HPV Vaccine Also Recommended For Men And Boys

Human Papillomavirus (HPV) is one of the most known and feared viruses, that infects the skin and mucous membranes and causes a psychological and sexual distress among patients, thus lowering the quality of life. There are over 130 types of HPV strains of which only about 40 strains infect the anogenital region, causing various lesions, either benign or pre-malignant, which can regress spontaneously after 6-24 months, or can lead to cancer if they are not early detected and correctly treated. The regression of the lesions depends on the immune system response , which varies from person to person.

Factors that can increase the risk of evolution of HPV infections to cancer are smoking, long-term use of oral contraceptives or impaired function of the immune system.

Among HPV types with increased risk for malignant lesions are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, and 73, and among those with low risk are HPV types 6 and 11.

Although until recently it was believed that women were most affected mainly because they can develop lesions on the cervix (in more than 70% of cervical cancer cases, HPV types 16 and 18 were involved) and men are just simple carriers. Recent studies have shown that HPV is involved in approximately 25% of cancers occurring in men , especially anal cancers.

HPV Vaccine

HPV vaccines, both quadrivalent (6,11,16,18 – recommended for females 9-26 years) and bivalent (recommended for females 10-25 16.18-years) have shown effectiveness in preventing intraepithelial lesions and cervical cancer in women. Recent studies suggest that the quadrivalent vaccine may be effective on other HPV types that are closely related to those included in the vaccine. This will decrease long-term morbidity, caused by HPV, possible pregnancy complications due to surgical treatments (for example – LLETZ – Large Loop Excision of the transformation zone) and cervical cancer mortality.

A recent study led by Dr. Giuliano A.R from University of San Florida included 4065 men aged 16-26 years, who received quadrivalent vaccine has shown that it can prevent the appearance of genital lesions. This result could have major long term implications , limiting the spread of infection, lowering long-term morbidity and mortality due to genital and anal cancers, both in women and men. The results will probably be visible over many years.

Whether you vaccinated or not, keep in mind that annual gynecological exams and Pap smears are mandatory for all women, regardless of age.

Von Willebrand’s Disease

Von Willebrand’s disease is an autosomal dominant bleeding disorder, resulting from a quantitative (Von Willebrand’s disease type 1 and Von Willebrand’s Disease type 3) or qualitative (Von Willebrand’s disease type 2) abnormality of von Willebrand factor, a plasma protein secreted by endothelial cells that circulates in plasma in multimers of up to 20 million daltons.

Von Willebrand factor has two hemostatic functions:

• Very large von Willebrand factor multimers are required for platelets to adhere normally to subendothelium  at sites of vessel wall injury.
• Multimers of all sizes form complexes in plasma with factor VIII of coagulation, which are required to maintain normal plasma factor VIII levels.

Therefore, two hereditary disorders  may cause  factor VIII deficiency:

1. Hemophilia A, in which the factor VIII molecule is not synthesized in normal amounts or is synthesized abnormally.
2. Von Willebrand’s Disease, in which von Willbrand factor molecule is not synthesized in normal amounts or is synthesized abnormally.

Von Willebrand’s Disease

Von Willebrand’s Disease Symptoms

Von Willebrand’s disease affects both sexes, patients typically have a positive maternal or paternal history. Bleeding manifestations are mild to moderate and include easy bruising, bleeding from small skin cuts that may stop and start over hours, increased menstrual bleeding (in women) and some abnormal bleeding after surgical procedures (tooth extraction, tonsillectomy). Screening coagulation tests reveal a long bleeding time and sometimes a slightly prolonged partial thromboplastin time, reflecting a moderately reduced plasma factor VIII level.

Vasoactive stimuli induced by stress or exercise may temporarily elevate plasma von Willebrand factor through release of endothelial store.  Hormonal changes associated with stress or pregnancy and an acute phase response to inflammation  or infection increase synthesis of von Willebrand factor, thus elevating von Willebrand factor in plasma. In persons with mild Von Willebrand’s disease, plasma level varation may cause screening tests to be normal on some occasion and abnormal on other occasions, making diagnosis difficult.

