Hemorrhoids – Treatment Options

Medications can help relieve symptoms associated with hemorrhoids. Ointments which protect the skin like zinc oxide can prevent injury and reduce itching by forming a barrier over the hemorrhoids. Suppositories used for 7 – 10 days soothes irritation and lubricates the anal canal during bowel movements. Some of these products contain chemicals that can harm the anal tissues if they are used for a long period of time.
Ointments containing hydrocortisone 1% have the effect of reducing inflammation and itching. These products should not be used more than 2 weeks as they can cause atrophy (thinning) of the skin. If  inflammation, thrombosis and irritation  occurs treatment that is generally recommended is local application of ointments containing anti-inflammatory substances, painkillers or anesthetic substance, suppositories with similar content, and in cases associated with constipation laxatives.

Minimally invasive surgery techniques

• Ligation with elastic bands. This process consists of applying a rubber band to the hemorrhoid. Circulation is interrupted and hemorrhoidal mucosa will necrosis (dies). Hemorrhoid is drawn into a tube, then strangled with a lever at the base to be mounted two rubber rings, so that the hemorrhoid dries, because it is not irrigated with blood anymore. After 7-10 days the hemorrhoid falls, leaving a small wound that scars quickly. This procedure is repeated every 2-3 weeks for the other hemorrhoids. This procedure requires no anesthesia.
• Sclerotherapy. In this procedure the doctor injects a chemical solution inside hemorrhoids. This method is useful only for small hemorrhoids and is less effective than ligation with elastic bands. The results are often short-lived and require repeated treatment.
• Laser photocoagulation. Clots the hemorrhoids and transforms them into fibrous scars. The method is very effective in small hemorrhoids but scar tissue can lead to stenosis or contrary to anal incontinence.
• Infrared coagulation. This technique uses a probe that emits infrared radiation and thus produces heat. The probe is applied to the hemorrhoid causing clotting and scar tissue transformation. The method is used alone or in combination with ligation with elastic bands and is considered more effective than laser therapy for treatment of hemorrhoids.
• Bipolar coagulation. Electrotherapy bipolar coagulation has a direct effect on the mucous membrane near the hemorrhoid. Bipolar probes are used to treat internal hemorrhoids that bleed.
• Galvanic current therapy. Galvanic current therapy is defined as hemorrhoids dissolution (destruction) by chemical means and electrical power supplies using a chemical reaction on the hemorrhoidal mass. The procedure takes around 10 minutes. Galvanic current, completely painless, is applied directly into veins: the current, positive or negative, causes a thermal or a chemical reaction in the tissues, which either destroys or obliterates the hemorrhoidal mass. It is a simple and safe procedure and requires no anesthesia or hospitalization, no sequelae, and does not cause severe complications.
• Cryotherapy (extreme freezing). A cryogenic device uses liquid nitrogen to freeze the hemorrhoid. This causes the affected tissue to die, so new tissue can grow in place. This technique has an increased effect when used to treat external hemorrhoids.
• Hemorrhoidal artery ligation of branches of internal hemorrhoidal artery with hemorrhoids atrophy as consequence.

Hemorrhoids

Surgery

• Hemorrhoidectomy. Hemorrhoidectomy is surgical resection of hemorrhoids. Hemorrhoidectomy is indicated in case of complications of hemorrhoids like (bleeding, pain, formation of a clot, inflammation of the anus) or while other treatments (sclerosis, cryotherapy, ligation) failed. It is performed under general anesthesia or spinal anesthesia. Hemorrhoidectomy may be performed as a day procedure, but due to inadequate outpatient care and increased levels of pain after this procedure hospitalization is often required (3 days). Hemorrhoidectomy is the most effective and complete way to remove hemorrhoids, but is associated with the highest complication rate (ano-rectal region pain, temporary difficulty in emptying the bladder, urinary tract infections, etc.).
• Hemorrhoidopexy. This procedure aims to reduce blood flow to hemorrhoidal tissue. Patients have less pain compared to those who experienced conventional techniques. Patients can return quickly to normal activities. Hemoroidopexia was associated with a higher risk of recurrence of hemorrhoids and rectal prolapse.

Hemorrhoids Treatment

Alternative Medicine Remedies

Treatment refers to external applications and internal administration of herbal preparations. External applications are antiseptic, soothing, healing and hemostatic.

• Oak Bark – 100 g bark is boiled in a liter of water, then filtered. Repeated compresses are applied.
• Yarrow, with hemostatic and healing properties, acts favorably in external applications: sitz baths, decoction compresses prepared from blossoms 60 g per liter water. Plant use was recommended even by Hippocrates, in the case of bleeding hemorrhoids.
• Horsetail – has a haemostatic role. It is used externally in the form of  prolonged decoction on compresses, prepared from 100 g per liter of plant.
• Elder leaves – are known as external topical. Leaf decoction of 100 g per liter water is applied on compresses.
• Vine leaves – due to their astringent properties, can be used externally in poultices.
• Blueberries are used as decoction obtained from a handful of blueberries, which are boiled in a liter of water until the quantity reduces to half. Applied externally in the form of washes and compresses. For daily hygiene alternating sitz baths with chamomile and marigold infusion.
• Boil 1kg of fresh cabbage about 30 minutes in 2-3 liters of water. The juice obtained is used for warm sitz baths daily. You can also use leeks, kept in the refrigerator and warmed before use or can be used interchangeably. After a bath of about 30 minutes, allow to dry (do not wipe), the painful place is smeared with marigold  cream . Treatment takes about a month.
• Mandrake-plant decoction should be boiled 1 / 2 hours. Wash the affected area for about 15 minutes in this decoction. These baths will be made every night.
• Walnut blooms in April and has female flowers – the actual nuts – and male flowers – some green bows filled with yellow pollen, which fertilizes the nuts after they fall and become dry black. You can collect on the floor and keep for 2-3 years. Treatment: in 2-3 liters of boiling water put a handful (about 20gr) of walnut bows, and cover, stop the fire. When the infusion cools enough, tested with the elbow, sitz baths are made until the infusion cools. You can reheat and use again. There will be 10 such baths in 10 consecutive nights. The patient must stay away from pepper, paprika and other spicy condiments and maintain strict hygiene.

Hemorrhoids – Causes, Risk Factors, Symptoms, Complications And Diagnosis

Hemorrhoids are varicose dilatations of the veins located in the wall of the anus and rectum. Veins of the anus and rectum have protective role, to help a perfect closure of the rectum. When exercising pressure on them, these vessels begin to dilate. Hemorrhoids are very common both in men and women, about half of people aged over 50 have hemorrhoids.

Types

Rectal veins in submucosa form a rich network, known as hemorrhoidal plexus. The hemorrhoidal plexus is divided into two parts: internal and external hemorrhoids hence the hemorrhoids division into two types:

1. Internal Hemorrhoids. Internal hemorrhoids are hemorrhoids that are inside the rectum above the anus. Internal hemorrhoids can not be seen with the naked eye and are covered with digestive lining that is not sensitive, so there is no pain.
2. External hemorrhoids. External hemorrhoids are formed under the skin of the anus. External hemorrhoids may be feelt (appearing as a small prominence under the skin of the anus) and pain is present due to the distension of the skin that is rich in sensory nerves.

