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22 | 2018-04-20 02:30:06 | Vaginal Microbiome Variation and Bacterial Vaginosis | By Dr Tomislav Meštrović, MD, PhD By forming a mutual relationship with the host, the vaginal microbiome (i.e. various kinds of vaginal microbial communities present in healthy women) has a significant impact on women’s health and disease. In the recent years our knowledge of those vaginal bacteria communities has expanded rapidly as a consequence of using modern molecular (cultivation-independent) methods for species identification. Bacterial vaginosis represents the most prevalent type of vaginal infection that occurs among reproductive-age women, and also the most common condition that prompts women to seek medical care. This condition, which is highly dependent on resident microbial flora, is linked to some severe sequelae such as pelvic inflammatory disease, preterm labor, as well as increased sensitivity to infection with various sexually-transmitted agents. A Shift in Vaginal Microbial Communities Although the term ‘bacterial vaginosis’ was coined more than half a century ago, its etiology and natural history remains elusive. Generally, this condition is characterized by a shift in microbial composition from an abundance of lactobacilli in healthy women, to an increase of commensal anaerobic bacteria (such as Gardnerella, Atopobium, Prevotella and a panoply of other species). As the aforementioned loss of lactobacilli results in reduced lactic acid production, the pH in the vaginal lumen increases. Furthermore, amine and salidase production increases, while the production of hydrogen peroxide and lactocin is diminished, leading to signs and symptoms of bacterial vaginosis. Women with this condition are characterized by heterogeneous communities of bacteria that exhibit increased richness and diversity of existent bacterial species. Such species heterogeneity in bacterial vaginosis is thought to arise from functional redundancy between them, which is in turn associated with improved community reliability when faced with environmental changes. Moreover, a thorough analysis of the vaginal microbiome may predict the recurrence of bacterial vaginosis if changes in the resident microflora are compared. Such recurrences in sexually-active women are not rare, and may even appear three times or more during the year. Microbial Associations with Clinical Criteria for Bacterial Vaginosis Related StoriesCertain bacterial species may increase HIV risk in women, finds new studyNew study finds certain bacterial species may increase HIV risk in womenIn a majority of clinical settings, women are diagnosed with bacterial vaginosis by using the Amsel criteria when three or more signs are present, such as a vaginal pH higher than 4.5, thin vaginal discharge, amine odor if potassium hydroxide is added to vaginal fluid, as well as the presence of vaginal epithelial cells overlaid with bacteria (also known as “clue cells”). Nugent scores that are based on weighted tallies of various cellular morphotypes (most notably lactobacilli, Gardnerella vaginalis, Bacteroides, as well as curved Gram-variable rod-shaped bacteria) are also widely used in the diagnosis of bacterial vaginosis. This scoring system ranges from 0-10, and scores higher than 7 are indicative of bacterial vaginosis. The advantage of these clinical criteria is that the diagnosis can be achieved by using light microscopy; however, that way it is impossible to get deep insights into the composition of present bacterial communities. On the other hand, deep sequencing analysis is quite expensive and still not pervasive in clinical practice, even though it can provide a clear picture of vaginal microbiota and allow the detection of recurrences and treatment failures. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources http://cmr.asm.org/content/29/2/223.full https://www.nature.com/articles/srep26674 https://www.ncbi.nlm.nih.gov/pubmed/26385347 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780402/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249696/ http://www.pnas.org/content/108/Supplement_1/4680.full journals.plos.org/plosone/article?id=10.1371/journal.pone.0037818 journals.plos.org/plosone/article?id=10.1371/journal.pone.0082599 Further ReadingBacterial VaginosisWhat is Vaginal Microbiome?Vaginal Microbiome During PregnancyVaginal Microbiome and Sexually Transmitted InfectionsVaginal Microbiome and Gynecological Cancer // Last Updated: Aug 8, 2017 |
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23 | 2018-04-20 02:30:10 | Balance Disorder - What are Balance Disorders? | By Dr Ananya Mandal, MD Balance disorders are disturbances in co-ordination that makes a person feel unsteady, dizzy or have a sensation of movement or spinning. The problem more often than not lies within the ears. Within the ear is a part called the inner ear. This has organs that are responsible for normal balance mechanisms. Normal mechanism of balance The inner ear contains an organ called the labyrinth. The inner ear co-ordinates with the eyes (what they see), as well as the feeling of the bones and joints, to maintain normal balance. The inner ear sends signals to the brain that also receives signals from these peripheral organs to given an idea of the position of the body. This helps in maintenance of balance. The labyrinth has a structure called the semicircular canals. These allow a person to feel and experience rotary (circular) motion. There are three semicircular canals called the superior, posterior, and horizontal canals. The canals converge at a point and this is close to the cochlea that is responsible for hearing. These are filled with a fluid. As the body moves, this fluid also moves. The ends of the semicircular canals have a bulb like formation that contains hair-like tiny cells. Rotation of the head causes a movement of the fluid leading to movement of the top portion of the hair cells that are embedded in the jelly-like cupula. There are two other organs called the utricle and saccule that are called otoliths. These detect linear acceleration, or movement in a straight line. Symptoms of balance disorders The symptoms of balance disorders include difficulty in maintaining orientation. One of the commonest complaints is feeling dizzy or experiencing vertigo. The room appears to be spinning. There may be light headedness or a feeling of floating. Sometimes there may be blurring of vision as well. Along with vertigo there is commonly nausea and vomiting, diarrhea, faintness, palpitations, drop in blood pressure, fear, anxiety, or panic. Causes of balance disorders There are several causes of balance disorders. Diseases and disorders affecting the brain or the inner ears are commonly responsible for balance disorders. Some common causes include infections of brain or inner ear, head injury, disorders of blood circulation affecting the inner ear or brain, certain medications, as part of aging etc. Some of the types of balance disorders include Benign Paroxysmal Positional Vertigo (BPPV), labrynthitis, Ménière's disease, vestibular neuronitis etc. Diagnosis of balance disorders Diagnosis of a balance disorder involves several laboratory as well as imaging studies. There are several associated conditions that may lead to balance disorders including ear infections, blood pressure changes, problems in vision etc. Diagnosis is usually made by an ENT specialist (Ear, nose and throat disease specialist) also known as an otolaryngologist. Treatment of balance disorders Treatment of balance disorders depends on the cause underlying the condition. Problems of balance are symptoms of an underlying disease rather than a disease in itself. One of the options is to treat the underlying disease such as ear infection, stroke, or multiple sclerosis. The second option is to treat the symptoms of the condition. This can be achieved by balance retraining exercises (vestibular rehabilitation) etc. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.royalberkshire.nhs.uk/.../balance_disorders.aspx?theme=Patient www.nidcd.nih.gov/.../balance.pdf familymed.uthscsa.edu/.../Gait%26Balance10.pdf www.medoto.unimelb.edu.au/files/doto/DizzinessandBalanceDisorders.pdf http://iapmr.org/ijpmr/ijpmr01/200105.pdf Further Reading Balance Disorder Symptoms What Causes Balance Disorders? Balance Disorder Pathophysiology Balance Disorder Diagnosis Balance Disorder Treatments Balance Disorder Research Last Updated: Oct 7, 2014 |
