Tag Archives: Amgen

Normal Blood pressure: How low should a person can go?

A new study suggests greater health benefits with a lower-than-standard number.

CLICK & SEE THE PICTURE : 

Blood pressure has long been one of the best markers of your health. It is a number you can remember and monitor. High blood pressure (hypertension) is linked to a greater risk of heart attacks and strokes.

About one out of three adults has high blood pressure, which is usually defined as a reading of 140/90 millimeters of mercury (mm Hg) or higher.

The first, or upper, number (systolic pressure) represents the pressure inside the arteries when the heart beats, and the second, or lower, number (diastolic pressure) is the pressure between beats when the heart rests.

Blood pressure rises with age because of increasing stiffness of large arteries, long-term buildup of plaque, and the effects of other diseases involving the heart and blood vessels. Typically, more attention is given to the diastolic reading as a major risk factor for cardiovascular disease.

“In fact, for a long time, some physicians felt that a systolic (upper) number higher than 140 could be tolerated in older people,” says Dr. Paul Huang, a cardiologist with Harvard-affiliated Massachusetts General Hospital. “But both upper and lower numbers are equally important.”

A new number to aim for

While 140/90 continues to be the blood pressure cutoff, a study published in the Nov. 26, 2015 issue of The New England Journal of Medicine shows that lowering pressure to around 120/80 may reap greater benefits.

Researchers examined the initial results from the Systolic Blood Pressure Intervention Trial, or SPRINT, which studied 9,361 adults over age 50 who either had hypertension or were at a high risk for cardiovascular disease.

The subjects were divided into two groups. The first received an intensive treatment to lower blood pressure to less than 120/80. The other group followed a standard treatment to lower it to less than 140/90.

After three years, the researchers found that the group with the target of below 120/80 had a 25% lower risk of heart attack, stroke, or cardiovascular death compared with those with the standard target of less than 140/90. They also had 27% fewer deaths from any cause. (The study was stopped early because the outcome in the intensive treatment group was so much better than in the standard treatment group.)
Ups and downs of lower numbers

This study supports observational studies that have found that lower blood pressure reduces cardiovascular risk.

But what does it take to get to the lower numbers? “On average, the people in the intensive treatment group took three blood pressure medications, while those in the standard treatment group only took two,” says Dr. Huang.

Moreover, the study found that the benefits in reducing heart attacks, strokes, and death were found equally in those older or younger than age 75. “So we can no longer say that a higher blood pressure is okay just because someone’s older,” he says.

But should older men focus on going lower? Is lower than 140/90 good enough, or should you be more aggressive and get that number down as close as possible to 120/80?

“If you currently are on blood pressure medicine, and your pressure is lower than 140/90, you should discuss with your doctor whether you should aim to go even lower,” says Dr. Huang. “There may be additional benefits to further reducing your stroke and heart attack risk.”

Still, there may be some downsides to going lower. For instance, many people may not want to take any additional medication. They may be concerned about battling common side effects, such as extra urination, erection problems, weakness, dizziness, insomnia, constipation, and fatigue. They also may have enough trouble monitoring their current medication without adding more to the mix.

Another potential problem: pressure that drops too low. “This could lead to dizziness and lightheadedness, especially when suddenly rising from a seated position, and increase your risk of falls,” says Dr. Huang.

Also, because the study was stopped early, other possible downsides of the extra medications, such as effects on cognitive function or kidney function, remain unknown.

Monitor your blood pressure:

If anything, this study reinforces the need for men to be more diligent about maintaining a healthy level, says Dr. Huang. He suggests older men follow these basic guidelines:

*Check your pressure every month and alert your doctor to changes. “If the upper number is repeatedly higher than 140, or the lower number higher than 90, let your doctor know,” he says.

*Continue to take your medications as prescribed. “If you suffer from any side effects, talk with your doctor about changing the dosage or drug.”

*Reduce your salt intake. “You do not have to go sodium-free, but be more aware of how much sodium is in the foods you eat,” he says. In general, try to keep your sodium intake below 2,000 milligrams a day. Foods that include the words “smoked,” “processed,” “instant,” or “cured” in the name or on the label are often quite high in sodium.

*Continue to exercise or adopt some kind of workout routine. “Activity and weight loss can help lower and maintain a healthy blood pressure,” says Dr. Huang.

From : Harvard Health Publications
Harvard Medical School

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Alzheimer’s disease

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Other Names: Alzheimer’s disease (AD), also known as Alzheimer disease, or just Alzheimer’s

Definition:
Alzheimer’s is a chronic neurodegenerative disease that usually starts slowly and gets worse over time. It destroys memory and other important mental functions.
It’s the most common cause of dementia — a group of brain disorders that results in the loss of intellectual and social skills. These changes are severe enough to interfere with day-to-day life.
In this disease, the brain cells themselves degenerate and die, causing a steady decline in memory and mental function….CLICK  & SEE

Alzheimer’s is a type of dementia that is more common with increasing age. People with a family history of the condition are also at increased risk of developing it.

