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Cristian Mihon

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3215

New Biomarkers Can Detect Ovarian Cancer

Infertility is associated with an increased incidence of ovarian cancer. A new study shows that mesothelin, a ovarian cancer antigen, appear in women who are infertile and have a increased risk for developing ovarian cancer. These study may suggest that in the future will be possible to identify which women with infertility have a high risk for developing ovarian cancer.

This new findings are extremely important, because medical tests which are available today are unable to detect ovarian cancer in its early stages and this is the reason why death rates from this disease are so high.

The researchers said that the clinical significance of this research is to increase awareness in general population, because it has been known for a long time, through epidemiology studies, that women with infertility, are having a higher risk to develop ovarian cancer, due to treatment assistance to become pregnant and also, women who never had children have a increased risk for ovarian cancer. This study is important because is showing that the researchers can identify an additional risk factor, that would help doctors to identify women with increase risk for ovarian cancer.

The authors of this study found that mesothelin antibodies are present in a high frequency in women who have a prematurely reduced ovarian function, including ovulatory dysfunction, ovarian failure and infertility. In contrast, women with endometriosis, who also have a high risk to develop ovarian cancer, did not have mesothelin antibodies in their blood.

Biomarkers for ovarian cancer

Biomarkers for ovarian cancer

Ovarian cancer is usually detected in advanced stages and for this reason, the disease has a poor prognosis. Current diagnostic tests are ineffective for early diagnosis and identifying this new possible biomarkers could be helpful to diagnose ovarian caner in earlier stages and can provide targets to improve the treatment of this disease during all stages.

With this study, researchers identified that CA125, HE4 and mesothelin are possible biomarkers which can detect ovarian cancer, before a clinical diagnosis is emitted. That study showed a statistically increased risk for ovarian cancer, in women who were positive for this biomarkers.

Many of the epidemiological studies have shown that exist an association between infertility and ovarian cancer and this association is independent to infertility drug treatment. Women with different types of infertility have different risks for developing ovarian cancer, noted the researchers, who highlighted that some women with unexplained infertility have positive mesothelin antibodies, which can indicate the fact that an autoimmune disorder is targeting the ovary. Other women with infertility have poor response to estrogen and to follicle-stimulating hormone, which has been associated with the presence of mesothelin antibodies. Women with ovarian cancer have positive antibodies which are similar to those found in women with infertility.

For this study, the researchers collected a total of 329 probes from women, 109 were from women with infertility, 28 from women with ovarian cancer, 24 from women with benign ovarian tumors or ovarian cysts, and 152 from healthy women. They also collected probes from women with infertility categories caused by endometriosis (23 probes), ovulatory dysfunction (17 probes), premature ovarian failure (25 probes) and unexplained infertility ( 44 probes).

The result was that mesothelin antigen levels and mesothelin antibodies were significantly higher in women with ovarian cancer, benign conditions and unexplained infertility, than in healthy women. The researchers noted that this association is not conclusive because some women have higher levels of mesothelin, some have mesothelin antibody, and some have both, but they observed that most patients with ovarian carcinoma had circulating mesothelin antigen. With the exception of unexplained infertility, mesothelin antigen was not significantly higher in the other types of infertility as compared with normal women.

3451

A New Strain Of Salmonella Highly Resistant To Antibiotics

In a study which was published in the Journal of Infectious Diseases, was shown that a team of researchers  from Pasteur Institute from France, describe a multiresistant strain of Salmonella enterica, subspecies Salmonella kentucky. This new strain of Salmonella is highly resistant to several antibiotics, especially to ciprofloxacin,which is a part of the fluoroquinolone class of antimicrobial drugs. Ciprofloxacin is the main antibiotic used in the treatment of severe cases of Salmonella infection.

The scientists informed that the resistant strain of  Salmonella kentucky, has infected 489 people in France, England, Wales and Denmark between 2000 and 2008. It was observed that this bacteria, firstly emerged in Africa.

Salmonella Kentucky

Salmonella Kentucky

Salmonella kentucky is the most common of Salmonella serotype which is found in poultry from America, but this seroptype has caused a few cases of illnesses. Scientists believe that widespread use of fluoroquinolones in Nigeria and Morocco may have helped this strain of Salmonella to develop antibiotic resistance. Turkeys and chickens exported from this countries and also from America  may be the carriers of this resistant strain.

In the U.S.A. are declared four antibiotic-resistant strains of Salmonella: Salmonella typhimurium, Salmonella newport, Salmonella hadar and  Salmonella heidelberg. Declaring of these strains of Salmonella as resistant to antibiotics would require food testing and controls for the pathogens before the food will reach consumers.

Salmonella Infection

Salmonella Infection

Salmonella heidelberg is a antibiotic-resistant strain of Salmonella, which was found in turkey meat and is affecting the people from U.S.A. since March, this year, killing one person and producing illnesses to others 76 people. For every case of Salmonella infection, confirmed by laboratory investigations, the Centers for Disease Control and Prevention estimates that are at least 30 unreported cases of Salmonella infection. It is estimated that this outbreak is responsible for more than 2.000 cases of infections.

Outbreaks caused by antibiotic-resistant Salmonella are leading to an increased rate of hospitalization and the rate of patients who die from infection with antibiotic resistant strains of Salmonella is increasing.

25175

Down Syndrome Trisomy 21 (Mongolism) – Causes, Karyotype, Symptoms, Antenatal Diagnosis

Down syndrome, trisomy 21 or the older term mongolism is a condition in which a person is born with certain distinctive features :  flat face, short neck, and a degree of mental delay (mental retardation). Although Down syndrome cannot be treated, most patients can lead a normal life. With the proper care and help they need, children with Down syndrome can have a spectacular growth and development and can become healthy and happy adults.

Down syndrome was described in 1861 by Seguin in 1866 by Langdon-Down who specify the clinical features of this syndrome and in 1959, Lejeune specifies the chromosomal etiology.