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24 | 2018-04-20 02:30:12 | What Causes Balance Disorders? | By Dr Ananya Mandal, MD Several diseases and disorders affecting the inner ear or brain or certain medications may cause balance disorders. The causes may vary from infections (viral or bacterial), head injury, disorders of blood circulation etc. Those who have injuries or illnesses of the eyes or have problems with the skeletal system (e.g. arthritis) may also experience balance difficulties. These disorders may lead to a conflict of signals to the brain about the sensation of movement and can lead to balance problems. If there is a conflict of signals between the eyes and the brain, for example, if a person tries to read while riding in a car, there is motion sickness. Some symptoms of motion sickness include dizziness, sweating, nausea, vomiting, and generalized discomfort. Main causes of balance disorders Broadly classifying balance disorders may occur due to problems in any of the four areas:- Disturbances of the labyrinth in the inner ear – Peripheral vestibular disorder Disturbances in the brain or its connecting nerves - Central vestibular disorder Problems of the body other than the head and brain – Systemic disorder Blood flow problems or Vascular disorder Types of balance disorder Some of the different types of balance disorder leading to impaired sense and maintenance of balance include:- Benign Paroxysmal Positional Vertigo (BPPV) This condition is characterized by brief but severe episodes of vertigo brought about by specific positional change of the head. The movement could be trivial for example rolling within the bed or trying rise up to a sitting position from lying position or even looking up at an object. It is found that movement of chalk crystals (otoconia) within the inner ear from one part of the balance system (utricle and saccule) to another part of the balance system (semi-circular canals) due to movement of the head gives rise to the symptoms. Although the exact cause of the condition is unknown, it is thought to be caused as a part of normal aging, infection or head injury. Ménière's disease This is caused by an imbalance between the pressures of the fluids within the inner ear. The exact cause is unknown. There are episodes of vertigo, hearing loss and sensation of fullness in the ear along with tinnitus (a ringing or roaring in the ears). Labrynthitis This is caused by infection and/or inflammation of the inner ear causing dizziness and loss of balance. Vestibular neuronitis This is caused by an infection of the vestibular nerve caused by a virus. There is generally rotatory vertigo (horizontal or vertical spinning) that may last for up to 48 hours, exacerbated by movement. Perilymph fistula In this condition there is leakage of inner ear fluid to the middle ear. This occurs due to head injury. Other causes of balance disorders Certain medications that depress the central nervous system may also increase the rate of falls by increasing the lack of coordination. Arthritis, joint pain, stroke, visual impairment, back or neck pain, myelopathy due to cervival spondylosis, normal-pressure hydrocephalus, parkinsonism and fall of blood pressure on standing (orthostatic hypotension) are other causes of balance problems and risk of falls among the elderly. Problems in the cerebellum of the brain also contribute to balance disorders. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.royalberkshire.nhs.uk/.../balance_disorders.aspx?theme=Patient www.nidcd.nih.gov/.../balance.pdf familymed.uthscsa.edu/.../Gait%26Balance10.pdf www.medoto.unimelb.edu.au/files/doto/DizzinessandBalanceDisorders.pdf http://iapmr.org/ijpmr/ijpmr01/200105.pdf Further Reading Balance Disorder - What are Balance Disorders? Balance Disorder Symptoms Balance Disorder Pathophysiology Balance Disorder Diagnosis Balance Disorder Treatments Balance Disorder Research Last Updated: Feb 6, 2014 |
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25 | 2018-04-20 02:30:13 | Balance Disorder Symptoms | By Dr Ananya Mandal, MD Balance disorders are diseases that give rise to symptoms of impaired balance and co-ordination. The balance problems are thus symptoms rather than a disease it itself. Some of the symptoms associated with balance disorders include:- Dizziness or vertigo with the room appearing to be spinning. There may be disorientation. There is marked change and deterioration of independent walking and mobility. The gait is typically staggering as the sufferer struggles to maintain balance. Some persons may have difficulty in rising from a lying or sitting position. There may be an increased risk of falls or actual falls. The sufferer may also complain of a feeling of falling. There is a sensation of light headedness or feeling woozy. Sometimes there may be double vision or blurring of vision. Nausea and vomiting, diarrhea and faintness may be seen as associated symptoms. The heart rate may accelerate leading to palpitations. In addition there may be fall in blood pressure accompanied by increased sweating. There may be exaggerated fear, anxiety or panic in response to disorientation. Sometimes there may be symptoms of depression, fatigue and reduced concentration as well. In specific balance disorders like Benign Paroxysmal Positional Vertigo (BPPV) there are characteristic symptoms. These include severe and intense short episodes of dizziness associated with moving the head or even turning over in bed or sitting up from lying position. In acute vestibular neuronitis, or labyrinthitis there is inflammation of the inner ear. This leads to sudden, intense vertigo persisting along with nausea and vomiting for several days. This condition leads to severe disability and mandates bed rest. Meniere's disease leads to repeated sudden episodes of vertigo lasting 30 minutes or longer. This is accompanied by fluctuating hearing loss and a feeling of fullness in the ear. In addition to these symptoms there are symptoms of buzzing or ringing in the ear (tinnitus). Vestibular Migraine may present with or without severe headaches. The dizziness may last for several minutes to days. The episodes of dizziness may be brought about by quick head turns, driving or riding in a vehicle or when watching TV. In addition there may be hearing loss, and ringing in the ears (tinnitus). Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.royalberkshire.nhs.uk/.../balance_disorders.aspx?theme=Patient www.nidcd.nih.gov/.../balance.pdf familymed.uthscsa.edu/.../Gait%26Balance10.pdf www.medoto.unimelb.edu.au/files/doto/DizzinessandBalanceDisorders.pdf http://iapmr.org/ijpmr/ijpmr01/200105.pdf Further Reading Balance Disorder - What are Balance Disorders? What Causes Balance Disorders? Balance Disorder Pathophysiology Balance Disorder Diagnosis Balance Disorder Treatments Balance Disorder Research Last Updated: May 26, 2013 |
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26 | 2018-04-20 02:30:17 | Balance Disorder Pathophysiology | By Dr Ananya Mandal, MD Balance disorders are caused by several incidents that may be episodes of infection, injury or blood flow problems to the inner ear or to the brain. Normal functioning of the balance organs within the ear The ears are divided into three discernible parts – the outer, middle and the inner ear. The outer ear is composed of the pinna that brings in sound waves onto the ear drum. The middle ear amplifies the sound wave and transmits it into the inner ear. The inner ear contains an organ called the labyrinth. There two major organs in the inner ear – the cochlea or the shell shaped hearing organ and the semicircular canals or the balance organs. The semicircular canals work to co-ordinate with the eyes (what they see) as well as the feeling of the bones and joints to maintain normal balance. When the inner ear coordinates with the signals from the eyes, it is called the vestibulo-ocular reflex (VOR). The inner ear sends signals to the brain that also receives signals from these peripheral organs to given an idea of the position of the body. This helps in maintenance of balance. The semicircular canals are three tubes set in three different right angles. They have a bulb at their ends. These are called superior, posterior, and horizontal canals. The canals converge at a point and this is close to the cochlea. These are filled with a fluid. As the body or the head moves, this fluid also moves. The bulbs at the ends of the canals contain tiny hair like structures. Rotation of the head causes a movement of the fluid leading to movement of the top portion of the hair cells that are embedded in the jelly-like cupula. There are two other organs called the utricle and saccule that are called otoliths. These detect linear acceleration, or movement in a straight line. When the hair is displaced, it sends signals to the brain via nerves and the body corrects itself or balances accordingly. Pathophysiology of balance disorders An acute loss of balance sensation can be either partial or total. It may be caused by viral infections or due to injury to the vital structures of the brain or inner ear. In the case of benign paroxysmal positional vertigo (BPPV), calcium carbonate crystals get dislodged from their usual position and move to one of the semicircular canals of the inner ear when the head is moved. There is an incorrect registration of movements with changes in body position and this may trigger an episode of intense vertigo. Injuries to the central nervous system may be caused by head injury or by disturbances of the blood circulation. This leads to dizziness, vertigo, and disequilibrium. With age there is a deterioration of the balance system leading to balance problems. Physical disabilities such as arthritis and joint pain also contribute to the problem. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.royalberkshire.nhs.uk/.../balance_disorders.aspx?theme=Patient www.nidcd.nih.gov/.../balance.pdf familymed.uthscsa.edu/.../Gait%26Balance10.pdf www.medoto.unimelb.edu.au/files/doto/DizzinessandBalanceDisorders.pdf http://iapmr.org/ijpmr/ijpmr01/200105.pdf http://www.nidcd.nih.gov/health/balance/pages/balance_disorders.aspx fyss.se/.../27.-Dizziness-and-balance-disorders.pdf Further Reading Balance Disorder - What are Balance Disorders? Balance Disorder Symptoms What Causes Balance Disorders? Balance Disorder Diagnosis Balance Disorder Treatments Balance Disorder Research Last Updated: May 26, 2013 |
