A Simple Guide to Urinary Incontinence
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What is Urinary Incontinence?
----------------------------------------
Urinary incontinence is a symptom and means the the uncontrollable leakage of urine.
It can cause a lot social discomfort to patients having this problem.
Men are more prone to it than women.
What are the Causes of Urinary Incontinence?
------------------------------------------------
Urinary Incontinence is a medical condition which may be temporary or permanent.
There are many causes of urinary incontinence:
Temporary urinary incontinence
------------------------------
1.Drinking too much tea, coffee or carbonated drinks can irritate the bladder and cause or contribute to incontinence.
Coffee and other drinks containing caffeine can be a particular problem as caffeine is a diuretic, i.e. it increases the urge to pass urine.
2.Excessive alcohol. Alcohol is also a diuretic. Because it has deppresant effect on the the brain, it may affect the person's judgement temporarily, hence resulting in accidental leakage of urine.
3.Some medications like diuretic pills, heart medications and antidepressants can cause or contribute to incontinence.
4.Urinary Tract Infection may cause sufficient irritation to the bladder to stimulate incontinence.
5.Constipation result in impaction of the stools in the rectum. This irritates the nerves to the bladder resulting in incontinence.
Permanent urinary incontinence
-------------------------------
In both sexes there are many conditions which can cause or contribute to chronic or persistent urinary incontinence:
1.Aging
With age there is a decrease in the bladder capacity to store urine.
2.Enlarged prostate in men
BPH or benign prostatic hypertrophy is associated with aging and can obstruct the urethra and block urinary flow resulting in urge or overflow incontinence.
3.Prostate Cancer in men
Prostate cancer can cause incontinence if untreated. However the incontinence in prostate cancer patients may be a side effect of treatment e.g. surgery, radiation therapy.
4.Prostatitis in men
Inflammation of the prostate gland sometimes can cause constriction of the urinary flow and incontinence.
5.Gynecological problems such as prolapsed uterus, enlarged utrue due to fiboids, ovarian cysts or tumours can pulled on the muscles of the perineum causing weakness of the muscles and poor constriction of the bladder opening
5.Surgery involving the organs near the bladder
Any operations involving organs such as the ovary, uterus, prostate, rectum can cause inadvertent damage to muscles or nerves of the urinary tract, resulting in incontinence.
6.Urinary tract obstruction
Any enlarged tumours along the urinary tract can obstruct the normal flow of urine and cause incontinence. Bladder stones can do the same.
7.Neurological conditions
Stroke, Parkinson's disease, tumours in the brain or spinal cord and injury to the nerves in pelvis or spinal cord can can affect the nerves to the bladder and weakening of the bladder opening muscles.
What are the Types of urinary incontinence?
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Urinary incontinence may be categorised into 4 main types. It is possible however to have more than one type of urinary incontinence
1.Stress incontinence
Leakage of urine occurs because of weakness of the pelvic floor muscles. When there is pressure exerted on the bladder - e.g. from laughing, sneezing, coughing, exercising or heavy lifting, pregnancy, the muscles at the opening of the bladder comes under stress and opens to allow leaking of urine.
2.Urge incontinence
There is an uncontrollable leakage of urine while suddenly feeling the urge to urinate.
3.Overflow incontinence
There is a constant dribbling of urine even after finishing urination. There is an inability to completely empty the bladder.
4.Functional incontinence
There is physical or mental impairment resulting in the failure to realise the need to urinate.As a result the person fail to get to the toilet in time and pass out the urine. Examples are people who suffer from dementia, parkinson or is incapacitated by poor physical movement.
Other types of urinary incontinence include enuresis(bed wetting ) which is common in chilldren,
Transient incontinence which is temporary and sometimes caused by medications.
What are the symptoms of urinary incontinence?
------------------------------------------------
The main symptom of urinary incontinence is leakage of urine. This leakage may be frequent and heavy, or it may be small and rare.
Some other symptoms of urinary incontinence include:
Urgency - a strong desire to urinate even when the bladder is not full together with pelvic discomfort or pressure
Frequency - urinating more than once in a two-hour period or more than seven times a day
Nocturia - the need to wake up and urinate at least twice during sleep
Dysuria - painful urination
Enuresis - bed-wetting or urinating while sleeping
How do you make the Diagnosis of urinary incontinence?
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1. history taking is important especially the pattern of urine leakage. Other history include symptoms of straining and discomfort, use of drugs, surgery, and illness.
2. physical examination will look for signs of medical conditions causing incontinence, such as pelvic tumors, stool impaction, and poor reflexes or sensations.
3. measurement of bladder capacity and residual urine for signs of poor functioning bladder muscles.
4.Stress test - the patient coughs vigorously as the doctor watches for loss of urine.
5.Urinalysis - urine is tested for infection, urinary stones.
6.Blood tests - for PSA( in case of Cancer of prostate) or alphafoetoprotein (in case of cancer of the ovaries)
5.Ultrasound -to visualize the kidneys, ureters, bladder, and urethra.
6.Cystoscopy - a thin lighted tube is used to see the inside of the urethra and bladder.
7.Urodynamics - measurement of pressure in the bladder and the flow of urine.
What is the Treatment of urinary incontinence?
-----------------------------------------------
Elderly patient tend to believe that the only way to prevent embarrassment is to wear absorbent pads or padded undergarments like adult Pampers. However the wetness may lead to rashes, sores, or infections.
Treatment involves:
A. making certain lifestyle changes.
1.Timed Voiding
Timed voiding (urinating) means writing a chart of your urination and leakage patterns for several days. This will then tell you which times of day you normally need to empty your bladder before leakage may occur.
2.Bladder training
This involves training your bladder to control the urge to urinate.
3.Changing Fluid Intake
Restricting your fluid intake, or changing the timing of fluid intake will help you to gain more control over the bladder. Restriction of alcohol, tea, coffee and other caffeinated beverages can reduce the amount of urine from your body
4.Exercises
Exercising the muscles of the pelvis(Kegel exercises) may strengthen the muscles of the affected area.
5.Vaginal cone therapy
This exercise for women involves the use of a set of five small vaginal cones of increasing weight. The patient simply places the small plastic cone within her vagina and hold it in by a mild reflex contraction of the pelvic floor muscles. This exercise is done twice a day for fifteen to twenty minutes.As the pelvic floor muscles becomes stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually.
6.Electrical stimulation
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles and strenthen the pelvic muscles.
This can reduce stress and urge incontinence.
7.Biofeedback
Using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can slowly control movement of these muscles.
B.Treating the cause of the incontinence:
1.Medications:
drugs may be given to treat urinary tract infections or inhibit contractions of an overactive bladder.
2,Pessaries
A pessary is a ring shaped medical device that is inserted into the vagina. It compresses the urethra against the pubic bone and elevates the bladder neck.
3.Surgery
Surgery to reduce the size of your prostate gland ( transurethral resection of the prostate or TURP) helps to reduce urinary incontinence in men.
Bladder repositioning
In older women incontinence results from the bladder dropping down toward the vagina. Surgery involves pulling the bladder up to a more normal position. Using an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.
Marshall-Marchetti-Krantz
This procedure also known as retropubic suspension or bladder neck suspension surgery, is performed using an incision across the abdomen. Stitches are placed in these tissues near the bladder neck and the urethra is then lifted, and the stitches are attached to the pubic bone or to tissue behind the pubic bone. The bladder neck is supported helping the patient to control the urine flow.
Slings
The sling procedure uses synthetic mesh material in the shape of a narrow ribbon that is placed under the urethra through one vaginal incision and two small abdominal incisions. The purpose is to provide support under the urethra. There are the Transobturator Tape Sling, the Tension-free Transvaginal Sling, and the Minisling.
Artificial urinary sphincter
Rarely the surgeon implants an artificial urinary sphincter a doughnut-shaped sac surrounding the urethra. To close the urethra A fluid fills and expands the sac. Pressing a valve implanted under the skin, the artificial sphincter can be deflated allowing urine from the bladder to pass.
4.Catheterization
A catheter may be inserted to drain the urine if your bladder never empties completely or if your bladder cannot empty because of poor muscle tone, post surgery or spinal cord injury. This can be done on a if required basis.Prolonged catherisation may lead to infection of the urinary tract.
5. Botox injections
Botox injection has been tried to reduce the sensitivity of the nerves at the opening of the bladder. It appears more successful for women than in men.
How do you prevent urinary incontinence?
----------------------------------------
Reduce your risk of urinary incontinence:
1.Maintain a healthy weight.
2.Obesity can lead to urinary incontinence.
3.Avoid constipation by drinking sufficient amounts of fibre and fluids in your diet.
4.Avoid drinks which can irritate your bladder such as coffee, tea, carbonated drinks and alcohol.
Tuesday, May 27, 2008
Friday, May 23, 2008
A Simple Guide to Benign Prostatic Hyperplasia
A Simple Guide to Benign Prostatic Hyperplasia
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What is Benign Prostatic Hyperplasia?
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Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.
What are the Causes of Benign Prostatic Hyperplasia?
------------------------------------------------------------
The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.
It is a walnut size gland encircling the lower urinary outlet of the bladder.
With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.
The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.
What are the symptoms and signs of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------
The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.
Symptoms:
1. difficulty in starting urination
2. straining at urination to produce a weak flow of urine
3. dribbling of the urine after urination
4. feeling of incomplete emptying of bladder even after urination.
5. nocturia -getting up at night more frequently to pass urine
6. frequency of urination
7. interrupted urine flow
8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)
Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate
2.urine examination to exclude infections
3.blood tests to check on kidney function
4.an ultrasound to have a better look at the prostate and also any damage to kidneys
5.a urine flow test(Uroflow) to see how fast you can pass urine
6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer
7. Cystoscopy - a ligted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine
8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)
What are the complications of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------
Prolonged blockage of the urine by BPH can cause serious complications:
1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain
2. Urine leakage or incontinence
3. recurring urine infections
4. bladder stone formation
5. blood in the urine
What is the treatment of Benign Prostatic Hyperplasia?
----------------------------------------------------------------
BPH sufferers may be referred to an Urologist for review. As lonas Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.
In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by :
1.adjustment of fluid intake
2.regular exercise,
3.proper diet with less red meat , more vegetables and fruits.
In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as :
4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.
In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,
5.catherisation and drainage of the urine may be necessary in acute retention of the urine
6.Surgery may be necessary.
This operation called TURP or transUrethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract.
Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfuction problems.
7. Antibiotics may be given for urinary infections
What are the preventive measures taken in Benign Prostatic Hyperplasia?
--------------------------------------------------------------------
1.Changing Fluid Intake
You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.
2.Bladder training & periuretharal muscle exercises
This involves training your bladder to control the urge to void.
3.Maintain a healthy weight.
4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.
What is the prognosis of Benign Prostatic Hyperplasia?
---------------------------------------------------------------
Very good after treatment.
-------------------------------------------------------------------
What is Benign Prostatic Hyperplasia?
--------------------------------------------------------
Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.
What are the Causes of Benign Prostatic Hyperplasia?
------------------------------------------------------------
The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.
It is a walnut size gland encircling the lower urinary outlet of the bladder.
With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.
The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.
What are the symptoms and signs of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------
The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.
Symptoms:
1. difficulty in starting urination
2. straining at urination to produce a weak flow of urine
3. dribbling of the urine after urination
4. feeling of incomplete emptying of bladder even after urination.
5. nocturia -getting up at night more frequently to pass urine
6. frequency of urination
7. interrupted urine flow
8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)
Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate
2.urine examination to exclude infections
3.blood tests to check on kidney function
4.an ultrasound to have a better look at the prostate and also any damage to kidneys
5.a urine flow test(Uroflow) to see how fast you can pass urine
6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer
7. Cystoscopy - a ligted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine
8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)
What are the complications of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------
Prolonged blockage of the urine by BPH can cause serious complications:
1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain
2. Urine leakage or incontinence
3. recurring urine infections
4. bladder stone formation
5. blood in the urine
What is the treatment of Benign Prostatic Hyperplasia?
----------------------------------------------------------------
BPH sufferers may be referred to an Urologist for review. As lonas Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.
In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by :
1.adjustment of fluid intake
2.regular exercise,
3.proper diet with less red meat , more vegetables and fruits.
In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as :
4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.
In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,
5.catherisation and drainage of the urine may be necessary in acute retention of the urine
6.Surgery may be necessary.
This operation called TURP or transUrethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract.
Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfuction problems.
7. Antibiotics may be given for urinary infections
What are the preventive measures taken in Benign Prostatic Hyperplasia?
--------------------------------------------------------------------
1.Changing Fluid Intake
You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.
2.Bladder training & periuretharal muscle exercises
This involves training your bladder to control the urge to void.
3.Maintain a healthy weight.
4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.
What is the prognosis of Benign Prostatic Hyperplasia?
---------------------------------------------------------------
Very good after treatment.
Friday, April 4, 2008
A Simple Guide to Erectile Dysfunction
A Simple Guide to Erectile Dysfunction
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What is erectile dysfunction (ED)?
----------------------------------------
Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"
The WHO sponsered Consultation recommend" a minimum of three months of erectile difficulty qualified foe a diagnosis of Erectile Dysfunction."
What is the incidence of ED?
-----------------------------------
The incidence of ED is unknown:
ED is currently underdiagnosed and undertreated.
More than 50% of all men 40-70 years old are likely to experience it.
What are the Causes of ED?
----------------------------
Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.
Medical causes:
------------------
1.vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)
high blood pressure
high cholesterol
heart disease
stroke
All these conditions affects the blood flowing and out of the penis.