Down Syndrome

Down Syndrome

Frequency of Down syndrome is 1.5 per 1000 infants and sex distribution is 3 to 2 for male gender. It is considered that in the occurrence of Down syndrome is involved advanced maternal age, especially over the age of 35. At mothers aged 28 years it is recorded an increased frequency of  births with Down syndrome, but this corresponds to a maximum number of births at this age. The risk increases with maternal age, as follows:

  • Under the age of 30 years, the risk of having a baby with Down syndrome is less than 0.1%;
  • Between 30 and 40 years, the risk of having a baby with Down syndrome is less than 1%;
  • Over 40 years, the risk of having a baby with Down syndrome is more than 1%;
  • Over 45 years, the risk of having a baby with Down syndrome is 3,3%;
  • Over the age of 50 years, the risk of having a baby with Down syndrome is about 15%.

Down Syndrome Causes And Karyotype

Down syndrome is caused by an abnormal cell division, most often in the ovule before conception or at the moment of conception. Less frequently, abnormal cell division can affect the spermatozoon at the moment of conception. The factors that cause cells to divide abnormally are not known. Genes are grouped in the form of chromosomes. Normally, a child inherits 46 chromosomes, 23 chromosomes from each parent . After the abnormal cell division resulting extra genetic material, usually an extra chromosome. In most cases of Down syndrome, extra genetic material  is represented by  a extra chromosome 21 , which means that each cell in the body has three copies of chromosome 21 instead of the usual two copies. The extra genetic material disrupts the normal course of development, causing the characteristic features of Down syndrome.
In terms of cytogenetics, Down syndrome can be:
  1. Free and homogeneous trisomy 21 in 92.5% of cases of Down syndrome. These cases are generally cases with de novo appearance, in which is involved maternal age. Karyotype is 47XX+21 or 47XY+21  and the cause is represented by a chromosomal non-disjunction of maternal origin (90%) or a chromosomal non-disjunction of paternal origin (10%).
  2. Mosaic trisomy 21 in 2.5% of cases of Down syndrome. These are sporadic cases, showing karyotype 47XX+21 / 46XX or 47XY+21 / 46XY. Phenotypic manifestations in this type of Down syndrome are more attenuated.
  3. Trisomy 21 with translocation in 5% of cases of Down syndrome. These are cases with de novo appearance, in which is involved a transmission of a paternal translocation. The karyotype is 46XX or 46XY  with a translocation between a supernumerary chromosome 21 and, most commonly, a chromosome of group D (pair of chromosomes 13, 14 and 15).
  4. Partial trisomy 21, very rare and is represented by cases of Down syndrome where is an excess of genetic material represented by an extra chromosome 21 which has deletions on q arms.
The study of these cases allow the identification of critical region on chromosome 21 which is responsible for Down syndrome phenotype. This critical region is located on 21q22 band of chromosome 21.
Down Syndrome Karyotype

The Clinical Presentation Of Down Syndrome (signs and symptoms)

General Characteristics of Down Syndrome :
Most children with Down syndrome have some of these physical traits:
  • Short stature : the child usually have slow growth rate, and in adulthood their height is lower than average;
  • Low muscle tone : a child suffering from Down syndrome may have less muscle strength than other children of the same age;
  • Short neck, thick with fat and excess skin : usually  this feature becomes less obvious as the child grows;
  • Short and stocky limbs, some children may have a wider space between the thumb and second finger of the foot;
  • One fold in the central part of the palm : it is called the simian line.

Down Syndrome Facial features:

  • Ears with modified form : usually small and with a low placement ;
  • Abnormal mouth and tongue: mouth is often open, exfoliative glossitis, tongue with scrotal appearance (in adolescents and adults), pseudomacroglossia;
  • Flattened nasal bridge : flat nose portion located between the two eyes (nasal bridge) is frequently clogged;
  • Brushfield’s spots : colored spots on the iris, these spots are not affecing the sight;
  • Malformation of the teeth: baby teeth may grow later and in an unusual way, agenesis of lateral incisors.
Down Syndrome or Trisomy 21
Down Syndrome Skeleton and skin features:  short arm, finger clinodactyly of the fifth finger with a single flexion crease, flat foot, increased space between first toe and second toe, xerosis, hyperkeratotic lesions, alopecia, vitiligo, foliculitis and recurent skin infections.
Psychomotor retardation: hypotonia occurs at birth, but mental retardation is less evident at birth. Children are affectionate, jovial and present difficulty in speech, like the game, arrange objects in order, the memory is not affected. They presents a moderate to sever mental retardation with an IQ = 20-85, with a average of 50.
Down syndrome associates malformations of organs and systems in 45% of cases:
Antenatal Down

Antenatal Down Syndrome

Down Syndrome Antenatal Diagnosis

Antenatal diagnosis of Down syndrome can be done by cytogenetic analysis of amniotic fluid or chorionic villi biopsy, which is done if there is suspicion of Down syndrome by maternal age. Antenatal diagnosis of Down syndrome can be also confirmed by fetal ultrasound.
Genetic consultation:
The risk of recurrence of Down syndrome varies according to karyotype abnormalities. Thus, if homogeneous trisomy 21 exists, then the risk of recurrence is 1% – 2%, and in the case of trisomy 21 with translocation, the risk of recurrence can be up to 20%.

6527

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) – Symptoms, Diagnosis, Treatment And Recommendations

Amyotrophic lateral sclerosis (also known as Lou Gehrig’s Disease) is characterized by a progressive loss (reduction) of certain nerve cells, of the  brain and spinal cord, called motor neurons. Motor neurons control voluntary muscles, muscles that make movement possible.
Amyotrophic lateral sclerosis is a progressive, debilitating, and a fatal disease. Walking, talking, eating, swallowing and other basic functions become more difficult with time. These conditions can cause different injuries, illness and other problems.
One to two people in 100,000 develop amyotrophic lateral sclerosis each year. Men are affected slightly more often than women. Although it can occur at any age, it is more common in middle-aged and elderly people.
The causes of amyotrophic lateral sclerosis are unknown. About 5-10% of people with amyotrophic lateral sclerosis present an inherited form of the disease. Amyotrophic lateral sclerosis is not contagious.

Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis

Amyotrophic Later Sclerosis Symptoms

Amyotrophic lateral sclerosis symptoms include:

  • Weakness or lack of precision in the hands and feet;
  • Gradual loss of strength in hands and feet;
  • Failure of voluntary control of hands and feet;
  • Muscle spasms;
  • Insecure, rigid walking;
  • Difficulty in swallowing, speaking and breathing;
  • Fatigue;
  • Frequent nightly muscle cramps, which may occur later in the disease;
  • Pain in the last stages of the disease.

It is important to remember that muscle weakness, fatigue, stiffness and muscle spasms do not necessarily indicate that amyotrophic lateral sclerosis is present. The first sign of amyotrophic lateral sclerosis is usually slight weakness in one of the legs, one of the hands, the face or tongue. Other problems may include increased clumsiness and difficulty performing tasks that require precise movements of the fingers and hands. Muscle spasms can occur. The weakness spreads to the hands and feet over several months or years. As the number of neurons continues to decrease, the muscle cells that are normally stimulated by these nerves also start to reduce in number and as an effect, muscles weaken.
Respiratory diseases are the most common serious complications of amyotrophic lateral sclerosis. While the neck and chest muscles become atrophic, swallowing and coughing become more difficult, which sometimes lead to aspiration of food or saliva into the trachea. This causes pneumonia (inflammation of lung tissue). Breathing problems worsen as the disease progresses, increasing the risk of infection and respiratory failure.
Pneumonia, pulmonary embolism, respiratory failure and heart failure (probably due to the lack of proper breathing after muscles weaken) are the most common causes of death amongst patients with amyotrophic lateral sclerosis. In most cases, death occurs no later than 3 to 6 years after the onset of symptoms, but some individuals survive for many years or even decades.

Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis Diagnosis

The diagnosis of amyotrophic lateral sclerosis is based on a detailed history, a physical exam of the nervous system and tests that evaluate nerve and muscle function. If amyotrophic lateral sclerosis is suspected, referral to a neurologist is recommended for diagnosis and treatment. A thorough medical history and a physical exam of the nervous system can usually help the neurologist diagnose the disease. Tests needed to confirm the diagnosis include an electromyogram (EMG) and Nerve conduction studies. The EMG helps measure the quality and rapidity of the nervous system and muscles. Nerve conduction studies test nerve activity.
Based on medical findings during the nervous system examination and the EMG and Nerve conduction studies results, other tests may be necessary to exclude other possible causes of symptoms. These tests include a muscle biopsy (tissue sample), blood tests and imaging tests, such as computer tomography (CT) or magnetic resonance imaging (MRI). Amyotrophic lateral sclerosis can be difficult to diagnose and the diagnosis can’t be elucidated before symptoms progress or until further testing and examination have not been performed. If amyotrophic lateral sclerosis is suspected, evaluation by a specialist who has experience in treatment and diagnosis of amyotrophic lateral sclerosis may lead to early diagnosis.
Even if it doesn’t affect the course or evolution of amyotrophic lateral sclerosis, early diagnose may:

  • Allow more time for decisions about the future and taking advantage of the time before symptoms become severe;
  • Help avoid unsatisfactory results of treatment derived from an incorrect diagnosis;
  • Give the opportunity to participate in clinical trials of new amyotrophic lateral sclerosis treatments.

Amyotrophic Lateral Sclerosis Treatment

Although there is no cure for amyotrophic lateral sclerosis, treatment can help maintain stability and independence, keep symptoms under control and avoid complications as much as possible. Treatment is targeted and offers emotional support as the disability worsens. Occupational and physical therapy can help maintain strength and function and helps most people stay fit. Speech therapy can help preserve the ability to communicate as speech disorders develop.
Medication can be used to relieve symptoms. Medication includes:

  • Baclofen, tizanidine, dantrolene and benzodiazepines like Diazepam to reduce stiffness, spasms and convulsions;
  • Quinine, phenytoin sodium, benzodiazepines or gabapentin to relieve muscle cramps;
  • Morphine to relieve dyspnea (difficult breathing);
  • Diazepam or lorazepam durgs that can help relieve anxiety caused by the respiratory disease;
  • American Academy of Neurology recommends acupuncture as an adjunctive method for breathing problems used in addition to medication or use of devices for artificial respiration;
  • Antidepressant medication improves depression, insomnia, reduced appetite or fatigue and reduces the production of saliva (which can help patients who have the salivation controlling muscles affected);
  • Medication that helps relieve pain and reduce muscle pain, which often occurs late in the disease.

If there are problems with food and saliva aspiration into the trachea, a tube can be inserted through the skin into the stomach (percutaneous endoscopic gastrostomy or PEG). This tube provides an easier way for adequate nutrition and medication managing.
Breathing apparatus (ventilators) may be necessary as the chest muscles are affected. Initially, additional oxygen can be administered through a nasal cannula, a flexible plastic tube that is placed in the nasal cavity. For patients with mild respiratory disease, non-surgical procedures can be used for ventilation. These include the use of positive pressure ventilation on two levels and noninvasive positive pressure, providing additional oxygen through a face mask. However, in some cases, tracheostomy (incision in the neck that opens trachea) can be done and oxygen can be delivered through a tracheostomy tube fixed into the incision.

