Endocrine Disorders:Causes & Types

May 24, 2018 Posted by admin Uncategorized 0 comments

The endocrine system is a network of glands that produce and release hormones that help control many important body functions, including the body’s ability to change calories into energy that powers cells and organs. The endocrine system influences how your heart beats, how your bones and tissues grow, even your ability to make a baby. It plays a vital role in whether or not you develop diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders.

Glands of the Endocrine System

Each gland of the endocrine system releases specific hormones into your bloodstream. These hormones travel through your blood to other cells and help control or coordinate many body processes.

Endocrine glands include:

Adrenal glands: Two glands that sit on top of the kidneys that release the hormone cortisol.
Hypothalamus: A part of the lower middle brain that tells the pituitary gland when to release hormones.
Ovaries: The female reproductive organs that release eggs and produce sex hormones.
Islet cells in the pancreas: Cells in the pancreas control the release of the hormones insulin and glucagon.
Parathyroid: Four tiny glands in the neck that play a role in bone development.
Pineal gland: A gland found near the center of the brain that may be linked to sleep patterns.
Pituitary gland: A gland found at the base of brain behind the sinuses. It is often called the “master gland” because it influences many other glands, especially the thyroid. Problems with the pituitary gland can affect bone growth, a woman’s menstrual cycles, and the release of breast milk.
Testes: The male reproductive glands that produce sperm and sexhormones.
Thymus: A gland in the upper chest that helps develop the body’s immune system early in life.
Thyroid: A butterfly-shaped gland in the front of the neck that controls metabolism.

Even the slightest hiccup with the function of one or more of these glands can throw off the delicate balance of hormones in your body and lead to an endocrine disorder, or endocrine disease.

Causes of Endocrine Disorders

Endocrine disorders are typically grouped into two categories:

Endocrine disease that results when a gland produces too much or too little of an endocrine hormone, called a hormone imbalance.
Endocrine disease due to the development of lesions (such as nodules or tumors) in the endocrine system, which may or may not affect hormone levels.

The endocrine’s feedback system helps control the balance of hormones in the bloodstream. If your body has too much or too little of a certain hormone, the feedback system signals the proper gland or glands to correct the problem. A hormone imbalance may occur if this feedback system has trouble keeping the right level of hormones in the bloodstream, or if your body doesn’t clear them out of the bloodstream properly.

Increased or decreased levels of endocrine hormone may be caused by:

A problem with the endocrine feedback system
Disease
Failure of a gland to stimulate another gland to release hormones (for example, a problem with the hypothalamus can disrupt hormone production in the pituitary gland)
A genetic disorder, such as multiple endocrine neoplasia (MEN) or congenital hypothyroidism
Infection
Injury to an endocrine gland
Tumor of an endocrine gland

Most endocrine tumors and nodules (lumps) are noncancerous. They usually do not spread to other parts of the body. However, a tumor or nodule on the gland may interfere with the gland’s hormone production.

Types of Endocrine Disorders

There are many different types of endocrine disorders. Diabetes is the most common endocrine disorder diagnosed in the U.S.

Other endocrine disorders include:

Adrenal insufficiency. The adrenal gland releases too little of the hormone cortisol and sometimes, aldosterone. Symptoms include fatigue, stomachupset, dehydration, and skin changes. Addison’s disease is a type of adrenal insufficiency.

Cushing’s disease. Overproduction of a pituitary gland hormone leads to an overactive adrenal gland. A similar condition called Cushing’s syndromemay occur in people, particularly children, who take high doses of corticosteroid medications.

Gigantism (acromegaly) and other growth hormone problems. If the pituitary gland produces too much growth hormone, a child’s bones and body parts may grow abnormally fast. If growth hormone levels are too low, a child can stop growing in height.

Hyperthyroidism. The thyroid gland produces too much thyroid hormone, leading to weight loss, fast heart rate, sweating, and nervousness. The most common cause for an overactive thyroid is an autoimmune disorder called Grave’s disease.

Hypothyroidism. The thyroid gland does not produce enough thyroid hormone, leading to fatigue, constipation, dry skin, and depression. The underactive gland can cause slowed development in children. Some types of hypothyroidism are present at birth.

Hypopituitarism. The pituitary gland releases little or no hormones. It may be caused by a number of different diseases. Women with this condition may stop getting their periods.

Multiple endocrine neoplasia I and II (MEN I and MEN II). These rare, genetic conditions are passed down through families. They cause tumors of the parathyroid, adrenal, and thyroid glands, leading to overproduction of hormones.

Polycystic ovary syndrome (PCOS). Overproduction of androgens interfere with the development of eggs and their release from the female ovaries. PCOS is a leading cause of infertility.

Precocious puberty. Abnormally early puberty that occurs when glands tell the body to release sex hormones too soon in life.

Testing for Endocrine Disorders

If you have an endocrine disorder, your doctor may refer you to a specialist called an endocrinologist. An endocrinologist is specially trained in problems with the endocrine system.

The symptoms of an endocrine disorder vary widely and depend on the specific gland involved. However, most people with endocrine disease complain of fatigue and weakness.

Blood and urine tests to check your hormone levels can help your doctors determine if you have an endocrine disorder. Imaging tests may be done to help locate or pinpoint a nodule or tumor.

Treatment of endocrine disorders can be complicated, as a change in one hormone level can throw off another. Your doctor or specialist may order routine blood work to check for problems or to determine if your medication or treatment plan needs to be adjusted.