Von Willebrand’s Disease Diagnosis

Definitive diagnosis requires:

• Total plasma von Willebrand factor antigen.
• Von Willebrand factor function, as determined by the ability of plasma to support agglutination of normal plates by ristocetin (ristocetin cofactor activity)
• Plasma factor VIII level.

In patients with common type 1 form of Von Wiellebrand’s disease results are concordant, von Wiellbeand factor antigen, von Wiellebrand factor function and plasma factor VIII level are equally depressed. The degree of depression varies from about 15% to 60%  of normal and determines the severity of a patient’s abnormal bleeding. Healthy persons with blood grup 0 also have reduced von Wiellebrand factor antigens levels (normal values from 60% down to 40%).

Von Willebrand’s Disease

Patients with type 2 Von Wiellebrand’s disease, synthesize abnormal von Wiellebrand factor molecules, resulting in selective deficiency  of vary large multimers of von Wiellebrand factor (types 2A and 2B) or in molecules that cannot bind coagulation factor VIII (type 2N). The type 2A and 2B variants are suspected when the rsults of test for von Wiellebrand factor antigen do not correspond with those of a screening test of agglutination of the patient’s plasma with different  concentrations of ristocetin.  Diagnosis is confirmed by demonstrating a reduced concentration of large von Wiellebrand factor multimers on agarose gel electrophoresis. The type 2N variant is clinically similar to mild hemophilia A , but the inheritance is autosomal recessive.

Von Willebrand’s Disease Treatment

Replacement of von Wiellebrand factor by infusion of cryoprecipitate controls or prevents bleeding in type 1 or type 2 Von Wiellebrand’s disease.

A pasteurized intermediate – purity factor VIII concentrate contain large multimers of von Wiellebrand factor and has not been found to transmit HIV infection or hepatitis. Therefore, it is a safe alternative to cryoprecipitate. Other intermediate – purity factor VIII concentrates are a less reliable source of von Wiellebrand factor when Humate – P, a pasteurized product, is unavailable.

Desmopressin is a analog of vasopressin that stimulates release into the plasma of von Wiellebrand factor stored within the Weibel – Palade bodies of endothelial cells. Desmopressin is important in type 1 of Von Wiellebrand’s disease but is usally of no value for type 2 Von Wiellebrand’s disease.

Epsilon – Aminocaproic acid or tranexamic acid should be also be given to suppress fibrinolysis.

Sitting Can Increase Cancer Risk According To New Study

Sitting in a chair for long periods or comfortably watching tv on your sofa can increase cancer risk according to recent studies.

A new study made public at the American Cancer Research annual conference , showed the link between lack of exercise and prolonged sitting and chaotic cell growth. Scientists stated that approximately 92.000 patients suffering from breast  and colon cancer can link their disease to physical inactivity and low fitness levels.

The research leader Christine Friedenreich from Alberta Heath Services Cancer Care in Canada, revealed her study findings in the Cancer Prevention Journal.

The study was conducted on post-menopausal woman and showed a decrease in cancer risk biological factors, progesterone and estrogen levels, body insulin resistance and inflammatory biological markers.

Although scientists have not determined the link between inflammation and cancer risk , it is well-known not that cytokines ( immune system cells that encourage cell multiplication and inhibit cell death), pay a major role in increasing cancer risk. Previous studies demonstrated that after activation (caused by inflammation) , immune cells start releasing O2 and N2 that can lead to DNA alteration.

In the case of colon and breast cancer, an overall 25%-30% decrease in risk factors was associated with improved fitness levels. The bottom line is that even a minimal improvement of one’s fitness level can reduce cancer risks.

On the other hand another has revealed that those present good fitness levels but sit in certain position for long periods of time are also at higher risk of cancer.

Scientists from Australia Baker Heart And Diabetes Institute showed that even short breaks can help prevent certain conditions.

Sitting Cancer Risk

Neville Owen, study leader stated that there are more and more clues that will place “sitting” on the cancer risk factors list. The period of sitting is also correlated with a higher cancer risk and the phenomenon is not related to weight or fitness level.

Doctor Owen is hopeful that his research results will be taken seriously resulting in some workplace regulations such as longer breaks, standing desks, and removing trash baskets.

