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Cancer that develops in the section of bile ducts within and outside the liver is called as intrahepatic and hilar cholangiocarcinoma, respectively. Distal cholangiocarcinoma is developed in the bile section that is associated with small intestine. Prognostic factors of cholangiocarcinoma are highly disputable. The prognosis of bile duct cancer is affected by various factors such as the site of cancer, type and grade (extent of cell abnormalities when examined under a microscope) of cholangiocarcinoma, physical health condition, treatment, etc. The risk factors for bile duct cancer include primary sclerosing cholangitis (a gradually developing disorder in which inflammation and scarring block bile ducts), chronic ulcerative colitis, and cysts within the bile ducts (these block bile flow, leading to bile duct enlargement, infection, and inflammation). Post-Segmentectomy Prognostic Factors of Distal Cholangiocarcinoma Distal bile duct cancer is the most common type of bile duct cancer after intrahepatic bile duct cancer. Nevertheless, the prognosis of distal cholangiocarcinoma is better when compared to other two types of bile duct cancer. Initial stage symptoms of distal cholangiocarcinoma include cholangitis, jaundice, etc. These symptoms can help in early identification of the disease. Further development of the tumor can be prevented by segmentectomy. Some of the risk factors that affect the prognosis of distal bile duct cancer are perineural infiltration, tumor markers, tumor cell differentiation, serum bilirubin, lymph node metastasis, amount of transfusion, age, etc. Complications within a Month Post-Surgery Around 44% of patients suffered from complications after a month of surgery. Complications experienced by bile duct cancer patients after they are treated with pancreaticoduodenectomy and whipple procedures for distal bile duct cancer are as follows. The most common postoperative problem faced is collection of intra-abdominal fluid and postoperative bleeding, which was experienced by almost 37% patients post-operation. Few patients suffered with life-threatening consequences such as liver failure, left hepatic artery damage, etc. Minimum number of patients hadn’t survived. Complications in Average Follow-up Period (2 to 177 Months) Around 47% of patients were affected by distal bile duct cancer for the second time, which indicates that 53% of patients do not experience recurrence during follow-up. Related StoriesInvestigating new cancer therapy candidates with live-cell imagingOut of the patients experienced with recurrence bile duct cancer, 47.3% of the patients were affected by local recurrence, 30% were affected with intrahepatic recurrence, and 23.2% were affected with systematic recurrence. Survival Rate The survival rate within first three years after the operation is around 55.3%. After five years, the survival rate was around 48.3%. Finally, after ten years, it was around 33.7%. Post-Segmentectomy Prognostic Factors of Extrahepatic Cholangiocarcinoma After extrahepatic cholangiocarcinoma segmentectomy, various data are subjected to evaluation to find the prognostic factors after segmentectomy of extrahepatic bile duct cancer. Such data include postoperative adjuvant treatment, pathologic factors, patient demographics, and intraoperative factors. Lymph node metastasis, tumor histology, and 5th American Joint Committee on Cancer stage were significant prognostic factors. Lymph node metastasis and tumor histology were identified as the prognostic factors that are independent, during the Cox proportional hazard regression for multivariate analysis. Despite the fact that the patients suffering from lymph node metastasis had experienced mean recurrence than those are not affected by lymph node metastasis, some patients attained cure post-segmentectomy. Survival Rate Around 20% to 30 % of the extrahepatic bile duct cancer patients survive for five years after surgical resection. Some patients survive even after five years even though they are affected with recurrent extrahepatic bile duct cancer. In some cases, recurrent bile duct cancer is identified only after five years post-segmentectomy. But the average survival rate is less when compared to the first five-year survival rate. The average survival rate within first year after the segmentectomy was around 72.9%. After three years, the survival rate was around 41.1%. Finally, after five years, it was around 32.5%. Factors Influencing Prognostic Factors in Advanced Cholangiocarcinoma After Surgery and Chemotherapy The survival rate of patients affected with advanced cholangiocarcinoma in the first year after the therapy, such as segmentectomy, chemotherapy, etc., was around 10.8%. After three years, the survival rate was around 5.4%. Finally, after five years, it was around 4.5%. Average survival rate of advanced bile duct cancer was eight and a half months. Univariate analysis method was used to evaluate the impact of various factors such as tumor-related, treatment, and multiple clinical parameters on advanced cholangiocarcinoma survival. Some of the parameters that do not affect the prognosis of advanced cholangiocarcinoma are perineural invasion, stenting, vascular invasion, age, history of cholelithiasis, resection margin status, diabetes, presence of metastasis, and gender. The prognosis of advanced bile duct cancer is also not influenced by size, location, and stage of the tumor. Survival rate of patients who underwent surgery was less compared to those treated with chemotherapy. Reviewed by Afsaneh Khetrapal Bsc (Hons) Sources https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356849/ www.mayoclinic.org/.../ovc-20202771 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834019/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712857/ http://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/survival www.urmc.rochester.edu/.../content.aspx Further ReadingTest for Bile Duct CancerCauses of Bile Duct CancerBile Duct Cancer - CholangiocarcinomaBile Duct Cancer ResearchSigns and Symptoms of Bile Duct CancerMore... // Last Updated: Sep 18, 2017" }, "102": { "category_2_x_medical_disease.id": 102, "category_2.id": 28, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bile Duct Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 102, "medical_disease.ts": "2018-04-20 02:35:20", "medical_disease.title": "Causes of Bile Duct Cancer", "medical_disease.content": "By Jeyashree Sundaram (MBA) The occurrence of cholangiocarcinoma is due to changes that take place in the cells of the bile duct in the liver DNA—the material which gives guidance to our body related to all chemical process. The changes in instruction are caused by DNA mutation, due to which the cells start growing uncontrollably and finally form cancer. The problems arising in the bile duct, which may or may not be due to the manifestation of cancer, such as irritation, inflammation, or any obstruction, cause dilemma in the digestive system or jaundice or lead to chronic diseases and produce parasitic infections. Causes The definitive cause of cholangiocarcinoma is still unknown. There are, however, cancer suppressor genes, which ultimately cause death of the cells and block cell division. Due to the mutations of DNA, cancer may occur as a result of turning on of oncogenes and turning off of the cancer suppressor genes. For a cell to turn cancerous there is a need for changes in various genes. In some cancers, the risk factors are increased due to change in DNA by parents. However, most of the bile duct cancers are not caused by inherited gene changes. Other expected causes of bile duct cancer are: Initial sclerosing cholangitis: It is a rare form of disease caused in the liver. It causes inflammation of the liver for a long period. Biliary stones: They are hard stones, which are similar to gallstones that appear in the bile duct, but look smaller. Infections: The liver fluke infection is caused by eating raw fish. Here, the infection is due to tiny parasitic worms known as liver flukes. Some of the parasites may stay longer in the bile duct and result in the formation of cancer. This problem is mostly found in Asian countries. Choledochal cysts: Any changes in the bile-filled sacs over the lining of the cells where the bile duct is connected can result in the formation of these cysts. Cirrhosis: Hepatitis and alcohol may damage the liver and produce a mark on the skin during the formation of cancer. It increases the risk of cholangiocarcinoma. Reflux: Flowing back of digestive juice from pancreas to the bile duct, which results in the inability to perfectly empty it, may cause cancer. Abnormalities in the duct: The presence of fluid-filled sacs or cysts in the bile duct from birth can result in cancer. Other factors such as erythrogenic intestine cancer, diabetes, and virus hepatitis are also thought to cause this type of cancer, but further studies are needed to confirm their exact role. Risk Factors Related StoriesInvestigating new cancer therapy candidates with live-cell imagingThe factors that increase the risk of cancer are termed as risk factors. Different diseases will have different risk factors. It does not mean that having one or more risk factor will lead to cancer. As the causes of this cancer still remain unidentified, researchers think that a few risk factors play a vital role in triggering it. The risk factors include: Gallstones: Gallstones get struck and remain in the bile duct for a long period of time, obstructing its proper functioning. Physique of a person: Overweight and obesity lead to the risk of growth of few cancers. Age: Bile duct cancer is generally not found in young people and children. More than 60 percent of cholangiocarcinoma-affected people are in the age group of 65 years and above. History of family genetics: Even though there is no evidence of inheritance of the disease, family history is thought to have some role in developing the cancer. Style of living Smoking: Owing to the use of tobacco, the risk of growth of bile duct tumor is increased. Exposure to dangerous chemicals: If proper protection is not provided to people working in chemical factories, it can increase the chance of getting affected by the disease. Chemicals such as asbestos, dioxins, radon, polychlorinated biphenyls, thorium dioxide, and nitrosamines are considered dangerous. Excess use of alcohol: The habit of drinking alcohol leads to bile duct cancer. It also escalates the risk of liver cancer. Ulcerative colitis: It affects the inner lining of the intestine, which causes damage to it. Studies indicate that people with ulcerative colitis seem to have moderate risk of expanding bile duct cancer; about 1 in 200 people with ulcerative colitis is expected to have the risk. In nearly 1 out of 10 people with ulcerative colitis, the complete intestine is infected and consists of primary sclerosing cholangitis. At present, the specialists are thinking that the risk factor associated with bile duct cancer is PSC rather than ulcerative colitis. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources www.mayoclinic.org/.../dxc-20202902 ukhealthcare.uky.edu/transplant/services/liver/bile-duct-cancer/ www.cancer.org/.../what-causes.html http://www.cancercenter.com/bile-duct-cancer/risk-factors/ www.nhs.uk/.../Introduction.aspx#causes Further ReadingTest for Bile Duct CancerBile Duct Cancer PrognosisBile Duct Cancer - CholangiocarcinomaBile Duct Cancer ResearchSigns and Symptoms of Bile Duct CancerMore... // Last Updated: Sep 18, 2017" }, "103": { "category_2_x_medical_disease.id": 103, "category_2.id": 28, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bile Duct Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 103, "medical_disease.ts": "2018-04-20 02:35:22", "medical_disease.title": "Bile Duct Cancer - Cholangiocarcinoma", "medical_disease.content": "Bile Bile ducts are thin tubes that connect the liver with the small intestine. These ducts transport bile (digestive fluid) formed in the liver and the gallbladder. Credit: BlueRingMedia/Shutterstock.com The bile duct system consists of a series of ductules (small tubes) in the liver that combines into ducts called the intrahepatic bile ducts. The duct coming from the gallbladder is called the cystic duct. The cystic and intrahepaticducts merge to form the common bile duct, which joins with the pancreatic duct and then reaches into the duodenum (beginning of the small intestine). Cancer in any part of these bile ducts is termed as cholangiocarcinoma. Adults aged above 65, usually males, and those having colitis or other forms of liver disease are at increased risk of having cholangiocarcinoma. The tumors involved in bile duct cancer metastases via the lymphatic system and then into the blood vessels that go into the liver. Classifications of bile duct cancer Bile duct cancer can be divided into two groups based on their location: intrahepatic (inside the liver) and extrahepatic (outside the liver). a) Intrahepatic bile duct cancer: These cancers originate in the ductules inside the liver. Very few bile duct cancers (5–10%) are intrahepatic, andthey are also known as intrahepatic cholangiocarcinomas. The different methods for analysis of intrahepatic bile duct tumors under a microscope (histopathologic study) are as follows: Periductal-infiltrating tumor growth pattern Intrahepatic cholangiocarcinoma. The combination of periductal-infiltrating mass-forming growth pattern. Mixed hepatocellular cholangiocarcinoma. Mass-forming tumor growth pattern. b) Extrahepatic bile duct cancer: Most bile duct cancers are extrahepatic, and so are found outside the liver. Extrahepatic bile ducts have distal and hilum regions and cancer can form in either of these regions. Perihilar bile duct cancer: These cancers are mostly present in the hilum region, at the end portion of the liver where the left and right bile ducts move outside the liver. Cancer in the perihilar bile duct is also termed as perihilar cholangiocarcinoma or Klaskin tumors. In perihilar bile tumor, the adenocarcinomas frequently foundinclude the following: Squamous cell carcinoma. Signet-ring cell carcinoma. Adenocarcinoma, NOS. Adenocarcinoma, intestinal type Carcinomain situ. Clear cell adenocarcinoma. Mucinous adenocarcinoma. Adenosquamous carcinoma. Distal extrahepatic bile duct cancer: In this kind of cancer, tumor cells are present in the distal region of the bile duct. Another name for distal extrahepatic bile duct cancer is extrahepatic cholangiocarcinomas. In extrahepatic bile duct tumor, adenocarcinomasare frequently found. The types of distal extrahepatic bile duct cancer are as follows: Oat cell carcinoma, also known as small cell carcinoma Undifferentiated carcinoma. Spindle and giant cell types. Small cell types. Noninvasive, papillary carcinoma. Invasive, papillary carcinoma. Papillomatosis. NOS, Carcinoma. Different stages of bile duct cancer Related StoriesInvestigating new cancer therapy candidates with live-cell imagingThe TNM system is used as a method of staging for all cancers. Knowledge of the stage of the cancer helps the physician to decide about the mode of treatment. In bile duct cancer, they provide the following crucial information: T (tumor)—specifies whether the primary tumor has spread to the adjacent tissues or organs through the duct wall. N (nodes)—informs whether the cancer has spread to the neighboring lymph nodes responsible for the immune system of the body. M (metastases)—reveals whether there is metastasis (spread) of the cancer to other organs such as the liver, the abdominal cavity lining, or the lungs. The term “TNM” is followed by alphabets or numbers 0–4, which give in-depth information about each of these aspects. The stages (0–4) of bile duct cancer are as follows: Stage 0: cancer is located only in the mucosa (lining) of the bile duct and has not gone into the deeper layers. It has also not affected any of the lymph nodes or other organs of the body. Stage I: cancer is still inside the bile duct, but has penetrated into the other layers of the bile duct wall, such as the muscle and fibrous tissues; it has not metastasized to other body parts. Stage II: cancer has spread to neighboring liver (IIB) or fat (IIB) tissues, through the bile duct wall. Stage III: sub-classified as A and B IIIA—cancer has metastasized only to the main portal vein, to the initial part of the small intestine, stomach, and colon, but not to the lymph nodes or other sites. IIIB—cancer has spread to the neighboring lymph nodes, but not to distantsites. Stage IV: sub-classified as A and B IVA—cancer is growing and has spread to nearby lymph nodes and blood vessels, but not any further. IVB—cancer has spread to lymph nodes that are far away from the tumor or even to distant sites. The position and severity of the cancer growth determines the outlook of bile duct cancer. Cholangiocarcinomasare treated by stenting, radiotherapy, chemotherapy, and photodynamic therapy. Unfortunately, it is possible for tumors in bile ducts to reoccur even after theyhave been removed. After surgery, the 5-year survival rate among patients is 20–50%. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources https://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq https://medlineplus.gov/ency/article/000263.htm www.nhs.uk/conditions/Cancer-of-the-bile-duct/Pages/Introduction.aspx www.cancer.gov/types/liver/hp/bile-duct-treatment-pdq#section/_202 www.cancer.org/.../what-is-bile-duct-cancer.html www.utmedicalcenter.org/.../ healthcare.utah.edu/.../bile-duct-cancer.php Further ReadingTest for Bile Duct CancerBile Duct Cancer PrognosisCauses of Bile Duct CancerBile Duct Cancer ResearchSigns and Symptoms of Bile Duct CancerMore... Last Updated: Oct 12, 2017" }, "104": { "category_2_x_medical_disease.id": 104, "category_2.id": 28, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bile Duct Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 104, "medical_disease.ts": "2018-04-20 02:35:24", "medical_disease.title": "Bile Duct Cancer Research", "medical_disease.content": "Bile duct cancer or cholangiocarcinoma is the cancer affecting the slender tubes that carry the digestive bile fluid. The liver is connected to the small intestine and the gallbladder by the bile duct. Cholangiocarcinoma is rare and can develop in people at any age, but it generally occurs in those aged above 50 years. Credit: Nerthuz/Shutterstock.com Comparatively, the study of bile duct cancer is difficult. Around the world, research on the cause, diagnosis, and treatment of bile duct cancer is ongoing at many medical centers. Research on bile duct surgery To treat bile duct cancer, doctors are continually trying to improve ways to bring more people to the surgical table. Liver transplantation is considered to be the best choice of treatment for bile duct cancer but other choices are also being analyzed. For instance, technical removal of cancer in the liver by surgery can be done, but this may lead to not much healthy liver left after surgery. Portal vein embolization is a method used to block the transportation of blood to one part of the liver. As this particular portion of the liver is compressed, the remainder of the liver expands to compensate for this. After a few weeks, the expanded side of the liver gets healthier, and thus ensures the possibility of the tumor on the other side to be removed by performing an operation. Liver transplantation and its research In the USA, research on liver transplants is being doneon people for whom the intrahepatic and hilar bile duct cancers remain without spreading. However, when both lobes of the liver are affected, removal of tumor is not possible with surgery. In this condition, the surgeon cannot recommend a transplant. For many people transplant is not a choice, as finding a liver donor is extremely difficult. There is always a danger of the cancer to recur in transplant surgery. People who have undergone surgery are likely to survive for 5 years in the ratio of 1:5. However, recent research results also state that the danger of acquiring cancer again is lowered by undergoing chemoradiotherapy (combination of radiotherapy and chemotherapy) before surgery. Almost 50% of such liver transplant patients live for 5 years or more after completion of surgery. It has also been seen that 4 of 5 patients survived for 5 years after undergoing chemoradiotherapy prior to surgery. Severe side effects are caused due to this treatment, which is available only for a small group of people who have cancer at an early stage that is not spread. Therapies related to research on bile duct cancer 1. Chemotherapy and radiation therapy To boost the performance of radiation therapy, researchers are evaluating different techniques. Three-dimensional conformal radiation therapy (3D-CRT), stereotactic body radiation therapy (SBRT), and intensity modulated radiation therapy (IMRT) are techniques that are widely used by doctors because theyare directed at only the tumor cells and not normal tissue. Intraoperative radiation (IORT) and proton beam radiation therapy techniques can be used but are mostly unavailable. Related StoriesInvestigating new cancer therapy candidates with live-cell imagingFor bile duct cancer, a mixture of new drugs is being tested as the effect of chemotherapy is not adequate. Studies are undergoing for giving chemo in different ways. For example, the combination of chemotherapy and embolization called trans-arterial chemoembolization (TACE). Chemo drugs are often given in the form of tiny beads to stop and fill the hepatic artery. 2. Light therapy Here, photodynamic therapy (PDT) is used to destroy cancer cells using light. First, a drug that is sensitive to light and acceptable by the cancer cell is consumed. Then bright light is shone on the cancer cell, which destroys the cancer cells by stimulating the drug. Second, to clear blocks and initiate smooth flow from bile duct to bowel, a small stent (a tiny tube) is placed in the bile duct. A few problems come up while doing this trial. During this trial the stent, which is sent to the bile duct, works efficiently along with PDT, and more so than with only the stent. The efficiency of having a stent is not known in its early stage. In previous results, they were unaware of the fact that having only a stent is not enough. This trial has closed and the results are awaited. The drug administered with PDT is thought to be destroyed by the body. Conversely, doctors also think that actually a small portion of the drug remains in the body even a month after treatment, which keeps growing and shows up during further treatment. Phase 4 of the research is investigating the duration of the stay of the drug in the body, and the possibilities of side effects during a second dose. 3. Radiofrequency ablation (RFA) Cancer cells are destroyed by heat produced by radio waves. Radiofrequency is one form of electrical energy used in ablation. Research says that bile duct cancer that cannot be removed from the liver by surgery can be controlled by RFA. Some researchers declare that bile duct cancer that comes after surgery in the liver can also be controlled. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources www.mayoclinic.org/.../ovc-20202771 https://www.cancer.org/cancer/bile-duct-cancer/about/new-research.html www.cancerresearchuk.org/.../research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888819/ https://www.cancer.gov/about-cancer/treatment/research https://rarediseases.info.nih.gov/diseases/9304/bile-duct-cancer Further ReadingTest for Bile Duct CancerBile Duct Cancer PrognosisCauses of Bile Duct CancerBile Duct Cancer - CholangiocarcinomaSigns and Symptoms of Bile Duct CancerMore... // Last Updated: Oct 12, 2017" }, "105": { "category_2_x_medical_disease.id": 105, "category_2.id": 28, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bile Duct Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 105, "medical_disease.ts": "2018-04-20 02:35:26", "medical_disease.title": "Signs and Symptoms of Bile Duct Cancer", "medical_disease.content": "Cancer in the bile ducts may not present with any symptoms in the initial stage. The bile duct is found in the inner part of the body and, therefore, it is difficult to detect early tumors during normal physical examinations. When the tumor at this stage grows and moves from the original location, it begins to exhibit symptoms. Symptoms Depending on the location of the tumor in the bile ducts, the symptoms may vary; however, they generally include the following: The skin and whites of the eyes turn yellow due to jaundice The most common symptom in bile duct cancer is jaundice, although jaundice can be non-cancerous in most cases. The first identified factor in a person having bile duct cancer is the yellowed skin and eyes. Also, for such patients, the covering of the inner parts of the body, such as the nose and mouth, has a mucus membrane. Bile (fluid) is made by the liver and then it is passed into the small intestine for further functioning. Jaundice can occur when the tumor in the liver obstructs the building up of bile, and hence the bile cannot flow into the intestine. Human Liver Anatomy. Image Credit: Designua / Shutterstock Blockade of the bile duct is caused by the presence of a yellowish-green chemical substance called bilirubin in the liver. This bilirubin then turns back into the bloodstream, body tissue, or sometimes settles in the inner part of the body. The yellow pigment present in the bile changes the white part of the eyes and the skin to a yellow color. Different types of jaundice are known to occur from other diseases, among them post-hepatic jaundice or obstructive jaundice is the one that is caused by bile duct cancer. The accurate cause of the jaundice has to be diagnosed and identified by the doctor, because multiple diseases related to jaundice are not critical or life-threatening, and cancer of the bile duct is one of the lesser general causes. Itching Itchy skin is a common temporary irritation that affects all people. In some rare incidences, it may lead to severe problems. People affected with bile duct cancer may have a sense of irritation due to the presence of higher amounts of bilirubin in the skin that comes from the blood. Itching is commonly identified in many patients with the disease. Related StoriesInvestigating new cancer therapy candidates with live-cell imagingClay colored stool Brown is the most normal color of stool, but in bile duct cancer patients the stool is very light in color. Owing to large accumulation of bilirubin in the duct, the bile may not be able to reach the intestine. In such people, fatty foods are not digested easily because the tumor obstructs the flow of the fluid and pancreatic mixture into the small intestine. The unusually pale color stool occurs due to the presence of these undigested fats. The stool may be greasy and bulky and tend to float in the toilet. The bilirubin concentration varies the stool color from pale yellow to nearly black. The stool turns to green or yellow in color due to the changes happening in the chemical structure of the bilirubin. If the liver produces less amounts of bilirubin or there is a dilution of the fecal matter, it causes yellow stool. Variations in color of stool also occur due to the presence of digestive enzymes and bacteria in the small intestine acting on the bilirubin. Different interpretations are designated for changes in stool color. Dark urine When bilirubin levels in the blood rise, it may also affect the color of urine, which has a dark appearance. Weakness Too much work done in a short period of time leads to weak and tired muscles. But, bile duct cancer patients complain of a general weakness of muscle or physical strength and the feeling that additional effort is needed to move the legs, arms, or other muscles. Abdominal pain A common symptom of the bile duct cancer is abdominal pain; but, this appears only in the advanced stages and not in the early stages. Usually, the pain develops from the right side of the abdomen, just underneath the ribs. Swollen abdomen Enlargement of the abdomen occurs due to the pressure of cancer in the nearby organs. Fever People affected with jaundice may develop fever due to inflammation in the bile ducts. At high body temperatures the patient has shivering and feels cold. Unexplained weight loss The bile duct tumor patients may not feel hunger. Without maintaining proper diet, they can easily lose weight. Nausea and vomiting Abnormality in liver functions or the development of bilirubin may produce nausea. It may also occur along with fever due to the infection caused by the obstruction of the bile duct. When these symptoms begin to manifest and are noticed, one should immediately consult with the doctor and confirm if they have cancer or some other disease. Depending upon the diagnosis, treatments will be decided. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023696/ http://www.cancercenter.com/bile-duct-cancer/symptoms/ www.cancer.org/.../signs-symptoms.html www.nhs.uk/.../Introduction.aspx#symptoms http://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/symptoms https://medlineplus.gov/bileductcancer.html Further ReadingTest for Bile Duct CancerBile Duct Cancer PrognosisCauses of Bile Duct CancerBile Duct Cancer - CholangiocarcinomaBile Duct Cancer ResearchMore... // Last Updated: Nov 7, 2017" }, "106": { "category_2_x_medical_disease.id": 106, "category_2.id": 28, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bile Duct Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 106, "medical_disease.ts": "2018-04-20 02:35:31", "medical_disease.title": "Treatment Options for Bile Duct Cancer", "medical_disease.content": "The liver creates a digestive juice called bile and stores it in the gall bladder. While eating, the gall bladder forces the bile through a tubegall bladder called the bile duct. Bile duct cancer or cholangiocarcinoma is a unique type of cancer that affects this tube that joins the liver and the gall bladder to the small intestine. Credit: Nerthuz/ Shutterstock.com In the bile duct, the appearance of cancer inside the liver is termed as intrahepatic cholangiocarcinoma and the appearance of cancer outside the liver is termed as extrahepatic cholangiocarcinoma, which is also more common. Types of treatments There are three standard treatment methods for bile duct cancer: surgery, radiation therapy, and chemotherapy. Surgery The surgical process destroys the maximum number of cancer cells from the body. The following are the surgical methods available as treatment for bile duct cancer. Removing the bile duct: If the cancer cell is small and if it is found only in the bile duct, then removal of the bile duct by surgery can be done. The presence of cancer is identified using a microscope, and the lymph nodes and cancer cells from lymph nodes that are taken out are viewed. Whipple procedure: In this surgical method, the gall bladder, head of pancreas, a part of the small intestine, bile duct, and a part of stomach are removed. The function of the pancreas is to produce insulin and adequate digestive juices, hence they are retained. Partial hepatectomy: In this kind of treatment, the cancer in a part of the liver is removed. The removed part may be a piece of cancer cell or a part of the big liver; a complete lobe along with some surrounding normal cells can also be removed. Although the surgeon destroys all the identified cancer cells during operation, a few patients are advised chemotherapy and radiation therapy after the surgery process to remove any remaining cancer cells in the tissues. Radiation therapy Radiation therapy is a type of cancer treatment that uses rays with high energy to remove the cancer cells. To treat bile duct cancer, radiation therapy may be utilized in various ways. External beam radiation therapy (EBRT): To destroy the cancer cells completely, this type of radiation therapy utilizes an x-ray machine kept outside the patient’s body. Measurements are taken carefully by the radiation team in order to determine the angles accurately. Three-dimensional conformal radiation therapy (3D-CRT): Here, specific computers are made use of to exactly map the tumor locations, so that from various directions the radiation beam can focus on the cancer cells. In this procedure, the damage to normal cells is reduced. Intensity-modulated radiation therapy (IMRT): This is an advanced type of 3D therapy. Computer-driven machines are used, which can be moved around to deliver radiation. Stereotactic body radiotherapy (SBRT): The SBRT technique utilizes the process of IMRT and 3D-CRT where it delivers the radiation in short time periods. Internal radiation therapy (branchytherapy): Internal radiation therapy is an important type of therapy that targets the cancer cells inside the liver and delivers giving high-dose radiation. Sometimes, branchytherapy is performed by placing the pellets over a tube. Chemotherapy Related StoriesInvestigating new cancer therapy candidates with live-cell imagingIn chemotherapy treatment, drugs are utilized to remove the cancer cells. In this treatment anticancer drugs are taken by mouth or induced in the vein. The administering of drugs for cancer that has developed throughout the body is called systemic treatment. Chemotherapy treatment can be useful to people affected by bile duct cancer, although this treatment method is found to be insufficient for this cancer type. Often, for patients in a very bad health condition, chemotherapy is not recommended. Hepatic artery infusion (HAI): For the bile duct cancer affected patient, when giving of chemotherapy treatment through the vein is not helpful, the drug is directly injected into the liver through the main artery using a pump placed in the liver. HAI can be used in combination with other drugs. New types of treatments Many new types of treatments are under the process of testing and examination in clinics. Some of them are given below. Liver transplant: In this method, the liver is completely removed and it is replaced by a donated healthy liver. In patients affected by perihilar bile duct cancers, liver transplant can be performed. For a few patients, a liver transplant may be a good choice. In the process of cancer research, clinical trials are considered as very essential elements. The motive of these trials is to find new treatments for cancer that are effective and safe, or better that the normally followed treatment methods. Cancer affected patients can participate in clinical trials while undergoing cancer treatment; this may be before, after, or during the period of their treatment procedures. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources: www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq#section/_51 http://ammf.org.uk/treatment-options-2/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731530/ https://medlineplus.gov/bileductcancer.html#cat_78 https://www.cancer.gov/types/liver Further ReadingTest for Bile Duct CancerBile Duct Cancer PrognosisCauses of Bile Duct CancerBile Duct Cancer - CholangiocarcinomaBile Duct Cancer ResearchMore... Last Updated: Dec 6, 2017" }, "107": { "category_2_x_medical_disease.id": 107, "category_2.id": 29, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biliary atresia", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 107, "medical_disease.ts": "2018-04-20 02:35:33", "medical_disease.title": "Biliary Atresia and Kasai Procedure", "medical_disease.content": "By Jonas Wilson, Ing. Med. Biliary atresia (BA) is a condition characterized by a discontinuity or obliteration of the extrahepatic or biliary system that results in bile flow obstruction. It is a rare disorder in newborn infants that requires early intervention, surgically, to prevent irreparable damage to the liver if left untreated. BA may be diagnosed by blood tests, abdominal X rays, ultrasound, and liver biopsies. It is treated surgically with the Kasai procedure or by a liver transplant. Infants affected by the condition may be grouped into three categories: BA without other malformations - This pattern of BA is seen in up to 85% of those affected and these infants do not present with jaundice at birth. However, they do develop jaundice within their first two months and their stool becomes increasingly alcoholic. Embryonic BA - This form of BA is also called BA splenic malformation and these infants tend to have cardiac anomalies and inferior vena cava interruptions and, as implied by the name, splenic anomalies such as polysplenia (accessory spleens) or asplenia (absence of normal spleen function). It occurs in about 10% of infants affected with BA and they tend to have a poorer prognosis compared to those that have BA without any congenital malformations. BA with other congenital malformations - Occurs in about 5% of affected infants and they present with malformations in organ systems such as the kidneys and may have heart defects, intestinal atresia, and imperforate anus. Like embryonic BA, these infants have a poor prognosis as well. Pathophysiological Mechanisms and Clinical Presentation The exact cause has not yet been identified, but several factors have been taken into consideration as potential culprits. It has been suggested that BA is not inherited from the parents, however, possible triggers include infections after birth (e.g., CMV), exposure to toxic substances, gene mutations, autoimmune dysfunction, and faulty embryogenesis. BA has a predilection in premature babies, females, and infants of African American or Asian descent. Jaundice is usually the first symptom. The infant has yellow skin as well as eyes. Other findings in these infants include light colored stools (grey or white), poor growth and weight gain as well as very dark urine. These symptoms are a direct consequence of failure of the liver to remove bilirubin, which is a substance physiologically produced by the breakdown of hemoglobin. Usually, bilirubin is taken up by the liver to be processed and excreted into bile. Failure of the bile ducts, like in biliary atresia, causes bilirubin to accumulate in the blood. Kasai Procedure Named after the surgeon who invented it, the Kasai procedure is the first line option for treating biliary atresia. It is an operation that results in a hepato-porto-enterostomy. The pediatric surgeon first removes the damaged bile ducts from the infant and then uses a loop from the intestines to replace the bile ducts. This procedure allows for the bile to flow directly from the liver to the small intestine. Thus, the attached segment of the intestine functions as the newextrahepatic bile duct system. Complications after the procedure include ascites (fluid build up in the abdomen), bacterial infection of the bile ducts, and portal hypertension if there is liver damage. The Kasai procedure is not curative; however, it corrects many of the symptoms caused by the atresia. Infants who fail to receive this surgical intervention, unfortunately, rarely live past their second birthday. Moreover, the procedure is mostly only effective in infants younger than the age of 3 months. This is because these infants are less likely to have developed irreparable liver damage. Infants who already have irreparable liver damage or those who have undergone the Kasai treatment unsuccessfully require liver transplants, which are definitively curative. Reviewed by Susha Cheriyedath, MSc Sources http://www.pedsurg.ucsf.edu/conditions--procedures/bilary-atresia.aspx www.childliverdisease.org/.../Biliary-Atresia www.niddk.nih.gov/.../facts.aspx // Last Updated: Aug 17, 2016" }, "108": { "category_2_x_medical_disease.id": 108, "category_2.id": 30, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Binge Eating Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 108, "medical_disease.ts": "2018-04-20 02:35:36", "medical_disease.title": "Binge-Eating Disorder Causes", "medical_disease.content": "By Yolanda Smith, BPharm Although the specific causes of binge-eating disorder are not clear, several risk factors are likely to increase the potential for an individual to develop the disorder. In most cases, several risk factors will contribute to the development of the disorder. Genetic Predisposition Individuals with a family history of eating disorders are at a significantly heightened risk of being affected by binge-eating disorder. This could be caused by a specific gene mutation that is inherited from the parents, which is linked to addiction to food and increased likelihood of an eating disorder. However, this could also result from acquired traits from the family, such as lifestyle and stress coping mechanisms. Psychological Factors There is a significant link between binge-eating and psychological disorders such as depression and anxiety, and many individuals that suffer from binge-eating disorder are affected by depression or anxiety, or have been in the past. Poor body image and low self-esteem may also have a role to play in the development of binge-eating disorder. People who are dissatisfied with the appearance or shape of their body are more susceptible to an eating disorder such as binge-eating disorder. History of Restricted Eating Patterns In particular, people that have a history of dieting with strict restriction of certain foods are more likely to be affected. Some patients with condition report excessive dieting habits that began in childhood or early adolescent years. It is believed that the restricted eating patterns have the potential to trigger the urge to binge eat, particular in combination with other risk factors, such as low-self esteem and stressful situation. Therefore, the craving or urge to eat the restricted food then leads to overeating and, if it happens repeatedly, binge-eating disorder can present. Biological Factors Related StoriesCross-sex hormone therapy may improve eating disorder symptoms in transgender peopleAED publishes World Eating Disorders Healthcare Rights document to promote better careResearchers developing smartphone app to help patients with eating disordersThere are also some health conditions or biological factors that may be involved in causing binge-eating disorder. For example, changes in the hunger and satiety hormones produced in the hypothalamus can lead to abnormal regulation of food intake and the possibility of binge-eating. Additionally, there is some evidence that the neurotransmitters in the brain such as serotonin may have a role to play although more research is required to support this notion. Binge-eating disorder usually present in adolescence or early adulthood, suggesting the age may have an impact on the presentation of the disease. This may also be linked to the hormonal changes in this period of life, however. Environmental Factors Social and cultural ideals of beauty, body weight and body shape may be a driving factor for binge-eating disorder. Many individuals feel an overwhelming pressure to maintain a slender body shape and use strict dieting techniques get there. However, these restrictions can be counter-productive and increase the urge to eat when faced with emotions stress. Additionally, unhealthy habits can be acquired from parents, particularly those that use food to comfort or reward their children or those that place a strong emphasis on body appearance and weight. Traumatic situations, such as emotional or sexual abuse, can also increase the risk of an eating disorder such as binge-eating disorder. References http://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/dxc-20182932 http://www.helpguide.org/articles/eating-disorders/binge-eating-disorder.htm#causes http://www.eatingdisorderhope.com/information/binge-eating-disorder http://www.nhs.uk/conditions/binge-eating/Pages/Introduction.aspx Further ReadingBinge-Eating Disorder TreatmentBinge-Eating Disorder Signs and SymptomsWhat Causes Binge Eating Disorder?Health Risks of Binge Eating Disorder // Last Updated: Apr 5, 2016" }, "109": { "category_2_x_medical_disease.id": 109, "category_2.id": 30, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Binge Eating Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 109, "medical_disease.ts": "2018-04-20 02:35:42", "medical_disease.title": "Binge-Eating Disorder Treatment", "medical_disease.content": "By Deborah Fields, BSc (Hons), PgDip, MCIPR Binge eating disorder (BED), a condition that involves a person rapidly and excessively eating over a period of time without purging and frequently repeating this, has various treatments. The way that medical staff can help the individual patient depends on thoroughly understanding the reasons behind the disorder developing. The range of professionals who can help with BED vary. The disorder was added to the Diagnostic and Statistical Manual of Mental Disorders, version V, which was published in 2013. In addition to a general practitioner who can help with the patient’s general health, the individual may need to seek further help from a psychologist, psychiatrist, social worker or attend overeater self-help groups. There are a number of treatment regimens that could help the patient to reduce their episodes of binge eating and lose weight. In general, psychological treatments tend to have longer lasting effects on patients in reducing BED than pharmaceuticals. Cognitive Behavioral Therapy (CBT) During a course of Cognitive Behavioral Therapy (CBT), a therapist will help the patient to talk through their problems with overeating to encourage different thought patterns. The therapy focuses on how the patient’s thought processes can lead to certain negative actions which can be altered. The therapist tries to assist by encouraging the affected person to reduce their problems down into smaller elements so that they can be tackled step by step to avoid the issues seeming too daunting. Psychotherapy With binge eating disorder, a patient can have underlying depression or other mental health issues. Psychotherapy either on an individual or group basis is designed to help the patient explore issues that are contributing to the way they feel about themselves. Interpersonal psychotherapy Medical staff will help the patient to talk about and examine how their relationships with friends and family are encouraging them to binge eat. The discussions help the patient to get to the root cause of issues. The therapists are trying to inspire the patient to develop their own interactive skills in order to cope with the different challenging dynamics between people around them. This is intended to help them have coping mechanisms instead of turning to binge eating. Bariatric surgery Related StoriesBinge eating can act as barrier to achieving weight-loss successAED publishes World Eating Disorders Healthcare Rights document to promote better careCross-sex hormone therapy may improve eating disorder symptoms in transgender peopleBED can cause severe health risks for some patients such as those who can go on to develop diabetes - a life threatening disease that causes high blood sugar. Some patients with BED do undergo bariatric surgery to reduce the size of their stomach with a gastric band. Alternatively, they can have some of the stomach cut away or have a gastric bypass for the small intestine leading the food to a different compartment. This is designed to help the patient lose weight. The success of BED in changing the behaviors of the patient varies even though they tend to lose some weight. Many continue to binge eat despite having undergone surgery. Medication BED has been strongly linked with emotional and mental health issues in some patients. As a result, some patients are prescribed medication to treat depression such as selective serotonin reuptake inhibitors. These have an impact on the chemicals in the brain related to the patient’s mood. Another type of medicine used for BED are anticonvulsants. Originally they were prescribed for seizures, but they can also help to reduce the tendency to binge eat in certain patients. There can, however, be side effects from taking any pharmaceutical medicines as treatment. Reviewed by: Dr Tomislav Meštrović, MD, PhD References http://www.nhs.uk/conditions/cognitive-behavioural-therapy/Pages/Introduction.aspx http://www.counselling-directory.org.uk/interpersonal-therapy.html http://www.nhs.uk/Conditions/Psychotherapy/Pages/Introduction.aspx https://en.wikipedia.org/wiki/Binge_eating_disorder https://en.wikipedia.org/wiki/Bariatric_surgery Further ReadingBinge-Eating Disorder CausesBinge-Eating Disorder Signs and SymptomsWhat Causes Binge Eating Disorder?Health Risks of Binge Eating Disorder Last Updated: May 19, 2016" }, "110": { "category_2_x_medical_disease.id": 110, "category_2.id": 30, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Binge Eating Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 110, "medical_disease.ts": "2018-04-20 02:35:45", "medical_disease.title": "Binge-Eating Disorder Signs and Symptoms", "medical_disease.content": "By Yolanda Smith, BPharm The signs and symptoms characteristic of binge-eating disorder primarily relate to the individual’s eating habits and relationship with food, rather than their physical appearance or body shape. While most affected patients are overweight, some people with binge-eating disorder have a normal body weight and most obese people do not have binge-eating disorder. The Binge-Eating Cycle While it is considered to be normal for individuals to overeat on certain occasions, such as festive holidays and events, excessive eating on a habitual basis can lead to associated feelings of shame and the presentation of a binge-eating disorder. People with binge-eating disorder often cycle through the following distinct stages that characterize the condition: Strict dieting and obsession with body shape and weight Tension or anxiety due to cravings for certain foods Binge-eating large quantities of food in a short time frame (e.g. 3000-5000 calories in 1-2 hours.) Shame or disgust about binge-eating habits and renewal of dieting to control weight. Distinct from individuals that suffer from bulimia nervosa, people with binge-eating disorder do not tend to purge the calories consumed following a binge-eating session. Instead, they continue with the current diet or to eat normal meals until the next binge-eating session. Behavioral Signs and Symptoms The behavior of an individual with binge-eating disorder is often the starkest sign of the disorder, particularly in the way they interact with food. These characteristic behaviors may include: Consuming large quantities of food in a short duration of time Continuing to eat even when full Eating alone more often than usual Inability to stop or control eating habits Frequent episodes of dieting without evidence of weight loss Attempting to hide evidence of binge-eating (e.g. hiding food packaging) Tendency to hoard or stockpile food Emotional Signs and Symptoms The emotional symptoms that present according to the individual’s relationship with food and their eating habits are hallmark of binge-eating disorder. They may include: Depression or anxiety Stress or tension that is relieved by eating Lack of control in quantity of food consumption Shame, disgust or embarrassment about eating behavior Desperation to control body weight and eating habits Related StoriesCross-sex hormone therapy may improve eating disorder symptoms in transgender peopleBinge eating can act as barrier to achieving weight-loss successNew study establishes link between prenatal stress and onset of eating disordersThe emotional component of binge-eating disorder is often the greatest factor that inhibits an individual from following normal eating patterns and prompts them to seek treatment for the disorder. Other Effects An individual affected by binge-eating disorder will often report related effects in many other facets of their life. For example, self-confidence can be reduced as a result of feeling out of control of food consumption habits. This can then have a significant effect on their performance at school or work, as well as have an impact on social relationships and activities. Other conditions that are linked to binge-eating disorder include: Insomnia Depression Anxiety Substance abuse Suicidal thoughts Weight gain The associated weight gain and increased risk of obesity can also lead to numerous medical complications, such as Type 2 diabetes mellitus, gallbladder disease, hypercholesterolemia, hypertension, cardiovascular disease, osteoarthritis, gastrointestinal disorders, sleep apnea and cancer. DSM-5 Diagnostic Criteria The diagnostic criteria for binge-eating disorder according to the diagnostic and statistical manual of mental disorders includes: Recurrent binge-eating episodes, either eating a larger quantity of food within a discrete period OR feeling out of control of food consumption during episodes. Binge eating episodes associated with eating more rapidly, until uncomfortably full, alone or without feeling hungry, and feeling of shame of disgust afterward. Distress about eating habits and binge-eating Binge-eating episodes occur at least one a week for at least 3 months Not associated with compensatory behavior or purging of calories that are linked to bulimia nervosa diagnosis. References http://www.timberlineknolls.com/eating-disorder/binge-eating/signs-effects/ http://www.helpguide.org/articles/eating-disorders/binge-eating-disorder.htm http://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/dxc-20182932 http://www.nhs.uk/conditions/binge-eating/Pages/Introduction.aspx https://www.nationaleatingdisorders.org/binge-eating-disorder Further ReadingBinge-Eating Disorder CausesBinge-Eating Disorder TreatmentWhat Causes Binge Eating Disorder?Health Risks of Binge Eating Disorder Last Updated: Apr 5, 2016" }, "111": { "category_2_x_medical_disease.id": 111, "category_2.id": 30, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Binge Eating Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 111, "medical_disease.ts": "2018-04-20 02:35:49", "medical_disease.title": "What Causes Binge Eating Disorder?", "medical_disease.content": "By Deborah Fields, BSc (Hons), PgDip, MCIPR Binge eating disorder is a condition that involves a person rapidly and excessively eating over a period of time and then feeling embarrassed about their over-consumption. In comparison to other disorders, the person does not purge the food afterwards. The disorder was recently recognized and added to the 2013 update of the Diagnostic and Statistical Manual of Mental Disorders. It is one of the three most common eating disorders (the others being anorexia nervosa and bulimia nervosa). Several reasons have been suggested for why a person develops the disorder. Genetic factors Some researchers have indicated that binge eating can be an inherited disorder with a variant in some people’s genes making them more prone to binge-eating. If a person has a family member who has binge eating disorder, this potentially makes them a higher risk for the disorder as well. Nevertheless, it must be taken into account that first-degree relatives usually share genes and environments; therefore it is hard to differentiate genetic factors from various environmental causes in familial instances of binge eating. Restrictive diets Another factor that is thought to be a factor in binge eating is the limiting of food intake as part of a strict diet. Eating patterns that are similar to starvation can alter the way the body feels about food and encourage excessive cravings for food. Examples of extreme diets that can inspire binge eating include delays in eating, very low calorie intakes and cutting out specific types of food. While the person who has been dieting changes their behavior to one that is more normal, they are at risk of overeating as a result. The feelings inspired by a diet can continue after the restricted pattern has changed to a more normal one. Environmental factors Related StoriesNew study establishes link between prenatal stress and onset of eating disordersAED publishes World Eating Disorders Healthcare Rights document to promote better careNovel, ultra-rare damaging genetic variants may contribute to eating disordersStudies have indicated that traumatic experiences can trigger overeating in a person. A series of challenging events that upset the patient, make them depressed, stressed or unhappy can have a dramatic impact. Furthermore, traumas and losses in life can trigger eating behaviors like binge eating that become intertwined with feelings and emotions. The person therefore turns to food as a form of comfort or escapism. Body image How a patient feels about their self-image plays a role in triggering the condition for some. Physical or sexual abuse during childhood has been linked to binge eating. Also other experiences that alter their self-esteem such as harsh remarks about how they look can contribute. Diagnosis Binge-eating can be dangerous for the health of the patient. A doctor can diagnose the condition and also suggest involving a psychologist to determine what is driving the binge eating disorder. The medical team will also assess through a series of tests such as physicals, blood and urine tests and consultations whether the excessive consumption of food is having an impact on other aspects of the patient’s health such as his or her blood pressure, heart health, cholesterol levels and sleep. There is also a risk of developing diabetes and gastrointestinal reflux disease. Reviewed by: Dr Tomislav Meštrović, MD, PhD References https://en.wikipedia.org/wiki/Binge_eating_disorder http://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/dxc-20182932 http://eating-disorders.org.uk/information/compulsive-overeating-binge-eating-disorder/ Further ReadingWhat is an Eating Disorder?What Causes Eating Disorders?Eating Disorder SignsEating Disorders DiagnosisEating Disorder TreatmentsMore... // Last Updated: May 19, 2016" }, "112": { "category_2_x_medical_disease.id": 112, "category_2.id": 30, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Binge Eating Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 112, "medical_disease.ts": "2018-04-20 02:35:52", "medical_disease.title": "Health Risks of Binge Eating Disorder", "medical_disease.content": "By Deborah Fields, BSc (Hons), PgDip, MCIPR Binge eating disorder (BED), a condition where a person repeatedly eats significantly more food over a certain period of time without purging, can cause major health risks for the individual. The risks of BED can be both physical and psychological for the patient. Image Copyright: Suzanne Tucker / Shutterstock Diabetes Binge-eating on a regular basis can increase the weight of a patient and contribute to them being at risk of type 2 diabetes. Diabetes is a disease where the body cannot respond effectively to sudden rises in high blood sugar. The condition does not develop overnight but can progress over a period of time. With regular binge-eating, the body will eventually not produce enough insulin to respond to an increase in the blood sugar triggered by the sudden high rise in calories. This can make the person who is binge eating feel even more hungry and lead to them eating yet more food. It can take time for the insulin in the body to reach a certain level in response. When it does, this also can also cause feelings of hunger. Foods eaten during binge-eating that can easily contribute to this dangerous development are ones that are high in carbohydrates such as potatoes, cakes, sweets or white bread. Osteoarthritis Osteoarthritis is a condition that causes joint stiffness and pain. People with BED can be at risk because of the extra pressure they put on their joints because of increased weight. The condition can improve for the patient if they can find a healthy way of reducing their weight. The severity of the condition can vary between people. High blood pressure BED can be a contributing factor in high blood pressure. Consistent high blood pressure over a period of time can make someone at higher risk for a life-threatening stroke or heart attack. Typically, a reading of systolic blood pressure above 140 mmHg and diastolic pressure above 90 mmHg can be dangerous, as well as the rise of only one of these figures. About 12.8% of all deaths globally each year can bea result of a high blood pressure.. High cholesterol Related StoriesNovel, ultra-rare damaging genetic variants may contribute to eating disordersNew study establishes link between prenatal stress and onset of eating disordersAED publishes World Eating Disorders Healthcare Rights document to promote better careBED can increase the cholesterol levels in your blood. Cholesterol is a type of fat in the body that helps it to work properly. If there is too much of it, however, it can contribute to strokes, atherosclerosis (thickening of the artery wall) and heart attacks. Foods that can increase cholesterol tend to have high levels of saturated fats (such as butter, full fat cheese, ghee and meats). Cancers BED may also encourage the development of cancer in some people. Increases in sugar and carbohydrate levels have been linked to increases in more severe forms of breast cancer (those without estrogen or progesterone receptors) in some populations. Gastro oesophageal reflux disease (GERD) Binge eating can trigger or make gastro oesophageal reflux disease, a condition where acidic or non-acidic contents of the stomach rise back into the oesophagus, worse in some people. It can cause chest pains, heart burn, sore throats, difficulty swallowing to name a few symptoms. Unchecked and untreated, this can also result in some pre-cancerous conditions. Depression A person’s mental health can also suffer further through binge eating. Their eating habits can make them feel bad about themselves. They may also experience social isolation and live a restricted lifestyle. Other potential psychological effects include really bad episodes of anxiety, self-harm and even suicide attempts. Reviewed by: Dr Tomislav Meštrović, MD, PhD References http://www.nhs.uk/conditions/binge-eating/Pages/Introduction.aspx http://www.diabetes.co.uk/binge-eating-disorders.html http://www.nhs.uk/conditions/Osteoarthritis/Pages/Introduction.aspx http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/ http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Whatishigh http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/ http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/ https://heartuk.org.uk/cholesterol-and-diet/low-cholesterol-diets-and-foods https://www.mentalhelp.net/blogs/binge-eating-disorder/ Further ReadingBinge-Eating Disorder CausesBinge-Eating Disorder TreatmentBinge-Eating Disorder Signs and SymptomsWhat Causes Binge Eating Disorder? Last Updated: May 19, 2016" }, "113": { "category_2_x_medical_disease.id": 113, "category_2.id": 31, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biomarker", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 113, "medical_disease.ts": "2018-04-20 02:35:58", "medical_disease.title": "Biomarker - What is a Biomarker?", "medical_disease.content": "By Dr Ananya Mandal, MD Biomarkers (short for biological markers) are biological measures of a biological state. By definition, a biomarker is \"a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacological responses to a therapeutic intervention.