2.diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED
3.nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis
4.hormonal problems-
low levels of testosterone(male hormone) can cause ED
5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.
6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.
7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillisers) may reduce the blood flow to the penis
8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.
Lifestyle causes:
----------------------
1.alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.
2.Smoking-
The incidence of ED in smokers are hiher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.
3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.
4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation
Psychosocial Causes:
-----------------------
1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause
3. Depresssion
4. Relationship Problems- marital problems and tensions may affect sexual relationship
5. fatigue.
How is the diagnosis of ED made?
---------------------------------
1.medical hisory especially about diabetes, hypertension, medications, alcohol adrug abuse,smoking.
2.medical examination including genitals and prostate
3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)
What is the treatment of ED?
------------------------------
Successful treatment of erectile dysfunction includes:
1. Lifestyle modifications:
exercising
dieting
quitting smoking
reducing alcohol/drug abuse
counselling to manage anxiety/stress/marital problems
2.treatment of underlying medical conditions such as diabetes
3.change of medications
4.medication for treatment of ED.
There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors
e.g. Viagra, Cialis, Levitra.
There is no instant erections when the medicine is taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.
Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.
6.Other treatments for erectile dysfunction
a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity
b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.
c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis
d:surgery for blocked blood vessels
e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse.
This surgery is offered when all other options failed.
How to cope with ED?
-----------------------
Erectile dysfunction can cause a lot of stress on one’s marital relationship.
Communication and honesty with the spouse is important in ED.so that she understands the problem and that she is not the cause of the problem.
In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.
-------------------------------------------
What is erectile dysfunction (ED)?
----------------------------------------
Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"
The WHO sponsered Consultation recommend" a minimum of three months of erectile difficulty qualified foe a diagnosis of Erectile Dysfunction."
What is the incidence of ED?
-----------------------------------
The incidence of ED is unknown:
ED is currently underdiagnosed and undertreated.
More than 50% of all men 40-70 years old are likely to experience it.
What are the Causes of ED?
----------------------------
Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.
Medical causes:
------------------
1.vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)
high blood pressure
high cholesterol
heart disease
stroke
All these conditions affects the blood flowing and out of the penis.
2.diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED
3.nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis
4.hormonal problems-
low levels of testosterone(male hormone) can cause ED
5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.
6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.
7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillisers) may reduce the blood flow to the penis
8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.
Lifestyle causes:
----------------------
1.alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.
2.Smoking-
The incidence of ED in smokers are hiher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.
3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.
4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation
Psychosocial Causes:
-----------------------
1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause
3. Depresssion
4. Relationship Problems- marital problems and tensions may affect sexual relationship
5. fatigue.
How is the diagnosis of ED made?
---------------------------------
1.medical hisory especially about diabetes, hypertension, medications, alcohol adrug abuse,smoking.
2.medical examination including genitals and prostate
3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)
What is the treatment of ED?
------------------------------
Successful treatment of erectile dysfunction includes:
1. Lifestyle modifications:
exercising
dieting
quitting smoking
reducing alcohol/drug abuse
counselling to manage anxiety/stress/marital problems
2.treatment of underlying medical conditions such as diabetes
3.change of medications
4.medication for treatment of ED.
There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors
e.g. Viagra, Cialis, Levitra.
There is no instant erections when the medicine is taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.
Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.
6.Other treatments for erectile dysfunction
a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity
b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.
c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis
d:surgery for blocked blood vessels
e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse.
This surgery is offered when all other options failed.
How to cope with ED?
-----------------------
Erectile dysfunction can cause a lot of stress on one’s marital relationship.
Communication and honesty with the spouse is important in ED.so that she understands the problem and that she is not the cause of the problem.
In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.
Tuesday, March 25, 2008
A Simple Guide to Urinary Stones
A Simple Guide to Urinary Stones
----------------------------------
What are Urinary Stones?
----------------------------
Urinary Stones are small, solid stones which occur when salts or minerals in the urine become solid crystals inside the kidney.
How are Urinary Stones formed?
----------------------------------------
Urinary Stones are formed usually because of the accumulation of salts and minerals especially calcium in the urine.
Usually the stones may be so small that they pass out through the urine without the knowledge of the patient.
Some however become bigger due to accumulation of the salts and minerals and the concentration of the urine.
The bigger stones may remain in the tubes of the kidney and are called renal stones.
Some smaller stones may move out of the kidney and passes through the ureters which are the the tubes bringing urine from the kidney to your bladder.
These are called ureteric stones.
If a ureteric stone gets stuck in the ureter, this can cause blockage of the urine and severe pain.(ureteric colic)
What are the types of Urinary Stones?
------------------------------------------
Different kinds of Urinary stones form from different salts in the urine.
1.Calcium stones forms about 80% of the urinary stones.
50% are made up of calcium oxalate and the rest are calcium phosphate.
They are spiky or large and smooth
2.Uric acid stones are caused by accumulation of excess amounts of uric acid which can be due to eating a lot of meat.
They are smooth, brown and soft
3.Struvite stones (infection stones) are produced when there is too much ammonia in the urine occuring especially in urinary tract infection.
The bacteria that cause these urinary infections can generate ammonia.
They are usually large and have a horn-like shape
This kind of kidney stone is most often found in women.
4.Cystine stones occurs when there is high levels of cystine in the urine. A hereditary disorder called cystinuria is the source of high cystine in the urine.
They are yellow and crystalline
Who is at risk of Urinary stones formation?
--------------------------------------------
Risk factors include:
1.Men get urinary stone more commonly than women
2.a previous history of kidney stone - 50% will develop another one within five years.
3.a family history of kidney stones
4.Age between 20 and 40
5.Not drinking enough water
6.eating a diet high in protein
7.taking certain medicines such as diuretics (water tablets), antacids and thyroid medications
8.having only one kidney, or an abnormally shaped kidney
What causes Urinary Stones?
---------------------------
Urinary Stones are caused by 4 main factors:
1.Insuffient water in the urine leading to concentration and stagnation of urine flow:
a.insufficient intake of water
b.intake of alcohol causing concentration of the blood volume
2.Excess Urinary Constituents:
a. Calcium:
High calcium intake (includes calcium tablets and high calcium milk)
Primary Hyperparathyroidism leading to high blood calcium
high Vitamin D intake cause high adsorption of calcium
medical conditions such as cancer, some kidney diseases, or sarcoidosis are more likely to develop calcium stones.
b. Oxalates:
high oxalate intake (cabbage,spinach,tomatoes, chocolates) in diet leads to high concentration of oxalates in urine
c. Uric Acid:
Gout or High Uric Acid can form crystals which may lead to stones
Treatments such as chemotherapy can also increase the risk of getting uric acid stones.
d: Cystine:
Hereditary cystinuria leads to high cystine in the urine and formation of cystine stones
About one in a hundred urinary stones is due to this illness.
Cystine stones tend to appear earlier in life between the ages of 10 and 30 years.
3. Infection of urine:
clumps of bacteria can form the nucleus of the stone.
Bacteria also produce ammonia which can promote formation of stones
4. Congenital deformity of the kidney and urinary tract:
these block the passage of concentrated urine and causes formation of stones.
What are the symptoms of Urinary Stones?
------------------------------------------
Many Urinary stones do not cause any symptoms.
Once an urinary stone enters the ureter and blocks the passage of urine flow, it may cause the following symptoms:
1.severe pain or aching in the back on one or both sides
2.sudden spasms of excruciating pain which usually starts in the upper back below the ribs, radiates around the flanks of the abdomen, down to the pubes, groin and genitalia.
3.Urine is bloody, cloudy or smelly
4.frequent urge to urinate, or a burning sensation during urination
5.fever and chills
6.nausea and vomiting
Urinary stones can be passed out of the body within 48 hours.
Sometimes attacks of pain from urinary stones may last for over 30 days.
How are Urinary Stones diagnosed?
---------------------------------
1.History of ureteric colic symptoms and physical examination showing tenderness of abdomen and flanks
Other tests may be done to confirm the diagnosis and to reveal the size, location and type of stone:
2.blood tests - to identify excess amounts of certain chemicals (calcium, uric acid, oxalates, cystines) related to the formation of stones
3.urine analysis - to look for signs of infection and presence of crystals
4.X-ray of abdomen - stones that contain calcium (80%) usually appears white on X-rays
5.Intravenous urogram (IVU) - an injection of a special dye that shows up the whole urinary system on X-ray images, revealing stones that can't usually be seen
6.ultrasound scan - can detect stones in kidneys and solid internal organs
7.non-contrast helical computerised tomography - X-ray images taken at different angles - can diagnose kidney stones, and is probable the most accurate diagnostic test
How are Urinary Stones treated?
---------------------------------
Treatment depends on the
1.type and
2.cause of the stone.
Most stones can be treated without surgery:
1.Drinking lots of water (two and a half to three litres per day)
2.staying physically active are often enough to move stones smaller than about 5mm out of the urinary tract.
3.paracetamol or codeine may be given to reduce the pain.
4.Infections can be treated with antibiotics.
Stones that are stuck can be removed in several ways:
1.Extracorporeal shock wave lithotripsy (ESWL)
Location of the urinary stone is dtermined using X-ray imaging or ultrasound scanning.
The patient lies in a side position while a machine called a lithotriptor sends targeted shock waves to break up the kidney stone.
There may be some pain as the stone breaks up, so the procedure is usually performed under local anaesthesia.
2.Ureteroscopic stone removal
A narrow, flexible instrument called a cystoscope can be passed up through the urethra and bladder and up the ureter where the stone is stuck. The stone is captured and removed.It can also be broken up with a laser beam or shock waves generated by a device attached at the end of the cytoscope. This procedure is usually done under general anaesthesia.
3.Percutaneous nephrolithotomy (PCNL)
Large stones can be surgically removed from the kidney.
The surgeon makes a small opening at the back and uses a telescopic instrument called a nephroscope to pull the stone out or break it up with shock waves or a laser.
This procedure is performed under general anesthesia.
How to prevent Urinary Stones?
---------------------------------
1.drink more fluid at least three litres every 24 hours.
2.reducing the amount of calcium in the diet to a normal level(not excessively high)
3.For calcium oxalate stones, reduce intake of high levels of oxalate - chocolate, tea, cooked spinach and asparagus.
4.For uric acid stones, less meat, fish, poultry, organs, peanuts and soya beans should be taken. Daily intake of allopurinol medicine can help reduce the level of uric acid in the urine.
5.For cystine stones, medicines can be given to reduce formation of the stones.
6.For struvite or "infection" stones,long term antibiotics may prevent chronic urinary infection.
Added 4th October 2008
-------------------------------------
Urinary stone:
--------------------
Melamine a chemical used for hardening plastic has found illegally in milk products in China in September 2008.
This causes urinary stones in babies.
----------------------------------
What are Urinary Stones?
----------------------------
Urinary Stones are small, solid stones which occur when salts or minerals in the urine become solid crystals inside the kidney.
How are Urinary Stones formed?
----------------------------------------
Urinary Stones are formed usually because of the accumulation of salts and minerals especially calcium in the urine.
Usually the stones may be so small that they pass out through the urine without the knowledge of the patient.
Some however become bigger due to accumulation of the salts and minerals and the concentration of the urine.
The bigger stones may remain in the tubes of the kidney and are called renal stones.
Some smaller stones may move out of the kidney and passes through the ureters which are the the tubes bringing urine from the kidney to your bladder.
These are called ureteric stones.
If a ureteric stone gets stuck in the ureter, this can cause blockage of the urine and severe pain.(ureteric colic)
What are the types of Urinary Stones?
------------------------------------------
Different kinds of Urinary stones form from different salts in the urine.
1.Calcium stones forms about 80% of the urinary stones.
50% are made up of calcium oxalate and the rest are calcium phosphate.
They are spiky or large and smooth
2.Uric acid stones are caused by accumulation of excess amounts of uric acid which can be due to eating a lot of meat.
They are smooth, brown and soft
3.Struvite stones (infection stones) are produced when there is too much ammonia in the urine occuring especially in urinary tract infection.
The bacteria that cause these urinary infections can generate ammonia.
They are usually large and have a horn-like shape
This kind of kidney stone is most often found in women.
4.Cystine stones occurs when there is high levels of cystine in the urine. A hereditary disorder called cystinuria is the source of high cystine in the urine.
They are yellow and crystalline
Who is at risk of Urinary stones formation?
--------------------------------------------
Risk factors include:
1.Men get urinary stone more commonly than women
2.a previous history of kidney stone - 50% will develop another one within five years.
3.a family history of kidney stones
4.Age between 20 and 40
5.Not drinking enough water
6.eating a diet high in protein
7.taking certain medicines such as diuretics (water tablets), antacids and thyroid medications
8.having only one kidney, or an abnormally shaped kidney
What causes Urinary Stones?
---------------------------
Urinary Stones are caused by 4 main factors:
1.Insuffient water in the urine leading to concentration and stagnation of urine flow:
a.insufficient intake of water
b.intake of alcohol causing concentration of the blood volume
2.Excess Urinary Constituents:
a. Calcium:
High calcium intake (includes calcium tablets and high calcium milk)
Primary Hyperparathyroidism leading to high blood calcium
high Vitamin D intake cause high adsorption of calcium
medical conditions such as cancer, some kidney diseases, or sarcoidosis are more likely to develop calcium stones.
b. Oxalates:
high oxalate intake (cabbage,spinach,tomatoes, chocolates) in diet leads to high concentration of oxalates in urine
c. Uric Acid:
Gout or High Uric Acid can form crystals which may lead to stones
Treatments such as chemotherapy can also increase the risk of getting uric acid stones.
d: Cystine:
Hereditary cystinuria leads to high cystine in the urine and formation of cystine stones
About one in a hundred urinary stones is due to this illness.
