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Ailmemts & Remedies

Sarcoidosis

Alternative Names : Sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease

Definition:
Sarcoidosis (from sarc meaning flesh, -oid, like, and -osis, process)  is a disease in which abnormal collections of chronic inflammatory cells (granulomas) form as nodules in multiple organs. The cause of sarcoidosis is unknown. Granulomas most often appear in the lungs or the lymph nodes, but virtually any organ can be affected. Normally the onset is gradual. Sarcoidosis may be asymptomatic or chronic. It commonly improves or clears up spontaneously. More than 2/3 of people with lung sarcoidosis have no symptoms after 9 years. About 50% have relapses. About 10% develop serious disability. Lung scarring or infection may lead to respiratory failure and death.

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Sarcoidosis most commonly affects young adults of both sexes, although studies have reported more cases in females. Incidence is highest for individuals younger than 40 and peaks in the age-group from 20 to 29 years; a second peak is observed for women over 50.

Sarcoidosis occurs throughout the world in all races with an average incidence of 16.5/100,000 in men and 19/100,000 in women. The disease is most prevalent in Northern European countries, and the highest annual incidence of 60/100,000 is found in Sweden and Iceland. In the United States, sarcoidosis is more common in people of African descent than Caucasians, with annual incidence reported as 35.5 and 10.9/100,000, respectively. Sarcoidosis is less commonly reported in South America, Spain, India, Canada, and the Philippines.

The differing incidence across the world may be at least partially attributable to the lack of screening programs in certain regions of the world and the overshadowing presence of other granulomatous diseases, such as tuberculosis, that may interfere with the diagnosis of sarcoidosis where they are prevalent. There may also be differences in the severity of the disease between people of different ethnicities. Several studies suggest that the presentation in people of African origin may be more severe and disseminated than for Caucasians, who are more likely to have asymptomatic disease.

Manifestation appears to be slightly different according to race and sex. Erythema nodosum is far more common in men than in women and in Caucasians than in other races. In Japanese patients, ophthalmologic and cardiac involvement are more common than in other races.

Sarcoidosis is one of the few pulmonary diseases with a higher prevalence in non-smokers

Classification:
Sarcoidosis may be divided into the following types:

*Annular sarcoidosis
*Erythrodermic sarcoidosis
*Ichthyosiform sarcoidosis
*Hypopigmented sarcoidosis
*Löfgren syndrome
*Lupus pernio
*Morpheaform sarcoidosis
*Mucosal sarcoidosis
*Neurosarcoidosis
*Papular sarcoid
*Scar sarcoid
*Subcutaneous sarcoidosis
*Systemic sarcoidosis
*Ulcerative sarcoidosis

Symptoms:
Sarcoidosis is a systemic disease that can affect any organ. Common symptoms are vague, such as fatigue unchanged by sleep, lack of energy, weight loss, aches and pains, arthritis, dry eyes, swelling of the knees, blurry vision, shortness of breath, a dry hacking cough or skin lesions. Sarcoidosis and cancer may mimic one another, making the distinction difficult.  The cutaneous symptoms vary, and range from rashes and noduli (small bumps) to erythema nodosum or lupus pernio. It is often asymptomatic.

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The combination of erythema nodosum, bilateral hilar lymphadenopathy and arthralgia is called Löfgren syndrome. This syndrome has a relatively good prognosis.

Renal, liver (including portal hypertension), heart or brain involvement may cause further symptoms and altered functioning. Sarcoidosis affecting the brain or nerves is known as neurosarcoidosis.

Cardiac sarcoidosis:
Although cardiac involvement is present in 20% to 30% of patients with sarcoidosis, only about 5% of patients with systemic sarcoidosis are symptomatic.

The presentation of cardiac sarcoidosis can range from asymptomatic conduction abnormalities to fatal ventricular arrhythmia. Myocardial sarcoidosis can be a rare cause of sudden cardiac death.

Eye:
Manifestations in the eye include uveitis, uveoparotitis, and retinal inflammation, which may result in loss of visual acuity or blindness. The combination of anterior uveitis, parotitis, VII cranial nerve paralysis and fever is called uveoparotid fever, and is associated with Heerfordt-Waldenstrom syndrome. (D86.8)

Nervous system:
The central nervous system is involved in fewer than 1% of patients with sarcoidosis. There is usually granulomatous involvement of the basal meninges that subsequently affects the cranial nerves. Myelopathy may be the initial clinical presentation of intramedullary neurosarcoidosis.