Hemorrhoids Doctor

Causes

Hemorrhoids occur when pressure increases in the veins around the anus and rectum. Factors that increase pressure in the hemorrhoidal plexus include:

• Gastrointestinal disorders (chronic constipation, diarrhea, etc.). Increased effort during defecation is considered the most common cause of hemorrhoids. This occurs frequently in patients with chronic constipation. Long periods of time spent on the toilet causes increased pressure in the veins of the rectal canal.
• Pregnancy and childbirth. Both pressure fetus in the abdomen and hormonal changes leads to enlargement of hemorrhoidal vessels. These vessels are subject to severe pressure during childbirth. For most women, hemorrhoids that occur after pregnancy are a temporary problem.
• Lifting heavy objects can cause increases in pressure in the hemorrhoidal plexus similar to those caused by constipation. Lifting weights is known as a hemorrhoids aggravating factor and is often associated with their formation.
• Poor diet, especially rich in meat and nourishing food without eating fruits and vegetables or foods that contain fiber (bran, yogurt, vegetables, etc.). The role of fiber is to stretch the gut (if you drink enough fluids) and to boost the volume bowel movements (peristalsis), easing digestion and maintaining normal activity of intestinal cells, favoring the absorption of nutrients and thus preventing constipation. Diets rich in spices favors hemorrhoids.
• Liver disease. Cirrhosis increases the pressure in the portal circulation whose expression is symptomatic hemorrhoids.
• Pelvic tumors, genital or rectal can compress the hemorrhoidal plexus drainage ways, and sometimes rectal wall itself.
• Extended sitting or standing
• Obesity
• Chronic Cough
• Chronic heart failure cause venous stasis in the lower hollow system.
• Excessive use of laxatives or enemas
• Excess alcohol, coffee, chocolate, caffeinated beverages consumption,
• Tobacco
• Anal sex

Patients who have family members with hemorrhoids are more likely to develop hemorrhoids. In hemorrhoids there is a hereditary predisposition related to a lower quality of collagen, which leads to impaired venous walls.

Hemorrhoids

Symptoms

Hemorrhoids symptoms include:

• Anal bleeding with “fresh blood”, bright red, in small quantities discovered in the stool, or on the toilet paper.
• Itching or irritation in the anal region
• Pain or discomfort in the anal region
• Swelling around the anus
• Elimination of mucus in the stool
• The appearance of stains on underwear due to mucous secretions.

External hemorrhoids may remain without symptoms: they do not bleed, are not painful and do not prevent defecation. They are seen during inspection as painless growths of soft consistency that from around the anus. Hemorrhoids are getting worse when coughing or during defecation effort.
The dominating symptom of internal hemorrhoids is bleeding, mucous discharge, pruritus (itching) and pain. Small quantities of blood losses, but repeated ,characteristic to hemorrhoids can produce anemia (the patient is pale and accuses tiredness). Due to continuous flow of these secretions and anal region irritation pruritus occurs (itching). Typically, patients with hemorrhoids do not cause pain, but the patient is complaining about the feeling of weight and incomplete evacuation after defecation. The occurrence of pain in patients with hemorrhoids in the anal region is associated with complications, especially inflammatory complications

Complications

• Anal fissure  (a tear in the mucous lining of the lower rectum that causes pain and bleeding during important bowel movements .
• Anal abscess (a collection of pus in the perianal region and also a medical emergency)
• Perianal fistula is a communication between the anal canal and perianal skin.
• Prolapsing, (internal hemorrhoids that reach the outside, followed by their swelling and difficult transition back, causing discomfort and pain)
• Thrombosis and inflammation. Hemorrhoid formation becomes painful and defecation is painful. Hemorrhoids appear as shiny purplish growths, turgid, very sensitive to touch. After 3-4 days, symptoms are relieved by breaking a small thrombosed nodule with bleeding  and elimination of thrombus.
• Strangulation of internal hemorrhoids

Hemorrhoids

Diagnosis

The diagnosis of hemorrhoids is established after carrying the patient medical history and physical examination. The patient is generally asked about bowel habits, including frequency and any recent changes, and certain symptoms such as pain, bleeding or itching in the anal region. Physical examination usually involves a digital rectal examination. For digital rectal examination the doctor will use disposable non-sterile surgical gloves, the index will be lubricated so that the maneuver will be as little annoying as possible. During the digital rectal examination  doctor feels the hemorrhoids and highlights laxity (slip lining).

Anuscopia
This examination means using a instrument as a short thin tube equipped with lighting to analyze the anal canal (the last centimeters).

Rectoscopy
Rectoscopy is an exam that allows visual exploration of the rectum wall. A Rectoscope involves inserting through the anus into the rectum a rigid endoscope called rectoscope (a tube with a length of 25 centimeters and 1.5 centimeters in diameter, equipped with an optical system). Biopsies are possible (removal of rectal tissue). Rectoscopy is useful to diagnose internal hemorrhoids.

Hemorrhoids Sigmoidoscopy

Sigmoidoscopy
This allows the doctor to observe a third area located in the lower colon (sigmoid colon). This exam is done using a thin tube, flexible, with a small camera is inserted all the way easily into the rectum and then moved easily through the intestine. During a sigmoidoscopy  samples can be harvested (biopsy) for examination under a micorscope.

Other diagnostic tests, including blood tests and analysis of faeces can be used to exclude other possible causes of symptoms.

Chlamydiosis – Treatment, Prevention And Complications

Chlamydia infection can be cured with antibiotics. This disease does not cause long term damage if treated in time, before complications occur. Left untreated, it can cause multiple complications.

Treatment is recommended for:

• Persons who tested positive for Chlamydia
• Sexual partners from the last 60 days of infected people, even if asymptomatic
• Newborn babies whose mothers were infected at birth.

It is very important to avoid sexual intercourse for 7 days after chalmydia treatment . If the sexual partner is not treated simultaneously, reinfection occurs. Chalmydia treatment should be encouraged for both sexual partners. Condoms are recommended to lower the chances reinfection. Some people who have chlamydia may also have, gonorrhea. In these cases, treatment includes antibiotics that can cure both gonorrhea and chlamydia. Reinfection is very possible. Chamydiosis symptoms that continue after treatment are likely caused by reinfection rather than an ineffective treatment. To prevent reinfection, sexual partners should be evaluated and treated, if necessary.

Repeated chamydia infections increase the risk for sexually inflammatory disease. Even one infection can lead to sexual inflammatory disease if not treated properly. Medical prescriptions of antibiotics recommended by your doctor must be respected. Treatment should be carried out completely, even if symptoms improve after a few days. Retesting is recommended 3-4 months after treatment to reduce the risk of complications and reinfection.

Chlamydiosis

Chalmydiosis Home Treatment

There is no treatment that can be done at home without consulting your doctor. Antibiotics must be administered exactly according to prescription. Only this way the infection can be cured. The discovery of a chlamydia infection can cause negative feelings about about a sexual partner like shame or anger towards the person who spread the infection, psychological counseling is recommended in these cases.

Antibiotics administered according to the prescription will cure chlamydia.
If antibiotics are not administered properly, the infection will not be eradicated. Prompt treatment is mandatory to prevent transmission of infection and to reduce the risk of complications such as pelvic inflammatory disease. Unprotected sexual intercourse should be avoided until the infected person or sexual partner have completely finished the treatment.

• Azithromycin
• Amoxicillin
• Doxycycline
• Erythromycin
• Ofloxacin
• Levofloxacin

All these antibiotics may be prescribed to men and women who are not pregnant. Pregnant women can take only the following antibiotics:

• Erythromycin
• Amoxicillin
• Azithromycin

Infants should only be administered erythromycin.

Recommended treatment regimens

There are several effective treatment regimens:

1. Azithromycin 1g orally – one dose
2. Doxycycline 100 mg orally 2 times a day – 7 days
3. Erythromycin 500 mg orally 4 times a day – 7 days
4. Ofloxacin 300 mg orally 2 times a day- 7 days
5. Lefloxacin 500 mg per os – 7 days

Azithromycin and doxycycline are both effective in treating chlamydia infection. Some people can not take some of these drugs, but alternative schemes exist. HIV infected persons also receive the same treatment and those uninfected.