Cystine stones tend to appear earlier in life between the ages of 10 and 30 years.
3. Infection of urine:
clumps of bacteria can form the nucleus of the stone.
Bacteria also produce ammonia which can promote formation of stones
4. Congenital deformity of the kidney and urinary tract:
these block the passage of concentrated urine and causes formation of stones.
What are the symptoms of Urinary Stones?
------------------------------------------
Many Urinary stones do not cause any symptoms.
Once an urinary stone enters the ureter and blocks the passage of urine flow, it may cause the following symptoms:
1.severe pain or aching in the back on one or both sides
2.sudden spasms of excruciating pain which usually starts in the upper back below the ribs, radiates around the flanks of the abdomen, down to the pubes, groin and genitalia.
3.Urine is bloody, cloudy or smelly
4.frequent urge to urinate, or a burning sensation during urination
5.fever and chills
6.nausea and vomiting
Urinary stones can be passed out of the body within 48 hours.
Sometimes attacks of pain from urinary stones may last for over 30 days.
How are Urinary Stones diagnosed?
---------------------------------
1.History of ureteric colic symptoms and physical examination showing tenderness of abdomen and flanks
Other tests may be done to confirm the diagnosis and to reveal the size, location and type of stone:
2.blood tests - to identify excess amounts of certain chemicals (calcium, uric acid, oxalates, cystines) related to the formation of stones
3.urine analysis - to look for signs of infection and presence of crystals
4.X-ray of abdomen - stones that contain calcium (80%) usually appears white on X-rays
5.Intravenous urogram (IVU) - an injection of a special dye that shows up the whole urinary system on X-ray images, revealing stones that can't usually be seen
6.ultrasound scan - can detect stones in kidneys and solid internal organs
7.non-contrast helical computerised tomography - X-ray images taken at different angles - can diagnose kidney stones, and is probable the most accurate diagnostic test
How are Urinary Stones treated?
---------------------------------
Treatment depends on the
1.type and
2.cause of the stone.
Most stones can be treated without surgery:
1.Drinking lots of water (two and a half to three litres per day)
2.staying physically active are often enough to move stones smaller than about 5mm out of the urinary tract.
3.paracetamol or codeine may be given to reduce the pain.
4.Infections can be treated with antibiotics.
Stones that are stuck can be removed in several ways:
1.Extracorporeal shock wave lithotripsy (ESWL)
Location of the urinary stone is dtermined using X-ray imaging or ultrasound scanning.
The patient lies in a side position while a machine called a lithotriptor sends targeted shock waves to break up the kidney stone.
There may be some pain as the stone breaks up, so the procedure is usually performed under local anaesthesia.
2.Ureteroscopic stone removal
A narrow, flexible instrument called a cystoscope can be passed up through the urethra and bladder and up the ureter where the stone is stuck. The stone is captured and removed.It can also be broken up with a laser beam or shock waves generated by a device attached at the end of the cytoscope. This procedure is usually done under general anaesthesia.
3.Percutaneous nephrolithotomy (PCNL)
Large stones can be surgically removed from the kidney.
The surgeon makes a small opening at the back and uses a telescopic instrument called a nephroscope to pull the stone out or break it up with shock waves or a laser.
This procedure is performed under general anesthesia.
How to prevent Urinary Stones?
---------------------------------
1.drink more fluid at least three litres every 24 hours.
2.reducing the amount of calcium in the diet to a normal level(not excessively high)
3.For calcium oxalate stones, reduce intake of high levels of oxalate - chocolate, tea, cooked spinach and asparagus.
4.For uric acid stones, less meat, fish, poultry, organs, peanuts and soya beans should be taken. Daily intake of allopurinol medicine can help reduce the level of uric acid in the urine.
5.For cystine stones, medicines can be given to reduce formation of the stones.
6.For struvite or "infection" stones,long term antibiotics may prevent chronic urinary infection.
Added 4th October 2008
-------------------------------------
Urinary stone:
--------------------
Melamine a chemical used for hardening plastic has found illegally in milk products in China in September 2008.
This causes urinary stones in babies.
Friday, March 21, 2008
A Simple Guide to Gallstones
A Simple Guide to Gallstones
------------------------------
What are gallstones?
----------------------
Gallstones are stones which are found in the gallbladder which is a sac storing bile from the liver.
They are made from cholesterol and other substances in the bile.
What causes gallstones?
-------------------------
Gallstones are formed when cholesterol and other substances like calcium found in bile combine to form stones.
They are more common in
1.overweight people
2.Females more than males
What are the symptoms?
------------------------------
Most people with gallstones do not have symptoms.
Symptomsoccur when a gallstone causes blockage in the bile duct causing obstruction to flow of bile from the liver to the intestine.
The symptoms may be:
1.mild pain in the upper right part of the abdomen and also just below the sternum just like gastritis.
2.Pain in the right upper back or shoulder blade area.
3.Pain is worse when you eat.
4.fever and chills
5.Yellowness of the eyes or skin
6.Dark coloured urine
7.Chest pain occurs when the pain radiates to the chest
How are gallstones diagnosed?
--------------------------------
1.Pain in the right side of the abdomen
2. Murphy's sign positive.
A thumb pressing against the right of the epigastrium causes more pain when the patients breathes in deeply
3.An ultrasound of the right side of the abdomen is the best way to find gallstones.
Most gallstones can be detected from the ultrasound.
4.gallbladder scan. A dye is injected into a vein in your arm.
X-rays are taken as the dye moves through your liver, bile duct, gallbladder.
What are the complications of gallstones?
-------------------------------------------------
A gallsone which is stuck in the bile duct(a tube which leads the bile from the liver to the gallbladder and small intestine) can give rise to:
1.Gallbladder inflmmation or infection(Cholecystitis)
2.Swelling and inflammation of the Pancreas(pancreatitis)
3.Hepatitis due to reflux of the bile back to the liver
4.Peritonitis(inflammation of the inner lining of the abdomen) if the bile duct or gallbladder perfoates or burst.
This is an emergency.
What is the treatment of gallstones?
----------------------------------------
1.If there is no symptoms, treatment is not needed.
2.If there is mild pain, some pain and antispasmodic medicines are given.
Patient is kept for observation.
If the pain goes away, the gallsone may have become unstuck in the bile duct and pass out into the intestine.
3.If there is severe pain or recurrence of another attack of pain, it is advisable to have the gallbladder removed.
a.Normal surgery to remove the gallbladder and the gallstones involve 4 holes in the abdomen and the use of a laparoscopic to cut away the gallbladder followed by stitching.
The surgery is usually very safe and the patient may not need to be hospitalised.
b.In an emergency, such as perforated gallbladder, immediate surgery may be required to remove the gallbladder and cleared the inner abdomen of leaked bile.
What is the prognosis of gallstones?
----------------------------------------------
Most people with gallstones do not have symptoms.
Sometimes gallstones may be detected while having tests for other health problems.
Sometimes an ultrasound done on an woman during pregnancy may show gallstones.
The prognosis for patients after surgery is usually good.
The bile will go straight to the intestine from the liver.
Digestion of oily food may not as good as before and is usually not noticeable.
------------------------------
What are gallstones?
----------------------
Gallstones are stones which are found in the gallbladder which is a sac storing bile from the liver.
They are made from cholesterol and other substances in the bile.
What causes gallstones?
-------------------------
Gallstones are formed when cholesterol and other substances like calcium found in bile combine to form stones.
They are more common in
1.overweight people
2.Females more than males
What are the symptoms?
------------------------------
Most people with gallstones do not have symptoms.
Symptomsoccur when a gallstone causes blockage in the bile duct causing obstruction to flow of bile from the liver to the intestine.
The symptoms may be:
1.mild pain in the upper right part of the abdomen and also just below the sternum just like gastritis.
2.Pain in the right upper back or shoulder blade area.
3.Pain is worse when you eat.
4.fever and chills
5.Yellowness of the eyes or skin
6.Dark coloured urine
7.Chest pain occurs when the pain radiates to the chest
How are gallstones diagnosed?
--------------------------------
1.Pain in the right side of the abdomen
2. Murphy's sign positive.
A thumb pressing against the right of the epigastrium causes more pain when the patients breathes in deeply
3.An ultrasound of the right side of the abdomen is the best way to find gallstones.
Most gallstones can be detected from the ultrasound.
4.gallbladder scan. A dye is injected into a vein in your arm.
X-rays are taken as the dye moves through your liver, bile duct, gallbladder.
What are the complications of gallstones?
-------------------------------------------------
A gallsone which is stuck in the bile duct(a tube which leads the bile from the liver to the gallbladder and small intestine) can give rise to:
1.Gallbladder inflmmation or infection(Cholecystitis)
2.Swelling and inflammation of the Pancreas(pancreatitis)
3.Hepatitis due to reflux of the bile back to the liver
4.Peritonitis(inflammation of the inner lining of the abdomen) if the bile duct or gallbladder perfoates or burst.
This is an emergency.
What is the treatment of gallstones?
----------------------------------------
1.If there is no symptoms, treatment is not needed.
2.If there is mild pain, some pain and antispasmodic medicines are given.
Patient is kept for observation.
If the pain goes away, the gallsone may have become unstuck in the bile duct and pass out into the intestine.
3.If there is severe pain or recurrence of another attack of pain, it is advisable to have the gallbladder removed.
a.Normal surgery to remove the gallbladder and the gallstones involve 4 holes in the abdomen and the use of a laparoscopic to cut away the gallbladder followed by stitching.
The surgery is usually very safe and the patient may not need to be hospitalised.
b.In an emergency, such as perforated gallbladder, immediate surgery may be required to remove the gallbladder and cleared the inner abdomen of leaked bile.
What is the prognosis of gallstones?
----------------------------------------------
Most people with gallstones do not have symptoms.
Sometimes gallstones may be detected while having tests for other health problems.
Sometimes an ultrasound done on an woman during pregnancy may show gallstones.
The prognosis for patients after surgery is usually good.
The bile will go straight to the intestine from the liver.
Digestion of oily food may not as good as before and is usually not noticeable.
Friday, March 14, 2008
A Simple Guide to Vulvitis
A Simple Guide to Vulvitis
------------------------------
What is Vulvitis?
----------------------
Vulvitis is an acute inflammation of the vulva in females.
What are the causes of Vulvitis?
---------------------------------------
Vulvitis is usually caused by the following:
Infections:
1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.
2.Fungal infection such as candidiasis
3.Herpes simplex in recurrent cases
4.Pediculosis pubis or lice
5.pinworm infection in children
6.Urinary infection such as cystitis
Allergies:
1.Clothings
2.perfumes
3.powders
4.drugs
Chemical irritants:
1.vaginal douche
2.detergents used to wash underwear
Mechanical irritants:
1.ill fitting underwear
2.inadequate sexual lubrication
Postmenopausal:
Atrophic vulvovaginitis after menopausal with dryness and inflammation of the vulval and vaginal lining
Generalised disorders:
Dermatological disorders such as lichen simplex
What are the symptoms and signs of Vulvitis?
------------------------------------------------
Persons who has Acute Vulvitis has the following
Symptoms:
1.vulval irritation and itch
2.discharge from vagina
3.painful or frequency of urination
4.excoriation of the inner lining of vulva
Signs:
1.discharge can be seen in female vagina
2.redness and inflammation of the vulva
How do you diagnose Vulvitis?
--------------------------------
Diagnosis can usually be made by :
1.History of vulval itch associated frequency of urination, painful urination or discharge from vagina
2.Vulva shows inflammation, excoriation of lining,
3.Vulval and vaginal swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
4. biopsy of the suspicious vulval lesions to exclude other causes of vulval problem such as tumor
What is the treatment of Vulvitis?
-------------------------------------
1.Approprate Antibiotics, antifungal for infections especially after urine bacterial culture
2.Antihistamine medicine for itch
3.Topical oestrogen cream for postmenopausal atrophic vulvovaginitis
4.Proper hygience after urination, sexual intercourse and bathing
5.Avoid strong soaps
6.Use of lubricants during sexual intercourse
7.Weight reduction if obese
8.Treat underlying condition such as diabetes,allergic dermatitis,other skin
conditions.
What is the prognosis of Vulvitis?
----------------------------------------
Prognosis is usually good with medication.
Sexual partner may need to be treated.
Recurrence is quite common.
------------------------------
What is Vulvitis?
----------------------
Vulvitis is an acute inflammation of the vulva in females.
What are the causes of Vulvitis?
---------------------------------------
Vulvitis is usually caused by the following:
Infections:
1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.
2.Fungal infection such as candidiasis
3.Herpes simplex in recurrent cases
4.Pediculosis pubis or lice
5.pinworm infection in children
6.Urinary infection such as cystitis
Allergies:
1.Clothings
2.perfumes
3.powders
4.drugs
Chemical irritants:
1.vaginal douche
2.detergents used to wash underwear
Mechanical irritants:
1.ill fitting underwear
2.inadequate sexual lubrication
Postmenopausal:
Atrophic vulvovaginitis after menopausal with dryness and inflammation of the vulval and vaginal lining
Generalised disorders:
Dermatological disorders such as lichen simplex
What are the symptoms and signs of Vulvitis?
