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..
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.
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.
Q: When my wife and I visited the Taj Mahal we bought a souvenir, a replica of the Taj made of chalk. It disappeared a few days after we returned. My wife finally confessed to having eaten the whole thing! Then I discovered that she has also been eating uncooked rice and occasionally red bricks too from the housing construction next door. I realise she needs help. Should I go to a psychiatrist?
A: Your wife has “pica”, a craving to eat things not normally considered food. People eat clay, chalk, mud and brick. Pica is an uncontrollable habit, so you’ll have to watch her for some time as she might resort to hiding the fact that she’s still eating non-food items. The urge is uncontrollable even though she knows it is wrong. It is often due to mineral deficiency. It is not a psychiatric problem. Consult a physician. She probably needs antihelminthics (de-worming), and supplements of iron, calcium and zinc.
Doggy pain..
Q: I take my Labrador for a walk in the mornings. He is exuberant, poorly trained and pulls on his leash. Of late I have noticed that my right hand tingles while holding the leash and that this sensation also wakes me up at night. The fingers are often stiff in the morning.
A: Your regular walk probably keeps you fit and provides you with the required amount of exercise. However, if the dog’s personality is as described, you need to take some precautions to prevent injury. Keep the dog on a short leash — holding it firmly at the distance of about one and a half feet, even if the leash is longer. Wear wrist guards and elbow guards. This will prevent injury due to sudden pulls and tugs.
The symptoms you describe sound like “carpal tunnel syndrome” where one of the nerves to the hand is trapped in the ligaments and bones at the wrist. It may have occurred due to injury while controlling the dog. It is better to see an orthopaedic surgeon who specialises in hand injuries.
Q: My one-year-old son developed fever and the doctor prescribed amoxicillin. After three days of he developed red rashes all over the body. My mother says it is measles but he is immunised.
A: Measles immunisation is given at the age of nine months. At that time antibodies, transferred from the mother through the placenta, are present but waning. If there is a high level of maternal antibodies, the vaccine may not produce a satisfactory response. This is the reason for a booster, which is given as the MMR (measles, mumps and rubella) vaccine at 15 months. Once this is also given the immunity is almost 100 per cent.
All rashes are not due to measles. Other viral infections can also lead to rashes. Amoxicillin causes non-specific red rashes in some people. Allergies can also cause rashes, in which case there will be associated itching.
Ulcer baby…..
Q: My baby is 10 months old and has developed severe ulcers in the mouth. My doctor says it is due to herpes infection. I always thought that herpes was a sexually transmitted disease.
A: Herpes is the name given to a group of viruses. Different viruses from this group can cause various diseases like chicken pox, ulcers in the mouth or herpes progenitalis. These ulcers are painful. So the baby may find it difficult to swallow. The doctor will usually prescribe some local treatment and antiviral medication.
Although this infection occurs in a large number of children, it is less common in those who are not bottle fed or given pacifiers.
Q: I had a chikungunya infection about six months ago but my ankles still hurt. I find locomotion difficult as there are sudden attacks of excruciating pain.
A: Unfortunately a chikungunya infection has a long lasting impact in some people. The joint pain either persists or keeps flaring up unexpectedly intermittently for as long as two years. When there is pain apply a capsaicin-containing ointment locally, then place ice on the joint as a cold compress, alternate it with heat from a hot water bottle, have physiotherapy and use analgesics for pain relief.
Definition:
Autism is a brain development disorder that is characterized by impaired social interaction and communication, and restricted and repetitive behavior, all starting before a child is three years old. This set of signs distinguishes autism from milder autism spectrum disorders (ASD) such as pervasive developmental disorder not otherwise specified (PDD-NOS).
Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by multigene interactions or by rare mutations. In rare cases, autism is strongly associated with agents that cause birth defects. Other proposed causes, such as childhood vaccines, are controversial; the vaccine hypotheses lack convincing scientific evidence. Most recent reviews estimate a prevalence of one to two cases per 1,000 people for autism, and about six per 1,000 for ASD, with ASD averaging a 4.3:1 male-to-female ratio. The number of people known to have autism has increased dramatically since the 1980s, at least partly as a result of changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved.