Riluzole

The drug called Riluzole can extend the life expectancy of patients with amyotrophic lateral sclerosis by several months. It is not known if the medication is effective but it causes slow release of certain chemicals in the brain (neurotransmitters) that are believed to have role in amyotrophic lateral sclerosis. Riluzole is the only drug approved for the treatment of amyotrophic lateral sclerosis.
There are several disadvantages in the use of Riluzole. Although it has been shown to extend the life by several months, there is no visible improvement in either symptoms or quality of life. Most individuals tolerate Riluzole well, but adverse effects such as nausea, vomiting, weakness, dizziness and coughing can occur. Because Riluzole can cause liver damage, patients taking the drug should have their liver function investigated. Riluzole is also expensive and may not bring benefits to patients who have atypical forms of amyotrophic lateral sclerosis.

Amyotrophic Lateral Sclerosis Home Treatment

Amyotrophic Lateral Sclerosis Home Treatment

Amyotrophic Lateral Sclerosis Home Treatment

For patients with amyotrophic lateral sclerosis, it’s important for both themselves and their family to learn how to cope with the effects of the disease. A big part of the treatment and care is done at home and a good home treatment can sometimes help keep symptoms under control and prevent complications. Early in the disease, light aerobic exercise and slow, easy stretching can help maintain strength, reduce fatigue and depression and prevent cramps and muscle spasms. A physiotherapist can recommend the planning of a scheme of activities without any risk and assess the always changing necessities of the disease. Patients with amyotrophic lateral sclerosis often have chewing and swallowing disorders. Changing the diet can help avoid suffocation and ensure an adequate nutrition. This may include: frequent and divided meals, and opting for easy to swallow soft foods. As amyotrophic lateral sclerosis progresses it will become increasingly difficult to mobilize and perform major daily activities. A variety of equipment and auxiliary equipment can help avoid injury and maintain independence. These may include:

  • A cervical collar to support the head if the neck muscles weaken;
  • Protective device for feet and ankles, cane, walking frame, wheelchair that helps mobility;
  • Ramps, handrails, high toilet seat or shower seat;
  • Writing board that can be erased, voice amplifiers or other devices that ease communication when speech becomes difficult.

There are many other devices that help bathing, feeding, dressing and communication. Consult an occupational therapists’ recommendation for the best equipment and information on what changes should be made to a house that ease the life of the patient and would help avoiding any life-threatening situations. Seek medical advice regarding the need for the medical home assistance of a nurse.

Amyotrophic Lateral Sclerosis Recommendations

The thorough study of the disease and it’s care options is recommended for individuals suffering from amyotrophic lateral sclerosis or who have a family member with amyotrophic lateral sclerosis. As the disease progresses, the best treatment and care measures must be taken. Whilst confronting the decisions that must be made, it should be kept in mind that what is useful for a person with amyotrophic lateral sclerosis can have a detrimental effect for others. Some patients want to try any medical treatment that is capable to prolong life, while others prefer comfort measures that do not necessarily prolong life. Analysis of the type of treatment chosen can be helpful. An assessment on how agressive the amyotrophic lateral sclerosis complications (e.g. respiratory diseases, eating difficulties, pneumonia, etc.) will be treated must be done before a treatment plan is decided. These options may require reconsideration during disease evolution because they can change after a while. Some questions to consider are:

  • Is tracheostomy accepted when dyspnea worsens? Tracheostomy ensures long-term assisted breathing by making an incision in the neck in order to open the trachea; oxygen can be supplied through a tube inserted into the hole created by the incision. There are other methods of assisted breathing that less invasive and can be used before tracheostomy, but most people with this disease face the decision of long term mechanical breathing assistance.
  • What type of treatment is needed if pneumonia or other serious lung infection develops?
  • Would the patient accept being fed through a tube placed in the stomach if swallowing ability is reduced or lost?
  • Choosing the person (attendant) to take and execute decisions in case of loss of ability to speak.

At a certain point in the evolution of amyotrophic lateral sclerosis, the purpose of the patient or close relatives may change from treating illness to maintaining comfort and dignity. Nursing homes channel their actions on reducing pain and other symptoms and ensuring a peaceful environment until the end of life.

Remember!
The progressive, debilitating nature of amyotrophic lateral sclerosis and the fact amyotrophic lateral sclerosis does not have a curative treatment makes amyotrophic lateral sclerosis a very difficult to manage disease. In addition to medical treatment it is necessary to provide emotional support by family, friends, doctors and other categories of people. Group support received from other patients with amyotrophic lateral sclerosis can be very useful as well as consulting a psychologist or psychiatrist. The patients’ families also need support as the disease worsens. Group therapy or advice may be useful for them. An organization like the ALSA (Amyotrophic Lateral Sclerosis Association) provides information and support services for people with amyotrophic lateral sclerosis and their families.

4437

Bipolar Disorder

Bipolar disorder or recurrent psychosis is a mental disorder consisting of abnormal mental status, energy and operational ability change of a person. Thus, a sequence of manic episodes and depressive episodes appears. Unlike changes in a person’s mental state during normal life, symptoms of this disease are more severe. Due to the variety of sensitiveness, an individual with this disorder can’t maintain friendly relations, has trouble at work, has poor performance and can even reach suicide. Typically, bipolar disorder begins in adolescence. Sometimes, however, it can develop from early childhood or even later, at old age.

Manic Depressive

Manic Depressive

People who have extreme mood changes from depression to severe manic episodes, may suffer from bipolar disorder.
During manic episodes of bipolar disorder, sufferers tend to have a euphoric mood, be hyperactive, restless and without feeling the need to sleep. They often spend large sums of money, which lead to severe financial problems.
During depressive episodes, people with this disorder are sad, feel hopeless, guilty and / or worthless and have low energy. Bipolar disorder is a disease that also affects the patients’ relatives.

Causes of bypolar disorder:

The causes of bipolar disorder vary among individuals. Studies of monozygotic twins show a substantial genetic contribution but the environment also has a great influence.

    • Childhood experiences:

Some long term studies indicate that children who receive a late diagnose with bipolar disorder may experience early symptoms such as cyclical affective abnormalities, major depressive episodes and possibly ADHD. Hypersensitivity and irritability may be present.

