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If You’re in Pain, Think UTI

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Pain while passing urine, a desire to urinate every few minutes, an inability to pass urine despite the urge, high-coloured, cloudy urine, abdominal pain, high fever, shivering and vomiting — a few or all of these are symptoms of an infection somewhere along the urinary tract. In the elderly, the only symptom may be a change in mental status. In men, the pain may be felt in the rectal area. In children, after a period of dryness, bedwetting may recur. In babies, the temperature can fall instead of rise, and there may be jaundice. Almost 25 per cent of visits to a physician is due to this very common infection.
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Urinary tract infection (UTI) affects all age groups and both sexes. It is much more common in women, because of the shorter urethra, its proximity to the anus, pregnancy (when the uterus obstructs the free flow of urine) and minor trauma during sexual intercourse. Thirty five per cent of women have one episode of UTI before the age of 30. Men tend to develop UTI if their prostrate gland is enlarged as this obstructs the flow of urine. In both sexes kidney stones, structural abnormalities of the urinary tract, diabetes or lack of immunity (HIV, cancer medication) can increase susceptibility to infection. Pregnant women can develop asymptomatic UTI with bacteria detected in their urine on routine examination. This condition, called “asymptomatic bactinuria” of pregnancy, needs to be treated.
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Physicians suspect that UTI exists based on the symptoms. A routine urine examination shows abnormalities like pus cells or blood in the urine. A culture can be done to determine the organism responsible so that the appropriate antibiotic can be administered.

Untreated patients of UTI can sometimes recover spontaneously without treatment in a few months. But the infection can also enter the blood stream, causing potentially fatal septicaemia. The kidneys may become scarred, too. This leads to high blood pressure and kidney failure. During pregnancy, recurrent or chronic UTI or asymptomatic UTI compromises the placental blood supply. This affects the baby’s nutrition, leading to low birth weight and sometimes causing the mother to go into premature labour.

There are several regimens for treating UTI. Depending on the organism and antibiotic, in adult women a three-day course is usually sufficient for mild infection. In most cases and in the case of men, however, a 7-10 or 14-day course is required. Oral medication is usually sufficient. If the infection has affected the kidney, hospitalisation and intravenous medication may be required. It is important to follow the doctor’s instructions and complete the course of antibiotics even if you are symptomatically better. In women, if the symptoms do not respond and there is also white discharge, there may be an underlying pelvic infection. In men, non-responsiveness to treatment may be due to unrecognised prostatitis.

One of the ways to prevent UTI is to drink plenty of water. The urine becomes dilute and the bladder gets flushed regularly. An adult needs around 2.5 litres of water a day. In hot, humid climates and in people who exercise vigorously the requirement may go up to 4-6 litres a day. Also, drink a glass of water before going to bed. Empty the bladder before and after intercourse. Drink a glass of water after intercourse.

A few studies have shown that cranberry juice (available in India, Hindi name karaunda) and blueberry juice (not available) helps reduce the frequency and duration of UTI. This is because the juice contains vitamin C which acidifies the urine. It also contains natural chemicals that make the bladder wall slippery and prevent bacteria from sticking to it and initiating an infection. Other citrus juices and tablets of vitamin C are effective but not as efficient. A tablespoon of home-made curd taken on an empty stomach first thing in the morning naturally repopulates the intestines with “good lactobacillus”. This decreases the likelihood of the growth of disease-causing bacteria in the rectum, from where they can enter the urethra.

The pelvic muscles become lax after childbirth. This increases the possibility of the bladder and uterus descending downwards while straining. “Accidents” with leakage of urine and urgency can also occur.

All these increase the chances of infection. Keegles exercises should be done regularly soon after childbirth. Also while passing urine, consciously stop and start. This tones the pelvic muscles.

Women tend to lean forward while urinating. This position is inefficient as it increases the angle between the bladder and the urethra, creating an obstruction to the flow of urine. Women should consciously lean backwards. Also, when the area is being washed after urination or passing motion, wash from front to back. This decreases the likelihood of contamination of the urethra with rectal bacteria

Source: The Telegraph ( Kolkata, India)

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Endometrial Biopsy

Introduction:An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find any problems in the endometrium. It also lets your doctor check to see if your body’s hormone levels that affect the endometrium are in balance.

Doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

The lining of the uterus changes throughout a woman’s menstrual cycle. Early in the menstrual cycle, the lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the lining is shed during normal menstrual bleeding.

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There are several ways to do an endometrial biopsy. Your doctor may use:

*A soft, straw-like device (pipelle) to suction a small sample of lining from the uterus. This method is fast and is not very painful.

*A sharp-edged tool called a curette. Your doctor will scrape a small sample and collect it with a syringe or suction. This is called a dilation and curettage (D&C). A D&C may be done to control heavy uterine bleeding (hemorrhage) or to help find the cause of bleeding. This is done with general or regional anesthesia.

*An electronic suction device (Vabra aspiration). This method can be uncomfortable.

*A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done
An endometrial biopsy is done to:

*Check for cancer. For example, an endometrial biopsy may be done to help determine the cause of some abnormal Pap test results.
*Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.