Recommended regimens for pregnant women

1. Erythromycin 500 mg orally 4 times a day – 7 days
2. Amoxicillin 500 mg orally 3 times a day – 7 days

Both erythromycin and amoxicillin can be used for treating infected pregnant women, although some may have few side effects to amoxicillin.

The following treatment schemes can be used:

• Erythromycin 250 mg orally 4 times per day – 14 days
• Azithromycin 1 g orally – one dose

Retesting is recommended 3 weeks after treatment. This is done to prevent complications unhealed infections.

Chlamydiosis Antibioti

Adverse Effects

The most common side effects of these drugs are nausea and vomiting. Azithromycin administered after meals reduces nausea.
Doxycycline has fewer cases of nausea and vomiting but can cause fungal infections. If the adverse effects that occur can not be controlled, a doctor must be consulted and antibiotics with fewer side effects will be prescribed.

A recent study shows that people taking large erythromycin doses concomitantly with other drugs have a increased risk for sudden death. The study demonstrates that administration of erythromycin concomitantly with drugs that inhibit liver enzymes such as calcium channel blockers, antifungal drugs, some antidepressants,  increase the risk for sudden death therefore it is recommended  these drugs are taken separately.

To be effective, antibiotics must be administered under medical prescription. If the treatment is interupted or certain doses are forgotten, the infection will not be eradicated. The advantage of azithromycin is that it can be administered in a single dose. Because it is easy to administer, this drug reduces the risk of chlamydia infection transmission.

Patients should avoid sexual contact during treatment. Patients who are taking a single dose of azithromycin should not have any sexual contact for 7 days after taking the tablet. Retesting is recommended 3-4 months after the end of treatment to reduce the risk of complications and the reinfection risk. Medical consultation is recommended if the symptoms continue or other symptoms appear 3-4 weeks after treatment. Women with pelvic inflammatory disease or men with epididymitis may require intravenous treatment in a hospital.

Left untreated, chalmydia infections can cause complications including abscesses that may require surgical drainage or excision of the abscess.

Prevention

Risk of infection with chlamydia or other sexually transmitted diseases can be reduced. Prevention of sexually transmitted diseases is much easier than treating them.

• Talk to your sexual partners about STDs before beginning  sexual intercourse with them. You must know if they are at risk for such diseases. Remember that you can be infected with a sexually transmitted agent without knowing. HIV, for example is positive to testing three to six months after the initial infection.
• Avoid sexual contact with a partner who has symptoms or was recently treated for a sexually transmitted disease.
• Avoid sexual contact if you have symptoms or you have been treated for a sexually transmitted disease.
• Do not have sexual contact with more partners at once, the risk for STDs if you have multiple sexual partners increases.
• Use condoms, as condom reduces the risk for STDs. The condom should be applied before starting intercourse.
• Use a condom during intercourse with a new partner, before being sure that no such disease.

Chlamydiosis Prevention

Complications
Chlamydiosis left untreated can cause a variety of complications. Complications in women include:

• Cervicitis (inflammation of the cervix)
• Urethritis (inflammation of the urethra)
• Endometritis (inflammation of the uterus)
• Inflammation of glands
• Pelvic inflammatory disease (inflammation of the uterus, fallopian tubes or ovaries)
• Pelvic abscess
• Infertility
• Fitz-Hugh-Curtis syndrome (a rare inflammatory liver disease).

Complications in pregnant women include:

• Ectopic pregnancy (outside the uterus)
• Abortion
• Premature birth
• Premature rupture of membranes.

Complications in newborns include:

• Premature birth – with an increased risk for other health problems
• Conjunctivitis – inflammation of the eyelids and eye area, approximately 50% of infected infants develop conjunctivitis
• The nose and throat infections
• Otitis media (ear infection)
• Urethritis (although rare in infants).

Complications in men include:

• Urethritis
• Epididymitis (inflammation of the tubules that carry sperm)
• Prostatitis (inflammation of the prostate ,gland that secretes the bulk of seminal fluid)
• Infertility.

Other complications that can occur in all untreated infected individuals include:

• Conjunctivitis
• Proctitis (inflammation of the membrane lining of the rectum)
• Various symptoms such as joint or eye inflammation, caused by bacterial infection (Reiter’s syndrome)
• Inflammation in the genital area, headache (headache), fever, fatigue and swollen groin lymph nodes.

Additional resources

1. The Essential Guide to Cure Chlamydia – The secret to healing virtually every step of Chlamydia By Doctor Patric James

Escherichia Coli (E. Coli) Infection – Treatment And Prevention

Correct treatment of infections with E. coli involves different antibiotics that can kill the bacteria because sensitivity to antibiotics of many strains of E. coli varies greatly. Treatment should be aimed at the causative agent itself, the bacteria, and any complications caused by diarrhea (dehydration, for example).

If the patient will develop renal or hematologic complications (kidney failure or anemia), the treatment may include:

• Carefully adjusted fluid intake and essential minerals, so that the patients does not develop fluid and electrolyte imbalances
• Dialysis: the procedure that eliminates toxic byproducts from the blood. Dialysis is a therapeutic mean used in some patients with renal failure due to bacterial infections
• Blood transfusion, to balance anemia.

E Coli

Antibiotics and resistance to treatment

Lately species of E. coli became resistant to treatment. In addition, their particular structure makes them resistant to antibiotics that can kill Gram-positive bacteria. In such circumstances, the choice of treatment can be quite difficult, and the number of available and effective antibiotics is reduced.

Currently E. coli is not resistant to:

• Amoxicillin
• Cephalosporins
• Carbapenems
• Aminoglycosides.

Resistance to treatment is an issue of great importance. This is due to excessive administration and often without a solid base of antibiotic treatment. Thus, the bacteria came into contact with drugs and have developed mechanisms that make it resistant. These mechanisms are then transmitted to future generations because they are included in the genetic code of the bacteria. In addition, some bacteria have what is called “cross-resistance” are not only resistant to the antibiotic that came in last in contact, but also to similar antibiotics in terms of chemical structure.

Patients are not advised to administer antibiotics on their own. Often, bacterial strains that cause diarrhea are not very aggressive, and the illness resolves in 5 to 10 days. Through measures that avoid complications such as dehydration, the patient can be maintained in the best possible condition but if the diarrhea is mixed with blood, the patient has intense abdominal cramps, and his health significantly degrades day by day, antibiotic treatment is recommended. This is done according to the sensitivity, the nature of microbiological investigation from which the effective antibiotics are determined.

Drugs to avoid

The infection evolution can be worsen by taking certain drugs that may do more harm than good:

• Antidiarrheal durgs: in some cases diarrhea caused by E. coli is caused by bacteria toxins that are eliminated through the stools. If you stop or slow the intestinal transit, tou favor the accumulation of these toxins with adverse effects on the entire body. As more toxins remain in the intestine, the more time the body has more to absorb them, complications occurring much faster and more serious.
• Loperamide: a antidiarrheal durg that works by reducing the longitudinal intestinal muscle tone, increaseing the circular muscle tone but eventually it increases the time food spends in the intesine and allowing absorbtion of water and other substances.
• Product containing salicylates, bismuth: ibuprofen, aspirin and other NSAIDs because these drugs can promote gastrointestinal bleeding.
  Such drugs should not be given to patients with diarrhea caused by E. coli .

If there is a unconfirmed suspicion of infection with E. coli, until the beginning of treatment the following should be also avoided:

• Difenoxid hydrochloride with atropine sulfate
• Imodium hydrochloride.

E Coli Treatment

Home Treatment

Recommendations for home treatment mainly refers to measures that can increase the patient’s personal comfort and prevent infection of others. If there is a relative infected you must try to protect yourself from contacting the infection. If you have diarrhea that lasts more than 48 hours it would be best to address a doctor to avoid complications such as dehydration.