At present Alzheimer’s disease medications and management strategies may temporarily improve symptoms. This can sometimes help people with Alzheimer’s disease maximize function and maintain independence.But because there’s no cure for this disease, it’s important to seek supportive services and tap into one’s support network as early as possible.

Symptoms:
At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer’s disease that one notices. But over time, the disease robs one of more of one’s memory, especially recent memories. The rate at which symptoms worsen varies from one person to other person.

If some one has Alzheimer’s, he or she may be the first to notice that the person are having unusual difficulty remembering things and organizing different thoughts. Or may not be recognizing that anything is wrong, even when changes are noticeable by the family members, close friends or co-workers.

Brain changes associated with Alzheimer’s disease lead to growing trouble with:
Alzimer’s is a slowly progressive chronic disease. It progresses in different stages:
Stages of Alzheimer’s disease:

*Effects of ageing on memory but not AD
*Forgetting things occasionally
*Misplacing items sometimes
*Minor short-term memory loss
*Not remembering exact details

Early stage Alzheimer’s:

*Not remembering episodes of forgetfulness
*Forgets names of family or friends
*Changes may only be noticed by close friends or relatives
*Some confusion in situations outside the familiar

Middle stage Alzheimer’s:

*Greater difficulty remembering recently learned information
*Deepening confusion in many circumstances
*Problems with sleep
*Trouble knowing where they are

Late stage Alzheimer’s:

*Poor ability to think
*Problems speaking
*Repeats same conversations
*More abusive, anxious, or paranoid

Causes:
Scientists believe that for most people, Alzheimer’s disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time.

Less than 5 percent of the time, Alzheimer’s is caused by specific genetic changes that virtually guarantee a person will develop the disease.

Although the causes of Alzheimer’s are not yet fully understood, its effect on the brain is clear. Alzheimer’s disease damages and kills brain cells. A brain affected by Alzheimer’s disease has many fewer cells and many fewer connections among surviving cells than does a healthy brain.

As more and more brain cells die, Alzheimer’s leads to significant brain shrinkage. When doctors examine Alzheimer’s brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:

*Plaques. These clumps of a protein called beta-amyloid may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication. Although the ultimate cause of brain-cell death in Alzheimer’s isn’t known, the collection of beta-amyloid on the outside of brain cells is a prime suspect.

*Tangles. Brain cells depend on an internal support and transport system to carry nutrients and other essential materials throughout their long extensions. This system requires the normal structure and functioning of a protein called tau.

In Alzheimer’s, threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system. This failure is also strongly implicated in the decline and death of brain cells.

Click & see: Transmittable Alzheimer’s’ concept raised :

Risk Factors:
Age:
Increasing age is the greatest known risk factor for Alzheimer’s. Alzheimer’s is not a part of normal aging, but your risk increases greatly after 65 years of age. Nearly half of those older than age 85 have Alzheimer’s.

People with rare genetic changes that virtually guarantee they’ll develop Alzheimer’s begin experiencing symptoms as early as their 30s.

Family history and genetics:

The risk of developing Alzheimer’s appears to be somewhat higher if a first-degree relative — parent or sibling — has the disease. Scientists have identified rare changes (mutations) in three genes that virtually guarantee a person who inherits them will develop Alzheimer’s. But these mutations account for less than 5 percent of Alzheimer’s disease.

Most genetic mechanisms of Alzheimer’s among families remain largely unexplained. The strongest risk gene researchers have found so far is apolipoprotein e4 (APOE e4). Other risk genes have been identified but not conclusively confirmed.

Sex: Women may be more likely than are men to develop Alzheimer’s disease, in part because they live longer.

Mild cognitive impairment:

People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia.

Those with MCI have an increased risk — but not a certainty — of later developing dementia. Taking action to develop a healthy lifestyle and strategies to compensate for memory loss at this stage may help delay or prevent the progression to dementia.

Past head trauma: People who’ve had a severe head trauma or repeated head trauma appear to have a greater risk of Alzheimer’s disease.

Lifestyle and heart health:

There’s no lifestyle factor that’s been conclusively shown to reduce your risk of Alzheimer’s disease.