Autism causes children to experience the world differently from the way most other children do. It’s hard for people with autism to talk with other people and express themselves using words. Some people who have autism keep to themselves and many can’t communicate without special help.
They also may react to what’s going on around them in unusual ways. Normal sounds may really bother someone with autism — so much so that the person covers his or her ears. Being touched, even in a gentle way, may feel uncomfortable.
Children with autism often can’t make connections that other kids make easily. For example, when someone smiles, you
know the smiling person is happy or being friendly. But a child with autism may have trouble connecting that smile with the person’s happy feelings.
A child who has autism also has trouble linking words with their meanings. Imagine trying to understand what someone is saying if you didn’t know what their words really meant. It is doubly frustrating then if a child can’t come up with the right words to express his or her own thoughts.
Autism causes children to act in unusual ways. They might flap their hands, say certain words over and over, have temper tantrums, or play only with one particular toy. Most kids with autism don’t like changes in routines. They like to stay on a schedule that is always the same. They also may insist that their toys or other objects be arranged a certain way and get upset if these items are moved or disturbed.
If someone has autism, his or her brain has trouble with an important job: making sense of the world. Every day, your brain interprets the sights, sounds, smells, and other sensations that you experience. If your brain couldn’t help you understand these things, you would have trouble functioning, talking, going to work or school, and doing other everyday things. People can be mildly affected by autism, so that they only have a little trouble in life, or they can be very affected, so that they need a lot of help.
Causes:
It has long been presumed that there is a common cause at the genetic, cognitive, and neural levels for autism’s characteristic triad of symptoms. However, there is increasing suspicion that autism is instead a complex disorder whose core aspects have distinct causes that often co-occur.
Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by multigene interactions or by rare mutations with major effects. Complexity arises due to interactions among multiple genes, the environment, and epigenetic factors which do not change DNA but are heritable and influence gene expression. Early studies of twins estimated heritability explains more than 90% of the risk of autism, assuming a shared environment and no other genetic or medical syndromes. However, most of the mutations that increase autism risk have not been identified. Typically, autism cannot be traced to a Mendelian (single-gene) mutation or to a single chromosome abnormality like Angelman syndrome or fragile X syndrome, and none of the genetic syndromes associated with ASDs has been shown to selectively cause ASD. Numerous candidate genes have been located, with only small effects attributable to any particular gene. The large number of autistic individuals with unaffected family members may result from copy number variations—spontaneous deletions or duplications in genetic material during meiosis. Hence, a substantial fraction of autism cases may be traceable to genetic causes that are highly heritable but not inherited: that is, the mutation that causes the autism is not present in the parental genome.
Gene replacement studies in mice suggest that autistic symptoms are closely related to later developmental steps that depend on activity in synapses and on activity-dependent changes, and that the symptoms may be reversed or reduced by replacing or modulating gene function after birth. All known teratogens (agents that cause birth defects) related to the risk of autism appear to act during the first eight weeks from conception, and though this does not exclude the possibility that autism can be initiated or affected later, it is strong evidence that autism arises very early in development. Although evidence for other environmental causes is anecdotal and has not been confirmed by reliable studies, extensive searches are underway. Environmental factors that have been claimed to contribute to or exacerbate autism, or may be important in future research, include certain foods, infectious disease, heavy metals, solvents, diesel exhaust, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illicit drugs, vaccines, and prenatal stress. Although parents may first become aware of autistic symptoms in their child around the time of a routine vaccination (and parental concern about vaccines has led to a decreasing uptake of childhood immunizations and an increasing likelihood of measles outbreaks), there is overwhelming scientific evidence showing no causal association between the measles-mumps-rubella vaccine and autism, and no scientific evidence that the vaccine preservative thiomersal helps cause autism.