Scalp:
Sarcoidosis of the scalp presents with diffuse or patchy hair loss.

Causes and pathophysiology:
The exact cause of sarcoidosis is not known. The current working hypothesis is that in genetically susceptible individuals sarcoidosis is caused through alteration in immune response after exposure to an environmental, occupational, or infectious agent.

Dysregulation of the immune system:
Granulomatous inflammation is characterized primarily by accumulation of monocytes, macrophages and activated T-lymphocytes, with increased production of key inflammatory mediators, TNF-alpha, IFN-gamma, IL-2 and IL-12, characteristic of a Th1-polarized response (T-helper lymphocyte-1 response). Sarcoidosis has paradoxical effects on inflammatory processes; it is characterized by increased macrophage and CD4 helper T-cell activation resulting in accelerated inflammation, however, immune response to antigen challenges such as tuberculin is suppressed. This paradoxic state of simultaneous hyper- and hypo- activity is suggestive of a state of anergy. The anergy may also be responsible for the increased risk of infections and cancer. It appears that regulatory T-lymphocytes in the periphery of sarcoid granulomas suppress IL-2 secretion which is hypothesized to cause the state of anergy by preventing antigen-specific memory responses.

While it is widely believed that TNF-alpha plays an important role in the formation of granulomas, it was observed that sarcoidosis can be triggered by treatment with the TNF-alpha antagonist etanercept.

Genetic associations:
Investigations of genetic susceptibility yielded many candidate genes but only few were confirmed by further investigations and no reliable genetic markers are known. Currently, the most interesting candidate gene is BTNL2; several HLA-DR risk alleles are also being investigated.  In persistent sarcoidosis the HLA haplotype HLA-B7-DR15 are either cooperating in disease or another gene between these two loci is associated. In non-persistent disease there is a strong genetic association with HLA DR3-DQ2.[19] Siblings have only a modestly increased risk (hazard ratio 5-6) of developing the disease, indicating that genetic susceptibility plays only a small role. The alternate hypothesis that family members share similar exposures to environmental pathogens is quite plausible to explain the apparent hereditary factor.

Infectious agents:
Several infectious agents appear to be significantly associated with sarcoidosis but none of the known associations is specific enough to suggest a direct causative role. Propionibacterium acnes can be found in bronchoalveolar lavage of approximately 70% patients and is associated with disease activity, however it can be also found in 23% of controls. A recent meta-analysis investigating the role of mycobacteria in sarcoidosis found it was present in 26.4% of cases, however the meta-analysis also detected a possible publication bias, so the results need further confirmation.

There have also been reports of transmission of sarcoidosis via organ transplants.

Vitamin D dysregulation:
Sarcoidosis frequently causes an increase in vitamin D production outside the kidney. Macrophages inside the granulomas convert vitamin D to its active form, resulting in elevated levels of the hormone 1,25-dihydroxyvitamin D and symptoms of hypervitaminosis D that may include fatigue, lack of strength or energy, irritability, metallic taste, temporary memory loss or cognitive problems. Physiological compensatory responses (e.g., suppression of the parathyroid hormone levels) may mean the patient does not develop frank hypercalcemia. This condition may be aggravated by high levels of estradiol and prolactin such as in pregnancy, leading to hypercalciuria and/or compensatory hypoparathyroidism.High levels of Vitamin D are also implicated in immune-system dysfunctions which tie into the sarcoid condition.

Hyperprolactinemia:
Prolactin is frequently increased in sarcoidosis, between 3–32% cases have hyperprolactinemia,  this frequently leads to amenorrhea, galactorrhea or nonpuerperal mastitis in women. Prolactin also has a broad spectrum of effects on the immune system and increased prolactin levels are associated with disease activity or may exacerbate symptoms in many autoimmune diseases and treatment with prolactin lowering medication has been shown effective in some cases. However it is unknown if this relation holds in sarcoidosis and the gender predilection in sarcoidosis is less pronounced than in some other autoimmune diseases where such relation has been established. In pregnancy, the effects of prolactin and estrogen counteract each other to some degree, with a slight trend to improve pulmonary manifestations of sarcoidosis while lupus, uveitis and arthralgia might slightly worsen.   Lupus, uveitis and arthralgia are known to be in some cases associated with increased prolactin levels and respond to bromocriptin treatment but so far this has not been investigated specifically for sarcoidosis. The reasons for increased prolactin levels in sarcoidosis are uncertain. It has been observed that prolactin is produced by T-lymphocytes in some autoimmune disorders in amounts high enough to affect the feedback by the hypothalamic dopaminergic system.