Make Time + Pause Time = Cancer Prevention

Cow’s Milk Protein Allergy

Cow’s milk protein can lead to various allergic pathologies manifested by urticaria, respiratory manifestations in the form of obstructive bronchitis or even anaphylactic shock.

Cow’s Milk Protein Allergy Causes

This pathology is based on allergy to protein components of cow’s milk: alpha-lactalbumin, beta-lactoglobulin and casein. Genetic studies have shown that if both parents suffer from atopic diseases, the probability for the child to be allergic to cow’s milk protein is 23%. The risk in the general population is 2% -3%.

Cow’s Milk Protein Allergy

The exact cause of disease is not fully known. The cause of the symptoms is a immune reaction type IV, cellular, with the intervention of multiple cytokines, which will increase the intestinal permeability and will lead to a increased absorption of foreign proteins, which will enhance the pathogenic chain.

Cow’s Milk Protein Allergy Symptoms

The clinical picture is dominated by enteral-like symptoms:

• Diarrhea.
• Flatulence.
• Abdominal bloating.
• Neutral weight or weight loss.
• Bloody stools may occur, which can guide to a diagnosis of colon damage.
• In cases of neglected forms of disease, atrophic intestinal lesions can occur.

Cow’s Milk Protein Allergy Diagnosis

Diagnosis of cow’s milk protein allergy is based on the cow’s milk elimination test, that causes the symptoms. The clinical diagnosis can not be replaced with any other paraclinical investigation or serologic analysis. In enteral form cow’s milk protein allergy, specific Ig E are not highlighted, early in the disease and the presence of specific IgG, does not confirm the disease.

Provocation test is also available for diagnosis, but it is considered a risky procedure in a infant with enteral obvious symptoms. The test is recommended to be postponed until the age of 6 months. This test should be performed by a doctor because of the risk of anaphylactic shock.

The test begins with a skin test and if local skin reactions appear, then no further testing is needed. If  no skin reaction are present, 5 ml of cow’s milk will be administrated, quantity that can be increased later, if there are no symptoms. It should be noted that gastrointestinal symptoms may occur after a week of testing, therefore the test results, positive or negative are best appreciated after a week interval.

Intestinal mucosa changes in cow’s milk protein allergy are present in the moment of diagnosis.  If the baby in question, also received foods containing gluten, besides cow’s milk, differential diagnosis with celiac disease is difficult to achieve.

Cow’s Milk Protein Allergy Symptoms

Cow’s Milk Protein Allergy Treatment

Treatment is based on the exclusion diet. If possible, the diet of the infant should be to be switched to breast milk. If this is not an option, extensively hydrolysed milk formulas will be administrated. Milk formulas which are containing soy protein may be used in forms of cow’s milk protein allergy with extra-digestive manifestations, because forms of disease with digestive manifestations are frequently associated with allergy to soy preparations.

Cow’s Milk Protein Allergy Prevention And Prognosis

Prevention is based on natural diet until the age of six months, especially in families where allergic diseases are present. After the age of 6 months, administration of cow’s milk, will cause very rarely serious allergic symptoms. The prognosis is good and symptoms of allergy will disappear in most cases, around the age of 2 years.

Preinfarction

Most are not aware that an infarction (heart attack) can affect the body in various ways, culminating with the damage of the structure and of the functions of the heart. Therefore, knowledge of the prior symptoms of a possible preinfarction (angina pectoris) or of a heart attack are very important. It should be emphasized, however, that the symptoms can vary from person to person.

Pain and Discomfort

Before the heart attack, people may feel, often, pain or chest discomfort. Both of the symptoms are manifested differently depending on the person. Some people may experience pressure in the chest. For others the pain is located in the heart area and can be perceived as the heart were swollen. However, pain may spread to other parts of the body: shoulders, back, neck and jaw. Any of these alarm signals can persist from a few awkward seconds to several minutes or more.

Breathing Disorders

Quite often, breathing disorders may precede a heart attack: breathing will be short, jerky (is not the result of any physical effort). The sensation is short-lived, being then followed by pain.