Management of diarrhea with antidiarrheal durgs available in pharmacies (which may be issued without a prescription) is prohibited, as some can do more harm than well. In certain situations, when diarrhea is toxic, drugs that reduce the removal of toxins from the body situation which can complicate the disease, sometimes leading to fatal consequences.

E Coli

During home treatment of diarrhea induced by infection with E. coli experts recommend:

• Do not manage diarrhea without the aid of a doctor , especially if you have bloody diarrhea or watery diarrhea but persistent in time
• Try to drink from time to time throughout the day, rehydration is very important. This can replace some of the ions lost in diarrheal stools.
• Rehydration is especially important as the diarrhea is accompanied by vomiting. Because dehydration can develop rapidly in infants and has serious consequences, they should immediately be submitted to a receiving emergency department to be rehydrated and treated appropriately. For adults, it is recommended to use small volumes of liquid because the stomach can not cope with larger volumes.

Patients are advised to pay great attention to early signs of dehydration such as:

• Dry mucous membranes
• Reducied tears volume
• Reduced diuresis (rare urination, small volume of urine, altered appearance – brown color);
• Feeling dizzy, faintness

Status of patients at extreme ages (young children or people over 65) can degrade very quickly. In such situations, alarm symptoms should be checked and whose presence must be immediately investigated such as: elevated fever, weakness, generalized pallor, reduced urine output. They can signal the occurrence of renal or hematologic complications.

E Coli Dehydration

How to protect ourselves from possible infection

In order to avoid infection with E. coli from contaminated food or water

1. Tips for food preparation. Meat, especially beef, should be cooked at temperatures of at least 70 degrees. For guidance, meat should be cooked until it loses its reddish color (but good minutes after that). The best thing would be if you can check the temperature with a thermometer for meat (specially designed for these purposes, which is found in appliances districts). You can make an incision in the the middle to ensure it is well cooked. Meat juice that is left on the plate should be white or yellow at most, never red or pink. Due to the infection possibility, not only bacterial but parasitic also, not cooked enough meat (bloody) is not recommended for consumption.
2. When you get ready to cook.  Wash hands thoroughly with soap and water, especially if  you handled raw meat. The tools that you use (knives, caps chopped, grinders, pans, pots) must also be washed before and after will be used. Do not plance the cooked meat on a plate where raw meat was, if this plate was not washed and dried. Meat should be cut on a separate cover, and vegetables on another, to reduce the risk of contamination. In the refrigerator, it is best to keep meat, seafood and fish separate from fruits and vegetables
3. Drink only pasteurized milk and juices
4. Drink only properly chlorinated water from trusted sources
5. Do not drink water from sources that are not sure. Such advice is useful if  you travel in underdeveloped countries where water is rare and treatment systems are unapropiate. All water that is consumed in these countries must be boiled or bottled \. Fruits and vegetables should be avoided (even if you wash with water). You can consume fruits only if they peel.

How to avoid direct transmission of E. coli infection

• Wash your hands with soap and water, especially after using the toilet or changing baby diapers (when you came in contact with E. coli from faeces). If you have more toilets at home and a family member wasdiagnosed with E. coli infection, the safest would be to that the infected person uses one toilet so as the spread of infection is avoided.
• If the infection was diagnosed in an infant, you should only use disposable diapers, you throw them away immediately after changing them
• Adults must be careful that children with diarrhea wash their hands properly after each stool. They should avoid the use of shared towels, not go to the pool, until the disease is cured, avoid nurseries, kindergartens or schools and places where the children can come into contact with other children
• Sink taps and toilets must be cleaned regularly with antibacterial substances
• Patients who were diagnosed with E. coli infection should not handle food, meat, do not work in nurseries or other care institutions until they heal (and tests indicate that not eliminate the bacteria);
• Water properly chlorinated swimming pool was planned, and tubs should be cleaned with antibacterial substances.

Turner Syndrome Causes, Symptoms And Karyotypes

Turner syndrome is defined by the presence of a single X chromosome (sex chromosome disease, and not an autosomal disease like Down syndrome), complete or partial monosomy which is present in all cells or only in a certain proportion and associates phenotypic aspects such as nanism, defects in development of ovaries and various visceral malformations. Karyotype of this syndrome is 45x. It was noted that 15 of 1000 fetuses from recognized pregnancies are with Turner syndrome, but 99% of them are ending in miscarriage in the first trimester of pregnancy. Sexual chromatin and chromosome analysis indicate that about 1 in 2500-3000 female newborns have a 45x karyotype, so they are diagnosed with Turner syndrome.

Turner Syndrome

It is estimated that the incidence of Turner syndrome, reported to all products of conception is 1% – 1.5%, Turner syndrome is one of the most common chromosomal abnormalities.

Turner Syndrome Causes

The cause for which, the majority of fetuses (95% – 99%) who are showing monosomy X, are aborted  it is not known.

It concludes that monosomy X, would be lethal and that for survival would be required some degree of mosaicism. Moreover, 50% of patients with Turner syndrome, present a mosaic karyotype or structural aberrations of the second X chromosome.

It was found that 70% of cases with Turner syndrome appear as a non-mitotic disjunction with a preferential loss of the paternal X chromosome. It is estimated that half of patients with Turner syndrome present mosaics with one of the cell lines, which is having a 45X karyotype. Other cell lines may contain two X chromosomes, three X chromosomes, very rarely XY chromosomes, or may contain structural abnormalities of chromosome X or Y. Structural abnormalities of the X chromosome, occurring in 30% of cases of Turner syndrome are often of paternal origin and in this situation, paternal age can be considered a risk factor.

Turner Syndrome Symptoms

The clinical presentation Of Turner Syndrome (signs and symptoms)

Turner syndrome presents a clinical picture, in which the existence of certain abnormalities is leading to the recognition and diagnosis of the syndrome at birth. Phenotype becomes evident with puberty, when appear gonadal dysgenesis which amplify the clinical dysfunction.

At birth, some signs may be considered pathognomonic for Turner syndrome: lymphedema of the dorasl part of the hands and feet, short neck, dysplastic and low implanted ears, light ptosis, hypoplastic mandible, dystrophic nails and pterigium coli (webbed neck).

Since puberty, patients with Turner syndrome have short stature (150 cm in 90% of cases), which also stands in childhood (short stature after age 2-5 years), gonadal dysgenesis (fibrosis of gonads with follicles degenerate ) and absence of the installation of  secondary female sexual characteristics: primary amenorrhea, mammary glands are not developt, axillary and pubic hair growth are underrepresented and infertility. It is also noted low implantation of hair, cardiovascular abnormalities of which coarctation of the aorta is the common.

Patients with Turner syndrome, often develop ear infections that can lead to deafness, also develop hypothyroidism or hyperthyroidism.

Intelligence is usually average or below average (IQ = 70-120). In patients with Turner syndrome, speech is not affected, but there is a motor deficit.

Described Karyotypes In Turner Syndrome

Turner syndrome is distinguished from other sex chromosome abnormalities, in particular from Klinefelter syndrome, by a variety of karyotype.

Besides the numerical abnormalities in Turner syndrome are structural abnormalities of one of the two X chromosomes, homogeneous or mosaic, all fitting as Turner syndrome cytogenetic varieties.

Turner syndrome cytogenetic variants and their frequency is the following::

• 45x in 53% of cases of Turner syndrome;
• Mosaicism 45x / 46XX in 15% of cases of Turner syndrome;
• X isochromosome,  46X,i(Xq) in 10% of cases of Turner syndrome;
• Mozacism 46X,i (Xq) / 46XX in 8% of cases of Turner syndrome;
• Deletions 46XXp- or 46XXq- in 6% of cases of Turner syndrome;
• Other mosaicism in 8% of cases of Turner syndrome.