\" Biomarkers are the measures used to perform a clinical assessment such as blood pressure or cholesterol level and are used to monitor and predict health states in individuals or across populations so that appropriate therapeutic intervention can be planned. Biomarkers may be used alone or in combination to assess the health or disease state of an individual. Variety of biomarkers A wide range of biomarkers are used today. Every biological system (for example the cardiovascular system, metabolic system or the immune system) has its own specific biomarkers. Many of these biomarkers are relatively easy to measure and form part of routine medical examinations. For example, a general health check may include assessment of blood pressure, heart rate, cholesterol, triglycerides and fasting glucose levels. Body measurements such as weight, body mass index (BMI), and waist-to-hip ratio are routinely used for assessing conditions such as obesity and metabolic disorders. Characteristics of an ideal biomarker Related StoriesCommon iron supplements linked to increased levels of a cancer biomarkerSperm epigenetics and fertilityPhilips introduces new web-based informatics platform to hasten drug research and biomarker discoveryAn ideal biomarker has certain characteristics that make it appropriate for checking a particular disease condition. Ideally, an ideal marker should have the following features: Safe and easy to measure Cost efficient to follow up Modifiable with treatment Consistent across gender and ethnic groups Biomarkers as health and disease predictors Biomarkers are used to predict serious illnesses such as diabetes and cardiovascular disease. Each individual biomarker indicates whether there is a disease or health state and can be combined to provide a detailed picture of how healthy a person is and whether or not a diagnosis needs to be made. Biomarkers in cancer detection and drug development The principles of biomarkers in disease have been applied to the detection, screening, diagnosis, treatment and monitoring of cancer. Traditionally, anti-cancer drugs were agents that killed both cancer cells and healthy cells. However, more targeted therapies have now been developed that can be directed to kill cancer cells only, while sparing healthy cells. The assessment of a typical biomarker in cancer helps in the development of therapies that can target the biomarker. This can minimize the risk of toxicity and reduce the cost of treatment. In cancer research, genetic studies are valuable because genetic abnormalities so often underlie the development of cancer. Certain DNA or RNA markers may therefore help in the detection and treatment of specific cancers. Reviewed by Sally Robertson, BSc Sources http://www.tsalliance.org/documents/UnlockBiomarkersDescription.pdf http://www.prb.org/pdf08/TodaysResearchAging14.pdf www.rci.rutgers.edu/~layla/AnalMedChem511/pdf_files/RB_pdf/nrd1130.pdf http://www.ias.ac.in/pubs/splpubs/pjubileebook/403.pdf Last Updated: Oct 7, 2014" }, "114": { "category_2_x_medical_disease.id": 114, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 114, "medical_disease.ts": "2018-04-20 02:36:06", "medical_disease.title": "Biopsy - What is Biopsy?", "medical_disease.content": "By Dr Ananya Mandal, MD Biopsy is a medical test that involves removal of tissue in order to examine it for disease. The tissue samples may be taken from any part of the body. There are several types of biopsies. Some biopsies involve removing a small amount of tissue with a needle while others involve surgically removing an entire lump or suspected tumor. Biopsies may also be performed using imaging guidance such as ultrasound, x-ray, computed tomography (CT), or magnetic resonance imaging (MRI). What are biopsies used for? Diagnosing tumors and cancers Tumors may be graded as cancerous (malignant) or non-cancerous (benign) with the help of biopsies Grading tumors Biopsies of cancers help to grade the tumor. The microscopic structure of the tumor often gives clues to the nature, rate of growth, aggressiveness of the cancer. The cancer is staged based on this. Staging helps to determine the plan of treatment and helps to predict the outcome or prognosis of the cancer. Other uses Biopsies can help identify other conditions such as infections and autoimmune disorders. Bone biopsy for example helps in diagnosis of bone infections. Bone marrow biopsy is used to diagnose cancer in the blood, such as leukemia and also for effects of drugs, toxins and infections. Where and how are biopsies performed? Related StoriesNew imaging technology could significantly improve the accuracy of cancer diagnosisIPF Catalyst Challenge recognizes Owlstone Medical’s Breath Biopsy platformNovel tool successfully predicts outcomes for lung cancerBiopsies may be performed on almost all organs like breast, kidneys, liver, bone marrow, bone, skin, lung, lymph nodes, muscles, nerves, testes, thyroid, bladder, heart, neck, prostate etc. Usually biopsies are performed as an out-patient procedure and do not require admission. Types of biopsy There are many different types of biopsy procedures: Needle biopsy – A fine needle is used to remove a small amount of tissue from the tumor or growth. This is called fine needle aspiration cytology (FNAC). Vacuum assisted biopsy — thicker, hollow needle removes cores of tissue with a single insertion of a vacuum assisted probe. Surgical biopsy – Here a small surgery is performed. A small or whole of the tumor is excised and removed for examination. This is a more extensive procedure and may require hospital stay. When an entire lump or suspicious area is removed, the procedure is called an ''excisional biopsy''. When only a sample of tissue is removed with preservation of the histological architecture of the tissue’s cells, the procedure is called an ''incisional biopsy'' or ''core biopsy''. How is biopsy analysed? The biopsy tissue is sent to the laboratory wherein a pathologist makes microscopically thin slices from it and fixes the slices onto a glass slide. This is then examined under the microscope after staining it with special dyes. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://ww5.komen.org/uploadedfiles/Content_Binaries/806-380a.pdf www.cancer.org/.../breast-biopsy-biopsy-types http://www.nlm.nih.gov/medlineplus/biopsy.html http://www.skincarephysicians.com/skincancernet/biopsy.html http://www.radiologyinfo.org/en/info.cfm?pg=biopgen Further Reading What is a Breast Biopsy? What is a Skin Biopsy? Cancer Biopsy Biopsy for Inflammatory Conditions Biopsy Analysis Last Updated: Oct 7, 2014" }, "115": { "category_2_x_medical_disease.id": 115, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 115, "medical_disease.ts": "2018-04-20 02:36:08", "medical_disease.title": "Types of Skin Biopsy", "medical_disease.content": "By Jonas Wilson, Ing. Med. Skin biopsies are procedures done to investigate cutaneous growths or lesions. Many skin pathologies can be diagnosed by direct observation and palpation. However, there are others that require diagnostic procedures involving microscopic and histopathological examinations. The various techniques that may be used to obtain skin biopsies include shave biopsy, punch biopsy and excisional biopsy. Skin biopsies, compared to other biopsies are relatively low-risk procedures and are associated with very few complications. However, like other biopsies, they require a consenting patient and anesthesia, typically local. Slide tissue biopsy from skin for diagnosis in pathology laboratory. Image Copyright: Pongsak A / Shutterstock Shave Biopsies This technique entails the use of a curved razor or small scalpel by an experienced surgeon to minimize the risk of scarring. It is the most commonly used technique. This is because it is relatively quick to perform, cost-effective and requires simple wound care. Shave biopsies may be done superficially, or via saucerization, and produce flat specimens. Superficial shave biopsies are mainly used to evaluate lesions that are predominantly in the epidermis of the skin. These include skin tags, warts, and squamous or basal cell carcinomas. Under local anesthetic, a thin disk of tissue is removed for examination. The area is kept moist and covered for at least 7 days to prevent significant scar formation. Related StoriesNew microbiopsy device could revolutionize testing for skin cancer, other diseasesNew laser imaging 'bowl' could reduce stages involved in spotting breast cancerCould a blood test predict how cancer spreads in children?Saucerization biopsies require the use of curved razor blades to obtain specimens from lesions that extend deeper into the skin, that is, into the dermis and subcutaneous fat. Indications for saucerization biopsies include suspicious lesions that are heavily pigmented or lesions that are difficult to remove via the superficial technique due to their anatomical location. Moreover, saucerization is preferred in the case of lesions in anatomical locations that are likely to produce scars that become hypertrophic or spread excessively. These include those found on the ears or upper arm. Punch Biopsies Punch biopsies produce cylindrical specimens due to their circular blades that are rotated through the skin to the subcutaneous tissue. These biopsies may be incisional or excisional. The type of punch biopsy adopted depends on the type of tissue and the size of the lesion. Lesions biopsied with this method include dysplastic nevi and bullous or inflammatory eruptions. These biopsies may require sutures to assist with quicker wound healing and to improve the chances of a better cosmetic result. Despite their ability to provide full-thickness specimens, punch biopsies are limited in terms of the width of sample obtained. This limitation is particularly crucial in tumor staging and in arriving at a prognosis of malignant lesions. Excisional Biopsies These biopsies involve removal of the entire lesion, including a margin of surrounding healthy skin as well. They are ideally suited for the removal and diagnosis of small melanomas. Excisional biopsies require sutures and may heal with scarring. Skin grafts or flaps may be used to replace large areas of skin that may have been removed during the procedure. Reviewed by Dr. Liji Thomas, MD. References http://www.aafp.org/afp/2011/1101/p995.html http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/skin-biopsy-punch-method http://www.mayoclinic.org/tests-procedures/skin-biopsy/home/ovc-20196287 Further ReadingBiopsy - What is Biopsy?What is a Breast Biopsy?What is a Skin Biopsy?Cancer BiopsyBiopsy for Inflammatory ConditionsMore... Last Updated: Aug 17, 2016" }, "116": { "category_2_x_medical_disease.id": 116, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 116, "medical_disease.ts": "2018-04-20 02:36:12", "medical_disease.title": "What is a Breast Biopsy?", "medical_disease.content": "By Dr Ananya Mandal, MD There are several types of breast biopsy. The choice of which type is suitable for an individual depends on various factors. Some of these include: The extent of suspicion of cancer of the breast tumor The size of the tumor The number of tumors Other medical problems Personal preferences of the patient Types of breast biopsy The various types of breast biopsy include: Fine needle aspiration biopsy or cytology (FNAB/FNAC) In this procedure the pathologist or the doctor uses a very thin needle (thinner than ones used for blood tests) attached to a syringe to withdraw a small amount of tissue from the suspicious area. The tissue is placed over a glass slide, stained with special dyes and examined under the microscope. The area of the biopsy is first numbed with a local anesthetic injection. For the procedure the doctor locates the lump by palpating it or feeling it by hand. In case the lump is not felt by hand the doctor may use imaging guidance of an ultrasound and watch the needle on a screen as it moves toward and into the mass. Another method is to use a stereotactic needle biopsy to guide the needle. In this the computers can map the exact location of the mass using mammograms taken from 2 angles. This helps in the biopsy. Related StoriesDiagnosing prostate cancer through a £225 urine testIPF Catalyst Challenge recognizes Owlstone Medical’s Breath Biopsy platformCould a blood test predict how cancer spreads in children?An FNAC may sometimes miss cancer if the needle does not get a tissue sample from the area of cancer cells. This may require a second FNAC or a different type of biopsy. Core needle biopsy This is similar to FNAC. In this the needle is slightly larger and hollow. It is used to withdraw small cylinders (or cores) of tissue from the abnormal area in the breast. This is also performed under local anesthesia. The needle is put in 3 to 6 times to get the samples, or cores. Imaging guidance may be used for this type of biopsy as well. A stereotactic core needle biopsy may also be performed under imaging guidance. Vacuum-assisted core biopsy This is done by a Vacuum Assisted Device. A hollow probe is put in through a cut over the lump. A cylinder of tissue is then pulled into the probe through a hole in its side, and a rotating knife inside the probe cuts the tissue sample from the rest of the breast. Surgical or open biopsy If the tumor is diagnosed using FNAC, treatment is planned accordingly. In some cases where diagnosis is not confirmed a surgical biopsy may be recommended. For this the lump may be totally or partially excised. This may also be called an open biopsy. Open biopsies are of two types - incisional biopsies and excisional biopsies. When an entire lump is removed, the procedure is called an ''excisional biopsy''. When only a sample of tissue is removed with preservation of the histological architecture of the tissue’s cells, the procedure is called an ''incisional biopsy''. Sentinel Node Biopsy This is biopsy of a sentinel lymph node. A sentinel lymph node is the first draining axillary lymph node from the breast. If tumor cells are detected in this node, the status of the spread of the cancer from the breast can be predicted. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://ww5.komen.org/uploadedfiles/Content_Binaries/806-380a.pdf www.cancer.org/.../breast-biopsy-biopsy-types http://www.radiologyinfo.org/en/info.cfm?pg=biopgen Further Reading Biopsy - What is Biopsy? What is a Skin Biopsy? Cancer Biopsy Biopsy for Inflammatory Conditions Biopsy Analysis // Last Updated: Feb 27, 2018" }, "117": { "category_2_x_medical_disease.id": 117, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 117, "medical_disease.ts": "2018-04-20 02:36:17", "medical_disease.title": "What is a Skin Biopsy?", "medical_disease.content": "By Dr Ananya Mandal, MD Skin cancer, skin inflammatory conditions and abnormal growths on the skin are most commonly diagnosed and the diagnosis is confirmed with a biopsy. Biopsy involves removal of a small sample of tissue and examining it under a microscope. The majority of biopsies performed to diagnose skin cancer involve a minor surgery. This may require local anesthesia and usually does not require hospital stay. Types of skin biopsy Tissue from the suspect lesion is surgically removed. There are several types of skin biopsy. Some of these include: Excisional biopsy This involves removal of the whole tumor. Sometimes healthy margin around the lesion is also removed. This leaves behind a small wound that may need stitches and dressing. Large biopsies may need a skin graft, or a skin flap to heal rapidly. Incisional biopsy This type involves removal of only a part of the lesion. This may be considered when a lesion is large or the location requires maximum preservation of tissue. Punch biopsy Sometimes a core or part of the tissue is scooped out - this is called a punch biopsy. A round needle is used for this type of biopsy. Related StoriesNew microbiopsy device could revolutionize testing for skin cancer, other diseasesDiagnosing prostate cancer through a £225 urine testNovel tool successfully predicts outcomes for lung cancerMinimal bleeding is noted with the 1 mm punch, and often the wound is left to heal without stitching for the smaller punch biopsies. However, these small punches fail to make accurate diagnosis. The common punch size use to diagnose most skin conditions is the 3.5 or 4 mm punch. The punch biopsy is preferred over the shave biopsy for the diagnosis of skin cancers like squamous cell carcinoma and for melanomas. Shave biopsy Shavings of the tissue from the top may also be removed. This is called a shave biopsy. An incisional biopsy generally is not used to remove a suspected melanoma. Nail bed biopsy If skin cancer or melanoma is suspected under the nail bed a nail bed biopsy is performed. During this procedure, part or all of the fingernail or toenail is removed. Fine Needle Aspiration Biopsy This is a procedure when a fine needle is used to withdraw a sample of tissue from the lesion. It is rarely used in skin lesions. It may be used commonly to obtain a sample from an internal organ, lymph node, or subcutaneous (beneath the skin) tissue. This is done to determine the possible spread of the cancer. After a biopsy Once the sample is removed by biopsy there may be bleeding that is stauched by using electrocautery. After removal of the tissue the sample of the tissue is cut into microscopic thin slices. This is fixed and stained with special dyes on a glass slide. The slide is then examined under the microscope by a pathologist or a dermatologist (skin specialist) or a pathodermatologists (who specializes in microscopic examinations of skin diseases). Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.acponline.org/about_acp/chapters/az/procedural-biopsy.pdf http://www.dermnetnz.org/procedures/biopsy.html http://www.skincarephysicians.com/skincancernet/biopsy.html http://www.radiologyinfo.org/en/info.cfm?pg=biopgen Further Reading Biopsy - What is Biopsy? What is a Breast Biopsy? Cancer Biopsy Biopsy for Inflammatory Conditions Biopsy Analysis // Last Updated: Feb 27, 2018" }, "118": { "category_2_x_medical_disease.id": 118, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 118, "medical_disease.ts": "2018-04-20 02:36:22", "medical_disease.title": "Cancer Biopsy", "medical_disease.content": "By Dr Ananya Mandal, MD Biopsy means removal tissue samples from a suspected lesion. It is one of the most important diagnostic tools for detection and confirmation of certain cancers. Types of biopsy When cancer is suspected, a variety of biopsy techniques are applied. Some of these include: An ''excisional biopsy'' is an attempt to remove an entire lesion. This also involves removal of the healthy margins around the lesion. \"Clear margins\" or \"negative margins\" means that no disease was found at the edges of the biopsy tissue. \"Positive margins\" means that disease has spread to the margins and a wider excision may be recommended. An ''incisional biopsy'' involves removal of a wedge of tissue or a bite of tissue. A variety of sizes of needle can collect tissue in the lumen (‘’core biopsy’’). Needle biopsy involves removal of a small sample of tissue from the lesion using a very fine needle. Needle or core biopsy may be guided with imaging studies like X ray, MRI or CT scan. Endoscopic biopsy is usually performed with aid of endoscopy. An endoscope is a thin long flexible tube with a camera and instruments on tis tip. This is common for gastrointestinal tract lesions. Biopsy on laparotomy or thoracotomy. When the whole tumor is removed for examination while operating on the patient, it is called laparotomy (opening up of the abdomen) or thoracotomy (opening up of the chest) biopsy. This is a form of excisional biopsy or open surgical biopsy. When the sentinel node has been found, it is removed (an excisional biopsy) and looked at under a microscope. This is called sentinel lymph node biopsy. After biopsy Related StoriesDiagnosing prostate cancer through a £225 urine testIPF Catalyst Challenge recognizes Owlstone Medical’s Breath Biopsy platformImmune ‘hotspots’ could help predict the risk of breast cancer relapse in patients, study finds Once the tissue is taken it is examined under the microscope for malignancy. The tissue sample is frozen into blocks and then sliced into microscopically thin slices. These slices are a single cell in thickness. These are then fixed onto a glass slide and stained with special dyes. The slides with the samples are then examined by a pathologist under the microscope. Cancerous lesion biopsy Microscopic examination of the lesion can say if the lesion is cancerous (malignant) or non-cancerous (non-malignant). It can also determine the type of cancer. For example, there are various tissue types of cancer like Adenocarcinoma, Squamous cell carcinoma etc. Examination also helps in grading the cancer. A low grade cancer is typically less aggressive and slow growing and slow spreading. On the other hand a high grade cancer is an aggressive form and spreads rapidly to distant organs. Biopsy of cancer lesions helps in staging the cancer. An early stage cancer is typically localized while an advanced stage cancer has spread to lymph nodes and other organs like liver, lungs and brain. Staging and grading of the cancer helps in planning treatment regimens appropriate for the type of cancer. It also helps to predict the possible outcome and survival. For example, an advanced cancer may mean a more intensive treatment regimen or palliative and symptomatic care alone. The patient in an advanced stage may not survive long. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.cancer.org/treatment/understandingyourdiagnosis/ http://www.cancer.org/treatment/understandingyourdiagnosis/ www.cap.org/.../pi_sentinel_lymph_node.pdf http://onlinelibrary.wiley.com/doi/10.3322/canjclin.22.3.158/pdf http://genomemedicine.com/content/pdf/gm332.pdf Further Reading Biopsy - What is Biopsy? What is a Breast Biopsy? What is a Skin Biopsy? Biopsy for Inflammatory Conditions Biopsy Analysis Last Updated: Nov 8, 2012" }, "119": { "category_2_x_medical_disease.id": 119, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 119, "medical_disease.ts": "2018-04-20 02:36:26", "medical_disease.title": "Biopsy for Inflammatory Conditions", "medical_disease.content": "By Dr Ananya Mandal, MD There are several non-cancerous conditions that may require a biopsy. Some of the other indications for biopsy can be outlined as: Inflammatory bowel diseases Biopsy of the gastrointestinal tract to detect suspected inflammatory bowel diseases like Crohn’s disease and Ulcerative colitis. Regular biopsies are taken to assess the activity of disease and to assess changes that appear before the lesions turn cancerous. Renal function Renal or kidney biopsy is indicated in alterations of renal function. Biopsy of kidney is combined with fluorescence microscopy. This helps in diagnosis of several forms of glomerulonephritis. Other indications include: IgA nephropathy Membranous glomerulonephritis Lupus nephritis Focal segmental glomerulonephritis membranoproliferative glomerulonephritis Interstitial nephritis Rapidly progressive glomerulonephritis Crescentic Glomerulonephritis etc. Benign breast diseases There are several benign breast conditions that require biopsy. Some of these include: Fibrosis and simple cysts Fibrosis are scar-like tissue formation in breast while cysts are fluid-filled sacs. These are called fibrocystic changes. They are most often diagnosed by a doctor based on symptoms, such as breast lumps, swelling, and tenderness or pain. The symptoms worsen just before the periods. These changes are most common in women of childbearing age, but they can affect women of any age. They are the most common benign condition of the breast. Hyperplasia Related StoriesDiagnosing prostate cancer through a £225 urine testNew laser imaging 'bowl' could reduce stages involved in spotting breast cancerNew imaging technology could significantly improve the accuracy of cancer diagnosisHyperplasia or overgrowth of the cells that line the ducts or the lobules of the breast. Depending on the growths they may be ductal hyperplasia or lobular hyperplasia. Lobular carcinoma in situ These are abnormal cells that look like cancer cells and grow in the lobules of the milk-producing glands of the breast. This is not cancer but may progress to cancer. Fibroadenoma and adenosis In adenosis, the breast lobules are enlarged, and they contain more glands than usual. This is not cancerous. Sclerosing adenosis is a special type of adenosis in which the enlarged lobules are distorted by scar-like fibrous tissue. Fibroadenomas are benign tumors made up of both glandular breast tissue and connective tissue. They are most common in young women in their 20s and 30s. Other benign breast conditions Other benign breast conditions that are diagnosed on biopsy include Phyllodes tumors, Intraductal papillomas, Fat necrosis and oil cysts, infections and inflammation of the breast or mastitis, radial scars, lipomas, hamartomas, hemangiomas, hematomas, adenomyoeptheliomas, and neurofibromas. None of these conditions raises breast cancer risk. Infectious diseases Infectious diseases are also diagnosed with biopsy. Lymph node biopsy is commonly performed to diagnose infectious diseases Metabolic disorders Certain metabolic disorders like Amyloidosis where degraded proteins accumulate in body tissues can be diagnosed using a biopsy. Transplanted organs Biopsies of transplanted organs are performed to check for graft rejection and also to see if the disease that necessitated transplant has not recurred. Infertility In cases of infertility that is not diagnosed by other methods, a testicular biopsy is used. This is needed when the sperm quality is low, but hormone levels still are within normal ranges. Vasculitis Biopsy of the temporal arteries to detect vasculitis Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.ersj.org.uk/content/9/8/1583.full.pdf http://www.patient.co.uk/health/biopsy www.cancer.org/acs/groups/cid/documents/webcontent/003180-pdf.pdf www.sgn-ssn.ch/.../Bruno_Vogt_-_When_to_Perform_a_Renal_Biopsy.pdf Further Reading Biopsy - What is Biopsy? What is a Breast Biopsy? What is a Skin Biopsy? Cancer Biopsy Biopsy Analysis Last Updated: Feb 27, 2018" }, "120": { "category_2_x_medical_disease.id": 120, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 120, "medical_disease.ts": "2018-04-20 02:36:33", "medical_disease.title": "Biopsy Analysis", "medical_disease.content": "By Dr Ananya Mandal, MD A biopsy involves removal of a sample of tissue from a suspected pathological lesion. The tissue may be small in amount, for example, in fine needle aspiration biopsy. Or the tissues may be large in amounts, for example, removal of the entire lesion along with healthy margins as seen in excisional biopsy. Who performs biopsy analysis? Biopsy analysis requires the skill of a highly trained doctor called a Pathologist. A pathologist specializes in the diagnosis of disease based on the analysis and visualizing the microscopic amounts of tissue samples under the microscope. Processing the tissue specimen Related StoriesCould a blood test predict how cancer spreads in children?Novel tool successfully predicts outcomes for lung cancerIPF Catalyst Challenge recognizes Owlstone Medical’s Breath Biopsy platformOnce the tissue is obtained for biopsy it is preserved in formalin or similar chemicals and transferred to the laboratory. This is done to preserve the structure of the tissue and prevent degradation or microbial infestation. The tissue is then frozen into a block of wax or similar substance. The block is then sliced into microscopically thin slices. Each of the slices are as thick as a single cell. The thin slice is then placed on a glass slide. The remaining tissue is stored for further studies, if required. The slide is then fixed (so that the tissue slice) remains attached to it and stained with special dyes. These dyes are special because they attach to certain parts of the cell giving them a characteristic appearance. The most commonly used stain is the Hematoxylin and eosin stain (H&E stain or HE stain). This stain shows up as blue color in the nucleus of the cell and the rest of proteins and body of the cell stains pink or red. Other stains include PAS, MVB, Congo Red etc. Preparation of report Staining and examination under the microscope enables the pathologist to see the exact structure of the tissue sample. Based on the findings, the Pathologist prepares a written report that will list any abnormalities or important findings. Discussion and planning treatment After the preliminary report from the pathologist the report needs to be co-ordinated with the clinical features and findings of the diseases. The attending doctor will then explain and discuss the results of the biopsy with the patient and his or her family. Based on this the diagnosis and treatment regimen is planned for individual patients. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://ukpmc.ac.uk/abstract/MED/19224216 www.razipath.com/.../...ical%20approach%20to%20testicular%20Biopsy.pdf dn3g20un7godm.cloudfront.net/.../...osis+and+Informative+Reporting.pdf http://www.pathkids.com/renal/renal_bx01.pdf Further Reading Biopsy - What is Biopsy? What is a Breast Biopsy? What is a Skin Biopsy? Cancer Biopsy Biopsy for Inflammatory Conditions Last Updated: Feb 27, 2018" }, "121": { "category_2_x_medical_disease.id": 121, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 121, "medical_disease.ts": "2018-04-20 02:36:38", "medical_disease.title": "Punch Biopsy (Skin)", "medical_disease.content": "By Jonas Wilson, Ing. Med. A punch biopsy is a type of skin biopsy. It is a diagnostic procedure that punches a hole in the skin to acquire tissue for laboratory examination, usually through microscopy or tissue culture. Skin biopsies, compared with biopsies of other organs, are relatively low-risk procedures that are conducted under local anesthesia, with very few associated complications. Punch biopsy is one of the three main types of skin biopsies. The other two are shave and excisional biopsies. In punch biopsies, small pieces of skin, from any part of the body, are removed using a tube-shaped sharp cutting tool. This tool has a blade that ranges in size from 1 mm to 8 mm. It is attached to a handle that can be rotated through the layers of skin, namely the dermis and epidermis, into the subcutaneous fat. This motion results in the production of a cylindrical sample. This specimen is then sent to a dermatologist, pathologist or dermato-pathologist, where it undergoes tissue fixation, preparation of slides and staining before microscopic examination. Alternatively, the sample may be stored in a solution for taking bacterial or viral laboratory cultures. Before conducting the procedure, the affected area is carefully marked, and the age of the lesion must be known. This is crucial, because when biopsies conducted prematurely or too late, may negatively affect results. In contrast to other biopsy methods, punch biopsies tend to heal with smaller scars that are typically smaller than the size of the instrument used. The healing time may be shortened still more if sutures are used to close the thickness of the wound. Indications Suspicious growths on the skin are the primary indications for a biopsy. The procedure is performed to evaluate the lesions or to confirm the type of malignant growth found. These cancerous growths include melanoma, squamous cell carcinoma and basal cell carcinoma. They are biopsied prior to employing more invasive surgical procedures to treat them. Related StoriesCould a blood test predict how cancer spreads in children?Diagnosing prostate cancer through a £225 urine testNew imaging technology could significantly improve the accuracy of cancer diagnosisCutaneous eruptions which may have multiple etiologies are also indications for a biopsy. Punch biopsies are typically the best type of skin biopsies since they enable examination of the full thickness of the skin. They may be performed in an outpatient setting, in the ward or operating room. Factors to be taken into account while planning the procedure include its psychological aspects and any direct consequences that may be expected from the results and/ or procedure. In some cases the sample is used to obtain a genetic diagnosis, either by cytogenetic or chromosomal study, and sometimes for the purpose of fibroblast culture. Contraindications There are few contraindications for performing a biopsy. These include allergy to local anesthetics and an active infection at the site of planned biopsy. Precautions are necessary in those patients who are on medications that affect the coagulation system, and in those with bleeding disorders. These may increase the risk of bleeding with the procedure if hemostasis is compromised. Complications Minor complications may occur after the procedure, and should be explained to the patient. Measures to identify and deal with them should be taken. Expected complications include: Pain at the biopsy site Infection of the wound Bleeding at the site Scar formation Reviewed by Dr. Liji Thomas, MD. References http://www.nhs.uk/conditions/Biopsy/Pages/Introduction.aspx http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/skin-biopsy-punch-method http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/punch-biopsy/?region=on Further ReadingBiopsy - What is Biopsy?Types of Skin BiopsyWhat is a Breast Biopsy?What is a Skin Biopsy?Cancer BiopsyMore... // Last Updated: Aug 17, 2016" }, "122": { "category_2_x_medical_disease.id": 122, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 122, "medical_disease.ts": "2018-04-20 02:36:43", "medical_disease.title": "How and Why is a Punch Biopsy Done? (Skin)", "medical_disease.content": "By Jonas Wilson, Ing. Med. A punch biopsy is a medical procedure that acquires tissue for laboratory examination, usually through tissue culture or microscopy, by taking a punch-size piece of skin from the body. It is a relatively low-risk procedure that is typically done under local anesthesia. Surgical intervention punch biopsy - Image Copyright: Alexilusmedical / Shutterstock Small pieces of skin from any part of the body are removed using a tube-shaped tool. It has a blade, which ranges in size from 1 mm to 8 mm. It is rotated through the skin to the subcutaneous fat. The specimens obtained are sent for microscopic and histopathological examination, or bacterial and/ or viral cultures. Punch biopsies, depending on the size of the lesion, may be incisional or excisional. Lesions biopsied with this technique include complex nevi and bullous or inflammatory eruptions. While punch biopsies are capable of showing the full thickness of lesions, they are limited in terms of how much width they are able to display with respect to the specimen obtained. This limitation is crucial in the staging and prognosis of malignant lesions. The procedure As with many medical procedures, patient consent must first be obtained. Moreover, information with regard to the reason for the procedure, what it entails, possible alternatives, cosmetic outcomes and potential results should all be discussed with the patient. The punch biopsy itself takes roughly 15 minutes and does not require any hospitalization. A patient may return to normal daily life immediately following a punch biopsy. Related StoriesNew microbiopsy device could revolutionize testing for skin cancer, other diseasesDiagnosing prostate cancer through a £225 urine testNew laser imaging 'bowl' could reduce stages involved in spotting breast cancerJust before the procedure, the patient is placed in a comfortable position with maximal and easy access to the area that needs to be biopsied. Local anesthetic is applied to the site and the skin is stretched in a manner perpendicular to its physiological lines of relaxation. A sterile punch biopsy is then introduced at an angle that is perpendicular to the anesthetized area of skin. It is subsequently rotated into to the skin at a 450 angle. Once the specimen has been obtained, the tool is withdrawn and pressure is applied to the area until bleeding stops. The biopsy sample is then stored in an appropriate medium before further diagnostic tests are carried out at a laboratory. Why is it done? Most skin pathologic conditions or lesions may be diagnosed by direct observation and/ or palpation. However, there are others that require microscopic and histological investigation. Primary indications for punch biopsies include suspicious skin growths and lesions. These include melanoma, carcinomas and various bullous or inflammatory skin conditions. Punch biopsies need to be prepared for. Factors such as the psychological implication of the results and/ or procedure must be taken into account. Precautions must be taken in patients who have a history of bleeding disorders and those that are on medications that affect hemostasis. The procedure cannot be undertaken in patients who present with active infection at the site of planned biopsy. Reviewed by Dr. Liji Thomas, MD. References http://www.nhs.uk/conditions/Biopsy/Pages/Introduction.aspx http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/skin-biopsy-punch-method http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/punch-biopsy/?region=on Further ReadingBiopsy - What is Biopsy?Types of Skin BiopsyWhat is a Breast Biopsy?What is a Skin Biopsy?Cancer BiopsyMore... // Last Updated: Aug 18, 2016" }, "123": { "category_2_x_medical_disease.id": 123, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 123, "medical_disease.ts": "2018-04-20 02:36:47", "medical_disease.title": "Punch Biopsy Results and Side Effects", "medical_disease.content": "By Jonas Wilson, Ing. Med. Punch biopsies are a type of technique used on the skin to obtain tissue for microscopic and histopathological examination. A tube-shaped sharp cutting tool is rotated through the skin to the subcutaneous fat to obtain a cylindrical-shaped specimen. This sample undergoes tissue fixation, preparation of slides and staining for microscopy, or storage in solution for bacterial or viral cultures. Primary indications for punch biopsy include suspicious skin growths and inflammatory or bullous eruptions. Active infections in the area or a known history of bleeding disorders are contraindications. Results Acquisition of results largely depends on the institution where the procedure was conducted. However, most are readily available within a few days if further tests or a second specialist opinion are not required. Technique and sample quality are crucial factors in being able to make an accurate diagnosis. Poor samples may result in missed diagnoses. Moreover, it is not uncommon to find that subsequent biopsies are necessary in order to ascertain a correct diagnosis. Abnormal pathology reports may have several findings. An abnormal result could indicate: Possible infection Benign tumors (such as moles) Precancerous lesions (including actinic keratosis) Cancerous growths (such as squamous cell carcinoma) Other skin conditions, such as eczema or psoriasis Results that are suggestive of pathology often require further testing in order to treat the patient, and to follow up the response to treatment, as well as to monitor lesion progression. However, follow-up treatment may not be required in cases where the biopsy resulted in complete lesion removal and there is no chance of recurrence. Complications Related StoriesDiagnosing prostate cancer through a £225 urine testNovel tool successfully predicts outcomes for lung cancerNew microbiopsy device could revolutionize testing for skin cancer, other diseasesPuncturing the skin may result in some degree of scarring. Healing is facilitated by the use of sutures, which greatly reduce the healing time and the incidence of scarring. Furthermore, the skill and technique of the surgeon also play a major role in scar development. The neater the procedure, the less the risk of developing a significant scar. The procedure typically requires the use of local anesthetic. Thus, a patient will not need to stay in a hospital following the procedure and may resume daily activities directly after. Allergy to local anesthetic or the medication used to induce deep sedation, however, may cause complications. Evidence of allergic reaction includes vesicles, itching and erythema. Peripheral vasodilation is usually self-limited, but may result in fainting, sweating and nausea. Other possible complications include bleeding at the site where the biopsy was taken and infection. To avoid infection, it is imperative that biopsies are not done at sites with active infection and that the site is thoroughly prepared before the procedure. In anatomical areas that are prone to infections, specific guidelines may be followed to reduce the risk, such as antibiotic therapy, although rarely indicated. Significant pain, if it occurs, may be treated with painkillers, but this is also a rare side effect of punch biopsies. A little bleeding may occur from the skin wound. Reviewed by Dr. Liji Thomas, MD. References http://www.nhs.uk/conditions/Biopsy/Pages/Introduction.aspx http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/skin-biopsy-punch-method http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/punch-biopsy/?region=on Further ReadingBiopsy - What is Biopsy?Types of Skin BiopsyWhat is a Breast Biopsy?What is a Skin Biopsy?Cancer BiopsyMore... Last Updated: Aug 31, 2016" }, "124": { "category_2_x_medical_disease.id": 124, "category_2.id": 32, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biopsy", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 124, "medical_disease.ts": "2018-04-20 02:36:48", "medical_disease.title": "Axillary Sampling and Sentinel Node Biopsy Comparison", "medical_disease.content": "By Susha Cheriyedath, MSc A sentinel node biopsy (SNB) is a clinical procedure in which the sentinel lymph node is removed and tested for the presence of cancer cells. If the result of an SNB is negative, it can suggest that the cancer has not spread to the lymph nodes or other parts of the body. A positive result for an SNB indicates the presence of cancerous cells in the sentinel lymph node and possibly in other lymph nodes in the surrounding area. The information gained from SNB is crucial for doctors in staging the cancer and devising a customized treatment plan. SNB is usually performed along with the surgery to remove the primary tumor, though it can also be done before or after tumor removal. The advent of SNB has enabled more accurate staging of cancer in several cases and also helps rule out the need of axillary dissection in some patients. SNB has been shown to be successful in detecting cancer in over 95% of breast cancer cases. Axillary sampling Axillary sampling involves the removal of a few suspicious lymph nodes to examine for the presence of cancer cells. About 3 to 6 nodes need to be removed for adequate sampling and accurate staging of the axilla. There are various axillary sampling methods based on the site of dissection and number of nodes dissected. They include: Pectoral lymph node biopsy: for patients who may not require post-operative radiotherapy following mastectomy. It involves the removal of nodes located at the upper portion of the breast’s axillary tail. Pectoral node-negative patients do not require radiotherapy post mastectomy. Triple node biopsy: involves removal of three nodes – first node from the lower axilla, second from the top of the axilla, and the third one from the internal mammary chain. Five-node sampling: involves the dissection of the breast’s axillary tail until five nodes are removed. Four-node sampling Lower axillary sampling. Related StoriesHeart disease risk in breast cancer patients after treatment not higher than average populationResearchers discover key enzyme driving breast cancerBreast cancer survival linked to muscle mass finds studyMany studies have argued against axillary sampling and have concluded that it is not a reliable method for axillary staging. According to one study, increasing the number of nodes removed to up to 10 resulted in higher chances of finding a metastatic node and thus strongly recommended removing about 10 nodes for sampling. Some other studies found that axillary sampling is associated with a risk of under staging the axilla and thus patients who are node-positive may not be recognized or treated appropriately. SNB, axillary sampling, and axillary dissection The standard surgical procedure in breast cancer patients is axillary node dissection, which involves the removal of the tumor along with all the axillary nodes involved. However, axillary dissection is associated with high morbidity. The most common complications of axillary node dissection include seroma, shoulder movement restriction, delayed wound healing, and parasthesia of the axilla and shoulder. In rare cases, Stewart-Treves syndrome and lymphangio-sarcoma may present. A study involving stage I and II breast cancer patients showed that axillary dissection is overused by physicians. In cases where there is no axillary node metastasis, axillary dissection is unnecessary and such cases need a procedure that can help in axillary staging without many complications. Studies have shown that axillary sampling is associated with less morbidity when compared to axillary dissect. SNB and axillary sampling have been recommended as an alternative to axillary dissection to reduce morbidity. Reviewed by Yolanda Smith, BPharm References http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356367 K. J. Edwards, M. A. Dordea, R. French, V. Kurup, Role of Combined Sentinel Lymph Node Biopsy and Axillary Node Sampling in Clinically Node-Negative Breast Cancer, Indian J Surg. 2015 Dec; 77(6): 495–501. doi: 10.1007/s12262-015-1300-1 http://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet // Last Updated: Nov 9, 2016" }, "125": { "category_2_x_medical_disease.id": 125, "category_2.id": 33, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosecurity", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 125, "medical_disease.ts": "2018-04-20 02:36:50", "medical_disease.title": "Biosecurity - What is Biosecurity?", "medical_disease.content": "By Dr Ananya Mandal, MD Biosecurity refers to measures that are taken to stop the spread or introduction of harmful organisms to human, animal and plant life. The measures taken are a combination of processes and systems that have been put in place by bioscience laboratories, customs agents and agricultural managers to prevent the use of dangerous pathogens and toxins. Goals of Biosecurity The main aim of biosecurity is to protect human health and to increase and protect agricultural produce through the prevention, control and management of biological risk factors. Biosecurity also aims to protect against acts of bioterrorism and to prevent adverse biosecurity events as well as offering advice on appropriate interventions and political and social changes that should be adopted by government regulatory agencies. What are the Biosecurity hazards? A variety of biosecurity hazards threaten health and biosafety. Some of these are listed in the table below: Table 1. Definitions of hazard as annlicable to different biosecurity sectors Sectors Definitions of hazard Food safety A biological, chemical or physical agent in, or condition of, food with the potential to cause an adverse health effect (CAC). Zoonoses A biological agent that can be transmitted naturally between wild or domestic animals and humans (OIE). Animal health Any pathogenic agent that could produce adverse consequences on the imnnrtation of a commodity (OIE). Plant health Any species, strain or biotype of plant, animal or pathogenic agent injurious to otants or plant products (IPPC). Plant health quarantine A pest of potential economic importance to the area endangered thereby and not yet present there, or present but not widely distributed and being officially controlled (IPPC). \"Biosafety\" in relation to plants and animals A living modified organism (LMO) that possesses a novel combination of relation to genetic material obtained through the use of modem biotechnology that is likely plants and to have adverse effects on the conservation and sustainable use of biological animals diversity, taking also into account risks to human health (Cartagena Protocol on Biosafetv'. \"Biosafety\" in relation to food A recombinant DNA organism directly effecting or remaining in a food that relation to could have an adverse effect on human health (Cartagena Protocol on food Biosafety). Invasive alien species An invasive alien species outside its natural past or present distribution whose introduction and/or snread threatens biodiversitv (CBD). Biosecurity in laboratories Pathological agents may be collected, grown, stored or handled in clinical laboratories, diagnostic facilities, public health laboratories, research centres and production facilities. All of these facilities are at risk of biosecurity incidents. The term “biorisk” refers to the risk associated with biological substances and infectious agents. Biorisk assessments are carried out to identify the acceptable and unacceptable levels of these risks. The methods adopted to manage the occurrence of biorisks is an important field of research. The reduction of biorisk involves the sharing of expertise and advice regarding the guidance and training that is needed for disease agents to be handled and controlled safely. There are several non-legislated guidelines that set out the standard of conduct or behavior with respect to a particular biological activity. Organizations and individuals voluntarily agree to abide by these guidelines. The term “biohazard” refers to a biological substance that poses a risk to health, particularly human health. Laboratory biosecurity involves responsibility for the protection, control and accountability of biological materials within facilities to prevent their unauthorized access, theft, misuse, loss, or intentional release or exposure. Misuse refers to the use of biological materials for inappropriate or illegitimate purposes. Examples of biological materials that require this management include pathogens and toxins, as well as non-pathogenic organisms such as vaccines, genetically modified organisms (GMOs) and cell components or genetic elements. Reviewed by Sally Robertson, BSc Sources www.who.int/foodsafety/fs_management/No_01_Biosecurity_Mar10_en.pdf www.who.int/.../WHO_CDS_EPR_2006_6.pdf www.americanprogress.org/.../...CURITY_A_COMPREHENSIVE_ACTION_PLAN.PDF http://books.sipri.org/files/misc/SIPRI09HAB.pdf www.forestry.gov.uk/.../FC_Biosecurity_Guidance.pdf http://www.wvu.edu/~agexten/Biosecure/Farm.pdf http://www.agr.state.il.us/premiseID/biosecuritybasics.pdf Further ReadingAnimal BiosecurityBiosecurity Agent ListBiosecurity ChallengesBiosecurity Incident List Last Updated: Oct 7, 2014" }, "126": { "category_2_x_medical_disease.id": 126, "category_2.id": 33, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosecurity", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 126, "medical_disease.ts": "2018-04-20 02:36:55", "medical_disease.title": "Animal Biosecurity", "medical_disease.content": "By Dr Ananya Mandal, MD Animal biosecurity refers to the actions and measures taken to prevent disease being introduced through animals into a specific geographical area or region. This form of biosecurity combines various different methods of prevention and disease containment. One critical element in animal biosecurity is biocontainment which aims to ensure the control and confinement of disease in a particular area so that further spread is prevented. In animal biosecurity, the epidemiological triad for the occurrence of disease needs to be considered, which includes the roles of the following in contributing to the development of disease: The individual host animal The disease itself The environment In the context of livestock, animal biosecurity refers to the measures taken to keep pathogens from infecting populations, herds, or groups of animals where they do not yet exist. The herd owner is usually responsible for protecting against the introduction of any new pathogens among the herd as well as limiting the spread of any existing disease. Several examples of measures that should be included in a successful animal biosecurity plan are: Isolation of new animals New animals brought to the farm should be isolated from existing groups of animals to prevent the spread of new, external infections. These animals should be isolated form the herd for a minimum of two weeks and preferably one month. The isolation facility should be at least several hundred yards from the herd and be positioned so that