However, some evidence suggests that the same factors that put you at risk of heart disease also may increase the chance that you’ll develop Alzheimer’s. Examples include:

*Lack of exercise (a sedentry life style)
*Smoking
*High blood pressure
*High blood cholesterol
*Elevated homocysteine levels
*Poorly controlled diabetes
*A diet lacking in fruits and vegetables

These risk factors are also linked to vascular dementia, a type of dementia caused by damaged blood vessels in the brain. Working with your health care team on a plan to control these factors will help protect your heart — and may also help reduce your risk of Alzheimer’s disease and vascular dementia

Diagnosis:
There is no specific test today that can confirms the Alzheimer’s disease. The doctor will make a judgment about whether Alzheimer’s is the most likely cause of the symptoms based on the information that the patient provides and results of various tests that can help clarify the diagnosis.

The doctor will Physical and neurological exam:

The doctor will perform a physical exam, and is likely to check the overall neurological health by testing the patient following:

*Reflexes
*Muscle tone and strength
*Ability to get up from a chair and walk across the room
*Sense of sight and hearing
*Coordination
*Balance

The doctor may ask the patient to under take the following tests:

1. Blood test: The tests may help the doctor to rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies

2. Mental status testing: The doctor may conduct a brief mental status test to assess the patient’s memory and other thinking skills. Short forms of mental status testing can be done in about 10 minutes.

3. Neuropsychological testing : The doctor may recommend a more extensive assessment of the patient’s thinking and memory. Longer forms of neuropsychological testing, which can take several hours to complete, may provide additional details about the mental function compared with others’ of a similar age and education level.

4. Brain imaging: Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer’s disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer’s.

Brain-imaging technologies include:

i) Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine, which makes loud banging noises while it produces images. MRIs are painless, but some people feel claustrophobic inside the machine and are disturbed by the noise.

MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. In addition, they may be used to assess whether shrinkage in brain regions implicated in Alzheimer’s disease has occurred.

ii) Computerized tomography (CT). For a CT scan, you’ll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create cross-sectional images (slices) of your brain. It’s currently used chiefly to rule out tumors, strokes and head injuries.

Positron emission tomography (PET). During a PET scan, you’ll be injected in a vein with a low-level radioactive tracer. You’ll lie on a table while an overhead scanner tracks the tracer’s flow through your brain.

The tracer may be a special form of glucose (sugar) that shows overall activity in various brain regions. This can show which parts of your brain aren’t functioning well. New PET techniques may be able to detect your brain level of plaques and tangles, the two hallmark abnormalities linked to Alzheimer’s.

Future diagnostic tests:

Researchers are working with doctors to develop new diagnostic tools to help definitively diagnose Alzheimer’s. Another important goal is to detect the disease before it causes the symptoms targeted by current diagnostic techniques — at the stage when Alzheimer’s may be most treatable as new drugs are discovered. This stage is called preclinical Alzheimer’s disease.

New tools under investigation include:

* Additional approaches to brain imaging
* More-sensitive tests of mental abilities
* Measurement of key proteins or protein patterns in blood or spinal fluid (biomarkers)

Treatment:
Current Alzheimer’s medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:

Cholinesterase inhibitors. These drugs work by boosting levels of a cell-to-cell communication chemical depleted in the brain by Alzheimer’s disease. Most people can expect to keep their current symptoms at bay for a time.

Less than half of those taking these drugs can expect to have any improvement. Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea and sleep disturbances.

Memantine (Namenda). This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer’s disease. It’s sometimes used in combination with a cholinesterase inhibitor.

Creating a safe and supportive environment:

Adapting the living situation to the needs of a person with Alzheimer’s is an important part of any treatment plan. For someone with Alzheimer’s, establishing and strengthening routine habits and minimizing memory-demanding tasks can make life much easier.

One can take these steps to support a person’s sense of well-being and continued ability to function:

*Always keep keys, wallets, mobile phones and other valuables in the same place at home, so they don’t become lost.
*See if the doctor can simplify the medication regimen to once-daily dosing, and arrange for the finances to be on automatic payment and automatic deposit.
*Develop the habit of carrying a mobile phone with location capability so that one can call in case the person is lost or confused and people can track the location via the phone. Also, program important phone numbers into the person’s phone, so that he or she does not have to try to recall them.
*Make sure regular appointments are on the same day at the same time as much as possible.
*Use a calendar or white board in the home to track daily schedules. Build the habit of checking off completed items so that you can be sure they were completed.
*Remove excess furniture, clutter and throw rugs.
*Install sturdy handrails on stairways and in bathrooms.
*Ensure that shoes and slippers are comfortable and provide good traction.
*Reduce the number of mirrors. People with Alzheimer’s may find images in mirrors confusing or frightening.

