores are killed. Unfortunately, some survive and are transported to glands in the chest called lymph nodes. In the lymph nodes, the spores that survive multiply, produce deadly toxins, and spread throughout the body. Severe hemorrhage and tissue death (necrosis) occurs in these lymph nodes in the chest. From there, the disease spreads to the adjacent lungs and the rest of the body. Inhalation anthrax is a very serious disease, and unfortunately, most affected individuals will die even if they get appropriate antibiotics. Why is this so? The antibiotics are effective in killing the bacteria, but they do not destroy the deadly toxins that have already been released by the anthrax bacteria.

GASTROINTESTINAL ANTHRAX

Now rare, anthrax of the bowels (gastrointestinal anthrax) is the result of eating undercooked, contaminated meat. The symptoms of this form of anthrax include nausea, loss of appetite, bloody diarrhea and fever followed by abdominal pain. The bacteria invade through the bowel wall. Then the infection spreads throughout the body through the bloodstream (septicemia) with deadly toxicity.

How is the diagnosis made of anthrax?

The history, including the occupation of the person, is important. The bacteria may be found in cultures or smears in cutaneous (skin) anthrax and in throat swabs and sputum in pulmonary anthrax. Chest X-rays may also show characteristic changes in and between the lungs. Once the anthrax is disseminated, bacteria can be seen in the blood using a microscope. Of course, if anthrax is deliberately spread, the manifestations of the disease may be unusual. Indeed, in the bioterrorism attack in the U.S. in 2001, anthrax spores were spread through the postal system as a white powder mailed with letters.

How is anthrax treated?

In most cases, early treatment can cure anthrax. The cutaneous (skin) form of anthrax can be treated with common antibiotics such as penicillin, tetracycline, erythromycin, and ciprofloxacin (Cipro). The pulmonary form of anthrax is a medical emergency. Early and continuous intravenous therapy with antibiotics may be lifesaving. In a bioterrorism attack, individuals exposed to anthrax will be given antibiotics before they become sick. A vaccine exists but is not yet available to the general public. Most experts think that the vaccine will also be given to exposed individuals who are victims of a bioterrorist attack. Of note, anthrax is a reportable disease. That means that local or state health agencies must be notified if a case of anthrax is diagnosed. These agencies can better characterize the anthrax so that the affected individual can receive the most effective treatment for that particular organism

How can anthrax be prevented?

Public-health measures to prevent contact with infected animals are invaluable. There is a vaccine available for people at high risk (such as veterinarians, laboratory technicians, employees of textile mills processing imported goat hair, and members of the armed forces). The Department of Defense and the U.S. Centers for Disease Control and Prevention are working very hard to prevent a bioterrorist attack and to be prepared to deal with the consequences if one occurs. For anthrax and other infectious diseases, vaccines with greater efficacy and fewer side effects are under development. Currently, most vaccines are given by injection into fat or muscle below the skin. Early studies in experimental animals are showing promise for an oral vaccine for anthrax. Obviously, a pill is easier to take than a shot, and the pill may even be a safer and more effective route of administration.

Anthrax At A Glance

Anthrax is an infection by bacteria transmitted from animals.
Anthrax causes skin, lung, and bowel disease and can be deadly.
Anthrax is diagnosed by cultures from infected tissues.
Anthrax is treated by antibiotics.
Anthrax can be prevented.
Sadly, the greatest threat of anthrax today is through a bioterrorist attack.
Federal, state, and local agencies are working hard to deal with this bioterrorist threat.

Oxford Handbook of Critical Care

2010-08-27T10:10:00.008+06:00

Oxford Handbook of Critical Care is a book based on the care of the emergency patients. It has informative description about all systems. The advancement of modern medicine is welcomed by all but the necessary measures with which one can really adopt with it is missing. so this book will help everyone to cope with the modern medicine and the emergency care of the patients.

DOWNLOAD

Eczema

2010-08-23T09:15:00.007+06:00

What is eczema?

Eczema is a general term for many types of skin inflammation, also known as dermatitis. The most common form of eczema is atopic dermatitis (some people use these two terms interchangeably). However, there are many different forms of eczema.