any drainage or wind does not carry contaminants back towards the herd. If complete isolation is impossible, a separate pen should be used to prevent nose-to-nose contact and the sharing of food or water supplies with existing animals. All new animals must be tested before being mixed with existing ones. Managing risk posed by visitors Disease can also be introduced to the herd by people travelling between groups of animals and visitors are an important consideration. Low risk visitors would be people from urban areas who have had no contact with livestock and are very unlikely to carry disease. Visitors should be asked to wear freshly laundered clothes and clean footwear but disposable plastic boots and coveralls may be provided for added protection. Moderate-risk visitors would include those who visit farms regularly but have little or no contact with animals such as delivery personnel or mechanics. These individuals are also advised to wear clean clothes and disposable coveralls and boots. They should also clean and disinfect any equipment used. High-risk visitors include veterinarians, livestock haulers, livestock owners and others who are in close contact with livestock. Disposable sleeves, boots, coveralls, gloves and other disposable or disinfectable clothing is a must. Reviewed by Sally Robertson, BSc Sources www.who.int/foodsafety/fs_management/No_01_Biosecurity_Mar10_en.pdf www.who.int/.../WHO_CDS_EPR_2006_6.pdf www.americanprogress.org/.../...CURITY_A_COMPREHENSIVE_ACTION_PLAN.PDF http://books.sipri.org/files/misc/SIPRI09HAB.pdf www.forestry.gov.uk/.../FC_Biosecurity_Guidance.pdf http://www.wvu.edu/~agexten/Biosecure/Farm.pdf http://www.agr.state.il.us/premiseID/biosecuritybasics.pdf http://ohioline.osu.edu/vme-fact/0005.html Further ReadingBiosecurity - What is Biosecurity?Biosecurity Agent ListBiosecurity ChallengesBiosecurity Incident List Last Updated: Mar 25, 2014" }, "127": { "category_2_x_medical_disease.id": 127, "category_2.id": 33, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosecurity", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 127, "medical_disease.ts": "2018-04-20 02:37:01", "medical_disease.title": "Biosecurity Agent List", "medical_disease.content": "By Dr Ananya Mandal, MD Some of the agents that cause a biosecurity concern are listed by the United States Government through the US Select Agent List. Some of these agents are zoonotic agents, meaning they can infect both humans and animals, while others are agents that can only infect one of humans, animals or plants. The list of select agents as updated in December 2012 is as follows: HHS SELECT AGENTS AND TOXINS Abrin Botulinum neurotoxins* Botulinum neurotoxin producing species ofClostridium* Conotoxins (Short, paralytic alpha conotoxins containing the following amino acid sequence X1CCX2PACGX3X4X5X6CX7) Coxiella burnetii Crimean-Congo haemorrhagic fever virus Diacetoxyscirpenol Eastern Equine Encephalitis virus1 Ebola virus* Francisella tularensis* Lassa fever virus Lujo virus Marburg virus* Monkeypox virus Reconstructed replication competent forms of the 1918 pandemic influenza virus containing any portion of the coding regions of all eight gene segments (Reconstructed 1918 Influenza virus) Ricin Rickettsia prowazekii SARS-associated coronavirus (SARS-CoV) Saxitoxin South American Haemorrhagic Fever viruses: Chapare Guanarito Junin Machupo Sabia Staphylococcal enterotoxins A,B,C,D,E subtypes T-2 toxin Tetrodotoxin Tick-borne encephalitis complex (flavi) viruses: Far Eastern subtype Siberian subtype Kyasanur Forest disease virus Omsk hemorrhagic fever virus Variola major virus (Smallpox virus)* Variola minor virus (Alastrim)* Yersinia pestis* OVERLAP SELECT AGENTS AND TOXINS Bacillus anthracis * Bacillus anthracis Pasteur strain Brucella abortus Brucella melitensis Brucella suis Burkholderia mallei* Burkholderia pseudomallei* Hendra virus Nipah virus Rift Valley fever virus Venezuelan equine encephalitis virus USDA SELECT AGENTS AND TOXINS African horse sickness virus African swine fever virus Avian influenza virus Classical swine fever virus Foot-and-mouth disease virus* Goat pox virus Lumpy skin disease virus Mycoplasma capricolum1 Mycoplasma mycoides Newcastle disease virus Peste des petits ruminants virus Rinderpest virus* Sheep pox virus Swine vesicular disease virus USDA PLANT PROTECTION AND QUARANTINE (PPQ) SELECT AGENTS AND TOXINS Peronosclerospora philippinensis (Peronosclerospora sacchari) Phoma glycinicola (formerly Pyrenochaeta glycines) Ralstonia solanacearum Rathayibacter toxicus Sclerophthora rayssiae Synchytrium endobioticum Xanthomonas oryzae Some agents that are inactive forms of select toxins may be excluded from the requirements of the Select Agent Regulations but can be accessed using the following link: http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20Exclusions.html. Some examples of agents that are excluded from the list include: Low pathogenic strains of avian influenza virus South American genotype of eastern equine encephalitis virus West African monkeypox viruses Any strain of Newcastle disease virus that is not virulent All subspecies of Mycoplasma capricolum except capripneumoniae (causes contagious caprine pleuropneumonia) All subspecies of Mycoplasma mycoides except mycoides small colony (causes contagious bovine pleuropneumonia) Any subtypes of Venezuelan equine encephalitis virus except for subtypes IAB or IC Vesicular stomatitis virus (exotic) including Indiana subtypes VSV-IN2, VSV-IN3 Reviewed by Sally Robertson, BSc Sources http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20List.html www.who.int/foodsafety/fs_management/No_01_Biosecurity_Mar10_en.pdf www.who.int/.../WHO_CDS_EPR_2006_6.pdf www.americanprogress.org/.../...CURITY_A_COMPREHENSIVE_ACTION_PLAN.PDF http://books.sipri.org/files/misc/SIPRI09HAB.pdf Further ReadingBiosecurity - What is Biosecurity?Animal BiosecurityBiosecurity ChallengesBiosecurity Incident List Last Updated: Mar 25, 2014" }, "128": { "category_2_x_medical_disease.id": 128, "category_2.id": 33, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosecurity", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 128, "medical_disease.ts": "2018-04-20 02:37:05", "medical_disease.title": "Biosecurity Challenges", "medical_disease.content": "By Dr Ananya Mandal, MD The two major biological threats that are faced in biosecurity include: Naturally occurring infectious diseases such as avian flu Biological weapons that are in the hands of states and terrorist organizations These threats pose a challenge in national safety and providing protection against these them forms the basis of biosecurity. Infectious diseases Infectious diseases have affected large populations throughout human history. Although these diseases are naturally occurring, they can cause more devastation than warfare. Some of the major pandemics or outbreaks of disease that have affected large parts of the world across geographical boundaries include the Black Death or bubonic plague in the 14th Century and the spread of Spanish flu in 1918-19. Worldwide, each of these pandemics killed tens of millions of people. Today, infectious diseases that pose a threat to humans include diseases such as cholera, avian flu, yellow fever, tuberculosis, HIV/AIDS and malaria. Since the 1960s and 70s, the widespread use of antibiotics and vaccines as well as early detection and surveillance of critical infections has eliminated several of the major infectious diseases such as measles and polio. Over the past few decades, however, infectious disease has staged a comeback, especially certain infections such as tuberculosis. Tuberculosis has developed resistance to commonly used antibiotics making it a biosecurity threat. In addition, previously unknown and “emerging” infections that have developed across the world include Legionnaire’s disease, Lyme disease, Sin Nombre variant of hantavirus, hepatitis C, SARS and new strains of influenza. Most of these diseases have originated in Europe, North America, and Japan and not from the developing nations. International trade, travel, and immigration have enabled infections emerging in certain areas to spread all over the world. Emergence of biological weapons Terrorist organizations and the military have used infectious diseases as weapons throughout the history of mankind. Since World War II, however, no state has used a biological weapon in battle. In 1915, the League of Nations negotiated the Geneva Protocol that banned the use of both chemical and bacteriological weapons but permitted their continued production, and stockpiling. In 1969, the United States, under President Richard M. Nixon, pledged to denounce its biological weapon development program completely. Before the Persian Gulf War of 1990 to 1991, Saddam Hussein’s Iraq weaponized large quantities of biological warfare agents that included anthrax bacteria, botulinum toxin and aflatoxin. Biological weapons take time to infect the populations they are targeted against and have the capacity to spread and affect vary large populations. In 1975, the first multilateral disarmament treaty, the Biological Weapons Convention (BWC), was entered into force and banned the development, possession, stockpiling, and transfer of biological weapons. Currently, 170 states are committed to the treaty and since 2013 another 10 have signed but have yet to ratify the treaty. Reviewed by Sally Robertson, BSc Sources www.who.int/foodsafety/fs_management/No_01_Biosecurity_Mar10_en.pdf www.who.int/.../WHO_CDS_EPR_2006_6.pdf www.americanprogress.org/.../...CURITY_A_COMPREHENSIVE_ACTION_PLAN.PDF http://books.sipri.org/files/misc/SIPRI09HAB.pdf www.forestry.gov.uk/.../FC_Biosecurity_Guidance.pdf http://www.wvu.edu/~agexten/Biosecure/Farm.pdf http://www.agr.state.il.us/premiseID/biosecuritybasics.pdf Further ReadingBiosecurity - What is Biosecurity?Animal BiosecurityBiosecurity Agent ListBiosecurity Incident List Last Updated: Mar 25, 2014" }, "129": { "category_2_x_medical_disease.id": 129, "category_2.id": 33, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosecurity", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 129, "medical_disease.ts": "2018-04-20 02:37:09", "medical_disease.title": "Biosecurity Incident List", "medical_disease.content": "By Dr Ananya Mandal, MD In 1966, Dr. Mario Jascalevich from New Jersey was accused of poisoning five patients with a plant-derived poison called tubocurarine. Between 1964 and 1966, a Japanese doctor called Mitsuru Suzuki contaminated sponge cakes and other sources of food with shigella dysenteriae (causes diarrhea) and salmonella typhi (causes typhoid), leading to 200 to 400 illnesses and four deaths. Between May 1977 and November 1980, a nursing home worker called Arnfinn Nesset killed 27 residents using a substance called curacit. In 1984, religious cult members held attacks in Dalles, Oregon using salmonella typhimurium in an attempt to affect the election and gain control of the Wasco County Court. The restaurant salad bars were used as the dissemination points and the attack led to 751 illnesses. A cult member was arrested on an unrelated charge and confessed later to being involved in the event. In the 1990s, Aum Shinrikyo tried to disseminate bacillus anthracis (anthrax - the vaccine strain), Clostridium botulinum and the Ebola virus in Tokyo, Japan to fulfil the apocalyptic prophecy. In 1995, Larry Wayne Harris ordered 3 vials of Yersinia pestis (causing plague) from the ATCC and in the same year laboratory technician Diane Thompson took Shigella dysenteriae Type 2 from a hospital and infected her co-workers. In 1995, a neurologist in Virginia called Dr. Ray W. Mettetal was found with ricin on his person after being arrested for something else. In 1998, a gastroenterologist in Louisiana called Richard Schmidt infected nurse Janice Allen with HIV by injecting her with blood from a patient who had AIDS. In 1999, a phlebotomist called Brian T. Stewart was sentenced to life imprisonment for deliberately infecting his baby with HIV-infected blood to avoid the cost of child support. In 2001, there were a series of anthrax attacks in the United States. In 2003, Professor Thomas Butler was arrested for removing 30 vials of Yersinia pestis from a laboratory. Reviewed by Sally Robertson, BSc Sources www.who.int/foodsafety/fs_management/No_01_Biosecurity_Mar10_en.pdf www.who.int/.../WHO_CDS_EPR_2006_6.pdf www.americanprogress.org/.../...CURITY_A_COMPREHENSIVE_ACTION_PLAN.PDF http://books.sipri.org/files/misc/SIPRI09HAB.pdf www.forestry.gov.uk/.../FC_Biosecurity_Guidance.pdf http://www.wvu.edu/~agexten/Biosecure/Farm.pdf http://www.agr.state.il.us/premiseID/biosecuritybasics.pdf Further ReadingBiosecurity - What is Biosecurity?Animal BiosecurityBiosecurity Agent ListBiosecurity Challenges Last Updated: May 2, 2014" }, "130": { "category_2_x_medical_disease.id": 130, "category_2.id": 34, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosensor", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 130, "medical_disease.ts": "2018-04-20 02:37:10", "medical_disease.title": "Biosensors - What are Biosensors?", "medical_disease.content": "The term “biosensor” is short for “biological sensor.” The device is made up of a transducer and a biological element that may be an enzyme, an antibody or a nucleic acid. The bioelement interacts with the analyte being tested and the biological response is converted into an electrical signal by the transducer. Depending on their particular application, biosensors are also known as immunosensors, optrodes, resonant mirrors, chemical canaries, biochips, glucometers and biocomputers. A commonly cited definition of a biosensor is: “A chemical sensing device in which a biologically derived recognition is coupled to a transducer, to allow the quantitative development of some complex biochemical parameter.” Parts of a biosensor Every biosensor comprises: A biological component that acts as the sensor An electronic component that detects and transmits the signal Biosensor elements A variety of substances may be used as the bioelement in a biosensor. Examples of these include: Nucleic acids Proteins including enzymes and antibodies. Antibody-based biosensors are also called immunosensors. Plant proteins or lectins Complex materials like tissue slices, microorganisms and organelles The signal generated when the sensor interacts with the analyte may be electrical, optical or thermal. It is then converted by means of a suitable transducer into a measurable electrical parameter – usually a current or voltage. Applications Biosensor probes are becoming increasingly sophisticated, mainly owing to a combination of advances in two technological fields: microelectronics and biotechnology. Biosensors are highly valuable devices for measuring a wide spectrum of analytes including organic compounds, gases, ions and bacteria. History of biosensors Related StoriesNanomedical Diagnostics introduces new NTA biosensor for faster, reliable characterization of proteinsTUM scientists develop new pH sensor that provides insights into tumor metabolismThe first experiment to mark the origin of biosensors was carried out by Leland C. Clark. For his experiment, Clark used platinum (Pt) electrodes to detect oxygen. He placed the enzyme glucose oxidase (GOD) very close to the surface of platinum by trapping it against the electrodes with a piece of dialysis membrane. The enzyme activity was modified according to the surrounding oxygen concentration. Glucose reacts with glucose oxidase (GOD) to give gluconic acid and produces two electrons and two protons, thereby reducing GOD. The reduced GOD, the electrons, protons and the surrounding oxygen all react to give hydrogen peroxide and oxidized GOD (the original form), therefore making more GOD available for more glucose to react with. The higher the glucose content, the more oxygen is consumed and the lower the glucose content, the more hydrogen peroxide is produced. This means either an increase in hydrogen peroxide or a decrease in oxygen can be measured to give an indication of the glucose concentration. Reviewed by Sally Robertson, BSc Sources www.cse.unt.edu/.../MohantyIEEEPotentials2006Mar-Apr.pdf http://www.ias.ac.in/resonance/Dec2004/pdf/Dec2004p33-44.pdf http://www.gwent.org/presentations/biointro.pdf www.crec.ifas.ufl.edu/academics/faculty/reyes/PDF/BiosensorsEAFBE.pdf http://nanohub.org/resources/2261/download/ http://www.ceb.utk.edu/bioprimer.pdf Further ReadingBiosensor ApplicationsBiosensor PrinciplesBiosensors and Food IndustrySurface Attachment of Biological Elements Last Updated: Oct 7, 2014" }, "131": { "category_2_x_medical_disease.id": 131, "category_2.id": 34, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosensor", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 131, "medical_disease.ts": "2018-04-20 02:37:13", "medical_disease.title": "Biosensor Applications", "medical_disease.content": "By Dr Ananya Mandal, MD Biosensors are devices comprising a biological element and a physiochemical detector that are used to detect analytes. These instruments have a wide range of applications ranging from clinical through to environmental and agricultural. The devices are also used in the food industry. Some examples of the fields that use biosensor technology include: General healthcare monitoring Screening for disease Clinical analysis and diagnosis of disease Veterinary and agricultural applications Industrial processing and monitoring Environmental pollution control Related StoriesNanomedical Diagnostics introduces new NTA biosensor for faster, reliable characterization of proteinsTUM scientists develop new pH sensor that provides insights into tumor metabolismBiosensors can provide cost-effective, easy-to-use, sensitive and highly accurate detection devices in a variety of research and commercial applications. Some examples of these applications are described below. Clinical and Diagnostic Applications One well known example of a clinically applied biosensor is the glucose monitor, which is used on a routine basis by diabetic individuals to check their blood sugar level. These devices detect the amount of blood glucose in undiluted blood samples allowing for the easy self-testing and monitoring that has revolutionized diabetes management. Applications in industry Biosensors are used in the food industry to measure carbohydrates, alcohols and acids, for example, during quality control processes. The devices may also be used to check fermentation during the production of beer, yoghurt and soft drinks. Another important application is their use in detecting pathogens in fresh meat, poultry or fish. Environmental applications Biosensors are used to check the quality of air and water. The devices can be used to pick up traces of organophosphates from pesticides or to check the toxicity levels of wastewater, for example. Reviewed by Sally Robertson, BSc Sources www.cse.unt.edu/.../MohantyIEEEPotentials2006Mar-Apr.pdf http://www.ias.ac.in/resonance/Dec2004/pdf/Dec2004p33-44.pdf http://www.gwent.org/presentations/biointro.pdf www.crec.ifas.ufl.edu/academics/faculty/reyes/PDF/BiosensorsEAFBE.pdf http://nanohub.org/resources/2261/download/ http://www.ceb.utk.edu/bioprimer.pdf Further ReadingBiosensors - What are Biosensors?Biosensor PrinciplesBiosensors and Food IndustrySurface Attachment of Biological Elements Last Updated: May 2, 2014" }, "132": { "category_2_x_medical_disease.id": 132, "category_2.id": 34, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosensor", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 132, "medical_disease.ts": "2018-04-20 02:37:19", "medical_disease.title": "Biosensor Principles", "medical_disease.content": "By Dr Ananya Mandal, MD The term “biosensor” is short for “biological sensor” and is a device made up of a transducer and a biological element that may be an enzyme, an antibody, or a nucleic acid. The biological element or bioelement interacts with the analyte being tested and the biological response is converted into an electrical signal by the transducer. Every biosensor has a biological component that acts as the sensor and an electronic component that detects and transmits the signal. Types of biosensors Biosensors can be grouped according to the type of biological element and transducer they contain. They may also be named according to how the biosensing takes place. The types of biological elements include: Enzymes Antibodies (also called immunosensors) Micro-organisms Biological tissue Organelles Types of biosensing The different ways that biosensing may occur are described below: If the bioelement binds to the analyte, the sensor is referred to as an affinity sensor. If the bioelement and the analyte give rise to a chemical change that can be used to measure the concentration of a substrate, the sensor is called a metabolic sensor. If the biological element combines with the analyte and does not change it chemically but converts it to an auxiliary substrate, the biosensor is called a catalytic sensor. Types of sensing elements Enzymes An enzyme is a protein that has a high selectivity for a particular substrate, which it binds to, bringing about a catalytic change. Enzymes are commercially available in highly purified states and are therefore useful in the mass production of enzyme sensors. Enzymes can be fixed onto the surface of a transducer through adsorption, covalent attachment, and entrapment in a gel or an electrochemically generated polymer. Antibodies or immunosensors Antibodies are produced by B-lymphocytes in response to antigenic stimuli such as foreign invaders or microbes. When used as biosensors in immunoassays, antibodies are immobilized on the surface of a transducer through covalent attachment by conjugation of amino, carboxyl, aldehyde or sulfhydryl groups. Antibodies are sensitive to changes in pH, ionic strength, chemical inhibitors and temperature. Immune sensors usually employ optical, fluorescence or acoustic transducers. Related StoriesNanomedical Diagnostics introduces new NTA biosensor for faster, reliable characterization of proteinsTUM scientists develop new pH sensor that provides insights into tumor metabolismMicroorganisms Microbes may be used to detect the consumption of oxygen or carbon dioxide in an environment using electrochemical techniques. Microbe biosensors have the advantage of being cheaper than enzymes or antibodies and are more stable. However they may be less selective than enzymes or antibodies. Other bioelements Organelles, nucleic acids and biological tissues have been researched as biosensors. Types of transducer Electrochemical transducers These are useful in electrochemical, amperometric and potentiometric signals. These electrodes are commonly made of platinum, gold, silver, stainless steel, or carbon-based inert materials. Amperometric transducers, detect changes in current that occur due to oxidation or reduction. The current reflects the reaction that takes place between the analyte and the bioelement. Potentiometric transducers can measure the charge accumulation (potential) of an electrochemical cell. The transducer is usually made up of an ion-selective electrode and a reference electrode. Optical transducers Fluorescence is commonly used in signal transduction, especially when using enzymes and antibodies. Fibre optic probes consist of at least two fibres. One is connected to a light source of a given wavelength range and produces the excitation wave. The other is linked to the photodiode that detects the change in optical density at a selected wavelength. Plasmon resonance transducers measure alterations in the refractive index at and close to the sensing element’s surface. Acoustic transducers These are devices in which mechanical acoustic waves act as the transduction system. The membrane contains chemically interactive materials in contact with a piezoelectric material. The devices vary according to the wave guiding process used. Usually, bulk acoustic wave (BAW) and surface acoustic wave (SAW) devices are used. Calorimetric transduction These measure the heat from the biochemical reaction between the sensing element and the analyte. Reviewed by Sally Robertson, BSc Sources www.cse.unt.edu/.../MohantyIEEEPotentials2006Mar-Apr.pdf http://www.ias.ac.in/resonance/Dec2004/pdf/Dec2004p33-44.pdf http://www.gwent.org/presentations/biointro.pdf www.crec.ifas.ufl.edu/academics/faculty/reyes/PDF/BiosensorsEAFBE.pdf http://nanohub.org/resources/2261/download/ http://www.ceb.utk.edu/bioprimer.pdf Further ReadingBiosensors - What are Biosensors?Biosensor ApplicationsBiosensors and Food IndustrySurface Attachment of Biological Elements Last Updated: May 2, 2014" }, "133": { "category_2_x_medical_disease.id": 133, "category_2.id": 34, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosensor", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 133, "medical_disease.ts": "2018-04-20 02:37:24", "medical_disease.title": "Biosensors and Food Industry", "medical_disease.content": "By Dr Ananya Mandal, MD Biosensors have extensive applications in the food and agriculture industries. The devices contain a transducer and a biological element, which may be an enzyme, antibody, microbe, or organelle. The biological element (bioelement) interacts with the analyte being tested and the biological response is converted into an electrical signal by the transducer. Related StoriesTUM scientists develop new pH sensor that provides insights into tumor metabolismNanomedical Diagnostics introduces new NTA biosensor for faster, reliable characterization of proteinsSome of the uses of biosensors in the agricultural and food industry include: Enzyme biosensors based on the inhibition of cholinesterase enzymes are used to detect traces of organophosphates and carbamates from pesticides that may be present as poisonous and harmful residues on farm produce. Some microbial sensors are selective and sensitive in the detection of ammonia and methane. Biological oxygen demand (BOD) analyzers use a bacteria such as Rhodococcus erythropolis immobilized in collagen or polyacrylamide. These devices are widely used to test the quality of waste water. BOD biosensors can analyze 2 to 20 samples every hour. Biosensors may be used to measure carbohydrates, alcohols, and acids in fermented foods. The devices are mainly used for quality control processes in food production. The devices, however, need to be kept sterile, frequently calibrated and require analyte dilution. Enzyme-based biosensors can be used in food quality control to measure amino acids, amides, amines, carbohydrates, heterocyclic compounds, carboxylic acids, gases, inorganic ions, cofactors, alcohols and phenols. Biosensors can also be used in the assessment and analysis of produce such as wine, beer and yoghurt. In food quality assessment, antibodies or immunosensors may be used in assays to detect small molecules such as water-soluble vitamins and chemical contaminants. They may also be used to detect any pathogenic organisms present in meat, poultry, eggs, and fish. Reviewed by Sally Robertson, BSc Sources http://www.ias.ac.in/resonance/Dec2004/pdf/Dec2004p33-44.pdf http://www.gwent.org/presentations/biointro.pdf www.crec.ifas.ufl.edu/academics/faculty/reyes/PDF/BiosensorsEAFBE.pdf http://nanohub.org/resources/2261/download/ http://www.ceb.utk.edu/bioprimer.pdf Further ReadingBiosensors - What are Biosensors?Biosensor ApplicationsBiosensor PrinciplesSurface Attachment of Biological Elements Last Updated: May 2, 2014" }, "134": { "category_2_x_medical_disease.id": 134, "category_2.id": 34, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Biosensor", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 134, "medical_disease.ts": "2018-04-20 02:37:28", "medical_disease.title": "Surface Attachment of Biological Elements", "medical_disease.content": "By Dr Ananya Mandal, MD A biosensor consists of a bioelement that interacts with an analyte and a transducer that converts the response into an electrical signal. The bioelement is usually an enzyme, antibody or microorganism and the transducer may be optical, acoustic, electrochemical or calorimetric. The first step in preparing a biosensor is the application of the biological element to the surface of the sensor. The sensor may be made of a metal, a polymer or glass. The most common method for applying the bioelement is to coat the sensor with the biological element. The most commonly used bioelements include enzymes, antibodies, organelles, biological tissue and microbes. Coating of the sensor may be achieved using polylysine, aminosilane, epoxysilane or nitrocellulose to allow attachment to silicon chips or silica glass. Related StoriesNanomedical Diagnostics introduces new NTA biosensor for faster, reliable characterization of proteinsTUM scientists develop new pH sensor that provides insights into tumor metabolismCoating may also be achieved by fixing the bioelement on the surface layer by layer using alternatively charged polymer coatings. Sometimes, three dimensional lattices of hydrogel or xerogel are used chemically or physically to trap the bioelement on the surface. Chemical entrapment of the bioelements refers to strong chemical bonding that keeps the element in place, while physical entrapment means the element is unable to pass through the pores in the gel’s matrix. Sol-gel is the hydrogel that is usually employed and is a glassy silica created through the polymerization of silicate monomers in the presence of the biological elements using physical entrapment. Other hydrogels used include acrylate hydrogel, which polymerize upon radical initiation. The bioelement and the sensor are coupled together in one of four ways: Membrane entrapment – A semipermeable membrane is used to separate the analyte and the bioelement. The sensor is attached to the bioelement. Physical adsorption – A combination of van der Waals forces, hydrophobic forces, hydrogen bonds, and ionic forces are used to attach the biomaterial to the sensor’s surface. Matrix entrapment – Also called porous entrapment, a porous encapsulation matrix is created around the biological element to help it bind to the sensor. Covalent Bonding – The sensor surface is treated as a reactive group that the bioelement binds to. Reviewed by Sally Robertson, BSc Sources www.cse.unt.edu/.../MohantyIEEEPotentials2006Mar-Apr.pdf http://www.ias.ac.in/resonance/Dec2004/pdf/Dec2004p33-44.pdf http://www.gwent.org/presentations/biointro.pdf www.crec.ifas.ufl.edu/academics/faculty/reyes/PDF/BiosensorsEAFBE.pdf http://nanohub.org/resources/2261/download/ http://www.ceb.utk.edu/bioprimer.pdf Further ReadingBiosensors - What are Biosensors?Biosensor ApplicationsBiosensor PrinciplesBiosensors and Food Industry Last Updated: May 2, 2014" }, "135": { "category_2_x_medical_disease.id": 135, "category_2.id": 35, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bipolar Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 135, "medical_disease.ts": "2018-04-20 02:37:32", "medical_disease.title": "Bipolar Disorder", "medical_disease.content": "By Dr Ananya Mandal, MD Bipolar disorder is a mental health disorder that was previously called manic depressive psychosis or manic depression. The condition is typically characterized by a mood that \"swings\" from a depressive state where an individual may feel down and lethargic to a manic phase that may cause them to feel hyperactive and jittery. In a healthy individual, mood swings are usually transient, lasting for a few hours or a day. However, in the case of bipolar disorder, moods may last for weeks or months at a time with a normal mood being the exception. Symptoms of bipolar disorder Related StoriesNew app may help predict, track manic and depressive episodes in bipolar patientsMSU scientists seek to identify brain mechanisms related to psychosisEvidence suggests two patterns of early symptoms precede and predict later BD risk The depressive phase It is often the depressive phase that helps identify a person with bipolar disorder. Most patients are initially diagnosed with depression and treatment is begun before the manic phase manifests. Depression is typically characterized by feelings of worthlessness, sorrow, unhappiness, inability to sleep, loss of appetite and lack of interest in hobbies and daily activities. Suicidal tendencies are also common. The manic phase Manic phase is typically characterized by feelings of excessive happiness, grand and ambitious planning, enhanced creativity, talking loudly, overspending of money, and an inability to sleep or eat due to excitement. Psychosis may also feature, with the patient experiencing hallucinations or delusions. Diagnosis and Treatment Individuals are evaluated for bipolar disorder using psychological tests and a detailed examination of their symptom history. Treatment is focused on controlling the exacerbation and severity of manic and depressive symptoms. Usually, a combination of approaches is used to control the condition, which may include: Medications such as mood stabilzers, antidepressants, and antipsychotics. The mood stabilizer lithium helps prevent episodes of mania and depression. Antidepressantshelp to control depression and prevent suicidal thoughts, while antipsychotics can reduce psychosis. Psychotherapy, cognitive behavioural therapy and counselling help the patient to cope with depression and provide advice about how to lead a life that is as normal as possible. Lifestyle modifications include regular exercise, eating a healthy, balanced diet, reducing caffeine and alcohol intake, and the cessation of smoking or any substance abuse. Reviewed by Sally Robertson, BSc Sources http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx www.nimh.nih.gov/.../nimh-bipolar-adults.pdf www.nami.org/.../ContentDisplay.cfm&ContentID=67728 http://brfa.avenue.org/BADFactSheet.pdf www.mentalhealthscreening.org/.../nimh%20Bipolar%20(brochure).pdf Further ReadingBipolar Disorder SymptomsBipolar Disorder DiagnosisBipolar Disorder TreatmentBipolar Disorder InterventionsBipolar Disorder CounselingMore... Last Updated: Sep 23, 2013" }, "136": { "category_2_x_medical_disease.id": 136, "category_2.id": 35, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bipolar Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 136, "medical_disease.ts": "2018-04-20 02:37:38", "medical_disease.title": "Bipolar Disorder Symptoms", "medical_disease.content": "By Dr Ananya Mandal, MD Bipolar disorder is typically characterized by mood swings that may last for several weeks to months at a time. These mood swings fall into two main categories: the depressive phase and the manic phase, with each phase characterized by distinct symptoms. Symptoms of the depressive phase Some of the depressive phase symptoms include: Feelings of worthlessness, unhappiness, hopelessness or emptiness Loss of interest in activities that were previously enjoyed Difficulty in falling and staying asleep or unusually long periods of sleep causing drowsiness Suicidal thoughts Depression may be present in varying degrees and may be severe, moderate, or mild. The mild form of depression is typically characterized by low mood (dysthymia) that may last for a period of weeks. Symptoms of the manic phase Some of the manic phase symptoms include: An excitable, happy mood accompanied by incessant, loud and rapid talking Difficulty sleeping due to feeling \"geared up\", jumpy, or excited Markedly reduced appetite Feeling energetic or \"on a high\" Rapid, racing or erratic thought patterns and conversation Irritable or explosive mood Psychosis (delusions and hallucinations) Related StoriesUMSOM researchers identify new role for mitochondria in cocaine-induced behaviorFunctional connectivity MRI could help detect brain disorders and diseasesMSU scientists seek to identify brain mechanisms related to psychosis People experiencing a manic phase may take on many activities or projects but fail to perform goal-oriented activities due to a tendency to be easily distracted. The manic phase may also lead them to excessively overspend on items they do not really need. In addition, this phase is often characterized by increased spates of high risk behaviour including having impulsive sex with unknown people or making spontaneous business investments. Hypomania Hypomania is a state of increased energy and activity that is of a lesser intensity than during the manic phase. Symptoms usually last for around a week and do not require emergency management. The mixed state The mixed state is when symptoms of both mania and depression exist at the same time. An individual may, for example, feel tearful during a manic phase or experience excited, racing thought patterns during a depressive phase. Diagnosis Bipolar disorder is diagnosed if an individual has a number of manic or depressive symptoms for most of the day, with few phases of stable mood. The mood swings need to be occurring on a daily or near-daily basis over a period of at least one to two weeks for the diagnosis to be confirmed. Reviewed by Sally Robertson, BSc Sources http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx www.nimh.nih.gov/.../nimh-bipolar-adults.pdf www.nami.org/.../ContentDisplay.cfm&ContentID=67728 http://brfa.avenue.org/BADFactSheet.pdf www.mentalhealthscreening.org/.../nimh%20Bipolar%20(brochure).pdf Further ReadingBipolar DisorderBipolar Disorder DiagnosisBipolar Disorder TreatmentBipolar Disorder InterventionsBipolar Disorder CounselingMore... Last Updated: Sep 23, 2013" }, "137": { "category_2_x_medical_disease.id": 137, "category_2.id": 35, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bipolar Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 137, "medical_disease.ts": "2018-04-20 02:37:42", "medical_disease.title": "Bipolar Disorder Diagnosis", "medical_disease.content": "By Dr Ananya Mandal, MD Diagnosing bipolar disorder involves a detailed analysis of the symptoms of the condition. Bipolar disorder is typically characterized by mood swings that range from depressive phases where a person may feel low, lethargic and suicidal through to manic phases where they may may feel excessively active, happy and jittery. Either phase may last for periods of weeks or months at a time. Diagnosis cannot be confirmed with a brain scan or a blood test; however, there are several recommended tests that are useful in diagnosing this condition. These include: Related StoriesStudy: Higher dose of anti-seizure drug during pregnancy may increase baby's risk of cleft lip, palateDiscordance between brain regions could lead to attention deficit disordersEvidence suggests two patterns of early symptoms precede and predict later BD risk A detailed physical examination A detailed inspection of the history and onset of the patient's symptoms, and the duration of depressive and manic episodes. The inability to sleep is a complication common to both the manic and depressive phases. During manic phases, the person may feel too \"wired-up\" or excited to sleep, while during depressive phases they may feel too low and sad to sleep. A brain scan and routine blood tests are also recommended. These tests may help detect brain conditions such as a brain tumor or stroke that may also cause symptoms of altered mental health. Blood is also tested to check levels of hormones such as thyroid hormone. Once other medical conditions are ruled out, a detailed mental health evaluation is performed, usually by a trained mental health professional or a psychiatrist. The patient's family history of bipolar disorder or other mental illnesses such as schizophrenia or depression is evaluated as well as the patient's symptoms including their duration, triggers of onset and severity. History may be obtained from the individual concerned as well as from their family, close relatives or spouse. Presentation of bipolar disorder In most cases, people with bipolar disorder visit the doctor while suffering from a depressive phase and having suicidal thoughts. However, some patients may present during a manic phase, particularly if they are also experiencing psychosis. Psychosis mayinvolve delusional thinking and hallucinations. People with unipolar disorder or depression do not suffer from mania and it is the presence of mania that specifically indicates bipolar disorder. Reviewed by Sally Robertson, BSc Sources http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx www.nimh.nih.gov/.../nimh-bipolar-adults.pdf www.nami.org/.../ContentDisplay.cfm&ContentID=67728 http://brfa.avenue.org/BADFactSheet.pdf www.mentalhealthscreening.org/.../nimh%20Bipolar%20(brochure).pdf Further ReadingBipolar DisorderBipolar Disorder SymptomsBipolar Disorder TreatmentBipolar Disorder InterventionsBipolar Disorder CounselingMore... Last Updated: Sep 23, 2013" }, "138": { "category_2_x_medical_disease.id": 138, "category_2.id": 35, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bipolar Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 138, "medical_disease.ts": "2018-04-20 02:37:46", "medical_disease.title": "Bipolar Disorder Treatment", "medical_disease.content": "By Dr Ananya Mandal, MD The treatment of bipolar disorder is focused on reducing the severity of manic and depressive episodes and helping sufferers lead an as-near-to-normal life as possible. There is no known cure for the condition and treatment usually involves a combination of medication and counselling or psychotherapy. Related StoriesLithium treatment associated with lowest risk of rehospitalization for bipolar disorder patientsUMSOM researchers identify new role for mitochondria in cocaine-induced behaviorFunctional connectivity MRI could help detect brain disorders and diseasesIf left untreated, manic or depressive phases may last for months and even as long as one year. Depressive phases are particularly harmful as they may lead to suicidal thoughts and urges to act on them. With treatment, symptoms usually subside after around three months and a stable mood is restored. Treatment outline Antidepressant medication. Mood stabilizers to prevent episodes of mania, hypomania, depression and establish a stable mood. Mood stabilizers may need to be taken daily and over long periods. One of the most commonly used agents of this class, lithium, is usually prescribed for periods of 6 months. The use of lithium may lead to severe side effects including vomiting and diarrhea and therefore requires regular monitoring. In addition, the drug should not be withdrawn or stopped abruptly as this may cause a flare-up of symptoms. Anticonvulsant drugs can also act as mood stabilizers. Antipsychotics for the treatment of psychosis and mania may also be used. Talking therapy, cognitive behavioural therapy, family and group therapy, and counselling are all useful approaches for treating patients with bipolar disorder. In individuals who experience a rapid cycling of high and low moods, combination therpy is prescribed. Lifestyle changes including regular exercise, adoption of a healthy and balanced diet, cessation of smoking or substance abuse, and reduction of alcohol and caffeine intake. Reviewed by Sally Robertson, BSc Sources http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx www.nimh.nih.gov/.../nimh-bipolar-adults.pdf www.nami.org/.../ContentDisplay.cfm&ContentID=67728 http://brfa.avenue.org/BADFactSheet.pdf www.mentalhealthscreening.org/.../nimh%20Bipolar%20(brochure).pdf Further ReadingBipolar DisorderBipolar Disorder SymptomsBipolar Disorder DiagnosisBipolar Disorder InterventionsBipolar Disorder CounselingMore... Last Updated: Mar 2, 2017" }, "139": { "category_2_x_medical_disease.id": 139, "category_2.id": 35, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bipolar Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 139, "medical_disease.ts": "2018-04-20 02:37:49", "medical_disease.title": "Bipolar Disorder Interventions", "medical_disease.content": "By Dr Ananya Mandal, MD Bipolar disorder is typically characterized by phases of depression followed by episodes of mania, with very few phases where mood is stable. A person living with the condition may experience either phase for weeks or months at a time, which may significantly interfere with their ability to manage daily activities such as working or socializing. During a manic phase, bipolar individuals tend to outperform others at work, but during a depressive phase they may find it difficult to function and perform. Therapy interventions Related StoriesLithium treatment associated with lowest risk of rehospitalization for bipolar disorder patientsNew app may help predict, track manic and depressive episodes in bipolar patientsUMSOM researchers identify new role for mitochondria in cocaine-induced behavior Therapy interventions for bipolar disorder include: Cognitive behavioural therapy or counselling These approaches aim to alter negative thought and behaviour patterns that lead to difficulty in coping with the condition. Family-focused counselling This approach is aimed at family members and caregivers, providing them with support and guidance in coping with the impacts of bipolar disorder on family relationships. The person suffering from bipolar disorder, their spouse and their family members need to understand the importance of adhering to medications such as mood stabilizers and being able to identify symptoms of an oncoming episode of severe depression or mania. Group therapy Counselling individuals as part of a group can improve their ability to cope with the symptoms of their condition. Identifying with other individuals suffering from similar disorders can ease the feelings of isolation or loneliness that living with mental illness can cause. In addition, skills-based programs can help patients learn to cope with medication side-effects, problems in the work place and relationship issues. Electroconvulsive therapy (ECT) ECT is used in severe cases of bipolar disorder, where medication and/or psychotherapy have failed to help an individual. A muscle relaxant and an anaesthetic are administered to render the procedure painless and free of anxiety. On average, ECT treatments last between 30 and 90 seconds and the patient usually recovers after around around 5 to 15 minutes. The procedure is usually performed in a day care unit. Some side effects of the procedure include confusion, disorientation and loss of memory. Reviewed by Sally Robertson, BSc Sources http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx www.nimh.nih.gov/.../nimh-bipolar-adults.pdf www.nami.org/.../ContentDisplay.cfm&ContentID=67728 http://brfa.avenue.org/BADFactSheet.pdf www.mentalhealthscreening.org/.../nimh%20Bipolar%20(brochure).pdf Further ReadingBipolar DisorderBipolar Disorder SymptomsBipolar Disorder DiagnosisBipolar Disorder TreatmentBipolar Disorder CounselingMore... Last Updated: Sep 23, 2013" }, "140": { "category_2_x_medical_disease.id": 140, "category_2.id": 35, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bipolar Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 140, "medical_disease.ts": "2018-04-20 02:37:58", "medical_disease.title": "Bipolar Disorder Counseling", "medical_disease.content": "By Dr Ananya Mandal, MD Treatments for bipolar disorder include medication and psychotherapy or counselling. Using a combination of these approaches may help reduce the dose of medication required to stabilize a patient's mood swings. Some of the benefits of counselling or \"talking therapy\" for people with bipolar disorder include: Guidance in coping with symptoms and identifying extreme mood changes and when to seek help Advice about how to cope with suicidal thoughts Education about bipolar disorder and living with the condition Support for individuals who have the condition as well as for their families Who provides counselling? Related StoriesStudy reveals the link between genetic variations and major psychiatric disordersEvidence suggests two patterns of early symptoms precede and predict later BD riskFamily study looks at potential genetic distinctions between bipolar disorder subtypes Counselling is typically provided by a psychologist, counsellor or a social worker and is usually prescribed by a patient's doctor. The frequency, duration and number of sessions a patient receives is determined according to their individual needs. Types of counselling Some of the methods used in counselling people with bipolar disorder include: Cognitive behavioural therap is one of the most well known approaches and is used to help patients learn to change any negative thoughts patterns that lead to behaviour that may be harmful to them. Family-focused therapy helps the family of a patient with bipolar disorder to identify, cope with and solve problems arising from living with the condition, as well as helping to improve communication between family members. Individuals with bipolar disorder may also be given assistance in improving their interpersonal relationships and regulating their social rhythms. This can help patientsto re-establish themselves in society and maintain regular daily routines and sleep patterns that may help prevent the onset of manic episodes. Psychoeducation is another approach offered which helps bipolar disorder patients learn about their condition and how to recognize signs of relapse so they can seek treatment prior to the onset of a manic episode. Psychoeducation is also a helpful tool for family members and carers of people with bipolar disorder. Reviewed by Sally Robertson, BSc Sources http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx www.nimh.nih.gov/.../nimh-bipolar-adults.pdf www.nami.org/.../ContentDisplay.cfm&ContentID=67728 http://brfa.avenue.org/BADFactSheet.pdf www.mentalhealthscreening.org/.../nimh%20Bipolar%20(brochure).pdf Further ReadingBipolar DisorderBipolar Disorder SymptomsBipolar Disorder DiagnosisBipolar Disorder TreatmentBipolar Disorder InterventionsMore... Last Updated: Sep 23, 2013" }, "141": { "category_2_x_medical_disease.id": 141, "category_2.id": 35, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bipolar Disorder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 141, "medical_disease.ts": "2018-04-20 02:38:01", "medical_disease.title": "Intermittent Explosive Disorder Causes", "medical_disease.content": "By Liji Thomas, MD Intermittent explosive disorder (IED) is part of the category of habit and impulse disorders, all of which have the common characteristic of inability or failure to resist a drive or impulse to do something which is harmful to self or others. Credit: ESB Professional/ Shutterstock.com The individual typically complains of inner tension which builds up until the act is committed, and experiences relief or pleasure once it is done. First called “monomanies instinctives” by Jean Etienne Esquirol, it is considered a disease of apparently purposeless irresistible urges. These disorders have been described first in the third edition of the Diagnostic and Statistical Manual (DSM-III). The psychiatric component is shown by the following characteristics: The violence of the act is out of all proportion to the factor that was the immediate precipitating cause The individual always puts the blame for the loss of control on some other person or situation rather than accepting responsibility for the aggressive impulse and action Lack of desire and motivation to change this behavior Risk factors Both environmental and genetic factors have been studied for their contribution to IED. Related StoriesFamily study looks at potential genetic distinctions between bipolar disorder subtypesEvidence suggests two patterns of early symptoms precede and predict later BD riskScientists decipher molecular structure of antipsychotic docked in its key receptor A family environment, which is characterized by verbal and physical violence and behavior, is strongly correlated with IED in the children. This may be because of the impact of childhood learning experiences, or due to shared genetic predispositions, as in other mental illnesses. A history of physical abuse or multiple traumatic experiences in childhood is also a risk factor for IED but is not universally found. Genetic factors may also operate in the transmission of the disorder. This may be due to differences in the way brain chemicals operate in these individuals. Any use of alcohol and/or drug use was much more common in IED patients, and multiple substance use increased the risk. Multiple substance abuse was even more strongly correlated with severity of IED, as was high-risk behavior in many forms. Peak incidence is in the teens, between the age of 6 and 40 years. Earlier age of onset was seen in males, at the age of 13 years, as compared to 19 years in females. IED had the earliest age of onset among all other disorders present in the same patient except for phobic anxiety, and thus it was unlikely to be caused by any of them. Other comorbid disorders include mood disorders, anxiety disorders, eating disorders, substance abuse, personality disorders and other impulse control disorders. Traumatic brain injury especially to the frontal cortex had occurred in some individuals who later became impulsive or had one of the impulse control disorders. This is important in that damage to the prefrontal cortex is known to produce such behavioral patterns. The presence of borderline, narcissistic, histrionic, and antisocial personality traits predict the risk of impulse control disorders, as does attention-deficit hyperactivity disorder (ADHD). The characteristically manic symptoms in IED, the high rate of comorbidity with bipolar disorder, and the good response to mood-stabilizing drugs, may point to IED being a variant of bipolar disorder. Reviewed by Afsaneh Khetrapal Bsc (Hons) Sources https://www.ncbi.nlm.nih.gov/pubmed/16259534 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105561/ https://www.ncbi.nlm.nih.gov/pubmed/10418808 www.mayoclinic.org/.../syc-20373921 Further ReadingWhat is Intermittent Explosive Disorder? Further ReadingBipolar DisorderBipolar Disorder SymptomsBipolar Disorder DiagnosisBipolar Disorder TreatmentBipolar Disorder InterventionsMore... Last Updated: Feb 28, 2018" }, "142": { "category_2_x_medical_disease.id": 142, "category_2.id": 36, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Birth Defects", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 142, "medical_disease.ts": "2018-04-20 02:38:04", "medical_disease.title": "Birth Defects", "medical_disease.content": "By Cashmere Lashkari Birth defects are problems which occur during fetal development in the womb. The problems can be either on the physical body or may affect the mental capabilities of the infant. Some birth defects develop in the first trimester of pregnancy, while others may arise during the last six months during organ formation. They can affect any part of the baby. According to statistics collected by the health department, a baby with a birth defect is born every four and half minutes in the United States. While comprehensive data on global birth defects is unavailable, there are a large number of babies born with birth defects each year. It is important that parents are made aware of the risk of birth defects so that they can eliminate common causes. What causes birth defects? Babies can be born with defects which are relatively minor, such as extra fingers or toes, while others may be born with severe defects, such as a hole in the heart. The cause of the defect is not always readily identifiable, and there is usually a mix of factors which will influence the proper growth of the fetus within the womb. The health of the mother, the presence of a medical condition such as diabetes, or obesity can be causes for birth defects. While genetics can cause some issues, most of the defects are usually caused by risky behavior during pregnancy. Addictive drugs, smoking, and drinking all have a detrimental effect on the fetus. Not taking prenatal care, lack of nutritious food, and even skipping vitamin and iron pills, can all lead to deficiencies in the mother. This in turn can translate into birth defects for the baby. So both genetic and environmental causes contribute to birth defects. Common birth defects The physically visible birth defects are the ones which are identified immediately - these could include extra appendages on feet and hands, a cleft lip, and spina bifida. In contrast, other defects may become more apparent as the child grows. They are usually identified when the child does not meet development milestones at appropriate ages. Birth defects that tend to be commonly seen include: Zika Virus This virus, which can be transmitted through a mosquito bite, blood transfusion or sexual contact, has been declared as a global public health emergency by the World Health Organization (WHO). If the virus is transmitted to a pregnant woman, the child may be born with a visibly smaller head size in proportion to the body. There is also a risk of brain damage that the WHO warns of. Spina Bifida This is a neural tube defect that affects the spinal column of the baby. The condition is not genetic or hereditary. It can be prevented by a pregnant woman having 400 micrograms of folic acid every day. The risk of this birth defect reduces by 70% by this simple measure. It is a common birth defect. Cleft Lip or Cleft Palate This is the fourth most common birth defect in children worldwide. It occurs if the separate parts of the face, which develop individually, do not join up properly. The severity of the defect can vary drastically. The cause is not yet identified. Surgical intervention is the usual cure for this birth defect. Related StoriesNo-carb diet for pregnant woman could harm fetus, study findsModifications in HIV test enable rapid detection of Zika virus, study statesBeing overweight or obese during pregnancy increases risk of birth defects, study findsCongenital Heart Disease This is the most common birth defect - it affects nearly 1 in every 150 babies born. Many times the defects are so minimal that they do not get identified until the person is well into adulthood. The severity of this varies drastically from case to case, but the majority of birth defect related deaths are caused by congenital heart disease. It can be caused due to a viral infection, medication, alcohol consumption, smoking, chronic illnesses of the mother, and genetic factors. They can be detected by sonography or ultrasounds. There are more than a dozen different types of heart conditions possible; therefore, treatment will depend on the condition. Down Syndrome This is one of the most common birth defects. 