Despite extensive investigation, how autism occurs is not well understood. Its mechanism can be divided into two areas: the pathophysiology of brain structures and processes associated with autism, and the neuropsychological linkages between brain structures and behaviors. The behaviors appear to have multiple pathophysiologies.
Autism affects about 1 in every 150 people, but no one knows what causes it. Some scientists think that some children might be more likely to get autism because it or similar disorders run in their families. Knowing the exact cause of autism is hard because the human brain is very complicated.
The brain contains over 100 billion nerve cells called neurons. Each neuron may have hundreds or thousands of connections to other nerve cells in the brain and body. The connections (which are made by releasing neurotransmitters) let different neurons in different areas of the brain — areas that help you see, feel, move, remember, and much more — work together.
For some reason, some of the cells and connections in the brain of a child with autism — especially those that affect communication, emotions, and senses — don’t develop properly or get damaged. Scientists are still trying to understand how and why this happens.
Symptoms:……...CLICK & SEE Core symptoms:
The severity of symptoms varies greatly between individuals, but all people with autism have some core symptoms in the areas of:
Social interactions and relationships. Symptoms may include:
*Significant problems developing nonverbal communication skills, such as eye-to-eye gazing, facial expressions, and body posture.
*Failure to establish friendships with children the same age.
*Lack of interest in sharing enjoyment, interests, or achievements with other people.
*Lack of empathy. People with autism may have difficulty understanding another person’s feelings, such as pain or sorrow.
Verbal and nonverbal communication. Symptoms may include:
*Delay in, or lack of, learning to talk. As many as 40% of people with autism never speak.1
*Problems taking steps to start a conversation. Also, people with autism have difficulties continuing a conversation after it has begun.
*Stereotyped and repetitive use of language. People with autism often repeat over and over a phrase they have heard previously (echolalia).
*Difficulty understanding their listener’s perspective. For example, a person with autism may not understand that someone is using humor. They may interpret the communication word for word and fail to catch the implied meaning.
Limited interests in activities or play. Symptoms may include:
*An unusual focus on pieces. Younger children with autism often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy.
*Preoccupation with certain topics. For example, older children and adults may be fascinated by video games, trading cards, or license plates.
*A need for sameness and routines. For example, a child with autism may always need to eat bread before salad and insist on driving the same route every day to school.
*Stereotyped behaviors. These may include body rocking and hand flapping.
Symptoms during childhood
Symptoms of autism are usually noticed first by parents and other caregivers sometime during the child’s first 3 years. Although autism is present at birth (congenital), signs of the disorder can be difficult to identify or diagnose during infancy. Parents often become concerned when their toddler does not like to be held; does not seem interested in playing certain games, such as peekaboo; and does not begin to talk. Sometimes, a child will start to talk at the same time as other children the same age, then lose his or her language skills. They also may be confused about their child’s hearing abilities. It often seems that a child with autism does not hear, yet at other times, he or she may appear to hear a distant background noise, such as the whistle of a train.
With early and intensive treatment, most children improve their ability to relate to others, communicate, and help themselves as they grow older. Contrary to popular myths about children with autism, very few are completely socially isolated or “live in a world of their own.”
Symptoms during teen years:
During the teen years, the patterns of behavior often change. Many teens gain skills but still lag behind in their ability to relate to and understand others. Puberty and emerging sexuality may be more difficult for teens who have autism than for others this age. Teens are at an increased risk for developing problems related to depression, anxiety, and epilepsy.
Symptoms in adulthood:
Some adults with autism are able to work and live on their own. The degree to which an adult with autism can lead an independent life is related to intelligence and ability to communicate. At least 33% are able to achieve at least partial independence.2
Some adults with autism need a lot of assistance, especially those with low intelligence who are unable to speak. Part- or full-time supervision can be provided by residential treatment programs. At the other end of the spectrum, adults with high-functioning autism are often successful in their professions and able to live independently, although they typically continue to have some difficulties relating to other people. These individuals usually have average to above-average intelligence.