    • Experiences of adult life:

Data suggests that environmental factors play a significant role in the development and evolution of bipolar disorder, and that individual’s psychosocial variables interact with genetic predisposition. There is evidence that life events and interpersonal relationships contribute to the onset and recurrent episodes of abnormal emotionality, as well as recurrence of depression. It has been demonstrated that half of the adults diagnosed with bipolar disorder report traumatic childhood events, such events being associated with early onset, recurrent episodes of negative evolution and disease.

    • Neural processes:

Researchers believe that structural and functional abnormalities of brain circuits can provide the basis for disorders of emotionality. Some studies have found anatomical abnormalities in areas such as the amygdala, the hippocampus and prefrontal cortex. Yet, despite 25 years of research there is still debate on the neuroscientific elements.

Bipolar Disorder

Bipolar Disorder

It has been suggested that a hipersensitivity in the eye-lovel melatonin receptor activity is a trustworthy indicator of bipolar disorder.

Diagnosis

Episodes of mania and depression are repeated throughout the life of patients diagnosed with bipolar disorder. However, most patients do not show any symptoms between the manic or depressive episodes. Only one third of patients diagnosed with bipolar disorder present some symptoms (yet unexplained) between episodes of mania and/or depression.

    • Bipolar disorder type I

Bipolar disorder type I is the classic form of the disease in which patients have periodic episodes of mania and depression.

    • Bipolar disorder type II

Is the form in which patients do not develop severe mania but go through episodes of hypomania that alternate with milder depression.

    • Rapid cycling bipolar disorder

You can talk about rapid cycling bipolar disorder when patients exhibit more than four manic or depressive episodes.

When it comes to long-term prospects related to patients with bipolar disorder, it is important to understand the disease with and without treatment.
Without proper treatment, the disease tends to worsen over time, depressive and manic episodes become increasingly severe. Episodes also tend to be more common.
On the other hand, when appropriate treatment is followed, patients with bipolar disorder can have a normal and productive life. Much of the therapy will help reduce the frequency and severity of manic episodes and/or depression, thus patients can enjoy life.

Treatment

The role of medication and psychosocial treatment
It is important that bipolar disorder is treated as soon as possible whilst under medical supervision. Most people who suffer from bipolar disorder can achieve a stabilization of the mood swings and symptoms associated with them, if they follow appropriate treatment. Recurrent bipolar disorders are diseases in which long-term therapy is required. To control the disease in the long term, a combination of medication and psychosocial treatment is the best treatment plan.

Bipolar Disorder Medication

Bipolar Disorder Medication

Medication

Drugs known as “mood stabilizers” are usually prescribed to stabilize mood swings of bipolar disorder patients. These drugs are administered over long periods of time (years). Drug treatment may be associated on short-term with other therapies to treat episodes of depression or mania that occur despite treatment for mood swings.

    • Antipsychotics

Atypical antipsychotic medication is also used in the treatment of bipolar disorder. These products have a special value in the treatment of manic episodes and help alleviate psychotic symptoms.

    • Lithium

Lithium has been used for a long time as a first choice treatment for anger control. It prevents both depressive and manic episodes.

    • Anticonvulsants

Anticonvulsants also serve as a mood stabilizer, particularly in patients who respond well to treatment. Sometimes they are administered in combination with lithium or its alternative.

    • Benzodiazepines

High-power benzodiazepines facilitate a peaceful sleep for patients suffering from insomnia. However, because these drugs can be addictive they can only be administered if the physician agrees and only for a short period of time.

25121

Tuberculosis – Symptoms, Diagnosis, Treatment And Prevention

Tuberculosis (TB) is a bacterial infection most often localized in the lungs (pulmonary tuberculosis) but can spread to other parts of the body (extra pulmonary tuberculosis). Tuberculosis is still a serious disease and a major cause of death in certain parts of the world. The “Koch bacillus” usually affects the lungs but may produce lesions in any organ or tissue of the human body. From the lungs, tuberculosis is easily spread to other people through coughing or sneezing. Although the treatment is a long term one, it is often completed successfully. The average duration of treatment is between 6 and 9 months. Tuberculosis can be found in latent form (on hold) or in active status.

  • Latent tuberculosis means that the tuberculosis-causing bacteria can exist in the body, but it cannot be spread to others, but this person may have active tuberculosis;
  • Active tuberculosis means the infection is present in the body and if the lungs are affected, the infection can be spread to others.
Tuberculosis

Tuberculosis

Human tubercle bacilli are ordinarily trasmitted by inhalation of infective droplets couched or sneezed into the air by a patient with open lesions (active tuberculosis). Bacilli remain active in wet sputum for months and even in dried sputum particles for weeks.

The routes of infection of tuberculosis are:

  1. Direct infection of the lung by inhalation of bacilli contained in droplets or dust particles is the most important way of infection.
  2. Alimentary infection, occurs through bovine bacillus, by the ingestion of contaminated milk. the organisms enter through the mucosa and the lymphoid tissues of the tonsils or pharynx to involve cervical lymph nodes, or through the intestine to reach the mesenteric lymph nodes. There may be no lesion at the entry point.
  3. Infection through skin (very rare) may occur in surgeons and pathologists who handle infected tissues.

As with any other infection, the development and course of tuberculosis are dependant upon virulence, dosage, and portal of entry of the bacteria. Also very important are the variable factors of the host: native and acquired resistance and hypersensitivity. Significant environmental factors tend to decrease the native resistance (malnutrition, physical and psychological stress, fatigue, certain diseases – diabetes melitus). Age appears to influence susceptibility – while infants, young adults and elderly persons are susceptible to the disease, children in the age group of 5 to 14 years are most resistant.

Causes

Tuberculosis is caused by Mycobacterium tuberculosis, a bacterium that grows slowly in body environments that are rich in blood and oxygen, such as the lungs.