85% of those born with the defect do not survive their first year and 50% of the babies who live will not survive beyond 50 years. It is a genetic disease caused by Trisomy 21 where in an extra chromosome exists in either the sperm or the egg causing a fatal mutation. There is no cure and screening tests are the only way to avoid the disorder. Living with birth defects A lot of research is being conducted into birth defects and their treatments. Some cures have been identified, but for the majority of those born with limiting defects, life is never easy. Proper screening and diagnosis in the womb may allow some defects to be corrected before birth. With this said, the majority of treatments are done after birth. A good family support system combined with adequate medical attention is the best way to move forward. Reviewed by Afsaneh Khetrapal, BSc (Hons) References https://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&v%3Asources=medlineplus-bundle&query=birth+defects&_ga=1.162838844.1474204042.1481905852 http://kidshealth.org/en/parents/birth-defects.html http://americanpregnancy.org/birth-defects/ http://americanpregnancy.org/birth-defects/spina-bifida/ http://americanpregnancy.org/pregnancy-complications/zika-virus-and-pregnancy/ http://americanpregnancy.org/birth-defects/down-syndrome/ http://americanpregnancy.org/birth-defects/congenital-heart/ http://americanpregnancy.org/birth-defects/cleft-lip-cleft-palate/ http://www.cdc.gov/ncbddd/birthdefects/facts.html Further ReadingCongenital Birth DefectsCongenital heart disease and exerciseBirth Defects in TwinsWhat is Albinism?What is Edward's Syndrome?More... Last Updated: Aug 3, 2017" }, "143": { "category_2_x_medical_disease.id": 143, "category_2.id": 36, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Birth Defects", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 143, "medical_disease.ts": "2018-04-20 02:38:12", "medical_disease.title": "Congenital Birth Defects", "medical_disease.content": "By Yolanda Smith, BPharm A congenital birth defect, also known as a congenital anomaly, is a condition that is present at birth due to structural deformities in the development of a fetus. Common examples of congenital birth defects include congenital heart disease, neural tube defects and Down syndrome. Some form of abnormality or birth defect is evident in approximately 3% of infants born in the United States. It is estimated that 276,000 newborns worldwide do not survive beyond 4 weeks of age due to congenital anomalies. Congenital heart disease and neural tube defects are among the most common birth defects that account for mortality rates. Newborn with bilateral club foot, also called congenital talipes equinovarus Image Copyright: Alis Leonte / Shutterstock Causes Congenital birth defects can result from a variety of factors, which may be genetic or environmental. As such, it is often difficult to establish the exact cause of the defect. Genetic factors include gene mutations or abnormalities that lead to the presentation of a defect at birth. These mutations may be inherited from the parents of the infant or occur spontaneously through errors of morphogenesis, infection, chromosomal abnormality and epigenetic modifications. Environmental factors include any factors beyond the genetic makeup of an individual that may cause congenital birth defects – these may include deficiencies in the pre-natal or post-natal environment. The diet of both the father and the mother is a critical factor, particularly the vitamin intake and levels of glucose at ovulation and conception. A teratogen is a substance that has the potential to cause birth defects, such as cigarette smoke or alcohol, and may be an environmental cause of birth defects. Diagnosis and Management Related StoriesBeing overweight or obese during pregnancy increases risk of birth defects, study findsZika suppresses immune system during pregnancy to harm baby, report researchersZika virus infection during pregnancy causes birth defects in 5% of babies, study findsSome congenital birth defects can be identified before the birth of the infant by way of prenatal screening during pregnancy. Screening can be conducted during: Preconception: to determine the individuals at risk of a congenital disorder, particularly for inherited hematological conditions. Peri-conception: to monitor risk according to maternal characteristics. Ultrasound imaging can screen for Down syndrome in the first trimester and fetal anomalies in the second trimester. Other tests may include amniocentesis to detect neural tube defects and chromosomal abnormalities. Neonatal: to screen for hematologic, metabolic, hormonal and other disorders in newborns. This also includes a clinical examination to assess for physical disorders and hearing ability. Congenital anomalies can lead to chronic disability and have a significant impact on the quality of life of affected individuals and their families. In many cases, structural anomalies can be corrected with pediatric surgery. Other conditions, such as thalassemia, sickle cell disease and congenital hypothyroidism can be managed with timely treatments. Understandably, the exact management plan will depend on the individual case and specific characteristics. Prevention As we are aware of some of the causes of congenital birth defects, it is possible to employ actions to prevent their occurrence. For example, preventative techniques that may help to reduce the incidence of congenital birth defects include: Improvements in diet of all women of reproductive age Dietary supplements with folic acid and iodine for women Abstinence or restriction of alcohol, radiation and other potentially harmful substances Maintenance of a healthy weight and screening for gestational diabetes Vaccination for rubella before conception Increased public awareness about congenital birth defect causes and prevention Reviewed by Afsaneh Khetrapal, BSc (Hons) References http://www.who.int/mediacentre/factsheets/fs370/en/ http://www.childrenshospital.org/conditions-and-treatments/conditions/birth-defects-and-congenital-anomalies/symptoms-and-causes http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1168872/ http://www.nature.com/scitable/topicpage/birth-defects-causes-and-statistics-863 Last Updated: Sep 7, 2016" }, "144": { "category_2_x_medical_disease.id": 144, "category_2.id": 36, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Birth Defects", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 144, "medical_disease.ts": "2018-04-20 02:38:14", "medical_disease.title": "Congenital heart disease and exercise", "medical_disease.content": "By Professor Werner Budts The number of adult patients with congenital heart disease is growing worldwide. Advances in medical treatment, percutaneous interventions, and surgery offer the vast majority of these patients a good life expectancy. However, life long follow-up is needed, especially for patients with residual lesions or sequels of previous interventions. This is why several adult congenital heart disease centers were set up. Although these centers initially aimed at providing optimal medical care, they also started to fulfill the need of these patients for including socio-professional counseling, socio-juridical help, and advice on physical activity. Indeed, it has been shown that physical activity in patients with congenital heart defects does not only improve their exercise capacity, but has also a beneficial effect on the mental health status. However, some studies showed that young patients with congenital heart disease tend to be more obese, which seems to be related to a more sedentary lifestyle. It is not uncommon that families overprotect some patients. But, also counseling physicians are not always sure about the type and the intensity of the exercise that could be allowed. In contrast, there are patients who want to exert themselves to limits that would better be avoided. So, the balance between under- and overprotection to maximize the benefit and to minimize the risk of physical activity has to be found for each individual. Several guidelines and recommendation papers have been published over the last years. However, applying these in daily practice discovered shortcomings and is maybe the reason why it is not uncommon that different sport advices are proposed for the same patient. The ESC recommendations on competitive and elite sports can’t be used, because they would be too restrictive for the overall adult congenital heart disease population. Other recommendations focus on children so that extrapolating them uncritically to adolescents and (young) adults would be wrong. Finally, in all papers on sport counseling the decision taking process is based on the anatomical defect. This leads to an unpractical long list of congenital heart defects that might have in their turn a variety of hemodynamic and electrophysiological sequels. For example, the exercise performance of a patient with repaired atrial septal defect without pulmonary arterial hypertension will differ from a patient with a repaired atrial septal defect with pulmonary arterial hypertension. The exercise performance of a patient with a repaired tetralogy of Fallot and severe pulmonary valve regurgitation with normal right ventricular function will differ from a patient with a repaired tetralogy of Fallot and severe pulmonary valve regurgitation with a severely damaged right ventricle. Because of the variety of anatomical and functional differences in these patients the idea arose to start the decision tree from the actual hemodynamic and electrophysiological status of the patient. This new concept and the lacking recommendations for adolescents and (young) adults motivated the Working Group of Grown Up Congenital Heart Disease and the Section on Sports Cardiology for writing a position paper. The scope was to produce clear, concise and practical recommendations, which can be used as an everyday clinical tool by congenital heart disease specialists. The recommendations would cover a wide spectrum of physical exercise, ranging from everyday physical activity to participation in leisure time sports. A six steps approach was developed. Six steps approach The first step is the review of the history of the patient, to understand the underlying congenital heart defect, and to know its potential complications. Alarming symptoms must first be worked out before and the clinical examination has to fit with the underlying disease. By the second step, five functional parameters are assessed: the ventricular performance the presence of pulmonary hypertension the size of the aorta the presence of arrhythmia the presence of cyanosis Evaluating these five variables gives insight in the hemodynamic and electrophysiological status of the patient. Dependent on the deviation from normal values, which are predefined in the position paper, the patient will enter the algorithm through a different route (Figure). Related StoriesVitamin B3 supplementation during pregnancy may prevent birth defects, in-vivo study suggestsNo-carb diet for pregnant woman could harm fetus, study findsBeing overweight or obese during pregnancy increases risk of birth defects, study finds In the third step is decided on the static component of the exercise. The basic idea is protecting the pressure or volume loaded ventricles and the aorta from the static component of an exercise. For example, for a moderate aortic valve stenosis, physical activity with a moderate static component is proposed (Figure). The fourth step is the (cardiopulmonary) exercise test. Based on the Borg scale and/or the maximal heart rate achieved during the exercise test, it is possible to delineate for each individual the level for “high” intensity, “moderate” intensity, and “low” intensity of an exercise. Dependent on the hemodynamic and electrophysiological status of the patient, the static component of an exercise is proposed. The level of intensity is decided on following the algorithm (Figure, solid lines) in step five. However, the algorithm may not be interpreted too restrictive. If a patient wants to sport with a higher static component, whereas the position paper suggests physical activity with a lower static component, it is suggested to perform at a lower intensity. For the frequency and duration of each exercise session, a combined minimum of 3 to 4.5 hours of physical activities per week is recommended; the minimum minutes per session should be 30 minutes. For team sports patients should be encouraged to participate in teams (or with peers) of similar physical fitness. The sixth step is follow-up. For patients training regularly at high intensity, follow-up as indicated by the ESC guidelines for competitive and elite sports is proposed. For patients with physical activities at moderate or low intensity level, follow-up as suggested by the ESC guidelines for grown up congenital heart disease is proposed. However, when signs or symptoms change, the patient needs to reenter the algorithm at step one. Conclusion To conclude the position paper envisages that these recommendations will result in more unified physical activity protocols. Such an individualized exercise prescription might offer a platform with the aim to maximize benefit for health and minimize the cardiovascular risk. Finally, it could be used as a tool for future research to increase the lacking level of evidence. Figure. (Click Image for larger view) Flow chart depicting in detail steps 2 to 5. Following evaluation of the five variables and the interpretation of the CPET, an individualized recommendation can be provided (solid lines). When patients insist on sports with high static component, where it is not recommended, PA at a lower level intensity is suggested (dotted lines). Further information Physical activity in adolescents and adults with congenital heart defects; individualized exercise prescription. Budts W, Börjesson M, Chessa M, van Buuren F, Trigo Trindade P, Corrado D, Heidbuchel H, Webb G, Holm J, Papadakis M. Eur Heart J. 2013 Nov 7 doi:10.1093/eurheartj/eht433 About Professor Werner Budts Prof Dr Werner Budts is cardiologist and Director of the Adult Congenital Heart Disease Clinic in the University Hospitals of Leuven, Belgium. In 1996, the adult care program started officially and, currently, more than 7000 adult congenital heart disease patients are in regular follow-up. This expansion was made possible because of a close cooperation with the Pediatric Cardiology department and the support of a dedicated medical, nursery, and administrative team. He founded the Belgian Working Group on Adult Congenital Heart Disease and initiated the Belgian Registry on Adult Congenital Heart Disease. He is a fellow of the European Society of Cardiology and the American College of Cardiology. Today, he is the secretary of the European Working Group of Grown Up Congenital Heart Disease. He is full professor at the Catholic University of Leuven and his research group publishes regularly clinical papers, including in high impact journal. His own research focuses mainly on clinical adult congenital heart disease, in particular pulmonary arterial hypertension and right heart hemodynamics. With clinical data, he supports in parallel the research from the Department of Public Health and Primary Care on quality of life, health care in congenital heart disease, and transfer and transition. Disclaimer: This article has not been subjected to peer review and is presented as the personal views of a qualified expert in the subject in accordance with the general terms and condition of use of the News-Medical.Net website. Last Updated: Aug 3, 2017" }, "145": { "category_2_x_medical_disease.id": 145, "category_2.id": 36, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Birth Defects", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 145, "medical_disease.ts": "2018-04-20 02:38:16", "medical_disease.title": "Birth Defects in Twins", "medical_disease.content": "By Cashmere Lashkari Babies from twin pregnancies are more likely to suffer from birth-related complications than those from singleton pregnancies. Fraternal and identical twins can be affected by pregnancy complications, and subsequent birth defects. One of the most common issues is that twins are very often delivered preterm, often due to premature rupture of the membranes. While most mother give birth to healthy babies, there may be problems that lead to improper development of one or both the fetuses. This increases the chance of twins being born with birth defects by 50%. Birth weight defects It is common for twins to be a little underweight compared to babies from singleton pregnancies. This is because they are born premature or before the entire pregnancy term is finished. Since a fetus mainly gains weight in the last trimester of pregnancy, in the case of preterm twins the babies do not get the opportunity to gain weight before birth. Babies will increase in weight soon after birth, but those born before 32 weeks and weighing less than 3.3 pounds are at increased risk for long term problems. Such problems include blindness, hearing loss, mental retardation and cerebral palsy. Genital and urinary defects A study conducted by the University of Florida’s Maternal Child Health Education Research and Data Center, found that boys were at a 29% higher risk of developing birth defects in pairs of opposite sex twins. The boys were two times more likely to be born with defects affecting their genitals and urinary organs than the girls. Researchers believe this is because boys develop at a slower pace in the womb as compared to girls. They believe that if the baby is further ahead in development it would be protected against certain birth defects. Congenital hip dislocation The same study by researchers at the University of Florida also found that boys were five times more likely to be born with an obstruction between the stomach and the small intestine. However a common birth defect in twin is congenital hip dislocation. Researchers computed that girls were ten times more likely to end up with congenital hip dislocation than boys. This condition has an abnormal hip joint wherein the ball at the top of the thigh bone, is not stable within the socket which is supposed to hold it. This often causes the ball and socket joint to dislocate at the time of birth. The ligaments on the hip are stretched or loosened due to this dysplasia. Twin to twin transfusion syndrome Identical twins who share a single placenta but have two separate amniotic sacs are called monochorionic twins. The shared placenta connects the blood supply of the twins, allowing the flow of blood between them. In case there is unequal blood supply, the twins will develop at different rates. This can lead to a condition where the smaller twin pumps blood to the larger twin. It is called twin to twin transfusion syndrome (TTTS). Gradually the donor twin will have a substantially lower blood supply, leading to anaemia as well as less amniotic fluid. The recipient twin will have an excessive blood supply, leading to excess urine production, bloating of the amniotic sac with too much fluid, and risk of a prenatal form of heart failure. Both twins will be born with birth defects and are very much at risk for being born preterm. If detected in time they may be treated in the womb and should be born healthy. Twin reversed arterial perfusion (TRAP) sequence Related StoriesZika virus infection during pregnancy causes birth defects in 5% of babies, study findsBeing overweight or obese during pregnancy increases risk of birth defects, study findsNo-carb diet for pregnant woman could harm fetus, study findsThis uncommon condition, also termed Acardiac Twinning, affects less than 1% of monochorionic twin pregnancies. In this condition, one twin develops with an abnormally functioning heart. It may also be missing other organs such as the head or limbs. The acardiac twin receives all its blood supply from the healthy twin as they are sharing umbilical artieres via the placenta. This places pressure on the healthy twin’s heart, putting it at risk of heart failure and even death. The survival rate for the healthy twin is 25-50% if the TRAP sequence is not treated in time. The condition can be identified by a simple ultrasound and will require prenatal care of the healthy twin to reduce the risk of heart failure. Unfortunately, the acardiac twin will not survive. Congenital heart defects Twins are more likely to develop a congenital heart defect than babies from singleton pregnancies. Congenital heart defects are the most common form of birth defect and there has been a have reduced mortality due to them in recent years. The term actually refers to a number of different defects that may affect the heart, which are classified as cyanotic and non-cyanotic. Cyanotic defects are easily identifiable based on the blue skin colour of the baby caused due to the lack of oxygen. Non-cyanotic defects may be tougher to identify at birth as they may not have any obvious physical symptoms. Reviewed by Afsaneh Khetrapal, BSc (Hons) References http://www.chw.org/medical-care/fetal-concerns-center/conditions/infant-complications/birth-defects-in-monochorionic-twin/ http://americanpregnancy.org/multiples/vanishing-twin-syndrome/ https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P08021 http://americanpregnancy.org/multiples/complications/ http://publish-www-ufl.wcm.osg.ufl.edu/news---archive/archive/2005/11/multiple-birth-babies-boys-have-higher-risk-of-defects.html http://www.chw.org/medical-care/fetal-concerns-center/conditions/infant-complications/twin-to-twin-transfusion-syndrome/ http://www.chw.org/medical-care/fetal-concerns-center/conditions/infant-complications/trap-sequence/ https://medlineplus.gov/ency/article/001114.htm Further ReadingBirth DefectsCongenital Birth DefectsCongenital heart disease and exerciseWhat is Albinism?What is Edward's Syndrome?More... // Last Updated: Dec 22, 2016" }, "146": { "category_2_x_medical_disease.id": 146, "category_2.id": 36, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Birth Defects", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 146, "medical_disease.ts": "2018-04-20 02:38:20", "medical_disease.title": "What is Albinism?", "medical_disease.content": "By Cashmere Lashkari Albinism is a rare condition. It is a genetic disorder which is characterized by the inadequate production of the pigment melanin. The disorder may be inherited from the parents. The condition is not life threatening, but those suffering from albinism may have to limit their outdoor activities as they cannot tolerate being in the sun for long. Melanin is the chemical that gives the skin, hair and the iris of the eye their color. Those suffering from albinism will have extremely pale skin, hair and eyes. They may also have some patches of skin or hair that have a darker shade than other parts. Some serious complications that may crop up include problems with the vision, and a higher risk of developing skin cancer. Albino young man portrait. Image Credit: Sondem / Shuttertock Types of Albinism There are primarily two basic types of albinism. These are oculocutaneous albinism and ocular albinism. Oculocutaneous albinism or OCA affects the pigment in the eyes, hair and skin. Those suffering from this condition will have white or pink hair, extremely pale skin and pale iris color. They usually suffer from eyesight problems because the photoreceptor cells are unable to process the light waves and send conflicting messages to the brain. Ocular albinism or OA, is not as obvious as the skin and hair do not have such extreme lack of pigmentation. However, the primary problem here lies with the eye sight. An examination of the eye will show lack of pigmentation in the iris and retina . This is the rarer form of albinism and is caused by a mutation in an X chromosome. Its inheritance therefore follows an X-linked pattern. It is not as obvious at birth as OCA. Symptoms of Albinism The most obvious symptoms are the pale color of the hair and the skin. The lack of melanin reduces the skin’s ability to protect itself from UV rays. This results in increased vulnerability to skin damage by solar exposure. However, a number of symptoms of albinism can be related to associated eye problems. The list below includes some possible symptoms related to vision in a person with albinism. Related StoriesZika virus infection during pregnancy causes birth defects in 5% of babies, study findsZika suppresses immune system during pregnancy to harm baby, report researchersModifications in HIV test enable rapid detection of Zika virus, study statesStrabismus: There is a misalignment of the eyes leading to a squint. Also known as being cross-eyed, it happens when one eye looks straight at an object while the other turns inwards, outwards, upwards or downwards. Both eyes do not move in a synchronized manner. This hampers optimal eye functioning. Nystagmus: A condition where the patient’s eyes move rapidly and uncontrollably. Often a preferred head position is developed to optimize vision and deal with the involuntary eye motion. This leads to strained muscles in the neck. Photophobia: A high degree of sensitivity to bright light from sources such as the sun, fluorescent bulbs or incandescent lighting. Because of the intense discomfort, the patient feels the need to squint or close the eyes for relief. Refractive Errors: Hyperopia or far sightedness, myopia or near sightedness and astigmatism or defect in the curvature of the cornea are the common types of refractive errors. Monocular Vision: A dependence on only one eye for vision, with the other eye not being used to send messages to the brain. This may thus become a lazy eye. Foveal Hypoplasia: Improper development of the retina during birth or childhood leading to poor vision. Faulty Optic Nerve: The nerve signals that must travel from the retina to the brain fail to develop properly and therefore do not transmit information as required. Transillumination Issues with Iris: The colored diaphragm between the anterior chamber of the eye and the lens is known as the iris. When it is lacking in the pigment melanin, it is unable to screen out the extra light entering the eye. This causes vision issues. Treatment Options for Albinism The production of melanin cannot be regulated artificially. For this reason, there is no cure for the subnormal synthesis of melanin which causes albinism. The skin may be protected from sun exposure to reduce the chances of sunburn as well as of skin cancer. Using sun screen of SPF 30 or more, good-quality sunglasses, long-sleeved garments and wide-brimmed hats are a good start to protect the patient. There is no cure for the eye problems caused by albinism. However, treatment options such as corrective glasses and contact lenses may help in some cases to improve the vision. Using correct lighting can help reduce the strain on the eye sight within the home. Children in school will need additional help to see distant objects in the classroom. Training and counseling may be required to equip teachers who handle children with albinism. Albinism does not worsen with age. It has no impact on the intelligence of a person. Genetic counseling of patients suffering from albinism helps them understand the disorder. It also helps deal with the possibility of future generations being affected with the condition. Having a support group makes it easier to deal with the challenges of albinism. Keeping a positive mental attitude and developing social skills to cope with the stigma attached to the condition help the patient immensely. Reviewed by Liji Thomas, MD. Sources https://www.nhs.uk/conditions/albinism/ www.mayoclinic.org/.../syc-20369184 http://kidshealth.org/en/teens/albinism.html www.scientificamerican.com/article/killing-albinos-tanzania-albinism/ https://www.albinism.org/information-bulletin-what-is-albinism/ https://rarediseases.info.nih.gov/diseases/5768/albinism https://www.aao.org/eye-health/diseases/what-is-albinism https://medlineplus.gov/ency/article/001479.htm Further ReadingAlbinism - Partial Absence of Pigment in the SkinAlbinism DiagnosisAlbinism CausesEpidemiology of Albinism // Last Updated: Mar 7, 2018" }, "147": { "category_2_x_medical_disease.id": 147, "category_2.id": 36, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Birth Defects", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 147, "medical_disease.ts": "2018-04-20 02:38:22", "medical_disease.title": "What is Edward's Syndrome?", "medical_disease.content": "By Cashmere Lashkari Edward’s syndrome is a genetic defect that results in several abnormalities in the body of the babies born with condition. Babies with this chromosomal condition die soon after birth. There is no cure for the condition. It is also known as Trisomy 18 and affects one in five thousand live births. The possibility of a woman giving birth to a child with Edward's syndrome increases with the age of the pregnant woman. While the condition is caused by a defect in chromosomes, it is not an inherited disease. In trisomy 18, the baby has three copies of chromosome number 18 instead of the requisite two. The error usually occurs during production of the sperm or the egg. It affects the normal growth of the baby. In 90% of the cases the defect has been attributed to the egg. The error occurs in cell division and is known as meiotic disjunction. Edward's Syndrome This is the most severe form of the condition. The baby will die shortly after being born. The baby usually has multiple defects and organ abnormalities such as a small misshapen head, a smaller-than-average jaw, clenched fists with overlapping fingers, low-set ears and exomphalos (this is when the intestines are found in a sac outside the stomach). There may be issues with the development of the heart, lungs and spinal column as well. These babies do not survive beyond the first month after birth. Mosaic Trisomy 18 A slightly less severe form of the condition, in mosaic trisomy 18 only some cells of the baby have an extra copy of chromosome 18. Depending on the number and type of cells affected, the disabilities will differ from baby to baby. About seven in ten babies with this condition may survive a year or more. In rare cases, where the disabilities are not very pronounced, the individual may survive into early adulthood, but will never be able to function independently. Partial Trisomy 18 This is the least severe form of the condition. In partial trisomy 18 only a section of the additional chromosome 18 is present rather than the entire additional chromosome. The severity of the baby’s disabilities will depend on the part of the chromosome present in the cells, as well as the number of cells which have the chromosomal defect. Partial trisomy 18 can be inherited when a parent carries a rearrangement of genetic material between two chromosomes, called a balanced translocation. Diagnosing Edward's Syndrome Related StoriesZika virus infection during pregnancy causes birth defects in 5% of babies, study findsNo-carb diet for pregnant woman could harm fetus, study findsBeing overweight or obese during pregnancy increases risk of birth defects, study findsScreening for Edward’s syndrome occurs between 10 to 14 weeks of pregnancy. The combined test checks for Down’s syndrome and Patau’s syndrome as well. Those found to be at high risk after the combined test will be advised to undergo a diagnostic test to confirm the presence of Edward's syndrome. This is done by checking the baby’s cells for an extra copy of chromosome 18. The two ways of obtaining the cell samples include chorionic villus sampling and amniocentesis. In chorionic villus sampling cells are collected from the placenta, or the tissue which connects the fetus to the mother. In amniocentesis a sample of the amniotic fluid in the womb around the baby is collected. This fluid contains the cells that the fetus has shed, and which are studied to obtain a definite diagnosis. Both these tests are invasive and have a small risk of causing a miscarriage. A new test that has been developed uses only a blood sample from the mother. This is a non-invasive prenatal testing technique though it is more expensive to administer. A mid-pregnancy scan at 18 to 21 weeks will also throw up any physical abnormalities that the fetus has. These are called congenital anomalies and often signal the presence of a serious disorder. The Decision Post Diagnosis Should the baby be diagnosed with Edward's Syndrome the doctor will suggest ending the pregnancy, as it is a severe disorder which has no cure. This can be an emotionally charged time for the pregnant mother and the family. Counselling is recommended as having a support system is crucial to dealing with this situation. If the mother chooses to continue the pregnancy, there is a fifty percent chance that the baby will be stillborn. Even if it is a live birth a number of medical complications may be expected. Baby girls have a higher survival rate than baby boys. Most of the time the baby will be admitted to the Neonatal Intensive Care Unit as the complications require a lot of critical care. Should the baby survive the first month, the family may be able to take the baby home from the hospital. Less than 10% of the babies survive to celebrate their first birthday. The caregivers need to be mentally prepared for the eventual death of the child. Sources https://www.nhs.uk/conditions/edwards-syndrome/ https://ghr.nlm.nih.gov/condition/trisomy-18 https://www.trisomy18.org/what-is-trisomy-18/ https://embryo.asu.edu/pages/trisomy-18-edwards-syndrome // Last Updated: Mar 13, 2018" }, "148": { "category_2_x_medical_disease.id": 148, "category_2.id": 37, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Birthmark", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 148, "medical_disease.ts": "2018-04-20 02:38:26", "medical_disease.title": "Birthmarks: Vascular and Pigmented", "medical_disease.content": "By Liji Thomas, MD Birthmarks are marks present on the skin from birth. They are mainly of two types: vascular and pigmented. Birthmark baby: Image Credit: Baby foto / Shutterstock Vascular Birthmarks These result from abnormalities in the formation of blood vessels, which form clumps under the skin or in deeper layers of the body. They are usually various shades of red or pink due to the color of the blood vessel, so two common types of vascular birthmarks are called strawberry hemangiomas and port-wine stains. Salmon patches are hemangiomas which are pink or red. They are also called angels’ kisses and sometimes stork bites when they occur on the face or the back of the neck respectively. Strawberry hemangiomas look just like the fruit whose name they bear, and are soft to touch. Port-wine stains are the color of grape juice and irregular in shape, being flush with the skin. Deeper hemangiomas are darker in color and may make the skin appear raised. Most hemangiomas grow over the first year of life but slowly shrink thereafter to become flat by the age of ten years in most cases; however, a light residual mark is often found to persist. Pigmented Birthmarks A pigmented birthmark derives its color from an abnormal group of pigment cells in the skin. There can be various colors, from black to tan. While many moles are small and round, some are large and have different colors. Moles may be either smooth and flush with the skin, or raised above the skin surface. They may have a smooth or rough texture. Some commonly encountered moles are called by specific names, such as the café-au-lait spots which take their name from their typical light brown color, which looks like coffee to which milk has been added. With this said, some people have dark brown café-au-lait spots. Mongolian spots are another common type of nevus which are bluish-grey in color, and are most common in darker-skinned children. They are usually present at birth and are seen over the back and the gluteal region. Diagnosis and Treatment While the etiology of most birthmarks is still unknown, some do have a familial association. Diagnosis is based upon the history and physical appearance. While most birthmarks are only of cosmetic significance, some types of nevi are associated with an increased risk of skin cancer. Therefore a careful follow-up is mandatory for any nevus (pigmented birthmark) which changes color or size, or becomes pruritic or infected. A biopsy may be necessary to rule out malignant changes. Treatment of these depends on the type of birthmark, as well as the presence of other worrisome conditions. It includes surgery or laser treatment. Vascular birthmarks are also treated by laser coagulation of the offending blood vessels. Very large hemangiomas may require special make-up to mask them if they occur in visible areas. Reviewed by Afsaneh Khetrapal BSc (Hons) References https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/birthmarks https://medlineplus.gov/birthmarks.html https://www.aad.org/public/kids/skin/birthmarks/different-kinds-of-birthmarks http://www.racgp.org.au/afp/201205/46543 Last Updated: Jul 3, 2017" }, "149": { "category_2_x_medical_disease.id": 149, "category_2.id": 38, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphenol A (BPA)", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 149, "medical_disease.ts": "2018-04-20 02:38:28", "medical_disease.title": "Bisphenol A (BPA): The FDA's Position", "medical_disease.content": "Bisphenol A (BPA) is an industrial chemical and is a component in polycarbonate plastic and epoxy resins. Almost all inner plastic linings of food cans and beverage containers are manufactured using BPA. Usually, plastic bottles that contain BPA are clear and tough. Some studies have proven that the bisphenol A can migrate into the beverages or food from the containers that are made up of plastic manufactured using this compound. Exposure to BPA may cause harmful health effects in adults and infants. People should be aware of the effects of BPA because even a very little quantity of BPA leached from food containers can be dangerous. FDA Evaluation The Food and Drug Administration (FDA) is a government agency regulated by the US Department of Health and Human Services. It works to ensure the effectiveness and safety of human and veterinary vaccines, drugs, medical equipment, and biological products. Chemical substances (like BPA) that may leach out of food containers into food require premarket approval from FDA. Regulatory changes may be made by the FDA based on the usage and safety of the product. Factors that are considered during the FDA’s safety evaluation include safe exposure levels, the nature of the chemical substances used for food packaging, and exposure to chemical substances in food containers that migrate into foods and beverages. Historical FDA view of BPA In 1960, BPA received its original approval, under the food additive rules and regulation of the FDA. In 2008, a documentation named “Draft Assessment of Bisphenol A for Use in Food Contact Applications” was released by the FDA. In October 2008, the FDA’s Science Board Subcommittee reviewed this documentation and released a report on it. In the same year, a monograph dealing with the potential human reproductive and developmental effects of BPA was released as part of the assessment of risk factors to human reproduction, by the National Toxicology Program Centre (NTPC). In 2009, reassessments by various researchers who were referred to in the NTPC paper were released by the FDA. Their relevance was evaluated to generate a risk analysis. In addition, five federal government scientific experts submitted independent reviews of these research studies in the same year. In April 2010, the independent evaluation results were released, followed by the report of the Center for Food Safety and Applied Nutrition (CFSAN). All relevant information was made available for public knowledge through the FDA. BPA in Biology and Metabolism Rising consumer interest in the safety of BPA has led the FDA to support various research trials and to provide additional information and correct inconsistencies in technical literature with respect to BPA. Many studies have provided information about the migration and metabolism of BPA in the human body. The FDA’s regulatory center and the National Center for Toxicological Research (NTCR) continues their research on further issues that might arise from BPA through different avenues of exposure of the human body to this chemical. NCTR Findings Under FDA Rodent studies conducted by the National Centre for Toxicological Research indicated that the level of BPA that is carried from the mother to the fetus was too low to be measured. In this research study, pregnant rodents were dosed with 100 to 1000 times the amount of BPA that humans may expect to be exposed to from food. No detectable BPA was present in unborn offspring even eight hours after exposing the pregnant rodent to BPA. Results demonstrated that the oral administration of BPA led to rapid metabolism of it into an inactive form. It has been observed that the metabolism and excretion of BPA in humans occurs more efficiently and rapidly than in rodents. Prohibiting BPA-Based Materials for Infant Feeding BPA-based polycarbonate resins: Amendments have been made in the FDA regulations to ban baby sippers and bottles that are made of BPA-based polycarbonate resins. This amendment was made in response to the American Chemistry Council’s (ACC) food additive petition. BPA-based epoxy resins: The FDA has revised its regulations in order to stop the use of infant formula packaging that was made up of BPA-based epoxy resins. This revision was made in 2013 in response to Congressman Edward Markey’s food additive petition. Current Situation Based on the hazard assessment of BPA conducted by the US Food and Drug Administration’s Center for Food Safety and Applied Nutrition (CFSAN), it has been concluded that the BPA exposure due to food contact does not cause harm in humans. This conclusion was made based on the internal review of FDA’s most recent research data. Reviewed by Liji Thomas, MD. References: https://www.fda.gov/newsevents/publichealthfocus/ucm064437.htm http://www.ucsusa.org/our-work/center-science-and-democracy/promoting-scientific-integrity/bisphenol-a.html#.WYlyRFV97IU https://iaomt.org/fda-finds-dose-effect-bpa-critics-dispute-findings/ https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/risk-management-bisphenol-bpa https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702012/ https://www.colorado.gov/pacific/sites/default/files/HHW_EnvEpi_Bisphenol-A-%28BPA%29-How-to-Reduce-Exposure_0.pdf http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/bpa/faq-20058331 Further ReadingBisphenol A (BPA) Health EffectsBPA: The EFSA positionLink between Bisphenol A and Increase in Blood PressureReducing exposure to bisphenol A (BPA) Last Updated: Sep 12, 2017" }, "150": { "category_2_x_medical_disease.id": 150, "category_2.id": 38, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphenol A (BPA)", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 150, "medical_disease.ts": "2018-04-20 02:38:31", "medical_disease.title": "Bisphenol A (BPA) Health Effects", "medical_disease.content": "By Jeyashree Sundaram (MBA) Bisphenol A (BPA) is used as a plasticizer in polycarbonate plastic and epoxy resin production. In addition, it is used as an additive agent in the fabrication process of polyvinyl chloride (PVC) as well as in manufacturing healthcare machines, contact lenses, toys, window foils, and storage media. It is one of the food contacting materials used widely in food and drink packages and in utensils used in the kitchen. It is a chemical compound manufactured in enormous quantities. Image Credit: molekuul_be / Shutterstock Human Exposure to BPA H BPA in several ways such as oral administration, inhalation, and application of transdermal medicines. The chief source of BPA exposure is food products. The key sources of nutritional contact with BPA are preserved or canned foods, as it is extensively used in the making of cans for food preservation and for the internal coating of jar caps. Sterilization of cans, by application of heat, causes the BPA to outflow from the epoxy coating into the food within the can and, consequently, increases human exposure to BPA. Humans can also be exposed to BPA through dust from flooring , adhesives comprising epoxy resins, household electronic appliances, and paints. Humans are predominantly exposed to BPA from dust found in workplaces and laboratories where large numbers of electric appliances and furniture are used. BPA is found in dental fillings, sealants, and substances used for crowns . BPA is also used in paper production, thermal printing, and payment cards. Effects of BPA on Human Health BPA is processed in the liver by the enzyme uridine 5’-diphospho-glucuronyl transferase . Epidemiological reports on the relationship between BPA and its health effects in humans have indicated that BPA is very harmful to human health. BPA is widely known as an endocrine-disrupting chemical (EDC). It has exhibited a role in the pathogenesis of various disorders of the endocrine system that include female and male infertility, hormone-reliant tumors such as breast and prostate cancer, and several other metabolic diseases such as polycystic ovary syndrome. Estimating BPA levels in humans, such as by biomonitoring BPA concentration in urine, is very important as humans are continuously exposed to it and it gets easily accumulated in the body. Effect of BPA on Newborns Researchers have reported that BPA concentrations are 11 times higher in infants than in adults. The ability of the liver to metabolize BPA is lower in babies than adults. Hence, the amount of BPA is increased and affects the health of infants. It can also cause childhood asthma in babies or newborns. Effects on Male and Female Fertility, and Fetal Development I ncreased BPA in the human body alters sperm function as well as fertilization in both men and women, and affects embryonic development. In females, BPA can affect endocrine function by altering secretion of gonadotropin-releasing hormones, which in turn impacts puberty and ovulation. BPA exposure has an effect on one of the most common health problems in women (polycystic ovary syndrome), due to a change in hormone secretion. T here are effects on the ovary due to BPA. For example, BPA exposure will lead to loss of follicles in the ovary. It also causes a decrease in the level of antral follicle counts and a lower survival rate of oocytes. BPA exposure damages the female reproductive system at various parts of the life cycle and may promote infertility. In addition, the amount of proteins in spermatozoa necessary for fertility is altered, causing infertility in males. Effects on Breast Cancer The possible relation between BPA exposure and breast cancer is monitored by estimating the BPA concentration among people with and without breast cancer. The structure of BPA is identical to estrogen. It interferes in hormone pathways and leads to harmful health effects. Chronic exposure to BPA causes malignant tumors in the mammary gland. Studies have shown the association between high levels of BPA and increased mammographic breast density. Effects in Heart Disease A higher concentration of BPA in urine is related to certain cardiovascular conditions such as heart attack, angina, and heart problems. Some reports have shown that acute BPA exposure causes development of an irregular heart rhythm, and constant exposure to BPA resulted in atherosclerosis and changes in blood pressure. Therefore, BPA exposure is considered to be a risk factor for heart-related disorders. Reviewed by Catherine Shaffer, M.Sc. Sources Health risk of exposure to Bisphenol A (BPA), https://www.ncbi.nlm.nih.gov/pubmed/25813067 BPA - Bisphenol A - possible effects during fetal development or on newborns, http://www.state.nj.us/humanservices/opmrdd/health/bpa.html Bisphenol A and human health: a review of the literature, https://www.ncbi.nlm.nih.gov/pubmed/23994667 Effects of bisphenol A on breast cancer and its risk factors, https://www.ncbi.nlm.nih.gov/pubmed/18843480 Bisphenol A, Hypertension, and Cardiovascular Diseases: Epidemiological, Laboratory, and Clinical Trial Evidence, https://www.ncbi.nlm.nih.gov/pubmed/26781251 Bisphenol-A Affects Male Fertility via Fertility-related Proteins in Spermatozoa, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360475/ Bisphenol-A and Female Infertility: A Possible Role of Gene-Environment Interactions, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586663/ Low-Dose Bisphenol A Exposure: A Seemingly Instigating Carcinogenic Effect on Breast Cancer, http://onlinelibrary.wiley.com/doi/10.1002/advs.201600248/full Bisphenol A (BPA), https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm Using Bisphenol-A to Study the Onset of Polycystic Ovarian Syndrome, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356057/ Further ReadingBisphenol A (BPA): The FDA's PositionBPA: The EFSA positionLink between Bisphenol A and Increase in Blood PressureReducing exposure to bisphenol A (BPA) Last Updated: Dec 4, 2017" }, "151": { "category_2_x_medical_disease.id": 151, "category_2.id": 38, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphenol A (BPA)", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 151, "medical_disease.ts": "2018-04-20 02:38:37", "medical_disease.title": "BPA: The EFSA position", "medical_disease.content": "Bisphenol A, also known as BPA, is one of the chemicals used for the manufacture of resins and plastic compounds. Polycarbonate is a high-quality transparent and rigid plastic that is produced using BPA. Baby bottles, beverage bottles, tableware, and storage containers are some of the examples of polycarbonate products. Credit: Dasha Petrenko/ Shutterstock.com In addition, BPA is used in manufacturing epoxy resins that are used in the lining and coatings of beverage cans or food products. Hence, the BPA chemical is possibly transferred in small amounts to beverages and foods. The European Food Safety Authority (EFSA) is an organization whose primary task is to collect scientific data from experts and analyze the substances included in the manufacture of products that come into contact directly with foodstuffs and other beverages. It is the main organization communicating to the public about the possible risks related to unsafe food. EFSA also provides advice and coordinates with international bodies, EU countries, and other agencies on the subject of food safety. Background of EFSA on BPA January 2007: The EFSA re-evaluated BPA from a group of expert studies carried out since 2002 and from studies in mice. After evidence was found by scientists about the limits of exposure of BPA in the human body, EFSA fixed the tolerable daily intake (TDI) level at 0.05 mg per kilogram of bodyweight. The expert group of EFSA proved that the lower dose of BPA in rodents is not robust. BPA exposure in the human body, for both adults and children through foods is much lower than the newly-set TDI. July 2008: In 2008, EPSA reconfirmed its existing position that products extracted from BPA-based polycarbonates such as water bottles, containers, and epoxy contacted foods are safe for use by all age groups. The BPA intake level (TDI) provides the safety margin to protect consumer health. There are many authorities including the European Commission’s Joint Research Centre, the US NTP, the Norwegian Scientific Committee for Food Safety, and Health Canada who recently reviewed the reassessment done by EFSA. They are a panel group focused on the mechanism to remove BPA from the body. They concluded that the human body immediately metabolizes BPA in the human body. The human fetal exposure to BPA is insignificant due to the rapid metabolism of the mother’s body. Similarly, newborns are also able to eliminate BPA from their body through metabolism of doses less than 1 mg per kilogram of body weight within a day. June 2009: Until the year 2009, there were no studies of based on criticisms of the position of EFSA on the findings of safe intake of BPA. May 2010: The EFSA aim is to update their previous stance regarding safety of BPA as well as the new research data, including the study of neurodevelopmental factors and the risk of BPA put forward by other organization bodies. January 17, 2014: The American Chemistry Council also supported the release of reaffirmations about the safety of BPA exposure by EFSA. EFSA finally announced in 2014 that BPA exposure in the human body from various sources is below the margin of safety intake level of BPA set up by government bodies. Other organizational support of EFSA’s opinion on BPA There are many government organizations in the world that have studied and evaluated the effects of BPA exposure on the human body. Organizations such as the U.S. Food and Drug Administration (FDA) have updated their position recently that BPA is safe for use at lower levels. Previously, FDA was against using BPA-based products, but after comprehensive reexamination, they concluded BPA is safe. The FDA current position aligns with the position of EFSA. U.S. government laboratories have supported the position of FDA and EFSA; recently FDA along with the government's Pacific Northwest National Laboratory (GPNNL) and the Centers for Disease Control and Prevention have conducted wide research on the risk of BPA in humans and animals. They have found that due to the metabolism of BPA in the body, there is a lower chance of health issues developing from exposure to any level of BPA in the body. Current position of EFSA on BPA Recently, EFSA has released new data that BPA may affect the immune system of animals, while there is significant evidence that it affects the human immune system. This result was found after complete re-evaluation of the toxicity and exposure from BPA. EFSA is continuing in its efforts to study and analyze the methodologies to reduce the TDI level against the toxicity of BPA. Reviewed by Catherine Schaffer, M.Sc. Sources: European Food Safety Authority (EFSA), https://europa.eu/european-union/about-eu/agencies/efsa_en EFSA, Bisphenol A, http://www.efsa.europa.eu/en/topics/topic/bisphenol EFSA Draft Opinion Finds BPA Exposure Levels Lower Than Previously Reported, www.americanchemistry.com/.../...s-Lower-Than-Previously-Reported.html Facts about BPA, factsaboutbpa.org/safety-assessments/european-food-safety-authority EFSA Scientific Opinion: BPA exposure of no risk to consumers, www.foodpackagingforum.org/.../efsa-scientific-opinion-bpa-exposure-of-no-risk-to-consumers EFSA draft opinion on the risks from BPA, https://www.food.gov.uk/science/bpa/efsa-bpa-consultation# Further ReadingBisphenol A (BPA): The FDA's PositionBisphenol A (BPA) Health EffectsLink between Bisphenol A and Increase in Blood PressureReducing exposure to bisphenol A (BPA) Last Updated: Dec 8, 2017" }, "152": { "category_2_x_medical_disease.id": 152, "category_2.id": 38, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphenol A (BPA)", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 152, "medical_disease.ts": "2018-04-20 02:38:43", "medical_disease.title": "Link between Bisphenol A and Increase in Blood Pressure", "medical_disease.content": "By Jeyashree Sundaram, MBA High blood pressure (BP) has reached epidemic proportions among the population worldwide. In the USA alone, 1 of every 3 adults is hypertensive, and another 1 out of 3 is pre-hypertensive. Researchers working on the causes of high blood pressure concur that bisphenol A is a major contributing factor to this state of affairs. Credit: Lighthunter/ Shutterstock.com (BPA) is a chemical that is used to make a wide range of products such as water bottles, food containers, contact lenses, and even dental fillings. New studies show that BPA from plastic bottles leaches into the food products contained within and raises the blood pressure within a few hours. Study findings also reveal that even a single exposure to consumption of canned beverages/food can impact the cardiovascular health of a person. The European Chemicals Agency has termed BPA a chemical of high concern and a major endocrine disrupter. Blood pressure and urine output There is a direct relationship between urine output and high BP: a hypertensive patient has increased urine output. Several studies using urinary BPA measurement have shown a positive association between serum BPA and hypertension. This association remained relatively constant across age, sex, BMI, or diabetic levels. It has been observed that after drinking from a can, a person shows increased levels of BPA in urine after 2 hours, whereas the same amount of beverage consumed from a glass bottle does not reflect in an increase in BPA in urine. BPA and increased blood pressure Studies report a direct link between the concentration of BPA and blood pressure. A 5-point increase in BP is seen following BPA exposure, which could be quite a significant percentage for those who are already hypertensive. Nevertheless, studies do not mention the onset of chronic hypertension due to repeated BPA exposures. Further longitudinal studies are required to clarify this aspect Drinking canned beverages BPA is widely used in making plastic bottles and the inner coating of beverage cans. Experiments show that systolic blood pressure increases by ≈4.5 mm Hg after consumption of two canned beverages (soft drinks or soups) compared with no change after