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27 | 2018-04-20 02:30:21 | Balance Disorder Diagnosis | By Dr Ananya Mandal, MD There are several disorders that may lead to balance problems. Diagnosis aims at detecting the cause of balance problems. Balance problems thus are symptoms of an underlying condition rather than a disease in itself. The cause of balance problems may vary between ear infections, blood pressure changes, vision problems or even medications that may cause balance problems. Steps in diagnosis of the conditions include:- Complete evaluation of the problem with history of onset, duration of the balance disorders and family history. A precipitating ear infection, vision problem or head injury or a history of intake of a balance problem causing medication is often found upon enquiring the history from the patient. This may provide valuable clues in diagnosing balance problems. Evaluation and diagnosis may be made by a primary physician who may then request the opinion or refer to an otolaryngologist to help evaluate a balance problem. An otolaryngologist or ENT surgeon is a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck. Physical examination – the next step is to obtain a detailed physical examination. The general health is examined that includes blood pressure and blood sugar evaluations, fluctuations of which may lead to balance problems or dizziness and falls. The ears are examined for abnormalities, hearing difficulties and infections if any. An electronystagmogram (ENG) is often advised. This test checks for abnormalities of the vestibular system. The caloric test may be performed as part of the ENG. For this test each ear is flushed with warm and then cold water one at a time. When water is flushed, the eyes move rapidly from side to side. This is called nystagmus. The amount of nystagmus resulting from the test is measured. Weak nystagmus or the absence of nystagmus may indicate an inner ear disorder. Another test for vestibular health is called posturography. The patient is asked to stand on a special platform capable of movement within a controlled visual environment. The sway of the body in response to movement and visual environment is recorded. Blood tests for detection of abnormalities like anemia, high or low blood sugar are advised. Usually a complete blood count, thyroid function test, liver and kidney function tests, electrolytes, blood urea nitrogen, creatinine, glucose, and vitamin B12 levels are tested. Imaging studies of the head including CT scan (Computed Tomography scan) or MRI scan (Magnetic resonance imaging scan) are performed to check for injuries and abnormalities in the brain and cerebellum part of the brain that controls balance and coordination. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.royalberkshire.nhs.uk/.../balance_disorders.aspx?theme=Patient www.nidcd.nih.gov/.../balance.pdf familymed.uthscsa.edu/.../Gait%26Balance10.pdf www.medoto.unimelb.edu.au/files/doto/DizzinessandBalanceDisorders.pdf http://iapmr.org/ijpmr/ijpmr01/200105.pdf Further Reading Balance Disorder - What are Balance Disorders? Balance Disorder Symptoms What Causes Balance Disorders? Balance Disorder Pathophysiology Balance Disorder Treatments Balance Disorder Research Last Updated: May 26, 2013 |
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28 | 2018-04-20 02:30:24 | Balance Disorder Treatments | By Dr Ananya Mandal, MD Balance problems are symptoms of an underlying condition rather than disease in itself. There are several different causes and varieties of disorders that may lead to balance problems. Thus treatment of balance disorders is also wide ranging and varied. For example, balance problems caused by ear infections are treated using antibiotics and anti-inflammatory agents while those due to side effects of medications are treated with stopping the suspected drug or medication. Some of the treatment options include:- Treatment for a disease or disorder that is leading to balance problems. This could be an ear infection, stroke, or multiple sclerosis. Other causes such as head injuries and disorders of the joints, high or low blood pressure and blood sugar are also treated specifically. Diet and lifestyle changes – in patients of Ménière's disease, dietary changes such as reducing intake of sodium or salt may help in reducing the symptoms of dizziness. In most patients avoidance of alcohol, caffeine and nicotine is advised. Treatment of inflammation within the inner ear. This includes labyrinthitis or vestibular neuroninitis. These are treated using anti-inflammatory agents including corticosteroids. Some aminoglycoside antibiotics, such as gentamicin and streptomycin may be used in treatment of balance problems caused by Ménière's disease. Streptomycin injections and application of gentamicin directly into the inner ear are useful for their ability to affect the hair cells of the balance system. Gentamicin also can affect the hair cells of the cochlea leading to hearing loss. Certain drugs may be used in some balance disorders. For example, in Ménière's disease Beta-histine can ease symptoms. Diuretics like hydrochlorthiazide may also be used. Other drugs include sedatives for dizziness including lorazepam that does not ease symptoms but helps patients cope with the sensation. Some drugs that work on motion sickness may be used. This includes drugs belonging to the classes antihistaminics and anticholinergics. Some calcium channel blockers like Verapamil and Nimodipine and GABA modulators like gabapentin and Baclofen may also help. Neurotransmitter reuptake inhibitors such as antidepressants SSRIs (Selective Serotonin Reuptake Inhibitors) including Fluoxetine, Escitalopram and trycyclic antidepressants including imipramine etc. may be useful in some patients. Balance retraining exercises (vestibular rehabilitation) – these exercises involve specific movements of the head and body. This helps in promotion of the compensation for the disorder. These are usually performed under the guidance of professionals with knowledge and understanding of the vestibular system and its association with other organs of the body. Those with Benign Paroxysmal Positional Vertigo (BPPV) suffer from dizziness due to misplaced crystals within the ear. Treatment involves moving these crystals out of areas that may trigger dizziness. This is achieved by head and neck positional exercises. In addition there may be counselling and cognitive behavioral therapy that is useful in persons with anxiety and depression. Surgery is necessitated in some severe causes of balance disorders. For example, in severe cases of Ménière's disease, surgery is the last resort. Surgical methods for Ménière's disease include Vestibular neuronectomy and Labyrinthectomy. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.royalberkshire.nhs.uk/.../balance_disorders.aspx?theme=Patient www.nidcd.nih.gov/.../balance.pdf familymed.uthscsa.edu/.../Gait%26Balance10.pdf www.medoto.unimelb.edu.au/files/doto/DizzinessandBalanceDisorders.pdf http://iapmr.org/ijpmr/ijpmr01/200105.pdf Further Reading Balance Disorder - What are Balance Disorders? Balance Disorder Symptoms What Causes Balance Disorders? Balance Disorder Pathophysiology Balance Disorder Diagnosis Balance Disorder Research Last Updated: May 26, 2013 |
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29 | 2018-04-20 02:30:29 | Balance Disorder Research | By Dr Ananya Mandal, MD Balance disorders are a variety of diseases and disorders that affect the inner ear or the brain. These conditions may also be caused as a side effect of several chemicals and medications. Scientists are researching the various underlying pathologies that may give rise to balance problems. The areas of research include the complex interactions between the balance-sensing organs, vision, labyrinth and the brain. Age and balance Researchers are looking at how advanced age is affecting normal balance. With the increase in the elderly population due to longer life expectancies these areas of research are gaining importance. More elderly are suffering from an impaired quality of life due to impaired mobility, lack of motor co-ordination and inability to lead an independent life. Vision and balance disorders The correlation between vision and balance disorders is also an important area of research. Researchers are looking at disease and injuries of the eyes and the nerves that connect the balance organs, eyes and the brain. Researchers are looking at eye movement and posture changes that may affect balance. Pathological diseases of the inner ear and balance disorders Pathological diseases of the inner ear and long term consequences of ear infections and brain infections like meningitis and encephalitis are also an area of research. Genetic causation of ear problems and subsequent balance problems in some diseases and disorders are being studied widely all over the world. Treatments of balance disorders The other part of research focuses on treatments of balance disorders. In addition, there are studies supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) that also show that the vestibular system plays an important role in modulating blood pressure. This could help in management of posture related fall of blood pressure called orthostatic hypotension. Orthostatic hypotension refers to sudden fall of blood pressure when an individual changes his or her position from sitting to standing or lying to sitting. This leads to severe dizziness and balance problems. Studies on otolithic organs There are studies that explore otolithic organs within the inner ears that detect linear movement. It is being studied how these organs differentiate between downward (gravitational) motion from linear (forward-backward or side-to side) motion. Exercises as a treatment Several researchers are working on the effectiveness of certain exercises as a treatment option. Strategies for new physical rehabilitation are also under investigation in clinical and research settings. Further research NIDCD, along with other Institutes at the National Institutes of Health, joined the National Aeronautics and Space Administration (NASA) for Neurolab are studying exposure to the weightlessness of space and balance changes associated with the condition. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources www.royalberkshire.nhs.uk/.../balance_disorders.aspx?theme=Patient www.nidcd.nih.gov/.../balance.pdf familymed.uthscsa.edu/.../Gait%26Balance10.pdf www.medoto.unimelb.edu.au/files/doto/DizzinessandBalanceDisorders.pdf http://iapmr.org/ijpmr/ijpmr01/200105.pdf Further Reading Balance Disorder - What are Balance Disorders? Balance Disorder Symptoms What Causes Balance Disorders? Balance Disorder Pathophysiology Balance Disorder Diagnosis Balance Disorder Treatments Last Updated: May 26, 2013 |