Nipah Virus fever: Causes, Symptoms & Prevention

May 21, 2018 Posted by admin Uncategorized 0 comments

Nipah Virus (NiV) Infection Grey-headed flying foxes (Pteropus poliocephalus)

Nipah virus (NiV) infection is a newly emerging zoo-nosis that causes severe disease in both animals and humans. The natural host of the virus are fruit bats of the Pteropodidae Family, Pteropus genus.

NiV was first identified during an outbreak of disease that took place in Kampung Sungai Nipah, Malaysia in 1998. On this occasion, pigs were the intermediate hosts. However, in subsequent NiV outbreaks, there were no intermediate hosts. In Bangladesh in 2004, humans became infected with NiV as a result of consuming date palm sap that had been contaminated by infected fruit bats. Human-to-human transmission has also been documented, including in a hospital setting in India.

Transmission:

Transmission of Nipah virus to humans may occur after direct contact with infected bats, infected pigs, or from other NiV infected people.

In Malaysia and Singapore, humans were apparently infected with Nipah virus only through close contact with infected pigs. The NiV strain identified in this outbreak appeared to have been transmitted initially from bats to pigs, with subsequent spread within pig populations. Incidental human infections resulted after exposure to infected pigs. No occurrence of person-to-person transmission was reported in this outbreak.

Conversely, person-to-person transmission of Nipah virus in Bangladesh and India is regularly reported. This is most commonly seen in the family and caregivers of Nipah virus-infected patients. Transmission also occurs from direct exposure to infected bats. A common example is consumption of raw date palm sap contaminated with infectious bat excretions.

Signs and Symptoms:

During the Nipah virus disease outbreak in 1998-99, 265 patients were infected with the virus. About 40% of those patients who entered hospitals with serious nervous disease died from the illness.

Long-term sequelae following Nipah virus infection have been noted, including persistent convulsions and personality changes.

Latent infections with subsequent reactivation of Nipah virus and death have also been reported months and even years after exposure.

Diagnosis:

Treatment:

Treatment is limited to supportive care. Because Nipah virus encephalitis can be transmitted person-to-person, standard infection control practices and proper barrier nursing techniques are important in preventing hospital-acquired infections (nosocomial transmission). Doctors from neurology departments will provide better care.

The drug ribavirin has been shown to be effective against the viruses in vitro, but human investigations to date have been inconclusive and the clinical usefulness of ribavirin remains uncertain.

Passive immunization using a human monoclonal antibody targeting the Nipah G glycoprotein has been evaluated in the post-exposure therapy in the ferret model and found to be of benefit.

Prevention:

Additional efforts focused on surveillance and awareness will help prevent future outbreaks. Research is needed to better understand the ecology of bats and Nipah virus, investigating questions such as the seasonality of disease within reproductive cycles of bats. Surveillance tools should include reliable laboratory assays for early detection of disease in communities and livestock, and raising awareness of transmission and symptoms is important in reinforcing standard infection control practices to avoid human-to-human infections in hospital settings (nosocomial infection).

A subunit vaccine, using the Hendra G protein, produces cross-protective antibodies against HENV and NIPV has been recently used in Australia to protect horses against Hendra virus. This vaccine offers great potential for henipavirus protection in humans as well.

Subdural Hematoma: Causes, Symptoms & Treatments

May 19, 2018 Posted by admin Uncategorized 0 comments

A subdural hematoma is a collection of blood outside the brain. Subdural hematomas are usually caused by severe head injuries. The bleeding and increased pressure on the brainfrom a subdural hematoma can be life-threatening. Some subdural hematomas stop and resolve spontaneously; others require surgical drainage.

What Is a Subdural Hematoma?

In a subdural hematoma, blood collects between the layers of tissue that surround the brain. The outermost layer is called the dura. In a subdural hematoma, bleeding occurs between the dura and the next layer, the arachnoid.

The bleeding in a subdural hematoma is under the skull and outside the brain, not in the brain itself. As blood accumulates, however, pressure on the brain increases. The pressure on the brain causes a subdural hematoma’s symptoms. If pressure inside the skull rises to very high level, a subdural hematoma can lead to unconsciousness and death.

Causes of Subdural Hematoma

Subdural hematoma is usually caused by a head injury, such as from a fall, motor vehicle collision, or an assault. The sudden blow to the head tears blood vessels that run along the surface of the brain. This is referred to as an acute subdural hematoma.

People with a bleeding disorder and people who take blood thinners are more likely to develop a subdural hematoma. A relatively minor head injury can cause subdural hematoma in people with a bleeding tendency.

In a chronic subdural hematoma, small veins on the outer surface of the brain may tear, causing bleeding in the subdural space. Symptoms may not be apparent for several days or weeks. Elderly people are at higher risk for chronic subdural hematoma because brain shrinkage causes these tiny veins to be more stretched and more vulnerable to tearing.

Symptoms of Subdural Hematoma

Symptoms of subdural hematoma depend mostly on the rate of bleeding:

In head injuries with sudden, severe bleeding causing a subdural hematoma, a person may lose consciousness and become comatose immediately.
A person may appear normal for days after a head injury, but slowly become confused and then unconscious several days later. This results from a slower rate of bleeding, causing a slowly enlarging subdural hematoma.
In very slow-growing subdural hematomas, there may be no noticeable symptoms for more than two weeks after the bleeding starts.

Symptoms of subdural hematoma can include:

Headache
Confusion
Change in behavior
Dizziness
Nausea and vomiting
Lethargy or excessive drowsiness
Weakness
Apathy
Seizures

People may vary widely in their symptoms of subdural hematoma. Besides the size of the subdural hematoma, a person’s age and other medical conditions can affect the response to having a subdural hematoma.