consumption of the same two beverages from glass bottles. BPA levels after canned soymilk: Soymilk from cans was used in some experiments because it has no ingredients that can cause a rise in BP. Experimental results showed that the urine of persons who drank soymilk from cans showed substantial increase in BPA levels, compared with those who drank from bottles made of glass. After consuming just two soymilk servings from cans, people showed a 5mm Hg increase in their systolic blood pressure, in contrast to no change in those who consumed two servings from a glass bottle. Effects of BPA on the cardiovascular system Although the exact mechanism of action of BPA on the cardiac system is not very clear, a number of pathways are possible. Human exposure to BPA is mainly via oral means. An association of BPA with all criteria for hypertension has been observed, but the connection was weak for high systolic BP and high diastolic BP. BPA exposure affects the mechanism of insulin secretion and results in weight gain leading to obesity which is an established factor in hypertension. BPA can bind to thyroid hormone receptors. It influences the actions of free thyroid hormone by causing a decrease in its level. Estrogen is important for endothelial regulation. Estrogen receptors play a vital function in the repair of blood vessels and in the control of blood pressure. BPA is said to be a xenoestrogen that mimics the function of estrogen in the body. This disrupts the estrogen levels in the body as well as estrogen action on its receptors. Postmenopausal women have shown greater effects due to BPA on their blood pressure. Long-term exposure to BPA even at low levels can affect the biological functioning of the circulatory system and can lead to circulatory issues such as arrhythmias, cardiac remodeling, atherosclerosis and hypertension. These issues are caused by alterations in the underlying molecular mechanisms such as rapid signaling of estrogen receptors, modification of cardiac calcium channels by phosphorylation of proteins involved in the mobilization of calcium, and oxidative stress. BPA is a potential toxin to the cardiac cells and generates reactive oxygen species by increased oxidative degradation of lipids, reduced glutathione levels, and reduced activity of the enzyme catalase. Injury to the primary endothelial cells due to oxidative stress is another effect of BPA. Continued exposure to BPA leads to lowering of nitric oxide (NO) content in the body that may cause vasoconstriction and poor blood supply to the heart. BPA also lowers the action of acetylcholinesterase in the body, which may result in reduced cardiac contractility and a slow heartbeat. Reviewed by Liji Thomas, MD. References: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024199/ https://pubchem.ncbi.nlm.nih.gov/compound/Bisphenol_A#section=Top https://www.ncbi.nlm.nih.gov/pubmed/26781251 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985394/ https://www.ncbi.nlm.nih.gov/pubmed/25489056 http://environment.harvard.edu/news/faculty-news/bpa-cans-and-plastic-bottles-linked-quick-rise-blood-pressure http://hyper.ahajournals.org/content/65/2/313 http://www.naturalmedicinejournal.com/journal/2015-02/bisphenol-beverage-containers-may-raise-blood-pressure http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/bpa/faq-20058331 https://examine.com/nutrition/erd-6-is-out-and-here-s-your-exclusive-sneak-peek/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143868/ Further ReadingBisphenol A (BPA): The FDA's PositionBisphenol A (BPA) Health EffectsBPA: The EFSA positionReducing exposure to bisphenol A (BPA) Further ReadingHigh Blood Pressure - HypertensionWhat Causes Hypertension – High Blood Pressure?Hypertension Symptoms and EffectsHypertension DiagnosisHypertension / High Blood Pressure TreatmentMore... Last Updated: Jan 4, 2018" }, "153": { "category_2_x_medical_disease.id": 153, "category_2.id": 38, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphenol A (BPA)", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 153, "medical_disease.ts": "2018-04-20 02:38:47", "medical_disease.title": "Reducing exposure to bisphenol A (BPA)", "medical_disease.content": "By Jeyashree Sundaram, MBA Bisphenol A (BPA) is an inorganic compound used in the production of polycarbonate (PC) plastics and epoxy resins. PC plastics are hard and are used in manufacturing baby bottles, reusable water bottles, food containers, tableware, and other storage containers. Epoxy resins are coated on the inner linings of metal containers such as food cans, bottle tops, and water supply tubing, in order to prevent corrosion of the metal leading to contamination of the stored food products. Credit: Ruslan Grumble/ Shutterstock.com The release of BPA from stored containers (PC containers and epoxy-varnished metallic containers) into foods and liquids during heating promotes the transfer of BPA contents leading to the consumption of food or liquids containing BPA. BPA is also transferred from mother to infant during breastfeeding. These are some of the possible ways in which people are exposed to BPA. Exposure to BPA causes several effects on human health such as obesity, premature puberty, repeated miscarriages, and diabetes. Methods for reducing BPA exposure 1. In bottle-fed infants Breast-feeding infants have a negligible risk of BPA exposure. However, the risk becomes higher when mothers switch over to bottle feeding. Some measures to reduce the risk of BPA exposure in infants and babies are as follows: Avoid the use of plastic bottles The use of “BPA-free” labeled bottles or bottles made of plastics with a cloudy or frozen look are advised, as they do not contain BPA. Liquid or powdered infant formula packed in metal containers should be avoided. Use of glass bottles is encouraged with extreme care. Eliminate the impact of high temperatures Microwaving plastic bottles, or filling plastic containers with hot substances such as milk or infant formula, should be avoided, as BPA and other chemicals may leach into the contents when the containers are heated up. Ensure proper cleaning Sterilization and cleaning should be done periodically according to the instructions in the user manual. Bottles should be cooled to room temperature before use. Bottles should be hand-washed with water and soap. The use of strong detergents or brushes should be avoided. Worn-out baby bottles and feeding cups having scratch marks should be discarded because this can cause the release of BPA and other chemicals into the food. 2. For pregnant or breast-feeding women Pregnant and breast-feeding women should avoid cooking or reheating food that has been plastic-wrapped or stored in plastic containers, even if they are microwave-safe. They should not reuse old or damaged containers, and should avoid food stored in cans. 3. For the general public Important measures that should be adopted to reduce the effects of BPA are as follows: Use utensils made of unlined metal, ceramic, or glass, to heat foods instead of plastic and lined metal containers. Plastics marked with recycle codes 1, 2, 4, 5, and 6 are recommended for use as they contain BPA in very low or negligible levels, as against those with recycle codes 3 and 7. Alcohol-based hand cleaners increase BPA absorption through the skin; therefore, it is wise to wash one’s hands with soap and water before handling food. It is better to use containers marked “Dishwasher safe” and “Microwave safe” for their respective purposes alone. Avoid thermal paper receipts from ATMs, grocery stores, and swiping machines as they contain BPA. Do not recycle receipts and other thermal paper since BPA residues from receipts can contaminate recycled paper. Purchase nontoxic wooden or BPA-free plastic toys for children. BPA is also present in dust in small quantities. Regular dusting and cleaning the floors of the house with a vacuum cleaner, wet mop, or a high-efficient air filter (HEPA) is recommended. Dental patients are advised to ask their dentists for BPA-free sealants or fillings. Consumption of coffee prepared in automatic coffeemakers should be avoided, because chemicals such as BPA, phthalates present in plastic containers, and tubings, can leach into the hot coffee. EPA action for reducing BPA The United States Environmental Protection Agency (EPA) concentrates on the production and processing of products that are most likely to cause environmental harm. BPA has been identified under the “Concern List” that includes chemicals causing risk to the environment under the Toxic Substances Control Act. EPA also works with other federal agencies such as the FDA, Consumer Product Safety Commission, Centers for Disease Control and Prevention, and the National Institutes of Health. Action taken by Canadian Government to reduce BPA usage The government of Canada published a report on “Evaluation of BPA risk.” It is based on the sources of exposure to BPA for infants and babies through the use of polycarbonate bottles at high temperatures and leaching of BPA from the can into infant formula. They have also announced other measures such as banning polycarbonate bottles, issuing strict migration restrictions for BPA in infant formula cans, and aiding industries to develop alternate food packaging material and a code of conduct. Reviewed by Liji Thomas, MD. References: https://www.colorado.gov/pacific/sites/default/files/HHW_EnvEpi_Bisphenol-A-%28BPA%29-How-to-Reduce-Exposure_0.pdf https://www.fda.gov/forconsumers/consumerupdates/ucm198024.htm https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm https://www.fda.gov/newsevents/publichealthfocus/ucm064437.htm http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/bpa/faq-20058331 https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/risk-management-bisphenol-bpa http://www.hazwastehelp.org/chemtoxpesticides/bisphenola.aspx http://www.northeastern.edu/protect/for-the-public-the-media/resource-center/protect-yourself-keeping-harmful-chemicals-out-of-your-life/protect-yourself-reduce-exposure-to-bisphenol-a-bpa-in-receipts/ https://www.health.ny.gov/environmental/chemicals/bisphenol_a/ https://www.ncbi.nlm.nih.gov/pubmed/25813067 https://www.omicsonline.org/open-access/correlation-between-bisphenol-a-exposure-and-adverse-health-effects-2329-6798-1000147.php?aid=41487 https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Baby-Bottles-And-Bisphenol-A-BPA.aspx https://oehha.ca.gov/media/downloads/proposition-65/chemicals/bpachemicalspecificfactsheet.pdf http://www.silentspring.org/sites/default/files/six_steps.pdf https://books.google.co.in/books?id=9hRi3ow_Kk4C&pg=PA8&lpg=PA8&dq=reduce+bpa+exposure&source=bl&ots=g-a8KIRnGe&sig=h5LR2jDu3glAb1GWL9hY_EXj8Ao&hl=en&sa=X&ved=0ahUKEwiOlcDIk-_VAhXGrY8KHUOYCao4KBDoAQg3MAM#v=onepage&q=reduce%20bpa%20exposure&f=false Further ReadingBisphenol A (BPA): The FDA's PositionBisphenol A (BPA) Health EffectsBPA: The EFSA positionLink between Bisphenol A and Increase in Blood Pressure Last Updated: Jan 4, 2018" }, "154": { "category_2_x_medical_disease.id": 154, "category_2.id": 39, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphosphonate", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 154, "medical_disease.ts": "2018-04-20 02:38:52", "medical_disease.title": "Bisphosphonates - What are Bisphosphonates?", "medical_disease.content": "By Dr Ananya Mandal, MD Bisphosphonates are medications that used to treat bone loss and are the most common agent to be prescribed for osteoporosis. These drugs can also reduce fracture risk in cases of previous fracture. Bone is constantly undergoing a turnover process in which osteoblasts create bone and osteoclasts destroy it. Bisphosphonates inhibit the actions of osteoclasts by promoting their apoptosis (programmed cell death), which, in turn, slows bone loss. Benefits of bisphosphonates Bisphosphonates slow ongoing bone damage, reduce bone pain and prevent abnormally high blood levels of calcium. In cancer patients with bone damage, bisphosphonates reduce the need for radiotherapy as well as reducing the risk of fracture. Overall, these drugs improve a patient’s chance of healing and recovering bone strength, which leads to an improved quality of life. Uses of bisphosphonates Bisphosphonates are used in bone diseases such as osteoporosis and Paget’s disease. In osteoporosis, bones become brittle and may fracture easily. In Paget’s disease, abnormal bone forms which can cause deformity and pain. The two most commonly prescribed bisphosphonates in the treatment of osteoporosis are alendronate and risedronate. Classes of bisphosphonates Bisphosphonates can be divided into two classes, which include: The nitrogenous bisphosphonates such as palmidronate, alendronate and zoledronate The non-nitrogenous bisphosphonates such as etidronate, clodronate and tiludronate. The two types of bisphosphonates differ in their mechanism of action for killing osteoclast cells. Dosage and administration Bisphosphonates are usually taken as tablets but can also be given by injection. These drugs can cause gastrointestinal irritation and should be taken with water on an empty stomach in the morning. Patients are advised to then wait for at least half an hour before eating or taking any other medications. They should also not lie down for 30 minutes after taking these tablets. For osteoporosis, treatment with bisphosphonates is usually given for at least five years depending on progress. For Paget’s disease, the treatment may be given for a shorter period of time. Side effects The most common side effect of bisphosphonate therapy is gastrointestinal irritation. This may give rise to stomach pain, heartburn, nausea, vomiting, constipation or diarrhoea. Other side effects include dizziness, headache, mouth ulcers and muscle and joint pain. A potentially serious but very rare side effect of bisphosphonate therapy is osteonecrosis of the jaw, which can destroy the jaw bone. Reviewed by Sally Robertson, BSc Sources www.cof.org.cn/.../Mechanisms%20of%20action%20of%20bisphosphonates.pdf http://www.homepages.ucl.ac.uk/~ucgatma/Anat3048/PAPERS www2.breastcancercare.org.uk/sites/default/files/Bisphosphonates.pdf www.utexas.edu/pharmacy/divisions/pharmaco/rounds/asias01-13-12.pdf http://myeloma.org/pdfs/UnderstandingBisphos_b3.2.pdf www.rheumatology.org.au/.../BISPHOSORALAugustfinal260807.pdf Further ReadingBisphosphonate UsesBisphosphonate Side-EffectsBisphosphonate Mechanism Last Updated: Oct 7, 2014" }, "155": { "category_2_x_medical_disease.id": 155, "category_2.id": 39, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphosphonate", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 155, "medical_disease.ts": "2018-04-20 02:38:57", "medical_disease.title": "Bisphosphonate Uses", "medical_disease.content": "By Dr Ananya Mandal, MD Bisphosphonates are agents used to prevent bone damage and are beneficial in the treatment of several diseases that affect the bones. Some of the uses of bisphosphonates include: Paget’s disease Examples of bisphosphonates that are used to suppress bone turnover in Paget’s disease include etidronate, clodronate, pamidronate, alendronate, risedronate and zoledronate. The two most commonly prescribed agents are alendronate and risedronate. Cancer involving the bone Bisphosphonates are very effective in the treatment of secondary cancer, cancer that has spread to the bones from elsewhere in the body. Cancer affecting the bones usually leads to increased bone destruction and high levels of blood calcium. The bones become fragile and prone to fracture, even on minor trauma. Examples of bisphosphonates that have been used for treating secondary cancer of the bone include zoledronate, clodronate, ibandronate, and pamidronate. Osteoporosis Osteoporosis is a condition that renders the bones brittle, fragile and prone to breakage. Osteoporosis is one of the more recent indications for bisphosphonate therapy. Etidronate was the first bisphosphonate approved to treat the condition, followed by alendronate, risedronate, ibandronate and zoledronate. These agents have been shown to increase bone mass and reduce spinal fracture risk by 30% to 70% in postmenopausal women. The long-term use (5–10 years) of bisphosphonates as a treatment for osteoporosis appears to be safe. Osteogenesis imperfecta Bisphosphonates may also be useful in “brittle bone” disorder or osteogenesis imperfecta. Palmidronate, in particular, has proved to be an effective treatment for this condition. Reviewed by Sally Robertson, BSc Sources www.cof.org.cn/.../Mechanisms%20of%20action%20of%20bisphosphonates.pdf http://www.homepages.ucl.ac.uk/~ucgatma/Anat3048 www2.breastcancercare.org.uk/sites/default/files/Bisphosphonates.pdf www.utexas.edu/pharmacy/divisions/pharmaco/rounds/asias01-13-12.pdf http://myeloma.org/pdfs/UnderstandingBisphos_b3.2.pdf www.rheumatology.org.au/.../BISPHOSORALAugustfinal260807.pdf Further ReadingBisphosphonates - What are Bisphosphonates?Bisphosphonate Side-EffectsBisphosphonate Mechanism Last Updated: May 2, 2014" }, "156": { "category_2_x_medical_disease.id": 156, "category_2.id": 39, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphosphonate", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 156, "medical_disease.ts": "2018-04-20 02:39:03", "medical_disease.title": "Bisphosphonate Side-Effects", "medical_disease.content": "By Dr Ananya Mandal, MD Bisphosphonate therapy does not usually cause severe side effects. Some of the most common side effects seen with this form of treatment include: Gastrointestinal irritation – Bisphosphonates can lead to irritation and inflammation of the esophagus and stomach lining. This can lead to heart burn, acid reflux, stomach pain, nausea, vomiting, constipation and diarrhea. Patients are advised to take bisphosphonates on an empty stomach with water, first thing in the morning. Patients should then wait for at least half an hour before eating or taking any other medications. They should also not lie down for 30 minutes after taking the tablets. Other side effects include fever, dizziness, blurred vision, red or painful eyes and headache. Fever associated with bisphosphonates is typically mild (100 to 101°F) and usually only seen after intravenous infusion of the drug. The fever may last for a few hours. Rarely, bisphosphonates cause mouth ulcers, swollen joints and muscle pain but these side effects are usually short term. Some patients may develop skin reactions such as a rash, itchiness or redness that may worsen on exposure to sunlight. A potentially serious but very rare side effect of bisphosphonate therapy is osteonecrosis of the jaw, which can destroy the jaw bone. Osteonecrosis is related to dental infection and all patients taking bisphosphonates need to be monitored closely for any dental infections, which will need to be treated promptly. Bisphosphonate use can lead to kidney damage and kidney dysfunction in some cases. Injections of bisphosphonates may irritate the veins causing them to inflame, a condition called phlebitis. Patients usually recover within 1 to 2 days. Reviewed by Sally Robertson, BSc Sources www.cof.org.cn/.../Mechanisms%20of%20action%20of%20bisphosphonates.pdf http://www.homepages.ucl.ac.uk/~ucgatma/Anat3048/ www2.breastcancercare.org.uk/sites/default/files/Bisphosphonates.pdf www.utexas.edu/pharmacy/divisions/pharmaco/rounds/asias01-13-12.pdf http://www.nejm.org/doi/pdf/10.1056/NEJMct1004903 http://myeloma.org/pdfs/UnderstandingBisphos_b3.2.pdf www.rheumatology.org.au/.../BISPHOSORALAugustfinal260807.pdf Further ReadingBisphosphonates - What are Bisphosphonates?Bisphosphonate UsesBisphosphonate Mechanism Last Updated: May 2, 2014" }, "157": { "category_2_x_medical_disease.id": 157, "category_2.id": 39, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bisphosphonate", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 157, "medical_disease.ts": "2018-04-20 02:39:07", "medical_disease.title": "Bisphosphonate Mechanism", "medical_disease.content": "By Dr Ananya Mandal, MD Normal bone physiology Bones are living tissues that undergo constant remodelling. In a healthy bone that has finished growing, the breakdown of old bone (by osteoclasts) and the formation of new bone (by osteoblasts) is a carefully regulated process. What happens in osteoporosis and bone damage? When osteoporosis occurs or when cancer affects the bones, the proportion of osteoclasts and osteoblasts becomes unbalanced and more bone is broken down than is replaced. This can cause the bones to weaken and become more prone to fracture, even on minor trauma or injury. How do bisphosphonates help? Bisphosphonates reduce the number and action of the osteoclasts, slowing the process of bone breakdown. Bisphosphonates cannot replace lost bone but can strengthen existing bone and reduce the damage that is caused by the disease process. Bisphosphonate molecules adhere to calcium and since the largest store of calcium in the human body is found in bones, high levels of bisphosphonates accumulate. The osteoclasts ingest the bound bisphosphonates and are eventually destroyed. Bisphosphonate types Bisphosphonates can be divided into two classes, which include: The nitrogenous bisphosphonates such as palmidronate, alendronate and zoledronate The non-nitrogenous bisphosphonates such as etidronate, clodronate and tiludronate. The two types of bisphosphonates differ in their mechanism of action for killing osteoclast cells. The non-nitrogenous bisphosphonates are taken up by the osteoclasts, which then die. Nitrogenous bisphosphonates bind and block the enzyme farnesyl diphosphate synthase in the HMG-CoA reductase pathway (also known as the mevalonate pathway). This prevents formation of farnesol and geranylgeraniol, metabolites that are important for connecting some small proteins to the cell membrane. This phenomenon is known as prenylation. Prenylation is an important part of bone health and remodelling. Benefits of treatment Some examples of the benefits bisphosphonate therapy provides include: Bone pain is relieved when bisphosphonates are used to treat Paget’s disease. In cancer patients with bone damage, bisphosphonates reduce the risk of pathological fracture. IA bone mineral density test (X-ray) is used to measure progress in osteoporosis therapy. An increased bone mineral density suggests the condition is improving. This test is taken every year or alternate years and detects the amount of calcium and minerals in the bones. Bisphosphonates correct and prevent abnormally high blood levels of calcium. In cancer patients with bone damage, bisphosphonates reduce the need for radiation therapy. Bisphosphonates improve the chances of bones healing and becoming stronger, therefore improving the patient’s quality of life. Reviewed by Sally Robertson, BSc Sources www.cof.org.cn/.../Mechanisms%20of%20action%20of%20bisphosphonates.pdf http://www.homepages.ucl.ac.uk/~ucgatma/Anat3048/ www2.breastcancercare.org.uk/sites/default/files/Bisphosphonates.pdf www.utexas.edu/pharmacy/divisions/pharmaco/rounds/asias01-13-12.pdf http://www.nejm.org/doi/pdf/10.1056/NEJMct1004903 http://myeloma.org/pdfs/UnderstandingBisphos_b3.2.pdf www.rheumatology.org.au/.../BISPHOSORALAugustfinal260807.pdf Further ReadingBisphosphonates - What are Bisphosphonates?Bisphosphonate UsesBisphosphonate Side-Effects Last Updated: May 2, 2014" }, "158": { "category_2_x_medical_disease.id": 158, "category_2.id": 40, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 158, "medical_disease.ts": "2018-04-20 02:39:13", "medical_disease.title": "How to Keep a Bladder Diary", "medical_disease.content": "By Dr Liji Thomas, MD Urge incontinence is caused by sudden spasms of the bladder muscle, or by an overactive bladder. This may be due to abnormal signals between the brain and the bladder. One way of approaching this problem is by keeping a bladder diary. Bladder diary headings A bladder diary consists of information charted by time, as to when you drink and how much, how much urine you pass and when. It also contains the timing, and amount, of urinary leakage. In most cases, your doctor will advise you to complete your bladder diary for three to seven days. The following headings will be requested: Fluid intake How much you drink, in milliliters or in cups or ounces. What fluids you drink When you drink each drink Fluids that should be charted include not just water, beverages and juices, or soups, but also ice cream, jellies, broth and sherbet. In fact, the bladder diary should note any food which is watery or turns liquid at room temperature. Urine output The amount of urine passed (a graduated vessel such as a urine hat may be used to measure it) When you pass urine in the bathroom The occurrence of urinary leakage Urge before urination Related StoriesSchistosomiasis: the biggest killer you’ve never heard of?Pioneering catheter insertion kit unveiled at the American Urology Association (AUA)Identifying overactive bladder syndromeDescribe your sensation at the time of each leakage/visit to the bathroom from the list below: Voided without a desire to void (for example, to keep to the bladder retraining schedule) Had a desire to void but did not void till the scheduled time Had the need to void but could put it off for a little while Had the urgent need to void and rushed to the bathroom Had the urgent need to void and leakage occurred before I reached the bathroom Activity at the time of leakage The activity you were engaged in through each episode of leakage: coughing, sneezing, lifting something heavy, standing, lying, or sitting down. Did you feel the urge to urinate or not before leakage occurred? How much urine leaked? A few drops Enough to wet the underwear or a pad Enough to soak underclothes, or empty the bladder How long should I log my urination pattern? The bladder diary should be used to track your drinking, urination and leakage patterns for three to seven days in succession. If you go to work, you should have a separate copy to keep at the office. Both copies should be taken when you report to your doctor. Though a bladder diary may be kept for any number of days, in practice the three-day diary is just as effective and accurate in its detailing of bladder voiding data as the longer versions. In addition, it reduces the chances that the patient will fill up a missed day or period from memory, increasing the truth and reproducibility of the records. A bladder diary may also be kept to provide a record of progress in bladder training, and to act as a source of motivation in case an occasional leakage happens. It also helps to identify when you can anticipate the possible occurrence of a leakage and take steps to avoid it, such as not drinking coffee or tea before going out or at bedtime. Reviewed by Dr Tomislav Meštrović, MD, PhD Resources http://www.guysandstthomas.nhs.uk/resources/patient-information/gynaecology/Bladder-diary.pdf https://patienteducation.osumc.edu/documents/voiding-record.pdf https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/daily-bladder-diary/Documents/diary_508.pdf http://www.ncbi.nlm.nih.gov/pubmed/16225527 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072614/ Further ReadingBladder Control and Diet ChangesUrine Analysis / UrinalysisWhat Does Urinalysis Involve?Urinalysis ParametersWhat Does 24-Hour Urine Collection Test Involve? // Last Updated: Aug 3, 2017" }, "159": { "category_2_x_medical_disease.id": 159, "category_2.id": 40, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 159, "medical_disease.ts": "2018-04-20 02:39:14", "medical_disease.title": "Bladder Control and Diet Changes", "medical_disease.content": "By Dr Liji Thomas, MD A healthy bladder will have an adequate capacity to retain urine and provide strong urges to pass urine when the maximum capacity is neared. In patients with limited storage capacity for various reasons - e.g. a small bladder or an irritable detrusor muscle - symptoms such as urinary incontinence will arise. These may include increased frequency of voiding by day and by night, with urgency and often urge incontinence. The role of foods and beverages on the bladder or on urine production by the kidney has been investigated in several studies. It is known that modifying the diet to dispose of these possible irritants or continence challenges may be helpful in preventing or reducing incontinence. Yet it is important to note that healthy bladder habits do not automatically mean healthy bladder function, as many factors (many of them unknown) are involved in the proper bladder function. Caffeine Caffeine is not only a diuretic of considerable potency, but is found in many foods and beverages. These include tea, coffee, several medications (available both with and without prescription), and many soft drinks. The role of caffeine in stimulating the bladder muscle, increasing its excitability and increasing the detrusor pressure is well known, and thus it provokes the symptoms of overactive bladder. The effects depend upon the dose. The patient needs to be asked about caffeine intake, and educated about the relationship between caffeine and overactive bladder symptoms. In addition, they may be asked to replace their caffeinated with non-caffeinated drinks, and the effects on the patient’s symptoms may be noted. If the change is not remarkable, and patients do not want to quit caffeine, they should be advised to limit their caffeine intake to 200 milligrams or less per day. This is equal to two cups of normal coffee. The restriction is intended to produce benefits such as the reduction in the symptoms of frequency and urgency. Other foods and drinks which provoke bladder irritability Though the evidence is weak, some studies do suggest a link between overactive bladder, urge incontinence and carbonated drinks in females. Furthermore, aspartame and other synthetic sweeteners have been shown to promote detrusor contractions in rodents, and if so, their consumption may lead to overactive bladder symptoms. Alcoholic drinks, citrus fruits, citrus juices, and hot peppers, may all increase the discomfort or excitability of the bladder, and provoke urinary leakage. The patient should be informed of the negative effects of these foods and advised to moderate their usage. In addition to these foods, specialists suggest eliminating suspect foods one by one from the diet to observe the effect of such omissions on the bladder symptoms. Fluid intake Related StoriesNew guide confronts unspoken subject of men’s incontinenceScientists create organoids that could help guide bladder cancer treatmentPioneering catheter insertion kit unveiled at the American Urology Association (AUA)It is well known that drinking too much fluid can lead to worsening of overactive bladder symptoms and provoke urinary leakage. However, the solution is not to restrict fluids, for the resulting over-concentration of urine may cause further irritation of the bladder mucosa, leading in turn to urgency, frequency and even infections of the urinary tract. It is thus wise to make an initial assessment of the patient’s current fluid intake, using (for instance) a bladder diary. The total intake per day should be about 1500 milliliters, but this should be differentiated depending on the patient’s weight. About 30 milliliters of fluid should be advised for each kilogram of body weight within a 24-hour period (according to the US Food Science Board guidelines). However, the fluid intake in the evening, for three to four hours preceding bedtime, should be restricted to avoid nocturnal frequency. Instead, more of the total intake should be in the morning and afternoon. Constipation and incontinence Constipation may be understood as defecation occurring less than three times a week, or as having to strain in order to pass stools. This condition is directly associated with urge incontinence in elderly patients, as well as with overactive bladder. Constipation of a severe degree also appears to be linked with loss of function of the pelvic floor muscles. In addition, when constipation is relieved, urgency and frequency of urination also show a considerable improvement. Dealing with chronic constipation is best done by choosing high-fiber foods such as wheat bran, deliberately drinking more liquid during the daytime, doing regular physical exercise of some sort, and setting up a routine for passing stools at a regular time. In addition, patients should be informed of the ill-effects of not responding to the urge to pass stools at once, instead postponing it for some reason. This leads to further drying out and hardening of the stools, exacerbating constipation. Diet control for weight reduction Being overweight or obese is a risk factor for overactive bladder symptoms, as well as urge incontinence in both men and women. This is probably due to the increased pressure exerted on the pelvic floor by the excessive weight which pushes up the intra-abdominal pressure. Chronically increased pelvic floor stress can damage the pelvic diaphragm, either the muscles or the nervous regulation, leading to dysfunction of bladder control. Weight control is thus of great importance in obese patients with urge incontinence. This should be given due attention, with regard to the proper diet in relation to other medical conditions which the patient has. In addition, tobacco smoking increases bladder irritation and provokes leakage of urine. The cough so often present in smokers also precipitates urinary stress incontinence. Reviewed by Dr Tomislav Meštrović, MD, PhD Resources http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734927/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206217/ http://www.womenshealth.gov/publications/our-publications/fact-sheet/urinary-incontinence.html https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-incontinence-in-men/Pages/facts.aspx#treatment Further ReadingHow to Keep a Bladder DiaryWhat is Bladder Cancer?What Causes Bladder Cancer?Bladder Cancer DiagnosisBladder Cancer TreatmentMore... // Last Updated: Aug 3, 2017" }, "160": { "category_2_x_medical_disease.id": 160, "category_2.id": 41, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 160, "medical_disease.ts": "2018-04-20 02:39:19", "medical_disease.title": "What is Bladder Cancer?", "medical_disease.content": "By Dr Ananya Mandal, MD Bladder cancer refers to the growth of a tumor within the lining of the bladder. In some cases, the tumor can invade surrounding tissue and spread to other parts of the body. The most common symptom of bladder cancer is blood in the urine and this should be investigated by a doctor. Normal urinary bladder The bladder is a hollow, balloon-like organ located in the pelvis that stores urine before it is excreted from the body. Urine produced in the kidneys is passed into the bladder via tubes called the ureters, which enter the bladder from either side. When the bladder is full, muscles in the bladder contract to push urine out of the body via a tube called the urethra. Types of bladder cancer One of the most common types of bladder cancer is transitional cell or urothelial carcinoma, which makes up about 90% of bladder cancers. These carcinomas resemble the urothelial cells that normally line the inner walls of the bladder. Urothelial cells are also found lining other parts of the urinary tract such as the ureters, urethra and parts of the kidneys. Transitional cell carcinomas can also affect these areas. Bladder tumors can be divided into non-invasive cancers, which are still confined to the bladder lining, and invasive cancers that have penetrated the lamina propria or grown even deeper into the muscle layers of the bladder. Transitional cell carcinomas are also divided into two subtypes: Papillary carcinomas – These are finger-like processes that extend from the inner surface of the bladder towards the centre. These are referred to as non-invasive papillary cancers, unless they grow into layers beyond the inner layer of bladder cells. If this occurs, the tumor is considered an invasive transitional cell carcinoma. Flat carcinomas – These growths stay flat against the lining of the bladder and do not grow towards its centre. If the flat tumor is confined to the inner layer of bladder cells, it is classed as a non-invasive carcinoma. If the tumor grows into the deeper layers of the bladder, however, it becomes an invasive transitional cell carcinoma. Related StoriesScientists create organoids that could help guide bladder cancer treatmentRisk factors associated with bladder cancer Some factors raise the risk of getting bladder cancer. Some of these risk factors are modifiable, such as smoking, while factors such as a family history of the condition are not modifiable. Some examples of the risk factors for developing bladder cancer include smoking, exposure to harmful chemicals (such as aromatase amines in dyes), older age, chronic bladder irritation, being female, and family history of the condition. Diagnosis To diagnose bladder cancer, a doctor tries to establish whether there are any risk factors for the condition. A physical examination of the rectum and vagina may be carried out to check for lumps and a urine sample arranged to test for infection or abnormal cells. If bladder cancer is suspected, a patient is referred for further tests such as cystoscopy, biopsy and a computed tomography (CT) scan. Treatment In cases of non-muscle invasive bladder cancer, the cancerous tissue can usually be removed while leaving the remainder of the bladder in tact. This is achieved using a technique called transurethral resection of a bladder tumor (TURBT), which may be followed by a dose of chemotherapy administered to the bladder to help prevent recurrence of the cancer. In cases of muscle-invasive bladder cancer, the whole bladder is usually removed in a process called radical cystectomy. If surgery is not possible, radiotherapy and chemotherapy may be advised. Those with non-muscle invasive bladder cancer usually survive for at least 5 years after diagnosis (in 80% to 90% of cases). However, recurrence rates are high, with a more invasive form of the cancer returning in around 10% of cases. Those with muscle-invasive bladder cancer have less chance of surviving for five years after diagnosis. Bladder cancer statistics Bladder cancer usually occurs in people aged over 55 years and the average age at diagnosis is 73 years. Bladder cancer is the fourth most common cancer diagnosed in men and is four times more common among men than among women. Overall, the chance that a man will develop bladder cancer during his lifetime is about 1 in 26, whereas for women, the chance is about 1 in 90. However, women who do develop the condition tend to have a worse outcome, since they are more prone to developing the muscle-invasive form of bladder cancer. White people are diagnosed with bladder cancer almost twice as often as black people are. Reviewed by Sally Robertson, BSc Sourceswww.nhs.uk/conditions/cancer-of-the-bladder/Pages/Introduction.aspx http://www.cancer.gov/cancertopics/wyntk/bladder/WYNTK_bladder.pdf www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf http://www.urologyhealth.org/content/moreinfo/bladdercancer.pdf http://www.cap.org/apps/docs/reference/myBiopsy/BladderUrothelial.pdfFurther ReadingWhat Causes Bladder Cancer?Bladder Cancer DiagnosisBladder Cancer TreatmentSymptoms of Bladder CancerWhat is Intravesical Therapy? Last Updated: Apr 23, 2014" }, "161": { "category_2_x_medical_disease.id": 161, "category_2.id": 41, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 161, "medical_disease.ts": "2018-04-20 02:39:21", "medical_disease.title": "What Causes Bladder Cancer?", "medical_disease.content": "By Dr Ananya Mandal, MD The exact cause of bladder cancer is not yet clear but certain factors that increase the risk of developing this condition have been identified. Cancer begins with a change in the genetic “blueprint” or DNA of the cell, which is contained in the nucleus. This DNA provides the cell with the instructions necessary for its growth, maturity, function and eventually death. A change in the structure of DNA is called a mutation. Normally, DNA damage is either repaired or the cells dies, but in the case of cancer, a cell containing abnormal DNA does not get repaired and still goes onto survive. The abnormal cell then proliferates, giving rise to further abnormal cells and eventually a tumor. Several factors are known to increase the risk of these DNA mutations occurring. Some of these include: Age – Bladder cancer usually occurs in people aged over 55 years and the average age-at-diagnosis is 73 years. Gender – Men are about three to four times more likely to develop bladder cancer than women are. However, women are at a greater risk of developing an invasive type of cancer that has a poorer outlook. Related StoriesScientists create organoids that could help guide bladder cancer treatmentSmoking – Smoking tobacco is the most important risk factor for bladder cancer. Studies have shown that smokers are at a significantly greater risk of bladder cancer than people who do not smoke or who only smoke for a short time. Exposure to harmful chemicals – Exposure to certain chemicals is another important cause of bladder cancer. Exposure to chemicals in the workplace (such as aniline dyes, 2-aaphthylamine, 4-Aminobiphenyl, xenylamine and benzidine) has been linked to an increased risk for bladder cancer. Arsenic – Exposure to arsenic has been linked to bladder cancer. In some parts of the world, high levels of arsenic are found in drinking water. Previous history of bladder cancer – People who have been treated once for non-invasive bladder cancer are at risk of the cancer recurring. They are also at risk of the cancer returning as a more aggressive, invasive form. Previous cancer therapy – People who have been treated with chemotherapy drugs such as cyclophosphamide are at an increased risk for bladder cancer. Radiotherapy also increases this risk, especially if the treatment was directed at the abdomen or pelvis. Family history of bladder cancer – People with a first degree relative such as a parent or sibling who has had bladder cancer are at an increased risk of developing this cancer. Reviewed by Sally Robertson, BSc Sourceshttp://www.nhs.uk/Conditions/Cancer-of-the-bladder/Pages/Causes.aspx http://www.cancer.gov/cancertopics/wyntk/bladder/WYNTK_bladder.pdf www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf http://www.urologyhealth.org/content/moreinfo/bladdercancer.pdf http://www.cap.org/apps/docs/reference/myBiopsy/BladderUrothelial.pdfFurther ReadingWhat is Bladder Cancer?Bladder Cancer DiagnosisBladder Cancer TreatmentSymptoms of Bladder CancerWhat is Intravesical Therapy? Last Updated: Apr 23, 2014" }, "162": { "category_2_x_medical_disease.id": 162, "category_2.id": 41, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 162, "medical_disease.ts": "2018-04-20 02:39:22", "medical_disease.title": "Bladder Cancer Diagnosis", "medical_disease.content": "By Dr Ananya Mandal, MD Bladder cancer may be suspected based on symptoms of the condition such as blood in the urine and the presence of risk factors such as a family history of bladder cancer. A diagnosis of bladder cancer usually involves the following steps: Details of the patient’s symptoms are obtained along with the details of any risk factors for bladder cancer such as a history of smoking, exposure to certain chemicals, or a family history of the condition. A physical examination of the rectum and vagina may be carried out to check for lumps and a urine sample arranged to test for infection or abnormal cells. If bladder cancer is suspected, a patient is referred for further tests such as cystoscopy, biopsy and a computed tomography (CT) scan. A urine sample is tested in the laboratory for the presence of infection or abnormal cells. The process of checking urine for abnormal cells is called urine cytology. Urine cytology may not be completely accurate, sometimes detecting abnormal cells when no cancer is present or failing to detect cancer when cancer is in fact present. This test is therefore often used alongside other tests to help diagnose the condition rather than acting as a definitive test in itself. Another useful test is cystoscopy. For this test, a long, thin flexible tube with a light and a camera attached is inserted into the urethra and used to view the inside of the bladder. The procedure usually takes 5 to 10 minutes. If cystoscopy reveals an abnormality in the bladder, a biopsy may be performed to remove tissue from the bladder for further analysis. If a biopsy suggests that cancer cells are present, a diagnosis of bladder cancer can be confirmed with imaging studies. These tests can also determine whether the cancer has spread beyond the bladder, and if so, how far. One examples of an imaging studies is a computerised tomography (CT) scan which uses a series of X-rays to show a detailed view of the inside of the body. A contrast dye may be administered to highlight areas of abnormality. A magnetic resonance imaging (MRI) scan may also be used to detect the tumor. Related StoriesScientists create organoids that could help guide bladder cancer treatmentAfter the cancer is detected, it is staged, which means determining how aggressive the cancer is and how likely it is to spread. This helps physicians to predict the likely outcome of treatments and choose the most appropriate therapy. The most widely used staging system for bladder cancer is the TNM system where T stands for tumor size, N for lymph node involvement and M for metastasis or spread of the cancer. Tumor size is categorized as the following: TIS or CIS (carcinoma in situ) refers to very early stage cancer that is confined the innermost lining of the bladder Ta refers to cancer that is just within the innermost lining of the bladder T1 refers to cancer that has started to spread beyond the bladder lining T2 is the first stage of muscle-invasive cancer, where the cancer has spread beyond the connective tissue and into the muscle of the bladder T3 refers to cancer that has protruded the bladder muscle and spread into the surrounding fat T4 is advanced bladder cancer that has spread beyond the bladder to other surrounding organs Lymph Node involvement is categorized in the following way: N0 indicates no lymph node involvement N1 indicates involvement of a single lymph node in the pelvis N2 indicates that two or more lymph nodes in the pelvis are affected N3 indicates that one or more lymph nodes in the groin are affected. Metastasis is divided into the following two categories: M0 indicates no spread of the cancer to other parts of the body M1 indicates that the cancer has spread beyond the bladder to other organs such as the liver, lungs and brain. Reviewed by Sally Robertson, BSc Sourceswww.nhs.uk/Conditions/Cancer-of-the-bladder/Pages/Diagnosis.aspx http://www.cancer.gov/cancertopics/wyntk/bladder/WYNTK_bladder.pdf www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf http://www.urologyhealth.org/content/moreinfo/bladdercancer.pdf http://www.cap.org/apps/docs/reference/myBiopsy/BladderUrothelial.pdfFurther ReadingWhat is Bladder Cancer?What Causes Bladder Cancer?Bladder Cancer TreatmentSymptoms of Bladder CancerWhat is Intravesical Therapy? Last Updated: Apr 28, 2014" }, "163": { "category_2_x_medical_disease.id": 163, "category_2.id": 41, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 163, "medical_disease.ts": "2018-04-20 02:39:28", "medical_disease.title": "Bladder Cancer Treatment", "medical_disease.content": "By Dr Ananya Mandal, MD The treatment of bladder cancer often involves a range of specialists from different fields including a clinical oncologist (cancer specialist), a radiologist, a pathologist, a social worker, a psychologist and a cancer nurse. Treatment plan for non-muscle-invasive bladder cancer In cases of non-invasive bladder cancer, the type of treatment is usually determined by various factors that predict patient outcome. Examples of these factors include size and location of the tumor, tumor number, cancer aggression level and whether there is any family history of bladder cancer. If the risk of the cancer growing or spreading is low, surgery to remove the tumor is usually recommended, followed by localized chemotherapy to reduce the risk of the cancer recurring. Surgical approach To remove a non-invasive bladder cancer, a procedure called transurethral resection of the bladder tumor (TURBT) is the most commonly chosen technique. In the majority of cases, a TURBT can be carried out during a biopsy procedure. The surgery is performed under general anaesthesia using a cystoscope to locate and cut away the tumor. Chemotherapy Chemotherapy may be given in two forms. Systemic chemotherapy is administered intravenously or injected into a muscle while local chemotherapy is targeted directly at the area affected by cancer. One form of local chemo is intravesical chemotherapy, where a solution of anticancer agents are placed directly into the bladder using a catheter. These drugs kill actively growing cancer cells and examples of the most commonly used agents are mitomycin and thiotepa. The solution is left in the bladder for about an hour before being drained away. The urine may contain some of the medication, so washing with soap and water is recommended after urination to prevent skin irritation. Systemic chemotherapy kills any rapidly dividing cells including cells that are not cancerous. This can cause various side effects such as nausea, vomiting, diarrhea, reduced appetite, hair loss and mouth ulcers. This form of therapy can also suppress the bone marrow causing anemia, infection and a tendency to bleed. With the use of intravesical chemotherapy, these side effects can be avoided. The most common side effect of intravesical chemotherapy is irritation of the bladder lining, which passes in a few days. Related StoriesScientists create organoids that could help guide bladder cancer treatmentBacillus Calmette-Guérin (BCG) vaccine Another intravesical treatment that may be given is the Bacillus Calmette-Guerin (BCG) vaccine. This is the most effective form of intravesical immunotherapy for early-stage bladder cancer. The presence of BCG in the bladder attracts the body’s immune cells, which then destroy the bladder cancer cells. Treatment plan for muscle-invasive bladder cancer Patients with muscle-invasive bladder cancer often have a less positive outlook than those with non-invasive cancer or cancer that has not yet invaded the muscle. The treatment recommended depends on the extent to which the cancer has spread. Cancer that has reached stages T2, T3 or T4, is often treated with a combination of chemotherapy, radiotherapy and surgery. Surgical approach The most common treatment method for muscle-invasive bladder cancer is radical cystectomy. This involves removal of the whole bladder as well as the nearby lymph nodes and some of the urethra. In men, the prostate is also removed and in women, the cervix and uterus is removed. An alternative outlet for urine is created during the procedure and is called a urinary diversion. Radiotherapy Radiotherapy kills cancer cells using pulses of radiation. Radiotherapy may be administered as a primary treatment to try and cure bladder cancer in people who cannot tolerate surgery. Radiotherapy may also be used as a palliative therapy to help relieve symptoms and ease suffering in cases of incurable cancer. Radiotherapy can lead to numerous side effects such as diarrhea, local skin inflammation, pain on urination, infertility and erectile dysfunction. Chemotherapy Intravenous chemotherapy may be given before radiotherapy to shrink the size of any tumors. The therapy may also be given in combination with radiotherapy before surgery or as a form of palliative therapy in cases of advanced cancer. Reviewed by Sally Robertson, BSc Sourceswww.nhs.uk/Conditions/Cancer-of-the-bladder/Pages/Treatment.aspx http://www.cancer.gov/cancertopics/wyntk/bladder/WYNTK_bladder.pdf www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf http://www.urologyhealth.org/content/moreinfo/bladdercancer.pdf http://www.cap.org/apps/docs/reference/myBiopsy/BladderUrothelial.pdfFurther ReadingWhat is Bladder Cancer?What Causes Bladder Cancer?Bladder Cancer DiagnosisSymptoms of Bladder CancerWhat is Intravesical Therapy? Last Updated: Apr 23, 2014" }, "164": { "category_2_x_medical_disease.id": 164, "category_2.id": 41, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 164, "medical_disease.ts": "2018-04-20 02:39:33", "medical_disease.title": "Symptoms of Bladder Cancer", "medical_disease.content": "By Dr Ananya Mandal, MD Some of the most common symptoms of bladder cancer include: Blood in the urine The presence of blood in the urine or hematuria is usually the first warning sign of bladder cancer. Depending on how much blood is present, the urine may appear a pale yellow-red or pink color. Sometimes, it may be even be dark red. Related StoriesScientists create organoids that could help guide bladder cancer treatmentSometimes, the amount of blood in the urine may be too small to be visible to the naked eye and may only be detected in a laboratory. Blood may also be present one day but not the next, with the urine staying clear for months. In the case of bladder cancer, however, the blood eventually reappears. Blood in a person’s urine does not necessarily mean they have bladder cancer. Hematuria may also be caused by urinary tract infections, benign tumors, bladder or kidney stones or other benign kidney diseases. Changes in urination Patients with bladder cancer may find they need to urinate more frequently and more suddenly. A person may feel the urgent need to urinate even though the bladder is not full. The patient may also experience pain or burning on urination. These symptoms may also be caused by conditions such as bladder infection, bladder stones or an overactive bladder but patients are advised to have any of these symptoms checked out by a doctor. Advanced bladder cancer Pain is not a common finding in bladder cancer but cancer that has advanced beyond the bladder to other parts of the body may cause back pain or bone pain. Patients may also experience excess fatigue and unexplained weight loss in cases of advanced disease. Reviewed by Sally Robertson, BSc Sourceswww.nhs.uk/Conditions/Cancer-of-the-bladder/Pages/Treatment.aspx http://www.cancer.gov/cancertopics/wyntk/bladder/WYNTK_bladder.pdf www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf http://www.urologyhealth.org/content/moreinfo/bladdercancer.pdf http://www.cap.org/apps/docs/reference/myBiopsy/BladderUrothelial.pdfFurther ReadingWhat is Bladder Cancer?What Causes Bladder Cancer?Bladder Cancer DiagnosisBladder Cancer TreatmentWhat is Intravesical Therapy? Last Updated: Apr 23, 2014" }, "165": { "category_2_x_medical_disease.id": 165, "category_2.id": 41, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 165, "medical_disease.ts": "2018-04-20 02:39:37", "medical_disease.title": "What is Intravesical Therapy?", "medical_disease.content": "By Yolanda Smith, BPharm Intravesical therapy is widely used in practice as an adjuvant treatment for early stage bladder cancer, following surgical transurethral resection. This is because it is a localized treatment that is administered directly into the bladder, leading to fewer systemic side effects but reduced efficacy on any metastases throughout the body. Treatment Overview The primary goal of intravesical therapy is to eradicate tumors from the localized area in the bladder. This may involve the use of cytotoxic or immunostimulatory agents to eliminate the abnormal cancer cells, according to the specific case and characteristics of the patient. It is a suitable option for early stage cancers that are noninvasive (stage 0) or minimally invasive (stage 1), whereas systemic therapy is preferred for higher stage or metastatic bladder cancer. For some patients with bladder cancer, intravesical therapy is the only treatment they will need to treat the cancer. This is considered to be preferable as the therapy is associated with significantly few side effects than other treatment. Procedure Initially, intravesical therapy involves the application of an anesthetic gel to the urethral area to numb the sensation and allow the insertion of a catheter into the urethra. Once inserted, the catheter is gently pushed upwards until it reaches the bladder. From this point, the catheter can then used to administer a liquid drug formulation directly to the bladder, bypassing the oral or intravenous route and thus minimizing systemic effects. The catheter can then be removed and the patient should be advised to refrain from passing urine in the next few hours, to allow the medication enough time in the bladder to have an optimal effect. After this time, the patient can relieve himself or herself as usual, or the urine may be drained with the catheter if still inserted, to eliminate the chemotherapy drug from the body. Care should be taken that urine passed in the next 6 hours does not come in contact with the skin, as it may cause an adverse reaction. Pharmaceutical Agents Related StoriesScientists create organoids that could help guide bladder cancer treatmentImmunotherapy agents stimulate the immune system to attack the cancer cells and include Bacillus Calmette-Guerin (BCG) and interferon. BCG is the most effective and is a bacterium that attracts the cells of the immune system to the area, which also affect the cancer cells in the bladder. This treatment is usually given in six separate doses, once a week for six weeks. Side effects of treatment with BCG may include flu-like symptoms, including fever, chills and fatigue. In rare cases, it can spread throughout the body and cause an infection similar to tuberculosis. Interferon-alpha is a substance that naturally has a stimulatory effect on the immune system. Side effects of treatment with this may include muscle aches, bone pain, headaches, nausea, vomiting, fatigue and loss of concentration. Cytotoxic agents used in intravesical chemotherapy target the