------------------------------------------------
Persons who has Acute Vulvitis has the following
Symptoms:
1.vulval irritation and itch
2.discharge from vagina
3.painful or frequency of urination
4.excoriation of the inner lining of vulva
Signs:
1.discharge can be seen in female vagina
2.redness and inflammation of the vulva
How do you diagnose Vulvitis?
--------------------------------
Diagnosis can usually be made by :
1.History of vulval itch associated frequency of urination, painful urination or discharge from vagina
2.Vulva shows inflammation, excoriation of lining,
3.Vulval and vaginal swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
4. biopsy of the suspicious vulval lesions to exclude other causes of vulval problem such as tumor
What is the treatment of Vulvitis?
-------------------------------------
1.Approprate Antibiotics, antifungal for infections especially after urine bacterial culture
2.Antihistamine medicine for itch
3.Topical oestrogen cream for postmenopausal atrophic vulvovaginitis
4.Proper hygience after urination, sexual intercourse and bathing
5.Avoid strong soaps
6.Use of lubricants during sexual intercourse
7.Weight reduction if obese
8.Treat underlying condition such as diabetes,allergic dermatitis,other skin
conditions.
What is the prognosis of Vulvitis?
----------------------------------------
Prognosis is usually good with medication.
Sexual partner may need to be treated.
Recurrence is quite common.
Monday, March 10, 2008
A Simple Guide to Urethritis
A Simple Guide to Urethritis
------------------------------
What is Urethritis?
----------------------
Urethritis is an acute infection of the urethra(the tube which allows passage of urine from the bladder to the outside).
What are the causes of Urethritis?
---------------------------------------
Urethritis is usually caused by the following:
1.sexually transmitted disease like gonorrhea and chlamydia.
2.Urinary infection such as cystitis
3.In males associated with prostatitis
4.Urinary stone stuck in the urethra may cause urethitis
6.urinary catheterisation
7.Injury to the urethra
8.Important component of Reiter's Syndrome
What are the symptoms and signs of Urethritis?
------------------------------------------------
Persons who has Acute Urethritis has the following
Symptoms:
------------------
1.painful urination
2.purulent discharge from penis in males or vagina in females
3.frequency of urination
4.cloudy and unpleasant smelling urine, sometimes blood in the urine
5.fever and chills
6.Polyathritis and conjunctivitis in Reiter's Syndrome
Signs:
------
1. pussy discharge can be seen in male's urethra or in female vagina
2.redness and inflammation of the opening of the urethra
How do you diagnose Urethritis?
--------------------------------
Diagnosis can usually be made by :
1.History of sexual activity followed by frequency of urination, painful urination or pussy discharge from urethra or vagina
2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms
3.Urine culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
4. cystoscopy may be necessary to exclude urinary stones,tumours of the bladder in the case of blood in the urine
What is the complications of Urethritis?
-------------------------------------
Upward infections from the urethra can lead to infections of the bladder and kidneys.
What is the treatment of Urethritis?
-------------------------------------
Analgesic medicine for pain
Approprate Antibiotics for infections especially after urine bacterial culture
Lots of fluids
What is the prognosis of Urethritis?
----------------------------------------
Prognosis is usually good with medication.
Sexual partner may need to be treated.
Recurrence is quite common.
------------------------------
What is Urethritis?
----------------------
Urethritis is an acute infection of the urethra(the tube which allows passage of urine from the bladder to the outside).
What are the causes of Urethritis?
---------------------------------------
Urethritis is usually caused by the following:
1.sexually transmitted disease like gonorrhea and chlamydia.
2.Urinary infection such as cystitis
3.In males associated with prostatitis
4.Urinary stone stuck in the urethra may cause urethitis
6.urinary catheterisation
7.Injury to the urethra
8.Important component of Reiter's Syndrome
What are the symptoms and signs of Urethritis?
------------------------------------------------
Persons who has Acute Urethritis has the following
Symptoms:
------------------
1.painful urination
2.purulent discharge from penis in males or vagina in females
3.frequency of urination
4.cloudy and unpleasant smelling urine, sometimes blood in the urine
5.fever and chills
6.Polyathritis and conjunctivitis in Reiter's Syndrome
Signs:
------
1. pussy discharge can be seen in male's urethra or in female vagina
2.redness and inflammation of the opening of the urethra
How do you diagnose Urethritis?
--------------------------------
Diagnosis can usually be made by :
1.History of sexual activity followed by frequency of urination, painful urination or pussy discharge from urethra or vagina
2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms
3.Urine culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
4. cystoscopy may be necessary to exclude urinary stones,tumours of the bladder in the case of blood in the urine
What is the complications of Urethritis?
-------------------------------------
Upward infections from the urethra can lead to infections of the bladder and kidneys.
What is the treatment of Urethritis?
-------------------------------------
Analgesic medicine for pain
Approprate Antibiotics for infections especially after urine bacterial culture
Lots of fluids
What is the prognosis of Urethritis?
----------------------------------------
Prognosis is usually good with medication.
Sexual partner may need to be treated.
Recurrence is quite common.
Saturday, March 8, 2008
A Simple Guide to Prostatitis
A Simple Guide to Prostatitis
------------------------------
What is Prostatitis?
----------------------
Prostatitis is an acute or chronic infection of the prostate gland.
What are the causes of Prostatitis?
------------------------------
Prostatitis is usually caused by the following:
1.enteric Gram negative organism from intestinal or bladder infection
2.tuberculosis occasionally
What are the symptoms and signs of Prostatitis?
---------------------------------------------------
Persons who has Acute Prostatitis has the following:
Symptoms:
1.frequency of urination and nocturia
2.urgency of urination
3.hematuria(blood in urine)
4.low back pain
5.perineal pain
6.slow initiation of urine
Signs:
Tenderness on palpation of the prostate per rectum
How do you diagnose Prostatitis?
--------------------------------
Diagnosis can usually be made by :
1.History of frequency of urination, urgent urination
2.Tenderness on palpation of the prostate per rectum
3. Culture of the expressed prostatic fluid by prostatic massage
4.Urine and prostatic fluid culture will determine the micro-organism involved and the antibiotic most appropriate for it.
What is the complications of Prostatitis?
-------------------------------------
Infections from the prostate can lead to infections of the bladder and up to the kidney.
What is the treatment of Prostatitis?
-------------------------------------
Analgesic medicine
Antibiotics for infections especially after urine and prostatic fluid bacterial culture
Lots of fluids
What is the prognosis of Prostatitis?
----------------------------------------
Prognosis is usually good with medication.
Recurrence is quite common.
------------------------------
What is Prostatitis?
----------------------
Prostatitis is an acute or chronic infection of the prostate gland.
What are the causes of Prostatitis?
------------------------------
Prostatitis is usually caused by the following:
1.enteric Gram negative organism from intestinal or bladder infection
2.tuberculosis occasionally
What are the symptoms and signs of Prostatitis?
---------------------------------------------------
Persons who has Acute Prostatitis has the following:
Symptoms:
1.frequency of urination and nocturia
2.urgency of urination
3.hematuria(blood in urine)
4.low back pain
5.perineal pain
6.slow initiation of urine
Signs:
Tenderness on palpation of the prostate per rectum
How do you diagnose Prostatitis?
--------------------------------
Diagnosis can usually be made by :
1.History of frequency of urination, urgent urination
2.Tenderness on palpation of the prostate per rectum
3. Culture of the expressed prostatic fluid by prostatic massage
4.Urine and prostatic fluid culture will determine the micro-organism involved and the antibiotic most appropriate for it.
What is the complications of Prostatitis?
-------------------------------------
Infections from the prostate can lead to infections of the bladder and up to the kidney.
What is the treatment of Prostatitis?
-------------------------------------
Analgesic medicine
Antibiotics for infections especially after urine and prostatic fluid bacterial culture
Lots of fluids
What is the prognosis of Prostatitis?
----------------------------------------
Prognosis is usually good with medication.
Recurrence is quite common.
Monday, March 3, 2008
A Simple Guide to PECOMA Cancer
A Simple Guide to PECOMA Cancer
-----------------------------------------
What are PECOMA Cancer?
-------------------------------------
Perivascular epithelioid cell tumor (PEComa) is a neoplasm composed chiefly of HMB-45-positive(a marker which is relatively specific for melanoma) epithelioid cells with clear to granular cytoplasm and a perivascular distribution.
Such tumors have been reported in different organs
Although rare, only 20 + cases worldwide, PEC tumors (PEComas) should be regarded as a tumor of uncertain malignant potential.
Who is at risk of getting PECOMA Cancers?
------------------------------------------------------------
The median patient age was 46 years (range, 15-97 years).
There is a marked female predominance (22 females, 4 males).
Sites of involvement included
1.the omentum or mesentery (6 cases),
2.uterus (4 cases),
3.pelvic soft tissues (3 cases),
4.abdominal wall (2 cases),
5.uterine cervix (2 cases),
6.vagina,(1 case).
7.retroperitoneum,(1 case).
8.thigh,(1 case).
9.falciform ligament,(1 case).
10.scalp,(1 case).
11.broad ligament,(1 case).
12.forearm, (1 case).
13.shoulder,(1 case).
14.neck (1 case).
The tumors ranged from 1.6 to 29 cm in size (median, 7.8 cm).
Tumors were
1.epithelioid (N = 9),
2.spindled (N = 7), or
3.mixed (N = 10).
What are the Symptoms of Pecoma Cancer?
---------------------------------------------------------
Among the common warning signs are:
1.weight loss,
2.pain in the bones
3.swelling of lymph nodes
4.Persistent fever
5.loss of appetite
6.generalised weakness and pallour
What are the Causes of Pecoma Cancer?
----------------------------------------------------------
Unknown.
Certain genetic abnormalities may be present.
They are more common in women.
How do you diagnose Pecoma Cancer?
-------------------------------------------------
1.HMB-45-positive(a marker which is relatively specific for melanoma)is present in all cases
2.Perivascular epithelioid cell present on biopsy
What is the Treatment of Pecoma Cancer?
-----------------------------------------------------
The onset of PEComa Cancer has been known to be very rapid.
Because of its vascular origin, it can spread very fast.
Surgery will be useful if detected at the early stage.
Chemotherapy and radiation therapy are the main treatment for Pecoma cancer.
Besides these treatments, stem cells infusion also give patients and their families another source for a cure.
What are the Prognosis for Pecoma Cancer?
-----------------------------------------------------------------------
Generally poor because onset is fast and spread diffuse.
-----------------------------------------
What are PECOMA Cancer?
-------------------------------------
Perivascular epithelioid cell tumor (PEComa) is a neoplasm composed chiefly of HMB-45-positive(a marker which is relatively specific for melanoma) epithelioid cells with clear to granular cytoplasm and a perivascular distribution.
Such tumors have been reported in different organs
Although rare, only 20 + cases worldwide, PEC tumors (PEComas) should be regarded as a tumor of uncertain malignant potential.
Who is at risk of getting PECOMA Cancers?
------------------------------------------------------------
The median patient age was 46 years (range, 15-97 years).
There is a marked female predominance (22 females, 4 males).
Sites of involvement included
1.the omentum or mesentery (6 cases),
2.uterus (4 cases),
3.pelvic soft tissues (3 cases),
4.abdominal wall (2 cases),
5.uterine cervix (2 cases),
6.vagina,(1 case).
7.retroperitoneum,(1 case).
8.thigh,(1 case).
9.falciform ligament,(1 case).
10.scalp,(1 case).
11.broad ligament,(1 case).
12.forearm, (1 case).
13.shoulder,(1 case).
14.neck (1 case).
The tumors ranged from 1.6 to 29 cm in size (median, 7.8 cm).
Tumors were
1.epithelioid (N = 9),
2.spindled (N = 7), or
3.mixed (N = 10).
What are the Symptoms of Pecoma Cancer?
---------------------------------------------------------
Among the common warning signs are:
1.weight loss,
2.pain in the bones
3.swelling of lymph nodes
4.Persistent fever
5.loss of appetite
6.generalised weakness and pallour
What are the Causes of Pecoma Cancer?
----------------------------------------------------------
Unknown.
Certain genetic abnormalities may be present.
They are more common in women.
How do you diagnose Pecoma Cancer?
-------------------------------------------------
1.HMB-45-positive(a marker which is relatively specific for melanoma)is present in all cases
2.Perivascular epithelioid cell present on biopsy
What is the Treatment of Pecoma Cancer?
-----------------------------------------------------
The onset of PEComa Cancer has been known to be very rapid.
Because of its vascular origin, it can spread very fast.
Surgery will be useful if detected at the early stage.
Chemotherapy and radiation therapy are the main treatment for Pecoma cancer.
Besides these treatments, stem cells infusion also give patients and their families another source for a cure.
What are the Prognosis for Pecoma Cancer?
-----------------------------------------------------------------------
Generally poor because onset is fast and spread diffuse.
Sunday, March 2, 2008
A Simple Guide to Chikungunya Fever
A Simple Guide to Chikungunya Fever
--------------------------------------
What is Chikungunya Fever?
-------------------------------
Chikungunya fever is an acute illness caused by the chikungunya virus transmitted to humans by the bite of an infected Aedes mosquito.
How is the Chikungunya Fever transmitted?
-----------------------------------------
Chikungunya virus is transmitted to humans by the bite of infected Aedes mosquito.
Monkeys and other wild animals may be possible source of the virus.
Infected mosquitoes will spread the virus to other humans when they bite their skin.
The condition was first detected in Eastern Africa in the 1950 and recently has also outbreaks in India, Africa, Indonesia and Malaysia.