Turner Syndrome Kariotypes

Tests Used For diagnosis of Turner Syndrome

• Standrad Karyotype of peripheral blood;
• Molecular biology tests, because in 5% – 10% of cases of Turner syndrome there is an XY cell clone that can not be detected by classical cytogenetics. Such cases have an increased risk to develop gonadoblastoma and require a removal of gonadal rudiments.

The medical management of Turner syndrome:

Biosynthesised growth hormone is administered at early ages to improve the stature with 10 cm. Administration of appropriate hormonal therapy may induce the installation of menstruation. Treatment with estrogen and progesterone ensure a harmonious development, puberty and a normal sex life. This treatment prevents osteoporosis and reduces cardiovascular risks of Turner syndrome. Establishment of early therapy, allows the state of pregnancy through in vitro fertilization and birth.

Turner Syndrome

Prenatal diagnosis of Turner syndrome:

Prenatal diagnosis in Turner syndrome is on the specific ultrasound signs, such as the vizualization of cystic higroma in first or second pregnancy trimester, fetal edema and highlighting the small size of the fetus. Is practice amniocentesis for fetal karyotype analysis.

Chlamydiosis – Causes, Risk Factors, Symptoms And Diagnosis

Chlamydiosis is a bacterial infection with Chlamydia, infectious agent that is transmitted through sexual contact. It is one of the most common STDs worldwide. Chlamydia infects the urethra in men, the cervical canal and superior reproductive organs in women. Chlamydia can also infect the rectum, eyelids and ocular surface. An infected mother can transmit the infection to her baby during birth. Between 50 and 70% of children born by infected mothers are infected at birth. They acquire the infection on the eye, rectum, vagina and the posterior wall of the neck. Between 30 and 40% of these infected infants develop complications such as conjunctivitis or pneumonia. Chlamydia infection increases the risk of infection with human immunodeficiency virus (HIV)

Chalmydiosis Couple

Causes

Chlamydiosis is an infection caused by a bacterium called Chlamydia trachomatis. It is transmitted by vaginal, anal or oral sex with an infected partner. A pregnant woman can pass the infection to the newborn. Infection can be present even in the absence of symptoms but it can be transmitted until it is treated.

Risk Factors

Risk factors for chlamydial infection include:

• Unprotected sex without condom
• More than one sexual partner
• One or more partners with increased risk. These includes those who have more than one sexual partner infected with Chlamydia.
• Age at the onset of sex life below 18
• A weakened immune system.

Any child with chlamydiosis require specialist consultation to determine its cause and to investigate a possible sexual abuse.

Chlamydiosis Transmission

Symptoms

Up to 90% of women and men with chlamydiosis do not show any symptoms. The time between infection and onset of symptoms, called the incubation period can range from days to months. Symptoms usually begin 1-3 weeks after the sexual contact.

Symptoms in women include:

• Dysuria (burning or pain when urinating)
• Cloudy urine
• Abnormal vaginal loss
• Abnormal vaginal bleeding between menstrual periods
• Genital pruritus (itching)
• Dysmenorrhea (irregular menstrual bleeding)
• Lower abdominal pain
• Fever and fatigu
•  Swollen glands (glands at the vaginal opening)
• Conjunctivitis.

Symptoms in men include:

• Painful or unpleasant sensation during urination (often the first symptom)
• Cloudy urine
• Watery or sticky discharge from the penis
• Scabs on penis
• Sensitivity of the anus or scrotum
• Conjunctivitis.

Chlamydia does not cause long term damage if treated before complications occur. Left untreated, chlamydiosis can cause multiple complications  especially in women. If a woman was infected at birth, the infant may also be infected. A  treated chlamydiosis does not provide protection from new reinfection. A new exposure will cause a reinfection, even if the previous infection was treated and cured.

Specialist Consult

Urgent medical consult is required if you notice one or more of the following symptoms:

In women:

• Sudden severe pain in the lower abdomen
• Lower abdominal pain associated with vaginal bleeding or vaginal discharge and fever of 37.8 C or more
• Dysuria (burning on urination), frequent urination, or inability to urinate, and fever of 37.8 C or more.

In men:

• Secretions from the penis and fever of 37.8 C or more
• Dysuria (burning on urination), frequent urination, or inability to urinate, and fever of 37.8 C or more
• Pain, swelling or tenderness of the scrotum and fever of 37.8 C or more.

Talk to your doctor in case of the following symptoms:

In women:

• Yellow vaginal discharge , viscous and foul-smelling
• Intermenstrual bleedings occurring more than once (if your cycles are regular)
• Pain during intercourse
• Bleeding after intercourse or shower
• Bumps, lumps, itching or blisters around the genital or anal area
• Burning, pain or itching when urinating or increased urinary frequency that lasts longer than 24 hours
• Lower abdominal pain without obvious cause, such as diarrhea or menstrual cramps.

Medical specialists recommended that can diagnose chlamydiosis include:

• GPs
• Medical interns
• Gynecologists
• Dermatologists.

Diagnosis

Diagnosis and treatment of chlamydiosis us inexpensive and  is available at the family doctor office usually. Some people are uncomfortable to consult a GP for a sexually transmitted disease. Most developed countries have specialized clinics or hospitals for diagnosis and treatment and keeping confidential the Chlamydia infection. However, it is good that your family knows about this disease.

Chlamydia infection is diagnosed through a medical history, physical examination and some tests. During the conduct of medical history, your doctor will ask the following questions:

1. Do you think you were exposed to a sexually transmitted disease? How do you know? Did you inform your partner regarding this matter?
2. What are your symptoms?
3. You have an abnormal discharge? if so, what is its color and smell?
4. Did you find any swelling around the genitals or in any other area?
5. Do you have urinary symptoms, including frequent urination, burning or stinging when urinating or do you urinate in small amounts?
6. Do you have pelvic pain or cramps during intercourse?
7. What method of contraception you use? Do you use a condom to protect yourself from sexually transmitted diseases?
8. Do you have had any history of sexually transmitted diseases?  Were you treated?

After the medical history

• A gynecological exam for women
• A urological examination (for urethritis or epididymitis) for men
• A urine test for chlamydia if there is no reason for gynecological or urological examinations to be made.

There are several types of tests that can be done to diagnose a chlamydiosis. Test results are usually available in 2-3 days, except for culture media that require 5 to 7 days. Other infections can be associated with Chlamydiosis. Testing is recommended for:

• Gonorrhea
• Syphilis
• HIV
• Bacterial vaginosis, a condition caused by the presence of bacteria that normally are not present in the vagina

Annual screening of all adolescents and women up to age 25 years is recommended. Women over 25 who have risky sexual behavior should also be monitored annually. Even a urine test for chlamydia if a complete genital or pelvic exam is not accessible. Pregnant women testing with risky  sexual behavior, so that the infection is not transmitted to infants. All pregnant women should be monitored during the first trimester. If a pregnant woman is at risk for chlamydia infection she should be retested in the third quarter. Retesting after 4-6 months of treatment. Women can reinfect from the same partner if the partner is left untreated.

Chlamydiosis

Watchful waiting

Watchful waiting is the period in which the person and the doctor observes the disease and symptoms without any medical treatment. Watchful waiting is not appropriate for Chlamydia infection. This infection does not cause damage if treated long before the occurence of complications. Untreated, can lead to multiple complications. You should avoid sexual contact before consulting a specialist. If known exposure to Chlamydia, treatment of both sexual partners is manitory. The treatment should be done even in the absence of complications. If there wasn’t ay sexual partner in last 60 days, the last sexual partner will be contacted

Escherichia Coli (E. Coli) Infection – Transmission, Symptoms And Diagnosis

Escherichia coli (abbreviated E. coli) is a bacterium that lives in the intestinal tract of man and animals. All individuals have it (starts to populate the intestinal lumen 40 hours after birth) and is part of the commensal flora (bacteria that live in the body of a healthy person but does not cause any disease). Newborn’s body comes in contact with the bacteria through water, foods or hospital staff.