Exercise:

Regular exercise is an important part of everybody’s wellness plan — and those with Alzheimer’s are no exception. Activities such as a daily 30-minute walk can help improve mood and maintain the health of your joints, muscles and heart.

Exercise can also promote restful sleep and prevent constipation. Make sure that the person with Alzheimer’s carries identification if she or he walks unaccompanied.

People with Alzheimer’s who develop trouble walking may still be able to use a stationary bike or participate in chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.

Yoga & Meditation : It is proved that even an acute Alzheimer’s patient can improve a lot if he or she does Yoga & meditation regularly under the guidance of an expart teacher.

Alzheimer’s patients should be careful of taking daily nutritional food in time.

Study results have been mixed about whether diet, exercise or other healthy lifestyle choices can prevent or reverse cognitive decline. But these healthy choices promote good overall health and may play a role in maintaining cognitive health, so there’s no harm in including the above good and healthy lifestyle.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
https://en.wikipedia.org/wiki/Alzheimer%27s_disease
http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/basics/definition/con-20023871

Epididymitis


Definition:-
Epididymitis is a medical condition in which there is inflammation of the epididymis (a curved structure at the back of the testicle in which sperm matures and is stored). This condition may be mildly to very painful, and the scrotum (sac containing the testicles) may become red, warm and swollen. It may be acute (of sudden onset) or rarely chronic.
…..Click to see the picture..

click to see the pictures

1: Epididymis

2: Head of epididymis
3: Lobules of epididymis
4: Body of epididymis
5: Tail of epididymis
6: Duct of epididymis
7: Deferent duct (ductus deferens or vas
Epididymitis is the most frequent cause of sudden scrotal pain. In contrast with men who have testicular torsion, the cremaster reflex (elevation of the testicle in response to stroking the upper inner thigh) is not altered. If the diagnosis is not entirely clear from the patient’s history and physical examination, a Doppler ultrasound scan can confirm increased flow of blood to the affected epididymis.

Infection is the most common cause.
In sexually active men, Chlamydia trachomatis is the most frequent causative microbe, followed by E. coli and Neisseria gonorrhoeae. In children, it may follow an infection in another part of the body (for example, a viral illness), or there may be an associated urinary tract anomaly. Another cause is sterile reflux of urine through the ejaculatory ducts. Antibiotics may be needed to control a component of infection. Treatment otherwise comprises pain killers or anti-inflammatory drugs and bed rest if necessary, and symptom control by resting the scrotum in a supported position.
Males of any age can get epididymitis, but it’s most common in men between the ages of 20 and 39.

Classification
Epididymitis can be classified into acute and chronic.

Acute Epididymis:>-click & see    .Swelling in a patient with epididymitis

1. Ductus Deferens
2. Epididymis
3. Testicle

Chronic epididymitis..>.click & see
Chronic epididymitis is epididymitis which ensues for more than six weeks. Chronic epididymitis is characterised by inflammation even when there is no infection present. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain. These include testicular cancer, enlarged scrotal veins (varicocele) or a cyst within the epididymis. As well, the nerves in the scrotal area are connected to those of the abdomen, sometimes causing pain similar to a hernia (see referred pain). This condition can develop even without the presence of the previously described known causes.

Typically, a second, longer round of treatment is used. It is believed that the hypersensitivity of certain structures, including nerves and muscles, may cause or contribute to chronic epididymitis. A procedure called a cord block is a last measure. This consists of an injection into the nerve that traces along the epididymis. The injection is a compound of several medications including a steroid, pain killers, and a high dose of an anti-inflammatory. This treatment can quell the pain for 2–3 months in ideal conditions. Some patients may only experience an even shorter duration of 2–3 days, while the fortunate ones in rare occasions are never bothered again. This procedure would of course have to be repeated when necessary, until the problem goes away completely, or until the routine is simply too bothersome. As a last resort, a patient may then decide to have the epididymis completely removed.

Symptoms:
Epididymitis symptoms depend on the cause. They can include:

#A tender, swollen, red or warm scrotum
#Testicle pain and tenderness, usually on one side — the pain may get worse when you have a bowel movement
#Painful urination or an urgent or frequent need to urinate
#Painful intercourse or ejaculation
#Chills and a fever
#A lump on the testicle
#Enlarged lymph nodes in the groin (inguinal nodes)
#Pain or discomfort in the lower abdomen or pelvic area
#Discharge from the penis
#Blood in the semen

Causes:-
#Infection is the most common cause of epididymitis. The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. There can be associated urethritis (inflammation of the urethra). Rarely, the infection reaches the epididymis via the bloodstream.