What are the Symptoms of chikungunya fever?
-----------------------------------------------
The incubation period in mosquito is 3-5 days and 1-12 days in humans.
Symptoms usually last 3-10 days.
Symptoms may be the same as denque fever:
1.fever of sudden onset
2.severe and prolonged joint pains with or without swelling
3.muscle pain
4.headache
5.chills
6.rash -no petechiae, more of a maculopaular rash
7.fatigue
8.nausea
9.vomiting.
The most severe symptom is the severe and prolonged joint pains which can even last up to 1 month.
Unlike dengue fever,there has been no documented cases of hemorrhagic (bleeding) or shock syndrome reported in chikungunya infection.
The chikungunya virus also does not affect the nervous system.
How do you diagnose chikungunya fever?
---------------------------------------
Diagnosis is made on the basis of :
1.high fever
2.severe and prolonged joint pain
3.blood tests for chikungunya fever
What is the treatment for chikungunya fever?
-------------------------------------------------
There is at present no specific medication or vaccine to treat chikungunya fever.
TREATMENT IS THEREFORE SYMPTOMATIC:
1.rest,
2.plenty of fluids and
3.pain medication such as paracetamol may relieve symptoms of joint pain, body aches and fever.
Aspirin and NSAIDs should be avoided if possible.
What is the prognosis of chikungunya fever?
--------------------------------------------
The illness is usually self-limiting.
Most symptoms lasts for 3-10 days and the joint pain may last for weeks to months.
Rarely does it cause death(through high fever and dehydration).
How can you prevent being infected with the chikungunya virus?
---------------------------------------------------------------------
The best way to prevent chikungunya infection is to avoid bites from the Aedes Mosquito.
Preventive measures are the same as dengue fever such as getting rid of mosquito breeding places.
--------------------------------------
What is Chikungunya Fever?
-------------------------------
Chikungunya fever is an acute illness caused by the chikungunya virus transmitted to humans by the bite of an infected Aedes mosquito.
How is the Chikungunya Fever transmitted?
-----------------------------------------
Chikungunya virus is transmitted to humans by the bite of infected Aedes mosquito.
Monkeys and other wild animals may be possible source of the virus.
Infected mosquitoes will spread the virus to other humans when they bite their skin.
The condition was first detected in Eastern Africa in the 1950 and recently has also outbreaks in India, Africa, Indonesia and Malaysia.
What are the Symptoms of chikungunya fever?
-----------------------------------------------
The incubation period in mosquito is 3-5 days and 1-12 days in humans.
Symptoms usually last 3-10 days.
Symptoms may be the same as denque fever:
1.fever of sudden onset
2.severe and prolonged joint pains with or without swelling
3.muscle pain
4.headache
5.chills
6.rash -no petechiae, more of a maculopaular rash
7.fatigue
8.nausea
9.vomiting.
The most severe symptom is the severe and prolonged joint pains which can even last up to 1 month.
Unlike dengue fever,there has been no documented cases of hemorrhagic (bleeding) or shock syndrome reported in chikungunya infection.
The chikungunya virus also does not affect the nervous system.
How do you diagnose chikungunya fever?
---------------------------------------
Diagnosis is made on the basis of :
1.high fever
2.severe and prolonged joint pain
3.blood tests for chikungunya fever
What is the treatment for chikungunya fever?
-------------------------------------------------
There is at present no specific medication or vaccine to treat chikungunya fever.
TREATMENT IS THEREFORE SYMPTOMATIC:
1.rest,
2.plenty of fluids and
3.pain medication such as paracetamol may relieve symptoms of joint pain, body aches and fever.
Aspirin and NSAIDs should be avoided if possible.
What is the prognosis of chikungunya fever?
--------------------------------------------
The illness is usually self-limiting.
Most symptoms lasts for 3-10 days and the joint pain may last for weeks to months.
Rarely does it cause death(through high fever and dehydration).
How can you prevent being infected with the chikungunya virus?
---------------------------------------------------------------------
The best way to prevent chikungunya infection is to avoid bites from the Aedes Mosquito.
Preventive measures are the same as dengue fever such as getting rid of mosquito breeding places.
Saturday, March 1, 2008
A Simple Guide to Dengue Fever
A Simple Guide to Dengue Fever
--------------------------------
What is dengue fever?
------------------------
Dengue fever is a acute viral infection caused by the dengue virus which is transmitted by the bite of an infected female Aedes msoquito.
What are the Types of Dengue Fever?
----------------------------------------------------
The dengue virus has 4 strains called serotypes 1, 2, 3 and 4.
An infection with one serotype does not protect you from the other serotypes.
A second dengue infection, especially with serotype 2, can cause an even worse infection such as Dengue Haemorrhagic Fever and Dengue Shock Syndrome which can be fatal.
What are the Symptoms of Dengue Fever?
----------------------------------------
The incubation period in mosquito is 8-12 days and 3-14 days in humans.
Symptoms usually last 3-14 days.
1.High, acute, prolonged fever (usually lasts for 5 to 7 days)
2.Severe headache
3.Pain behind the eyes
4.Muscle and joint pains
5.Rashes
6.Nausea , vomiting
7.Abdominal discomfort
8.Loss of appetite
9.Fatigue
10.Diarrhoea
A rash usually appears 3-4 days after the fever.
There are 3 types of dengue rash.
1.Petechial Rash:
----------------
This is the most common with the petechial rash appearing as red dots under the skin.
The rashes are usually found on the limbs and lower abdomen and is due to the bleeding under the skin.
2.Diffuse erythematous rash with areas of normal skin:
----------------------------------------------------
The whole skin becomes reddish with scattered, small areas of normal skin .
3.Maculopapular rash:
--------------------
The last type of rash appears as red flat or raised leisons(Maculopaular).
The rash can be itchy .
What are the Complications of Dengue Fever?
------------------------------------------
The complications of Dengue Fever are:
1.Dengue Hemorrhagic Fever
---------------------------------------------
a. Fever
b.bleeding likely to occur from the nose, mouth, and gums.
Bruises and ecchymosis may appear as a sign of bleeding under the skin.
There are small red spots on the skin.
c.the urine may contain blood.
d.vomiting of blood and malena(black stools) indicate bleeding in the stomach.
e.low plalelet count of <100,000
f.Hypoalbuminaemia
g.pleural effusion
h.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain
2. Dengue Shock Syndrome
-----------------------------
Without prompt treatment for the bleeding, the person can go into
a.shock
b.hypotension
c.narrowed pulse pressure(< 2omm Hg)
d.impaired organ perfusion which result in organ failure and death.
Dengue Haemorrhagic Fever and Dengue Shock Syndrome is fatal in about 5 percent of the cases, mostly among children and young adults.
How do you diagnose Dengue Fever?
---------------------------------
1.History of acute fever and bleeding signs
2.A low platelet count (<100,000)is suggestive of dengue fever.
3.Specific blood test(IgG and IgM antibody) for dengue virus can also be conducted. IgM antibodies occur on the 5th day of illness and last for 2 months.
What is the treatment of dengue fever?
-----------------------------------------
There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the dengue virus.
Treatment is mainly supportive.
1. Rest
2.drinking lots of water to prevent dehydration will help.
3.Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.
4. Intravenous fluids for hypotension and dehydration.
5.Daily blood tests (platelets and hematocrit)may be necessary to monitor the risk of bleeding
6. Platelets transfusion when the the platelet count is less than 20,000.
The illness can last up to 10 days, but complete recovery can take as long as a month.
How is dengue fever spread?
-----------------------------
Dengue Fever is spread only through the bite of the infected Aedes mosquitoes.
The transmission cycle for dengue starts when:
1.Infected Aedes mosquito bites a healthy person.
2.4-7 days later,the infected person develops fever
3..When fever starts, the person is infectious for about 5 days.
4.If an Aedes mosquito bites the person during this time when he is infectious, it will be infected by the the dengue virus.
5.The virus will multiply in the second mosquito for 5-7 days.
6.The mosquito then becomes infective.
7.The cycle starts again when it bites another person.
How can you prevent being infected with the dengue virus?
----------------------------------------------------------
To prevent dengue fever, you must prevent the breeding of its carrier, the Aedes mosquitoes.
This will be explained another time
--------------------------------
What is dengue fever?
------------------------
Dengue fever is a acute viral infection caused by the dengue virus which is transmitted by the bite of an infected female Aedes msoquito.
What are the Types of Dengue Fever?
----------------------------------------------------
The dengue virus has 4 strains called serotypes 1, 2, 3 and 4.
An infection with one serotype does not protect you from the other serotypes.
A second dengue infection, especially with serotype 2, can cause an even worse infection such as Dengue Haemorrhagic Fever and Dengue Shock Syndrome which can be fatal.
What are the Symptoms of Dengue Fever?
----------------------------------------
The incubation period in mosquito is 8-12 days and 3-14 days in humans.
Symptoms usually last 3-14 days.
1.High, acute, prolonged fever (usually lasts for 5 to 7 days)
2.Severe headache
3.Pain behind the eyes
4.Muscle and joint pains
5.Rashes
6.Nausea , vomiting
7.Abdominal discomfort
8.Loss of appetite
9.Fatigue
10.Diarrhoea
A rash usually appears 3-4 days after the fever.
There are 3 types of dengue rash.
1.Petechial Rash:
----------------
This is the most common with the petechial rash appearing as red dots under the skin.
The rashes are usually found on the limbs and lower abdomen and is due to the bleeding under the skin.
2.Diffuse erythematous rash with areas of normal skin:
----------------------------------------------------
The whole skin becomes reddish with scattered, small areas of normal skin .
3.Maculopapular rash:
--------------------
The last type of rash appears as red flat or raised leisons(Maculopaular).
The rash can be itchy .
What are the Complications of Dengue Fever?
------------------------------------------
The complications of Dengue Fever are:
1.Dengue Hemorrhagic Fever
---------------------------------------------
a. Fever
b.bleeding likely to occur from the nose, mouth, and gums.
Bruises and ecchymosis may appear as a sign of bleeding under the skin.
There are small red spots on the skin.
c.the urine may contain blood.
d.vomiting of blood and malena(black stools) indicate bleeding in the stomach.
e.low plalelet count of <100,000
f.Hypoalbuminaemia
g.pleural effusion
h.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain
2. Dengue Shock Syndrome
-----------------------------
Without prompt treatment for the bleeding, the person can go into
a.shock
b.hypotension
c.narrowed pulse pressure(< 2omm Hg)
d.impaired organ perfusion which result in organ failure and death.
Dengue Haemorrhagic Fever and Dengue Shock Syndrome is fatal in about 5 percent of the cases, mostly among children and young adults.
How do you diagnose Dengue Fever?
---------------------------------
1.History of acute fever and bleeding signs
2.A low platelet count (<100,000)is suggestive of dengue fever.
3.Specific blood test(IgG and IgM antibody) for dengue virus can also be conducted. IgM antibodies occur on the 5th day of illness and last for 2 months.
What is the treatment of dengue fever?
-----------------------------------------
There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the dengue virus.
Treatment is mainly supportive.
1. Rest
2.drinking lots of water to prevent dehydration will help.
3.Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.
4. Intravenous fluids for hypotension and dehydration.
5.Daily blood tests (platelets and hematocrit)may be necessary to monitor the risk of bleeding
6. Platelets transfusion when the the platelet count is less than 20,000.
The illness can last up to 10 days, but complete recovery can take as long as a month.
How is dengue fever spread?
-----------------------------
Dengue Fever is spread only through the bite of the infected Aedes mosquitoes.
The transmission cycle for dengue starts when:
1.Infected Aedes mosquito bites a healthy person.
2.4-7 days later,the infected person develops fever
3..When fever starts, the person is infectious for about 5 days.
4.If an Aedes mosquito bites the person during this time when he is infectious, it will be infected by the the dengue virus.
5.The virus will multiply in the second mosquito for 5-7 days.
6.The mosquito then becomes infective.
7.The cycle starts again when it bites another person.
How can you prevent being infected with the dengue virus?
----------------------------------------------------------
To prevent dengue fever, you must prevent the breeding of its carrier, the Aedes mosquitoes.
This will be explained another time
Thursday, February 28, 2008
A Simple Guide to Stomatitis
A Simple Guide to Stomatitis
-----------------------------------
What is Stomatitis?
--------------------------
Stomatitis means inflammation of the mouth
What are the Causes of Stomatitis?
---------------------------------------------
There are many many disorders which can cause Stomatitis:
1.Bacteria, viruses, fungus
2.avitaminosis
3.leukemia,agranulocytosis
4.Dental problems,poor fitting denture, poor dental hygience
5.smoking
6.medicines: phenytoin, iodides, barbiturates
7.stress
What are the Symptoms of Stomatitis?
----------------------------------------------
Stomatitis usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.
It may begin with a tingling or burning sensation, followed by a red hyperemia of the inside of the lining of the cheek, gums or tongues.
The inflamed surfaces may develop into ulcers
Occasionally, a severe occurrence may be accompanied by fever,lymphadenopathy and lethargy.
Most mouth inflammation is not infectious except bacterial,fungal and viral infections.
Oral mucosal smears may be necessary to determine those with bacterial or fungal infections.
What is the Treatment of Stomatitis?
-------------------------------------------
The exact treatment will depend on the cause of the Stomatitis.
Sometimes all that is required is to remove the cause of the Stomatitis such as an ill fitting denture.
