Eczema: Risk factors, Diagnosis and Management

Eczema: Risk factors, Diagnosis and Management

Definition

Eczema refers to a chronic inflammatory skin condition, characterized by dry skin, with patches that are red and intensely itchy. These patches of eczema may ooze, become scaly, crusted or hardened. The patients may have times when their skin is obvious and other times once they have rash. it's also called atopic dermatitis

Atopy refers to a hereditary tendency toward eczema, asthma and rhinitis (hay fever). People with eczema may suffer with one among the opposite atopic diseases. Both dermatitis and eczema mean inflammation of the skin

Types of eczema

Atopic dermatitis

Atopic dermatitis is that the commonest sort of eczema. it always starts in childhood, and sometimes gets milder or goes away by adulthood. atopic eczema is a component of what doctors call the atopic triad. “Triad” means three. the opposite two diseases within the triad are asthma and pollinosis . many of us with atopic eczema have all three conditions

Contact dermatitis

If you've got red, irritated skin that’s caused by a reaction to substances you touch, you'll have dermatitis . It comes in two types: Allergic dermatitis is an system reaction to an irritant like latex or metal. Irritant dermatitis starts when a chemical or other substance irritates your skin

Dyshidrotic eczema

Dyshidrotic eczema causes small blisters to make on your hands and feet. It’s more common in women than men

Hand eczema

Eczema that only affects your hands is named hand eczema. you'll get this sort if you're employed during a job like hairdressing or cleaning, where you often use chemicals that irritate the skin

Neuro dermatitis

Neuro dermatitis is analogous to atopic eczema . It causes thick, scaly patches to crop up on your skin

Nummular eczema

This type of eczema causes round, coin-shaped spots to make on your skin. The word “nummular” means coin in Latin. Nummular eczema looks very different from other sorts of eczema, and it can itch tons

Stasis dermatitis

Stasis dermatitis happens when fluid leaks out of weakened veins into your skin. This fluid causes swelling, redness, itching, and pain

What can trigger eczema

Having eczema means when the skin barrier is broken , moisture evaporates and this makes the skin more vulnerable to allergens and irritants. This irritation can trigger the skin to release certain chemicals that make the skin itchy. If you scratch, more chemicals are released and therefore the skin feels even itchier. This “scratch and itch” cycle are often most distressing

Known triggers (or aggravating factors) for eczema in some people include

Dry skin

Scratching (night gloves and clipped fingernails could also be needed in young children)

Viral or bacterial infections

Swimming in chlorinated swimming pools

Playing in sand and particularly sandpits

Sitting directly on carpets or grass

Inhalant allergens – worsening of eczema in spring and summer can also flow from to pollen sensitivity

Food intolerances to artificial colour and preservative in some people

Irritants like perfumes, soap, chemicals, woollen or synthetic fabrics

Temperature changes (such as heat) or overly heated rooms

Stress (this can make it worse but eczema isn't a psychological condition)

Contact with allergens can worsen eczema, and allergen avoidance or minimization often brings about improvement. For example

Close contact with animals can cause itching or hives, as can sitting and playing on the grass

Contact with house dust mite allergen on the skin can increase inflammation

Constant exposure to water, soap, grease, food or chemicals can damage the protective barrier function of the skin. Once the protective barrier of the skin is lost, eczema frequently develops

Risk factors behind Eczema

Many factors during a person’s environment can make eczema worse; these include heat, dust, wool, pets and irritants like soap and detergents

Being unwell, for instance having a standard cold can make eczema flare

Infections with bacteria or viruses can make eczema worse. Bacterial infection (usually with a bug called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and should need specific treatment. An infection with the oral herpes virus (herpes simplex) can cause a sudden painful widespread (and occasionally dangerous) flare of eczema, with weeping small sores and should need treatment with oral antiviral treatment. Topical steroids shouldn't be used if this is often an opportunity

Dryness of the skin

Teething in babies

In some people food allergens may cause flares in eczema

?What are the symptoms of atopic eczema

The skin usually feels dry

Some areas of the skin become red and inflamed. the foremost common areas affected are next to skin creases, like the front of the elbows and wrists, backs of knees and round the neck. However, any areas of skin could also be affected. The face is usually affected in babies with atopic dermatitis 

Inflamed skin is itchy. If you scratch tons it's going to cause patches of skin to become thickened

Sometimes the inflamed areas of skin become blistered and weepy

Sometimes inflamed areas of skin become infected

Diagnosis and Test used for Eczema

While the medical history is of paramount importance, additional tests can help support the diagnosis of atopic dermatitis or identify other conditions which can be causing symptoms  

a number of these tests are

Blood tests: These require alittle blood sample, typically drawn through a needle within the arm. One such test looks for top levels of eosinophils, cells within the blood that are a part of an immune response . Another looks for top levels of a molecule called IgE antibody. Blood levels of those are elevated in people with atopic diseases, including eczema. Even more useful are allergen-specific IgE tests, which measure levels of the antibody, each of which is related to a special allergen

Skin biopsy: during this procedure a doctor first numbs the skin then removes one or more small pieces of skin, which is used to rule out other skin diseases from atopic dermatitis , sort of a low-grade carcinoma or psoriasis

Allergy skin testing: Prick skin tests are often done to common foods or inhalant allergens to means sensitization or lack of sensitization to specific allergens because of eczema

Patch testing: during this test, small patches covered with allergenic chemicals are placed on the skin for 48 hours, then removed and thus the skin reaction is evaluated at 72-96 hours for atopic dermatitis . It can identify contact allergy to chemical sensitizers like fragrances, metals, lanolin, rubber, etc

Buccal swabs: the within of the cheek are often swabbed with a cotton applicator to urge cells as a source of DNA material to look for mutations within the Filaggrin gene, one of the causes of eczema

Treatment and medicines therapy

Daily “Soak and Seal”

Soak within the bath or shower a day for 15-20 minutes so as that the skin absorbs plenty of water. Use warm water

A gentle skin cleanser should be used without scrubbing

Excess water should be gently pat away and thus the recommended medicine or moisturizer should be immediately applied to moist skin