Preinfaction (Angina) Symptoms

Fatigue

Unjustified fatigue can be caused either by high blood pressure, cardiovascular diseases or heart diseases. This is determined by how badly the heart works. In any of the cases mentioned above, the heart must make a greater effort than normal and for this reason, the amount of blood and of oxygen becomes insufficient. When this situation will occur, the patient will feel increasingly tired.

Sleep Disorders

For many people, one of the preinfarction symptoms is difficulty in falling asleep, insomnia or anxiety. Even when is sleeping, the patient has a sleep that is  not restful. This symptoms can occur with months or weeks before the onset of any myocardial disease.

Indigestion

The sensation of heartburn may be confused with heart attack. But it is possible that even indigestion (especially if it is recurrent) to be a warning sign for a heart attack.

Emotional Disorders

Although it is not basically a symptom of preinfarction, some emotional imbalance may signal the possibility of triggering a preinfarction, especially if there are other symptoms. In this situation, the person may experience anxiety or fear with variable intensity that might occur as the onset of a heart attack.

Lifestyle

A person’s lifestyle can contribute to the development of a myocardial disease. Excessive weight, diet, the level of activity and the emotional state can play an important role in triggering a heart attack. Obesity, smoking, sedentary lifestyle, high blood pressure, high cholesterol or permanent stress are risk factors for those who might suffer a heart attack.

Pulmonary Fibrosis

Pulmonary fibrosis is a chronic disease characterized by deposition of connective tissue in the lungs and ultimately leading to airflow limitation. Pulmonary fibrosis occurs in various diseases and is manifested mainly by progressive dyspnea. Diagnosis of pulmonary fibrosis is based on clinical examination and laboratory investigations, but certainty diagnosis is put on histopathological examination.

Diagnosing pulmonary fibrosis can be extremely difficult because the difference between idiopathic and non-idiopathic pulmonary fibrosis is not always clear and the classifications for both diseases have created confusion. In addition, other diseases, including chronic obstructive pulmonary disease, asthma and heart failure can mimic pulmonary fibrosis, so doctors need to exclude these diseases before diagnosis.

Pulmonary Fibrosis – Diagnosis

Medical history, physical examination and chest radiography are not sufficient to diagnose pulmonary fibrosis, but they may exclude other diseases. In conclusion, these investigations which may be required, are:

1. X-ray of the chest – this will provide information about the scar tissue, typical for pulmonary fibrosis, and is useful to determine the stage of the disease and treatment. In some cases, X-ray can be normal and further tests will be needed to explain the presence of dyspnea, for example.
2. Lung scanning by high resolution computed tomography – this provides clear and detailed images of the lungs, unlike conventional scans or chest X-rays.
3. Pulmonary function tests – establish the lung function: the amount of air stored in the lungs.
4. Oximetry – this simple test is performed through a small device that is placed on one of the fingers and is designed to measure blood oxygen saturation. Oximetry is the simplest way of monitoring the disease, sometimes more accurate than chest X-ray.
5. Stress test – is performed on the treadmill or on a stationary bike, and is designed to monitor lung function during physical activity.

Often, pulmonary fibrosis can be diagnosed accurately by sampling a small sample of lung tissue (biopsy) analyzed in the laboratory. The tissue sample can be obtained as follows:

1. Bronchoscopy (transbronchial biopsy) – the specialist removes a very small tissue sample, usually no bigger than the tip of a needle – with a small, flexible tube (bronchoscope), which is inserted through the mouth or nose into the lungs. In general, the risks are minor, most often sore throat and hoarseness are temporary.
2. Bronchoalveolar lavage – the doctor injects salt water (saline) through a bronchoscope into a section of the lung and will immediately vacuum. The solution contains cells aspirated from alveolar sacs. Although the samples obtained by bronchoalveolar lavage are bigger than those from the first procedure, this procedure not always provide sufficient information for the diagnosis of pulmonary fibrosis.
3. Surgical biopsy – this procedure is more invasive than others, and is the only way to get a tissue sample large enough for the diagnosis.

Pulmonary Fibrosis

Pulmonary Fibrosis Treatment

Lung scarring can not be cured and no treatment has not proven to be effective in stopping the evolution of pulmonary fibrosis. Some treatments can temporarily reverse the disease and will improve the quality of life.