Other symptoms:
Many people with autism have symptoms similar to attention deficit hyperactivity disorder (ADHD). But these symptoms, especially problems with social relationships, are more severe for people with autism. For more information, see the topic Attention Deficit Hyperactivity Disorder.
About 10% of people with autism have some form of savant skills-special limited gifts such as memorizing lists, calculating calendar dates, drawing, or musical ability.1
Many people with autism have unusual sensory perceptions. For example, they may describe a light touch as painful and deep pressure as providing a calming feeling. Others may not feel pain at all. Some people with autism have strong food likes and dislikes and unusual preoccupations.
Sleep problems occur in about 40% to 70% of people with autism.
Other conditions:
Autism is one of several types of pervasive developmental disorders (PDDs), also called autism spectrum disorders (ASD). It is not unusual for autism to be confused with other PDDs, such as Asperger’s disorder or syndrome, or to have overlapping symptoms. A similar condition is called pervasive developmental disorder-NOS (not otherwise specified). PDD-NOS occurs when children display similar behaviors but do not meet the criteria for autism. It is commonly called just PDD. In addition, other conditions with similar symptoms may also have similarities to or occur with autism.
Diagnosis:
Diagnosis is based on behavior, not cause or mechanism. Autism is defined in the DSM-IV-TR as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior. Sample symptoms include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with parts of objects. Onset must be prior to age three years, with delays or abnormal functioning in either social interaction, language as used in social communication, or symbolic or imaginative play. The disturbance must not be better accounted for by Rett syndrome or childhood disintegrative disorder. ICD-10 uses essentially the same definition.
Several diagnostic instruments are available. Two are commonly used in autism research: the Autism Diagnostic Interview-Revised (ADI-R) is a semistructured parent interview, and the Autism Diagnostic Observation Schedule (ADOS) uses observation and interaction with the child. The Childhood Autism Rating Scale (CARS) is used widely in clinical environments to assess severity of autism based on observation of children.
A pediatrician commonly performs a preliminary investigation by taking developmental history and physically examining the child. If warranted, diagnosis and evaluations are conducted with help from ASD specialists, observing and assessing cognitive, communication, family, and other factors using standardized tools, and taking into account any associated medical conditions. A pediatric neuropsychologist is often asked to assess behavior and cognitive skills, both to aid diagnosis and to help recommend educational interventions. A differential diagnosis for ASD at this stage might also consider mental retardation, hearing impairment, and a specific language impairment such as Landau-Kleffner syndrome.
Clinical genetics evaluations are often done once ASD is diagnosed, particularly when other symptoms already suggest a genetic cause. Although genetic technology allows clinical geneticists to link an estimated 40% of cases to genetic causes, consensus guidelines in the U.S. and UK are limited to high-resolution chromosome and fragile X testing. A genotype-first model of diagnosis has been proposed, which would routinely assess the genome’s copy number variations. As new genetic tests are developed several ethical, legal, and social issues will emerge. Commercial availability of tests may precede adequate understanding of how to use test results, given the complexity of autism’s genetics. Metabolic and neuroimaging tests are sometimes helpful, but are not routine.
ASD can sometimes be diagnosed by age 14 months, although diagnosis becomes increasingly stable over the first three years of life: for example, a one-year-old who meets diagnostic criteria for ASD is less likely than a three-year-old to continue to do so a few years later. In the UK the National Autism Plan for Children recommends at most 30 weeks from first concern to completed diagnosis and assessment, though few cases are handled that quickly in practice. A 2006 U.S. study found the average age of first evaluation by a qualified professional was 48 months and of formal ASD diagnosis was 61 months, reflecting an average 13-month delay, all far above recommendations.[102] Although the symptoms of autism and ASD begin early in childhood, they are sometimes missed; adults may seek diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some locations to claim disability living allowances or other benefits.