Try to do this within three minutes. This seals within the water. (If you're applying skin medicine, don't apply moisturizer over it)

A skin cleanser could also be a bar or liquid used to clean the skin. Use products that are authorized to be used on “sensitive skin

Emollients (moisturizers)

Emollients (moisturizers) are a significant a neighborhood of eczema treatment. A moisturizer could also be a skin care product that adds moisture to the skin. Ointments and creams are recommended instead of lotion for people with very dry skin. they're used to replace lost skin moisture, help restore the normal barrier function of the skin, help the skin feel easier and reduce

.Emollients are very safe to use. you'll apply them as often as you'd like or wish

Depression: Causes, symptoms, and coverings 

Introduction

Everyone feels sad or low sometimes, but these feelings usually pass with a touch time. Depression also called “clinical depression” or a “depressive disorder” may be a mood disorder that causes distressing symptoms that affect how you are feeling , think, and handle daily activities, like sleeping, eating or working

Depression are often a neighborhood of several psychological state problems

Bipolar disorder

Borderline mental disorder (BPD) and other personality disorders

Schizo affective  disorder

?What are the various sorts of depression

:Two of the fore most common sorts of depression are

Major depression having symptoms of depression most of the day, nearly a day for a minimum of 2 weeks that interfere together with your ability to figure , sleep, study, eat, and luxuriate in life. An episode can occur just one occasion during a person’s lifetime, but more often,  

individual has several episodes

Persistent clinical depression (dysthymia) having symptoms of depression that last for a minimum of 2 years. an individual diagnosed with this type of depression may have episodes of major depression along side periods of less severe symptoms

Some sorts of depression are slightly different, or they'll develop under unique circumstances, such as

Perinatal Depression: Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression)

Postpartum depression (PPD) may be a condition that describes a variety of physical and emotional changes that a lot of mothers can have after having a baby. PPD are often treated with medication and counseling

Seasonal major affective disorder (SAD): SAD may be a sort of depression that comes and goes with the seasons, typically starting within the late fall and early winter and departure during the spring and summer

Psychotic Depression: this sort of depression occurs when an individual has severe depression plus some sort of psychosis, like having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations)

Bipolar disorder is different from depression. the rationale it's included during this list is because someone with manic depression experiences episodes of utmost low moods (depression). But an individual with manic depression also experiences extreme high moods (called “mania”)

.Depression level supported gender and age

Women have depression more often than men. Biological, lifecycle, and hormonal factors that are unique to women could also be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt

Men with depression are more likely to be very tired, irritable, and sometimes angry. they'll lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of medicine or alcohol. Many men don't recognize their depression and fail to hunt help

Older adults with depression may have less obvious symptoms, or they'll be less likely to admit to feelings of sadness or grief. they're also more likely to possess medical conditions, like heart condition , which can cause or contribute to depression

Younger children with depression may pretend to vomit , refuse to travel to high school , hold close a parent, or worry that a parent may die

Older children and teenagers with depression may get into trouble at college , sulk, and be irritable. Teens with depression may have symptoms of other disorders, like anxiety, eating disorders, or drug abuse 

Epidemiology

Depression is prevalent among all age groups, in most walks of life. . Indians are among the worlds most depressed. consistent with a World Health Organization-sponsored study, while around 9% of individuals in India reported having an extended period of depression within their lifetime, nearly 36% suffered from what's called Major Depressive Episode (MDE)

Approximately 11% of Canadians meet criteria for MDD at some point in their lives and approximately 4% of Canadians suffer from MDD within any given year.1 About 2% of individuals with depression kill , and 50% of those individuals will are in touch with their GP within the month preceding the suicide

Lowest prevalence of MDE was in China (12%). the typical age of depression in India is 31.9 years compared to 18.8 years in China, and 22.7 years within the US. The female: male ratio was about 2:1.”WHO ranks depression because the fourth leading explanation for disability worldwide and projects that by 2020, it'll be the second leading cause

Risk Factors for depression include

Prior episode(s)

Family history of clinical depression 

Female gender

Postpartum period

Peri/postmenopausal period

Medical co-morbidity

Lack of social support

Major life stressor (loss of beloved or other members of social network)

Substance abuse

History of adverse childhood events

Negative cognitive style

Causes of depression

The exact explanation for depression isn't known. Many researchers believe it's caused by chemical changes within the brain. this might flow from to a drag together with your genes, or triggered by certain stressful events. More likely, it’s a mixture of both

Some sorts of depression run in families. But depression also can occur if you've got no case history of the illness. Anyone can develop depression, even kids. the subsequent may play a task in depression

Alcohol or substance abuse 

Certain medical conditions, including underactive thyroid, cancer, or future pain

Certain medications like steroids

Sleeping problems

Stressful life events, such as

Breaking up with a boyfriend or girlfriend

Failing a category 

Death or illness of somebody on the brink of you

Divorce

Childhood abuse or neglect

Job loss

Social isolation (common within the elderly)

?What are the signs and symptoms of depression

Sadness is merely one small a part of depression and a few people with depression might not feel sadness in the least . Different people have different symptoms. Some symptoms of depression include

Persistent sad, anxious, or “empty” mood

Feelings of hopelessness or pessimism

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in hobbies or activities

Decreased energy, fatigue, or being “slowed down”

Difficulty concentrating, remembering, or making decisions

Difficulty sleeping, early-morning awakening, or oversleeping

Appetite and/or weight changes

Thoughts of death or suicide or suicide attempts

Restlessness or irritability

Aches or pains, headaches, cramps, or digestive problems without a transparent physical cause and/or that don't ease even with treatment

Suicide Risk Assessment

Once patient has met MDD criteria, conduct a suicide risk assessment

Ask the patient if they need thoughts of death or suicide, feel life isn't worth living, have made a previous suicide attempt and if there's a case history of suicide

If the solution is yes to any of the above, ask about their plans for suicide (e.g., have they considered a way , do they need access to material required for suicide and if they need written a note)