Medications

Patients with pulmonary fibrosis are initially treated with corticosteroids (prednisone), sometimes in combination with other drugs that stimulate the immune system (methotrexate or cyclosporine). However, none of these combinations has not proved very effective at all.

Lung transplantation

Lung transplantation may be an option of last resort for young people with severe pulmonary fibrosis who have not benefited from other treatment options. To fit the conditions necessary for transplant should stop smoking (if they smoke) and to be healthy enough to cope with surgery and post-transplant treatment, and be willing and able to undergo to the necessary medical rehabilitation program after transplant and to be patient and to be supported emotionally as long as are waiting for a donor. This last specification is important because waiting lists for organ donation are very long.

Other approaches

Other treatments for pulmonary fibrosis focuses on improving quality of life. These include:

• Oxygen therapy – Oxygen does not cure lung lesions, but contribute to the process of respiration, prevent and reduce complications in the presence of a low oxygen level in blood, improves sleep quality and provides better overall body condition. Oxygen therapy reduces symptoms of right heart failure.
• Pulmonary rehabilitation – This is a formal program for people with chronic lung diseases, including medical management. The purpose of pulmonary rehabilitation is not only to treat disease or relieve symptoms, but will help people with pulmonary fibrosis to live a satisfactory life. Pulmonary rehabilitation programs focus on breathing techniques, effective learning, on education, emotional support and nutritional counseling.

Pulmonary Fibrosis Home Remedies

Active involvement in treatment and maintaining a good general health are the main goals for the patient with pulmonary fibrosis. It is important to:

• Stop smoking – The first thing for a person diagnosed with pulmonary fibrosis is to quit smoking. There are several programs that use a variety of techniques that have proved useful in this regard. And because passive smoking is as harmful to the lungs, do not let others smoke around you.
• Constantly exercise – Physical exercise is a double-edged sword for people diagnosed with lung disease.  Doctors recommend patients to practice breathing exercises for short term, in order to keep a good lung function and to reduce stress. Mild physical exercise can help. If you are an active person talk to your doctor about a exercise program that could be effective for you.
• Adopt a healthy diet – Patients with lung disease may lose weight because they can manifest discomfort during eating, which leads to consuming smaller amounts of food, but also because a lot of energy is consumed by respiration effort. It is recommended a nutrient rich diet that contains essential fats, vitamins and minerals.
• Prevent fatigue – Are recommend at least 8 hours of sleep per night for the immune system to be stimulated.
• Control the evolution of gastroesophageal reflux disease – is recommended: a break of at least three hours between meals, eat small meals and avoid any foods that trigger the symptoms.

Pulmonary Fibrosis

Thyroid NodulesFibrosis is the medical term which describs scars. Scarring of lung tissue is defined as pulmonary fibrosis. This condition can be caused by several diseases, including chronic inflammatory processes (sarcoidosis, Wegener granulomatosis), infections, interactions with various environmental agents (asbestos, silica, certain gases), exposure to ionizing radiation (radiotherapy), chronic diseases (lupus erythematosus, rheumatoid arthritis) and certain medications.

In isolated cases, chronic inflammation and pulmonary fibrosis can develop without a cause which can be identified. Some of these patients may develop idiopathic pulmonary fibrosis, unresponsive to medical treatment, while others may have other types of pulmonary fibrosis such as nonspecific interstitial pneumonia, in this disease the results to suppressive therapy are favorable.

Pulmonary fibrosis is a disease known as interstitial lung disease, which is the general term for a variety of chronic lung diseases. Lungs in a patient with pulmonary fibrosis are stiff due to scarring of the lung tissue and due to fibrosis of the interstitium between lung alveoli. Scar tissue is unable to carry oxygen.

Pulmonary Fibrosis

Symptoms Of Pulmonary Fibrosis

Signs and symptoms of pulmonary fibrosis include:

• Dyspnoea (shortness of breath).
• Dry cough.
• Fatigue.
• Unexplained weight loss.
• Muscle and joint pain.