Underdiagnosis and overdiagnosis are problems in marginal cases, and much of the recent increase in the number of reported ASD cases is likely due to changes in diagnostic practices. The increasing popularity of drug treatment options and the expansion of benefits has given providers incentives to diagnose ASD, resulting in some overdiagnosis of children with uncertain symptoms. Conversely, the cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis. It is particularly hard to diagnose autism among the visually impaired, partly because some of its diagnostic criteria depend on vision, and partly because autistic symptoms overlap with those of common blindness syndromes.
Treatment:
There is no cure for autism, but doctors, therapists, and special teachers can help people with autism overcome or adjust to many difficulties. The earlier a child starts treatment for autism, the better.
The main goals of treatment are to lessen associated deficits and family distress, and to increase quality of life and functional independence. No single treatment is best and treatment is typically tailored to the child’s needs. Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors; claims that intervention by age two to three years is crucial are not substantiated. Available approaches include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.Educational interventions have some effectiveness in children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children and is well-established for improving intellectual performance of young children.[106] Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided. The limited research on the effectiveness of adult residential programs shows mixed results.
Many medications are used to treat ASD symptoms that interfere with integrating a child into home or school when behavioral treatment fails. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics. Aside from antipsychotics, there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD. A person with ASD may respond atypically to medications, the medications can have adverse effects, and no known medication relieves autism’s core symptoms of social and communication impairments.
Although many alternative therapies and interventions are available, few are supported by scientific studies.Treatment approaches have little empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance. Scientific evidence appears to matter less to service providers than program marketing, training availability, and parent requests. Though most alternative treatments, such as melatonin, have only mild adverse effects some may place the child at risk. A 2008 study found that compared to their peers, autistic boys have significantly thinner bones if on casein-free diets; in 2005, botched chelation therapy killed a five-year-old child with autism.
Treatment is expensive; indirect costs are more so. A U.S. study estimated an average cost of $3.2 million in 2003 U.S. dollars for someone born in 2000, with about 10% medical care, 30% extra education and other care, and 60% lost economic productivity. Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems; one 2008 U.S. study found a 14% average loss of annual income in families of children with ASD, and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment. After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning.
Different children need different kinds of help, but learning how to communicate is always an important first step. Spoken language can be hard for kids with autism to learn. Most understand words better by seeing them, so therapists teach them how to communicate by pointing or using pictures or sign language. That makes learning other things easier, and eventually, many children with autism learn to talk fluently.
Therapists also help children learn social skills, such as how to greet people, wait for a turn, and follow directions. Some children need special help with living skills (like brushing teeth or making a bed). Others have trouble sitting still or controlling their tempers and need therapy to help them control their behavior. Some children take medications to help their moods and behaviour, but there’s no medicine for autism.
Students with mild autism sometimes can go to mainstream school. But many children with autism need calmer, more orderly surroundings. They also need teachers trained to understand the problems they have with communicating and learning. They may learn at home or in classes at special or private schools.
Other conditions
Autism is one of several types of pervasive developmental disorders (PDDs), also called autism spectrum disorders (ASD). It is not unusual for autism to be confused with other PDDs, such as Asperger’s disorder or syndrome, or to have overlapping symptoms. A similar condition is called pervasive developmental disorder-NOS (not otherwise specified). PDD-NOS occurs when children display similar behaviors but do not meet the criteria for autism. It is commonly called just PDD. In addition, other conditions with similar symptoms may also have similarities to or occur with autism.
Prognosis:
There is no known cure. Children recover occasionally, sometimes after intensive treatment and sometimes not; it is not known how often this happens. Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination. Although core difficulties remain, symptoms often become less severe in later childhood. Few high-quality studies address long-term prognosis. Some adults show modest improvement in communication skills, but a few decline; no study has focused on autism after midlife. Acquiring language before age six, having an IQ above 50, and having a marketable skill all predict better outcomes; independent living is unlikely with severe autism. A 2004 British study of 68 adults who were diagnosed before 1980 as autistic children with IQ above 50 found that 12% achieved a high level of independence as adults, 10% had some friends and were generally in work but required some support, 19% had some independence but were generally living at home and needed considerable support and supervision in daily living, 46% needed specialist residential provision from facilities specializing in ASD with a high level of support and very limited autonomy, and 12% needed high-level hospital care. A 2005 Swedish study of 78 adults that did not exclude low IQ found worse prognosis; for example, only 4% achieved independence. A 2008 Canadian study of 48 young adults diagnosed with ASD as preschoolers found outcomes ranging through poor (46%), fair (32%), good (17%), and very good (4%); 56% of these young adults had been employed at some point during their lives, mostly in volunteer, sheltered or part time work. Changes in diagnostic practice and increased availability of effective early intervention make it unclear whether these findings can be generalized to recently diagnosed children.