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30 | 2018-04-20 02:30:35 | Health Benefits of Bananas | By Liji Thomas, MD Bananas have been around for centuries, and the largest production is in India which, however, consumes most of what it produces itself. This is not surprising, given the unique blend of taste and health that makes up a banana, complete with its own individual wrapper (biodegradable to boot), and inbuilt marker of expiry dates (as the skin turns black). Credit: Hanna_photo/ Shutterstock.com Bananas are often classified as sweet bananas, which are eaten as a dessert or snack, and cooking bananas, which are usually called plantains. Votaries swear by them either raw or cooked or processed in various forms. Nutrient composition Bananas contain several bioactive compounds including: Phenolic compounds Carotenoids Biogenic amines Phytosterols They are also rich in a number of beneficial nutritional components. These include (per medium banana, about 118 g): 27g carbohydrates of which 14g is in the form of sugars (5.9 g glucose, 5.7 g fructose, and 2.8 g sucrose Dietary fiber of 3.1 g, of which 2.1g is soluble and 1g insoluble. Fibers are a form of insoluble starch composed of multiple sugars bonded by chemical linkages, which are resistant to chemical hydrolysis within the gut. Thus, they reach the colon intact and are subjected to microbial fermentation by gut bacteria. This not only produces better stool volume by binding water but results in the formation of some essential short-chain fatty acids (SCFAs) which are absorbed and used as energy sources. Fiber thus comprises not only dietary fiber which is mainly mechanical in effect but functional fiber which has a positive effect upon health. The sources of fiber which yield 5 g per serving are called excellent, and good if they give 2.5 g per serving. Under this classification, bananas are good sources of fiber. Resistant starch is slow to be digested by alpha-amylase and thus prevents a spike in the blood glucose. Potassium content of 422 mg which is positively related to cardiovascular health Vitamins: 33% of the RDI of B6, 11% for vitamin C Minerals: 8% of the RDI for magnesium and copper, 14% for manganese Protein content is 1.3 g and fat is only 0.4 g per medium banana. Health effects Related StoriesQUT researchers develop golden-orange bananas rich in pro-vitamin AResearch shows probiotics can reduce incidence of sepsis in infantsRestaurant placemats can encourage children to choose healthier food optionsBanana consumption has been studied in a number of ways, and some of the health impacts include: Energy food for athletes One medium banana contains about 105 calories, compared to 144 calories for a serving of potato. Bananas are thus cost-effective as a source of energy. They are used as quick nutrient-dense boosts of energy for endurance workouts and sports, with a glycemic index of 51. Antioxidant actions The bioactives in bananas include several strong antioxidants (banana has over 1000 mmol of TE in ORAC units, comparable to kiwi fruit), and are thus useful in protecting the body against inflammatory and oxidative stresses. They may protect against age-related or other chronic degenerative conditions. Lowering of blood pressure and cardioprotective effect The high potassium content is probably responsible for its ability to reduce the blood pressure, along with its low sodium content. Potassium deficiency is thought to be the underlying factor in hypertension, especially because it helps to push down sodium concentration in the blood. Some studies found that eating a couple of bananas a day led to a 10% fall in blood pressure over one week, and that 5 bananas a day was half as effective as the use of antihypertensive medication. Control of blood sugar levels and metabolic syndrome Diabetics would benefit from consuming under-ripe rather than overripe bananas, which have a glycemic index of 43 and 74 respectively and cause the blood glucose to rise to an average of 62 and 106 respectively. This is due to the increased starch content as compared to sugar content in under-ripe bananas. Control of body weight The high fiber content of banana makes it ideal as a low-calorie nutrient-dense food for overweight people. The resistant starch in under-ripe bananas and plantains can substitute for many calorie-rich starchy foods, and its benefits go beyond diabetes control to dyslipidemia correction and weight control. It also promotes satiety and reduces total energy intake. Prevention of kidney tumors While having 75 or more servings of fruits or vegetables per month is known to be protective against renal cell carcinoma by about 40%, this effect was most marked in the case of banana consumption. Protection against colon cancer Resistant starch may also help reduce or dilute the concentrations of toxic substances such as fecal ammonia and N-nitroso compounds in the colonic lumen, but this is still under study. If confirmed, bananas would play a part in preventing colon cancer by reason of the lente carbohydrate (slowly digested carbohydrate). Reviewed by Afsaneh Khetrapal Bsc (Hons) Sources https://www.ncbi.nlm.nih.gov/pubmed/27041291 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649719/ https://www.ncbi.nlm.nih.gov/pubmed/1395467 https://www.ncbi.nlm.nih.gov/pubmed/20968236 https://www.ncbi.nlm.nih.gov/pubmed/15287678 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355124/ http://www.news.appstate.edu/2012/05/28/bananas-are-beneficial/ https://www.ncbi.nlm.nih.gov/pubmed/15455348 Last Updated: Feb 27, 2018 |
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31 | 2018-04-20 02:30:39 | Barbiturates - What are Barbiturates? | By Sally Robertson, BSc Barbiturates are synthetic drugs used in medicine to depress the central nervous system. The effects range from mild sedation to coma and they may be used a sedatives, hypnotics or as part of anesthesia. Some barbiturates are used to relieve tension or anxiety prior to surgery. Barbiturates used to be regularly prescribed to treat insomnia, depression and anxiety, but the small difference between a normal dose and an overdose led to a number of accidental deaths, as well as people using them to commit suicide. Therefore, the use of barbiturates as sedatives or hypnotics to relieve insomnia or daytime restlessness caused by everyday stresses is no longer advised and has been replaced with safer medicines. Today, they are generally only used to treat extreme and serious cases of insomnia. They are also used to help control seizures in epilepsy and some are used as an adjunct to anesthesia. Pharmacological barbiturates are based on the parent compound barbituric acid. The type of barbituate depends on the substituent used at position 5 of this basic skeleton. Around 2500 different types of barbiturates have been synthesized since 1881, when barbital, the first pharmacologically active form, was synthesized. However only around 50 of these agents have ever been used in medicine. Availability and Legal Status Under the Medicines Act, barbiturates are only available as prescription doctors, meaning they can only be bought at a pharmacy with a doctor’s prescription. They are available in the following forms. Tablet Capsule Elixir Solution Suspension Enema Suppository The Misuse of Drugs Act classes barbiturates as class B drugs, which means they can be bought in accordance with a doctor’s prescription, but any other form of possession or supply counts as an offence. The maximum penalty a person can receive for any unauthorised possession is 5 years in prison and a fine for possession. For supply, the maximum penalty is 14 years in prison and a fine. If barbiturates are prepared as injection drugs, they are then classified as class A drugs and the penalties for possession and supply are more severe. Effects of Barbiturates Barbiturates slow down the CNS in a similar way to alcohol and depending on how rapidly they produce effects and the duration of those effects, they may be classed as ultra-short-, short-, intermediate- or long-acting. In the case of the long-acting phenobarbital and barbital, effects may last for up to 24 hours and these are used in combination with other drugs to prevent convulsion in epilepsy. The effects of Intermediate-acting barbiturates such as butabarbital sodium last for between 6 and 12 hours and these are used to treat insomnia. Pentobarbital is an example of a short-acting barbituate used to help patients fall asleep. The ultra-short acting thiamylal is administered as an injection to induce unconsciousness patients about to undergo surgery. Gaseous anesthetics are then used to maintain the unconsciousness throughout the surgical procedure. Small does of barbiturates make people feel relaxed, uninhibited, mildly euphoric, free of anxiety and sleepy. Larger doses can cause hostility, anxiety, body ataxia, slurred speech, paranoia and suicidal thoughts. The risk of falling over or having an accident is also increased. With prolonged use, tolerance can quickly develop, meaning larger does than the original dose are then required to produce the same effects. This can increase the risk of overdose, signs of which include shallow breathing, rapid and weak pulse, dilated pupils, clammy skin, coma and even death as a result of the central nervous system and respiratory system become severely depressed. Withdrawal Since tolerance and physical dependence can develop with p prolonged use of barbiturates, withdrawal from regular use can lead to various problems including the following: Irritability Faintness Anxiety Nausea Insomnia Sometimes convulsions In cases where a person withdraws from regular use of very high doses, symptoms can be more severe and include the following: Low blood pressure Hallucinations Delirium Seizures Sudden withdrawal from the regular use of high doses can be fatal and for individuals who have become addicted to barbiturates it is essential that they seek the care of trained rehabilitation professionals to help them withdraw safely and effectively. Sources www.mayoclinic.org/.../drg-20069290 https://www.dea.gov/druginfo/drug_data_sheets/Barbiturates.pdf http://www.britannica.com/science/barbiturate http://www.emcdda.europa.eu/publications/drug-profiles/barbiturates Further ReadingBarbiturate HistoryBarbiturate AbuseBarbiturate MechanismBarbiturate Risks Last Updated: Jun 19, 2016 |