Diagnosis of Subdural Hematoma

People who come to medical attention after a head injury often undergo head imaging, usually with computed tomography (CT scan) or magnetic resonance imaging (MRI scan). These tests create images of the interior of the skull, usually detecting any subdural hematoma present. MRI is slightly superior to CT in detecting subdural hematoma, but CT is faster and more readily available.

Rarely, angiography may be used to diagnose subdural hematoma. During angiography (angiogram), a catheter is inserted through an artery in the groin and threaded into the arteries of he neck and brain. Special dye is then injected, and an X-ray screen shows blood flow through the arteries and veins.

Treatment of Subdural Hematoma

Treatment of subdural hematomas depends on their severity. Treatment can range from watchful waiting to brain surgery.

In small subdural hematomas with mild symptoms, doctors may recommend no specific treatment other than observation. Repeated head imaging tests are often performed to monitor whether the subdural hematoma is improving.

More severe or dangerous subdural hematomas require surgery to reduce the pressure on the brain. Surgeons can use various techniques to treat subdural hematomas:

Burr hole trephination. A hole is drilled in the skull over the area of the subdural hematoma, and the blood is suctioned out through the hole.
Craniotomy. A larger section of the skull is removed, to allow better access to the subdural hematoma and reduce pressure. The removed skull is replaced shortly after the procedure.
Craniectomy. A section of the skull is removed for an extended period of time, to allow the injured brain to expand and swell without permanent damage. Craniectomy is not often used to treat subdural hematoma.

People with severe subdural hematomas are often seriously ill, requiring machine-supported breathing and other forms of life support.

If a person has a bleeding problem or is taking blood thinners, measures should be taken to improve blood clotting. This may include giving medicines or blood products, and reversal of any blood thinners, when possible. Other medications to help reduce swelling or pressure in the brain or control seizures may also be used.

Epilepsy: Causes, Symptoms & Treatments

May 17, 2018 Posted by admin Uncategorized 0 comments

Epilepsy is a chronic disorder of the brain that affects people of all ages.
Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.
Nearly 80% of the people with epilepsy live in low- and middle-income countries.
People with epilepsy respond to treatment approximately 70% of the time.
About three fourths of people with epilepsy living in low- and middle- income countries do not get the treatment they need.
In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination.

Epilepsy is a chronic disorder of the brain that affects people worldwide. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized), and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.

Seizure episodes are a result of excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than 1 per year to several per day.

One seizure does not signify epilepsy (up to 10% of people worldwide have one seizure during their lifetime). Epilepsy is defined as having 2 or more unprovoked seizures. Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BC. Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries. This stigma continues in many countries today and can impact on the quality of life for people with the disorder and their families.

Signs and symptoms

Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions.

People with seizures tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression. Similarly, the risk of premature death in people with epilepsy is up to 3 times higher than the general population, with the highest rates found in low- and middle-income countries and rural versus urban areas.

A great proportion of the causes of death related to epilepsy in low- and middle-income countries are potentially preventable, such as falls, drowning, burns and prolonged seizures.

Causes

Epilepsy is not contagious. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and has no identifiable cause.

Epilepsy with a known cause is called secondary epilepsy, or symptomatic epilepsy. The causes of secondary (or symptomatic) epilepsy could be:

brain damage from prenatal or perinatal injuries (e.g. a loss of oxygen or trauma during birth, low birth weight),
congenital abnormalities or genetic conditions with associated brain malformations,
a severe head injury,
a stroke that restricts the amount of oxygen to the brain,
an infection of the brain such as meningitis, encephalitis, neurocysticercosis,
certain genetic syndromes,
a brain tumor.

Treatment

Epilepsy can be treated easily and affordably with inexpensive daily medication that costs as little as US$ 5 per year. Recent studies in both low- and middle-income countries have shown that up to 70% of children and adults with epilepsy can be successfully treated (i.e. their seizures completely controlled) with anti-epileptic drugs (AEDs). Furthermore, after 2 to 5 years of successful treatment and being seizure-free, drugs can be withdrawn in about 70% of children and 60% of adults without subsequent relapse.

In low- and middle-income countries, about three fourths of people with epilepsy may not receive the treatment they need. This is called the “treatment gap”.
In many low- and middle-income countries, there is low availability of AEDs. A recent study found the average availability of generic antiepileptic medicines in the public sector of low- and middle-income countries to be less than 50%. This may act as a barrier to accessing treatment.
It is possible to diagnose and treat most people with epilepsy at the primary health- care level without the use of sophisticated equipment.
WHO demonstration projects have indicated that training primary health-care providers to diagnose and treat epilepsy can effectively reduce the epilepsy treatment gap. However, the lack of trained health-care providers can act as a barrier to treatment for people with epilepsy.
Surgical therapy might be beneficial to patients who respond poorly to drug treatments.

Prevention

Idiopathic epilepsy is not preventable. However, preventive measures can be applied to the known causes of secondary epilepsy.

Preventing head injury is the most effective way to prevent post-traumatic epilepsy.
Adequate perinatal care can reduce new cases of epilepsy caused by birth injury.
The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of febrile seizures.
Central nervous system infections are common causes of epilepsy in tropical areas, where many low- and middle-income countries are concentrated.
Elimination of parasites in these environments and education on how to avoid infections can be effective ways to reduce epilepsy worldwide, for example those cases due to neurocysticercosis.

Social and economic impacts

Epilepsy accounts for 0.6%, of the global burden of disease, a time-based measure that combines years of life lost due to premature mortality and time lived in less than full health. Epilepsy has significant economic implications in terms of health care needs, premature death and lost work productivity.