Living With Autism:
Some children with mild autism will grow up and be able to live on their own. Those with more serious problems will always need some kind of help. But all children with autism have brighter futures when they have the support and understanding of doctors, teachers, caregivers, parents, brothers, sisters, and friends.
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.
Q: My father has become old and forgetful. His neurologist has started him on some very expensive tablets, but there hasn’t been much improvement. We are in a quandary as to whether the treatment is worth continuing.
………………………………… It is important to remember that medications for neurological diseases in old age may take time to act
A: Forgetfulness often occurs as people get older. In 10 per cent of them it is due to dementia. In others, it may be due to Alzheimer’s disease or caused by arteriosclerotic changes (fat deposits) in the arteries which compromise the blood supply to crucial areas of the brain. It is difficult to reverse damage that has already occurred. However, progression can be prevented by treating and controlling any underlying diseases like diabetes and high blood pressure and correcting lipid profile abnormalities. Mental exercises involving memorising, regular walking and physiotherapy are beneficial. There are also specific medications which do prevent progression and offer some improvement. These are expensive and take time to act. In the long run it may be better to follow the neurologist’s advice.
Too much gas :-
Q: I am badly constipated and when I am in public I release foul smelling gas. My stomach also feels bloated all the time. It is embarrassing and uncomfortable. I went to a gastroenterologist who said there is no block or disease.
A:Constipation in the absence of a physical block or a medical problem occurs when there is not enough roughage in the diet. Roughage is found in high fibre foods like whole grains, fruits and vegetables. The present recommendations for these are 4-5 helpings a day. In addition, fluid intake should be at least three litres a day. Milk increases the feeling of bloating and gas production. Reduce the intake of milk to 400 ml a day. Physical exercise like walking for 40 minutes a day will help the intestines function efficiently.
Immunise now:-
Q: I read about immunisation and when I questioned my mother found that she has not given me any injections after the age of one year. I am now 20 years old.
A: It is never too late to complete your immunisation schedule and make it up to date. Unfortunately, many adults feel “I did not receive all these new injections and I grew up without a problem.†This is an argument brought forth again and again. Immunisations prevent disease. Although 90 per cent of the people recover from these preventable diseases without sequelae, 10 per cent do develop problems. Some of these like paralysis, blindness, brain damage or sterility may be devastating, though not life threatening. You have probably missed MMR (measles mumps rubella), hepatitis A, hepatitis B, varicella (chicken pox), pneumococcus, menigococcus, typhoid and your boosters due at 1.5, 5 years, 10 years and 16 years.
Cold limb :-
Q: I am a heavy smoker (15 cigarettes a day) and now I feel that my left leg is cold, painful, heavy and weak.
A: The nicotine in cigarettes can compromise blood supply to the limbs. The vessels narrow and go into spasm. This is called thrombo anginitis obliterans or Berger’s disease. The limb becomes cold and numb. Eventually gangrene may set in. Please go to a vascular surgeon and check if this is the case. He may be able to release any block or bypass it. Any treatment offered will only succeed if you stop the precipitating factor — cigarettes. Remember, cigarette smoking is injurious to health.
Weaning time :-
Q: At what age can I wean my baby?