The extrapituitary prolactin is believed to play a role as a cytokine like proinflammatory factor. Prolactin antibodies are believed to play a role in hyperprolactinemia in other autoimmune disorders and high prevalence endocrine autoimmunity has been observed in patients with sarcoidosis.[30] It may also be a consequence of renal disease or treatment with steroids. Neurosarcoidosis may occasionally cause hypopituiarism but has not been reported to cause hyperprolactinemia.

Thyroid disease:
In women, a substantial association of thyroid disease and sarcoidosis has been reported. The association is less marked but still significant for male patients. Female patients have a significantly elevated risk for hypothyroidism, hyperthyroidism and thyroid autoimmunity and it appears that autoimmunity is very important in the pathogenesis of thyroid disease in this population. Thyroid granulomatosis on the other hand is uncommon.

Hypersensitivity/autoimmune:
Association of autoimmune disorders has been frequently observed. The exact mechanism of this relation is not known but some evidence supports the hypothesis that this is a consequence of Th1 lymphokine prevalence.

Sarcoidosis has been associated with celiac disease. Celiac disease is a condition in which there is a chronic reaction to certain protein chains, commonly referred to as glutens, found in some cereal grains. This reaction causes destruction of the villi in the small intestine, with resulting malabsorption of nutrients.

An association with type IV hypersensitivity has been described. Tests of delayed cutaneous hypersensitivity have been used to measure progression.

Other:
While disputed, some cases have been associated with inhalation of the dust from the collapse of the World Trade Center after the September 11, 2001 attacks . Chicago comedian, Bernie Mac, suffered from sarcoidosis and died of pneumonia as a result of his compromised immune system. Reggie White, a former standout National Football League player, also suffered from sarcoidosis, and the disease played a major role in his death.

Risk Factors:
While anyone can develop sarcoidosis, factors that may increase your risk include:

*Age and sex. Sarcoidosis usually occurs between the ages of 20 and 40. Women are slightly more likely to develop the disease than are men.

*Race. Black Americans have a higher incidence of sarcoidosis than do white Americans. Also, sarcoidosis may be more severe in blacks and more likely to cause skin problems.

*Ethnicity. Worldwide, sarcoidosis is most commonly reported in people whose families originally came from Northern Europe — particularly Scandinavia and Britain. People with Japanese ancestry are more likely to develop eye or cardiac complications from sarcoidosis.

*Family history. If someone in your family has had sarcoidosis, you are more likely to develop the disease yourself.

Complications:
In about two-thirds of people with sarcoidosis, the condition resolves with no lasting consequences. But in some people, sarcoidosis can become chronic and lead to complications that may affect different parts of our body, such as : Lungs,Eyes,Kidneys,Heart, Nervous system  and Reproductive system.

Diagnosis:
Sarcoidosis can be difficult to diagnose, partly because the disease produces few signs and symptoms in its early stages. And when symptoms do occur, they vary by organ system affected and can mimic those of other disorders. A variety of diagnostic tests can narrow the possibilities and rule out other conditions.

Imaging tests
*X-ray. A simple chest X-ray can reveal evidence of lung damage or enlarged lymph nodes in your chest. In fact, some people have been diagnosed with sarcoidosis before they have any symptoms — from the evidence provided by chest X-rays taken for other reasons.

*CT scan. Computerized tomography (CT) uses a computer to combine a large number of X-rays views taken from many different directions into detailed, cross-sectional images of your internal structures.

Lab tests
Samples of your blood may be tested to check your general health and to see how well your kidneys and liver are functioning.

Lung function tests
These tests typically measure:

…#The volume of your lungs
…#How much air you can breathe in and out
…#How fast you can breathe air out
…#How well your lungs deliver oxygen to your blood

Biopsies
A biopsy is a small sample of tissue taken from a part of your body believed to be affected by sarcoidosis. The sample can be tested for the types of granulomas that are commonly seen in sarcoidosis. Biopsies can most easily be taken from your skin, from lymph nodes right under the skin, or from the outer membrane of your eye.

Lung biopsies can be obtained during a bronchoscopy (brong-KOS-kuh-pee). This procedure uses a thin, flexible tube that contains a fiber-optic camera and a grasping tool. After the tube is inserted down your throat, a doctor uses the grasping tool to remove a small sample of lung tissue — about the size of a grain of rice. The sample is sent to a microbiology laboratory to look for specific organisms.