Eczema can affect people of any age, although the condition is most common in infants, and about 85% of people have an onset prior to 5 years of age. Eczema will permanently resolve by age 3 in about half of affected infants. In others, the condition tends to recur throughout life. People with eczema often have a family history of the condition or a family history of other allergic conditions, such as asthma or hay fever. Up to 20% of children and 1%-2% of adults are believed to have eczema. Eczema is slightly more common in girls than in boys. It occurs in people of all races.

Eczema is not contagious, but since it is believed to be at least partially inherited, it is not uncommon to find members of the same family affected.

What are the causes of eczema?

Doctors do not know the exact cause of eczema, but a defect of the skin that impairs its function as a barrier, possibly combined with an abnormal function of the immune system, are believed to be an important factors. Studies have shown that in people with atopic dermatitis, there are gene defects that lead to abnormalities in certain proteins (such as filaggrin) that are important in maintaining the barrier of normal skin.

Some forms of eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewelry, or sweat. Environmental allergens (substances that cause allergic reactions) may also cause outbreaks of eczema. Changes in temperature or humidity, or even psychological stress, can lead to outbreaks of eczema in some people.

What are the symptoms of eczema?

Eczema most commonly causes dry, reddened skin that itches or burns, although the appearance of eczema varies from person to person and varies according to the specific type of eczema. Intense itching is generally the first symptom in most people with eczema. Sometimes, eczema may lead to blisters and oozing lesions, but eczema can also result in dry and scaly skin. Repeated scratching may lead to thickened, crusty skin.

While any region of the body may be affected by eczema, in children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.

What are the different types of eczema?

Atopic dermatitis is the most common of the many types of eczema, and sometimes people use the two terms interchangeably. But there are many terms used to describe specific forms of eczema that may have very similar symptoms to atopic dermatitis. These are listed and briefly described below.

Atopic dermatitis

Atopic dermatitis is a chronic skin disease characterized by itchy, inflamed skin and is the most common cause of eczema. The condition tends to come and go, depending upon exposures to triggers or causative factors. Factors that may cause atopic dermatitis (allergens) include environmental factors like molds, pollen, or pollutants; contact irritants like soaps, detergents, nickel (in jewelry), or perfumes; food allergies; or other allergies. Around two-thirds of those who develop the condition do so prior to 1 year of age.

Contact eczema

Contact eczema (contact dermatitis) is a localized reaction that includes redness, itching, and burning in areas where the skin has come into contact with an allergen (an allergy-causing substance to which an individual is sensitized) or with a general irritant such as an acid, a cleaning agent, or other chemical. Other examples of contact eczema include reactions to laundry detergents, soaps, nickel (present in jewelry), cosmetics, fabrics, clothing, and perfume. Due to the vast number of substances with which individuals have contact, it can be difficult to determine the trigger for contact dermatitis

Seborrheic eczema

Seborrheic eczema (seborrheic dermatitis) is a form of skin inflammation of unknown cause. The signs and symptoms of seborrheic eczema include yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body. Dandruff and "cradle cap" in infants are examples of seborrheic eczema. It is commonplace for seborrheic dermatitis to inflame the face at the creases of the cheeks and/or the nasal folds. Seborrheic dermatitis is not necessarily associated with itching.

Nummular eczema

Nummular eczema (nummular dermatitis) is characterized by coin-shaped patches of irritated skin -- most commonly located on the arms, back, buttocks, and lower legs -- that may be crusted, scaling, and extremely itchy. This form of eczema is relatively uncommon and occurs most frequently in elderly men. Nummular eczema is usually a chronic condition. A personal or family history of atopic dermatitis, asthma, or allergies increases the risk of developing the condition.

Neurodermatitis

Neurodermatitis, also known as lichen simplex chronicus, is a chronic skin inflammation caused by a scratch-itch cycle that begins with a localized itch (such as an insect bite) that becomes intensely irritated when scratched. Women are more commonly affected by neurodermatitis than men, and the condition is most frequent in people 20-50 years of age. This form of eczema results in scaly patches of skin on the head, lower legs, wrists, or forearms. Over time, the skin can become thickened and leathery. Stress can exacerbate the symptoms of neurodermatitis.