The following measures may help to reduce pain from Stomatitis:
Proper oral hygience:
---------------------
1.keep your mouth clean at all times,
2.avoid foods that are spicy, acidic, salty or particularly hot or cold, which can make the symptoms worse,
3.eat a healthy diet that includes fresh fruit and vegetables,
4.gargle with warm salt water,
5.use a diluted chlorhexidine mouthwash once a day to help reduce the length of time the stomatitis last.
6.sprays and rinses are also available for pain relief.
Medical treatment:
-------------------
The main treatment of the Stomatitis is application of topical corticosteroids (Kenalog in orabase or Oracorte E), or other soothing preparations.
Where bacteria are present the appropriate antibiotic will treat the Stomatitis.
Antifungal agents are used to treat fungal infection.
Vitamin B replacements are important in cases due to deficiency of the vitamins.
Underlying condition:
-------------------
Treatment of systemic condition causing the Stomatitis such as leukemia,
What are the Prevention measures in Stomatitis?
---------------------------------------------------------
Good oral hygiene may help in the prevention of some types of stomatitis or complications from stomatitis.
This includes brushing the teeth at least twice per day, flossing at least daily, and going for regular dental checkup and cleaning.
Try to avoid getting run down by making sure you eat a balanced diet, take regular exercise and learn to manage stress.
What is the prognosis of the Stomatitis?
---------------------------------------------
The outlook for most stomatitis is good.
Those with underlying condition such as leukemia will improve with treatment of the illness.
-----------------------------------
What is Stomatitis?
--------------------------
Stomatitis means inflammation of the mouth
What are the Causes of Stomatitis?
---------------------------------------------
There are many many disorders which can cause Stomatitis:
1.Bacteria, viruses, fungus
2.avitaminosis
3.leukemia,agranulocytosis
4.Dental problems,poor fitting denture, poor dental hygience
5.smoking
6.medicines: phenytoin, iodides, barbiturates
7.stress
What are the Symptoms of Stomatitis?
----------------------------------------------
Stomatitis usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.
It may begin with a tingling or burning sensation, followed by a red hyperemia of the inside of the lining of the cheek, gums or tongues.
The inflamed surfaces may develop into ulcers
Occasionally, a severe occurrence may be accompanied by fever,lymphadenopathy and lethargy.
Most mouth inflammation is not infectious except bacterial,fungal and viral infections.
Oral mucosal smears may be necessary to determine those with bacterial or fungal infections.
What is the Treatment of Stomatitis?
-------------------------------------------
The exact treatment will depend on the cause of the Stomatitis.
Sometimes all that is required is to remove the cause of the Stomatitis such as an ill fitting denture.
The following measures may help to reduce pain from Stomatitis:
Proper oral hygience:
---------------------
1.keep your mouth clean at all times,
2.avoid foods that are spicy, acidic, salty or particularly hot or cold, which can make the symptoms worse,
3.eat a healthy diet that includes fresh fruit and vegetables,
4.gargle with warm salt water,
5.use a diluted chlorhexidine mouthwash once a day to help reduce the length of time the stomatitis last.
6.sprays and rinses are also available for pain relief.
Medical treatment:
-------------------
The main treatment of the Stomatitis is application of topical corticosteroids (Kenalog in orabase or Oracorte E), or other soothing preparations.
Where bacteria are present the appropriate antibiotic will treat the Stomatitis.
Antifungal agents are used to treat fungal infection.
Vitamin B replacements are important in cases due to deficiency of the vitamins.
Underlying condition:
-------------------
Treatment of systemic condition causing the Stomatitis such as leukemia,
What are the Prevention measures in Stomatitis?
---------------------------------------------------------
Good oral hygiene may help in the prevention of some types of stomatitis or complications from stomatitis.
This includes brushing the teeth at least twice per day, flossing at least daily, and going for regular dental checkup and cleaning.
Try to avoid getting run down by making sure you eat a balanced diet, take regular exercise and learn to manage stress.
What is the prognosis of the Stomatitis?
---------------------------------------------
The outlook for most stomatitis is good.
Those with underlying condition such as leukemia will improve with treatment of the illness.
Tuesday, February 19, 2008
A Simple Guide to Cystitis
A Simple Guide to Cystitis
------------------------------
What is Cystitis?
----------------------
Cystitis is an acute or chronic infection of the urinary bladder.
What are the causes of Cystitis?
------------------------------
Cystitis is usually caused by the following:
1. ascending infection of the urinary bladder from the urethra.
2. in females frequently associated with sexual activity eg. honeymoon cystitis
3.In males with enlargement of the prostate or infection of the prostate
4. In children, the bacteria E.coli of the same type as the child's bowels
5.More frequently present in Diabetic patients
6.procedures such as urinary catheterisation
7.cystitis is more common in the female,especially those on contraceptive pills or with intrauterine contraceptive devices.
8. may be associated with congenital abnormalities of the urinary tract such as bladder neck obstruction,urethral reflux,neurogenic bladder,and urinary incontinence.
What are the symptoms and signs of Cystitis?
-------------------------------------
Persons who has Acute Cystitis has the following symptoms:
1.frequency of urination and nocturia
2.painful urination
3.suprapubic discomfort
4.cloudy and unpleasant smelling urine, sometimes blood in the urine
5.fever and chills especially in children
Signs:
Tenderness on palpation in the suprapubic region
How do you diagnose Cystitis?
--------------------------------
Diagnosis can usually be made by :
1.History of frequency of urination, painful urination
2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms
3.Urine culture will determine the micro-organism involved and the antibiotic most appropriate for it.
4. cystoscopy may be necessary to exclude tumours of the bladder
What are the complications of Cystitis?
-------------------------------------
Upward infections from the bladder can lead to infections of the kidneys and kidney failure.
What is the treatment of Cystitis?
-------------------------------------
Analgesic or antispasmodic medicine
Antibiotics for infections especially after urine bacterial culture
Lots of fluids
What is the prognosis of Cystitis?
----------------------------------------
Prognosis is usually good with medication.
Recurrence is quite common.
cystitis,frequency,painful,nocturia,sexual activity,antibiotics,analgesic, cystoscopy, urine test, bacteria culture,prostate
------------------------------
What is Cystitis?
----------------------
Cystitis is an acute or chronic infection of the urinary bladder.
What are the causes of Cystitis?
------------------------------
Cystitis is usually caused by the following:
1. ascending infection of the urinary bladder from the urethra.
2. in females frequently associated with sexual activity eg. honeymoon cystitis
3.In males with enlargement of the prostate or infection of the prostate
4. In children, the bacteria E.coli of the same type as the child's bowels
5.More frequently present in Diabetic patients
6.procedures such as urinary catheterisation
7.cystitis is more common in the female,especially those on contraceptive pills or with intrauterine contraceptive devices.
8. may be associated with congenital abnormalities of the urinary tract such as bladder neck obstruction,urethral reflux,neurogenic bladder,and urinary incontinence.
What are the symptoms and signs of Cystitis?
-------------------------------------
Persons who has Acute Cystitis has the following symptoms:
1.frequency of urination and nocturia
2.painful urination
3.suprapubic discomfort
4.cloudy and unpleasant smelling urine, sometimes blood in the urine
5.fever and chills especially in children
Signs:
Tenderness on palpation in the suprapubic region
How do you diagnose Cystitis?
--------------------------------
Diagnosis can usually be made by :
1.History of frequency of urination, painful urination
2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms
3.Urine culture will determine the micro-organism involved and the antibiotic most appropriate for it.
4. cystoscopy may be necessary to exclude tumours of the bladder
What are the complications of Cystitis?
-------------------------------------
Upward infections from the bladder can lead to infections of the kidneys and kidney failure.
What is the treatment of Cystitis?
-------------------------------------
Analgesic or antispasmodic medicine
Antibiotics for infections especially after urine bacterial culture
Lots of fluids
What is the prognosis of Cystitis?
----------------------------------------
Prognosis is usually good with medication.
Recurrence is quite common.
cystitis,frequency,painful,nocturia,sexual activity,antibiotics,analgesic, cystoscopy, urine test, bacteria culture,prostate
Wednesday, February 13, 2008
A Simple Guide to Cholera
A Simple Guide to Cholera
---------------------------------
What is Cholera?
---------------------------
Cholera is an acute infectious illness caused by the Vibrio cholorae bacteria.
What is the cause of Cholera?
----------------------------------
The bacteria which causes Cholera is the Vibrio cholorae which is an extremely hardy bacteria able to live in polluted water and contaminated food.
There are 2 main types of cholera bacteria:
1.the Classic short slightly curved Gram negative aerobic rods
2.The El Tor strain which is hardier,persists longer in nature and is more likely to cause carrier states in humans.
Incubation period is 12 hours to 6 days.
What are symptoms of Cholera?
----------------------------------------------
The main symptoms of Cholera are
1. Vomiting after 12 hours of ingestion of bacteria
2. abrupt painless rice water diarrhoea
3. abdominal pain
4. prostration and muscle cramps
Severe cases may have dehydration leading to:
1.hypotension
2.cardiovascular collapse
3.tachycardia
4.difficulty in breathing and cyanosis
5.weak peripheral pulses
6.delirium and disorientation
7.lassitude and tiredness
8.convulsions in small children
Symptoms usually appear within 12 hours after exposure to the germ and last up to 1 week.
How is Cholera transmitted?
------------------------------------------
Most epidemics are water borne espcially after severe flooding.
The germs can also be transmitted by food handlers.
How is the diagnosis of Cholera made?
-----------------------------------------------------
Doctors generally diagnose Cholera based on the symptoms and a physical examination.
Confirmation is by blood tests and stool cultures.
What are the complications of Cholera?
-------------------------------------------
Cholera is a disease which can kill espcially through its complications:
1.Severe dehydration especially in young children and the very old patients
2.Hypovolemic shock
3.uncompensated metabolic acidosis
4.renal failure
How is Cholera treated?
-------------------------------------
Cholera is an infectious disease which can spread to other people through contaminated food and water.
It is therefore advisable to quarantine the patient in hospitals.
1.The most important complication in Cholera is dehydration so prompt replacement of fluids and electrolytes intravenously is necessary.
WHO diarrhea treatment solution consists of
a.4gms of sodium chloride
b.6.5gms of sodium acetate
c.1 gm of potassium chloride
d.10gms of glucose
in 1 liter of sterile distilled water.
Where intravenous administration of diarrhea solution is not available, isotonic drinks and even coconut water may act as replacements.
2. Careful monitoring of the patient as 1 liter of fluid may be lost in the stools in one hour.
3.Antibiotics is the main treatment against cholera.
The best antibiotic is tetracycline or deoxycline.
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Cholera prevented?
----------------------------------------
Prevention of Cholera can be by vaccination with the cholera vaccine.
However the success rate of immunisation against Cholera is only 20-30% so most doctors do not recommended it.
You can avoid infection by:
Avoid eating or drinking foods or liquids that might be contaminated
Good food hygience
What is the prognosis of Cholera?
-------------------------------------
Prognosis is excellent with prompt treatment of rehydration treatment.
After replacement symptoms usually clear within 48 hours with tetracycline treatment.
---------------------------------
What is Cholera?
---------------------------
Cholera is an acute infectious illness caused by the Vibrio cholorae bacteria.
What is the cause of Cholera?
----------------------------------
The bacteria which causes Cholera is the Vibrio cholorae which is an extremely hardy bacteria able to live in polluted water and contaminated food.
There are 2 main types of cholera bacteria:
1.the Classic short slightly curved Gram negative aerobic rods
2.The El Tor strain which is hardier,persists longer in nature and is more likely to cause carrier states in humans.
Incubation period is 12 hours to 6 days.
What are symptoms of Cholera?
----------------------------------------------
The main symptoms of Cholera are
1. Vomiting after 12 hours of ingestion of bacteria
2. abrupt painless rice water diarrhoea
3. abdominal pain
4. prostration and muscle cramps
Severe cases may have dehydration leading to:
1.hypotension
2.cardiovascular collapse
3.tachycardia
4.difficulty in breathing and cyanosis
5.weak peripheral pulses
6.delirium and disorientation
7.lassitude and tiredness
8.convulsions in small children
Symptoms usually appear within 12 hours after exposure to the germ and last up to 1 week.
How is Cholera transmitted?
------------------------------------------
Most epidemics are water borne espcially after severe flooding.
The germs can also be transmitted by food handlers.
How is the diagnosis of Cholera made?
-----------------------------------------------------
Doctors generally diagnose Cholera based on the symptoms and a physical examination.
Confirmation is by blood tests and stool cultures.
What are the complications of Cholera?
-------------------------------------------
Cholera is a disease which can kill espcially through its complications:
1.Severe dehydration especially in young children and the very old patients
2.Hypovolemic shock
3.uncompensated metabolic acidosis
4.renal failure
How is Cholera treated?
-------------------------------------
Cholera is an infectious disease which can spread to other people through contaminated food and water.
It is therefore advisable to quarantine the patient in hospitals.
1.The most important complication in Cholera is dehydration so prompt replacement of fluids and electrolytes intravenously is necessary.
WHO diarrhea treatment solution consists of
a.4gms of sodium chloride
b.6.5gms of sodium acetate
c.1 gm of potassium chloride
d.10gms of glucose
in 1 liter of sterile distilled water.
Where intravenous administration of diarrhea solution is not available, isotonic drinks and even coconut water may act as replacements.
2. Careful monitoring of the patient as 1 liter of fluid may be lost in the stools in one hour.
3.Antibiotics is the main treatment against cholera.
The best antibiotic is tetracycline or deoxycline.
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Cholera prevented?
----------------------------------------
Prevention of Cholera can be by vaccination with the cholera vaccine.