Symptoms

If the latent form of tuberculosis is present, there are no symptoms and it cannot be spread to others. If active form is present, then symptoms are present and the infection can be spread to others. Symptoms are related to the type of tuberculosis present, be it pulmonary (the most common) or extrapulmonary. Other affections such as pneumonia and lung cancer can have similar symptoms as tuberculosis.

Active TB symptoms

Active tuberculosis symptoms emerge gradually and cover a period of several weeks to months. There may be some mild symptoms as well. Common symptoms include:

  • Cough accompanied by thick mucus, sometimes with blood (sputum) for a period of approximately two weeks;
  • Tachycardia (rapid heartbeat);
  • Increased neck volume (affected lymph nodes in the region).

Other symptoms may include:

  • Fever, chills and sweating during sleep;
  • Fatigue and weakness of physical force;
  • Loss of appetite and weight loss with no explicable reason;
  • Decreases in the breath amplitude, chest pain.
Tuberculosis

Tuberculosis

Symptoms of extrapulmonary active TB

Symptoms of infection in other areas (excepting the lungs) vary depending on location. The infection usually remains in the lungs but bacteria can migrate thorugh the blood flow in different parts of the body.

The onset of the infection can be so light that it can easily be ignored by the patient. In a person with a healthy immune system (unaffected by other diseases/infections) the body fights bacteria by encapsulating it (wrapping it) in formations named tubers. The bacteria remain alive but cannot multiply or spread elsewhere in the body or to other persons. This stage corresponds to latent tuberculosis and many people do not overcome it.

A positive tuberculin test is how many people discover that they have latent form of TB. It takes 48 hours after the test for the reaction to take place, which is indicated by a red swelling where the needle pierced the skin. Or it can be tested with QuantiFERON-TB Gold, a blood test, which gives results in about 24 hours.

If a person’s immune system becomes unable to prevent multiplication of the bacteria, tuberculosis becomes active. In patients with latent tuberculosis, 5% (one in twenty people) will develop active tuberculosis within a year of the initial infection.

Active pulmonary tuberculosis is highly contagious. Tuberculosis is spread when a person who has the infection expires bacteria and another person inhales it from the air. The tuberculosis bacteria can remain in the air for several hours. Coughing, sneezing, laughing and singing may release more bacteria than breathing itself.

Tuberculosis is more likely to spread under the following conditions:

  • For people living in crowded environments. Tuberculosis can spread easily in homes, hospitals, shelters for homeless people, schools, barracks and prisons
  • For people who live with people that are already suffering from tuberculosis. This is a factor that increases the possibility of contracting the disease. Tuberculosis is not spread by handling objects touched by an infected person.

In general, after two weeks of treatment with antiobiotics the infection is contained and cannot be spread to others. Discontinuation of medication may cause delayed healing and also recurrence. In these cases it is necessary to restart the therapy. Reappearance may occur  6 to 12 months after stopping the treatment. Also, omitting to finish the treatment (stopping it at some point), can influence the bacteria’s ability to develop resistance to the administered drug, making the treatment more difficult.

Tuberculin Test

Tuberculin Test

Without treatment, the active form of tuberculosis can cause serious complications, such as:

  • Cavities or pockets in the lung parenchyma. These diseased areas of the lungs can cause bleeding and may lead to overgrowth of other bacteria and the formation of abscesses (pus-filled cavities);
  • Holes that form between the airways  (broncho-pleural fistula);
  • Difficulty in breathing due to blocked airways.

Risks

Infants, children and individuals infected with HIV, which also show the active form of tuberculosis, need special treatment.

Individuals have an increased risk of becoming infected with tuberculosis when:

  • Come into contact with persons with active tuberculosis (at home, at work, at school). Active tuberculosis is highly contagious;
  • Care for people who have active untreated tuberculosis (medical staff)
  • Live in crowded conditions where they can come into contact with people who have tuberculosis, such as those working in prisons, hospitals, nursing homes, military barracks, shelters for homeless people
  • Poor access to medical care, such as homeless people, farm workers (farmers) or people who use drugs or alcohol
  • Traveling from, or in regions where tuberculosis is common, such as Latin America, Africa, Asia, Eastern Europe and Russia.

People with latent form of tuberculosis (which can not be spread to other people) are at risk of developing active tuberculosis if they:

  • Suffer from a disease and undergo a treatment that weakens the immune system, such as HIV, some cancers or diabetes;
  • Have poor access to medical care, such as beggars, workers in different areas or alcohol and drug users;
  • Follow a long-term treatment with corticosteroids.
  • Show a weakened immune system such as the elderly, newborns, women who recently gave birth, people who have had organ transplants and take medications for preventing organ rejection;
  • Suffer from a chronic lung disease caused by inhalation of various dusts (silicosis);
  • Are 10% below normal weight.

Specialty Consult

The doctor should be contacted immediately if a person:

  • Has symptoms (continuous cough accompanied by fever, fatigue and weight loss) that could be caused by tuberculosis;
  • Was in intimate contact with someone who has active tuberculosis (which can be transmitted to others) or someone who might be suspected of having tuberculosis;
  • Yellowing of skin, or if the accused shows pain after taking Isoniazid or other anti tuberculosis drugs.

The doctor should be contacted as well if, after the tuberculosis test a red swelling at the location of the neeedle puncture. The test reaction should be inspected by a specialist after 2-3 days, to decide if the patient needs other tests or treatment.

One of the following specialists should be consulted if tuberculosis is suspected:

  • Nearest public health center
  • Doctors (general practitioners, family medicine doctors, internists, pediatricians)
  • Pneumology doctors specializing in treating lung problems
  • Infection disease specialists in treating infectious diseases.

If a patient has tuberculosis resistant to several types of medication, he should go to a  specialized hospital in such tuberculosis treatment.