Treatment :
Currently, there’s no cure for sarcoidosis. For one in ten people the disease slowly gets worse over time and for one in 50 it proves fatal. However, for the majority of those with the disorder – around eight out of every ten people, in fact – the condition resolves spontaneously after a few years and never comes back.

Relief from symptoms can be found with anti-inflammatory painkillers, and steroids can also prove extremely effective. When used to treat chronic sarcoidosis, steroids may need to be used at a low dose for many months, sometimes a year or more. During this time, regular blood and lung function tests and chest x-rays are performed to monitor how well the treatment is working. In more severe cases, immunosuppressive drugs such as methotrexate are used. Newer drugs such as infliximab may also be prescribed.

Prognosis:
The disease can remit spontaneously or become chronic, with exacerbations and remissions. In some patients, it can progress to pulmonary fibrosis and death. Approximately half of the cases resolve without treatment or can be cured within 12–36 months and most within 5 years. Some cases persist several decades.  Where the heart is involved, the prognosis is poor.   Patients with sarcoidosis appear to be at significantly increased risk for cancer, in particular lung cancer, malignant lymphomas,[40] and cancer in other organs known to be affected in sarcoidosis.   In sarcoidosis-lymphoma syndrome, sarcoidosis is followed by the development of a lymphoproliferative disorder such as non-Hodgkin lymphoma. This may be attributed to the underlying immunological abnormalities that occur during the sarcoidosis disease process.  Sarcoidosis can also follow cancer   or occur concurrently with cancer. There have been reports of hairy cell leukemia,  acute myeloid leukemia,  and acute myeloblastic leukemia   associated with sarcoidosis.
In pregnancy:
Sarcoidosis generally does not prevent successful pregnancy and delivery; the endogenous estrogen in pregnancy may even have a slightly beneficial immunomodulatory effect. In most cases the course of sarcoidosis is unaffected by pregnancy; there is improvement in a few cases and worsening of symptoms in very few cases.
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.

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Resources:
http://en.wikipedia.org/wiki/Sarcoidosis
http://www.bbc.co.uk/health/physical_health/conditions/sarcoidosis1.shtml
http://www.mayoclinic.com/health/sarcoidosis/DS00251

http://www.metrohealth.org/body.cfm?id=1554

Categories
Ailmemts & Remedies

Bell’s Palsy

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Definition:-
Bell’s palsy or idiopathic facial paralys  is a dysfunction of cranial nerve VII (the facial nerve) that results in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell’s palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell’s palsy is the most common acute mononeuropathy (disease involving only one nerve) and is the most common cause of acute facial nerve paralysis.

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Bell’s palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day. It can occur bilaterally resulting in total facial paralysis in around 1% of cases.

It is thought that an inflammatory condition leads to swelling of the facial nerve. The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell’s palsy has been found.

Corticosteroids have been found to improve outcomes while anti-viral drugs have not. Early treatment is necessary for steroids to be effective. Most people recover spontaneously and achieve near-normal to normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment.

Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision. In some cases denture wearers experience some discomfort.

Bell’s palsy occurs when the nerve that controls facial muscles on one side of your face becomes swollen or inflamed. As a result of Bell’s palsy, your face feels stiff. Half your face appears to droop, your smile is one-sided, and your eye resists closing.

Bell’s palsy can affect anyone, but rarely affects people under the age of 15 or over the age of 60.

For most people, Bell’s palsy symptoms improve within a few weeks, with complete recovery in three to six months. About 10 percent will experience a recurrence of Bell’s palsy, sometimes on the other side of the face. A small number of people continue to have some Bell’s palsy signs and symptoms for life.

Bell’s palsy occurs more often in people who:

*Are pregnant, especially during the third trimester, or who are in the first week after giving birth
*Have diabetes
*Have an upper respiratory infection, such as the flu or a cold

Also, some people who have recurrent attacks of Bell’s palsy, which is rare, have a family history of recurrent attacks. In those cases, there may be a genetic predisposition to Bell’s palsy.

Symptoms:
Bell’s palsy is characterized by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. Facial palsy is typified by inability to control movement in the facial muscles. The paralysis is of the infranuclear/lower motor neuron type.

The facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, and salivation. They also innervate the stapedial (stapes) muscles of the middle ear and carry taste sensations from the anterior two thirds of the tongue.