cell division process of all cells in the area. There are a wide range of cytotoxic agents that may be indicated, including mitomycin C, valrubicin, doxorubicin, epirubicin, and gemcitabine. The primary side effects associated with this therapy are irritation and burning, which are localized to the bladder. References http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-treating-intravesical-therapy http://www.cancerresearchuk.org/about-cancer/type/bladder-cancer/treatment/early/treatment-into-the-bladder http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440939/ Further ReadingWhat is Bladder Cancer?What Causes Bladder Cancer?Bladder Cancer DiagnosisBladder Cancer TreatmentSymptoms of Bladder Cancer Last Updated: Jan 18, 2016" }, "166": { "category_2_x_medical_disease.id": 166, "category_2.id": 42, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Stones", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 166, "medical_disease.ts": "2018-04-20 02:39:40", "medical_disease.title": "Symptoms and Diagnosis of Bladder Stones", "medical_disease.content": "By Yolanda Smith, BPharm Bladder stones are hard masses of mineral that form in the bladder when it doesn’t empty entirely. Some patients with bladder stones may not notice any symptoms, as the lumps are small enough to pass out of the bladder and be excreted in the urine. However, other patients with larger stones that irritate the bladder wall or obstruct the urine flow report several symptoms. Diagnosis of bladder stones involves a consultation to discuss medical history and a physical examination. This is often followed by diagnostic imaging techniques, such as a spiral computed tomography (CT) scan, x-ray or ultrasound to confirm the presence of bladder stones. Image Copyright: joloei, Image ID: 93276157 via Shutterstock.com Symptoms Symptoms of bladder stones are usually only evident when the stones irritate the bladder lining or obstruct the flow of urine. The typical symptoms of a patient presenting with bladder stones may include: Moderate-severe lower abdominal pain Difficulty or pain upon urination Frequent urge to urinate Cloudy or dark urine Hematuria Pain in or around penis (in men) It is common for the flow of urine to suddenly stop and the patient to experience some pain in the penis, scrotum, perineum back or hip. Additionally, many patients with bladder stones also have a urinary tract infection (UTI), with symptoms such as pain and fever. This is because a UTI can both cause and result from bladder stones. Initial Diagnostic Tests The diagnosis of bladder stones usually begins with a comprehensive medical history, including past procedures in the pelvic region. A physical exam is the next step to investigate the cause of the symptoms, specifically enlargement of the bladder in the lower abdominal region. A rectal examination is also usually needed for men that present with symptoms, as it can reveal an enlarged prostate or related problems. A urine culture is often collected for urinalysis, to examine for the presence of blood, bacteria and or crystallized mineral in the urine. This is also useful to detect a urinary tract infection. In some cases, cystoscopy may also be indicated to further investigate the cause of the symptoms and make an accurate diagnosis. Diagnostic Imaging Techniques The most common imaging technique to diagnose bladder stone is computerized tomography (CT) scan, which creates cross-sectional images of the abdominal region to detect bladder stones. A spiral CT scan is more efficient and provides greater definition of the internal structures that can detect even small stones and provides results more quickly. An intravenous pyelogram is a special type of imaging test that involves the injection of a contrast material into a vein that is excreted via the renal tract. X-ray imaging is then used at regular intervals throughout this process to observe the movement of the material and check for bladder stones. Ultrasound uses the reflection of sound waves off the organs and internal structures to visualize the bladder and detect any stones present. X-ray imaging can be sometimes used to detect the presence of bladder stones in the urinary system, however, this test is less sensitive and does not show all stones. It is important for patients with bladder stones to be diagnosed as soon as possible to allow them to receive adequate treatment for the condition and minimise any complications that may occur. References http://www.nhs.uk/conditions/bladder-stones/pages/introduction.aspx http://www.nytimes.com/health/guides/disease/bladder-stones/overview.html#Symptoms http://emedicine.medscape.com/article/2120102-clinical http://www.mayoclinic.org/diseases-conditions/bladder-stones/basics/tests-diagnosis/con-20030296 Further ReadingPrevention and Management of Bladder StonesWhat Are Cystoscopy and Ureteroscopy? Last Updated: Feb 16, 2016" }, "167": { "category_2_x_medical_disease.id": 167, "category_2.id": 42, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Stones", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 167, "medical_disease.ts": "2018-04-20 02:39:46", "medical_disease.title": "Prevention and Management of Bladder Stones", "medical_disease.content": "By Yolanda Smith, BPharm The first step in the prevention and management of bladder stones is to drink a large volume of water to help flush out any small stones in the bladder to be excreted in the urine. However, a surgical procedure may be required to remove bladder stones, particularly if the stones are large or the bladder does not empty entirely. Following the removal of stones, any underlying cause should be identified and appropriately managed to prevent the recurrence of bladder stones. Prevention of Bladder Stone Individuals with recurrent urinary tract infections (UTIs) are at an increased risk for bladder stones forming and may benefit from techniques to prevent them. These include: Increasing fluid intake to lower urine concentration (2-3 liters a day) Regular emptying of the bladder Double voiding to increasing emptying of urine from the bladder Using laxatives to avoid constipation These techniques are often beneficial and help to stop the formation of bladder stones with minimal adverse effects on the individual. Transurethral Cystolitholapaxy Transurethral cystolitholapaxy is a procedure that is commonly used to remove bladder stones in adults. The procedure involves the insertion of a cystoscope into the urethra, which is gentle pushed up into the bladder. The small camera at the end of the cystoscope helps to locate the stones, which can then be broken into fragments with lasers or ultrasound waves that are transmitted from the cystoscope. The resulting smaller pieces can usually be excreted when the patient next passes urine. This procedure occurs under local or general anaesthetic so that it is painless for most patients. Some individuals may acquire a urinary tract infection following the procedure and, for this reason, a short course of prophylactic antibiotics is routinely prescribed. Other complications may include injury to the bladder. Percutaneous suprapubic cystolitholapaxy Percutaneous suprapubic cystolitholapaxy is a procedure usually used for young children to reduce the risk of urethral damage but can also be used for some adult patients. It involves a small incision in the lower abdominal skin and the bladder to allow the direct removal of the stones. This is usually carried out under general anesthetic. Open cystostomy Open cystostomy is a procedure used for very large stones or men with an enlarged prostate. It involves a large incision in the abdomen and bladder to remove the stone and may be combined with other purposes to remove part of the prostate gland or bladder diverticula, depending on the specific case. This procedure is associated with more severe pain following the surgery and a longer recovery time when compared to other procedure types. However, it is the only option in some cases, such as when the bladder stone is large. Underlying Cause Following the removal of the bladder stones, it is important to identify any underlying causes that may lead to the formation of new stones in the bladder. These can then be prevented by: Reduction of prostate enlargement with medication or surgery to decrease the pressure on the bladder. Use of catheter to help drain bladder if it doesn’t empty entirely (e.g. neurogenic bladder) Use of a pessary or surgical procedures to hold the bladder in position if cystocele is present Surgical removal of bladder diverticula This is an important step, as patients with these conditions are susceptible to the recurrence of bladder stones. References http://www.nhs.uk/conditions/bladder-stones/pages/introduction.aspx http://www.nhs.uk/Conditions/Bladder-stones/Pages/Treatment.aspx http://emedicine.medscape.com/article/2120102-treatment#showall http://www.mayoclinic.org/diseases-conditions/bladder-stones/basics/treatment/con-20030296 https://www.nlm.nih.gov/medlineplus/ency/article/001275.htm Further ReadingSymptoms and Diagnosis of Bladder StonesWhat Are Cystoscopy and Ureteroscopy? Last Updated: Feb 16, 2016" }, "168": { "category_2_x_medical_disease.id": 168, "category_2.id": 42, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bladder Stones", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 168, "medical_disease.ts": "2018-04-20 02:39:48", "medical_disease.title": "What Are Cystoscopy and Ureteroscopy?", "medical_disease.content": "By Dr Liji Thomas, MD Cystoscopy and ureteroscopy are diagnostic or therapeutic procedures, usually performed by urologists, or doctors who specialize in diseases of the urinary tract. These procedures use endoscopes to look into the organs of interest, and they are aimed at direct visualization of the interior of the ureters and the bladder in order to diagnose (and sometimes treat) urinary complaints. Cystoscopy Cystoscopy is a procedure that uses a long, thin optical instrument (also known as cystoscope), with an eyepiece and a small lighted lens at either end, connected by a tube. The tube may be either rigid or flexible, depending on whether it will be used for diagnosis or for treatment. The cystoscope transmits clear and detailed images of the inner mucous membrane that lines the urinary bladder and the urethra. A cystoscopy is performed to find the cause of conditions such as: Recurrent or chronic urinary tract infections Hematuria Urinary frequency Urinary urgency Urinary retention after voiding Urinary incontinence Dysuria Problems with initiating or completing urination Atypical cells found on urinalysis Issues which can be picked up by cystoscopy include: Bladder stones Abnormal growths such as tissue, polyps or tumors Strictures of the urethra, as for instance, due to prostatic hypertrophy or urethral scarring Cystoscopy may also be used to treat some problems, such as: Bladder or urethral stone Plugging a bleeding point in the bladder Removal of small tumors or growths Urethral or bladder biopsy Treatment of urinary leakage by injecting filler material Obtaining urine for testing from the ureters Removal of a stent from the ureter Retrograde pyelography which helps visualize urinary flow or obstruction Ureteroscopy Related StoriesTunable Resistive Pulse Sensing (TRPS) to accurately characterize nano and microscopic particlesTecan to introduce Fluent Gx Automation Workstation for clinical and regulated laboratoriesDiagnosing prostate cancer through a £225 urine testUreteroscopy is a method that uses ureteroscope, which is similar to a cystoscope, but still longer and thinner, so that it can be introduced into the ureters through the openings where they communicate with the bladder. It allows the urologist to see the interior of the kidneys and the ureters. The main indications for ureteroscopy are: Evaluating the cause of urinary obstruction such as stones, tumors or growths Looking for other abnormalities of the ureters or kidneys The biopsy of ureter or kidney After ureteroscopy occasional swelling of the ureter is observed. A small soft tube may be placed inside the ureter to ensure the free flow of urine while the edema goes down. The stent may remain in place for a few days, and may cause mild discomfort in the area of the kidney or bladder. Its removal may require a cystoscopy. Both cystoscopy and ureteroscopy usually take less than half an hour, unless a treatment procedure is included. Ureteroscopy is done under sedation and general anesthesia. Cystoscopy may be done under sedation, while general anesthesia is required for cystoscopy with biopsy, and cystoscopy used to inject filler or medications into the bladder wall. What to expect afterwards and what are the risks? The following may be expected after either of these tests: Mild burning in the kidney or bladder area – especially during urination Insignificant bleeding in urine Urgency or frequency of urine Such symptoms may be alleviated by fomentation of the urethral orifice with a warm, damp soft cloth, and by increasing the fluid intake for two hours after the procedure. Like any test which involves entry into the body spaces, cystoscopy and ureteroscopy carry some risks, most notably: Urinary infections Excessive bleeding Pain Difficulty with urination due to the burning sensation Injury to nearby organs Urethral stricture due to scarring Retention of urine due to urethral swelling Anesthetic complications Reviewed by: Dr Tomislav Meštrović, MD, PhD Sources www.niddk.nih.gov/.../default.aspx http://www.nhs.uk/conditions/cystoscopy/pages/why-is-it-necessary.aspx http://www.healthdirect.gov.au/cystoscopy http://www.health.harvard.edu/bladder-and-bowel/cystoscopy Further ReadingSymptoms and Diagnosis of Bladder StonesPrevention and Management of Bladder Stones // Last Updated: Jan 13, 2017" }, "169": { "category_2_x_medical_disease.id": 169, "category_2.id": 43, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bleeding", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 169, "medical_disease.ts": "2018-04-20 02:39:49", "medical_disease.title": "What Can Cause Blood in Poo? (Stool)", "medical_disease.content": "By Sally Robertson, BSc Blood in the stool may be noticed after a bowel movement or following a test arranged by a doctor. It denotes the presence of bleeding somewhere within the gastrointestinal tract, comprising the mouth, esophagus, stomach, small intestine, large intestine and anus. The amount of blood in the stool may be so small that it is only detected by a fecal occult test, which looks for non-visible blood in the stool. If more blood is present, it may be noticed on toilet tissue or seen as bright red blood in the stool after a bowel movement. Bleeding from the gut may make the stool look black and tarry, which is referred to as melena. Bright red blood is referred to as hematochezia. Melena is more likely to occur when the blood originates in the esophagus, stomach or small intestine, while hematochezia is more likely when the source is the large intestine or rectum. Some of the most common causes of gastrointestinal bleeding and blood in the stool are described below. Diverticular Disease Here, small pouches or pockets called diverticula develop in and project from the intestinal lining. They are common in older individuals and are thought to form as the result of weakening of the colonic wall over time as hard stools are passed through it. Diverticular disease does not usually cause symptoms, but the diverticula sometimes become infected or bleed. Approximately 15% of individuals with this disease find that they pass blood in their stool. However, the problem does not usually cause pain and it is self-limited in around 80% of cases. Bleeding that does not clear up may require hospital monitoring and blood transfusion. Anal Fissure This is a small tear or cut in the thin, moist lining of the anus, often as a result of passing a hard and/or large stool. This can cause pain and bleeding. The majority of anal fissures resolve without treatment, especially if simple changes are made such as an increased intake of dietary fiber, although medication or surgery is occasionally required. Ulcerative Colitis Related StoriesRegular intake of Aspirin in elderly could mean higher than previously thought risk of bleeding says new studyResearchers identify new anti-inflammatory drug targetGene therapy shows promising effect against blood clots, study statesUlcerative colitis is an inflammatory bowel disease characterized by chronic inflammation and ulceration of the innermost lining of the colon and rectum. Symptoms develop gradually, but the condition can be debilitating or even life-threatening. No cure has yet been developed, but treatment is often effective in improving symptoms. Angiodysplasia of the Colon This condition is characterized by alteration in the aging blood vessels in the colon, which become fragile, swell and break, resulting in bleeding. The bleeding may be slow, eventually causing anemia, or it may be severe and require hospital monitoring and blood transfusion. Peptic Ulcers A peptic ulcer is a sore found in the stomach or duodenum. It is often the result of infection by the organism Helicobacter pylori, or the ongoing use of anti-inflammatory drugs such as ibuprofen and aspirin. The most common symptom is stomach pain, which may be exacerbated by stress or eating spicy food. Colon Polyps and Colorectal Cancer Polyps are small growths that form on the colon lining. They are usually benign, but can increase in size, start to bleed and potentially become cancerous, leading to colon cancer. This can be fatal if the cancer is not discovered until it is advanced. Rectal cancer is cancer that arises in the last section of the colon. Colon and rectal cancers are together referred to as colorectal cancers. Anyone can develop colon polyps, although people aged 50 years and older are at an increased risk, along with people who smoke, are overweight, or have a family history of colon polyps or colon cancer. Colorectal cancer often causes bleeding that cannot be seen with the naked eye. It is therefore important that regular screening for this disease be done, since polyps found early on in the course of disease can usually be removed so that cancer is prevented from developing in a number of cases. Reviewed by Liji Thomas, MD References http://www.nhs.uk/conditions/Diverticular-disease-and-diverticulitis/Pages/Introduction.aspx https://medlineplus.gov/ency/article/000238.htm http://www.msdmanuals.com/en-gb/home/digestive-disorders/symptoms-of-digestive-disorders/gastrointestinal-bleeding https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works Further ReadingCauses of Blood in Urine // Last Updated: May 5, 2017" }, "170": { "category_2_x_medical_disease.id": 170, "category_2.id": 43, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bleeding", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 170, "medical_disease.ts": "2018-04-20 02:39:52", "medical_disease.title": "Causes of Blood in Urine", "medical_disease.content": "By Sally Robertson, BSc Although blood in the urine or hematuria can be alarming, it is not usually an indicator of a life-threatening condition. It can sometimes be related to a serious health issue. If the blood is visible to the naked eye, the condition is referred to as “macroscopic,” “visible,” or “gross” hematuria. This should be investigated by a doctor. Sometimes, the blood can only be seen under a microscope. This is referred to as “microscopic” or “non-visible” hematuria. This should also be investigated because not even the smallest amount of blood should be present in healthy urine. Blood seen in the urine arises from somewhere in the urinary tract, which is made up of the bladder, kidneys, ureters and urethra. Some of the most common causes are given below. Image Credit: Sirirat / Shutterstock Urinary Tract Infection These infections often arise when bacteria migrate upwards through the urethra and start to proliferate in the bladder, causing cystitis. Signs of a urinary tract infection include a frequent urge to urinate, a pain and burning sensation when urinating and urine that has a stronger smell than usual. Kidney Infection Also called pyelonephritis, a kidney infection results when bacteria in the blood stream or ureters move into the kidney. This may lead to the same symptoms caused by urinary tract infection, although kidney infection may also cause a fever and abdominal pain. Kidney or Bladder Stone Minerals present in the urine sometimes form crystals in the lining of the kidney or bladder, which can eventually develop into stones. These do not usually cause pain, but they can lead to a blockage or may be passed in urine, which can be extremely painful and also lead to bleeding. Urethritis Related StoriesIntensive Care MedicineResearchers identify new anti-inflammatory drug targetCommon sense concerns over Nerf gun eye injuries from doctorsThis term refers to inflammation of the urethra, the tube through which urine passes when it is eliminated from the body. It is often caused by a sexually transmitted disease such as chlamydia infection. Enlarged Prostate Also referred to as benign prostatic hyperplasia, this refers to the increase in size of the prostate in and after middle age. As the gland becomes bigger, it compresses the urethra, which can obstruct urine flow, making urination more difficult or slower, and leading to bleeding. Prostatitis (infection of the prostate) may also cause these symptoms. Kidney Disease or Injury Kidney disease often causes microscopic hematuria. The blood-filtering units of the kidney called glomeruli become inflamed. Examples of conditions that can cause kidney disease include diabetes, vasculitis, viral infection and certain immune disorders that affect the glomeruli. Accidents that result in injury to the kidney can also cause blood to be passed in the urine. Kidney, Bladder or Prostate Cancer Generally, all these cancers have a higher incidence in individuals aged 50 years and older. Aside form hematuria, other symptoms of urinary malignancies include the following: Kidney cancer – an abdominal mass and persistent pain in the loin Bladder cancer - more frequent and urgent need to urinate; pain on urination Prostate cancer - more frequent and urgent need to urinate; difficulty emptying the bladder Inherited Disorders Inherited conditions such as sickle cell anemia (due to defective hemoglobin in erythrocytes) and Alport syndrome (abnormality of the glomerular filtering membrane) can cause both macroscopic and microsopic hematuria. Certain medications Some drugs such as the antibiotic penicillin and the anticancer therapeutic cyclophosphamide can cause hematuria. If a person already has a condition that causes the bladder to bleed, then the use of anticoagulants such as aspirin or heparin may also lead to macroscopic hematuria. Visiting the Doctor A doctor will investigate the cause of hematuria by asking about the patient’s symptoms and carrying out a full physical examination. This may include a rectal examination for men and a vaginal examination for women. Blood and urine tests will be arranged and if infection is suspected, antibiotics may be prescribed. If the tests do not indicate infection, then the patient is referred to a specialist. Reviewed by Liji Thomas, MD References http://www.mayoclinic.org/diseases-conditions/blood-in-urine/basics/definition/con-20032338 http://www.nhs.uk/conditions/blood-in-urine/Pages/Introduction.aspx Further ReadingWhat Can Cause Blood in Poo? (Stool) // Last Updated: May 8, 2017" }, "171": { "category_2_x_medical_disease.id": 171, "category_2.id": 44, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blepharitis", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 171, "medical_disease.ts": "2018-04-20 02:39:57", "medical_disease.title": "Blepharitis Types and Causes", "medical_disease.content": "By Susha Cheriyedath, MSc A common disorder of the eye, blepharitis, is a condition in which there is visible inflammation in the eyelids. Bacteria causes irritation and the eyelids become red and itchy. Though it does not cause permanent damage to vision, blepharitis causes discomfort to patients. Women in their peri- and post-menopausal stage are more prone to the dysfunction of the meibomian glands. Blepharitis Inflammation - Image Credit: Gromovataya / Shutterstock Types of Blepharitis Blepharitis is classified into three types: Anterior blepharitis Posterior blepharitis Mixed blepharitis In anterior blepharitis, the eyelid skin, base, and follicles of the eyelashes are affected—the outside of the eyelid, in the front edge attached to the eyelashes. Posterior blepharitis occurs at the inner edge, the eyelid that is in contact with the eyeball. In some patients, both anterior and posterior type of blepharitis can occur, which is termed as mixed blepharitis. Causes of Anterior Blepharitis Staphylococcal infections or seborrheic dermatitis is the main cause of anterior blepharitis. Staphylococcal Infections Symptoms such as mild sticky eyelids, thicker margins of the eyelid, and missing eyelashes occur due to Staphylococcal blepharitis. Although Staphylococcus bacteria are commonly present in the skin, nose, buttocks, and the surface of the armpits, they can enter the human body through a cut or insect bite in the skin or through skin openings while using medical equipment (for example, urinary catheters). The bacterium Staphylococcus causes a group of infections, from minor skin and soft tissue infections to invasive infections called Staphylococcal infections or staph infections. Among the many varieties of Staphylococci, the bacterium Staphylococcus aureus consists of methicillin-resistant Staphylococcus aureus (MRSA), which resists antibiotics such as flucloxacillin, commonly used for staph infections. Staphylococcus aureus, the cause of most infections has PVL-Staphylococcus aureus, which generate Panton-Valentine leukocidin (PVL), a toxin that kills white blood cells resulting in recurring skin infections. Even though infections can affect healthy individuals, people with a weak immune system (for example, patients undergoing chemotherapy) are more prone to these infections. Seborrhoeic Dermatitis Seborrhoeic dermatitis is a type of eczema visible in places where the sebaceous glands are active. The yeast Malassezia furfur is said to activate seborrhoeic dermatitis. Sebum production is, however, not related to the severity of the eczema. Some individuals are free from eczema even though the sebum production is higher. Though the exact cause of Seborrhoeic dermatitis is not understood completely, conditions such as depression, epilepsy, heavy intake of alcohol, and medications such as psoralen, lithium, and interferon induce the risk of Seborrhoeic dermatitis. Blepharitis could be due to metabolites such as reduced fatty acids, rise in the levels of oleic acid, and increase of cholesterol and triglycerides. Symptoms such as red scaly margins in the eyelid are visible. Causes of Posterior Blepharitis In posterior blepharitis, problems are associated with the inner part of the eyelid. The eyelid margins have minute oil glands, called meibomian glands. These are positioned in both the lower and upper eyelids with each lid carrying 15–20 glands. The openings of the glands lie inside the line of the eyelash, typically on the eyelid edges. The oil percolates slowly when the eyes are blinked; however, the gland collapses when it is empty. The oil produced by this gland merges with the watery component in the eye and together a tear film is created. This oily layer provides a coating to the water layer and protects the water from evaporation. When the quality or quantity of the water or oil is altered, there are symptoms such as eye irritation. Meibomian blepharitis shows symptoms such as poor tear quality and redness in the eyelid lining. This is because the glands in the eyelids produce oil irregularly, which also favors bacterial growth. The secretions of the meibomian glands are broken down by the bacteria, causing irritation to the eye, while giving a foamy look to the tear film. The excess oil that is formed along the edge of the eyelid will lead to inflammation, crusty, with flakes. The inflammation of the margin of the eyelid can put a ceiling on the meibomian gland slits. This obstruction will decrease oil production and the oil that stays in the gland will be thick and contaminated. What Causes Meibomian Gland Dysfunction? Although there are many conditions for the dysfunction of the meibomian glands, one particular skin condition, rosacea, can block the functioning of the meibomian gland. The species Demodex folliculorum found in follicles of the hair and in meibomian glands is present in larger quantities in rosacea patients. The over deposit of these species may possibly prompt the immune system, as in many rosacea patients the eyes may appear red or watery (ocular rosacea) and patients have a feeling of irritation in the eyes. The two species of Demodex, the genus of tiny mites, are responsible for blepharitis. Anterior blepharitis is caused by Demodex folliculorum and posterior blepharitis is caused by Demodex brevis. While the Demodex mite creates direct damage, it also carries the bacteria Staphylococci that cause Staphylococcal infections. Sources http://www.nhs.uk/conditions/blepharitis/Pages/Introduction.aspx www.nhs.uk/.../Introduction.aspx http://eyewiki.aao.org/Blepharitis www.aad.org/public/diseases/scaly-skin/seborrheic-dermatitis#causes http://dryeyezone.com/encyclopedia/mgcare.html http://eczema.dermis.net/content/e02causesof/e441/e446/index_eng.html http://blepharitistreatment.org.uk/ www.aoa.org/.../blepharitis?sso=y www.guysandstthomas.nhs.uk/.../...mmatory-condition-of-the-eyelids.pdf https://www.eyeworld.org/article-new-antibiotic-opti https://www.aapos.org/terms/conditions/141 https://www.rosacea.org/patients/causes/demodex https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946818/ Further ReadingBlepharitis Complications // Last Updated: Jun 21, 2017" }, "172": { "category_2_x_medical_disease.id": 172, "category_2.id": 44, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blepharitis", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 172, "medical_disease.ts": "2018-04-20 02:40:06", "medical_disease.title": "Blepharitis Complications", "medical_disease.content": "By Afsaneh Khetrapal BSc (Hons) The inflammation of the rims/edges of the eyelids due to obstruction of the oil glands is called blepharitis. This is a common eye disorder, and patients with blepharitis experience discomfort, itchiness, and irritation in the eyes. Blepharitis can be easily diagnosed and treated and, if untreated, may lead to complications. Fortunately, serious complications are uncommon. Blepharitis inflammation. Image Credit: donikz / Shutterstock Complications Caused by Staphylococcal Blepharitis The below are identified as the complications caused by Staphylococcal blepharitis (S. blepharitis): Madarosis Entropion Ectropion Trichiasis Chalazion Styes Bacterial conjunctivitis The inflammation of the eyelid margin and folliculitis due to the S. blepharitis results in madarosis, which is characterized by the lack of eyebrows or eyelashes. Blepharitis can lead to a condition called entropion, in which the eyelid margins turn inward, resulting in malposition of the eyelid. Congenital entropion can also lead to ectropion, in which there is sagging of the lower eyelid and the eyelid is turned outward. Chronic blepharitis patients may suffer from Trichiasis, an abnormality in the eyelid where the eyelashes are turned inward and grow toward the eye. This ingrowth of eyelashes rubs the cornea, the conjunctiva, and the eyelids (inner surface) and results in eye irritation. The difference between entropian and trichiasis is that, in the former there is a malposition with the eyelid margin, whereas in the latter, there is a malposition in the growth of the eyelash. In conditions such as posterior blepharitis, the openings to the meibomian glands are totally blocked and the oil that is produced forms cysts in the eyelid. This leads to a condition called Chalazion or meibomian cyst. Styes or hordeolum results when infections are caused at the roots of the eyelashes. A painful boil-like swelling can be seen on the outer eyelid, which is usually filled with pus. Bacterial conjunctivitis occurs when the bacteria present in the eyelids cause infections. Although children are more prone, adults can also develop pink eye-conjunctivitis, where there is a thick, yellow-green secretion. The bacterial type is highly contagious and spreads when individuals establish direct or indirect contact with secretions of the infected individual. Complications Caused by Demodex Blepharitis When the cause of blepharitis is due to the species Demodex folliculorum (D.folliculorum) and Demodex brevis (D. brevis), it can create other complications as well. D. folliculorum is found in the eyelash follicle and D. brevis is seen in the sebaceous and meibomian glands. In search of sebum, its main source of food, D. brevis goes deep into the glands, feeds on the epithelial cells, and damages the eyelid margin directly. The life span of adult mites is limited and the infestation of Demodex mites is dependent on mating. In untreated blepharitis, complications arise as mating is not prevented and this allows direct transmission of the mites. A greater number of mites will lead to greater damage. In general, Demodex mites are found in larger numbers in patients with a condition called Rosacea. These mites can also act as a vector for bacteria. Bacillus oleronius, detected in Demodex mites, have an effect on patients with Rosacea. Blepharitis can lead to Ocular rosacea, an inflammation of the eye that causes an itching and burning sensation. However, sometimes ocular rosacea may develop first, before showing facial symptoms of Rosacea. Epithelial hyperplasia can be caused due to micro-abrasions inflicted by the mites. Cylindrical dandruff is formed around the eyelash base. Demodex mites are the likely causes of recurrence of chalazia. Other than eyelash misalignment, the debris of the mites release bacterial antigens that could trigger inflammatory responses. Corneal Complications Patients suffering from long-time blepharitis face the risk of eyelid scarring. D. brevis is connected to corneal manifestations. Corneal infections and ulcers pose a threat to the vision. Chronic conditions of blepharitis can give rise to infections in the cornea. Swelling and redness of the eye can harm the cornea and result in Keratitis–damage to the transparent eye layer. The Demodex species can influence marginal infiltration, nodular scar, superficial opacity, and corneal vascularization. Complications Due to Tear Film Deficiency Conditions such as Seborrheic Blepharitis, Meibomian Seborrheic Blepharitis, and Angular Blepharitis lead to instability of the tear film and make the eyelids dry, scaly, or emit a white foamy discharge. Lubrication in the eye is affected and patients may find it difficult to wear contact lenses. Dry Eye Syndrome When tears are not produced properly or if the consistency of the tear is such that it evaporates quickly, dry eye may occur. The meibomian glands present in the eyelids produce oily fluids that form the outer layer of the tear film. However, complications arising from blepharitis may lead to dry eye as dysfunction of the meibomian gland (Meibomian blepharitis) will create an imbalance in the tear component. Chronic blepharitis, combined with conjunctivitis results in Blepharoconjunctivitis, causing inflammation and irritation in the eyelids. Regular eyelid hygiene, intake of omega-3 fatty acid supplements, and proper treatment of blepharitis can avert complications and help to maintain good vision. Sources http://blepharitistreatment.org.uk/blepharitis-complications/ http://eyewiki.aao.org/Entropion https://www.aao.org/eye-health/diseases/what-is-trichiasis http://www.nhs.uk/conditions/Ectropion/Pages/Introduction.aspx https://www.aoa.org/documents/optometrists/QRG-10A.pdf https://nei.nih.gov/health/blepharitis/blepharitis http://www.visioneyeinstitute.com.au/article/what-is-blepharitis/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358936/ www.mayoclinic.org/.../con-20024605 www.mayoclinic.org/.../con-20022732 www.nhsdirect.wales.nhs.uk/.../#Complications www.mayoclinic.org/.../con-20035058 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946818/ www.med.umich.edu/.../Blepharoconjunctivitis.pdf https://patient.info/in/health/blepharitis-leaflet Further ReadingBlepharitis Types and Causes Last Updated: Jul 3, 2017" }, "173": { "category_2_x_medical_disease.id": 173, "category_2.id": 45, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 173, "medical_disease.ts": "2018-04-20 02:40:09", "medical_disease.title": "Blood Group", "medical_disease.content": "The human blood consists of liquid called plasma that comprises white and red blood cells, and platelets. The antibodies and antigens present in the blood help to identify one’s blood group. The proteinaceous substance inside the plasma is called antibodies. Antibodies are a part of body's natural defense. They alert the immune system by identifying foreign substances, such as microorganisms, and destroying them. The protein molecules found on the surface of red blood cells are called antigens. Image author: InvictaHOG / commons.wikimedia.org Major divisions of blood ABO system defines four main blood groups. Group A: It contains A antigens in the red blood cells with anti-B antibodies in the plasma. Group B: It contains B antigens with anti-A antibodies in the plasma. Group O: It contains anti-A and anti-B antibodies in the plasma, but antigens are absent. Group AB: It contains A and B antigens, but antibodies are absent. Sub-types of blood group These main blood groups are sub-divided into eight types and each can be either RhD negative or RhD positive. One can have any one of these eight blood groups: A+ (A RhD positive) and A− (A RhD negative) B+ (B RhD positive) and B− (B RhD negative) O+ (O RhD positive) and O− (O RhD negative) AB+ (AB RhD positive) and AB− (AB RhD negative) “O” blood group The most common blood group is “O,” which is found in 48% of the UK population. Hospitals request blood group O very frequently, as half of the donor population has this blood group. The blood group O’s red blood cells are compatible and versatile. They are more compatible with other blood groups of the ABO system, but patients of this group can receive red blood cell transfusions only from their own group. An important blood group is O negative, which is commonly called “universal.” Red blood cells can be received by patients with blood groups A, B, and O, irrespective of whether they are Rh positive or Rh negative. The O negative red cells are unique and can be safely given to a patient whose blood type is unknown or immediately unavailable. Therefore, this blood type is necessary in departments such as Emergencies & Accidents; the demand for O negative blood in all hospitals is around 13% but only 7% of the population has this blood. “AB” blood group The AB group is the rarest of ABO, because it is found in only 1 in 25 donors. AB red cells can be transfused to patients with AB blood and so this is the rarest of its form. AB is the least requested blood type by hospitals and so it is important to ensure a close balance between collections and hospital requests. Patients with severe blood loss can be treated with the freshly frozen plasma produced by AB blood group. Hence, donors of AB blood group are given high importance. Related StoriesUsing Cord Blood to Alleviate the Symptoms of AutismCommon ketone supplement may reduce blood sugar in diabetics, suggests studyTesting for alpha fetoprotein may improve early liver cancer detection, finds studySometimes, in a year, the demand for AB positive rises occasionally. The hospitals rely on the female donor's support to receive blood and blood products during the time of demand. Around 1% of the donor population is AB negative, which is the rarest blood type. Since it is rarest, it is hard and difficult to find new donors and collect sufficient amount of blood. “A” blood group The second most common blood group found in the donor population is group A. The largest blood group does not mean it is all plain sailing, but it is undoubtedly one of the most requested blood groups by hospitals. Balancing the collections and demand is rigorous. Negative donors have a very important role in making platelets. Platelets are one of the blood components that help prevent bruising and stop bleeding. Around 60% of platelets are used to help cancer patients. Platelets of group A are constantly in high demand, as they can be given to patients of all ABO groups, making them extremely versatile. A higher priority is given to ensuring a regular and consistent supply of platelets, which can last only up to 7 days (compared to 35 days for red cells). “B” blood group Blood group B is found in only 10% of donors. The South Asian (20%) and Black communities (25%) seem to have more group B individuals than the White European communities (9%). To ensure that the patient need for this blood group is met consistently, the clinics encourage new donors from communities such as Black, Asian, and other minorities. The Black communities are more susceptible to sickle cell anemia and the South Asian communities to thalassemia. During such critical conditions, patients may require multiple transfusions, and sometime throughout their lives. It is important that patients receive blood that is tested extensively to better match their own during regular transfusions. Around 1 in 7 patients, B negative donors can help Rh positive and negative patients from groups B and AB−. The B negative donors are more in demand, as the hospitals depend heavily on them for the required blood. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources http://www.nhs.uk/conditions/blood-groups/Pages/Introduction.aspx https://www.blood.co.uk/why-give-blood/the-need-for-blood/group-o/ http://thebloodconnection.org/about-blood/blood-education/blood-types/ www.betterhealth.vic.gov.au/.../blood-groups http://www.redcrossblood.org/learn-about-blood/blood-types.html http://kidshealth.org/en/teens/blood-types.html Further ReadingBlood Type and Giving BloodWhat is Rh Blood Group? Last Updated: Aug 7, 2017" }, "174": { "category_2_x_medical_disease.id": 174, "category_2.id": 45, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 174, "medical_disease.ts": "2018-04-20 02:40:13", "medical_disease.title": "Blood Type and Giving Blood", "medical_disease.content": "By Afsaneh Khetrapal BSc (Hons) Blood is represented by 36 known blood group systems. The ABO group and Rh group are the most important and familiar blood group systems for blood transfusion. The ABO group determines the blood group (A, B, O, or AB) of a person, whereas the classification of positive (+) or negative (-) blood of an individual is specifically determined by RHD gene of the Rh group. The essential difference between positive (+) and negative (-) hinges on the presence or the absence of the RHD gene. Commonly known blood groups are created by the ABO group and the Rh group. Blood donor at donation. Image Credit: May Preechaya / Shutterstock Blood Subtypes When a patient requires a single blood transfusion, they can be given blood only based on the ABO group and the Rh group. In contrast, when a patient requires multiple blood transfusions, they need to be given extensively matched blood. When determining the most suitable blood group for the patients, subtypes of all the blood group systems are taken into consideration. Only based on the ABO group and the Rh type, a donor can give blood when there is a requirement for blood transfusion. In some cases, some patients may require ongoing multiple blood transfusions for the rest of their lives. For instance, if a patient has blood loss due to surgery, he will be transfused with red blood cells. The red blood cells are also used in treating anemia. The platelets transfusion is carried out to treat cancer patients as they tend to lose healthy cells during the process of radiation or chemotherapy. Also, people who are affected by burns need plasma transfusions. Ro subtype ‘Dce’ is produced by combining RHCE and RHD genes, which is also called as the Ro subtype. It could also be assumed from the 'Dce' that if someone has the Ro subtype, they would have the RHD gene and thereby a positive blood group. It signifies that for the people with the Ro subtype, they always have either A+, B+, AB+, or O+ blood type. Management of sickle cell disease is an example of a need for ongoing, regular transfusions. Ideally, the Ro subtype blood should be given to the Ro subtype patient with sickle cell disease. Ro blood is rare among the donors. Related StoriesAdvanced live cell imaging reveals brain’s response to blood vessel injuryUsing Cord Blood to Alleviate the Symptoms of AutismBreathtaking evolution amongst Indonesian tribe - bigger spleens for free-divingO Rh negative blood can be given to any patient regardless of the blood type, which made it very essential. Commonly, donors with the B Rh positive blood group are found in ethnic communities of Black and south Asian minority. Rare Blood Types If an individual's blood has rare antigens or lacks common antigens, then their blood type is considered rare. It purely depends on what is presented in the blood along with the ABO types, and the Rhesus positive or negative determines the rare type. The presence and absence of antigens A and B determine the four major blood groups. Blood group A – It contains antigens A on the red blood cells with anti-B antibodies in the plasma. Blood group B – It contains antigens B on the red blood cells with anti-A antibodies in the plasma. Blood group AB – It contains antigens A and B but antibodies are absent. Blood group O – Antigens are absent but it contains both anti-A and anti-B antibodies in the plasma. During transfusion, there are many methods followed for safe matching of the blood type. The universal donor, O blood group, donates blood cells to the antibodies. A and AB blood types are supplied with red blood cells by group A. B and AB blood types are supplied with red blood cells by group B. Group AB receives blood cells from all the groups but can donate only to AB blood types. Apart from antigens A and B, there is another one called Rh factor which is of two types: positive and negative, depending on its availability. The blood from Rh negative individuals can be given to the Rh negative patients, whereas the blood from both Rh negative and positive can be given only to the Rh positive patients. The blood type O negative is found in the universal red cell donor. The blood type AB is found in the universal plasma donor. Acquiring the Blood Type The blood type of an individual is inherited just like the color of the eyes and hair. Finding an exact match for the blood type of rare kind is a difficult task. It may cause severe side effects if less matched blood is given. Hence, it is always advised to give the patients the best suitable blood. Every individual will not be aware of their blood types and subtypes. But individuals with rare blood group should share their blood group details with donors if they belong to the same ethnic heritage. So, we are aware that we need numerous donors from the black heritage for treating patients with sickle cell disease, and we need donors who are primarily from Asian, Mediterranean, or Arab heritage for patients with thalassaemia. Blood with a certain combination of genes is the Ro subtype. Only 2% of the donors have Ro subtype, which has led the donors to be valued highly. Sources www.blood.co.uk/.../ http://www.redcrossblood.org/learn-about-blood/blood-types.html www.blood.co.uk/why-give-blood/the-need-for-blood/rare-blood-types/ http://www.carterbloodcare.org/blood-facts/blood-types/ http://www.thebloodcenter.org/Donor/BloodFacts.aspx http://www.nhs.uk/conditions/blood-groups/Pages/Introduction.aspx Further ReadingBlood GroupWhat is Rh Blood Group? Last Updated: Aug 7, 2017" }, "175": { "category_2_x_medical_disease.id": 175, "category_2.id": 45, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 175, "medical_disease.ts": "2018-04-20 02:40:19", "medical_disease.title": "What is Rh Blood Group?", "medical_disease.content": "The Rh blood group is considered to be one of the more complex types of blood groups in humans and it is secondary to the ABO blood group in transfusion medicine. It was discovered 60 years ago and named after the Rhesus monkey. The polymorphic genes that encode the antigens in the Rh blood group are at a higher level, which explains the reason for its complexity. Objectives of Antigens in Rh The RHD gene and RHCE gene are closely linked and a wide range of Rh antigens that are encoded by the hybrid Rh genes are produced by various genetic rearrangements. There have been almost 49 Rh antigens identified until today, among which D, C, E, c, and e are the most significant. The presence of high immunogenic in Rh antigens affects the importance of the Rh blood group type. When the D antigen appears in transfused or fetal RBCs, nonproduction of D antigen leads to the production of anti-D. For this reason, the Rh status of an individual is routinely determined with blood test in individuals who are donating blood, receiving a blood transfusion, or pregnant. The RH antigen specificity is determined by the sequence of the amino acids. A part of the protein complex in the membrane of the RBC is expressed as Rh antigens. Due to the expression of complex erythroid line cells, the Rh antigens are expressed only in the RBCs. The reason for this complex composition is unknown, but it is assumed to be a tetramer. This contains two molecules of Rh proteins and two molecules of Rh associated glycoprotein (RhAG). Either of RhD or of RhCE can be the Rh proteins, where RhD carries the D antigen and RhCE carries the C/C and E/e antigens. The presence of both RhCE and RhD in a single complex is still unknown, but in D negative individuals the complex would contain only RhCE. Proteins in Rh System It is assumed that the Rh antigens play an important role in maintaining the integrity of the RBC membrane, which lacks the abnormally shaped Rh antigens. Deletion of RhAG causes the rare Rhnull phenotype in individuals. Such individuals may have RBCs that show no Rh antigens due to its unfeasibility in getting targeted to the RBC membrane. The absence of Rh complex leads to a shorter lifespan, alterations in RBC shape, and an increase in osmotic fragility, all of which contributes to very mild hemolytic anemia. Antibodies against many Rh antigens are developed in patients during the adverse transfusion reactions, which may be critical to the patients. It is important to note the fact that the blood group proteins are found with the first member of a family of urea transporters and the first member of a family of water channels that are aquaporins, which are Kidd and Colton blood groups, respectively. Persistence of Rh Antigens The occurrence of D antigen is 92% in dark skinned people, 85% in Caucasians, and 99% in Asians. The frequency of C antigen is found 68% in Caucasians, 27% in dark skinned people, and 93% in Asians. The E antigen is found 22% in people of dark skin, 39% in Asians, and 29% in Caucasians. The C antigen is found 80% in Caucasians, 47% in Asians, and 96% in dark skinned people. On the other hand, the E antigen is found 98% in people of dark skin and Caucasians and 96% in Asians. Rh-factor - Image Credit: NoPainNoGain / Shutterstock Persistence of Rh Phenotype Related StoriesConsuming one hundred percent fruit juice does not alter blood sugar levels, study suggestsTraces of caffeine and its byproducts in the blood can be indicative of Parkinson’s diseaseScientists imitate the Human Blood-retinal barrier on a microfluidic chipThe Rh haplotype Dce can be found mostly in dark skinned people with an incidence of 44%. The deletion of the RHD gene results in Rh D-negative phenotype in 15% of Caucasians. Rh D-negative is found in 8% of Africans show up the Rh D-phenotype that are increased by three molecular backgrounds. One such background is the deletion of RHD gene, which is common among Caucasians. The other two mechanisms are inheritance of the RHD pseudogene or RHD hybrid gene. The premature stop codon introduced by the duplication of nucleotides is found in the RHD pseudogene. The RHD hybrid gene contains RHCE gene sequencing nucleotide. DCe, a Rh haplotype, is commonly found in Caucasians with 42%, in Native Americans with 44%, and Asians with 70%. Rh D-negative phenotype can be found very rarely in Asians with just 1%, and about 8% with dark skinned people and with higher frequency of 15% in Caucasians. Production of antibodies against Rh antigens Antibody type (IgG, IgM): The IgG type mainly contains most of the Rh antibodies. Antibody reactivate: The activation of complement is done very rarely by the Rh antibodies. The Rh antibodies are blinded to the RBCs and they also mark them for destruction by the spleen called extra-vascular hemolysis. This type is capable of hemolysis. Transfusion reaction: Antibodies such as anti-D, anti-C, anti-e, and anti-c can cause extra-vascular hemolytic transfusion reactions, which are often delayed. Hemolytic disease in newborns: This accounts for 50% of the maternal alloimmunization by the D antigens, making it the most common cause. The anti-D and anti-c antibodies can contribute to causing several diseases and anti-C, anti-E, and anti-e may cause diseases ranging from mild to moderate in severity. Reviewed by Yolanda Smith, BPharm Sources https://www.ncbi.nlm.nih.gov/books/NBK2269/ https://www.britannica.com/science/Rh-blood-group-system http://www.bloodjournal.org/content/95/2/375?sso-checked=true http://anthro.palomar.edu/blood/Rh_system.htm http://www.bbguy.org/2016/05/13/rh-blood-group-terminology/ www.blood.co.uk/why-give-blood/the-need-for-blood/the-rh-system/ https://www.aerzteblatt.de/pdf/DI/104/10/a651e.pdf Further ReadingBlood GroupBlood Type and Giving Blood // Last Updated: Nov 20, 2017" }, "176": { "category_2_x_medical_disease.id": 176, "category_2.id": 46, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 176, "medical_disease.ts": "2018-04-20 02:40:20", "medical_disease.title": "Types of Blood Cancer", "medical_disease.content": "By Afsaneh Khetrapal BSc (Hons) The production and function of blood cells are affected by blood cancer. Blood is produced in the bone marrow, where most of these cancers originate. Three types of blood cells that mature and develop from the stem cells of bone marrow are red blood cells, white blood cells, and platelets. The uncontrolled growth of an abnormal type of blood cell interrupts the development process of normal blood cells in most of the blood cancers. Functions of the blood, such as fighting off infections and preventing serious bleeding, are restricted by these abnormal blood cells (or) cancerous cells. Three Main Types of Blood Cancer Blood cancer can commonly be divided into three types: Leukemia Lymphoma Myeloma A factor named lymphocyte is a type of white blood cell that fights infections. The lymphocytes that are abnormal become lymphoma cells, which multiply and collect in both lymph nodes and other tissues. Gradually, the immune system is impaired by these cancerous cells. Leukemia The rapid production of abnormal white blood cells causes a type of cancer called leukemia, which is found in the blood and bone marrow. Leukemia can be either acute or chronic. Immediate treatment is required for chronic leukemia, which progresses more slowly than acute leukemia. Photomicrograph of bone marrow aspirate from a patient with leukocytosis, showing blast cells of acute myeloid leukemia (AML), type M5, myelomonocytic, cancer of white blood cells. Image Credit: David Litman / Shutterstock Many patients with acute leukemia have responded successfully to treatments. In chronic leukemia, the cells tend to divide slowly because of better treatment with targeted therapies. Participation in a clinical trial provides access to experimental therapies for some patients, so it is always good to talk to the doctor and find out whether joining a clinical trial is right for you or not. Leukemia is classed as either lymphocytic or myelogenous. Lymphocytic leukemia signifies the abnormal cell growth that becomes lymphocytes in the marrow, which are a type of white blood cell that plays a role in the immune system. The abnormal cell growth that occurs in the marrow which later matures into white blood cells is called myelogenous leukemia. Related StoriesScientists identify key genetic events responsible for initiating childhood leukemiaModular gene enhancers may be suitable target in treatment of blood cancerHigh ADAR1 enzyme levels correlate with reduced survival rates in multiple myelomaThe four major classifications of leukemia are: Acute myelogenous leukemia Chronic myelogenous leukemia Acute lymphocytic leukemia Chronic lymphocytic leukemia Leukemia may occur in both adults and children. The symptoms of leukemia may vary depending on its type and stage, and they include headaches, enlarged liver and spleen, fever, chills, night sweats and other flu-like symptoms, bone pain, weight loss, paleness, pinhead-size red spots on the skin, swollen tonsils, swollen or bleeding, gums, weakness, and fatigue. Lymphoma Lymphoma affects the lymphatic system and results in excessive removal of fluids from the body and production of immune cells. The two categories of lymphomas are Hodgkin lymphoma and non-Hodgkin lymphoma. The Hodgkin lymphoma is found in people with lymphoma which is about 12%. Once considered fatal, it has now been transformed into a curable condition thanks to breakthrough research. Cancer Cell Lymphoma Immunotherapy 3D. Image Credit: CI Photos / Shutterstock Most