*See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How To Prepare
Tell your doctor if you:

*Are or might be pregnant. An endometrial biopsy is not done during pregnancy.

*Are taking any medicines.

*Are allergic to any medicines.

*Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).

*Have been treated for a vaginal, cervical, or pelvic infection.

*Have any heart or lung problems.
Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

If you are not bleeding heavily, you might want to take an NSAID medicine such as ibuprofen one to two hours before the test, to reduce the possibility of uterine cramps during the procedure. Ask your physician for a recommendation ahead of time.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are having a dilation and curettage (D&C) and will go to sleep (general anesthesia) for the test, do not eat or drink anything for 8 hours before the test. If you are taking any medicines, ask your doctor what medicines you can take the day of the test.

How It Is Done
An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor’s office.

Your cervix may be numbed with a spray or injection of local anesthetic.

You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.

The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.

An endometrial biopsy takes 5 to 15 minutes.

Dilation and curettage (D&C)
A D&C is usually done in a hospital or clinic. Most women do not need to stay overnight but can go home the same day.

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your cervix will be gently spread open (dilated). Depending on the reason for the D&C, your doctor may use a tool called a hysteroscope to look inside the uterus. A small spoon-shaped instrument (curette) is then guided through the cervix and into the uterus. The top layer of the lining of the uterus is carefully scraped off and removed (along with any other tissue that looks abnormal) for biopsy.

If you have general anesthesia, you will be watched by a nurse in the recovery room until you are fully awake.

You can do most of your normal activities in a few days. Do not lift anything heavy for a few days after the test. Do not douche or have sex for one week after the test.

How It Feels
If you have not had any pain medicine, you may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp.

Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.

An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Dilation and curettage (D&C)
If general anesthesia is used during a D&C, you will be asleep and feel nothing. After the test, you will feel sleepy for a few hours. You may be tired for a few days after the test. You may also have a mild sore throat if a tube (endotracheal tube, or ET) was placed in your throat to help you breathe during the test. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks Factors:
You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment.There is also a small risk of disturbing a very early pregnancy. To guard against this, your doctor might order a pregnancy test before performing the biopsy.

After the test:
You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not douche. You may have to avoid sex or using tampons for several days. Ask your doctor when you can have sex or use tampons again.

Follow any instructions your doctor gave you. Call your doctor if you have:

*Heavy vaginal bleeding (more than a normal menstrual period).

*A fever.

*Belly pain.

*Bad-smelling vaginal discharge.

Results:
Time to know the results:
An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.


Endometrial biopsy  Normal
: No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.

Endometrial biopsy  Abnormal:

*A noncancerous (benign) growth, called a polyp, is present.

*Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.

*Cell changes that may lead to cancer are present.

For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endometrial-biopsy.shtml
http://women.webmd.com/endometrial-biopsy

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Childhood Obesity

Definition:Obesity is defined as an excessive accumulation of body fat. Obesity is present when total body weight is more than 25 percent fat in boys and more than 32 percent fat in girls (Lohman, 1987). Although childhood obesity is often defined as a weight-for-height in excess of 120 percent of the ideal, skinfold measures are more accurate determinants of fatness (Dietz, 1983; Lohman, 1987).

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A trained technician may obtain skinfold measures relatively easily in either a school or clinical setting. The triceps alone, triceps and subscapular, triceps and calf, and calf alone have been used with children and adolescents. When the triceps and calf are used, a sum of skinfolds of 10-25mm is considered optimal for boys, and 16-30mm is optimal for girls (Lohman, 1987).

A few extra pounds do not suggest obesity. However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise. Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for the height and body type. Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.

Causes:
The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Basically, obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that the children will also be obese. However, when both parents are obese, the children have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:

* poor eating habits
* overeating or binging
* lack of exercise (i.e., couch potato kids)
* family history of obesity
* medical illness (endocrine, neurological problems)
* medications (steroids, some psychiatric medications)
* stressful life events or changes (separations, divorce, moves, deaths, abuse)
* family and peer problems
* low self-esteem
* depression or other emotional problems

As with adult-onset obesity, childhood obesity has multiple causes centering around an imbalance between energy in (calories obtained from food) and energy out (calories expended in the basal metabolic rate and physical activity). Childhood obesity most likely results from an interaction of nutritional, psychological, familial, and physiological factors.

* The Family

The risk of becoming obese is greatest among children who have two obese parents (Dietz, 1983). This may be due to powerful genetic factors or to parental modeling of both eating and exercise behaviors, indirectly affecting the child’s energy balance. One half of parents of elementary school children never exercise vigorously (Ross & Pate, 1987).

* Low-energy Expenditure

The average American child spends several hours each day watching television; time which in previous years might have been devoted to physical pursuits. Obesity is greater among children and adolescents who frequently watch television (Dietz & Gortmaker, 1985), not only because little energy is expended while viewing but also because of concurrent consumption of high-calorie snacks. Only about one-third of elementary children have daily physical education, and fewer than one-fifth have extracurricular physical activity programs at their schools (Ross & Pate, 1987).