Although most strains of E. coli are not dangerous, there are exceptions, such as serotype O 157: H7, which is incriminated in the occurrence of serious food poisoning, anemia or kidney failure, or strains that may be etiologic agents of diarrhea and bleeding, enterohaemorrhagic E. coli (EHEC). Some strains of E. coli are incriminated in the occurrence of urinary tract infections. The bacteria is a comensal while it does not posses virulence factors (genetic changes). It is believed that this bacterium is transmitted mainly fecal-oral due to poor hygiene.

E. Coli Infection

E. coli is a Gram-negative bacteria , that can not hold a special purple dye inside the cell. This test is very important, because on this basis, bacteria are classified into two groups, depending on the cell wall.  E. coli can live in  aerobic environments (with oxigen) and anaerobic environments (without oxygen) therefore the bacillus is considered to be facultative anaerobic. Some strains of E. coli have increased mobilitity.

E.Coli Transmission

Infecting Strains

Contact with E. coli occurs early in life of the individual, since the first days of life. E. coli can be contracted from outside if you come in contact with biological products that contain faeces. For this reason, the presence of E. coli is an important factor in determining the fecal contamination of soil, water and food.

Food Contamination With E. coli

Food can be contaminated with E. coli during cooking and can cause serious infections in humans if these products are not cooked properly. For example, if you do not cook the meat to at least 70 degrees, bacteria will not be destroyed, and the risk of food poisoning exists. One of the most common forms of infection is consumption of insufficiently cooked meat. In addition, any food that comes in contact with the contaminated meat will be contaminated as well.

Foods that may be contaminated with E. coli

Raw milk or dairy products – can spread bacteria from the cow’s udder in the milk. To avoid consumption of potentially infected milk, pasteurized milk consumption is recommended. During the process of pasteurization the product is brought to high temperatures that can destroy potentially pathogenic flora. Pasteurization does not destroy all microorganisms, but only those that can cause diseases. Fruits and raw vegetables which are not washed properly, and are eaten directly after being purchased, may be contaminated with bacteria. Some fruits and vegetables can also be pasteurized, and if possible, experts recommend this option, including for natural juices. The list of foods that can be pasteurized include: nuts, honey, cheese, eggs, cream, soy sauce, wine, water, vinegar, juices, beer and canned products.

Water contamination with E. coli

Sometimes, in conditions of non-compliance to hygiene measures animal feces get into contact with natural waters like: lakes, rivers, water reservoirs. Sometimes even water pools can be infected by ingestion or aspiration the body comes in contact with potentially pathogenic strains. Major E. coli outbreaks are determined by contamination of larger water reservoirs, in the absence of effective systems of chlorination and disinfection

Direct transmission from person to person of E. coli

E. coli can spread from person to person, especially when basic standards of hygiene are not met, when hands are not washed after going to the toilet. E. coli can contaminate objects, and usually people are not carefu,l and do not wash their hands and thus can get in contact with the skin of another host, thus indirectly transmitting infection.

E.Coli Infection Symptoms

Symptoms of E. coli infection vary significantly depending on the location of infection, host age and immune status at the time (which allows bacteria to multiply in the body). In some cases individuals are only carriers of pathogenic strains and did not develop infection – remain asymptomatic, but can transmit E. Coli to other persons. Clinical stage begins 3-4 days after contracting E. coli. Most patients develop a gastrointestinal infection, because the fecal-oral trasmission is the most common. In this case the infection is manifested by:

• Severe stomach pain, abdominal cramps and spontaneous tenderness to palpation of the abdomen ;
• Diarrhea, watery at first, but may become bloody (depending on the pathogenic strain);
• Nausea and vomiting

Children frequently develop infections with E. coli serotype O157: H7 (E. coli enterohaemorrhagic) compared with adults. This strain is particularly dangerous because it has the ability to stimulate the formation of potentially lethal toxins. Serotype O157: H7 can cause life-threatening complications and can be fatal, especially in small children and elderly persons. The most dangerous complications beeing haemolytic uraemic syndrome and acute renal failure.

In some situations E. coli may end up contaminating the peritoneal cavity due to a perforated ulcer, perforated appendix, or even a failed suregery leading to bacterial peritonitis, which can be fatal without prompt treatment.

The clinical picture of patients with symptomatic infection with E. coli is not specific to this bacteria, there are many conditions that can cause the same spectrum of symptoms. Diagnosis of infection with E. coli can be relatively difficult to establish even to suspect, because bacterial infections that cause diarrhea are accompanied by high fever. In afebrile patients or very low fever, the doctor may overlook the possibility that the symptoms could be of infectious nature.

Symptoms induced by infection with common strains of E. coli occurred in a patient with competent immune system, which may limit the growth of E. Coli, will imporve and even disappear in a week without complication. In such cases, patients recover without receiving special treatment, some even without seeing the doctor for this problem. But if the bacteria is more aggressive, complications can occur, mainly due to fluid and electrolyte imbalances (presence of diarrhea) and acute renal failure. It begins at 2-14 days after infection. If complications arise, the patient’s general condition will worsen and the clinical picture may include:

• Cool, pale skin
• Fever
• Weakness
• Temporo-spatial confusion
• Hematuria
• Hematoma

E Coli Infection

E.coli Infection Diagnosis

Investigation of patients who present to the infirmary complaining of explosive diarrhea with with onset of a few days and impaired general condition, is started with general history and physical examination. Patient history is the baseline of expert advice. Your doctor will find more information about symptoms, risk factors, lifestyle, compliance with basic hygiene measures, personal history and your close relatives (especially family members).

The main questions that the physician may address the patient:

• When the diarrhea started, how long it took and how frequent is it?
• Is there blood, mucus or pus in the stool or is it just watery?
• Have you noticed chills or fever?
• Abdominal cramps, nausea, vomiting?
• Did the general condition change? Did you encounter unusual fatigue, irritability?
• Have you felt dizzy?

The doctor may suspect an infection caused by E. coli if the following risk factors exist:

• The patient came from a care institution, elderly center, day care
• Consumption of inadequately cooked foods, restaurant meals (especially exotic restaurants)
• Semi-raw meat consumption, unpasteurized milk, unpasteurized juices
• Contact with other patients who have recently had diarrhea
• Recent trips in areas with poor hygiene, non-potable water
• Recent administration of antibiotics.

History is followed by general physical examination during which the doctor will:

• Take the patient’s temperature
• Measure blood pressure and pulse
• Inspect skin, skin analysis by creating a consistent skin fold
• Abdomen palpation
• Perform a digital rectal exam to determine precisely whether or not traces of blood exist in the stool.

E Coli Doctor

If an infectious diarrhea is suspected, samples of diarrheal stools, will be analyzed microbiologically. Special stain are made,  and the sample will be placed in different culture mediums to determines the type of bacteria that is responsible for the symptoms. Because it is possible that the bacteria to be removed only during the onset of symptoms, the best option is that the samples are collected quickly. For this reason it is recommended that patients present to the doctor as soon as possible, especially if diarrhea contains traces of blood.

There are other more laborious and expensive methods to diagnose an infection with E. coli (immunoassay methods, immunofluorescent), but in general microbiological analysis provides the correct diagnosis. After the diagnosis of infection with E. coli has been established, some patients will be monitored more closely. These are groups at risk, very young or very elderly patients (extreme ages), those with compromised immune status, and all patients who are infected with highly virulent strains, known for their ability to cause complications. Monitoring involves periodic collection of  urine samples, blood salmples and other tests which show the overall health status.

Diabetes And Weight Loss – The Healthy Way

For people with diabetes, weight loss can mean giving up insulin injections and other medications. Building a good weight loss plan for a person with diabetes is essential. There is no doubt that most people with type 2 diabetes are overweight and  if they lose some pounds, they will have a lower level of blood sugar and a better overall health.