Tuberculosis Doctor

Tuberculosis Doctor

Watchful Waiting

The watchful waiting period refers to a prudent approach (seeing and doing). If the patient feels better on his own, medication is no longer needed. If the condition worsens, the doctor, together with the patient will decide the next step. If the patient shows continuous symptoms of tuberculosis (combined with symptoms like fever, cough, fatigue and weight loss) treatment is necessary. The doctor or other health professionals should be contacted as soon as possible. Also, if someone came into contact with a person who has active tuberculosis, he or she shouldn’t wait for the first symptoms to appear, a doctor should be contacted as soon as possible.

Investigations

Diagnosis of active pulmonary tuberculosis
Doctors diagnose active pulmonary tuberculosis using anamnesis (history of the disease), physical examination of the patient and examining the patient and observing the symptoms (cough, fatigue, fever and sweating while sleeping). Doctors will also take into account the results of sputum cultures. Mucus examination from the lungs is the best method to diagnose active tuberculosis. If the bacteria grows on culture mediums, susceptibility testing will show the types of drugs capable of destroying the bacteria. Susceptibility testing results appear after 1-6 weeks because Mycobacterium tuberculosis grows very slowly.
Researchers are working on new tests that can provide faster results. Chest radiography does not give a clear indication of tuberculosis. Radiography is indicated if the tuberculin test result is positive, if tuberculosis symptoms such as cough, fatigue, fever or sweating appear during sleep or if there is an uncertain reaction to the tuberculin test due to a weakened immune system.

Diagnosis of latent pulmonary tuberculosis
Tuberculin skin test will show if latent tuberculosis is present. The test will also show if another infection with tuberculosis was present at any given time before the patient underwent the test. QuantiFERON-TB Gold is a blood test which was approved by the FDA (U.S. Food and Drug Administration) to detect latent tuberculosis. It’s faster and more accurate than the skin test, but is still less accessible.

Diagnosis of extrapulmonary tuberculosis
The diagnosis of extrapulmonary tuberculosis includes varied tests:

  • Taking a sample from the affected location (biopsy). The sample is sent to a laboratory for analysis;
  • Urine culture for the detection of renal tuberculosis;
  • Sample from the fluid surrounding the spinal cord (CSF – cerebrospinal fluid) to detect cerebral infection with tuberculosis;
  • Tomography to detect if tuberculosis has spread in the body; can also diagnose lung cavities caused by tuberculosis;
  • MRI (Magnetic Resonance Imaging) to detect brain tuberculosis and spinal cord tuberculosis;
  • HIV testing is usually done along TB testing. Patients can also get tested for hepatitis.

Tests during TB treatment
During treatment, sputum testing is done once a month or sometimes more often, to make sure that antibiotics are effective. At the end of treatment, a chest radiography for future reference. Patients may undergo another series of tests in order to check if the medication affects other organs: the liver function, eye tests (if ethambutol was adminstred) and acoustic tests (if streptomycin was administred)

Tuberculosis X-ray

Tuberculosis X-ray

Diagnosis

All patients with tuberculosis who present themselves at the local or state hospitals can spread the infection to other people and cause an outbreak. Most medical authorities try to prevent tuberculosis outbreaks and encourage early testing for people with a high risk of contracting and developing the disease.
Centers for Disease Control and Prevention recommend TB testing for people who:

  • Are infected with HIV (Human Immuno-Deficiency Virus) or other conditions that put them at risk of contacting the tuberculosis infection;
  • Are living with a person who has active tuberculosis;
  • Use drugs;
  • Born in areas of the world where tuberculosis is common: Latin America, Africa, Asia, Eastern Europe or Russia;
  • Live or work in hospices, shelters for homeless people, prisons, etc.;

Treatment

Physicians treat tuberculosis with antibiotics to kill the bacteria. These drugs are administered to all persons who have tuberculosis, including infants, children, pregnant women and people with deficient or weakened immune systems. People who have latent tuberculosis also receive treatment to prevent the transformation of the bacteria into the active form.

In treating latent or active TB, it is recommended:

  • Using combinations of drugs to treat tuberculosis. Standard initial treatment combines four drugs to prevent TB from becoming multiresistant to treatment;
  • Following treatment for a minimum of six months or more if necessary;
  • Strictly following the indications for treatment. That could mean daily presence of specialized medical staff daily when the drugs are administered. Treatment includes full administration of all doses of antibiotic. These consultations ensure correct treatment, which is necessary due to its long duration;
  • Trying different combinations of drugs, if the treatment doesn’t show any results, due to bacterial resistance (when tests show that the bacteria causing TB is still active).

Extrapulmonary tuberculosis treatment
Extrapulmonary tuberculosis treatment, is usually the same as for pulmonary tuberculosis. You may need other types of drugs, corresponding to the place where the infection is localized or if other complications exist.
Note!
There are various treatments recommended for people with HIV and tuberculosis. If the treatment is stopped too soon, or the doses are not taken properly, the treatment could last longer or the patient may need to start the treatment again from the beginning. This can lead to worsening symptoms or antibiotic-resistant infections that are more difficult to treat.
Curing tuberculosis requires the administration of antibiotic treatment all the way!

Correct administration of medication is important for people with weakened immune systems. They could be at risk of infection recurrence because initial infection was never cured. Recurrences often occur 6-12 months after treatment. Treatment for recurrences is based on the severity of the disease and takes into account the medicine administered during the initial treatment. Doctors also use medication to prevent conversion of latent tuberculosis in the active form.

Treatment is very important for people who have latent tuberculosis and:

  • Also HIV infected;
  • Underwent a chest radiography that suggests tuberculosis infection, but did not complete the tuberculosis treatment;
  • Are drug addicts;
  • Have a disease or are taking medications that weakens immune system;
  • Underwent a tuberculin skin test two years ago, which was negative, but now is positive.

Home treatment focuses on the correct drug use, in order to prevent the development of bacterial resistance. The patient must maintain contact with health professionals and also report any side effects, especially vision problems. If the patient plans to move during treatment it is recommended to announce health professionals in order to make arrangements for a continuous administration of medication. Home treatment includes:

  • A healthy diet to ensure the necessary intake of  nutrients, vitamins, , that the body needs in order to fight back the infection. It is also indicated to consult a dietitian;
  • Covering the mouth when coughing or sneezing. In the first two months of treatment, when disease can spread easily to others.