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32 | 2018-04-20 02:30:41 | Barbiturate History | By Dr Ananya Mandal, MD Sleep disorders have been managed using several means throughout the history of mankind. It all began with alcohol and alkaloids of opium and other narcotic plants (hemp, belladonna, henbane, etc). It was in the late 19th and early 20th centuries that drugs such as paraldehyde, chloral hydrate, and bromides were developed for induction and maintenance of sleep. In 1864 Adolf von Bayer developed malonylurea from which in the early 20th century came the barbiturates. These agents were first brought to the market in 1904 by Farbwerke Fr Bayer and Co. Barbiturates are basically a closed-chain ureic compound, whose nucleus is malonylurea. Malonyurea is a combination of urea and malonic acid, an acid derivative taken from apples. Barbiturates were synthesized in 1864 by Adolf von Baeyer. The process was then perfected by the French chemist Edouard Grimaux in 1879. Origin of the term barbiturates There are several speculations about the origin of the term barbiturates. Some suggest it was a name given by Baeyer in honor of his friend Barbara. Yet others suggest that Baeyer celebrated his discovery of these compounds in a tavern near his home that was frequented by artillery officers. These officers were celebrating the day of their patron, St Barbara. The name could have come from there. Another possibility of the name was that the name came from the “barbed” appearance of the molecule due to the appearance of the crystals of these ureic compounds. Revolution in psychiatric and neurological disorders The first agent of this class was diethyl-barbituric acid. This spelled a revolution in psychiatric and neurological disorders of the time. It was successfully used in many patients with serious neuroses and psychoses. They were one of the first agents to be used in controlling seizures and in inducing sleep in insomniacs. With time barbiturates started the era of intravenous anesthetic agents. Before thiopentone, general anesthesia meant induction using the gases like nitrous oxide. Barbiturates in the 20th century Over the initial years of the 20th century more than 2,500 barbiturates were synthesized. Of these 50 were eventually employed clinically. Their use spread wide before physicians became aware of their risk of dependence and abuse liability. It was in 1912 that the first cases of dependence on barbiturates were reported from Germany. After initial reports, more physicians reported delirium and withdrawal symptoms on abrupt discontinuation or dose reduction of barbiturates. It was in 1950 that researchers published a paper that finally established that physical dependence on barbiturates is a possibility that can be induced in the laboratory as well in experimental conditions. What was surprising was that despite use of barbiturates for over five decades, it was only in the 1950’s that barbiturates were accepted as drugs that could cause dependence. It took another two decades for the physicians to be aware that these agents could cause dependence and abuse and should be prescribed only sparingly in select cases. Today 5 or 6 derivates of barbiturates are still being used as inducers of general anesthesia and serious forms of insomnia and in some types of epilepsy. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.duc.auburn.edu/~deruija/GABA_Barbiturates2002.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424120/ http://www.tropiart.com/i_home/drugs/Barbiturates.pdf www.md.rcm.upr.edu/publications/sidney_kaye/Barbiturate_Poisoning.pdf www.homehealth-uk.com/medical/professional_drugtests_barbiturates.htm Further Reading Barbiturates - What are Barbiturates? Barbiturate Mechanism Barbiturate Risks Barbiturate Abuse Last Updated: May 26, 2013 |
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33 | 2018-04-20 02:30:47 | Barbiturate Abuse | By Dr Ananya Mandal, MD Barbiturates were first used in 1903. They are derivatives of the chemical molecule barbituric acid. There are over 2000 derivatives of barbituric acid that have been used in medicine. Dependence and abuse liability It was in 1912 that the first cases of dependence on barbiturates were reported from Germany. Dependence or physical dependence is defined as a condition when long term use of a drug results in the phenomenon of tolerance and discontinuation or dose reduction of the drug leads to onset of negative symptoms called withdrawal symptoms. Tolerance means that increasingly high doses of the drug are needed to achieve the same efficacy. After initial reports, more followed on the same lines. These reported delirium and withdrawal symptoms on abrupt discontinuation or dose reduction of barbiturates. It was in 1950 that researchers published a paper that finally established that physical dependence on barbiturates is a possibility that can be induced in the laboratory as well in experimental conditions. What was surprising was that despite use of barbiturates for over five decades, it was only in the 1950’s that barbiturates were accepted as drugs that could cause dependence. It took another two decades for the physicians to be aware that these agents could cause dependence and abuse and should be prescribed only sparingly in select cases. Drug abuse Drug abuse has been defined by the World Health Organization (WHO, I969) as the “persistent or sporadic excessive use of a drug inconsistent with or unrelated to acceptable medical practice”. Both dependence and abuse are closely related and are parts of the same spectrum of conditions with abuse being at the lower end of the spectrum and dependence being at the higher end. Abuse of barbiturates may vary between occasional use of a barbiturate hypnotic at night to intermittent use during the day leading to intoxication. Severe cases include intravenous use of the agent and finally physical dependence and addiction. Barbiturate abuse Regular consumption of 450 mg of a barbiturate that is traditionally used for sedation or sleep induction for a period of eight weeks is likely to lead to a psychological and/or physical dependence. There are around 60 different barbiturate compounds that are in use:- The ones that have a short duration of action have a low abuse potential and their use in limited to the hospitals in general anesthesia. The ones that have a longer duration of action include phenobarbitone and are used as anti-seizure drugs. Dependence of these agents are also rare but not impossible. Barbiturates that are rapidly acting and useful for sleep induction are the ones that lead to a high or a mood change and intoxication. These have the highest abuse potential and may cause dependence. Common agents abused include amylobarbitone, quinalbarbitone, pentobarbitone etc. Unlike the social profiles of other drug abusers barbiturate abuse is seen among socially stable, middle-aged persons who may be stably employed or housewives. These persons however do not abuse injectable barbiturates. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources pubmedcentralcanada.ca/picrender.cgi?artid=926509&blobtype=pdf http://www.duc.auburn.edu/~deruija/GABA_Barbiturates2002.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424120/ http://www.tropiart.com/i_home/drugs/Barbiturates.pdf www.md.rcm.upr.edu/publications/sidney_kaye/Barbiturate_Poisoning.pdf www.homehealth-uk.com/medical/professional_drugtests_barbiturates.htm Further Reading Barbiturates - What are Barbiturates? Barbiturate History Barbiturate Mechanism Barbiturate Risks Last Updated: May 26, 2013 |