Common symptoms of pulmonary fibrosis are difficulty in breathing (especially during or after physical activity) and dry cough. Often, this symptoms occur when the disease is in an advanced stage and lung lesions are already formed (which are irreversible). Usually, breathing problems are progressively worsen and patients experience difficulty in breathing even during routine activities (talking on the phone or eating).

Causes Of Pulmonary Fibrosis

The process of breathing

During inspiration air flows to the lungs through the bronchi. Inside the lungs, the bronchi are subdivided like the branches of a tree into a million smaller airways called bronchioles, which ramify, and are provided at the ends with small sacs called pulmonary alveoli. One lung has about 300 million alveoli. In the wall of pulmonary sacs are blood vessels (capillaries) through which oxygen passes into the blood and carbon dioxide (waste product from metabolism) is removed.

Respiratory System

What happens in pulmonary fibrosis?

In case of pulmonary fibrosis, the alveoli are damaged and form scar tissue, which delimit and separate the alveoli. Normally, alveoli are very elastic, like little balloons which contract with each breath. Scars make lung tissue to be thick and rigid and pulmonary alveoli less flexible, which leads to breathing problems.

In patients suffering from pulmonary fibrosis, healing is hampered by other circumstances. Normally, when a person has an injury (cut), the body form new blood vessels that carry oxygen and nutrients to the affected cells, but in people with pulmonary fibrosis, blood vessels are filled by scar tissue.

What causes lung damage?

1.  Environmental and occupational factors. Long-term exposure to a range of toxins and pollutants can affect the lungs. Among them are: silica dust (silicosis) and asbestos fibers (asbestosis). Constant exposure to some organic substances, including grain, sugar cane and animal droppings can cause pulmonary fibrosis.
2. Radiations. A relatively small percentage of patients who are treated with radiotherapy for lung cancer or breast cancer, after a certain period of time will develop pulmonary fibrosis. Disease severity depends on: the time of radiation exposure, the amount of radiation, the administration of chemotherapy and the presence of underlying lung disease.
3. Drugs. Many of the substances involved in the drug composition, especially drugs used in chemotherapy (methotrexate, cyclophosphamide), drugs used to treat cardiac arrhythmias and other cardiovascular diseases, certain medications used to treat mental disorders, and some antibiotics ( nitrofurantoin, sulfasalazine).
4. Gastroesophageal reflux disease (GERD). Acid reflux occurs when stomach acid content in coming back into the esophagus. Gastroesophageal reflux disease plays a significant role in pulmonary fibrosis. Although patients with pulmonary fibrosis are frequently suffering from GERD, they don’t present specific symptoms of the disease – heartburn and belching.
5. Other diseases. Serious lung infections, such as tuberculosis and pneumonia can cause permanent lung damage. There are diseases that affect tissues throughout the entire body, not just the lungs, such as systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polio, Sjogren’s syndrome and sarcoidosis. In rare cases, scleroderma is associated with a particularly severe form of pulmonary fibrosis.

Idiopathic pulmonary fibrosis: when the cause of the disease is not known

List of chemicals and of diseases that can cause pulmonary fibrosis is long, even so, most often the cause is never found. Pulmonary fibrosis whose causes are not known is called idiopathic pulmonary fibrosis. Scientists have formulated several theories on the factors that can trigger idiopathic pulmonary fibrosis, among them are viruses, and the exposure to cigarette smoke. Also, it is considered that heredity factors play an important role, even though many patients do not inherit the disease directly.

Pulmonary Fibrosis

Pulmonary Fibrosis Risk Factors

Factors that predispose to pulmonary fibrosis are:

• Age. Even if the disease can be diagnosed in children and infants, pulmonary fibrosis affects mostly middle-aged adults and old age adults.
• Sex. Men are more likely to develop pulmonary fibrosis than women.
• Toxins. People who work in mining, agriculture and construction are at increased risk of developing pulmonary fibrosis.
• Radiation and chemotherapy.