However the success rate of immunisation against Cholera is only 20-30% so most doctors do not recommended it.
You can avoid infection by:
Avoid eating or drinking foods or liquids that might be contaminated
Good food hygience
What is the prognosis of Cholera?
-------------------------------------
Prognosis is excellent with prompt treatment of rehydration treatment.
After replacement symptoms usually clear within 48 hours with tetracycline treatment.
Tuesday, February 12, 2008
A Simple Guide to Cervical Spondylosis
A Simple Guide to Cervical Spondylosis
---------------------------------------------
What is Cervical Spondylosis?
----------------------------------
Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.
Who get Cervical Spondylosis?
-------------------------------------
Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.
What are the causes of Cervical Spondylosis?
-----------------------------------------------
The causes of Cervical Spondylosis are:
1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.
2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.
3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.
What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------
1.The onset is usually gradual with occasional neck pain over weeks or months.
2.There may be a history of trauma to the neck or prolonged neck strain.
3.Early morning neck stiffness and pain may occur,then wears off during the day.
4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.
5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.
6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.
7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.
8.Muscle weakness of the upper and/or lower limb with muscle wasting
Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.
How is Cervical Spondylosis diagnosed?
-----------------------------------------
Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine
How to treat Cervical Spondylosis?
------------------------------------
Not every patient suffer the same degree of symptoms
1. mild requiring only exercises or mild pain killers.
2. more severe require:
a.Neck collars
b.physiotherapy -cervical traction, shortwave diathermy, neck exercises
c.NSAIDs painkillers
d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs
3. All cases require:
protection of neck from muscle strain
avoidance of excessive bending and turning of neck
maintenance of good posture
avoidance of emotional stress
What is the prognosis of Cervical Spondylosis?
------------------------------------------------
Symptoms comes and go.
With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Injury and stress can aggravate the condition.
There is no cure.
---------------------------------------------
What is Cervical Spondylosis?
----------------------------------
Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.
Who get Cervical Spondylosis?
-------------------------------------
Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.
What are the causes of Cervical Spondylosis?
-----------------------------------------------
The causes of Cervical Spondylosis are:
1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.
2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.
3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.
What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------
1.The onset is usually gradual with occasional neck pain over weeks or months.
2.There may be a history of trauma to the neck or prolonged neck strain.
3.Early morning neck stiffness and pain may occur,then wears off during the day.
4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.
5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.
6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.
7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.
8.Muscle weakness of the upper and/or lower limb with muscle wasting
Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.
How is Cervical Spondylosis diagnosed?
-----------------------------------------
Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine
How to treat Cervical Spondylosis?
------------------------------------
Not every patient suffer the same degree of symptoms
1. mild requiring only exercises or mild pain killers.
2. more severe require:
a.Neck collars
b.physiotherapy -cervical traction, shortwave diathermy, neck exercises
c.NSAIDs painkillers
d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs
3. All cases require:
protection of neck from muscle strain
avoidance of excessive bending and turning of neck
maintenance of good posture
avoidance of emotional stress
What is the prognosis of Cervical Spondylosis?
------------------------------------------------
Symptoms comes and go.
With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Injury and stress can aggravate the condition.
There is no cure.
Friday, February 8, 2008
A Simple Guide to Urticaria
A Simple Guide to Urticaria
---------------------------------
What is Urticaria?
----------------------
Urticaria is an itchy rash that occurs rapidly anywhere on the body.
The rash may occur often simultaneously at multiple sites.
It is usually temporary disappearing after 24 hours although new rashes may occur at other sites.
What causes Urticaria?
---------------------------
Urticaria is usually due to known mast cell stimulants although in the majority of cases the cause is unknown.
Urticaria is not contagious and for most patients the condition may be managed well with treatment and avoidance of mast cell stimulants:
1. Certain foods: eggs, nuts, fruits,shellfish, fish, chocolates
2. Certain drugs: antibiotics, NSAIDs
3. Physical stimulants: pressure, sweating, cold temperature, sunlight
4. Infections: viral, bacteria
5. Others: flowers, pollen, beestings, animal furs, soaps
What are the symptoms and signs of Urticaria?
-------------------------------------------------------
The rash is typically itchy and appear rapidly as localised red swelling on the skin measuring a few mm to more than 10 cm in size in different shapes.
The swelling can also occur on eyelids, lips, palms and soles.
Urticaria is usually harmless and disappear within a few days or week.
However because it can involve very extensive areas of the body, it can cause a lot of irritation and a lot of anxiety.
Very rarely the urticaria can lasts months to years causing disruption to work and social life.
What makes patients with Urticaria itch?
----------------------------------------------------
In people with Urticaria, the mast cell stimulant can cause histamine release from mast cells.
The histamine is the predominant chemical which is responsible for the inflammatory response which leads to changes of the blood vessels of the skin.
This leads to more blood flow to the affected skin and excessive fluid moving into the surrounding tissues , causing itching and swelling.
How can Urticaria be treated?
------------------------------------
One of the most important part of treatment is to to try to identify the substance or underlying medical condtion which may cause the Urticaria.
Avoidance of the causative substance or treatment of the underlying medical conditions such as infections will lead to the resolution of the urticaria.
One of the most important components of an Urticaria treatment routine is to prevent scratching.
Cold compresses applied directly to itchy skin can also help relieve itching.
Antihistamine tablets will usually relieve the itch and suppress the eruption of the rash.
The antihistamine need to be taken regularly for long as the urticaria is active.
If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce itch.
Corticosteroid tablets may be prescribed if necessary.
How can Urticaria be prevented?
----------------------------------------
Find the causative agent and avoid it.
Avoid sudden changes in temperature or humidity
Avoid sweating or overheating
Avoid certain foods (e.g.,eggs, nuts, seafood, chocolates)
Avoid harsh soaps, detergents, and solvents
Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
---------------------------------
What is Urticaria?
----------------------
Urticaria is an itchy rash that occurs rapidly anywhere on the body.
The rash may occur often simultaneously at multiple sites.
It is usually temporary disappearing after 24 hours although new rashes may occur at other sites.
What causes Urticaria?
---------------------------
Urticaria is usually due to known mast cell stimulants although in the majority of cases the cause is unknown.
Urticaria is not contagious and for most patients the condition may be managed well with treatment and avoidance of mast cell stimulants:
1. Certain foods: eggs, nuts, fruits,shellfish, fish, chocolates
2. Certain drugs: antibiotics, NSAIDs
3. Physical stimulants: pressure, sweating, cold temperature, sunlight
4. Infections: viral, bacteria
5. Others: flowers, pollen, beestings, animal furs, soaps
What are the symptoms and signs of Urticaria?
-------------------------------------------------------
The rash is typically itchy and appear rapidly as localised red swelling on the skin measuring a few mm to more than 10 cm in size in different shapes.
The swelling can also occur on eyelids, lips, palms and soles.
Urticaria is usually harmless and disappear within a few days or week.
However because it can involve very extensive areas of the body, it can cause a lot of irritation and a lot of anxiety.
Very rarely the urticaria can lasts months to years causing disruption to work and social life.
What makes patients with Urticaria itch?
----------------------------------------------------
In people with Urticaria, the mast cell stimulant can cause histamine release from mast cells.
The histamine is the predominant chemical which is responsible for the inflammatory response which leads to changes of the blood vessels of the skin.
This leads to more blood flow to the affected skin and excessive fluid moving into the surrounding tissues , causing itching and swelling.
How can Urticaria be treated?
------------------------------------
One of the most important part of treatment is to to try to identify the substance or underlying medical condtion which may cause the Urticaria.
Avoidance of the causative substance or treatment of the underlying medical conditions such as infections will lead to the resolution of the urticaria.
One of the most important components of an Urticaria treatment routine is to prevent scratching.
Cold compresses applied directly to itchy skin can also help relieve itching.
Antihistamine tablets will usually relieve the itch and suppress the eruption of the rash.
The antihistamine need to be taken regularly for long as the urticaria is active.
If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce itch.
Corticosteroid tablets may be prescribed if necessary.
How can Urticaria be prevented?
----------------------------------------
Find the causative agent and avoid it.
Avoid sudden changes in temperature or humidity
Avoid sweating or overheating
Avoid certain foods (e.g.,eggs, nuts, seafood, chocolates)
Avoid harsh soaps, detergents, and solvents
Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
Friday, January 25, 2008
A Simple Guide to Varicose Veins
A Simple Guide to Varicose Veins
---------------------------------
What are Varicose Veins?
----------------------------
Varicose Veins are swollen veins in the legs which has ballooned up over time.
They are more common in women than in men.
What are the causes of Varicose Veins?
----------------------------------------
The cause of the Varicose Vein is due to the accumulation and stagnation of blood in the veins over time.
From the heart blood flows easily downwards to the legs into the capillaries to supply nutrient and oxygen to the foot.
From the foot the blood is then pushed up though the veins right up to the heart.
Movement of the blood in the veins is assisted by the contraction of muscles pushing the blood upwards.
When the muscle relaxes, the blood in the veins gravitates downwards but is prevented from going down by valves in the veins.
If the valve in the vein fails, blood begins to accumulates and stagnate in the veins causing ballooning and dilation of the veins.
The distended veins are then called Varicose Veins.
Causes for the failure of the valves in the veins are:
1.Hereditary - some people are born with inherent weakness of the valve of the veins.
2.Prolonged standing -causes gravitation of the blood down the veins
3.Pregnancy - the veins may be partially blocked by weight of the foetus causing stagnation of blood
4.Obesity - the weight of the body causes the blood to slow down and gravitates down wards in the veins.
5.pelvic tumours like ovarian cysts can partially block the blood flow up the veins.
6.Tight stockings- constricts the blood vessels mechanically
7.Smoking- constricts the blood vessel through its chemicals
What are the complications of Varicose Veins?
------------------------------------------------
Varicose Veins reduces the blood flow in the legs and can give rise to
complications:
1.Phlebitis-
inflmmation of the varicose vein is due to a blood clot stucked in the vein forming a thrombosis.
The skin over the inflammed vein becomes hot, red, swollen and tender.
A thrombosis in the superficial veins are usually not dangerous but a deep vein thrombosis can become detached and lodged in the lungs causing pulmonary embolism.
2.Haemorrhage-
bleeding may occur when a swollen varicose vein with thinned walls burst.
Blood will then flow out.
Trauma or injury of the swollen varicose vein can also cause bleeding.
3.varicose ulcers may occur when the swollen venous wall gradually stretched and breaks without bleeding.
The break may slowly develop into a ulcer becoming larger unless treated.
4.varicose pigmentation results from skin discoloration from an iron containing pigment called hemosiderin from broken down red blood cells stucked in the varicose veins.
What are the symptoms of Varicose Veins?
----------------------------------------------
1. Swollen blood vessels in the legs
2. Varicose pigmentation
3. Varicose ulcers
4. Phlebitis
What are the investigations needed in assessment of varicose veins?
--------------------------------------------------------------------
The type, size, location and depth of the varicose vein problem can be determined by various non-invasive diagnostic tests:
1.venous doppler,
2.PPG, and
3.color duplex ultrasound.
What is the treatment for Varicose Veins?
-------------------------------------------
1. No treatment if condition is mild
2. Elastic stocking- support stockings and pressure bandaging compress the valves of the veins together to prevent backflow and prevent dilation of the veins.
Once the stockings are in place, you should exercise by walking as much as possible. When sitting raise the legs.
While sleeping do not use the stockings.
Raise the bottom of bed or put legs on pillows to elevate the legs.
While stockings can slow down the natural course of the disease and reduce the painful symptoms. they WILL NOT CURE the disease.
3. Medical treatment:
Injection of veins-
a.Traditional Sclerotherapy
Here the veins are injected with a small amount of a solution causing them to collapse and disappear.
b.Ultrasound Guided Sclerotheraphy
By using a Doppler/Duplex Ultrasound system the doctor can get a x-ray-like picture of the deeper vein and inject at strategic locations of the vein.
c.Foam Sclerotherapy
Similar to traditional sclerotherapy, but using a foaming agent, making it more suitable for larger veins.
d.IPL Laser Therapy used mostly for the smallest spider veins.
In this method a light beam is pulsed onto the veins to seal them.
4. Surgical treatment:
a.tying of veins-
The simplest treatment consist of tying the superficial vein in the upper thigh preventing the flow of blood in the superficial vein and deflecting it into the deeper vein.
b.stripping of veins
this consist of removal of the long superficial vein using a instrument called the stripper.
After the removal of the vein, firm pressure is applied to the leg.
c.Ambulatory Phlebectomy
Parts of the vein is removed through tiny incisions leaving only small puncture marks and requires no stitches.
d.Closure(Radiofrequency Occlusion)
A super-thin catheter is inserted in the vein and when removed it closes the vein behind it by the use of radio frequency waves.
e.Endovenous Laser Treatment -same as the Closure Procedure, except the catheter emits laser rays instead of radio frequency waves
How can Varicose Veins be prevented?
---------------------------------------
1.Reduce weight
2.Exercise
3.Aviod prolonged standing
4.Put your feet up
---------------------------------
What are Varicose Veins?
----------------------------
Varicose Veins are swollen veins in the legs which has ballooned up over time.
They are more common in women than in men.
What are the causes of Varicose Veins?
----------------------------------------
The cause of the Varicose Vein is due to the accumulation and stagnation of blood in the veins over time.
From the heart blood flows easily downwards to the legs into the capillaries to supply nutrient and oxygen to the foot.
From the foot the blood is then pushed up though the veins right up to the heart.