An Indian study conducted in 1998 calculated that the cost per patient of epilepsy treatment was as high as 88.2% of the country’s per capita Gross National Product (GNP), and epilepsy-related costs, which included medical costs, travel, and lost work time, exceeded $2.6 billion/year (2013 USD).(1)

Although the social effects vary from country to country, the discrimination and social stigma that surround epilepsy worldwide are often more difficult to overcome than the seizures themselves. People living with epilepsy can be targets of prejudice. The stigma of the disorder can discourage people from seeking treatment for symptoms, so as to avoid becoming identified with the disorder.

Hepatitis A : Causes, Symptoms & Treatments

May 14, 2018 Posted by admin Uncategorized 0 comments

What is hepatitis A?

Hepatitis A is a serious liver disease caused by infection with the hepatitis A virus. How is hepatitis A virus spread? Hepatitis A virus is usually spread from getting particles of fecal material (poop) into your mouth that are too small to be seen. This can happen through household or sexual contact with an infected person or by eating hepatitis A virus-contaminated food or drinking hepatitis A virus contaminated water. Casual contact, such as in a school or work setting, has not been known to spread hepatitis A virus.

What are the symptoms of hepatitis A virus infection?

Infected people can have no symptoms at all or be extremely ill. Only 30% of children less than six years of age develop symptoms, while 70% of older children and adults develop symptoms. If a person does develop symptoms, they might include fever, tiredness, loss of appetite, nausea, abdominal pain, dark urine, or jaundice (yellowing of the eyes and skin). These symptoms can last up to six months. Even without symptoms, people infected with hepatitis A virus can spread the infection to others.

How serious is hepatitis A virus infection?

About 30% of people with hepatitis A virus require hospitalization. Adults who become ill often miss several weeks of work. Although deaths due to hepatitis A virus are uncommon, death still can occur from overwhelming hepatitis A virus infection that causes liver failure.

How can hepatitis A virus infection be prevented?

Safe and effective vaccines to prevent hepatitis A virus infection have been available now. Good hand washing will also help reduce the spread of hepatitis A virus. Always wash your hands with soap and water after using the toilet, changing a diaper, and before preparing or eating food.

External Hermorrhoids: Causes, Symptoms & Treatments

May 7, 2018 Posted by admin Uncategorized 0 comments

What causes external hemorrhoids?

The most common cause of external hemorrhoids is repeated straining while having a bowel movement. Hemorrhoids develop when the veins of the rectum or anus become dilated or enlarged and can be either “internal” or “external.” External hemorrhoids are usually found beneath the skin that surrounds the anus.

SYMPTOMS

There is a range of symptoms that can affect a person with hemorrhoids. Symptoms tend to vary depending on the severity of your hemorrhoids. Some of the symptoms that you may have include the following:

itching around the anus or rectal area
pain around the anus
lumps near or around the anus
blood in the stool

You may notice bleeding when using the bathroom. This includes seeing blood on toilet paper or in the toilet. Lumps around the anus may feel as if they are swollen.

CAUSES:

What are the causes of external hemorrhoids?

The most common cause of hemorrhoids is repeated straining while having a bowel movement. This is often caused by severe cases of constipation or diarrhea. Straining gets in the way of blood flow into and out of the area. This results in the pooling of blood and enlargement of the vessels in that area.

Pregnant women may also be at an increased risk of hemorrhoids because of the pressure that the uterus places on these veins.

Treating external hemorrhoids:

Hemorrhoids can be treated a few ways depending on severity. Your doctor may ask if you have any preference for certain types of medications or treatments.

Some general treatments that your doctor might suggest include ice packs to reduce swelling, suppositories, or hemorrhoid creams.

These options can offer relief to individuals who have a milder case of hemorrhoids. If you have a more severe case, your doctor may suggest treatment with a surgical procedure.

Surgical treatments include:

removal of hemorrhoids, known as hemorrhoidectomy
burning of hemorrhoid tissue with infrared photo, laser, or electrical coagulation
sclerotherapy or rubber band ligation to reduce the hemorrhoids

PREVENTION:

The main factor for preventing external hemorrhoids is to avoid straining during bowel movements. If you have severe constipation, you may want to try using aids such as laxativesor including more fiber in your diet.

Stool softeners are another popular over-the-counter option that can help you with temporary constipation due to pregnancy or other factors. If these options don’t help, you may want to talk with your doctor about other options to reduce strain.

Fibroid in Uterus: Symptoms & Treatments

May 4, 2018 Posted by admin Uncategorized 0 comments

If you have uterine fibroids, you may or may not need treatment. It depends on whether they cause you any problems.

Not all fibroids grow. Even large ones may not cause any symptoms, and most shrink after menopause.

Still, you and your doctor should check on their growth, especially if you develop symptoms like bleeding or pain. So you should at least get pelvic exams every year.

Home Remedies?

You can’t cure fibroids on your own. But you can do things that help you feel better. When fibroids grow on the outside of the uterus, you may become aware of a mass on your abdomen. You can lie down and put a hot pack or hot water bottle on your lower belly to ease the pain. You’d need to do this several times a day.

What Medicines Help?

You can take pain relievers, such as ibuprofen. But be sure to follow the instructions on the label so you don’t accidentally take too much. If you and your doctor decide you need to take something for your fibroids, you may want to consider these other options:

Hormone therapy. To help prevent more growth of the fibroid, your doctor may recommend that you stop taking birth control pills or hormone replacement therapy. But in some cases, your doctor may prescribe birth control pills to help control the bleeding and anemiafrom fibroids, even though the hormones may cause fibroids to grow.