In sexually active men, Chlamydia trachomatis is responsible for two-thirds of cases, followed by Neisseria gonorrhoeae and E. coli (or other bacteria that cause urinary tract infection). Particularly among men over age 35 in whom the cause is E. coli, epididymitis is commonly due to urinary tract obstruction. Less common microbes include Ureaplasma, Mycobacterium, and cytomegalovirus, or Cryptococcus in patients with HIV infection. E. coli is more common in boys before puberty, the elderly and homosexual men.

#Other infections. Boys, older men and homosexual men are more likely to have epididymitis caused by a non-sexually transmitted bacterial infection. For men and boys who’ve had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection.

#Non-infectious causes are also possible
. Reflux of sterile urine (urine without bacteria) through the ejaculatory ducts may cause inflammation with obstruction. In children, it may be a response following an infection with enterovirus, adenovirus or Mycoplasma pneumoniae.

#The heart medication amiodarone. In some cases, this anti-arrhythmic medication causes inflammation of the epididymis. Epididymitis caused by amiodarone is treated by temporarily discontinuing the drug or reducing the dose.

#Tuberculosis. In some cases, tuberculosis can cause epididymitis.

#Urine in the epididymis. Known as chemical epididymitis, this occurs when urine flows backward into the epididymis. It may occur with heavy lifting or straining.

Epididymitis can also be caused by genito-urinary surgery, including prostatectomy and urinary catheterization. Congestive epididymitis is a long-term complication of vasectomy. Chemical epididymitis may also result from drugs such as amiodarone.

Diagnosis:-
Epididymitis can be hard to distinguish from testicular torsion. Both can occur at the same time. A urologist may need to be consulted.

Epididymitis usually has a gradual onset. On physical examination, the testicle is usually found to be in its normal vertical position, of equal size compared to its counterpart, and not high-riding. Typical findings are redness, warmth and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle). The cremasteric reflex (if it was normal before) remains normal. This is a useful sign to distinguish it from testicular torsion. If there is pain relieved by elevation of the testicle, this is called Prehn’s sign, which is however non-specific.

Analysis of the urine may or may not be normal. Before the advent of sophisticated medical imaging techniques, surgical exploration was the standard of care. Nowadays, color Doppler ultrasound is the preferred test. It can demonstrate increased blood flow (also compared to the normal side), as opposed to testicular torsion. Nuclear testicular blood flow testing is rarely used.

Additional tests may be necessary to identify underlying causes. In younger children, a urinary tract anomaly is frequently found. In sexually active men, tests for sexually transmitted diseases may be done. These may include microscopy and culture of a first void urine sample, Gram stain and culture of fluid or a swab from the urethra, nuclear acid amplification tests (to amplify and detect microbial DNA or other nucleic acids) or tests for syphilis and HIV.

Treatment:-
Antibiotics are used if an infection is suspected. Fluoroquinolones are no longer recommended for sexually transmitted infections, because of the resistance of Neisseria gonorrhoeae . A cephalosporin (such as ceftriaxone) combined with doxycycline is an alternative. Azithromycin can be used for susceptible strains.

For cases caused by enteric organisms (such as E. coli), ofloxacin or levofloxacin are recommended.

In children, quinolones and doxycycline are best avoided. Since bacteria that cause urinary tract infections are often the cause of epididymitis in children, co-trimoxazole or suited penicillins (for example, cephalexin) can be used. If there is a sexually transmitted disease, the partner should also be treated.

Household remedies such as elevation of the scrotum and cold compresses applied regularly to the scrotum may relieve the pain. Painkillers or anti-inflammatory drugs are often necessary. Hospitalisation is indicated for severe cases, and check-ups can ensure the infection has cleared up. Surgery is rarely necessary, except, for example, in those rare instances where an abscess forms.

Home Remedies & Change of Lifestyle:-
Having epididymitis usually means you’re experiencing considerable pain and discomfort. To ease your symptoms, you may  try  the advices:

#Rest in bed. Depending on the severity of your discomfort, you may want to stay in bed one or two days.

#Elevate your scrotum. While lying down, place a folded towel under your scrotum.

#Wear an athletic supporter. A supporter provides better support than boxers do for the scrotum.

#Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes or so to avoid damaging your skin.

#Don’t have sex until your infection has cleared up. Ask your doctor when you can have sex again.

Risk factors:-

Sexually transmitted epididymitis
Several factors increase your risk of getting epididymitis caused by an STD, including:

#High-risk sexual behaviors, such as having multiple sex partners, having sex with a partner with an STD and having sex without a condom.

#Personal history of an STD. You’re at increased risk of an infection that causes epididymitis if you’ve had an STD in the past.
Non-STD infections:-
Several things increase your risk of epididymitis caused by an infection other than an STD, including:

#Past prostate or urinary tract infections. Chronic urinary tract infections or prostate infections are linked to bacterial infections that can cause epididymitis.