During the diet, blood sugar, insulin levels and drug usage should be monitored closely. Not making mistakes is very important, and the right way should be followed: regardless of a patient’s weight, blood sugar will drop even though the patient will only lose a few pounds. Some studies have shown that a combination of diet and exercise reduces the risk of developing diabetes by 58%. These included people who were overweight with an increased blood sugar level, but not so high in order to diagnose diabetes.

Weight Loss

Weight loss

Weight loss of even a few pounds can lead to:

• Lower blood sugar
• Blood pressure values reduce;
• Improved cholesterol levels;
• Reduced pressure on the hip joints, knees, ankles and the legs.

In addition the patient will notice that he has more energy, is more mobile and can breathe more easily. If a person with diabetes follows a diet, fluctuations and changes in blood glucose should be checked carefully. Giving up a meal can affect the delicate balance of glucose, insulin and medication. It is therefore essential that all patients consult an expert when following a diet. It is best to consult with your doctor before starting the diet, and then seek the help of a nutritionist especially patients who are treated with insulin or oral hypoglycaemic medication.

A Balanced diet is important in patients with diabetes also patients are advised to avoid blood sugar imbalances. A lower energy intake by 500 calories a day is also recommended and cutting calories from all nutritional groups is the safest way to achieve this : proteins, fats and carbohydrates. It is important that patients maintain a good percentage (balance):

•  50-55% carbohydrates
• 30% fat
• 10-15% protein.

Carbohydrates control

Carbohydrates have the greatest effect on blood sugar levels, because they are converted into glucose at the very beginning of digestion. The consumption of complex carbohydrates (blackened cereals and vegetables, for example) is a good thing because they are absorbed more slowly into the bloodstream and reduce the appearance of glycemic peaks. Giving up a part of carbohydrates – a common strategy people who want to lose weight adopt can be dangerous in patients with diabetes.

When the body does not receive the glucose it needs for metabolic processes, metabolic changes occur and lipids are burned (a process called ketosis). The person will feel less hungry and will eat less – but long term fat burning can have adverse effects on the body. Ketosis involves a decrease in oxygen transport to tissues, which  overburdens the eyes, kidneys, heart and liver. This is why a diet low in carbohydrates and high in protein (like Atkins) is not safe (recommended) for persons with diabetes. Diabetics need to maintain a balanced diet so that their body can use nutrients without triggering ketosis.

Diabetes Weight Loss

Problems that can occur with a diet in patients with diabetes

For any individual certain diets can be difficult, but patients with diabetes may find it to be more difficult as they must eat when blood sugar drops. It can be very difficult to reduce calorie intake when the patient must be careful to eat when blood sugar drops and prevent drug over-dosage. Both hyperglycemia and hypoglycemia are two important issues for people with diabetes.

Hypoglycemia (low blood glucose) occurs when the amount of insulin the body is higher than it needs. In early stages, hypoglycemia can cause confusion, dizziness and tremors. In more advanced stages, hypoglycemia can be dangerous and it leads to fainting followed by coma. Hypoglycemia is common among dieters who want to lose weight, because reducing the number of calories affects blood sugar levels. If the patient does not reduce the dose of insulin or oral medication according with the new die, hypoglycemia is very probable.

Hyperglycemia (elevated blood glucose) can occur when the patient uses lower doses of insulin than needed to control blood sugar levels. This occurs when patients with diabetes under insulin or hypoglycaemic medication therpay are not using the proper diet-dose treatment scheme.

The effect of exercise in diabetes

One benefit is that exercise helps maintain good blood sugar levels, so the patient should not cut too many calories during the diet. If the patient walks 20 minutes more per day, a reduction in the number of calories with only 200 or 300 calories each day and can still show good results. This way blood sugar levels can be adjusted. In addition, weight loss occurs gradually . It is important to remember that each type of exercise affects blood glucose levels in different ways.

Aerobic exercise can cause an immediate decrease in blood glucose levels. Weight lifting and exercise for muscle fortifying, may affect blood sugar levels several hours later. This can be a problem, especially in patients that rely on a car. Therefore, patients should check their blood sugar before they climb behind the wheel. It is also a good idea, as a diabetes patient to have snack in your car: fruits, biscuits, juice. It is recommend that patients monitor their blood sugar closely when doing exercise because physical activity leads to the blood,liver and muscles glucose consumption. Over time, if the patient maintains regular exercise, the dosage of hypoglycaemic agents and even doses of insulin will be reduced.

Insulin Therapy

Starting the weight loss plan

Losing weight is never easy. Therefore, a nutritionist can develop a program that is tailored to the patient’s lifestyle, a program with realistic goals. Each patient needs a menu to follow every day, needs to know how to change the doses of insulin and medication based on what he eats and how much exercise he does, as this is the safest way to lose weight when suffering from diabetes.

Interatrial Septal Defect – Diagnosis And Treatment

Interatrial septal defect is an anatomical defect of the interatrial septum that allows a communication between the left atrium  and the right atrium. During intrauterine life, foramen ovale assures the blood flow from the right atrium into the left atrium, because the lungs are deprived of blood circulation.  Lack of closure of foramen ovale, causes the defect known as interatrial septal defect type fossa ovale. Interatrial septal defect incidence is 10% of congenital heart malformative diseases. It is a congenital heart malformation with left-right shunt and increased pulmonary flow.

Baby With Interatrial Septal Defect

Depending on the location of parietal defect, the interatrial septal defect has following types:

1. Foramen ovale interatrial septal defect – persistent foramen ovale give a small defect, which is different from the ostium secundum interatrial septal defect only by smaller sizes,  because is located in the same area were is located ostium secundum interatrial septal defect.
2. Ostium secundum interatrial septal defect – a greater lack of  interatrial septum characterizes this type of defect located in the middle portion of the interatrial wall. Is the most common type, because it represents 70% of all interatrial septal defects. Sometimes it can appear as a membrane with many perforations. Association of  Ostium secundum interatrial septal defect and mitral stenosis is known as Lutembacher syndrome.
3. Interatrial ostium primum septal defect – defect is located in the lower part of interatrial septum associated with atrioventricular valvular defect.
4. Coronary sinus interatrial septal defect – the absence of interatrial wall at the site of drainage of coronary venous sinus.
5. Venous sinus interatrial septal defect – represents a superior location of the defect at the shedding of the superior vena cava. In some cases is associated with partial pulmonary venous drainage.
6. Unique atrium interatrial septal defect – when the interatrial septum is totally absent but the valvular structures (mitral and tricuspid) are normal.

Pathophysiology:

The parietal defect produces a left-right shunt. Due to higher pressure, blood passes from the left atrium into the right atrium, pulmonary circulation load, leading in time to the installation of a pulmonary vascular hypertension. Volume of blood is dependent on the size of the defect, right ventricular compliance and pulmonary vascular resistance. Pulmonary stasis predisposes to recurrent infections. Long evolution of a large interatrial septal defect, can lead to irreversible pulmonary vascular hypertension, with installation of Eisemenger syndrome, characterized by cyanosis and cardiac decompensation, because the shunt is reversed from left-right shunt to a right-left shunt.

Interatrial Septal Defect

Symptoms:

The majority of interatrial septal defects, even those defects wich are signifiant remain asymptomatic hemodynamically and are discovered incidentally during medical examinations or when they become symptomatic in the second or third decade of life. At clinical examination can be detected an ejection systolic murmur in pulmonary focus given by increasing of the blood flow through the pulmonary valve and duplication of the second cardiac sound. The symptoms that appear in children and young adults are: asthenia, fatigue and shortness of breath with exercise, palpitations given by atrial extrasystoles or by the installation of atrial fibrillation.