Risk factors for idiopathic pulmonary fibrosis are:

Although the causes of idiopathic pulmonary fibrosis are not known, researchers have identified certain factors that increase the risk of developing this disease:

• Smoking. This condition occurs with a higher prevalence among smokers and people who had quit smoking.
• Genetic factors. A severe form of idiopathic pulmonary fibrosis has been identified in certain families. Researchers did not identified genes the are involved in the development of the disease, but have found genetic changes in the respiratory proteins.
• Viruses. Many people have reported symptoms of pulmonary fibrosis after a viral infection, especially if it was caused by a herpes virus  and Epstein-Barr virus (causes mononucleosis).

Pulmonary Fibrosis Complications

1. Decreased blood oxygen levels (hypoxemia) – Because pulmonary fibrosis reduces the amount of oxygen that reaches the respiratory system, the patient may manifest hypoxemia. Lack of oxygen can disrupt normal functioning of the body and low levels of oxygen may be life-threatening.
2. Pulmonary hypertension – Unlike systemic hypertension, this condition occurs only in the pulmonary arteries. Onset occurs when capillaries are compressed by scar tissue, which lead to increased resistance to blood flow in the lungs (pulmonary vascular resistance). This, in turn, leads to high blood pressure within the pulmonary arteries. Pulmonary hypertension is a serious disease that progressively worsens and eventually can be fatal.
3. Right heart failure or acute pulmonary heart disease – is a serious condition characterized by the inability of the heart (right ventricle) to ensure and to pump enough blood to flow through the pulmonary arteries.
4. Respiratory failure – This is the final stage of chronic lung disease. Occurs when the blood oxygen level is dangerously low, the consequences are: cardiac arrhythmias and unconsciousness.

Cancer

Cancer. A diagnosis that turns your world upside down, without any warning. This diagnosis is emitted very often recently, due to unhealthy lifestyle changes, pollution and stress. Regardless of location or staging, there are over 100 types of cancer. If the cancer is diagnosed early, the chances of a currative treatment are higher.

What should be done? We should pay more attention to what the body is trying to convey, screening methods and adopt a healthy lifestyle. We also must be very careful to risk factors such as irregular meals, smoking, excessive alcohol consumption, prolonged exposure to sunlight, genetic factors and so on.

In addition, we must observe and investigate any warning signs.

1. Persistent Cough

Persistent cough or bloody expectoration may represent manifestations of bronchitis, of sinusitis or of a lung cancer, especially if the cough period is exceeding one month.

2. Persistent Dysphagia

Persistent dysphagia, or difficulty during swallowing may indicate an esophagitis, gastroesophageal reflux disease or esophageal cancer.

3. Changes In Bowel Movement

Changes in bowel movement could be the result of changes in dietary habits or the result of an inadequate fluid intake. Constipation alternating with diarrhea or loose stool, like a pencil, can announce a colon cancer.

4. Bloating

Bloating is a fairly common symptom, especially in sedentary people, those with irregular meals or with biliary disorders. Bloating can announce an ovarian cancer, if is accompanied by pain localized in the pelvic region or in the lower abdominal region, with early satiety or urination disorders.

5. Bloody Stool

Blood in stool may represent a result of hemorrhoidal disease or anal fissures, but may also appear in colon cancer and the most appropriate paraclinical investigation is colonoscopy.

6. Anemia

Any anemia should be investigated, in order to find a cause. Gastric cancer can cause iron deficiency anemia and can be investigated by upper gastrointestinal endoscopy.

7. Losing weight

Losing weight which can not be explained, especially if weight loss is more than 5 kg in a month, could be a sign of cancer.

8. Breast swelling

Any swelling of the breasts or galactorrhea should be investigated mandatory, even if it is the case of breast fibroadenoma or breast cysts. Mammography and breast ultrasound are investigations of choice, in the diagnosis of breast cancer.

9. Testicular swelling

Approximately 90% of men who have testicular cancer notice a non-painful swelling of the testicles. Any testicular swelling should be investigated even though it may be due an infection or varicocele.

10. Urinary Problems

Urinary disorders manifested by frequent urination and small amounts of urine, or interrupted jet can announce for women, urinary infections, rarely bladder cancer or in men prostate adenoma, or prostate cancer. A digital rectal exam is mandatory and a blood test called PSA.

11. Hematuria

Blood that is present in the urine is called hematuria and may announce a urinary infection, kidney stones or bladder or kidney cancer.