Consider emergency psychiatric consultation and in-patient treatment if the patient has: persistent suicidal thoughts; a previous suicide attempt; or a current plan

If the patient is taken into account low risk, discuss and/or create a security plan with the patient, detailing steps the patient will take if their situation deteriorates

Treatment and medications for depressed person

The first step in getting the proper treatment is to go to a health care provider or psychological state professional, like a psychiatrist or psychologist. Your health care provider can do an exam, interview, and lab tests to rule out other health conditions which will have an equivalent symptoms as depression

Once diagnosed, depression are often treated with medications, psychotherapy, or a mixture of the 2 . If these treatments don't reduce symptoms, brain stimulation therapy could also be another treatment choice to explore

Medications

Medications called antidepressants can work well to treat depression

Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the quantity of the neurochemical serotonin within the brain. SSRIs are often the first-line treatment for depression. samples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), ser traline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Tricyclics and tricyclic-related drugs

Monoamine oxidase inhibitors (MAOIs)

They can take 2 to 4 weeks to figure . Antidepressants can have side effects, but many side effects may lessen over time. ask your health care provider about any side effects that you simply have. don't stop taking your antidepressant without first lecture your health care provider

Psychotherapy

Psychotherapy helps by teaching new ways of thinking and behaving, and changing habits which will be contributing to depression. Therapy can assist you understand and run through difficult relationships or situations which will be causing your depression or making it worse

Brain stimulation therapies

Electroconvulsive therapy (ECT) and other brain stimulation therapies could also be an option for people with severe depression who don't answer antidepressant medications. ECT is that the best studied brain stimulation therapy and has the longest history of use.

Transcranial magnetic stimulation (TMS) uses pulses of energy to stimulate nerve cells within the brain that are believe to affect mood. there's some research to suggest that it can help relieve depression

Light therapy may relieve depression symptoms within the winter time. However, it's usually not considered a first-line treatment

How to control and stop yourself from depression

As you continue treatment, you'll start to feel better gradually. Remember that if you're taking an antidepressant, it's going to take 2 to 4 weeks to start out working. attempt to do things that you simply wont to enjoy. Go easy on yourself. Other things which will help include

Trying to move and exercise

Breaking up large tasks into small ones, set priorities, and do what you'll as you'll 

Spending time with people and open up to a trusted friend or relative

Postponing important life decisions until you are feeling better. Discuss decisions with others who know you well

Avoiding self-medication with alcohol or with drugs not prescribed for you

How to support an individual who is depressed

If you recognize someone who has depression, first help him or her see a health care provider or psychological state professional. you'll also

Offer support, understanding, patience, and encouragement

Never ignore comments about suicide, and report them to your loved one’s health care provider or therapist

Invite him or her out for walks, outings, and other activities

Help him or her adhere to the treatment plan, like setting reminders to require prescribed 

medications

Help him or her by ensuring that he or she has transportation to therapy appointments

.Remind him or her that, with time and treatment, Depression will lift

Health Assessment 

 is that the gather information about as patient's physiological, psychological, sociological, and spiritual status inorderto identify actual and potential health problems

The purposes of the health assessment

 Obtain baseline data and expand the info base from which

subsequent phases of the nursing process can evolve

 to spot and managea sort of patient problems (actual and

potential)

 Evaluate the effectiveness of medical care 

 Enhance the nurse-patient relationship

 Make clinical judgments

Therapeutic relationship 

Therapeutic communication defined as apurposeful sort of conversation, serving as some extent of human

contact between nurse and client allowing them to succeed in common health-related goal

Phases of communication

 Introductory

 Working

 Termination–closing

Preparation for Health assessment includes the 

A-Preparation for the nurse

Wearproper comfortable uniform

 Should be knowledgably: know disease process, physiological mental and psychological changes which can effects client's condition and has scientific background to gather complete

accurate data

 Skillful: skills to perform physical examination and use

tools

 Receiving requesttoper form physical examination

 Working associated with professional nursing issues as (confidentiality, respect and following infection control measures–handwashing)

B-Preparation of physical environment

a- Clean wells furnished place

b- Quiet

c- Proper temperature

d- Proper ventilation

e- Proper humidity

f- Proper light–natural and artificial light may used

C-Preparation of Client

 The nurse identify herself\his tot he client

Explain thepurpose for examination and therefore the procedures which can 

perform

 Explain the necessity for changing position during examination asking the client ifhe\she has the power to try to to so

Maintain the client privacy

 Provide the client with clean gown

D-Preparation of the equipments

 Besure that’s the equipments is in fitness working well

 Clean well arrange daccording to use

 All infection control measures should bevtaken into account 

—Gathering Data

—Subjective data-Said by the client(S) by using interview to gather the subsequent data

—Biographical

—Past history

—Present history

—Family history

—Information associated with lifestyle& activities of daily living

Objective data -Observed by the nurse(O)

—Physical Examination: collection of objective data by using

many techniques such as: The order of techniques is as

follows (Inspection-Palpation-Percussion-

Auscultation)

—A. Inspection : critical observation* always first *

. Take time to“observe”with eyes, nose

. Use good lighting

. Look at color , shape , symmetry, position

. Observe for odors from skin, breath, wound

—B. Palpation : light and deep touch

. Back of hand(dorsal aspect) to assess skin

temperature

. Fingers (light) within1-2cm to assess texture,moisture, areas often derness, pain and assess size,shape, and consist encyoflesions

. Deep palpation= 4-5cm to assess mass and organs

. Bimanual using two hand 5-8 cm to assess organs

—C. Percussion : sound sproduced by striking or tapping body surface

. Produces different sounds counting on underlying structures (dull, resonant, flat, and tympanic)

. wont to determine under lying structures

. Action is perform edin the wrist.

—D. Auscultation : taking note of sound sproduced by the

body

. Flat diaphragm picksup high-pitched respiratory

sounds best

. Bell picks uplow pitched sounds like heart murmurs

.