of the non-Hodgkin lymphomas are B-cell lymphomas, which are capable of growing either quickly (high-grade) or slowly (low-grade). B-cell non-Hodgkin lymphomas are of 14 types. Remaining are the T-cell lymphomas that are named after a different cancerous white blood cell, or lymphocyte. The symptoms of lymphoma include fever, weight loss, difficulty in breathing or chest pain, rash, itchy skin, weakness and fatigue, sweating, and swollen lymph nodes in the neck, armpits, or groin. Myeloma The cancer of plasma cells is myeloma. The disease- and infection-fighting antibodies are produced in the body by white blood cells known as plasma cells. The normal production and function of red and white blood cells are affected by the multiplication of myeloma cells. Kidney damage can be caused by an abnormally high amount of these dysfunctional antibodies in the bloodstream. The myeloma cells are known to produce a substance capable of causing destruction of the bone, resulting in fracture or pain. The soft tissues inside the bones are the bone marrow, where myeloma cells are produced. In the body, myeloma cells travel through the bloodstream and sometimes get collected in other bones. It is generally referred to as multiple myeloma, because it frequently occurs at many sites in the bone marrow. The symptoms and signs of myeloma are anemia (reduced red blood cell count), renal damage (kidney failure), weight loss hypercalcemia (excessive calcium in the blood), susceptibility to infection, osteoporosis, bone pain, bone swelling or fracture, and high protein levels in the blood and/or urine. Myeloma occurs more frequently in men who are exposed to radiation, work in petroleum-related industries, are over the age of 50, and are obese. The following are the options available for treating myeloma: chemotherapy, immunomodulators (drugs that target specific areas of the immune system), and drugs to treat anemia, radiation therapy, stem cell transplant, and participation in a clinical trial, which provides access to experimental therapies for some patients. It is good to talk with the doctor and find out whether the clinical trial is the right option to follow when diagnosed with myeloma. Sources http://www.hematology.org/Patients/Cancers/ http://www.cancercenter.com/terms/blood-cancers/ http://www.upmccancercenter.com/cancer-care/blood/types/leukemia http://www.leukaemia.org.au/blood-cancers/lymphomas/lymphomas http://www.leukaemia.org.au/myeloma https://www.cancer.gov/types/leukemia https://www.cdc.gov/cancer/myeloma/index.htm // Last Updated: Aug 10, 2017" }, "177": { "category_2_x_medical_disease.id": 177, "category_2.id": 47, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Clot", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 177, "medical_disease.ts": "2018-04-20 02:40:25", "medical_disease.title": "Blood Clot Treatment", "medical_disease.content": "By Dr Ananya Mandal, MD A blood clot or thrombus can form in the vessel walls of arteries or veins. An arterial thrombus is a very dangerous clot that can obstruct the flow of blood to major organs and cause complications such as stroke, transient ischemic attack (TIA or mini-stroke), heart attack, or peripheral arterial disease. A venous thrombus can occur in the deep veins of the body such as a deep leg vein (deep vein thrombosis, DVT) or a blood vessel of the lung. In DVT, a piece of the clot may detach and travel to the lungs where it can lodge and create another blockage. This is a potentially life-threatening complication of deep vein thrombosis called pulmonary embolism (PE). DVT and PE are collectively termed venous thromboembolism (VTE). The treatments that are available for treating VTE include anticoagulant medications such as heparin or warfarin. These are also called blood thinners. These drugs do not break a clot down but reduce the clot’s ability to coagulate and prevent further growth of the clot. This can also reduce the risk of a clot fragment breaking off and travelling to the lung or brain. Anti-coagulants also help prevent the recurrence of clots. In summary, the aims of blood thinning treatments in thrombosis include: Preventing the clot from growing bigger Preventing the formation of new clots Preventing the clot from breaking off and moving to major body organs Preventing recurrence Preventing long-term complications Medications Heparin Heparin is given by injection or drip into a vein as unfractionated heparin. The blood coagulability needs to be closely monitored while using heparin because blood that has become too thin can lead to uncontrolled bleeding. A calculation called the International Normalized Ratio (INR) is used to standardize the results of prothrombin time and monitor the therapy. Without warfarin, a person with DVT may have an INR of around 1.0 (typically 0.8 to 1.2) and the goal of treatment is usually to achieve an INR of around 2.0 to 3.0. Related StoriesResearch finds correlation between perioperative air travel and high risk of venous thromboembolismOf ‘miracles’ and money: Why hemophilia drugs are so expensiveDAWN study increases window for treatment of stroke patientsLow-molecular weight heparin (LMWH) LMWH is a modification of traditional unfractionated heparin. Examples of these drugs include enoxaparin, dalteparin, fondaparinux and tinzaparin and they are delivered by subcutaneous injection. These LMWH preparations do not require monitoring and have largely replaced unfractionated heparin in the management of VTE. Warfarin The fast-acting, injectable blood-thinners heparin and LMWH are eventually replaced by warfarin, a type of anticoagulant that can be taken in tablet form. At the start of therapy, heparin or LMWH is given along with warfarin because it takes several days (at least 5 days) for the protective effects of warfarin to begin. The amount or dosage of warfarin administered varies from person to person. Other oral blood thinners The oral blood thinner rivaroxaban has been approved by the Food and Drugs Administration for the treatment of DVT and recurrent VTE. Other examples of orally administered anticoagulants that have been approved for use include dabigatran, apixaban and edoxaban. Thrombolytics Thromoblytics are agents that can break down clots. The drug most commonly used for this purpose is tPA (tissue plasminogen activator), which is administered intravenously. In some cases, clot dissolving medications may being injected directly into the clot itself using a catheter. Inferior vena cava filter These vascular filters are implanted into the inferior vena cava to prevent a pulmonary emboli. The filter is designed to capture a blood clot fragment that may have broken loose from a deep vein in the leg and started to move towards the lung or heart. Reviewed by Sally Robertson, BSc Sourceshttp://www.nhs.uk/conditions/Thrombosis/Pages/Introduction.aspx www.ahrq.gov/patients-consumers/prevention/disease/bloodclots.pdf www.nhmrc.gov.au/.../cp125_stop_the_clot_patient_brochure.pdf http://www.med.illinois.edu/hematology/PDF%20Files/Hemostasis.pdf www.clevelandclinicmeded.com/.../ http://www.sign.ac.uk/pdf/pat122.pdf http://files.www.clotconnect.org/DVT_and_PE.pdf https://www.ghc.org/all-sites/guidelines/vte-diagnosis.pdfFurther ReadingBlood Clot PrognosisBlood Clot - What is a Blood Clot? Last Updated: Apr 14, 2014" }, "178": { "category_2_x_medical_disease.id": 178, "category_2.id": 47, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Clot", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 178, "medical_disease.ts": "2018-04-20 02:40:30", "medical_disease.title": "Blood Clot Prognosis", "medical_disease.content": "By Dr Ananya Mandal, MD A blood clot or thrombus can occur in both the arterial and venous blood vessels. A part of a clot can also break away form the main clot and travel to the lung or brain where it causes another blockage or embolism. The condition may be treated with anticoagulants or blood thinners, which decrease the clot’s ability to cause blockage as well as preventing its growth. Examples of the most commonly used anticoagulants include heparin and warfarin. Duration of therapy The duration of therapy with blood thinners depends on various factors such as: Size and location of the clot Presence of risk factors associated with the clot formation Presence of risk factors that can lead to recurrence of clots If the risk of recurrence is low, then short-term treatment for 3 months is often sufficient. However, if the risk for developing another clot is high, long-term treatment of more than 3 months may be necessary and often lasts for several years or even for the patient’s lifetime. Venothromboembolism (VTE) and cancer Several cancers raise the risk of thrombosis because tumors can produce substances that activate coagulation or the blood clotting system. In addition, several chemotherapy drugs used to treat cancers also raise the risk of VTE. For example, tamoxifen used in breast cancer therapy raises the risk of clots. Thrombosis and pulmonary hypertension Related StoriesStudy highlights risks involved in short-term use of PICCsOf ‘miracles’ and money: Why hemophilia drugs are so expensiveResearch finds correlation between perioperative air travel and high risk of venous thromboembolismA blood clot that arises in a vessel of the lung or pulmonary embolism (PE) can increase the resistance to blood flow in the pulmonary vessels, leading to pulmonary hypertension. This can eventually lead to symptoms such as shortness of breath, decreased ability to exercise and chest discomfort. Pain persistence after DVT Blood thinners can prevent the recurrence or growth of blood clots but cannot dissolve them. However, in most cases, the body breaks down blood clots, which gradually disappear. Most patients treated with blood thinners for deep vein thrombosis or PE recover within several weeks to months of treatment, without any complications. However, some clots get converted into scar tissue which can damage the valves present in veins. This can cause valve dysfunction, a condition called chronic venous insufficiency or post thrombotic syndrome. Symptoms of post thrombotic syndrome include long term swelling, chronic pain, pressure, heaviness, tightness and changes in the skin such as dryness, hardening, pigmentation, ulcer formation or itching. Exercise after thrombosis Doctor advise patients about which type and amount of exercise is considered safe, but generally exercises such as walking or swimming are considered beneficial. Exercise can increase circulation, reduce inflammation and improve a patient’s sense of wellbeing. In cases of PE, exercise can help to improve lung function. Reviewed by Sally Robertson, BSc Sourceshttp://www.nhs.uk/conditions/Thrombosis/Pages/Introduction.aspx www.ahrq.gov/patients-consumers/prevention/disease/bloodclots.pdf www.nhmrc.gov.au/.../cp125_stop_the_clot_patient_brochure.pdf http://www.med.illinois.edu/hematology/PDF%20Files/Hemostasis.pdf www.clevelandclinicmeded.com/.../ http://www.sign.ac.uk/pdf/pat122.pdf http://files.www.clotconnect.org/DVT_and_PE.pdf https://www.ghc.org/all-sites/guidelines/vte-diagnosis.pdfFurther ReadingBlood Clot TreatmentBlood Clot - What is a Blood Clot? Last Updated: Apr 14, 2014" }, "179": { "category_2_x_medical_disease.id": 179, "category_2.id": 47, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Clot", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 179, "medical_disease.ts": "2018-04-20 02:40:35", "medical_disease.title": "Blood Clot - What is a Blood Clot?", "medical_disease.content": "By Dr Ananya Mandal, MD Blood clotting or coagulation is a normal but complex bodily process that is designed to prevent bleeding in response to an injury or cut. However, sometimes blood clots form in critical locations such as the heart, lung or brain and can cause serious complications if they are not treated in time. Clots can occur in both the arterial and venous blood vessels. Arteries are the blood vessels that carry fresh and oxygenated blood away from the heart and around the body (apart from pulmonary arteries that carry blood to the lungs), while veins are the vessels that carry deoxygenated blood back to the heart from the rest of the body. Arterial thrombosis A blood clot that forms in an artery or an arterial thrombus is a very dangerous clot that can obstruct the flow of blood to major organs and cause complications such as stroke, transient ischemic attack (TIA or mini-stroke), heart attack, or peripheral arterial disease. Venous thrombosis A venous thrombus can occur in the deep veins of the body such as a deep leg vein or a blood vessel of the lung. Deep vein thrombosis (DVT) usually occurs in the large veins of the calf or thigh where it causes pain and inflammation. A piece of the clot may also detach and travel to the lungs where it may lodge and create another blockage. This is a potentially life-threatening complication of deep vein thrombosis called pulmonary embolism (PE). DVT and PE are collectively termed venous thromboembolism or VTE. Risks associated with blood clots Related StoriesCancer risk found to be three times greater after acute thrombosis in the legPulmonary embolism rarely identified in patients at emergency department after faintingStudy highlights risks involved in short-term use of PICCsThrombosis and its complications are one of the leading causes of death and disability worldwide. The condition is more common in individuals aged over 40 years but people can develop the condition at any age. Some of the factors that raise the risk of thrombosis include: Family history of thrombosis, DVT and PE Blood vessel damage as a result of infection, surgery or inflammation Some medications such as oral contraceptive pills and hormone replacement therapy Obesity and being overweight Females are more at risk of VTE, particularly pregnant women. Being inactive for long periods of time. If a person is laid up in bed for long periods after major surgery, for example, the risk of VTE rises dramatically. Some examples of serious illnesses that can lead to prolonged periods of bed rest include heart attack, heart failure, stroke and spinal cord injury. Symptoms of thrombosis The symptoms of a blood clot range from mild to severe. In DVT, classic symptoms include: Pain and swelling in one leg, usually the calf Feeling of warmth in the area where the clot has formed. Reddening of skin, particularly behind and below the knee. In patients with PE, symptoms include shortness of breath, chest pain that worsens on inhalation, a cough that may produce blood, and feeling faint or passing out. Reviewed by Sally Robertson, BSc Sources http://www.nhs.uk/conditions/Thrombosis/Pages/Introduction.aspx www.ahrq.gov/patients-consumers/prevention/disease/bloodclots.pdf www.nhmrc.gov.au/.../cp125_stop_the_clot_patient_brochure.pdf http://www.med.illinois.edu/hematology/PDF%20Files/Hemostasis.pdf www.clevelandclinicmeded.com/.../ http://www.sign.ac.uk/pdf/pat122.pdf http://files.www.clotconnect.org/DVT_and_PE.pdf https://www.ghc.org/all-sites/guidelines/vte-diagnosis.pdf Further ReadingBlood Clot TreatmentBlood Clot Prognosis Last Updated: Oct 7, 2014" }, "180": { "category_2_x_medical_disease.id": 180, "category_2.id": 48, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Donation", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 174, "medical_disease.ts": "2018-04-20 02:40:13", "medical_disease.title": "Blood Type and Giving Blood", "medical_disease.content": "By Afsaneh Khetrapal BSc (Hons) Blood is represented by 36 known blood group systems. The ABO group and Rh group are the most important and familiar blood group systems for blood transfusion. The ABO group determines the blood group (A, B, O, or AB) of a person, whereas the classification of positive (+) or negative (-) blood of an individual is specifically determined by RHD gene of the Rh group. The essential difference between positive (+) and negative (-) hinges on the presence or the absence of the RHD gene. Commonly known blood groups are created by the ABO group and the Rh group. Blood donor at donation. Image Credit: May Preechaya / Shutterstock Blood Subtypes When a patient requires a single blood transfusion, they can be given blood only based on the ABO group and the Rh group. In contrast, when a patient requires multiple blood transfusions, they need to be given extensively matched blood. When determining the most suitable blood group for the patients, subtypes of all the blood group systems are taken into consideration. Only based on the ABO group and the Rh type, a donor can give blood when there is a requirement for blood transfusion. In some cases, some patients may require ongoing multiple blood transfusions for the rest of their lives. For instance, if a patient has blood loss due to surgery, he will be transfused with red blood cells. The red blood cells are also used in treating anemia. The platelets transfusion is carried out to treat cancer patients as they tend to lose healthy cells during the process of radiation or chemotherapy. Also, people who are affected by burns need plasma transfusions. Ro subtype ‘Dce’ is produced by combining RHCE and RHD genes, which is also called as the Ro subtype. It could also be assumed from the 'Dce' that if someone has the Ro subtype, they would have the RHD gene and thereby a positive blood group. It signifies that for the people with the Ro subtype, they always have either A+, B+, AB+, or O+ blood type. Management of sickle cell disease is an example of a need for ongoing, regular transfusions. Ideally, the Ro subtype blood should be given to the Ro subtype patient with sickle cell disease. Ro blood is rare among the donors. Related StoriesAdvanced live cell imaging reveals brain’s response to blood vessel injuryUsing Cord Blood to Alleviate the Symptoms of AutismBreathtaking evolution amongst Indonesian tribe - bigger spleens for free-divingO Rh negative blood can be given to any patient regardless of the blood type, which made it very essential. Commonly, donors with the B Rh positive blood group are found in ethnic communities of Black and south Asian minority. Rare Blood Types If an individual's blood has rare antigens or lacks common antigens, then their blood type is considered rare. It purely depends on what is presented in the blood along with the ABO types, and the Rhesus positive or negative determines the rare type. The presence and absence of antigens A and B determine the four major blood groups. Blood group A – It contains antigens A on the red blood cells with anti-B antibodies in the plasma. Blood group B – It contains antigens B on the red blood cells with anti-A antibodies in the plasma. Blood group AB – It contains antigens A and B but antibodies are absent. Blood group O – Antigens are absent but it contains both anti-A and anti-B antibodies in the plasma. During transfusion, there are many methods followed for safe matching of the blood type. The universal donor, O blood group, donates blood cells to the antibodies. A and AB blood types are supplied with red blood cells by group A. B and AB blood types are supplied with red blood cells by group B. Group AB receives blood cells from all the groups but can donate only to AB blood types. Apart from antigens A and B, there is another one called Rh factor which is of two types: positive and negative, depending on its availability. The blood from Rh negative individuals can be given to the Rh negative patients, whereas the blood from both Rh negative and positive can be given only to the Rh positive patients. The blood type O negative is found in the universal red cell donor. The blood type AB is found in the universal plasma donor. Acquiring the Blood Type The blood type of an individual is inherited just like the color of the eyes and hair. Finding an exact match for the blood type of rare kind is a difficult task. It may cause severe side effects if less matched blood is given. Hence, it is always advised to give the patients the best suitable blood. Every individual will not be aware of their blood types and subtypes. But individuals with rare blood group should share their blood group details with donors if they belong to the same ethnic heritage. So, we are aware that we need numerous donors from the black heritage for treating patients with sickle cell disease, and we need donors who are primarily from Asian, Mediterranean, or Arab heritage for patients with thalassaemia. Blood with a certain combination of genes is the Ro subtype. Only 2% of the donors have Ro subtype, which has led the donors to be valued highly. Sources www.blood.co.uk/.../ http://www.redcrossblood.org/learn-about-blood/blood-types.html www.blood.co.uk/why-give-blood/the-need-for-blood/rare-blood-types/ http://www.carterbloodcare.org/blood-facts/blood-types/ http://www.thebloodcenter.org/Donor/BloodFacts.aspx http://www.nhs.uk/conditions/blood-groups/Pages/Introduction.aspx Further ReadingBlood GroupWhat is Rh Blood Group? Last Updated: Aug 7, 2017" }, "181": { "category_2_x_medical_disease.id": 181, "category_2.id": 48, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Donation", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 181, "medical_disease.ts": "2018-04-20 02:40:38", "medical_disease.title": "Giving Blood", "medical_disease.content": "Most people can donate blood. Men can donate blood every 12 weeks and women can donate every 16 weeks. We should ensure the safety of both the person who is donating blood and the patient who receives the blood. Blood donation is a simple process and saves many lives. Donor’s blood is collected and can be used to treat patients who are in need. Credit: Neykor Chonrossainatee/Shutterstock.com Who can donate blood? The following factors determine the person’s capability of donating blood: Generally fit and healthy Weighing more than 50 kg or 7 stone 12 lbs Age between 17 and 66 (it is acceptable at the age of 70 if one has donated blood before) Age above 70 and have donated in the last two years. Before donating blood, individuals should be aware of the eligibility criteria to donate blood and check with the health personnel about existing medical conditions that may affect their suitability to give blood. Blood volume estimation is required for women under the age of 20 who weighs under 65 kg or 10st 3lb (or) if the height is under 168 cm or 5' 6\". Who should not donate blood? The information about the blood safety is listed below. The following common conditions do disqualify the person from donating blood as the donated blood may cause harm to the receiver: planning for an HIV, Human T-cell lymphotropic virus (HTLV) or Hepatitis test with HIV positive a hepatitis B carrier a hepatitis C carrier with HTLV positive already treated for syphilis ever worked as commercial sex worker ever injected with drugs in the recent past or long ago A consultation is also required to ensure the eligibility of the person. Common eligibility questions include receiving treatment, taking medication, cancer, received blood, blood products or organs, illness, pregnancy, tattoos, and traveling outside of the country. One may donate blood if consumed a drug prescribed by the doctor. It is advised not to donate blood or platelets at least for 12 months immediately after having sexual contact with an individual who may be at risk of the conditions listed above. How to donate blood? The following are the basic steps to prepare for donating blood: Ensure your eligibility to donate blood. Fix an appointment in advance. Register as a blood donor at the venue or online. Follow the recommended preparations before donating blood. The blood collectors ensure it does not take more than an hour for a blood donation appointment. You will be asked to read a welcome leaflet that explains the importance of blood safety. Instructions tend to vary according to each venue; hence, it is important to read. Fluids will often be provided before you donate blood, which will help you to feel better after the blood donation. Procedures involved in donating blood A drop of blood will be tested to check the hemoglobin levels. If one is not eligible to donate blood, the patient will be notified of the reason why and may be called for another appointment if they will become eligible at a later point. If an individual is eligible to donate blood, they will be asked to provide personal details such as name, address, and date of birth. Donor’s forearm will be pressurized with a cuff. Related StoriesAmerican Red Cross is facing blood shortage and urging donors to come forthStudy suggests frequent blood donation as feasible and safe option for donorsResearch examines awareness, knowledge, and practice of blood donation in Bangladesh The apt vein is found by examining the arm and cleansed with antiseptic. A needle is inserted to collect the blood, which is transported to a blood bag marked with a unique donor number through a tube. Individuals should be asked to inform staff if they experience any pain or discomfort. A weighing scale is used to automatically stop the blood flow on reaching a level of 470 ml, which takes around 5-10 minutes. Once the needle is removed, it is treated with an antiseptic and sterile bandage. Donated blood will be transported to the blood banks where it will be tested before providing it to hospitals. Donor's body will be able to restore the donated blood. After Donating Blood Patients should be advised to rest for a while after donating blood to allow their body to recover. The sterile bandage should remain in place for at least 30 minutes after donating the blood. The following advice is useful for patients after giving blood: Avoid carrying anything heavy after blood donation. Try not to take a hot water shower immediately after donating blood. Rest immediately if you feel unstable (dizzy, nauseous, hot, trembling, sweating) and drink plenty of water to feel better. Bruises are harmless and will disappear in time. If bleeding presents, sit and raise the arm while pressing the area where it's bleeding for 5 minutes. If patients become unwell within 2 weeks after donating blood (except cold or cold sore) without a reason for your illness, the blood donation venue should be contacted to make necessary steps to not transfuse the donated blood to patients. Reviewed by Yolanda Smith, BPharm Sources https://www.blood.co.uk/who-can-give-blood/ http://www.nhs.uk/conditions/blood-groups/Pages/Introduction.aspx http://www.redcrossblood.org/learn-about-blood/blood-types.html http://www.unitedbloodservices.org/pdf/bs300l-ubs.pdf http://www.bloodcenters.org/donate-blood/am-i-eligible/ http://www.redcrossblood.org/donating-blood/eligibility-requirements www.mskcc.org/.../general-blood-platelet-donor-guidelines Further ReadingBlood Type and Giving Blood // Last Updated: Aug 29, 2017" }, "182": { "category_2_x_medical_disease.id": 182, "category_2.id": 49, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Sugar", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 182, "medical_disease.ts": "2018-04-20 02:40:42", "medical_disease.title": "What is Blood Sugar?", "medical_disease.content": "By Dr Ananya Mandal, MD Blood sugar or blood glucose level is the amount of glucose present in the blood of a human or animal. Blood glucose is a tightly regulated biochemical parameter in blood. It is important for metabolic homeostasis. Blood sugar - a misnomer The term 'blood sugar' is a misnomer since it means only glucose. Yet there are other sugars besides glucose that are present in blood. Food contains several different types of sugars e.g. fructose from fruits, galactose and lactose from milk and dairy, sorbitol, xylose, maltose etc. These sugars are inert with regard to the human metabolism and its regulation by insulin hormone and thus blood sugar tends to refer to glucose alone. Normal levels of blood glucose Normal levels range between 3.6 and 5.8 mM (mmol/l). In humans normal blood glucose levels are around 90 mg/dl, equivalent to 5mM (mmol/l). Since the molecular weight of glucose, C6H12O6, is about 180 g/mol, when calculated the total amount of glucose normally in circulating human blood is around 3.3 to 7g (assuming an ordinary adult blood volume of 5 litres). Blood glucose is measured in terms of molarity, measured in mmol/L or millimoles per litre. In the United States, and to a lesser extent elsewhere, mass concentration, measured in mg/dL.If a mg/dL figure is to be converted to mmol/L, it is to be divided by 18 or multiply by 0.055. Similarly to convert a mmol/L figure to mg/dL it is to be multiplied by 18 or divided by 0.055. Normal fluctuations in levels of glucose Related StoriesStudy: Hot spots of type 1 diabetes found in food swampsOne class of diabetes drug not associated with reduced risk of deathStudy compares survival outcomes of different drugs for type 2 diabetes Glucose levels in blood fall to indicate hunger. The brain is dependent on glucose as its primary energy producing substance. Low blood glucose indicates to the brain that there is need for food intake and this triggers sensations of hunger. Glucose is absorbed from the intestines and via blood stream it reaches the liver and various body cells to provide the primary source of energy for body's cells. Glucose levels rise after meals for an hour or two by a few grams and are usually lowest in the morning, before the first meal of the day. The morning levels are the lowest since it follows around 6 to 8 hours of fasting throughout the night. Imbalances of glucose levels in blood If the body fails to maintain normal levels of glucose, it may give rise to several disease conditions. Persistently high blood glucose is called hyperglycemia. Diabetes mellitus is characterized by persistent hyperglycemia from any of several causes. It results from the body’s failure to regulate blood sugar. Long term hyperglycemia leads to damage to several organs like the retina, kidneys, arteries etc. If blood sugar levels drop too low, a potentially fatal condition called hypoglycemia develops. This may be manifested as weakness, drowsiness, shaking, irritability, sweating etc. In severe cases it may lead to loss of consciousness and even brain damage. To convert blood glucose readings between the two units: Divide a mg/dL figure by 18 (or multiply by 0.055) to get mmol/L. Multiply a mmol/L figure by 18 (or divide by 0.055) to get mg/dL. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources professional.diabetes.org/.../04-Blood-Sugar.pdf http://ndep.nih.gov/media/knownumbers_eng.pdf http://www.learningaboutdiabetes.org/downloads/HighBloodSugarEN.pdf https://diabetesatwork.org/_files/handouts/I_A01b_HO.pdf www.healthinfotranslations.org/pdfDocs/FastingBloodSugarTest_Som.pdf http://www.lincolnsurgery.com/media/ask-diabetes.pdf www.gov.ns.ca/.../DAPBloodSugarBrochure-1.pdf Further Reading Blood Sugar Normal Values Blood Sugar Regulation Blood Sugar Glucose Measurement Low Blood Sugar Last Updated: Dec 3, 2012" }, "183": { "category_2_x_medical_disease.id": 183, "category_2.id": 49, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Sugar", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 183, "medical_disease.ts": "2018-04-20 02:40:47", "medical_disease.title": "Blood Sugar Normal Values", "medical_disease.content": "By Dr Ananya Mandal, MD Blood sugar fluctuations Blood sugar levels are tightly regulated by a variety of stimulations and mechanisms. This is important for metabolic homeostasis. Levels may fluctuate after fasting for long periods of time or an hour or two after consumption of food. Despite this, the fluctuations are minor. Normal human blood glucose levels remains within a remarkably narrow range. In most humans this varies from about 82 mg/dl to 110 mg/dl (4.4 to 6.1 mmol/l). The blood sugar levels rises to nearly 140 mg/dl (7.8 mmol/l) or a bit more in normal humans after a full meal. In humans normal blood glucose levels are around 90 mg/dl, equivalent to 5mM (mmol/l). Related StoriesWomen with type-1 diabetes face tough situation after giving birthGenome editing identifies neural circuit behind leptin’s anti-obesity and anti-diabetes effectsStudy: Hot spots of type 1 diabetes found in food swampsSince the molecular weight of glucose, C6H12O6, is about 180 g/mol, when calculated the total amount of glucose normally in circulating human blood is around 3.3 to 7g (assuming an ordinary adult blood volume of 5 litres). In other words in a healthy adult male of 75 kg (165 lb) with a blood volume of 5 litres (1.3 gal), a blood glucose level of 100 mg/dl or 5.5 mmol/l means a total of about 5 g (0.2 oz or 0.002 gal, 1/500 of the total) of glucose in the blood. This also means approximately 45 g (1½ ounces) in the total body water. Total body water includes more than merely blood and will be usually about 60% of the total body weight in men. 5 grams of glucose is about equivalent to a small sugar packet or a teaspoon full of sugar. To be considered a non-diabetic the American Diabetes Association recommends a post-meal glucose level less than 180 mg/dl (10 mmol/l) and a pre-meal blood glucose level of 90-130 mg/dl (5 to 7.2 mmol/l). Molarity and mass concentration Blood glucose is measured in terms of molarity, measured in mmol/L or millimoles per litre. In the United States, and to a lesser extent elsewhere, mass concentration, measured in mg/dL.If a mg/dL figure is to be converted to mmol/L, it is to be divided by 18 or multiply by 0.055. Similarly to convert a mmol/L figure to mg/dL it is to be multiplied by 18 or divided by 0.055. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.diabetes.ca/diabetes-and-you/living/management/manage-glucose/ diabetes.niddk.nih.gov/dm/pubs/type1and2/YourGuide2Diabetes_508.pdf professional.diabetes.org/.../04-Blood-Sugar.pdf http://ndep.nih.gov/media/knownumbers_eng.pdf http://www.learningaboutdiabetes.org/downloads/HighBloodSugarEN.pdf https://diabetesatwork.org/_files/handouts/I_A01b_HO.pdf www.healthinfotranslations.org/pdfDocs/FastingBloodSugarTest_Som.pdf http://www.lincolnsurgery.com/media/ask-diabetes.pdf www.gov.ns.ca/.../DAPBloodSugarBrochure-1.pdf Further Reading What is Blood Sugar? Blood Sugar Regulation Blood Sugar Glucose Measurement Low Blood Sugar Last Updated: Sep 5, 2016" }, "184": { "category_2_x_medical_disease.id": 184, "category_2.id": 49, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Sugar", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 184, "medical_disease.ts": "2018-04-20 02:40:48", "medical_disease.title": "Blood Sugar Regulation", "medical_disease.content": "By Dr Ananya Mandal, MD Blood glucose or blood sugar, as it is commonly called, is a tightly regulated biochemical parameter in normal humans and animals. The body maintains the blood sugar within a narrow range. There are several interacting systems that regulate blood sugar. Of these, regulation of blood sugar by the hormone insulin is the most important. Hormonal regulation of blood sugar Insulin is synthesized in significant quantities only in beta cells in the pancreas. When the beta cell is appropriately stimulated, insulin is secreted from the cell by exocytosis. The insulin then diffuses into small blood vessels of the pancreas. Related StoriesResistance exercise may improve indicators of type 2 diabetes, study suggestsStudy: Hot spots of type 1 diabetes found in food swampsConsumption of low-calorie sweeteners could promote metabolic syndrome, increase diabetes risk Insulin is secreted in primarily in response to elevated blood concentrations of glucose. Thus insulin is secreted as the body detects high blood glucose and helps regulate the levels of glucose. There are some other stimuli like sight and taste of food, increased blood levels of amino acids and fatty acids that may also promote the release of insulin. During digestion (around one or two hours following a meal), insulin release is not continuous, but occurs in bursts. Other hormones that regulate blood sugar include glucagon, growth hormone, cortisol and catecholamines. These increase blood glucose by reducing uptake of the sugar by the various organs of the body. These are termed catabolic hormones. Insulin is the anabolic hormone that decreases blood glucose. Uptake of blood sugar As blood glucose rises after a large carbohydrate meal, a glucose transporter GLUT 2 increases its affinity for glucose. These transporters GLUT 1, 2, and 3 are proteins and not enzymes. GLUT 2 and the enzyme glucokinase coordinate glucose control in liver. This converts Glucose to Glucose 6 Phosphate. The reaction utilizes ATP or energy. This conversion causes utilization of the Glucose 6 phosphate in the glycolysis reaction. The liver can also take up fructose similarly from honey, soda sweeteners, sucrose, etc. and metabolize it to release its carbon skeleton as glucose in the post-absorptive phase (gluconeogenesis). When blood glucose rises the glucose transporters rise this causes increased glucose transport inside the β cell by GLUT 2 and results in raised G-6-P concentration, which increases glucose metabolism, which in turn stimulates the β cell to secrete insulin. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://class.fst.ohio-state.edu/fst761/Glucose%20Transporters.pdf http://www.ableweb.org/volumes/vol-16/14-butler.pdf ebooks.cambridge.org/chapter.jsf www.aafpfoundation.org/hepp_files/files/NovoIntroToInsulinENG.pdf http://www.japi.org/july2007/suppliment/19.pdf Further Reading What is Blood Sugar? Blood Sugar Normal Values Blood Sugar Glucose Measurement Low Blood Sugar Last Updated: Dec 3, 2012" }, "185": { "category_2_x_medical_disease.id": 185, "category_2.id": 49, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Sugar", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 185, "medical_disease.ts": "2018-04-20 02:40:53", "medical_disease.title": "Blood Sugar Glucose Measurement", "medical_disease.content": "By Dr Ananya Mandal, MD Imbalances of blood sugar are common among patients of diabetes mellitus. Diabetes indicates persistently high blood sugar that may cause damage to various organs like the kidney, heart, small arteries and the eyes (retina). Diabetics are also prone to sudden drops in blood sugar called hypoglycaemia. To monitory these fluctuations blood sugar measurement is vital in diabetic individuals. Some of the considerations in blood glucose measurement include: Sample Glucose can be measured in whole blood or serum (ie, plasma). Earlier blood glucose was measured in whole blood. Nowadays serum is extracted from blood and glucose is measured in the serum. Whole blood and serum blood glucose is often different. Red blood cells have higher concentration of protein than serum and serum has higher water content and more dissolved glucose than whole blood. To obtain blood glucose in serum from figures in whole blood, it is multiplied by 1.15. Blood is collected from a vein (usually in the crook of the arm). The blood sample is collected into vacuum tubes. Blood sample needs to be collected from a different arm other than the one where there is the intravenous line to prevent confusion of the results with the intravenous fluids. After meals the levels in the veins are somewhat lower than capillary or arterial blood. The estimate is by about 10%. The surrounding temperature before processing affects blood glucose level estimation. At refrigerator temperatures, glucose remains relatively stable for several hours in a blood sample. At room temperature (25 °C), a loss of 1 to 2% of total glucose per hour is seen in whole blood samples. If the blood is allowed to clot the glucose in the sample gets metabolized by the blood cells unless the cells are separated. If there are higher numbers of red or white blood cells there is excessive glycolysis in the sample with substantial reduction of glucose level. This occurs if the sample is not processed immediately and leads to a faulty result. To prevent such losses blood samples are collected in Fluoride tubes (ie, gray-top) since fluoride inhibits glycolysis. Red-top serum separator tubes can also be used for samples after being centrifuged isolating the serum from cells. Timing of the test Blood sugar is measured at various points of time to give an idea about the body’s blood glucose regulation system. The primary test is the fasting blood glucose. (FBG). This is measured after overnight fasting. Blood glucose normally is lowest early in the morning after 6 to 8 hours of fasting overnight. Two hours post prandial blood glucose or PPG is the next common test. After a carbohydrate rich, full meal, two hours are allowed to elapse before blood is taken again for estimation of glucose. This test gives an estimation of glucose handling by the body. Other tests include oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT) wherein a fixed amount of glucose is administered orally or intravenously respectively and repeated blood sugar tests are performed to check on the body’s glucose handling. Another important test is the glycosylated haemoglobin (HbA1C). This test gives an idea about fluctuations of glucose in blood over a period of last three months. Blood glucose can also be self-monitored by the patient using meters or hand help portable monitors. Blood glucose is co-ordinated with urine glucose test as well. Methods of blood sugar measurement Related StoriesConsumption of low-calorie sweeteners could promote metabolic syndrome, increase diabetes riskWearable medical patch shows promise for early detection of hypoglycemia in type 1 diabetesWomen with type-1 diabetes face tough situation after giving birth The earlier method used to measure blood sugar is a chemical method that exploits the ''nonspecific reducing'' property of glucose in a reaction with an indicator substance that changes color when reduced. There are other blood compounds like urea that also have reducing properties, this technique may yield faulty results. The method currently in use, utilizes enzymes specific to glucose and is less likely to yield errors of this kind. The two most common employed enzymes are glucose oxidase and hexokinase. The enzyme is embedded on a strip or a test strip. When the blood is applied onto the strip the strip changes in composition and color. This strip is then inserted into a meter for a reading. Test strip shapes and their exact chemical composition vary between meter systems and cannot be interchanged. Abnormal glucose readings Abnormalities of fasting blood glucose is indicative of problems in the multiple control mechanism of glucose regulation. There are several influences on blood glucose level apart from diabetes and food intake. These include infections, physical or psychological stress, prolonged exercise etc. Causes of Abnormal Glucose Levels Persistent Hyperglycemia Transient Hyperglycemia Persistent Hypoglycemia Transient Hypoglycemia Reference Range, FBG: 70-110 mg/dl Diabetes Mellitus Pheochromocytoma Insulinoma Acute Alcohol Ingestion Adrenal cortical hyperactivity Cushing's Syndrome Severe Liver Disease Adrenal cortical insufficiency Addison's Disease Drugs: salicylates, antituberculosis agents Hyperthyroidism Acute stress reaction Hypopituitarism Severe Liver disease Acromegaly Shock Galactosemia Several Glycogen storage diseases Obesity Convulsions Ectopic Insulin production from tumors Hereditary fructose intolerance Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.soahac.on.ca/pdffiles/DEC%20Blood%20sugar%20testing.pdf http://www.idf.org/webdata/docs/SMBG_EN2.pdf www.ucdenver.edu/.../ud07.pdf clinicians.org/images/upload/7%20Measuring%20Blood%20Sugar%20VLL.pdf http://clinicians.org/images/upload/Insulin_handout_7.pdf Further Reading What is Blood Sugar? Blood Sugar Normal Values Blood Sugar Regulation Low Blood Sugar Last Updated: Dec 3, 2012" }, "186": { "category_2_x_medical_disease.id": 186, "category_2.id": 49, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Sugar", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 186, "medical_disease.ts": "2018-04-20 02:40:56", "medical_disease.title": "Low Blood Sugar", "medical_disease.content": "By Dr Ananya Mandal, MD Low blood sugar is referred to as hypoglycaemia. It is the most common and most dangerous condition for many people with both type 1 and type 2 diabetes. This occurs when the blood glucose drops below the normal level. Levels of blood glucose below 70 mg/dl are considered below normal according to the American Diabetes Association. This level, however, may be different for different individuals and this may sometimes depend on age or body mass of the individual. For example, blood sugar of 90mg/dl is considered low for a baby or for an elderly person. Hypoglycaemia, when severe may lead to insulin shock, which can be life threatening if not promptly treated. Reasons for hypoglycaemia or low blood sugar Persons with diabetes are most at risk of hypoglycaemia and associated complications. Some of the common causes of low blood sugar among diabetics include: Overdose of insulin Skipping, omitting or delaying a meal Excessive alcohol consumption along with skipping a meal Wrong site of insulin injection that has led to faster absorption rates Excessive exercise Severe illness or injury that ups the requirement of insulin Use of other hormones or medications that increase the action of the blood sugar lowering medications Symptoms of low blood sugar The brain utilizes glucose as the primary source of energy. With fall in blood sugar levels the brain is deprived of glucose and this may lead to weakness, fatigue and irritability initially and convulsions/seizures and unconsciousness if not corrected immediately. The list of general symptoms of low blood sugar include: Nervousness Shakiness Fatigue Tiredness Weakness Personality change/irrational behavior Weakness of limbs Dizziness Blurry vision Poor coordination Loss of sense of balance and falls Nausea and sometimes vomiting Sweating Palpitations and rapid heart beats Hunger Light headedness Drowsiness Lack of concentration Headache Severe conditions lead to convulsions or seizures and even unconsciousness. Related StoriesWomen with type-1 diabetes face tough situation after giving birthWearable medical patch shows promise for early detection of hypoglycemia in type 1 diabetesFDA permits marketing of Dexcom G6 integrated continuous glucose monitoring systemSymptoms vary from person to person and most diabetics are adept at recognizing their symptoms of hypoglycaemia. Management of low blood sugar It is a myth that only diabetics on insulin are at risk of hypoglycaemia. Those on oral medications are also at risk of this condition. Those with frequent attacks of hypoglycaemia may need a change in their treatment plan. Usual immediate treatment includes a blood sugar check and one of the following treatments called emergency foods. It is usually 15gms of glucose equivalent or carbohydrate equivalent this may mean: 3 or 4 glucose tablets 4 ounces (half a cup) of any fruit juice 4 ounces (half a cup) of a regular-not diet-soft drink 1 tube of glucose gel 8 ounces (a cup) of milk 5 or 6 pieces of hard candy (not sugar free) 1 tablespoon of sugar or honey The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If the level continues to be low the emergency foods need to be re-administered. If the next meal is an hour or more away, a snack should be eaten once the emergency foods have raised the blood glucose level to 70 mg/dL or above. Prevention of low blood sugar Low blood sugar episodes may be prevented by changing the therapy regimen or by adopting other practices. These include: Taking meals on time Not to skip meals or snacks Checking blood sugars regularly Adjust medications and exercise to maintain normal blood sugar control Avoid excess alcohol especially along with skipping meals Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.jdrf.org/index.cfm?page_id=108124 www.hamiltonhealthsciences.ca/.../LowBloodSugar-trh.pdf www.diabetes.ca/.../hypoglycemia-tool-kidney-disease.pdf http://lbmc.org/diabetes/HYPOGLYCEMIA.pdf http://www.sbo.hampton.k12.va.us/departments/health/HypoHyper12.pdf http://www.library.umc.edu/pe-db/Hypoglycemia%20and%20Diabetes.pdf http://www.uihealthcare.com/topics/diabetes/diab4396.html http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/ http://www.nlm.nih.gov/medlineplus/ency/article/000386.htm Further Reading What is Blood Sugar? Blood Sugar Normal Values Blood Sugar Regulation Blood Sugar Glucose Measurement Last Updated: Dec 3, 2012" }, "187": { "category_2_x_medical_disease.id": 187, "category_2.id": 50, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Test", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 187, "medical_disease.ts": "2018-04-20 02:40:58", "medical_disease.title": "NIPT Test (Noninvasive Prenatal Testing)", "medical_disease.content": "By Liji Thomas, MD The NIPT (noninvasive prenatal testing) is a genetic test performed on pregnant women, in order to detect fetal chromosomal aneuploidies. It is based upon the testing of cell-free fetal DNA (cf-fDNA) separated from the blood of the mother. It requires only a simple blood draw and is associated with no serious complications, like other blood tests. Basis of the NIPT test Fetal DNA fragments leak into maternal circulation in small amounts during pregnancy from the amniotic fluid. This can be analyzed, and all the adjoining sequences linked up, to map them to the individual chromosomes. Recently developed techniques such as shotgun massively parallel sequencing (MPS), especially if designed to target the chromosomes of interest, such as 21 or 18, make it easy, fast and inexpensive to sequence and compare fetal and maternal DNA in these specified chromosomal regions. This helps identify excessive material in the fetal chromosomes and quantify it, to give the risk of aneuploidy. In other words, having more of chromosome 21 material than expected signals that the fetus has an extra 21st chromosome. This test can be done by about 10 weeks of gestation, and is highly specific for the current pregnancy because it is cleared within an hour by the woman’s body. This means that no cell-free fetal DNA can be found more than an hour after delivery of the fetus. NIPT differences to other prenatal tests The triple and quadruple tests, followed by ultrasound imaging, have a high false positive rate for Down syndrome of between 2% and 7%, which is usually followed by invasive testing such as amniocentesis and chorionic villus sampling. This, besides being uncomfortable and expensive, has a 1-2% of miscarriage. NIPT was first introduced clinically in 2011, and has become immensely popular, as it is much less invasive in some cases, and more sensitive and specific than currently available tests for prenatal diagnosis. At present, NIPT is offered by governmentally funded agencies to the following high-risk categories in pregnancy, though private centers may offer it to anyone who asks: Older mothers (35 years or above at the time of delivery) Suspicious ultrasound findings indicating a risk of aneuploidy History of a baby with trisomy Any test yields a result positive for a higher risk of aneuploidy Parental karyotype with a balanced Robertsonian translocation which increases the risk of trisomy 13 or 21 in the fetus The difference that NIPT makes is that direct chromosomal testing is performed in this case, whereas indirect measures of chromosomal abnormality, such as resulting hormone levels in the mother’s blood, is measured in the triple and quadruple tests. This gives NIPT a high accuracy of over 98% in detecting a fetus with Down syndrome. Other conditions which can be currently tested for simultaneously include trisomy 13, 18, 22, and aneuploidies of the X or Y chromosomes, such as Turner syndrome or Klinefelter syndrome. However, the sensitivities and specificities for these conditions are lower than that for Down syndrome. Fetal sex and paternity is also detectable at an early stage of pregnancy. Diagnosis of more genetic abnormalities are being worked on currently, involving single gene mutations. Test results Related StoriesIQuity launches pioneering RNA-based blood test to diagnose fibromyalgiaVitamin D blood test may have potential to rapidly diagnose bipolar disorder in childrenFDA permits marketing of first blood test to evaluate mild traumatic brain injuryThe test results may be one of three types: Positive, which means the child will almost certainly have Down syndrome; invasive testing is offered to confirm this. Negative, which is interpreted to mean the fetus is very unlikely to have Down syndrome Inconclusive, which means no conclusions could be drawn because there was too little cf-fDNA to be tested. The NIPT test may be repeated a little later, when more cf-fDNA is likely to be present. This makes up about 4% of cases. About 98% of babies who have trisomic conditions will be detected by NIPT testing. False positives are very few, about 1 in 300, and may be due to a vanishing twin syndrome if done very early in pregnancy, or because the DNA came from a placenta which contains a few areas of chromosomal abnormality that are absent in the fetus proper (called ‘confined placental mosaicism’). In very rare cases the abnormality is actually in the mother’s DNA rather than in the baby’s. False negatives, when the baby has a chromosomal anomaly that is not detected, which may occur because there is too little fetal DNA to be checked, or because the placenta (from which the cf-fDNA is shed) lacks the abnormality that is present in the baby, and rarely, because of a defective testing procedure. NIPT testing is affected greatly by the fraction of cf-fDNA present in the mother’s blood, which depends upon the mother’s body mass, race, the presence of mosaicism, the age of pregnancy, and whether the pregnancy is a singleton or multiple gestation. Caution However, a strong note of caution needs to be sounded; NIPT is a screening test, and its results should be shared only by a health professional who is qualified to interpret the results and give proper counseling to the patient. For instance, NIPT may become a tool to facilitate selective female feticide in many regions of the world where female children are unwelcome. This is even more challenging to stop because of the ease of the test, unlike the more advanced facilities needed to perform the other more invasive screening tests. In addition, it may make it still easier to detect a host of other genetic disorders. Thus, it may seem that NIPT is a great advance in making accurate aneuploidy testing available in low-resource areas of the world, but not enough thought has been given to its legal and ethical application. For instance, how to discourage the selective abortion of female, Down syndrome, or otherwise ‘defective’ children (without lethal anomalies), the need to discriminate between pathological and incidental variants of alleles without unnecessarily inducing panic and pushing up abortion rates, and making information readily and accurately available to all stakeholders, all remain pressing unsolved issues of today. It is essential also to remember that disabled people will always be present in society, and weeding out disabled children may release a Frankenstein’s monster—viz, neglect of adults in society who are disabled (by accident or illness) by the very children who were selected for by the use of such tests. Families with disabled children may also find social acceptance and the facilities to manage such children lacking in the future. Reviewed by Chloe Barnett, BSc Sources https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303457/ http://www.rapid.nhs.uk/guides-to-nipd-nipt/nipt-for-down-syndrome/ nuffieldbioethics.org/.../NIPT-ethical-issues-full-report.pdf https://www.ncbi.nlm.nih.gov/pubmed/25112487 // Last Updated: Mar 22, 2018" }, "188": { "category_2_x_medical_disease.id": 188, "category_2.id": 51, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Transfusion", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 188, "medical_disease.ts": "2018-04-20 02:41:01", "medical_disease.title": "What is a Blood Transfusion?", "medical_disease.content": "By Dr Ananya Mandal, MD Blood transfusion refers to the administration of donated blood products such as red blood cells, platelets or plasma. Blood transfusion is indicated in the treatment of various conditions including trauma, bleeding disorders and blood loss due to surgery. Blood transfusion is required when blood loss has occurred or the body fails to produce enough blood or blood components to meet the body’s needs. Blood transfusion essentially involves replacement of the blood components that are lacking. These include: Red blood cells (RBCs) containing the hemoglobin that carries oxygen to the various organs and tissues in the body. Patients with low hemoglobin (anemia) require blood transfusions to replace these RBCs. A blood transfusion is generally needed if the haemoglobin is below 70 g/L (grams per litre) but may also be necessary if the haemoglobin is between 70 g/L and 100 g/L. The procedure is not usually required when a person’s hemoglobin is above 100 g/L. Platelets are small cells in blood that aid blood clotting and help to prevent bleeding after injury. If a patient’s platelet count is low or the platelets do not function properly, a platelet transfusion may be required. Blood donation Related StoriesResearchers develop new test that predicts need for massive blood transfusion in trauma patientsBlood transfusions should be gender matched between donor and recipientExperts endorse recommendations for restrictive blood transfusions Blood is usually collected from voluntary blood donors. Donated blood undergoes extensive checking and testing to prevent the transmission of blood-borne infections through the transfusion of contaminated blood. Common infections that may be transmitted in this manner include HIV and Hepatitis B and C. Risks associated with blood transfusion Blood transfusion is associated with several risks. In the past, the transmission of infections was one of the most important risk factors associated with blood transfusion. Nowadays, this