Clinicians should determine whether the forehead muscles are spared. Due to an anatomical peculiarity, forehead muscles receive innervation from both sides of the brain. The forehead can therefore still be wrinkled by a patient whose facial palsy is caused by a problem in one of the hemispheres of the brain (central facial palsy). If the problem resides in the facial nerve itself (peripheral palsy) all nerve signals are lost on the ipsilateral (same side of the lesion) half side of the face, including to the forehead (contralateral forehead still wrinkles).

One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. The major differences in this condition are the presence of small blisters, or vesicles, on the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete).

Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy.

The main symptom of Bell’s palsy is a sudden weakness or paralysis in one side of your face that causes it to droop. This may make it hard for you to close your eye on that side of your face.

Other symptoms include:

*Drooling.
*Eye problems, such as excessive tearing or a dry eye.
*Loss of ability to taste.
*Pain in or behind your ear.
*Numbness in the affected side of your face.
*Increased sensitivity to sound.
*Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days — making it difficult to smile or close your eye on the affected side
*Facial droop and difficulty making facial expressions
*Pain around the jaw or in or behind your ear on the affected side
*Increased sensitivity to sound on the affected side
*Headache
*Changes in the amount of tears and saliva you produce

In rare cases, Bell’s palsy can affect the nerves on both sides of your face.


Cause
:-
Some viruses are thought to establish a persistent (or latent) infection without symptoms, e.g. the Zoster virus of the face and Epstein-Barr viruses, both of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested as cause behind the acute Bell’s palsy. Studies suggest that this new activation could be preceded by trauma, environmental factors, and metabolic or emotional disorders, thus suggesting that stress – emotional stress, environmental stress (e.g. cold), physical stress (e.g. trauma) – in short, a host of different conditions, may trigger reactivation.

Other viruses that have been linked to Bell’s palsy include:

*The virus that causes chickenpox and shingles (herpes zoster)
*The virus that causes mononucleosis (Epstein-Barr)
*Another virus in the same family (cytomegalovirus)

With Bell’s palsy, the nerve that controls your facial muscles, which passes through a narrow corridor of bone on its way to your face, becomes inflamed and swollen — usually from a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

Pathology:
It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell’s palsy per se. Possible causes include tumor, meningitis, stroke, diabetes mellitus, head trauma and inflammatory diseases of the cranial nerves (sarcoidosis, brucellosis, etc.). In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy. In a few cases, bilateral facial palsy has been associated with acute HIV infection.

In some research the herpes simplex virus type 1 (HSV-1) was identified in a majority of cases diagnosed as Bell’s palsy. This has given hope for anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir). Other research[5] however, identifies HSV-1 in only 31 cases (18 percent), herpes zoster (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases clinically diagnosed as Bell’s Palsy. That infection with herpes simplex virus should play a major role in cases diagnosed as Bell’s palsy therefore remains a hypothesis that requires further research.

In addition, the herpes simplex virus type 1 (HSV-1) infection is associated with demyelination of nerves. This nerve damage mechanism is different from the above mentioned – that oedema, swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage. Demyelination may not even be directly caused by the virus, but by an unknown immune system response. The quote below captures this hypothesis and the implication for other types of treatment:

It is also possible that HSV-1 replication itself is not responsible for the damage to the facial nerves and that inhibition of HSV-1 replication by acyclovir does not prevent the progression of nerve dysfunction. Because the demyelination of facial nerves caused by HSV-1 reactivation, via an unknown immune response, is implicated in the pathogenesis of HSV-1-induced facial palsy, a new strategy of treatment to inhibit such an immune reaction may be also effective.

Diagnosis:-
Bell’s palsy is a diagnosis of exclusion; by elimination of other reasonable possibilities. Therefore, by definition, no specific cause can be ascertained. Bell’s palsy is commonly referred to as idiopathic or cryptogenic, meaning that it is due to unknown causes. Being a residual diagnostic category, the Bell’s Palsy diagnosis likely spans different conditions that our current level of medical knowledge cannot distinguish. This may inject fundamental uncertainty into the discussion below of etiology, treatment options, recovery patterns etc. See also the section below on Other symptoms. Studies   show that a large number of patients (45%) are not referred to a specialist, which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. A significant number of cases are misdiagnosed (ibid.). This is unsurprising from a diagnosis of exclusion, which depends on a thorough investigation.