Bladder Cancer: Causes, Symptoms, Risk factors and Medications

introduction

Bladder cancer begins when healthy cells within the bladder lining, most ordinarily urothelial cells, change and grow out of control, forming a mass called a tumor. A tumor are often cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumour means the tumor can grow but won't spread

The bladder may be a hollow organ within the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. Urine is formed by the kidneys and is then carried to the bladder through tubes called ureters. once you urinate, the muscles within the bladder contract, and urine is forced out of the bladder through a tube called the urethra

Structure of bladder

Start and spread of bladder cancer

The wall of the bladder has several layers, which are made from differing types of cells (see How is bladder cancer staged? for descriptions of the various layers)

Most bladder cancers start within the innermost lining of the bladder, which is named the urothelium or transitional epithelium. because the cancer grows into or through the opposite layers within the bladder wall, it becomes more advanced and may be harder to treat

Over time, the cancer might grow outside the bladder and into nearby structures. it'd spread to nearby lymph nodes, or to other parts of the body. (If bladder cancer spreads, it often goes first to distant lymph nodes, the bones, the lungs, or the liver

Stages of bladder cancer

Stage 0: The cancer cells are found only on the surface of the inner lining of the bladder. The 

doctor may call this carcinoma in place 

Stage I: The tumor has grown deeper into the inner lining of the bladder. But it hasn’t invaded the muscle layer of the bladder

Stage II: The tumor has invaded the muscle layer of the bladder

Stage III: The tumor has grown through the muscle layer to succeed in tissues near the bladder, like the prostate, uterus, or vagina

Stage IV: The tumor has invaded the wall of the pelvis or abdomen, but cancer isn't found in any lymph nodes. Or, the cancer cells have spread to a minimum of one lymph gland or to parts of the body distant from the bladder, like the liver, lungs, or bones

Types of bladder cancer

The type of bladder cancer depends on how it's under the microscope. the three main sorts of bladder cancer are

Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It begins within the urothelial cells found within the lining the bladder. Urothelial carcinoma is that the common term for this sort of bladder cancer. Previously, it had been called transitional cell carcinoma or TCC

Squamous cell carcinoma. Squamous cells develop within the bladder lining in response to irritation and inflammation. Over time these cells may become cancerous. epithelial cell carcinoma accounts for about 4% of all bladder cancers

This type accounts for about 2% of all bladder cancers and develops from glandular cells

In addition to its cell type, bladder cancer could also be described as noninvasive, non-muscle-invasive, or muscle-invasive

Non-muscle-invasive. Non-muscle-invasive bladder cancer typically has only grown into the lamina propria. Non-muscle invasive cancer can also be called superficial cancer, although this term is getting used less actually because it's going to incorrectly suggest that this sort of cancer isn't serious

Muscle-invasive. Muscle-invasive bladder cancer has grown into the bladder’s wall muscle and sometimes into the fatty layers or surrounding tissue outside the bladder

Background

Timeline Developmental stages

19th century The cytoscope develops. the primary cystectomy for bladder cancer is performed.

1940s–1960s Urine cytology emerges as a tool to detect recurrent bladder and tract cancers

1970s Cigarette smoking is linked to bladder cancer risk. First chemotherapy drug is released for bladder cancer.

1980s Mitomycin chemotherapy is consolidated. Surgical advances improve bladder cancer survival. First successful combination chemotherapy for advanced bladder cancer is achieved.

1990s Surgical techniques consolidate. New chemotherapies emerge to treat bladder cancer.

2000s New chemotherapies convince extend survival against bladder cancer. CT scan improves bladder cancer detection.

Recent years As of 2010, bladder cancer resulted in 170,000 deaths up from 114,000 in 1990 worldwide. Current treatment options for people with bladder cancer can include surgery, intravesical therapy, chemotherapy, radiotherapy and immunotherapy.

Prevalence of Bladder cancer at world wide

Globally, in 2010, bladder cancer resulted in 170,000 deaths up from 114,000 in 1990.[53] this is often a rise of 19.4%, adjusted for increase in total world population.

In the us , bladder cancer is that the fourth commonest sort of cancer in men and therefore the ninth commonest cancer in women. quite 50,000 men and 16,000 women are diagnosed with bladder cancer annually . Smoking can only partially explain this higher incidence in men. One other reason is that the androgen receptor, which is far more active in men than in women, plays a serious part within the development of the cancer. Bladder cancer is that the seventh commonest cancer within the UK (around 10,400 people were diagnosed with the disease in 2011), and it's the seventh commonest explanation for cancer death (around 5,200 people died in 2012

Causes and risk factors that results in bladder cancer

Bladder defects from birth

Chemotherapy and radiotherapy

Chronic bladder infections and irritations

Exposure to certain chemicals including aromatic amines

Low fluid consumption

Personal or case history of bladder cancer

Being male and/or white (women have lower rates of bladder cancer, as do African-Americans, Hispanics, Asian-Americans, and Native Americans

Some medications and dietary supplements – pioglitazone (Actos) and aristolochic acid (mainly from plants within the Aristolochia family)

Exposure to arsenic in beverage

People who add the subsequent industries or who have the subsequent professions even have an increased risk of bladder cancer, likely thanks to exposure to certain chemicals

Manufacturing of rubber, leather, textiles and paint products

Printing

Painters

Machinists

Hairdressers

Truck drivers

Complications during Bladder cancer

Emotional impact

Continent urinary diversion

Urostomy

Erectile dysfunction

Narrowing of the vagina

Symptoms and signs of Bladder cancer

Bladder cancer may cause these common symptoms

Finding blood in your urine (which may make the urine look rusty or darker red)

Feeling an urgent got to empty your bladder

Having to empty your bladder more often than you wont to

Feeling the necessity to empty your bladder without results

Needing to strain (bear down) once you empty your bladder

Feeling pain once you empty your bladder

These symptoms could also be caused by bladder cancer or by other health problems, like an infection

Diagnosis and testing of bladder

Urine tests: The lab checks your urine for blood, cancer cells, and other signs of disease

Cystoscopy: Your doctor uses a skinny , lighted tube (a cystoscope) to seem directly into your bladder. it's going to be done at your doctor’s office. This test are often uncomfortable because the doctor will insert the cystoscope into the bladder through your urethra. you'll need local anaesthesia for this test