GnRH agonists. GnRH is a hormone your body naturally makes. An “agonist” medicine counters that hormone, and your doctor may prescribe one to shrink fibroids and reduce anemia. These drugs are expensive. You shouldn’t take them for more than 6 months because they can make you more likely to get osteoporosis, which makes your bones too frail. Your doctor may also prescribe a low dose of progestin, another hormone, to make osteoporosis less likely. (When you stop taking a GnRH agonist, your fibroids can grow back).

SERMs. SERMs are a type of medicine that works on your estrogen levels. (SERMs stands for selective estrogen receptor modulators.) They may be able to shrink fibroids without causing menopause symptoms. But researchers aren’t yet sure how well they work for this purpose.

What Procedures Might Work?

There are several possibilities that you and your doctor can consider.

Fibroid embolization can shrink a fibroid. Your doctor will inject polyvinyl alcohol (PVA) into the arteries that feed the fibroid. The PVA blocks the blood supply to the fibroid, which makes it shrink. It’s not surgery, but you may need to spend several nights in the hospital because you may have nausea, vomiting, and pain in the first few days afterward.

Endometrial ablation is a procedure in which doctors destroy the lining of uterus to cut down on the bleeding linked to small fibroids.

Myomectomy is a surgery to remove fibroids. If you plan to become pregnant, your doctor may recommend this over other procedures. But it may cause scarring that can lead to infertility. You’ll need to wait 4 to 6 months after surgery before you try to conceive. In most women, symptoms go away following a myomectomy. But in others, the fibroids come back. Whether it works will partly depend on how many fibroids you have and whether the surgeon could remove them all. A myomectomy may be abdominal surgery, or your surgeon may use a hysteroscope or laparoscope to remove the fibroids without having to make a large cut on your abdomen. There is also an experimental method that uses MRI-guided intense ultrasound energy to pinpoint the fibroids and shrink or destroy them.

Hysterectomy is surgery to remove the uterus. Many women don’t need treatment that’s this drastic. You won’t be able to get pregnantafter this operation.

Details of Blastocyst Transfer & ICSI in IVF treatments

May 3, 2018 Posted by admin Uncategorized 0 comments

IVF – In Vitro Fertilization:

In Vitro Fertilization is probably the best known and most widely used ART procedure. For well over a decade, IVF has allowed infertile couples the chance to conceive and bear children. The best candidates for IVF are women with damaged fallopian tubes.

IVF is a four-stage procedure. The beginning of this process involves ovarian stimulation to produce several mature eggs that can be harvested from the ovary before they have been released from the follicles, and the monitoring and collection of eggs. Multiple eggs are removed from the woman and placed in a special medium for two to three hours. The male semen is processed, using different techniques to obtain a vigorous motile sperm. The prepared sperm is then introduced into the medium containing the egg(s).

In Vitro Fertilization with Embryo Transfer (IVF – ET)

In the fourth stage of IVF, many of these eggs will fertilize and develop into embryos, which are then transferred back into the woman’s uterus through a simple procedure that requires no anesthesia. In most cases, egg recovery is preceded by a period during which the woman receives daily hormone medications to stimulate the growth of multiple eggs. In some instances, however, it may be possible to accomplish IVF without the use of these ovulation induction medications.

ICSI:

Intracytoplasmic sperm injection (ICSI) is a highly sophisticated technique for injecting one single sperm into an egg using microscopic and micromanipulation instruments. In men with low sperm count, low motility or a high number of abnormal sperm, this technique has proven to be a highly successful remedy.

Combined with IVF or ZIFT, the procedure of ICSI is able to achieve a high rate of fertilization and normal embryo development. ICSI has even been successful in cases where sperm must be taken directly from the testes (testicular biopsy) due to the absence of sperm in the ejaculate or a previous vasectomy. ICSI is also the best choice when other andrology tests identify a possible problem with sperm function.

ICSI & IVF

ICSI is a more aggressive approach compared to traditional IVF. During a traditional cycle of IVF, the sperm and eggs are introduced together in a cultured medium, while the ICSI procedure takes an individual egg and microscopically inseminates it with an individual sperm. The successfully fertilized eggs are observed, graded for quality and reintroduced to the mother’s uterus.

Blastocyst Transfer:

This is a procedure that allows a longer time for the embryo to develop in the laboratory (five days instead of two to three). This enables the embryo to reach the Blastocyst stage, which is the natural embryonic stage for implantation in the uterus.

Many couples undergoing In Vitro Fertilization accept the risk of multiple gestation as an integral part of the treatment process. They want to maximize their chances of achieving a pregnancy and will transfer three or more embryos to achieve their goal. After all, the chance of taking home a baby is not 100%, and the cost of an IVF cycle can be quite significant. Sometimes, the financial resources of a particular couple may only allow them to undergo an IVF cycle once in their lifetime. The end result of transferring 3 or more embryos has been a significant increase in the rate of triplet and higher order multiple pregnancies. There are enormous medical, social, and financial consequences of this increase in multiple birth rate.

One solution to this problem may be to culture the embryos for 5 or 6 days, to the blastocyst stage. Embryos developing to the blastocyst stage (blastocysts), have a higher implantation rate than embryos grown only three days, and are more likely to succeed in initiating a pregnancy. As result, only two blastocysts need to be transferred to have the same pregnancy rate usually seen when 3 or more embryos that have been grown for only 2 or 3 days are transferred into the uterus. In other words, fewer embryos are needed to achieve the same or higher pregnancy rate, resulting in a lower incidence of multiple gestation.