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34 | 2018-04-20 02:30:50 | Barbiturate Mechanism | By Dr Ananya Mandal, MD Barbiturates may have been abandoned as sedatives and tranquillizers due to their high abuse and dependence potential and risk of side effects, but they continue to hold an important place in neurology practice today. There are several uses of these agents and at present there are two major uses – as an agent that induces general anesthesia and as an agent that may control seizures. Mechanism of action The primary mechanism of action of barbiturates is inhibition of the central nervous system. It causes central nervous system depression. This is brought about by stimulating the inhibitory neurotransmitter system in the brain called the [gamma]-aminobutyric acid (GABA) system. The GABA channel is a Chloride channel that has five cells at its gate. When barbiturates bind to the GABA channel they lead to prolonged opening of the channel letting in Chloride ions into the cells in the brain. This leads to increased negative charge and alters the voltage in the brain cells. This change in voltage makes the brain cells resistant to nerve impulses and thus depresses them. Barbiturates used in anesthesia including Thiopentone sodium (also known as pentothal) also act by decreasing Calcium flow between the membranes. Barbiturates for controlling seizures and maintaining sleep Barbiturates that are used in controlling seizures include phenobarbitone. These are found to be effective in partial, complex partial and secondarily generalised seizures. There are other first line and more effective agents useful for these conditions, but phenobarbitone remains one of the effective agents that may be used when all others fail. Barbiturates are also used for inducing and maintaining sleep. Due to the narrow therapeutic dose range that leads to an increased risk of over dosage these agents are not routinely prescribed in sleep disorders. Another use of these agents is in the evaluation of patients with medically intractable seizure disorders for possible surgical therapy. Uses of barbiturates Sedation – these agents have largely been replaced by more modern and safer agents like benzodiazepines in this area. Sleep induction or hypnosis – in short term insomnia, barbiturates may be effective. This is because they tend to lose their effectiveness in sleep induction and maintenance after 2 weeks of use. Before surgery as a preanesthetic agent – sedation is given prior to surgery to allay anxiety and to ease the process of induction of general anesthesia. This is also an area where benzodiazepines have replaced barbiturates. Induction of general anesthesia – Thiopentone or pentothal is routinely used as an injectable induction agent in general anesthesia. Treatment of seizures - treatment of partial and generalized tonic-clonic and cortical focal seizures could still utilize barbiturates including mephobarbital, Phenobarbital. Acute convulsions – acute onset convulsions including status epilepticus, eclapmsia during pregnancy, meningitis, tetanus and toxic reactions to strychnine or local anesthetics, convulsions during cholera etc. are indications for use of barbiturates. Onset and duration of action Long-Acting Barbiturates – these are generally used in seizures. The action starts slow (30-60 minutes) and lasts longer (10-16 hrs). Intermediate-Acting Barbiturates – these are generally used in inducing and maintaining sleep. The action starts slow (45-60 minutes) and lasts for an intermediate duration (6-8 hrs). Short-Acting Barbiturates – these are also used as sedatives. Relatively rapid onset (10-15 minutes) and relatively short duration of action is seen (3-4 hrs). Ultra-Short-Acting Barbiturates – these are used in induction of anesthesia. These have an immediate onset of action that lasts for a very short duration. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources adisonline.com/.../...nical_Use_of_Barbiturates_in_Neurological.3.aspx http://www.duc.auburn.edu/~deruija/GABA_Barbiturates2002.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424120/ http://www.tropiart.com/i_home/drugs/Barbiturates.pdf www.md.rcm.upr.edu/publications/sidney_kaye/Barbiturate_Poisoning.pdf www.homehealth-uk.com/medical/professional_drugtests_barbiturates.htm Further Reading Barbiturates - What are Barbiturates? Barbiturate History Barbiturate Risks Barbiturate Abuse Last Updated: May 26, 2013 |
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35 | 2018-04-20 02:30:55 | Barbiturate Risks | By Dr Ananya Mandal, MD Barbiturates once enjoyed vast popularity as sedatives and sleep inducing agents. Over time their side effects led to more caution and at present these agents are seldom prescribed for insomnia and sleep disorders. Some of the risks associated with barbiturates use include:- Drowsiness Barbiturates are primarily sedatives and they induce sleep. Since this is their primary pharmacological effect, some amount of excessive drowsiness is commonly seen especially in case of overdose. This sleepiness may persist over the next day as well. This may manifest as a hangover sleepiness that makes driving and operating heavy machinery on the next day morning a hazard. There is impaired psychomotor function and increased pain perception that may persist over the next day. Dependence and tolerance to barbiturates Over long term use dependence develops to barbiturates. This means that patients are unable to sleep without taking barbiturates. Tolerance is an associated phenomenon. This means over long term use sleep is difficult without increasing the dose. Finally the highest dose range of the drugs fails to produce sleep but may lead to other side effects. Depression of respiration Barbiturates have a narrow therapeutic range. This means these agents lead to side effects when they cross the normal dose range. Since this range is a narrow one there is a risk of over dose. Barbiturates in high doses cause depression of the respiratory centre of the brain leading to decreased drive for respiration. In severe cases of over dosage there is a complete suppression of respiration leading to respiratory failure. Peripheral Nervous System depression The peripheral nervous system is also depressed with over dosage of barbiturates. There is a decreased excitation of neuronal receptors that is enhanced by several other concomitant agents and drugs. Cardiovascular depression There is decreased cardiac contractility and cardiac output. This means the heart pumps blood with less power of contraction. There is also a decrease in blood flow to the brain. Action on enzymes of the liver There are several enzymes present in the liver that function in metabolizing various drugs. Barbiturates enhance the action of these enzymes. This is called enzyme induction. Enzyme induction leads to increased metabolism of certain medications concomitantly taken along with barbiturates. This means the duration of action of these drugs is markedly reduced when taken alongside barbiturates. Some of the drugs whose metabolism and effectiveness is affected by barbiturate use include anti-seizure drugs like phenytoin and carbamazepine, antibiotics like rifampicin etc. Action on the renal function There is decreased flow rate (glomerular flow rate) into the kidneys and decreased blood flow to the kidneys due to use of barbiturates. This results in lowered blood pressure and decreased urine volume Barbiturate risks in older patients and pregnant women The risk of side effects of barbiturates is higher in older patients and among pregnant women. This is because with age the ability to excrete and eliminate the drugs from the system decreases. Elderly over the age of 65 are at higher risk of experiencing adverse effects of barbiturates and also are at risk of drug dependence and accidental overdose. If taken during pregnancy these agents pass through the mother’s blood into the fetus via the placenta. The baby may be born with congenital abnormalities. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://www.duc.auburn.edu/~deruija/GABA_Barbiturates2002.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424120/ http://www.tropiart.com/i_home/drugs/Barbiturates.pdf www.md.rcm.upr.edu/publications/sidney_kaye/Barbiturate_Poisoning.pdf www.homehealth-uk.com/medical/professional_drugtests_barbiturates.htm Further Reading Barbiturates - What are Barbiturates? Barbiturate History Barbiturate Mechanism Barbiturate Abuse Last Updated: May 26, 2013 |
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36 | 2018-04-20 02:30:56 | Bardet-Biedl Syndrome - What is Bardet-Biedl Syndrome? | By Dr Ananya Mandal, MD Bardet-Biedl syndrome is a condition that affects several parts of the body. It runs in families and may severely impair the sufferer. Symptoms and features of the condition One of the major features of Bardet-Biedl syndrome is loss of vision. Loss of vision occurs as the retina, that is the light sensing tissue or layer at the back of the eye, fails gradually. The problems appear initially as difficulty in seeing in the dark. This is seen in childhood as a slow onset condition. This is followed by development of blind spots in vision that leads to falls and knocks initially. Over time, these blind spots enlarge and turn into a tunnel where only the center is visible. With time the central clear area also clouds. By the time the child reaches adolescence or early adulthood, he may become legally blind. Another characteristic feature is obesity. There is typical abdominal obesity that begin in early childhood and continues throughout life. This may give rise to other complications like type 2 diabetes, high blood pressure and abnormally high levels of cholesterol. Typically there may also be presence of extra fingers and/or toes along with mental retardation, learning problems, and abnormalities of the genital organs. Bardet-Biedl syndrome epidemiology This is a rare condition and is seen in 1 in 140,000 to 1 in 160,000 newborns in most of North America and Europe. The prevalence is slightly higher on the island of Newfoundland (off the east coast of Canada), where it affects an estimated 1 in 17,000 newborns. Further Bedouin population of Kuwait and Arabs are also more commonly affected with prevalence there being about 1 in 13,500 newborns. Causes of Bardet-Biedl syndrome Bardet-Biedl syndrome is a genetically inherited condition. It results from mutations in at least 14 different genes in the body. These are commonly called BBS genes. It is found that these genes help make the hair like cellular structures called cilia. These cilia are involved in cell movement, different chemical signalling pathways perception of sensory input (such as sight, hearing, and smell) etc. The BBS genes code for proteins that maintain the functions of the cilia. Defects in these genes lead to defective cilia. The inheritance of Bardet-Biedl syndrome is autosomal recessive. This means parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene but have no symptoms of the condition (carriers of the gene). Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://ghr.nlm.nih.gov/condition/bardet-biedl-syndrome http://www.jnma.com.np/issue/172/235-237.pdf http://mun-h-center.se/upload/MunhDoc/Diagnoser/Eng/Fr%C3%A5/eLAUf.pdf http://www.cags.org.ae/pdf/209900.pdf http://www.japi.org/september2005/PC-781.pdf Further Reading Bardet-Biedl Syndrome Symptoms Bardet-Biedl Syndrome Pathophysiology // Last Updated: Oct 7, 2014 |