Biopsy: Your doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to seem for cancer cells is named a biopsy. In most cases, a biopsy is that the only sure thanks to tell whether cancer is present

If bladder cancer is diagnosed, your doctor must learn the extent (stage) of the disease to assist you select the simplest treatment. Your doctor may order these tests

Blood tests: Blood tests can show how well the liver and kidneys are working

Chest x-ray: An x-ray of the chest can show a tumor within the lung

IVP: A dye that shows abreast of x-rays is injected into your vessel . The dye collects in your urine, which makes the bladder and therefore the remainder of the tract show abreast of x-rays

CT scan: you'll receive an injection of contrast medium so your tract and lymph nodes show up clearly within the pictures. The CT scan can show cancer within the bladder, lymph nodes, or elsewhere within the abdomen

MRI: you'll receive an injection of contrast medium . MRI can show cancer within the bladder, lymph nodes, or other tissues within the abdomen

Ultrasound: the image of an ultrasound can show a tumor or blockage within the tract 

Treatment and Medications

Several newer sorts of treatment are now being studied to be used against bladder cancer

Surgery

Some surgeons are employing a newer approach to cystectomy during which they sit at an impact panel within the OR and maneuver robotic arms to try to to the surgery. This approach, referred to as a robotic cystectomy, lets the surgeon operate through several small incisions rather than one large one. this might help patients recover more quickly from surgery

Intravesical therapy

Researchers are watching variety of latest medicines to ascertain if putting them into the bladder after surgery can help lower the danger of the cancer returning . The hope is to seek out some that are better and/or safer than currently used drugs like Bacillus Calmette-Guérin (BCG) and mitomycin

Photodynamic therapy

Photodynamic therapy (PDT) is now being studied to ascertain if it’s useful in treating early stage bladder cancers. A light-sensitive drug is injected into the blood and allowed to gather within the cancer cells for a couple of days. Then a special sort of laser light is concentrated on the inner lining of the bladder through a cystoscope. the sunshine changes the drug within the cancer cells into a replacement chemical which will kill them

An advantage of PDT is that it can kill cancer cells with little or no harm to nearby normal cells. One drawback is that the chemical must be activated by light, so only cancers near the surface of the bladder lining are often treated during this way. the sunshine can’t reach cancers that have grown deeper into the bladder wall or have spread to other organs

 Immunotherapy

Immunotherapy is treatment that uses the body’s own system to fight the cancer

Intravesical immunotherapy: One sort of immunotherapy already wont to treat some early bladder cancers is BCG, which may be a sort of intravesical therapy. When this germ is put into the bladder (in liquid form), it attracts immune cells to the bladder lining, which then attack cancer cells

Immune checkpoint inhibitors: a crucial a part of the system is its ability to stay itself from attacking the body’s normal cells. It does this by using “checkpoints” – molecules on immune cells that require to be turned on (or off) to start out an immune reaction . Cancer cells sometimes use these checkpoints to avoid being attacked by the system 

Gene therapy

Adding or changing the particular genes inside cancer cells or other cells within the body – is another new treatment method being tested for bladder cancer. One approach to gene therapy uses special viruses that are modified within the lab. The modified virus is put into the bladder and infects the bladder cancer cells. When this infection occurs, the virus injects a gene into the cells for GM-CSF, an system hormone which will help system cells to attack the cancer

Preventing Bladder cancer

Although there's not a guaranteed method to stop bladder cancer, people can surely reduce the danger of getting it. for instance , smokers are far more likely to develop bladder cancer than nonsmokers

Also, those exposed to industrial or environmental carcinogens like azo dyes and arylamines are at a better risk. People working with dyes, rubbers, textiles, paints, pesticides, insecticides, leathers, and chemicals are more vulnerable

Avoiding any potential carcinogens by inhalation, ingestion, or direct contact would definitely reduce risk not only of bladder cancer but also of other cancers

Nutritional factors are widely investigated in cancer prevention

Autism: Causes, Epidemiology, Treatment and Prevention

Definition

Autism, or autism spectrum disorder, refers to a variety of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, also as by unique strengths and differences. We now know that there's not one autism but many sorts , caused by different combinations of genetic and environmental influences. The term “spectrum” reflects the wide variation in challenges and strengths possessed by everyone with autism

Types of autism

There are four main sub-types of autism recognized within the Diagnostic and Statistical Manual of Mental Disorders

Autistic Disorder, also referred to as autism, childhood autism, early autism , Kanner’s syndrome or infantile psychosis. People with autistic disorder usually have significant language delays, social and communication challenges, and weird behaviors and interests. many of us with autistic disorder even have intellectual disability

Asperger Syndrome, also referred to as Asperger’s disorder or just Asperger’s. People with Asperger syndrome usually have some milder symptoms of autistic disorder. they could have social challenges and weird behaviors and interests. However, they typically don't have problems with language or intellectual disability

Childhood Disintegrative Disorder, also referred to as CDD, dementia infantalis, disintegrative psychosis or Heller’s syndrome. These children develop normally for a minimum of two years then lose some or most of their communication and social skills. this is often a particularly rare disorder and its existence as a separate condition may be a matter of debate among many psychological state professionals

Pervasive Developmental Disorder-Not otherwise Specified, also referred to as PDD (NOS) or atypical autism

  ?How common is Autism

Autism statistics from the U.S. Centers for Disease Control and Prevention (CDC) released in March 2014 identify around 1 in 68 American children as on the autism spectrum – a ten-fold increase in prevalence in 40 years. Careful research shows that this increase is merely partly explained by improved diagnosis and awareness. Studies also show that autism is four to 5 times more common among boys than girls. An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism within the us 

ASD affects over 2 million individuals within the U.S. and tens of millions worldwide. Moreover, government autism statistics suggest that prevalence rates have increased 10% to 17% annually in recent years. there's no established explanation for this continuing increase, although improved diagnosis and environmental influences are two reasons often considered

Historical background about ASDs

The term Autism comes from the Greek word “autos,” meaning “self”. Eugen Bleuler coined the word “autism” in 1908 among severely withdrawn schizophrenic patients