Marfan Syndrome: Causes, Symptoms & Treatments

Apr 30, 2018 Posted by admin Uncategorized 0 comments

What is Marfan syndrome?

Marfan syndrome is a heritable condition that affects the connective tissue. The primary purpose of connective tissue is to hold the body together and provide a framework for growth and development. In Marfan syndrome, the connective tissue is defective and does not act as it should. Because connective tissue is found throughout the body, the syndrome can affect many body systems, including the skeleton, eyes, heart and blood vessels, nervous system, skin, and lungs.

Who gets this syndrome?

Marfan syndrome affects men, women, and children, and has been found among people of all races and ethnic backgrounds.

What are the signs and symptoms?

It affects different people in different ways. Some people have only mild symptoms, while others are more severely affected. In most cases, the symptoms progress as the person ages. The body systems most often affected by the syndrome are:

Skeleton. People with the syndrome are typically very tall, slender, and loose-jointed. Because Marfan syndrome affects the long bones of the skeleton, a person’s arms, legs, fingers, and toes may be disproportionately long in relation to the rest of the body. A person with the syndrome often has a long, narrow face, and the roof of the mouth may be arched, causing the teeth to be crowded. Other skeletal problems include a sternum (breastbone) that is either protruding or indented, curvature of the spine (scoliosis), and flat feet.
Eyes. More than half of all people with the condition experience dislocation of one or both lenses of the eye. The lens may be slightly higher or lower than normal, and may be shifted off to one side. The dislocation may be minimal, or it may be pronounced and obvious. One serious complication that may occur with this disorder is retinal detachment. Many people with the condition are also nearsighted (myopic), and some can develop early glaucoma (high pressure within the eye) or cataracts (the eye’s lens loses its clearness).

Picture of Syringomas on the Eyelids of a Marfan Syndrome Patient

Heart and blood vessels (cardiovascular system). Marfan syndrome patients have problems associated with the heart and blood vessels. Because of faulty connective tissue, the wall of the aorta (the large artery that carries blood from the heart to the rest of the body) may be weakened and stretch, a process called aortic dilatation. Aortic dilatation increases the risk that the aorta will tear (aortic dissection) or rupture, causing serious heart problems or sometimes sudden death. Sometimes, defects in heart valves can also cause problems. In some cases, certain valves may leak, creating a “heart murmur,” which a doctor can hear with a stethoscope. Small leaks may not result in any symptoms, but larger ones may cause shortness of breath, fatigue, and palpitations (a very fast or irregular heart rate).
Nervous system. The brain and spinal cord are surrounded by fluid contained by a membrane called the dura, which is composed of connective tissue. Marfan syndrome patients grow older, the dura often weakens and stretches, then begins to weigh on the vertebrae in the lower spine and wear away the bone surrounding the spinal cord. This is called dural ectasia. These changes may cause only mild discomfort; or they may lead to radiated pain in the abdomen; or to pain, numbness, or weakness in the legs.
Skin. Many people with Marfan syndrome develop stretch marks on their skin, even without any weight change. These stretch marks can occur at any age and pose no health risk. However, people with Marfan syndrome are also at increased risk for developing an abdominal or inguinal hernia, in which a bulge develops that contains part of the intestines.
Lungs. Although connective tissue problems make the tiny air sacs within the lungs less elastic, people with Marfan syndrome generally do not experience noticeable problems with their lungs. If, however, these tiny air sacs become stretched or swollen, the risk of lung collapse may increase. Rarely, people with Marfan syndrome may have sleep-related breathing disorders such as snoring, or sleep apnea (which is characterized by brief periods when breathing stops).

Is Marfan syndrome genetic or inherited (causes)?

Caused by a defect, or mutation, in the gene that determines the structure of fibrillin-1, a protein that is an important part of connective tissue. A person with Marfan syndrome is born with the disorder, even though it may not be diagnosed until later in life.

The defective gene that causes Marfan syndrome can be inherited: The child of a person who has Marfan syndrome has a 50 percent chance of inheriting the disease. Sometimes a new gene defect occurs during the formation of sperm or egg cells, making it possible for two parents without the disease to have a child with the disease. But this is rare. Two unaffected parents have only a 1 in 10,000 chance of having a child with Marfan syndrome. Possibly 25 percent of cases are due to a spontaneous mutation at the time of conception.

Although everyone with Marfan syndrome has a defect in the same gene, different mutations are found in different families, and not everyone experiences the same characteristics to the same degree. In other words, the defective gene expresses itself in different ways in different people. This phenomena is known as variable expression. Scientists do not yet understand why variable expression occurs in people with Marfan syndrome.

How Is Marfan Syndrome Treated?

Marfan syndrome requires a treatment plan that is individualized to the patient’s needs. Some people need regular follow-up appointments with their doctor, and during the growth years, routine cardiovascular, eye, and orthopedic exams. Others may need medications or surgery. The approach depends on the structures affected and the severity:

Medications:

Medications are typically not used to treat Marfan syndrome. However, your doctor may prescribe a beta-blocker, which decreases the forcefulness of the heartbeat and the pressure within the arteries, thus preventing or slowing the enlargement of the aorta. Beta-blocker therapy is usually started when the person with Marfan syndrome is young.

Some people are unable to take beta-blockers because they have asthma or because of the medication’s side effects, which may include drowsiness or weakness, headaches, slowed heartbeat, swelling of the hands and feet or trouble breathing and sleeping. In these cases, another medication called a calcium channel blocker may be recommended.