#An uncircumcised penis or an anatomical abnormality of the urinary tract. These conditions increase your risk of epididymitis caused by a bacterial infection.

#Medical procedures that affect the urinary tract. Procedures such as surgery or having a urinary catheter or scope inserted into the penis can introduce bacteria into the genital-urinary tract, leading to infection.

#Prostate enlargement. Having an enlarged prostate that obstructs bladder function and causes urine to remain in the bladder puts you at higher risk of bladder infections, which increases the risk of epididymitis.

Epididymitis may eventually cause:

#Scrotal abscess, when infected tissue fills with pus

#Chronic epididymitis, which can occur when untreated acute epididymitis leads to recurrent episodes

#Shrinkage of the affected testicle (atrophy)

#Reduced fertility, but this is rare

If the condition spreads from your epididymis to your testicle, the resulting condition is known as epididymo-orchitis. Signs, symptoms and treatment options are basically the same as they are for epididymitis.

Prevention:-
If your epididymitis was caused by an STD, your partner also will need treatment. If your partner doesn’t get treatment, you may contract the STD again. Safer sexual practices, such as monogamous sex and condom use, help protect against STDs that can cause epididymitis.

If you have recurrent urninary tract infections or other risk factors for epididymitis, your doctor may discuss with you other ways to prevent epididymitis from recurring.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.


Resources:

http://en.wikipedia.org/wiki/Epididymitis
http://www.mayoclinic.com/health/epididymitis/DS00603

 

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New Osteoporosis Drug

The drug, called denosumab, blocks production of cells that break down bones. In two studies, spinal fractures were reduced by two-thirds in women ages 60-90 and in men getting prostate cancer therapy
……………New Osteoporosis Drug
The first member of a new class of osteoporosis drugs reduced spinal fractures by about two-thirds in post-menopausal women and in men undergoing hormone-deprivation therapy for prostate cancer, according to two studies released online Tuesday by the .
……….denosumabandimmunity-1
The drug, called denosumab, blocks production of cells called osteoclasts that break down bones, and physicians have high hopes for it because of its efficacy, ease of administration and apparent lack of severe side effects. But it’s a biological agent rather than a chemical, meaning it’s difficult to produce, and it is likely to be the highest-priced osteoporosis drug in an already-crowded marketplace.

The most well-known osteoporosis drug, Fosamax, is in a class known as bisphosphonates. Those drugs actually kill osteoclasts but carry the risk of stomach and esophageal irritation and have been linked to some cases of jaw necrosis.

Amgen, the manufacturer of denosumab, has not said how much the drug will cost, but analysts expect it to be at least $2,000 a year — and potentially much higher — and predict yearly sales of $2 billion to $3 billion.

Already, many insurance companies are pushing physicians to the generic version of Fosamax, alendronate, which costs about $100 a year.

Some medical experts think a high price would discourage the use of denosumab.

“If it is going to be quite a bit higher than the next-most-expensive drug, I don’t see that it is going to be used so widely,” said Dr. Frederick R. Singer, director of the endocrine/bone disease program at John Wayne Cancer Institute in Santa Monica, who was not involved in the research.

An advisory committee of the Food and Drug Administration will meet Thursday to consider Amgen’s application for approval of the drug, to be called Prolia, for treating osteoporosis in women and in men being treated for prostate cancer. If approved, it would be the first drug specifically approved for treating such men.

As many as half of women and 30% of men will suffer an osteoporosis-related fracture during their lifetime, according to the International Osteoporosis Foundation. About a third of the 2 million American men with prostate cancer undergo hormone-deprivation therapy to prevent release of the hormones that fuel the tumors, which sharply increases their risk of osteoporosis.

The two new trials were designed and funded by Amgen, and most of the researchers were Amgen employees or recipients of funds from the company. Nonetheless, osteoporosis experts were impressed.

“From a scientific standpoint, these are outstanding publications,” Singer said.

The first study included 7,686 women ages 60 to 90. Half were given an injection of denosumab every six months for three years, and half received a placebo. Overall, 2.3% of women receiving the drug had a spinal fracture and 0.7% had a hip fracture, compared with 7.2% and 1.2% in the placebo group.

That is similar to or slightly better than results with bisphosphonates, although the drugs have not been compared head to head.

The drug “does everything you would want a drug to do in women to prevent fractures,” said Dr. John S. Adams, an orthopedic surgeon at UCLA‘s Geffen School of Medicine.

The second study involved 1,468 prostate cancer patients receiving hormone-deprivation therapy. They underwent the same protocol as the women. Overall, 1.5% of men receiving the drug had a spinal fracture, compared with 3.9% of those in the placebo group. Men receiving the drug also had a 5.6% increase in bone mineral density, while those receiving placebo had a 1% decline.