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37 | 2018-04-20 02:31:00 | Bardet-Biedl Syndrome Symptoms | By Dr Ananya Mandal, MD Bardet-Biedl syndrome affects more than one system in the body and symptoms may vary between individuals even in the same family. Common symptoms that may be seen in this condition include:- Vision loss One of the major features of Bardet-Biedl syndrome is loss of vision. Loss of vision occurs as the retina, that is the light sensing tissue or layer at the back of the eye, fails gradually. The problems appear initially as difficulty in seeing in the dark. This is seen in childhood as a slow onset condition. This is followed by development of blind spots in vision that leads to falls and knocks initially. Over time, these blind spots enlarge and turn into a tunnel where only the center is visible. With time the central clear area also clouds. By the time the child reaches adolescence or early adulthood, he may become legally blind. Obesity Another characteristic feature is obesity. There is typical abdominal obesity that begins in early childhood and continues throughout life. Obesity related conditions Obesity may give rise to other complications like type 2 diabetes, high blood pressure and abnormally high levels of cholesterol. Abnormalities of the fingers and/or toes Typically there may also be presence of extra fingers and/or toes. In addition the fingers and/or toes may be short and fused together. Learning difficulties There may be mental retardation, learning problems, intellectual disability and impaired speech. There may be delayed development of motor skills such as standing and walking. Behavioral problems There are associated behavioral problems including emotional immaturity and inappropriate outbursts, and clumsiness or poor coordination. Underdeveloped genitals The genital organs may also be underdeveloped. The amount of sex hormones produced by males with this condition is typically low and this makes them infertile. Kidney and other organ problems There may be mild to severe life threatening kidney problems and kidney formation abnormalities in these patients. The heart, liver, and digestive system may also be affected. In the heart there may be enlargement of the ventricles and cardiomyopathy. In the digestive system there may be presence of fibrosis. Facial abnormalities There are distinctive facial abnormalities in most patients. There are jaw and tooth deformities. There may be extra teeth or small and thin teeth roots. Due to these deformities snoring is common. In addition there may be feeding difficulties and drooling as well. Anosmia There may be a partial or complete loss of the sense of smell (anosmia). Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://ghr.nlm.nih.gov/condition/bardet-biedl-syndrome http://www.jnma.com.np/issue/172/235-237.pdf http://mun-h-center.se/upload/MunhDoc/Diagnoser/Eng/Fr%C3%A5/eLAUf.pdf http://www.cags.org.ae/pdf/209900.pdf http://www.japi.org/september2005/PC-781.pdf Further Reading Bardet-Biedl Syndrome - What is Bardet-Biedl Syndrome? Bardet-Biedl Syndrome Pathophysiology Last Updated: Jul 22, 2013 |
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38 | 2018-04-20 02:31:06 | Bardet-Biedl Syndrome Pathophysiology | By Dr Ananya Mandal, MD Bardet-Biedl Syndrome is a genetically inherited condition. It is the result of inheriting mutations or alterations in the genes. At least 14 different genes have been identified that may be mutated or altered in individuals with this syndrome. Genetics of Bardet-Biedl syndrome There are 14 different genes that may be altered or mutated in individuals with Bardet-Biedl syndrome. These are commonly termed BBS genes. These genes code for proteins that are involved in the maintenance and function of cilia of the cells. What are cilia? Cilia are finger-like or hair-like structures that are present on the surfaces of many types of cells. These are involved in movement of the cells and different chemical signalling pathways. Cilia are also vital in perception of sensory input including sight, smell and hearing. Deformed cilia Mutations in BBS genes may lead to deformed cilia. Due to these defects there may be disruptions in important chemical signalling pathways. This leads to impaired sensory perceptions. These defective cilia are the basic pathology of Bardet-Biedl syndrome. BBS1 and BBS10 gene Around 25% of all cases of this syndrome result from mutations in the BBS1 gene. Another 20 percent of cases are caused by mutations in the BBS10 gene. The other BBS genes each account for only a small percentage of all cases of this condition. In a quarter of patients no specific gene or cause is known. Genetic changes in a specific BBS gene may exist alone or in combination with mutations in other genes that may modify the course of the disease. These additional changes of genes along with the original changes in the genes are responsible for the variations of signs and symptoms of Bardet-Biedl syndrome. Inheritance of Bardet-Biedl syndrome Bardet-Biedl syndrome is inherited in an autosomal recessive pattern. This means for a child to inherit the condition both parents have to have a single copy of the mutated gene. These parents do not manifest the symptoms of the condition and typically do not show signs and symptoms of the condition. Associations with other genetic disorders There are several genetic disorders that may be associated with Bardet-Biedl syndrome. Commonly other cilia related disorders may be associated with this syndrome. This includes Meckel–Gruber syndrome, Alstrom syndrome, nephronophthisis, polycystic kidney, primary ciliary dyskinesia, retinitis pigmentosa and some forms of retinal degeneration. Reviewed by April Cashin-Garbutt, BA Hons (Cantab) Sources http://ghr.nlm.nih.gov/condition/bardet-biedl-syndrome http://www.jnma.com.np/issue/172/235-237.pdf http://mun-h-center.se/upload/MunhDoc/Diagnoser/Eng/Fr%C3%A5/eLAUf.pdf http://www.cags.org.ae/pdf/209900.pdf http://www.japi.org/september2005/PC-781.pdf Further Reading Bardet-Biedl Syndrome - What is Bardet-Biedl Syndrome? Bardet-Biedl Syndrome Symptoms Last Updated: Jul 22, 2013 |
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39 | 2018-04-20 02:31:08 | Bariatric Embolization | By Dr Liji Thomas, MD Obesity affects almost half a billion people worldwide. It is fast becoming the major killer, overtaking even long-term predators such as tobacco. Its consequences range from diabetes and cardiovascular disease, which are metabolic in origin, to cancers of the endometrium, breast, and colon. Secondary complications of obesity include diabetes-linked blindness, renal failure, and psychological disturbances. Conventional Treatments for Obesity Obesity treatment has long focused on dietary regulation, exercise, and behavioral modification techniques. Some drugs have also been used in the treatment of obesity but are linked with unacceptable adverse effects. Bariatric surgery is advised in patients with morbid obesity, where the body mass index is 40 or above, or even 35 with other medical conditions. These include techniques which reduce gastric volume, or those which prevent proper digestion. These are considered to be of high efficacy in selected patient groups, both in reducing obesity and its linked complications. However, with unaltered eating habits, even bariatric surgery may be followed by a gradual return to weight gain. In this context, gastric artery embolization or bariatric arterial embolization (BAE) is emerging as a powerful tool. Bariatric Arterial Embolization The stomach is supplied by left and right gastric arteries, as well as the right gastroepiploic artery, and the short gastric arteries. Embolization of some vessels in the upper gastrointestinal (GI) tract has been a well-rehearsed practice in the treatment of GI bleeding as in portal cirrhosis with resulting portal hypertension. This technique rarely produces gut ischemia due to numerous collateral vessels in the foregut. Bariatric arterial embolization refers to percutaneous catheter-directed left gastric artery embolization in order to induce relatively poor blood supply to the fundus, the area of the stomach that produces ghrelin. At least two branches are occluded, introducing transarterially a sclerosant agent such as morrhuate or polyvinyl alcohol (PVA) beads of varying diameter. While the efficacy of embolization in reducing ghrelin secretion is unchallenged, the effect in terms of weight loss has not been proved as conclusively. The Importance of Ghrelin in Obesity The stomach is not merely a storehouse of ingested food, nor a digestive organ. It is also a neurohormonal system. The fundus carries numerous pathways for the nervous regulation of appetite and satiety. Ghrelin is a peptide hormone released mainly from the fundus of the stomach, which regulates long-term appetite and energy maintenance. It is released under conditions of hunger or starvation and stimulates the brain to initiate food intake. The next major site of ghrelin production is the duodenum, which releases the peptide at up to 20 times lower concentrations than the fundus. In response to ghrelin secretion, the following actions occur: a rise in growth hormone release a rise in gastric acid secretion Increased gastric motility faster gastric emptying reduced insulin secretion Increased ghrelin levels lead to increased adipose tissue deposition and obesity. Safety Profile of BAE Complications of the procedure have included: Pulmonary embolism Perforated gastric ulcers Gastritis Distal esophageal stricture Non-target embolization with unintended tissue damage Greater safety for the procedure involves various measures such as doing it under CT guidance, using radio-opaque alginate beams which are visualized under fluoroscopic guidance, and a special microcatheter which prevents reflux of the injected material. Trials are still underway to establish optimum procedural guidelines for patient safety. Reviewed by Susha Cheriyedath, MSc References http://evtoday.com/2014/04/gastric-embolization-to-treat-obesity/ http://www.hindawi.com/journals/jobe/2014/185349/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414740/ // Last Updated: Aug 17, 2016 |