Surgery:

The goal of surgery for Marfan syndrome is to prevent aortic dissection or rupture and to treat problems affecting the heart’s valves, which control the flow of blood in and out of the heart and between the heart’s chambers.

The decision to perform surgery is based on the size of the aorta, expected normal size of the aorta, rate of aortic growth, age, height, gender, and family history of aortic dissection. Surgery involves replacing the dilated portion of the aorta with a graft, a piece of man-made material that is inserted to replace the damaged or weak area of the blood vessel.

A leaky aortic or mitral valve (the valve that controls the flow of blood between the two left chambers of the heart) can damage the left ventricle (the lower chamber of the heart that is the main pumping chamber) or cause heart failure. In these cases, surgery to replace or repair the affected valve is necessary. If surgery is performed early, before the valves are damaged, the aortic or mitral valve may be repaired and preserved. If the valves are damaged, they may need to be replaced.

If surgery is needed, you should consult with a surgeon who is experienced in surgery for Marfan syndrome. People who have surgery for Marfan syndrome still require life-long follow-up care to prevent future complications associated with the disease.

How Does Marfan Sydrome Affect Lifestyle Choices?

Activity. Most people with Marfan syndrome can participate in certain types of physical and/or recreational activities. Those with dilation of the aorta will be asked to avoid high intensity team sports, contact sports, and isometric exercises (such as weight lifting). Ask your cardiologist about activity guidelines for you.
Pregnancy . Genetic counseling should be performed prior to pregnancy because Marfan syndrome is an inherited condition. Pregnant women with Marfan syndrome are also considered high-risk cases. If the aorta is normal size, the risk for dissection is lower, but not absent. Those with even slight enlargement are at higher risk and the stress of pregnancy may cause more rapid dilation. Careful follow-up, with frequent blood pressure checks and monthly echocardiograms is required during pregnancy. If there is rapid enlargement or aortic regurgitation, bed rest may be required. Your doctor will discuss with you the best method of delivery with you.
Endocarditis prevention. People with Marfan syndrome who have heart or valve involvement or who have had heart surgery may be at increased risk for bacterial endocarditis. This is an infection of the heart valves or tissue which occurs when bacteria enters the blood stream. To prevent this, antibiotics may be needed prior to dental or surgical procedures. Ask your doctor whether you need antibiotics, and if so, how much and what kind should be taken. A wallet card may be obtained from the American Heart Association with specific antibiotic guidelines.
Emotional considerations. Learning you have Marfan syndrome may cause you to feel angry, frightened or sad. You may need to make changes in your lifestyle and adjust to having careful medical follow-up the rest of your life. You may have financial concerns. You also need to consider the risk to your future children. The National Marfan Foundation can provide support.

Cystic fibrosis in Pancreas : Causes, Symptoms & Treatments

Apr 28, 2018 Posted by admin Uncategorized 0 comments

What is the pancreas?

The pancreas is an organ approximately six inches long that is located in the abdomen behind the stomach and in front of the spine and aorta. The pancreas is divided into three regions: the head, the body, and the tail. The head of the pancreas is located on the right side of the abdomen adjacent to the duodenum. The tail is on the left side of the abdomen, and the body lies between the head and the tail.

There are two functional parts to the pancreas, referred to as the exocrine and endocrine parts. The majority of the cells of the pancreas produce digestive juices which contain the enzymes necessary for digesting food in the intestine. The enzymes are secreted into smaller collecting ducts within the pancreas (side branches). The side branches empty into a larger duct, the main pancreatic duct, which empties into the intestine through the papilla of Vater in the duodenum. During passage through the ducts, bicarbonate is added to the digestive enzymes to make the pancreatic secretion alkaline. The cells and ducts producing the digestive juices comprise the exocrine part of the pancreas.

Just before the main pancreatic duct enters the duodenum, it usually merges with the common bile duct that collects bile (a fluid that helps to digest fat) produced by the liver. The common bile duct usually joins the pancreatic duct in the head of the pancreas. The union of these two ducts forms the ampulla of Vater which drains both the bile and pancreatic fluid into the duodenum through the papilla of Vater.

Buried within the tissue of the pancreas, primarily in the head, are small collections of cells, termed the Islets of Langerhans. The cells of the Islets produce several hormones, for example, insulin, glucagon, and somatostatin; that are released into the blood (the islets do not connect with the pancreatic ducts) and travel in the blood to other parts of the body. These hormones have effects throughout the body, for example, insulin, which helps to regulate blood sugar levels. The hormone-secreting portion of the pancreas – the Islets – is the endocrine part of the pancreas.

What are pancreatic cysts?

Pancreatic cysts are collections (pools) of fluid that can form within the head, body, and tail of the pancreas. Some pancreatic cysts are true cysts (non-inflammatory cysts), that is, they are lined by a special layer of cells that are responsible for secreting fluid into the cysts. Other cysts are pseudocysts (inflammatory cysts) and do not contain specialized lining cells. Often these pseudocysts contain pancreatic digestive juices because they are connected to the pancreatic ducts. Pancreatic cysts can range in size from several millimeters to several centimeters. Many pancreatic cysts are small and benign and produce no symptoms, but some cysts become large and cause symptoms, and others are cancerous or precancerous. (Precancerous cysts are benign cysts that have the potential to become cancerous.)

Different types of cysts contain different types of fluids. For example, pseudocysts that form after an attack of acute pancreatitis contain digestive enzymes such as amylase in high concentrations. Mucinous cysts contain mucus (a proteinaceous liquid) produced by the mucinous cells that form the inside lining of the cyst.

What are the symptoms of pancreatic cysts?