There was no decline in non-spinal fractures.

Many of the patients in both studies reported soreness at the injection site and transient bone pain similar to arthritis. The drug caused eczema, an inflammation of the epidermis, in a few patients,and about 12 of the women got a serious skin infection called cellulitis.

Some earlier, small studies showed an apparent small increase in tumors in treated patients, but that was not observed in either of the new studies. Such potentially severe side effects will be a focus of the FDA panel.

“This appears to be the most potent of the osteoporosis drugs,” Singer said, “but it will require very careful monitoring to look for rare side effects,” which did not show up for other drugs until large numbers of people took them.

Source:The Los Angeles Times

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Behcet’s Disease

Other Nemes: Behçet’s syndrome, Morbus Behçet, Behçet-Adamantiades syndrome, or Silk Road disease.

Definition:
Behcet’s  disease (BD), is a chronic form of vasculitis (inflammation of the blood vessels) involving four primary symptoms: oral and genital ulcers, ocular inflammation, and arthritis.

The inflammation of Behcet’s disease leads to numerous symptoms that may initially seem unrelated. The signs and symptoms of Behcet’s disease — which may include mouth sores, eye inflammation, skin rashes and lesions, and genital sores — vary from person to person and may come and go on their own.

The exact cause of Behcet’s is unknown, but it may be an autoimmune disorder, which means the body’s immune system mistakenly attacks some of its own healthy cells. Both genetic and environmental factors may be responsible for Behcet’s disease.

Description:
Behçet’s disease (BD) was named in 1937 after the Turkish dermatologist Hulusi Behçet, who first described the triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. As a systemic disease, it can also involve visceral organs such as the gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems. This syndrome can be fatal due to ruptured vascular aneurysms or severe neurological complications.

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In the 1930s Hulusi Behçet observed the three classic symptoms (oral and genital ulcers and eye inflammation) now define this complex condition. BD also has a unique ability to affect all sizes of blood vessels, including arteries and veins. Symptoms related to vasculitis, such as inflammation of joints, gastrointestinal areas, or the central nervous system, are also common.

Symptoms of this disease may have been described by Hippocrates in the 5th century BC, in his 3rd Epidemion-book. Its first modern formal description was published in 1922.

Some sources use the term “Adamandiades  syndrome” or “Adamandiades-Behçet syndrome”, for the work done by Benediktos Adamantiades. However, the current World Health Organization/ICD-10 standard is “Behçet disease”.

In 1991, Saudi Arabian medical researchers discovered “neuro-Behcet’s disease”, a neurological involvement in Behcet’s disease, considered one of the most devastating manifestations of the disease

Demographics:
Incidence of BD is very rare in the United States with approximately five in 100,000 people developing the syndrome. In Middle Eastern and Asian countries between Iran and Japan (known as the “Old Silk Route”), BD is quite prevalent. Incidence in these countries is double that of the United States.

More than twice as many females are diagnosed with BD than males in the United States. However, in Middle Eastern and Asian areas, significantly more men are affected than females.

Causes:
No one knows why the immune system starts to behave this way in Behçet ‘s disease. It is not because of any known infections, it is not hereditary, it does not have to do with ethnic origin, gender, life-style, or age, where someone has lived or where they have been on holiday. It is not associated with cancer, and links with tissue-types (which are under investigation) are not certain. It does not follow the usual pattern for autoimmune diseases.

Behçet disease is normally caused by an autoimmune response that triggers inflammation of the blood vessels. Researchers have discovered a gene, HLA-B51, which predisposes an individual to BD. However, not all individuals with this gene develop the disease. The specific event leading to onset of BD is not known, but there are speculations that it may be related to the following:

*herpes simplex virus infections

*frequent infections of Streptococcus bacteria

*environmental factors

Diagnosis & Symptoms:
Behçet disease is diagnosed based on a set of guidelines established by an international group of physicians. A physician observes clinical signs and symptoms during patient examination. The most recent and accepted guidelines for a positive diagnosis include the presence of recurring oral ulcers (three or more times in one year) and at least two of four secondary symptoms, including recurring genital ulcers, uveitis, skin lesions, a positive pathergy test.

A pathergy test is a skin-prick test to see if a red bump will form at the injection site. If there is a reaction, the test is positive. This test may be given to patients suspected of BD, but it is not an indicator for the disease. Only a small percentage of patients diagnosed with BD actually test positive.

It is diagnosed clinically by specific patterns of symptoms and repeated outbreaks. Other causes for these symptoms have to be ruled out before making the diagnosis. The symptoms do not have to occur together, but can have happened at any time.