In 1943 American child psychiatrist Leo Kanner studied 11 children. the youngsters had features of difficulties in social interactions, difficulty in adapting to changes in routines, good memory, sensitivity to stimuli (especially sound), resistance and allergies to food, good intellectual potential, echolalia or propensity to repeat words of the speaker and difficulties in spontaneous activity

In 1944 Hans Asperger, working separately, studied a gaggle of youngsters . His children also resembled Kanner’s descriptions. the youngsters he studied, however, didn't have echolalia as a linguistic problem but spoke like grownups. He also mentioned that a lot of of the youngsters were clumsy and different from normal children in terms of fine motor skills

Next Bruno Bettelheim studied the effect of three therapy sessions with children who he called autistic. He claimed that the matter within the children was thanks to coldness of their mothers. He separated the youngsters from their parents. Kanner and Bettelheim both worked towards making hypothesis that showed autistic children had frigid mothers

Bernard Rimland was a psychologist and parent of a toddler with autism. He disagreed with Bettelheim. He didn't agree that the explanation for his son’s autism was thanks to either his or his wife’s parenting skills. In 1964, Bernard Rimland published, Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behavior

Autism came to be better known within the 1970’s. The Erica Foundation started education and therapy for psychotic children within the beginning of the 80s. Many parents still confused autism with retardation and psychosis

It was in 1980’s that Asperger’s work was translated to English and published and came into knowledge

It was within the 1980’s that research on autism gained momentum. it had been increasingly believed that parenting had no role in causation of autism and there have been neurological disturbances and other genetic ailments like tuberous sclerosis, metabolic disturbances like PKU or chromosomal abnormalities like fragile X syndrome

Lorna Wing, along side Christopher Gillberg at BNK (Children’s Neuro-Psychiatric Clinic) in Sweden within the 1980’s found the Wing’s triad of disturbed mutual contact, disturbed mutual communication and limited imagination. within the 1990’s they added another factor making it a square. The factor was limited planning ability

Ole Ivar Lovaas studied and furthered behavioural analysis and treatment of youngsters with autism. Lovaas achieved limited success initially together with his experimental behaviour analysis. He developed it to focus on younger children (less than 5 years of age) and implemented treatment reception and increased the intensity (a measurement of the quantity of “therapy time”) to about 40 hours weekly. Lovaas wrote Teaching Developmentally Disabled Children: The Me Book in 1981. In 2002, Lovaas wrote, Teaching Individuals with Developmental Delays: Basic Intervention Techniques

Signs and symptoms of ASDs

People with ASDs may have problems with social, emotional, and communication skills. they could repeat certain behaviors and won't want change in their daily activities. many of us with ASDs even have alternative ways of learning, listening , or reacting to things. ASDs begin during  infancy and last throughout a person’s life

A child or adult with an ASD might have

Not play “pretend” games (pretend to “feed” a doll)

Not point at objects to point out interest (point at an airplane flying over)

Not check out objects when another person points at them

Have trouble concerning others or not have an interest in people in the least

Avoid eye contact and need to be alone

Have trouble understanding other people’s feelings or talking about their own feelings

Prefer to not be held or cuddled or might cuddle only they need to

Appear to be unaware when people ask them but answer other sounds

Be very curious about people, but not skills to speak , play, or relate to them

Repeat or echo words or phrases said to them, or repeat words or phrases in situ of normal language (echolalia)

Have trouble expressing their needs using typical words or motions

Repeat actions over and once again

Have trouble adapting when a routine changes

Have unusual reactions to the way things smell, taste, look, feel, or sound

Lose skills they once had (for instance, stop saying words they were using)

Causes of Autism

There’s nobody explanation for autism. Research suggests that autism develops from a mixture of genetic and non-genetic, or environmental, influences. These influences appear to extend the danger that a toddler will develop autism

Autism’s genetic risk factors: Changes in certain genes increase the danger that a toddler will develop autism. If a parent carries one or more of those gene changes, they'll get passed to a toddler (even if the parent doesn't have autism)

Autism’s environmental risk factors: certain environmental influences may further increase – or reduce – autism risk in people that are genetically predisposed to the disorder. Importantly, the rise or decrease in risk appears to be small for anybody of those risk factors

Advanced parent age (either parent)

Pregnancy and birth complications (e.g. extreme prematurity [before 26 weeks], low birth weight, multiple pregnancies [twin, triplet, etc.])

Use of alcohol

Maternal metabolic conditions like diabetes and obesity

Use of anti-seizure drugs during pregnancy

Untreated phenylketonuria (called PKU, an inborn disorder caused by the absence of an enzyme)

Rubella (German measles)

Diagnosis of ASDs

Diagnosing autism spectrum disorder (ASD) are often difficult, since there's no medical test, sort of a biopsy , to diagnose the disorders. Doctors check out the child’s behavior and development to form a diagnosis

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional are often considered very reliable. Diagnosing an ASD takes two steps

Developmental Screening

Comprehensive Diagnostic Evaluation

Developmental Screening

Developmental screening may be a short test to inform if children are learning basic skills once they should, or if they could have delays. During developmental screening the doctor might ask the parent some questions or talk and play with the kid during an exam to ascertain how she learns, speaks, behaves, and moves. A delay in any of those areas might be a symbol of a drag 

All children should be screened for developmental delays and disabilities during regular well-child doctor visits at

9 months

18 months

24 or 30 months

Additional screening could be needed if a toddler is at high risk for developmental problems thanks to preterm birth, low birth weight or other reasons. additionally , all children should be screened specifically for ASD during regular well-child doctor visits at

18 months

24 months

Other lab tests could also be done under specific circumstances. These tests include

Chromosomal analysis, which can be done if intellectual disability is present or there's a case history of intellectual disability. for instance , fragile X syndrome, which causes a variety of below-normal intelligence problems also as autistic-like behaviors, are often identified with a chromosomal analysis

An electroencephalograph (EEG), which is completed if there are symptoms of seizures

MRI, which can be done if there are signs of differences within the structure of the brain