The symptoms of pancreatic cysts depend on their size and location. Small (less than two cm) cysts usually cause no symptoms. Large pancreatic cysts can causeabdominal pain and back pain presumably by exerting pressure on the surrounding tissues and nerves.
Small or large cysts in the head of the pancreas also may cause jaundice(yellowing of the skin and eyes with darkening of the urine) due to obstruction of the common bile duct. (Obstruction causes bile to back up and forces bilirubin–the chemical that produces jaundice–back into the bloodstream and forces it to be excreted in the urine.)
If the cysts become infected, it may result in fever, chills, and sepsis.
On rare occasions, large pseudocysts can compress the stomach or the duodenum leading to obstruction to the movement of food in the intestines, resulting in abdominal pain and vomiting.
If a cyst becomes malignant and begins to invade the surrounding tissues, it may lead to the same type of pain as pancreatic cancer, pain that usually is constant and felt in the back and upper abdomen.

What are the causes of pancreatic cysts?

There are two major types of pancreatic cysts; pseudocysts (inflammatory cysts) and true cysts (non-inflammatory cysts). Inflammatory cysts are benign, whereas non-inflammatory cysts can be benign, precancerous, or cancerous.

Pseudocysts

Most of the inflammatory cysts of the pancreas are pancreatic pseudocysts. Pseudocysts of the pancreas result from pancreatitis (inflammation of the pancreas). The common causes of pancreatitis include alcoholism, gallstones, trauma, and surgery. The fluid inside the pseudocysts represents liquefied dead pancreatic tissue, cells of inflammation, and a high concentration of digestive enzymes that are present in pancreatic exocrine secretions. (Most pseudocysts have connections with the pancreatic ducts.) Most pseudocysts caused by acute pancreatitis resolve spontaneously (without treatment) within several weeks. Pseudocysts that need treatment are those that persist beyond six weeks and are causing symptoms such as pain, obstruction of the stomach or duodenum, or have become infected.

True cysts

Serous cyst adenomas: These cysts are mostly benign and commonly occur in middle-aged women. They usually are located in the body or tail of the pancreas. Typically they are small and cause no symptoms although rarely they may cause abdominal pain.
Mucinous cyst adenomas: Thirty percent of these cysts contain cancer, and those that do not contain cancer are considered precancerous. They also commonly occur in middle-aged women and are usually located in the body or tail of the pancreas.
Intraductal papillary mucinous neoplasm (IPMN): These cysts have a high likelihood of being or becoming cancerous. At the time of diagnosis, there is a 40% to 50% chance of the cyst already being cancerous. These cysts are more common in middle-aged men and are more commonly located in the head of the pancreas. The cysts typically produce large amounts of mucous which sometimes can be seen draining out of the papilla of Vater at the time of endoscopic retrograde cholangio-pancreatography (ERCP), a test that visualizes the ampulla of Vater and the pancreatic duct. These cysts can cause abdominal pain, jaundice, and pancreatitis. Increased risk for cancer occurs with older age of the patient, presence of symptoms, involvement of the main pancreatic duct, dilation of the main pancreatic duct over 10 mm, the presence of nodules in the wall of the duodenum, and size over 3 cm for side-branch IPMN.
Solid pseudopapillary tumor of the pancreas: These are rare tumors that have both solid and cystic components and are found mainly in young Asian and black women. They may reach a large size and can become malignant. Prognosis is excellent after complete surgical resection of these tumors.

What is the treatment for pancreatic cysts?

The most important aspect of management of pancreatic cysts is the determination of whether a cyst is benign (and usually needs no treatment) or if it is precancerous or cancerous and must be removed.

The second most important aspect of management is to determine whether a patient with a precancerous or cancerous pancreatic cyst is a suitable surgical candidate. In medical centers experienced in performing pancreatic surgery, surgical removal of precancerous or cancerous cysts results in a high rate of cure.

Very small cysts can be followed to detect an increase in size that may indicate cancer or an increased risk of developing cancer. Not all cysts need to have endoscopic ultrasound or be aspirated; some may have characteristics so suggestive of malignancy that surgery is recommended without endoscopic ultrasound. Others may have characteristics so suggestive of a non-cancerous cyst that no endoscopic ultrasound needs to be done although imaging studies (ultrasound, CT, MRI) may be repeated periodically. There are not yet standard recommendations for managing pancreatic cysts. Different medical centers have adopted different approaches to diagnosis and treatment. Management decisions must be individualized for each patient after discussions with a doctor familiar with the patient’s health status. The following are examples of how a doctor might manage pancreatic cysts.

Pancreatic pseudocysts need treatment if they persist beyond six weeks after acute pancreatitis, especially if they reach a large size and cause symptoms such as obstruction of the stomach or common bile duct, abdominal pain, or become infected. Small pancreatic cysts (for example, cysts smaller than one cm) will have little chance of being cancerous. Nevertheless, even these small cysts can grow in size and turn cancerous in the future. Thus, these patients are monitored with yearly scans (for example, yearly ultrasound or MRI). The cysts do not have to be evaluated with endoscopic ultrasound and fine needle aspiration. If the cysts grow in size and/or cause symptoms, the patient will be evaluated further using endoscopic ultrasound and fine needle aspiration.
Pancreatic cysts larger than 2 cm in young, healthy individuals usually are treated with surgical removal, especially if the cysts produce symptoms.
Pancreatic cysts larger than 2 cm in elderly patients can be studied with endoscopic ultrasound and fine needle aspiration. If fluid cytology, CEA measurements or analysis of DNA suggest cancerous or precancerous changes, the patients can be evaluated for pancreatic surgery.

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