Risk Factors:
Although a mild case of Bell’s palsy normally disappears within a month, recovery from a case involving total paralysis varies. Complications may include:

*Irreversible damage to your facial nerve
*Misdirected regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you’re trying to move others (synkinesis) — for example, when you smile, the eye on the affected side may close
*Partial or complete blindness of the eye that won’t close, due to excessive dryness and scratching of the cornea, the clear protective covering of the eye.

Treatment:=
In patients presenting with incomplete facial palsy, where the prognosis for recovery is very good, treatment may be unnecessary. Patients presenting with complete paralysis, marked by an inability to close the eyes and mouth on the involved side, are usually treated. Early treatment (within 3 days after the onset) is necessary for therapy to be effective.[9] Steroids have been shown to be effective at improving recovery while antivirals have not.

Steroids
Corticosteroid such as prednisone significantly improves recovery at 6 months and are thus recommended.

Antivirals
Antivirals (such as acyclovir) are ineffective in improving recovery from Bell’s palsy beyond steroids alone. They were however commonly prescribed due to a theoretical link between Bell’s palsy and the herpes simplex and varicella zoster virus.

Physical therapy
Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery
One way to relieve the pressure on the facial nerve is to surgically open the bony passage through which it passes. This decompression surgery is controversial and rarely recommended. In some cases, however, plastic surgery may be needed to make your face look and work better.

Home Remedy  & Lyfe Style:
Home treatment may include:
*Protecting the eye you can’t close. Using lubricating eyedrops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched.

*Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help ease your pain.

*Applying moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.

*Doing your physical therapy exercises. Massaging and exercising your face according to your physical therapist’s advice may help relax your facial muscles.

Alternative medicine:
Although there’s little scientific evidence to support the use of alternative medicine for people with Bell’s palsy, some people with the condition may benefit from the following:

*Relaxation techniques, such as meditation and yoga, may relieve muscle tension and chronic pain.

*Acupuncture, placing thin needles into your skin to relieve pain, may stimulate nerves and muscles, offering some relief.(The efficacy of acupuncture remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).

*Biofeedback training, by teaching you to use your thoughts to control your body, may help you gain better control over your facial muscles.

*Vitamin therapy — specifically B-12, B-6 and zinc — may help nerve growth

Prognosis:
Even without any treatment, Bell’s palsy tends to carry a good prognosis. In a 1982 study, when no treatment was available, of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later. After a follow-up of at least 1 year or until restoration, complete recovery had occurred in more than two thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients. Another study found that incomplete palsies disappear entirely, nearly always in the course of one month. The patients who regain movement within the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop sequelae. A third study found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis.

Major complications of the condition are chronic loss of taste (ageusia), chronic facial spasm and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete paralysis. Where the eye does not close completely, the blink reflex is also affected, and care must be taken to protect the eye from injury.

Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections that branch out to their proper destinations. During regrowth, nerves are generally able to track the original path to the right destination – but some nerves may sidetrack leading to a condition known as synkinesis. For instance, regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. For example, when the person closes the eye, the corner of the mouth lifts involuntarily.

In addition, around 6%[citation needed] of patients exhibit crocodile tear syndrome, also called gustatolacrimal reflex or Bogorad’s Syndrome, on recovery, where they will shed tears while eating. This is thought to be due to faulty regeneration of the facial nerve, a branch of which controls the lacrimal and salivary glands. Gustatorial sweating can also occur.

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/Bell’s_palsy
http://www.mayoclinic.com/health/bells-palsy/DS00168
http://www.webmd.com/brain/tc/bells-palsy-treatment-overview

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Categories
Health Problems & Solutions

Some Health Quaries & Answers

 

Q: My husband and I both have corns on our feet. His corns fell off after he applied corn caps. Mine did not even though I used the same caps. The caps keep falling off instead.

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A: If the corn caps worked for your husband, trying the same brand makes sense. For self-treatment to be successful, the foot has to be dry when you apply the caps. Also, do not walk barefoot even in the house. When you have a bath, tie your leg in a plastic bag so that the caps do not get wet. You need to leave them on as long as possible.

Even though the lesions appear similar, in your case the diagnosis may be something else like warts. If they are still present after three months of self-treatment with corn plasters, consult a dermatologist and consider having them surgically removed.

HIS  FACE WAS PARALYZED :-

Q: My uncle was travelling in a car sitting next to the window. After he reached home he found that he could not move the right side of his face, or even close the eye. Is this a stroke?