Stasis dermatitis

Stasis dermatitis is a skin irritation on the lower legs, generally related to the circulatory problem known as venous insufficiency, in which the function of the valves within the veins has been compromised. Stasis dermatitis occurs almost exclusively in middle-aged and elderly people, with approximately 6%-7% of the population over 50 years of age being affected by the condition. The risk of developing stasis dermatitis increases with advancing age. Symptoms include itching and/or reddish-brown discoloration of the skin on one or both legs..

Dyshidrotic eczema

Dyshidrotic eczema (dyshidrotic dermatitis) is an irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn. The cause of dyshidrotic eczema is unknown. Dyshidrotic eczema is also known as vesicular palmoplantar dermatitis, dyshidrosis, or pompholyx.

How is eczema diagnosed?

To diagnose eczema, doctors rely on a thorough physical examination of the skin as well as the patient's account of the history of the condition. In particular, the doctor will ask when the condition appeared, if the condition is associated with any changes in environment or contact with certain materials, and whether it is aggravated in any specific situations. Eczema may have a similar appearance to other diseases of the skin, including infections or reactions to certain medications, so the diagnosis is not always simple.

If a doctor suspects that a patient has allergic contact dermatitis, allergy tests, possibly including a skin "patch test," may be carried out in an attempt to identify the specific trigger of the condition.

There are no laboratory or blood tests that can be used to establish the diagnosis of eczema.

What is the treatment for eczema?

The goals for the treatment of eczema are to prevent itching, inflammation, and worsening of the condition. Treatment of eczema may involve both lifestyle changes and the use of medications. Treatment is always based upon an individual's age, overall health status, and the type and severity of the condition.

Corticosteroid creams are sometimes prescribed to decrease the inflammatory reaction in the skin. These may be mild-, medium-, or high-potency corticosteroid creams depending upon the severity of the symptoms. If itching is severe, oral antihistamines may be prescribed. To control itching, the sedative type antihistamine drugs (for example, diphenhydramine [Benadryl], hydroxyzine [Atarax, Vistaril], and cyproheptadine) appear to be most effective.

In some cases, a short course of oral corticosteroids (such as prednisone) is prescribed to control an acute outbreak of eczema, although their long-term use is discouraged in the treatment of this non life-threatening condition because of unpleasant and potentially harmful side effects.

Finally, two topical (cream) medications have been approved by the U.S. FDA for the treatment of eczema: tacrolimus (Protopic) and pimecrolimus (Elidel). These drugs belong to a class of immune suppressant drugs known as calcineurin inhibitors.

Can eczema be prevented?

While there is no cure for eczema, you can take steps to manage your symptoms and lessen the severity of outbreaks. Such measures include

avoidance of over-bathing;
applying moisturizer frequently, especially after bathing;
bathing in warm, not hot, water and using a mild soap;
limiting or avoiding contact with known irritants like soaps, perfumes, detergents, jewelry, environmental irritants, etc.;
wearing loose-fitting clothing (cotton clothing may be less irritating for many people than wool or synthetic fibers);
the use of cool compresses to help control itching;
exercise, meditation, or other stress management techniques can help those for whom stress is a trigger;
wearing protective gloves for activities that require frequent submersion of the hands in water;
avoiding activities that make you hot and sweaty as well as abrupt changes in temperature and humidity;
practicing good skin hygiene even when you are not having symptoms.

Eczema At A Glance

Eczema is a general term for many types of skin inflammation, also known as dermatitis. The term eczema is sometimes used interchangeably with atopic dermatitis, the most common form of eczema.
Eczema is believed to result from a genetic defect that results in an abnormality of the skin's barrier function.
Eczema is most common in infants and young children. All races can be affected.
Triggers of eczema outbreaks can be environmental irritants or allergens; substances like soaps, perfumes, or chemicals; food allergies; lifestyle stress; or changes in temperature or humidity.
Treatment can include oral or topical corticosteroids, antihistamines, or immune-suppressing drugs known as calcineurin inhibitors.
While eczema is not preventable, self-care measures such as frequent hydration of skin and avoidance of extreme temperatures and known irritants can help manage symptoms and reduce the severity of outbreaks.