12.Limph Nodes Enlargement

Prominent and persistent lymph nodes may occur as a result of an infection but if they remain swollen for weeks and do not return to normal, the problem should be investigated to exclude lymphatic cancer.

13. Mole Changes

Any change in color, shape or volume of moles should be investigated by your dermatologist. Early diagnosis of skin cancer, influences the prognosis of this disease.

14. Wounds that do not heal

Unhealing wounds occur more often in diabetics, but they also represent a warning sing if they appear on the gums, tongue and tonsils

15. Headaches

Headaches can have many causes including aneurysms and rarely, tumors.

16. Vaginal bleeding and discharge

Vaginal bleeding outside normal menstruation, may announce additional to uterine fibroids, ovarian cysts or complicated vaginal infections and uterine cancer. Especially if it occurs between periods, after intercourse or postmenopausal it should be investigated by your gynecologist.

Thyroid Nodules

Thyroid nodules are common. 4-7% of adults have such palpable formations and 50-70% of adults discover thyroid nodules after a ultrasound examination of the thyroid.

The risk for a thyroid nodule to be malignant is between 20-40%. Patients who presented a thyroid nodule that has grown over several months, those who presented pain in the thyroid nodule with an acute onset (usually due to a intracystic bleeding), the association between cervical lymph nodes and  insidious and persistent pain should be directed to an endocrinologist.

All patients with thyroid nodules that associates stridor, must present themselves on the same day for assessment by a specialist, because such events may be due to recurrent laryngeal nerve damage, secondary to a thyroid carcinoma.

Suspicious Symptoms In Patients With Thyroid Nodules

• A family history of thyroid cancer.
• History of radiation or exposure to ionizing radiation.
• Children who have thyroid nodules.
• Hoarseness or stridor without further explanations, which are associated with the presence of goiter.
• A thyroid mass  which is rapidly growing within the order of weeks.
• Palpable cervical lymphadenopathy.
• Insidious and persistent pain that lasts several weeks.

Initial investigations

All patients with thyroid nodules should perform a thyroid function tests. Patients with polinodular goiter associated with hyperthyroidism, have a lower risk of developing thyroid cancer.

Thyroid Nodules

Some studies have shown that subjects with high levels of TSH hormone, have an increased risk for thyroid malignancy.

Ultrasound examination

Can provide valuable information on thyroid node characteristics, the potential for malignancy and accurate assessment of growth by serial ultrasound examinations. American Thyroid Association recommends that all patients should benefit from ultrasound examination, while the guidelines issued by the British Thyroid Association suggest that this examination is useful only as a guide to aspiration and to identify possible non-dominant nodules.

Suggestive ultrasound aspects for thyroid cancer:

• Hypoecogen aspect – moderate risk.
• Absent halo or edges which are difficult to distinguish – moderate risk.
• Blood flow at Doppler examination – moderate risk.
• Microcalcifications – high risk.

Fine needle aspiration

Cytological test accuracy varies, depending on the manner of the sampling and the interpretation of results by the cytopathologist. Studies have shown that non-diagnostic aspirates rate ranges between 15-30% and is higher for thyroid nodules smaller than 1 cm, compared with those over 1 cm. If two attempts of fine needle aspiration do not allow the formulation of diagnosis, biopsy is recommended (with or without ultrasound guidance).

It was also found that of all the tests for diagnosing thyroid malignancy, fine needle aspiration was more accurate than ultrasound examination.

Thyroid Nodules

Ultrasound guidance increases the accuracy of fine needle aspiration from 85% to 95% and may also be useful in order to select the most suspicious thyroid node to be biopsied for a multinodular thyroid.

In patients with multinodular goiter, the most suspicious node in terms of  ultrasound appearance, is elected to be biopsied. If none of the thyroid nodes are suspicious, is elected to be biopsied the node with the largest dimensions.

Other investigations

• Nuclear magnetic resonance.
• CT
• Determination of serum thyroglobulin is not very useful in the diagnosis
• Highlighting antithyroid antibodies (ATPO) may be relevant if is wanted to be excluded autoimmune thyroiditis.