Treatment of ASDs

Applied behavioral analysis (ABA

This intervention works by breaking down skills like communication and cognitive skills into smaller and simpler tasks. The tasks are then taught during a highly structured way. the straightforward tasks over time coalesce into more complex skills that help in development

Early start Denver model

This is yet one more behavioral intervention that mixes applied behavioral analysis with developmental and relationship based approaches. the kid is brought into interactive social relationships, using positive emotional exchanges and joint play activities. It improves cognitive, language and adaptive behavioral skills

Discrete Trial Training (DTT

This is a method of teaching that uses a series of trials and efforts to show each step of a desired behavior or response

Pivotal Response Training (PRT

This is intended to extend the child’s motivation to find out and monitor his or her own behaviour and start communication

Verbal Behavior Intervention (VBI

VBI may be a sort of ABA that focuses on teaching verbal skills

Speech and language Therapy (SLT

This therapy aims at improving communication and language skills. this will improve their ability to interact with others socially. This intervention may use visual aids, stories and toys and other aids to develop language skills

Occupational therapy

This focuses on development and maintenance of fine motor and adaptive skills

Stem cell therapy

Medicines

Medicines are most ordinarily wont to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.

Prevention

Although the precise explanation for autism isn't known in most instances, some cases are linked to chemical exposure during pregnancy. Therefore, it's essential to avoid taking any drugs during pregnancy unless the doctor specifically prescribes them

It is also essential to avoid drinking alcoholic beverages of any kind during pregnancy. Being immunized against rubella (German measles) before becoming pregnant can prevent rubella-associated autism

Following delivery, there are certain measures which will be helpful in preventing autism. One is early diagnosis and treatment of phenylketonuria (PKU). this is often a genetic disease that's caused by the shortage of a liver enzyme required to digest the enzyme phenylalanine

Similarly, early diagnosis and treatment of disorder may reduce the danger of a toddler having autism

HIV/AIDS: Causes, Treatment and Prevention

Introduction

HIV may be a virus that attacks the system , which is our body’s natural defense against illness. The virus destroys a kind of white blood corpuscle within the system called a T-helper cell, and makes copies of itself inside these cells. T-helper cells also are mentioned as CD4 cells

The virus is really not one, but several different viruses within the class of Retroviridae and therefore the genus Lentivirus. The species differs and there's a bigger list of subtypes. There are two major types: HIV 1 and HIV 2 – HIV 1 is assumed to originate from chimpanzees and gorillas in western Africa; HIV 2 originates from sooty mangabeys (another ape) found in Senegal and Ghana. HIV 1 is that the more deadly and is that the explanation for the AIDS pandemic and may be divided into the M, N, O, and P subgroups, but HIV 2 is additionally known to cause AIDS

Structure of HIV

As HIV destroys more CD4 cells and makes more copies of itself, it gradually breaks down a person’s system . this suggests someone living with HIV, who isn't receiving treatment, will find it harder and harder to repel infections and diseases. HIV spreads through bodily fluids that include

Blood

Semen

Vaginal and rectal fluids

Breast milk

Replication process of HIV viruses in physical body

The virus infects the body’s macrophages, dendritic cells, and T-cells, viz. most frequently the CD4+ lymphocytes, by attaching itself to them via its gp120 protein to the e.g

T-cell’s CD4+ protein. The CCR-5 protein then induces the fusion of the membranes. An inherent property of lentiviruses is that they need a single-strand RNA strand, not DNA, and this strand is injected when the cytoplasm’s merge because the HIV’s membrane fuses thereupon of the T-cell

The RNA is converted into DNA by polymerase and is inserted into the T-cell’s genome strand using DNA integrase. Hence, the virus is literally replacing a part of the physical body 

The infected T-cell now produces HIV RNA and amino acids that form new HIV viruses and their protein coats. These viruses then spread throughout the body the infection rate increases

The T-cells then die, causing AIDS because the immunodeficiency occurs when the bulk of T-cells are denatured. At the replication of the viral RNA, which happens 10 billion times per day, there's an opportunity of mutation of 1 nucleotide per 9 200 nucleotides, meaning resistance could develop

The virus is then spread via blood transfusions, sexual activity , or during birth (i.e. mother-to-child transmission, MTCT)

Everyday activities like sharing food and water, kissing, shaking hand, or using an equivalent toilet aren't factors that spread the condition

AIDS occurs when the body catches a secondary, an opportunistic, disease thanks to the decreased immune defense strength

Stages involved in HIV patient

HIV advances piecemeal , overwhelming your system and getting worse over time. The three stages of HIV infection are

Acute HIV infection

The first few weeks after infection is named the acute infection stage. During this point the virus rapidly reproduces. Your system responds by producing HIV antibodies. many of us experience temporary flu-like symptoms during this stage. Even without symptoms, HIV is very contagious during this point . a number of the symptoms during this stages includes

Fever (raised temperature)

Body rash

Sore throat

Swollen glands

Headache

Upset stomach

Joint aches and pains

Muscle pain

Clinical latency

After the primary month approximately , HIV enters the clinical latency phase . This stage can last from a couple of years to a couple of decades. Progression are often slowed with antiretroviral therapy. Some people have symptoms. many of us don't , but it’s still contagious. because the virus progresses, you’re left with fewer T cells. This causes you to more vulnerable to disease, infection, and infection-related cancers

AIDS (acquired immunodeficiency syndrome)

Without treatment, HIV is probably going to advance to AIDS. At that time , the system is just too weak to repel life-threatening disease and infection. Untreated, anticipation with AIDS is about three years

AIDS may be a disease caused by HIV. It’s the foremost advanced stage of HIV. But simply because you've got HIV doesn’t mean you’ll develop AIDS. HIV destroys T cells called CD4 cells. These cells help your system fight infections. Healthy adults generally have a CD4 count of 800 to 1,000 per cubic millimetre . If you've got HIV and your CD4 count falls below 200 per cubic millimetre , you'll be diagnosed with AIDS