A: The World Health Organisation (WHO) recommends exclusive breast feeding for six months. That doesn’t seem very practical if the mother is working as most organisations don’t give more than three months of maternity leave. Weaning can be started after 120 days (4 months). It’s best to use home-made and home-cooked powders and cereals rather than precooked readymade tinned preparations. Try to use a bowl and spoon for feeding and avoid bottles and pacifiers.
Measles is a highly contagious viral illness.Measles, also known as rubeola, is a disease caused by a virus, specifically a paramyxovirus of the genus Morbillivirus.
Reports of measles go back to at least 600 BCE, however, the first scientific description of the disease and its distinction from smallpox is attributed to the Persian physician Ibn Razi (Rhazes) 860-932 who published a book entitled “Smallpox and Measles” (in Arabic: Kitab fi al-jadari wa-al-hasbah).
Measles is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing a house with an infected person will catch it. Airborne precautions should be taken for all suspected cases of measles.
The incubation period usually lasts for 4–12 days (during which there are no symptoms).
Infected people remain contagious from the appearance of the first symptoms until 3–5 days after the rash appears.
Immunity to the disease occurs after vaccination or active infection:
Before widespread immunization, measles was so common during childhood that the majority of the population had been infected by age 20. Measles cases dropped over the last several decades to virtually none in the U.S. and Canada because of widespread immunization, but rates have crept up again recently.
Some parents are refusing to have their children vaccinated because of fears that the MMR vaccine, which protects against Measles, Mumps, and Rubella, can cause autism.
Large studies of thousands of children have found no connection between this vaccine and the development of autism, however, lower vaccination rates can cause outbreaks of measles, mumps, and rubella — which can be serious.
Symptoms
sore throat
runny nose
cough
muscle pain
fever
bloodshot eyes
tiny white spots inside the mouth (called Koplik’s spots)
photophobia (light sensitivity)
rash
appears around the fifth day of the disease
may last 4 to 7 days
usually starts on the head and spreads to other areas, progressing downward
maculopapular rash — appears as both macules (flat, discolored areas) and papules (solid, red, elevated areas) that later merge together (confluent)
itching of the rash
Note: The period between the appearance of the earliest symptoms and the appearance of a rash or fever is usually 3 to 5 days.
The classical symptoms of measles include a fever for at least three days, and the three Cs—cough, coryza (runny nose) and conjunctivitis (red eyes). The fever may reach up to 105° Fahrenheit/ 40° Celsius. Koplik’s spots seen inside the mouth are pathognomonic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.
The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing itching. The rash is said to “stain”, changing colour from red to dark brown before disappearing. notice that there is German Measles, that it’s rash never spreads allover the whole body as measles… it is important to differentiate it from German type.
Signs and tests
viral culture (rarely done)
a measles serology.
Diagnosis
A detailed history should be taken including course of the disease so far, vaccination, history, contact history, and travel history.
Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs. Observation of Koplik’s spots is also diagnostic of measles.
Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens. In cases of measles infection following secondary vaccine failure IgM antibody may not be present. In these cases serological confirmation may be made by showing IgG antibody rises by Enzymeimmunoasay or complement fixation
Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis.
Treatment
There is no specific treatment or antiviral therapy for uncomplicated measles. Most patients with uncomplicated measles will recover with rest and supportive treatment. Though some children may require supplementation with Vitamin A. Symptoms may be relieved with bed rest, acetaminophen, and humidified air.
Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with the measles. This cell, known as the Warthin-Finkeledey cell, is a multinucleated giant with eosinophilic cytoplasmic and nuclear inclusions.
Some herbal medicines:
1.Termeric roots are dried in the sun andground to a fine powder.The powder is mixed with a few drops of honey and juice of few bitter groud leaves and taken with beneficial results.
2.Cinnamon (dalchini) is used as a prophylatic agent to control German measles.
Complications:
Associated bacterial infection may cause otitis media, bronchitis. Encephalitis occurs in approximately 1 out of 1,000 measles cases.
Complications with measles are relatively common, ranging from relatively common and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis). Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 percent.
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.
Help taken from: healthline.com/adamcontent/measles, en.wikipedia.org & Miracles of herbs
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