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A: This sounds more like “Bell’s palsy” than a stroke. It is an isolated paralysis of the facial nerve. It is common in persons between 15-60 years of age and in diabetics. It occurs because the facial nerve passes through a narrow bony canal in the ear before its branches enter the facial muscles. Exposure to cold can cause the nerve to swell up. It then becomes compressed. The pressure causes the paralysis. This can also occur as a result of an infection with the Herpes Simplex virus.

Treatment is with antiviral agents, steroids and physiotherapy. Recovery is usually complete.

POTTY TRAINING

Q: My six-year-old son has no control over his bowel movement. His pants and underwear are constantly soiled because part of the motion leaks out. It is not diarrhoea. This happens in school too, and it is becoming a problem.

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A: If your son had control of his motion initially and has now lost it, he probably suffers from a condition called “encopresis”. It occurs when the child does not go to the toilet when he feels the urge. This results in chronic constipation. Once the rectum is full of impacted stools, liquid motion from above can leak out of the anus causing this problem.

Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movement. This means training your son to go to the toilet as soon as the urge to defecate occurs. Also, try to send him to the toilet every day at a fixed time.

The diet should contain dietary fibre in the form of four to five helpings of fruits or vegetables a day.

DARK PATCHES

Q: I developed dark patches on my arms and legs. I went to one of the clinics advertised on television and they diagnosed macular amyloidosis (I don’t know what that is) and advised laser treatment. I am a bit nervous about this.

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A: Macular amyloidosis is a skin condition in which itchy lesions appear as flat dusky-brown or greyish spots that may eventually form patches of darkened skin. It is found symmetrically distributed over the upper back between the shoulder blades, on the chest, sometimes on the arms, and rarely on the legs.

The diagnosis has to be made after a biopsy. All dark patches are not macular amyloidosis (yours seem non-itchy) nor do they require expensive treatment like laser therapy. Go to a dermatologist, confirm the diagnosis and then start treatment. Usually anti histamines and topical steroids are tried initially. Do not believe everything said in advertisements on television.

CURE  FOR  PCOS

Q: My daughter has polycystic ovarian syndrome (PCOS). Each time the doctor puts her on tablets, and she is alright for a few months. As soon as the treatment is discontinued, her periods become irregular.

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A: PCOS occurs because of an inherited abnormal gene for food metabolism. As a result the sufferer tends to become obese, develop acne and have irregular periods. The gene will always be present. The tendency to manifest the gene can be controlled if —

* Your daughter jogs 40 minutes a day

* She maintains her BMI at 23 (BMI is weight divided by height in metre squared).

Pills or exercise — the choice is hers.

ATTEMPTED  RAPE

Q: A relative tried to rape me during my childhood. Now I have abdominal pain all the time. I think I have an infection.


A: Since you are worried, and with reason, test your blood for VDRL, HIV and HbAg. Also, do an ultrasound of the abdomen and pelvis. If all these are normal, you have nothing to worry about.

Move on with your life and forget the past. Almost 95 per cent women face unwelcome unwanted sexual advances at some time in their life. Take lessons in karate, Kung Fu or some other martial art. It will make you more confident and ensure nothing like that happens again.

Source: The Telegraph ( Kolkata, India)

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Categories
Ailmemts & Remedies

Lagophthalmos

Synonym(s): Hare’s eye

[G. lagos, hare + ophthalmos, eye]

Definition:
Lagophthalmos is defined as the inability to close the eyelids completely. A condition in which a complete closure of the eyelids over the eyeball is difficult or impossible.

Blinking covers the eye with a thin layer of tear fluid, thereby promoting a moist environment necessary for the cells of the exterior part of the eye. The tears also flush out foreign bodies and wash them away. This is crucial to maintain lubrication and proper eye health. If this process is impaired, as in lagophthalmos, the eye can suffer abrasions and infections. Lagopthalmos leads to corneal drying and ulceration.

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Nocturnal lagophthalmos is the inability to close the eyelids during sleep. Lagophthalmos is associated with exposure keratopathy, poor sleep, and persistent exposure-related symptoms.

Detection:There are a variety of causes of lagophthalmos, grouped as proptosis/eye exposure etiologies and palpebral insufficiency etiologies. Although obvious lagophthalmos is usually detected, it is sometimes difficult to recognize obscure lagophthalmos, due either to eyelash obstruction or overhang of the upper lid anterior and inferior to the most superior portion of the lower lid in a closed position. A novel classification system and illustrations of obvious and obscure lagophthalmos for detection.