* Heredity

Since not all children who eat non-nutritious foods, watch several hours of television daily, and are relatively inactive develop obesity, the search continues for alternative causes. Heredity has recently been shown to influence fatness, regional fat distribution, and response to overfeeding (Bouchard et al., 1990). In addition, infants born to overweight mothers have been found to be less active and to gain more weight by age three months when compared with infants of normal weight mothers, suggesting a possible inborn drive to conserve energy (Roberts, Savage, Coward, Chew, & Lucas, 1988).

Complecations:
There are many risks and complications with obesity. Physical consequences include:

* increased risk of heart disease
* high blood pressure
* diabetes
* breathing problems
* trouble sleeping

Child and adolescent obesity is also associated with increased risk of emotional problems. Teens with weight problems tend to have much lower self-esteem and be less popular with peers. Depression, anxiety, and obsessive compulsive disorder can also occur.

Treatment :
Obese children need a thorough medical evaluation be a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten to increase the child’s or adolescent’s level of physical activity. Lasting weight loss can only occur when there is self-motivation. Since obesity affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent.

Obesity treatment programs for children and adolescents rarely have weight loss as a goal. Rather, the aim is to slow or halt weight gain so the child will grow into his or her body weight over a period of months to years. Dietz (1983) estimates that for every 20 percent excess of ideal body weight, the child will need one and one-half years of weight maintenance to attain ideal body weight.

Early and appropriate intervention is particularly valuable. There is considerable evidence that childhood eating and exercise habits are more easily modified than adult habits (Wolf, Cohen, Rosenfeld, 1985). Three forms of intervention include:

1. Physical Activity

Adopting a formal exercise program, or simply becoming more active, is valuable to burn fat, increase energy expenditure, and maintain lost weight. Most studies of children have not shown exercise to be a successful strategy for weight loss unless coupled with another intervention, such as nutrition education or behavior modification (Wolf et al., 1985). However, exercise has additional health benefits. Even when children’s body weight and fatness did not change following 50 minutes of aerobic exercise three times per week, blood lipid profiles and blood pressure did improve (Becque, Katch, Rocchini, Marks, & Moorehead, 1988).

2. Diet Management

Fasting or extreme caloric restriction is not advisable for children. Not only is this approach psychologically stressful, but it may adversely affect growth and the child’s perception of “normal” eating. Balanced diets with moderate caloric restriction, especially reduced dietary fat, have been used successfully in treating obesity (Dietz, 1983). Nutrition education may be necessary. Diet management coupled with exercise is an effective treatment for childhood obesity (Wolf et al., 1985).

3. Behavior Modification

Many behavioral strategies used with adults have been successfully applied to children and adolescents: self-monitoring and recording food intake and physical activity, slowing the rate of eating, limiting the time and place of eating, and using rewards and incentives for desirable behaviors. Particularly effective are behaviorally based treatments that include parents (Epstein et al., 1987). Graves, Meyers, and Clark (1988) used problem-solving exercises in a parent-child behavioral program and found children in the problem-solving group, but not those in the behavioral treatment-only group, significantly reduced percent overweight and maintained reduced weight for six months. Problem-solving training involved identifying possible weight-control problems and, as a group, discussing solutions.

Obesity frequently becomes a lifelong issue. The reason most obese adolescents gain back their pounds is that after they have reached their goal, they go back to their old habits of eating and exercising. An obese adolescent must therefore learn to eat and enjoy healthy foods in moderate amounts and to exercise regularly to maintain the desired weight. Parents of an obese child can improve their children’s self esteem by emphasizing the child’s strengths and positive qualities rather than just focusing on their weight problem.

When a child or adolescent with obesity also has emotional problems, a child and adolescent psychiatrist can work with the child’s family physician to develop a comprehensive treatment plan. Such a plan would include reasonable weight loss goals, dietary and physical activity management, behavior modification, and family involvement.

Resources:
http://www.lipsychiatric.com/common-disorders.asp#obe
http://www.kidsource.com/kidsource/content2/obesity.html

Little chocolate a day keeps heart attacks at bay

They were so addicted, they just could not give up their favourite daily snack  not even in the interest of science…..click & see

But chocolate lovers who flunked out of a Johns Hopkins University study on aspirin and heart disease helped researchers stumble on an explanation of why a little chocolate a day can cut the risk of heart attack.

It turns out chocolate, like aspirin, affects the platelets that cause blood to clot, Diane Becker of the Johns Hopkins University’s School of Medicine and her colleagues discovered.

“What these chocolate offenders taught us is that the chemical in cocoa beans has a biochemical effect similar to aspirin in reducing platelet clumping, which can be fatal if a clot forms and blocks a blood vessel, causing a heart attack,”Becker said.

The 139 so-called chocolate offenders took part in a larger study of 1,200 people with a family history of heart disease.

The study looked at the effects of aspirin on blood platelets. Before they got the aspirin, the volunteers were asked to stay on a strict regimen of exercise, refrain from smoking and avoid caffeinated drinks, wine, grapefruit juice and chocolate.

Source:The Times Of India