Diagnosis of interatrial septal defect:

The clinical suspicion of interatrial septal defect is confirmed by laboratory investigations:

1. Cardiothoracic radiography: heart shadow is increased by the enlarged  right atrium and right ventricle associated with pulmonary stasis.
2. Echocardiography: is the most simple and reliable method that specify the diagnosis, location, size, direction of the shunt, hemodynamic implications of the right ventricle, tricuspid valve and estimates the left ventricular function. This exploration can exclude other associated anomalies such as mitral regurgitation, Ebstein disease or ventricular septal defect.
3. Cardiac catheterization, interatrial septal defect can be confirmed by passing of the probe from the right atrium into the left atrium. The interatrial septal defect with a long evolution, with severe pulmonary hypertension represents a indication for cardiac catheterization to assess the reversibility of pulmonary hypertension or if is contraindicated for surgery. Is a procedure that is indicated of routine in patients with interatrial septal defect, over 45 years to exclude a coronary artery disease.

Septal defect

Treatmnet:

The treatment of interatrial septal defect is exclusively surgical. Interatrial septal defect closure is recommended for all uncomplicated cases with significant shunt left-right and  pulmonary blood flow / systemic blood flow ration greater than 1.5. Ideally this should be done at the age of 2-4 years. To children with small and trivial defect is not indicated surgery and they are checked periodically.

Heart Defect

Interatrial septal defect closure may be made:

1. Interventional – by placing a device in the catheterization laboratory, which will close the defect, avoiding surgery.
2. Surgical, which can be done:

• Conventional, when the parietal defect is closed by direct suturing if is small or using a pericardium patch or a textile patch, which closes the defect, if the interatrial septal defect is important.
• Robotic surgical method, the difference from the classical approach is made by the small incisions, by a better esthetic result and by a reduced hospitalization period by reducing the surgical trauma.

Postoperative evolution is easy in most cases. Postoperative mortality must be zero or less than 1%, even in cases with long evolution and preoperative complications (embolism, arrhythmias, endocarditis). Locked in time, quality of life is identical to that of the general population.

Myocardial Infarction – Causes, Risk Factors, Signs And Symptoms

Myocardial infarction or heart attack is a medical emergency in which blood flow to the heart is suddenly blocked, causing heart muscle death due to lack of oxygen. Oxygenated blood flow that is supplyed to the heart by the coronary arteries become blocked by atheromatous plaques, that rupture and form a thrombus (blood clot) around them. Without blood supply, as any living tissue the heart muscle dies. If a large area of myocardium is affected, death is very probable. Emergency myocardial infarction treatment is manditory to restore blood flow to the infarction area.

Myocardial Infarction Protocol

If the person suspected of a heart attack and was prescribed nitroglycerin, it is advisable to administer a nitroglycerin pill. After 5 minutes, if the pain does not respond or it gets worse, call the emergency services. If a heart attack or unstable angina is presumed and nitroglycerin was not prescribed to that patient, the patient must present to the emergency room or imediately call the ambulance. It is important to begin treatment as soon as possible.

Each year about 40% of myocardial infarctions are fatal, of which more than half of deaths occur in the emergency room or before reaching the hospital. After calling the ambulance, chew an aspirin. A recent study showed that those taking aspirin during a heart attack and after another month had a lower risk of dying  due to complications like stroke than those not taking aspirin.

Myocardial Infarction

Myocardial Infarction Causes

The main cause of both unstable angina and myocardial infarction is coronary artery disease. Coronary heart disease occurs when atheromatous plaques appear along the internal walls of coronary arteries and thus reduces blood flow to the heart. In majority of people coronary heart diseases begins in adolescence and develops over the years. Elevated cholesterol, hypertension and smoking damages your arteries and contributes to plaque formation. The process of forming plaques inside blood vessels is called atherosclerosis.

Coronary atherosclerosis leads in time to angina and worse to myocardial infarction. It is a slow process that can develop for years without any symptoms.

Meanwhile, like limestone deposits on the inside of pipe installations, fat is deposited on the walls of arteries that feed the heart and narrows them. The effect is to reduce blood flow to a portion of the heart muscle. To this process blood clots can be added (thrombus) a process known as atherothrombosis. When there is total cessation of blood flow to an area (usually by a blood clot formation) results in a myocardial infarction. Atherosclerosis can occur in any vascular territory, producing symptoms in that territory, eg the coronary arteries (heart): angina pectoris, myocardial infarction, carotid arteries (supplying the brain): stroke, femoral artery, popliteal (supplying the legs): intermittent claudication (pain in muscles).

Myocardial Infarction

Myocardial Infarction Risk Factors

Anyone can reduce risk of heart attack!

Certain factors, called coronary risk factors, increase the risk of atherosclerosis. The process of atherosclerosis can be slowed by reducing these risk factors, thus reducing the risk of death or disability by myocardial infarction. Although not always perfectly predictable, there are some people who have a higher risk than the general population to suffer from a heart attack or angina attacks. These people are carriers of known coronary risk factors. Risk factors fall into two categories: modifiable (those on which we can not have any influence, such as male gender, age or genetic inheritance), and the changeble (important to know because they can be influenced by correcting some unhealthy habits or through drugs). In some families there is a greater tendency of developing myocardial infarction. Its incidence increases with age also, and men are more likely than women to suffer from a heart attack at younger age.

These risk factors – heredity, age and sex – can not be changed but if the patient changes his lifestyle and reduces risk factors , chances of living a longer and healthier life will improve. Prevention of acute myocardial infarction is the best thing and it is never too late to change habits that can harm your heart. This means to do regular health checks and reduce coronary risk factors. Sometime sthe presence of only one risk factor from the set is enaugh to increase the risk of coronary heart disease. Thus, unfortunately, we see increasingly and frequently young patients (between 30-40 years) hospitalized for acute myocardial infarction, where the only measurable coronary risk factor is smoking.

Stress also called the illness of the century, which like smoking is often seen in young people must also be kept under control before irreversible harmful effects on health manifest.

Regular checks and blood tests, especially under the supervision of the family doctor are very important to know your level of blood lipids (cholesterol and triglycerides) and blood sugar.

Myocardial Infarction Blood Tests

Myocaridal Infarction Signs and Symptoms

Sometimes a heart attack starts suddenly and intensely. But often, the onset is slow, with mild pain and discomfort. Patients do not understand what is happening and wait too long before getting help. If you notice any of the myocardial infarction symptoms, do not miss a minute! Seek help immediately! When you suffer a heart attack every minute counts! Be sure to recognize clinical signs, as this can save your life.

Symptoms and signs of acute myocardial infarction need to recognize are:

• Previous intense chest pain with pressure, burning, weight, grip sensation
• Pain may radiate to the shoulder, arms, neck, back and upper abdomen
• Pain duration is more than 20 minutes (up to several hours), does not respond to sublingual nitroglycerin tablets (3 tablets taken every 5 minutes)
• Pain may be accompanied by other signs: dizziness, fainting, nausea, vomiting, sweating, choking, anxiety, nervousness, palpitations (not all of these clinical signs occur in every acute myocardial infarction).
• Pain usually begins with a low intensity and increase in intensity over several minutes to a maximum. Discomfort may be intermittent. Chest pain that reaches maximum intensity within seconds can be a sign of another disease, aneurysm of aorta.

Myocardial Infarction

If you have one or more of these signs, do not wait any delay could be fatal! Call the ambulance!

What happens if a patient with acute myocardial infarction not present at the hospital? Risks of ignoring the warning symptoms for acute myocardial infarction are multiple:

• Sudden death
• Severe arrhythmias
• Development of new angina pain that further increases patient risk for sudden death
• Appearance of heart failure (fatigue, suffocation, and possibly edema in the legs being the most common symptoms)

Myocardial infarction treatment