Causes:
The inability to provide function to the eyelid is typically secondary to a previous or ongoing condition, surgery, or event. This paralysis is usually isolated to just one side of the face. Lagophthalmos and facial paralysis are typically diagnosed due to:

*Bell’s Palsy
*Trauma
*Neurosurgery
*Bacterial infection
*Cerebral vascular accidents (strokes)

Pathophysiology
Lagophtalmos can arise from a malfunction of the Facial nerve. Lagopthalmos can also occur in comatose patients having a decrease in orbicularis tone, in patients having palsy of the facial nerve (7th cranial nerve), and in people with severe skin disorders such as ichthyosis.

Risk Factors:
Your eyelids play a crucial role in protecting and providing nourishment to your eyes. When blinking or eyelid closure function is lost, the health of your eyes can be at risk. Many experts have noted several complications associated with lagophthalmos:

*Severe dry eye and discomfort
*Corneal ulceration (damage to the cornea-the clear tissue covering the front of your eye)
*Decrease or loss of vision
*Unsatisfactory appearance

Diagnosis:

A diagnosis can usually be made with a focused history and slit lamp examination. Treatment is multipronged and may include minor procedures or ocular surgery to correct the lid malposition; natural, topical or oral agents; and punctal plugs to manage ocular surface effects. Correct and timely diagnosis allows greater opportunity for relief of patient suffering and prevention of severe ocular surface pathology, as well as educated planning for future ocular surgical procedures.

Treatment:
Today, lagopthalmos is most likely to arise after an inexperienced or unwise cosmetic/plastic surgeon performs an overenthusiastic upper blepharoplasty, which is an operation performed to remove excessive skin overlying the upper eyelid (suprapalpebral hooding) that often occurs with aging. This can appreciably improve the patient’s appearance, and make the patient look younger. If, however, excessive skin is removed, the appearance is unnatural and “lagopthalmos” is one of the signs of such excessive skin removal.

It all begins with your diagnosis of your condition by your ophthalmologist. Typically, if your paralysis is expected to last less than six months, your doctor will recommend the use of drops and ointments throughout the day to help maintain a well-nourished eye.

If your paralysis is deemed permanent or persists without improvement, your surgeon may want to perform surgery to control the paralysis and provide a more natural function to your eyelid. The most common surgical procedure involves the placement of a small, pure-gold eyelid weight into your eyelid. This procedure very simple and is typically performed under local anesthesia in an outpatient setting.

How Does The Gold Eyelid Weight Work?

It’s very simple. The appropriate implant ‘weight’ will be selected your physician. When implanted into your lid margin, the weight will essentially allow earth’s gravity to gently pull your eye closed when your muscles relax. However, this will not affect your ability to open your eye…. when you tense the muscle, your eyelid will open normally.

CLICK & SEE

Is Gold A Safe Material?
Each weight is made from 99.99% gold (pure gold). Pure gold is an excellent material because it is biologically stable and inert. Because the gold will never break down, your surgeon can always remove it if deemed necessary. Gold has been used for decades for the treatment of lagophthalmos and is recognized by experts as an extremely safe and effective device material. If you have a known sensitivity or allergy to gold, notify your physician before surgery.

What Happens During Surgery? How Is The Gold Weight Implanted?
Gold eyelid weight surgery is usually performed under local anesthesia in an outpatient setting. Previous to the day of the surgery, your physician will have selected the appropriate gold weight size for your specific needs.

During the procedure, your physician will first make a small incision in your eyelid, just above your eyelashes. This incision will allow your physician to create a small pocket inside your lid for the gold implant to rest. The weight will be secured to your lid with sutures. Each weight contains small channels or grooves to house the sutures below the surface of the implant. The incision is closed with sutures. A protective pad will be applied to cover your eyelid.

What Happens After Surgery? What Should I Expect Regarding The Function And Appearance Of My Eyelid?

As always, your condition and progress will be closely monitored by your physician. Following the removal of your eye protection, you should be able to experience normal blinking and eyelid closure function.

Like any surgery, the incision will take time to heal. If you experience significant discomfort or swelling around the incision, contact your physician immediately.

Any questions or concerns you have about your surgery can best be answered by your surgeon. You can best insure the best outcome for your procedure by carefully following your surgeon’s instructions.

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/Lagophthalmos
http://www.iopinc.com/patient_link/lagophthalmos.asp
http://www.drugs.com/dict/lagophthalmos.html
http://www.ncbi.nlm.nih.gov/pubmed/16671223