risk is much smaller due to stringent blood screening processes. Other risk factors associated with blood transfusion include: An allergic reaction to the blood may occur. These reactions range in severity from a mild skin reaction or fever, for example, through to more severe and life threatening reactions A severe allergic reaction may occur as a result of mismatched transfusion due to ABO or Rh incompatibility, for example. Blood is typed into 4 major groups: A, B, O and AB. In cases of ABO incompatibility, the reaction is invariably severe and leads to destruction of circulating donor RBCs, respiratory collapse and acute renal failure. Transfusion associated circulatory overload (TACO) Transfusion associated lung injury (TRALI) Over time, repeated blood transfusions may cause iron overload that leads to iron deposition in the tissues and organ injury. Reviewed by Sally Robertson, BSc Sources www.cec.health.nsw.gov.au/.../transfusion-english.pdf www.ucl.ac.uk/anaesthesia/StudentsandTrainees/BloodTransfusion.pdf www.cancer.org/acs/groups/cid/documents/webcontent/002989-pdf.pdf www.liver-eg.org/includes/lectures/clinical/blood%20transfusion.pdf Further ReadingHistory of Blood TransfusionBlood Transfusion PrecautionsBlood Transfusion Substitutes Last Updated: Mar 31, 2014" }, "189": { "category_2_x_medical_disease.id": 189, "category_2.id": 51, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Transfusion", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 189, "medical_disease.ts": "2018-04-20 02:41:05", "medical_disease.title": "History of Blood Transfusion", "medical_disease.content": "By Dr Ananya Mandal, MD The first research into blood transfusion dates back to the 17th Century when British physician William Harvey fully described the circulation and properties of blood in 1628. The first blood transfusions were also attempted around this time, although these were often unsuccessful and proved fatal in humans. The first successful blood transfusion recorded was performed by British physician Richard Lower in 1665 when he bled a dog almost to death and then revived the animal by transfusing blood from another dog via a tied artery. Related StoriesBlood transfusions should be gender matched between donor and recipientResearchers develop illuminated pajamas for babies being treated for jaundiceExperts endorse recommendations for restrictive blood transfusions In 1667, Jean-Baptiste Denis who was physician to King Louis XIV, performed the transfusion of blood from an animal to a human. Denis transfused the blood from a sheep to a 15-year old boy and later to a labourer, both of whom survived the transfusions. In 1818, British obstetrician James Blundell successfully transfused human blood to a patient who had hemorrhaged during childbirth. In 1901, Karl Landsteiner, an Austrian physician discovered the first human blood groups, which helped transfusion to become a safer practice. By performing experiments in which he mixed blood samples taken from his staff, Landsteiner discovered blood groups A, B and O and established the basic principals of ABO compatibility. In 1907, an American surgeon called Reuben Ottenberg suggested that patient and donor blood should be grouped and cross matched before a blood transfusion procedure. Between 1914 and 1918, anticoagulants such as sodium citrate were found to prolong the shelf life of blood and refrigeration also proved to be an effective means of preserving blood. In the 1920’s and 30’s, the voluntary donation of blood for storage and use was started. At around the same time, Edwin Cohn developed cold ethanol fractionation, a method of breaking down blood into its component parts to obtain albumin, gamma globulin and fibrinogen, for example. During the Second World War, blood transfusion was used on a large scale to treat injured soldiers and became well known as a life saving procedure. Reviewed by Sally Robertson, BSc Sources www.redcrossblood.org/learn-about-blood/history-blood-transfusion http://www.blood.co.uk/about-blood/history/ http://www.ishim.net/Articles/Blood%20Transfusion%20in%20History.pdf https://www.bbts.org.uk/news/latest_news/the_timeline__blood_donation/ Further ReadingWhat is a Blood Transfusion?Blood Transfusion PrecautionsBlood Transfusion Substitutes Last Updated: Mar 31, 2014" }, "190": { "category_2_x_medical_disease.id": 190, "category_2.id": 51, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Transfusion", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 190, "medical_disease.ts": "2018-04-20 02:41:10", "medical_disease.title": "Blood Transfusion Precautions", "medical_disease.content": "By Dr Ananya Mandal, MD Certain precautions and guidelines must be adhered to in blood transfusion to ensure the safety of the procedure. The steps involved in obtaining and checking donor blood for transfusion are described below. The donor is asked to complete a questionnaire detailing any history of infectious diseases and other medical issues before they are allowed to donate blood for transfusion. The donor’s hemoglobin level is checked. Once collected, the blood is examined and screened for possible infectious agents such as HIV and hepatitis. The blood from the donor is cross matched with the patient’s blood sample to check it is compatible. Blood group is determined by the antigen profile of an individuals’ red blood cells. The most important antigens in blood typing are the ABO and Rh antigens. Every individual has an ABO blood type (blood group A, B, AB, or O), which means their red blood cells may display antigen A, antigen B, both antigens, or neither antigen. Each person is also either positive or negative for the Rh antigen. Overall, these antigens can combine to give eight possible blood types. The patient is only considered for transfusion if they really stand to benefit from the procedure. A complete blood count is performed to check levels of the various blood components including red blood cells, white blood cells, and platelets. Coagulation (clotting) tests are also performed. The blood is transfused through tubing that is connected to a needle or catheter supplying the vein. The amount of blood transfused depends on the individual patient’s needs. During blood transfusion, vital signs such as temperature, heart rate, and blood pressure are carefully monitored Some patients may get a sudden fever during or within 24 hours of the transfusion, which may be relieved with acetaminophen or paracetamol. This fever is a common reaction to the white blood cells present in donated blood. Reviewed by Sally Robertson, BSc Sources www.cec.health.nsw.gov.au/.../transfusion-english.pdf www.ucl.ac.uk/anaesthesia/StudentsandTrainees/BloodTransfusion.pdf www.cancer.org/acs/groups/cid/documents/webcontent/002989-pdf.pdf www.liver-eg.org/includes/lectures/clinical/blood%20transfusion.pdf http://whqlibdoc.who.int/publications/2005/9241580364_chap8.pdf http://www.cancer.org/treatment/treatmentsandsideeffects Further ReadingWhat is a Blood Transfusion?History of Blood TransfusionBlood Transfusion Substitutes Last Updated: Mar 31, 2014" }, "191": { "category_2_x_medical_disease.id": 191, "category_2.id": 51, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blood Transfusion", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 191, "medical_disease.ts": "2018-04-20 02:41:15", "medical_disease.title": "Blood Transfusion Substitutes", "medical_disease.content": "By Dr Ananya Mandal, MD Blood transfusion is associated with risks that can be avoided by using substitutes to blood transfusion. Furthermore, supplies of donor blood are limited and substitutes or alternatives to blood transfusion may help curb the shortages. Some of the alternatives to blood transfusion that are available include: Volume expanders Blood loss involves the loss of blood volume. The human body normally contains around 5 litres of blood. When a lot of body fluids are lost, shock may set in. This blood loss and shock can be prevented by administering solutions that expand the plasma volume, restoring it to a normal level and keeping the circulation going. The most common fluids used to achieve this in the hospital setting include normal saline (sterile water with a precise amount of salt) and lactated Ringer’s solution (saline plus other chemicals). These are administered directly into the blood stream via intravenous catheters. Growth factors Related StoriesWorld Hepatitis Day – gearing towards eliminating viral hepatitis by 2030Lipoprotein abnormalities linked to vaso-occlusive events in patients with sickle cell diseaseSickle cell patients, families and doctors face a ‘fight for everything’Hematopoietic growth factors stimulate the bone marrow to make more blood cells. In patients with low blood counts, these agents can help increase the red blood cell, white blood cell, or platelet counts. However, one disadvantage of growth factor therapy over blood transfusion is that growth factors often take many days or weeks to raise the blood counts and are not useful for patients who need their blood cell urgently restored. Other important drawbacks of growth factor therapy include lack of treatment response in cases of severe bone marrow disease and an increased risk for certain types of cancer including lymphocytic leukemia, multiple myeloma, breast cancer and cervical cancer. Growth factors are also more expensive than whole blood transfusion. Autologous blood transfusion An autologous blood transfusion involves some of the patient’s own blood being removed, filtered and then introduced back into the patient. This is the preferred option in planned surgeries. Using the patient’s own blood reduces the need for transfusions from other donors. Reviewed by Sally Robertson, BSc Sources www.cec.health.nsw.gov.au/.../transfusion-english.pdf www.ucl.ac.uk/anaesthesia/StudentsandTrainees/BloodTransfusion.pdf www.cancer.org/acs/groups/cid/documents/webcontent/002989-pdf.pdf www.liver-eg.org/includes/lectures/clinical/blood%20transfusion.pdf http://whqlibdoc.who.int/publications/2005/9241580364_chap8.pdf http://www.cancer.org/treatment/treatmentsandsideeffects/ Further ReadingWhat is a Blood Transfusion?History of Blood TransfusionBlood Transfusion Precautions Last Updated: May 6, 2014" }, "192": { "category_2_x_medical_disease.id": 192, "category_2.id": 52, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Blue Nevi", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 192, "medical_disease.ts": "2018-04-20 02:41:18", "medical_disease.title": "Blue Nevus / Nevi / Mole", "medical_disease.content": "By Liji Thomas, MD Blue nevi are a category of melanocytic tumors, which arise from the proliferation of dermal dendritic melanocytes to form an acquired pigmented mole. They are also called pigmented nevi, nevomelanocytic nevi of acquired origin, or melanocytic nevi. These are typically innocuous tumors. The melanocytes are deep in the skin, unless with the brown or black moles. Dermoscopy shows an unchanging steel-blue pattern. The most frequently observed variants include the common blue nevi and cellular blue nevi. A third of all oral nevi are blue nevi, and these occur most often on the scalp, the dorsal sides of the hands or feet, and the sacral area. Among these, the sacral area shows cellular blue nevi most frequently. The extremities are more likely to have common blue nevi. They are present in about three percent of Japanese people, and their prevalence is usually higher in Asians; however, they also occur in 0.5-4 percent of Caucasians. Women are twice as often affected as men. Blue Nevus on the Nose of a Female - Image Credit: Anthony Ricci / Shutterstock Origin Blue nevi arise from active dermal melanocytes present at birth, which occurs in these sites. In most other sites, these cells disappear from the dermis during fetal life. Common blue nevi contain spindled dendritic melanocytes, while cellular blue nevi show ovoid melanocytes. Junctional cells are rarely present. Genetics of Blue Nevi Most acquired melanocytic nevi have somatic activating mutations in MAPK signaling pathway genes, especially BRAF and NRAS genes. These are uncommonly found in blue nevi, which supports their independent origin, together with their clinical and histopathological features. However, blue nevi do exhibit somatic mutations of one of the genes which code for the G protein α-subunits, namely, GNAQ or GNA11 genes, mostly in codon 209. These lead to a loss of GTPase activity and upregulates the MAPK pathway signaling. This is the same effect as occurs with BRAF and NRAS mutations. These mutations are oncogenic but their effect is not sufficient in isolation to cause cancerous changes, which correlates with the low risk of malignancy with blue nevi. Tumors which become malignant show a rapid increase in size. Common Blue Nevi These may occur in any age group, or even be present at birth. The most common age of occurrence is in adolescence. They are usually small smooth single papules colored dark blue to black. They are usually less than one centimeter in size. The color is due to the reflection of blue light, which has a shorter wavelength than light of other colors – the Tyndall scattering. Cellular Blue Nevi These may also be seen at any age. However, they usually arise below the age of 40 years. They are dark-colored, being bluish-black, and appear as plaques or nodules. They may be from one to several centimeters in size. Some larger cellular blue nevi on the trunk may appear histologically identical to a melanoma, but metastatic spread almost never occurs. FISH analysis is sometimes useful in distinguishing between such tumors and melanomas. Other Variants Rare variants and related dermal melanocytic proliferations have not been well studied, but the characteristic mutations are much less frequent in these than with the more common subtypes. Diagnosis and Management Blue nevi are diagnosed by their peculiar color, but if any suspicion of melanoma exists, the lesion is excised and sent for histopathological examination. Blue nevi may be ignored if they are of typical size and appearance, and have a normal rate of growth. However, in most cases excision biopsy would be preferred to rule out more deadly conditions such as melanomas. Excision under local anesthesia is preferred If the nevi have recently appeared or are fast growing, or if a melanoma or other skin cancer is to be ruled out based on the clinical appearance, or if they are very unsightly. Recurrence is uncommon but satellite lesions do occasionally occur following excision, and must be evaluated by biopsy to rule out malignant transformation. Reviewed by Afsaneh Khetrapal BSc (Hons) References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609613/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965271/ https://www.ncbi.nlm.nih.gov/pubmed/11224601 http://www.dermnetnz.org/topics/blue-naevus/ https://patient.info/in/doctor/blue-naevus Last Updated: May 10, 2017" }, "193": { "category_2_x_medical_disease.id": 193, "category_2.id": 53, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 193, "medical_disease.ts": "2018-04-20 02:41:22", "medical_disease.title": "Bone cancer (sarcoma) - What is bone cancer?", "medical_disease.content": "By Dr Ananya Mandal, MD Bone cancer may be of two basic types: Primary bone cancer - cancer that begins in the bone Secondary bone cancer - cancer that begins elsewhere in the body (for example lungs, breast, liver etc.) that has spread to the bone Primary bone cancer is a rare form of cancer - about 500 cases are diagnosed in the UK each year (only about one in every 500 cancers). Around 2,600 people in United States of America are diagnosed with primary or secondary bone cancer each year. Bone cancers make for 2% of all cancers in the USA. How does bone cancer begin? The cancer usually begins with bone pain that usually gets worse over time and may wake the affected person from sleep. There may be bone fractures on relatively less severe impact or trauma and swelling and tenderness over the affected area as well. Joint movement may be difficult if the joints are affected. In addition, there may be weakness, weight loss, fever and other general symptoms. 1-6 Causes and risk factors The exact causes of bone cancer are unknown. Risk factors include exposure to radiation in the past, having Paget’s disease of the bone that affects the growth cycle of the bone cells. Only around 1% of persons with Paget’s disease may develop bone cancer. There is no evidence that an injury to the bone causes cancer. There may be a link to rare genetic conditions such as Li-Fraumeni syndrome. Types of Primary bone cancer Bone is made up of cells that grow and collagen fibres (tough, elastic fibres) as well as minerals like Calcium that give it the hardness. There are two main types of cells within the hard bone tissue that mould the bone. These cells are Osteoblasts and Osteoclasts. Osteoblasts form the bone by laying down bone material. Osteoclasts dissolve the particles of bone and cause resorption. These cells are active throughout life and work in tandem balance to keep the bone constantly growing and dissolving. There is a slow but constant turnover of bone. Another type of cell is chondrocytes which make cartilage. These make the hard tissues that cover the ends of bones in joints. In the centre of some larger bones is the soft bone marrow that is the place where blood cells are manufactured. Although bone cancers are rare, there are four major types of bone cancer of primary origin. These include osteosarcoma, Ewing’s sarcoma, spindle cell sarcoma and chondrosarcoma. Osteosarcoma This is the commonest type of primary bone cancer. In the United Kingdom, around 150 new cases are diagnosed each year. The cancer is seen commonly in children and young adults between ages of 5 and 20. Among young people osteosarcoma is the third most common cancer after leukaemia and brain tumours. Osteosarcoma affects larger bones, such as the thigh bone (femur) or the shin bone (tibia). Ewing's sarcoma Around 100 new cases of this cancer are detected in the UK each year. Ewing’s sarcoma also affects children and young people aged between 10 and 20. Ewing’s sarcoma also affects larger bones like pelvis, thigh bone or shin bone. Spindle cell sarcoma Around 80 new cases of this cancer are diagnosed in UK each year. This cancer is similar to osteosarcoma and is diagnosed in adults aged 40 or over. Chondrosarcoma This cancer is diagnosed in 80 individuals in UK each year. This is the cancer of middle ages and is diagnosed in people aged between 40 and 50. Commonly affected sites include pelvis, thigh bone, upper arm bone, shoulder blade (scapula) and the ribs. Management of bone cancers Bone cancer treatment includes therapy with medication or chemotherapy to reduce the size of the tumor and then follow up with surgery to remove the affected area of bone. Earlier bone cancer surgery involved removal of the limb altogether (amputation). These days the affected part of the bone may be removed and replaced with metal implants. This is called limb-sparing surgery. Outcome Bone cancer that is detected early and is confined to the bone is relatively easier to treat with a better outlook. On the other hand cancer that has spread to the bone marrow or to other organs like lungs, liver etc. is difficult to treat and chances of survival are relatively low. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Further Reading Causes and symptoms of bone cancer Types of bone cancer Diagnosis of bone cancer Treatment of bone cancer Source www.nhs.uk/conditions/Cancer-of-the-bone/Pages/Introduction.aspx www.royalmarsden.nhs.uk/.../osteosarcoma.aspx www.bbc.co.uk/.../typescancer_bone.shtml http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002616/ http://www.patient.co.uk/health/Cancer-of-the-Bone-(Primary).htm www.mdanderson.org/.../index.html Last Updated: Oct 14, 2014" }, "194": { "category_2_x_medical_disease.id": 194, "category_2.id": 53, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 194, "medical_disease.ts": "2018-04-20 02:41:27", "medical_disease.title": "Causes and symptoms of bone cancer", "medical_disease.content": "By Dr Ananya Mandal, MD Cancers usually begin when the growth cycle of a cell is abnormal. Normal cells have genetic blue prints or guidelines that regulate their growth, attainment of maturity, reproduction and functions and ultimately death. The DNA provides these basic information and instructions. If there is a change in the DNA at a point it is called a mutation. This change may alter the instructions that control cell growth. This ultimately may lead to the death of the cells or even to an uncontrolled growth of the cells. The cells continue to grow without stopping or dying and also reproduce uncontrollably. This leads to formation of a lump of tissue called a tumour. 1-8 In some cases this tumor may be harmless or slow growing and is termed benign. This tumor, apart from pressing on the surrounding tissues may not affect the person. In some cases the mutation of the DNA may lead to cancer. Left untreated or unchecked the cancer cells may spread to other organs from the affected area of the bone. The spread may affect the bone marrow that lies within the inner core of the bone and is responsible for formation of blood cells or into other organs via blood vessels. Who does bone cancer usually affect? Most primary bone cancers affect children and young people in whom there is a growth spurt and rapid bone growth. Bone cancers commonly affect the fast growing ends of the bones. The ends of the bones are the fastest growing sites of the bone where the osteoblasts are most active. Risk factors for bone cancer The exact cause of bone cancers that originate from the bone (Primary bone cancers) is not known. It is speculated that some risk factors may raise the chance of getting bone cancers. It must be remembered that primary bone cancers are very rare. These risk factors include: Age - The risk of osteosarcoma is highest during the teenage growth spurts Height – There may be link between tall children and osteosarcoma. Sex - Osteosarcoma is more common in males than in females. Ethnicity - Osteosarcoma is slightly more common in African Americans than in whites. Those who have been exposed to radiation or radiation therapy previously are at a higher risk of bone cancers. Those with Paget’s disease of the bone are also at risk of bone cancers. However, the risk of bone cancers in individuals with Paget’s disease is less than 1%. Chondroma also increases the risk of osteosarcoma. There is a rare genetic condition called Li-Fraumeni syndrome. This affects 1 in every 142,000 people and may raise the risk of bone cancers. Hereditary multiple exostoses (HME) and inherited breast cancer may also raise the risk of bone cancers. Babies with a rare type of childhood cancer which develops in the eye called retinoblastoma have a higher risk of bone cancers. Ewing’s sarcoma has been seen three times more commonly in babies who are born with an umbilical hernia. The cause of this association is as yet unknown. Umbilical hernia occurs in some babies at birth when their abdominal contents like intestines tend to protrude out from their navel that refuses to close. The risk of Ewing’s sarcoma in these babies however is very small with only one in 110,000 children with an umbilical hernia going on to develop Ewing’s sarcoma. Bone cancer has often been linked to injuries to a limb but this association is not proven. Symptoms of bone cancer The most common symptom of bone cancer is bone pain. The affected area is tender to touch and the child is often seen avoiding the use of the joint or limb with the affected bone. The pain becomes chronic and may worsen during the night and affect sleep. Ewing sarcoma patients complain of rapidly worsening bone pain. This bone pain may be mistaken for arthritis in older adults and “growing pains” in children and teenagers. Apart from pain and tenderness there may be swelling and redness and a noticeable lump over the affected area. If the affected area is near the joint, movement at the joint may be stiff or restricted. Bones affected with cancer are also weak and brittle and may fracture or break easily with minor injuries or trauma. Other less common but more serious symptoms include: high temperature (fever) of 38C (100.4F) or above sweating, usually at night weakness fatigue anemia unexplained weight loss etc. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Further Reading Bone cancer (sarcoma) - What is bone cancer? Types of bone cancer Diagnosis of bone cancer Treatment of bone cancer Sources http://www.nhs.uk/Conditions/Cancer-of-the-bone/Pages/Causes.aspx www.royalmarsden.nhs.uk/.../osteosarcoma.aspx www.bbc.co.uk/.../typescancer_bone.shtml http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002616/ http://www.patient.co.uk/health/Cancer-of-the-Bone-(Primary).htm http://www.boneandcancerfoundation.org/pdfs/Osteosarcoma-2.pdf http://www.cancer.umn.edu/cancerinfo/sarcoma/osteosarcoma.html www.cancer.org/acs/groups/cid/documents/webcontent/003069-pdf.pdf Last Updated: Nov 30, 2013" }, "195": { "category_2_x_medical_disease.id": 195, "category_2.id": 53, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 195, "medical_disease.ts": "2018-04-20 02:41:30", "medical_disease.title": "Types of bone cancer", "medical_disease.content": "By Dr Ananya Mandal, MD Bone cancers may originate in the bone or may originate elsewhere in the body and spread to the bones. The first type is called Primary bone cancer while the second is called Secondary bone cancer. All types of bone cancer are very rare but Primary bone cancers are particularly rare. 1-6 Types of bone cell The bone is a dynamic organ unlike its appearance of a hard inert organ. There are cells within it, as well as fibers or tough tissues called collagen and minerals like Calcium and Phosphates. The cells include Osteoblasts, Osteoclasts and Chondrocytes. The osteoblasts are cells that multiply regularly to provide the growth and structure of the bones. The Osteoclasts help in removal or dissolution of the excess bone tissues. This helps in moulding a remoulding of the bone to suit the structure and function. Chorndrocytes give rise to the cartilage tissues that cap the ends of the bones especially at the joints. All these cells are constantly growing and dying to make the bone an organ like any other in the body. Cancer occurs when these cells have abnormalities in their growth cycles and grow unimpeded. Types of bone cancer Primary bone cancers may affect the bone cells. These cancers are all termed “sarcoma”. A sarcoma is a cancer that originates from cells that construct the connective tissues (supporting tissues) of the body. This includes cells of the bone, muscle, cartilage, ligaments, etc. Types of bone cancers include osteosarcoma, Ewing's sarcoma, spindle cell sarcoma and chondrosarcome. Osteosarcoma This is the most common type of primary bone cancer but is rare in the general population. In the UK around 150 new cases are diagnosed each year. Osteosarcoma commonly affects children and young adults between ages 5 and 20 years. Among children Osteosarcoma is the third most common cancer in young people after leukaemia and brain tumours. The male:female ratio is 1.4:1. It arises from bone-forming cells or osteoblasts. This cancer affects large bones like thigh bone (femur) or the shin bone (tibia) more commonly than other bones. It typically develops in the growing ends of the bone near the knee and may also affect the upper arms bones. However, any bone can be affected. Ewing's sarcoma Ewing's sarcoma is detected in around 100 people each year in the UK. This type of cancer also affects children and young adults predominantly with most cases seen in people aged between 10 and 20 years. However, around 1% of cases may be detected in those over 20 as well. The condition is extremely rare over the age of 40. It is very uncommon in the African and Asian population. The male to female rate of incidence is 1.5:1. This cancer also affects the thigh bone, shin bone and the pelvis or hip bone. Spindle cell sarcoma This is a rare type of bone cancer with an estimated 80 cases each year. The cancer is similar to osteosarcoma in terms of appearance, symptoms and management protocols and plans. However, this type of cancer is commonly seen in adults over the age of 40. Chondrosarcoma This type of cancer occurs in the Chondrocytes and is rare with around 80 cases diagnosed each year in the UK. This cancer may be found in the middle aged and those between ages 40 and 50. Males and females are equally affected. The most common sites of Chrondrosarcoma are the pelvis or hip bone, thigh bones, upper arm bone (humerus), shoulder blade (scapula) and the ribs. They may arise from pre-existing lesions like osteochondromas and chondromas or they can be primary. Rare types of primary bone cancer Other rare types of primary bone tumour include: Leiomyosarcoma fibrosarcoma (affects the fibrous tissues in the leg, arm or jaw) malignant fibrous histiocytoma (affecting connective tissues) angiosarcoma (affects the blood vessels) chordoma (spine and base of the skull) malignant giant cell tumour Secondary bone cancer Secondary bone tumors are those that originate from other cancer sites. These may be multiple or single. The most common sites from where bone cancers or metastasis may occur are breast, prostate, lung, kidney and thyroid. In children common sites from where bone cancer may originate include Wilm’s tumor and neuroblastoma. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Further Reading Bone cancer (sarcoma) - What is bone cancer? Causes and symptoms of bone cancer Diagnosis of bone cancer Treatment of bone cancer Sources www.nhs.uk/conditions/Cancer-of-the-bone/Pages/Introduction.aspx http://www.patient.co.uk/health/Cancer-of-the-Bone-(Primary).htm http://www.patient.co.uk/doctor/Bone-Tumours.htm www.mdanderson.org/.../index.html http://www.boneandcancerfoundation.org/pdfs/Osteosarcoma-2.pdf http://www.cancer.umn.edu/cancerinfo/sarcoma/osteosarcoma.html Last Updated: Sep 4, 2012" }, "196": { "category_2_x_medical_disease.id": 196, "category_2.id": 53, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 196, "medical_disease.ts": "2018-04-20 02:41:35", "medical_disease.title": "Diagnosis of bone cancer", "medical_disease.content": "By Dr Ananya Mandal, MD Children and young adults with symptoms of bone cancer present to their physician with bone pain, swelling, lump or a fracture. Diagnosis is made on the basis of physical examination and detailed imaging studies. 1-6 Diagnosis of bone cancer includes taking a medical history, physical examination and so forth. Medical history History of bone pain, radiation exposure, Paget’s disease, retinoblastoma and umbilical hernia at birth is important. Family history of Li-Fraumeni syndrome or HME needs to be evaluated as these may raise the risk of bone cancers. Physical examination A physical examination shows the signs of a bone tumor. The long bones (especially at the ends) like the thigh bone (femur), shin bone (tibia), upper arm (humerus), pelvis (hip bone) are commonly affected. However, other bones may also be affected. A complete physical examination reveals swelling, tenderness, joint movement restriction etc. Routine blood tests Routine blood tests are advised. If there is affliction of the bone marrow due to spread of the cancer there may be anemia, low white blood cell or platelet counts. Blood biochemical tests Blood biochemical tests may show increase in an enzyme called alkaline phosphatise in patients with osteosarcoma X-ray of the bone This is the most common and most cost effective investigation advised when a bone condition is suspected. The patient who presents to the physician with a fracture may have an underlying bone cancer that may be suspected on an X ray. If the X ray is suggestive of bone cancer the patient is referred to a specialist for further evaluation and management. Biopsy This is the most definite method of detecting bone cancer. Biopsy involves taking a small sample of the affected area of the bone and staining it with suitable dyes on a slide and examining the cells of the sample under a microscope in the laboratory. Biopsy is used to detect the type of cancer, the stage or grade of the cancer and how aggressive the cancer is. This helps in planning management of the cancer and also helps in predicting the outcome of the cancer. Biopsy of the bone may be taken by one of the two methods - core needle biopsy or open biopsy. A core needle biopsy is performed after applying local or general anesthesia. A thin needle is inserted into the bone and a sample of tissue is removed. An open biopsy is usually performed under general anaesthesia. The surgeon makes an incision over the affected bone and removes a larger section of the bone for analysis. MRI scan MRI scan is another imaging study that uses a strong magnetic field and radio waves to look at the bones and the organs of the body. This may be advised to detect the size and spread of any cancerous tumour within the bone. CT scan A CT scan also involves taking a series of X-rays that look at the size and extent of spread of the cancer. CT scans of the chest may reveal spread of the bone cancer to the lungs. Bone scan A bone scan or Bone scintigraphy using technetium99 may be prescribed. This used a small amount of radioactive material (technetium99) that is injected into the veins of the arm. Abnormal areas of bone will absorb the material at a faster rate than normal bone. A special camera is then used to take pictures of these “hot spots” where the dye is concentrated. A Positron emission tomography (PET) scan may also be performed. Staging bone cancer After diagnosis and confirmation of the cancer the cancer is staged into various stages. Staging helps to decide on the treatment and also helps to determine the outcome of the cancer. Stage 1 for example is when the cancer is low grade and has not spread beyond the bone. Stage 2 is when the cancer has still not spread beyond the bone but testing shows that it is high grade cancer and has the potential for spread. Stage 3 occurs when the cancer has spread into other parts of the body, such as the lungs. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Further Reading Bone cancer (sarcoma) - What is bone cancer? Causes and symptoms of bone cancer Types of bone cancer Treatment of bone cancer Sources http://www.nhs.uk/Conditions/Cancer-of-the-bone/Pages/Diagnosis.aspx www.bbc.co.uk/.../typescancer_bone.shtml http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002616/ http://www.patient.co.uk/health/Cancer-of-the-Bone-(Primary).htm http://www.boneandcancerfoundation.org/pdfs/Osteosarcoma-2.pdf www.clinicaladvances.com/article_pdfs/ho-article-201010-geller.pdf Last Updated: Sep 4, 2012" }, "197": { "category_2_x_medical_disease.id": 197, "category_2.id": 53, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 197, "medical_disease.ts": "2018-04-20 02:41:40", "medical_disease.title": "Treatment of bone cancer", "medical_disease.content": "By Dr Ananya Mandal, MD Who treats bone cancer? Bone cancer is usually treated by a team of health care providers. The team includes: an orthopaedic surgeon who specializes in conditions of the bones and joints a clinical oncologist or cancer specialist a pathologist a radiologist pain relief specialist or palliative care specialist a psychologist a cancer nurse a social worker These are termed multi-disciplinary teams that assist people with bone cancer. 1-6 Types of treatment of bone cancer Bone cancers are usually treated with three modalities of treatment: Chemotherapy – with the use of anticancer drugs that are used to shrink the tumors Surgical therapy Radiation therapy Most patients need a combination of these therapeutic approaches for management of bone cancer. Different types of bone cancer are usually treated in a similar way. The treatment usually begins with chemotherapy to prevent spread and shrink the tumor and thereafter surgery may be carried out to remove the section of cancerous bone. Earlier surgery meant removal of the affected limb altogether – or limb amputation. These days it is possible to reconstruct the part of the bone that is removed using metallic implants. This is called limb sparing surgery. Radiotherapy is used after surgery to kill any residual cancer cells. It is helpful in some types of cancer (such as Ewing’s sarcoma, for example). Chemotherapy for bone cancer Cancer killing medications are used to kill the tumor cells and shrink the tumor. This may be given before surgery, in combination with radiotherapy before surgery (chemoradiation) as is preferred in Ewing sarcoma, after surgery to prevent the cancer from returning and to control the symptoms in very advanced and non-curable bone cancers. Chemotherapy may be given in cycles. Patient may or may not be admitted to the hospital but may have to visit the day care centers where the drug may be injected into their veins using infusions. A cycle involves taking the chemotherapy medication for several days followed by a gap of a few weeks to allow the body to recover from the effects of the treatment. A low grade cancer requires less number of chemotherapy cycles than a high grade tumor. Medications that are used in bone cancer chemotherapy include: Carboplatin Cisplatin Cyclophophamide Doxorubicin Epirubicin Etoposide Ifosphamide Methotrexate with Leucovorin Common side effects include: nausea vomiting diarrhea loss of appetite loss of hair weakness mouth ulcers risk of infections bleeding infertility etc. Since bone cancers affect children and young people the risk of infertility after chemotherapy should be considered and patients or their guardians should be counselled regarding choice of sperm or egg storage for future fertility choices. Radiation therapy for bone cancer Radiation therapy uses high energy X-ray or gamma ray beams to kill the cancer cells. This may be used before and after surgery to treat bone cancer. Radiotherapy sessions may also be administered in cycles five days a week with a break from treatment over the weekends. Side effects of radiation therapy include skin burns, rashes, weakness, nausea, loss of hair etc. Surgery Limb-sparing surgery is preferred if the cancer has not spread beyond the bone, and the affected bone itself is in an easily accessible position like in one of the arms, legs, shoulder, hip etc. The surgery involves removing the section of affected bone and a bit of the surrounding healthy bone (just in case the cancer has spread to the tissues) and replacement of the part of the bone with a metal implant called prosthesis. As an alternative bone grafts from another part of the body may also be used as a replacement. If the cancer has affected a joint like the knee, elbow or shoulder joint, an artificial joint may have to be placed. The artificial joint is usually a combination of plastic, metal, and ceramics. Amputation is needed if the cancer has spread beyond the bone and affected blood vessels and nerves, skin or if the limb sparing surgery has failed. Amputation is also opted if the bone that is affected is not easily accessible like the ankle joint. Patients who require an amputation need counselling and may need help of an occupational therapist and counselling for opting an artificial limb. Biological therapy Some agents have been developed for use against bone cancers. These originate from the cells of the body and are thus termed biological therapy. These target the cancer cells selectively and thus cause less side effects than chemotherapeutic agents. A new medication called mifamurtide has recently been approved for the treatment of high-grade osteosarcoma. This agent is an immune macrophage stimulant. It acts by stimulating the immune system to produce specialised cells that can kill the cancer cells selectively. This means less side effects than seen with conventional chemotherapy agents. Mifamurtide is given after surgery and also in combination with chemotherapy. It serves to kill any remaining cancerous cells and to help prevent the cancer from returning. Common side effects include nausea, vomiting, headache, constipation, allergies, muscle and joint pain, hearing loss, blurring of vision etc. Outcome of bone cancer The outcome of bone cancer is determined by survival for at least five years after diagnosis. For localised osteosarcoma and Ewing’s sarcoma five year survival is seen in around 60% and 70% people respectively. Those in whom the osteosarcoma or Ewing’s sarcoma has spread the chances of five year survival is only 10% and 30% respectively. For those with low-grade chondrosarcoma 8 out of 10 people may survive five years after diagnosis and for high-grade chondrosarcoma only 3 out of 10 people may survive five years after treatment. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Further Reading Bone cancer (sarcoma) - What is bone cancer? Causes and symptoms of bone cancer Types of bone cancer Diagnosis of bone cancer Sources http://www.nhs.uk/Conditions/Cancer-of-the-bone/Pages/Treatment.aspx www.bbc.co.uk/.../typescancer_bone.shtml http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002616/ http://www.patient.co.uk/health/Cancer-of-the-Bone-(Primary).htm http://www.boneandcancerfoundation.org/pdfs/Osteosarcoma-2.pdf http://www.cancer.umn.edu/cancerinfo/sarcoma/osteosarcoma.html Last Updated: Sep 4, 2012" }, "198": { "category_2_x_medical_disease.id": 198, "category_2.id": 53, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Cancer", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 198, "medical_disease.ts": "2018-04-20 02:41:42", "medical_disease.title": "Secondary Bone Cancer", "medical_disease.content": "By Jeyashree Sundaram (MBA) While most patients have concerns about the prognosis when they develop secondary cancer, it depends on factors, such as the spread of the cancer to one or more parts in the body, spread rate and how the disease is responding to treatment. These are difficult to forecast and this indecision could be difficult to handle. Managing Symptoms Patients may report symptoms of backache (which may worsen even after sufficient rest), gnawing pain (continuous pain), weaker bones, vomiting, dehydration, confusion, constipation, pain in the abdomen – all due to the increased levels of calcium. As bone marrow produces blood cells, due to cancer, blood cells can be lowered and the patient may be anaemic. The risk of infection, bruise and bleeding can increase; compression of spinal cord, such as weakness or numbness or pain in the legs, paralysis, incontinence and bladder control may also be lost. Though pains and aches may be common, if there is a new pain, it is better to discuss with a physician. Initial diagnosis and treatment will help to prevent additional problems such as severe pain or fractures of bone. Patients with cancer in the bone marrow may feel very tired. Physicians suggest blood test for checking counts of blood cells. When red blood cells are reduced, then a blood transfusion is suggested. When blood has more calcium, patients may tend to be weak, drowsy, confused and experience constipation. Medications such as bisphosphonates and fluids will be given to the patients so that the extra calcium is flushed out of the body. Bisphosphonates strengthen the bones and help in bone damage prevention. Patients consume them in the form of tablets or as drips; however, side effects such as stomach ache and constipation are possible with the use of bisphosphonates. Diagnosis and Treatment Tests such as X-rays, MRI scans, PET scans, bone scans and bone marrow tests are done for diagnosing bone cancer. Calcium levels are checked using blood tests. Chest x-rays will determine whether the cancer has spread to the lungs. Changes to the bone and a possibility for a secondary bone cancer is diagnosed by bone x-rays. All the bones are viewed, and abnormal areas are clearly seen using bone scans. When the causative agent of the changes is unknown, then bone biopsy such as surgical biopsy or core needle biopsy is suggested where cell samples are taken from the affected bone. When secondary bone cancer is diagnosed before primary cancer, then further tests are carried out to detect the origin of primary cancer. The treatments will shrink the size of the tumor and help in alleviating pain; when the tumor size is reduced, the pressure it exerts on the surrounding tissues or nerves is reduced. In radiotherapy treatment, the waves focus on the cancer cells and destroy them, which decreases the pressure on the spinal cord. Thus, pain and few other symptoms can be reduced. When cancer is found is the spine, rods are inserted for stabilizing and strengthening the spine. Painkillers and steroids are used for relieving pressure. In cases where the spine bones have collapsed and painkillers are found to be ineffective, a special medical cement is injected to the spine by a method called kyphoplasty or vertebroplasty. During kyphoplasty, physicians use a balloon with the help of a needle and bring back the usual bone shape, whereas in vertebroplasty, medical cement is injected in the swelling area that actually presses the spinal cord. Biological therapy such as use of denosumab (monoclonal antibody) helps in strengthening the bones and decreases the risk of bone breakages. Physicians often inject the medicine. Denosumab is approved by The National Institute of Health and Care Excellence (NICE) for treating breast cancer that has extended into the bones. Though surgery is not a very commonly used treatment method, it is recommended when the bones are found to be weak. Specific surgeries such as hip joint surgery or surgery to place metal pins for fixing the fracture in weak bones generally help in strengthening the bones. When patients have germ cell cancer, lymphoma or small cell lung cancer, chemotherapy treatment is provided for the compressed spinal cord. When the spinal cord is subject to compression, the patient may not be able to move like a normal individual, which pose other health issues: The risk of blood clots increases with increased lying time. To lower risk, elastic compression can be worn. Blood thinning medications (anticoagulants) can be taken in tablet form or as an injection. A higher lying time increases the risk of infection in the chest; practicing deep breathing exercises will reduce risk of this. It is advised to change positions frequently to avoid pressure sores. Difficulty in controlling the bowel or bladder is possible due to the pressure exerted on the nerves. Medications can help in bowel functioning. A catheter – a small tube - is used to drain the bladder. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources www.cancerresearchuk.org/.../treatment www.cancerresearchuk.org/.../about www.macmillan.org.uk/.../being-diagnosed http://www.cancerindex.org/bone_mets.htm www.cancer.ie/.../treatment#sthash.nvohSLPQ.dpbs www.cancer.ie/.../secondary-bone-cancer#sthash.hP3Dh6Bn.dpbs www.christie.nhs.uk/.../ Further ReadingBone cancer (sarcoma) - What is bone cancer?Causes and symptoms of bone cancerTypes of bone cancerDiagnosis of bone cancerTreatment of bone cancer // Last Updated: Sep 18, 2017" }, "199": { "category_2_x_medical_disease.id": 199, "category_2.id": 54, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Marrow", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 199, "medical_disease.ts": "2018-04-20 02:41:44", "medical_disease.title": "What is Bone Marrow?", "medical_disease.content": "By Dr Ananya Mandal, MD Bone marrow is the soft spongy tissue that lies within the hollow interior of long bones. In adults, marrow in large bones produces new blood cells. Bone marrow forms around 4% of total body weight (around 2.6 kg in a healthy adult). Types of bone marrow There are two types of bone marrow: red marrow that is responsible for producing red blood cells, white blood cells and platelets yellow marrow consisting mainly of fat cells There are a number of blood vessels and capillaries traversing through the marrow making it a very vascular organ. At birth and in early childhood most of the marrow is red. As a person ages more and more of it is converted to the yellow type. About half of adult bone marrow is red. Functions of bone marrow Red blood cells (erythrocytes) carry oxygen to the tissues. Platelets or thrombocytes (derived from megakaryocytes) help prevent bleeding and aid in clotting of blood. Granulocytes (neutrophils, basophils and eosinophils) and macrophages (collectively known as myeloid cells) fight infections from bacteria, fungi, and other parasites. They also remove dead cells and remodel tissue and bones. Related StoriesFast food triggers the immune system making it hyperactiveCould a blood test predict how cancer spreads in children?Researchers develop new approach to protect stem cell recipients from graft-versus-host disease B-lymphocytes produce antibodies, while T-lymphocytes can directly kill or isolate invading cells. RBC live for around 170 days and rest are shorter lived and need to be replenished continuously. An average human requires approximately one hundred billion new hematopoietic cells each day. This is performed by the Hematopoietic Stem Cells (HSCs). Bone marrow and stem cells Around the central bore of the bone or the central sinus lie the Mesenchymal stem cells. These cells have the capacity to form various cells of the body including osteoblasts (that form bones), chondrocytes (that form cartilage), myocytes (that form muscles) and other cells. Apart from this there are the endothelial stem cells that form blood vessels. Bone marrow pathology and diagnosis Certain diseases of the bone marrow like leukemia, multiple myeloma, myelodysplastic syndrome (MDS), pancytopenia, anemia etc. require examination of the bone marrow tissue. This is called bone marrow aspiration or bone marrow biopsy. A needle is used to withdraw samples of the marrow from within the bone. This is often a very painful process. Bone marrow is suppressed with the use of cancer chemotherapy. This leads to severe drop in production of RBCs (leading to anemia), WBCs (leading to increased risk of life threatening infections) and platelets (leading to risk of bleeding tendencies). With advent of medical science it is possible now to transplant the bone marrow in diseased individuals. This process has shown success in a number of cancer patients. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources stemcells.nih.gov/.../D.%20Chapter%202.pdf fbae.org/.../Bone%20Marrow%20Cells.pdf www.dako.com/...4_11jun09_guide_to_bone_marrow_diagnosis_chapter_1.pdf www.mds-foundation.org/wp-content/uploads/2011/10/BoneMarrowBook.pdf Further Reading Bone Marrow Diseases Bone Marrow Transplant Last Updated: Oct 14, 2012" }, "200": { "category_2_x_medical_disease.id": 200, "category_2.id": 54, "category_2.ts": "2018-04-18 05:30:55", "category_2.title": "Bone Marrow", "category_2.category_1": "B", "category_1.id": 1, "category_1.ts": "2018-04-18 05:17:00", "category_1.title": "B", "medical_disease.id": 200, "medical_disease.ts": "2018-04-20 02:41:47", "medical_disease.title": "Bone Marrow Diseases", "medical_disease.content": "By Dr Ananya Mandal, MD The bone marrow is a soft spongy tissue within the bones. It is the seat of production of hematopoietic cells. These cells include red blood cells or erythrocytes, white blood cells like granulocytes and myelocytes and platelets like thrombocytes. The sites of bone marrow location include the sternum (middle of the chest), pelvis (hip bone), and femur (thigh bone). Stem cells The bone marrow contains stem cells that are primitive cells capable of turning into any desired cell in the body. As needed, the stem cells differentiate to become a particular kind of cell - a white blood cell, red blood cell, or platelet. From the bone marrow only the mature cells are released into the blood stream. Apart from the stem cells the bone marrow contains supporting fibrous tissues as well. Main bone marrow problems Diseases of the bone marrow may lead to an abnormality in the production of any of the mature blood cells, or their precurosor or predecessor immature cells. The main types of problems with the bone marrow include: increased production of one type of cell - this packs up the marrow with one type of cells and decreases the production of the other cell types increase in one cell line because the cells do not die at normal times producing immature cells that do not mature or function properly producing fragile cells that die easily or producing less number of cells increased growth of the supporting fibrous tissue network leading to formation of abnormal cells and decreased numbers of cells. lack of iron making RBC formation difficult spread of other diseases to the bone marrow Diseases of the different cell types Cell types and functions: White blood cells (WBCs) WBCs are of five different types: lymphocytes neutrophils (also called granulocytes) eosinophils basophils monocytes These play different roles in infection prevention and protection of the body. For example, Neutrophils, basophils, and eosinophils kill and digest bacteria. Monocytes kill bacteria but also are produced more rapidly than the neutrophils and tend to be longer lived. Lymphocytes are of two types B and T. T cells distinguish between own and foreign and B cells that circulate in the blood, produce antibodies - proteins that attach to specific antigens from the invading bacteria or viruses. Red blood cells (RBCs) RBCs are disc shaped small cells without a nucleus. They carry iron in a heme protein called hemoglobin. Hemoglobin allows RBCs to carry oxygen to tissues throughout the body. Platelets or thrombocytes These are small parts of large cells called megakaryocytes. Platelets circulate in blood and help in clotting process to plug holes in leaking blood vessels and to help activate other clotting factors. Diseases and disorders of the bone marrow The diseases and disorders of the bone marrow include Leukemia, Myelodysplastic Syndrome, Myeloproliferative disorders and so forth. Leukemia Related StoriesStudy sheds light on how the HSC niche is maintainedCould a blood test predict how cancer spreads in children?Two immunotherapy approaches for multiple myeloma show hope Leukemia is a cancer of the white blood cells that can affect any of the five WBC types. The cancer affects a line of cell that begins to replicate non-stop clogging the bone marrow and decreasing production of other cells. The resulting leukemic cloned cells do not function normally. They do not fight infections. Patients with leukemia may have frequent infections, anemia, bleeding, bruising, night sweats, and bone and joint pain. The spleen that normally filters the blood and gets rid of old cells, may become enlarged. Lymph nodes that house the WBCs may also enlarge. Blood picture shows immature cells from the bone marrow called blast cells. These are released due to excess production within the bone marrow. Myelodysplastic Syndrome (MDS) MDS is a group of diseases where there is abnormal bone marrow cell production. There are not enough normal blood cells being made. This leads to anemia, bleeding and risk of infections. MDS syndromes are classified by how the cells in the bone marrow and blood smear look under the microscope. This includes anemias that are resistant to treatment, those that are inherited or genetic and a complex form of MDS. Over time, MDS tends to progress to acute myeloid leukemia. Myeloproliferative disorders (MPD) “Myelo” means bone marrow and MPD signifies proliferation of the bone marrow. These are a group of diseases. There is overproduction of a precursor (immature form) of a marrow cell. This results in release of the immature forms of other precursors as well that are released in blood as blast forms when the body requires them. The bone marrow in MPD shows a mixture of cells in various stages of maturity. Aplastic anemia This is a condition where there is loss or suppression of production of RBCs. This may be due to a defect in the stem cell producing them or due to an injury to the bone marrow environment. The injury may result from exposure to chemicals such as benzene, radiation, or certain drugs or may be genetic e.g. Fanconi's anemia or associated with a viral infection with parvo virus. Iron deficiency anemias Iron deficiency anemias lead to the formation of deformed and smaller RBCs released from the marrow. These are pale and small and are called microcytic RBCs. Anemias may also be caused by deficiency or dysfunction of erythropoietin, a chemical produced by the kidneys that stimulates RBC production. Other diseases and disorders of the bone marrow Other diseases and disorders of the bone marrow include: Disorders of plasma cells or Plasma cell dyscrasia – There is overproduction of one clone of a B lymphocyte and its antibody protein. Lymphomas and other cancers that spread into the marrow and affect cell production. Thrombotic thrombocytopenic purpura – This results in the reduction of platelet production and bleeding tendencies. Unexplained cytopenia – This results in decrease in production of all cell types. Other causes include small cell tumors of childhood, Mast cell disease, Disseminated granulomatous disease, Primary amyloidosis, Metabolic bone disease etc. Bone marrow depression may be caused due to cancer chemotherapy, bone marrow transplantation and cancer radiation therapy. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.pathology.vcu.edu/.../Marrow%203.pdf https://www.healthinfotranslations.org/pdfDocs/BoneMarrowBiopsy_Fr.pdf labtestsonline.org/understanding/conditions/bone-marrow-disorders/ stemcells.nih.gov/.../D.%20Chapter%202.pdf www.mds-foundation.org/wp-content/uploads/2011/10/BoneMarrowBook.pdf www.dako.com/...4_11jun09_guide_to_bone_marrow_diagnosis_chapter_1.pdf Further Reading What is Bone Marrow? Bone Marrow Transplant Last Updated: Oct 14, 2012" } } } }