Drug Treatment

Antibiotics are used simultaneously to treat tuberculosis. For people who present multidrug-resistant tuberculosis, drug treatment can continue for 24 months. Antibiotics are can be given as injections or pills.
Extrapulmonary tuberculosis is currently treated with the same drugs and for the same period of time as pulmonary tuberculosis but cerebral tuberculosis , bone tuberculosis in children can be treated in less than 12 months. Corticosteroid drugs may also be recommended in severe cases in order to reduce inflammation.

One or two antibiotics are generally used to treat latent tuberculosis infection which can not be spread to others, but can turn into active tuberculosis. Poly-drug therapy for tuberculosis treatment involves the administration of four antibiotics at the same time. This is the standard treatment for active tuberculosis.

Four of the most commonly used antibiotics:

  • Isoniazid
  • Rifampicin
  • Pyrazinamide
  • Ethambutol.

Other drugs are used if the treatment is not effective or if the person has a known case of antibiotic resistant TB. Other drugs commonly used include:

  • Streptomycin (STM)
  • Rifampicin

Note!
It is very important to administer the full dose of drugs recommended by doctors. This promotes healing and removes the risk of relapse (disease recurrence) and the development of antibiotic resistant bacteria.

Tuberculosis Treatment

Tuberculosis Treatment

Surgical Treatment

The treatment is rarely surgical but it can treat complications of the lungs or other body parts.
Surgery is indicated:

  • To stop lung hemorrhages that can not be stopped by any other method;
  • The removal of “pockets” (collections) of pus that were not reabsorbed after antibiotic treatment;

Surgery for extrapulmonary tuberculosis is often used to remove or repair damaged organs or prevent complications such as:

  • Brain level tuberculosis infections. The doctor may place a surgical drain (tube) that drains excess fluid to prevent an increase in pressure that can affect the brain;
  • TB pericarditis (infection at heart level). The surgeon may remove the pericardium that surrounds the heart;
  • Renal tuberculosis (infection of the kidneys ). The surgeon may need to remove the affected kidney, repair it or other parts of the urinary system;
  • Joint infection. Surgery may be required to cure the affected areas of the spine or joints (orthopedic surgery).

Prevention

How to avoid contacting active tuberculosis.

Active tuberculosis is an infection that spreads in the body of the sick person and is highly contagious. The World Health Organization estimates that one third of the world population is infected with the bacterium that causes tuberculosis. To prevent infection people must:

  • Do not spend too much time in a crowded places with known people with active tuberculosis (if the person is not under treatment for at least two weeks);
  • Wear protective masks, especially they are working in care centers for those with tuberculosis.

How to avoid turning latent tuberculosis in active tuberculosis.

Generally treatment with Isoniazid for 9 months or Rifampin/Rifampicin for 6 months, prevents conversion of latent tuberculosis. This treatment is recommended for people which were discovered as carriers of bacteria after the tuberculin test

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Marfan Syndrome

Marfan syndrome is a genetic disorder that affects connective tissue ( the elastic tissue that connects the different organs and their components). This syndrome is characterized by dilatation of aorta at the base ( the first part of the main artery that carries blood from the heart to the rest of the body), heart valve dysfunction, lens dislocation, myopia and the lengthening of the extremities – hand, feet and toes. If not discovered in time, the condition can cause sudden death of the patient.

Connective Tissue

Connective Tissue

Causes

Marfan syndrome is a genetic disorder. The gene can be passed from either parents to any children. In exceptional cases the disorder is not inherited from parents, in this situation there is a tendency to produce a new genetic mutation that affects the infant. This situation is far more serious than when the disease could be transmitted genetically. Even in cases in which the gene is passed only from the mother to the child, the severity of the disease varies from person to person.

1 in 10.000 people are affected by Marfan syndrome. The gene that has an abnormal development influences fibrillin, a protein that have an important role in the formation of elastic fibers of connective tissue. The gene may be affected in various ways, this could be the explanation why  Marfan syndrome may have different degrees of severity, from patient to patient. Fibrillin is found in the wall of the aorta ( this can explain the dilation of the aortic base), and in the lens fibers that maintain its stability and prevent the dislocation of the lens.

Marfan Syndrome

Marfan Syndrome

Signs and symptoms

Usually, Marfan syndrome shows few signs and symptoms such as difficulty in walking or in coordination, poor eyesight, chest pain ( in terms of existence of an abnormal aorta). Also, knee or shoulder dislocation can occur in patients with this disease because of the long ligaments.

As the child grows the signs of this syndrome become obvious.

Patients suffering from Marfan syndrome are very tall and reported to the size of the trunk, the limbs are very long. The existence of this syndrome increases the risk of developing problems like scoliosis, kyphosis, deformity of the foot, forming a cavity in the chest and extremely flexible joints.

Symptoms of Marfan Syndrome

Symptoms of Marfan Syndrome

Treatment

The most important thing is to monitor the health of the aorta by professional consult, echocardiography and other techniques to detect cardiovascular changes. If the aorta is dilated it is recommended to be used treatment with drugs which lower the blood pressure. It is also recommended that the patient should avoid sports that involve lifting weights or can overwork the heart. In patients with pathological deviation of the spine may be needed surgery or physiotherapy.

Inheritance of Marfan Syndrome

Inheritance of Marfan Syndrome

Surgery is required in sever cases of scoliosis or kyphosis. This procedure follows the spinal correction with a support rod which is inserted into the spine  during surgery.  It also can be used bone graft to fuse the  spine.A cardiologist surgeon can replace the aortic valve with a graft, when the valve exceeds a certain size (measured by special tests). Without this procedure, the aorta may grow in size and might break, which is extremely dangerous