Movement of the blood in the veins is assisted by the contraction of muscles pushing the blood upwards.
When the muscle relaxes, the blood in the veins gravitates downwards but is prevented from going down by valves in the veins.
If the valve in the vein fails, blood begins to accumulates and stagnate in the veins causing ballooning and dilation of the veins.
The distended veins are then called Varicose Veins.
Causes for the failure of the valves in the veins are:
1.Hereditary - some people are born with inherent weakness of the valve of the veins.
2.Prolonged standing -causes gravitation of the blood down the veins
3.Pregnancy - the veins may be partially blocked by weight of the foetus causing stagnation of blood
4.Obesity - the weight of the body causes the blood to slow down and gravitates down wards in the veins.
5.pelvic tumours like ovarian cysts can partially block the blood flow up the veins.
6.Tight stockings- constricts the blood vessels mechanically
7.Smoking- constricts the blood vessel through its chemicals
What are the complications of Varicose Veins?
------------------------------------------------
Varicose Veins reduces the blood flow in the legs and can give rise to
complications:
1.Phlebitis-
inflmmation of the varicose vein is due to a blood clot stucked in the vein forming a thrombosis.
The skin over the inflammed vein becomes hot, red, swollen and tender.
A thrombosis in the superficial veins are usually not dangerous but a deep vein thrombosis can become detached and lodged in the lungs causing pulmonary embolism.
2.Haemorrhage-
bleeding may occur when a swollen varicose vein with thinned walls burst.
Blood will then flow out.
Trauma or injury of the swollen varicose vein can also cause bleeding.
3.varicose ulcers may occur when the swollen venous wall gradually stretched and breaks without bleeding.
The break may slowly develop into a ulcer becoming larger unless treated.
4.varicose pigmentation results from skin discoloration from an iron containing pigment called hemosiderin from broken down red blood cells stucked in the varicose veins.
What are the symptoms of Varicose Veins?
----------------------------------------------
1. Swollen blood vessels in the legs
2. Varicose pigmentation
3. Varicose ulcers
4. Phlebitis
What are the investigations needed in assessment of varicose veins?
--------------------------------------------------------------------
The type, size, location and depth of the varicose vein problem can be determined by various non-invasive diagnostic tests:
1.venous doppler,
2.PPG, and
3.color duplex ultrasound.
What is the treatment for Varicose Veins?
-------------------------------------------
1. No treatment if condition is mild
2. Elastic stocking- support stockings and pressure bandaging compress the valves of the veins together to prevent backflow and prevent dilation of the veins.
Once the stockings are in place, you should exercise by walking as much as possible. When sitting raise the legs.
While sleeping do not use the stockings.
Raise the bottom of bed or put legs on pillows to elevate the legs.
While stockings can slow down the natural course of the disease and reduce the painful symptoms. they WILL NOT CURE the disease.
3. Medical treatment:
Injection of veins-
a.Traditional Sclerotherapy
Here the veins are injected with a small amount of a solution causing them to collapse and disappear.
b.Ultrasound Guided Sclerotheraphy
By using a Doppler/Duplex Ultrasound system the doctor can get a x-ray-like picture of the deeper vein and inject at strategic locations of the vein.
c.Foam Sclerotherapy
Similar to traditional sclerotherapy, but using a foaming agent, making it more suitable for larger veins.
d.IPL Laser Therapy used mostly for the smallest spider veins.
In this method a light beam is pulsed onto the veins to seal them.
4. Surgical treatment:
a.tying of veins-
The simplest treatment consist of tying the superficial vein in the upper thigh preventing the flow of blood in the superficial vein and deflecting it into the deeper vein.
b.stripping of veins
this consist of removal of the long superficial vein using a instrument called the stripper.
After the removal of the vein, firm pressure is applied to the leg.
c.Ambulatory Phlebectomy
Parts of the vein is removed through tiny incisions leaving only small puncture marks and requires no stitches.
d.Closure(Radiofrequency Occlusion)
A super-thin catheter is inserted in the vein and when removed it closes the vein behind it by the use of radio frequency waves.
e.Endovenous Laser Treatment -same as the Closure Procedure, except the catheter emits laser rays instead of radio frequency waves
How can Varicose Veins be prevented?
---------------------------------------
1.Reduce weight
2.Exercise
3.Aviod prolonged standing
4.Put your feet up
Tuesday, January 1, 2008
A Simple Guide to Obesity Part 2
A Simple Guide to Obesity Part 2
--------------------------------------
What is the Treatment of Obesity?
----------------------------------------
Motivation:
---------------
Motivation is the key to weight control.
Knowing the dangers of obesity will help to motivate a person to lose weight.
Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.
Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.
Regular Exercise:
-------------
Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.
Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.
Lead an active lifestyle.
Do not sit and watch TV all the time.
Diet Control:
-------------
Choose a healthy diet with with reduced calories and which is nutritionally balanced
Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar
Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.
A combination of diet and exercise is more effective in reducing than either one alone.
Medication:
-----------------
Two main types of medications are available to help control weight:
1.Appetite suppressants:
-----------------------------
help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.
They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.
They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia, pregnency.
They should be used for short term (6-12 months) as there is also a danger of dependency.
2.Fat absorption suppressant:
------------------------------------
prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.
Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.
Less fat is available for putting on weight.
They should be avoided in malabsorrption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhoea due to the fat passed out in the stools.
They can be taken for a longer peroid of 2 years.
Surgery:
-----------
Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems.
Surgery should be used only drug therapy, diet, exercise have failed.
Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.
Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease.
A band is placed over the middle of the stomach making it narrow and not capable of taking much food.
Surgery has some complications such as infections.
How do you prevent recurrence of Obesity?
---------------------------------------------------
Many studies showed that most people will regain weight within 5 years.
You can maintain your weight by
1.eating a low calorie diet, low in fats
2.maintaining a healthy exercise regime
3.maintaining motivation and self esteem
4.monitoring your weight food intake and exercise
--------------------------------------
What is the Treatment of Obesity?
----------------------------------------
Motivation:
---------------
Motivation is the key to weight control.
Knowing the dangers of obesity will help to motivate a person to lose weight.
Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.
Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.
Regular Exercise:
-------------
Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.
Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.
Lead an active lifestyle.
Do not sit and watch TV all the time.
Diet Control:
-------------
Choose a healthy diet with with reduced calories and which is nutritionally balanced
Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar
Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.
A combination of diet and exercise is more effective in reducing than either one alone.
Medication:
-----------------
Two main types of medications are available to help control weight:
1.Appetite suppressants:
-----------------------------
help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.
They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.
They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia, pregnency.
They should be used for short term (6-12 months) as there is also a danger of dependency.
2.Fat absorption suppressant:
------------------------------------
prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.
Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.
Less fat is available for putting on weight.
They should be avoided in malabsorrption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhoea due to the fat passed out in the stools.
They can be taken for a longer peroid of 2 years.
Surgery:
-----------
Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems.
Surgery should be used only drug therapy, diet, exercise have failed.
Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.
Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease.
A band is placed over the middle of the stomach making it narrow and not capable of taking much food.
Surgery has some complications such as infections.
How do you prevent recurrence of Obesity?
---------------------------------------------------
Many studies showed that most people will regain weight within 5 years.
You can maintain your weight by
1.eating a low calorie diet, low in fats
2.maintaining a healthy exercise regime
3.maintaining motivation and self esteem
4.monitoring your weight food intake and exercise
A Simple Guide to Obesity
A Simple Guide to Obesity
-------------------------------
What is obesity?
--------------------
Obesity is defined as having a weight 20% above the desirable weight which is having a BMI (Body Mass Index) of 22 or less.
It is a chronic medical condition where fat accumulates in the body due to excess calories.
Obesity is harmful to the person's health and well being.
What causes obesity?
--------------------------
Many factors contributes to obesity:
Genetic factors
-------------------
Obesity runs in the family and is hereditary.
Family members who share the same diet and lifestyle may have the same overweight condition.
Environmental factors
---------------------------
The environment is an important factor in determining obesity.
1.Overeating -
many people have an increased craving for food.
It has found that these people lack a hormone called serotonin in the brain which acts to decreased appetite.
2.low metabolism -
some people has a lower metabolic rate tends to accumulate the excess energy from food as fats in the body.
Classic example is hypothyroidism where the low thyroid hormone reduce the capacity of the body to burn off energy so they become lethargic and fat.
3.lack of exercise -
Exercise helps to burn up calories.
People who tend to have a sedentary life without exercise tends to be overweight
4.Certain medications:
some medications like corticosteroids, female hormones aand antidepressants tends to cause increased appetite and water retention and contributes to weight gain.
Psychological factors
---------------------
Psychological factors may be the cause of tendency to overindulge in food.
Some people eats more out of boredom, sadness, or anger.
Others overeat as a way of dealing with stress or depression.
Rare illnesses:
------------------
Some rare illnesses like hypothyroidism, Cushing's syndrome, depression, and certain neurological problems can lead to overeating.
These conditions are believed to be responsible for only about one percent of all obesity cases.
What is the criteria for diagnosis of Obesity?
------------------------------------------------
The most widely used method is the body mass index (BMI).
BMI is the gauge of the amount of body fat in adults.
BMI = Your Weight (kg)
---------------------
Height (metres) x Height (metres)
The risk of developing heart disease and diabetes begins at BMI values of 23 kg/m2 and above.
BMI (kg/m2) (for adults):
Risk of Heart Disease and Diabetes
27.5 and above
High Risk
23.0 - 27.4
Moderate Risk
18.5 - 22.9
Low Risk (healthy range)
Less than 18.5
Risk of nutritional deficiency diseases and osteoporosis
Knowing your BMI will motivate you to lower your weight.
What are the Complications from obesity?
----------------------------------------
Health hazards
------------------
Obesity is not just a cosmetic problem.
Many serious medical conditions are associated with it:
--------------------------------------------------------------------------
1.High blood pressure
2.High blood cholesterol
3.Diabetes
4.Coronary heart disease
5.Stroke
6.Gallbladder disease
7.Liver disease
8.Degenerative joint disease
9.Cancer (colon, uterine, breast and other cancers).
10.Gout,caused by high levels of uric acid in the blood from the high purine
proteins consumed.
11.Sleep apnoea
Emotional effects:
------------------
1.Feelings of rejection, shame, or depression
2.Feeling undesirable compared with a slim person.
3.Some face prejudice or discrimination.
4.Some may be seen as lazy or lacking in self-control.
Treatment of Obesity will follow in A Simple Guide to Obesity Part 2
-------------------------------
What is obesity?
--------------------
Obesity is defined as having a weight 20% above the desirable weight which is having a BMI (Body Mass Index) of 22 or less.
It is a chronic medical condition where fat accumulates in the body due to excess calories.
Obesity is harmful to the person's health and well being.
What causes obesity?
--------------------------
Many factors contributes to obesity:
Genetic factors
-------------------
Obesity runs in the family and is hereditary.
Family members who share the same diet and lifestyle may have the same overweight condition.
Environmental factors
---------------------------
The environment is an important factor in determining obesity.
1.Overeating -
many people have an increased craving for food.
It has found that these people lack a hormone called serotonin in the brain which acts to decreased appetite.
2.low metabolism -
some people has a lower metabolic rate tends to accumulate the excess energy from food as fats in the body.
Classic example is hypothyroidism where the low thyroid hormone reduce the capacity of the body to burn off energy so they become lethargic and fat.
3.lack of exercise -
Exercise helps to burn up calories.
People who tend to have a sedentary life without exercise tends to be overweight
4.Certain medications:
some medications like corticosteroids, female hormones aand antidepressants tends to cause increased appetite and water retention and contributes to weight gain.
Psychological factors
---------------------
Psychological factors may be the cause of tendency to overindulge in food.
Some people eats more out of boredom, sadness, or anger.
Others overeat as a way of dealing with stress or depression.
Rare illnesses:
------------------
Some rare illnesses like hypothyroidism, Cushing's syndrome, depression, and certain neurological problems can lead to overeating.
These conditions are believed to be responsible for only about one percent of all obesity cases.
What is the criteria for diagnosis of Obesity?
------------------------------------------------
The most widely used method is the body mass index (BMI).
BMI is the gauge of the amount of body fat in adults.
BMI = Your Weight (kg)
---------------------
Height (metres) x Height (metres)
The risk of developing heart disease and diabetes begins at BMI values of 23 kg/m2 and above.
BMI (kg/m2) (for adults):
Risk of Heart Disease and Diabetes
27.5 and above
High Risk
23.0 - 27.4
Moderate Risk
18.5 - 22.9
Low Risk (healthy range)
Less than 18.5
Risk of nutritional deficiency diseases and osteoporosis
Knowing your BMI will motivate you to lower your weight.
What are the Complications from obesity?
----------------------------------------
Health hazards
------------------
Obesity is not just a cosmetic problem.
Many serious medical conditions are associated with it:
--------------------------------------------------------------------------
1.High blood pressure
2.High blood cholesterol
3.Diabetes
4.Coronary heart disease
5.Stroke
6.Gallbladder disease
7.Liver disease
8.Degenerative joint disease
9.Cancer (colon, uterine, breast and other cancers).
10.Gout,caused by high levels of uric acid in the blood from the high purine
proteins consumed.
11.Sleep apnoea
Emotional effects:
------------------
1.Feelings of rejection, shame, or depression
2.Feeling undesirable compared with a slim person.
3.Some face prejudice or discrimination.
4.Some may be seen as lazy or lacking in self-control.
Treatment of Obesity will follow in A Simple Guide to Obesity Part 2
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