You can even be diagnosed with AIDS if you've got HIV and develop an infection that's rare in people that don’t have HIV. AIDS weakens your system to the purpose where it can not repel most diseases and infections. that creates you susceptible to a good range of illnesses, including

Pneumonia

Tuberculosis

Candidiasis

Cytomegalovirus, a kind of herpes

Cryptococci meningitis

Toxoplasmosis, an infection causes by a parasite

Cryptosporidiosis, an infection caused by an intestinal parasite

Cancer, including Kaposi’s sarcoma (KS) and lymphoma

Kidney disease

Symptoms that you simply may have during this point can include

Weight loss

Chronic diarrhea

Night sweats

A fever

A persistent cough

Mouth and skin problems

Regular infections

Serious illnesses or diseases

Causes or Possibilities of HIV/AIDS

Some of the ways HIV is spread from person to person include

Having unprotected sex with an infected person. this is often the foremost common route of transmission

Sharing needles, syringes, and other items for injection drug use with an infected person

Passing it on to an unborn child if the mother is HIV-positive

Passing it on to a baby through breast milk if the mother is HIV-positive

Being exposed to infected fluids, usually through needle sticks

Having a transfusion or organ and tissue transplant also can transmit the virus. But rigorous testing for HIV in blood ensures that this is often very rare within the us 

It’s theoretically possible, but considered extremely rare, for HIV to spread via

Oral sex

Being bitten by an infected person

Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or fluids

HIV doesn't spread through

Skin-to-skin contact

Hugging, shaking hands, or kissing

Air or water

Eating or drinking items, including drinking fountains

Saliva, tears, or sweat (unless mixed with blood from an infected person)

Sharing a rest room , towels, or bedding

Mosquitoes or other insects

Complications during HIV

Tuberculosis

Hepatitis

Toxoplasmosis

Sexually transmitted infections

Liver or kidney damage

Urinary tract infection

Testing and Screening of HIV (Diagnosis)

There are four main sorts of HIV test

Antibody Screening Tests: These tests check for a sort of protein that your body makes in response to the HIV infection, 2-8 weeks later. They’re also called immunoassay or ELISA tests

Antibody/Antigen Combination Tests: The CDC recommends these blood tests. they will detect HIV as soon as 20 days before antibody screening tests. They check for HIV antigen, a protein called p24 that’s a part of the virus that shows up 2-4 weeks after infection, also as HIV antibodies. A rapid antibody/antigen test can offer you leads to 20 minutes

RNA Test: This looks for the virus itself and may diagnose HIV about 10 days after you’ve been exposed. It’s expensive, though, so it’s usually not the primary test. But if you’re at high risk and you've got flu-like symptoms, your doctor might want to use it

In-Home Test Kits: Two kits are available. One option is to prick your finger to urge alittle blood sample that you simply send to a lab. For the opposite , you’ll swab your upper and lower gums and test the sample during a vial. You get a end in 20 minutes

Western blot or fluorescence microscopy assay

HIV-1 macromolecule test, which looks for the virus itself

Treating of HIV/AIDS

The classes of anti-HIV drugs include

Non-nucleoside polymerase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to form copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune)

Nucleoside or nucleotide polymerase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV must make copies of itself. Examples include Abacavir (Ziagen), and therefore the combination drugs emtricitabine-tenofovir (Truvada), and lamivudine-zidovudine (Combivir)

Protease inhibitors (PIs). PIs disable protease, another protein that HIV must make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan)

Entry or fusion inhibitors. These drugs block HIV’s entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry)

Integrase inhibitors. These drugs work by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells. Examples include raltegravir (Isentress), elvitegravir (Vitekta) and dolutegravir (Tivicay)

Fusion Inhibitors: Fusion inhibitors are a replacement class of medicine that act against HIV by preventing the virus from fusing with the within of a cell, preventing it from replicating. The group of medicine includes Enfuvirtide, also referred to as Fuzeon or T-20

Antiretroviral therapy (ART) is that the use of HIV medicines to treat HIV infection. People on ART take a mixture of HIV medicines (called an HIV regimen) a day . ART is suggested for everybody infected with HIV. ART can’t cure HIV, but HIV medicines help people with HIV live longer, healthier lives. ART also reduces the danger of HIV transmission

Prevention of HIV/AIDS

Because the foremost common ways HIV is transmitted is thru anal or vaginal sex or sharing drug injection equipment with an individual infected with HIV, it's important to require steps to scale back the risks related to these. They include

Know your HIV status. Everyone between the ages of 13 and 64 should be tested for HIV a minimum of once. If you're at increased risk for HIV, you ought to be tested for HIV a minimum of once a year

If you've got HIV, you'll get medical aid , treatment, and supportive services to assist you stay healthy and reduce your ability to transmit the virus to others

If you're pregnant and find that you simply have HIV, treatments are available to scale back the prospect that your baby will have HIV

Shingles ( herpes zoster )

 Shingles: Fire belt

 What is a fiery belt and its symptoms

 It is a viral infection that appears in the skin of an infected person in the abdomen or chest, causing severe pain similar to the pain of burns, and appears

 A rash in these places with a red belt

 Does a fiery belt cause death

 A belt of fire does not cause death, but it is accompanied by very severe pain

 The Herpes virus is the one that causes this infection. These viruses remain in the body after the initial infection, and do not appear again until they happen

 Decrease in the body’s immunity, especially the elderly, and it starts to appear to include very severe pain, similar to pain in the stomach area or

 Chest belt included

 Fire belt requires the use of anti-inflammatory drugs (acyclovir) in addition to analgesics to reduce the associated pain

 For the fiery belt

 And can use natural remedies such as compresses to the place of pain, and pay attention to the diet, as it greatly affects the reduction

 Pain associated with a fiery belt.  And a lot of foods that contain vitamin C such as lemon, orange and pepper, and vitamin B12 found in vegetables, zinc, and vitamin E, and amino acids

 Medicinal forms of the fiery belt

 Zovirax 400 Tablets

 Tablet every 6 hours

 Zovirax Cream

 Paint in the affected area, morning and evening

Neurobion tablet

 three times after meal