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There are three levels of certainty for diagnosis:

1.International Study Group diagnostic guidelines (very strict for research purposes)

2.Practical clinical diagnosis (generally agreed pattern but not as strict)

3.’Suspected’ or ‘Possible’ diagnosis (incomplete pattern of symptoms)

International Study Group diagnostic guidelines:
Must have

*oral (aphthous) ulcers (any shape, size or number at least 3 times in any 12 months),
along with 2 out of the next 4 “hallmark” symptoms:

*genital ulcers (including anal ulcers and spots in the genital region and swollen testicles or epididymitis in men),

*skin lesions (papulo-pustules, folliculitis, erythema nodosum, acne in post-adolescents not on corticosteroids),

*eye inflammation (iritis, uveitis, retinal vasculitis, cells in the vitreous),

*pathergy reaction (papule >2 mm dia. 24-48 hrs or more after needle-prick).

Practical clinical diagnosis:

Must have

*mouth ulcers,
along with 1 of the 4 hallmark symptoms above and with 2 of the symptoms below:

*arthritis/arthralgia,

*nervous system symptoms,

*stomach and/or bowel inflammation,

*deep vein thrombosis,

*superficial thrombophlebitis,

*cardio-vascular problems of inflammatory origin,

*inflammatory problems in chest and lungs,

*problems with hearing and/or balance,

*extreme exhaustion,

*changes of personality, psychoses,

*any other members of the family with a diagnosis of Behcet disease

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Mouth ulcer with Behcet’s Disease.

Aphthous ulcer in a patient with Behcet Disease.

…. .
Aphthous ulcer in a patient with Behcet Disease.

‘Suspected’ or ‘Possible’ diagnosis:

Usually given when someone does not have mouth ulcers or has mouth ulcers but does not have 1 of the 4 hallmark symptoms but has other symptoms and signs of inflammation and other causes for these have been ruled out.

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Treatment:
Current treatment is aimed at easing the symptoms, reducing inflammation, and controlling the immune system. Anti-TNF therapy such as infliximab has shown promise in treating the uveitis associated with the disease. Another Anti-TNF agent, Etanercept, may be useful in patients with mainly skin and mucosal symptoms.

Interferon alfa-2a may also be an effective alternative treatment, particularly for the genital and oral ulcers as well as ocular lesions. Azathioprine, when used in combination with interferon alfa-2b also shows promise, and Colchicine can be useful for treating some genital ulcers, erythema nodosum, and arthritis in women, and arthritis in men.

Thalidomide has also been used due to its immune-modifying effect. Dapsone and rebamipide have been shown, in small studies, to have beneficial results for mucocutaneous lesions.

A different orientation could be explored in Behçet Disease, especially with genetic linkage to HLA-B51 antigen, just like the prevalence of HLA-B27 in ankylosing spondylitis. Ankylosing spondylitis is not due to an ‘oveactive’ immune system; instead it is a true autoimmune disease caused by molecular mimicry of the Osp (outer surface protein) with the Klebsiella pneumoniae germ (2 enzymes produced by this normally non-virulent pathogen), which is always present as a sub-clinical infection, typically at the ileocecal junction. The combination of antibiotics targeted to this specific germ, and dietary controls (elimination or severe restriction of all starches) could therefore potentially provide the most effective treatments, but such treatments have not yet been proven or generally approved. At the current time, a similar infectious origin has not yet been confirmed that leads to Behçet disease, but certain strains of Streptococcus sanguis has been found to have a homologous antigenicity.

Prognosis:
For most patients, the prognosis of Behçet disease is good. Individuals typically experience periods of active symptoms followed by periods of remission in which there are no symptoms. The length of these intervals varies, with ulcerous outbreaks lasting a few weeks and other symptoms occurring for longer durations. With proper treatments and medication, patients can continue to lead active lifestyles in most cases.

Development of vascular or neurological complications often indicates a poorer prognosis. Blindness due to ocular inflammation is also prevalent in patients with BD.

Recovery and rehabilitation:
Unlike most diseases, BD has symptoms that periodically flare up and then disappear for a period of time. As a result, patients may have long intervals with no complications. After treatment for active symptoms, patients usually require rest due to fatigue. Moderate exercise is also recommended to improve circulation and muscle strength.

Click to learn more about:->Behcet’s Disease

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Behcet%27s_disease
http://www.healthline.com/galecontent/behet-disease
http://www.visualsunlimited.com/browse/vu425/vu425957.html
http://vasculitis.med.jhu.edu/typesof/behcets.html
http://www.visualsunlimited.com/browse/vu425/vu425958.html