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40 | 2018-04-20 02:31:12 | Bariatric Surgery - What is Bariatric Surgery? | By Dr Ananya Mandal, MD Exercise and diet alone often fails to effectively treat people with extreme and excessive obesity. Bariatric surgery is an operation that is performed in order to help such individuals lose weight. Evidence suggests that bariatric surgery may lower death rates for patients with severe obesity, especially when coupled with healthy eating and lifestyle changes after surgery. Principles of bariatric surgery The basic principle of bariatric surgery is to restrict food intake and decrease the absorption of food in the stomach and intestines. The digestion process begins in the mouth where food is chewed and mixed with saliva and other enzyme-containing secretions. The food then reaches the stomach where it is mixed with digestive juices and broken down so that nutrients and calories can be absorbed. Digestion then becomes faster as food moves into the duodenum (first part of the small intestine) where it is mixed with bile and pancreatic juice. Bariatric surgery is designed to alter or interrupt this digestion process so that food is not broken down and absorbed in the usual way. A reduction in the amount of nutrients and calories absorbed enables patients to lose weight and decrease their risk for obesity-related health risks or disorders. Body mass index (BMI) Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity and help determine whether bariatric intervention is required. Clinically severe obesity describes a BMI of over 40 kg/m2 or a BMI of over 35 kg/m2 in combination with severe health problems. Health problems associated with obesity include type 2 diabetes, arthritis, heart disease, and severe obstructive sleep apnea. The Food and Drug Administration (FDA) approves the use of adjustable gastric banding for patients with a BMI of 30 kg/m2 or more who also have at least one of these conditions. Types of Bariatric Surgery There are various types of bariatric surgeries that can be performed. Surgery may be performed using an “open” approach, which involves cutting open the abdomen or by means of laparoscopy, during which surgical instruments are guided into the abdomen through small half-inch incisions. Today, most bariatric surgery is laparoscopic because compared with open surgery, it requires less extensive cuts, causes relatively minimal tissue damage, leads to fewer post-operative complications and allows for earlier hospital discharge. There are four types of operations that are offered: Adjustable gastric banding (AGB) Roux-en-Y gastric bypass (RYGB) Biliopancreatic diversion with a duodenal switch (BPD-DS) Vertical sleeve gastrectomy (VSG) Diagram of Surgical Options. Image credit: Walter Pories, M.D. FACS. Related StoriesObesity surgery reduces the risk of death by half finds new studyEach of the surgery types has advantages and disadvantages and various patient factors affect which procedure is chosen including BMI, eating habits, health problems related to obesity, and number of previous stomach surgeries. The patient and provider should discuss the most suitable option by considering the benefits and risks of each type of surgery. Surgical and post-operative risks People who have had bariatric surgery need to adhere to a rigorous and lifelong diet and exercise plan to prevent complications and to avoid putting on weight after surgery. In addition, patients may develop excess loose and folded skin that requires further surgery to remove and tighten. As with all types of surgery, bariatric surgery is associated with risks including internal bleeding, deep vein thrombosis, infections, and pulmonary embolism (blood clot in the lungs). It is estimated that the risk of dying shortly after bariatric surgery is around 1 in 200. Reviewed by Sally Robertson, BSc References http://www.nhs.uk/conditions/weight-loss-surgery/Pages/Introduction.aspx http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/patients/clinics/bariatric/bariatric/BARIATRIC-SURGERY.pdf http://www.siumed.edu/surgery/bariatric/files/Gastric%20bypass%20surgery%20guide.pdf http://www.lapsf.com/bariatricsurgery.pdf https://louisville.edu/medschool/gimedicine/division-lecture-files/marsano-lectures/bariatric%20surgery.pdf Further ReadingBariatric Surgery Side EffectsBariatric Surgery TypesDiet After Bariatric SurgeryWeight Loss After Bariatric SurgeryTaste Changes Following Bariatric SurgeryMore... Last Updated: Oct 7, 2014 |
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41 | 2018-04-20 02:31:15 | Bariatric Surgery Side Effects | By Dr Ananya Mandal, MD Bariatric surgery is a procedure performed on obese individuals in order to help them achieve rapid weight loss. The risks associated with bariatric surgery fall into two main categories: those related to restricted food intake and rapid weight loss and those associated with the surgical procedure itself. Accordingly, side effects can be categorized as: Immediate post-operative complications Infection of the wound and of the operative site (affects around 1 in 20 patients) Internal bleeding (occurs in around 1 in 100 patients) Development of blood clots (occurs in around 1 in 100 patients). Clots may develop in leg veins (deep vein thrombosis) or travel up to the lungs causing a pulmonary embolism, which can be life threatening. Death The immediate complications of bariatric surgery can result in a patient’s death. Pulmonary embolism, severe bleeding, major infection, stroke, or heart attack are all conditions that put the patient’s life at serious risk. The estimated risk of death after gastric band insertion is around 1 in 200 and after gastric bypass surgery, the risk is around 1 in 100. Factors that raise the risk of dying due to post-operative complications include age, male gender, high blood pressure, increased risk for pulmonary embolism and a body mass index of 50 or above. Risks for pulmonary embolism include a history of pulmonary hypertension, deep vein thrombosis, and blood clots. Development of gallstones Gall bladder stones are a common outcome of bariatric surgery, with stones developing in around 1 in 12 individuals. Gallstones are aggregates of chemicals and cholesterol that eventually clog up the gall bladder. The stones may be symptomless or may cause intense pain in the abdomen as well as nausea, vomiting and jaundice. Stoma blockage Stoma blockage is a common complication of gastric bypass surgery that occurs when the opening (stoma) that connects the stomach pouch to the small intestine becomes blocked by a piece of food, resulting in persistent vomiting. The condition occurs in around one-fifth of patients and is treated by directing a small flexible tube called an endoscope into the stoma where a balloon attached to the endoscope is inflated to remove the obstruction. To avoid stoma blockage, food must always be taken in small bites and chewed thoroughly. Excess skin Related StoriesObesity surgery reduces the risk of death by half finds new study Rapid weight loss among obese individuals results in skin becoming excessively loose and folded. Folds of skin are most typically acquired around the breasts, back, abdomen, limbs, and hips and are normally most apparent 12 to 18 months after surgery. The folds can be unsightly and may harbour moisture leading to infections and rashes. These excess skin flaps can be removed and the skin tightened using cosmetic surgery. Effects on mental health Rapid weight loss may have a detrimental effect on mental health, with many patients suffering from depression and anxiety after surgery. Patients may also develop relationship problems with their partner. Additionally, social occasions orientated around meals may make the patient feel isolated and anxious due to their much reduced appetite and restricted diet. Slippage of the gastric band Gastric band slippage is a problem that affects around 1 in 50 patients who have had an adjustable band fitted. The band slips out of position and the stomach pouch becomes bigger than it should be, resulting in nausea, vomiting and heartburn. Further surgery is then required to repair the slippage. Intolerance to foods Food intolerance occurs in around 1 in 35 patients who have had bariatric surgery and may develop years after the procedure. Foods such as red meat may bring on heartburn, nausea and vomiting. Reviewed by Sally Robertson, BSc References http://www.nhs.uk/Conditions/weight-loss-surgery/Pages/risks.aspx http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/patients/clinics/bariatric/bariatric/BARIATRIC-SURGERY.pdf http://www.siumed.edu/surgery/bariatric/files/Gastric%20bypass%20surgery%20guide.pdf http://www.lapsf.com/bariatricsurgery.pdf https://louisville.edu/medschool/gimedicine/division-lecture-files/marsano-lectures/bariatric%20surgery.pdf Further ReadingBariatric Surgery - What is Bariatric Surgery?Bariatric Surgery TypesDiet After Bariatric SurgeryWeight Loss After Bariatric SurgeryTaste Changes Following Bariatric SurgeryMore... Last Updated: Aug 27, 2013 |
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